Additional Risk Factor (additional + risk_factor)

Distribution by Scientific Domains
Distribution within Medical Sciences


Selected Abstracts


Management of hypertension and stroke prevention: results of the Italian cardiologist survey

INTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 2 2009
G. Tocci
Summary Objective: To provide an overview of current habits, priorities, perceptions and knowledge of cardiologists with regard to hypertension and stroke prevention in outpatient practice. Methods: A sample of 203 cardiologists operating in outpatient clinics and randomly selected amongst members of the largest Italian Outpatient Cardiologist Association were interviewed by e-mail, in April,May 2007. Results: The interviewed cardiologists reported that hypertensive outpatients represent a large percentage of their practice population, in which the clinical priority was blood pressure (BP) reduction. Stroke was identified as the most important event to prevent and it was also perceived as the most preventable hypertension-related cardiovascular event. A remarkably high rate of achieved BP control was reported, to a degree that it is inconsistent with current epidemiological reports and with the relatively low percentage use of combination therapies declared by cardiologists. Additional risk factors, organ damage, diabetes mellitus and atrial fibrillation were consistently reported in hypertensive patients. Among antihypertensive drug classes, a preference for angiotensin-converting enzyme inhibitors has been expressed by the majority of physicians; this choice was generally justified by evidence derived from international trials or by the antihypertensive efficacy of this drug class. Conclusions: The results confirm the presence of weaknesses in the current services for patients with hypertension, even when being managed by cardiologists. Discrepancies between perceptions and reality, or clinical practice and guideline recommendations are also highlighted. An analysis of these aspects may help to identify current areas of potential improvement for stroke prevention in the clinical management of hypertension in cardiology practice. [source]


A study of dietary advice and care provided to HIV positive patients referred for lipid lowering: as part of a service improvement initiative

JOURNAL OF HUMAN NUTRITION & DIETETICS, Issue 4 2008
N.A. Billing
Background:, Combination antiretroviral therapy (ART) has dramatically reduced mortality in HIV-infected patients. As life expectancy of HIV infected patients has increased, concerns about the long-term effects of treatment grow (Sax, 2006). HIV positive patients have a greater risk of myocardial infarction (MI) and ART has been associated with a 26% increase in the rate of MI per year of exposure (DAD Study Group, 2003). The aim of this study was to evaluate provision of dietetic care to patients referred for lipid lowering advice and identify potential areas for service improvement. Methods:, Departmental activity statistics identified 117 new clients referred for lipid lowering advice in the previous 11 months. The biochemical data and dietetic record cards were screened, of the initial sample 30 were excluded as they did not have follow up biochemistry after their dietetic consultation and a further seven were excluded as they were seen primarily for other conditions. The remaining cards (n = 80) had their dietetic record cards audited to check dietary topics discussed, risk factors identified length before follow up and clinical outcomes. Results:, There were 68 men and 12 women in this sample with a mean age of 46 years and mean body mass index (BMI) of 25.4 kg m,2 (3.7 kg m,2). Of the clients referred, only 48.8% of the sample had high density lipoprotein (HDL): cholesterol ratios taken to calculate cardiovascular risk and most patients were seen an average of 30.7 days (35.3 days) after high was identified. Following their dietetic consultation, 77% of clients had a reduction in their cholesterol levels and 61% had a reduction in triglyceride levels. This sample's average percentage change in cholesterol was ,10% (16%) and triglyceride was ,6% (32%). The most popular dietary advice was reducing saturated fat intake (90%), increasing fibre intake (76%), benefits of plant stanols (40%), importance of regular meals (29%), exercise (26%) and benefits of omega three (11%). Additional risk factors identified 11% of clients seen were smokers, however most records (66%) did not have documentation on whether smoking behaviour was discussed. Only 20% of clients had a follow up appointments and not all were seen within 3 months with average time between follow up being 14.9 weeks (13.2 weeks). Discussion:, Improvement in biochemical results were comparable to a study by Henry et al., (1998) which showed that in HIV infected clients receiving ART, diet modification and increased exercise were successful in reducing cholesterol levels by 11% and triglyceride levels by 21%. The level of smoking was considerably lower than other studies (DAD Study Group, 2003) which reported 56% of HIV positive clients to be smokers. A large number of clients were lost to follow up and were not seen within 3 months. Lazzaretti et al., (2007) showed in a randomized trial that seeing patients at regular 3 month intervals for dietary intervention prevented an increase in lipid blood levels in individuals who start ART. Conclusions:, Not all clients are having their cardiovascular risk calculated before referral for dietary advice. Clients are not being seen at regular intervals by dietitians, some are lost to follow up and smoking status is not regularly documented during dietetic consultation. References, Data Collection on Adverse Events of Anti-HIV Drugs (DAD) Study Group. (2003) Combination antiretroviral therapy and the risk of myocardial infarction. N. Engl. J. Med.349, 1993,2003. Friis-Moller, N., Weber, R., Reiss, P., Thiebaut, R., Kirk, O., d'Arminio, M.A. et al. (2003) Cardiovascular disease risk factors in HIV patients' association with antiretroviral therapy. Results from the DAD study. AIDS17, 1179,1193. Henry, K., Melroe, H., Huebesch, J., Hermundson, J. & Simpson, J. (1998) Atorvastatin and gemfibrozil for protease inhibitor-related lipid abnormalities. Lancet352, 1031,1032. Sax, P.E. (2006)Strategies for management and treatment of dyslipidemia in HIV/AIDS. AIDS Care 18, 149,157. Lazzaretti, R., Pinto-Ribeiro, J., Kummer, R., Polanczyk, C. & Sprinz, E. (2007) Dietary intervention when starting HAART prevents the increase in lipids independently of drug regimen: a randomized trial. Oral abstract session: 4th IAS Conference on HIV Pathogenesis, Treatment and Prevention: Abstract no.WEAB303. [source]


