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PubMed2025

Prevalence and predictors of low bone mineral density in pediatric inflammatory bowel disease.

OBJECTIVES: Bone health is at risk in children with inflammatory bowel disease (IBD). This study examined the prevalence and predictors of low bone mineral density (BMD) in a cohort of children and young adults with IBD. METHODS: This single-center retrospective study included patients with IBD, ages 3.5-22 years, with completed dual x-ray absorptiometry (DXA) scans from 2006 to 2019. Demographic, clinical, and laboratory data were collected. Logistic regression analysis identified predictors associated with low BMD (Z-scores ≤ -2 standard deviations [SDs]) for three outcomes. In an overlapping IBD cohort with available genetic data between 2002 and 2019 (n = 378), genetic risk for diminished bone health was calculated using published polygenic risk scores generated from genome-wide association studies based on DXA or heel ultrasound speed of sound (SOS). Linear regression analysis examined associations of low BMD and genetic risk. RESULTS: Low BMD prevalence was 7% in our cohort (n = 600) based on spine bone mineral apparent density (BMAD), which best accounts for growth delays. Median (interquartile range [IQR]) spine BMAD Z-score was -0.37 SD (-1.11 to 0.35). Predictors of low BMAD included lower BMI Z-score (odds ratio [OR]: 0.67, p value: 0.02) and decreased height Z-score (OR: 0.6, p value: 0.005). Of those with longitudinal data (n = 118), low BMI (OR: 0.44, p value: <0.001) and steroid use (OR: 3.42, p value: 0.01) were associated with suboptimal bone health (Z-scores ≤ -1SD). In the cohort with genetic data, heel genomic SOS (β [standard error] = 0.17 [0.35], p ≤ 0.01) was associated with BMD. CONCLUSIONS: Lower BMI should prompt DXA monitoring in pediatric IBD. Genetic predisposition may identify an at-risk subpopulation.

Humans↗

PubMed1992

Pharmacodynamic system analysis of the biophase level predictor and the transduction function.

This work deals with the pharmacodynamic problem of relating a drug effect E(t) to an observable pharmacokinetic (PK) predictor variable r(t), which may be a venous and/or arterial drug level, some other PK variable, or a drug infusion scheme. It is proposed that the relationship between E(t) and r(t) may, in many cases, be appropriately modeled as E(t) = N(F(r(t))) [for practical analysis reasons, F(r(t)) is denoted the biophase level, cb(t), the operator F() is accordingly denoted the biophase level predictor (BLP), and N() is denoted the transduction function (TF)]. This work proposes a method for determining the two fundamental components, BLP and TF, that define the E(t)-r(t) relationship. The BLP is determined by a hysteresis minimization (HM) technique with the following features: (1) the method considers errors in both HM variables; (2) the method is suitable for dealing with the important case in which the predictor variable is a drug infusion scheme; (3) the approach is noncompartmental in contrast to the effect-compartment approaches and it does not require a specific structured modeling of the cb(t)-r(t) relationship when dealing with drugs with linear PKs in a general operational sense; and (4) the method makes use of a dimensionless transformation of the hysteresis variable that eliminates numerical scaling problems so that a complex penalty function optimization approach can be avoided. The TF is determined by a cross validation procedure in conjunction with the BLP determined by HM. The method is demonstrated using pharmacodynamic data for several drugs, considering both concentration-based and drug input-based r(t) values. The significance of the information obtained from the determined BLP and TF is discussed, including the concepts of equilibration dynamics and overloading. The limitations and potential problems of the methodology are discussed.

Alfentanil↗

PubMed2000

Clinical predictors of pulmonary hypertension in patients undergoing liver transplant evaluation.

