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Sample records for 5-year risk score

  1. Validation of a 5-year risk score of hip fracture in postmenopausal women. The Danish Nurse Cohort Study

    DEFF Research Database (Denmark)

    Hundrup, Y A; Jacobsen, R K; Andreasen, A H;

    2010-01-01

    We evaluated the Women's Health Initiative (WHI) hip fracture risk score in 15,648 postmenopausal Danish nurses. The algorithm was well calibrated for Denmark. However, the sensitivity was poor at common decision making thresholds. Obtaining sensitivity better than 80% led to a low specificity...... of 61.4%. INTRODUCTION: A new score based on data from the WHI has been designed to predict 5-year risk of hip fracture in postmenopausal women. The performance of the algorithm has not been validated in populations with different lifestyle characteristics and ethnicity. The aim of this study...... predicted too many fractures in HT-users (12 observed, 22 expected) and too few in non HT-users (107 observed, 81 expected). CONCLUSIONS: While the WHI algorithm was well calibrated on the Danish population, the clinical utility of the WHI algorithm in Danish postmenopausal women was limited by poor...

  2. Validation of a 5-year risk score of hip fracture in postmenopausal women. The Danish Nurse Cohort Study

    DEFF Research Database (Denmark)

    Hundrup, Y A; Jacobsen, R K; Andreasen, A H;

    2010-01-01

    We evaluated the Women's Health Initiative (WHI) hip fracture risk score in 15,648 postmenopausal Danish nurses. The algorithm was well calibrated for Denmark. However, the sensitivity was poor at common decision making thresholds. Obtaining sensitivity better than 80% led to a low specificity...

  3. Development and validation of a risk score predicting substantial weight gain over 5 years in middle-aged European men and women.

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    Annika Steffen

    Full Text Available BACKGROUND: Identifying individuals at high risk of excess weight gain may help targeting prevention efforts at those at risk of various metabolic diseases associated with weight gain. Our aim was to develop a risk score to identify these individuals and validate it in an external population. METHODS: We used lifestyle and nutritional data from 53°758 individuals followed for a median of 5.4 years from six centers of the European Prospective Investigation into Cancer and Nutrition (EPIC to develop a risk score to predict substantial weight gain (SWG for the next 5 years (derivation sample. Assuming linear weight gain, SWG was defined as gaining ≥ 10% of baseline weight during follow-up. Proportional hazards models were used to identify significant predictors of SWG separately by EPIC center. Regression coefficients of predictors were pooled using random-effects meta-analysis. Pooled coefficients were used to assign weights to each predictor. The risk score was calculated as a linear combination of the predictors. External validity of the score was evaluated in nine other centers of the EPIC study (validation sample. RESULTS: Our final model included age, sex, baseline weight, level of education, baseline smoking, sports activity, alcohol use, and intake of six food groups. The model's discriminatory ability measured by the area under a receiver operating characteristic curve was 0.64 (95% CI = 0.63-0.65 in the derivation sample and 0.57 (95% CI = 0.56-0.58 in the validation sample, with variation between centers. Positive and negative predictive values for the optimal cut-off value of ≥ 200 points were 9% and 96%, respectively. CONCLUSION: The present risk score confidently excluded a large proportion of individuals from being at any appreciable risk to develop SWG within the next 5 years. Future studies, however, may attempt to further refine the positive prediction of the score.

  4. Genetic Risk Score of 46 Type 2 Diabetes Risk Variants Associates With Changes in Plasma Glucose and Estimates of Pancreatic beta-Cell Function Over 5 Years of Follow-Up

    DEFF Research Database (Denmark)

    Andersson, E. A.; Allin, K. H.; Sandholt, C. H.;

    2013-01-01

    study population was genotyped for 46 variants, and a genetic risk score was constructed. During a median follow-up of 11 years, 327 of 5,850 individuals developed diabetes. Physical examinations and oral glucose tolerance tests were performed at baseline and after 5 years (n = 3,727). The risk......More than 40 genetic risk variants for type 2 diabetes have been validated. We aimed to test whether a genetic risk score associates with the incidence of type 2 diabetes and with 5-year changes in glycemic traits and whether the effects were modulated by changes in BMI and lifestyle. The Inter99...... of incident type 2 diabetes was increased with a hazard ratio of 1.06 (95% CI 1.03-1.08) per risk allele. While the population in general had improved glucose regulation during the 5-year follow-up period, each additional allele in the genetic risk score was associated with a relative increase in fasting, 30...

  5. Development and Validation of a Risk Score Predicting Substantial Weight Gain over 5 Years in Middle-Aged European Men and Women

    DEFF Research Database (Denmark)

    Steffen, Annika; Sørensen, Thorkild; Knüppel, Sven;

    2013-01-01

    Identifying individuals at high risk of excess weight gain may help targeting prevention efforts at those at risk of various metabolic diseases associated with weight gain. Our aim was to develop a risk score to identify these individuals and validate it in an external population....

  6. Do MCAT scores predict USMLE scores? An analysis on 5 years of medical student data

    OpenAIRE

    Gauer, Jacqueline L.; Wolff, Josephine M.; Jackson, J. Brooks

    2016-01-01

    Introduction: The purpose of this study was to determine the associations and predictive values of Medical College Admission Test (MCAT) component and composite scores prior to 2015 with U.S. Medical Licensure Exam (USMLE) Step 1 and Step 2 Clinical Knowledge (CK) scores, with a focus on whether students scoring low on the MCAT were particularly likely to continue to score low on the USMLE exams.Method: Multiple linear regression, correlation, and chi-square analyses were performed to determi...

  7. Do MCAT scores predict USMLE scores? An analysis on 5 years of medical student data

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    Jacqueline L. Gauer

    2016-09-01

    Full Text Available Introduction: The purpose of this study was to determine the associations and predictive values of Medical College Admission Test (MCAT component and composite scores prior to 2015 with U.S. Medical Licensure Exam (USMLE Step 1 and Step 2 Clinical Knowledge (CK scores, with a focus on whether students scoring low on the MCAT were particularly likely to continue to score low on the USMLE exams. Method: Multiple linear regression, correlation, and chi-square analyses were performed to determine the relationship between MCAT component and composite scores and USMLE Step 1 and Step 2 CK scores from five graduating classes (2011–2015 at the University of Minnesota Medical School (N=1,065. Results: The multiple linear regression analyses were both significant (p<0.001. The three MCAT component scores together explained 17.7% of the variance in Step 1 scores (p<0.001 and 12.0% of the variance in Step 2 CK scores (p<0.001. In the chi-square analyses, significant, albeit weak associations were observed between almost all MCAT component scores and USMLE scores (Cramer's V ranged from 0.05 to 0.24. Discussion: Each of the MCAT component scores was significantly associated with USMLE Step 1 and Step 2 CK scores, although the effect size was small. Being in the top or bottom scoring range of the MCAT exam was predictive of being in the top or bottom scoring range of the USMLE exams, although the strengths of the associations were weak to moderate. These results indicate that MCAT scores are predictive of student performance on the USMLE exams, but, given the small effect sizes, should be considered as part of the holistic view of the student.

  8. Cardiovascular events in acromegaly: distinct role of Agatston and Framingham score in the 5-year prediction.

    Science.gov (United States)

    Ragonese, Marta; Alibrandi, Angela; Di Bella, Gianluca; Salamone, Ignazio; Puglisi, Soraya; Cotta, Oana Ruxandra; Torre, Maria Luisa; Ferrau, Francesco; Ruggeri, Rosaria Maddalena; Trimarchi, Francesco; Cannavo, Salvatore

    2014-09-01

    Prediction of ischemic cardiovascular events (ICE) in acromegalic patients stratified accordingly with Framingham (FS) and Agatston score (AS). 32 patients with active (group A (0)) and 20 with controlled (group B (0)) acromegaly have been enrolled. During the 5-year follow-up, 19 out of 32 patients in group A (0) reached disease control. At entry, FS and AS, by an eight-slice MDCT scanner, were calculated in all patients. ICE were diagnosed by autopsy, if lethal, and by electrocardiography and/or echocardiography, if non-lethal. Overall, 9.6 % of patients died for lethal ICE. AS >400, but not high FS at entry, was associated with increased risk of lethal ICE. Lethal ICE had occurred in two patients of group A (0) and three of group B (0) (p NS), while a non-lethal ICE had occurred in two cases of the former and in other two of the latter group (p NS). Either FS or AS was correlated with the risk for ICE overall (p 400 is associated with increased risk of lethal ICE, while high FS is associated with reduced life expectancy, regardless of disease control.

  9. Timing and risk factors for clinical fractures among postmenopausal women: a 5-year prospective study

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    Rinkens Paula ELM

    2006-10-01

    Full Text Available Abstract Background Many risk factors for fractures have been documented, including low bone-mineral density (BMD and a history of fractures. However, little is known about the short-term absolute risk (AR of fractures and the timing of clinical fractures. Therefore, we assessed the risk and timing of incident clinical fractures, expressed as 5-year AR, in postmenopausal women. Methods In total, 10 general practice centres participated in this population-based prospective study. Five years after a baseline assessment, which included clinical risk factor evaluation and BMD measurement, 759 postmenopausal women aged between 50 and 80 years, were re-examined, including undergoing an evaluation of clinical fractures after menopause. Risk factors for incident fractures at baseline that were significant in univariate analyses were included in a multivariate Cox survival regression analysis. The significant determinants were used to construct algorithms. Results In the total group, 12.5% (95% confidence interval (CI 10.1–14.9 of the women experienced a new clinical fracture. A previous clinical fracture after menopause and a low BMD (T-score Conclusion In postmenopausal women, clinical fractures cluster in time. One in two women with a recent clinical fracture had a new clinical fracture within 5 years, regardless of BMD. The 5-year AR for a first clinical fracture was much lower and depended on BMD.

  10. Results from Tunka-133 (5 years observation) and from the Tunka-HiSCORE prototype

    Science.gov (United States)

    Prosin, V. V.; Berezhnev, S. F.; Budnev, N. M.; Brückner, M.; Chiavassa, A.; Chvalaev, O. A.; Dyachok, A. V.; Epimakhov, S. N.; Gafarov, A. V.; Gress, O. A.; Gress, T. I.; Horns, D.; Kalmykov, N. N.; Karpov, N. I.; Kiryuhin, S. N.; Konstantinov, E. N.; Korobchenko, A. V.; Korosteleva, E. E.; Kozhin, V. A.; Kunnas, M.; Kuzmichev, L. A.; Lubsandorzhiev, B. K.; Lubsandorzhiev, N. B.; Mirgazov, R. R.; Monkhoev, R. D.; Nachtigall, R.; Osipova, E. A.; Pakhorukov, A. L.; Panasyuk, M. I.; Pankov, L. V.; Poleschuk, V. A.; Popova, E. G.; Porelli, A.; Ptuskin, V. S.; Rubtsov, G. I.; Rüger, M.; Samoliga, V. S.; Semeney, Y. A.; Silaev, A. A.; Silaev, A. A.; Skurikhin, A. V.; Spiering, C.; Sveshnikova, L. G.; Tluczykont, M.; Wischnewski, R.; Zagorodnikov, A. V.; Zurbanov, A. V.

    2016-07-01

    Data obtained with two detectors located at the Tunka Cosmic Ray facility are presented. The Cherenkov light array for registration of extensive air showers (EAS) Tunka-133 collected data during 5 winter seasons since 2009 to 2014. The differential energy spectrum of all particles and the dependence of the average maximum depth on the energy in the range of 6 · 1015-1018 eV measured for 1540 hours of observation are presented. The preliminary all particle energy spectrum by the data of Tunka-HiSCORE prototype array, installed in 2013, is presented. Some additional experiments in the Tunka Valley are briefly described.

  11. Low FAB score as a predictor of future falling in patients with Parkinson's disease: a 2.5-year prospective study.

    Science.gov (United States)

    Kataoka, Hiroshi; Ueno, Satoshi

    2015-09-01

    Falling is one of the most disabling features of Parkinson's disease (PD). Many cross-sectional studies, case-control studies, and prospective studies have attempted to identify risk factors or predictors of falls, but consistent results are yet to be obtained because of the various factors involved. We prospectively studied patients with various severities of PD to identify risk factors for future falls during 2.5 years of follow-up. We registered 95 patients with PD, and 83 patients were included in data analysis. A total of 23 variables were evaluated by multivariate logistic regression analysis. Thirty-one patients (37%) had a previous history of falling, and 26 patients (30%) experienced their first fall. The prevalence of falls at 2.5 years was 62% (52 of 83 patients). Frontal Assessment Battery (FAB) score (OR 1.393, p = 0.005, 95% CI 1.104-1.759) and history of fall present (OR 0.142, p = 0.002, 95% CI 0.042-0.48) were related to falling on multiple logistic regression analysis. The following variables differed significantly between patients with first falls and those without falling: levodopa equivalent dose (p = 0.023), UPDRS part I (p = 0.006), SF-8 (p = 0.017), and FAB (p = 0.026). Calculation of the FAB score may be useful for predicting the risk of future falls in patients with various severities of PD. Our results suggest that a low FAB score combined with a history of falling within the past 6 months carries an increased risk of future falls.

  12. Increased risk of stroke and transient ischemic attack in 5-year survivors of Hodgkin lymphoma

    DEFF Research Database (Denmark)

    De Bruin, Marie L; Dorresteijn, Lucille D A; van't Veer, Mars B;

    2009-01-01

    Cox regression techniques to study treatment-related factors and other risk factors. All statistical tests were two-sided. RESULTS: After a median follow-up of 17.5 years, 96 patients developed cerebrovascular disease (55 strokes, 31 TIAs, and 10 with both TIA and stroke; median age = 52 years). Most......, after prolonged follow-up. The cumulative incidence of ischemic stroke or TIA 30 years after Hodgkin lymphoma treatment was 7% (95% CI = 5% to 8%). Radiation to the neck and mediastinum was an independent risk factor for ischemic cerebrovascular disease (hazard ratio = 2.5, 95% CI = 1.1 to 5.6 vs......BACKGROUND: Information on clinically verified stroke and transient ischemic attack (TIA) following Hodgkin lymphoma is scarce. We quantified the long-term risk of cerebrovascular disease associated with the use of radiotherapy and chemotherapy in survivors of Hodgkin lymphoma and explored...

  13. Modifiable health risks in Atlantic Canadian employees: a 5-year report.

    Science.gov (United States)

    Makrides, L; Sawatzky, C; Petrie, J; Veinot, P

    2010-12-01

    A number of modifiable health risks, such as smoking, inactivity and obesity have been linked to increased employer costs, including decreased productivity and increased absenteeism and health claims. The purpose of this paper is to report on the health profile and prevalence of modifiable health risks in an Atlantic Canadian Employee Database. Data were collected over a 5-year period (2001-2006) by the Atlantic Health and Wellness Institute, the research arm of Creative Wellness Solutions, in Halifax, Nova Scotia, Canada. Each employee of 51 workplaces (n = 6067; 2665 males, 3402 females; average age 41.3 years) completed a Health Risk Assessment questionnaire on smoking, nutrition and physical activity behaviours. Clinical data measurements were blood pressure, blood cholesterol, weight and height. Data were compared for private, public and health sectors. Sixteen percent had elevated blood pressure (≥ 140/90 mmHg), 20% smoked cigarettes, 70% were overweight [body mass index (BMI) ≥ 25 kg/m(2)], 31% were obese (BMI ≥ 30 kg/m(2)), 38% had elevated non-fasting cholesterol levels (≥ 5.20 mmol/l) and 49% were inactive (health risks (i.e. daily tobacco smoking, physical inactivity, overweight and high blood pressure). Health care sector employees were healthier overall, but there was substantial room for improvement. The present analysis identified an alarming prevalence of modifiable health risks in Atlantic Canadian employees. Workplaces need to invest in workplace wellness to reduce the risks and promote better health among employees, thus increasing productivity and decreasing the financial burden on employers.

  14. Disclosure Risk from Factor Scores

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    Drechsler Jörg

    2014-03-01

    Full Text Available Remote access can be a powerful tool for providing data access for external researchers. Since the microdata never leave the secure environment of the data-providing agency, alterations of the microdata can be kept to a minimum. Nevertheless, remote access is not free from risk. Many statistical analyses that do not seem to provide disclosive information at first sight can be used by sophisticated intruders to reveal sensitive information. For this reason the list of allowed queries is usually restricted in a remote setting. However, it is not always easy to identify problematic queries. We therefore strongly support the argument that has been made by other authors: that all queries should be monitored carefully and that any microlevel information should always be withheld. As an illustrative example, we use factor score analysis, for which the output of interest - the factor loading of the variables - seems to be unproblematic. However, as we show in the article, the individual factor scores that are usually returned as part of the output can be used to reveal sensitive information. Our empirical evaluations based on a German establishment survey emphasize that this risk is far from a purely theoretical problem.

  15. Osteoporosis and the risk of symptomatic nephrolithiasis: a population-based 5-year follow-up study in Taiwan.

    Science.gov (United States)

    Chou, Ping-Song; Kuo, Chun-Nan; Hung, Kuo-Sheng; Chang, Wei-Chiao; Liao, Yu-Chien; Chi, Ying-Chen; Chou, Wei-Po; Tsai, Shih-Jen; Liu, Mu-En; Lai, Chiou-Lian; Chou, Yii-Her; Chang, Wei-Pin

    2014-10-01

    This study estimates the risk of symptomatic nephrolithiasis within 5 years of newly diagnosed osteoporosis in a Taiwan population. This cohort study consisted of patients with a diagnosis of osteoporosis between Jan. 2003 and Dec. 2005 (N = 1634). Four age- and gender- matched patients for every patient in the study cohort were selected using random sampling as the comparison cohort (N = 6536). All patients were tracked for 5 years from the date of cohort entry to identify whether they developed symptomatic nephrolithiasis. Cox proportional hazard regressions were performed to evaluate the 5-year nephrolithiasis-free survival rates. During the 5-year follow-up period, 60 osteoporosis patients (3.7%) and 165 non- osteoporosis patients (2.5%) developed symptomatic nephrolithiasis. The adjusted HR of symptomatic nephrolithiasis was 1.38 times greater risk for patients with osteoporosis than for the comparison cohort (95% confidence interval (CI) 1.03-1.86; P nephrolithiasis.

  16. Factors increasing the caries risk of second primary molars in 5-year-old Dutch children

    NARCIS (Netherlands)

    Elfrink, Marlies E C; Schuller, Annemarie A; Veerkamp, Jaap S J; Poorterman, Jan H G; Moll, Henriette A; ten Cate, Bob J M

    2010-01-01

    BACKGROUND: Caries is still a prevalent condition in 5-year-old children. At present, knowledge regarding some aetiological factors, like deciduous molar hypomineralization (DMH), is limited. AIM: To investigate aetiological factors both directly and indirectly associated with caries in second prima

  17. Insulin Resistance and Cardiovascular Risk Factors in 3-to 5-Year-Old Overweight or Obese Children

    NARCIS (Netherlands)

    Bocca, Gianni; Ongering, Eva C.; Stolk, Ronald P.; Sauer, Pieter J. J.

    2013-01-01

    Background/Aims: The increasing rate of overweight and obesity is alarming. The complications of overweight and obesity at a young age are largely unknown. We aimed to assess the prevalence of insulin resistance (IR) and cardiovascular risk factors among overweight and obese children aged 3-5 years.

  18. Prevalence of cryptosporidium in children under 5 years of age, immunocompromised patients and high risk persons in Isfahan province

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    Mehdi Azami

    2008-09-01

    Full Text Available Background: Cryptosporidium is an important enteric parasite which causes diarrheal illness in humans and animals worldwide. With attention to the role of cryptosporidium in producing diarrhea and mortality in immunocopromised patients and children under 5 years of age, the present study was designed to identify the prevalence of cryptosporidium and potential risk factors in Isfahan province. Methods: This descriptive study was done in Isfahan province from October 2003 to April 2004. A total of 642 children under 5 years of age, immunocompromised patients and high risk persons selected randomly and their stool samples were studied microscopically using Sheater's Sucrose Flotation technique and stained by modified Ziehl-Neelsen staining method. Results: The overall prevalence of cryptosporidium was 4.7% (30 samples. The prevalence rates of infection were 4.6%, 3.5% and 5.4% in children under 5 years of age, immunocompromised patients and high risk persons, respectively. The highest prevalence of infection (6.2% belonged to 1-2 years old children in the group of under 5 years of age, 3-4 years in immunocompromised patients group and 5-10 years in high risk persons group (10%, 6.2% and 14.8% respectively. Conclusion: Cryptosporidium is significantly prevalent in children under 5 years of age, immune compromised patients and high risk persons in Isfahan province. Therefore, health policy makers have to design a plan to identify and treat infected subjected with cryptosporidium thus as a result the transmission of the disease can be prevented in the society.

  19. Population-based 5-year follow-up study in Taiwan of dementia and risk of stroke.

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    Mu-En Liu

    Full Text Available BACKGROUND: This study estimates the risk of stroke within 5 years of newly diagnosed dementia among elderly persons aged 65 and above. We examined the relationship between antipsychotic usage and development of stroke in patients with dementia. METHODS: We conducted a nationwide 5-year population-based study using data retrieved from the Longitudinal Health Insurance Database 2005 (LHID2005 in Taiwan. The study cohort comprised 2243 patients with dementia aged ≥65 years who had at least one inpatient service claim or at least 2 ambulatory care claims, whereas the comparison cohort consisted of 6714 randomly selected subjects (3 for every dementia patient and were matched with the study group according to sex, age, and index year. We further classified dementia patients into 2 groups based on their history of antipsychotic usage. A total of 1450 patients were classified into the antipsychotic usage group and the remaining 793 patients were classified into the non-antipsychotic usage group. Cox proportional-hazards regressions were performed to compute the 5-year stroke-free survival rates after adjusting for potentially confounding factors. RESULTS: The dementia patients have a 2-fold greater risk of developing stroke within 5 years of diagnosis compared to non-dementia age- and sex-matched subjects, after adjusting for other risk factors (95% confidence interval (CI = 2.58-3.08; P<.001. Antipsychotic usage among patients with dementia increases risk of stroke 1.17-fold compared to patients without antipsychotic treatment (95% CI = 1.01-1.40; P<.05. CONCLUSIONS: Dementia may be an independent risk factor for stroke, and the use of antipsychotics may further increase the risk of stroke in dementia patients.

  20. MODELING CREDIT RISK THROUGH CREDIT SCORING

    OpenAIRE

    Adrian Cantemir CALIN; Oana Cristina POPOVICI

    2014-01-01

    Credit risk governs all financial transactions and it is defined as the risk of suffering a loss due to certain shifts in the credit quality of a counterpart. Credit risk literature gravitates around two main modeling approaches: the structural approach and the reduced form approach. In addition to these perspectives, credit risk assessment has been conducted through a series of techniques such as credit scoring models, which form the traditional approach. This paper examines the evolution of...

  1. Cardiovascular risk score in Rheumatoid Arthritis

    Science.gov (United States)

    Wagan, Abrar Ahmed; Mahmud, Tafazzul E Haque; Rasheed, Aflak; Zafar, Zafar Ali; Rehman, Ata ur; Ali, Amjad

    2016-01-01

    Objective: To determine the 10-year Cardiovascular risk score with QRISK-2 and Framingham risk calculators in Rheumatoid Arthritis and Non Rheumatoid Arthritis subjects and asses the usefulness of QRISK-2 and Framingham calculators in both groups. Methods: During the study 106 RA and 106 Non RA patients age and sex matched participants were enrolled from outpatient department. Demographic data and questions regarding other study parameters were noted. After 14 hours of fasting 5 ml of venous blood was drawn for Cholesterol and HDL levels, laboratory tests were performed on COBAS c III (ROCHE). QRISK-2 and Framingham risk calculators were used to get individual 10-year CVD risk score. Results: In this study the mean age of RA group was (45.1±9.5) for Non RA group (43.7±8.2), with female gender as common. The mean predicted 10-year score with QRISK-2 calculator in RA group (14.2±17.1%) and Non RA group was (13.2±19.0%) with (p-value 0.122). The 10-year score with Framingham risk score in RA group was (12.9±10.4%) and Non RA group was (8.9±8.7%) with (p-value 0.001). In RA group QRISK-2 (24.5%) and FRS (31.1%) cases with predicted score were in higher risk category. The maximum agreement scores between both calculators was observed in both groups (Kappa = 0.618 RA Group; Kappa = 0.671 Non RA Group). Conclusion: QRISK-2 calculator is more appropriate as it takes RA, ethnicity, CKD, and Atrial fibrillation as factors in risk assessment score. PMID:27375684

  2. Security Risk Scoring Incorporating Computers' Environment

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    Eli Weintraub

    2016-04-01

    Full Text Available A framework of a Continuous Monitoring System (CMS is presented, having new improved capabilities. The system uses the actual real-time configuration of the system and environment characterized by a Configuration Management Data Base (CMDB which includes detailed information of organizational database contents, security and privacy specifications. The Common Vulnerability Scoring Systems' (CVSS algorithm produces risk scores incorporating information from the CMDB. By using the real updated environmental characteristics the system enables achieving accurate scores compared to existing practices. Framework presentation includes systems' design and an illustration of scoring computations.

  3. Increased Risk of Stroke and Transient Ischemic Attack in 5-Year Survivors of Hodgkin Lymphoma

    NARCIS (Netherlands)

    M.L. de Bruin; L.D.A Dorresteijn; M.B. van 't Veer; A.D.G. Krol; H.J. van der Pal; A.C. Kappelle; W. Boogerd; B.M.P. Aleman; F.E. van Leeuwen

    2009-01-01

    Information on clinically verified stroke and transient ischemic attack (TIA) following Hodgkin lymphoma is scarce. We quantified the long-term risk of cerebrovascular disease associated with the use of radiotherapy and chemotherapy in survivors of Hodgkin lymphoma and explored potential pathogenic

  4. Increased risk of stroke and transient ischemic attack in 5-year survivors of Hodgkin lymphoma.

    NARCIS (Netherlands)

    Bruin, M.L. De; Dorresteijn, L.D.A.; Veer, M.B. van 't; Krol, A.D.; Pal, H.J. van der; Kappelle, A.C.; Boogerd, W.; Aleman, B.M.; Leeuwen, F.E. van

    2009-01-01

    BACKGROUND: Information on clinically verified stroke and transient ischemic attack (TIA) following Hodgkin lymphoma is scarce. We quantified the long-term risk of cerebrovascular disease associated with the use of radiotherapy and chemotherapy in survivors of Hodgkin lymphoma and explored potential

  5. Cardiovascular risk factors and 5-year mortality in the Copenhagen Stroke Study

    DEFF Research Database (Denmark)

    Kammersgaard, Lars Peter; Olsen, Tom Skyhøj

    2005-01-01

    by Cox proportional hazards analyses adjusted for age, gender, stroke severity, and risk factor profile. RESULTS: In Kaplan-Meier analyses atrial fibrillation (AF), ischemic heart disease, diabetes, and previous stroke were associated with increased mortality, while smoking and alcohol intake were.......0-1.4), and previous stroke (HR 1.4; 95% CI 1.1-1.7), after adjustment for age, gender, and stroke severity. CONCLUSIONS: AF, diabetes, smoking, and previous stroke significantly affect long-term survival. Although smoking and daily alcohol consumption appeared to be associated with improved survival in the univariate...... analyses, adjustment for other factors and especially age revealed the lethal effect of smoking, while the positive effect of alcohol disappeared. More focus on secondary preventive measures, such as anticoagulation for AF, smoking cessation, and proper treatment of diabetes may significantly improve long...

  6. Cardiovascular risk factors and 5-year mortality in the Copenhagen Stroke Study

    DEFF Research Database (Denmark)

    Kammersgaard, Lars Peter; Olsen, Tom Skyhøj

    2005-01-01

    analyses, adjustment for other factors and especially age revealed the lethal effect of smoking, while the positive effect of alcohol disappeared. More focus on secondary preventive measures, such as anticoagulation for AF, smoking cessation, and proper treatment of diabetes may significantly improve long...... population. METHODS: We studied 905 ischemic stroke patients from the community-based Copenhagen Stroke Study. Patients had a CT scan and stroke severity was measured by the Scandinavian Stroke Scale on admission. A comprehensive evaluation was performed by a standardized medical examination...... by Cox proportional hazards analyses adjusted for age, gender, stroke severity, and risk factor profile. RESULTS: In Kaplan-Meier analyses atrial fibrillation (AF), ischemic heart disease, diabetes, and previous stroke were associated with increased mortality, while smoking and alcohol intake were...

  7. Occupational injury and disease incidence and risk factors in Finnish agriculture based on 5-year insurance records.

    Science.gov (United States)

    Karttunen, Janne P; Rautiainen, Risto H

    2013-01-01

    The aim of this retrospective cohort study was to evaluate the incidence of and risk factors for compensated occupational injuries and diseases in agriculture. The study population consisted of 78,679 Finnish farmers, spouses, and salaried family members covered by mandatory workers' compensation insurance. This population had a total of 24,424 occupational injuries and 1684 diseases from 2000 to 2004. In the 5-year period, 20.2% of the population had (one or more) injuries and 2.0% had occupational diseases. Multiple claims were common particularly among livestock producers. Using Poisson regression analyses, we identified several personal and farm-related risk factors, with relative risk estimates ranging from 1.07 to 3.08 for injuries and from 1.45 to 3.01 for diseases. Cattle-intensive geographic regions, occupational health service membership, large farm size, and farming alone were identified as risk factors for both outcomes. Further, male gender, higher number of insurance years, and residing on the farm were among risk factors for injury. These risk factors identified from a large longitudinal data set can be considered for developing and targeting interventions for farmers at highest risk of occupational injury and disease.

  8. RISK FACTOR DIAGNOSTIC SCORE IN DIABETIC FOOT

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    Mohamed Shameem P. M

    2016-09-01

    Full Text Available INTRODUCTION Diabetic foot ulcers vary in their clinical presentation and nature of severity and therefore create a challenging problem to the treating surgeon regarding the prediction of the clinical course and the end result of the treatment. Clinical studies have shown that there are certain risk factors for the progression of foot ulcers in diabetics and it may therefore be possible to predict the course of an ulcer foot at presentation itself, thus instituting proper therapy without delay. Spoken otherwise clinical scoring may tell that this particular ulcer is having highest chance of amputation, then one may be able to take an early decision for the same and avoid the septic complications, inconvenience to the patient, long hospital stay and cost of treatments. AIM OF THE STUDY Aim of the study is to evaluate the above-mentioned scoring system in predicting the course the diabetic foot ulcers. MATERIALS AND METHODS 50 patients with Diabetic Foot attending the OPD of Department of Surgery of Government Hospital attached to Calicut Medical College are included in the present study. After thorough history taking and clinical examination, six risk factors like Age, pedal vessels, renal function, neuropathy, radiological findings and ulcers were observed in the patients by giving certain scoring points to each of them. The total number of points scored by the patients at the time of admission or OPD treatment was correlated with the final outcome in these patients, whether leading to amputation or conservative management. All the data was analysed using standard statistical methods. OBSERVATIONS AND RESULTS There were 12 females and 38 males with a female to male ratio 1:3.1. All were aged above 30 years. Twenty-four (48% of them were between 30-60 years and twenty six (52% were above 60 years. 10 patients were treated conservatively with risk score range: 10 to 35. Six had single toe loss with risk score: 25 to 35. Six had multiple toe loss

  9. A score model for predicting post-liver trans-plantation survival in HBV cirrhosis-related hepatocellular carcinoma recipients:a single center 5-year experience

    Institute of Scientific and Technical Information of China (English)

    Li-Ying Wang; Xin-Hua Chen; Tian-An Jiang; Fen Chen; Shu-Sen Zheng; Xiao Xu; Wei-Lin Wang; Jian Wu; Min Zhang; Yan Shen; Sheng Yan; Hai-Yang Xie

    2015-01-01

    BACKGROUND: The prognostic prediction of liver transplan-tation (LT) guides the donor organ allocation. However, there is currently no satisfactory model to predict the recipients' outcome, especially for the patients with HBV cirrhosis-re-lated hepatocellular carcinoma (HCC). The present study was to develop a quantitative assessment model for predicting the post-LT survival in HBV-related HCC patients. METHODS: Two hundred and thirty-eight LT recipients at the Liver Transplant Center, First Affiliated Hospital, Zhejiang University School of Medicine between 2008 and 2013 were included in this study. Their post-LT prognosis was recorded and multiple risk factors were analyzed using univariate and multivariate analyses in Cox regression. RESULTS: The score model was as follows: 0.114×(Child-Pugh score)-0.002×(positive HBV DNA detection time)+0.647× (number of tumor nodules)+0.055×(max diameter of tumor nodules)+0.231×lnAFP+0.437×(tumor differentiation grade). The receiver operating characteristic curve analysis showed that the area under the curve of the scoring model for predict-ing the post-LT survival was 0.887. The cut-off value was 1.27, which was associated with a sensitivity of 72.5% and a speci-ficity of 90.7%, respectively. CONCLUSION: The quantitative score model for predicting post-LT survival proved to be sensitive and specific.

  10. Prenatal methamphetamine exposure, home environment, and primary caregiver risk factors predict child behavioral problems at 5 years.

    Science.gov (United States)

    Twomey, Jean; LaGasse, Linda; Derauf, Chris; Newman, Elana; Shah, Rizwan; Smith, Lynne; Arria, Amelia; Huestis, Marilyn; DellaGrotta, Sheri; Roberts, Mary; Dansereau, Lynne; Neal, Charles; Lester, Barry

    2013-01-01

    This study investigated the prospective association between prenatal methamphetamine (MA) exposure and child behavioral problems at 5 years while also examining the home environment at 30 months and several primary caregiver (PC) risk factors. Participants were 97 MA-exposed and 117 comparison children and their PCs enrolled in the Infant Development, Environment and Lifestyle Study. Hypotheses were that child behaviors would be adversely impacted by (a) prenatal MA exposure, (b) home environments that provided less developmental stimulation and emotional responsiveness to the child, and (c) the presence of PC psychological symptoms and other risk factors. Prenatal MA exposure was associated with child externalizing behavioral problems at 5 years. Home environments that were more conducive to meeting children's developmental and emotional needs were associated with fewer internalizing and externalizing behavioral problems. Independent of prenatal MA exposure, PC parenting stress and psychological symptoms were associated with increased child behavioral problems. Findings suggest prenatal MA exposure may contribute to externalizing behavioral problems in early childhood and the importance of considering possible vulnerabilities related to prenatal MA exposure in the context of the child's caregiving environment.

  11. Estimated Risk of Developing Selected DSM-IV Disorders Among 5-Year-Old Children with Prenatal Cocaine Exposure

    Science.gov (United States)

    Morrow, Connie E.; Xue, Lihua; Manjunath, Sudha; Culbertson, Jan C.; Accornero, Veronica H.; Anthony, James C.; Bandstra, Emmalee S.

    2016-01-01

    This study estimated childhood risk of developing selected DSM-IV Disorders, including Attention-Deficit Hyperactivity Disorder (ADHD), Oppositional Defiant Disorder (ODD), and Separation Anxiety Disorder (SAD), in children with prenatal cocaine exposure (PCE). Children were enrolled prospectively at birth (n=476) with prenatal drug exposures documented by maternal interview, urine and meconium assays. Study participants included 400 African-American children from the birth cohort, 208 cocaine-exposed (CE) and 192 non-cocaine-exposed (NCE) who attended a 5-year follow-up assessment and whose caregiver completed the Computerized Diagnostic Interview Schedule for Children. Under a generalized linear model (logistic link), Fisher’s exact methods were used to estimate the CE-associated relative risk (RR) of these disorders. Results indicated a modest but statistically robust elevation of ADHD risk associated with increasing levels of PCE (pEstimated cumulative incidence proportions among CE children were 2.9% for ADHD (vs 3.1% NCE); 1.4% for SAD (vs 1.6% NCE); and 4.3% for ODD (vs 6.8% NCE). Findings offer suggestive evidence of increased risk of ADHD (but not ODD or SAD) in relation to an increasing gradient of PCE during gestation.

  12. Increased Serum Sodium and Serum Osmolarity Are Independent Risk Factors for Developing Chronic Kidney Disease; 5 Year Cohort Study

    Science.gov (United States)

    Kuwabara, Masanari; Hisatome, Ichiro; Roncal-Jimenez, Carlos A.; Niwa, Koichiro; Andres-Hernando, Ana; Jensen, Thomas; Bjornstad, Petter; Milagres, Tamara; Cicerchi, Christina; Song, Zhilin; Garcia, Gabriela; Sánchez-Lozada, Laura G.; Ohno, Minoru; Lanaspa, Miguel A.; Johnson, Richard J.

    2017-01-01

    Background Epidemics of chronic kidney disease (CKD) not due to diabetes mellitus (DM) or hypertension have been observed among individuals working in hot environments in several areas of the world. Experimental models have documented that recurrent heat stress and water restriction can lead to CKD, and the mechanism may be mediated by hyperosmolarity that activates pathways (vasopressin, aldose reductase-fructokinase) that induce renal injury. Here we tested the hypothesis that elevated serum sodium, which reflects serum osmolality, may be an independent risk factor for the development of CKD. Methods This study was a large-scale, single-center, retrospective 5-year cohort study at Center for Preventive Medicine, St. Luke’s International Hospital, Tokyo, Japan, between 2004 and 2009. We analyzed 13,201 subjects who underwent annual medical examination of which 12,041 subjects (age 35 to 85) without DM and/or CKD were enrolled. This analysis evaluated age, sex, body mass index, abdominal circumference, hypertension, dyslipidemia, hyperuricemia, fasting glucose, BUN, serum sodium, potassium, chloride and calculated serum osmolarity. Results Elevated serum sodium was an independent risk factor for development of CKD (OR: 1.03, 95% CI, 1.00–1.07) after adjusted regression analysis with an 18 percent increased risk for every 5 mmol/L change in serum sodium. Calculated serum osmolarity was also an independent risk factor for CKD (OR: 1.04; 95% CI, 1.03–1.05) as was BUN (OR: 1.08; 95% CI, 1.06–1.10) (independent of serum creatinine). Conclusions Elevated serum sodium and calculated serum osmolarity are independent risk factors for developing CKD. This finding supports the role of limiting salt intake and preventing dehydration to reduce risk of CKD. PMID:28081152

  13. Risk indicators and potential risk factors for caries in 5-year-olds of different ethnic groups in Amsterdam.

    NARCIS (Netherlands)

    Verrips, G.H.; Frencken, J.E.; Kalsbeek, H.; Horst, G. ter; Filedt Kok-Weimar, T.L.

    1992-01-01

    The aim of this study was threefold: first, to assess the oral health of Turkish, Moroccan, Surinamese, Dutch and "other" 5-yr-old children living in Amsterdam; second, to identify risk indicators for caries, in addition to ethnicity; and third, to identify potential risk factors related to differen

  14. Risk of sudden sensorineural hearing loss in stroke patients: A 5-year nationwide investigation of 44,460 patients.

    Science.gov (United States)

    Kuo, Chin-Lung; Shiao, An-Suey; Wang, Shuu-Jiun; Chang, Wei-Pin; Lin, Yung-Yang

    2016-09-01

    Poststroke sudden sensorineural hearing loss (SSNHL) can hinder communication between patients and healthcare professionals, thereby restricting participation in rehabilitation programs and limiting improvements in physical performance. However, the relationship between stroke and SSNHL remains unclear. This study employed a nationwide population-based dataset to investigate the relationship between stroke and SSNHL.The Taiwan Longitudinal Health Insurance Database was used to compile data from 11,115 stroke patients and a comparison cohort of 33,345 matched nonstroke enrollees. Each patient was followed for 5 years to identify new-onset SSNHL. Stratified Cox proportional-hazard regression analysis was used to examine the association of stroke with subsequent SSNHL.Among the 44,460 patients, 66 patients (55,378 person-years) from the stroke cohort and 105 patients (166,586 person-years) from the comparison cohort were diagnosed with SSNHL. The incidence of SSNHL was approximately twice as high among stroke patients than among nonstroke patients (1.19 and 0.63/1000 person-years, respectively). Stroke patients had a 71% increased risk of SSNHL, compared with nonstroke patients (adjusted hazard ratio [HR] 1.71, 95% confidence interval [CI] 1.24-2.36). We also observed a remarkable increase in risk of SSNHL in stroke patients within 1-year of follow-up (adjusted HR 5.65, 95% CI 3.07-10.41) or under steroid therapy during hospitalization (adjusted HR 5.14, 95% CI 2.08-12.75).Patients with stroke had a higher risk of subsequent SSNHL compared with patients without stroke. In particular, stroke patients within 1-year follow-up and those undergoing steroid therapy during hospitalization should be treated with the utmost caution, considering that the risk of SSNHL increases by more than 5-fold.

  15. Consuming cassava as a staple food places children 2-5 years old at risk for inadequate protein intake, an observational study in Kenya and Nigeria

    Directory of Open Access Journals (Sweden)

    Gichuki Simon

    2010-02-01

    Full Text Available Abstract Background Inadequate protein intake is known to be deleterious in animals. Using WHO consensus documents for human nutrient requirements, the protein:energy ratio (P:E of an adequate diet is > 5%. Cassava has a very low protein content. This study tested the hypothesis that Nigerian and Kenyan children consuming cassava as their staple food are at greater risk for inadequate dietary protein intake than those children who consume less cassava. Methods A 24 hour dietary recall was used to determine the food and nutrient intake of 656 Nigerian and 449 Kenyan children aged 2-5 years residing in areas where cassava is a staple food. Anthropometric measurements were conducted. Diets were scored for diversity using a 12 point score. Pearson's Correlation Coefficients were calculated to relate the fraction of dietary energy obtained from cassava with protein intake, P:E, and dietary diversity. Results The fraction of dietary energy obtained from cassava was > 25% in 35% of Nigerian children and 89% of Kenyan children. The mean dietary diversity score was 4.0 in Nigerian children and 4.5 in Kenyan children, although the mean number of different foods consumed on the survey day in Nigeria was greater than Kenya, 7.0 compared to 4.6. 13% of Nigerian and 53% of Kenyan children surveyed had inadequate protein intake. The fraction of dietary energy derived from cassava was negatively correlated with protein intake, P:E, and dietary diversity. Height-for age z score was directly associated with protein intake and negatively associated with cassava consumption using regression modeling that controlled for energy and zinc intake. Conclusions Inadequate protein intake was found in the diets of Nigerian and Kenyan children consuming cassava as a staple food. Inadequate dietary protein intake is associated with stunting in this population. Interventions to increase protein intake in this vulnerable population should be the focus of future work.

  16. Prevelence of latent tuberculosis and associated risk factors in children under 5 years of age in Karachi, Pakistan

    Directory of Open Access Journals (Sweden)

    Mubashir Zafar

    2014-01-01

    Full Text Available Background: As infected children represent a large proportion of the pool from which tuberculosis (TB cases will arise and its associated risk factors that influence TB infection are basic cause for burden of TB. Aim: This study was to determine the prevalence of latent TB and associated risk factors in children less than 5 year of age in Karachi, Pakistan. Setting and Design: Cross-sectional study and it was conducted in tertiary care hospital in Karachi. Materials and Methods: In this study, children who were living in contact with individuals who had proven smear-positive pulmonary TB cases were investigated. A tuberculin skin test (TST was performed on each child. TST sizes ≥5 and 10 mm, respectively, were considered positive. Statistical Analysis: A random effects logistic regression model, which takes into account the clustering of contacts within households, was used to assess the relationship between the tuberculin response of the contact and risk factors. Results are reported as unadjusted and adjusted odds ratios and their 95% confidence intervals. The likelihood ratio test was used to assess the overall significance of risk factors, tests for trend, and tests for interaction. Results: The distribution of TST responses followed a bimodal pattern, with 135 (35% children presenting a palpable induration. The risk of positive TST response in the child increased with the geographic proximity of the child to the individual with TB within the household and with the degree of activities shared with the individual with TB. Nutritional status and presence of a bacille Calmette-Guérin (BCG scar were not independent risk factors for TST positivity in this population. On multivariate analysis, the effect of geographic proximity to the individual with TB, household size, and duration of cough in the index case persisted for TST responses ≥5 mm. Conclusions: Positive TST in a child reflects most probably TB infection rather than previous BCG

  17. Breast cancer risk prediction using a clinical risk model and polygenic risk score.

    Science.gov (United States)

    Shieh, Yiwey; Hu, Donglei; Ma, Lin; Huntsman, Scott; Gard, Charlotte C; Leung, Jessica W T; Tice, Jeffrey A; Vachon, Celine M; Cummings, Steven R; Kerlikowske, Karla; Ziv, Elad

    2016-10-01

    Breast cancer risk assessment can inform the use of screening and prevention modalities. We investigated the performance of the Breast Cancer Surveillance Consortium (BCSC) risk model in combination with a polygenic risk score (PRS) comprised of 83 single nucleotide polymorphisms identified from genome-wide association studies. We conducted a nested case-control study of 486 cases and 495 matched controls within a screening cohort. The PRS was calculated using a Bayesian approach. The contributions of the PRS and variables in the BCSC model to breast cancer risk were tested using conditional logistic regression. Discriminatory accuracy of the models was compared using the area under the receiver operating characteristic curve (AUROC). Increasing quartiles of the PRS were positively associated with breast cancer risk, with OR 2.54 (95 % CI 1.69-3.82) for breast cancer in the highest versus lowest quartile. In a multivariable model, the PRS, family history, and breast density remained strong risk factors. The AUROC of the PRS was 0.60 (95 % CI 0.57-0.64), and an Asian-specific PRS had AUROC 0.64 (95 % CI 0.53-0.74). A combined model including the BCSC risk factors and PRS had better discrimination than the BCSC model (AUROC 0.65 versus 0.62, p = 0.01). The BCSC-PRS model classified 18 % of cases as high-risk (5-year risk ≥3 %), compared with 7 % using the BCSC model. The PRS improved discrimination of the BCSC risk model and classified more cases as high-risk. Further consideration of the PRS's role in decision-making around screening and prevention strategies is merited.

  18. A Clinical Algorithm to Identify HIV Patients at High Risk for Incident Active Tuberculosis: A Prospective 5-Year Cohort Study.

    Directory of Open Access Journals (Sweden)

    Susan Shin-Jung Lee

    Full Text Available Predicting the risk of tuberculosis (TB in people living with HIV (PLHIV using a single test is currently not possible. We aimed to develop and validate a clinical algorithm, using baseline CD4 cell counts, HIV viral load (pVL, and interferon-gamma release assay (IGRA, to identify PLHIV who are at high risk for incident active TB in low-to-moderate TB burden settings where highly active antiretroviral therapy (HAART is routinely provided.A prospective, 5-year, cohort study of adult PLHIV was conducted from 2006 to 2012 in two hospitals in Taiwan. HAART was initiated based on contemporary guidelines (CD4 count < = 350/μL. Cox regression was used to identify the predictors of active TB and to construct the algorithm. The validation cohorts included 1455 HIV-infected individuals from previous published studies. Area under the receiver operating characteristic (ROC curve was calculated.Seventeen of 772 participants developed active TB during a median follow-up period of 5.21 years. Baseline CD4 < 350/μL or pVL ≥ 100,000/mL was a predictor of active TB (adjusted HR 4.87, 95% CI 1.49-15.90, P = 0.009. A positive baseline IGRA predicted TB in patients with baseline CD4 ≥ 350/μL and pVL < 100,000/mL (adjusted HR 6.09, 95% CI 1.52-24.40, P = 0.01. Compared with an IGRA-alone strategy, the algorithm improved the sensitivity from 37.5% to 76.5%, the negative predictive value from 98.5% to 99.2%. Compared with an untargeted strategy, the algorithm spared 468 (60.6% from unnecessary TB preventive treatment. Area under the ROC curve was 0.692 (95% CI: 0.587-0.798 for the study cohort and 0.792 (95% CI: 0.776-0.808 and 0.766 in the 2 validation cohorts.A validated algorithm incorporating the baseline CD4 cell count, HIV viral load, and IGRA status can be used to guide targeted TB preventive treatment in PLHIV in low-to-moderate TB burden settings where HAART is routinely provided to all PLHIV. The implementation of this algorithm will avoid unnecessary

  19. [A simple point score for definition of the risk of postoperative complications].

    Science.gov (United States)

    Grundmann, R; Papoulis, C

    1989-01-01

    During a 5-year-period we recorded prospectively 5,823 patients who had undergone general surgery and documented the postoperative complications as wound infection, pneumonia, reoperations and death. A score including all these complications was developed to evaluate the risk of an operation more exactly than using the wound infection rate alone. This method seems to provide a continuous monitoring and the comparison of the complication risks of certain operations within a quality assurance program. For gastric and colon surgery we found a correlation between postoperative antibiotic use and score, but not between score and postoperative hospitalization time.

  20. Predicting 10-Year Risk of Fatal Cardiovascular Disease in Germany: An Update Based on the SCORE-Deutschland Risk Charts

    Science.gov (United States)

    Rücker, Viktoria; Keil, Ulrich; Fitzgerald, Anthony P; Malzahn, Uwe; Prugger, Christof; Ertl, Georg; Heuschmann, Peter U; Neuhauser, Hannelore

    2016-01-01

    Estimation of absolute risk of cardiovascular disease (CVD), preferably with population-specific risk charts, has become a cornerstone of CVD primary prevention. Regular recalibration of risk charts may be necessary due to decreasing CVD rates and CVD risk factor levels. The SCORE risk charts for fatal CVD risk assessment were first calibrated for Germany with 1998 risk factor level data and 1999 mortality statistics. We present an update of these risk charts based on the SCORE methodology including estimates of relative risks from SCORE, risk factor levels from the German Health Interview and Examination Survey for Adults 2008–11 (DEGS1) and official mortality statistics from 2012. Competing risks methods were applied and estimates were independently validated. Updated risk charts were calculated based on cholesterol, smoking, systolic blood pressure risk factor levels, sex and 5-year age-groups. The absolute 10-year risk estimates of fatal CVD were lower according to the updated risk charts compared to the first calibration for Germany. In a nationwide sample of 3062 adults aged 40–65 years free of major CVD from DEGS1, the mean 10-year risk of fatal CVD estimated by the updated charts was lower by 29% and the estimated proportion of high risk people (10-year risk > = 5%) by 50% compared to the older risk charts. This recalibration shows a need for regular updates of risk charts according to changes in mortality and risk factor levels in order to sustain the identification of people with a high CVD risk. PMID:27612145

  1. Body Mass Index Genetic Risk Score and Endometrial Cancer Risk.

    Directory of Open Access Journals (Sweden)

    Jennifer Prescott

    Full Text Available Genome-wide association studies (GWAS have identified common variants that predispose individuals to a higher body mass index (BMI, an independent risk factor for endometrial cancer. Composite genotype risk scores (GRS based on the joint effect of published BMI risk loci were used to explore whether endometrial cancer shares a genetic background with obesity. Genotype and risk factor data were available on 3,376 endometrial cancer case and 3,867 control participants of European ancestry from the Epidemiology of Endometrial Cancer Consortium GWAS. A BMI GRS was calculated by summing the number of BMI risk alleles at 97 independent loci. For exploratory analyses, additional GRSs were based on subsets of risk loci within putative etiologic BMI pathways. The BMI GRS was statistically significantly associated with endometrial cancer risk (P = 0.002. For every 10 BMI risk alleles a woman had a 13% increased endometrial cancer risk (95% CI: 4%, 22%. However, after adjusting for BMI, the BMI GRS was no longer associated with risk (per 10 BMI risk alleles OR = 0.99, 95% CI: 0.91, 1.07; P = 0.78. Heterogeneity by BMI did not reach statistical significance (P = 0.06, and no effect modification was noted by age, GWAS Stage, study design or between studies (P≥0.58. In exploratory analyses, the GRS defined by variants at loci containing monogenic obesity syndrome genes was associated with reduced endometrial cancer risk independent of BMI (per BMI risk allele OR = 0.92, 95% CI: 0.88, 0.96; P = 2.1 x 10-5. Possessing a large number of BMI risk alleles does not increase endometrial cancer risk above that conferred by excess body weight among women of European descent. Thus, the GRS based on all current established BMI loci does not provide added value independent of BMI. Future studies are required to validate the unexpected observed relation between monogenic obesity syndrome genetic variants and endometrial cancer risk.

  2. Risk scores-the modern Oracle of Delphi?

    Science.gov (United States)

    Kronenberg, Florian; Schwaiger, Johannes P

    2017-03-01

    Recently, 4 new risk scores for the prediction of mortality and cardiovascular events were especially tailored for hemodialysis patients; these scores performed much better than previous scores. Tripepi et al. found that these risk scores were even more predictive for all-cause and cardiovascular death than the measurement of the left ventricular mass index was. Nevertheless, the investigation of left ventricular mass and function has its own place for other reasons.

  3. Modeling Linkage Disequilibrium Increases Accuracy of Polygenic Risk Scores

    DEFF Research Database (Denmark)

    Vilhjálmsson, Bjarni J; Yang, Jian; Finucane, Hilary K;

    2015-01-01

    Polygenic risk scores have shown great promise in predicting complex disease risk and will become more accurate as training sample sizes increase. The standard approach for calculating risk scores involves linkage disequilibrium (LD)-based marker pruning and applying a p value threshold...

  4. Genetic Risk Score Predicts Late-Life Cognitive Impairment

    Directory of Open Access Journals (Sweden)

    Mariegold E. Wollam

    2015-01-01

    Full Text Available Introduction. A family history of Alzheimer’s disease is a significant risk factor for its onset, but the genetic risk associated with possessing multiple risk alleles is still poorly understood. Methods. In a sample of 95 older adults (Mean age = 75.1, 64.2% female, we constructed a genetic risk score based on the accumulation of risk alleles in BDNF, COMT, and APOE. A neuropsychological evaluation and consensus determined cognitive status (44 nonimpaired, 51 impaired. Logistic regression was performed to determine whether the genetic risk score predicted cognitive impairment above and beyond that associated with each gene. Results. An increased genetic risk score was associated with a nearly 4-fold increased risk of cognitive impairment (OR = 3.824, P = .013 when including the individual gene polymorphisms as covariates in the model. Discussion. A risk score combining multiple genetic influences may be more useful in predicting late-life cognitive impairment than individual polymorphisms.

  5. Polygenic risk scores for schizophrenia and bipolar disorder predict creativity

    NARCIS (Netherlands)

    Power, R.A.; Steinberg, S.; Bjornsdottir, G.; Rietveld, C.A.; Abdellaoui, A.; Nivard, M.M.; Johannesson, M.; Galesloot, T.E.; Hottenga, J.J.; Willemsen, G.; Cesarini, D.; Benjamin, D.J.; Magnusson, P.K.; Ullen, F.; Tiemeier, H.; Hofman, A.; Rooij, F.J. van; Walters, G.B.; Sigurdsson, E.; Thorgeirsson, T.E.; Ingason, A.; Helgason, A.; Kong, A.; Kiemeney, B.; Koellinger, P.; Boomsma, D.I.; Gudbjartsson, D.; Stefansson, H.; Stefansson, K.

    2015-01-01

    We tested whether polygenic risk scores for schizophrenia and bipolar disorder would predict creativity. Higher scores were associated with artistic society membership or creative profession in both Icelandic (P = 5.2 x 10(-6) and 3.8 x 10(-6) for schizophrenia and bipolar disorder scores, respectiv

  6. RISKS MANAGEMENT. A PROPENSITY SCORE APPLICATION

    Directory of Open Access Journals (Sweden)

    Constangioara Alexandru

    2008-05-01

    Full Text Available Risk management is relatively unexplored in Romania. Although Romanian specialists dwell on theoretical aspects such as the risks classification and the important distinction between risks and uncertainty the practical relevance of the matter is outside existing studies. Present paper uses a dataset of consumer data to build a propensity scorecard based on relevant quantitative modeling.

  7. Credit scores, cardiovascular disease risk, and human capital.

    Science.gov (United States)

    Israel, Salomon; Caspi, Avshalom; Belsky, Daniel W; Harrington, HonaLee; Hogan, Sean; Houts, Renate; Ramrakha, Sandhya; Sanders, Seth; Poulton, Richie; Moffitt, Terrie E

    2014-12-02

    Credit scores are the most widely used instruments to assess whether or not a person is a financial risk. Credit scoring has been so successful that it has expanded beyond lending and into our everyday lives, even to inform how insurers evaluate our health. The pervasive application of credit scoring has outpaced knowledge about why credit scores are such useful indicators of individual behavior. Here we test if the same factors that lead to poor credit scores also lead to poor health. Following the Dunedin (New Zealand) Longitudinal Study cohort of 1,037 study members, we examined the association between credit scores and cardiovascular disease risk and the underlying factors that account for this association. We find that credit scores are negatively correlated with cardiovascular disease risk. Variation in household income was not sufficient to account for this association. Rather, individual differences in human capital factors—educational attainment, cognitive ability, and self-control—predicted both credit scores and cardiovascular disease risk and accounted for ∼45% of the correlation between credit scores and cardiovascular disease risk. Tracing human capital factors back to their childhood antecedents revealed that the characteristic attitudes, behaviors, and competencies children develop in their first decade of life account for a significant portion (∼22%) of the link between credit scores and cardiovascular disease risk at midlife. We discuss the implications of these findings for policy debates about data privacy, financial literacy, and early childhood interventions.

  8. Healthy lifestyle and normal waist circumference are associated with a lower 5-year risk of type 2 diabetes in middle-aged and elderly individuals

    Science.gov (United States)

    Chen, Chu-Chih; Liu, Kiang; Hsu, Chih-Chen; Chang, Hsing-Yi; Chung, Hsiao-Chun; Liu, Jih-Shin; Liu, Yo-Hann; Tsai, Tsung-Lung; Liaw, Wen-Jin; Lin, I-Ching; Wu, Hsi-Wen; Juan, Chung-Chou; Chiu, Hou-Chang; Lee, Marion M.; Hsiung, Chao A.

    2017-01-01

    Abstract Type 2 diabetes mellitus (DM) is known to be closely associated with lifestyle and obesity and has a prevalence that increases with age. This study aimed to assess the short-term composite effect of diet, physical activity, psychosocial health, and waist circumference (WC) on the incidence of DM in the elderly and to provide a lifestyle-based predictive index. We used baseline measurements (2009–2013) of 5349 community-dwelling participants (aged 55 years and older, 52% female) of the Healthy Aging Longitudinal Study in Taiwan (HALST) for fasting plasma glucose, HbA1C, serum cholesterol, triglycerides, blood pressures, WC, and outcomes of home-visit questionnaire. Principal component analysis (PCA) was used to identify participants with a healthy lifestyle (HLF: higher diet, physical activity, and psychosocial scores) and a lower WC, with cutoffs determined by the receiver-operating characteristics. A Cox regression model was applied to 3424 participants without DM at baseline by linking to their National Health Insurance records (median follow-up of 3.1 years). In total, 247 new DM cases (7.2%) were identified. The HLF and lower WC group had a relative risk (RR) of DM of 0.54 (95% CI 0.35–0.82) compared to the non-HLF and higher WC group. When stratified by the presence of impaired glucose tolerance (IGT) or metabolic syndrome (MS), only participants with IGT/MS showed significant risks (RR 0.55; 95% CI 0.33–0.92). However, except for WC, the individual lifestyle factors were nonsignificant in the overall model without PCA. A composite protective effect of HLF and normal WC on DM within 5 years was observed, especially in those with IGT or MS. Psychosocial health constituted an important lifestyle factor in the elderly. The cutoffs identified could be used as a lifestyle-based risk index for DM. Maintaining an HLF to prevent DM is especially important for the elderly. PMID:28178143

  9. Cryptosporidiosis Risk in New Zealand Children Under 5 Years Old is Greatest in Areas with High Dairy Cattle Densities.

    Science.gov (United States)

    Lal, Aparna; Dobbins, Timothy; Bagheri, Nasser; Baker, Michael G; French, Nigel P; Hales, Simon

    2016-12-01

    The public health risks associated with dairy farming intensification are an emerging concern. We examine the association between dairy cattle density and cryptosporidiosis risk in children dairy industry. Multi-level Poisson regression was used to model reported cryptosporidiosis (N = 3869 cases) incidence in relation to dairy cattle densities across urban and rural areas separately, after controlling for microbiological quality of public drinking water supplies and neighbourhood socio-economic factors using the Census Area Unit of residence. Within urban areas, the risk of cryptosporidiosis in children less than 5 years old was significantly, positively associated with medium and high dairy cattle density IRR 1.3 (95% CI 1.2, 1.5) and 1.5 (95% CI 1.2, 1.9) respectively, when compared to areas with no dairy cattle. Within rural areas, the incidence risk of cryptosporidiosis in children less than 5 years old were significantly, positively associated with medium and high dairy cattle density: IRR 1.7 (95% CI 1.3, 2.3) and 2.0 (95% CI 1.5, 2.8) respectively, when compared to areas with no dairy cattle. These results have public health implications for children living on and in proximity to intensively stocked dairy cattle farms.

  10. Beyond Statistics: The Economic Content of Risk Scores.

    Science.gov (United States)

    Einav, Liran; Finkelstein, Amy; Kluender, Raymond; Schrimpf, Paul

    2016-04-01

    "Big data" and statistical techniques to score potential transactions have transformed insurance and credit markets. In this paper, we observe that these widely-used statistical scores summarize a much richer heterogeneity, and may be endogenous to the context in which they get applied. We demonstrate this point empirically using data from Medicare Part D, showing that risk scores confound underlying health and endogenous spending response to insurance. We then illustrate theoretically that when individuals have heterogeneous behavioral responses to contracts, strategic incentives for cream skimming can still exist, even in the presence of "perfect" risk scoring under a given contract.

  11. The Revolving Door Phenomenon in an Italian Acute Psychiatric Ward: A 5-Year Retrospective Analysis of the Potential Risk Factors.

    Science.gov (United States)

    Di Lorenzo, Rosaria; Sagona, Marco; Landi, Giulia; Martire, Lisa; Piemonte, Chiara; Del Giovane, Cinzia

    2016-09-01

    To highlight the revolving door (RD) phenomenon in an acute psychiatric ward, we retrospectively identified the patients hospitalized three or more times in a calendar year from 1/1/2009 to 31/12/2013 as RD patients (RDP). We collected sociodemographic and clinical variables of RDP and statistically analyzed the potential RD risk factors. We divided RDP into "high" and "extremely high" utilizers and evaluated the variables related to more frequent readmissions. RDP represented 5.68% of all patients and their hospitalizations (RDH) 25% of all admissions. The statistically significant risk factors for all RDH were "disability pension," "substance abuse/dependence," "mild/severe aggressiveness," and "psychiatric and social rehabilitative programs". The comparison between "high" and "extremely high" utilizers showed that "manic episodes" and "personality disorders," among the diagnoses, "familial relational conflicts" and "violence/suicidality", among the hospitalization reasons, were statistically significant risk factors for more frequent readmissions. RD phenomenon was greatly affected by severe clinical conditions with social disability.

  12. Relation of androgen receptor gene polymorphism to bone mineral density and fracture risk in early postmenopausal women during a 5-year randomized hormone replacement therapy trial.

    Science.gov (United States)

    Salmén, Timo; Heikkinen, Anna-Mari; Mahonen, Anitta; Kröger, Heikki; Komulainen, Marja; Pallonen, Heli; Saarikoski, Seppo; Honkanen, Risto; Mäenpää, Pekka H

    2003-02-01

    In women, the influence of androgens on bone health is not clear. It has been suggested that the androgen receptor (AR) genotype is associated with bone mineral density and serum androgen levels in pre- and perimenopausal women, but the association between AR genotype, bone mineral density, and fracture risk has not been studied in postmenopausal women. Therefore, we studied whether AR polymorphism affects bone mineral density, bone mineral density change, or fracture risk in a 5-year randomized hormone replacement therapy (HRT) trial on 331 early postmenopausal women (mean baseline age, 52.7 +/- 2.3 years). The participants consisted of two treatment groups: the HRT group (n = 151) received a sequential combination of 2 mg estradiol valerate and 1 mg cyproterone acetate with or without vitamin D3, 100-300 IU + 93 mg calcium as lactate/day, and the non-HRT group (n = 180) received 93 mg calcium alone or in combination with vitamin D3, 100-300 IU/day for 5 years. Bone mineral density was measured from lumbar spine and proximal femur (DXA) before and after the 5-year trial. All new symptomatic, radiographically defined fractures were recorded during the follow-up. The length of CAG repeat in exon 1 of AR gene was evaluated after polymerase chain reaction (PCR) amplification. The subjects were divided into three repeat groups according to AR alleles. None of the baseline characteristics were associated with AR gene polymorphism and HRT treatment. The polymorphism did not influence the calculated annual changes of lumbar or femoral neck bone mineral density during the 5-year follow-up in the HRT (p = 0.926 and 0.146, respectively) or non-HRT (p = 0.818 and 0.917, respectively) groups. In all, 28 women sustained 33 fractures during the follow-up. Thus, the numbers of fractures were limited. The AR repeat length variation was not significantly associated with fracture risk in the HRT or non-HRT groups (p = 0.632 and 0.459, respectively; Cox proportional hazards model

  13. Establishing a risk scoring system for predicting erosive esophagitis

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    Hung-Hsu Hung

    2016-09-01

    Conclusion: This simple noninvasive risk scoring system, including factors of age, gender, body mass index, waist circumference, triglyceride, and high-density lipid cholesterol, effectively predicted EE and stratified its incidence.

  14. Evaluating Damage Potential in Security Risk Scoring Models

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    Eli Weintraub

    2016-05-01

    Full Text Available A Continuous Monitoring System (CMS model is presented, having new improved capabilities. The system is based on the actual real-time configuration of the system. Existing risk scoring models assume damage potential is estimated by systems' owner, thus rejecting the information relying in the technological configuration. The assumption underlying this research is based on users' ability to estimate business impacts relating to systems' external interfaces which they use regularly in their business activities, but are unable to assess business impacts relating to internal technological components. According to the proposed model systems' damage potential is calculated using technical information on systems' components using a directed graph. The graph is incorporated into the Common Vulnerability Scoring Systems' (CVSS algorithm to produce risk scoring measures. Framework presentation includes system design, damage potential scoring algorithm design and an illustration of scoring computations.

  15. Prevalence and Risk Factor Analysis of Acute Respiratory tract Infections in Rural areas of Kashmir valley under 5 Years of Age

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    Abid Ali Mir

    2012-07-01

    Full Text Available Research Question: How important is acute respiratory tract infections in children less than 5 years of age and what are the main factors that need attention. Objective: To determine the magnitude of ARI under 5 years of age in rural areas of Kashmir valley. 2 To identify various risk factors responsible for ARI. Methodology: Community based Cross sectional study using multistage sampling procedure was used to study 1644 children. A house to house survey was carried out in the defined geographical region in order to determine the prevalence and risk factors of ARI less than 5 years of age. Results: Among 1644 children under 5 years of age studied, 886 (53.89% were males and 758 (46.11% female. An overall prevalence of 21.41% under 5 years of age was observed in a Kashmir valley. The prevalence of ARI varied according to the age of child being 19.3% in age group of 0–1 years, 23.0% in 1–3 years and 20.4% in age group of 3–5 years. Prevalence of ARI was more (22.5% in male children as compared to female (20.05% children [P>0.05]. The socio demographic variables that showed a significant relationship with ARI prevalence were parental literacy status (OR = 1.806; CI = 1.333 – 2.447; P < 0.05 and more so the Mother’s literacy status (OR = 1.635; CI = 1.284 – 2.083; P < 0.05. ARI risk being high among Malnourished children (OR = 2.38; CI = 1.804 – 3.157; P<0.05, inappropriately immunized children (OR=2.41; CI = 1.853 – 3.154, P<0.05, children lacking exclusive Breast feeding (OR = 4.854; CI = 3.735 – 6.309; P< 0.05 or put on early or delayed weaning (OR = 1.66; CI = 1.302 – 2.140; P < 0.05. Environmental / housing variables also showed significant association with ARI with risk being high in children living in poor ventilation (OR = 4.865; CI = 3.78 – 6.259; P < 0.05, overcrowded houses (OR = 1.829; CI = 1.442 – 2.320; P < 0.05, houses with kitchen not separate (OR = 1.829, CI = 1.442 – 5.481, P < 0.05, and using cooking fuel

  16. Similar risk reduction of death of extended-release metoprolol once daily and immediate-release metoprolol twice daily during 5 years after myocardial infarction.

    Science.gov (United States)

    Herlitz, J; Dellborg, M; Karlson, B W; Lindqvist, J; Sandèn, W; Svensson, H; Sjölin, M; Wedel, H

    1999-04-01

    The pooled results from five placebo-controlled postinfarction studies with metoprolol have shown a significant reduction in total mortality. All five studies used immediate-release metoprolol twice daily. An extended-release formulation of metoprolol for once-daily use has since been developed. The aim of the present study was to compare the two different forms of metoprolol with regard to the risk reduction of death for 5 years postinfarction and to analyze whether treatment with the beta-blocker metoprolol is associated with a reduced mortality after the introduction of modern therapies such as thrombolysis, aspirin, and ACE inhibitors. All patients discharged after an acute myocardial infarction (AMI) from Sahlgrenska University Hospital (SU) during 1986-1987 (n = 740, Period I) and during 1990-1991 (n = 1446, Period II) from both SU and Ostra Hospital, Göteborg, Sweden, were included in the study. During Period I, 56% were prescribed immediate-release metoprolol compared with 61% prescribed extended-release metoprolol during Period II. Immediate-release metoprolol was not available for outpatient use during Period II. In a multivariate analysis, all variables significantly associated with either increased or decreased postinfarction mortality during Periods I and II (univariate analysis of patient characteristics, medical history, complications during the AMI medication at discharge) studied were with Cox's proportional hazards model. Treatment with immediate-release metoprolol was significantly associated with reduced mortality over 5 years during Period I (relative risk reduction for total mortality, -34%, P = 0.003; 95% CI for RR, 0.51-0.87), and treatment with extended-release metoprolol was significantly associated with reduced mortality during Period II (-34%, P metoprolol given once daily was associated with a similar risk reduction of death over 5 years as immediate-release metoprolol given twice daily. The data, furthermore, indicate that the beta

  17. Polygenic risk scores for schizophrenia and bipolar disorder predict creativity.

    OpenAIRE

    Power, Robert A.; Steinberg, Stacy; Bjornsdottir, Gyda; Rietveld, Cornelius A.; Abdellaoui, Abdel; Nivard, Michel M; Johannesson, Magnus; Galesloot, Tessel E.; Hottenga, Jouke J.; Willemsen, Gonneke; Cesarini, David; Benjamin, Daniel J.; Magnusson, Patrik K. E.; Ullén, Fredrik; Tiemeier, Henning

    2015-01-01

    To access publisher's full text version of this article click on the hyperlink at the bottom of the page We tested whether polygenic risk scores for schizophrenia and bipolar disorder would predict creativity. Higher scores were associated with artistic society membership or creative profession in both Icelandic (P = 5.2 × 10(-6) and 3.8 × 10(-6) for schizophrenia and bipolar disorder scores, respectively) and replication cohorts (P = 0.0021 and 0.00086). This could not be accounted for by...

  18. Polygenic risk scores for schizophrenia and bipolar disorder predict creativity.

    Science.gov (United States)

    Power, Robert A; Steinberg, Stacy; Bjornsdottir, Gyda; Rietveld, Cornelius A; Abdellaoui, Abdel; Nivard, Michel M; Johannesson, Magnus; Galesloot, Tessel E; Hottenga, Jouke J; Willemsen, Gonneke; Cesarini, David; Benjamin, Daniel J; Magnusson, Patrik K E; Ullén, Fredrik; Tiemeier, Henning; Hofman, Albert; van Rooij, Frank J A; Walters, G Bragi; Sigurdsson, Engilbert; Thorgeirsson, Thorgeir E; Ingason, Andres; Helgason, Agnar; Kong, Augustine; Kiemeney, Lambertus A; Koellinger, Philipp; Boomsma, Dorret I; Gudbjartsson, Daniel; Stefansson, Hreinn; Stefansson, Kari

    2015-07-01

    We tested whether polygenic risk scores for schizophrenia and bipolar disorder would predict creativity. Higher scores were associated with artistic society membership or creative profession in both Icelandic (P = 5.2 × 10(-6) and 3.8 × 10(-6) for schizophrenia and bipolar disorder scores, respectively) and replication cohorts (P = 0.0021 and 0.00086). This could not be accounted for by increased relatedness between creative individuals and those with psychoses, indicating that creativity and psychosis share genetic roots.

  19. Predicting stroke through genetic risk functions the CHARGE risk score project

    NARCIS (Netherlands)

    C.A. Ibrahim-Verbaas (Carla); M. Fornage (Myriam); J.C. Bis (Joshua); S.-H. Choi (Seung-Hoan); B.M. Psaty (Bruce); J.B. Meigs (James); M. Rao (Madhu); M.A. Nalls (Michael); M. Fontes (Michel); C.J. O'Donnell (Christopher); S. Kathiresan (Sekar); G.B. Ehret (Georg); C.S. Fox (Caroline); R. Malik (Rainer); C. Kubisch (Christian); R. Schmidt (Reinhold); J. Lahti (Jari); S.R. Heckbert (Susan); T. Lumley (Thomas); K.M. Rice (Kenneth); J.I. Rotter (Jerome); K.D. Taylor (Kent); A.R. Folsom (Aaron); E.A. Boerwinkle (Eric); W.D. Rosamond (Wayne); E. Shahar (Eyal); R.F. Gottesman (Rebecca); P.J. Koudstaal (Peter Jan); N. Amin (Najaf); R.G. Wieberdink (Renske); A. Dehghan (Abbas); A. Hofman (Albert); A.G. Uitterlinden (André); A.L. DeStefano (Anita); S. Debette (Stéphanie); L. Xue (Luting); A. Beiser (Alexa); P.A. Wolf (Philip); C. DeCarli (Charles); M.A. Ikram (Arfan); S. Seshadri (Sudha); T.H. Mosley (Thomas); W.T. Longstreth Jr; C.M. van Duijn (Cock); L.J. Launer (Lenore)

    2014-01-01

    textabstractBackground and Purpose - Beyond the Framingham Stroke Risk Score, prediction of future stroke may improve with a genetic risk score (GRS) based on single-nucleotide polymorphisms associated with stroke and its risk factors. Methods - The study includes 4 population-based cohorts with 204

  20. A Soft Intelligent Risk Evaluation Model for Credit Scoring Classification

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    Mehdi Khashei

    2015-09-01

    Full Text Available Risk management is one of the most important branches of business and finance. Classification models are the most popular and widely used analytical group of data mining approaches that can greatly help financial decision makers and managers to tackle credit risk problems. However, the literature clearly indicates that, despite proposing numerous classification models, credit scoring is often a difficult task. On the other hand, there is no universal credit-scoring model in the literature that can be accurately and explanatorily used in all circumstances. Therefore, the research for improving the efficiency of credit-scoring models has never stopped. In this paper, a hybrid soft intelligent classification model is proposed for credit-scoring problems. In the proposed model, the unique advantages of the soft computing techniques are used in order to modify the performance of the traditional artificial neural networks in credit scoring. Empirical results of Australian credit card data classifications indicate that the proposed hybrid model outperforms its components, and also other classification models presented for credit scoring. Therefore, the proposed model can be considered as an appropriate alternative tool for binary decision making in business and finance, especially in high uncertainty conditions.

  1. Framingham risk score and alternatives for prediction of coronary heart disease in older adults.

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    Nicolas Rodondi

    Full Text Available BACKGROUND: Guidelines for the prevention of coronary heart disease (CHD recommend use of Framingham-based risk scores that were developed in white middle-aged populations. It remains unclear whether and how CHD risk prediction might be improved among older adults. We aimed to compare the prognostic performance of the Framingham risk score (FRS, directly and after recalibration, with refit functions derived from the present cohort, as well as to assess the utility of adding other routinely available risk parameters to FRS. METHODS: Among 2193 black and white older adults (mean age, 73.5 years without pre-existing cardiovascular disease from the Health ABC cohort, we examined adjudicated CHD events, defined as incident myocardial infarction, CHD death, and hospitalization for angina or coronary revascularization. RESULTS: During 8-year follow-up, 351 participants experienced CHD events. The FRS poorly discriminated between persons who experienced CHD events vs. not (C-index: 0.577 in women; 0.583 in men and underestimated absolute risk prediction by 51% in women and 8% in men. Recalibration of the FRS improved absolute risk prediction, particulary for women. For both genders, refitting these functions substantially improved absolute risk prediction, with similar discrimination to the FRS. Results did not differ between whites and blacks. The addition of lifestyle variables, waist circumference and creatinine did not improve risk prediction beyond risk factors of the FRS. CONCLUSIONS: The FRS underestimates CHD risk in older adults, particularly in women, although traditional risk factors remain the best predictors of CHD. Re-estimated risk functions using these factors improve accurate estimation of absolute risk.

  2. A new scoring system to stratify risk in unstable angina

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    Salzberg Simón

    2003-08-01

    Full Text Available Abstract Background We performed this study to develop a new scoring system to stratify different levels of risk in patients admitted to hospital with a diagnosis of unstable angina (UA, which is a complex syndrome that encompasses different outcomes. Many prognostic variables have been described but few efforts have been made to group them in order to enhance their individual predictive power. Methods In a first phase, 473 patients were prospectively analyzed to determine which factors were significantly associated with the in-hospital occurrence of refractory ischemia, acute myocardial infarction (AMI or death. A risk score ranging from 0 to 10 points was developed using a multivariate analysis. In a second phase, such score was validated in a new sample of 242 patients and it was finally applied to the entire population (n = 715. Results ST-segment deviation on the electrocardiogram, age ≥ 70 years, previous bypass surgery and troponin T ≥ 0.1 ng/mL were found as independent prognostic variables. A clear distinction was shown among categories of low, intermediate and high risk, defined according to the risk score. The incidence of the triple end-point was 6 %, 19.2 % and 44.7 % respectively, and the figures for AMI or death were 2 %, 11.4 % and 27.6 % respectively (p Conclusions This new scoring system is simple and easy to achieve. It allows a very good stratification of risk in patients having a clinical diagnosis of UA. They may be divided in three categories, which could be of help in the decision-making process.

  3. Risk Factors for Long-Term Mortality after Hospitalization for Community-Acquired Pneumonia: A 5-Year Prospective Follow-Up Study.

