Science.gov

Sample records for brazil predictive risk

  1. Predictive qualitative risk model of bovine rabies occurrence in Brazil.

    PubMed

    Braga, Guilherme Basseto; Grisi-Filho, José Henrique Hildebrand; Leite, Bruno Meireles; de Sena, Elaine Fátima; Dias, Ricardo Augusto

    2014-03-01

    Bovine rabies remains endemic in Brazil and despite control efforts, the disease still spreads insidiously. The main vector is the hematophagous bat, Desmodus rotundus. The present work aimed to create a predictive qualitative model of the occurrence of bovine rabies in each municipality in 25 of the 27 Brazilian States. The risk of rabies transmission from bats to bovine was estimated using decision-tree models of receptivity and vulnerability. Questionnaires, which covered a number of questions related to the surveillance of possible risk factors, such as bovine rabies outbreaks in the previous year, the presence of bat roosts, bat rabies positivity and environmental changes, were sent to the local veterinary units of each State. The bovine density and geomorphologic features were obtained from national databases and geographic information systems. Of the 433 municipalities presenting bovine rabies outbreaks in 2010, 178 (41.1%) were classified by the model as high risk, 212 (49.0%) were classified as moderate risk, 25 (5.8%) were classified as low risk, whereas the risk was undetermined in 18 municipalities (4.1%). An ROC curve was built to determine if the risk evaluated by the model could adequately discriminate between municipalities with and without rabies occurrence in future years. The risk estimator for the year 2011 was classified as moderately accurate. In the future, these models could allow the targeting of rabies control efforts, with the adoption of control measures directed to the higher risk locations and the optimization of the field veterinary staff deployment throughout the country. Additionally, efforts must be made to encourage continuous surveillance of risk factors. PMID:24433635

  2. Predictive risk mapping of schistosomiasis in Brazil using Bayesian geostatistical models.

    PubMed

    Scholte, Ronaldo G C; Gosoniu, Laura; Malone, John B; Chammartin, Frédérique; Utzinger, Jürg; Vounatsou, Penelope

    2014-04-01

    Schistosomiasis is one of the most common parasitic diseases in tropical and subtropical areas, including Brazil. A national control programme was initiated in Brazil in the mid-1970s and proved successful in terms of morbidity control, as the number of cases with hepato-splenic involvement was reduced significantly. To consolidate control and move towards elimination, there is a need for reliable maps on the spatial distribution of schistosomiasis, so that interventions can target communities at highest risk. The purpose of this study was to map the distribution of Schistosoma mansoni in Brazil. We utilized readily available prevalence data from the national schistosomiasis control programme for the years 2005-2009, derived remotely sensed climatic and environmental data and obtained socioeconomic data from various sources. Data were collated into a geographical information system and Bayesian geostatistical models were developed. Model-based maps identified important risk factors related to the transmission of S. mansoni and confirmed that environmental variables are closely associated with indices of poverty. Our smoothed predictive risk map, including uncertainty, highlights priority areas for intervention, namely the northern parts of North and Southeast regions and the eastern part of Northeast region. Our predictive risk map provides a useful tool for to strengthen existing surveillance-response mechanisms. PMID:24361640

  3. Chikungunya risk for Brazil

    PubMed Central

    Azevedo, Raimunda do Socorro da Silva; Oliveira, Consuelo Silva; Vasconcelos, Pedro Fernando da Costa

    2015-01-01

    This study aimed to show, based on the literature on the subject, the potential for dispersal and establishment of the chikungunya virus in Brazil. The chikungunya virus, a Togaviridae member of the genus Alphavirus, reached the Americas in 2013 and, the following year, more than a million cases were reported. In Brazil, indigenous transmission was registered in Amapa and Bahia States, even during the period of low rainfall, exposing the whole country to the risk of virus spreading. Brazil is historically infested by Ae. aegypti and Ae. albopictus, also dengue vectors. Chikungunya may spread, and it is important to take measures to prevent the virus from becoming endemic in the country. Adequate care for patients with chikungunya fever requires training general practitioners, rheumatologists, nurses, and experts in laboratory diagnosis. Up to November 2014, more than 1,000 cases of the virus were reported in Brazil. There is a need for experimental studies in animal models to understand the dynamics of infection and the pathogenesis as well as to identify pathophysiological mechanisms that may contribute to identifying effective drugs against the virus. Clinical trials are needed to identify the causal relationship between the virus and serious injuries observed in different organs and joints. In the absence of vaccines or effective drugs against the virus, currently the only way to prevent the disease is vector control, which will also reduce the number of cases of dengue fever. PMID:26398876

  4. Chikungunya risk for Brazil.

    PubMed

    Azevedo, Raimunda do Socorro da Silva; Oliveira, Consuelo Silva; Vasconcelos, Pedro Fernando da Costa

    2015-01-01

    This study aimed to show, based on the literature on the subject, the potential for dispersal and establishment of the chikungunya virus in Brazil. The chikungunya virus, a Togaviridae member of the genusAlphavirus, reached the Americas in 2013 and, the following year, more than a million cases were reported. In Brazil, indigenous transmission was registered in Amapa and Bahia States, even during the period of low rainfall, exposing the whole country to the risk of virus spreading. Brazil is historically infested by Ae. aegypti and Ae. albopictus, also dengue vectors. Chikungunya may spread, and it is important to take measures to prevent the virus from becoming endemic in the country. Adequate care for patients with chikungunya fever requires training general practitioners, rheumatologists, nurses, and experts in laboratory diagnosis. Up to November 2014, more than 1,000 cases of the virus were reported in Brazil. There is a need for experimental studies in animal models to understand the dynamics of infection and the pathogenesis as well as to identify pathophysiological mechanisms that may contribute to identifying effective drugs against the virus. Clinical trials are needed to identify the causal relationship between the virus and serious injuries observed in different organs and joints. In the absence of vaccines or effective drugs against the virus, currently the only way to prevent the disease is vector control, which will also reduce the number of cases of dengue fever. PMID:26398876

  5. Shallow landslide prediction and analysis with risk assessment using a spatial model in the coastal region in the state of São Paulo, Brazil

    NASA Astrophysics Data System (ADS)

    Camarinha, P. I. M.; Canavesi, V.; Alvalá, R. C. S.

    2013-10-01

    In Brazil, most of the disasters involving landslide occur in coastal regions, with population density concentrated on steep slopes. Thus, different approaches have been used to evaluate the landslide risk, although the greatest difficulty is related to the scarcity of spatial data with good quality. In this context, four cities located on the southeast coast of Brazil - Santos, Cubatão, Caraguatatuba and Ubatuba - in a region with the rough reliefs of the Serra do Mar and with a history of natural disasters were evaluated. Spatial prediction by fuzzy gamma technique was used for the landslide susceptibility mapping, considering environmental variables from data and software in the public domain. To validate the susceptibility mapping results, it was overlapped with risk sectors provided by the Geological Survey of Brazil (CPRM). A positive correlation was observed between the classes most susceptible and the location of these sectors. The results were also analyzed from the categorization of risk levels provided by CPRM. To compare the approach with other studies using landslide-scar maps, correlated indexes were evaluated, which also showed satisfactory results, thus indicating that the methodology presented is appropriate for risk assessment in urban areas and can be replicated to municipalities that do not have risk areas mapped.

  6. Prediction of health risk due to polycyclic aromatic hydrocarbons present in urban air in Rio de Janeiro, Brazil.

    PubMed

    Rainho, C R; Velho, A M A; Corrêa, S M; Mazzei, J L; Aiub, C A F; Felzenszwalb, I

    2013-01-01

    Risk assessment can provide a comprehensive estimate of potential effects of contaminants under specific, well-defined, and well-described circumstances, providing quantitative relationships between exposure and effects to identify and to define areas of concern. We investigated the mutagenic activity of particulate matter in air samples collected from three sites in Rio de Janeiro city. Samples were collected using a high-volume sampler at Avenida Brasil, at Campus of Universidade do Estado do Rio de Janeiro, and at Rebouças Tunnel. Six polycyclic aromatic hydrocarbons were quantified by gas chromatography/mass spectrometry. Salmonella typhimurium TA98 and the derivative strains TA98/1.8-DNP(6), YG1021, and YG1024, commonly used in mutagenicity assays, were treated (10-50 µg/plate), with and without exogenous metabolization. The highest values for the polycyclic aromatic hydrocarbons were detected at Rebouças Tunnel. For chrysene, as an example, the concentration was nearly 200 times higher than that established by the US Environmental Protection Agency. Frequent traffic jams can place bus drivers who go through the Rebouças Tunnel at risk of exposure to up to 0.69 ng/m(3) benzo(a) pyrene. Independent of exogenous metabolization, mutagenicity was detected in strains YG1021 and YG1024 at all the sites, suggesting nitro and amino derivatives of polycyclic aromatic hydrocarbons. Rebouças Tunnel air samples gave the highest values for rev/µg and rev/m(3). This could be due to the fact that the long, enclosed passageway through a mountain restricts ventilation. The cancer risk estimate in this study was 10(-3) for the benzo(a)pyrene, at the two sites, indicating a high risk. PMID:23479151

  7. Hepatitis B virus infection in Haemodialysis Centres from Santa Catarina State, Southern Brazil. Predictive risk factors for infection and molecular epidemiology

    PubMed Central

    Carrilho, Flair J; Moraes, Cleusa R; Pinho, João RR; Mello, Isabel MVGC; Bertolini, Dennis A; Lemos, Marcílio F; Moreira, Regina C; Bassit, Leda C; Cardoso, Rita A; Ribeiro-dos-Santos, Gabriela; Da Silva, Luiz C

    2004-01-01

    Background Patients under haemodialysis are considered at high risk to acquire hepatitis B virus (HBV) infection. Since few data are reported from Brazil, our aim was to assess the frequency and risk factors for HBV infection in haemodialysis patients from 22 Dialysis Centres from Santa Catarina State, south of Brazil. Methods This study includes 813 patients, 149 haemodialysis workers and 772 healthy controls matched by sex and age. Serum samples were assayed for HBV markers and viraemia was detected by nested PCR. HBV was genotyped by partial S gene sequencing. Univariate and multivariate statistical analyses with stepwise logistic regression analysis were carried out to analyse the relationship between HBV infection and the characteristics of patients and their Dialysis Units. Results Frequency of HBV infection was 10.0%, 2.7% and 2.7% among patients, haemodialysis workers and controls, respectively. Amidst patients, the most frequent HBV genotypes were A (30.6%), D (57.1%) and F (12.2%). Univariate analysis showed association between HBV infection and total time in haemodialysis, type of dialysis equipment, hygiene and sterilization of equipment, number of times reusing the dialysis lines and filters, number of patients per care-worker and current HCV infection. The logistic regression model showed that total time in haemodialysis, number of times of reusing the dialysis lines and filters, and number of patients per worker were significantly related to HBV infection. Conclusions Frequency of HBV infection among haemodialysis patients at Santa Catarina state is very high. The most frequent HBV genotypes were A, D and F. The risk for a patient to become HBV positive increase 1.47 times each month of haemodialysis; 1.96 times if the dialysis unit reuses the lines and filters ≥ 10 times compared with haemodialysis units which reuse < 10 times; 3.42 times if the number of patients per worker is more than five. Sequence similarity among the HBV S gene from isolates

  8. Melanoma Risk Prediction Models

    Cancer.gov

    Developing statistical models that estimate the probability of developing melanoma cancer over a defined period of time will help clinicians identify individuals at higher risk of specific cancers, allowing for earlier or more frequent screening and counseling of behavioral changes to decrease risk.

  9. Cancer Risk Prediction and Assessment

    Cancer.gov

    Cancer prediction models provide an important approach to assessing risk and prognosis by identifying individuals at high risk, facilitating the design and planning of clinical cancer trials, fostering the development of benefit-risk indices, and enabling estimates of the population burden and cost of cancer.

  10. Risk prediction for invasive candidiasis

    PubMed Central

    Ahmed, Armin; Azim, Afzal; Baronia, Arvind Kumar; Marak, K. Rungmei S. K.; Gurjar, Mohan

    2014-01-01

    Over past few years, treatment of invasive candidiasis (IC) has evolved from targeted therapy to prophylaxis, pre-emptive and empirical therapy. Numerous predisposing factors for IC have been grouped together in various combinations to design risk prediction models. These models in general have shown good negative predictive value, but poor positive predictive value. They are useful in selecting the population which is less likely to benefit from empirical antifungal therapy and thus prevent overuse of antifungal agents. Current article deals with various risk prediction models for IC and their external validation studies. PMID:25316979

  11. Neuroanatomy Predicts Individual Risk Attitudes

    PubMed Central

    Gilaie-Dotan, Sharon; Tymula, Agnieszka; Cooper, Nicole; Kable, Joseph W.; Glimcher, Paul W.

    2014-01-01

    Over the course of the last decade a multitude of studies have investigated the relationship between neural activations and individual human decision-making. Here we asked whether the anatomical features of individual human brains could be used to predict the fundamental preferences of human choosers. To that end, we quantified the risk attitudes of human decision-makers using standard economic tools and quantified the gray matter cortical volume in all brain areas using standard neurobiological tools. Our whole-brain analysis revealed that the gray matter volume of a region in the right posterior parietal cortex was significantly predictive of individual risk attitudes. Participants with higher gray matter volume in this region exhibited less risk aversion. To test the robustness of this finding we examined a second group of participants and used econometric tools to test the ex ante hypothesis that gray matter volume in this area predicts individual risk attitudes. Our finding was confirmed in this second group. Our results, while being silent about causal relationships, identify what might be considered the first stable biomarker for financial risk-attitude. If these results, gathered in a population of midlife northeast American adults, hold in the general population, they will provide constraints on the possible neural mechanisms underlying risk attitudes. The results will also provide a simple measurement of risk attitudes that could be easily extracted from abundance of existing medical brain scans, and could potentially provide a characteristic distribution of these attitudes for policy makers. PMID:25209279

  12. Neuroanatomy predicts individual risk attitudes.

    PubMed

    Gilaie-Dotan, Sharon; Tymula, Agnieszka; Cooper, Nicole; Kable, Joseph W; Glimcher, Paul W; Levy, Ifat

    2014-09-10

    Over the course of the last decade a multitude of studies have investigated the relationship between neural activations and individual human decision-making. Here we asked whether the anatomical features of individual human brains could be used to predict the fundamental preferences of human choosers. To that end, we quantified the risk attitudes of human decision-makers using standard economic tools and quantified the gray matter cortical volume in all brain areas using standard neurobiological tools. Our whole-brain analysis revealed that the gray matter volume of a region in the right posterior parietal cortex was significantly predictive of individual risk attitudes. Participants with higher gray matter volume in this region exhibited less risk aversion. To test the robustness of this finding we examined a second group of participants and used econometric tools to test the ex ante hypothesis that gray matter volume in this area predicts individual risk attitudes. Our finding was confirmed in this second group. Our results, while being silent about causal relationships, identify what might be considered the first stable biomarker for financial risk-attitude. If these results, gathered in a population of midlife northeast American adults, hold in the general population, they will provide constraints on the possible neural mechanisms underlying risk attitudes. The results will also provide a simple measurement of risk attitudes that could be easily extracted from abundance of existing medical brain scans, and could potentially provide a characteristic distribution of these attitudes for policy makers. PMID:25209279

  13. Shallow landslide prediction and analysis with risk assessment using a spatial model in a coastal region in the state of São Paulo, Brazil

    NASA Astrophysics Data System (ADS)

    Camarinha, P. I. M.; Canavesi, V.; Alvalá, R. C. S.

    2014-09-01

    This study presents a methodology for susceptibility mapping of shallow landslides just from data and software from the public domain. The study was conducted in a mountainous region located on the southeastern Brazilian coast, in the state of São Paulo. The proposal is that the methodology can be replicated in a practical and reliable way in several other municipalities that do not have such mappings and that often suffer from landslide-related disasters. The susceptibility mapping was generated based on the following maps: geological, soils, slope, horizontal and vertical curvatures, and land use. The thematic classes of these maps were weighted according to technical and scientific criteria related to the triggering of landslides, and were crossed by the fuzzy gamma technique. The mapping was compared with the risk sector survey made by the Brazilian Geological Survey (CPRM), which is the official database used by municipalities and civil defense in risk management. The results showed positive correlations, so that the critical risk sectors had higher proportions for the more susceptible classes. To compare the approach with other studies using landslide-scar maps, correlated indices were evaluated, which also showed satisfactory results, thus indicating that the methodology presented is appropriate for risk assessment in urban areas.

  14. Developmental dyslexia: predicting individual risk

    PubMed Central

    Thompson, Paul A; Hulme, Charles; Nash, Hannah M; Gooch, Debbie; Hayiou-Thomas, Emma; Snowling, Margaret J

    2015-01-01

    Background Causal theories of dyslexia suggest that it is a heritable disorder, which is the outcome of multiple risk factors. However, whether early screening for dyslexia is viable is not yet known. Methods The study followed children at high risk of dyslexia from preschool through the early primary years assessing them from age 3 years and 6 months (T1) at approximately annual intervals on tasks tapping cognitive, language, and executive-motor skills. The children were recruited to three groups: children at family risk of dyslexia, children with concerns regarding speech, and language development at 3;06 years and controls considered to be typically developing. At 8 years, children were classified as ‘dyslexic’ or not. Logistic regression models were used to predict the individual risk of dyslexia and to investigate how risk factors accumulate to predict poor literacy outcomes. Results Family-risk status was a stronger predictor of dyslexia at 8 years than low language in preschool. Additional predictors in the preschool years include letter knowledge, phonological awareness, rapid automatized naming, and executive skills. At the time of school entry, language skills become significant predictors, and motor skills add a small but significant increase to the prediction probability. We present classification accuracy using different probability cutoffs for logistic regression models and ROC curves to highlight the accumulation of risk factors at the individual level. Conclusions Dyslexia is the outcome of multiple risk factors and children with language difficulties at school entry are at high risk. Family history of dyslexia is a predictor of literacy outcome from the preschool years. However, screening does not reach an acceptable clinical level until close to school entry when letter knowledge, phonological awareness, and RAN, rather than family risk, together provide good sensitivity and specificity as a screening battery. PMID:25832320

  15. Risk factors for ocular toxoplasmosis in Brazil.

    PubMed

    Ferreira, A I C; De Mattos, C C Brandão; Frederico, F B; Meira, C S; Almeida, G C; Nakashima, F; Bernardo, C R; Pereira-Chioccola, V L; De Mattos, L C

    2014-01-01

    The aim of this study was to investigate risk factors for ocular toxoplasmosis (OT) in patients who received medical attention at a public health service. Three hundred and forty-nine consecutive patients, treated in the Outpatient Eye Clinic of Hospital de Base, São José do Rio Preto, São Paulo state, Brazil, were enrolled in this study. After an eye examination, enzyme-linked immunosorbent assay (ELISA) was used to determine anti-Toxoplasma gondii antibodies. The results showed that 25.5% of the patients were seronegative and 74.5% were seropositive for IgG anti-T. gondii antibodies; of these 27.3% had OT and 72.7% had other ocular diseases (OOD). The presence of cats or dogs [odds ratio (OR) 2.22, 95% confidence interval (CI) 1.24-3.98, P = 0.009] and consumption of raw or undercooked meat (OR 1.77, 95% CI 1.05-2.98, P = 0.03) were associated with infection but not with the development of OT. Age (OT 48.2 ± 21.2 years vs. OOD: 69.5 ± 14.7 years, P < 0.0001) and the low level of schooling/literacy (OT vs. OOD: OR 0.414, 95% CI 0.2231-0.7692, P = 0.007) were associated with OT. The presence of dogs and cats as well as eating raw/undercooked meat increases the risk of infection, but is not associated with the development of OT. PMID:23507508

  16. Evaluating probabilistic dengue risk forecasts from a prototype early warning system for Brazil.

    PubMed

    Lowe, Rachel; Coelho, Caio As; Barcellos, Christovam; Carvalho, Marilia Sá; Catão, Rafael De Castro; Coelho, Giovanini E; Ramalho, Walter Massa; Bailey, Trevor C; Stephenson, David B; Rodó, Xavier

    2016-01-01

    Recently, a prototype dengue early warning system was developed to produce probabilistic forecasts of dengue risk three months ahead of the 2014 World Cup in Brazil. Here, we evaluate the categorical dengue forecasts across all microregions in Brazil, using dengue cases reported in June 2014 to validate the model. We also compare the forecast model framework to a null model, based on seasonal averages of previously observed dengue incidence. When considering the ability of the two models to predict high dengue risk across Brazil, the forecast model produced more hits and fewer missed events than the null model, with a hit rate of 57% for the forecast model compared to 33% for the null model. This early warning model framework may be useful to public health services, not only ahead of mass gatherings, but also before the peak dengue season each year, to control potentially explosive dengue epidemics. PMID:26910315

  17. [Predictive microbiology and risk assessment].

    PubMed

    Hildebrandt, G; Kleer, J

    2004-05-01

    Predictive microbiology (predictive modelling PM), in spite of its limits and short-comings, may often contribute to a reduction of the problems arising when HACCP systems are established or microbiological risk assessment is done. Having identified the agents which constitute a risk and the contamination rate and density in the raw material, the influences of production steps and storage on these microorganisms have to be examined. Finally, there should be an exposure assessment, i.e. an estimate of the contamination density in the final product at the time of consumption. Should the exposure assessment together with data from dose response assessments reveal a potential for intake of inacceptable numbers of organisms, the risk identified has to be characterized. As a consequence, risk management should result in a modification of the composition of the product and/or of the production process so that the risk does not surpass an acceptable limit. For this approach it is indispensable to have product- and process-specific information on the multiplication of pathogens prior to heat treatment, on reduction of their density by thermal treatment and on growth or dying of organisms having survived heat treatment or penetrated into the product after heat treatment as post-process contaminant. Commonly, challenge tests are conducted to provide such information. But they are time consuming and, as their results are only valid for the specific product tested and the conditions prevailing during the experiment, the have to be repeated if there is any modification of intrinsic or extrinsic factors. At least partially, the PM may replace the challenge tests. The efficiency of the models is rated particularly high if they are used already at the stage of product development when the question has to be answered whether a planned recipe or process of production are already save or have to be modified to become save. PMID:15233338

  18. Blood Pressure Patterns May Predict Stroke Risk

    MedlinePlus

    ... fullstory_158731.html Blood Pressure Patterns May Predict Stroke Risk Odds increase with rapid rise in middle ... overall pattern to predict a patient's risk of stroke or early death, new research suggests. "Our study ...

  19. Developmental Dyslexia: Predicting Individual Risk

    ERIC Educational Resources Information Center

    Thompson, Paul A.; Hulme, Charles; Nash, Hannah M.; Gooch, Debbie; Hayiou-Thomas, Emma; Snowling, Margaret J.

    2015-01-01

    Background: Causal theories of dyslexia suggest that it is a heritable disorder, which is the outcome of multiple risk factors. However, whether early screening for dyslexia is viable is not yet known. Methods: The study followed children at high risk of dyslexia from preschool through the early primary years assessing them from age 3 years and 6…

  20. Liver Cancer Risk Prediction Models

    Cancer.gov

    Developing statistical models that estimate the probability of developing liver cancer over a defined period of time will help clinicians identify individuals at higher risk of specific cancers, allowing for earlier or more frequent screening and counseling of behavioral changes to decrease risk.

  1. Cervical Cancer Risk Prediction Models

    Cancer.gov

    Developing statistical models that estimate the probability of developing cervical cancer over a defined period of time will help clinicians identify individuals at higher risk of specific cancers, allowing for earlier or more frequent screening and counseling of behavioral changes to decrease risk.

  2. Pancreatic Cancer Risk Prediction Models

    Cancer.gov

    Developing statistical models that estimate the probability of developing pancreatic cancer over a defined period of time will help clinicians identify individuals at higher risk of specific cancers, allowing for earlier or more frequent screening and counseling of behavioral changes to decrease risk.

  3. Prostate Cancer Risk Prediction Models

    Cancer.gov

    Developing statistical models that estimate the probability of developing prostate cancer over a defined period of time will help clinicians identify individuals at higher risk of specific cancers, allowing for earlier or more frequent screening and counseling of behavioral changes to decrease risk.

  4. Ovarian Cancer Risk Prediction Models

    Cancer.gov

    Developing statistical models that estimate the probability of developing ovarian cancer over a defined period of time will help clinicians identify individuals at higher risk of specific cancers, allowing for earlier or more frequent screening and counseling of behavioral changes to decrease risk.

  5. Lung Cancer Risk Prediction Models

    Cancer.gov

    Developing statistical models that estimate the probability of developing lung cancer over a defined period of time will help clinicians identify individuals at higher risk of specific cancers, allowing for earlier or more frequent screening and counseling of behavioral changes to decrease risk.

  6. Bladder Cancer Risk Prediction Models

    Cancer.gov

    Developing statistical models that estimate the probability of developing bladder cancer over a defined period of time will help clinicians identify individuals at higher risk of specific cancers, allowing for earlier or more frequent screening and counseling of behavioral changes to decrease risk.

  7. Testicular Cancer Risk Prediction Models

    Cancer.gov

    Developing statistical models that estimate the probability of testicular cervical cancer over a defined period of time will help clinicians identify individuals at higher risk of specific cancers, allowing for earlier or more frequent screening and counseling of behavioral changes to decrease risk.

  8. Colorectal Cancer Risk Prediction Models

    Cancer.gov

    Developing statistical models that estimate the probability of developing colorectal cancer over a defined period of time will help clinicians identify individuals at higher risk of specific cancers, allowing for earlier or more frequent screening and counseling of behavioral changes to decrease risk.

  9. Breast Cancer Risk Prediction Models

    Cancer.gov

    Developing statistical models that estimate the probability of developing breast cancer over a defined period of time will help clinicians identify individuals at higher risk of specific cancers, allowing for earlier or more frequent screening and counseling of behavioral changes to decrease risk.

  10. Esophageal Cancer Risk Prediction Models

    Cancer.gov

    Developing statistical models that estimate the probability of developing esophageal cancer over a defined period of time will help clinicians identify individuals at higher risk of specific cancers, allowing for earlier or more frequent screening and counseling of behavioral changes to decrease risk.

  11. Family Factors Predicting Categories of Suicide Risk

    ERIC Educational Resources Information Center

    Randell, Brooke P.; Wang, Wen-Ling; Herting, Jerald R.; Eggert, Leona L.

    2006-01-01

    We compared family risk and protective factors among potential high school dropouts with and without suicide-risk behaviors (SRB) and examined the extent to which these factors predict categories of SRB. Subjects were randomly selected from among potential dropouts in 14 high schools. Based upon suicide-risk status, 1,083 potential high school…

  12. Earthquake prediction decision and risk matrix

    NASA Astrophysics Data System (ADS)

    Zou, Qi-Jia

    1993-08-01

    The issuance of an earthquake prediction must cause widespread social responses. It is suggested and discussed in this paper that the comprehensive decision issue for earthquake prediction considering the factors of the social and economic cost. The method of matrix decision for earthquake prediction (MDEP) is proposed in this paper and it is based on the risk matrix. The goal of decision is that search the best manner issuing earthquake prediction so that minimize the total losses of economy. The establishment and calculation of the risk matrix is discussed, and the decision results taking account of economic factors and not considering the economic factors are compared by examples in this paper.

  13. Evaluating probabilistic dengue risk forecasts from a prototype early warning system for Brazil

    PubMed Central

    Lowe, Rachel; Coelho, Caio AS; Barcellos, Christovam; Carvalho, Marilia Sá; Catão, Rafael De Castro; Coelho, Giovanini E; Ramalho, Walter Massa; Bailey, Trevor C; Stephenson, David B; Rodó, Xavier

    2016-01-01

    Recently, a prototype dengue early warning system was developed to produce probabilistic forecasts of dengue risk three months ahead of the 2014 World Cup in Brazil. Here, we evaluate the categorical dengue forecasts across all microregions in Brazil, using dengue cases reported in June 2014 to validate the model. We also compare the forecast model framework to a null model, based on seasonal averages of previously observed dengue incidence. When considering the ability of the two models to predict high dengue risk across Brazil, the forecast model produced more hits and fewer missed events than the null model, with a hit rate of 57% for the forecast model compared to 33% for the null model. This early warning model framework may be useful to public health services, not only ahead of mass gatherings, but also before the peak dengue season each year, to control potentially explosive dengue epidemics. DOI: http://dx.doi.org/10.7554/eLife.11285.001 PMID:26910315

  14. Risk Profiles for Leishmania infantum Infection in Brazil.

    PubMed

    Alves, Erika Barretto; Costa, Carlos Henrique Nery; de Carvalho, Fernando Aécio Amorim; Pires E Cruz, Maria do Socorro; Werneck, Guilherme Loureiro

    2016-06-01

    The aim of this study was to characterize risk profiles for Leishmania infantum infection in a population living in an area endemic for visceral leishmaniasis. A cohort study was conducted between January 2004 and December 2006 with the participation of 430 individuals living in the city of Teresina, northeast Brazil, who were initially negative for the Montenegro test. Data analysis was performed using the classification and regression tree method. The cumulative incidence (CI) of Montenegro's test conversion was 35% at 18-month follow-up. Eight different risk profiles for L. infantum infection were identified. The profile with the highest risk (CI = 75%) comprised individuals with less than 4 years of education who had never lived outside Teresina. The profile with the lowest risk (CI = 5%) included highly educated subjects who had owned a dog for 5 years or more and lived in areas that received some type of intervention. These results show that there is a high degree of complexity involved in the risk for L. infantum infection and point out the need of developing new studies to perform a comprehensive analysis focused on investigating the interrelation between risk factors rather than their isolated roles on the determination of infection levels in urban areas. PMID:27114290

  15. Youth Perspectives on Risk and Resiliency: A Case Study from Juiz De Fora, Brazil

    ERIC Educational Resources Information Center

    Morrison, Penelope; Nikolajski, Cara; Borrero, Sonya; Zickmund, Susan

    2014-01-01

    The present work seeks to contribute to studies of cross-cultural risk and resiliency by presenting results from qualitative research with adolescents attending programs for at-risk youth in Juiz de Fora, Brazil. In 1990, Brazil introduced the Child and Adolescent Act (ECA), a significant piece of legislation that has had a direct impact on how…

  16. Overview of entry risk predictions

    NASA Astrophysics Data System (ADS)

    Mrozinski, R.; Mendeck, G.; Cutri-Kohart, R.

    Risk to people on the ground from uncontrolled entries of spacecraft is a primary concern when analyzing end-of-life disposal options for satellites. Countries must balance this risk with the need to mitigate an exponentially growing space debris population. Currently the United States does this via guidelines that call for a satellite to be disposed of in a controlled manner if an uncontrolled entry would be too risky to people on the ground. This risk is measured by a quantity called "casualty expectation", or E , where casualty expectation is defined as the expectedc number of people suffering death or injury due to a spacecraft entry event. If Ec exceeds 1 in 10,000, U. S. guidelines state that the entry should be controlled rather than uncontrolled. Since this guideline can have serious impacts on the cost, lifetime, and even the mission and functionality of a satellite, it is critical that this quantity be estimated well, and decision makers understand all assumptions and limitations inherent in the resulting value. This paper discusses several issues regarding estimates of casualty expectation, beginning with an overview of relevant United States policies and guidelines. The equation the space industry typically uses to estimate casualty expectation is presented, along with a look at the sensitivity of the results to the typical assumptions, models, and initial condition uncertainties. Differences in these modeling issues with respect to launch failure Ec estimates are included in the discussion. An alternate quantity to assess risks due to spacecraft entries is introduced. "Probability of casualty", or Pc , is defined as the probability of one or more instances of people suffering death or injury due to a spacecraft entry event. The equation to estimate Pc is derived, where the same assumptions, modeling, and initial condition issues for Ec apply. Several examples are then given of both Ec and Pc estimate calculations. Due to the difficult issues in

  17. Gastrointestinal parasites of cats in Brazil: frequency and zoonotic risk.

    PubMed

    Monteiro, Maria Fernanda Melo; Ramos, Rafael Antonio Nascimento; Calado, Andréa Maria Campos; Lima, Victor Fernando Santana; Ramos, Ingrid Carla do Nascimento; Tenório, Rodrigo Ferreira Lima; Faustino, Maria Aparecida da Glória; Alves, Leucio Câmara

    2016-04-12

    Gastrointestinal helminths are considered to be the most common parasites affecting cats worldwide. Correct diagnosis of these parasites in animals living in urban areas is pivotal, especially considering the zoonotic potential of some species (e.g. Ancylostoma sp. and Toxocara sp.). In this study, a copromicroscopic survey was conducted using fecal samples (n = 173) from domestic cats living in the northeastern region of Brazil. Samples were examined through the FLOTAC technique and the overall results showed positivity of 65.31% (113/173) among the samples analyzed. Coinfections were observed in 46.01% (52/113) of the positive samples. The most common parasites detected were Ancylostoma sp., Toxocara cati, Strongyloides stercoralis, Trichuris sp., Dipylidium caninum and Cystoisospora sp. From an epidemiological point of view, these findings are important, especially considering that zoonotic parasites (e.g. Ancylostoma sp. and Toxocara sp.) were the nematodes most frequently diagnosed in this study. Therefore, the human population living in close contact with cats is at risk of infection caused by the zoonotic helminths of these animals. In addition, for the first time the FLOTAC has been used to diagnosing gastrointestinal parasites of cats in Brazil. PMID:27096530

  18. Suicidality among pregnant women in Brazil: prevalence and risk factors.

    PubMed

    Castro e Couto, Tiago; Brancaglion, Mayra Yara Martins; Cardoso, Mauro Nogueira; Faria, Gustavo Coutinho; Garcia, Frederico Duarte; Nicolato, Rodrigo; Aguiar, Regina Amélia Lopes P; Leite, Henrique Vitor; Corrêa, Humberto

    2016-04-01

    Suicide is one of the major causes of preventable death. We evaluated suicidality among pregnant women who participated in prenatal care in Brazil. A total of 255 patients were assessed using semi-structured interviews as well as the Edinburgh Postnatal Depression Scale (EPDS), Beck Depression Inventory (BDI), and Mini-International Neuropsychiatric Interview (MINI) Plus. Thereafter, Stata 12 was used to identify the significant predictors of current suicide risk (CSR) among participants using univariate and multivariate analyses (p < 0.05). According to MINI Plus module C, the lifetime suicide attempt rate was 12.55%. The overall CSR was 23.53%, distributed across risk levels of low (12.55%), moderate (1.18%), and high (9.80%). Our rates approximate those found in another Brazilian study (18.4%). Antenatal depression (AD), lifetime bipolar disorder, and any current anxiety disorder (as measured using the MINI) as well as BDI scores ≥15 and EPDS scores ≥11 were identified as positive risk factors in a univariate analysis (p < 0.001). These factors changed after a multivariate analysis was employed, and only years of education [odds ratio (OR) = 0.45; 95% confidence intervals (CIs) = 0.21-0.99], AD (OR = 3.42; 95% CIs = 1.37-8.53), and EPDS scores ≥11 (OR = 4.44; 95% CIs = 1.97-9.97) remained independent risk factors. AD and other psychiatric disorders were the primary risk factors for suicidality, although only the former remained an independent factor after a multivariate analysis. More than 10 years of education and EPDS scores ≥11 were also independent factors; the latter can be used as a screening tool for suicide risk. PMID:26189445

  19. Anxiety sensitivity cognitive concerns predict suicide risk.

    PubMed

    Oglesby, Mary Elizabeth; Capron, Daniel William; Raines, Amanda Medley; Schmidt, Norman Bradley

    2015-03-30

    Anxiety sensitivity (AS) cognitive concerns, which reflects fears of mental incapacitation, have been previously associated with suicidal ideation and behavior. The first study aim was to replicate and extend upon previous research by investigating whether AS cognitive concerns can discriminate between those at low risk versus high risk for suicidal behavior. Secondly, we aimed to test the incremental predictive power of AS cognitive concerns above and beyond known suicide risk factors (i.e., thwarted belongingness and insomnia). The sample consisted of 106 individuals (75% meeting current criteria for an Axis I disorder) recruited from the community. Results revealed that AS cognitive concerns were a robust predictor of elevated suicide risk after covarying for negative affect, whereas AS social and physical concerns were not. Those with high, relative to low, AS cognitive scores were 3.67 times more likely to be in the high suicide risk group. Moreover, AS cognitive concerns significantly predicted elevated suicide risk above and beyond relevant suicide risk factors. Results of this study add to a growing body of the literature demonstrating a relationship between AS cognitive concerns and increased suicidality. Incorporating AS cognitive concerns amelioration protocols into existing interventions for suicidal behavior may be beneficial. PMID:25636499

  20. Risk analysis for occurrences of schistosomiasis in the coastal area of Porto de Galinhas, Pernambuco, Brazil

    PubMed Central

    2014-01-01

    Background Manson’s schistosomiasis continues to be a severe public health problem in Brazil, where thousands of people live under the risk of contracting this parasitosis. In the Northeast of Brazil, schistosomiasis has expanded from rural areas to the coast of Pernambuco State, where the intermediate host is Biomphalaria glabrata snails. This study aims at presenting situational analyses on schistosomiasis at the coastal locality of Porto de Galinhas, Pernambuco, Brazil, by determining the risk factors relating to its occurrence from the epidemiological and spatial perspectives. Methods In order to gather prevalence data, a parasitological census surveys were conducted in 2010 in the light of the Kato-Katz technique. Furthermore, malacological surveys were also conducted in the same years so as to define the density and infection rates of the intermediate host. Lastly, socioeconomic-behavioral survey was also conducted to determine the odds ratio for infection by Schistosoma mansoni. Based on these data, spatial analyses were done, resulting in maps of the risk of disease transmission. To predict the risk of schistosomiasis occurrence, a multivariate logistic regression was performed using R 2.13 software. Results Based on prevalence, malacological and socioeconomic-behavioural surveys, it was identified a prevalence of 15.7% in the investigated population (2,757 individuals). Due to the malacological survey, 36 breeding sites were identified, of which 11 were classified as foci of schistosomiasis transmission since they pointed out snails which were infected by Schistosoma mansoni. Overall, 11,012 snails (Biomphalaria glabrata) were collected. The multivariate regression model identified six explanatory variables of environmental, socioeconomic and demographic nature. Spatial sweep analysis by means of the Bernoulli method identified one statistically significant cluster in Salinas (RR = 2.2; p-value < 0.000), the district with the highest occurrence

  1. Trends and predictions for gastric cancer mortality in Brazil

    PubMed Central

    de Souza Giusti, Angela Carolina Brandão; de Oliveira Salvador, Pétala Tuani Candido; dos Santos, Juliano; Meira, Karina Cardoso; Camacho, Amanda Rodrigues; Guimarães, Raphael Mendonça; Souza, Dyego L B

    2016-01-01

    AIM: To analyze the effect of age-period and birth cohort on gastric cancer mortality, in Brazil and across its five geographic regions, by sex, in the population over 20 years of age, as well as make projections for the period 2010-2029. METHODS: An ecological study is presented herein, which distributed gastric cancer-related deaths in Brazil and its geographic regions. The effects of age-period and birth cohort were calculated by the Poisson regression model and projections were made with the age-period-cohort model in the statistical program R. RESULTS: Progressive reduction of mortality rates was observed in the 1980’s, and then higher and lower mortality rates were verified in the 2000’s, for both sexes, in Brazil and for the South, Southeast and Midwest regions. A progressive decrease in mortality rates was observed for the Northeast (both sexes) and North (men only) regions within the period 1995-1999, followed by rising rates. CONCLUSION: Regional differences were demonstrated in the mortality rates for gastric cancer in Brazil, and the least developed regions of the country will present increases in projected mortality rates. PMID:27605887

  2. Cardiovascular Risk in Men Aged Over 40 in Boa Vista, Brazil

    PubMed Central

    de Lima Junior, Mário Maciel; Bezerra, Emanuel Araújo; Ticianeli, José Geraldo

    2016-01-01

    Background: Cardiovascular disease is the most common cause of disease in the developed world. Early detection and risk prediction are a key component in reducing cardiovascular mortality. The Framingham Risk Score uses age, sex, cholesterol, blood pressure, diabetes, and smoking to calculate the 10-year risk probability of developing cardiovascular disease for a given patient. The aim of this study was to examine cardiovascular disease risk in men aged over 40 years in Boa Vista, Brazil and identify socioeconomic factors contributing to the risk. Methods: This was an epidemiological, cross-sectional, descriptive study. Physical examination and questionnaire survey were conducted on the participants. Results: Of the 598 participants (average age = 55.38 ± 10.77 years), 346 completed all the examinations and answered the survey, while 252 completed the survey and the physical examinations but did not undertake the laboratory tests. A large proportion of participants were overweight (42.6%) or obese (23.6%), 14.5% were hypertensive, and 71.9% were prehypertensive. Consumption of red meat and junk food was high, while participation in the exercise was low. Framingham scores ranged from −3 to 13 (mean score: 3.86 ± 3.16). A total of 204 participants (34.1%) had a low risk of cardiovascular disease, 98 (16.4%) had a medium risk, and 44 (7.4%) possessed high risk. Increased abdominal circumference (P = 0.013), resting pulse (P = 0.002), and prostate-specific antigen levels (P < 0.001) were associated with increased risk of cardiovascular disease. Conclusions: Our study highlights a worrying trend in increasing obesity and hypertension, most likely associated with increasingly poor diet and reduced participation in exercises. As the Brazilian population ages, this will drive increasing rates of cardiovascular mortality unless these trends are reversed. This study suggests that such campaigns should focus on men over the age of 40, who are married or divorced and of

  3. Risk of Dengue for Tourists and Teams during the World Cup 2014 in Brazil

    PubMed Central

    van Panhuis, Willem G.; Hyun, Sangwon; Blaney, Kayleigh; Marques, Ernesto T. A.; Coelho, Giovanini E.; Siqueira, João Bosco; Tibshirani, Ryan; da Silva, Jarbas B.; Rosenfeld, Roni

    2014-01-01

    Abstract Background This year, Brazil will host about 600,000 foreign visitors during the 2014 FIFA World Cup. The concern of possible dengue transmission during this event has been raised given the high transmission rates reported in the past by this country. Methodology/Principal Findings We used dengue incidence rates reported by each host city during previous years (2001–2013) to estimate the risk of dengue during the World Cup for tourists and teams. Two statistical models were used: a percentile rank (PR) and an Empirical Bayes (EB) model. Expected IR's during the games were generally low (<10/100,000) but predictions varied across locations and between models. Based on current ticket allocations, the mean number of expected symptomatic dengue cases ranged from 26 (PR, 10th–100th percentile: 5–334 cases) to 59 (EB, 95% credible interval: 30–77 cases) among foreign tourists but none are expected among teams. These numbers will highly depend on actual travel schedules and dengue immunity among visitors. Sensitivity analysis for both models indicated that the expected number of cases could be as low as 4 or 5 with 100,000 visitors and as high as 38 or 70 with 800,000 visitors (PR and EB, respectively). Conclusion/Significance The risk of dengue among tourists during the World Cup is expected to be small due to immunity among the Brazil host population provided by last year's epidemic with the same DENV serotypes. Quantitative risk estimates by different groups and methodologies should be made routinely for mass gathering events. PMID:25079960

  4. Korean Risk Assessment Model for Breast Cancer Risk Prediction

    PubMed Central

    Park, Boyoung; Ma, Seung Hyun; Shin, Aesun; Chang, Myung-Chul; Choi, Ji-Yeob; Kim, Sungwan; Han, Wonshik; Noh, Dong-Young; Ahn, Sei-Hyun; Kang, Daehee; Yoo, Keun-Young; Park, Sue K.

    2013-01-01

    Purpose We evaluated the performance of the Gail model for a Korean population and developed a Korean breast cancer risk assessment tool (KoBCRAT) based upon equations developed for the Gail model for predicting breast cancer risk. Methods Using 3,789 sets of cases and controls, risk factors for breast cancer among Koreans were identified. Individual probabilities were projected using Gail's equations and Korean hazard data. We compared the 5-year and lifetime risk produced using the modified Gail model which applied Korean incidence and mortality data and the parameter estimators from the original Gail model with those produced using the KoBCRAT. We validated the KoBCRAT based on the expected/observed breast cancer incidence and area under the curve (AUC) using two Korean cohorts: the Korean Multicenter Cancer Cohort (KMCC) and National Cancer Center (NCC) cohort. Results The major risk factors under the age of 50 were family history, age at menarche, age at first full-term pregnancy, menopausal status, breastfeeding duration, oral contraceptive usage, and exercise, while those at and over the age of 50 were family history, age at menarche, age at menopause, pregnancy experience, body mass index, oral contraceptive usage, and exercise. The modified Gail model produced lower 5-year risk for the cases than for the controls (p = 0.017), while the KoBCRAT produced higher 5-year and lifetime risk for the cases than for the controls (p<0.001 and <0.001, respectively). The observed incidence of breast cancer in the two cohorts was similar to the expected incidence from the KoBCRAT (KMCC, p = 0.880; NCC, p = 0.878). The AUC using the KoBCRAT was 0.61 for the KMCC and 0.89 for the NCC cohort. Conclusions Our findings suggest that the KoBCRAT is a better tool for predicting the risk of breast cancer in Korean women, especially urban women. PMID:24204664

  5. Crime and violence in Brazil: Systematic review of time trends, prevalence rates and risk factors☆

    PubMed Central

    Murray, Joseph; Cerqueira, Daniel Ricardo de Castro; Kahn, Tulio

    2013-01-01

    Between 1980 and 2010 there were 1 million homicides in Brazil. Dramatic increases in homicide rates followed rises in inequality, more young men in the population, greater availability of firearms, and increased drug use. Nevertheless, disarmament legislation may have helped reduce homicide rates in recent years. Despite its very high rate of lethal violence, Brazil appears to have similar levels of general criminal victimization as several other Latin American and North American countries. Brazil has lower rates of drug use compared to other countries such as the United States, but the prevalence of youth drug use in Brazil has increased substantially in recent years. Since 1990, the growth of the Brazilian prison population has been enormous, resulting in the fourth largest prison population in the world. Through a systematic review of the literature, we identified 10 studies assessing the prevalence of self-reported offending in Brazil and 9 studies examining risk factors. Levels of self-reported offending seem quite high among school students in Brazil. Individual and family-level risk factors identified in Brazil are very similar to those found in high-income countries. PMID:24027422

  6. Crime and violence in Brazil: Systematic review of time trends, prevalence rates and risk factors.

    PubMed

    Murray, Joseph; Cerqueira, Daniel Ricardo de Castro; Kahn, Tulio

    2013-09-01

    Between 1980 and 2010 there were 1 million homicides in Brazil. Dramatic increases in homicide rates followed rises in inequality, more young men in the population, greater availability of firearms, and increased drug use. Nevertheless, disarmament legislation may have helped reduce homicide rates in recent years. Despite its very high rate of lethal violence, Brazil appears to have similar levels of general criminal victimization as several other Latin American and North American countries. Brazil has lower rates of drug use compared to other countries such as the United States, but the prevalence of youth drug use in Brazil has increased substantially in recent years. Since 1990, the growth of the Brazilian prison population has been enormous, resulting in the fourth largest prison population in the world. Through a systematic review of the literature, we identified 10 studies assessing the prevalence of self-reported offending in Brazil and 9 studies examining risk factors. Levels of self-reported offending seem quite high among school students in Brazil. Individual and family-level risk factors identified in Brazil are very similar to those found in high-income countries. PMID:24027422

  7. Mathematical Modeling Applied to Prediction of Landslides in Southern Brazil

    NASA Astrophysics Data System (ADS)

    Silva, Lúcia; Araújo, João; Braga, Beatriz; Fernandes, Nelson

    2013-04-01

    Mass movements are natural phenomena that occur on the slopes and are important agents working in landscape development. These movements have caused serious damage to infrastructure and properties. In addition to the mass movements occurring in natural slopes, there is also a large number of accidents induced by human action in the landscape. The change of use and land cover for the introduction of agriculture is a good example that have affected the stability of slopes. Land use and/or land cover changes have direct and indirect effects on slope stability and frequently represent a major factor controlling the occurrence of man-induced mass movements. In Brazil, especially in the southern and southeastern regions, areas of original natural rain forest have been continuously replaced by agriculture during the last decades, leading to important modifications in soil mechanical properties and to major changes in hillslope hydrology. In these regions, such effects are amplified due to the steep hilly topography, intense summer rainfall events and dense urbanization. In November 2008, a major landslide event took place in a rural area with intensive agriculture in the state of Santa Catarina (Morro do Baú) where many catastrophic landslides were triggered after a long rainy period. In this area, the natural forest has been replaced by huge banana and pine plantations. The state of Santa Catarina in recent decades has been the scene of several incidents of mass movements such as this catastrophic event. In this study, based on field mapping and modeling, we characterize the role played by geomorphological and geological factors in controlling the spatial distribution of landslides in the Morro do Baú area. In order to attain such objective, a digital elevation model of the basin was generated with a 10m grid in which the topographic parameters were obtained. The spatial distribution of the scars from this major event was mapped from another image, obtained immediately

  8. [Identification of schistosomiasis risk areas using spatial analysis in Lauro de Freitas, Bahia State, Brazil].

    PubMed

    Cardim, Luciana Lobato; Ferraudo, Antonio Sergio; Pacheco, Selma Turrioni Azevedo; Reis, Renato Barbosa; Silva, Marta Mariana Nascimento; Carneiro, Deborah Daniela M Trabuco; Bavia, Maria Emilia

    2011-05-01

    The spread of schistosomiasis mansoni defies efforts by Brazil's Unified National Health System, thus demonstrating the need to reassess endemic control programs in the country. The aim of this study was to demarcate geographic areas at risk of schistosomiasis in Lauro de Freitas, Bahia State, Brazil, and to establish the epidemiological and socioeconomic profile of the disease in this municipality (county). Kernel density estimator exploratory analysis was used for visual identification of areas at risk. Kulldorff & Nagarwalla's spatial analysis was used to obtain statistically significant clusters and to measure risk. These technologies identified four risk areas for schistosomiasis. Clusters identified within the risk areas were characterized by lower socioeconomic conditions. Multiple correspondence analyses showed a distinct profile for positive patients in the primary cluster. The techniques employed here represent an important methodological acquisition for tracking and controlling schistosomiasis in Lauro de Freitas. PMID:21655841

  9. Unrestrained outsourcing in Brazil: more precarization and health risks for workers.

    PubMed

    Druck, Graça

    2016-06-20

    This article discusses the current status of outsourcing in Brazil, with new regulation underway featuring a bill of law under review by the National Congress, aimed at allowing outsourcing for all activities. The authors argue that outsourcing and precarization of work are inseparable phenomena, based on the results of 20 years of research in Brazil that reveals the more precarious working conditions of outsourced workers in different occupational categories. They focus particularly on workers' health: outsourcing of risks has led to more fatal work accidents, invariably at higher rates in outsourced workers. Finally, the article contends that to remove restraints on outsourcing in Brazil amounts to legalizing and legitimizing predatory workforce exploitation, disregarding workers' physical limits, exposing them to risk of fatal accidents, and reverting to forms of work that violate the human condition. PMID:27333136

  10. Brief Report: Young People at Risk for Eating Disorders in Southeast Brazil

    ERIC Educational Resources Information Center

    Moya, Tatiana; Fleitlich-Bilyk, Bacy; Goodman, Robert

    2006-01-01

    A representative sample of 7-14-year-old young people in southeast Brazil (N=1251) was assessed using standardized parent and youth interviews, thereby identifying an "at-risk" group of young people who met one or more DSM-IV criteria for anorexia and/or bulimia nervosa. These young people were compared with an age and gender matched comparison…

  11. Venomous mollusks: the risks of human accidents by conus snails (gastropoda: conidae) in Brazil.

    PubMed

    Haddad, Vidal; de Paula Neto, João Batista; Cobo, Válter José

    2006-01-01

    Mollusks of the genus Conus present a venomous apparatus composed of radulae, a chitin structure linked to glands, which injects potent neurotoxic peptides, causing serious human envenomation and even death, associated with the blockage of certain receptors and muscular paralysis. No reported envenomation has occurred in Brazil, but certain populations are at risk of accidents. PMID:17160331

  12. Brazil.

    PubMed

    1985-09-01

    Brazil's population in 1985 was 135 million, with an annual growth rate (1982) of 2.3%. The infant mortality rate (1981) was 92/1000, and life expectancy stood at 62.8 years. 76% of the adult population was literate. Brazil is a federal republic which recognizes 5 political parties. 55% of the population is Portuguese, Italian, German, Japanese, African, or American Indian; 38% is white. Of the work force of 50 million, 35% are engaged in agriculture, 25% work in industry, and 40% are employed in services. Trade union membership totals 6 million. The agricultural sector accounts for 12% of the GDP and 40% of exports. Brazil is largely self-sufficient in terms of food. The GDP was US$218 billion in 1984, with an annual growth rate of 4%. Per capita GDP was US$1645. Brazil's power, transportation, and communications systems have improved greatly in recent years, providing a base for economic development. High inflation rates have been a persistent problem. PMID:12178118

  13. Mitochondrial DNA haplotype predicts deafness risk

    SciTech Connect

    Hutchin, T.; Cortopassi, G.

    1995-12-18

    Since mitochondrial DNA (mtDNA) does not recombine in humans, once deleterious variation arises within a particular mtDNA clone it remains linked to that clonal type. An A to G mutation at mtDNA position 1555 confers matrilineal deafness among Asians and others. Two major mtDNA types (I and II) have been defined in Asians by D-loop sequencing. We have determined the D-loop sequence of 8 unrelated deaf Asians bearing the 1555G mutation, and find that 7 are of type II, whereas only one is of type I. Thus the frequency of the 1555G mutation is higher in type II mtDNA than type I (P = 0.035, binomial test), and persons with type II mtDNA are more likely to become deaf. Type II mtDNAs are rare in the Caucasian population, which may explain the rarity of this form of deafness in the United States. Negative Darwinian selection is expected to rapidly eliminate mtDNAs bearing severely deleterious mutations; but mildly deleterious mutations whose phenotype is expressed after reproduction should persist on the mtDNA background in which they arose. Thus determination of mtDNA clonal type has the potential to predict human risk for diseases that are the result of mildly deleterious mtDNA mutations which confer a post-reproductive phenotype. 4 refs., 1 fig.

  14. Risk of symptomatic dengue for foreign visitors to the 2014 FIFA World Cup in Brazil.

    PubMed

    Massad, Eduardo; Wilder-Smith, Annelies; Ximenes, Raphael; Amaku, Marcos; Lopez, Luis Fernandez; Coutinho, Francisco Antonio Bezerra; Coelho, Giovanini Evelim; Silva, Jarbas Barbosa da; Struchiner, Claudio José; Burattini, Marcelo Nascimento

    2014-06-01

    Brazil will host the FIFA World Cup™, the biggest single-event competition in the world, from June 12-July 13 2014 in 12 cities. This event will draw an estimated 600,000 international visitors. Brazil is endemic for dengue. Hence, attendees of the 2014 event are theoretically at risk for dengue. We calculated the risk of dengue acquisition to non-immune international travellers to Brazil, depending on the football match schedules, considering locations and dates of such matches for June and July 2014. We estimated the average per-capita risk and expected number of dengue cases for each host-city and each game schedule chosen based on reported dengue cases to the Brazilian Ministry of Health for the period between 2010-2013. On the average, the expected number of cases among the 600,000 foreigner tourists during the World Cup is 33, varying from 3-59. Such risk estimates will not only benefit individual travellers for adequate pre-travel preparations, but also provide valuable information for public health professionals and policy makers worldwide. Furthermore, estimates of dengue cases in international travellers during the World Cup can help to anticipate the theoretical risk for exportation of dengue into currently non-infected areas. PMID:24863976

  15. Risk of symptomatic dengue for foreign visitors to the 2014 FIFA World Cup in Brazil

    PubMed Central

    Massad, Eduardo; Wilder-Smith, Annelies; Ximenes, Raphael; Amaku, Marcos; Lopez, Luis Fernandez; Coutinho, Francisco Antonio Bezerra; Coelho, Giovanini Evelim; da Silva, Jarbas Barbosa; Struchiner, Claudio José; Burattini, Marcelo Nascimento

    2014-01-01

    Brazil will host the FIFA World Cup™, the biggest single-event competition in the world, from June 12-July 13 2014 in 12 cities. This event will draw an estimated 600,000 international visitors. Brazil is endemic for dengue. Hence, attendees of the 2014 event are theoretically at risk for dengue. We calculated the risk of dengue acquisition to non-immune international travellers to Brazil, depending on the football match schedules, considering locations and dates of such matches for June and July 2014. We estimated the average per-capita risk and expected number of dengue cases for each host-city and each game schedule chosen based on reported dengue cases to the Brazilian Ministry of Health for the period between 2010-2013. On the average, the expected number of cases among the 600,000 foreigner tourists during the World Cup is 33, varying from 3-59. Such risk estimates will not only benefit individual travellers for adequate pre-travel preparations, but also provide valuable information for public health professionals and policy makers worldwide. Furthermore, estimates of dengue cases in international travellers during the World Cup can help to anticipate the theoretical risk for exportation of dengue into currently non-infected areas. PMID:24863976

  16. CSF 5-HIAA Predicts Suicide Risk after Attempted Suicide.

    ERIC Educational Resources Information Center

    Nordstrom, Peter; And Others

    1994-01-01

    Studied suicide risk after attempted suicide, as predicted by cerebrospinal fluid (CSF) monoamine metabolite concentrations, in 92 psychiatric mood disorder inpatients admitted shortly after attempting suicide. Results revealed that low CSF 5-hydroxyindoleacetic acid (5-HIAA) predicted short-range suicide risk after attempted suicide in mood…

  17. Rural tourism: a risk factor for schistosomiasis transmission in Brazil.

    PubMed

    Enk, Martin Johannes; Amaral, Graciela Larissa; Costa e Silva, Matheus Fernandes; Silveira-Lemos, Denise; Teixeira-Carvalho, Andréa; Martins-Filho, Olindo Assis; Correa-Oliveira, Rodrigo; Gazinnelli, Giovanni; Coelho, Paulo Marcos Zech; Massara, Cristiano Lara

    2010-07-01

    This paper reports an outbreak of acute schistosomiasis among 38 tourists who rented a country house in the district of Igarapé, the metropolitan region of Belo Horizonte, Brazil, during a holiday period in 2006. A total number of 32 individuals were positive for Schistosoma mansoni. Results of stool examinations revealed individual S. mansoni egg counts per gram of faeces (epg) ranging from 4-768 epg with a geometric mean egg count of 45. The most frequent clinical symptoms were abdominal pain (78.1%), headache (75%), fever (65.6%), dry cough (65.2%) and both diarrhoea and asthenia (59.4%). A malacological survey of the area, where 22 specimens of Biomphalaria glabrata were collected, revealed three (13.6%) specimens eliminating Schistosoma cercariae. This investigation re-confirms a recently described pattern of schistosomiasis infection, resulting in the acute form of the disease and connected to rural tourism, which contributes to the spread of the disease among the middle-class and into non-endemic areas. The lack of specific knowledge about acute schistosomiasis among health services causes an increased number of unnecessary diagnostic procedures and delays in accurate diagnosis and treatment, resulting in considerable discomfort for the patients. PMID:20721505

  18. Lipoprotein metabolism indicators improve cardiovascular risk prediction

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Background: Cardiovascular disease risk increases when lipoprotein metabolism is dysfunctional. We have developed a computational model able to derive indicators of lipoprotein production, lipolysis, and uptake processes from a single lipoprotein profile measurement. This is the first study to inves...

  19. Blood Pressure Patterns May Predict Stroke Risk

    MedlinePlus

    ... at Erasmus University Medical Center in Rotterdam, the Netherlands. High blood pressure is the number one risk ... of epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands; Andrew Rogove, M.D., Ph.D., medical director, ...

  20. Municipal temperature and heatwave predictions as a tool for integrated socio-environmental impact analysis in Brazil

    NASA Astrophysics Data System (ADS)

    Costa, D.

    2015-12-01

    Numerical climate models render data in a gridded format which is often problematic for integrated analysis with other kinds of data in jurisdictional formats. In this paper a joint analysis of municipal Gross Domestic Product per capita (GDPc) and predicted temperature increase was undertaken in order to estimate different levels of human and economic exposure. This is based on a method of converting model outputs into a country municipal grid which enabled depicting climate predictions from the Eta-Hadgem2-ES Regional Climate Model (RCM) into the municipal level in Brazil. The conversion to country municipality grid was made using a combination of interpolation and buffering techniques in ArcGIS for two emission scenarios (RCP 4.5 and 8.5) and three timeframes (2011-2040, 2041-2070, 2071-2100) for mean temperature increase and number of heatwave days (WSDI). The results were used to support the Third National Communication (TCN) of Brazil to the United Nations Framework Convention on Climate Change (UNFCCC) and show a coherent matching of the gridded output from the original RCM. The joint climate and GDPc analysis show that in the beginning of the century the more severe warming is centred over regions where GDPc is generally higher (Centre-West and Southeast). At the end of the century, critical levels of warming spread north and northeastwards where municipalities have the lowest GDPc levels. In the high emission scenario (RCP 8.5) the strongest warming and the spreading over poorer regions is anticipated to the mid-century. These results are key to further explore solutions for climate change adaptation based on current resources and prepare in different sectors, for long-term risk management and climate adaptation planning strategies.

  1. Bridge: a GUI package for genetic risk prediction

    PubMed Central

    2013-01-01

    Background Risk prediction models capitalizing on genetic and environmental information hold great promise for individualized disease prediction and prevention. Nevertheless, linking the genetic and environmental risk predictors into a useful risk prediction model remains a great challenge. To facilitate risk prediction analyses, we have developed a graphical user interface package, Bridge. Results The package is built for both designing and analyzing a risk prediction model. In the design stage, it provides an estimated classification accuracy of the model using essential genetic and environmental information gained from public resources and/or previous studies, and determines the sample size required to verify this accuracy. In the analysis stage, it adopts a robust and powerful algorithm to form the risk prediction model. Conclusions The package is developed based on the optimality theory of the likelihood ratio and therefore theoretically could form a model with high performance. It can be used to handle a relatively large number of genetic and environmental predictors, with consideration of their possible interactions, and so is particularly useful for studying risk prediction models for common complex diseases. PMID:24359333

  2. Risk prediction models for hepatocellular carcinoma in different populations

    PubMed Central

    Ma, Xiao; Yang, Yang; Tu, Hong; Gao, Jing; Tan, Yu-Ting; Zheng, Jia-Li; Bray, Freddie; Xiang, Yong-Bing

    2016-01-01

    Hepatocellular carcinoma (HCC) is a malignant disease with limited therapeutic options due to its aggressive progression. It places heavy burden on most low and middle income countries to treat HCC patients. Nowadays accurate HCC risk predictions can help making decisions on the need for HCC surveillance and antiviral therapy. HCC risk prediction models based on major risk factors of HCC are useful and helpful in providing adequate surveillance strategies to individuals who have different risk levels. Several risk prediction models among cohorts of different populations for estimating HCC incidence have been presented recently by using simple, efficient, and ready-to-use parameters. Moreover, using predictive scoring systems to assess HCC development can provide suggestions to improve clinical and public health approaches, making them more cost-effective and effort-effective, for inducing personalized surveillance programs according to risk stratification. In this review, the features of risk prediction models of HCC across different populations were summarized, and the perspectives of HCC risk prediction models were discussed as well. PMID:27199512

  3. Risk prediction models for hepatocellular carcinoma in different populations.

    PubMed

    Ma, Xiao; Yang, Yang; Tu, Hong; Gao, Jing; Tan, Yu-Ting; Zheng, Jia-Li; Bray, Freddie; Xiang, Yong-Bing

    2016-04-01

    Hepatocellular carcinoma (HCC) is a malignant disease with limited therapeutic options due to its aggressive progression. It places heavy burden on most low and middle income countries to treat HCC patients. Nowadays accurate HCC risk predictions can help making decisions on the need for HCC surveillance and antiviral therapy. HCC risk prediction models based on major risk factors of HCC are useful and helpful in providing adequate surveillance strategies to individuals who have different risk levels. Several risk prediction models among cohorts of different populations for estimating HCC incidence have been presented recently by using simple, efficient, and ready-to-use parameters. Moreover, using predictive scoring systems to assess HCC development can provide suggestions to improve clinical and public health approaches, making them more cost-effective and effort-effective, for inducing personalized surveillance programs according to risk stratification. In this review, the features of risk prediction models of HCC across different populations were summarized, and the perspectives of HCC risk prediction models were discussed as well. PMID:27199512

  4. Predicting cancer risks from dental computed tomography.

    PubMed

    Wu, T-H; Lin, W-C; Chen, W-K; Chang, Y-C; Hwang, J-J

    2015-01-01

    Dental computed tomography (CT) has become a common tool when carrying out dental implants, yet there is little information available on its associated cancer risk. The objective of this study was to estimate the lifetime-attributable risk (LAR) of cancer incidence that is associated with the radiation dose from dental CT scans and to evaluate the effect of scan position, sex, and age on the cancer risk. This retrospective cohort study involved 505 participants who underwent CT scans. The mean effective doses for male and female patients in the maxilla group were 408 and 389 µSv (P = 0.055), respectively, whereas the mean effective doses for male and female patients in the mandible groups were 475 and 450 µSv (P < 0.001), respectively. The LAR for cancer incidence after mandible CT scanning varied from 1 in 16,196 for a 30-y-old woman to 1 in 114,680 for a 70-y-old man. The organ-specific cancer risks for thyroid cancer, other cancers, leukemia, and lung cancer account for 99% of the LAR. Among patients of all ages, the estimated LAR of a mandible scan was higher than that of a maxilla scan. Furthermore, the LAR for female thyroid cancer had a peak before age 45 y. The risk for a woman aged 30 y is roughly 8 times higher than that of a woman aged 50 y. After undergoing a dental CT scan, the possible cancer risks related to sex and age across various different anatomical regions are not similar. The greatest risk due to a dental CT scan is for a mandible scan when the woman is younger than 45 y. Given the limits of the sample size, machine parameters, and the retrospective nature of this study, the results need to be interpreted within the context of this patient population. Future studies will be of value to corroborate these findings. PMID:25359782

  5. Using open source data for flood risk mapping and management in Brazil

    NASA Astrophysics Data System (ADS)

    Whitley, Alison; Malloy, James; Chirouze, Manuel

    2013-04-01

    Whitley, A., Malloy, J. and Chirouze, M. Worldwide the frequency and severity of major natural disasters, particularly flooding, has increased. Concurrently, countries such as Brazil are experiencing rapid socio-economic development with growing and increasingly concentrated populations, particularly in urban areas. Hence, it is unsurprising that Brazil has experienced a number of major floods in the past 30 years such as the January 2011 floods which killed 900 people and resulted in significant economic losses of approximately 1 billion US dollars. Understanding, mitigating against and even preventing flood risk is high priority. There is a demand for flood models in many developing economies worldwide for a range of uses including risk management, emergency planning and provision of insurance solutions. However, developing them can be expensive. With an increasing supply of freely-available, open source data, the costs can be significantly reduced, making the tools required for natural hazard risk assessment more accessible. By presenting a flood model developed for eight urban areas of Brazil as part of a collaboration between JBA Risk Management and Guy Carpenter, we explore the value of open source data and demonstrate its usability in a business context within the insurance industry. We begin by detailing the open source data available and compare its suitability to commercially-available equivalents for datasets including digital terrain models and river gauge records. We present flood simulation outputs in order to demonstrate the impact of the choice of dataset on the results obtained and its use in a business context. Via use of the 2D hydraulic model JFlow+, our examples also show how advanced modelling techniques can be used on relatively crude datasets to obtain robust and good quality results. In combination with accessible, standard specification GPU technology and open source data, use of JFlow+ has enabled us to produce large-scale hazard maps

  6. Aflatoxins in food products consumed in Brazil: a preliminary dietary risk assessment.

    PubMed

    Andrade, P D; de Mello, M Homem; França, J A; Caldas, E D

    2013-01-01

    A preliminary dietary exposure assessment for aflatoxins (AFs; AFB1, AFB2, AFG1 and AFG2) was conducted to evaluate the potential carcinogenic risks for the Brazilian population. AF concentration data in food were obtained from analysis reports issued by the Central Public Health Laboratory of the Federal District (LACEN-DF) and from published work. Food consumption and body weight (bw) data were obtained from a national survey conducted in 2008/2009. Cancer risks arising from exposure to aflatoxins were assessed using the carcinogenic potency of AFs estimated by the JECFA, and hepatitis B virus prevalence in the Brazilian population. Additionally, margins of exposure (MOE) were also calculated for the various scenarios investigated. A total of 942 food samples were analysed for AFs in the Federal District between 2002 and 2011 with 4.5% of them being positive for at least one aflatoxin (LOQ = 2 µg kg(-1)). The highest percentage of contamination was found in peanuts (8.1%) and Brazil nuts (6.0%), with mean levels ranging from 6.7 µg kg(-1) in peanut products to 36.9 µg kg(-1) in Brazil nuts. Most of the studies conducted elsewhere in Brazil found similar results. Total AF intake for the total Brazilian population and high consumers of food relevant for AF contamination in Brazil (upper bound; samples < LOQ = 0.5 LOQ) were 6.8 and 27.6 ng kg(-1) bw day(-1), respectively. Cancer risk reached 0.0753 cancers year(-1) per 10(5) individuals for the total population and 0.3056 cancers year(-1) per 10(5) individuals for high consumers. MOE reached 25 and 6 for the total population and high consumers, respectively, indicating a potential risk for consumers. Aflatoxins are genotoxic carcinogens, and government action should be maintained and continuously improved in order to guarantee that human exposure levels are kept as low as possible. PMID:22963655

  7. Predicting the risk of sudden cardiac death.

    PubMed

    Lerma, Claudia; Glass, Leon

    2016-05-01

    Sudden cardiac death (SCD) is the result of a change of cardiac activity from normal (typically sinus) rhythm to a rhythm that does not pump adequate blood to the brain. The most common rhythms leading to SCD are ventricular tachycardia (VT) or ventricular fibrillation (VF). These result from an accelerated ventricular pacemaker or ventricular reentrant waves. Despite significant efforts to develop accurate predictors for the risk of SCD, current methods for risk stratification still need to be improved. In this article we briefly review current approaches to risk stratification. Then we discuss the mathematical basis for dynamical transitions (called bifurcations) that may lead to VT and VF. One mechanism for transition to VT or VF involves a perturbation by a premature ventricular complex (PVC) during sinus rhythm. We describe the main mechanisms of PVCs (reentry, independent pacemakers and abnormal depolarizations). An emerging approach to risk stratification for SCD involves the development of individualized dynamical models of a patient based on measured anatomy and physiology. Careful analysis and modelling of dynamics of ventricular arrhythmia on an individual basis will be essential in order to improve risk stratification for SCD and to lay a foundation for personalized (precision) medicine in cardiology. PMID:26660287

  8. Relative Risk of Visceral Leishmaniasis in Brazil: A Spatial Analysis in Urban Area

    PubMed Central

    de Araújo, Valdelaine Etelvina Miranda; Pinheiro, Letícia Cavalari; Almeida, Maria Cristina de Mattos; de Menezes, Fernanda Carvalho; Morais, Maria Helena Franco; Reis, Ilka Afonso; Assunção, Renato Martins; Carneiro, Mariângela

    2013-01-01

    Background Visceral leishmaniasis (VL) is a vector-borne disease whose factors involved in transmission are poorly understood, especially in more urban and densely populated counties. In Brazil, the VL urbanization is a challenge for the control program. The goals were to identify the greater risk areas for human VL and the risk factors involved in transmission. Methodology This is an ecological study on the relative risk of human VL. Spatial units of analysis were the coverage areas of the Basic Health Units (146 small-areas) of Belo Horizonte, Minas Gerais State, Brazil. Human VL cases, from 2007 to 2009 (n = 412), were obtained in the Brazilian Reportable Disease Information System. Bayesian approach was used to model the relative risk of VL including potential risk factors involved in transmission (canine infection, socioeconomic and environmental features) and to identify the small-areas of greater risk to human VL. Principal Findings The relative risk of VL was shown to be correlated with income, education, and the number of infected dogs per inhabitants. The estimates of relative risk of VL were higher than 1.0 in 54% of the areas (79/146). The spatial modeling highlighted 14 areas with the highest relative risk of VL and 12 of them are concentrated in the northern region of the city. Conclusions The spatial analysis used in this study is useful for the identification of small-areas according to risk of human VL and presents operational applicability in control and surveillance program in an urban environment with an unequal spatial distribution of the disease. Thus the frequent monitoring of relative risk of human VL in small-areas is important to direct and prioritize the actions of the control program in urban environment, especially in big cities. PMID:24244776

  9. Predicting risk and the emergence of schizophrenia.

    PubMed

    Clarke, Mary C; Kelleher, Ian; Clancy, Maurice; Cannon, Mary

    2012-09-01

    This article gives an overview of genetic and environmental risk factors for schizophrenia. The presence of certain molecular, biological, and psychosocial factors at certain points in the life span, has been linked to later development of schizophrenia. All need to be considered in the context of schizophrenia as a lifelong brain disorder. Research interest in schizophrenia is shifting to late childhood/early adolescence for screening and preventative measures. This article discusses those environmental risk factors for schizophrenia for which there is the largest evidence base. PMID:22929868

  10. Predicting Risk Sensitivity in Humans and Lower Animals: Risk as Variance or Coefficient of Variation

    ERIC Educational Resources Information Center

    Weber, Elke U.; Shafir, Sharoni; Blais, Ann-Renee

    2004-01-01

    This article examines the statistical determinants of risk preference. In a meta-analysis of animal risk preference (foraging birds and insects), the coefficient of variation (CV), a measure of risk per unit of return, predicts choices far better than outcome variance, the risk measure of normative models. In a meta-analysis of human risk…

  11. Submission Form for Peer-Reviewed Cancer Risk Prediction Models

    Cancer.gov

    If you have information about a peer-reviewd cancer risk prediction model that you would like to be considered for inclusion on this list, submit as much information as possible through the form on this page.

  12. Development and Application of Chronic Disease Risk Prediction Models

    PubMed Central

    Oh, Sun Min; Stefani, Katherine M.

