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At least 19 recordsLinked to original sources
PubMed1991

Are the Brown and Harris "vulnerability factors" risk factors for depression?

The Brown and Harris model of depression holds that certain "vulnerability factors"--namely early maternal loss, lack of a confiding relationship, greater than three children under the age of 14 at home and unemployment--can interact with "provoking agents" to increase the risk of depression. The validity of this model has been widely debated, with most of the discussion concerning the interactive nature of the model. There has been relatively little attention paid to the possibility that the "vulnerability factors" may be risk factors for depression. The purpose of this paper is to determine whether the four Brown and Harris "vulnerability factors" are associated with an elevated risk of depression, irrespective of whether they may interact with provoking agents. The analysis contained in this paper utilizes power analyses and confidence intervals. The findings suggest that the lack of a confiding relationship is strongly associated with depression, and that all four of the "vulnerability factors" may be associated with an increased risk of depression.

Depressive Disorder↗
PubMed1992

[Combination therapy of cardiovascular risk factors].

Risk factors for cardiovascular diseases, which are the leading cause of mortality in the industrialized countries, are well investigated; however, the results of intervention studies on the therapy of single risk factors were disappointing in the past. Recently, there has been growing evidence that there might be a closer pathophysiological relation between arterial hypertension, hypercholesterolemia, obesity, impaired glucose tolerance and genetic disposition than previously thought. For the treatment of the individual patient, this concept requires a complete work-up and comprehensive therapy of all risk factors. The therapy of several mildly elevated risk factors may be more beneficial than a too vigorous reduction of the blood pressure alone. At the beginning of every therapeutic regimen, there has to be a nonpharmacological approach. Diet and weight reduction even in mild obesity are more efficient in influencing several risk factors at the same time than pharmacological therapy. Metabolic consequences of drug treatment have to be carefully monitored.

Cardiovascular Diseases↗
PubMed1990

Synergistic effects of risk factors.

Risk factors for coronary heart disease (CHD), stroke, congestive heart failure and total mortality were analysed in two random population samples of men in Gothenburg, Sweden, aged 50 and 47-55 years, respectively, at entry. A series of potential risk factors for the above mentioned end-points have been analysed in univariate and multivariate logistic analyses. Population attributable risks were also calculated. Significant risk factors in multivariate analyses are summarized. For CHD they were: family history of CHD, hypercholesterolemia, hypertension, tobacco smoking, psychologic stress, low social class and diabetes mellitus. In hypertensives, proteinuria was measured and found to be significant also. Stroke risk factors were: family history of stroke, blood pressure, smoking, high waist/hip ratio, high plasma fibrinogen, psychologic stress, proteinuria, atria fibrillation and transitory ischemic attacks. Hypertension, smoking, high waist/hip ratio and psychologic stress were risk factors for congestive heart failure.

Aged↗
PubMed1978

Intermittent claudication: prevalence and risk factors.

Risk factors for intermittent claudication (IC) were studied in 54 patients--that is, all patients with IC on the lists of two general practices--and 108 controls. Smoking was the factor most strongly associated with the development of IC, but systolic and diastolic blood pressures and concentrations of triglyceride, urate, and fibrinogen were all significantly higher among the patients with IC than the controls. The presence of more than one factor appeared to be associated with a multiplicative increase in risk. Cholesterol, an important risk factor for ischaemic heart disease, was not associated with an increased risk of IC. IC was present in about 2% of the men and 1% of the women, who were aged 45-69 years. These findings suggest that IC, a common and disabling manifestation of atheroslcerosis, may be largely preventable.

Aged↗
PubMed1992

Analysing the relationship between change in a risk factor and risk of disease.

