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Long-term Risk (long-term + risk)
Selected AbstractsPredictors of Long-Term Risk for Heart Failure Hospitalization after Acute Myocardial InfarctionANNALS OF NONINVASIVE ELECTROCARDIOLOGY, Issue 3 2010Juha S. Perkiömäki M.D. Background: Data on the value of baseline brain natriuretic peptide (BNP) and autonomic markers in predicting heart failure (HF) hospitalization after an acute myocardial infarction (AMI) are limited. Methods: A consecutive series of patients with AMI without a previous history of HF (n = 569) were followed up for 8 years. At baseline, the patients had a blood sample for determination of BNP, a 24-hour Holter recording for evaluating heart rate variability (HRV) and heart rate turbulence (HRT), and an assessment of baroreflex sensitivity (BRS) using phenylephrine test. Results: During the follow-up, 79 (14%) patients were hospitalized due to HF. Increased baseline BNP, decreased HRV, HRT, and BRS had a significant association with HF hospitalization in univariate comparisons (P < 0.001 for all). After adjusting with all the relevant clinical parameters, BNP, HRV, and HRT still significantly predicted HF hospitalization (P < 0.001 for BNP and for the short-term scaling exponent ,1, P < 0.01 for turbulence slope). In the receiver operator characteristics curve analysis, the area under the curve for BNP was 0.77, for the short-term scaling exponent ,1 0.69, for turbulence slope 0.71, and for BNP/standard deviation of all N-N intervals ratio 0.80. Conclusion: Baseline increased BNP and impaired autonomic function after AMI yield significant information on the long-term risk for HF hospitalization. Ann Noninvasive Electrocardiol 2010;15(3):250,258 [source] Tissue Integration of Polyacrylamide Hydrogel: An Experimental Study of Periurethral, Perivesical, and Mammary Gland Tissue in the PigDERMATOLOGIC SURGERY, Issue 2008DMSC, LISE H. CHRISTENSEN MD BACKGROUND Polyacrylamide hydrogel (PAAG) is a nondegradable water-based polymer with high viscoelasticity. The gel is used as a tissue filler, the only risk being prolonged infection with anaerobic, contaminating microorganisms if not treated early with broad-spectrum antibiotics. OBJECTIVE With silicone gel as reference, PAAG tissue integration and migration was studied in a longitudinal study of the pig. MATERIALS AND METHODS Forty-one pigs were used. PAAG and silicone gel were injected into mammary tissue, and PAAG was injected into urethral or bladder wall or the anal canal. Tissues and regional lymph nodes were examined at 1, 1 1/2, 3, 3 1/2, 6, 12, and 14 months, and other lymph nodes and organs were examined at 1, 6, 12, and 14 months. RESULTS PAAG was invaded by macrophages and giant cells that were gradually replaced by a network of fibrous tissue. Silicone gel was seen inside these cells or as large vacuoles, surrounded by a fibrous capsule. Regional lymph nodes contained PAAG only at 1 1/2 months and silicone gel at 12 months. CONCLUSION PAAG is a stable, viscoelastic bulking agent, which unlike silicone gel is slowly integrated within its host tissue via a thin fibrous network. Long-term risk of fibrosis and migration is minimal. [source] The Impact of Childhood Epilepsy on Neurocognitive and Behavioral Performance: A Prospective Longitudinal StudyEPILEPSIA, Issue 4 2000Laura L. Bailet Summary: Purpose: To assess neurocognitive and behavioral performance in children with idiopathic epilepsy (CWE, n = 74), their siblings without epilepsy (control, n = 23), and children with migraine (CWM, n = 13), and to identify medical factors related to learning or behavioral problems in CWE. Methods: Subjects, ages 8,13 years with IQs of ,80, completed a neurocognitive test battery annually for ,3 years. For CWE, age at seizure onset, most recent EEG results, seizure type, seizure frequency, current antiepileptic drug (AED), and most recent AED serum levels were documented at each visit. Results: CWE and CWM had high rates of grade retention and placement in special education compared with sibling controls. CWE performed worse than controls on numerous neurocognitive variables. These differences persisted over time. CWE with abnormal EEGs scored lower than CWE with normal EEGs on reading and spelling measures, even with comparable IQs. Age at seizure onset, seizure type, and seizure frequency were not related to neurocognitive or behavioral test scores. CWE taking carbamazepine (CBZ) performed better than CWE taking valproate (VPA) on academic achievement measures, although the study lacked controls necessary to assess this finding thoroughly. CWM did not differ from CWE or controls in cognitive or academic achievement skills. Conclusions: Long-term risk of learning problems exists among CWE as compared with controls, even with normal IQs and well-controlled seizures. Predicting learning problems in CWE based on medical factors remains elusive. Monitoring of educational progress and neurocognitive screening may be most effective in assessing academic risk for CWE. [source] Depleted uranium,the growing concernJOURNAL OF APPLIED TOXICOLOGY, Issue 3 2002Aqel W. Abu-Qare Abstract Recently, several studies have reported on the health and environmental consequences of the use of depleted uranium. Depleted uranium is a heavy metal that is also radioactive. It is commonly used in missiles as a counterweight because of its very high density (1.6 times more than lead). Immediate health risks associated with exposure to depleted uranium include kidney and respiratory problems, with conditions such as kidney stones, chronic cough and severe dermatitis. Long-term risks include lung and bone cancer. Several published reports implicated exposure to depleted uranium in kidney damage, mutagenicity, cancer, inhibition of bone, neurological deficits, significant decrease in the pregnancy rate in mice and adverse effects on the reproductive and central nervous systems. Acute poisoning with depleted uranium elicited renal failure that could lead to death. The environmental consequences of its residue will be felt for thousands of years. It is