scholarly journals Pre-loss personal factors and prolonged grief disorder in bereaved mothers

2018 ◽  
Vol 49 (14) ◽  
pp. 2370-2378 ◽  
Author(s):  
Richard D. Goldstein ◽  
Carter R. Petty ◽  
Sue E. Morris ◽  
Melanie Human ◽  
Hein Odendaal ◽  
...  
Keyword(s):  
Risk Factors ◽  
Psychosocial Functioning ◽  
Maternal Age ◽  
Risk Groups ◽  
Risk Scores ◽  
Sudden Infant ◽  
Personal Factors ◽  
Higher Alcohol ◽  
Prolonged Grief Disorder ◽  
Prolonged Grief

AbstractBackgroundIdentifying characteristics of individuals at greatest risk for prolonged grief disorder (PGD) can improve its detection and elucidate the etiology of the disorder. The Safe Passage Study, a study of women at high risk for sudden infant death syndrome (SIDS), prospectively examined the psychosocial functioning of women while monitoring their healthy pregnancies. Mothers whose infants died of SIDS were followed in bereavement.MethodsPre-loss data were collected from 12 000 pregnant mothers and analyzed for their associations with grief symptoms and PGD in 50 mothers whose infants died from SIDS, from 2 to 48 months after their infant's death, focusing on pre-loss risk factors of anxiety, depression, alcohol use, maternal age, the presence of other living children in the home, and previous child loss.ResultsThe presence of any four risk factors significantly predicted PGD for 24 months post-loss (p < 0.003); 2–3 risk factors predicted PGD for 12 months (p = 0.02). PGD rates increased in the second post-loss year, converging in all groups to approximately 40% by 3 years. Pre-loss depressive symptoms were significantly associated with PGD. Higher alcohol intake and older maternal age were consistently positively associated with PGD. Predicted risk scores showed good discrimination between PGD and no PGD 6–24 months after loss (C-statistic = 0.83).ConclusionsA combination of personal risk factors predicted PGD in 2 years of bereavement. There is a convergence of risk groups to high rates at 2–3 years, marked by increased PGD rates in mothers at low risk. The risk factors showed different effects on PGD.

Risk Factors of Prolonged Grief Disorder: A Conceptual Framework

2011 ◽  
Author(s):  
Evgenia Milman ◽  
Christopher J. Mackinnon ◽  
Martin Drapeau
Keyword(s):  
Risk Factors ◽  
Conceptual Framework ◽  
Prolonged Grief Disorder ◽  
Prolonged Grief

Abstract 15941: Derivation of Risk-Scores That Stratify Risk of Hospitalization and Death in SARS-CoV-2 Positive Patients

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Kirk U Knowlton ◽  
Heidi T May ◽  
Stacey Knight ◽  
Tami L Bair ◽  
Viet T Le ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
High Risk ◽  
Risk Groups ◽  
Risk Scores ◽  
Individual Risk ◽  
Variable Intensity ◽  
Intermountain Healthcare ◽  
Demographic Risk ◽  
Demographic Risk Factor

Introduction: It is well-documented that COVID-19 patients with pre-existing cardiovascular-related disorders are at higher risk of a complicated course. It would be valuable to integrate individual risk factors into overall risk scores for hospitalization and death from COVID-19. Methods: The Intermountain Healthcare medical record database was searched for all individuals tested for SARS-CoV-2 infection up to June 8, 2020. Data from test-positive patients (pts) was analyzed to determine the characteristics of pts requiring hospitalization. From these data, 2 risk scores for hospitalization were derived using multi-variable modeling: of only demographic and risk-factor data, or also including concurrent medications. The risk scores were also applied to predict the risk of dying from COVID-19. Results: Of 104,018 people tested at Intermountain Healthcare for SARS-CoV-2, 5505 (5.3%) were positive. Of test-positive pts, 451 (8.2%) were hospitalized, and 37 (0.7%) died. Using a demographic/risk factor only score, 1.4, 7.0, and 36.6% of low-, moderate-, and high-risk groups, respectively, were hospitalized (AUC=0.826). Using demographic risk-factors and medications, 1.4, 5.6, and 40.3% of low-, moderate-, and high-risk patients were hospitalized (AUC=0.854, Table 1). The demographic/risk factor-score was also predictive of the risk of dying, with 0%, 0.9% and 4.5% in low-, moderate-, and high-risk groups dying (AUC=0.918). Adding medications to the risk-factors model further improved the prediction of death with 0.1, 0.04, and 4.9% in the low-, moderate-, and high-risk groups dying (AUC=0.942, Table 2). Conclusions: We demonstrate the derivation of highly predictive risk scores for COVD-19 patients at low, moderate, and high risks of hospitalization or death. Pending appropriate validation in another cohort, application of these risk-scores may allow healthcare systems to risk-stratify COVID-19 patients requiring variable intensity of care.

scholarly journals A validated novel continuous prognostic index to deliver stratified medicine in pediatric acute lymphoblastic leukemia

Blood ◽  
2020 ◽  
Vol 135 (17) ◽  
pp. 1438-1446 ◽  
Author(s):  
Amir Enshaei ◽  
David O’Connor ◽  
Jack Bartram ◽  
Jeremy Hancock ◽  
Christine J. Harrison ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Lymphoblastic Leukemia ◽  
Risk Stratification ◽  
Cox Regression ◽  
Residual Disease ◽  
Lymphoblastic Leukemia ◽  
Prognostic Index ◽  
Risk Groups ◽  
Risk Scores ◽  
Predicting Outcome