Clinical prediction of portopulmonary hypertension (PPHTN) is critical in the preoperative evaluation of candidates for orthotopic liver transplantation (OLT) because of its association with significant morbidity and mortality. To determine the clinical, laboratory, and echocardiographic predictors of PPHTN, we retrospectively evaluated 55 candidates before OLT. From those, 8 candidates had pulmonary hypertension ([HTN] group A) and 47 candidates did not (group B). Pulmonary HTN was defined as a mean pulmonary artery pressure (PAP) of 25 mm Hg or greater and either elevated pulmonary vascular resistance or normal pulmonary artery wedge pressure. The significant predictors of PPHTN were (1) systemic arterial HTN (63% in group A v 9% in group B; P <.001), (2) loud pulmonary component of the second heart sound (38% v 2%; P =. 001), (3) right ventricular (RV) heave (38% v 4%; P =.002), (4) RV dilatation by echocardiogram (63% v 0%; P <.001), (5) RV hypertrophy by echocardiogram (38% v 0%; P =.001), and (6) echocardiogram-estimated systolic PAP (SPAP) greater than 40 mm Hg (63% v 2%; P <.001). The sensitivity of these variables for the detection of pulmonary HTN ranges from 37% to 63%, and their specificity from 91% to 100%. We conclude that several clinical and echocardiographic features are significantly associated with pulmonary HTN in patients with cirrhosis. In particular, echocardiogram-estimated SPAP greater than 40 mm Hg is strongly associated with pulmonary HTN and is specific. These predictors, however, are not sensitive enough to identify all the patients with PPHTN. Therefore, the evaluation of a combination of these variables may be useful for the preoperative identification of pulmonary HTN in liver transplant candidates.

Case-Control Studies↗

PubMed2005

Predictors of noninvasive ventilation tolerance in patients with amyotrophic lateral sclerosis.

Noninvasive ventilation (NIV) appears to improve survival and quality of life in patients with amyotrophic lateral sclerosis (ALS), but little is known about predictors of NIV tolerance. NIV use was assessed and clinical predictors of tolerance were investigated, using predictive modeling, in ALS patients diagnosed and followed in our clinic until death over a 4-year time period. Patients were prescribed NIV based on current practice parameters when respiratory symptoms were present or forced vital capacity was less than 50%. We prescribed NIV in 52% (72) of patients. For those prescribed NIV, information regarding tolerance was available for 50 patients, with 72% (36) tolerant to its use. Tolerance was six times more likely in limb-onset than bulbar-onset ALS patients, with a trend toward reduced tolerance in those with lower forced vital capacity at NIV initiation. Age, gender, and duration of disease were not predictors of NIV tolerance. We conclude that a majority of ALS patients who are prescribed NIV can successfully become tolerant to its use.

Aged↗

PubMed1985

Predictors of acute confusional states in hospitalized elderly patients.

Development of two models for predicting acute confusional states in elderly post-surgical hip-fracture patients is described. Admission variables were used in the first model to predict confusion in the first five postoperative days; treatment and clinical progress data were added for the second model to predict on a day-to-day basis. The main sample was 170 patients from four hospitals (M age = 78.8) with no prior history of mental impairment. Over half (51.5%) evidenced some confusion postoperatively. Three variables were significant in the admission model: age, errors on a mental status test, and level of pre-injury activity. Age and test errors remained significant in the daily model and urine elimination problems were added, but the strongest predictor was the previous day's confusion score. When that effect was removed, pain, narcotics, and mobility emerged as important predictors. Validity testing suggested that the three admission factors were core predictors of acute confusional states.

Aged↗

PubMed1990

Depression and anxiety among chronically ill heart patients: age differences in risk and predictors.

Anxiety and depression for 399 survivors of a 1,102-member heart disease cohort were assessed 8 to 9 years post-hospitalization. Approximately one-third reported symptoms of emotional distress and one-fourth were on anti-anxiety drugs. Predictors of anxiety and depression were analyzed through logistic regression. Subjects age 65 and over were less likely than younger patients to report anxiety or depression and also reported less heart-associated disability, the strongest predictor of distress for both age groups. Other significant predictors included a previous history of distress, low income, female sex, and beta blocker use.

Age Factors↗

PubMed2004

Tumor size as a predictor of outcome in pediatric non-metastatic osteosarcoma of the extremity.

