			Home About us Contact

Risk Predictors (risk + predictor)

Distribution by Scientific Domains

Medical Sciences	93%

Selected Abstracts

Risk assessment scales for pressure ulcer prevention: a systematic review

JOURNAL OF ADVANCED NURSING, Issue 1 2006
Pedro L. Pancorbo-Hidalgo PhD RN
Aim., This paper reports a systematic review conducted to determine the effectiveness of the use of risk assessment scales for pressure ulcer prevention in clinical practice, degree of validation of risk assessment scales, and effectiveness of risk assessment scales as indicators of risk of developing a pressure ulcer. Background., Pressure ulcers are an important health problem. The best strategy to avoid them is prevention. There are several risk assessment scales for pressure ulcer prevention which complement nurses' clinical judgement. However, some of these have not undergone proper validation. Method., A systematic bibliographical review was conducted, based on a search of 14 databases in four languages using the keywords pressure ulcer or pressure sore or decubitus ulcer and risk assessment. Reports of clinical trials or prospective studies of validation were included in the review. Findings., Thirty-three studies were included in the review, three on clinical effectiveness and the rest on scale validation. There is no decrease in pressure ulcer incidence was found which might be attributed to use of an assessment scale. However, the use of scales increases the intensity and effectiveness of prevention interventions. The Braden Scale shows optimal validation and the best sensitivity/specificity balance (57·1%/67·5%, respectively); its score is a good pressure ulcer risk predictor (odds ratio = 4·08, CI 95% = 2·56,6·48). The Norton Scale has reasonable scores for sensitivity (46·8%), specificity (61·8%) and risk prediction (OR = 2·16, CI 95% = 1·03,4·54). The Waterlow Scale offers a high sensitivity score (82·4%), but low specificity (27·4%); with a good risk prediction score (OR = 2·05, CI 95% = 1·11,3·76). Nurses' clinical judgement (only considered in three studies) gives moderate scores for sensitivity (50·6%) and specificity (60·1%), but is not a good pressure ulcer risk predictor (OR = 1·69, CI 95% = 0·76,3·75). Conclusion., There is no evidence that the use of risk assessment scales decreases pressure ulcer incidence. The Braden Scale offers the best balance between sensitivity and specificity and the best risk estimate. Both the Braden and Norton Scales are more accurate than nurses' clinical judgement in predicting pressure ulcer risk. [source]

Blood Pressure Components in Clinical Hypertension

JOURNAL OF CLINICAL HYPERTENSION, Issue 9 2006
Michel E. Safar MD
This review offers a critical evaluation of the remarkable progress in antihypertensive therapy since its inception. Despite the introduction of newer, more sophisticated drugs, treatment results have remained stable. Problems impeding further improvement include limited patient compliance, clinical inertia, incomplete adherence to guidelines, and dependence on brachial artery cuff pressures for diagnosis, risk assessment, and treatment response. Brachial artery systolic and pulse pressures do not reliably represent aortic or carotid artery pressures, which are better risk predictors for the heart and brain. Mean pressure, which is the same throughout the arterial tree, is directly measurable by cuff oscillometry, and might become the best single risk predictor. Available drugs have limited ability to decrease the aortic stiffness that is responsible for the elevated systolic blood pressure of aging. Therefore, to improve risk assessment and therapeutic benefit, we might include mean blood pressure and pulse pressure into blood pressure measurements, pursue efforts to measure central blood pressure, and search for new drugs to reduce arterial stiffness. [source]

Longitudinal study on the relationship between serum albumin and periodontal disease

JOURNAL OF CLINICAL PERIODONTOLOGY, Issue 4 2008
Masanori Iwasaki
Abstract Aim: The purpose of this study was to evaluate the relationship between periodontal disease and the general health status in community-dwelling elderly using the serum albumin concentration as a criterion index of the severity of underlying disease and nutrition. Material and Methods: Six hundred subjects aged 70 years underwent a baseline examination. Dental examinations were carried out at baseline and once a year for 4 years. Periodontal conditions were estimated for subjects with at least one remaining tooth. Clinical attachment levels at six sites of all teeth present were measured. A change in loss of attachment of 3 mm or greater in 1 year at each site was defined as periodontal disease progression. Data were analysed in subjects for whom data were available for 4 years. Results: Serum albumin concentration at baseline ranged from 3.4 to 5.0 g/dl with a mean of 4.3±0.2. When the analysis was stratified by smoking status, we found that serum albumin concentration had a significant effect on periodontal disease progression among non-smokers (standardized regression coefficient=,0.16; p=0.017), using multiple regression analysis. Conclusions: The findings of the present study suggest that serum albumin concentration is a significant risk predictor of periodontal disease progression among elderly non-smokers. [source]

