Multiple Risk / Causation: From 1 Different Sources
More than one risk factor for the development of a disease or other outcome is present and their combined presence results in an increased risk. The increased risk may be due to the additive effects of the risks associated with the separate risk factors, or to synergism.
A chronic, usually progressive disease of the central nervous system, with the gradual patchy disorganization of the protective myelin cells. It is almost certainly an auto-immune disorder, although viral infections sometimes seem to initiate the condition, and physical trauma is often seen to anomalously precede the first symptoms.... multiple sclerosis
An aspect of personal behaviour or lifestyle, an environmental exposure, or an inborn or inherited characteristic, which, on the basis of scientific evidence, is known to be associated with health-related condition(s) considered important to prevent.... risk factor
The function of identifying and assessing problems that could occur and bring about losses legally, clinically or financially.... risk management
See RISK REGISTER.... at-risk register
The individual with this psychiatric disorder has two or more di?erent personalities, often contrasting. The dominant personality at the time determines the behaviour and attitude of the individual, who customarily seems not to know about the other personality – or personalities. The switch from one personality to another is abrupt and the mental condition of the di?ering personalities is usually normal. It is possible that child abuse is a factor in the disorder, which is treated by psychotherapy. The classic multiple personality was the ?ctional form of Dr Jekyll and Mr Hyde.... multiple personality disorder
The probability that an event will occur.... risk
The qualitative or quantitative estimation of the likelihood of adverse effects that may result from exposure to specified health hazards or from the absence of beneficial influences.... risk assessment
The process of analysing and comparing, on a single scale, the expected positive (benefits) and negative (risks, costs) results of an action, or lack of an action.... risk-benefit analysis
The probability of an event in a population as contrasted with relative risk. See “relative risk”.... absolute risk
A measure of treatment effect that compares the probability (or mean) of a type of outcome in the control group with that of a treatment group.... absolute risk reduction
A risk that has minimal detrimental effects or for which the benefits outweigh the potential hazards.... acceptable risk
In a total population, the proportion of disease incidence, or risk of the disease, that can be attributed to exposure to a specific risk factor; the difference between the risk in the total population and the risk in the unexposed group.... attributable risk
Initially driven by anxiety about the possibility of medical negligence cases, clinical risk management has evolved into the study of IATROGENIC DISEASE. The ?rst priority of risk managers is to ensure that all therapies in medicine are as safe as possible. Allied to this is a recognition that errors may occur even when error-prevention strategies are in place. Lastly, any accidents that occur are analysed, allowing a broader understanding of their cause. Risk management is generally centred on single adverse events. The threat of litigation is taken as an opportunity to expose unsafe conditions of practice and to put pressure on those with the authority to implement change. These might include senior clinicians, hospital management, the purchasing authorities, and even the Secretary of State for Health. Attention is focused on organisational factors rather than on the individuals involved in a speci?c case.... clinical risk management
The process of gathering, analysing and comparing an individual’s prognostic health characteristics with a standard age group, thereby predicting the likelihood that a person may develop a health problem.... health risk appraisal
A chemical, psychological, physiological, social, environmental or genetic factor or conditions that predisposes an individual to the development of a disease or injury.... health risk factor
Twins occur about once in 80 pregnancies, triplets once in 6,000, and quadruplets about once in 500,000. Quintuplets are exceedingly rare. Such is the natural state of a?airs.
In recent years, however, the position has been altered by the introduction of the so-called fertility drugs, such as CLOMIPHENE, and human menopausal gonadotrophin which, through the medium of the PITUITARY GLAND, stimulate the production of ova (see OVUM). Their wide use in the treatment of INFERTILITY has resulted in an increase in the number of multiple births, a recognised hazard of giving too large a dose.
Twins may be binovular or uniovular. Binovular, or fraternal, twins are the result of the mother’s releasing two ova within a few days of each other and both being fertilised by separate spermatozoa (see SPERMATOZOON). They both develop separately in the mother’s womb and are no more alike than is usual with members of the same family. They are three times as common as uniovular, or identical, twins, who are developed from a single ovum fertilised by a single spermatozoon, but which has split early in development. This is why they are usually so remarkably alike in looks and mental characteristics. Unlike binovular twins, who may be of the same or di?erent sex, they are always of the same sex.