inhaled and passed through the skin and eyes, transferred through the placenta into the fetus, distributed into tissues and eliminated in urine. The use of depleted uranium during the Gulf and Kosovo Wars and the crash of a Boeing airplane carrying depleted uranium in Amsterdam in 1992 were implicated in a health concern related to exposure to depleted uranium. Copyright © 2002 John Wiley & Sons, Ltd. [source] Metformin use and diabetic pregnancy,has its time come?DIABETIC MEDICINE, Issue 3 2006G. Hawthorne Abstract The prevalence of Type 2 diabetes in women of childbearing age continues to grow as the incidence of Type 2 diabetes increases. Recent evidence shows that treatment of gestational diabetes ensures the best possible outcome for pregnancy complicated by gestational diabetes. Metformin is a logical treatment in these circumstances but there has always been concern about its safety for the fetus, particularly as it crosses the placenta and it may increase the risk of teratogenesis. Although evidence is accumulating that metformin is useful and has a role in polycystic ovary syndrome, a condition of insulin resistance, it is not yet accepted as treatment for Type 2 diabetes in pregnancy and gestational diabetes. Observational data supports the use of metformin in Type 2 diabetes in pregnancy and its role in gestational diabetes is currently under investigation. Metformin may become an important treatment for women with either gestational or Type 2 diabetes in pregnancy and indeed may have additional important benefits for women, including reducing insulin resistance, body weight and long-term risk of diabetes. There is a need for a randomized controlled trial in women with Type 2 diabetes in pregnancy with long-term follow-up of both mothers and children. Until then the best advice remains that optimized glycaemic control prior to conception and during pregnancy is the most important intervention for best possible pregnancy outcome. [source] Risk assessment for nonindigenous pests: 1.DIVERSITY AND DISTRIBUTIONS, Issue 5 2001Mapping the outputs of phenology models to assess the likelihood of establishment Abstract This paper demonstrates the use of phenology models mapped over the landscape as a tool in support of risk assessments for nonindigenous plant pests. Drawing on the relationship between pest development and temperature, the approach uses gridded sequential interpolated temperatures at a resolution of 1 km, linked with phenology models, to predict the potential for a pest to develop throughout the landscape. The potential for establishment of Colorado beetle (Leptinotarsa decemlineata) in England and Wales was used as an illustration. The likelihood of the pest completing a single generation during a 30-year period (1961,90) was computed. Summaries of phenology, based firstly upon point temperature series from weather stations and secondly upon temperatures interpolated across the landscape, were compared. The results revealed that the use of point data led to a 70% likelihood of over-estimating the area at risk from year to year. In the case of average long-term risk however, the point-based and landscape-wide distributions of establishment potential were similar. We demonstrate how the use of phenology models running on a daily time scale provides date based results, so allowing outputs to be tied in with periods in the cropping cycle. The application of daily data in computing the phenological results, unlike the main body of published work on pest risk assessment which uses averaged monthly data, reflects more fully the underlying variability and degrees of sensitivity of the pest to changes in weather. [source] Long-term prognostic value of B-type natriuretic peptide in cardiac and non-cardiac causes of acute dyspnoeaEUROPEAN JOURNAL OF CLINICAL INVESTIGATION, Issue 11 2007M. Christ Abstract Background, B-type natriuretic peptide (BNP) levels significantly predict increased risk of death in heart failure. The predictive role of BNP levels in patients with non-cardiac causes of acute dyspnoea presenting to the emergency department is not well characterized. Materials and methods, The B-type natriuretic peptide for Acute Shortness of Breath EvaLuation (BASEL) study enrolled consecutive patients with acute dyspnoea. Results, Cumulative mortality was 14·8%, 33·1% and 51·9% in 452 patients (age: 19,97 years; 58% male) within low (< 100 pg mL,1), intermediate (100,500 pg mL,1) and high (> 500 pg mL,1) BNP plasma levels at 18 months of follow-up. BNP classes (point estimate: 1·55, 95%CI: 1·19,2·03, P = 0·001) in addition to age, increased heart rate and diuretic use emerged as significant predictors for long-term mortality in multivariable Cox regression analyses. The BNP concentration alone had an area under the receiver operating characteristic curve of 0·71 (95%CI: 0·66,0·76; P < 0·001) for predicting 18 months mortality. BNP plasma levels independently predicted long-term risk of death in patients with non-cardiac (point estimate: 1·72, 95%CI: 1·16,2·56; P = 0·007) and with cardiac causes of acute dyspnoea (point estimate: 2·21, 95%CI: 1·34,3·64; P = 0·002). Conclusions, BNP levels are strong and independent predictors for long-term mortality in unselected dyspnoeic patients presenting to the emergency department independent from the cause of dyspnoea. [source] Insulin intensification , the rationale and the targetINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 2009A. Liebl Summary Aims:, To review the key evidence supporting targets for glycaemic control in people with type 2 diabetes and the implications for management in primary care. Method:, Literature review. Results:, Achieving early glycaemic control may reduce long-term risk by minimising the ,metabolic memory' effect of hyperglycaemia. Several large studies have failed to confirm expectations that intensive treatment would offer greater reductions in risk. This may reflect the failure to achieve control blood glucose early in the course of diabetes. Management guidelines emphasise the importance of targets for glycaemic control, but differ in the