Atorvastatin Decreases C-Reactive Protein-Induced Inflammatory Response in Pulmonary Artery Smooth Muscle Cells by Inhibiting Nuclear Factor-,B Pathway

CARDIOVASCULAR THERAPEUTICS, Issue 1 2010
Jie Li
C-reactive protein (CRP) is well-known inflammatory marker, and recognized as a risk predictor of pulmonary arterial diseases. Although statins have a beneficial effect in animal models and patients with pulmonary arterial hypertension (PAH), the underlying mechanisms of their actions have less been investigated. The aims of this study was to examined the effects of CRP on expressions of interleukin-6 (IL-6) and monocyte chemoattractant protein-1 (MCP-1), and the possible mechanisms of atorvastatin on CRP-induced IL-6 and MCP-1 production in cultured human pulmonary artery smooth muscle cells (PASMCs). In a preliminary study, the human PASMCs were stimulated by a variety of concentrations of CRP (5,200 ,g/mL) at different time points (0, 3, 6, 9, 12, 18 and 24 h) for the purpose of determining the dose- and time-dependent effects of CRP on inflammatory response of the cells. Then, the cells were pre-incubated for 2 h with atorvastatin (0.1,10 ,mol/L) in the presence of CRP. The supernatant levels of both IL-6 and MCP-1 secretion were examined by ELISA. The cellular mRNA expressions of IL-6 and MCP-1 and nuclear factor-,B (NF-,B) activity were determined by real-time reverse transcription and polymerase chain reaction (RT-PCR) and electrophoretic mobility shift assay (EMSA), respectively. CRP resulted in elevated IL-6 and MCP-1 secretion and mRNA expression in a dose- and time-dependent manner. In addition, CRP also significantly activated the NF-,B pathway. Preincubation with 0.1,10 ,mol/L of atorvastatin significantly decreased the secretions of IL-6 and MCP-1 induced by CRP. Moreover, 10 ,mol/L of atorvastatin completely abrogated CRP-induced increase in IL-6 and MCP-1 by attenuating the activation of NF-,B. The present study demonstrated that inhibiting effect of atorvastatin on CRP-induced inflammatory response in cultured PASMCs was associated with NF-,B pathway. This pathway might represent a promising target for controlling CRP-induced inflammatory response in pulmonary arterial diseases. [source]

Smoking in pregnancy: a risk factor for adverse neurodevelopmental outcome in preterm infants?

ACTA PAEDIATRICA, Issue 7 2010
U Kiechl-Kohlendorfer
Abstract Aim:, To assess whether smoking in pregnancy influences neurodevelopmental outcome at 2-years of age in preterm infants with a gestational age <32 weeks. Methods:, Between January 2003 and December 2005 we prospectively enrolled 181 infants born alive between 23 and 32 weeks of gestation; 142 infants (78.5%) completed the follow-up visit. The association between candidate risk factors and delayed motor or mental development (Bayley Scales of Infant Development II; psychomotor or mental developmental index <85) was analysed by means of logistic regression analysis. Results:, Low maternal age, smoking in pregnancy, low gestational age, low birth weight, small for gestational age, chronic lung disease, intracerebral haemorrhage, periventricular leucomalacia, and retinopathy of prematurity (stages 3 and 4) all were associated with an increased risk for delayed development (p < 0.05, each). Smoking in pregnancy, small for gestational age and chronic lung disease maintained significance in a multivariable analysis. Conclusion:, Smoking in pregnancy emerged as a risk predictor for adverse neurodevelopmental outcome in our study. Strategies to reduce smoking in pregnancy should be further endorsed. [source]

