RESUMO
@#Assessment of risk of a fragility fracture is a vital step a physician needs to undertake in every patient suspected of osteoporosis, as this will influence the decisions on whether to treat with a pharmacological agent, with which drug, and for how long. After risk stratification, patients deemed Very High-Risk should be considered for an anabolic agent, or if this is not feasible, a parenteral anti-resorptive. High- Risk or Moderate-Risk patients may be considered for oral bisphosphonates.
RESUMO
BACKGROUND/AIMS: This study aimed to develop and validate a risk prediction model for the development of hepatocellular carcinoma (HCC) in treatment-naïve patients receiving oral antiviral treatment for chronic hepatitis B (CHB). METHODS: We investigated 2,061 Korean treatment-naïve patients with CHB treated with entecavir as an initial therapy. A risk score model for HCC development was developed based on multivariable Cox regression model in a single center (n=990) and was validated using the time-dependent area under the receiver operating characteristic curve (AUROC) in three other centers (n=1,071). The difference of HCC development among risk groups (low, intermediate, and high) categorized by risk score was also investigated. RESULTS: The cumulative incidence rates of HCC at 5 years were 11.2% and 8.9% in the testing and validation cohorts, respectively. HCC-Risk Estimating Score in CHB patients Under Entecavir (HCC-RESCUE) is formulated as (age+15×gender [female=0 / male=1]+23×cirrhosis [absence=0 / presence=1]). The AUROCs at 1 year, 3 years, and 5 years were 0.82, 0.81, and 0.81, respectively, in the validation cohort. A significant difference of HCC development in each risk group was determined by the 5-year HCC risk score in the validation cohort (low risk group, 2.1%; intermediate risk group, 9.3%; high risk group, 41.2%, p<0.001). CONCLUSIONS: The study presents a new risk score model with a good ability to predict HCC development and determine high risk patients for HCC development consisting of readily available clinical factors in treatment-naïve CHB patients receiving entecavir.
Assuntos
Humanos , Antivirais , Carcinoma Hepatocelular , Estudos de Coortes , Hepatite B Crônica , Hepatite Crônica , Incidência , Medição de Risco , Curva ROCRESUMO
Centre for Children Committing Offences (CCCO), at Child Development Institute (CDI) in Toronto, Canada, developed Early Assessment Risk Lists (EARL-20B for boys; EARL-21G for girls), for young children at-risk for future criminality. In this first EARL prospective longitudinal study, 573 boys and 294 girls who participated in SNAP®, a gender-specific evidence-based model for at-risk children (6-11 years), 8.2% of boys and 3.1% of girls had registered criminal offences at follow up (mean age 14.9 and 14.6 respectively). EARL Total, Family, Child, and Responsivity domain scores, including two gender-specific risk items and Overall Clinical Judgment predicted early onset of criminal activity. Findings suggest that gender-sensitive clinical risk assessment and management tools are important for effectively identifying and potentially reducing criminal outcomes.
En el Centro para Niños Infractores (CCCO), del Instituto de Desarrollo Infantil (CDI) en Toronto (Canadá), se desarrollaron las Listas de Evaluación de Riesgos Tempranos (EARL-20B para niños; EARL-21G para niñas), para niños en riesgo de desarrollar criminalidad. En este primer estudio longitudinal de las EARL, 573 niños y 294 niñas que participaron en SNAP un modelo basado en evidencia de género específico para riesgo en niños (6-11 años), 8.2 % de niños y 3.1 % de las niñas registraron delitos criminales durante el seguimiento (M = 14.9 y 14.6, respectivamente). Los puntajes de EARL Total, Familia, Niños y Responsividad, incluyendo dos ítems de riesgo específicos de género, y el Juicio Clínico General predicen el inicio temprano de actividad criminal. Los resultados sugieren que la evaluación del riesgo clínico sensible al género y el manejo de herramientas son importantes para la identificación efectiva y potencialmente reducen los resultados criminales.