scholarly journals Adult Patient Risk Stratification Using a Risk Score for Periodontitis

2019 ◽  
Vol 8 (3) ◽  
pp. 307 ◽  
Author(s):  
Miguel de Araújo Nobre ◽  
Ana Ferro ◽  
Paulo Maló
Keyword(s):  
Risk Score ◽  
Risk Model ◽  
Risk Groups ◽  
First Year ◽  
C Statistic ◽  
History Of ◽  
Study Population ◽  
Subgingival Calculus ◽  
Analytical Tools

Background: There is a need for analytical tools predicting the risk of periodontitis. The purpose of this study was to estimate and evaluate a risk score for prediction of periodontitis. Materials and methods: This case-cohort study included a random sample of 155 cases (with periodontitis) and 175 controls (randomly sampled from the study population at baseline) that were followed for 3-year. A logistic regression model was used with estimation of the risk ratio (RR) for each potential predictor. Results: The risk model included the predictors “age > 53 years” (RR = 0.53), “smoking” (RR = 2.9), “gingivitis at baseline” (RR = 3.1), “subgingival calculus at baseline” (RR = 1.9), “history of periodontitis” (RR = 2.3), and “less than 2 observations in the first year of follow-up” (RR = 3.7). Patients were distributed into three risk groups based on the preanalysis risk: low risk, moderate risk, and high risk. The risk score discrimination (95% confidence interval (CI)) was 0.75 (0.70; 0.80) (p < 0.001, C-statistic). Conclusions: The risk score estimated in the present study enabled to identify patients at higher risk of experiencing periodontitis and may be considered a useful tool for both clinicians and patients.

scholarly journals Risk Score to Predict Dental Caries in Adult Patients for Use in the Clinical Setting

2019 ◽  
Vol 8 (2) ◽  
pp. 203 ◽  
Author(s):  
Miguel de Araújo Nobre ◽  
Ana Sezinando ◽  
Inês Fernandes ◽  
Paulo Maló
Keyword(s):  
Dental Caries ◽  
Risk Score ◽  
Risk Model ◽  
Risk Groups ◽  
C Statistic ◽  
Risk Algorithm ◽  
Study Population ◽  
Level Of Significance ◽  
Bacterial Plaque ◽  
Systemic Condition

Background: There is a need for risk prediction tools in caries research. This investigation aimed to estimate and evaluate a risk score for prediction of dental caries. Materials and Methods: This case-cohort study included a random sample of 177 cases (with dental caries) and 220 controls (randomly sampled from the study population at baseline), followed for 3 years. The risk ratio (RR) for each potential predictor was estimated using a logistic regression model. The level of significance was 5%. Results: The risk model for dental caries included the predictors: “presence of bacterial plaque/calculus” (RR = 4.1), “restorations with more than 5 years” (RR = 2.3), “>8 teeth restored” (RR = 2.0), “history/active periodontitis” (RR = 1.7) and “presence of systemic condition” (RR = 1.4). The risk model discrimination (95% confidence interval) was 0.78 (0.73; 0.82) (p < 0.001, C-statistic). Patients were distributed into three risk groups based on the pre-analysis risk (54%): low risk (<half the pre-analysis risk; caries incidence = 6.8%), moderate risk (half-to-less than the pre-analysis risk; caries incidence = 20.4%) and high risk (≥the pre-analysis risk; caries incidence = 27%). Conclusions: The present study estimated a simple risk score for prediction of dental caries retrieved from a risk algorithm with good discrimination.

scholarly journals A Peri-Implant Disease Risk Score for Patients with Dental Implants: Validation and the Influence of the Interval between Maintenance Appointments

2019 ◽  
Vol 8 (2) ◽  
pp. 252 ◽  
Author(s):  
Miguel de Araújo Nobre ◽  
Francisco Salvado ◽  
Paulo Nogueira ◽  
Evangelista Rocha ◽  
Peter Ilg ◽  
...  
Keyword(s):  
High Risk ◽  
Risk Score ◽  
Disease Risk ◽  
Disease Incidence ◽  
Risk Groups ◽  
Risk Profile ◽  
Moderate Risk ◽  
C Statistic ◽  
Disease Risk Score ◽  
Very High

