Predicting Persistent Developmental Stuttering Using a Cumulative Risk Approach

2021 ◽  
pp. 1-26
Author(s):  
Cara M. Singer ◽  
Sango Otieno ◽  
Soo-Eun Chang ◽  
Robin M. Jones
Keyword(s):  
Risk Factors ◽  
Predictive Validity ◽  
Predictive Factors ◽  
Language Skills ◽  
Speech Sound ◽  
Cumulative Risk ◽  
Standard Score ◽  
Persistent Developmental Stuttering ◽  
Risk Approach ◽  
Developmental Stuttering

Purpose: The purpose of this study was to explore how well a cumulative risk approach, based on empirically supported predictive factors, predicts whether a young child who stutters is likely to develop persistent developmental stuttering. In a cumulative risk approach, the number of predictive factors indicating a child is at risk to develop persistent stuttering is evaluated, and a greater number of indicators of risk are hypothesized to confer greater risk of persistent stuttering. Method: We combined extant data on 3- to 5-year-old children who stutter from two longitudinal studies to identify cutoff values for continuous predictive factors (e.g., speech and language skills, age at onset, time since onset, stuttering frequency) and, in combination with binary predictors (e.g., sex, family history of stuttering), used all-subsets regression and receiver operating characteristic curves to compare the predictive validity of different combinations of 10 risk factors. The optimal combination of predictive factors and the odds of a child developing persistent stuttering based on an increasing number of factors were calculated. Results: Based on 67 children who stutter (i.e., 44 persisting and 23 recovered) with relatively strong speech-language skills, the predictive factor model that yielded the best predictive validity was based on time since onset (≥ 19 months), speech sound skills (≤ 115 standard score), expressive language skills (≤ 106 standard score), and stuttering severity (≥ 17 Stuttering Severity Instrument total score). When the presence of at least two predictive factors was used to confer elevated risk to develop persistent stuttering, the model yielded 93% sensitivity and 65% specificity. As a child presented with a greater number of these four risk factors, the odds for persistent stuttering increased. Conclusions: Findings support the use of a cumulative risk approach and the predictive utility of assessing multiple domains when evaluating a child's risk of developing persistent stuttering. Clinical implications and future directions are discussed.

scholarly journals Modeling Exposure to Multiple Childhood Social Risk Factors and Physical Capability and Common Affective Symptoms in Later Life

2016 ◽  
Vol 30 (3) ◽  
pp. 386-407 ◽  
Author(s):  
Rishi Caleyachetty ◽  
Rebecca Hardy ◽  
Rachel Cooper ◽  
Marcus Richards ◽  
Laura D. Howe ◽  
...  
Keyword(s):  
Risk Factors ◽  
Factor Analysis ◽  
Risk Factor ◽  
Cumulative Risk ◽  
Later Life ◽  
Social Risk ◽  
Social Risk Factors ◽  
Physical Capability ◽  
Affective Symptoms ◽  
Risk Approach

Objective: This study presents three approaches, that is, cumulative risk, factor analysis, and latent class analysis, to summarize exposure to multiple childhood social risk factors and to compare their utility when examining associations with physical capability and common affective symptoms in adults aged 60 to 64 years. Methods: Data came from the U.K. Medical Research Council (MRC) National Survey of Health and Development, with prospective childhood social risk factor data collected in 1950 to 1957 and retrospectively in 1989. Physical capability and common affective symptom data were collected in 2006 to 2011. Results: The cumulative risk approach and factor analysis provided evidence that children who were exposed to multiple social risk factors had lower levels of physical capability and more symptoms of common affective symptoms in later life. Discussion: The cumulative social risk approach and the use of factor analysis to identify contexts of social risk, may offer viable methods for linking multiple childhood social risk exposure to aging outcomes.

Gallstones in a Newborn-Cohort with Sickle Cell Anemia (SCA): Cumulative Risk and Predictive Factors

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 513-513 ◽  
Author(s):  
Annie Kamdem ◽  
Cécile Arnaud ◽  
Nadia Médejel ◽  
Clément Tassel ◽  
Isabelle Hau ◽  
...  
Keyword(s):  
Risk Factors ◽  
Predictive Factors ◽  
Cox Regression ◽  
Reticulocyte Count ◽  
Cumulative Risk ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Abdominal Sonography ◽  
Alpha Thalassemia ◽  
Febrile Episodes

