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Sample records for incidence pathogenesis risk

  1. Incidence, risk factors, and pathogenesis of second malignancies in patients with non-Hodgkin lymphoma.

    PubMed

    Tward, Jonathan; Glenn, Martha; Pulsipher, Michael; Barnette, Phillip; Gaffney, David

    2007-08-01

    Most Non-Hodgkin's Lymphoma patients will survive their diagnosis. High dose chemotherapy and autologous stem cell transplantation, and radiation therapy have all been implicated as risk factors to secondary cancer development. Herein, we will review the molecular biology, examine the epidemiologic findings, discuss the impact of both chemotherapy and radiotherapy, and focus on the special populations of pediatrics and high dose chemotherapy and autologous stem cell transplantation with regard to secondary cancer development. PMID:17701578

  2. The incidence, pathogenesis, diagnosis, and treatment of fat embolism.

    PubMed

    Müller, C; Rahn, B A; Pfister, U; Meinig, R P

    1994-02-01

    Fat embolism syndrome is a potentially serious and life threatening complication of long bone trauma, blunt trauma, and intramedullary manipulation. In long bone fractures, fat embolism is encountered in 0.9% to 2.2% of cases. During intramedullary manipulations, such as prosthetic stem insertion or reaming, the incidence is typically lower (range, 0.5% to 0.8%). Diagnosis is dependent upon the clinical recognition of dyspnea, petechiae, and cognitive dysfunction in the first several days following fracture, trauma, or intramedullary surgery. Treatment consists of pulmonary support and aggressive resuscitation. Studies support early fracture fixation, but the role of systemic steroids, heparin, and other modalities remains speculative. PMID:8196970

  3. Risk-based Classification of Incidents

    NASA Technical Reports Server (NTRS)

    Greenwell, William S.; Knight, John C.; Strunk, Elisabeth A.

    2003-01-01

    As the penetration of software into safety-critical systems progresses, accidents and incidents involving software will inevitably become more frequent. Identifying lessons from these occurrences and applying them to existing and future systems is essential if recurrences are to be prevented. Unfortunately, investigative agencies do not have the resources to fully investigate every incident under their jurisdictions and domains of expertise and thus must prioritize certain occurrences when allocating investigative resources. In the aviation community, most investigative agencies prioritize occurrences based on the severity of their associated losses, allocating more resources to accidents resulting in injury to passengers or extensive aircraft damage. We argue that this scheme is inappropriate because it undervalues incidents whose recurrence could have a high potential for loss while overvaluing fairly straightforward accidents involving accepted risks. We then suggest a new strategy for prioritizing occurrences based on the risk arising from incident recurrence.

  4. Risk Insights Gained from Fire Incidents

    SciTech Connect

    Kazarians, Mardy; Nowlen, Steven P.

    1999-06-10

    There now exist close to 20 years of history in the application of Probabilistic Risk Assessment (PRA) for the analysis of fire risk at nuclear power plants. The current methods are based on various assumptions regarding fire phenomena, the impact of fire on equipment and operator response, and the overall progression of a fire event from initiation through final resolution. Over this same time period, a number of significant fire incidents have occurred at nuclear power plants around the world. Insights gained from US experience have been used in US studies as the statistical basis for establishing fire initiation frequencies both as a function of the plant area and the initiating fire source.To a lesser extent, the fire experience has also been used to assess the general severity and duration of fires. However, aside from these statistical analyses, the incidents have rarely been scrutinized in detail to verify the underlying assumptions of fire PRAs. This paper discusses an effort, under which a set of fire incidents are being reviewed in order to gain insights directly relevant to the methods, data, and assumptions that form the basis for current fire PRAs. The paper focuses on the objectives of the effort, the specific fire events being reviews methodology, and anticipated follow-on activities.

  5. Transfusion-Related Acute Lung Injury: Incidence, Pathogenesis and the Role of Multicomponent Apheresis in Its Prevention.

    PubMed

    Popovsky, Mark A

    2008-01-01

    SUMMARY: Although transfusion-related acute lung injury (TRALI) is now appreciated as the most common cause of death from transfusion, its incidence remains unknown. The most frequently cited figure is 1:5,000 plasma-containing components. Certain patient groups may be at significantly higher risk. TRALI is both underdiagnosed and un-derreported. It is misdiagnosed as transfusion-associated circulatory overload. Several mechanisms have been proposed for its pathogenesis-leukocyte antibodies and the 2-hit model. These may overlap, and both involve transfusion of leukocyte antibodies. Passive transfusion of leukocyte antibodies is strongly associated with TRALI; these are identified in 60-85% of cases. Multiparous blood donors are the most frequent source of these antibody-containing components. The antibodies are HLA class I and II and/or granulocyte-specific. In 50% of cases the antibody corresponds to an epitope in the patient. HLA class I antibodies have been shown to prime and activate neutrophils. Clinical reports and animal models link HNA-3a antibodies with severe lung injury. A number of TRALI prevention and risk mitigation strategies have been proposed. In the UK and the USA, these strategies have centered upon excluding 'high risk' (HLA/HNA antibody containing) plasma from fresh frozen plasma and platelet products. Multicomponent apheresis collection of platelets, plasma and red blood cells is a means of accomplishing this objective. PMID:21512631

  6. Alzheimer's disease risk genes and mechanisms of disease pathogenesis

    PubMed Central

    Karch, Celeste M.; Goate, Alison M.

    2014-01-01

    Here, we review the genetic risk factors for late onset Alzheimer's disease (AD) and their role in AD pathogenesis. Recent advances in our understanding of the human genome, namely technological advances in methods to analyze millions of polymorphisms in thousands of subjects, have revealed new genes associated with AD risk: ABCA7, BIN1, CASS4, CD33, CD2AP, CELF1, CLU, CR1, DSG2, EPHA1, FERMT2, HLA-DRB5-DBR1, INPP5D, MS4A, MEF2C, NME8, PICALM, PTK2B, SLC24H4 RIN3, SORL1, ZCWPW1. Emerging technologies to analyze the entire genome in large datasets have also revealed coding variants that increase AD risk: PLD3 and TREM2. We review the relationship between these AD risk genes and the cellular and neuropathological features of AD. Together, understanding the mechanisms underlying the association of these genes with risk for disease will provide the most meaningful targets for therapeutic development to date. PMID:24951455

  7. Post Traumatic Endophthalmitis: Incidence and Risk Factors

    PubMed Central

    Dehghani, Ali Reza; Rezaei, Leila; Salam, Hasan; Mohammadi, Zahra; Mahboubi, Mohammad

    2014-01-01

    Post traumatic endophthalmitis is an uncommon but severe complication of ocular trauma. We aimed to identify the incidence of post traumatic endophthalmitis and its contributing risk factors in Feiz hospital (Isfahan, Iran) from 2006 until 2010. Medical records of 1042 patients with open globe injury were analyzed and data were collected including age, sex, location of being injured, visual acuity (VA), time from injury to hospitalization and to repair, site of ophthalmic injury and the presence of foreign body. The frequency of post-traumatic endophthalmitis was about 2.1% (N = 22) of all patients. Nine of 22 cases with endophthalmitis were under 8 years. The visual acuity at the time of admission was seen to be contributed to high rate of endophthalmitis. Intraocular foreign body was detected in 139 patients; and the rate of endophthalmitis was 5% among these patients. Statistical analysis showed significant relationship between presence of foreign body and higher rate of endophthalmitis. Also, duration of hospitalization was significantly different between two study groups (P = 0.019). There were no significant differences between two groups in terms of other studied variables. Patients with low age, low visual acuity at admission, presence of intraocular foreign body and long duration of hospital stay had a higher risk of endophthalmitis after the repair of the globe. Compared to the reports of other large institutions, we can attribute the low incidence rate of endophthalmitis in our institution to the early use of systemic antibiotics such as gentamycin and cephalosporins in the first hour of hospitalization until discharge. PMID:25363107

  8. [Osteoradionecrosis. I. Etiology, pathogenesis, clinical aspects and risk factors].

    PubMed

    Thiel, H J

    1989-01-01

    In curative therapy of mouth-cavity and oropharyngeal carcinomas the osteoradionecrosis has to be accepted as a calculated risk with an incidence of 4-35%. It is the question of a radio-caused bone death that comes about by progressive and irreversible morphological alterations at bones and at vessels: Loss of osteocytes, active osteoblasts and osteoclasts (hypocellularity), injury of normal bone metabolism, slackening of regeneration process, extreme susceptibility to infections of the devitalized bone, radio-induced obliterating endarteritis with hyalinization, thrombosis and fibrosing of vessels, obliteration of the lumen and gradual reduction of blood-supply at the level of tissue (hypovascularity and hypoxemia: Aseptic osteoradionecrosis, radio-osteonecrosis). If there is a secondary infection of dental, periodontal or traumatic origin additionally, the condition explodes as septic osteoradionecrosis with the symptoms and findings of radio-osteomyelitis. The osteoradionecrosis begins more frequently in the mandibula than in the maxilla. The cumulative incidence is 30% after 6, 60% after 12, and more than 80% after 24 months. The duration of osteoradionecrosis follows an exponential curve with constant probability of necrosis termination at any moment after necrosis event in which the monthly probability of necrosis healing is nearly 0.06. Risk factors for formation of an osteoradionecrosis are tumor neighbourhood to bones and teeth, tumor and mandibula dosis, tumor stage, irradiation technique, status of teeth as well as moment and carrying out of tooth extractions. Tumors in neighbourhood of mandibula have a fivefold higher risk, with 80 Gy irradiated patients a 2.9-fold and toothed patients a 2.6-fold, altogether high-risk patients have a 17.7-fold higher necrosis risk than low-risk patients. Promoting factors are caries, parodontosis, a periapical pathology, a trauma, irritation by artificial teeth, elective tooth extraction before irradiation, tooth

  9. Current understanding of allergic transfusion reactions: incidence, pathogenesis, laboratory tests, prevention and treatment.

    PubMed

    Hirayama, Fumiya

    2013-02-01

    Non-haemolytic transfusion reactions are the most common type of transfusion reaction and include transfusion-related acute lung injury, transfusion-associated circulatory overload, allergic reactions, febrile reactions, post-transfusion purpura and graft-versus- host disease. Although life-threatening anaphylaxis occurs rarely, allergic reactions occur most frequently. If possible, even mild transfusion reactions should be avoided because they add to patients' existing suffering. During the last decade, several new discoveries have been made in the field of allergic diseases and transfusion medicine. First, mast cells are not the only cells that are key players in allergic diseases, particularly in the murine immune system. Second, it has been suggested that immunologically active undigested or digested food allergens in a donor's blood may be transferred to a recipient who is allergic to these antigens, causing anaphylaxis. Third, washed platelets have been shown to be effective for preventing allergic transfusion reactions, although substantial numbers of platelets are lost during washing procedures, and platelet recovery after transfusion may not be equivalent to that with unwashed platelets. This review describes allergic transfusion reactions, including the above-mentioned points, and focusses on their incidence, pathogenesis, laboratory tests, prevention and treatment. PMID:23215650

  10. [Hypertension in patients with polycystic kidney disease -  incidence, pathogenesis, prognosis, therapy].

    PubMed

    Tesař, V; Reiterová, J

    2013-06-01

    Hypertension is common in patients with autosomal dominant polycystic kidney disease (ADPKD) very early usually already in adolescence and its occurrence precedes the decrease of glomerular filtration rate. Expansion of renal cysts causing local renal ischemia and activation of the reninangiotensin system is believed to play a decisive role in its pathogenesis. Hypertension in ADPKD leads to early development of left ventricle hypertrophy and definitely contributes to the progression of chronic renal insufficiency. In ADPKD optimal control of blood pressure dramatically decreases the risk of left ventricle hypertrophy and contributes to its regression, but the beneficial effect of optimal compared to standard blood pressure control on the progression of chronic renal insufficiency has yet to be unequivocally demonstrated. Angiotensin converting enzyme inhibitors and/ or angiotensin receptor blockers are the drugs of choice in the treatment of hypertension in ADPKD. New drugs blocking the growth of renal cysts (e. g. inhibitors of V2 vasopressin antagonists) may have in ADPKD positive impact not only of the growth of the cysts and kidney volume, but also on the rate of loss of glomerular filtration rate. The influence of these drugs on the control of blood pressure, if any, remains uncertain. PMID:23808746

  11. The Childhood Incidents That Increase Later Suicide Risk

    MedlinePlus

    ... Incidents That Increase Later Suicide Risk Exposure to domestic violence, abuse cast a long shadow, study finds To ... 13, 2016 (HealthDay News) -- Adults who witnessed parental domestic violence in childhood are at increased risk for suicide ...

  12. Clostridium difficile Infection: Epidemiology, Pathogenesis, Risk Factors, and Therapeutic Options

    PubMed Central

    Seyedjavadi, Sima Sadat; Goudarzi, Hossein; Mehdizadeh Aghdam, Elnaz; Nazeri, Saeed

    2014-01-01

    The incidence and mortality rate of Clostridium difficile infection have increased remarkably in both hospital and community settings during the last two decades. The growth of infection may be caused by multiple factors including inappropriate antibiotic usage, poor standards of environmental cleanliness, changes in infection control practices, large outbreaks of C. difficile infection in hospitals, alteration of circulating strains of C. difficile, and spread of hypervirulent strains. Detection of high-risk populations could be helpful for prompt diagnosis and consequent treatment of patients suffering from C. difficile infection. Metronidazole and oral vancomycin are recommended antibiotics for the treatment of initial infection. Current treatments for C. difficile infection consist of supportive care, discontinuing the unnecessary antibiotic, and specific antimicrobial therapy. Moreover, novel approaches include fidaxomicin therapy, monoclonal antibodies, and fecal microbiota transplantation mediated therapy. Fecal microbiota transplantation has shown relevant efficacy to overcome C. difficile infection and reduce its recurrence. PMID:24991448

  13. Differences in Risk Factors for Recurrent Versus Incident Preterm Delivery

    PubMed Central

    Grantz, Katherine L.; Hinkle, Stefanie N.; Mendola, Pauline; Sjaarda, Lindsey A.; Leishear, Kira; Albert, Paul S.

    2015-01-01

    Risk factors for preterm delivery have been described, but whether risk factors differ in the context of prior preterm delivery history is less understood. We assessed whether known risk factors were different in women with versus without prior preterm delivery using medical records of the first and second singleton deliveries in 25,820 Utah women (2002–2010). Longitudinal transition models with modified Poisson regression calculated adjusted relative risks and 95% confidence intervals, with multiplicative interactions between each preterm risk factor and prior preterm delivery status to explore whether risk factors varied between incident and recurrent preterm delivery at <37 weeks. Fewer second pregnancy factors were associated with recurrent preterm delivery, including alcohol, thyroid disease, and depression. Smoking was associated with increased risk for incident (relative risk (RR) = 1.95, 95% confidence interval (CI): 1.53, 2.49) but not recurrent (RR = 1.09, 95% CI: 0.71, 1.19) preterm delivery, whereas alcohol was associated with an increased risk for recurrent (RR = 2.38, 95% CI: 1.53, 3.71) but not incident (RR = 0.98, 95% CI: 0.67, 1.43; Pinteraction = 0.02 and <0.01) preterm delivery, respectively. Prior term delivery did not necessarily confer protection from known second pregnancy preterm delivery risk factors. In the setting of a prior preterm delivery, many risk factors did not persist. Prior preterm delivery history is important when assessing subsequent preterm delivery risk factors. PMID:26033931

  14. Differences in risk factors for recurrent versus incident preterm delivery.

    PubMed

    Grantz, Katherine L; Hinkle, Stefanie N; Mendola, Pauline; Sjaarda, Lindsey A; Leishear, Kira; Albert, Paul S

    2015-07-15

    Risk factors for preterm delivery have been described, but whether risk factors differ in the context of prior preterm delivery history is less understood. We assessed whether known risk factors were different in women with versus without prior preterm delivery using medical records of the first and second singleton deliveries in 25,820 Utah women (2002-2010). Longitudinal transition models with modified Poisson regression calculated adjusted relative risks and 95% confidence intervals, with multiplicative interactions between each preterm risk factor and prior preterm delivery status to explore whether risk factors varied between incident and recurrent preterm delivery at <37 weeks. Fewer second pregnancy factors were associated with recurrent preterm delivery, including alcohol, thyroid disease, and depression. Smoking was associated with increased risk for incident (relative risk (RR) = 1.95, 95% confidence interval (CI): 1.53, 2.49) but not recurrent (RR = 1.09, 95% CI: 0.71, 1.19) preterm delivery, whereas alcohol was associated with an increased risk for recurrent (RR = 2.38, 95% CI: 1.53, 3.71) but not incident (RR = 0.98, 95% CI: 0.67, 1.43; Pinteraction = 0.02 and <0.01) preterm delivery, respectively. Prior term delivery did not necessarily confer protection from known second pregnancy preterm delivery risk factors. In the setting of a prior preterm delivery, many risk factors did not persist. Prior preterm delivery history is important when assessing subsequent preterm delivery risk factors. PMID:26033931

  15. Premature Cardiac Contractions and Risk of Incident Ischemic Stroke

    PubMed Central

    Ofoma, Uchenna; He, Fan; Shaffer, Michele L.; Naccarelli, Gerard V.; Liao, Duanping

    2012-01-01

    Background The etiologies of ischemic stroke remain undetermined in 15% to 40% of patients. Apart from atrial fibrillation, other arrhythmias are less well-characterized as risk factors. Premature cardiac contractions are known to confer long-term cardiovascular risks, like myocardial infarction. Ischemic stroke as cardiovascular risk outcome remains a topic of interest. We examined the prospective relationships in the Atherosclerosis Risk in Communities (ARIC) study, to determine whether premature atrial (PAC) or ventricular (PVC) contractions are associated with increased risk for incident ischemic stroke. Methods and Results We analyzed 14 493 baseline stroke-free middle-aged individuals in the ARIC public-use data. The presence of PAC or PVC at baseline was assessed from 2-minute electrocardiogram. A physician-panel confirmed and classified all stroke cases. Average follow-up time was 13 years. Proportional hazards models assessed associations between premature contractions and incident stroke. PACs and PVCs were identified in 717 (4.9%) and 793 (5.5%) participants, respectively. In all, 509(3.5%) participants developed ischemic stroke. The hazard ratio (HR) (95% confidence interval [CI]) associated with PVC was 1.77 (1.30, 2.41), attenuated to 1.25 (0.91, 1.71) after adjusting for baseline stroke risk factors. The interaction between PVC and baseline hypertension was marginally significant (P=0.08). Among normotensives, having PVCs was associated with nearly 2-fold increase in the rate of incident ischemic stroke (HR 1.69; 95% CI 1.02, 2.78), adjusting for stroke risk factors. The adjusted risk of ischemic stroke associated with PACs was 1.30 (95% CI 0.92, 1.83). Conclusions Presence of PVCs may indicate an increased risk of ischemic stroke, especially in normotensives. This risk approximates risk of stroke from being black, male, or obese in normotensives from this cohort. PMID:23316293

  16. [Pathogenesis of anorexia nervosa. Neurobiological risk factors and possible endophenotypes].

    PubMed

    Pászthy, Bea; Törzsök-Sonnevend, Mária

    2014-01-26

    Anorexia nervosa is a serious, chronical state of illness which often starts in childhood or adolescence and has serious consequences on the quality of life. This review focuses on the heterogenity of the disease with emphasis on special diagnostic implications in case of childhood onset. Research findings of the last decade showed that genetic and neurobiological vulnerabilities are at least as potent risk factors as psychological, family constellations and sociocultural preferences. The heritability of eating disorders levels those of diseases predominantly influenced by biological factors. The authors give a summary of the most investigated neurobiologic and neurocognitive factors which could be the fundaments of a biological vulnerablilty. To date, no common risk factor could be identified, but some existing adversities can clearly be related to distinct subgroups with the disorder. The concept of endo- and subphenotypes leads to more specific and more efficient methods of therapy in other somatic and psychiatric diseases. PMID:24440724

  17. Baseline Caries Risk Assessment as a Predictor of Caries Incidence

    PubMed Central

    Chaffee, Benjamin W.; Cheng, Jing; Featherstone, John D. B.

    2015-01-01

    Few studies have evaluated clinical outcomes following caries risk assessment in large datasets that reflect risk assessments performed during routine practice. OBJECTIVE From clinical records, compare 18-month caries incidence according to baseline caries risk designation. METHODS For this retrospective cohort study, data were collected from electronic records of non-edentulous adult patients who completed an oral examination and caries risk assessment (CRA) at a university instructional clinic from 2007 to 2012 (N=18,004 baseline patients). The primary outcome was the number of new decayed/restored teeth from the initial CRA to the ensuing oral examination, through June 30, 2013 (N=4468 patients with follow-up). We obtained doubly-robust estimates for 18-month caries increment by baseline CRA category (low, moderate, high, extreme), adjusted for patient characteristics (age, sex, payer type, race/ethnicity, number of teeth), provider type, and calendar year. RESULTS Adjusted mean decayed, restored tooth (DFT) increment from baseline to follow-up was greater with each rising category of baseline caries risk, from low (0.94), moderate (1.26), high (1.79), to extreme (3.26). The percentage of patients with any newly affected teeth (DFT increment >0) was similar among low-risk and moderate-risk patients (cumulative incidence ratio, RR: 1.01; 95% confidence interval, CI: 0.83, 1.23), but was increased relative to low-risk patients among high-risk (RR: 1.28; 95% CI: 1.10, 1.52), and extreme-risk patients (RR: 1.52; 95% CI: 1.23, 1.87). CONCLUSIONS These results lend evidence that baseline caries risk predicts future caries in this setting, supporting the use of caries risk assessment to identify candidate patients for more intensive preventive therapy. PMID:25731155

  18. Estimated incidence and risk factors of sudden unexpected death

    PubMed Central

    Lin, Feng-Chang; Mehta, Neil; Mounsey, Louisa; Nwosu, Anthony; Pursell, Irion; Chung, Eugene H; Mounsey, J Paul; Simpson, Ross J

    2016-01-01

    Objective In this manuscript, we estimate the incidence and identify risk factors for sudden unexpected death in a socioeconomically and racially diverse population in one county in North Carolina. Estimates of the incidence and risk factors contributing to sudden death vary widely. The Sudden Unexpected Death in North Carolina (SUDDEN) project is a population-based investigation of the incidence and potential causes of sudden death. Methods From 3 March 2013 to 2 March 2014, all out-of-hospital deaths in Wake County, North Carolina, were screened to identify presumed sudden unexpected death among free-living residents between the ages of 18 and 64 years. Death certificate, public and medical records were reviewed and adjudicated to confirm sudden unexpected death cases. Results Following adjudication, 190 sudden unexpected deaths including 122 men and 68 women were identified. Estimated incidence was 32.1 per 100 000 person-years overall: 42.7 among men and 22.4 among women. The majority of victims were white, unmarried men over age 55 years, with unwitnessed deaths at home. Hypertension and dyslipidaemia were common in men and women. African-American women dying from sudden unexpected death were over-represented. Women who were under age 55 years with coronary disease accounted for over half of female participants with coronary artery disease. Conclusions The overall estimated incidence of sudden unexpected death may account for approximately 10% of all deaths classified as ‘natural’. Women have a lower estimated incidence of sudden unexpected death than men. However, we found no major differences in age or comorbidities between men and women. African-Americans and young women with coronary disease are at risk for sudden unexpected death. PMID:27042316

  19. Reduced Risk of Incident Kidney Cancer from Walking and Running

    PubMed Central

    Williams, Paul T.

    2013-01-01

    Purpose Test whether incident kidney cancer risk is associated with exercise energy expenditure (i.e., metabolic equivalents, 1 MET) when calculated from distance walked or run. Methods Hazard ratios (HR) and 95% confidence intervals (95%CI) from Cox proportional hazard analyses of self-reported physician-diagnosed incident kidney cancer vs. MET-hours/wk in 91,820 subjects recruited between 1991 and 1993 (7.7 yr follow-up of 42,833 subjects) and between 1998 and 1999 (6.4 yr follow-up of 33,053 subjects) as part of the National Runners' Health Study and between 1998 and 1999 as part of the National Walkers' Health Study (5.7 yr follow-up of 15,934 subjects). Results Fifty-two incident cancers were reported. Age- and sex-adjusted risk declined 1.9% per MET-hour/wk run or walked (HR: 0.981; 95%CI: 0.964 to 0.997, P=0.02). Compared to walking or running below guidelines levels (<7.5 MET-hours/wk), the risk for incident kidney cancer was 61% lower for meeting the guidelines (HR: 0.39, 95%CI: 0.11 to 1.08, P=0.07 for 7.5 to 12.5 MET-hours/wk), 67% lower for exercising one to two-times the recommended level (HR: 0.33; 95%CI: 0.15 to 0.72, P=0.005 for 12.6 to 25.1 MET-hours/wk), and 76.3% lower for exercising ≥2-times the recommended level (HR: 0.24; 95%CI: 0.11 to 0.52, P=0.0005 for ≥25.2 MET-hours/wk). Incident kidney cancer risk also increased in association with baseline BMI (P=0.002), smoking (P=0.02), and hypertensive (P=0.007) and diabetes medication use (P=0.01), however, exercise-associated reductions in kidney cancer risk persisted for 12.6 to 25.1 MET-hours/wk (HR: 0.35, P=0.01), and ≥ 25.2 MET-hours/wk (HR: 0.29, P=0.004) vis-à-vis <7.5 MET-hours/wk when also adjusted for BMI, hypertension, diabetes, and pack-years smoked. Conclusion Running and walking may reduce incident kidney cancer risk independent of its other known risk factors. PMID:23863620

  20. Environmental Pollution: A Tangible Risk for NAFLD Pathogenesis

    PubMed Central

    Arciello, Mario; Gori, Manuele; Maggio, Roberta; Barbaro, Barbara; Tarocchi, Mirko; Galli, Andrea; Balsano, Clara

    2013-01-01

    The liver is crucial for human life, and the health of this organ often mirrors the health of the individual. The liver can be the target of several diseases, the most prevalent of which, as a consequence of development and changes in human lifestyles, is the nonalcoholic fatty liver disease (NAFLD). NAFLD is a multifactorial disease that embraces many histo-pathologic conditions and is highly linked to metabolic derangements. Technological progress and industrialization have also had the consequence of releasing pollutants in the environment, for instance pesticides or solvents, as well as by-products of discharge, such as the particulate matter. In the last decade, a growing body of evidence has emerged, shedding light on the potential impact of environmental pollutants on liver health and, in particular, on NAFLD occurrence. These contaminants have a great steatogenic potential and need to be considered as tangible NAFLD risk factors. There is an urgent need for a deeper comprehension of their molecular mechanisms of action, as well as for new lines of intervention to reduce their worldwide diffusion. This review wishes to sensitize the community to the effects of several environmental pollutants on liver health. PMID:24213605

  1. Incidence and risk factors of workplace violence on psychiatric staff

    PubMed Central

    Ridenour, Marilyn; Lanza, Marilyn; Hendricks, Scott; Hartley, Dan; Rierdan, Jill; Zeiss, Robert; Amandus, Harlan

    2015-01-01

    BACKGROUND A study by Hesketh et al. found that 20% of psychiatric nurses were physically assaulted, 43% were threatened with physical assault, and 55% were verbally assaulted at least once during the equivalent of a single work week. From 2005 through 2009, the U.S. Department of Justice reported that mental health occupations had the second highest average annual rate of workplace violence, 21 violent crimes per 1,000 employed persons aged 16 or older. OBJECTIVE An evaluation of risk factors associated with patient aggression towards nursing staff at eight locked psychiatric units. PARTICIPANTS Two-hundred eighty-four nurses in eight acute locked psychiatric units of the Veterans Health Administration throughout the United States between September 2007 and September 2010. METHODS Rates were calculated by dividing the number of incidents by the total number of hours worked by all nurses, then multiplying by 40 (units of incidents per nurse per 40-hour work week). Risk factors associated with these rates were analyzed using generalized estimating equations with a Poisson model. RESULTS Combining the data across all hospitals and weeks, the overall rate was 0.60 for verbal aggression incidents and 0.19 for physical aggression, per nurse per week. For physical incidents, the evening shift (3 pm – 11 pm) demonstrated a significantly higher rate of aggression than the day shift (7 am – 3 pm). Weeks that had a case-mix with a higher percentage of patients with personality disorders were significantly associated with a higher risk of verbal and physical aggression. CONCLUSION Healthcare workers in psychiatric settings are at high risk for aggression from patients. PMID:24894691

  2. Metabolomics and Incidence of Atrial Fibrillation in African Americans: The Atherosclerosis Risk in Communities (ARIC) Study

    PubMed Central

    Alonso, Alvaro; Yu, Bing; Qureshi, Waqas T.; Grams, Morgan E.; Selvin, Elizabeth; Soliman, Elsayed Z.; Loehr, Laura R.; Chen, Lin Y.; Agarwal, Sunil K.; Alexander, Danny; Boerwinkle, Eric

    2015-01-01

    Background Atrial fibrillation (AF) is a common arrhythmia. Application of metabolomic approaches, which may identify novel pathways and biomarkers of disease risk, to a longitudinal epidemiologic study of AF has been limited. Methods We determined the prospective association of 118 serum metabolites identified through untargeted metabolomics profiling with the incidence of newly-diagnosed AF in 1919 African-American men and women from the Atherosclerosis Risk in Communities study without AF at baseline (1987–1989). Incident AF cases through 2011 were ascertained from study electrocardiograms, hospital discharge codes, and death certificates. Results During a median follow-up of 22 years, we identified 183 incident AF cases. In Cox proportional hazards models adjusted for age, sex, smoking, body mass index, systolic blood pressure, use of antihypertensive medication, diabetes, prevalent heart failure, prevalent coronary heart disease, and kidney function, two conjugated bile acids (glycolithocholate sulfate and glycocholenate sulfate) were significantly associated with AF risk after correcting for multiple comparisons (p<0.0004). Multivariable-adjusted hazard ratios (95% confidence intervals) of AF were 1.22 (1.12–1.32) for glycolithocholate sulfate and 1.22 (1.10–1.35) for glycocholenate sulfate per 1-standard deviation higher levels. Associations were not appreciably different after additional adjustment for alcohol consumption or concentrations of circulating albumin and liver enzymes. Conclusion We found an association of higher levels of two bile acids with an increased risk of AF, pointing to a potential novel pathway in AF pathogenesis. Replication of results in independent studies is warranted. PMID:26544570

  3. PARTICIPATION IN ACTIVITY AND RISK FOR INCIDENT DELIRIUM

    PubMed Central

    Yang, Frances M.; Inouye, Sharon K.; Fearing, Michael A.; Kiely, Dan K.; Marcantonio, Edward R.; Jones, Richard N.

    2008-01-01

    Objectives To examine the mediating role of activity participation between educational attainment and risk for incidence delirium; and to examine the contribution of participation in specific activities to the development of delirium. Design and Setting Prospective cohort study. An urban teaching hospital in New Haven, Connecticut, USA. Participants Drawn from two prospective cohort studies of 779 newly hospitalized patients aged 70 and older without dementia. Measurements The main outcome was delirium measured by the full Confusion Assessment Method (CAM) algorithm, which consisted of acute onset and fluctuating course, inattention, and either disorganized thinking or altered level of consciousness, as rated by trained clinical interviewers. Results Bivariable results indicated a significant relationship between both education and the development of delirium (odds ratio, 0.92 [95% confidence interval (CI), 0.88 to 0.97], and between activity and delirium (odds ratio, 0.60 [95% CI, 0.46 to 0.79]. In multivariable analysis, activity mediated the relationship between education and risk for delirium. Considering each activity separately, multivariable logistic regression analysis showed that regular exercise significantly lowered the risk for developing delirium (odds ratio, 0.76 [95% CI, 0.60 to 0.96]. Conclusion Among older persons without dementia, activity participation before hospitalization is a mediator between education and incidence of delirium. Specifically, we found that participation in regular exercise was found to be significantly protective against delirium. PMID:18547359

  4. Injury incidence, risk factors and prevention in Australian rules football.

    PubMed

    Hrysomallis, Con

    2013-05-01

    Along with the enjoyment and the other positive benefits of sport participation, there is also the risk of injury that is elevated in contact sport. This review provides a summary of injury incidence in Australian rules football (ARF), identifies injury risk factors, assesses the efficacy of interventions to reduce injury risk and makes recommendations for future research. The most common injuries were found to be muscle strains, particularly hamstrings; joint ligament sprains, especially ankle; haematomas and concussion. The most severe joint injury was anterior cruciate ligament rupture. Mouthguards are commonly worn and have been shown to reduce orofacial injury. There is evidence that thigh pads can reduce the incidence of thigh haematomas. There is a reluctance to wear padded headgear and an attempt to assess its effectiveness was unsuccessful due to low compliance. The most readily identified risk factor was a history of that injury. There were conflicting findings as to the influence strength imbalances or deficit has on hamstring injury risk in ARF. Static hamstring flexibility was not related to risk but low hip flexor/quadriceps flexibility increased hamstring injury risk. High lower-limb and high hamstring stiffness were associated with an elevated risk of hamstring injury. Since stiffness can be modulated through strength or flexibility training, this provides an area for future intervention studies. Low postural balance ability was related to a greater risk of ankle injury in ARF, players with poor balance should be targeted for balance training. There are preliminary data signifying a link between deficiencies in hip range of motion and hip adductor strength with groin pain or injury. This provides support for future investigation into the effectiveness of an intervention for high-risk players on groin injury rate. Low cross-sectional area of core-region muscle has been associated with more severe injuries and a motor control exercise intervention

  5. Global epidemiology of gout: prevalence, incidence and risk factors.

    PubMed

    Kuo, Chang-Fu; Grainge, Matthew J; Zhang, Weiya; Doherty, Michael

    2015-11-01

    Gout is a crystal-deposition disease that results from chronic elevation of uric acid levels above the saturation point for monosodium urate (MSU) crystal formation. Initial presentation is mainly severely painful episodes of peripheral joint synovitis (acute self-limiting 'attacks') but joint damage and deformity, chronic usage-related pain and subcutaneous tophus deposition can eventually develop. The global burden of gout is substantial and seems to be increasing in many parts of the world over the past 50 years. However, methodological differences impair the comparison of gout epidemiology between countries. In this comprehensive Review, data from epidemiological studies from diverse regions of the world are synthesized to depict the geographic variation in gout prevalence and incidence. Key advances in the understanding of factors associated with increased risk of gout are also summarized. The collected data indicate that the distribution of gout is uneven across the globe, with prevalence being highest in Pacific countries. Developed countries tend to have a higher burden of gout than developing countries, and seem to have increasing prevalence and incidence of the disease. Some ethnic groups are particularly susceptible to gout, supporting the importance of genetic predisposition. Socioeconomic and dietary factors, as well as comorbidities and medications that can influence uric acid levels and/or facilitate MSU crystal formation, are also important in determining the risk of developing clinically evident gout. PMID:26150127

  6. Metabolic Risk Factors of Sporadic Alzheimer’s Disease: Implications in the Pathology, Pathogenesis and Treatment

    PubMed Central

    Chakrabarti, Sasanka; Khemka, Vineet Kumar; Banerjee, Anindita; Chatterjee, Gargi; Ganguly, Anirban; Biswas, Atanu

    2015-01-01

    Alzheimer’s disease (AD), the major cause of dementia among the elderly world-wide, manifests in familial and sporadic forms, and the latter variety accounts for the majority of the patients affected by this disease. The etiopathogenesis of sporadic AD is complex and uncertain. The autopsy studies of AD brain have provided limited understanding of the antemortem pathogenesis of the disease. Experimental AD research with transgenic animal or various cell based models has so far failed to explain the complex and varied spectrum of AD dementia. The review, therefore, emphasizes the importance of AD related risk factors, especially those with metabolic implications, identified from various epidemiological studies, in providing clues to the pathogenesis of this complex disorder. Several metabolic risk factors of AD like hypercholesterolemia, hyperhomocysteinemia and type 2 diabetes have been studied extensively both in epidemiology and experimental research, while much less is known about the role of adipokines, pro-inflammatory cytokines and vitamin D in this context. Moreover, the results from many of these studies have shown a degree of variability which has hindered our understanding of the role of AD related risk factors in the disease progression. The review also encompasses the recent recommendations regarding clinical and neuropathological diagnosis of AD and brings out the inherent uncertainty and ambiguity in this area which may have a distinct impact on the outcome of various population-based studies on AD-related risk factors. PMID:26236550

  7. Metabolic Risk Factors of Sporadic Alzheimer's Disease: Implications in the Pathology, Pathogenesis and Treatment.

    PubMed

    Chakrabarti, Sasanka; Khemka, Vineet Kumar; Banerjee, Anindita; Chatterjee, Gargi; Ganguly, Anirban; Biswas, Atanu

    2015-08-01

    Alzheimer's disease (AD), the major cause of dementia among the elderly world-wide, manifests in familial and sporadic forms, and the latter variety accounts for the majority of the patients affected by this disease. The etiopathogenesis of sporadic AD is complex and uncertain. The autopsy studies of AD brain have provided limited understanding of the antemortem pathogenesis of the disease. Experimental AD research with transgenic animal or various cell based models has so far failed to explain the complex and varied spectrum of AD dementia. The review, therefore, emphasizes the importance of AD related risk factors, especially those with metabolic implications, identified from various epidemiological studies, in providing clues to the pathogenesis of this complex disorder. Several metabolic risk factors of AD like hypercholesterolemia, hyperhomocysteinemia and type 2 diabetes have been studied extensively both in epidemiology and experimental research, while much less is known about the role of adipokines, pro-inflammatory cytokines and vitamin D in this context. Moreover, the results from many of these studies have shown a degree of variability which has hindered our understanding of the role of AD related risk factors in the disease progression. The review also encompasses the recent recommendations regarding clinical and neuropathological diagnosis of AD and brings out the inherent uncertainty and ambiguity in this area which may have a distinct impact on the outcome of various population-based studies on AD-related risk factors. PMID:26236550

  8. Emergency peripartum hysterectomy: Incidence, indications, risk factors and outcome

    PubMed Central

    Machado, Lovina S.M.