Incidence and Precipitating Factors of Morbidity among Israeli Travelers Abroad

JOURNAL OF TRAVEL MEDICINE, Issue 5 2002
Lihi Winer
Background: During recent years international travel, including visits to the developing world, has become increasingly popular. Many of these travelers suffer from some sort of health problem during their trip or after their return. Travelers clinics that give pretravel immunization and counseling have emerged. This study analyzes the incidence and risk factors for health problems among Israelis traveling abroad. Methods: The study surveyed by telephone 200 people who visited the traveler's clinic at Soroka Medical Center in Beer-Sheva during the years 1998 to 1999. The travelers were questioned after returning from their journey about the type and duration of the trip, compliance with medical advice given in the travel clinic, and health problems during the trip. Results: The mean age was 26.4 ± 9.4 years, 7% went on an organized tour, 23% traveled alone, and 77% traveled with a friend. The mean duration of the trip was 14.7 ± 13.4 weeks. Of the travelers, 70% reported some health impairment. Problems reported most frequently were gastrointestinal tract diseases (43%), respiratory tract diseases (25%), and injuries (10%). Only 4% were admitted to a hospital during their trip. After their return, 19.5% consulted a physician. Comparing the group of travelers who were sick with the rest, a correlation between noncompliance with the keeping of food hygiene and illness was found (p = .008). Additional risk factors for illness were long duration (p < .001), solitary trip (p = .04), and young age (p < .001). Of the people who were advised to take antimalaria chemoprophylaxis, 55% reported regular use of these drugs. Compliance with treatment correlated with older age (p < .001), short duration of stay (p = .01), previous experience, and travel to Africa (p < .001). Conclusions: Most of the travelers to developing countries are young, travel for long periods, and live in basic conditions during their stay abroad. For these reasons travelers are at increased risk for morbidity. High risk travelers should be identified and counseled in order to increase their compliance with the medical advice and immunizations. A screening program for returning travelers should be considered. [source]


A population-based study of coarctation of the aorta: Comparisons of infants with and without associated ventricular septal defect

BIRTH DEFECTS RESEARCH, Issue 5 2001
Dana Swartzberg Wollins
Background Coarctation of the aorta (CoA) is a congenital cardiovascular malformation (CCVM) sometimes associated with ventricular septal defect (VSD). Although the phenotypic association is well documented, little research exists on the epidemiological features distinguishing CoA with and without VSD. Methods The Baltimore,Washington Infant Study (1981,1989), a population-based study of CCVM, evaluated 126 infants with "pure" CoA (free of associated cardiac defects) and 67 infants with CoA and VSD (COA/VSD) in comparison to 3,572 controls. Results The proportion of infants with associated extracardiac anomalies was greater among CoA/VSD than among pure CoA (31% versus 11%). Infants with CoA/VSD were twice as likely as those with pure CoA to be born small for gestational age (23% versus 12%, respectively, compared with 6% of controls). All-cause mortality during the first year of life was higher in CoA/VSD than in pure CoA (21% vs. 7%). Multiple logistic regression models revealed that family history of CCVM was associated with pure CoA (adjusted case-control odds ratio [OR] = 4.6; 99% confidence interval [CI] = 1.5,13.9) and with CoA/VSD (OR = 5.9, CI = 1.2,23.5); maternal history of organic solvent exposures early in pregnancy was also associated with pure CoA (OR = 3.2, CI = 1.0,10.2) and with CoA/VSD (OR = 3.7, CI 0.9,14.9). Additional risk factors, including maternal epilepsy (OR = 5.3, CI = 0.9,30.6), and use of macrodantin (OR = 6.7, CI = 1.4,31.8) were associated only with pure CoA. Conclusions These findings highlight possible genetic and environmental differences between pure CoA and CoA/VSD and may stimulate further investigations of the etiology of CoA. Teratology 64:229,236, 2001. © 2001 Wiley-Liss, Inc. [source]


Glycaemic status and cardiovascular disease in type 2 diabetes mellitus: re-visiting glycated haemoglobin targets for cardiovascular disease prevention

DIABETES OBESITY & METABOLISM, Issue 6 2007
Sherita H. Golden
Cardiovascular disease (CVD) is the leading cause of death among people with type 2 diabetes. Recent attention has focused on chronic hyperglycaemia as an additional risk factor in people with diabetes since their excess CVD risk is not entirely explained by traditional cardiovascular risk factors. Clinical trials of intensive glucose control to reduce CVD events have been equivocal, but recent epidemiological studies have shown that HbAlc, a measure of chronic hyperglycaemia, predicts incident cardiovascular events. This review, which focuses on type 2 diabetes, summarizes (i) the epidemiological literature examining the relation between glycaemic status, as assessed by glycated haemoglobin (HbAlc) and CVD, (ii) the controversy regarding treatment goals for HbAlc in terms of preventing microvascular disease vs. macrovascular disease and (iii) on-going clinical trials of intensive glycaemic control for CVD prevention. [source]


Reflecting on Type 2 Diabetes Prevention: More Questions than Answers!

