scholarly journals What are the biopsychosocial risk factors associated with pain in postpartum runners? Development of a clinical decision tool

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0255383
Author(s):  
Shefali Mathur Christopher ◽  
Chad E. Cook ◽  
Suzanne J. Snodgrass
Keyword(s):  
Risk Factors ◽  
Clinical Decision ◽  
Multivariate Logistic Regression Model ◽  
Decision Tool ◽  
Childbearing Age ◽  
Fatigue Score ◽  
Factors Associated ◽  
Bivariate Regression ◽  
And Performance ◽  
Age Studies

Background In 2019, a majority of runners participating in running events were female and 49% were of childbearing age. Studies have reported that women are initiating or returning to running after childbirth with up to 35% reporting pain. There are no studies exploring running-related pain or risk factors for this pain after childbirth in runners. Postpartum runners have a variety of biomechanical, musculoskeletal, and physiologic impairments from which to recover from when returning to high impact sports like running, which could influence initiating or returning to running. Therefore, the purpose of this study was to identify risk factors associated with running-related pain in postpartum runners with and without pain. This study also aimed to understand the compounding effects of multiple associative risk factors by developing a clinical decision tool to identify postpartum runners at higher risk for pain. Methods Postpartum runners with at least one child ≤36 months who ran once a week and postpartum runners unable to run because of pain, but identified as runners, were surveyed. Running variables (mileage, time to first postpartum run), postpartum variables (delivery type, breastfeeding, incontinence, sleep, fatigue, depression), and demographic information were collected. Risk factors for running-related pain were analyzed in bivariate regression models. Variables meeting criteria (P<0.15) were entered into a multivariate logistic regression model to create a clinical decision tool. The tool identified compounding factors that increased the probability of having running-related pain after childbirth. Results Analyses included 538 postpartum runners; 176 (32.7%) reporting running-related pain. Eleven variables were included in the multivariate model with six retained in the clinical decision tool: runner type-novice (OR 3.51; 95% CI 1.65, 7.48), postpartum accumulated fatigue score of >19 (OR 2.48; 95% CI 1.44, 4.28), previous running injury (OR 1.95; 95% CI 1.31, 2.91), vaginal delivery (OR 1.63; 95% CI 1.06, 2.50), incontinence (OR 1.95; 95% CI 1.31, 2.84) and <6.8 hours of sleep on average per night (OR 1.89; 95% CI 1.28, 2.78). Having ≥ 4 risk factors increased the probability of having running-related pain to 61.2%. Conclusion The results of this study provide a deeper understanding of the risk factors for running-related pain in postpartum runners. With this information, clinicians can monitor and educate postpartum runners initiating or returning to running. Education could include details of risk factors, combinations of factors for pain and strategies to mitigate risks. Coaches can adapt running workload accounting for fatigue and sleep fluctuations to optimize recovery and performance. Future longitudinal studies that follow asymptomatic postpartum women returning to running after childbirth over time should be performed to validate these findings.

scholarly journals LO31: Identification of high risk factors associated with 30 day serious adverse events among syncope patients transported to the emergency department by emergency medical services

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S38
Author(s):  
L. Yau ◽  
M.A. Mukarram ◽  
S. Kim ◽  
K. Arcot ◽  
K. Thavorn ◽  
...  
Keyword(s):  
Risk Factors ◽  
Emergency Department ◽  
Heart Disease ◽  
High Risk ◽  
Clinical Decision ◽  
Decision Tool ◽  
Serious Adverse Events ◽  
Factors Associated ◽  
High Risk Factors ◽  
Pathways Of Care

