Browsing by Subject "risk factors"

Now showing 1 - 10 of 23
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    Characteristics and Operative Outcomes for Children Undergoing Repair of Truncus Arteriosus: A Contemporary Multicenter Analysis
    (Elsevier, 2019) Mastropietro, Christopher W.; Amula, Venu; Sassalos, Peter; Buckley, Jason R.; Smerling, Arthur J.; Iliopoulos, Illias; Riley, Christine M.; Jennings, Aimee; Cashen, Katherine; Narasimhulu, Sukumar Suguna; Gowda, Keshava Murty Narayana; Bakar, Adnan M.; Wilhelm, Michael; Badheka, Aditya; Moser, Elizabeth A. S.; Costello, John M.; Pediatrics, School of Medicine
    Objective We sought to describe characteristics and operative outcomes of children who underwent repair of truncus arteriosus and identify risk factors for the occurrence of major adverse cardiac events (MACE) in the immediate postoperative period in a contemporary multicenter cohort. Methods We conducted a retrospective review of children who underwent repair of truncus arteriosus between 2009 and 2016 at 15 centers within the United States. Patients with associated interrupted or obstructed aortic arch were excluded. MACE was defined as the need for postoperative extracorporeal membrane oxygenation (ECMO), cardiopulmonary resuscitation (CPR), or operative mortality. Risk factors for MACE were identified using multivariable logistic regression analysis and reported as odds ratios (OR) with 95% confidence intervals (CI). Results We reviewed 216 patients. MACE occurred in 44 patients (20%) and did not vary significantly over time. Twenty-two patients (10%) received postoperative ECMO, 26 (12%) received CPR, and 15 (7%) suffered operative mortality. With multivariable logistic regression analysis (which included adjustment for center effect), factors independently associated with MACE were failure to diagnose truncus arteriosus prior to discharge from the nursery (OR:3.1; 95%CI:1.3,7.4), cardiopulmonary bypass duration greater than 150 minutes (OR:3.5; 95%CI:1.5,8.5), and right ventricle-to-pulmonary artery conduit diameter greater than 50mm/m2 (OR:4.7; 95%CI:2.0,11.1). Conclusions In a contemporary multicenter analysis, 20% of children undergoing repair of truncus arteriosus experienced MACE. Early diagnosis, shorter duration of cardiopulmonary bypass, and use of smaller diameter right ventricle-to-pulmonary artery conduits represent potentially modifiable factors that could decrease morbidity and mortality in this fragile patient population.
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    Clinical and Genetic Risk Factors for Adverse Metabolic Outcomes in North American Testicular Cancer Survivors
    (National Comprehensive Cancer Network, 2018-03) Abu Zaid, Mohammad; Gathirua-Mwangi, Wambui G.; Fung, Chunkit; Monahan, Patrick O.; El-Charif, Omar; Williams, Annalynn M.; Feldman, Darren R.; Hamilton, Robert J.; Vaughn, David J.; Beard, Clair J.; Cook, Ryan; Althouse, Sandra; Ardeshir-Rouhani-Fard, Shirin; Dinh, Paul C., Jr.; Sesso, Howard D.; Einhorn, Lawrence H.; Fossa, Sophie D.; Travis, Lois B.; Medicine, School of Medicine
    Background: Testicular cancer survivors (TCS) are at significantly increased risk for cardiovascular disease (CVD), with metabolic syndrome (MetS) an established risk factor. No study has addressed clinical and genetic MetS risk factors in North American TCS. Patients and Methods: TCS were aged <55 years at diagnosis and received first-line chemotherapy. Patients underwent physical examination, and had lipid panels, testosterone, and soluble cell adhesion molecule-1 (sICAM-1) evaluated. A single nucleotide polymorphism in rs523349 (5-α-reductase gene, SRD5A2), recently implicated in MetS risk, was genotyped. Using standard criteria, MetS was defined as ≥3 of the following: hypertension, abdominal obesity, hypertriglyceridemia, decreased high-density lipoprotein (HDL) cholesterol level, and diabetes. Matched controls were derived from the National Health and Nutrition Examination Survey. Results: We evaluated 486 TCS (median age, 38.1 years). TCS had a higher prevalence of hypertension versus controls (43.2% vs 30.7%; P<.001) but were less likely to have decreased HDL levels (23.7% vs 34.8%; P<.001) or abdominal obesity (28.2% vs 40.1%; P<.001). Overall MetS frequency was similar in TCS and controls (21.0% vs 22.4%; P=.59), did not differ by treatment (P=.20), and was not related to rs523349 (P=.61). For other CVD risk factors, TCS were significantly more likely to have elevated low-density lipoprotein (LDL) cholesterol levels (17.7% vs 9.3%; P<.001), total cholesterol levels (26.3% vs 11.1%; P<.001), and body mass index ≥25 kg/m2 (75.1% vs 69.1%; P=.04). On multivariate analysis, age at evaluation (P<.001), testosterone level ≤3.0 ng/mL (odds ratio [OR], 2.06; P=.005), and elevated sICAM-1 level (ORhighest vs lowest quartile, 3.58; P=.001) were significantly associated with MetS. Conclusions and Recommendations: Metabolic abnormalities in TCS are characterized by hypertension and increased LDL and total cholesterol levels but lower rates of decreased HDL levels and abdominal obesity, signifying possible shifts in fat distribution and fat metabolism. These changes are accompanied by hypogonadism and inflammation. TCS have a high prevalence of CVD risk factors that may not be entirely captured by standard MetS criteria. Cancer treatment–associated MetS requires further characterization.