Background: There is a need for tools that provide prediction of peri-implant disease. The purpose of this study was to validate a risk score for peri-implant disease and to assess the influence of the recall regimen in disease incidence based on a five-year retrospective cohort. Methods: Three hundred and fifty-three patients with 1238 implants were observed. A risk score was calculated from eight predictors and risk groups were established. Relative risk (RR) was estimated using logistic regression, and the c-statistic was calculated. The effect/impact of the recall regimen (≤ six months; > six months) on the incidence of peri-implant disease was evaluated for a subset of cases and matched controls. The RR and the proportional attributable risk (PAR) were estimated. Results: At baseline, patients fell into the following risk profiles: low-risk (n = 102, 28.9%), moderate-risk (n = 68, 19.3%), high-risk (n = 77, 21.8%), and very high-risk (n = 106, 30%). The incidence of peri-implant disease over five years was 24.1% (n = 85 patients). The RR for the risk groups was 5.52 (c-statistic = 0.858). The RR for a longer recall regimen was 1.06, corresponding to a PAR of 5.87%. Conclusions: The risk score for estimating peri-implant disease was validated and showed very good performance. Maintenance appointments of < six months or > six months did not influence the incidence of peri-implant disease when considering the matching of cases and controls by risk profile.

scholarly journals Hypertension Burden and the Risk of New-Onset Atrial Fibrillation

Hypertension ◽  
2021 ◽  
Vol 77 (3) ◽  
pp. 919-928
Author(s):  
So-Ryoung Lee ◽  
Chan Soon Park ◽  
Eue-Keun Choi ◽  
Hyo-Jeong Ahn ◽  
Kyung-Do Han ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Total Study Population ◽  
Increased Risk ◽  
Burden Scale ◽  
History Of ◽  
Study Population ◽  
Korean National Health Insurance ◽  
Stage 1 ◽  
The Relationship

The association between the cumulative hypertension burden and the development of atrial fibrillation (AF) is unclear. We aimed to investigate the relationship between hypertension burden and the development of incident AF. Using the Korean National Health Insurance Service database, we identified 3 726 172 subjects who underwent 4 consecutive annual health checkups between 2009 and 2013, with no history of AF. During the median follow-up of 5.2 years, AF was newly diagnosed in 22 012 patients (0.59% of the total study population; 1.168 per 1000 person-years). Using the blood pressure (BP) values at each health checkup, we determined the burden of hypertension (systolic BP ≥130 mm Hg or diastolic BP ≥80 mm Hg), stratified as 0 to 4 per the hypertension criteria. The subjects were grouped according to hypertension burden scale 1 to 4: 20% (n=742 806), 19% (n=704 623), 19% (n=713 258), 21% (n=766 204), and 21% (n=799 281). Compared with normal people, subjects with hypertension burdens of 1, 2, 3, and 4 were associated with an 8%, 18%, 26%, and 27% increased risk of incident AF, respectively. On semiquantitative analyses with further stratification of stage 1 (systolic BP of 130–139 mm Hg or diastolic BP of 80–89 mm Hg) and stage 2 (systolic BP ≥140 mm Hg or diastolic BP ≥90 mm Hg) hypertension, the risk of AF increased with the hypertension burden by up to 71%. In this study, both a sustained exposure and the degree of increased BP were associated with an increased risk of incident AF. Tailored BP management should be emphasized to reduce the risk of AF.

scholarly journals Outcomes following feeding gastrostomy (FG) insertion in patients with learning disability: a retrospective cohort study using the health improvement network (THIN) database

BMJ Open ◽  
2019 ◽  
Vol 9 (6) ◽  
pp. e026714 ◽  
Author(s):  
Philip R Harvey ◽  
Tom Thomas ◽  
Joht Singh Chandan ◽  
Neeraj Bhala ◽  
Krishnarajah Nirantharakumar ◽  
...  
Keyword(s):  
Cohort Study ◽  
Learning Disability ◽  
Incidence Rate ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Health Improvement ◽  
History Of ◽  
Study Population ◽  
The Health Improvement Network