Introduction: The majority of syncope patients transported to the emergency department (ED) by emergency medical services (EMS) are low-risk with very few suffering serious adverse events (SAE) within 30-days and over 50% are diagnosed with vasovagal syncope. These patients can potentially be diverted by EMS to alternate pathways of care (primary care or syncope clinic) if appropriately identified. We sought to identify high-risk factors associated with SAE within 30-days of ED disposition as a step towards developing an EMS clinical decision tool. Methods: We prospectively enrolled adult syncope patients who were transported to 5 academic EDs by EMS. We collected standardized variables at EMS presentation from history, clinical examination and investigations including ECG and ED disposition. We also collected concerning symptoms identified and EMS interventions. Adjudicated SAE included death, myocardial infarction, arrhythmia, structural heart disease, pulmonary embolism, hemorrhage and procedural interventions. Multivariable logistic regression was used for analysis. Results: 990 adult syncope patients (mean age 58.9 years, 54.9% females and 16.8% hospitalized) were enrolled with 137 (14.6%) patients suffering SAE within 30-days of ED disposition. Of 42 candidate predictors, we identified 5 predictors that were significantly associated with SAE on multivariable analysis: ECG abnormalities [OR=1.77; 95%CI 1.36-2.48] (non-sinus rhythm, high degree atrioventricular block, left bundle branch block, ST-T wave changes or Q waves), cardiac history [OR=2.87; 95%CI 1.86-4.41] (valvular or coronary heart disease, cardiomyopathy, congestive heart failure, arrhythmias or device insertions), EMS interventions or concerning symptoms [OR=4.88; 95%CI 3.13- 7.62], age &gt;50 years [OR=3.18; 95%CI 1.68-6.02], any abnormal vital signs [OR=1.58; 95%CI 1.03-2.42] (any EMS systolic blood pressure &gt;180 or &lt;100 mmHg, heart rate &lt;50 or &gt;100/minute, respiratory rate &gt;25/minute, oxygen saturation &lt;91%). [C-statistic: 0.81; Hosmer Lemeshow p=0.30]. Conclusion: We identified high-risk factors that are associated with 30-day SAE among syncope patients transported to the ED by EMS. This will aid in the development of a clinical decision tool to identify low-risk patients for diversion to alternate pathways of care.

scholarly journals Risk Factors Associated with Overweight among Adolescents in Serbia/ Dejavniki Tveganja, Povezani S Prekomerno Telesno Težo Pri Mladostnikih V Srbiji

2014 ◽  
Vol 53 (4) ◽  
pp. 283-293 ◽  
Author(s):  
Katarina Boričić ◽  
Snežana Simić ◽  
Nađa Vasiljević ◽  
Jelena Marinković
Keyword(s):  
Risk Factors ◽  
Wealth Index ◽  
Cross Sectional Study ◽  
Normal Weight ◽  
Multivariate Logistic Regression Model ◽  
Preventive Interventions ◽  
Multivariate Logistic Regression ◽  
Cross Sectional ◽  
Factors Associated ◽  
Skipping Breakfast

AbstractIntroduction. The pandemic of obesity in adolescents is one of the challenges of public health.Aim. The aim of this study was to examine the association of overweight with demographic, socioeconomic and lifestyle factors among Serbian adolescents.Method. A cross-sectional study of 2139 adolescents aged 10 to 19 years was carried out. Data used in this study were from the 2006 Health Survey. In accordance with the international sex- and age-specific Body Mass Index cut-off points, all participants were classified as being normal weight or overweight, including obese. The association between the risk factors and overweight were examined using a multivariate logistic regression model.Results. The study showed that 28.9% of boys and 17.0% of girls were overweight, while 14.5% of boys and 8.1% of girls were obese. Boys were more likely to be overweight/obese, compared with girls. Being younger (p< 0.01 for 14 to 15 years) and (p< 0.01, for 16 to 19 years), engaging in physical activities that last less than 7 hours a week, in such a manner that they breathe quickly and become sweaty, (p< 0.01) and skipping breakfast (p< 0.05) were risk factors significantly associated with overweight among adolescents. No significant association was found with wealth index.Conclusion. These findings should be an integral part of further preventive interventions, especially oriented towards younger adolescents, who are physically inactive, have a habit of skipping breakfast and are boys.

Reversibility of Delirium in Palliative Care (DRAFT)

2018 ◽  
Author(s):  
Tiffany Shaw ◽  
Eric Prommer
Keyword(s):  
Risk Factors ◽  
Decision Making ◽  
Palliative Care ◽  
Clinical Case ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Factors Associated ◽  
Frequent Event ◽  
Study Intervention

Delirium is a frequent event in patients with advanced cancer. Untreated delirium affects assessment of symptoms, impairs communication including participation in clinical decision-making. This study used specific diagnostic criteria for delirium and prospectively identified precipitating causes of delirium. The study identified factors associated with reversible and irreversible delirium. Impact of delirium on prognosis was evaluated. This chapter describes the basics of the study, including funding, year study began, year study was published, study location, who was studied, who was excluded, how many patients, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, gives a summary and discusses implications, and concludes with a relevant clinical case. Topics covered include delirium, neoplasms, palliative care, polypharmacy, risk factors, and therapeutics.

