Books on the topic 'Confounding Factor'
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1
Kleespies, Phillip M. Medical Illness, Suicide, and Assisted Death. Edited by Phillip M. Kleespies. Oxford University Press, 2015. http://dx.doi.org/10.1093/oxfordhb/9780199352722.013.28.
Abstract:
Because of their focus on psychopathology, mental health clinicians may overlook the potential significance of medical illness as a risk factor for suicide. In this chapter, the author presents evidence that physical illness, particularly certain physical illnesses, can be independent risk factors for suicide. In a number of these illnesses, depression is clearly a confounding risk factor, while in others the illness itself or its consequent functional impairments may lead to increased risk. When an individual has multiple physical illnesses, as often happens with the elderly, the cumulative burden can become overwhelming and heighten the risk of suicide. When physical illness becomes terminal, the competent patient has the right to refuse life-sustaining treatment. Whether that individual can receive assistance in dying has been more controversial. The chapter concludes with a presentation of data from a state where assisted suicide, also known as assisted death, has been legalized.
2
Jardine, Alan G., and Rajan K. Patel. Lipid disorders of patients with chronic kidney disease. Edited by David J. Goldsmith. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199592548.003.0102.
Abstract:
The risk of developing cardiovascular (CV) disease is increased in patients with chronic kidney disease (CKD) and although dyslipidaemia is a major contributory factor to the development of premature CV disease, the relationship is complex. Changes in lipid fractions are related to glomerular filtration rate and the presence and severity of proteinuria, diabetes, and other confounding factors. The spectrum of CV disease changes from lipid-dependent, atheromatous coronary disease in early CKD to lipid-independent, non-coronary disease, manifesting as heart failure, and sudden cardiac death in advanced and end-stage renal disease. Statin-based lipid-lowering therapy is proven to reduce coronary events across the spectrum of CKD. The relative reduction in overall CV events, however, diminishes as CKD progresses and the proportion of lipid-dependent coronary events declines. There is nevertheless a strong argument for the use of statin-based therapy across the spectrum of CKD. The argument is particularly strong for those patients with progressive renal disease who will eventually require transplantation, in whom preventive therapy should start as early as possible. The SHARP study established the benefits and endorses the use of lipid-lowering therapy in CKD 3-4 but uncertainty about the value of initiation of statin therapy in CKD 5 remains. There is, however, no rationale for stopping agents started earlier in the course of the illness for compelling indications, particularly in those who will ultimately be transplanted. The place of high-density lipoprotein-cholesterol raising and triglyceride lowering therapy needs to be assessed in trials. Modifying dyslipidaemia in CKD has demonstrated that lipid-dependent atheromatous cardiovascular disease is only one component of the burden of CV disease in CKD patients, that this is proportionately less in advanced CKD, and that modification of lipid profiles is only one part of CV risk management.
3
Smith, George Davey. The biopsychosocial approach. Oxford University Press, 2015. http://dx.doi.org/10.1093/med:psych/9780198530343.003.0005.
Abstract:
This chapter provides a critique of whether the biopsychosocial model is useful in understanding aetiological factors in chronic diseases. It illustrates the arguments by referring to studies on peptic ulcer and ischaemic heart diseases, and shows that bias and confounding can generate spurious findings and associations, especially in observational studies.
4
Scott, David L. Outcomes. Oxford University Press, 2013. http://dx.doi.org/10.1093/med/9780199642489.003.0029.
Abstract:
Outcomes evaluate the impact of disease. In rheumatology they span measures of disease activity, end-organ damage, and quality of life. Some outcomes are categorical, such as the presence or absence of remission. Other outcomes involve extended numeric scales such as joint counts, radiographic scores, and quality of life measures. Outcomes can be measured in the short term—weeks and months—or over years and decades. Short-term outcomes, though readily related to treatment, may have less relevance for patients. Clinical trials focus on short-term outcomes whereas observational studies explore longer-term outcomes. The matrix of rheumatic disease outcomes is exemplified by rheumatoid arthritis. Its outcomes span disease activity assessments like joint counts, damage assessed by erosive scores, quality of life evaluated by disease-specific measures like the Health Assessment Questionnaire (HAQ) or generic measures like the Short Form 36 (SF-36), overall assessments like remission, and end result such as joint replacement or death. Outcome measures are used to capture the impact of treating rheumatic diseases, and are influenced by both disease severity and the effectiveness of treatment. However, they are also influenced by a range of confounding factors. Demographic factors like age, gender, and ethnicity can all have crucial impacts. Deprivation is important, as poverty invariably worsens outcomes. Finally, comorbidities affect outcomes and patients with multiple comorbid conditions usually have worse quality of life with poorer outcomes for all diseases. These multiple confounding factors mean comparing outcomes across units without adjustment will invariably show major differences.
