Early Transient Hypoglycemia and Test Performance in At-Risk Newborns

Objective This study aimed to evaluate if early (within the first 3 hours after birth) transient neonatal hypoglycemia (TNH) is associated with poor academic performance in infants at-risk for hypoglycemia. Study Design This was a retrospective cohort study of at risk-infants (late preterm infants, small and large for gestational age infants, and infants of diabetic mothers [IDMs]) who were born in 1998 and 1999 at the University of Arkansas for Medical Sciences and had ≥1 recorded glucose concentration. The outcome measure was proficiency on 4th grade literacy and mathematics achievement tests. Three glucose concentration cutoffs for defining hypoglycemia (<35, <40, and <45 mg/dL) were investigated. Logistic regression models were developed to examine the association between early TNH and achievement test proficiency based on perinatal factors. Results Among 726 infants, 472 had one, 233 had two, and 21 had three risk factor(s). Early TNH (glucose concentration <35, <40, and <45 mg/dL) was observed in 6.3, 11.6, and 20.5% of the study cohort, respectively. Irrespective of the cutoff used, the frequency of early TNH (number of patients with early TNH in a risk category divided by the total number of patients in that category) was significantly greater among infants with multiple risk factors. After controlling for perinatal factors, early TNH (cutoffs <35 and <40 mg/dL) was significantly associated with decreased probability of proficiency in literacy but not mathematics. Despite that early TNH was more common in IDMs and infants with three risk factors, the category or number of risk factors did not impact academic proficiency. Conclusion Early TNH (<35 and <40 mg/dL) was associated with lower adjusted probability of proficiency on 4th grade literacy achievement tests in at-risk infants. The impact of early TNH on academic performance was similar irrespective of category or number of risk factors. Key Points

Download Full-text

Indication to postoperative radiotherapy for oral cavity squamous cell carcinoma: what’s new in the Depth of Infiltration (DOI) era?

British Journal of Radiology ◽

10.1259/bjr.20210705 ◽

2021 ◽

Author(s):

Daniela Alterio ◽

Rita De Berardinis ◽

Matteo Augugliaro ◽

Pasqualina D’Urso ◽

Stefania Volpe ◽

...

Keyword(s):

Risk Factors ◽

Oral Cavity ◽

Squamous Cell ◽

Tnm Classification ◽

Postoperative Radiotherapy ◽

Tnm Staging ◽

Stage Migration ◽

Number Of Patients ◽

The Impact ◽

Depth Of Infiltration

Objectives: The last edition of the American Joint Committee on Cancer (AJCC eighth) has introduced the depth of infiltration (DOI) as a new prognostic parameter in oral cavity squamous cell carcinomas (OCSCCs). Aim of this study is to analyze the impact of stage migration on the indication to postoperative radiotherapy (PORT). Methods: OCSCCs treated at two Institutions between 2014 and 2019 were retrieved. Per the AJCC eighth, only pT3 primarily OCSCCs were considered; availability of the pathologic specimen was a further inclusion criterion. Risk factors considered for PORT were: pT3-pT4, nodal involvement, positive/close surgical margins, perineural and lymph vascular invasion. Results: One-hundred forty-nine patients staged as pT3 AJCC eighth were included. A four-fold increase in the number of patients staged as pT3 from the seventh to the eighth AJCC was found. Stage migration to pT3 was equally due to the downstaging from former pT4 (38%) and upstaging of former pT1-pT2 (35%). Considering the former pT1-pT2 53 patients, 13 (25%) had no risk factors for PORT other than DOI. Among 25 cases with former pT1-pT2 and negative lymph nodes no additional risk factors were found in 11 (44%). Conclusion: Ninety percent of patients had at least one risk factor besides DOI and would have received PORT also according to the AJCC seventh; notably, of former pT1-pT2N0, half of them have been upstaged to pT3 in the current TNM classification. The role of PORT in this cohort of patients has not been clarified yet. Advances in knowledge: Other-than-DOI risk factors leading to PORT indication are highly prevalent in OCSSC patients classified as pT3 per the latest AJCC TNM staging system and should therefore be considered for a comprehensive oncological assessment.