Abstract Abstract 513 Background: The accelerated hemolysis in SCA increases bilirubin excretion and the susceptibility to pigment gallstone formation. Uridine diphosphate-glucuronosyltransferase (UGT1A1) gene polymorphism and alpha-thalassemia are factors known to modify this risk. However, their relative influence and other factors such as SCA disease severity and the use of ceftriaxone for acute febrile episodes remain to be explored in a newborn cohort. The goal of this study was to define the cumulative incidence and risk factors for the occurrence of gallstones in a SCA-newborn-cohort. Patients and Methods: Alpha-genes, beta-globin haplotypes, UGT1AI genotype, G6PD-enzymatic activity were recorded; baseline biological parameters were determined during the second year of life, away from crises and transfusions as previously described (Blood 2011,117, 4). Annual check-ups including abdominal sonography were performed as soon as the age of 1 year. Cholecystectomy was systematically performed in the 6 months following the discovery and confirmation of presence of gallstones. All hospitalizations and their causes were prospectively recorded. Patients were censored on the date of gallstone occurrence or last abdominal sonography; event rates/year (pain crises, ACS, febrile episodes) were calculated, and KM-estimated cumulative risk for gallstones and Cox regression were used to assess the predictive factors for gallstones. Results: SCA-patients (364: 353 SS, 8 Sb0, 3 SDPunjab; 182 F,182 M) born before February 2010 and followed until the age of 18–20 years were included in this study. Alpha-thalassemia was present in 46% patients (available in 323; 2 genes: n=33; 3 genes: n=116; 4 genes: n=172; 5 genes: n=2); beta-haplotypes (available in 291) were Car/Car in 42.6%, Ben/Ben in 19.9%, Sen/Sen in 9.6%, and others in 27.8%. G6PD activity (available in 309) was deficient in 11.6%. UGTA1 polymorphism (available in 175) showed Gilbert genotype in 19.8%, i.e., 7/7 in 13.4% and 7/8 in 6.4%. The frequency of the other genotypes was: 5/6: 6.4%; 5/7:7%; 5/8:0.6%; 6/6:23.3%, 6/7:34.3%; and 6/8:8.1%. Unconjugated bilirubin values at baseline were significantly correlated with the total number of UGTA1A1 repeats (r=0.415, p<0.001). Mean rates (SD) of pain crises, ACS and acute febrile episodes were 0.56 (0.68), 0.12 (0.18), 0.34 (0.54), respectively. Gallstones were observed in 98/364 patients at the median age of 9.2 (range: 2.5 to 17.9 years). The cumulative risk of gallstones was 5% by age 5, 20.7% by age 10 and 35.6 % by age 15 and was not significantly different in patients with Gilbert polymorphism (Log Rank p=0.4) but was significantly related to the number of alpha-genes (Log-Rank p=0.039). However, the risk was significantly increased in patients homozygous or heterozygous for (TA8) (Log Rank p=0.016). Univariate Cox regression analysis showed that the number of alpha-genes was a significant risk factor (p=0.014) whereas G6PD deficiency, beta-haplotypes and Gilbert genotype were not significant risk factors; however, the presence of at least one allele (TA8) was a significant risk factor (p=0.025). Among the baseline biological parameters, hemoglobin, WBC, neutrophils, platelets, MCV, and bilirubin were not significant factors whereas HbF level (p=0.028), reticulocyte count (p<0.001) and LDH (p=0.020) significantly increased the risk for gallstones. Among clinical events, pain crises, ACS and febrile episodes significantly increased the risk (p<0.001). Multivariate Cox analysis including all the significant risk factors in the univariate analysis retained the deletion of 2 alpha genes (HR=4.66; 95% CI:1.11-19.52,p=0.035) which decreases the risk, the presence of at least one allele (TA8) (HR=2.26:95% CI:1.07-4.78, p=0.032), which increases the risk and the baseline reticulocytes count per 1×109/L increase(HR:1.001;1.000-1.002;p=0.005), as independent and significant predictive factors for gallstones. Conclusion: This prospective SCA newborn-cohort study shows that gallstones may begin as soon as 2.5 years of age and that the cumulative risk reaches a high 35.6% by age 15. The deletion of 2 alpha genes, the presence of at least one UGT1A1 (TA8) allele and high baseline reticulocyte count are independent and significant predictive factors showing that the risks are multifacturial and highly and primarily dependent on hemolysis Disclosures: No relevant conflicts of interest to declare.

Abnormal speech sound representation in persistent developmental stuttering

Neurology ◽  
2005 ◽  
Vol 65 (8) ◽  
pp. 1246-1252 ◽  
Author(s):  
S. Corbera ◽  
M.-J. Corral ◽  
C. Escera ◽  
M. A. Idiazabal
Keyword(s):  
Speech Sound ◽  
Persistent Developmental Stuttering ◽  
Developmental Stuttering

scholarly journals Cumulative Risks from Stressor Exposures and Personal Risk Factors in the Workplace: Examples from a Scoping Review

2021 ◽  
Vol 18 (11) ◽  
pp. 5850
Author(s):  
Mary A. Fox ◽  
Richard Todd Niemeier ◽  
Naomi Hudson ◽  
Miriam R. Siegel ◽  
Gary Scott Dotson
Keyword(s):  
Risk Factors ◽  
Risk Assessment ◽  
Scoping Review ◽  
Multiple Stressors ◽  
Cumulative Risk ◽  
Real Life ◽  
Personal Factors ◽  
Exposure Limits ◽  
Personal Risk ◽  
Personal Risk Factors