BACKGROUND: Better predictors of outcome would allow improved risk-adapted therapy for pediatric nonmetastatic osteosarcoma of the extremity. We investigated the predictive value of MR imaging-based measures of absolute and relative tumor size and volume at the time of diagnosis. We also assessed the relation of tumor size to age and histologic response. METHODS: We retrospectively abstracted demographic, treatment history, and outcome information of patients treated on a single institutional protocol. A single pediatric oncologic radiologist manually measured each primary lesion and the affected native bone in three dimensions on MR images obtained at the time of diagnosis. Eight parameters of tumor size were analyzed for their value in predicting overall survival (OS) and event-free survival (EFS). RESULTS: The median age of the 42 patients was 13.5 years (range: 5.9-18.7 years); 50% were female and 74% were Caucasian. Absolute tumor volume was an important predictor of OS (P < 0.05); absolute tumor depth (analyzed as a continuous variable) was a significant predictor of OS (P = 0.018) and EFS (P = 0.036). Relative measures of tumor size were not found to predict outcome. No relation was seen between tumor size and histologic response. CONCLUSIONS: Absolute tumor size at the time of diagnosis is significantly predictive of OS and EFS. If validated in a larger study, this indicator should be used in the design of risk-adapted treatment protocols for osteosarcoma.

Adolescent↗

PubMed2003

Using lowess to remove systematic trends over time in predictor variables prior to logistic regression with quantile categories.

In case-control studies one may employ logistic regression to model the relationship between binary responses and continuous predictor variables that have been categorized by the empirical quartiles of the controls. Sometimes, however, systematic trends over time (or drifts) contaminate the laboratory measurements of predictor variables. In this paper we consider the use of locally weighted robust regression (lowess) to estimate and remove these systematic trends when the trends for the cases and controls have a common shape. One can then use the lowess adjusted data in the desired logistic regression model. We illustrate these methods with a case-control study that was designed to assess the risk of oesophageal cancer as a function of the quartile categories of sphinganine levels in the blood serum. Upon examination of the data, it was discovered that the sphinganine laboratory measurements were contaminated by a systematic trend, the magnitude of which depended only on the day of analysis. This trend needed to be removed before performing further analyses of the data. In addition, we present simulations to examine the use of lowess methods to estimate and remove various shapes of trends from contaminated predictor data before constructing logistic regression models with quartile categories. We found that using the trend-contaminated data tends to give attenuated parameter estimates and hence lower significance and power levels than using the uncontaminated data. Conversely, using appropriate lowess methods to adjust the data tends to give nearly unbiased parameter estimates, near nominal significance levels, and improved power.

Adult↗

PubMed2006

First-trimester maternal serum levels of placental hormones are independent predictors of second-trimester fetal growth parameters.

OBJECTIVE: To determine whether first-trimester maternal serum levels of pregnancy-associated plasma protein-A (PAPP-A) and free beta-human chorionic gonadotropin (fbeta-hCG) are independent predictors of second-trimester fetal growth parameters. METHODS: This was a cohort study over a 1-year period involving 594 Chinese women who underwent both first-trimester combined screening for Down syndrome and a routine second-trimester ultrasound examination. Maternal PAPP-A and fbeta-hCG levels (expressed in log(10) of multiples of median (MoM)), crown-rump length (CRL) (expressed in standardized Z-score (Z-CRL)), and maternal height and weight, were correlated with the Z-score of biparietal diameter (Z-BPD), femur length (Z-FL) and abdominal circumference (Z-AC) measured in the second trimester, using the Pearson test, followed by multiple regression analysis. RESULTS: Z-BPD, Z-FL and Z-AC were positively correlated with log(10) PAPP-A MoM, CRL and maternal height (all P < 0.05), while log(10) fbeta-hCG MoM was negatively correlated with Z-AC (P < 0.05). After controlling for the effects of CRL, maternal height and weight, log(10) PAPP-A MoM was found to be an independent positive predictor of Z-FL (r = 0.797, P < 0.001) and Z-AC (r = 0.305, P = 0.049), and log(10) fbeta-hCG MoM was an independent negative predictor of Z-FL (r = -0.381, P = 0.023) and Z-AC (r = -0.418, P = 0.002). Neither hormonal level was related to Z-BPD. CONCLUSIONS: First-trimester PAPP-A and fbeta-hCG are independent factors that influence subsequent fetal growth. PAPP-A level is positively correlated with FL and AC in the second trimester, while fbeta-hCG level is negatively correlated with them. However, BPD is not affected by either of the hormones.

Adult↗

PubMed2006

First-trimester maternal serum level of pregnancy-associated plasma protein-A is an independent predictor of fetal maxillary bone length.