Download Full-text

The phenomenon of social risk families and its dynamics in Lithuania

SHS Web of Conferences ◽

10.1051/shsconf/20185103001 ◽

2018 ◽

Vol 51 ◽

pp. 03001

Author(s):

Vide Gudzinskiene ◽

Rimvydas Augutavicius

Keyword(s):

Risk Factors ◽

At Risk ◽

Physical Environment ◽

Social Risk ◽

Public Concern ◽

Social Risk Factors ◽

Scientific Problem ◽

Number Of Children ◽

Social And Physical Environment ◽

The Impact

Families at risk are definitely the urgent public concern that requires immediate solutions in Lithuania. It is important to mention that the children growing within the families at risk are in the centre of concern as their social and physical environment is not stimulating enough, leading to a number of different problems the families and children themselves are facing. In general, the number of such children makes about 4 percent of the total number of children in the country and this rate has remained stable for many years. Scientific problem – the problems experienced by children growing within social risk families and the impact of social risk factors on children's socialization and integration. Object – phenomenon of families at risk in Lithuania. Task of the article – to analyze the phenomenon of social risk families and its trends in Lithuania.

Download Full-text

An unexpectedly high occurrence of aciclovir-induced neuropsychiatric symptoms in patients treated for herpesvirus CNS infection: a prospective observational study

Journal of Antimicrobial Chemotherapy ◽

10.1093/jac/dkz357 ◽

2019 ◽

Vol 74 (12) ◽

pp. 3565-3572 ◽

Cited By ~ 1

Author(s):

Johan Lindström ◽

Anders Helldén ◽

Jan Lycke ◽

Anna Grahn ◽

Marie Studahl

Keyword(s):

Risk Factors ◽

Renal Function ◽

Medical Records ◽

Regression Models ◽

Prospective Observational Study ◽

Neuropsychiatric Symptoms ◽

Cns Infection ◽

Albumin Ratio ◽

Number Of Patients ◽

The Impact

Abstract Background Aciclovir is effective in herpesvirus infections of the CNS. Aciclovir-induced neuropsychiatric symptoms (AINS) have been reported and are associated with high CSF concentrations of aciclovir metabolite 9-carboxymethoxymethylguanine (CMMG). Risk factors except for renal failure have not been explored, and disruption of the blood–brain barrier (BBB) in acute CNS infection may be of interest. Objectives To investigate the impact of risk factors on aciclovir and CMMG concentrations, and to relate the results to AINS. Methods We investigated 21 consecutively included, consenting patients treated with aciclovir or valaciclovir for herpesvirus CNS infection. Regression models were constructed to study the impact of risk factors including BBB disruption, as measured with CSF:serum albumin ratio, on CSF aciclovir and CMMG concentrations. Medical records were assessed retrospectively to identify patients with AINS. Results Increased CSF:serum albumin ratio, as well as decreased renal function and high aciclovir doses, was associated with increased aciclovir and CMMG concentrations in the CSF. We identified five patients with new neuropsychiatric symptoms; four of those were considered to have AINS and had increased CSF CMMG concentrations. Only one patient without suspicion of AINS had an increased CSF CMMG concentration. Conclusions In patients with herpesvirus CNS infections, BBB disruption is associated with increasing aciclovir and CMMG CSF concentrations. We also found an unexpectedly high number of patients with AINS. Evaluation of CSF:serum albumin ratios, renal function and CSF concentrations of aciclovir and CMMG may all contribute to the optimization of aciclovir dosing and avoidance of AINS.