    2011-01-01

    Background: Peripartum hysterectomy is a major operation and is invariably performed in the presence of life threatening hemorrhage during or immediately after abdominal or vaginal deliveries. Material and Methods: A Medline search was conducted to review the recent relevant articles in English literature on emergency peripartum hysterectomy. The incidence, indications, risk factors and outcome of emergency peripartum hysterectomy were reviewed. Results: The incidence of emergency peripartum hysterectomy ranged from 0.24 to 8.7 per 1000 deliveries. Emergency peripartum hysterectomy was found to be more common following cesarean section than vaginal deliveries. The predominant indication for emergency peripartum hysterectomy was abnormal placentation (placenta previa/accreta) which was noted in 45 to 73.3%, uterine atony in 20.6 to 43% and uterine rupture in 11.4 to 45.5 %. The risk factors included previous cesarean section, scarred uterus, multiparity, older age group. The maternal morbidity ranged from 26.5 to 31.5% and the mortality from 0 to 12.5% with a mean of 4.8%. The decision of performing total or subtotal hysterectomy was influenced by the patient's condition. Conclusion: Emergency peripartum hysterectomy is a most demanding obstetric surgery performed in very trying circumstances of life threatening hemorrhage. The indication for emergency peripartum hysterectomy in recent years has changed from traditional uterine atony to abnormal placentation. Antenatal anticipation of the risk factors, involvement of an experienced obstetrician at an early stage of management and a prompt hysterectomy after adequate resuscitation would go a long way in reducing morbidity and mortality. PMID:22171242

  9. Individual and Combined Risk Factors for Incident Atrial Fibrillation and Incident Stroke: An Analysis of 3 Million At-Risk US Patients

    PubMed Central

    Chyou, Janice Y; Hunter, Tina D; Mollenkopf, Sarah A; Turakhia, Mintu P; Reynolds, Matthew R

    2015-01-01

    Background The incremental effects of risk factor combinations for atrial fibrillation (AF) and stroke are incompletely understood. We sought to quantify the risks of incident AF and stroke for combinations of established risk factors in a large US sample. Methods and Results Patients with no evidence of AF or stroke in 2007 were stratified by combinations of the following risk factors: heart failure, hypertension, diabetes, age 65 to 74, age ≥75, coronary artery disease, and chronic kidney disease. Patients with ≥2 of the first 5 or ≥3 of the first 7, classified as “high-risk,” and an age-matched sample of patients with fewer risk factors, classified as “low-risk,” were followed over 2008–2010 for incident AF and stroke. Annualized incidence rates and risks were quantified for each combination of factors by using Cox regression. Annualized incidence rates for AF, stroke, and both were 3.59%, 3.27%, and 0.62% in 1 851 653 high-risk patients and 1.32%, 1.48%, and 0.18% in 1 156 221 low-risk patients, respectively. Among patients with 1 risk factor, those with age ≥75 had the highest hazards of incident AF and stroke (HR 9.2, 6.9). Among patients with 2 risk factors, those with age ≥75 and heart failure had the highest annualized incidence rates of AF and stroke (10.2%, 5.9%). The combination of age ≥75 and hypertension was prevalent and had the highest incidences of AF and stroke. Conclusions Adults with combinations of known risk factors are at increased risk of incident AF and stroke, but combinations of risk factors are not always additive. PMID:26206736

  10. [Incidence and risk factors for infections from hemodialysis catheters].

    PubMed

    Jean, G

    2001-01-01

    We report here a revue of hemodialysis catheter-related infections data published since 1985. The reported prevalence of bacteremia is 1 to 20% of catheters, and incidence is 0.72 to 9/1000 catheter-days. Local infection is reported in 6 to 63% of catheters and in 1 to 5/1000 catheter-days. Tunneled catheters and implantables chambers reported less infection rate. The most severe complication is endocarditis (4% rate). Death occurs in 8 to 20% of cases. Reported microbial data show that Staphylococcus aureus (SA) is responsible for most infections ahead of non-aureus Staphylococcus. SA skin colonisation is a risk factor for catheter colonisation and the first step of infection. On the other hand, the host immunity impairment in hemodialysis patients seems a significant risk factor. Iron overload, specially after blood transfusions, older age, diabetes mellitus, low serum albumin level, previous history of bacteremia and immunosuppressive treatment have been frequently involved. Other catheter-related factors are time of use, absence of tunnel and use for parenteral nutrition. Nurses plans, dressing type and frequency, nurses work experience are also important. In spite of recent progress in risk factor understanding, hemodialysis-related infection remains frequent. Multicentre studies are necessary to better evaluated care protocols and new catheter material. PMID:11811006

  11. Incidence and risk factors of delirium in patients post pancreaticoduodenectomy

    PubMed Central

    Gallagher, Tom K; McErlean, Sarah; O'Farrell, Aimee; Hoti, Emir; Maguire, Donal; Traynor, Oscar J; Conlon, Kevin C; Geoghegan, Justin G

    2014-01-01

    Background Post-operative delirium is an important and common complication of major abdominal surgery characterized by acute confusion with fluctuating consciousness. The aim of this study was to establish the incidence of post-operative delirium in patients undergoing a pancreaticoduodenectomy and to determine the risk factors for its development. Methods From a prospectively maintained database, a retrospective cohort analysis was performed of 50 consecutive patients who underwent a pancreaticoduodenectomy at the National Surgical Centre for Pancreatic Cancer in St. Vincent's University Hospital, Dublin and whose entire post-operative stay was in this institution, between July 2011 and December 2012. Two independent medical practitioners assessed all data and delirium was diagnosed according to criteria of the Diagnostic and Statistical Manual Disorder (DSM), fourth edition. Univariate and multivariate analyses were performed. Results Seven patients (14%) developed post-operative delirium. The median onset was on the second post-operative day. Older age was predictive of an increased risk of delirium post-operatively. Those who developed delirium had a significantly increased length of stay (LOS) as well as a significantly increased risk of developing at least a grade 3 complication (Clavien-Dindo classification). Conclusion This study demonstrates that post-operative delirium is associated with a more complicated recovery after a pancreaticoduodenectomy and that older age is independently predictive of its development. Focused screening may allow targeted preventative strategies to be used in the peri-operative period to reduce complications and costs associated with delirium. PMID:24750484

  12. Infection as a Risk Factor in the Pathogenesis of Primary Biliary Cirrhosis: Pros and Cons

    PubMed Central

    Kumagi, Teru; Abe, Masanori; Ikeda, Yoshiou; Hiasa, Yoichi

    2010-01-01

    Primary biliary cirrhosis (PBC) is a chronic and slowly progressive cholestatic liver disease of autoimmune etiology, characterized by injury of the intrahepatic bile ducts that may eventually lead to cirrhosis and liver failure. Evidence suggests cardinal roles for both environmental factors and genetic susceptibility. Nevertheless, the absolute etiology of PBC is unclear, despite recent well-designed case-control studies that reported environmental risk factors, including infectious agents, for PBC. Of the reported infectious agents, some of them are not reproducible and remain controversial. However, infection is no doubt one of the major risks among the environmental factors. This is supported by the fact that infectious agents in autoimmune diseases express antigens resulting in molecular mimicry and xenobiotics that play a role in breaking tolerance. Taken together, recent findings from genome wide assays as well as novel animal models may enable us to better understand the mechanism of pathogenesis responsible for this disease. PMID:21297250

  13. Incidence, risk factors, and outcomes of Fusobacterium species bacteremia

    PubMed Central

    2013-01-01

    Background Fusobacterium species (spp.) bacteremia is uncommon and has been associated with a variety of clinical presentations. We conducted a retrospective, population based study to determine the relative proportion of species in this genus causing bacteremia and the risk factors for infection and adverse clinical outcomes. Methods All cases of Fusobacterium spp. bacteremia detected at a regional microbiology laboratory serving outpatient and acute care for a population of approximately 1.3 million people over 11 years were identified from a computerized database. Clinical data on these cases was extracted from an administrative database and analyzed to determine underlying risk factors for and outcomes of infection. Results There were 72 incident cases of Fusobacterium spp. bacteremia over the study period (0.55 cases/100,000 population per annum). F. nucleatum was the most frequent species (61%), followed by F. necrophorum (25%). F. necrophorum bacteremia occurred in a younger population without underlying comorbidities and was not associated with mortality. F. nucleatum bacteremia was found in an older population and was associated with underlying malignancy or receiving dialysis. Death occurred in approximately 10% of F. nucleatum cases but causality was not established in this study. Conclusions Fusobacterium spp. bacteremia in our community is uncommon and occurs in approximately 5.5 cases per million population per annum. F. necrophorum occurred in an otherwise young healthy population and was not associated with any mortality. F. nucleatum was found primarily in older patients with chronic medical conditions and was associated with a mortality of approximately 10%. Bacteremias from other Fusobacterium spp. were rare. PMID:23734900

  14. The Skinny on Sexual Risk: The Effects of BMI on STI Incidence and Risk

    PubMed Central

    Arnold, Anna; Lewis, Jessica B.; Magriples, Urania; Ickovics, Jeannette R.

    2011-01-01

    Few studies examine the influence of body mass index (BMI) on sexual risk. The purpose of this study was to determine whether BMI among 704 young mothers (ages 14–25) related to STI incidence and sexual risk. We examined the effect of BMI groups (normal weight, overweight, and obese) at 6 months postpartum on STI incidence and risky sex (e.g., unprotected sex, multiple partners, risky and casual partner) at 12 months post-partum. At 6 months postpartum, 31% of participants were overweight and 40% were obese. Overweight women were more likely to have an STI (OR = 1.79, 95% CI = 1.11–2.89, P < .05) and a risky partner (OR = 1.64, 95% CI = 1.01–2.08, P < .05) at 12 months postpartum compared to normal weight women. However, obese women were less likely to have an STI than normal weight women (OR = .57, 95% CI = .34–.96, P < .01). BMI related to STI incidence and sexual risk behavior. Integrated approaches to weight loss and sexual risk prevention should be explored. PMID:20976536

  15. The skinny on sexual risk: the effects of BMI on STI incidence and risk.

    PubMed

    Kershaw, Trace S; Arnold, Anna; Lewis, Jessica B; Magriples, Urania; Ickovics, Jeannette R

    2011-10-01

    Few studies examine the influence of body mass index (BMI) on sexual risk. The purpose of this study was to determine whether BMI among 704 young mothers (ages 14-25) related to STI incidence and sexual risk. We examined the effect of BMI groups (normal weight, overweight, and obese) at 6 months postpartum on STI incidence and risky sex (e.g., unprotected sex, multiple partners, risky and casual partner) at 12 months postpartum. At 6 months postpartum, 31% of participants were overweight and 40% were obese. Overweight women were more likely to have an STI (OR = 1.79, 95% CI = 1.11-2.89, P < .05) and a risky partner (OR = 1.64, 95% CI = 1.01-2.08, P < .05) at 12 months postpartum compared to normal weight women. However, obese women were less likely to have an STI than normal weight women (OR = .57, 95% CI = .34-.96, P < .01). BMI related to STI incidence and sexual risk behavior. Integrated approaches to weight loss and sexual risk prevention should be explored. PMID:20976536

  16. Avian necrotic enteritis: experimental models, host immunity, pathogenesis, risk factors, and vaccine development.

    PubMed

    Lee, K W; Lillehoj, H S; Jeong, W; Jeoung, H Y; An, D J

    2011-07-01

    The increasing trends of legislative restrictions and voluntary removal of antibiotic growth promoters worldwide has already affected, and will continue to affect, poultry production and animal health. Necrotic enteritis (NE) is being considered among the most important infectious diseases in the current poultry production system globally, with an estimated annual economic loss of more than $2 billion, largely attributable to medical treatments and impaired growth performance. Thus, there is an urgent need to develop rational, alternative, and integrated management strategies not only to control NE, but also to prevent it. In both humans and many warm-blooded animals and birds, NE is caused by Clostridium perfringens, a gram-positive, anaerobic, spore-forming bacterium. To accomplish these goals, better understanding of host- and environmentally related factors on the development of NE and potential vaccination strategies against C. perfringens infection will be necessary. Furthermore, a reliable and reproducible NE disease model is needed for characterization of C. perfringens pathogenesis and host protective immunity. This review summarizes recent developments in NE disease models, pathogenesis, host immunity, risk factors, and vaccine development for C. perfringens-associated NE in poultry. PMID:21673152

  17. Injuries in professional modern dancers: incidence, risk factors, and management.

    PubMed

    Shah, Selina; Weiss, David S; Burchette, Raoul J

    2012-03-01

    Modern (or contemporary) dance has become increasingly popular, yet little has been reported with respect to modern dance injuries and their consequences. The purpose of this study is to define the incidence, risk factors, and management of musculoskeletal injuries in professional modern dancers. A total of 184 dancers in the United States completed an anonymous 17-page questionnaire on their injuries, including extensive details regarding the two most severe injuries that had occurred in the prior 12 months. According to their self-reports, a total of 82% of the dancers had suffered between one and seven injuries. The foot and ankle (40%) was the most common site of injury, followed by the lower back (17%) and the knee (16%). The rate of injuries was 0.59 per 1,000 hours of class and rehearsal. Injured male dancers returned to full dancing after a median of 21 days, while females returned after a median of 18 days. Most dancers missed no performances due to injury. Of the medical consultations sought by dancers for their injuries, 47% were made to physicians, 41% to physical therapists, and 34% to chiropractors. The majority of dancers adhered to the advice given them by consultants (87% of males and 78% of females for the most severe injury). While the majority of injuries were considered work-related (61% of the most severe injury and 69% of the second most severe), few were covered by Workers' Compensation insurance (12% and 5% respectively). These professional modern dancers suffer from a rate of injury similar to other groups of professional dancers. Most dancers return to a partial level of dancing several weeks before attempting full-capacity dancing. PMID:22390950

  18. An Update on Fetal Alcohol Syndrome-Pathogenesis, Risks, and Treatment.

    PubMed

    Gupta, Keshav K; Gupta, Vinay K; Shirasaka, Tomohiro

    2016-08-01

    Alcohol is a well-established teratogen that can cause variable physical and behavioral effects on the fetus. The most severe condition in this spectrum of diseases is known as fetal alcohol syndrome (FAS). The differences in maternal and fetal enzymes, in terms of abundance and efficiency, in addition to reduced elimination, allow for alcohol to have a prolonged effect on the fetus. This can act as a teratogen through numerous methods including reactive oxygen species (generated as by products of CYP2E1), decreased endogenous antioxidant levels, mitochondrial damage, lipid peroxidation, disrupted neuronal cell-cell adhesion, placental vasoconstriction, and inhibition of cofactors required for fetal growth and development. More recently, alcohol has also been shown to have epigenetic effects. Increased fetal exposure to alcohol and sustained alcohol intake during any trimester of pregnancy is associated with an increased risk of FAS. Other risk factors include genetic influences, maternal characteristics, for example, lower socioeconomic statuses and smoking, and paternal chronic alcohol use. The treatment options for FAS have recently started to be explored although none are currently approved clinically. These include prenatal antioxidant administration food supplements, folic acid, choline, neuroactive peptides, and neurotrophic growth factors. Tackling the wider impacts of FAS, such as comorbidities, and the family system have been shown to improve the quality of life of FAS patients. This review aimed to focus on the pathogenesis, especially mechanisms of alcohol teratogenicity, and risks of developing FAS. Recent developments in potential management strategies, including prenatal interventions, are discussed. PMID:27375266

  19. Suicidal risk among infertile women undergoing in-vitro fertilization: Incidence and risk factors.

    PubMed

    Shani, Chen; Yelena, Stukalina; Reut, Ben Kimhy; Adrian, Shulman; Sami, Hamdan

    2016-06-30

    Despite the fact that depression and other emotional distress are well documented in infertile women, little is known about the relationship between infertility and suicidal risk. The aim of this cross sectional study was to examine the rate of suicide risk (suicidal ideation/suicidal attempts) among 106 infertile women visiting Infertility and In-Vitro Fertilization (IVF) Hospital Unit, and to identify the demographic, medical and clinical correlates to suicidal risk. The incidence of suicide risk was 9.4%. Suicidal women were more likely to be childless or had fewer children and experienced higher levels of depressive symptoms. In addition, they reported more frequently on denial, social withdrawal and self-blame coping strategies compared to participants without suicidal risk. A multiple logistic regression model revealed that being childless, using non-positive reappraisal and exhibiting depressive symptoms were significant predictors of suicide risk in the future. These results suggest that routine assessment of suicidal risk and depression should be provided for infertile women in the course of IVF. Furthermore, future interventions should focus on helping them acquire different emotions regulation strategies and provide alternative skills for positive coping. PMID:27084991

  20. Association between Mitochondrial DNA Copy Number in Peripheral Blood and Incident CKD in the Atherosclerosis Risk in Communities Study.

    PubMed

    Tin, Adrienne; Grams, Morgan E; Ashar, Foram N; Lane, John A; Rosenberg, Avi Z; Grove, Megan L; Boerwinkle, Eric; Selvin, Elizabeth; Coresh, Josef; Pankratz, Nathan; Arking, Dan E

    2016-08-01

    Mitochondrial dysfunction in kidney cells has been implicated in the pathogenesis of CKD. Mitochondrial DNA (mtDNA) copy number is a surrogate measure of mitochondrial function, and higher mtDNA copy number in peripheral blood has been associated with lower risk of two important risk factors for CKD progression, diabetes and microalbuminuria. We evaluated whether mtDNA copy number in peripheral blood associates with incident CKD in a population-based cohort of middle-aged adults. We estimated mtDNA copy number using 25 high-quality mitochondrial single nucleotide polymorphisms from the Affymetrix 6.0 array. Among 9058 participants, those with higher mtDNA copy number had a lower rate of prevalent diabetes and lower C-reactive protein levels and white blood cell counts. Baseline eGFR did not differ significantly by mtDNA copy number. Over a median follow-up of 19.6 years, 1490 participants developed CKD. Higher mtDNA copy number associated with lower risk of incident CKD (highest versus lowest quartile: hazard ratio 0.65; 95% confidence interval, 0.56 to 0.75; P<0.001) after adjusting for age, sex, and race. After adjusting for additional risk factors of CKD, including prevalent diabetes, hypertension, C-reactive protein level, and white blood cell count, this association remained significant (highest versus lowest quartile: hazard ratio 0.75; 95% confidence interval, 0.64 to 0.87; P<0.001). In conclusion, higher mtDNA copy number associated with lower incidence of CKD independent of traditional risk factors and inflammation biomarker levels in this cohort. Further research on modifiable factors influencing mtDNA copy number may lead to improvement in the prevention and treatment of CKD. PMID:26794963

  1. Risk factors and metabolic mechanisms in the pathogenesis of uraemic cardiac disease.

    PubMed

    Bhandari, Sunil

    2011-01-01

    Chronic kidney disease has been increasingly recognized as a risk factor for incident heart failure. Despite advances in chronic heart failure treatment, the prognosis remains poor. The annual mortality from all cardiovascular causes in the end stage renal disease population is significantly higher than the general population, accounting for more than half of all deaths in this group. The mechanisms underlying the enhanced susceptibility to myocardial ischemia in chronic kidney disease are not well defined. Traditional cardiovascular risk factors, although common in chronic kidney disease, do not exert the same impact as in the general population. The presence of "renal-specific" non-traditional risk factors including endothelial dysfunction, inflammation, oxidative stress, anaemia, proteinuria and changes in vitamin D metabolism (encompassing the complex interactions of calcium and phosphate metabolism, hyperparathyroidism and vascular calcification) play an important role in cardiovascular disease progression. An increased understanding of the array of metabolic changes/adaptations occurring in uraemic heart disease have allowed one to consider optimal management strategies and to develop new strategies for future management of uraemic heart disease. PMID:21196237

  2. One-Year Incidence of Psychiatric Disorders and Associated Risk Factors among Adolescents in the Community

    ERIC Educational Resources Information Center

    Roberts, Robert E.; Roberts, Catherine R.; Chan, Wenyaw

    2009-01-01

    Background: We have few data on incidence of psychiatric disorders among adolescents. This study examined first incidence of disorders among adolescents and baseline factors which increased or decreased risk of new onset cases a year later. Methods: Data were analyzed from Teen Health 2000 (TH2K), a probability sample of 4,175 youths 11-17 and…

  3. The Lymphedema and Gynecologic Cancer (LEG) Study: Incidence, Risk Factors, and | Division of Cancer Prevention

    Cancer.gov

    DESCRIPTION (provided by applicant): The proposed study, "Lymphedema and Gynecologic cancer (LEG): Incidence, Risk Factors and Impact", will innovatively utilize the cooperative group setting of the GOG (Gynecologic Oncology Group) to prospectively study 1300 women newly diagnosed with cervical, endometrial, or vulvar cancer to determine the incidence and impact of lower extremity lymphedema following surgical treatment of these diseases. |

  4. Are passive smoking, air pollution and obesity a greater mortality risk than major radiation incidents?

    PubMed Central

    Smith, Jim T

    2007-01-01

    Background Following a nuclear incident, the communication and perception of radiation risk becomes a (perhaps the) major public health issue. In response to such incidents it is therefore crucial to communicate radiation health risks in the context of other more common environmental and lifestyle risk factors. This study compares the risk of mortality from past radiation exposures (to people who survived the Hiroshima and Nagasaki atomic bombs and those exposed after the Chernobyl accident) with risks arising from air pollution, obesity and passive and active smoking. Methods A comparative assessment of mortality risks from ionising radiation was carried out by estimating radiation risks for realistic exposure scenarios and assessing those risks in comparison with risks from air pollution, obesity and passive and active smoking. Results The mortality risk to populations exposed to radiation from the Chernobyl accident may be no higher than that for other more common risk factors such as air pollution or passive smoking. Radiation exposures experienced by the most exposed group of survivors of Hiroshima and Nagasaki led to an average loss of life expectancy significantly lower than that caused by severe obesity or active smoking. Conclusion Population-averaged risks from exposures following major radiation incidents are clearly significant, but may be no greater than those from other much more common environmental and lifestyle factors. This comparative analysis, whilst highlighting inevitable uncertainties in risk quantification and comparison, helps place the potential consequences of radiation exposures in the context of other public health risks. PMID:17407581

  5. Estimating Worker Risk Levels Using Accident/Incident Data

    SciTech Connect

    Kenoyer, Judson L.; Stenner, Robert D.; Andrews, William B.; Scherpelz, Robert I.; Aaberg, Rosanne L.

    2000-09-26

    The purpose of the work described in this report was to identify methods that are currently being used in the Department of Energy (DOE) complex to identify and control hazards/risks in the workplace, evaluate them in terms of their effectiveness in reducing risk to the workers, and to develop a preliminary method that could be used to predict the relative risks to workers performing proposed tasks using some of the current methodology. This report describes some of the performance indicators (i.e., safety metrics) that are currently being used to track relative levels of workplace safety in the DOE complex, how these fit into an Integrated Safety Management (ISM) system, some strengths and weaknesses of using a statistically based set of indicators, and methods to evaluate them. Also discussed are methods used to reduce risk to the workers and some of the techniques that appear to be working in the process of establishing a condition of continuous improvement. The results of these methods will be used in future work involved with the determination of modifying factors for a more complex model. The preliminary method to predict the relative risk level to workers during an extended future time period is based on a currently used performance indicator that uses several factors tracked in the CAIRS. The relative risks for workers in a sample (but real) facility on the Hanford site are estimated for a time period of twenty years and are based on workforce predictions. This is the first step in developing a more complex model that will incorporate other modifying factors related to the workers, work environment and status of the ISM system to adjust the preliminary prediction.

  6. Cerebrovascular Diseases in Workers at Mayak PA: The Difference in Radiation Risk between Incidence and Mortality.

    PubMed

    Simonetto, Cristoforo; Schöllnberger, Helmut; Azizova, Tamara V; Grigoryeva, Evgenia S; Pikulina, Maria V; Eidemüller, Markus

    2015-01-01

    A detailed analysis of cerebrovascular diseases (CeVD) for the cohort of workers at Mayak Production Association (PA) is presented. This cohort is especially suitable for the analysis of radiation induced circulatory diseases, due to the detailed medical surveillance and information on several risk factors. The risk after external, typically protracted, gamma exposure is analysed, accounting for potential additional internal alpha exposure. Three different endpoints have been investigated: incidence and mortality from all cerebrovascular diseases and incidence of stroke. Particular emphasis was given to the form of the dose-response relationship and the time dependence of the radiation induced risk. Young attained age was observed to be an important, aggravating modifier of radiation risk for incidence of CeVD and stroke. For incidence of CeVD, our analysis supports a dose response sub-linear for low doses. Finally, the excess relative risk per dose was confirmed to be significantly higher for incidence of CeVD compared to CeVD mortality and incidence of stroke. Arguments are presented for this difference to be based on a true biological effect. PMID:25933038

  7. Cerebrovascular Diseases in Workers at Mayak PA: The Difference in Radiation Risk between Incidence and Mortality

    PubMed Central

    Simonetto, Cristoforo; Schöllnberger, Helmut; Azizova, Tamara V.; Grigoryeva, Evgenia S.; Pikulina, Maria V.; Eidemüller, Markus

    2015-01-01

    A detailed analysis of cerebrovascular diseases (CeVD) for the cohort of workers at Mayak Production Association (PA) is presented. This cohort is especially suitable for the analysis of radiation induced circulatory diseases, due to the detailed medical surveillance and information on several risk factors. The risk after external, typically protracted, gamma exposure is analysed, accounting for potential additional internal alpha exposure. Three different endpoints have been investigated: incidence and mortality from all cerebrovascular diseases and incidence of stroke. Particular emphasis was given to the form of the dose-response relationship and the time dependence of the radiation induced risk. Young attained age was observed to be an important, aggravating modifier of radiation risk for incidence of CeVD and stroke. For incidence of CeVD, our analysis supports a dose response sub-linear for low doses. Finally, the excess relative risk per dose was confirmed to be significantly higher for incidence of CeVD compared to CeVD mortality and incidence of stroke. Arguments are presented for this difference to be based on a true biological effect. PMID:25933038

  8. Falls in Korean Polio Survivors: Incidence, Consequences, and Risk Factors

    PubMed Central

    Lee, SeungYeol; Yang, Eun Joo; Kim, Keewon; Jung, Se Hee; Jang, Soong-Nang; Han, Soo Jeong; Kim, Wan-Ho

    2016-01-01

    Falls and fall-related injuries are important issue among polio survivors. The purpose of this study was to determine the incidence of, and consequences and factors associated with falls among Korean polio survivors. A total of 317 polio survivors participated in this study. All participants completed a questionnaire including fall history, symptoms related to post-polio syndrome and other information through a telephone interview. Among them, 80 participants visited our clinic for additional physical measurements and tests. Of the 317 respondents, 68.5% reported at least one fall in the past year. Of the fallers, 42.5% experienced at least one fall during one month. Most falls occurred during ambulation (76.6%), outside (75.2%) and by slipping down (29.7%). Of fallers, 45% reported any injuries caused by falls, and 23.3% reported fractures specifically. Female sex, old age, low bone mineral density, the presence of symptoms related to post-polio syndrome (PPS), poor balance confidence, short physical performance battery and weak muscle strength of knee extensor were not significantly associated with falls. Only leg-length discrepancy using spine-malleolar distance (SMD) was a significant factor associated with falls among Korean polio survivors. Our findings suggest that malalignment between the paralytic and non-paralytic limb length should be addressed in polio survivors for preventing falls. PMID:26839487

  9. Falls in Korean Polio Survivors: Incidence, Consequences, and Risk Factors.

    PubMed

    Nam, Ki Yeun; Lee, SeungYeol; Yang, Eun Joo; Kim, Keewon; Jung, Se Hee; Jang, Soong-Nang; Han, Soo Jeong; Kim, Wan-Ho; Lim, Jae-Young

    2016-02-01

    Falls and fall-related injuries are important issue among polio survivors. The purpose of this study was to determine the incidence of, and consequences and factors associated with falls among Korean polio survivors. A total of 317 polio survivors participated in this study. All participants completed a questionnaire including fall history, symptoms related to post-polio syndrome and other information through a telephone interview. Among them, 80 participants visited our clinic for additional physical measurements and tests. Of the 317 respondents, 68.5% reported at least one fall in the past year. Of the fallers, 42.5% experienced at least one fall during one month. Most falls occurred during ambulation (76.6%), outside (75.2%) and by slipping down (29.7%). Of fallers, 45% reported any injuries caused by falls, and 23.3% reported fractures specifically. Female sex, old age, low bone mineral density, the presence of symptoms related to post-polio syndrome (PPS), poor balance confidence, short physical performance battery and weak muscle strength of knee extensor were not significantly associated with falls. Only leg-length discrepancy using spine-malleolar distance (SMD) was a significant factor associated with falls among Korean polio survivors. Our findings suggest that malalignment between the paralytic and non-paralytic limb length should be addressed in polio survivors for preventing falls. PMID:26839487

  10. Risk factors differ between recurrent and incident preeclampsia: a hospital-based cohort study

    PubMed Central

    Boghossian, Nansi S.; Yeung, Edwina; Mendola, Pauline; Hinkle, Stefanie N.; Laughon, S. Katherine; Zhang, Cuilin; Albert, Paul S.

    2014-01-01

    Purpose Examine whether risk factors, including prepregnancy body mass index (BMI), differ between recurrent and incident preeclampsia. Methods Data included electronic medical records of nulliparas (n=26,613) delivering ≥2 times in Utah (2002–2010). Modified Poisson regression models were used to examine: 1) adjusted relative risks (RR) of preeclampsia and 95% confidence intervals (CI) associated with prepregnancy BMI; 2) maternal risk factor differences between incident and recurrent preeclampsia among primiparous women. Results In the 1st pregnancy, compared to normal weight women [BMI:18.5–24.9], preeclampsia risks for overweight [BMI:25–29.9], obese class I [BMI:30–34.9], and obese class II/III [BMI: ≥35] women were 1.82 (95% CI=1.60–2.06), 2.10 (95% CI=1.76–2.50), and 2.84 (95% CI=2.32–3.47), respectively while 2nd pregnancy incident preeclampsia risks were 1.66 (95% CI=1.27–2.16), 2.31 (95% CI=1.67–3.20), and 4.29 (95% CI=3.16–5.82), respectively. Recurrent preeclampsia risks associated with BMI were highest among obese class I women (RR=1.60; 95% CI=1.06–2.42) without increasing in a dose-response manner. Non-white women had higher recurrence risk than white women (RR=1.70; 95% CI=1.16–2.50) while 2nd pregnancy incident preeclampsia risk did not differ by race. Conclusion Prepregnancy BMI appeared to have stronger associations with risk of incident preeclampsia either in the 1st or 2nd pregnancy, than with recurrence risk. Non-white women had higher recurrence risk. PMID:25453345

  11. Ventilator-Associated Pneumonia: Incidence, Risk Factors and Outcome in Paediatric Intensive Care Units at Cairo University Hospital

    PubMed Central

    Galal, Yasmine S.; Ibrahiem, Sally K.