Progression to clinically diagnosed and treated diabetes from impaired glucose tolerance and impaired fasting glycaemia

DIABETIC MEDICINE, Issue 12 2003
Q. Qiao
Abstract Aims To evaluate the risk of diabetes in subjects with impaired fasting glycemia (IFG) as compared with impaired glucose tolerance (IGT) and normal glucose tolerance. Methods Men (1223) and women (1370) aged 45,64 years and free of diabetes at baseline were followed-up for 10 years, with 26 737 person years accumulated. The incident diabetic cases were identified through the national Drug Register and the Hospital Discharge Register. Results During the 10 years of follow-up, 53 (4.3%) men and 47 (3.4%) women developed diabetes. IFG alone defined 22 (15.5/1000 person years) diabetic cases, which was higher than for subjects with normal fasting glucose. Subjects with isolated IGT identified an additional 34 cases (155% more) which could not be defined by IFG alone. The area under the ROC curve was larger for 2-h glucose (0.77, 95% CI 0.72,0.82) than for fasting glucose (0.65, 0.58,0.71). The multivariate adjusted Cox hazard ratio was higher for isolated IGT (3.9, 95% CI 2.4,6.2) than for isolated IFG (2.3, 0.9,5.7) as compared with subjects with neither IFG nor IGT. Conclusion Both IFG and IGT are risk predictors for diabetes, but IGT defines a much larger target population for prevention. [source]

Clinical Assessment and Rest and Stress Echocardiography for Prediction of Long-Term Prognosis in African Americans with Known or Suspected Coronary Artery Disease

ECHOCARDIOGRAPHY, Issue 5 2009
Stephen G. Sawada M.D.
Background: There is limited information on noninvasive risk stratification of African Americans, a high-risk group for cardiovascular events. We investigated the value of clinical assessment and echocardiography for the prediction of a long-term prognosis in African Americans. Methods: Dobutamine echocardiography was performed in 324 African Americans. Two-dimensional measurements were performed at rest, and rest and stress wall motion was assessed. A retrospective follow-up was conducted for cardiac events: myocardial infarction (MI) or cardiac death (CD). Results: The mean age was 59 ± 12 years, and 83% of patients had hypertension. The follow-up was obtained in 318 (98%) patients for a mean of 5.3 years. The events occurred in 107 (33%) subjects. The independent predictors of events were history of MI (P = 0.001, risk ratio [RR] 2.04), ischemia (P = 0.007, RR 1.97), fractional shortening (P = 0.033, RR 0.08), and left atrial (LA) dimension (P = 0.034, RR 1.39). An LA size of 3.6 cm and a fractional shortening of 0.30 were the best cutoff values for the prediction of events. Prior MI, ischemia, LA size >3.6 cm, and fractional shortening <0.30 were each considered independent risk predictors for events. The event rates were 13%, 21%, 38%, 59%, and 57% in patients with 0, 1, 2, 3, and 4 risk predictors, respectively. Event-free survival progressively worsened with an increasing number of predictors: 0 or 1 versus 2 predictors, P < 0.001; 2 versus 3 or 4 predictors, P = 0.003. Conclusion: The long-term prognosis of African Americans can be accurately predicted by clinical assessment combined with rest and stress echocardiography. [source]

Blood Pressure Components in Clinical Hypertension

Prospective study of complier individuals under periodontal maintenance therapy: analysis of clinical periodontal parameters, risk predictors and the progression of periodontitis

JOURNAL OF CLINICAL PERIODONTOLOGY, Issue 1 2009
Telma Campos Medeiros Lorentz
Abstract Aim: This prospective study aimed to evaluate the progression of periodontitis and the influence of risk variables among individuals attending a programme of periodontal maintenance treatment in an academic environment. Material and Methods: A total of 150 individuals diagnosed with chronic moderate-advanced periodontitis, and who had finished active periodontal treatment, were incorporated into the periodontal maintenance therapy. Social, demographic and biological variables of interest from subjects were collected at quarterly recalls, over a 12-month period. The effect of variables of interest and confounding on the periodontal status and progression of periodontitis was tested by univariate and multivariate logistic analysis. Results: A total of 130 subjects (86.7%) showed stable periodontal status, whereas 20 subjects (13.3%) presented periodontitis progression. Twenty-eight subjects (18.66%) presented tooth loss that resulted in a total of 47 lost teeth (1.38%). Diabetes was not found to be associated with periodontitis progression (p=0.67). Smoking was significantly associated with a greater progression of periodontitis (OR=2.7, 95% CI 1.01,7.22). Conclusions: Periodontal maintenance programmes in academic environment can stabilize the periodontal condition obtained after active periodontal therapy as well as control the action of risk variables for the progression of periodontitis. [source]

