Abstract 17220: Risk Factors for Recurrent Peripartum Cardiomyopathy in 783 Women in California

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_1) ◽  
Author(s):  
Punag Divanji ◽  
Gregory Nah ◽  
Ian Harris ◽  
Anu Agarwal ◽  
Nisha I Parikh

Introduction: Characterized by significant left ventricular (LV) dysfunction and clinical heart failure (HF), peripartum cardiomyopathy (PPCM) has an incidence of approximately 1/2200 live births (0.04%). Prior studies estimate that approximately 25% of those with recovered LV function will have recurrent clinical PPCM during subsequent pregnancies, compared to 50% of those without recovered LV function. Specific predictors of recurrent PPCM have not been studied in cohorts with large numbers. Methods: From 2005-2011, we identified 1,872,227 pregnancies by International Classification of Diseases, 9th Revision (ICD-9) codes in the California Healthcare Cost and Utilization Project (HCUP) database, which captures over 95% of the California hospitalized population. Excluding 15,765 women with prior cardiovascular disease (myocardial infarction, coronary artery disease, stroke, HF, valve disease, or congenital heart disease), yielded n=1,856,462 women. Among women without prior cardiovascular disease, we identified index and subsequent pregnancies with PPCM to determine episodes of recurrent PPCM. We considered the following potential predictors of PPCM recurrence in both univariate and age-adjusted logistic regression models: age, race, hypertension, diabetes, smoking, obesity, chronic kidney disease, family history, pre-eclampsia, ectopic pregnancy, income, and insurance status. Results: In HCUP, n=783 women had pregnancies complicated by PPCM (mean age=30.8 years). Among these women, n=133 had a subsequent pregnancy (17%; mean age=28.1 years), with a mean follow-up of 4.34 years (±1.71 years). In this group of 133 subsequent pregnancies, n=14 (10.5%) were complicated by recurrent PPCM, with a mean time-to-event of 2.2 years (±1.89 years). Among the risk factors studied, the only univariate predictor of recurrent PPCM was grand multiparity, defined as ≥ 5 previous deliveries (odds ratio: 22; 95% confidence interval 4.43-118.22). The other predictors we studied were not significantly associated with recurrent PPCM in either univariate or multivariable models. Conclusion: In a large population database in California with 783 cases of PPCM over a 6-year period, 17% of women had a subsequent pregnancy, of which 10.5% had recurrent PPCM. In age-adjusted logistic regression models, grand multiparity was the only statistically significant predictor of recurrent PPCM.

2019 ◽  
Vol 100 (2) ◽  
pp. 151-172
Author(s):  
Eileen M. Ahlin

There is relatively little literature examining risk factors associated with sexual victimization among youth in custody. The current study explored whether risk of forced sexual victimization among youth in custody differs by gender or perpetrator. Using data from a sample of 8,659 youth who participated in the National Survey of Youth in Custody, multivariate logistic regression models were employed to investigate gender differences in risk factors associated with overall forced sexual victimization and staff-on-inmate and inmate-on-inmate forced sexual victimization. Findings suggest that gender differences are more pronounced when perpetrator type is considered.


2016 ◽  
Vol 19 (3) ◽  
pp. 385-397 ◽  
Author(s):  
Sepedeh Gholizadeh ◽  
Abbas Moghimbeigi ◽  
Jalal Poorolajal ◽  
Mohammadali Khjeian ◽  
Fatemeh Bahramian ◽  
...  

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e050672
Author(s):  
Markku Partinen ◽  
Brigitte Holzinger ◽  
Charles M Morin ◽  
Colin Espie ◽  
Frances Chung ◽  
...  