    2016-01-01

    Introduction Ventilator-Associated Pneumonia (VAP) is a major cause of hospital morbidity, mortality and increased health care costs. Although the epidemiology, pathogenesis and outcome of VAP are well described in adults; few data exist regarding VAP in paediatric patients, especially in developing countries. Aim To determine the incidence, risk factors and outcome of VAP in two Paediatric Intensive Care Units (PICUs) at Cairo University Hospital. Materials and Methods A total of 427 patients who received Mechanical Ventilation (MV) were included in this prospective study during the period from September 2014 till September 2015. Patients were observed daily till VAP occurrence, discharge from the unit or death, whichever came first. Demographic, clinical characteristics, laboratory results, radiographic and microbiological reports were recorded for all patients. Results Nearly 31% patients developed VAP among the entire cohort. The incidence density was 21.3 per 1000 ventilator days. The most frequently isolated organisms from VAP patients were Pseudomonas aeruginosa (47.7%), Acinetobacter (18.2%) and Methicillin-resistant Staphylococcus aureus (MRSA) (14.4%). VAP patients were significantly younger than non-VAP ones. The incidence of VAP in comatose patients and those with MOSF was significantly higher. Prior antibiotic use for > 48 h before MV, supine body positioning and reintubation were significantly associated with VAP. On multiple logistic regression analysis, MOSF; prior antibiotic use > 48h; reintubation; coma; and age remained independent predictors of VAP. Mortality rate among the VAP group was significantly higher compared to the non-VAP one (68.2% vs. 48.5%, p<0.001). Survival curve analysis showed a shorter median survival time in VAP patients. Conclusion Identification of risk factors and outcome of VAP in PICUs may help in reducing the incidence and improving patients’ outcomes. The incidence of VAP in this study was relatively high. The most

  12. Interactions Between Race/Ethnicity and Anthropometry in Risk of Incident Diabetes

    PubMed Central

    Lutsey, Pamela L.; Pereira, Mark A.; Bertoni, Alain G.; Kandula, Namratha R.; Jacobs, David R.

    2010-01-01

    This study examined how adiposity influences racial/ethnic differences in diabetes incidence by exploring whether relations between anthropometric measures and incident diabetes vary by race/ethnicity. Data from the Multi-Ethnic Study of Atherosclerosis initiated in 2000 (n = 5,446 US men and women aged 45–84 years) were analyzed by using proportional hazards and Poisson regression. The diabetes incidence rate was 2/100 person-years (n = 479 cases). Interactions were present between race and anthropometry (P-interaction(race × body mass index) = 0.002). The slope of incident diabetes per anthropometric unit was greatest for Chinese, less for whites and Hispanics, and still less for blacks. For small waist, risk of incident diabetes was <1/100 person-years for all racial/ethnic groups. At intermediate waist levels, Chinese had the highest and whites the lowest rates of incident diabetes. At the respective 95th percentiles of waist circumference, risk of incident diabetes per 100 person-years was 3.9 for Chinese (104 cm), 3.5 for whites (121 cm), 5.0 for blacks (125 cm), and 5.3 for Hispanics (121 cm). Adiposity influenced relative diabetes occurrence across racial/ethnic groups, in that Chinese had a steeper diabetes risk per unit of adiposity. However, the generally low level of adiposity in Chinese led to a relatively low diabetes occurrence. PMID:20570825

  13. Incidence, risk factors, and morphology in operating microscope light retinopathy

    SciTech Connect

    Khwarg, S.G.; Linstone, F.A.; Daniels, S.A.; Isenberg, S.J.; Hanscom, T.A.; Geoghegan, M.; Straatsma, B.R.

    1987-03-15

    A review of 135 consecutive cataract operations identified ten cases (7.4%) of operating microscope light retinopathy. Ophthalmoscopically, these light retinopathy lesions appeared as a focal pigment epithelial change with varying degrees of pigment clumping in the center. Fluorescein angiography accentuated the lesion by demonstrating a sharply demarcated transmission defect, occasionally with multiple satellite lesions. The shape of the lesion matched the shape of the illuminating source of the particular operating microscope used during the surgery. The most significant risk factor associated with the production of these light retinopathy lesions was prolonged operating time. Mean total operating time for the ten patients with light retinopathy was 51 minutes longer than for those without (P less than .0001). Other significant associated factors were the presence of diabetes mellitus (P less than .03), younger age (P less than .05), and the use of hydrochlorothiazide (P less than .04).

  14. Testosterone and prostate cancer: an evidence-based review of pathogenesis and oncologic risk

    PubMed Central

    Michaud, Jason E.; Billups, Kevin L.; Partin, Alan W.

    2015-01-01

    Testosterone plays a central role in male development and health. Likewise, androgen deficiency, or hypogonadism, is associated with a variety of symptoms including decreased energy, diminished libido and erectile dysfunction, among others. Male androgen levels steadily decline with age, and, in a subset of symptomatic older men, can result in late-onset hypogonadism (LOH). Over the last decade, increased awareness of hypogonadism among patients and providers has led to a significant rise in the use of testosterone replacement therapy (TRT) for hypogonadism, and especially in LOH. Accompanying the rise in TRT are concerns of potential adverse effects, including cardiovascular risks and the promotion of prostate cancer. The ‘androgen hypothesis’ asserts that prostate cancer development and progression is driven by androgens, and thus TRT has the theoretical potential to drive prostate cancer development and progression. In this review, we examine existing data surrounding testosterone and prostate cancer. There is significant evidence that androgens promote prostate cancer in experimental systems. However, there is no clear evidence that elevations in endogenous testosterone levels promote the development of prostate cancer in humans. As a result of experimental and historical data on the progression of prostate cancer following TRT, there has been widespread belief that TRT will promote disease progression in prostate cancer patients. Despite these fears, there are a growing number of studies demonstrating no increase in prostate cancer incidence among men on TRT. Furthermore, in studies involving a small number of patients, there has been no discernable increase in disease progression in prostate cancer patients on TRT. While data from large, prospective, randomized, controlled trials are absent, TRT in select prostate cancer patients is likely safe. In the end, the use of TRT in prostate cancer patients is still considered experimental and should only be

  15. Incidence of primary hepatitis C infection and risk factors for transmission in an Australian prisoner cohort

    PubMed Central

    2010-01-01

    Background Hepatitis C virus (HCV) infection is common in prisoner populations, particularly those with a history of injecting drug use (IDU). Previous studies of HCV incidence have been based on small case numbers and have not distinguished risk events in prison from those in the community. Methods HCV incidence was examined in a longitudinal cohort of 488 Australian prisoners with a history of IDU and documented to be seronegative within 12 months prior to enrolment. Inmates were tested for anti-HCV antibodies and viremia, and interviewed about demographic and behavioral risk factors for transmission. Results The cohort was predominantly male (65%) with high rates of prior imprisonment (72%) and tattooing (73%), as well as longstanding IDU (mean 8.5 years). Ninety-four incident HCV cases were identified (incidence 31.6 per 100 person years). Independent associations were observed between incident infection and prior imprisonment (p = 0.02) and tattooing (p = 0.03), and surprisingly also with methadone maintenance treatment (MMT) (p < 0.001). Conclusions High rates of new HCV infection were found in this prisoner cohort reflecting their substantive risk behavior profile, despite having remained uninfected for many years. The association with MMT is challenging and highlights the need for better understanding of prison-specific HCV transmission risks, as well as the uptake and effectiveness of prevention programs. PMID:20964864

  16. Invasive candidiasis in liver transplant patients: Incidence and risk factors in a pediatric cohort.

    PubMed

    De Luca, M; Green, M; Symmonds, J; Klieger, S B; Soltys, K; Fisher, B T

    2016-03-01

    Prolonged OR, re-transplantation, and high-volume intraoperative transfusion have been associated with increased risk for IC in adult LT recipients. Antifungal prophylaxis is recommended for adult patients with these risk factors. There are limited data on the incidence of and risk factors for IC in pediatric LT recipients. A retrospective cohort study of all pediatric LT patients at the CHOP between 2000 and 2012 and the CHP between 2004 and 2012 was performed to define the incidence of IC within 30 days of LT. A 3:1 matched case-control study with incidence density sampling was performed. Conditional logistic regression analyses were used to explore risk factors associated with IC. Among 397 recipients, the incidence of IC was 2.5%. Bivariate analyses showed that ICU admission prior to transplant, OR > 10 h, intraoperative volume infusion of >300 mL/kg, and broad-spectrum antibiotics were significantly associated with IC. In a multivariate model, only ICU admission remained significantly associated with IC. Antifungal prophylaxis was not significantly protective against IC. The low incidence of IC and lack of an identified protective effect from antifungal prophylaxis suggest that prophylaxis in pediatric LT recipients should not be routinely recommended to prevent IC events in the first 30 days post-transplant. PMID:26748472

  17. Metabolic Syndrome and Risk of Cervical Human Papillomavirus Incident and Persistent Infection.

    PubMed

    Huang, Xin; Zhao, Qun; Yang, Pingting; Li, Ying; Yuan, Hong; Wu, Liuxin; Chen, Zhiheng

    2016-03-01

    Few studies have been conducted on the relationship between metabolic syndrome (MetS) and cervical human papillomavirus (HPV) incidence and persistent infection. We performed a prospective cohort study including 8598 female employees in Hunan, China. First, the subjects were stratified into HPV-negative (N = 7282) and HPV-positive (N = 1316) subgroups, according to the results of an HPV DNA test at baseline. Second, comparisons of the risks of HPV incident and persistent infection between MetS-positive (exposed) and MetS-negative (unexposed) groups were conducted among the HPV-negative and -positive subgroups, respectively. There were 976 (11.39%) subjects diagnosed with MetS and 1316 subjects diagnosed with HPV infection at baseline. The 12-month cumulative incidence of any type of HPV and high-risk type HPV were 7.28% (530/7282) and 6.26% (456/7282), respectively. Obesity was a modifier of the association between MetS and HPV incident infection. As long as obesity presented, MetS and hypertriglyceridemia were significantly associated with an increased risk of HPV incident infection (any-type or high-risk type) (adjusted risk ratios (RR) were 2.88 (95% confidence interval (CI): 1.16, 7.19) and 3.29 (95% CI: 1.47, 7.38), respectively). Among those infected with HPV at baseline, the 12-month type-specific persistence rates were 51.67% and 53.38% for any-type and high-risk type HPV, respectively. No interaction was found between obesity and MetS with regard to the risk of HPV persistence. After adjustment for confounding factors, MetS was still associated with increased risk of any-type HPV persistence (RRadj = 1.21, 95% CI: 1.05, 1.41) and high-risk type HPV persistence (RRadj = 1.25, 95% CI: 1.09, 1.46). No single metabolic component was associated with the risk of HPV persistence. The prevalence of MetS was 11.39% among the Hunan female occupational population. MetS was associated with an increased risk of persistent cervical HPV infection and also

  18. Metabolic Syndrome and Risk of Cervical Human Papillomavirus Incident and Persistent Infection

    PubMed Central

    Huang, Xin; Zhao, Qun; Yang, Pingting; Li, Ying; Yuan, Hong; Wu, Liuxin; Chen, Zhiheng

    2016-01-01

    Abstract Few studies have been conducted on the relationship between metabolic syndrome (MetS) and cervical human papillomavirus (HPV) incidence and persistent infection. We performed a prospective cohort study including 8598 female employees in Hunan, China. First, the subjects were stratified into HPV-negative (N = 7282) and HPV-positive (N = 1316) subgroups, according to the results of an HPV DNA test at baseline. Second, comparisons of the risks of HPV incident and persistent infection between MetS-positive (exposed) and MetS-negative (unexposed) groups were conducted among the HPV-negative and -positive subgroups, respectively. There were 976 (11.39%) subjects diagnosed with MetS and 1316 subjects diagnosed with HPV infection at baseline. The 12-month cumulative incidence of any type of HPV and high-risk type HPV were 7.28% (530/7282) and 6.26% (456/7282), respectively. Obesity was a modifier of the association between MetS and HPV incident infection. As long as obesity presented, MetS and hypertriglyceridemia were significantly associated with an increased risk of HPV incident infection (any-type or high-risk type) (adjusted risk ratios (RR) were 2.88 (95% confidence interval (CI): 1.16, 7.19) and 3.29 (95% CI: 1.47, 7.38), respectively). Among those infected with HPV at baseline, the 12-month type-specific persistence rates were 51.67% and 53.38% for any-type and high-risk type HPV, respectively. No interaction was found between obesity and MetS with regard to the risk of HPV persistence. After adjustment for confounding factors, MetS was still associated with increased risk of any-type HPV persistence (RRadj = 1.21, 95% CI: 1.05, 1.41) and high-risk type HPV persistence (RRadj = 1.25, 95% CI: 1.09, 1.46). No single metabolic component was associated with the risk of HPV persistence. The prevalence of MetS was 11.39% among the Hunan female occupational population. MetS was associated with an increased risk of persistent cervical HPV infection

  19. [The critical incident reporting system as an instrument of risk management for better patient safety].

    PubMed

    Panzica, M; Krettek, C; Cartes, M

    2011-09-01

    The probability that an inpatient will be harmed by a medical procedure is at least 3% of all patients. As a consequence, hospital risk management has become a central management task in the health care sector. The critical incident reporting system (CIRS) as a voluntary instrument for reporting (near) incidents plays a key role in the implementation of a risk management system. The goal of the CIRS is to register system errors without assigning guilt or meting out punishment and at the same time increasing the number of voluntary reports. PMID:21877221

  20. Ventricular Conduction Defects and the Risk of Incident Heart Failure in the Atherosclerosis Risk in Communities (ARIC) Study

    PubMed Central

    Zhang, Zhu-ming; Rautaharju, Pentti M.; Prineas, Ronald J.; Loehr, Laura; Rosamond, Wayne; Soliman, Elsayed Z.

    2016-01-01

    Background We evaluated the risk of incident heart failure (HF) associated with various categories of ventricular conduction defects (VCD) and examined the impact of QRS duration on the risk of HF. Methods and Results This analysis included 14,478 participants from the Atherosclerosis Risk in Communities (ARIC) study who were free of HF at baseline. VCDs (n=377) were categorized into right and left bundle branch blocks (RBBB and LBBB, respectively), bifascicular BBB (RBBB with fascicular block), indetermined type VCD (IVCD), and pooled-VCD group excluding lone RBBB. During an average of 18 years follow-up, 1,772 participants were hospitalized for incident HF. Compared to No-VCD, LBBB and pooled-VCD were strongly associated with increased risk of incident HF (multivariable hazard ratio 2.87 and 2.29, respectively). Compared to No-VCD with QRS duration <100 ms, HF risk was 1.17-fold for the No-VCD group with QRS duration 100–119 ms, 1.97-fold for pooled-VCD group with QRS duration 120–139 ms and 3.25-fold with QRS duration ≥140 ms. HF risk for pooled VCD group remained significant (1.74-fold for QRS duration 120–139 ms and 2.81-fold for QRS duration 140 ms or longer) in the subgroup free from cardiovascular disease at baseline. Lone RBBB was not associated with incident HF. Conclusions VCDs except for isolated RBBB are strong predictors of incident HF, and HF risk is further increased as the QRS duration is prolonged above 140 ms. PMID:25582389

  1. Population-Based Prospective Study of Cigarette Smoking and Risk of Incident Essential Tremor

    PubMed Central

    Louis, Elan D.; Benito-León, Julián; Bermejo-Pareja, Félix

    2009-01-01

    BACKGROUND Smoking cigarettes is associated with lower risk of Parkinson’s disease (PD). Despite the clinical links between PD and essential tremor (ET), there are few data on smoking in ET. One study showed an association between smoking and lower ET prevalence. We now study whether baseline smoking is associated with lower risk of incident ET. METHODS Using a population-based, cohort design, baseline cigarette smoking habits were assessed in 3,348 participants in an epidemiological study in Spain, among whom 77 developed incident ET. RESULTS There were 3,348 participants, among whom 397 (11.9%) were smokers at baseline. Five (6.5%) of 77 incident ET cases had been smokers at baseline compared with 392 (12.0%) of 3,271 controls (p = 0.14). Baseline pack-years were lower in incident ET cases than controls (9.2 ± 17.7 vs. 15.7 ± 28.4, p = 0.002). Participants were stratified into baseline pack-year tertiles and few incident ET cases were in the highest tertile (4 [5.2%] cases vs. 431 [13.2%] controls, p = 0.039). In Cox Proportional Hazards Models, highest baseline pack-year tertile was associated with lower risk of incident ET; those in the highest pack-year tertile were one-third as likely to develop ET when compared to non-smokers (RR = 0.37, 95% CI = 0.14–1.03, p = 0.057 [unadjusted model] and RR = 0.29, 95% CI = 0.09–0.90, p = 0.03 [adjusted model]). CONCLUSIONS We demonstrated an association between baseline heavy cigarette smoking and lower risk of incident ET. The biological basis for this association requires future investigation. PMID:18458228

  2. Population-Based Study of Baseline Ethanol Consumption and Risk of Incident Essential Tremor

    PubMed Central

    Louis, Elan D.; Benito-León, Julián; Bermejo-Pareja, Félix

    2009-01-01

    Background Recent postmortem studies have demonstrated pathological changes, including Purkinje cell loss, in the cerebellum in essential tremor (ET). Toxic exposures that compromise cerebellar tissue could lower the threshold for developing ET. Ethanol is a well-established cerebellar toxin, resulting in Purkinje cell loss. Objective To test whether higher baseline ethanol consumption is a risk factor for the subsequent development of incident ET. Methods Lifetime ethanol consumption was assessed at baseline (1994-1995) in a prospective, population-based study in central Spain of 3,285 elderly participants, 76 of whom developed incident ET by follow-up (1997-1998). Results In a Cox proportional hazards model adjusting for cigarette pack-years, depressive symptoms and community, the baseline number of drink-years was marginally associated with higher risk of incident ET (relative risk, RR = 1.003, p = 0.059). In an adjusted Cox model, highest baseline drink-year quartile doubled the risk of incident ET (RR = 2.29, p = 0.018) while other quartiles were associated with more modest elevations in risk (RR3rd quartile = 1.82 [p = 0.10], RR2nd quartile = 1.75 [p = 0.10], RR1st quartile = 1.43 [p = 0.34] vs. non-drinkers [RR = 1.00]). With each higher drink-year quartile, risk of incident ET increased an average of 23% (p = 0.01, test for trend). Conclusions Higher levels of chronic ethanol consumption increased the risk of developing ET. Ethanol is often used for symptomatic relief; studies should explore whether higher consumption levels are a continued source of underlying cerebellar neurotoxicity in patients who already manifest this disease. PMID:19359288

  3. [Crohn's disease and cancer risk. Incidence/prevalence, clinical characteristics, and potential prevention strategies].

    PubMed

    Allgayer, Hubert; Holtmeier, Wolfgang; Dietrich, Christoph F

    2007-09-15

    Epidemiologic data concerning the risk for colorectal cancer in ulcerative colitis are based on a variety of large and well-conducted cohort studies. Guidelines for tumor prevention have been published by the German Gastroenterology Society (DGVS) in 2004. By contrast, the risk constellations in Crohn's disease are less clear and guidelines are lacking. Based on a recent literature search (PubMed March 2007), the published data predominantly expressed as relative risk and/or standardized incidence/mortality ratio are critically reviewed with recommendations for tumor prevention strategies based on individual risk constellations. PMID:17879011

  4. Sickle Cell Trait and Incident Ischemic Stroke in the Atherosclerosis Risk in Communities (ARIC) Study

    PubMed Central

    Caughey, Melissa C.; Loehr, Laura R.; Key, Nigel S.; Derebail, Vimal K.; Gottesman, Rebecca F.; Kshirsagar, Abhijit V.; Grove, Megan L.; Heiss, Gerardo

    2014-01-01

    Background and Purpose Numerous case reports describe stroke in individuals with sickle cell trait (SCT) in the absence of traditional risk factors for cerebrovascular disease. To date, no prospective epidemiological studies have investigated this association. Methods A population-based sample of African Americans (N=3,497, mean age=54, female=62%) was followed from 1987–2011 in the Atherosclerosis Risk in Communities Study (ARIC), contributing a total of 65,371 person-years. Hazard ratios and incidence rate differences for ischemic stroke were estimated, contrasting SCT to homozygous hemoglobin A (HbAA). Models were adjusted for age, sex, smoking, diabetes, hypertension, total cholesterol, atrial fibrillation, and coronary heart disease. Results SCT was identified in 223 (6.4%) participants. Over a median follow up of 22 years, 401 subjects experienced incident stroke (89% ischemic). Incident ischemic stroke was more frequent among those with SCT (13%) than HbAA (10%). SCT was associated with an ischemic stroke hazard ratio of 1.4 (1.0 – 2.0), and an incidence rate difference amounting to 1.9 (0.4 – 3.8) extra strokes per 1000 person-years. Conclusion We observed an increased risk of ischemic stroke in African Americans with SCT. Further investigation of the incidence and pathophysiology of stroke in SCT patients is warranted. PMID:25139879

  5. Risk assessment for loader- and dozer-related fatal incidents in U.S. mining.

    PubMed

    Md-Nor, Zainalabidin; Kecojevic, Vladislav; Komljenovic, Dragan; Groves, William

    2008-06-01

    The paper presents the results of research aimed at developing a risk assessment process that can be used to more thoroughly characterise risks associated with loader- and dozer-related fatal incidents in US mining. The assessment is based on historical data obtained from the US Mine Safety and Health Administration investigation reports, which includes 77 fatal incidents that occurred from 1995 to 2006. The Preliminary Hazard Assessment method is used in identifying and quantifying risks. Risk levels are then developed using a pre-established risk matrix that ranks them according to probability and severity. The resulting assigned risk value can then be used to prioritise risk control strategies. A total of 10 hazards were identified for loaders. The hazards 'failure to follow adequate maintenance procedure' and 'failure of mechanical/electrical/hydraulic components' were the most severe and frequent hazards and they fell into the category of 'high' risk. The same number of hazards was identified for dozers. The hazard 'failure to identify adverse site/geological conditions' was the most severe and frequent hazard and it fell into the category of 'high' risk. PMID:18642163

  6. Epidemiology of Pediatric Closed Head Injury: Incidence, Clinical Characteristics, and Risk Factors.

    ERIC Educational Resources Information Center

    Goldstein, Felicia C.; Levin, Harvey S.

    1987-01-01

    The paper reviews the epidemiology of pediatric closed head injury. Incidence rates, etiologic/pathophysiologic correlates, and associated risk factors are discussed. Suggestions offered for future research concern relationships among age, etiology, and pathophysiology in outcome studies and premorbid measures of personality/intellectual…

  7. Incidence and risk predictors for osteonecrosis of the jaw in cancer patients treated with intravenous bisphosphonates

    PubMed Central

    2015-01-01

    Introduction The aim of this study was to establish the incidence of bisphosphonate-related osteonecrosis of the jaws (BRONJ) in oncologic patients and to determine risk predictors with respect to this condition. Material and methods This retrospective review included 197 oncologic patients treated from January 2005 to December 2010 with administration of bisphosphonates (BPs) as part of management. Sex, age, type of cancer diagnosed, period of substantial disease, oral surgery, type of bisphosphonate, number of doses, and cases of BRONJ diagnosis were recorded. The cumulative incidence and incidence rate of BRONJ were calculated. The factors that influenced BRONJ were assessed with multivariate logistic regression and with estimations of 95% confidence intervals and odd ratios. Values of p ≤ 0.05 were considered significant. Results The BRONJ appeared in 9.64% of patients. The BRONJ incidence rate was 1 in 28 patients per year of BP treatment. Logistic regression showed that the odds of osteonecrosis increased 1.0172-fold with each given dose of BP. The BRONJ risk with zoledronate was 5-fold higher than that with pamidronate or ibandronate. The risk of BRONJ increased by 40-fold after dental surgery. Conclusions Period of BP administration and type of BP used are important risk predictors for the development of BRONJ in oncologic patients treated with intravenous administration of these drugs. Patient-related factors are dental or periodontal events connected with need for oral surgery. PMID:25995747

  8. Sinusoidal obstruction syndrome after allogeneic hematopoietic stem cell transplantation: Incidence, risk factors and outcomes.

    PubMed

    Yakushijin, K; Atsuta, Y; Doki, N; Yokota, A; Kanamori, H; Miyamoto, T; Ohwada, C; Miyamura, K; Nawa, Y; Kurokawa, M; Mizuno, I; Mori, T; Onizuka, M; Taguchi, J; Ichinohe, T; Yabe, H; Morishima, Y; Kato, K; Suzuki, R; Fukuda, T

    2016-03-01

    This retrospective study was conducted in Japan to determine the incidence, risk factors and outcomes of sinusoidal obstruction syndrome (SOS) after allogeneic hematopoietic stem cell transplantation (HSCT). Among 4290 patients undergoing allogeneic HSCT between 1999 and 2010, 462 were diagnosed with SOS according to the Seattle criteria (cumulative incidence, 10.8%). The cumulative incidence of SOS diagnosed by the modified Seattle criteria was 9.3%. Of 462 patients, 107 met the Baltimore criteria and 168 had severe SOS with renal and/or respiratory failure. The median onset for SOS was 12 days after HSCT (range, -2-30). Overall survival at day 100 was 32% for SOS and 15% for severe SOS. Multivariate analyses showed that significant independent risk factors for SOS were the number of HSCTs, age, performance status, hepatitis C virus-seropositivity, advanced disease status and myeloablative regimen. SOS was highly associated with overall mortality (hazard ratio, 2.09; P<0.001). Our retrospective survey showed that the cumulative incidence of SOS in Japan was 10.8%, similar to that previously reported in Western countries, and that the overall survival of patients who developed SOS was low. Furthermore, several risk factors were identified. Preventive and therapeutic strategies for high-risk SOS patients must be established to improve overall survival. PMID:26595082

  9. Primate-specific miR-603 is implicated in the risk and pathogenesis of Alzheimer's disease

    PubMed Central

    Liu, Bing; Cui, Qinghua; Wang, Yun

    2016-01-01

    Alzheimer's disease (AD) is a serious neurodegenerative disease, and microRNAs (miRNAs) have been linked to its pathogenesis. miR-603, a novel primate-specific miRNA and an intronic miRNA of a human brain highly expressed gene KIAA1217, is implicated in the risk and pathogenesis of AD. The rs11014002 single nucleotide polymorphism (SNP) (C/U), which locates in miR-603 precursor (pre-miR-603), exhibits a protective effect towards AD risk. Additionally, the rs11014002 SNP promotes the biogenesis of mature miR-603. miR-603 downregulates LRPAP1 mRNA and protein levels through directly binding the 3′ untranslated region (3′UTR) of LRPAP1. Moreover, miR-603 increases LRP1 protein expression. LRPAP1 and LRP1, playing opposite roles, are involved in Aβ clearance and pathogenesis of AD. Strikingly, miR-603 exhibits a relatively higher expression and there is a loss of a negative correlation between miR-603 and LRPAP1/RND1 mRNA levels in the hippocampi of patients with AD. In addition, miR-603 directly downregulates a key neuronal apoptotic component-E2F1, and prevents HeLa cells from undergoing H2O2-induced apoptosis. This work suggests that miR-603 may be a novel AD-relevant miRNA and that its rs11014002 SNP may serve as a protective factor against AD. PMID:26856603

  10. High systemic bone mineral density increases the risk of incident knee OA and joint space narrowing, but not radiographic progression of existing knee OA: The MOST study

    PubMed Central

    Nevitt, Michael C.; Zhang, Yuqing; Javaid, M. Kassim; Neogi, Tuhina; Curtis, Jeffrey R.; Niu, Jingbo; McCulloch, Charles E.; Segal, Neil A.; Felson, David T.

    2010-01-01

    Objectives Previous studies suggest that high systemic bone mineral density (BMD) is associated with incident knee OA defined by osteophytes, but not with joint space narrowing (JSN), and are inconsistent regarding BMD and progression of existing OA. We tested the association of BMD with incident and progressive tibiofemoral OA in a large, prospective study of men and women ages 50–79 with, or at risk for, knee OA. Methods Baseline and 30-month weight-bearing PA and lateral knee x-rays were scored for K–L grade, JSN and osteophytes. Incident OA was defined as the development of K–L grade ≥2 at follow-up. All knees were classified for increases in grade of JSN and osteophytes from baseline. The association of gender-specific quartiles of baseline BMD with risk of incident and progressive OA was analyzed using logistic regression, adjusting for covariates. Results The mean age of 1,754 subjects was 63.2 (SD, 7.8) and BMI 29.9 (SD, 5.4). In knees without baseline OA, higher femoral neck and whole body BMD were associated with an increased risk of incident OA and increases in grade of JSN and osteophytes (p < 0.01 for trends); adjusted odds were 2.3 to 2.9-fold greater in the highest vs. the lowest BMD quartiles. In knees with existing OA, progression was not significantly related to BMD. Conclusions In knees without OA, higher systemic BMD was associated with a greater risk of the onset of JSN and K–L grade ≥2. The role of systemic BMD in early knee OA pathogenesis warrants further investigation. PMID:19147619

  11. Neuropsychiatric symptoms, APOE ε4, and the risk of incident dementia

    PubMed Central

    Pink, Anna; Stokin, Gorazd B.; Bartley, Mairead M.; Roberts, Rosebud O.; Sochor, Ondrej; Machulda, Mary M.; Krell-Roesch, Janina; Knopman, David S.; Acosta, Jazmin I.; Christianson, Teresa J.; Pankratz, V. Shane; Mielke, Michelle M.; Petersen, Ronald C.