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    Comparison of Risk Factor Control in the Year After Discharge for Ischemic Stroke Versus Acute Myocardial Infarction
    (American Heart Association, 2018-02) Bravata, Dawn M.; Daggy, Joanne; Brosch, Jared; Sico, Jason J.; Baye, Fitsum; Myers, Laura J.; Roumie, Christianne L.; Cheng, Eric; Coffing, Jessica; Arling, Greg; Medicine, School of Medicine
    BACKGROUND AND PURPOSE: The Veterans Health Administration has engaged in quality improvement to improve vascular risk factor control. We sought to examine blood pressure (<140/90 mm Hg), lipid (LDL [low-density lipoprotein] cholesterol <100 mg/dL), and glycemic control (hemoglobin A1c <9%), in the year post-hospitalization for acute ischemic stroke or acute myocardial infarction (AMI). METHODS: We identified patients who were hospitalized (fiscal year 2011) with ischemic stroke, AMI, congestive heart failure, transient ischemic attack, or pneumonia/chronic obstructive pulmonary disease. The primary analysis compared risk factor control after incident ischemic stroke versus AMI. Facilities were included if they cared for ≥25 ischemic stroke and ≥25 AMI patients. A generalized linear mixed model including patient- and facility-level covariates compared risk factor control across diagnoses. RESULTS: Forty thousand two hundred thirty patients were hospitalized (n=75 facilities): 2127 with incident ischemic stroke and 4169 with incident AMI. Fewer stroke patients achieved blood pressure control than AMI patients (64%; 95% confidence interval, 0.62-0.67 versus 77%; 95% confidence interval, 0.75-0.78; P<0.0001). After adjusting for patient and facility covariates, the odds of blood pressure control were still higher for AMI than ischemic stroke patients (odds ratio, 1.39; 95% confidence interval, 1.21-1.51). There were no statistical differences for AMI versus stroke patients in hyperlipidemia (P=0.534). Among patients with diabetes mellitus, the odds of glycemic control were lower for AMI than ischemic stroke patients (odds ratio, 0.72; 95% confidence interval, 0.54-0.96). CONCLUSIONS: Given that hypertension control is a cornerstone of stroke prevention, interventions to improve poststroke hypertension management are needed
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    Comprehensive assessment of youth violence in five Caribbean countries: Gender and age differences
    (Taylor & Francis, 2017) Gentle-Genitty, Carolyn; Kim, Jangmin; Yi, Eun-Hye; Slater, Douglas; Reynolds, Beverly; Bragg, Natasha; School of Social Work
    Differences in gender and age have been established in the context of crime, violence, and prevalence of risk and protective factors. These studies are often notable only in the Western Hemisphere. Despite growth in crime and violence in the Caribbean Community (CARICOM), relatively little understanding of violence in CARICOM member states exists. In light of these concerns, the major purposes of this study include: (1) comprehensively assessing the scope of the four behaviors (i.e., engagement, victimization, witness, and report) in relation to violence and youth’s perceptions of risk and protective factors in family and school domains, and (2) examining how they differ by youth’s gender and age. This study draws on assessment data on youth violence in five CARICOM Member States: Antigua and Barbuda, St. Kitts and Nevis, St. Lucia, Jamaica, and Trinidad and Tobago using a completed 51-item quantitative questionnaire from approximately 512 students. The results suggest that violence engagement, victimization, witness, and report significantly differed by gender and age. Male students were more likely to engage in violence, but less likely to report such violence to adults. Similarly, older students reported that they were more likely to engage in and witness violence. For risk and protective factors, female students reported significantly higher scores on domestic violence, whereas male students had higher scores on the access to drugs/weapons. Older students also tended to report higher levels of some school risk factors and lower levels of some protective factors in both family and school.