    2014-01-01

    Currently, non-communicable chronic diseases are a major cause of morbidity and mortality worldwide, and a large proportion of chronic diseases are preventable through risk factor management. However, the prevention efficacy at the individual level is not yet satisfactory. Chronic disease prediction models have been developed to assist physicians and individuals in clinical decision-making. A chronic disease prediction model assesses multiple risk factors together and estimates an absolute disease risk for the individual. Accurate prediction of an individual's future risk for a certain disease enables the comparison of benefits and risks of treatment, the costs of alternative prevention strategies, and selection of the most efficient strategy for the individual. A large number of chronic disease prediction models, especially targeting cardiovascular diseases and cancers, have been suggested, and some of them have been adopted in the clinical practice guidelines and recommendations of many countries. Although few chronic disease prediction tools have been suggested in the Korean population, their clinical utility is not as high as expected. This article reviews methodologies that are commonly used for developing and evaluating a chronic disease prediction model and discusses the current status of chronic disease prediction in Korea. PMID:24954311

  13. Detection and risk assessment of diarrheagenic E. coli in recreational beaches of Brazil.

    PubMed

    Rodrigues, Vanessa F V; Rivera, Irma N G; Lim, Keah-Ying; Jiang, Sunny C

    2016-08-15

    Marine beaches are important recreational and economic resources in Brazil, but the beaches' water quality is negatively impacted by the discharge of domestic sewage effluent. The occurrence of diarrheagenic Escherichiacoli among the E. coli isolated from three Brazilian marine beaches was investigated. Multiplex and single step PCR were used to screen 99 E. coli isolates for ten target toxin genes. Six toxin genes, stx1, eae, estp, esth, astA, and bfpA, were identified in 1% to 35% of the isolates. A quantitative microbial risk assessment (QMRA) of human exposure to diarrheagenic E. coli during marine recreation was carried out. The results indicated that the diarrheagenic E. coli risk is well below the U.S. EPA's recommended daily recreational risk benchmark. However, the overall recreational health risk due to all pathogens in the water could be much higher and exceeded the U.S. EPA's benchmark. PMID:27301685

  14. Risk avoidance in sympatric large carnivores: reactive or predictive?

    PubMed

    Broekhuis, Femke; Cozzi, Gabriele; Valeix, Marion; McNutt, John W; Macdonald, David W

    2013-09-01

    1. Risks of predation or interference competition are major factors shaping the distribution of species. An animal's response to risk can either be reactive, to an immediate risk, or predictive, based on preceding risk or past experiences. The manner in which animals respond to risk is key in understanding avoidance, and hence coexistence, between interacting species. 2. We investigated whether cheetahs (Acinonyx jubatus), known to be affected by predation and competition by lions (Panthera leo) and spotted hyaenas (Crocuta crocuta), respond reactively or predictively to the risks posed by these larger carnivores. 3. We used simultaneous spatial data from Global Positioning System (GPS) radiocollars deployed on all known social groups of cheetahs, lions and spotted hyaenas within a 2700 km(2) study area on the periphery of the Okavango Delta in northern Botswana. The response to risk of encountering lions and spotted hyaenas was explored on three levels: short-term or immediate risk, calculated as the distance to the nearest (contemporaneous) lion or spotted hyaena, long-term risk, calculated as the likelihood of encountering lions and spotted hyaenas based on their cumulative distributions over a 6-month period and habitat-associated risk, quantified by the habitat used by each of the three species. 4. We showed that space and habitat use by cheetahs was similar to that of lions and, to a lesser extent, spotted hyaenas. However, cheetahs avoided immediate risks by positioning themselves further from lions and spotted hyaenas than predicted by a random distribution. 5. Our results suggest that cheetah spatial distribution is a hierarchical process, first driven by resource acquisition and thereafter fine-tuned by predator avoidance; thus suggesting a reactive, rather than a predictive, response to risk. PMID:23692142

  15. HIV risk behaviors among outpatients with severe mental illness in Rio de Janeiro, Brazil

    PubMed Central

    WAINBERG, MILTON L.; MCKINNON, KAREN; ELKINGTON, KATHERINE; MATTOS, PAULO E.; GRUBER MANN, CLAUDIO; DE SOUZA PINTO, DIANA; OTTO-SALAJ, LAURA; COURNOS, FRANCINE; AND THE INVESTIGATORS OF PRISSMA

    2008-01-01

    We conducted the first study to examine rates of sexual activity, sexual risk behaviors, sexual protective behaviors, injection drug use (IDU), needle sharing, and knowledge about HIV/AIDS among outpatients with severe mental illness (SMI) in Rio de Janeiro, Brazil. Using a measure with demonstrated reliability, we found that 42% of 98 patients engaged in vaginal or anal sex within the past three months. Comorbid substance use disorder was significantly associated with sexual activity. Only 22% of sexually active patients used condoms consistently, despite having better HIV knowledge than those who were sexually abstinent. Overall, 45% of patients reported not engaging in any HIV protective behaviors. There were no reports of drug injection. Adults with SMI in Brazil are in need of efficacious HIV prevention programs and policies that can sustain these programs within mental health treatment settings. PMID:18836542

  16. Risk analysis of herbicide quinclorac residues in irrigated rice areas, Santa Catarina, Brazil.

    PubMed

    Resgalla, Charrid; Noldin, José A; Tamanaha, Márico S; Deschamps, Francisco C; Eberhardt, D S; Rörig, L R

    2007-11-01

    Deterministic and probabilistic risk analyses were carried out for seven hydrographic basins in the State of Santa Catarina (Brazil), where irrigated rice is cultivated. Monitoring studies conducted in 1998/1999 and 1999/2000 had found that the herbicide quinclorac was the most frequently detected agrochemical residue, occurring in five of the seven hydrographic basins. In order to assess the ecological risk posed by quinclorac, median lethal concentration (LC(50)) and median effective concentration (EC(50)) data were obtained for quinclorac in toxicity tests with organisms routinely used in Brazil for this purpose. Experiments were carried out on microcosms associated with the irrigated rice crop to evaluate the effects of the herbicide on the natural plankton community. The deterministic analyses showed that the risk presented by the herbicide residues to the phytoplankton require mitigating action, while the probabilistic analysis revealed that the levels of risk for the aquatic community were acceptable. Field experiments showed that the recommended application concentration of the product directly affects phytoplankton and has an indirect, short-term effect on the zooplankton community. PMID:17879160

  17. Risk factors predictive of atrial fibrillation after lung cancer surgery.

    PubMed

    Iwata, Takekazu; Nagato, Kaoru; Nakajima, Takahiro; Suzuki, Hidemi; Yoshida, Shigetoshi; Yoshino, Ichiro

    2016-08-01

    Postoperative atrial fibrillation (POAF), the most frequent arrhythmia after pulmonary resection, is a cause of both morbidity and mortality. Being able to predict the risk of POAF before surgery would help us evaluate the surgical risk and plan prophylaxis. We investigated the reported preoperative risk factors associated with the incidence of POAF and found that the recommended predictive factors were quite variable. Therefore, we evaluated the previously reported preoperative risk factors for POAF using our institutional data. We discuss our findings in this short review. Male gender, resected lung volume, brain natriuretic peptide (BNP), and left ventricular early transmitral velocity/mitral annular early diastolic velocity (E/e') calculated by echocardiography were suggested as independent predictors for POAF, but the predictive values of each individual parameter were not high. The lack of definitive predictors for POAF warrants further investigations by gathering the reported knowledge, to establish an effective preoperative examination strategy. PMID:26471506

  18. Clinical Risk Prediction by Exploring High-Order Feature Correlations

    PubMed Central

    Wang, Fei; Zhang, Ping; Wang, Xiang; Hu, Jianying

    2014-01-01

    Clinical risk prediction is one important problem in medical informatics, and logistic regression is one of the most widely used approaches for clinical risk prediction. In many cases, the number of potential risk factors is fairly large and the actual set of factors that contribute to the risk is small. Therefore sparse logistic regression is proposed, which can not only predict the clinical risk but also identify the set of relevant risk factors. The inputs of logistic regression and sparse logistic regression are required to be in vector form. This limits the applicability of these models in the problems when the data cannot be naturally represented vectors (e.g., medical images are two-dimensional matrices). To handle the cases when the data are in the form of multi-dimensional arrays, we propose HOSLR: High-Order Sparse Logistic Regression, which can be viewed as a high order extension of sparse logistic regression. Instead of solving one classification vector as in conventional logistic regression, we solve for K classification vectors in HOSLR (K is the number of modes in the data). A block proximal descent approach is proposed to solve the problem and its convergence is guaranteed. Finally we validate the effectiveness of HOSLR on predicting the onset risk of patients with Alzheimer’s disease and heart failure. PMID:25954428

  19. Association between perceived lifetime risk of cardiovascular disease and calculated risk in a male population in Brazil

    PubMed Central

    de Lima, Mário Maciel; da Silva, Glaciane Rocha; Jensem Filho, Sebastião Salazar; Granja, Fabiana

    2016-01-01

    Aim Cardiovascular disease is the major cause of morbidity and mortality across the world. Despite health campaigns to improve awareness of cardiovascular risk factors, there has been little improvement in cardiovascular mortality. In this study, we sought to examine the association between cardiovascular risk factors and people’s perception on cardiovascular risk. Methods This was an epidemiological, cross-sectional, descriptive, prospective study of Masonic men aged >40 years in Boa Vista, Brazil. Participants completed a health survey, which included three questions about perception of their stress level, overall health status, and risk of a heart attack. In addition, demographic and biological data were collected. Results A total of 101 Masonic men took part in the study; their mean age (± standard deviation) was 55.35±9.17 years and mean body mass index was 28.77±4.51 kg/m2. Answers to the lifestyle questionnaire suggested an overall healthy lifestyle, including good diet and moderate exercise, although despite this ~80% were classified as overweight or obese. The majority of participants felt that they had a low stress level (66.3%), good overall general health (63.4%), and were at low risk of having a heart attack (71.3%). Masons who were overweight were significantly more likely to perceive themselves to be at risk of a heart attack (P=0.025). Conclusion Despite over half of participants having a moderate to high risk of cardiovascular disease according to traditional risk factors, less than a third perceived themselves to be at high risk. Public health campaigns need to better communicate the significance of traditional cardiovascular risk in order to improve awareness of risk among the general population. PMID:27382297

  20. Predicting adolescent's cyberbullying behavior: A longitudinal risk analysis.

    PubMed

    Barlett, Christopher P

    2015-06-01

    The current study used the risk factor approach to test the unique and combined influence of several possible risk factors for cyberbullying attitudes and behavior using a four-wave longitudinal design with an adolescent US sample. Participants (N = 96; average age = 15.50 years) completed measures of cyberbullying attitudes, perceptions of anonymity, cyberbullying behavior, and demographics four times throughout the academic school year. Several logistic regression equations were used to test the contribution of these possible risk factors. Results showed that (a) cyberbullying attitudes and previous cyberbullying behavior were important unique risk factors for later cyberbullying behavior, (b) anonymity and previous cyberbullying behavior were valid risk factors for later cyberbullying attitudes, and (c) the likelihood of engaging in later cyberbullying behavior increased with the addition of risk factors. Overall, results show the unique and combined influence of such risk factors for predicting later cyberbullying behavior. Results are discussed in terms of theory. PMID:25828551

  1. Is the microagglutination test (MAT) good for predicting the infecting serogroup for leptospirosis in Brazil?

    PubMed

    Blanco, Roberta Morozetti; dos Santos, Luis Fernando; Galloway, Renee Lynn; Romero, Eliete Caló

    2016-02-01

    Leptospirosis is a zoonotic infection caused by pathogenic members of the genus Leptospira spp. Knowledge of the prevalent serovars and their maintenance hosts is essential to understand the disease. The aim of this study was to evaluate the ability of serology by the microscopic agglutination test (MAT) to predict the serogroups compared with results of identification of leptospires in São Paulo, Brazil. MAT correctly assigned the serogroup of the infecting isolate in 49/52 cases (94.23%). The serogroup Icterohaemorrhagiae was the predominant serogroup (88.46%). This study showed the usefulness of the MAT to correctly identify the infecting serogroup with a good overall agreement between the serologically-identified infecting serogroup and by identification of the isolate and can be used in epidemiological surveys in São Paulo. However, it should be complemented by the identification of Leptospira isolates. PMID:26851592

  2. [Early pregnancy risk: development and validation of a predictive instrument].

    PubMed

    Burrows, R; Rosales, M E; Díaz, M; Muzzo, S

    1994-06-01

    An early pregnancy risk scale, with scores ranging from 11 to 66 points from lower to higher risk, was constructed using variables associated with teenager's pregnancy. This scale was applied to 3000 female teenagers, coming from Metropolitan Santiago public schools. The sample was divided in three risk groups: group A (high risk) with scores equal or over 35 points, group B (low risk) with scores equal or below 20 points and group B (intermediate risk) with scores between 20.1 and 34.9 points. These girls were followed during 2 years. During this period, 84 girls became pregnant, 24 of 184 (13%) in group A, 60 of 2332 (2.6%) in group C and none of 307 in group B. There were 104 school desertions in group A and 37 in group B. To study associations and analyze risk, the sample was divided in two risk groups: high, with scores over 27 and low, with scores below 27. There was a high association between pregnancy risk score and the occurrence of pregnancy (RR 5.25 p < 0.0001) and school desertion (RR 3.32 p < 0.0001). Pregnancy was predicted with a 78% sensitivity and 55.6% specificity. School desertion was predicted with a 74% sensitivity and 56% specificity. The importance variable weighing using multiple regression models, to improve the predictor's sensitivity and specificity, is discussed. PMID:7732221

  3. Reformulating Suicide Risk Formulation: From Prediction to Prevention.

    PubMed

    Pisani, Anthony R; Murrie, Daniel C; Silverman, Morton M

    2016-08-01

    Psychiatrists-in-training typically learn that assessments of suicide risk should culminate in a probability judgment expressed as "low," "moderate," or "high." This way of formulating risk has predominated in psychiatric education and practice, despite little evidence for its validity, reliability, or utility. We present a model for teaching and communicating suicide risk assessments without categorical predictions. Instead, we propose risk formulations which synthesize data into four distinct judgments to directly inform intervention plans: (1) risk status (the patient's risk relative to a specified subpopulation), (2) risk state (the patient's risk compared to baseline or other specified time points), (3) available resources from which the patient can draw in crisis, and (4) foreseeable changes that may exacerbate risk. An example case illustrates the conceptual shift from a predictive to a preventive formulation, and we outline steps taken to implement the model in an academic psychiatry setting. Our goal is to inform educational leaders, as well as individual educators, who can together cast a prevention-oriented vision in their academic programs. PMID:26667005

  4. Automated Risk Prediction for Esophageal Optical Endomicroscopic Images

    PubMed Central

    Kothari, Sonal; Wu, Hang; Tong, Li; Woods, Kevin E.; Wang, May D.

    2016-01-01

    Biomedical in vivo imaging has been playing an essential role in diagnoses and treatment in modern medicine. However, compared with the fast development of medical imaging systems, the medical imaging informatics, especially automated prediction, has not been fully explored. In our paper, we compared different feature extraction and classification methods for prediction pipeline to analyze in vivo endomicroscopic images, obtained from patients who are at risks for the development of gastric disease, esophageal adenocarcionoma. Extensive experiment results show that the selected feature representation and prediction algorithms achieved high accuracy in both binary and multi-class prediction tasks. PMID:27532065

  5. Utility functions predict variance and skewness risk preferences in monkeys

    PubMed Central

    Genest, Wilfried; Stauffer, William R.; Schultz, Wolfram

    2016-01-01

    Utility is the fundamental variable thought to underlie economic choices. In particular, utility functions are believed to reflect preferences toward risk, a key decision variable in many real-life situations. To assess the validity of utility representations, it is therefore important to examine risk preferences. In turn, this approach requires formal definitions of risk. A standard approach is to focus on the variance of reward distributions (variance-risk). In this study, we also examined a form of risk related to the skewness of reward distributions (skewness-risk). Thus, we tested the extent to which empirically derived utility functions predicted preferences for variance-risk and skewness-risk in macaques. The expected utilities calculated for various symmetrical and skewed gambles served to define formally the direction of stochastic dominance between gambles. In direct choices, the animals’ preferences followed both second-order (variance) and third-order (skewness) stochastic dominance. Specifically, for gambles with different variance but identical expected values (EVs), the monkeys preferred high-variance gambles at low EVs and low-variance gambles at high EVs; in gambles with different skewness but identical EVs and variances, the animals preferred positively over symmetrical and negatively skewed gambles in a strongly transitive fashion. Thus, the utility functions predicted the animals’ preferences for variance-risk and skewness-risk. Using these well-defined forms of risk, this study shows that monkeys’ choices conform to the internal reward valuations suggested by their utility functions. This result implies a representation of utility in monkeys that accounts for both variance-risk and skewness-risk preferences. PMID:27402743

  6. Intensification of cattle ranching production systems: socioeconomic and environmental synergies and risks in Brazil.

    PubMed

    Latawiec, A E; Strassburg, B B N; Valentim, J F; Ramos, F; Alves-Pinto, H N

    2014-08-01

    Intensification of Brazilian cattle ranching systems has attracted both national and international attention due to its direct relation with Amazon deforestation on the one hand and increasing demand of the global population for meat on the other. Since Brazilian cattle ranching is predominantly pasture-based, we particularly focus on pasture management. We summarize the most recurrent opportunities and risks associated with pasture intensification that are brought up within scientific and political dialogues, and discuss them within the Brazilian context. We argue that sustainable intensification of pasturelands in Brazil is a viable way to increase agricultural output while simultaneously sparing land for nature. Since environmental degradation is often associated with low-yield extensive systems in Brazil, it is possible to obtain higher yields, while reversing degradation, by adopting practices like rotational grazing, incorporation of legumes and integrated crop-livestock-forestry systems. Technical assistance is however essential, particularly for small- and medium-scale farmers. Sound complementary policies and good governance must accompany these measures so that a 'rebound effect' does not lead to increased deforestation and other adverse social and environmental impacts. It is also important that animal welfare is not compromised. Although the discussion is presented with respect to Brazil, some aspects are relevant to other developing countries. PMID:26263189

  7. Toxoplasmosis screening and risk factors amongst pregnant females in Natal, northeastern Brazil.

    PubMed

    Barbosa, Isabelle Ribeiro; de Carvalho Xavier Holanda, Cecília Maria; de Andrade-Neto, Valter Ferreira

    2009-04-01

    Toxoplasmosis results in systemic disease, and if the mother is infected for the first time during gestation, the fetus may suffer substantial damage. Relatively little is known about the epidemiology of toxoplasmosis in pregnancy in most states of northeastern Brazil. Seroprevalence of toxoplasmosis among pregnant woman was studied in Natal, capital of Rio Grande do Norte State, in northeastern Brazil, from March to December 2007. The sera were tested for IgM and avidity of IgG antibodies to Toxoplasma by a microparticle enzyme immunoassay. The overall seroprevalence was high [126/190 (66.3%)]; prevalence increased with age indicating that in this setting most infections occur in adulthood (third decade of life). Only one pregnant woman was IgM positive and had high-avidity antibodies. The high percentage of pregnant women who are vulnerable to this parasite (33.1%) favors primary infection during pregnancy. Our studies show that direct contact with cats or dogs was highly associated with toxoplasmosis (odds ratio 2.72, P<0.001, 95% CI 1.46-5.02). The number of years in school (P<0.001), precarious socioeconomic status and limited knowledge about the disease (Prisk factors for infection corroborate other studies in Brazil. PMID:19211119

  8. Decreasing flood risk perception in Porto Alegre - Brazil and its influence on water resource management decisions

    NASA Astrophysics Data System (ADS)

    Allasia, D. G.; Tassi, R.; Bemfica, D.; Goldenfum, J. A.

    2015-06-01

    Porto Alegre is the capital and largest city in the Brazilian state of Rio Grande do Sul in Southern Brazil with approximately 1.5 million inhabitants. The city lies on the eastern bank of the Guaiba Lake, formed by the convergence of five rivers and leading to the Lagoa dos Patos, a giant freshwater lagoon navigable by even the largest of ships. This river junction has become an important alluvial port as well as a chief industrial and commercial centre. However, this strategic location resulted in severe damage because of its exposure to flooding from the river system, affecting the city in the years 1873, 1928, 1936, 1941 and 1967. In order to reduce flood risk, a complex system of levees and pump stations was implemented during 1960s and 1970s. Since its construction, not a single large flood event occurred. However, in recent years, the levees in the downtown region of Porto Alegre were severally criticized by city planners and population. Several projects have been proposed to demolish the Mauá Wall due to the false perception of lack of flood risk. Similar opinions and reactions against flood infrastructure have been observed in other cities in Brazil, such as Itajaí and Blumenau, with disastrous consequences. This paper illustrates how the perception of flood risk in Porto Alegre has changed over recent years as a result of flood infrastructure, and how such changes in perceptions can influence water management decisions.

  9. Coronary heart disease risk prediction in the Atherosclerosis Risk in Communities (ARIC) study.

    PubMed

    Chambless, Lloyd E; Folsom, Aaron R; Sharrett, A Richey; Sorlie, Paul; Couper, David; Szklo, Moyses; Nieto, F Javier

    2003-09-01

    Risk prediction functions for incident coronary heart disease (CHD) were estimated using data from the Atherosclerosis Risk in Communities (ARIC) Study, a prospective study of CHD in 15,792 persons recruited in 1987-1989 from four U.S. communities, with follow-up through 1998. Predictivity of which individuals had incident CHD was assessed by increase in area under ROC curves resulting from adding nontraditional risk factors and markers of subclinical disease to a basic model containing only traditional risk factors. We also assessed the increase in population attributable risk. The additional factors were body mass index; waist-hip ratio; sport activity index; forced expiratory volume; plasma fibrinogen, factor VIII, von Willebrand factor, and Lp(a); heart rate; Keys score; pack-years smoking; and subclinical disease marker carotid intima-media thickness. These factors substantially improved prediction of future CHD for men, less for women, and also increased attributable risks. PMID:14505774

  10. Risk assessment and life prediction of complex engineering systems

    SciTech Connect

    Garcia, M.D.; Varma, R.; Heger, A.S.

    1996-03-01

    Many complex engineering systems will exceed their design life expectancy within the next 10 to 15 years. It is also expected that these systems must be maintained and operated beyond their design life. This paper presents a integrated approach for managing the risks associated with aging effects and predicting the residually expectancy these systems, The approach unifies risk assessment, enhanced surveillance and testing, and robust computational models to assess the risk, predict age, and develop a life-extension management procedure. It also relies on the state of the art in life-extension and risk assessment methods from the nuclear power industry. Borrowing from the developments in decision analysis, this approach should systematically identify the options available for managing the existing aging systems beyond their intended design life.

  11. Cumulative risk hypothesis: Predicting and preventing child maltreatment recidivism.

    PubMed

    Solomon, David; Åsberg, Kia; Peer, Samuel; Prince, Gwendolyn

    2016-08-01

    Although Child Protective Services (CPS) and other child welfare agencies aim to prevent further maltreatment in cases of child abuse and neglect, recidivism is common. Having a better understanding of recidivism predictors could aid in preventing additional instances of maltreatment. A previous study identified two CPS interventions that predicted recidivism: psychotherapy for the parent, which was related to a reduced risk of recidivism, and temporary removal of the child from the parent's custody, which was related to an increased recidivism risk. However, counter to expectations, this previous study did not identify any other specific risk factors related to maltreatment recidivism. For the current study, it was hypothesized that (a) cumulative risk (i.e., the total number of risk factors) would significantly predict maltreatment recidivism above and beyond intervention variables in a sample of CPS case files and that (b) therapy for the parent would be related to a reduced likelihood of recidivism. Because it was believed that the relation between temporary removal of a child from the parent's custody and maltreatment recidivism is explained by cumulative risk, the study also hypothesized that that the relation between temporary removal of the child from the parent's custody and recidivism would be mediated by cumulative risk. After performing a hierarchical logistic regression analysis, the first two hypotheses were supported, and an additional predictor, psychotherapy for the child, also was related to reduced chances of recidivism. However, Hypothesis 3 was not supported, as risk did not significantly mediate the relation between temporary removal and recidivism. PMID:27352090

  12. Risk prediction tools for cancer in primary care.

    PubMed

    Usher-Smith, Juliet; Emery, Jon; Hamilton, Willie; Griffin, Simon J; Walter, Fiona M

    2015-12-22

    Numerous risk tools are now available, which predict either current or future risk of a cancer diagnosis. In theory, these tools have the potential to improve patient outcomes through enhancing the consistency and quality of clinical decision-making, facilitating equitable and cost-effective distribution of finite resources such as screening tests or preventive interventions, and encouraging behaviour change. These potential uses have been recognised by the National Cancer Institute as an 'area of extraordinary opportunity' and an increasing number of risk prediction models continue to be developed. The data on predictive utility (discrimination and calibration) of these models suggest that some have potential for clinical application; however, the focus on implementation and impact is much more recent and there remains considerable uncertainty about their clinical utility and how to implement them in order to maximise benefits and minimise harms such as over-medicalisation, anxiety and false reassurance. If the potential benefits of risk prediction models are to be realised in clinical practice, further validation of the underlying risk models and research to assess the acceptability, clinical impact and economic implications of incorporating them in practice are needed. PMID:26633558

  13. Predicting perceived risk of crime: a multilevel study.

    PubMed

    Russo, Silvia; Roccato, Michele; Vieno, Alessio

    2011-12-01

    With a sample of Italians selected from 71 Italian counties (N = 1,868), we performed two multilevel analyses aimed at predicting the perceived risk of crime at local (i.e., in the participants' county of residence) and at societal (i.e., in the context of Italian society) levels. A significant proportion of the variation in local risk perception was at the county level. The following individual variables predicted higher levels of this variable: indirect victimization, the perception of social and physical disorder, being a woman, being poorly educated, and being an older person. Among the ecological predictors, the crime rate and unemployment rate predicted higher levels of local crime risk perception, while the immigrant rate did not. Perceived risk of crime at the societal level did not show significant variation at the county level. Education, being a man, trusting people, and adhesion to post-materialistic values predicted lower levels of societal crime risk perception, while number of sons/daughters and exposure to television news increased it. The limitations and possible development of this study are discussed. PMID:21161721

  14. Risk prediction tools for cancer in primary care

    PubMed Central

    Usher-Smith, Juliet; Emery, Jon; Hamilton, Willie; Griffin, Simon J; Walter, Fiona M

    2015-01-01

    Numerous risk tools are now available, which predict either current or future risk of a cancer diagnosis. In theory, these tools have the potential to improve patient outcomes through enhancing the consistency and quality of clinical decision-making, facilitating equitable and cost-effective distribution of finite resources such as screening tests or preventive interventions, and encouraging behaviour change. These potential uses have been recognised by the National Cancer Institute as an ‘area of extraordinary opportunity' and an increasing number of risk prediction models continue to be developed. The data on predictive utility (discrimination and calibration) of these models suggest that some have potential for clinical application; however, the focus on implementation and impact is much more recent and there remains considerable uncertainty about their clinical utility and how to implement them in order to maximise benefits and minimise harms such as over-medicalisation, anxiety and false reassurance. If the potential benefits of risk prediction models are to be realised in clinical practice, further validation of the underlying risk models and research to assess the acceptability, clinical impact and economic implications of incorporating them in practice are needed. PMID:26633558

  15. Identification of the high risk emergency surgical patient: Which risk prediction model should be used?

    PubMed Central

    Stonelake, Stephen; Thomson, Peter; Suggett, Nigel

    2015-01-01

    Introduction National guidance states that all patients having emergency surgery should have a mortality risk assessment calculated on admission so that the ‘high risk’ patient can receive the appropriate seniority and level of care. We aimed to assess if peri-operative risk scoring tools could accurately calculate mortality and morbidity risk. Methods Mortality risk scores for 86 consecutive emergency laparotomies, were calculated using pre-operative (ASA, Lee index) and post-operative (POSSUM, P-POSSUM and CR-POSSUM) risk calculation tools. Morbidity risk scores were calculated using the POSSUM predicted morbidity and compared against actual morbidity according to the Clavien–Dindo classification. Results The actual mortality was 10.5%. The average predicted risk scores for all laparotomies were: ASA 26.5%, Lee Index 2.5%, POSSUM 29.5%, P-POSSUM 18.5%, CR-POSSUM 10.5%. Complications occurred following 67 laparotomies (78%). The majority (51%) of complications were classified as Clavien–Dindo grade 2–3 (non-life-threatening). Patients having a POSSUM morbidity risk of greater than 50% developed significantly more life-threatening complications (CD 4–5) compared with those who predicted less than or equal to 50% morbidity risk (P = 0.01). Discussion Pre-operative risk stratification remains a challenge because the Lee Index under-predicts and ASA over-predicts mortality risk. Post-operative risk scoring using the CR-POSSUM is more accurate and we suggest can be used to identify patients who require intensive care post-operatively. Conclusions In the absence of accurate risk scoring tools that can be used on admission to hospital it is not possible to reliably audit the achievement of national standards of care for the ‘high-risk’ patient. PMID:26468369

  16. Evaluating karst geotechnical risk in the urbanized area of Sete Lagoas, Minas Gerais, Brazil

    NASA Astrophysics Data System (ADS)

    Galvão, Paulo; Halihan, Todd; Hirata, Ricardo

    2015-11-01

    An increase in groundwater consumption in the municipality of Sete Lagoas (Minas Gerais, Brazil) has induced subsidence and collapse in the last three decades. The area is associated with natural karst conditions. The primary objective of this research was to evaluate and identify the potential subsidence or collapse risk zones. Aerial photographs, lithologic well profiles, optical well logs, and geologic mapping were utilized to categorize risk factors influencing karst subsidence and collapse, which were then applied to an index system. The study showed that the majority of the urbanized area overlies mantled limestone from the Sete Lagoas Formation covered with unconsolidated sediments, contained within a graben, resulting in barrier boundaries for groundwater flow. This structure, together with natural karst processes, explains the location of solutionally enlarged bedding-plane conduits and high hydraulic conductivity in the limestone. Five risks zones in the municipality were identified (negligible, low, moderate, considerable, and high risks) related to geologic and hydrologic risk factors. The urbanized area is located largely in the high risk zone where the majority of the collapse features are located. Additional intensive groundwater extraction in that area will likely generate additional events.

  17. Investigation on Cardiovascular Risk Prediction Using Physiological Parameters

    PubMed Central

    Lin, Wan-Hua; Zhang, Heye; Zhang, Yuan-Ting

    2013-01-01

    Cardiovascular disease (CVD) is the leading cause of death worldwide. Early prediction of CVD is urgently important for timely prevention and treatment. Incorporation or modification of new risk factors that have an additional independent prognostic value of existing prediction models is widely used for improving the performance of the prediction models. This paper is to investigate the physiological parameters that are used as risk factors for the prediction of cardiovascular events, as well as summarizing the current status on the medical devices for physiological tests and discuss the potential implications for promoting CVD prevention and treatment in the future. The results show that measures extracted from blood pressure, electrocardiogram, arterial stiffness, ankle-brachial blood pressure index (ABI), and blood glucose carry valuable information for the prediction of both long-term and near-term cardiovascular risk. However, the predictive values should be further validated by more comprehensive measures. Meanwhile, advancing unobtrusive technologies and wireless communication technologies allow on-site detection of the physiological information remotely in an out-of-hospital setting in real-time. In addition with computer modeling technologies and information fusion. It may allow for personalized, quantitative, and real-time assessment of sudden CVD events. PMID:24489599

  18. Risk Factors for Death from Visceral Leishmaniasis in an Urban Area of Brazil

    PubMed Central

    Druzian, Angelita F.; de Souza, Albert S.; de Campos, Diogo N.; Croda, Julio; Higa, Minoru G.; Dorval, Maria Elizabeth C.; Pompilio, Mauricio A.; de Oliveira, Polliana A.; Paniago, Anamaria M. M.

    2015-01-01

    Background Over the last three decades, the epidemiological profile of visceral leishmaniasis (VL) has changed with epidemics occurring in large urban centers of Brazil, an increase in HIV/AIDS co-infection, and a significant increase in mortality. The objective of this study was to identify the risk factors associated with death among adult patients with VL from an urban endemic area of Brazil. Methodology A prospective cohort study included 134 adult patients with VL admitted to the University Hospital of the Federal University of Mato Grosso do Sul between August 2011 and August 2013. Principal Findings Patients ranged from 18 to 93 years old, with a mean age of 43.6 (±15.7%). Of these patients, 36.6% were co-infected with HIV/AIDS, and the mortality rate was 21.6%. In a multivariate analysis, the risk factors associated with death were secondary bacterial infection (42.86, 5.05–363.85), relapse (12.17, 2.06–71.99), edema (7.74, 1.33–45.05) and HIV/AIDS co-infection (7.33, 1.22–43.98). Conclusions/Significance VL has a high mortality rate in adults from endemic urban areas, especially when coinciding with high rates of HIV/AIDS co-infection. PMID:26274916

  19. Variation of surface ozone in Campo Grande, Brazil: meteorological effect analysis and prediction.

    PubMed

    Pires, J C M; Souza, A; Pavão, H G; Martins, F G

    2014-09-01

    The effect of meteorological variables on surface ozone (O3) concentrations was analysed based on temporal variation of linear correlation and artificial neural network (ANN) models defined by genetic algorithms (GAs). ANN models were also used to predict the daily average concentration of this air pollutant in Campo Grande, Brazil. Three methodologies were applied using GAs, two of them considering threshold models. In these models, the variables selected to define different regimes were daily average O3 concentration, relative humidity and solar radiation. The threshold model that considers two O3 regimes was the one that correctly describes the effect of important meteorological variables in O3 behaviour, presenting also a good predictive performance. Solar radiation, relative humidity and rainfall were considered significant for both O3 regimes; however, wind speed (dispersion effect) was only significant for high concentrations. According to this model, high O3 concentrations corresponded to high solar radiation, low relative humidity and wind speed. This model showed to be a powerful tool to interpret the O3 behaviour, being useful to define policy strategies for human health protection regarding air pollution. PMID:24854500

  20. The role of risk propensity in predicting self-employment.

    PubMed

    Nieß, Christiane; Biemann, Torsten

    2014-09-01

    This study aims to untangle the role of risk propensity as a predictor of self-employment entry and self-employment survival. More specifically, it examines whether the potentially positive effect of risk propensity on the decision to become self-employed turns curvilinear when it comes to the survival of the business. Building on a longitudinal sample of 4,973 individuals from the German Socio-Economic Panel, we used event history analyses to evaluate the influence of risk propensity on self-employment over a 7-year time period. Results indicated that whereas high levels of risk propensity positively predicted the decision to become self-employed, the relationship between risk propensity and self-employment survival followed an inverted U-shaped curve. PMID:24588336

  1. Providing access to risk prediction tools via the HL7 XML-formatted risk web service.

    PubMed

    Chipman, Jonathan; Drohan, Brian; Blackford, Amanda; Parmigiani, Giovanni; Hughes, Kevin; Bosinoff, Phil

    2013-07-01

    Cancer risk prediction tools provide valuable information to clinicians but remain computationally challenging. Many clinics find that CaGene or HughesRiskApps fit their needs for easy- and ready-to-use software to obtain cancer risks; however, these resources may not fit all clinics' needs. The HughesRiskApps Group and BayesMendel Lab therefore developed a web service, called "Risk Service", which may be integrated into any client software to quickly obtain standardized and up-to-date risk predictions for BayesMendel tools (BRCAPRO, MMRpro, PancPRO, and MelaPRO), the Tyrer-Cuzick IBIS Breast Cancer Risk Evaluation Tool, and the Colorectal Cancer Risk Assessment Tool. Software clients that can convert their local structured data into the HL7 XML-formatted family and clinical patient history (Pedigree model) may integrate with the Risk Service. The Risk Service uses Apache Tomcat and Apache Axis2 technologies to provide an all Java web service. The software client sends HL7 XML information containing anonymized family and clinical history to a Dana-Farber Cancer Institute (DFCI) server, where it is parsed, interpreted, and processed by multiple risk tools. The Risk Service then formats the results into an HL7 style message and returns the risk predictions to the originating software client. Upon consent, users may allow DFCI to maintain the data for future research. The Risk Service implementation is exemplified through HughesRiskApps. The Risk Service broadens the availability of valuable, up-to-date cancer risk tools and allows clinics and researchers to integrate risk prediction tools into their own software interface designed for their needs. Each software package can collect risk data using its own interface, and display the results using its own interface, while using a central, up-to-date risk calculator. This allows users to choose from multiple interfaces while always getting the latest risk calculations. Consenting users contribute their data for future

  2. HIV infection and risk behaviors among male port workers in Santos, Brazil.

    PubMed Central

    Larcerda, R; Stall, R; Gravato, N; Tellini, R; Hudes, E S; Hearst, N

    1996-01-01

    OBJECTIVES. This paper measured the extent to which human immunodeficiency virus (HIV) infection has spread among the male working-class population of Santos, Brazil. METHODS. Questionnaires on risk behaviors and blood tests were administered to a random sample (n = 395) of male port workers employed by the Santos Port Authority. RESULTS. Although the rate of HIV infection among these men- the working-class male population of Santos-remains low (1.1%), self-reported behavioral risks for HIV infection are common. CONCLUSIONS. There is still time to prevent a widespread outbreak of HIV infection among the hetero-sexual population of Santos and of the transportation corridors emanating from that city. PMID:8712280

  3. Identification of Risk Areas for Visceral Leishmaniasis in Teresina, Piaui State, Brazil

    PubMed Central

    de Almeida, Andréa S.; de Andrade Medronho, Roberto; Werneck, Guilherme L.

    2011-01-01

    This study used spatial analysis to identify areas at greatest risk of visceral leishmaniasis (VL) in the urban area of Teresina, Brazil during 2001–2006. The results from kernel ratios showed that peripheral census tracts were the most heavily affected. Local spatial analysis showed that in the beginning of the study period local clusters of high incidence of VL were mostly located in the southern and northeastern parts of the city, but in subsequent years those clusters also appeared in the northern region of the city, suggesting that the pattern of VL is not static, and the disease may occasionally spread to other areas of the municipality. We also observed a spatial correlation between VL rates and all socioeconomic and demographic indicators evaluated (P < 0.01). The concentration of interventions in high-risk areas could be an effective strategy to control the disease in the urban setting. PMID:21540375

  4. Clustering of Risk Factors for Non-Communicable Diseases among Adolescents from Southern Brazil

    PubMed Central

    2016-01-01

    Introduction The aim of this study was to investigate the simultaneous presence of risk factors for non-communicable diseases and the association of these risk factors with demographic and economic factors among adolescents from southern Brazil. Methods The study included 916 students (14–19 years old) enrolled in the 2014 school year at state schools in São José, Santa Catarina, Brazil. Risk factors related to lifestyle (i.e., physical inactivity, excessive alcohol consumption, smoking, sedentary behaviour and unhealthy diet), demographic variables (sex, age and skin colour) and economic variables (school shift and economic level) were assessed through a questionnaire. Simultaneous behaviours were assessed by the ratio between observed and expected prevalences of risk factors for non-communicable diseases. The clustering of risk factors was analysed by multinomial logistic regression. The clusters of risk factors that showed a higher prevalence were analysed by binary logistic regression. Results The clustering of two, three, four, and five risk factors were found in 22.2%, 49.3%, 21.7% and 3.1% of adolescents, respectively. Subgroups that were more likely to have both behaviours of physical inactivity and unhealthy diet simultaneously were mostly composed of girls (OR = 3.03, 95% CI = 1.57–5.85) and those with lower socioeconomic status (OR = 1.83, 95% CI = 1.05–3.21); simultaneous physical inactivity, excessive alcohol consumption, sedentary behaviour and unhealthy diet were mainly observed among older adolescents (OR = 1.49, 95% CI = 1.05–2.12). Subgroups less likely to have both behaviours of sedentary behaviour and unhealthy diet were mostly composed of girls (OR = 0.58, 95% CI = 0.38–0.89); simultaneous physical inactivity, sedentary behaviour and unhealthy diet were mainly observed among older individuals (OR = 0.66, 95% CI = 0.49–0.87) and those of the night shift (OR = 0.59, 95% CI = 0.43–0.82). Conclusion Adolescents had a high prevalence

  5. Repeat Cardiovascular Risk Assessment after Four Years: Is There Improvement in Risk Prediction?

    PubMed Central

    Chamnan, Parinya; Simmons, Rebecca K.; Sharp, Stephen J.; Khaw, Kay-Tee; Wareham, Nicholas J.; Griffin, Simon J.

    2016-01-01

    Background Framingham risk equations are widely used to predict cardiovascular disease based on health information from a single time point. Little is known regarding use of information from repeat risk assessments and temporal change in estimated cardiovascular risk for prediction of future cardiovascular events. This study was aimed to compare the discrimination and risk reclassification of approaches using estimated cardiovascular risk at single and repeat risk assessments Methods Using data on 12,197 individuals enrolled in EPIC-Norfolk cohort, with 12 years of follow-up, we examined rates of cardiovascular events by levels of estimated absolute risk (Framingham risk score) at the first and second health examination four years later. We calculated the area under the receiver operating characteristic curve (aROC) and risk reclassification, comparing approaches using information from single and repeat risk assessments (i.e., estimated risk at different time points). Results The mean Framingham risk score increased from 15.5% to 17.5% over a mean of 3.7 years from the first to second health examination. Individuals with high estimated risk (≥20%) at both health examinations had considerably higher rates of cardiovascular events than those who remained in the lowest risk category (<10%) in both health examinations (34.0 [95%CI 31.7–36.6] and 2.7 [2.2–3.3] per 1,000 person-years respectively). Using information from the most up-to-date risk assessment resulted in a small non-significant change in risk classification over the previous risk assessment (net reclassification improvement of -4.8%, p>0.05). Using information from both risk assessments slightly improved discrimination compared to information from a single risk assessment (aROC 0.76 and 0.75 respectively, p<0.001). Conclusions Using information from repeat risk assessments over a period of four years modestly improved prediction, compared to using data from a single risk assessment. However, this

  6. Risk Communication Concerning Welding Fumes for the Primary Preventive Care of Welding Apprentices in Southern Brazil

    PubMed Central

    Cezar-Vaz, Marta Regina; Bonow, Clarice Alves; Cezar Vaz, Joana

    2015-01-01

    This study’s aim was to assess the perceptions of welding apprentices concerning welding fumes being associated with respiratory and cardiovascular disorders and assess the implementation of risk communication as a primary prevention tool in the welding training process. This quasi-experimental, non-randomized study with before-and-after design was conducted with 84 welding apprentices in Southern Brazil. Poisson Regression analysis was used. Relative Risk was the measure used with a 95% confidence interval and 5% (p ≤ 0.05) significance level. Significant association was found between perceptions of worsened symptoms of respiratory disorders caused by welding fumes and educational level (p = 0.049), the use of goggles to protect against ultraviolet rays (p = 0.023), and access to services in private health facilities without insurance coverage (p = 0.001). Apprentices younger than 25 years old were 4.9 times more likely to perceive worsened cardiovascular symptoms caused by welding fumes after risk communication (RR = 4.91; CI 95%: 1.09 to 22.2). The conclusion is that risk communication as a primary preventive measure in continuing education processes implemented among apprentices, who are future welders, was efficacious. Thus, this study confirms that risk communication can be implemented as a primary prevention tool in welding apprenticeships. PMID:25607606

  7. Risk communication concerning welding fumes for the primary preventive care of welding apprentices in southern Brazil.

    PubMed

    Cezar-Vaz, Marta Regina; Bonow, Clarice Alves; Vaz, Joana Cezar

    2015-01-01

    This study's aim was to assess the perceptions of welding apprentices concerning welding fumes being associated with respiratory and cardiovascular disorders and assess the implementation of risk communication as a primary prevention tool in the welding training process. This quasi-experimental, non-randomized study with before-and-after design was conducted with 84 welding apprentices in Southern Brazil. Poisson Regression analysis was used. Relative Risk was the measure used with a 95% confidence interval and 5% (p ≤ 0.05) significance level. Significant association was found between perceptions of worsened symptoms of respiratory disorders caused by welding fumes and educational level (p = 0.049), the use of goggles to protect against ultraviolet rays (p = 0.023), and access to services in private health facilities without insurance coverage (p = 0.001). Apprentices younger than 25 years old were 4.9 times more likely to perceive worsened cardiovascular symptoms caused by welding fumes after risk communication (RR = 4.91; CI 95%: 1.09 to 22.2). The conclusion is that risk communication as a primary preventive measure in continuing education processes implemented among apprentices, who are future welders, was efficacious. Thus, this study confirms that risk communication can be implemented as a primary prevention tool in welding apprenticeships. PMID:25607606

  8. Risk perception and occupational accidents: a study of gas station workers in southern Brazil.

    PubMed

    Cezar-Vaz, Marta Regina; Rocha, Laurelize Pereira; Bonow, Clarice Alves; Silva, Mara Regina Santos da; Vaz, Joana Cezar; Cardoso, Letícia Silveira

    2012-07-01

    The present study aimed to identify the perceptions of gas station workers about physical, chemical, biological and physiological risk factors to which they are exposed in their work environment; identify types of occupational accidents involving gas station workers and; report the development of a socioenvironmental intervention as a tool for risk communication to gas station workers. A quantitative study was performed with 221 gas station workers in southern Brazil between October and December 2010. Data collection was performed between October to December 2010 via structured interviews. The data were analyzed using SPSS 19.0. The participants identified the following risk types: chemical (93.7%), physical (88.2%), physiological (64.3%) and biological (62.4%). In this sample, 94.1% of gas station workers reported occupational accidents, and 74.2% reported fuel contact with the eyes (p < 0.05). It is concluded that workers perceive risks, and that they tend to relate risks with the occurrence of occupational accidents as an indicator of the dangerous nature of their work environment. PMID:22851948

  9. Protective and risk factors for toxocariasis in children from two different social classes of Brazil.

    PubMed

    Santarém, Vamilton Alvares; Leli, Flávia Noris Chagas; Rubinsky-Elefant, Guita; Giuffrida, Rogério

    2011-01-01

    The aim of this study was to analyze the prevalence of Toxocara spp. antibodies in children from two different socioeconomic classes in the Presidente Prudente municipality, São Paulo State, Brazil, and the protective and risk factors associated with toxocariasis. One hundred and twenty-six middle-class (MC) and 126 disadvantaged children (DC) were included in this study. Anti-Toxocara ELISA test was performed in order to evaluate seroprevalence. A survey was applied to the children's guardians/parents in order to analyze the protective and risk factors. The overall prevalence was 11.1%, and of 9.5% (12/126) and 12.7% (16/126) for MC and DC subgroups, respectively. Toxocara seropositivity was inversely proportional to the family income. A high household income was considered a protective factor for toxocariasis in the total population and in both MC and DC subgroups. Being a girl was considered a protective factor for the total population and for both subgroups. Whilst being an owner of cat was a risk factor for children belonging to the total and for both MC and DC subgroups, having dog was considered as a risk factor for only the MC. Epidemiologic protective/factor risks can be distinct depending on the strata of the same population. Thus, it is relevant to evaluate these factors independently for different socioeconomic classes in order to design future investigations and programs for preventing the infection of human beings by Toxocara spp. and other geohelminths. PMID:21537752

  10. RegCM4 Dynamical Downscaling of Seasonal Climate Predictions over the Southeast of Brazil

    NASA Astrophysics Data System (ADS)

    Reboita, Michelle S.; Dutra, Lívia M. M.; da Rocha, Rosmeri P.

    2013-04-01

    In this study the Regional Climate Model version 4 (RegCM4) was nested in the General Circulation Model from the Brazilian Center for Weather Forecasts and Climate Studies (CPTEC) to produce three month (seasonal) predictions to the southeast of Brazil (SB). The predictions for MAM (March-April-May), AMJ (April-May-June) and SON (September-October-November) of 2012 used six different parameterizations of convection: 1) Grell with Arakawa-Schubert (GAS) closure, 2) Grell with Fritsch-Chappell (GFC) closure, 3) Kuo, 4) Emanuel (EM), 5) Mixed-1 with GFC and Emanuel schemes over the land and ocean, respectively and 6) Mixed-2 with Emanuel and GFC over the land and ocean, respectively. The simulations started 48 days before the seasons of interest to permit a spin-up period. The predicted precipitation was compared with observation from Climate Prediction Center (CPC). For MAM/2012, the experiment with Kuo scheme presented the seasonal precipitation similar to CPC, while GAS, GFC and Mixed-1 experiments underestimated the precipitation (~1-2 mm/day) over the center of SB and EM and Mixed-2 schemes overestimated it (~4 mm/day) over most part of SB. For AMJ/2012 all experiments underestimated the precipitation (~2-3 mm/day) in the central-south part of SB, but they simulated the precipitation intensity close to the observation over the center-north SB (except the EM which shows overestimation in this area). For this season, Mixed-1 presented the smaller bias compared to the other convective schemes. For AMJ/2012, the experiments underestimated the precipitation (~2-4 mm/day) over the center-north of SB and overestimated it (~2-4 mm/day) in the eastern sector. In this period, the EM and Mixed-1 predictions presented the smaller bias compared to CPC. Considering the three seasons, this study suggests that the best convective scheme to seasonal predictions for SB is Mixed-1, while GFC, GAS and Kuo also produce satisfactory seasonal precipitation.

  11. Predicting impacts of climate change on Fasciola hepatica risk.

    PubMed

    Fox, Naomi J; White, Piran C L; McClean, Colin J; Marion, Glenn; Evans, Andy; Hutchings, Michael R

    2011-01-01

    Fasciola hepatica (liver fluke) is a physically and economically devastating parasitic trematode whose rise in recent years has been attributed to climate change. Climate has an impact on the free-living stages of the parasite and its intermediate host Lymnaea truncatula, with the interactions between rainfall and temperature having the greatest influence on transmission efficacy. There have been a number of short term climate driven forecasts developed to predict the following season's infection risk, with the Ollerenshaw index being the most widely used. Through the synthesis of a modified Ollerenshaw index with the UKCP09 fine scale climate projection data we have developed long term seasonal risk forecasts up to 2070 at a 25 km square resolution. Additionally UKCIP gridded datasets at 5 km square resolution from 1970-2006 were used to highlight the climate-driven increase to date. The maps show unprecedented levels of future fasciolosis risk in parts of the UK, with risk of serious epidemics in Wales by 2050. The seasonal risk maps demonstrate the possible change in the timing of disease outbreaks due to increased risk from overwintering larvae. Despite an overall long term increase in all regions of the UK, spatio-temporal variation in risk levels is expected. Infection risk will reduce in some areas and fluctuate greatly in others with a predicted decrease in summer infection for parts of the UK due to restricted water availability. This forecast is the first approximation of the potential impacts of climate change on fasciolosis risk in the UK. It can be used as a basis for indicating where active disease surveillance should be targeted and where the development of improved mitigation or adaptation measures is likely to bring the greatest benefits. PMID:21249228

  12. Ensemble Streamflow Predictions in the Três Marias Basin, Brazil

    NASA Astrophysics Data System (ADS)

    Mainardi Fan, Fernando; Schwanenberg, Dirk; Kuwajima, Julio; Assis dos Reis, Alberto; Collischonn, Walter

    2014-05-01

    Hydropower is the main electricity source of Brazil. The related hydropower reservoirs are multi-purpose thus besides efficient and reliable energy production, they are relevant for flood control. In this context, the present study shows results of an Ensemble Streamflow Prediction (ESP) for supporting the operational decision making implemented at Três Marias hydroelectric power project located in the São Francisco River basin in Brazil. It is a large tropical river basin with approximately 55,000km² up to the Três Marias dam. The hydrological model used in the study is the MGB-IPH (Modelo de Grandes Bacias from Instituto de Pesquisas Hidráulicas), a large scale distributed hydrological model. Applied in an operational forecasting mode, it uses an empirical data assimilation method to take into account real time streamflow observations to update its state variables. We present results of a hindcast experiment with observed precipitation and streamflow data from the local energy utility, CEMIG (Companhia Energética de Minas Gerais), and from the Brazilian water agency, ANA (Agencia Nacional de Água),. Probabilistic Numerical Weather Predictions (NWP) from CPTEC (Centro de Previsão de Tempo e Estudos Climáticos), ECMWF (European Centre for Medium-Range Weather Forecast) and NOAA (National Oceanic and Atmospheric Administration) are used to generate the ESP. The data products and the MGB-IPH model are integrated into an open shell forecasting platform based on the software package Delft-FEWS. Inside the forecasting platform a hindcast mode over a forecast lead time of 10-16 days in recent rainfall periods is applied in. The ESP results are compared to deterministic forecasts of the Três Marias reservoir inflow. The results assessment verifies the added value of the ESP in general in comparison to the use of deterministic forecasts by means of different performance indicators. The ESP derived from the ECMWP ensemble shows the best performance. A future

  13. Common polygenic variation enhances risk prediction for Alzheimer's disease.

    PubMed

    Escott-Price, Valentina; Sims, Rebecca; Bannister, Christian; Harold, Denise; Vronskaya, Maria; Majounie, Elisa; Badarinarayan, Nandini; Morgan, Kevin; Passmore, Peter; Holmes, Clive; Powell, John; Brayne, Carol; Gill, Michael; Mead, Simon; Goate, Alison; Cruchaga, Carlos; Lambert, Jean-Charles; van Duijn, Cornelia; Maier, Wolfgang; Ramirez, Alfredo; Holmans, Peter; Jones, Lesley; Hardy, John; Seshadri, Sudha; Schellenberg, Gerard D; Amouyel, Philippe; Williams, Julie

    2015-12-01

    The identification of subjects at high risk for Alzheimer's disease is important for prognosis and early intervention. We investigated the polygenic architecture of Alzheimer's disease and the accuracy of Alzheimer's disease prediction models, including and excluding the polygenic component in the model. This study used genotype data from the powerful dataset comprising 17 008 cases and 37 154 controls obtained from the International Genomics of Alzheimer's Project (IGAP). Polygenic score analysis tested whether the alleles identified to associate with disease in one sample set were significantly enriched in the cases relative to the controls in an independent sample. The disease prediction accuracy was investigated in a subset of the IGAP data, a sample of 3049 cases and 1554 controls (for whom APOE genotype data were available) by means of sensitivity, specificity, area under the receiver operating characteristic curve (AUC) and positive and negative predictive values. We observed significant evidence for a polygenic component enriched in Alzheimer's disease (P = 4.9 × 10(-26)). This enrichment remained significant after APOE and other genome-wide associated regions were excluded (P = 3.4 × 10(-19)). The best prediction accuracy AUC = 78.2% (95% confidence interval 77-80%) was achieved by a logistic regression model with APOE, the polygenic score, sex and age as predictors. In conclusion, Alzheimer's disease has a significant polygenic component, which has predictive utility for Alzheimer's disease risk and could be a valuable research tool complementing experimental designs, including preventative clinical trials, stem cell selection and high/low risk clinical studies. In modelling a range of sample disease prevalences, we found that polygenic scores almost doubles case prediction from chance with increased prediction at polygenic extremes. PMID:26490334

  14. Lung cancer in never smokers Epidemiology and risk prediction models

    PubMed Central

    McCarthy, William J.; Meza, Rafael; Jeon, Jihyoun; Moolgavkar, Suresh

    2012-01-01

    In this chapter we review the epidemiology of lung cancer incidence and mortality among never smokers/ nonsmokers and describe the never smoker lung cancer risk models used by CISNET modelers. Our review focuses on those influences likely to have measurable population impact on never smoker risk, such as secondhand smoke, even though the individual-level impact may be small. Occupational exposures may also contribute importantly to the population attributable risk of lung cancer. We examine the following risk factors in this chapter: age, environmental tobacco smoke, cooking fumes, ionizing radiation including radon gas, inherited genetic susceptibility, selected occupational exposures, preexisting lung disease, and oncogenic viruses. We also compare the prevalence of never smokers between the three CISNET smoking scenarios and present the corresponding lung cancer mortality estimates among never smokers as predicted by a typical CISNET model. PMID:22882894

  15. Gastrointestinal and ectoparasites from urban stray dogs in Fortaleza (Brazil): high infection risk for humans?

    PubMed

    Klimpel, Sven; Heukelbach, Jörg; Pothmann, David; Rückert, Sonja

    2010-08-01

    Dogs are important definite or reservoir hosts for zoonotic parasites. However, only few studies on the prevalence of intestinal parasites in urban areas in Brazil are available. We performed a comprehensive study on parasites of stray dogs in a Brazilian metropolitan area. We included 46 stray dogs caught in the urban areas of Fortaleza (northeast Brazil). After euthanization, dogs were autopsied. Ectoparasites were collected, and the intestinal content of dogs were examined for the presence of parasites. Faecal samples were collected and analysed using merthiolate iodine formaldehyde concentration method. A total of nine different parasite species were found, including five endoparasite (one protozoan, one cestode and three nematode species) and four ectoparasite species (two flea, one louse and one tick species). In the intestinal content, 3,162 specimens of four helminth species were found: Ancylostoma caninum (prevalence, 95.7%), Dipylidium caninum (45.7%), Toxocara canis (8.7%) and Trichuris vulpis (4.3%). A total of 394 ectoparasite specimens were identified, including Rhipicephalus sanguineus (prevalence, 100.0%), Heterodoxus spiniger (67.4%), Ctenocephalides canis (39.1%) and Ctenocephalides felis (17.4%). In the faeces, intestinal parasites were detected in 38 stray dogs (82.6%), including oocysts of Giardia sp. (2.2%) and eggs of the nematode A. caninum (82.6%). Neither eggs nor larval stages of D. caninum, T. canis or T. vulpis were detected in dog faeces. Sensitivity of faecal examination for A. caninum was 86.4% (95% confidence interval, 72.0-94.3) but zero percentage for the other intestinal helminth species. Our data show that stray dogs in northeast Brazil carry a multitude of zoonotic ecto- and endoparasites, posing a considerable risk for humans. With the exception of A. caninum, sensitivity of faecal examination was negligible. PMID:20532563

  16. Risk factors for inadequate prenatal care use in the metropolitan area of Aracaju, Northeast Brazil

    PubMed Central

    Ribeiro, Eleonora RO; Guimarães, Alzira Maria DN; Bettiol, Heloísa; Lima, Danilo DF; Almeida, Maria Luiza D; de Souza, Luiz; Silva, Antônio Augusto M; Gurgel, Ricardo Q

    2009-01-01

    Background The aim of prenatal care is to promote good maternal and foetal health and to identify risk factors for adverse pregnancy outcomes in an attempt to promptly manage and solve them. Although high prenatal care attendance is reported in most areas in Brazil, perinatal and neonatal mortalities are disproportionally high, raising doubts about the quality and performance of the care provided. The objective of the present study was to evaluate the adequacy of prenatal care use and the risk factors involved in inadequate prenatal care utilization in the metropolitan area of Aracaju, Northeast Brazil. Methods A survey was carried out with puerperal women who delivered singleton liveborns in all four maternity hospitals of Aracaju. A total of 4552 singleton liveborns were studied. The Adequacy of Prenatal Care Utilization Index, modified according to the guidelines of the Prenatal Care and Birth Humanization Programme, was applied. Socioeconomic, demographic, biological, life style and health service factors were evaluated by multiple logistic regression. Results: Prenatal care coverage in Aracaju was high (98.3%), with a mean number of 6.24 visits. Prenatal care was considered to be adequate or intensive in 66.1% of cases, while 33.9% were considered to have inadequate usage. Age < 18 to 34 years at delivery, low maternal schooling, low family income, two or more previous deliveries, maternal smoking during pregnancy, having no partner and prenatal care obtained outside Aracaju were associated with inadequate prenatal care use. In contrast, private service attendance protected from inadequate prenatal care use. Conclusion Prenatal care coverage was high. However, a significant number of women still had inadequate prenatal care use. Socioeconomic inequalities, demographic factors and behavioural risk factors are still important factors associated with inadequate prenatal care use. PMID:19622174

  17. Performance of an Adipokine Pathway-Based Multilocus Genetic Risk Score for Prostate Cancer Risk Prediction

    PubMed Central

    Ribeiro, Ricardo J. T.; Monteiro, Cátia P. D.; Azevedo, Andreia S. M.; Cunha, Virgínia F. M.; Ramanakumar, Agnihotram V.; Fraga, Avelino M.; Pina, Francisco M.; Lopes, Carlos M. S.; Medeiros, Rui M.; Franco, Eduardo L.

    2012-01-01

    Few biomarkers are available to predict prostate cancer risk. Single nucleotide polymorphisms (SNPs) tend to have weak individual effects but, in combination, they have stronger predictive value. Adipokine pathways have been implicated in the pathogenesis. We used a candidate pathway approach to investigate 29 functional SNPs in key genes from relevant adipokine pathways in a sample of 1006 men eligible for prostate biopsy. We used stepwise multivariate logistic regression and bootstrapping to develop a multilocus genetic risk score by weighting each risk SNP empirically based on its association with disease. Seven common functional polymorphisms were associated with overall and high-grade prostate cancer (Gleason≥7), whereas three variants were associated with high metastatic-risk prostate cancer (PSA≥20 ng/mL and/or Gleason≥8). The addition of genetic variants to age and PSA improved the predictive accuracy for overall and high-grade prostate cancer, using either the area under the receiver-operating characteristics curves (P<0.02), the net reclassification improvement (P<0.001) and integrated discrimination improvement (P<0.001) measures. These results suggest that functional polymorphisms in adipokine pathways may act individually and cumulatively to affect risk and severity of prostate cancer, supporting the influence of adipokine pathways in the pathogenesis of prostate cancer. Use of such adipokine multilocus genetic risk score can enhance the predictive value of PSA and age in estimating absolute risk, which supports further evaluation of its clinical significance. PMID:22792137

  18. Patterns of Migration and Risks Associated with Leprosy among Migrants in Maranhão, Brazil

    PubMed Central

    Murto, Christine; Chammartin, Frédérique; Schwarz, Karolin; da Costa, Lea Marcia Melo; Kaplan, Charles; Heukelbach, Jorg

    2013-01-01

    Leprosy remains a public health problem in Brazil with new case incidence exceeding World Health Organization (WHO) goals in endemic clusters throughout the country. Migration can facilitate movement of disease between endemic and non-endemic areas, and has been considered a possible factor in continued leprosy incidence in Brazil. A study was conducted to investigate migration as a risk factor for leprosy. The study had three aims: (1) examine past five year migration as a risk factor for leprosy, (2) describe and compare geographic and temporal patterns of migration among past 5-year migrants with leprosy and a control group, and (3) examine social determinants of health associated with leprosy among past 5-year migrants. The study implemented a matched case-control design and analysis comparing individuals newly diagnosed with leprosy (n = 340) and a clinically unapparent control group (n = 340) without clinical signs of leprosy, matched for age, sex and location in four endemic municipalities in the state of Maranhão, northeastern Brazil. Fishers exact test was used to conduct bivariate analyses. A multivariate logistic regression analysis was employed to control for possible confounding variables. Eighty cases (23.5%) migrated 5-years prior to diagnosis, and 55 controls (16.2%) migrated 5-years prior to the corresponding case diagnosis. Past 5 year migration was found to be associated with leprosy (OR: 1.59; 95% CI 1.07–2.38; p = 0.02), and remained significantly associated with leprosy after controlling for leprosy contact in the family, household, and family/household contact. Poverty, as well as leprosy contact in the family, household and other leprosy contact, was associated with leprosy among past 5-year migrants in the bivariate analysis. Alcohol consumption was also associated with leprosy, a relevant risk factor in susceptibility to infection that should be explored in future research. Our findings provide insight into patterns of

  19. A risk scoring system for prediction of haemorrhagic stroke.

    PubMed

    Zodpey, S P; Tiwari, R R

    2005-01-01

    The present pair-matched case control study was carried out at Government Medical College Hospital, Nagpur, India, a tertiary care hospital with the objective to devise and validate a risk scoring system for prediction of hemorrhagic stroke. The study consisted of 166 hospitalized CT scan proved cases of hemorrhagic stroke (ICD 9, 431-432), and a age and sex matched control per case. The controls were selected from patients who attended the study hospital for conditions other than stroke. On conditional multiple logistic regression five risk factors- hypertension (OR = 1.9. 95% Cl = 1.5-2.5). raised scrum total cholesterol (OR = 2.3, 95% Cl = 1.1-4.9). use of anticoagulants and antiplatelet agents (OR = 3.4, 95% Cl =1.1-10.4). past history of transient ischaemic attack (OR = 8.4, 95% Cl = 2.1- 33.6) and alcohol intake (OR = 2.1, 95% Cl = 1.3-3.6) were significant. These factors were ascribed statistical weights (based on regression coefficients) of 6, 8, 12, 21 and 8 respectively. The nonsignificant factors (diabetes mellitus, physical inactivity, obesity, smoking, type A personality, history of claudication, family history of stroke, history of cardiac diseases and oral contraceptive use in females) were not included in the development of scoring system. ROC curve suggested a total score of 21 to be the best cut-off for predicting haemorrhag stroke. At this cut-off the sensitivity, specificity, positive predictivity and Cohen's kappa were 0.74, 0.74, 0.74 and 0.48 respectively. The overall predictive accuracy of this additive risk scoring system (area under ROC curve by Wilcoxon statistic) was 0.79 (95% Cl = 0.73-0.84). Thus to conclude, if substantiated by further validation, this scorincy system can be used to predict haemorrhagic stroke, thereby helping to devise effective risk factor intervention strategy. PMID:16479901

  20. Seroprevalence and risk factors for dengue infection in socioeconomically distinct areas of Recife, Brazil

    PubMed Central

    Braga, Cynthia; Luna, Carlos Feitosa; Martelli, Celina MariaTurchi; de Souza, Wayner Vieira; Cordeiro, Marli Tenório; Alexander, Neal; Militão de Albuquerque, Maria de Fátima Pessoa; Silveira Júnior, José Constantino; Marques, Ernesto T.

    2013-01-01

    Brazil currently accounts for the majority of dengue cases reported in the Americas, with co-circulation of DENV 1, 2 and 3. Striking variation in the epidemiological pattern of infection within cities has been observed. Therefore, investigation of dengue transmission in small areas is important to formulate control strategies. A population-based household survey was performed in three diverse socio-economic and environmental areas of Recife, a large urban center of Brazil, between 2005 and 2006. Dengue serostatus and individual- and household-level risk factors for infection were collected in residents aged between 5 and 64 years. A total of 2,833 individuals were examined, and their residences were geo-referenced. Anti-dengue IgG antibodies were measured using commercial ELISA. The dengue seroprevalence and the force of infection were estimated in each area. Individual and household variables associated with seropositivity were assessed by multilevel models for each area. A spatial analysis was conducted to identify risk gradients of dengue seropositivity using generalized additive models (GAM). The dengue seroprevalence was 91.1%, 87.4% 74.3%, respectively, in the deprived, intermediate and high socioeconomic areas, inversely related to their socio-economic status. In the deprived area, 59% of children had already been exposed to dengue virus by the age of 5 years and the estimated force of infection was three times higher than that in the privileged area. The risk of infection increased with age in the three areas. Working or studying outside the home area was a risk factor for seropositivity in the deprived area (OR=2.26; 95% CI: 1.18-4.30). Number of persons per room was a risk factor for seropositivity in the intermediate (OR=3.00; 95% CI: 3.21-7.37) and privileged areas (OR=1.81; 95% CI: 1.07-3.04). Living in a house, as opposed to an apartment, was a risk factor for seropositivity in the privileged area (OR=3.62; 95% CI: 2.43-5.41). The main difference

  1. Prediction of cardiac risk in patients undergoing vascular surgery

    SciTech Connect

    Morise, A.P.; McDowell, D.E.; Savrin, R.A.; Goodwin, C.A.; Gabrielle, O.F.; Oliver, F.N.; Nullet, F.R.; Bekheit, S.; Jain, A.C.

    1987-03-01

    In an attempt to determine whether noninvasive cardiac testing could be used to assess cardiac risk in patients undergoing surgery for vascular disease, the authors studied 96 patients. Seventy-seven patients eventually underwent major vascular surgery with 11 (14%) experiencing a significant cardiac complication. Thallium imaging was much more likely to be positive (p less than 0.01) in patients with a cardiac complication; however, there was a significant number of patients with cardiac complications who had a positive history or electrocardiogram for myocardial infarction. When grouped by complication and history of infarction, thallium imaging, if negative, correctly predicted low cardiac risk in the group with a history of infarction. Thallium imaging, however, did not provide a clear separation of risk in those without a history of infarction. Age and coronary angiography, on the other hand, did reveal significant differences within the group without a history of infarction. The resting radionuclide ejection fraction followed a similar pattern to thallium imaging. It is concluded that a positive history of myocardial infarction at any time in the past is the strongest risk predictor in this population and that the predictive value of noninvasive testing is dependent on this factor. Considering these findings, a proposed scheme for assessing risk that will require further validation is presented.

  2. Risk reversals in predictive testing for Huntington disease.

    PubMed Central

    Almqvist, E; Adam, S; Bloch, M; Fuller, A; Welch, P; Eisenberg, D; Whelan, D; Macgregor, D; Meschino, W; Hayden, M R

    1997-01-01

    The first predictive testing for Huntington disease (HD) was based on analysis of linked polymorphic DNA markers to estimate the likelihood of inheriting the mutation for HD. Limits to accuracy included recombination between the DNA markers and the mutation, pedigree structure, and whether DNA samples were available from family members. With direct tests for the HD mutation, we have assessed the accuracy of results obtained by linkage approaches when requested to do so by the test individuals. For six such individuals, there was significant disparity between the tests. Three went from a decreased risk to an increased risk, while in another three the risk was decreased. Knowledge of the potential reasons for these changes in results and impact of these risk reversals on both patients and the counseling team can assist in the development of strategies for the prevention and, where necessary, management of a risk reversal in any predictive testing program. Images Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 PMID:9382108

  3. Use of Chronic Kidney Disease to Enhance Prediction of Cardiovascular Risk in Those at Medium Risk.

    PubMed

    Chia, Yook Chin; Lim, Hooi Min; Ching, Siew Mooi

    2015-01-01

    Based on global cardiovascular (CV) risk assessment for example using the Framingham risk score, it is recommended that those with high risk should be treated and those with low risk should not be treated. The recommendation for those of medium risk is less clear and uncertain. We aimed to determine whether factoring in chronic kidney disease (CKD) will improve CV risk prediction in those with medium risk. This is a 10-year retrospective cohort study of 905 subjects in a primary care clinic setting. Baseline CV risk profile and serum creatinine in 1998 were captured from patients record. Framingham general cardiovascular disease risk score (FRS) for each patient was computed. All cardiovascular disease (CVD) events from 1998-2007 were captured. Overall, patients with CKD had higher FRS risk score (25.9% vs 20%, p = 0.001) and more CVD events (22.3% vs 11.9%, p = 0.002) over a 10-year period compared to patients without CKD. In patients with medium CV risk, there was no significant difference in the FRS score among those with and without CKD (14.4% vs 14.6%, p = 0.84) However, in this same medium risk group, patients with CKD had more CV events compared to those without CKD (26.7% vs 6.6%, p = 0.005). This is in contrast to patients in the low and high risk group where there was no difference in CVD events whether these patients had or did not have CKD. There were more CV events in the Framingham medium risk group when they also had CKD compared those in the same risk group without CKD. Hence factoring in CKD for those with medium risk helps to further stratify and identify those who are actually at greater risk, when treatment may be more likely to be indicated. PMID:26496190

  4. Prediction of risk for drug use in high school students.

    PubMed

    Climent, C E; de Aragon, L V; Plutchik, R

    1990-05-01

    On the basis of questionnaires administered to almost 2,000 high school students in Cali, Colombia, a subset of items was selected that deal primarily with parent--child relationships. This 53-item set, referred to as the Drug Risk Scale (DRS), was administered to two new cross-validation samples, one consisting of high school students and the other consisting of drug addicts attending drug rehabilitation centers. Significant differences in parent--child relations were found between these new groups. The DRS was also found to have reasonably high sensitivity and specificity. Its potential value as a risk-prediction instrument is discussed. PMID:2258260

  5. Prediction of risk for drug use in high school students.

    PubMed

    Climent, C E; de Aragón, L V; Plutchik, R

    1989-11-01

    On the basis of questionnaires administered to almost 2,000 high school students in Cali, Colombia, a subset of items was selected that deal primarily with parent-child relationships. This 53 item set, referred to as the Drug Risk Scale (DRS), was administered to two new cross-validation samples, one consisting of high school students and the other consisting of drug addicts attending drug rehabilitation centers. Significant differences in parent-child relations were found between these new groups. The DRS was also found to have reasonably high sensitivity and specificity. Its potential value as a risk-prediction instrument is discussed. PMID:2628355

  6. Risk assessment and lifetime prediction for metallic components

    NASA Astrophysics Data System (ADS)

    Hu, Shaowei; Moran, Brian

    2008-11-01

    In order to contribute to the development of a methodology for risk assessment (fatigue reliability) and lifetime prediction for safety critical metallic components, the risk assessment and lifetime prediction for critical metallic components are studied. First order reliability method (FORM) is used and application to weep hole cracks in C141 wing is analyzed. A novel method of fitting a closed form mathematical expression for probability of detecting (POD) to experimental C-scan data from C141 weep holes was used in the analysis. FORM methods are combined to compute fatigue reliability for the weep hole configuration. The method shows promise for development as a standalone personal computer based system for structural integrity and reliability assessment.