Role of hepatitis B virus genotypes and quantitative HBV DNA in metastasis and recurrence of hepatocellular carcinoma

JOURNAL OF MEDICAL VIROLOGY, Issue 4 2008
Yuehua Huang
Abstract Identification of risk factors for recurrence and metastasis of HCC is important for the prognosis of HCC surveillance in chronic HBV infection. In this article, 125 HCC patients recruited were followed up prospectively for tumor metastasis and recurrence for a median of 104 (10,130) weeks. HBV DNA level was detected by LightCycler-based real-time fluorescence quantitative polymerase chain reaction-restriction system. HBV genotypes were determined by using PCR restriction-fragment length polymorphism. BCP and PC mutations were performed by PCR and direct sequencing of amplified products. Among 125 HCC patients, 19 patients were excluded because of the lack of follow-up data and the remaining 106 patients were followed up of 2 years and entered into analysis. Sixty-nine patients had tumor metastasis or recurrence during the follow-up and the cumulative probability of HCC metastasis or recurrence was 65.1%. On multivariate analysis, genotype C and HBV DNA level were the risk factors for HCC recurrence or metastasis. The incidence of recurrence or metastasis increased with baseline HBV DNA level in a dose-response relationship ranging from 22% for HBV DNA level of less than 3 log10 copies/ml to 80% for HBV DNA level of 5 log10 copies/ml or greater (P,=,0.012). Fifty-seven (74.0%) and 12 (41.4%) patients had metastasis or recurrence in patients with genotype C and B, respectively. The adjusted OR of recurrence or metastasis for genotype C compared with genotype B was 9.755 (P,=,0.009). In conclusion, elevated HBV DNA level and genotype C are strong risk predictors of HCC metastasis or recurrence. J. Med. Virol. 80:591,597, 2008. © 2008 Wiley-Liss, Inc. [source]

Usefulness of Risk Stratification for Future Cardiac Events in Infarct Survivors with Severely Depressed Versus Near-Normal Left Ventricular Function: Results From a Prospective Long-Term Follow-Up Study

ANNALS OF NONINVASIVE ELECTROCARDIOLOGY, Issue 1 2003
Thomas Klingenheben
Background: Although primary preventive therapy with implantable cardioverter defibrillators has recently been shown to be effective in patients with coronary artery disease and left ventricular dysfunction, further identification of patients at particularly high risk for arrhythmic death would improve the cost effectiveness of device therapy. The value of risk stratification in postinfarction patients with versus those without left ventricular dysfunction has not been investigated in detail in infarct survivors treated according to contemporary therapeutic guidelines. Methods: Patients with acute myocardial infarction underwent coronary angiography including left ventricular angiography in an attempt to restore antegrade flow of the infarct-related artery. Additionally, patients underwent noninvasive autonomic risk stratification by means of heart rate variability (HRV) and baroreflex sensitivity (BRS) measurements prior to hospital discharge. Results: A total of 411 patients were prospectively included in the study. The primary study endpoint of cardiac death and arrhythmic events was significantly more common in patients with LVEF , 35% as compared to those with preserved LV function (27% vs 4%; P < 0.0001). In patients with LV dysfunction, HRV and BRS were significant risk predictors on univariate (P < 0.01 for BRS; P = 0.04 for HRV) and multivariate (P = 0.028 for BRS; P = 0.053 for HRV) analyses. In contrast, in patients with preserved LV function, only patency of the infarct artery but not autonomic markers was significantly predictive of cardiac death and arrhythmic events. Conclusion: The present study demonstrates that autonomic testing does not yield predictive power in infarct survivors with preserved left ventricular function. Accordingly, cost effectiveness of risk stratification and subsequent preventive therapy may be improved by restricting risk stratification to patients with impaired LV function. [source]