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    Depression and Stroke: Cause or Consequence?
    (2005) Williams, Linda S.
    Depression after stroke is common. Although different opinions exist about the definition, diagnosis, and measurement of outcomes related to depression after stroke, there is little debate about the prevalence of depression symptoms and their impact on stroke survivors and their families. Depression after stroke has long been recognized as a common condition with many negative effects in the poststroke period, but more recently depression has also been identified as an independent stroke risk factor. Given that there are at least 500,000 new ischemic strokes yearly in the United States, a conservative estimate is that 150,000 U.S. stroke survivors develop poststroke depression each year. Because effective treatments exist but are likely underutilized for depression, this is an important example of an evidence-practice gap to which increased efforts to improve care should be made. Such efforts would likely improve not only patient symptoms but may also decrease stroke risk, influence stroke functional recovery, decrease mortality, and reduce poststroke health care utilization. This article provides an overview of depression diagnosis in stroke, reviews the epidemiology of poststroke depression and its associated morbidity and mortality, and reviews existing evidence on the treatment and prevention of poststroke depression.
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    Epidemiology of colorectal cancer.
    (IJMEG, 2016) Marley, Andrew R.; Nan, Hongmei; Department of Epidemiology, Richard M. Fairbanks School of Public Health
    Colorectal cancer is currently the third deadliest cancer in the United States and will claim an estimated 49,190 U.S. lives in 2016. The purpose of this review is to summarize our current understanding of this disease, based on nationally published statistics and information presented in peer-reviewed journal articles. Specifically, this review will cover the following topics: descriptive epidemiology (including time and disease trends both in the United States and abroad), risk factors (environmental, genetic, and gene-environment interactions), screening, prevention and control, and treatment. Landmark discoveries in colorectal cancer risk factor research will also be presented. Based on the information reviewed for this report, we suggest that future U.S. public health efforts aim to increase colorectal cancer screening among African American communities, and that future worldwide colorectal cancer epidemiology studies should focus on researching nutrient-gene interactions towards the goal of improving personalized treatment and prevention strategies.
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    Genetic Testing and Type 2 Diabetes Risk Awareness
    (2014-03) de Groot, Mary; Wessel, Jennifer
    Purpose The purpose of this study was to examine the motivational, attitudinal, and behavioral predictors of interest in genetic testing (GT) in those with and without awareness of their risk for type 2 diabetes (T2DM). Methods A convenience sample of adults visiting emergency departments, libraries, or an online research registry was surveyed. Responses from adults without diabetes who reported 1 or more risk factors for T2DM (eg, family history, body mass index > 25) were included in the analyses (n = 265). Results Participants were 37 ± 11 years old, white (54%), and female (69%), with some college education (53%) and an annual income below $25 000 (44%). Approximately half (52%) expressed interest in GT for T2DM. Individuals were stratified by perceived risk for T2DM (risk aware or risk unaware). Among the risk aware, younger age (P < .04) predicted greater interest in GT. Among the risk unaware, family history of T2DM (P < .008) and preference to know genetic risk (P < .0002) predicted interest in GT. Both groups identified the need for low-cost GT. Conclusions GT is an increasingly available and accurate tool to predict T2DM risk for patients. In this sample, GT was a salient tool for those with and without awareness of their T2DM risk. Financial accessibility is critical to use of this tool for both groups.
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    High Rates of Readmission in Necrotizing Pancreatitis: Natural History or Opportunity for Improvement?
    (Springer, 2019-09) Maatman, Thomas K.; Mahajan, Sarakshi; Roch, Alexandra M.; Lewellen, Kyle A.; Heimberger, Mark A.; Colgate, Cameron L.; Ceppa, Eugene P.; House, Michael G.; Nakeeb, Attila; Schmidt, C. Max; Zyromski, Nicholas J.; Surgery, School of Medicine
    Background Necrotizing pancreatitis (NP) is a complex and heterogeneous disease with a protracted disease course. Hospital readmission is extremely common; however, few data exist regarding the cause of readmission in NP. Methods A retrospective review of NP patients treated between 2005 and 2017 identified patients readmitted both locally and to our hospital. All patients with unplanned hospital readmissions were evaluated to determine the cause for readmission. Clinical and demographic factors of all patients were recorded. As appropriate, two independent group t tests and Pearson’s correlation or Fisher’s exact tests were performed to analyze the relationship between index admission clinical factors and readmission. p values of < 0.05 were accepted as statistically significant. Results Six hundred one NP patients were reviewed. Median age was 52 years (13–96). Median index admission length of stay was 19 days (2–176). The most common etiology was biliary (49.9%) followed by alcohol (20.0%). Unplanned readmission occurred in 432 patients (72%) accounting for a total of 971 unique readmissions (mean readmissions/patient, 2.3). The most common readmission indications were symptomatic necrosis requiring supportive care and/or intervention (31.2%), infected necrosis requiring antibiotics and/or intervention (26.6%), failure to thrive (9.7%), and non-necrosis infection (6.6%). Patients requiring readmission had increased incidence of index admission renal failure (21.3% vs. 14.2%, p = 0.05) and cardiovascular failure (12.5% vs. 4.7%, p = 0.01). Discussion Readmission in NP is extremely common. Significant portions of readmissions are a result of the disease natural history; however, a percentage of readmissions appear to be preventable. Patients with organ failure are at increased risk for unplanned readmission and will benefit from close follow-up.