    2015-01-01

    Objective: To investigate the population-based interaction between a biological variable (APOE ε4), neuropsychiatric symptoms, and the risk of incident dementia among subjects with prevalent mild cognitive impairment (MCI). Methods: We prospectively followed 332 participants with prevalent MCI (aged 70 years and older) enrolled in the Mayo Clinic Study of Aging for a median of 3 years. The diagnoses of MCI and dementia were made by an expert consensus panel based on published criteria, after reviewing neurologic, cognitive, and other pertinent data. Neuropsychiatric symptoms were determined at baseline using the Neuropsychiatric Inventory Questionnaire. We used Cox proportional hazards models, with age as a time scale, to calculate hazard ratios (HRs) and 95% confidence intervals (CIs). Models were adjusted for sex, education, and medical comorbidity. Results: Baseline agitation, nighttime behaviors, depression, and apathy significantly increased the risk of incident dementia. We observed additive interactions between APOE ε4 and depression (joint effect HR = 2.21; 95% CI = 1.24–3.91; test for additive interaction, p < 0.001); and between APOE ε4 and apathy (joint effect HR = 1.93; 95% CI = 0.93–3.98; test for additive interaction, p = 0.031). Anxiety, irritability, and appetite/eating were not associated with increased risk of incident dementia. Conclusions: Among prevalent MCI cases, baseline agitation, nighttime behaviors, depression, and apathy elevated the risk of incident dementia. There was a synergistic interaction between depression or apathy and APOE ε4 in further elevating the risk of incident dementia. PMID:25653291

  12. Marriage and the Risk of Incident HIV infection in Rakai, Uganda

    PubMed Central

    Nalugoda, Fred; Guwatudde, David; Bwaninka, John B; Makumbi, Fredrick E; Lutalo, Tom; Kagaayi, Joseph; Sewankambo, Nelson K; Kigozi, Godfrey; Serwadda, David M; Kong, Xiangrong; Wawer, Maria J; Wabwire-Mangen, Fred; Gray, Ronald H

    2013-01-01

    Objective Studies suggest that the prevalence of HIV is higher among long term marital/consensual relationships than in the unmarried. We assessed the risk of incident HIV infection by marital status in rural Rakai, Uganda. Design Longitudinal data from the Rakai Community Cohort Study (RCCS) between 1999 - 2011 Methods We estimated HIV incidence per 100 person years (py) in sexually active individuals aged 15-49 with a total of 44,179.6 person years (py) who were never married (females 2,929py, males 4,261py), currently married or in long-term consensual relationships (“currently married females 29,823py, males 21,299py) and previously married (females 3,563py, males 1,475). Poisson multivariable regression was used to estimate the unadjusted and adjusted incident rate ratios (IRRs) and 95% confidence intervals (95% CI) of HIV acquisition. Results HIV incidence among currently married persons was 0.93/100py, which was lower than the never married (1.51/100py) and previously married (2.85/100py). The risk of HIV acquisition was significantly lower in the currently married compared to the never married among women (Adj IRR=0.26, 95% CI: 0.16-0.42), but not men (Adj IRR=0.69, 95% CI: 0.31-1.52). HIV incidence was lower among first marriages (0.73/100py) compared to second or higher order marriages (1.38/100py). Multiple sex partners significantly increased the risk of HIV acquisition in both women (Adj IRR=2.53, 95% CI: 1.6, 3.97) and men (Adj IRR=1.77, 95% CI: 1.20-2.60). Conclusion Current marriage especially first order marriage was associated with reduced risk of HIV acquisition in women, but not in men, and multiple sex partnerships increased HIV risk for both sexes. PMID:24419066

  13. Incidence and familial risk of pleural mesothelioma in Sweden: a national cohort study.

    PubMed

    Ji, Jianguang; Sundquist, Jan; Sundquist, Kristina

    2016-09-01

    Familial clustering of pleural mesothelioma was reported previously, but none of the reports quantified the familial risk of mesothelioma or the association with other cancers. The contributions of shared environmental or genetic factors to the aggregation of mesothelioma were unknown.We used a number of Swedish registers, including the Swedish Multigeneration Register and the Swedish Cancer Register, to examine the familial risk of mesothelioma in offspring. Standardised incidence ratios (SIRs) were used to calculate the risk. Age standardised incidence rates of mesothelioma were calculated from the Swedish Cancer Registry.The incidence of mesothelioma reached its peak rate in 2000 and decreased thereafter. Risk of mesothelioma was significantly increased when parents or siblings were diagnosed with mesothelioma, with SIRs of 3.88 (95% CI 1.01-10.04) and 12.37 (95% CI 5.89-22.84), respectively. Mesothelioma was associated with kidney (SIR 2.13, 95% CI 1.16-3.59) and bladder cancers (SIR 2.09, 95% CI 1.32-3.14) in siblings. No association was found between spouses.Family history of mesothelioma, including both parental and sibling history, is an important risk factor for mesothelioma. Shared genetic factors may contribute to the observed familial clustering of mesothelioma, but the contribution of shared environmental factors could not be neglected. The association with kidney and bladder cancers calls for further study to explore the underlying mechanisms. PMID:27174879

  14. Incidence and Risk Factors of Symptomatic Peripartum Diastasis of Pubic Symphysis

    PubMed Central

    Yoo, Jeong Joon; Lee, Young-Kyun; Hong, Joon Seok; Kang, Bun-Jung; Koo, Kyung-Hoi

    2014-01-01

    This study was undertaken to determine incidence, associated risk factors, and clinical outcomes of a diastasis of pubic symphysis. Among 4,151 women, who delivered 4,554 babies at the Department of Obstetrics of Seoul National University Bundang hospital from January 2004 to December 2006, eleven women were diagnosed as having a symptomatic diastasis of pubic symphysis. We estimated the incidence of the diastasis and identified the associated risk factors. To evaluate the pain relief and reduction of diastasis we followed up the 11 diastatic patients. The incidence of the diastasis was 1/385. Primiparity (P = 0.010) and twin gestation (P = 0.016) appeared as risk factors for diastasis by univairable analysis; and twin gestation appeared to be the only risk factor (P = 0.006) by logistic analysis. Two patients were operated due to intractable pain; and the remaining nine patients were treated conservatively. The diastatic gap decreased to less than 1.5 cm by 2 to 6 weeks after the diagnosis and then remained stationary. At a mean follow-up of 22.1 months (range, 12 to 47 months), five of 11 patients had persistent symphysis pubis dysfunction. Diastasis is more frequent than generally acknowledged. Pregnant women with multiple gestations should be informed about the potential risk of pubic symphysis diastasis. PMID:24550659

  15. Maternal risk behavior and caries incidence in children with sickle cell disease.

    PubMed

    Soares, Felipe Fagundes; Cangussu, Maria Cristina Teixeira; Vianna, Maria Isabel Pereira; Rossi, Thais Regis Aranha; Carvalho, Anderson Santos; Brito, Maria Goretti Silva

    2016-01-01

    The aim of this study was to analyze the incidence of caries, in relation to maternal risk behaviors and clinical conditions representing different levels of sickle cell disease severity. A total of 295 children aged 6 to 60 months participated in this cohort conducted from August 2007 to December 2008. They were diagnosed and monitored by the referral service of the state. Interviews were made with families to identify sociodemographic variables, and an oral exam was performed to determine dental caries. The SRQ (Self Report Questionnaire) scale was used to diagnose the presence of common mental disorders, and the CAGE (Cut down, Annoyed, Guilty and Eye opener) was applied to determine abusive use of alcohol. The absolute and relative frequencies of the variables of interest were analyzed by Chi-square and Mann-Whitney, with a 5% significance level. The incidence variables were analyzed according to the logistic regression model, with a confidence interval of 95%. Caries incidence (1.98; SD = 4.68) was higher in the HbSS genotype. There was a statistically significant association between caries incidence and both abusive use of alcohol (32.43%, RR = 1.99; 1.05-3.78; 95%CI) and common mental disorders (8.77% RR = 0.37; 0.15-0.93; 95%CI). There was also an association between caries incidence and maternal risk behavior, indicating that the care network should be expanded to include patients with sickle cell disease. PMID:26676194

  16. Recent trends in cancer incidence: impact of risk factors, diagnostic activities and data quality of registration.

    PubMed

    Dehler, Silvia; Tonev, Simeon; Korol, Dimitri; Rohrmann, Sabine; Dimitrova, Nadya

    2014-01-01

    Aims and background. Cancer incidence variations are influenced by different factors including socioeconomic status, risk factors and use of screening. The purpose of this study was to examine trends in cancer incidence in two urban areas in Europe showing differences in influencing factors but also some common characteristics in the context of data quality of the corresponding cancer registries.Methods. Age-standardized incidence rates (world standard - ASRW) for cases diagnosed in 2000-2009 for Sofia (Bulgaria) and the Canton of Zurich (Switzerland) were calculated using data from the corresponding cancer registries. Average annual percent change (AAPC) was estimated with Joinpoint regression analysis. Data quality was estimated in terms of proportions of microscopically verified (MV%) and death-certificate-only (DCO%) cases. Results. ASRWs for all sites were higher in Zurich for men (311 vs 262 per 100,000) and women (241 vs 231 per 100,000) than in Sofia. Colorectal (both sexes), lung (men), cervical and corpus uteri cancer had a higher incidence in Sofia. Prostate, breast and lung (women) cancer were more often diagnosed in Zurich. A significant increase in female lung cancer incidence was observed in both areas. Overall incidence decreased in Zurich, while it did not significantly change in Sofia. MV% was lower in Sofia than in the Canton of Zurich but increased steadily up to 85% in 2009, whereas in the Canton of Zurich MV% was more or less stable around 95%. The DCO% of Sofia was 19% in 2000 and steadily decreased to 8% in 2009. In the Canton of Zurich, the DCO% decreased from 5% in 2000 but increased again from 2006 onwards, up to 3% in 2009. Conclusions. Cancer incidence rates differ between Sofia and Zurich. Differences concerning socioeconomic status, risk factors, use of cancer screening but also data quality may influence these results. PMID:25296588

  17. Incident atrial fibrillation hazard in hypertensive population: a risk function from and for clinical practice.

    PubMed

    Alves-Cabratosa, Lia; García-Gil, Maria; Comas-Cufí, Marc; Ponjoan, Anna; Martí, Ruth; Parramon, Dídac; Blanch, Jordi; Ramos, Rafel

    2015-06-01

    Determining the risk of atrial fibrillation within the hypertensive population without ischemic vascular disease would aid in decision making on preventive approaches. Accordingly, we aimed to estimate the risk of incident atrial fibrillation in this population. We conducted an historical cohort study between July 1, 2006, and December 31, 2011, using anonymized longitudinal patient information from primary care and hospital discharge records contained in the System for the Development of Research in Primary Care database. We included 255 440 hypertensive patients, aged ≥55 years at the time of study entry. Individuals with previous atrial fibrillation, ischemic heart disease, stroke, and peripheral artery disease were excluded. To build the incident atrial fibrillation risk function, a derivation and a validation cohort were defined, representing 60% and 40% of the entire database, respectively, and a Cox proportional hazards model was fitted. Atrial fibrillation incidence was 7.24 per 1000 person-years (95% confidence interval, 7.08-7.40). The final model included age, weight, total cholesterol, heart failure, valvular heart disease, and antihypertensive treatment. Its concordance index (standard error) was 0.769 (0.004) and 0.768 (0.005) in the derivation and validation datasets, respectively. This research provides a tool, built with variables from daily clinical practice, that can be readily used in the primary care setting to predict atrial fibrillation incidence in the hypertensive population without ischemic vascular disease. The tool may help tailor individualized diagnostic and preventive care decisions. PMID:25847950

  18. Ischemic Heart Disease in Workers at Mayak PA: Latency of Incidence Risk after Radiation Exposure

    PubMed Central

    Simonetto, Cristoforo; Azizova, Tamara V.; Grigoryeva, Evgenia S.; Kaiser, Jan C.; Schöllnberger, Helmut; Eidemüller, Markus

    2014-01-01

    We present an updated analysis of incidence and mortality from atherosclerotic induced ischemic heart diseases in the cohort of workers at the Mayak Production Association (PA). This cohort constitutes one of the most important sources for the assessment of radiation risk. It is exceptional because it comprises information on several other risk factors. While most of the workers have been exposed to external gamma radiation, a large proportion has additionally been exposed to internal radiation from inhaled plutonium. Compared to a previous study by Azizova et al. 2012, the updated dosimetry system MWDS-2008 has been applied and methods of analysis have been revised. We extend the analysis of the significant incidence risk and observe that main detrimental effects of external radiation exposure occur after more than about 30 years. For mortality, significant risk was found in males with an excess relative risk per dose of 0.09 (95% CI: 0.02; 0.16) while risk was insignificant for females. With respect to internal radiation exposure no association to risk could be established. PMID:24828606

  19. Decreasing Incidence of Gonorrhea in Homosexually Active Men—Minimal Effect on Risk of AIDS

    PubMed Central

    Handsfield, H. Hunter

    1985-01-01

    The incidence of gonorrhea in homosexually active men in Seattle-King County and in Washington State as a whole decreased by 57% from 1982 to 1984, compared with a 20% decrease among heterosexual men and women. This probably reflects behavioral changes of homosexual men in response to the epidemic of the acquired immunodeficiency syndrome (AIDS). Nevertheless, changes in sexual behavior that greatly reduce the incidence of gonorrhea do not necessarily result in a similar reduction in the risk of exposure to the virus that causes AIDS. PMID:4090477

  20. Prospective risk analysis prior to retrospective incident reporting and analysis as a means to enhance incident reporting behaviour: a quasi-experimental field study.

    PubMed

    Kessels-Habraken, Marieke; De Jonge, Jan; Van der Schaaf, Tjerk; Rutte, Christel

    2010-05-01

    Hospitals can apply prospective and retrospective methods to reduce the large number of medical errors. Retrospective methods are used to identify errors after they occur and to facilitate learning. Prospective methods aim to determine, assess and minimise risks before incidents happen. This paper questions whether the order of implementation of those two methods influences the resultant impact on incident reporting behaviour. From November 2007 until June 2008, twelve wards of two Dutch general hospitals participated in a quasi-experimental reversed-treatment non-equivalent control group design. The six units of Hospital 1 first conducted a prospective analysis, after which a sophisticated incident reporting and analysis system was implemented. On the six units of Hospital 2 the two methods were implemented in reverse order. Data from the incident reporting and analysis system and from a questionnaire were used to assess between-hospital differences regarding the number of reported incidents, the spectrum of reported incident types, and the profession of reporters. The results show that carrying out a prospective analysis first can improve incident reporting behaviour in terms of a wider spectrum of reported incident types and a larger proportion of incidents reported by doctors. However, the proposed order does not necessarily yield a larger number of reported incidents. This study fills an important gap in safety management research regarding the order of the implementation of prospective and retrospective methods, and contributes to literature on incident reporting. This research also builds on the network theory of social contagion. The results might indicate that health care employees can disseminate their risk perceptions through communication with their direct colleagues. PMID:20202731

  1. Late-Onset Alzheimer Risk Variants in Memory Decline, Incident Mild Cognitive Impairment and Alzheimer Disease

    PubMed Central

    Carrasquillo, Minerva M.; Crook, Julia E.; Pedraza, Otto; Thomas, Colleen S.; Pankratz, V. Shane; Allen, Mariet; Nguyen, Thuy; Malphrus, Kimberly G.; Ma, Li; Bisceglio, Gina D.; Roberts, Rosebud O.; Lucas, John A.; Smith, Glenn E.; Ivnik, Robert J.; Machulda, Mary M.; Graff-Radford, Neill R.; Petersen, Ronald C.; Younkin, Steven G.; Ertekin-Taner, Nilüfer

    2014-01-01

    Background Genome-wide association studies (GWAS) of late-onset Alzheimer's disease (LOAD) identified risk variants. We assessed the association of nine variants with memory and progression to mild cognitive impairment (MCI) or LOAD (MCI/LOAD). Methods Older Caucasians, cognitively normal at baseline and longitudinally evaluated at Mayo Clinic Rochester and Jacksonville, were assessed for associations of genetic variants with memory decline (n=2,262) using linear mixed models and for incident MCI/LOAD (n=2,674) with Cox proportional hazards models. Each variant was tested both individually and collectively using a single weighted risk score. Results APOE-ε4 was significantly associated with worse memory at baseline (β=-0.88, p=2.78E-03) and increased rate of 5-year decline (β=-1.43, p=3.71E-06) with highly significant overall effect on memory (p=3.88E-09). CLU-locus risk allele rs11136000-G was associated with worse memory at baseline (β=-0.51, p=0.012), but not with increased rate of decline. CLU allele was also associated with incident MCI/LOAD (hazard ratio=HR=1.14, p=0.049) in sensitivity analysis. MS4A6A-locus risk allele rs610932-C was associated with increased incident MCI/LOAD in primary analysis (HR=1.17, p=0.016) and had suggestive association with lower baseline memory (β=-0.35, p=0.08). PICALM-locus risk allele rs3851179-G had nominally significant HR in both primary and sensitivity analysis, but with a protective estimate. LOAD risk alleles ABCA7-rs3764650-C and EPHA1-rs11767557-A associated with increased rates of memory decline in the subset of subjects with a final diagnosis of MCI/LOAD. Risk scores excluding APOE were not significant, whereas APOE-inclusive risk scores associated with worse memory and incident MCI/LOAD. Conclusions The collective influence of the nine top LOAD GWAS variants on memory decline and progression to MCI/LOAD appears limited. Given the significant associations observed with APOE-ε4, discovery of the biologically

  2. Incident-level risk factors for firefighter injuries at structural fires.

    PubMed

    Fabio, Anthony; Ta, Myduc; Strotmeyer, Stephen; Li, Wei; Schmidt, Eric

    2002-11-01

    Firefighting is a demanding occupation, laden with hazardous exposures which result in traumatic injuries. Little epidemiologic evidence exists quantifying these factors, however. We conducted an incident-level case-control study of National Fire Incident Reporting System data of the association between firefighter injury and incident characteristics. Risk factors included 5 or more alarms (OR = 3.85; 95% CI, 3.32-4.48), number of stories (> 3 vs. ground level OR = 2.49; 95% CI, 1.43 to 1.55), and at least one civilian injury (OR = 3.69; 95% CI, 3.55-3.84). Risk of injury was reduced for fires originating 49 feet and higher (OR = 0.57; 95% CI, 0.49-0.66). This analysis suggests that fireground-specific situations such as the number of stories or a civilian injury increase the risk of injury. Given the danger of firefighting, the identification of risk factors through epidemiologic methods is vital to developing safety measures. PMID:12448357

  3. Incidence and Risk Factors of C5 Palsy following Posterior Cervical Decompression: A Systematic Review

    PubMed Central

    Tian, Ye; Liang, Lei; Wang, Ce; Yang, Lili; Yuan, Wen

    2014-01-01

    Background C5 palsy is a serious but poorly understood complication after posterior cervical decompression that could lead to muscle weakness, brachialgia and numbness of the upper limbs. The incidence of C5 palsy varies greatly between studies. The risk factors are inconclusive and even conflicting. Object To perform a systematic review on the incidence and risk factors of C5 palsy after posterior cervical decompression. Materials and Methods Four databases, PubMed, Embase, Web of Science and Cochrane CENTRAL, were searched to identify eligible studies. Either a fixed- or a random-effects model was used to calculate the pooled odd ratio (RR) or standardized mean difference (SMD) with its 95% confidence interval (95%CI). Results Of the 589 pre-recruited studies, 25 were included in this study for systematic review. The pooled incidence of C5 palsy after posterior decompression was 5.8% (95%CI: 4.4–7.2%). The incidence after open-door laminoplasty, double-door laminoplasty and laminectomy was 4.5%, 3.1% and 11.3%, respectively. The significant risk factors of C5 palsy were OPLL (OR, 2.188; 95%CI, 1.307–3.665), narrower intervertebral foramen (SMD, −0.972; 95%CI, −1.398 to −0.545), laminectomy (vs. open-door laminoplasty, OR, 2.988; 95%CI, 1.298–6.876), excessive spinal cord drift (SMD, 1.289, 95%CI, 0,197–2.381) and male gender (OR, 1.54; 95%CI, 1.036–2.301). Conclusions The results of this systematic review suggest that patients with excessive spinal cord drift, preexisting intervertebral foramenal stenosis, OPLL, laminectomy and male gender are at high risk for postoperative C5 palsy, and risk-reduction options should be considered for such patients. PMID:25162509

  4. Incidence and Risk Factors for Neonatal Tetanus in Admissions to Kilifi County Hospital, Kenya

    PubMed Central

    Ibinda, Fredrick; Bauni, Evasius; Kariuki, Symon M.; Fegan, Greg; Lewa, Joy; Mwikamba, Monica; Boga, Mwanamvua; Odhiambo, Rachael; Mwagandi, Kiponda; Seale, Anna C.; Berkley, James A.; Dorfman, Jeffrey R.; Newton, Charles R. J. C.

    2015-01-01

    Background Neonatal Tetanus (NT) is a preventable cause of mortality and neurological sequelae that occurs at higher incidence in resource-poor countries, presumably because of low maternal immunisation rates and unhygienic cord care practices. We aimed to determine changes in the incidence of NT, characterize and investigate the associated risk factors and mortality in a prospective cohort study including all admissions over a 15-year period at a County hospital on the Kenyan coast, a region with relatively high historical NT rates within Kenya. Methods We assessed all neonatal admissions to Kilifi County Hospital in Kenya (1999–2013) and identified cases of NT (standard clinical case definition) admitted during this time. Poisson regression was used to examine change in incidence of NT using accurate denominator data from an area of active demographic surveillance. Logistic regression was used to investigate the risk factors for NT and factors associated with mortality in NT amongst neonatal admissions. A subset of sera from mothers (n = 61) and neonates (n = 47) were tested for anti-tetanus antibodies. Results There were 191 NT admissions, of whom 187 (98%) were home deliveries. Incidence of NT declined significantly (Incidence Rate Ratio: 0.85 (95% Confidence interval 0.81–0.89), P<0.001) but the case fatality (62%) did not change over the study period (P = 0.536). Younger infant age at admission (P = 0.001) was the only independent predictor of mortality. Compared to neonatal hospital admittee controls, the proportion of home births was higher among the cases. Sera tested for antitetanus antibodies showed most mothers (50/61, 82%) had undetectable levels of antitetanus antibodies, and most (8/9, 89%) mothers with detectable antibodies had a neonate without protective levels. Conclusions Incidence of NT in Kilifi County has significantly reduced, with reductions following immunisation campaigns. Our results suggest immunisation efforts are effective if

  5. Incidence, Risks, and Sequelae of Posterior Fossa Syndrome in Pediatric Medulloblastoma

    SciTech Connect

    Korah, Mariam P.; Esiashvili, Natia; Mazewski, Claire M.; Hudgins, Roger J.; Tighiouart, Mourad; Janss, Anna J.; Schwaibold, Frederick P.; Crocker, Ian R.; Curran, Walter J.; Marcus, Robert B.

    2010-05-01

    Purpose: To investigate the incidence, risks, severity, and sequelae of posterior fossa syndrome (PFS) in children with medulloblastoma. Methods and Materials: Between 1990 and 2007, 63 children with medulloblastoma at Emory University and Children's Healthcare of Atlanta were treated with craniectomy followed by radiation. Fifty-one patients were assigned to a standard-risk group, and 12 patients were assigned to a high-risk group. Five patients had <1.5-cm{sup 2} residual tumor, 4 had >=1.5-cm{sup 2} residual tumor, and the remainder had no residual tumor. Eleven patients had disseminated disease. Patients received craniospinal irradiation at a typical dose of 23.4 Gy or 36 Gy for standard- or high-risk disease, respectively. The posterior fossa was given a total dose of 54 or 55.8 Gy. Nearly all patients received chemotherapy following cooperative group protocols. Results: Median follow-up was 7 years. PFS developed in 18 patients (29%). On univariate analysis, brainstem invasion, midline tumor location, younger age, and the absence of radiographic residual tumor were found to be predictors of PFS; the last two variables remained significant on multivariate analysis. From 1990 to 2000 and from 2001 to 2007, the proportions of patients with no radiographic residual tumor were 77% and 94%, respectively. During the same eras, the proportions of patients with PFS were 17% and 39%. Only 4 patients had complete recovery at last follow-up. Conclusions: The incidence of PFS increased in the latter study period and is proportional to more aggressive surgery. Children with midline tumors exhibiting brainstem invasion are at increased risk. With the increased incidence of PFS and the permanent morbidity in many patients, the risks and benefits of complete tumor removal in all patients need to be reexamined.

  6. Risk factors for prostate cancer incidence and progression in the health professionals follow-up study

    PubMed Central

    Giovannucci, Edward; Liu, Yan; Platz, Elizabeth A.; Stampfer, Meir J.; Willett, Walter C.

    2008-01-01

    Risk factors for prostate cancer could differ for various subgroups, such as for “aggressive” and “non-aggressive” cancers or by grade or stage. Determinants of mortality could differ from those for incidence. Using data from the Health Professionals Follow-Up Study, we re-examined 10 factors (cigarette smoking history, physical activity, BMI, family history of prostate cancer, race, height, total energy consumption, and intakes of calcium, tomato sauce and α-linolenic acid) using multivariable Cox regression in relation to multiple subcategories for prostate cancer risk. These were factors that we previously found to be predictors of prostate cancer incidence or advanced prostate cancer in this cohort, and that have some support in the literature. In this analysis, only 4 factors had a clear statistically significant association with overall incident prostate cancer: African–American race, positive family history, higher tomato sauce intake (inversely) and α-linolenic acid intake. In contrast, for fatal prostate cancer, recent smoking history, taller height, higher BMI, family history, and high intakes of total energy, calcium and α-linolenic acid were associated with a statistically significant increased risk. Higher vigorous physical activity level was associated with lower risk. In relation to these risk factors, advanced stage at diagnosis was a good surrogate for fatal prostate cancer, but high-grade (Gleason ≥ 7 or Gleason ≥ 8) was not. Only for high calcium intake was there a close correspondence for associations among high-grade cancer, advanced and fatal prostate cancer. Tomato sauce (inversely) and α-linolenic acid (positively) intakes were strong predictors of advanced cancer among those with low-grade cancers at diagnosis. Although the proportion of advanced stage cancers was much lower after PSA screening began, risk factors for advanced stage prostate cancers were similar in the pre-PSA and PSA era. The complexity of the clinical

  7. Incidence, risk factors and mortality of tuberculosis in Danish HIV patients 1995-2007

    PubMed Central

    2011-01-01

    Background Human Immunodeficiency Virus (HIV) infection predisposes to tuberculosis (TB). We described incidence, risk factors and prognosis of TB in HIV-1 infected patients during pre (1995-1996), early (1997-1999), and late Highly Active Antiretroviral Therapy (HAART) (2000-2007) periods. Methods We included patients from a population-based, multicenter, nationwide cohort. We calculated incidence rates (IRs) and mortality rates (MRs). Cox's regression analysis was used to estimate risk factors for TB infection with HAART initiation included as time updated variable. Kaplan-Meier was used to estimate mortality after TB. Results Among 2,668 patients identified, 120 patients developed TB during the follow-up period. The overall IR was 8.2 cases of TB/1,000 person-years of follow-up (PYR). IRs decreased during the pre-, early and late-HAART periods (37.1/1000 PYR, 12.9/1000 PYR and 6.5/1000 PYR respectively). African and Asian origin, low CD4 cell count and heterosexual and injection drug user route of HIV transmission were risk factors for TB and start of HAART reduced the risk substantially. The overall MR in TB patients was 34.4 deaths per 1,000 PYR (95% Confidence Interval: 22.0-54.0) and was highest in the first two years after the diagnosis of TB. Conclusions Incidence of TB still associated with conventional risk factors as country of birth, low CD4 count and route of HIV infection while HAART reduces the risk substantially. The mortality in this patient population is high in the first two years after TB diagnosis. PMID:21605366

  8. Television viewing time and risk of incident diabetes mellitus: the English Longitudinal Study of Ageing

    PubMed Central

    Smith, L; Hamer, M

    2014-01-01

    Aim To investigate the longitudinal association between television viewing time and risk of incident diabetes mellitus in an elderly sample of adults in England. Methods Analyses of data from the English Longitudinal Study of Ageing. At baseline (2008), participants reported their television viewing time and physical activity level. Diabetes mellitus was recorded from self-reported physician diagnosis at 2-year follow-up. Associations between television viewing time and combined television viewing time and physical activity level with risk of incident diabetes mellitus at follow-up were examined using adjusted logistic regression models. Results A total of 5964 participants (mean ± sd age 65 ± 9 years at baseline, 44% male) were included in the analyses. There was an association between baseline television viewing time and risk of incident diabetes mellitus at 2-year follow-up (≥ 6 h/day compared with <2 h/day; odds ratio 4.27, 95% CI 1.69, 10.77), although the association was attenuated to the null in final adjusted models that included BMI. Participants who were inactive/had high television viewing time at baseline were almost twice as likely to have diabetes mellitus at 2-year follow-up than those who were active/had low television viewing time (fully adjusted odds ratio 1.94, 95% CI 1.02, 3.68), although active participants reporting high television viewing were not at risk. Conclusion Interventions to reduce the incidence of diabetes in the elderly that focus on both increasing physical activity and reducing television viewing time might prove useful. PMID:24975987

  9. Multi factorial interactions in the pathogenesis pathway of Alzheimer’s disease: a new risk charts for prevention of dementia

    PubMed Central

    2010-01-01

    Background The population longitudinal study named “The Conselice Study” has been the focus of the present investigation. 65 years old or older participants of this population study on brain aging were followed up for 5 years: 937 subjects completed the follow-up. Relationships of 46 genetic, phenotypic, clinical and nutritional factors on incident cognitive decline and incident dementia cases were investigated. Results A new statistical approach, called the Auto Contractive Map (AutoCM) was applied to find relationship between variables and a possible hierarchy in the relevance of each variable with incident dementia. This method, based on an artificial adaptive system, was able to define the association strength of each variable with all the others. Moreover, few variables resulted to be aggregation points in the variable connectivity map related to cognitive decline and dementia. Gene variants and cognate phenotypic variables showed differential degrees of relevance to brain aging and dementia. A risk map for age associated cognitive decline and dementia has been constructed and will be presented and discussed. Conclusion This map of variables may be use to identify subjects with increased risk of developing cognitive decline end/or dementia and provide pivotal information for early intervention protocols for prevention of dementia. PMID:21172063

  10. Incidence of Online Health Information Search: A Useful Proxy for Public Health Risk Perception

    PubMed Central

    Scammon, Debra L

    2013-01-01

    Background Internet users use search engines to look for information online, including health information. Researchers in medical informatics have found a high correlation of the occurrence of certain search queries and the incidence of certain diseases. Consumers’ search for information about diseases is related to current health status with regard to a disease and to the social environments that shape the public’s attitudes and behaviors. Objective This study aimed to investigate the extent to which public health risk perception as demonstrated by online information searches related to a health risk can be explained by the incidence of the health risk and social components of a specific population’s environment. Using an ecological perspective, we suggest that a population’s general concern for a health risk is formed by the incidence of the risk and social (eg, media attention) factors related with the risk. Methods We constructed a dataset that included state-level data from 32 states on the incidence of the flu; a number of social factors, such as media attention to the flu; private resources, such as education and health insurance coverage; public resources, such as hospital beds and primary physicians; and utilization of these resources, including inpatient days and outpatient visits. We then explored whether online information searches about the flu (seasonal and pandemic flu) can be predicted using these variables. We used factor analysis to construct indexes for sets of social factors (private resources, public resources). We then applied panel data multiple regression analysis to exploit both time-series and cross-sectional variation in the data over a 7-year period. Results Overall, the results provide evidence that the main effects of independent variables—the incidence of the flu (P<.001); social factors, including media attention (P<.001); private resources, including life quality (P<.001) and health lifestyles (P=.009); and public

  11. Risk factors associated with injury and mortality from paediatric low speed vehicle incidents: a systematic review.

    PubMed

    Paul Anthikkat, Anne; Page, Andrew; Barker, Ruth

    2013-01-01

    Objective. This study reviews modifiable risk factors associated with fatal and nonfatal injury from low-speed vehicle runover (LSVRO) incidents involving children aged 0-15 years. Data Sources. Electronic searches for child pedestrian and driveway injuries from the peer-reviewed literature and transport-related websites from 1955 to 2012. Study Selection. 41 studies met the study inclusion criteria. Data Extraction. A systematic narrative summary was conducted that included study design, methodology, risk factors, and other study variables. Results. The most commonly reported risk factors for LSVRO incidents included age under 5 years, male gender, and reversing vehicles. The majority of reported incidents involved residential driveways, but several studies identified other traffic and nontraffic locations. Low socioeconomic status and rental accommodation were also associated with LSVRO injury. Vehicles were most commonly driven by a family member, predominantly a parent. Conclusion. There are a number of modifiable vehicular, environmental, and behavioural factors associated with LSVRO injuries in young children that have been identified in the literature to date. Strategies relating to vehicle design (devices for increased rearward visibility and crash avoidance systems), housing design (physical separation of driveway and play areas), and behaviour (driver behaviour, supervision of young children) are discussed. PMID:23781251

  12. Covariate adjustment of cumulative incidence functions for competing risks data using inverse probability of treatment weighting.

    PubMed

    Neumann, Anke; Billionnet, Cécile

    2016-06-01

    In observational studies without random assignment of the treatment, the unadjusted comparison between treatment groups may be misleading due to confounding. One method to adjust for measured confounders is inverse probability of treatment weighting. This method can also be used in the analysis of time to event data with competing risks. Competing risks arise if for some individuals the event of interest is precluded by a different type of event occurring before, or if only the earliest of several times to event, corresponding to different event types, is observed or is of interest. In the presence of competing risks, time to event data are often characterized by cumulative incidence functions, one for each event type of interest. We describe the use of inverse probability of treatment weighting to create adjusted cumulative incidence functions. This method is equivalent to direct standardization when the weight model is saturated. No assumptions about the form of the cumulative incidence functions are required. The method allows studying associations between treatment and the different types of event under study, while focusing on the earliest event only. We present a SAS macro implementing this method and we provide a worked example. PMID:27084321

  13. Risk factors associated with the incidence of foal mortality in an extensively managed mare herd.

    PubMed Central

    Haas, S D; Bristol, F; Card, C E

    1996-01-01

    The purpose of this study was to determine the incidence of neonatal mortality in a large, extensively managed mare herd and what risk factors were involved in foal mortality. For a 6 wk period between April 18, 1994, and May 31, 1994, 334 foals were born, of which 74 died before reaching 10 d of age, giving an overall mortality of 22% for this period. Seventy four percent of the foal deaths occurred within 48 h of parturition. The major causes of foal mortality included starvation/exposure 27%, septicemia 26%, and dystocia 20%. Weekly incidences varied significantly, ranging from 67% for week 1 to 14% for week 5 (P < 0.01). Other risk factors that were associated with foal death included failure of passive transfer (P < 0.0001), poor mothering ability (P < 0.0001), the presence of dystocia (P < 0.0001), low birth weight (p < 0.05), lack of rainfall (P < 0.01), and low temperatures (P < 0.1). The effect of sire, mare age, mare body condition, and foal sex were not significant risk factors for foal survival (P > 0.1). Further studies are required to determine if changing management procedures will be effective in reducing the incidence of neonatal foal mortality in this extensively managed herd. PMID:8640655

  14. Risk Factors Associated with Injury and Mortality from Paediatric Low Speed Vehicle Incidents: A Systematic Review

    PubMed Central

    Paul Anthikkat, Anne; Page, Andrew; Barker, Ruth

    2013-01-01

    Objective. This study reviews modifiable risk factors associated with fatal and nonfatal injury from low-speed vehicle runover (LSVRO) incidents involving children aged 0–15 years. Data Sources. Electronic searches for child pedestrian and driveway injuries from the peer-reviewed literature and transport-related websites from 1955 to 2012. Study Selection. 41 studies met the study inclusion criteria. Data Extraction. A systematic narrative summary was conducted that included study design, methodology, risk factors, and other study variables. Results. The most commonly reported risk factors for LSVRO incidents included age under 5 years, male gender, and reversing vehicles. The majority of reported incidents involved residential driveways, but several studies identified other traffic and nontraffic locations. Low socioeconomic status and rental accommodation were also associated with LSVRO injury. Vehicles were most commonly driven by a family member, predominantly a parent. Conclusion. There are a number of modifiable vehicular, environmental, and behavioural factors associated with LSVRO injuries in young children that have been identified in the literature to date. Strategies relating to vehicle design (devices for increased rearward visibility and crash avoidance systems), housing design (physical separation of driveway and play areas), and behaviour (driver behaviour, supervision of young children) are discussed. PMID:23781251

  15. 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

  16. The Incidence and Risk of Herpes Zoster in Patients With Sleep Disorders

    PubMed Central

    Chung, Wei-Sheng; Lin, Hsuan-Hung; Cheng, Nan-Cheng

    2016-01-01

    Abstract Lack of sleep can compromise the immune system, which may reactivate latent varicella-zoster virus. Studies on sleep disorders and the risk of herpes zoster (HZ) are scant. We conducted a population-based cohort study to evaluate the risk of HZ in patients with sleep disorders and potential risk factors for HZ development. We identified patients with sleep disorders without apnea from 2002 to 2005 by using the Taiwan Longitudinal Health Insurance Database. The patients without sleep disorders were randomly selected and frequency matched with patients with sleep disorders according to age, sex, and index year. We estimated the follow-up time in person-years for the patients from the entry date until HZ diagnosis, loss to follow-up, or the end of 2010. We used Cox proportional hazards regression models and a sensitivity analysis to estimate the risk of HZ while controlling for demographic characteristics and comorbidities. A total of 131,001 study participants (follow-up, 948,177 person-years; mean age, 51.2 ± 16.5 years; 62.2% women) were included in the study. Patients with sleep disorders exhibited a higher incidence of HZ compared with a comparison cohort when stratified by age, sex, and comorbidities. After adjustment for covariates, the sleep disorder cohort exhibited a 1.23-fold greater risk of HZ compared with the comparison cohort (95% confidence interval [CI] = 1.17–1.30). The incidence of HZ increased with age. Adults ages 65 years and older exhibited a 6.11-fold greater risk of HZ development compared with their younger counterparts (95% CI = 5.34–7.00). Cancers and autoimmune diseases were independent risk factors of HZ development. The patients with sleep disorders may carry an increased risk of developing HZ. PMID:26986095

  17. Cohort study of Air Canada pilots: mortality, cancer incidence, and leukemia risk.

    PubMed

    Band, P R; Le, N D; Fang, R; Deschamps, M; Coldman, A J; Gallagher, R P; Moody, J