  7. Predicting Epidemic Risk from Past Temporal Contact Data

    PubMed Central

    Valdano, Eugenio; Poletto, Chiara; Giovannini, Armando; Palma, Diana; Savini, Lara; Colizza, Vittoria

    2015-01-01

    Understanding how epidemics spread in a system is a crucial step to prevent and control outbreaks, with broad implications on the system’s functioning, health, and associated costs. This can be achieved by identifying the elements at higher risk of infection and implementing targeted surveillance and control measures. One important ingredient to consider is the pattern of disease-transmission contacts among the elements, however lack of data or delays in providing updated records may hinder its use, especially for time-varying patterns. Here we explore to what extent it is possible to use past temporal data of a system’s pattern of contacts to predict the risk of infection of its elements during an emerging outbreak, in absence of updated data. We focus on two real-world temporal systems; a livestock displacements trade network among animal holdings, and a network of sexual encounters in high-end prostitution. We define the node’s loyalty as a local measure of its tendency to maintain contacts with the same elements over time, and uncover important non-trivial correlations with the node’s epidemic risk. We show that a risk assessment analysis incorporating this knowledge and based on past structural and temporal pattern properties provides accurate predictions for both systems. Its generalizability is tested by introducing a theoretical model for generating synthetic temporal networks. High accuracy of our predictions is recovered across different settings, while the amount of possible predictions is system-specific. The proposed method can provide crucial information for the setup of targeted intervention strategies. PMID:25763816

  8. Risk prediction score for death of traumatised and injured children

    PubMed Central

    2014-01-01

    Background Injury prediction scores facilitate the development of clinical management protocols to decrease mortality. However, most of the previously developed scores are limited in scope and are non-specific for use in children. We aimed to develop and validate a risk prediction model of death for injured and Traumatised Thai children. Methods Our cross-sectional study included 43,516 injured children from 34 emergency services. A risk prediction model was derived using a logistic regression analysis that included 15 predictors. Model performance was assessed using the concordance statistic (C-statistic) and the observed per expected (O/E) ratio. Internal validation of the model was performed using a 200-repetition bootstrap analysis. Results Death occurred in 1.7% of the injured children (95% confidence interval [95% CI]: 1.57–1.82). Ten predictors (i.e., age, airway intervention, physical injury mechanism, three injured body regions, the Glasgow Coma Scale, and three vital signs) were significantly associated with death. The C-statistic and the O/E ratio were 0.938 (95% CI: 0.929–0.947) and 0.86 (95% CI: 0.70–1.02), respectively. The scoring scheme classified three risk stratifications with respective likelihood ratios of 1.26 (95% CI: 1.25–1.27), 2.45 (95% CI: 2.42–2.52), and 4.72 (95% CI: 4.57–4.88) for low, intermediate, and high risks of death. Internal validation showed good model performance (C-statistic = 0.938, 95% CI: 0.926–0.952) and a small calibration bias of 0.002 (95% CI: 0.0005–0.003). Conclusions We developed a simplified Thai pediatric injury death prediction score with satisfactory calibrated and discriminative performance in emergency room settings. PMID:24575982

  9. Predicting epidemic risk from past temporal contact data.

    PubMed

    Valdano, Eugenio; Poletto, Chiara; Giovannini, Armando; Palma, Diana; Savini, Lara; Colizza, Vittoria

    2015-03-01

    Understanding how epidemics spread in a system is a crucial step to prevent and control outbreaks, with broad implications on the system's functioning, health, and associated costs. This can be achieved by identifying the elements at higher risk of infection and implementing targeted surveillance and control measures. One important ingredient to consider is the pattern of disease-transmission contacts among the elements, however lack of data or delays in providing updated records may hinder its use, especially for time-varying patterns. Here we explore to what extent it is possible to use past temporal data of a system's pattern of contacts to predict the risk of infection of its elements during an emerging outbreak, in absence of updated data. We focus on two real-world temporal systems; a livestock displacements trade network among animal holdings, and a network of sexual encounters in high-end prostitution. We define the node's loyalty as a local measure of its tendency to maintain contacts with the same elements over time, and uncover important non-trivial correlations with the node's epidemic risk. We show that a risk assessment analysis incorporating this knowledge and based on past structural and temporal pattern properties provides accurate predictions for both systems. Its generalizability is tested by introducing a theoretical model for generating synthetic temporal networks. High accuracy of our predictions is recovered across different settings, while the amount of possible predictions is system-specific. The proposed method can provide crucial information for the setup of targeted intervention strategies. PMID:25763816

  10. Improving default risk prediction using Bayesian model uncertainty techniques.

    PubMed

    Kazemi, Reza; Mosleh, Ali

    2012-11-01

    Credit risk is the potential exposure of a creditor to an obligor's failure or refusal to repay the debt in principal or interest. The potential of exposure is measured in terms of probability of default. Many models have been developed to estimate credit risk, with rating agencies dating back to the 19th century. They provide their assessment of probability of default and transition probabilities of various firms in their annual reports. Regulatory capital requirements for credit risk outlined by the Basel Committee on Banking Supervision have made it essential for banks and financial institutions to develop sophisticated models in an attempt to measure credit risk with higher accuracy. The Bayesian framework proposed in this article uses the techniques developed in physical sciences and engineering for dealing with model uncertainty and expert accuracy to obtain improved estimates of credit risk and associated uncertainties. The approach uses estimates from one or more rating agencies and incorporates their historical accuracy (past performance data) in estimating future default risk and transition probabilities. Several examples demonstrate that the proposed methodology can assess default probability with accuracy exceeding the estimations of all the individual models. Moreover, the methodology accounts for potentially significant departures from "nominal predictions" due to "upsetting events" such as the 2008 global banking crisis. PMID:23163724

  11. How to make predictions about future infectious disease risks

    PubMed Central

    Woolhouse, Mark

    2011-01-01

    Formal, quantitative approaches are now widely used to make predictions about the likelihood of an infectious disease outbreak, how the disease will spread, and how to control it. Several well-established methodologies are available, including risk factor analysis, risk modelling and dynamic modelling. Even so, predictive modelling is very much the ‘art of the possible’, which tends to drive research effort towards some areas and away from others which may be at least as important. Building on the undoubted success of quantitative modelling of the epidemiology and control of human and animal diseases such as AIDS, influenza, foot-and-mouth disease and BSE, attention needs to be paid to developing a more holistic framework that captures the role of the underlying drivers of disease risks, from demography and behaviour to land use and climate change. At the same time, there is still considerable room for improvement in how quantitative analyses and their outputs are communicated to policy makers and other stakeholders. A starting point would be generally accepted guidelines for ‘good practice’ for the development and the use of predictive models. PMID:21624924

  12. Cadmium and lead in seafood from the Aratu Bay, Brazil and the human health risk assessment.

    PubMed

    da Araújo, Cecilia Freitas Silva; Lopes, Mariângela Vieira; Vasquez, Mirian Rocha; Porcino, Thiago Santos; Ribeiro, Amanda Santos Vaz; Rodrigues, Juliana Lima Gomes; Oliveira, Sérgio Soares do Prado; Menezes-Filho, José Antonio

    2016-04-01

    This study aimed to evaluate cadmium (Cd) and lead (Pb) levels in seafood and perform a risk assessment based on individual food consumption frequency of inhabitants of the Aratu Bay, Brazil. From December 2013 to November 2014, ready-to-market seafood, including fish [pititinga (Lile piquitinga) and small green eel (Gobionellus oceanicus)], mollusks [mussel (Mytella guyanensis) and oyster (Crassostrea rhizophorae)], and crustaceans [white shrimp (Litopenaeus schmitti) and blue crab (Callinectes exasperatus)], were purchased bimonthly from a local artisanal shellfish harvester. Metal levels were analyzed by graphite furnace atomic absorption spectrometry (GFAAS). Based on the volunteer' seafood consumption, estimates of the non-carcinogenic target hazard quotients (THQs) were calculated. The annual concentrations (μg/g, w/w) of Cd were 0.007 (±0.001) in crustaceans, 0.001 (±0.0003) in fish, and 0.446 (±0.034) in mollusks. Lead levels were risk; however, 9.1 % presented THQs between ≥1 and <9.9. These data are important to inform the community of the imminent exposure risk through communication strategies, with the purpose of minimizing exposure and, consequently, the health effects associated with it. PMID:27034241

  13. Ecological risk analysis of pesticides used on irrigated rice crops in southern Brazil.

    PubMed

    Vieira, Danielle Cristina; Noldin, José Alberto; Deschamps, Francisco C; Resgalla, Charrid

    2016-11-01

    Based on studies conducted in the past decade in the southern region of Brazil to determine residue levels of the pesticides normally used on irrigated rice crops, changes can be observed in relation to the presence of pesticides in the waters of the main river basins in Santa Catarina State. In previous harvests, the presence of residues of 7 pesticides was determined, with the herbicide bentazon and the insecticide carbofuran being the products showing highest frequency. Following toxicological tests conducted with 8 different test organisms, deterministic and probabilistic risk analysis was performed to assess the situation of the river basins in areas used for the production of irrigated rice. Of the species tested, the herbicide bentazon showed greatest toxicity toward plants, but did not present an ecological risk because in the worst-case scenario the highest concentration of this pesticide in the environment is 37 times lower than the lowest EC50/LC50 value obtained in the tests. The insecticide carbofuran, which had the highest toxicity toward the organisms used in the tests, presented an ecological risk in the deterministic analysis, but without any associated probability. The results highlight the need for increased efforts in training farmers in crop management practices and for the continual monitor of water bodies for the presence of pesticide residues. PMID:27479455

  14. Cadmium and lead in seafood from the Aratu Bay, Brazil and the human health risk assessment.

    PubMed

    Silva da Araújo, Cecilia Freitas; Lopes, Mariângela Vieira; Vaz Ribeiro, Mirian Rocha; Porcino, Thiago Santos; Vaz Ribeiro, Amanda Santos; Rodrigues, Juliana Lima Gomes; do Prado Oliveira, Sérgio Soares; Menezes-Filho, José Antonio

    2016-04-01

    This study aimed to evaluate cadmium (Cd) and lead (Pb) levels in seafood and perform a risk assessment based on individual food consumption frequency of inhabitants of the Aratu Bay, Brazil. From December 2013 to November 2014, ready-to-market seafood, including fish [pititinga (Lile piquitinga) and small green eel (Gobionellus oceanicus)], mollusks [mussel (Mytella guyanensis) and oyster (Crassostrea rhizophorae)], and crustaceans [white shrimp (Litopenaeus schmitti) and blue crab (Callinectes exasperatus)], were purchased bimonthly from a local artisanal shellfish harvester. Metal levels were analyzed by graphite furnace atomic absorption spectrometry (GFAAS). Based on the volunteer’ seafood consumption, estimates of the non-carcinogenic target hazard quotients (THQs) were calculated. The annual concentrations (μg/g, w/w) of Cd were 0.007 (±0.001) in crustaceans, 0.001 (±0.0003) in fish, and 0.446 (±0.034) in mollusks. Lead levels were risk; however, 9.1 % presented THQs between ≥1 and <9.9. These data are important to inform the community of the imminent exposure risk through communication strategies, with the purpose of minimizing exposure and, consequently, the health effects associated with it. PMID:27359001

  15. Methods and Techniques for Risk Prediction of Space Shuttle Upgrades

    NASA Technical Reports Server (NTRS)

    Hoffman, Chad R.; Pugh, Rich; Safie, Fayssal

    1998-01-01

    Since the Space Shuttle Accident in 1986, NASA has been trying to incorporate probabilistic risk assessment (PRA) in decisions concerning the Space Shuttle and other NASA projects. One major study NASA is currently conducting is in the PRA area in establishing an overall risk model for the Space Shuttle System. The model is intended to provide a tool to predict the Shuttle risk and to perform sensitivity analyses and trade studies including evaluation of upgrades. Marshall Space Flight Center (MSFC) and its prime contractors including Pratt and Whitney (P&W) are part of the NASA team conducting the PRA study. MSFC responsibility involves modeling the External Tank (ET), the Solid Rocket Booster (SRB), the Reusable Solid Rocket Motor (RSRM), and the Space Shuttle Main Engine (SSME). A major challenge that faced the PRA team is modeling the shuttle upgrades. This mainly includes the P&W High Pressure Fuel Turbopump (HPFTP) and the High Pressure Oxidizer Turbopump (HPOTP). The purpose of this paper is to discuss the various methods and techniques used for predicting the risk of the P&W redesigned HPFTP and HPOTP.

  16. Toddler self-regulation skills predict risk for pediatric obesity

    PubMed Central

    Graziano, Paulo A.; Calkins, Susan D.; Keane, Susan P.

    2010-01-01

    Objective To investigate the role of early self-regulation skills, including emotion regulation, sustained attention, and inhibitory control/reward sensitivity, in predicting pediatric obesity in early childhood. Method Participants for this study included 57 children (25 girls) obtained from three different cohorts participating in a larger ongoing longitudinal study. At 2 years of age, participants participated in several laboratory tasks designed to assess their self-regulation abilities. Height and weight measures were collected when children were 2 and 5.5 years of age. Results Self-regulation skills in toddlerhood were predictive of both normal variations in BMI development and pediatric obesity. Specifically, emotion regulation was the primary self-regulation skill involved in predicting normative changes in BMI as no effects were found for sustained attention or inhibitory control/reward sensitivity. However, both emotion regulation and inhibitory control/reward sensitivity predicted more extreme weight problems (i.e., pediatric obesity), even after controlling for 2yr BMI. Thus, toddlers with poorer emotion regulation skills and lower inhibitory control skills/higher reward sensitivity were more likely to be classified as overweight/at risk at 5.5 years of age. Conclusion Early self-regulation difficulties across domains (i.e., behavioral, and emotional) represent significant individual risk factors for the development of pediatric obesity. Mechanisms by which early self-regulation skills may contribute to the development of pediatric obesity are discussed. PMID:20065961

  17. Alternative dietary indices both strongly predict risk of chronic disease.

    PubMed

    Chiuve, Stephanie E; Fung, Teresa T; Rimm, Eric B; Hu, Frank B; McCullough, Marjorie L; Wang, Molin; Stampfer, Meir J; Willett, Walter C

    2012-06-01

    The Healthy Eating Index-2005 (HEI-2005) measures adherence to the 2005 Dietary Guidelines for Americans, but the association between the HEI-2005 and risk of chronic disease is not known. The Alternative Healthy Eating Index (AHEI), which is based on foods and nutrients predictive of chronic disease risk, was associated inversely with chronic disease risk previously. We updated the AHEI, including additional dietary factors involved in the development of chronic disease, and assessed the associations between the AHEI-2010 and the HEI-2005 and risk of major chronic disease prospectively among 71,495 women from the Nurses' Health Study and 41,029 men from the Health Professionals Follow-Up Study who were free of chronic disease at baseline. During ≥24 y of follow-up, we documented 26,759 and 15,558 incident chronic diseases (cardiovascular disease, diabetes, cancer, or nontrauma death) among women and men, respectively. The RR (95% CI) of chronic disease comparing the highest with the lowest quintile was 0.84 (0.81, 0.87) for the HEI-2005 and 0.81 (0.77, 0.85) for the AHEI-2010. The AHEI-2010 and HEI-2005 were most strongly associated with coronary heart disease (CHD) and diabetes, and for both outcomes the AHEI-2010 was more strongly associated with risk than the HEI-2005 (P-difference = 0.002 and <0.001, respectively). The 2 indices were similarly associated with risk of stroke and cancer. These findings suggest that closer adherence to the 2005 Dietary Guidelines may lower risk of major chronic disease. However, the AHEI-2010, which included additional dietary information, was more strongly associated with chronic disease risk, particularly CHD and diabetes. PMID:22513989

  18. Utilizing environmental, socioeconomic data and GIS techniques to estimate the risk for ascariasis and trichuriasis in Minas Gerais, Brazil.

    PubMed

    Scholte, Ronaldo G C; Freitas, Corina C; Dutra, Luciano V; Guimaraes, Ricardo J P S; Drummond, Sandra C; Oliveira, Guilherme; Carvalho, Omar S

    2012-02-01

    The impact of intestinal helminths on human health is well known among the population and health authorities because of their wide geographic distribution and the serious problems they cause. Geohelminths are highly prevalent and have a big impact on public health, mainly in underdeveloped and developing countries. Geohelminths are responsible for the high levels of debility found in the younger population and are often related to cases of chronic diarrhea and malnutrition, which put the physical and intellectual development of children at risk. These geohelminths have not been sufficiently studied. One obstacle in implementing a control program is the lack of knowledge of the prevalence and geographical distribution. Geographical information systems (GIS) and remote sensing (RS) have been utilized to improve understanding of infectious disease distribution and climatic patterns. In this study, GIS and RS technologies, as well as meteorological, social, and environmental variables were utilized for the modeling and prediction of ascariasis and trichuriasis. The GIS and RS technologies specifically used were those produced by orbital sensing including the Moderate Resolution Imaging Spectroradiometer (MODIS) and the Shuttle Radar Topography Mission (SRTM). The results of this study demonstrated important factors related to the transmission of ascariasis and trichuriasis and confirmed the key association between environmental variables and the poverty index, which enabled us to identify priority areas for intervention planning in the state of Minas Gerais in Brazil. PMID:22041638

  19. Prevalence and risk-mapping of bovine brucellosis in Maranhão State, Brazil.

    PubMed

    Borba, M R; Stevenson, M A; Gonçalves, V S P; Neto, J S Ferreira; Ferreira, F; Amaku, M; Telles, E O; Santana, S S; Ferreira, J C A; Lôbo, J R; Figueiredo, V C F; Dias, R A

    2013-06-01

    Between 2007 and 2009, a cross-sectional survey was carried out in Maranhão State, Brazil to estimate the seroprevalence of and risk factors for bovine brucellosis. In total, 749 herds and 6779 cows greater than two years of age were blood sampled. At the time of sampling a questionnaire to collect details on possible risk factors for bovine brucellosis was administered to the participating herd manager. A logistic regression model was developed to quantify the association between herd demographic and management characteristics and the herd-level brucellosis status. Spatial analyses were carried out to identify areas of the state where the presence of brucellosis was unaccounted-for by the explanatory variables in the logistic regression model. The estimated herd-level prevalence of brucellosis in Maranhão was 11.4% (95% CI 9.2-14) and the individual animal-level prevalence was 2.5% (95% CI 1.7-3.6). Herds with more than 54 cows older than two years of age, herds that used rented pasture to feed cattle, and the presence of wetlands on the home farm increased the risk of a herd being brucellosis positive. Infected farms were identified throughout the state, particularly in the central region and on the northwestern border. Spatial analyses of the Pearson residuals from the logistic regression model identified an area in the center of the state where brucellosis risk was not well explained by the predictors included in the final logistic regression model. Targeted investigations should be carried out in this area to determine more precisely the reasons for the unexplained disease excess. This process might uncover previously unrecognized risk factors for brucellosis in Maranhão. PMID:23218657

  20. The Impact of Dietary and Metabolic Risk Factors on Cardiovascular Diseases and Type 2 Diabetes Mortality in Brazil

    PubMed Central

    de Oliveira Otto, Marcia C.; Afshin, Ashkan; Micha, Renata; Khatibzadeh, Shahab; Fahimi, Saman; Singh, Gitanjali; Danaei, Goodarz; Sichieri, Rosely; Monteiro, Carlos A; Louzada, Maria L. C.; Ezzati, Majid; Mozaffarian, Dariush

    2016-01-01

    Background Trends in food availability and metabolic risk factors in Brazil suggest a shift toward unhealthy dietary patterns and increased cardiometabolic disease risk, yet little is known about the impact of dietary and metabolic risk factors on cardiometabolic mortality in Brazil. Methods Based on data from Global Burden of Disease (GBD) Study, we used comparative risk assessment to estimate the burden of 11 dietary and 4 metabolic risk factors on mortality due to cardiovascular diseases and diabetes in Brazil in 2010. Information on national diets and metabolic risks were obtained from the Brazilian Household Budget Survey, the Food and Agriculture Organization database, and large observational studies including Brazilian adults. Relative risks for each risk factor were obtained from meta-analyses of randomized trials or prospective cohort studies; and disease-specific mortality from the GBD 2010 database. We quantified uncertainty using probabilistic simulation analyses, incorporating uncertainty in dietary and metabolic data and relative risks by age and sex. Robustness of findings was evaluated by sensitivity to varying feasible optimal levels of each risk factor. Results In 2010, high systolic blood pressure (SBP) and suboptimal diet were the largest contributors to cardiometabolic deaths in Brazil, responsible for 214,263 deaths (95% uncertainty interval [UI]: 195,073 to 233,936) and 202,949 deaths (95% UI: 194,322 to 211,747), respectively. Among individual dietary factors, low intakes of fruits and whole grains and high intakes of sodium were the largest contributors to cardiometabolic deaths. For premature cardiometabolic deaths (before age 70 years, representing 40% of cardiometabolic deaths), the leading risk factors were suboptimal diet (104,169 deaths; 95% UI: 99,964 to 108,002), high SBP (98,923 deaths; 95%UI: 92,912 to 104,609) and high body-mass index (BMI) (42,643 deaths; 95%UI: 40,161 to 45,111). Conclusion suboptimal diet, high SBP, and high

  1. Risk of hypertension in Yozgat Province, Central Anatolia: application of Framingham Hypertension Prediction Risk Score.

    PubMed

    Kilic, M; Ede, H; Kilic, A I

    2016-04-01

    The aim of this cross-sectional study was to estimate the risk of hypertension in 1106 Caucasian individuals aged 20-69 years in Yozgat Province, using the Framingham Hypertension Risk Prediction Score (FHRPS). According to FHRPS, average risk of developing hypertension over 4 years was 6.2%. The participants were classified into low- (<5%), moderate- (5% to 10%) and high- (>10%) risk groups. The percentage of participants that fell into these groups was 59.4%, 19.8% and 20.8% respectively. The proportion of participants in the high-risk group was similar to the 4-year incidence of hypertension (21.3%) in the Turkish population. Regression analysis showed that high salt consumption and low educational level significantly increased the risk of hypertension. Economic level, fat consumption, life satisfaction, physical activity, and fruit and vegetable consumption were not correlated with risk of hypertension. This study shows that FHRPS can also be used for predicting risk of hypertension in Central Anatolia. PMID:27432406

  2. Meta-Prediction of MTHFR Gene Polymorphism Mutations and Associated Risk for Colorectal Cancer

    PubMed Central

    Yu, C. H.

    2016-01-01

    The methylenetetrahydrofolate reductase (MTHFR) gene is one of the most investigated of the genes associated with chronic human diseases because of its associations with hyperhomocysteinemia and toxicity. It has been proposed as a prototype gene for the prevention of colorectal cancer (CRC). The major objectives of this meta-analysis were to examine the polymorphism-mutation patterns of MTHFR and their associations with risk for CRC as well as potential contributing factors for mutations and disease risks. This analysis included 33,626 CRC cases and 48,688 controls across 92 studies for MTHFR 677 and 16,367 cases and 24,874 controls across 54 studies for MTHFR 1298, comprising data for various racial and ethnic groups, both genders, and multiple cancer sites. MTHFR 677 homozygous TT genotype was protective (p < .05) for CRC for all included populations; however, with heterogeneity across various racial–ethnic groups and opposing findings, it was a risk genotype for the subgroup of Hispanics (p < .01). Additional countries for which subgroup analyses resulted in 677 TT as a risk genotype included Turkey, Romania, Croatia, Hungary, Portugal, Mexico, Brazil, U.S. Hawai’i, Taiwan, India, and Egypt. Countries with the highest mutation rates and risks for both MTHFR 677 and 1298 genotypes are presented using global maps to visualize the grouping patterns. Meta-predictive analyses revealed that air pollution levels were associated with gene polymorphisms for both genotypes. Future nursing research should be conducted to develop proactive measures to protect populations in cities where air pollution causes more deaths. PMID:26858257

  3. Meta-Prediction of MTHFR Gene Polymorphism Mutations and Associated Risk for Colorectal Cancer.

    PubMed

    Shiao, S P K; Yu, C H

    2016-07-01

    The methylenetetrahydrofolate reductase (MTHFR) gene is one of the most investigated of the genes associated with chronic human diseases because of its associations with hyperhomocysteinemia and toxicity. It has been proposed as a prototype gene for the prevention of colorectal cancer (CRC). The major objectives of this meta-analysis were to examine the polymorphism-mutation patterns of MTHFR and their associations with risk for CRC as well as potential contributing factors for mutations and disease risks. This analysis included 33,626 CRC cases and 48,688 controls across 92 studies for MTHFR 677 and 16,367 cases and 24,874 controls across 54 studies for MTHFR 1298, comprising data for various racial and ethnic groups, both genders, and multiple cancer sites. MTHFR 677 homozygous TT genotype was protective (p <05) for CRC for all included populations; however, with heterogeneity across various racial-ethnic groups and opposing findings, it was a risk genotype for the subgroup of Hispanics (p <01). Additional countries for which subgroup analyses resulted in 677 TT as a risk genotype included Turkey, Romania, Croatia, Hungary, Portugal, Mexico, Brazil, U.S. Hawai'i, Taiwan, India, and Egypt. Countries with the highest mutation rates and risks for both MTHFR 677 and 1298 genotypes are presented using global maps to visualize the grouping patterns. Meta-predictive analyses revealed that air pollution levels were associated with gene polymorphisms for both genotypes. Future nursing research should be conducted to develop proactive measures to protect populations in cities where air pollution causes more deaths. PMID:26858257

  4. Predicting risk selection following major changes in Medicare.

    PubMed

    Pizer, Steven D; Frakt, Austin B; Feldman, Roger

    2008-04-01

    The Medicare Modernization Act of 2003 created several new types of private insurance plans within Medicare, starting in 2006. Some of these plan types previously did not exist in the commercial market and there was great uncertainty about their prospects. In this paper, we show that statistical models and historical data from the Medicare Current Beneficiary Survey can be used to predict the experience of new plan types with reasonable accuracy. This lays the foundation for the analysis of program modifications currently under consideration. We predict market share, risk selection, and stability for the most prominent new plan type, the stand-alone Medicare prescription drug plan (PDP). First, we estimate a model of consumer choice across Medicare insurance plans available in the data. Next, we modify the data to include PDPs and use the model to predict the probability of enrollment for each beneficiary in each plan type. Finally, we calculate mean-adjusted actual spending by plan type. We predict that adverse selection into PDPs will be substantial, but that enrollment and premiums will be stable. Our predictions correspond well to actual experience in 2006. PMID:17557273

  5. Coordinating perioperative care for the 'high risk' general surgical patient using risk prediction scoring.

    PubMed

    Hafiz, Shaziz; Lees, Nicholas Peter

    2016-01-01

    Identifying 'high risk' (> 5% mortality score) emergency general surgical patients early, allows appropriate perioperative care to be allocated by securing critical care beds and ensuring the presence of senior surgeons and senior anesthetists intraoperatively. Scoring systems can be used to predict perioperative risk and coordinate resources perioperatively. Currently it is unclear which estimate of risk correlates with current resource deployment. A retrospective study was undertaken assessing the relationship between deployment of perioperative resources: senior surgeon, senior anesthetist and critical care bed. The study concluded that almost all high risk patients with high POSSUM mortality and morbidity scores had a consultant senior surgeon present intraoperatively. Critically unwell patients with higher operative severity and perioperative morbidity scores received higher care (HDU/ICU) beds postoperatively, ensuring that they received appropriate care if their condition deteriorated. Therefore POSSUM scoring should be used perioperatively in emergency cases to coordinate appropriate perioperative care for high risk general surgical patients. PMID:26901929

  6. Ethnozoology in Brazil: analysis of the methodological risks in published studies.

    PubMed

    Lyra-Neves, R M; Santos, E M; Medeiros, P M; Alves, R R N; Albuquerque, U P

    2015-11-01

    There has been a growth in the field of Ethnozoology throughout the years, especially in Brazil, where a considerable number of scientific articles pertaining to this subject has been published in recent decades. With this increase in publications comes the opportunity to assess the quality of these publications, as there are no known studies assessing the methodological risks in this area. Based on this observation, our objectives were to compile the papers published on the subject of ethnozoology and to answer the following questions: 1) Do the Brazilian ethnozoological studies use sound sampling methods?; 2) Is the sampling quality influenced by characteristics of the studies/publications? The studies found in databases and using web search engines were compiled to answer these questions. The studies were assessed based on their nature, sampling methods, use of hypotheses and tests, journal's impact factor, and animal group studied. The majority of the studies analyzed exhibited problems associated with the samples, as 144 (66.98%) studies were classified as having a high risk of bias. With regard to the characteristics analyzed, we determined that a quantitative nature and the use of tests are essential components of good sampling. Most studies classified as moderate and low risk either did not provide these data or provided data that were not clear; therefore, these studies were classified as being of a quali-quantitative nature. Studies performed with vertebrate groups were of high risk. Most of the papers analyzed here focused on fish, insects, and/or mollusks, thus highlighting the difficulties associated with conducting interviews regarding tetrapod vertebrates. Such difficulties are largely related to the extremely strict Brazilian laws, justified by the decline and extinction of some species, related to the use of wild tetrapod vertebrates. PMID:26628244

  7. Metal concentrations in surface water and sediments from Pardo River, Brazil: human health risks.

    PubMed

    Alves, Renato I S; Sampaio, Carolina F; Nadal, Martí; Schuhmacher, Marta; Domingo, José L; Segura-Muñoz, Susana I

    2014-08-01

    Pardo River (Brazil) is suffering from an important anthropogenic impact due to the pressure of highly populated areas and the influence of sugarcane cultivation. The objective of the present study was to determine the levels of 13 trace elements (As, Be, Cd, Cr, Cu, Pb, Mn, Hg, Ni, Tl, Sn, V and Zn) in samples of surface water and sediments from the Pardo River. Furthermore, the human health risks associated with exposure to those metals through oral intake and dermal absorption were also evaluated. Spatial and seasonal trends of the data were closely analyzed from a probabilistic approach. Manganese showed the highest mean concentrations in both water and sediments, remarking the incidence of the agricultural activity and the geological characteristics within the basin. Thallium and arsenic were identified as two priority pollutants, being the most important contributors to the Hazard Index (HI). Since non-carcinogenic risks due to thallium exposure slightly exceeded international guidelines (HI>1), a special effort should be made on this trace element. However, the current concentrations of arsenic, a carcinogenic element, were in accordance to acceptable lifetime risks. Nowadays, there is a clear increasing growth in human population and economic activities in the Pardo River, whose waters have become a serious strategic alternative for the potential supply of drinking water. Therefore, environmental monitoring studies are required not only to assure that the current state of pollution of Pardo River does not mean a risk for the riverside population, but also to assess the potential trends in the environmental levels of those elements. PMID:24949813

  8. Predicting risk of adverse drug reactions in older adults.

    PubMed

    Lavan, Amanda Hanora; Gallagher, Paul

    2016-02-01

    Adverse drug reactions (ADRs) are common in older adults, with falls, orthostatic hypotension, delirium, renal failure, gastrointestinal and intracranial bleeding being amongst the most common clinical manifestations. ADR risk increases with age-related changes in pharmacokinetics and pharmacodynamics, increasing burden of comorbidity, polypharmacy, inappropriate prescribing and suboptimal monitoring of drugs. ADRs are a preventable cause of harm to patients and an unnecessary waste of healthcare resources. Several ADR risk tools exist but none has sufficient predictive value for clinical practice. Good clinical practice for detecting and predicting ADRs in vulnerable patients includes detailed documentation and regular review of prescribed and over-the-counter medications through standardized medication reconciliation. New medications should be prescribed cautiously with clear therapeutic goals and recognition of the impact a drug can have on multiple organ systems. Prescribers should regularly review medication efficacy and be vigilant for ADRs and their contributory risk factors. Deprescribing should occur at an individual level when drugs are no longer efficacious or beneficial or when safer alternatives exist. Inappropriate prescribing and unnecessary polypharmacy should be minimized. Comprehensive geriatric assessment and the use of explicit prescribing criteria can be useful in this regard. PMID:26834959

  9. Predicting risk of adverse drug reactions in older adults

    PubMed Central

    Lavan, Amanda Hanora; Gallagher, Paul

    2016-01-01

    Adverse drug reactions (ADRs) are common in older adults, with falls, orthostatic hypotension, delirium, renal failure, gastrointestinal and intracranial bleeding being amongst the most common clinical manifestations. ADR risk increases with age-related changes in pharmacokinetics and pharmacodynamics, increasing burden of comorbidity, polypharmacy, inappropriate prescribing and suboptimal monitoring of drugs. ADRs are a preventable cause of harm to patients and an unnecessary waste of healthcare resources. Several ADR risk tools exist but none has sufficient predictive value for clinical practice. Good clinical practice for detecting and predicting ADRs in vulnerable patients includes detailed documentation and regular review of prescribed and over-the-counter medications through standardized medication reconciliation. New medications should be prescribed cautiously with clear therapeutic goals and recognition of the impact a drug can have on multiple organ systems. Prescribers should regularly review medication efficacy and be vigilant for ADRs and their contributory risk factors. Deprescribing should occur at an individual level when drugs are no longer efficacious or beneficial or when safer alternatives exist. Inappropriate prescribing and unnecessary polypharmacy should be minimized. Comprehensive geriatric assessment and the use of explicit prescribing criteria can be useful in this regard. PMID:26834959

  10. Perinatal Immunotoxicity: Why Adult Exposure Assessment Fails to Predict Risk

    PubMed Central

    Dietert, Rodney R.; Piepenbrink, Michael S.

    2006-01-01

    Recent research has pointed to the developing immune system as a remarkably sensitive toxicologic target for environmental chemicals and drugs. In fact, the perinatal period before and just after birth is replete with dynamic immune changes, many of which do not occur in adults. These include not only the basic maturation and distribution of immune cell types and selection against autoreactive lymphocytes but also changes designed specifically to protect the pregnancy against immune-mediated miscarriage. The newborn is then faced with critical immune maturational adjustments to achieve an immune balance necessary to combat myriad childhood and later-life diseases. All these processes set the fetus and neonate completely apart from the adult regarding immunotoxicologic risk. Yet for decades, safety evaluation has relied almost exclusively upon exposure of the adult immune system to predict perinatal immune risk. Recent workshops and forums have suggested a benefit in employing alternative exposures that include exposure throughout early life stages. However, issues remain concerning when and where such applications might be required. In this review we discuss the reasons why immunotoxic assessment is important for current childhood diseases and why adult exposure assessment cannot predict the effect of xenobiotics on the developing immune system. It also provides examples of developmental immunotoxicants where age-based risk appears to differ. Finally, it stresses the need to replace adult exposure assessment for immune evaluation with protocols that can protect the developing immune system. PMID:16581533

  11. Recent Enhancements to the Genetic Risk Prediction Model BRCAPRO

    PubMed Central

    Mazzola, Emanuele; Blackford, Amanda; Parmigiani, Giovanni; Biswas, Swati

    2015-01-01

    BRCAPRO is a widely used model for genetic risk prediction of breast cancer. It is a function within the R package BayesMendel and is used to calculate the probabilities of being a carrier of a deleterious mutation in one or both of the BRCA genes, as well as the probability of being affected with breast and ovarian cancer within a defined time window. Both predictions are based on information contained in the counselee’s family history of cancer. During the last decade, BRCAPRO has undergone several rounds of successive refinements: the current version is part of release 2.1 of BayesMendel. In this review, we showcase some of the most notable features of the software resulting from these recent changes. We provide examples highlighting each feature, using artificial pedigrees motivated by complex clinical examples. We illustrate how BRCAPRO is a comprehensive software for genetic risk prediction with many useful features that allow users the flexibility to incorporate varying amounts of available information. PMID:25983549

  12. Seroprevalence and risk factors associated with ovine toxoplasmosis in Northeast Brazil

    PubMed Central

    Andrade, Milena M. Clementino; Carneiro, Mariangela; Medeiros, Andrea D.; Neto, Valter Andrade; Vitor, Ricardo W.A.

    2013-01-01

    Serum samples of 930 sheep were tested by ELISA to assess the prevalence of anti-Toxoplasma gondii antibodies and to identify risk factors associated with the presence of toxoplasmosis in two regions of Rio Grande do Norte (Northeast Brazil), with different climatic conditions. The overall estimated prevalence was 22.1%, with 26.3% and 17.8% positive sheep in Leste Potiguar and Central Potiguar regions, respectively. Among the positive sheep, 18.1% had low-avidity IgG antibodies, suggesting the occurrence of recent toxoplasmosis. The risk factors for toxoplasmosis in sheep were: presence of cats (odds ratio (OR) = 1.55; confidence interval (CI) 95% = 1.11–2.16), age of the animals, with adults presenting a greater chance of infection (OR = 2.44; CI 95% = 1.58–3.75), and the use of running water (OR = 1.61; CI 95% = 1.25–2.09), characterizing the existence of transmission by sporulated oocysts of T. gondii in the environment. PMID:23707895

  13. Prevalence and risk factors associated to ovine toxoplasmosis in northeastern Brazil.

    PubMed

    Mendonça, Carlos Eduardo D'Alencar; Barros, Sílvia Letícia Bomfim; Guimarães, Vitor Andrade Accioly; Ferraudo, Antonio Sergio; Munhoz, Alexandre Dias

    2013-01-01

    In this study, we aimed to determine the prevalence and risk factors associated to Toxoplasma gondii infection in sheep from northeastern Brazil. A total of 932 ovine serum samples from 54 properties in 19 municipalities of the state of Sergipe were collected and assayed using indirect fluorescent antibody test. The assay used antibodies against Toxoplasma gondii (IFAT-IgG) with a cutoff point of 1:64. We observed that 28.22% (263/932) of the ovine samples were serum-reactive. In a logistic regression, factors such as consumption of water directly from the source, consumption of water from a deep well, and age below 12 months were associated with protection; whereas factors such as presence of cats on the property, presence of slatted floor, and use of exchanged or borrowed breeding males were associated with infection. The studied area can be considered endemic for toxoplasmosis, so it is necessary to adopt preventive and control measures because this zoonotic infection poses risks to public health. PMID:23856735

  14. Peak Pc Prediction in Conjunction Analysis: Conjunction Assessment Risk Analysis. Pc Behavior Prediction Models

    NASA Technical Reports Server (NTRS)

    Vallejo, J.J.; Hejduk, M.D.; Stamey, J. D.

    2015-01-01

    Satellite conjunction risk typically evaluated through the probability of collision (Pc). Considers both conjunction geometry and uncertainties in both state estimates. Conjunction events initially discovered through Joint Space Operations Center (JSpOC) screenings, usually seven days before Time of Closest Approach (TCA). However, JSpOC continues to track objects and issue conjunction updates. Changes in state estimate and reduced propagation time cause Pc to change as event develops. These changes a combination of potentially predictable development and unpredictable changes in state estimate covariance. Operationally useful datum: the peak Pc. If it can reasonably be inferred that the peak Pc value has passed, then risk assessment can be conducted against this peak value. If this value is below remediation level, then event intensity can be relaxed. Can the peak Pc location be reasonably predicted?

  15. Clinical Prediction of Fall Risk and White Matter Abnormalities

    PubMed Central

    Koo, Bang-Bon; Bergethon, Peter; Qiu, Wei Qiao; Scott, Tammy; Hussain, Mohammed; Rosenberg, Irwin; Caplan, Louis R.; Bhadelia, Rafeeque A.

    2015-01-01

    Background The Tinetti scale is a simple clinical tool designed to predict risk of falling by focusing on gait and stance impairment in elderly persons. Gait impairment is also associated with white matter (WM) abnormalities. Objective To test the hypothesis that elderly subjects at risk for falling, as determined by the Tinetti scale, have specific patterns of WM abnormalities on diffusion tensor imaging. Design, Setting, and Patients Community-based cohort of 125 homebound elderly individuals. Main Outcome Measures Diffusion tensor imaging scans were analyzed using tract-based spatial statistics analysis to determine the location of WM abnormalities in subjects with Tinetti scale scores of 25 or higher (without risk of falls) and lower than 25 (with risk of falls). Multivariate linear least squares correlation analysis was performed to determine the association between Tinetti scale scores and local fractional anisotropy values on each skeletal voxel controlling for possible confounders. Results In subjects with risk of falls (Tinetti scale score <25), clusters of abnormal WM were seen in the medial frontal and parietal subcortical pathways, genu and splenium of corpus callosum, posterior cingulum, prefrontal and orbitofrontal pathways, and longitudinal pathways that connect frontal-parietal-temporal lobes. Among these abnormalities, those in medial frontal and parietal subcortical pathways correlated with Mini-Mental State Examination scores, while the other locations were unrelated to these scores. Conclusions Elderly individuals at risk for falls as determined by the Tinetti scale have WM abnormalities in specific locations on diffusion tensor imaging, some of which correlate with cognitive function scores. PMID:22332181

  16. Adolescent Expectations of Early Death Predict Adult Risk Behaviors

    PubMed Central

    Nguyen, Quynh C.; Villaveces, Andres; Marshall, Stephen W.; Hussey, Jon M.; Halpern, Carolyn T.; Poole, Charles

    2012-01-01

    Only a handful of public health studies have investigated expectations of early death among adolescents. Associations have been found between these expectations and risk behaviors in adolescence. However, these beliefs may not only predict worse adolescent outcomes, but worse trajectories in health with ties to negative outcomes that endure into young adulthood. The objectives of this study were to investigate perceived chances of living to age 35 (Perceived Survival Expectations, PSE) as a predictor of suicidal ideation, suicide attempt and substance use in young adulthood. We examined the predictive capacity of PSE on future suicidal ideation/attempt after accounting for sociodemographics, depressive symptoms, and history of suicide among family and friends to more fully assess its unique contribution to suicide risk. We investigated the influence of PSE on legal and illegal substance use and varying levels of substance use. We utilized the National Longitudinal Study of Adolescent Health (Add Health) initiated in 1994–95 among 20,745 adolescents in grades 7–12 with follow-up interviews in 1996 (Wave II), 2001–02 (Wave III) and 2008 (Wave IV; ages 24–32). Compared to those who were almost certain of living to age 35, perceiving a 50–50 or less chance of living to age 35 at Waves I or III predicted suicide attempt and ideation as well as regular substance use (i.e., exceeding daily limits for moderate drinking; smoking ≥ a pack/day; and using illicit substances other than marijuana at least weekly) at Wave IV. Associations between PSE and detrimental adult outcomes were particularly strong for those reporting persistently low PSE at both Waves I and III. Low PSE at Wave I or Wave III was also related to a doubling and tripling, respectively, of death rates in young adulthood. Long-term and wide-ranging ties between PSE and detrimental outcomes suggest these expectations may contribute to identifying at-risk youth. PMID:22870260

  17. Predicting the use of Individualized Risk Assessment for Breast Cancer

    PubMed Central

    Bartle-Haring, Suzanne; Toviessi, Paula; Katafiasz, Heather

    2008-01-01

    Purpose The purpose of this study was to investigate the decision to obtain individualized risk assessment after a breast cancer education session. Methods A sample of both African American and Caucasian women was used to determine if there were differences by race/ethnicity in uptake of the assessment and differences in the variables that were most predictive of uptake. The sample included 166 women between the ages of 18 and 80. Sixty-two percent of the sample were African American women. Key Findings The results suggested that African American women and Caucasian women used different factors and used other factors differently to decide whether or not to obtain an individualized risk assessment. Conclusions and Implications These results are discussed within the context of health disparities among ethnic minority and Caucasian women with implications for breast cancer control programs. The results of this study would suggest that knowledge alone does not lead to opting for a personalized risk assessment, and that African American and Caucasian women use different pieces of information, or information differently to make decision about getting more personalized information about risk. PMID:18319147

  18. Risk prediction with machine learning and regression methods.

    PubMed

    Steyerberg, Ewout W; van der Ploeg, Tjeerd; Van Calster, Ben

    2014-07-01

    This is a discussion of issues in risk prediction based on the following papers: "Probability estimation with machine learning methods for dichotomous and multicategory outcome: Theory" by Jochen Kruppa, Yufeng Liu, Gérard Biau, Michael Kohler, Inke R. König, James D. Malley, and Andreas Ziegler; and "Probability estimation with machine learning methods for dichotomous and multicategory outcome: Applications" by Jochen Kruppa, Yufeng Liu, Hans-Christian Diener, Theresa Holste, Christian Weimar, Inke R. König, and Andreas Ziegler. PMID:24615859

  19. Polygenic risk scores for schizophrenia and bipolar disorder predict creativity.

    PubMed

    Power, Robert A; Steinberg, Stacy; Bjornsdottir, Gyda; Rietveld, Cornelius A; Abdellaoui, Abdel; Nivard, Michel M; Johannesson, Magnus; Galesloot, Tessel E; Hottenga, Jouke J; Willemsen, Gonneke; Cesarini, David; Benjamin, Daniel J; Magnusson, Patrik K E; Ullén, Fredrik; Tiemeier, Henning; Hofman, Albert; van Rooij, Frank J A; Walters, G Bragi; Sigurdsson, Engilbert; Thorgeirsson, Thorgeir E; Ingason, Andres; Helgason, Agnar; Kong, Augustine; Kiemeney, Lambertus A; Koellinger, Philipp; Boomsma, Dorret I; Gudbjartsson, Daniel; Stefansson, Hreinn; Stefansson, Kari

    2015-07-01

    We tested whether polygenic risk scores for schizophrenia and bipolar disorder would predict creativity. Higher scores were associated with artistic society membership or creative profession in both Icelandic (P = 5.2 × 10(-6) and 3.8 × 10(-6) for schizophrenia and bipolar disorder scores, respectively) and replication cohorts (P = 0.0021 and 0.00086). This could not be accounted for by increased relatedness between creative individuals and those with psychoses, indicating that creativity and psychosis share genetic roots. PMID:26053403

  20. A Model to Predict the Risk of Keratinocyte Carcinomas.

    PubMed

    Whiteman, David C; Thompson, Bridie S; Thrift, Aaron P; Hughes, Maria-Celia; Muranushi, Chiho; Neale, Rachel E; Green, Adele C; Olsen, Catherine M

    2016-06-01

    Basal cell and squamous cell carcinomas of the skin are the commonest cancers in humans, yet no validated tools exist to estimate future risks of developing keratinocyte carcinomas. To develop a prediction tool, we used baseline data from a prospective cohort study (n = 38,726) in Queensland, Australia, and used data linkage to capture all surgically excised keratinocyte carcinomas arising within the cohort. Predictive factors were identified through stepwise logistic regression models. In secondary analyses, we derived separate models within strata of prior skin cancer history, age, and sex. The primary model included terms for 10 items. Factors with the strongest effects were >20 prior skin cancers excised (odds ratio 8.57, 95% confidence interval [95% CI] 6.73-10.91), >50 skin lesions destroyed (odds ratio 3.37, 95% CI 2.85-3.99), age ≥ 70 years (odds ratio 3.47, 95% CI 2.53-4.77), and fair skin color (odds ratio 1.75, 95% CI 1.42-2.15). Discrimination in the validation dataset was high (area under the receiver operator characteristic curve 0.80, 95% CI 0.79-0.81) and the model appeared well calibrated. Among those reporting no prior history of skin cancer, a similar model with 10 factors predicted keratinocyte carcinoma events with reasonable discrimination (area under the receiver operator characteristic curve 0.72, 95% CI 0.70-0.75). Algorithms using self-reported patient data have high accuracy for predicting risks of keratinocyte carcinomas. PMID:26908057

  1. Risk Factors for Bartonella species Infection in Blood Donors from Southeast Brazil.

    PubMed

    Diniz, Pedro Paulo Vissotto de Paiva; Velho, Paulo Eduardo Neves Ferreira; Pitassi, Luiza Helena Urso; Drummond, Marina Rovani; Lania, Bruno Grosselli; Barjas-Castro, Maria Lourdes; Sowy, Stanley; Breitschwerdt, Edward B; Scorpio, Diana Gerardi

    2016-03-01

    Bacteria from the genus Bartonella are emerging blood-borne bacteria, capable of causing long-lasting infection in marine and terrestrial mammals, including humans. Bartonella are generally well adapted to their main host, causing persistent infection without clinical manifestation. However, these organisms may cause severe disease in natural or accidental hosts. In humans, Bartonella species have been detected from sick patients presented with diverse disease manifestations, including cat scratch disease, trench fever, bacillary angiomatosis, endocarditis, polyarthritis, or granulomatous inflammatory disease. However, with the advances in diagnostic methods, subclinical bloodstream infection in humans has been reported, with the potential for transmission through blood transfusion been recently investigated by our group. The objective of this study was to determine the risk factors associated with Bartonella species infection in asymptomatic blood donors presented at a major blood bank in Southeastern Brazil. Five hundred blood donors were randomly enrolled and tested for Bartonella species infection by specialized blood cultured coupled with high-sensitive PCR assays. Epidemiological questionnaires were designed to cover major potential risk factors, such as age, gender, ethnicity, contact with companion animals, livestock, or wild animals, bites from insects or animal, economical status, among other factors. Based on multivariate logistic regression, bloodstream infection with B. henselae or B. clarridgeiae was associated with cat contact (adjusted OR: 3.4, 95% CI: 1.1-9.6) or history of tick bite (adjusted OR: 3.7, 95% CI: 1.3-13.4). These risk factors should be considered during donor screening, as bacteremia by these Bartonella species may not be detected by traditional laboratory screening methods, and it may be transmitted by blood transfusion. PMID:26999057

  2. Risk Factors for Bartonella species Infection in Blood Donors from Southeast Brazil

    PubMed Central

    Diniz, Pedro Paulo Vissotto de Paiva; Velho, Paulo Eduardo Neves Ferreira; Pitassi, Luiza Helena Urso; Drummond, Marina Rovani; Lania, Bruno Grosselli; Barjas-Castro, Maria Lourdes; Sowy, Stanley; Breitschwerdt, Edward B.; Scorpio, Diana Gerardi

    2016-01-01

    Bacteria from the genus Bartonella are emerging blood-borne bacteria, capable of causing long-lasting infection in marine and terrestrial mammals, including humans. Bartonella are generally well adapted to their main host, causing persistent infection without clinical manifestation. However, these organisms may cause severe disease in natural or accidental hosts. In humans, Bartonella species have been detected from sick patients presented with diverse disease manifestations, including cat scratch disease, trench fever, bacillary angiomatosis, endocarditis, polyarthritis, or granulomatous inflammatory disease. However, with the advances in diagnostic methods, subclinical bloodstream infection in humans has been reported, with the potential for transmission through blood transfusion been recently investigated by our group. The objective of this study was to determine the risk factors associated with Bartonella species infection in asymptomatic blood donors presented at a major blood bank in Southeastern Brazil. Five hundred blood donors were randomly enrolled and tested for Bartonella species infection by specialized blood cultured coupled with high-sensitive PCR assays. Epidemiological questionnaires were designed to cover major potential risk factors, such as age, gender, ethnicity, contact with companion animals, livestock, or wild animals, bites from insects or animal, economical status, among other factors. Based on multivariate logistic regression, bloodstream infection with B. henselae or B. clarridgeiae was associated with cat contact (adjusted OR: 3.4, 95% CI: 1.1–9.6) or history of tick bite (adjusted OR: 3.7, 95% CI: 1.3–13.4). These risk factors should be considered during donor screening, as bacteremia by these Bartonella species may not be detected by traditional laboratory screening methods, and it may be transmitted by blood transfusion. PMID:26999057

  3. Severe physical punishment: risk of mental health problems for poor urban children in Brazil

    PubMed Central

    Duarte, Cristiane S; Peres, Clovis A; Nascimento, Rosimeire; Curto, Bartira M; Paula, Cristiane S

    2009-01-01

    Abstract Objective To examine the relationship between specific types of child mental health problems and severe physical punishment, in combination with other important known risk factors. Methods We conducted a cross-sectional study in Embu, São Paulo, Brazil, as the Brazilian component of a multicountry survey on abuse in the family environment. From a probabilistic sample of clusters that included all eligible households (women aged 15–49 years with a son or daughter < 18 years of age), we randomly selected one mother–child pair per household (n = 813; attrition rate: 17.6%). This study focused on children aged 6–17 years (n = 480). Child Behaviour Checklist CBCL/6–18 was used to identify children with internalizing problems only, externalizing problems only, and both internalizing and externalizing problems (comorbidity). Severe physical punishment was defined as being hit with an object, being kicked, choked, smothered, burnt, scalded, branded, beaten or threatened with a weapon. We examined other potential correlates from four domains: child (gender, age, ever witnessing marital violence); mother (education, unemployment, anxiety or depression, marital violence); father (absence, drunkenness); and family (socioeconomic status). The WHO Self-Reporting Questionnaire (SRQ-20) was used to identify maternal anxiety or depression (score > 7). Backward logistic regression analysis identified independent correlates and significant interactions. Findings Multivariate modelling showed that severe punishment was an independent correlate of comorbid internalizing and externalizing problems but was not associated with internalizing problems only. It increased the risk of externalizing problems alone only for children and adolescents not exposed to maternal anxiety or depression. Maternal anxiety or depression increased the risk only for children or adolescents not exposed to severe punishment. Conclusion Severe punishment may be related to child mental

  4. Tryptophan Predicts the Risk for Future Type 2 Diabetes.

    PubMed

    Chen, Tianlu; Zheng, Xiaojiao; Ma, Xiaojing; Bao, Yuqian; Ni, Yan; Hu, Cheng; Rajani, Cynthia; Huang, Fengjie; Zhao, Aihua; Jia, Weiping; Jia, Wei

    2016-01-01

    Recently, 5 amino acids were identified and verified as important metabolites highly associated with type 2 diabetes (T2D) development. This report aims to assess the association of tryptophan with the development of T2D and to evaluate its performance with existing amino acid markers. A total of 213 participants selected from a ten-year longitudinal Shanghai Diabetes Study (SHDS) were examined in two ways: 1) 51 subjects who developed diabetes and 162 individuals who remained metabolically healthy in 10 years; 2) the same 51 future diabetes and 23 strictly matched ones selected from the 162 healthy individuals. Baseline fasting serum tryptophan concentrations were quantitatively measured using ultra-performance liquid chromatography triple quadruple mass spectrometry. First, serum tryptophan level was found significantly higher in future T2D and was positively and independently associated with diabetes onset risk. Patients with higher tryptophan level tended to present higher degree of insulin resistance and secretion, triglyceride and blood pressure. Second, the prediction potential of tryptophan is non-inferior to the 5 existing amino acids. The predictive performance of the combined score improved after taking tryptophan into account. Our findings unveiled the potential of tryptophan as a new marker associated with diabetes risk in Chinese populations. The addition of tryptophan provided complementary value to the existing amino acid predictors. PMID:27598004

  5. Predicted 10-year risk of cardiovascular disease is influenced by the risk equation adopted: a cross-sectional analysis

    PubMed Central

    Gray, Benjamin J; Bracken, Richard M; Turner, Daniel; Morgan, Kerry; Mellalieu, Stephen D; Thomas, Michael; Williams, Sally P; Williams, Meurig; Rice, Sam; Stephens, Jeffrey W

    2014-01-01

    Background Validated risk equations are currently recommended to assess individuals to determine those at ‘high risk’ of cardiovascular disease (CVD). However, there is no longer a risk ‘equation of choice’. Aim This study examined the differences between four commonly-used CVD risk equations. Design and setting Cross-sectional analysis of individuals who participated in a workplace-based risk assessment in Carmarthenshire, south Wales. Method Analysis of 790 individuals (474 females, 316 males) with no prior diagnosis of CVD or diabetes. Ten-year CVD risk was predicted by entering the relevant variables into the QRISK2, Framingham Lipids, Framingham BMI, and JBS2 risk equations. Results The Framingham BMI and JBS2 risk equations predicted a higher absolute risk than the QRISK2 and Framingham Lipids equations, and CVD risk increased concomitantly with age irrespective of which risk equation was adopted. Only a small proportion of females (0–2.1%) were predicted to be at high risk of developing CVD using any of the risk algorithms. The proportion of males predicted at high risk ranged from 5.4% (QRISK2) to 20.3% (JBS2). After age stratification, few differences between isolated risk factors were observed in males, although a greater proportion of males aged ≥50 years were predicted to be at ‘high risk’ independent of risk equation used. Conclusions Different risk equations can influence the predicted 10-year CVD risk of individuals. More males were predicted at ‘high risk’ using the JBS2 or Framingham BMI equations. Consideration should also be given to the number of isolated risk factors, especially in younger adults when evaluating CVD risk. PMID:25267049

  6. Predictive model of avian electrocution risk on overhead power lines.

    PubMed

    Dwyer, J F; Harness, R E; Donohue, K

    2014-02-01

    Electrocution on overhead power structures negatively affects avian populations in diverse ecosystems worldwide, contributes to the endangerment of raptor populations in Europe and Africa, and is a major driver of legal action against electric utilities in North America. We investigated factors associated with avian electrocutions so poles that are likely to electrocute a bird can be identified and retrofitted prior to causing avian mortality. We used historical data from southern California to identify patterns of avian electrocution by voltage, month, and year to identify species most often killed by electrocution in our study area and to develop a predictive model that compared poles where an avian electrocution was known to have occurred (electrocution poles) with poles where no known electrocution occurred (comparison poles). We chose variables that could be quantified by personnel with little training in ornithology or electric systems. Electrocutions were more common at distribution voltages (≤ 33 kV) and during breeding seasons and were more commonly reported after a retrofitting program began. Red-tailed Hawks (Buteo jamaicensis) (n = 265) and American Crows (Corvus brachyrhynchos) (n = 258) were the most commonly electrocuted species. In the predictive model, 4 of 14 candidate variables were required to distinguish electrocution poles from comparison poles: number of jumpers (short wires connecting energized equipment), number of primary conductors, presence of grounding, and presence of unforested unpaved areas as the dominant nearby land cover. When tested against a sample of poles not used to build the model, our model distributed poles relatively normally across electrocution-risk values and identified the average risk as higher for electrocution poles relative to comparison poles. Our model can be used to reduce avian electrocutions through proactive identification and targeting of high-risk poles for retrofitting. PMID:24033371

  7. Multi-parametric prediction for cardiovascular risk assessment.

    PubMed

    Henriques, Jorge; de Carvalho, Paulo; Rocha, Teresa; Paredes, Simão; Morais, João

    2016-01-01

    The employment of personal health systems (pHealth) is a valuable concept in the management of chronic diseases, particularly in the context of cardiovascular diseases. By means of a continuous monitoring of the patient it is possible to seamless access multiple sources of data, including physiological signals, providing professionals with a global and reliable view of the patient's status. In practice, it is possible the prompt diagnosis of events, the early prediction of critical events and the implementation of personalized therapies. Furthermore, the information collected during long periods creates new opportunities in the diagnosis of a disease, in its evolution, and in the prediction of possible complications. The focus of this work is the research and implementation of multi-parametric algorithms for data analysis in pHealth context, including data mining techniques as well as physiological signal modelling and processing. In particular, fusion strategies for cardiovascular status evaluation (namely cardiovascular risk assessment and cardiac function estimation) and multi-parametric prediction algorithms for the early detection of cardiovascular events (such as hypertension, syncope and heart failure decompensation) will be addressed. PMID:27225547

  8. Risk Factors for Infection with Different Hepatitis C Virus Genotypes in Southern Brazil

    PubMed Central

    Paraboni, Marisa Lúcia Romani; Sbeghen, Marina Dallagasperina; Wolff, Fernando Herz; Moreira, Leila Beltrami

    2012-01-01

    Objectives. To investigate the proportion of different genotypes in countryside microregions in southern Brazil, and their association with risk factors. Methods. Cross-sectional study including a convenience sample of patients who tested positive for HCV-RNA and were referred to a regional health center for genotyping, from December 2003 to January 2008. Data were obtained through the National Disease Surveillance Data System, from laboratory registers and from patient charts. Identification of genotypes was carried out using the Restriction Fragment Length Polymorphism “in house” technique. Independent associations with genotypes were evaluated in multinomial logistic regression and prevalence rates of genotypes were estimated with modified Poisson regression. Results. The sample consisted of 441 individuals, 41.1 ± 12.0 years old, 56.5% men. Genotype 1 was observed in 41.5% (95% CI 37.9–48.1) of patients, genotype 2 in 19.3% (95% CI 15.0–23.6), and genotype 3 in 39.2% (95% CI 35.6–43.0). HCV genotype was significantly associated with gender and age. Dental procedures were associated with higher proportion of genotype 2 independently of age, education, and patient treatment center. Conclusions. The hepatitis C virus genotype 1 was the most frequent. Genotype 2 was associated with female gender, age, and dental procedure exposition. PMID:22666173

  9. Respiratory syncytial virus seasonality in Brazil: implications for the immunisation policy for at-risk populations

    PubMed Central

    Freitas, André Ricardo Ribas; Donalisio, Maria Rita

    2016-01-01

    Respiratory syncytial virus (RSV) infection is the leading cause of hospitalisation for respiratory diseases among children under 5 years old. The aim of this study was to analyse RSV seasonality in the five distinct regions of Brazil using time series analysis (wavelet and Fourier series) of the following indicators: monthly positivity of the immunofluorescence reaction for RSV identified by virologic surveillance system, and rate of hospitalisations per bronchiolitis and pneumonia due to RSV in children under 5 years old (codes CID-10 J12.1, J20.5, J21.0 and J21.9). A total of 12,501 samples with 11.6% positivity for RSV (95% confidence interval 11 - 12.2), varying between 7.1 and 21.4% in the five Brazilian regions, was analysed. A strong trend for annual cycles with a stable stationary pattern in the five regions was identified through wavelet analysis of the indicators. The timing of RSV activity by Fourier analysis was similar between the two indicators analysed and showed regional differences. This study reinforces the importance of adjusting the immunisation period for high risk population with the monoclonal antibody palivizumab taking into account regional differences in seasonality of RSV. PMID:27120006

  10. Clinical and molecular characterization of patients at risk for hereditary melanoma in southern Brazil.

    PubMed

    Ashton-Prolla, Patricia; Bakos, Lucio; Junqueira, Gerson; Giugliani, Roberto; Azevedo, Sergio J; Hogg, David

    2008-02-01

    Melanoma is the most dangerous of all common skin cancers, due to its propensity to metastasize. Therefore, identification of at-risk populations may allow early detection of disease at a curable stage. In Europe and North America, between 8-14% of melanoma patients have a family history of the disease, and a subset of these individuals possess germline mutations in the CDKN2A gene, which encodes the p16(INK4A) and p14(ARF) tumor suppressors. We identified 30 patients (29 families) from Southern Brazil, who had a family history of melanoma and/or pancreatic cancer; or a personal history of multiple primary melanoma. We screened this cohort for mutations in the CDKN2A and CDK4 genes, and detected two functional mutations: a G-34T transversion in 5'untranslated region; and a M53I alteration encoded in exon 2. Both mutants have been previously associated with melanoma and demonstrate founder effects. We conclude that germline mutations of CDKN2A occur in the Brazilian population, and that these mutations likely originated in Europe. PMID:17713569

  11. Spatio-temporal modelling of climate-sensitive disease risk: Towards an early warning system for dengue in Brazil

    NASA Astrophysics Data System (ADS)

    Lowe, Rachel; Bailey, Trevor C.; Stephenson, David B.; Graham, Richard J.; Coelho, Caio A. S.; Sá Carvalho, Marilia; Barcellos, Christovam

    2011-03-01

    This paper considers the potential for using seasonal climate forecasts in developing an early warning system for dengue fever epidemics in Brazil. In the first instance, a generalised linear model (GLM) is used to select climate and other covariates which are both readily available and prove significant in prediction of confirmed monthly dengue cases based on data collected across the whole of Brazil for the period January 2001 to December 2008 at the microregion level (typically consisting of one large city and several smaller municipalities). The covariates explored include temperature and precipitation data on a 2.5°×2.5° longitude-latitude grid with time lags relevant to dengue transmission, an El Niño Southern Oscillation index and other relevant socio-economic and environmental variables. A negative binomial model formulation is adopted in this model selection to allow for extra-Poisson variation (overdispersion) in the observed dengue counts caused by unknown/unobserved confounding factors and possible correlations in these effects in both time and space. Subsequently, the selected global model is refined in the context of the South East region of Brazil, where dengue predominates, by reverting to a Poisson framework and explicitly modelling the overdispersion through a combination of unstructured and spatio-temporal structured random effects. The resulting spatio-temporal hierarchical model (or GLMM—generalised linear mixed model) is implemented via a Bayesian framework using Markov Chain Monte Carlo (MCMC). Dengue predictions are found to be enhanced both spatially and temporally when using the GLMM and the Bayesian framework allows posterior predictive distributions for dengue cases to be derived, which can be useful for developing a dengue alert system. Using this model, we conclude that seasonal climate forecasts could have potential value in helping to predict dengue incidence months in advance of an epidemic in South East Brazil.

  12. Carnival or football, is there a real risk for acquiring dengue fever in Brazil during holidays seasons?

    NASA Astrophysics Data System (ADS)

    Aguiar, Maíra; Rocha, Filipe; Pessanha, José Eduardo Marques; Mateus, Luis; Stollenwerk, Nico

    2015-02-01

    More than 600,000 football fans, coming from all over the world, were expected to visit Brazil during the FIFA World Cup 2014. International travel can become a public health problem when the visitors start to become sick, needing medical intervention and eventually hospitalization. The occurrence of dengue fever infections in Brazil is persistent and has been increasing since the 1980s, and the health authorities were expected to take preventive measures and to warn the visitors about the risks during the tournament period. Before the World Cup started, studies have been published stating that dengue could be a significant problem in some of the Brazilian cities hosting the games. These conclusions were taken after a brief observation of the available data, analyzing its mean and standard deviation only, or based on seasonal climate forecasts, causing alarm for the world cup in Brazil. Here, with a more careful data analysis, we show that the seasonality of the disease plays a major role in dengue transmission. The density of dengue cases in Brazil is residual during winter in the Southern hemisphere (mid June to mid September) and the fans of football were not likely to get dengue during the tournament period.

  13. A Genetic Risk Score Combining Ten Psoriasis Risk Loci Improves Disease Prediction

    PubMed Central

    Chen, Haoyan; Poon, Annie; Yeung, Celestine; Helms, Cynthia; Pons, Jennifer; Bowcock, Anne M.; Kwok, Pui-Yan; Liao, Wilson

    2011-01-01

    Psoriasis is a chronic, immune-mediated skin disease affecting 2–3% of Caucasians. Recent genetic association studies have identified multiple psoriasis risk loci; however, most of these loci contribute only modestly to disease risk. In this study, we investigated whether a genetic risk score (GRS) combining multiple loci could improve psoriasis prediction. Two approaches were used: a simple risk alleles count (cGRS) and a weighted (wGRS) approach. Ten psoriasis risk SNPs were genotyped in 2815 case-control samples and 858 family samples. We found that the total number of risk alleles in the cases was significantly higher than in controls, mean 13.16 (SD 1.7) versus 12.09 (SD 1.8), p = 4.577×10−40. The wGRS captured considerably more risk than any SNP considered alone, with a psoriasis OR for high-low wGRS quartiles of 10.55 (95% CI 7.63–14.57), p = 2.010×10−65. To compare the discriminatory ability of the GRS models, receiver operating characteristic curves were used to calculate the area under the curve (AUC). The AUC for wGRS was significantly greater than for cGRS (72.0% versus 66.5%, p = 2.13×10−8). Additionally, the AUC for HLA-C alone (rs10484554) was equivalent to the AUC for all nine other risk loci combined (66.2% versus 63.8%, p = 0.18), highlighting the dominance of HLA-C as a risk locus. Logistic regression revealed that the wGRS was significantly associated with two subphenotypes of psoriasis, age of onset (p = 4.91×10−6) and family history (p = 0.020). Using a liability threshold model, we estimated that the 10 risk loci account for only11.6% of the genetic variance in psoriasis. In summary, we found that a GRS combining 10 psoriasis risk loci captured significantly more risk than any individual SNP and was associated with early onset of disease and a positive family history. Notably, only a small fraction of psoriasis heritability is captured by the common risk variants identified to date. PMID:21559375

  14. Evaluation of the health risks to garment workers in the city of Xambrê-PR, Brazil.

    PubMed

    Sant'Ana, Marco Antônio; Kovalechen, Fabrício

    2012-01-01

    This study evaluated the risks for cardiovascular disease and the life habits of garment industry workers in northwestern Paraná state, Brazil. The following parameters were assessed: body composition, cardiorespiratory fitness, eating habits and physical activities by garment industry workers. Cardiovascular risk was observed in some of the studied subjects, in the form of high BMI and reduced maximal oxygen uptake. The development of a workplace quality-of-life program is suggested, aiming to stimulate the development of physical activities to improve the cardiovascular conditioning of workers. PMID:22317639

  15. Predicting Pneumonitis Risk: A Dosimetric Alternative to Mean Lung Dose

    SciTech Connect

    Tucker, Susan L.; Mohan, Radhe; Liengsawangwong, Raweewan; Martel, Mary K.; Liao Zhongxing

    2013-02-01

    Purpose: To determine whether the association between mean lung dose (MLD) and risk of severe (grade {>=}3) radiation pneumonitis (RP) depends on the dose distribution pattern to normal lung among patients receiving 3-dimensional conformal radiation therapy for non-small-cell lung cancer. Methods and Materials: Three cohorts treated with different beam arrangements were identified. One cohort (2-field boost [2FB]) received 2 parallel-opposed (anteroposterior-posteroanterior) fields per fraction initially, followed by a sequential boost delivered using 2 oblique beams. The other 2 cohorts received 3 or 4 straight fields (3FS and 4FS, respectively), ie, all fields were irradiated every day. The incidence of severe RP was plotted against MLD in each cohort, and data were analyzed using the Lyman-Kutcher-Burman (LKB) model. Results: The incidence of grade {>=}3 RP rose more steeply as a function of MLD in the 2FB cohort (N=120) than in the 4FS cohort (N=138), with an intermediate slope for the 3FS group (N=99). The estimated volume parameter from the LKB model was n=0.41 (95% confidence interval, 0.15-1.0) and led to a significant improvement in fit (P=.05) compared to a fit with volume parameter fixed at n=1 (the MLD model). Unlike the MLD model, the LKB model with n=0.41 provided a consistent description of the risk of severe RP in all three cohorts (2FB, 3FS, 4FS) simultaneously. Conclusions: When predicting risk of grade {>=}3 RP, the mean lung dose does not adequately take into account the effects of high doses. Instead, the effective dose, computed from the LKB model using volume parameter n=0.41, may provide a better dosimetric parameter for predicting RP risk. If confirmed, these findings support the conclusion that for the same MLD, high doses to small lung volumes ('a lot to a little') are worse than low doses to large volumes ('a little to a lot').

  16. Assessing the Relative Ecological Importance and Deforestation Risks of Unprotected Areas in Western Brazil Using Landsat, CBERS and Quantum GIS

    NASA Astrophysics Data System (ADS)

    Smith, A.; Sevilla, C.; Lanclos, A.; Carson, C.; Larson, J.; Sankaran, M.; Saad, M.

    2012-12-01

    In addition to understanding Brazilian policies and currently utilized methodologies, the measurement of the impacts of deforestation is essential for enhancing techniques to reduce deforestation in the future. Adverse impacts of deforestation include biodiversity loss, increased carbon dioxide emissions, and a reduced rate of evapotranspiration, all of which contribute directly or indirectly to global warming. With the continual growth in population in developing countries such as Brazil, increased demands are placed on infrastructural development and food production. As a result, forested areas are cleared for agricultural production. Recently, exploration for hydrocarbons in Western Brazil has also intensified as a means to stimulate the economy, as abundant oil and gas is believed to be found in these regions. Unfortunately, hydrocarbon-rich regions of Western Brazil are also home to thousands of species. Many of these regions are as of yet untapped but are at risk of ecological disruption as a result of impending human activity. This project utilized Landsat 5 TM to monitor deforestation in a subsection of the Brazilian states of Rondônia and Amazonas. A risk map identifying areas susceptible to future deforestation, based on factors such as proximity to roads, bodies of water, cities, and proposed hydrocarbon activities such as pipeline construction, was created. Areas at higher risk of clearance were recommended to be a target for enhanced monitoring and law enforcement. In addition, an importance map was created based on biodiversity and location of endangered species. This map was used to identify potential areas for future protection. A Chinese-Brazilian satellite, CBERS 2B CCD was also utilized for comparison. The NDVI model was additionally replicated in Quantum GIS, an open source software, so that local communities and policymakers could benefit without having to pay for expensive ArcGIS software. The capabilities of VIIRS were also investigated to

  17. Personalized medicine: risk prediction, targeted therapies and mobile health technology

    PubMed Central

    2014-01-01

    Personalized medicine is increasingly being employed across many areas of clinical practice, as genes associated with specific diseases are discovered and targeted therapies are developed. Mobile apps are also beginning to be used in medicine with the aim of providing a personalized approach to disease management. In some areas of medicine, patient-tailored risk prediction and treatment are applied routinely in the clinic, whereas in other fields, more work is required to translate scientific advances into individualized treatment. In this forum article, we asked specialists in oncology, neurology, endocrinology and mobile health technology to discuss where we are in terms of personalized medicine, and address their visions for the future and the challenges that remain in their respective fields. PMID:24580858

  18. Is More Better? Combining Actuarial Risk Scales to Predict Recidivism among Adult Sex Offenders

    ERIC Educational Resources Information Center

    Seto, Michael C.

    2005-01-01

    The present study was conducted to determine whether combining the results of multiple actuarial risk scales increases accuracy in predicting sex offender recidivism. Multiple methods of combining 4 validated actuarial risk scales--the Violence Risk Appraisal Guide, the Sex Offender Risk Appraisal Guide, the Rapid Risk Assessment for Sexual…

  19. Genomic medicine and risk prediction across the disease spectrum.

    PubMed

    Kotze, Maritha J; Lückhoff, Hilmar K; Peeters, Armand V; Baatjes, Karin; Schoeman, Mardelle; van der Merwe, Lize; Grant, Kathleen A; Fisher, Leslie R; van der Merwe, Nicole; Pretorius, Jacobus; van Velden, David P; Myburgh, Ettienne J; Pienaar, Fredrieka M; van Rensburg, Susan J; Yako, Yandiswa Y; September, Alison V; Moremi, Kelebogile E; Cronje, Frans J; Tiffin, Nicki; Bouwens, Christianne S H; Bezuidenhout, Juanita; Apffelstaedt, Justus P; Hough, F Stephen; Erasmus, Rajiv T; Schneider, Johann W

    2015-01-01

    Genomic medicine is based on the knowledge that virtually every medical condition, disease susceptibility or response to treatment is caused, regulated or influenced by genes. Genetic testing may therefore add value across the disease spectrum, ranging from single-gene disorders with a Mendelian inheritance pattern to complex multi-factorial diseases. The critical factors for genomic risk prediction are to determine: (1) where the genomic footprint of a particular susceptibility or dysfunction resides within this continuum, and (2) to what extent the genetic determinants are modified by environmental exposures. Regarding the small subset of highly penetrant monogenic disorders, a positive family history and early disease onset are mostly sufficient to determine the appropriateness of genetic testing in the index case and to inform pre-symptomatic diagnosis in at-risk family members. In more prevalent polygenic non-communicable diseases (NCDs), the use of appropriate eligibility criteria is required to ensure a balance between benefit and risk. An additional screening step may therefore be necessary to identify individuals most likely to benefit from genetic testing. This need provided the stimulus for the development of a pathology-supported genetic testing (PSGT) service as a new model for the translational implementation of genomic medicine in clinical practice. PSGT is linked to the establishment of a research database proven to be an invaluable resource for the validation of novel and previously described gene-disease associations replicated in the South African population for a broad range of NCDs associated with increased cardio-metabolic risk. The clinical importance of inquiry concerning family history in determining eligibility for personalized genotyping was supported beyond its current limited role in diagnosing or screening for monogenic subtypes of NCDs. With the recent introduction of advanced microarray-based breast cancer subtyping, genetic testing

  20. Predicting environmental risk: A road map for the future.

    PubMed

    Jager, Tjalling

    2016-01-01

    Frameworks for environmental risk assessment (ERA) focus on comparing results from separate exposure and effect assessments. Exposure assessment generally relies on mechanistic fate models, whereas the effects assessment is anchored in standard test protocols and descriptive statistics. This discrepancy prevents a useful link between these two pillars of ERA, and jeopardizes the realism and efficacy of the entire process. Similar to exposure assessment, effects assessment requires a mechanistic approach to translate the output of fate models into predictions for impacts on populations and food webs. The aim of this study was to discuss (1) the central importance of the individual level, (2) different strategies of dealing with biological complexity, and (3) the role that toxicokinetic-toxicodynamic (TKTD) models, energy budgets, and molecular biology play in a mechanistic revision of the ERA framework. Consequently, an outline for a risk assessment paradigm was developed that incorporates a mechanistic effects assessment in a consistent manner, and a "roadmap for the future." Such a roadmap may play a critical role to eventually arrive at a more scientific and efficient ERA process, and needs to be used to shape our long-term research agendas. PMID:27484139

  1. Simplifying clinical use of the genetic risk prediction model BRCAPRO.

    PubMed

    Biswas, Swati; Atienza, Philamer; Chipman, Jonathan; Hughes, Kevin; Barrera, Angelica M Gutierrez; Amos, Christopher I; Arun, Banu; Parmigiani, Giovanni

    2013-06-01

    Health care providers need simple tools to identify patients at genetic risk of breast and ovarian cancers. Genetic risk prediction models such as BRCAPRO could fill this gap if incorporated into Electronic Medical Records or other Health Information Technology solutions. However, BRCAPRO requires potentially extensive information on the counselee and her family history. Thus, it may be useful to provide simplified version(s) of BRCAPRO for use in settings that do not require exhaustive genetic counseling. We explore four simplified versions of BRCAPRO, each using less complete information than the original model. BRCAPROLYTE uses information on affected relatives only up to second degree. It is in clinical use but has not been evaluated. BRCAPROLYTE-Plus extends BRCAPROLYTE by imputing the ages of unaffected relatives. BRCAPROLYTE-Simple reduces the data collection burden associated with BRCAPROLYTE and BRCAPROLYTE-Plus by not collecting the family structure. BRCAPRO-1Degree only uses first-degree affected relatives. We use data on 2,713 individuals from seven sites of the Cancer Genetics Network and MD Anderson Cancer Center to compare these simplified tools with the Family History Assessment Tool (FHAT) and BRCAPRO, with the latter serving as the benchmark. BRCAPROLYTE retains high discrimination; however, because it ignores information on unaffected relatives, it overestimates carrier probabilities. BRCAPROLYTE-Plus and BRCAPROLYTE-Simple provide better calibration than BRCAPROLYTE, so they have higher specificity for similar values of sensitivity. BRCAPROLYTE-Plus performs slightly better than BRCAPROLYTE-Simple. The Areas Under the ROC curve are 0.783 (BRCAPRO), 0.763 (BRCAPROLYTE), 0.772 (BRCAPROLYTE-Plus), 0.773 (BRCAPROLYTE-Simple), 0.728 (BRCAPRO-1Degree), and 0.745 (FHAT). The simpler versions, especially BRCAPROLYTE-Plus and BRCAPROLYTE-Simple, lead to only modest loss in overall discrimination compared to BRCAPRO in this dataset. Thus, we conclude that

  2. Genetic risk prediction and neurobiological understanding of alcoholism.

    PubMed

    Levey, D F; Le-Niculescu, H; Frank, J; Ayalew, M; Jain, N; Kirlin, B; Learman, R; Winiger, E; Rodd, Z; Shekhar, A; Schork, N; Kiefer, F; Kiefe, F; Wodarz, N; Müller-Myhsok, B; Dahmen, N; Nöthen, M; Sherva, R; Farrer, L; Smith, A H; Kranzler, H R; Rietschel, M; Gelernter, J; Niculescu, A B

    2014-01-01

    We have used a translational Convergent Functional Genomics (CFG) approach to discover genes involved in alcoholism, by gene-level integration of genome-wide association study (GWAS) data from a German alcohol dependence cohort with other genetic and gene expression data, from human and animal model studies, similar to our previous work in bipolar disorder and schizophrenia. A panel of all the nominally significant P-value SNPs in the top candidate genes discovered by CFG  (n=135 genes, 713 SNPs) was used to generate a genetic  risk prediction score (GRPS), which showed a trend towards significance (P=0.053) in separating  alcohol dependent individuals from controls in an independent German test cohort. We then validated and prioritized our top findings from this discovery work, and subsequently tested them in three independent cohorts, from two continents. A panel of all the nominally significant P-value single-nucleotide length polymorphisms (SNPs) in the top candidate genes discovered by CFG (n=135 genes, 713 SNPs) were used to generate a Genetic Risk Prediction Score (GRPS), which showed a trend towards significance (P=0.053) in separating alcohol-dependent individuals from controls in an independent German test cohort. In order to validate and prioritize the key genes that drive behavior without some of the pleiotropic environmental confounds present in humans, we used a stress-reactive animal model of alcoholism developed by our group, the D-box binding protein (DBP) knockout mouse, consistent with the surfeit of stress theory of addiction proposed by Koob and colleagues. A much smaller panel (n=11 genes, 66 SNPs) of the top CFG-discovered genes for alcoholism, cross-validated and prioritized by this stress-reactive animal model showed better predictive ability in the independent German test cohort (P=0.041). The top CFG scoring gene for alcoholism from the initial discovery step, synuclein alpha (SNCA) remained the top gene after the stress

  3. Genetic determinants of risk factors for cardiovascular disease in a population from rural Brazil.

    PubMed

    Velásquez-Meléndez, Gustavo; Parra, Flavia C; Gazzinelli, Andrea; Williams-Blangero, Sarah; Correa-Oliveira, Rodrigo

    2007-04-01

    We investigate the heritability of and pleiotropic relationships among triglycerides and cholesterol lipoproteins that have long been considered traditional risk factors for cardiovascular disease. Quantitative lipid and lipoprotein phenotypes were determined for a cross-sectional sample of a community in Jequitinhonha valley in northern Minas Gerais state, Brazil. The sample consisted primarily of subsistence farmers. Two hundred sixty-nine individuals (128 males and 141 females), ages 18-88 years, were sampled. Eighty-eight percent (n = 252) of the individuals belonged to a single pedigree, which was highly informative for genetic analysis. Data on anthropometrics, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), total cholesterol, and triglycerides were available for each study participant. Extended pedigrees were constructed using the pedigree-based data management software PedSys. Univariate and bivariate variance-components analyses, adjusted by sex and age, were performed using the SOLAR software package. Heritability estimates of lipids and lipoproteins ranged from 29% to 45% (p < 0.008). The highest heritability estimated was for HDL-C (h2 = 44.8%, p < 0.0001), and this was the only trait that exhibited a significant household effect (c2 = 25%). Strong positive genetic correlations were found between triglycerides and very low density lipoprotein (VLDL) (rhog = 0.998) and between total cholesterol and LDL-C (rhog = 0.948). Significant genetic correlations were also found between triglycerides and LDL-C, between total cholesterol and VLDL, and between total cholesterol and LDL-C and VLDL, and finally between LDL and VLDL. There was a significant negative environmental correlation between triglycerides and HDL-C (rhoe = -0.406). PMID:18027813

  4. Rural tourism as risk factor for the transmission of schistosomiasis in Minas Gerais, Brazil.

    PubMed

    Enk, Martin J; Caldeira, Roberta L; Carvalho, Omar S; Schall, Virginia T

    2004-01-01

    Recently, the booming rural tourism in endemic areas of the state of Minas Gerais was identified as a contributing factor in the dissemination of the infection with Schistosoma mansoni. This article presents data from six holiday resorts in a rural district approximately 100 km distant from Belo Horizonte, MG, Brazil, where a possibly new and until now unperceived way of transmission was observed. The infection takes place in swimming pools and little ponds, which are offered to tourists and the local population for fishing and leisure activities. The health authorities of the district reported cases of schistosomiasis among the local population after visiting these sites. As individuals of the non-immune middle class parts of the society of big urban centers also frequent these resorts, infection of these persons cannot be excluded. A malacological survey revealed the presence of molluscs of the species Biomphalaria glabrata and Biomphalaria straminea at the resorts. The snails (B. glabrata) of one resort tested positive for S. mansoni. In order to resolve this complex problem a multidisciplinary approach including health education, sanitation measures, assistance to the local health services, and evolvement of the local political authorities, the local community, the tourism association, and the owners of the leisure resorts is necessary. This evidence emphasizes the urgent need for a participative strategic plan to develop the local tourism in an organized and well-administered way. Only so this important source of income for the region can be ensured on the long term without disseminating the disease and putting the health of the visitors at risk. PMID:15486645

  5. Predicting the Risk of Rheumatoid Arthritis and Its Age of Onset through Modelling Genetic Risk Variants with Smoking

    PubMed Central

    Scott, Ian C.; Seegobin, Seth D.; Steer, Sophia; Tan, Rachael; Forabosco, Paola; Hinks, Anne; Eyre, Stephen; Morgan, Ann W.; Wilson, Anthony G.; Hocking, Lynne J.; Wordsworth, Paul; Barton, Anne; Worthington, Jane; Cope, Andrew P.; Lewis, Cathryn M.