ObjectivesSleep is important for human health and well-being. No previous study has assessed whether the COVID-19 pandemic impacts sleep and daytime function across the globe.MethodsThis large-scale international survey used a harmonised questionnaire. Fourteen countries participated during the period of May–August 2020. Sleep and daytime problems (poor sleep quality, sleep onset and maintenance problems, nightmares, hypnotic use, fatigue and excessive sleepiness) occurring ‘before’ and ‘during’ the pandemic were investigated. In total, 25 484 people participated and 22 151 (86.9%) responded to the key parameters and were included. Effects of COVID-19, confinement and financial suffering were considered. In the fully adjusted logistic regression models, results (weighted and stratified by country) were adjusted for gender, age, marital status, educational level, ethnicity, presence of sleep problems before COVID-19 and severity of the COVID-19 pandemic in each country at the time of the survey.ResultsThe responders were mostly women (64%) with a mean age 41.8 (SD 15.9) years (median 39, range 18–95). Altogether, 3.0% reported having had COVID-19; 42.2% reported having been in confinement; and 55.9% had suffered financially. All sleep and daytime problems worsened during the pandemic by about 10% or more. Also, some participants reported improvements in sleep and daytime function. For example, sleep quality worsened in about 20% of subjects and improved in about 5%. COVID-19 was particularly associated with poor sleep quality, early morning awakening and daytime sleepiness. Confinement was associated with poor sleep quality, problems falling asleep and decreased use of hypnotics. Financial suffering was associated with all sleep and daytime problems, including nightmares and fatigue, even in the fully adjusted logistic regression models.ConclusionsSleep problems, fatigue and excessive sleepiness increased significantly worldwide during the first phase of the COVID-19 pandemic. Problems were associated with confinement and especially with financial suffering.


2020 ◽  
Vol 13 (10) ◽  
pp. 2172-2177
Author(s):  
Nguyen Hoai Nam ◽  
Peerapol Sukon

Aim: The present study aimed to investigate the effects of different risk factors on stillbirth of piglets born from oxytocin-assisted parturitions. Materials and Methods: Data were collected from a total of 1121 piglets born from 74 Landrace x Yorkshire crossbred sows from a herd. Logistic regression models were used to determine the associations between stillbirth and different risk factors including parity (1, 2, 3-5, and 6-10), gestation length (GL) (112-113, 114-116, and 117-119 days), litter size, birth order (BO), sex, birth interval (BI), cumulative farrowing duration, birth weight (BW), crown rump length, BW deviation, body mass index, ponderal index (PI), and the use of oxytocin during expulsive stage of farrowing. Results: The incidence of stillbirth at litter level and stillbirth rate was 59.5% (44/74) and 8.1% (89/1094), respectively. The final multivariate logistic regression selected BO, BI, PI, GL, and parity as the five most significant risk factors for stillbirth. Increased BO and BI, GL <114 and >116 days, parity 6-10, and low PI increased the stillbirth rate in piglets. Conclusion: Several factors previously determined as risks for stillbirth in exogenous oxytocin-free parturitions also existed in exogenous oxytocin-assisted parturitions. One dose of oxytocin at fairly high BO did not increase stillbirth, whereas two doses of oxytocin were potentially associated with increased values.


2021 ◽  
Vol 50 (Supplement_1) ◽  
Author(s):  
Yingying Wang

Abstract Background Obesity and homocysteine (Hcy) are two important risk factors for cardiovascular disease (CVD); however, there were conflicting results for the relationship between them. Our study is to explore the associations of general and central obesity with hyperhomocysteinemia (HHcy) in middle-aged women. Methods The current analysis was based on data from 11007 women aged 40-60 years. Height, weight, and waist circumference (WC) were measured and serum homocysteine was determined. Multiple logistic regression models were used to assess the associations of the risk of hyperhomocysteinemia (HHcy, Hcy&gt;15μmol/L) with BMI and WC. Results 13.71% women had HHcy. The prevalences of BMI-based general obesity and WC-based central obesity were 11.17% and 22.88%, respectively. Compared with non-obese women, the mean serum Hcy concentration was significantly higher in WC-based central obese women (P = 0.002), but not in BMI-based general obese women (P &gt; 0.05). In the multiple logistic regression models, central obesity was positively related to the risk of HHcy (OR = 1.30, 95%CI=1.10 to 1.52), while general obesity was inversely related to the risk of HHcy (OR = 0.82, 95%CI=0.72 to 0.93 and OR = 0.71,95% CI = 0.57 to 0.89). Conclusions Central obesity was positively, while general obesity was negatively related to the risk of HHcy. Menopause showed no effect modification on these associations. Key messages Homocysteine; Central obesity; Menopause; Cardiovascular Disease


Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 5710-5710
Author(s):  
Dhvani Thakker ◽  
Charles Yun ◽  
Adam Goldrich ◽  
Helzner Elizabeth ◽  
Daniel Fein ◽  
...  