scholarly journals 726. Operational Impact of Infectious Disease Threats During Military Travel

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S462-S462
Author(s):  
Michael A Boatwright ◽  
Gregory Utz ◽  
Anjali Kunz ◽  
Rhonda E Colombo ◽  
Jamie Fraser ◽  
...  
Keyword(s):  
Infectious Disease ◽  
Risk Factors ◽  
Negative Impact ◽  
Close Contact ◽  
Military Training ◽  
Febrile Illness ◽  
Multivariate Logistic Regression Model ◽  
Street Vendor ◽  
Factors Associated ◽  
Operational Impact

Abstract Background We evaluated the incidence and operational impact of travelers’ diarrhea (TD), influenza-like illness (ILI) and undifferentiated febrile illness (FI) in US active duty (AD) personnel traveling outside the continental U.S for deployment (DEP), joint military training exercises (EXR) or other military travel (e.g. Temporary Duty Travel) (TDY). Methods AD personnel traveling for ≤ 6.5 months were prospectively enrolled between 2010-2019. Participants completed a post-travel survey regarding risk behaviors, illnesses and impact on daily activities. Trip purpose was categorized into DEP, EXR, TDY and syndromic definitions were used to identify cases of TD, ILI and FI based on symptoms. A multivariate logistic regression model with backward selection was used to determine the odds ratio associated with partial or complete incapacitation due to infections (a composite endpoint of either TD, ILI or FI). Results 1822 servicemembers were enrolled: 36.2% traveled on DEP, 36.2% for EXR and 27.7% for TDY (Table 1). 83.5% of personnel traveling for DEP were Special Operations and Marine units, and 82% of the EXR group participated in Pacific Pathways. Overall, 19% of US personnel experienced infections associated with partial or complete incapacitation (median duration of incapacitation- TD: 1 day; ILI: 4 days; FI: 3 days). DEP personnel had a longer travel duration and the highest rate of partial or complete incapacitation due to TD, ILI or FI (Figure 1 and 2). Risk factors associated with partial or complete incapacitation due to infections were non-adherence with malaria chemoprophylaxis (OR: 1.7 [95%CI:1.2-2.4]), close contact with locals (OR:1.7 [95%CI:1.3-2.2]), inability to clean hands regularly before meals (OR: 1.7 [95%CI: 1.3-2.3]), fresh water or rodent exposure OR: 1.4 (95%CI:1.1-1.9) and consuming street vendor food (OR:1.8 [95%CI:1.3-2.4]). Table 1. Demographic and travel characteristics of AD personnel traveling outside the continental US. Proportion of AD servicemembers that experienced TD, ILI or undifferentiated febrile illness during DEP, EXR, TDY (p&lt;0.05 for the comparison of each illness between DEP, EXR and TDY). Figure 2. Proportion of AD personnel with partial or complete incapacitation due to TD, ILI or FI during DEP, EXR or TDY (p &lt; 0.05 for the comparison of each illness between DEP, EXR and TDY). Conclusion Infectious disease syndromes are common during overseas military travel. TD had the highest negative impact on military travel especially among DEP personnel. We identified several modifiable risk factors associated with incapacitating infections which can be used to inform preventive and treatment strategies. Disclosures All Authors: No reported disclosures

scholarly journals Risk Factors Associated with Poor Physical Fitness in Three- to Six-Year-Old Children in Tujia-Nationality Settlement of China

2018 ◽  
Vol 2018 ◽  
pp. 1-9
Author(s):  
Xiaoli Liu ◽  
Zheng Xiang ◽  
Chaoneng Liu ◽  
Xiangrong Shi ◽  
Xinfeng Yi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Physical Fitness ◽  
Significant Risk ◽  
Normal Weight ◽  
Obese Children ◽  
Activity Time ◽  
Childbearing Age ◽  
Factors Associated ◽  
Fitness Assessment ◽  
Younger Age