DIABETES OBESITY & METABOLISM, Issue 2007
J. Rosenstock
Given the enormous public health and economic burden posed by the global epidemic of type 2 diabetes mellitus (T2DM), intervention in the prediabetes stage of disease to prevent progression to T2DM and its vascular complications seems the most sensible approach. Precisely how best to intervene remains the subject of much debate. Prudent lifestyle changes have been shown to significantly reduce the risk of progression in individuals with impaired fasting glucose (IFG) and impaired glucose tolerance (IGT). Although lifestyle modifications are notoriously difficult to maintain, there is evidence that intensive intervention results in continued preventive benefit after the stopping of structured counselling. A number of drug therapies, including metformin, acarbose, orlistat and rosiglitazone, have also been proven effective in preventing progression from IFG/IGT, but unresolved issues still remain. Specifically, whether large numbers of individuals with glucose dysregulation who may never progress to T2DM should be exposed to the risk of pharmacological adverse effects is a topic of discussion and debate. Furthermore, there are limited data on the effectiveness of implementing interventions during the prediabetic state to prevent cardiovascular complications that may be hyperglycaemia related. A recent American Diabetes Association (ADA) consensus statement on IFG/IGT recommends lifestyle modification for individuals with IFG or IGT. Of note, the ADA consensus statement introduces the option of adding metformin treatment to lifestyle changes in those individuals who have combined IFG/IGT plus an additional risk factor for progression and who also have some features that increase the likelihood of benefiting from metformin treatment. The dipeptidyl peptidase-4 inhibitors are a new class of oral antidiabetic agents that, in addition to being effective in improving glycaemic control, may exert beneficial effects in preserving ,-cell function. These characteristics, combined with a low risk of hypoglycaemia, weight neutrality and what appears , so far , to be a relatively benign tolerability profile, make these agents intriguing candidates for preventive treatment. [source]


Myocardial perfusion imaging and cardiac events in a cohort of asymptomatic patients with diabetes living in southern France

DIABETIC MEDICINE, Issue 4 2006
A. Sultan
Abstract Aims, To assess the association between abnormal stress myocardial perfusion imaging (MPI) and cardiac events (CE) in asymptomatic patients with diabetes and with , 1 additional risk factor. Predictors of abnormal stress MPI were also evaluated. Methods, Four hundred and forty-seven consecutive patients who underwent stress MPI were prospectively followed for 2.1 [0.5,4.1] years for the subsequent occurrence of hard CE (myocardial infarction and sudden or coronary death) and soft CE (unstable angina and ischaemic heart failure requiring hospitalization). Re-vascularization procedures performed as a result of the screening protocol were not included in the analysis. Results, Follow-up was successful in 419 of 447 patients (94%), of whom 71 had abnormal MPI at baseline. Medical therapy was intensified in all subjects and especially in those with abnormal MPI. Twenty-three patients with abnormal MPI underwent a re-vascularization procedure. CEs occurred in 14 patients, including six of 71 patients (8.5%) with abnormal MPI and eight of 348 patients (2.3%) with normal MPI (P < 0.005). Only two patients developed a hard CE and 12 a soft CE. In multivariate analysis, abnormal MPI was the strongest predictor for CEs [odds ratio (OR) (95% CI) = 5.6 (1.7,18.5)]. Low-density lipoprotein cholesterol , 3.35 mmol/l [OR (95% CI) = 7.3; 1.5,34.7] and age > median [OR (95% CI) = 6.0 (1.2,28.6)] were additional independent predictors for CE. The independent predictors for abnormal MPI were male gender, plasma triglycerides , 1.70 mmol/l, creatinine clearance < 60 ml/min and HbA1c > 8%, with male gender the strongest [OR (95% CI) = 4.0 (1.8,8.8)]. Conclusions, Asymptomatic patients with diabetes in this study had a very low hard cardiac event rate over an intermediate period. This could be explained by the effects of intervention or by the low event rate in the background population. Randomized studies of cardiac heart disease screening are required in asymptomatic subjects with diabetes to determine the effectiveness of this intervention. Diabet. Med. (2006) [source]


Matched case,control study to evaluate risk factors for hyperlactataemia in HIV patients on antiretroviral therapy

HIV MEDICINE, Issue 4 2003
D Datta
Background Lactic acidosis is a life-threatening event during antiretroviral therapy (ART). Hyperlactataemia may be a prelude to acidosis. Our database study suggested that female gender, intercurrent illness and didanosine (ddI)-based regimens may increase risk of lactic acidosis. The aim of this matched case,control study was to identify risk factors for hyperlactataemia requiring screening. Methods Cases were defined as patients with two consecutive lactate samples ,3.5 mmol/L taken more than 1 week apart. Cases were matched to two controls on gender, use of ddI and total duration of therapy using a 6-month window on either side. Controls never had raised lactate >2.5 mmol/L. A conditional logistic regression analysis using the PHREG procedure in SAS (SAS Institute Inc, Cary, NC) was performed with a discreet logistic model stratified by matching variables. Results Twenty-one cases were matched to 42 controls. In the univariate model, current use of stavudine (d4T), total cholesterol >5.3 mmol/L and glucose levels ,5.2 mmol/L gave increased likelihood of persistent hyperlactataemia. The multivariate model showed current use of d4T to be a significant independent predictor of persistent hyperlactataemia. Conclusions The results of this case,control study indicate that, when controlling for ddI use, d4T use is an additional risk factor for hyperlactataemia. [source]


Asymmetric sphincter innervation is associated with fecal incontinence after anal sphincter trauma during childbirth