Download Full-text

Awareness of Risk Factors among Persons at Risk for Lung Cancer, Chronic Obstructive Pulmonary Disease and Sleep Apnea: A Canadian Population-Based Study

Canadian Respiratory Journal ◽

10.1155/2010/426563 ◽

2010 ◽

Vol 17 (6) ◽

pp. 287-294 ◽

Cited By ~ 12

Author(s):

Shannon L Walker ◽

David L Saltman ◽

Rosemary Colucci ◽

Lesli Martin

Keyword(s):

Risk Factors ◽

Lung Cancer ◽

At Risk ◽

Sleep Apnea ◽

First Nations ◽

Lung Diseases ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Lifestyle Choices ◽

The Impact

OBJECTIVE: To assess awareness among persons at risk for lung cancer, chronic obstructive pulmonary disease (COPD) and sleep apnea regarding symptoms and risk factors of the disease, and their attitudes regarding the disease and toward those who are affected.METHODS: A quantitative hybrid telephone and Internet survey of a representative population of Canadian adults at risk for at least one of the three diseases was conducted. To measure the awareness and attitudes of First Nations, Inuit and Métis people to these diseases, a proportionate number were also surveyed.RESULTS: A total of 3626 individuals were contacted. Of these, 3036 (84%) were eligible to participate. Of those at risk for lung cancer and COPD, 65% and 69%, respectively, were due to tobacco smoke exposure. Among those at risk, 72% believed that they were informed about lung cancer compared with 36% for COPD and 56% for sleep apnea. Most respondents were knowledgeable about the common symptoms of lung cancer, COPD and sleep apnea, but were less aware of the impact lifestyle choices could have on the development of these disorders and the availability of treatment. Most of the participants (77%) believed that smoking was an addiction rather than a habit (19%). There were no significant differences in the awareness of risk factors, symptoms and attitudes toward all three lung diseases between First Nations, Inuit and Métis people and the general population.CONCLUSIONS: Canadians are reasonably aware of risk factors and symptoms for lung cancer and sleep apnea. However, there is poor awareness of COPD as a disease entity. There is a lack of appreciation for the impact lifestyle choices and changes can have on lung diseases.

Download Full-text

Student Hunger on Campus: Food Insecurity Among College Students and Implications for Academic Institutions

American Journal of Health Promotion ◽

10.1177/0890117117719620 ◽

2017 ◽

Vol 32 (2) ◽

pp. 349-354 ◽

Cited By ~ 59

Author(s):

Devon C. Payne-Sturges ◽

Allison Tjaden ◽

Kimberly M. Caldeira ◽

Kathryn B. Vincent ◽

Amelia M. Arria

Keyword(s):

Risk Factors ◽

College Students ◽

At Risk ◽

Academic Performance ◽

Food Insecurity ◽

Living Arrangements ◽

Health Concern ◽

Household Food Security ◽

P Value ◽

Depression Symptoms

Purpose: To estimate the prevalence of food insecurity among students at a large mid-Atlantic publicly funded university; examine the association between food insecurity, demographic characteristics, potential financial risk factors, and self-reported physical and mental health and academic performance; and identify possible risk factors for food insecurity. Design: Cross-sectional survey. Setting: Large, public mid-Atlantic university. Participants: Two hundred thirty-seven undergraduate students. Measures: US Department of Agriculture (USDA) 18-item Household Food Security Survey Module (HFSSM) and questions on demographics, student status, economic factors, housing stability, living arrangements, academic performance, and self-rated physical health and depression symptoms. Analysis: Multivariate logistic regression analysis. Results: Among students surveyed, 15% were food insecure; an additional 16% were at risk of food insecurity. Students who were African American, other race/ethnicity, receiving multiple forms of financial aid, or experiencing housing problems were more likely to be food insecure or at the risk of food insecurity (Adjusted Odds Ratio [AOR] = 4.00, 95% confidence interval [CI] = 1.83-8.71, P value < .0001; AOR = 5.26, 95% CI = 1.85-14.98, P value = .002; AOR = 3.43, 95% CI = 1.85-6.37, P value <.001; AOR = 8.00, 95% CI = 3.57-17.93, P value < .0001, respectively). Food secure students were less likely to report depression symptoms than at-risk or food insecure students. Conclusion: Food insecurity among college students is an important public health concern that might have implications for academic performance, retention, and graduation rates. Universities that measure food insecurity among their students will be better positioned to advocate for policy changes at state and federal levels regarding college affordability and student financial assistance.