    Directory of Open Access Journals (Sweden)

    Jan C Holter

    Full Text Available Contributors to long-term mortality in patients with community-acquired pneumonia (CAP remain unclear, with little attention paid to pneumonia etiology. We examined long-term survival, causes of death, and risk factors for long-term mortality in adult patients who had been hospitalized for CAP, with emphasis on demographic, clinical, laboratory, and microbiological characteristics.Two hundred and sixty-seven consecutive patients admitted in 2008-2011 to a general hospital with CAP were prospectively recruited and followed up. Patients who died during hospital stay were excluded. Demographic, clinical, and laboratory data were collected within 48 hours of admission. Extensive microbiological work-up was performed to establish the etiology of CAP in 63% of patients. Mortality data were obtained from the Norwegian Cause of Death Registry. Cox regression models were used to identify independent risk factors for all-cause mortality.Of 259 hospital survivors of CAP (median age 66 years, 79 (30.5% died over a median of 1,804 days (range 1-2,520 days. Cumulative 5-year survival rate was 72.9% (95% CI 67.4-78.4%. Standardized mortality ratio was 2.90 for men and 2.05 for women. The main causes of death were chronic obstructive pulmonary disease (COPD, vascular diseases, and malignancy. Independent risk factors for death were the following (hazard ratio, 95% CI: age (1.83 per decade, 1.47-2.28, cardiovascular disease (2.63, 1.61-4.32, COPD (2.09, 1.27-3.45, immunocompromization (1.98, 1.17-3.37, and low serum albumin level at admission (0.75 per 5 g/L higher, 0.58-0.96, whereas active smoking was protective (0.32, 0.14-0.74; active smokers were younger than non-smokers (P < 0.001. Microbial etiology did not predict mortality.Results largely confirm substantial comorbidity-related 5-year mortality after hospitalization for CAP and the impact of several well-known risk factors for death, and extend previous findings on the prognostic value of serum albumin

  4. The fracture risk assessment tool (FRAX® score in subclinical hyperthyroidism

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    Polovina Snežana

    2015-01-01

    Full Text Available Background/Aim. The Fracture Risk Assessment Tool (FRAX® score is the 10-year estimated risk calculation tool for bone fracture that includes clinical data and hip bone mineral density measured by dual-energy x-ray absorptiometry (DXA. The aim of this cross-sectional study was to elucidate the ability of the FRAX® score in discriminating between bone fracture positive and negative pre- and post-menopausal women with subclinical hyperthyroidism. Methods. The bone mineral density (by DXA, thyroid stimulating hormone (TSH level, free thyroxine (fT4 level, thyroid peroxidase antibodies (TPOAb titre, osteocalcin and beta-cross-laps were measured in 27 pre- and post-menopausal women with newly discovered subclinical hyperthyroidism [age 58.85 ± 7.83 years, body mass index (BMI 27.89 ± 3.46 kg/m2, menopause onset in 46.88 ± 10.21 years] and 51 matched euthyroid controls (age 59.69 ± 5.72 years, BMI 27.68 ± 4.66 kg/m2, menopause onset in 48.53 ± 4.58 years. The etiology of subclinical hyperthyroisims was autoimmune thyroid disease or toxic goiter. FRAX® score calculation was performed in both groups. Results. In the group with subclinical hyperthyroidism the main FRAX® score was significantly higher than in the controls (6.50 ± 1.58 vs 4.35 ± 1.56 respectively; p = 0.015. The FRAX® score for hip was also higher in the evaluated group than in the controls (1.33 ± 3.92 vs 0.50 ± 0.46 respectively; p = 0.022. There was no correlations between low TSH and fracture risk (p > 0.05. The ability of the FRAX® score in discriminating between bone fracture positive and negative pre- and postmenopausal female subjects (p < 0.001 is presented by the area under the curve (AUC plotted via ROC analysis. The determined FRAX score cut-off value by this analysis was 6%, with estimated sensitivity and specificity of 95% and 75.9%, respectively. Conclusion. Pre- and postmenopausal women with subclinical hyperthyroidism have higher FRAX® scores and thus

  5. Risk factors for death among children less than 5 years old hospitalized with diarrhea in rural western Kenya, 2005-2007: a cohort study.

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    Ciara E O'Reilly

    Full Text Available BACKGROUND: Diarrhea is a leading cause of childhood morbidity and mortality in sub-Saharan Africa. Data on risk factors for mortality are limited. We conducted hospital-based surveillance to characterize the etiology of diarrhea and identify risk factors for death among children hospitalized with diarrhea in rural western Kenya. METHODS AND FINDINGS: We enrolled all children <5 years old, hospitalized with diarrhea (≥3 loose stools in 24 hours at two district hospitals in Nyanza Province, western Kenya. Clinical and demographic information was collected. Stool specimens were tested for bacterial and viral pathogens. Bivariate and multivariable logistic regression analyses were carried out to identify risk factors for death. From May 23, 2005 to May 22, 2007, 1,146 children <5 years old were enrolled; 107 (9% children died during hospitalization. Nontyphoidal Salmonella were identified in 10% (118, Campylobacter in 5% (57, and Shigella in 4% (42 of 1,137 stool samples; rotavirus was detected in 19% (196 of 1,021 stool samples. Among stools from children who died, nontyphoidal Salmonella were detected in 22%, Shigella in 11%, rotavirus in 9%, Campylobacter in 5%, and S. Typhi in <1%. In multivariable analysis, infants who died were more likely to have nontyphoidal Salmonella (adjusted odds ratio [aOR] = 6·8; 95% CI 3·1-14·9, and children <5 years to have Shigella (aOR = 5·5; 95% CI 2·2-14·0 identified than children who survived. Children who died were less likely to be infected with rotavirus (OR = 0·4; 95% CI 0·2-0·8. Further risk factors for death included being malnourished (aOR = 4·2; 95% CI 2·1-8·7; having oral thrush on physical exam (aOR = 2·3; 95% CI 1·4-3·8; having previously sought care at a hospital for the illness (aOR = 2·2; 95% CI 1·2-3·8; and being dehydrated as diagnosed at discharge/death (aOR = 2·5; 95% CI 1·5-4·1. A clinical diagnosis of malaria, and malaria parasites seen on

  6. Risk assessment and risk scores in the management of aortic aneurysms.

    Science.gov (United States)

    Von Meijenfeldt, Gerdine C I; Van Der Laan, Maarten J; Zeebregts, Clark J; Balm, Ron; Verhagen, Hence J M

    2016-04-01

    The decision whether to operate a patient or not can be challenging for a clinician for both ruptured abdominal aortic aneurysms (AAAs) as well as elective AAAs. Prior to surgical intervention it would be preferable that the clinician exactly knows which clinical variables lower or increase the chances of morbidity and mortality postintervention. To help in the preoperative counselling and shared decision making several clinical variables can be identified as risk factors and with these, risk models can be developed. An ideal risk score for aneurysm repair includes routinely obtained physiological and anatomical variables, has excellent discrimination and calibration, and is validated in different geographical areas. For elective AAA repair, several risk scores are available, for ruptured AAA treatment, these scores are far less well developed. In this manuscript, we describe the designs and results of published risk scores for elective and open repair. Also, suggestions for uniformly reporting of risk factors and their statistical analyses are described. Furthermore, the preliminary results of a new risk model for ruptured aortic aneurysm will be discussed. This score identifies age, hemoglobin, cardiopulmonary resuscitation and preoperative systolic blood pressure as risk factors after multivariate regression analysis. This new risk score can help to identify patients that would not benefit from repair, but it can also potentially identify patients who would benefit and therefore lower turndown rates. The challenge for further research is to expand on validation of already existing promising risk scores in order to come to a risk model with optimal discrimination and calibration.

  7. Predicting Reoffending Using the Structured Assessment of Violence Risk in Youth (SAVRY): A 5-Year Follow-Up Study of Male Juvenile Offenders in Hunan Province, China

    Science.gov (United States)

    Zhou, Jiansong; Witt, Katrina; Cao, Xia; Chen, Chen; Wang, Xiaoping

    2017-01-01

    Background Juvenile violent offending is a serious worldwide public health issue. Objective The study examined whether the Structured Assessment of Violence Risk in Youth (SAVRY) can be used to predict violent reoffending in Chinese male juvenile offenders, and to determine which risk/protective domains (items) are associated with violent recidivism. Methods A total of 246 male juvenile offenders were recruited. SAVRY domains were scored by trained raters based on file review and interviews with participants and their legal guardians. Information on further arrests, charges, or convictions for violent offences were collected from police records over a five year follow-up. Results Over the course of the five year follow-up periods, 63 (25.6%) juvenile offenders were re-arrested for a further violent reoffence. Receiver Operating Characteristic (ROC) analyses showed Areas Under the Curve (AUCs) ranging from 0.60 to 0.68 for the SAVRY total, risk and protective score domains. Univariate logistic regression analysis showed that 7 of the 30 SAVRY items were significantly associated with reoffending; explaining 36.2% of the variance. Backward stepwise multiple logistic regression analysis showed the independently predictive items were items 2 (‘history of non-violent offending’), 17 (‘negative attitudes’), 18 (‘risk-taking/impulsivity’), and 20 (‘anger management problems’). Together these four items explained 25.0% of the variance in reoffending. Conclusions The results suggested that the SAVRY can be meaningfully used to inform the development and evaluation of effective violence risk assessment and management approaches for male juvenile offenders detained in a Youth Detention Center in Hunan province, China. PMID:28076443

  8. Risk for high depressive symptoms in diagnosed and previously undetected diabetes: 5-year follow-up results of the Heinz Nixdorf Recall study.

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    Andrea Icks

    Full Text Available OBJECTIVE: The objective of this study was to determine the risk for the development of high depressive symptoms in study participants with diagnosed and previously undetected diabetes mellitus compared to those without diabetes in a prospective population-based cohort study in Germany. METHODS: We estimated the 5-year cumulative incidence of high depressive symptoms in participants without high depressive symptoms at baseline (n = 3,633, 51.4% men, mean age (SD 59.1 (7.6 years, 7.0% diagnosed diabetes, 5.3% previously undetected diabetes from the population-based Heinz Nixdorf Recall study. Diabetes was assessed by self-report, medication, and blood glucose. High depressive symptoms were assessed using CES-D. We calculated odds ratios and their corresponding 95% confidence interval, using multiple logistic regression analyses. RESULT: Cumulative 5-year incidences (95% CI of high depressive symptoms in participants with diagnosed, undetected, and without diabetes were 7.1 (4.2-10.9, 4.1 (1.8-8.0, and 6.5 (5.6-7.4, respectively. The age-sex-adjusted OR for developing high depressive symptoms was 1.22 (0.74-2.03 in participants with diagnosed compared to those without diabetes, and 1.00 (0.59-1.68 after adjustment for BMI, physical activity, education, stroke, and myocardial infarction. The age-sex adjusted OR for developing high depressive symptoms in participants with previously undetected diabetes compared to those without diabetes was 0.72; 0.35-1.48; and fully adjusted 0.62; 0.30-1.30. CONCLUSION: We found no significant associations, maybe due to low power. However, our results are in line with a recent meta-analysis suggesting that risk of developing high depressive symptoms in patients with diagnosed diabetes may be moderately higher than in those without diabetes, and that comorbidity may explain in part this association. In participants with previously undetected diabetes, this first longitudinal study indicates that the risk is not

  9. Risk for High Depressive Symptoms in Diagnosed and Previously Undetected Diabetes: 5-Year Follow-Up Results of the Heinz Nixdorf Recall Study

    Science.gov (United States)

    Icks, Andrea; Albers, Bernd; Haastert, Burkhard; Pechlivanis, Sonali; Pundt, Noreen; Slomiany, Uta; Erbel, Raimund; Jöckel, Karl-Heinz; Kruse, Johannes; Kulzer, Bernd; Nowotny, Bettina; Herder, Christian; Giani, Guido; Moebus, Susanne

    2013-01-01

    Objective The objective of this study was to determine the risk for the development of high depressive symptoms in study participants with diagnosed and previously undetected diabetes mellitus compared to those without diabetes in a prospective population-based cohort study in Germany. Methods We estimated the 5-year cumulative incidence of high depressive symptoms in participants without high depressive symptoms at baseline (n = 3,633, 51.4% men, mean age (SD) 59.1 (7.6) years, 7.0% diagnosed diabetes, 5.3% previously undetected diabetes) from the population-based Heinz Nixdorf Recall study. Diabetes was assessed by self-report, medication, and blood glucose. High depressive symptoms were assessed using CES-D. We calculated odds ratios and their corresponding 95% confidence interval, using multiple logistic regression analyses. Result Cumulative 5-year incidences (95% CI) of high depressive symptoms in participants with diagnosed, undetected, and without diabetes were 7.1 (4.2–10.9), 4.1 (1.8–8.0), and 6.5 (5.6–7.4), respectively. The age-sex-adjusted OR for developing high depressive symptoms was 1.22 (0.74–2.03) in participants with diagnosed compared to those without diabetes, and 1.00 (0.59–1.68) after adjustment for BMI, physical activity, education, stroke, and myocardial infarction. The age-sex adjusted OR for developing high depressive symptoms in participants with previously undetected diabetes compared to those without diabetes was 0.72; 0.35–1.48; and fully adjusted 0.62; 0.30–1.30. Conclusion We found no significant associations, maybe due to low power. However, our results are in line with a recent meta-analysis suggesting that risk of developing high depressive symptoms in patients with diagnosed diabetes may be moderately higher than in those without diabetes, and that comorbidity may explain in part this association. In participants with previously undetected diabetes, this first longitudinal study indicates that the risk is not

  10. Framingham risk score with cardiovascular events in chronic kidney disease.

    Directory of Open Access Journals (Sweden)

    Szu-Chia Chen

    Full Text Available The Framingham Risk Score (FRS was developed to predict coronary heart disease in various populations, and it tended to under-estimate the risk in chronic kidney disease (CKD patients. Our objectives were to determine whether FRS was associated with cardiovascular events, and to evaluate the role of new risk markers and echocardiographic parameters when they were added to a FRS model. This study enrolled 439 CKD patients. The FRS is used to identify individuals categorically as "low" (4.7 cm, left ventricular hypertrophy or left ventricular ejection fraction<50% to the FRS model significantly improves the predictive values for cardiovascular events. In CKD patients, "high" risk categorized by FRS predicts cardiovascular events. Novel biomarkers and echocardiographic parameters provide additional predictive values for cardiovascular events. Future study is needed to assess whether risk assessment enhanced by using these biomarkers and echocardiographic parameters might contribute to more effective prediction and better care for patients.

  11. The relationship between Elder Risk Assessment (ERA scores and cardiac revascularization: a cohort study in Olmsted County, Minnesota, USA

    Directory of Open Access Journals (Sweden)

    Sharma S

    2013-09-01

    Full Text Available Saurabh Sharma,1 Shruti Datta,1 Shahyar Gharacholou,1,2 Shahzad K Siddique,3 Stephen S Cha,4 Paul Y Takahashi1,5,6 1Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA; 2Division of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA; 3Shifa International Hospital, Islamabad, Pakistan; 4Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA; 5Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, MN, USA; 6Kogod Center of Aging, Mayo Clinic, Rochester, MN, USA Purpose: The aging population is predisposed to cardiovascular disease. Our goal was to determine the relationship between a higher Elder Risk Assessment (ERA score and coronary artery bypass graft (CABG or percutaneous coronary intervention (PCI, in adults over 60 years. Methods: This was a retrospective cohort study in a primary care internal medicine practice. Patients included community-dwelling individuals aged 60 years or older on January 1, 2005. The primary outcome was a combined outcome of CABG and PCI in 2 years. The secondary outcome was mortality 5 years after CABG or PCI. The primary predictor variable was the score on the ERA Index, an instrument that predicts emergency room visits and hospitalization. The outcomes were obtained using administrative data from electronic medical records. The analysis included logistic regression, with odds ratios for the primary outcome and time-to-event analysis for mortality. Results: The records of 12,650 patients were studied. A total of 902 patients (7.1% had either CABG or PCI, with an average age of 74.5 years (±8.3 years. There were 205 patients (23% who experienced CABG or PCI in the highest-score group (top 10% compared with 29 patients (3% in the lowest score group, for an odds ratio of 15.4; 95% confidence interval, 10.1–23.5. There was a greater association of revascularization events by increasing score group. We noted increased mortality by increasing ERA score, in patients

  12. Relationship between framingham risk score and coronary artery calcium score in asymptomatic Korean individuals

    Energy Technology Data Exchange (ETDEWEB)

    Heo, So Young; Park, Noh Hyuck; Park, Chan Sub; Seong, Su Ok [Dept. of Radiology, Myongji Hospital, Seonam University College of Medicine, Goyang (Korea, Republic of)

    2016-02-15

    We explored the association between Framingham risk score (FRS) and coronary artery calcium score (CACS) in asymptomatic Korean individuals. We retrospectively analyzed 2216 participants who underwent routine health screening and CACS using the 64-slice multidetector computed tomography between January 2010 and June 2014. Relationship between CACS and FRS, and factors associated with discrepancy between CACS and FRS were analyzed. CACS and FRS were positively correlated (p < 0.0001). However, in 3.7% of participants with low coronary event risk and high CACS, age, male gender, smoker, hypertension, total cholesterol, diabetes mellitus, and body mass index (BMI; ≥ 35) were associated with the discrepancy. In the diagnostic prediction model for discrepancy, the receiver operating characteristic curve including factors associated with FRS, diastolic blood pressure (≥ 75 mm Hg), diabetes mellitus, and BMI (≥ 35) showed that the area under the curve was 0.854 (95% confidence interval, 0.819–0.890), indicating good sensitivity. Diabetes mellitus or obesity (BMI ≥ 35) compensate for the weakness of FRS and may be potential indicators for application of CACS in asymptomatic Koreans with low coronary event risk.

  13. A risk scoring system for prediction of haemorrhagic stroke.

    Science.gov (United States)

    Zodpey, S P; Tiwari, R R

    2005-01-01

    The present pair-matched case control study was carried out at Government Medical College Hospital, Nagpur, India, a tertiary care hospital with the objective to devise and validate a risk scoring system for prediction of hemorrhagic stroke. The study consisted of 166 hospitalized CT scan proved cases of hemorrhagic stroke (ICD 9, 431-432), and a age and sex matched control per case. The controls were selected from patients who attended the study hospital for conditions other than stroke. On conditional multiple logistic regression five risk factors- hypertension (OR = 1.9. 95% Cl = 1.5-2.5). raised scrum total cholesterol (OR = 2.3, 95% Cl = 1.1-4.9). use of anticoagulants and antiplatelet agents (OR = 3.4, 95% Cl =1.1-10.4). past history of transient ischaemic attack (OR = 8.4, 95% Cl = 2.1- 33.6) and alcohol intake (OR = 2.1, 95% Cl = 1.3-3.6) were significant. These factors were ascribed statistical weights (based on regression coefficients) of 6, 8, 12, 21 and 8 respectively. The nonsignificant factors (diabetes mellitus, physical inactivity, obesity, smoking, type A personality, history of claudication, family history of stroke, history of cardiac diseases and oral contraceptive use in females) were not included in the development of scoring system. ROC curve suggested a total score of 21 to be the best cut-off for predicting haemorrhag stroke. At this cut-off the sensitivity, specificity, positive predictivity and Cohen's kappa were 0.74, 0.74, 0.74 and 0.48 respectively. The overall predictive accuracy of this additive risk scoring system (area under ROC curve by Wilcoxon statistic) was 0.79 (95% Cl = 0.73-0.84). Thus to conclude, if substantiated by further validation, this scorincy system can be used to predict haemorrhagic stroke, thereby helping to devise effective risk factor intervention strategy.

  14. Scope Complexity Options Risks Excursions (SCORE) Factor Mathematical Description.

    Energy Technology Data Exchange (ETDEWEB)

    Gearhart, Jared Lee [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Samberson, Jonell Nicole [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Shettigar, Subhasini [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Jungels, John [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Welch, Kimberly M. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Jones, Dean A. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States)

    2017-03-01

    The purpose of the Scope, Complexity, Options, Risks, Excursions (SCORE) model is to estimate the relative complexity of design variants of future warhead options, resulting in scores. SCORE factors extend this capability by providing estimates of complexity relative to a base system (i.e., all design options are normalized to one weapon system). First, a clearly defined set of scope elements for a warhead option is established. The complexity of each scope element is estimated by Subject Matter Experts (SMEs), including a level of uncertainty, relative to a specific reference system. When determining factors, complexity estimates for a scope element can be directly tied to the base system or chained together via comparable scope elements in a string of reference systems that ends with the base system. The SCORE analysis process is a growing multi-organizational Nuclear Security Enterprise (NSE) effort, under the management of the NA-12 led Enterprise Modeling and Analysis Consortium (EMAC). Historically, it has provided the data elicitation, integration, and computation needed to support the out-year Life Extension Program (LEP) cost estimates included in the Stockpile Stewardship Management Plan (SSMP).

  15. Modeling Linkage Disequilibrium Increases Accuracy of Polygenic Risk Scores

    Science.gov (United States)

    Vilhjálmsson, Bjarni J.; Yang, Jian; Finucane, Hilary K.; Gusev, Alexander; Lindström, Sara; Ripke, Stephan; Genovese, Giulio; Loh, Po-Ru; Bhatia, Gaurav; Do, Ron; Hayeck, Tristan; Won, Hong-Hee; Ripke, Stephan; Neale, Benjamin M.; Corvin, Aiden; Walters, James T.R.; Farh, Kai-How; Holmans, Peter A.; Lee, Phil; Bulik-Sullivan, Brendan; Collier, David A.; Huang, Hailiang; Pers, Tune H.; Agartz, Ingrid; Agerbo, Esben; Albus, Margot; Alexander, Madeline; Amin, Farooq; Bacanu, Silviu A.; Begemann, Martin; Belliveau, Richard A.; Bene, Judit; Bergen, Sarah E.; Bevilacqua, Elizabeth; Bigdeli, Tim B.; Black, Donald W.; Bruggeman, Richard; Buccola, Nancy G.; Buckner, Randy L.; Byerley, William; Cahn, Wiepke; Cai, Guiqing; Campion, Dominique; Cantor, Rita M.; Carr, Vaughan J.; Carrera, Noa; Catts, Stanley V.; Chambert, Kimberly D.; Chan, Raymond C.K.; Chen, Ronald Y.L.; Chen, Eric Y.H.; Cheng, Wei; Cheung, Eric F.C.; Chong, Siow Ann; Cloninger, C. Robert; Cohen, David; Cohen, Nadine; Cormican, Paul; Craddock, Nick; Crowley, James J.; Curtis, David; Davidson, Michael; Davis, Kenneth L.; Degenhardt, Franziska; Del Favero, Jurgen; DeLisi, Lynn E.; Demontis, Ditte; Dikeos, Dimitris; Dinan, Timothy; Djurovic, Srdjan; Donohoe, Gary; Drapeau, Elodie; Duan, Jubao; Dudbridge, Frank; Durmishi, Naser; Eichhammer, Peter; Eriksson, Johan; Escott-Price, Valentina; Essioux, Laurent; Fanous, Ayman H.; Farrell, Martilias S.; Frank, Josef; Franke, Lude; Freedman, Robert; Freimer, Nelson B.; Friedl, Marion; Friedman, Joseph I.; Fromer, Menachem; Genovese, Giulio; Georgieva, Lyudmila; Gershon, Elliot S.; Giegling, Ina; Giusti-Rodrguez, Paola; Godard, Stephanie; Goldstein, Jacqueline I.; Golimbet, Vera; Gopal, Srihari; Gratten, Jacob; Grove, Jakob; de Haan, Lieuwe; Hammer, Christian; Hamshere, Marian L.; Hansen, Mark; Hansen, Thomas; Haroutunian, Vahram; Hartmann, Annette M.; Henskens, Frans A.; Herms, Stefan; Hirschhorn, Joel N.; Hoffmann, Per; Hofman, Andrea; Hollegaard, Mads V.; Hougaard, David M.; Ikeda, Masashi; Joa, Inge; Julia, Antonio; Kahn, Rene S.; Kalaydjieva, Luba; Karachanak-Yankova, Sena; Karjalainen, Juha; Kavanagh, David; Keller, Matthew C.; Kelly, Brian J.; Kennedy, James L.; Khrunin, Andrey; Kim, Yunjung; Klovins, Janis; Knowles, James A.; Konte, Bettina; Kucinskas, Vaidutis; Kucinskiene, Zita Ausrele; Kuzelova-Ptackova, Hana; Kahler, Anna K.; Laurent, Claudine; Keong, Jimmy Lee Chee; Lee, S. Hong; Legge, Sophie E.; Lerer, Bernard; Li, Miaoxin; Li, Tao; Liang, Kung-Yee; Lieberman, Jeffrey; Limborska, Svetlana; Loughland, Carmel M.; Lubinski, Jan; Lnnqvist, Jouko; Macek, Milan; Magnusson, Patrik K.E.; Maher, Brion S.; Maier, Wolfgang; Mallet, Jacques; Marsal, Sara; Mattheisen, Manuel; Mattingsdal, Morten; McCarley, Robert W.; McDonald, Colm; McIntosh, Andrew M.; Meier, Sandra; Meijer, Carin J.; Melegh, Bela; Melle, Ingrid; Mesholam-Gately, Raquelle I.; Metspalu, Andres; Michie, Patricia T.; Milani, Lili; Milanova, Vihra; Mokrab, Younes; Morris, Derek W.; Mors, Ole; Mortensen, Preben B.; Murphy, Kieran C.; Murray, Robin M.; Myin-Germeys, Inez; Mller-Myhsok, Bertram; Nelis, Mari; Nenadic, Igor; Nertney, Deborah A.; Nestadt, Gerald; Nicodemus, Kristin K.; Nikitina-Zake, Liene; Nisenbaum, Laura; Nordin, Annelie; O’Callaghan, Eadbhard; O’Dushlaine, Colm; O’Neill, F. Anthony; Oh, Sang-Yun; Olincy, Ann; Olsen, Line; Van Os, Jim; Pantelis, Christos; Papadimitriou, George N.; Papiol, Sergi; Parkhomenko, Elena; Pato, Michele T.; Paunio, Tiina; Pejovic-Milovancevic, Milica; Perkins, Diana O.; Pietilinen, Olli; Pimm, Jonathan; Pocklington, Andrew J.; Powell, John; Price, Alkes; Pulver, Ann E.; Purcell, Shaun M.; Quested, Digby; Rasmussen, Henrik B.; Reichenberg, Abraham; Reimers, Mark A.; Richards, Alexander L.; Roffman, Joshua L.; Roussos, Panos; Ruderfer, Douglas M.; Salomaa, Veikko; Sanders, Alan R.; Schall, Ulrich; Schubert, Christian R.; Schulze, Thomas G.; Schwab, Sibylle G.; Scolnick, Edward M.; Scott, Rodney J.; Seidman, Larry J.; Shi, Jianxin; Sigurdsson, Engilbert; Silagadze, Teimuraz; Silverman, Jeremy M.; Sim, Kang; Slominsky, Petr; Smoller, Jordan W.; So, Hon-Cheong; Spencer, Chris C.A.; Stahl, Eli A.; Stefansson, Hreinn; Steinberg, Stacy; Stogmann, Elisabeth; Straub, Richard E.; Strengman, Eric; Strohmaier, Jana; Stroup, T. Scott; Subramaniam, Mythily; Suvisaari, Jaana; Svrakic, Dragan M.; Szatkiewicz, Jin P.; Sderman, Erik; Thirumalai, Srinivas; Toncheva, Draga; Tooney, Paul A.; Tosato, Sarah; Veijola, Juha; Waddington, John; Walsh, Dermot; Wang, Dai; Wang, Qiang; Webb, Bradley T.; Weiser, Mark; Wildenauer, Dieter B.; Williams, Nigel M.; Williams, Stephanie; Witt, Stephanie H.; Wolen, Aaron R.; Wong, Emily H.M.; Wormley, Brandon K.; Wu, Jing Qin; Xi, Hualin Simon; Zai, Clement C.; Zheng, Xuebin; Zimprich, Fritz; Wray, Naomi R.; Stefansson, Kari; Visscher, Peter M.; Adolfsson, Rolf; Andreassen, Ole A.; Blackwood, Douglas H.R.; Bramon, Elvira; Buxbaum, Joseph D.; Børglum, Anders D.; Cichon, Sven; Darvasi, Ariel; Domenici, Enrico; Ehrenreich, Hannelore; Esko, Tonu; Gejman, Pablo V.; Gill, Michael; Gurling, Hugh; Hultman, Christina M.; Iwata, Nakao; Jablensky, Assen V.; Jonsson, Erik G.; Kendler, Kenneth S.; Kirov, George; Knight, Jo; Lencz, Todd; Levinson, Douglas F.; Li, Qingqin S.; Liu, Jianjun; Malhotra, Anil K.; McCarroll, Steven A.; McQuillin, Andrew; Moran, Jennifer L.; Mortensen, Preben B.; Mowry, Bryan J.; Nthen, Markus M.; Ophoff, Roel A.; Owen, Michael J.; Palotie, Aarno; Pato, Carlos N.; Petryshen, Tracey L.; Posthuma, Danielle; Rietschel, Marcella; Riley, Brien P.; Rujescu, Dan; Sham, Pak C.; Sklar, Pamela; St. Clair, David; Weinberger, Daniel R.; Wendland, Jens R.; Werge, Thomas; Daly, Mark J.; Sullivan, Patrick F.; O’Donovan, Michael C.; Kraft, Peter; Hunter, David J.; Adank, Muriel; Ahsan, Habibul; Aittomäki, Kristiina; Baglietto, Laura; Berndt, Sonja; Blomquist, Carl; Canzian, Federico; Chang-Claude, Jenny; Chanock, Stephen J.; Crisponi, Laura; Czene, Kamila; Dahmen, Norbert; Silva, Isabel dos Santos; Easton, Douglas; Eliassen, A. Heather; Figueroa, Jonine; Fletcher, Olivia; Garcia-Closas, Montserrat; Gaudet, Mia M.; Gibson, Lorna; Haiman, Christopher A.; Hall, Per; Hazra, Aditi; Hein, Rebecca; Henderson, Brian E.; Hofman, Albert; Hopper, John L.; Irwanto, Astrid; Johansson, Mattias; Kaaks, Rudolf; Kibriya, Muhammad G.; Lichtner, Peter; Lindström, Sara; Liu, Jianjun; Lund, Eiliv; Makalic, Enes; Meindl, Alfons; Meijers-Heijboer, Hanne; Müller-Myhsok, Bertram; Muranen, Taru A.; Nevanlinna, Heli; Peeters, Petra H.; Peto, Julian; Prentice, Ross L.; Rahman, Nazneen; Sánchez, María José; Schmidt, Daniel F.; Schmutzler, Rita K.; Southey, Melissa C.; Tamimi, Rulla; Travis, Ruth; Turnbull, Clare; Uitterlinden, Andre G.; van der Luijt, Rob B.; Waisfisz, Quinten; Wang, Zhaoming; Whittemore, Alice S.; Yang, Rose; Zheng, Wei; Kathiresan, Sekar; Pato, Michele; Pato, Carlos; Tamimi, Rulla; Stahl, Eli; Zaitlen, Noah; Pasaniuc, Bogdan; Belbin, Gillian; Kenny, Eimear E.; Schierup, Mikkel H.; De Jager, Philip; Patsopoulos, Nikolaos A.; McCarroll, Steve; Daly, Mark; Purcell, Shaun; Chasman, Daniel; Neale, Benjamin; Goddard, Michael; Visscher, Peter M.; Kraft, Peter; Patterson, Nick; Price, Alkes L.

    2015-01-01

    Polygenic risk scores have shown great promise in predicting complex disease risk and will become more accurate as training sample sizes increase. The standard approach for calculating risk scores involves linkage disequilibrium (LD)-based marker pruning and applying a p value threshold to association statistics, but this discards information and can reduce predictive accuracy. We introduce LDpred, a method that infers the posterior mean effect size of each marker by using a prior on effect sizes and LD information from an external reference panel. Theory and simulations show that LDpred outperforms the approach of pruning followed by thresholding, particularly at large sample sizes. Accordingly, predicted R2 increased from 20.1% to 25.3% in a large schizophrenia dataset and from 9.8% to 12.0% in a large multiple sclerosis dataset. A similar relative improvement in accuracy was observed for three additional large disease datasets and for non-European schizophrenia samples. The advantage of LDpred over existing methods will grow as sample sizes increase. PMID:26430803

  16. Integrating genetics and social science: genetic risk scores.

    Science.gov (United States)

    Belsky, Daniel W; Israel, Salomon

    2014-01-01

    The sequencing of the human genome and the advent of low-cost genome-wide assays that generate millions of observations of individual genomes in a matter of hours constitute a disruptive innovation for social science. Many public use social science datasets have or will soon add genome-wide genetic data. With these new data come technical challenges, but also new possibilities. Among these, the lowest-hanging fruit and the most potentially disruptive to existing research programs is the ability to measure previously invisible contours of health and disease risk within populations. In this article, we outline why now is the time for social scientists to bring genetics into their research programs. We discuss how to select genetic variants to study. We explain how the polygenic architecture of complex traits and the low penetrance of individual genetic loci pose challenges to research integrating genetics and social science. We introduce genetic risk scores as a method of addressing these challenges and provide guidance on how genetic risk scores can be constructed. We conclude by outlining research questions that are ripe for social science inquiry.

  17. Healthy lifestyle and normal waist circumference are associated with a lower 5-year risk of type 2 diabetes in middle-aged and elderly individuals: Results from the healthy aging longitudinal study in Taiwan (HALST).

    Science.gov (United States)

    Chen, Chu-Chih; Liu, Kiang; Hsu, Chih-Chen; Chang, Hsing-Yi; Chung, Hsiao-Chun; Liu, Jih-Shin; Liu, Yo-Hann; Tsai, Tsung-Lung; Liaw, Wen-Jin; Lin, I-Ching; Wu, Hsi-Wen; Juan, Chung-Chou; Chiu, Hou-Chang; Lee, Marion M; Hsiung, Chao A

    2017-02-01

    Type 2 diabetes mellitus (DM) is known to be closely associated with lifestyle and obesity and has a prevalence that increases with age. This study aimed to assess the short-term composite effect of diet, physical activity, psychosocial health, and waist circumference (WC) on the incidence of DM in the elderly and to provide a lifestyle-based predictive index.We used baseline measurements (2009-2013) of 5349 community-dwelling participants (aged 55 years and older, 52% female) of the Healthy Aging Longitudinal Study in Taiwan (HALST) for fasting plasma glucose, HbA1C, serum cholesterol, triglycerides, blood pressures, WC, and outcomes of home-visit questionnaire. Principal component analysis (PCA) was used to identify participants with a healthy lifestyle (HLF: higher diet, physical activity, and psychosocial scores) and a lower WC, with cutoffs determined by the receiver-operating characteristics. A Cox regression model was applied to 3424 participants without DM at baseline by linking to their National Health Insurance records (median follow-up of 3.1 years).In total, 247 new DM cases (7.2%) were identified. The HLF and lower WC group had a relative risk (RR) of DM of 0.54 (95% CI 0.35-0.82) compared to the non-HLF and higher WC group. When stratified by the presence of impaired glucose tolerance (IGT) or metabolic syndrome (MS), only participants with IGT/MS showed significant risks (RR 0.55; 95% CI 0.33-0.92). However, except for WC, the individual lifestyle factors were nonsignificant in the overall model without PCA.A composite protective effect of HLF and normal WC on DM within 5 years was observed, especially in those with IGT or MS. Psychosocial health constituted an important lifestyle factor in the elderly. The cutoffs identified could be used as a lifestyle-based risk index for DM. Maintaining an HLF to prevent DM is especially important for the elderly.

  18. Common clinical practice versus new PRIM score in predicting coronary heart disease risk

    DEFF Research Database (Denmark)

    Frikke-Schmidt, Ruth; Tybjærg-Hansen, Anne; Schnohr, Peter;

    2010-01-01

    To compare the new Patient Rule Induction Method (PRIM) Score and common clinical practice with the Framingham Point Score for classification of individuals with respect to coronary heart disease (CHD) risk.......To compare the new Patient Rule Induction Method (PRIM) Score and common clinical practice with the Framingham Point Score for classification of individuals with respect to coronary heart disease (CHD) risk....

  19. Multi-locus genetic risk score predicts risk for Crohn's disease in Slovenian population

    NARCIS (Netherlands)

    Zupančič, Katarina; Skok, Kristijan; Repnik, Katja; Weersma, Rinse K; Potočnik, Uroš; Skok, Pavel

    2016-01-01

    AIM: To develop a risk model for Crohn's disease (CD) based on homogeneous population. METHODS: In our study were included 160 CD patients and 209 healthy individuals from Slovenia. The association study was performed for 112 single nucleotide polymorphisms (SNPs). We generated genetic risk scores (

  20. SCORING ASSESSMENT AND FORECASTING MODELS BANKRUPTCY RISK OF COMPANIES

    Directory of Open Access Journals (Sweden)

    SUSU Stefanita

    2014-07-01

    Full Text Available Bankruptcy risk made the subject of many research studies that aim at identifying the time of the bankruptcy, the factors that compete to achieve this state, the indicators that best express this orientation (the bankruptcy. The threats to enterprises require the managers knowledge of continually economic and financial situations, and vulnerable areas with development potential. Managers need to identify and properly manage the threats that would prevent achieving the targets. In terms of methods known in the literature of assessment and evaluation of bankruptcy risk they are static, functional, strategic, and scoring nonfinancial models. This article addresses Altman and Conan-Holder-known internationally as the model developed at national level by two teachers from prestigious universities in our country-the Robu-Mironiuc model. Those models are applied to data released by the profit and loss account and balance sheet Turism Covasna company over which bankruptcy risk analysis is performed. The results of the analysis are interpreted while trying to formulate solutions to the economic and financial viability of the entity.

  1. Metabolic syndrome and Framingham risk score in obese young adults

    Directory of Open Access Journals (Sweden)

    Felix F. Widjaja

    2013-05-01

    Full Text Available Background: The increase number of the metabolic syndrome (MetS among young adults was mostly caused by obesity. MetS increases the risk of coronary heart disease (CHD which can be estimated by Framingham risk score (FRS. The study was aimed to know the prevalence of MetS and FRS in obese young adults and to associate them with the components of MetS. Methods: A total of 70 male and female students aged 18 to 25 years with BMI ≥ 25 kg/m2 in Faculty of Medicine Universitas Indonesia were selected consecutively. The blood samples used to test fasting blood glucose, total cholesterol, high-density lipoprotein, and triglyceride were examined in Department of Clinical Pathology, Cipto Mangunkusumo Hospital after fasting for 14 to 16 hours. International Diabetes Federation (IDF definition was used to diagnose MetS. Univariate and bivariate analysis were done. Results: The prevalence of MetS based on IDF definition was 18.6% among obese young adults. The most associated MetS components was hypertriglyceridemia (OR 12.13; 95% CI 2.92-50.46; p = 0.001, followed with high blood pressure (OR 9.33; 95% CI 2.26-38.56; p = 0.001, low-HDL (OR 8.33; 95% CI 2.17-32.05; p = 0.003, and impaired fasting glucose (p = 0.03. Four subjects had FRS ≥ 1% and 66 subjects had risk < 1%. Increased FRS was not associated with MetS (p = 0.154. There was no component of MetS associated with increased FRS. Conclusion: Prevalence of MetS in obese young adults was similar with obese children and adolescents. Although no association of MetS and FRS was found, they are significant predictors for CHD which should not be used separately. (Med J Indones. 2013;22:100-6Keywords: Abdominal obesity, Framingham risk score, metabolic syndrome, young adults

  2. Posttraumatic Stress Disorder among Danish Soldiers 2.5 Years after Military Deployment in Afghanistan: The Role of Personality Traits as Predisposing Risk Factors

    Directory of Open Access Journals (Sweden)

    Janne Hellerup Nielsen

    2015-02-01

    Full Text Available Understanding the development of posttraumatic stress disorder (PTSD implicates research regarding factors besides the preceding traumatic event. This study investigated the influence of predisposing personality traits on development of PTSD in a group of Danish Soldiers deployed to Afghanistan (N = 445. Using a prospective design data was collected using questionnaires including the NEO Five Factor Inventory and the Posttraumatic Stress Disorder Checklist. The results showed a PTSD-prevalence of 9.2% in the total sample 2.5 years after homecoming. Using Kruskal-Wallis, Mann-Whitney U, and Spearman¡'s rho significant relationships were identified between pre-existing personality traits of neuroticism and agreeableness with development of PTSD symptoms 2.5 years after homecoming, however, a number of additional cofounders were identified.

  3. SCORE underestimates cardiovascular risk (CVR of HIV+ patients

    Directory of Open Access Journals (Sweden)

    R Ramírez

    2012-11-01

    Full Text Available The new European Guidelines of Dislipidemia Management of the European Societies of Cardiology and Arteriosclerosis consider HIV+ as patients at high risk of developing cardiovascular events and deaths. The objective of the study was to evaluate cardiovascular events and deaths in a series of HIV+ patients. Observational, cross-sectional study, including a cohort of HIV+ and HIV− patients from 2008. CVR was calculated using the SCORE-CVR chart. Variation on lipid profile and incidence of cardiovascular events, cardiovascular death or death related to any cause were recorded. Data was analyzed using SPSS version 20.0 for MAC. 154 HIV+ and 155 HIV− patients were included. Mean age: 44.8±9.5 vs 55.2±14.3 y and 69.5% vs 49% males respectively (p<0.01. Mean time since HIV+ diagnosis was 11±6.2 y. Mean BMI and systolic blood pressure were lower in HIV+ (25.1±6.7 kg/m2 vs 28.7±5.1 kg/m2, (p<0.01 and 119.6±19.4 vs 124.7±14.7 mmHg, (p=0.044; respectively. A lower proportion of hypertense, diabetic and obese patients was observed in HIV+ (25.5% vs 6.5%; 20.6% vs 3.9% and 36.8% vs 12.3% but a larger proportion of smokers (68.8% vs 29.7% was observed (p<0.01 in all cases. Mean cholesterol and LDLc were lower in HIV+ (191.2±41.4 vs 218.5±44.6 mg/dl and 109.5±33.9 vs 134.6±37.7 mg/dl; p<0.01; respectively but with a lower mean HDLc and higher TG (50.3±19 mg/dl vs 55.2±14.9 mg/dl; p=0.013 and 156.7±85.7 vs 135.8±66.2 mg/dl; p=0.017; respectively. There was no significant difference in mean CVR-SCORE (3.5±3.6% vs 4.4±3.8%; p=0.091. With this SCORE, 5.2±5.3 and 6.7±5.8 cardiovascular events or deaths should be expected in HIV+ and HIV− respectively at 10 y. Four years later cholesterol, LDLc, HDLc, TG in HIV+ and HIV− patients did not vary compared with those obtained 4 y before. 5 events and 1 death were seen at 4 y follow-up in HIV+, and in HIV− patients. The incidence of events in HIV+ patients is similar to the expected according

  4. Risk stratification in non-ST elevation acute coronary syndromes: Risk scores, biomarkers and clinical judgment

    Directory of Open Access Journals (Sweden)

    David Corcoran

    2015-09-01

    Clinical guidelines recommend an early invasive strategy in higher risk NSTE-ACS. The Global Registry of Acute Coronary Events (GRACE risk score is a validated risk stratification tool which has incremental prognostic value for risk stratification compared with clinical assessment or troponin testing alone. In emergency medicine, there has been a limited adoption of the GRACE score in some countries (e.g. United Kingdom, in part related to a delay in obtaining timely blood biochemistry results. Age makes an exponential contribution to the GRACE score, and on an individual patient basis, the risk of younger patients with a flow-limiting culprit coronary artery lesion may be underestimated. The future incorporation of novel cardiac biomarkers into this diagnostic pathway may allow for earlier treatment stratification. The cost-effectiveness of the new diagnostic pathways based on high-sensitivity troponin and copeptin must also be established. Finally, diagnostic tests and risk scores may optimize patient care but they cannot replace patient-focused good clinical judgment.

  5. Risk of hypertension in Yozgat Province, Central Anatolia: application of Framingham Hypertension Prediction Risk Score.

    Science.gov (United States)

    Kilic, M; Ede, H; Kilic, A I

    2016-07-10

    The aim of this cross-sectional study was to estimate the risk of hypertension in 1106 Caucasian individuals aged 20-69 years in Yozgat Province, using the Framingham Hypertension Risk Prediction Score (FHRPS). According to FHRPS, average risk of developing hypertension over 4 years was 6.2%. The participants were classified into low- (10%) risk groups. The percentage of participants that fell into these groups was 59.4%, 19.8% and 20.8% respectively. The proportion of participants in the high-risk group was similar to the 4-year incidence of hypertension (21.3%) in the Turkish population. Regression analysis showed that high salt consumption and low educational level significantly increased the risk of hypertension. Economic level, fat consumption, life satisfaction, physical activity, and fruit and vegetable consumption were not correlated with risk of hypertension. This study shows that FHRPS can also be used for predicting risk of hypertension in Central Anatolia.

  6. Individualized Risk of Surgical Complications: An Application of the Breast Reconstruction Risk Assessment Score

    Science.gov (United States)

    Mlodinow, Alexei S.; Khavanin, Nima; Hume, Keith M.; Simmons, Christopher J.; Weiss, Michael J.; Murphy, Robert X.; Gutowski, Karol A.

    2015-01-01

    Background: Risk discussion is a central tenet of the dialogue between surgeon and patient. Risk calculators have recently offered a new way to integrate evidence-based practice into the discussion of individualized patient risk and expectation management. Focusing on the comprehensive Tracking Operations and Outcomes for Plastic Surgeons (TOPS) database, we endeavored to add plastic surgical outcomes to the previously developed Breast Reconstruction Risk Assessment (BRA) score. Methods: The TOPS database from 2008 to 2011 was queried for patients undergoing breast reconstruction. Regression models were constructed for the following complications: seroma, dehiscence, surgical site infection (SSI), explantation, flap failure, reoperation, and overall complications. Results: Of 11,992 cases, 4439 met inclusion criteria. Overall complication rate was 15.9%, with rates of 3.4% for seroma, 4.0% for SSI, 6.1% for dehiscence, 3.7% for explantation, 7.0% for flap loss, and 6.4% for reoperation. Individualized risk models were developed with acceptable goodness of fit, accuracy, and internal validity. Distribution of overall complication risk was broad and asymmetric, meaning that the average risk was often a poor estimate of the risk for any given patient. These models were added to the previously developed open-access version of the risk calculator, available at http://www.BRAscore.org. Conclusions: Population-based measures of risk may not accurately reflect risk for many individual patients. In this era of increasing emphasis on evidence-based medicine, we have developed a breast reconstruction risk assessment calculator from the robust TOPS database. The BRA Score tool can aid in individualizing—and quantifying—risk to better inform surgical decision making and better manage patient expectations. PMID:26090295

  7. Development and validation of a clinical scoring system for predicting risk of HCC in asymptomatic individuals seropositive for anti-HCV antibodies.

    Directory of Open Access Journals (Sweden)

    Mei-Hsuan Lee

    Full Text Available BACKGROUND: The development of a risk assessment tool for long-term hepatocellular carcinoma risk would be helpful in identifying high-risk patients and providing information of clinical consultation. METHODS: The model derivation and validation cohorts consisted of 975 and 572 anti-HCV seropositives, respectively. The model included age, alanine aminotransferase (ALT, the ratio of aspirate aminotransferase to ALT, serum HCV RNA levels and cirrhosis status and HCV genotype. Two risk prediction models were developed: one was for all-anti-HCV seropositives, and the other was for anti-HCV seropositives with detectable HCV RNA. The Cox's proportional hazards models were utilized to estimate regression coefficients of HCC risk predictors to derive risk scores. The cumulative HCC risks in the validation cohort were estimated by Kaplan-Meier methods. The area under receiver operating curve (AUROC was used to evaluate the performance of the risk models. RESULTS: All predictors were significantly associated with HCC. The summary risk scores of two models derived from the derivation cohort had predictability of HCC risk in the validation cohort. The summary risk score of the two risk prediction models clearly divided the validation cohort into three groups (p<0.001. The AUROC for predicting 5-year HCC risk in the validation cohort was satisfactory for the two models, with 0.73 and 0.70, respectively. CONCLUSION: Scoring systems for predicting HCC risk of HCV-infected patients had good validity and discrimination capability, which may triage patients for alternative management strategies.

  8. Comprehensive coronary risk determination in primary prevention: an imaging and clinical based definition combining computed tomographic coronary artery calcium score and national cholesterol education program risk score.

    Science.gov (United States)

    Nasir, Khurram; Vasamreddy, Chandra; Blumenthal, Roger S; Rumberger, John A

    2006-06-16

    Cardiovascular disease (CVD) is the leading cause of mortality and a major cause of morbidity. Coronary heart disease (CHD) accounts for nearly half of all CVD deaths. Currently estimation of risk in primary prevention is based on the Framingham risk equations, which inputs traditional risk factors and is helpful in predicting the development of CHD in asymptomatic individuals. However many individuals suffer events in the absence of established risk factors for atherosclerosis and broad based population risk estimations may have little precision when applied to a given individual. To meet the challenge of CHD risk assessment, several tools have been developed to identify atherosclerotic disease in its preclinical stages. This paper aims to incorporate information from coronary artery calcification (CAC) scoring from a computed tomographic "heartscan" (using Electron Beam Tomography (EBT) as the validated prototype) along with current Framingham risk profiling in order to refine risk on an absolute scale by combining imaging and clinical data to affect a more comprehensive calculation of absolute risk in a given individual. For CAC scores above the 75th percentile but or =55 years, women> or =65 years) a CAC = 0 will result in an age point score corresponding to the age-group whose median CAC score is zero i.e., 40-44 years for men and 55-59 years for women. The utilization of CAC scores allows the inclusion of sub-clinical disease definition into the context of modifiable risk factors as well as identifies high-risk individuals requiring aggressive treatment.

  9. Cell cycle progression score is a marker for five-year lung cancer-specific mortality risk in patients with resected stage I lung adenocarcinoma

    Science.gov (United States)

    Eguchi, Takashi; Kadota, Kyuichi; Chaft, Jamie; Evans, Brent; Kidd, John; Tan, Kay See; Dycoco, Joe; Kolquist, Kathryn; Davis, Thaylon; Hamilton, Stephanie A.; Yager, Kraig; Jones, Joshua T.; Travis, William D.; Jones, David R.; Hartman, Anne-Renee; Adusumilli, Prasad S.

    2016-01-01

    Purpose The goals of our study were (a) to validate a molecular expression signature (cell cycle progression [CCP] score and molecular prognostic score [mPS; combination of CCP and pathological stage {IA or IB}]) that identifies stage I lung adenocarcinoma (ADC) patients with a higher risk of cancer-specific death following curative-intent surgical resection, and (b) to determine whether mPS stratifies prognosis within stage I lung ADC histological subtypes. Methods Formalin-fixed, paraffin-embedded stage I lung ADC tumor samples from 1200 patients were analyzed for 31 proliferation genes by quantitative RT-PCR. Prognostic discrimination of CCP score and mPS was assessed by Cox proportional hazards regression, using 5-year lung cancer–specific mortality as the primary outcome. Results In multivariable analysis, CCP score was a prognostic marker for 5-year lung cancer–specific mortality (HR=1.6 per interquartile range; 95% CI, 1.14–2.24; P=0.006). In a multivariable model that included mPS instead of CCP, mPS was a significant prognostic marker for 5-year lung cancer–specific mortality (HR=1.77; 95% CI, 1.18–2.66; P=0.006). Five-year lung cancer–specific survival differed between low-risk and high-risk mPS groups (96% vs 81%; P<0.001). In patients with intermediate-grade lung ADC of acinar and papillary subtypes, high mPS was associated with worse 5-year lung cancer–specific survival (P<0.001 and 0.015, respectively), compared with low mPS. Conclusion This study validates CCP score and mPS as independent prognostic markers for lung cancer–specific mortality and provides quantitative risk assessment, independent of known high-risk features, for stage I lung ADC patients treated with surgery alone. PMID:27153551

  10. Changes in lifestyle, biological risk factors and total homocysteine in relation to MTHFR C677T genotype: a 5-year follow-up study

    DEFF Research Database (Denmark)

    Linneberg, A; Thuesen, Betina Heinsbæk; Jørgensen, Torben

    2009-01-01

    with changes in several biological risk factors, such as waist circumference, diastolic blood pressure, total cholesterol and LDL cholesterol (Pwaist circumference and MTHFR genotype seemed stronger in TT individuals than in CC/CT individuals (P (interaction)=0.03). CONCLUSIONS......BACKGROUND/OBJECTIVES: Total homocysteine (tHcy) has been associated with increased risk of several diseases in the general population. It is not clear whether these associations are causal. A less healthy lifestyle as well as a less favorable biological risk factor profile have been related...... to increased tHcy in cross-sectional studies. In addition, the methylenetetrahydrofolate reductase (MTHFR) C677T gene variant is an important determinant of elevated tHcy. The main objective of the study was to examine the effect of changes in biological risk factors and lifestyle on tHcy in relation to MTHFR...

  11. Risk scores for diabetes and impaired glycaemia in the Middle East and North Africa

    DEFF Research Database (Denmark)

    Handlos, Line Neerup; Witte, Daniel Rinse; Almdal, Thomas Peter

    2013-01-01

    AIMS: To develop risk scores for diabetes and diabetes or impaired glycaemia for individuals living in the Middle East and North Africa region. In addition, to derive national risk scores for Algeria, Saudi Arabia and the United Arab Emirates and to compare the performance of the regional risk...

  12. Reciprocal influences between maternal parenting and child adjustment in a high-risk population: a 5-year cross-lagged analysis of bidirectional effects.

    Science.gov (United States)

    Barbot, Baptiste; Crossman, Elizabeth; Hunter, Scott R; Grigorenko, Elena L; Luthar, Suniya S

    2014-09-01

    This study examines longitudinally the bidirectional influences between maternal parenting (behaviors and parenting stress) and mothers' perceptions of their children's adjustment, in a multivariate approach. Data was gathered from 361 low-income mothers (many with psychiatric diagnoses) reporting on their parenting behavior, parenting stress, and their child's adjustment, in a 2-wave longitudinal study over 5 years. Measurement models were developed to derive 4 broad parenting constructs (involvement, control, rejection, and stress) and 3 child adjustment constructs (internalizing problems, externalizing problems, and social competence). After measurement invariance of these constructs was confirmed across relevant groups and over time, both measurement models were integrated in a single crossed-lagged regression analysis of latent constructs. Multiple reciprocal influences were observed between parenting and perceived child adjustment over time: Externalizing and internalizing problems in children were predicted by baseline maternal parenting behaviors, and child social competence was found to reduce parental stress and increase parental involvement and appropriate monitoring. These findings on the motherhood experience are discussed in light of recent research efforts to understand mother-child bidirectional influences and their potential for practical applications.

  13. Evaluation of risk for type 2 diabetes mellitus in medical students using Indian diabetes risk score

    Directory of Open Access Journals (Sweden)

    Pranita Ashok

    2011-01-01

    Full Text Available Background: According to World Health Organisation, type 2 diabetes mellitus [type 2 D. M] has recently escalated in all age groups and is now being identified in younger age groups. This underscores the need for mass awareness and screening programs to detect diabetes at an early stage. For this purpose we have used a simplified Indian Diabetes Risk Score (IDRS for prediction of diabetes in undergraduate medical students. Objectives: To screen and to identify 1st MBBS students at risk for developing type 2 D. M using IDRS. Materials and Methods : 261 undergraduates (1st MBBS students were scored using IDRS which includes age, family history of diabetes, exercise status, and waist circumference. After scoring them, we assessed random capillary blood glucose (RCBG in students with high IDRS score. Students with RCBG ≥ 113 mg/dl are followed for definitive tests for diagnosis of prediabetes and diabetes. Results and Conclusion: We have assessed 261 students till now. It was observed that 5%, 55%, and 38% students in High, Moderate, and Low risk group, respectively, for developing type 2 D. M. The mean abdominal obesity in high risk students was 101.95 ± 5.76 as compared to 79.17 ± 11.08 in moderate and low risk students (P 113 mg/dl in which one student found to have prediabetic. Conclusion: This underscores the need for further investigations to detect diabetes at an early stage and to overcome the disease burden of diabetes in future. Prevention of obesity and promotion of physical activity have to be the future plan of action which can be suggested in the form of regular exercise and diet planning for the students as part of an integrated approach.

  14. Editorial: risk scoring for colon cancer screening: validated, but still not ready for prime time.

    Science.gov (United States)

    Lin, Otto S

    2011-06-01

    Risk stratification for colorectal cancer screening would allow us to use less expensive screening tests, such as sigmoidoscopy with or without fecal blood testing, on lower risk individuals, and reserve colonoscopy for those at higher risk. In this issue, Levitzky et al. validates a risk score that was previously developed by Imperiale et al., finding similar results among three ethnic groups. Risk scoring would detect 82-87% of proximal advanced neoplasia while decreasing colonoscopy use by 33-46%. However, before risk scoring is ready for widespread use, sigmoidoscopy access and performance issues need to be addressed, and we must be comfortable with missing some proximal neoplasms.

  15. A risk score to predict type 2 diabetes mellitus in an elderly Spanish Mediterranean population at high cardiovascular risk.

    Directory of Open Access Journals (Sweden)

    Marta Guasch-Ferré

    Full Text Available INTRODUCTION: To develop and test a diabetes risk score to predict incident diabetes in an elderly Spanish Mediterranean population at high cardiovascular risk. MATERIALS AND METHODS: A diabetes risk score was derived from a subset of 1381 nondiabetic individuals from three centres of the PREDIMED study (derivation sample. Multivariate Cox regression model ß-coefficients were used to weigh each risk factor. PREDIMED-personal Score included body-mass-index, smoking status, family history of type 2 diabetes, alcohol consumption and hypertension as categorical variables; PREDIMED-clinical Score included also high blood glucose. We tested the predictive capability of these scores in the DE-PLAN-CAT cohort (validation sample. The discrimination of Finnish Diabetes Risk Score (FINDRISC, German Diabetes Risk Score (GDRS and our scores was assessed with the area under curve (AUC. RESULTS: The PREDIMED-clinical Score varied from 0 to 14 points. In the subset of the PREDIMED study, 155 individuals developed diabetes during the 4.75-years follow-up. The PREDIMED-clinical score at a cutoff of ≥6 had sensitivity of 72.2%, and specificity of 72.5%, whereas AUC was 0.78. The AUC of the PREDIMED-clinical Score was 0.66 in the validation sample (sensitivity = 85.4%; specificity = 26.6%, and was significantly higher than the FINDRISC and the GDRS in both the derivation and validation samples. DISCUSSION: We identified classical risk factors for diabetes and developed the PREDIMED-clinical Score to determine those individuals at high risk of developing diabetes in elderly individuals at high cardiovascular risk. The predictive capability of the PREDIMED-clinical Score was significantly higher than the FINDRISC and GDRS, and also used fewer items in the questionnaire.

  16. A Risk Score to Predict Type 2 Diabetes Mellitus in an Elderly Spanish Mediterranean Population at High Cardiovascular Risk

    Science.gov (United States)

    Guasch-Ferré, Marta; Bulló, Mònica; Costa, Bernardo; Martínez-Gonzalez, Miguel Ángel; Ibarrola-Jurado, Núria; Estruch, Ramon; Barrio, Francisco; Salas-Salvadó, Jordi

    2012-01-01

    Introduction To develop and test a diabetes risk score to predict incident diabetes in an elderly Spanish Mediterranean population at high cardiovascular risk. Materials and Methods A diabetes risk score was derived from a subset of 1381 nondiabetic individuals from three centres of the PREDIMED study (derivation sample). Multivariate Cox regression model ß-coefficients were used to weigh each risk factor. PREDIMED-personal Score included body-mass-index, smoking status, family history of type 2 diabetes, alcohol consumption and hypertension as categorical variables; PREDIMED-clinical Score included also high blood glucose. We tested the predictive capability of these scores in the DE-PLAN-CAT cohort (validation sample). The discrimination of Finnish Diabetes Risk Score (FINDRISC), German Diabetes Risk Score (GDRS) and our scores was assessed with the area under curve (AUC). Results The PREDIMED-clinical Score varied from 0 to 14 points. In the subset of the PREDIMED study, 155 individuals developed diabetes during the 4.75-years follow-up. The PREDIMED-clinical score at a cutoff of ≥6 had sensitivity of 72.2%, and specificity of 72.5%, whereas AUC was 0.78. The AUC of the PREDIMED-clinical Score was 0.66 in the validation sample (sensitivity = 85.4%; specificity = 26.6%), and was significantly higher than the FINDRISC and the GDRS in both the derivation and validation samples. Discussion We identified classical risk factors for diabetes and developed the PREDIMED-clinical Score to determine those individuals at high risk of developing diabetes in elderly individuals at high cardiovascular risk. The predictive capability of the PREDIMED-clinical Score was significantly higher than the FINDRISC and GDRS, and also used fewer items in the questionnaire. PMID:22442692

  17. MODALITY OF DETERMINING THE TOTAL SCORE OF RISKS IN INTERNAL AUDIT

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    FRANCA DUMITRU

    2012-11-01

    Full Text Available Risk analysis materializes in: applying to the weightings of risk factors the level of risk assessment, on risk factors, based on the assessments made by auditors regarding: the functionality of internal control, the influence of quantitative and qualitative elements; determination of the total risk score, which represents a sum of weights between the appreciation level of each risk and the weightings of risk factors.

  18. The application of European system for cardiac operative risk evaluation II (EuroSCORE II and Society of Thoracic Surgeons (STS risk-score for risk stratification in Indian patients undergoing cardiac surgery

    Directory of Open Access Journals (Sweden)

    Deepak Borde

    2013-01-01

    Full Text Available Aims and Objectives: To validate European system for cardiac operative risk evaluation II (EuroSCORE II and Society of Thoracic Surgeons (STS risk-score for predicting mortality and STS risk-score for predicting morbidity in Indian patients after cardiac surgery. Materials and Methods: EuroSCORE II and STS risk-scores were obtained pre-operatively for 498 consecutive patients. The patients were followed for mortality and various morbidities. The calibration of the scoring systems was assessed using Hosmer-Lemeshow test. The discriminative capacity was estimated by area under receiver operating characteristic (ROC curves. Results: The mortality was 1.6%. For EuroSCORE II and STS risk-score C-statics of 5.43 and 6.11 were obtained indicating satisfactory model fit for both the scores. Area under ROC was 0.69 and 0.65 for EuroSCORE II and STS risk-score with P values of 0.068 and 0.15, respectively, indicating poor discriminatory power. Good fit and discrimination was obtained for renal failure, long-stay in hospital, prolonged ventilator support and deep sternal wound infection but the scores failed in predicting risk of reoperation and stroke. Mortality risk was correctly estimated in low ( 5% patients by both scoring systems. Conclusions: EuroSCORE II and STS risk-scores have satisfactory calibration power in Indian patients but their discriminatory power is poor. Mortality risk was over-estimated by both the scoring systems in high-risk patients. The present study highlights the need for forming a national database and formulating risk stratification tools to provide better quality care to cardiac surgical patients in India.

  19. Modified Mediterranean diet score and cardiovascular risk in a North American working population.

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    Justin Yang

    Full Text Available INTRODUCTION: Greater adherence to a Mediterranean diet is linked to lower risk for cardiovascular morbidity/mortality in studies of Mediterranean cohorts, older subjects, and/or those with existing health conditions. No studies have examined the effects of this dietary pattern in younger working populations in the United States. We investigated the effects of Mediterranean diet adherence on cardiovascular disease (CVD biomarkers, metabolic syndrome and body composition in an occupationally active, non-Mediterranean cohort. METHODS: A cross-sectional study in a cohort of 780 career male firefighters, ages 18 years or older, from the United States Midwest. No dietary intervention was performed. A modified Mediterranean diet score (mMDS was developed for assessment of adherence to a Mediterranean dietary pattern from a previously administered life-style questionnaire that examined pre-existing dietary habits. Clinical data from fire department medical examinations were extracted and analyzed. RESULTS: Obese subjects had significantly lower mMDS, and they reported greater fast/take-out food consumption (p<0.001 and intake of sweetened drinks during meals (p = 0.002. After multivariate adjustment, higher mMDS was inversely related to risk of weight gain over the past 5 years (odds ratio [OR]: 0.57, 95% confidence interval [CI]: 0.39-0.84, p for trend across score quartiles: 0.01; as well as the presence of metabolic syndrome components (OR: 0.65, 95% CI: 0.44-0.94, p for trend across score quartiles: 0.04. Higher HDL-cholesterol (p = 0.008 and lower LDL-cholesterol (p = 0.04 were observed in those with higher mMDS in linear regression after multivariate adjustment for age, BMI and physical activity. CONCLUSIONS: In a cohort of young and active US adults, greater adherence to a Mediterranean-style dietary pattern had significant inverse associations with metabolic syndrome, LDL-cholesterol and reported weight gain, and was significantly and

  20. Polygenic risk score is associated with increased disease risk in 52 Finnish breast cancer families.

    Science.gov (United States)

    Muranen, Taru A; Mavaddat, Nasim; Khan, Sofia; Fagerholm, Rainer; Pelttari, Liisa; Lee, Andrew; Aittomäki, Kristiina; Blomqvist, Carl; Easton, Douglas F; Nevanlinna, Heli

    2016-08-01

    The risk of developing breast cancer is increased in women with family history of breast cancer and particularly in families with multiple cases of breast or ovarian cancer. Nevertheless, many women with a positive family history never develop the disease. Polygenic risk scores (PRSs) based on the risk effects of multiple common genetic variants have been proposed for individual risk assessment on a population level. We investigate the applicability of the PRS for risk prediction within breast cancer families. We studied the association between breast cancer risk and a PRS based on 75 common genetic variants in 52 Finnish breast cancer families including 427 genotyped women and pedigree information on ~4000 additional individuals by comparing the affected to healthy family members, as well as in a case-control dataset comprising 1272 healthy population controls and 1681 breast cancer cases with information on family history. Family structure was summarized using the BOADICEA risk prediction model. The PRS was associated with increased disease risk in women with family history of breast cancer as well as in women within the breast cancer families. The odds ratio (OR) for breast cancer within the family dataset was 1.55 [95 % CI 1.26-1.91] per unit increase in the PRS, similar to OR in unselected breast cancer cases of the case-control dataset (1.49 [1.38-1.62]). High PRS-values were informative for risk prediction in breast cancer families, whereas for the low PRS-categories the results were inconclusive. The PRS is informative in women with family history of breast cancer and should be incorporated within pedigree-based clinical risk assessment.

  1. Feasibility and reliability of a newly developed antenatal risk score card in routine care

    NARCIS (Netherlands)

    Veen, M.J.; Birnie, E.; Poeran, J.; Torij, H.W.; Steegers, E.A.P.; Bonsel, G.J.

    2015-01-01

    OBJECTIVE: to study in routine care the feasibility and inter-rater reliability of the Rotterdam Reproductive Risk Reduction risk score card (R4U), a new semi-quantitative score card for use during the antenatal booking visit. The R4U covers clinical and non-clinical psychosocial factors and ident

  2. Polygenic risk scores for smoking: Predictors for alcohol and cannabis use?

    NARCIS (Netherlands)

    Vink, J.M.; Hottenga, J.J.; Geus, E.J.C. de; Willemsen, G.; Neale, M.C.; Furberg, H.; Boomsma, D.I.

    2014-01-01

    Background and Aims A strong correlation exists between smoking and the use of alcohol and cannabis. This paper uses polygenic risk scores to explore the possibility of overlapping genetic factors. Those scores reflect a combined effect of selected risk alleles for smoking. Methods Summary-level P-v

  3. Vertebral fracture risk (VFR) score for fracture prediction in postmenopausal Women

    DEFF Research Database (Denmark)

    Lillholm, Martin; Ghosh, A.; Pettersen, P. C.

    2011-01-01

    Early prognosis of osteoporosis risk is not only important to individual patients but is also a key factor when screening for osteoporosis drug trial populations. We present an osteoporosis fracture risk score based on vertebral heights. The score separated individuals who sustained fractures (by...

  4. Diet scores and cardio-metabolic risk factors among Guatemalan young adults

    OpenAIRE

    2008-01-01

    We assessed the association of four diet quality scores with multiple cardio-metabolic outcomes among Guatemalan young adults experiencing the nutrition transition. We obtained cross-sectional dietary, demographic, anthropometric and cardio-metabolic risk factor data from 1220 Guatemalan adults (mean age 32·7 (SD 5·8) years) in 2002–4, and computed a Recommended Food Score (RFS), Not Recommended Food Score (NRFS), Food Variety Score (FVS) and the Dietary Quality Index-International (DQI-I). A...

  5. A risk prediction score for invasive mold disease in patients with hematological malignancies.

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    Marta Stanzani

    Full Text Available BACKGROUND: A risk score for invasive mold disease (IMD in patients with hematological malignancies could facilitate patient screening and improve the targeted use of antifungal prophylaxis. METHODS: We retrospectively analyzed 1,709 hospital admissions of 840 patients with hematological malignancies (2005-2008 to collect data on 17 epidemiological and treatment-related risk factors for IMD. Multivariate regression was used to develop a weighted risk score based on independent risk factors associated with proven or probable IMD, which was prospectively validated during 1,746 hospital admissions of 855 patients from 2009-2012. RESULTS: Of the 17 candidate variables analyzed, 11 correlated with IMD by univariate analysis, but only 4 risk factors (neutropenia, lymphocytopenia or lymphocyte dysfunction in allogeneic hematopoietic stem cell transplant recipients, malignancy status, and prior IMD were retained in the final multivariate model, resulting in a weighted risk score 0-13. A risk score of 5% of IMD, with a negative predictive value (NPV of 0.99, (95% CI 0.98-0.99. During 2009-2012, patients with a calculated risk score at admission of 6 (0.9% vs. 10.6%, P <0.001. CONCLUSION: An objective, weighted risk score for IMD can accurately discriminate patients with hematological malignancies at low risk for developing mold disease, and could possibly facilitate "screening-out" of low risk patients less likely to benefit from intensive diagnostic monitoring or mold-directed antifungal prophylaxis.

  6. [Prematurity risk according to prematurity risk score and postpartal morbidity of the newborn infants (author's transl)].

    Science.gov (United States)

    Coradello, H; Lubec, G; Simbruner, G

    1981-02-01

    Risk of premature birth was evaluated retrospectively in 610 women in the first days after delivery using the prematurity risk score published by Thalhammer 1973. The calculated risk of premature birth was compared than prospectively to postpartal morbidity of the newborn infants as determined by duration of hospital stay, incidence of respiratory distress syndrome, need of artificial ventilation and mortality. A positive correlation could be found between risk of premature birth and postpartal morbidity of the newborn infants especially in small premature infants with birthweights of 2000 grams and less. The same correlation existed also in two groups of infants out of two different obstetric clinics which showed the same distribution of prenatal risks and the same prenatal care frequencies. It clearly becomes evident that infants with the same prenatal risks but good prenatal care during pregnancy had much lower hospital stays, lower respiratory distress frequencies and lower mortality rates than babies delivered from pregnancies badly cared for. These prenatal care related differences in postpartum morbidity again were much more evident in infants out of lower birth weight classes.

  7. Systematic review of obesity surgery mortality risk score--preoperative risk stratification in bariatric surgery.

    Science.gov (United States)

    Thomas, Harun; Agrawal, Sanjay

    2012-07-01

    Bariatric surgery is the best long term treatment for morbid obesity. However, it carries risks of considerable morbidity and potential mortality. There is no published review on pre-operative identification of high-risk patients in bariatric surgery. This systematic review analyses obesity surgery mortality risk score (OS-MRS) as a tool for pre-operative prediction of mortality risk in bariatric surgery. Medline and Embase was systematically searched using the medical subjects headings (MeSH) terms 'bariatric surgery' and 'mortality' with further free text search and cross references. Studies that described OS-MRS to predict mortality risk after bariatric surgery were included in this review. Six studies evaluated 9,382 patients to assess the validity of OS-MRS to predict the mortality risk after bariatric surgery. Patient's age ranged from 19 to 67 years, and the body mass index ranged from 30 to 84. There were 83 deaths among the 9,382 patients (0.88 %) with individual studies reporting a mortality range from 0 % to 1.49 %. There were 13 deaths among 4,912 (0.26 %) class A patients, 55 deaths among 4,124 (1.33 %) class B patients and 15 deaths among 346 (4.34 %) class C patients. Mortality in classes A, B and C was significantly different from each of the other two classes (P < 0.05, χ(2)). This systematic review confirms that OS-MRS stratifies the mortality risk in the three-risk classification subgroups of patients. The OS-MRS can be used for pre-operative identification of high-risk patients undergoing primary Roux-en-Y gastric bypass surgery.

  8. Risk Factors for Malnutrition among Children 5-years and Younger in the Akuapim-North District in the Eastern Region of Ghana

    Directory of Open Access Journals (Sweden)

    Alex Kojo Anderson

    2010-05-01

    Full Text Available Malnutrition remains a significant public health problem in developing countries. The aim of thisstudy was to identify risk factors for malnutrition among preschool children in the Akwapim-North District inthe Eastern Region of Ghana. This was a cross-sectional study. Mothers who brought their children to the “WellBaby Check-up” clinics were invited to participate. Anthropometric measurements (weight and height/lengthand blood hemoglobin were measured. Mothers also completed a questionnaire consisting of closed andopen-ended questions. A total of 305 pre-school-age children were included in this study. Of this sample,43.3% were males, and 56.7% were females. The prevalence of wasting, stunting, and underweight was 6.2,11.4 and 7.3%, respectively. The majority of the children (80.7% were anemic. Children who wereexclusively breastfed for 6 months showed slightly lower prevalence of both anemia (75.5% vs. 89.0% andstunting (8% vs. 13% but not wasting (8.3% vs. 4.3% or underweight (8.3% vs. 5.2% compared to theirmixed feeding counterparts. Children under 12 months of age showed a higher prevalence of wasting (9.4%compared to other age groups. Children from homes with electricity showed lower prevalence of stunting(9.7% vs. 17.6%, p = 0.050, and children from households with a radio showed lower prevalence of wasting(5.3% vs. 19.0%, p = 0.033. Nutrition education encouraging exclusive breastfeeding and adequate provisionof animal protein to preschool children is important in semi-rural and farming communities in developingcountries such as Ghana in order to combat the prevalence of childhood malnutrition (stunting, wasting,underweight and anemia.

  9. Beyond the SYNTAX score--advantages and limitations of other risk assessment systems in left main percutaneous coronary intervention.

    Science.gov (United States)

    Capodanno, Davide

    2013-01-01

    Risk stratification is an emerging topic in the modern management of patients with left main disease referred for percutaneous coronary intervention (PCI). Recent years have witnessed an explosive multiplication of risk models for prognostic stratification in complex PCI. Many of this models deal with modification of the angiographic SYNTAX score, or seek to overcome its known pitfalls and limitations, including lack of clinical and functional information, inter- and intra-observer variabilities, and poor calibration. Risk scoring systems beyond the SYNTAX score may be classified into angiographic (residual SYNTAX score, coronary artery bypass grafting SYNTAX score), clinical (EuroSCORE I and II, ACEF score and modified ACEF scores), combined clinical and angiographic (Global Risk Classification, Clinical SYNTAX score, logistic Clinical SYNTAX score, SYNTAX score II) and functional (Functional SYNTAX score). This article reviews current concepts in risk modeling and explores the advantages and limitations of the alternatives to the SYNTAX score in patients undergoing left main PCI. 

  10. A genetic risk score combining ten psoriasis risk loci improves disease prediction.

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    Haoyan Chen

    Full Text Available Psoriasis is a chronic, immune-mediated skin disease affecting 2-3% of Caucasians. Recent genetic association studies have identified multiple psoriasis risk loci; however, most of these loci contribute only modestly to disease risk. In this study, we investigated whether a genetic risk score (GRS combining multiple loci could improve psoriasis prediction. Two approaches were used: a simple risk alleles count (cGRS and a weighted (wGRS approach. Ten psoriasis risk SNPs were genotyped in 2815 case-control samples and 858 family samples. We found that the total number of risk alleles in the cases was significantly higher than in controls, mean 13.16 (SD 1.7 versus 12.09 (SD 1.8, p = 4.577×10(-40. The wGRS captured considerably more risk than any SNP considered alone, with a psoriasis OR for high-low wGRS quartiles of 10.55 (95% CI 7.63-14.57, p = 2.010×10(-65. To compare the discriminatory ability of the GRS models, receiver operating characteristic curves were used to calculate the area under the curve (AUC. The AUC for wGRS was significantly greater than for cGRS (72.0% versus 66.5%, p = 2.13×10(-8. Additionally, the AUC for HLA-C alone (rs10484554 was equivalent to the AUC for all nine other risk loci combined (66.2% versus 63.8%, p = 0.18, highlighting the dominance of HLA-C as a risk locus. Logistic regression revealed that the wGRS was significantly associated with two subphenotypes of psoriasis, age of onset (p = 4.91×10(-6 and family history (p = 0.020. Using a liability threshold model, we estimated that the 10 risk loci account for only 11.6% of the genetic variance in psoriasis. In summary, we found that a GRS combining 10 psoriasis risk loci captured significantly more risk than any individual SNP and was associated with early onset of disease and a positive family history. Notably, only a small fraction of psoriasis heritability is captured by the common risk variants identified to date.

  11. Correlation between Timi Risk Score and Clinical Outcome in Patients with Unstable Angina Pectoris

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    Savovic Zorica

    2016-06-01

    Full Text Available Given Taking that the TIMI score is a major predictor of MACE, this study aimed to determine the value of the TIMI risk score in predicting poor outcomes (death, myocardial infarction, recurrent pain in patients presenting with unstable angina pectoris in short-term observation. A total of 107 patients with APns were examined at the Clinical Centre Kragujevac and were included in the investigation. The TIMI score was determined on the first day of hospitalization. During hospitalization, the following factors were also observed: troponin, ECG evolution, further therapy (pharmacologic therapy and/or emergency PCI or CABG, age, hypertension and hyperlipidaemia. The low-risk group (TIMI 0 - 2 included 30.8% of patients, whereas 47.6% of patients were in the intermediate-risk group (TIMI 3 - 4, and 21.5% of patients were in the high-risk group (TIMI 5 - 7. Good outcomes (without adverse event and poor outcomes (death, myocardial infarction, and recurring chest pain were dependent on the TIMI risk score. The increase in TIMI risk score per one unit increased the risk of a poor outcome by 54%. Troponin and TIMI risk score were positively correlated. Our results suggest that the TIMI risk score may be a reliable predictor of a poor outcome (MACE during the short-term observation of patients with APns. Moreover, patients identified as high-risk benefit from early invasive PCI, enoxaparin and Gp IIb/IIIa inhibitors. Th us, routine use of the TIMI risk score at admission may reduce the number of patients not recognized as high-risk.

  12. High lifetime risk of cardiovascular disease vs low 10-year Framingham risk score in HIV-infected subjects under ART in Spain: the Coronator study

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    C Miralles

    2012-11-01

    associated with an increased lifetime risk were older age, non-Spanish origin and longer time on ART. Adjusted OR for patients on ART longer than 10 years (vs<5 years was 2.2 [95% CI 1.13–4.34]. No relationship was found with current or nadir CD4 lymphocyte counts, CDC stage C, HCV confection or type of ART. Conclusions: There are significant disparities between the low 10y CVD risk estimated with FRS and the elevated lifetime risk in HIV patients on ART. Prolonged ART is associated with an increased CVD lifetime risk.

  13. Risk prediction is improved by adding markers of subclinical organ damage to SCORE

    DEFF Research Database (Denmark)

    Sehestedt, Thomas; Jeppesen, Jørgen Lykke; Hansen, Tine W;

    2010-01-01

    .8-5.9)], PWV > 12 m/s [HR 1.9 (1.1-3.3) for SCORE > or = 5% and 7.3 (3.2-16.1) for SCORE or = 5% as well as subclinical organ damage, increased specificity of risk prediction from 75 to 81% (P sensitivity from 72 to 65% (P = 0.......4). Broaden primary prevention from subjects with SCORE > or = 5% to include subjects with 1% organ damage increased sensitivity from 72 to 89% (P = 0.006), but reduced specificity from 75 to 57% (P ....07). CONCLUSION: Subclinical organ damage predicted cardiovascular death independently of SCORE and the combination may improve risk prediction....

