scholarly journals Understanding Peri-Implantitis as a Plaque-Associated and Site-Specific Entity: On the Local Predisposing Factors

2019 ◽  
Vol 8 (2) ◽  
pp. 279 ◽  
Author(s):  
Alberto Monje ◽  
Angel Insua ◽  
Hom-Lay Wang
Keyword(s):  
Risk Factors ◽  
At Risk ◽  
Dental Implants ◽  
Predisposing Factors ◽  
Narrative Review ◽  
Disease Development ◽  
Site Specific ◽  
Triggering Factors ◽  
Patients At Risk ◽  
The Impact

The prevalence of implant biological complications has grown enormously over the last decade, in concordance with the impact of biofilm and its byproducts upon disease development. Deleterious habits and systemic conditions have been regarded as risk factors for peri-implantitis. However, little is known about the influence of local confounders upon the onset and progression of the disease. The present narrative review therefore describes the emerging local predisposing factors that place dental implants/patients at risk of developing peri-implantitis. A review is also made of the triggering factors capable of inducing peri-implantitis and of the accelerating factors capable of interfering with the progression of the disease.

European Respiratory Society Statement on Sleep Apnoea, Sleepiness and Driving Risk

2020 ◽  
pp. 2001272
Author(s):  
Maria R Bonsignore ◽  
Winfried Randerath ◽  
Sofia Schiza ◽  
Johan Verbraecken ◽  
Mark W Elliott ◽  
...  
Keyword(s):  
At Risk ◽  
Motor Vehicle ◽  
Task Force ◽  
Present Report ◽  
Sleep Apnoea ◽  
Accident Risk ◽  
European Respiratory Society ◽  
Obstructive Sleep ◽  
Patients At Risk ◽  
The Impact

Obstructive sleep apnoea (OSA) is highly prevalent and is a recognised risk factor for motor vehicle accidents (MVA). Effective treatment with continuous positive airway pressure (CPAP) has been associated with a normalisation of this increased accident risk. Thus, many jurisdictions have introduced regulations restricting the ability of OSA patients from driving until effectively treated. However, uncertainty prevails regarding the relative importance of OSA severity determined by the apnoea-hypopnoea frequency per hour and the degree of sleepiness in determining accident risk. Furthermore, the identification of subjects at risk for OSA and/or accident risk remains elusive. The introduction of official European regulations regarding fitness to drive prompted the European Respiratory Society to establish a Task Force to address the topic of sleep apnoea, sleepiness and driving with a view to providing an overview to clinicians involved in treating patients with the disorder. The present report evaluates the epidemiology of MVA in patients with OSA, the mechanisms involved in this association, the role of screening questionnaires, driving simulators and other techniques to evaluate sleepiness and/or impaired vigilance, the impact of treatment on MVA risk in affected drivers, and highlights the evidence gaps regarding the identification of OSA patients at risk for MVA.

Abstract 038: A Novel Histology Based Classification System to Identify Patients at Risk for Postoperative Atrial Fibrillation

2013 ◽  
Vol 113 (suppl_1) ◽  
Author(s):  
Mahek Mirza ◽  
Anton Strunets ◽  
Ekhson Holmuhamedov ◽  
Jasbir Sra ◽  
Paul H Werner ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
At Risk ◽  
Classification System ◽  
Area Under The Curve ◽  
Postoperative Atrial Fibrillation ◽  
Right Atrial ◽  
Class Iii ◽  
Atrial Fibrosis ◽  
Patients At Risk ◽  
The Impact

Postoperative atrial fibrillation (PoAF) is a common complication in up to 40% of patients after cardiac surgery, increasing morbidity, hospital stay and costs. The myocardial substrate underlying PoAF is not fully characterized. The objective was to assess the impact of atrial fibrosis on incident AF and define the fibrosis threshold level predictive of PoAF. Methods: Right atrial appendages removed from patients undergoing elective CABG with no history of AF or class III/IV heart failure were used to characterize the ratio of collagen to myocardium (Masson’s trichrome; NIH ImageJ software; Fig A), which was correlated with incident AF. Percentage burden of fibrosis predictive of PoAF with high sensitivity and specificity was determined by ROC curve. Results: Of 28 patients (67±10 years, 64% males), 15 had PoAF. There were no age, gender or comorbidity differences between groups. Compared to the group that remained in sinus rhythm, patients with PoAF had a significantly higher ratio of extracellular collagen to myocardium (45±16% vs. 5±4%, p <0.001; Fig B). A threshold ratio of 12.7% collagen to myocardium (ROC area under the curve 0.997; z statistic 137; P<0.0001) with 96% sensitivity and 97% specificity identified those with PoAF (Fig C). A classification system based on histological extent of atrial fibrosis is proposed for identifying patients at risk for PoAF (Fig D). Conclusion: Ongoing studies will confirm the predictive value of this new classification system for identifying the atrial substrate predisposing PoAF and correlate with preoperative cardiac imaging and circulatory serum biomarkers to provide a novel noninvasive tool to stratify patients at risk for PoAF.