OBJECTIVE: To derive a nomogram of fetal maxillary bone length (MAX) for a Chinese population and to study whether first-trimester maternal serum levels of pregnancy-associated plasma protein-A (PAPP-A) is an independent predictor of fetal MAX. METHODS: This was a prospective observational study over 10 months examining Chinese women with a singleton pregnancy who attended the first-trimester screening program for Down syndrome. The subjects had the fetal crown-rump length (CRL), nuchal translucency, MAX, maternal serum PAPP-A and free beta-human chorionic gonadotropin (fbeta-hCG) levels measured. A nomogram of MAX was derived using normal pregnancies with reliable dates. The correlations between MAX, CRL, PAPP-A and fbeta-hCG levels were studied, after correction for gestational dependency using Z-score transformation for the ultrasound markers (Z-MAX and Z-CRL), and logarithmic transformation of multiple of gestation-specific medians for the biochemical markers (log10PAPP-A multiples of the median (MoM) and log10fbeta-hCG MoM), using the Pearson test and multiple regression analysis. RESULTS: During the study period, 607 Chinese women met the inclusion criteria. The mean gestational age at the first-trimester screening was 12 + 4 weeks (SD, 4 days). Curve estimation analysis showed that a linear relationship fit best between MAX and CRL (MAX (mm) = -0.01 + 0.101 * CRL (mm); r = 0.826; P < 0.0001), and between MAX and gestational age (MAX (mm) = -8.465 + 0.170 * gestational age (day); r = 0.754; SD = 0.71; P < 0.0001). There were significant positive correlations between Z-MAX and Z-CRL (r = 0.627; P = < 0.0001), Z-MAX and log10PAPP-A MoM (r = 0.239; P = < 0.0001). Multiple regression analysis showed that both Z-CRL (P = < 0.0001) and log10 PAPP-A MoM (P = 0.048) were independent predictors for Z-MAX. CONCLUSION: Both CRL and maternal levels of PAPP-A are independent predictors of the fetal MAX measured during the first trimester. The positive correlation between PAPP-A levels and fetal MAX is consistent with the known biological function of PAPP-A on bone growth. This association must be adjusted for when both PAPP-A and MAX are combined for screening of Down syndrome.

Asian People↗

PubMed1999

Predictors of recurrence in surgical stage II endometrial adenocarcinoma.

OBJECTIVE: A retrospective review of surgical stage II endometrial carcinoma was performed to evaluate clinical course, treatment, recurrence rate, and survival. METHODS: A list of patients with clinical and surgical stage II endometrial carcinoma was obtained through the tumor registry and from the pathology department from 1988 to 1996. Data were collected on all cases of patients with endometrial carcinoma meeting stage II criteria by FIGO surgical staging. Variables including stage, histology, grade, lymph vascular space invasion (LVI), type and extent of surgery, radiation type and amount, smoking, menstrual status, parity, and age were evaluated for their predictive ability of disease recurrence. Cox proportional hazard regression models were used to examine the potential predictors of time to relapse univariately and multivariately. RESULTS: Of patients identified, 65 underwent primary surgical staging. Only adenocarcinomas were included. Mean follow-up time was 4.7 years (range 0.2-9.6 years). Postoperative radiation was given to 85.7% of patients. There were 10 patients (15.4%) with recurrence of disease with a mean time to recurrence of 25 months. Five-year disease-specific survival was 93%. The only significant predictor of time to relapse was LVI (P = 0.002) in the multivariate analysis. CONCLUSION: This retrospective review suggests that primary surgery followed by postoperative radiation therapy gives excellent results in surgical stage II disease. LVI appears to be a strong predictor of disease recurrence regardless of postoperative radiation therapy. It is difficult to draw conclusions about the type and amount of radiation given because recurrence rate is so low; however, it is reasonable to continue adjuvant radiation especially in cases where LVI is identified.

Adenocarcinoma↗

PubMed2000

Probabilistic Mental Models with Continuous Predictors.

Gigerenzer and his colleagues have sought to develop psychologically plausible models of human judgment. Their models are classified as ones of bounded rationality based on a principle of one-reason decision making. The models associated with the theory of Probabilistic Mental Models (PMM) have been developed for tasks in which all predictors are binary. This article extends PMM to the case of continuous predictors. The current model employs the limitation on the number of categories people use in making absolute judgments along a single perceptual dimension (7 +/- 2; Miller, 1956). The algorithm transforms each continuous predictor to be consistent with this limitation, then implements a step-down one-reason decision procedure similar to previous PMM models. Like previous PMM models, the 7 +/- 2 model predicts binary judgments as well as a multiple-regression model. However, the model does not successfully predict the probability judgments of individual participants, which is also true of all other models in the literature. Copyright 2000 Academic Press.