Abstract Background: Multiple Myeloma (MM) is the second most common hematologic malignancy in the United States. African Americans have among the highest risks of MM and MGUS with several distinct features compared to existing literature. Furthermore, the prevalence of MM is even higher in the Afro-Caribbean population. Cytogenetic and molecular genetic abnormalities predict outcome in patients with MM. Hyperdiploid MM (H-MM) generally has a better prognosis than nonhyperdiploid MM (NH-MM). In addition, patients with additional chromosome 1 abnormalities, loss of chromosome 13, translocation t(14;16) and t(4;14) tend to have a worse survival while patients with translocations t(11;14) are associated with improved survival. In our patient population, the most common cytogenetic abnormalities and their effect on survival remain unknown. Objective: This study was performed to establish a profile of Afro-Caribbean patients with newly diagnosed Multiple Myeloma in order to gain further insight into unique cytogenetic abnormalities and their effects on survival. Methods: Patients with Multiple Myeloma at Kings County Hospital Center and University Hospital at Brooklyn from 2000-2013 were identified by our tumor registries (n=311). We included all the newly diagnosed patients from 2000-2013 who underwent a bone marrow biopsy and conventional cytogenetic by chromosome banding and FISH (n= 173). Patients who did not have a cytogenetic analysis were excluded. Data was collected at the time of initial presentation to include demographics and cytogenetic abnormalities. Survival data was obtained from Social Security Death Index. Differences in frequency of each cytogenetic abnormality by mortality status were examined using Chi-Square or Fisher’s Exact Tests. Two sets of age-adjusted logistic regression models were used to examine potential cytogenetic correlates of both poor (less than two years) and good (4 years or more) survival. Data analysis was performed using SPSS Advanced Statistics. Results: The median age at the time of diagnosis was 65 (Range 36-90). Chromosome banding and FISH showed abnormal cytogenetics in 46% of our patients (n=79). These patients were also found to have multiple abnormal clones. NH-MM was found in 24% (n=19) and H-MM was found in 39% (n=31) of the 79 patients. The most commonly affected abnormalities were trisomiesof odd-numbered chromosomes; +1 (47%), +3 (19%), +5 (21%), +7 (24%), +9 (47%), +11 (42%), +15 (44%), +17 (9%) and +19 (29%). Thirty five percent of 173 patients have expired (n=60). The median survival in the deceased patients was 6.2 years (Range 0.34-12.9). When we examined all patients who lived greater than four years post-diagnosis (n=152), we found significant abnormalities including +5 (p=0.052), NH-MM (p=0.009) and t(11;14) (p=0.03) (See Table 1). Indicators of poor prognosis including 1q gain (p=0.13), loss of chromosome 13 (p=0.21) and del17 (p=0.08) were not significant. In patients who are living, 19% (n=29) have not yet reached the four-year post-diagnosis survival. Less than ten percent underwent autologous stem cell transplantation. Excludes patients who lived less than 3 months post diagnosis August 5 2014 Table 1: Age-Adjusted Logistic Regression Models Predicting Good Survival (lived 4 years or more post-diagnosis) Chromosome abnormality ( + gain, - loss) Age-Adjusted Odds Ratio (95% CI) N=152 P-value 1+ 0.77 (0.26, 2.29) 0.63 1- 2.91 (0.58, 14.57) 0.19 3+ 1.05 (0.35, 3.17) 0.93 5+ 0.47 (0.22, 1.00) 0.052 7+ 0.39 (0.14, 1.10) 0.08 11+ 0.80 (0.36, 1.75) 0.57 14+ 2.07 (0.62, 6.91) 0.24 15+ 0.74 (0.34,1.60) 0.44 19+ 1.20 (0.46, 3.13) 0.71 X- 0.42 (0.11, 1.50) 0.18 Y- 0.40 (0.13, 1.26) 0.12 Hyperdiploidy 0.88 (0.39, 2.00) 0.88 Nonhyperdiplody 0.24 (0.08, 0.70) 0.009 t(4;14) 0.76 (0.27, 2.15) 0.60 t(11;14) 0.18 (0.04, 0.86) 0.03 Conclusion: In this group of Afro-Caribbean patients, median survival (6 years) was higher than Surveillance, Epidemiology, and End Results (SEER) data and more recent review of literature. Gain of chromosome 5 and t(11;14) are consistent with existing data for good prognosis. However, NH-MM which is usually an indicator of poor prognosis was also highly significant in the four-year post-diagnosis survival. This further supports the notion that prognostic value of cytogenetic analysis in this population requires further exploration. Disclosures No relevant conflicts of interest to declare.