NEUROUROLOGY AND URODYNAMICS, Issue 1 2007
Beate M. Wietek
Abstract Aims Functional asymmetry of pelvic floor innervation has been shown to exist in healthy subjects, and has been proposed to be a predictor of increased risk for fecal incontinence in case of trauma. However, this remains to be shown for different clinical conditions such as traumatic childbirth. Methods A conventional surface EMG system was used to assess the innervation of the external anal sphincter. A symmetry index was used to define the relative EMG amplitude asymmetry of the external anal sphincter between 0 (symmetric) and 1 (asymmetric). Three cohorts were studied: 40 nulliparous women in the third trimester (Study 1), 15 primiparous women within 6 months following vaginal delivery without clinically apparent anal sphincter trauma (Study 2), and 50 women after childbirth-related third or fourth degree perineal tear 6,12 months postpartum (Study 3). Furthermore, all women underwent conventional anorectal manometry. Results Sixteen or forty nulliparous women reported signs of fecal incontinence; however, relative asymmetry was not correlated to symptom severity (P,=,0.345), and not to manometric measures (Study 1). In Study 2, Women who had suffered clinically apparent anal sphincter trauma (P,=,0.07) tended to have a stronger association between incontinence and asymmetry. In Study 3, 19/50 women reported moderate to severe incontinence. Asymmetry and symptom severity were significantly correlated (P,<,0.001). Patients with incontinence had a significantly higher asymmetry score than their continent counterparts. Conclusion Functional asymmetry of anal sphincter innervation is significantly associated with incontinence symptoms, but only after childbirth-related sphincter injuries and therefore, should be regarded as an additional risk factor. Neurourol. Urodynam. © 2006 Wiley-Liss, Inc. [source]


Epidemiology of childhood type 2 diabetes and obesity

PEDIATRIC DIABETES, Issue 2007
Jonathan Shaw
Abstract:, Over the last decade, it has become apparent that type 2 diabetes extends not only into the young adult population but is also found in adolescents and even, occasionally, in children. The limited data that are currently available present a rather uncertain picture, with a rather wide range of prevalences and incidences of type 2 diabetes in children and adolescents. Not surprisingly, the majority of the cases, and the highest prevalences, have been found among ethnic groups known to be at high risk of adult type 2 diabetes. Nevertheless, even in European populations, where the prevalence of type 2 diabetes remains very low among children and adolescents and certainly is considerably smaller than type 1 diabetes, there are several cases reported. The risk factors for type 2 diabetes in children and adolescents are, as expected, similar to those seen in adults, with obesity being almost always present. In utero exposure to hyperglycemia now appears to be an additional risk factor to having a family history of diabetes and suggests that better management of diabetes in pregnancy and prevention of gestational diabetes may reduce the risk of diabetes developing in the offspring. [source]


Sensitization to wheat flour and enzymes and associated respiratory symptoms in British bakers

AMERICAN JOURNAL OF INDUSTRIAL MEDICINE, Issue 2 2009
Joanne Harris-Roberts PhD
Abstract Rationale Current literature suggests that flour exposed workers continue to be at risk of allergic sensitization to flour dust and respiratory ill health. Objectives A cross-sectional study of 225 workers currently potentially exposed to flour dust in British bakeries was performed to identify predictors of sensitization to wheat flour and enzymes. Results Work-related nasal irritation was the most commonly reported symptom (28.9%) followed by eye irritation (13.3%) and work-related cough or chest tightness (both 10.2%). Work-related chest tightness was significantly associated (OR 7.9, 1.3,46.0) with co-sensitization to wheat flour and any added enzyme. Working at a bakery with inadequate control measures was not a risk factor for reporting work-related respiratory symptoms (OR 1.3, 0.4,3.7). Fifty-one workers were atopic and 23 (14%) were sensitized to workplace allergens. Atopy was the strongest predictive factor (OR 18.4, 5.3,64.3) determining sensitization. Current versus never smoking (OR 4.7, 1.1,20.8) was a significant risk factor for sensitization to wheat flour or enzymes in atopic workers only, corrected for current level and duration of exposure. This effect was not seen in non-atopic workers (OR 1.9, 0.2,17.9). Evidence of sensitization to less commonly encountered allergens was also seen to Aspergillus niger derived cellulase, hemicellulase and xylanase mix, in addition to glucose oxidase and amyloglucosidase mix. Conclusions The combination of health surveillance and exposure control in this population has been insufficient to prevent clinically significant workplace sensitization. Smoking may pose an additional risk factor for sensitization in atopic workers. Am. J. Ind. Med. 52:133,140, 2009. © 2008 Crown copyright. [source]


Acute pancreatic damage associated with convulsive status epilepticus: A report of three cases

PSYCHIATRY AND CLINICAL NEUROSCIENCES, Issue 6 2001
Katsuhiko Ogawa
Abstract Three cases involving a previously unreported association of acute pancreatic damage following convulsive status epilepticus (SE) are presented. A review of literature failed to reveal a similar association between SE and acute pancreatic damage. As possible pathophysiological mechanisms of this so far unknown sequel of SE, increased intraduodenal pressure during SE leading to the reflux of the duodenal contents into the pancreatic duct, along with altered metabolism of oxygen-derived free radicals during a prolonged seizure with hypoxia and ischemia resulting in acinar cell injury are suggested. We believe that SE should be considered as an additional risk factor of acute pancreatitis and that pancreatic enzymes should be monitored in patients who have prolonged seizures. [source]


Discretionary government intervention and the mispricing of index futures

THE JOURNAL OF FUTURES MARKETS, Issue 12 2003
Paul Draper
This article examines how and to what extent direct market intervention by the Hong Kong government in both the stock and futures markets affected the pricing relationship between the Hang Seng Index futures and the cash index during the period of the Asian financial crisis. The study avoids infrequent trading and nonexecution problems by using tradeable bid and offer quotes for the constituent stocks of the index. The results show that arbitrage efficiency was impeded during, and in the immediate aftermath of, the intervention. The findings suggest that discretionary government action introduces an additional risk factor for arbitrageurs that continues to disrupt normal market processes even after the government ceases to intervene. The continued disruption following the government's actions in the market also stems from a poorly developed stock loan market that impedes short selling, as well as a lack of liquidity in the market. © 2003 Wiley Periodicals, Inc. Jrl Fut Mark 23:1159,1189, 2003 [source]