Journal Article↗

PubMed1999

Predictors of influenza vaccine acceptance among healthy adults.

BACKGROUND: Previous studies investigating predictors of influenza vaccine acceptance have focused on high-risk patients or health care workers. Few studies have examined flu shot acceptance among healthy adults in workplace settings, even though influenza vaccine is recommended for this group as well. METHODS: Two studies investigated predictors of flu vaccine acceptance in workplace samples of healthy adults. In the first study, 79 university employees were interviewed, while in the second, 435 corporate employees completed a questionnaire. RESULTS: In the first study, flu shot acceptance was predicted by perceived effectiveness of the vaccine (r = 0.36), perceived likelihood of vaccine side effects (r = -0.32), and having received the shot in the previous year (r = 0.25). In the second study, flu shot acceptance was again predicted by perceived effectiveness (r = 0.49), likelihood of side effects (r = -0.31), and previous flu shot (r = 0.66) and was also related to older age (r = 0.10) and to predicted percentage of co-workers who also received the shot (r = 0.24). CONCLUSIONS: The current studies indicate that predictors of vaccine acceptance among healthy adults are similar to those identified in studies of high-risk patient populations and health care workers.

Adolescent↗

PubMed2000

Predictors of cigarette and alcohol susceptibility and use among Hispanic migrant adolescents.

BACKGROUND: Little is known about interpersonal and broader sociocultural factors related to protection from or use of tobacco and alcohol among immigrant adolescents. This study presents the baseline predictors of tobacco and alcohol use and susceptibility to tobacco and alcohol among Hispanic migrant adolescents. METHODS: The sample consisted of 660 Hispanic adolescents (51% male) between the ages of 11 and 16 years enrolled in the Migrant Education Program through the County Office of Education. Slightly more than 75% of the study sample was first generation Hispanics and 79% preferred to speak Spanish. An interviewer-administered survey assessed the following information: standard demographic characteristics, modeling of cigarette smoking (including parental and peer smoking), attitudes (including self-standards and anticipated outcomes), acculturation, communication with parents, amount of social support, and satisfaction with social support. RESULTS: Significant predictors of susceptibility to tobacco and smoking status included age, gender, attitudes toward cigarettes (e.g., anticipated outcomes, self-standards), satisfaction with social support, and parent-child communication. Factors that were also significant predictors of susceptibility to alcohol and drinking status were age, attitudes toward drinking, satisfaction with social support, and level of parent-child communication. In addition, peer and household use of alcohol predicted adolescent outcomes. CONCLUSIONS: Based on these results it is suggested that tobacco and alcohol prevention efforts for first-generation Hispanic adolescents should target not only usual concerns (e.g., availability, peer pressure, modeling, expectancies), but also parent-child communication.

Adolescent↗

PubMed2001

Predictors of smoking reduction and cessation in a cohort of danish moderate and heavy smokers.

BACKGROUND: The aim of this study was to examine the extent and gender distribution of unassisted tobacco reduction and cessation in a cohort of moderate and heavy smokers and to identify possible predictor variables associated with these changes in smoking behavior. METHODS: This was a prospective population study of 3,791 moderate and heavy smokers, 15 g tobacco/day or more, who were enrolled in the Copenhagen City Heart Study in 1976-1978 and attended a reexamination 5 years later. Data on smoking behavior were collected at baseline and follow-up. Smoking reduction was defined as a decrease in mean daily tobacco consumption of 10 g or more. Using multivariate logistic regression, subjects who reported reduced smoking or who reported smoking cessation were compared with subjects who continued the habit unchanged. RESULTS: After 5 years 13% of the men and 9% of the women had reduced their tobacco consumption, and 9 and 7%, respectively, had quit altogether. Smoking reduction was strongly associated with high tobacco consumption (25+ g/day) at baseline and also with severely impaired lung function (FEV(1) <50% predicted) and overweight (BMI >25). Predictors of smoking cessation included impaired lung function and a tobacco consumption of 15-24 g/day. Additional determinants of smoking reduction and cessation such as inhalation habits and sociodemographic variables differed by gender. CONCLUSIONS: Several predictors of smoking reduction and cessation were identified, indicating that these subgroups of smokers differ substantially from continuing smokers. This should be taken into account when assessing potential health benefits from these changes in smoking behavior.