Protecting worker and public health involves an understanding of multiple determinants, including exposures to biological, chemical, or physical agents or stressors in combination with other determinants including type of employment, health status, and individual behaviors. This has been illustrated during the COVID-19 pandemic by increased exposure and health risks for essential workers and those with pre-existing conditions, and mask-wearing behavior. Health risk assessment practices for environmental and occupational health typically do not incorporate multiple stressors in combination with personal risk factors. While conceptual developments in cumulative risk assessment to inform a more holistic approach to these real-life conditions have progressed, gaps remain, and practical methods and applications are rare. This scoping review characterizes existing evidence of combined stressor exposures and personal factors and risk to foster methods for occupational cumulative risk assessment. The review found examples from many workplaces, such as manufacturing, offices, and health care; exposures to chemical, physical, and psychosocial stressors combined with modifiable and unmodifiable determinants of health; and outcomes including respiratory function and disease, cancers, cardio-metabolic diseases, and hearing loss, as well as increased fertility, menstrual dysfunction and worsened mental health. To protect workers, workplace exposures and modifiable and unmodifiable characteristics should be considered in risk assessment and management. Data on combination exposures can improve assessments and risk estimates and inform protective exposure limits and management strategies.

scholarly journals Infectious events in patients with severe COVID-19: results of a cohort of patients with high prevalence of underlying immune defect

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Anastasia Saade ◽  
Giulia Moratelli ◽  
Guillaume Dumas ◽  
Asma Mabrouki ◽  
Jean-Jacques Tudesq ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cumulative Incidence ◽  
Cumulative Risk ◽  
Incidence Density ◽  
Hospital Acquired Infections ◽  
Underlying Malignancy ◽  
Single Center Study ◽  
High Prevalence ◽  
Immune Defect ◽  
Hospital Acquired

Abstract Background Empirical antibiotic has been considered in severe COVID-19 although little data are available regarding concomitant infections. This study aims to assess the frequency of infections, community and hospital-acquired infections, and risk factors for infections and mortality during severe COVID-19. Methods Retrospective single-center study including consecutive patients admitted to the intensive care unit (ICU) for severe COVID-19. Competing-risk analyses were used to assess cumulative risk of infections. Time-dependent Cox and fine and gray models were used to assess risk factors for infections and mortality. Propensity score matching was performed to estimate the effect of dexamethasone. Results We included 100 patients including 34 patients with underlying malignancies or organ transplantation. First infectious event was bacterial for 35 patients, and fungal for one. Cumulative incidence of infectious events was 27% [18–35] at 10 ICU-days. Prevalence of community-acquired infections was 7% [2.8–13.9]. Incidence density of hospital-acquired infections was 125 [91–200] events per 1000 ICU-days. Risk factors independently associated with hospital-acquired infections included MV. Patient’s severity and underlying malignancy were associated with mortality. Dexamethasone was associated with increased infections (36% [20–53] vs. 12% [4–20] cumulative incidence at day-10; p = 0.01). After matching, dexamethasone was associated with hospital-acquired infections (35% [18–52] vs. 13% [1–25] at 10 days, respectively, p = 0.03), except in the subset of patients requiring MV, and had no influence on mortality. Conclusions In this population of COVID-19 patients with high prevalence of underlying immune defect, a high risk of infections was noted. MV and use of steroids were independently associated with infection rate.

Dorsal and ventral language pathways in persistent developmental stuttering

Cortex ◽  
2016 ◽  
Vol 81 ◽  
pp. 79-92 ◽  
Author(s):  
Vered Kronfeld-Duenias ◽  
Ofer Amir ◽  
Ruth Ezrati-Vinacour ◽  
Oren Civier ◽  
Michal Ben-Shachar
Keyword(s):  
Persistent Developmental Stuttering ◽  
Developmental Stuttering ◽  
Language Pathways

Risk Factors for Suicide Attempts Among African American Women Experiencing Recent Intimate Partner Violence

2002 ◽  
Vol 17 (3) ◽  
pp. 283-295 ◽  
Author(s):  
Martie P. Thompson ◽  
Nadine J. Kaslow ◽  
J. B. Kingree
Keyword(s):  
Risk Factors ◽  
African American ◽  
Suicide Attempt ◽  
African American Women ◽  
Suicide Attempts ◽  
Risk Model ◽  
Cumulative Risk ◽  
American Women ◽  
Cumulative Risk Model ◽  
Risk Factors For Suicide

The purposes of this study were to identify risk factors for suicide attempts among 200 African American abused women (100 attempters, 100 nonattempters) and to test a cumulative risk model to determine if a woman’s likelihood of making a suicide attempt increased as the number of risk factors increased. Results revealed that attempters were significantly more likely than nonattempters to report high levels of depressive symptoms, hopelessness, drug abuse, and childhood abuse and neglect. Results from the cumulative risk model revealed a linear association between the number of risk factors and the odds of making a suicide attempt. Compared to women with no risk factors, women with two risk factors, women with three risk factors, and women with four to five risk factors were 10, 25, and 107 times, respectively, more likely to attempt suicide. The identification of risk variables highlights the importance of designing interventions to address these factors in order to reduce the risk of suicidal behavior in abused, African American women.