Cross-Sectional Tests of Multifactor CCAPMs using Conditional Moments and Time-Series Restrictions,

ASIA-PACIFIC JOURNAL OF FINANCIAL STUDIES, Issue 5 2009
Jinyong Kim
Abstract Two different methods are used to evaluate the performance of the consumption-based asset pricing models to explain the cross-section of expected stock returns in conditional moments: one is to scale the returns, and the other is to model time-varying factor loadings, using instrument variables. Maximum correlation portfolios are constructed to directly impose restrictions on the time-series intercepts, especially in a model whose factors are not returns. The empirical results are as follow: the consumption-based models perform no better than the standard CAPM; adding the return on human capital as an additional risk factor does not help explain the cross-section; and the Fama-French three-factor model shows the best ability to lower the pricing error. [source]


Venous thromboembolism associated with the management of acute thrombotic thrombocytopenic purpura

BRITISH JOURNAL OF HAEMATOLOGY, Issue 5 2003
Helen Yarranton
Summary. Venous thromboembolism (VTE) is not a feature of thrombotic thrombocytopenic purpura (TTP), but there has been a recent report of VTE in association with plasma exchange (PEX) treatment for TTP using the solvent detergent (SD) plasma, PLAS+®SD. We reviewed the occurrence of VTE in 68 consecutive patients with TTP (25 men, 43 women). Eight documented VTE events [six deep venous thromboses (DVTs), three pulmonary emboli] were identified in seven patients (all female) during PEX therapy. All six DVTs were associated with central lines at the site of thrombosis. Other known precipitating factors included pregnancy, immobility, obesity and factor V Leiden heterozygosity. VTE occurred at a mean of 53 d following the first PEX. The European SD plasma, Octaplas® was the last plasma to be used in PEX prior to the VTE in 7/8 events. This is the first report of VTE following Octaplas® infusion. VTE is a multifactorial disease and, although several known precipitating factors were present in all patients in this study, the use of large volumes of SD plasma in PEX may be an additional risk factor. We recommend prevention of VTE with graduated elastic compression stockings (class I) at diagnosis and prophylactic low-molecular-weight heparin once the platelet count rises above 50 × 109/l. [source]


PAI-1 promoter 4G/5G genotype as an additional risk factor for venous thrombosis in subjects with genetic thrombophilic defects

BRITISH JOURNAL OF HAEMATOLOGY, Issue 1 2000
Rafael Seguí
Impaired fibrinolysis as a result of increased plasminogen activator inhibitor-1 (PAI-1) levels in plasma is a common finding in patients with deep vein thrombosis (DVT). A 4G/5G polymorphism in the promoter region of the PAI-1 gene has been reported to influence the levels of PAI-1. The 4G allele was found to be associated with higher plasma PAI-1 activity (act), but contradictory results on the incidence of the 4G allele in DVT patients have been reported. The aim of this study was to analyse whether the PAI-1 promoter 4G/5G genotype increases the risk of venous thrombosis in subjects with thrombophilic defects, and to determine the distribution of the PAI-1 4G/5G genotype and its relation to plasma PAI-1 levels in 190 unrelated patients with DVT in comparison with a control group of 152 healthy subjects. No differences between the 4G/5G allele distribution in the DVT group (0·43/0·57) and in the control group (0·42/0·58) were observed. However, the presence of the 4G allele significantly increased the risk of thrombosis in patients with other thrombophilic defects. Significantly higher PAI-1 levels were observed in DVT patients than in the controls. Our results also showed significant differences in the plasma levels of PAI-1 antigen (ag) and PAI-1 act among the 4G/5G genotypes in DVT patients. A multivariate analysis revealed that, in the DVT group, PAI-1 ag levels were influenced by the 4G allele dosage, triglyceride levels and body mass index (BMI). The influence of the 4G allele dosage on PAI-1 levels was independent of the triglyceride levels and BMI. In the control group, no significant correlation between PAI-1 levels and 4G allele dosage was observed. In conclusion, the PAI-1 promoter polymorphism was found to have an influence on PAI-1 levels in DVT patients and on the risk of venous thrombosis in subjects with other genetic thrombophilic defects. [source]


Insufficient energy and nutrient intake in children with motor disability

ACTA PAEDIATRICA, Issue 8 2009
P Kilpinen-Loisa
Abstract Aim:, Children with motor disabilities are at increased risk of compromised bone health due to impaired weight bearing. Poor nutritional status may be an additional risk factor. The aim of this study was to evaluate energy and nutrient intakes in children with motor disability. Patients and Methods:, Fifty-four children with motor disability (cerebral palsy in 59%) were included. Three-day food diaries were collected and analysed. The results were compared with recommended dietary allowances for age and sex. Results:, The median age was 10.9 years. The median energy intake was 76% of the recommendation and <80% in 57% of children. Of the total energy, 17% was from protein, 32% from fat and 50% from carbohydrates. The medians were for calcium intake 142% and for vitamin D intake 76% of the recommendation; serum 25-hydroxy-vitamin D concentrations were low (median 46 nmol/L). Children with low energy intake were shorter and lighter and had more severe motor disability than children with sufficient energy intake. Conclusion: Insufficient energy and nutrient intake is common in children with motor disability. This may have adverse health effects especially when associated with low vitamin D intake. Energy and vitamin D supplements should be considered. [source]


Aplasia cutis congenita of the scalp: How much therapy is necessary in large defects?