  14. A weighted genetic risk score using all known susceptibility variants to estimate rheumatoid arthritis risk

    Science.gov (United States)

    Yarwood, Annie; Han, Buhm; Raychaudhuri, Soumya; Bowes, John; Lunt, Mark; Pappas, Dimitrios A; Kremer, Joel; Greenberg, Jeffrey D; Plenge, Robert; Worthington, Jane; Barton, Anne; Eyre, Steve

    2015-01-01

    Background There is currently great interest in the incorporation of genetic susceptibility loci into screening models to identify individuals at high risk of disease. Here, we present the first risk prediction model including all 46 known genetic loci associated with rheumatoid arthritis (RA). Methods A weighted genetic risk score (wGRS) was created using 45 RA non-human leucocyte antigen (HLA) susceptibility loci, imputed amino acids at HLA-DRB1 (11, 71 and 74), HLA-DPB1 (position 9) HLA-B (position 9) and gender. The wGRS was tested in 11 366 RA cases and 15 489 healthy controls. The risk of developing RA was estimated using logistic regression by dividing the wGRS into quintiles. The ability of the wGRS to discriminate between cases and controls was assessed by receiver operator characteristic analysis and discrimination improvement tests. Results Individuals in the highest risk group showed significantly increased odds of developing anti-cyclic citrullinated peptide-positive RA compared to the lowest risk group (OR 27.13, 95% CI 23.70 to 31.05). The wGRS was validated in an independent cohort that showed similar results (area under the curve 0.78, OR 18.00, 95% CI 13.67 to 23.71). Comparison of the full wGRS with a wGRS in which HLA amino acids were replaced by a HLA tag single-nucleotide polymorphism showed a significant loss of sensitivity and specificity. Conclusions Our study suggests that in RA, even when using all known genetic susceptibility variants, prediction performance remains modest; while this is insufficiently accurate for general population screening, it may prove of more use in targeted studies. Our study has also highlighted the importance of including HLA variation in risk prediction models. PMID:24092415

  15. Comparison of risk scoring systems for patients presenting with upper gastrointestinal bleeding

    DEFF Research Database (Denmark)

    Stanley, Adrian J; Laine, Loren; Dalton, Harry R

    2017-01-01

    OBJECTIVE: To compare the predictive accuracy and clinical utility of five risk scoring systems in the assessment of patients with upper gastrointestinal bleeding. DESIGN: International multicentre prospective study. SETTING: Six large hospitals in Europe, North America, Asia, and Oceania....... RESULTS: The Glasgow Blatchford score was best (area under the receiver operating characteristic curve (AUROC) 0.86) at predicting intervention or death compared with the full Rockall score (0.70), PNED score (0.69), admission Rockall score (0.66, and AIMS65 score (0.68) (all P... thresholds of ≥4 for PNED, ≥2 for AIMS65, ≥4 for admission Rockall, and ≥5 for full Rockall were optimal at predicting death, with sensitivities of 65.8-78.6% and specificities of 65.0-65.3%. No score was helpful at predicting rebleeding or length of stay. CONCLUSIONS: The Glasgow Blatchford score has high...

  16. Midregional Proadrenomedullin Improves Risk Stratification beyond Surgical Risk Scores in Patients Undergoing Transcatheter Aortic Valve Replacement.

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    Adam Csordas

    Full Text Available Conventional surgical risk scores lack accuracy in risk stratification of patients undergoing transcatheter aortic valve replacement (TAVR. Elevated levels of midregional proadrenomedullin (MR-proADM levels are associated with adverse outcome not only in patients with manifest chronic disease states, but also in the general population.We investigated the predictive value of MR-proADM for mortality in an unselected contemporary TAVR population.We prospectively included 153 patients suffering from severe aortic stenosis who underwent TAVR from September 2013 to August 2014. This population was compared to an external validation cohort of 205 patients with severe aortic stenosis undergoing TAVR. The primary endpoint was all cause mortality.During a median follow-up of 258 days, 17 out of 153 patients who underwent TAVR died (11%. Patients with MR-proADM levels above the 75th percentile (≥ 1.3 nmol/l had higher mortality (31% vs. 4%, HR 8.9, 95% CI 3.0-26.0, P 6.8 only showed a trend towards higher mortality (18% vs. 9%, HR 2.1, 95% CI 0.8-5.6, P = 0.13. The Harrell's C-statistic was 0.58 (95% CI 0.45-0.82 for the EuroSCORE II, and consideration of baseline MR-proADM levels significantly improved discrimination (AUC = 0.84, 95% CI 0.71-0.92, P = 0.01. In bivariate analysis adjusted for EuroSCORE II, MR-proADM levels ≥1.3 nmol/l persisted as an independent predictor of mortality (HR 9.9, 95% CI (3.1-31.3, P <0.01 and improved the model's net reclassification index (0.89, 95% CI (0.28-1.59. These results were confirmed in the independent validation cohort.Our study identified MR-proADM as a novel predictor of mortality in patients undergoing TAVR. In the future, MR-proADM should be added to the commonly used EuroSCORE II for better risk stratification of patients suffering from severe aortic stenosis.

  17. Association of a Dietary Score with Incident Type 2 Diabetes: The Dietary-Based Diabetes-Risk Score (DDS.

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    Ligia J Dominguez

    Full Text Available Strong evidence supports that dietary modifications may decrease incident type 2 diabetes mellitus (T2DM. Numerous diabetes risk models/scores have been developed, but most do not rely specifically on dietary variables or do not fully capture the overall dietary pattern. We prospectively assessed the association of a dietary-based diabetes-risk score (DDS, which integrates optimal food patterns, with the risk of developing T2DM in the SUN ("Seguimiento Universidad de Navarra" longitudinal study.We assessed 17,292 participants initially free of diabetes, followed-up for a mean of 9.2 years. A validated 136-item FFQ was administered at baseline. Taking into account previous literature, the DDS positively weighted vegetables, fruit, whole cereals, nuts, coffee, low-fat dairy, fiber, PUFA, and alcohol in moderate amounts; while it negatively weighted red meat, processed meats and sugar-sweetened beverages. Energy-adjusted quintiles of each item (with exception of moderate alcohol consumption that received either 0 or 5 points were used to build the DDS (maximum: 60 points. Incident T2DM was confirmed through additional detailed questionnaires and review of medical records of participants. We used Cox proportional hazards models adjusted for socio-demographic and anthropometric parameters, health-related habits, and clinical variables to estimate hazard ratios (HR of T2DM.We observed 143 T2DM confirmed cases during follow-up. Better baseline conformity with the DDS was associated with lower incidence of T2DM (multivariable-adjusted HR for intermediate (25-39 points vs. low (11-24 category 0.43 [95% confidence interval (CI 0.21, 0.89]; and for high (40-60 vs. low category 0.32 [95% CI: 0.14, 0.69]; p for linear trend: 0.019.The DDS, a simple score exclusively based on dietary components, showed a strong inverse association with incident T2DM. This score may be applicable in clinical practice to improve dietary habits of subjects at high risk of T2DM

  18. Dietary Intake Is Related to Multifactor Cardiovascular Risk Score in Obese Boys

    Science.gov (United States)

    Schumacher, Tracy L.; Burrows, Tracy L.; Cliff, Dylan P.; Jones, Rachel A.; Okely, Anthony D.; Baur, Louise A.; Morgan, Philip J.; Callister, Robin; Boggess, May M.; Collins, Clare E.

    2014-01-01

    Cardiovascular disease (CVD) originates in childhood and early identification of risk factors provides an early intervention opportunity. The aim was to identify children at higher risk using a CVD risk score, developed from factors known to cluster in childhood. Risk was scored as very high (≥97.5th centile), high (≥95th), moderate (≥90th) or threshold (<90th) using normal pediatric reference ranges for 10 common biomedical risk factors. These were summed in a multifactor CVD risk score and applied to a sample of 285 observations from 136 overweight Australian children (41% male, aged 7–12 years). Strength of associations between CVD risk score and individual biomedical and dietary variables were assessed using univariate logistic regression. High waist circumference (Odds Ratio: 5.48 [95% CI: 2.60–11.55]), body mass index (OR: 3.22 [1.98–5.26]), serum insulin (OR: 3.37 [2.56–4.42]) and triglycerides (OR: 3.02 [2.22–4.12]) were all significantly related to CVD risk score. High intakes of total fat (OR: 4.44 [1.19–16.60]), sugar (OR: 2.82 [1.54–5.15]) and carbohydrate (OR 1.75 [1.11–2.77]) were significantly related to CVD risk score in boys only. This multifactor CVD risk score could be a useful tool for researchers to identify elevated risk in children. Further research is warranted to examine sex-specific dietary factors related to CVD risk in children. PMID:27429277

  19. Dietary Intake Is Related to Multifactor Cardiovascular Risk Score in Obese Boys

    Directory of Open Access Journals (Sweden)

    Tracy L. Schumacher

    2014-07-01

    Full Text Available Cardiovascular disease (CVD originates in childhood and early identification of risk factors provides an early intervention opportunity. The aim was to identify children at higher risk using a CVD risk score, developed from factors known to cluster in childhood. Risk was scored as very high (≥97.5th centile, high (≥95th, moderate (≥90th or threshold (<90th using normal pediatric reference ranges for 10 common biomedical risk factors. These were summed in a multifactor CVD risk score and applied to a sample of 285 observations from 136 overweight Australian children (41% male, aged 7–12 years. Strength of associations between CVD risk score and individual biomedical and dietary variables were assessed using univariate logistic regression. High waist circumference (Odds Ratio: 5.48 [95% CI: 2.60–11.55], body mass index (OR: 3.22 [1.98–5.26], serum insulin (OR: 3.37 [2.56–4.42] and triglycerides (OR: 3.02 [2.22–4.12] were all significantly related to CVD risk score. High intakes of total fat (OR: 4.44 [1.19–16.60], sugar (OR: 2.82 [1.54–5.15] and carbohydrate (OR 1.75 [1.11–2.77] were significantly related to CVD risk score in boys only. This multifactor CVD risk score could be a useful tool for researchers to identify elevated risk in children. Further research is warranted to examine sex-specific dietary factors related to CVD risk in children.

  20. Development and Evaluation of a Genetic Risk Score for Obesity

    Science.gov (United States)

    Belsky, Daniel W.; Moffitt, Terrie E.; Sugden, Karen; Williams, Benjamin; Houts, Renate; McCarthy, Jeanette; Caspi, Avshalom

    2013-01-01

    Background Results from genome-wide association studies (GWAS) represent a potential resource for etiological and treatment research. GWAS of obesity-related phenotypes have been especially successful. To translate this success into a research tool, we developed and tested a “genetic risk score” (GRS) that summarizes an individual’s genetic predisposition to obesity. Methods Different GWAS of obesity-related phenotypes report different sets of single nucleotide polymorphisms (SNPs) as the best genomic markers of obesity risk. Therefore, we applied a 3-stage approach that pooled results from multiple GWAS to select SNPs to include in our GRS: The 3 stages are (1) Extraction. SNPs with evidence of association are compiled from published GWAS; (2) Clustering. SNPs are grouped according to patterns of linkage disequilibrium; (3) Selection. Tag SNPs are selected from clusters that meet specific criteria. We applied this 3-stage approach to results from 16 GWAS of obesity-related phenotypes in European-descent samples to create a GRS. We then tested the GRS in the Atherosclerosis Risk in the Communities (ARIC) Study cohort (N=10,745, 55% female, 77% white, 23% African American). Results Our 32-locus GRS was a statistically significant predictor of body mass index (BMI) and obesity among ARIC whites (for BMI, r=0.13, p<1×10−30; for obesity, area under the receiver operating characteristic curve (AUC)=0.57 [95% CI 0.55–0.58]). The GRS improved prediction of obesity (as measured by delta-AUC and integrated discrimination index) when added to models that included demographic and geographic information. FTO- and MC4R-linked SNPs, and a non-genetic risk assessment consisting of a socioeconomic index (p<0.01 for all comparisons). The GRS also predicted increased mortality risk over 17 years of follow-up. The GRS performed less well among African Americans. Conclusions The obesity GRS derived using our 3-stage approach is not useful for clinical risk prediction, but

  1. A Study of Risk Factors and T- Score Variability in Romanian Women with Postmenopausal Osteoporosis.

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    Rodica TöRöK-Oance

    2013-12-01

    Full Text Available The purpose of this study was to analyse the prevalence of postmenopausal osteoporosis risk factors and to analyse the T-score variability in spine and hip according to the associated risk factors.This is a retrospective study (2003-2007 including 177 female patients with postmenopausal osteoporosis. The patients were separated in seven groups according to the number of risk factors per case. The T-score was compared between this groups using unpaired t-Student test.The most frequent risk factor was early menopause (44.63%, followed by low consumption of dairy products (37.29%, coffee consumption (25.99%, sedentary lifestyle (20.9%, smoking (19.21%, delayed menarche (15.25%, low body mass index (10.71%, nulliparity (7.91%, alcohol consumption (0.56%. The maximum number of risk factors per case was six. The T-score decreased with increasing number of risk factors. T-score differences are statistically significant when comparing cases with 6 risk factors to cases with 5 risk factors (P=0.0315 in spine; P=0.0088 in hip, 4 risk factors (P=0.0076 in spine; P=0.043 in hip, 3 risk factors (P<0.0001 in spine; P=0.0205 in hip, 2 risk factors (P=0.0012 in spine; P<0.0001 in hip, a single risk factor (P<0.001 in spine and hip and no risk factor (P=0.0075 in spine; P=0.0006 in hip.Association of several risk factors leads to decrease of T-score so being able to avoid any such factors may contribute to a better bone mineral density. This could be achieved by the education of female population regarding postmenopausal osteoporosis risk factors, followed by adopting an appropriate lifestyle and diet.

  2. Poor predictive ability of the risk chart SCORE in a Danish population

    DEFF Research Database (Denmark)

    Saidj, Madina; Jørgensen, Torben; Prescott, Eva;

    2013-01-01

    In Denmark, the European risk chart Systematic COronary Risk Evaluation (SCORE) from the European Society of Cardiology is recommended for use in cardiovascular prevention. Nevertheless, its predictive ability in a Danish population has never been investigated. The purpose of this study was there...... was therefore to assess the predictive ability of the SCORE risk chart with regard to fatal cardiovascular risk according to the socio-demographic factors of age, sex, income and education in a Danish population.......In Denmark, the European risk chart Systematic COronary Risk Evaluation (SCORE) from the European Society of Cardiology is recommended for use in cardiovascular prevention. Nevertheless, its predictive ability in a Danish population has never been investigated. The purpose of this study...

  3. HIV infection does not contribute to increased cardiovascular risk as assessed by Framingham risk score

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    I Ramsay

    2012-11-01

    significant predictors. The overall mean cfPWV for the HIV cohort (n=47 was 9.09±2.13 m/s compared to 11.95±2.37 m/s in the control group (n=46(p<0.01. HIV infection does not contribute to increased cardiovascular risk as assessed by Framingham risk score or carotid-femoral pulse wave velocity. This may be due to good control of traditional cardiovascular risk factors and a healthy lifestyle in this cohort.

  4. A Simple Risk Score for Identifying Individuals with Impaired Fasting Glucose in the Southern Chinese Population

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    Hui Wang

    2015-01-01

    Full Text Available This study aimed to develop and validate a simple risk score for detecting individuals with impaired fasting glucose (IFG among the Southern Chinese population. A sample of participants aged ≥20 years and without known diabetes from the 2006–2007 Guangzhou diabetes cross-sectional survey was used to develop separate risk scores for men and women. The participants completed a self-administered structured questionnaire and underwent simple clinical measurements. The risk scores were developed by multiple logistic regression analysis. External validation was performed based on three other studies: the 2007 Zhuhai rural population-based study, the 2008–2010 Guangzhou diabetes cross-sectional study and the 2007 Tibet population-based study. Performance of the scores was measured with the Hosmer-Lemeshow goodness-of-fit test and ROC c-statistic. Age, waist circumference, body mass index and family history of diabetes were included in the risk score for both men and women, with the additional factor of hypertension for men. The ROC c-statistic was 0.70 for both men and women in the derivation samples. Risk scores of ≥28 for men and ≥18 for women showed respective sensitivity, specificity, positive predictive value and negative predictive value of 56.6%, 71.7%, 13.0% and 96.0% for men and 68.7%, 60.2%, 11% and 96.0% for women in the derivation population. The scores performed comparably with the Zhuhai rural sample and the 2008–2010 Guangzhou urban samples but poorly in the Tibet sample. The performance of pre-existing USA, Shanghai, and Chengdu risk scores was poorer in our population than in their original study populations. The results suggest that the developed simple IFG risk scores can be generalized in Guangzhou city and nearby rural regions and may help primary health care workers to identify individuals with IFG in their practice.

  5. Prognostic value of risk score and urinary markers in idiopathic membranous nephropathy.

    NARCIS (Netherlands)

    Brand, Jan van den; Hofstra, J.M.; Wetzels, J.F.M.

    2012-01-01

    BACKGROUND AND OBJECTIVES: Accurate prediction of prognosis may improve management of patients with idiopathic membranous nephropathy. This study compared the Toronto Risk Score and urinary low-molecular weight proteins. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: One hundred four patients with b

  6. A risk score for predicting mortality in patients with asymptomatic mild to moderate aortic stenosis

    DEFF Research Database (Denmark)

    Holme, Ingar; Pedersen, Terje R; Boman, Kurt

    2012-01-01

    BackgroundPrognostic information for asymptomatic patients with aortic stenosis (AS) from prospective studies is scarce and there is no risk score available to assess mortality.ObjectivesTo develop an easily calculable score, from which clinicians could stratify patients into high and lower risk...... of mortality, using data from the Simvastatin and Ezetimibe in Aortic Stenosis (SEAS) study.MethodA search for significant prognostic factors (p...

  7. Assessing Framingham cardiovascular risk scores in subjects with diabetes and their correlation with diabetic retinopathy

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    Deepali R Damkondwar

    2012-01-01

    Full Text Available Aim: To study the Framingham cardiovascular risk assessment scores in subjects with diabetes and their association with diabetic retinopathy in subjects with diabetes. Materials and Methods: In this population-based prospective study, subjects with diabetes were recruited (n=1248; age ≥40 years. The Framingham cardiovascular risk scores were calculated for 1248 subjects with type 2 diabetes. The scores were classified as high risk (>10%, and low risk (<10%. Results: Out of the 1248 subjects, 830 (66.5% patients had a low risk of developing cardiovascular disease (CVD in 10 years and 418 (33.5% had a high risk of developing CVD in 10 years. The risk of developing CVD was more in males than females (56.8% vs. 7% The prevalence of both diabetic retinopathy and sight-threatening retinopathy was more in the high-risk group (21% and 4.5%, respectively. The risk factors for developing diabetic retinopathy were similar in both the groups (low vs. high - duration of diabetes (OR 1.14 vs. 1.08, higher HbA1c (OR 1.24 vs. 1.22, presence of macro- and microalbuminuria (OR 10.17 vs. 6.12 for macro-albuminuria and use of insulin (OR 2.06 vs. 4.38. The additional risk factors in the high-risk group were presence of anemia (OR 2.65 and higher serum high density lipoprotein (HDL cholesterol (OR 1.05. Conclusion: Framingham risk scoring, a global risk assessment tool to predict the 10-year risk of developing CVD, can also predict the occurrence and type of diabetic retinopathy. Those patients with high CVD scores should be followed up more frequently and treated adequately. This also warrants good interaction between the treating physician/cardiologist and the ophthalmologist.

  8. Evaluation of nosocomial infection risk using APACHE II scores in the neurological intensive care unit.

    Science.gov (United States)

    Li, Hai-Ying; Li, Shu-Juan; Yang, Nan; Hu, Wen-Li

    2014-08-01

    To evaluate the feasibility and accuracy of using the Acute Physiology, Age and Chronic Health Evaluation II (APACHE II) scoring system for predicting the risk of nosocomial infection in the neurological intensive care unit (NICU), 216 patients transferred to NICU within 24hours of admission were retrospectively evaluated. Based on admission APACHE II scores, they were classified into three groups, with higher APACHE II scores representing higher infectious risk. The device utilization ratios and device-associated infection ratios of NICU patients were analyzed and compared with published reports on patient outcome. Statistical analysis of nosocomial infection ratios showed obvious differences between the high-risk, middle-risk and low-risk groups (pAPACHE II model in predicting the risk of nosocomial infection was 0.81, which proved to be reliable and consistent with the expectation. In addition, we found statistical differences in the duration of hospital stay (patient-days) and device utilization (device-days) between different risk groups (pAPACHE II scoring system was validated in predicting the risk of nosocomial infection, duration of patient-days and device-days, and providing accurate assessment of patients' condition, so that appropriate prevention strategies can be implemented based on admission APACHE II scores.

  9. Incidence of cardiovascular events after kidney transplantation and cardiovascular risk scores: study protocol

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    Lorenzo-Aguiar Dolores

    2011-01-01

    Full Text Available Abstract Background Cardiovascular disease (CVD is the major cause of death after renal transplantation. Not only conventional CVD risk factors, but also transplant-specific risk factors can influence the development of CVD in kidney transplant recipients. The main objective of this study will be to determine the incidence of post-transplant CVD after renal transplantation and related factors. A secondary objective will be to examine the ability of standard cardiovascular risk scores (Framingham, Regicor, SCORE, and DORICA to predict post-transplantation cardiovascular events in renal transplant recipients, and to develop a new score for predicting the risk of CVD after kidney transplantation. Methods/Design Observational prospective cohort study of all kidney transplant recipients in the A Coruña Hospital (Spain in the period 1981-2008 (2059 transplants corresponding to 1794 patients. The variables included will be: donor and recipient characteristics, chronic kidney disease-related risk factors, pre-transplant and post-transplant cardiovascular risk factors, routine biochemistry, and immunosuppressive, antihypertensive and lipid-lowering treatment. The events studied in the follow-up will be: patient and graft survival, acute rejection episodes and cardiovascular events (myocardial infarction, invasive coronary artery therapy, cerebral vascular events, new-onset angina, congestive heart failure, rhythm disturbances and peripheral vascular disease. Four cardiovascular risk scores were calculated at the time of transplantation: the Framingham score, the European Systematic Coronary Risk Evaluation (SCORE equation, and the REGICOR (Registre Gironí del COR (Gerona Heart Registry, and DORICA (Dyslipidemia, Obesity, and Cardiovascular Risk functions. The cumulative incidence of cardiovascular events will be analyzed by competing risk survival methods. The clinical relevance of different variables will be calculated using the ARR (Absolute Risk

  10. Using family atopy scores to identify the risk of atopic dermatitis in infants

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    Melisa Anggraeni

    2014-11-01

    Full Text Available Background Atopic dermatitis is the first manifestation of allergic disease in early life. Early interventions may prevent the development of allergy disease. Allergy trace cards have been used to identify the level of allergic risk, based on family atopy scores. Because environmental factors may also influence the development of atopic dermatitis, the usefulness of the allergy trace card needs to be reevaluated. Objective To compare the incidence of atopic dermatitis in infants aged 0-4 months with total family atopy scores of > 0 to those with scores of 0. Methods We conducted this cohort study from June 1, 2012 to December 31, 2012 at Sanglah Hospital, Denpasar. Family atopy score was tabulated from all pregnant woman in the Obstetric Outpatient Clinic and the Maternity Room. Subjects were divided into two groups based on their total family atopy score: those with scores > 0 and those with scores of 0. The appearance of atopic dermatitis symptoms in the infants were evaluated until they reached 4 months of age. The incidence of atopic dermatitis in two groups was compared using Chi-square test. Results The incidence of atopic dermatitis in this study was 10.9%. The group with total family atopy scores of 0 had a significantly higher incidence of atopic dermatitis than the group with scores > 0 (adjusted RR 22.5; 95%CI 8.8 to 57.0; P = 0.001. Conclusion The incidence of atopic dermatitis is higher in infants with total family atopy score > 0 and this group has a 22.5 times higher risk of atopic dermatitis compared to infants with total family atopy score of 0. Allergy trace cards are relevant in differentiating the risk of atopy with regards to development of atopic dermatitis. We suggest that family atopy scores be evaluated during antenatal care in order to limit the development of atopic dermatitis in infants. [Paediatr Indones. 2014;54:330-7.].

  11. How much does HDL cholesterol add to risk estimation? A report from the SCORE Investigators.

    LENUS (Irish Health Repository)

    Cooney, Marie Therese

    2009-06-01

    Systematic COronary Risk Evaluation (SCORE), the risk estimation system recommended by the European guidelines on cardiovascular disease prevention, estimates 10-year risk of cardiovascular disease mortality based on age, sex, country of origin, systolic blood pressure, smoking status and either total cholesterol (TC) or TC\\/high-density lipoprotein cholesterol (HDL-C) ratio. As, counterintuitively, these two systems perform very similarly, we have investigated whether incorporating HDL-C and TC as separate variables improves risk estimation.

  12. Psoriasis and the Framingham risk score in a Danish hospital cohort

    DEFF Research Database (Denmark)

    Gyldenløve, Mette; Jensen, Peter; Linneberg, Allan

    2014-01-01

    -2011. Median psoriasis area and severity index score was 5.8 (range 0.0-39.8), and 10% of the patients received systemic antipsoriatic treatment. Body mass index (26.2 vs. 25.2 kg/m(2) , P = 0.005), waist circumference (96.0 vs. 88.0 cm, P ...BACKGROUND: Psoriasis is a chronic inflammatory skin disease, which is associated with an increased risk of cardiovascular morbidity and mortality. Our aim was to compare the Framingham risk score, a method to estimate coronary heart disease and prevalences of cardiovascular risk factors.......009) were significantly higher in patients with psoriasis. We found no significant differences in Framingham risk scores between the groups. CONCLUSIONS: Patients from the hospital cohort had a higher prevalence of certain cardiovascular risk factors compared to individuals without psoriasis from...

  13. A Bayesian framework for automated cardiovascular risk scoring on standard lumbar radiographs

    DEFF Research Database (Denmark)

    Petersen, Peter Kersten; Ganz, Melanie; Mysling, Peter

    2012-01-01

    the score. Since the aorta is invisible on X-ray images, its position is reasoned from (1) the shape and location of the lumbar vertebrae and (2) the location, shape, and orientation of potential calcifications. The proposed framework follows the principle of Bayesian inference, which has several advantages......We present a fully automated framework for scoring a patients risk of cardiovascular disease (CVD) and mortality from a standard lateral radiograph of the lumbar aorta. The framework segments abdominal aortic calcifications for computing a CVD risk score and performs a survival analysis to validate...

  14. Cardiovascular disease risk score prediction models for women and its applicability to Asians

    Directory of Open Access Journals (Sweden)

    Goh LGH

    2014-03-01

    Full Text Available Louise GH Goh,1 Satvinder S Dhaliwal,1 Timothy A Welborn,2 Peter L Thompson,2–4 Bruce R Maycock,1 Deborah A Kerr,1 Andy H Lee,1 Dean Bertolatti,1 Karin M Clark,1 Rakhshanda Naheed,1 Ranil Coorey,1 Phillip R Della5 1School of Public Health, Curtin Health Innovation Research Institute, Curtin University, Perth, WA, Australia; 2Sir Charles Gairdner Hospital, Nedlands, Perth, WA, Australia; 3School of Population Health, University of Western Australia, Perth, WA, Australia; 4Harry Perkins Institute for Medical Research, Perth, WA, Australia; 5School of Nursing and Midwifery, Curtin Health Innovation Research Institute, Curtin University, Perth, WA, Australia Purpose: Although elevated cardiovascular disease (CVD risk factors are associated with a higher risk of developing heart conditions across all ethnic groups, variations exist between groups in the distribution and association of risk factors, and also risk levels. This study assessed the 10-year predicted risk in a multiethnic cohort of women and compared the differences in risk between Asian and Caucasian women. Methods: Information on demographics, medical conditions and treatment, smoking behavior, dietary behavior, and exercise patterns were collected. Physical measurements were also taken. The 10-year risk was calculated using the Framingham model, SCORE (Systematic COronary Risk Evaluation risk chart for low risk and high risk regions, the general CVD, and simplified general CVD risk score models in 4,354 females aged 20–69 years with no heart disease, diabetes, or stroke at baseline from the third Australian Risk Factor Prevalence Study. Country of birth was used as a surrogate for ethnicity. Nonparametric statistics were used to compare risk levels between ethnic groups. Results: Asian women generally had lower risk of CVD when compared to Caucasian women. The 10-year predicted risk was, however, similar between Asian and Australian women, for some models. These findings were

  15. Women up, men down: the clinical impact of replacing the Framingham Risk Score with the Reynolds Risk Score in the United States population.

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    Matthew C Tattersall

    Full Text Available BACKGROUND: The Reynolds Risk Score (RRS is one alternative to the Framingham Risk Score (FRS for cardiovascular risk assessment. The Adult Treatment Panel III (ATP III integrated the FRS a decade ago, but with the anticipated release of ATP IV, it remains uncertain how and which risk models will be integrated into the recommendations. We sought to define the effects in the United States population of a transition from the FRS to the RRS for cardiovascular risk assessment. METHODS: Using the National Health and Nutrition Examination Surveys, we assessed FRS and RRS in 2,502 subjects representing approximately 53.6 Million (M men (ages 50-79 and women (ages 45-79, without cardiovascular disease or diabetes. We calculated the proportion reclassified by RRS and the subset whose LDL-C goal achievement changed. RESULTS: Compared to FRS, the RRS assigns a higher risk category to 13.9% of women and 9.1% of men while assigning a lower risk to 35.7% of men and 2% of women. Overall, 4.7% of women and 1.1% of men fail to meet newly intensified LDL-C goals using the RRS. Conversely, 10.5% of men and 0.6% of women now meet LDL-C goal using RRS when they had not by FRS. CONCLUSION: In the U.S. population the RRS assigns a new risk category for one in six women and four of nine men. In general, women increase while men decrease risk. In conclusion, adopting the RRS for the 53.6 million eligible U.S. adults would result in intensification of clinical management in 1.6 M additional women and 2.10 M fewer men.

  16. Predictive value of updating framingham risk scores with novel risk markers in the U.S. general population

    NARCIS (Netherlands)

    B.S. Ferket (Bart); B.J.H. van Kempen (Bob); M.G.M. Hunink (Myriam); I. Agarwal (Isha); M. Kavousi (Maryam); O.H. Franco (Oscar); E.W. Steyerberg (Ewout); W. Max (Wendy); K.E. Fleischmann (Kirsten)

    2014-01-01

    textabstractBackground: According to population-based cohort studies CT coronary calcium score (CTCS), carotid intima-media thickness (cIMT), high-sensitivity C- reactive protein (CRP), and ankle-brachial index (ABI) are promising novel risk markers for improving cardiovascular risk assessment. Thei

  17. Comparison of contemporary risk scores for predicting outcomes after surgery for active infective endocarditis.

    Science.gov (United States)

    Wang, Tom Kai Ming; Oh, Timothy; Voss, Jamie; Gamble, Greg; Kang, Nicholas; Pemberton, James

    2015-03-01

    Decision making regarding surgery for acute bacterial endocarditis is complex given its heterogeneity and often fatal course. Few studies have investigated the utility of operative risk scores in this setting. Endocarditis-specific scores have recently been developed. We assessed the prognostic utility of contemporary risk scores for mortality and morbidity after endocarditis surgery. Additive and logistic EuroSCORE I, EuroSCORE II, additive Society of Thoracic Surgeon's (STS) Endocarditis Score and additive De Feo-Cotrufo Score were retrospectively calculated for patients undergoing surgery for endocarditis during 2005-2011. Pre-specified primary outcomes were operative mortality, composite morbidity and mortality during follow-up. A total of 146 patients were included with an operative mortality of 6.8 % followed for 4.1 ± 2.4 years. Mean scores were additive EuroSCORE I: 8.0 ± 2.5, logistic EuroSCORE I: 13.2 ± 10.1 %, EuroSCORE II: 9.1 % ± 9.4 %, STS Score: 32.2 ± 13.5 and De Feo-Cotrufo Score: 14.6 ± 9.2. Corresponding areas under curve (AUC) for operative mortality 0.653, 0.645, 0.656, 0.699 and 0.744; for composite morbidity were 0.623, 0.625, 0.720, 0.714 and 0.774; and long-term mortality 0.588, 0.579, 0.686, 0.735 and 0.751. The best tool for post-operative stroke was EuroSCORE II: AUC 0.837; for ventilation >24 h and return to theatre the De Feo-Cotrufo Scores were: AUC 0.821 and 0.712. Pre-operative inotrope or intra-aortic balloon pump treatment, previous coronary bypass grafting and dialysis were independent predictors of operative and long-term mortality. In conclusion, risk models developed specifically from endocarditis surgeries and incorporating endocarditis variables have improved prognostic ability of outcomes, and can play an important role in the decision making towards surgery for endocarditis.

  18. Correlation between the FINish diabetes risk score and the severity of coronary artery disease

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    Đurić Predrag

    2014-01-01

    Full Text Available Background/Aim. The FINish Diabetes RIsk SCore (FINDRISC which includes age, body mass index (BMI, waist circumference, physical (in activity, diet, arterial hypertension, history of high glucose levels, and family history of diabetes, is of a great significance in identifying patients with impaired glucose tolerance and a 10-year risk assessment of developing type 2 diabetes in adults. Due to the fact that the FINDRISC score includes parameters which are risk factors for coronary artery disease (CAD, our aim was to determine a correlation between this score, and some of its parameters respectively, with the severity of angiographically verified CAD in patients with stable angina in two ways: according to the Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX score and the number of diseased coronary arteries. Methods. The study included 70 patients with stable angina consecutively admitted to the Clinic of Cardiology, Military Medical Academy, Belgrade. The FINDRISC score was calculated in all the patients immediately prior to angiography. Venous blood samples were collected and inflammatory markers [erythrocyte sedimentation rate (ESR, leucocytes, C-reactive protein (CRP, total cholesterol, HDL cholesterol, triglycerides and fasting glucose] determined. Coronary angiography was performed in order to determine the severity of coronary artery disease according to the SYNTAX score and the number of affected coronary vessels: 1-vessel, 2-vessel or 3-vessel disease (hemodynamically significant stenoses: more than 70% of the blood vessel lumen. The patients were divided into three groups regarding the FINDRISC score: group I: 5-11 points; group II: 12-16 points; group III: 17-22 points. Results. Out of 70 patients (52 men and 18 women enrolled in this study, 14 had normal coronary angiogram. There was a statistically significant positive correlation between the FINDRISC score and its parameters respectively

  19. A Retrospective Analysis of Pressure Ulcer Incidence and Modified Braden Scale Score Risk Classifications.

    Science.gov (United States)

    Chen, Hong-Lin; Cao, Ying-Juan; Wang, Jing; Huai, Bao-Sha

    2015-09-01

    The Braden Scale is the most widely used pressure ulcer risk assessment in the world, but the currently used 5 risk classification groups do not accurately discriminate among their risk categories. To optimize risk classification based on Braden Scale scores, a retrospective analysis of all consecutively admitted patients in an acute care facility who were at risk for pressure ulcer development was performed between January 2013 and December 2013. Predicted pressure ulcer incidence first was calculated by logistic regression model based on original Braden score. Risk classification then was modified based on the predicted pressure ulcer incidence and compared between different risk categories in the modified (3-group) classification and the traditional (5-group) classification using chi-square test. Two thousand, six hundred, twenty-five (2,625) patients (mean age 59.8 ± 16.5, range 1 month to 98 years, 1,601 of whom were men) were included in the study; 81 patients (3.1%) developed a pressure ulcer. The predicted pressure ulcer incidence ranged from 0.1% to 49.7%. When the predicted pressure ulcer incidence was greater than 10.0% (high risk), the corresponding Braden scores were less than 11; when the predicted incidence ranged from 1.0% to 10.0% (moderate risk), the corresponding Braden scores ranged from 12 to 16; and when the predicted incidence was less than 1.0% (mild risk), the corresponding Braden scores were greater than 17. In the modified classification, observed pressure ulcer incidence was significantly different between each of the 3 risk categories (P less than 0.05). However, in the traditional classification, the observed incidence was not significantly different between the high-risk category and moderate-risk category (P less than 0.05) and between the mild-risk category and no-risk category (P less than 0.05). If future studies confirm the validity of these findings, pressure ulcer prevention protocols of care based on Braden Scale scores can

  20. Comparison of mortality risk: a score for very low birthweight infants

    Science.gov (United States)

    Maier, R; Rey, M; Metze, B; Obladen;, M; TARNOW-MORDI, W.

    1997-01-01

    AIM—To develop and evaluate a score which quantifies mortality risk in very low birthweight (VLBW) infants (birthweight below 1500 g) at admission to the neonatal intensive care unit.
METHODS—Five hundred and seventy two VLBW infants admitted from 1978 to 1987 were randomly assigned to a cohort (n = 396) for score development and a cohort (n = 176) for score validation. Two hundred and ninety four VLBW infants admitted from 1988 to 1991 were used to compare risk adjusted mortality between the two eras.
RESULTS—Using multiple regression analysis, birthweight, Apgar score at 5 minutes, base excess at admission, severity of respiratory distress syndrome, and artificial ventilation were predictive of death in the development cohort. According to regression coefficients, a score ranging from 3 to 40 was developed. At a cutoff of 21, it predicted death in the validation cohort with a sensitivity of 0.85, a specificity of 0.73, and a correct classification rate of 0.76. The area under the receiver operating characteristic curve was 0.86. There was no significant difference in risk severity and in risk adjusted mortality between the eras 1978-87 and 1988-91.
CONCLUSION—The present score is robust, easily obtainable at admission, and permits early randomisation based on mortality risk.

 Keywords: mortality risk; scoring system; very low birthweight PMID:9175942

  1. Risk stratification with the risk chart from the European Society of Hypertension compared with SCORE in the general population

    DEFF Research Database (Denmark)

    Sehestedt, Thomas; Jeppesen, Jørgen; Hansen, Tine W;

    2009-01-01

    OBJECTIVE: The risk chart from the European Society of Hypertension (ESH) and Systemic Coronary Risk Evaluation (SCORE) from the European Society of Cardiology (ESC) are equally recommended tools for risk stratification. However, ESH risk chart recommends measuring subclinical organ damage, whereas...... SCORE is based on traditional risk factors. We wanted to compare the predictive performance of the two charts. METHODS: In a Danish population sample of 1344 individuals aged 41, 51, 61 and 71 years without known diabetes, prior stroke or myocardial infarction, not receiving cardiovascular, antidiabetic...... or lipid-lowering medications and with higher than optimal blood pressure (> or =120/80 mmHg), we measured traditional risk factors and subclinical organ damage. The endpoints were cardiovascular death and a composite of cardiovascular death, nonfatal myocardial infarction and stroke (CEP). RESULTS: During...

  2. The high-density lipoprotein-adjusted SCORE model worsens SCORE-based risk classification in a contemporary population of 30,824 Europeans

    DEFF Research Database (Denmark)

    Mortensen, Martin B; Afzal, Shoaib; Nordestgaard, Børge G;

    2015-01-01

    discrimination of future fatal CVD, compared with SCORE, but decreased the detection rate (sensitivity) of the 5% high-risk threshold from 42 to 26%, yielding a negative net reclassification index (NRI) of -12%. Importantly, using SCORE-HDL, the sensitivity was zero among women. Both SCORE and SCORE.......8 years of follow-up, 339 individuals died of CVD. In the SCORE target population (age 40-65; n = 30,824), fewer individuals were at baseline categorized as high risk (≥5% 10-year risk of fatal CVD) using SCORE-HDL compared with SCORE (10 vs. 17% in men, 1 vs. 3% in women). SCORE-HDL did not improve......-HDL overestimated risk of fatal CVD. In well-calibrated models developed from the CGPS, HDL did not improve discrimination or NRI. Lowering the decision threshold from 5 to 1% led to progressive gain in NRI for both CVD mortality and morbidity. CONCLUSION: SCORE-HDL did not improve discrimination compared...

  3. Ten-year absolute risk of osteoporotic fractures according to BMD T score at menopause

    DEFF Research Database (Denmark)

    Abrahamsen, Bo; Vestergaard, Peter; Rud, Bo;

    2006-01-01

    was 10.9% as opposed to an expected risk of 5.7%. Relative risk gradients were similar to those of the recent meta-analysis. CONCLUSIONS: In healthy women, examined in the first year or two after menopause, 10-year fracture risk was higher at each level of BMD T score than expected from the model...... by Kanis et al. Inclusion of HRT users in the cohorts used may have led to higher BMD values and lower absolute fracture risk in the Kanis model. These longitudinal data can be used directly in estimating absolute fracture risk in untreated north European women from BMD at menopause....

  4. New risk markers may change the HeartScore risk classification significantly in one-fifth of the population

    DEFF Research Database (Denmark)

    Olsen, M H; Hansen, T W; Christensen, M K;

    2008-01-01

    The study aim was to determine whether urine albumin/creatinine ratio (UACR), high-sensitivity C-reactive protein (hsCRP) or N-terminal pro-brain natriuretic peptide (Nt-proBNP) added to risk prediction based on HeartScore and history of diabetes or cardiovascular disease. A Danish population sam......CRP in subjects with low-moderate risk and UACR and Nt-proBNP in subjects with known diabetes of cardiovascular disease changed HeartScore risk classification significantly in 19% of the population.......The study aim was to determine whether urine albumin/creatinine ratio (UACR), high-sensitivity C-reactive protein (hsCRP) or N-terminal pro-brain natriuretic peptide (Nt-proBNP) added to risk prediction based on HeartScore and history of diabetes or cardiovascular disease. A Danish population...... sample of 2460 individuals was divided in three groups: 472 subjects receiving cardiovascular medication or having history of diabetes, prior myocardial infarction or stroke, 559 high-risk subjects with a 10-year risk of cardiovascular death above 5% as estimated by HeartScore, and 1429 low-moderate risk...

  5. Unsupervised deep learning applied to breast density segmentation and mammographic risk scoring

    DEFF Research Database (Denmark)

    Kallenberg, Michiel Gijsbertus J.; Petersen, Peter Kersten; Nielsen, Mads

    2016-01-01

    Mammographic risk scoring has commonly been automated by extracting a set of handcrafted features from mammograms, and relating the responses directly or indirectly to breast cancer risk. We present a method that learns a feature hierarchy from unlabeled data. When the learned features are used...... as the input to a simple classifier, two different tasks can be addressed: i) breast density segmentation, and ii) scoring of mammographic texture. The proposed model learns features at multiple scales. To control the models capacity a novel sparsity regularizer is introduced that incorporates both lifetime...... and population sparsity. We evaluated our method on three different clinical datasets. Our state-of-the-art results show that the learned breast density scores have a very strong positive relationship with manual ones, and that the learned texture scores are predictive of breast cancer. The model is easy...

  6. A Risk Score to Predict Hypertension in Primary Care Settings in Rural India.

    Science.gov (United States)

    Sathish, Thirunavukkarasu; Kannan, Srinivasan; Sarma, P Sankara; Razum, Oliver; Thrift, Amanda Gay; Thankappan, Kavumpurathu Raman

    2016-01-01

    We used the data of 297 participants (15-64 years old) from a cohort study (2003-2010) who were free from hypertension at baseline, to develop a risk score to predict hypertension by primary health care workers in rural India. Age ≥35 years, current smoking, prehypertension, and central obesity were significantly associated with incident hypertension. The optimal cutoff value of ≥3 had a sensitivity of 78.6%, specificity of 65.2%, positive predictive value of 41.1%, and negative predictive value of 90.8%. The area under the receiver operating characteristic curve of the risk score was 0.802 (95% confidence interval = 0.748-0.856). This simple and easy to administer risk score could be used to predict hypertension in primary care settings in rural India.

  7. Risk Score Model for Predicting Sonographic Non-Alcoholic Fatty Liver Disease in Children and Adolescents

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    Parinaz Poursafa

    2011-06-01

    Full Text Available Objective: This study aimed to develop and test the validity of a risk score to be used as a simple tool to identify those children at high risk of sonographic non-alcoholic fatty liver disease (NAFLD. Methods:This cross-sectional study was conducted among 962 participants aged 6-18 years in Isfahan, Iran. They consisted of three groups of nearly equal number of normal-weight, overweight and obese individuals. Coefficients of the logistic regression models were used to assign a score value for each variable and the composite sonographic NAFLD risk score was calculated as the sum of those scores. Performance of model was assessed by receiver operating characteristic (ROC curve procedure. Findings:Data of 931 participants was included in the analysis. The sonographic findings of 16.8% of participants were compatible with NAFLD. Age, sex, body mass index, waist circumference and serum triglycerides level were diagnosed as factors associated with NAFLD. The risk score was calculated as 50 for sonographic NAFLD. Conclusion:This study, to the best of our knowledge is the first of its kind in the pediatric age group, focuses on predicting sonographic NAFLD from easily-measured factors. It may suggest an association of hypertriglyceridemic-waist phenotype with NAFLD in the pediatric age group.

  8. Evaluation of a risk factor scoring model in screening for undiagnosed diabetes in China population

    Institute of Scientific and Technical Information of China (English)

    Jian-jun DONG; Neng-jun LOU; Jia-jun ZHAO; Zhong-wen ZHANG; Lu-lu QIU; Ying ZHOU; Lin LIAO

    2011-01-01

    Objective:To develop a risk scoring model for screening for undiagnosed type 2 diabetes in Chinese population.Methods:A total of 5348 subjects from two districts of Jinan City,Shandong Province,China were enrolled.Group A (2985) included individuals from east of the city and Group B (2363) from west of the city.Screening questionnaires and a standard oral glucose tolerance test (OGTr) were completed by all subjects.Based on the stepwise logistic regression analysis of Group A,variables were selected to establish the risk scoring model.The validity and effectiveness of this model were evaluated in Group B.Results:Based on stepwise logistic regression analysis performed with data of Group A,variables including age,body mass index (BMI),waist-to-hip ratio (WHR),systolic pressure,diastolic pressure,heart rate,family history of diabetes,and history of high glucose were accepted into the risk scoring model.The risk for having diabetes increased along with aggregate scores.When Youden index was closest to 1,the optimal cutoff value was set up at 51.At this point,the diabetes risk scoring model could identify diabetes patients with a sensitivity of 83.3% and a specificity of 66.5%,making the positive predictive value 12.83%and negative predictive value 98.53%.We compared our model with the Finnish and Danish model and concluded that our model has superior validity in Chinese population.Conclusions:Our diabetes risk scoring model has satisfactory sensitivity and specificity for identifying undiagnosed diabetes in our population,which might be a simple and practical tool suitable for massive diabetes screening.

  9. Evaluation of the relative risk of stroke in patients with hypertension using cerebrovascular hemodynamic accumulative score

    Institute of Scientific and Technical Information of China (English)

    HUANG Jiuyi; WANG Guiqing; GUO Jiping; CAO Yifeng; WANG Yan; YANG Yongju; YU Xuehai

    2007-01-01

    The relative risk(RR)of stroke in patients with hypertension was evaluated by using synthetic index of cerebrovascular hemodynamics.A total of 7,371 patients with hypertension with ages≥40 years were selected from a population-based cohort study of the risk factors for stroke.The data on the baseline investigation of risk factors,the determination of cerebrovascular hemodynamic parameters (CVHP),and stroke follow-up were analyzed.The RR of stroke in patients with hypertension was evaluated by CVHP scores.Univariate analysis indicated that hypertension,complicated by other risk factors,had significant statistical association with the onset of stroke.RRS for stroke when hypertension complicated with decrease of hemodynamic scores,heart disease,cigarette smoking and alcohol consumption were 4.93(95%CI,3.26-7.45),1.90(95%CI,1.36-2.66),1.99(95%CI,1.42-2.79)and 1.73(95%CI,1.19-2.53)respectively.In multivariate analysis,hemodynamic score,age,sex,cigarette smoking,family history of stroke and systolic blood pressure were selected by the Cox regression for inclusion in the final analysis.Among them,the RR of hemodynamic score was highest.The analysis of doseresponse relationships indicated that when the hemodynamic scores in patients with hypertension were lower than 75 points,the RR of stroke at 75,60,45,30 and 15 points were 2.85,4.43,4.54,5.40 and 9.88,respectively.The risk of stroke in patients with hypertension is closely associated with hemodynamic impairment and the hemodynamic score may be used for quantitative evaluation of relative risks of stroke.

  10. The value of the CHA2DS2-VASc score for refining stroke risk stratification in patients with atrial fibrillation with a CHADS2 score 0-1

    DEFF Research Database (Denmark)

    Olesen, Jonas Bjerring; Torp-Pedersen, Christian; Hansen, Morten Lock

    2012-01-01

    associated with increasing CHA2DS2-VASc score was estimated in Cox regression models adjusted for year of inclusion and antiplatelet therapy. The value of adding the extra CHA2DS2-VASc risk factors to the CHADS2 score was evaluated by c-statistics, Net Reclassification Improvement (NRI) and Integrated....... Of the cohort with a CHADS2 score of 0-1, the stroke/thromboembolism rate per 100 person-years increased with increasing CHA2DS2-VASc score (95% confidence interval): 0.84 (0.65-1.08), 1.79 (1.53-2.09), 3.67 (3.34-4.03), 5.75 (5.33-6.21), and 8.18 (6.68-10.02) at one year follow-up with CHA2DS2-VASc scores of 0......DS2-VASc score significantly improved the predictive value of the CHADS2 score alone and a CHA2DS2-VASc score=0 could clearly identify 'truly low risk' subjects. Use of the CHA2DS2-VASc score would significantly improve classification of AF patients at low and intermediate risk of stroke, compared...

  11. A modified risk assessment scoring system for post laser in situ keratomileusis ectasia in topographically normal patients

    Directory of Open Access Journals (Sweden)

    Mohammad Miraftab

    2014-01-01

    Conclusion: Our modified ectasia risk scoring system for patients with normal corneal topography can predict post LASIK ectasia risk with acceptable sensitivity and specificity. However, there are still unidentified risk factors for which further studies are required.

  12. Assessment of the EuroSCORE risk scoring system for patients undergoing coronary artery bypass graft surgery in a group of Iranian patients

    Directory of Open Access Journals (Sweden)

    Hamidreza Jamaati

    2015-01-01

    Full Text Available Background and Aims: Previous studies around the world indicated validity and accuracy of European System for Cardiac Operative Risk Evaluation (EuroSCORE risk scoring system we evaluated the EuroSCORE risk scoring system for patients undergoing coronary artery bypass graft (CABG surgery in a group of Iranian patients. Materials and Methods: In this cohort 2220 patients more than 18 years, who were performed CABG surgery in Massih Daneshvari Hospital, from January 2004 to March 2010 were recruited. Predicted mortality risk scores were calculated using logistic EuroSCORE and Acute Physiology and Chronic Health Evaluation II (APACHE II and compared with observed mortality. Calibration was measured by the Hosmer-Lemeshow (HL test and discrimination by using the receiver operating characteristic (ROC curve area. Results: Of the 2220 patients, in hospital deaths occurred in 270 patients (mortality rate of 12.2%. The accuracy of mortality prediction in the logistic EuroSCORE and APACHE II model was 89.1%; in the local EuroSCORE (logistic was 91.89%; and in the local EuroSCORE support vector machines (SVM was 98.6%. The area under curve for ROC curve, was 0.724 (95% confidence interval [CI]: 0.57-0.88 for logistic EuroSCORE; 0.836 (95% CI: 0.731-0.942 for local EuroSCORE (logistic; 0.978 (95% CI: 0.937-1 for Local EuroSCORE (SVM; and 0.832 (95% CI: 0.723-0.941 for APACHE II model. The HL test showed good calibration for the local EuroSCORE (SVM, APACHE II model and local EuroSCORE (logistic (P = 0.823, P = 0.748 and P = 0.06 respectively; but there was a significant difference between expected and observed mortality according to EuroSCORE model (P = 0.033. Conclusion: We detected logistic EuroSCORE risk model is not applicable on Iranian patients undergoing CABG surgery.

  13. Development of an adverse drug reaction risk assessment score among hospitalized patients with chronic kidney disease.

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    Fatemeh Saheb Sharif-Askari

    Full Text Available BACKGROUND: Adverse drug reactions (ADRs represent a major burden on the healthcare system. Chronic kidney disease (CKD patients are particularly vulnerable to ADRs because they are usually on multiple drug regimens, have multiple comorbidities, and because of alteration in their pharmacokinetics and pharmacodynamic parameters. Therefore, one step towards reducing this burden is to identify patients who are at increased risk of an ADR. OBJECTIVE: To develop a method of identifying CKD patients who are at increased risk for experiencing ADRs during hospitalisation. MATERIALS AND METHODS: Factors associated with ADRs were identified by using demographic, clinical and laboratory variables of patients with CKD stages 3 to 5 (estimated glomerular filtration rate, 10-59 ml/min/1.73 m2 who were admitted between January 1, 2012, and December 31, 2012, to the renal unit of Dubai Hospital. An ADR risk score was developed by constructing a series of logistic regression models. The overall model performance for sequential models was evaluated using Akaike Information Criterion for goodness of fit. Odd ratios of the variables retained in the best model were used to compute the risk scores. RESULTS: Of 512 patients (mean [SD] age, 60 [16] years, 62 (12.1% experienced an ADR during their hospitalisation. An ADR risk score included age 65 years or more, female sex, conservatively managed end-stage renal disease, vascular disease, serum level of C-reactive protein more than 10 mg/L, serum level of albumin less than 3.5 g/dL, and the use of 8 medications or more during hospitalization. The C statistic, which assesses the ability of the risk score to predict ADRs, was 0.838; 95% CI, 0.784-0.892. CONCLUSION: A score using routinely available patient data can be used to identify CKD patients who are at increased risk of ADRs.

  14. The development of a risk score for unplanned removal of peripherally inserted central catheter in newborns

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    Priscila Costa

    2015-06-01

    Full Text Available OBJECTIVE: to develop a risk score for unplanned removal of peripherally inserted central catheter in newborns.METHOD: prospective cohort study conducted in a neonatal intensive care unit with newborn babies who underwent 524 catheter insertions. The clinical characteristics of the newborn, catheter insertion and intravenous therapy were tested as risk factors for the unplanned removal of catheters using bivariate analysis. The risk score was developed using logistic regression. Accuracy was internally validated based on the area under the Receiver Operating Characteristic curve.RESULTS: the risk score was made up of the following risk factors: transient metabolic disorders; previous insertion of catheter; use of a polyurethane double-lumen catheter; infusion of multiple intravenous solutions through a single-lumen catheter; and tip in a noncentral position. Newborns were classified into three categories of risk of unplanned removal: low (0 to 3 points, moderate (4 to 8 points, and high (≥ 9 points. Accuracy was 0.76.CONCLUSION: the adoption of evidence-based preventative strategies based on the classification and risk factors faced by the newborn is recommended to minimize the occurrence of unplanned removals.

  15. Predictive value of updating Framingham risk scores with novel risk markers in the U.S. general population.

    Directory of Open Access Journals (Sweden)

    Bart S Ferket

    Full Text Available BACKGROUND: According to population-based cohort studies CT coronary calcium score (CTCS, carotid intima-media thickness (cIMT, high-sensitivity C- reactive protein (CRP, and ankle-brachial index (ABI are promising novel risk markers for improving cardiovascular risk assessment. Their impact in the U.S. general population is however uncertain. Our aim was to estimate the predictive value of four novel cardiovascular risk markers for the U.S. general population. METHODS AND FINDINGS: Risk profiles, CRP and ABI data of 3,736 asymptomatic subjects aged 40 or older from the National Health and Nutrition Examination Survey (NHANES 2003-2004 exam were used along with predicted CTCS and cIMT values. For each subject, we calculated 10-year cardiovascular risks with and without each risk marker. Event rates adjusted for competing risks were obtained by microsimulation. We assessed the impact of updated 10-year risk scores by reclassification and C-statistics. In the study population (mean age 56±11 years, 48% male, 70% (80% were at low (<10%, 19% (14% at intermediate (≥10-<20%, and 11% (6% at high (≥20% 10-year CVD (CHD risk. Net reclassification improvement was highest after updating 10-year CVD risk with CTCS: 0.10 (95%CI 0.02-0.19. The C-statistic for 10-year CVD risk increased from 0.82 by 0.02 (95%CI 0.01-0.03 with CTCS. Reclassification occurred most often in those at intermediate risk: with CTCS, 36% (38% moved to low and 22% (30% to high CVD (CHD risk. Improvements with other novel risk markers were limited. CONCLUSIONS: Only CTCS appeared to have significant incremental predictive value in the U.S. general population, especially in those at intermediate risk. In future research, cost-effectiveness analyses should be considered for evaluating novel cardiovascular risk assessment strategies.

  16. Risk of Asthma in Late Preterm Infants: A Propensity Score Approach

    Science.gov (United States)

    Voge, Gretchen A; Katusic, Slavica K; Qin, Rui; Juhn, Young J

    2015-01-01

    Background The risk of asthma, specifically in former late preterm infants, has not been well defined. Covariate imbalance and lack of controlling for this has led to inconsistent results in prior studies. Objective Determine the risk of asthma in former late preterm infants using a propensity score approach. Methods The study was a population-based birth cohort study. Study subjects were all children born in Rochester, Minnesota, between 1976 and 1982. Asthma status during the first seven years of life was assessed by applying predetermined criteria. The propensity score was formulated using 15 covariates by fitting a logistic regression model for late preterm birth versus term birth. We applied the propensity score method to match late preterm infants (34 0/7 to 36 6/7 weeks gestation) to term infants (37 0/7 to 40 6/7 weeks gestation) within a caliper of 0.2 standard deviation of logit of propensity score. Results Of the eligible 7,040 infants, 5,915 children had complete data. Before propensity score matching, late preterm infants had a higher risk of asthma (20 of 262, 7.6%) compared to full-term infants (272 of 5,653, 4.8%)(p=0.039). There was significant covariate imbalance between comparison groups. After matching with propensity scores, we found that former late preterm infants had a similar risk of asthma to the matched full-term infants (6.6% vs. 7.7%, respectively, p=0.61), and the result were consistent with covariate-adjustment, Cox regression models controlling for significant covariates (p=0.57). Conclusion A late preterm birth history is not independently associated with childhood asthma, as the reported risk of asthma among former late preterm infants appears to be due to covariate imbalance. PMID:25944734

  17. A clinically useful risk-score for chronic kidney disease in HIV infection

    DEFF Research Database (Denmark)

    Mocroft, Amanda; Lundgren, Jens; Ross, Michael;

    2014-01-01

    baseline eGFR, female gender, lower CD4 nadir, hypertension, diabetes and cardiovascular disease predicted CKD and were included in the risk score (Figure 1). The incidence of CKD in those at low, medium and high risk was 0.8/1000 PYFU (95% CI 0.6-1.0), 5.6 (95% CI 4.5-6.7) and 37.4 (95% CI 34.......0-40.7) (Figure 1). The risk score showed good discrimination (Harrell's c statistic 0.92, 95% CI 0.90-0.93). The number needed to harm (NNTH) in patients starting ATV or LPV/r was 1395, 142 or 20, respectively, among those with low, medium or high risk. NNTH were 603, 61 and 9 for those with a low, medium...

  18. An Inflammatory Polymorphisms Risk Scoring System for the Differentiation of Ischemic Stroke Subtypes

    Science.gov (United States)

    Muiño, Elena; Krupinski, Jurek; Carrera, Caty; Gallego-Fabrega, Cristina; Montaner, Joan; Fernández-Cadenas, Israel

    2015-01-01

    Inflammation has been associated with atherothrombotic stroke and recently with cardioembolic stroke. Different genetic risk factors have been specifically associated with the subtypes of ischemic stroke (cardioembolic, atherothrombotic, and lacunar). However, there are no studies that have generated genetic risk scores for the different subtypes of ischemic stroke using polymorphisms associated with inflammation. Methods. We have analyzed 68 polymorphisms of 30 inflammatory mediator genes in 2,685 subjects: 1,987 stroke cases and 698 controls. We generated a genetic scoring system with the most significant polymorphisms weighted by the odds ratio of every polymorphism and taken into consideration the stroke subtype. Results. Three polymorphisms, rs1205 (CRP gene), rs1800779, and rs2257073 (NOS3 gene), were associated with cardioembolic stroke (p value <0.05). The score generated was only associated with the cardioembolic stroke subtype (p value: 0.001) and was replicated in an independent cohort (p value: 0.017). The subjects with the highest score presented a cardioembolic stroke in 92.2% of the cases (p value: 0.002). Conclusion. The genetics of inflammatory markers is more closely associated with cardioembolic strokes than with atherothrombotic or lacunar strokes. The genetic risk scoring system could be useful in the prediction and differentiation of ischemic stroke; however, it might be specific to particular ischemic stroke subtypes. PMID:26355258

  19. Obstetrical complications and Apgar score in subjects at risk of psychosis.

    Science.gov (United States)

    Kotlicka-Antczak, Magdalena; Pawełczyk, Agnieszka; Rabe-Jabłońska, Jolanta; Smigielski, Janusz; Pawełczyk, Tomasz

    2014-01-01

    The objective of the study was to identify associations between a history of obstetrical complications (OCs) and the future development of symptoms indicating risk of psychosis (At Risk Mental State - ARMS). The frequency of OCs was assessed in 66 ARMS subjects, 50 subjects with the first episode of schizophrenia (FES) and 50 healthy controls. Obstetrical data was obtained from medical documentation and evaluated with the Lewis and Murray Scale. Definite OCs, according to the Lewis and Murray Scale, occurred significantly more frequently in the ARMS group compared to the controls (χ(2) = 7.79, p = 0.005; OR = 4.20, 95% CI = 1.46-12.11), as well as in the FES subjects compared to the controls (χ(2) = 8.39, p = 0.004; OR = 4.64, 95% CI = 1.56-13.20). Apgar scores in the first (Apgar 1) and the fifth minute after birth (Apgar 5) were significantly lower in the FES subjects compared to the controls (for Apgar 1 score Z = 4.439, p Apgar 5 score Z = 5.250, p Apgar 5 scores compared to the healthy controls (Z = 3.458, p = 0.0016). The results indicate that OCs and low Apgar 5 score should be considered important factors in identifying subjects at risk of developing psychosis.

  20. Diet scores and cardio-metabolic risk factors among Guatemalan young adults.

    Science.gov (United States)

    Gregory, Cria O; McCullough, Marjorie L; Ramirez-Zea, Manuel; Stein, Aryeh D

    2009-06-01

    We assessed the association of four diet quality scores with multiple cardio-metabolic outcomes among Guatemalan young adults experiencing the nutrition transition. We obtained cross-sectional dietary, demographic, anthropometric and cardio-metabolic risk factor data from 1220 Guatemalan adults (mean age 32.7 (sd 5.8) years) in 2002-4, and computed a Recommended Food Score (RFS), Not Recommended Food Score (NRFS), Food Variety Score (FVS) and the Dietary Quality Index-International (DQI-I). All four scores were correlated with energy intake (r 0.23-0.49; all P metabolic syndrome or its components; rather some were positively associated with risk factors. Among both men and women the DQI-I was positively associated with BMI (kg/m2; beta = 0.10, 95 % CI 0.003, 0.21 (men); beta = 0.07, 95 % CI 0.01, 0.14 (women)) and waist circumference (cm; beta = 0.02, 95 % CI 0.01, 0.03 (men); beta = 0.02, 95 % CI = 0.01, 0.02 (women)). Among men, the RFS was positively associated with TAG (mg/l; beta = 0.11, 95 % CI 0.02, 0.21) and glucose (mg/l; beta = 0.13: 95 % CI 0.03, 0.22). We conclude that indices of diet quality are not consistently associated with chronic disease risk factor prevalence in this population of Guatemalan young adults.

  1. An Asian validation of the TIMI risk score for ST-segment elevation myocardial infarction.

    Directory of Open Access Journals (Sweden)

    Sharmini Selvarajah

    Full Text Available BACKGROUND: Risk stratification in ST-elevation myocardial infarction (STEMI is important, such that the most resource intensive strategy is used to achieve the greatest clinical benefit. This is essential in developing countries with wide variation in health care facilities, scarce resources and increasing burden of cardiovascular diseases. This study sought to validate the Thrombolysis In Myocardial Infarction (TIMI risk score for STEMI in a multi-ethnic developing country. METHODS: Data from a national, prospective, observational registry of acute coronary syndromes was used. The TIMI risk score was evaluated in 4701 patients who presented with STEMI. Model discrimination and calibration was tested in the overall population and in subgroups of patients that were at higher risk of mortality; i.e., diabetics and those with renal impairment. RESULTS: Compared to the TIMI population, this study population was younger, had more chronic conditions, more severe index events and received treatment later. The TIMI risk score was strongly associated with 30-day mortality. Discrimination was good for the overall study population (c statistic 0.785 and in the high risk subgroups; diabetics (c statistic 0.764 and renal impairment (c statistic 0.761. Calibration was good for the overall study population and diabetics, with χ2 goodness of fit test p value of 0.936 and 0.983 respectively, but poor for those with renal impairment, χ2 goodness of fit test p value of 0.006. CONCLUSIONS: The TIMI risk score is valid and can be used for risk stratification of STEMI patients for better targeted treatment.

  2. Development of a Simple Clinical Risk Score for Early Prediction of Severe Dengue in Adult Patients.

    Directory of Open Access Journals (Sweden)

    Ing-Kit Lee

    Full Text Available We aimed to develop and validate a risk score to aid in the early identification of laboratory-confirmed dengue patients at high risk of severe dengue (SD (i.e. severe plasma leakage with shock or respiratory distress, or severe bleeding or organ impairment. We retrospectively analyzed data of 1184 non-SD patients at hospital presentation and 69 SD patients before SD onset. We fit a logistic regression model using 85% of the population and converted the model coefficients to a numeric risk score. Subsequently, we validated the score using the remaining 15% of patients. Using the derivation cohort, two scoring algorithms for predicting SD were developed: models 1 (dengue illness ≤4 days and 2 (dengue illness >4 days. In model 1, we identified four variables: age ≥65 years, minor gastrointestinal bleeding, leukocytosis, and platelet count ≥100×109 cells/L. Model 1 (ranging from -2 to +6 points showed good discrimination between SD and non-SD, with an area under the receiver operating characteristic curve (AUC of 0.848 (95% confidence interval [CI], 0.771-0.924. The optimal cutoff value for model 1 was 1 point, with a sensitivity and specificity for predicting SD of 70.3% and 90.6%, respectively. In model 2 (ranging from 0 to +3 points, significant predictors were age ≥65 years and leukocytosis. Model 2 showed an AUC of 0.859 (95% CI, 0.756-0.963, with an optimal cutoff value of 1 point (sensitivity, 80.3%; specificity, 85.8%. The median interval from hospital presentation to SD was 1 day. This finding underscores the importance of close monitoring, timely resuscitation of shock including intravenous fluid adjustment and early correction of dengue-related complications to prevent the progressive dengue severity. In the validation data, AUCs of 0.904 (95% CI, 0.825-0.983 and 0.917 (95% CI, 0.833-1.0 in models 1 and 2, respectively, were achieved. The observed SD rates (in both cohorts were 50% for those with a score of ≥2 points

  3. Risk scoring systems for adults admitted to the emergency department: a systematic review

    DEFF Research Database (Denmark)

    Brabrand, Mikkel; Folkestad, Lars; Clausen, Nicola G

    2010-01-01

    , on scoring systems developed to assess medical patients at admission. The primary endpoints were in-hospital mortality or transfer to the intensive care unit. Studies derived for only a single or few diagnoses were excluded. The ability to identify patients at risk (discriminatory power) and agreement......ABSTRACT: BACKGROUND: Patients referred to a medical admission unit (MAU) represent a broad spectrum of disease severity. In the interest of allocating resources to those who might potentially benefit most from clinical interventions, several scoring systems have been proposed as a triaging tool...... are perfect and all have their weaknesses. More research is needed before the use of scoring systems can be fully implemented to the risk assessment of acutely admitted medical patients....

  4. Prediction of individual genetic risk to prostate cancer using a polygenic score

    DEFF Research Database (Denmark)

    Szulkin, Robert; Whitington, Thomas; Eklund, Martin

    2015-01-01

    BACKGROUND: Polygenic risk scores comprising established susceptibility variants have shown to be informative classifiers for several complex diseases including prostate cancer. For prostate cancer it is unknown if inclusion of genetic markers that have so far not been associated with prostate ca...

  5. Genetic risk scores and number of autoantibodies in patients with rheumatoid arthritis

    NARCIS (Netherlands)

    Maehlen, Marthe T.; Olsen, Inge C.; Andreassen, Bettina K.; Viken, Marte K.; Jiang, Xia; Alfredsson, Lars; Kallberg, Henrik; Brynedal, Boel; Kurreeman, Fina; Daha, Nina; Toes, Rene; Zhernakova, Alexandra; Gutierrez-Achury, Javier; de Bakker, Paul I. W.; Martin, Javier; Teruel, Maria; Gonzalez-Gay, Miguel A.; Rodriguez-Rodriguez, Luis; Balsa, Alejandro; Uhlig, Till; Kvien, Tore K.; Lie, Benedicte A.

    2015-01-01

    Objective Certain HLA-DRB1 alleles and single-nucleotide polymorphisms (SNPs) are associated with rheumatoid arthritis (RA). Our objective was to examine the combined effect of these associated variants, calculated as a cumulative genetic risk score (GRS) on RA predisposition, as well as the number

  6. Impact of malnutrition on pediatric risk of mortality score and outcome in Pediatric Intensive Care Unit

    OpenAIRE

    2016-01-01

    Objectives: This study was done to determine the effect of malnutrition on mortality in Pediatric Intensive Care Unit (PICU) and on the pediatric risk of mortality (PRISM) scoring. Subjects and Methods: This was a prospective study done over 1 year. There were total 400 patients (1 month 14 years), who were divided into cases with weight for age

  7. A clinical and echocardiographic score for assigning risk of major events after dobutamine echocardiograms

    NARCIS (Netherlands)

    T. Marwick (Thomas); L. Case (Laura); D. Poldermans (Don); H. Boersma (Eric); J.J. Bax (Jeroen); T. Sawada (Takahiro); J.D. Thomas (James)

    2004-01-01

    textabstractObjectives We sought to develop and validate a risk score combining both clinical and dobutamine echocardiographic (DbE) features in 4,890 patients who underwent DbE at three expert laboratories and were followed for death or myocardial infarction for up to five years. Background In cont

  8. Prostate cancer staging with extracapsular extension risk scoring using multiparametric MRI: a correlation with histopathology

    Energy Technology Data Exchange (ETDEWEB)

    Boesen, Lars; Mikines, Kari [Herlev University Hospital, Department of Urology, Herlev (Denmark); Chabanova, Elizaveta; Loegager, Vibeke; Thomsen, Henrik S. [Herlev University Hospital, Department of Radiology, Herlev (Denmark); Balslev, Ingegerd [Herlev University Hospital, Department of Pathology, Herlev (Denmark)

    2015-06-01

    To evaluate the diagnostic performance of preoperative multiparametric MRI with extracapsular extension (ECE) risk-scoring in the assessment of prostate cancer tumour stage (T-stage) and prediction of ECE at final pathology. Eighty-seven patients with clinically localised prostate cancer scheduled for radical prostatectomy were prospectively enrolled. Multiparametric MRI was performed prior to prostatectomy, and evaluated according to the ESUR MR prostate guidelines by two different readers. An MRI clinical T-stage (cT{sub MRI}), an ECE risk score, and suspicion of ECE based on tumour characteristics and personal opinion were assigned. Histopathological prostatectomy results were standard reference. Histopathology and cT{sub MRI} showed a spearman rho correlation of 0.658 (p < 0.001) and a weighted kappa = 0.585 [CI 0.44;0.73](reader A). ECE was present in 31/87 (36 %) patients. ECE risk-scoring showed an AUC of 0.65-0.86 on ROC-curve for both readers, with sensitivity and specificity of 81 % and 78 % at best cutoff level (reader A), respectively. When tumour characteristics were influenced by personal opinion, the sensitivity and specificity for prediction of ECE changed to 61 %-74 % and 77 %-88 % for the readers, respectively. Multiparametric MRI with ECE risk-scoring is an accurate diagnostic technique in determining prostate cancer clinical tumour stage and ECE at final pathology. (orig.)

  9. Diet Quality Scores and Risk of Nasopharyngeal Carcinoma in Chinese Adults: A Case-Control Study.

    Science.gov (United States)

    Wang, Cheng; Lin, Xiao-Ling; Fan, Yu-Ying; Liu, Yuan-Ting; Zhang, Xing-Lan; Lu, Yun-Kai; Xu, Chun-Hua; Chen, Yu-Ming

    2016-02-25

    Many studies show that dietary factors may affect the risk of nasopharyngeal carcinoma (NPC). We examined the association between overall diet quality and NPC risk in a Chinese population. This case-control study included 600 NPC patients and 600 matched controls between 2009 and 2011 in Guangzhou, China. Habitual dietary intake and various covariates were assessed via face-to-face interviews. Diet quality scores were calculated according to the Healthy Eating Index-2005 (HEI-2005), the alternate Healthy Eating Index (aHEI), the Diet Quality Index-International (DQI-I), and the alternate Mediterranean Diet Score (aMed). After adjustment for various lifestyle and dietary factors, greater diet quality scores on the HEI-2005, aHEI, and DQI-I-but not on the aMed-showed a significant association with a lower risk of NPC (p-trends, <0.001-0.001). The odds ratios (95% confidence interval) comparing the extreme quartiles of the three significant scores were 0.47 (0.32-0.68) (HEI-2005), 0.48 (0.33-0.70) (aHEI), and 0.43 (0.30-0.62) (DQI-I). In gender-stratified analyses, the favorable association remained significant in men but not in women. We found that adherence to the predefined dietary patterns represented by the HEI-2005, aHEI, and DQI-I scales predicted a lower risk of NPC in adults from south China, especially in men.

  10. Integrative prognostic risk score in acute myeloid leukemia with normal karyotype

    NARCIS (Netherlands)

    F. Damm (Frederik); M. Heuser (Michael); H.M. Morgan (Helen); K. Wagner (Katharina); K. Görlich (Kerstin); A. Großhennig (Anika); I. Hamwi (Iyas); F. Thol (Felicitas); E. Surdziel (Ewa); W. Fiedler (Walter); M. Lübbert (Michael); L. Kanz (Lothar); C. Reuter (Christoph); G. Heil (Gerhard); H.R. Delwel (Ruud); B. Löwenberg (Bob); P.J.M. Valk (Peter); J. Krauter; A. Ganser (Arnold)

    2011-01-01

    textabstractTo integrate available clinical and molecular information for cytogenetically normal acute myeloid leukemia (CN-AML) patients into one risk score, 275 CN-AML patients from multicenter treatment trials AML SHG Hannover 0199 and 0295 and 131 patients from HOVON/SAKK protocols as external c

  11. Autism risk assessment in siblings of affected children using sex-specific genetic scores

    Directory of Open Access Journals (Sweden)

    Carayol Jerome

    2011-10-01

    Full Text Available Abstract Background The inheritance pattern in most cases of autism is complex. The risk of autism is increased in siblings of children with autism and previous studies have indicated that the level of risk can be further identified by the accumulation of multiple susceptibility single nucleotide polymorphisms (SNPs allowing for the identification of a higher-risk subgroup among siblings. As a result of the sex difference in the prevalence of autism, we explored the potential for identifying sex-specific autism susceptibility SNPs in siblings of children with autism and the ability to develop a sex-specific risk assessment genetic scoring system. Methods SNPs were chosen from genes known to be associated with autism. These markers were evaluated using an exploratory sample of 480 families from the Autism Genetic Resource Exchange (AGRE repository. A reproducibility index (RI was proposed and calculated in all children with autism and in males and females separately. Differing genetic scoring models were then constructed to develop a sex-specific genetic score model designed to identify individuals with a higher risk of autism. The ability of the genetic scores to identify high-risk children was then evaluated and replicated in an independent sample of 351 affected and 90 unaffected siblings from families with at least 1 child with autism. Results We identified three risk SNPs that had a high RI in males, two SNPs with a high RI in females, and three SNPs with a high RI in both sexes. Using these results, genetic scoring models for males and females were developed which demonstrated a significant association with autism (P = 2.2 × 10-6 and 1.9 × 10-5, respectively. Conclusions Our results demonstrate that individual susceptibility associated SNPs for autism may have important differential sex effects. We also show that a sex-specific risk score based on the presence of multiple susceptibility associated SNPs allow for the identification of

  12. A novel risk score to predict cardiovascular disease risk in national populations (Globorisk)

    DEFF Research Database (Denmark)

    Hajifathalian, Kaveh; Ueda, Peter; Lu, Yuan

    2015-01-01

    BACKGROUND: Treatment of cardiovascular risk factors based on disease risk depends on valid risk prediction equations. We aimed to develop, and apply in example countries, a risk prediction equation for cardiovascular disease (consisting here of coronary heart disease and stroke) that can be reca...

  13. Assessing the Caprini Score for Risk Assessment of Venous Thromboembolism in Hospitalized Medical Patients

    Science.gov (United States)

    Chopra, Vineet; Bernstein, Steven J.; Hofer, Timothy P.; Flanders, Scott A.

    2017-01-01

    Background The optimal approach to assess risk of venous thromboembolism (VTE) in hospitalized medical patients is unknown. We examined how well the Caprini risk assessment model (RAM) predicts VTE in hospitalized medical patients. Methods Between January 2011 and March 2014, VTE events and risk factors were collected from non-intensive care unit (ICU) medical patients hospitalized in facilities across Michigan. Following calculation of the Caprini score for each patient, mixed logistic spline regression was used to determine the predicted probabilities of 90-day VTE by receipt of pharmacologic prophylaxis across the Caprini risk continuum. Results A total of 670 (1.05%) of 63,548 eligible patients experienced a VTE event within 90 days of hospital admission. The mean Caprini risk score was 4.94 (range 0 - 28). Predictive modeling revealed a consistent linear increase in VTE for Caprini scores between 1-10; estimates beyond a score of 10 were unstable. Receipt of pharmacologic prophylaxis resulted in a modest decrease in VTE risk (odds ratio=0.85; 95% confidence interval 0.72 - 0.99, p = 0.04). However, the low overall incidence of VTE led to large estimates of numbers needed to treat in order to prevent a single VTE event. A Caprini cut-point demonstrating clear benefit of prophylaxis was not detected. Conclusions Although a linear association between the Caprini RAM and risk of VTE was noted, an extremely low incidence of VTE events in non-ICU medical patients was observed. The Caprini RAM was unable to identify a subset of medical patients who benefit from pharmacologic prophylaxis. PMID:26551977

  14. SBRT for the Primary Treatment of Localized Prostate Cancer: The Effect of Gleason Score, Dose and Heterogeneity of Intermediate risk on Outcome Utilizing 2.2014 NCCN Risk Stratification Guidelines

    Directory of Open Access Journals (Sweden)

    Matthew eBernetich

    2014-11-01

    Full Text Available Purpose: To report an update of our previous experience using stereotactic body radiation therapy (SBRT for the primary treatment of prostate cancer, risk stratified by the updated NCCN version 2.2014, reporting efficacy and toxicity in a community hospital setting.Methods: From 2007 to 2012, 142 localized prostate cancer patients were treated with SBRT using CyberKnife. NCCN guidelines Version 2.2014 risk groups analyzed included very low (20%, low (23%, intermediate (35%, and high (22% risk. To further explore group heterogeneity and to comply with new guidelines, we separated our prior intermediate risk group into favorable intermediate and unfavorable intermediate groups depending on how many intermediate risk factors were present (one vs. >one. The unfavorable intermediate group was further analyzed in combination with the high risk group as per NCCN guidelines Version 2.2014.Various dose levels were used over the years of treatment, and have been categorized into low dose (35 Gy, n=5 or 36.25 Gy, n=107 and high dose (37.5 Gy, n=30. All treatments were delivered in five fractions. Toxicity was assessed using Radiation Therapy Oncology Group criteria.Results: 5-year actuarial freedom from biochemical failure (FFBF was 100%, 91.7%, 95.2%, 90.0% and 86.7% for very low, low, intermediate and high risk patients, respectively (NS. A significant difference in 5 year FFBF was noted for patients with Gleason score >8 vs. 7 vs. 5/6 (p=0.03 and low vs. high dose (p=0.05. T-stage, pretreatment PSA, age, risk stratification group and use of ADT did not affect 5-year FFBF. Multivariate analysis revealed Gleason score and dose to be the most predictive factors for 5-year FFBF.Conclusion: Our experience with SBRT for the primary treatment of localized prostate cancer demonstrates favorable efficacy and toxicity comparable to the results reported for IMRT in literature. Gleason score remains the single most important pretreatment predictor of outcome.