There are numerous examples in the epidemiologic literature of analyses that relate the change in a risk factor, such as serum cholesterol, to the risk of an adverse outcome, such as heart disease. Many of these analyses fit some type of regression model (such as logistic regression or the Cox model for survival time data) that includes both the change in the risk factor and the baseline value as covariates. We show that this method of adjusting for the baseline level can produce misleading results. The problem occurs when the true value of the risk factor relates to the outcome, and the measured value differs from the true value due to measurement error. We may find the observed change in the risk factor significantly related to the outcome when there is in fact no relationship between the true change and the outcome. If the question of interest is whether a person who lowers his level of the risk factor by means of drugs or lifestyle changes will thereby reduce his risk of disease, then we should consider an association due solely to measurement error as spurious. We present a method that adjusts for the measurement error in a linear regression analysis and show that an analogous adjustment applies asymptotically to logistic regression. As in other errors-in-variables problems, this analysis depends on knowledge of the relative variances of the random variation, the true baseline value, and the true change. Since the magnitudes of these variances are usually unknown and sometimes unknowable (the distinction between true change and measurement error being ambiguous), we recommend a sensitivity analysis that examines how the analysis results depend on the assumptions concerning the variances. The commonly used analysis method corresponds to the extreme case in which there is no measurement error. We use data from the Framingham Study and simulations to illustrate these points.

Bias↗
PubMedDate not supplied

Diabetes and coronary risk factors, relative risk for single factors and aggregation of more factors in a general population sample from northern Italy.

In the course of a general population survey in Mirano (Venice), Northern Italy, a random sample of 1,903 subjects (50.1% men) aged 20-59 was examined. Fifty-five were diabetic (fasting plasma glucose greater than or equal to 140 mg/dl or diagnosed by a physician) and 1,670 non-diabetic subjects (fasting plasma glucose below 110 mg/dl). In this paper an assessment was made on the more frequent occurrence of coronary risk factors (serum cholesterol and triglycerides, body mass index (BMI), systolic blood pressure, cigarette smoking) and, in particular, of their aggregation in diabetic patients as compared to non-diabetic controls. The occurrence of any one of the coronary risk factors studied was more frequent in diabetic subjects and significantly so for triglyceridemia in both sexes and for systolic blood pressure and BMI in men. The aggregation of two or more risk factors was also more frequent in diabetic subjects than controls. Finally, the combined score of coronary risk as calculated by multiple logistic function showed higher values for diabetic subjects. These results confirm the need for a systematic search for coronary risk factors in diabetic subjects in order to prevent cardiovascular complications.

Adult↗
PubMed1986

[Age as a risk factor].

Risk factors like myocardial infarction, hypertension, and diabetes are increasing with age and cause higher perioperative mortality and morbidity. Advanced and complicated stages of various malignant and benign diseases of colon, gall bladder and bile ducts, stomach and great vessels are also more common in the aged population and therefore enlarge the risks of surgery. There is no dependency between age and frequency of intraoperative complications. No difference could be proven in regard to the malignancy of colorectal cancer in patients younger than 50 and older than 80 years.

Adolescent↗
PubMed1990

Relationship of mammographic parenchymal patterns with breast cancer risk factors and risk of breast cancer in a prospective study.

A prospective study has been conducted on 4954 female volunteers from the Island of Guernsey between 1977 and 1985 to examine risk factors for breast cancer and their relationship to mammographic parenchymal patterns as assessed by Wolfe's method of grading. Up to September 1988, 69 women had developed breast cancer, 11 of whom were prevalent cases being diagnosed within six months of mammography. The remaining incident cases were diagnosed six to 126 months (median 65 months) after entry to the study. Univariate analysis showed that the distribution of Wolfe grades in the population was significantly associated with menopausal status, age, parity, adiposity, age at menarche, age at first childbirth and use of oral contraception, but not with a family history of breast cancer. Multivariate analysis of the data for these variables from either pre- and/or post-menopausal women indicated that age, parity and adiposity were significantly related to Wolfe grade pattern. Age had an opposite effect in pre- compared with postmenopausal women thus the probability of either a P2 or DY pattern increased with increasing age in premenopausal but decreased in postmenopausal women so that incidence peaked around the menopause. Other variables did not achieve significance in the multivariate analysis. Odds ratios (ORs) were calculated for women with P2 or DY patterns using those with N1 or P1 grades as the reference group. The ORs were determined at two censoring times; one at five years and the other to include the most recent follow-up of this cohort. The ORs were adjusted for years of follow-up, age and adiposity and in postmenopausal women adjustment was also made for age at menarche.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

[Infant mortality in the town of Djibouti--risks, risk factors and risk markers].