Nonlinear Analysis of Heart Rate Variability: Fractal and Complexity Measures of Heart Rate Behavior

ANNALS OF NONINVASIVE ELECTROCARDIOLOGY, Issue 2 2000
Juha S. Perkiömäki M.D.
Many new methods of analyzing heart rate (HR) variability have been developed to describe the features in HR behavior that cannot be detected by traditional time- and frequency-domain methods. Some of the new methods, such as analysis of fractal correlation properties and complexity of HR dynamics, have provided clinically useful information in various patient populations. Importantly, some fractal analysis methods are better risk predictors of mortality than traditional HR variability measures, and analysis of complexity of HR dynamics has been shown to predict the spontaneous onset of atrial fibrillation. New analysis methods based on nonlinear dynamics are a promising tool for better understanding of normal and abnormal HR behavior. More work will be needed to establish the clinical applicability of traditional and new analysis methods of HR variability. [source]

Adverse neurodevelopmental outcome in preterm infants: risk factor profiles for different gestational ages

ACTA PAEDIATRICA, Issue 5 2009
U Kiechl-Kohlendorfer
Abstract Aim: Assessment of risk predictors for adverse neurodevelopmental outcome at 1 year of age in preterm infants with a gestational age <30 weeks (Group I) and 30,32 weeks (Group II). Methods: Between January 2003 and December 2006, we prospectively enrolled 310 live-born infants between 23 and 32 weeks of gestation. The association between candidate risk factors and delayed motor or mental development (Bayley Scales of infant development II; psychomotor or mental developmental index <85) was analysed by means of logistic regression analysis. Results: Two hundred and fifty infants were eligible for follow-up, and 205 (82.0%) completed the follow-up visit. Intracerebral haemorrhage, small for gestational age and late-onset sepsis were associated with an increased risk for delayed development in Group I (p < 0.05, each). Premature rupture of membranes was a risk condition relevant to Group II. Antenatal steroids were associated with a decreased risk of neurodevelopmental delay in both groups. Conclusion: This study identified distinct risk factors for adverse outcome in preterm infants of lower (<30 weeks) and higher (30,32 weeks) gestational age. In the lower gestational age group, neonatal risk predictors are most important. Antenatal steroids appear to decrease the risk for adverse outcome in both age groups. [source]

Epidemiology and stratification of risk for sudden cardiac death

CLINICAL CARDIOLOGY, Issue S1 2005
Philip J. Podrid M.D.
Abstract Sudden cardiac death (SCD) is a major cause of mortality in the United States. Approximately 65% of cases of SCD occur in patients with underlying acute or chronic ischemic heart disease. The incidence of SCD increases 2- to 4-fold in the presence of coronary disease and 6- to 10-fold in the presence of structural heart disease. Ventricular fibrillation (VF) precipitated by ventricular tachycardia (VT) is a common mechanism of cardiac arrest leading to SCD. Triggers for SCD include electrolyte disturbances, heart failure, and transient ischemia. Although a large percentage of patients with out-of-hospital SCD do not survive, successful resuscitation to hospitalization has improved in recent years. One of the challenges for preventing SCD lies in identifying individuals at highest risk for SCD within a lower-risk population. The progression from conventional risk factors of coronary artery disease to arrhythmogenesis and SCD can be represented as a cascade of changes associated with levels of increasing risk. At the first level is atherogenesis, followed by changes in atherosclerotic plaque anatomy, which may be mediated by inflammatory processes. Disruption of active plaque formed during a transitional state initiates the thrombotic cascade and acute occlusion, after which acute changes in myocardial electrophysiology become the immediate trigger for arrhythmogenesis and SCD. Each level of the cascade offers different opportunities for risk prediction. Among the classes of risk predictors are clinical markers, such as ECG measures and ejection fraction. Transient risk markers, such as inflammatory markers, are potentially useful for identifying triggers for SCD. In the future, genetic profiling is expected to allow better assessment of individual risks for SCD. [source]