Abstract Risk stratification is essential for the delivery of optimal treatment in childhood acute lymphoblastic leukemia. However, current risk stratification algorithms dichotomize variables and apply risk factors independently, which may incorrectly assume identical associations across biologically heterogeneous subsets and reduce statistical power. Accordingly, we developed and validated a prognostic index (PIUKALL) that integrates multiple risk factors and uses continuous data. We created discovery (n = 2405) and validation (n = 2313) cohorts using data from 4 recent trials (UKALL2003, COALL-03, DCOG-ALL10, and NOPHO-ALL2008). Using the discovery cohort, multivariate Cox regression modeling defined a minimal model including white cell count at diagnosis, pretreatment cytogenetics, and end-of-induction minimal residual disease. Using this model, we defined PIUKALL as a continuous variable that assigns personalized risk scores. PIUKALL correlated with risk of relapse and was validated in an independent cohort. Using PIUKALL to risk stratify patients improved the concordance index for all end points compared with traditional algorithms. We used PIUKALL to define 4 clinically relevant risk groups that had differential relapse rates at 5 years and were similar between the 2 cohorts (discovery: low, 3% [95% confidence interval (CI), 2%-4%]; standard, 8% [95% CI, 6%-10%]; intermediate, 17% [95% CI, 14%-21%]; and high, 48% [95% CI, 36%-60%; validation: low, 4% [95% CI, 3%-6%]; standard, 9% [95% CI, 6%-12%]; intermediate, 17% [95% CI, 14%-21%]; and high, 35% [95% CI, 24%-48%]). Analysis of the area under the curve confirmed the PIUKALL groups were significantly better at predicting outcome than algorithms employed in each trial. PIUKALL provides an accurate method for predicting outcome and more flexible method for defining risk groups in future studies.

scholarly journals The Essential Thrombocythemia, Thrombotic Risk Stratification, and Cardiovascular Risk Factors

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Salvatrice Mancuso ◽  
Vincenzo Accurso ◽  
Marco Santoro ◽  
Simona Raso ◽  
Angelo Davide Contrino ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Essential Thrombocythemia ◽  
Scoring Systems ◽  
Risk Groups ◽  
Risk Scores ◽  
Driver Mutations ◽  
Thrombotic Risk ◽  
The Impact

Essential thrombocythemia is a rare hematological malignancy with good overall survival, but moderate to high risk of developing arterial or venous thrombosis lifelong. Different thrombotic risk scores for patients with essential thrombocythemia have been proposed, but only one of them (the IPSET-t scoring system) takes into account the classical cardiovascular risk factors as one of the scoring items. Currently, in clinical practice, the presence of cardiovascular risk factors in patients with diagnosis of ET rarely determines the decision to initiate cytoreductive therapies. In our study, we compared different risk models to estimate the thrombotic risk of 233 ET patients and the role of specific driver mutations and evaluated the impact that conventional cardiovascular risk factors (hypertension, cigarette smoking, diabetes, obesity, and dyslipidaemia) have on thrombotic risk in patients with ET. Perspective studies conducted on a polycentric large cohort of patients should be conducted to estimate the impact of cardiovascular risk factors in determining thrombosis in ET patients, evaluating the opportunity of initiating a cytoreductive therapy in patients with cardiovascular risk factors, even if classified into low to moderate risk groups according to other scoring systems.

Prolonged Grief Disorder

2014 ◽  
Author(s):  
A.H. Jordan ◽  
B.T. Litz
Keyword(s):  
Prolonged Grief Disorder ◽  
Prolonged Grief

Risk Factors for Bleeding during Treatment of Acute Venous Thromboembolism

1996 ◽  
Vol 76 (05) ◽  
pp. 682-688 ◽  
Author(s):  
Jos P J Wester ◽  
Harold W de Valk ◽  
Karel H Nieuwenhuis ◽  
Catherine B Brouwer ◽  
Yolanda van der Graaf ◽  
...  
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
Surface Area ◽  
Body Surface Area ◽  
Body Surface ◽  
Small Body ◽  
Bleeding Risk ◽  
Risk Scores ◽  
Risk Of Bleeding ◽  
Acute Venous Thromboembolism

Summary Objective: Identification of risk factors for bleeding and prospective evaluation of two bleeding risk scores in the treatment of acute venous thromboembolism. Design: Secondary analysis of a prospective, randomized, assessor-blind, multicenter clinical trial. Setting: One university and 2 regional teaching hospitals. Patients: 188 patients treated with heparin or danaparoid for acute venous thromboembolism. Measurements: The presenting clinical features, the doses of the drugs, and the anticoagulant responses were analyzed using univariate and multivariate logistic regression analysis in order to evaluate prognostic factors for bleeding. In addition, the recently developed Utrecht bleeding risk score and Landefeld bleeding risk index were evaluated prospectively. Results: Major bleeding occurred in 4 patients (2.1%) and minor bleeding in 101 patients (53.7%). For all (major and minor combined) bleeding, body surface area ≤2 m2 (odds ratio 2.3, 95% Cl 1.2-4.4; p = 0.01), and malignancy (odds ratio 2.4, 95% Cl 1.1-4.9; p = 0.02) were confirmed to be independent risk factors. An increased treatment-related risk of bleeding was observed in patients treated with high doses of heparin, independent of the concomitant activated partial thromboplastin time ratios. Both bleeding risk scores had low diagnostic value for bleeding in this sample of mainly minor bleeders. Conclusions: A small body surface area and malignancy were associated with a higher frequency of bleeding. The bleeding risk scores merely offer the clinician a general estimation of the risk of bleeding. In patients with a small body surface area or in patients with malignancy, it may be of interest to study whether limited dose reduction of the anticoagulant drug may cause less bleeding without affecting efficacy.

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