    1996-01-15

    Despite the special working environment and exposures of airline pilots, data on risk of death and cancer incidence in this occupational group are limited. The authors investigated a cohort of 2,740 Air Canada pilots who contributed 62,449 person-years of observation. All male pilots employed for at least 1 year on and since January 1, 1950, were studied. The cutoff date for outcome information was December 31, 1992. Standardized mortality ratio (SMR) and standardized incidence ratio (SIR) were used to compare mortality rates and cancer incidence rates of the cohort with the respective Canadian population rates. Ninety percent confidence intervals of the SMR and SIR were calculated. Statistically significant decreased mortality was observed for all causes (SMR = 0.63, 90% confidence interval (CI) 0.56-0.70), for all cancers (SMR = 0.61, 90% CI 0.48-0.76), and for all noncancer diseases (SMR = 0.53, 90% CI 0.45-0.62). Mortality from aircraft accidents was significantly raised (SMR = 26.57, 90% CI 19.3-35.9). Significantly decreased cancer incidence was observed for all cancers (SIR = 0.71, 90% CI 0.61-0.82), rectal cancer (SIR = 0.42, 90% CI 0.14-0.96), lung cancer (SIR = 0.28, 90% CI 0.16-0.46), and bladder cancer (SIR = 0.36, 90% CI 0.12-0.82). Prostate cancer (SIR = 1.87, 90% CI 1.38-2.49) and acute myeloid leukemia (SIR = 4.72, 90% CI 2.05-9.31) were significantly increased. The preferred relative risk model for radiation-induced nonchronic lymphoid leukemia (Beir V report) was applied to the cohort by using published estimates of in-flight radiation exposures. The estimated relative risk ranged from 1.001 to 1.06 and did not differ significantly from the observed SIR (SIR = 1.88, 90% CI 0.80-3.53). However, the incidence rate of acute myeloid leukemia was significantly increased. Monitoring of in-flight radiation exposure and long-term follow-up of civil aviation crew members is needed to further assess cancer incidence and leukemia risk in this special

  18. Relation between Neospora caninum and abortion in dairy cows: Risk factors and pathogenesis of disease.

    PubMed

    Klauck, Vanderlei; Machado, Gustavo; Pazinato, Rafael; Radavelli, Willian M; Santos, Daiane S; Berwaguer, Jean Carlo; Braunig, Patricia; Vogel, Fernanda F; Da Silva, Aleksandro S

    2016-03-01

    Neosporosis is a parasitic disease cause by Neospora caninum, a parasite of great importance in livestock. This study aimed to evaluate the presence of antibody against N. caninum in dairy cattle with history of abortion, as well as to identify associated risk factors for neosporosis. Animals suspected of neosporosis (n = 130) after clinical examination were randomly selected. Sera samples from 29 farms were submitted to indirect immunofluorescence technique (IFA) in order to detect antibodies against N. caninum, and animals were considered positive if ≥ IFA 1:200. An epidemiological questionnaire was used to verify probable risk factors for neosporosis and their cause-effect relation. Serological results showed that 43.8% of the animals were seropositives for N. caninum. The univariate statistical analysis found a significant relation between neoporosis and age. The number of pregnancies and the number of years that the farms had been producing milk were found as associated risk factors for the disease either by univariate or by multivariate analyses. The cause-effect model found a possible relation between reproductive problems and positive serology for neosporosis (P = 0.06). Therefore, it was concluded that approximately 44% of dairy cows with history of abortion were seropositives for N. caninum and that age and the number of years that the farms had been producing milk are risk factors for parasite infection in dairy cattle. PMID:26747583

  19. Side Effects of Radiographic Contrast Media: Pathogenesis, Risk Factors, and Prevention

    PubMed Central

    Tasanarong, Adis

    2014-01-01

    Radiocontrast media (RCM) are medical drugs used to improve the visibility of internal organs and structures in X-ray based imaging techniques. They may have side effects ranging from itching to a life-threatening emergency, known as contrast-induced nephropathy (CIN). We define CIN as acute renal failure occurring within 24–72 hrs of exposure to RCM that cannot be attributed to other causes. It usually occurs in patients with preexisting renal impairment and diabetes. The mechanisms underlying CIN include reduction in medullary blood flow leading to hypoxia and direct tubule cell damage and the formation of reactive oxygen species. Identification of patients at high risk for CIN is important. We have reviewed the risk factors and procedures for prevention, providing a long list of references enabling readers a deep evaluation of them both. The first rule to follow in patients at risk of CIN undergoing radiographic procedure is monitoring renal function by measuring serum creatinine and calculating the eGFR before and once daily for 5 days after the procedure. It is advised to discontinue potentially nephrotoxic medications, to choose radiocontrast media at lowest dosage, and to encourage oral or intravenous hydration. In high-risk patients N-acetylcysteine may also be given. PMID:24895606

  20. Acute hepatitis A in Italy: incidence, risk factors and preventive measures.

    PubMed

    Tosti, M E; Spada, E; Romanò, L; Zanetti, A; Mele, A

    2008-10-01

    The incidence of, and risk factors for, acute hepatitis A (AHA) were assessed by using data collected from the Italian surveillance system of acute viral hepatitis (SEIEVA). To this end, a case-control study within a population-based surveillance for acute viral hepatitis was performed. AHA incidence has been estimated since 1991; the association with considered risk factors was analysed from 2001 to 2006 employing cases of acute hepatitis B (AHB) as controls. The incidence of AHA declined from 4 / 100 000 in 1991 to 1.4/100 000 in 2006, with a peak during 1996-1998 due to an outbreak in southern Italy. The incidence of AHA was highest among persons aged 15-24 years. The case-fatality rate was 2.9 / 10 000. Contact with individuals with AHA [adjusted OR (OR(adj)) = 3.8, 95% CI 2.7-5.5; population-attributable risk (PAR) = 7.5%], travelling to endemic areas (OR(adj) = 3.1, 95% CI = 2.6-3.8; PAR = 19.5%), ingestion of raw shellfish (OR(adj) = 1.8, 95% CI = 1.6-2.1; PAR = 26.6%), and cohabitation with day care children (OR(adj) = 1.3, 95% CI = 1.01-1.7; PAR = 2.3%) were the main important risk factors. In 2003, an outbreak, with high case-fatality rate occurred among intravenous drug users, in a central Italian town. A weak association was found for male homosexuality when acute hepatitis C cases were employed as controls (OR(adj) = 1.4 CI, 95% CI = 1.1-1.9). Hepatitis A virus infections are currently occurring more frequently in adults, in whom the disease is most severe. In conclusion, looking at the attributable risks, at present most of the AHA infections are due to shellfish consumption, travel to endemic areas and contact with patients with AHA. Vaccination of individuals at increased risk of infection, as well as persons with underling liver disease and those at increased risk of complications, combined with surveillance of shellfish retail outlets are efficient control measures. PMID:18837830

  1. Incident diabetes mellitus, hypertension, and cardiovascular disease risk in exercising hypercholesterolemic patients.

    PubMed

    Williams, Paul T; Franklin, Barry A

    2015-11-15

    Exercise may be an important treatment for hypercholesterolemic patients, particularly in statin users who are at increased diabetes risk. We therefore used Cox proportional hazard analyses to compare running and walking dose (metabolic equivalent hours/day [MET-h/d]) to diabetes, hypertension, and cardiovascular disease (CVD) risk in hypercholesterolemic patients. There were 60 diabetic- and 373 CVD-related deaths during a 10.1-year mortality surveillance of 6,688 hypercholesterolemic patients. In addition, there were 177 incident nonfatal diabetes, 815 incident nonfatal hypertensions, and 323 incident nonfatal CVD events during a 6.4-year follow-up of 6,971 hypercholesterolemic patients who supplied follow-up questionnaires. Fatal and nonfatal diabetes risk decreased 26% (p = 0.002) and 19% (p ≤0.0001) per MET-h/d, respectively, and relative to <1.07 MET-h/d decreased 35% (p = 0.19) and 55% (p ≤0.0001), respectively, for 1.8 to 3.6 MET-h/d and 73% (p = 0.02) and 71% (p ≤0.0001), respectively, for ≥3.6 MET-h/d. Fatal and nonfatal CVD risk decreased 8% (p = 0.008) and 3% (p = 0.22) per MET-h/d, respectively, and relative to <1.07 MET-h/d decreased 10% (p = 0.45) and 36% (p = 0.008) for 1.8 to 3.6 MET-h/d, respectively, and 37% (p = 0.009) and 26% (p = 0.10), respectively, for ≥3.6 MET-h/d. Incident hypertension risk decreased 4% (p = 0.01) per MET-h/d, and relative to <1.07 MET-h/d decreased 29% (p = 0.002) for 1.8 to 3.6 MET-h/d and 31% (p = 0.001) for ≥3.6 MET-h/d. In conclusion, running and walking for exercise lowers diabetes, hypertension, and CVD risk in hypercholesterolemic patients and should more than compensate for the purported 9% increase in diabetes risk from statin use. By preventing morbidity and mortality for a specific existing medical condition, some exercise expenses may qualify for flexible spending account expenditures in hypercholesterolemic patients when prescribed by a physician. PMID:26423772

  2. Risk factors for incident erectile dysfunction among community-dwelling men

    PubMed Central

    Hall, Susan A.; Shackelton, Rebecca; Rosen, Raymond C.; Araujo, Andre B.

    2012-01-01

    Introduction Compared to the prevalence of erectile dysfunction (ED), fewer studies have focused on the incidence of ED and even fewer have focused on non-medical risk factors. Aim We examined psychosocial, demographic/socioeconomic, medical/behavioral, and sexual function risk factors at T1 (1987–1989) and development of incident ED at T2 (1995–1997). Methods Longitudinal population-based epidemiologic study of 814 community-dwelling men participating in the Massachusetts Male Aging Study. Main outcome measure ED was defined according to a validated, discriminant-analytic formula based on questionnaire responses and categorized as moderate/complete ED vs. none/minimal. Multivariate logistic regression models (odds ratios [ORs] and 95% confidence intervals [CIs]) were used to estimate the association of risk factors with ED. Results Among 814 men free of ED at T1, 22% developed moderate/complete ED at T2 (on average approximately 8.8 years later). In a multivariate model, sexual function variables captured at baseline were inversely associated with ED (e.g., more or similar level of sexual arousal compared to adolescence vs. less, OR=0.56, 95% CI: 0.34, 0.92; frequency of sexual thoughts at least 2–3 times weekly vs. less, OR=0.55, 95% CI: 0.33, 0.92) after adjustment for age, education, and other risk factors. Conclusions Our results indicate that in the context of other risk factors, sexual desire variables at baseline were associated with incident ED. This in turn suggests that indications of reduced function appear earlier than ED itself, and that there may be a time window for intervention before a loss of erectile function. PMID:19929915

  3. Fifty-Year Trends in Atrial Fibrillation Prevalence, Incidence, Risk Factors, and Mortality in the Community

    PubMed Central

    Schnabel, Renate B.; Yin, Xiaoyan; PhilimonGona; Larson, Martin G.; Beiser, Alexa S.; McManus, David D.; Newton-Cheh, Christopher; Lubitz, Steven A.; Magnani, Jared W.; Ellinor, Patrick T.; SudhaSeshadri; Wolf, Philip A; Vasan, Ramachandran S.; Benjamin, Emelia J.; Levy, Daniel

    2015-01-01

    Summary Background Comprehensive long-term data on atrial fibrillation trends in men and women are scant. Methods We investigated trends in atrial fibrillation incidence, prevalence, and risk factors, and in stroke and mortality following its onset in Framingham Heart Study participants (n=9511) from 1958 to 2007. To accommodate sex differences in atrial fibrillation risk factors and disease manifestations, sex-stratified analyses were performed. Findings During 50 years of observation (202,417 person-years), there were 1,544 new-onset atrial fibrillation cases (46.8% women). We observed about a fourfold increase in the age-adjusted prevalence and more than a tripling in age-adjusted incidence of atrial fibrillation (prevalence 20.4 versus 96.2 per 1000 person-years in men; 13.7 versus 49.4 in women; incidence rates in first versus last decade 3.7 versus 13.4 per 1000 person-years in men; 2.5 versus 8.6 in women, ptrend<0.0001). For atrial fibrillation diagnosed by ECG during routine Framingham examinations, age-adjusted prevalence increased (12.6versus 25.7 per 1000 person-years in men; 8.1 versus 11.8 in women, ptrend<0.0001). The age-adjusted incidence increased, but did not achieve statistical significance. Although the prevalence of most risk factors changed over time, their associated hazards for atrial fibrillation changed little. Multivariable-adjusted proportional hazards models revealed a 73.5% decline in stroke and a 25.4% decline in mortality following atrial fibrillation onset (ptrend=0.0001, ptrend=0.003, respectively). Interpretation Our data suggest that observed trends of increased incidence of atrial fibrillation in the community were partially due to enhanced surveillance. Stroke occurrence and mortality following atrial fibrillation onset declined over the decades, and prevalence increased approximately fourfold. The hazards for atrial fibrillation risk factors remained fairly constant. Our data indicate a need for measures to enhance early

  4. Fitness, Body Habitus, and the Risk of Incident Type 2 Diabetes Mellitus in Korean Men.

    PubMed

    Jae, Sae Young; Franklin, Barry A; Choo, Jina; Yoon, Eun Sun; Choi, Yoon-Ho; Park, Won Hah

    2016-02-15

    The relative contributions of cardiorespiratory fitness (CRF) and body habitus to predict incident type 2 diabetes mellitus (T2DM) remain unclear. We prospectively investigated the relation of CRF and body habitus on the risk of developing T2DM in men. Participants included 3,770 apparently healthy men who initially presented without baseline evidence of diabetes, cardiovascular disease, and hypertension. Participants were divided into 3 groups as normal weight (18.5 to 24.9 kg/m(2)), obese I (25.0 to 29.9 kg/m(2)), and obese II (≥30.0 kg/m(2)). CRF was directly measured by peak oxygen uptake (VO2peak) and categorized into unfit and fit cohorts based on the median value of age-specific VO2peak. Diabetes was defined as a glycated hemoglobin >6.5% and/or a fasting glucose >126 mg/dl at baseline and follow-up examinations. During a median follow-up of 5 years, 170 men (4.5%) developed diabetes. After adjusting for age and fasting glucose, the relative risk and 95% confidence interval (CI) for incident T2DM were 1.52 (95% CI 1.11 to 2.07) for obese I and 3.11 (95% CI 1.35 to 7.16) for obese II versus normal weight and 0.69 (95% CI 0.51 to 0.95) for fit versus unfit. However, these associations were no longer statistically significant after adjusting for potential confounders with VO2peak (1.32; 95% CI 0.96 to 1.83 for obese I and 1.61, 95% CI 0.64 to 4.06 for obese II vs normal weight) or body mass index (0.75, 95% CI 0.54 to 1.05 for fit vs unfit). In the joint analysis, obese-unfit men had 1.81 times (95% CI 1.22 to 2.69) greater risk of incident T2DM, but obese-fit men were not at increased risk of incident T2DM (0.95, 95% CI 0.57 to 1.58) compared with fit-normal weight men. In conclusion, these results suggest that both CRF and obesity predict the incidence of T2DM independent of potential confounders; however, CRF appears to attenuate the risk of developing diabetes in obese men. PMID:26721657

  5. Extra-articular disease manifestations in rheumatoid arthritis: incidence trends and risk factors over 46 years

    PubMed Central

    Turesson, C; O'Fallon, W; Crowson, C; Gabriel, S; Matteson, E

    2003-01-01

    Objective: To investigate the trends in incidence of extra-articular rheumatoid arthritis (ExRA) in a well defined community based cohort of patients with rheumatoid arthritis (RA), and to examine possible predictors of ExRA occurrence. Methods: Using the resources of the Rochester Epidemiology Project, a retrospective medical record review was conducted of a cohort of 609 cases of RA in Olmsted County, MN, diagnosed during 1955–94. These cases had been previously classified using the ACR 1987 criteria for RA. Patients were followed up from 1955 to 2000 (median follow up 11.8 years; range 0.1–42.8), and incident ExRA manifestations were recorded according to predefined criteria. Time to first presentation of ExRA was compared in patients with RA by decade of diagnosis. Possible ExRA risk factors were identified in case record reviews. Results: ExRA occurred in 247 patients (40.6%). A subgroup of 78 patients (12.8%) had ExRA manifestations considered to be severe in a previous study from Malmö, Sweden. The incidence of severe ExRA did not change significantly over the decades (p=0.165). In a multivariate analysis the main predictors of severe ExRA were smoking at RA diagnosis (risk ratio (RR)=2.94; 95% confidence interval (95% CI) 1.68 to 5.13) and early disability (Steinbrocker class III-IV at diagnosis) (RR=2.45; 95% CI 1.51 to 4.00). The effect of smoking overwhelmed the weaker effect of rheumatoid factor seropositivity. Conclusion: There was no decrease in the incidence of extra-articular manifestations in patients with RA diagnosed up to 1995. Smoking and early disability are independent risk factors for extra-articular RA. PMID:12860726

  6. Incidence, risk stratification, antibiogram of pathogens isolated and clinical outcome of ventilator associated pneumonia

    PubMed Central

    Gupta, Alok; Agrawal, Avinash; Mehrotra, Sanjay; Singh, Abhishek; Malik, Shruti; Khanna, Arjun

    2011-01-01

    Background: The initial empirical therapy of Ventilator Associated Pneumonia (VAP) modified based on the knowledge of local microbiological data is associated with decreased morbidity and mortality. The objective was to find the incidence and risk factors associated with VAP, the implicated pathogens and their susceptibility pattern as well as to assess the final clinical outcome in VAP. Materials and Methods: This was a prospective cohort study of 107 patients taken on ventilatory support for two or more days and those not suffering from pneumonia prior were to be taken on ventilator. The study was done over a period of one year. VAP was diagnosed using clinical pulmonary infection score of >6. The mortality, incidence of VAP, frequency of different pathogens isolated, their antibiotic sensitivity pattern, duration of mechanical ventilation and duration of hospital stay were assessed. Statistical Analysis: Univariate analysis, χ2 test and paired t-test. Results: The incidence of VAP was 28.04%. Mortality in VAP group was 46.67%, while in the non-VAP group was 27.28%. High APACHE II score was associated with a high mortality rate as well as increased incidence of VAP. The most common organisms isolated from endotracheal aspirate of patients who developed VAP were Pseudomonas aeruginosa, Methicillin-resistant Staphylococcus aureus (MRSA), Klebsiella pneumoniae and Acinetobacter baumannii. Most strains of Pseudomonas (55.56%) were resistant to commonly used beta-lactam antibiotics known to be effective against Pseudomonas. All strains of Staphylococcus aureus were MRSA and most isolates of K. pneumoniae (85.71%) were extended-spectrum beta-lactamase producing. About 50% isolates of Acinetobacter were resistant to carbapenems. Mortality was highest for infections caused by A. baumannii (83.33%) and K. pneumoniae (71.42%). Conclusions: APACHE II score can be used to stratify the risk of development of VAP and overall risk of mortality. Drug-resistant strains of

  7. Body Mass Index and the Risk of Incident Non-Communicable Diseases after Starting Antiretroviral Therapy

    PubMed Central

    Koethe, J. R.; Jenkins, C. A.; Turner, M.; Bebawy, S.; Shepherd, B. E.; Wester, C. W.; Sterling, T. R.

    2014-01-01

    Objective Obesity and HIV-infection are associated with an increased incidence of non-infectious co-morbid medical conditions, but the relationship between body mass index (BMI) and the development of non-communicable diseases (NCDs) among individuals on antiretroviral therapy (ART) has not been well-characterized. Methods A cohort study of adults initiating ART between 1998 and 2010 at an academic center with systematic laboratory and clinical data collection, including AIDS and NCD diagnoses. The relationship between BMI at ART initiation and the risk of incident cardiovascular, hepatic, renal or oncologic NCDs was assessed using Cox proportional hazard models. BMI was fit using restricted cubic splines and models adjusted for age, sex, race, CD4+ count, protease inhibitor use, year of initiation, and prior AIDS-defining illness. Results Among 1089 patients in the analysis cohort, 54% had normal BMI, 28% were overweight, and 18% were obese. Baseline BMI was associated with developing an incident NCD (p=<0.01) but the relationship was non-linear. Compared to a BMI of 25 kg/m2, a BMI of 30 kg/m2 conferred a lower risk of an incident NCD diagnosis (HR 0.59; 95% CI: 0.40, 0.87). This protective effect was attenuated at a BMI of 35 kg/m2 (HR 0.78; 95% CI: 0.49, 1.23). Results were similar in sensitivity analyses incorporating tobacco, alcohol and drug use, statin and antihypertensive exposure, and virologic suppression. Conclusions Overweight individuals starting ART have a lower risk of developing NCDs compared to normal BMI individuals, which may reflect a biological effect of adipose tissue versus differences in patient or provider behaviors. PMID:25230709

  8. Incidence of dental caries in primary dentition and risk factors: a longitudinal study.

    PubMed

    Corrêa-Faria, Patrícia; Paixão-Gonçalves, Suzane; Paiva, Saul Martins; Pordeus, Isabela Almeida

    2016-05-20

    The objectives of this prospective, longitudinal, population-based study were to estimate the incidence of dental caries in the primary dentition, identify risk factors and determine the proportion of children receiving dental treatment, through a two-year follow up. The first dental exam was conducted with 381 children aged one to five years, at health centers during immunization campaigns; 184 of them had dental caries and 197 had no caries experience. The second exam was carried out two years later at a nursery or at home with the same individuals who participated in the first exam. The diagnosis of dental caries was performed using the dmft criteria. Parents were interviewed regarding socioeconomic indicators. Descriptive, bivariate and adjusted Poisson regression analyses were performed. Among the 381 children, 234 were reexamined after two years (non-exposed: 139; exposed: 95). The overall incidence of dental caries was 46.6%. The greatest incidence of dental caries was found in the group of children with previous caries experience (61.1%). Among the children without dental caries in the first exam, 36.7% exhibited caries in the second exam. The majority of children (72.6%) received no treatment for carious lesions in the two-year interval between examinations. Children with previous dental caries (RR: 1.52, 95%CI: 1.12-2.05) had a greater risk of developing new lesions, compared with the children without previous dental caries. The incidence of dental caries was high and most of children's caries were untreated. Previous caries experience is a risk factor for developing new carious lesions in children. PMID:27223127

  9. Incidence and risk factors for intimate partner violence during the postpartum period

    PubMed Central

    Silva, Elisabete Pereira; Valongueiro, Sandra; de Araújo, Thália Velho Barreto; Ludermir, Ana Bernarda

    2015-01-01

    OBJECTIVE To estimate the incidence and identify risk factors for intimate partner violence during postpartum. METHODS This prospective cohort study was conducted with women, aged between 18-49 years, enrolled in the Brazilian Family Health Strategy in Recife, Northeastern Brazil, between 2005 and 2006. Of the 1.057 women interviewed during pregnancy and postpartum, 539 women, who did not report violence before or during pregnancy, were evaluated. A theoretical-conceptual framework was built with three levels of factors hierarchically ordered: women’s and partners’ sociodemografic and behavioral characteristics, and relationship dynamics. Incidence and risk factors of intimate partner violence were estimated by Poisson Regression. RESULTS The incidence of violence during postpartum was 9.3% (95%CI 7.0;12.0). Isolated psychological violence was the most common (4.3%; 95%CI 2.8;6.4). The overlapping of psychological with physical violence occurred at 3.3% (95%CI 2.0;5.3) and with physical and/or sexual in almost 2.0% (95%CI 0.8;3.0) of cases. The risk of partner violence during postpartum was increased for women with a low level of education (RR = 2.6; 95%CI 1.3;5.4), without own income (RR = 1.7; 95%CI 1.0;2.9) and those who perpetrated physical violence against their partner without being assaulted first (RR = 2.0; 95%CI 1.2;3.4), had a very controlling partner (RR = 2.5; 95%CI 1.1;5.8), and had frequent fights with their partner (RR = 1.7; 95%CI 1.0;2.9). CONCLUSIONS The high incidence of intimate partner violence during postpartum and its association with aspects of the relationship’s quality between the couple, demonstrated the need for public policies that promote conflict mediation and enable forms of empowerment for women to address the cycle of violence. PMID:26270012

  10. Incidence and risk factors of fractures in patients with rheumatoid arthritis: an Asian prospective cohort study.

    PubMed

    Kim, Dam; Cho, Soo-Kyung; Choi, Chan-Bum; Jun, Jae-Bum; Kim, Tae-Hwan; Lee, Hye-Soon; Lee, Jisoo; Lee, Shin-Seok; Yoo, Dae-Hyun; Yoo, Wan-Hee; Sung, Yoon-Kyoung; Bae, Sang-Cheol

    2016-09-01

    Rheumatoid arthritis (RA) patients have high risk for osteoporosis and fracture. We aimed to identify the incidence rate and risk factors of fractures in Asian RA patients. A total of 3557 RA patients in the KORean Observational study Network for Arthritis (KORONA) were included and observed over a mean follow-up of 18 months. A fracture was assessed as total, major, or minor fractures; major fracture was defined as a vertebral or hip fracture, and the other fractures were classified as minor fractures. The standardized incidence ratio (SIR) of fracture in RA patients was calculated compared with general population, and possible risk factors for fractures were explored using multivariable logistic regression analyses. A total of 194 patients with 215 fractures were observed, and the SIR of the total fracture in RA patients was 2.2 [95 % confidence interval (CI) 1.9-2.6]. The SIRs of major and minor fractures were 1.5 (CI 1.1-2.0) and 3.0 (CI 2.5-3.7), respectively. Advanced age [odds ratio (OR) 1.03, CI 1.02-1.05, p < 0.01] and having history of prior fracture (OR 2.17, CI 1.54-3.08, p < 0.01) were risk factors for total fractures. In addition, higher HAQ increased fracture risk (OR 2.02, CI 1.05-3.89, p = 0.04), whereas the use of bisphosphonate showed protective effect for future fractures (OR 0.34, CI 0.14-0.87, p = 0.02) in patients with osteoporosis. RA patients had a 2.2-fold increased risk of fractures as compared with general population. In Asian RA patients, advanced age and history of prior fracture were the most important risk factors for new fractures. PMID:26965417

  11. Incidence and risk factors for hypogammaglobulinemia in pediatric patients following allo-SCT.

    PubMed

    Frangoul, H; Min, E; Wang, W; Chandrasekhar, R; Calder, C; Evans, M; Manes, B; Bruce, K; Brown, V; Ho, R; Domm, J

    2013-11-01

    We evaluated the incidence and risk factors for hypogammaglobulinemia after allogeneic hematopoietic SCT (HSCT) in pediatric patients. Ig levels were measured pre-transplant, every 2 weeks until day 100 and then monthly post SCT in 185 patients undergoing myeloablative HSCT. Median age was 9 years; 142 (77%) had malignant disease and 114 (62%) received stem cells from an unrelated source. Hypogammaglobulinemia (IgG <500 mg/dL) developed in 143 (77%) of the patients at a median of 56 days (range 15-339) post SCT. The cumulative incidence of hypogammaglobulinemia at 1 year was higher among patients who developed acute GVHD (97% vs 54%, P<0.001), and for those receiving stem cells from an unrelated source (94% vs 51%, P<0.001). The cumulative incidence of TRM was significantly higher for patients with hypogammaglobulinemia (P=0.026). In multivariable analysis, lower pre-transplant IgG level (P<0.001), younger age (P=0.012), diagnosis of malignant disease (P<0.001), receiving unrelated SCT (P<0.001) and development of acute GVHD (P<0.001) were all significantly associated with higher risk of hypogammaglobulinemia post HSCT. We conclude that hypogammaglobulinemia is common, following allogeneic HSCT in pediatric patients, especially in those with malignant diseases, those who receive an unrelated transplant or patients who develop GVHD. PMID:23708706

  12. Incidence, Characteristics, Risk Factors, and Outcomes of Takotsubo Cardiomyopathy With and Without Ventricular Arrhythmia.

    PubMed

    Auzel, Olivier; Mustafic, Hazrije; Pillière, Rémy; El Mahmoud, Rami; Dubourg, Olivier; Mansencal, Nicolas

    2016-04-15

    Takotsubo cardiomyopathy (TC) is a medical entity mimicking an acute coronary syndrome (ACS). Ventricular arrhythmia (VA) in TC has been reported in small studies, leading to uncertain knowledge of its incidence. We sought to describe the characteristics, incidence, predictive factors, and outcomes of VA in patients presenting with TC. Over a 12-year period, we reviewed all patients (n = 5,484) referred to our coronary care unit for a suspicion of ACS. TC was diagnosed in 90 patients according to the Mayo Clinic criteria. Incidence of VA among TC was 10%. In multivariate analysis, the factors significantly associated with an increased risk of VA were syncope (p = 0.007), age <55 years (p = 0.008), atypical TC (p = 0.04), a troponin I peak >7 μg/L (p = 0.04), and dobutamine use during hospitalization (p = 0.04). During follow-up, there was no significant difference in mortality rate between patients with or without VA. In conclusion, VA occurred in 10% of patients at the acute phase of TC and independent predictive factors of VA were syncope, atypical pattern of TC, high troponin peak, dobutamine use, and a relatively young age in a female and menopausal population. During the acute phase, identification of high-risk patients with VA allows better management, with electrocardiographic monitoring and therapeutic intervention in the coronary care unit. PMID:26874546

  13. INCIDENCE AND RISK FACTORS FOR CHRONIC PELVIC PAIN AFTER HYSTEROSCOPIC STERILIZATION

    PubMed Central

    YUNKER, Amanda C.; RITCH, Jessica M. B.; ROBINSON, Erica F.; GOLISH, Cara T.

    2014-01-01

    Objective To investigate the incidence and pre-operative risk factors for developing pelvic pain after hysteroscopic sterilization using the Essure™ micro-inserts Design Retrospective cohort study (Canadian Task Force classification II-2). Setting University Medical Center Patients A total of 458 patients who underwent hysteroscopic sterilization with Essure™ between January 1, 2005 and June 30, 2012. Results The incidence of acute pelvic pain after hysteroscopic sterilization was 8.1%, and the incidence of persistent pain after 3 months post-procedure was 4.2%. The range of presentation with pain was 1 to 469 days, with a mean time of 56 days. Of the patients that developed chronic pelvic pain after the procedure, 75% presented within 130 days of the procedure. Patients with previous diagnoses of any chronic pain (chronic pelvic pain, chronic low back pain, chronic headache, and fibromyalgia) were more likely to report both acute pain (OR 6.81, 95% CI 2.95,15.73) and chronic pain (OR 6.15, 95% CI 2.10,18.10) after hysteroscopic sterilization. Conclusions Pelvic pain may develop after hysteroscopic sterilization. Patients with preexisting chronic pain diagnoses may be at increased risk of developing pelvic pain after the procedure. Fifty percent of new pelvic pain after Essure™ placement will resolve by 3 months. PMID:24952343

  14. Incidence and Risk Factors of Striae Distensae Following Breast Augmentation Surgery: A Cohort Study

    PubMed Central

    Valente, Denis Souto; Zanella, Rafaela Koehler; Doncatto, Leo Francisco; Padoin, Alexandre Vontobel

    2014-01-01

    Background The significant increase in the popularity of breast augmentation surgeries has led to an increase in the number and types of complications; among these is the postoperative occurrence of Striae Distensae (SD). The objective of this study was to investigate the incidence of SD and describing its occurrence in association with age, breast implant volume, history of SD, history of pregnancies and breastfeeding, body mass index (BMI), changes in postoperative weight, smoking habits, and use of oral contraceptives. Methods A cohort study was conducted and the patient data from a specific social group that underwent augmentation mammaplasty with silicone breast implants in a private clinic was analyzed. Results 563 patients entered the cohort, while 538 completed the study. The SD incidence was 7.06%. The risk was almost the double at 22–28 years of age and triple in women of 21 years of age or less. The women who did not use oral contraceptives were 2.59 times more likely of developing SD. A higher incidence of SD was observed among those with normal or low BMI values, smokers, and in those who had implants larger than 300 ml. Conclusions Young age, larger implant volumes, smoking, and normal or low BMI values were the risk factors responsible for the development of SD; while using oral contraceptives was found to be a protective factor. PMID:24844230

  15. Education and risk of incident dementia during the premotor and motor phases of essential tremor (NEDICES).

    PubMed

    Benito-León, Julián; Contador, Israel; Louis, Elan D; Cosentino, Stephanie; Bermejo-Pareja, Félix

    2016-08-01

    Individuals with late-onset essential tremor (ET) (e.g., older adults) seem to have an increased prevalence of mild cognitive impairment and dementia, and a higher risk of incident dementia. It is well-known that education has a protective role against dementia in individuals without a pre-existing neurologic disorder, but evidence regarding the maintenance of this effect during the premotor and motor phases of ET is unknown. Our aim was to determine the influence of education on the risk of dementia in a population-based cohort of ET patients and controls. In a prospective study (Neurological Disorders in Central Spain), participants ≥65 years old were evaluated twice: at baseline (1994-1995) and at follow-up (1997-1998). There were 3 groups: premotor (i.e., participants first diagnosed with incident ET at follow-up), prevalent ET (i.e., participants diagnosed with ET at baseline and at follow-up), and controls. Participants were stratified into lower education (≤primary studies) versus higher education (≥secondary studies) categories. Dementia risk was estimated using Cox proportional-hazards models (higher education control group = reference category). Among the participants, 3878 had a mean duration of follow-up of 3.2 years. Eight (16.7%) of 48 lower education premotor ET patients developed incident dementia versus 1 (3.3%) of 30 higher education premotor ET patients, 9 (7.1%) of 126 lower education prevalent ET patients, 7 (8.8%) of 80 higher education prevalent ET patients, and 92 (4.9%) of 1892 lower education controls (P < 0.001). In comparison to the higher education controls, the adjusted hazard ratios for incident dementia were 5.84 (lower education premotor ET, P < 0.001); 1.36 (higher education premotor ET, P = 0.76); 2.13 (lower education prevalent ET, P = 0.04); 2.79 (higher education prevalent ET, P = 0.01); and 1.66 (lower education controls, P = 0.01). Our results suggest that a higher educational attainment may ameliorate the risk

  16. Risk factors for incident HIV infection among antenatal mothers in rural Eastern Cape, South Africa

    PubMed Central

    Businge, Charles Bitamazire; Longo-Mbenza, Benjamin; Mathews, Verona

    2016-01-01

    Background The prevalence of HIV among antenatal clients in South Africa has remained at a very high rate of about 29% despite substantial decline in several sub-Saharan countries. There is a paucity of data on risk factors for incident HIV infection among antenatal mothers and women within the reproductive age bracket in local settings in the Eastern Cape, South Africa. Objective To establish the risk factors for incident HIV infection among antenatal clients aged 18–49 years attending public antenatal clinics in rural Eastern Cape, South Africa. Design This was an unmatched case–control study carried out in public health antenatal clinics of King Sabata District Municipality between January and March 2014. The cases comprised 100 clients with recent HIV infection; the controls were 200 HIV-negative antenatal clients. Socio-demographic, sexual, and behavioral data were collected using interviewer-administered questionnaires adapted from the standard DHS5 women's questionnaire. Multivariate logistic regression models were used to identify the independent risk factors for HIV infection. A p<0.05 was considered statistically significant. Results The independent risk factors for incident HIV infection were economic dependence on the partner, having older male partners especially among women aged ≤20 years, and sex under the influence of alcohol. Conclusions Therefore, effective prevention of HIV among antenatal mothers in KSDM must target the improvement of the economic status of women, thereby reducing economic dependence on their sexual partners; address the prevalent phenomenon of cross-generation sex among women aged <20 years; and regulate the brewing, marketing, and consumption of alcohol. PMID:26800877

  17. Incidence and risk factors of prolonged mechanical ventilation in neuromuscular scoliosis surgery.

    PubMed

    Udink ten Cate, Floris E A; van Royen, Barend J; van Heerde, Marc; Roerdink, Dianne; Plötz, Frans B

    2008-07-01

    Patients with neuromuscular scoliosis (NMS) are frequently considered at high risk for postoperative complications based on their underlying disease and comorbidities. Postoperative complications include prolonged mechanical ventilation (MV), defined longer than 72 h, at the paediatric intensive care unit. The objectives of this retrospective study were to assess the incidence of prolonged MV in patients with NMS following scoliosis surgery and to identify predictive risk factors. A total of 46 consecutive patients underwent surgical spinal fusion and instrumentation for progressive NMS. Prolonged MV was required in seven of 46 patients (15%). The only risk factor for prolonged MV was a decreased preoperative pulmonary function. Forced expired volume in 1 s and vital capacity were significantly decreased in patients with MV >72 h compared with patients with MV <72 h. Routine preoperative pulmonary function testing may reveal important information with regard to restrictive lung disease in the preoperative assessment of patients with NMS and predict the early postoperative clinical course. PMID:18525479

  18. Reducing the Incidence of Postoperative Nausea and Vomiting Begins With Risk Screening: An Evaluation of the Evidence.