    2013-01-01

    The improved characterisation of risk factors for rheumatoid arthritis (RA) suggests they could be combined to identify individuals at increased disease risks in whom preventive strategies may be evaluated. We aimed to develop an RA prediction model capable of generating clinically relevant predictive data and to determine if it better predicted younger onset RA (YORA). Our novel modelling approach combined odds ratios for 15 four-digit/10 two-digit HLA-DRB1 alleles, 31 single nucleotide polymorphisms (SNPs) and ever-smoking status in males to determine risk using computer simulation and confidence interval based risk categorisation. Only males were evaluated in our models incorporating smoking as ever-smoking is a significant risk factor for RA in men but not women. We developed multiple models to evaluate each risk factor's impact on prediction. Each model's ability to discriminate anti-citrullinated protein antibody (ACPA)-positive RA from controls was evaluated in two cohorts: Wellcome Trust Case Control Consortium (WTCCC: 1,516 cases; 1,647 controls); UK RA Genetics Group Consortium (UKRAGG: 2,623 cases; 1,500 controls). HLA and smoking provided strongest prediction with good discrimination evidenced by an HLA-smoking model area under the curve (AUC) value of 0.813 in both WTCCC and UKRAGG. SNPs provided minimal prediction (AUC 0.660 WTCCC/0.617 UKRAGG). Whilst high individual risks were identified, with some cases having estimated lifetime risks of 86%, only a minority overall had substantially increased odds for RA. High risks from the HLA model were associated with YORA (P<0.0001); ever-smoking associated with older onset disease. This latter finding suggests smoking's impact on RA risk manifests later in life. Our modelling demonstrates that combining risk factors provides clinically informative RA prediction; additionally HLA and smoking status can be used to predict the risk of younger and older onset RA, respectively. PMID:24068971

  6. Risk factors associated with sero-positivity to Toxoplasma gondii in captive neotropical felids from Brazil.

    PubMed

    Ramos Silva, Jean Carlos; Marvulo, Maria Fernanda Vianna; Dias, Ricardo Augusto; Ferreira, Fernando; Amaku, Marcos; Adania, Cristina Harumi; Ferreira Neto, José Soares

    2007-03-17

    From September 1995 to February 2001, blood samples were collected from 865 neotropical felids belonging to 8 different species. These animals were housed in 86 institutions located in 78 cities of 20 Brazilian states. Our goal was to identify the risk factors associated with sero-positivity to Toxoplasma gondii in captive neotropical felids from Brazil. All serum samples were tested by the modified agglutination test (MAT), using formalin-fixed whole tachyzoites and mercaptoethanol. For each animal an individual questionnaire was filled with questions about tattoo number, felid species, age, sex, origin, number of animals in the group, introduction of new animals in the group, time in the institution, eating meat previously frozen for a period <7 days in the last 6 months, eating meat of run-over or euthanized animals in the last 6 months, predation of rodents or birds in the last 6 months and presence of domestic cats near the enclosures in the last 6 months. The total sero-prevalence was 55% (95% CI: 52%, 57%). We estimated a prevalence of 46% (95% CI: 40%, 54%) for jaguarundi (Puma yagouaroundi); 58% (95% CI: 53%, 63%) for ocelot (Leopardus pardalis); 50% (95% CI: 45%, 56%) for oncilla (L. tigrinus); 54% (95% CI: 46%, 62%) for margay (L. wiedii); 12% (95% CI: 4%, 31%) for Pampas-cat (L. colocolo); 83% (95% CI: 65%, 93%) for Geoffroy's-cat (L. geoffroyi); 64% (95% CI: 50%, 68%) for jaguar (Panthera onca) and 48% (95% CI: 42%, 54%) for puma (Puma concolor). Multiple logistic regression was used to evaluate the association between the variables in the questionnaire and sero-positivity to T. gondii. We concluded that the independent risk factors for toxoplasmosis were: age >3 years (OR=4.75 [2.75; 8.2]), eating meat previously frozen for a period <7 days (OR=2.23 [1.24; 4.01]), and consumption of animals that were run-over or euthanized (OR=1.64; [1.14; 2.37]). PMID:17140683

  7. Prevalence and risk factors associated with Leptospira spp. infection in technified swine farms in the state of Alagoas, Brazil: risk factors associated with Leptospira spp. in swine farms.

    PubMed

    Valença, R M B; Mota, R A; Castro, V; Anderlini, G A; Pinheiro Júnior, J W; Brandespim, D F; Valença, S R F A; Guerra, M M P

    2013-02-01

    The aim of this study was to determine the prevalence and to identify the risk factors associated with Leptospira spp. infection in technified pig farms in the state of Alagoas, Brazil. To compose sample for the prevalence study, 342 pigs were used (312 sows and 30 boars) proceeding from seven swine farms distributed in five districts of the state of Alagoas, Brazil. The infection's serological diagnosis was performed by microscopic agglutination test. The risk factors analysis was performed using research questionnaires consisting of objective questions related to the breeder, the general characteristics of the property, and the productive, reproductive and sanitary management. Prevalence of 16.1% (55/342) of pigs seropositive was obtained. The associated risk factors were not performing quarantine (P = 0.003, OR = 5.43, CI = 1.79-16.41) and the use of artificial insemination (P = 0.023, OR = 3.38, CI = 1.18-9.66). A significant association of sow infection with the increased number of stillborn and mummified foetuses was found, as well as with the increased frequency of oestrus recurrence and the increased weaning-to-oestrus interval of seropositive sows. One might state that Leptospira spp. infection is disseminated in technified pig farms in the State of Alagoas, favouring reproductive failures and the impairment of zootechnical performance in these properties. The risk factors identified in this study are facilitators in the infecting agent dissemination and should be adjusted to control the disease in the herds studied. PMID:22469011

  8. Presence of high-risk clones of OXA-23-producing Acinetobacter baumannii (ST79) and SPM-1-producing Pseudomonas aeruginosa (ST277) in environmental water samples in Brazil.

    PubMed

    Turano, Helena; Gomes, Fernando; Medeiros, Micheli; Oliveira, Silvane; Fontes, Lívia C; Sato, Maria I Z; Lincopan, Nilton

    2016-09-01

    This study reports the presence of hospital-associated high-risk lineages of OXA-23-producing ST79 Acinetobacter baumannii and SPM-1-producing ST277 Pseudomonas aeruginosa in urban rivers in Brazil. These findings indicate that urban rivers can act as reservoirs of clinically important multidrug-resistant bacteria, which constitute a potential risk to human and animal health. PMID:27342783

  9. Variability, Predictability, and Risk in the Alaskan Arctic Waters

    NASA Astrophysics Data System (ADS)

    Arbetter, T. E.; Goldstein, M. A.; Lynch, A. H.

    2015-12-01

    Summer sea ice extent in the Arctic has been in decline since 1996, but after successive record September minimums in 2005, 2007, and 2012, the possibility of developing the high Arctic has rapidly changed from something decades away to an imminent opportunity. The Obama administration permitted Royal Dutch Shell to conduct exploratory oil drilling in the Chukchi Sea in summer 2015. If successful, further development will follow. The Bering Strait, as the exit of the Northern Sea Route, has already seen increased ship traffic, and this will likely continue if the sea ice remains reliably low. While not the only factor, predictability of sea ice extent, particularly on seasonal scales (3-12 months), is essential; a wrong decision will be costly if not catastrophic (e.g, Kulluk 2012). Using a reduced form model, we investigate geophysical processes which govern the advance and retreat of the sea ice edge at key points (e.g., Nome, Kotzebue, Barrow, Prudhoe Bay). Using the Black-Scholes Option Pricing formula, we estimate costs and risks associated with the ice edge variability.

  10. AN APPROACH TO PREDICT RISKS TO WILDLIFE POPULATIONS FROM MERCURY AND OTHER STRESSORS

    EPA Science Inventory

    The U.S. Environmental Protection Agency's National Health and Environmental Effects Research Laboratory (NHEERL) is developing tools for predicting risks of multiple stressors to wildlife populations, which support the development of risk-based protective criteria. NHEERL's res...

  11. Decision-making competence predicts domain-specific risk attitudes.

    PubMed

    Weller, Joshua A; Ceschi, Andrea; Randolph, Caleb

    2015-01-01

    Decision-making competence (DMC) reflects individual differences in rational responding across several classic behavioral decision-making tasks. Although it has been associated with real-world risk behavior, less is known about the degree to which DMC contributes to specific components of risk attitudes. Utilizing a psychological risk-return framework, we examined the associations between risk attitudes and DMC. Italian community residents (n = 804) completed an online DMC measure, using a subset of the original Adult-DMC battery. Participants also completed a self-reported risk attitude measure for three components of risk attitudes (risk-taking, risk perceptions, and expected benefits) across six risk domains. Overall, greater performance on the DMC component scales were inversely, albeit modestly, associated with risk-taking tendencies. Structural equation modeling results revealed that DMC was associated with lower perceived expected benefits for all domains. In contrast, its association with perceived risks was more domain-specific. These analyses also revealed stronger indirect effects for the DMC → expected benefits → risk-taking path than the DMC → perceived riskrisk-taking path, especially for behaviors that may be considered more maladaptive in nature. These results suggest that DMC performance differentially impacts specific components of risk attitudes, and may be more strongly related to the evaluation of expected value of a specific behavior. PMID:26029128

  12. Decision-making competence predicts domain-specific risk attitudes

    PubMed Central

    Weller, Joshua A.; Ceschi, Andrea; Randolph, Caleb

    2015-01-01

    Decision-making competence (DMC) reflects individual differences in rational responding across several classic behavioral decision-making tasks. Although it has been associated with real-world risk behavior, less is known about the degree to which DMC contributes to specific components of risk attitudes. Utilizing a psychological risk-return framework, we examined the associations between risk attitudes and DMC. Italian community residents (n = 804) completed an online DMC measure, using a subset of the original Adult-DMC battery. Participants also completed a self-reported risk attitude measure for three components of risk attitudes (risk-taking, risk perceptions, and expected benefits) across six risk domains. Overall, greater performance on the DMC component scales were inversely, albeit modestly, associated with risk-taking tendencies. Structural equation modeling results revealed that DMC was associated with lower perceived expected benefits for all domains. In contrast, its association with perceived risks was more domain-specific. These analyses also revealed stronger indirect effects for the DMC → expected benefits → risk-taking path than the DMC → perceived riskrisk-taking path, especially for behaviors that may be considered more maladaptive in nature. These results suggest that DMC performance differentially impacts specific components of risk attitudes, and may be more strongly related to the evaluation of expected value of a specific behavior. PMID:26029128

  13. Does albuminuria predict renal risk and/or cardiovascular risk in obese type 2 diabetic patients?

    PubMed

    Bentata, Yassamine; Abouqal, Redouane

    2014-01-01

    Increased urinary albumin excretion (UAE) is a marker of renal and cardiovascular risk in patients with type 2 diabetes (DT2). What about the obese patient with DT2? Does albuminuria predict the progression of renal disease and/or cardiovascular disease? The objective of this study is to determine the link between albuminuria, renal risk and cardiovascular risk in a cohort of obese DT2 patients. This is a prospective study begun in September 2006. It included DT2 patients presenting obesity defined by a body mass index (BMI)>30 Kg/m(2). Three groups of patients were defined: normo-albuminuria (Urinary Albumin Excretion UAE<30 mg/day or Albumin Creatinine Ratio ACR<30 mg/g), micro-albuminuria (UAE=30-300 mg/day or ACR=30-300 mg/g) and macro-albuminuria (UAE>300 mg/day or ACR>300 mg/g). Data on 144 obese DT2 patients were compiled: The mean age of our patients was 59 ± 9 years and the sex ratio 0.26. The incidence of ESRD was higher in the macro-albuminuria group than in the two other groups (26.5% vs. 1.2%, p<0.001). The incidence of cardiovascular events was 15.4%, 14.3% and 23.5% in the normo, micro and macro-albuminuria groups (p=0.48). A history of cardiovascular comorbidities was the main cardiovascular risk in multivariate analysis (0R=15.07; 95% CI=5.30-42.82; p<0.001) and the low admission GFR (0R=5.67; 95% CI=1.23-9.77; p=0.008) was the main factor for progression of kidney disease in multivariate analysis. Albuminuria may be a better marker of kidney disease progression than of cardiovascular risk in the obese DT2 patient, according to our results. However, to accurately demonstrate the link albuminuria - renal risk and albuminuria - cardiovascular risk in the obese DT2 patient, additional studies using very strict criteria of selection and judgment are needed. PMID:24551483

  14. Risk factors associated with selected indicators of milk quality in semiarid northeastern Brazil.

    PubMed

    Oliveira, C J B; Lopes Júnior, W D; Queiroga, R C R E; Givisiez, P E N; Azevedo, P S; Pereira, W E; Gebreyes, W A

    2011-06-01

    The aim of this study was to gain information on quality traits, mainly bacterial and somatic cell counts of bulk milk, produced by small- and medium-scale producers in a semiarid northeastern region of Brazil and to identify and characterize possible risk factors associated with those quality traits. A cross-sectional study was performed on 50 farms. Bulk milk samples were collected for bacterial and somatic cell counts. Additionally, information about farm demographics, general management practices, hygiene, and milking procedures was also obtained. Multivariable analysis using logistic regression was performed with predictors previously identified by univariate analysis using a Fisher's Exact test. Aerobic mesophilic bacteria counts varied from 3.59 log to 6.95 log cfu/mL, with geometric mean of 5.27 log cfu/mL. Mean total coliform count was 3.27 log (1.52 log to 5.89 log) most probable number (MPN)/mL, whereas mean thermotolerant coliforms was 2.38 log (1.48 log to 4.75 log) MPN/mL. A high positive correlation was observed between aerobic mesophilic bacteria and coliform counts. Although most farms met the standard for the current regulations for total bacteria (88%) and somatic cell counts (94%), nearly half of the producers (46%) would have problems in achieving the 2012 threshold limit for total bacteria count if no improvement in milk quality occurs. Mean value for staphylococci was 3.99 log (2.31 log to 6.24 log) cfu/mL, and Staphylococcus aureus was detected in 33 (66%) farms. Premilking teat-end wash procedure (odds ratio=0.191) and postmilking teat dip (odds ratio=0.67) were associated with lower aerobic mesophilic bacteria and Staphylococcus aureus counts in bulk milk, respectively. Considering that the farm characteristics in this study are representative of the semiarid northeastern region, these findings encourage further investigations for supporting intervention measures intended to improve the quality of milk produced by smallholders. PMID

  15. Distribution of Short-Term and Lifetime Predicted Risks of Cardiovascular Diseases in Peruvian Adults

    PubMed Central

    Quispe, Renato; Bazo-Alvarez, Juan Carlos; Burroughs Peña, Melissa S; Poterico, Julio A; Gilman, Robert H; Checkley, William; Bernabé-Ortiz, Antonio; Huffman, Mark D; Miranda, J Jaime

    2015-01-01

    Background Short-term risk assessment tools for prediction of cardiovascular disease events are widely recommended in clinical practice and are used largely for single time-point estimations; however, persons with low predicted short-term risk may have higher risks across longer time horizons. Methods and Results We estimated short-term and lifetime cardiovascular disease risk in a pooled population from 2 studies of Peruvian populations. Short-term risk was estimated using the atherosclerotic cardiovascular disease Pooled Cohort Risk Equations. Lifetime risk was evaluated using the algorithm derived from the Framingham Heart Study cohort. Using previously published thresholds, participants were classified into 3 categories: low short-term and low lifetime risk, low short-term and high lifetime risk, and high short-term predicted risk. We also compared the distribution of these risk profiles across educational level, wealth index, and place of residence. We included 2844 participants (50% men, mean age 55.9 years [SD 10.2 years]) in the analysis. Approximately 1 of every 3 participants (34% [95% CI 33 to 36]) had a high short-term estimated cardiovascular disease risk. Among those with a low short-term predicted risk, more than half (54% [95% CI 52 to 56]) had a high lifetime predicted risk. Short-term and lifetime predicted risks were higher for participants with lower versus higher wealth indexes and educational levels and for those living in urban versus rural areas (P<0.01). These results were consistent by sex. Conclusions These findings highlight potential shortcomings of using short-term risk tools for primary prevention strategies because a substantial proportion of Peruvian adults were classified as low short-term risk but high lifetime risk. Vulnerable adults, such as those from low socioeconomic status and those living in urban areas, may need greater attention regarding cardiovascular preventive strategies. PMID:26254303

  16. Prediction of Risk Factors of Frequent Relapse Idiopathic Nephrotic Syndrome.

    PubMed

    Jahan, I; Hanif, M; Ali, M A; Hoque, M M

    2015-10-01

    This case control study was aimed to identify the predictive risk factors for frequent relapse idiopathic nephrotic syndrome (INS) and conducted in Sir Salimullah Medical College & Mitford Hospital, Dhaka and at Renal and Dialysis Unit of Dhaka Shishu Hospital and Bangladesh Institute of Child Health (BICH), Dhaka, from January 2006 to December 2006. We examined retrospectively the clinical course of fifty cases of frequent relapse nephrotic syndrome (FRNS) as cases and fifty cases of infrequent relapse nephrotic syndrome (IRNS) as control who met the predefined enrollment criteria, followed for at least one year after initial onset of disease. After enrollment following parameters were studied as predictors of frequent relapse: i) Socio-demographic variables: age, sex, socio-economic condition, number of living room ii) Disease related variables i.e. age of onset, duration of illness, frequency of relapse within the 1st year, regimen of initial steroid therapy, total cumulative dose of steroid for remission, day of remission after starting steroid, association with atopy and infection, concomitant upper respiratory illness iii) Biochemical and pathological variables (at the time of initial attack) i.e. Serum albumin, serum cholesterol, blood urea, 24 hours urinary protein, serum creatinine, complete blood count, urine RBC, urine pus cell, urine culture. The test statistics used to analyses the data were descriptive statistics, Chi-square probability test, Student's t-test and Binary logistic regression analysis for Odds ratio. Both univariate and multivariate logistic regression analysis revealed that age of onset (P<0.001, OR=0.9, 95% CI=0.85-0.95), poor socioeconomic status (P<0.034, OR=0.5.8, 95% CI=1.14-29.5) and low serum albumin level at the time of initial presentation (P<0.022, OR=0.8, 95% CI=0.65-0.97) were independent predictors of frequent relapse nephrotic syndrome. In conclusion, we demonstrated that age at onset, poor socioeconomic condition and low

  17. Causes of death and associated risk factors among climacteric women from Southern Brazil: a population based-study

    PubMed Central

    2014-01-01

    Background Aging and menopause are particular cardiovascular risk factors for women, due to estrogen deprivation at the time of menopause. Studies show that diabetes mellitus (DM), smoking, hypertension, high body mass index (BMI), and serum lipids are associated with increased risk of cardiovascular disease (CVD), the main cause of female mortality in Brazil. The aim of this study was to assess the mortality rate, causes of death and associated risk factors in a cohort of women from Brazil. Methods A longitudinal population-based study of menopausal status is currently underway in a city in South Brazil. In 2010, a third follow-up of this population was performed to assess cardiovascular risk and mortality rate between 1995 and 2011. For this analysis, 358 participants were studied. At baseline, participants had completed a standardized questionnaire including demographic, lifestyle, medical and reproductive characteristics. In addition to the contacts with relatives, mortality data were obtained through review of medical records in all city hospitals and the Center for Health Information (NIS/RS-SES). Multivariate-adjusted hazard risk (HR) and 95% confidence intervals (CI95%) were estimated using Cox proportional hazards regression. Survival curves were estimated using the Kaplan-Meier curve. Results There were 17 (4.7%) deaths from all causes during the study period. Seven (41.2%) deaths were caused by CVD, including four cases of stroke and three cases of myocardial infarction. Six (35.3%) deaths were due to cancer, and four (23.5%) were due to other reasons. In the age and smoking-adjusted multivariate models, diabetes (HR 6.645, 95% CI: 1.938–22.79, p = 0.003), alcohol intake (HR 1.228, 95% CI: 1.014-1.487, p = 0.035) and postmenopausal status (HR = 6.216, 95% CI: 0.963–40.143, p = 0.055) were associated with all-cause mortality. A significant association was found between abdominal obesity (WHR ≥ 0.85) and mortality even after the adjustment for BMI

  18. Design and prospective evaluation of a risk-based surveillance system for shrimp grow-out farms in northeast Brazil.

    PubMed

    Marques, Ana Rita; Pereira, Marcelo; Ferreira Neto, Jose Soares; Ferreira, Fernando

    2015-12-01

    The farming of Pacific white shrimp Litopennaeus vannamei in northeast Brazil, has proven to be a promising sector. However, the farming of Pacific white shrimp in Brazil has been affected negatively by the occurrence of viral diseases, threatening this sector's expansion and sustainability. For this reason, the drafting of a surveillance system for early detection and definition of freedom from viral diseases, whose occurrence could result in high economic loses, is of the utmost importance. The stochastic model AquaVigil was implemented to prospectively evaluate different surveillance strategies to determine freedom from disease and identify the strategy with the lowest sampling efforts, making the best use of available resources through risk-based surveillance. The worked example presented was designed for regional application for the state of Ceará and can easily be applied to other Brazilian states. The AquaVigil model can analyse any risk-based surveillance system that considers a similar outline to the strategy here presented. PMID:26596650

  19. Comparison of Epidemiological Methods for Estimation of Hepatitis B Incidence and Residual Risk for Blood Donors in Southern Brazil

    PubMed Central

    Kupek, Emil; Petry, Andrea

    2011-01-01

    Background and Objective. The objective of this work was to compare three methods for estimating hepatitis B virus (HBV) incidence and residual risk. Methods. Computerized blood donor records in southern Brazil were examined for the period 2004–2006. The methods for estimating HBV incidence included stand-alone HBsAg, HBsAg yield method, and an extension of the latter which added recent anti-HBc seroconversions as incident HBV cases. Results. HBV incidences for the above methods were 9.91, 20.09, and 22.93 per 100000 repeat donors, respectively. In the same order, corresponding residual risks were 1 : 62482, 1 : 30821, and 1 : 47559, respectively. First-time donors had 52 higher HBV incidence compared to repeat donors. Conclusion. Although the three methods compared produced overlapping 95% confidence intervals, their variation was considerably lower for the method which included recent anti-HBc seroconversions. First-time donors are primary cause for concern regarding HBV transmission via blood transfusion in southern Brazil. PMID:25346858

  20. Perceived Mental Illness Stigma and HIV Risk Behaviors Among Adult Psychiatric Outpatients in Rio de Janeiro, Brazil

    PubMed Central

    Elkington, Katherine S.; McKinnon, Karen; Mann, Claudio Gruber; Collins, Pamela Y.; Leu, Cheng-Shiun; Wainberg, Milton L.

    2009-01-01

    We examined the associations between perceived mental illness stigma and HIV risk and protective behaviors among adults with severe mental illness (SMI) in Rio de Janeiro, Brazil. We measured mental illness stigma across three domains (“Personal Experiences,” “Perceived Attractiveness,” and “Relationship Discrimination”), and examined the relationship between experiences of stigma in each domain and HIV risk and protective behaviors over the past three months in 98 outpatients with SMI. Those who reported greater “Relationship Discrimination” stigma were significantly more likely to be sexually active and to have unprotected sex; they were significantly less likely to report deliberately having fewer partners as a way to protect themselves from HIV. The role of stigma in unprotected sexual behavior should be examined further and considered in any HIV prevention intervention for people with SMI. PMID:19543974

  1. Case-control study evaluating the sow's risk factors associated with stillbirth piglets in Midwestern in Brazil.

    PubMed

    Silva, Gustavo Sousa; da Costa Lana, Marconni Victor; Dias, Geovanny Bruno Gonçalves; da Cruz, Raquel Aparecida Sales; Lopes, Leticya Lerner; Machado, Gustavo; Corbellini, Luis Gustavo; Gava, Danielle; Souza, Marcos Almeida; Pescador, Caroline Argenta

    2015-02-01

    Reproductive failure in swine herds is often difficult to diagnose and is important to swine production. The present study aims to identify the potential risk factors (infectious/noninfectious) for stillborn piglets in two commercial swine farms situated in midwestern region of Brazil. The potential risk factors were included in a multivariable logistic model, and the dependent variable was defined as the presence of at least one stillborn piglet in a given litter (yes or no). In the best fit model, two variables from the multivariable analysis, total litter size (p = 0.01), and average birth weight (p = 0.03) were significantly associated with the presence of stillborn piglets at the farms examined in this study. Porcine circovirus type 2 (PCV2) was detected in 29.1 % of the litters. Neither parvovirus (PPV) nor leptospirosis infections were identified in this study, suggesting that they have a minor impact on reproductive disease. PMID:25516004

  2. The Efficacy of Violence Prediction: A Meta-Analytic Comparison of Nine Risk Assessment Tools

    ERIC Educational Resources Information Center

    Yang, Min; Wong, Stephen C. P.; Coid, Jeremy

    2010-01-01

    Actuarial risk assessment tools are used extensively to predict future violence, but previous studies comparing their predictive accuracies have produced inconsistent findings as a result of various methodological issues. We conducted meta-analyses of the effect sizes of 9 commonly used risk assessment tools and their subscales to compare their…

  3. The potential of large studies for building genetic risk prediction models

    Cancer.gov

    NCI scientists have developed a new paradigm to assess hereditary risk prediction in common diseases, such as prostate cancer. This genetic risk prediction concept is based on polygenic analysis—the study of a group of common DNA sequences, known as singl

  4. Developing Risk Prediction Models for Postoperative Pancreatic Fistula: a Systematic Review of Methodology and Reporting Quality.

    PubMed

    Wen, Zhang; Guo, Ya; Xu, Banghao; Xiao, Kaiyin; Peng, Tao; Peng, Minhao

    2016-04-01

    Postoperative pancreatic fistula is still a major complication after pancreatic surgery, despite improvements of surgical technique and perioperative management. We sought to systematically review and critically access the conduct and reporting of methods used to develop risk prediction models for predicting postoperative pancreatic fistula. We conducted a systematic search of PubMed and EMBASE databases to identify articles published before January 1, 2015, which described the development of models to predict the risk of postoperative pancreatic fistula. We extracted information of developing a prediction model including study design, sample size and number of events, definition of postoperative pancreatic fistula, risk predictor selection, missing data, model-building strategies, and model performance. Seven studies of developing seven risk prediction models were included. In three studies (42 %), the number of events per variable was less than 10. The number of candidate risk predictors ranged from 9 to 32. Five studies (71 %) reported using univariate screening, which was not recommended in building a multivariate model, to reduce the number of risk predictors. Six risk prediction models (86 %) were developed by categorizing all continuous risk predictors. The treatment and handling of missing data were not mentioned in all studies. We found use of inappropriate methods that could endanger the development of model, including univariate pre-screening of variables, categorization of continuous risk predictors, and model validation. The use of inappropriate methods affects the reliability and the accuracy of the probability estimates of predicting postoperative pancreatic fistula. PMID:27303124

  5. Predicting extinction risk of Brazilian Atlantic forest angiosperms.

    PubMed

    Leão, Tarciso C C; Fonseca, Carlos R; Peres, Carlos A; Tabarelli, Marcelo

    2014-10-01

    Understanding how plant life history affects species vulnerability to anthropogenic disturbances and environmental change is a major ecological challenge. We examined how vegetation type, growth form, and geographic range size relate to extinction risk throughout the Brazilian Atlantic Forest domain. We used a database containing species-level information of 6,929 angiosperms within 112 families and a molecular-based working phylogeny. We used decision trees, standard regression, and phylogenetic regression to explore the relationships between species attributes and extinction risk. We found a significant phylogenetic signal in extinction risk. Vegetation type, growth form, and geographic range size were related to species extinction risk, but the effect of growth form was not evident after phylogeny was controlled for. Species restricted to either rocky outcrops or scrub vegetation on sandy coastal plains exhibited the highest extinction risk among vegetation types, a finding that supports the hypothesis that species adapted to resource-limited environments are more vulnerable to extinction. Among growth forms, epiphytes were associated with the highest extinction risk in non-phylogenetic regression models, followed by trees, whereas shrubs and climbers were associated with lower extinction risk. However, the higher extinction risk of epiphytes was not significant after correcting for phylogenetic relatedness. Our findings provide new indicators of extinction risk and insights into the mechanisms governing plant vulnerability to extinction in a highly diverse flora where human disturbances are both frequent and widespread. PMID:24665927

  6. Climatic Variables Do Not Directly Predict Spider Richness and Abundance in Semiarid Caatinga Vegetation, Brazil.

    PubMed

    Carvalho, Leonardo S; Sebastian, Nicholas; Araújo, Helder F P; Dias, Sidclay C; Venticinque, Eduardo; Brescovit, Antonio D; Vasconcellos, Alexandre

    2015-02-01

    Spiders are abundant in tropical ecosystems and exert predatory pressure on a wide variety of invertebrate populations and also serve as prey for many others organisms, being part of complex interrelationships influenced directly and indirectly by a myriad of factors. We examined the influence of biotic (i.e., prey availability) and abiotic (i.e., temperature, precipitation, relative humidity, real evapotranspiration) factors on species richness and abundance during a two-year period in the semiarid Caatinga vegetation in northeastern Brazil. Data were analyzed through partial autocorrelation functions, cross correlations, and a path analysis. A total of 2522 spiders were collected with beating tray, pit-fall traps, and malaise traps, comprising 91 species and 34 families. Spider abundance peaked in the rainy season. Our results suggest that total invertebrate abundance has a direct influence on spider richness and abundance, whereas the effects of precipitation were mainly indirectly related to most spider assemblage parameters. The increase in vegetation cover with the rainy season in the Caatinga provides more breeding and foraging sites for spiders and stimulates their activities. Additionally, rainfall in arid and semiarid ecosystems stimulated the activity and reproduction of many herbivore and detritivore invertebrates dependent on plant biomass and necromass consumption, leading to an increase in spider prey availability. PMID:26308806

  7. Predicting urban outdoor thermal comfort by the Universal Thermal Climate Index UTCI—a case study in Southern Brazil

    NASA Astrophysics Data System (ADS)

    Bröde, Peter; Krüger, Eduardo L.; Rossi, Francine A.; Fiala, Dusan

    2012-05-01

    Recognising that modifications to the physical attributes of urban space are able to promote improved thermal outdoor conditions and thus positively influence the use of open spaces, a survey to define optimal thermal comfort ranges for passers-by in pedestrian streets was conducted in Curitiba, Brazil. We applied general additive models to study the impact of temperature, humidity, and wind, as well as long-wave and short-wave radiant heat fluxes as summarised by the recently developed Universal Thermal Climate Index (UTCI) on the choice of clothing insulation by fitting LOESS smoothers to observations from 944 males and 710 females aged from 13 to 91 years. We further analysed votes of thermal sensation compared to predictions of UTCI. The results showed that females chose less insulating clothing in warm conditions compared to males and that observed values of clothing insulation depended on temperature, but also on season and potentially on solar radiation. The overall pattern of clothing choice was well reflected by UTCI, which also provided for good predictions of thermal sensation votes depending on the meteorological conditions. Analysing subgroups indicated that the goodness-of-fit of the UTCI was independent of gender and age, and with only limited influence of season and body composition as assessed by body mass index. This suggests that UTCI can serve as a suitable planning tool for urban thermal comfort in sub-tropical regions.

  8. Predicting urban outdoor thermal comfort by the Universal Thermal Climate Index UTCI--a case study in Southern Brazil.

    PubMed

    Bröde, Peter; Krüger, Eduardo L; Rossi, Francine A; Fiala, Dusan

    2012-05-01

    Recognising that modifications to the physical attributes of urban space are able to promote improved thermal outdoor conditions and thus positively influence the use of open spaces, a survey to define optimal thermal comfort ranges for passers-by in pedestrian streets was conducted in Curitiba, Brazil. We applied general additive models to study the impact of temperature, humidity, and wind, as well as long-wave and short-wave radiant heat fluxes as summarised by the recently developed Universal Thermal Climate Index (UTCI) on the choice of clothing insulation by fitting LOESS smoothers to observations from 944 males and 710 females aged from 13 to 91 years. We further analysed votes of thermal sensation compared to predictions of UTCI. The results showed that females chose less insulating clothing in warm conditions compared to males and that observed values of clothing insulation depended on temperature, but also on season and potentially on solar radiation. The overall pattern of clothing choice was well reflected by UTCI, which also provided for good predictions of thermal sensation votes depending on the meteorological conditions. Analysing subgroups indicated that the goodness-of-fit of the UTCI was independent of gender and age, and with only limited influence of season and body composition as assessed by body mass index. This suggests that UTCI can serve as a suitable planning tool for urban thermal comfort in sub-tropical regions. PMID:21604151

  9. [FIBRA-RJ Network: frailty and risk of hospitalization in the elderly in Rio de Janeiro, Brazil].

    PubMed

    Perez, Mariangela; Lourenço, Roberto Alves

    2013-07-01

    The objective of this study was to determine the risk profile and factors associated with frailty in elderly community residents. The population consisted of individuals 65 years or older living in the northern districts of the city of Rio de Janeiro, Brazil, and who held private health insurance policies. The cross-sectional study was done at baseline in a cohort with a sample (N = 764) stratified by gender and age. Risk stratification used probability of repeated admissions (PRA) as the screening instrument. Following bivariate analyses, logistic regression analyses were performed to study associations between probability of repeated admissions and socio-demographic, health-status, functional, and cognitive variables. Of the total sample, 6.7% were classified as high risk. Cancer, falls, chronic obstructive pulmonary disease, use of medication, receiving a visit from a health professional, being bedridden at home, living alone, and level of activities of daily living were statistically associated with risk of hospitalization. The instrument appeared to be useful for stratifying risk in the elderly. PMID:23843005

  10. Which Risk Factors Predict the Basic Reading Skills of Children at Risk for Emotional and Behavioral Disorders?

    ERIC Educational Resources Information Center

    Nelson, J. Ron; Stage, Scott; Trout, Alex; Duppong-Hurley, Kristin; Epstein, Michael H.

    2008-01-01

    Multinomial stepwise logistic regression analyses were used to establish the most robust set of risk factors that would best predict low basic reading skills (i.e., a standard score less than 85 on the Woodcock Reading Mastery Test-Revised Basic Reading Skills cluster) of kindergarten and first-grade children at risk for emotional and behavioral…

  11. Predictive Risk Factors in the Treatment of Gestational Diabetes Mellitus

    PubMed Central

    Aktun, Lebriz Hale; Yorgunlar, Betul; Karaca, Nilay; Akpak, Yaşam Kemal

    2015-01-01

    OBJECTIVE This study aims to investigate predictive risk factors in the treatment of gestational diabetes mellitus (GDM). PATIENTS AND METHODS A total of 256 pregnant women who underwent 75 g oral glucose tolerance test (OGTT) during 24–28 weeks of pregnancy were included according to the World Health Organization criteria. Demographic characteristics of the patients, including age, parity, family history of diabetes, body weight before pregnancy, and body weight at the diagnosis of GDM, were recorded. Fasting insulin and hemoglobin A1c (HbA1c) values at the time of diagnosis were evaluated. The patients were divided into two groups: those requiring insulin treatment (insulin group, n = 89) and those receiving diet therapy (diet group, n = 167) during pregnancy according to the American Diabetes Association recommendations. RESULTS A total of 34.76% of the pregnant women with GDM required insulin treatment. The mean age of these patients was significantly higher compared to the diet group (34.9 ± 0.6 years vs. 31.9 ± 0.6 years; P = 0.004). Body mass index before pregnancy was also significantly higher in the insulin group than that in the diet group (32 ± 0.9 kg/m2 vs. 29 ± 0.7 kg/m2; P = 0.004). Fasting blood glucose (FBG) during OGTT was 105.6 ± 2.1 mg/dL and 96.7 ± 1.1 mg/dL in the insulin group and diet group, respectively (P < 0.001). There was no significant difference in fasting plasma glucose during OGTT between the groups (P = 0.069), while plasma glucose at two hours was 161.1 ± 6.8 mg/dL in the insulin group and 145.1 ± 3.7 mg/dL in the diet group (P = 0.027). At the time of diagnosis, HbA1c values were significantly higher in the insulin group compared to the diet group (5.3 ± 0.1 vs. 4.9 ± 0.1; P = 0.001). There was no significant difference in FBG and homeostasis model assessment-insulin resistance values between the groups (P = 0.908, P = 0.073). CONCLUSION Our study results suggest that age, family history of diabetes, body weight before

  12. Childhood trauma and suicide risk in a sample of young individuals aged 14-35 years in southern Brazil.

    PubMed

    Barbosa, Luana Porto; Quevedo, Luciana; da Silva, Giovanna Del Grande; Jansen, Karen; Pinheiro, Ricardo Tavares; Branco, Jerônimo; Lara, Diogo; Oses, Jean; da Silva, Ricardo Azevedo

    2014-07-01

    Suicide is among the main causes of death of people aged between 15 and 44 years old. Childhood trauma is an important risk factor for suicide. Hence, the objective of this study was to verify the relationship between childhood trauma and current suicide risk (suicidal behavior and ideation) in individuals aged 14-35 years, in the city of Pelotas, Brazil. This is a cross-sectional, population-based study. Sample selection was performed by clusters. Suicide risk was evaluated using the Mini International Neuropsychiatric Interview (MINI) and Childhood trauma was assessed with the Childhood Trauma Questionnaire (CTQ). Moreover, the participants responded to a questionnaire concerning socioeconomic status, work, and substance use. The sample was composed of 1,380 individuals. The prevalence of suicide risk was 11.5%. The prevalence figures of childhood trauma were 15.2% (emotional neglect), 13.5% (physical neglect), 7.6% (sexual abuse), 10.1% (physical abuse), and 13.8% (emotional abuse). Suicide risk was associated (p<.001) with gender, work, alcohol abuse, tobacco use, and all types of childhood trauma. The odds of suicide risk were higher in women (OR=1.8), people who were not currently working (OR=2.3), individuals who presented alcohol abuse (OR=2.6), and among tobacco smokers (OR=3.4). Moreover, suicide risk was increased in all types of trauma: emotional neglect (OR=3.7), physical neglect (OR=2.8), sexual abuse (OR=3.4), physical abuse (OR=3.1), and emotional abuse (OR=6.6). Thus, preventing early trauma may reduce suicide risk in young individuals. PMID:24629481

  13. Risk Prediction Models for Other Cancers or Multiple Sites

    Cancer.gov

    Developing statistical models that estimate the probability of developing other multiple cancers over a defined period of time will help clinicians identify individuals at higher risk of specific cancers, allowing for earlier or more frequent screening and counseling of behavioral changes to decrease risk.

  14. Evaluation of the predictability of real-time crash risk models.

    PubMed

    Xu, Chengcheng; Liu, Pan; Wang, Wei

    2016-09-01

    The primary objective of the present study was to investigate the predictability of crash risk models that were developed using high-resolution real-time traffic data. More specifically the present study sought answers to the following questions: (a) how to evaluate the predictability of a real-time crash risk model; and (b) how to improve the predictability of a real-time crash risk model. The predictability is defined as the crash probability given the crash precursor identified by the crash risk model. An equation was derived based on the Bayes' theorem for estimating approximately the predictability of crash risk models. The estimated predictability was then used to quantitatively evaluate the effects of the threshold of crash precursors, the matched and unmatched case-control design, and the control-to-case ratio on the predictability of crash risk models. It was found that: (a) the predictability of a crash risk model can be measured as the product of prior crash probability and the ratio between sensitivity and false alarm rate; (b) there is a trade-off between the predictability and sensitivity of a real-time crash risk model; (c) for a given level of sensitivity, the predictability of the crash risk model that is developed using the unmatched case-controlled sample is always better than that of the model developed using the matched case-controlled sample; and (d) when the control-to-case ratio is beyond 4:1, the increase in control-to-case ratio does not lead to clear improvements in predictability. PMID:27332063

  15. A Comparative Study of Adolescent Risk Assessment Instruments: Predictive and Incremental Validity

    ERIC Educational Resources Information Center

    Welsh, Jennifer L.; Schmidt, Fred; McKinnon, Lauren; Chattha, H. K.; Meyers, Joanna R.

    2008-01-01

    Promising new adolescent risk assessment tools are being incorporated into clinical practice but currently possess limited evidence of predictive validity regarding their individual and/or combined use in risk assessments. The current study compares three structured adolescent risk instruments, Youth Level of Service/Case Management Inventory…

  16. Evaluating the Utility of a Risk Assessment To Predict Recidivism among Male and Female Adolescents.

    ERIC Educational Resources Information Center

    Sharkey, Jill D.; Furlong, Michael J.; Jimerson, Shane R.; O'Brien, Kathryn M.

    2003-01-01

    This longitudinal study examined risk assessment dimensions and practices used by the Orange County (California) Juvenile Probation Office to identify youth most at risk of re-offending. Results indicated that the risk assessment was not equally predictive for females and males. The use of gender specific norms or gender neutral assessments and…

  17. Mapping of risk and susceptibility of shallow-landslide in the city of São Paulo, Brazil

    NASA Astrophysics Data System (ADS)

    Listo, Fabrizio de Luiz Rosito; Carvalho Vieira, Bianca

    2012-10-01

    In the city of São Paulo, where about 11 million people live, landslides and flooding occur frequently, especially during the summer. These landslides cause the destruction of houses and urban equipment, economic damage, and the loss of lives. The number of areas threatened by landslides has been increasing each year. The objective of this article is to analyze the probability of risk and susceptibility to shallow landslides in the Limoeiro River basin, which is located at the head of the Aricanduva River basin, one of the main hydrographic basins in the city of São Paulo. To map areas of risk, we created a cadastral survey form to evaluate landslide risk in the field. Risk was categorized into four levels based on natural and anthropogenic factors: R1 (low risk), R2 (average risk), R3 (high risk), and R4 (very high risk). To analyze susceptibility to shallow landslides, we used the SHALSTAB (Shallow Landsliding Stability) mathematical model and calculated the Distribution Frequency (DF) of the susceptibility classes for the entire basin. Finally, we performed a joint analysis of the average Risk Concentration (RC) and Risk Potential (RP). We mapped 14 risk sectors containing approximately 685 at-risk homes, more than half of which presented a high (R3) or very high (R4) probability of risk to the population. In the susceptibility map, 41% of the area was classified as stable and 20% as unconditionally unstable. Although the latter category accounted a smaller proportion of the total area, it contained a concentration (RC) of 41% of the mapped risk areas with a risk potential (RP) of 12%. We found that the locations of areas predicted to be unstable by the model coincided with the risk areas mapped in the field. This combination of methods can be applied to evaluate the risk of shallow landslides in densely populated areas and can assist public managers in defining areas that are unstable and inappropriate for occupation.

  18. Age and regional differences in clinical presentation and risk of hospitalization for dengue in Brazil, 2000-2014

    PubMed Central

    Burattini, Marcelo N.; Lopez, Luis F.; Coutinho, Francisco A.B.; Siqueira, João B.; Homsani, Sheila; Sarti, Elsa; Massad, Eduardo

    2016-01-01

    OBJECTIVES: Dengue cases range from asymptomatic to severe, eventually leading to hospitalization and death. Timely and appropriate management is critical to reduce morbidity. Since 1980, dengue has spread throughout Brazil, affecting an increasing number of individuals. This paper describes age and regional differences in dengue’s clinical presentation and associated risk of hospitalization based on more than 5 million cases reported to the Brazilian Ministry of Health from 2000-2014. METHODS: We performed a retrospective analysis of ∼5,450,000 dengue cases, relating clinical manifestations and the risk of hospitalization to age, gender, previous infection by dengue, dengue virus serotype, years of formal education, delay to first attendance and the occurrence of dengue during outbreaks and in different Brazilian regions. RESULTS: Complicated forms of dengue occurred more frequently among those younger than 10 years (3.12% vs 1.92%) and those with dengue virus 2 infection (7.65% vs 2.42%), with a delay to first attendance >2 days (3.18% vs 0.82%) and with ≤4 years of formal education (2.02% vs 1.46%). The risk of hospitalization was higher among those aged 6-10 years old (OR 4.57; 95% CI 1.43-29.96) and those who were infected by dengue virus 2 (OR 6.36; 95% CI 2.52-16.06), who lived in the Northeast region (OR 1.38; 95% CI 1.11-2.10) and who delayed first attendance by >5 days (composite OR 3.15; 95% CI 1.33-8.9). CONCLUSIONS: In Brazil, the occurrence of severe dengue and related hospitalization is associated with being younger than 10 years old, being infected by dengue virus 2 or 3, living in the Northeast region (the poorest and the second most populated) and delaying first attendance for more than 2 days.

  19. The development of an automated ward independent delirium risk prediction model.

    PubMed

    de Wit, Hugo A J M; Winkens, Bjorn; Mestres Gonzalvo, Carlota; Hurkens, Kim P G M; Mulder, Wubbo J; Janknegt, Rob; Verhey, Frans R; van der Kuy, Paul-Hugo M; Schols, Jos M G A

    2016-08-01

    Background A delirium is common in hospital settings resulting in increased mortality and costs. Prevention of a delirium is clearly preferred over treatment. A delirium risk prediction model can be helpful to identify patients at risk of a delirium, allowing the start of preventive treatment. Current risk prediction models rely on manual calculation of the individual patient risk. Objective The aim of this study was to develop an automated ward independent delirium riskprediction model. To show that such a model can be constructed exclusively from electronically available risk factors and thereby implemented into a clinical decision support system (CDSS) to optimally support the physician to initiate preventive treatment. Setting A Dutch teaching hospital. Methods A retrospective cohort study in which patients, 60 years or older, were selected when admitted to the hospital, with no delirium diagnosis when presenting, or during the first day of admission. We used logistic regression analysis to develop a delirium predictive model out of the electronically available predictive variables. Main outcome measure A delirium risk prediction model. Results A delirium risk prediction model was developed using predictive variables that were significant in the univariable regression analyses. The area under the receiver operating characteristics curve of the "medication model" model was 0.76 after internal validation. Conclusions CDSSs can be used to automatically predict the risk of a delirium in individual hospitalised patients' by exclusively using electronically available predictive variables. To increase the use and improve the quality of predictive models, clinical risk factors should be documented ready for automated use. PMID:27177868

  20. Intelligence Predicts Scholastic Achievement Irrespective of SES Factors: Evidence from Brazil

    ERIC Educational Resources Information Center

    Colom, Roberto; Flores-Mendoza, Carmen E.

    2007-01-01

    This study explores whether or not intelligence tests' scores predict individual differences in scholastic achievement irrespective of SES factors such parents' income and education. The variables of interest are analyzed considering three independent samples of participants comprising a total of 641 children. The participants belonged to a…

  1. Predicting carbon dynamics in integrated production systems in Brazil using the CQESTR model

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Process-based carbon models are research tools to predict management impact on soil organic carbon (SOC) and options to increase SOC stocks and reduce CO2. The CQESTR model was used to examine the effect of soil management practices, including integrated crop-livestock system (iCLS), and various sc...

  2. A New Method to Predict the Epidemiology of Fungal Keratitis by Monitoring the Sales Distribution of Antifungal Eye Drops in Brazil

    PubMed Central

    Ibrahim, Marlon Moraes; de Angelis, Rafael; Lima, Acacio Souza; Viana de Carvalho, Glauco Dreyer; Ibrahim, Fuad Moraes; Malki, Leonardo Tannus; de Paula Bichuete, Marina; de Paula Martins, Wellington; Rocha, Eduardo Melani

    2012-01-01

    Purpose Fungi are a major cause of keratitis, although few medications are licensed for their treatment. The aim of this study is to observe the variation in commercialisation of antifungal eye drops, and to predict the seasonal distribution of fungal keratitis in Brazil. Methods Data from a retrospective study of antifungal eye drops sales from the only pharmaceutical ophthalmologic laboratory, authorized to dispense them in Brazil (Opthalmos) were gathered. These data were correlated with geographic and seasonal distribution of fungal keratitis in Brazil between July 2002 and June 2008. Results A total of 26,087 antifungal eye drop units were sold, with a mean of 2.3 per patient. There was significant variation in antifungal sales during the year (p<0.01). A linear regression model displayed a significant association between reduced relative humidity and antifungal drug sales (R2 = 0.17,p<0.01). Conclusions Antifungal eye drops sales suggest that there is a seasonal distribution of fungal keratitis. A possible interpretation is that the third quarter of the year (a period when the climate is drier), when agricultural activity is more intense in Brazil, suggests a correlation with a higher incidence of fungal keratitis. A similar model could be applied to other diseases, that are managed with unique, or few, and monitorable medications to predict epidemiological aspects. PMID:22457787

  3. Ryegrass cv. Lema and guava cv. Paluma biomonitoring suitability for estimating nutritional contamination risks under seasonal climate in Southeastern Brazil.

    PubMed

    Bulbovas, Patricia; Camargo, Carla Z S; Domingos, Marisa

    2015-08-01

    The risks posed by nutrient deposition due to air pollution on ecosystems and their respective services to human beings can be appropriately estimated by bioindicator plants when they are well acclimated to the study region environmental conditions. This assumption encouraged us to comparatively evaluate the accumulation potential of ryegrass cv. Lema and guava cv. Paluma macro and micronutrients. We also indicated the most appropriate species for biomonitoring nutrient contamination risks in tropical areas of Southeastern Brazil, which are characterized by marked dry and wet seasons and complex mixtures of air pollutants from different sources (industries, vehicle traffic and agriculture). The study was conducted in 14 sites with different neighboring land uses, within the Metropolitan Region of Campinas, central-eastern region of São Paulo State. The exposure experiments with ryegrass and guava were consecutively repeated 40 (28 days each) and 12 (84 days each) times, respectively, from Oct/2010 to Sept/2013. Macro and micronutrients were analyzed and background concentrations and enrichment ratios (ER) were estimated to classify the contamination risk within the study region. Significantly higher ER suggested that ryegrass were the most appropriate accumulator species for N, S, Mg, Fe, Mn, Cu and Zn deposition and guava for K, Ca, P and B deposition. Based on these biomonitoring adjustments, we concluded that the nutrient deposition was spatially homogeneous in the study area, but clear seasonality in the contamination risk by nutritional inputs was evidenced. Significantly higher contamination risk by S, Fe, K and B occurred during the dry season and enhanced contamination risk by Mn, Cu and Zn were highlighted during the wet season. Distinctly high contamination risk was estimated for S, Fe and Mn in several exposure experiments. PMID:25938695

  4. Risk factors and prevalence of newborn hearing loss in a private health care system of Porto Velho, Northern Brazil

    PubMed Central

    de Oliveira, Juliana Santos; Rodrigues, Liliane Barbosa; Aurélio, Fernanda Soares; da Silva, Virgínia Braz

    2013-01-01

    OBJECTIVE: To determine the prevalence of hearing loss and to analyze the results of newborn hearing screening and audiological diagnosis in private health care systems. METHODS Cross-sectional and retrospective study in a database of newborn hearing screening performed by a private clinic in neonates born in private hospitals of Porto Velho, Rondônia, Northern Brazil. The screening results, the risk for hearing loss, the risk indicators for hearing loss and the diagnosis were descriptively analyzed. Newborns cared in rooming in with their mothers were compared to those admitted to the Intensive Care Unit regarding risk factors for hearing loss. RESULTS: Among 1,146 (100%) enrolled newborns, 1,064 (92.8%) passed and 82 (7.2%) failed the hearing screening. Among all screened neonates, 1,063 (92.8%) were cared in rooming and 83 (7.2%) needed intensive care; 986 (86.0%) were considered at low risk and 160 (14.0%) at high risk for hearing problems. Of the 160 patients identified as having high risk for hearing loss, 83 (37.7%) were admitted to an hospitalized in the Intensive Care Unit, 76 (34.5%) used ototoxic drugs and 38 (17.2%) had a family history of hearing loss in childhood. Hearing loss was diagnosed in two patients (0.2% of the screened sample). CONCLUSIONS: The prevalence of hearing loss in newborns from private hospitals was two cases per 1,000 evaluated patients. The use of ototoxic drugs, admission to Intensive Care Unit and family history of hearing loss were the most common risk factors for hearing loss in the studied population. PMID:24142311

  5. Risk factors for childhood pneumonia among the urban poor in Fortaleza, Brazil: a case--control study.

    PubMed Central

    Fonseca, W.; Kirkwood, B. R.; Victora, C. G.; Fuchs, S. R.; Flores, J. A.; Misago, C.

    1996-01-01

    Reported are the results of a case-control study carried out between July 1989 and June 1990 in Fortaleza city, Ceará State, Brazil, to determine the factors that place young children living in urban slum conditions at increased risk of contracting pneumonia. Cases were 650 under-2-year-olds with a radiological diagnosis of pneumonia who were recruited at the main paediatric hospital in the city over a full calendar year. Age-matched controls were recruited from the neighbourhood where the cases lived. Cases and controls were compared with respect to a variety of sociodemographic, environmental, reproductive, nutritional, and morbidity factors, and a risk factor questionnaire was administered to the mother of each child or to the child's normal guardian. Cases and controls were also weighed and measured. Malnutrition was the most important risk factor for childhood pneumonia in the study population, with weight-for-age, height-for-age, and weight-for-height also being important risk factors. In view of the high prevalence of stunting in the study population, there is an urgent need to reduce the level of malnutrition as a priority. Attendance at a day care centre was also associated with a high odds ratio. In view of the growing numbers of children attending day care centres in both developing and developed countries, it is essential that ways be identified to improve the design and management of such centres in order to minimize the risk of pneumonia. Increased risks of childhood pneumonia were also associated with low birth weight, non-breast-feeding, crowding, high parity, and incomplete vaccination status, but not with socioeconomic status or environmental variables. Finally, children who had suffered from previous episodes of wheezing or been hospitalized for pneumonia had a greater than threefold increased risk of contracting the disease. PMID:8706236

  6. Predictive performance of prostate cancer risk in Chinese men using 33 reported prostate cancer risk-associated SNPs

    PubMed Central

    Zheng, Jie; Liu, Fang; Lin, Xiaoling; Wang, Xiang; Ding, Qiang; Jiang, Haowen; Chen, Hongyan; Lu, Daru; Jin, Guangfu; Hsing, Ann W.; Shao, Qiang; Qi, Jun; Ye, Yu; Wang, Zhong; Gao, Xin; Wang, Guozeng; Chu, Lisa W.; OuYang, Jun; Huang, Yichen; Chen, Yanbo; Gao, Yutang; Shi, Rong; Wu, Qijun; Wang, Meilin; Zhang, Zhengdong; Hu, Yanlin; Sun, Jielin; Zheng, S. Lilly; Gao, Xu; Xu, Chuanliang; Mo, Zengnan; Sun, Yinghao; Xu, Jianfeng

    2011-01-01

    Background Genome-wide association studies (GWAS) have identified more than 30 single nucleotide polymorphisms (SNPs) that were reproducibly associated with prostate cancer (PCa) risk in populations of European descent. In aggregate, these variants have shown potential to predict risk for PCa in European men. However, their utility for PCa risk prediction in Chinese men is unknown. Methods We selected 33 PCa risk-related SNPs that were originally identified in populations of European descent. Genetic scores were estimated for subjects in a Chinese case-control study (1,108 cases and 1,525 controls) based on these SNPs. To assess the performance of the genetic score on its ability to predict risk for PCa, we calculated Area under the curve (AUC) of the receiver operating characteristic (ROC) in combination with 10-fold cross-validation. Results The genetic score was significantly higher for cases than controls (P = 5.91×10-20), and was significantly associated with risk of PCa in a dose-dependent manner (P for trend: 4.78×10-18). The AUC of the genetic score was 0.604 for risk prediction of PCa in Chinese men. When ORs derived from this Chinese study population were used to calculate genetic score, the AUCs were 0.631 for all 33 SNPs and 0.617 when using only the 11 significant SNPs. Conclusion Our results indicate that genetic variants related to PCa risk may be useful for risk prediction in Chinese men. Prospective studies are warranted to further evaluate these findings. PMID:21796652

  7. Gender Differences in Risk Factors for Delayed Diagnosis of HIV/AIDS in a Midsized City of Brazil.

    PubMed

    Ferreira, Rosangela Franco Guedes; Neto, Severino Correia do Prado; Santana, Natalia Colares; Guimarães, Denise Alves; Oliveira, Claudia Di Lorenzo

    2016-01-01

    Patients treated in the specialized service at a midsized city in Brazil participated in a cross-sectional study that aimed to identify the risk factors for delayed diagnosis of HIV/AIDS. Through interviews and review of medical records, information was collected on sociodemographic and clinical characteristics and diagnoses. The study included 403 patients, of whom 216 (53.6%) were male and 311 (77.1%) had ≤8 years of education. According to the criteria adopted in this study, 162 (40.2%) of the participants had a late diagnosis of AIDS. Only 19 (4.7%) were diagnosed by routine examinations and 45 (11.2%) presented with AIDS-defining disease at the time of diagnosis. After adjustments, the results showed that having more education was protective against a late diagnosis for women. With the advance of the AIDS epidemic to small town and rural Brazil, vulnerable populations now include low-income and less educated women, most of whom have had monogamous relationships throughout their lives. PMID:25294852

  8. Predicting pathogen risks to aid beach management: the real value of quantitative microbial risk assessment (QMRA).

    PubMed

    Ashbolt, Nicholas J; Schoen, Mary E; Soller, Jeffrey A; Roser, David J

    2010-09-01

    There has been an ongoing dilemma for agencies that set criteria for safe recreational waters in how to provide for a seasonal assessment of a beach site versus guidance for day-to-day management. Typically an overall 'safe' criterion level is derived from epidemiologic studies of sewage-impacted beaches. The decision criterion is based on a percentile value for a single sample or a moving median of a limited number (e.g. five per month) of routine samples, which are reported at least the day after recreator exposure has occurred. The focus of this paper is how to better undertake day-to-day recreational site monitoring and management. Internationally, good examples exist where predictive empirical regression models (based on rainfall, wind speed/direction, etc.) may provide an estimate of the target faecal indicator density for the day of exposure. However, at recreational swimming sites largely impacted by non-sewage sources of faecal indicators, there is concern that the indicator-illness associations derived from studies at sewage-impacted beaches may be inappropriate. Furthermore, some recent epidemiologic evidence supports the relationship to gastrointestinal (GI) illness with qPCR-derived measures of Bacteroidales/Bacteroides spp. as well as more traditional faecal indicators, but we understand less about the environmental fate of these molecular targets and their relationship to bather risk. Modelling pathogens and indicators within a quantitative microbial risk assessment framework is suggested as a way to explore the large diversity of scenarios for faecal contamination and hydrologic events, such as from waterfowl, agricultural animals, resuspended sediments and from the bathers themselves. Examples are provided that suggest that more site-specific targets derived by QMRA could provide insight, directly translatable to management actions. PMID:20638095

  9. Multivariate prediction of emerging psychosis in adolescents at high risk for schizophrenia

    PubMed Central

    Shah, Jai; Eack, Shaun M; Montrose, Debra M; Tandon, Neeraj; Miewald, Jean M; Prasad, Konsale M; Keshavan, Matcheri S

    2012-01-01

    Background Accurate prediction of psychosis development in high-risk populations is an important but thus far elusive goal. Of the many diverse etiologic and risk factors identified thus far, few have been combined into prospective risk ascertainment models. We tested the predictive power of familial, neurobiological, socioenvironmental, cognitive and clinical risk factors through an integrative biopsychosocial model for emerging psychosis in young relatives at familial risk for schizophrenia. Methods 96 young first- and second- degree relatives of schizophrenia probands were followed for an average of 2.38 (SD = 0.98) years to examine their trajectory towards psychosis. Iterative structural equation modelling utilizing multiple etiologic and risk factors was employed to estimate their joint contribution to prediction of psychosis development. Results The rate of conversion to psychosis over the study period was 12.5%. In the final model, clinical measures of schizotypy were directly predictive of conversion, with early (familial, biological, socioenvironmental) and cognitive risk factors indirectly predictive of psychosis through increased baseline clinical symptomatology. Our model provided an excellent fit to the observed data, with sensitivity of 0.17, specificity of 0.99, positive predictive value of 0.67 and negative predictive value of 0.89. Conclusions Integrative modeling of multivariate data from familial, neurobiological, socioenvironmental, cognitive and clinical domains represents a powerful approach to prediction of psychosis development. The high specificity and low sensitivity found using a combination of such variables suggests that their utility may be in confirmatory testing among already selected high-risk individuals, rather than for initial screening. These findings also highlight the importance of data from a broad array of etiologic and risk factors, even within a familial high-risk population. With further refinement and validation, such

  10. Predicting Risk of Suicide Attempt Using History of Physical Illnesses From Electronic Medical Records

    PubMed Central

    Luo, Wei; Tran, Truyen; Berk, Michael; Venkatesh, Svetha

    2016-01-01

    Background Although physical illnesses, routinely documented in electronic medical records (EMR), have been found to be a contributing factor to suicides, no automated systems use this information to predict suicide risk. Objective The aim of this study is to quantify the impact of physical illnesses on suicide risk, and develop a predictive model that captures this relationship using EMR data. Methods We used history of physical illnesses (except chapter V: Mental and behavioral disorders) from EMR data over different time-periods to build a lookup table that contains the probability of suicide risk for each chapter of the International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10) codes. The lookup table was then used to predict the probability of suicide risk for any new assessment. Based on the different lengths of history of physical illnesses, we developed six different models to predict suicide risk. We tested the performance of developed models to predict 90-day risk using historical data over differing time-periods ranging from 3 to 48 months. A total of 16,858 assessments from 7399 mental health patients with at least one risk assessment was used for the validation of the developed model. The performance was measured using area under the receiver operating characteristic curve (AUC). Results The best predictive results were derived (AUC=0.71) using combined data across all time-periods, which significantly outperformed the clinical baseline derived from routine risk assessment (AUC=0.56). The proposed approach thus shows potential to be incorporated in the broader risk assessment processes used by clinicians. Conclusions This study provides a novel approach to exploit the history of physical illnesses extracted from EMR (ICD-10 codes without chapter V-mental and behavioral disorders) to predict suicide risk, and this model outperforms existing clinical assessments of suicide risk. PMID:27400764

  11. Predicting reading disability: early cognitive risk and protective factors.

    PubMed

    Eklund, Kenneth Mikael; Torppa, Minna; Lyytinen, Heikki

    2013-02-01

    This longitudinal study examined early cognitive risk and protective factors for Grade 2 reading disability (RD). We first examined the reading outcome of 198 children in four developmental cognitive subgroups that were identified in our previous analysis: dysfluent trajectory, declining trajectory, unexpected trajectory and typical trajectory. We found that RD was unevenly distributed among the subgroups, although children with RD were found in all subgroups. A majority of the children with RD had familial risk for dyslexia. Second, we examined in what respect children with similar early cognitive development but different RD outcome differ from each other in cognitive skills, task-focused behaviour and print exposure. The comparison of the groups with high cognitive risk but different RD outcome showed significant differences in phonological skills, in the amount of shared reading and in task-focused behaviour. Children who ended up with RD despite low early cognitive risk had poorer cognitive skills, more task avoidance and they were reading less than children without RD and low cognitive risk. In summary, lack of task avoidance seemed to act as a protective factor, which underlines the importance of keeping children interested in school work and reading. PMID:23297103

  12. Improvement in Cardiovascular Risk Prediction with Electronic Health Records.

    PubMed

    Pike, Mindy M; Decker, Paul A; Larson, Nicholas B; St Sauver, Jennifer L; Takahashi, Paul Y; Roger, Véronique L; Rocca, Walter A; Miller, Virginia M; Olson, Janet E; Pathak, Jyotishman; Bielinski, Suzette J

    2016-06-01

    The aim of this study was to compare the QRISKII, an electronic health data-based risk score, to the Framingham Risk Score (FRS) and atherosclerotic cardiovascular disease (ASCVD) score. Risk estimates were calculated for a cohort of 8783 patients, and the patients were followed up from November 29, 2012, through June 1, 2015, for a cardiovascular disease (CVD) event. During follow-up, 246 men and 247 women had a CVD event. Cohen's kappa statistic for the comparison of the QRISKII and FRS was 0.22 for men and 0.23 for women, with the QRISKII classifying more patients in the higher-risk groups. The QRISKII and ASCVD were more similar with kappa statistics of 0.49 for men and 0.51 for women. The QRISKII shows increased discrimination with area under the curve (AUC) statistics of 0.65 and 0.71, respectively, compared to the FRS (0.59 and 0.66) and ASCVD (0.63 and 0.69). These results demonstrate that incorporating additional data from the electronic health record (EHR) may improve CVD risk stratification. PMID:26960568

  13. icuARM-II: improving the reliability of personalized risk prediction in pediatric intensive care units

    PubMed Central

    Cheng, Chih-Wen; Chanani, Nikhil; Maher, Kevin; Wang

    2016-01-01

    Clinicians in intensive care units (ICUs) rely on standardized scores as risk prediction models to predict a patient’s vulnerability to life-threatening events. Conventional Current scales calculate scores from a fixed set of conditions collected within a specific time window. However, modern monitoring technologies generate complex, temporal, and multimodal patient data that conventional prediction models scales cannot fully utilize. Thus, a more sophisticated model is needed to tailor individual characteristics and incorporate multiple temporal modalities for a personalized risk prediction. Furthermore, most scales models focus on adult patients. To address this needdeficiency, we propose a newly designed ICU risk prediction system, called icuARM-II, using a large-scaled pediatric ICU database from Children’s Healthcare of Atlanta. This novel database contains clinical data collected in 5,739 ICU visits from 4,975 patients. We propose a temporal association rule mining framework giving clinicians a potential to perform predict risks prediction based on all available patient conditions without being restricted by a fixed observation window. We also develop a new metric that can rigidly assesses the reliability of all all generated association rules. In addition, the icuARM-II features an interactive user interface. Using the icuARM-II, our results demonstrated showed a use case of short-term mortality prediction using lab testing results, which demonstrated a potential new solution for reliable ICU risk prediction using personalized clinical data in a previously neglected population.

  14. Long‐Term Post‐CABG Survival: Performance of Clinical Risk Models Versus Actuarial Predictions

    PubMed Central

    Carr, Brendan M.; Romeiser, Jamie; Ruan, Joyce; Gupta, Sandeep; Seifert, Frank C.; Zhu, Wei

    2015-01-01

    Abstract Background/aim Clinical risk models are commonly used to predict short‐term coronary artery bypass grafting (CABG) mortality but are less commonly used to predict long‐term mortality. The added value of long‐term mortality clinical risk models over traditional actuarial models has not been evaluated. To address this, the predictive performance of a long‐term clinical risk model was compared with that of an actuarial model to identify the clinical variable(s) most responsible for any differences observed. Methods Long‐term mortality for 1028 CABG patients was estimated using the Hannan New York State clinical risk model and an actuarial model (based on age, gender, and race/ethnicity). Vital status was assessed using the Social Security Death Index. Observed/expected (O/E) ratios were calculated, and the models' predictive performances were compared using a nested c‐index approach. Linear regression analyses identified the subgroup of risk factors driving the differences observed. Results Mortality rates were 3%, 9%, and 17% at one‐, three‐, and five years, respectively (median follow‐up: five years). The clinical risk model provided more accurate predictions. Greater divergence between model estimates occurred with increasing long‐term mortality risk, with baseline renal dysfunction identified as a particularly important driver of these differences. Conclusions Long‐term mortality clinical risk models provide enhanced predictive power compared to actuarial models. Using the Hannan risk model, a patient's long‐term mortality risk can be accurately assessed and subgroups of higher‐risk patients can be identified for enhanced follow‐up care. More research appears warranted to refine long‐term CABG clinical risk models. doi: 10.1111/jocs.12665 (J Card Surg 2016;31:23–30) PMID:26543019

  15. Predicting Parkinson disease in the community using a nonmotor risk score.

    PubMed

    Darweesh, Sirwan K L; Koudstaal, Peter J; Stricker, Bruno H; Hofman, Albert; Steyerberg, Ewout W; Ikram, M Arfan

    2016-07-01

    At present, there are no validated methods to identify persons who are at increased risk for Parkinson Disease (PD) from the general population. We investigated the clinical usefulness of a recently proposed non-motor risk score for PD (the PREDICT-PD risk score) in the population-based Rotterdam Study. At baseline (1990), we constructed a weighted risk score based on 10 early nonmotor features and risk factors in 6492 persons free of parkinsonism and dementia. We followed these persons for up to 20 years (median 16.1 years) for the onset of PD until 2011. We studied the association between the PREDICT-PD risk score and incident PD using competing risk regression models with adjustment for age and sex. In addition, we assessed whether the PREDICT-PD risk score improved discrimination (C-statistics) and risk classification (net reclassification improvement) of incident PD beyond age and sex. During follow-up, 110 persons were diagnosed with incident PD. The PREDICT-PD risk score was associated with incident PD (hazard ratio [HR] = 1.30; 95 % confidence interval [1.06; 1.59]) and yielded a small, non-significant improvement in overall discrimination (ΔC-statistic = 0.018[-0.005; 0.041]) and risk classification (net reclassification improvement = 0.172[-0.017; 0.360]) of incident PD. In conclusion, the PREDICT-PD risk score only slightly improves long-term prediction of PD in the community. PMID:26898908

  16. Cardiorespiratory fitness is a stronger indicator of cardiometabolic risk factors and risk prediction than self-reported physical activity levels.

    PubMed

    Gray, Benjamin J; Stephens, Jeffrey W; Williams, Sally P; Davies, Christine A; Turner, Daniel; Bracken, Richard M

    2015-11-01

    This study investigated the relationships of self-reported physical activity levels and cardiorespiratory fitness in 81 males to assess which measurement is the greatest indicator of cardiometabolic risk. Physical activity levels were determined by the General Practice Physical Activity Questionnaire tool and cardiorespiratory fitness assessed using the Chester Step Test. Cardiovascular disease risk was estimated using the QRISK2, Framingham Lipids, Framingham body mass index and Joint British Societies' Guidelines-2 equations, and type 2 diabetes mellitus risk calculated using QDiabetes, Leicester Risk Assessment, Finnish Diabetes Risk Score and Cambridge Risk Score models. Categorising employees by cardiorespiratory fitness categories ('Excellent/Good' vs 'Average/Below Average') identified more differences in cardiometabolic risk factor (body mass index, waist circumference, total cholesterol, total cholesterol:high-density lipoprotein ratio, high-density lipoprotein cholesterol, triglycerides, HbA(1c)) scores than physical activity (waist circumference only). Cardiorespiratory fitness levels also demonstrated differences in all four type 2 diabetes mellitus risk prediction models and both the QRISK2 and Joint British Societies' Guidelines-2 cardiovascular disease equations. Furthermore, significant negative correlations (p < 0.001) were observed between individual cardiorespiratory fitness values and estimated risk in all prediction models. In conclusion, from this preliminary observational study, cardiorespiratory fitness levels reveal a greater number of associations with markers of cardiovascular disease or type 2 diabetes mellitus compared to physical activity determined by the General Practice Physical Activity Questionnaire tool. PMID:26361778

  17. Predictions of Leukemia Risks to Astronauts from Solar Particle Events

    NASA Technical Reports Server (NTRS)

    Cucinotta, F. A.; Atwell, W.; Kim, M. Y.; George, K. A.; Ponomarev, A.; Nikjoo, H.; Wilson, J. W.

    2006-01-01

    Leukemias consisting of acute and chronic myeloid leukemia and acute lymphatic lymphomas represent the earliest cancers that appear after radiation exposure, have a high lethality fraction, and make up a significant fraction of the overall fatal cancer risk from radiation for adults. Several considerations impact the recommendation of a preferred model for the estimation of leukemia risks from solar particle events (SPE's): The BEIR VII report recommends several changes to the method of calculation of leukemia risk compared to the methods recommended by the NCRP Report No. 132 including the preference of a mixture model with additive and multiplicative components in BEIR VII compared to the additive transfer model recommended by NCRP Report No. 132. Proton fluences and doses vary considerably across marrow regions because of the characteristic spectra of primary solar protons making the use of an average dose suspect. Previous estimates of bone marrow doses from SPE's have used an average body-shielding distribution for marrow based on the computerized anatomical man model (CAM). We have developed an 82-point body-shielding distribution that faithfully reproduces the mean and variance of SPE doses in the active marrow regions (head and neck, chest, abdomen, pelvis and thighs) allowing for more accurate estimation of linear- and quadratic-dose components of the marrow response. SPE's have differential dose-rates and a pseudo-quadratic dose response term is possible in the peak-flux period of an event. Also, the mechanistic basis for leukemia risk continues to improve allowing for improved strategies in choosing dose-rate modulation factors and radiation quality descriptors. We make comparisons of the various choices of the components in leukemia risk estimates in formulating our preferred model. A major finding is that leukemia could be the dominant risk to astronauts for a major solar particle event.