  15. Population-standardized genetic risk score: the SNP-based method of choice for inherited risk assessment of prostate cancer

    Directory of Open Access Journals (Sweden)

    Carly A Conran

    2016-01-01

    Full Text Available Several different approaches are available to clinicians for determining prostate cancer (PCa risk. The clinical validity of various PCa risk assessment methods utilizing single nucleotide polymorphisms (SNPs has been established; however, these SNP-based methods have not been compared. The objective of this study was to compare the three most commonly used SNP-based methods for PCa risk assessment. Participants were men (n = 1654 enrolled in a prospective study of PCa development. Genotypes of 59 PCa risk-associated SNPs were available in this cohort. Three methods of calculating SNP-based genetic risk scores (GRSs were used for the evaluation of individual disease risk such as risk allele count (GRS-RAC, weighted risk allele count (GRS-wRAC, and population-standardized genetic risk score (GRS-PS. Mean GRSs were calculated, and performances were compared using area under the receiver operating characteristic curve (AUC and positive predictive value (PPV. All SNP-based methods were found to be independently associated with PCa (all P 0.05 for comparisons between the three methods, and all three SNP-based methods had a significantly higher AUC than family history (all P < 0.05. Results from this study suggest that while the three most commonly used SNP-based methods performed similarly in discriminating PCa from non-PCa at the population level, GRS-PS is the method of choice for risk assessment at the individual level because its value (where 1.0 represents average population risk can be easily interpreted regardless of the number of risk-associated SNPs used in the calculation.

  16. The New York PTSD Risk Score for Assessment of Psychological Trauma: Male and Female Versions

    Science.gov (United States)

    Boscarino, Joseph A.; Kirchner, H. Lester; Hoffman, Stuart N.; Sartorius, Jennifer; Adams, Richard E.; Figley, Charles R.

    2012-01-01

    We previously developed a new posttraumatic stress disorder (PTSD) screening instrument – the New York PTSD Risk Score (NYPRS). Since research suggests different PTSD risk factors and outcomes for men and women, in the current study we assessed the suitability of male and female versions of this screening instrument among 3,298 adults exposed to traumatic events. Using diagnostic test methods, including receiver operating curve (ROC) and bootstrap techniques, we examined different prediction domains, including core PTSD symptoms, trauma exposures, sleep disturbances, depression symptoms, and other measures to assess PTSD prediction models for men and women. While the original NYPRS worked well in predicting PTSD, significant interaction was detected by gender, suggesting that separate models are warranted for men and women. Model comparisons suggested that while the overall results appeared robust, prediction results differed by gender. For example, for women, core PTSD symptoms contributed more to the prediction score than for men. For men, depression symptoms, sleep disturbance, and trauma exposure contributed more to the prediction score. Men also had higher cut-off scores for PTSD compared to women. There were other gender-specific differences as well. The NYPRS is a screener that appears to be effective in predicting PTSD status among at-risk populations. However, consistent with other medical research, this instrument appears to require male and female versions to be the most effective. PMID:22648009

  17. What does my patient's coronary artery calcium score mean? Combining information from the coronary artery calcium score with information from conventional risk factors to estimate coronary heart disease risk

    Directory of Open Access Journals (Sweden)

    Pletcher Mark J

    2004-08-01

    Full Text Available Abstract Background The coronary artery calcium (CAC score is an independent predictor of coronary heart disease. We sought to combine information from the CAC score with information from conventional cardiac risk factors to produce post-test risk estimates, and to determine whether the score may add clinically useful information. Methods We measured the independent cross-sectional associations between conventional cardiac risk factors and the CAC score among asymptomatic persons referred for non-contrast electron beam computed tomography. Using the resulting multivariable models and published CAC score-specific relative risk estimates, we estimated post-test coronary heart disease risk in a number of different scenarios. Results Among 9341 asymptomatic study participants (age 35–88 years, 40% female, we found that conventional coronary heart disease risk factors including age, male sex, self-reported hypertension, diabetes and high cholesterol were independent predictors of the CAC score, and we used the resulting multivariable models for predicting post-test risk in a variety of scenarios. Our models predicted, for example, that a 60-year-old non-smoking non-diabetic women with hypertension and high cholesterol would have a 47% chance of having a CAC score of zero, reducing her 10-year risk estimate from 15% (per Framingham to 6–9%; if her score were over 100, however (a 17% chance, her risk estimate would be markedly higher (25–51% in 10 years. In low risk scenarios, the CAC score is very likely to be zero or low, and unlikely to change management. Conclusion Combining information from the CAC score with information from conventional risk factors can change assessment of coronary heart disease risk to an extent that may be clinically important, especially when the pre-test 10-year risk estimate is intermediate. The attached spreadsheet makes these calculations easy.

  18. A clinically useful risk-score for chronic kidney disease in HIV infection

    Directory of Open Access Journals (Sweden)

    Amanda Mocroft

    2014-11-01

    Full Text Available Introduction: Development of a simple, widely applicable risk score for chronic kidney disease (CKD allows comparisons of risks or benefits of starting potentially nephrotoxic antiretrovirals (ARVs as part of a treatment regimen. Materials and Methods: A total of 18,055 HIV-positive persons from the Data on Adverse Drugs (D:A:D study with >3 estimated glomerular filtration rates (eGFRs >1/1/2004 were included. Persons with use of tenofovir (TDF, atazanavir (ritonavir boosted (ATV/r and unboosted (ATV, lopinavir (LPV/r and other boosted protease inhibitors (bPIs before baseline (first eGFR >60 ml/min/1.73 m2 after 1/1/2004 were excluded. CKD was defined as confirmed (>3 months apart eGFR 5 points risk of developing CKD. Increased incidence of CKD associated with starting ARVs was modelled by including ARVs as time-updated variables. The risk score was externally validated on two independent cohorts. Results: A total of 641 persons developed CKD during 103,278.5 PYFU (incidence 6.2/1000 PYFU, 95% CI 5.7–6.7. Older age, intravenous drug use, HCV+ antibody status, lower baseline eGFR, female gender, lower CD4 nadir, hypertension, diabetes and cardiovascular disease predicted CKD and were included in the risk score (Figure 1. The incidence of CKD in those at low, medium and high risk was 0.8/1000 PYFU (95% CI 0.6–1.0, 5.6 (95% CI 4.5–6.7 and 37.4 (95% CI 34.0–40.7 (Figure 1. The risk score showed good discrimination (Harrell's c statistic 0.92, 95% CI 0.90–0.93. The number needed to harm (NNTH in patients starting ATV or LPV/r was 1395, 142 or 20, respectively, among those with low, medium or high risk. NNTH were 603, 61 and 9 for those with a low, medium or high risk starting TDF, ATV/r or bPIs. The risk score was externally validated on 2603 persons from the Royal Free Hospital clinic cohort (94 events, incidence 5.1/1000 PYFU; 95% CI 4.1–6.1 and 2013 persons from the control arms of SMART/ESPRIT (32 events, incidence 3.8/1000 PYFU

  19. Analysis of Surgical Site Infection after Musculoskeletal Tumor Surgery: Risk Assessment Using a New Scoring System

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    Satoshi Nagano

    2014-01-01

    Full Text Available Surgical site infection (SSI has not been extensively studied in musculoskeletal tumors (MST owing to the rarity of the disease. We analyzed incidence and risk factors of SSI in MST. SSI incidence was evaluated in consecutive 457 MST cases (benign, 310 cases and malignant, 147 cases treated at our institution. A detailed analysis of the clinical background of the patients, pre- and postoperative hematological data, and other factors that might be associated with SSI incidence was performed for malignant MST cases. SSI occurred in 0.32% and 12.2% of benign and malignant MST cases, respectively. The duration of the surgery (P=0.0002 and intraoperative blood loss (P=0.0005 was significantly more in the SSI group than in the non-SSI group. We established the musculoskeletal oncological surgery invasiveness (MOSI index by combining 4 risk factors (blood loss, operation duration, preoperative chemotherapy, and the use of artificial materials. The MOSI index (0–4 points score significantly correlated with the risk of SSI, as demonstrated by an SSI incidence of 38.5% in the group with a high score (3-4 points. The MOSI index score and laboratory data at 1 week after surgery could facilitate risk evaluation and prompt diagnosis of SSI.

  20. Framingham coronary heart disease risk score can be predicted from structural brain images in elderly subjects.

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    Jane Maryam Rondina

    2014-12-01

    Full Text Available Recent literature has presented evidence that cardiovascular risk factors (CVRF play an important role on cognitive performance in elderly individuals, both those who are asymptomatic and those who suffer from symptoms of neurodegenerative disorders. Findings from studies applying neuroimaging methods have increasingly reinforced such notion. Studies addressing the impact of CVRF on brain anatomy changes have gained increasing importance, as recent papers have reported gray matter loss predominantly in regions traditionally affected in Alzheimer’s disease (AD and vascular dementia in the presence of a high degree of cardiovascular risk. In the present paper, we explore the association between CVRF and brain changes using pattern recognition techniques applied to structural MRI and the Framingham score (a composite measure of cardiovascular risk largely used in epidemiological studies in a sample of healthy elderly individuals. We aim to answer the following questions: Is it possible to decode (i.e., to learn information regarding cardiovascular risk from structural brain images enabling individual predictions? Among clinical measures comprising the Framingham score, are there particular risk factors that stand as more predictable from patterns of brain changes? Our main findings are threefold: i we verified that structural changes in spatially distributed patterns in the brain enable statistically significant prediction of Framingham scores. This result is still significant when controlling for the presence of the APOE 4 allele (an important genetic risk factor for both AD and cardiovascular disease. ii When considering each risk factor singly, we found different levels of correlation between real and predicted factors; however, single factors were not significantly predictable from brain images when considering APOE4 allele presence as covariate. iii We found important gender differences, and the possible causes of that finding are discussed.

  1. A metabolic syndrome severity score: A tool to quantify cardio-metabolic risk factors.

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    Wiley, Joshua F; Carrington, Melinda J

    2016-07-01

    Metabolic syndrome is a cluster of cardio-metabolic risk factors and is associated with increased mortality. There is no standard, validated way to assess the severity of aggregated metabolic syndrome risk factors. Cardiovascular and diabetes risk factor data came from two studies conducted in Australia from 2006 to 2010 in adults aged 18 or above. In medication free adults, sex-specific clinical thresholds and Principal Component Analysis were used to develop a formula to calculate a metabolic syndrome severity score (MetSSS). These scores were compared to scores derived using the same process in subgroups by sex, age, medication status, and time. We also examined the MetSSS in relation to other known risk factors. In 2125 adults (57.6±14.7years of age), the MetSSS ranged from 0 to 8.7 with a mean of 2.6. There were strong correlations (.95-.99) between the MetSSS in medication free adults and the MetSSS calculated from subgroups. MetSSS predicted medication initiation for hypertension, hyperlipidemia and hyperglycemia over six months (OR=1.31, 95% CI [1.00-1.70], per MetSSS unit, p=.043). Lower education, medication prescription, history of smoking and age were associated with higher MetSSS (all p<.05). Higher physical but not mental health quality of life was associated with lower MetSSS (p<.001). A standardized formula to measure cardio-metabolic risk factor severity was constructed and demonstrated expected relations with known risk factors. The use of the MetSSS is recommended as a measure of change within individuals in cardio-metabolic risk factors and to guide treatment and management.

  2. Alimentary Habits, Physical Activity, and Framingham Global Risk Score in Metabolic Syndrome

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    Soares, Thays Soliman; Piovesan, Carla Haas; Gustavo, Andréia da Silva; Macagnan, Fabrício Edler; Bodanese, Luiz Carlos; Feoli, Ana Maria Pandolfo, E-mail: anamariafeoli@hotmail.com [Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS (Brazil)

    2014-04-15

    Metabolic syndrome is a complex disorder represented by a set of cardiovascular risk factors. A healthy lifestyle is strongly related to improve Quality of Life and interfere positively in the control of risk factors presented in this condition. To evaluate the effect of a program of lifestyle modification on the Framingham General Cardiovascular Risk Profile in subjects diagnosed with metabolic syndrome. A sub-analysis study of a randomized clinical trial controlled blind that lasted three months. Participants were randomized into four groups: dietary intervention + placebo (DIP), dietary intervention + supplementation of omega 3 (fish oil 3 g/day) (DIS3), dietary intervention + placebo + physical activity (DIPE) and dietary intervention + physical activity + supplementation of omega 3 (DIS3PE). The general cardiovascular risk profile of each individual was calculated before and after the intervention. The study included 70 subjects. Evaluating the score between the pre and post intervention yielded a significant value (p < 0.001). We obtained a reduction for intermediate risk in 25.7% of subjects. After intervention, there was a significant reduction (p < 0.01) on cardiovascular age, this being more significant in groups DIP (5.2%) and DIPE (5.3%). Proposed interventions produced beneficial effects for reducing cardiovascular risk score. This study emphasizes the importance of lifestyle modification in the prevention and treatment of cardiovascular diseases.

  3. Risk score modeling of multiple gene to gene interactions using aggregated-multifactor dimensionality reduction

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    Dai Hongying

    2013-01-01

    Full Text Available Abstract Background Multifactor Dimensionality Reduction (MDR has been widely applied to detect gene-gene (GxG interactions associated with complex diseases. Existing MDR methods summarize disease risk by a dichotomous predisposing model (high-risk/low-risk from one optimal GxG interaction, which does not take the accumulated effects from multiple GxG interactions into account. Results We propose an Aggregated-Multifactor Dimensionality Reduction (A-MDR method that exhaustively searches for and detects significant GxG interactions to generate an epistasis enriched gene network. An aggregated epistasis enriched risk score, which takes into account multiple GxG interactions simultaneously, replaces the dichotomous predisposing risk variable and provides higher resolution in the quantification of disease susceptibility. We evaluate this new A-MDR approach in a broad range of simulations. Also, we present the results of an application of the A-MDR method to a data set derived from Juvenile Idiopathic Arthritis patients treated with methotrexate (MTX that revealed several GxG interactions in the folate pathway that were associated with treatment response. The epistasis enriched risk score that pooled information from 82 significant GxG interactions distinguished MTX responders from non-responders with 82% accuracy. Conclusions The proposed A-MDR is innovative in the MDR framework to investigate aggregated effects among GxG interactions. New measures (pOR, pRR and pChi are proposed to detect multiple GxG interactions.

  4. Automated texture scoring for assessing breast cancer masking risk in full field digital mammography

    DEFF Research Database (Denmark)

    Kallenberg, Michiel Gijsbertus J; Petersen, Kersten; Lilholm, Martin;

    validation. To assess the independency of the texture scores of breast density, density was determined for each image using Volpara. RESULTS: The odds ratios for interval cancer were 1.59 (95%CI: 0.76-3.32), 2.07 (1.02-4.20), and 3.14 (1.60-6.17) for quartile 2, 3 and 4 respectively, relative to quartile 1....... Correlation between the texture scores and breast density was 0.59 (0.52-0.64). Breast density adjusted odds ratios, as determined with logistic regression, were 1.49 (0.71-3.13), 1.58 (0.75-3.33), and 1.97 (0.91-4.27). CONCLUSIONS: The CSAE texture score is independently associated with the risk of having...

  5. Predicting high risk of exacerbations in bronchiectasis: the E-FACED score

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    Martinez-Garcia, MA; Athanazio, RA; Girón, R; Máiz-Carro, L; de la Rosa, D; Olveira, C; de Gracia, J; Vendrell, M; Prados-Sánchez, C; Gramblicka, G; Corso Pereira, M; Lundgren, FL; Fernandes De Figueiredo, M; Arancibia, F; Rached, SZ

    2017-01-01

    Background Although the FACED score has demonstrated a great prognostic capacity in bronchiectasis, it does not include the number or severity of exacerbations as a separate variable, which is important in the natural history of these patients. Objective Construction and external validation of a new index, the E-FACED, to evaluate the predictive capacity of exacerbations and mortality. Methods The new score was constructed on the basis of the complete cohort for the construction of the original FACED score, while the external validation was undertaken with six cohorts from three countries (Brazil, Argentina, and Chile). The main outcome was the number of annual exacerbations/hospitalizations, with all-cause and respiratory-related deaths as the secondary outcomes. A statistical evaluation comprised the relative weight and ideal cut-off point for the number or severity of the exacerbations and was incorporated into the FACED score (E-FACED). The results obtained after the application of FACED and E-FACED were compared in both the cohorts. Results A total of 1,470 patients with bronchiectasis (819 from the construction cohorts and 651 from the external validation cohorts) were followed up for 5 years after diagnosis. The best cut-off point was at least two exacerbations in the previous year (two additional points), meaning that the E-FACED has nine points of growing severity. E-FACED presented an excellent prognostic capacity for exacerbations (areas under the receiver operating characteristic curve: 0.82 for at least two exacerbations in 1 year and 0.87 for at least one hospitalization in 1 year) that was statistically better than that of the FACED score (0.72 and 0.78, P<0.05, respectively). The predictive capacities for all-cause and respiratory mortality were 0.87 and 0.86, respectively, with both being similar to those of the FACED. Conclusion E-FACED score significantly increases the FACED capacity to predict future yearly exacerbations while maintaining the

  6. Predicting PTSD using the New York Risk Score with genotype data: potential clinical and research opportunities

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    Boscarino JA

    2013-04-01

    Full Text Available Joseph A Boscarino,1,2 H Lester Kirchner,3,4 Stuart N Hoffman,5 Porat M Erlich1,4 1Center for Health Research, Geisinger Clinic, Danville, 2Department of Psychiatry, Temple University School of Medicine, Philadelphia, 3Division of Medicine, Geisinger Clinic, Danville, 4Department of Medicine, Temple University School of Medicine, Philadelphia, 5Department of Neurology, Geisinger Clinic, Danville, PA, USA Background: We previously developed a post-traumatic stress disorder (PTSD screening instrument, ie, the New York PTSD Risk Score (NYPRS, that was effective in predicting PTSD. In the present study, we assessed a version of this risk score that also included genetic information. Methods: Utilizing diagnostic testing methods, we hierarchically examined different prediction variables identified in previous NYPRS research, including genetic risk-allele information, to assess lifetime and current PTSD status among a population of trauma-exposed adults. Results: We found that, in predicting lifetime PTSD, the area under the receiver operating characteristic curve (AUC for the Primary Care PTSD Screen alone was 0.865. When we added psychosocial predictors from the original NYPRS to the model, including depression, sleep disturbance, and a measure of health care access, the AUC increased to 0.902, which was a significant improvement (P = 0.0021. When genetic information was added in the form of a count of PTSD risk alleles located within FKBP, COMT, CHRNA5, and CRHR1 genetic loci (coded 0–6, the AUC increased to 0.920, which was also a significant improvement (P = 0.0178. The results for current PTSD were similar. In the final model for current PTSD with the psychosocial risk factors included, genotype resulted in a prediction weight of 17 for each risk allele present, indicating that a person with six risk alleles or more would receive a PTSD risk score of 17 × 6 = 102, the highest risk score for any of the predictors studied. Conclusion: Genetic

  7. Risk prediction score for severe high altitude illness: a cohort study.

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    Florence Canouï-Poitrine

    Full Text Available Risk prediction of acute mountain sickness, high altitude (HA pulmonary or cerebral edema is currently based on clinical assessment. Our objective was to develop a risk prediction score of Severe High Altitude Illness (SHAI combining clinical and physiological factors. Study population was 1017 sea-level subjects who performed a hypoxia exercise test before a stay at HA. The outcome was the occurrence of SHAI during HA exposure. Two scores were built, according to the presence (PRE, n = 537 or absence (ABS, n = 480 of previous experience at HA, using multivariate logistic regression. Calibration was evaluated by Hosmer-Lemeshow chisquare test and discrimination by Area Under ROC Curve (AUC and Net Reclassification Index (NRI.The score was a linear combination of history of SHAI, ventilatory and cardiac response to hypoxia at exercise, speed of ascent, desaturation during hypoxic exercise, history of migraine, geographical location, female sex, age under 46 and regular physical activity. In the PRE/ABS groups, the score ranged from 0 to 12/10, a cut-off of 5/5.5 gave a sensitivity of 87%/87% and a specificity of 82%/73%. Adding physiological variables via the hypoxic exercise test improved the discrimination ability of the models: AUC increased by 7% to 0.91 (95%CI: 0.87-0.93 and 17% to 0.89 (95%CI: 0.85-0.91, NRI was 30% and 54% in the PRE and ABS groups respectively. A score computed with ten clinical, environmental and physiological factors accurately predicted the risk of SHAI in a large cohort of sea-level residents visiting HA regions.

  8. Prostate cancer staging with extracapsular extension risk scoring using multiparametric MRI

    DEFF Research Database (Denmark)

    Boesen, Lars; Chabanova, Elizaveta; Løgager, Vibeke

    2015-01-01

    based on tumour characteristics and personal opinion were assigned. Histopathological prostatectomy results were standard reference. RESULTS: Histopathology and cTMRI showed a spearman rho correlation of 0.658 (p .../87 (36 %) patients. ECE risk-scoring showed an AUC of 0.65-0.86 on ROC-curve for both readers, with sensitivity and specificity of 81 % and 78 % at best cutoff level (reader A), respectively. When tumour characteristics were influenced by personal opinion, the sensitivity and specificity for prediction...

  9. Lack of physical activity in young children is related to higher composite risk factor score for cardiovascular disease

    DEFF Research Database (Denmark)

    Tanha, Tina; Wollmer, Per; Thorsson, Ola

    2011-01-01

    This study evaluates whether accelerometer-measured physical activity is related to higher composite risk factor scores for cardiovascular disease (CVD) in children.......This study evaluates whether accelerometer-measured physical activity is related to higher composite risk factor scores for cardiovascular disease (CVD) in children....

  10. Puntaje de detección de riesgo nutricional para mortalidad en pacientes críticamente enfermos: NSRR: Nutritional Score Risk Research Nutritional score risk for mortality in critically ill patients: NSRR: Nutritional Score Risk Research

    Directory of Open Access Journals (Sweden)

    A. M. Marín Ramírez

    2008-10-01

    Full Text Available Objetivo: El objetivo principal del estudio fue la validación de un puntaje en la valoración nutricional al momento de llegar a la Unidad de Cuidados Intensivos (UCI con o sin enfermedad previa, con el fin de establecer riesgos nutricionales de muerte desde el ingreso. Diseño: Se realizó un estudio descriptivo, prospectivo, observacional de carácter transversal de abril del 2004 a diciembre del 2006. Ámbito: El estudio fue realizado en UCI. Pacientes y participantes: Para el estudio se lograron encuestar 228 pacientes. Las encuestas eran realizadas al familiar cercano que vivía con el paciente, en aquel momento que el familiar mostrar no convivencia con el paciente y/o desconocimiento de su patrón de ingesta de alimentos durante el diario la encuesta era descartada. Se seleccionaron al azar con patologías críticas (sepsis, trauma, pacientes neurocríticos, pacientes médicos, obstétricas críticas, etc. en dos unidades de cuidados intensivos. Intervenciones: Interrogatorio a familiares. Variables de interés: El puntaje escogido fue el Nutritional Score Risk (NSR el cual es elaborado para pacientes mayores de 65 años, puntaje que es ahora modificado para ser utilizado en las unidades de cuidados intensivos en forma práctica, viable, rápida, clara y útil en la obtención de resultados. Resultados: Nuestro estudio demostró que las alteraciones del NSR se pueden observar en todas las edades, establecido por no haber una correlación directa entre la edad y el NSR encontrado (r = 0,15, p = 0,018, además se encontró que el sufrir enfermedades crónicas que alteren las condiciones de ingesta alimentaria adecuada es un parámetro aislado significativo para incrementar la probabilidad de muerte al ingreso a la UCI (p = 0,002. Conclusiones: El NSR mostró que pacientes con un puntaje alto al ingresar por alguna patología aguda se encuentran en riesgo nutricional de morir.Aim: The aim of our study has been applying a nutritional score

  11. Composite risk scores and composite endpoints in the risk prediction of outcomes in anticoagulated patients with atrial fibrillation. The Loire Valley Atrial Fibrillation Project.

    Science.gov (United States)

    Banerjee, A; Fauchier, L; Bernard-Brunet, A; Clementy, N; Lip, G Y H

    2014-03-01

    Several validated risk stratification schemes for prediction of ischaemic stroke (IS)/thromboembolism (TE) and major bleeding are available for patients with non-valvular atrial fibrillation (NVAF). On the basis for multiple common risk factors for IS/TE and bleeding, it has been suggested that composite risk prediction scores may be more practical and user-friendly than separate scores for bleeding and IS/TE. In a long-term prospective hospital registry of anticoagulated patients with newly diagnosed AF, we compared the predictive value of existing risk prediction scores as well as composite risk scores, and also compared these risk scoring systems using composite endpoints. Endpoint 1 was the simple composite of IS and major bleeds. Endpoint 2 was based on a composite of IS plus intracerebral haemorrhage (ICH). Endpoint 3 was based on weighted coefficients for IS/TE and ICH. Endpoint 4 was a composite of stroke, cardiovascular death, TE and major bleeding. The incremental predictive value of these scores over CHADS2 (as reference) for composite endpoints was assessed using c-statistic, net reclassification improvement (NRI) and integrated discrimination improvement (IDI). Of 8,962 eligible individuals, 3,607 (40.2%) had NVAF and were on OAC at baseline. There were no statistically significant differences between the c-statistics of the various risk scores, compared with the CHADS2 score, regardless of the endpoint. For the various risk scores and various endpoints, NRI and IDI did not show significant improvement (≥1%), compared with the CHADS2 score. In conclusion, composite risk scores did not significantly improve risk prediction of endpoints in patients with NVAF, regardless of how endpoints were defined. This would support individualised prediction of IS/TE and bleeding separately using different separate risk prediction tools, and not the use of composite scores or endpoints for everyday 'real world' clinical practice, to guide decisions on

  12. THE IMPACT OF SEVERITY OF DIABETIC RETINOPATHY IN CARDIOVASCULAR DISEASE RISK ASSESSMENT USING FRAMINGHAM RISK SCORE - A PILOT STUDY

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    Nidhi

    2015-08-01

    Full Text Available Diabetic retinopathy (DR is the most common micro vascular complications of diabetes, estimated to affect approximately 100 million people worldwide, while cardiovascular disease (CVD is the leading cause of death in individuals with type II diabetes. There is limited Indian data reporting the association of Diabetic retinopathy and its severity with CVD. AIM : To study the relation between the severity of DR and risk of CVD in cen tral Indian subjects. MATERIALS AND METHODS : The subjects consisted of 50 patients with Diabetes mellitus type II having varying grades of diabetic retinopathy attending eye OPD of a tertiary care hospital in central India. 10 year risk of developing CVD was estimated using the Framingham Risk Score. RESULTS : The number of subjects with an increased risk of developing CVD increased with advancing age (28.57% in 40 - 49 years to 61 .53% in > 60 years age group. The risk of CVD was slightly more in males (55. 55% compared to females (43.47%. Out of the 30 patients having sight threatening diabetic retinopathy, 13 had low risk of developing CVD while 17 had high risk of developing CVD. The prevalence of sight threatening retinopathy was more in the high risk group (56.67% when compared to the low - risk group (40%. DISCUSSION : We found that more subjects having high risk of developing CVD had sight - threatening DR compared to those having low risk. CONCLUSION : Diabetic retinopathy may contribute to CVD risk in Indian population too. A careful cardiovascular assessment and follow - up may be required in individuals with diabetic retinopathy, using a larger sample size

  13. Multivariate injury risk criteria and injury probability scores for fractures to the distal radius.

    Science.gov (United States)

    Burkhart, Timothy A; Andrews, David M; Dunning, Cynthia E

    2013-03-15

    The purpose of this study was to develop a multivariate distal radius injury risk prediction model that incorporates dynamic loading variables in multiple directions, and interpret the distal radius failure data in order to establish injury probability thresholds. Repeated impacts with increasing intensity were applied to the distal third of eight human cadaveric radius specimens (mean (SD) age=61.9 (9.7)) until injury occurred. Crack (non-propagating damage) and fracture (specimen separated into at least two fragments) injury events were recorded. Best subsets analysis was performed to find the best multivariate injury risk model. Force-only risk models were also determined for comparison. Cumulative distribution functions were developed from the parameters of a Weibull analysis and the forces and risk scores (i.e., values calculated from the injury risk models) from 10% to 90% probability were calculated. According to the adjusted R(2), variance inflation factor and p-values, the model that best predicted the crack event included medial/lateral impulse, Fz load rate, impact velocity and the natural logarithm of Fz (Adj. R(2)=0.698), while the best predictive model of the fracture event included medial/lateral impulse, impact velocity and peak Fz (Adj. R(2)=0.845). The multivariate models predicted injury risk better than both the Fz-only crack (Adj. R(2)=0.551) and fracture (Adj. R(2)=0.293) models. Risk scores of 0.5 and 0.6 corresponded to 10% failure probability for the crack and fracture events, respectively. The inclusion of medial/lateral impulse and impact velocity in both crack and fracture models, and Fz load rate in the crack model, underscores the dynamic nature of these events. This study presents a method capable of developing a set of distal radius fracture prediction models that can be used in the assessment and development of distal radius injury prevention interventions.

  14. Development of a claims-based risk score to identify obese individuals.

    Science.gov (United States)

    Clark, Jeanne M; Chang, Hsien-Yen; Bolen, Shari D; Shore, Andrew D; Goodwin, Suzanne M; Weiner, Jonathan P

    2010-08-01

    Obesity is underdiagnosed, hampering system-based health promotion and research. Our objective was to develop and validate a claims-based risk model to identify obese persons using medical diagnosis and prescription records. We conducted a cross-sectional analysis of de-identified claims data from enrollees of 3 Blue Cross Blue Shield plans who completed a health risk assessment capturing height and weight. The final sample of 71,057 enrollees was randomly split into 2 subsamples for development and validation of the obesity risk model. Using the Johns Hopkins Adjusted Clinical Groups case-mix/predictive risk methodology, we categorized study members' diagnosis (ICD) codes. Logistic regression was used to determine which claims-based risk markers were associated with a body mass index (BMI) > or = 35 kg/m(2). The sensitivities of the scores > or =90(th) percentile to detect obesity were 26% to 33%, while the specificities were >90%. The areas under the receiver operator curve ranged from 0.67 to 0.73. In contrast, a diagnosis of obesity or an obesity medication alone had very poor sensitivity (10% and 1%, respectively); the obesity risk model identified an additional 22% of obese members. Varying the percentile cut-point from the 70(th) to the 99(th) percentile resulted in positive predictive values ranging from 15.5 to 59.2. An obesity risk score was highly specific for detecting a BMI > or = 35 kg/m(2) and substantially increased the detection of obese members beyond a provider-coded obesity diagnosis or medication claim. This model could be used for obesity care management and health promotion or for obesity-related research.

  15. Applicability of Two International Risk Scores in Cardiac Surgery in a Reference Center in Brazil

    Energy Technology Data Exchange (ETDEWEB)

    Garofallo, Silvia Bueno; Machado, Daniel Pinheiro; Rodrigues, Clarissa Garcia; Bordim, Odemir Jr.; Kalil, Renato A. K.; Portal, Vera Lúcia, E-mail: veraportal.pesquisa@gmail.com [Post-Graduation Program in Health Sciences: Cardiology, Instituto de Cardiologia/Fundação Universitária de Cardiologia, Porto Alegre, RS (Brazil)

    2014-06-15

    The applicability of international risk scores in heart surgery (HS) is not well defined in centers outside of North America and Europe. To evaluate the capacity of the Parsonnet Bernstein 2000 (BP) and EuroSCORE (ES) in predicting in-hospital mortality (IHM) in patients undergoing HS at a reference hospital in Brazil and to identify risk predictors (RP). Retrospective cohort study of 1,065 patients, with 60.3% patients underwent coronary artery bypass grafting (CABG), 32.7%, valve surgery and 7.0%, CABG combined with valve surgery. Additive and logistic scores models, the area under the ROC (Receiver Operating Characteristic) curve (AUC) and the standardized mortality ratio (SMR) were calculated. Multivariate logistic regression was performed to identify the RP. Overall mortality was 7.8%. The baseline characteristics of the patients were significantly different in relation to BP and ES. AUCs of the logistic and additive BP were 0.72 (95% CI, from 0.66 to 0.78 p = 0.74), and of ES they were 0.73 (95% CI; 0.67 to 0.79 p = 0.80). The calculation of the SMR in BP was 1.59 (95% CI; 1.27 to 1.99) and in ES, 1.43 (95% CI; 1.14 to 1.79). Seven RP of IHM were identified: age, serum creatinine > 2.26 mg/dL, active endocarditis, systolic pulmonary arterial pressure > 60 mmHg, one or more previous HS, CABG combined with valve surgery and diabetes mellitus. Local scores, based on the real situation of local populations, must be developed for better assessment of risk in cardiac surgery.

  16. A 17-gene stemness score for rapid determination of risk in acute leukaemia.

    Science.gov (United States)

    Ng, Stanley W K; Mitchell, Amanda; Kennedy, James A; Chen, Weihsu C; McLeod, Jessica; Ibrahimova, Narmin; Arruda, Andrea; Popescu, Andreea; Gupta, Vikas; Schimmer, Aaron D; Schuh, Andre C; Yee, Karen W; Bullinger, Lars; Herold, Tobias; Görlich, Dennis; Büchner, Thomas; Hiddemann, Wolfgang; Berdel, Wolfgang E; Wörmann, Bernhard; Cheok, Meyling; Preudhomme, Claude; Dombret, Herve; Metzeler, Klaus; Buske, Christian; Löwenberg, Bob; Valk, Peter J M; Zandstra, Peter W; Minden, Mark D; Dick, John E; Wang, Jean C Y

    2016-12-15

    Refractoriness to induction chemotherapy and relapse after achievement of remission are the main obstacles to cure in acute myeloid leukaemia (AML). After standard induction chemotherapy, patients are assigned to different post-remission strategies on the basis of cytogenetic and molecular abnormalities that broadly define adverse, intermediate and favourable risk categories. However, some patients do not respond to induction therapy and another subset will eventually relapse despite the lack of adverse risk factors. There is an urgent need for better biomarkers to identify these high-risk patients before starting induction chemotherapy, to enable testing of alternative induction strategies in clinical trials. The high rate of relapse in AML has been attributed to the persistence of leukaemia stem cells (LSCs), which possess a number of stem cell properties, including quiescence, that are linked to therapy resistance. Here, to develop predictive and/or prognostic biomarkers related to stemness, we generated a list of genes that are differentially expressed between 138 LSC(+) and 89 LSC(-) cell fractions from 78 AML patients validated by xenotransplantation. To extract the core transcriptional components of stemness relevant to clinical outcomes, we performed sparse regression analysis of LSC gene expression against survival in a large training cohort, generating a 17-gene LSC score (LSC17). The LSC17 score was highly prognostic in five independent cohorts comprising patients of diverse AML subtypes (n = 908) and contributed greatly to accurate prediction of initial therapy resistance. Patients with high LSC17 scores had poor outcomes with current treatments including allogeneic stem cell transplantation. The LSC17 score provides clinicians with a rapid and powerful tool to identify AML patients who do not benefit from standard therapy and who should be enrolled in trials evaluating novel upfront or post-remission strategies.

  17. Predicting high risk of exacerbations in bronchiectasis: the E-FACED score

    Directory of Open Access Journals (Sweden)

    Martinez-Garcia MA

    2017-01-01

    countries (Brazil, Argentina, and Chile. The main outcome was the number of annual exacerbations/hospitalizations, with all-cause and respiratory-related deaths as the secondary outcomes. A statistical evaluation comprised the relative weight and ideal cut-off point for the number or severity of the exacerbations and was incorporated into the FACED score (E-FACED. The results obtained after the application of FACED and E-FACED were compared in both the cohorts.Results: A total of 1,470 patients with bronchiectasis (819 from the construction cohorts and 651 from the external validation cohorts were followed up for 5 years after diagnosis. The best cut-off point was at least two exacerbations in the previous year (two additional points, meaning that the E-FACED has nine points of growing severity. E-FACED presented an excellent prognostic capacity for exacerbations (areas under the receiver operating characteristic curve: 0.82 for at least two exacerbations in 1 year and 0.87 for at least one hospitalization in 1 year that was statistically better than that of the FACED score (0.72 and 0.78, P<0.05, respectively. The predictive capacities for all-cause and respiratory mortality were 0.87 and 0.86, respectively, with both being similar to those of the FACED.Conclusion: E-FACED score significantly increases the FACED capacity to predict future yearly exacerbations while maintaining the score’s simplicity and prognostic capacity for death. Keywords: FACED score, E-FACED score, mortality, bronchiectasis, exacerbations

  18. MORTALITY RISK ASSESSMENT IN PICU USING PRISM-III-24 SCORE

    Directory of Open Access Journals (Sweden)

    Harilal Naik

    2014-11-01

    Full Text Available OBJECTIVE: Assessment of risk of mortality using PRISM III-24 score in children admitted to PICU of Basaweshwara Teaching and General Hospital, attached to Mahadevappa Rampure Medical College, Gulbarga. DESIGN: Prospective cohort study. Setting: PICU of BTGH, Gulbarga. METHODS: 404 patients who had been admitted consecutively to the PICU during a period of 12 months (July 2011 to June 2012 were studied. PRISM III-24 score was calculated. Hospital outcome was recorded as survived/expired. Calibration and discrimination of the model was calculated by Hosmer-Lemeshow goodness-of-fit test and Area under the ROC Curve. The association between r (empirical function and PRISM III-24 score was assessed by Binary Logistic Regression method. RESULTS: Out of 404 patients, 363 (89.85% survived and 41 (10.15% expired. Males formed the majority (227/404. CNS cases (n=118, 29.2% constituted the majority. Mean age, length of hospitalization, and mean PRISM III-24 score were 59.22±51.12 months, 99.84±91.61 hours, and 4.92±7.74 (range 0-36. The test was well designed for the study (goodness-of-fit value P-value 0.186. ROC analysis indicated a strong predictive power for the PRISM III-24 (AUC 0.936. The observed (O mortality rate was 10.15% and the expected (E mortality rate was 10.12% with an O/E ratio of 1.003. CONCLUSION: PRISM III-24 score is a good predictor of mortality in PICU patients under Indian circumstances. The PRISM III-24 scoring system was highly calibrated in our institute.

  19. Risk Pricing in Emerging Economies: Credit Scoring and Private Banking in Iran

    Directory of Open Access Journals (Sweden)

    Yiannis Anagnostopoulos

    2016-01-01

    Full Text Available Iran’s banking industry as a developing country is comparatively very new to risk management practices. An inevitable predictive implication of this rapid growth is the growing concerns with regard to credit risk management which is the motivation of conducting this research. The paper focuses on the credit scoring aspect of credit risk management using both logit and probit regression approaches. Real data on corporate customers are available for conducting this research which is also a contribution to this area for all other developing countries. Our questions focus on how future customers can be classified in terms of credibility, which models and methods are more effective in better capturing risks. Findings suggest that probit approaches are more effective in capturing the significance of variables and goodness-of-fitness tests. Seven variables of the Ohlson O-Score model are used: CL_CA, INTWO, OENEG, TA_TL, SIZE, WCAP_TA, and ROA; two were found to be statistically significant in logit (ROA, TL_TA and three were statistically significant in probit (ROA, TL_TA, SIZE. Also, CL_CA, ROA, and WCAP_TA were the three variables with an unexpected correlation to the probability of default. The prediction power with the cut-off point is set equal to 26% and 56.91% for defaulted customers in both logit and probit models. However, logit achieved 54.85% correct estimation of defaulted assets, 0.37% more than what probit estimated.

  20. Genetic risk scores link body fat distribution with specific cardiometabolic profiles

    DEFF Research Database (Denmark)

    Svendstrup, Mathilde; Sandholt, Camilla H; Andersson Galijatovic, Ehm Astrid

    2016-01-01

    OBJECTIVE: Forty-nine known single nucleotide polymorphisms (SNPs) associating with body mass index (BMI)-adjusted waist-hip-ratio (WHR) (WHRadjBMI) were recently suggested to cluster into three groups with different associations to cardiometabolic traits. Genetic risk scores of the clusters......, including fasting serum triglyceride (β = 0.98% mmol/L, P = 3.33 × 10(-) (8) ) and Matsuda index (β = -0.74%, P = 1.29 × 10(-) (4) ). No similar associations for Clusters 2 and 3 were found. The three clusters showed different patterns of association with waist circumference, hip circumference, and height...... on the risk of incident diabetes and associations with detailed cardiometabolic phenotypes were tested. METHODS: In a prospective study of 6,121 Inter99 individuals, the risk of incident diabetes using Cox proportional hazards regression was evaluated. Using linear regession, the associations between genetic...

  1. Job level risk assessment using task level strain index scores: a pilot study.

    Science.gov (United States)

    Drinkaus, Phillip; Bloswick, Donald S; Sesek, Richard; Mann, Clay; Bernard, Thomas

    2005-01-01

    This paper explores 2 methods of modifying the Strain Index (SI) to assess the ergonomic risk of multi-task jobs. Twenty-eight automotive jobs (15 cases and 13 controls) were studied. The first method is based on the maximum task SI score, and the second method is modeled on the NIOSH Composite Lifting Index (CLI) algorithm, named cumulative assessment of risk to the distal upper extremity (CARD). Significant odds ratios of 11 (CI 1.7-69) and 24 (CI 2.4-240) were obtained using the modified maximum task and CARD, respectively. This indicates that modification of the SI may be useful in determining the risk of distal upper extremity injury associated with a multi-task job.

  2. Impact of malnutrition on pediatric risk of mortality score and outcome in Pediatric Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Romi Nangalu

    2016-01-01

    Full Text Available Objectives: This study was done to determine the effect of malnutrition on mortality in Pediatric Intensive Care Unit (PICU and on the pediatric risk of mortality (PRISM scoring. Subjects and Methods: This was a prospective study done over 1 year. There were total 400 patients (1 month 14 years, who were divided into cases with weight for age <3 rd centile and controls with ≥3 rd centile of WHO charts. Cases were subdivided into mild/moderate (61-80% of expected weight for age and severe malnutrition (<60%. Results: Out of total, 38.5% patients were underweight, and malnutrition was more in infancy, 61/104, i.e. 58.5% (P - 0.003. There was no significant difference in vitals at admission. Cases needed prolonged mechanical ventilation (P - 0.0063 and hospital stay (P - 0.0332 compared to controls. Mean and median PRISM scores were comparable in both the groups, but mortality was significantly higher in severely malnourished (P value 0.027. Conclusion: Severe malnutrition is independently associated with higher mortality even with similar PRISM score. There is need to give an additional score to children with weight for age <60% of expected.

  3. Pre-operative risk scores for the prediction of outcome in elderly people who require emergency surgery

    Directory of Open Access Journals (Sweden)

    Bates Tom

    2007-06-01

    Full Text Available Abstract Background The decision on whether to operate on a sick elderly person with an intra-abdominal emergency is one of the most difficult in general surgery. A predictive risk-score would be of great value in this situation. Methods A Medline search was performed to identify those predictive risk-scores relevant to sick elderly patients in whom emergency surgery might be life-saving. Results Many of the risk scores for surgical patients include the operative findings or require tests which are not available in the acute situation. Most of the relevant studies include younger patients and elective surgery. The Glasgow Aneurysm Score and Hardman Index are specific to ruptured aortic aneurysm while the Boey Score and the Hacetteppe Score are specific to perforated peptic ulcer. The Reiss Index and Fitness Score can be used pre-operatively if the elements of the score can be completed in time. The ASA score, which includes a significant element of subjective clinical judgement, can be augmented with factors such as age and urgency of surgery but no test has a negative predictive value sufficient to recommend against surgical intervention without clinical input. Conclusion Risk scores may be helpful in sick elderly patients needing emergency abdominal surgery but an experienced clinical opinion is still essential.

  4. Risk stratification in cardiovascular disease primary prevention - scoring systems, novel markers, and imaging techniques.

    LENUS (Irish Health Repository)

    Zannad, Faiez

    2012-04-01

    The aim of this paper is to review and discuss current methods of risk stratification for cardiovascular disease (CVD) prevention, emerging biomarkers, and imaging techniques, and their relative merits and limitations. This report is based on discussions that took place among experts in the area during a special CardioVascular Clinical Trialists workshop organized by the European Society of Cardiology Working Group on Cardiovascular Pharmacology and Drug Therapy in September 2009. Classical risk factors such as blood pressure and low-density lipoprotein cholesterol levels remain the cornerstone of risk estimation in primary prevention but their use as a guide to management is limited by several factors: (i) thresholds for drug treatment vary with the available evidence for cost-effectiveness and benefit-to-risk ratios; (ii) assessment may be imprecise; (iii) residual risk may remain, even with effective control of dyslipidemia and hypertension. Novel measures include C-reactive protein, lipoprotein-associated phospholipase A(2) , genetic markers, and markers of subclinical organ damage, for which there are varying levels of evidence. High-resolution ultrasound and magnetic resonance imaging to assess carotid atherosclerotic lesions have potential but require further validation, standardization, and proof of clinical usefulness in the general population. In conclusion, classical risk scoring systems are available and inexpensive but have a number of limitations. Novel risk markers and imaging techniques may have a place in drug development and clinical trial design. However, their additional value above and beyond classical risk factors has yet to be determined for risk-guided therapy in CVD prevention.

  5. A modified HEART risk score in chest pain patients with suspected non-ST-segment elevation acute coronary syndrome

    Institute of Scientific and Technical Information of China (English)

    Chun-Peng MA; Xiao WANG; Qing-Sheng WANG; Xiao-Li LIU; Xiao-Nan HE; Shao-Ping NIE

    2016-01-01

    ObjectiveTo validate a modified HEART [History, Electrocardiograph (ECG), Age, Risk factors and Troponin] risk score in chest pain patients with suspected non-ST-segment elevation acute coronary syndrome (NSTE-ACS) in the emergency department (ED).Methods This retrospective cohort study used a prospectively acquired database and chest pain patients admitted to the emergency department with suspected NSTE-ACS were enrolled. Data recorded on arrival at the ED were used. The serum sample of high-sensitivity cardiac Troponin I other than conventional cardiac Troponin I used in the HEART risk score was tested. The modified HEART risk score was calculated. The end point was the occurrence of major adverse cardiac events (MACE) defined as a composite of acute myocardial infarction (AMI), percu-taneous intervention (PCI), coronary artery bypass graft (CABG), or all-cause death, within three months after initial presentation.Results A total of 1,300 patients were enrolled. A total of 606 patients (46.6%) had a MACE within three months: 205 patients (15.8%) were diag-nosed with AMI, 465 patients (35.8%) underwent PCI, and 119 patients (9.2%) underwent CABG. There were 10 (0.8%) deaths. A progres-sive, significant pattern of increasing event rate was observed as the score increased (P < 0.001 byχ2 for trend). The area under the receiver operating characteristic curve was 0.84. All patients were classified into three groups: low risk (score 0–2), intermediate risk (score 3–4), and high risk (score 5–10). Event rates were 1.1%, 18.5%, and 67.0%, respectively (P < 0.001).ConclusionsThe modified HEART risk score was validated in chest pain patients with suspected NSTE-ACS and may complement MACE risk assessment and patients triage in the ED. A prospective study of the score is warranted.

  6. A score to predict short-term risk of COPD exacerbations (SCOPEX

    Directory of Open Access Journals (Sweden)

    Make BJ

    2015-01-01

    Full Text Available Barry J Make,1 Göran Eriksson,2 Peter M Calverley,3 Christine R Jenkins,4 Dirkje S Postma,5 Stefan Peterson,6 Ollie Östlund,7 Antonio Anzueto8 1Division of Pulmonary Sciences and Critical Care Medicine, National Jewish Health, University of Colorado Denver School of Medicine, Denver, CO, USA; 2Department of Respiratory Medicine and Allergology, University Hospital, Lund, Sweden; 3Pulmonary and Rehabilitation Research Group, University Hospital Aintree, Liverpool, UK; 4George Institute for Global Health, The University of Sydney and Concord Clinical School, Woolcock Institute of Medical Research, Sydney, NSW, Australia; 5Department of Pulmonology, University of Groningen and GRIAC Research Institute, University Medical Center Groningen, Groningen, The Netherlands; 6StatMind AB, Lund, Sweden; 7Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden; 8Department of Pulmonary/Critical Care, University of Texas Health Sciences Center and South Texas Veterans Healthcare System, San Antonio, TX, USA Background: There is no clinically useful score to predict chronic obstructive pulmonary disease (COPD exacerbations. We aimed to derive this by analyzing data from three existing COPD clinical trials of budesonide/formoterol, formoterol, or placebo in patients with moderate-to-very-severe COPD and a history of exacerbations in the previous year. Methods: Predictive variables were selected using Cox regression for time to first severe COPD exacerbation. We determined absolute risk estimates for an exacerbation by identifying variables in a binomial model, adjusting for observation time, study, and treatment. The model was further reduced to clinically useful variables and the final regression coefficients scaled to obtain risk scores of 0–100 to predict an exacerbation within 6 months. Receiver operating characteristic (ROC curves and the corresponding C-index were used to investigate the discriminatory

  7. Tuberculosis and risk of acute myocardial infarction: a propensity score-matched analysis.

    Science.gov (United States)

    Huaman, M A; Kryscio, R J; Fichtenbaum, C J; Henson, D; Salt, E; Sterling, T R; Garvy, B A

    2017-02-16

    Several pathogens have been associated with increased cardiovascular disease (CVD) risk. Whether this occurs with Mycobacterium tuberculosis infection is unclear. We assessed if tuberculosis disease increased the risk of acute myocardial infarction (AMI). We identified patients with tuberculosis index claims from a large de-identified database of ~15 million adults enrolled in a U.S. commercial insurance policy between 2008 and 2010. Tuberculosis patients were 1:1 matched to patients without tuberculosis claims using propensity scores. We compared the occurrence of index AMI claims between the tuberculosis and non-tuberculosis cohorts using Kaplan-Meier curves and Cox Proportional Hazard models. Data on 2026 patients with tuberculosis and 2026 propensity-matched patients without tuberculosis were included. AMI was more frequent in the tuberculosis cohort compared with the non-tuberculosis cohort, 67 (3·3%) vs. 32 (1·6%) AMI cases, respectively, P < 0·01. Tuberculosis was associated with an increased risk of AMI (adjusted hazard ratio (HR) 1·98, 95% confidence intervals (CI) 1·3-3·0). The results were similar when the analysis was restricted to pulmonary tuberculosis (adjusted HR 2·43, 95% CI 1·5-4·1). Tuberculosis was associated with an increased risk of AMI. CVD risk assessment should be considered in tuberculosis patients. Mechanistic studies of tuberculosis and CVD are warranted.

  8. Mental Health in Low-to-Moderate Risk Preterm, Low Birth Weight, and Small for Gestational Age Children at 4 to 5 Years: The Role of Early Maternal Parenting

    Science.gov (United States)

    Westrupp, Elizabeth M.; Mensah, Fiona K.; Giallo, Rebecca; Cooklin, Amanda; Nicholson, Jan M.

    2012-01-01

    Objectives: The majority of children born preterm, with low birth weight, or small for gestational age are born with low-to-moderate risk (LTM), yet most research focuses on the high-risk group. Little is known about whether children with LTM perinatal risk are at greater risk for mental health problems, or what the role of early maternal…

  9. A risk-scoring scheme for suicide attempts among patients with bipolar disorder in a Thai patient cohort

    Directory of Open Access Journals (Sweden)

    Patumanond J

    2012-04-01

    Full Text Available Chidchanok Ruengorn1,2, Kittipong Sanichwankul3, Wirat Niwatananun2, Suwat Mahatnirunkul3, Wanida Pumpaisalchai3, Jayanton Patumanond11Clinical Epidemiology Program, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; 2Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand; 3Suanprung Psychiatric Hospital, Chiang Mai, ThailandBackground: In Thailand, risk factors associated with suicide attempts in bipolar disorder (BD are rarely investigated, nor has a specific risk-scoring scheme to assist in the identification of BD patients at risk for attempting suicide been proposed.Objective: To develop a simple risk-scoring scheme to identify patients with BD who may be at risk for attempting suicide.Methods: Medical files of 489 patients diagnosed with BD at Suanprung Psychiatric Hospital between October 2006 and May 2009 were reviewed. Cases included BD patients hospitalized due to attempted suicide (n = 58, and seven controls were selected (per suicide case among BD in- and out-patients who did not attempt suicide, with patients being visited the same day or within 1 week of case study (n = 431. Broad sociodemographic and clinical factors were gathered and analyzed using multivariate logistic regression, to obtain a set of risk factors. Scores for each indicator were weighted, assigned, and summed to create a total risk score, which was divided into low, moderate, and high-risk suicide attempt groups.Results: Six statistically significant indicators associated with suicide attempts were included in the risk-scoring scheme: depression, psychotic symptom(s, number of previous suicide attempts, stressful life event(s, medication adherence, and BD treatment years. A total risk score (possible range -1.5 to 11.5 explained an 88.6% probability of suicide attempts based on the receiver operating characteristic (ROC analysis. Likelihood ratios of suicide attempts with low risk scores (below 2

  10. Scope Complexity Options Risks Excursions (SCORE) Version 3.0 Mathematical Description.

    Energy Technology Data Exchange (ETDEWEB)

    Gearhart, Jared Lee [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Samberson, Jonell Nicole [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Shettigar, Subhasini [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Jungels, John [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Welch, Kimberly M. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Jones, Dean A. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States)

    2017-03-01

    The purpose of the Scope, Complexity, Options, Risks, Excursions (SCORE) model is to estimate the relative complexity of design variants of future warhead options. The results of this model allow those considering these options to understand the complexity tradeoffs between proposed warhead options. The core idea of SCORE is to divide a warhead option into a well- defined set of scope elements and then estimate the complexity of each scope element against a well understood reference system. The uncertainty associated with estimates can also be captured. A weighted summation of the relative complexity of each scope element is used to determine the total complexity of the proposed warhead option or portions of the warhead option (i.e., a National Work Breakdown Structure code). The SCORE analysis process is a growing multi-organizational Nuclear Security Enterprise (NSE) effort, under the management of the NA- 12 led Enterprise Modeling and Analysis Consortium (EMAC), that has provided the data elicitation, integration and computation needed to support the out-year Life Extension Program (LEP) cost estimates included in the Stockpile Stewardship Management Plan (SSMP).

  11. Validation of the Korean Version of the Lewy Body Composite Risk Score (K-LBCRS).

    Science.gov (United States)

    Ryu, Hui Jin; Kim, Minyoung; Moon, Yeonsil; Choi, Yeji; Han, Jee-Young; Galvin, James E; Han, Seol-Heui

    2017-01-01

    The Lewy body composite risk score (LBCRS) is a useful clinical screening tool to help determine whether the dementia is related to Lewy body pathology. The purpose of this study is to verify reliability, validity, and diagnostic usefulness of Korean version of LBCRS (K-LBCRS). CDR-sum of boxes, Mini-Mental State Examination, and standardized scales related to cognition, mood, behavior, and motor function were administered to a total of 107 subjects, including 30 dementia with Lewy bodies (DLB), 54 Alzheimer's disease (AD), and 23 cognitively normal elderly people and their collateral informants. Internal consistency of the K-LBCRS was good with Cronbach's alpha of 0.85, and concurrent validity was also satisfactory, with K-LBCRS correlating highly with CDR-SB and other scales. The test-retest reliability was very high with a Pearson correlation coefficient of 0.97. The mean scores of K-LBCRS were significantly different among three groups, with DLB (6.2±2.4), AD (1.4±1.3), and controls (0.3±0.6). We identified a cut-off score of 3 as best to differentiate between DLB and AD, having AUC of 0.97 (95% CI 0.94-1.00), sensitivity 97%, specificity 83%, positive predictive value 76%, negative predictive value 98%, which is the same score suggested in the original study. This study shows K-LBCRS as a new useful screening tool for Korean DLB patients in clinical settings.

  12. Paleolithic and Mediterranean diet pattern scores and risk of incident, sporadic colorectal adenomas.

    Science.gov (United States)

    Whalen, Kristine A; McCullough, Marji; Flanders, W Dana; Hartman, Terryl J; Judd, Suzanne; Bostick, Roberd M

    2014-12-01

    The Western dietary pattern is associated with higher risk of colorectal neoplasms. Evolutionary discordance could explain this association. We investigated associations of scores for 2 proposed diet patterns, the "Paleolithic" and the Mediterranean, with incident, sporadic colorectal adenomas in a case-control study of colorectal polyps conducted in Minnesota (1991-1994). Persons with no prior history of colorectal neoplasms completed comprehensive questionnaires prior to elective, outpatient endoscopy; of these individuals, 564 were identified as cases and 1,202 as endoscopy-negative controls. An additional group of community controls frequency-matched on age and sex (n = 535) was also recruited. Both diet scores were calculated for each participant and categorized into quintiles, and associations were estimated using unconditional logistic regression. The multivariable-adjusted odds ratios comparing persons in the highest quintiles of the Paleolithic and Mediterranean diet scores relative to the lowest quintiles were, respectively, 0.71 (95% confidence interval (CI): 0.50, 1.02; Ptrend = 0.02) and 0.74 (95% CI: 0.54, 1.03; Ptrend = 0.05) when comparing cases with endoscopy-negative controls and 0.84 (95% CI: 0.56, 1.26; Ptrend = 0.14) and 0.77 (95% CI: 0.53, 1.11; Ptrend = 0.13) when comparing cases with community controls. These findings suggest that greater adherence to the Paleolithic diet pattern and greater adherence to the Mediterranean diet pattern may be similarly associated with lower risk of incident, sporadic colorectal adenomas.

  13. A competing risk approach for the European Heart SCORE model based on cause-specific and all-cause mortality

    DEFF Research Database (Denmark)

    Støvring, Henrik; Harmsen, Charlotte G; Wisløff, Torbjørn;

    2013-01-01

    pressure, and total cholesterol level. The SCORE model, however, is not mathematically consistent and does not estimate all-cause mortality. Our aim is to modify the SCORE model to allow consistent estimation of both CVD-specific and all-cause mortality. Methods: Using a competing risk approach, we first...

  14. 75 FR 54020 - Federal Housing Administration Risk Management Initiatives: New Loan-to-Value and Credit Score...

    Science.gov (United States)

    2010-09-03

    ... [Docket No. FR-5404-N-02] Federal Housing Administration Risk Management Initiatives: New Loan-to-Value and Credit Score Requirements AGENCY: Office of the Assistant Secretary for Housing--Federal Housing... minimum credit score threshold and reduce the maximum LTV. At the end of the public comment period...

  15. Association between genetic risk scoring for schizophrenia and bipolar disorder with regional subcortical volumes

    Science.gov (United States)

    Caseras, X; Tansey, K E; Foley, S; Linden, D

    2015-01-01

    Previous research has shown coincident abnormal regional brain volume in patients with schizophrenia (SCZ) and bipolar disorder (BD) compared with controls. Whether these abnormalities are genetically driven or explained by secondary effects of the disorder or environmental factors is unknown. We aimed to investigate the association between genetic risk scoring (GRS) for SCZ and BD with volume of brain areas previously shown to be different between these clinical groups and healthy controls. We obtained subcortical brain volume measures and GRS for SCZ and BD from a sample of 274 healthy volunteers (71.4% females, mean age 24.7 (s.d. 6.9)). Volume of the globus pallidus was associated with the shared GRS between SCZ and BD, and also with the independent GRS for each of these disorders. Volume of the amygdala was associated with the non-shared GRS between SCZ and BD, and with the independent GRS for BD. Our results for volume of the globus pallidus support the idea of SCZ and BD sharing a common underlying neurobiological abnormality associated with a common genetic risk for both these disorders. Results for volume of the amygdala, though, would suggest the existence of a distinct mechanism only associated with genetic risk for BD. Finally, the lack of association between genetic risk and volume of most subcortical structures suggests that the volumetric differences reported in patient–control comparisons may not be genetically driven, but a consequence of the disorder or co-occurring environmental factors. PMID:26645627

  16. A Quantitative Climate-Match Score for Risk-Assessment Screening of Reptile and Amphibian Introductions

    Science.gov (United States)

    van Wilgen, Nicola J.; Roura-Pascual, Núria; Richardson, David M.

    2009-09-01

    Assessing climatic suitability provides a good preliminary estimate of the invasive potential of a species to inform risk assessment. We examined two approaches for bioclimatic modeling for 67 reptile and amphibian species introduced to California and Florida. First, we modeled the worldwide distribution of the biomes found in the introduced range to highlight similar areas worldwide from which invaders might arise. Second, we modeled potentially suitable environments for species based on climatic factors in their native ranges, using three sources of distribution data. Performance of the three datasets and both approaches were compared for each species. Climate match was positively correlated with species establishment success (maximum predicted suitability in the introduced range was more strongly correlated with establishment success than mean suitability). Data assembled from the Global Amphibian Assessment through NatureServe provided the most accurate models for amphibians, while ecoregion data compiled by the World Wide Fund for Nature yielded models which described reptile climatic suitability better than available point-locality data. We present three methods of assigning a climate-match score for use in risk assessment using both the mean and maximum climatic suitabilities. Managers may choose to use different methods depending on the stringency of the assessment and the available data, facilitating higher resolution and accuracy for herpetofaunal risk assessment. Climate-matching has inherent limitations and other factors pertaining to ecological interactions and life-history traits must also be considered for thorough risk assessment.

  17. Development of an Open-Heart Intraoperative Risk Scoring Model for Predicting a Prolonged Intensive Care Unit Stay

    Directory of Open Access Journals (Sweden)

    Sirirat Tribuddharat

    2014-01-01

    Full Text Available Background. Based on a pilot study with 34 patients, applying the modified sequential organ failure assessment (SOFA score intraoperatively could predict a prolonged ICU stay, albeit with only 4 risk factors. Our objective was to develop a practicable intraoperative model for predicting prolonged ICU stay which included more relevant risk factors. Methods. An extensive literature review identified 6 other intraoperative risk factors affecting prolonged ICU stay. Another 168 patients were then recruited for whom all 10 risk factors were extracted and analyzed by logistic regression to form the new prognostic model. Results. The multivariate logistic regression analysis retained only 6 significant risk factors in the model: age ≥ 60 years, PaO2/FiO2 ratio ≤ 200 mmHg, platelet count ≤ 120,000/mm3, requirement for inotrope/vasopressor ≥ 2 drugs, serum potassium ≤ 3.2 mEq/L, and atrial fibrillation grading ≥2. This model was then simplified into the Open-Heart Intraoperative Risk (OHIR score, comprising the same 6 risk factors for a total score of 7—a score of ≥3 indicating a likely prolonged ICU stay (AUC for ROC of 0.746. Conclusions. We developed a new, easy to calculate OHIR scoring system for predicting prolonged ICU stay as early as 3 hours after CPB. It comprises 6 risk factors, 5 of which can be manipulated intraoperatively.

  18. An obesity genetic risk score is associated with metabolic syndrome in Chinese children.

    Science.gov (United States)

    Zhao, Xiaoyuan; Xi, Bo; Shen, Yue; Wu, Lijun; Hou, Dongqing; Cheng, Hong; Mi, Jie

    2014-02-10

    Recent genome-wide association studies have identified several single nucleotide polymorphisms (SNPs) associated with body mass index (BMI)/obesity. In this study, we aim to examine the associations of obesity related loci with risk of metabolic syndrome (MetS) in a children population from China. A total of 431 children with MetS and 3046 controls were identified based on the modified ATPIII definition. 11 SNPs (FTO rs9939609, MC4R rs17782313, GNPDA2 rs10938397, BDNF rs6265, FAIM2 rs7138803, NPC1 rs1805081, SEC16B rs10913469, SH2B1 rs4788102, PCSK1rs6235, KCTD15 rs29941, BAT2 rs2844479) were genotyped by TaqMan 7900. Of 11 SNPs, GNPDA2 rs10938397, BDNF rs6265, and FAIM2 rs7138803 were nominally associated with risk of MetS (GNPDA2 rs10938397: odds ratio (OR)=1.21, 95% confidence interval (CI)=1.04-1.40, P=0.016; BDNF rs6265: OR=1.19, 95% CI=1.03-1.39, P=0.021; FAIM2 rs7138803: OR=1.20, 95% CI=1.02-1.40, P=0.025); genetic risk score (GRS) was significantly associated with risk of MetS (OR=1.09, 95% CI=1.04-1.15, P=5.26×10(-4)). After further adjustment for BMI, none of SNPs were associated with risk of MetS (all P>0.05); the association between GRS and risk of MetS remained nominally (OR=1.02, 95%CI=0.96-1.08, P=0.557). However, after correction for multiple testing, only GRS was statistically associated with risk of MetS in the model without adjustment for BMI. The present study demonstrated that there were nominal associations of GNPDA2 rs10938397, BDNF rs6265, and FAIM2 rs7138803 with risk of MetS. The SNPs in combination have a significant effect on risk of MetS among Chinese children. These associations above were mediated by adiposity.

  19. Framingham Risk Score underestimates cardiovascular disease risk in severe psoriatic patients: implications in cardiovascular risk factors management and primary prevention of cardiovascular disease.

    Science.gov (United States)

    Torres, Tiago; Sales, Rita; Vasconcelos, Carlos; Martins da Silva, Berta; Selores, Manuela

    2013-11-01

    Severe psoriasis has been associated with increase cardiovascular mortality, due to a higher prevalence of traditional cardiovascular risk factors and premature atherosclerosis, as a consequence of its systemic inflammation. Recently, it has been estimated that severe psoriasis may confer an increased 6.2% on long-term risk of cardiovascular disease based on Framingham Risk Score, which can have practical implications in the treatment of cardiovascular risk factors and primary prevention of cardiovascular disease, as treatment guidelines account for the risk of cardiovascular disease in treatment goals. The aim of this study was to analyze the influence of the attributable risk of severe psoriasis on long-term risk of cardiovascular disease and its implication on the correct treatment of cardiovascular risk factors and primary prevention of cardiovascular disease on a real-world cohort of patients. One hundred severe psoriasis patients without psoriatic arthritis or previous cardiovascular disease were evaluated and it was found that more than half of the patients were reclassified to a higher cardiovascular risk category with important clinical implications on the correct management of their cardiovascular risk factors and primary prevention of cardiovascular disease, as a considerable proportion of patients with hypertension, hypercholesterolemia and coronary heart disease equivalent risk were not being correctly managed.

  20. A Novel Risk Score to the Prediction of 10-year Risk for Coronary Artery Disease Among the Elderly in Beijing Based on Competing Risk Model.

    Science.gov (United States)

    Liu, Long; Tang, Zhe; Li, Xia; Luo, Yanxia; Guo, Jin; Li, Haibin; Liu, Xiangtong; Tao, Lixin; Yan, Aoshuang; Guo, Xiuhua

    2016-03-01

    The study aimed to construct a risk prediction model for coronary artery disease (CAD) based on competing risk model among the elderly in Beijing and develop a user-friendly CAD risk score tool. We used competing risk model to evaluate the risk of developing a first CAD event. On the basis of the risk factors that were included in the competing risk model, we constructed the CAD risk prediction model with Cox proportional hazard model. Time-dependent receiver operating characteristic (ROC) curve and time-dependent area under the ROC curve (AUC) were used to evaluate the discrimination ability of the both methods. Calibration plots were applied to assess the calibration ability and adjusted for the competing risk of non-CAD death. Net reclassification index (NRI) and integrated discrimination improvement (IDI) were applied to quantify the improvement contributed by the new risk factors. Internal validation of predictive accuracy was performed using 1000 times of bootstrap re-sampling. Of the 1775 participants without CAD at baseline, 473 incident cases of CAD were documented for a 20-year follow-up. Time-dependent AUCs for men and women at t = 10 years were 0.841 [95% confidence interval (95% CI): 0.806-0.877], 0.804 (95% CI: 0.768-0.839) in Fine and Gray model, 0.784 (95% CI: 0.738-0.830), 0.733 (95% CI: 0.692-0.775) in Cox proportional hazard model. The competing risk model was significantly superior to Cox proportional hazard model on discrimination and calibration. The cut-off values of the risk score that marked the difference between low-risk and high-risk patients were 34 points for men and 30 points for women, which have good sensitivity and specificity. A sex-specific multivariable risk factor algorithm-based competing risk model has been developed on the basis of an elderly Chinese cohort, which could be applied to predict an individual's risk and provide a useful guide to identify the groups at a high risk for CAD among the Chinese adults over 55

  1. A Novel Risk Score to the Prediction of 10-year Risk for Coronary Artery Disease Among the Elderly in Beijing Based on Competing Risk Model

    Science.gov (United States)

    Liu, Long; Tang, Zhe; Li, Xia; Luo, Yanxia; Guo, Jin; Li, Haibin; Liu, Xiangtong; Tao, Lixin; Yan, Aoshuang; Guo, Xiuhua

    2016-01-01

    Abstract The study aimed to construct a risk prediction model for coronary artery disease (CAD) based on competing risk model among the elderly in Beijing and develop a user-friendly CAD risk score tool. We used competing risk model to evaluate the risk of developing a first CAD event. On the basis of the risk factors that were included in the competing risk model, we constructed the CAD risk prediction model with Cox proportional hazard model. Time-dependent receiver operating characteristic (ROC) curve and time-dependent area under the ROC curve (AUC) were used to evaluate the discrimination ability of the both methods. Calibration plots were applied to assess the calibration ability and adjusted for the competing risk of non-CAD death. Net reclassification index (NRI) and integrated discrimination improvement (IDI) were applied to quantify the improvement contributed by the new risk factors. Internal validation of predictive accuracy was performed using 1000 times of bootstrap re-sampling. Of the 1775 participants without CAD at baseline, 473 incident cases of CAD were documented for a 20-year follow-up. Time-dependent AUCs for men and women at t = 10 years were 0.841 [95% confidence interval (95% CI): 0.806–0.877], 0.804 (95% CI: 0.768–0.839) in Fine and Gray model, 0.784 (95% CI: 0.738–0.830), 0.733 (95% CI: 0.692–0.775) in Cox proportional hazard model. The competing risk model was significantly superior to Cox proportional hazard model on discrimination and calibration. The cut-off values of the risk score that marked the difference between low-risk and high-risk patients were 34 points for men and 30 points for women, which have good sensitivity and specificity. A sex-specific multivariable risk factor algorithm-based competing risk model has been developed on the basis of an elderly Chinese cohort, which could be applied to predict an individual's risk and provide a useful guide to identify the groups at a high risk for CAD among the Chinese

  2. Prediction of coronary risk by SYNTAX and derived scores: synergy between percutaneous coronary intervention with taxus and cardiac surgery.

    Science.gov (United States)

    Yadav, Mayank; Palmerini, Tullio; Caixeta, Adriano; Madhavan, Mahesh V; Sanidas, Elias; Kirtane, Ajay J; Stone, Gregg W; Généreux, Philippe

    2013-10-01

    The introduction of the SYNTAX (Synergy Between PCI With Taxus and Cardiac Surgery) score has prompted a renewed interest for angiographic risk stratification in patients undergoing percutaneous coronary intervention. Syntax score is based on qualitative and quantitative characterization of coronary artery disease by including 11 angiographic variables that take into consideration lesion location and characteristics. Thus far, this score has been shown to be an effective tool to risk-stratify patients with complex coronary artery disease undergoing percutaneous coronary intervention in the landmark SYNTAX trial, as well as in other clinical settings. This review provides an overview of its current applications, including its integration with other nonangiographic clinical scores, and explores future applications of the SYNTAX and derived scores.

  3. Oxidative balance scores and risk of incident colorectal cancer in a US prospective cohort study.

    Science.gov (United States)

    Dash, Chiranjeev; Bostick, Roberd M; Goodman, Michael; Flanders, W Dana; Patel, Roshni; Shah, Roma; Campbell, Peter T; McCullough, Marjorie L

    2015-04-15

    Although oxidative stress is implicated in colorectal carcinogenesis, human studies on associations of individual prooxidants and antioxidants with colorectal cancer (CRC) have been inconclusive. We incorporated individual environmental factors known to affect oxidative stress into 4 oxidative balance scores (OBS) and investigated their associations with CRC in the Cancer Prevention Study II Nutrition Cohort. During 1999-2009, a total of 1,109 incident CRC cases were identified among 80,063 participants in the Nutrition Cohort who had completed detailed questionnaires. Four OBS with different weighting methods (equal weights, literature review-based, a posteriori data-based, and weights based on Bayesian analysis) were created by combining 16 dietary and nondietary lifestyle factors. Higher values for all 4 OBS, representing more antioxidant exposures than prooxidant exposures, were associated with 41%-53% lower risks of CRC; for example, the relative risk for the highest OBS quartile versus the lowest in the Bayesian analysis was 0.50 (95% confidence interval: 0.41, 0.61). The associations were more modest when OBS was restricted to either dietary or nondietary components. These results, obtained using comprehensive summary measures of oxidative balance-especially considering the similarity of the findings derived using the different weighting methods-support the hypothesis that a predominance of antioxidant lifestyle exposures (both dietary and nondietary) over prooxidant lifestyle exposures reduces risk of CRC.

  4. An Update on the Utility of Coronary Artery Calcium Scoring for Coronary Heart Disease and Cardiovascular Disease Risk Prediction.

    Science.gov (United States)

    Kianoush, Sina; Al Rifai, Mahmoud; Cainzos-Achirica, Miguel; Umapathi, Priya; Graham, Garth; Blumenthal, Roger S; Nasir, Khurram; Blaha, Michael J

    2016-03-01

    Estimating cardiovascular disease (CVD) risk is necessary for determining the potential net benefit of primary prevention pharmacotherapy. Risk estimation relying exclusively on traditional CVD risk factors may misclassify risk, resulting in both undertreatment and overtreatment. Coronary artery calcium (CAC) scoring personalizes risk prediction through direct visualization of calcified coronary atherosclerotic plaques and provides improved accuracy for coronary heart disease (CHD) or CVD risk estimation. In this review, we discuss the most recent studies on CAC, which unlike historical studies, focus sharply on clinical application. We describe the MESA CHD risk calculator, a recently developed CAC-based 10-year CHD risk estimator, which can help guide preventive therapy allocation by better identifying both high- and low-risk individuals. In closing, we discuss calcium density, regional distribution of CAC, and extra-coronary calcification, which represent the future of CAC and CVD risk assessment research and may lead to further improvements in risk prediction.

  5. The coronary calcium score is a more accurate predictor of significant coronary stenosis than conventional risk factors in symptomatic patients

    DEFF Research Database (Denmark)

    Nicoll, R; Wiklund, U; Zhao, Y;

    2016-01-01

    risk factor assessment, computed tomographic coronary angiogram (CTCA) or conventional angiography and a CT scan for coronary artery calcium (CAC) scoring. 1539 (27.9%) patients had significant stenosis, 5.5% of whom had zero CAC. In 5074 patients, multiple binary regression showed the most important...... predictor of significant stenosis to be male gender (B=1.07) followed by diabetes mellitus (B=0.70) smoking, hypercholesterolaemia, hypertension, family history of CAD and age but not obesity. When the log transformed CAC score was included, it became the most powerful predictor (B=1.25), followed by male...... gender (B=0.48), diabetes, smoking, family history and age but hypercholesterolaemia and hypertension lost significance. The CAC score is a more accurate predictor of >50% stenosis than risk factors regardless of the means of assessment of stenosis. The sensitivity of risk factors, CAC score...

  6. Neonatal status: an objective scoring method for identifying infants at risk for poor outcome.

    Science.gov (United States)

    Salamy, A; Davis, S; Eldredge, L; Wakeley, A; Tooley, W H

    1988-01-01

    The likelihood of sustaining neurological, sensory or cognitive deficits is considerably greater for very low birthweight (VLBW) infants who require intensive care in early postnatal life than those without major neonatal illness. Identifying which, if any, medical events are responsible for an adverse outcome is most difficult in the face of multiple concurrent complications. In this research, a principal components analysis was performed in order to arrive at a set of orthogonal variables which succinctly described clinical involvement in the nursery. With this procedure, a single hypothetical factor depicting neonatal status (NS) was computed. Principal component scores were then generated for NS and assigned to 252 VLBW (less than 1500 g) infants. These subjects were followed prospectively from birth to 4 years of age. Standardized measures of neurological, sensory and intellectual function were regularly administered. Neonatal status was shown to be significantly correlated with the various test results and predictive of long-term development. When subjects were divided into quartiles with respect to NS, a specific subgroup was identified as "at high risk" for poor outcome. Those subjects falling into the lower quartile incurred more neurological abnormalities persisting beyond the first year. They also suffered a higher incidence of intracranial hemorrhage and sensori-neural hearing loss. In addition, the lower 25%, as a group, scored well below all others on traditional tests of mental ability. These differences were sustained throughout infancy and early childhood and could not be attributed to a number of demographic variables including sex, gestational age, birthweight, Apgar scores or parental educational level.