    PubMed

    Smith, Christopher A; Ruth-Sahd, Lisa

    2016-04-01

    Postoperative nausea and vomiting (PONV) is a daily concern for patients and perianesthesia nurses. PONV is experienced by approximately one third of all surgical patients. Identification of patients at risk for PONV through preoperative risk assessment is an effective means in reducing the incidence of PONV. Perianesthesia nurses are positioned to implement such risk assessments by using simplified risk scores to identify moderate to high-risk patients. Risk assessment allows for facilitation of targeted prophylaxis which positively impacts the patients' surgical outcome and experience. Targeted prophylaxis is efficacious in reducing the institutional incidence of PONV which decreases resource utilization and cost. The perianesthesia nurse is the crucial component in minimizing the PONV in the post-surgical patient. This evaluation of the evidence reveals that preoperative PONV risk screening leads to decreased incidence of PONV for the surgical patient, improves patient satisfaction and reduces postoperative complications. PMID:27037170

  19. Acute Lung Injury Complicating Blood Transfusion in Post-Partum Hemorrhage: Incidence and Risk Factors

    PubMed Central

    Teofili, Luciana; Bianchi, Maria; Zanfini, Bruno A.; Catarci, Stefano; Sicuranza, Rossella; Spartano, Serena; Zini, Gina; Draisci, Gaetano

    2014-01-01

    Background We retrospectively investigated the incidence and risk factors for transfusion-related acute lung injury (TRALI) among patients transfused for post-partum hemorrhage (PPH). Methods We identified a series of 71 consecutive patients with PPH requiring the urgent transfusion of three or more red blood cell (RBC) units, with or without transfusion of fresh frozen plasma (FFP) and/or platelets (PLT). Clinical records were then retrieved and examined for respiratory distress events. According to the 2004 consensus definition, cases of new-onset hypoxemia, within 6 hours after transfusion, with bilateral pulmonary changes, in the absence of cardiogenic pulmonary edema were identified as TRALI. If an alternative risk factor for acute lung injury was present, possible TRALI was diagnosed. Results Thirteen cases of TRALI and 1 case of possible TRALI were identified (overall incidence 19.7%). At univariate analysis, patients with TRALI received higher number of RBC, PLT and FFP units and had a longer postpartum hospitalization. Among the diseases occurring in pregnancy- and various pre-existing comorbidities, only gestational hypertension and pre-eclampsia, significantly increased the risk to develop TRALI (p = 0.006). At multivariate analysis including both transfusion- and patient-related risk factors, pregnancy-related, hypertensive disorders were confirmed to be the only predictors for TRALI, with an odds ratio of 27.7 ( 95% CI 1.27–604.3, p=0.034). Conclusions Patients suffering from PPH represent a high-risk population for TRALI. The patients with gestational hypertension and pre-eclampsia, not receiving anti-hypertensive therapy, have the highest risk. Therefore, a careful monitoring of these patients after transfusions is recommended. PMID:25408855

  20. The emerging molecular pathogenesis of neuroblastoma: implications for improved risk assessment and targeted therapy

    PubMed Central

    2009-01-01

    Neuroblastoma is one of the most common solid tumors of childhood, arising from immature sympathetic nervous system cells. The clinical course of patients with neuroblastoma is highly variable, ranging from spontaneous regression to widespread metastatic disease. Although the outcome for children with cancer has improved considerably during the past decades, the prognosis of children with aggressive neuroblastoma remains dismal. The clinical heterogeneity of neuroblastoma mirrors the biological and genetic heterogeneity of these tumors. Ploidy and MYCN amplification have been used as genetic markers for risk stratification and therapeutic decision making, and, more recently, gene expression profiling and genome-wide DNA copy number analysis have come into the picture as sensitive and specific tools for assessing prognosis. The applica tion of new genetic tools also led to the discovery of an important familial neuroblastoma cancer gene, ALK, which is mutated in approximately 8% of sporadic tumors, and genome-wide association studies have unveiled loci with risk alleles for neuroblastoma development. For some of the genomic regions that are deleted in some neuroblastomas, on 1p, 3p and 11q, candidate tumor suppressor genes have been identified. In addition, evidence has emerged for the contribution of epigenetic disturbances in neuroblastoma oncogenesis. As in other cancer entities, altered microRNA expression is also being recognized as an important player in neuroblastoma. The recent successes in unraveling the genetic basis of neuroblastoma are now opening opportunities for development of targeted therapies. PMID:19638189

  1. Incidence, Outcomes, and Risk Factors of Community-Acquired and Hospital-Acquired Acute Kidney Injury

    PubMed Central

    Hsu, Chien-Ning; Lee, Chien-Te; Su, Chien-Hao; Wang, Yu-Ching Lily; Chen, Hsiao-Ling; Chuang, Jiin-Haur; Tain, You-Lin

    2016-01-01

    Abstract The disease burden and outcomes of community-acquired (CA-) and hospital-acquired acute kidney injury (HA-AKI) are not well understood. The aim of the study was to investigate the incidence, outcomes, and risk factors of AKI in a large Taiwanese adult cohort. This retrospective cohort study examined 734,340 hospital admissions from a group of hospitals within an organization in Taiwan between January 1, 2010 and December 31, 2014. Patients with AKI at discharge were classified as either CA- or HA-AKI based on the RIFLE (risk, injury, failure, loss of function, end stage of kidney disease) classification criteria. Outcomes were in-hospital mortality, dialysis, recovery of renal function, and length of stay. Risks of developing AKI were determined using multivariate logistic regression based on demographic and baseline clinical characteristics and nephrotoxin use before admission. AKI occurred in 1.68% to 2% hospital discharges among adults without and with preexisting chronic kidney disease (CKD), respectively. The incidence of CA-AKI was 17.25 and HA-AKI was 8.14 per 1000 admissions. The annual rate of CA-AKI increased from 12.43 to 19.96 per 1000 people, but the change in HA-AKI was insignificant. Comparing to CA-AKI, those with HA-AKI had higher levels of in-hospital mortality (26.07% vs 51.58%), mean length of stay (21.25 ± 22.35 vs 35.84 ± 34.62 days), and dialysis during hospitalization (1.45% vs 2.06%). Preexisting systemic diseases, including CKD were associated with increased risks of CA-AKI, and nephrotoxic polypharmacy increased risk of both CA- and HA-AKI. Patients with HA-AKI had more severe outcomes than patients with CA-AKI, and demonstrated different spectrum of risk factors. Although patients with CA-AKI with better outcomes, the incidence increased over time. It is also clear that optimal preventive and management strategies of HA- and CA-AKI are urgently needed to limit the risks in susceptible individuals. PMID:27175701

  2. SU-E-T-208: Incidence Cancer Risk From the Radiation Treatment for Acoustic Neuroma Patient

    SciTech Connect

    Kim, D; Chung, W; Shin, D; Yoon, M

    2014-06-01

    Purpose: The present study aimed to compare the incidence risk of a secondary cancer from therapeutic doses in patients receiving intensitymodulated radiotherapy (IMRT), volumetric modulated arc therapy (VMAT), and stereotactic radiosurgery (SRS). Methods: Four acoustic neuroma patients were treated with IMRT, VMAT, or SRS. Their incidnece excess relative risk (ERR), excess absolute risk (EAR), and lifetime attributable risk (LAR) were estimated using the corresponding therapeutic doses measured at various organs by radio-photoluminescence glass dosimeters (RPLGD) placed inside a humanoid phantom. Results: When a prescription dose was delivered in the planning target volume of the 4 patients, the average organ equivalent doses (OED) at the thyroid, lung, normal liver, colon, bladder, prostate (or ovary), and rectum were measured. The OED decreased as the distance from the primary beam increased. The thyroid received the highest OED compared to other organs. A LAR were estimated that more than 0.03% of AN patients would get radiation-induced cancer. Conclusion: The tyroid was highest radiation-induced cancer risk after radiation treatment for AN. We found that LAR can be increased by the transmitted dose from the primary beam. No modality-specific difference in radiation-induced cancer risk was observed in our study.

  3. Investigating the Contribution of Common Genetic Variants to the Risk and Pathogenesis of ADHD

    PubMed Central

    Hamshere, Marian; Holmans, Peter; Langley, Kate; Zaharieva, Irina; Hawi, Ziarah; Kent, Lindsey; Gill, Michael; Williams, Nigel; Owen, Michael J.; O'Donovan, Michael

    2012-01-01

    Objective: A major motivation for seeking disease-associated genetic variation is to identify novel risk processes. Although rare copy number variants (CNVs) appear to contribute to attention deficit hyperactivity disorder (ADHD), common risk variants (single-nucleotide polymorphisms [SNPs]) have not yet been detected using genome-wide association studies (GWAS). This raises the concern as to whether future larger-scale, adequately powered GWAS will be worthwhile. The authors undertook a GWAS of ADHD and examined whether associated SNPs, including those below conventional levels of significance, influenced the same biological pathways affected by CNVs. Method: The authors analyzed genome-wide SNP frequencies in 727 children with ADHD and 5,081 comparison subjects. The gene sets that were enriched in a pathway analysis of the GWAS data (the top 5% of SNPs) were tested for an excess of genes spanned by large, rare CNVs in the children with ADHD. Results: No SNP achieved genome-wide significance levels. As previously reported in a subsample of the present study, large, rare CNVs were significantly more common in case subjects than comparison subjects. Thirteen biological pathways enriched for SNP association significantly overlapped with those enriched for rare CNVs. These included cholesterol-related and CNS development pathways. At the level of individual genes, CHRNA7, which encodes a nicotinic receptor subunit previously implicated in neuropsychiatric disorders, was affected by six large duplications in case subjects (none in comparison subjects), and SNPs in the gene had a gene-wide p value of 0.0002 for association in the GWAS. Conclusions: Both common and rare genetic variants appear to be relevant to ADHD and index-shared biological pathways. PMID:22420046

  4. Incidence of acute volleyball injuries: a prospective cohort study of injury mechanisms and risk factors.

    PubMed

    Bahr, R; Bahr, I A

    1997-06-01

    The purpose of the study was to examine the incidence and mechanisms of acute volleyball injuries, with particular reference to possible risk factors for ankle injuries. Coaches and players in the top two divisions of the Norwegian Volleyball Federation were asked to keep records of exposure time and all acute volleyball injuries causing a player to miss at least one playing day during one season. We found 89 injuries among 272 players during 51588 player hours, 45837 h of training and 5751 h of match play. The total injury incidence was 1.7 +/- 0.2 per 1000 h of play, 1.5 +/- 0.2 during training and 3.5 +/- 0.8 during match play. The ankle (54%) was the most commonly injured region, followed by the lower back (11%), knee (8%), shoulder (8%) and fingers (7%). Of the ankle injuries, 79% were recurrences, and the relative risk of injury was 3.8 (P < 0.0001) for previously injured ankles (38 of 232) vs. non-injured ankles (10 of the 234). Moreover, a reinjury was observed in 21 of the 50 ankles that had suffered an ankle sprain within the last 6 months (42.0 +/- 7.0%; risk ratio: 9.8 vs. uninjured ankles; P < 0.000001). The data indicate that external supports should be worn for 6-12 months after an ankle sprain and that specific injury prevention programs may be developed for ankle sprains in volleyball. PMID:9200321

  5. Incident Major Depressive Episodes increase the severity and risk of apathy in HIV infection

    PubMed Central

    Kamat, Rujvi; Cattie, Jordan E.; Marcotte, Thomas D.; Woods, Steven Paul; Franklin, Donald R.; Corkran, Stephanie H.; Ellis, Ronald J.; Grant, Igor; Heaton, Robert K.

    2015-01-01

    Apathy and depression are inter-related yet separable and prevalent neuropsychiatric disturbances in persons infected with HIV. In the present study of 225 HIV+ persons, we investigated the role of an incident depressive episode in changes in apathy. Participants completed the apathy subscale of the Frontal Systems Behavior Scale during a detailed neuropsychiatric and neuromedical evaluation at visit 1 and again at approximately a 14 month follow-up. The Composite International Diagnostic Interview was used to obtain diagnoses of a new major depressive disorder. At their follow-up visit, participants were classified into four groups depending on their visit 1 elevation in apathy and new major depressive episode (MDE) status. Apathetic participants at baseline with a new MDE (n=23) were at risk for continued, clinically elevated apathy at follow-up, although severity of symptoms did not increase. Of the 144 participants without clinically elevated apathy at visit 1, those who developed a new MDE (n=16) had greater apathy symptomatology at follow-up than those without MDE. These findings suggest that HIV+ individuals, who do not as yet present with elevated apathy, may be at greater risk of elevated psychiatric distress should they experience a new/recurrent depressive episode. Thus, in the context of previous findings, it appears that although apathy and depression are separable constructs, they interact such that a new depressive episode is a risk factor for incident apathy. PMID:25679203

  6. Fluctuation analysis-based risk assessment for respiratory virus activity and air pollution associated asthma incidence.

    PubMed

    Liao, Chung-Min; Hsieh, Nan-Hung; Chio, Chia-Pin

    2011-08-15

    Asthma is a growing epidemic worldwide. Exacerbations of asthma have been associated with bacterial and viral respiratory tract infections and air pollution. We correlated the asthma admission rates with fluctuations in respiratory virus activity and traffic-related air pollution, namely particulate matter with an aerodynamic diameter ≤ 10 μm (PM₁₀), nitrogen dioxide (NO₂), carbon monoxide (CO), sulfur dioxide (SO₂), and ozone (O₃). A probabilistic risk assessment framework was developed based on a detrended fluctuation analysis to predict future respiratory virus and air pollutant associated asthma incidence. Results indicated a strong association between asthma admission rate and influenza (r=0.80, p<0.05) and SO₂ level (r=0.73, p<0.05) in Taiwan in the period 2001-2008. No significant correlation was found for asthma admission and PM₁₀, O₃, NO₂, and CO. The proposed fluctuation analysis provides a simple correlation exponent describing the complex interactions of respiratory viruses and air pollutants with asthma. This study revealed that there was a 95% probability of having exceeded 2987 asthma admissions per 100,000 population. It was unlikely (30% probability) that the asthma admission rate exceeded 3492 per 100,000 population. The probability of asthma admission risk can be limited to below 50% by keeping the correlation exponent of influenza to below 0.9. We concluded that fluctuation analysis based risk assessment provides a novel predictor of asthma incidence. PMID:21663946

  7. Non-melanoma skin cancer in Portuguese kidney transplant recipients - incidence and risk factors*

    PubMed Central

    Pinho, André; Gouveia, Miguel; Cardoso, José Carlos; Xavier, Maria Manuel; Vieira, Ricardo; Alves, Rui

    2016-01-01

    Background Cancer is currently among the three leading causes of death after solid organ transplantation and its incidence is increasing. Non-melanoma skin cancer - squamous cell carcinoma and basal cell carcinoma - is the most common malignancy found in kidney transplant recipients (KTRs). The incidence of non-melanoma skin cancer in KTRs has not been extensively studied in Portugal. Objectives To determine the incidence of non-melanoma skin cancer in KTRs from the largest Portuguese kidney transplant unit; and to study risk factors for non-melanoma skin cancer. Methods Retrospective analysis of clinical records of KTRs referred for the first time for a dermatology consultation between 2004 and 2013. A case-control study was performed on KTRs with and without non-melanoma skin cancer. Results We included 288 KTRs with a median age at transplantation of 47 years, a male gender predominance (66%) and a median transplant duration of 3.67 years. One fourth (n=71) of KTRs developed 131 non-melanoma skin cancers, including 69 (53%) squamous cell carcinomas and 62 (47%) basal cell carcinomas (ratio squamous cell carcinoma: basal cell carcinoma 1.11), with a mean of 1.85 neoplasms per patient. Forty percent of invasive squamous cell carcinomas involved at least two clinical or histological high-risk features. The following factors were associated with a higher risk of non-melanoma skin cancer: an older age at transplantation and at the first consultation, a longer transplant duration and the presence of actinic keratosis. KTRs treated with azathioprine were 2.85 times more likely to develop non-melanoma skin cancer (p=0.01). Conclusion Non-melanoma skin cancer was a common reason for dermatology consultation in Portuguese KTRs. It is imperative for KTRs to have access to specialized dermatology consultation for early referral and treatment of skin malignancies. PMID:27579740

  8. Blood pressure and risk of cancer incidence and mortality in the Metabolic Syndrome and Cancer Project.

    PubMed

    Stocks, Tanja; Van Hemelrijck, Mieke; Manjer, Jonas; Bjørge, Tone; Ulmer, Hanno; Hallmans, Göran; Lindkvist, Björn; Selmer, Randi; Nagel, Gabriele; Tretli, Steinar; Concin, Hans; Engeland, Anders; Jonsson, Håkan; Stattin, Pär

    2012-04-01

    Observational studies have shown inconsistent results for the association between blood pressure and cancer risk. We investigated the association in 7 cohorts from Norway, Austria, and Sweden. In total, 577799 adults with a mean age of 44 years were followed for, on average, 12 years. Incident cancers were 22184 in men and 14744 in women, and cancer deaths were 8724 and 4525, respectively. Cox regression was used to calculate hazard ratios of cancer per 10-mmHg increments of midblood pressure, which corresponded with 0.7 SDs and, for example, an increment of systolic/diastolic blood pressure of 130/80 to 142/88 mmHg. All of the models used age as the time scale and were adjusted for possible confounders, including body mass index and smoking status. In men, midblood pressure was positively related to total incident cancer (hazard ratio per 10 mmHg increment: 1.07 [95% CI: 1.04-1.09]) and to cancer of the oropharynx, colon, rectum, lung, bladder, kidney, malignant melanoma, and nonmelanoma skin cancer. In women, midblood pressure was not related to total incident cancer but was positively related to cancer of the liver, pancreas, cervix, uterine corpus, and malignant melanoma. A positive association was also found for cancer mortality, with HRs per 10-mmHg increment of 1.12 (95% CI: 1.08-1.15) for men and 1.06 (95% CI: 1.02-1.11) for women. These results suggest a small increased cancer risk overall in men with elevated blood pressure level and a higher risk for cancer death in men and women. PMID:22353615

  9. Gastric cancer in Africa: what do we know about incidence and risk factors?

    PubMed

    Asombang, Akwi W; Kelly, Paul

    2012-02-01

    Gastric cancer is a major contributor to mortality worldwide, yet its incidence varies widely around the world in a way which our current understanding of aetiology cannot fully explain. Incidence data from Africa are weak, reflecting poor diagnostic resources, but there are firm data on intestinal metaplasia and gastric atrophy which are important steps in the carcinogenesis pathway. The available registry data suggest that incidence is unlikely to be dramatically different from Europe or North America. Helicobacter pylori infection is an important permissive factor in the development of cancer, but H. pylori seroprevalence is high all over Africa and cannot clearly be correlated with cancer. However, there is evidence that specific bacterial virulence genes, particularly vacA and iceA allele1, do contribute to cancer risk. Intestinal metaplasia and gastric atrophy have been the focus of twelve studies and are common in Africa. Epstein-Barr virus, which causes 10% of cancer worldwide, is the focus of only one African study. Work in other continents demonstrates that other risk factors apply only to one or other of the two major histological types, intestinal and diffuse. Diet, smoking, alcohol and salt intake predispose to the intestinal type of cancer, but genetic factors predispose to the diffuse type. There is a pressing need for information on the histological types occurring in Africa, and their associated risk factors. Most urgently, information on dietary predisposition to cancer is required to inform public health policy with respect to the demographic transition (urbanisation and lifestyle changes) which is occurring all over the continent. PMID:22136952

  10. Incidence and risk factors for retinopathy of prematurity in extreme low birth weight Chinese infants.

    PubMed

    Yau, Gordon S K; Lee, Jacky W Y; Tam, Victor T Y; Liu, Catherine C L; Chu, Benjamin C Y; Yuen, Can Y F

    2015-06-01

    The objective of this study is to determine the incidence and risk factors of retinopathy of prematurity (ROP) in extremely low birth weight (ELBW) Chinese infants. A retrospective medical record review of all ELBW (≤1,000 g) neonates screened for ROP from 2007 to 2012 was performed in Hong Kong. ROP screening was conducted at 2 neonatal intensive care units by 3 pediatric ophthalmologists using the Royal College of Ophthalmologists ROP guideline and the International Classification of ROP. Maternal and neonatal covariates were analyzed using univariate and multivariate regression analyses for both ROP and Type 1 ROP. In 131 ELBW Chinese infants, the mean gestational age (GA) and birth weight (BW) were 27.3 ± 3.3 weeks and 806.9 ± 133.7 g, respectively. The incidence of ROP and Type 1 ROP was 53.4 and 14.5 %, respectively. For ROP, a lighter BW, smaller GA, vaginal delivery, postnatal hypotension, inotrope use, bronchopulmonary dysplasia, surfactant use, invasive mechanical ventilation, and supplementary oxygen were independent risk factors for ROP, while PET was protective (P ≤ 0.02). On multivariate analysis, a smaller GA was a risk factor, while PET and congenital heart disease were protective for ROP development (P ≤ 0.01). For Type 1 ROP, a lighter BW, smaller GA, surfactant use, and invasive mechanical ventilation were independent risk factors for ROP, while PET was protective (P ≤ 0.02). There were no significant covariates on multivariate analysis for Type 1 ROP. In ELBW, preterm Chinese infants, a smaller GA was a risk factor for ROP, while PET and congenital heart disease were protective for ROP development in multivariate analysis. PMID:24898774

  11. Neutron equivalent doses and associated lifetime cancer incidence risks for head & neck and spinal proton therapy

    NASA Astrophysics Data System (ADS)

    Athar, Basit S.; Paganetti, Harald

    2009-08-01

    In this work we have simulated the absorbed equivalent doses to various organs distant to the field edge assuming proton therapy treatments of brain or spine lesions. We have used computational whole-body (gender-specific and age-dependent) voxel phantoms and considered six treatment fields with varying treatment volumes and depths. The maximum neutron equivalent dose to organs near the field edge was found to be approximately 8 mSv Gy-1. We were able to clearly demonstrate that organ-specific neutron equivalent doses are age (stature) dependent. For example, assuming an 8-year-old patient, the dose to brain from the spinal fields ranged from 0.04 to 0.10 mSv Gy-1, whereas the dose to the brain assuming a 9-month-old patient ranged from 0.5 to 1.0 mSv Gy-1. Further, as the field aperture opening increases, the secondary neutron equivalent dose caused by the treatment head decreases, while the secondary neutron equivalent dose caused by the patient itself increases. To interpret the dosimetric data, we analyzed second cancer incidence risks for various organs as a function of patient age and field size based on two risk models. The results show that, for example, in an 8-year-old female patient treated with a spinal proton therapy field, breasts, lungs and rectum have the highest radiation-induced lifetime cancer incidence risks. These are estimated to be 0.71%, 1.05% and 0.60%, respectively. For an 11-year-old male patient treated with a spinal field, bronchi and rectum show the highest risks of 0.32% and 0.43%, respectively. Risks for male and female patients increase as their age at treatment time decreases.

  12. Incidence and risk factors for retinopathy of prematurity in multiple gestations: a Chinese population study.

    PubMed

    Yau, Gordon S K; Lee, Jacky W Y; Tam, Victor T Y; Yip, Stan; Cheng, Edith; Liu, Catherine C L; Chu, Benjamin C Y; Wong, Ian Y H

    2015-05-01

    To determine the incidence and risk factors of retinopathy of prematurity (ROP) among new-born Chinese infants of multiple gestations.A retrospective review of medical records was performed for all neonates of multiple gestations screened for ROP between January 2007 and December 2012 in 2 neonatal intensive care units in Hong Kong. Screening was offered to very low birth weight (VLBW; ≤1500 g) and/or preterm (gestation ≤32 weeks) neonates using the Royal College of Ophthalmologists ROP guideline and the International Classification of ROP by 3 pediatric ophthalmologists. Maternal and neonatal covariates were analyzed using univariate and multivariate regression analyses for both ROP and Type 1 ROP.A total of 153 Chinese infants of multiple gestations were included in the study. The mean gestational age (GA) was 30.8 ± 2.4 weeks and the mean birth weight (BW) was 1284.8 ± 267.4 g. The incidence of ROP and Type 1 ROP was 11.8% and 3.9%, respectively. On univariate analysis, younger GA, lighter birth weight, postnatal hypotension, inotropes use, bronchopulmonary disease, and intraventricular hemorrhage were common independent risk factors for the development of ROP and Type 1 ROP (all P ≤ 0.04). On multivariate analysis, younger GA, surfactant use, invasive mechanical ventilation, higher mean oxygen concentration, thrombocytopenia, intraventricular hemorrhage, total parental nutrition, and hypoglycemia were significant risk factors for ROP. For Type 1 ROP, there were no significant dependent risk factors.In preterm Chinese infants born from multiple gestations, prematurity, lighter weight, postnatal hypotension, inotropes use, bronchopulmonary dysplasia, and an intraventricular hemorrhage were common independent risk factors for the development of ROP and Type 1 ROP. PMID:25950699

  13. Incidence and Risks of Congenital Anomalies of Kidney and Urinary Tract in Newborns

    PubMed Central

    Tain, You-Lin; Luh, Hsing; Lin, Ching-Yuang; Hsu, Chien-Ning

    2016-01-01

    Abstract Congenital anomalies of the kidney and urinary tract (CAKUT) are 1 of the major factors in young adults needing renal replacement therapy, but there is little extensive assessment of their incidence and risk factors. This study aimed to evaluate trends in the incidence of and risk factors for CAKUT among all births in Taiwan. This population-based case–control study design was conducted using the Taiwan national births registry, which contains detailed information about maternal health and characteristics of newborns, supplied by health professionals. Of 1,603,794 newborns registered between 2004 and 2014, 668 infants were reported to have CAKUT. Newborns without congenital anomalies were matched with CAKUT cases by birth year, month, and Apgar score in a ratio of 5:1. Odds ratio (OR) and 95% confidence interval (CI) for developing CAKUT were calculated using a conditional multivariate logistic regression model. The incidence of CAKUT was approximately 4.2 per 10,000 births. The adjusted ORs for CAKUT in newborns associated with maternal age of 20 to 29 (OR, 2.18; 95% CI, 1.11–4.28), or 30 to 39 (OR, 2.29; 95% CI, 1.17–4.51), maternal gestational diabetes (OR, 2.22, 95% CI, 1.06–4.67), maternal thalassemia/hemochromatosis (OR, 2.67; 95% CI, 1.35–5.27), polyhydramnios or oligohydramnios (OR, 9.16; 95% CI, 5.46–15.37), birth parity >1 (OR, 0.27; 95% CI, 0.15–0.50), having a gestational age <37 weeks (OR, 1.48; 95% CI, 1.23–1.78), and being a boy (OR, 1.83; 95% CI, 1.53–2.19). Infants of mother with gestational diabetes were more likely to have congenital anomalies, small gestational age (<37 weeks) and low birth weight. CAKUT are associated with several maternal health risk factors. As Taiwan has the highest prevalence and incidence rates of end-stage renal disease in the world, these findings strongly support the need to develop professional guidelines for prenatal counseling and management of women at risk of adverse birth outcomes, to

  14. The Risk Implications of Globalisation: An Exploratory Analysis of 105 Major Industrial Incidents (1971-2010).

    PubMed

    Beck, Matthias

    2016-03-01

    This paper revisits work on the socio-political amplification of risk, which predicts that those living in developing countries are exposed to greater risk than residents of developed nations. This prediction contrasts with the neoliberal expectation that market driven improvements in working conditions within industrialising/developing nations will lead to global convergence of hazard exposure levels. It also contradicts the assumption of risk society theorists that there will be an ubiquitous increase in risk exposure across the globe, which will primarily affect technically more advanced countries. Reviewing qualitative evidence on the impact of structural adjustment reforms in industrialising countries, the export of waste and hazardous waste recycling to these countries and new patterns of domestic industrialisation, the paper suggests that workers in industrialising countries continue to face far greater levels of hazard exposure than those of developed countries. This view is confirmed when a data set including 105 major multi-fatality industrial disasters from 1971 to 2000 is examined. The paper concludes that there is empirical support for the predictions of socio-political amplification of risk theory, which finds clear expression in the data in a consistent pattern of significantly greater fatality rates per industrial incident in industrialising/developing countries. PMID:26978378

  15. The Risk Implications of Globalisation: An Exploratory Analysis of 105 Major Industrial Incidents (1971–2010)

    PubMed Central

    Beck, Matthias

    2016-01-01

    This paper revisits work on the socio-political amplification of risk, which predicts that those living in developing countries are exposed to greater risk than residents of developed nations. This prediction contrasts with the neoliberal expectation that market driven improvements in working conditions within industrialising/developing nations will lead to global convergence of hazard exposure levels. It also contradicts the assumption of risk society theorists that there will be an ubiquitous increase in risk exposure across the globe, which will primarily affect technically more advanced countries. Reviewing qualitative evidence on the impact of structural adjustment reforms in industrialising countries, the export of waste and hazardous waste recycling to these countries and new patterns of domestic industrialisation, the paper suggests that workers in industrialising countries continue to face far greater levels of hazard exposure than those of developed countries. This view is confirmed when a data set including 105 major multi-fatality industrial disasters from 1971 to 2000 is examined. The paper concludes that there is empirical support for the predictions of socio-political amplification of risk theory, which finds clear expression in the data in a consistent pattern of significantly greater fatality rates per industrial incident in industrialising/developing countries. PMID:26978378

  16. Prevalence, incidence and risk factors of carpal tunnel syndrome in a large footwear factory.

    PubMed

    Roquelaure, Y; Mariel, J; Dano, C; Fanello, S; Penneau-Fontbonne, D

    2001-01-01

    The study was conducted to assess the prevalence and incidence of carpal tunnel syndrome (CTS) in a large modern footwear factory and to identify factors predictive of CTS. To this end, 199 workers were examined in 1996, and 162 of them were re-examined in 1997. Ergonomic and psychosocial risk factors of CTS were assessed by workpost analysis and self-administered questionnaire. The prevalence of CTS at baseline in 1996 and in 1997 was 16.6% (95%CI: 11.4-21.7) and 11.7% (95%CI: 6.7-16.8), respectively. The incidence rate of CTS in 1997 was 11.7% (95%CI: 6.7-7.8). No specific type of job performance was associated with CTS. Obesity (OR = 4.4; 95%CI: 1.1-17.1) and psychological distress at baseline (OR = 4.3; 95%CI: 1.0-18.6) were strongly predictive of CTS. Rapid trigger movements of the fingers were also predictive of CTS (OR = 3.8; 95%CI: 1.0-17.2). A strict control of thework by superiors was negatively associatedwith CTS (OR = 0.5; 95%CI: 0.2-1.3). The prevalence and incidence of CTS in this workforce were largely higher than in the general population and numerous industries. The study highlights the role of psychological distress in workers exposed to a high level of physical exposure and psychological demand. PMID:11885919

  17. Worldwide Increasing Incidence of Thyroid Cancer: Update on Epidemiology and Risk Factors

    PubMed Central

    Frasca, Francesco; Regalbuto, Concetto; Squatrito, Sebastiano; Vigneri, Riccardo

    2013-01-01

    Background. In the last decades, thyroid cancer incidence has continuously and sharply increased all over the world. This review analyzes the possible reasons of this increase. Summary. Many experts believe that the increased incidence of thyroid cancer is apparent, because of the increased detection of small cancers in the preclinical stage. However, a true increase is also possible, as suggested by the observation that large tumors have also increased and gender differences and birth cohort effects are present. Moreover, thyroid cancer mortality, in spite of earlier diagnosis and better treatment, has not decreased but is rather increasing. Therefore, some environmental carcinogens in the industrialized lifestyle may have specifically affected the thyroid. Among potential carcinogens, the increased exposure to medical radiations is the most likely risk factor. Other factors specific for the thyroid like increased iodine intake and increased prevalence of chronic autoimmune thyroiditis cannot be excluded, while other factors like the increasing prevalence of obesity are not specific for the thyroid. Conclusions. The increased incidence of thyroid cancer is most likely due to a combination of an apparent increase due to more sensitive diagnostic procedures and of a true increase, a possible consequence of increased population exposure to radiation and to other still unrecognized carcinogens. PMID:23737785

  18. Baseline subjective memory complaints associate with increased risk of incident dementia: the PREADVISE trial

    PubMed Central

    Abner, EL; Kryscio, RJ; Caban-Holt, AM; Schmitt, FA

    2015-01-01

    Background Subjective memory complaints reflect patient-identified deficits in memory and have been linked to increased risk of future dementia in nondemented (including cognitively intact) older adults. Objectives To assess the risk of incident dementia during follow-up for participants in the Prevention of Alzheimer’s Disease with Vitamin E and Selenium (PREADVISE) study who reported memory complaints at baseline. Design Double-blind, placebo controlled 2×2 randomized controlled trial that transformed into an observational cohort following discontinuation of supplementation in the SELECT parent trial. Setting PREADVISE participants were assessed at 130 local clinical study sites in the United States, Canada, and Puerto Rico during the controlled trial phase and were later followed by telephone from a centralized location during the observational phase. Participants PREADVISE enrolled a total of 7,547 nondemented men over the age of 60; 4,271 consented to participation in the observational study. Measurements Participants were interviewed at baseline for memory complaints. The Memory Impairment Screen (MIS) was administered to each participant at the annual memory screening. Participants who failed the MIS also received a more detailed neurocognitive assessment: an expanded Consortium to Establish a Registry in Alzheimer’s Disease (CERADe) neuropsychological battery was used during the RCT, and the modified Telephone Interview for Cognitive Status (TICS-m) was used during the observational study. Participants who failed the second screen were asked to have a memory work-up with a local physician and to share their medical records with PREADVISE. Subgroups of men who did not fail the MIS were also asked to complete the CERADe battery and TICS-m for validation purposes. Additional measures collected include self-reported medical history, medication use, and the AD8 Dementia Screening Test. Results After controlling for important risk factors for dementia, Cox

  19. Patient characteristics and risk factors of early and late death in incident peritoneal dialysis patients.

    PubMed

    Liu, Xinhui; Huang, Rong; Wu, Haishan; Wu, Juan; Wang, Juan; Yu, Xueqing; Yang, Xiao

    2016-01-01

    This study was conducted to identify key patient characteristics and risk factors for peritoneal dialysis (PD) mortality in terms of different time-point of death occurrence. The incident PD patients from January 1, 2006 to December 31, 2013 in our PD center were recruited and followed up until December 31, 2015. Patients who died in the early period (the first 3 months) were older, had higher neutrophil to lymphocyte ratio (N/L), serum phosphorus, and uric acid level, and had lower diastolic pressure, hemoglobin, serum albumin, and calcium levels. After adjustment of gender, age, and PD inception, higher N/L level [hazard ratio (HR) 1.115, P = 0.006], higher phosphorus lever (HR 1.391, P < 0.001), lower hemoglobin level (HR 0.596, P < 0.001), and lower serum albumin level (HR 0.382, P = 0.017) were risk factors for early mortality. While, presence of diabetes (HR 1.627, P = 0.001), presence of cardiovascular disease (HR 1.847, P < 0.001) and lower serum albumin level (HR 0.720, P = 0.023) were risk factors for late mortality (over 24 months). In conclusion, patient characteristics and risk factors associated with early and late mortality in incident PD patients were different, which indicated specific management according to patient characteristics at the initiation of PD should be established to improve PD patient survival. PMID:27576771

  20. Fractures of the Sacrum After Chemoradiation for Rectal Carcinoma: Incidence, Risk Factors, and Radiographic Evaluation

    SciTech Connect

    Kim, Han Jo; Boland, Patrick J.; Meredith, Dennis S.; Lis, Eric; Zhang Zhigang; Shi Weiji; Yamada, Yoshiya J.; Goodman, Karyn A.