5
Scott, David L. Outcomes. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199642489.003.0029_update_001.
Abstract:
Outcomes evaluate the impact of disease. In rheumatology they span measures of disease activity, end-organ damage, and quality of life. Some outcomes are categorical, such as the presence or absence of remission. Other outcomes involve extended numeric scales such as joint counts, radiographic scores, and quality of life measures. Outcomes can be measured in the short term—weeks and months—or over years and decades. Short-term outcomes, though readily related to treatment, may have less relevance for patients. Clinical trials focus on short-term outcomes whereas observational studies explore longer-term outcomes. The matrix of rheumatic disease outcomes is exemplified by rheumatoid arthritis. Its outcomes span disease activity assessments like joint counts, damage assessed by erosive scores, quality of life evaluated by disease-specific measures like the Health Assessment Questionnaire (HAQ) or generic measures like the Short Form 36 (SF-36), overall assessments like remission, and end result such as joint replacement or death. Outcome measures are used to capture the impact of treating rheumatic diseases, and are influenced by both disease severity and the effectiveness of treatment. However, they are also influenced by a range of confounding factors. Demographic factors like age, gender, and ethnicity can all have crucial impacts. Deprivation is important, as poverty invariably worsens outcomes. Finally, comorbidities affect outcomes and patients with multiple comorbid conditions usually have worse quality of life with poorer outcomes for all diseases. These multiple confounding factors mean comparing outcomes across units without adjustment will invariably show major differences.
6
McLean, Anthony S., and Stephen J. Huang. Cardiac injury biomarkers in the critically ill. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0301.
Abstract:
To be clinically relevant, a good cardiac biomarker should have four main characteristics. It should be organ-, disease- and stage-specific to be useful in diagnosis. Its release should be timely and its half-life should be long enough to make measurement possible and meaningful. Its serum or blood concentration should be proportional to disease severity; hence, can be used as a monitoring tool. Finally, their concentrations have implications on long-term outcomes. To date, only a handful of cardiac biomarkers have clinical relevance in the intensive care setting—cardiac troponins (as a marker of cardiac injury) and B-type natriuretic peptide (as a marker of cardiac stress) being probably the most useful. However, cautious interpretations of these biomarkers are needed in intensive care patients as several confounding factors can affect their concentrations.
7
Weiss, Helen. Design issues in global mental health trials in low-resource settings. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199680467.003.0004.
Abstract:
In this chapter we outline the key principles in design and analysis of trials for mental health. The chapter focuses on randomized controlled trials as these are the gold-standard trial design, which minimizes confounding due to other factors and enables us to draw conclusions about the effectiveness of the intervention. Other key principles of trial design discussed in the chapter include methods to develop a clearly stated, testable research hypothesis, definition of well-defined outcomes, appropriate choice of the control condition, masking of providers and participants where possible, realistic sample size estimates, and appropriate data monitoring and statistical analysis plans. The chapter also outlines alternatives to the parallel arm superiority trial design, such as equivalence and non-inferiority trials, cross-over, stepped wedge, fixed adaptive, and patient preference trial designs.
8
Glover, Vivette. Maternal Stress During Pregnancy and Infant and Child Outcome. Edited by Amy Wenzel. Oxford University Press, 2014. http://dx.doi.org/10.1093/oxfordhb/9780199778072.013.006.
Abstract:
Many independent prospective studies show maternal stress, anxiety, or depression during pregnancy poses an increased risk for her child to have a wide range of adverse outcomes including emotional problems, ADHD or conduct disorder, or impaired cognitive development. Several studies have shown that these adverse outcomes are independent of possible confounding factors, such as postpartum anxiety and depression. Most children are not affected, and those who are can be affected in different ways, probably due to different genetic vulnerabilities and the quality of postpartum care. An evolutionary explanation for the observed changes is proposed. Underlying mechanisms are just starting to be understood: altered function of the placenta, allowing more of the stress hormone cortisol to pass through to the fetus, may well be important, as may epigenetic changes. The implications are that improved emotional care of pregnant women should improve outcomes for their children to a clinically significant degree.
9
Cleary, Paul, Sam Ghebrehewet, and David Baxter. Essential statistics and epidemiology. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198745471.003.0022.