ACTA PAEDIATRICA, Issue 6 2005
B Bernbeck
Abstract Aim: To show that local antibiotic management and a regular inspection of aplasia cutis congenita of the skull can give an excellent result. Method: This case reports a girl born with aplasia cutis congenita of the skull presenting with a large aplasia of the epidermis, dermis, subcutaneous tissue and galea, including a bone defect without any additional risk factor, e.g. early eschar formation, cerebrospinal fluid leakage or uncommon dural blood vessels. Results: A primarily conservative treatment with local wet and antibiotic dressings together with a systemic antibiotic treatment for the first 2 wk led to an excellent result and thus prevented untimely operative and peri-operative procedures. Conclusions: Here we have shown that conservative treatment might be an option, even if the wound diameter is greater than 1 cm2, to prevent infants from any untimely operative procedure with an elevated operative risk if any additional risk factors are excluded. [source]


Child sexual abuse in the etiology of depression: A systematic review of reviews

DEPRESSION AND ANXIETY, Issue 7 2010
Roberto Maniglio Psy.D. Ph.D.
Abstract Background: Despite a large amount of research, there is considerable controversy about the role that child sexual abuse plays in the etiology of depression. To prevent interpretative difficulties, mistaken beliefs, or confusion among professionals who turn to this literature for guidance, this article addresses the best available scientific evidence on the topic, by providing a systematic review of the several reviews that have investigated the literature on the issue. Methods: Seven databases were searched, supplemented with hand search of reference lists from retrieved papers. The author and a psychiatrist independently evaluated the eligibility of all studies identified, abstracted data, and assessed study quality. Disagreements were resolved by consensus. Results: Four reviews, including about 60,000 subjects from 160 studies and having no limitations that could invalidate their results, were analyzed. There is evidence that child sexual abuse is a significant, although general and nonspecific, risk factor for depression. The relationship ranges from small-to-medium in magnitude and is moderated by sample source. Additional variables may either act independently to promote depression in people with a history of sexual abuse or interact with such traumatic experience to increase the likelihood of depression in child abuse survivors. Conclusions: For all victims of abuse, programs should focus not only on treating symptoms, but also on reducing additional risk factors. Depressed adults who seek psychiatric treatment should be enquired about early abuse within admission procedures. Depression and Anxiety, 2010. © 2010 Wiley-Liss, Inc. [source]


Incentive-elicited striatal activation in adolescent children of alcoholics

ADDICTION, Issue 8 2008
James M. Bjork
ABSTRACT Aims Deficient recruitment of motivational circuitry by non-drug rewards has been postulated as a pre-morbid risk factor for substance dependence (SD). We tested whether parental alcoholism, which confers risk of SD, is correlated with altered recruitment of ventral striatum (VS) by non-drug rewards in adolescence. Design During functional magnetic resonance imaging, adolescent children of alcoholics (COA; age 12,16 years) with no psychiatric disorders (including substance abuse) and similarly aged children with no risk factors responded to targets to win or avoid losing $0, $0.20, $1, $5 or a variable amount (ranging from $0.20 to $5). Results In general, brain activation by either reward anticipation or outcome notification did not differ between COA and age/gender-matched controls. Cue-elicited reward anticipation activated portions of VS in both COA and controls. In nucleus accumbens (NAcc), signal change increased with anticipated reward magnitude (with intermediate recruitment by variable incentives) but not with loss magnitudes. Reward deliveries activated the NAcc and mesofrontal cortex in both COA and controls. Losses activated anterior insula bilaterally in both groups, with more extensive right anterior insula activation by losses in controls. NAcc signal change during anticipation of maximum rewards (relative to non-reward) correlated positively with both Brief Sensation-Seeking Scale scores and with self-reported excitement in response to maximum reward cues (relative to cues for non-reward). Conclusions Among adolescents with no psychiatric disorders, incentive-elicited VS activation may relate more to individual differences in sensation-seeking personality than to presence of parental alcoholism alone. Future research could focus on adolescents with behavior disorders or additional risk factors. [source]


Valproate-induced thrombocytopenia: a prospective monotherapy study

EPILEPSIA, Issue 3 2008
Wassim Nasreddine
Summary Purpose: The frequency of valproate (VPA)-induced thrombocytopenia varied widely in previous studies, due to methodological differences. Our objective was to evaluate the relationship between trough VPA plasma levels and platelet counts and assess risk factors for the development of thrombocytopenia. Methods: Patients with refractory partial epilepsy were enrolled in this double-blind, multicenter, concentration,response trial that evaluated the efficacy and safety of high versus low trough plasma VPA concentrations following administration of divalproex sodium as monotherapy. Trough VPA concentrations and concomitant platelet counts were drawn at baseline and intermittently throughout the 24-week trial. Bivariate correlations and multivariate stepwise regression analysis were performed between platelet counts and multiple variables. A logistic regression analysis was done to determine the probability of developing thrombocytopenia at various VPA levels. Results: A total of 851 VPA levels and concomitant platelet counts were analyzed in 265 patients. Of these, 17.7% of patients experienced at least one episode of thrombocytopenia (platelet count , 100,000/,l) after exposure to divalproex sodium. A significant negative correlation was found between VPA levels and platelet counts. Women were significantly more likely to develop thrombocytopenia. The probability of developing thrombocytopenia substantially increased at trough VPA levels above 100 ,g/ml in women and above 130 ,g/ml in men. Discussion: Our data strongly support a causal relationship between rising plasma VPA levels and reduced platelet counts, with additional risk factors including female gender and lower baseline platelet counts. [source]