The authors report the results of the first survey on infancy mortality rate carried out in the town of Djibouti since the Republic of Djibouti became independent. Infancy mortality rate is 141 +/- 11o/00, and in correlation with some risk factors well identified: jobless, lack of fecal hygiene, bottle-feeding of infant, vaccinal coverage not adequate. It is mainly a post-natal mortality of exogenous origin and therefore possible to be reduced in the framework of the strategy of Primary Health Cares progressively set up by the Government of the Republic of Djibouti.

Africa, Eastern↗
PubMed1985

Exercise electrocardiogram and coronary heart disease mortality in the Multiple Risk Factor Intervention Trial. Multiple Risk Factor Intervention Trial Research Group.

The Multiple Risk Factor Intervention Trial (MRFIT), a coronary heart disease (CAD) primary prevention trial, examined the effect on the CAD mortality rate of a special intervention (SI) program to reduce blood cholesterol level, diastolic blood pressure and cigarette smoking in 35- to 57-year-old men. Half of the 12,866 participants were randomly assigned to usual care (UC) in the community. During 6 to 8 years of follow-up, the CAD mortality rate was 7% lower in the SI than in the UC group, a nonsignificant difference. An a priori subgroup hypothesis proposed that men with a normal electrocardiographic response to a heart-rate-limited exercise test would experience particular benefit from intervention. An abnormal response, defined as an ST-depression integral measured by computer greater than a pre-determined voltage-time cutpoint, was observed in 12.5% of the men at baseline, and was associated with a 3-fold elevation in risk of CAD death within the UC group. In the subgroup with a normal exercise electrocardiographic response, there was no significant SI-UC difference in the CAD mortality rate (16.0 and 13.8 per 1,000, respectively, for SI and UC men). In contrast, there was a 57% lower rate among men in the SI group with an abnormal test result compared with men in the UC group (22.2 vs 51.8 per 1,000). The relative risks (SI/UC) in these 2 strata were significantly different (p = 0.002). These findings suggest that men with elevated risk factors who have an abnormal exercise test response may benefit substantially from risk factor reduction.

Adult↗
PubMed1992

Adverse outcome in surgery for chronic leg ischaemia--risk factors and risk prediction when using different statistical methods.

OBJECTIVE: to compare two different statistical methods in predicting the outcome of surgery for chronic leg ischaemia. MATERIAL: the present study from the Swedvasc registry is based on an inception cohort of 1635 patients with chronic leg ischaemia (intermittent claudication in 609 and critical ischaemia in 1026 patients), who have been followed until 1 year after surgery. Outcome was classified as improved vs. not improved, amputated or dead in claudication and as the intact leg vs. amputation or death in critical ischaemia. METHODS: logistic regression analysis was compared to the inductive expert system program, Assistant Professional, in the prediction of outcome. Seventy per cent of cases in the data base were used to create a risk factor model including 17 variables registered in Swedvasc. These variables included an assessment of patients overall health status, severity of disease, the surgeon's experience and surgical procedures. This model was then evaluated using the remaining 30% of the patients in the data base. RESULTS: a risk score indicating a probability of an adverse outcome exceeding 0.5 was, in patients with intermittent claudication, associated with a sensitivity of 38% using logistic regression and 26% using Assistant Professional. The percentages of correctly predicted adverse outcomes were 29 and 50%, respectively. In patients with critical ischaemia, the sensitivities with the two methods were 68 and 38% and the predictive values 42 and 57%, respectively. CONCLUSIONS: the risk scores created with the two methods gave low sensitivities. It is concluded that risk functions could not be used to predict an adverse outcome in patients operated on for chronic leg ischaemia with the data set used.

Aged↗
PubMed1986

Relationship between baseline risk factors and coronary heart disease and total mortality in the Multiple Risk Factor Intervention Trial. Multiple Risk Factor Intervention Trial Research Group.