Early Transient Hypoglycemia and Test Performance in At-Risk Newborns

2021 ◽  
Author(s):  
Nahed O. ElHassan ◽  
Eric W. Schaefer ◽  
Basilia Gonzalez ◽  
Thomas Nienaber ◽  
Luc P. Brion ◽  
...  
Keyword(s):  
Risk Factors ◽  
At Risk ◽  
Academic Performance ◽  
Glucose Concentration ◽  
Achievement Tests ◽  
Large For Gestational Age ◽  
Study Cohort ◽  
Perinatal Factors ◽  
Number Of Patients ◽  
The Impact

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

scholarly journals The phenomenon of social risk families and its dynamics in Lithuania

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.

scholarly journals Does Physical Activity Regulate Prostate Carcinogenesis and Prostate Cancer Outcomes? A Narrative Review

2020 ◽  
Vol 17 (4) ◽  
pp. 1441 ◽  
Author(s):  
Marco Capece ◽  
Massimiliano Creta ◽  
Armando Calogero ◽  
Roberto La Rocca ◽  
Luigi Napolitano ◽  
...  
Keyword(s):  
Physical Activity ◽  
Prostate Cancer ◽  
Functional Outcomes ◽  
Narrative Review ◽  
Common Disease ◽  
Prostate Carcinogenesis ◽  
Patients At Risk ◽  
The Impact ◽  
Circulating Levels

Background: Prostate cancer (PCa) represents a common disease in men aged >65 years. The role of physical activity (PA) in patients at risk or diagnosed with PCa represents an evolving issue. We aimed to summarize available evidences about the impact of PA on the pathophysiology and clinical outcomes of PCa. Methods: We performed a narrative review. Evidences about the role of PA in elderly patients in terms of PCa biology, epidemiology, oncological and functional outcomes, as well as in terms of impact on the outcomes of androgen deprivation therapy (ADT) were summarized. Results: Potential pathophysiological pathways hypothesized to explain the benefits of PA in terms of prostate carcinogenesis include circulating levels of Insulin-like growth factor-1 (IGF-1), oxidative stress, systemic inflammation, sex hormones, and myokines. Clinically, emerging evidences support the hypothesis that PA is associated with decreased PCa risk, improved PCa-related survival, improved functional outcomes, and reduced ADT-related adverse events.

scholarly journals Predicting Persistent Opioid Use, Abuse, and Toxicity Among Cancer Survivors

2019 ◽  
Vol 112 (7) ◽  
pp. 720-727 ◽  
Author(s):  
Lucas K Vitzthum ◽  
Paul Riviere ◽  
Paige Sheridan ◽  
Vinit Nalawade ◽  
Rishi Deka ◽  
...  
Keyword(s):  
Risk Factors ◽  
At Risk ◽  
Cancer Survivors ◽  
Critical Role ◽  
Multivariable Analysis ◽  
Area Under The Curve ◽  
Opioid Abuse ◽  
Opioid Use ◽  
Multivariable Logistic Regression Model ◽  
Patients At Risk

Abstract Background Although opioids play a critical role in the management of cancer pain, the ongoing opioid epidemic has raised concerns regarding their persistent use and abuse. We lack data-driven tools in oncology to understand the risk of adverse opioid-related outcomes. This project seeks to identify clinical risk factors and create a risk score to help identify patients at risk of persistent opioid use and abuse. Methods Within a cohort of 106 732 military veteran cancer survivors diagnosed between 2000 and 2015, we determined rates of persistent posttreatment opioid use, diagnoses of opioid abuse or dependence, and admissions for opioid toxicity. A multivariable logistic regression model was used to identify patient, cancer, and treatment risk factors associated with adverse opioid-related outcomes. Predictive risk models were developed and validated using a least absolute shrinkage and selection operator regression technique. Results The rate of persistent opioid use in cancer survivors was 8.3% (95% CI = 8.1% to 8.4%); the rate of opioid abuse or dependence was 2.9% (95% CI = 2.8% to 3.0%); and the rate of opioid-related admissions was 2.1% (95% CI = 2.0% to 2.2%). On multivariable analysis, several patient, demographic, and cancer and treatment factors were associated with risk of persistent opioid use. Predictive models showed a high level of discrimination when identifying individuals at risk of adverse opioid-related outcomes including persistent opioid use (area under the curve [AUC] = 0.85), future diagnoses of opioid abuse or dependence (AUC = 0.87), and admission for opioid abuse or toxicity (AUC = 0.78). Conclusion This study demonstrates the potential to predict adverse opioid-related outcomes among cancer survivors. With further validation, personalized risk-stratification approaches could guide management when prescribing opioids in cancer patients.