Conditioning Information and European Bond Fund Performance

EUROPEAN FINANCIAL MANAGEMENT, Issue 2 2003
Florinda Silva
G11; G12; G14 In this paper we evaluate the performance of European bond funds using unconditional and conditional models. As conditioning information we use variables that we find to be useful in predicting bond returns in the European market. The results show that, in general, bond funds are not able to outperform passive strategies. These findings are robust to whatever model (unconditional versus conditional and single versus multi-index) we use. The multi-index model seems to add some explanatory power in relation to the single-index model. Furthermore, when we incorporate the predetermined information variables, we can observe a slight tendency towards better performance. This evidence is consistent with previous studies on stock funds and comes in support of the argument that conditional models might allow for a better assessment of performance. However, our results suggest that the impact of additional risk factors seems to be greater than the impact of incorporating predetermined information variables. [source]


Stable long-term opioid medication per se does not always cause loss of driving ability: the doctor and patient must consider additional risk factors for unsafe driving

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 6 2006
H. Breivik
No abstract is available for this article. [source]


Adverse perinatal conditions in hearing-impaired children in a developing country

PAEDIATRIC & PERINATAL EPIDEMIOLOGY, Issue 5 2006
Bolajoko O. Olusanya
Summary Prevailing adverse perinatal conditions in developing countries have been associated with substantial mortality, but little evidence exists on their impact on permanent childhood disabilities and morbidity due to limitations in clinical investigations and medical records. This study aims to identify the possible association between parent-reported adverse perinatal conditions and permanent hearing loss, in order to establish service needs within current maternal and child health programmes. Structured questionnaires were administered to 363 parents of deaf children and 309 parents of normal-hearing children in an inner city area of Lagos, Nigeria. The parents were from all social classes. After a multivariable logistic regression analysis, birth asphyxia [OR 20.45; 95% CI 6.26, 66.85], difficult delivery [OR 8.09; 95% CI 2.76, 23.68], neonatal jaundice [OR 2.45; 95% CI 1.25, 4.79] and neonatal seizures [OR 2.30; 95% CI 1.09, 4.85] were associated with permanent hearing loss. Consanguineous marriages [OR 6.69; 95% CI 2.72, 16.46] and family history of deafness [OR 6.27; 95% CI 2.07, 18.97] also emerged as additional risk factors for permanent hearing loss. In addition, parents of children in state-owned schools for the deaf were significantly more likely to belong to higher social classes compared with normal-hearing children in mainstream state-owned schools. There is a need to incorporate services for the early detection of permanent hearing loss into current maternal and child healthcare programmes in developing countries. [source]


Debunking the ,only 50%' myth: prevalence of established risk factors in New Zealanders with self-reported ischaemic heart disease

AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 5 2005
Martin Tobias
Objective: To estimate the prevalence of established risk factors for ischaemic heart disease (IHD) in New Zealand adults and compare the prevalence in adults with and without this disease. Design: Data were obtained from the 2002/03 New Zealand Health Survey. Risk factor prevalence was determined by: selfreported doctor diagnosis of high blood pressure, high cholesterol and diabetes; self-report of smoking and physical inactivity; and measurement of obesity. Presence of IHD was based on self-report of heart disease (doctor diagnosed at age 25 years or over) together with current medical or past surgical treatment for this disease. Multiple logistic regression was used to determine prevalence rate ratios (PRRs) for males and females separately, adjusting for age, ethnicity and deprivation. Results: The overall prevalence of IHD was 8%. Overall risk factor prevalences were in the range of 20,25% for each of high blood pressure, high cholesterol, smoking, obesity and physical inactivity, and approximately 5% for diabetes. Overall, 94,97% of adults with IHD had at least one risk factor (depending on how smoking was defined). The PRRs of IHD were highest for cholesterol (about 4.5), followed by blood pressure (about 2.3), with all other risk factors around 1.5. PAF estimates indicate that 80,85% of IHD was attributable to the presence of at least one risk factor for all age, gender and ethnic groups. Conclusions: Established risk factors account for 80,85% of the non-fatal burden of IHD in New Zealand. Limited research resources would be better used to evaluate which interventions are effective and efficient at reducing exposure of all population groups to known risk factors, rather than on identification of additional risk factors. [source]


Enuresis in childhood, and urinary and fecal incontinence in adult life: do they share a common cause?

BJU INTERNATIONAL, Issue 7 2005
Ayse Gurbuz
OBJECTIVE To investigate whether there is any association between urinary or fecal incontinence and childhood bedwetting, and given such a relationship, to detect which type of urinary incontinence (UI) is associated with childhood bedwetting. PATIENTS AND METHODS In all, 1021 patients who were admitted to the outpatient gynaecology clinics of the authors' institution for an annual gynaecological examination were included in this descriptive clinical study. A simple multi-choice screening questionnaire was used to collect data for analysis. RESULTS There was a history of bedwetting in childhood in 181 (21.1%) of women without and in 48 (29.6%) of those with UI; the difference was significant (chi-square, P < 0.05). Women with stress UI had significantly higher rates of enuresis in childhood (35.4%) than those without UI (21.1%; P = 0.003). Of women who had a history of bedwetting in childhood, 12.2% had stress UI, but only 6.4% of those with no such history had stress UI. Fecal incontinence was significantly more common in women with a history of bedwetting in childhood (P < 0.05). CONCLUSION A history of childhood bedwetting seems to increase the risk of having UI, stress UI and fecal incontinence. Being aware of this association may provide an opportunity to avoid exposing these women to additional risk factors for these condition. [source]