ObjectivesTo measure the rates of lower respiratory tract infection (LRTI) and mortality following feeding gastrostomy (FG) placement in patients with learning disability (LD). Following this to compare these rates between those having LRTI prior to FG placement and those with no recent LRTI.DesignRetrospective cohort study.Setting and participantsThe study population included patients with LD undergoing FG placement in the ‘The Health Improvement Network’ database. Patients with LRTI in the year prior (LYP) to their FG placement were compared with patients without a history of LRTI in the year prior (non-LYP) to FG placement. FG placement and LD were identified using Read codes previously developed by an expert panel.Main outcome measuresIncidence rate ratio (IRR) of developing LRTI and mortality following FG, comparing patients with LRTI in the year prior to FG placement to patients without a history of LRTI.Results214 patients with LD had a FG inserted including 743.4 person years follow-up. 53.7% were males and the median age was 27.6 (IQR 19.6 to 38.6) years. 27.1% were in the LYP patients. 18.7% had a LRTI in the year following FG, with an estimated incidence rate of 254 per 1000-person years. Over the study period the incidence rate of LRTI in LYP patients was 369 per 1000-person years, in non-LYP patients this was 91 per 1000-person years (adjusted IRR 4.21 (95% CI 2.68 to 6.63) p<0.001). 27.1% of patients died during study follow-up. Incidence rate of death was 80 and 45 per 1000-person year for LYP and non-LYP patients, respectively (adjusted IRR 1.80 (1.00 to 3.23) p=0.05).ConclusionIn LD patients, no clinically meaningful reduction in LRTI incidence was observed following FG placement. Mortality and LRTI were higher in patients with at least one LRTI in the year preceding FG placement, compared with those without a preceding LRTI.

scholarly journals Clinical Characteristics in Early Childhood Associated with a Nevus-Prone Phenotype in Adults from Tropical Australia: Two Decades of Follow-Up of the Townsville Preschool Cohort Study

2020 ◽  
Vol 17 (22) ◽  
pp. 8680
Author(s):  
Ramez Barsoum ◽  
Simone L. Harrison
Keyword(s):  
Longitudinal Research ◽  
Sun Exposure ◽  
Cost Effective ◽  
Risk Groups ◽  
Melanoma Risk ◽  
Bottom Quartile ◽  
Targeted Screening ◽  
History Of ◽  
Tropical Australia

Having numerous melanocytic nevi increases melanoma risk. Few studies have enumerated nevi in children and re-examined them as adults. We aimed to determine if childhood nevus-counts predict nevus-prone adults, and further explore the relevance of host-factors and sun-exposure. Fifty-one Caucasian residents of Townsville (19.16° S, Queensland, Australia) had full-body nevus-counts aged 1–6 and 21–31 years-old. Sun-exposure was determined from questionnaires. Children in the upper-quartile of nevus-counts acquired nevi more rapidly than those in the bottom-quartile (13.3 versus 4.7 nevi/year; p < 0.0005). Children sunburnt before 7 years-old acquired more incident nevi by adulthood (238 versus 126, p = 0.003) particularly if sunburn was severe (321 versus 157.5, p = 0.003) or erythema occurred annually (380 versus 132, p = 0.008). Fair-skinned, freckled children with some nevi ≥ 3 mm, solar lentigines, or a family history of melanoma acquired more incident nevi than children without these attributes. Nevus-prone adults exhibit distinguishing features earlier in life (<7 years-old in Queensland) than has been shown previously. In addition to intervening with sun-protection counselling early enough to reduce risk, being able to reliably triage children into high- and low melanoma-risk groups may inform more efficacious and cost-effective targeted-screening in melanoma-prone populations. Further longitudinal research is needed to confirm that these attributes can reliably separate risk-groups.