Background. Physical fitness has been recognized not only as an integrated predictor of the body's functional status, but also as an important marker of health outcomes. The aim of this study was to examine the factors associated with physical fitness among 3-6-year-old children within the Tujia-Nationality settlement in the years 2005, 2010, and 2014. Methods. Demographics questionnaires and fitness assessment were performed to identify the risk factors for poor physical fitness (PPF) among 3- to 6-year-old children in the years 2005, 2010, and 2014 in the area of southwest Hubei of China. Results. Of the 2128 children, 495 were classified as PPF (23.3%). In 2005, the percentage of PPF children was 21.7%, and the percentage of PPF children decreased from 29.1% in 2010 to 18.8% in 2014. Furthermore, Urban area children had a significant risk of PPF than rural area children (OR=1.299, P=0.031). Three-year-old children had 2.150-fold risk of PPF as compared to 6-year-old children. The children with less than 0.5 hours of activity time per day had 1.95-fold risk of PPF as compared to those with 1-2-hour activity time per day, respectively. Underweight and overweight/obese children had 2.74-fold and 1.67-fold risk of PPF as compared to normal weight children. Children had 1.97-fold risk of PPF when their father’s schooling ceased after middle school and 1.51-fold risk of PPF when their father’s schooling ceased after high school, respectively. Conclusions. These results demonstrated that the incidence of PPF children went up from 2005 to 2010 and then down from 2010 to 2014 within the Tujia settlement. For the children in this area, the risk factors associated with PPF included urban location, younger age, less than 1-hour activity time per day in kindergarten, underweight/overweight, low father’s education level, and mother’s childbearing age being less than 20 years.

scholarly journals Identifying children at high risk for recurrence child abuse

2021 ◽  
Vol 29 (1) ◽  
pp. 230949902199641
Author(s):  
Jidapa Wongcharoenwatana ◽  
Jariya Tarugsa ◽  
Kamolporn Kaewpornsawan ◽  
Perajit Eamsobhana ◽  
Chatupon Chotigavanichaya ◽  
...  
Keyword(s):  
Risk Factors ◽  
Child Abuse ◽  
Causes Of Death ◽  
Multivariate Logistic Regression Model ◽  
Abused Children ◽  
Factors Associated ◽  
Increased Risk ◽  
Two Factors ◽  
Death Cases ◽  
Child Age

Purpose: To evaluate the characteristics of abused children, families and abusive event and to identify risk factors associated with recurrence of child abuse. Methods: Retrospective data from 133 children aged between 2 months to 15 years old who were diagnosed as abuse between year 2002 and 2017. Thirteen items related to characteristics of the child, families, abusive event were selected. These factors were analyzed by multivariate logistic regression model for association with repeated child abuse. Results: Total of 133 subjects with average age of 5.25 ± 4.65 years old. There were 54 cases (40.60%) reported of repeated abuse. Majority of repeated abuse type in this study was physical abuse (73.68%). Most perpetrators were child’s own parents (45.10%). Factors associated with increased risk of repeated abuse were child age 1–5 years old (AOR = 4.95/95%CI = 1.06–23.05), 6–10 years old (AOR = 6.80/95%CI = 1.22–37.91) and perpetrator was child’s own parent (AOR = 21.34/95%CI = 3.51–129.72). Three cases of mortality were found with single-visit children and one case in recurrence. Most of death cases were children less than 1-year-old with average age of 7 months. Causes of death were subdural hematoma with skull and ribs fracture. Conclusions: Identifying risk factors for repeated child abuse help in recognizing child at risk to provide prompt intervention. This study found two factors associated with higher risk of abuse recurrence: child age 1–10 years old and abusive parents. Children who presented with these risk factors should be recognized and intensively monitored.

scholarly journals Risk Factors Associated with Early Detection of Cervical Cancer by the IVA Method in Women of Childbearing Age In the City of Ternate

2021 ◽  
Vol 2 (4) ◽  
pp. 1305-1320
Author(s):  
Hairudin La Patilaiya ◽  
Nursia Aja ◽  
Taufik Yunus
Keyword(s):  
Risk Factors ◽  
Cervical Cancer ◽  
Early Detection ◽  
Health Center ◽  
World Health ◽  
Access To Information ◽  
Women Of Childbearing Age ◽  
Childbearing Age ◽  
Factors Associated ◽  
The World