strategies they recommend for dose intensification. All, however, acknowledge the importance of individualising treatment. Conclusion:, Early achievement of targets for glycaemic control may be important to reduce long-term risk in people with diabetes, but treatment should be tailored to individual need. [source] Lead in hair dyes, short-term appeal vs. long-term riskINTERNATIONAL JOURNAL OF COSMETIC SCIENCE, Issue 3 2000Lansdown No abstract is available for this article. [source] Long-Term Leisure Time Physical Activity and Properties of Bone: A Twin Study,,JOURNAL OF BONE AND MINERAL RESEARCH, Issue 8 2009Hongqiang Ma Abstract Effects of physical activity on bone properties, when controlled for genetic effects, are not fully understood. We aimed to study the association between long-term leisure time physical activity (LTPA) and bone properties using twin pairs known to be discordant for leisure time physical activity for at least 30 yr. Volumetric BMD and geometric properties were measured at the tibia shaft and distal end using pQCT in 16 middle-aged (50,74 yr) same-sex twin pairs (seven monozygotic [MZ] and nine dizygotic [DZ] pairs) selected from a population-based cohort. Paired differences between active and inactive co-twins were studied. Active members of MZ twin pairs had larger cortical bone cross-sectional area (intrapair difference: 8%, p = 0.006), thicker cortex (12%, p = 0.003), and greater moment of inertia (Imax, 20%, p = 0.024) at the tibia shaft than their inactive co-twins. At the distal tibia, trabecular BMD (12%, p = 0.050) and compressive strength index (18%, p = 0.038) were also higher in physically active MZ pair members than their inactive co-twins. The trends were similar, but less consistently so, in DZ pairs as in MZ pairs. Our genetically controlled study design shows that LTPA during adulthood strengthens bones in a site-specific manner, that is, the long bone shaft has a thicker cortex, and thus higher bending strength, whereas the distal bone has higher trabecular density and compressive strength. These results suggest that LTPA has a potential causal role in decreasing the long-term risk of osteoporosis and thus preventing osteoporotic fractures. [source] Reduced fecundity and offspring performance in small populations of the declining grassland plants Primula veris and Gentiana luteaJOURNAL OF ECOLOGY, Issue 1 2000Marc Kéry Summary 1,We studied reproduction and offspring performance in relation to population size in the declining self-incompatible perennials Primula veris and Gentiana lutea. In both species, reproduction was strongly reduced in small populations, where plants produced fewer seeds per fruit and per plant. Total seed mass per plant was higher in large populations, but individual seeds were smaller, indicating a trade-off between seed number and size. Reproduction was depressed most strongly in populations consisting of less than c. 200 (P. veris) and c. 500 plants (G. lutea), respectively. 2,The inclusion of plant size (an integrated measure of habitat quality) in the statistical models did not change the relationships between fecundity and population size. Pollen limitation or inbreeding depression in small populations are therefore more likely explanations for these patterns than is habitat quality. 3,Germination rate and survival of seedlings in a common environment was not related to population size in either species, although P. veris developed into larger rosettes when seeds were derived from large populations. This suggests that inbreeding depression occurs in small populations of P. veris. 4,In a factorial fertilizer-by-competition experiment with P. veris, offspring from larger populations grew significantly larger and responded more strongly to fertilizer. For this declining species genetic deterioration as a result of habitat fragmentation may therefore aggravate the effects of environmental changes such as habitat eutrophication. 5,Our results suggest that small populations may face an increased short-term risk of extinction because of reduced reproduction, and an increased long-term risk because they are less able to respond to environmental changes. [source] C-reactive protein and coronary heart disease: a critical reviewJOURNAL OF INTERNAL MEDICINE, Issue 4 2008J. P. Casas Abstract. Modestly elevated baseline concentrations of C-reactive protein (CRP), the classical acute phase protein, are associated with the long-term risk of coronary heart disease in general populations, whilst the major acute phase response of CRP following myocardial infarction is associated with death and cardiac complications. The pathogenic and clinical significance of these associations is controversial. Here we critically review the evidence and describe large-scale epidemiological studies, novel experiments and possible specific therapies which will rigorously inform the debate. We distinguish between the potential pathogenicity of high acute phase circulating CRP concentrations in individuals with substantial tissue damage and modest but persistent increases in baseline values in generally healthy subjects. [source] ORIGINAL ARTICLE: Venous thromboembolism and subsequent diagnosis of subarachnoid hemorrhage: a 20-year cohort studyJOURNAL OF THROMBOSIS AND HAEMOSTASIS, Issue 8 2010H. T. SØRENSEN Summary.,Background:,Venous thromboembolism is a predictor of subsequent risk of ischemic stroke and intracerebral hemorrhage, but no data are available regarding its association with risk of subarachnoid hemorrhage. Objectives:,To examine this issue, we conducted a nationwide cohort study in Denmark. Patients and methods: Between 1977 and 2007, we identified 97 558 patients with a hospital diagnosis of venous thromboembolism and obtained information on risk of subsequent subarachnoid hemorrhage during follow-up in the Danish Registry of Patients. The incidence of subarachnoid hemorrhage in the venous thromboembolism cohort was compared with that of 453 406 population control cohort members. Results:,For patients with pulmonary embolism (PE), there was clearly an increased risk of subarachnoid hemorrhage, both during the first year of follow-up [relative risk 2.69; 95% confidence interval (CI), 1.32,5.48] and during later follow-up of 2,20 years (relative risk 1.40; 95% CI, 1.05,1.87). For patients with deep venous thrombosis (DVT) the risk was likewise clearly increased during the first year of follow-up (relative risk 1.91; 95% CI, 1.13,3.22), but not during later follow-up (relative risk 1.04; 95% CI, 0.81,1.32). Conclusions:,We found evidence that PE is associated with an increased long-term risk of subarachnoid hemorrhage. The two diseases might share etiologic pathways affecting the vessel wall or share unknown risk factors. [source] Proton pump inhibitors and long-term risk of recurrent upper gastrointestinal bleedingALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 2 2009Y.