  7. Could symptoms and risk factors diagnose COPD? Development of a Diagnosis Score for COPD

    Directory of Open Access Journals (Sweden)

    Salameh P

    2012-09-01

    Full Text Available Pascale Salameh,1 Georges Khayat,2 Mirna Waked31Faculties of Pharmacy and of Public Health, Lebanese University, Beirut, 2Faculty of Medicine, Hôtel Dieu de France Hospital, Beirut and Saint Joseph University, Beirut, 3Faculty of Medicine, Saint George Hospital, Beirut and Balamand University, Beirut, LebanonBackground: Diagnosing chronic obstructive pulmonary disease (COPD without spirometry is still a challenge. Our objective in this study was to develop a scale for diagnosis of COPD.Methods: Data were taken from a cross-sectional epidemiological study. After reducing chronic respiratory symptoms, a logistic regression was used to select risk factors for and symptoms of COPD. The rounded coefficients generated a Diagnosis Score for COPD (DS-COPD, which was dichotomized and differentiated between COPD and other individuals with respiratory symptoms.Results: We constructed a tool for COPD diagnosis with good properties, comprising 12 items. The area under the curve was 0.849; the positive predictive value was 76% if the DS-COPD was >20 and the negative predictive value was 97% if the DS-COPD was <10. A DS-COPD of 10–19 represented a zone mostly suggestive of no COPD (77%. The score was also inversely correlated with forced expiratory volume in 1 second/forced vital capacity.Conclusion: In this study, a tool for diagnosis of COPD was constructed with good properties for use in the epidemiological setting, mainly in cases of low or high scoring. It would be of particular interest in the primary care setting, where spirometry may not be available. Prospective studies and application in clinical settings would be necessary to validate this scale further.Keywords: diagnosis, scale, development, spirometry

  8. Association between Knee Osteoarthritis, Cardiovascular Risk Factors, and the Framingham Risk Score in South Koreans: A Cross-Sectional Study

    Science.gov (United States)

    Kim, Ho Sun; Shin, Joon-Shik; Lee, Jinho; Lee, Yoon Jae; Kim, Me-riong; Bae, Young-Hyeon; Park, Ki Byung; Lee, Eun-Jung; Kim, Joo-Hee

    2016-01-01

    Background Osteoarthritis is a significant burden on personal health and for social cost, and its prevalence is rising. Recent research has revealed an association between osteoarthritis and cardiovascular disease, and this study uses the Framingham risk score (FRS), which is widely used as a composite index of cardiovascular risk factors, to investigate the association between osteoarthritis and various cardiovascular risk factors. Methods A total 9,514 participants aged 50 years or older who received knee X-ray diagnosis of the 5th Korean National Health and Nutrition Examination Survey (total surveyees = 24,173) released by the Korean Centers for Disease Control and Prevention was included for analysis. Knee osteoarthritis patients were defined as participants with K-L grade ≥2 on knee X-ray regardless of knee pain. The association between major cardiovascular risk factors (blood pressure, diabetes, cholesterol, and smoking habits), FRS, and knee osteoarthritis was analyzed, adjusting for various covariates. Results Prevalence of knee osteoarthritis in Koreans aged ≥50 years was 36.6%, and higher in women (men: 24.9%, women: 45.4%). Prevalence of knee osteoarthritis in participants with hypertension was significantly higher than those without hypertension (fully adjusted odds ratio (OR) 1.26; 95% confidence interval (CI) 1.08–1.48). Knee osteoarthritis prevalence was also higher in participants with impaired fasting glucose or diabetes than those without (age, sex adjusted OR 1.19; 95% CI 1.00–1.41). Also, OR values increased statistically significantly with FRS as a continuous variable (fully adjusted OR 1.007; 95% CI 1.00–1.01). Conclusions Prevalence of knee osteoarthritis was associated with hypertension and diabetes, which are major cardiovascular risk factors, and the FRS. Further studies on FRS pertaining to its relationship with osteoarthritis are warranted. PMID:27764239

  9. The "Dry-Run" Analysis: A Method for Evaluating Risk Scores for Confounding Control.

    Science.gov (United States)

    Wyss, Richard; Hansen, Ben B; Ellis, Alan R; Gagne, Joshua J; Desai, Rishi J; Glynn, Robert J; Stürmer, Til

    2017-03-06

    A propensity score (PS) model's ability to control confounding can be assessed by evaluating covariate balance across exposure groups after PS adjustment. The optimal strategy for evaluating a disease risk score (DRS) model's ability to control confounding is less clear. DRS models cannot be evaluated through balance checks within the full population, and they are usually assessed through prediction diagnostics and goodness-of-fit tests. A proposed alternative is the "dry-run" analysis, which divides the unexposed population into "pseudo-exposed" and "pseudo-unexposed" groups so that differences on observed covariates resemble differences between the actual exposed and unexposed populations. With no exposure effect separating the pseudo-exposed and pseudo-unexposed groups, a DRS model is evaluated by its ability to retrieve an unconfounded null estimate after adjustment in this pseudo-population. We used simulations and an empirical example to compare traditional DRS performance metrics with the dry-run validation. In simulations, the dry run often improved assessment of confounding control, compared with the C statistic and goodness-of-fit tests. In the empirical example, PS and DRS matching gave similar results and showed good performance in terms of covariate balance (PS matching) and controlling confounding in the dry-run analysis (DRS matching). The dry-run analysis may prove useful in evaluating confounding control through DRS models.

  10. Combination of European System for Cardiac Operative Risk Evaluation (EuroSCORE) and Cardiac Surgery Score (CASUS) to Improve Outcome Prediction in Cardiac Surgery.

    Science.gov (United States)

    Doerr, Fabian; Heldwein, Matthias B; Bayer, Ole; Sabashnikov, Anton; Weymann, Alexander; Dohmen, Pascal M; Wahlers, Thorsten; Hekmat, Khosro

    2015-08-17

    BACKGROUND We hypothesized that the combination of a preoperative and a postoperative scoring system would improve the accuracy of mortality prediction and therefore combined the preoperative 'additive EuroSCORE' (European system for cardiac operative risk evaluation) with the postoperative 'additive CASUS' (Cardiac Surgery Score) to form the 'modified CASUS'. MATERIAL AND METHODS We included all consecutive adult patients after cardiac surgery during January 2007 and December 2010 in our prospective study. Our single-centre study was conducted in a German general referral university hospital. The original additive and the 'modified CASUS' were tested using calibration and discrimination statistics. We compared the area under the curve (AUC) of the receiver characteristic curves (ROC) by DeLong's method and calculated overall correct classification (OCC) values. RESULTS The mean age among the total of 5207 patients was 67.2 ± 10.9 years. Whilst the ICU mortality was 5.9% we observed a mean length of ICU stay of 4.6 ± 7.0 days. Both models demonstrated excellent discriminatory power (mean AUC of 'modified CASUS': ≥ 0.929; 'additive CASUS': ≥ 0.920), with no significant differences according to DeLong. Neither model showed a significant p-value (cardiac surgery by combining a preoperative and a postoperative scoring system. A separate calculation of the two individual elements is therefore recommended.

  11. Computed Tomography Coronary Artery Calcium Scoring Review of Evidence Base and Cost-effectiveness in Cardiovascular Risk Prediction

    NARCIS (Netherlands)

    Vliegenthart, Rozemarijn; Morris, Pamela B.

    2012-01-01

    Cardiovascular risk factor-scoring algorithms may fall short in identifying asymptomatic individuals who will subsequently suffer a coronary event. It is generally thought that evaluation of the extent of the atherosclerotic plaque and total plaque burden can improve cardiovascular risk stratificati

  12. A four-year cardiovascular risk score for type 2 diabetic inpatients

    Directory of Open Access Journals (Sweden)

    Dolores Ramírez-Prado

    2015-06-01

    Full Text Available As cardiovascular risk tables currently in use were constructed using data from the general population, the cardiovascular risk of patients admitted via the hospital emergency department may be underestimated. Accordingly, we constructed a predictive model for the appearance of cardiovascular diseases in patients with type 2 diabetes admitted via the emergency department. We undertook a four-year follow-up of a cohort of 112 adult patients with type 2 diabetes admitted via the emergency department for any cause except patients admitted with acute myocardial infarction, stroke, cancer, or a palliative status. The sample was selected randomly between 2010 and 2012. The primary outcome was time to cardiovascular disease. Other variables (at baseline were gender, age, heart failure, renal failure, depression, asthma/chronic obstructive pulmonary disease, hypertension, dyslipidaemia, insulin, smoking, admission for cardiovascular causes, pills per day, walking habit, fasting blood glucose and creatinine. A cardiovascular risk table was constructed based on the score to estimate the likelihood of cardiovascular disease. Risk groups were established and the c-statistic was calculated. Over a mean follow-up of 2.31 years, 39 patients had cardiovascular disease (34.8%, 95% CI [26.0–43.6%]. Predictive factors were gender, age, hypertension, renal failure, insulin, admission due to cardiovascular reasons and walking habit. The c-statistic was 0.734 (standard error: 0.049. After validation, this study will provide a tool for the primary health care services to enable the short-term prediction of cardiovascular disease after hospital discharge in patients with type 2 diabetes admitted via the emergency department.

  13. The correction of TTO-scores for utility curvature using a risk-free utility elicitation method.

    Science.gov (United States)

    Attema, Arthur E; Brouwer, Werner B F

    2009-01-01

    This paper describes and employs a new method to correct time tradeoff (TTO)-scores for utility of life duration curvature. In contrast to most previous attempts to do so, it uses a risk-free method that corresponds well to the risk-free properties of the TTO-method. In addition, the method is robust to several biases that occur under methods that incorporate risk. Our results show a significant degree of curvature in utility of life duration and therefore a clear bias in TTO-scores. The risk-free method seems to be useful to correct TTO-scores for this influence and leads to significantly higher quality-adjustment factors.

  14. A risk score for predicting 30-day mortality in heart failure patients undergoing non-cardiac surgery

    DEFF Research Database (Denmark)

    Andersson, Charlotte; Gislason, Gunnar H; Hlatky, Mark A;

    2014-01-01

    BACKGROUND: Heart failure is an established risk factor for poor outcomes in patients undergoing non-cardiac surgery, yet risk stratification remains a clinical challenge. We developed an index for 30-day mortality risk prediction in this particular group. METHODS AND RESULTS: All individuals...... with heart failure undergoing non-cardiac surgery between October 23 2004 and October 31 2011 were included from Danish administrative registers (n = 16 827). In total, 1787 (10.6%) died within 30 days. In a simple risk score based on the variables from the revised cardiac risk index, plus age, gender, acute...... by bootstrapping (1000 re-samples) provided c-statistic of 0.79. A more complex risk score based on stepwise logistic regression including 24 variables at P failure, this simple...

  15. Additive prognostic value of the SYNTAX score over GRACE, TIMI, ZWOLLE, CADILLAC and PAMI risk scores in patients with acute ST-segment elevation myocardial infarction treated by primary percutaneous coronary intervention.

    Science.gov (United States)

    Brkovic, Voin; Dobric, Milan; Beleslin, Branko; Giga, Vojislav; Vukcevic, Vladan; Stojkovic, Sinisa; Stankovic, Goran; Nedeljkovic, Milan A; Orlic, Dejan; Tomasevic, Miloje; Stepanovic, Jelena; Ostojic, Miodrag

    2013-08-01

    This study evaluated additive prognostic value of the SYNTAX score over GRACE, TIMI, ZWOLLE, CADILLAC and PAMI risk scores in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI). All six scores were calculated in 209 consecutive STEMI patients undergoing pPCI. Primary end-point was the major adverse cardiovascular event (MACE--composite of cardiovascular mortality, non-fatal myocardial infarction and stroke); secondary end point was cardiovascular mortality. Patients were stratified according to the SYNTAX score tertiles (≤12; between 12 and 19.5; >19.5). The median follow-up was 20 months. Rates of MACE and cardiovascular mortality were highest in the upper tertile of the SYNTAX score (p SYNTAX score was independent multivariable predictor of MACE and cardiovascular mortality when added to GRACE, TIMI, ZWOLLE, and PAMI risk scores. However, the SYNTAX score did not improve the Cox regression models of MACE and cardiovascular mortality when added to the CADILLAC score. The SYNTAX score has predictive value for MACE and cardiovascular mortality in patients with STEMI undergoing primary PCI. Furthermore, SYNTAX score improves prognostic performance of well-established GRACE, TIMI, ZWOLLE and PAMI clinical scores, but not the CADILLAC risk score. Therefore, long-term survival in patients after STEMI depends less on detailed angiographical characterization of coronary lesions, but more on clinical characteristics, myocardial function and basic angiographic findings as provided by the CADILLAC score.

  16. [Dystocia risk score: a decision making tool to combat maternal mortality].

    Science.gov (United States)

    Ndiaye, Papa; Niang, Khadim; Diallo, Issakha

    2013-01-01

    As a way to prevent maternal mortality and stillbirth, the dystocia risk score includes three components: a left column provides a list of eight characteristics to check for in the woman; an upper horizontal section provides a checklist of possible outcomes of the pregnancy itself: and a rectangular grid indicates the prognosis in three zones: a large red (dangerous), a medium-sized grey (doubtful) and a small blue (hopeful). The DRS is positive if there is at least one cross in the dangerous zone and/or two crosses in the doubtful zone (it indicates that the woman should be referred to a center specialized in obstetric emergency care); elsewhere, the DRS is negative. The validation test gives good results (sensitivity=83.61%, specificity=90.05%, positive predictive value=72.34%, and negative predictive value=94.04%). Its large-scale use would accelerate the identification of pregnant women with a high risk of dystocia. Their timely referral to specialized emergency obstetrics centers would increase the efficacy of care and reduce the levels of maternal mortality and stillbirth.

  17. Hypomineralized second primary molars: Prevalence data in Dutch 5-year-olds

    NARCIS (Netherlands)

    Elfrink, M.E.C.; Schuller, A.A.; Weerheijm, K.L.; Veerkamp, J.S.J.

    2008-01-01

    The aim of this cross-sectional observational study was to report on the prevalence of hypomineralizations in second primary molars in 5-year-old Dutch children. In the study 386 (45% girls) 5-year-old Dutch children, all insured by a Health Insurance Fund, participated. Scoring criteria for molar i

  18. Hypomineralized second primary molars : prevalence data in Dutch 5-year-olds

    NARCIS (Netherlands)

    Elfrink, M E C; Schuller, A A; Weerheijm, K L; Veerkamp, J S J

    2008-01-01

    The aim of this cross-sectional observational study was to report on the prevalence of hypomineralizations in second primary molars in 5-year-old Dutch children. In the study 386 (45% girls) 5-year-old Dutch children, all insured by a Health Insurance Fund, participated. Scoring criteria for molar i

  19. Hypomineralized second primary molars: prevalence data in Dutch 5-year-olds

    NARCIS (Netherlands)

    Elfrink, M.E.C.; Schuller, A.A.; Weerheijm, K.L.; Veerkamp, J.S.J.

    2008-01-01

    The aim of this cross-sectional observational study was to report on the prevalence of hypomineralizations in second primary molars in 5-year-old Dutch children. In the study 386 (45% girls) 5-year-old Dutch children, all insured by a Health Insurance Fund, participated. Scoring criteria for molar i

  20. Specific scoring systems to predict survival of patients with high-risk myelodysplastic syndrome (MDS) and de novo acute myeloid leukemia (AML) after intensive antileukemic treatment based on results of the EORTC-GIMEMA AML-10 and intergroup CRIANT studies.

    Science.gov (United States)

    Oosterveld, Margriet; Suciu, Stefan; Muus, Petra; Germing, Ulrich; Delforge, Michel; Belhabri, Amin; Aul, Carlo; Selleslag, Dominik; Ferrant, Augustin; Marie, Jean-Pierre; Amadori, Sergio; Jehn, Ulrich; Mandelli, Franco; Hess, Uwe; Hellström-Lindberg, Eva; Cakmak-Wollgast, Songuel; Vignetti, Marco; Labar, Boris; Willemze, Roel; de Witte, Theo

    2015-01-01

    High-risk myelodysplastic syndrome (MDS) patients have usually a less favorable outcome after intensive treatment compared with de novo acute myeloid leukemia (AML) patients. This may reflect different disease-related and patient-related factors. The purpose of this analysis is to identify disease-specific prognostic factors and to develop prognostic scores for both patient groups. A total of 692 patients in the EORTC/GIMEMA AML-10 study and 289 patients in the CRIANT study received identical remission-induction and consolidation treatment. Estimated 5-year survival rate was 34 % in the AML-10 versus 27 % in the CRIANT study, and estimated disease-free survival was 40 % versus 28 %, respectively. In multivariate analysis, cytogenetic characteristics, white blood count, and age appeared prognostic for survival in both studies. French-American-British (FAB) subtype and performance status were prognostic in the AML-10 study only, whereas number of cytopenias and duration of antecedent hematologic disorder >6 months were prognostic in the CRIANT study only. The prognostic scores distinguish three groups with a 5-year survival rate of 54, 38, and 19 % in the AML-10 study versus 69, 37, and 5 % in the CRIANT study. The prognostic value of these scores has been validated on two external series. The new scoring systems form a practical tool to predict the outcome of individual MDS and AML patients treated with intensive antileukemic therapy.

  1. A genetic risk score of 45 coronary artery disease risk variants associates with increased risk of myocardial infarction in 6041 Danish individuals

    DEFF Research Database (Denmark)

    Krarup, N T; Borglykke, A; Allin, K H;

    2015-01-01

    discrimination improvement (IDI) added to the European SCORE for 10-year MI risk prediction. RESULTS: The GRS associated significantly with risk of incident MI (allele-dependent hazard ratio (95%CI): 1.06 (1.02-1.11), p = 0.01) but not with CAD (p = 0.39). Stratification revealed association of GRS with MI...... in men (1.06 (1.01-1.12), p = 0.02) and in individuals above the median of 45.11 years of age (1.06 (1.00-1.12), p = 0.03). There was no interaction between GRS and gender (p = 0.90) or age (p = 0.83). The GRS improved neither NRI nor IDI. CONCLUSION: The GRS of 45 GWAS identified risk variants increase...

  2. [The application of genetic risk score in genetic studies of complex human diseases].

    Science.gov (United States)

    Dayan, Niu; Weili, Yan

    2015-12-01

    Complex diseases such as cardiovascular disease, type 2 diabetes, essential hypertension, asthma, obesity and cancer have spread across the globe and become the predominant cause of death. There are growing concerns over the role of genetic susceptibility in pathogenesis of complex diseases. However, the related susceptibility genes and sequence variations are still unknown. To elucidate the genetic basis of complex diseases, researchers have identified a large number of genetic variants associated with complex diseases through genome-wide association studies (GWAS) and candidate gene studies recently. The identification of these causal and/or associated variants promotes the development of approaches for complex diseases prediction and prevention. Genetic risk score (GRS), an emerging method for exploring correlation between single nucleotide polymorphisms (SNPs) and clinical phenotypes of complex diseases, integrates weak effects of multiple SNPs and dramatically enhances predictability of complex diseases by gene polymorphisms. This method has been applied successfully in genetic studies of many complex diseases. Here we focus on the introduction of the computational methods and evaluation criteria of GRS, enumerate a series of achievements through GRS application, discuss some limitations during application, and finally prospect the future of GRS.

  3. Combining the ASA Physical Classification System and Continuous Intraoperative Surgical Apgar Score Measurement in Predicting Postoperative Risk.

    Science.gov (United States)

    Jering, Monika Zdenka; Marolen, Khensani N; Shotwell, Matthew S; Denton, Jason N; Sandberg, Warren S; Ehrenfeld, Jesse Menachem

    2015-11-01

    The surgical Apgar score predicts major 30-day postoperative complications using data assessed at the end of surgery. We hypothesized that evaluating the surgical Apgar score continuously during surgery may identify patients at high risk for postoperative complications. We retrospectively identified general, vascular, and general oncology patients at Vanderbilt University Medical Center. Logistic regression methods were used to construct a series of predictive models in order to continuously estimate the risk of major postoperative complications, and to alert care providers during surgery should the risk exceed a given threshold. Area under the receiver operating characteristic curve (AUROC) was used to evaluate the discriminative ability of a model utilizing a continuously measured surgical Apgar score relative to models that use only preoperative clinical factors or continuously monitored individual constituents of the surgical Apgar score (i.e. heart rate, blood pressure, and blood loss). AUROC estimates were validated internally using a bootstrap method. 4,728 patients were included. Combining the ASA PS classification with continuously measured surgical Apgar score demonstrated improved discriminative ability (AUROC 0.80) in the pooled cohort compared to ASA (0.73) and the surgical Apgar score alone (0.74). To optimize the tradeoff between inadequate and excessive alerting with future real-time notifications, we recommend a threshold probability of 0.24. Continuous assessment of the surgical Apgar score is predictive for major postoperative complications. In the future, real-time notifications might allow for detection and mitigation of changes in a patient's accumulating risk of complications during a surgical procedure.

  4. Alguns fatores associados a excesso de peso, baixa estatura e déficit de peso em menores de 5 anos Some risk factors associated with overweight, stunting and wasting among children under 5 years old

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    Márcia R. Vitolo

    2008-06-01

    Full Text Available OBJETIVO: Examinar fatores socioeconômicos e outras condições de vida familiar associadas a excesso de peso, baixa estatura e baixo peso para a estatura em menores de 5 anos. MÉTODOS: Estudo transversal avaliou 3.957 crianças entre 1 mês e 5 anos de idade durante campanha nacional de imunização no município de São Leopoldo (RS em 2002. As condições socioeconômicas e de saneamento das áreas de abrangência das unidades de saúde foram agrupadas por análise de cluster dos setores do censo populacional de 2001. RESULTADOS: Déficit de peso para estatura ocorreu em 2,6% das crianças, baixa estatura em 9,1% e excesso de peso em 9,8%. A regressão logística multivariada sugere que os fatores associados à chance de excesso de peso foram: área de condições socioeconômicas alta (RC = 1,47; IC95% 1,09-1,96, filhos únicos (RC = 1,44; IC95% 1,00-2,07 e peso ao nascer ≥ 2.500 g (RC = 2,21; IC95%1,27-3,83. A chance de déficit de peso associou-se ao baixo peso ao nascer (RC = 3,46; IC95% 2,06-5,80 e idade da mãe OBJECTIVE: To explore whether socioeconomic and sanitary conditions, maternal and child factors are associated with overweight, stunting, and wasting in children under five year old in the city of São Leopoldo, southern Brazil. METHODS: Cross-sectional study of 3,957 children aged 1 month to 5 years conducted in all primary care services of the city during the National Children's Vaccination Day in 2002. Maternal and child factors were assessed by a questionnaire. Children's height and weight were measured. Cluster analysis was used to group the areas served by the primary care services according to socioeconomic and sanitary conditions of the census tracts assessed by the 2001 National Census. RESULTS: Wasting was observed in 2.6% of children, stunting in 9.1% and overweight in 9.8%. The multivariable logistic regression model suggests that overweight was associated with higher socioeconomic status and better sanitation of

  5. Additive composite ABCG2, SLC2A9 and SLC22A12 scores of high-risk alleles with alcohol use modulate gout risk.

    Science.gov (United States)

    Tu, Hung-Pin; Chung, Chia-Min; Min-Shan Ko, Albert; Lee, Su-Shin; Lai, Han-Ming; Lee, Chien-Hung; Huang, Chung-Ming; Liu, Chiu-Shong; Ko, Ying-Chin

    2016-09-01

    The aim of the present study was to evaluate the contribution of urate transporter genes and alcohol use to the risk of gout/tophi. Eight variants of ABCG2, SLC2A9, SLC22A12, SLC22A11 and SLC17A3 were genotyped in male individuals in a case-control study with 157 gout (33% tophi), 106 asymptomatic hyperuricaemia and 295 control subjects from Taiwan. The multilocus profiles of the genetic risk scores for urate gene variants were used to evaluate the risk of asymptomatic hyperuricaemia, gout and tophi. ABCG2 Q141K (T), SLC2A9 rs1014290 (A) and SLC22A12 rs475688 (C) under an additive model and alcohol use independently predicted the risk of gout (respective odds ratio for each factor=2.48, 2.03, 1.95 and 2.48). The additive composite Q141K, rs1014290 and rs475688 scores of high-risk alleles were associated with gout risk (P<0.0001). We observed the supramultiplicative interaction effect of genetic urate scores and alcohol use on gout and tophi risk (P for interaction=0.0452, 0.0033). The synergistic effect of genetic urate score 5-6 and alcohol use indicates that these combined factors correlate with gout and tophi occurrence.

  6. Prediction of Outcome After Emergency High-Risk Intra-abdominal Surgery Using the Surgical Apgar Score

    DEFF Research Database (Denmark)

    Cihoric, Mirjana; Toft Tengberg, Line; Bay-Nielsen, Morten

    2016-01-01

    BACKGROUND: With current literature quoting mortality rates up to 45%, emergency high-risk abdominal surgery has, compared with elective surgery, a significantly greater risk of death and major complications. The Surgical Apgar Score (SAS) is predictive of outcome in elective surgery, but has never...... been validated exclusively in an emergency setting. METHODS: A consecutive prospective single-center cohort study of 355 adults undergoing emergency high-risk abdominal surgery between June 2013 and May 2014 is presented. The primary outcome measure was 30-day mortality. Secondary outcome measures were...... the incidence of both outcomes. Area under the curve was used to demonstrate the scores' discriminatory power. RESULTS: One hundred eighty-one (51.0%) patients developed minor or no complications. The overall incidence of major complications was 32.7% and the overall death rate was 16.3%. Risk of major...

  7. Almanac 2012: Cardiovascular risk scores. The national society journals present selected research that has driven recent advances in clinical cardiology

    Directory of Open Access Journals (Sweden)

    Jill P. Pell

    2013-03-01

    Full Text Available Global risk scores use individual level information on non-modifiable risk factors (such as age, sex, ethnicity and family history and modifiable risk factors (such as smoking status and blood pressure to predict an individual’s absolute risk of an adverse event over a specified period of time in the future. Cardiovascular risk scores have two major uses in practice. First, they can be used to dichotomise people into a group whose baseline risk, and therefore potential absolute benefit, is sufficiently high to justify the costs and risks associated with an intervention (whether treatment or prevention and a group with a lower absolute risk to whom the intervention is usually denied. Second, they can be used to assess the effectiveness of an intervention (such as smoking cessation or antihypertensive treatment at reducing an individual’s risk of future adverse events. In this context, they can be helpful in informing patients, motivating them to change their lifestyle, and reinforcing the importance of continued compliance.

  8. A competing-risk-based score for predicting twenty-year risk of incident diabetes: the Beijing Longitudinal Study of Ageing study

    Science.gov (United States)

    Liu, Xiangtong; Chen, Zhenghong; Fine, Jason Peter; Liu, Long; Wang, Anxin; Guo, Jin; Tao, Lixin; Mahara, Gehendra; Yang, Kun; Zhang, Jie; Tian, Sijia; Li, Haibin; Liu, Kuo; Luo, Yanxia; Zhang, Feng; Tang, Zhe; Guo, Xiuhua

    2016-01-01

    Few risk tools have been proposed to quantify the long-term risk of diabetes among middle-aged and elderly individuals in China. The present study aimed to develop a risk tool to estimate the 20-year risk of developing diabetes while incorporating competing risks. A three-stage stratification random-clustering sampling procedure was conducted to ensure the representativeness of the Beijing elderly. We prospectively followed 1857 community residents aged 55 years and above who were free of diabetes at baseline examination. Sub-distribution hazards models were used to adjust for the competing risks of non-diabetes death. The cumulative incidence function of twenty-year diabetes event rates was 11.60% after adjusting for the competing risks of non-diabetes death. Age, body mass index, fasting plasma glucose, health status, and physical activity were selected to form the score. The area under the ROC curve (AUC) was 0.76 (95% Confidence Interval: 0.72–0.80), and the optimism-corrected AUC was 0.78 (95% Confidence Interval: 0.69–0.87) after internal validation by bootstrapping. The calibration plot showed that the actual diabetes risk was similar to the predicted risk. The cut-off value of the risk score was 19 points, marking mark the difference between low-risk and high-risk patients, which exhibited a sensitivity of 0.74 and specificity of 0.65. PMID:27849048

  9. Using "big data" to capture overall health status: properties and predictive value of a claims-based health risk score.

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    Rita Hamad

    Full Text Available Investigators across many fields often struggle with how best to capture an individual's overall health status, with options including both subjective and objective measures. With the increasing availability of "big data," researchers can now take advantage of novel metrics of health status. These predictive algorithms were initially developed to forecast and manage expenditures, yet they represent an underutilized tool that could contribute significantly to health research. In this paper, we describe the properties and possible applications of one such "health risk score," the DxCG Intelligence tool.We link claims and administrative datasets on a cohort of U.S. workers during the period 1996-2011 (N = 14,161. We examine the risk score's association with incident diagnoses of five disease conditions, and we link employee data with the National Death Index to characterize its relationship with mortality. We review prior studies documenting the risk score's association with other health and non-health outcomes, including healthcare utilization, early retirement, and occupational injury.We find that the risk score is associated with outcomes across a variety of health and non-health domains. These examples demonstrate the broad applicability of this tool in multiple fields of research and illustrate its utility as a measure of overall health status for epidemiologists and other health researchers.

  10. Risk score for predicting adolescent mental health problems among children using parental report only : the TRAILS study

    NARCIS (Netherlands)

    Burger, Huibert; Boks, Marco P.; Hartman, Catharina A.; Aukes, Maartje F.; Verhulst, Frank C.; Ormel, Johan; Reijneveld, Sijmen A.

    2014-01-01

    OBJECTIVE: To construct a risk score for adolescent mental health problems among children, using parental data only and without potentially stigmatizing mental health items. METHODS: We prospectively derived a prediction model for mental health problems at age 16 using data from parent report on 167

  11. A Risk-Scoring Model to Predict One-year Major Adverse Cardiac Events after Percutaneous Coronary Intervention

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    Seyed-Ebrahim Kassaian

    2015-12-01

    Full Text Available Background: The aim of the present study was to develop a scoring system for predicting 1-year major adverse cardiac events (MACE, including mortality, target vessel or target lesion revascularization, coronary artery bypass graft surgery, and non-fatal myocardial infarction after percutaneous coronary intervention (PCI.Methods: The data were extracted from a single center PCI registry. The score was created based on the clinical, procedural, and laboratory characteristics of 8206 patients who underwent PCI between April 2004 and October 2009. Consecutive patients undergoing PCI between November 2009 and February 2011 (n= 2875 were included as a validation data set. Results: Diabetes mellitus, increase in the creatinine level, decrease in the left ventricular ejection fraction, presentation with the acute coronary syndrome, number of diseased vessels, primary PCI, PCI on the left anterior descending artery and saphenous vein graft, and stent type and diameter were identified as the predictors of the outcome and used to develop the score (R² = 0.795. The models had adequate goodness of fit (Hosmer-Lemeshow statistic; p value = 0.601 and acceptable ability of discrimination (c-statistics = 0.63. The score categorized the individual patients as low-, moderate-, and high-risk for the occurrence of MACE. The validation of the model indicated a good agreement between the observed and expected risks.Conclusion: An individual risk-scoring system based on both clinical and procedural variables can be used conveniently to predict 1-year MACE after PCI. Risk classification based on this score can assist physicians in decision-making and postprocedural health care. 

  12. Does Preendoscopy Rockall Score Safely Identify Low Risk Patients following Upper Gastrointestinal Haemorrhage?

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    Matthew R. Johnston

    2015-01-01

    Full Text Available Objective. To determine if preendoscopy Rockall score (PERS enables safe outpatient management of New Zealanders with upper gastrointestinal haemorrhage (UGIH. Methods. Retrospective analysis of adults with UGIH over 59 consecutive months. PERS, diagnosis, demographics, need for endoscopic therapy, transfusion or surgery and 30-day mortality and 14-day rebleeding rate, and sensitivity and specificity of PERS for enabling safe discharge preendoscopy were calculated. Results. 424 admissions with UGIH. Median age was 74.3 years (range 19–93 years, with 55.1% being males. 30-day mortality was 4.6% and 14-day rebleeding rate was 6.0%. Intervention was required in 181 (46.6%: blood transfusion (147 : 37.9%, endoscopic intervention (75 : 19.3%, and surgery (8 : 2.1%. 42 (10.8% had PERS = 0 with intervention required in 15 (35.7%. Females more frequently required intervention, OR 1.73 (CI: 1.12–2.69. PERS did not predict intervention but did predict 30-day mortality: each point increase equated to an increase in mortality of OR 1.46 (CI: 1.11–1.92. Taking NSAIDs/aspirin reduced 30-day mortality, OR 0.22 (CI: 0.08–0.60. Conclusion. PERS identifies 10.8% of those with UGIH as low risk but 35.7% required intervention or died. It has a limited role in assessing these patients and should not be used to identify those suitable for outpatient endoscopy.

  13. CHADS2 and CHA2DS2-VASc score to assess risk of stroke and death in patients paced for sick sinus syndrome

    DEFF Research Database (Denmark)

    Svendsen, Jesper Hastrup; Nielsen, Jens Cosedis; Darkner, Stine

    2013-01-01

    The risk of stroke in patients with atrial fibrillation (AF) can be assessed by use of the CHADS2 and the CHA2DS2-VASc score system. We hypothesised that these risk scores and their individual components could also be applied to patients paced for sick sinus syndrome (SSS) to evaluate risk of str...

  14. Power of IRT in GWAS: successful QTL mapping of sum score phenotypes depends on interplay between risk allele frequency, variance explained by the risk allele, and test characteristics.

    Science.gov (United States)

    van den Berg, Stéphanie M; Service, Susan K

    2012-12-01

    As data from sequencing studies in humans accumulate, rare genetic variants influencing liability to disease and disorders are expected to be identified. Three simulation studies show that characteristics and properties of diagnostic instruments interact with risk allele frequency to affect the power to detect a quantitative trait locus (QTL) based on a test score derived from symptom counts or questionnaire items. Clinical tests, that is, tests that show a positively skewed phenotypic sum score distribution in the general population, are optimal to find rare risk alleles of large effect. Tests that show a negatively skewed sum score distribution are optimal to find rare protective alleles of large effect. For alleles of small effect, tests with normally distributed item parameters give best power for a wide range of allele frequencies. The item-response theory framework can help understand why an existing measurement instrument has more power to detect risk alleles with either low or high frequency, or both kinds.

  15. External validation of a clinical scoring system for the risk of gestational diabetes mellitus

    NARCIS (Netherlands)

    van Leeuwen, M.; Opmeer, B. C.; Zweers, E. J. K.; van Ballegooie, E.; ter Brugge, H. G.; de Valk, H. W.; Visser, G. H. A.; Mol, B. W. J.

    2009-01-01

    Aim: A prediction rule for gestational diabetes mellitus (GDM) could be helpful in early detection and increased efficiency of screening. A prediction rule by means of a clinical scoring system is available, but has never been validated externally. The aim of this study was to validate the scoring s

  16. Development and evaluation of a risk score for type 2 diabetes mellitus among middle-aged Chinese rural population based on the RuralDiab Study

    Science.gov (United States)

    Zhou, Hao; Li, Yuqian; Liu, Xiaotian; Xu, Fei; Li, Linlin; Yang, Kaili; Qian, Xinling; Liu, Ruihua; Bie, Ronghai; Wang, Chongjian

    2017-01-01

    The purpose of this study was to establish a simple and effective risk score for type 2 diabetes mellitus (T2DM) in middle-aged rural Chinese. Total of 5453 participants aged 30–59 years from the Rural Diabetes, Obesity and Lifestyle (RuralDiab) study were recruited for establishing the RuralDiab risk score by using logistic regression analysis. The RuralDiab risk score was validated in a prospective study from Henan Province of China, and compared with previous risk scores by using the receiver-operating characteristics cure. Ultimately, sex, age, family history of diabetes, physical activity, waist circumference, history of dyslipidemia, diastolic blood pressure, body mass index were included in the RuralDiab risk score (range from 0 to 36), and the optimal cutoff value was 17 with 67.9% sensitivity and 67.8% specificity. The area under the cures (AUC) of the RuralDiab risk score was 0.723(95%CI: 0.710–0.735) for T2DM in validation population, which was significant higher than the American Diabetes Association score (AUC: 0.636), the Inter99 score (AUC: 0.669), the Oman risk score (AUC: 0.675). The RuralDiab risk score was established and demonstrated an appropriate performance for predicting T2DM in middle-aged Chinese rural population. Further studies for validation should be implemented in different populations. PMID:28209984

  17. Is there a role for coronary artery calcium scoring for management of asymptomatic patients at risk for coronary artery disease?: Clinical risk scores are not sufficient to define primary prevention treatment strategies among asymptomatic patients.

    Science.gov (United States)

    Blaha, Michael J; Silverman, Michael G; Budoff, Matthew J

    2014-03-01

    Although risk factors have proven to be useful therapeutic targets, they are poor predictors of risk. Traditional risk scores are moderately successful in predicting future CHD events and can be a starting place for general risk categorization. However, there is substantial heterogeneity between traditional risk and actual atherosclerosis burden, with event rates predominantly driven by burden of atherosclerosis. Serum biomarkers have yet to show any clinically significant incremental value to the FRS and even when combined cannot match the predictive value of atherosclerosis imaging. As clinicians, are we willing to base therapy decisions on risk models that lack optimum-achievable accuracy and limit personalization? The decision to treat a patient in primary prevention must be a careful one because the benefit of therapy in an asymptomatic patient must clearly outweigh the potential risk. CAC, in particular, provides a personalized assessment of risk and may identify patients who will be expected to derive the most, and the least, net absolute benefit from treatment. Emerging evidence hints that CAC may also promote long-term adherence to aspirin, exercise, diet, and statin therapy. When potentially lifelong treatment decisions are on the line, clinicians must arm their patients with the most accurate risk prediction tools, and subclinical atherosclerosis testing with CAC is, at the present time, superior to any combination of risk factors and serum biomarkers.

  18. Multicentre validation of the Geneva Risk Score for hospitalised medical patients at risk of venous thromboembolism. Explicit ASsessment of Thromboembolic RIsk and Prophylaxis for Medical PATients in SwitzErland (ESTIMATE).

    Science.gov (United States)

    Nendaz, M; Spirk, D; Kucher, N; Aujesky, D; Hayoz, D; Beer, J H; Husmann, M; Frauchiger, B; Korte, W; Wuillemin, W A; Jäger, K; Righini, M; Bounameaux, H

    2014-03-03

    There is a need to validate risk assessment tools for hospitalised medical patients at risk of venous thromboembolism (VTE). We investigated whether a predefined cut-off of the Geneva Risk Score, as compared to the Padua Prediction Score, accurately distinguishes low-risk from high-risk patients regardless of the use of thromboprophylaxis. In the multicentre, prospective Explicit ASsessment of Thromboembolic RIsk and Prophylaxis for Medical PATients in SwitzErland (ESTIMATE) cohort study, 1,478 hospitalised medical patients were enrolled of whom 637 (43%) did not receive thromboprophylaxis. The primary endpoint was symptomatic VTE or VTE-related death at 90 days. The study is registered at ClinicalTrials.gov, number NCT01277536. According to the Geneva Risk Score, the cumulative rate of the primary endpoint was 3.2% (95% confidence interval [CI] 2.2-4.6%) in 962 high-risk vs 0.6% (95% CI 0.2-1.9%) in 516 low-risk patients (p=0.002); among patients without prophylaxis, this rate was 3.5% vs 0.8% (p=0.029), respectively. In comparison, the Padua Prediction Score yielded a cumulative rate of the primary endpoint of 3.5% (95% CI 2.3-5.3%) in 714 high-risk vs 1.1% (95% CI 0.6-2.3%) in 764 low-risk patients (p=0.002); among patients without prophylaxis, this rate was 3.2% vs 1.5% (p=0.130), respectively. Negative likelihood ratio was 0.28 (95% CI 0.10-0.83) for the Geneva Risk Score and 0.51 (95% CI 0.28-0.93) for the Padua Prediction Score. In conclusion, among hospitalised medical patients, the Geneva Risk Score predicted VTE and VTE-related mortality and compared favourably with the Padua Prediction Score, particularly for its accuracy to identify low-risk patients who do not require thromboprophylaxis.

  19. Development and Validation of a Simple Risk Score for Undiagnosed Type 2 Diabetes in a Resource-Constrained Setting

    Directory of Open Access Journals (Sweden)

    Antonio Bernabe-Ortiz

    2016-01-01

    Full Text Available Objective. To develop and validate a risk score for detecting cases of undiagnosed diabetes in a resource-constrained country. Methods. Two population-based studies in Peruvian population aged ≥35 years were used in the analysis: the ENINBSC survey (n=2,472 and the CRONICAS Cohort Study (n=2,945. Fasting plasma glucose ≥7.0 mmol/L was used to diagnose diabetes in both studies. Coefficients for risk score were derived from the ENINBSC data and then the performance was validated using both baseline and follow-up data of the CRONICAS Cohort Study. Results. The prevalence of undiagnosed diabetes was 2.0% in the ENINBSC survey and 2.9% in the CRONICAS Cohort Study. Predictors of undiagnosed diabetes were age, diabetes in first-degree relatives, and waist circumference. Score values ranged from 0 to 4, with an optimal cutoff ≥2 and had a moderate performance when applied in the CRONICAS baseline data (AUC = 0.68; 95% CI: 0.62–0.73; sensitivity 70%; specificity 59%. When predicting incident cases, the AUC was 0.66 (95% CI: 0.61–0.71, with a sensitivity of 69% and specificity of 59%. Conclusions. A simple nonblood based risk score based on age, diabetes in first-degree relatives, and waist circumference can be used as a simple screening tool for undiagnosed and incident cases of diabetes in Peru.

  20. Development and Validation of a Simple Risk Score for Undiagnosed Type 2 Diabetes in a Resource-Constrained Setting.

    Science.gov (United States)

    Bernabe-Ortiz, Antonio; Smeeth, Liam; Gilman, Robert H; Sanchez-Abanto, Jose R; Checkley, William; Miranda, J Jaime; Study Group, Cronicas Cohort

    Objective. To develop and validate a risk score for detecting cases of undiagnosed diabetes in a resource-constrained country. Methods. Two population-based studies in Peruvian population aged ≥35 years were used in the analysis: the ENINBSC survey (n = 2,472) and the CRONICAS Cohort Study (n = 2,945). Fasting plasma glucose ≥7.0 mmol/L was used to diagnose diabetes in both studies. Coefficients for risk score were derived from the ENINBSC data and then the performance was validated using both baseline and follow-up data of the CRONICAS Cohort Study. Results. The prevalence of undiagnosed diabetes was 2.0% in the ENINBSC survey and 2.9% in the CRONICAS Cohort Study. Predictors of undiagnosed diabetes were age, diabetes in first-degree relatives, and waist circumference. Score values ranged from 0 to 4, with an optimal cutoff ≥2 and had a moderate performance when applied in the CRONICAS baseline data (AUC = 0.68; 95% CI: 0.62-0.73; sensitivity 70%; specificity 59%). When predicting incident cases, the AUC was 0.66 (95% CI: 0.61-0.71), with a sensitivity of 69% and specificity of 59%. Conclusions. A simple nonblood based risk score based on age, diabetes in first-degree relatives, and waist circumference can be used as a simple screening tool for undiagnosed and incident cases of diabetes in Peru.

  1. Predictive 5-Year Survivorship Model of Cystic Fibrosis

    Science.gov (United States)

    Liou, Theodore G.; Adler, Frederick R.; FitzSimmons, Stacey C.; Cahill, Barbara C.; Hibbs, Jonathan R.; Marshall, Bruce C.

    2007-01-01

    The objective of this study was to create a 5-year survivorship model to identify key clinical features of cystic fibrosis. Such a model could help researchers and clinicians to evaluate therapies, improve the design of prospective studies, monitor practice patterns, counsel individual patients, and determine the best candidates for lung transplantation. The authors used information from the Cystic Fibrosis Foundation Patient Registry (CFFPR), which has collected longitudinal data on approximately 90% of cystic fibrosis patients diagnosed in the United States since 1986. They developed multivariate logistic regression models by using data on 5,820 patients randomly selected from 11,630 in the CFFPR in 1993. Models were tested for goodness of fit and were validated for the remaining 5,810 patients for 1993. The validated 5-year survivorship model included age, forced expiratory volume in 1 second as a percentage of predicted normal, gender, weight-for-age z score, pancreatic sufficiency, diabetes mellitus, Staphylococcus aureus infection, Burkerholderia cepacia infection, and annual number of acute pulmonary exacerbations. The model provides insights into the complex nature of cystic fibrosis and supplies a rigorous tool for clinical practice and research. PMID:11207152

  2. The Patient- And Nutrition-Derived Outcome Risk Assessment Score (PANDORA: Development of a Simple Predictive Risk Score for 30-Day In-Hospital Mortality Based on Demographics, Clinical Observation, and Nutrition.

    Directory of Open Access Journals (Sweden)

    Michael Hiesmayr

    Full Text Available To develop a simple scoring system to predict 30 day in-hospital mortality of in-patients excluding those from intensive care units based on easily obtainable demographic, disease and nutrition related patient data.Score development with general estimation equation methodology and model selection by P-value thresholding based on a cross-sectional sample of 52 risk indicators with 123 item classes collected with questionnaires and stored in an multilingual online database.Worldwide prospective cross-sectional cohort with 30 day in-hospital mortality from the nutritionDay 2006-2009 and an external validation sample from 2012.We included 43894 patients from 2480 units in 32 countries. 1631(3.72% patients died within 30 days in hospital. The Patient- And Nutrition-Derived Outcome Risk Assessment (PANDORA score predicts 30-day hospital mortality based on 7 indicators with 31 item classes on a scale from 0 to 75 points. The indicators are age (0 to 17 points, nutrient intake on nutritionDay (0 to 12 points, mobility (0 to 11 points, fluid status (0 to 10 points, BMI (0 to 9 points, cancer (9 points and main patient group (0 to 7 points. An appropriate model fit has been achieved. The area under the receiver operating characteristic curve for mortality prediction was 0.82 in the development sample and 0.79 in the external validation sample.The PANDORA score is a simple, robust scoring system for a general population of hospitalised patients to be used for risk stratification and benchmarking.

  3. Health care index score and risk of death following tuberculosis diagnosis in HIV-positive patients

    DEFF Research Database (Denmark)

    Podlekareva, D N; Grint, D; Post, F A;

    2013-01-01

    To assess health care utilisation for patients co-infected with TB and HIV (TB-HIV), and to develop a weighted health care index (HCI) score based on commonly used interventions and compare it with patient outcome.......To assess health care utilisation for patients co-infected with TB and HIV (TB-HIV), and to develop a weighted health care index (HCI) score based on commonly used interventions and compare it with patient outcome....

  4. Breast cancer risk prediction using a polygenic risk score in the familial setting: a prospective study from the Breast Cancer Family Registry and kConFab

    Science.gov (United States)

    Li, Hongyan; Feng, Bingjian; Miron, Alexander; Chen, Xiaoqing; Beesley, Jonathan; Bimeh, Emmanuella; Barrowdale, Daniel; John, Esther M.; Daly, Mary B.; Andrulis, Irene L.; Buys, Saundra S.; Kraft, Peter; Thorne, Heather; Chenevix-Trench, Georgia; Southey, Melissa; Antoniou, Antonis C.; James, Paul A.; Terry, Mary Beth; Phillips, Kelly-Anne; Hopper, John L.; Mitchell, Gillian; Goldgar, David E.

    2016-01-01

    Purpose This study examined the utility of sets of Single Nucleotide Polymorphisms (SNPs) in familial but non-BRCA-associated breast cancer (BC). Methods We derived a polygenic risk score (PRS) based on 24 known BC risk SNPs for 4,365 women from the BCFR and kConFab familial BC cohorts. We compared scores in women based on cancer status at baseline. 2,599 women unaffected at enrollment were followed for an average of 7.4 years. Cox proportional hazards regression was used to analyze the association of PRS with BC risk. The BOADICEA risk prediction algorithm was used to measure risk based on family history alone. Results The mean (SD) PRS baseline was 2.25 (0.35) for the affected and 2.17 (0.35) for unaffected women from combined cohorts (p<10−6). During follow-up, 205 BCs occurred. The hazard ratios for continuous PRS (per SD), and upper vs. lower quintiles were 1.38 (95% CI: 1.22–1.56) and 3.18 (95% CI: 1.84–5.23) respectively. Based on their PRS-based predicted risk, management for up to 23% of women could be altered. Conclusion Including BC-associated SNPs in risk assessment can provide more accurate risk prediction than family history alone and can influence recommendations for cancer screening and prevention modalities for high-risk women. PMID:27171545

  5. Agreement between the SCORE and D’Agostino Scales for the Classification of High Cardiovascular Risk in Sedentary Spanish Patients

    Directory of Open Access Journals (Sweden)

    Luis García-Ortiz

    2009-11-01

    Full Text Available Background: To evaluate agreement between cardiovascular risk in sedentary patients as estimated by the new Framingham-D’Agostino scale and by the SCORE chart, and to describe the patient characteristics associated with the observed disagreement between the scales. Design: A cross-sectional study was undertaken involving a systematic sample of 2,295 sedentary individuals between 40–65 years of age seen for any reason in 56 primary care offices. An estimation was made of the Pearson correlation coefficient and kappa statistic for the classification of high risk subjects (≥20% according to the Framingham-D’Agostino scale, and ≥5% according to SCORE. Polytomous logistic regression models were fitted to identify the variables associated with the discordance between the two scales. Results: The mean risk in males (35% was 19.5% ± 13% with D’Agostino scale, and 3.2% ± 3.3% with SCORE. Among females, they were 8.1% ± 6.8% and 1.2% ± 2.2%, respectively. The correlation between the two scales was 0.874 in males (95% CI: 0.857–0.889 and 0.818 in females (95% CI: 0.800–0.834, while the kappa index was 0.50 in males (95% CI: 0.44%–0.56% and 0.61 in females (95% CI: 0.52%–0.71%. The most frequent disagreement, characterized by high risk according to D’Agostino scale but not according to SCORE, was much more prevalent among males and proved more probable with increasing age and increased LDL-cholesterol, triglyceride and systolic blood pressure values, as well as among those who used antihypertensive drugs and smokers. Conclusions: The quantitative correlation between the two scales is very high. Patient categorization as corresponding to high risk generates disagreements, mainly among males, where agreement between the two classifications is only moderate.

  6. 'Prediction models for risk of developing type 2 diabetes: systematic literature search and independent external validation study'

    NARCIS (Netherlands)

    Beulens, Joline W J; Abbasi, Ali; Peelen, Linda M; Spijkerman, Annemieke M W; van der A, Daphne L; Corpeleijn, Eva; Bakker, Stephan J L; van der Schouw, Yvonne T

    2013-01-01

    OBJECTIVE: To validate risk scores to predict occurrence of type 2 diabetes in the Dutch population. DESIGN: Prospective cohort study. METHODS: Twelve basic risk scores and 13 extensive risk scores with biomarkers were used to predict the risk of developing type 2 diabetes during 7.5 years in a pros

  7. Risk-based priority scoring for Brookhaven National Laboratory environmental restoration programs

    Energy Technology Data Exchange (ETDEWEB)

    Morris, S.C.; Meinhold, A.F.

    1995-05-01

    This report describes the process of estimating the risk associated with environmental restoration programs under the Brookhaven National Laboratory Office of Environmental Restoration. The process was part of an effort across all Department of Energy facilities to provide a consistent framework to communicate risk information about the facilities to senior managers in the DOE Office of Environmental Management to foster understanding of risk activities across programs. the risk evaluation was a qualitative exercise. Categories considered included: Public health and safety; site personnel safety and health; compliance; mission impact; cost-effective risk management; environmental protection; inherent worker risk; environmental effects of clean-up; and social, cultural, political, and economic impacts.

  8. Therapeutic implications of selecting the SCORE (European versus the D'AGOSTINO (American risk charts for cardiovascular risk assessment in hypertensive patients

    Directory of Open Access Journals (Sweden)

    Giné-Garriga Maria

    2009-05-01

    Full Text Available Abstract Background No comparisons have been made of scales estimating cardiovascular mortality and overall cardiovascular morbidity and mortality. The study objectives were to assess the agreement between the Framingham-D'Agostino cardiovascular risk (CVR scale and the chart currently recommended in Europe (SCORE with regard to identification of patients with high CVR, and to describe the discrepancies between them and the attendant implications for the treatment of hypertension and hyperlipidaemia. Methods A total of 474 hypertensive patients aged 40–65 years monitored in primary care were enrolled into the study. CVR was assessed using the Framingham-D'Agostino scale, which estimates the overall cardiovascular morbidity and mortality risk, and the SCORE chart, which estimates the cardiovascular mortality risk. Cardiovascular risk was considered to be high for values ≥ 20% and ≥ 5% according to the Framingham-D'Agostino and SCORE charts respectively. Kappa statistics was estimated for agreement in classification of patients with high CVR. The therapeutic recommendations in the 2007 European Guidelines on Cardiovascular Disease Prevention were followed. Results Mean patient age was 54.1 (SD 7.3, and 58.4% were males. A high CVR was found in 17.5% using the SCORE chart (25.3% males, 6.6% females and in 32.7% using the D'Agostino method (56.9% males, 12,7% females. Kappa coefficient was 0.52, and increased to 0.68 when the high CVR threshold was established at 29% according to D'Agostino. Hypertensive patients with high SCORE and non-high D'Agostino (1.7% were characterized by an older age, diabetes, and a lower atherogenic index, while the opposite situation (16.9% was associated to males, hyperlipidaemia, and a higher atherogenic index. Variables with a greater weight in discrepancies were sex and smoking. A 32.0% according to SCORE and 33.5% according to D'Agostino would be candidates to receive antihypertensive treatment, and 15.8% and

  9. The predictive value of CHADS₂ risk score in post myocardial infarction arrhythmias - a Cardiac Arrhythmias and RIsk Stratification after Myocardial infArction (CARISMA) substudy

    DEFF Research Database (Denmark)

    Ruwald, Anne-Christine Huth; Gang, Uffe; Thomsen, Poul Erik Bloch;

    2014-01-01

    of this study was to investigate if CHADS₂ score (congestive heart failure, hypertension, age ≥75 years, diabetes and previous stroke/TCI [doubled]) can be used as a risk tool for predicting cardiac arrhythmias after MI. METHODS: The study included 297 post-MI patients from the CARISMA study with left...

  10. Pathway-Specific Aggregate Biomarker Risk Score Is Associated With Burden of Coronary Artery Disease and Predicts Near-Term Risk of Myocardial Infarction and Death

    DEFF Research Database (Denmark)

    Ghasemzedah, Nima; Hayek, Salim; Ko, Yi-An

    2017-01-01

    BACKGROUND: Inflammation, coagulation, and cell stress contribute to atherosclerosis and its adverse events. A biomarker risk score (BRS) based on the circulating levels of biomarkers C-reactive protein, fibrin degradation products, and heat shock protein-70 representing these 3 pathways was a st...

  11. Changes in subclinical organ damage vs. in Framingham risk score for assessing cardiovascular risk reduction during continued antihypertensive treatment: a LIFE substudy

    DEFF Research Database (Denmark)

    Olsen, Michael H; Wachtell, Kristian; Ibsen, Hans;

    2011-01-01

    To investigate whether in-treatment measurements of subclinical organ damage (SOD) assessed by elevated urine albumin/creatinine ratio (UACR) or electrocardiographic left ventricular hypertrophy improved the prediction of the composite cardiovascular endpoint of cardiovascular death, nonfatal...... myocardial infarction and stroke beyond in-treatment Framingham risk score (FRS)....

  12. The Risk/Benefit Analysis of Oral Anticoagulant Treatment in Atrial Fibrillation Using HAS-BLED and CHA2DS2-VASc Score

    Directory of Open Access Journals (Sweden)

    Ionela Silivastru (Cozlea

    2015-12-01

    Full Text Available Introduction. The purpose of this study is to evaluate the risk and the benefit of oral anticoagulant treatment in nonvalvular atrial fibrillation (AF patients, using the two scores recommended by the guidelines: the CHA2DS2-VASc score and HAS-BLED score.

  13. Hip and fragility fracture prediction by 4-item clinical risk score and mobile heel BMD: a women cohort study

    Directory of Open Access Journals (Sweden)

    Thulesius Hans

    2010-03-01

    Full Text Available Abstract Background One in four Swedish women suffers a hip fracture yielding high morbidity and mortality. We wanted to revalidate a 4-item clinical risk score and evaluate a portable heel bone mineral density (BMD technique regarding hip and fragility fracture risk among elderly women. Methods In a population-based prospective cohort study we used clinical risk factors from a baseline questionnaire and heel BMD to predict a two-year hip and fragility fracture outcome for women, in a fracture preventive program. Calcaneal heel BMD was measured by portable dual X-ray laser absorptiometry (DXL and compared to hip BMD, measured with stationary dual X-ray absorptiometry (DXA technique. Results Seven women suffered hip fracture and 14 women fragility fracture/s (at hip, radius, humerus and pelvis among 285 women; 60% having heel BMD ≤ -2.5 SD. The 4-item FRAMO (Fracture and Mortality Index combined the clinical risk factors age ≥80 years, weight Conclusions In a follow-up study we identified high risk groups for hip and fragility fracture with our plain 4-item risk model. Increased fracture risk was also related to decreasing heel BMD in calcaneal bone, measured with a mobile DXL technique. A combination of high FRAMO Index, prior fragility fracture, and very low BMD restricted the high risk group to 11%, among whom most hip fractures occurred (71%. These practical screening methods could eventually reduce hip fracture incidence by concentrating preventive resources to high fracture risk women.

  14. Effect of using cardiovascular risk scoring in routine risk assessment in primary prevention of cardiovascular disease: protocol for an overview of systematic reviews

    Science.gov (United States)

    Studzin´ski, Krzysztof; Tomasik, Tomasz; Krzyszton´, Janusz; Józ´wiak, Jacek; Windak, Adam

    2017-01-01

    Introduction Major clinical practice guidelines recommend assessing risk of cardiovascular disease (CVD) using absolute/global/total CVD risk scores. However, the effectiveness of using them in clinical practice, despite publication of numerous randomised controlled trials (RCTs), is still poorly understood. To summarise and analyse current knowledge in this field, we will carry out an overview of existing systematic reviews (SRs). The objective of this overview will be to assess the effect of using cardiovascular risk scoring in routine risk assessment in primary prevention of CVD compared with standard care. Methods and analysis We will include SRs and meta-analyses which take into account RCTs and quasi-RCTs investigating the effect of using cardiovascular risk scoring in routine risk assessment in primary prevention of CVD. SRs will be retrieved from 4 bibliographical databases and reference lists of identified reviews. Additionally, the PROSPERO database will be searched for unpublished, ongoing or recently completed SRs. 2 reviewers will assess the SRs independently for eligibility and bias. The data will be extracted to a special form. Any disagreement will be resolved by discussion. In case of lack of consensus, a third author will arbitrate. The overview of SRs will be reported according to the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) statement. Ethics and dissemination Ethics approval is not required for overview of SRs. We will summarise evidence concerning whether use of the absolute/global/total CVD risk scoring tools in primary prevention of CVD is effective and supported with scientific data or not. If we face unsatisfactory confirmation, we will highlight a need for further research and advice on how to plan such a study. We will submit the results of our study for peer-review publication in a journal indexed in the international bibliographic database of biomedical information. PMID:28274967

  15. Metastatic Tissue Proteomic Profiling Predicts 5-Year Outcomes in Patients with Colorectal Liver Metastases

    Directory of Open Access Journals (Sweden)

    Santiago Marfà

    2016-10-01

    Full Text Available Colorectal cancer (CRC is one of the most common cancers in the developed countries, and nearly 70% of patients with CRC develop colorectal liver metastases (CRLMs. During the last decades, several scores have been proposed to predict recurrence after CRLM resection. However, these risk scoring systems do not accurately reflect the prognosis of these patients. Therefore, this investigation was designed to identify a proteomic profile in human hepatic tumor samples to classify patients with CRLM as “mild” or “severe” based on the 5-year survival. The study was performed on 85 CRLM tumor samples. Firstly, to evaluate any distinct tumor proteomic signatures between mild and severe CRLM patients, a training group of 57 CRLM tumor samples was characterized by surface-enhanced laser desorption/ionization time-of-flight mass spectrometry, and a classification and regression tree (CART analysis was subsequently performed. Finally, 28 CRLM tumor samples were used to confirm and validate the results obtained. Based on all the protein peaks detected in the training group, the CART analysis was generated, and four peaks were considered to be the most relevant to construct a diagnostic algorithm. Indeed, the multivariate model yielded a sensitivity of 85.7% and a specificity of 86.1%, respectively. In addition, the receiver operating characteristic (ROC curve showed an excellent diagnostic accuracy to discriminate mild from severe CRLM patients (area under the ROC: 0.903. Finally, the validation process yielded a sensitivity and specificity of 68.8% and 83.3%, respectively. We identified a proteomic profile potentially useful to determine the prognosis of CRLM patients based on the 5-year survival.

  16. Modified physiological and operative score for the enumeration of mortality and morbidity risk assessment model in general surgery

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    AIM: To establish a scoring system for predicting the incidence of postoperative complications and mortality in general surgery based on the physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM), and to evaluate its efficacy.METHODS: Eighty-four patients with postoperative complications or death and 172 patients without postoperative complications, who underwent surgery in our department during the previous 2 years, were retrospectively analyzed by logistic regression. Fifteen indexes were investigated including age, cardiovascular function, respiratory function, blood test results,endocrine function, central nervous system function,hepatic function, renal function, nutritional status, extent of operative trauma, and course of anesthesia. Modified POSSUM (M-POSSUM) was developed using significant risk factors with its efficacy evaluated.RESULTS: The significant risk factors were found to be age, cardiovascular function, respiratory function,hepatic function, renal function, blood test results,endocrine function, nutritional status, duration of operation, intraoperative blood loss, and course of anesthesia. These factors were all included in the scoring system. There were significant differences in the scores between the patients with and without postoperative complications, between the patients died and survived with complications, and between the patients died and survived without complications. The receiver operating characteristic curves showed that the M-POSSUM could accurately predict postoperative complications and mortality.CONCLUSION: M-POSSUM correlates well with postoperative complications and mortality, and is more accurate than POSSUM.

  17. A 5 year prospective study of patient-relevant outcomes after total knee replacement

    DEFF Research Database (Denmark)

    Nilsdotter, A-K; Toksvig-Larsen, S; Roos, E M

    2008-01-01

    OBJECTIVE: To prospectively describe self-reported outcomes up to 5 years after total knee replacement (TKR) in Osteoarthritis (OA) and to study which patient-relevant factors may predict outcomes for pain and physical function (PF). METHODS: 102 consecutive patients with knee OA, 63 women and 39...... postoperatively. RESULTS: Response rate at 5 years was 86%. At 6 months significant improvement was seen in all KOOS and SF-36 scores (P

  18. Automatic computation of CHA2DS2-VASc score: information extraction from clinical texts for thromboembolism risk assessment.

    Science.gov (United States)

    Grouin, Cyril; Deléger, Louise; Rosier, Arnaud; Temal, Lynda; Dameron, Olivier; Van Hille, Pascal; Burgun, Anita; Zweigenbaum, Pierre

    2011-01-01

    The CHA2DS2-VASc score is a 10-point scale which allows cardiologists to easily identify potential stroke risk for patients with non-valvular fibrillation. In this article, we present a system based on natural language processing (lexicon and linguistic modules), including negation and speculation handling, which extracts medical concepts from French clinical records and uses them as criteria to compute the CHA2DS2-VASc score. We evaluate this system by comparing its computed criteria with those obtained by human reading of the same clinical texts, and by assessing the impact of the observed differences on the resulting CHA2DS2-VASc scores. Given 21 patient records, 168 instances of criteria were computed, with an accuracy of 97.6%, and the accuracy of the 21 CHA2DS2-VASc scores was 85.7%. All differences in scores trigger the same alert, which means that system performance on this test set yields similar results to human reading of the texts.

  19. Texting while driving: the development and validation of the distracted driving survey and risk score among young adults

    OpenAIRE

    Bergmark, Regan W.; Gliklich, Emily; Guo, Rong; Gliklich, Richard E.

    2016-01-01

    Background: Texting while driving and other cell-phone reading and writing activities are high-risk activities associated with motor vehicle collisions and mortality. This paper describes the development and preliminary evaluation of the Distracted Driving Survey (DDS) and score. Methods: Survey questions were developed by a research team using semi-structured interviews, pilot-tested, and evaluated in young drivers for validity and reliability. Questions focused on texting while driving and ...

  20. Biochemical outcomes after robot-assisted radical prostatectomy in patients with follow-up more than5-years

    Institute of Scientific and Technical Information of China (English)

    Kwang Hyun Kim; Sey Kiat Lim; Tae-Young Shin; Byung Ha Chung; Sung Joon Hong; Koon Ho Rha

    2013-01-01

    In this study,we assessed biochemical outcomes after robot-assisted radical prostatectomy (RARP).Between July 2005 and November 2007,one hundred and seventy-six consecutive patients treated by RARP without neoadjuvant treatment were included in this study.All procedures were performed by a single surgeon and the median follow-up period was 60 months (interquartile range (IQR):59-69).The median prostate specific antigen was 7.50 ng ml-1 (IQR:5.14-11.45) and 39.2% of the patients were classified as intermediate risk and 15.3% were classified as high risk; on final pathological examination,35.2% of the patients had non-organ confined disease and 37.5%and 14.2% had Gleason scores of 7 and 8-10,respectively.The biochemical recurrence (BCR)-free survival rates at 3 and 5 years were 85.6% and 81.2%,respectively.The 5-year BCR-free survival rates stratified by pathologic Gleason scores were 93.1% in Gleason scores of 6 or less,74.5% in a Gleason score of 7,and 58.1% in Gleason scores of 8 or greater,respectively (P<0.001).When stratified by pathologic stage,the BCR-free survival rates were 89.8% in pT2 patients,66.2% in pT3a patients,and 39.3% in pT3b patients at 5 years following RARP,respectively (P<0.001).Preoperative prostate-specific antigen (PSA),pathologic stage,postoperative Gleason score and surgical margin status were independently associated with BCR in multivariate analysis.In this study,we report biochemical outcomes after RARP with the longest follow-up periods to date in Asian men.We found that robotic surgery provided satisfactory biochemical outcomes,and that RARP is a safe and effective procedure in terms of oncologic outcomes.

  1. Analysis of risk factors for children 5 years and younger which bronchial asthma is occurrence and development%5岁以下儿童支气管哮喘发生及持续发展的危险因素分析

    Institute of Scientific and Technical Information of China (English)

    程远; 陈德晖

    2014-01-01

    我国调查显示约有90.33%支气管哮喘(简称哮喘)儿童首次喘息发生在5岁及以前,虽然临床上有如此高的患病率,但5岁以下反复喘息儿童因难以获得肺通气功能等客观的哮喘评估指标,临床诊断需基于患儿的病史、临床表现及其对平喘药物的治疗反应来确定。故目前有关5岁及以下年幼儿哮喘的诊断手段十分有限。本文通过对患儿的出生史、喂养营养史、家居环境因素、遗传因素、过敏原及病原微生物分析,了解5岁及以下哮喘患儿的既往危险因素及导致其持续发展的危险因素,对5岁及以下儿童哮喘的早期识别诊断、早期治疗提供理论依据。%Survey shows that about 90.33% of children with wheezing occurred in the first 5 years,although such a high prevalence,but recurrent wheezing children under 5 years old is difficult to obtain the data with pulmonary function and other objective asthma evaluation index,the clinical diagnosis is based on history,clinical manifestations and drug reactions.So currently about the diagnosis of asthma in 5 years old is very limited.Through the history of children′s birth,feeding and nutritional history, environmental factors,genetic factors,allergens and pathogens factors to understand the risk factors of past and developing with asthma in the first 5 years,it can provide the theoretical basis of early diagnosis and early treatment with asthma in the first 5 years.

  2. Value and limitations of existing scores for the assessment of cardiovascular risk: a review for clinicians.

    LENUS (Irish Health Repository)

    Cooney, Marie Therese

    2009-09-29

    Atherosclerotic cardiovascular diseases (CVDs) are the biggest causes of death worldwide. In most people, CVD is the product of a number of causal risk factors. Several seemingly modest risk factors may, in combination, result in a much higher risk than an impressively raised single factor. For this reason, risk estimation systems have been developed to assist clinicians to assess the effects of risk factor combinations in planning management strategies. In this article, the performances of the major risk estimation systems are reviewed. Most perform usably well in populations that are similar to the one used to derive the system, and in other populations if calibrated to allow for different CVD mortality rates and different risk factor distributions. The effect of adding "new" risk factors to age, sex, smoking, lipid status, and blood pressure is usually small, but may help to appropriately reclassify some of those patients who are close to a treatment threshold to a more correct "treat\\/do not treat" category. Risk estimation in the young and old needs more research. Quantification of the hoped-for benefits of the multiple risk estimation approach in terms of improved outcomes is still needed. But, it is likely that the widespread use of such an approach will help to address the issues of both undertreatment and overtreatment.

  3. Development of a Korean Fracture Risk Score (KFRS for Predicting Osteoporotic Fracture Risk: Analysis of Data from the Korean National Health Insurance Service.

    Directory of Open Access Journals (Sweden)

    Ha Young Kim

    Full Text Available Asian-specific prediction models for estimating individual risk of osteoporotic fractures are rare. We developed a Korean fracture risk prediction model using clinical risk factors and assessed validity of the final model.A total of 718,306 Korean men and women aged 50-90 years were followed for 7 years in a national system-based cohort study. In total, 50% of the subjects were assigned randomly to the development dataset and 50% were assigned to the validation dataset. Clinical risk factors for osteoporotic fracture were assessed at the biennial health check. Data on osteoporotic fractures during the follow-up period were identified by ICD-10 codes and the nationwide database of the National Health Insurance Service (NHIS.During the follow-up period, 19,840 osteoporotic fractures were reported (4,889 in men and 14,951 in women in the development dataset. The assessment tool called the Korean Fracture Risk Score (KFRS is comprised of a set of nine variables, including age, body mass index, recent fragility fracture, current smoking, high alcohol intake, lack of regular exercise, recent use of oral glucocorticoid, rheumatoid arthritis, and other causes of secondary osteoporosis. The KFRS predicted osteoporotic fractures over the 7 years. This score was validated using an independent dataset. A close relationship with overall fracture rate was observed when we compared the mean predicted scores after applying the KFRS with the observed risks after 7 years within each 10th of predicted risk.We developed a Korean specific prediction model for osteoporotic fractures. The KFRS was able to predict risk of fracture in the primary population without bone mineral density testing and is therefore suitable for use in both clinical setting and self-assessment. The website is available at http://www.nhis.or.kr.

  4. Development and validation of a bedside risk score for MRSA among patients hospitalized with complicated skin and skin structure infections

    Directory of Open Access Journals (Sweden)

    Zilberberg Marya D

    2012-07-01

    Full Text Available Abstract Background Methicillin-resistant Staphylococcus aureus (MRSA is a frequent cause of complicated skin and skin structure infections (cSSSI. Patients with MRSA require different empiric treatment than those with non-MRSA infections, yet no accurate tools exist to aid in stratifying the risk for a MRSA cSSSI. We sought to develop a simple bedside decision rule to tailor empiric coverage more accurately. Methods We conducted a large multicenter (N=62 hospitals retrospective cohort study in a US-based database between April 2005 and March 2009. All adult initial admissions with ICD-9-CM codes specific to cSSSI were included. Patients admitted with MRSA vs. non-MRSA were compared with regard to baseline demographic, clinical and hospital characteristics. We developed and validated a model to predict the risk of MRSA, and compared its performance via sensitivity, specificity and other classification statistics to the healthcare-associated (HCA infection risk factors. Results Of the 7,183 patients with cSSSI, 2,387 (33.2% had MRSA. Factors discriminating MRSA from non-MRSA were age, African-American race, no evidence of diabetes mellitus, cancer or renal dysfunction, and prior history of cardiac dysrhythmia. The score ranging from 0 to 8 points exhibited a consistent dose–response relationship. A MRSA score of 5 or higher was superior to the HCA classification in all characteristics, while that of 4 or higher was superior on all metrics except specificity. Conclusions MRSA is present in 1/3 of all hospitalized cSSSI. A simple bedside risk score can help discriminate the risk for MRSA vs. other pathogens with improved accuracy compared to the HCA definition.

  5. Scoring system for the selection of high-risk patients in the intensive care unit

    NARCIS (Netherlands)

    Iapichino, G; Mistraletti, G; Corbella, D; Bassi, G; Borotto, E; Miranda, DR; Morabito, A

    2006-01-01

    Objective. Patients admitted to the intensive care unit greatly differ in severity and intensity of care. We devised a system for selecting high-risk patients that reduces bias by excluding low-risk patients and patients with an early death irrespective of the treatment. Design: A posteriori analysi

  6. Automated texture scoring for assessing breast cancer masking risk in full field digital mammography

    DEFF Research Database (Denmark)

    Kallenberg, Michiel Gijsbertus J; Petersen, Peter Kersten; Lillholm, Martin

    2015-01-01

    PURPOSE: The goal of this work is to develop a method to identify women at high risk for having breast cancer that is easily missed in regular mammography screening. Such a method will provide a rationale for selecting women for adjunctive screening. It goes beyond current risk assessment models...

  7. Credit risk assessment model for Jordanian commercial banks: Neural scoring approach

    Directory of Open Access Journals (Sweden)

    Hussain Ali Bekhet

    2014-01-01

    Full Text Available Despite the increase in the number of non-performing loans and competition in the banking market, most of the Jordanian commercial banks are reluctant to use data mining tools to support credit decisions. Artificial neural networks represent a new family of statistical techniques and promising data mining tools that have been used successfully in classification problems in many domains. This paper proposes two credit scoring models using data mining techniques to support loan decisions for the Jordanian commercial banks. Loan application evaluation would improve credit decision effectiveness and control loan office tasks, as well as save analysis time and cost. Both accepted and rejected loan applications, from different Jordanian commercial banks, were used to build the credit scoring models. The results indicate that the logistic regression model performed slightly better than the radial basis function model in terms of the overall accuracy rate. However, the radial basis function was superior in identifying those customers who may default.

  8. DUAL-ENERGY X-RAY ABSORPTIOMETRY AND CALCULATED FRAX RISK SCORES MAY UNDERESTIMATE OSTEOPOROTIC FRACTURE RISK IN VITAMIN D–DEFICIENT VETERANS WITH HIV INFECTION

    Science.gov (United States)

    Stephens, Kelly I.; Rubinsztain, Leon; Payan, John; Rentsch, Chris; Rimland, David; Tangpricha, Vin

    2017-01-01

    Objective We evaluated the utility of the World Health Organization Fracture Risk Assessment Tool (FRAX) in assessing fracture risk in patients with human immunodeficiency virus (HIV) and vitamin D deficiency. Methods This was a retrospective study of HIV-infected patients with co-existing vitamin D deficiency at the Atlanta Veterans Affairs Medical Center. Bone mineral density (BMD) was assessed by dual-energy X-ray absorptiometry (DEXA), and the 10-year fracture risk was calculated by the WHO FRAX algorithm. Two independent radiologists reviewed lateral chest radiographs for the presence of subclinical vertebral fractures. Results We identified 232 patients with HIV and vitamin D deficiency. Overall, 15.5% of patients met diagnostic criteria for osteoporosis on DEXA, and 58% had low BMD (T-score between −1 and −2.5). The median risk of any major osteoporotic and hip fracture by FRAX score was 1.45 and 0.10%, respectively. Subclinical vertebral fractures were detected in 46.6% of patients. Compared to those without fractures, those with fractures had similar prevalence of osteoporosis (15.3% versus 15.7%; P>.999), low BMD (53.2% versus 59.3%; P = .419), and similar FRAX hip scores (0.10% versus 0.10%; P = .412). While the FRAX major score was lower in the nonfracture group versus fracture group (1.30% versus 1.60%; P = .025), this was not clinically significant. Conclusion We found a high prevalence of subclinical vertebral fractures among vitamin D–deficient HIV patients; however, DEXA and FRAX failed to predict those with fractures. Our results suggest that traditional screening tools for fragility fractures may not be applicable to this high-risk patient population. PMID:26684149

  9. A risk score model for the metastasis of level Ib lymph node based on the clinicopathological features of nasopharyngeal carcinoma in a large sample.

    Science.gov (United States)

    Yi, Wei; Li, Xian; Liu, Zhigang; Jiang, Changbin; Niu, Daoli; Xia, Yunfei

    2014-09-01

    The aim of the present study was to develop a metastatic risk score model of neck level Ib lymph nodes in primary nasopharyngeal carcinoma (NPC) to guide the level Ib radiotherapy. There were a total of 1,557 patients enrolled in the study, and of these patients, 1,145 were included in the training set. Univariate χ(2) analysis and multivariate logistic regression analyses were used to screen the independent risk factors to construct the risk score model. A total of 85 patients in the validating set underwent a pathology biopsy of level Ib lymph nodes to test the model. The remaining 327 patients from the prognostic-research set were used to evaluate the prognostic impact of level Ib irradiation in high- and low-risk groups. The independent risk factors in the model were carotid sheath involvement, the maximal diameter of the neck lymph nodes (≥20 mm) and the involvement of the level II/III/IV lymph nodes. The involvement of level IV was assigned score 2 and the other risk factors were assigned score 1. According to the total scores, the patients were divided into the low- (total score, 0-1; level Ib metastasis rate, 0.5%) and high-risk groups (total score, 2-4; level Ib metastasis rate, 8.5%). In the validating set, the metastatic rate of level Ib in 43 low-risk patients was 0%, and the rate was 31.0% (13/42) in 42 high-risk patients. In the prognostic-research set, the prognosis of 137 low-risk patients was not affected by level Ib irradiation. However, level Ib unirradiation was an independent prognostic factor for the locoregional recurrence in 190 high-risk patients. According to the data, the novel score model could help assess the metastatic risk of level Ib in primary NPC, and the radiotherapy on level Ib may impact the locoregional recurrence in high-risk patients.

  10. A multiparametric clinical and echocardiographic score to risk stratify patients with chronic systolic heart failure: derivation and testing.

    Science.gov (United States)

    Fontanive, Paolo; Miccoli, Mario; Simioniuc, Anca; Angelillis, Marco; Di Bello, Vitantonio; Baggiani, Angelo; Bongiorni, Maria Grazia; Marzilli, Mario; Dini, Frank Lloyd

    2013-11-01

    Although echo Doppler and biomarkers are the most common examinations performed worldwide in heart failure (HF), they are rarely considered in risk scores. In outpatients with chronic HF and left ventricular ejection fraction (LVEF) ≤45%, data on clinical status, echo Doppler variables, aminoterminal pro-type B natriuretic peptide (NT-proBNP), estimated glomerular filtration rate (eGFR), and drug therapies were combined to build up a multiparametric score. We randomly selected 250 patients to produce a derivation cohort and 388 patients were used as a testing cohort. Follow-up lasted 29 ± 23 months. The univariable predictors that entered into the multivariable Cox model were as follows: furosemide daily dose >25 mg, inability to tolerate angiotensin converting enzyme (ACE) inhibitors, inability to tolerate β-blockers, age >75 years, New York Heart Association (NYHA) >2, eGFR96 mL/m(2) , moderate-to-severe mitral regurgitation (MR) and LVEF derivation cohort (68.4% sensitivity, 79.5% specificity, area under the curve [AUC] 78.7%) or in the testing cohort (73.7% sensitivity, 71.3% specificity, AUC 77.2%). All-cause mortality significantly increased with increasing score both in the derivation and in the testing cohort (P < 0.0001). In conclusion, this multiparametric score is able to predict mortality in chronic systolic HF.

  11. Derivation and Evaluation of a Risk-Scoring Tool to Predict Participant Attrition in a Lifestyle Intervention Project.