Background : Cervical cancer is one of the main problems in women's health in the world, including Indonesia. According to the 2018 Global Cancer Observatory from the World Health Organization (WHO), the most common cancer cases in Indonesia are breast cancer, which is 58,256 cases or 16.7% of the total 348,809 cancer cases. Cervical cancer (neck of the womb) is the second most common type of cancer in Indonesia, with 32,469 cases or 9.3% of the total cases. Objective: To determine the risk factors associated with early detection of cervical cancer using Visual Inspection with Acetic Acid (IVA) ) in women of childbearing age in the Work Area of the Ternate City Health Center for Siko Treatment. Methods: This research is a quantitative analytic study with a cross sectional design. Data collection was carried out from December 2020 to January 2021. The population was all patients who underwent examinations at the Maternal and Child Health Polyclinic (KIA) at the Siko Care Health Center in Ternate City as many as 227 patients and a sample of 145 female patients of childbearing age from January to September 2020. Techniques sampling is simple random sampling. Data analysis used univariate and bivariate with chi-square test. The research variable consists of the dependent variable, namely early detection of cervical cancer, while the independent variables are knowledge, husband's support, access to information and culture. Results: Shows that age (46.9%), knowledge of VIA (50.3%), attitude (55.2%), husband's support (52.4%), access to information (62.1%), culture (51.7%), Support Officer (48.3%), early detection of cervical cancer IVA method (55.2%), while the bivariate results include: Age (0.000, OR=19,011; CI=8.095-44,647), knowledge (0.001; OR=2.86; CI=1.563-18.367), attitude (0.000; OR=215.524 CI=53,456-868.955), husband's support (0.002; OR=1.448 CI=1.688-11.933), access to information (0.000; OR=2,294; CI=1,574-15,976), culture (0,003; OR=2,202 CI=1,648-10,717), health worker support (0,000; OR=27,111 CI;11,023-66,680). Conclusion: There is a relationship between knowledge, husband's support, access to information and culture with early detection of cervical cancer against the IVA method. Based on the results of the study, it is recommended that the relevant agencies, namely the Siko Health Center, always improve health education to the community, especially mothers and husbands regarding early detection of cervical cancer through various media tools including leaflets, posters, flipcharts and other media. Through this counseling, it is hoped that the community will be more interested and understand the material presented more quickly

scholarly journals Validation of a Clinical Decision Rule to Identify Risk Factors Associated With Multidrug-Resistant Urinary Pathogens in the Emergency Department

2018 ◽  
Vol 53 (1) ◽  
pp. 56-60 ◽  
Author(s):  
Brett A. Faine ◽  
Nicholas Mohr ◽  
Priyanka Vakkalanka ◽  
Ari S. Gao ◽  
Stephen Y. Liang
Keyword(s):  
Risk Factors ◽  
Emergency Department ◽  
Nursing Home ◽  
Decision Rule ◽  
Validation Cohort ◽  
Clinical Decision ◽  
Multidrug Resistant ◽  
Clinical Decision Rule ◽  
Factors Associated ◽  
Home Residency

Background: Antimicrobial resistance remains a significant obstacle for clinicians when treating patients presenting to the emergency department (ED) with urinary tract infections. Objective: The goal of the proposed study was to validate a previously developed clinical decision rule identifying risk factors for multidrug-resistant (MDR) urinary pathogens. Methods: We conducted a validation study of a previously published clinical decision rule to identify patients with MDR urinary pathogens using a cohort from an urban academic center ED with annual census over 80 000. Using our previously identified clinical risk factors, we determined the sensitivity, specificity, positive likelihood ratio (+LR), and negative LR (−LR) to estimate measures of precision of our clinical decision rule in the validation cohort. Results: Factors associated with MDR urinary pathogen included sex, recent hospitalization, nursing home residency, and catheter placement. Using our previously defined threshold of greater than 1 risk factor, the adjusted model in the validation cohort identified that only nursing home residency was associated with positive MDR pathogen (adjusted odds ratio = 4.13; 95% CI = 1.95-8.77). The clinical decision rule in the validation cohort yielded a sensitivity of 56.4%, specificity of 66.3%, +LR of 1.7, and −LR of 0.7. Conclusion and Relevance: Our clinical decision rule to identify patients at risk for MDR urinary pathogens was unable to be validated in the setting of different antimicrobial resistance patterns. Future studies should evaluate an improved clinical decision rule identifying risk factors associated with MDR pathogens that performs well in varying patient populations.

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