  18. Risk and return: evaluating Reverse Tracing of Precursors earthquake predictions

    NASA Astrophysics Data System (ADS)

    Zechar, J. Douglas; Zhuang, Jiancang

    2010-09-01

    In 2003, the Reverse Tracing of Precursors (RTP) algorithm attracted the attention of seismologists and international news agencies when researchers claimed two successful predictions of large earthquakes. These researchers had begun applying RTP to seismicity in Japan, California, the eastern Mediterranean and Italy; they have since applied it to seismicity in the northern Pacific, Oregon and Nevada. RTP is a pattern recognition algorithm that uses earthquake catalogue data to declare alarms, and these alarms indicate that RTP expects a moderate to large earthquake in the following months. The spatial extent of alarms is highly variable and each alarm typically lasts 9 months, although the algorithm may extend alarms in time and space. We examined the record of alarms and outcomes since the prospective application of RTP began, and in this paper we report on the performance of RTP to date. To analyse these predictions, we used a recently developed approach based on a gambling score, and we used a simple reference model to estimate the prior probability of target earthquakes for each alarm. Formally, we believe that RTP investigators did not rigorously specify the first two `successful' predictions in advance of the relevant earthquakes; because this issue is contentious, we consider analyses with and without these alarms. When we included contentious alarms, RTP predictions demonstrate statistically significant skill. Under a stricter interpretation, the predictions are marginally unsuccessful.

  19. Prevalence and risk factors for cannabis use in low-income pregnant women in São Paulo, Brazil.

    PubMed

    Shu, Janet E; Huang, Hsiang; Menezes, Paulo R; Faisal-Cury, Alexandre

    2016-02-01

    Cannabis is the most commonly used illicit drug during the perinatal period and has potential risks to the fetus. The purpose of this study is to estimate the 1-year prevalence of cannabis use and identify associated factors for a population of low-income pregnant women in Brazil. We performed a cross-sectional analysis of 831 women surveyed using a structured questionnaire to collect sociodemographic, clinical, and substance use history. The 1-year prevalence of antenatal cannabis use was 4.2 %; reported lifetime use was 9.6 %. The presence of a common mental disorder and active tobacco smoking were independently associated with cannabis use, OR = 3.3 (95 % CI 1.65-6.59) and OR = 6.89 (95 % CI 3.45-13.8), respectively. PMID:25971852

  20. The prevalence and correlates of behavioral risk factors for cardiovascular health among Southern Brazil adolescents: a cross-sectional study

    PubMed Central

    2012-01-01

    Background The adoption of health-related behaviors is an important part of adolescence. This study examined the prevalence and correlates of the isolated and simultaneous presence of behavioral risk factors for cardiovascular health (BRFCH) among adolescents in Curitiba, Southern Brazil. Methods A cross-sectional study was performed with 1,628 adolescents (aged 11-17.9 years, 52.5% males) that were randomly selected from 44 public schools. Self-report instruments were used to assess the variables. Six BRFCH were analyzed: insufficiently active, excessive TV watching, current alcohol and tobacco use, daily soft drinks consumption and inadequate fruit and vegetable consumption. Sociodemographic and behavioral variables were studied as possible correlates of the presence of BRFCH. Results The BRFCH with the highest prevalence were insufficiently active (50.5%, 95% confidence interval [95% CI]: 48.0-52.9) and daily soft drinks consumption (47.6%, 95% CI: 45.1-50.0). Approximately 30% of the adolescents presented three or more BRFCH simultaneously. Girls, adolescents who did not participate in organized physical activity, and who used computer/video games daily were the main high-risk subgroups for insufficiently active. Boys and those who used computer/video games daily were the high-risk subgroups for daily soft drinks consumption. For excessive TV watching, we identified to be at risk those who were from a high economic class, unemployed, and who used computer/video games daily. For current alcohol use, we identified older adolescents, who were from a high economic class and who worked to be at risk. Older adolescents, who worked and who spent little active time during a physical education class were the high-risk subgroups for current tobacco use. For inadequate fruit and vegetable consumption, we identified those who did not participate in organized physical activity to be at risk. Older adolescents, who were from a high economic class, who did not participate

  1. Optimization of agricultural field workability predictions for improved risk management

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Risks introduced by weather variability are key considerations in agricultural production. The sensitivity of agriculture to weather variability is of special concern in the face of climate change. In particular, the availability of workable days is an important consideration in agricultural practic...

  2. PREDICTING RISKS TO WILDLIFE FROM THE OFFTARGET MOVEMENT OF HERBICIDES

    EPA Science Inventory

    While insecticide applications are generally thought of as the greatest pesticide risk to wildlife, the recent literature would suggest the indirect effects of herbicides on wildlife are much greater. The resulting alteration of habitat and decrease in food sources from the off ...

  3. Toward risk reduction: predicting the future burden of occupational cancer.

    PubMed

    Hutchings, Sally; Rushton, Lesley

    2011-05-01

    Interventions to reduce cancers related to certain occupations should be evidence-based. The authors have developed a method for forecasting the future burden of occupational cancer to inform strategies for risk reduction. They project risk exposure periods, accounting for cancer latencies of up to 50 years, forward in time to estimate attributable fractions for a series of forecast target years given past and projected exposure trends and under targeted reduction scenarios. Adjustment factors for changes in exposed numbers and levels are applied in estimation intervals within the risk-exposure periods. The authors illustrate the methods by using a range of scenarios for reducing lung cancer due to occupational exposure to respirable crystalline silica. Attributable fractions for lung cancer due to respirable crystalline silica could be potentially reduced from 2.07% in 2010 to nearly 0% by 2060, depending on the timing and success of interventions. Focusing on achieving compliance with current exposure standards in small industries can be more effective than setting standards at a lower level. The method can be used to highlight high-risk carcinogens, industries, and occupations. It is adaptable for other countries and other exposure situations in the general environment and can be extended to include socioeconomic impact assessment. PMID:21447477

  4. Predicting Children's Depressive Symptoms from Community and Individual Risk Factors

    ERIC Educational Resources Information Center

    Dallaire, Danielle H.; Cole, David A.; Smith, Thomas M.; Ciesla, Jeffrey A.; LaGrange, Beth; Jacquez, Farrah M.; Pineda, Ashley Q.; Truss, Alanna E.; Folmer, Amy S.

    2008-01-01

    Community, demographic, familial, and personal risk factors of childhood depressive symptoms were examined from an ecological theoretical approach using hierarchical linear modeling. Individual-level data were collected from an ethnically diverse (73% African-American) community sample of 197 children and their parents; community-level data were…

  5. Androidal fat dominates in predicting cardiometabolic risk in postmenopausal women

    Technology Transfer Automated Retrieval System (TEKTRAN)

    We hypothesized that soy isoflavones would attenuate the anticipated increase in androidal fat mass in postmenopausal women during the 36-month treatment, and thereby favorably modify the circulating cardiometabolic risk factors: triacylglycerol, LDLC, HDL-C, glucose, insulin, uric acid, C-reactive ...

  6. Prediction of Violence Perpetration Among High-Risk Youth

    ERIC Educational Resources Information Center

    Sussman, Steve; Skara, Silvana; Weiner, Michelle D.; Dent, Clyde W.

    2004-01-01

    Objectives: To prospectively examine demographic background, personality, perceived environment, and behavior as violence perpetration predictors in emerging adulthood among high-risk adolescents using problem-behavior theory as a conceptual perspective. Methods: Self-report questionnaires were administered 5 years apart to 676 participants.…

  7. Predicting Disease Risk, Identifying Stakeholders, and Informing Control Strategies: A Case Study of Anthrax in Montana.

    PubMed

    Morris, Lillian R; Blackburn, Jason K

    2016-06-01

    Infectious diseases that affect wildlife and livestock are challenging to manage and can lead to large-scale die-offs, economic losses, and threats to human health. The management of infectious diseases in wildlife and livestock is made easier with knowledge of disease risk across space and identifying stakeholders associated with high-risk landscapes. This study focuses on anthrax, caused by the bacterium Bacillus anthracis, risk to wildlife and livestock in Montana. There is a history of anthrax in Montana, but the spatial extent of disease risk and subsequent wildlife species at risk are not known. Our objective was to predict the potential geographic distribution of anthrax risk across Montana, identify wildlife species at risk and their distributions, and define stakeholders. We used an ecological niche model to predict the potential distribution of anthrax risk. We overlaid susceptible wildlife species distributions and land ownership delineations on our risk map. We found that there was an extensive region across Montana predicted as potential anthrax risk. These potentially risky landscapes overlapped the ranges of all 6 ungulate species considered in the analysis and livestock grazing allotments, and this overlap was on public and private land for all species. Our findings suggest that there is the potential for a multi-species anthrax outbreak on multiple landscapes across Montana. Our potential anthrax risk map can be used to prioritize landscapes for surveillance and for implementing livestock vaccination programs. PMID:27169560

  8. Is Food Insecurity Associated with HIV Risk? Cross-Sectional Evidence from Sexually Active Women in Brazil

    PubMed Central

    Tsai, Alexander C.; Hung, Kristin J.; Weiser, Sheri D.

    2012-01-01

    Background Understanding how food insecurity among women gives rise to differential patterning in HIV risks is critical for policy and programming in resource-limited settings. This is particularly the case in Brazil, which has undergone successive changes in the gender and socio-geographic composition of its complex epidemic over the past three decades. We used data from a national survey of Brazilian women to estimate the relationship between food insecurity and HIV risk. Methods and Findings We used data on 12,684 sexually active women from a national survey conducted in Brazil in 2006–2007. Self-reported outcomes were (a) consistent condom use, defined as using a condom at each occasion of sexual intercourse in the previous 12 mo; (b) recent condom use, less stringently defined as using a condom with the most recent sexual partner; and (c) itchy vaginal discharge in the previous 30 d, possibly indicating presence of a sexually transmitted infection. The primary explanatory variable of interest was food insecurity, measured using the culturally adapted and validated Escala Brasiliera de Segurança Alimentar. In multivariable logistic regression models, severe food insecurity with hunger was associated with a reduced odds of consistent condom use in the past 12 mo (adjusted odds ratio [AOR] = 0.67; 95% CI, 0.48–0.92) and condom use at last sexual intercourse (AOR = 0.75; 95% CI, 0.57–0.98). Self-reported itchy vaginal discharge was associated with all categories of food insecurity (with AORs ranging from 1.46 to 1.94). In absolute terms, the effect sizes were large in magnitude across all outcomes. Underweight and/or lack of control in sexual relations did not appear to mediate the observed associations. Conclusions Severe food insecurity with hunger was associated with reduced odds of condom use and increased odds of itchy vaginal discharge, which is potentially indicative of sexually transmitted infection, among sexually active women in Brazil

  9. Comparison of Methods for Renal Risk Prediction in Patients with Type 2 Diabetes (ZODIAC-36)

    PubMed Central

    Riphagen, Ineke J.; Kleefstra, Nanne; Drion, Iefke; Alkhalaf, Alaa; van Diepen, Merel; Cao, Qi; Groenier, Klaas H.; Landman, Gijs W. D.; Navis, Gerjan; Bilo, Henk J. G.; Bakker, Stephan J. L.

    2015-01-01

    Background Patients with diabetes are at high risk of death prior to reaching end-stage renal disease, but most models predicting the risk of kidney disease do not take this competing risk into account. We aimed to compare the performance of Cox regression and competing risk models for prediction of early- and late-stage renal complications in type 2 diabetes. Methods Patients with type 2 diabetes participating in the observational ZODIAC study were included. Prediction models for (micro)albuminuria and 50% increase in serum creatinine (SCr) were developed using Cox regression and competing risk analyses. Model performance was assessed by discrimination and calibration. Results During a total follow-up period of 10 years, 183 out of 640 patients (28.6%) with normoalbuminuria developed (micro)albuminuria, and 22 patients (3.4%) died without developing (micro)albuminuria (i.e. experienced the competing event). Seventy-nine out of 1,143 patients (6.9%) reached the renal end point of 50% increase in SCr, while 219 (19.2%) died without developing the renal end point. Performance of the Cox and competing risk models predicting (micro)albuminuria was similar and differences in predicted risks were small. However, the Cox model increasingly overestimated the risk of increase in SCr in presence of a substantial number of competing events, while the performance of the competing risk model was quite good. Conclusions In this study, we demonstrated that, in case of substantial numbers of competing events, it is important to account for the competing risk of death in renal risk prediction in patients with type 2 diabetes. PMID:25775414

  10. A comparison of the predictive properties of nine sex offender risk assessment instruments.

    PubMed

    Smid, Wineke J; Kamphuis, Jan H; Wever, Edwin C; Van Beek, Daniël J

    2014-09-01

    Sex offender treatment is most effective when tailored to risk-need-responsivity principles, which dictate that treatment levels should match risk levels as assessed by structured risk assessment instruments. The predictive properties, missing values, and interrater agreement of the scores of 9 structured risk assessment instruments were compared in a national sample of 397 Dutch convicted sex offenders. The instruments included the Rapid Risk Assessment for Sexual Offense Recidivism, Static-99, Static-99R, a slightly modified version of Static-2002 and Static-2002R, Structured Anchored Clinical Judgments Minimum, Risk Matrix 2000, Sexual Violence Risk 20, and a modified version of the Sex Offender Risk Appraisal Guide; sexual and violent (including sexual) recidivism was assessed over 5- and 10-year fixed and variable follow-up periods. In general, the instrument scores showed moderate to large predictive accuracy for the occurrence of reoffending and the number of reoffenses in this sample. Predictive accuracy regarding latency showed more variability across instrument scores. Static-2002R and Static-99R scores showed a slight but consistent advantage in predictive properties over the other instrument scores across outcome measures and follow-up periods in this sample. The results of Sexual Violence Risk 20 and Rapid Risk Assessment for Sexual Offense Recidivism scores were the least positive. A positive association between predictive accuracy and interrater agreement at the item level was found for both sexual recidivism (r = .28, p = .01) and violent (including sexual) recidivism (r = .45, p < .001); no significant association was found between predictive accuracy and missing values at the item level. Results underscore the feasibility and utility of these instruments for informing treatment selection according to the risk-need-responsivity principles. PMID:24773035

  11. Population prevalence of hereditary breast cancer phenotypes and implementation of a genetic cancer risk assessment program in southern Brazil

    PubMed Central

    2009-01-01

    In 2004, a population-based cohort (the Núcleo Mama Porto Alegre - NMPOA Cohort) was started in Porto Alegre, southern Brazil and within that cohort, a hereditary breast cancer study was initiated, aiming to determine the prevalence of hereditary breast cancer phenotypes and evaluate acceptance of a genetic cancer risk assessment (GCRA) program. Women from that cohort who reported a positive family history of cancer were referred to GCRA. Of the 9218 women enrolled, 1286 (13.9%) reported a family history of cancer. Of the 902 women who attended GCRA, 55 (8%) had an estimated lifetime risk of breast cancer ≥ 20% and 214 (23.7%) had pedigrees suggestive of a breast cancer predisposition syndrome; an unexpectedly high number of these fulfilled criteria for Li-Fraumeni-like syndrome (122 families, 66.7%). The overall prevalence of a hereditary breast cancer phenotype was 6.2% (95%CI: 5.67-6.65). These findings identified a problem of significant magnitude in the region and indicate that genetic cancer risk evaluation should be undertaken in a considerable proportion of the women from this community. The large proportion of women who attended GCRA (72.3%) indicates that the program was well-accepted by the community, regardless of the potential cultural, economic and social barriers. PMID:21637504

  12. Risk factors associated with seropositivity for Leishmania spp. and Trypanosoma cruzi in dogs in the state of Paraiba, Brazil.

    PubMed

    Fernandes, Annielle Regina da Fonseca; Pimenta, Carla Lauise Rodrigues Menezes; Vidal, Ivana Fernandes; Oliveira, Gabriela Capriogli; Sartori, Raissa Saran; Araújo, Raizza Barros; Melo, Márcia Almeida; Langoni, Hélio; Azevedo, Sérgio Santos

    2016-01-01

    The aim of this survey was to determine the seropositivity and risk factors for Leishmania spp. and Trypanosoma cruzi in dogs in the State of Paraíba, Northeastern Brazil. A total of 1,043 dogs were tested, and the serological diagnoses of Chagas disease (CD) and canine visceral leishmaniasis (CVL) was performed by the indirect fluorescent antibody test (IFAT). Animals that tested seropositive for both diseases (by IFAT) were further subjected to ELISA. Of the 1,043 dogs 81 (7.8%; 95% CI = 6.1-9.4%) tested seropositive for Leishmania spp., while 83 were seropositive for T. cruzi (7.9%; 95% CI = 6.3-9.6%). Simultaneous serological reactions were detected in 49 animals (4.6%; 95% CI= 3.6-6.2%). Semi-domiciled housing (OR = 2.044), free housing (OR = 4.151), and soil (OR = 3.425) and soil/cement (OR = 3.065) environmental conditions were identified as risk factors for CVL seropositivity. The risk factors identified for CD seropositivity were semi-domiciled (OR = 2.353) or free housing (OR = 3.454), and contact with bovine (OR = 2.015). This study revealed the presence of dogs in the Paraíba State seropositive for CVL and CD, suggesting the need for revisiting and intensification of disease control measures through constant monitoring of the canine population. PMID:26982555

  13. Landscape risk factors for attacks of vampire bats on cattle in Sao Paulo, Brazil.

    PubMed

    Gomes, Murilo Novaes; Monteiro, Antonio Miguel Vieira; Lewis, Nicola; Gonçalves, Celso Alberto; Filho, Vladimir de Souza Nogueira

    2010-02-01

    Vampire-bat (Desmodus rotundus) attacks on cattle are a major concern for cattle-raising area. Blood loss and paralytic rabies due to bat bites can impose severe losses on the livestock. We took four municipalities inside the Sao Joao da Boa Vista veterinary district (Sao Paulo, Brazil) as a study area and tested a set of landscape features for spatial correlation with distance to areas in which vampire-bat attacks on cattle were documented. Bat- and cattle-related data from the Sao Paulo State Rabies Control Program were used. Landscape data (first-order rivers and their tributaries, main roads, railways and urban areas) were obtained from official cartographic agencies; forest, sugarcane and pasture data were acquired from remote-sensing mappings. The study area was taken as a grid split into 178 cells. Each 4kmx4km cell was filled with bat, cattle and landscape data. Our analysis detected that grid cells that were closer to areas of bat attacks on cattle had higher cattle density and a greater percentage of the land committed to sugarcane cropping, and were close to forest fragments. These results shed light on the need for rethink the Rabies Control Program strategies for defining the surveillance of vampire-bat populations and rabies control in the state of Sao Paulo, Brazil. PMID:20004487

  14. The cumulative effects of known susceptibility variants to predict primary biliary cirrhosis risk.

    PubMed

    Tang, R; Chen, H; Miao, Q; Bian, Z; Ma, W; Feng, X; Seldin, M F; Invernizzi, P; Gershwin, M E; Liao, W; Ma, X

    2015-01-01

    Multiple genetic variants influence the risk for development of primary biliary cirrhosis (PBC). To explore the cumulative effects of known susceptibility loci on risk, we utilized a weighted genetic risk score (wGRS) to evaluate whether genetic information can predict susceptibility. The wGRS was created using 26 known susceptibility loci and investigated in 1840 UK PBC and 5164 controls. Our data indicate that the wGRS was significantly different between PBC and controls (P=1.61E-142). Moreover, we assessed predictive performance of wGRS on disease status by calculating the area under the receiver operator characteristic curve. The area under curve for the purely genetic model was 0.72 and for gender plus genetic model was 0.82, with confidence limits substantially above random predictions. The risk of PBC using logistic regression was estimated after dividing individuals into quartiles. Individuals in the highest disclosed risk group demonstrated a substantially increased risk for PBC compared with the lowest risk group (odds ratio: 9.3, P=1.91E-084). Finally, we validated our findings in an analysis of an Italian PBC cohort. Our data suggested that the wGRS, utilizing genetic variants, was significantly associated with increased risk for PBC with consistent discriminant ability. Our study is a first step toward risk prediction for PBC. PMID:25569263

  15. Prediction of the level of ionospheric scintillation at equatorial latitudes in Brazil using a neural network

    NASA Astrophysics Data System (ADS)

    Lima, G. R. T.; Stephany, S.; Paula, E. R.; Batista, I. S.; Abdu, M. A.

    2015-08-01

    Electron density irregularity structures, often associated with ionospheric plasma bubbles, drive amplitude and phase fluctuations in radio signals that, in turn, create a phenomenon known as ionospheric scintillation. The phenomenon occurs frequently around the magnetic equator where plasma instability mechanisms generate postsunset plasma bubbles and density depletions. A previous correlation study suggested that scintillation at the magnetic equator may provide a forecast of subsequent scintillation at the equatorial ionization anomaly southern peak. In this work, it is proposed to predict the level of scintillation over São Luís (2.52°S, 44.3°W; dip latitude: ~2.5°S) near the magnetic equator with lead time of hours but without specifying the moment at which the scintillation starts or ends. A collection of extended databases relating scintillation to ionospheric variables for São Luís is employed to perform the training of an artificial neural network with a new architecture. Two classes are considered, not strong (null/weak/moderate) and strong scintillation. An innovative scheme preprocesses the data taking into account similarities of the values of the variables for the same class. A formerly proposed resampling heuristic is employed to provide a balanced number of tuples of each class in the training set. Tests were performed showing that the proposed neural network is able to predict the level of scintillation over the station on the evening ahead of the data sample considered between 17:30 and 19:00 LT.

  16. Perceived extrinsic mortality risk and reported effort in looking after health: testing a behavioral ecological prediction.

    PubMed

    Pepper, Gillian V; Nettle, Daniel

    2014-09-01

    Socioeconomic gradients in health behavior are pervasive and well documented. Yet, there is little consensus on their causes. Behavioral ecological theory predicts that, if people of lower socioeconomic position (SEP) perceive greater personal extrinsic mortality risk than those of higher SEP, they should disinvest in their future health. We surveyed North American adults for reported effort in looking after health, perceived extrinsic and intrinsic mortality risks, and measures of SEP. We examined the relationships between these variables and found that lower subjective SEP predicted lower reported health effort. Lower subjective SEP was also associated with higher perceived extrinsic mortality risk, which in turn predicted lower reported health effort. The effect of subjective SEP on reported health effort was completely mediated by perceived extrinsic mortality risk. Our findings indicate that perceived extrinsic mortality risk may be a key factor underlying SEP gradients in motivation to invest in future health. PMID:24990431

  17. Radiation risk predictions for Space Station Freedom orbits

    NASA Technical Reports Server (NTRS)

    Cucinotta, Francis A.; Atwell, William; Weyland, Mark; Hardy, Alva C.; Wilson, John W.; Townsend, Lawrence W.; Shinn, Judy L.; Katz, Robert

    1991-01-01

    Risk assessment calculations are presented for the preliminary proposed solar minimum and solar maximum orbits for Space Station Freedom (SSF). Integral linear energy transfer (LET) fluence spectra are calculated for the trapped proton and GCR environments. Organ dose calculations are discussed using the computerized anatomical man model. The cellular track model of Katz is applied to calculate cell survival, transformation, and mutation rates for various aluminum shields. Comparisons between relative biological effectiveness (RBE) and quality factor (QF) values for SSF orbits are made.

  18. Endocrine and Metabolic Biomarkers Predicting Early Childhood Obesity Risk.

    PubMed

    Socha, Piotr; Hellmuth, Christian; Gruszfeld, Dariusz; Demmelmair, Hans; Rzehak, Peter; Grote, Veit; Weber, Martina; Escribano, Joaquin; Closa-Monasterolo, Ricardo; Dain, Elena; Langhendries, Jean-Paul; Riva, Enrica; Verduci, Elvira; Koletzko, Berthold

    2016-01-01

    There is growing evidence of long-term effects of early dietary intervention in infancy on later obesity risk. Many studies showed reduced risk of obesity with breastfeeding in infancy, which could be related to the reduced protein intake with human milk compared to infant formula. In a randomized controlled trial (Childhood Obesity Project), we were able to show that infant formula with reduced protein content results in lower BMI both at 2 and 6 years. These effects seem to be mediated mainly by branched-chain amino acids which stimulate the insulin-like growth factor (IGF)-1 axis and insulin release. In this trial, we also showed an influence of high-protein diet on larger kidney size, which seems to be partly explained by a significant effect of free IGF-1 on kidney volume. The IGF-1 axis was shown to regulate early growth, adipose tissue differentiation and early adipogenesis in animals and in humans. Leptin and adiponectin can also be regarded as important endocrine regulators of obesity. These markers were tested in observational studies. Leptin seems to be closely correlated with BMI but changes in adiponectin require further exploration. Still, there is a lack of good data or some results are contradictory to indicate the role of either leptin or adiponectin in infancy for determining later obesity risk. PMID:27088335

  19. Predicting women's alcohol risk-taking while abroad.

    PubMed

    Smith, Gabie; Klein, Sarah

    2010-05-01

    Numerous studies have examined risk factors that are associated with heavy alcohol use; however, much of this research has not addressed factors that specifically relate to women's alcohol use. The current study has extended the previous literature on women's alcohol-use behavior by examining factors associated with risky drinking in young women traveling abroad (n = 55). Using a pretest-posttest design, we examined the influence of disinhibition sensation-seeking and endorsement of social enhancement alcohol expectancies in relation to participation in risky alcohol use while abroad for three weeks. Analyses confirmed that disinhibition sensation-seeking and social enhancement alcohol expectancies were associated with participation in risky alcohol-use behaviors while abroad (controlling for alcohol-use at the pretest). Analysis of qualitative data reinforced the importance of social facilitation in women's alcohol risk-taking. Participants' qualitative data also emphasized characteristics of situational disinhibition relating to travel as well as culturally-specific motivations for alcohol-use behaviors. Further research examining women's personal need for disinhibition and the role of situational disinhibition in motivating alcohol risk-taking is warranted. In addition, the current findings suggest that interventions focusing on the connections between alcohol use and enhancement of social relationships and the potential isolating effects of non-use are necessary. PMID:20512745

  20. A Utility/Cost Analysis of Breast Cancer Risk Prediction Algorithms

    PubMed Central

    Abbey, Craig K.; Wu, Yirong; Burnside, Elizabeth S.; Wunderlich, Adam; Samuelson, Frank W.; Boone, John M.

    2016-01-01

    Breast cancer risk prediction algorithms are used to identify subpopulations that are at increased risk for developing breast cancer. They can be based on many different sources of data such as demographics, relatives with cancer, gene expression, and various phenotypic features such as breast density. Women who are identified as high risk may undergo a more extensive (and expensive) screening process that includes MRI or ultrasound imaging in addition to the standard full-field digital mammography (FFDM) exam. Given that there are many ways that risk prediction may be accomplished, it is of interest to evaluate them in terms of expected cost, which includes the costs of diagnostic outcomes. In this work we perform an expected-cost analysis of risk prediction algorithms that is based on a published model that includes the costs associated with diagnostic outcomes (true-positive, false-positive, etc.). We assume the existence of a standard screening method and an enhanced screening method with higher scan cost, higher sensitivity, and lower specificity. We then assess expected cost of using a risk prediction algorithm to determine who gets the enhanced screening method under the strong assumption that risk and diagnostic performance are independent. We find that if risk prediction leads to a high enough positive predictive value, it will be cost-effective regardless of the size of the subpopulation. Furthermore, in terms of the hit-rate and false-alarm rate of the of the risk-prediction algorithm, iso-cost contours are lines with slope determined by properties of the available diagnostic systems for screening. PMID:27335532

  1. A utility/cost analysis of breast cancer risk prediction algorithms

    NASA Astrophysics Data System (ADS)

    Abbey, Craig K.; Wu, Yirong; Burnside, Elizabeth S.; Wunderlich, Adam; Samuelson, Frank W.; Boone, John M.

    2016-03-01

    Breast cancer risk prediction algorithms are used to identify subpopulations that are at increased risk for developing breast cancer. They can be based on many different sources of data such as demographics, relatives with cancer, gene expression, and various phenotypic features such as breast density. Women who are identified as high risk may undergo a more extensive (and expensive) screening process that includes MRI or ultrasound imaging in addition to the standard full-field digital mammography (FFDM) exam. Given that there are many ways that risk prediction may be accomplished, it is of interest to evaluate them in terms of expected cost, which includes the costs of diagnostic outcomes. In this work we perform an expected-cost analysis of risk prediction algorithms that is based on a published model that includes the costs associated with diagnostic outcomes (true-positive, false-positive, etc.). We assume the existence of a standard screening method and an enhanced screening method with higher scan cost, higher sensitivity, and lower specificity. We then assess expected cost of using a risk prediction algorithm to determine who gets the enhanced screening method under the strong assumption that risk and diagnostic performance are independent. We find that if risk prediction leads to a high enough positive predictive value, it will be cost-effective regardless of the size of the subpopulation. Furthermore, in terms of the hit-rate and false-alarm rate of the of the risk prediction algorithm, iso-cost contours are lines with slope determined by properties of the available diagnostic systems for screening.

  2. Predicting Students at Risk in General Chemistry Using Pre-semester Assessments and Demographic Information

    NASA Astrophysics Data System (ADS)

    Wagner, Eugene P.; Sasser, Howell; Dibiase, Warren J.

    2002-06-01

    Predicting student performance in the classroom is an important area of educational research owing to its potential for helping educators identify students who may have difficulty grasping the material in a course. The goal of this research was to develop a sensitive and specific pre-semester assessment for students enrolled in general chemistry for science majors that would identify students at risk for failing the course. The student pre-semester assessment (SPSA) predicted 40.8% of the students who went on to fail first-semester general chemistry. It was a better predictor of at-risk students than the Toledo exam (27.7%), SAT (16.8%), or predicted grade point index (PGI) (29.4%). The inclusion of demographic variables did little to increase the SPSA's predictive power, but math and chemistry background and age significantly increased the accuracy of predicting at-risk students when combined with either the SAT score or the PGI.

  3. The utility and predictive value of combinations of low penetrance genes for screening and risk prediction of colorectal cancer

    PubMed Central

    Hawken, Steven J.; Greenwood, Celia M. T.; Hudson, Thomas J.; Kustra, Rafal; McLaughlin, John; Yang, Quanhe; Zanke, Brent W.

    2010-01-01

    Despite the fact that colorectal cancer (CRC) is a highly treatable form of cancer if detected early, a very low proportion of the eligible population undergoes screening for this form of cancer. Integrating a genomic screening profile as a component of existing screening programs for CRC could potentially improve the effectiveness of population screening by allowing the assignment of individuals to different types and intensities of screening and also by potentially increasing the uptake of existing screening programs. We evaluated the utility and predictive value of genomic profiling as applied to CRC, and as a potential component of a population-based cancer screening program. We generated simulated data representing a typical North American population including a variety of genetic profiles, with a range of relative risks and prevalences for individual risk genes. We then used these data to estimate parameters characterizing the predictive value of a logistic regression model built on genetic markers for CRC. Meta-analyses of genetic associations with CRC were used in building science to inform the simulation work, and to select genetic variants to include in logistic regression model-building using data from the ARCTIC study in Ontario, which included 1,200 CRC cases and a similar number of cancer-free population-based controls. Our simulations demonstrate that for reasonable assumptions involving modest relative risks for individual genetic variants, that substantial predictive power can be achieved when risk variants are common (e.g., prevalence > 20%) and data for enough risk variants are available (e.g., ~140–160). Pilot work in population data shows modest, but statistically significant predictive utility for a small collection of risk variants, smaller in effect than age and gender alone in predicting an individual’s CRC risk. Further genotyping and many more samples will be required, and indeed the discovery of many more risk loci associated with

  4. Multi-locus genetic risk score predicts risk for Crohn’s disease in Slovenian population

    PubMed Central

    Zupančič, Katarina; Skok, Kristijan; Repnik, Katja; Weersma, Rinse K; Potočnik, Uroš; Skok, Pavel

    2016-01-01

    AIM: To develop a risk model for Crohn’s disease (CD) based on homogeneous population. METHODS: In our study were included 160 CD patients and 209 healthy individuals from Slovenia. The association study was performed for 112 single nucleotide polymorphisms (SNPs). We generated genetic risk scores (GRS) based on the number of risk alleles using weighted additive model. Discriminatory accuracy was measured by area under ROC curve (AUC). For risk evaluation, we divided individuals according to positive and negative likelihood ratios (LR) of a test, with LR > 5 for high risk group and LR < 0.20 for low risk group. RESULTS: The highest accuracy, AUC of 0.78 was achieved with GRS combining 33 SNPs with optimal sensitivity and specificity of 75.0% and 72.7%, respectively. Individuals with the highest risk (GRS > 5.54) showed significantly increased odds of developing CD (OR = 26.65, 95%CI: 11.25-63.15) compared to the individuals with the lowest risk (GRS < 4.57) which is a considerably greater risk captured than in one SNP with the highest effect size (OR = 3.24). When more than 33 SNPs were included in GRS, discriminatory ability was not improved significantly; AUC of all 74 SNPs was 0.76. CONCLUSION: The authors proved the possibility of building accurate genetic risk score based on 33 risk variants on Slovenian CD patients which may serve as a screening tool in the targeted population. PMID:27076762

  5. School Violence in Taiwan: Examining How Western Risk Factors Predict School Violence in an Asian Culture

    ERIC Educational Resources Information Center

    Chen, Ji-Kang; Astor, Ron Avi

    2010-01-01

    The current study explores whether theorized risk factors in Western countries can be used to predict school violence perpetration in an Asian cultural context. The study examines the associations between risk factors and school violence perpetration in Taiwan. Data were obtained from a nationally representative sample of 14,022 students from…

  6. Post-Stroke Depression in Primary Support Persons: Predicting Those at Risk.

    ERIC Educational Resources Information Center

    Tompkins, Connie A.; And Others

    1988-01-01

    Assessed psychosocial impact of stroke on patient's primary support person. Collected three waves of data at six-month intervals. At first wave, identified support persons at risk for depression. At second and third waves, predicted and validated risk with at least 74 percent accuracy. Variables included Time 1 depression, optimism, concern about…

  7. Predicting Adolescent Risk Behaviors Based on an Ecological Framework and Assets

    ERIC Educational Resources Information Center

    Reininger, Belinda M.; Evans, Alexandra E.; Griffin, Sarah F.; Sanderson, Maureen; Vincent, Murray L.; Valois, Robert F.; Parra-Medina, Deborah

    2005-01-01

    Objectives: To examine the relationship between an aggregate risk score (smoking, drinking, and number of sex partners) and measures of youth assets in a sample of 3439 youth aged 14?18 years. Methods: Linear regression models for African American and white males and females predicted an aggregate risk score. Results: After adjustments, the youth…

  8. Clinical prediction of fall risk and white matter abnormalities: a diffusion tensor imaging study

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The Tinetti scale is a simple clinical tool designed to predict risk of falling by focusing on gait and stance impairment in elderly persons. Gait impairment is also associated with white matter (WM) abnormalities. Objective: To test the hypothesis that elderly subjects at risk for falling, as deter...

  9. A Novel Risk Score to the Prediction of 10-year Risk for Coronary Artery Disease Among the Elderly in Beijing Based on Competing Risk Model

    PubMed Central

    Liu, Long; Tang, Zhe; Li, Xia; Luo, Yanxia; Guo, Jin; Li, Haibin; Liu, Xiangtong; Tao, Lixin; Yan, Aoshuang; Guo, Xiuhua

    2016-01-01

    Abstract The study aimed to construct a risk prediction model for coronary artery disease (CAD) based on competing risk model among the elderly in Beijing and develop a user-friendly CAD risk score tool. We used competing risk model to evaluate the risk of developing a first CAD event. On the basis of the risk factors that were included in the competing risk model, we constructed the CAD risk prediction model with Cox proportional hazard model. Time-dependent receiver operating characteristic (ROC) curve and time-dependent area under the ROC curve (AUC) were used to evaluate the discrimination ability of the both methods. Calibration plots were applied to assess the calibration ability and adjusted for the competing risk of non-CAD death. Net reclassification index (NRI) and integrated discrimination improvement (IDI) were applied to quantify the improvement contributed by the new risk factors. Internal validation of predictive accuracy was performed using 1000 times of bootstrap re-sampling. Of the 1775 participants without CAD at baseline, 473 incident cases of CAD were documented for a 20-year follow-up. Time-dependent AUCs for men and women at t = 10 years were 0.841 [95% confidence interval (95% CI): 0.806–0.877], 0.804 (95% CI: 0.768–0.839) in Fine and Gray model, 0.784 (95% CI: 0.738–0.830), 0.733 (95% CI: 0.692–0.775) in Cox proportional hazard model. The competing risk model was significantly superior to Cox proportional hazard model on discrimination and calibration. The cut-off values of the risk score that marked the difference between low-risk and high-risk patients were 34 points for men and 30 points for women, which have good sensitivity and specificity. A sex-specific multivariable risk factor algorithm-based competing risk model has been developed on the basis of an elderly Chinese cohort, which could be applied to predict an individual's risk and provide a useful guide to identify the groups at a high risk for CAD among the Chinese

  10. Comparison of Measured and Predicted Bioconcentration Estimates of Pharmaceuticals in Fish Plasma and Prediction of Chronic Risk.

    PubMed

    Nallani, Gopinath; Venables, Barney; Constantine, Lisa; Huggett, Duane

    2016-05-01

    Evaluation of the environmental risk of human pharmaceuticals is now a mandatory component in all new drug applications submitted for approval in EU. With >3000 drugs currently in use, it is not feasible to test each active ingredient, so prioritization is key. A recent review has listed nine prioritization approaches including the fish plasma model (FPM). The present paper focuses on comparison of measured and predicted fish plasma bioconcentration factors (BCFs) of four common over-the-counter/prescribed pharmaceuticals: norethindrone (NET), ibuprofen (IBU), verapamil (VER) and clozapine (CLZ). The measured data were obtained from the earlier published fish BCF studies. The measured BCF estimates of NET, IBU, VER and CLZ were 13.4, 1.4, 0.7 and 31.2, while the corresponding predicted BCFs (based log Kow at pH 7) were 19, 1.0, 7.6 and 30, respectively. These results indicate that the predicted BCFs matched well the measured values. The BCF estimates were used to calculate the human: fish plasma concentration ratios of each drug to predict potential risk to fish. The plasma ratio results show the following order of risk potential for fish: NET > CLZ > VER > IBU. The FPM has value in prioritizing pharmaceutical products for ecotoxicological assessments. PMID:27003806

  11. Not all risk taking behavior is bad: Associative sensitivity predicts learning during risk taking among high sensation seekers

    PubMed Central

    Humphreys, Kathryn L.; Lee, Steve S.; Tottenham, Nim

    2013-01-01

    Risk taking behavior can be both adaptive and maladaptive depending on context. The majority of studies of risk taking, however, focus on clinical populations and dangerous or harmful risk taking. Individual differences in learning during risk taking are rarely examined in relation to task performance. The present study examined risk taking and associated outcomes in an exploration-based instrumental learning task (Balloon Emotional Learning Task; BELT), which presented a series of balloons in which participants pump up for points. Consistent with prior work, sensation seeking predicted increased risk taking behavior. Importantly, however, a significant interaction between sensation seeking and associative sensitivity, an attentional construct defined as the frequency and remoteness of automatic cognitive activity, was found. Specifically, among individuals high in sensation seeking, associative sensitivity predicted fewer balloon explosions and an increase in points earned on the balloon condition with the most potential feedback driven learning. Thus, these findings suggest that sensation seekers are a heterogeneous group, and secondary traits such as associative sensitivity moderate behavior such as risk taking and learning according to context. PMID:23935235

  12. Mediated effects of physical risk factors, leader-member exchange and empowerment in predicting perceived injury risk.

    PubMed

    Muldoon, Jeffery; Matthews, Russell A; Foley, Caroline

    2012-04-01

    In the context of conservation of resources theory, we examine the indirect (mediated) effects of physical risk factors, leader-member exchange (LMX) and empowerment on perceived injury risk in a heterogeneous sample (N = 226) of individuals employed in occupations related to production, construction and installation/maintenance. Positioning work role stressors and upward safety communications as two important mediating variables, as predicted, LMX and empowerment demonstrated significant indirect effects on perceived injury risk. Results from our model also provide preliminary evidence that an asymmetrical dualistic process exists in terms of the effect physical risk factors have on perceived injury risk via depletion of both psychological (i.e. role stressors) and physical resources (i.e. physical symptoms). Theoretical and practical implications based on the results of our model are also discussed. PMID:22282314

  13. Occurrence and risk factors associated to Toxoplasma gondii infection in sheep from Rio de Janeiro, Brazil

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Toxoplasmosis is an important cause of abortion in sheep and a zoonotic risk to humans, leading to significant hazards to health and to economic losses. This study examined the soroprevalence and associated risk factors for infection with Toxoplama gondii in 379 sheep from 12 flocks in Rio de Janeir...

  14. Implications of Cardiovascular Disease Risk Assessment Using the WHO/ISH Risk Prediction Charts in Rural India

    PubMed Central

    Raghu, Arvind; Praveen, Devarsetty; Peiris, David; Tarassenko, Lionel; Clifford, Gari

    2015-01-01

    Cardiovascular disease (CVD) risk in India is currently assessed using the World Health Organization/International Society for Hypertension (WHO/ISH) risk prediction charts since no population-specific models exist. The WHO/ISH risk prediction charts have two versions—one with total cholesterol as a predictor (the high information (HI) model) and the other without (the low information (LI) model). However, information on the WHO/ISH risk prediction charts including guidance on which version to use and when, as well as relative performance of the LI and HI models, is limited. This article aims to, firstly, quantify the relative performance of the LI and HI WHO/ISH risk prediction (for WHO-South East Asian Region D) using data from rural India. Secondly, we propose a pre-screening (simplified) point-of-care (POC) test to identify patients who are likely to benefit from a total cholesterol (TC) test, and subsequently when the LI model is preferential to HI model. Analysis was performed using cross-sectional data from rural Andhra Pradesh collected in 2005 with recorded blood cholesterol measurements (N = 1066). CVD risk was computed using both LI and HI models, and high risk individuals who needed treatment(THR) were subsequently identified based on clinical guidelines. Model development for the POC assessment of a TC test was performed through three machine learning techniques: Support Vector Machine (SVM), Regularised Logistic Regression (RLR), and Random Forests (RF) along with a feature selection process. Disagreement in CVD risk predicted by LI and HI WHO/ISH models was 14.5% (n = 155; p<0.01) overall and comprised 36 clinically relevant THR patients (31% of patients identified as THR by using either model). Using two patient-specific parameters (age, systolic blood pressure), our POC assessment can pre-determine the benefit of TC testing and choose the appropriate risk model (out-of-sample AUCs:RF-0.85,SVM-0.84,RLR:0.82 and maximum sensitivity-98%). The

  15. Prediction of near-term breast cancer risk using a Bayesian belief network

    NASA Astrophysics Data System (ADS)

    Zheng, Bin; Ramalingam, Pandiyarajan; Hariharan, Harishwaran; Leader, Joseph K.; Gur, David

    2013-03-01

    Accurately predicting near-term breast cancer risk is an important prerequisite for establishing an optimal personalized breast cancer screening paradigm. In previous studies, we investigated and tested the feasibility of developing a unique near-term breast cancer risk prediction model based on a new risk factor associated with bilateral mammographic density asymmetry between the left and right breasts of a woman using a single feature. In this study we developed a multi-feature based Bayesian belief network (BBN) that combines bilateral mammographic density asymmetry with three other popular risk factors, namely (1) age, (2) family history, and (3) average breast density, to further increase the discriminatory power of our cancer risk model. A dataset involving "prior" negative mammography examinations of 348 women was used in the study. Among these women, 174 had breast cancer detected and verified in the next sequential screening examinations, and 174 remained negative (cancer-free). A BBN was applied to predict the risk of each woman having cancer detected six to 18 months later following the negative screening mammography. The prediction results were compared with those using single features. The prediction accuracy was significantly increased when using the BBN. The area under the ROC curve increased from an AUC=0.70 to 0.84 (p<0.01), while the positive predictive value (PPV) and negative predictive value (NPV) also increased from a PPV=0.61 to 0.78 and an NPV=0.65 to 0.75, respectively. This study demonstrates that a multi-feature based BBN can more accurately predict the near-term breast cancer risk than with a single feature.

  16. Fluoride concentrations in the water of Maringá, Brazil, considering the benefit/risk balance of caries and fluorosis.

    PubMed

    Bergamo, Edmara Tatiely Pedroso; Barbana, Marlon; Terada, Raquel Sano Suga; Cury, Jaime Aparecido; Fujimaki, Mitsue

    2015-01-01

    Current Brazilian law regarding water fluoridation classification is dichotomous with respect to the risks of and benefits for oral diseases, and fluoride (F) concentrations less than 0.6 or above 0.8 mg F/L are considered outside the normal limits. Thus, the law does not consider that both caries and fluorosis are dependent on the dosage and duration of fluoride exposure because they are both chronic diseases. Therefore, this study evaluated the quality of water fluoridation in Maringá, PR, Brazil, considering a new classification for the concentration of F in water the supply, based on the anticaries benefit and risk of fluorosis (CECOL/USP, 2011). Water samples (n = 325) were collected monthly over one year from 28 distribution water networks: 20 from treatment plants and 8 from artesian wells. F concentrations were determined using a specific ion electrode. The average F concentration was 0.77 mg F/L (ppm F), ranging from 0.44 to 1.22 mg F/L. Considering all of the water samples analyzed, 83.7% of them presented from 0.55 to 0.84 mg F/L, and according to the new classification used, they would provide maximum anticaries benefit with a low risk of fluorosis. This percentage was lower (75.4%) in the water samples supplied from artesian wells than from those distributed by the treatment plant (86%). In conclusion, based on the new classification of water F concentrations, the quality of water fluoridation in Maringá is adequate and is within the range of the best balance between risk and benefit. PMID:25760066

  17. A novel air quality analysis and prediction system for São Paulo, Brazil to support decision-making

    NASA Astrophysics Data System (ADS)

    Hoshyaripour, Gholam Ali; Brasseur, Guy; Andrade, Maria Fatima; Gavidia-Calderón, Mario; Bouarar, Idir

    2016-04-01

    The extensive economic development and urbanization in southeastern Brazil (SEB) in recent decades have notably degraded the air quality with adverse impacts on human health. Since the Metropolitan Area of São Paulo (MASP) accommodates the majority of the economic growth in SEB, it overwhelmingly suffers from the air pollution. Consequently, there is a strong demand for developing ever-better assessment mechanisms to monitor the air quality and to assist the decision makers to mitigate the air pollution in MASP. Here we present the results of an air quality modeling system designed for SEB with focuses on MASP. The Weather Research and Forecast model with Chemistry (WRF-Chem) is used considering the anthropogenic, biomass-burning and biogenic emissions within a 1000×1500 km domain with resolution of 10 km. FINN and MEGAN are used for the biomass-burning and biogenic emissions, respectively. For the anthropogenic emissions we use a local bottom-up inventory for the transport sector and the HTAPv2 global inventory for all other sectors. The bottom-up inventory accounts for the traffic patterns, vehicle types and their emission factors in the area and thus could be used to evaluate the effect of changes in these parameters on air quality in MASP. The model outputs are compered to the satellite and ground-based observations for O3 and NOx. The results show that using the bottom-up or top-down inventories individually can result in a huge deviation between the predictions and observations. On the other hand, combining the inventories significantly enhances the forecast accuracy. It also provides a powerful tool to quantify the effects of traffic and vehicle emission policies on air quality in MASP.

  18. Population-Level Prediction of Type 2 Diabetes From Claims Data and Analysis of Risk Factors.

    PubMed

    Razavian, Narges; Blecker, Saul; Schmidt, Ann Marie; Smith-McLallen, Aaron; Nigam, Somesh; Sontag, David

    2015-12-01

    We present a new approach to population health, in which data-driven predictive models are learned for outcomes such as type 2 diabetes. Our approach enables risk assessment from readily available electronic claims data on large populations, without additional screening cost. Proposed model uncovers early and late-stage risk factors. Using administrative claims, pharmacy records, healthcare utilization, and laboratory results of 4.1 million individuals between 2005 and 2009, an initial set of 42,000 variables were derived that together describe the full health status and history of every individual. Machine learning was then used to methodically enhance predictive variable set and fit models predicting onset of type 2 diabetes in 2009-2011, 2010-2012, and 2011-2013. We compared the enhanced model with a parsimonious model consisting of known diabetes risk factors in a real-world environment, where missing values are common and prevalent. Furthermore, we analyzed novel and known risk factors emerging from the model at different age groups at different stages before the onset. Parsimonious model using 21 classic diabetes risk factors resulted in area under ROC curve (AUC) of 0.75 for diabetes prediction within a 2-year window following the baseline. The enhanced model increased the AUC to 0.80, with about 900 variables selected as predictive (p < 0.0001 for differences between AUCs). Similar improvements were observed for models predicting diabetes onset 1-3 years and 2-4 years after baseline. The enhanced model improved positive predictive value by at least 50% and identified novel surrogate risk factors for type 2 diabetes, such as chronic liver disease (odds ratio [OR] 3.71), high alanine aminotransferase (OR 2.26), esophageal reflux (OR 1.85), and history of acute bronchitis (OR 1.45). Liver risk factors emerge later in the process of diabetes development compared with obesity-related factors such as hypertension and high hemoglobin A1c. In conclusion

  19. Wheezing conditions in early childhood: prevalence and risk factors in the city of São Paulo, Brazil.

    PubMed Central

    Benício, Maria Helena D.; Ferreira, Marcelo U.; Cardoso, Maria Regina A.; Konno, Sílvia C.; Monteiro, Carlos A.

    2004-01-01

    OBJECTIVE: To investigate the prevalence and risk factors for wheezing disorders in early childhood in São Paulo, Brazil, the largest metropolitan area of South America. METHODS: A population-based cross-sectional survey of 1132 children aged 6-59 months was carried out between 1995 and 1996 to obtain information on recent wheezing and on independent variables such as demographic, socioeconomic, environmental, maternal and nutritional variables and immunization status. Intestinal parasitic infections were diagnosed using standard techniques. Multiple unconditional logistic regression was used to describe associations between outcome and independent variables. FINDINGS: The prevalence of recent wheezing (one or more reported episodes in the past 12 months) was 12.5%; 93% of children with wheezing were also reported to have a medical diagnosis of asthma. Recent wheezing was associated with low per capita income, poor quality of housing, day-care attendance, low birth weight and infection with intestinal helminths. CONCLUSION: Wheezing in early childhood in São Paulo, although more common than in most developing countries, remains less prevalent than in urban areas of industrialized countries. Low income and conditions associated with poverty (poor housing, low birth weight and parasitic infections) are some of the main risk factors for wheezing disorders among young children in this city. PMID:15508196

  20. Anti-Toxocara spp. antibodies in an adult healthy population: serosurvey and risk factors in Southeast Brazil

    PubMed Central

    Negri, Elaine Cristina; Santarém, Vamilton Alvares; Rubinsky-Elefant, Guita; Giuffrida, Rogério

    2013-01-01

    Objective To evaluate the frequency of anti-Toxocara spp. antibodies in an adult healthy population. Methods The study was performed by interviewing 253 blood donors, from 19 to 65 years of age, in a hematological centre in Presidente Prudente, São Paulo, southeast Brazil. A survey was applied to blood donors in order to evaluate the possible factors associated to the presence of antibodies, including individual (gender and age), socioeconomic (scholarship, familial income and sanitary facilities) and habit information (contact with soil, geophagy, onycophagy and intake of raw/undercooked meat) as well as the presence of dogs or cats in the household. ELISA test was run for detection of the anti-Toxocara spp. IgG antibodies. Bivariate analysis followed by logistic regression was performed to evaluate the potential risk factors associated to seropositivity. Results The overall prevalence observed in this study was 8.7% (22/253). Contact with soil was the unique risk factor associated with the presence of antibodies (P=0.017 8; OR=3.52; 95% CI=1.244-9.995). Conclusions The results of this study reinforce the necessity in promoting preventive public health measures, even for healthy adult individual, particularly those related to the deworming of pets to avoid the soil contamination, and hygiene education of the population. PMID:23620840

  1. Oral mucosal lesions in Indians from Northeast Brazil: cross-sectional study of prevalence and risk indicators.

    PubMed

    Cury, Patricia Ramos; Porto, Lia Pontes Arruda; dos Santos, Jean Nunes; Figueiredo e Ribeiro, Livia Silva; de Aquino Xavier, Flavia Caló; Figueiredo, Andreia Leal; Ramalho, Luciana Maria Pedreira

    2014-12-01

    The aim of this cross-sectional study was to evaluate the prevalence of oral mucosal lesions, and their risk indicators in adult Kiriri Indians from Northeast Brazil. Clinical oral examination was performed on a representative sample of 223 Indians (age ≥ 19 years). A systematic evaluation of lips, labial mucosa and sulcus, commissures, buccal mucosa and sulcus, gingiva and alveolar ridge, tongue, floor of the mouth, and soft and hard palate was performed. Bivariate analysis was conducted to assess associations between mucosal conditions and age, gender, income, educational level, diabetic status, and smoking status. Mucosal lesions were found in 50 participants (22.4%). The most prevalent lesions were fistulae (6.2%) and traumatic ulcers (4.48%). Oral mucosal was associated with higher age (≥ 35 years; odds ratio [OR] = 1.99, 95% confidence interval [CI]: 1.05-3.76, P = 0.03) and lower education level (<9 years; OR = 2.13, 95% CI: 0.96-4.71, P = 0.06). Mucosal conditions are prevalent in Kiriri Indians and the presence of mucosal lesions is associated with advanced age and lower education. A public health program aimed at preventing and treating mucosal lesions and targeted toward the high-risk group is vital to improve the oral health status of this population. PMID:25501053

  2. Postpartum posttraumatic stress disorder in a fetal high-risk maternity hospital in the city of Rio de Janeiro, Brazil.

    PubMed

    Henriques, Tatiana; Moraes, Claudia Leite de; Reichenheim, Michael E; Azevedo, Gustavo Lobato de; Coutinho, Evandro Silva Freire; Figueira, Ivan Luiz de Vasconcellos

    2015-12-01

    The objectives of this study were to estimate the prevalence of postpartum posttraumatic stress disorder (PTSD) in a maternity hospital for fetal high-risk pregnancies and to identify vulnerable subgroups. This was a cross-sectional study at a fetal high-risk maternity hospital in Rio de Janeiro, Brazil, with a sample of 456 women who had given birth at this hospital. The Trauma History Questionnaire and Post-Traumatic Stress Disorder Checklist were used to screen for lifetime traumatic events and PTSD symptoms, respectively. Overall prevalence of PTSD was 9.4%. Higher PTSD prevalence was associated with three or more births, a newborn with a 1-minute Apgar score of seven or less, history of mental disorder prior to or during the index pregnancy, postpartum depression, physical or psychological intimate partner violence during the pregnancy, a history of unwanted sexual experience, and lifetime exposure to five or more traumas. Rapid diagnosis and treatment of PTSD are essential to improve the mother's quality of life and the infant's health. PMID:26872229

  3. Assessing the risk of bovine fasciolosis using linear regression analysis for the state of Rio Grande do Sul, Brazil.

    PubMed

    Silva, Ana Elisa Pereira; Freitas, Corina da Costa; Dutra, Luciano Vieira; Molento, Marcelo Beltrão

    2016-02-15

    Fasciola hepatica is the causative agent of fasciolosis, a disease that triggers a chronic inflammatory process in the liver affecting mainly ruminants and other animals including humans. In Brazil, F. hepatica occurs in larger numbers in the most Southern state of Rio Grande do Sul. The objective of this study was to estimate areas at risk using an eight-year (2002-2010) time series of climatic and environmental variables that best relate to the disease using a linear regression method to municipalities in the state of Rio Grande do Sul. The positivity index of the disease, which is the rate of infected animal per slaughtered animal, was divided into three risk classes: low, medium and high. The accuracy of the known sample classification on the confusion matrix for the low, medium and high rates produced by the estimated model presented values between 39 and 88% depending of the year. The regression analysis showed the importance of the time-based data for the construction of the model, considering the two variables of the previous year of the event (positivity index and maximum temperature). The generated data is important for epidemiological and parasite control studies mainly because F. hepatica is an infection that can last from months to years. PMID:26827853

  4. Informal Trade of Psychoactive Herbal Products in the City of Diadema, SP, Brazil: Quality and Potential Risks

    PubMed Central

    Soares Neto, Julino Assunção Rodrigues; Kato, Edna Myiake; Galduróz, José Carlos F.; Marques, Luis Carlos; Macrini, Thiago; Rodrigues, Eliana

    2013-01-01

    The present study aimed to assess the quality and risks involved in the consumption of psychoactive herbal products (PHs) that are available through informal commerce in the city of Diadema, SP, Brazil. Methods of ethnography were used to conduct the fieldwork during which four dealers were selected to record the collection, handling, packaging, types of PHs marketed, and their therapeutic purposes. In addition, lots of the PHs selected were purchased from the dealers and analyzed using microbiology and pharmacognosy techniques. 217 PHs were recorded and categorized into two main groups: stimulants (67%) and depressants (27%) of the central nervous system; sixteen of them were selected, and their 52 lots were acquired. The deficiencies observed in handling and packaging these lots by dealers were confirmed by microbiological analysis; 80.8% of them presented risk according to the indicators defined by the Brazilian Pharmacopoeia. The pharmacognostic analysis confirmed the authenticity of only 9 to 16 PHs analyzed. In addition, descriptions of contraindications, adverse reactions, and drug interactions were found in the literature for the PHs. The results of this study allow the observation of the priorities for the sanitary adequacy of the popular trade of herbs. PMID:23818934

  5. [Cardiovascular risk assessment and risk stratification- guided therapy: predict, prevent and individualize].

    PubMed

    Ural, Dilek

    2011-09-01

    Modern concept in primary prevention of cardiovascular diseases (CVD) entails assessing the person's global risk and making the right management in accordance with these results. Correspondingly, 3 steps recommended for the prevention of CVD under risk guidance are: (a) risk assessment via a proper system like Framingham Risk Score, SCORE, QRISK, PROCAM; (b) decision-making in the proper management in terms of informing the patient about lifestyle changes that he or she can cope and drug selection; and (c) evaluation of treatment decision in terms of cost effectiveness. Although, a significant decline is observed in CVD morbidity and mortality, particularly in the western countries, we still are trying to approach to competent quality measures about management under CV risk guidance. This review summarizes the main challenges regarding risk stratification-guided management strategy in primary prevention of CVD. PMID:21821497

  6. Prevalence and risk factors of Hepatitis C virus infection in Brazil, 2005 through 2009: a cross-sectional study

    PubMed Central

    2013-01-01

    Background Hepatitis C chronic liver disease is a major cause of liver transplant in developed countries. This article reports the first nationwide population-based survey conducted to estimate the seroprevalence of HCV antibodies and associated risk factors in the urban population of Brazil. Methods The cross sectional study was conducted in all Brazilian macro-regions from 2005 to 2009, as a stratified multistage cluster sample of 19,503 inhabitants aged between 10 and 69 years, representing individuals living in all 26 State capitals and the Federal District. Hepatitis C antibodies were detected by a third-generation enzyme immunoassay. Seropositive individuals were retested by Polymerase Chain Reaction and genotyped. Adjusted prevalence was estimated by macro-regions. Potential risk factors associated with HCV infection were assessed by calculating the crude and adjusted odds ratios, 95% confidence intervals (95% CI) and p values. Population attributable risk was estimated for multiple factors using a case–control approach. Results The overall weighted prevalence of hepatitis C antibodies was 1.38% (95% CI: 1.12%–1.64%). Prevalence of infection increased in older groups but was similar for both sexes. The multivariate model showed the following to be predictors of HCV infection: age, injected drug use (OR = 6.65), sniffed drug use (OR = 2.59), hospitalization (OR = 1.90), groups socially deprived by the lack of sewage disposal (OR = 2.53), and injection with glass syringe (OR = 1.52, with a borderline p value). The genotypes 1 (subtypes 1a, 1b), 2b and 3a were identified. The estimated population attributable risk for the ensemble of risk factors was 40%. Approximately 1.3 million individuals would be expected to be anti-HCV-positive in the country. Conclusions The large estimated absolute numbers of infected individuals reveals the burden of the disease in the near future, giving rise to costs for the health care system and society at

  7. Psychological Distress and Arrhythmia: Risk Prediction and Potential Modifiers

    PubMed Central

    Peacock, James; Whang, William

    2014-01-01

    The connection between the heart and the brain has long been anecdotally recognized but systematically studied only relatively recently. Cardiac arrhythmias, especially sudden cardiac death, remain a major public health concern and there is mounting evidence that psychological distress plays a critical role as both a predictor of high-risk cardiac substrate and as an inciting trigger. The transient, unpredictable nature of emotions and cardiac arrhythmias have made their study challenging, but evolving technologies in monitoring and imaging along with larger epidemiological data sets have encouraged more sophisticated studies examining this relationship. Here we review the research on psychological distress including anger, depression and anxiety on cardiac arrhythmias, insights into proposed mechanisms, and potential avenues for future research. PMID:23621968

  8. To predict or not to predict? The dilemma of predicting the risk of suboptimal cytoreduction in ovarian cancer.

    PubMed

    Kang, S; Park, S-Y

    2011-12-01

    Although maximal cytoreduction is the cornerstone of current treatment for patients with advanced ovarian cancer, optimal cytoreduction is not always achievable in the clinic. Therefore, using clinical characteristics, diagnostic imaging, serum biomarkers or laparoscopic findings, many studies have attempted to find models for predicting surgical resectability. However, most of these prediction models showed limited effectiveness and have not been properly validated. To establish a reliable prediction model, several requirements should be met. First, the goal of surgical cytoreduction should be adequately defined. Second, the desired accuracy for making the model clinically useful should be defined. Third, the model should test all relevant predictors, including clinical, radiological and biochemical predictors, and be developed using a large dataset that provides a sufficient number of events. Fourth, any prediction model should be validated with a relevant external dataset. Lastly, the prediction model should be able to aid decision making and, thereby, improve the outcome of patients. Therefore, randomized clinical trials with decision making based on prediction models are urgently required. PMID:22180395

  9. Development and Predictive Effects of Eating Disorder Risk Factors during Adolescence: Implications for Prevention Efforts

    PubMed Central

    Rohde, Paul; Stice, Eric; Marti, C. Nathan

    2014-01-01

    Objective Although several prospective studies have identified factors that increase risk for eating disorders, little is known about when these risk factors emerge and escalate, or when they begin to predict future eating disorder onset. The objective of this report was to address these key research gaps. Method Data were examined from a prospective study of 496 community female adolescents (M = 13.5, SD = 0.7 at baseline) who completed eight annual assessments of potential risk factors and eating disorders from preadolescence to young adulthood. Results Three variables exhibited positive linear increases: Perceived pressure to be thin, thin-ideal internalization and body dissatisfaction; three were best characterized as quadratic effects: dieting (essentially little change); negative affectivity (overall decrease), and BMI (overall increase). Elevated body dissatisfaction at ages 13, 14, 15, and 16 predicted DSM-5 eating disorders onset in the 4 year period after each assessment, but the predictive effects of other risk factors were largely confined to age 14; BMI did not predict eating disorders at any age. Discussion The results imply that these risk factors are present by early adolescence, though eating disorders tend to emerge in late adolescence and early adulthood. These findings emphasize the need for efficacious eating disorder prevention programs for early adolescent girls, perhaps targeting 14 year olds, when risk factors appear to be most predictive. In early adolescence, it might be fruitful to target girls with body dissatisfaction, as this was the most consistent predictor of early eating disorder onset in this study. PMID:24599841

  10. [The risk of urban yellow fever outbreaks in Brazil by dengue vectors. Aedes aegypti and Aedes albopictus].

    PubMed

    Mondet, B; da Rosa, A P; Vasconcelos, P F

    1996-01-01

    Urban yellow fever (YF) epidemics have disappeared from Brazil since about 50 years, but a selvatic cycle still exist. In many States, cases are more or less numerous each year. Ae. aegypti was eradicated in 1954, re-appeared temporarily in 1967, and then definitively in 1976-1977. Ae. aegypti is a vector of yellow few (YF), but also of dengue, whose first cases were reported in 1982. Today, dengue is endemic in many regions. A second Flavivirus vector, Aedes albopictus is present since about ten years in some States, from which Säo Paulo. The analysis of the YF cases between 1972 and 1994 allowed us to determine the epidemiologic regions. In the first region, the endemic area, the YF virus is circulating "silently" among monkeys, and the emergence of human cases is rare. In the second region, the epidemic area, some epizootics occur in a more or less cyclic way, and human cases can be numerous. Nevertheless, these outbreaks are considered "selvatic" epidemics, as long as Ae. aegypti is not concerned. From the Amazonian region, the virus moves forward along the forest galleries of the Amazone tributaries, from North to South. Actually, dengue epidemics appear in quite all States, and reflect the geographical distribution of Ae. aegypti. Recently, Ae. aegypti was found in the southern part of the Pará State, in the Carajás region considered to be the source of the main YF epidemics. In another hand, Ae. albopictus is now increasing its distribution area, specially in the suburban zones. The ecology of this potential vector, which seems to have a great adaptative capacity, give this vector an intermediate position between the forest galleries, where the YF virus circulates, and the agglomerations infested with Ae. aegypti. Since a few years, the possibility of urban YF is threatening Brazil, it is more and more predictable and we must survey very carefully the epidemiological situation in some regions of the country. PMID:8924767

  11. Predicted 10-year risk of cardiovascular disease among Canadian adults using modified Framingham Risk Score in association with dietary intake.

    PubMed

    Setayeshgar, Solmaz; Whiting, Susan J; Pahwa, Punam; Vatanparast, Hassanali

    2015-10-01

    Initial risk assessment to estimate 10-year risk of cardiovascular disease (CVD) is completed by Framingham Risk Score (FRS). In 2012 2 modifications were added to FRS by the Canadian Cardiovascular Society: FRS is doubled in subjects aged 30-59 years who have CVD present in a first-degree relative before 55 years of age for men and 65 years of age for women; and cardiovascular age is calculated for each individual. Our aim was to implement these modifications and evaluate differences compared with traditional FRS. Further, we evaluated the association between dietary intake and 10-year risk. The Canadian Health Measures Survey data cycle 1 was used among participants aged 30-74 years (n = 2730). Descriptive and logistic regression analyses were conducted using STATA SE 11. Using modified FRS for predicting 10-year risk of CVD significantly increased the estimated risk compared with the traditional approach, 8.66% ± 0.35% versus 6.06% ± 0.18%, respectively. Greater impact was observed with the "cardiovascular age" modification in men versus women. The distribution of Canadians in low- (<10%) and high-risk (≥20%) categories of CVD show a significant difference between modified and traditional FRS: 67.4% versus 79.6% (low risk) and 13.7% versus 4.5% (high risk), respectively. The odds of having risk ≥10% was significantly greater in low-educated, abdominally obese individuals or those with lower consumption of breakfast cereal and fruit and vegetable and greater potato and potato products consumption. In conclusion, the traditional FRS method significantly underestimates CVD risk in Canadians; thus, applying modified FRS is beneficial for screening. Additionally, fibre consumption from fruit and vegetable or breakfast cereals might be beneficial in reducing CVD risks. PMID:26417841

  12. Predictive Factors and Risk Mapping for Rift Valley Fever Epidemics in Kenya

    PubMed Central

    Munyua, Peninah M.; Murithi, R. Mbabu; Ithondeka, Peter; Hightower, Allen; Thumbi, Samuel M.; Anyangu, Samuel A.; Kiplimo, Jusper; Bett, Bernard; Vrieling, Anton; Breiman, Robert F.; Njenga, M. Kariuki

    2016-01-01

    Background To-date, Rift Valley fever (RVF) outbreaks have occurred in 38 of the 69 administrative districts in Kenya. Using surveillance records collected between 1951 and 2007, we determined the risk of exposure and outcome of an RVF outbreak, examined the ecological and climatic factors associated with the outbreaks, and used these data to develop an RVF risk map for Kenya. Methods Exposure to RVF was evaluated as the proportion of the total outbreak years that each district was involved in prior epizootics, whereas risk of outcome was assessed as severity of observed disease in humans and animals for each district. A probability-impact weighted score (1 to 9) of the combined exposure and outcome risks was used to classify a district as high (score ≥ 5) or medium (score ≥2 - <5) risk, a classification that was subsequently subjected to expert group analysis for final risk level determination at the division levels (total = 391 divisions). Divisions that never reported RVF disease (score < 2) were classified as low risk. Using data from the 2006/07 RVF outbreak, the predictive risk factors for an RVF outbreak were identified. The predictive probabilities from the model were further used to develop an RVF risk map for Kenya. Results The final output was a RVF risk map that classified 101 of 391 divisions (26%) located in 21 districts as high risk, and 100 of 391 divisions (26%) located in 35 districts as medium risk and 190 divisions (48%) as low risk, including all 97 divisions in Nyanza and Western provinces. The risk of RVF was positively associated with Normalized Difference Vegetation Index (NDVI), low altitude below 1000m and high precipitation in areas with solonertz, luvisols and vertisols soil types (p <0.05). Conclusion RVF risk map serves as an important tool for developing and deploying prevention and control measures against the disease. PMID:26808021

  13. Improving Personalized Clinical Risk Prediction Based on Causality-Based Association Rules

    PubMed Central

    Cheng, Chih-wen; Wang, May D.

    2016-01-01

    Developing clinical risk prediction models is one of the main tasks of healthcare data mining. Advanced data collection techniques in current Big Data era have created an emerging and urgent need for scalable, computer-based data mining methods. These methods can turn data into useful, personalized decision support knowledge in a flexible, cost-effective, and productive way. In our previous study, we developed a tool, called icuARM- II, that can generate personalized clinical risk prediction evidence using a temporal rule mining framework. However, the generation of final risk prediction possibility with icuARM-II still relied on human interpretation, which was subjective and, most of time, biased. In this study, we propose a new mechanism to improve icuARM-II’s rule selection by including the concept of causal analysis. The generated risk prediction is quantitatively assessed using calibration statistics. To evaluate the performance of the new rule selection mechanism, we conducted a case study to predict short-term intensive care unit mortality based on personalized lab testing abnormalities. Our results demonstrated a better-calibrated ICU risk prediction using the new causality-base rule selection solution by comparing with conventional confidence-only rule selection methods. PMID:27532063

  14. Predictive cytogenetic biomarkers for colorectal neoplasia in medium risk patients

    PubMed Central

    Ionescu, EM; Nicolaie, T; Ionescu, MA; Becheanu, G; Andrei, F; Diculescu, M; Ciocirlan, M

    2015-01-01

    Rationale: DNA damage and chromosomal alterations in peripheral lymphocytes parallels DNA mutations in tumor tissues. Objective: The aim of our study was to predict the presence of neoplastic colorectal lesions by specific biomarkers in “medium risk” individuals (age 50 to 75, with no personal or family of any colorectal neoplasia). Methods and Results: We designed a prospective cohort observational study including patients undergoing diagnostic or opportunistic screening colonoscopy. Specific biomarkers were analyzed for each patient in peripheral lymphocytes - presence of micronuclei (MN), nucleoplasmic bridges (NPB) and the Nuclear Division Index (NDI) by the cytokinesis-blocked micronucleus assay (CBMN). Of 98 patients included, 57 were “medium risk” individuals. MN frequency and NPB presence were not significantly different in patients with neoplastic lesions compared to controls. In “medium risk” individuals, mean NDI was significantly lower for patients with any neoplastic lesions (adenomas and adenocarcinomas, AUROC 0.668, p 00.5), for patients with advanced neoplasia (advanced adenoma and adenocarcinoma, AUROC 0.636 p 0.029) as well as for patients with adenocarcinoma (AUROC 0.650, p 0.048), for each comparison with the rest of the population. For a cut-off of 1.8, in “medium risk” individuals, an NDI inferior to that value may predict any neoplastic lesion with a sensitivity of 97.7%, an advanced neoplastic lesion with a sensitivity of 97% and adenocarcinoma with a sensitivity of 94.4%. Discussion: NDI score may have a role as a colorectal cancer-screening test in “medium risk” individuals. Abbreviations: DNA = deoxyribonucleic acid; CRC = colorectal cancer; EU = European Union; WHO = World Health Organization; FOBT = fecal occult blood test; CBMN = cytokinesis-blocked micronucleus assay; MN = micronuclei; NPB = nucleoplasmic bridges; NDI = Nuclear Division Index; FAP = familial adenomatous polyposis; HNPCC = hereditary non

  15. Unravelling the structure of species extinction risk for predictive conservation science

    PubMed Central

    Lee, Tien Ming; Jetz, Walter

    2011-01-01

    Extinction risk varies across species and space owing to the combined and interactive effects of ecology/life history and geography. For predictive conservation science to be effective, large datasets and integrative models that quantify the relative importance of potential factors and separate rapidly changing from relatively static threat drivers are urgently required. Here, we integrate and map in space the relative and joint effects of key correlates of The International Union for Conservation of Nature-assessed extinction risk for 8700 living birds. Extinction risk varies significantly with species' broad-scale environmental niche, geographical range size, and life-history and ecological traits such as body size, developmental mode, primary diet and foraging height. Even at this broad scale, simple quantifications of past human encroachment across species' ranges emerge as key in predicting extinction risk, supporting the use of land-cover change projections for estimating future threat in an integrative setting. A final joint model explains much of the interspecific variation in extinction risk and provides a remarkably strong prediction of its observed global geography. Our approach unravels the species-level structure underlying geographical gradients in extinction risk and offers a means of disentangling static from changing components of current and future threat. This reconciliation of intrinsic and extrinsic, and of past and future extinction risk factors may offer a critical step towards a more continuous, forward-looking assessment of species' threat status based on geographically explicit environmental change projections, potentially advancing global predictive conservation science. PMID:20943690

  16. Prevalence of hepatitis C virus among users attending a voluntary testing centre in Rio Grande, southern Brazil: predictive factors and hepatitis C virus genotypes.