-C. Hsu No abstract is available for this article. [source] A simple validated GIS expert system to map relative soil vulnerability and patterns of erosion during the muddy floods of 2000,2001 on the South Downs, Sussex, UKLAND DEGRADATION AND DEVELOPMENT, Issue 4 2010H. Faulkner Abstract The soils of the South Downs in East Sussex, England (UK), are dominated by loessic silt (>70 per cent) and are prone to crusting. Continuing erosion of these soils means that they are thin, typically less than 25,cm thick and are becoming stonier, more droughty and less easier to work. Rates of erosion are relatively low but during extreme events, soils are vulnerable and on- and off-site erosion is a current and long-term risk. Property damage due to muddy flooding is of particular concern. Due to a long history of research interest, a rich database exists on the erosional history of an area of approximately 75,km2 of these thin, calcareous South Downs soils. In particular, during the winter of 2000,2001, Hortonian overland flow was common on certain crop types. Consequent sheet, rill and gully erosion was intense. The gullies and rills formed by runoff during these winter events were mapped in detail. In this paper, a method to estimate soil vulnerability to erosion is described and illustrated. Then, to validate the predictive efficacy of the algorithm used, the actual mapped distribution of rills and gullies following the winter events of 2001 on a particularly badly-affected site are compared with predictions from our soil erosion vulnerability model. Methods for adjusting the land-cover weightings to optimise the map fit are outlined. In a further survey of the utility of the map, it was discovered that farmers' recollections of events provided additional verification. Thus, one implication of our research is that erosion models can be validated by inviting farmers to comment on their efficacy to predict known histories. Copyright © 2010 John Wiley & Sons, Ltd. [source] Early intervention of recent onset mild persistent asthma in children aged under 11 yrs: the Steroid Treatment As Regular Therapy in early asthma (START) trialPEDIATRIC ALLERGY AND IMMUNOLOGY, Issue 2006Yu-Zhi Chen Inhaled corticosteroids are known to be effective in persistent asthma, but their long-term effect in mild persistent disease of recent onset, which is particularly relevant in children, requires clarification. The objective of this study was to determine the long-term efficacy of regular inhaled low-dose budesonide in children aged <11 yrs with mild persistent asthma with onset within 2 yrs of enrollment. Children aged 5,10 yrs formed part of the population of the inhaled Steroid Treatment As Regular Therapy in early asthma (START) study, and they were randomized in a double-blind manner to treatment with once daily budesonide 200 ,g or placebo via TurbuhalerTM in addition to usual clinical care and other asthma medication. The double-blind treatment phase continued for 3 yrs. Of the 1974 children, 1000 in the budesonide group and 974 in the placebo group, were analyzed for efficacy. Addition of once-daily budesonide to usual care was associated with a significant increase in the time to first severe asthma-related event (SARE) and significantly reduced risk of SARE over 3 yrs. The hazard ratio relative to usual care (placebo) was 0.60 (95% confidence interval: 0.40,0.90; p = 0.012), with a relative risk reduction of 40%. Children receiving budesonide also needed significantly less intervention with other inhaled corticosteroids (12.3% vs. 22.5% over 3 yrs; p < 0.01), with trends towards decreased usage of oral/systemic corticosteroids and inhaled short-acting ,2 -agonists. Budesonide treatment also had a significant beneficial effect on lung function relative to placebo. In conclusion, early intervention adding once-daily budesonide to usual care in children with mild, persistent asthma of recent onset reduces the long-term risk and frequency of SAREs and improves lung function compared with usual care alone. [source] DNA Damage, Apoptosis and Langerhans Cells,Activators of UV-induced Immune Tolerance,PHOTOCHEMISTRY & PHOTOBIOLOGY, Issue 2 2008Laura Timares Solar UVR is highly mutagenic but is only partially absorbed by the outer stratum corneum of the epidermis. UVR can penetrate into the deeper layers of the epidermis, depending on melanin content, where it induces DNA damage and apoptosis in epidermal cells, including those in the germinative basal layer. The cellular decision to initiate either cellular repair or undergo apoptosis has evolved to balance the acute need to maintain skin barrier function with the long-term risk of retaining precancerous cells. Langerhans cells (LCs) are positioned suprabasally, where they may sense UV damage directly, or indirectly through recognition of apoptotic vesicles and soluble mediators derived from surrounding keratinocytes. Apoptotic vesicles will contain UV-induced altered proteins that may be presented to the immune system as foreign. The observation that UVR induces immune tolerance to skin-associated antigens suggests that this photodamage response has evolved to preserve the skin barrier by protecting it from autoimmune attack. LC involvement in this process is not clear and controversial. We will highlight some basic concepts of