The relationship between selected baseline risk factors and subsequent coronary heart disease (CHD) death and total mortality among participants in the Multiple Risk Factor Intervention Trial (MRFIT) was studied in order to determine whether the three risk factors used to identify high-risk men for the trial were associated with CHD death; whether other risk factors measured at baseline, especially lipoprotein cholesterol levels, were associated with CHD and total mortality; and whether there were any differences between special intervention (SI) and usual care (UC) participants in the relationship of the specific levels of risk factors to CHD or total mortality. The three main risk factors (blood cholesterol, cigarette smoking, and diastolic blood pressure) and age were significantly associated with CHD mortality; age, diastolic blood pressure, and cigarette smoking were associated with total mortality. The risk score based on the multiple logistic equation developed from the Framingham Study was also strongly associated with CHD mortality. When the joint associations of selected baseline risk factors with CHD and total mortality were considered, age, diastolic blood pressure, cigarette smoking, and low- and high-density lipoprotein cholesterol were significantly associated with CHD mortality; age, cigarette smoking, and low-density lipoprotein cholesterol were positively associated with total mortality. Systolic blood pressure significantly improved the prediction of CHD mortality for SI and UC men when it was added to a regression model that included age, diastolic blood pressure, cigarettes smoked per day, body mass index, and lipoprotein levels, but improved the prediction of total mortality only for SI men. In similar analyses, serum thiocyanate improved the prediction of both CHD and total mortality for UC men. Among SI men the improved prediction gained by considering serum thiocyanate was less pronounced and not significant for CHD death. This latter finding may be due in part to the changes made in smoking behavior by SI participants during the course of the study. The estimated regression coefficients for CHD and total mortality endpoints were not significantly different between the SI and UC groups.

Adult↗
PubMed1992

Serum cholesterol level and mortality findings for men screened in the Multiple Risk Factor Intervention Trial. Multiple Risk Factor Intervention Trial Research Group.

BACKGROUND: With increased efforts to lower serum cholesterol levels, it is important to quantify associations between serum cholesterol level and causes of death other than coronary heart disease, for which an etiologic relationship has been established. METHODS: For an average of 12 years, 350,977 men aged 35 to 57 years who had been screened for the Multiple Risk Factor Intervention Trial were followed up following a single standardized measurement of serum cholesterol level and other coronary heart disease risk factors; 21,499 deaths were identified. RESULTS: A strong, positive, graded relationship was evident between serum cholesterol level measured at initial screening and death from coronary heart disease. This relationship persisted over the 12-year follow-up period. No association was noted between serum cholesterol level and stroke. The absence of an association overall was due to different relationships of serum cholesterol level with intracranial hemorrhage and nonhemorrhagic stroke. For the latter, a positive, graded association with serum cholesterol level was evident. For intracranial hemorrhage, cholesterol levels less than 4.14 mmol/L (less than 160 mg/dL) were associated with a twofold increase in risk. A serum cholesterol level less than 4.14 mmol/L (less than 160 mg/dL) was also associated with a significantly increased risk of death from cancer of the liver and pancreas; digestive diseases, particularly hepatic cirrhosis; suicide; and alcohol dependence syndrome. In addition, significant inverse graded associations were found between serum cholesterol level and cancers of the lung, lymphatic, and hematopoietic systems, and chronic obstructive pulmonary disease. No significant associations were found of serum cholesterol level with death from colon cancer, with accidental deaths, or with homicides. Overall, the inverse association between serum cholesterol level and most cancers weakened with increasing follow-up but did not disappear. The association between cholesterol level and death due to cancer of the lung and liver, chronic obstructive pulmonary disease, cirrhosis, and suicide weakened little over follow-up. CONCLUSIONS: The association of serum cholesterol with specific causes of death varies in direction, strength, gradation, and persistence. Further research on the determinants of low serum cholesterol level in populations and long-term follow-up of participants in clinical trials are necessary to assess whether inverse associations with noncardiovascular disease causes of death are consequences of noncardiovascular disease, whether serum cholesterol level and noncardiovascular disease are both consequences of other factors, or whether these associations are causal.

Adult↗