    PubMed

    Germano, F N; dos Santos, C A; Honscha, G; Strasburg, A; Gabbi, B; Mendoza-Sassi, R A; Soares, E A; Seuánez, H N; Soares, M A; Martínez, A M B

    2010-07-01

    We estimated the prevalence of hepatitis C (HCV) infection and associated risk factors in 750 individuals attending the Voluntary Counseling and Testing Center of Rio Grande (VCT/RG), in Southern Brazil, and identified viral genotypes. Demographic data and risk factors for HCV transmission were also collected and analysed. Anti-HCV antibody-positive individuals were tested for HCV-RNA and genotyped by sequencing the 5' untranslated region of the viral genome. Prevalence estimates of anti-HCV and HCV-RNA were 6% and 5.5%, respectively. We identified genotypes 1 (67%), 2 (2%) and 3 (31%); the latter was more prevalent than in other regions of Brazil. Anti-HCV prevalence in VCT/RG users was similar to previous reports. Age, previous blood transfusion, sexual orientation and injecting drug use were independent predictors of HCV infection. The presence of multiple risk factors was also associated with a higher risk for HCV infection. HCV genotype was not associated with any variable analysed in this study. PMID:20852195

  17. A Risk Score to Predict Hypertension in Primary Care Settings in Rural India.

    PubMed

    Sathish, Thirunavukkarasu; Kannan, Srinivasan; Sarma, P Sankara; Razum, Oliver; Thrift, Amanda Gay; Thankappan, Kavumpurathu Raman

    2016-01-01

    We used the data of 297 participants (15-64 years old) from a cohort study (2003-2010) who were free from hypertension at baseline, to develop a risk score to predict hypertension by primary health care workers in rural India. Age ≥35 years, current smoking, prehypertension, and central obesity were significantly associated with incident hypertension. The optimal cutoff value of ≥3 had a sensitivity of 78.6%, specificity of 65.2%, positive predictive value of 41.1%, and negative predictive value of 90.8%. The area under the receiver operating characteristic curve of the risk score was 0.802 (95% confidence interval = 0.748-0.856). This simple and easy to administer risk score could be used to predict hypertension in primary care settings in rural India. PMID:26354334

  18. Cardiovascular risk prediction: a comparative study of Framingham and quantum neural network based approach

    PubMed Central

    Narain, Renu; Saxena, Sanjai; Goyal, Achal Kumar

    2016-01-01

    Purpose Currently cardiovascular diseases (CVDs) are the main cause of death worldwide. Disease risk estimates can be used as prognostic information and support for treating CVDs. The commonly used Framingham risk score (FRS) for CVD prediction is outdated for the modern population, so FRS may not be accurate enough. In this paper, a novel CVD prediction system based on machine learning is proposed. Methods This study has been conducted with the data of 689 patients showing symptoms of CVD. Furthermore, the dataset of 5,209 CVD patients of the famous Framingham study has been used for validation purposes. Each patient’s parameters have been analyzed by physicians in order to make a diagnosis. The proposed system uses the quantum neural network for machine learning. This system learns and recognizes the pattern of CVD. The proposed system has been experimentally evaluated and compared with FRS. Results During testing, patients’ data in combination with the doctors’ diagnosis (predictions) are used for evaluation and validation. The proposed system achieved 98.57% accuracy in predicting the CVD risk. The CVD risk predictions by the proposed system, using the dataset of the Framingham study, confirmed the potential risk of death, deaths which actually occurred and had been recorded as due to myocardial infarction and coronary heart disease in the dataset of the Framingham study. The accuracy of the proposed system is significantly higher than FRS and other existing approaches. Conclusion The proposed system will serve as an excellent tool for a medical practitioner in predicting the risk of CVD. This system will be serving as an aid to medical practitioners for planning better medication and treatment strategies. An early diagnosis may be effectively made by using this system. An overall accuracy of 98.57% has been achieved in predicting the risk level. The accuracy is considerably higher compared to the other existing approaches. Thus, this system must be used

  19. A Global Risk Score (GRS) to Simultaneously Predict Early and Late Tumor Recurrence Risk after Resection of Hepatocellular Carcinoma1

    PubMed Central

    Dekervel, Jeroen; Popovic, Dusan; van Malenstein, Hannah; Windmolders, Petra; Heylen, Line; Libbrecht, Louis; Bulle, Ashenafi; De Moor, Bart; Van Cutsem, Eric; Nevens, Frederik; Verslype, Chris; van Pelt, Jos

    2016-01-01

    OBJECTIVES: Recurrence of hepatocellular carcinoma can arise from the primary tumor (“early recurrence”) or de novo from tumor formation in a cirrhotic environment (“late recurrence”). We aimed to develop one simple gene expression score applicable in both the tumor and the surrounding liver that can predict the recurrence risk. METHODS: We determined differentially expressed genes in a cell model of cancer aggressiveness. These genes were first validated in three large published data sets of hepatocellular carcinoma from which we developed a seven-gene risk score. RESULTS: The gene score was applied on two independent large patient cohorts. In the first cohort, with only tumor data available, it could predict the recurrence risk at 3 years after resection (68 ± 10% vs 35 ± 7%, P = .03). In the second cohort, when applied on the tumor, this gene score predicted early recurrence (62 ± 5% vs 37 ± 4%, P < .001), and when applied on the surrounding liver tissue, the same genes also correlated with late recurrence. Four patient classes with each different time patterns and rates of recurrence could be identified based on combining tumor and liver scores. In a multivariate Cox regression analysis, our gene score remained significantly associated with recurrence, independent from other important cofactors such as disease stage (P = .007). CONCLUSIONS: We developed a Global Risk Score that is able to simultaneously predict the risk of early recurrence when applied on the tumor itself, as well as the risk of late recurrence when applied on the surrounding liver tissue. PMID:27084430

  20. The role of the implementation of policies for the prevention of exposure to Radon in Brazil-a strategy for controlling the risk of developing lung cancer.

    PubMed

    Lino, Aline da Rocha; Abrahão, Carina Meira; Amarante, Marcus Paulo Fernandes; de Sousa Cruz, Marcelo Rocha

    2015-01-01

    Lung cancer is the leading cause of cancer death in the United States and other industrialised countries. The most important risk factor is active smoking. However, given the increased incidence of lung cancer in non-smokers, it is necessary to improve knowledge regarding other risk factors. Radon (Rn) is a noble gas and is the most important natural source of human exposure to ionizing radiation. Exposure to high levels of this radioactive gas is related to an increased risk of developing lung cancer. The objective of this work is to highlight the importance of measuring indoor concentration of this gas and identify which steps should be taken for achieving radiological protection. A survey was conducted on the websites of the National Health Surveillance Agency (ANVISA), LAMIN (Mineral Analysis Laboratory), CPRM (Geological Survey of Brazil), Ministry of Health and PubMed. Using the words 'radon', 'lung', 'cancer', and PubMed®, 1,371 results were obtained; when using the words 'radon', 'lung', 'cancer', and with 'Brazil' or 'Brazilians', only six results were obtained. We emphasise that lung cancer is a major public health problem and the exposure to Rn indoors should be considered as a risk factor for lung cancer in non-smokers. Buildings or houses with high concentrations of Rn should be identified. However, currently in Brazil-a country with great potential for mineral extraction-there are no specific regulated recommendations to control indoor exposure to Rn. PMID:26435745

  1. Perceived Susceptibility to AIDS Predicts Subsequent HIV Risk: A Longitudinal Evaluation of Jail Inmates

    PubMed Central

    Adams, Leah M.; Stuewig, Jeffrey B.; Tangney, June P.; Kashdan, Todd B.

    2013-01-01

    Theories of health behavior change suggest that perceived susceptibility to illness precedes health-protective behavior. We used a cross-lagged panel design to explore the relationship between perceived susceptibility to AIDS, and HIV risk behavior pre-incarceration and post-release in a sample of 499 jail inmates, a group at high risk for HIV. We also explored moderators of this relationship. HIV risk was calculated with a Bernoulli mathematical process model. Controlling for pre-incarceration HIV risk, perceived susceptibility to AIDS predicted less post-release HIV risk; the reverse relationship was not supported. Consistent with health behavior change theories, perceived susceptibility seemed to partially guide behavior. However, this relationship was not true for everyone. African-Americans and individuals high in borderline personality features exhibited no relationship between perceived susceptibility and changes in HIV risk. This suggests that targeted interventions are needed to use information about risk level to prevent HIV contraction. PMID:23591920

  2. Perceived susceptibility to AIDS predicts subsequent HIV risk: a longitudinal evaluation of jail inmates.

    PubMed

    Adams, Leah M; Stuewig, Jeffrey B; Tangney, June P; Kashdan, Todd B

    2014-06-01

    Theories of health behavior change suggest that perceived susceptibility to illness precedes health-protective behavior. We used a cross-lagged panel design to explore the relationship between perceived susceptibility to AIDS, and HIV risk behavior pre-incarceration and post-release in a sample of 499 jail inmates, a group at high risk for HIV. We also explored moderators of this relationship. HIV risk was calculated with a Bernoulli mathematical process model. Controlling for pre-incarceration HIV risk, perceived susceptibility to AIDS predicted less post-release HIV risk; the reverse relationship was not supported. Consistent with health behavior change theories, perceived susceptibility seemed to partially guide behavior. However, this relationship was not true for everyone. African-Americans and individuals high in borderline personality features exhibited no relationship between perceived susceptibility and changes in HIV risk. This suggests that targeted interventions are needed to use information about risk level to prevent HIV contraction. PMID:23591920

  3. The simultaneous presence of health risk behaviors in freshman college students in Brazil.

    PubMed

    Silva, Diego Augusto Santos; Petroski, Edio Luiz

    2012-06-01

    The objective of this study was to assess the prevalence and factors associated with simultaneous health risk behaviors in freshmen college students enrolled in a Brazilian university. We interviewed 738 students (59.2% men) with average age of 20.1 years (CI 95%: 19.8-20.5). The risk behaviors assessed were smoking habit, alcohol use, unhealthy diet and physical inactivity. Independent variables were sex, age, employment, marital status, maternal education, study shift and socioeconomic level. It was found that 8.7% were smokers, 45.9% showed alcohol abuse, 59.4% had inadequate diet and 18.5% were physically inactive. Of the students, 20.2% showed no risk behavior, 39.1% one behavior, 29.0% two risk behaviors and 11.7% three and/or four risk behaviors. Males (OR: 2.04, CI 95%: 1.13-3.67) and night shift students (OR: 1.83, CI 95%: 1.01-3.33) were more likely to have three and/or four risk behaviors. Health promotion interventions focusing simultaneous behavior changes should be employed at the university. PMID:21979565

  4. Prediction models for cardiovascular disease risk in the general population: systematic review

    PubMed Central

    Hooft, Lotty; Schuit, Ewoud; Debray, Thomas P A; Collins, Gary S; Tzoulaki, Ioanna; Lassale, Camille M; Siontis, George C M; Chiocchia, Virginia; Roberts, Corran; Schlüssel, Michael Maia; Gerry, Stephen; Black, James A; Heus, Pauline; van der Schouw, Yvonne T; Peelen, Linda M; Moons, Karel G M

    2016-01-01

    Objective To provide an overview of prediction models for risk of cardiovascular disease (CVD) in the general population. Design Systematic review. Data sources Medline and Embase until June 2013. Eligibility criteria for study selection Studies describing the development or external validation of a multivariable model for predicting CVD risk in the general population. Results 9965 references were screened, of which 212 articles were included in the review, describing the development of 363 prediction models and 473 external validations. Most models were developed in Europe (n=167, 46%), predicted risk of fatal or non-fatal coronary heart disease (n=118, 33%) over a 10 year period (n=209, 58%). The most common predictors were smoking (n=325, 90%) and age (n=321, 88%), and most models were sex specific (n=250, 69%). Substantial heterogeneity in predictor and outcome definitions was observed between models, and important clinical and methodological information were often missing. The prediction horizon was not specified for 49 models (13%), and for 92 (25%) crucial information was missing to enable the model to be used for individual risk prediction. Only 132 developed models (36%) were externally validated and only 70 (19%) by independent investigators. Model performance was heterogeneous and measures such as discrimination and calibration were reported for only 65% and 58% of the external validations, respectively. Conclusions There is an excess of models predicting incident CVD in the general population. The usefulness of most of the models remains unclear owing to methodological shortcomings, incomplete presentation, and lack of external validation and model impact studies. Rather than developing yet another similar CVD risk prediction model, in this era of large datasets, future research should focus on externally validating and comparing head-to-head promising CVD risk models that already exist, on tailoring or even combining these models to local

  5. Predicting the Unpredictable? Identifying High-Risk versus Low-Risk Parents with Intellectual Disabilities

    ERIC Educational Resources Information Center

    McGaw, Sue; Scully, Tamara; Pritchard, Colin

    2010-01-01

    Objectives: This study set out to identify risk factors affecting parents with intellectual disabilities (IDs) by determining: (i) whether perception of family support differs between parents with IDs, referring professionals, and a specialist parenting service; (ii) whether multivariate familial and demographic factors differentiates "high-risk"…

  6. Utilizing Dental Electronic Health Records Data to Predict Risk for Periodontal Disease.

    PubMed

    Thyvalikakath, Thankam P; Padman, Rema; Vyawahare, Karnali; Darade, Pratiksha; Paranjape, Rhucha

    2015-01-01

    Periodontal disease is a major cause for tooth loss and adversely affects individuals' oral health and quality of life. Research shows its potential association with systemic diseases like diabetes and cardiovascular disease, and social habits such as smoking. This study explores mining potential risk factors from dental electronic health records to predict and display patients' contextualized risk for periodontal disease. We retrieved relevant risk factors from structured and unstructured data on 2,370 patients who underwent comprehensive oral examinations at the Indiana University School of Dentistry, Indianapolis, IN, USA. Predicting overall risk and displaying relationships between risk factors and their influence on the patient's oral and general health can be a powerful educational and disease management tool for patients and clinicians at the point of care. PMID:26262380

  7. Assessment of uncertainties in radiation-induced cancer risk predictions at clinically relevant doses

    SciTech Connect

    Nguyen, J.; Moteabbed, M.; Paganetti, H.

    2015-01-15

    Purpose: Theoretical dose–response models offer the possibility to assess second cancer induction risks after external beam therapy. The parameters used in these models are determined with limited data from epidemiological studies. Risk estimations are thus associated with considerable uncertainties. This study aims at illustrating uncertainties when predicting the risk for organ-specific second cancers in the primary radiation field illustrated by choosing selected treatment plans for brain cancer patients. Methods: A widely used risk model was considered in this study. The uncertainties of the model parameters were estimated with reported data of second cancer incidences for various organs. Standard error propagation was then subsequently applied to assess the uncertainty in the risk model. Next, second cancer risks of five pediatric patients treated for cancer in the head and neck regions were calculated. For each case, treatment plans for proton and photon therapy were designed to estimate the uncertainties (a) in the lifetime attributable risk (LAR) for a given treatment modality and (b) when comparing risks of two different treatment modalities. Results: Uncertainties in excess of 100% of the risk were found for almost all organs considered. When applied to treatment plans, the calculated LAR values have uncertainties of the same magnitude. A comparison between cancer risks of different treatment modalities, however, does allow statistically significant conclusions. In the studied cases, the patient averaged LAR ratio of proton and photon treatments was 0.35, 0.56, and 0.59 for brain carcinoma, brain sarcoma, and bone sarcoma, respectively. Their corresponding uncertainties were estimated to be potentially below 5%, depending on uncertainties in dosimetry. Conclusions: The uncertainty in the dose–response curve in cancer risk models makes it currently impractical to predict the risk for an individual external beam treatment. On the other hand, the ratio

  8. Assessment of uncertainties in radiation-induced cancer risk predictions at clinically relevant doses

    PubMed Central

    Nguyen, J.; Moteabbed, M.; Paganetti, H.

    2015-01-01

    Purpose: Theoretical dose–response models offer the possibility to assess second cancer induction risks after external beam therapy. The parameters used in these models are determined with limited data from epidemiological studies. Risk estimations are thus associated with considerable uncertainties. This study aims at illustrating uncertainties when predicting the risk for organ-specific second cancers in the primary radiation field illustrated by choosing selected treatment plans for brain cancer patients. Methods: A widely used risk model was considered in this study. The uncertainties of the model parameters were estimated with reported data of second cancer incidences for various organs. Standard error propagation was then subsequently applied to assess the uncertainty in the risk model. Next, second cancer risks of five pediatric patients treated for cancer in the head and neck regions were calculated. For each case, treatment plans for proton and photon therapy were designed to estimate the uncertainties (a) in the lifetime attributable risk (LAR) for a given treatment modality and (b) when comparing risks of two different treatment modalities. Results: Uncertainties in excess of 100% of the risk were found for almost all organs considered. When applied to treatment plans, the calculated LAR values have uncertainties of the same magnitude. A comparison between cancer risks of different treatment modalities, however, does allow statistically significant conclusions. In the studied cases, the patient averaged LAR ratio of proton and photon treatments was 0.35, 0.56, and 0.59 for brain carcinoma, brain sarcoma, and bone sarcoma, respectively. Their corresponding uncertainties were estimated to be potentially below 5%, depending on uncertainties in dosimetry. Conclusions: The uncertainty in the dose–response curve in cancer risk models makes it currently impractical to predict the risk for an individual external beam treatment. On the other hand, the ratio

  9. Anxiety and depression symptoms as risk factors for non-adherence to antiretroviral therapy in Brazil

    PubMed Central

    Campos, Lorenza Nogueira; Guimarães, Mark Drew Crosland; Remien, Robert H.

    2009-01-01

    Depression and anxiety are common among HIV-infected people and rank among the strongest predictors of non-adherence to antiretroviral therapy (ART). This longitudinal study aimed to assess whether symptoms of anxiety and depression are predictors of non-adherence among patients initiating ART at two public referral centers (n=293) in Belo Horizonte, Brazil. Prevalence of severe anxiety and depression symptoms before starting ART was 12.6% and 5.8%, respectively. Severe anxiety was a predictor of non-adherence to ART during follow-up period (RH=1.87; 95% CI=1.14–3.06) adjusted for low education, unemployment, alcohol use in the last month and symptoms of AIDS; while a history of injection drug use had borderline statistical significance with non-adherence. These findings suggest that using a brief screening procedure to assess anxiety and depression symptoms before initiating ART help identify individuals for interventions to improve adherence and quality of life. PMID:18648925

  10. Risk factors for treatment delay in pulmonary tuberculosis in Recife, Brazil

    PubMed Central

    dos Santos, Martinho APS; Albuquerque, Maria FPM; Ximenes, Ricardo AA; Lucena-Silva, Norma LCL; Braga, Cynthia; Campelo, Antônio RL; Dantas, Odimariles MS; Montarroyos, Ulisses R; Souza, Wayner V; Kawasaki, Alexandre M; Rodrigues, Laura C

    2005-01-01

    Background Tuberculosis is still a great challenge to public health in Brazil and worldwide. Early detection followed by effective therapy is extremely important in controlling the disease. Recent studies have investigated reasons for delays in treatment, but there is no agreed definition of what constitutes an "acceptable" delay. This study investigates factors associated with total delay in treatment of tuberculosis. Methods A cohort of adult cases of pulmonary tuberculosis diagnosed over a two-year period was studied. Patients were interviewed on entry, reporting the duration of symptoms before the start of treatment, and sputum and blood samples were collected. It was decided that sixty days was an acceptable total delay. Associations were investigated using univariable and multivariable analysis and the population attributable fraction was estimated. Results Of 1105 patients, 62% had a delay of longer than 60 days. Age, sex, alcoholism and difficulty of access were not associated with delays, but associations were found in the case of unemployment, having given up smoking, having lost weight and being treated in two of the six health districts. The proportion attributable to: not being an ex-smoker was 31%; unemployment, 18%; weight loss, 12%, and going to the two worst health districts, 25%. Conclusion In this urban area, delays seem to be related to unemployment and general attitudes towards health. Although they reflect the way health services are organized, delays are not associated with access to care. PMID:15777473

  11. The environmental risk as a culture in the Sinos Valley, Brazil.

    PubMed

    Pedde, Valdir; Figueiredo, João A; Tundisi, José G; Lenz, Cátia A

    2014-12-01

    The proposal of analysis of the social-environmental perception will be developed from the discourse as a constitutive element of reality. The discourse practices and their concretion will be the source of meaning and social-cultural value. Thus, the chosen research method was the qualitative and quantitative case study. In the first part of the text we will recapture a theoretical input by Mary Douglas on risk and culture, as well as on the acceptance of the risks in society. In the second part, we cover a few data of the case of the risks resulting from the tanning industry and on how the society of the "Vale do Rio dos Sinos" relates to these risks. In this article we conclude that risk perception of the population is directly related with past experiences, thus, assigning a meaning to all new events. This meaning is the result of a sociocultural construction. It is worth noting that behind this history, there are basic issues related to population survival, i.e., both the industrialists and workers establish partnerships when the society creates a movement against the leather industry. PMID:25590748

  12. The environmental risk as a culture in the Sinos Valley, Brazil.

    PubMed

    Pedde, Valdir; Figueiredo, João A; Tundisi, José G; Lenz, Cátia A

    2014-12-01

    The proposal of analysis of the social-environmental perception will be developed from the discourse as a constitutive element of reality. The discourse practices and their concretion will be the source of meaning and social-cultural value. Thus, the chosen research method was the qualitative and quantitative case study. In the first part of the text we will recapture a theoretical input by Mary Douglas on risk and culture, as well as on the acceptance of the risks in society. In the second part, we cover a few data of the case of the risks resulting from the tanning industry and on how the society of the "Vale do Rio dos Sinos" relates to these risks. In this article we conclude that risk perception of the population is directly related with past experiences, thus, assigning a meaning to all new events. This meaning is the result of a sociocultural construction. It is worth noting that behind this history, there are basic issues related to population survival, i.e., both the industrialists and workers establish partnerships when the society creates a movement against the leather industry. PMID:25493693

  13. Evaluation of the Modified Asthma Predictive Index in High-Risk Preschool Children

    PubMed Central

    Chang, Timothy S.; Lemanske, Robert F.; Guilbert, Theresa W.; Gern, James E.; Coen, Michael H.; Evans, Michael D.; Gangnon, Ronald E.; Page, C. David; Jackson, Daniel J.

    2013-01-01

    BACKGROUND Prediction of subsequent school-age asthma during the preschool years has proven challenging. OBJECTIVE To confirm in a post hoc analysis the predictive ability of the modified Asthma Predictive Index (mAPI) in a high-risk cohort and a theoretical unselected population. We also tested a potential mAPI modification with a 2-wheezing episode requirement (m2API) in the same populations. METHODS Subjects (n = 289) with a family history of allergy and/or asthma were used to predict asthma at age 6, 8, and 11 years with the use of characteristics collected during the first 3 years of life. The mAPI and the m2API were tested for predictive value. RESULTS For the mAPI and m2API, school-age asthma prediction improved from 1 to 3 years of age. The mAPI had high predictive value after a positive test (positive likelihood ratio ranging from 4.9 to 55) for asthma development at years 6, 8, and 11. Lowering the number of wheezing episodes to 2 (m2API) lowered the predictive value after a positive test (positive likelihood ratio ranging from 1.91 to 13.1) without meaningfully improving the predictive value of a negative test. Posttest probabilities for a positive mAPI reached 72% and 90% in unselected and high-risk populations, respectively. CONCLUSIONS In a high-risk cohort, a positive mAPI greatly increased future asthma probability (eg, 30% pretest probability to 90% posttest probability) and is a preferred predictive test to the m2API. With its more favorable positive posttest probability, the mAPI can aid clinical decision making in assessing future asthma risk for preschool-age children. PMID:24187656

  14. The assisted prediction modelling frame with hybridisation and ensemble for business risk forecasting and an implementation

    NASA Astrophysics Data System (ADS)

    Li, Hui; Hong, Lu-Yao; Zhou, Qing; Yu, Hai-Jie

    2015-08-01

    The business failure of numerous companies results in financial crises. The high social costs associated with such crises have made people to search for effective tools for business risk prediction, among which, support vector machine is very effective. Several modelling means, including single-technique modelling, hybrid modelling, and ensemble modelling, have been suggested in forecasting business risk with support vector machine. However, existing literature seldom focuses on the general modelling frame for business risk prediction, and seldom investigates performance differences among different modelling means. We reviewed researches on forecasting business risk with support vector machine, proposed the general assisted prediction modelling frame with hybridisation and ensemble (APMF-WHAE), and finally, investigated the use of principal components analysis, support vector machine, random sampling, and group decision, under the general frame in forecasting business risk. Under the APMF-WHAE frame with support vector machine as the base predictive model, four specific predictive models were produced, namely, pure support vector machine, a hybrid support vector machine involved with principal components analysis, a support vector machine ensemble involved with random sampling and group decision, and an ensemble of hybrid support vector machine using group decision to integrate various hybrid support vector machines on variables produced from principle components analysis and samples from random sampling. The experimental results indicate that hybrid support vector machine and ensemble of hybrid support vector machines were able to produce dominating performance than pure support vector machine and support vector machine ensemble.

  15. Predicting Stroke Risk Based on Health Behaviours: Development of the Stroke Population Risk Tool (SPoRT)

    PubMed Central

    Manuel, Douglas G.; Tuna, Meltem; Perez, Richard; Tanuseputro, Peter; Hennessy, Deirdre; Bennett, Carol; Rosella, Laura; Sanmartin, Claudia; van Walraven, Carl; Tu, Jack V.

    2015-01-01

    Background Health behaviours, important factors in cardiovascular disease, are increasingly a focus of prevention. We appraised whether stroke risk can be accurately assessed using self-reported information focused on health behaviours. Methods Behavioural, sociodemographic and other risk factors were assessed in a population-based survey of 82 259 Ontarians who were followed for a median of 8.6 years (688 000 person-years follow-up) starting in 2001. Predictive algorithms for 5-year incident stroke resulting in hospitalization were created and then validated in a similar 2007 survey of 28 605 respondents (median 4.2 years follow-up). Results We observed 3 236 incident stroke events (1 551 resulting in hospitalization; 1 685 in the community setting without hospital admission). The final algorithms were discriminating (C-stat: 0.85, men; 0.87, women) and well-calibrated (in 65 of 67 subgroups for men; 61 of 65 for women). An index was developed to summarize cumulative relative risk of incident stroke from health behaviours and stress. For men, each point on the index corresponded to a 12% relative risk increase (180% risk difference, lowest (0) to highest (9) scores). For women, each point corresponded to a 14% relative risk increase (340% difference, lowest (0) to highest (11) scores). Algorithms for secondary stroke outcomes (stroke resulting in death; classified as ischemic; excluding transient ischemic attack; and in the community setting) had similar health behaviour risk hazards. Conclusion Incident stroke can be accurately predicted using self-reported information focused on health behaviours. Risk assessment can be performed with population health surveys to support population health planning or outside of clinical settings to support patient-focused prevention. PMID:26637172

  16. Risk perception in family health work: study with workers in Southern Brazil.

    PubMed

    Cezar-Vaz, Marta Regina; Soares, Jorgana Fernanda de Souza; Figueiredo, Paula Pereira de; Azambuja, Eliana Pinho de; Sant'anna, Cynthia Fontella; Costa, Valdecir Zavarese da

    2009-01-01

    This analytical and qualitative study aimed to identify how workers in the Family Health Strategy perceive the risks they are exposed to at work. Thematic analysis and the reference framework of the work process were used to examine the contents of interviews with 48 subjects (community health agents, nurses, nursing auxiliaries and physicians). The workers noticed the following risks: physical and moral violence, typical work accident, emotional exhaustion, lack of problem-solving ability and occupational disease. The results predominantly show the connection with the object / subject of the work and the social environmental characteristics of the related communities. The study adds to the body of knowledge and can systemize collective and individual technological processes for occupational health risk management in primary health care. PMID:20126937

  17. Assessment of the landslide and flood risks in São Paulo City, Brazil

    NASA Astrophysics Data System (ADS)

    Vieira, Bianca; Listo, Fabrízio

    2010-05-01

    In Brazilian cities, especially during summer, the landslides and floods cause disaster and economic losses. Aricanduva basin is one of the most critical in the Metropolitan Region of São Paulo (RMSP), where many types of morphodynamic processes occur. This is the largest river basin in São Paulo City. The current situation is characterized by intense urbanization, soil sealing and consequent reduction of soil infiltration, increasing the frequency of flood events in this area. Thus, the main objective of this paper is to map risk areas of landslides and floods in the sub-basin Limoeiro, located in the head of the Aricanduva basin. For mapping the risk areas, we prepared a record field to floods and landslides, based on several studies. Initially, it were identified the natural indicators (vegetation, topography, surface cover and drainage) and anthropogenic (urban pattern, soil cover, building types, occupation density, road conditions, infrastructure, drainage systems, distance between houses and slope, at the top and base, and the drainage channel). On the second step of this research, we identified the evidences of mass movements (scars, cracks, subsidence, trees, poles and inclined walls). Thus, on the basis of this analysis it was possible to define the risk probability: R1 (low or no risk), R2 (moderate), R3 (high) and, R4 (very high). Subsequently, by means of oblique photographs (taken from helicopter flight) it was possible to define risk areas in the basin. In all the sectors identified, were recorded approximately 903 urban settlements. The results showed that from the 25 sectors of risk, 14 sectors (56%) presented landslide risk and 11 (44%), flood risk. Of the sectors that showed landslide risk areas, 21% have very high probability (R4), 21% high (R3), 29% moderate (R2) and 29% low (R1). The sectors at flood risk presented 45% of very high probability (R4), 10% high (R3), 18% moderate (R2) and 27% low (R1). There is large presence of sediments from

  18. Persisting arthralgia due to Mayaro virus infection in a traveler from Brazil: is there a risk for attendants to the 2014 FIFA World Cup?

    PubMed

    Slegers, C A D; Keuter, M; Günther, S; Schmidt-Chanasit, J; van der Ven, A J; de Mast, Q

    2014-07-01

    The 2014 FIFA World Cup and the 2016 Olympic Games will attract large groups of visitors to Brazil. These visitors will be at risk for different arboviral infections, some of which not well known outside endemic areas. We report a case of a 52-year-old Dutch woman who presented with persistent arthralgia due to a Mayaro virus (MAYV) infection which she contracted in the Amazon basin in Brazil. MAYV is a mosquito-borne alphavirus which primarily circulates in humid tropical forests of South America. Infections are rarely reported in travelers and are characterized by an acute febrile illness which is often followed by a prolonged and sometimes incapacitating polyarthralgia. Both travelers and physicians should be aware of the risk of these arboviral infections and the importance of mosquito bite prevention should be stressed. PMID:24856445

  19. Individual risk of cutaneous melanoma in New Zealand: developing a clinical prediction aid

    PubMed Central

    2014-01-01

    Background New Zealand and Australia have the highest melanoma incidence rates worldwide. In New Zealand, both the incidence and thickness have been increasing. Clinical decisions require accurate risk prediction but a simple list of genetic, phenotypic and behavioural risk factors is inadequate to estimate individual risk as the risk factors for melanoma have complex interactions. In order to offer tailored clinical management strategies, we developed a New Zealand prediction model to estimate individual 5-year absolute risk of melanoma. Methods A population-based case–control study (368 cases and 270 controls) of melanoma risk factors provided estimates of relative risks for fair-skinned New Zealanders aged 20–79 years. Model selection techniques and multivariate logistic regression were used to determine the important predictors. The relative risks for predictors were combined with baseline melanoma incidence rates and non-melanoma mortality rates to calculate individual probabilities of developing melanoma within 5 years. Results For women, the best model included skin colour, number of moles > =5 mm on the right arm, having a 1st degree relative with large moles, and a personal history of non-melanoma skin cancer (NMSC). The model correctly classified 68% of participants; the C-statistic was 0.74. For men, the best model included age, place of occupation up to age 18 years, number of moles > =5 mm on the right arm, birthplace, and a history of NMSC. The model correctly classified 67% of cases; the C-statistic was 0.71. Conclusions We have developed the first New Zealand risk prediction model that calculates individual absolute 5-year risk of melanoma. This model will aid physicians to identify individuals at high risk, allowing them to individually target surveillance and other management strategies, and thereby reduce the high melanoma burden in New Zealand. PMID:24884419

  20. An epidemiological model for prediction of endometrial cancer risk in Europe.

    PubMed

    Hüsing, Anika; Dossus, Laure; Ferrari, Pietro; Tjønneland, Anne; Hansen, Louise; Fagherazzi, Guy; Baglietto, Laura; Schock, Helena; Chang-Claude, Jenny; Boeing, Heiner; Steffen, Annika; Trichopoulou, Antonia; Bamia, Christina; Katsoulis, Michalis; Krogh, Vittorio; Palli, Domenico; Panico, Salvatore; Onland-Moret, N Charlotte; Peeters, Petra H; Bueno-de-Mesquita, H Bas; Weiderpass, Elisabete; Gram, Inger T; Ardanaz, Eva; Obón-Santacana, Mireia; Navarro, Carmen; Sánchez-Cantalejo, Emilio; Etxezarreta, Nerea; Allen, Naomi E; Khaw, Kay Tee; Wareham, Nick; Rinaldi, Sabina; Romieu, Isabelle; Merritt, Melissa A; Gunter, Marc; Riboli, Elio; Kaaks, Rudolf

    2016-01-01

    Endometrial cancer (EC) is the fourth most frequent cancer in women in Europe, and as its incidence is increasing, prevention strategies gain further pertinence. Risk prediction models can be a useful tool for identifying women likely to benefit from targeted prevention measures. On the basis of data from 201,811 women (mostly aged 30-65 years) including 855 incident EC cases from eight countries in the European Prospective Investigation into Cancer and Nutrition cohort, a model to predict EC was developed. A step-wise model selection process was used to select confirmed predictive epidemiologic risk factors. Piece-wise constant hazard rates in 5-year age-intervals were estimated in a cause-specific competing risks model, five-fold-cross-validation was applied for internal validation. Risk factors included in the risk prediction model were body-mass index (BMI), menopausal status, age at menarche and at menopause, oral contraceptive use, overall and by different BMI categories and overall duration of use, parity, age at first full-term pregnancy, duration of menopausal hormone therapy and smoking status (specific for pre, peri- and post-menopausal women). These variables improved the discriminating capacity to predict risk over 5 years from 71% for a model based on age alone to 77% (overall C statistic), and the model was well-calibrated (ratio of expected to observed cases = 0.99). Our model could be used for the identification of women at increased risk of EC in Western Europe. To achieve an EC-risk model with general validity, a large-scale cohort-consortium approach would be needed to assess and adjust for population variation. PMID:25968175

  1. Predicting Prostate Cancer Mortality Among Men With Intermediate to High-Risk Disease and Multiple Unfavorable Risk Factors

    SciTech Connect

    Nguyen, Paul L. Chen Minghui; Catalona, William J.; Moul, Judd W.; Sun, Leon; D'Amico, Anthony V.

    2009-03-01

    Purpose: To determine whether the number of unfavorable risk factors could be used to predict the risk of prostate cancer-specific mortality (PCSM) among men with intermediate- to high-risk prostate cancer. Methods and Materials: We studied 1,063 men who underwent radical prostatectomy (n = 559), external beam radiotherapy (n = 288), or radiotherapy plus androgen suppression therapy (n = 116) for prostate cancer between 1965 and 2002. Fine and Gray's regression analysis was used to determine whether an increasing number of unfavorable risk factors (prostate-specific antigen level >10 ng/mL, Gleason score of {>=}7, clinical Stage T2b or greater, or pretreatment prostate-specific antigen velocity >2.0 ng/mL/y) was associated with the interval to PCSM and all-cause mortality. Results: Median follow-up was 5.6 years. Compared with those with one risk factor, the adjusted hazard ratio for PCSM was 2.3 (95% confidence interval 1.1-4.8; p = 0.03) for two risk factors, 5.4 (95% confidence interval 2.7-10.7; p < 0.0001) for three risk factors, and 13.6 (95% confidence interval 6.3-29.2; p < 0.0001) for all four risk factors. The 5-year cumulative incidence of PCSM was 2.4% for one factor, 2.4% for two factors, 7.0% for three factors, and 14.7% for all four factors. Prostate cancer deaths as a proportion of all deaths was 19% for one factor, 33% for two factors, 53% for three factors, and 80% for four factors. Conclusion: The number of unfavorable risk factors was significantly associated with PCSM. Prostate cancer was the major cause of death in men with at least three risk factors. Therefore, these men should be considered for clinical trials designed to assess whether survival is prolonged with the addition of novel agents to current standards of practice.

  2. Predictive capacity of risk assessment scales and clinical judgment for pressure ulcers: a meta-analysis.

    PubMed

    García-Fernández, Francisco Pedro; Pancorbo-Hidalgo, Pedro L; Agreda, J Javier Soldevilla

    2014-01-01

    A systematic review with meta-analysis was completed to determine the capacity of risk assessment scales and nurses' clinical judgment to predict pressure ulcer (PU) development. Electronic databases were searched for prospective studies on the validity and predictive capacity of PUs risk assessment scales published between 1962 and 2010 in English, Spanish, Portuguese, Korean, German, and Greek. We excluded gray literature sources, integrative review articles, and retrospective or cross-sectional studies. The methodological quality of the studies was assessed according to the guidelines of the Critical Appraisal Skills Program. Predictive capacity was measured as relative risk (RR) with 95% confidence intervals. When 2 or more valid original studies were found, a meta-analysis was conducted using a random-effect model and sensitivity analysis. We identified 57 studies, including 31 that included a validation study. We also retrieved 4 studies that tested clinical judgment as a risk prediction factor. Meta-analysis produced the following pooled predictive capacity indicators: Braden (RR = 4.26); Norton (RR = 3.69); Waterlow (RR = 2.66); Cubbin-Jackson (RR = 8.63); EMINA (RR = 6.17); Pressure Sore Predictor Scale (RR = 21.4); and clinical judgment (RR = 1.89). Pooled analysis of 11 studies found adequate risk prediction capacity in various clinical settings; the Braden, Norton, EMINA (mEntal state, Mobility, Incontinence, Nutrition, Activity), Waterlow, and Cubbin-Jackson scales showed the highest predictive capacity. The clinical judgment of nurses was found to achieve inadequate predictive capacity when used alone, and should be used in combination with a validated scale. PMID:24280770

  3. Prevalence and risk factors for Hepatitis C and HIV-1 infections among pregnant women in Central Brazil

    PubMed Central

    2009-01-01

    Background Hepatitis C (HCV) and human immunodeficiency virus (HIV) infections are a major burden to public health worldwide. Routine antenatal HIV-1 screening to prevent maternal-infant transmission is universally recommended. Our objectives were to evaluate the prevalence of and potential risk factors for HCV and HIV infection among pregnant women who attended prenatal care under the coverage of public health in Central Brazil. Methods Screening and counselling for HIV and HCV infections was offered free of charge to all pregnant women attending antenatal clinic (ANC) in the public health system, in Goiania city (~1.1 million inhabitants) during 2004–2005. Initial screening was performed on a dried blood spot collected onto standard filter paper; positive or indeterminate results were confirmed by a second blood sample. HCV infection was defined as a positive or indeterminate sample (EIA test) and confirmed HCV-RNA technique. HIV infection was defined according to standard criteria. Factors associated with HIV and HCV infections were identified with logistic regression. The number needed to screen (NNS) to prevent one case of infant HIV infection was calculated using the Monte Carlo simulation method. Results A total of 28,561 pregnant women were screened for HCV and HIV-1 in ANC. Mean maternal age was 23.9 years (SD = 5.6), with 45% of the women experiencing their first pregnancy. Prevalence of HCV infection was 0.15% (95% CI 0.11%–0.20%), and the risk increased with age (p < 0.01). The prevalence of anti-HIV infection was 0.09% (95% CI 0.06%–0.14%). Black women had a 4.9-fold (95% CI 1.42–16.95) greater risk of HIV-1 infection compared to non-black women. NNS to prevent one case of infant HIV infection ranged from 4,141 to 13,928. Conclusion The prevalence of HIV and HCV infections were low among pregnant women, with high acceptability rates in the opt-in strategy in primary care. Older maternal age was a risk factor for HCV and antenatal HCV testing

  4. An epidemiologic risk prediction model for ovarian cancer in Europe: the EPIC study

    PubMed Central

    Li, K; Hüsing, A; Fortner, R T; Tjønneland, A; Hansen, L; Dossus, L; Chang-Claude, J; Bergmann, M; Steffen, A; Bamia, C; Trichopoulos, D; Trichopoulou, A; Palli, D; Mattiello, A; Agnoli, C; Tumino, R; Onland-Moret, N C; Peeters, P H; Bueno-de-Mesquita, H B(as); Gram, I T; Weiderpass, E; Sánchez-Cantalejo, E; Chirlaque, M-D; Duell, E J; Ardanaz, E; Idahl, A; Lundin, E; Khaw, K-T; Travis, R C; Merritt, M A; Gunter, M J; Riboli, E; Ferrari, P; Terry, K; Cramer, D; Kaaks, R

    2015-01-01

    Background: Ovarian cancer has a high case-fatality ratio, largely due to late diagnosis. Epidemiologic risk prediction models could help identify women at increased risk who may benefit from targeted prevention measures, such as screening or chemopreventive agents. Methods: We built an ovarian cancer risk prediction model with epidemiologic risk factors from 202 206 women in the European Prospective Investigation into Cancer and Nutrition study. Results: Older age at menopause, longer duration of hormone replacement therapy, and higher body mass index were included as increasing ovarian cancer risk, whereas unilateral ovariectomy, longer duration of oral contraceptive use, and higher number of full-term pregnancies were decreasing risk. The discriminatory power (overall concordance index) of this model, as examined with five-fold cross-validation, was 0.64 (95% confidence interval (CI): 0.57, 0.70). The ratio of the expected to observed number of ovarian cancer cases occurring in the first 5 years of follow-up was 0.90 (293 out of 324, 95% CI: 0.81–1.01), in general there was no evidence for miscalibration. Conclusion: Our ovarian cancer risk model containing only epidemiological data showed modest discriminatory power for a Western European population. Future studies should consider adding informative biomarkers to possibly improve the predictive ability of the model. PMID:25742479

  5. A spline-based tool to assess and visualize the calibration of multiclass risk predictions.

    PubMed

    Van Hoorde, K; Van Huffel, S; Timmerman, D; Bourne, T; Van Calster, B

    2015-04-01

    When validating risk models (or probabilistic classifiers), calibration is often overlooked. Calibration refers to the reliability of the predicted risks, i.e. whether the predicted risks correspond to observed probabilities. In medical applications this is important because treatment decisions often rely on the estimated risk of disease. The aim of this paper is to present generic tools to assess the calibration of multiclass risk models. We describe a calibration framework based on a vector spline multinomial logistic regression model. This framework can be used to generate calibration plots and calculate the estimated calibration index (ECI) to quantify lack of calibration. We illustrate these tools in relation to risk models used to characterize ovarian tumors. The outcome of the study is the surgical stage of the tumor when relevant and the final histological outcome, which is divided into five classes: benign, borderline malignant, stage I, stage II-IV, and secondary metastatic cancer. The 5909 patients included in the study are randomly split into equally large training and test sets. We developed and tested models using the following algorithms: logistic regression, support vector machines, k nearest neighbors, random forest, naive Bayes and nearest shrunken centroids. Multiclass calibration plots are interesting as an approach to visualizing the reliability of predicted risks. The ECI is a convenient tool for comparing models, but is less informative and interpretable than calibration plots. In our case study, logistic regression and random forest showed the highest degree of calibration, and the naive Bayes the lowest. PMID:25579635

  6. Assessing Risk Prediction Models Using Individual Participant Data From Multiple Studies

    PubMed Central

    Pennells, Lisa; Kaptoge, Stephen; White, Ian R.; Thompson, Simon G.; Wood, Angela M.; Tipping, Robert W.; Folsom, Aaron R.; Couper, David J.; Ballantyne, Christie M.; Coresh, Josef; Goya Wannamethee, S.; Morris, Richard W.; Kiechl, Stefan; Willeit, Johann; Willeit, Peter; Schett, Georg; Ebrahim, Shah; Lawlor, Debbie A.; Yarnell, John W.; Gallacher, John; Cushman, Mary; Psaty, Bruce M.; Tracy, Russ; Tybjærg-Hansen, Anne; Price, Jackie F.; Lee, Amanda J.; McLachlan, Stela; Khaw, Kay-Tee; Wareham, Nicholas J.; Brenner, Hermann; Schöttker, Ben; Müller, Heiko; Jansson, Jan-Håkan; Wennberg, Patrik; Salomaa, Veikko; Harald, Kennet; Jousilahti, Pekka; Vartiainen, Erkki; Woodward, Mark; D'Agostino, Ralph B.; Bladbjerg, Else-Marie; Jørgensen, Torben; Kiyohara, Yutaka; Arima, Hisatomi; Doi, Yasufumi; Ninomiya, Toshiharu; Dekker, Jacqueline M.; Nijpels, Giel; Stehouwer, Coen D. A.; Kauhanen, Jussi; Salonen, Jukka T.; Meade, Tom W.; Cooper, Jackie A.; Cushman, Mary; Folsom, Aaron R.; Psaty, Bruce M.; Shea, Steven; Döring, Angela; Kuller, Lewis H.; Grandits, Greg; Gillum, Richard F.; Mussolino, Michael; Rimm, Eric B.; Hankinson, Sue E.; Manson, JoAnn E.; Pai, Jennifer K.; Kirkland, Susan; Shaffer, Jonathan A.; Shimbo, Daichi; Bakker, Stephan J. L.; Gansevoort, Ron T.; Hillege, Hans L.; Amouyel, Philippe; Arveiler, Dominique; Evans, Alun; Ferrières, Jean; Sattar, Naveed; Westendorp, Rudi G.; Buckley, Brendan M.; Cantin, Bernard; Lamarche, Benoît; Barrett-Connor, Elizabeth; Wingard, Deborah L.; Bettencourt, Richele; Gudnason, Vilmundur; Aspelund, Thor; Sigurdsson, Gunnar; Thorsson, Bolli; Kavousi, Maryam; Witteman, Jacqueline C.; Hofman, Albert; Franco, Oscar H.; Howard, Barbara V.; Zhang, Ying; Best, Lyle; Umans, Jason G.; Onat, Altan; Sundström, Johan; Michael Gaziano, J.; Stampfer, Meir; Ridker, Paul M.; Michael Gaziano, J.; Ridker, Paul M.; Marmot, Michael; Clarke, Robert; Collins, Rory; Fletcher, Astrid; Brunner, Eric; Shipley, Martin; Kivimäki, Mika; Ridker, Paul M.; Buring, Julie; Cook, Nancy; Ford, Ian; Shepherd, James; Cobbe, Stuart M.; Robertson, Michele; Walker, Matthew; Watson, Sarah; Alexander, Myriam; Butterworth, Adam S.; Angelantonio, Emanuele Di; Gao, Pei; Haycock, Philip; Kaptoge, Stephen; Pennells, Lisa; Thompson, Simon G.; Walker, Matthew; Watson, Sarah; White, Ian R.; Wood, Angela M.; Wormser, David; Danesh, John

    2014-01-01

    Individual participant time-to-event data from multiple prospective epidemiologic studies enable detailed investigation into the predictive ability of risk models. Here we address the challenges in appropriately combining such information across studies. Methods are exemplified by analyses of log C-reactive protein and conventional risk factors for coronary heart disease in the Emerging Risk Factors Collaboration, a collation of individual data from multiple prospective studies with an average follow-up duration of 9.8 years (dates varied). We derive risk prediction models using Cox proportional hazards regression analysis stratified by study and obtain estimates of risk discrimination, Harrell's concordance index, and Royston's discrimination measure within each study; we then combine the estimates across studies using a weighted meta-analysis. Various weighting approaches are compared and lead us to recommend using the number of events in each study. We also discuss the calculation of measures of reclassification for multiple studies. We further show that comparison of differences in predictive ability across subgroups should be based only on within-study information and that combining measures of risk discrimination from case-control studies and prospective studies is problematic. The concordance index and discrimination measure gave qualitatively similar results throughout. While the concordance index was very heterogeneous between studies, principally because of differing age ranges, the increments in the concordance index from adding log C-reactive protein to conventional risk factors were more homogeneous. PMID:24366051

  7. Assessing risk prediction models using individual participant data from multiple studies.

    PubMed

    Pennells, Lisa; Kaptoge, Stephen; White, Ian R; Thompson, Simon G; Wood, Angela M

    2014-03-01

    Individual participant time-to-event data from multiple prospective epidemiologic studies enable detailed investigation into the predictive ability of risk models. Here we address the challenges in appropriately combining such information across studies. Methods are exemplified by analyses of log C-reactive protein and conventional risk factors for coronary heart disease in the Emerging Risk Factors Collaboration, a collation of individual data from multiple prospective studies with an average follow-up duration of 9.8 years (dates varied). We derive risk prediction models using Cox proportional hazards regression analysis stratified by study and obtain estimates of risk discrimination, Harrell's concordance index, and Royston's discrimination measure within each study; we then combine the estimates across studies using a weighted meta-analysis. Various weighting approaches are compared and lead us to recommend using the number of events in each study. We also discuss the calculation of measures of reclassification for multiple studies. We further show that comparison of differences in predictive ability across subgroups should be based only on within-study information and that combining measures of risk discrimination from case-control studies and prospective studies is problematic. The concordance index and discrimination measure gave qualitatively similar results throughout. While the concordance index was very heterogeneous between studies, principally because of differing age ranges, the increments in the concordance index from adding log C-reactive protein to conventional risk factors were more homogeneous. PMID:24366051

  8. Improving coeliac disease risk prediction by testing non-HLA variants additional to HLA variants

    PubMed Central

    Romanos, Jihane; Rosén, Anna; Kumar, Vinod; Trynka, Gosia; Franke, Lude; Szperl, Agata; Gutierrez-Achury, Javier; van Diemen, Cleo C; Kanninga, Roan; Jankipersadsing, Soesma A; Steck, Andrea; Eisenbarth, Georges; van Heel, David A; Cukrowska, Bozena; Bruno, Valentina; Mazzilli, Maria Cristina; Núñez, Concepcion; Bilbao, Jose Ramon; Mearin, M Luisa; Barisani, Donatella; Rewers, Marian; Norris, Jill M; Ivarsson, Anneli; Boezen, H Marieke; Liu, Edwin; Wijmenga, Cisca

    2014-01-01

    Background The majority of coeliac disease (CD) patients are not being properly diagnosed and therefore remain untreated, leading to a greater risk of developing CD-associated complications. The major genetic risk heterodimer, HLA-DQ2 and DQ8, is already used clinically to help exclude disease. However, approximately 40% of the population carry these alleles and the majority never develop CD. Objective We explored whether CD risk prediction can be improved by adding non-HLA-susceptible variants to common HLA testing. Design We developed an average weighted genetic risk score with 10, 26 and 57 single nucleotide polymorphisms (SNP) in 2675 cases and 2815 controls and assessed the improvement in risk prediction provided by the non-HLA SNP. Moreover, we assessed the transferability of the genetic risk model with 26 non-HLA variants to a nested case–control population (n=1709) and a prospective cohort (n=1245) and then tested how well this model predicted CD outcome for 985 independent individuals. Results Adding 57 non-HLA variants to HLA testing showed a statistically significant improvement compared to scores from models based on HLA only, HLA plus 10 SNP and HLA plus 26 SNP. With 57 non-HLA variants, the area under the receiver operator characteristic curve reached 0.854 compared to 0.823 for HLA only, and 11.1% of individuals were reclassified to a more accurate risk group. We show that the risk model with HLA plus 26 SNP is useful in independent populations. Conclusions Predicting risk with 57 additional non-HLA variants improved the identification of potential CD patients. This demonstrates a possible role for combined HLA and non-HLA genetic testing in diagnostic work for CD. PMID:23704318

  9. Evaluation of Major Online Diabetes Risk Calculators and Computerized Predictive Models

    PubMed Central

    Stiglic, Gregor; Pajnkihar, Majda

    2015-01-01

    Classical paper-and-pencil based risk assessment questionnaires are often accompanied by the online versions of the questionnaire to reach a wider population. This study focuses on the loss, especially in risk estimation performance, that can be inflicted by direct transformation from the paper to online versions of risk estimation calculators by ignoring the possibilities of more complex and accurate calculations that can be performed using the online calculators. We empirically compare the risk estimation performance between four major diabetes risk calculators and two, more advanced, predictive models. National Health and Nutrition Examination Survey (NHANES) data from 1999–2012 was used to evaluate the performance of detecting diabetes and pre-diabetes. American Diabetes Association risk test achieved the best predictive performance in category of classical paper-and-pencil based tests with an Area Under the ROC Curve (AUC) of 0.699 for undiagnosed diabetes (0.662 for pre-diabetes) and 47% (47% for pre-diabetes) persons selected for screening. Our results demonstrate a significant difference in performance with additional benefits for a lower number of persons selected for screening when statistical methods are used. The best AUC overall was obtained in diabetes risk prediction using logistic regression with AUC of 0.775 (0.734) and an average 34% (48%) persons selected for screening. However, generalized boosted regression models might be a better option from the economical point of view as the number of selected persons for screening of 30% (47%) lies significantly lower for diabetes risk assessment in comparison to logistic regression (p < 0.001), with a significantly higher AUC (p < 0.001) of 0.774 (0.740) for the pre-diabetes group. Our results demonstrate a serious lack of predictive performance in four major online diabetes risk calculators. Therefore, one should take great care and consider optimizing the online versions of questionnaires that were

  10. Mortality Risk Prediction by Application of Pediatric Risk of Mortality Scoring System in Pediatric Intensive Care Unit

    PubMed Central

    Khajeh, Ali; Noori, Noor Mohammad; Reisi, Mohsen; Fayyazi, Afshin; Mohammadi, Mahdi; Miri-Aliabad, Ghasem

    2013-01-01

    Objective The Pediatric Risk of Mortality (PRISM) score is one of the scores used by many pediatricians for prediction of the mortality risk in the pediatric intensive care unit (PICU). Herein, we intend to evaluate the efficacy of PRISM score in prediction of mortality rate in PICU. Methods In this cohort study, 221 children admitted during an 18-month period to PICU, were enrolled. PRISM score and mortality risk were calculated. Follow up was noted as death or discharge. Results were analyzed by Kaplan-Meier curve, ROC curve, Log Rank (Mantel-Cox), Logistic regression model using SPSS 15. Findings Totally, 57% of the patients were males. Forty seven patients died during the study period. The PRISM score was 0-10 in 71%, 11-20 in 20.4% and 21-30 in 8.6%. PRISM score showed an increase of mortality from 10.2% in 0-10 score patients to 73.8% in 21-30 score ones. The survival time significantly decreased as PRISM score increased (P≤0.001). A 7.2 fold mortality risk was present in patients with score 21-30 compared with score 0-10. ROC curve analysis for mortality according to PRISM score showed an under curve area of 80.3%. Conclusion PRISM score is a good predictor for evaluation of mortality risk in PICU. PMID:24800015

  11. Sociodemographic and environmental risk factors for American cutaneous leishmaniasis (ACL) in the State of Alagoas, Brazil.

    PubMed

    Pedrosa, Fernando de Araújo; Ximenes, Ricardo Arraes de Alencar

    2009-08-01

    The multiplicity of factors involved in the transmission of the American cutaneous leishmaniasis (ACL) constitutes a challenge to its control. Thus, knowledge of such factors may contribute extremely toward redefining the control strategies. The aim of this study was to identify sociodemographic and environmental factors relating to ACL transmission in the State of Alagoas, Brazil. A case-control study with incident cases was conducted. Diagnostic criteria were the presence of compatible skin lesions, laboratory confirmation, and clinical cure after treatment. Two control groups were matched to cases by sex and age: one comprising neighbors and the other from a community-based draw; controls were individuals with no lesion and a negative Montenegro intradermal reaction. Between July 1, 2004 and February 1, 2007, 98 cases and the same number of controls per group were selected. In the multivariate analysis, for both control groups, ACL was associated with absence of a gas stove and forest less than 200 m away; for neighborhood controls with schooling of 4 years or less, family income greater than one minimum salary, birds inside the home, forest-related leisure activities, and rural work or school activities; and for community controls with non-durable wall material in the house, per capita income greater than US$ 28.31, animals inside the house, and absence of dogs and cats around the house. Specific control measures are recommended for areas with similar characteristics: protection for individuals undertaking forest-related leisure activities; distancing houses from forests by more than 200 m; and elimination of bird or other animal-rearing inside homes. General measures of improved housing and living conditions are also recommended. PMID:19635869

  12. An agro-climatic approach to determine citrus postbloom fruit drop risk in Southern Brazil

    NASA Astrophysics Data System (ADS)

    Soares-Colletti, Ana R.; Alvares, Clayton A.; Sentelhas, Paulo C.

    2015-10-01

    Postbloom fruit drop (PFD) causes lesions on the petals of citrus flowers and induces fruit abscission causing severe damage to production when the flowering period coincides with intense rainfall. The aims of this study were to develop a phenological-climatological model for citrus PFD occurrence and, together with weather data series from several locations, to determine and map the agro-climatic favorability of PFD occurrence in the state of São Paulo, Southern Brazil. A phenological flowering model was developed to identify when citrus flowering occurs. The flowering starts after when a temperature below 10 °C in the months of June or July is reached followed by cumulative rainfall within 5 days of at least 20 mm, and then 96 °C days. Between the beginning of flowering and its peak, 147 °C days are required, and between the peak and its end, approximately 229 °C days, being 206 °C days from the peak to the moment when flowers remaining are about 50 % of total. The relationship between PFD incidence and accumulated rainfall during the critical period (between flowering peak and 50 % of flowers remaining) was adjusted by the Gompertz model (R 2 = 0.99, p < 0.05). After its validation, this model was used to estimate PFD incidence for 29 locations in the state, from 1993 to 2013, which allowed to map the PFD climatic favorability for the state through a Geographical Information System using linear models based on latitude, longitude, and altitude. The obtained map showed a trend of PFD incidence increasing from the northwest of the state of São Paulo towards the south and the coastal region, with medium to very high favorability in the center of the state. The results of this study can be used by growers as a guide for disease control planning as well as for defining the regions where the climatic conditions are likely to escape this disease.

  13. An agro-climatic approach to determine citrus postbloom fruit drop risk in Southern Brazil

    NASA Astrophysics Data System (ADS)

    Soares-Colletti, Ana R.; Alvares, Clayton A.; Sentelhas, Paulo C.

    2016-06-01

    Postbloom fruit drop (PFD) causes lesions on the petals of citrus flowers and induces fruit abscission causing severe damage to production when the flowering period coincides with intense rainfall. The aims of this study were to develop a phenological-climatological model for citrus PFD occurrence and, together with weather data series from several locations, to determine and map the agro-climatic favorability of PFD occurrence in the state of São Paulo, Southern Brazil. A phenological flowering model was developed to identify when citrus flowering occurs. The flowering starts after when a temperature below 10 °C in the months of June or July is reached followed by cumulative rainfall within 5 days of at least 20 mm, and then 96 °C days. Between the beginning of flowering and its peak, 147 °C days are required, and between the peak and its end, approximately 229 °C days, being 206 °C days from the peak to the moment when flowers remaining are about 50 % of total. The relationship between PFD incidence and accumulated rainfall during the critical period (between flowering peak and 50 % of flowers remaining) was adjusted by the Gompertz model ( R 2 = 0.99, p < 0.05). After its validation, this model was used to estimate PFD incidence for 29 locations in the state, from 1993 to 2013, which allowed to map the PFD climatic favorability for the state through a Geographical Information System using linear models based on latitude, longitude, and altitude. The obtained map showed a trend of PFD incidence increasing from the northwest of the state of São Paulo towards the south and the coastal region, with medium to very high favorability in the center of the state. The results of this study can be used by growers as a guide for disease control planning as well as for defining the regions where the climatic conditions are likely to escape this disease.

  14. Association between vehicular emissions and cardiorespiratory disease risk in Brazil and its variation by spatial clustering of socio-economic factors.

    PubMed

    Requia, Weeberb J; Koutrakis, Petros; Roig, Henrique L; Adams, Matthew D; Santos, Cleide M

    2016-10-01

    Many studies have suggested that socio-economic factors are strong modifiers of human vulnerability to air pollution effects. Most of these studies were performed in developed countries, specifically in the US and Europe. Only a few studies have been performed in developing countries, and analyzed small regions (city level) with no spatial disaggregation. The aim of this study was to assess the association between vehicle emissions and cardiorespiratory disease risk in Brazil and its modification by spatial clustering of socio-economic conditions. We used a quantile regression model to estimate the risk and a geostatistical approach (K means) to execute spatial cluster analysis. We performed the risk analysis in three stages. First, we analyzed the entire study area (primary analysis), and then we conducted a spatial cluster analysis based on various municipal-level socio-economic factors, followed by a sensitivity analysis. We studied 5444 municipalities in Brazil between 2008 and 2012. Our findings showed a significant association between cardiorespiratory disease risk and vehicular emissions. We found that a 15% increase in air pollution is associated with a 6% increase in hospital admissions rates. The results from the spatial cluster analysis revealed two groups of municipalities with distinct sets of socio-economic factors and risk levels of cardiorespiratory disease related to exposure to vehicular emissions. For example, for vehicle emissions of PM in 2008, we found a relative risk of 4.18 (95% CI: 3.66, 4.93) in the primary analysis; in Group 1, the risk was 0.98 (95% CI: 0.10, 2.05) while in Group 2, the risk was 5.56 (95% CI: 4.46, 6.25). The risk in Group 2 was 480% higher than the risk in Group 1, and 35% higher than the risk in the primary analysis. Group 1 had higher values (3rd quartile) for urbanization rate, highway density, and GDP; very high values (≥3rd quartile) for population density; median values for distance from the capital; and lower

  15. INCIDENCE DENSITY, PROPORTIONATE MORTALITY, AND RISK FACTORS OF ASPERGILLOSIS IN MAGELLANIC PENGUINS IN A REHABILITATION CENTER FROM BRAZIL.

    PubMed

    Silva Filho, Rodolfo Pinho da; Xavier, Melissa Orzechowski; Martins, Aryse Moreira; Ruoppolo, Valéria; Mendoza-Sassi, Raúl Andrés; Adornes, Andréa Corrado; Cabana, Ângela Leitzke; Meireles, Mário Carlos Araújo

    2015-12-01

    Aspergillosis, an opportunistic mycosis caused by the Aspergillus genus, affects mainly the respiratory system and is considered one of the most significant causes of mortality in captive penguins. This study aimed to examine a 6-yr period of cases of aspergillosis in penguins at the Centro de Recuperação de Animais Marinhos (CRAM-FURG), Rio Grande, Brazil. A retrospective cohort study was conducted using the institution's records of penguins received from January 2004 to December 2009. Animals were categorized according to the outcome "aspergillosis," and analyzed by age group, sex, oil fouling, origin, prophylactic administration of itraconazole, period in captivity, body mass, hematocrit, and total plasma proteins. A total of 327 Magellanic penguins (Spheniscus magellanicus) was studied, 66 of which died of aspergillosis. Proportionate mortality by aspergillosis was 48.5%, and incidence density was 7.3 lethal aspergillosis cases per 100 penguins/mo. Approximately 75% of the aspergillosis cases occurred in penguins that had been transferred from other rehabilitation centers, and this was considered a significant risk factor for the disease. Significant differences were also observed between the groups in regard to the period of time spent in captivity until death, hematocrit and total plasma proteins upon admission to the center, and body mass gain during the period in captivity. The findings demonstrate the negative impacts of aspergillosis on the rehabilitation of Magellanic penguins, with a high incidence density and substantial mortality. PMID:26667521

  16. Prevalence and risk factors associated with endoparasitosis of dogs and cats in Espírito Santo, Brazil.

    PubMed

    Campos, Diefrey Ribeiro; Oliveira, Luanna Castro; de Siqueira, Daniele Fassina; Perin, Lívia Reisen; Campos, Nayara Camatta; Aptekmann, Karina Preising; Martins, Isabella Vilhena Freire

    2016-09-01

    The objective of this study was to determine the prevalence and risk factors for the occurrence of endoparasitosis in dogs and cats in Espírito Santo, Brazil. For the study, 345 dogs and 160 cats were examined. Faecal samples from the animals were collected, and owners were interviewed about their handling of their animals. For the diagnosis of the infections, the Willis-Molley, simple centrifugal flotation and formalin-ether sedimentation techniques were performed. The data found in the tests were tabulated and analysed with a chi-square test (p <0.05), and calculation of odds ratios (OR) with confidence intervals of 95% were then performed to determine the association between the variables and the outcome of stool examinations. The prevalence of parasites was 59% for dogs and 54% for cats. The genus Ancylostoma was the most prevalent (45%). Supplying filtered water, not feeding raw foods, standardisation of a defecation site and cleaning up the faeces reduced the chances of developing intestinal parasites. An increased frequency of deworming was also shown to be a protective factor; specifically animals which received anthelmintic more than once a year had a lower predisposition for intestinal parasites. PMID:27447218

  17. Risk prediction by genetic risk scores for coronary heart disease is independent of self-reported family history

    PubMed Central

    Tada, Hayato; Melander, Olle; Louie, Judy Z.; Catanese, Joseph J.; Rowland, Charles M.; Devlin, James J.; Kathiresan, Sekar; Shiffman, Dov

    2016-01-01

    Aims Genetic risk scores (GRSs) have been associated with coronary heart disease (CHD) in large studies. We asked whether expanding an established 27-variant GRS (GRS27) to a 50-variant GRS (GRS50) improved CHD prediction and whether GRSs are independent of self-reported family history of CHD. Methods and results The association between GRSs and incident CHD was assessed in Cox models adjusting for established risk factors in 23 595 participants of the Malmö Diet and Cancer study—a prospective, population-based study. During a median follow-up of 14.4 years, 2213 participants experienced a first CHD event. After adjustment for established risk factors, both GRS27 and GRS50 were associated with incident CHD [hazard ratio (HR) = 1.70 for high (top quintile) vs. low (bottom quintile) of GRS27; 95% confidence interval (CI): 1.48–1.94; Ptrend = 1.6 × 10−15 and HR = 1.92 for GRS50; 95% CI: 1.67–2.20; Ptrend = 6.2 × 10−22]. Adding 23 single nucleotide polymorphisms (SNPs) to GRS27 improved risk prediction (P = 3 × 10−6). Further adjustment for self-reported family history did not appreciably change the risk estimates of either GRS27 (HR = 1.65; 95% CI: 1.45–1.89) or GRS50 (HR = 1.87; 95% CI: 1.63–2.14). The addition of GRS50 to established risk factors, including self-reported family history, improved discrimination (P < 0.0001) and reclassification (continuous net reclassification improvement index = 0.17, P < 0.0001). In young participants (below median age), those with high GRS50 had 2.4-fold greater risk (95% CI: 1.85–3.12) than those with low GRS50. Conclusion The addition of 23 SNPs to an existing GRS27 improved CHD risk prediction and was independent of self-reported family history. Coronary heart disease risk assessment by GRS could be particularly useful in young individuals. PMID:26392438

  18. Predictive Validity of Pressure Ulcer Risk Assessment Tools for Elderly: A Meta-Analysis.

    PubMed

    Park, Seong-Hi; Lee, Young-Shin; Kwon, Young-Mi

    2016-04-01

    Preventing pressure ulcers is one of the most challenging goals existing for today's health care provider. Currently used tools which assess risk of pressure ulcer development rarely evaluate the accuracy of predictability, especially in older adults. The current study aimed at providing a systemic review and meta-analysis of 29 studies using three pressure ulcer risk assessment tools: Braden, Norton, and Waterlow Scales. Overall predictive validities of pressure ulcer risks in the pooled sensitivity and specificity indicated a similar range with a moderate accuracy level in all three scales, while heterogeneity showed more than 80% variability among studies. The studies applying the Braden Scale used five different cut-off points representing the primary cause of heterogeneity. Results indicate that commonly used screening tools for pressure ulcer risk have limitations regarding validity and accuracy for use with older adults due to heterogeneity among studies. PMID:26337859

  19. Predicting risk for medical malpractice claims using quality-of-care characteristics.

    PubMed Central

    Charles, S C; Gibbons, R D; Frisch, P R; Pyskoty, C E; Hedeker, D; Singha, N K

    1992-01-01

    The current fault-based tort system assumes that claims made against physicians are inversely related to the quality of care they provide. In this study we identified physician characteristics associated with elements of medical care that make physicians vulnerable to malpractice claims. A sample of physicians (n = 248) thought to be at high or low risk for claims was surveyed on various personal and professional characteristics. Statistical analysis showed that 9 characteristics predicted risk group. High risk was associated with increased age, surgical specialty, emergency department coverage, increased days away from practice, and the feeling that the litigation climate was "unfair." Low risk was associated with scheduling enough time to talk with patients, answering patients' telephone calls directly, feeling "satisfied" with practice arrangements, and acknowledging greater emotional distress. Prediction was more accurate for physicians in practice 15 years or less. We conclude that a relationship exists between a history of malpractice claims and selected physician characteristics. PMID:1462538

  20. An Empiric HIV Risk Scoring Tool to Predict HIV-1 Acquisition in African Women

    PubMed Central

    Brown, Elizabeth; Palanee, Thesla; Nair, Gonasagrie; Gafoor, Zakir; Zhang, Jingyang; Richardson, Barbra A.; Chirenje, Zvavahera M.; Marrazzo, Jeanne M.; Baeten, Jared M.

    2016-01-01

    Objective: To develop and validate an HIV risk assessment tool to predict HIV acquisition among African women. Design: Data were analyzed from 3 randomized trials of biomedical HIV prevention interventions among African women (VOICE, HPTN 035, and FEM-PrEP). Methods: We implemented standard methods for the development of clinical prediction rules to generate a risk-scoring tool to predict HIV acquisition over the course of 1 year. Performance of the score was assessed through internal and external validations. Results: The final risk score resulting from multivariable modeling included age, married/living with a partner, partner provides financial or material support, partner has other partners, alcohol use, detection of a curable sexually transmitted infection, and herpes simplex virus 2 serostatus. Point values for each factor ranged from 0 to 2, with a maximum possible total score of 11. Scores ≥5 were associated with HIV incidence >5 per 100 person-years and identified 91% of incident HIV infections from among only 64% of women. The area under the curve (AUC) for predictive ability of the score was 0.71 (95% confidence interval [CI]: 0.68 to 0.74), indicating good predictive ability. Risk score performance was generally similar with internal cross-validation (AUC = 0.69; 95% CI: 0.66 to 0.73) and external validation in HPTN 035 (AUC = 0.70; 95% CI: 0.65 to 0.75) and FEM-PrEP (AUC = 0.58; 95% CI: 0.51 to 0.65). Conclusions: A discrete set of characteristics that can be easily assessed in clinical and research settings was predictive of HIV acquisition over 1 year. The use of a validated risk score could improve efficiency of recruitment into HIV prevention research and inform scale-up of HIV prevention strategies in women at highest risk. PMID:26918545

  1. The East London glaucoma prediction score: web-based validation of glaucoma risk screening tool

    PubMed Central

    Stephen, Cook; Benjamin, Longo-Mbenza

    2013-01-01

    AIM It is difficult for Optometrists and General Practitioners to know which patients are at risk. The East London glaucoma prediction score (ELGPS) is a web based risk calculator that has been developed to determine Glaucoma risk at the time of screening. Multiple risk factors that are available in a low tech environment are assessed to provide a risk assessment. This is extremely useful in settings where access to specialist care is difficult. Use of the calculator is educational. It is a free web based service. Data capture is user specific. METHOD The scoring system is a web based questionnaire that captures and subsequently calculates the relative risk for the presence of Glaucoma at the time of screening. Three categories of patient are described: Unlikely to have Glaucoma; Glaucoma Suspect and Glaucoma. A case review methodology of patients with known diagnosis is employed to validate the calculator risk assessment. RESULTS Data from the patient records of 400 patients with an established diagnosis has been captured and used to validate the screening tool. The website reports that the calculated diagnosis correlates with the actual diagnosis 82% of the time. Biostatistics analysis showed: Sensitivity = 88%; Positive predictive value = 97%; Specificity = 75%. CONCLUSION Analysis of the first 400 patients validates the web based screening tool as being a good method of screening for the at risk population. The validation is ongoing. The web based format will allow a more widespread recruitment for different geographic, population and personnel variables. PMID:23550097

  2. Current Developments in Dementia Risk Prediction Modelling: An Updated Systematic Review

    PubMed Central

    Tang, Eugene Y. H.; Harrison, Stephanie L.; Errington, Linda; Gordon, Mark F.; Visser, Pieter Jelle; Novak, Gerald; Dufouil, Carole; Brayne, Carol; Robinson, Louise; Launer, Lenore J.; Stephan, Blossom C. M.

    2015-01-01

    Background Accurate identification of individuals at high risk of dementia influences clinical care, inclusion criteria for clinical trials and development of preventative strategies. Numerous models have been developed for predicting dementia. To evaluate these models we undertook a systematic review in 2010 and updated this in 2014 due to the increase in research published in this area. Here we include a critique of the variables selected for inclusion and an assessment of model prognostic performance. Methods Our previous systematic review was updated with a search from January 2009 to March 2014 in electronic databases (MEDLINE, Embase, Scopus, Web of Science). Articles examining risk of dementia in non-demented individuals and including measures of sensitivity, specificity or the area under the curve (AUC) or c-statistic were included. Findings In total, 1,234 articles were identified from the search; 21 articles met inclusion criteria. New developments in dementia risk prediction include the testing of non-APOE genes, use of non-traditional dementia risk factors, incorporation of diet, physical function and ethnicity, and model development in specific subgroups of the population including individuals with diabetes and those with different educational levels. Four models have been externally validated. Three studies considered time or cost implications of computing the model. Interpretation There is no one model that is recommended for dementia risk prediction in population-based settings. Further, it is unlikely that one model will fit all. Consideration of the optimal features of new models should focus on methodology (setting/sample, model development and testing in a replication cohort) and the acceptability and cost of attaining the risk variables included in the prediction score. Further work is required to validate existing models or develop new ones in different populations as well as determine the ethical implications of dementia risk prediction

  3. Framingham Coronary Heart Disease Risk Score Can be Predicted from Structural Brain Images in Elderly Subjects

    PubMed Central

    Rondina, Jane Maryam; Squarzoni, Paula; Souza-Duran, Fabio Luis; Tamashiro-Duran, Jaqueline Hatsuko; Scazufca, Marcia; Menezes, Paulo Rossi; Vallada, Homero; Lotufo, Paulo A.; de Toledo Ferraz Alves, Tania Correa; Busatto Filho, Geraldo

    2014-01-01

    Recent literature has presented evidence that cardiovascular risk factors (CVRF) play an important role on cognitive performance in elderly individuals, both those who are asymptomatic and those who suffer from symptoms of neurodegenerative disorders. Findings from studies applying neuroimaging methods have increasingly reinforced such notion. Studies addressing the impact of CVRF on brain anatomy changes have gained increasing importance, as recent papers have reported gray matter loss predominantly in regions traditionally affected in Alzheimer’s disease (AD) and vascular dementia in the presence of a high degree of cardiovascular risk. In the present paper, we explore the association between CVRF and brain changes using pattern recognition techniques applied to structural MRI and the Framingham score (a composite measure of cardiovascular risk largely used in epidemiological studies) in a sample of healthy elderly individuals. We aim to answer the following questions: is it possible to decode (i.e., to learn information regarding cardiovascular risk from structural brain images) enabling individual predictions? Among clinical measures comprising the Framingham score, are there particular risk factors that stand as more predictable from patterns of brain changes? Our main findings are threefold: (i) we verified that structural changes in spatially distributed patterns in the brain enable statistically significant prediction of Framingham scores. This result is still significant when controlling for the presence of the APOE 4 allele (an important genetic risk factor for both AD and cardiovascular disease). (ii) When considering each risk factor singly, we found different levels of correlation between real and predicted factors; however, single factors were not significantly predictable from brain images when considering APOE4 allele presence as covariate. (iii) We found important gender differences, and the possible causes of that finding are discussed. PMID

  4. Association between risk behaviors and adiposity indicators in adolescents from Southern Brazil: A methodological approach.