2010 ◽  
Vol 49 (06) ◽  
pp. 608-612 ◽  
Author(s):  
D. Renner ◽  
B. Fischer ◽  
M. Kutschmann

Summary Objectives: A low rate of newly developed pressure ulcers is considered as an important quality indicator in nursing. However, the result of a hospital depends not only on the quality of care but on the risk profile of its patients as well. Therefore, based on multiple logistic regression models we describe a method for calculating risk-adjusted quality indicators in nursing. Method: Based on data of 1,009,989 patients from 1747 hospitals in 2009, we developed two multiple logistic regression models to identify and to weigh a possible joint influence of several risk factors on newly developed pressure ulcers. In a further step, we calculated risk-adjusted rates. Results: Factors remaining in the regression models were “micro-movements on admission”, “diabetes mellitus”, “age” and “days on intensive care unit”. Based on the corresponding regression coefficients and the logistic function, the expected rate of newly developed pressure ulcers was calculated for every hospital. Fi nally, expected rates and observed rates both were used to calculate risk-adjusted rates. Conclusion: The simultaneous consideration of relevant risk factors by means of risk- adjusted quality indicators ensures a fair comparison of hospitals.


2003 ◽  
Vol 131 (1) ◽  
pp. 599-606 ◽  
Author(s):  
L. S. LEONTIDES ◽  
E. GRAFANAKIS ◽  
C. GENIGEORGIS

Blood samples were taken from 50 finishing pigs at 90–105 kg in each of 59 randomly selected farrow-to-finish herds. The sera were tested for antibodies to Salmonella enterica by the Danish mix-ELISA. Samples with an optical density of >10% were considered to be positive. Associations between the odds of seropositivity of pigs and possible risk factors were evaluated in multivariable logistic regression models. The results of the analysis indicated that pigs fed non-pelleted dry or wet ration had 11 (P=0·0004) or 9 (P=0·02) times, respectively, lower odds of seropositivity than those fed pelleted ration. The risk of seropositivity was 4 (P=0·0006) times higher in pigs fed a combination of chlortetracycline, procaine penicillin and sulphamethazine during fattening than in those fed an approved growth promotor or a probiotic.


2017 ◽  
Vol 103 (8) ◽  
pp. 795-797 ◽  
Author(s):  
Summer Sherburne Hawkins ◽  
Sheryl L Rifas-Shiman ◽  
Matthew W Gillman ◽  
Elsie M Taveras

Background/aimsWe examined associations of ever crossing upwards ≥2 (vs <2) major weight-for-length (WFL) percentiles in the first 24 months with obesity at 5 years among white and black children.MethodsWe included 10 979 white and 1245 black children from the Linked CENTURY Study with percentile crossing data in all four 6-month periods in the first 24 months and obesity (age-specific and sex-specific body mass index ≥95th percentile) at 5 years. We used adjusted logistic regression models and stratified by race.Results64% of children crossed upwards ≥2 major WFL percentiles in the first 2 years. Among white children, 12% were obese vs 7% for <2 crossings, while among black children the frequencies were 23% vs 9%. Black children (adjusted OR 2.94, 2.04 to 4.23) who had ever crossed upwards ≥2 major WFL percentiles had a higher odds of obesity at age 5 than white children (adjusted OR 1.89, 1.64 to 2.18) (interaction p=0.02).ConclusionsOur results suggest that rapid weight gain in infancy is more deleterious among black than white children for later obesity.


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