photobiology and review recent advances pertaining to UV-induced DNA damage, apoptosis regulation, novel immunomodulatory mechanisms and the role of LCs in generating antigen-specific regulatory T cells. [source] The Incidence of Cancer in a Population-Based Cohort of Canadian Heart Transplant RecipientsAMERICAN JOURNAL OF TRANSPLANTATION, Issue 3 2010Y. Jiang To assess the long-term risk of developing cancer among heart transplant recipients compared to the Canadian general population, we carried out a retrospective cohort study of 1703 patients who received a heart transplant between 1981 and 1998, identified from the Canadian Organ Replacement Register database. Vital status and cancer incidence were determined through record linkage to the Canadian Mortality Database and Canadian Cancer Registry. Cancer incidence rates among heart transplant patients were compared to those of the general population. The observed number of incident cancers was 160 with 58.9 expected in the general population (SIR = 2.7, 95% CI = 2.3, 3.2). The highest ratios were for non-Hodgkin's lymphoma (NHL) (SIR = 22.7, 95% CI = 17.3, 29.3), oral cancer (SIR = 4.3, 95% CI = 2.1, 8.0) and lung cancer (SIR = 2.0, 95% CI = 1.2, 3.0). Compared to the general population, SIRs for NHL were particularly elevated in the first year posttransplant during more recent calendar periods, and among younger patients. Within the heart transplant cohort, overall cancer risks increased with age, and the 15-year cumulative incidence of all cancers was estimated to be 17%. There is an excess of incident cases of cancer among heart transplant recipients. The relative excesses are most marked for NHL, oral and lung cancer. [source] Limiting Financial Disincentives in Live Organ Donation: A Rational Solution to the Kidney ShortageAMERICAN JOURNAL OF TRANSPLANTATION, Issue 11 2006R. S. Gaston Availability of kidney transplantation is limited by an inadequate supply of organs, with no apparent remedy on the immediate horizon and increasing reliance on living donors (LDs). While some have advocated financial remuneration to stimulate donation, the National Organ Transplant Act (NOTA) of 1984 expressly forbids the offer of ,valuable consideration.' However, recent developments indicate some fluidity in the definition of valuable consideration while evolving international standards highlight deficiencies (particularly regarding long-term care and follow-up) in the current American system. Recognizing that substantial financial and physical disincentives exist for LDs, we propose a policy change that offers the potential to enhance organ availability as well as address concerns regarding long-term care. Donors assume much greater risk than is widely acknowledged, risk that can be approximated for the purpose of determining appropriate compensation. Our proposal offsets donor risk via a package of specific benefits (life insurance, health insurance and a small amount of cash) to minimize hazard and ensure donor interests are protected after as well as before nephrectomy. It will fund medical follow-up and enable data collection so that long-term risk can be accurately assessed. The proposal should be cost effective with only a small increase in the number of LDs, and the net benefit will become greater if removal of disincentives stimulates even further growth. As importantly, by directly linking compensation to risk, we believe it preserves the essence of kidney donation as a gift, consistent with NOTA and implementable in the United States without altering current legal statutes. [source] Predictors of Long-Term Risk for Heart Failure Hospitalization after Acute Myocardial InfarctionANNALS OF NONINVASIVE ELECTROCARDIOLOGY, Issue 3 2010Juha S. Perkiömäki M.D. Background: Data on the value of baseline brain natriuretic peptide (BNP) and autonomic markers in predicting heart failure (HF) hospitalization after an acute myocardial infarction (AMI) are limited. Methods: A consecutive series of patients with AMI without a previous history of HF (n = 569) were followed up for 8 years. At baseline, the patients had a blood sample for determination of BNP, a 24-hour Holter recording for evaluating heart rate variability (HRV) and heart rate turbulence (HRT), and an assessment of baroreflex sensitivity (BRS) using phenylephrine test. Results: During the follow-up, 79 (14%) patients were hospitalized due to HF. Increased baseline BNP, decreased HRV, HRT, and BRS had a significant association with HF hospitalization in univariate comparisons (P < 0.001 for all). After adjusting with all the relevant clinical parameters, BNP, HRV, and HRT still significantly predicted HF hospitalization (P < 0.001 for BNP and for the short-term scaling exponent ,1, P < 0.01 for turbulence slope). In the receiver operator characteristics curve analysis, the area under the curve for BNP was 0.77, for the short-term scaling exponent ,1 0.69, for turbulence slope 0.71, and for BNP/standard deviation of all N-N intervals ratio 0.80. Conclusion: Baseline increased BNP and impaired autonomic function after AMI yield significant information on the long-term risk for HF hospitalization. Ann Noninvasive Electrocardiol 2010;15(3):250,258 [source] Estimating the risk of rare complications: is the ,rule of three' good enough?ANZ JOURNAL OF SURGERY, Issue 7-8 2009John Ludbrook Abstract The clinical problem:, If a surgeon has performed a particular operation on n consecutive patients without major complications, what is the long-term risk of major complications after performing many more such operations? Examples of such operations are endoscopic cholecystectomy, nephrectomy and sympathectomy. The statistical problem and solutions:, This general problem has exercised the minds of theoretical statisticians for more than 80 years. They agree only that the long-term risk is best expressed as the upper bound of a 95% confidence interval. We consider many proposed solutions, from those that involve complex statistical theory to the empirical ,rule of three', popular among clinicians, in which the percentage risk is given by the formula 100 × (3/n). Our conclusions:, The ,rule of three' grossly underestimates the future risks and can be applied only when the initial complication rate is zero (that is, 0/n). If the initial complication rate is greater than zero, then no simple ,rule' suffices. We give the results of applying the more popular statistical models, including their coverage. The ,exact' Clopper,Pearson interval has wider coverage across all proportions than its nominal 95%, and is, thus, too conservative. The Wilson score confidence interval gives about 95% coverage on average overall population proportions, except very small ones, so we prefer it to the Clopper,Pearson method. Unlike all the other intervals, Bayesian intervals with uniform priors yield exactly 95% coverage at any observed proportion. Thus, we strongly recommend Bayesian intervals and provide free software for executing them. [source] Health Beliefs toward Cardiovascular Risk Reduction in Patients Admitted to Chest Pain Observation UnitsACADEMIC EMERGENCY MEDICINE, Issue 5 2009David A. Katz MD Abstract Objectives:, Even after acute coronary syndrome (ACS) is ruled out, observational studies have suggested that many patients with nonspecific chest pain have a high burden of cardiovascular risk factors (CRFs) and are at increased long-term risk of ischemic heart disease (IHD)-related mortality. The aim of this study was to evaluate the premise that evaluation in an observation unit for symptoms of possible ACS is a "teachable moment" with regard to modification of CRFs. Methods:, The authors conducted a baseline face-to-face interview and a 3-month telephone interview of 83 adult patients with at least one modifiable CRF who presented with symptoms of possible ACS to an academic medical center. Existing questionnaires were adapted to measure Health Belief Model (HBM) constructs for IHD. Stage of change and self-reported CRF-related behaviors (diet, exercise, and smoking) were assessed using previously validated measures. The paired t-test or signed rank test was used to compare baseline and 3-month measures of health behavior within the analysis sample. Results:, Of the 83 study patients, 45 and 40% reported having received clinician advice regarding diet and physical activity during the observation unit encounter, respectively; 69% of current smokers received advice to quit smoking. Patients reported lower susceptibility to IHD (13.3 vs. 14.0, p = 0.06) and greater perceived benefit of healthy lifestyles (27.5 vs. 26.4, p = 0.0003) at 3-month follow-up compared to baseline. Patients also reported greater readiness to change and improved self-reported behaviors at follow-up (vs. baseline): decreased intake of saturated fat (10.1% vs. 10.5% of total calories, p = 0.005), increased fruit and vegetable intake (4.0 servings/day vs. 3.6 servings/day, p = 0.01), and fewer cigarettes (13 vs. 18, p = 0.002). Conclusions:, Observed changes in IHD health beliefs and CRF-related behaviors during follow-up support the idea that observation unit admission is a teachable moment. Patients with modifiable risk factors may benefit from systematic interventions to deliver CRF-related counseling during observation unit evaluation. [source] Tropical Storm Gamma and the Mosquitia of eastern Honduras: a little-known story from the 2005 hurricane seasonAREA, Issue 4 2009David M Cochran Jr The 2005 Atlantic hurricane season was unprecedented in terms of storm activity in the United States, Mexico, Central America and Caribbean. Given the impacts of hurricanes Katrina and Rita, the Honduran Mosquitia sparked little attention despite being hit by two hurricanes and a tropical storm in 2005. This article recounts the history of these storms in the Afro-Caribbean community of Batalla, drawing from public weather advisories and testimony of local residents obtained through participatory research. We contextualise this local history with results from the first paleotempestological study undertaken in the Mosquitia to shed light on long-term risk of catastrophic storms in the region and to demonstrate the value of integrating these two research approaches. Our findings contribute to recent ethnographic research on hazards by describing how a coastal people understand and respond to tropical cyclones and how landscape change influences the vulnerability of a coastal area. Although residents have not witnessed a storm as intense as those documented in the paleotempestological record, their knowledge and perceptions show how tropical cyclones can be disasters while leaving behind no sedimentary records. The paleotempestological evidence, however, reminds us that catastrophic hurricanes have struck the Mosquitia in the past and will do so again in the future. Understanding the interactions between contemporary human perceptions and responses and long-term hurricane risk provides insight for emergency managers and local stakeholders to better prepare for such a catastrophic event. [source] Cutaneous invasive squamous cell carcinoma: 10-year experience and recommendations for follow upAUSTRALASIAN JOURNAL OF DERMATOLOGY, Issue 4 2009Corinne Yoong ABSTRACT Currently, the National Health and Medical Research Council do not have any recommendations about the frequency of follow up after treatment of primary cutaneous invasive squamous cell cancer (SCC), due to a lack of data. The present study aimed to establish appropriate follow-up times and to determine the long-term risk of subsequent non-melanoma skin cancers and melanoma. Patients who had a primary invasive cutaneous SCC excised during 1996 were retrospectively identified from the databases of a dermatologist in private practice in south-east Queensland. Data on size, site, depth, differentiation, perineural involvement, lymphovascular involvement of the index SCC were obtained. The patients were regularly followed up and lymph-node involvement, patient immunocompetence, and the presence of local recurrences and subsequent SCC, basal cell carcinomas and melanoma were recorded. Forty patients were identified, comprising 25 men and 15 women with a mean age of 65 years. The majority (60%) of primary incident SCC were in the low-risk category. The median follow-up time was 7.5 years. One in two developed a second SCC within 5 years, a significant number had a second SCC detected only in 5,10 year follow up, and 72.5% had a BCC within 5 years, and 82.5% at 10 years. One in eight had a subsequent melanoma detected. [source] Serum sex hormones and the 20-year risk of lower urinary tract symptoms in community-dwelling older menBJU INTERNATIONAL, Issue 11 2010Michael D. Trifiro Study Type , Prognosis (inception cohort) Level of Evidence 2b OBJECTIVE To evaluate serum sex steroid hormone concentrations and long-term risk of subsequent lower urinary tract symptoms (LUTS) in a cohort of community-dwelling older men. SUBJECTS AND METHODS Between 1984 and 1987, serum sex hormone concentrations were measured in participants in the Rancho Bernardo Study, a prospective, community-based study. In 2006, the American Urological Association Symptom Index (AUA-SI) was mailed to surviving male participants. Logistic regression was used to examine associations of baseline hormone concentrations with AUA-SI. RESULTS Among 158 surviving men with complete data and no history of prostate cancer, the mean (sd) age at serum sex steroid assessment was 58 (6.6) years with a mean (sd) follow-up of 20.3 (0.6) years. In age-adjusted logistic regression, there was a significant inverse association of testosterone : dihydrotestosterone (DHT) with LUTS (P = 0.05). Also, men with higher concentrations of bioavailable testosterone had a 56% decreased risk of LUTS compared with those with hypogonadal concentrations, although the association was not statistically significant (odds ratios 0.44, 95% confidence interval 0.14,1.40) or distributed evenly among quartiles. There were no significant associations of total testosterone, oestradiol (E2), testosterone : E2, DHT, or dehydroepiandrosterone with LUTS or with any measured hormones and urinary bother. CONCLUSIONS In this cohort, men with higher mid-life levels of testosterone : DHT and bioavailable testosterone had a decreased 20-year risk of LUTS. These data support other studies reporting inverse associations of serum testosterone with LUTS. Clinical trials of testosterone therapy should include LUTS and clinical benign prostatic hyperplasia as outcomes. [source] Comparison of the 308-nm excimer laser and a 308-nm excimer lamp with 311-nm narrowband ultraviolet B in the treatment of psoriasisBRITISH JOURNAL OF DERMATOLOGY, Issue 4 2005K. Köllner Summary Background, Psoriasis is a chronic, genetically determined inflammatory disease, characterized by an immunomediated pathogenesis, which affects approximately 1,3% of the population. Various modalities have been used for psoriasis treatment, including ultraviolet (UV) radiation. Narrowband UVB (311 nm) phototherapy is a well-established, widely used and highly efficient treatment for psoriasis, but a big disadvantage is that large areas of unaffected skin are irradiated along with the psoriatic lesions. Objectives, This investigation evaluates a 308-nm excimer laser and a 308-nm excimer lamp in comparison with 311-nm narrowband UVB in the treatment of patch psoriasis by using two different dose-increase schemes. Materials and methods, Fifteen patients with plaque psoriasis were enrolled in the study (first regime). Three different psoriatic lesions were treated with the 308-nm excimer laser, the 308-nm excimer lamp or 311-nm narrowband UVB three times per week. UVB doses were increased slowly and stepwise (1, 1, 2, 2, 3, 3, ,multiple MEDs). Sixteen patients were enrolled in the second regime. Two plaques were treated with the 308-nm excimer laser or with the 308-nm lamp with an accelerated scheme (2, 2, 4, 4, 6, 6, ,multiple MEDs) three times per week. We increased the UVB doses every second treatment (first and second regime) during the whole treatment. If blistering occurred, the blistered plaque was not treated on the next scheduled treatment. At every third visit and 1, 2 and 4 months after the last treatment a Psoriasis Severity Index (PSI) score was assigned in both regimes. Results, Using Friedman analysis, the PSI scores did not show a statistically significant difference (P > 0·05) comparing 308-nm laser therapy, 308-nm lamp therapy and 311-nm narrowband therapy after 10 weeks in the first regime. The mean number of treatments to achieve clearance was 24. With the accelerated scheme, clearance could be achieved with fewer treatments and with half the cumulative dose of the first regime. Nevertheless, the side-effects such as blistering and crusting were also increased. Conclusions, Both 308-nm light sources can clear patch psoriasis in a similar manner to standard phototherapy, with the advantage of the ability to treat exclusively the affected skin and with a reduced cumulative dose, thus perhaps reducing the long-term risk of carcinogenicity. [source] Prospective analysis of carotid artery flow in breast cancer patients treated with supraclavicular irradiation 8 or more years previously,CANCER, Issue 2 2008No increase in ipsilateral carotid stenosis after radiation noted Abstract BACKGROUND. To the authors' knowledge, the effects of supraclavicular fossa radiation on the carotid artery are not well described. In the current study, the authors performed a prospective study to examine the long-term risk of carotid artery stenosis after supraclavicular irradiation for breast cancer. METHODS. A total of 46 breast cancer patients who were treated with adjuvant radiation to the supraclavicular fossa with >8 years of follow-up underwent bilateral Doppler imaging of the carotid artery. Two independent cardiologists interpreted each ultrasound study with no knowledge of which side was treated. RESULTS. The median follow-up from the date of diagnosis was 14.6 years and the mean patient age at the time of ultrasound was 55 years. The median prescribed dose to the supraclavicular fossa was 50 grays. Four patients were found to have clinically relevant, asymptomatic carotid stenosis, for which a cardiology referral was necessary. Only 1 of these 4 