Avoiding Opioid Misuse After Surgery in the Era of the Opioid Epidemic

2020 ◽  
Vol 86 (11) ◽  
pp. 1565-1572
Author(s):  
Michael J. Petersen ◽  
Kathryne W. Adams ◽  
Nicole F. Siparsky
Keyword(s):  
At Risk ◽  
Monitoring Program ◽  
Opioid Therapy ◽  
Surgical Patients ◽  
Educational Video ◽  
Aberrant Behavior ◽  
Opioid Misuse ◽  
Video Viewing ◽  
Patients At Risk ◽  
The Impact

Background Chronic pain patients at risk of addiction can be identified through pre-prescription screening with the opioid risk tool (ORT); there is no equivalent for surgical patients. Our aims were to validate the ORT in the surgical population and assess the impact of patient education on compliance with proper storage and disposal (S&D) of unused opioid therapy (UOT). Methods Each subject completed the ORT, prevideo and postvideo surveys, educational video viewing, and compliance survey. Aberrant behavior was assessed by questionnaire, chart review, and Illinois Prescription Monitoring Program review. Results We recruited 24 subjects who underwent emergency surgery; 18 (of 24) were prescribed an opioid on discharge and 15 (of 18) were followed for 1 month. Before education, 38% (n = 9 of 24) of subjects identified proper UOT disposal and 63% (n = 15 of 24) identified safe handling of opioids. After education, 75% (n = 18 of 24) identified proper S&D. On ORT, 9 of 24 subjects (38%) scored moderate-risk to high-risk for opioid misuse. Half of subjects who demonstrated aberrant behavior (n = 7 of 12, 58%) scored in the low-risk range on ORT; 67% of subjects (n = 10 of 15) retained UOT, and 67% (n = 10 of 15) safely stored UOT. Few subjects (30%; n = 3 of 10) who stored their UOT reported proper disposal of UOT. Discussion The ORT is not useful in identifying acute pain surgical patients at risk for aberrant behavior. An educational video increased awareness of, but not compliance with, safe S&D of UOT. Opioid overprescription continues to contribute to opioid misuse.

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

2010 ◽  
Vol 17 (6) ◽  
pp. 287-294 ◽  
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.

Educational intervention for physicians to address the risk of opioid abuse

2017 ◽  
Vol 13 (5) ◽  
pp. 303 ◽  
Author(s):  
Margaret K. Pasquale, PhD ◽  
Richard L. Sheer, BA ◽  
Jack Mardekian, PhD ◽  
Elizabeth T. Masters, MS, MPH ◽  
Nick C. Patel, PharmD, PhD ◽  
...  
Keyword(s):  
Mental Health ◽  
At Risk ◽  
Patient Information ◽  
Opioid Abuse ◽  
High Dose ◽  
Opioid Use ◽  
Educational Materials ◽  
Patients At Risk ◽  
Ed Visits ◽  
The Impact

Objective: To evaluate the impact of a pilot intervention for physicians to support their treatment of patients at risk for opioid abuse.Setting, design and patients, participants: Patients at risk for opioid abuse enrolled in Medicare plans were identified from July 1, 2012 to April 30, 2014 (N = 2,391), based on a published predictive model, and linked to 4,353 opioid-prescribing physicians. Patient-physician clusters were randomly assigned to one of four interventions using factorial design.Interventions: Physicians received one of the following: Arm 1, patient information; Arm 2, links to educational materials for diagnosis and management of pain; Arm 3, both patient information and links to educational materials; or Arm 4, no communication.Main outcome measures: Difference-in-difference analyses compared opioid and pain prescriptions, chronic high-dose opioid use, uncoordinated opioid use, and opioid-related emergency department (ED) visits. Logistic regression compared diagnosis of opioid abuse between cases and controls postindex.Results: Mailings had no significant impact on numbers of opioid or pain medications filled, chronic high-dose opioid use, uncoordinated opioid use, ED visits, or rate of diagnosed opioid abuse. Relative to Arm 4, odds ratios (95% CI) for diagnosed opioid abuse were Arm 1, 0.95(0.63-1.42); Arm 2, 0.83(0.55-1.27); Arm 3, 0.72(0.46-1.13). While 84.7 percent had ≥ 1 psychiatric diagnoses during preindex (p = 0.89 between arms), only 9.5 percent had ≥ 1 visit with mental health specialists (p = 0.53 between arms).Conclusions: Although this intervention did not affect pain-related outcomes, future interventions involving care coordination across primary care and mental health may impact opioid abuse and improve quality of life of patients with pain.

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