Download Full-text

Risk factors associated with development and persistence of long COVID

10.1101/2021.09.22.21263998 ◽

2021 ◽

Author(s):

Yusuke Miyazato ◽

Shinya Tsuzuki ◽

Shinichiro Morioka ◽

Mari Terada ◽

Satoshi Kutsuna ◽

...

Keyword(s):

Risk Factors ◽

At Risk ◽

Linear Regression Analysis ◽

Patient Characteristics ◽

Cross Sectional ◽

Residual Symptoms ◽

Factors Associated ◽

Mild Disease ◽

Number Of Patients ◽

Low Body Mass Index

Background Long COVID has been a social concern. Though patient characteristics associated with developing long COVID are partially known, those associated with persisting it have not been identified. Methods We conducted a cross-sectional questionnaire survey of patients after COVID-19 recovery who visited the National Center for Global Health and Medicine between February 2020 and March 2021. Demographic and clinical data, and the presence and duration of long COVID were obtained. We identified factors associated with development and persistence of long COVID using multivariate logistic and linear regression analysis, respectively. Results We analyzed 457 of 526 responses (response rate, 86.9%). The median age was 47 years, and 378 patients (84.4%) had mild disease in acute phase. The number of patients with any symptoms after 6 and 12 months after onset or diagnosis were 120 (26.3%) and 40 (8.8%), respectively. Women were at risk for development of fatigue (OR 2.03, 95% CI 1.31-3.14), dysosmia (OR 1.91, 95% CI 1.24-2.93), dysgeusia (OR 1.56, 95% CI 1.02-2.39), and hair loss (OR 3.00, 95% CI 1.77-5.09), and were at risk for persistence of any symptoms (coefficient 38.0, 95% CI 13.3-62.8). Younger age and low body mass index were risk factors for developing dysosmia (OR 0.96, 95% CI 0.94-0.98, and OR 0.94, 95% CI 0.89-0.99, respectively) and dysgeusia (OR 0.98, 95% CI 0.96-1.00, and OR 0.93, 95% CI 0.88-0.98, respectively). Conclusion We identified risk factors for the persistence as well as development of long COVID. Many patients suffer from long-term residual symptoms, even in mild cases.

Download Full-text

Analysis of Risk Factors Progression of Preterm Delivery Using Electronic Health Records

10.21203/rs.3.rs-78033/v1 ◽

2020 ◽

Author(s):

Zeineb Safi ◽

Neethu Venugopal ◽

Haytham Ali ◽

Michel Makhlouf ◽

Sabri Boughorbel

Keyword(s):

Risk Factors ◽

Electronic Health Records ◽

Preterm Delivery ◽

Control Group ◽

Study Cohort ◽

Patient History ◽

Health Records ◽

Time Points ◽

Electronic Health ◽

The Impact

Abstract Background: Preterm deliveries have many negative health implications on both mother and child. Identifying the population level factors that increase the risk of preterm deliveries is an important step in the direction of mitigating the impact and reducing the frequency of occurrence of preterm deliveries. The purpose of this work is to identify preterm delivery risk factors and their progression throughout the pregnancy from a large collection of Electronic Health Records (EHR). Results: The study cohort includes more than 60,000 deliveries in the USA with the complete medical history from EHR for diagnoses, medications, procedures and demographics. We propose a temporal analysis of risk factors by estimating and comparing risk ratios at different time points prior to the delivery event. We selected the following time points before delivery: 9, 6, 3 and 1 month(s). We did so by conducting a retrospective cohort study of patient history for a selected set of mothers who delivered preterm and a control group of mothers that delivered full-term. We analyzed the extracted data using a logistic regression model. The results of our analyses showed that the highest risk ratio corresponds to history of previous preterm delivery. Other risk factors were identified, some of which are consistent with those that are reported in the literature, others need further investigation. Conclusions: The comparative analysis of the risk factors at different time points showed that risk factors in the early pregnancy related to patient history and chronic condition, while the risk factors in late pregnancy are specific to the current pregnancy. Our analysis unifies several previously reported studies on preterm risk factors. It also gives important insights on the changes of risk factors in the course of pregnancy.