The Risk of Seizure Recurrence After a First Unprovoked Afebrile Seizure in Childhood: An Extended Follow-up

PEDIATRICS ◽  
1996 ◽  
Vol 98 (2) ◽  
pp. 216-225 ◽  
Author(s):  
Shlomo Shinnar ◽  
Anne T. Berg ◽  
Solomon L. Moshe ◽  
Christine O'Dell ◽  
Marta Alemany ◽  
...  
Keyword(s):  
Risk Factors ◽  
Age Of Onset ◽  
Multivariable Analysis ◽  
Cumulative Risk ◽  
Febrile Seizures ◽  
Recurrence Risk ◽  
Early Recurrence ◽  
Seizure Recurrence ◽  
Unprovoked Seizure ◽  
History Of

Objective. To assess the long-term recurrence risks after a first unprovoked seizure in childhood. Methods. In a prospective study, 407 children who presented with a first unprovoked seizure were then followed for a mean of 6.3 years from the time of first seizure. Results. One hundred seventy-one children (42%) experienced subsequent seizures. The cumulative risk of seizure recurrence was 29%,37%,42%, and 44% at 1,2,5, and 8 years, respectively. The median time to recurrence was 5.7 months, with 53% of recurrences occurring within 6 months, 69% within 1 year, and 88% within 2 years. Only 5 recurrences (3%) occurred after 5 years. On multivariable analysis, risk factors for seizure recurrence included a remote symptomatic etiology, an abnormal electroencephalogram (EEG), a seizure occurring while asleep, a history of prior febrile seizures, and Todd's paresis. In cryptogenic cases, the risk factors were an abnormal EEG and an initial seizure during sleep. In remote symptomatic cases, risk factors were a history of prior febrile seizures and age of onset younger than 3 years. Risk factors for late recurrences (after 2 years) were etiology, an abnormal EEG, and prior febrile seizures in the overall group and an abnormal EEG in the cryptogenic group. These are similar to the risk factors for early recurrence. Conclusions. The majority of children with a first unprovoked seizure will not have recurrences. Children with cryptogenic first seizures and a normal EEG whose initial seizure occurs while awake have a particularly favorable prognosis, with a 5-year recurrence risk of only 21%. Late recurrences do occur but are uncommon.

scholarly journals Prevalence of risk factors for stuttering among boys: analytical cross-sectional study

2014 ◽  
Vol 132 (3) ◽  
pp. 152-157 ◽  
Author(s):  
Cristiane Moço Canhetti Oliveira ◽  
Paula Roberta Nogueira
Keyword(s):  
Risk Factors ◽  
Cross Sectional Study ◽  
Physical Stress ◽  
Control Group ◽  
Sectional Study ◽  
Quality Factors ◽  
Hearing Disorders ◽  
Cross Sectional ◽  
Family Attitudes ◽  
Developmental Stuttering

CONTEXT AND OBJECTIVE:There have been few studies on the risk factors for subgroups of stuttering. The aim of this study was to characterize the risk factors for developmental familial stuttering among boys who stutter and who do not stutter, such as disfluency types, associated quality and communication factors, emotional and physical stress, familial attitudes and personal reactions.DESIGN AND SETTING:Analytical cross-sectional study with a control group, performed at the Fluency Studies Laboratory of the Department of Speech and Hearing Disorders of a public university.METHODS: The parents of 40 age-matched stuttering and non-stuttering boys took part in this study. The participants were divided into two groups: stuttering children (SC) and non-stuttering children (NSC), with ages between 6 years 0 months and 11 years 11 months. Initially, all of the participants underwent a fluency assessment and then data were gathered using the Protocol for the Risk of Developmental Stuttering.RESULTS:There were no differences in the physical stress distribution factors and personal reactions between the groups. Inappropriate familial attitudes were presented by 95% of the SC and 30% of the NSC. Four risk factors analyzed were not shown by the NSC, namely stuttering-like disfluency, quality factors, physical stress and emotional stresses.CONCLUSIONS:The findings suggest that the presence of stuttering-like disfluency, associated quality and communication factors, emotional stress and inappropriate family attitudes are important risk factors for familial developmental stuttering among boys.

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