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Short-term Risk (short-term + risk)
Selected AbstractsPredicting short-term disease progression among HIV-infected patients in Asia and the Pacific region: preliminary results from the TREAT Asia HIV Observational Database (TAHOD)HIV MEDICINE, Issue 3 2005J Zhou Objectives HIV disease progression has been well documented in Western populations. This study aimed to estimate the short-term risk of AIDS and death from the TREAT Asia HIV Observational Database (TAHOD), a prospective, multicentre cohort study in Asia and the Pacific region. Methods Prospective data were analysed to estimate short-term disease progression. Endpoints were defined as the time from study entry to diagnosis with AIDS or death. Antiretroviral treatment was fitted as a time-dependent variable. Predictors of disease progression were assessed using Cox proportional hazards models, and prognostic models were developed using Weibull models. Results A total of 1260 patients with prospective follow-up data contributed 477 person-years of follow-up, during which 18 patients died and 34 were diagnosed with AIDS, a combined rate of 10.1 per 100 person-years. Compared with patients receiving antiretroviral treatment, patients not on treatment had a higher rate of disease progression (17.6 vs. 8.1 per 100 person-years, respectively). Baseline CD4 count was the strongest predictor of disease progression. Prognostic models, using either a baseline CD4 count as the sole marker or markers including baseline haemoglobin, AIDS-related symptoms and previous or current antiretroviral treatment, were successful at identifying patients at high risk of short-term disease progression. Conclusions Similar to the situation in Western countries, baseline CD4 count was the strongest predictor of short-term disease progression. Prognostic models based on readily available clinical data and haemoglobin level should be useful in estimating short-term clinical risk in HIV-infected patients in Asia and the Pacific region. [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] Evidence-based medicine: Review of guidelines and trials in the prevention of secondary stroke,JOURNAL OF HOSPITAL MEDICINE, Issue S4 2008David J. Likosky MD Abstract Transient ischemic attack (TIA) carries a substantial short-term risk for stroke, which is a leading cause of disability and death in the United States. Despite the existing evidence-based guidelines for secondary prevention of stroke, variability in the assessment, diagnostic testing, and treatment of patients with TIA in actual clinical practice remains. Identification of stroke etiology via radiological examination is of paramount importance for the appropriate treatment of patients after TIA or stroke. Management of ischemic stroke or TIA includes lifestyle modifications, reduction of modifiable risk factors (eg, hypertension, diabetes, and elevated cholesterol), and appropriate therapeutic treatments. Antiplatelet therapy is the cornerstone of secondary prevention of stroke; guidelines for its use for noncardioembolic cases have been developed from a solid evidence base. Additional therapeutic approaches include HMG-CoA reductase inhibitors (statins), antihypertensives, and anticoagulants. The results of ongoing large trials will further clarify the role of specific antiplatelet agents for the secondary prevention of stroke in patients with noncardioembolic ischemic stroke or TIA. Journal of Hospital Medicine 2008;3(4 Suppl):S6,S19. © 2008 Society of Hospital Medicine. [source] Venous thromboembolism and subsequent short-term risk of an occult cancerJOURNAL OF THROMBOSIS AND HAEMOSTASIS, Issue 2 2008H. T. SŘRENSEN [source] Should fimbriae be included in pertussis vaccines?APMIS, Issue 9 2009Studies on ELISA IgG anti-Fim2/3 antibodies after vaccination, infection The anti-Fim response and long-term persistence after vaccination and infection may be of importance in understanding population immunity. Longitudinal serum samples (n = 1330) from 542 non-infected children related to a Swedish vaccine trial showed that the post vaccination (DTPa5) antibody decay curve for pertussis ELISA IgG anti-fimbriae2/3 (anti-Fim2/3) was bi-phasic. A slower one followed an initial rapid decay approximately 5,6 months after the third dose at 12 months of age. After 71 months, however, 60% still had concentrations above ,5 EU/ml, a level that had been shown to correlate with decreased risk of disease. Booster responses after re-vaccination with DTPa5 at 4, 5 and 6 years of age were strong and appeared within 1 week after vaccination, indicating immune memory. Ninety-six young children with verified pertussis infection, for whom we had serum samples both before, during and after the infection, showed a high response if they had been primed with fimbriae (either DTPa5 or DTPwc). In contrast, 76% of infected children not primed with fimbriae (a DTPa2 or DT group) only had concentrations below the minimum level of detection in all samples taken during and after the infection. In two Swedish seroepidemiological surveys, one from 1997 just after reintroduction of universal childhood vaccination against pertussis and one from 2007, the proportion of children 2,3 years with anti-Fim2/3 concentrations <5 EU/ml was similar and above 90%. This reflects that the two- or three-component pertussis vaccines (DTPa2 and DTPa3) that were introduced in Sweden in 1996 do not induce anti-Fim2/3 antibodies. In previous studies it was shown in multivariate analyses that levels of IgG anti-Fim2/3 ,5 EU/ml reduced short-term risk of pertussis in small children. As the antibody response to Fim2/3 after infection is poor in children who have not been primed earlier in life, inclusion of immunogenic Fim2/3 in future pertussis vaccines should be considered. [source] Risk factors for severe infections in patients with rheumatoid arthritis treated with rituximab in the autoimmunity and rituximab registryARTHRITIS & RHEUMATISM, Issue 9 2010J.