Abstract:
This chapter provides a grounding in basic statistics, descriptive epidemiology, analytical epidemiology, and hypothesis testing appropriate for health protection practitioners. The analysis of categorical data using frequency distributions, and charts, and the interpretation of epidemic curves is described. The description of quantitative data including central tendency, standard deviation, and interquartile range is concisely explained. The role of geographical information systems and different disease map types is used to demonstrate how disease clusters may be detected. Determining possible association between specific risk factors and outcome is described in the section on analytical epidemiology, using the risk ratio and the odds ratio. The use of these in different study/investigation types is explained. The importance of confounding, matching, and standardization in study design is described. The final part of the chapter covers hypothesis testing to distinguish between real differences and chance variation, and the use of confidence intervals.
10
Knezevic, Nebojsa Nick, Benjamin Cantu, Ivana Knezevic, and Kenneth D. Candido. Chronic Back Pain in the Elderly: Spinal Stenosis. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190271787.003.0022.
Abstract:
Chronic low back pain (CLBP) is a common reason for physician office visits among the elderly. Predictive factors for CLBP are female sex, social isolation, hypertension, and joint pain. In the elderly, CLBP may be related to degenerative spinal stenosis with disk degeneration and overall spondylosis. A detailed medical history and a targeted, comprehensive physical examination are the initial approaches to rule out underlying disease that requires urgent attention. Clinical and evidence-based approaches to management suggest avoiding early MRI or CT, as imaging in elderly patients has proven both impractical and uneconomical. Instead, good clinical judgment should be used for making diagnoses. Consensus on the best initial approaches for managing CLBP has not yet been achieved, and conservative therapy is suggested, varying from use of pharmacologic agents, physical therapy, electrical stimulation, and physical manipulations to epidural injections. Surgical alternatives are avoided due to confounding and multiple comorbidities in older patients.
11
Wald, Ron, and Ziv Harel. The Long-Term Outcomes of Acute Kidney Injury. Oxford University Press, 2014. http://dx.doi.org/10.1093/med/9780199653461.003.0015.
Abstract:
Recent research has provided important insights on the long-term outcomes of patients who develop acute kidney injury (AKI) in the setting of critical illness. Large epidemiologic studies have demonstrated compelling associations between episodes of AKI and progressive kidney disease and death, respectively, although such studies do not establish causality due to the potential for confounding. Whether AKI is intrinsically toxic or a mere by-product of serious comorbidities (e.g. prior chronic kidney disease, heart failure, diabetes), there is no doubt that AKI survivors are a high-risk group who would likely benefit from close post-discharge follow-up. Recent studies have shown that a minority of patients with AKI receive specialized nephrology follow-up after discharge, suggesting an opportunity for quality improvement. Emerging research is evaluating factors that predict chronic kidney disease, end-stage renal disease, and death among AKI survivors. This work will, it is hoped, suggest new targets for prevention and treatment, with the goal of enhancing the likelihood of recovery following AKI.
12
Remington, Gary, Ofer Agid, Hiroyoshi Takeuchi, Jimmy Lee, and Araba Chintoh. Ultra-treatment resistance. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198828761.003.0012.
Abstract:
Ultra-treatment resistance or ultra-resistant schizophrenia is defined as describing individuals who meet criteria for treatment-resistant schizophrenia and receive an adequate trial of clozapine in the absence of other confounding factors that might compromise response (e.g. substance abuse, antipsychotic non-adherence), but demonstrate a suboptimal response. Because the definition currently hinges on a trial of clozapine, ‘clozapine-resistant schizophrenia’ has also been proposed as a more precise descriptor. This chapter reviews issues specific to classifying this subpopulation, including existing criteria and challenges in their clinical application. It also underscores the importance of this conceptual framework in terms of better understanding schizophrenia’s heterogeneity and the opportunity to establish different pathophysiological subtypes, in this case based on treatment response. It reviews existing evidence specific to this sample, which at this point is limited as only recently have efforts begun to isolate these individuals for the purpose of investigation. Finally, it highlights the dynamic nature of this strategy, since gains in understanding will demand that the framework, terminology, and criteria be continuously revisited and revised.
13
Bhopal, Raj S. Concepts of Epidemiology. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198739685.001.0001.