Molecular characterization of six unrelated Italian patients affected by pyrimidine 5,-nucleotidase deficiency

BRITISH JOURNAL OF HAEMATOLOGY, Issue 5 2003
Paola Bianchi
Summary. Pyrimidine 5,-nucleotidase deficiency is a rare autosomal recessive disorder characterized by haemolytic anaemia, marked basophilic stippling and accumulation of pyrimidine nucleotides within the erythrocytes. The gene encoding for this enzyme (P5,N-1) has been cloned recently, and seven mutations have so far been identified in 11 unrelated families. We describe the haematological and molecular characteristics of six unrelated Italian patients affected by pyrimidine 5,-nucleotidase deficiency (one from northern and five from southern Italy). The sequence of the complete P5,N-1 gene showed the presence of four different new mutations: a missense mutation AAT,AGT at codon 190 (Asn,Ser), one splicing mutation (IVS9-1 g-c) and two frameshift mutations, DelG576 and InsGG743. Although the molecular defect was homozygous in all patients but one, parents' consanguinity could be confirmed in only one case. InsGG743 was detected in two cases, and DelG576 was found in three patients originating from southern Italy, suggesting a possible geographical distribution of the genetic defect. Haematological data showed the presence of peripheral spherocytosis in all cases, although only one had a concomitant membrane defect. An increase in serum ferritin levels was observed in the splenectomized patients, suggesting that the iron status of these subjects should be monitored and that they should be investigated for potential additional risk factors for iron accumulation. [source]


2153: Can we treat glaucoma by non-IOP related approaches?

ACTA OPHTHALMOLOGICA, Issue 2010
I STALMANS
Intra-ocular pressure is the main risk factor for the progression of glaucoma. However, intra-ocular pressure lowering is not always sufficient to halt the progressive ganglion cell loss. Indeed, additional risk factors have been identified for glaucoma progression that can explain why some patients progress despite rigourous intra-ocular pressure lowering. Vascular risk factors, such as low perfusion pressure, can be taken into account in the management of our glaucoma patients. The treatment options for these vascular risk factors will be discussed during the lecture. Moreover, neuroprotective strategies might open therapeutic perspectives to directly support the ganglion cells and thus help stabilizing the disease. Possible neuroprotective agents will be highlighted. [source]


Deprivation, ethnicity and prematurity in infant respiratory failure in PICU in the UK

ACTA PAEDIATRICA, Issue 8 2010
DR O'Donnell
Abstract Aim:, To describe the epidemiology of infants admitted to Paediatric Intensive Care (PIC) with acute respiratory failure including bronchiolitis. Methods:, Data from all consecutive admissions from 2004 to 2007 in all 29 designated Paediatric Intensive Care Units (PICUs) in England and Wales were collected. Admission rates, risk-adjusted mortality, length of stay, ventilation status, preterm birth, deprivation and ethnicity were studied. Results:, A total of 4641 infants under 1 year of age had an unplanned admission to PIC with acute respiratory failure (ARF), an admission rate of 1.80 per 1000 infants per year. There was a reduced rate of admission with bronchiolitis in South Asian children admitted to PICU, which is not explained by case-mix. Children born preterm had a higher rate of admission and longer stay, but a similar low mortality. Risk-adjusted mortality was higher in South Asian infants and the highest in those with ARF (OR 1.76, 95% CI 1.20,2.57) compared with the rest of the PICU population. Conclusion:, Acute respiratory failure in infants causes most of the seasonal variation in unplanned admission to intensive care. Socioeconomic deprivation and prematurity are additional risk factors for admission. Fewer South Asian infants are admitted to PICU with a diagnosis of bronchiolitis, but risk-adjusted mortality is higher in South Asian infants overall. [source]


Effects of the angiotensin II receptor blocker losartan on the monocyte expression of biglycan in hypertensive patients

CLINICAL AND EXPERIMENTAL PHARMACOLOGY AND PHYSIOLOGY, Issue 9 2010
Maria A Sardo
Summary 1.,Recently, we demonstrated that biglycan (BGN) is increased in circulating monocyte cells from hypertensive patients and that angiotensin (Ang) II is able to increase BGN expression. The present study was designed to investigate the effects of treatment with the angiotensin AT1 receptor antagonist losartan on monocyte BGN mRNA and protein expression in essential hypertension. 2.,One hundred and twenty-six newly diagnosed hypertensive patients without additional risk factors for atherosclerosis and cardiovascular disease were treated with 100 mg losartan once daily for 6 months. Biglycan mRNA and protein expression was determined in monocytes isolated from peripheral blood before (T0) and after (T1) therapy. Plasma levels of interleukin (IL)-6, tumour necrosis factor (TNF)-, and high sensitivity C-reactive protein (hs-CRP) were also determined. In addition, BGN mRNA and protein expression was determined after the ex vivo addition of 1 ,mol/L AngII to monocytes isolated from 20 randomly selected hypertensive patients. 3.,Biglycan mRNA and protein expression, blood pressure and plasma levels of fibrinogen, IL-6, TNF-, and CRP were significantly lower at T1 than at T0. Variations in BGN expression were associated with inflammatory markers, but not directly with blood pressure. In AngII-stimulated monocytes, BGN mRNA and protein expression was significantly lower at T1 that at T0. Moreover, mean BGN mRNA expression in AngII-stimulated monocytes isolated from losartan-treated patients was similar to baseline expression in unstimulated monocytes from untreated patients. 4.,The results of the present study show that losartan can reduce BGN expression in monocytes from hypertensive patients, without any linear association with blood pressure, suggesting that the effects of AngII on BGN expression in monocytes may be modulated, in part, by an AT1 receptor blocker. [source]