    Science.gov (United States)

    Jiang, Luohua; Yang, Jing; Huang, Haixiao; Johnson, Ann; Dill, Edward J; Beals, Janette; Manson, Spero M; Roubideaux, Yvette

    2016-05-01

    Participant attrition in clinical trials and community-based interventions is a serious, common, and costly problem. In order to develop a simple predictive scoring system that can quantify the risk of participant attrition in a lifestyle intervention project, we analyzed data from the Special Diabetes Program for Indians Diabetes Prevention Program (SDPI-DP), an evidence-based lifestyle intervention to prevent diabetes in 36 American Indian and Alaska Native communities. SDPI-DP participants were randomly divided into a derivation cohort (n = 1600) and a validation cohort (n = 801). Logistic regressions were used to develop a scoring system from the derivation cohort. The discriminatory power and calibration properties of the system were assessed using the validation cohort. Seven independent factors predicted program attrition: gender, age, household income, comorbidity, chronic pain, site's user population size, and average age of site staff. Six factors predicted long-term attrition: gender, age, marital status, chronic pain, site's user population size, and average age of site staff. Each model exhibited moderate to fair discriminatory power (C statistic in the validation set: 0.70 for program attrition, and 0.66 for long-term attrition) and excellent calibration. The resulting scoring system offers a low-technology approach to identify participants at elevated risk for attrition in future similar behavioral modification intervention projects, which may inform appropriate allocation of retention resources. This approach also serves as a model for other efforts to prevent participant attrition.

  12. Lack of utility of risk score and gynecological examination for screening for sexually transmitted infections in sexually active adolescents

    Directory of Open Access Journals (Sweden)

    Côrtes Rejane LM

    2009-03-01

    Full Text Available Abstract Background Sexually transmitted infections constitute the main health risk among adolescents. In developing countries the diagnosis and treatment of cervical infections is based on the syndromic approach. In this study we estimated the prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae among female adolescents from a Health Sector of the city of Goiânia, Brazil, and validated cervicitis diagnosis using World Health Organization/Ministry of Health risk score and gynecological examination. Methods A cross-sectional community-based sample of 914 15- to 19-year-old female teenagers was randomly selected and referred to the local Family Health Program. Of these, 472 (51.6% were sexually active and gynecological examinations were carried out for 427. Endocervical samples were collected to perform the polymerase chain reaction for C. trachomatis and N. gonorrhoeae. Performance of risk score, the presence of mucopurulent discharge, friability, ectopia and pain during cervical maneuver were compared with the presence of C. trachomatis or N. gonorrhoeae or both. Results The prevalence of C. trachomatis and N. gonorrhoeae was 14.5% and 2.1%, respectively. The risk score had a specificity of 31.9% (95% confidence interval, 21.2 to 44.2 and a positive predictive value of 20.8% (95% confidence interval, 13.5 to 29.7. Friability was the component of the gynecological examination that presented the best performance with a sensitivity of 43.5%, specificity of 81.0%, and 30.6% of positive predictive value. Conclusion The prevalence of infection by C. trachomatis and N. gonorrhoeae was high among these sexually active adolescents. The syndromic approach is clearly inadequate for screening and treating these infections in this population. Therefore, the implantation of other strategies to control these infections among adolescents is urgently required.

  13. Change in health status (EQ-5D over 5 years among individuals with and without type 2 diabetes mellitus in the SHIELD longitudinal study

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    Grandy Susan

    2012-08-01

    Full Text Available Abstract Background Health-related quality of life studies among adults with type 2 diabetes mellitus, using the EQ-5D, have been short term and have not assessed change over years. This study assessed the change in health status and health-related quality of life over 5 years among individuals with and without diabetes. Methods Respondents to the US Study to Help Improve Early evaluation and management of risk factors Leading to Diabetes (SHIELD completed the EuroQol-5D (EQ-5D at baseline (2004 and 5 years later (2009. Visual analog scale (VAS score and health index score were computed at baseline and year 5, and the change over 5 years was measured for individuals with type 2 diabetes mellitus (T2DM and those without diabetes, and T2DM adults with and without diabetic complications. Linear regression models were used to determine change in EQ-5D score, controlling for age, gender, race, education, household income, and body mass index (BMI. Results There was significantly greater decline in the EQ-5D index score in the T2DM group (-0.031 [SD 0.158], compared with those without diabetes (-0.016 [0.141], p = 0.001. Compared with respondents without diabetes, those with T2DM had a larger reduction in EQ-5D index score, after controlling for demographics (p = 0.001. EQ-5D VAS score declined over 5 years for both groups: -1.42 (18.1 for the T2DM group, and -0.63 (15.8 for the group without diabetes, but the between-group difference was not significant either before (p = 0.09 or after (p = 0.12, controlling for demographics. T2DM respondents with diabetic complications had a greater decline in EQ-5D scores than T2DM respondents without complications (p  Conclusion Over a 5-year period, health status of respondents with T2DM declined significantly compared with those with no diabetes, indicating that the burden of the disease has a long-term detrimental impact. This decline in health status is likely to impact utility scores (fewer

  14. Comparison of SCORE-predicted risk of death due to cardiovascular events in women before and after menopause

    Directory of Open Access Journals (Sweden)

    Anna Piskorz

    2015-09-01

    Full Text Available Introduction : Approximately 55% of women in Europe die from cardiovascular events, mostly as a result of coronary diseases and cerebral stroke. There is a 10-year shift in the cardiovascular risk between women and men. The risk in a 55-year-old female patient is similar to that of a 45-year-old man, thus the risk among women increases rapidly around the age of 50, when menopause prevails to occur. The purpose of the study was to assess and compare the SCORE-predicted risk of a fatal cardiovascular incident in pre- and postmenopausal women. Material and methods : The cross-sectional study was conducted as part of community nursing practice. It covered 219 women – inhabitants of Krakow, aged from 30 to 65, without clinically validated cardiovascular diseases of arteriosclerotic and/or diabetic origin, who volunteered to take part in the study. The group was divided into three subgroups: K1 – menstruating women (n = 113, K2a – women after natural menopause (n = 88, and K2b – women after surgical menopause (n = 18. The study made use of a lifestyle questionnaire, which concerned the social and economic status, and lifestyle habits including tobacco smoking. Arterial blood pressure was measured, and total cholesterol concentration in blood (mmol/l was recorded. Results : A high (≥ 5% level of the SCORE risk was discovered in 14.3% of postmenopausal women, as compared to 0.9% in the group of menstruating women. An average risk of a fatal cardiovascular incident during the following 10 years was significantly higher among women from groups K2a (2.61% and K2b (2.32% as compared to K1 – menstruating women (0.38%. No difference was, however, discovered between groups of naturally (K2a and surgically menopausal women (K2b. Conclusions : A significantly higher risk of SCORE-predicted death caused by a cardiovascular incident, as compared to the group of women in the premenopausal period, is characteristic of women in the postmenopausal period.

  15. 广州地区5岁以下儿童哮喘发生及持续发展的危险因素分析%The risk factors of occurrence and development of asthma in children under 5 years old in Guangzhou area

    Institute of Scientific and Technical Information of China (English)

    程远; 陈德晖; 孙宝清; 郑佩燕; 刘文宽; 蔡勇; 周荣; 罗碧莹; 全小芳

    2015-01-01

    目的 探讨5岁以下儿童哮喘发生及持持发展的危险因素.方法 通过对广州地区确诊的5岁以下哮喘患儿150例进行统一标准的问卷调查,并与同地区同年龄段健康儿童117例进行病例对照比较,并结合血嗜酸性粒细胞计数、血清过敏原、血清九项呼吸道病原学、血清支原体IgM抗体测定及病毒咽拭子PCR检测等实验室检查,分析哮喘发生的危险因素,并对研究对象进行跟踪随访,将哮喘组分为哮喘稳定组及哮喘持续组,进行比较分析导致年幼儿童哮喘发生及持续发展至5岁以后的重要危险因素.结果 生后第1年有被动吸烟暴露史、家居环境(潮湿、多花草、有布艺沙发、地毯或毛绒玩具、蟑螂多)、父母及1、2级亲属有过敏史、其他有过敏性疾病史、螨类、屋尘、牛奶、鸡蛋过敏是5岁以下儿童哮喘发病的危险因素(x2=4.99、5.37、16.29、37.32、47.73、48.27、15.27、25.45、25.45、138.47、26.81、9.25、24.35和4.51,均P<0.05).哮喘组中病毒感染阳性率45.33%,支原体感染占44.00%;哮喘稳定组与哮喘持续组的比较显示哮喘持续组的螨类过敏阳性率为76.92%,较哮喘稳定组的27.93%明显升高且差异有统计学意义(xz=28.71,P<0.01).结论 导致5岁以下儿童哮喘发病的危险因素包括吸烟暴露、家居环境、父母过敏史、自身过敏史、病菌感染等因素,其中螨虫过敏是导致5岁以下儿童哮喘症状持续至较大年龄的重要危险因素.%Objective Through the investigation of asthma in children under 5 years old and the healthy children in the same age in Guangzhou area,to analyze the important risk factors of asthma.Methods Through the questionnaire investigation of 150 asthma in children under 5 years old in Guangzhou area,combined the examination with blood eosinophil counts,serum allergen and serum levels of respiratory pathogens,mycoplasma antibody and virus swab PCR,the risk

  16. Cardiovascular risk prediction in the general population with use of suPAR, CRP, and Framingham Risk Score

    DEFF Research Database (Denmark)

    Lyngbæk, Stig; Marott, Jacob L; Sehestedt, Thomas;

    2013-01-01

    for men (p=0.034) and borderline significant for women (p=0.054), while the integrated discrimination improvement was highly significant (P≤0.001) for both genders. CONCLUSIONS: suPAR provides prognostic information of CVD risk beyond FRS and improves risk prediction substantially when combined with CRP...... events were recorded. After adjusting for FRS, women with suPAR levels in the highest tertile had a 1.74-fold (95% confidence interval [CI]: 1.08-2.81, p=0.027) and men a 2.09-fold (95% CI: 1.37-3.18, p20%) risk categories, respectively. This was reflected in a significant improvement of C statistics...

  17. Genetic predisposition to coronary heart disease and stroke using an additive genetic risk score: a population-based study in Greece

    Science.gov (United States)

    Objective: To determine the extent to which the risk for incident coronary heart disease (CHD) increases in relation to a genetic risk score (GRS) that additively integrates the influence of high-risk alleles in nine documented single nucleotide polymorphisms (SNPs) for CHD, and to examine whether t...

  18. Framingham Risk Score for Prediction of Cardiovascular Diseases: A Population-Based Study from Southern Europe

    Science.gov (United States)

    Artigao-Rodenas, Luis M.; Carbayo-Herencia, Julio A.; Divisón-Garrote, Juan A.; Gil-Guillén, Vicente F.; Massó-Orozco, Javier; Simarro-Rueda, Marta; Molina-Escribano, Francisca; Sanchis, Carlos; Carrión-Valero, Lucinio; López de Coca, Enrique; Caldevilla, David; López-Abril, Juan; Carratalá-Munuera, Concepción; Lopez-Pineda, Adriana

    2013-01-01

    Background The question about what risk function should be used in primary prevention remains unanswered. The Framingham Study proposed a new algorithm based on three key ideas: use of the four risk factors with the most weight (cholesterol, blood pressure, diabetes and smoking), prediction of overall cardiovascular diseases and incorporating the concept of vascular age. The objective of this study was to apply this new function in a cohort of the general non Anglo-Saxon population, with a 10-year follow-up to determine its validity. Methods The cohort was studied in 1992-94 and again in 2004-06. The sample comprised 959 randomly-selected persons, aged 30-74 years, who were representative of the population of Albacete, Spain. At the first examination cycle, needed data for the new function were collected and at the second examination, data on all events were recorded during the follow-up period. Discrimination was studied with ROC curves. Comparisons of prediction models and reality in tertiles (Hosmer-Lemeshow) were performed, and the individual survival functions were calculated. Results The mean risks for women and men, respectively, were 11.3% and 19.7% and the areas under the ROC curve were 0.789 (95%CI, 0.716-0.863) and 0.780 (95%CI, 0.713-0.847) (P<0.001, both). Cardiovascular disease events occurred in the top risk tertiles. Of note were the negative predictive values in both sexes, and a good specificity in women (85.6%) and sensitivity in men (79.1%) when their risk for cardiovascular disease was high. This model overestimates the risk in older women and in middle-aged men. The cumulative probability of individual survival by tertiles was significant in both sexes (P<0.001). Conclusions The results support the proposal for “reclassification” of Framingham. This study, with a few exceptions, passed the test of discrimination and calibration in a random sample of the general population from southern Europe. PMID:24039972

  19. International Energy Security Indicators and Turkey’s Energy Security Risk Score

    OpenAIRE

    2014-01-01

    Energy security has been a priority for many countries. What makes energy security that important is; its bilateral relationship with economic, political, social, environmental sustainability and military issues. As an inevitable consequence of globalization cooperation in the field has been a must and it is required international energy security indicators to make energy security risk evaluations in order to establish adequate policies. The aim of the study is to review energy security withi...

  20. Modified Mediterranean Diet Score and Cardiovascular Risk in a North American Working Population

    OpenAIRE

    2014-01-01

    Introduction: Greater adherence to a Mediterranean diet is linked to lower risk for cardiovascular morbidity/mortality in studies of Mediterranean cohorts, older subjects, and/or those with existing health conditions. No studies have examined the effects of this dietary pattern in younger working populations in the United States. We investigated the effects of Mediterranean diet adherence on cardiovascular disease (CVD) biomarkers, metabolic syndrome and body composition in an occupationally ...

  1. Intermediate acting non-depolarizing neuromuscular blocking agents and risk of postoperative respiratory complications: prospective propensity score matched cohort study

    Science.gov (United States)

    Grosse-Sundrup, Martina; Henneman, Justin P; Sandberg, Warren S; Bateman, Brian T; Uribe, Jose Villa; Nguyen, Nicole Thuy; Ehrenfeld, Jesse M; Martinez, Elizabeth A; Kurth, Tobias

    2012-01-01

    Objective To determine whether use of intermediate acting neuromuscular blocking agents during general anesthesia increases the incidence of postoperative respiratory complications. Design Prospective, propensity score matched cohort study. Setting General teaching hospital in Boston, Massachusetts, United States, 2006-10. Participants 18 579 surgical patients who received intermediate acting neuromuscular blocking agents during surgery were matched by propensity score to 18 579 reference patients who did not receive such agents. Main outcome measures The main outcome measures were oxygen desaturation after extubation (hemoglobin oxygen saturation 3%) and reintubations requiring unplanned admission to an intensive care unit within seven days of surgery. We also evaluated effects on these outcome variables of qualitative monitoring of neuromuscular transmission (train-of-four ratio) and reversal of neuromuscular blockade with neostigmine to prevent residual postoperative neuromuscular blockade. Results The use of intermediate acting neuromuscular blocking agents was associated with an increased risk of postoperative desaturation less than 90% after extubation (odds ratio 1.36, 95% confidence interval 1.23 to 1.51) and reintubation requiring unplanned admission to an intensive care unit (1.40, 1.09 to 1.80). Qualitative monitoring of neuromuscular transmission did not decrease this risk and neostigmine reversal increased the risk of postoperative desaturation to values less than 90% (1.32, 1.20 to 1.46) and reintubation (1.76, 1.38 to 2.26). Conclusion The use of intermediate acting neuromuscular blocking agents during anesthesia was associated with an increased risk of clinically meaningful respiratory complications. Our data suggest that the strategies used in our trial to prevent residual postoperative neuromuscular blockade should be revisited. PMID:23077290

  2. Influence of an elevated nutrition risk score (NRS) on survival in patients following gastrectomy for gastric cancer.

    Science.gov (United States)

    Bachmann, J; Müller, T; Schröder, A; Riediger, C; Feith, M; Reim, D; Friess, H; Martignoni, M E

    2015-07-01

    In the last years, the impact of weight loss in patients with malignant tumors has come more and more into the focus of clinical research, as the occurrence of weight loss is often associated with a reduced survival. Weight loss can be a hint for metastases in patients suffering from malignant tumors; furthermore, these patients are usually not able to be treated with chemotherapy. The aim of the study was to show the influence of weight loss and an elevated nutrition risk score on survival following tumor resection in patients suffering from gastric cancer. In 99 patients in whom a gastrectomy due to gastric cancer was performed, the nutrition risk score was calculated and its influence on mortality, morbidity and survival was analyzed. Of the included patients, 45 % of the patients gave a history of weight loss; they had significantly more often a NRS ≥ 3. In UICC stage 1a/b, a NRS ≥ 3 was associated with a significantly reduced survival compared to patients with a NRS gastric cancer, the influence of a reduced NRS is negligible.

  3. Does von Willebrand factor improve the predictive ability of current risk stratification scores in patients with atrial fibrillation?

    Science.gov (United States)

    García-Fernández, Amaya; Roldán, Vanessa; Rivera-Caravaca, José Miguel; Hernández-Romero, Diana; Valdés, Mariano; Vicente, Vicente; Lip, Gregory Y. H.; Marín, Francisco

    2017-01-01

    Von Willebrand factor (vWF) is a biomarker of endothelial dysfunction. We investigated its role on prognosis in anticoagulated atrial fibrillation (AF) patients and determined whether its addition to clinical risk stratification schemes improved event-risk prediction. Consecutive outpatients with non-valvular AF were recruited and rates of thrombotic/cardiovascular events, major bleeding and mortality were recorded. The effect of vWF on prognosis was calculated using a Cox regression model. Improvements in predictive accuracy over current scores were determined by calculating the integrated discrimination improvement (IDI), net reclassification improvement (NRI), comparison of receiver-operator characteristic (ROC) curves and Decision Curve Analysis (DCA). 1215 patients (49% males, age 76 (71–81) years) were included. Follow-up was almost 7 years. Significant associations were found between vWF and cardiovascular events, stroke, mortality and bleeding. Based on IDI and NRI, addition of vWF to CHA2DS2-VASc statistically improved its predictive value, but c-indexes were not significantly different. For major bleeding, the addition of vWF to HAS-BLED improved the c-index but not IDI or NRI. DCA showed minimal net benefit. vWF acts as a simple prognostic biomarker in AF and, whilst its addition to current scores statistically improves prediction for some endpoints, absolute changes and impact on clinical decision-making are marginal. PMID:28134282

  4. The WHO score predicts treatment outcome in low risk gestational trophoblastic neoplasia patients treated with weekly intramuscular methotrexate

    Directory of Open Access Journals (Sweden)

    Mitra M Gilani

    2013-01-01

    Full Text Available Background: Gestational trophoblastic neoplasia (GTN includes a spectrum of disease ranging from hydatidifrom mole to choriocarcinoma. Low risk GTN is defined as persistent molar pregnancy with a WHO score lower than seven. The optimal chemotherapeutic regimen still remains controversial. Aim: The objectives of this study was to determine efficacy and safety of weekly intramuscular methotrexte in the treatment of low risk gestational trophoblastic neoplasia.(LRGTN and also identify prognostic factors associated with treatment failure, necessitating second line chemotherapy. Materials and Methods: Sixty-six women with LRGTN from 2001 to 2009 were treated with weekly intramuscular methotrexate at 40mg/m 2 as first line therapy.Monitoring of treatment was done with weekly checking of βhCG level. Three consecutive negative βhCG measurements showed complete response. After first negative βhCG measurement, one additional dose was administered for consolidation. Results: Of 66 patients, who started the treatment five continued their treatment in other medical centres and were excluded from final analysis for treatment evaluation, and seven discontinued first line therapy because of hepatotoxicity. Of the remaining 54, complete remission occurred in 43 (79.6% and eleven were resistant to first line therapy. Mean WHO score prior to starting chemotherapy was significantly different between two groups of response and resistance according to our data. Change of treatment to second line Actinomycin-D was necessary in eigtheen cases because of resistance to first line in eleven and liver enzyme elevation in seven patients. Sixteen of these 18 responded to Actinomycin-D as second line and one needed hysterectomy for complete response. One patient received multiagent chemotherapy for complete remission. Conclusion: We recommend this effective and safe method of chemotherapy for women with LRGTN. According to our data, lower mean WHO score predicts a better

  5. Framingham Risk Scores for coronary heart disease in a cohort of Saudi Arabian men and women with spinal cord injury.

    Science.gov (United States)

    Hussain, Amjad; Qureshi, Ahmed Zaheer; Ayaz, Saeed Bin; Rathore, Farooq Azam

    2016-06-01

    People with spinal cord injury (SCI) are at increased risk of developing coronary heart disease (CHD). This study aimed at predicting CHD risk in a cohort of Saudi patients with SCI in comparison with patients without SCI and to correlate different demographic and clinical factors with Framingham Risk Score (FRS) in SCI patients. The study was conducted at the rehabilitation and the main hospitals of King Fahad Medical City, Riyadh, Saudi Arabia; on sixty patients with SCI and sixty controls of age ≥20 years. FRS was calculated on a web-based calculator. For the SCI group, sub-groups were made for statistical analysis based on gender, cigarette smoking, neurological level and completeness of injury. The mean FRS for the SCI group (2 ± 7.9) was significantly higher (P Saudi patients with SCI had a higher FRS as compared to controls, however, majority had a low risk of developing CHD in next 10 years. The age, SBP and total cholesterol surfaced as positive predictors of CHD in SCI patients. Time since SCI, smoking, and neurological level or completeness of injury did not influence the resultant FRS and thus the development of CHD.

  6. SCREENING FOR UNDIAGNOSED DIABETIC SUBJECTS USING A SIMPLIFIED INDIAN DIABETES RISK SCORE [IDRS] IN KHAMMAM URBAN

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    Pothukuchi Madhavi

    2016-07-01

    Full Text Available BACKGROUND The rising prevalence of diabetes in developing countries is closely associated with industrialisation and socioeconomic development. The major determinants of diabetics in these countries are population growth, age structure, and urbanisation, prevalence of obesity because of increased intake of junk food, lack of physical activity, and stress among urban dwellers. Diabetes is increasingly concentrated in the urban areas. Hence, the present study was undertaken. METHODOLOGY A community based cross-sectional study was carried out in Raghunadhapalem, an urban area of Khammam with a total population of 1552. List of areas under Khammam (urban was obtained from Municipal Corporation and the present study area Raghunadhapalem, was chosen by simple random sampling technique. Duration of the study was 4 months. RESULTS Majority 232 (74.3% of study participants are at risk of developing Diabetes in future. Majority 291 (93.3% of the study participants do not have family history of diabetes. CONCLUSIONS IDRS is a simple, useful and cost-effective screening tool for diabetes in resource limited settings. By identifying the high & medium risk individuals using IDRS, we could make screening programs more cost effective.

  7. High-resolution computed tomography in patients with atypical 'cardiac' chest pain: a study investigating patients at 10-year cardiovascular risks defined by the Framingham and PROCAM scores

    Institute of Scientific and Technical Information of China (English)

    Choon Kiat ANG; Kui Hian SIM; Alan Yean Yip FONG; Sze Piaw CHIN; Tiong Kiam ONG; Seyfarth M Tobias; Wei Ling CHAN; Chee Khoon LIEW; Rapaee ANNUAR; Houng Bang LIEW

    2006-01-01

    Background and objective Atypical 'cardiac' chest pain (ACCP) is not usually caused by myocardial ischaemia. Current noninvasive investigations for these symptoms are not yet as accurate as invasive coronary angiography. The latest 64-row multi-detector computed tomography (MDCT) technology is non-invasive, has high specificity and negative predictive values for the detection of significant coronary disease. Our aim was to investigate if this modality can provide more information in the assessment of outpatients with ACCP in addition to established cardiovascular risk scores. Methods Seventy consecutive patients presenting to the outpatient clinic with ACCP underwent 64-row MDCT scan of the coronary arteries. They were categorized into low, medium or high risk groups based upon the Framingham and PROCAM scores. We defined a clinically abnormal MDCT scan as coronary stenosis =50% or calcium score >400 Agatston. Results Fifty-three (75.7%) patients did not have clinically abnormal scans. Framingham score classified 43 patients as low-risk while PROCAM classified 59 patients as low-risk. MDCT scans were abnormal for 18.6% and 22.0% of the respective low-risk group of patients. For patients with medium-to-high risk, 33.3% and 36.4% of Framingham and PROCAM patient groups respectively had abnormal MDCT scans. Conclusion MDCT adds valuable information in the assessment of patients with ACCP by identifying a significant proportion of patients categorized as low-risk to have underlying significant coronary stenosis and coronary calcification by established cardiovascular risk scores.

  8. Development and validation of a risk score for chronic kidney disease in HIV infection using prospective cohort data from the D:A:D study.

    Directory of Open Access Journals (Sweden)

    Amanda Mocroft

    2015-03-01

    Full Text Available Chronic kidney disease (CKD is a major health issue for HIV-positive individuals, associated with increased morbidity and mortality. Development and implementation of a risk score model for CKD would allow comparison of the risks and benefits of adding potentially nephrotoxic antiretrovirals to a treatment regimen and would identify those at greatest risk of CKD. The aims of this study were to develop a simple, externally validated, and widely applicable long-term risk score model for CKD in HIV-positive individuals that can guide decision making in clinical practice.A total of 17,954 HIV-positive individuals from the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D study with ≥3 estimated glomerular filtration rate (eGFR values after 1 January 2004 were included. Baseline was defined as the first eGFR > 60 ml/min/1.73 m2 after 1 January 2004; individuals with exposure to tenofovir, atazanavir, atazanavir/ritonavir, lopinavir/ritonavir, other boosted protease inhibitors before baseline were excluded. CKD was defined as confirmed (>3 mo apart eGFR ≤ 60 ml/min/1.73 m2. Poisson regression was used to develop a risk score, externally validated on two independent cohorts. In the D:A:D study, 641 individuals developed CKD during 103,185 person-years of follow-up (PYFU; incidence 6.2/1,000 PYFU, 95% CI 5.7-6.7; median follow-up 6.1 y, range 0.3-9.1 y. Older age, intravenous drug use, hepatitis C coinfection, lower baseline eGFR, female gender, lower CD4 count nadir, hypertension, diabetes, and cardiovascular disease (CVD predicted CKD. The adjusted incidence rate ratios of these nine categorical variables were scaled and summed to create the risk score. The median risk score at baseline was -2 (interquartile range -4 to 2. There was a 1:393 chance of developing CKD in the next 5 y in the low risk group (risk score < 0, 33 events, rising to 1:47 and 1:6 in the medium (risk score 0-4, 103 events and high risk groups (risk score ≥ 5, 505

  9. Interactions of Lipid Genetic Risk Scores with Estimates of Metabolic Health in a Danish Population

    DEFF Research Database (Denmark)

    Justesen, Johanne M; Allin, Kristine H; Sandholt, Camilla H

    2015-01-01

    status as estimated from body mass index, waist circumference, and insulin resistance assessed using homeostasis model assessment of insulin resistance. All 4 lipid weighted GRSs associated strongly with their respective trait (from P=3.3×10–69 to P=1.1×10–123). We found interactions between...... the triglyceride weighted GRS and body mass index and waist circumference on fasting triglyceride levels in Inter99 and replicated these findings in Health2006 (Pinteraction=9.8×10–5 and 2.0×10–5, respectively, in combined analysis). Conclusions—Our findings suggest that individuals who are obese may be more......Background—There are several well-established lifestyle factors influencing dyslipidemia and currently; 157 genetic susceptibility loci have been reported to be associated with serum lipid levels at genome-wide statistical significance. However, the interplay between lifestyle risk factors...

  10. Genetic Risk Scores Associated with Baseline Lipoprotein Subfraction Concentrations Do Not Associate with Their Responses to Fenofibrate

    Directory of Open Access Journals (Sweden)

    Alexis C. Frazier-Wood

    2014-08-01

    Full Text Available Lipoprotein subclass concentrations are modifiable markers of cardiovascular disease risk. Fenofibrate is known to show beneficial effects on lipoprotein subclasses, but little is known about the role of genetics in mediating the responses of lipoprotein subclasses to fenofibrate. A recent genomewide association study (GWAS associated several single nucleotide polymorphisms (SNPs with lipoprotein measures, and validated these associations in two independent populations. We used this information to construct genetic risk scores (GRSs for fasting lipoprotein measures at baseline (pre-fenofibrate, and aimed to examine whether these GRSs also associated with the responses of lipoproteins to fenofibrate. Fourteen lipoprotein subclass measures were assayed in 817 men and women before and after a three week fenofibrate trial. We set significance at a Bonferroni corrected alpha <0.05 (p < 0.004. Twelve subclass measures changed with fenofibrate administration (each p = 0.003 to <0.0001. Mixed linear models which controlled for age, sex, body mass index (BMI, smoking status, pedigree and study-center, revealed that GRSs were associated with eight baseline lipoprotein measures (p < 0.004, however no GRS was associated with fenofibrate response. These results suggest that the mechanisms for changes in lipoprotein subclass concentrations with fenofibrate treatment are not mediated by the genetic risk for fasting levels.

  11. Performance of the Finnish Diabetes Risk Score and a Simplified Finnish Diabetes Risk Score in a Community-Based, Cross-Sectional Programme for Screening of Undiagnosed Type 2 Diabetes Mellitus and Dysglycaemia in Madrid, Spain: The SPREDIA-2 Study

    Science.gov (United States)

    Burgos-Lunar, C.; Lahoz, C.; Mostaza, J. M.; Abánades-Herranz, J. C.; Laguna-Cuesta, F.; Estirado-de Cabo, E.; García-Iglesias, F.; González-Alegre, T.; Fernández-Puntero, B.; Montesano-Sánchez, L.; Vicent-López, D.; Cornejo-del Río, V.; Fernández-García, P. J.; Sánchez-Arroyo, V.; Sabín-Rodríguez, C.; López-López, S.; Patrón-Barandio, P.; Gómez-Campelo, P.

    2016-01-01

    Aim To evaluate the performance of the Finnish Diabetes Risk Score (FINDRISC) and a simplified FINDRISC score (MADRISC) in screening for undiagnosed type 2 diabetes mellitus (UT2DM) and dysglycaemia. Methods A population-based, cross-sectional, descriptive study was carried out with participants with UT2DM, ranged between 45–74 years and lived in two districts in the north of metropolitan Madrid (Spain). The FINDRISC and MADRISC scores were evaluated using the area under the receiver operating characteristic curve method (ROC-AUC). Four different gold standards were used for UT2DM and any dysglycaemia, as follows: fasting plasma glucose (FPG), oral glucose tolerance test (OGTT), HbA1c, and OGTT or HbA1c. Dysglycaemia and UT2DM were defined according to American Diabetes Association criteria. Results The study population comprised 1,426 participants (832 females and 594 males) with a mean age of 62 years (SD = 6.1). When HbA1c or OGTT criteria were used, the prevalence of UT2DM was 7.4% (10.4% in men and 5.2% in women; p<0.01) and the FINDRISC ROC-AUC for UT2DM was 0.72 (95% CI, 0.69–0.74). The optimal cut-off point was ≥13 (sensitivity = 63.8%, specificity = 65.1%). The ROC-AUC of MADRISC was 0.76 (95% CI, 0.72–0.81) with ≥13 as the optimal cut-off point (sensitivity = 84.8%, specificity = 54.6%). FINDRISC score ≥12 for detecting any dysglycaemia offered the best cut-off point when HbA1c alone or OGTT and HbA1c were the criteria used. Conclusions FINDRISC proved to be a useful instrument in screening for dysglycaemia and UT2DM. In the screening of UT2DM, the simplified MADRISC performed as well as FINDRISC. PMID:27441722

  12. Predictive value of subclinical autistic traits at age 14-15 months for behavioural and cognitive problems at age 3-5 years.

    Science.gov (United States)

    Möricke, Esmé; Swinkels, Sophie H N; Beuker, Karin T; Buitelaar, Jan K

    2010-08-01

    It is unclear whether subclinical autistic traits at very young age are transient or stable, and have clinical relevance. This study investigated the relationship between early subclinical autistic traits and the occurrence of later developmental and behavioural problems as well as problems in cognitive and language functioning. Parents of infants aged 14-15 months from the general population completed the Early Screening of Autistic Traits Questionnaire (ESAT). Three groups of children with high, moderate, and low ESAT-scores (total n = 103) were selected. Follow-up assessments included the CBCL 1(1/2)-5 at age 3 years, and the SCQ, the ADI-R, the ADOS-G, an on-verbal intelligence test, and language tests for comprehension and production at age 4-5 years. None of the children met criteria for autism spectrum disorder at follow-up. Children with high ESAT-scores at 14-15 months showed significantly more internalizing and externalizing problems at age 3 years and scored significantly lower on language tests at age 4-5 years than children with moderate or low ESAT-scores. Further, significantly more children with high ESAT-scores (14/26, 53.8%) than with moderate and low ESAT-scores (5/36, 13.9% and 1/41, 2.4%, respectively) were in the high-risk/clinical range on one or more outcome domains (autistic symptoms, behavioural problems, cognitive and language abilities). Subclinical autistic traits at 14-15 months predict later behavioural problems and delays in cognitive and language functioning rather than later ASD-diagnoses. The theoretical implications of the findings lie in the pivotal role of early social and communication skills for the development of self-regulation of emotions and impulses. The practical implications bear on the early recognition of children at risk for behavioural problems and for language and cognitive problems.

  13. 75 FR 66724 - Endangered and Threatened Species; 5-Year Review

    Science.gov (United States)

    2010-10-29

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF COMMERCE... (NOAA), Commerce. ACTION: Notice of availability of a 5-year review for the U.S. Distinct Population... electronic message to Shelley.norton@noaa.gov . Electronic copies of the 5-year review are available...

  14. Diabetes patient at risk score - a novel system for triaging appropriate referrals of inpatients with diabetes to the diabetes team.

    Science.gov (United States)

    Rajendran, Rajesh; Round, Rachael-Marie; Kerry, Christopher; Barker, Sarah; Rayman, Gerry

    2015-06-01

    The acceptability, uptake and effectiveness of a new referral tool - the diabetes patient at risk (DPAR) score - were evaluated and the timeliness of review of referred inpatients by the diabetes team was measured. For this, a snapshot survey of ward healthcare professionals (HCPs) and a review of all DPAR referrals to the diabetes team between 1 September 2013 and 31 January 2014 were undertaken. All referrals in November 2013 were audited for timeliness of review. 77% of HCPs agreed/strongly agreed that the tool improved access to the diabetes team. 76% of referrals were from nurses. 80% of who should have been referred were referred; the remaining had already been reviewed by the diabetes team and therefore did not require referral. Only 11% of referrals were inappropriate. All DPAR referrals were reviewed within the stipulated time period in November 2013. Overall, the DPAR system was well accepted, successfully identified appropriate referrals and facilitated referrals in a timely manner to the diabetes team.

  15. A risk score for predicting coronary artery disease in women with angina pectoris and abnormal stress test finding.

    Science.gov (United States)

    Lo, Monica Y; Bonthala, Nirupama; Holper, Elizabeth M; Banks, Kamakki; Murphy, Sabina A; McGuire, Darren K; de Lemos, James A; Khera, Amit

    2013-03-15

    Women with angina pectoris and abnormal stress test findings commonly have no epicardial coronary artery disease (CAD) at catheterization. The aim of the present study was to develop a risk score to predict obstructive CAD in such patients. Data were analyzed from 337 consecutive women with angina pectoris and abnormal stress test findings who underwent cardiac catheterization at our center from 2003 to 2007. Forward selection multivariate logistic regression analysis was used to identify the independent predictors of CAD, defined by ≥50% diameter stenosis in ≥1 epicardial coronary artery. The independent predictors included age ≥55 years (odds ratio 2.3, 95% confidence interval 1.3 to 4.0), body mass index angina pectoris and abnormal stress test findings. This tool, if validated, could help to guide testing strategies in women with angina pectoris.

  16. A Common Genetic Variant Risk Score is Associated with Drug-Induced QT Prolongation and Torsade de Pointes Risk: A Pilot Study.

    Science.gov (United States)

    Strauss, David G; Vicente, Jose; Johannesen, Lars; Blinova, Ksenia; Mason, Jay W; Weeke, Peter; Behr, Elijah R; Roden, Dan M; Woosley, Raymond; Kosova, Gulum; Rosenberg, Michael A; Newton-Cheh, Christopher

    2017-02-17

    Background -Drug-induced QT interval prolongation, a risk factor for life-threatening ventricular arrhythmias, is a potential side effect of many marketed and withdrawn medications. The contribution of common genetic variants previously associated with baseline QT interval to drug-induced QT prolongation and arrhythmias is not known. Methods -We tested the hypothesis that a weighted combination of common genetic variants contributing to QT interval at baseline, identified through genome-wide association studies, can predict individual response to multiple QT-prolonging drugs. Genetic analysis of 22 subjects was performed in a secondary analysis of a randomized, double-blind, placebo-controlled, cross-over trial of 3 QT-prolonging drugs with 15 time-matched QT and plasma drug concentration measurements. Subjects received single doses of dofetilide, quinidine, ranolazine and placebo. The outcome was the correlation between a genetic QT score comprising 61 common genetic variants and the slope of an individual subject's drug-induced increase in heart rate corrected QT (QTc) vs. drug concentration. Results -The genetic QT score was correlated with drug-induced QTc prolongation. Among white subjects, genetic QT score explained 30% of the variability in response to dofetilide (r = 0.55 [95% CI, 0.09-0.81], P = 0.02), 23% in response to quinidine (r = 0.48 [95% CI, -0.03 to 0.79], P = 0.06) and 27% in response to ranolazine (r = 0.52 [95% CI, 0.05 to 0.80], P = 0.03). Furthermore, the genetic QT score was a significant predictor of drug-induced torsade de pointes in an independent sample of 216 cases compared to 771 controls (r(2) = 12%, P = 1x10(-7)). Conclusions -We demonstrate that a genetic QT score comprising 61 common genetic variants explains a significant proportion of the variability in drug-induced QT prolongation and is a significant predictor of drug-induced torsade de pointes. These findings highlight an opportunity for recent genetic discoveries to improve

  17. Dickkopf-1 as a novel predictor is associated with risk stratification by GRACE risk scores for predictive value in patients with acute coronary syndrome: a retrospective research.

    Directory of Open Access Journals (Sweden)

    Lin Wang

    Full Text Available OBJECTIVE: Dickkopf-1 (DKK-1, a major regulator of the Wnt pathway, plays an important role in cardiovascular disease. However, no study has evaluated the association of DKK-1 and acute coronary syndrome (ACS. We investigated this association and whether the Global Registry of Acute Coronary Events (GRACE hospital-discharge risk score predicting major adverse cardiac events (MACE can be improved by adding the DKK-1 value. METHODS: We enrolled 291 patients (46 with ST-segment elevation myocardial infarction [STEMI] and 245 with non-ST elevated ACS [NSTE-ACS] who were divided into groups by tertiles of baseline plasma DKK-1 level measured by ELISA. The GRACE risk score was calculated and predictive value alone and together with DKK-1 and/or high-sensitivity C-reactive protein (hs-CRP level were assessed, respectively. RESULTS: Compared with patients with NSTE-ACS, those with STEMI had higher plasma DKK-1 level at baseline (P = 0.006. Plasma DKK-1 level was correlated with hs-CRP level (r = 0.295, P<0.001 and was greater with high than intermediate or low GRACE scores (P = 0.002 and P<0.001, respectively. We found 44 (15.1% MACEs during a median 2-year follow-up. DKK-1 levels were higher for patients with than without events (P<0.001. The rate of MACE increased with increasing DKK-1 level (P<0.001. The area under the receiver operating characteristic curve for GRACE score with MACE was 0.524 and improved to 0.791 with the addition of hs-CRP level, 0.775 with the addition of DKK-1 level and 0.847 with both values added. CONCLUSIONS: DKK-1 is an independent predictor of long-term MACE of patients with ACS. The long-term predictive ability of post-discharge GRACE score may be enhanced by adding DKK-1 level.

  18. Critical Overview of the Risk Scoring Systems to Predict Non-Responsiveness to Intravenous Immunoglobulin in Kawasaki Syndrome

    Directory of Open Access Journals (Sweden)

    Donato Rigante

    2016-02-01

    Full Text Available Kawasaki syndrome (KS is the most relevant cause of heart disease in children living in developed countries. Intravenous immunoglobulin (IVIG has a preventive function in the formation of coronary artery abnormalities and a poor strictly-curative action in established coronary damage. More than two decades ago, the Harada score was set to assess which children with KS should be subject to administration of IVIG, evaluating retrospectively a large cohort of patients with regard to age, sex and laboratory data. Nowadays, high dose IVIG is administered to all children with a confirmed diagnosis of KS, but a tool for predicting non-responsiveness to the initial infusion of IVIG has not been found. The prediction of IVIG resistance is a crucial issue, as recognising these high-risk patients should consent the administration of an intensified initial treatment in combination with IVIG in order to prevent coronary injuries. Few reports have focused on factors, referring to both clinical parameters and laboratory data at the onset of KS, in order to predict which patients might be IVIG non-responsive. We have analysed three different risk scores which were formulated to predict IVIG resistance in Japanese children with typical KS, but their application in non-Japanese patients or in those with incomplete and atypical patterns of the disease has been studied in a fragmentary way. Overall, our analysis showed that early and definite ascertainment of likely IVIG non-responders who require additional therapies reducing the development of coronary artery involvement in children with KS is still a challenge.

  19. Caspofungin versus fluconazole as prophylaxis of invasive fungal infection in high-risk liver transplantation recipients: A propensity score analysis.

    Science.gov (United States)

    Fortún, Jesús; Muriel, Alfonso; Martín-Dávila, Pilar; Montejo, Miguel; Len, Oscar; Torre-Cisneros, Julian; Carratalá, Jordi; Muñoz, Patricia; Fariñas, Carmen; Moreno, Asunción; Fresco, Gema; Goikoetxea, Josune; Gavaldá, Joan; Pozo, Juan Carlos; Bodro, Marta; Vena, Antonio; Casafont, Fernando; Cervera, Carlos; Silva, José Tiago; Aguado, José M

    2016-04-01

    Targeted prophylaxis has proven to be an efficient strategy in liver transplantation recipients (LTRs). The aim of this study was to compare the effectiveness and safety of caspofungin with that of fluconazole in high-risk (HR) LTRs. Caspofungin and fluconazole were compared in a multicenter, retrospective, cohort study in HR-LTRs in Spain. Outcomes were assessed at 180 days after transplantation. A propensity score approach was applied. During the study period (2005-2012), we analyzed 195 HR-LTRs from 9 hospitals. By type of prophylaxis, 97 patients received caspofungin and 98 received fluconazole. Of a total of 17 (8.7%) global invasive fungal infections (IFIs), breakthrough IFIs accounted for 11 (5.6%) and invasive aspergillosis (IA) accounted for 6 (3.1%). By univariate analysis, no differences were observed in the prevention of global IFIs. However, caspofungin was associated with a significant reduction in the rate of breakthrough IFIs (2.1% versus 9.2%, P = 0.04). In patients requiring dialysis (n = 62), caspofungin significantly reduced the frequency of breakthrough IFIs (P = 0.03). The propensity score analysis confirmed a significant reduction in the frequency of IA in patients receiving caspofungin (absolute risk reduction, 0.06; 95% confidence interval [CI], 0.001-0.11; P = 0.044). Linear regression analysis revealed a significant decrease in blood alanine aminotransferase levels and a significant increase in bilirubin levels after administration of caspofungin. Caspofungin and fluconazole have similar efficacy for the prevention of global IFIs in HR-LTRs in this observational, multicenter cohort study. However, caspofungin was associated with a significant reduction of breakthrough IFIs and, after adjusting for confounders, caspofungin was associated with a lower rate of IA. This benefit is probably more favorable in patients on dialysis. Caspofungin is safe in HR-LTRs, although bilirubin levels may be increased.

  20. Development of risk-based trading farm scoring system to assist with the control of bovine tuberculosis in cattle in England and Wales.

    Science.gov (United States)

    Adkin, A; Brouwer, A; Simons, R R L; Smith, R P; Arnold, M E; Broughan, J; Kosmider, R; Downs, S H

    2016-01-01

    Identifying and ranking cattle herds with a higher risk of being or becoming infected on known risk factors can help target farm biosecurity, surveillance schemes and reduce spread through animal trading. This paper describes a quantitative approach to develop risk scores, based on the probability of infection in a herd with bovine tuberculosis (bTB), to be used in a risk-based trading (RBT) scheme in England and Wales. To produce a practical scoring system the risk factors included need to be simple and quick to understand, sufficiently informative and derived from centralised national databases to enable verification and assess compliance. A logistic regression identified herd history of bTB, local bTB prevalence, herd size and movements of animals onto farms in batches from high risk areas as being significantly associated with the probability of bTB infection on farm. Risk factors were assigned points using the estimated odds ratios to weight them. The farm risk score was defined as the sum of these individual points yielding a range from 1 to 5 and was calculated for each cattle farm that was trading animals in England and Wales at the start of a year. Within 12 months, of those farms tested, 30.3% of score 5 farms had a breakdown (sensitivity). Of farms scoring 1-4 only 5.4% incurred a breakdown (1-specificity). The use of this risk scoring system within RBT has the potential to reduce infected cattle movements; however, there are cost implications in ensuring that the information underpinning any system is accurate and up to date.

  1. A 22-single nucleotide polymorphism Alzheimer's disease risk score correlates with family history, onset age, and cerebrospinal fluid A beta(42)

    NARCIS (Netherlands)

    Sleegers, Kristel; Bettens, Karolien; De Roeck, Arne; Van Cauwenberghe, Caroline; Cuyvers, Elise; Verheijen, Jan; Struyfs, Hanne; Van Dongen, Jasper; Vermeulen, Steven; Engelborghs, Sebastiaan; Vandenbulcke, Mathieu; Vandenberghe, Rik; De Deyn, Peter Paul; Van Broeckhoven, Christine

    2015-01-01

    Introduction: The ability to identify individuals at increased genetic risk for Alzheimer's disease (AD) may streamline biomarker and drug trials and aid clinical and personal decision making. Methods: We evaluated the discriminative ability of a genetic risk score (GRS) covering 22 published geneti

  2. Development and validation of a risk score for chronic kidney disease in HIV infection using prospective cohort data from the D:A:D study

    NARCIS (Netherlands)

    Mocroft, A.; Lundgren, J.D.; Ross, M.; Law, M.; Reiss, P.; Kirk, O.; Smith, C.; Wentworth, D.; Neuhaus, J.; Fux, C.A.; Moranne, O.; Morlat, P.; Johnson, M.A.; Ryom, L.; Burger, D.M.

    2015-01-01

    BACKGROUND: Chronic kidney disease (CKD) is a major health issue for HIV-positive individuals, associated with increased morbidity and mortality. Development and implementation of a risk score model for CKD would allow comparison of the risks and benefits of adding potentially nephrotoxic antiretrov

  3. Screening for type 2 diabetes mellitus in patients with mental illness: application of a self-assessment score for diabetes mellitus risk.

    Science.gov (United States)

    Shin, Jinah K; Shortridge-Baggett, Lillie M; Sachmechi, Issac; Barron, Charles; Chiu, Ya-Lin; Bajracharya, Bhavana; Bang, Heejung

    2014-12-30

    Various methods for diabetes risk assessment have been developed over a decade, but they were not evaluated in patients with mental illness. This study examined the feasibility and utility of a self-assessment score for type 2 diabetes mellitus (DM2) risk among patients with mental illness. DM2 risk was assessed by patients with mental illness as well as clinicians via a self-assessment questionnaire, and the resulting scores were compared to each other as well as with actual diagnosis. Of 100 patients, nine patients were newly revealed to have DM2 and 34 patients have pre-DM2. Patients tended to underreport risk factors - obesity and physical activity - so perceived to have lower risk. Sensitivity of the self-assessment score was different when used by patients and by clinicians despite correlation coefficient of 0.82. Based on positive predictive values, we may expect one out of two patients who have high scores actually have DM2 or pre-DM2. Also, the discrimination capability was reasonably high (AUC=0.79), comparable to its performance observed in general populations. The self-assessment score has potential as a simple and adjunct tool to identify a high risk group of DM2/pre-DM2 among persons with mental illness, especially, when used together with health care providers.

  4. Use of net reclassification improvement (NRI method confirms the utility of combined genetic risk score to predict type 2 diabetes.

    Directory of Open Access Journals (Sweden)

    Claudia H T Tam

    Full Text Available BACKGROUND: Recent genome-wide association studies (GWAS identified more than 70 novel loci for type 2 diabetes (T2D, some of which have been widely replicated in Asian populations. In this study, we investigated their individual and combined effects on T2D in a Chinese population. METHODOLOGY: We selected 14 single nucleotide polymorphisms (SNPs in T2D genes relating to beta-cell function validated in Asian populations and genotyped them in 5882 Chinese T2D patients and 2569 healthy controls. A combined genetic score (CGS was calculated by summing up the number of risk alleles or weighted by the effect size for each SNP under an additive genetic model. We tested for associations by either logistic or linear regression analysis for T2D and quantitative traits, respectively. The contribution of the CGS for predicting T2D risk was evaluated by receiver operating characteristic (ROC analysis and net reclassification improvement (NRI. RESULTS: We observed consistent and significant associations of IGF2BP2, WFS1, CDKAL1, SLC30A8, CDKN2A/B, HHEX, TCF7L2 and KCNQ1 (8.5×10(-18risk, which yielded odds ratios ranging from 1.07 to 2.09. The 8 significant SNPs exhibited joint effect on increasing T2D risk, fasting plasma glucose and use of insulin therapy as well as reducing HOMA-β, BMI, waist circumference and younger age of diagnosis of T2D. The addition of CGS marginally increased AUC (2% but significantly improved the predictive ability on T2D risk by 11.2% and 11.3% for unweighted and weighted CGS, respectively using the NRI approach (P<0.001. CONCLUSION: In a Chinese population, the use of a CGS of 8 SNPs modestly but significantly improved its discriminative ability to predict T2D above and beyond that attributed to clinical risk factors (sex, age and BMI.

  5. Validity of the Finnish Diabetes Risk Score for Detecting Undiagnosed Type 2 Diabetes among General Medical Outpatients in Botswana

    Science.gov (United States)

    Tshikuka, Jose-Gaby; Nkomazna, Oathokwa; Amone-P'Olak, Kennedy

    2016-01-01

    This was a cross-sectional study designed to assess the validity of the Finnish Diabetes Risk Score for detecting undiagnosed type 2 diabetes among general medical outpatients in Botswana. Participants aged ≥20 years without previously diagnosed diabetes were screened by (1) an 8-item Finnish diabetes risk assessment questionnaire and (2) Haemoglobin A1c test. Data from 291 participants were analyzed (74.2% were females). The mean age of the participants was 50.1 (SD = ±11) years, and the prevalence of undiagnosed diabetes was 42 (14.4%) with no significant differences between the gender (20% versus 12.5%, P = 0.26). The area under curve for detecting undiagnosed diabetes was 0.63 (95% CI 0.55–0.72) for the total population, 0.65 (95% CI: 0.56–0.75) for women, and 0.67 (95% CI: 0.52–0.83) for men. The optimal cut-off point for detecting undiagnosed diabetes was 17 (sensitivity = 48% and specificity = 73%) for the total population, 17 (sensitivity = 56% and specificity = 66%) for females, and 13 (sensitivity = 53% and specificity = 77%) for males. The positive predictive value and negative predictive value were 20% and 89.5%, respectively. The findings indicate that the Finnish questionnaire was only modestly effective in predicting undiagnosed diabetes among outpatients in Botswana.

  6. Genetic risk score does not correlate with body mass index of Latina women in a clinical trial.

    Science.gov (United States)

    Coenen, Kimberly R; Karp, Sharon M; Gesell, Sabina B; Dietrich, Mary S; Morgan, Thomas M; Barkin, Shari L

    2011-10-01

    Obesity disproportionately affects Latina women. Common genetic variants are convincingly associated with body mass index (BMI) and may be used to create genetic risk scores (GRS) for obesity that could define genetically influenced forms of obesity and alter response to clinical trial interventions. The objective of this study was (1) to identify the frequency and effect size of common obesity genetic variants in Latina women; (2) to determine the clinical utility of a GRS for obesity with Latina women participating in a community-based clinical trial. DNA from 85 Latina women was genotyped for eight genetic variants previously associated with BMI in Caucasians, but not yet assessed in Latina populations. The main outcome measure was the correlation of GRS (sum of eight risk alleles) with BMI, waist circumference, and percent body fat. A majority (83%) of participants had a BMI ≥25. Frequency of loci near FTO, MC4R, and GNPDA2 were lower in Latinas than Caucasians. Association of each locus with BMI was lower in Latinas compared to Caucasians with no significant correlations with BMI. We conclude that an eight locus GRS has no clinical utility for explaining obesity or predicting response to intervention in Latina women participating in a clinical trial.

  7. Quadratic function between arterial partial oxygen pressure and mortality risk in sepsis patients: an interaction with simplified acute physiology score.

    Science.gov (United States)

    Zhang, Zhongheng; Ji, Xuqing

    2016-10-13

    Oxygen therapy is widely used in emergency and critical care settings, while there is little evidence on its real therapeutic effect. The study aimed to explore the impact of arterial oxygen partial pressure (PaO2) on clinical outcomes in patients with sepsis. A large clinical database was employed for the study. Subjects meeting the diagnostic criteria of sepsis were eligible for the study. All measurements of PaO2 were extracted. The primary endpoint was death from any causes during hospital stay. Survey data analysis was performed by using individual ICU admission as the primary sampling unit. Quadratic function was assumed for PaO2 and its interaction with other covariates were explored. A total of 199,125 PaO2 samples were identified for 11,002 ICU admissions. Each ICU stay comprised 18 PaO2 samples in average. The fitted multivariable model supported our hypothesis that the effect of PaO2 on mortality risk was in quadratic form. There was significant interaction between PaO2 and SAPS-I (p = 0.007). Furthermore, the main effect of PaO2 on SOFA score was nonlinear. The study shows that the effect of PaO2 on mortality risk is in quadratic function form, and there is significant interaction between PaO2 and severity of illness.

  8. Genetic assessment of age-associated Alzheimer disease risk: Development and validation of a polygenic hazard score

    Science.gov (United States)

    Cupples, L. Adrienne; Thompson, Wesley K.; Besser, Lilah; Kukull, Walter A.; Holland, Dominic; Chen, Chi-Hua; Brewer, James B.; Karow, David S.; Kauppi, Karolina; Bonham, Luke W.; Rosen, Howard J.; Miller, Bruce L.; Dillon, William P.; Wilson, David M.; Pericak-Vance, Margaret; Haines, Jonathan L.; Farrer, Lindsay A.; Mayeux, Richard; Hardy, John; Goate, Alison M.; Schellenberg, Gerard D.; Andreassen, Ole A.

    2017-01-01

    Background Identifying individuals at risk for developing Alzheimer disease (AD) is of utmost importance. Although genetic studies have identified AD-associated SNPs in APOE and other genes, genetic information has not been integrated into an epidemiological framework for risk prediction. Methods and findings Using genotype data from 17,008 AD cases and 37,154 controls from the International Genomics of Alzheimer’s Project (IGAP Stage 1), we identified AD-associated SNPs (at p < 10−5). We then integrated these AD-associated SNPs into a Cox proportional hazard model using genotype data from a subset of 6,409 AD patients and 9,386 older controls from Phase 1 of the Alzheimer’s Disease Genetics Consortium (ADGC), providing a polygenic hazard score (PHS) for each participant. By combining population-based incidence rates and the genotype-derived PHS for each individual, we derived estimates of instantaneous risk for developing AD, based on genotype and age, and tested replication in multiple independent cohorts (ADGC Phase 2, National Institute on Aging Alzheimer’s Disease Center [NIA ADC], and Alzheimer’s Disease Neuroimaging Initiative [ADNI], total n = 20,680). Within the ADGC Phase 1 cohort, individuals in the highest PHS quartile developed AD at a considerably lower age and had the highest yearly AD incidence rate. Among APOE ε3/3 individuals, the PHS modified expected age of AD onset by more than 10 y between the lowest and highest deciles (hazard ratio 3.34, 95% CI 2.62–4.24, p = 1.0 × 10−22). In independent cohorts, the PHS strongly predicted empirical age of AD onset (ADGC Phase 2, r = 0.90, p = 1.1 × 10−26) and longitudinal progression from normal aging to AD (NIA ADC, Cochran–Armitage trend test, p = 1.5 × 10−10), and was associated with neuropathology (NIA ADC, Braak stage of neurofibrillary tangles, p = 3.9 × 10−6, and Consortium to Establish a Registry for Alzheimer’s Disease score for neuritic plaques, p = 6.8 × 10−6) and

  9. SCANDCLEFT RANDOMIZED TRIALS: SPEECH OUTCOMES IN 5-YEAR-OLDS WITH UCLP - velopharyngeal competency and hypernasality

    DEFF Research Database (Denmark)

    Lohmander, Anette; Persson, Christina; Willadsen, Elisabeth;

    2016-01-01

    Objective: Adequate velopharyngeal function and speech is a main objective in treatment of cleft palate. The aim was to investigate if there were differences in velopharyngeal competency and hypernasality at 5 years of age in children with UCLP randomized to different surgical methods for primary...... palatal repair were tested against a common procedure. Main Outcome Measures: VPC-Sum, a composite score of velopharyngeal competency, and hypernasality from blinded assessments. Results: Occurrence of more than mild hypernasality and VPC-Sum scores of incompetence varied between 18 and 40......% with no statistical significant difference between the arms in any of the three trials. Conclusions: The methods within each trial revealed similar results regarding velopharyngeal competency at age 5 years. Similar speech outcome was reached with different methods for primary palatal repair but the burden of care...

  10. Skin autofluorescence as proxy of tissue AGE accumulation is dissociated from SCORE cardiovascular risk score, and remains so after 3 years

    NARCIS (Netherlands)

    Tiessen, Ans H.; Jager, Willemein; ter Bogt, Nancy C. W.; Beltman, Frank W.; van der Meer, Klaas; Broer, Jan; Smit, Andries J.

    2014-01-01

    Background: Skin autofluorescence (SAF), as a proxy of AGE accumulation, is predictive of cardiovascular (CVD) complications in i.a. type 2 diabetes mellitus and renal failure, independently of most conventional CVD risk factors. The present exploratory substudy of the Groningen Overweight and Lifes

  11. CHADS2 and CHA2DS2-VASc scores as bleeding risk indices for patients with atrial fibrillation: the Bleeding with Antithrombotic Therapy Study.

    Science.gov (United States)

    Toyoda, Kazunori; Yasaka, Masahiro; Uchiyama, Shinichiro; Iwade, Kazunori; Koretsune, Yukihiro; Nagata, Ken; Sakamoto, Tomohiro; Nagao, Takehiko; Yamamoto, Masahiro; Gotoh, Jun; Takahashi, Jun C; Minematsu, Kazuo

    2014-05-01

    The CHADS2 and CHA2DS2-VASc scores, that is, ischemic stroke risk indices for patients having atrial fibrillation (AF), may also be useful as bleeding risk indices. Japanese patients with AF, who routinely took oral antithrombotic agents were enrolled from a prospective, multicenter study. The CHADS2 and CHA2DS2-VASc scores were assessed based on information at entry. Scores of 0, 1 and ⩾2 were defined as the low, intermediate and high ischemic risk categories, respectively, for each index. Of 1221 patients, 873 took warfarin, 114 took antiplatelet agents and 234 took both. The annual incidence of ischemic stroke was 0.76% in the low-risk category, 1.46% in the intermediate-risk category and 2.90% in the high-risk category by CHADS2 scores, and 1.44, 0.42 and 2.50%, respectively, by CHA2DS2-VASc scores. The annual incidence of major bleeding in each category was 1.52, 2.19 and 2.25% by CHADS2, and 1.44, 1.69 and 2.24% by CHA2DS2-VASc. After multivariate adjustment, the CHADS2 was associated with ischemia (odds ratio 1.76, 95% confidence interval 1.03-3.38 per 1-category increase) and the CHA2DS2-VASc tended to be associated with ischemia (2.18, 0.89-8.43). On the other hand, associations of the indices with bleeding were weak. In conclusion, bleeding risk increased gradually as the CHADS2 and CHA2DS2-VASc scores increased in Japanese antithrombotic users, although the statistical impact was rather weak compared with their predictive power for ischemic stroke.

  12. Clinical prediction of 5-year survival in systemic sclerosis

    DEFF Research Database (Denmark)

    Fransen, Julie Munk; Popa-Diaconu, D; Hesselstrand, R;

    2011-01-01

    Systemic sclerosis (SSc) is associated with a significant reduction in life expectancy. A simple prognostic model to predict 5-year survival in SSc was developed in 1999 in 280 patients, but it has not been validated in other patients. The predictions of a prognostic model are usually less accurate...... in other patients, especially from other centres or countries. A study was undertaken to validate the prognostic model to predict 5-year survival in SSc in other centres throughout Europe....

  13. A weighted polygenic risk score using 14 known susceptibility variants to estimate risk and age onset of psoriasis in Han Chinese.

    Directory of Open Access Journals (Sweden)

    Xianyong Yin

    Full Text Available With numbers of common variants identified mainly through genome-wide association studies (GWASs, there is great interest in incorporating the findings into screening individuals at high risk of psoriasis. The purpose of this study is to establish genetic prediction models and evaluate its discriminatory ability in psoriasis in Han Chinese population. We built the genetic prediction models through weighted polygenic risk score (PRS using 14 susceptibility variants in 8,819 samples. We found the risk of psoriasis among individuals in the top quartile of PRS was significantly larger than those in the lowest quartile of PRS (OR = 28.20, P < 2.0×10(-16. We also observed statistically significant associations between the PRS, family history and early age onset of psoriasis. We also built a predictive model with all 14 known susceptibility variants and alcohol consumption, which achieved an area under the curve statistic of ~ 0.88. Our study suggests that 14 psoriasis known susceptibility loci have the discriminating potential, as is also associated with family history and age of onset. This is the genetic predictive model in psoriasis with the largest accuracy to date.

  14. GRACE与CRUSADE危险评分的相关性研究%Study on the Correlation of GRACE and CRUSADE Risk Score

    Institute of Scientific and Technical Information of China (English)

    廖敏辉; 李平; 刘永刚

    2015-01-01

    目的::利用GRACE和CRUSADE危险评分指导PCI术患者使用抗血栓药。方法:对某三甲医院147例行经皮冠脉介入治疗术( PCI)的急性冠脉综合征( ACS)患者入院时GRACE评分与CRUSADE评分进行研究,探讨PCI患者危险因素的积分情况以及两评分的相关性。结果:两评分的危险因素部分相同,两评分具有显著正相关。结论:临床应同时评估GRACE评分和CRUSADE评分,充分权衡出血与缺血风险,制定抗栓治疗策略。%Objective:To guide antithrombotic medication in the patients with PCI by GRACE and CRUSADE risk score. Meth-ods:The GRACE and CRUSADE score at the admission of 147 patients with ACS undergone PCI in one 3-level hospital were analyzed, and the two risk scores of the PCI patients and the correlation between the two scores were studied. Results:The risk factors in the two scores were part of the same, and the two scores had significant positive correlation. Conclusion: The GRACE score and CRUSADE score should be assessed at the same time in clinics to weigh the risk of bleeding and ischemia fully and then develop strategies for an-tithrombotic treatment.

  15. Does the routine use of global coronary heart disease risk scores translate into clinical benefits or harms? A systematic review of the literature

    Directory of Open Access Journals (Sweden)

    Crespo Eric

    2008-03-01

    Full Text Available Abstract Background Guidelines now recommend routine assessment of global coronary heart disease (CHD risk scores. We performed a systematic review to assess whether global CHD risk scores result in clinical benefits or harms. Methods We searched MEDLINE (1966 through June 13, 2007 for articles relevant to our review. Using predefined inclusion and exclusion criteria, we included studies of any design that provided physicians with global risk scores or allowed them to calculate scores themselves, and then measured clinical benefits and/or harms. Two reviewers reviewed potentially relevant studies for inclusion and resolved disagreement by consensus. Data from each article was then abstracted into an evidence table by one reviewer and the quality of evidence was assessed independently by two reviewers. Results 11 studies met criteria for inclusion in our review. Six studies addressed clinical benefits and 5 addressed clinical harms. Six studies were rated as "fair" quality and the others were deemed "methodologically limited". Two fair quality studies showed that physician knowledge of global CHD risk is associated with increased prescription of cardiovascular drugs in high risk (but not all patients. Two additional fair quality studies showed no effect on their primary outcomes, but one was underpowered and the other focused on prescribing of lifestyle changes, rather than drugs whose prescribing might be expected to be targeted by risk level. One of these aforementioned studies showed improved blood pressure in high-risk patients, but no improvement in the proportion of patients at high risk, perhaps due to the high proportion of participants with baseline risks significantly exceeding the risk threshold. Two fair quality studies found no evidence of harm from patient knowledge of global risk scores when they were accompanied by counseling, and optional or scheduled follow-up. Other studies were too methodologically limited to draw conclusions

  16. A Phase II Trial of SABR (Stereotactic Ablative Body Radiotherapy for Low-Risk Prostate Cancer Using a Non-Robotic Linear Accelerator and Real-Time Target Tracking: Report of Toxicity, Quality of Life and Disease Control Outcomes with 5-Year Minimum Followup

    Directory of Open Access Journals (Sweden)

    Constantine Anastasios Mantz

    2014-11-01

    Full Text Available Purpose/Objective(s: Herein, we report the results of an IRB-approved phase II trial of Varian Trilogy/TrueBeam-based SABR monotherapy for low-risk prostate cancer using the Calypso® System to provide real-time electromagnetic tracking of the prostate’s position during treatment delivery. Materials/Methods: A total of 102 low-risk patients completed protocol treatment between January 2007 and May 2009. A total dose of 40.0 Gy in 5 every-other-day fractions of 8.0 Gy was prescribed to the planning target volume. Target setup and tracking procedures were as follows: (1 the Calypso® System was used to achieve target setup prior to each fraction; (2 conebeam CT imaging was then used for correction of setup error and for assessment of target and Organs-at-Risk (OAR deformations; (3 after treatment delivery was initiated, the Calypso® System then provided real-time intrafractional target tracking. The NCI CTCAE v3.0 was used to assess urinary and rectal toxicity during treatment and at defined followup time points. Biochemical response and quality of life measurements were made at concurrent followup points.Results: Urinary toxicities were most common. At 6 months, 19.6%, 2.9% and 4.9% of patients reported grades 1 – 2 urinary frequency, dysuria and retention, respectively. Rectal toxicities were uncommon. By 12 months, 2.9% of patients reported painless rectal bleeding with subsequent symptom resolution without requiring invasive interventions. Quality of life measurements demonstrated a significant decline over baseline in urinary irritative/obstructive scores at 1 month following SABR but otherwise did not demonstrate any difference for bowel, bladder and sexual function scores at any other followup time point. One patient suffered biochemical recurrence at 6 years following SABR.Conclusions: At five years minimum followup for this favorable patient cohort, prostate SABR resulted in favorable toxicity, quality of life and biochemical

  17. What happens to cavitated primary teeth over time? A 3.5-year prospective cohort study in China

    NARCIS (Netherlands)

    Hu, X.; Chen, X.; Fan, M.; Mulder, J.; Frencken, J.E.F.M.

    2013-01-01

    OBJECTIVES: Data showed that among 5-year-old Chinese, 96.7% of cavitated primary teeth were left untreated. The study aimed to report on the course of cavitated primary teeth within the Chinese health-care system over a period of 3.5 years. METHODS: Selection of high caries risk children for inclus

  18. Childhood leukaemia incidence below the age of 5 years near French nuclear power plants

    Energy Technology Data Exchange (ETDEWEB)

    Laurier, D [Institute for Radiation Protection and Nuclear Safety, IRSN/DRPH/SRBE, BP 17, 92262 Fontenay aux Roses cedex (France); Hemon, D; Clavel, J [INSERM Unit 754, Villejuif (France)], E-mail: Dominique.laurier@irsn.fr

    2008-09-01

    A recent study indicated an excess risk of leukaemia among children under the age of 5 years living in the vicinity of nuclear power plants in Germany. We present results relating to the incidence of childhood leukaemia in the vicinity of nuclear power plants in France for the same age range. These results do not indicate an excess risk of leukaemia in young children living near French nuclear power plants. (note)

  19. Childhood leukaemia incidence below the age of 5 years near French nuclear power plants.

    Science.gov (United States)

    Laurier, D; Hémon, D; Clavel, J

    2008-09-01

    A recent study indicated an excess risk of leukaemia among children under the age of 5 years living in the vicinity of nuclear power plants in Germany. We present results relating to the incidence of childhood leukaemia in the vicinity of nuclear power plants in France for the same age range. These results do not indicate an excess risk of leukaemia in young children living near French nuclear power plants.

  20. Validating a Prognostic Scoring System for Postmastectomy Locoregional Recurrence in Breast Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Cheng, Skye Hung-Chun, E-mail: skye@kfsyscc.org [Department of Radiation Oncology, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan (China); Clinical Research Office, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan (China); Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina (United States); Tsai, Stella Y. [Department of Radiation Oncology, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan (China); Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina (United States); Yu, Ben-Long [Department of Surgery, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan (China); Horng, Cheng-Fang [Clinical Research Office, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan (China); Chen, Chii-Ming [Department of Surgery, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan (China); Jian, James J. [Department of Radiation Oncology, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan (China); Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina (United States); Chu, Nan-Min [Department of Medical Oncology, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan (China); Tsou, Mei-Hua [Department of Pathology, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan (China); Liu, Mei-Ching [Department of Medical Oncology, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan (China); Huang, Andrew T. [Department of Medical Oncology, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan (China); Department of Medicine, Duke University Medical Center, Durham, North Carolina (United States); Prosnitz, Leonard R. [Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina (United States)

    2013-03-15

    Purpose: This study is designed to validate a previously developed locoregional recurrence risk (LRR) scoring system and further define which groups of patients with breast cancer would benefit from postmastectomy radiation therapy (PMRT). Methods and Materials: An LRR risk scoring system was developed previously at our institution using breast cancer patients initially treated with modified radical mastectomy between 1990 and 2001. The LRR score comprised 4 factors: patient age, lymphovascular invasion, estrogen receptor negativity, and number of involved lymph nodes. We sought to validate the original study by examining a new dataset of 1545 patients treated between 2002 and 2007. Results: The 1545 patients were scored according to the previously developed criteria: 920 (59.6%) were low risk (score 0-1), 493 (31.9%) intermediate risk (score 2-3), and 132 (8.5%) were high risk (score ≥4). The 5-year locoregional control rates with and without PMRT in low-risk, intermediate-risk, and high-risk groups were 98% versus 97% (P=.41), 97% versus 91% (P=.0005), and 89% versus 50% (P=.0002) respectively. Conclusions: This analysis of an additional 1545 patients treated between 2002 and 2007 validates our previously reported LRR scoring system and suggests appropriate patients for whom PMRT will be beneficial. Independent validation of this scoring system by other institutions is recommended.

  1. Simple Risk Score for Prediction of Early Recurrence of Hepatocellular Carcinoma within the Milan Criteria after Orthotopic Liver Transplantation

    Science.gov (United States)

    Feng, Jiliang; Wu, Jushan; Zhu, Ruidong; Feng, Dezhao; Yu, Lu; Zhang, Yan; Bu, Dayu; Li, Chenlei; Zhou, Yuyan; Si, Lianghao; Liu, Yuhan; Liang, Ziwei; Xu, Jianing; Wu, Tianjun

    2017-01-01

    Ten to twenty percent of the hepatocellular carcinoma (HCC) patients fulfilling the Milan criteria (MC) recurred within three years after orthotopic liver transplantation (OLT). We therefore utilize a training cohort to develop an improved prognostic model for predicting the recurrence in these patients. By univariate and multivariate analysis, AFP level [cut-off value: 321 ng/mL, area under the curve (AUC) = 0.724, 95% confidence interval (CI) = 0.604–0.843, P < 0.001] and cytokeratin-19 (CK19) and glypican-3 (GPC3) expression pattern from nine putative prognostic factors were entered in risk factor scoring model to conjecture the tumor recurrence. In the training cohort, the AUC value of the model was 0.767 (95% CI = 0.645–0.890, P < 0.001), which was the highest among all the elements. The model’s performance was then assessed using a validation cohort. In the validation cohort, the AUC value of the model was 0.843 (95% CI = 0.720−0.966, P < 0.001) which was higher than any other elements. The results indicated that model had high performance with good discrimination ability and significantly improved the predictive capacity for the recurrence of HCC patients within MC after OLT. PMID:28276470

  2. Dietary predictors of 5-year changes in waist circumference

    DEFF Research Database (Denmark)

    Halkjaer, Jytte; Tjønneland, Anne; Overvad, Kim

    2009-01-01

    the association between intake from 21 food and beverage groups and the subsequent 5-year difference in waist circumference. METHODS: The study population consisted of 22,570 women and 20,126 men, aged 50 to 64 years at baseline, with complete data on baseline and follow-up waist circumference, baseline diet (192...... items food frequency questionnaire), body mass index, and selected potential confounders (eg, smoking status, sport activities, and intake of alcoholic beverages). Multiple linear regression analyses were performed. RESULTS: For women, 5-year difference in waist circumference was inversely related...... to intake from red meat, vegetables, fruit, butter, and high-fat dairy products, whereas intake from potatoes, processed meat, poultry, and snack foods was positively associated. For men, red meat and fruit intakes were inversely associated with 5-year difference in waist circumference, whereas snack foods...

  3. Development and validation of a risk score for chronic kidney disease in HIV infection using prospective cohort data from the D:A:D study

    DEFF Research Database (Denmark)

    Mocroft, Amanda; Lundgren, Jens D; Ross, Michael

    2015-01-01

    BACKGROUND: Chronic kidney disease (CKD) is a major health issue for HIV-positive individuals, associated with increased morbidity and mortality. Development and implementation of a risk score model for CKD would allow comparison of the risks and benefits of adding potentially nephrotoxic...... antiretrovirals to a treatment regimen and would identify those at greatest risk of CKD. The aims of this study were to develop a simple, externally validated, and widely applicable long-term risk score model for CKD in HIV-positive individuals that can guide decision making in clinical practice. METHODS...... AND FINDINGS: A total of 17,954 HIV-positive individuals from the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) study with ≥3 estimated glomerular filtration rate (eGFR) values after 1 January 2004 were included. Baseline was defined as the first eGFR > 60 ml/min/1.73 m2 after 1 January 2004...

  4. An investigation on the deciduous dental caries and the related risk factors of 3-5 year-old children in Ningxia Province%宁夏地区3~5岁儿童乳牙患龋现况及风险因素分析

    Institute of Scientific and Technical Information of China (English)

    李艳青; 马敏; 于英凡; 刘英

    2014-01-01

    目的:了解宁夏地区3~5岁儿童乳牙患龋情况及相关影响因素。方法:对宁夏地区6个县(市、区)的2952名3~5岁儿童进行口腔健康检查,对患龋高危儿童和无龋儿童家长进行问卷调查,并进行统计分析。结果:①宁夏地区3-5岁儿童乳牙龋均和龋面均分别为2.60和4.19,患龋率为57.41%,回、汉族儿童的患龋率、龋均无统计学差异(P>0.05);②是否为早产、开始刷牙年龄及频率、进甜食频率、有含奶嘴或母亲乳头睡觉习惯、母亲孕期患病等因素在两组儿童间有显著性差异( P<0.05);而是否为低出生体质量、家长学历、饮用水源、喂养方式、是否使用含氟牙膏等因素在两组间无统计学差异( P>0.05);③乳牙患龋与父母口腔保健知识态度、刷牙后及睡前进甜食、进甜食频率、有含奶嘴或母亲乳头睡觉习惯、开始刷牙年龄有关。结论:减少儿童含糖食品的摄入量及频率以及避免婴儿期不当喂养习惯,将早产儿列为龋病好发的弱势人群,给予高度重视。%AIM:To investigate the status of deciduous dental caries and the related risk factors of 3-5 year-old Children in Ningxia Province .METHODS:2952 Children aged 3-5 years old from 6 counties in Ningxia were included for clinical caries examination .Caries-active and caries-free children were selected to complete the questionnaire .SPSS 17.0 statistical software package was used for data analysis .RESULTS:The prevalence of dental caries, dmft, dmfts of the children was 57.41%, 2.51 and 4.19 respectivesy.The prevalence of dental caries was not statistically different between Hui and Han nationalities .Significant difference was found between caries -active and caries-free children in premature delivery , addition of sugar in milk , the age of starting tooth-brushing , frequency of sugar intake and sweet intake before sleep (P0.05).Logistic analy

  5. 5-Yearly Review 2005 - Proposal 11 - Modifications to Review Methods

    CERN Document Server

    2006-01-01

    In accordance with the Council's request in October 2006, this document sets out proposed modifications to Review Methods for the future, which are part of the current 5-Yearly Review (Proposal 11). This concerns the 5-Yearly Review and Annual remuneration review methods and procedures (Annex A 1 of the Staff Rules). In the light of recent experience, the Management's proposals aim to set methods and procedures for future reviews, ensuring that they are tailored to the Organization's requirements, and to introduce simplifications, increase efficiency and reduce the cost of these processes.