    PubMed

    Silva, Danilo Rp; Ohara, David; Tomeleri, Crisieli M; Batista, Mariana B; Fernandes, Rômulo A; Ronque, Enio Rv; Sardinha, Luís B; Cyrino, Edilson S

    2016-09-01

    The aim of this study was to analyze the association between risk behaviors and adiposity indicators in adolescents and to discuss some methodological aspects related to this relationship. We evaluated 1,321 adolescents (55.2% female) aged 10-16 years. Relative body fat (%fat) by measurement of triceps and subscapular skinfold thickness and waist circumference (WC) were used as total and central adiposity indicators, respectively. Physical inactivity, time spent in front of the TV, the consumption of soda and/or chocolate, alcohol, and tobacco smoking were analyzed as risk behaviors. Information about the socioeconomic status (categorized into three levels) and nutritional status of the mother (overweight or normal weight) were used as adjustment factors in the analyses of prevalence ratio (PR) of the outcomes and their associated 95% confidence intervals (95% CI). The chi-square test and Poisson regression were used for statistical analyses. Low associations were found between risk behaviors and adiposity indicators. Tobacco smoking was the most positively correlated behavior with adiposity in girls (%fat: PR = 1.61; 95% CI = 1.04-2.47; WC: PR = 1.90; 95% CI = 1.17-3.08) and in adolescents whose mothers were normal weight (%fat: PR = 2.31; 95% CI = 1.33-4.03; WC: PR: 2.31; CI: 1.19-4.46). Additionally, as an important methodological issue, we highlighted the assessment of risk behaviors in adolescents as crucial to producing more robust evidence on the subject. Of the investigated behaviors, we concluded that tobacco smoking is the behavior most associated with adiposity indicators. PMID:26311484

  5. An agro-climatic approach to determine citrus postbloom fruit drop risk in Southern Brazil.

    PubMed

    Soares-Colletti, Ana R; Alvares, Clayton A; Sentelhas, Paulo C

    2016-06-01

    Postbloom fruit drop (PFD) causes lesions on the petals of citrus flowers and induces fruit abscission causing severe damage to production when the flowering period coincides with intense rainfall. The aims of this study were to develop a phenological-climatological model for citrus PFD occurrence and, together with weather data series from several locations, to determine and map the agro-climatic favorability of PFD occurrence in the state of São Paulo, Southern Brazil. A phenological flowering model was developed to identify when citrus flowering occurs. The flowering starts after when a temperature below 10 °C in the months of June or July is reached followed by cumulative rainfall within 5 days of at least 20 mm, and then 96 °C days. Between the beginning of flowering and its peak, 147 °C days are required, and between the peak and its end, approximately 229 °C days, being 206 °C days from the peak to the moment when flowers remaining are about 50 % of total. The relationship between PFD incidence and accumulated rainfall during the critical period (between flowering peak and 50 % of flowers remaining) was adjusted by the Gompertz model (R (2) = 0.99, p < 0.05). After its validation, this model was used to estimate PFD incidence for 29 locations in the state, from 1993 to 2013, which allowed to map the PFD climatic favorability for the state through a Geographical Information System using linear models based on latitude, longitude, and altitude. The obtained map showed a trend of PFD incidence increasing from the northwest of the state of São Paulo towards the south and the coastal region, with medium to very high favorability in the center of the state. The results of this study can be used by growers as a guide for disease control planning as well as for defining the regions where the climatic conditions are likely to escape this disease. PMID:26493198

  6. Development of a disease risk prediction model for downy mildew (Peronospora sparsa) in boysenberry.

    PubMed

    Kim, Kwang Soo; Beresford, Robert M; Walter, Monika

    2014-01-01

    Downy mildew caused by Peronospora sparsa has resulted in serious production losses in boysenberry (Rubus hybrid), blackberry (Rubus fruticosus), and rose (Rosa sp.) in New Zealand, Mexico, and the United States and the United Kingdom, respectively. Development of a model to predict downy mildew risk would facilitate development and implementation of a disease warning system for efficient fungicide spray application in the crops affected by this disease. Because detailed disease observation data were not available, a two-step approach was applied to develop an empirical risk prediction model for P. sparsa. To identify the weather patterns associated with a high incidence of downy mildew berry infections (dryberry disease) and derive parameters for the empirical model, classification and regression tree (CART) analysis was performed. Then, fuzzy sets were applied to develop a simple model to predict the disease risk based on the parameters derived from the CART analysis. High-risk seasons with a boysenberry downy mildew incidence >10% coincided with months when the number of hours per day with temperature of 15 to 20°C averaged >9.8 over the month and the number of days with rainfall in the month was >38.7%. The Fuzzy Peronospora Sparsa (FPS) model, developed using fuzzy sets, defined relationships among high-risk events, temperature, and rainfall conditions. In a validation study, the FPS model provided correct identification of both seasons with high downy mildew risk for boysenberry, blackberry, and rose and low risk in seasons when no disease was observed. As a result, the FPS model had a significant degree of agreement between predicted and observed risks of downy mildew for those crops (P = 0.002). PMID:23883152

  7. How Well Do Stroke Risk Scores Predict Hemorrhage in Patients With Atrial Fibrillation?

    PubMed

    Quinn, Gene R; Singer, Daniel E; Chang, Yuchiao; Go, Alan S; Borowsky, Leila H; Fang, Margaret C

    2016-09-01

    The decision to use anticoagulants for atrial fibrillation depends on comparing a patient's estimated risk of stroke to their bleeding risk. Several of the risk factors in the stroke risk schemes overlap with hemorrhage risk. We compared how well 2 stroke risk scores (CHADS2 and CHA2DS2-VASc) and 2 hemorrhage risk scores (the ATRIA bleeding score and the HAS-BLED score) predicted major hemorrhage on and off warfarin in a cohort of 13,559 community-dwelling adults with AF. Over a cumulative 64,741 person-years of follow-up, we identified a total of 777 incident major hemorrhage events. The ATRIA bleeding score had the highest predictive ability of all the scores in patients on warfarin (c-index of 0.74 [0.72 to 0.76] compared with 0.65 [0.62 to 0.67] for CHADS2, 0.65 [0.62 to 0.67] for CHA2DS2-VASc, and 0.64 [0.61 to 0.66] for HAS-BLED) and in those off warfarin (0.77 [0.74 to 0.79] compared with 0.67 [0.64 to 0.71] for CHADS2, 0.67 [0.64 to 0.70] for CHA2DS2-VASc, and 0.68 [0.65 to 0.71] for HAS-BLED). In conclusion, although CHADS2 and CHA2DS2-VASc stroke scores were better at predicting hemorrhage than chance alone, they were inferior to the ATRIA bleeding score. Our study supports the use of dedicated hemorrhage risk stratification tools to predict major hemorrhage in atrial fibrillation. PMID:27394408

  8. Geriatric Nutritional Risk Index (GNRI) Independently Predicts Amputation Inchronic Criticallimb Ischemia (CLI)

    PubMed Central

    Luo, Han; Yang, Hongliu; Huang, Bin; Yuan, Ding; Zhu, Jingqiang; Zhao, Jichun

    2016-01-01

    Objective General malnutrition usually occurs in critical limb ischemia (CLI) patients because of shortness of appetite and sleeplessness leaded by chronic pain. And amputation frequently is end-point of CLI patients. So the aim of this study was to assess the predictive ability of Geriatric nutritional risk index (GNRI) for predicting amputation in patients with CLI. Methods A retrospective study was designed. Demographics, history, comorbidity, and risk factors for peripheral vascular disease of admitted patients, and laboratory study were documented. Patients’ height, weight and BMI were recorded. Amputation was identified as end-point during follow-up. Patients’ amputation-free survival (AFS) was recorded. Result 172 patients were identified, with mean age 71.98±3.12. Geriatric nutritional risk index (GNRI) = 90 was taken as cutoff value of high risk of amputation for CLI patients via using receiver operating characteristic (ROC) curve. Span of follow-up was 12–48 months. During follow-up, 60 patients (36.04%) received amputation surgery. And analyzed by Cox proportional hazards model, it is found that GNRI was the independent predictive factor for amputation in long term. Conclusion This study revealed that GNRI was a reliable and effective predictive marker for AFS. GNRI could identify patients with high risk for amputation in early time. PMID:27010532

  9. Risk Prediction of One-Year Mortality in Patients with Cardiac Arrhythmias Using Random Survival Forest

    PubMed Central

    Miao, Fen; Cai, Yun-Peng; Zhang, Yu-Xiao; Li, Ye; Zhang, Yuan-Ting

    2015-01-01

    Existing models for predicting mortality based on traditional Cox proportional hazard approach (CPH) often have low prediction accuracy. This paper aims to develop a clinical risk model with good accuracy for predicting 1-year mortality in cardiac arrhythmias patients using random survival forest (RSF), a robust approach for survival analysis. 10,488 cardiac arrhythmias patients available in the public MIMIC II clinical database were investigated, with 3,452 deaths occurring within 1-year followups. Forty risk factors including demographics and clinical and laboratory information and antiarrhythmic agents were analyzed as potential predictors of all-cause mortality. RSF was adopted to build a comprehensive survival model and a simplified risk model composed of 14 top risk factors. The built comprehensive model achieved a prediction accuracy of 0.81 measured by c-statistic with 10-fold cross validation. The simplified risk model also achieved a good accuracy of 0.799. Both results outperformed traditional CPH (which achieved a c-statistic of 0.733 for the comprehensive model and 0.718 for the simplified model). Moreover, various factors are observed to have nonlinear impact on cardiac arrhythmias prognosis. As a result, RSF based model which took nonlinearity into account significantly outperformed traditional Cox proportional hazard model and has great potential to be a more effective approach for survival analysis. PMID:26379761

  10. Predicting reoffense in pedophilic child molesters by clinical diagnoses and risk assessment.

    PubMed

    Eher, Reinhard; Olver, Mark E; Heurix, Isabelle; Schilling, Frank; Rettenberger, Martin

    2015-12-01

    A Diagnostic and Statistical Manual of Mental Disorders (DSM)-based diagnosis of pedophilia has so far failed to predict sexual reoffense in convicted child molesters, probably because of its broad and unspecific conceptualization. In this study, therefore, we investigated the prognostic value of the subtype exclusive pedophilia and a series of customary risk assessment instruments (SSPI, Static-99, Stable-2007, VRS:SO) and the PCL-R in a sample of prison released pedophilic sexual offenders. First, we examined the convergent validity of risk assessment instruments (N = 261). Then, we calculated the predictive accuracy of the measures and diagnosis for sexual recidivism by ROC analyses and subsequent Cox regression (N = 189). Also, predictive values with more clinical immediacy were calculated (sensitivity, specificity, PPV and NPV). The VRS:SO, the SSPI, and the Static-99 significantly predicted sexual recidivism, as did a diagnosis of exclusive pedophilia. Also, the VRS:SO predicted sexual reoffense significantly better than the Stable-2007, the Static-99/Stable-2007 combined score, and the PCL-R. When used combined, only the VRS:SO and a diagnosis of exclusive pedophilia added incremental validity to each other. Our findings support that the clinical diagnosis of an exclusive pedophilia based on DSM criteria and VRS:SO defined risk factors can reliably discriminate higher from lower risk offenders, even within the select subgroup of pedophilic child molesters. PMID:26146817

  11. Predicting crash risk and identifying crash precursors on Korean expressways using loop detector data.

    PubMed

    Kwak, Ho-Chan; Kho, Seungyoung

    2016-03-01

    In order to improve traffic safety on expressways, it is important to develop proactive safety management strategies with consideration for segment types and traffic flow states because crash mechanisms have some differences by each condition. The primary objective of this study is to develop real-time crash risk prediction models for different segment types and traffic flow states on expressways. The mainline of expressways is divided into basic segment and ramp vicinity, and the traffic flow states are classified into uncongested and congested conditions. Also, Korean expressways have irregular intervals between loop detector stations. Therefore, we investigated on the effect and application of the detector stations at irregular intervals for the crash risk prediction on expressways. The most significant traffic variables were selected by conditional logistic regression analysis which could control confounding factors. Based on the selected traffic variables, separate models to predict crash risk were developed using genetic programming technique. The model estimation results showed that the traffic flow characteristics leading to crashes are differed by segment type and traffic flow state. Especially, the variables related to the intervals between detector stations had a significant influence on crash risk prediction under the uncongested condition. Finally, compared with the single model for all crashes and the logistic models used in previous studies, the proposed models showed higher prediction performance. The results of this study can be applied to develop more effective proactive safety management strategies for different segment types and traffic flow states on expressways with loop detector stations at irregular intervals. PMID:26710266

  12. Metabolic profile and cardiovascular risk patterns of an Indian tribe living in the Amazon Region of Brazil.

    PubMed

    Tavares, Edelweiss F; Vieira-Filho, João P B; Andriolo, Adagmar; Sañudo, Adriana; Gimeno, Suely G A; Franco, Laércio J

    2003-02-01

    The Parkatêjê Indians, belonging to the Jê group and inhabiting the Mãe Maria Reservation in the southeast of the state of Pará in the Amazon Region of Brazil, have suffered rapid and intensive cultural changes in recent years. This survey was designed to characterize the metabolic profile and the frequency of cardiovascular risk factors in this community. Ninety subjects (90.0% of the adult population without admixture) were investigated. Anthropometric measurements were performed and the following clinical characteristics measured: glycemia, serum insulin and proinsulin (fasting and 2-hr post 75 g of glucose load), beta-cell function (%B) and insulin sensitivity (%S) estimated by HOMA, HbA1c, GAD65 antibody, serum lipids, uric acid, creatinine, leptin, and blood pressure. Information about alcohol use, smoking, and medical history was obtained through individual interviews. The prevalences were: overweight, 67.8%; obesity, 14.4%; central obesity, 72.2%; hypertension, 4.4%; dyslipidemia, 44.4%; hyperuricemia, 5.6%; GAD65 antibody positivity, 4.4%; smoking, 25.6%; chronic alcohol use, 0.0%. One case of impaired glucose tolerance (1.1%) and one case of impaired fasting glycemia (1.1%) were diagnosed during this study and one case of diabetes (1.1%) was diagnosed previously. The diabetic woman was excluded from the analyses involving HbA1c, glycemia, insulin, proinsulin, %B, and %S. All creatinine values were normal. Blood pressure did not correlate with age, anthropometric measurements, insulin, proinsulin, and natural logarithm (ln) transformed %S. After adjustment for age and sex, there were positive correlations between total cholesterol and body mass index (BMI; r = 0.24), triglycerides and BMI (r = 0.44), triglycerides and waist-to-hip ratio (WHR; r = 0.52), In leptin and BMI (r = 0.41), In leptin and WHR (r = 0.29), uric acid and systolic blood pressure (r = 0.34), uric acid and triglycerides (r = 0.22). Systolic (r = 0.04; r = 0.70) and diastolic (r = 0

  13. External Validation of the Garvan Nomograms for Predicting Absolute Fracture Risk: The Tromsø Study

    PubMed Central

    Ahmed, Luai A.; Nguyen, Nguyen D.; Bjørnerem, Åshild; Joakimsen, Ragnar M.; Jørgensen, Lone; Størmer, Jan; Bliuc, Dana; Center, Jacqueline R.; Eisman, John A.; Nguyen, Tuan V.; Emaus, Nina

    2014-01-01

    Background Absolute risk estimation is a preferred approach for assessing fracture risk and treatment decision making. This study aimed to evaluate and validate the predictive performance of the Garvan Fracture Risk Calculator in a Norwegian cohort. Methods The analysis included 1637 women and 1355 aged 60+ years from the Tromsø study. All incident fragility fractures between 2001 and 2009 were registered. The predicted probabilities of non-vertebral osteoporotic and hip fractures were determined using models with and without BMD. The discrimination and calibration of the models were assessed. Reclassification analysis was used to compare the models performance. Results The incidence of osteoporotic and hip fracture was 31.5 and 8.6 per 1000 population in women, respectively; in men the corresponding incidence was 12.2 and 5.1. The predicted 5-year and 10-year probability of fractures was consistently higher in the fracture group than the non-fracture group for all models. The 10-year predicted probabilities of hip fracture in those with fracture was 2.8 (women) to 3.1 times (men) higher than those without fracture. There was a close agreement between predicted and observed risk in both sexes and up to the fifth quintile. Among those in the highest quintile of risk, the models over-estimated the risk of fracture. Models with BMD performed better than models with body weight in correct classification of risk in individuals with and without fracture. The overall net decrease in reclassification of the model with weight compared to the model with BMD was 10.6% (p = 0.008) in women and 17.2% (p = 0.001) in men for osteoporotic fractures, and 13.3% (p = 0.07) in women and 17.5% (p = 0.09) in men for hip fracture. Conclusions The Garvan Fracture Risk Calculator is valid and clinically useful in identifying individuals at high risk of fracture. The models with BMD performed better than those with body weight in fracture risk prediction. PMID:25255221

  14. Comparison of time series models for predicting campylobacteriosis risk in New Zealand.

    PubMed

    Al-Sakkaf, A; Jones, G

    2014-05-01

    Predicting campylobacteriosis cases is a matter of considerable concern in New Zealand, after the number of the notified cases was the highest among the developed countries in 2006. Thus, there is a need to develop a model or a tool to predict accurately the number of campylobacteriosis cases as the Microbial Risk Assessment Model used to predict the number of campylobacteriosis cases failed to predict accurately the number of actual cases. We explore the appropriateness of classical time series modelling approaches for predicting campylobacteriosis. Finding the most appropriate time series model for New Zealand data has additional practical considerations given a possible structural change, that is, a specific and sudden change in response to the implemented interventions. A univariate methodological approach was used to predict monthly disease cases using New Zealand surveillance data of campylobacteriosis incidence from 1998 to 2009. The data from the years 1998 to 2008 were used to model the time series with the year 2009 held out of the data set for model validation. The best two models were then fitted to the full 1998-2009 data and used to predict for each month of 2010. The Holt-Winters (multiplicative) and ARIMA (additive) intervention models were considered the best models for predicting campylobacteriosis in New Zealand. It was noticed that the prediction by an additive ARIMA with intervention was slightly better than the prediction by a Holt-Winter multiplicative method for the annual total in year 2010, the former predicting only 23 cases less than the actual reported cases. It is confirmed that classical time series techniques such as ARIMA with intervention and Holt-Winters can provide a good prediction performance for campylobacteriosis risk in New Zealand. The results reported by this study are useful to the New Zealand Health and Safety Authority's efforts in addressing the problem of the campylobacteriosis epidemic. PMID:23551848

  15. Projecting Risk: The Importance of the HCR-20 Risk Management Scale in Predicting Outcomes with Forensic Patients.

    PubMed

    Vitacco, Michael J; Tabernik, Holly E; Zavodny, Denis; Bailey, Karen; Waggoner, Christina

    2016-03-01

    The present study evaluates data from 116 forensic inpatients who underwent violent risk assessments, which included the Historical, Clinical, Risk-20 (HCR-20), from 2006 to 2013 as part of an opportunity to be conditionally discharged from state forensic facilities. Of the 116 inpatients, 58 were never released, 39 were released and returned to a hospital, and 19 were released and never returned. Results from analyses of variance and multinomial logistic regression found the risk management (R) scale of the HCR-20 successfully predicted group membership in that higher scores were associated with a greater likelihood of not being released from a forensic facility or returning to a forensic facility after release. The results of this study indicate that clinicians should consider community-based risk variables when evaluating forensic patients for potential return to the community. This research demonstrates that clinicians failing to fully consider dynamic risk factors associated with community integration jeopardize the quality and thoroughness of their violence risk assessment with regards to readiness for release. Copyright © 2016 John Wiley & Sons, Ltd. PMID:27009396

  16. Determining the main risk factors and high-risk groups of breast cancer using a predictive model for breast cancer risk assessment in South Korea.

    PubMed

    Lee, Eun-Ok; Ahn, Sei-Hyun; You, Chunghee; Lee, Dong-Suk; Han, Wonshik; Choe, Kuk-Jin; Noh, Dong-Young

    2004-01-01

    This study was aimed at developing a predictive model for assessing the breast cancer risk of Korean women under the assumption of differences in the risk factors between Westerners and Koreans. The cohort comprised 384 breast cancer patients and 2 control groups: one comprising 166 hospitalized patients and the other comprising 104 nurses and teachers. Two initial models were produced by comparing cases and the 2 control groups, and the final equations were established by selecting highly significant variables of the initial models to test the accuracy of the models in terms of disease probability and predictability. Both the initial models and the final disease-probability models were confirmed to exhibit high degrees of accuracy and predictability. Major risk factors determined by comparing the patients with hospitalized controls were a family history, menstrual regularity, total menstrual duration, age at first full-term pregnancy, and duration of breastfeeding. Major risk factors determined by comparing patients with nurse/teacher controls were age, education level, menstrual regularity, drinking status, and smoking status. The predictive model developed here shows that risk factors for breast cancer differ between Korean and Western subjects in the aspect of breastfeeding behavior. However, identifying the relationship between genetic susceptibility and breast cancer will require further studies with larger samples. In a model with nurse/teacher controls, drinking and higher education were found to be protective variables, whereas smoking was a risk factor. Hence the predictive model in this group could not be generalized to the Korean population; instead, breast cancer incidence needs to be compared among nurses and teachers in a nurse-and-teacher cohort. PMID:15525868

  17. The Violence Risk Scale: predictive validity and linking changes in risk with violent recidivism in a sample of high-risk offenders with psychopathic traits.

    PubMed

    Lewis, Kathy; Olver, Mark E; Wong, Stephen C P

    2013-04-01

    The Violence Risk Scale (VRS) uses ratings of static and dynamic risk predictors to assess violence risk, identify targets for treatment, and assess changes in risk following treatment. The VRS was rated pre- and posttreatment on a sample of 150 males, mostly high-risk violent offenders many with psychopathic personality traits. These individuals attended a high-intensity institution-based cognitive-behavioral-oriented violence reduction treatment program in Canada and were then followed up for approximately 5 years postrelease to determine court adjudicated community violent recidivism. VRS scores significantly predicted violent recidivism. Measurements of risk reduction using dynamic VRS predictors were significantly correlated with reduction of violent recidivism after controlling for various potential confounds. The results suggest that, in a high-risk group of offenders with significant psychopathic traits, the VRS demonstrated predictive validity and the dynamic predictors can be used to assess treatment progress, which is linked to a specific criterion variable, thus, fulfilling the criteria for causal dynamic predictors set forth by Kraemer et al. PMID:22556356

  18. Predictive risk mapping of West Nile virus (WNV) infection in Saskatchewan horses

    PubMed Central

    Epp, Tasha Y.; Waldner, Cheryl; Berke, Olaf

    2011-01-01

    The objective of this study was to develop a model using equine data from geographically limited surveillance locations to predict risk categories for West Nile virus (WNV) infection in horses in all geographic locations across the province of Saskatchewan. The province was divided geographically into low-, medium-, or high-risk categories for WNV, based on available serology information from 923 horses obtained through 4 studies of WNV infection in horse populations in Saskatchewan. Discriminant analysis was used to build models using the observed risk of WNV in horses and geographic division-specific environmental data as well as to predict the risk category for all areas, including those beyond the surveillance zones. High-risk areas were indicated by relatively lower rainfall, higher temperatures, and a lower percentage of area covered in trees, water, and wetland. These conditions were most often identified in the southwest corner of the province. Environmental conditions can be used to identify those areas that are at highest risk for WNV. Public health managers could use prediction maps, which are based on animal or human information and developed from annual early season meteorological information, to guide ongoing decisions about when and where to focus intervention strategies for WNV. PMID:22210991

  19. An update review on risk factors and scales for prediction of deep sternal wound infections.

    PubMed

    Buja, Alessandra; Zampieron, Alessandra; Cavalet, Sara; Chiffi, Daniele; Sandonà, Paolo; Vinelli, Angela; Baldovin, Tatjana; Baldo, Vincenzo

    2012-08-01

    Surgical site infections are the most common nosocomial infections in surgical patients. The preventable and the unmodifiable risk factors for deep sternal wound infections (DSWI) have been amply assessed in the literature. The aim of this review was to describe the results of the numerous published studies to describe all the DSWI risk factors and the scales devised to predict SWI, with a view to providing an update on this issue. A comprehensive search of the Medline and Embase databases was performed (considering studies from January 1995 to April 2011); and a manual search was also conducted using references cited in original publications and relevant review articles. There are several risk factors associated with DSWI, which could be classified in four categories as demographic (e.g. sex and age), behavioural (e.g. smoking and obesity), baseline clinical conditions (e.g. diabetes, hypertension and COPD) and surgical operative risk factors (e.g. duration of operation and emergency operation). Six scales for predicting the risk of DSWI are described in the literature: they vary not only in accuracy but also in ease of application and they are applied at different times (some only preoperatively and others also postoperatively). This study provides a broad update on our knowledge of the risk factors for DSWI and the scales for prediction with a view to improving the management of infections at cardiosurgery units. PMID:22151350

  20. Geographical information system and predictive risk maps of urinary schistosomiasis in Ogun State, Nigeria

    PubMed Central

    Ekpo, Uwem F; Mafiana, Chiedu F; Adeofun, Clement O; Solarin, Adewale RT; Idowu, Adewumi B

    2008-01-01

    Background The control of urinary schistosomiasis in Ogun State, Nigeria remains inert due to lack of reliable data on the geographical distribution of the disease and the population at risk. To help in developing a control programme, delineating areas of risk, geographical information system and remotely sensed environmental images were used to developed predictive risk maps of the probability of occurrence of the disease and quantify the risk for infection in Ogun State, Nigeria. Methods Infection data used were derived from carefully validated morbidity questionnaires among primary school children in 2001–2002, in which school children were asked among other questions if they have experienced "blood in urine" or urinary schistosomiasis. The infection data from 1,092 schools together with remotely sensed environmental data such as rainfall, vegetation, temperature, soil-types, altitude and land cover were analysis using binary logistic regression models to identify environmental features that influence the spatial distribution of the disease. The final regression equations were then used in Arc View 3.2a GIS software to generate predictive risk maps of the distribution of the disease and population at risk in the state. Results Logistic regression analysis shows that the only significant environmental variable in predicting the presence and absence of urinary schistosomiasis in any area of the State was Land Surface Temperature (LST) (B = 0.308, p = 0.013). While LST (B = -0.478, p = 0.035), rainfall (B = -0.006, p = 0.0005), ferric luvisols (B = 0.539, p = 0.274), dystric nitosols (B = 0.133, p = 0.769) and pellic vertisols (B = 1.386, p = 0.008) soils types were the final variables in the model for predicting the probability of an area having an infection prevalence equivalent to or more than 50%. The two predictive risk maps suggest that urinary schistosomiasis is widely distributed and occurring in all the Local Government Areas (LGAs) in State. The high-risk

  1. Space Weather Influence on Power Systems: Prediction, Risk Analysis, and Modeling

    NASA Astrophysics Data System (ADS)

    Yatsenko, Vitaliy

    2016-04-01

    This report concentrates on dynamic probabilistic risk analysis of optical elements for complex characterization of damages using physical model of solid state lasers and predictable level of ionizing radiation and space weather. The following main subjects will be covered by our report: (a) solid-state laser model; (b) mathematical models for dynamic probabilistic risk assessment; and (c) software for modeling and prediction of ionizing radiation. A probabilistic risk assessment method for solid-state lasers is presented with consideration of some deterministic and stochastic factors. Probabilistic risk assessment is a comprehensive, structured, and logical analysis method aimed at identifying and assessing risks in solid-state lasers for the purpose of cost-e®ectively improving their safety and performance. This method based on the Conditional Value-at-Risk measure (CVaR) and the expected loss exceeding Value-at-Risk (VaR). We propose to use a new dynamical-information approach for radiation damage risk assessment of laser elements by cosmic radiation. Our approach includes the following steps: laser modeling, modeling of ionizing radiation in°uences on laser elements, probabilistic risk assessment methods, and risk minimization. For computer simulation of damage processes at microscopic and macroscopic levels the following methods are used: () statistical; (b) dynamical; (c) optimization; (d) acceleration modeling, and (e) mathematical modeling of laser functioning. Mathematical models of space ionizing radiation in°uence on laser elements were developed for risk assessment in laser safety analysis. This is a so-called `black box' or `input-output' models, which seeks only to reproduce the behaviour of the system's output in response to changes in its inputs. The model inputs are radiation in°uences on laser systems and output parameters are dynamical characteristics of the solid laser. Algorithms and software for optimal structure and parameters of

  2. PREDICT-PD: Identifying risk of Parkinson's disease in the community: methods and baseline results

    PubMed Central

    Noyce, Alastair J; Bestwick, Jonathan P; Silveira-Moriyama, Laura; Hawkes, Christopher H; Knowles, Charles H; Hardy, John; Giovannoni, Gavin; Nageshwaran, Saiji; Osborne, Curtis; Lees, Andrew J; Schrag, Anette

    2014-01-01

    Objectives To present methods and baseline results for an online screening tool to identify increased risk for Parkinson's disease (PD) in the UK population. Methods Risk estimates for future PD were derived from the results of a systematic review of risk factors and early features of PD. Participants aged 60–80 years without PD were recruited by self-referral. They completed an online survey (including family history, non-motor symptoms and lifestyle factors), a keyboard-tapping task and the University of Pennsylvania Smell Identification Test. Risk scores were calculated based on survey answers. Preliminary support for the validity of this algorithm was assessed by comparing those estimated to be higher risk for PD with those at lower risk using proxies, including smell loss, REM-sleep behaviour disorder and reduced tapping speed, and by assessing associations in the whole group. Results 1324 eligible participants completed the survey and 1146 undertook the keyboard-tapping task. Smell tests were sent to 1065 participants. Comparing the 100 highest-risk participants and 100 lowest-risk participants, median University of Pennsylvania Smell Identification Test scores were 30/40 versus 33/40 (p<0.001), mean number of key taps in 30 s were 55 versus 58 (p=0.045), and 24% versus 10% scored above cut-off for REM-sleep behaviour disorder (p=0.008). Regression analyses showed increasing risk scores were associated with worse scores in the three proxies across the whole group (p≤0.001). Conclusions PREDICT-PD is the first study to systematically combine risk factors for PD in the general population. Validity to predict risk of PD will be tested through longitudinal follow-up of incident PD diagnosis. PMID:23828833

  3. Battered Women's Perceptions of Risk Versus Risk Factors and Instruments in Predicting Repeat Reassault

    ERIC Educational Resources Information Center

    Heckert, D. Alex; Gondolf, Edward W.

    2004-01-01

    This study partially replicates and expands on a previous study that showed women's perceptions of risk to be a strong predictor of reassault among batterers. The current study employed a larger and multisite sample, a longer follow-up period of 15 months, and multiple outcomes including "repeated reassault" (n = 499). According to the multinomial…

  4. PREDICTING RISKS OF UNCHARACTERISTIC WILDFIRES: APPLICATION OF THE RISK ASSESSMENT PROCESS

    EPA Science Inventory

    The U.S. Forest Service is struggling with a legacy of over 100 years of fire suppression on the country's national forest lands and an increasing occurrence of uncharacteristically large, intense wildfires. This paper reviews the risk assessment process and describes how it can...

  5. SNPs and breast cancer risk prediction for African American and Hispanic women.

    PubMed

    Allman, Richard; Dite, Gillian S; Hopper, John L; Gordon, Ora; Starlard-Davenport, Athena; Chlebowski, Rowan; Kooperberg, Charles

    2015-12-01

    For African American or Hispanic women, the extent to which clinical breast cancer risk prediction models are improved by including information on susceptibility single nucleotide polymorphisms (SNPs) is unknown, even though these women comprise increasing proportions of the US population and represent a large proportion of the world's population. We studied 7539 African American and 3363 Hispanic women from the Women's Health Initiative. The age-adjusted 5-year risks from the BCRAT and IBIS risk prediction models were measured and combined with a risk score based on >70 independent susceptibility SNPs. Logistic regression, adjusting for age group, was used to estimate risk associations with log-transformed age-adjusted 5-year risks. Discrimination was measured by the odds ratio (OR) per standard deviation (SD) and the area under the receiver operator curve (AUC). When considered alone, the ORs for African American women were 1.28 for BCRAT, and 1.04 for IBIS. When combined with the SNP risk score (OR 1.23), the corresponding ORs were 1.39 and 1.22. For Hispanic women the corresponding ORs were 1.25 for BCRAT, and 1.15 for IBIS. When combined with the SNP risk score (OR 1.39), the corresponding ORs were 1.48 and 1.42. There was no evidence that any of the combined models were not well calibrated. Including information on known breast cancer susceptibility loci provides approximately 10 and 19% improvement in risk prediction using BCRAT for African Americans and Hispanics, respectively. The corresponding figures for IBIS are approximately 18 and 26%, respectively. PMID:26589314

  6. Predicting Fractures in an International Cohort using Risk Factor Algorithms, Without Bone Mineral Density

    PubMed Central

    Sambrook, Philip N; Flahive, Julie; Hooven, Fred H; Boonen, Steven; Chapurlat, Roland; Lindsay, Robert; Nguyen, Tuan V; Díez-Perez, Adolfo; Pfeilschifter, Johannes; Greenspan, Susan L; Hosmer, David; Netelenbos, J Coen; Adachi, Jonathan D; Watts, Nelson B; Cooper, Cyrus; Roux, Christian; Rossini, Maurizio; Siris, Ethel S; Silverman, Stuart; Saag, Kenneth G; Compston, Juliet E; LaCroix, Andrea; Gehlbach, Stephen

    2016-01-01

    Clinical risk factors are associated with increased probability of fracture in postmenopausal women. We sought to compare prediction models using self-reported clinical risk factors, excluding bone-mineral density (BMD), to predict incident fracture among postmenopausal women. The GLOW study enrolled women aged ≥55 years were seen at 723 primary care practices in 10 countries. The population comprised 19,586 women aged ≥60 years who were not receiving anti-osteoporosis medication and were followed annually for 2 years. Self-administered questionnaires were used to collect data on characteristics, fracture risk factors, previous fractures, and health status. The main outcome measure compares the c index for models using the WHO Fracture Risk (FRAX), the Garvan Fracture Risk Calculator (FRC), and a simple model using age and prior fracture. Over 2 years, 880 women reported incident fractures including 69 hip fractures, 468 “major fractures” (as defined by FRAX) and 583 “osteoporotic fractures” (as defined by FRC). Using baseline clinical risk factors, both FRAX and FRC showed moderate ability to correctly order hip fracture times (c index for hip fracture: 0.78 and 0.76, respectively). C indices for “major” and “osteoporotic” fractures showed lower values, at 0.61 and 0.64. Neither algorithm was better than the model based on age+fracture history alone (c index for hip fracture: 0.78). In conclusion, estimation of fracture risk in an international primary care population of postmenopausal women can be made using clinical risk factors alone, without BMD. However, more sophisticated models incorporating multiple clinical risk factors including falls were not superior to more parsimonious models in predicting future fracture in this population. PMID:21887705

  7. EVALUATING RISK-PREDICTION MODELS USING DATA FROM ELECTRONIC HEALTH RECORDS

    PubMed Central

    WANG, LE; SHAW, PAMELA A.; MATHELIER, HANSIE M.; KIMMEL, STEPHEN E.; FRENCH, BENJAMIN

    2016-01-01

    The availability of data from electronic health records facilitates the development and evaluation of risk-prediction models, but estimation of prediction accuracy could be limited by outcome misclassification, which can arise if events are not captured. We evaluate the robustness of prediction accuracy summaries, obtained from receiver operating characteristic curves and risk-reclassification methods, if events are not captured (i.e., “false negatives”). We derive estimators for sensitivity and specificity if misclassification is independent of marker values. In simulation studies, we quantify the potential for bias in prediction accuracy summaries if misclassification depends on marker values. We compare the accuracy of alternative prognostic models for 30-day all-cause hospital readmission among 4548 patients discharged from the University of Pennsylvania Health System with a primary diagnosis of heart failure. Simulation studies indicate that if misclassification depends on marker values, then the estimated accuracy improvement is also biased, but the direction of the bias depends on the direction of the association between markers and the probability of misclassification. In our application, 29% of the 1143 readmitted patients were readmitted to a hospital elsewhere in Pennsylvania, which reduced prediction accuracy. Outcome misclassification can result in erroneous conclusions regarding the accuracy of risk-prediction models. PMID:27158296

  8. Utility of a Language Screening Measure for Predicting Risk for Language Impairment in Bilinguals

    PubMed Central

    Peña, Elizabeth D.; Bedore, Lisa M.; Gillam, Ronald B.

    2015-01-01

    Purpose This study evaluated the accuracy of an experimental version of the Bilingual English Spanish Oral Screener (BESOS; Peña, Bedore, Iglesias, Gutiérrez-Clellen, & Goldstein, 2008) for predicting the long-term risk for language impairment (LI) for a matched group of preschool-aged Spanish–English bilingual children with and without LI. Method A total of 1,029 Spanish–English bilingual children completed the BESOS before entering kindergarten. A subset of 167 participants completed a follow-up language evaluation in 1st grade. Twenty-one of these children were identified as having LI and were matched to a group of 21 typically developing peers from the larger sample. A series of discriminant analyses were used to determine the combination of scores on the BESOS that most accurately predicted 2 years later which children presented with and without LI. Results The linear combination of the semantics and morphosyntax scores in the best language resulted in predictive sensitivity of 95.2% and predictive specificity of 71.4%, with an overall accuracy of 81% for predicting risk for LI. Conclusion A bilingual language screener administered before kindergarten can be useful for predicting risk for LI in bilingual children in 1st grade. PMID:25885932

  9. Factors Predicting Adherence to Risk Management Behaviors of Women at Increased Risk for Developing Lymphedema

    PubMed Central

    Sherman, Kerry A.; Miller, Suzanne M.; Roussi, Pagona; Taylor, Alan

    2014-01-01

    Purpose Lymphedema affects 20-30% of women following breast cancer treatment. However, even when women are informed, they do not necessarily adhere to recommended lymphedema self-management regimens. Utilizing the Cognitive-Social Health Information Processing framework, we assessed cognitive and emotional factors influencing adherence to lymphedema risk management. Methods Women with breast cancer who had undergone breast and lymph node surgery were recruited through the Fox Chase Cancer Centre breast clinic. Participants (N=103) completed measures of lymphedema-related perceived risk, beliefs and expectancies, distress, self-regulatory ability to manage distress, knowledge, and adherence to risk management behaviors. They then received the American Cancer Society publication “Lymphedema: What Every Woman with Breast Cancer Should Know”. Cognitive and affective variables were reassessed at 6- and 12-months post-baseline. Results Maximum likelihood multilevel model analyses indicated that overall adherence increased over time, with significant differences between baseline and 6- and 12- month assessments. Adherence to wearing gloves was significantly lower than that for all other behaviors except electric razor use. Distress significantly decreased, and knowledge significantly increased, over time. Greater knowledge, higher self-efficacy to enact behaviors, lower distress, and higher self-regulatory ability to manage distress were associated with increased adherence. Conclusions Women who understand lymphedema risk management and feel confident in managing this risk are more likely to adhere to recommended strategies. These factors should be rigorously assessed as part of routine care to ensure that women have the self-efficacy to seek treatment and the self-regulatory skills to manage distress, which may undermine attempts to seek medical assistance. PMID:24970542

  10. A score to predict short-term risk of COPD exacerbations (SCOPEX)

    PubMed Central

    Make, Barry J; Eriksson, Göran; Calverley, Peter M; Jenkins, Christine R; Postma, Dirkje S; Peterson, Stefan; Östlund, Ollie; Anzueto, Antonio

    2015-01-01

    Background There is no clinically useful score to predict chronic obstructive pulmonary disease (COPD) exacerbations. We aimed to derive this by analyzing data from three existing COPD clinical trials of budesonide/formoterol, formoterol, or placebo in patients with moderate-to-very-severe COPD and a history of exacerbations in the previous year. Methods Predictive variables were selected using Cox regression for time to first severe COPD exacerbation. We determined absolute risk estimates for an exacerbation by identifying variables in a binomial model, adjusting for observation time, study, and treatment. The model was further reduced to clinically useful variables and the final regression coefficients scaled to obtain risk scores of 0–100 to predict an exacerbation within 6 months. Receiver operating characteristic (ROC) curves and the corresponding C-index were used to investigate the discriminatory properties of predictive variables. Results The best predictors of an exacerbation in the next 6 months were more COPD maintenance medications prior to the trial, higher mean daily reliever use, more exacerbations during the previous year, lower forced expiratory volume in 1 second/forced vital capacity ratio, and female sex. Using these risk variables, we developed a score to predict short-term (6-month) risk of COPD exacerbations (SCOPEX). Budesonide/formoterol reduced future exacerbation risk more than formoterol or as-needed short-acting β2-agonist (salbutamol). Conclusion SCOPEX incorporates easily identifiable patient characteristics and can be readily applied in clinical practice to target therapy to reduce COPD exacerbations in patients at the highest risk. PMID:25670896

  11. Nottingham prognostic index plus (NPI+) predicts risk of distant metastases in primary breast cancer.

    PubMed

    Green, Andrew R; Soria, D; Powe, D G; Nolan, C C; Aleskandarany, M; Szász, M A; Tőkés, A M; Ball, G R; Garibaldi, J M; Rakha, E A; Kulka, J; Ellis, I O

    2016-05-01

    The Nottingham prognostic index plus (NPI+) is based on the assessment of biological class combined with established clinicopathologic prognostic variables providing improved patient outcome stratification for breast cancer superior to the traditional NPI. This study aimed to determine prognostic capability of the NPI+ in predicting risk of development of distant disease. A well-characterised series of 1073 primary early-stage BC cases treated in Nottingham and 251 cases from Budapest were immunohistochemically assessed for cytokeratin (Ck)5/6, Ck18, EGFR, oestrogen receptor (ER), progesterone receptor, HER2, HER3, HER4, Mucin 1 and p53 expression. NPI+ biological class and prognostic scores were assigned using individual algorithms for each biological class incorporating clinicopathologic parameters and investigated in terms of prediction of distant metastases-free survival (MFS). The NPI+ identified distinct prognostic groups (PG) within each molecular class which were predictive of MFS providing improved patient outcome stratification superior to the traditional NPI. NPI+ PGs, between series, were comparable in predicting patient outcome between series in luminal A, basal p53 altered and HER2+/ER+ (p > 0.01) tumours. The low-risk groups were similarly validated in luminal B, luminal N, basal p53 normal tumours (p > 0.01). Due to small patient numbers the remaining PGs could not be validated. NPI+ was additionally able to predict a higher risk of metastases at certain distant sites. This study may indicate the NPI+ as a useful tool in predicting the risk of metastases. The NPI+ provides accurate risk stratification allowing improved individualised clinical decision making for breast cancer. PMID:27116185

  12. Risk factors associated with resistance to HIV testing among transwomen in Brazil.

    PubMed

    Pinheiro Júnior, F M L; Kendall, C; Martins, T A; Mota, R M S; Macena, R H M; Glick, J; Kerr-Correa, F; Kerr, L

    2016-01-01

    Transwomen are a high-risk population for HIV/AIDS worldwide. However, many transwomen do not test for HIV. This study aimed to identify factors associated with resistance to HIV testing among transwomen in Fortaleza/CE. A cross-sectional study was conducted between August and December 2008 with a sample of 304 transwomen recruited through respondent-driven sampling. Data analysis utilized Respondent-Driven Sampling Analysis Tool and SPSS 11.0. Univariate, bivariate, and multivariate analyses examined risk factors associated with resistance to HIV testing. Less than 18 years of age (OR = 4.221; CI = 2.419-7.364), sexual debut before 10 years of age (OR = 6.760; CI = 2.996-15.256), using illegal drugs during sex (OR = 2.384; CI = 1.310-4.339), experience of discrimination (OR = 3.962; CI = 1.540-10.195) and a belief that the test results were not confidential (OR = 3.763; CI = 2.118-6.688) are independently associated with resistance to testing. Intersectoral and targeted strategies aimed at encouraging the adoption of safer sexual behaviors and testing for HIV among transwomen are required. PMID:26274065

  13. Risk factors assessment and risk prediction models in lung cancer screening candidates

    PubMed Central

    Wachuła, Ewa; Szabłowska-Siwik, Sylwia; Boratyn-Nowicka, Agnieszka; Czyżewski, Damian

    2016-01-01

    From February 2015, low-dose computed tomography (LDCT) screening entered the armamentarium of diagnostic tools broadly available to individuals at high-risk of developing lung cancer. While a huge number of pulmonary nodules are identified, only a small fraction turns out to be early lung cancers. The majority of them constitute a variety of benign lesions. Although it entails a burden of the diagnostic work-up, the undisputable benefit emerges from: (I) lung cancer diagnosis at earlier stages (stage shift); (II) additional findings enabling the implementation of a preventive action beyond the realm of thoracic oncology. This review presents how to utilize the risk factors from distinct categories such as epidemiology, radiology and biomarkers to target the fraction of population, which may benefit most from the introduced screening modality. PMID:27195269

  14. Risk factors assessment and risk prediction models in lung cancer screening candidates.

    PubMed

    Adamek, Mariusz; Wachuła, Ewa; Szabłowska-Siwik, Sylwia; Boratyn-Nowicka, Agnieszka; Czyżewski, Damian

    2016-04-01

    From February 2015, low-dose computed tomography (LDCT) screening entered the armamentarium of diagnostic tools broadly available to individuals at high-risk of developing lung cancer. While a huge number of pulmonary nodules are identified, only a small fraction turns out to be early lung cancers. The majority of them constitute a variety of benign lesions. Although it entails a burden of the diagnostic work-up, the undisputable benefit emerges from: (I) lung cancer diagnosis at earlier stages (stage shift); (II) additional findings enabling the implementation of a preventive action beyond the realm of thoracic oncology. This review presents how to utilize the risk factors from distinct categories such as epidemiology, radiology and biomarkers to target the fraction of population, which may benefit most from the introduced screening modality. PMID:27195269

  15. Predictive Mapping of Human Risk for West Nile Virus (WNV) Based on Environmental and Socioeconomic Factors

    PubMed Central

    Rochlin, Ilia; Turbow, David; Gomez, Frank; Ninivaggi, Dominick V.; Campbell, Scott R.

    2011-01-01

    A West Nile virus (WNV) human risk map was developed for Suffolk County, New York utilizing a case-control approach to explore the association between the risk of vector-borne WNV and habitat, landscape, virus activity, and socioeconomic variables derived from publically available datasets. Results of logistic regression modeling for the time period between 2000 and 2004 revealed that higher proportion of population with college education, increased habitat fragmentation, and proximity to WNV positive mosquito pools were strongly associated with WNV human risk. Similar to previous investigations from north-central US, this study identified middle class suburban neighborhoods as the areas with the highest WNV human risk. These results contrast with similar studies from the southern and western US, where the highest WNV risk was associated with low income areas. This discrepancy may be due to regional differences in vector ecology, urban environment, or human behavior. Geographic Information Systems (GIS) analytical tools were used to integrate the risk factors in the 2000–2004 logistic regression model generating WNV human risk map. In 2005–2010, 41 out of 46 (89%) of WNV human cases occurred either inside of (30 cases) or in close proximity (11 cases) to the WNV high risk areas predicted by the 2000–2004 model. The novel approach employed by this study may be implemented by other municipal, local, or state public health agencies to improve geographic risk estimates for vector-borne diseases based on a small number of acute human cases. PMID:21853103

  16. Use of a Cumulative Risk Scale to Predict Poor Intellectual and Academic Outcomes in Childhood Epilepsy.

    PubMed

    Kavanaugh, Brian C; Scarborough, Vanessa Ramos; Salorio, Cynthia F

    2016-06-01

    Discrete risk factors for poor outcomes in childhood epilepsy have been identified, but it is unclear whether the combined effect of several risk factors better predicts outcome. The Epilepsy Cumulative Risk Scale was developed to quantify cumulative risk for poor outcomes in childhood epilepsy. Participants included 156 clinic-referred children with epilepsy. The Epilepsy Cumulative Risk Scale was developed using variables previously associated with functional outcomes. Scale utility was examined through its association with intellectual and academic functioning. All Epilepsy Cumulative Risk Scale variables were significantly associated with functioning. The Total Score (ie, cumulative effect) was most strongly correlated with cognition and academic skills. A Total Score ≥ 5 had the best sensitivity and specificity for differentiating those at high risk for poor outcomes. The Epilepsy Cumulative Risk Scale shows promise as a practical, data-driven tool for quantification of cumulative risk for poor outcomes in childhood epilepsy and may be helpful in detecting those needing referral for additional services. PMID:26747083

  17. Simple risk factors to predict urgent endoscopy in nonvariceal upper gastrointestinal bleeding pre-endoscopically

    PubMed Central

    Wang, Jianzong; Hu, Duanming; Tang, Wen; Hu, Chuanyin; Lu, Qin; Li, Juan; Zhu, Jianhong; Xu, Liming; Sui, Zhenyu; Qian, Mingjie; Wang, Shaofeng; Yin, Guojian

    2016-01-01

    Abstract The goal of this study is to evaluate how to predict high-risk nonvariceal upper gastrointestinal bleeding (NVUGIB) pre-endoscopically. A total of 569 NVUGIB patients between Match 2011 and January 2015 were retrospectively studied. The clinical characteristics and laboratory data were statistically analyzed. The severity of NVUGIB was based on high-risk NVUGIB (Forrest I–IIb), and low-risk NVUGIB (Forrest IIc and III). By logistic regression and receiver-operating characteristic curve, simple risk score systems were derived which predicted patients’ risks of potentially needing endoscopic intervention to control bleeding. Risk score systems combined of patients’ serum hemoglobin (Hb) ≤75 g/L, red hematemesis, red stool, shock, and blood urine nitrogen ≥8.5 mmol/L within 24 hours after admission were derived. As for each one of these clinical signs, the relatively high specificity was 97.9% for shock, 96.4% for red stool, 85.5% for red hematemesis, 76.7% for Hb ≤75 g/L, and the sensitivity was 50.8% for red hematemesis, 47.5% for Hb ≤75 g/L, 14.2% for red stool, and 10.9% for shock. When these 5 clinical signs were presented as a risk score system, the highest area of receiver-operating characteristic curve was 0.746, with sensitivity 0.675 and specificity 0.733, which discriminated well with high-risk NVUGIB. These simple risk factors identified patients with high-risk NVUGIB of needing treatment to manage their bleeding pre-endoscopically. Further validation in the clinic was required. PMID:27367977

  18. Simple risk factors to predict urgent endoscopy in nonvariceal upper gastrointestinal bleeding pre-endoscopically.

    PubMed

    Wang, Jianzong; Hu, Duanming; Tang, Wen; Hu, Chuanyin; Lu, Qin; Li, Juan; Zhu, Jianhong; Xu, Liming; Sui, Zhenyu; Qian, Mingjie; Wang, Shaofeng; Yin, Guojian

    2016-06-01

    The goal of this study is to evaluate how to predict high-risk nonvariceal upper gastrointestinal bleeding (NVUGIB) pre-endoscopically. A total of 569 NVUGIB patients between Match 2011 and January 2015 were retrospectively studied. The clinical characteristics and laboratory data were statistically analyzed. The severity of NVUGIB was based on high-risk NVUGIB (Forrest I-IIb), and low-risk NVUGIB (Forrest IIc and III). By logistic regression and receiver-operating characteristic curve, simple risk score systems were derived which predicted patients' risks of potentially needing endoscopic intervention to control bleeding. Risk score systems combined of patients' serum hemoglobin (Hb) ≤75 g/L, red hematemesis, red stool, shock, and blood urine nitrogen ≥8.5 mmol/L within 24 hours after admission were derived. As for each one of these clinical signs, the relatively high specificity was 97.9% for shock, 96.4% for red stool, 85.5% for red hematemesis, 76.7% for Hb ≤75 g/L, and the sensitivity was 50.8% for red hematemesis, 47.5% for Hb ≤75 g/L, 14.2% for red stool, and 10.9% for shock. When these 5 clinical signs were presented as a risk score system, the highest area of receiver-operating characteristic curve was 0.746, with sensitivity 0.675 and specificity 0.733, which discriminated well with high-risk NVUGIB. These simple risk factors identified patients with high-risk NVUGIB of needing treatment to manage their bleeding pre-endoscopically. Further validation in the clinic was required. PMID:27367977

  19. The Utility of Risk Assessment Instruments for the Prediction of Recidivism in Sexual Homicide Perpetrators

    ERIC Educational Resources Information Center

    Hill, Andreas; Rettenberger, Martin; Habermann, Niels; Berner, Wolfgang; Eher, Reinhard; Briken, Peer

    2012-01-01

    To examine the predictive accuracy of four well established risk assessment instruments (PCL-R, HCR-20, SVR-20, and Static-99) in an important subgroup of sexual offenders, these instruments were assessed retrospectively based on information from forensic psychiatric court reports in a sample of 90 released male sexual homicide offenders (out of…

  20. Predicting Recidivism Among Adjudicated Delinquents: A Model to Identify High Risk Offenders.

    ERIC Educational Resources Information Center

    Grenier, Charles E.; Roundtree, George A.

    1987-01-01

    Studied 100 clients of the East Baton Rouge Parish Family Court to develop predictive model for identifying offenders at high risk for recidivism. Found important predictor variables to be presence of delinquent siblings or friends, school problems, type of offense committed, and gender of delinquent. (Author/NB)

  1. A Naive Bayes machine learning approach to risk prediction using censored, time-to-event data.

    PubMed

    Wolfson, Julian; Bandyopadhyay, Sunayan; Elidrisi, Mohamed; Vazquez-Benitez, Gabriela; Vock, David M; Musgrove, Donald; Adomavicius, Gediminas; Johnson, Paul E; O'Connor, Patrick J

    2015-09-20

    Predicting an individual's risk of experiencing a future clinical outcome is a statistical task with important consequences for both practicing clinicians and public health experts. Modern observational databases such as electronic health records provide an alternative to the longitudinal cohort studies traditionally used to construct risk models, bringing with them both opportunities and challenges. Large sample sizes and detailed covariate histories enable the use of sophisticated machine learning techniques to uncover complex associations and interactions, but observational databases are often 'messy', with high levels of missing data and incomplete patient follow-up. In this paper, we propose an adaptation of the well-known Naive Bayes machine learning approach to time-to-event outcomes subject to censoring. We compare the predictive performance of our method with the Cox proportional hazards model which is commonly used for risk prediction in healthcare populations, and illustrate its application to prediction of cardiovascular risk using an electronic health record dataset from a large Midwest integrated healthcare system. PMID:25980520

  2. Predicting High Risk Adolescents' Substance Use over Time: The Role of Parental Monitoring

    ERIC Educational Resources Information Center

    Clark, Heddy Kovach; Shamblen, Stephen R.; Ringwalt, Chris L.; Hanley, Sean

    2012-01-01

    We examined whether parental monitoring at baseline predicted subsequent substance use in a high-risk youth population. Students in 14 alternative high schools in Washington State completed self-report surveys at three time points over the course of 2 years. Primary analyses included 1,423 students aged 14-20 who lived with at least one parent or…

  3. Predicting Dyslexia at Age 11 from a Risk Index Questionnaire at Age 5

    ERIC Educational Resources Information Center

    Helland, Turid; Plante, Elena; Hugdahl, Kenneth

    2011-01-01

    This study focused on predicting dyslexia in children ahead of formal literacy training. Because dyslexia is a constitutional impairment, risk factors should be seen in preschool. It was hypothesized that data gathered at age 5 using questions targeting the dyslexia endophenotype should be reliable and valid predictors of dyslexia at age 11. A…

  4. Parental Literacy Predicts Children's Literacy: A Longitudinal Family-Risk Study

    ERIC Educational Resources Information Center

    Torppa, Minna; Eklund, Kenneth; van Bergen, Elsje; Lyytinen, Heikki

    2011-01-01

    This family-risk (FR) study examined whether the literacy skills of parents with dyslexia are predictive of the literacy skills of their offspring. We report data from 31 child-parent dyads where both had dyslexia (FR-D) and 68 dyads where the child did not have dyslexia (FR-ND). Findings supported the differences in liability of FR children with…

  5. Predicting the Risk of Attrition for Undergraduate Students with Time Based Modelling

    ERIC Educational Resources Information Center

    Chai, Kevin E. K.; Gibson, David

    2015-01-01

    Improving student retention is an important and challenging problem for universities. This paper reports on the development of a student attrition model for predicting which first year students are most at-risk of leaving at various points in time during their first semester of study. The objective of developing such a model is to assist…

  6. Predicting Students at Risk in General Chemistry Using Pre-semester Assessments and Demographic Information.

    ERIC Educational Resources Information Center

    Wagner, Eugene P.; Sasser, Howell; DiBiase, Warren J.

    2002-01-01

    Develops a sensitive and specific pre-semester assessment for students enrolled in general chemistry for science majors that would identify students at risk for failing the course. The student pre-semester assessment (SPSA) predicted 40.8% of the students who went on to fail first-semester general chemistry. It was a better predictor of at-risk…

  7. DOSIMETRY MODELING OF INHALED FORMALDEHYDE: BINNING NASAL FLUX PREDICTIONS FOR QUANTITATIVE RISK ASSESSMENT

    EPA Science Inventory

    Dosimetry Modeling of Inhaled Formaldehyde: Binning Nasal Flux Predictions for Quantitative Risk Assessment. Kimbell, J.S., Overton, J.H., Subramaniam, R.P., Schlosser, P.M., Morgan, K.T., Conolly, R.B., and Miller, F.J. (2001). Toxicol. Sci. 000, 000:000.

    Interspecies e...

  8. Using Predictive Modelling to Identify Students at Risk of Poor University Outcomes

    ERIC Educational Resources Information Center

    Jia, Pengfei; Maloney, Tim

    2015-01-01

    Predictive modelling is used to identify students at risk of failing their first-year courses and not returning to university in the second year. Our aim is twofold. Firstly, we want to understand the factors that lead to poor first-year experiences at university. Secondly, we want to develop simple, low-cost tools that would allow universities to…

  9. Adolescent inpatient girls’ report of dependent life events predicts prospective suicide risk

    PubMed Central

    Stone, Lindsey Beth; Liu, Richard; Yen, Shirley

    2014-01-01

    Adolescents with a history of suicidal behavior are especially vulnerable for future suicide attempts, particularly following discharge from an inpatient psychiatric admission. This study is the first to test whether adolescents’ tendency to generate stress, or report more dependent events to which they contributed, was predictive of prospective suicide events. Ninety adolescent psychiatric inpatients who were admitted for recent suicide risk, completed diagnostic interviews, assessments of history of suicidal behavior, and a self-report questionnaire of major life events at baseline. Participants were followed over the subsequent 6 months after discharge to assess stability vs. onset of suicide events. Cox proportional hazard regressions were used to predict adolescents’ time to suicide events. Results supported hypothesis, such that only recent greater dependent events, not independent or overall events, predicted risk for prospective suicide events. This effect was specific to adolescent girls. Importantly, dependent events maintained statistical significance as a predictor of future suicide events after co-varying for the effects of several established risk factors and psychopathology. Results suggest that the tendency to generate dependent events may contribute unique additional prediction for adolescent girls’ prospective suicide risk, and highlight the need for future work in this area. PMID:24893759

  10. Development and validation of a predictive mortality risk score from a European hemodialysis cohort

    PubMed Central

    Floege, Jürgen; Gillespie, Iain A; Kronenberg, Florian; Anker, Stefan D; Gioni, Ioanna; Richards, Sharon; Pisoni, Ronald L; Robinson, Bruce M; Marcelli, Daniele; Froissart, Marc; Eckardt, Kai-Uwe

    2015-01-01

    Although mortality risk scores for chronic hemodialysis (HD) patients should have an important role in clinical decision-making, those currently available have limited applicability, robustness, and generalizability. Here we applied a modified Framingham Heart Study approach to derive 1- and 2-year all-cause mortality risk scores using a 11,508 European incident HD patient database (AROii) recruited between 2007 and 2009. This scoring model was validated externally using similar-sized Dialysis Outcomes and Practice Patterns Survey (DOPPS) data. For AROii, the observed 1- and 2-year mortality rates were 13.0 (95% confidence interval (CI; 12.3–13.8)) and 11.2 (10.4–12.1)/100 patient years, respectively. Increasing age, low body mass index, history of cardiovascular disease or cancer, and use of a vascular access catheter during baseline were consistent predictors of mortality. Among baseline laboratory markers, hemoglobin, ferritin, C-reactive protein, serum albumin, and creatinine predicted death within 1 and 2 years. When applied to the DOPPS population, the predictive risk score models were highly discriminatory, and generalizability remained high when restricted by incidence/prevalence and geographic location (C-statistics 0.68–0.79). This new model offers improved predictive power over age/comorbidity-based models and also predicted early mortality (C-statistic 0.71). Our new model delivers a robust and reproducible mortality risk score, based on readily available clinical and laboratory data. PMID:25651366

  11. Schistosomiasis risk estimation in Minas Gerais State, Brazil, using environmental data and GIS techniques.

    PubMed

    Guimarães, Ricardo J P S; Freitas, Corina C; Dutra, Luciano V; Moura, Ana C M; Amaral, Ronaldo S; Drummond, Sandra C; Scholte, Ronaldo G C; Carvalho, Omar S

    2008-01-01

    The influence of climate and environmental variables to the distribution of schistosomiasis has been assessed in several previous studies. Also Geographical Information System (GIS), is a tool that has been recently tested for better understanding the spatial disease distribution. The objective of this paper is to further develop the GIS technology for modeling and control of schistosomiasis using meteorological and social variables and introducing new potential environmental-related variables, particularly those produced by recently launched orbital sensors like the Moderate Resolution Imaging Spectroradiometer (MODIS) and the Shuttle Radar Topography Mission (SRTM). Three different scenarios have been analyzed, and despite of not quite large determination factor, the standard deviation of risk estimates was considered adequate for public health needs. The main variables selected as important for modeling purposes was topographic elevation, summer minimum temperature, the NDVI vegetation index, and the social index HDI91. PMID:18692017

  12. High Susceptibility to Cry1Ac and Low Resistance Allele Frequency Reduce the Risk of Resistance of Helicoverpa armigers to Bt Soybean in Brazil.

    PubMed

    Dourado, Patrick M; Bacalhau, Fabiana B; Amado, Douglas; Carvalho, Renato A; Martinelli, Samuel; Head, Graham P; Omoto, Celso

    2016-01-01

    The Old World bollworm, Helicoverpa armigera (Hübner), was recently introduced into Brazil, where it has caused extensive damage to cotton and soybean crops. MON 87701 × MON 89788 soybean, which expresses the Bt protein Cry1Ac, was recently deployed in Brazil, providing high levels of control against H. armigera. To assess the risk of resistance to the Cry1Ac protein expressed by MON 87701 × MON 89788 soybean in Brazil, we conducted studies to evaluate the baseline susceptibility of H. armigera to Cry1Ac, in planta efficacy including the assessment of the high-dose criterion, and the initial resistance allele frequency based on an F2 screen. The mean Cry1Ac lethal concentration (LC50) ranged from 0.11 to 1.82 μg·mL-1 of diet among all H. armigera field populations collected from crop seasons 2013/14 to 2014/15, which indicated about 16.5-fold variation. MON 87701 × MON 89788 soybean exhibited a high level of efficacy against H. armigera and most likely met the high dose criterion against this target species in leaf tissue dilution bioassays up to 50 times. A total of 212 F2 family lines of H. armigera were established from field collections sampled from seven locations across Brazil and were screened for the presence of MON 87701 × MON 89788 soybean resistance alleles. None of the 212 families survived on MON 87701 × MON 89788 soybean leaf tissue (estimated allele frequency = 0.0011). The responses of H. armigera to Cry1Ac protein, high susceptibility to MON 87701 × MON 89788 soybean, and low frequency of resistance alleles across the main soybean-producing regions support the assumptions of a high-dose/refuge strategy. However, maintenance of reasonable compliance with the refuge recommendation will be essential to delay the evolution of resistance in H. armigera to MON 87701 × MON 89788 soybean in Brazil. PMID:27532632

  13. High Susceptibility to Cry1Ac and Low Resistance Allele Frequency Reduce the Risk of Resistance of Helicoverpa armigers to Bt Soybean in Brazil

    PubMed Central

    Bacalhau, Fabiana B.; Amado, Douglas; Carvalho, Renato A.; Martinelli, Samuel; Head, Graham P.; Omoto, Celso

    2016-01-01

    The Old World bollworm, Helicoverpa armigera (Hübner), was recently introduced into Brazil, where it has caused extensive damage to cotton and soybean crops. MON 87701 × MON 89788 soybean, which expresses the Bt protein Cry1Ac, was recently deployed in Brazil, providing high levels of control against H. armigera. To assess the risk of resistance to the Cry1Ac protein expressed by MON 87701 × MON 89788 soybean in Brazil, we conducted studies to evaluate the baseline susceptibility of H. armigera to Cry1Ac, in planta efficacy including the assessment of the high-dose criterion, and the initial resistance allele frequency based on an F2 screen. The mean Cry1Ac lethal concentration (LC50) ranged from 0.11 to 1.82 μg·mL−1 of diet among all H. armigera field populations collected from crop seasons 2013/14 to 2014/15, which indicated about 16.5-fold variation. MON 87701 × MON 89788 soybean exhibited a high level of efficacy against H. armigera and most likely met the high dose criterion against this target species in leaf tissue dilution bioassays up to 50 times. A total of 212 F2 family lines of H. armigera were established from field collections sampled from seven locations across Brazil and were screened for the presence of MON 87701 × MON 89788 soybean resistance alleles. None of the 212 families survived on MON 87701 × MON 89788 soybean leaf tissue (estimated allele frequency = 0.0011). The responses of H. armigera to Cry1Ac protein, high susceptibility to MON 87701 × MON 89788 soybean, and low frequency of resistance alleles across the main soybean-producing regions support the assumptions of a high-dose/refuge strategy. However, maintenance of reasonable compliance with the refuge recommendation will be essential to delay the evolution of resistance in H. armigera to MON 87701 × MON 89788 soybean in Brazil. PMID:27532632

  14. A Risk Prediction Model for Smoking Experimentation in Mexican American Youth

    PubMed Central

    Talluri, Rajesh; Wilkinson, Anna V.; Spitz, Margaret R.; Shete, Sanjay

    2014-01-01

    Background Smoking experimentation in Mexican American youth is problematic. In light of the research showing that preventing smoking experimentation is a valid strategy for smoking prevention, there is a need to identify Mexican American youth at high risk for experimentation. Methods A prospective population-based cohort of 1179 adolescents of Mexican descent was followed for 5 years starting in 2005–06. Participants completed a baseline interview at a home visit followed by three telephone interviews at intervals of approximately 6 months and additional interviews at two home visits in 2008–09 and 2010–11. The primary end point of interest in this study was smoking experimentation. Information regarding social, cultural, and behavioral factors (e.g., acculturation, susceptibility to experimentation, home characteristics, household influences) was collected at baseline using validated questionnaires. Results Age, sex, cognitive susceptibility, household smoking behavior, peer influence, neighborhood influence, acculturation, work characteristics, positive outcome expectations, family cohesion, degree of tension, ability to concentrate, and school discipline were found to be associated with smoking experimentation. In a validation dataset, the proposed risk prediction model had an AUC of 0.719 (95% confidence interval, 0.637 to 0.801)for predicting absolute risk for smoking experimentation within 1 year. Conclusions The proposed risk prediction model is able to quantify the risk of smoking experimentation in Mexican American adolescents. PMID:25063521

  15. Potential ecological risk assessment and prediction of soil heavy metal pollution around coal gangue dump

    NASA Astrophysics Data System (ADS)

    Jiang, X.; Lu, W. X.; Yang, Q. C.; Yang, Z. P.

    2014-03-01

    Aim of the present study is to evaluate the potential ecological risk and predict the trend of soil heavy metal pollution around a~coal gangue dump in Jilin Province (Northeast China). The concentrations of Cd, Pb, Cu, Cr and Zn were monitored by inductively coupled plasma mass spectrometry (ICP-MS). The potential ecological risk index method developed by Hakanson (1980) was employed to assess the potential risk of heavy metal pollution. The potential ecological risk in an order of E(Cd) > E(Pb) > E(Cu) > E(Cr) > E(Zn) have been obtained, which showed that Cd was the most important factor led to risk. Based on the Cd pollution history, the cumulative acceleration and cumulative rate of Cd were estimated, and the fixed number of years exceeding standard prediction model was established, which was used to predict the pollution trend of Cd under the accelerated accumulation mode and the uniform mode. Pearson correlation analysis and correspondence analysis are employed to identify the sources of heavy metal, and the relationship between sampling points and variables. These findings provide some useful insights for making appropriate management strategies to prevent and decrease heavy metal pollution around coal gangue dump in Yangcaogou coal mine and other similar areas elsewhere.

  16. Practical prediction model for the risk of 2-year mortality of individuals in the general population.

    PubMed

    Goldfarb-Rumyantzev, Alexander; Gautam, Shiva; Brown, Robert S

    2016-04-01

    This study proposed to validate a prediction model and risk-stratification tool of 2-year mortality rates of individuals in the general population suitable for office practice use. A risk indicator (R) derived from data in the literature was based on only 6 variables: to calculate R for an individual, starting with 0, for each year of age above 60, add 0.14; for a male, add 0.9; for diabetes mellitus, add 0.7; for albuminuria >30 mg/g of creatinine, add 0.7; for stage ≥3 chronic kidney disease (CKD), add 0.9; for cardiovascular disease (CVD), add 1.4; or for both CKD and CVD, add 1.7. We developed a univariate logistic regression model predicting 2-year individual mortality rates. The National Health and Nutrition Examination Survey (NHANES) data set (1999-2004 with deaths through 2006) was used as the target for validation. These 12,515 subjects had a mean age of 48.9±18.1 years, 48% males, 9.5% diabetes, 11.7% albuminuria, 6.8% CVD, 5.4% CKD, and 2.8% both CKD and CVD. Using the risk indicator R alone to predict mortality demonstrated good performance with area under the receiver operating characteristic (ROC) curve of 0.84. Dividing subjects into low-risk (R=0-1.0), low intermediate risk (R>1.0-3.0), high intermediate risk (R>3.0-5.0) or high-risk (R>5.0) categories predicted 2-year mortality rates of 0.52%, 1.44%, 5.19% and 15.24%, respectively, by the prediction model compared with actual mortality rates of 0.29%, 2.48%, 5.13% and 13.40%, respectively. We have validated a model of risk stratification using easily identified clinical characteristics to predict 2-year mortality rates of individuals in the general population. The model demonstrated performance adequate for its potential use for clinical practice and research decisions. PMID:26951378

  17. A biological approach to the interspecies prediction of radiation-induced mortality risk

    SciTech Connect

    Carnes, B.A.; Grahn, D.; Olshansky, S.J.

    1997-08-01

    Evolutionary explanations for why sexually reproducing organisms grow old suggest that the forces of natural selection affect the ages when diseases occur that are subject to a genetic influence (referred to here as intrinsic diseases). When extended to the population level for a species, this logic leads to the general prediction that age-specific death rates from intrinsic causes should begin to rise as the force of selection wanes once the characteristic age of sexual maturity is attained. Results consistent with these predictions have been found for laboratory mice, beagles, and humans where, after adjusting for differences in life span, it was demonstrated that these species share a common age pattern of mortality for intrinsic causes of death. In quantitative models used to predict radiation-induced mortality, risks are often expressed as multiples of those observed in a control population. A control population, however, is an aging population. As such, mortality risks related to exposure must be interpreted relative to the age-specific risk of death associated with aging. Given the previous success in making interspecies predictions of age-related mortality, the purpose of this study was to determine whether radiation-induced mortality observed in one species could also be predicted quantitatively from a model used to describe the mortality consequences of exposure to radiation in a different species. Mortality data for B6CF{sub 1} mice and beagles exposed to {sup 60}Co {gamma}-rays for the duration of life were used for analysis.

  18. Risk Prediction Modeling of Sequencing Data Using a Forward Random Field Method

    PubMed Central

    Wen, Yalu; He, Zihuai; Li, Ming; Lu, Qing

    2016-01-01

    With the advance in high-throughput sequencing technology, it is feasible to investigate the role of common and rare variants in disease risk prediction. While the new technology holds great promise to improve disease prediction, the massive amount of data and low frequency of rare variants pose great analytical challenges on risk prediction modeling. In this paper, we develop a forward random field method (FRF) for risk prediction modeling using sequencing data. In FRF, subjects’ phenotypes are treated as stochastic realizations of a random field on a genetic space formed by subjects’ genotypes, and an individual’s phenotype can be predicted by adjacent subjects with similar genotypes. The FRF method allows for multiple similarity measures and candidate genes in the model, and adaptively chooses the optimal similarity measure and disease-associated genes to reflect the underlying disease model. It also avoids the specification of the threshold of rare variants and allows for different directions and magnitudes of genetic effects. Through simulations, we demonstrate the FRF method attains higher or comparable accuracy over commonly used support vector machine based methods under various disease models. We further illustrate the FRF method with an application to the sequencing data obtained from the Dallas Heart Study. PMID:26892725

  19. Predictive risk modelling in health: options for New Zealand and Australia.

    PubMed

    Panattoni, Laura E; Vaithianathan, Rhema; Ashton, Toni; Lewis, Geraint H

    2011-02-01

    Predictive risk models (PRMs) are case-finding tools that enable health care systems to identify patients at risk of expensive and potentially avoidable events such as emergency hospitalisation. Examples include the PARR (Patients-at-Risk-of-Rehospitalisation) tool and Combined Predictive Model used by the National Health Service in England. When such models are coupled with an appropriate preventive intervention designed to avert the adverse event, they represent a useful strategy for improving the cost-effectiveness of preventive health care. This article reviews the current knowledge about PRMs and explores some of the issues surrounding the potential introduction of a PRM to a public health system. We make a particular case for New Zealand, but also consider issues that are relevant to Australia. PMID:21367330

  20. The interaction between genetic risk and childhood sexual abuse in the prediction of adolescent violent behavior.

    PubMed

    Beaver, Kevin M

    2008-12-01

    A rich line of empirical research has indicated that antisocial behaviors are the result of genetic factors and environmental factors working interactively. The current study uses this knowledge base as a springboard to examine the effects of childhood sexual abuse and genetic risk in the prediction of adolescent violent delinquency. To address this issue, data from the National Longitudinal Study of Adolescent Health were analyzed. The results of the analyses reveal that childhood sexual abuse interacts with genetic risk to predict involvement in violent delinquency for males. The effects of childhood sexual abuse and genetic risk as well as the interaction between the two are unrelated to violent delinquency for females. Implications of the study are discussed. PMID:18840900

  1. At risk or not at risk? A meta-analysis of the prognostic accuracy of psychometric interviews for psychosis prediction

    PubMed Central

    Fusar-Poli, Paolo; Cappucciati, Marco; Rutigliano, Grazia; Schultze-Lutter, Frauke; Bonoldi, Ilaria; Borgwardt, Stefan; Riecher-Rössler, Anita; Addington, Jean; Perkins, Diana; Woods, Scott W; McGlashan, Thomas H; Lee, Jimmy; Klosterkötter, Joachim; Yung, Alison R; McGuire, Philip

    2015-01-01

    An accurate detection of individuals at clinical high risk (CHR) for psychosis is a prerequisite for effective preventive interventions. Several psychometric interviews are available, but their prognostic accuracy is unknown. We conducted a prognostic accuracy meta-analysis of psychometric interviews used to examine referrals to high risk services. The index test was an established CHR psychometric instrument used to identify subjects with and without CHR (CHR+ and CHR−). The reference index was psychosis onset over time in both CHR+ and CHR− subjects. Data were analyzed with MIDAS (STATA13). Area under the curve (AUC), summary receiver operating characteristic curves, quality assessment, likelihood ratios, Fagan’s nomogram and probability modified plots were computed. Eleven independent studies were included, with a total of 2,519 help-seeking, predominately adult subjects (CHR+: N=1,359; CHR−: N=1,160) referred to high risk services. The mean follow-up duration was 38 months. The AUC was excellent (0.90; 95% CI: 0.87-0.93), and comparable to other tests in preventive medicine, suggesting clinical utility in subjects referred to high risk services. Meta-regression analyses revealed an effect for exposure to antipsychotics and no effects for type of instrument, age, gender, follow-up time, sample size, quality assessment, proportion of CHR+ subjects in the total sample. Fagan’s nomogram indicated a low positive predictive value (5.74%) in the general non-help-seeking population. Albeit the clear need to further improve prediction of psychosis, these findings support the use of psychometric prognostic interviews for CHR as clinical tools for an indicated prevention in subjects seeking help at high risk services worldwide. PMID:26407788

  2. Limited Clinical Utility of a Genetic Risk Score for the Prediction of Fracture Risk in Elderly Subjects

    PubMed Central

    Eriksson, Joel; Evans, Daniel S.; Nielson, Carrie M.; Shen, Jian; Srikanth, Priya; Hochberg, Marc; McWeeney, Shannon; Cawthon, Peggy M.; Wilmot, Beth; Zmuda, Joseph; Tranah, Greg; Mirel, Daniel B; Challa, Sashi; Mooney, Michael; Crenshaw, Andrew; Karlsson, Magnus; Mellström, Dan; Vandenput, Liesbeth; Orwoll, Eric; Ohlsson, Claes

    2014-01-01

    Context It is important to identify the patients at highest risk of fractures. A recent large-scale meta-analysis identified 63 autosomal SNPs associated with bone mineral density (BMD), of which 16 were also associated with fracture risk. Based on these findings two genetic risk scores (GRS63 and GRS16) were developed. Objective To determine the clinical usefulness of these GRS for the prediction of BMD, BMD change and fracture risk in elderly subjects. Design, Settings and Participants Two male (MrOS US, MrOS Sweden) and one female (SOF) large prospective cohorts of older subjects. Main Outcome Measures BMD, BMD change and radiographically and/or medically confirmed incident fractures (8,067 subjects, 2,185 incident non-vertebral or vertebral fractures). Results GRS63 was associated with BMD (≅3% of the variation explained), but not with BMD change. Both GRS63 and GRS16 were associated with fractures. After BMD-adjustment, the effect sizes for these associations were substantially reduced. Similar results were found using an unweighted GRS63 and an unweighted GRS16 compared to those found using the corresponding weighted risk scores. Only minor improvements in C-statistics (AUC) for fractures were seen when the GRSs were added to a base model (age, weight and height) and no significant improvements in C-statistics were seen when they were added to a model further adjusted for BMD. Net reclassification improvements with the addition of the GRSs to a base model were modest and substantially attenuated in BMD-adjusted models. Conclusions and Relevance GRS63 is associated with BMD, but not BMD change, suggesting that the genetic determinants of BMD differ from those of BMD change. When BMD is known, the clinical utility of the two GRSs for fracture prediction is limited in elderly subjects. PMID:25043339

  3. The importance of climatic factors and outliers in predicting regional monthly campylobacteriosis risk in Georgia, USA

    NASA Astrophysics Data System (ADS)

    Weisent, J.; Seaver, W.; Odoi, A.; Rohrbach, B.