Abstract:
Epidemiology is a population science that underpins health improvement and health care, and is concerned with the pattern, frequency, trends, and causes of disease. This book teaches its applications to population health research, policy-making, health service planning, health promotion, and clinical care. The book emphasizes concepts and principles. In 10 chapters, the book explains what epidemiology is; illustrates the basis of epidemiology in populations; provides a framework for analysing diseases by time, place, and person; introduces error, bias, and confounding; explains how we move from association to causation; considers the natural history, spectrum, and iceberg of disease in relation to medical screening; discusses the acquisition and analysis of data on incidence and prevalence of risk factors and diseases; shows the ways in which epidemiological data are presented, including relative and absolute risks; provides an integrated overview of study designs and the principles of data analysis; and considers the theoretical and ethical basis of epidemiology both in the past and the future. The emphasis is on interactive learning, with each chapter including learning objectives, theoretical and numerical exercises, questions and answers, and a summary. The text is illustrated, with detailed material in tables. The book is written in plain English, and the necessary technical and specialized terminology is explained and defined in a glossary. The book is for postgraduate courses in epidemiology, public health, and health policy. It is also suitable for clinicians, undergraduate students in medicine, nursing and other health disciplines, and researchers.
14
Barsoum, Rashad S. Schistosomiasis. Edited by Neil Sheerin. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199592548.003.0182_update_001.
Abstract:
AbstractSchistosomiasis is a parasitic disease that affects millions of people in 78 countries, where it is held responsible for considerable morbidity and mortality. It is caused by a blood fluke, which provokes an immunological response to hundreds of its antigens. This induces multi-organ pathology through the formation of tissue granulomata or circulating immune complexes. In addition, it is amyloidogenic and carcinogenic, through the interaction of immunological perturbation with confounding metabolic and genetic factors. The primary targets of schistosomiasis are urinary and hepatointestinal.The lower urinary tract is mainly affected in S. haematobium infection, and may lead to chronic pyelonephritis and/or obstructive nephropathy. The colon and liver are the targets of S. mansoni and S. japonicum infection, leading to hepatic fibrosis, portal hypertension, and liver failure. S. mansoni may also lead to immune complex glomerulonephritis, which is discussed elsewhere. Both S. haematobium and S. mansoni ova may be carried with the venous circulation to the lungs, where they provoke granulomatous and immune-mediated endothelial injury leading to cor-pulmonale. Ova may be subsequently carried with the arterial circulation to form ‘metastatic’ granulomas in other tissues, notably the brain (S. japonicum), spinal cord (S. haematobium), skin, conjunctiva, and genital organs.Schistosomiasis is preventable. World Health Organization programmes have successfully eradicated or reduced the incidence of infection in many countries, particularly Egypt and China. Prevention strategies include health education, raising hygiene standards, and interruption of the parasite’s life cycle by snail control and mass treatment. The search for a vaccine continues. Effective antiparasitic treatment is now possible with high elimination rates. Available agents include praziquantel and artemether for all species, metrifonate for S. haematobium, and oxamniquine for S. mansoni. Successful outcome correlates with early intervention, before fibrosis has occurred.
15
Barsoum, Rashad S. Schistosomiasis. Edited by Vivekanand Jha. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199592548.003.0194_update_001.
Abstract:
The urinary system is the primary target of Schistosoma haematobium infection, which leads to granuloma formation in the lower urinary tract that heals with fibrosis and calcification. While the early lesions may be associated with distressing acute or subacute symptoms, it is the late lesions that constitute the main clinical impact of schistosomiasis. The latter include chronic cystitis, ureteric fibrosis, ureterovesical obstruction or reflux which may lead to chronic pyelonephritis. Secondary bacterial infection and bladder cancer are the main secondary sequelae of urinary schistosomiasis.The kidneys are also a secondary target of S. mansoni infection, attributed to the systemic immune response to the parasite. Specific immune complexes are responsible for early, often asymptomatic, possibly reversible, mesangioproliferative lesions which are categorized as ‘class I’. Subsequent classes (II–VI) display different histopathology, more serious clinical disease, and confounding pathogenic factors. Class II lesions are encountered in patients with concomitant salmonellosis; they are typically exudative and associated with acute-onset nephrotic syndrome. Classes III (mesangiocapillary glomerulonephritis) and IV (focal segmental sclerosis) are progressive forms of glomerular disease associated with significant hepatic pathology. They are usually associated with immunoglobulin A deposits which seem to have a significant pathogenic role. Class V (amyloidosis) occurs with long-standing active infection with either S. haematobium or S. mansoni. Class VI is seen in patients with concomitant HCV infection, where the pathology is a mix of schistosomal and cryoglobulinaemic lesions, as well as amyloidosis which seems to be accelerated by the confounded pathogenesis.Early schistosomal lesions, particularly those of the lower urinary tract, respond to antiparasitic treatment. Late urological lesions may need surgery or endoscopic interventions. As a rule, glomerular lesions do not respond to treatment with the exception of class II where dual antiparasitic and antibiotic therapy is usually curative. Patients with end-stage kidney disease may constitute specific, yet not insurmountable technical and logistic problems in dialysis or transplantation. Recurrence after transplantation is rare.