  6. A propensity score matched analysis of obesity as an independent risk factor for postoperative complications in reduction mammaplasty

    Institute of Scientific and Technical Information of China (English)

    James D Goggin; Stacy Wong; Jessica E Pruszynski; Jon P Ver Halen

    2016-01-01

    Aim: Reduction mammaplasty is a commonly performed procedure for the treatment of symptomatic macromastia and is increasingly desired by the obese population. With the increasing prevalence obesity in the population, it is imperative to understand its effect on postoperative outcomes. The purpose of this study is to evaluate obesity as an independent risk factor for postoperative complications in breast reduction surgery using 1:1 patient matching through propensity scores between obese patients and non-obese controls.Methods: Between 2005 and 2013, the National Surgical Quality Improvement Program dataset identified a total of 6,016 patients as having undergone primary reduction mammaplasty with 30-day postoperative follow-up. Patients were divided into obese [body mass index (BMI) of 30 or more] vs. not obese (BMI below 30). Patients were initially analyzed using standard multivariable analysis. Using propensity scores obtained from a logistic regression model, patients were subsequently matched 1:1 according to preoperative and operative variables to truly isolate the effect of obesity on surgical outcomes. Outcomes were compared between the matched cohorts using McNemar’s test and the Wilcoxon signed rank test.Results: In unmatched multivariable analysis, rates of overall complications (7.2%vs. 5.3%,P = 0.0024), wound complications (5.5%vs. 3.6%,P = 0.0004), superficial surgical site infection (4.1%vs. 2.8%,P = 0.0050), and wound dehiscence (0.3%vs. 1.1%,P = 0.0005) were found to be statistically different between obesevs. non-obese, respectively. However, when comparing 1:1 matched obese and non-obese patients, only wound complications (4.6%vs. 3.1%,P = 0.0334) were significantly increased in the obese cohort.Conclusion: Using the most robust statistical tools available, obesity was determined to affect wound complications after breast reduction without increased detriment on other major complications when compared to the non-obese. Obesity should be a

  7. Validación del score de riesgo TIMI para pacientes con síndrome coronario agudo sin elevación del ST TIMI risk score validation for patients with acute coronary syndrome without ST elevation

    Directory of Open Access Journals (Sweden)

    Rodrigo H. Bagur

    2009-10-01

    Full Text Available Los síndromes coronarios agudos sin elevación del segmento ST (SCA-SST son causa frecuente de hospitalización, siendo responsables del 10 al 15% de infartos de miocardio (IM o muertes al año. El objetivo fue evaluar eventos cardiovasculares a 6 meses de seguimiento y validar el score de riesgo TIMI (Thrombolysis in Myocardial Infarction en nuestra población. Se analizaron retrospectivamente pacientes con diagnóstico de SCA-SST. Se realizó seguimiento telefónico a los 6 meses del ingreso. Los puntos finales evaluados fueron la combinación de muerte, internación por síndrome coronario agudo y necesidad de revascularización. Se incluyeron 204 pacientes. El 70.2% eran hombres, edad promedio de 64.5 ± 11.8 años. Luego de la evaluación inicial, se hizo diagnóstico de angina inestable en el 34.6%, IM en 38.9% y el 26.4% fueron catalogados como "dolor no coronario". Al aplicar el score de TIMI, 52 (25.5% pacientes tenían riesgo bajo, 106 (52% riesgo intermedio, y 46 (22.5% riesgo alto. La mortalidad global fue 12.6%. Se encontró un incremento progresivo y significativo en la tasa de eventos combinados a medida que aumentaba el score de TIMI (p Non-ST elevation acute coronary syndromes (NSTE-ACS are frequent cause of hospitalization, being responsible for 10-15% of infarcts or deaths per year. The study was designed to analyze 6 months follow-up of cardiovascular events as well as to validate the Thrombolysis in Myocardial Infarction (TIMI risk score for patients hospitalized for NSTE-ACS. We retrospectively analyzed patients admitted with NSTE-ACS. Telephone follow-up were performed at 6 month. Combination of death, re-admission for acute coronary syndrome and revascularization were considered as end point. Two hundred and four patients were included for the analysis. There were 70.2% males, with a mean age of 64.5 ± 11.8 years. After the initial evaluation, we diagnosed unstable angina in 34.6% of cases, MI in 38.9% of cases, and 26

  8. The European System for Cardiac Operative Risk Evaluation (EuroSCORE is not appropriate for withholding surgery in high-risk patients with aortic stenosis: a retrospective cohort study

    Directory of Open Access Journals (Sweden)

    Légaré Jean-Francois

    2009-07-01

    Full Text Available Abstract Background The European System for Cardiac Operative Risk Evaluation (EuroSCORE is a widely used risk assessment tool in patients with severe aortic stenosis to determine operability and to select patients for alternative therapies such as transcatheter aortic valve implantation. The objective of this study was to determine the accuracy of the EuroSCORE in predicting mortality following aortic valve replacement (AVR. Methods The logistic EuroSCORE was determined for all consecutive patients that underwent conventional AVR between 1995 and 2005 at our institution. Provincial Vital Statistics were used to determine all-cause mortality. The accuracy of the prognostic risk prediction provided by logistic EuroSCORE was assessed by comparing observed and expected operative mortality. Results During the study period, a total of 1,421 patients underwent AVR including 237 patients (16.7% that had a logistic EuroSCORE > 20. Among these patients, the mean predicted operative mortality was 38.7% (SD = 18.1. The actual mortality of these patients was significantly lower than that predicted by EuroSCORE (11.4% vs. 38.7%, observed/expected ratio 0.29, 95% CI 0.15–0.52, P 20 (log rank P = 0.0001, approximately 60% are alive at five years. Conclusion Actual operative mortality in patients undergoing AVR is significantly lower than that predicted by the logistic EuroSCORE. Additionally, medium-term survival following AVR is acceptable in high-risk patients with EuroSCORE > 20. More accurate risk prediction models are needed for risk-stratifying patients with severe aortic stenosis.

  9. Scoring Subjectivity and Item Performance on Measures Used to Assess Violence Risk: The PCL-R and HCR-20 as Exemplars

    Science.gov (United States)

    Rufino, Katrina A.; Boccaccini, Marcus T.; Guy, Laura S.

    2011-01-01

    Although reliability is essential to validity, most research on violence risk assessment tools has paid little attention to strategies for improving rater agreement. The authors evaluated the degree to which perceived subjectivity in scoring guidelines for items from two measures--the Psychopathy Checklist-Revised (PCL-R) and the Historical,…

  10. Work ability as prognostic risk marker of disability pension : Single-item work ability score versus multi-item work ability index

    NARCIS (Netherlands)

    Roelen, C.A.M.; Rhenen, van W.; Groothoff, J.W.; Klink, van der J.J.L.; Twisk, W.R.; Heymans, M.W.

    2014-01-01

    Work ability predicts future disability pension (DP). A single-item work ability score (WAS) is emerging as a measure for work ability. This study compared single-item WAS with the multi-item work ability index (WAI) in its ability to identify workers at risk of DP.

  11. Longitudinal trends in diet and effects of sex, race, and education on dietary quality score change: the Coronary Artery Risk Development in Young Adults study

    NARCIS (Netherlands)

    Sijtsma, F.P.C.; Meyer, K.A.; Steffen, L.M.; Shikany, J.M.; Horn, van L.; Harnack, L.J.; Kromhout, D.; Jacobs, D.R.

    2012-01-01

    Background: The food supply and dietary preferences have changed in recent decades. Objective: We studied time- and age-related individual and population-wide changes in a dietary quality score and food groups during 1985–2006. Design: The Coronary Artery Risk Development in Young Adults (CARDIA) st

  12. Analyzing 5 years of EC-TEL proceedings

    NARCIS (Netherlands)

    Reinhardt, Wolfgang; Meier, Christian; Drachsler, Hendrik; Sloep, Peter

    2011-01-01

    Reinhardt, W., Meier, C., Drachsler, H., & Sloep, P. B. (2011). Analyzing 5 years of EC-TEL proceedings. In C. D. Kloos, D. Gillet, R. M. Crespo García, F. Wild, & M. Wolpers (Eds.), Towards Ubiquitous Learning: 6th European Conference of Technology Enhanced Learning, EC-TEL 2011 (pp. 531-536). Sept

  13. Your Child's Development: 1.5 Years (18 Months)

    Science.gov (United States)

    ... Kids For Parents MORE ON THIS TOPIC Your Child's Checkup: 1.5 Years (18 Months) Feeding Your 1- to 2-Year-Old Medical Care and Your 1- to 2-Year-Old Movement, Coordination, and Your 1- to 2-Year-Old Sleep and Your 1- to 2-Year-Old Growth and Your 1- to 2-Year-Old Communication ...

  14. The HAS-BLED Score Identifies Patients with Acute Venous Thromboembolism at High Risk of Major Bleeding Complications during the First Six Months of Anticoagulant Treatment.

    Directory of Open Access Journals (Sweden)

    Judith Kooiman

    Full Text Available The HAS-BLED score enables a risk estimate of major bleeds in patients with atrial fibrillation on vitamin K-antagonists (VKA treatment, but has not been validated for patients with venous thromboembolism (VTE. We analyzed whether the HAS-BLED score accurately identifies patients at high risk of major bleeds during VKA treatment for acute VTE.Medical records of 537 patients with acute VTE (primary diagnosis pulmonary embolism in 223, deep vein thrombosis in 314 starting VKA treatment between 2006-2007 were searched for items on the HAS-BLED score and the occurrence of major bleeds during the first 180 days of follow-up. The hazard ratio (HR for the occurrence of major bleeds comparing non-high with high-risk patients as defined by a HAS-BLED score ≥ 3 points was calculated using Cox-regression analysis.Major bleeds occurred in 11/537 patients (2.0%, 5.2/100 person years, 95% CI 2.8-9.2. Cumulative incidences of major bleeds were 1.3% (95% CI 0.1-2.5 in the non-high (HAS-BLED < 3 and 9.6% (95%CI 2.2-17.0 in the high-risk group (HAS-BLED ≥ 3, (p <0.0001 by Log-Rank test, with a HR of 8.7 (95% CI 2.7-28.4. Of the items in the HAS-BLED score, abnormal renal function (HR 10.8, 95% CI 1.9-61.7 and a history of bleeding events (HR 10.4, 95% CI 2.5-42.5 were independent predictors of major bleeds during follow-up.Acute VTE patients with a HAS-BLED score ≥ 3 points are at increased risk of major bleeding. These results warrant for correction of the potentially reversible risk factors for major bleeding and careful International Normalized Ratio monitoring in acute VTE patients with a high HAS-BLED score.

  15. Investigation on Risk Factors for Hand-foot-mouth Disease Among Children Under 5 Years Old in Rural Areas of Xiangtan Prefecture%湘潭市农村地区5岁以下儿童手足口病危险因素调查

    Institute of Scientific and Technical Information of China (English)

    袁伟; 李新春; 李艳霞; 刘富强

    2013-01-01

    目的 探索湘潭市农村地区5岁以下儿童手足口病(HFMD)发病的危险因素,为防控手足口病提供科学依据. 方法 选择湘潭市农村地区60例HFMD患儿作为病例组,同期同一乡镇60例健康儿童作为对照组,采用统一的调查表进行调查,SPSS13.0软件进行单因素和多因素非条件Logistic回归分析. 结果 确诊的24例HFMD病例中,EV71和CoxA16感染的构成比分别为66.7% (16/24)和4.2%(1/24).单因素分析结果有统计学意义的变量包括居室内外有家禽粪便、儿童近3个月发生上呼吸道感染、腹泻或胃肠炎、儿童作息规律、儿童接种过轮状病毒疫苗共4项因素.多因素分析结果显示儿童作息规律(OR =0.05,95% CI:0.01~0.26),接种过轮状病毒疫苗(OR =0.16,95% CI:0.06~0.40)是儿童HFMD发病的保护因素;近3个月儿童发生上呼吸道感染、腹泻或胃肠炎(OR=11.65,95% CI:3.75~36.15)则是儿童HFMD发病的危险因素. 结论 提高儿童机体免疫力、养成良好的生活卫生习惯有助于控制农村地区儿童HFMD发生.%Objective To explore the risk factors for hand - foot - mouth disease (HFMD) among children under 5 years old in rural areas of Xiangtan prefecture, so as to provide scientific basis for the prevention and control of HFMD. Methods Totally, 60 HFMD patients under 5 years old in the rural area of Xiangtan prefecture were recruited into the case group, and 60 healthy children with the same township in the same period were recruited into the control group. Their guardians were investigated with the unified survey questionnaire. The data were analyzed by univariate analysis and multivariate non - conditional Logistic regression analysis with SPSS13.0. Results Among the pathogens of 24 confirmed HFMD cases, EV71 and CoxA16 constituted 66.7% (16/24) and 4.2% (1/24), respectively. Univariate analysis showed that statistically significant variables included indoor and outdoor poultry manure, upper

  16. A case control study on the risk factors of viral diarrhea in children below 5 years old%5岁以下婴幼儿病毒性腹泻的危险因素配对病例对照研究

    Institute of Scientific and Technical Information of China (English)

    许可; 霍翔; 祖荣强; 李亮; 汤奋扬; 朱凤才; 羊海涛; 汪华

    2011-01-01

    Objective: To assess the risk factors of viral diarrhea among children below 5 years old. Methods:A case-control study was conducted on two groupe of children matched by sex, age with or without viral diarrhea from hospitals in Xuzhou and Zhenjiang area. The pathogen of diarrhea was confirmed by ELISA and RT-PCR methods. Interview was carried out with uniform designed questionnaires. Cox's proportional hazards regression analysis was then performed. Results:Factors that were independently associated with the development of viral diarrhea, would include children's address, weight, parents' Schooling and profession, washing-up sink in kitchen, cutting cooked and uncooked foods by different kitchen knife and target, raising pets, cooker washing hands before cook, the children contacting animals and taking antibiotics one week ago before diarrhea. Anamnesis and rotavims vaccine inoculation were not found associating with viral diarrhea. Multivariate logistic regression model was then fitted with three variables, including washing-up sink in kitchen, cutting cooked and uncooked foods by different kitchen knife and target, taking antibiotics one week ago before diarrhea. The 95% CI of OR was 0.340~0.852, 0.295~0.705 and 2.153~6.227 separately. Conclusion:The risk of viral diarrhea increased with worse hygienic habits and antibiotics taken.%目的:探讨5岁以下婴幼儿病毒性腹泻的危险因素.方法:采用性别、年龄匹配的1:2配对病例对照研究,对江苏省徐州、镇江市县级医疗机构2007年10月至2008年10月收治的5岁以下腹泻儿童500例和对照儿童1 000例进行问卷调查.腹泻的病原体采用酶联免疫吸附剂测定(enzyme linked immunosorbent assay,ELISA)或反转录PCR(reverse transcription-PCR,RT-PCR)进行检测确认.数据采用Cox比例风险模型拟合Logistic回归.结果:单因素分析显示病毒性腹泻患儿的城乡差异、父母受教育程度、职业、家庭饮食卫生(包括厨

  17. The caries related risk factors of 5 years old preschool children in Langfang,Hebei province%河北省廊坊地区5岁学龄前儿童乳牙龋相关行为危险因素调查研究

    Institute of Scientific and Technical Information of China (English)

    高萍; 李富者; 孙鹏; 刘敏

    2013-01-01

    Objective To investigate the caries related risk factors of 5 years old preschool children in Lang-fang , Hebei province . Methods A multiple stratified and cluster randomized sampling method was used to gain 7 115 years old preschool children .Structured questionnaire were used to collect related information .Re-sponse rate was 95.9% .Results The percentage of children consumes sugary food everyday was 25.2% .55.2%of children brushed their teeth everyday reported by their guardian .The percentage of children started to clean teeth before 2 years old was 12.0% .18.3% of children use fluoridated toothpaste and more than 60.3% of guard-ian did not know the effect of fluoridated toothpaste on teeth .More than 66.3% of guardian did not know preven-tive effect of sealant on the caries .The attitude of the majority of guardian to oral health was positive .The distri-bution of caries related risk factors was related to urbanization and guardian's education .Conclusion Integrated and specified oral health education and promotion program is urgent for the studied population .%目的调查河北廊坊地区5岁儿童乳牙龋相关行为危险因素,为有针对性地提出乳牙龋防治策略提供依据。方法采用分层、多阶段、随机、整群抽样的方法获得5岁儿童711名,由监护人填写结构式问卷,收回有效问卷682份,应答率95.9%。结果25.2%的儿童每天至少进食1次含糖食品。55.2%的5岁儿童每天刷牙,2岁前开始刷牙的只有12.0%。家长报告只有18.3%的孩子使用含氟牙膏,超过60.3%的家长不知道含氟牙膏对牙齿的作用,66.3%的家长不知道窝沟封闭能防龋。绝大部分家长对儿童口腔保健的态度积极。龋危险因素存在城乡差异,且与家长文化程度相关。结论适宜在该地区有针对性开展乳牙龋综合健康教育和促进活动。

  18. Dopaminergic therapy and subthalamic stimulation in Parkinson's disease: a review of 5-year reports.

    Science.gov (United States)

    Romito, Luigi M; Albanese, Alberto

    2010-11-01

    The long-term efficacy and safety of deep brain stimulation (DBS) implant for Parkinson's disease (PD) is described in several recent papers. This procedure has been reported to permit a stable reduction of dopaminergic therapy requirements for up to 5 years, although some expectation of deterioration in non-dopaminergic signs has been recently stated. Our aim is to perform a literature-based review of papers available describing long-term post-operative follow-up after a bilateral implant for subthalamic DBS (STN-DBS). Only peer-reviewed published papers with a post-operative follow-up of at least 5 years were considered. Clinical outcome, disease progression and side effects were assessed at baseline and 2 (or 3 years) and 5 years after surgery. Seven papers were included in the review. A total of 238 patients were analyzed. STN-DBS was confirmed to be an effective treatment for selected patients with PD. In all studies, off-related motor symptoms improved dramatically, compared with pre-implant, at 2 (or 3, according to the study) years and this result persisted at 5-year evaluations. Antiparkinsonian drug reductions, improvements in motor fluctuations and dyskinesias, functional measures and the progression of underlying PD were also reported in all series. Some axial scores, in particular postural stability and speech, improved transiently. Persisting adverse effects included eyelid opening apraxia, weight gain, psychiatric disorders, depression, dysarthria, dyskinesias, and apathy. The present review of the 5-year observations confirms that STN-DBS is a powerful method in the management of PD, but its long-term effects must be thoroughly assessed.

  19. Cardiovascular disease risk prediction by the American College of Cardiology (ACC)/American Heart Association (AHA) Atherosclerotic Cardiovascular Disease (ASCVD) risk score among HIV-infected patients in sub-Saharan Africa

    Science.gov (United States)

    Hemphill, Linda C.; Palai, Tommy; Nkele, Isaac; Bennett, Kara; Lockman, Shahin; Triant, Virginia A.

    2017-01-01

    Objectives HIV-infected patients are at increased risk for cardiovascular disease (CVD). However, general population CVD risk prediction equations that identify HIV-infected patients at elevated risk have not been widely assessed in sub-Saharan African (SSA). Methods HIV-infected adults from 30–50 years of age with documented viral suppression were enrolled into a cross-sectional study in Gaborone, Botswana. Participants were screened for CVD risk factors. Bilateral carotid intima-media thickness (cIMT) was measured and 10-year predicted risk of cardiovascular disease was calculated using the Pooled Cohorts Equation for atherosclerotic CVD (ASCVD) and the 2008 Framingham Risk Score (FRS) (National Cholesterol Education Program III–NCEP III). ASCVD ≥7.5%, FRS ≥10%, and cIMT≥75th percentile were considered elevated risk for CVD. Agreement in classification of participants as high-risk for CVD by cIMT and FRS or ASCVD risk score was assessed using McNemar`s Test. The optimal cIMT cut off-point that matched ASCVD predicted risk of ≥7.5% was assessed using Youden’s J index. Results Among 208 HIV-infected patients (female: 55%, mean age 38 years), 78 (38%) met criteria for ASCVD calculation versus 130 (62%) who did not meet the criteria. ASCVD classified more participants as having elevated CVD risk than FRS (14.1% versus 2.6%, McNemar’s exact test p = 0.01), while also classifying similar proportion of participants as having elevated CVD like cIMT (14.1% versus 19.2%, McNemar’s exact test p = 0.34). Youden’s J calculated the optimal cut point at the 81st percentile for cIMT to correspond to an ASCVD score ≥7.5% (sensitivity = 72.7% and specificity = 88.1% with area under the curve for the receiver operating characteristic [AUC] of 0.82, 95% Mann-Whitney CI: 0.66–0.99). Conclusion While the ASCVD risk score classified more patients at elevated CVD risk than FRS, ASCVD score classified similar proportion of patients as high risk when compared with

  20. Pranlukast reduces asthma exacerbations during autumn especially in 1- to 5-year-old boys

    Science.gov (United States)

    Campos Alberto, Eduardo; Suzuki, Shuichi; Sato, Yoshinori; Hoshioka, Akira; Abe, Hiroki; Saito, Kimiyuki; Tsubaki, Toshikazu; Haraki, Mana; Sawa, Akiko; Nakayama, Yoshio; Kojima, Hiroyuki; Shigeta, Midori; Yamaide, Fumiya; Kohno, Yoichi; Shimojo, Naoki

    2017-01-01

    Background Leukotriene receptor antagonists have been used to prevent virus-induced asthma exacerbations in autumn. Its efficacy, however, might differ with age and sex. Objective This study aimed to investigate whether pranlukast added to usual asthma therapy in Japanese children during autumn, season associated with the peak of asthma, reduces asthma exacerbations. It was also evaluated the effect of age and sex on pranlukast's efficacy. Methods A total of 121 asthmatic children aged 1 to 14 years were randomly assigned to receive regular pranlukast or not according to sex, and were divided in 2 age groups, 1–5 years and 6–14 years. The primary outcome was total asthma score calculated during 8 weeks by using a sticker calendar related to the days in which a child experienced a worsening of asthma symptoms. This open study lasted 60 days from September 15 to November 14, 2007. Results Significant differences in pranlukast efficacy were observed between sex and age groups. Boys aged 1 to 5 years had the lower total asthma score at 8 weeks (p = 0.002), and experienced fewer cold episodes (p = 0.007). There were no significant differences between pranlukast and control group in total asthma score at 8 weeks (p = 0.35), and in the days in which a child experienced a worsening of asthma symptoms (p = 0.67). Conclusion There was a substantial benefit of adding pranlukast to usual therapy in asthmatic children, especially in boys aged 1 to 5 years, during autumn season. PMID:28154801

  1. Prone Breast Intensity Modulated Radiation Therapy: 5-Year Results

    Energy Technology Data Exchange (ETDEWEB)

    Osa, Etin-Osa O.; DeWyngaert, Keith [Department of Radiation Oncology, New York University School of Medicine, New York, New York (United States); Roses, Daniel [Department of Surgery, New York University School of Medicine, New York, New York (United States); Speyer, James [Department of Medical Oncology, New York University School of Medicine, New York, New York (United States); Guth, Amber; Axelrod, Deborah [Department of Surgery, New York University School of Medicine, New York, New York (United States); Fenton Kerimian, Maria [Department of Radiation Oncology, New York University School of Medicine, New York, New York (United States); Goldberg, Judith D. [Department of Population Health, New York University School of Medicine, New York, New York (United States); Formenti, Silvia C., E-mail: Silvia.formenti@nyumc.org [Department of Radiation Oncology, New York University School of Medicine, New York, New York (United States)

    2014-07-15

    Purpose: To report the 5-year results of a technique of prone breast radiation therapy delivered by a regimen of accelerated intensity modulated radiation therapy with a concurrent boost to the tumor bed. Methods and Materials: Between 2003 and 2006, 404 patients with stage I-II breast cancer were prospectively enrolled into 2 consecutive protocols, institutional trials 03-30 and 05-181, that used the same regimen of 40.5 Gy/15 fractions delivered to the index breast over 3 weeks, with a concomitant daily boost to the tumor bed of 0.5 Gy (total dose 48 Gy). All patients were treated after segmental mastectomy and had negative margins and nodal assessment. Patients were set up prone: only if lung or heart volumes were in the field was a supine setup attempted and chosen if found to better spare these organs. Results: Ninety-two percent of patients were treated prone, 8% supine. Seventy-two percent had stage I, 28% stage II invasive breast cancer. In-field lung volume ranged from 0 to 228.27 cm{sup 3}, mean 19.65 cm{sup 3}. In-field heart volume for left breast cancer patients ranged from 0 to 21.24 cm{sup 3}, mean 1.59 cm{sup 3}. There was no heart in the field for right breast cancer patients. At a median follow-up of 5 years, the 5-year cumulative incidence of isolated ipsilateral breast tumor recurrence was 0.82% (95% confidence interval [CI] 0.65%-1.04%). The 5-year cumulative incidence of regional recurrence was 0.53% (95% CI 0.41%-0.69%), and the 5-year overall cumulative death rate was 1.28% (95% CI 0.48%-3.38%). Eighty-two percent (95% CI 77%-85%) of patients judged their final cosmetic result as excellent/good. Conclusions: Prone accelerated intensity modulated radiation therapy with a concomitant boost results in excellent local control and optimal sparing of heart and lung, with good cosmesis. Radiation Therapy Oncology Group protocol 1005, a phase 3, multi-institutional, randomized trial is ongoing and is evaluating the equivalence of a similar dose and

  2. Apgar score

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/article/003402.htm Apgar score To use the sharing features on this page, ... birth. Virginia Apgar, MD (1909-1974) introduced the Apgar score in 1952. How the Test is Performed The ...

  3. Clinical study on HAT and SEDAN score scales and related risk factors for predicting hemorrhagic transformation following thrombolysis in acute ischemic stroke

    Directory of Open Access Journals (Sweden)

    Heng WEI

    2015-03-01

    Full Text Available Objective To investigate the value of HAT and SEDAN score scales in predicting hemorrhagic transformation (HT following the recombinant tissue-type plasminogen activator (rt-PA intravenous thrombolysis in acute ischemic stroke patients and risk factors affecting HT.  Methods A total of 143 patients with acute ischemic stroke underwent rt-PA intravenous thrombolysis within 4.50 h of onset and their clinical data were collected. According to head CT after thrombolysis, patients were divided into HT group (18 cases and non-HT group (125 cases. Single factor analysis was used to assess differences in HAT and SEDAN score scales and related risk factors of ischemic stroke in 2 groups, and further Logistic regression analysis was used to investigate independent predictors of HT. Receiver operating characteristic (ROC curve was used to evaluate the sensitivity and specificity of HAT and SEDAN score scales in predicting HT.  Results Univariate Logistic regression analysis showed that history of atrial fibrillation (AF, admission systolic blood pressure (SBP, admission blood glucose level, early low density of head CT, thrombolytic time window, National Institute of Health Stroke Scale (NIHSS, HAT and SEDAN scores were all risk factors for HT after thrombolysis (P < 0.05, for all. Multivariate Logistic regression analysis showed that history of AF (OR = 1.677, 95% CI: 1.332-2.111; P = 0.000, admission SBP (OR = 1.102, 95% CI: 1.009-1.204; P = 0.031, admission blood glucose level (OR = 1.870, 95% CI: 1.119-3.125; P = 0.017, thrombolysis time window (OR = 1.030, 95%CI: 1.009-1.052; P = 0.005, NIHSS score (OR = 1.574, 95%CI: 1.186-2.090; P = 0.002, HAT score (OR = 2.515, 95%CI: 1.273-4.970;P = 0.008 and SEDAN score (OR = 2.413, 95%CI: 1.123-5.185; P = 0.024 were risk factors for HT after thrombolysis. ROC curve analysis showed that HAT score could predict HT with 94.40% sensitivity and 41.60% specificity, and area under curve (AUC was 0.70. SEDAN

  4. Clinical impact and risk stratification of balloon angioplasty for femoropopliteal disease in nitinol stenting era: Retrospective multicenter study using propensity score matching analysis

    Directory of Open Access Journals (Sweden)

    Taketsugu Tsuchiya

    2016-07-01

    Full Text Available Objective: Nitinol stenting could bring the better outcome in endovascular therapy for femoropopliteal disease. However, it might be expected that recent marked advances in both device technology and operator technique had led to improved efficacy of balloon angioplasty even in this segment. The aims of this study were to evaluate the clinical impact of balloon angioplasty for femoropopliteal disease and make risk stratification clear by propensity score matching analysis. Methods: Based on the multicenter retrospective data, 2758 patients (balloon angioplasty: 729 patients and nitinol stenting: 2029 patients, those who underwent endovascular therapy for femoropopliteal disease, were analyzed. Results: The propensity score matching procedure extracted a total of 572 cases per group, and the primary patency rate of balloon angioplasty and nitinol stenting groups after matching was significantly the same (77.2% vs 82.7% at 1 year; 62.2% vs 64.3% at 3 years; 47.8% vs 54.3% at 5 years. In multivariate Cox hazard regression analysis, significant predictors for primary patency were diabetes mellitus, regular dialysis, cilostazol use, chronic total occlusion, and intra-vascular ultra-sonography use. The strategy of balloon angioplasty was not evaluated as a significant predictor for the primary patency. After risk stratification using five items (diabetes mellitus, regular dialysis, no use of intra-vascular ultra-sonography, chronic total occlusion, and no use of cilostazol: the DDICC score, the estimated primary patency rates of each group (low, DDICC score 0–2; moderate, DDICC score 3; high risk, DDICC score 4–5 were 88.6%, 78.3%, and 63.5% at 1 year; 75.2%, 60.7%, and 39.8% at 3 years; and 66.0%, 47.1%, and 26.3% at 5 years (p < 0.0001. The primary patency rate of balloon angioplasty and nitinol stenting groups was significantly the same in each risk stratification. Conclusion: This study suggests that balloon angioplasty does

  5. Development of a new risk score for incident type 2 diabetes using updated diagnostic criteria in middle-aged and older chinese.

    Directory of Open Access Journals (Sweden)

    Xingwang Ye

    Full Text Available Type 2 diabetes mellitus (T2DM reaches an epidemic proportion among adults in China. However, no simple score has been created for the prediction of T2DM incidence diagnosed by updated criteria with hemoglobin A1c (HbA1c ≥ 6.5% included in Chinese. In a 6-year follow-up cohort in Beijing and Shanghai, China, we recruited a total of 2529 adults aged 50-70 years in 2005 and followed them up in 2011. Fasting plasma glucose (FPG, HbA1c, and C-reactive protein (CRP were measured and incident diabetes was identified by the recently updated criteria. Of the 1912 participants without T2DM at baseline, 924 were identified as having T2DM at follow-up, and most of them (72.4% were diagnosed using the HbA1c criterion. Baseline body mass index, FPG, HbA1c, CRP, hypertension, and female gender were all significantly associated with incident T2DM. Based upon these risk factors, a simple score was developed with an estimated area under the receiver operating characteristic curve of 0.714 (95% confidence interval: 0.691, 0.737, which performed better than most of existing risk score models developed for eastern Asian populations. This simple, newly constructed score of six parameters may be useful in predicting T2DM in middle-aged and older Chinese.

  6. Failure of siblings to thrive beyond 5 years of age

    Directory of Open Access Journals (Sweden)

    Himanshu Jain

    2013-01-01

    Full Text Available We describe a family in which parents had consanguinity, being children of real sisters. They had given birth to five children. In their family, children remained healthy from birth to pre-school age and then started having symptoms around the age of 5 years and two of them succumbed to this illness. Polyglandular autoimmune syndrome Type-1 is a rare sporadic autosomal recessive disease. It is characterized by the existence of two or more endocrinal disorders. Patients may require lifelong hormone replacement therapy for survival.

  7. Spectral analysis-based risk score enables early prediction of mortality and cerebral performance in patients undergoing therapeutic hypothermia for ventricular fibrillation and comatose status

    OpenAIRE

    2015-01-01

    Background: Early prognosis in comatose survivors after cardiac arrest due to ventricular fibrillation (VF) is unreliable, especially in patients undergoing mild hypothermia. We aimed at developing a reliable risk-score to enable early prediction of cerebral performance and survival. Methods: Sixty-one out of 239 consecutive patients undergoing mild hypothermia after cardiac arrest, with eventual return of spontaneous circulation (ROSC), and comatose status on admission fulfilled the inclu...

  8. Nutritional Risk in Major Abdominal Surgery: Protocol of a Prospective Observational Trial to Evaluate the Prognostic Value of Different Nutritional Scores in Pancreatic Surgery

    OpenAIRE

    Probst, Pascal; Haller, Sebastian; Dörr-Harim, Colette; Bruckner, Thomas; Ulrich,Alexis; Hackert, Thilo; Diener, Markus K; Knebel, Phillip

    2015-01-01

    Background The influence of patients’ preoperative nutritional status on their clinical outcome has already been proven. Therefore, patients with malnutrition are in need of additional therapeutic efforts. However, for pancreatic surgery, evidence suggesting the adequacy of existing nutritional assessment scores to estimate malnutrition associated with postoperative outcome is limited. Objective The aim of the observational trial “Nutritional Risk in Major Abdominal Surgery (NURIMAS) Pancreas...

  9. Does adhesive capsulitis of the shoulder increase the risk of stroke? A population-based propensity score-matched follow-up study.

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    Chueh-Hung Wu

    Full Text Available OBJECTIVES: A previous population-based study reported an increased risk of stroke after the occurrence of adhesive capsulitis of the shoulder (ACS, but there were substantial imbalances in the distribution of age and pre-existing vascular risk factors between subjects with ACS and without ACS, which might lead to a confounded association between ACS and stroke. The purpose of the present large-scale propensity score-matched population-based follow-up study was to clarify whether there is an increased stroke risk after ACS. METHODS: We used a logistic regression model that includes age, sex, pre-existing comorbidities and socioeconomic status as covariates to compute the propensity score. A total of 22025 subjects with at least two ambulatory visits with the principal diagnosis of ACS in 2001 was enrolled in the ACS group. The non-ACS group consisted of 22025, propensity score-matched subjects without ACS. The stroke-free survival curves for these 2 groups were compared using the Kaplan-Meier method. Stratified Cox proportional hazard regression with patients matched on propensity score was used to estimate the effect of ACS on the occurrence of stroke. RESULTS: During the two-year follow-up period, 657 subjects in the ACS group (2.98% and 687 in the non-ACS group (3.12% developed stroke. The hazard ratio (HR of stroke for the ACS group was 0.93 compared to the non-ACS group (95% confidence interval [CI], 0.83-1.04, P = 0.1778. There was no statistically significant difference in stroke subtype distribution between the two groups (P = 0.2114. CONCLUSIONS: These findings indicate that ACS itself is not associated with an increased risk of subsequent stroke.

  10. Proton pump inhibitor use and risk of adverse cardiovascular events in aspirin treated patients with first time myocardial infarction: nationwide propensity score matched study

    DEFF Research Database (Denmark)

    Charlot, Mette; Grove, Erik; Hansen, Peter Riis;

    2011-01-01

    OBJECTIVE: To examine the effect of proton pump inhibitors on adverse cardiovascular events in aspirin treated patients with first time myocardial infarction. DESIGN: Retrospective nationwide propensity score matched study based on administrative data. Setting All hospitals in Denmark. PARTICIPANTS...... analysis showed no increase in risk related to use of H(2) receptor blockers (1.04, 0.79 to 1.38; P=0.78). Conclusion In aspirin treated patients with first time myocardial infarction, treatment with proton pump inhibitors was associated with an increased risk of adverse cardiovascular events....

  11. Prognostic factors and scoring system for death from visceral leishmaniasis: an historical cohort study in Brazil.

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    Wendel Coura-Vital

    2014-12-01

    Full Text Available In Brazil, case-fatality rates attributable to visceral leishmaniasis (VL are high and knowledge of the risk factors associated with death may help reduce mortality. The aim of this study was to construct and validate a scoring system for prognosis of death from VL by using all cases reported in Brazil from 2007 to 2011.In this historical cohort study, 18,501 VL cases were analyzed; of these, 17,345 cases were cured and 1,156 cases caused death. The database was divided into two series: primary (two-thirds of cases, to develop the model score, and secondary (one-third of cases, to validate the scoring system. Multivariate logistic regression models were performed to identify factors associated with death from VL, and these were included in the scoring system.The factors associated with death from VL were: bleeding (score 3; splenomegaly (score 1; edema (score 1; weakness (score 1; jaundice (score 1; Leishmania-HIV co-infection (score 1; bacterial infection (score 1; and age (≤0.5 years [score 5]; >0.5 and ≤1 [score 2]; >19 and ≤50 [score 2]; >50 and <65 [score 3]; ≥65 [score 5]. It was observed that patients with a score of 4 had a probability of death of approximately 4.5% and had a worse prognosis. The sensitivity, specificity, and accuracy of this score were 89.4, 51.2, and 53.5, respectively.The scoring system based on risk factors for death showed good performance in identifying patients with signs of severity at the time of clinical suspicion of VL and can contribute to improving the surveillance system for reducing case fatalities. The classification of patients according to their prognosis for death may assist decision-making regarding the transfer of the patients to hospitals more capable of handling their condition, admission to the intensive care unit, and adequate support and specific treatment.

  12. Clozapine for severe ("kraepelinian" schizophrenia: Sustained improvement over 5 years

    Directory of Open Access Journals (Sweden)

    Ricardo de Oliveira-Souza

    Full Text Available Abstract Clozapine has become a keystone in the treatment of schizophrenia because of its efficacy as an antipsychotic with negligible neuroleptic effects. The long-term stability of its effects, however, is poorly understood, because most studies have probed the usefulness of clozapine over a period of weeks to several months at the most. Knowing whether clozapine's benefits are sustained over the very long-term, i.e., more than 5 years, may be critical for cost-benefit analyses. Objective: To report the results of an open study on the efficacy of clozapine over the very long-term. Methods: Thirty-three adults (26 men with severe (kraepelinian schizophrenia were assessed at regular intervals using a brief neuropsychiatric battery over a 5-year period. Results: A significant improvement was observed between the pre-clozapine and the first "on-clozapine" evaluation. This improvement was paralleled by a remarkable conversion of schizophrenia from "active" (mostly paranoid into "residual" in 70% of all patients. Eight patients became functionally productive to the point of being capable of living an independent life. Roughly one-third of our cases showed no improvement. Conclusions: Clozapine is a safe and effective drug for patients with severe schizophrenia who have failed to improve on other antipsychotic drugs. Clozapine's maximal benefit is established by the end of the first year of treatment and continues unabated for many years thereafter. Clozapine-resistant patients remain a major challenge calling for the discovery of new treatments for schizophrenia.

  13. Antipsychotic Prescriptions for Children Aged 5 Years or Younger

    Directory of Open Access Journals (Sweden)

    Ana Lòpez-De Fede

    2014-10-01

    Full Text Available The use of antipsychotics in very young children is of concern given the lack of empirical evidence in their efficacy and long-term impact on children’s health. This study examined the prescription of antipsychotics among children aged ≤5 years enrolled in a state Medicaid program. Secondary data analysis was conducted using the Medicaid administrative data of a southeastern state. Using SAS 9.3, descriptive statistics were performed to examine socio-demographic characteristics, psychiatric diagnoses, off-label use, receipt of medications from multiple psychotropic drug classes, and receipt of non-pharmacologic psychiatric services among children aged ≤5 years who received antipsychotic prescriptions in calendar year (CY 2011. A total of 112 children in the target age group received antipsychotics in CY 2011, the most common prescription being risperidone. The most common listed psychiatric diagnosis was attention deficit hyperactivity disorder. Two in five children received antipsychotics for off-label use. Three in four children also received medications from at least one other psychotropic drug class. More than half did not receive adjunct psychiatric services. State-level policies offering specific guidance and recommendations for antipsychotic use among very young children are urgently needed. Future research is warranted to examine long-term impact of such practices on children’s growth and development.

  14. Predicting asthma in preschool children at high risk presenting in primary care: Development of a clinical asthma prediction score

    NARCIS (Netherlands)

    L.B. Van Der Mark (Lonneke); K.E. Wonderen (Karina); J. Mohrs (Jacob); W.M.C. van Aalderen (Willem); G. ter Riet; P.J.E. Bindels (Patrick)

    2014-01-01

    textabstractBackground: A setting-specific asthma prediction score for preschool children with wheezing and/or dyspnoea presenting in primary healthcare is needed since existing indices are mainly based on general populations. Aims: To find an optimally informative yet practical set of predictors fo

  15. A chemical risk ranking and scoring method for the selection of harmful substances to be specially controlled in occupational environments.

    Science.gov (United States)

    Shin, Saemi; Moon, Hyung-Il; Lee, Kwon Seob; Hong, Mun Ki; Byeon, Sang-Hoon

    2014-11-20

    This study aimed to devise a method for prioritizing hazardous chemicals for further regulatory action. To accomplish this objective, we chose appropriate indicators and algorithms. Nine indicators from the Globally Harmonized System of Classification and Labeling of Chemicals were used to identify categories to which the authors assigned numerical scores. Exposure indicators included handling volume, distribution, and exposure level. To test the method devised by this study, sixty-two harmful substances controlled by the Occupational Safety and Health Act in Korea, including acrylamide, acrylonitrile, and styrene were ranked using this proposed method. The correlation coefficients between total score and each indicator ranged from 0.160 to 0.641, and those between total score and hazard indicators ranged from 0.603 to 0.641. The latter were higher than the correlation coefficients between total score and exposure indicators, which ranged from 0.160 to 0.421. Correlations between individual indicators were low (-0.240 to 0.376), except for those between handling volume and distribution (0.613), suggesting that each indicator was not strongly correlated. The low correlations between each indicator mean that the indicators and independent and were well chosen for prioritizing harmful chemicals. This method proposed by this study can improve the cost efficiency of chemical management as utilized in occupational regulatory systems.

  16. A Chemical Risk Ranking and Scoring Method for the Selection of Harmful Substances to be Specially Controlled in Occupational Environments

    Directory of Open Access Journals (Sweden)

    Saemi Shin

    2014-11-01

    Full Text Available This study aimed to devise a method for prioritizing hazardous chemicals for further regulatory action. To accomplish this objective, we chose appropriate indicators and algorithms. Nine indicators from the Globally Harmonized System of Classification and Labeling of Chemicals were used to identify categories to which the authors assigned numerical scores. Exposure indicators included handling volume, distribution, and exposure level. To test the method devised by this study, sixty-two harmful substances controlled by the Occupational Safety and Health Act in Korea, including acrylamide, acrylonitrile, and styrene were ranked using this proposed method. The correlation coefficients between total score and each indicator ranged from 0.160 to 0.641, and those between total score and hazard indicators ranged from 0.603 to 0.641. The latter were higher than the correlation coefficients between total score and exposure indicators, which ranged from 0.160 to 0.421. Correlations between individual indicators were low (−0.240 to 0.376, except for those between handling volume and distribution (0.613, suggesting that each indicator was not strongly correlated. The low correlations between each indicator mean that the indicators and independent and were well chosen for prioritizing harmful chemicals. This method proposed by this study can improve the cost efficiency of chemical management as utilized in occupational regulatory systems.

  17. Age at natural menopause genetic risk score in relation to age at natural menopause and primary open-angle glaucoma in a US-based sample

    Science.gov (United States)

    Pasquale, Louis R.; Aschard, Hugues; Kang, Jae H.; Bailey, Jessica N. Cooke; Lindström, Sara; Chasman, Daniel I.; Christen, William G.; Allingham, R. Rand; Ashley-Koch, Allison; Lee, Richard K.; Moroi, Sayoko E.; Brilliant, Murray H.; Wollstein, Gadi; Schuman, Joel S.; Fingert, John; Budenz, Donald L.; Realini, Tony; Gaasterland, Terry; Gaasterland, Douglas; Scott, William K.; Singh, Kuldev; Sit, Arthur J.; Igo, Robert P.; Song, Yeunjoo E.; Hark, Lisa; Ritch, Robert; Rhee, Douglas J.; Gulati, Vikas; Havens, Shane; Vollrath, Douglas; Zack, Donald J.; Medeiros, Felipe; Weinreb, Robert N.; Pericak-Vance, Margaret A.; Liu, Yutao; Kraft, Peter; Richards, Julia E.; Rosner, Bernard A.; Hauser, Michael A.; Haines, Jonathan L.; Wiggs, Janey L.

    2017-01-01

    Abstract Objective: Several attributes of female reproductive history, including age at natural menopause (ANM), have been related to primary open-angle glaucoma (POAG). We assembled 18 previously reported common genetic variants that predict ANM to determine their association with ANM or POAG. Methods: Using data from the Nurses’ Health Study (7,143 women), we validated the ANM weighted genetic risk score in relation to self-reported ANM. Subsequently, to assess the relation with POAG, we used data from 2,160 female POAG cases and 29,110 controls in the National Eye Institute Glaucoma Human Genetics Collaboration Heritable Overall Operational Database (NEIGHBORHOOD), which consists of 8 datasets with imputed genotypes to 5.6+ million markers. Associations with POAG were assessed in each dataset, and site-specific results were meta-analyzed using the inverse weighted variance method. Results: The genetic risk score was associated with self-reported ANM (P = 2.2 × 10–77) and predicted 4.8% of the variance in ANM. The ANM genetic risk score was not associated with POAG (Odds Ratio (OR) = 1.002; 95% Confidence Interval (CI): 0.998, 1.007; P = 0.28). No single genetic variant in the panel achieved nominal association with POAG (P ≥0.20). Compared to the middle 80 percent, there was also no association with the lowest 10th percentile or highest 90th percentile of genetic risk score with POAG (OR = 0.75; 95% CI: 0.47, 1.21; P = 0.23 and OR = 1.10; 95% CI: 0.72, 1.69; P = 0.65, respectively). Conclusions: A genetic risk score predicting 4.8% of ANM variation was not related to POAG; thus, genetic determinants of ANM are unlikely to explain the previously reported association between the two phenotypes. PMID:27760082

  18. Z-Score 模型对科技型上市公司财务风险预警的适用性检验%Compatibility Inspects of Z-score Model to Financial Risk of Quoted Companies

    Institute of Scientific and Technical Information of China (English)

    张蔚虹; 朱海霞

    2012-01-01

    This paper chooses 20 ST companies which was declared special transactions in 2011 and 20 matched non -ST sized listed companies as samples, By Z - score model, it analyzes the financial data of ST companies and non - ST companies three years before special treat and has the Z - values. By the Z - values, the paper finds that the financing risk warning of Z - score model for the technology enterprise is valid-%选取2011年宣布特别处理的科技型上市公司中的20家ST公司,以及与其同行业、资产总额基本相同的20家非ST公司作为研究样本,利用Z—Score模型分析了ST公司宣布特别处理前三年度非ST公司相对应年度的财务数据,计算得出Z值.通过对Z值的分析,认为Z-Score模型对我国科技型上市公司财务风险的预警是有效的.

  19. Development and verification of child observation sheet for 5-year-old children.

    Science.gov (United States)

    Fujimoto, Keiko; Nagai, Toshisaburo; Okazaki, Shin; Kawajiri, Mie; Tomiwa, Kiyotaka

    2014-02-01

    The aim of the study was to develop a newly devised child observation sheet (COS-5) as a scoring sheet, based on the Childhood Autism Rating Scale (CARS), for use in the developmental evaluation of 5-year-old children, especially focusing on children with autistic features, and to verify its validity. Seventy-six children were studied. The children were recruited among participants of the Japan Children's Cohort Study, a research program implemented by the Research Institute of Science and Technology for Society (RISTEX) from 2004 to 2009. The developmental evaluation procedure was performed by doctors, clinical psychologists, and public health nurses. The COS-5 was also partly based on the Kyoto Scale of Psychological Development 2001 (Kyoto Scale 2001). Further, the Developmental Disorders Screening Questionnaire for 5-Years-Olds, PDD-Autism Society Japan Rating Scale (PARS), doctor interview questions and neurological examination for 5-year-old children, and the Draw-a-Man Test (DAM) were used as evaluation scales. Eighteen (25.4%) children were rated as Suspected, including Suspected PDD, Suspected ADHD and Suspected MR. The COS-5 was suggested to be valid with favorable reliability (α=0.89) and correlation with other evaluation scales. The COS-5 may be useful, with the following advantages: it can be performed within a shorter time frame; it facilitates the maintenance of observation quality; it facilitates sharing information with other professions; and it is reliable to identify the autistic features of 5-year-old children. In order to verify its wider applications including the screening of infants (18months to 3years old) by adjusting the items of younger age, additional study is needed.

  20. Using “Big Data” to Capture Overall Health Status: Properties and Predictive Value of a Claims-Based Health Risk Score

    Science.gov (United States)

    Hamad, Rita; Modrek, Sepideh; Kubo, Jessica; Goldstein, Benjamin A.; Cullen, Mark R.

    2015-01-01

    Background Investigators across many fields often struggle with how best to capture an individual’s overall health status, with options including both subjective and objective measures. With the increasing availability of “big data,” researchers can now take advantage of novel metrics of health status. These predictive algorithms were initially developed to forecast and manage expenditures, yet they represent an underutilized tool that could contribute significantly to health research. In this paper, we describe the properties and possible applications of one such “health risk score,” the DxCG Intelligence tool. Methods We link claims and administrative datasets on a cohort of U.S. workers during the period 1996–2011 (N = 14,161). We examine the risk score’s association with incident diagnoses of five disease conditions, and we link employee data with the National Death Index to characterize its relationship with mortality. We review prior studies documenting the risk score’s association with other health and non-health outcomes, including healthcare utilization, early retirement, and occupational injury. Results and Conclusions We find that the risk score is associated with outcomes across a variety of health and non-health domains. These examples demonstrate the broad applicability of this tool in multiple fields of research and illustrate its utility as a measure of overall health status for epidemiologists and other health researchers. PMID:25951622

  1. Pediatric injuries in maxillofacial trauma: a 5 year study.

    Science.gov (United States)

    Kumaraswamy, S V; Madan, Nanjappa; Keerthi, R; Singh, Deora Shakti

    2009-06-01

    Fractures of the facial skeleton in children are less frequent. This clinical retrospective study of 5 year was conducted on 95 patients aged less than 16 years who sustained maxillofacial injuries during the period 2003 to 2008. Age, sex, etiology incidence and type of fracture were studied. The ratio of boys to girls was 1.9:1. The 7-12 year age group was commonly involved and the highest incidence was at age of ten years. Falls were the most common cause of injury accounting for 41%, followed by road traffic accidents (30%). Sports related injuries, assault and child abuse were also the causes of injury in children. Dentoalveolar injuries were found to be highest incidence with 42.1% followed by mandibular fractures. The soft tissue injuries were associated the pediatric maxillofacial trauma were found to be 34.7% of all cases.

  2. MANDIBULAR INCISOR EXTRACTION: A 5-YEAR FOLLOW-UP

    Directory of Open Access Journals (Sweden)

    Kadir BEYCAN

    2016-10-01

    Full Text Available This case report presents the mandibular incisor extraction treatment of a patient with dental Class I malocclusion and lower crowding, in whom one mandibular incisor extraction was selected as the treatment of choice to improve the dental occlusion. A 19-year-old male patient’s chief complaint was the crowding of lower incisors. He had a straight profile with normal upper and lower lip projection. Upper and lower dental midlines were coincident with the facial midline. The patient had Class I molar and canine relationships on both sides. He had Class I skeletal relationship, low angle vertical pattern, and proclined upper and lower incisors. The treatment plan included the extraction of lower right central incisor to resolve the crowding. At the end of 16-month active fixed treatment, lower dental crowding was resolved. At the 5-year follow-up, the patient had a stable occlusion, with the results of the orthodontic treatment maintained.

  3. Pyomyositis in a 5-year-old child.

    Science.gov (United States)

    Romeo, S; Sunshine, S

    2000-07-01

    We present a case of pyomyositis in an otherwise healthy 5-year-old child that underscores the potential for serious, life-threatening complications. Pyomyositis of the gluteal, psoas, and iliacus muscles was associated with osteomyelitis, septic arthritis, a large inferior vena cava thrombus, septic pulmonary emboli, and eventual pneumonia. Primary pyomyositis is a purulent infection of striated muscle thought to be caused by seeding from a transient bacteremia. The focal infection typically forms an abscess that generally responds to intravenous antibiotics and occasionally requires adjunctive computed tomography-guided aspiration and drainage. This localized infectious process rarely produces further sequelae unless treatment is delayed. Pyomyositis is rare in healthy individuals and requires a high clinical suspicion in patients who present with fever, leukocytosis, and localized pain.

  4. How do 5-year-olds understand questions?

    DEFF Research Database (Denmark)

    Sauerland, Uli; Grohmann, Kleanthes; Teresa Guasti, Maria

    2016-01-01

    the question word was related to the sentential subject or object position of the verb. The findings show that there is considerable variation among languages, but the two factors mentioned consistently affect children’s performance. The cross-linguistic variation shows that three linguistic factors facilitate......The comprehension of constituent questions is an important topic for language acquisition research and for applications in the diagnosis of language impairment. This article presents the results of a study investigating the comprehension of different types of questions by 5-year-old, typically...... developing children across 19 European countries, 18 different languages, and 7 language (sub-)families. The study investigated the effects of two factors on question formation: (a) whether the question contains a simple interrogative word like ‘who’ or a complex one like ‘which princess’, and (b) whether...

  5. Statistical Analyses for NANOGrav 5-year Timing Residuals

    CERN Document Server

    Wang, Y; Jenet, F A; Chatterjee, S; Demorest, P B; Dolch, T; Ellis, J A; Lam, M T; Madison, D R; McLaughlin, M; Perrodin, D; Rankin, J; Siemens, X; Vallisneri, M

    2016-01-01

    In pulsar timing, timing residuals are the differences between the observed times of arrival and the predictions from the timing model. A comprehensive timing model will produce featureless residuals, which are presumably composed of dominating noise and weak physical effects excluded from the timing model (e.g. gravitational waves). In order to apply the optimal statistical methods for detecting the weak gravitational wave signals, we need to know the statistical properties of the noise components in the residuals. In this paper we utilize a variety of non-parametric statistical tests to analyze the whiteness and Gaussianity of the North American Nanohertz Observatory for Gravitational Waves (NANOGrav) 5-year timing data which are obtained from the Arecibo Observatory and the Green Bank Telescope from 2005 to 2010 (Demorest et al. 2013). We find that most of the data are consistent with white noise; Many data deviate from Gaussianity at different levels, nevertheless, removing outliers in some pulsars will m...

  6. Statistical analyses for NANOGrav 5-year timing residuals

    Science.gov (United States)

    Wang, Yan; Cordes, James M.; Jenet, Fredrick A.; Chatterjee, Shami; Demorest, Paul B.; Dolch, Timothy; Ellis, Justin A.; Lam, Michael T.; Madison, Dustin R.; McLaughlin, Maura A.; Perrodin, Delphine; Rankin, Joanna; Siemens, Xavier; Vallisneri, Michele

    2017-02-01

    In pulsar timing, timing residuals are the differences between the observed times of arrival and predictions from the timing model. A comprehensive timing model will produce featureless residuals, which are presumably composed of dominating noise and weak physical effects excluded from the timing model (e.g. gravitational waves). In order to apply optimal statistical methods for detecting weak gravitational wave signals, we need to know the statistical properties of noise components in the residuals. In this paper we utilize a variety of non-parametric statistical tests to analyze the whiteness and Gaussianity of the North American Nanohertz Observatory for Gravitational Waves (NANOGrav) 5-year timing data, which are obtained from Arecibo Observatory and Green Bank Telescope from 2005 to 2010. We find that most of the data are consistent with white noise; many data deviate from Gaussianity at different levels, nevertheless, removing outliers in some pulsars will mitigate the deviations.

  7. Colonic resection for colovesical fistula: 5-year follow-up.

    Science.gov (United States)

    Walker, K. G; Anderson, J. H; Iskander, N; McKee, R. F; Finlay, I. G

    2002-07-01

    OBJECTIVES: The outcome of colovesical fistula management may be unsatisfactory; complications are reported in up to 45% of patients. Published studies are retrospective and tend to lack standardized management strategies and long-term follow-up. This cohort study assesses a policy of resection of colovesical fistulae in continuity with any distal colorectal stricture, and includes 5-year follow-up. METHOD: All patients undergoing surgery in our institution for colovesical fistula between February 1991 and April 1995 were entered into the study. The fistulae were resected in continuity with any distal bowel stricture, according to a standard single-stage operative protocol. Postoperative mortality and morbidity were recorded, and prospective review was undertaken at April 2000. RESULTS: Nineteen consecutive patients entered the study. The source of the fistula was diverticular disease (n = 14), colorectal cancer (n = 3), trauma (n = 1) or Crohn's (n = 1) disease. Thirteen patients had a colorectal stricture. One patient died due to ischaemic colitis within 30 days of surgery. Eleven other patients died of unrelated causes before April 2000, in whom there was no evidence of fistula recurrence before death at a median of 37 months after operation (range 2-95 months). At 5-year follow-up there was no evidence of fistula recurrence in the seven remaining patients. CONCLUSIONS: A policy of resection of the fistula and associated colorectal stricture with primary bowel anastomosis and bladder drainage, resulted in no recurrences and low morbidity. However comorbidity is important in this patient population, most of whom will die from unrelated causes within a few years.

  8. Incremental prognostic value of coronary computed tomographic angiography over coronary artery calcium score for risk prediction of major adverse cardiac events in asymptomatic diabetic individuals

    Science.gov (United States)

    Min, James K.; Labounty, Troy M.; Gomez, Millie J.; Achenbach, Stephan; Al-Mallah, Mouaz; Budoff, Matthew J.; Cademartiri, Filippo; Callister, Tracy Q.; Chang, Hyuk-Jae; Cheng, Victor; Chinnaiyan, Kavitha M.; Chow, Benjamin; Cury, Ricardo; Delago, Augustin; Dunning, Allison; Feuchtner, Gudrun; Hadamitzky, Martin; Hausleiter, Jorg; Kaufmann, Philipp; Kim, Yong-Jin; Leipsic, Jonathon; Lin, Fay Y.; Maffei, Erica; Raff, Gilbert; Shaw, Leslee J.; Villines, Todd C.; Berman, Daniel S.

    2015-01-01

    Background Coronary artery disease (CAD) diagnosis by coronary computed tomographic angiography (CCTA) is useful for identification of symptomatic diabetic individuals at heightened risk for death. Whether CCTA-detected CAD enables improved risk assessment of asymptomatic diabetic individuals beyond clinical risk factors and coronary artery calcium scoring (CACS) remains unexplored. Methods From a prospective 12-center international registry of 27,125 individuals undergoing CCTA, we identified 400 asymptomatic diabetic individuals without known CAD. Coronary stenosis by CCTA was graded as 0%, 1–49%, 50–69%, and ≥70%. CAD was judged on a per-patient, per-vessel and per-segment basis as maximal stenosis severity, number of vessels with ≥50% stenosis, and coronary segments weighted for stenosis severity (segment stenosis score), respectively. We assessed major adverse cardiovascular events (MACE) – inclusive of mortality, nonfatal myocardial infarction (MI), and late target vessel revascularization ≥90 days (REV) – and evaluated the incremental utility of CCTA for risk prediction, discrimination and reclassification. Results Mean age was 60.4 ± 9.9 years; 65.0% were male. At a mean follow-up 2.4 ± 1.1 years, 33 MACE occurred (13 deaths, 8 MI, 12 REV) [8.25%; annualized rate 3.4%]. By univariate analysis, per-patient maximal stenosis [hazards ratio (HR) 2.24 per stenosis grade, 95% confidence interval (CI) 1.61–3.10, p < 0.001], increasing numbers of obstructive vessels (HR 2.30 per vessel, 95% CI 1.75–3.03, p < 0.001) and segment stenosis score (HR 1.14 per segment, 95% CI 1.09–1.19, p < 0.001) were associated with increased MACE. After adjustment for CAD risk factors and CACS, maximal stenosis (HR 1.80 per grade, 95% CI 1.18–2.75, p = 0.006), number of obstructive vessels (HR 1.85 per vessel, 95% CI 1.29–2.65, p < 0.001) and segment stenosis score (HR 1.11 per segment, 95% CI 1.05–1.18, p < 0.001) were associated with increased risk of

  9. Risk of nodal metastases at laparoscopic pelvic lymphadenectomy using PSA, Gleason score, and clinical stage in men with localized prostate cancer.

    Science.gov (United States)

    Hoenig, D M; Chi, S; Porter, C; Tackett, L; Smith, D S; Cohen, S I; Stein, B S

    1997-08-01

    Laparoscopic pelvic lymph node dissection (LPLND) is a low-morbidity procedure used to stage prostate cancer accurately prior to definitive local therapy. To better select patients for LPLND, we reviewed the clinical features of 120 patients with clinically localized prostate cancer who underwent LPLND to define significant risk factors for nodal metastases. The age ranged from 43 to 79 years (mean 68). Serum prostate specific antigen (PSA) concentration ranged from 1.3 to 329 ng/mL, Gleason score ranged from 2 to 9, and clinical stage ranged from T1b to T3c. Nodal metastases were discovered in 15 patients (13%). Among men with a Gleason score > or = 7, 21% had nodal metastases (P = 0.004). A serum PSA > 20 ng/mL and clinical stage T1b, T2b, or greater also were statistically significant predictors of lymph node metastases (20% and 19%, respectively). In multivariate analysis, Gleason score significantly predicted nodal metastases when controlling for all other clinical measures. Therefore, LPLND is indicated for any patient with a Gleason score > or = 7, PSA > 20 ng/mL, and advanced clinical T stage, independently or in combination.

  10. Apgar Scores

    Science.gov (United States)

    ... Stages Listen Español Text Size Email Print Share Apgar Scores Page Content Article Body As soon as your ... the syringe, but is blue; her one minute Apgar score would be 8—two points off because she ...

  11. Comparison of Accuracy of Diabetes Risk Score and Components of the Metabolic Syndrome in Assessing Risk of Incident Type 2 Diabetes in Inter99 Cohort

    DEFF Research Database (Denmark)

    Shafizadeh, Tracy B; Moler, Edward J; Kolberg, Janice A

    2011-01-01

    Background: Given the increasing worldwide incidence of diabetes, methods to assess diabetes risk which would identify those at highest risk are needed. We compared two risk-stratification approaches for incident type 2 diabetes mellitus (T2DM); factors of metabolic syndrome (MetS) and a previously...

  12. Surgical Treatment for Adult Spinal Deformity: Projected Cost Effectiveness at 5-Year Follow-Up

    Science.gov (United States)

    Terran, Jamie; McHugh, Brian J.; Fischer, Charla R.; Lonner, Baron; Warren, Daniel; Glassman, Steven; Bridwell, Keith; Schwab, Frank; Lafage, Virginie

    2014-01-01

    Background In the United States, expenditures related to spine care are estimated to account for $86 billion annually. Policy makers have set a cost-effectiveness benchmark of less than $100,000/quality adjusted life year (QALY), forcing surgeons to defend their choices economically. This study projects the cost/QALY for surgical treatment of adult spinal deformity at 5-year follow-up based on 2-year cost- and health-related quality-of-life (HRQOL) data. Methods In a review of 541 patients with adult spinal deformity, the patients who underwent revision or were likely to undergo revision were identified and cost of surgery was doubled to account for the second procedure; all other patients maintained the cost of the initial surgery. Oswestry Disability Index (ODI) was modeled by revision status based on literature findings. Total surgical cost was based on Medicare reimbursement. Chi square and student t tests were utilized to compare cost-effective and non–cost-effective patients. Results The average cost/QALY at 5-year follow-up was $120,311.73. A total of 40.7% of patients fell under the threshold of a cost/QALY <$100,000. Cost-effective patients had higher baseline ODI scores (45% vs 34% [P=0.001]), lower baseline total Scoliosis Research Society scores (2.89 vs 3.00 [P=0.04]), and shorter fusions (8.23 vs 9.87 [P=0.0001]). Conclusion We found 40.7% of patients to be below the threshold of cost effectiveness. Factors associated with reaching the threshold <$100,000/QALY were greater preoperative disability, diagnosis of idiopathic scoliosis, poor preoperative HRQOL scores, and fewer fusion levels. PMID:24688328

  13. Resting Heart Rate Is Not a Good Predictor of a Clustered Cardiovascular Risk Score in Adolescents: The HELENA Study.

    Directory of Open Access Journals (Sweden)

    Augusto César Ferreira de Moraes

    Full Text Available Resting heart rate (RHR reflects sympathetic nerve activity a significant association between RHR and all-cause and cardiovascular mortality has been reported in some epidemiologic studies.To analyze the predictive power and accuracy of RHR as a screening measure for individual and clustered cardiovascular risk in adolescents. The study comprised 769 European adolescents (376 boys participating in the HELENA cross-sectional study (2006-2008 were included in this study. Measurements on systolic blood pressure, HOMA index, triglycerides, TC/HDL-c, VO2máx and the sum of four skinfolds were obtained, and a clustered cardiovascular disease (CVD risk index was computed. The receiver operating characteristics curve was applied to calculate the power and accuracy of RHR to predict individual and clustered CVD risk factors.RHR showed low accuracy for screening CVD risk factors in both sexes (range 38.5%-54.4% in boys and 45.5%-54.3% in girls. Low specificity's (15.6%-19.7% in boys; 18.1%-20.0% in girls were also found. Nevertheless, the sensitivities were moderate-to-high (61.4%-89.1% in boys; 72.9%-90.3% in girls.RHR is a poor predictor of individual CVD risk factors and of clustered CVD and the estimates based on RHR are not accurate. The use of RHR as an indicator of CVD risk in adolescents may produce a biased screening of cardiovascular health in both sexes.

  14. Second-generation autologous chondrocyte transplantation: MRI findings and clinical correlations at a minimum 5-year follow-up

    Energy Technology Data Exchange (ETDEWEB)

    Kon, E. [Biomechanics Laboratory, III Clinic, Rizzoli Orthopaedic Institute, Via Di Barbiano 1/10, 40136 Bologna (Italy); Di Martino, A., E-mail: a.dimartino@biomec.ior.it [Biomechanics Laboratory, III Clinic, Rizzoli Orthopaedic Institute, Via Di Barbiano 1/10, 40136 Bologna (Italy); Filardo, G. [Biomechanics Laboratory, III Clinic, Rizzoli Orthopaedic Institute, Via Di Barbiano 1/10, 40136 Bologna (Italy); Tetta, C.; Busacca, M. [Radiology, Rizzoli Orthopaedic Institute, Bologna (Italy); Iacono, F. [Biomechanics Laboratory, III Clinic, Rizzoli Orthopaedic Institute, Via Di Barbiano 1/10, 40136 Bologna (Italy); Delcogliano, M. [Orthopaedic Departement San Carlo di Nancy Hospital, Rome (Italy); Albisinni, U. [Radiology, Rizzoli Orthopaedic Institute, Bologna (Italy); Marcacci, M. [Biomechanics Laboratory, III Clinic, Rizzoli Orthopaedic Institute, Via Di Barbiano 1/10, 40136 Bologna (Italy)

    2011-09-15

    Objective: To evaluate the clinical outcome of hyaluronan-based arthroscopic autologous chondrocyte transplantation at a minimum of 5 years of follow-up and to correlate it with the MRI evaluation parameters. Methods: Fifty consecutive patients were included in the study and evaluated clinically using the Cartilage Standard Evaluation Form as proposed by ICRS and the Tegner score. Forty lesions underwent MRI evaluation at a minimum 5-year follow-up. For the description and evaluation of the graft, we employed the MOCART-scoring system. Results: A statistically significant improvement in all clinical scores was observed at 2 and over 5 years. The total MOCART score and the signal intensity (3D-GE-FS) of the repair tissue were statistically correlated to the IKDC subjective evaluation. Larger size of the treated cartilage lesions had a negative influence on the degree of defect repair and filling, the integration to the border zone and the subchondral lamina integrity, whereas more intensive sport activity had a positive influence on the signal intensity of the repair tissue, the repair tissue surface, and the clinical outcome. Conclusion: Our findings confirm the durability of the clinical results obtained with Hyalograft C and the usefulness of MRI as a non-invasive method for the evaluation of the repaired tissue and the outcome after second-generation autologous transplantation over time.

  15. The predictive capacity of the Glasgow-Blatchford score for the risk stratification of upper gastrointestinal bleeding in an emergency department

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    José Manuel Recio-Ramírez

    2015-05-01

    Full Text Available Objectives: To assess the ability of the Glasgow Blatchford Score (GBS system to identify the need for urgent upper gastrointestinal endoscopy (UGIE in patients with upper gastrointestinal bleeding (UGIB. Methods: An observational, retrospective study was carried out in all patients attended at the ER for suspected UGIB in one year. Patients were split into two categories -high-risk (>2 and low-risk (≤2- by means of the GBS system. Results: A total of 60 patients were included. Of these, 46 were classified as "high-risk" (> 2 and 14 as "low-risk" (≤ 2 subjects. The characteristics of patients in the low-risk group included: Mean age: 46.6 ± 13.7 (18-88 years. Males/females: 7/7. Urgent endoscopy revealed: normal (50%; n = 7; esophagitis (21.4%; n = 3; gastritis (14.2%; n = 2; Mallory-Weiss syndrome (7.1%; n = 1; non-bleeding varices (7.1%; n = 1. The characteristics of patients in the high-risk group included: Mean age: 68.7 ± 19.8 (31-91 years. Males/females: 30/16. Digestive endoscopy revealed: Gastric/duodenal ulcer (56.52%; n = 26; normal (17.39%; n = 8; esophagitis (8.69%; n = 4; gastritis (8.69%; n = 4; angioectasia (4.34%; n = 2; bleeding varices (4.34%; n = 2. Low-risk patients exhibited no lesions requiring urgent management during endoscopy, and the sensitivity of the GBS scale for high-risk UGIB detection was found to be 100% (95% CI: 86.27%, 99.71%, with a specificity of 48.28% (95% CI: 29.89, 67.1%. Conclusions: The GBS scale seems to accurately identify patients with low-risk UGIB, who may be managed on an outpatient basis and undergo delayed upper GI endoscopy at the outpatient clinic.

  16. In-hospital prognosis in non-ST-segment elevation acute coronary syndrome derived using a new risk score based on electrocardiographic parameters obtained at admission.

    Science.gov (United States)

    Jiménez-Candil, Javier; González Matas, José Manuel; Cruz González, Ignacio; Hernández Hernández, Jesús; Martín, Ana; Pabón, Pedro; Martín, Francisco; Martín-Luengo, Cándido

    2010-07-01

    Several electrocardiographic variables are of prognostic value in non-ST-segment elevation acute coronary syndrome (NSTEACS). From observations in 427 patients, we developed a new risk score (the ECG-RS) based on admission ECG findings that can be used to determine the likelihood of death or recurrent ischemia during hospitalization, which occurred in 36% of patients. Logistic regression analysis, which considered seven electrocardiographic variables and variables from the Thrombolysis in Myocardial Infarction (TIMI) risk score, identified the following significant predictors: corrected QT interval (QTc) > or =450 ms (odds ratio 4.2, Psegment depression >0.5 mm (odds ratio 2.7, P or =450 ms, 2 points for ST-segment depression >0.5 mm, and 1 point for left atrial enlargement. When patients were divided into three groups on the basis of their ECG-RSs (i.e. or =4), the risk of death or recurrent ischemia was significantly different between the groups, at 11%, 27% and 58%, respectively (P< .001). In conclusion, the new ECG-RS provides a simple, rapid and accurate means of determining prognosis in patients with NSTEACS.

  17. Equine-associated maxillofacial injuries: retrospective 5-year analysis.

    Science.gov (United States)

    Islam, Shofiq; Gupta, Benjamin; Taylor, Christopher J; Chow, Jeffrey; Hoffman, Gary R

    2014-02-01

    We explored the relation between the causes of facial injuries in equestrians and the presence or absence of associated injuries. Over a 5-year period we retrospectively reviewed all patients who presented to the John Hunter Hospital, New South Wales, with facial injuries that had resulted from activity with horses. We analysed the rates of hard and soft tissue injuries, and of associated injuries by sex and mechanism. A total of 85 patients were included (50 female and 35 male) with an age range of 2-88 years. There was a significant difference in the rate of maxillofacial and associated injuries when groups were analysed for sex and mechanism of injury. Facial injuries caused by falling from a horse were more often associated with other injuries in men than in women (p<0.05), and men were 4 times more likely to present with associated injuries than women (OR 3.9; 95% CI 1.1 to 14) We also found significant differences in the rates of facial fracture. Women who had been kicked by a horse were more likely to sustain bony injuries than men (p<0.05). Our data confirm the association between kicks and facial fracture, and this may provide an impetus for the development of appropriate protective equipment. Patients who sustain facial injuries when falling from a horse often present with associated injuries and this has practical implications for clinicians involved in their management.

  18. Undergraduates’ opinion after 5-year experience with rotary endodontic instruments

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    Flávia Sens Fagundes Tomazinho

    2011-01-01

    Full Text Available Introduction: Dentistry evolution in the past few years has revolutionized daily practice in some specialties. One of these revolutions has occurred in Endodontics due to the advancement of rotary techniques for root canal preparation and its subsequent incorporation into the teaching of Dentistry undergraduates. Objective: The aim of this study was to report a 5-year experience on the undergraduate laboratorial and clinical use of rotary endodontic preparation at a private university. Material and methods: Data survey was performed by using a questionnaire composed of nine objective questions; the questionnaire was answered by the undergraduates. Results: The results showed a positive acceptance regarding the undergraduate teaching of the rotary technique (94.7%. The following advantages were highlighted: faster root canal preparation (91.6% and reduction of patient’s stress (80.9%. Conclusion: It can be concluded that the experience with the two undergraduate groups was excellent due to the high acceptance level of the new technique by the students.

  19. Construction and Validation of a 14-Year Cardiovascular Risk Score for Use in the General Population: The Puras-GEVA Chart

    Science.gov (United States)

    Artigao-Ródenas, Luis Miguel; Carbayo-Herencia, Julio Antonio; Palazón-Bru, Antonio; Divisón-Garrote, Juan Antonio; Sanchis-Domènech, Carlos; Vigo-Aguiar, Isabel; Gil-Guillén, Vicente Francisco

    2015-01-01

    Abstract The current cardiovascular risk tables are based on a 10-year period and therefore, do not allow for predictions in the short or medium term. Thus, we are unable to take more aggressive therapeutic decisions when this risk is very high. To develop and validate a predictive model of cardiovascular disease (CVD), to enable calculation of risk in the short, medium and long term in the general population. Cohort study with 14 years of follow-up (1992–2006) was obtained through random sampling of 342,667 inhabitants in a Spanish region. Main outcome: time-to-CVD. The sample was randomly divided into 2 parts [823 (80%), construction; 227 (20%), validation]. A stepwise Cox model was constructed to determine which variables at baseline (age, sex, blood pressure, etc) were associated with CVD. The model was adapted to a points system and risk groups based on epidemiological criteria (sensitivity and specificity) were established. The risk associated with each score was calculated every 2 years up to a maximum of 14. The estimated model was validated by calculating the C-statistic and comparison between observed and expected events. In the construction sample, 76 patients experienced a CVD during the follow-up (82 cases per 10,000 person-years). Factors in the model included sex, diabetes, left ventricular hypertrophy, occupational physical activity, age, systolic blood pressure × heart rate, number of cigarettes, and total cholesterol. Validation yielded a C-statistic of 0.886 and the comparison between expected and observed events was not significant (P: 0.49–0.75). We constructed and validated a scoring system able to determine, with a very high discriminating power, which patients will develop a CVD in the short, medium, and long term (maximum 14 years). Validation studies are needed for the model constructed. PMID:26632692

  20. The use of exome genotyping to predict pathological Gleason score upgrade after radical prostatectomy in low-risk prostate cancer patients.

    Directory of Open Access Journals (Sweden)

    Jong Jin Oh

    Full Text Available Active surveillance (AS is a promising option for patients with low-risk prostate cancer (PCa, however current criteria could not select the patients correctly, many patients who fulfilled recent AS criteria experienced pathological Gleason score upgrade (PGU after radical prostatectomy (RP. In this study, we aimed to develop an accurate model for predicting PGU among low-risk PCa patients by using exome genotyping.We genotyped 242,221 single nucleotide polymorphisms (SNPs on a custom HumanExome BeadChip v1.0 (Illuminam Inc. in blood DNA from 257 low risk PCa patients (PSA <10 ng/ml, biopsy Gleason score (GS ≤6 and clinical stage ≤T2a who underwent radical prostatectomy. Genetic data were analyzed using an unconditional logistic regression to calculate an odds ratio as an estimate of relative risk of PGU, which defined pathologic GS above 7. Among them, we selected persistent SNPs after multiple testing using FDR method, and we compared accuracies from the multivariate logistic model incorporating clinical factors between included and excluded selected SNP information.After analysis of exome genotyping, 15 SNPs were significant to predict PGU in low risk PCa patients. Among them, one SNP--rs33999879 remained significant after multiple testing. When a multivariate model incorporating factors in Epstein definition--PSA density, biopsy GS, positive core number, tumor per core ratio and age was devised for the prediction of PGU, the predictive accuracy of the multivariate model was 78.4% (95%CI: 0.726-0.834. By addition the factor of rs33999879 in aforementioned multivariate model, the predictive accuracy was 82.9%, which was significantly increased (p = 0.0196.The rs33999879 SNP is a predictor for PGU. The addition of genetic information from the exome sequencing effectively enhanced the predictive accuracy of the multivariate model to establish suitable active surveillance criteria.

  1. Comparing risk of new onset diabetes mellitus in chronic kidney disease patients receiving peritoneal dialysis and hemodialysis using propensity score matching.

    Directory of Open Access Journals (Sweden)

    Che-Yi Chou

    Full Text Available Chronic kidney disease (CKD patients are at risk for developing new-onset diabetes mellitus (NODM even after hemodialysis (HD and peritoneal dialysis (PD treatment. It is not clear if the incidence for NODM is different in CKD patients receiving HD and PD. This study compared the risk of NODM in PD patients and HD patients.All HD and PD patients in Taiwan Renal Registry Database from 1997 to 2005 were included and all patients were followed to December 31, 2008. The risk of NODM was analyzed in PD patients and propensity score matched HD patients using logistic regression for early type NODM (6 months after dialysis.A total of 2548 PD patients and 10192 HD patients who had no diabetes on the initiation of dialysis were analyzed. The incidence for NODM was 3.7 per 100 patient/year for HD and 2.4 for PD patients. HD patients are more at risk for developing early type NODM (p<0.001 with an adjusted odds ratio of 1.41 [95% confidence interval (CI 1.12-1.78]. HD patients are more at risk for late type NODM (p<0.001 with an adjusted hazard ratio of 2.01 (95% CI: 1.77-2.29. Patient's age was negatively associated with risk of early type of NODM (p<0.001 but positively associated with risk of late type NODM (p<0.001.Chronic kidney disease patients receiving hemodialysis are more at risk for developing new-onset diabetes mellitus compared to those receiving peritoneal dialysis.

  2. Scoring methods and results for qualitative evaluation of public health impacts from the Hanford high-level waste tanks. Integrated Risk Assessment Program

    Energy Technology Data Exchange (ETDEWEB)

    Buck, J.W.; Gelston, G.M.; Farris, W.T.

    1995-09-01

    The objective of this analysis is to qualitatively rank the Hanford Site high-level waste (HLW) tanks according to their potential public health impacts through various (groundwater, surface water, and atmospheric) exposure pathways. Data from all 149 single-shell tanks (SSTs) and 23 of the 28 double-shell tanks (DSTs) in the Tank Waste Remediation System (TWRS) Program were analyzed for chemical and radiological carcinogenic as well as chemical noncarcinogenic health impacts. The preliminary aggregate score (PAS) ranking system was used to generate information from various release scenarios. Results based on the PAS ranking values should be considered relative health impacts rather than absolute risk values.

  3. Long-term efficacy of risedronate: a 5-year placebo-controlled clinical experience

    DEFF Research Database (Denmark)

    Sorensen, O H; Crawford, G M; Mulder, H;

    2003-01-01

    turnover. A total of 265 women (placebo, 130; 5 mg risedronate, 135) entered the study extension and 220 (83%) completed the additional 2 years. Fracture results observed in the study extension were consistent with those observed in the first 3 years. The risk of new vertebral fractures was significantly....... Increases in spine and hip bone mineral density that occurred in the risedronate group during the first 3 years were maintained or increased with a further 2 years of treatment. The mean increase from baseline in lumbar spine BMD over 5 years was 9.3% (P

  4. Conservative management of chronic gastric volvulus:44 cases over 5 years

    Institute of Scientific and Technical Information of China (English)

    Yao-Chun; Hsu; Chin-Lin; Perng; Jai-Jen; Tsai; Hwai-Jeng; Lin

    2010-01-01

    AIM:To investigate clinical outcomes of patients with chronic gastric volvulus(GV)who were managed conservatively over a 5-year period.METHODS:A total of 44 consecutive patients with chronic GV,as diagnosed by barium study between October 2002 and July 2008 were investigated.All of these patients received conservative management initially without anatomical correction.Their clinical manifestations,diagnostic work-ups,and clinical outcomes were analyzed.We sought to identify independent risk factors for poor...

  5. Literature-based genetic risk scores for coronary heart disease : the Cardiovascular Registry Maastricht (CAREMA) Prospective Cohort Study

    NARCIS (Netherlands)

    Vaathorst, A.A.; Lu Yingchang (Kevin), Y.; Heijmans, B.T.; Dolle, M.E.; Bohringer, S.; Putter, de H.; Imholz, S.; Merry, A.H.; Greevenbroek, M.M.; Jukema, J.W.; Gorgels, A.P.; Brandt, van den P.A.; Muller, M.R.; Schouten, L.J.; Feskens, E.J.M.; Boer, J.M.A.; Slagboom, P.E.

    2012-01-01

    Background-Genome-wide association studies (GWAS) have identified many single-nucleotide polymorphisms (SNPs) associated with coronary heart disease (CHD) or CHD risk factors (RF). Using a case-cohort study within the prospective Cardiovascular Registry Maastricht (CAREMA) cohort, we tested if genet

  6. Evaluation of primary androgen deprivation therapy in prostate cancer patients using the J-CAPRA risk score

    Directory of Open Access Journals (Sweden)

    Hideyuki Akaza

    2013-06-01

    Conclusions: Based on large-scale registry data, this report is the first to analyze the outcomes of MAB therapy in patients with prostate cancer at a wide range of disease stages. MAB therapy may provide significant survival benefits in intermediate- and high-risk patients.