    2014-01-01

    Incidence of Campylobacter infection exhibits a strong seasonal component and regional variations in temperate climate zones. Forecasting the risk of infection regionally may provide clues to identify sources of transmission affected by temperature and precipitation. The objectives of this study were to (1) assess temporal patterns and differences in campylobacteriosis risk among nine climatic divisions of Georgia, USA, (2) compare univariate forecasting models that analyze campylobacteriosis risk over time with those that incorporate temperature and/or precipitation, and (3) investigate alternatives to supposedly random walk series and non-random occurrences that could be outliers. Temporal patterns of campylobacteriosis risk in Georgia were visually and statistically assessed. Univariate and multivariable forecasting models were used to predict the risk of campylobacteriosis and the coefficient of determination (R 2) was used for evaluating training (1999-2007) and holdout (2008) samples. Statistical control charting and rolling holdout periods were investigated to better understand the effect of outliers and improve forecasts. State and division level campylobacteriosis risk exhibited seasonal patterns with peaks occurring between June and August, and there were significant associations between campylobacteriosis risk, precipitation, and temperature. State and combined division forecasts were better than divisions alone, and models that included climate variables were comparable to univariate models. While rolling holdout techniques did not improve predictive ability, control charting identified high-risk time periods that require further investigation. These findings are important in (1) determining how climatic factors affect environmental sources and reservoirs of Campylobacter spp. and (2) identifying regional spikes in the risk of human Campylobacter infection and their underlying causes.

  4. Prediction of cardiovascular disease risk among low-income urban dwellers in metropolitan Kuala Lumpur, Malaysia.

    PubMed

    Su, Tin Tin; Amiri, Mohammadreza; Mohd Hairi, Farizah; Thangiah, Nithiah; Bulgiba, Awang; Majid, Hazreen Abdul

    2015-01-01

    We aimed to predict the ten-year cardiovascular disease (CVD) risk among low-income urban dwellers of metropolitan Malaysia. Participants were selected from a cross-sectional survey conducted in Kuala Lumpur. To assess the 10-year CVD risk, we employed the Framingham risk scoring (FRS) models. Significant determinants of the ten-year CVD risk were identified using General Linear Model (GLM). Altogether 882 adults (≥30 years old with no CVD history) were randomly selected. The classic FRS model (figures in parentheses are from the modified model) revealed that 20.5% (21.8%) and 38.46% (38.9%) of respondents were at high and moderate risk of CVD. The GLM models identified the importance of education, occupation, and marital status in predicting the future CVD risk. Our study indicated that one out of five low-income urban dwellers has high chance of having CVD within ten years. Health care expenditure, other illness related costs and loss of productivity due to CVD would worsen the current situation of low-income urban population. As such, the public health professionals and policy makers should establish substantial effort to formulate the public health policy and community-based intervention to minimize the upcoming possible high mortality and morbidity due to CVD among the low-income urban dwellers. PMID:25821810

  5. Prediction of Cardiovascular Disease Risk among Low-Income Urban Dwellers in Metropolitan Kuala Lumpur, Malaysia

    PubMed Central

    Su, Tin Tin; Amiri, Mohammadreza; Mohd Hairi, Farizah; Thangiah, Nithiah; Majid, Hazreen Abdul

    2015-01-01

    We aimed to predict the ten-year cardiovascular disease (CVD) risk among low-income urban dwellers of metropolitan Malaysia. Participants were selected from a cross-sectional survey conducted in Kuala Lumpur. To assess the 10-year CVD risk, we employed the Framingham risk scoring (FRS) models. Significant determinants of the ten-year CVD risk were identified using General Linear Model (GLM). Altogether 882 adults (≥30 years old with no CVD history) were randomly selected. The classic FRS model (figures in parentheses are from the modified model) revealed that 20.5% (21.8%) and 38.46% (38.9%) of respondents were at high and moderate risk of CVD. The GLM models identified the importance of education, occupation, and marital status in predicting the future CVD risk. Our study indicated that one out of five low-income urban dwellers has high chance of having CVD within ten years. Health care expenditure, other illness related costs and loss of productivity due to CVD would worsen the current situation of low-income urban population. As such, the public health professionals and policy makers should establish substantial effort to formulate the public health policy and community-based intervention to minimize the upcoming possible high mortality and morbidity due to CVD among the low-income urban dwellers. PMID:25821810

  6. Long-term Failure Prediction based on an ARP Model of Global Risk Network

    NASA Astrophysics Data System (ADS)

    Lin, Xin; Moussawi, Alaa; Szymanski, Boleslaw; Korniss, Gyorgy

    Risks that threaten modern societies form an intricately interconnected network. Hence, it is important to understand how risk materializations in distinct domains influence each other. In the paper, we study the global risks network defined by World Economic Forum experts in the form of Stochastic Block Model. We model risks as Alternating Renewal Processes with variable intensities driven by hidden values of exogenous and endogenous failure probabilities. Based on the expert assessments and historical status of each risk, we use Maximum Likelihood Evaluation to find the optimal model parameters and demonstrate that the model considering network effects significantly outperforms the others. In the talk, we discuss how the model can be used to provide quantitative means for measuring interdependencies and materialization of risks in the network. We also present recent results of long-term predictions in the form of predicated distributions of materializations over various time periods. Finally we show how the simulation of ARP's enables us to probe limits of the predictability of the system parameters from historical data and ability to recover hidden variable. Supported in part by DTRA, ARL NS-CTA.

  7. Identifying the necessary and sufficient number of risk factors for predicting academic failure.

    PubMed

    Lucio, Robert; Hunt, Elizabeth; Bornovalova, Marina

    2012-03-01

    Identifying the point at which individuals become at risk for academic failure (grade point average [GPA] < 2.0) involves an understanding of which and how many factors contribute to poor outcomes. School-related factors appear to be among the many factors that significantly impact academic success or failure. This study focused on 12 school-related factors. Using a thorough 5-step process, we identified which unique risk factors place one at risk for academic failure. Academic engagement, academic expectations, academic self-efficacy, homework completion, school relevance, school safety, teacher relationships (positive relationship), grade retention, school mobility, and school misbehaviors (negative relationship) were uniquely related to GPA even after controlling for all relevant covariates. Next, a receiver operating characteristic curve was used to determine a cutoff point for determining how many risk factors predict academic failure (GPA < 2.0). Results yielded a cutoff point of 2 risk factors for predicting academic failure, which provides a way for early identification of individuals who are at risk. Further implications of these findings are discussed. PMID:22182300

  8. Risk Prediction for Prostate Cancer Recurrence Through Regularized Estimation with Simultaneous Adjustment for Nonlinear Clinical Effects*

    PubMed Central

    Long, Qi; Chung, Matthias; Moreno, Carlos S.; Johnson, Brent A.

    2011-01-01

    In biomedical studies, it is of substantial interest to develop risk prediction scores using high-dimensional data such as gene expression data for clinical endpoints that are subject to censoring. In the presence of well-established clinical risk factors, investigators often prefer a procedure that also adjusts for these clinical variables. While accelerated failure time (AFT) models are a useful tool for the analysis of censored outcome data, it assumes that covariate effects on the logarithm of time-to-event are linear, which is often unrealistic in practice. We propose to build risk prediction scores through regularized rank estimation in partly linear AFT models, where high-dimensional data such as gene expression data are modeled linearly and important clinical variables are modeled nonlinearly using penalized regression splines. We show through simulation studies that our model has better operating characteristics compared to several existing models. In particular, we show that there is a non-negligible effect on prediction as well as feature selection when nonlinear clinical effects are misspecified as linear. This work is motivated by a recent prostate cancer study, where investigators collected gene expression data along with established prognostic clinical variables and the primary endpoint is time to prostate cancer recurrence. We analyzed the prostate cancer data and evaluated prediction performance of several models based on the extended c statistic for censored data, showing that 1) the relationship between the clinical variable, prostate specific antigen, and the prostate cancer recurrence is likely nonlinear, i.e., the time to recurrence decreases as PSA increases and it starts to level off when PSA becomes greater than 11; 2) correct specification of this nonlinear effect improves performance in prediction and feature selection; and 3) addition of gene expression data does not seem to further improve the performance of the resultant risk

  9. Concepts and challenges in cancer risk prediction for the space radiation environment.

    PubMed

    Barcellos-Hoff, Mary Helen; Blakely, Eleanor A; Burma, Sandeep; Fornace, Albert J; Gerson, Stanton; Hlatky, Lynn; Kirsch, David G; Luderer, Ulrike; Shay, Jerry; Wang, Ya; Weil, Michael M

    2015-07-01

    Cancer is an important long-term risk for astronauts exposed to protons and high-energy charged particles during travel and residence on asteroids, the moon, and other planets. NASA's Biomedical Critical Path Roadmap defines the carcinogenic risks of radiation exposure as one of four type I risks. A type I risk represents a demonstrated, serious problem with no countermeasure concepts, and may be a potential "show-stopper" for long duration spaceflight. Estimating the carcinogenic risks for humans who will be exposed to heavy ions during deep space exploration has very large uncertainties at present. There are no human data that address risk from extended exposure to complex radiation fields. The overarching goal in this area to improve risk modeling is to provide biological insight and mechanistic analysis of radiation quality effects on carcinogenesis. Understanding mechanisms will provide routes to modeling and predicting risk and designing countermeasures. This white paper reviews broad issues related to experimental models and concepts in space radiation carcinogenesis as well as the current state of the field to place into context recent findings and concepts derived from the NASA Space Radiation Program. PMID:26256633

  10. Concepts and challenges in cancer risk prediction for the space radiation environment

    NASA Astrophysics Data System (ADS)

    Barcellos-Hoff, Mary Helen; Blakely, Eleanor A.; Burma, Sandeep; Fornace, Albert J.; Gerson, Stanton; Hlatky, Lynn; Kirsch, David G.; Luderer, Ulrike; Shay, Jerry; Wang, Ya; Weil, Michael M.

    2015-07-01

    Cancer is an important long-term risk for astronauts exposed to protons and high-energy charged particles during travel and residence on asteroids, the moon, and other planets. NASA's Biomedical Critical Path Roadmap defines the carcinogenic risks of radiation exposure as one of four type I risks. A type I risk represents a demonstrated, serious problem with no countermeasure concepts, and may be a potential "show-stopper" for long duration spaceflight. Estimating the carcinogenic risks for humans who will be exposed to heavy ions during deep space exploration has very large uncertainties at present. There are no human data that address risk from extended exposure to complex radiation fields. The overarching goal in this area to improve risk modeling is to provide biological insight and mechanistic analysis of radiation quality effects on carcinogenesis. Understanding mechanisms will provide routes to modeling and predicting risk and designing countermeasures. This white paper reviews broad issues related to experimental models and concepts in space radiation carcinogenesis as well as the current state of the field to place into context recent findings and concepts derived from the NASA Space Radiation Program.

  11. Canine visceral leishmaniasis in Barra de Guaratiba, Rio de Janeiro, Brazil: assessment of risk factors.

    PubMed

    Cabrera, Maria Alice A; Paula, Adelzon A; Camacho, Luis Antonio B; Marzochi, Mauro Célio A; Xavier, Samanta C; da Silva, Alba Valéria M; Jansen, Ana Maria

    2003-01-01

    Barra de Guaratiba is a coastal area of the city of Rio de Janeiro where American visceral leishmaniasis (AVL) is endemic. Although control measures including killing of dogs and use of insecticides have been applied at this locality, the canine seroprevalence remains at 25% and during 1995 and 1997 eight autochthonous human cases were notified. In order to evaluate factors related to the increase of the risk for Leishmania (Leishmania) chagasi infection in dogs we have screened 365 dogs by anti-Leishmania immunofluorescent antibody test (IFAT) and captured sandflies in the domestic and peridomestic environment. Some variables related to the infection were assessed by uni- and multivariate analysis. The distance of the residence from the forest border, its altitude and the presence of the opossum Didelphis marsupialis in the backyard, were found predictor factors for L. (L.) chagasi infection in dogs in Barra de Guaratiba. The presence of Lutzomyia longipalpis in the peridomestic environment indicates the possibility of appearence of new human cases. Our data also suggest the presence of a sylvatic enzootic cycle at this locality. PMID:12754572

  12. [Violence and psychosocial risks: narratives of adolescents living in shelters in Rio de Janeiro, Brazil].

    PubMed

    Botelho, Adriana Pedreira; Moraes, Mayara Cristina Muniz Bastos; Leite, Ligia Costa

    2015-01-01

    This article contains part of the results of the "Youth, Disaffiliation and Violence" extension project developed at the Institute of Psychiatry of the Federal University of Rio de Janeiro in 2008. It seeks to present experiences of violence experienced in three different contexts, namely in the family home, on the streets and in shelter units (SU), from the standpoint of adolescents. Thirty adolescents in five SUs in the municipality of Rio de Janeiro were interviewed. A qualitative approach was used in order to examine a relatively unknown reality, seeking a contextual understanding from the perspective of the social actors. To achieve this goal, this study sought the contribution of oral reports as the methodology for data collection. The theory of communication was the method of analysis, through the objective/subjective narratives of experiences of adolescents, establishing categories and points of analysis that permeate these experiences. The results revealed that youths housed in shelters are exposed to various psychosocial risks related to violence experienced in the environments visited. Lastly, the need for setting up an intersectorial network aiming at providing effective and comprehensive care for adolescents was highlighted. PMID:25650593

  13. Youth substance use and body composition: does risk in one area predict risk in the other?

    PubMed

    Pasch, Keryn E; Velazquez, Cayley E; Cance, Jessica Duncan; Moe, Stacey G; Lytle, Leslie A

    2012-01-01

    Both substance use and obesity are prevalent among youth. As youth age, substance use rates increase and over the past three decades, obesity rates among youth have tripled. While these two factors have both short- and long-term health impacts, little research has explored how substance use and obesity among youth may be related. This study explores the bi-directional longitudinal relationships between substance use and body composition. Participants (N = 704; 50.7% female) were mostly white (86.4%) with a baseline mean age of 14.7 years. Objectively measured body composition was used to calculate body mass index z-scores (BMI z-score) and percent body fat. Cross-lagged structural equation models, accounting for clustering at the school level, were run to determine the longitudinal association between body composition and self-reported substance use (alcohol, cigarette, and marijuana), adjusting for socio-demographic characteristics, pubertal status, and weight satisfaction. Baseline alcohol use predicted decreased BMI z-score at follow-up and a similar association with percent body fat approached significance. Baseline cigarette use predicted increased percent body fat. No longitudinal associations were seen between baseline body composition and future substance use. Our results suggest that substance use contributes to subsequent body composition; however, body composition does not contribute to subsequent substance use. Continued research that explores these relationships longitudinally is greatly needed. PMID:21853355

  14. Youth Substance Use and Body Composition: Does Risk in One Area Predict Risk in the Other?

    PubMed Central

    Velazquez, Cayley E.; Cance, Jessica Duncan; Moe, Stacey G.; Lytle, Leslie A.

    2013-01-01

    Both substance use and obesity are prevalent among youth. As youth age, substance use rates increase and over the past three decades, obesity rates among youth have tripled. While these two factors have both short- and long-term health impacts, little research has explored how substance use and obesity among youth may be related. This study explores the bi-directional longitudinal relationships between substance use and body composition. Participants (N = 704; 50.7% female) were mostly white (86.4%) with a baseline mean age of 14.7 years. Objectively measured body composition was used to calculate body mass index z-scores (BMI z-score) and percent body fat. Cross-lagged structural equation models, accounting for clustering at the school level, were run to determine the longitudinal association between body composition and self-reported substance use (alcohol, cigarette, and marijuana), adjusting for socio-demographic characteristics, pubertal status, and weight satisfaction. Baseline alcohol use predicted decreased BMI z-score at follow-up and a similar association with percent body fat approached significance. Baseline cigarette use predicted increased percent body fat. No longitudinal associations were seen between baseline body composition and future substance use. Our results suggest that substance use contributes to subsequent body composition; however, body composition does not contribute to subsequent substance use. Continued research that explores these relationships longitudinally is greatly needed. PMID:21853355

  15. Development and validation of a risk calculator for prediction of mortality after infrainguinal bypass surgery

    PubMed Central

    Gupta, Prateek K.; Ramanan, Bala; Lynch, Thomas G.; Sundaram, Abhishek; MacTaggart, Jason N.; Gupta, Himani; Fang, Xiang; Pipinos, Iraklis I.

    2012-01-01

    Objective For peripheral arterial disease, infrainguinal bypass grafting (BPG) carries a higher perioperative risk compared with peripheral endovascular procedures. The choice between the open and endovascular therapies is to an extent dependent on the expected periprocedural risk associated with each. Tools for estimating the periprocedural risk in patients undergoing BPG have not been reported in the literature. The objective of this study was to develop and validate a calculator to estimate the risk of perioperative mortality ≤30 days of elective BPG. Methods We identified 9556 patients (63.9% men) who underwent elective BPG from the 2007 to 2009 National Surgical Quality Improvement Program data sets. Multivariable logistic regression analysis was performed to identify risk factors associated with 30-day perioperative mortality. Bootstrapping was used for internal validation. The risk factors were subsequently used to develop a risk calculator. Results Patients had a median age of 68 years. The 30-day mortality rate was 1.8% (n = 170). Multivariable logistic regression analysis identified seven preoperative predictors of 30-day mortality: increasing age, systemic inflammatory response syndrome, chronic corticosteroid use, chronic obstructive pulmonary disease, dependent functional status, dialysis dependence, and lower extremity rest pain. Bootstrapping was used for internal validation. The model demonstrated excellent discrimination (C statistic, 0.81; bias-corrected C statistic, 0.81) and calibration. The validated risk model was used to develop an interactive risk calculator using the logistic regression equation. Conclusions The validated risk calculator has excellent predictive ability for 30-day mortality in a patient after an elective BPG. It is anticipated to aid in surgical decision making, informed patient consent, preoperative optimization, and consequently, risk reduction. PMID:22632800

  16. Predicting the Risk of Pelvic Node Involvement Among Men With Prostate Cancer in the Contemporary Era

    SciTech Connect

    Nguyen, Paul L. Chen, M.-H.; Hoffman, Karen E.; Katz, Matthew S.; D'Amico, Anthony V.

    2009-05-01

    Purpose: The 'Roach formula' for the risk of pelvic lymph node metastases [(2/3) * PSA + (Gleason score - 6) * 10] was developed in the early prostate-specific antigen (PSA) era. We examined the accuracy of this formula in contemporary patients. Methods: We included men in the Surveillance, Epidemiology, and End Results Registry with a diagnosis of clinical T1c-T4 prostate cancer in 2004 who had a surgical lymph node evaluation, Gleason score (typically from prostatectomy), and baseline PSA level (n = 9,387). Expected and observed rates of node positivity were compared. Results: Ninety-eight percent were clinical T1c/T2, and 97% underwent prostatectomy. Overall, 309 patients (3.29%) had positive lymph nodes. Roach scores overestimated the actual rate of positive lymph nodes in the derivation set by 16-fold for patients with Roach score less than or equal to 10%, by 7-fold for scores greater than 10-20%, and by approximately 2.5-fold for scores greater than 20%. Applying these adjustment factors to Roach scores in the validation data set yielded accurate predictions of risk. For those with Roach score less than or equal to 10%, adjusted expected risk was 0.2% and observed risk was 0.2%. For Roach score greater than 10-20%, adjusted expected risk was 2.0% and observed risk was 2.1%. For Roach score greater than 20-30%, adjusted expected risk was 9.7% and observed risk was 6.5%. For Roach score greater than 30-40%, adjusted expected risk was 13.9% and observed risk was 13.9%. Conclusion: Applied to contemporary patients with mainly T1c/T2 disease, the Roach formula appears to overestimate pelvic lymph node risk. The adjustment factors presented here should be validated by using biopsy Gleason scores and extended lymphadenectomies.

  17. Risk factors predict post-traumatic stress disorder differently in men and women

    PubMed Central

    Christiansen, Dorte M; Elklit, Ask

    2008-01-01

    Background About twice as many women as men develop post-traumatic stress disorder (PTSD), even though men as a group are exposed to more traumatic events. Exposure to different trauma types does not sufficiently explain why women are more vulnerable. Methods The present work examines the effect of age, previous trauma, negative affectivity (NA), anxiety, depression, persistent dissociation, and social support on PTSD separately in men and women. Subjects were exposed to either a series of explosions in a firework factory near a residential area or to a high school stabbing incident. Results Some gender differences were found in the predictive power of well known risk factors for PTSD. Anxiety predicted PTSD in men, but not in women, whereas the opposite was found for depression. Dissociation was a better predictor for PTSD in women than in men in the explosion sample but not in the stabbing sample. Initially, NA predicted PTSD better in women than men in the explosion sample, but when compared only to other significant risk factors, it significantly predicted PTSD for both men and women in both studies. Previous traumatic events and age did not significantly predict PTSD in either gender. Conclusion Gender differences in the predictive value of social support on PTSD appear to be very complex, and no clear conclusions can be made based on the two studies included in this article. PMID:19017412

  18. Prediction of risk and incidence of dry eye in critical patients1

    PubMed Central

    de Araújo, Diego Dias; Almeida, Natália Gherardi; Silva, Priscila Marinho Aleixo; Ribeiro, Nayara Souza; Werli-Alvarenga, Andreza; Chianca, Tânia Couto Machado

    2016-01-01

    Objectives: to estimate the incidence of dry eye, to identify risk factors and to establish a risk prediction model for its development in adult patients admitted to the intensive care unit of a public hospital. Method: concurrent cohort, conducted between March and June, 2014, with 230 patients admitted to an intensive care unit. Data were analyzed by bivariate descriptive statistics, with multivariate survival analysis and Cox regression. Results: 53% out of 230 patients have developed dry eye, with onset mean time of 3.5 days. Independent variables that significantly and concurrently impacted the time for dry eye to occur were: O2 in room air, blinking more than five times per minute (lower risk factors) and presence of vascular disease (higher risk factor). Conclusion: dry eye is a common finding in patients admitted to adults intensive care units, and care for its prevention should be established. PMID:27192415

  19. Reporting guidance for violence risk assessment predictive validity studies: the RAGEE Statement.

    PubMed

    Singh, Jay P; Yang, Suzanne; Mulvey, Edward P

    2015-02-01

    Available reporting guidelines for prognostic and diagnostic accuracy studies apply primarily to biological assessment and outcomes, overlooking behavioral issues with major public health and safety implications such as violence. The present study aimed to develop the first set of reporting guidance for predictive validity studies of violence risk assessments: the Risk Assessment Guidelines for the Evaluation of Efficacy (RAGEE) Statement. A systematic search of 8 electronic databases prior to September 2012 identified 279 reporting guidelines for prognostic and diagnostic accuracy studies. Unique items were extracted and modified to make them relevant to risk assessment. A 4-wave Delphi process involving a multidisciplinary team of 37 international experts resulted in a 50-item reporting checklist. The panelists endorsed the RAGEE Statement checklist as being highly satisfactory and as indicating study features that should be reported routinely in manuscripts. Use of these proposed standards has the potential to improve the quality of the risk assessment literature. PMID:25133921

  20. Cultivated microalgae spills: hard to predict/easier to mitigate risks.

    PubMed

    Gressel, Jonathan; van der Vlugt, Cécile J B; Bergmans, Hans E N

    2014-02-01

    Cultivating algae on a large scale will inevitably lead to spills into natural ecosystems. Most risk analyses have dealt only with transgenic algae, without considering the risks of cultivating the corresponding non-transgenic wild type species. This is despite the long-studied 'paradox of the plankton', which describes the unsuitability of laboratory experimentation or modeling to predict the outcome of introducing non-native algae into a new ecosystem. Risk analyses of transgenic strains of native algae can be based on whether they are more fit or less fit than their wild type, but these are not possible with non-native species. Risks from spills can be minimized by mutagenically or transgenically deleting genes that are unnecessary in culture but obligatory in nature. PMID:24369876

  1. Predicting the Risk of Secondary Lung Malignancies Associated With Whole-Breast Radiation Therapy

    SciTech Connect

    Ng, John; Shuryak, Igor; Xu Yanguang; Clifford Chao, K.S.; Brenner, David J.; Burri, Ryan J.

    2012-07-15

    Purpose: The risk of secondary lung malignancy (SLM) is a significant concern for women treated with whole-breast radiation therapy after breast-conserving surgery for early-stage breast cancer. In this study, a biologically based secondary malignancy model was used to quantify the risk of secondary lung malignancies (SLMs) associated with several common methods of delivering whole-breast radiation therapy (RT). Methods and Materials: Both supine and prone computed tomography simulations of 15 women with early breast cancer were used to generate standard fractionated and hypofractionated whole-breast RT treatment plans for each patient. Dose-volume histograms (DVHs) of the ipsilateral breast and lung were calculated for each patient on each plan. A model of spontaneous and radiation-induced carcinogenesis was used to determine the relative risks of SLMs for the different treatment techniques. Results: A higher risk of SLMs was predicted for supine breast irradiation when compared with prone breast irradiation for both the standard fractionation and hypofractionation schedules (relative risk [RR] = 2.59, 95% confidence interval (CI) = 2.30-2.88, and RR = 2.68, 95% CI = 2.39-2.98, respectively). No difference in risk of SLMs was noted between standard fractionation and hypofractionation schedules in either the supine position (RR = 1.05, 95% CI = 0.97-1.14) or the prone position (RR = 1.01, 95% CI = 0.88-1.15). Conclusions: Compared with supine whole-breast irradiation, prone breast irradiation is associated with a significantly lower predicted risk of secondary lung malignancy. In this modeling study, fractionation schedule did not have an impact on the risk of SLMs in women treated with whole-breast RT for early breast cancer.

  2. Renal scintigraphy predicts global cardiovascular risk in hypertensive subjects with normal serum creatinine levels.

    PubMed

    Mazza, Alberto; Rampin, Lucia; Montemurro, Domenico; Schiavon, Laura; Zuin, Marco; Grassetto, Gaia; Chondrogiannis, Sotirios; Al-Nahhas, Adil; Ramazzina, Emilio; Rubello, Domenico

    2011-12-01

    BACKGROUND. This cross-sectional study investigates the role of renal scintigraphy on cardiovascular (CV) risk stratification in normoalbuminuric, non-diabetic hypertensive subjects (HTs) free from CV disease and renal dysfunction. METHODS. In 200 HTs aged 55-75 years, glomerular filtration rate (GFR) was measured by technetium-99m-diethylene triamine pentacetic acid clearance during renal scintigraphy. Stage III chronic kidney disease (CKD) was defined as GFR < 60 ml/min/1.73 m(2). For comparing the impact of different methods for CKD diagnosis on CV risk stratification, CKD was also considered as GFR estimated by the Modification of Diet in Renal Disease (MDRD) equation and Cockcroft-Gault's formula. Target organ damage (TOD) was assessed by echocardiography and carotid ultrasonography. Gender-specific odds ratio (OR) with 95% confidence intervals for CKD were derived from a multiple stepwise logistic regression analysis. Global CV risk was stratified according to routine examinations, TOD and CKD. RESULTS. In 38% of cases, an unknown stage III CKD was found. Independent of age, CKD was predicted by history of hypertension (OR = 1.69, p = 0.0001), albuminuria (OR = 1.25, p = 0.0001), smoking (OR = 1.85, p = 0.028) and pulse pressure (OR = 1.21, p = 0.019) in men only. Men had an increased risk of CKD (OR = 2.62, p = 0.002) in comparison with women. Prevalence of TOD was significantly higher only in HTs having CKD diagnosed by renal scintigraphy; TOD and CKD assessment added to classic risk factors modified the CV risk stratification from low-moderate to high and very high. CONCLUSIONS. Renal scintigraphy is an important aid in risk stratification and should be performed in HTs aged >55 years. Pulse pressure was the main blood pressure component that predicted the risk of stage III CKD. PMID:22017389

  3. Risk Recognition, Attachment Anxiety, Self-Efficacy, and State Dissociation Predict Revictimization

    PubMed Central

    Bockers, Estelle; Roepke, Stefan; Michael, Lars; Renneberg, Babette; Knaevelsrud, Christine

    2014-01-01

    Background Previous research has identified a number of variables that constitute potential risk factors for victimization and revictimization. However, it remains unclear which factors are associated not only with childhood or adolescent victimization, but specifically with revictimization. The aim of this study was to determine whether risk recognition ability and other variables previously associated with revictimization are specifically able to differentiate individuals with childhood victimization only from revictimized individuals, and thus to predict revictimization. Methods Participants were N = 85 women aged 21 to 64 years who were interpersonally victimized in childhood or adolescence only, interpersonally revictimized in another period of life, or not victimized. A logistic regression analysis was conducted to examine whether risk recognition ability, sensation seeking, self-efficacy, state dissociation, shame, guilt, assertiveness, and attachment anxiety predicted group membership. Results The logistic regression analysis revealed risk recognition ability, attachment anxiety, state dissociation, and self-efficacy as significant predictors of revictimization. The final model accurately classified 82.4% of revictimized, 59.1% of victimized and 93.1% of non-victimized women. The overall classification rate was 80%. Conclusions This study suggests that risk recognition ability, attachment anxiety, self-efficacy, and state dissociation play a key role in revictimization. Increased risk recognition ability after an interpersonal trauma may act as a protective factor against repeated victimization that revictimized individuals may lack. A lack of increased risk recognition ability in combination with higher attachment anxiety, lower self-efficacy, and higher state dissociation may increase the risk of revictimization. PMID:25238153

  4. Is Obesity a Risk Factor for Wheezing Among Adolescents? A Prospective Study in Southern Brazil

    PubMed Central

    Noal, Ricardo B.; Menezes, Ana M.B.; Macedo, Silvia E.C.; Dumith, Samuel C.; Perez-Padilla, Rogelio; Araújo, Cora L.P.; Hallal, Pedro C.

    2012-01-01

    Purpose To investigate the effect of obesity at the start of adolescence on the prevalence, incidence and maintenance of chest wheezing among individuals aged 11–15 years in a birth cohort in a developing country. Methods The seventh follow-up of the 1993 Pelotas birth cohort occurred in 2004 (individuals aged 10–11 years). Between January and August 2008, the eighth follow-up of the cohort was conducted. All the individuals of the original cohort who were alive (who were then adolescents aged between 14 and 15 years) were targets for the study. The International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire was used to define wheezing. In addition to the body mass index (BMI), used to define obesity by the World Health Organization (WHO) criteria, we assessed skinfold thickness. Results From the original cohort, 4,349 individuals were located (85.7% follow-up rate). The prevalence of chest wheezing at 11 and 15 years were 13.5% (95% CI: 12.5%–14.5%) and 12.1% (95% CI: 11.1%–13.1%), respectively. The prevalence of wheezing at both times was 4.5% (95% CI: 3.9%–5.1%) and the incidence of wheezing was 7.5% (95% CI: 6.7%–8.3%). Independent of the effect of various confounding variables, the prevalence of wheezing at 15 years was 50% greater among obese individuals than among eutrophic individuals at 11 years (RR 1.53; 95% CI: 1.14–2.05). The greater the skinfold tertile at 11 years, the higher the prevalence of wheezing at 15 years was (p = .011). Weight status and skinfolds did not present any association with incident wheezing. After controlling for confounding factors, the risk of persistent wheezing among obese individuals at 11 years was 1.82 (95% CI: 1.30–2.54). Conclusions Since obesity at the start of adolescence is associated with asthma symptom persistence, prevention and treatment of obesity may reduce avoidable healthcare costs and disease burden. PMID:23283159

  5. Urban and architectural risk factors for malaria in indigenous Amazonian settlements in Brazil: a typological analysis.

    PubMed

    Leandro-Reguillo, Patricia; Thomson-Luque, Richard; Monteiro, Wuelton M; de Lacerda, Marcus V G

    2015-01-01

    In the Amazon, m alaria is highly endemic in indigenous populations, which are often considered one of the last barriers to malaria elimination due to geographic isolation. Although the improvement of housing conditions is a good strategy towards the control and prevention of vector-borne diseases, such as malaria, this preventive practice has been barely undertaken in Latin America. An analysis of the architectural and urban features of indigenous Amazonian populations is essential to define and adapt these vector control measures. A total of 32 villages of 29 different ethnicities were studied and mapped by reviewing literature and visual information, and using a geographic information system. The most important architectural and urban characteristics influencing malaria were analysed according to the following categories: number of households and dimensions, supporting area, openings, materials, lifespan and location. Housing typologies found were classified within each of these variables. The results of this typological analysis included an easy-to-handle working template and revealing of features that benefit or hamper the presence of malaria vectors in Amerindians communities. Among risk factors, presence of open eaves, permeable walls, open-side constructions, large number of sleepers indoors, temporary-ephemeral houses, linear villages along stream banks, houseboats villages, poor urban drainage and villages surrounded by anthropogenic environments were highlighted. Indigenous settlements very permissive for anophelines were identified in ethnic groups, such as the Yanomami, Palikur, Paumari, Waimiri-Atroari and Wajãpi. Positive features were also recognized, including opaque and closed houses, large radial villages on bare soil, highly elevated stilted houses and the fire indoors, found among the Yawalapiti, Ashaninka, and Gavião-Parkatejê tribes. However, as Amazonian indigenous settlement typologies vary greatly even among villages of the same ethnic

  6. Life span decrements in fluid intelligence and processing speed predict mortality risk.

    PubMed

    Aichele, Stephen; Rabbitt, Patrick; Ghisletta, Paolo

    2015-09-01

    We examined life span changes in 5 domains of cognitive performance as predictive of mortality risk. Data came from the Manchester Longitudinal Study of Cognition, a 20-plus-year investigation of 6,203 individuals ages 42-97 years. Cognitive domains were general crystallized intelligence, general fluid intelligence, verbal memory, visuospatial memory, and processing speed. Life span decrements were evident across these domains, controlling for baseline performance at age 70 and adjusting for retest effects. Survival analyses stratified by sex and conducted independently by cognitive domain showed that lower baseline performance levels in all domains-and larger life span decrements in general fluid intelligence and processing speed-were predictive of increased mortality risk for both women and men. Critically, analyses of the combined predictive power of cognitive performance variables showed that baseline levels of processing speed (in women) and general fluid intelligence (in men), and decrements in processing speed (in women and in men) and general fluid intelligence (in women), accounted for most of the explained variation in mortality risk. In light of recent evidence from brain-imaging studies, we speculate that cognitive abilities closely linked to cerebral white matter integrity (such as processing speed and general fluid intelligence) may represent particularly sensitive markers of mortality risk. In addition, we presume that greater complexity in cognition-survival associations observed in women (in analyses incorporating all cognitive predictors) may be a consequence of longer and more variable cognitive declines in women relative to men. PMID:26098167

  7. Prediction of Potential Cancer-Risk Regions Based on Transcriptome Data: Towards a Comprehensive View

    PubMed Central

    Alisoltani, Arghavan; Fallahi, Hossein; Ebrahimi, Mahdi; Ebrahimi, Mansour; Ebrahimie, Esmaeil

    2014-01-01

    A novel integrative pipeline is presented for discovery of potential cancer-susceptibility regions (PCSRs) by calculating the number of altered genes at each chromosomal region, using expression microarray datasets of different human cancers (HCs). Our novel approach comprises primarily predicting PCSRs followed by identification of key genes in these regions to obtain potential regions harboring new cancer-associated variants. In addition to finding new cancer causal variants, another advantage in prediction of such risk regions is simultaneous study of different types of genomic variants in line with focusing on specific chromosomal regions. Using this pipeline we extracted numbers of regions with highly altered expression levels in cancer condition. Regulatory networks were also constructed for different types of cancers following the identification of altered mRNA and microRNAs. Interestingly, results showed that GAPDH, LIFR, ZEB2, mir-21, mir-30a, mir-141 and mir-200c, all located at PCSRs, are common altered factors in constructed networks. We found a number of clusters of altered mRNAs and miRNAs on predicted PCSRs (e.g.12p13.31) and their common regulators including KLF4 and SOX10. Large scale prediction of risk regions based on transcriptome data can open a window in comprehensive study of cancer risk factors and the other human diseases. PMID:24796549

  8. Explicit modeling of ancestry improves polygenic risk scores and BLUP prediction

    PubMed Central

    Chen, Chia-Yen; Han, Jiali; Hunter, David J.; Kraft, Peter; Price, Alkes L.

    2016-01-01

    Polygenic prediction using genome-wide SNPs can provide high prediction accuracy for complex traits. Here, we investigate the question of how to account for genetic ancestry when conducting polygenic prediction. We show that the accuracy of polygenic prediction in structured populations may be partly due to genetic ancestry. However, we hypothesized that explicitly modeling ancestry could improve polygenic prediction accuracy. We analyzed three GWAS of hair color, tanning ability and basal cell carcinoma (BCC) in European Americans (sample size from 7,440 to 9,822) and considered two widely used polygenic prediction approaches: polygenic risk scores (PRS) and Best Linear Unbiased Prediction (BLUP). We compared polygenic prediction without correction for ancestry to polygenic prediction with ancestry as a separate component in the model. In 10-fold cross-validation using the PRS approach, the R2 for hair color increased by 66% (0.0456 to 0.0755; p<10−16), the R2 for tanning ability increased by 123% (0.0154 to 0.0344; p<10−16) and the liability-scale R2 for BCC increased by 68% (0.0138 to 0.0232; p<10−16) when explicitly modeling ancestry, which prevents ancestry effects from entering into each SNP effect and being over-weighted. Surprisingly, explicitly modeling ancestry produces a similar improvement when using the BLUP approach, which fits all SNPs simultaneously in a single variance component and causes ancestry to be underweighted. We validate our findings via simulations, which show that the differences in prediction accuracy will increase in magnitude as sample sizes increase. In summary, our results show that explicitly modeling ancestry can be important in both PRS and BLUP prediction. PMID:25995153

  9. Bankruptcy prediction for credit risk using neural networks: a survey and new results.

    PubMed

    Atiya, A F

    2001-01-01

    The prediction of corporate bankruptcies is an important and widely studied topic since it can have significant impact on bank lending decisions and profitability. This work presents two contributions. First we review the topic of bankruptcy prediction, with emphasis on neural-network (NN) models. Second, we develop an NN bankruptcy prediction model. Inspired by one of the traditional credit risk models developed by Merton (1974), we propose novel indicators for the NN system. We show that the use of these indicators in addition to traditional financial ratio indicators provides a significant improvement in the (out-of-sample) prediction accuracy (from 81.46% to 85.5% for a three-year-ahead forecast). PMID:18249923

  10. A Bayesian Framework for Early Risk Prediction in Traumatic Brain Injury

    PubMed Central

    Chaganti, Shikha; Plassard, Andrew J.; Wilson, Laura; Smith, Miya A.; Patel, Mayur B.; Landman, Bennett A.

    2016-01-01

    Early detection of risk is critical in determining the course of treatment in traumatic brain injury (TBI). Computed tomography (CT) acquired at admission has shown latent prognostic value in prior studies; however, no robust clinical risk predictions have been achieved based on the imaging data in large-scale TBI analysis. The major challenge lies in the lack of consistent and complete medical records for patients, and an inherent bias associated with the limited number of patients samples with high-risk outcomes in available TBI datasets. Herein, we propose a Bayesian framework with mutual information-based forward feature selection to handle this type of data. Using multi-atlas segmentation, 154 image-based features (capturing intensity, volume and texture) were computed over 22 ROIs in 1791 CT scans. These features were combined with 14 clinical parameters and converted into risk likelihood scores using Bayes modeling. We explore the prediction power of the image features versus the clinical measures for various risk outcomes. The imaging data alone were more predictive of outcomes than the clinical data (including Marshall CT classification) for discharge disposition with an area under the curve of 0.81 vs. 0.67, but less predictive than clinical data for discharge Glasgow Coma Scale (GCS) score with an area under the curve of 0.65 vs. 0.85. However, in both cases, combining imaging and clinical data increased the combined area under the curve with 0.86 for discharge disposition and 0.88 for discharge GCS score. In conclusion, CT data have meaningful prognostic value for TBI patients beyond what is captured in clinical measures and the Marshall CT classification. PMID:27127331

  11. A Bayesian framework for early risk prediction in traumatic brain injury

    NASA Astrophysics Data System (ADS)

    Chaganti, Shikha; Plassard, Andrew J.; Wilson, Laura; Smith, Miya A.; Patel, Mayur B.; Landman, Bennett A.

    2016-03-01

    Early detection of risk is critical in determining the course of treatment in traumatic brain injury (TBI). Computed tomography (CT) acquired at admission has shown latent prognostic value in prior studies; however, no robust clinical risk predictions have been achieved based on the imaging data in large-scale TBI analysis. The major challenge lies in the lack of consistent and complete medical records for patients, and an inherent bias associated with the limited number of patients samples with high-risk outcomes in available TBI datasets. Herein, we propose a Bayesian framework with mutual information-based forward feature selection to handle this type of data. Using multi-atlas segmentation, 154 image-based features (capturing intensity, volume and texture) were computed over 22 ROIs in 1791 CT scans. These features were combined with 14 clinical parameters and converted into risk likelihood scores using Bayes modeling. We explore the prediction power of the image features versus the clinical measures for various risk outcomes. The imaging data alone were more predictive of outcomes than the clinical data (including Marshall CT classification) for discharge disposition with an area under the curve of 0.81 vs. 0.67, but less predictive than clinical data for discharge Glasgow Coma Scale (GCS) score with an area under the curve of 0.65 vs. 0.85. However, in both cases, combining imaging and clinical data increased the combined area under the curve with 0.86 for discharge disposition and 0.88 for discharge GCS score. In conclusion, CT data have meaningful prognostic value for TBI patients beyond what is captured in clinical measures and the Marshall CT classification.

  12. Simulation of multiple ion channel block provides improved early prediction of compounds’ clinical torsadogenic risk

    PubMed Central

    Mirams, Gary R.; Cui, Yi; Sher, Anna; Fink, Martin; Cooper, Jonathan; Heath, Bronagh M.; McMahon, Nick C.; Gavaghan, David J.; Noble, Denis

    2011-01-01

    Aims The level of inhibition of the human Ether-à-go-go-related gene (hERG) channel is one of the earliest preclinical markers used to predict the risk of a compound causing Torsade-de-Pointes (TdP) arrhythmias. While avoiding the use of drugs with maximum therapeutic concentrations within 30-fold of their hERG inhibitory concentration 50% (IC50) values has been suggested, there are drugs that are exceptions to this rule: hERG inhibitors that do not cause TdP, and drugs that can cause TdP but are not strong hERG inhibitors. In this study, we investigate whether a simulated evaluation of multi-channel effects could be used to improve this early prediction of TdP risk. Methods and results We collected multiple ion channel data (hERG, Na, l-type Ca) on 31 drugs associated with varied risks of TdP. To integrate the information on multi-channel block, we have performed simulations with a variety of mathematical models of cardiac cells (for rabbit, dog, and human ventricular myocyte models). Drug action is modelled using IC50 values, and therapeutic drug concentrations to calculate the proportion of blocked channels and the channel conductances are modified accordingly. Various pacing protocols are simulated, and classification analysis is performed to evaluate the predictive power of the models for TdP risk. We find that simulation of action potential duration prolongation, at therapeutic concentrations, provides improved prediction of the TdP risk associated with a compound, above that provided by existing markers. Conclusion The suggested calculations improve the reliability of early cardiac safety assessments, beyond those based solely on a hERG block effect. PMID:21300721

  13. Development of a metabolites risk score for one-year mortality risk prediction in pancreatic adenocarcinoma patients

    PubMed Central

    Fontana, Andrea; Mazza, Tommaso; Tavano, Francesca; Gioffreda, Domenica; Mattivi, Fulvio; Andriulli, Angelo; Vrhovsek, Urska; Pazienza, Valerio

    2016-01-01

    Purpose Survival among patients with adenocarcinoma pancreatic cancer (PDCA) is highly variable, which ranges from 0% to 20% at 5 years. Such a wide range is due to tumor size and stage, as well other patients' characteristics. We analyzed alterations in the metabolomic profile, of PDCA patients, which are potentially predictive of patient's one-year mortality. Experimental design A targeted metabolomic assay was conducted on serum samples of patients diagnosed with pancreatic cancer. Statistical analyses were performed only for those 27 patients with information on vital status at follow-up and baseline clinical features. Random Forest analysis was performed to identify all metabolites and clinical variables with the best capability to predict patient's mortality risk at one year. Regression coefficients were estimated from multivariable Weibull survival model, which included the most associated metabolites. Such coefficients were used as weights to build a metabolite risk score (MRS) which ranged from 0 (lowest mortality risk) to 1 (highest mortality risk). The stability of these weights were evaluated performing 10,000 bootstrap resamplings. Results MRS was built as a weighted linear combination of the following five metabolites: Valine (HR = 0.62, 95%CI: 0.11–1.71 for each standard deviation (SD) of 98.57), Sphingomyeline C24:1 (HR = 2.66, 95%CI: 1.30–21.09, for each SD of 20.67), Lysine (HR = 0.36, 95%CI: 0.03–0.77, for each SD of 51.73), Tripentadecanoate TG15 (HR = 0.25, 95%CI: 0.01–0.82, for each SD of 2.88) and Symmetric dimethylarginine (HR = 2.24, 95%CI: 1.28–103.08, for each SD of 0.62), achieving a very high discrimination ability (survival c-statistic of 0.855, 95%CI: 0.816–0.894). Such association was still present even after adjusting for the most associated clinical variables (confounders). Conclusions The mass spectrometry-based metabolomic profiling of serum represents a valid tool for discovering novel candidate biomarkers with

  14. The PRIMROSE cardiovascular risk prediction models for people with severe mental illness

    PubMed Central

    Osborn, David PJ; Hardoon, Sarah; Omar, Rumana Z; Holt, Richard IG; King, Michael; Larsen, John; Marston, Louise; Morris, Richard W; Nazareth, Irwin; Walters, Kate; Petersen, Irene

    2015-01-01

    Importance People with Severe Mental Illness (SMI) including schizophrenia and bipolar disorder have excess cardiovascular disease (CVD). Risk prediction models, validated for the general population, may not accurately estimate cardiovascular risk in this group. Objectives To develop and validate a risk model exclusive to predicting CVD events in people with SMI, using established cardiovascular risk factors and additional variables. Design Prospective cohort and risk score development study. Setting UK Primary care Participants 38,824 people with a diagnosis of SMI (schizophrenia, bipolar disorder or other non-organic psychosis) aged 30-90 years. Median follow-up 5.6 years with 2,324 CVD events (6%). Main outcomes and measures Ten year risk of first cardiovascular event (myocardial infarction, angina pectoris, cerebrovascular accidents or major coronary surgery). Predictors included age, gender, height, weight, systolic blood pressure, diabetes, smoking, body mass index (BMI), lipid profile, social deprivation, SMI diagnosis, prescriptions of antidepressant , antipsychotics and reports of heavy alcohol use. Results We developed two risk models for people with SMI: The PRIMROSE BMI model and a lipid model. These mutually excluded lipids and BMI. From cross-validations, in terms of discrimination, for men, the PRIMROSE lipid model D statistic was 1.92 (1.80-2.03) and C statistic was 0.80 (0.76-0.83) compared to 1.74 (1.54-1.86) and 0.78 (0.75-0.82) for published Framingham risk scores; in women corresponding results were 1.87 (1.76-1.98) and 0.80 (0.76-0.83) for the PRIMROSE lipid model and 1.58 (1.48-1.68) and 0.76 (0.72-0.80) for Framingham. Discrimination statistics for the PRIMROSE BMI model were comparable to those for the PRIMROSE lipid model. Calibration plots suggested that both PRIMROSE models were superior to the Framingham models. Conclusion and relevance The PRIMROSE BMI and lipid CVD risk prediction models performed better in SMI than models which only

  15. Clinicogenetic risk models predict early progression of follicular lymphoma after first-line immunochemotherapy.

    PubMed

    Jurinovic, Vindi; Kridel, Robert; Staiger, Annette M; Szczepanowski, Monika; Horn, Heike; Dreyling, Martin H; Rosenwald, Andreas; Ott, German; Klapper, Wolfram; Zelenetz, Andrew D; Barr, Paul M; Friedberg, Jonathan W; Ansell, Stephen; Sehn, Laurie H; Connors, Joseph M; Gascoyne, Randy D; Hiddemann, Wolfgang; Unterhalt, Michael; Weinstock, David M; Weigert, Oliver

    2016-08-25

    Follicular lymphoma (FL) is a clinically and molecularly heterogeneous disease. Posttreatment surrogate end points, such as progression of disease within 24 months (POD24) are promising predictors for overall survival (OS) but are of limited clinical value, primarily because they cannot guide up-front treatment decisions. We used the clinical and molecular data from 2 independent cohorts of symptomatic patients in need of first-line immunochemotherapy (151 patients from a German Low-Grade Lymphoma Study Group [GLSG] trial and 107 patients from a population-based registry of the British Columbia Cancer Agency [BCCA]) to validate the predictive utility of POD24, and to evaluate the ability of pretreatment risk models to predict early treatment failure. POD24 occurred in 17% and 23% of evaluable GLSG and BCCA patients, with 5-year OS rates of 41% (vs 91% for those without POD24, P < .0001) and 26% (vs 86%, P < .0001), respectively. The m7-FL International Prognostic Index (m7-FLIPI), a prospective clinicogenetic risk model for failure-free survival, had the highest accuracy to predict POD24 (76% and 77%, respectively) with an odds ratio of 5.82 in GLSG (P = .00031) and 4.76 in BCCA patients (P = .0052). A clinicogenetic risk model specifically designed to predict POD24, the POD24-PI, had the highest sensitivity to predict POD24, but at the expense of a lower specificity. In conclusion, the m7-FLIPI prospectively identifies the smallest subgroup of patients (28% and 22%, respectively) at highest risk of early failure of first-line immunochemotherapy and death, including patients not fulfilling the POD24 criteria, and should be evaluated in prospective trials of precision medicine approaches in FL. PMID:27418643

  16. Blood glucose may be an alternative to cholesterol in CVD risk prediction charts

    PubMed Central

    2013-01-01

    Background Established risk models for the prediction of cardiovascular disease (CVD) include blood pressure, smoking and cholesterol parameters. The use of total cholesterol for CVD risk prediction has been questioned, particularly for primary prevention. We evaluated whether glucose could be used instead of total cholesterol for prediction of fatal CVD using data with long follow-up. Methods We followed-up 6,095 men and women aged ≥16 years who participated 1977-79 in a community based health study and were anonymously linked with the Swiss National Cohort until the end of 2008. During follow-up, 727 participants died of CVD. Based on the ESC SCORE methodology (Weibull regression), we used age, sex, blood pressure, smoking, and fasting glucose or total cholesterol. The mean Brier score (BS), area under the receiver-operating characteristic curve (AUC) and integrated discrimination improvement (IDI) were used for model comparison. We validated our models internally using cross-validation and externally using another data set. Results In our models, the p-value of total cholesterol was 0.046, that of glucose was p < 0.001. The model with glucose had a slightly better predictive capacity (BS: 2216x10-5 vs. 2232x10-5; AUC: 0.9181 vs. 0.9169, IDI: 0.009 with p-value 0.026) and could well discriminate the overall risk of persons with high and low concentrations. The external validation confirmed these findings. Conclusions Our study suggests that instead of total cholesterol glucose can be used in models predicting overall CVD mortality risk. PMID:23351551

  17. Children’s Experiences of Maternal Incarceration-Specific Risks: Predictions to Psychological Maladaptation

    PubMed Central

    Dallaire, Danielle H.; Zeman, Janice L.; Thrash, Todd M.

    2014-01-01

    Children of incarcerated mothers are at increased risk for social and emotional difficulties, yet few studies have investigated potential mechanisms of risk within this population. This research simultaneously examined the association of children’s experience of incarceration-specific risk factors (e.g., witness mother’s arrest) and environmental risks (e.g., low educational attainment) to children’s psychological maladaptation using a multi-informant design and a latent variable analytic approach. Participants were 117 currently incarcerated mothers (64.1% African American), their 151 children (53.6% boys, M age =9.8 years, range =6–12 years, 61.7% African American), and the 118 caregivers (74.8% female, 61.9% grandparents, 62.2% African American) of the children. Mothers, children, and caregivers each provided accounts of children’s experiences related to maternal incarceration and children’s internalizing and externalizing behavior problems. Mothers and caregivers each supplied information about 10 environmental risk factors. Findings from structural equation modeling indicate that children’s incarceration-specific risk experiences predict internalizing and externalizing behavior problems whereas the influence of environmental risks was negligible. Follow-up analyses examining the contribution of specific risks indicate that significant predictors differ by reporter and separate into effects of family incarceration history and direct experiences of maternal incarceration. Incarceration-specific experiences place children at higher risk for maladjustment than exposure to general environmental risk factors. These findings indicate the need to critically examine children’s exposure to experiences related to maternal incarceration and family incarceration history to help to clarify the multifaceted stressor of maternal incarceration. PMID:24871820

  18. Host response to cuckoo song is predicted by the future risk of brood parasitism

    PubMed Central

    2013-01-01

    Introduction Risk assessment occurs over different temporal and spatial scales and is selected for when individuals show an adaptive response to a threat. Here, we test if birds respond to the threat of brood parasitism using the acoustical cues of brood parasites in the absence of visual stimuli. We broadcast the playback of song of three brood parasites (Chalcites cuckoo species) and a sympatric non-parasite (striated thornbill, Acanthiza lineata) in the territories of superb fairy-wrens (Malurus cyaneus) during the peak breeding period and opportunistic breeding period. The three cuckoo species differ in brood parasite prevalence and the probability of detection by the host, which we used to rank the risk of parasitism (high risk, moderate risk, low risk). Results Host birds showed the strongest response to the threat of cuckoo parasitism in accordance with the risk of parasitism. Resident wrens had many alarm calls and close and rapid approach to the playback speaker that was broadcasting song of the high risk brood parasite (Horsfield’s bronze-cuckoo, C. basalis) across the year (peak and opportunistic breeding period), some response to the moderate risk brood parasite (shining bronze-cuckoo, C. lucidus) during the peak breeding period, and the weakest response to the low risk brood parasite (little bronze-cuckoo, C. minutillus). Playback of the familiar control stimulus in wren territories evoked the least response. Conclusion Host response to the threat of cuckoo parasitism was assessed using vocal cues of the cuckoo and was predicted by the risk of future parasitism. PMID:23692969

  19. Calibration of risk prediction models: impact on decision-analytic performance.

    PubMed

    Van Calster, Ben; Vickers, Andrew J

    2015-02-01

    Decision-analytic measures to assess clinical utility of prediction models and diagnostic tests incorporate the relative clinical consequences of true and false positives without the need for external information such as monetary costs. Net Benefit is a commonly used metric that weights the relative consequences in terms of the risk threshold at which a patient would opt for treatment. Theoretical results demonstrate that clinical utility is affected by a model';s calibration, the extent to which estimated risks correspond to observed event rates. We analyzed the effects of different types of miscalibration on Net Benefit and investigated whether and under what circumstances miscalibration can make a model clinically harmful. Clinical harm is defined as a lower Net Benefit compared with classifying all patients as positive or negative by default. We used simulated data to investigate the effect of overestimation, underestimation, overfitting (estimated risks too extreme), and underfitting (estimated risks too close to baseline risk) on Net Benefit for different choices of the risk threshold. In accordance with theory, we observed that miscalibration always reduced Net Benefit. Harm was sometimes observed when models underestimated risk at a threshold below the event rate (as in underestimation and overfitting) or overestimated risk at a threshold above event rate (as in overestimation and overfitting). Underfitting never resulted in a harmful model. The impact of miscalibration decreased with increasing discrimination. Net Benefit was less sensitive to miscalibration for risk thresholds close to the event rate than for other thresholds. We illustrate these findings with examples from the literature and with a case study on testicular cancer diagnosis. Our findings strengthen the importance of obtaining calibrated risk models. PMID:25155798

  20. Investigating the predictive of risk-taking attitudes and behaviors among Iranian drivers

    PubMed Central

    Habibi, Ehsanollah; Haghi, Azam; Maracy, Mohammad Reza

    2014-01-01

    Background: World Health Organization findings shows that up to year 2020 the number of fatality due to driving accidents will increases up to 65%, which is 80% is in developing countries. Iran has one of the highest rates of road traffic accident mortality rate in the world. Materials and Methods: The cross-sectional study was carried out in the center and west of Iran upon 540 ordinary and taxi drivers who were driving regularly from bus terminals and the travel agencies to other cities. Data collection tool is a questionnaire that measuring driving risk taking by two items of risky driving behaviors and risk taking attitudes. Findings: The results of this study showed that the averages of risk driving behaviors scores were higher than the average of risk taking attitudes scores. The results of logistic regression test showed that the risky driving behaviors can be a predictor of driving accidents due to individuals’ risk taking (P = 0.014). Among all these variables, attitude toward rule violations and speeding, aggressive driving and violation of the road laws respectively are important predictive of drivers’ risk taking (P < 0.0010). Discussion and Conclusion: Although attitude toward risk taking has been located at a low level by different ways, a desired result was not obtained from the reduction of those high risky behaviors; in fact, high-rate of accidents and traffic incidence in Iran indicates this matter well. PMID:24741659

  1. Temperamental exuberance and executive function predict propensity for risk-taking in childhood

    PubMed Central

    Lahat, Ayelet; Degnan, Kathryn A.; White, Lauren K.; McDermott, Jennifer Martin; Henderson, Heather A.; Lejuez, C. W.; Fox, Nathan A.

    2015-01-01

    The present study takes a multilevel approach to examine developmental trajectories in risk-taking propensity. We examined the moderating role of specific executive function components, attention shifting and inhibitory control, on the link between exuberant temperament in infancy and propensity for risk-taking in childhood. Risk-taking was assessed using a task previously associated with sensation seeking and antisocial behaviors. Two hundred and ninety one infants were brought into the lab and behaviors reflecting exuberance were observed at 4, 9, 24, and 36 months of age. Executive function was assessed at 48 months of age. Risk-taking propensity was measured when children were 60 months of age. The results indicate that exuberance and attention shifting, but not inhibitory control, significantly interact to predict propensity for risk-taking. Exuberance was positively associated with risk-taking propensity among children relatively low in attention shifting but unrelated for children high in attention shifting. These findings illustrate the multifinality of developmental outcomes for temperamentally exuberant young children and point to the distinct regulatory influences of different executive functions for children of differing temperaments. Attention shifting likely affords a child the ability to consider both positive and negative consequences, and moderates the relation between early exuberance and risk-taking propensity. PMID:22781858

  2. Risk stratification in perforated duodenal ulcers. A prospective validation of predictive factors.

    PubMed Central

    Boey, J; Choi, S K; Poon, A; Alagaratnam, T T

    1987-01-01

    In order to validate a previously derived set of risk factors, 259 consecutive patients who had simple closure or definitive operation for perforated duodenal ulcers were studied prospectively. Major medical illness, preoperative shock, and longstanding perforation (more than 24 hours) correctly predicted the outcome in 93.8% of patients. Most importantly, 16 patients (6.2%) who died after operation could be identified (no false-negative error). The mortality rate increased progressively with increasing numbers of risk factors: 0%, 10%, 45.5%, and 100% in patients with none, one, two, and all three risk factors, respectively. These findings underscore the importance of patient selection and the feasibility of a risk grading system in guiding surgical management. Definitive surgery can be done safely in good-risk patients. Simple closure is preferable in those patients with uncomplicated perforations if any risk factor is present. Truncal vagotomy and drainage may be required if there is coexisting bleeding or stenosis. Nonoperative treatment deserves re-evaluation in patients with all three risk factors because of their uniformly dismal outcome after operation. PMID:3800459

  3. Composite risk scores and composite endpoints in the risk prediction of outcomes in anticoagulated patients with atrial fibrillation. The Loire Valley Atrial Fibrillation Project.

    PubMed

    Banerjee, A; Fauchier, L; Bernard-Brunet, A; Clementy, N; Lip, G Y H

    2014-03-01

    Several validated risk stratification schemes for prediction of ischaemic stroke (IS)/thromboembolism (TE) and major bleeding are available for patients with non-valvular atrial fibrillation (NVAF). On the basis for multiple common risk factors for IS/TE and bleeding, it has been suggested that composite risk prediction scores may be more practical and user-friendly than separate scores for bleeding and IS/TE. In a long-term prospective hospital registry of anticoagulated patients with newly diagnosed AF, we compared the predictive value of existing risk prediction scores as well as composite risk scores, and also compared these risk scoring systems using composite endpoints. Endpoint 1 was the simple composite of IS and major bleeds. Endpoint 2 was based on a composite of IS plus intracerebral haemorrhage (ICH). Endpoint 3 was based on weighted coefficients for IS/TE and ICH. Endpoint 4 was a composite of stroke, cardiovascular death, TE and major bleeding. The incremental predictive value of these scores over CHADS2 (as reference) for composite endpoints was assessed using c-statistic, net reclassification improvement (NRI) and integrated discrimination improvement (IDI). Of 8,962 eligible individuals, 3,607 (40.2%) had NVAF and were on OAC at baseline. There were no statistically significant differences between the c-statistics of the various risk scores, compared with the CHADS2 score, regardless of the endpoint. For the various risk scores and various endpoints, NRI and IDI did not show significant improvement (≥1%), compared with the CHADS2 score. In conclusion, composite risk scores did not significantly improve risk prediction of endpoints in patients with NVAF, regardless of how endpoints were defined. This would support individualised prediction of IS/TE and bleeding separately using different separate risk prediction tools, and not the use of composite scores or endpoints for everyday 'real world' clinical practice, to guide decisions on

  4. A novel neural-inspired learning algorithm with application to clinical risk prediction.

    PubMed

    Tay, Darwin; Poh, Chueh Loo; Kitney, Richard I

    2015-04-01

    Clinical risk prediction - the estimation of the likelihood an individual is at risk of a disease - is a coveted and exigent clinical task, and a cornerstone to the recommendation of life saving management strategies. This is especially important for individuals at risk of cardiovascular disease (CVD) given the fact that it is the leading causes of death in many developed counties. To this end, we introduce a novel learning algorithm - a key factor that influences the performance of machine learning-based prediction models - and utilities it to develop CVD risk prediction tool. This novel neural-inspired algorithm, called the Artificial Neural Cell System for classification (ANCSc), is inspired by mechanisms that develop the brain and empowering it with capabilities such as information processing/storage and recall, decision making and initiating actions on external environment. Specifically, we exploit on 3 natural neural mechanisms responsible for developing and enriching the brain - namely neurogenesis, neuroplasticity via nurturing and apoptosis - when implementing ANCSc algorithm. Benchmark testing was conducted using the Honolulu Heart Program (HHP) dataset and results are juxtaposed with 2 other algorithms - i.e. Support Vector Machine (SVM) and Evolutionary Data-Conscious Artificial Immune Recognition System (EDC-AIRS). Empirical experiments indicate that ANCSc algorithm (statistically) outperforms both SVM and EDC-AIRS algorithms. Key clinical markers identified by ANCSc algorithm include risk factors related to diet/lifestyle, pulmonary function, personal/family/medical history, blood data, blood pressure, and electrocardiography. These clinical markers, in general, are also found to be clinically significant - providing a promising avenue for identifying potential cardiovascular risk factors to be evaluated in clinical trials. PMID:25576352

  5. An RES-Based Model for Risk Assessment and Prediction of Backbreak in Bench Blasting

    NASA Astrophysics Data System (ADS)

    Faramarzi, F.; Ebrahimi Farsangi, M. A.; Mansouri, H.

    2013-07-01

    Most blasting operations are associated with various forms of energy loss, emerging as environmental side effects of rock blasting, such as flyrock, vibration, airblast, and backbreak. Backbreak is an adverse phenomenon in rock blasting operations, which imposes risk and increases operation expenses because of safety reduction due to the instability of walls, poor fragmentation, and uneven burden in subsequent blasts. In this paper, based on the basic concepts of a rock engineering systems (RES) approach, a new model for the prediction of backbreak and the risk associated with a blast is presented. The newly suggested model involves 16 effective parameters on backbreak due to blasting, while retaining simplicity as well. The data for 30 blasts, carried out at Sungun copper mine, western Iran, were used to predict backbreak and the level of risk corresponding to each blast by the RES-based model. The results obtained were compared with the backbreak measured for each blast, which showed that the level of risk achieved is in consistence with the backbreak measured. The maximum level of risk [vulnerability index (VI) = 60] was associated with blast No. 2, for which the corresponding average backbreak was the highest achieved (9.25 m). Also, for blasts with levels of risk under 40, the minimum average backbreaks (<4 m) were observed. Furthermore, to evaluate the model performance for backbreak prediction, the coefficient of correlation ( R 2) and root mean square error (RMSE) of the model were calculated ( R 2 = 0.8; RMSE = 1.07), indicating the good performance of the model.

  6. Can we improve clinical prediction of at-risk older drivers?

    PubMed Central

    Bowers, Alex R.; Anastasio, R. Julius; Sheldon, Sarah S.; O’Connor, Margaret G.; Hollis, Ann M.; Howe, Piers D.; Horowitz, Todd S.

    2013-01-01

    Objectives To conduct a pilot study to evaluate the predictive value of the Montreal Cognitive Assessment test (MoCA) and a brief test of multiple object tracking (MOT) relative to other tests of cognition and attention in identifying at-risk older drivers, and to determine which combination of tests provided the best overall prediction. Methods Forty-seven currently-licensed drivers (58 to 95 years), primarily from a clinical driving evaluation program, participated. Their performance was measured on: (1) a screening test battery, comprising MoCA, MOT, MiniMental State Examination (MMSE), Trail-Making Test, visual acuity, contrast sensitivity, and Useful Field of View (UFOV); and (2) a standardized road test. Results Eighteen participants were rated at-risk on the road test. UFOV subtest 2 was the best single predictor with an area under the curve (AUC) of .84. Neither MoCA nor MOT was a better predictor of the at-risk outcome than either MMSE or UFOV, respectively. The best four-test combination (MMSE, UFOV subtest 2, visual acuity and contrast sensitivity) was able to identify at-risk drivers with 95% specificity and 80% sensitivity (.91 AUC). Conclusions Although the best four-test combination was much better than a single test in identifying at-risk drivers, there is still much work to do in this field to establish test batteries that have both high sensitivity and specificity. PMID:23954688

  7. Using the Lorenz Curve to Characterize Risk Predictiveness and Etiologic Heterogeneity.

    PubMed

    Mauguen, Audrey; Begg, Colin B

    2016-07-01

    The Lorenz curve is a graphical tool that is used widely in econometrics. It represents the spread of a probability distribution, and its traditional use has been to characterize population distributions of wealth or income, or more specifically, inequalities in wealth or income. However, its utility in public health research has not been broadly established. The purpose of this article is to explain its special usefulness for characterizing the population distribution of disease risks, and in particular for identifying the precise disease burden that can be predicted to occur in segments of the population that are known to have especially high (or low) risks, a feature that is important for evaluating the yield of screening or other disease prevention initiatives. We demonstrate that, although the Lorenz curve represents the distribution of predicted risks in a population at risk for the disease, in fact it can be estimated from a case-control study conducted in the population without the need for information on absolute risks. We explore two different estimation strategies and compare their statistical properties using simulations. The Lorenz curve is a statistical tool that deserves wider use in public health research. PMID:27096256

  8. The Patterns, Risk Factors, and Prediction of Progression in Chronic Kidney Disease: A Narrative Review.

    PubMed

    Collister, David; Ferguson, Thomas; Komenda, Paul; Tangri, Navdeep

    2016-07-01

    Chronic kidney disease (CKD) is a global public health problem that is associated with excess morbidity, mortality, and health resource utilization. The progression of CKD is defined by a decrease in glomerular filtration rate and leads to a variety of metabolic abnormalities including acidosis, hypertension, anemia, and mineral bone disorder. Lower glomerular filtration rate also bears a strong relationship with an increased risk of cardiovascular events, end-stage renal disease, and death. Patterns of CKD progression include linear and nonlinear trajectories, but kidney function can remain stable for years in some individuals. Addressing modifiable risk factors for the progression of CKD is needed to attenuate its associated morbidity and mortality. Developing effective risk prediction models for CKD progression is critical to identify patients who are more likely to benefit from interventions and more intensive monitoring. Accurate risk-prediction algorithms permit systems to best align health care resources with risk to maximize their effects and efficiency while guiding overall decision making. PMID:27475658

  9. CIBMTR Chronic GVHD Risk Score Predicts Mortality in an Independent Validation Cohort

    PubMed Central

    Arora, Mukta; Hemmer, Michael T.; Ahn, Kwang Woo; Klein, John P.; Cutler, Corey S.; Urbano-Ispizua, Alvaro; Couriel, Daniel R.; Alousi, Amin M.; Gale, Robert Peter; Inamoto, Yoshihiro; Weisdorf, Daniel J.; Li, Peigang; Antin, Joseph H.; Bolwell, Brian J.; Boyiadzis, Michael; Cahn, Jean-Yves; Cairo, Mitchell S.; Isola, Luis M.; Jacobsohn, David A.; Jagasia, Madan; Klumpp, Thomas R.; Petersdorf, Effie W.; Santarone, Stella; Schouten, Harry C.; Wingard, John R.; Spellman, Stephen R.; Pavletic, Steven Z.; Lee, Stephanie J.; Horowitz, Mary M.; Flowers, Mary E.D.

    2015-01-01

    We previously reported a risk score that predicted mortality in patients with chronic graft-versus-host disease (CGVHD) after hematopoietic stem cell transplant (HCT) between 1995–2004 and reported to the Center for International Blood and Marrow Transplant Registry (CIBMTR). We sought to validate this risk score in an independent CIBMTR cohort of 1128 patients with CGVHD transplanted between 2005–2007 using the same inclusion criteria and risk-score calculations. According to the sum of the overall risk score (range 1 to 12), patients were assigned to 4 risk-groups (RGs): RG1 (0–2), RG2 (3–6), RG3 (7–8) and RG4 (9–10). RG3 and 4 were combined as RG4 comprised only 1% of the total cohort. Cumulative incidences of non relapse mortality (NRM) and probability of overall survival (OS) were significantly different between each RG (all p<0.01). NRM and OS at five years after CGVHD for each RG were 17% and 72% in RG1, 26% and 53% in RG2, and 44% and 25% in RG 3, respectively (all p<0.01). Our study validates the prognostic value of the CIBMTR CGVHD RGs for OS and NRM in a contemporary transplant population. The CIBMTR CGVHD RGs can be used to predict major outcomes, tailor treatment planning, and enrollment in clinical trials. PMID:25528390

  10. Potential ecological risk assessment and prediction of soil heavy-metal pollution around coal gangue dump

    NASA Astrophysics Data System (ADS)

    Jiang, X.; Lu, W. X.; Zhao, H. Q.; Yang, Q. C.; Yang, Z. P.

    2014-06-01

    The aim of the present study is to evaluate the potential ecological risk and trend of soil heavy-metal pollution around a coal gangue dump in Jilin Province (Northeast China). The concentrations of Cd, Pb, Cu, Cr and Zn were monitored by inductively coupled plasma mass spectrometry (ICP-MS). The potential ecological risk index method developed by Hakanson (1980) was employed to assess the potential risk of heavy-metal pollution. The potential ecological risk in the order of ER(Cd) > ER(Pb) > ER(Cu) > ER(Cr) > ER(Zn) have been obtained, which showed that Cd was the most important factor leading to risk. Based on the Cd pollution history, the cumulative acceleration and cumulative rate of Cd were estimated, then the fixed number of years exceeding the standard prediction model was established, which was used to predict the pollution trend of Cd under the accelerated accumulation mode and the uniform mode. Pearson correlation analysis and correspondence analysis are employed to identify the sources of heavy metals and the relationship between sampling points and variables. These findings provided some useful insights for making appropriate management strategies to prevent or decrease heavy-metal pollution around a coal gangue dump in the Yangcaogou coal mine and other similar areas elsewhere.

  11. The MEST score provides earlier risk prediction in lgA nephropathy.

    PubMed

    Barbour, Sean J; Espino-Hernandez, Gabriela; Reich, Heather N; Coppo, Rosanna; Roberts, Ian S D; Feehally, John; Herzenberg, Andrew M; Cattran, Daniel C

    2016-01-01

    The Oxford Classification of IgA nephropathy (IgAN) includes the following four histologic components: mesangial (M) and endocapillary (E) hypercellularity, segmental sclerosis (S) and interstitial fibrosis/tubular atrophy (T). These combine to form the MEST score and are independently associated with renal outcome. Current prediction and risk stratification in IgAN requires clinical data over 2 years of follow-up. Using modern prediction tools, we examined whether combining MEST with cross-sectional clinical data at biopsy provides earlier risk prediction in IgAN than current best methods that use 2 years of follow-up data. We used a cohort of 901 adults with IgAN from the Oxford derivation and North American validation studies and the VALIGA study followed for a median of 5.6 years to analyze the primary outcome (50% decrease in eGFR or ESRD) using Cox regression models. Covariates of clinical data at biopsy (eGFR, proteinuria, MAP) with or without MEST, and then 2-year clinical data alone (2-year average of proteinuria/MAP, eGFR at biopsy) were considered. There was significant improvement in prediction by adding MEST to clinical data at biopsy. The combination predicted the outcome as well as the 2-year clinical data alone, with comparable calibration curves. This effect did not change in subgroups treated or not with RAS blockade or immunosuppression. Thus, combining the MEST score with cross-sectional clinical data at biopsy provides earlier risk prediction in IgAN than our current best methods. PMID:26759049

  12. Early Prodromal Symptoms Can Predict Future Psychosis in Familial High-Risk Youth

    PubMed Central

    Tandon, Neeraj; Montrose, Debra; Shah, Jai; Rajarethinam, RP; Diwadkar, Vaibhav A.; Keshavan, Matcheri S.

    2011-01-01

    Background Efforts to predict psychosis in individuals at high risk for schizophrenia have focused on the identification of sub-threshold clinical criteria and neurobiological markers, including neuropsychological assessment, structural and functional brain imaging, and psychophysiological testing. We sought to evaluate the relative utility of psychosis proneness measures for prospective prediction of psychotic disorders in a group of young relatives at familial risk for schizophrenia. Methods We examined the receiver operating characteristics of sub-threshold symptoms in predicting conversion to psychosis in a group of 97 young first- and second-degree relatives of persons with schizophrenia over a 2-year period. Towards this end, we utilized the Structured Interview of Prodromal Symptoms to derive measures of two of the four Scale of Prodromal Symptoms subscales (positive and disorganized) and the Chapman Magical Ideation and Perceptual Aberration scales. These four measures were, together, taken to reflect a putative index of psychosis proneness. Results Eleven of the 97 subjects developed a psychotic disorder over 2 years of follow-up. Seventeen of the 97 subjects tested positive on this index of psychosis proneness at baseline and of these 10 converted to psychosis. The sensitivity and specificity of the test were 91 percent and 92 percent respectively. The positive predictive value of the test was 59 percent and its negative predictive value was 99 percent. Addition of measures of cognitive or social function to the index decreased its predictive ability, reducing its specificity and/or sensitivity. Conclusions A relatively simple set of clinical measures can be utilized to prospectively identify familial high-risk individuals who convert to psychosis with high specificity and sensitivity. Implications for the proposed addition of an “Attenuated Psychosis Syndrome” in DSM-5 are discussed. PMID:22056319

  13. Identifying combinations of risk and protective factors predicting physical activity change in high school students.

    PubMed

    Dunton, Genevieve Fridlund; Atienza, Audie A; Tscherne, James; Rodriguez, Daniel

    2011-02-01

    Research sought to identify combinations of risk and protective factors predicting change in physical activity (PA) over one year in high school students. Adolescents (N = 344; M = 15.7 years) participated in a longitudinal study with assessment of demographics, substance use/smoking exposure, height and weight, psychological factors, and PA in 10th and 11th grade. PA participation in 11th grade was greatest for adolescents who engaged in PA and had high sports competence (78%), and least for adolescents who did not engage in or enjoy PA (13%) in 10th grade. Identifying adolescent subgroups at risk for decreasing PA can inform the development of tailored interventions. PMID:21467595