-E. Gottenberg Objective The risk of severe infection is a crucial factor in the assessment of the short-term risk:benefit ratio of biologic drugs in rheumatoid arthritis (RA). There is no increase in severe infections in RA patients treated with rituximab (RTX) in controlled trials, but this has not yet been assessed in daily practice. We undertook this study to investigate the occurrence of and risk factors for severe infections in off-trial patients using data from the AutoImmunity and Rituximab (AIR) registry. Methods The AIR registry was set up by the French Society of Rheumatology. The charts of patients with severe infections were reviewed. Results Of the enrolled patients, 1,303 had at least 1 followup visit at 3 months or later, with a mean ± SD followup period of 1.2 ± 0.8 years (1,629 patient-years). Eighty-two severe infections occurred in 78 patients (5.0 severe infections per 100 patient-years), half of them in the 3 months following the last RTX infusion. Multivariate analysis showed that chronic lung disease and/or cardiac insufficiency (odds ratio 3.0 [95% confidence interval 1.3,7.3], P = 0.01), extraarticular involvement (odds ratio 2.9 [95% confidence interval 1.3,6.7], P = 0.009), and low IgG level (<6 gm/liter) before initiation of RTX treatment (odds ratio 4.9 [95% confidence interval 1.6,15.2], P = 0.005) were significantly associated with increased risk of a severe infection. Conclusion The rate of severe infections in current practice is similar to that reported in clinical trials. The risk factors for severe infections include chronic lung and/or cardiac disease, extraarticular involvement, and low IgG before RTX treatment. This suggests that serum IgG should be checked and the risk:benefit ratio of RTX discussed for patients found to have low levels of IgG. [source] The role of monitored natural recovery in sediment remediationINTEGRATED ENVIRONMENTAL ASSESSMENT AND MANAGEMENT, Issue 1 2006Victor S Magar Abstract The long-term goal of monitored natural recovery (MNR) is to achieve ecological recovery of biological endpoints in order to protect human and ecological health. Insofar as ecological recovery is affected by surface-sediment-contaminant concentrations, the primary recovery processes for MNR are natural sediment burial and contaminant transformation and weathering to less toxic forms. This paper discusses the overall approach for effective implementation of MNR for contaminated sediment sites. Several lines of evidence that may be used to demonstrate natural recovery processes are summarized, including documentation of source control; evidence of contaminant burial; measurement of surface sediment mixing depths and the active sediment benthic layer; measurement of sediment stability; contaminant transformation and weathering; modeling sediment transport, contaminant transport, and ecological recovery; measuring ecological recovery and long-term risk reduction; knowledge of future plans for use and development of the site; and watershed and institutional controls. In general, some form of natural recovery is expected and should be included as part of a remedy at virtually all contaminated sediment sites. Further, MNR investigations and an understanding of natural recovery processes provide cost-effective information and support the evaluation of more aggressive remedies such as capping, dredging, and the use of novel amendments. The risk of dredging or capping may be greater than the risk of leaving sediments in place at sites where capping or dredging offer little long-term environmental gain but pose significant short-term risks for workers, local communities, and the environment. [source] Manipulating sex ratios for conservation: short-term risks and long-term benefitsANIMAL CONSERVATION, Issue 1 2002C. Wedekind Manipulating family sex ratio is often possible, either through non-invasive methods like changing sex-determining ecological or social factors, or through more invasive methods such as hormone treatment of embryos or sperm sexing prior to using assisted reproductive technologies. If the number of available eggs limits population growth, the production of relatively more daughters than sons may eventually lead to increased population growth in terms of absolute numbers. However, any deviation of the effective sex ratio from equality increases the rate of inbreeding and the loss of genetic variance in the next generation. I show here that there is a range of female biased sex ratios where increased population growth outweighs the effect of an enhanced inbreeding rate during the first generation or the first few generations after the start of a sex ratio manipulation programme. This is especially so in small and declining populations, where some sex ratio manipulations not only increase the effective population number Ne, but also shift the population quickly into population numbers that are safe against the Allee effect. Consequently, an optimal sex ratio manipulation with respect to the genetic quality of a population means sending an endangered population first through a genetic bottleneck to achieve increased Ne, and hence decreased rates of inbreeding, in the long run. [source] | |||||||||||||