    2012-11-01

    Purpose: Sacral insufficiency fractures after adjuvant radiation for rectal carcinoma can present similarly to recurrent disease. As a complication associated with pelvic radiation, it is important to be aware of the incidence and risk factors associated with sacral fractures in the clinical assessment of these patients. Methods and Materials: Between 1998 and 2007, a total of 582 patients with locally advanced rectal carcinoma received adjuvant chemoradiation and surgical excision. Of these, 492 patients had imaging studies available for review. Hospital records and imaging studies from all 492 patients were retrospectively evaluated to identify risk factors associated with developing a sacral insufficiency fracture. Results: With a median follow-up time of 3.5 years, the incidence of sacral fractures was 7.1% (35/492). The 4-year sacral fracture free rate was 0.91. Univariate analysis showed that increasing age ({>=}60 vs. <60 years), female sex, and history of osteoporosis were significantly associated with shorter time to sacral fracture (P=.01, P=.004, P=.001, respectively). There was no significant difference in the time to sacral fracture for patients based on stage, radiotherapy dose, or chemotherapy regimen. Multivariate analysis showed increasing age ({>=}60 vs. <60 years, hazard ratio [HR] = 2.50, 95% confidence interval [CI] = 1.22-5.13, P=.01), female sex (HR = 2.64, CI = 1.29-5.38, P=.008), and history of osteoporosis (HR = 3.23, CI = 1.23-8.50, P=.02) were independent risk factors associated with sacral fracture. Conclusions: Sacral insufficiency fractures after pelvic radiation for rectal carcinoma occur more commonly than previously described. Independent risk factors associated with fracture were osteoporosis, female sex, and age greater than 60 years.

  1. Patient characteristics and risk factors of early and late death in incident peritoneal dialysis patients

    PubMed Central

    Liu, Xinhui; Huang, Rong; Wu, Haishan; Wu, Juan; Wang, Juan; Yu, Xueqing; Yang, Xiao

    2016-01-01

    This study was conducted to identify key patient characteristics and risk factors for peritoneal dialysis (PD) mortality in terms of different time-point of death occurrence. The incident PD patients from January 1, 2006 to December 31, 2013 in our PD center were recruited and followed up until December 31, 2015. Patients who died in the early period (the first 3 months) were older, had higher neutrophil to lymphocyte ratio (N/L), serum phosphorus, and uric acid level, and had lower diastolic pressure, hemoglobin, serum albumin, and calcium levels. After adjustment of gender, age, and PD inception, higher N/L level [hazard ratio (HR) 1.115, P = 0.006], higher phosphorus lever (HR 1.391, P < 0.001), lower hemoglobin level (HR 0.596, P < 0.001), and lower serum albumin level (HR 0.382, P = 0.017) were risk factors for early mortality. While, presence of diabetes (HR 1.627, P = 0.001), presence of cardiovascular disease (HR 1.847, P < 0.001) and lower serum albumin level (HR 0.720, P = 0.023) were risk factors for late mortality (over 24 months). In conclusion, patient characteristics and risk factors associated with early and late mortality in incident PD patients were different, which indicated specific management according to patient characteristics at the initiation of PD should be established to improve PD patient survival. PMID:27576771

  2. Avascular necrosis of bone after allogeneic bone marrow transplantation: clinical findings, incidence and risk factors.

    PubMed

    Socié, G; Sélimi, F; Sedel, L; Frija, J; Devergie, A; Esperou Bourdeau, H; Ribaud, P; Gluckman, E

    1994-03-01

    In the present study we describe the incidence, clinical course, and management of avascular necrosis of bone following allogeneic bone marrow transplantation, and identify risk factors related to its development. All patients developing avascular necrosis of bone after allogeneic bone marrow transplantation between January 1974 and September 1992 were included in the analysis and were studied using the Hôpital Saint Louis Bone Marrow Transplant Database and hospital records. 27/727 allogeneic transplant recipients developed avascular necrosis leading to an 8.1% incidence at 5 years, by product limit estimate, ranging from 5% to 11.2%. Symptoms developed 119-1747 d (median 398 d) after transplantation. In these 27 patients a total of 52 joints were affected (mean 1.92 per patient, range 1-7). The hip joint was most often affected (69% of patients). All patients had joint pain that led to diagnosis by means of standard radiographs with or without the help of technetium-99 scans and/or magnetic resonance imaging. All but three patients received steroid therapy for acute graft-versus-host disease. Among 10 factors tested, three were shown to be significantly linked to an increased risk for developing avascular necrosis by multivariate analysis: male gender (relative risk (RR) 4.72, P = 0.002), age older than 16 (RR = 3.87, P = 0.004), and acute graft-versus-host disease requiring steroid therapy (RR = 6.30, P = 0.0002). 10 patients (37%) required joint replacement within 19 months (range 2-42) following diagnosis of avascular necrosis. In conclusion, avascular necrosis of bone is a frequent late complication of allogeneic bone marrow transplantation causing significant morbidity and requiring replacement surgery in one-third of affected patients. In this 18-year single-centre survey, older age, male gender and steroid therapy given for acute graft-versus-host disease were shown to independently increase the risk of avascular necrosis of bone. PMID:8043445

  3. Environmental and genetic risk factors and gene-environment interactions in the pathogenesis of chronic obstructive lung disease.

    PubMed Central

    Walter, R; Gottlieb, D J; O'Connor, G T

    2000-01-01

    Current understanding of the pathogenesis of chronic obstructive pulmonary disease (COPD), a source of substantial morbidity and mortality in the United States, suggests that chronic inflammation leads to the airways obstruction and parenchymal destruction that characterize this condition. Environmental factors, especially tobacco smoke exposure, are known to accelerate longitudinal decline of lung function, and there is substantial evidence that upregulation of inflammatory pathways plays a vital role in this process. Genetic regulation of both inflammatory responses and anti-inflammatory protective mechanisms likely underlies the heritability of COPD observed in family studies. In alpha-1 protease inhibitor deficiency, the only genetic disorder known to cause COPD, lack of inhibition of elastase activity, results in the parenchymal destruction of emphysema. Other genetic polymorphisms have been hypothesized to alter the risk of COPD but have not been established as causes of this condition. It is likely that multiple genetic factors interacting with each other and with a number of environmental agents will be found to result in the development of COPD. PMID:10931792

  4. Liver aminotransferases and risk of incident type 2 diabetes: a systematic review and meta-analysis.

    PubMed

    Kunutsor, Setor K; Apekey, Tanefa A; Walley, John

    2013-07-15

    We evaluated the associations of liver aminotransferases with risk of type 2 diabetes (T2D) in general populations by conducting a systematic review and meta-analysis of published prospective studies. Studies were identified in a literature search of PubMed, EMBASE, and Web of Science from 1950 through October 2012. Of the 2,729 studies reviewed, 17 studies involving 60,359 participants and 3,890 incident T2D events were included. All of the studies assessed associations between alanine aminotransferase (ALT) level and T2D, with heterogeneous findings (I(2) = 88%, 95% confidence interval (CI): 82, 92; P < 0.001). The pooled fully adjusted relative risk of T2D was 1.26 (95% CI: 1.14, 1.41) per 1-standard-deviation change in log baseline ALT level. This association became nonsignificant after trim-and-fill correction for publication bias. Nine studies evaluated associations between aspartate aminotransferase (AST) levels and T2D risk, with a corresponding relative risk of 1.02 (95% CI: 0.99, 1.04). The relative risk of T2D per 5-IU/L increase in ALT level was 1.16 (95% CI: 1.08, 1.25). Available data indicate moderate associations of ALT with risk of T2D events, which may be attributable to publication bias. There was no evidence for an increased risk of T2D with AST. Large prospective studies may still be needed to establish the magnitude and nature of these associations. PMID:23729682

  5. Gender difference in apolipoprotein E-associated risk for familial Alzheimer disease: a possible clue to the higher incidence of Alzheimer disease in women.

    PubMed Central

    Payami, H.; Zareparsi, S.; Montee, K. R.; Sexton, G. J.; Kaye, J. A.; Bird, T. D.; Yu, C. E.; Wijsman, E. M.; Heston, L. L.; Litt, M.; Schellenberg, G. D.

    1996-01-01

    Late-onset Alzheimer disease (AD) is associated with the apolipoprotein E (APOE)-epsilon4 allele. In late-onset familial AD, women have a significantly higher risk of developing the disease than do men. The aim of this study was to determine whether the gender difference in familial AD is a function of APOE genotype. We studied 58 late-onset familial AD kindreds. Kaplan-Meier survival analysis was used to assess genotype-specific distributions of age at onset. Odds ratios were estimated by logistic regression with adjustment for age and by conditional logistic regression with stratification on families. All methods detected a significant gender difference for the epsilon4 heterozygous genotype. In women, epsilon4 heterozygotes had higher risk than those without epsilon4; there was no significant difference between epsilon4 heterozygotes and epsilon4 homozygotes. In men, epsilon4 heterozygotes had lower risk than epsilon4 homozygotes; there was not significant difference between epsilon4 heterozygotes and those without epsilon4. A direct comparison of epsilon4 heterozygous men and women revealed a significant twofold increased risk in women. We confirmed these results in 15 autopsy-confirmed AD kindreds from the National Cell Repository at Indiana University Alzheimer Disease Center. These observations are consistent with the increased incidence of familial AD in women and may be a critical clue to the role of gender in the pathogenesis of AD. PMID:8644745

  6. Gender difference in apolipoprotein E-associated risk for familial Alzheimer disease: A possible clue to the higher incidence of Alzheimer disease in women

    SciTech Connect

    Payami, H.; Zareparsi, S.; Montee, K.R.; Litt, M.

    1996-04-01

    Late-onset Alzheimer disease (AD) is associated with the apolipoprotein E (APOE)-{epsilon}4 allele. In late-onset familial AD, women have a significantly higher risk of developing the disease than do men. The aim of this study was to determine whether the gender difference in familial AD is a function of APOE genotype. We studied 58 late-onset familial AD kindreds. Kaplan-Meier survival analysis was used to assess genotype-specific distributions of age at onset. Odds ratios were estimated by logistic regression with adjustment for age and by conditional logistic regression with stratification on families. All methods detected a significant gender difference for the {epsilon}4 heterozygous genotype. In women, {epsilon}4 heterozygotes had higher risk than those without {epsilon}4; there was no significant difference between {epsilon}4 heterozygotes and {epsilon}4 homozygotes. In men, {epsilon}4 heterozygotes had lower risk than {epsilon}4 homozygotes; there was no significant difference between {epsilon}4 heterozygotes and those without {epsilon}4. A direct comparison of {epsilon}4 heterozygous men and women revealed a significant two-fold increased risk in women. We confirmed these results in 15 autopsy-confirmed AD kindreds from the National Cell Repository at Indiana University Alzheimer Disease Center. These observations are consistent with the increased incidence of familial AD in women and may be a critical clue to the role of gender in the pathogenesis of AD. 53 refs., 2 figs., 2 tabs.

  7. Gallbladder cancer: incidence and survival in a high-risk area of Chile.

    PubMed

    Bertran, Enriqueta; Heise, Katy; Andia, Marcelo E; Ferreccio, Catterina

    2010-11-15

    We assessed population incidence rates 1998-2002 and 5-year survival rates of 317 primary gallbladder cancer (GBC) entered in the population-based cancer registry in Valdivia. We analyzed GBC incidence (Poisson regression) and GBC survival (Cox regression). Cases were identified by histology (69.4%), clinical work-up (21.8%), or death certificate only (8.8%). Main symptoms were abdominal pain (82.8%), jaundice (53.6%) nausea (42.6%), and weight loss (38.2%); at diagnosis, 64% had Stage TNM IV. In the period, 4% of histopathological studies from presumptively benign cholecystectomies presented GBC. GBC cases were mainly females (76.0%), urban residents (70.3%), Hispanic (83.7%) of low schooling <4 years (64.0%). GBC standardized incidence rate per 100,000 (SIR) were all 17.5 (95%CI: 15.5-19.4), women 24.3, and men 8.6 (p < 0.00001); Mapuche 25.0, Hispanic 16.2 (p = 0.09). The highest SIRs were in Mapuche (269.2) and Hispanic women (199.6) with <4 years of schooling. Lowest SIRs were among Hispanic men (19.8) and women (21.9) with >8 years of schooling. Low schooling, female and urban residence were independent risk factors. By December 31, 2007, 6 (1.9%) cases were living, 280 (88.3%) died from GBC, 32 (10.1%) were lost of follow-up. Kaplan Meier Global 5-year survival was: 10.3%, 85% at stage I and 1.9% at stage IV; median survival: 3.4 months. Independent poor prognostic factors were TNM IV, jaundice and nonincidental diagnoses. Our results suggest that women of Mapuche ancestry with low schooling (>50 years) are at the highest risk of presenting and dying from GBC and should be the target for early detection programs. PMID:20473911

  8. Body mass index and the risk of incident functional disability in elderly Japanese

    PubMed Central

    Zhang, Shu; Tomata, Yasutake; Sugiyama, Kemmyo; Kaiho, Yu; Honkura, Kenji; Watanabe, Takashi; Tanji, Fumiya; Sugawara, Yumi; Tsuji, Ichiro

    2016-01-01

    Abstract The relationship between the body mass index (BMI) and the incidence of cause-specific disability remains unclear. We conducted a prospective cohort study of 12,376 Japanese individuals aged ≥65 years who were followed up for 5.7 years. Information on BMI and other lifestyle factors was collected via a questionnaire in 2006. Functional disability data were retrieved from the public Long-term Care Insurance database. BMI was divided into 6 groups (<21, 21–<23, 23–<25, 25–<27[reference], 27–<29 and ≥29). Hazard ratios and 95% confidence intervals for cause-specific disability were estimated using Cox proportional hazards regression models. A U-shaped relationship between BMI and functional disability was observed, with a nadir at 26. The nadir BMI values with the lowest disability risk were 28 for dementia, 25 for stroke, and 23 for joint disease. A low BMI (<23) was a risk factor for disability due to dementia, the HR values (95% CI) being 2.48 (1.70–3.63) for BMI <21 and 2.25 (1.54–3.27) for BMI 21 to <23; a high BMI (≥29) was a risk factor for disability due to joint disease, the HR value (95% CI) being 2.17 (1.40–3.35). There was no significant relationship between BMI and disability due to stroke. The BMI nadirs for cause-specific disability differed: a low BMI (<23) was a risk factor for disability due to dementia, and a high BMI (≥29) was a risk factor for disability due to joint disease. Because BMI values of 23 to <29 did not pose a significantly higher risk for each cause of disability, this range should be regarded as the optimal one for the elderly population. PMID:27495075

  9. Incidence, risk factors and outcomes of de novo malignancies post liver transplantation

    PubMed Central

    Mukthinuthalapati, Pavan Kedar; Gotur, Raghavender; Ghabril, Marwan

    2016-01-01

    Liver transplantation (LT) is associated with a 2 to 7 fold higher, age and gender adjusted, risk of de novo malignancy. The overall incidence of de novo malignancy post LT ranges from 2.2% to 26%, and 5 and 10 years incidence rates are estimated at 10% to 14.6% and 20% to 32%, respectively. The main risk factors for de novo malignancy include immunosuppression with impaired immunosurveillance, and a number of patient factors which include; age, latent oncogenic viral infections, tobacco and alcohol use history, and underlying liver disease. The most common cancers after LT are non-melanoma skin cancers, accounting for approximately 37% of de novo malignancies, with a noted increase in the ratio of squamous to basal cell cancers. While these types of skin cancer do not impact patient survival, post-transplant lymphoproliferative disorders and solid organ cancer, accounting for 25% and 48% of malignancies, are associated with increased mortality. Patients developing these types of cancer are diagnosed at more advanced stages, and their cancers behave more aggressively compared with the general population. Patients undergoing LT for primary sclerosing cholangitis (particularly with inflammatory bowel disease) and alcoholic liver disease have high rates of malignancies compared with patients undergoing LT for other indications. These populations are at particular risk for gastrointestinal and aerodigestive cancers respectively. Counseling smoking cessation, skin protection from sun exposure and routine clinical follow-up are the current approach in practice. There are no standardized surveillance protocol, but available data suggests that regimented surveillance strategies are needed and capable of yielding cancer diagnosis at earlier stages with better resulting survival. Evidence-based strategies are needed to guide optimal surveillance and safe minimization of immunosuppression. PMID:27134701

  10. Spatial Estimation of Populations at Risk from Radiological Dispersion Device Terrorism Incidents

    SciTech Connect

    Regens, J.L.; Gunter, J.T.

    2008-07-01

    Delineation of the location and size of the population potentially at risk of exposure to ionizing radiation is one of the key analytical challenges in estimating accurately the severity of the potential health effects associated with a radiological terrorism incident. Regardless of spatial scale, the geographical units for which population data commonly are collected rarely coincide with the geographical scale necessary for effective incident management and medical response. This paper identifies major government and commercial open sources of U.S. population data and presents a GIS-based approach for allocating publicly available population data, including age distributions, to geographical units appropriate for planning and implementing incident management and medical response strategies. In summary: The gravity model offers a straight-forward, empirical tool for estimating population flows, especially when geographical areas are relatively well-defined in terms of accessibility and spatial separation. This is particularly important for several reasons. First, the spatial scale for the area impacted by a RDD terrorism event is unlikely to match fully the spatial scale of available population data. That is, the plume spread typically will not uniformly overlay the impacted area. Second, the number of people within the impacted area varies as a function whether an attack occurs during the day or night. For example, the population of a central business district or industrial area typically is larger during the day while predominately residential areas have larger night time populations. As a result, interpolation techniques that link population data to geographical units and allocate those data based on time-frame at a spatial scale that is relevant to enhancing preparedness and response. The gravity model's main advantage is that it efficiently allocates readily available, open source population data to geographical units appropriate for planning and implementing

  11. Incidence and risk factors of chronic thromboembolic pulmonary hypertension in patients after acute pulmonary embolism

    PubMed Central

    Yang, Suqiao; Yang, Yuanhua; Zhai, Zhenguo; Kuang, Tuguang; Gong, Juanni; Zhang, Shuai; Zhu, Jianguo; Liang, Lirong; Shen, Ying H.

    2015-01-01

    Background Early identification and treatment of chronic thromboembolic pulmonary hypertension (CTEPH) are critical to prevent disease progression. We determined the incidence and risk factors for CTEPH in patients with a first episode of acute pulmonary embolism (PE). Methods In this study, consecutive patients with first-episode acute PE were followed for ≤5 years. Pulmonary hypertension (PH) was screened for by echocardiography. Suspected cases were evaluated by right heart catheterization (RHC) and pulmonary angiography (PA). If invasive procedures were not permitted, PH was diagnosed by systolic pulmonary artery pressure (SPAP) >50 mmHg. Diagnosis of CTEPH was confirmed by PA, ventilation/perfusion (V/Q) lung scan, or computed tomography (CT) PA (CTPA). Results Overall, 614 patients with acute PE were included (median follow-up, 3.3 years). Ten patients were diagnosed with CTEPH: cumulative incidence 0.8% [95% confidence interval (CI), 0.0-1.6%] at 1 year, 1.3% (95% CI, 0.3-2.3%) at 2 years, and 1.7% (95% CI, 0.7-2.7%) at 3 years. No cases of CTEPH developed after 3 years. History of lower-limb varicose veins [hazard ratio (HR), 4.3; 95% CI, 1.2-15.4; P=0.024], SPAP >50 mmHg at initial PE episode (HR, 23.5; 95% CI, 2.7-207.6; P=0.005), intermediate-risk PE (HR, 1.2; 95% CI, 1.0-1.4; P=0.030), and CT obstruction index over 30% at 3 months after acute PE (HR, 42.5; 95% CI, 4.4-409.8; P=0.001) were associated with increased risk of CTEPH. Conclusions CTEPH was not rare after acute PE in this Chinese population, especially within 3 years of diagnosis. Lower-limb varicose veins, intermediate-risk PE with elevated SPAP in the acute phase, and residual emboli during follow-up might increase the risk of CTEPH. PMID:26716031

  12. Anastomotic leakage after anterior resection for rectal cancer with mesorectal excision: incidence, risk factors, and management.

    PubMed

    Tortorelli, Antonio Pio; Alfieri, Sergio; Sanchez, Alejandro Martin; Rosa, Fausto; Papa, Valerio; Di Miceli, Dario; Bellantone, Chiara; Doglietto, Giovanni Battista

    2015-01-01

    We investigated risk factors and prognostic implications of symptomatic anastomotic leakage after anterior resection for rectal cancer, and the influence of a diverting stoma. Our retrospective review of prospective collected data analyzed 475 patients who underwent anterior resection for rectal cancer. Uni- and multivariate analysis was made between anastomotic leakage and patient, tumor, and treatment variables, either for the overall group (n = 475) and in the midlow rectal cancer subgroup (n = 291). Overall rate of symptomatic leakage was 9 per cent (43 of 475) with no related postoperative mortality. At univariate analysis, significant factors for leak were a tumor less than 6 cm from the anal verge (13.7 vs 6.6%; P = 0.011) and intraoperative transfusions (16.9 vs 4.3%; P = 0.001). Similar results were observed in the midlow rectal cancer subgroup. At multivariate analysis, no parameter resulted in being an independent prognostic factor for risk of leakage. In patients with a leakage, a temporary enterostomy considerably reduced the need for reoperation (12.5 vs 77.8%; P < 0.0001) and the risk of a permanent stoma (18.7 vs 28.5%; P = 0.49). The incidence of anastomotic failure increases for lower tumors, whereas it is not influenced by radiotherapy. Defunctioning enterostomy does not influence the leak rate, but it mitigates clinical consequences. PMID:25569064

  13. Incidence and Risk Factors Associated With Hospitalization for Variant Angina in Korea

    PubMed Central

    Kim, Hack-Lyoung; Lee, Sang Hyung; Kim, Jayeun; Kim, Hyun Joo; Lim, Woo-Hyun; Seo, Jae-Bin; Chung, Woo-Young; Kim, Sang-Hyun; Zo, Joo-Hee; Kim, Myung-A; Lee, Jin Yong

    2016-01-01

    Abstract This study aimed to determine the incidence and the risk factors of hospitalization for variant angina (VA) in Korean patients. Using the National Inpatient Sample (NIS) database, manufactured and released by the Health Insurance Review and Assessment Service (HIRA) in Korea, the incidence of hospitalization and rehospitalization for VA were calculated. The numbers of patients hospitalized for VA were estimated to be 14,362 in 2009, 17,492 in 2010, and 20,592 in 2011. The standardized incidence rates of hospitalization for VA were 31.4% in 2009, 36.5% in 2010, and 41.7% in 2011 (relative increase rate from 2009 to 2011, 33.0%, P for trend < 0.0001). VA patients predominantly belonged to the middle-age group between 40 and 69 years (75.5%), and there were 54.3% male. Based on the hospitalization episodes, the number of rehospitalization was calculated to be 879, 1141, and 1446 patients out of 1867, 2274, and 2677 patients from 2009, 2010, and 2011, respectively. The rates of rehospitalization for VA were 47.1% in 2009, 50.2% in 2010, and 54.0% in 2011 (P for trend < 0.0001). Age was an independent factor associated with rehospitalization for VA. Hospitalization for VA occurred most frequently in fall from 2009 to 2011. In conclusion, hospitalization rates for VA steadily increased from 2009 to 2011 in Korea, and about a half of VA patients was hospitalized more than once a year in 2009 to 2011. Proper health policy and patient education are warranted to control the high rate of hospitalization for VA. PMID:27043695

  14. The incidence, risk factors and characteristics of pressure ulcers in hospitalized patients in China

    PubMed Central

    Jiang, Qixia; Li, Xiaohua; Qu, Xiaolong; Liu, Yun; Zhang, Liyan; Su, Chunyin; Guo, Xiujun; Chen, Yuejuan; Zhu, Yajun; Jia, Jing; Bo, Suping; Liu, Li; Zhang, Rui; Xu, Ling; Wu, Leyan; Wang, Hai; Wang, Jiandong

    2014-01-01

    Pressure ulcers are very common in hospital patients. Though many studies have been reported in many countries, the large-scale benchmarking prevalence of pressure ulcers in China is not available. The aim of this study is to quantify the prevalence of pressure ulcers and the incidence of hospital-acquired pressure ulcers and analyze risk factors in hospitalized patients in China. A multi-central cross-sectional survey was conducted in one university hospital and 11 general hospitals in China. The Minimum Data Set (MDS) recommended by European Pressure Ulcer Advisory Panel (EUPAP) was used to collect information of inpatients. All patients stayed in hospital more than 24 hours and older than 18 years signed consent form and were included. Data from 39952 out of 40415 (98.85%) inpatients were analyzed. Of the 39952 patients, 631 patients (including 1024 locations) had pressure ulcers. The prevalence rate of pressure ulcers in 12 hospitals was 1.58% (0.94-2.97%). The incidence of hospital-acquired pressure ulcers (HAPU) was 0.63% (0.20-1.20%). The most common locations developed pressure ulcers were sacrum, heels, and iliac crests. The common stages of pressure ulcers were stage I and II. Patients in Intensive Care Unit, Geriatric and Neurological Department were easier to develop pressure ulcers. The prevalence and incidence of pressure ulcers in China was lower than that reported in European and other countries. The stages of pressure ulcers in China were different than that reported in European countries. Our study provides with a baseline value for intensive research on pressure ulcer in China. PMID:24966973

  15. Incidence of and Risk Factors for Mastoiditis after Intensity Modulated Radiotherapy in Nasopharyngeal Carcinoma

    PubMed Central

    Yu, Xiao-Li; Tang, Ling-Long; Chen, Lei; Mao, Yan-Ping; Lin, Li; Zhang, Lu-Lu; Shao, Jian-Yong; Guo, Ying; Ma, Jun; Sun, Ying

    2015-01-01

    Purpose To report the incidence of and risk factors for mastoiditis after intensity-modulated radiotherapy (IMRT) in nasopharyngeal carcinoma (NPC). Patients and Methods Retrospective analysis of pretreatment and follow-up magnetic resonance imaging (MRI) data for 451 patients with NPC treated with IMRT at a single institution. The diagnosis of mastoiditis was based on MRI; otomastoid opacification was rated as Grade 0 (none), 1 (mild), 2 (moderate) or 3 (severe) by radiologists blinded to clinical outcome. This study mainly focused on severe mastoiditis; patients were divided into three groups: the G0M (Grade 0 mastoiditis before treatment) group, G1-2M (Grade 1 to 2 mastoiditis before treatment) group and G3M (Grade 3 mastoiditis before treatment) group. The software SAS9.3 program was used to analyze the data. Results For the entire cohort, the incidence of Grade 3 mastoiditis was 20% before treatment and 31%, 19% and 17% at 3, 12 and 24 months after radiotherapy, respectively. In the G0M group, the incidence of severe mastoiditis was 0% before treatment and 23%, 15% and 13% at 3, 12 and 24 months after radiotherapy, respectively. Multivariate analysis revealed T category (OR=0.68, 95% CI = 0.469 to 0.984), time (OR=0.668, 95% CI = 0.59 to 0.757) and chemotherapy (OR=0.598, 95% CI = 0.343 to 0.934) were independent factors associated with severe mastoiditis in the G0M group after treatment. Conclusions Mastoiditis, as diagnosed by MRI, occurs as a progressive process that regresses and resolves over time in patients with NPC treated using IMRT. PMID:26114761

  16. Incident Diabetes and Mobility Limitations: Reducing Bias Through Risk-set Matching

    PubMed Central

    2015-01-01

    Background. Increased prevalence of diabetes in the U.S. population could contribute substantially to increases in disability at older ages. Previous studies have examined the association between prevalent diabetes and various impairments and disabilities. Methods considering incident, rather than prevalent, diabetes as the exposure of interest can reduce bias in estimates of these associations. Methods. Risk-set matching, a type of propensity score matching meant to handle time-varying exposures, was used to estimate the relationship between incident diabetes and mobility limitations among adults in the Health and Retirement Study. This approach ensures that covariates precede diabetes onset rather than follow it. Results. Individuals who were diagnosed with diabetes during the study period accumulated more subsequent mobility limitations than were accumulated by matched controls. Among observationally similar pairs of individuals, those who developed diabetes reported an average of 24.9% more mobility limitations at study exit than those who did not. Conclusions. The magnitude of the relationship between diabetes and limitations estimated in this article is smaller than that presented in previous studies, but the method presented here is likely to provide a less-biased estimate of the association between diabetes and accumulation of mobility limitations. PMID:25414516

  17. Breast Cancer-Related Arm Lymphedema: Incidence Rates, Diagnostic Techniques, Optimal Management and Risk Reduction Strategies

    SciTech Connect

    Shah, Chirag; Vicini, Frank A.

    2011-11-15

    As more women survive breast cancer, long-term toxicities affecting their quality of life, such as lymphedema (LE) of the arm, gain importance. Although numerous studies have attempted to determine incidence rates, identify optimal diagnostic tests, enumerate efficacious treatment strategies and outline risk reduction guidelines for breast cancer-related lymphedema (BCRL), few groups have consistently agreed on any of these issues. As a result, standardized recommendations are still lacking. This review will summarize the latest data addressing all of these concerns in order to provide patients and health care providers with optimal, contemporary recommendations. Published incidence rates for BCRL vary substantially with a range of 2-65% based on surgical technique, axillary sampling method, radiation therapy fields treated, and the use of chemotherapy. Newer clinical assessment tools can potentially identify BCRL in patients with subclinical disease with prospective data suggesting that early diagnosis and management with noninvasive therapy can lead to excellent outcomes. Multiple therapies exist with treatments defined by the severity of BCRL present. Currently, the standard of care for BCRL in patients with significant LE is complex decongestive physiotherapy (CDP). Contemporary data also suggest that a multidisciplinary approach to the management of BCRL should begin prior to definitive treatment for breast cancer employing patient-specific surgical, radiation therapy, and chemotherapy paradigms that limit risks. Further, prospective clinical assessments before and after treatment should be employed to diagnose subclinical disease. In those patients who require aggressive locoregional management, prophylactic therapies and the use of CDP can help reduce the long-term sequelae of BCRL.