  7. Social competence of 3 to 5-year-old children born with low birth weight

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    Nurul Komariah

    2015-05-01

    Full Text Available Background Low birth weight (LBW has long been used as an indicator of public health. Low birth weight is not a proxy for any dimension of other maternal or perinatal health outcomes. Low birth weight infants require special care, and have more chronic conditions, learning delays, and attention deficit hyperactivity disorders compared to infants of normal birth weight (NBW. Social competence is viewed as a primary component of healthy function and development and is an important predictor of academic and financial success.Objective To examine social competence of children aged 3-5 years born with low birth weight.Methods This cross-sectional study was undertaken in Palembang in 2012. Subjects consisted of children aged 3-5 years attended a preschool in the Seberang Ulu I District, Palembang, and were divided into two groups: low birth weight (LBW and normal birth weight (NBW. Social competence was assessed by observation and Interaction Rating Scale (IRS and Parenting Style questionnaire (PSQ. Chi-square analysis was used to compare social competence between the two groups. Multivariate regression logistic analysis was used to assess for the dominant factors that may affect a child’s social competence.Results Low birth weight children aged 3 to 5 years had a 1.435 times higher risk of low social competence compared to normal birth weight children of similar age. (RP 1.435; 95%CI 1.372 to 13.507; P=0.019. Multivariate regression logistic analysis revealed that parenting style was a dominant factor affecting social competence.Conclusion Social competence in 3 to 5-year-old children born with low birth weight is lower compared to those with normal birth weight.

  8. Laboratory-based and office-based risk scores and charts to predict 10-year risk of cardiovascular disease in 182 countries

    DEFF Research Database (Denmark)

    Ueda, Peter; Woodward, Mark; Lu, Yuan

    2017-01-01

    and southeast Asia and eastern Europe, including China and Russia. In HICs, the proportion of people aged 40-64 years at high risk of CVD ranged from 1% for South Korean women to 42% for Czech men (using a ≥10% risk threshold), and in low-income countries ranged from 2% in Uganda (men and women) to 13...

  9. Multimarker Strategy for Short-Term Risk Assessment in Patients With Dyspnea in the Emergency Department The MARKED (Multi mARKer Emergency Dyspnea)-Risk Score

    NARCIS (Netherlands)

    Eurlings, Luc W.; Sanders-van Wijk, Sandra; van Kimmenade, Roland; Osinski, Aart; van Helmond, Lidwien; Vallinga, Maud; Crijns, Harry J.; van Dieijen-Visser, Marja P.; Brunner-La Rocca, Hans-Peter; Pinto, Yigal M.

    2012-01-01

    Objectives The study aim was to determine the prognostic value of a multimarker strategy for risk-assessment in patients presenting to the emergency department (ED) with dyspnea. Background Combining biomarkers with different pathophysiological backgrounds may improve risk stratification in dyspneic

  10. Validation of a Dutch risk score predicting poor outcome in adults with bacterial meningitis in Vietnam and Malawi.

    Directory of Open Access Journals (Sweden)

    Ewout S Schut

    Full Text Available We have previously developed and validated a prognostic model to predict the risk for unfavorable outcome in Dutch adults with bacterial meningitis. The aim of the current study was to validate this model in adults with bacterial meningitis from two developing countries, Vietnam and Malawi. Demographic and clinical characteristics of Vietnamese (n = 426, Malawian patients (n = 465 differed substantially from those of Dutch patients (n = 696. The Dutch model underestimated the risk of poor outcome in both Malawi and Vietnam. The discrimination of the original model (c-statistic [c] 0.84; 95% confidence interval 0.81 to 0.86 fell considerably when re-estimated in the Vietnam cohort (c = 0.70 or in the Malawian cohort (c = 0.68. Our validation study shows that new prognostic models have to be developed for these countries in a sufficiently large series of unselected patients.

  11. Professionally applied fluoride gel in low-caries 10.5-year-olds.

    Science.gov (United States)

    Truin, G J; van 't Hof, M A

    2005-05-01

    The question has been raised whether low-caries children regularly using fluoride toothpaste will benefit from the professional application of additional fluoride gel. To investigate the caries-reducing effect of semi-annually-applied neutral 1% sodium fluoride gel, we carried out a double-blind randomized controlled clinical trial (n = 594) in a child population, initially aged 9.5-11.5 years, with baseline caries experience of D3MFS = 0 (decayed, missing, and filled tooth surfaces of permanent teeth). The mean number of tooth surfaces saved from caries development by fluoride gel application after 4 years was 0.2 D3MFS (SE = 0.17). The preventive fraction (PF) showed a mean relative effect of professionally applied fluoride gel of 18%. The cariostatic effect of the fluoride gel on pits and fissures would have been influenced by the sealant strategy in the study. Professionally applied fluoride gel showed no statistically significant effect on mean D3MFS score in low-caries 9.5- to 11.5-year-olds.

  12. A 5-year prospective observational study of the outcomes of international treatment guidelines for Crohn's disease.

    LENUS (Irish Health Repository)

    Cullen, Garret

    2012-02-01

    BACKGROUND & AIMS: Therapeutic strategies for patients with Crohn\\'s disease are based on American and European guidelines. High rates of corticosteroid dependency and low remission rates are identified as weaknesses of this therapy and as justification for early introduction of biologic agents (top-down treatment) in moderate\\/severe Crohn\\'s disease. We reviewed outcomes and corticosteroid-dependency rates of patients with moderate-to-severe disease who were treated according to the international guidelines. METHODS: Consecutive patients (102) newly diagnosed with Crohn\\'s disease in 2000-2002 were identified from a prospectively maintained database. Severity of disease was scored using the Harvey-Bradshaw Index (HBI). Disease was classified by Montreal classification. Five-year follow-up data were recorded. RESULTS: Seventy-two patients had moderate\\/severe disease at diagnosis (HBI >8). Fifty-four (75%) had nonstricturing, nonpenetrating disease (B1). Sixty-four (89%) received corticosteroids, and 44 (61%) received immunomodulators. Twenty-one patients (29%) received infliximab. Thirty-nine patients (54%) required resection surgery. At a median of 5 years, 66 of 72 (92%) patients with moderate\\/severe disease were in remission (median HBI, 1). Twenty-five patients (35%) required neither surgery nor biologic therapy. CONCLUSIONS: When international treatment guidelines are strictly followed, Crohn\\'s disease patients can achieve high rates of remission and low rates of morbidity at 5 years. Indiscriminate use of biologic agents therefore is not appropriate for all patients with moderate-to-severe disease.

  13. Configuring Balanced Scorecards for Measuring Health System Performance: Evidence from 5 Years' Evaluation in Afghanistan

    Science.gov (United States)

    Edward, Anbrasi; Kumar, Binay; Kakar, Faizullah; Salehi, Ahmad Shah; Burnham, Gilbert; Peters, David H.

    2011-01-01

    Background In 2004, Afghanistan pioneered a balanced scorecard (BSC) performance system to manage the delivery of primary health care services. This study examines the trends of 29 key performance indicators over a 5-year period between 2004 and 2008. Methods and Findings Independent evaluations of performance in six domains were conducted annually through 5,500 patient observations and exit interviews and 1,500 provider interviews in >600 facilities selected by stratified random sampling in each province. Generalized estimating equation (GEE) models were used to assess trends in BSC parameters. There was a progressive improvement in the national median scores scaled from 0–100 between 2004 and 2008 in all six domains: patient and community satisfaction of services (65.3–84.5, pperformance benchmarking during the 5-year period. However, scorecard reconfigurations are needed to integrate effectiveness and efficiency measures and accommodate changes in health systems policy and strategy architecture to ensure its continued relevance and effectiveness as a comprehensive health system performance measure. The process of BSC design and implementation can serve as a valuable prototype for health policy planners managing performance in similar health care contexts. Please see later in the article for the Editors' Summary PMID:21814499

  14. Cocoa flavanol intake improves endothelial function and Framingham Risk Score in healthy men and women: a randomised, controlled, double-masked trial: the Flaviola Health Study.

    Science.gov (United States)

    Sansone, Roberto; Rodriguez-Mateos, Ana; Heuel, Jan; Falk, David; Schuler, Dominik; Wagstaff, Rabea; Kuhnle, Gunter G C; Spencer, Jeremy P E; Schroeter, Hagen; Merx, Marc W; Kelm, Malte; Heiss, Christian

    2015-10-28

    Cocoa flavanol (CF) intake improves endothelial function in patients with cardiovascular risk factors and disease. We investigated the effects of CF on surrogate markers of cardiovascular health in low risk, healthy, middle-aged individuals without history, signs or symptoms of CVD. In a 1-month, open-label, one-armed pilot study, bi-daily ingestion of 450 mg of CF led to a time-dependent increase in endothelial function (measured as flow-mediated vasodilation (FMD)) that plateaued after 2 weeks. Subsequently, in a randomised, controlled, double-masked, parallel-group dietary intervention trial (Clinicaltrials.gov: NCT01799005), 100 healthy, middle-aged (35-60 years) men and women consumed either the CF-containing drink (450 mg) or a nutrient-matched CF-free control bi-daily for 1 month. The primary end point was FMD. Secondary end points included plasma lipids and blood pressure, thus enabling the calculation of Framingham Risk Scores and pulse wave velocity. At 1 month, CF increased FMD over control by 1·2 % (95 % CI 1·0, 1·4 %). CF decreased systolic and diastolic blood pressure by 4·4 mmHg (95 % CI 7·9, 0·9 mmHg) and 3·9 mmHg (95 % CI 6·7, 0·9 mmHg), pulse wave velocity by 0·4 m/s (95 % CI 0·8, 0·04 m/s), total cholesterol by 0·20 mmol/l (95 % CI 0·39, 0·01 mmol/l) and LDL-cholesterol by 0·17 mmol/l (95 % CI 0·32, 0·02 mmol/l), whereas HDL-cholesterol increased by 0·10 mmol/l (95 % CI 0·04, 0·17 mmol/l). By applying the Framingham Risk Score, CF predicted a significant lowering of 10-year risk for CHD, myocardial infarction, CVD, death from CHD and CVD. In healthy individuals, regular CF intake improved accredited cardiovascular surrogates of cardiovascular risk, demonstrating that dietary flavanols have the potential to maintain cardiovascular health even in low-risk subjects.

  15. The first Latin-American risk stratification system for cardiac surgery: can be used as a graphic pocket-card score.

    Science.gov (United States)

    Carosella, Victorio C; Navia, Jose L; Al-Ruzzeh, Sharif; Grancelli, Hugo; Rodriguez, Walter; Cardenas, Cesar; Bilbao, Jorge; Nojek, Carlos

    2009-08-01

    This study aims to develop the first Latin-American risk model that can be used as a simple, pocket-card graphic score at bedside. The risk model was developed on 2903 patients who underwent cardiac surgery at the Spanish Hospital of Buenos Aires, Argentina, between June 1994 and December 1999. Internal validation was performed on 708 patients between January 2000 and June 2001 at the same center. External validation was performed on 1087 patients between February 2000 and January 2007 at three other centers in Argentina. In the development dataset the area under receiver operating characteristics (ROC) curve was 0.73 and the Hosmer-Lemeshow (HL) test was P=0.88. In the internal validation ROC curve was 0.77. In the external validation ROC curve was 0.81, but imperfect calibration was detected because the observed in-hospital mortality (3.96%) was significantly lower than the development dataset (8.20%) (Pcard score allows an easy bedside application with acceptable statistic precision.

  16. Neurotrophic factor-related gene polymorphisms and adult attention deficit hyperactivity disorder (ADHD) score in a high-risk male population.

    Science.gov (United States)

    Conner, Alex C; Kissling, Christian; Hodges, Edward; Hünnerkopf, Regina; Clement, R Marc; Dudley, Edward; Freitag, Christine M; Rösler, Michael; Retz, Wolfgang; Thome, Johannes

    2008-12-05

    Adult attention deficit hyperactivity disorder (ADHD) is a widely under-reported but nevertheless common condition with a clear heritable component. Several genes have been proposed to play a role in the childhood onset of this neurodevelopmental disorder; however, association studies of persistence of ADHD into adulthood have rarely been performed. Neurotrophic factors (NTFs) are known to be involved in several aspects of neuronal development and neural plasticity in adults. They have also been linked, particularly through brain-derived neurotrophic factor (BDNF) interaction with dopamine transport, to the pathophysiology of ADHD. This study compares the genotypes of six different single nucleotide polymorphisms of genes within the neurotrophin system and their possible association with adult ADHD score in 143 high-risk male subjects referred to a forensic psychiatric unit. The genes included NTF3, NTRK2 (TrkB), NTRK3 (TrkC), BDNF, and p75(NTR). While none of the SNPs showed significant association with ADHD symptoms, one polymorphism within the exon of NTF3 (rs6332) showed a trend toward an association between the A-allele and increased scores using both the retrospective childhood analysis Wender-Utah Rating Scale (WURS-k) (P = 0.05) and the adult ADHD assessment Wender-Reimherr interview (P = 0.03). This SNP is a silent mutation which might be in linkage disequilibrium with a functional risk variant for ADHD. As the association was only suggestive, however, this finding needs replication in a larger study with higher power.

  17. WMAP 5-year constraints on α and me

    Science.gov (United States)

    Scóccola, Claudia G.; Landau, Susana J.; Vucetich, Héctor

    2010-11-01

    We have studied the role of fundamental constants in an updated recombination scenario. We focus on the time variation of the fine structure constant α, and the electron mass me in the early Universe. In the last years, helium recombination has been studied in great detail revealing the importance of taking new physical processes into account in the calculation of the recombination history. The equations to solve the detailed recombination scenario can be found for example in Wong et al. 2008. In the equation for helium recombination, a term which accounts for the semi-forbidden transition 23p-11s is added. Furthermore, the continuum opacity of HI is taken into account by a modification in the escape probability of the photons that excite helium atoms, with the fitting formulae proposed Kholupenko et al 2007. We have analized the dependences of the quantities involved in the detailed recombination scenario on α and me. We have performed a statistical analysis with COSMOMC to constrain the variation of α and me at the time of neutral hydrogen formation. The observational set used for the analysis was data from the WMAP 5-year temperature and temperature-polarization power spectrum and other CMB experiments such as CBI, ACBAR and BOOMERANG and the power spectrum of the 2dFGRS. Considering the joint variation of α and me we obtain the following bounds: -0.011 Landau et al 2008, which were obtained in the standard recombination scenario and using WMAP 3 year release data. The constraints are tighter in the current analysis, which is an expectable fact since we are working with more accurate data from WMAP. The bounds obtained are consistent with null variation, for both α and me, but in the present analysis, the 68% confidence limits on the variation of both constants have changed. In the case of α, the present limit is more consistent with null variation than the previous one, while in the case of me the single parameters limits have moved toward lower values

  18. Predicting mortality after congenital heart surgeries: Evaluation of the Aristotle and Risk Adjustement in Congenital Heart surgery-1 risk prediction scoring systems: A retrospective single center analysis of 1150 patients

    Directory of Open Access Journals (Sweden)

    Shreedhar S Joshi

    2014-01-01

    Full Text Available Aims and Objectives: To validate Aristotle basic complexity and Aristotle comprehensive complexity (ABC and ACC and risk adjustment in congenital heart surgery-1 (RACHS-1 prediction models for in hospital mortality after surgery for congenital heart disease in a single surgical unit. Materials and Methods: Patients younger than 18 years, who had undergone surgery for congenital heart diseases from July 2007 to July 2013 were enrolled. Scoring for ABC and ACC scoring and assigning to RACHS-1 categories were done retrospectively from retrieved case files. Discriminative power of scoring systems was assessed with area under curve (AUC of receiver operating curves (ROC. Calibration (test for goodness of fit of the model was measured with Hosmer-Lemeshow modification of χ2 test. Net reclassification improvement (NRI and integrated discrimination improvement (IDI were applied to assess reclassification. Results: A total of 1150 cases were assessed with an all-cause in-hospital mortality rate of 7.91%. When modeled for multivariate regression analysis, the ABC (χ2 = 8.24, P = 0.08, ACC (χ2 = 4.17 , P = 0.57 and RACHS-1 (χ2 = 2.13 , P = 0.14 scores showed good overall performance. The AUC was 0.677 with 95% confidence interval (CI of 0.61-0.73 for ABC score, 0.704 (95% CI: 0.64-0.76 for ACC score and for RACHS-1 it was 0.607 (95%CI: 0.55-0.66. ACC had an improved predictability in comparison to RACHS-1 and ABC on analysis with NRI and IDI. Conclusions: ACC predicted mortality better than ABC and RCAHS-1 models. A national database will help in developing predictive models unique to our populations, till then, ACC scoring model can be used to analyze individual performances and compare with other institutes.

  19. Insight, psychopathology, explanatory models and outcome of schizophrenia in India: a prospective 5-year cohort study

    Directory of Open Access Journals (Sweden)

    Johnson Shanthi

    2012-09-01

    Full Text Available Abstract Background The sole focus of models of insight on bio-medical perspectives to the complete exclusion of local, non-medical and cultural constructs mandates review. This study attempted to investigate the impact of insight, psychopathology, explanatory models of illness on outcome of first episode schizophrenia. Method Patients diagnosed to have DSM IV schizophrenia (n = 131 were assessed prospectively for insight, psychopathology, explanatory models of illness at baseline, 6, 12 and 60 months using standard instruments. Multiple linear and logistic regression and generalized estimating equations (GEE were employed to assess predictors of outcome. Results We could follow up 95 (72.5% patients. Sixty-five of these patients (68.4% achieved remission. There was a negative relationship between psychosis rating and insight scores. Urban residence, fluctuating course of the initial illness, and improvement in global functioning at 6 months and lower psychosis rating at 12 months were significantly related to remission at 5 years. Insight scores, number of non-medical explanatory models and individual explanatory models held during the later course of the illness were significantly associated with outcome. Analysis of longitudinal data using GEE showed that women, rural residence, insight scores and number of non-medical explanatory models of illness held were significantly associated with BPRS scores during the study period. Conclusions Insight, the disease model and the number of non-medical model positively correlated with improvement in psychosis arguing for a complex interaction between the culture, context and illness variables. These finding argue that insight and explanatory models are secondary to psychopathology, course and outcome of the illness. The awareness of mental illness is a narrative act in which people make personal sense of the many challenges they face. The course and outcome of the illness, cultural context

  20. POSTTRAUMATIC STRESS DISORDER AMONG INDONESIAN CHILDREN 5 YEARS AFTER THE TSUNAMI.

    Science.gov (United States)

    Irwantol; Faisal; Zulfa, Hendra

    2015-09-01

    Children are at risk for developing posttraumatic stress disorder (PTSD) due to experiencing or living in a disaster area. The factors that increase the likelihood of a child developing PTSD need further clarification. We studied the factors associated with PTSD among children who experienced the tsunami in Sumatra, Indonesia. We conducted a cross sectional study in 2 subdistricts of Sumatra 5 years after experiencing a tsunami. Children aged 7-13 years were enrolled using stratified cluster sampling. A tsunami-modified version of The PsySTART Rapid Triage System was used to question children about their tsunami-specific traumatic experiences. Trauma symptoms were evaluated using the Trauma Symptom Checklist For Children (TSCC). The diagnosis of PTSD was made using the Child PTSD Symptom Scale (CPSS) and DSM-IV criteria. The data were analyzed with chi-square tests and multivariate logistic regression analysis with 95% confidence intervals (CI). A total of 262 children were enrolled in this study. The prevalence of PTSD in these children was 20.6%. On multivariate analysis, having experienced a delay in evacuation (PR = 4.5; 95% CI: 2.794-13.80; p PTSD 5 years after the tsunami. Children who experienced a traumatic event in which they were unable to escape or when there is a delay in evacuation are at risk of developing PTSD and need appropriate treatment.

  1. [The Octabaix study. Baseline assessment and 5 years of follow-up].

    Science.gov (United States)

    Ferrer, Assumpta; Formiga, Francesc; Padrós, Gloria; Badia, Teresa; Almeda, Jesús; Octabaix, Grupo Estudio

    This is a review of a prospective, community-based study with a follow-up period of 5years. It is a study of 328 participants aged 85 at baseline, of which 62% were female, 53% widows, and a third of them living alone. High blood pressure was observed in 75.9%, dyslipidaemia in 51.2%, and diabetes in 17.7%. At baseline the median Barthel Index was 95, the Spanish version of the Mini-Mental State Examination was 28, the Charlson index 1, the Mini Nutritional Assessment 25, the Gijón test 10, the visual analogue scale of the Quality of Life Test was 60, and with a mean of 6.1 prescription drugs. A lower quality of life was also associated with female gender, a phenotype of frailty, heart failure, and a high level of social risk. At 5years of follow-up, the mortality rate was high, with 138 (42.1%) of the population sample dying at the end of the period. It represents an annual mortality rate of 8.4%. Thus, a common denominator of this review has been the high importance of functionality and overall comorbidity factors associated with mortality in this very old age group, compared to other more traditional factors in younger populations. Several studies of frailty have also been assessed in this group, as well as falls, nutritional risk, diabetes and successful aging, including important aspects to better understand this population group.

  2. Chronic pancreatitis with pancreaticolithiasis and pseudocyst in a 5-year-old boy with homozygous SPINK1 mutation

    Energy Technology Data Exchange (ETDEWEB)

    Kuehn, Axel C.; Hirsch, Wolfgang [University of Leipzig, Department of Diagnostic Radiology - Pediatric Radiology, Faculty of Medicine, Leipzig (Germany); Teich, Niels; Caca, Karel [University of Leipzig, Department of Internal Medicine II - Gastroenterology / Hepatology, Faculty of Medicine, Leipzig (Germany); Limbach, Anne [University of Leipzig, Department of Pediatrics, Faculty of Medicine, Leipzig (Germany)

    2005-09-01

    We report a 5-year-old boy with a 5-month history of symptoms owing to chronic pancreatitis. Abdominal imaging revealed a large pseudocyst in the pancreatic tail and concretions in the main pancreatic duct. Successful endoscopic papillotomy and stent implantation were performed. Genetic testing showed homozygous SPINK1-N34S mutation, which is an established risk factor for chronic pancreatitis. (orig.)

  3. A modified Mediterranean diet score is associated with a lower risk of incident metabolic syndrome over 25 years among young adults: the CARDIA (Coronary Artery Risk Development in Young Adults) study.

    Science.gov (United States)

    Steffen, Lyn M; Van Horn, Linda; Daviglus, Martha L; Zhou, Xia; Reis, Jared P; Loria, Catherine M; Jacobs, David R; Duffey, Kiyah J

    2014-11-28

    The Mediterranean diet has been reported to be inversely associated with incident metabolic syndrome (MetSyn) among older adults; however, this association has not been studied in young African American and white adults. The objective of the present study was to evaluate the association of a modified Mediterranean diet (mMedDiet) score with the 25-year incidence of the MetSyn in 4713 African American and white adults enrolled in the Coronary Artery Risk Development in Young Adults (CARDIA) study. A diet history questionnaire was used to assess dietary intake at baseline, year 7 and year 20 and a mMedDiet score was created. Cardiovascular risk factors were measured at multiple examinations over 25 years. The MetSyn was defined according to the National Cholesterol Education Program Adult Treatment Panel III (ATP III) criteria. Cox proportional-hazards regression analysis was use to evaluate associations for incident MetSyn across the mMedDiet score categories adjusting for demographic characteristics, lifestyle factors and BMI. Higher mMedDiet scores represented adherence to a dietary pattern rich in fruit, vegetables, whole grains, nuts and fish, but poor in red and processed meat and snack foods. The incidence of MetSyn components (abdominal obesity, elevated TAG concentrations and low HDL-cholesterol concentrations) was lower in those with higher mMedDiet scores than in those with lower scores. Furthermore, the incidence of the MetSyn was lower across the five mMedDiet score categories; the hazard ratios and 95 % CI from category 1 to category 5 were 1·0; 0·94 (0·76, 1·15); 0·84 (0·68, 1·04); 0·73 (0·58, 0·92); and 0·72 (0·54, 0·96), respectively (P trend= 0·005). These findings suggest that the risk of developing the MetSyn is lower when consuming a diet rich in fruit, vegetables, whole grains, nuts and fish.

  4. A melanoma risk score in a Brazilian population Um escore de risco para melanoma em uma população brasileira

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    Lucio Bakos

    2013-04-01

    Full Text Available BACKGROUND: Important risk factors for cutaneous melanoma (CM are recognized, but standardized scores for individual assessment must still be developed. OBJECTIVES: The objective of this study was to develop a risk score of CM for a Brazilian sample. METHODS: To verify the estimates of the main risk factors for melanoma, derived from a meta-analysis (Italian-based study, and externally validate them in a population in southern Brazil by means of a case-control study. A total of 117 individuals were evaluated. Different models were constructed combining the summary coefficients of different risk factors, derived from the meta-analysis, multiplied by the corresponding category of each variable for each participant according to a mathematical expression. RESULTS: the variable that best predicted the risk of CM in the studied population was hair color (AUC: 0.71; 95% CI: 0.62-0.79. Other important factors were freckles, sunburn episodes, and skin and eye color. Consideration of other variables such as common nevi, elastosis, family history, and premalignant lesions did not improve the predictive ability of the models. CONCLUSION: The discriminating capacity of the proposed model proved to be superior or comparable to that of previous risk models proposed for CM. FUNDAMENTOS: importantes fatores de risco para melanoma cutâneo são reconhecidos, mas escores padronizados para avaliação individual ainda precisam ser elaborados. OBJETIVOS: o objetivo deste estudo foi desenvolver um escore de risco de melanoma cutâneo para uma amostra brasileira. MÉTODOS: verificar as estimativas dos principais fatores de risco para melanoma, derivado de uma meta-análise (estudo de base italiano e, externamente, validar em uma população do sul do Brasil por um estudo caso-controle. Um total de 117 indivíduos foram avaliados. RESULTADOS: a variável com maior poder preditivo para o risco de melanoma cutâneo na população estudada foi a cor do cabelo (AUC: 0

  5. Score Correlation

    OpenAIRE

    Fabián, Z. (Zdeněk)

    2010-01-01

    In this paper, we study a distribution-dependent correlation coefficient based on the concept of scalar score. This new measure of association of continuous random variables is compared by means of simulation experiments with the Pearson, Kendall and Spearman correlation coefficients.

  6. Characterization and scoring of skin changes in severe acute malnutrition in children between 6 months and 5 years of age

    DEFF Research Database (Denmark)

    Heilskov, S; Vestergaard, Christian; Babirekere, E

    2015-01-01

    AND METHODS: At Mulago Hospital, Mwanamugimu (Department of Paediatrics and Child Health), Uganda, 120 children were included over a period of six months and observed when treated for severe acute malnutrition. Skin changes were registered through clinical examination and photo documentation and associated...

  7. Development of an indoor air quality checklist for risk assessment of indoor air pollutants by semiquantitative score in nonindustrial workplaces

    Directory of Open Access Journals (Sweden)

    Syazwan AI

    2012-04-01

    Full Text Available AI Syazwan1, B Mohd Rafee1, Juahir Hafizan2, AZF Azman1, AM Nizar3, Z Izwyn4, AA Muhaimin5, MA Syafiq Yunos6, AR Anita1, J Muhamad Hanafiah1, MS Shaharuddin1, A Mohd Ibthisham7, Mohd Hasmadi Ismail8, MN Mohamad Azhar1, HS Azizan1, I Zulfadhli9, J Othman101Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia; 2Department of Environmental Science, Faculty of Environmental Studies, Universiti Putra Malaysia, Selangor, Malaysia; 3Pharmacology Unit, Department of Human Anatomy, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia; 4Department of Therapy and Rehabilitation, Faculty of Health Science and Biomedical Engineering, Universiti Teknologi Malaysia, Johor, Malaysia; 5Department of Environmental Management, Faculty of Environmental Studies, Universiti Putra Malaysia, Selangor, Malaysia; 6Plant Assessment Technology (PAT, Industrial Technology Division (BTI, Malaysian Nuclear Agency (Nuklear Malaysia, Bangi, Kajang, Malaysia; 7Department of Mechanical Engineering, Faculty of Mechanical Engineering, Universiti Teknologi Malaysia, UTM Skudai, Johor, Malaysia; 8Department of Forest Production, Faculty of Forestry, Universiti Putra Malaysia, Selangor, Malaysia; 9Faculty of Built Environment and Architect, Universiti Teknologi Malaysia, Skudai, Johor, Malaysia; 10Department of Counsellor Education and Counselling Psychology (DCECP, Faculty of Educational Studies, Universiti Putra Malaysia, Selangor, MalaysiaBackground: To meet the current diversified health needs in workplaces, especially in nonindustrial workplaces in developing countries, an indoor air quality (IAQ component of a participatory occupational safety and health survey should be included.Objectives: The purpose of this study was to evaluate and suggest a multidisciplinary, integrated IAQ checklist for evaluating the health risk of building occupants. This IAQ checklist proposed to support

  8. EFFECTS OF PRENATAL METHAMPHETAMINE EXPOSURE ON BEHAVIORAL AND COGNITIVE FINDINGS AT 7.5 YEARS

    Science.gov (United States)

    Diaz, Sabrina D.; Smith, Lynne M.; LaGasse, Linda L.; Derauf, Chris; Newman, Elana; Shah, Rizwan; Arria, Amelia; Huestis, Marilyn A.; Grotta, Sheri Della; Dansereau, Lynne M.; Neal, Charles; Lester, Barry M.

    2014-01-01

    Objective To examine child behavioral and cognitive outcomes after prenatal exposure to methamphetamine. Study design 412 mother-infant pairs (204 methamphetamine-exposed and 208 unexposed matched comparisons) were enrolled in the Infant Development, Environment and Lifestyle (IDEAL) study. The 151 children exposed to methamphetamine and 147 comparisons who attended the 7.5 year visit were included. Exposure was determined by maternal self-report and/or positive meconium toxicology. Maternal interviews assessed behavioral and cognitive outcomes using the Conner’s Parent Rating Scale – Revised: Short Form (CPRS-R:S). Results After adjusting for covariates, children exposed to methamphetamine had significantly higher cognitive problems subscale scores than comparisons and were 2.8 times more likely to have cognitive problems scores that were above average on the CPRS-R:S No association between prenatal methamphetamine exposure and behavioral problems, measured by the oppositional, hyperactivity and ADHD Index subscales, were found. Conclusion Prenatal methamphetamine exposure was associated with increased cognitive problems which may impact academic achievement and lead to increased negative behavioral outcomes. PMID:24630350

  9. Food neophobia and mealtime food consumption in 4–5 year old children

    Directory of Open Access Journals (Sweden)

    Wardle Jane

    2006-07-01

    Full Text Available Abstract Background Previous research has documented a negative association between maternal report of child food neophobia and reported frequency of consumption of fruit, vegetables, and meat. This study aimed to establish whether neophobia is associated with lower intake of these food types in naturalistic mealtime situations. Methods One hundred and nine parents of 4–5 year olds completed questionnaires which included a six-item version of the Child Food Neophobia Scale (CFNS. The children took part in a series of 3 test lunch meals at weekly intervals at school at which they were presented with: chicken, cheese, bread, cheese crackers, chocolate biscuits, grapes and tomatoes or carrot sticks. Food items served to each child were weighed before and after the meal to assess total intake of items in four categories: Fruit and vegetables, Protein foods, Starchy foods and Snack foods. Pearson Product Moment Correlations and independent t tests were performed to examine associations between scores on the CFNS and consumption during lunches. Results Neophobia was associated with lower consumption of fruit and vegetables, protein foods and total calories, but there was no association with intake of starch or snack foods. Conclusion These results support previous research that has suggested that neophobia impacts differentially on consumption of different food types. Specifically it appears that children who score highly on the CFNS eat less fruit, vegetables and protein foods than their less neophobic peers. Attempts to increase intake of fruit, vegetables and protein might usefully incorporate strategies known to reduce the neophobic response.

  10. Treatment of Chronic Patellar Tendinopathy with Autologous Bone Marrow Stem Cells: A 5-Year-Followup

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    Cecilia Pascual-Garrido

    2012-01-01

    Full Text Available The purpose of this study is to determine if patients with chronic patellar tendinopathy will improve clinically after the inoculation of bone marrow mononuclear cells (BM-MNCs. Eight patients with chronic patellar tendinopathy were included. Patients averaged 24 years old (range 14–35. All patients were refractory to conservative treatment for at least 6 months before the procedure. BM-MNCs were harvested from the iliac bone crest and inoculated under ultrasound guide in the patellar tendon lesion. Improvement was assessed through established clinical scores and ultrasound. At 5-year followup, statistically significant improvement was seen for most clinical scores. Seven of eight patients said they would have the procedure again if they had the same problem in the opposite knee and were completely satisfied with the procedure. Seven of 8 patients thought that the results of the procedure were excellent. According to our results, inoculation of BM-MNCs could be considered as a potential therapy for those patients with chronic patellar tendinopathy refractory to nonoperative treatments.

  11. The prediction of the in-hospital mortality of acutely ill medical patients by electrocardiogram (ECG) dispersion mapping compared with established risk factors and predictive scores--a pilot study.

    LENUS (Irish Health Repository)

    Kellett, John

    2011-08-01

    ECG dispersion mapping (ECG-DM) is a novel technique that analyzes low amplitude ECG oscillations and reports them as the myocardial micro-alternation index (MMI). This study compared the ability of ECG-DM to predict in-hospital mortality with traditional risk factors such as age, vital signs and co-morbid diagnoses, as well as three predictive scores: the Simple Clinical Score (SCS)--based on clinical and ECG findings, and two Medical Admission Risk System scores--one based on vital signs and laboratory data (MARS), and one only on laboratory data (LD).

  12. Primeiro escore de risco inflamatório das endopróteses de aorta First inflammatory risk score for aortic endoprostheses

    Directory of Open Access Journals (Sweden)

    Edmo Atique Gabriel

    2008-12-01

    Full Text Available OBJETIVO: Propor um escore de risco inflamatório para tratamento endovascular dos aneurismas da aorta. MÉTODOS: Vinte e cinco pacientes foram seguidos do período pré-operatório até 3º mês de pós-operatório (1 hora, 6 horas, 24 horas, 48 horas, 7 dias, 1 mês, 2 meses e 3 meses. Variáveis inflamatórias avaliadas foram proteína C reativa, velocidade de hemossedimentação, interleucinas (IL-6, IL8, fator de necrose tumoral alfa, L-selectina, molécula de adesão intercelular (ICAM-1, transfusão de hemáceas, volume de cristalóide, volume de contraste, material da prótese, número de próteses, contagem total de leucócitos e linfócitos. O teste de Spearman apontou as variáveis candidatas ao maior risco inflamatório, segundo P OBJECTIVE: To purpose an inflammatory risk score for aortic aneurysm endovascular treatment. METHODS: Twenty-five patients were followed-up from preoperative period to third month postoperatively (1-hour, 6-hour, 24-hour, 48-hour, 7-day, 1-month, 2- month and 3month. Inflammatory variables were C-reactive protein, hemosedimentation velocity, interleukins (IL-6, IL-8, tumor necrosis factor-Alpha, L-selectin, intercellular adhesion molecule (ICAM-1, red blood cells transfusion, volume of crystalloid, volume of contrast, type of endoprosthesis, number of endoprostheses, total count of leukocytes and lymphocytes. Spearman test defined the variables considered as candidates to higher inflammatory risk based on P < 20%. Logistic regression defined the variables considered as selected for final score based on P < 10%. ROC curve analysis revealed the cut-off values for variables selected by logistic regression. RESULTS: Variables defined by Spearman test were: volume of crystalloid (P=0.04, type of endoprosthesis (P=0.04, volume of contrast (P=0.02, preoperative IL-8 (P = 0.10, 1 - month ICAM-1 (P=0.03 and 1-month L-selectin (P=0.06. Logistic regression revealed that volume of crystalloid and preoperative IL-8

  13. Environmental risk score as a new tool to examine multi-pollutants in epidemiologic research: an example from the NHANES study using serum lipid levels.

    Directory of Open Access Journals (Sweden)

    Sung Kyun Park

    Full Text Available OBJECTIVE: A growing body of evidence suggests that environmental pollutants, such as heavy metals, persistent organic pollutants and plasticizers play an important role in the development of chronic diseases. Most epidemiologic studies have examined environmental pollutants individually, but in real life, we are exposed to multi-pollutants and pollution mixtures, not single pollutants. Although multi-pollutant approaches have been recognized recently, challenges exist such as how to estimate the risk of adverse health responses from multi-pollutants. We propose an "Environmental Risk Score (ERS" as a new simple tool to examine the risk of exposure to multi-pollutants in epidemiologic research. METHODS AND RESULTS: We examined 134 environmental pollutants in relation to serum lipids (total cholesterol, high-density lipoprotein cholesterol (HDL, low-density lipoprotein cholesterol (LDL and triglycerides using data from the National Health and Nutrition Examination Survey between 1999 and 2006. Using a two-stage approach, stage-1 for discovery (n = 10818 and stage-2 for validation (n = 4615, we identified 13 associated pollutants for total cholesterol, 9 for HDL, 5 for LDL and 27 for triglycerides with adjustment for sociodemographic factors, body mass index and serum nutrient levels. Using the regression coefficients (weights from joint analyses of the combined data and exposure concentrations, ERS were computed as a weighted sum of the pollutant levels. We computed ERS for multiple lipid outcomes examined individually (single-phenotype approach or together (multi-phenotype approach. Although the contributions of ERS to overall risk predictions for lipid outcomes were modest, we found relatively stronger associations between ERS and lipid outcomes than with individual pollutants. The magnitudes of the observed associations for ERS were comparable to or stronger than those for socio-demographic factors or BMI. CONCLUSIONS: This study suggests ERS

  14. Coalesced Multicentric Analysis of 2,351 Patients With Myelodysplastic Syndromes Indicates an Underestimation of Poor-Risk Cytogenetics of Myelodysplastic Syndromes in the International Prognostic Scoring System

    Science.gov (United States)

    Schanz, Julie; Steidl, Christian; Fonatsch, Christa; Pfeilstöcker, Michael; Nösslinger, Thomas; Tuechler, Heinz; Valent, Peter; Hildebrandt, Barbara; Giagounidis, Aristoteles; Aul, Carlo; Lübbert, Michael; Stauder, Reinhard; Krieger, Otto; Garcia-Manero, Guillermo; Kantarjian, Hagop; Germing, Ulrich; Haase, Detlef; Estey, Elihu

    2011-01-01

    Purpose The International Prognostic Scoring System (IPSS) remains the most commonly used system for risk classification in myelodysplastic syndromes (MDSs). The IPSS gives more weight to blast count than to cytogenetics. However, previous publications suggested that cytogenetics are underweighted in the IPSS. Here we investigate the prognostic impact of cytogenetic subgroups compared with that of bone marrow blast count in a large, multicentric, international patient cohort. Patients and Methods In total, 2,351 patients with MDS who have records in the German-Austrian and the MD Anderson Cancer Center databases were included and analyzed in univariate and multivariate models regarding overall survival and risk of transformation to acute myeloid leukemia (AML). The data were analyzed separately for patients treated with supportive care without specific therapy, with AML-like chemotherapy, or with other therapy regimens (low-dose chemotherapy, demethylating agents, immune modulating agents, valproic acid, and cyclosporine). Results The prognostic impact of poor-risk cytogenetic findings (as defined by the IPSS classification) on overall survival was as unfavorable as an increased (> 20%) blast count. The hazard ratio (compared with an abnormal karyotype or a bone marrow blast count < 5%) was 3.3 for poor-risk cytogenetics, 4.8 for complex abnormalities harboring chromosomes 5 and/or 7, and 3.1 for a blast count of 21% to 30% (P < .01 for all categories). The predictive power of the IPSS cytogenetic subgroups was unaffected by type of therapy given. Conclusion The independent prognostic impact of poor-risk cytogenetics on overall survival is equivalent to the impact of high blast counts. This finding should be considered in the upcoming revision of the IPSS. PMID:21519021

  15. Chronic dietary risk characterization for pesticide residues: a ranking and scoring method integrating agricultural uses and food contamination data.

    Science.gov (United States)

    Nougadère, Alexandre; Reninger, Jean-Cédric; Volatier, Jean-Luc; Leblanc, Jean-Charles

    2011-07-01

    A method has been developed to identify pesticide residues and foodstuffs for inclusion in national monitoring programs with different priority levels. It combines two chronic dietary intake indicators: ATMDI based on maximum residue levels and agricultural uses, and EDI on food contamination data. The mean and 95th percentile of exposure were calculated for 490 substances using individual and national consumption data. The results show that mean ATMDI exceeds the acceptable daily intake (ADI) for 10% of the pesticides, and the mean upper-bound EDI is above the ADI for 1.8% of substances. A seven-level risk scale is presented for substances already analyzed in food in France and substances not currently sought. Of 336 substances analyzed, 70 pesticides of concern (levels 2-5) should be particularly monitored, 22 of which are priority pesticides (levels 4 and 5). Of 154 substances not sought, 36 pesticides of concern (levels 2-4) should be included in monitoring programs, including 8 priority pesticides (level 4). In order to refine exposure assessment, analytical improvements and developments are needed to lower the analytical limits for priority pesticide/commodity combinations. Developed nationally, this method could be applied at different geographic scales.

  16. Characteristics of highly impaired children with severe chronic pain: a 5-year retrospective study on 2249 pediatric pain patients

    Directory of Open Access Journals (Sweden)

    Zernikow Boris

    2012-05-01

    Full Text Available Abstract Background Prevalence of pain as a recurrent symptom in children is known to be high, but little is known about children with high impairment from chronic pain seeking specialized treatment. The purpose of this study was the precise description of children with high impairment from chronic pain referred to the German Paediatric Pain Centre over a 5-year period. Methods Demographic variables, pain characteristics and psychometric measures were assessed at the first evaluation. Subgroup analysis for sex, age and pain location was conducted and multivariate logistic regression applied to identify parameters associated with extremely high impairment. Results The retrospective study consisted of 2249 children assessed at the first evaluation. Tension type headache (48%, migraine (43% and functional abdominal pain (11% were the most common diagnoses with a high rate of co-occurrence; 18% had some form of musculoskeletal pain disease. Irrespective of pain location, chronic pain disorder with somatic and psychological factors was diagnosed frequently (43%. 55% of the children suffered from more than one distinct pain diagnosis. Clinically significant depression and general anxiety scores were expressed by 24% and 19% of the patients, respectively. Girls over the age of 13 were more likely to seek tertiary treatment compared to boys. Nearly half of children suffered from daily or constant pain with a mean pain value of 6/10. Extremely high pain-related impairment, operationalized as a comprehensive measure of pain duration, frequency, intensity, pain-related school absence and disability, was associated with older age, multiple locations of pain, increased depression and prior hospital stays. 43% of the children taking analgesics had no indication for pharmacological treatment. Conclusion Children with chronic pain are a diagnostic and therapeutic challenge as they often have two or more different pain diagnoses, are prone to misuse of

  17. Aplicação do escore CRIB para avaliar o risco de mortalidade neonatal The use of CRIB score for predicting neonatal mortality risk

    Directory of Open Access Journals (Sweden)

    Ana Lúcia F. Sarquis

    2002-01-01

    Full Text Available Objetivos: 1 avaliar o valor preditivo do Clinical Risk Index for Babies (CRIB para óbito hospitalar; 2 identificar a variável do escore com melhor valor preditivo; e 3 comparar a capacidade do escore CRIB para predizer mortalidade hospitalar com a do peso de nascimento, da idade gestacional e do excesso de base isolados. Métodos: o escore CRIB foi aplicado de forma prospectiva em 100 recém-nascidos admitidos consecutivamente na Unidade Neonatal do HC-UFPR, que tinham peso de nascimento igual ou inferior a 1.500 g ou idade gestacional menor que 31 semanas. Resultados: cinqüenta e cinco recém-nascidos eram do sexo feminino e 45, do masculino, a média do peso de nascimento foi de 1.078,0 277,0 g, e da idade gestacional de 29,2 2,8 semanas. Vinte e um pacientes foram a óbito. A mortalidade nos graus 1, 2, 3 e 4 do CRIB foi, respectivamente, de 6,6%; 46,2%, 85,7% e 100,0%. A precisão do escore para mortalidade foi confirmada (área sob a curva ROC = 0,877, e a melhor variável do escore para prognosticar o óbito hospitalar foi o excesso de base máximo (área sob a curva ROC = 0,795. Comparado com peso de nascimento e idade gestacional, o CRIB foi significativamente melhor para predizer mortalidade. Conclusões: além de ser útil no prognóstico do óbito hospitalar, o CRIB mostrou-se um escore de aplicação simples. Com base nos resultados encontrados, recomenda-se sua incorporação na rotina das unidades neonatais.Objective: to examine the clinical risk index for babies (CRIB predictive value for hospital death; to identify the score variable with the best predictive value and to compare CRIB score capability to predict hospital mortality to birth weight, gestational age and base excess. Methods: CRIB score was obtained through a prospective way from 100 newborns with birthweight of 1,500 g or less or gestational age less than 31 weeks, who were admitted consecutively to the Neonatal Unit of Hospital das Clínicas, Universidade

  18. Assessment of Iron Overload in Homozygous and Heterozygous Beta Thalassemic Children below 5 Years of Age

    Directory of Open Access Journals (Sweden)

    Dhiraj J. Trivedi

    2014-07-01

    Full Text Available Background: Thalassemia is a genetic disease having 3-7% carrier rate in Indians. It is transfusion dependent anemia having high risk of iron overloading. A clinical symptom of iron overload becomes detectable in second decade causing progressive liver, heart and endocrine glands damage. There is a need to assess iron overload in thalassemics below 5 years of age to protect them from complications at later age of life. Aims and objectives: Present study was undertaken to estimate serum iron status and evaluate serum transferrin saturation in both homozygous & heterozygous form of thalassemia as an index of iron overload among children of one to five years of age. Materials and Methods: Clinically diagnosed thirty cases of β thalassemia major & thirty cases of β thalassemia minor having severe anemia, hepatospleenomegaly and between 1 year to 5 years of age were included in study group and same age matched healthy controls were included in the study. RBC indices and HbA, HbA2 and HbF were estimated along with serum iron & serum Total Iron Binding Capacity (TIBC and serum transferrin levels. Results: Significant difference was observed in hemoglobin levels between control and both beta thalassemia groups. Mean Corpuscular Volume (MCV and Mean Corpuscular Hemoglobin (MCH values were reduced. Hemoglobin electrophoresis showed the elevated levels of HbF and HbA2 in both beta thalassemia groups. Among serum iron parameters, serum iron, TIBC and transferrin saturation were elevated whereas serum transferrin levels were low in thalassemia major in children below 5 years of age. Conclusion: Although clinical symptoms of iron overload have been absent in thalassemic children below five years of age, biochemical iron overloading has started at much lower age which is of great concern.

  19. CLINICAL PROFILE OF ACUTE LOWER RESPIRATORY TRACT INFECTIONS IN CHILDREN BETWEEN 2MONTHS TO 5 YEARS

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    Amitoj Singh Chhina

    2015-08-01

    Full Text Available BACKGROUND : Acute respiratory infections are a leading cause of morbidity and mortality in under - five children in developing countries. Hence, the present study was undertaken to study the various risk factors, clinical profile and outcome of acute lower respiratory tract infections (ALRI in children aged 2 month to 5 years. OBJECTIVE : clinical features, laborato ry assessment and morbidity and mortality pattern associated with acute lower respiratory tract infections in children aged 2 months to 5 years. METHODS: 100 ALRI cases fulfilling WHO criteria for pneumonia, in the age group of 2 month to 5 years were evaluated for clinical profile as per a predesigned proforma in a rural medical college. RESULTS : Of cases 61% were infants and remaining 39%12 - 60 months age group, males outnumbered females with sex ratio of 1.3;1. Elevated total leukocyte counts for age were observed in only 22% of cases, of these 3% were having pneumonia, 9% severe pneumonia and 10% very severe pneumonia. Significant association was found between leukocytosis and ALRI severity (p= 0.0001 Positive blood culture was obtained in 8% of cases and was significantly associated with ALRI severity (p=. 0.027. Among the ALRI cases, 84% required oxygen supplementation at any time during the hospital stay and 8% required mechanical ventilation. The mortality rate was 1%; with 99% of cases recovering and getting discharged uneventfully. CONCLUSION : Among the clinical variables, the signs and symptoms of ALRI as per the WHO ARI Control Programme were found in almost all cases. Regarding the laboratory profile, leukocytosis and blood culture positivity w ere observed in a small percentage, but significant association with ALRI severity was observed for both. Thus, clinical signs, and not invasive blood tests are a better diagnostic tools, though the latter may provide additional therapeutic and prognostic information in severe disease

  20. Measurement of coronary calcium scores by electron beam computed tomography or exercise testing as initial diagnostic tool in low-risk patients with suspected coronary artery disease

    Energy Technology Data Exchange (ETDEWEB)

    Geluk, Christiane A.; Perik, Patrick J.; Tio, Rene A.; Goette, Marco J.W.; Hillege, Hans L.; Zijlstra, Felix [University Medical Center Groningen, Thoraxcenter, Department of Cardiology, Groningen (Netherlands); Dikkers, Riksta; Vliegenthart, Rozemarijn; Houwers, Janneke B.; Willems, Tineke P.; Oudkerk, Matthijs [University Medical Center Groningen, Department of Radiology, Groningen (Netherlands)

    2008-02-15

    We determined the efficiency of a screening protocol based on coronary calcium scores (CCS) compared with exercise testing in patients with suspected coronary artery disease (CAD), a normal ECG and troponin levels. Three-hundred-and-four patients were enrolled in a screening protocol including CCS by electron beam computed tomography (Agatston score), and exercise testing. Decision-making was based on CCS. When CCS{>=}400, coronary angiography (CAG) was recommended. When CCS<10, patients were discharged. Exercise tests were graded as positive, negative or nondiagnostic. The combined endpoint was defined as coronary event or obstructive CAD at CAG. During 12{+-}4 months, CCS{>=}400, 10-399 and <10 were found in 42, 103 and 159 patients and the combined endpoint occurred in 24 (57%), 14 (14%) and 0 patients (0%), respectively. In 22 patients (7%), myocardial perfusion scintigraphy was performed instead of exercise testing due to the inability to perform an exercise test. A positive, nondiagnostic and negative exercise test result was found in 37, 76 and 191 patients, and the combined endpoint occurred in 11 (30%), 15 (20%) and 12 patients (6%), respectively. Receiver-operator characteristics analysis showed that the area under the curve of 0.89 (95% CI: 0.85-0.93) for CCS was superior to 0.69 (95% CI: 0.61-0.78) for exercise testing (P<0.0001). In conclusion, measurement of CCS is an appropriate initial screening test in a well-defined low-risk population with suspected CAD. (orig.)

  1. Evaluation of the Finnish Diabetes Risk Score to predict type 2 diabetes mellitus in a Colombian population: A longitudinal observational study

    Institute of Scientific and Technical Information of China (English)

    Diego; Gomez-Arbelaez; Laura; Alvarado-Jurado; Miguel; Ayala-Castillo; Leonardo; Forero-Naranjo; Paul; Anthony; Camacho; Patricio; Lopez-Jaramillo

    2015-01-01

    AIM: To assess the performance of the Finnish Diabetes Risk Score(FINDRISC) questionnaire for detecting and predicting type 2 diabetes mellitus(DM2) in a Colombian population.METHODS: This is a longitudinal observational study conducted in Floridablanca, Colombia. Adult subjects(age ≥ 35 years) without known diabetes, were included. A modified version of FINDRISC was completed, and the glycemia values from all the subjects were collected from the hospital’s database. Firstly, a cross-sectional analysis was performed and then, the subsample of prediabetic participants was followed for diabetes incidence. RESULTS: A total of 772 subjects were suitable for the study. The overall prevalence of undiagnosed DM2 was 2.59%, and the incidence of DM2 among the prediabetic participants was 7.5 per 100 person-years after a total of 265257 person-years follow-up. The FINDRISC at baseline was significantly associated with undiagnosed and incident DM2. The area under receiver operating characteristics curve of the FINDRISC score for detecting undiagnosed DM2 in both men and women was 0.7477 and 0.7175, respectively; and for predicting the incidence of DM2 among prediabetics was 71.99% in men and 67.74% in women. CONCLUSION: The FINDRISC questionnaire is a useful screening tool to identify cross-sectionally unknown DM2 and to predict the incidence of DM2 among prediabetics in the Colombian population.

  2. Short term clinical disease progression in HIV-1 positive patients taking combination antiretroviral therapy : The EuroSIDA risk-score

    DEFF Research Database (Denmark)

    Mocroft, A; Ledergerber, B; Zilmer, K;

    2007-01-01

    (CI), 2.7-3.3]. Current levels of viral load, CD4 cell count, CD4 cell slope, anaemia, and body mass index all independently predicted new AIDS/death, as did age, exposure group, a prior AIDS diagnosis, prior antiretroviral treatment and stopping all antiretroviral drugs. The EuroSIDA risk......OBJECTIVES: To derive and validate a clinically applicable prognostic score for predicting short-term disease progression in HIV-infected patients taking combination antiretroviral therapy (cART). DESIGN AND METHODS: Poisson regression was used to identify prognostic markers for new AIDS....../death in patients taking cART. A score was derived for 4169 patients from EuroSIDA and validated on 5150 patients from the Swiss HIV Cohort Study (SHCS). RESULTS: In EuroSIDA, 658 events occurred during 22 321 person-years of follow-up: an incidence rate of 3.0/100 person-years of follow-up [95% confidence interval...

  3. Internal Model of Commercial Bank as an Instrument for Measuring Credit Risk of the Borrower in Relation to Financial Performance (Credit Scoring and Bankruptcy Models

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    Belás Jaroslav

    2011-12-01

    Full Text Available Commercial banks generally use different methods and procedures for managing credit risk. The internal rating method in which the client has an important position in the process of granting credit provides a comprehensive assessment of client creditworthiness. The aim of this article is to analyze selected theoretical, methodological and practical aspects of internal rating models of commercial banks within the context of models that measures financial performance and to make a comparison of results of real - rating models which are used in the Czech Republic and Slovakia. The results of the chosen credit scoring and bankruptcy methods on selected companies from segments of small and medium-sized companies are presented.

  4. Tracking time interval changes of pulmonary nodules on follow-up 3D CT images via image-based risk score of lung cancer

    Science.gov (United States)

    Kawata, Y.; Niki, N.; Ohmatsu, H.; Kusumoto, M.; Tsuchida, T.; Eguchi, K.; Kaneko, M.; Moriyama, N.

    2013-03-01

    In this paper, we present a computer-aided follow-up (CAF) scheme to support physicians to track interval changes of pulmonary nodules on three dimensional (3D) CT images and to decide the treatment strategies without making any under or over treatment. Our scheme involves analyzing CT histograms to evaluate the volumetric distribution of CT values within pulmonary nodules. A variational Bayesian mixture modeling framework translates the image-derived features into an image-based risk score for predicting the patient recurrence-free survival. Through applying our scheme to follow-up 3D CT images of pulmonary nodules, we demonstrate the potential usefulness of the CAF scheme which can provide the trajectories that can characterize time interval changes of pulmonary nodules.

  5. Does Future Diabetes Risk Impair Current Quality of Life? A Cross-Sectional Study of Health-Related Quality of Life in Relation to the Finnish Diabetes Risk Score (FINDRISC.

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    Saku Väätäinen

    Full Text Available Present study examines the relationship between the estimated risk of developing type 2 diabetes (T2D and health-related quality of life (HRQoL. We quantify the association between Finnish Diabetes Risk Score (FINDRISC and HRQoL, and examine the potential use of FINDRISC as tool to evaluate HRQoL indirectly.We conducted a cross-sectional study comprising 707 Finnish people without a diagnosis of T2D between the ages of 51 and 75 years. The risk of developing T2D was assessed using the validated and widely used FINDRISC (range 0-26 points, and quality of life was measured using two preference-based HRQoL instruments (15D and SF-6D and one health profile instrument (SF-36. Effects of the individual FINDRISC items and demographic and clinical characteristics, such as co-morbidities, on HRQoL were studied using multivariable Tobit regression models.Low HRQoL was significantly and directly associated with the estimated risk of developing T2D. An approximate 4-5 point change in FINDRISC score was observed to be associated with clinically noticeable changes in the preference-based instrument HRQoL index scores. The association between HRQoL and the risk of developing T2D was also observed for most dimensions of HRQoL in all applied HRQoL instruments. Overall, old age, lack of physical activity, obesity, and history of high blood glucose were the FINDRISC factors most prominently associated with lower HRQoL.The findings may help the health care professionals to substantiate the possible improvement in glucose metabolism and HRQoL potentially achieved by lifestyle changes, and better convince people at high risk of T2D to take action towards healthier lifestyle habits. FINDRISC may also provide an accurate proxy for HRQoL, and thus by estimating the risk of T2D with the FINDRISC, information about patients' HRQoL may also be obtained indirectly, when it is not feasible to use HRQoL instruments.

  6. Validation of the Ability of SYNTAX and Clinical SYNTAX Scores to Predict Adverse Cardiovascular Events After Stent Implantation: A Systematic Review and Meta-Analysis.

    Science.gov (United States)

    Chen, JiaYuan; Tang, Buzhou; Lin, YongQing; Ru, Ying; Wu, MaoXiong; Wang, Xiaolong; Chen, Qingcai; Chen, YangXin; Wang, JingFeng

    2016-10-01

    To compare the predicative ability of SYNTAX (Synergy between PCI with Taxus and Cardiac Surgery) and clinical SYNTAX scores for major adverse cardiac events (MACEs) after stent implantation in patients with coronary artery disease (CAD). Studies were identified by electronic and manual searches. Twenty-six studies were included in the meta-analysis. The pooled C-statistics of SYNTAX score for 1- and 5-year all-cause mortality (ACM) were 0.65 (95% confidence interval [CI]: 0.61-0.68) and 0.62 (95% CI: 0.59-0.65), respectively, with weak heterogeneity. The 1- and 5-year ACM pooled C-statistics for clinical SYNTAX scores were significantly higher at 0.77 and 0.71, respectively (Ps SYNTAX score for predicting 1-year ACM per unit was 1.04 (95% CI: 1.03-1.05). Calibration analysis indicated SYNTAX scores overestimated the risk of major adverse cardiac and cerebrovascular events in each risk stratum. The SYNTAX score demonstrated minimal discrimination in predicting 1- or 5-year adverse cardiovascular events after percutaneous coronary intervention in patients with CAD. The clinical SYNTAX score could further improve the predictive capability for ACM but not MACE.

  7. Understanding factors that influence the use of risk scoring instruments in the management of patients with unstable angina or non-ST-elevation myocardial infarction in the Netherlands: a qualitative study of health care practitioners’ perceptions.

    NARCIS (Netherlands)

    Engel, J.; Heeren, M.J.; Wulp, I. van der; Bruijne, M.C. de; Wagner, C.

    2014-01-01

    Background Cardiac risk scores estimate a patient’s risk of future cardiac events or death. They are developed to inform treatment decisions of patients diagnosed with unstable angina or non-ST-elevation myocardial infarction. Despite recommending their use in guidelines and evidenc

  8. Cardiometabolic Risk Assessments by Body Mass Index z-Score or Waist-to-Height Ratio in a Multiethnic Sample of Sixth-Graders

    Directory of Open Access Journals (Sweden)

    Henry S. Kahn

    2014-01-01

    Full Text Available Convention defines pediatric adiposity by the body mass index z-score (BMIz referenced to normative growth charts. Waist-to-height ratio (WHtR does not depend on sex-and-age references. In the HEALTHY Study enrollment sample, we compared BMIz with WHtR for ability to identify adverse cardiometabolic risk. Among 5,482 sixth-grade students from 42 middle schools, we estimated explanatory variations (R2 and standardized beta coefficients of BMIz or WHtR for cardiometabolic risk factors: insulin resistance (HOMA-IR, lipids, blood pressures, and glucose. For each risk outcome variable, we prepared adjusted regression models for four subpopulations stratified by sex and high versus lower fatness. For HOMA-IR, R2 attributed to BMIz or WHtR was 19%–28% among high-fatness and 8%–13% among lower-fatness students. R2 for lipid variables was 4%–9% among high-fatness and 2%–7% among lower-fatness students. In the lower-fatness subpopulations, the standardized coefficients for total cholesterol/HDL cholesterol and triglycerides tended to be weaker for BMIz (0.13–0.20 than for WHtR (0.17–0.28. Among high-fatness students, BMIz and WHtR correlated with blood pressures for Hispanics and whites, but not black boys (systolic or girls (systolic and diastolic. In 11-12 year olds, assessments by WHtR can provide cardiometabolic risk estimates similar to conventional BMIz without requiring reference to a normative growth chart.

  9. Effects of Adolescent Childbearing on Maternal Depression and Problem Behaviors: A Prospective, Population-Based Study Using Risk-Set Propensity Scores.

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    Alison E Hipwell

    Full Text Available Adolescent mothers are reportedly at risk for depression and problem behaviors in the postpartum period, but studies have rarely considered developmental context and have yet to disentangle the effects of childbearing on adolescent functioning from selection effects that are associated with early pregnancy. The current study examined changes in adolescent depression, conduct problems and substance use (alcohol, tobacco and marijuana across the peripartum period using risk-set propensity scores derived from a population-based, prospective study that began in childhood (the Pittsburgh Girls Study, PGS. Each of 147 childbearing adolescents (ages 12-19 was matched with two same-age, non-childbearing adolescents (n = 294 on pregnancy propensity using 15 time-varying risk variables derived from sociodemographic, psychopathology, substance use, family, peer and neighborhood domains assessed in the PGS wave prior to each pregnancy (T1. Postpartum depression and problem behaviors were assessed within the first 6 months following delivery (T2; data gathered from the non-childbearing adolescent controls spanned the same interval. Within the childbearing group, conduct problems and marijuana use reduced from T1 to T2, but depression severity and frequency of alcohol or tobacco use showed no change. When change was compared across the matched groups, conduct problems showed a greater reduction among childbearing adolescents. Relative to non-childbearing adolescents who reported more frequent substance use with time, childbearing adolescents reported no change in alcohol use and less frequent use of marijuana across the peripartum period. There were no group differences in patterns of change for depression severity and tobacco use. The results do not support the notion that adolescent childbearing represents a period of heightened risk for depression or problem behaviors.

  10. 危重孕产妇住重症监护病房时间延长的危险因素分析——北京市3家医院5年回顾性研究%Analysis of risk factors of prolonged intensive care unit stay of critically ill obstetric patients: a 5-year retrospective review in 3 hospitals in Beijing

    Institute of Scientific and Technical Information of China (English)

    林英; 朱曦; 刘飞; 赵扬玉; 杜俊; 么改琦; 李文雄; 贾晓君

    2011-01-01

    独立危险因素.结论 危重孕产妇ICU住院时间延长的发生率较高.临床上可以根据危险因素预测危重孕产妇ICU住院时间延长,加强规律产前检查、避免产科及内科严重并发症;发病后尽快转入ICU并在ICU内加强各器官功能支持可能有助于缩短ICU住院时间.%Objective To identify the risk factors of prolonged intensive care unit (ICU) stay of critically ill obstetric patients. Methods A retrospective analysis of cases of critically ill obstetric patients admitted to the ICUs of Peking University Third Hospital, Capital Medical University Affiliated Beijing Chaoyang Hospital, and PLA 306 Hospital from January 1st 2006 to December 31st 2010 was made. Data included demographics, causes of critical illness or complications that prompted ICU admission, the acute physiology and chronic health evaluation Ⅰ (APACHE Ⅱ ) scores, the time intervals between onset of acute symptoms and ICU admission, laboratory test results, treatment measures, length of ICU stay and the final maternal mortality. Data were used to identify univariate and multivariate predictors for prolonged ICU stay.Results During the 5-year period there were 207 obstetric patients[mean age (31. 74±2.32) years old,mean gestational age (34. 86±4. 72) weeks]were transferred to the ICU for critical care (42 ICU admissions per 10 000 deliveries), and among them 4 women died (mortality rate 1.93%). The pathogenesis of the cases could be divided into direct obstetric pathologies (n= 138) and indirect or coincidental pathologies (n= 69).The most common obstetric causes of admission were massive postpartum haemorrhage (n= 42, 20. 29%)and pregnancy-associated hypertension (n= 36, 17.39%), followed by acute fatty liver of pregnancy (AFLP,n= 27, 13.04%), obstetric disseminated intravascular coagulation (DIC, n= 23, 11.11%). The most common non-obstetric causes of admission were acute heart failure (n= 26, 12. 56%) and acute respiratory failure (n = 22, 10. 63 %), followed by

  11. Predictors of long term survival after hepatic resection for hilar cholangiocarcinoma:A retrospective study of 5-year survivors

    Institute of Scientific and Technical Information of China (English)

    Mohamed Abd El Wahab; Ayman El Nakeeb; Ehab El Hanafy; Ahmad M Sultan; Ahmed Elghawalby; Waleed Askr; Mahmoud Ali; Mohamed Abd El Gawad; Tarek Salah

    2016-01-01

    AIM:To determine predictors of long term survival after resection of hilar cholangiocarcinoma(HC) by comparing patients surviving > 5 years with those who survived 5 years.RESULTS:There were 34(14%) long term survivors(5 year survivors) among the 243 patients.Fiveyear survivors were younger at diagnosis than those surviving less than 5 years(mean age,50.47 ± 4.45 vs 54.59 ± 4.98,p = 0.001).Gender,clinical presentation,preoperative drainage,preoperative serum bilirubin,albumin and serum glutamic-pyruvic transaminase were similar between the two groups.The level of CA 19-9 was significantly higher in patients surviving 5 year,includingyoung age(p = 0.001),serum CA19-9(p = 0.0001),non-cirrhotic liver(p = 0.02),major hepatic resection(p = 0.001),caudate lobe resection(p = 0.006),well differentiated tumour(p = 0.03),lymph node status(0.008),R0 resection margin(p = 0.0001) and early postoperative liver cell failure(p = 0.02).CONCLUSION:Liver status,resection of caudate lobe,lymph node status,R0 resection and CA19-9 were demonstrated to be independent risk factors for long term survival.

  12. A MultiFactorial Risk Score to weigh toxicities and co-morbidities relative to costs of antiretrovirals in a cohort of HIV-infected patients

    Directory of Open Access Journals (Sweden)

    M Tontodonati

    2012-11-01

    Full Text Available Purpose of the study: Considering costs of antiretrovirals (ARVs for HIV patients is increasingly needed. A simple and comprehensive tool weighing comorbidities and ARV-related toxicities could be useful to judge the appropriateness of use of more expensive drugs. We conceived a MultiFactorial Risk Score (MFRS to evaluate the appropriateness of ARVs prescription relative to their costs. Methods: HIV patients were consecutively enrolled in 2010-2011. We considered socio-demographic characteristics, HIV history, cardiovascular risk factors, low energy fractures, bone density. Psychological factors were assessed by BDI, DS14 and TAS-20. The MFRS was calculated as the sum of the following: age (<30y 1 point; 1 point increase every 5y, 10 for≥70; AIDS diagnosis (5; CD4 nadir (5 if <100; 1 point less every 100 CD4 increase; ART line (0 first, up to 5 for≥6 lines; lipodistrophy (5; HCV coinfection (7; education (1 degree, 2 secondary, 3 primary; alcohol (3 and drug abuse (5; working activity (3 if unemployed; hypertension (3; cholesterol≥200 mg/dl (3; diabetes (3; Framingham score (7 if>7%; creatinine (0 if <1 mg/dl, 1 if<1.2; 2 if<1.5>1.2, 5 if<2> 1.5, 7 if≥2; bone fractures (7; bone status at DEXA (0 normal, 3 osteopenic, 5 osteoporotic; cancer (5; depression (3 if BDI>17; other psychiatric illness (5. Annual costs of individual ART regimens were calculated. MFRS was correlated in univariate and multivariate models with all variables. All statistical analyses were carried out using Stata 10.1. Summary of results: We enrolled 241 HIV patients, 74.3% males, aged 44.5±9.9y; 19 patients (7.8% were untreated, 74.8% of treated had undetectable HIV RNA. Mean Nadir CD4 counts were 218±168, 38.5% of patients had an AIDS diagnosis. Mean individual ARV annual cost was 10,976±5,360. Mean MFRS was 28.5±13.9 (4–64. MFRS was significantly higher (p<0.001 in patients with older age, longer duration of HIV infection, lower CD4 nadirs, AIDS diagnosis

  13. Configuring balanced scorecards for measuring health system performance: evidence from 5 years' evaluation in Afghanistan.

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    Anbrasi Edward

    2011-07-01

    Full Text Available BACKGROUND: In 2004, Afghanistan pioneered a balanced scorecard (BSC performance system to manage the delivery of primary health care services. This study examines the trends of 29 key performance indicators over a 5-year period between 2004 and 2008. METHODS AND FINDINGS: Independent evaluations of performance in six domains were conducted annually through 5,500 patient observations and exit interviews and 1,500 provider interviews in >600 facilities selected by stratified random sampling in each province. Generalized estimating equation (GEE models were used to assess trends in BSC parameters. There was a progressive improvement in the national median scores scaled from 0-100 between 2004 and 2008 in all six domains: patient and community satisfaction of services (65.3-84.5, p<0.0001; provider satisfaction (65.4-79.2, p<0.01; capacity for service provision (47.4-76.4, p<0.0001; quality of services (40.5-67.4, p<0.0001; and overall vision for pro-poor and pro-female health services (52.0-52.6. The financial domain also showed improvement until 2007 (84.4-95.7, p<0.01, after which user fees were eliminated. By 2008, all provinces achieved the upper benchmark of national median set in 2004. CONCLUSIONS: The BSC has been successfully employed to assess and improve health service capacity and service delivery using performance benchmarking during the 5-year period. However, scorecard reconfigurations are needed to integrate effectiveness and efficiency measures and accommodate changes in health systems policy and strategy architecture to ensure its continued relevance and effectiveness as a comprehensive health system performance measure. The process of BSC design and implementation can serve as a valuable prototype for health policy planners managing performance in similar health care contexts. Please see later in the article for the Editors' Summary.

  14. Laryngeal Mask Airway for Cesarean Delivery: A 5-Year Retrospective Cohort Study

    Science.gov (United States)

    Geng, Zhi-Yu; Wang, Dong-Xin

    2017-01-01

    Background: The laryngeal mask airway (LMA) is the most commonly used rescue airway in obstetric anesthesia. The aim of this retrospective cohort study was to evaluate the application of the LMA in parturients undergoing cesarean delivery (CD) for 5 years in our hospital. As a secondary objective, we investigated the incidence of airway-related complication in obstetric general anesthesia (GA). Methods: We collected electronic data for all obstetric patients who received GA for CD between January 2010 and December 2014 in Peking University First Hospital. Based on the different types of airway device, patients were divided into endotracheal intubation (ET) group and LMA group. The incidences of regurgitation and aspiration, as well as maternal and neonatal postoperative outcomes were compared between groups. Results: During the 5-year study, GA was performed in 192 cases, which accounted for 2.0% of all CDs. The main indications for GA were contraindication to neuraxial anesthesia or a failed block. Among these, ET tube was used in 124 cases (68.9%) and LMA in 56 cases (31.1%). The percentage of critical patients above the American Society of Anesthesiologists' Grade II was 24/124 in ET group and 4/56 in LMA group (P = 0.036). The emergent delivery rate was 63.7% for ET group and 37.5% for LMA group (P = 0.001). None of the patients had regurgitation or aspiration. There were no significant differences in terms of neonatal Apgar scores, maternal and neonatal postoperative outcomes between the two groups. Conclusions: Our results suggested that GA was mainly used for contraindication to neuraxial anesthesia or a failed block, and emergent CDs accounted for most cases. The second-generation LMA could be used for obstetric anesthesia, but correct position to achieve a good seal is the key to prevent reflux and aspiration. Whether they could replace the tracheal tube in routine practice needs further large prospective studies. PMID:28218212

  15. Assessment of dental caries predictors in 6-year-old school children - results from 5-year retrospective cohort study

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    Masood Mohd

    2012-11-01

    Full Text Available Abstract Background This was a retrospective cohort study undertaken to assess the rate and pattern of dental caries development in 6-year-old school children followed-up for a period of 5 years, and to identify baseline risk factors that were associated with 5 years caries experience in Malaysian children. Methods This 5-years retrospective cohort study comprised primary school children initially aged 6 years in 2004. Caries experience of each child was recorded annually using World Health Organization criteria. The rates of dental caries were recorded in prevalence and incidence density of carious lesions from baseline to final examination. Risk assessment was done to assess relative risk for caries after 5 years in children with baseline caries status. Simple and multiple logistic regression analysis were performed to identify significant independent risk factors for caries. Results The sample consisted of 1830 school children. All components of DMFT showed significant differences between baseline and final examination. Filled teeth (FT component of the DMFT showed the greatest increases. Results revealed the initial baseline caries level in permanent dentition was a strong predictor for future caries after 5 years (RR=3.78, 95% CI=3.48-4.10, P0.001. Logistic regression analysis showed significant association between caries occurrence and residence (urban/rural (OR=1.80, Pp observed from baseline and after 5 years was 5.80 persons/100 person-year of observation. The rate of new caries-affected tooth (IDt in the period from baseline and after 5-years was 0.76 teeth/100 teeth-year of observation. Conclusion The majority of 12-year-old school children (70% were caries-free and most of the caries were concentrated in only a small proportion (30% of them. We found that the presence of caries in permanent teeth at the age of 6 years was a strong predictor of future caries development in this population. The strong evidence of early permanent teeth

  16. Pathogen Changes and Risk Factor Analysis of Community-acquired Pneumonia in the Elderly of A Hospital in Zhe- jiang Province in Recent 5 Years%浙江省某院5年来老年社区获得性肺炎的病原体变迁及危险因素分析

    Institute of Scientific and Technical Information of China (English)

    钟雷; 裘雨林

    2014-01-01

    目的:了解我院老年社区获得性肺炎(CAP)的病原体和耐药性变迁,分析 CAP 发病的高危因素,为老年 CAP 的预防和治疗提供指导意见。方法回顾性分析2008-2012年的315例老年 CAP 患者的资料,对痰标本进行培养、分离和鉴定,药敏试验采用 K - B 法。对相关危险因素进行单因素和多因素 Logistic 回归分析。结果315份痰标本病原体培养阳性113份,阳性率为35.9%,2008-2012年各年阳性率分别为36.2%(21/58)、33.9%(19/56)、36.1%(22/61)、36.4%(24/66)和36.5%(27/74),差异无统计学意义(χ2=0.574,P ﹥0.05);共分离出130株病原体,革兰阳性菌43株(占33.1%),革兰阴性菌51株(占39.2%),非典型病原体36株(占27.7%)。其中分布最多的4种病原体为肺炎链球菌、肺炎支原体、流感嗜血杆菌和肺炎克雷伯菌,分别占23.9%、20.8%、15.4%和14.6%。2008-2012年肺炎链球菌(由34.8%下降至18.8%)和流感嗜血杆菌(由26.1%下降至9.4%)的比重逐年下降,肺炎克雷伯菌(由8.7%上升至18.8%)和肺炎支原体(由13.0%上升至31.3%)逐年上升;肺炎链球菌对青霉素的耐药率在5年都很高,且在后2年达到100%。多因素 Logistic 回归分析显示年龄、吸烟史、烟龄、慢性阻塞性肺疾病(COPD)、哮喘、慢性支气管炎、肺结核、支气管扩张和肺癌是 CAP 的独立危险因素(P ﹤0.05)。结论本地区老年 CAP 的病原体构成和耐药性均发生了明显变迁,由以往以肺炎链球菌为主,逐渐变为以肺炎支原体为主,耐药性增强且呈多重耐药特点;吸烟和呼吸道疾病是老年 CAP 的高危因素。%Objective To explore the pathogen changes and drug - resistance evolution of community - acquired pneu-monia(CAP)in the elderly,and to analyze the risk factors related to CAP,in order to to provide guidance

  17. Mycobacterium tuberculosis complex transmission is not associated with recent immigration (≤5 years) in Florida.

    Science.gov (United States)

    Séraphin, Marie Nancy; Lauzardo, Michael

    2015-12-01

    As tuberculosis (TB) incidence decreases in the US, foreign-born persons continue to account for a larger proportion of the burden. In these cross-sectional analyses of 1149 culture-confirmed TB cases genotyped using spoligotyping and 24-locus MIRU, we show that over a quarter of cases among the foreign-born population in Florida resulted from recent transmission of the Mycobacterium tuberculosis complex. In addition, over a third of these cases occurred among persons who had immigrated 5 years or less prior to their diagnosis. Although recent immigration was not a significant predictor of TB transmission, younger age, birthplace in the Americas, homelessness, drug use and TB lineage are risk factors for TB transmission among the foreign-born population in Florida. These data provide actionable insights into TB transmission among the foreign-born population in Florida.

  18. Abdominal obesity status among Arora preschool children (2-5 years of Amritsar

    Directory of Open Access Journals (Sweden)

    N. Kaur

    2014-11-01

    Full Text Available ABSTRACT: Abdominal obesity is a state of excessive accumulation of central subcutaneous and visceral fat, has emerged as an important predictor for cardiovascular and metabolic risks in children and adolescents. Waist circumference is a highly sensitive and specific measure of abdominal obesity. Very few studies are available to the prevalence of abdominal obesity. Therefore in the present study an attempt has been made to report the prevalence of abdominal obesity among preschool children of Amritsar (Punjab. This study was undertaken among 1879 (949 boys and 930 girls Arora preschool children aged 2-5 years of Amritsar. Waist circumference was taken on each subjects using standard technique. Abdominal obesity was assessed by using waist circumference criterion of National Health and Nutrition Examination Survey. Present study revealed that abdominal obese were10.4% and 6.3% among boys and girls, respectively. The percentage prevalence of abdominal obesity was lower in the Amritsar children than other populations.

  19. Characteristics and Costs of Disability Pensions in Finnish Agriculture Based on 5-Year Insurance Records.

    Science.gov (United States)

    Karttunen, Janne P; Rautiainen, Risto H; Leppälä, Jarkko

    2015-01-01

    The characteristics and costs of disability pensions in Finnish farmers were investigated. The data included a total of 4,088 permanent or temporary disability pensions of the self-employed Finnish farming population over a 5-year period (2008-2012), an annual rate of 1.04 new cases per 100 person-years (males 0.94/100 and females 1.24/100). These cases resulted in the loss of almost 6,800 person-years and 60.2 million Euros in pension costs in the 5-year period. Almost half of the outcomes (44.6%) were primarily related to diseases of the musculoskeletal system (MSDs). Other common outcomes were mental and behavioral disorders (17.5%), injuries (9.8%), diseases of the circulatory system (7.8%), and diseases of the nervous system (6.6%). Relative proportions of these outcomes and their costs were similar with few exceptions. Although farmers have high risk of acute traumatic injuries, they also have a high risk of chronic conditions that affect their work ability. Particularly MSDs were common primary reasons for disability pension among farmers in general and among female farmers in particular. In addition to healthy lifestyle choices, improvements in the working envir