Venous Thromboembolism Risk Model Predicts Early Progression and Overall Mortality in Cancer Patients Receiving Chemotherapy

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 172-172 ◽  
Author(s):  
Nicole M. Kuderer ◽  
Alok A. Khorana ◽  
Charles W. Francis ◽  
Eva Culakova ◽  
Thomas L. Ortel ◽  
...  
Keyword(s):  
Overall Survival ◽  
Prognostic Factors ◽  
Venous Thromboembolism ◽  
Disease Progression ◽  
Cancer Patients ◽  
Risk Score ◽  
Risk Model ◽  
Risk Groups ◽  
Group I ◽  
All Cause Mortality

Abstract Background: Venous Thromboembolism (VTE) is a common complication of cancer and is strongly associated with early all-cause mortality during the course of cancer chemotherapy (Kuderer et al. ASCO 2008). A clinical model for predicting the risk of VTE in cancer patients initiating chemotherapy has been recently developed and validated (Khorana et al. Blood 2008). Risk of VTE in low (group I), intermediate (group II) and high risk patients (group III) was 0.8%, 1.8% and 7.1%, respectively. The aim of current study is to evaluate the ability of the VTE risk model to predict disease progression and early all-cause mortality. Methods: A prospective study of 4,458 adult cancer patients with solid tumors or malignant lymphoma initiating a new chemotherapy regimen was conducted between 2002 and 2006 at 115 randomly selected practice sites throughout the USA. Demographic, clinical and treatment-related information was captured prospectively at baseline and during the first four cycles of chemotherapy, including rates of documented VTE, disease recurrence and deaths from all causes. Progression-free survival (PFS) and overall survival (OS) within 4 months of starting chemotherapy were estimated by the method of Kaplan-Meier and adjusted hazard ratios (HR ± 95% CI) were estimated by a Cox regression model, incorporating VTE as a time-dependent covariate. Results: Patient age ranged from 18–97 with a mean of 60 years. VTE occurred in 3% of patients by 4 months with a median of 38 days following initiation of chemotherapy. The HR for VTE occurrence among risk score groups II and III, compared to group I, were 3.07 [1.39–6.77] and 11.73 [5.22–16.37], (P&lt;0.0001) respectively. Within 4 months, disease progression occurred in 298 patients and 137 patients died. Death or disease progression was reported in 7%, 18% and 28% of risk score groups I, II and III, respectively. HR for reduced PFS among risk groups II and III compared to group I were 2.77 [1.97–3.87] and 4.27 [2.90–6.27], respectively (P&lt;0.0001). Death from all causes within 4 months of treatment initiation was reported in 1.2%, 5.9% and 12.7% patients for risk groups I, II and III. HR estimates for mortality among groups II and III were 3.56 [1.91–6.66] and 6.89 [3.50–13.57], respectively (P&lt;0.0001). In multivariate analysis, the risk score and VTE occurrence were both significant independent predictors for early mortality and reduced PFS after adjusting for major prognostic factors including: age, stage, cancer type, ECOG performance status, Charlson comorbidity index, body mass index, relative dose intensity, and year of enrollment. Conclusions: VTE is strongly associated with increased early all-cause mortality during the course of cancer chemotherapy. A recently validated risk score is not only predictive of VTE occurrence, but also of progression-free and overall survival demonstrating a strong association with prognostic factors for disease progression and mortality.

Blood mRNA signature to predict survival in patients with metastatic melanoma treated with tremelimumab.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 9080-9080 ◽  
Author(s):  
Yvonne M. Saenger ◽  
Jay Magidson ◽  
Bobby Chi-Hung Liaw ◽  
Karl Wassmann ◽  
William Barker ◽  
...  
Keyword(s):  
Metastatic Melanoma ◽  
Risk Score ◽  
Peripheral Blood ◽  
Validation Cohort ◽  
Risk Groups ◽  
Phase Iii ◽  
Gene Model ◽  
Training Cohort ◽  
Melanoma Patients