So far as fraternal, or binovular, twins are concerned, multiple pregnancy may be an inherited tendency; it certainly occurs more often in certain families, but this may be partly due to chance. A woman who has already given birth to twins is ten times more likely to have another multiple pregnancy than one who has not previously had twins. The statistical chance of a third pair of twins is 1:512,000. Identical twins do not run in families.
The relative proportion of twins of each type varies in di?erent races. Identical twins have much the same frequency all over the world: around 3 per 1,000 maternities. Fraternal twins are rare in Mongolian races: less than 3 per 1,000 maternities. In Caucasians they occur two or three times as often as identical twins: between 7 (Spain and Portugal) and 10 (Czech and Slovak Republics and Greece) per 1,000 maternities. They are more common in Afro-Caribbeans, reaching 30 per 1,000 maternities in certain West African populations.
Rarely, uniovular twins may not develop as separate individuals, being physically joined in some way. They are called conjoined or (traditionally) Siamese twins. Depending on the extent of common structures shared by the infants – this ranges from a common umbilical cord to twins with conjoined heads or a common liver – the infants may be successfully separated by surgery. (See CONJOINED TWINS.)
Parents of twins, triplets, etc. can obtain advice and help from the Twins and Multiple Births Association (TAMBA).... multiple births
The ratio of the risk of disease or death among the exposed to the risk among the unexposed; this usage is synonymous with risk ratio.... relative risk
Multiple sclerosis is a progressive disease of the BRAIN and SPINAL CORD, which, although slow in its onset, in time may produce marked symptoms such as PARALYSIS and tremors (see TREMOR), and may ultimately result in a severely disabled invalid. The disorder consists of hardened patches, from the size of a pin-head to that of a pea or larger, scattered here and there irregularly through the brain and spinal cord. Each patch is made up of a mass of the CONNECTIVE TISSUE (neuroglia), which should be present only in su?cient amount to bind the nerve-cells and ?bres together. In the earliest stage, the insulating sheaths (MYELIN) of the nerve-?bres in the hardened patches break up, are absorbed, and leave the nerve-?bres bare, the connective tissue being later formed between these.
Cause Although this is one of the most common diseases of the central nervous system in Europe – there are around 50,000 affected individuals in Britain alone – the cause is still not known. The disease comes on in young people (onset being rare after the age of 40), apparently without previous illness. The ratio of women-to-men victims is 3:2. It is more common in ?rst and second children than in those later in birth order, and in small rather than big families. There may be a hereditary factor for MS, which could be an autoimmune disorder: the body’s defence system attacks the myelin in the central nervous system as if it were a ‘foreign’ tissue.
Symptoms These depend greatly upon the part of the brain and cord affected by the sclerotic patches. Temporary paralysis of a limb, or of an eye muscle, causing double vision, and tremors upon exertion, ?rst in the affected parts, and later in all parts of the body, are early symptoms. Sti?ness of the lower limbs causing the toes to catch on small irregularities in the ground and trip the person in walking, is often an annoying symptom and one of the ?rst to be noticed. Great activity is shown in the re?ex movements obtained by striking the tendons and by stroking the soles of the feet. The latter re?ex shows a characteristic sign (Babinski sign) in which the great toe bends upwards and the other toes spread apart as the sole is stroked, instead of the toes collectively bending downwards as in the normal person. Tremor of the eye movements (nystagmus) is usually found. Trembling handwriting, interference with the functions of the bladder, giddiness, and a peculiar ‘staccato’ or ‘scanning’ speech are common symptoms at a later stage. Numbness and tingling in the extremities occur commonly, particularly in the early stages of the disease. As the disease progresses, the paralyses, which were transitory at ?rst, now become con?rmed, often with great rigidity in the limbs. In many patients the disease progresses very slowly.