Adult↗

PubMed2001

Predictors of sunburn among Canadian adults.

BACKGROUND: Data from the 1996 National Survey on Sun Exposure & Protective Behaviors (4,023 respondents) were analyzed to identify independent predictors of sunburn among adult Canadians. METHODS: Multivariate models predicting sunburn odds were developed using unconditional logistic regression. Backward elimination model selection was used to identify independent predictors of sunburn. RESULTS: Nonbehavioral characteristics found to predict sunburn were younger age, male sex, light skin color, nonblack hair color, and birthplace in North America or Europe. Behavioral predictors of sunburn included high awareness of the UV Index, working outdoors in the summer, longer leisure time in the sun, forgetfulness about protecting oneself from the sun, and seeking a tan. Sun avoidance between 11 AM and 4 PM was associated with lower odds of sunburn, while seeking shade when outside and use of protective clothing showed nonsignificant associations with lower sunburn odds. Sunscreen use was found to have a nonsignificant positive association with sunburn. CONCLUSIONS: These findings highlight risk factors to be considered in the targeting of sunburn reduction strategies to high-risk groups and suggest that sun avoidance, seeking shade, and use of protective clothing may be effective in preventing sunburn.

Adolescent↗

PubMed1996

Marital status as a predictor of survival in idiopathic dilated cardiomyopathy: the Washington, DC dilated cardiomyopathy study.

Marital status and other socioeconomic and clinical factors were examined as predictors of survival in idiopathic dilated cardiomyopathy using data from a hospital-based study in Washington, DC. Twenty-five (18.1%) of the cases (n = 138) were single, 66 (47.8%) were married, 25 (18.1%) were divorced or separated, and 22 (15.9%) were widowed. Married patients were more likely to be male, to have an annual household income greater than $15,000, and to live with another person (p < or = 0.01) as compared with those who were single, widowed, divorced or separated. Widowed patients were older on average and more likely to abstain from drinking alcohol. The cumulative survival among widowed patients at 12 and 24 months was 54.6 and 48.5%, respectively, as compared with 75.8 and 59.0% among single patients and 80.0 and 71.2% among married patients. The survival of divorced or separated patients was relatively good with a cumulative survival of 84.0% at both 12 and 24 months. Older age, lower ejection fraction, ventricular arrhythmias, bundle branch block, and marital status were significant predictors of survival in univariate analysis using the proportional hazards model. In multivariable analysis, age, race, ejection fraction, and marital status were statistically significant independent predictors of survival, with single patients with idiopathic dilated cardiomyopathy having a poorer survival than those who were married (adjusted RR = 2.5, 95% CI 1.1-6.2, p < 0.05). The observed association with marital status may be explained by psychosocial factors not examined in the present study such as quality of social network or psychological stress.

Adult↗

PubMed1983

Major and minor life events as predictors of psychological distress: further issues and findings.

Current trends in research on stressful life events and disease have been to focus upon other psychosocial factors that may be associated with stress and illness relationships. Recently, the study of relatively minor life events or situations (e.g., daily hassles) has provided a promising alternative avenue of inquiry into basic stress measurement and the relationship of stress to disorder. While initial findings in this area of research appear encouraging, several methodological and procedural issues currently preclude definitive conclusions. The present paper outlines several of the most important limitations of existing research on this topic and provides further data taking these limitations into account for the role of minor life events as predictors of psychological distress. The results of the present prospective study indicate that undesirable minor events (e.g., hassles) significantly predict psychological symptoms, even once initial symptom status is controlled for statistically. Additionally, hassles were uniformly better predictors of subsequent psychological symptoms than were major life event categories; potentially important interactive effects (e.g., hassles x prior symptoms; hassles x prior major events) were also tested and their implications are discussed. Finally, basic associations between major and minor events were examined. The findings are discussed specifically in the context of recent advances in this area and more generally in relation to clarifying our understanding of psychosocial predictors of disorder.

Adolescent↗