Download Full-text

Assessing the Impact of Person-level Matching Algorithms to Identify Risk of Fatal Opioid Overdose Across Disparate Datasets: Retrospective Analysis (Preprint)

10.2196/preprints.18088 ◽

2020 ◽

Author(s):

Lindsey Ferris ◽

Jonathan P. Weiner ◽

Brendan Saloner ◽

Hadi Kharrazi

Keyword(s):

Public Health ◽

Risk Factors ◽

At Risk ◽

Area Under The Curve ◽

The United States ◽

Risk Indicators ◽

Mortality Data ◽

Opioid Overdose ◽

Fatal Overdose ◽

The Impact

BACKGROUND The opioid epidemic in the United States has precipitated a need for public health agencies to better understand risk factors associated with fatal overdoses. Matching person-level information stored in public health, medical, and human services datasets can enhance the understanding of opioid overdose risk factors and interventions. A major impediment to using datasets from separate agencies, has been the lack of a cross-organization unique identifier. Although different matching techniques that leverage patient demographic information can be used, the impact of using a particular matching approach is not well understood. OBJECTIVE This study compares the impact of using probabilistic versus deterministic matching algorithms to link disparate datasets together for identifying persons at risk of a fatal overdose. METHODS This study used statewide prescription drug monitoring program (PDMP), arrest, and mortality data matched at the person-level using a probabilistic and two deterministic matching algorithms. Impact of matching was assessed by comparing the prevalence of key risk indicators, the outcome, and performance of a multivariate logistic regression for fatal overdose using the combined datasets. RESULTS The probabilistically matched population had the highest degree of matching within the PDMP data and with arrest and mortality data, resulting in the highest prevalence of high-risk indicators and the outcome. Model performance using area under the curve (AUC) was comparable across the algorithms (probabilistic: 0.847; deterministic-basic: 0.854; deterministic+zip: 0.826), but demonstrated tradeoffs between sensitivity and specificity. CONCLUSIONS The probabilistic algorithm was more successful in linking patients with PDMP data with death and arrest data, resulting in a larger at-risk population. However, deterministic-basic matching may be a suitable option for understanding high-level risk based on the model’s area under the curve (0.854). The clinical use case should be considered when selecting a matching approach, as probabilistic algorithms can be more resource-intensive and costly to maintain compared with deterministic algorithms.

Download Full-text

Do We Really Need Plasma-Derived FVIII Concentrates in Every PUP to Minimize the Risk of Inhibitor Development?

Blood ◽

10.1182/blood-2018-99-114756 ◽

2018 ◽

Vol 132 (Supplement 1) ◽

pp. 3522-3522

Author(s):

Susan Halimeh ◽

Hannelore Rott ◽

Manuela Siebert ◽

Günther Kappert

Keyword(s):