patients had stenosis involving the irradiated carotid artery only; 1 patient had bilateral stenosis and 2 patients had only contralateral stenosis. There was no difference noted with regard to isolated ipsilateral versus contralateral medial intimal thickening of the carotid artery (5 patients vs 6 patients, respectively). Furthermore, there were no differences noted with regard to ipsilateral versus contralateral peak systolic flow in the internal (83.5 vs 85.6 cm/seconds; P = .522 by the Student t test and P = .871 by the signed rank test) or common (74.4 vs 77.0 cm/seconds; P = .462 by the Student t test and P = .246 by the signed rank test) carotid artery. CONCLUSIONS. In this prospective study of breast cancer patients with long follow-up, there was no evidence of late, clinically relevant stenosis, increased intimal thickening, or increased peak systolic carotid artery flow secondary to supraclavicular irradiation. Cancer 2008. © 2007 American Cancer Society. [source] Health care for childhood cancer survivorsCANCER, Issue 4 2004Insights, perspectives from a Delphi panel of young adult survivors of childhood cancer Abstract BACKGROUND Most children diagnosed with cancer are surviving into adulthood but are not receiving adequate or appropriate follow-up health care. However, to the authors' knowledge, there is little literature published to date exploring potential barriers to long-term risk-based follow-up care for young adult survivors of childhood cancer. METHODS In the current study, using a modified Delphi technique, young adult cancer survivors identified barriers to utilizing appropriate follow-up care and offered suggestions for ways to enhance health care in this young adult population. RESULTS Major barriers to health care were found to be a lack of knowledge on the part of both physicians and survivors regarding long-term health issues related to cancer. Suggestions to enhance care included self-advocacy training for survivors and advanced training for primary care physicians who may treat childhood cancer survivors as they transition into adulthood. CONCLUSIONS The results of the current study are consistent with reports that young adult survivors of childhood cancer need or desire information regarding their medical histories, psychosocial support, and social advocacy. Cancer 2004;100:843,50. © 2004 American Cancer Society. [source] Three-year follow-up of the first prospective randomized comparison between paclitaxel and sirolimus stents: The TAXi-LATE trialCATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 2 2007Alexandre Berger MD Abstract Goal: Analysis of the 3-year outcome of the original population of the TAXi trial which compared the efficacy of the paclitaxel (PES) and the sirolimus (SES) stents in a randomized "real world" investigation. History: The widespread use of drug-eluting stents strongly modified the world of interventional cardiology. The TAXi trial was a randomized comparison between PES and SES and showed similar efficacy between the two prostheses. Recently, emerging discussions raised questions about potential long-term risk with the use of DES. The present work attempts to describe the long-term outcome of the patients compared during the TAXi trial. Method: During April 2003 and January 2004, 202 patients were prospectively randomly assigned to the PES group (102 patients) and to the SES group (100 patients). The primary aim of the present investigation was the comparison of combined incidence of cardiac death, myocardial infarction, and target lesion revascularization within 36-months. Results: No difference in mortality of all causes was noted in the PES and the SES groups (3% vs. 7%, P = 0.98) or in major adverse cardiac event free survival (89% vs. 83%, P = 0.28). Four stent thromboses were observed, two in the PES group (205 and 788 days) and two in the SES group (210 and 772 days). Conclusion: The long-term outcome analysis of the TAXi trial confirms available published data showing the equivalence of PES and SES on clinical basis. © 2007 Wiley-Liss, Inc. [source] The Long-Term Risk of Stroke in Patients with Acute Myocardial Infarction Complicated with New-Onset Atrial FibrillationCLINICAL CARDIOLOGY, Issue 8 2009Asanin R. Milika MD Background The long-term risk of stroke after acute myocardial infarction (AMI) complicated with new-onset atrial fibrillation (AF) remains unclear. The aim of this study was to determine the long-term risk of AF and stroke in patients with AMI complicated with new-onset AF. Methods Patients with AMI complicated with new-onset AF (n = 260) and those without new-onset AF (n = 292) were followed for a mean of 7 years. All patients had sinus rhythm at hospital discharge. Results During the follow-up, AMI patients with new-onset AF had more frequent AF than those without new-onset AF (10.4% vs 2.7%, respectively; P < 0.0001). New-onset AF during AMI was a significant predictor of subsequent AF occurrence (the time elapsing between 2 consecutive R waves [RR] = 3.15, P = 0.004); but AF recurrence in follow-up (RR = 5.08, P = 0.001) and non-anticoagulation at discharge (RR = 0.29, P = 0.008) were independent predictors of stroke (Cox regression analysis). A period of 3.5 hours of AF within the first 48 hours of AMI was the high sensitivity cut-off level for the prediction of low long-term risk of stroke obtained by receiver operating characteristic analysis. Among patients who did not receive anticoagulants at discharge, the patients with short AF did not experience stroke and AF recurrence during follow-up, while those in the other group developed it (10.8%, P = 0.038 and 13.5%, P = 0.019, respectively). Conclusion New-onset AF during AMI identifies the patients at long-term risk for stroke who may potentially benefit from anticoagulant therapy. Atrial fibrillation recurrence in follow-up was independently related to the development of stroke. However, for low-risk patients with AF (those with short AF occurring early in AMI) long-term anticoagulants might not be required. Copyright © 2009 Wiley Periodicals, Inc. [source] | ||||||||||||||||||||||||||||||||||