People with multiple sclerosis, and their relatives, can obtain help and guidance from the Multiple Sclerosis Society. Another helpful organisation is the Multiple Sclerosis Resources Centre. Those with sexual or marital problems arising out of the illness can obtain information from SPOD (Association to Aid the Sexual and Personal Relationships of People with a Disability). (See APPENDIX 2: ADDRESSES: SOURCES OF INFORMATION, ADVICE, SUPPORT AND SELFHELP.)
Treatment is di?cult, because the most that can be done is to lead a life as free from strain as possible, to check the progress of the disease. The use of INTERFERON beta seems to slow the progress of MS and this drug is licensed for use in the UK for patients with relapsing, remitting MS over two years, provided they can walk unaided – a controversial restriction on this (expensive) treatment. CORTICOSTEROIDS may be of help to some patients.
The NATIONAL INSTITUTE FOR CLINICAL EXCELLENCE (NICE) ruled in 2001 that the use of the drugs interferon beta and glatiramer acetate for patients with multiple sclerosis was not cost-e?ective but recommended that the Department of Health, the National Assembly for Wales and the drug manufacturers should consider ways of making the drugs available in a cost-e?ective way. Subsequently the government said that it would consider funding a ‘risk-sharing’ scheme in which supply of drugs to patients would be funded only if treatment trials in individuals with MS showed that they were e?ective.
The Department of Health has asked NICE to assess two CANNABIS derivatives as possible treatments for multiple sclerosis and the relief of post-operative pain. Trials of an under-thetongue spray and a tablet could, if successsful, lead to the two drugs being available around 2005.
It is important to keep the nerves and muscles functioning, and therefore the patient should remain at work as long as he or she is capable of doing it, and in any case should exercise regularly.... multiple sclerosis (ms)
An approach consisting of identifying and devoting more care to individuals or groups who, for biological, environmental or socioeconomic reasons, are at special risk of having their health impaired, contracting a specific disease, or having inadequate attention paid to their health problems.... risk approach
The practice of bringing several risks together for insurance purposes in order to balance the consequences of the realization of each individual risk.... risk pooling
Risk rating means that high-risk individuals will pay more than the average premium price.... risk rating
The practice of singling out or disaggregating a particular risk from a pool of insured risks.... risk selection
The distribution of financial risk among parties furnishing a service. For example, if a hospital and a group of medical practitioners form a corporation to provide health care at a fixed price, a risk-sharing arrangement would entail both the hospital and the group being held liable if expenses were to exceed revenues.... risk sharing
A rare disorder in which a person has 2 or more distinct personalities, each of which dominates at different times. The personalities are usually very different from each other.... multiple personality
See pregnancy, multiple.... multiple pregnancy
See multiple myeloma.... myeloma, multiple
an assessment tool that predicts a ten-year risk of developing cardiovascular disease based on gender, age, total and HDL cholesterol, blood pressure, and smoking, thereby enabling preventative treatment. It does not incorporate the presence of diabetes or familial history of cardiovascular disease into the scoring.... framingham risk score
see exostosis.... hereditary multiple exostoses
(MEN) see MENS.... multiple endocrine neoplasia
(MODS, multi-organ failure, multiple organ failure, MOF) a common cause of death following severe injury, overwhelming infection, or immune deficiency states.... multiple organ dysfunction syndrome
(MSA) a condition that results from degeneration of cells in the *basal ganglia (resulting in *parkinsonism), the *cerebellum (resulting in *ataxia), the *pyramidal system, and the *autonomic nervous system (resulting in symptoms of autonomic failure, such as postural hypotension).... multiple system atrophy
(RMI) a scoring system that combines ultrasound findings, menopausal status and age, and serum CA125 levels to give an estimate of the risk of malignancy in a woman with a mass in the Fallopian tubes or ovaries. If the total RMI score is <200 the risk of malignancy is considered to be low. If the total RMI score is >200 the chances of malignancy are raised and management should be planned with a gynaecological oncologist.... risk of malignancy index
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