Joint Damage ◽

High Titre ◽

Study Cohort ◽

Historical Cohort ◽

Inhibitor Development ◽

Number Of Patients ◽

Bayer Healthcare ◽

Personalised Treatment ◽

Von Willebrand ◽

The Impact

Abstract Background: The development of inhibitors due to infused factor VIII (FVIII) remains a significant challenge in haemophilia treatment, particularly in previously untreated patients (PUPs). Inhibitors in PUPs usually develop within the first 50 exposure days (EDs), with a median time to inhibitor development of around 10-15 EDs. The impact of product type on the risk of inhibitor development remains controversial. Whilst some studies have found no difference in the rate of inhibitor development between plasma-derived (pd) and recombinant (r)FVIII products, other studies have reported higher rates of inhibitor development after treatment with rFVIII. The prospective, randomised SIPPET study found an 87% higher incidence of inhibitors in PUPs treated with rFVIII than in PUPs treated with pdFVIII concentrates containing von Willebrand factor (VWF). Methods The aim of this study was to investigate a personalised treatment approach in PUPs in order to limit both joint damage and inhibitor development. This approach included the use of intensive monitoring from an early age, tailored prophylaxis using pdFVIII concentrates and personalised physiotherapy regimen. FVIII levels and Von Willebrand Antigen (VWF-Ag) were measured after birth (if possible), before start of prophylaxis and during prophylaxis. The inhibitor titre was measured every 3-4 EDs. Our study cohort was compared with a historical cohort (2004 - 2012) treated with early prophylaxis with hamster cell-derived rFVIII or pdFVIII. We enrolled 24 patients, 9 from the historical cohort (7 treated with rFVIII and 2 with pdFVIII) and since 2013 15 patients from in the study cohort (14 treated with pdFVIII and 1 not yet treated). Results: Since 2013 all 14 PUPs started early prophylaxis with pdFVIII/VWF. Initial dose ranged from 25 IU/kg/10 days to 60 IU/kg/week for the first 20 ED and thereafter individual dose escalation was performed. So far, no patient had developed and inhibitor to FVIII. In our historical group 4 out of 7 patients developed a high titre inhibitor (≥ 5 BU) during the first 20 EDs with rFVIII, but none of the patients receiving prophylaxis with pdFVIII (n=2) (p=0.007). All patients who developed an inhibitor later on had a VWF-Ag below 77%, those patients receiving rFVIII and remaining without an inhibitor had an VWF-Ag above 77% (n=3); this difference was highly significant (p<0.001). Conclusion: We found that individually tailored treatment schedules and early prophylaxis seems to minimize the incidence of inhibitors in our cohort. Nevertheless, it has to be investigated if PUPs with a high VWF-level can be treated safely with rFVIII without risking the development of inhibitors. We recommend further prospective studies with a greater number of patients. Disclosures Halimeh: Bayer healthcare, Baxalta Innovations, Biotest, CSL Behring, Novartis, Novo Nordisk, Octapharma, LFB, Pfizer: Honoraria; Bayer Healthcare, Baxalta Innovations, Biotest, CSL Behring, Novo Nordisk, Octapharma, Pfizer: Research Funding.

Download Full-text

Hypoglycemia screening of asymptomatic newborns on the 2nd day of life

Journal of Neonatal-Perinatal Medicine ◽

10.3233/npm-210861 ◽

2021 ◽

pp. 1-6

Author(s):

H. Karbalivand ◽

A. Iyare ◽

A. Aponte ◽

X. Xianhong ◽

M. Kim ◽

...

Keyword(s):

Risk Factors ◽

Gestational Age ◽

Glucose Concentration ◽

Prospective Observational Study ◽

Point Of Care ◽

Large For Gestational Age ◽

Endocrine Society ◽

Point Of Care Test ◽

American Academy Of Pediatrics

BACKGROUND: Neonatal hypoglycemia management in the first 48 hours is guided by the American Academy of Pediatrics (AAP) and Pediatric Endocrine Society (PES) recommendations. Our aim was to determine the incidence of hypoglycemia via point of care test (POCT) on the 2nd day of life (DOL) among healthy, asymptomatic neonates regardless of risk factors. METHODS: In this prospective observational study, preprandial point of care glucose concentration was measured on the 2nd DOL in 150 healthy, asymptomatic neonates in the newborn nursery. We used 50 mg/dl (2.8 mmol/L) as the hypoglycemia threshold based on PES recommendations. RESULTS: The incidence of hypoglycemia on the second DOL was 10% among asymptomatic neonates (no risk factors = 8% ; late preterm birth (LPT) + small for gestational age (SGA) = 16% ; large for gestational age (LGA) + infant of diabetic mother (IDM) = 6%). SGA + LPT neonates accounted for the majority of the hypoglycemic cases (53.3%) and exhibited a trend towards the lowest glucose concentration (p = 0.09). CONCLUSION: The incidence of hypoglycemia on DOL 2 among asymptomatic neonates is high and of unclear significance in the absence of dedicated neurodevelopmental follow-up.

Download Full-text