9080 Background: Tremelimumab (Ticilimumumab, Pfizer), a monoclonal antibody targeting CTLA-4, a T cell inhibitory molecule, has shown activity in metastatic melanoma. Ipilimumab (Yervoy, BMS), another antibody targettingCTLA-4, improves survival relative to a peptide vaccine and is now FDA approved. A minority of patients will achieve durable tumor control with CTLA-4 blockade and biomarkers are urgently needed to identify those patients. Methods: 170 inflammatory, melanoma-specific and CTLA4-pathway related mRNA transcripts were measured using RT-PCR in pre-treatment peripheral blood samples from 218 patients with refractory melanoma receiving tremelimumab in a multi-center phase II study. A 2-class latent model yielded a risk score based on 4-genes that was highly predictive of survival (p<0.001), and was used to categorize patients into low, medium and high-risk groups. An independent cohort of 260 treatment naïve melanoma patients receiving tremelimumab as part of a multi-center phase III study was then used to validate the risk score as well as the 3 risk groups defined using the pre-specified cut-points. Results: There was no significant difference between the two cohorts in terms of age, gender, stage of disease or ECOG status. Median time of follow up was 297 days for the training cohort and 386 days for the validation cohort. 67% of patients in the training cohort and 70% of patients in the validation died during time of follow-up. Collectively, the ability of the 170 genes to predict survival exhibited a high degree of consistency across the cohorts (p < 0.001). A 4-gene model including cathepsin D (CTSD), Phopholipase A2 group VII (PLA2G7), Thioredoxin reductase 1 (TXNRD-1) and Interleukin 1 receptor associated kinase 3 (IRAK3) predicted survival in the validation cohort (p=0.001 by log rank test). Multivariable cox analysis showed that the 4-gene model added to the predictive value of clinical predictors (p<0.0001). Conclusions: Expression levels of CTSD, PLA2G7, TXNRD1, and IRAK3 in peripheral blood are predictive of survival in melanoma patients treated with ticilimumab (αCTLA-4). Blood mRNA signatures should be further explored to define patient subsets likely to benefit from immunotherapy.

scholarly journals Association of BMI, comorbidities and all-cause mortality by using a baseline mortality risk model

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0253696
Author(s):  
Jia Li ◽  
Gyorgy Simon ◽  
M. Regina Castro ◽  
Vipin Kumar ◽  
Michael S. Steinbach ◽  
...  
Keyword(s):  
Body Mass ◽  
Mortality Risk ◽  
Risk Model ◽  
Risk Groups ◽  
Baseline Risk ◽  
Increased Risk ◽  
Wide Range ◽  
Baseline Mortality ◽  
All Cause Mortality

Objective The association of body mass index (BMI) and all-cause mortality is controversial, frequently referred to as a paradox. Whether the cause is metabolic factors or statistical biases is still controversial. We assessed the association of BMI and all-cause mortality considering a wide range of comorbidities and baseline mortality risk. Methods Retrospective cohort study of Olmsted County residents with at least one BMI measurement between 2000–2005, clinical data in the electronic health record and minimum 8 year follow-up or death within this time. The cohort was categorized based on baseline mortality risk: Low, Medium, Medium-high, High and Very-high. All-cause mortality was assessed for BMI intervals of 5 and 0.5 Kg/m2. Results Of 39,739 subjects (average age 52.6, range 18–89; 38.1% male) 11.86% died during 8-year follow-up. The 8-year all-cause mortality risk had a “U” shape with a flat nadir in all the risk groups. Extreme BMI showed higher risk (BMI <15 = 36.4%, 15 to <20 = 15.4% and ≥45 = 13.7%), while intermediate BMI categories showed a plateau between 10.6 and 12.5%. The increased risk attributed to baseline risk and comorbidities was more obvious than the risk based on BMI increase within the same risk groups. Conclusions There is a complex association between BMI and all-cause mortality when evaluated including comorbidities and baseline mortality risk. In general, comorbidities are better predictors of mortality risk except at extreme BMIs. In patients with no or few comorbidities, BMI seems to better define mortality risk. Aggressive management of comorbidities may provide better survival outcome for patients with body mass between normal and moderate obesity.

scholarly journals Beberapa Faktor Host yang Berpengaruh terhadap Kejadian Gonore pada Wanita Pekerja Seks Tidak Langsung (Studi pada Pemandu Lagu Karaoke di Kabupaten Wonosobo)