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    The Influence of Social Isolation and Other Risk Factors on Older African Immigrants' Emotional Well-Being
    (2022-08) Adeniji, Dolapo Omolola; Adamek, Margaret; Hong, Michin; Gentle-Genitty, Carolyn; Huber, Lesa
    Social isolation has been documented as a significant challenge for older adults, including those who are immigrants. The conventional wisdom blames social isolation among older immigrant adults on language barriers, living arrangements, and age at migration, however, this does not allow for analytical clarity on how social isolation interacts with other important risk factors to influence emotional well-being among older African immigrants. This study offers an important contribution to the existing knowledge by examining how social isolation and other risk factors interact to impact emotional well-being among older African immigrants. It uses life course theory, acculturation theory, resilience theory, and cumulative risk theory to identify the relevant stressors or risk factors such as living arrangements, financial satisfaction, acculturation predictors, transportation, and grandchild care. A mixed-methods approach integrating quantitative and qualitative research methods was used in the study. For the collection of quantitative data, 163 participants aged 60 and over completed an online or mailed survey. Hierarchical regression was used to analyze the quantitative data. Findings showed that ethnic social relations and living arrangements had a unique contribution to the social isolation of the participants. Also, social isolation, ethnic social relations, and financial satisfaction significantly influenced the emotional well-being of study participants. For the study’s qualitative data, the researcher conducted in-depth interviews with 11 participants, age 63-79, by telephone. Five major themes were generated from the data using a thematic analysis approach, which included (a) minimal social engagement outside of the home, (b) barriers to social engagement, (c) satisfaction with finances, (d) fewer socialization consequences, and (e) coping strategies. The overall finding showed that the participants lacked social engagement outside of the home, which negatively affected their emotional well-being. Implications for social work practice and policy as well as recommendations were emphasized in the study.
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    Investigating Thoracic Vertebral Fractures in Residential Environments
    (Elsevier, 2024-09) Singh, Gurbinder; Rao, Varun; Kazi, Fezaan; Wague, Aboubacar; Zaazoue, Mohamed A.; Neurological Surgery, School of Medicine
    Introduction Thoracic vertebral fractures within homes are pivotal public health concerns due to their associated morbidity and significant healthcare expenditures. This study aims to dissect the intricate epidemiology of these injuries, integrating comprehensive risk factors beyond conventional demographics and location analyses. Methods Utilizing a decade of data (2013–2022) from the National Electronic Injury Surveillance System, this study examines thoracic vertebral fractures across age and gender in household settings. Inclusion criteria targeted specific thoracic spine-related terms, analyzing fractures by location (e.g., kitchen, stairs) and associated products. Data processing employed R programming, with statistical analysis focusing on descriptive statistics and multivariate logistic regression, to identify fracture patterns and assess gender differences in fracture risks through Adjusted Odds Ratios (AORs). Results Analysis of 46,371 thoracic vertebral fractures identified stairs as the primary site (26.81%), with subsequent frequent locations being bedrooms (18.52%), living rooms (17.88%), and kitchens (16.29%). Gender-specific risk analysis revealed females had a higher likelihood of fractures on stairs (AOR = 1.24, 95% CI: 1.16–1.37, P < 0.001) and in bedrooms (AOR = 1.13, 95% CI: 1.09–1.54, P < 0.001). The most affected age group was 51–60, showcasing the multifaceted nature of risk factors beyond mere location. Discussion This study transcends prior insights by detailing the influence of various factors, including socioeconomic status and lifestyle, on fracture risk. It emphasizes the complexity of household fractures, highlighting gender and age as pivotal but not exclusive risk determinants. Conclusions By offering a comprehensive analysis that incorporates a wide array of risk factors, this study advances the understanding of thoracic vertebral fractures in residential environments. It underscores the necessity for targeted preventive measures that are cognizant of the multifactorial nature of these injuries, paving the way for improved safety interventions and public health policies.