2017 ◽  
Vol 2 (2) ◽  
pp. 69
Author(s):  
Anita Nugrahaeni ◽  
Muchlis Achsan Udji Sofro ◽  
Zahroh Shaluhiyah ◽  
Antono Suryosaputro ◽  
Bagoes Widjanarko
Keyword(s):  
Condom Use ◽  
Sexual Activity ◽  
Sex Workers ◽  
Sampling Technique ◽  
Risk Groups ◽  
Observational Research ◽  
Chi Square ◽  
History Of ◽  
Study Population ◽  
Case Design

Background : Gonorrhoea is a health problem with increasing rates worldwide. The phenomena of increasing and spreading gonorrhoea cases affect the high risk groups including Indirect Female Sex Workers (IFSWs). The aim of this study was to explain some host factors as the risk factors of gonorrhoea in IFSWs in Wonosobo.Methods : This is an observational research with control case design. The study population was IFSWs who worked as lady companions in karaoke under the guidance of NGO Wonosobo Youth Center and had done the STI examination by STI clinic. The subjects were 84 consist of 42 case and 42 control. Samples were collected by consecutive sampling technique. Data analysis used chi-square, Odd Ratio (OR) and logistic regression.Results : Influencing factors to the occurence of gonorrhoea in IFSWs were history ofcombination sexual activity (p=0,013; OR=3,843; 95% CI= 1,323-11,63), history of STI (p=0,013; OR=3,863; 95% CI= 1,328-11,240), and consistency of condom use (p=0,009; OR=5,778; 95% CI=1,553-21,491).Conclusion : Factors that had been proven to influence the occurence of gonorrhoea in ISFWs were history of combination sexual activity, history of STI, and consistency of condom use.

scholarly journals Effectiveness among MSM of an HIV PrEP program developed in a Parisian sexual health center

2021 ◽  
Vol 31 (Supplement_3) ◽  
Author(s):  
B Thomas ◽  
P Piron ◽  
E de La Rochebrochard ◽  
C Segouin ◽  
P Troude
Keyword(s):  
High Risk ◽  
Sexual Health ◽  
Health Center ◽  
Post Exposure Prophylaxis ◽  
First Year ◽  
Success Ratio ◽  
History Of ◽  
Exposure Prophylaxis ◽  
Very High

Abstract Background HIV pre-exposure prophylaxis (PrEP) is highly effective but depends on patients' adherence and follow-up. To enhance follow-up quality and care engagement, the PrEP program developed in our Parisian sexual health center offers accompanying measures throughout the patients' course of care, relying notably on an identified and easily accessible referent. This trained paramedic counselor in sexual health provides support in organizing appointments, phone and email follow-up to answer daily questions, as well as one-on-one sessions of therapeutic support and counseling. This study aimed to assess the effectiveness of such a PrEP program among men who have sex with men (MSM). Methods This retrospective observational study included all MSM who initiated PrEP for the first time between 1 August 2018 and 30 June 2019 in the Fernand-Widal hospital sexual health center, Paris, France. Sociodemographic characteristics, sexual practices including very high risk situations (chemsex practice and/or sexually transmitted diseases at initiation and/or history of post-exposure prophylaxis [PEP]) and course of care during the first year were described. A novel metric developed by Hendrickson et al., the PrEP success ratio at 12 months, was used to assess effectiveness of PrEP. Results Among the 125 MSM included in this study, the median age was 33 and most had only male partners. At initiation, 58% were considered at very high risk of HIV infection, mainly due to a history of PEP. During the first year, patients attended a median of 3 visits (Q1-Q3, 2-4). At 12 months, 96% (95% CI, 92.6 to 99.4) of patients had a successful PrEP course, with no reported seroconversion. Conclusions This experiment highlights the possibility of achieving a high PrEP success ratio among MSM in a real-world setting. The accompanying measures set up in our sexual health center could explain the effectiveness of our PrEP program in comparison with previous studies. Key messages In a Parisian sexual health center that developed an HIV PrEP program with a trained paramedic counselor in sexual health, 96% of MSM achieved a successful PrEP course at 12 months. Accompanying measures for PrEP users could play a key role in achieving high PrEP success among MSM.

Sign in / Sign up

Export Citation Format

Share Document