  18. The incidence and risk factors for postoperative urinary retention in neurosurgical patients

    PubMed Central

    Alsaidi, Mohammed; Guanio, Joanne; Basheer, Azam; Schultz, Lonni; Abdulhak, Muwaffak; Nerenz, David; Chedid, Mokbel; Seyfried, Donald

    2013-01-01

    Background: Postoperative urinary retention (POUR) is a common problem in adult neurosurgical patients. The incidence of POUR is unknown and the etiology has not been well established. POUR can lead to urogenital damage, prolonged hospital stay, higher cost, and infection. This study elucidates several risk factors that contribute to POUR in a variety of neurosurgical patients in one institution. Methods: A total of 137 neurosurgical patients were prospectively followed up for the development of POUR, which we defined as initial postvoid residual (PVR1) >250 ml 6 hours after removal of an indwelling urinary catheter (IUC). For patients with PVR >250 ml on the third check, IUCs were reinserted and kept in for 5-7 days. Results: Of the 137 patients, 68 (50%) were male, 41% (56/137) were 60 years or older, 86% (118/137) underwent spinal surgery, and 54% (74/137) had anesthesia over 200 minutes. Overall incidence of clinical POUR was 39.4% (54/137). Significantly higher rates of PVR1 >250 were noted in males, patients older than 60 years, and those who underwent spine surgery. When considering all patient characteristics (except selective alpha blockers), only gender, surgery time, and surgery type remained significant. In addition, PVR1 >250 was positively associated with longer length of stay. Of all patients, 24 (18%) had IUCs reinserted postoperatively or should have had one (5 refused and 2 had a third PVR). The association of IUC reinsertion with male gender was significant. Conclusion: Male gender, time of anesthesia >200 minutes, older age, and spinal surgery are the most significant risk factors associated with POUR in neurosurgical patients. PMID:23772331

  19. Paleolithic and Mediterranean diet pattern scores and risk of incident, sporadic colorectal adenomas.

    PubMed

    Whalen, Kristine A; McCullough, Marji; Flanders, W Dana; Hartman, Terryl J; Judd, Suzanne; Bostick, Roberd M

    2014-12-01

    The Western dietary pattern is associated with higher risk of colorectal neoplasms. Evolutionary discordance could explain this association. We investigated associations of scores for 2 proposed diet patterns, the "Paleolithic" and the Mediterranean, with incident, sporadic colorectal adenomas in a case-control study of colorectal polyps conducted in Minnesota (1991-1994). Persons with no prior history of colorectal neoplasms completed comprehensive questionnaires prior to elective, outpatient endoscopy; of these individuals, 564 were identified as cases and 1,202 as endoscopy-negative controls. An additional group of community controls frequency-matched on age and sex (n = 535) was also recruited. Both diet scores were calculated for each participant and categorized into quintiles, and associations were estimated using unconditional logistic regression. The multivariable-adjusted odds ratios comparing persons in the highest quintiles of the Paleolithic and Mediterranean diet scores relative to the lowest quintiles were, respectively, 0.71 (95% confidence interval (CI): 0.50, 1.02; Ptrend = 0.02) and 0.74 (95% CI: 0.54, 1.03; Ptrend = 0.05) when comparing cases with endoscopy-negative controls and 0.84 (95% CI: 0.56, 1.26; Ptrend = 0.14) and 0.77 (95% CI: 0.53, 1.11; Ptrend = 0.13) when comparing cases with community controls. These findings suggest that greater adherence to the Paleolithic diet pattern and greater adherence to the Mediterranean diet pattern may be similarly associated with lower risk of incident, sporadic colorectal adenomas. PMID:25326623

  20. Paleolithic and Mediterranean Diet Pattern Scores and Risk of Incident, Sporadic Colorectal Adenomas

    PubMed Central

    Whalen, Kristine A.; McCullough, Marji; Flanders, W. Dana; Hartman, Terryl J.; Judd, Suzanne; Bostick, Roberd M.

    2014-01-01

    The Western dietary pattern is associated with higher risk of colorectal neoplasms. Evolutionary discordance could explain this association. We investigated associations of scores for 2 proposed diet patterns, the “Paleolithic” and the Mediterranean, with incident, sporadic colorectal adenomas in a case-control study of colorectal polyps conducted in Minnesota (1991–1994). Persons with no prior history of colorectal neoplasms completed comprehensive questionnaires prior to elective, outpatient endoscopy; of these individuals, 564 were identified as cases and 1,202 as endoscopy-negative controls. An additional group of community controls frequency-matched on age and sex (n = 535) was also recruited. Both diet scores were calculated for each participant and categorized into quintiles, and associations were estimated using unconditional logistic regression. The multivariable-adjusted odds ratios comparing persons in the highest quintiles of the Paleolithic and Mediterranean diet scores relative to the lowest quintiles were, respectively, 0.71 (95% confidence interval (CI): 0.50, 1.02; Ptrend = 0.02) and 0.74 (95% CI: 0.54, 1.03; Ptrend = 0.05) when comparing cases with endoscopy-negative controls and 0.84 (95% CI: 0.56, 1.26; Ptrend = 0.14) and 0.77 (95% CI: 0.53, 1.11; Ptrend = 0.13) when comparing cases with community controls. These findings suggest that greater adherence to the Paleolithic diet pattern and greater adherence to the Mediterranean diet pattern may be similarly associated with lower risk of incident, sporadic colorectal adenomas. PMID:25326623

  1. Specificity of Incident Diagnostic Outcomes in Patients at Clinical High Risk for Psychosis

    PubMed Central

    Webb, Jadon R.; Addington, Jean; Perkins, Diana O.; Bearden, Carrie E.; Cadenhead, Kristin S.; Cannon, Tyrone D.; Cornblatt, Barbara A.; Heinssen, Robert K.; Seidman, Larry J.; Tarbox, Sarah I.; Tsuang, Ming T.; Walker, Elaine F.; McGlashan, Thomas H.; Woods, Scott W.

    2015-01-01

    It is not well established whether the incident outcomes of the clinical high-risk (CHR) syndrome for psychosis are diagnostically specific for psychosis or whether CHR patients also are at elevated risk for a variety of nonpsychotic disorders. We collected 2 samples (NAPLS-1, PREDICT) that contained CHR patients and a control group who responded to CHR recruitment efforts but did not meet CHR criteria on interview (help-seeking comparison patients [HSC]). Incident diagnostic outcomes were defined as the occurrence of a SIPS-defined psychosis or a structured interview diagnosis from 1 of 3 nonpsychotic Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) groups (anxiety, bipolar, or nonbipolar mood disorder), when no diagnosis in that group was present at baseline. Logistic regression revealed that the CHR vs HSC effect did not vary significantly across study for any emergent diagnostic outcome; data from the 2 studies were therefore combined. CHR (n = 271) vs HSC (n = 171) emergent outcomes were: psychosis 19.6% vs 1.8%, bipolar disorders 1.1% vs 1.2%, nonbipolar mood disorders 4.4% vs 5.3%, and anxiety disorders 5.2% vs 5.3%. The main effect of CHR vs HSC was statistically significant (OR = 13.8, 95% CI 4.2–45.0, df = 1, P < .001) for emergent psychosis but not for any emergent nonpsychotic disorder. Sensitivity analyses confirmed these findings. Within the CHR group emergent psychosis was significantly more likely than each nonpsychotic DSM-IV emergent disorder, and within the HSC group emergent psychosis was significantly less likely than most emergent nonpsychotic disorders. The CHR syndrome is specific as a marker for research on predictors and mechanisms of developing psychosis. PMID:26272875

  2. Adverse events during intrahospital transport of critically ill patients: incidence and risk factors

    PubMed Central

    2013-01-01

    Background Transport of critically ill patients for diagnostic or therapeutic procedures is at risk of complications. Adverse events during transport are common and may have significant consequences for the patient. The objective of the study was to collect prospectively adverse events that occurred during intrahospital transports of critically ill patients and to determine their risk factors. Methods This prospective, observational study of intrahospital transport of consecutively admitted patients with mechanical ventilation was conducted in a 38-bed intensive care unit in a university hospital from May 2009 to March 2010. Results Of 262 transports observed (184 patients), 120 (45.8%) were associated with adverse events. Risk factors were ventilation with positive end-expiratory pressure >6 cmH2O, sedation before transport, and fluid loading for intrahospital transports. Within these intrahospital transports with adverse events, 68 (26% of all intrahospital transports) were associated with an adverse event affecting the patient. Identified risk factors were: positive end-expiratory pressure >6 cmH2O, and treatment modification before transport. In 44 cases (16.8% of all intrahospital transports), adverse event was considered serious for the patient. In our study, adverse events did not statistically increase ventilator-associated pneumonia, time spent on mechanical ventilation, or length of stay in the intensive care unit. Conclusions This study confirms that the intrahospital transports of critically ill patients leads to a significant number of adverse events. Although in our study adverse events have not had major consequences on the patient stay, efforts should be made to decrease their incidence. PMID:23587445

  3. Sacral Insufficiency Fractures After Preoperative Chemoradiation for Rectal Cancer: Incidence, Risk Factors, and Clinical Course

    SciTech Connect

    Herman, Michael P.; Kopetz, Scott; Bhosale, Priya R.; Eng, Cathy; Skibber, John M.; Rodriguez-Bigas, Miguel A.; Feig, Barry W.; Chang, George J.; Delclos, Marc E.; Krishnan, Sunil; Crane, Christopher H.; Das, Prajnan

    2009-07-01

    Purpose: Sacral insufficiency (SI) fractures can occur as a late side effect of pelvic radiation therapy. Our goal was to determine the incidence, risk factors, and clinical course of SI fractures in patients treated with preoperative chemoradiation for rectal cancer. Materials and Methods: Between 1989 and 2004, 562 patients with non-metastatic rectal adenocarcinoma were treated with preoperative chemoradiation followed by mesorectal excision. The median radiotherapy dose was 45 Gy. The hospital records and radiology reports of these patients were reviewed to identify those with pelvic fractures. Radiology images of patients with pelvic fractures were then reviewed to identify those with SI fractures. Results: Among the 562 patients, 15 had SI fractures. The 3-year actuarial rate of SI fractures was 3.1%. The median time to SI fractures was 17 months (range, 2-34 months). The risk of SI fractures was significantly higher in women compared to men (5.8% vs. 1.6%, p = 0.014), and in whites compared with non-whites (4% vs. 0%, p = 0.037). On multivariate analysis, gender independently predicted for the risk of SI fractures (hazard ratio, 3.25; p = 0.031). Documentation about the presence or absence of pain was available for 13 patients; of these 7 (54%) had symptoms requiring pain medications. The median duration of pain was 22 months. No patient required hospitalization or invasive intervention for pain control. Conclusions: SI fractures were uncommon in patients treated with preoperative chemoradiation for rectal cancer. The risk of SI fractures was significantly higher in women. Most cases of SI fractures can be managed conservatively with pain medications.

  4. Sweetened Beverage Consumption, Incident Coronary Heart Disease and Biomarkers of Risk in Men

    PubMed Central

    de Koning, Lawrence; Malik, Vasanti S.; Kellogg, Mark D.; Rimm, Eric B.; Willett, Walter C.; Hu, Frank B.

    2012-01-01

    Background Sugar-sweetened beverage consumption is associated with weight gain and risk of type 2 diabetes. Few studies have tested for a relationship with coronary heart disease (CHD), or intermediate biomarkers. The role of artificially sweetened beverages is also unclear. Methods and Results We performed an analysis of the Health Professionals Follow-up study, a prospective cohort study including 42 883 men. Associations of cumulatively averaged sugar-sweetened (e.g. sodas) and artificially sweetened (e.g. diet sodas) beverage intake with incident fatal and non-fatal CHD (myocardial infarction) were examined using proportional hazard models. There were 3683 CHD cases over 22 years of follow-up. Participants in the top quartile of sugar-sweetened beverage intake had a 20% higher relative risk of CHD than those in the bottom quartile (RR=1.20, 95% CI: 1.09, 1.33, p for trend < 0.01) after adjusting for age, smoking, physical activity, alcohol, multivitamins, family history, diet quality, energy intake, BMI, pre-enrollment weight change and dieting. Artificially sweetened beverage consumption was not significantly associated with CHD (multivariate RR=1.02, 95% CI: 0.93, 1.12, p for trend = 0.28). Adjustment for self-reported high cholesterol, high triglycerides, high blood pressure and diagnosed type 2 diabetes slightly attenuated these associations. Intake of sugar-sweetened but not artificially sweetened beverages was significantly associated with increased triglycerides, CRP, IL6, TNFr1, TNFr2, decreased HDL, Lp(a), and leptin (p values < 0.02). Conclusions Consumption of sugar-sweetened beverages was associated with increased risk of CHD and some adverse changes in lipids, inflammatory factors, and leptin. Artificially sweetened beverage intake was not associated with CHD risk or biomarkers. PMID:22412070

  5. Incidence and risk factors of renal hematoma: a prospective study of 1,300 SWL treatments.

    PubMed

    Schnabel, M J; Gierth, M; Chaussy, C G; Dötzer, K; Burger, M; Fritsche, H M

    2014-06-01

    Shock wave lithotripsy (SWL) is the gold standard for the treatment of upper urinary tract stones. Despite being relatively non-invasive, SWL can cause renal hematoma (RHT). The aim of this study was to determine incidence and risk factors for RHT following SWL. 857 patients were included in a prospectively maintained database. The observation period spans from 2007 to 2012. 1,324 procedures were performed due to kidney stones. Treatment protocol included power ramping and shock wave frequency of 60-90 per minute as well as an ultrasound check within 3 days of SWL for all patients. Patients with RHT were analyzed, and treatment characteristics were compared with the complete population in a non-statistical manner due to the low event count. RHTs after SWL, sized between 2.6 × 0.6 cm and 17 × 15 cm, were verified in seven patients (0.53%). In four patients, the RHT was asymptomatic. Three patients developed pain after SWL treatment due to a RHT. In one patient surgical intervention was necessary due to a symptomatic RHT, the kidney was preserved. The risk of RHT following SWL treatment of kidney stones is about 0.5%. Clinically relevant or symptomatic RHTs occur in 0.23%, RHTs requiring surgical intervention are extremely rare. Older age and vascular comorbidities appear to be risk factors for the development of RHT. The technical characteristics of SWL treatment and intake of low-dose acetylsalicylic acid due to an imperative cardiologic indication do not appear to influence the risk. Prospective studies are warranted. PMID:24419328

  6. Incidence of and risk factors for cognitive impairment in an early Parkinson disease clinical trial cohort

    PubMed Central

    Uc, E Y.; McDermott, M P.; Marder, K S.; Anderson, S W.; Litvan, I; Como, P G.; Auinger, P; Chou, K L.; Growdon, J C.

    2009-01-01

    Objective: To investigate the incidence of and risk factors for cognitive impairment in a large, well-defined clinical trial cohort of patients with early Parkinson disease (PD). Methods: The Mini-Mental State Examination (MMSE) was administered periodically over a median follow-up period of 6.5 years to participants in the Deprenyl and Tocopherol Antioxidative Therapy of Parkinsonism trial and its extension studies. Cognitive impairment was defined as scoring 2 standard deviations below age- and education-adjusted MMSE norms. Results: Cumulative incidence of cognitive impairment in the 740 participants with clinically confirmed PD (baseline age 61.0 ± 9.6 years, Hoehn-Yahr stage 1–2.5) was 2.4% (95% confidence interval: 1.2%–3.5%) at 2 years and 5.8% (3.7%–7.7%) at 5 years. Subjects who developed cognitive impairment (n = 46) showed significant progressive decline on neuropsychological tests measuring verbal learning and memory, visuospatial working memory, visuomotor speed, and attention, while the performance of the nonimpaired subjects (n = 694) stayed stable. Cognitive impairment was associated with older age, hallucinations, male gender, increased symmetry of parkinsonism, increased severity of motor impairment (except for tremor), speech and swallowing impairments, dexterity loss, and presence of gastroenterologic/urologic disorders at baseline. Conclusions: The relatively low incidence of cognitive impairment in the Deprenyl and Tocopherol Antioxidative Therapy of Parkinsonism study may reflect recruitment bias inherent to clinical trial volunteers (e.g., younger age) or limitations of the Mini-Mental State Examination–based criterion. Besides confirming known risk factors for cognitive impairment, we identified potentially novel predictors such as bulbar dysfunction and gastroenterologic/urologic disorders (suggestive of autonomic dysfunction) early in the course of the disease. GLOSSARY CI = confidence interval; COWA = Controlled Word Association

  7. Cancer incidence and risks in selected agricultural settlements in the Negev of Israel.

    PubMed

    Avnon, L; Oryan, I; Kordysh, E; Goldsmith, J; Sobel, R; Friger, M

    1998-01-01

    Medical staff of two Negev kibbutzim invited epidemiologists to help them investigate cancer rates among their members. Our objectives were (a) to determine whether the cancer rate in the kibbutzim was elevated or abnormal and (b) to determine the role of agricultural and other relevant exposures if cancer incidence was elevated. We validated cases of cancer by kibbutz records and by surveying other information; we computed expected values on the basis of the age-sex-calendar period and site-specific cancer incidence rates reported by the Israel Cancer Registry for the entire population; and we compared the data for the 2 kibbutzim with data derived for similar age and sex groups in 2 other kibbutzim, which were assumed not to have increased cancer rates. In addition, we planned and conducted a case-referent study, including the design, pretest, and use of questionnaires, including data about lifetime exposures (i.e., type of work and its duration, agricultural and industrial chemicals, smoking and alcohol use, demographic variables, health experiences, and family history). In only one of the kibbutzim, for which high cancer rates were suspected, was there significant excess for all sites in persons who were less than 40 y of age. In one of the "comparison" kibbutzim, we found increased cancer rates overall. Much of the excess in the high cancer kibbutzim was in hematological cancer (i.e., leukemia and lymphoma). Multiple years of work in fields, orchards, and landscape, as well as orchard work that commenced before 1960, were associated with increased risk of cancer (p < .08). We also found an association between cancer rate and numbers of industrial chemicals used (p < .08). Pipe and cigarette smoking were also associated with increased cancer incidence. In the multivariate analysis, the association with calendar year in which orchard work was started and multiple exposures to industrial chemicals was stronger than associations noted in the univariate analyses

  8. The incidence and risk factors of peripherally inserted central catheter-related infection among cancer patients

    PubMed Central

    Gao, Yufang; Liu, Yuxiu; Ma, Xiaoyan; Wei, Lili; Chen, Weifen; Song, Lei

    2015-01-01

    Background As the use of peripherally inserted central catheters (PICCs) increased in chemotherapy, the identification of complications and risk factors became essential to prevent patient harm. But little is known about PICC-related infection and risk factors among patients with cancer. Our study was to identify the prevalence, patterns, and risk factors of catheter-related infections associated with PICCs. Methods A 3-year prospective cohort study was conducted in a university-affiliated hospital. All patients with cancer who met inclusion criteria were enrolled. The patients were followed up until catheter removal. Tip cultures were routinely performed at the time of catheter removal. The general information was recorded at the time of PICC insertion, weekly care, and removal. Univariable and multivariable logistic regression analyses were applied for identification of risk factors. Results In total, 912 cancer patients with 912 PICCs of 96,307 catheter days were enrolled. Ninety-four developed PICC-related infection; 46 were exit-site infection, 43 were catheter bacterial colonization, and five were PICC-related bloodstream infection. The median time from catheter insertion to infection was 98.26 days. Multivariate analysis showed StatLock fixing (odds ratio [OR] =0.555, 95% confidence interval [CI]: 0.326–0.945) and tip position located in the lower one-third of the superior vena cava (OR =0.340, 95% CI: 0.202–0.571) were associated with lower PICC infection rate. Catheter care delay (OR =2.612, 95% CI: 1.373–4.969) and indwelling mostly in summer (OR =4.784, 95% CI: 2.681–8.538) were associated with higher infection incidence. Conclusion StatLock fixing and tip position located in the lower one-third of the superior vena cava were protective factors against PICC-related infection, while catheter care delay and indwelling mostly in summer were risk factors. Policy and measures targeting these factors may be necessary to reduce the risk of infection

  9. Dietary flavonoid intake and risk of incident depression in midlife and older women123

    PubMed Central

    Rimm, Eric B; O’Reilly, Eilis J; Okereke, Olivia I

    2016-01-01

    Background: The impact of dietary flavonoid intakes on risk of depression is unclear. Objective: We prospectively examined associations between estimated habitual intakes of dietary flavonoids and depression risk. Design: We followed 82,643 women without a previous history of depression at baseline from the Nurses’ Health Study [(NHS) aged 53–80 y] and the Nurses’ Health Study II [(NHSII) aged 36–55 y]. Intakes of total flavonoids and subclasses (flavonols, flavones, flavanones, anthocyanins, flavan-3-ols, polymeric flavonoids, and proanthocyanidins) were calculated from validated food-frequency questionnaires collected every 2–4 y. Depression was defined as physician- or clinician-diagnosed depression or antidepressant use and was self-reported in response to periodic questionnaires. Cox proportional hazards models were performed to examine associations. Results: A total of 10,752 incident depression cases occurred during a 10-y follow-up. Inverse associations between flavonol, flavone, and flavanone intakes and depression risk were observed. Pooled multivariable-adjusted HRs (95% CIs) were 0.93 (0.88, 0.99), 0.92 (0.86, 0.98), and 0.90 (0.85, 0.96) when comparing the highest (quintile 5) with the lowest (quintile 1) quintiles, respectively, with evidence of linear trends across quintiles (P-trend = 0.0004–0.08). In flavonoid-rich food-based analyses, the HR was 0.82 (95% CI: 0.74, 0.91) among participants who consumed ≥2 servings citrus fruit or juices/d compared with <1 serving/wk. In the NHS only, total flavonoids, polymers, and proanthocyanidin intakes showed significantly (9–12%) lower depression risks. In analyses among late-life NHS participants (aged ≥65 y at baseline or during follow-up), for whom we were able to incorporate depressive symptoms into the outcome definition, higher intakes of all flavonoid subclasses except for flavan-3-ols were associated with significantly lower depression risk; flavones and proanthocyanidins showed the

  10. Contribution of Major Lifestyle Risk Factors for Incident Heart Failure in Older Adults

    PubMed Central

    Del Gobbo, Liana C.; Kalantarian, Shadi; Imamura, Fumiaki; Lemaitre, Rozenn; Siscovick, David S.; Psaty, Bruce M.; Mozaffarian, Dariush

    2015-01-01

    Objectives The goal of this study was to determine the relative contribution of major lifestyle factors on the development of heart failure (HF) in older adults. Background HF incurs high morbidity, mortality, and health care costs among adults ≥65 years of age, which is the most rapidly growing segment of the U.S. population. Methods We prospectively investigated separate and combined associations of lifestyle risk factors with incident HF (1,380 cases) over 21.5 years among 4,490 men and women in the Cardiovascular Health Study, which is a community-based cohort of older adults. Lifestyle factors included 4 dietary patterns (Alternative Healthy Eating Index, Dietary Approaches to Stop Hypertension, an American Heart Association 2020 dietary goals score, and a Biologic pattern, which was constructed using previous knowledge of cardiovascular disease dietary risk factors), 4 physical activity metrics (exercise intensity, walking pace, energy expended in leisure activity, and walking distance), alcohol intake, smoking, and obesity. Results No dietary pattern was associated with developing HF (p > 0.05). Walking pace and leisure activity were associated with a 26% and 22% lower risk of HF, respectively (pace >3 mph vs. <2 mph; hazard ratio [HR]: 0.74; 95% confidence interval [CI]: 0.63 to 0.86; leisure activity ≥845 kcal/week vs. <845 kcal/week; HR: 0.78; 95% CI: 0.69 to 0.87). Modest alcohol intake, maintaining a body mass index <30 kg/m2, and not smoking were also independently associated with a lower risk of HF. Participants with ≥4 healthy lifestyle factors had a 45% (HR: 0.55; 95% CI: 0.42 to 0.74) lower risk of HF. Heterogeneity by age, sex, cardiovascular disease, hypertension medication use, and diabetes was not observed. Conclusions Among older U.S. adults, physical activity, modest alcohol intake, avoiding obesity, and not smoking, but not dietary patterns, were associated with a lower risk of HF. PMID:26160366

  11. The incidence of early post-operative complications following uvulopalatopharyngoplasty: identification of predictive risk factors

    PubMed Central

    2013-01-01

    Objective Characterize complications following uvulopalatopharyngoplasty (UPPP) for obstructive sleep apnea. Study design Retrospective chart review. Subjects and methods Charts of patients undergoing UPPP at an academic teaching hospital from 1999 to 2005 were reviewed. Results 345 consecutive patients (248 inpatients; 97 outpatients) were studied. The most common post-operative complication in the entire study was oxyhemoglobin desaturation (12.8%). Three patients suffered major complications (airway obstruction, pulmonary edema, arrhythmia). Regarding complications limited to the post-anaesthetic care unit alone, only 8.2% of patients had oxyhemoglobin desaturation after discontinuation of oxygen supplementation. Inpatients requiring supplemental oxygen on the ward had significantly higher mean AHI (37.4 vs. 31.4; p=0.05) and BMI (32.3 kg/m2 vs. 28.9 kg/m2; p=0.004) than those who did not. Those inpatients who were obese (BMI > 30 kg/m2) with an AHI≥22 were associated with an increased risk of requiring oxygen on the ward (odds ratio = 3.48, 95% CI = 1.56 – 7.78). Conclusion The incidence of post-UPPP complications is much lower than the literature has historically suggested. Selected patients should be able to safely undergo outpatient UPPP. Patients with higher AHI, higher BMI, or multiple comorbidities are at higher risk for postoperative complications and are most appropriate for overnight monitoring. PMID:23570393

  12. Postoperative arrhythmias after cardiac surgery: incidence, risk factors, and therapeutic management.

    PubMed

    Peretto, Giovanni; Durante, Alessandro; Limite, Luca Rosario; Cianflone, Domenico

    2014-01-01

    Arrhythmias are a known complication after cardiac surgery and represent a major cause of morbidity, increased length of hospital stay, and economic costs. However, little is known about incidence, risk factors, and treatment of early postoperative arrhythmias. Both tachyarrhythmias and bradyarrhythmias can present in the postoperative period. In this setting, atrial fibrillation is the most common heart rhythm disorder. Postoperative atrial fibrillation is often self-limiting, but it may require anticoagulation therapy and either a rate or rhythm control strategy. However, ventricular arrhythmias and conduction disturbances can also occur. Sustained ventricular arrhythmias in the recovery period after cardiac surgery may warrant acute treatment and long-term preventive strategy in the absence of reversible causes. Transient bradyarrhythmias may be managed with temporary pacing wires placed at surgery, but significant and persistent atrioventricular block or sinus node dysfunction can occur with the need for permanent pacing. We provide a complete and updated review about mechanisms, risk factors, and treatment strategies for the main postoperative arrhythmias. PMID:24511410

  13. Incisional hernia after open resections for colorectal liver metastases – incidence and risk factors

    PubMed Central

    Nilsson, Jan H.; Strandberg Holka, Peter; Sturesson, Christian

    2016-01-01

    Background Incisional hernia is one of the most common complications after laparotomy. The aim of this retrospective study was to investigate incidence, location and risk factors for incisional hernia after open resection for colorectal liver metastases including the use of perioperative chemotherapy and targeted therapy evaluated by computed tomography. Methods Patients operated for colorectal liver metastases between 2010 and 2013 were included. Incisional hernia was defined as a discontinuity in the abdominal fascia observed on computed tomography. Results A total of 256 patients were analyzed in regard to incisional hernia. Seventy-eight patients (30.5%) developed incisional hernia. Hernia locations were midline alone in 66 patients (84.6%) and involving the midline in another 8 patients (10.3%). In multivariate analysis, preoperative chemotherapy >6 cycles (hazard ratio 2.12, 95% confidence interval 1.14–3.94), preoperative bevacizumab (hazard ratio 3.63, 95% confidence interval 1.86–7.08) and incisional hernia from previous surgery (hazard ratio 3.50, 95% confidence interval 1.98–6.18) were found to be independent risk factors. Conclusions Prolonged preoperative chemotherapy and also preoperative bevacizumab were strong predictors for developing an incisional hernia. After an extended right subcostal incision, the hernia location was almost exclusively in the midline. PMID:27154807

  14. [Risk factors for the oral use of antibiotics and animal treatment incidence of weaners in Switzerland].

    PubMed

    Hirsiger, P; Malik, J; Kommerlen, D; Vidondo, B; Arnold, C; Harisberger, M; Spring, P; Sidler, X

    2015-12-01

    In the present study, risk factors for the use of oral antibiotics in weaned piglets were collected on 112 pig farms by a personal questionaire. The most common indication for an antibiotic group therapy was diarrhoea, and the most frequently used antibiotic was Colistin. On average, 27.33 daily doses in the control farms and 387.21 daily doses in the problem farms per 1000 weaners were administered on a given day. The significant risk factors in the multivariate model were poor hygiene in the water supply of suckling piglets, less than two doses ofprestarter feed daily, lack of an all-in-and-all-out production system in weaners, no herd book performance data analysis, and less than two of the legally prescribed veterinary visits per year. Furthermore, the treatment incidence of weaners for oral antibiotics was calculated on the basis of the drug inventory. This study provides evidence that the use of oral antibiotics in weaners can be reduced by interventions in hygiene and management. PMID:26891574

  15. Antimicrobial Resistance Incidence and Risk Factors among Helicobacter pylori–Infected Persons, United States

    PubMed Central

    Sobel, Jeremy; Pruckler, Janet M.; Song, Qunsheng; Swerdlow, David; Friedman, Cindy; Sulka, Alana; Swaminathan, Balasubra; Taylor, Tom; Hoekstra, Mike; Griffin, Patricia; Smoot, Duane; Peek, Rick; Metz, David C.; Bloom, Peter B.; Goldschmid, Steven; Parsonnet, Julie; Triadafilopoulos, George; Perez-Perez, Guillermo I.; Vakil, Nimish; Ernst, Peter; Czinn, Steve; Dunne, Donald; Gold, Ben D.

    2004-01-01

    Helicobacter pylori is the primary cause of peptic ulcer disease and an etiologic agent in the development of gastric cancer. H. pylori infection is curable with regimens of multiple antimicrobial agents, and antimicrobial resistance is a leading cause of treatment failure. The Helicobacter pylori Antimicrobial Resistance Monitoring Program (HARP) is a prospective, multicenter U.S. network that tracks national incidence rates of H. pylori antimicrobial resistance. Of 347 clinical H. pylori isolates collected from December 1998 through 2002, 101 (29.1%) were resistant to one antimicrobial agent, and 17 (5%) were resistant to two or more antimicrobial agents. Eighty-seven (25.1%) isolates were resistant to metronidazole, 45 (12.9%) to clarithromycin, and 3 (0.9%) to amoxicillin. On multivariate analysis, black race was the only significant risk factor (p < 0.01, hazard ratio 2.04) for infection with a resistant H. pylori strain. Formulating pretreatment screening strategies or providing alternative therapeutic regimens for high-risk populations may be important for future clinical practice. PMID:15207062

  16. Drinking water: a risk factor for high incidence of esophageal cancer in Anyang, China.

    PubMed

    Cao, Wenbo; Han, Jianying; Yuan, Yi; Xu, Zhixiang; Yang, Shengli; He, Weixin

    2016-06-01

    Anyang is known to be a high-incidence area of esophageal cancer (EC) in China. Among a long list of risk factors, the quality of drinking water was evaluated. We have selected 3806 individuals and collected 550 drinking water samples correspondent with this not-matched case-control survey. There are 531 EC patients included based on Population Cancer Registry from 92 townships, of which 3275 controls with long-lived aged over 90 years and free from EC are used as controls in the same regions. Our result suggests that the quality of drinking water is a highly associated risk factor for EC. The residential ecological environment and the quality of water resource positively link with each other. The analysis of water samples also demonstrated that the concentrations of methyl ethylamine, morpholine, N-methylbenzylamine, nitrate and chloride in water from springs and rivers are higher than those in well and tap water (P = 0.001). Micronuclei formation tests show that well water and tap water in these regions have no mutagenicity. PMID:26399884

  17. Postoperative Arrhythmias after Cardiac Surgery: Incidence, Risk Factors, and Therapeutic Management

    PubMed Central

    Cianflone, Domenico

    2014-01-01

    Arrhythmias are a known complication after cardiac surgery and represent a major cause of morbidity, increased length of hospital stay, and economic costs. However, little is known about incidence, risk factors, and treatment of early postoperative arrhythmias. Both tachyarrhythmias and bradyarrhythmias can present in the postoperative period. In this setting, atrial fibrillation is the most common heart rhythm disorder. Postoperative atrial fibrillation is often self-limiting, but it may require anticoagulation therapy and either a rate or rhythm control strategy. However, ventricular arrhythmias and conduction disturbances can also occur. Sustained ventricular arrhythmias in the recovery period after cardiac surgery may warrant acute treatment and long-term preventive strategy in the absence of reversible causes. Transient bradyarrhythmias may be managed with temporary pacing wires placed at surgery, but significant and persistent atrioventricular block or sinus node dysfunction can occur with the need for permanent pacing. We provide a complete and updated review about mechanisms, risk factors, and treatment strategies for the main postoperative arrhythmias. PMID:24511410

  18. Structural chromosomal aberrations as potential risk markers in incident cancer patients.

    PubMed

    Vodenkova, Sona; Polivkova, Zdenka; Musak, Ludovit; Smerhovsky, Zdenek; Zoubkova, Hana; Sytarova, Sylvie; Kavcova, Elena; Halasova, Erika; Vodickova, Ludmila; Jiraskova, Katerina; Svoboda, Miroslav; Ambrus, Miloslav; Hemminki, Kari; Vodicka, Pavel

    2015-07-01

    Epidemiological prospective studies have shown that increased chromosomal aberrations (CAs) in peripheral blood lymphocytes may predict cancer risk. Here, we report CAs in newly diagnosed 101 colorectal, 87 lung and 158 breast cancer patients and corresponding healthy controls. Strong differences in distributions of aberrant cells (ACs), CAs, chromatid-type aberrations (CTAs) and chromosome-type aberrations (CSAs) were observed in lung and breast cancer patients as compared to healthy controls. In colorectal cancer (CRC) patients, only CTAs were significantly elevated. Binary logistic regression, adjusted for main confounders, indicates that all the analysed cytogenetic parameters along with smoking were significantly associated with breast and lung cancer risks. Significant differences in terminal deletions between breast cancer patients and corresponding female controls were recorded (0.39 vs. 0.18; P ≤ 0.05). We did not find any association of CAs with TNM (tumor nodus metastasis) stages or histopathological grade in either cancer type. CAs were neither associated with additional tumor characteristics-invasivity, ductal and lobular character, estrogene/progesterone receptors in breast tumors nor with non-small/small cell and bronchogenic/pulmonary types of lung tumors. Our study demonstrates that CAs serve as a predictive marker for breast and lung cancer, whereas only CTAs were elevated in incident CRC patients. PMID:25800034

  19. Incidence and survival of stomach cancer in a high-risk population of Chile

    PubMed Central

    Heise, Katy; Bertran, Enriqueta; Andia, Marcelo E; Ferreccio, Catterina

    2009-01-01

    AIM: To study the incidence and survival rate of stomach cancer (SC) and its associated factors in a high risk population in Chile. METHODS: The population-based cancer registry of Valdivia, included in the International Agency for Research on Cancer system, covers 356 396 residents of Valdivia Province, Southern Chile. We studied all SC cases entered in this Registry during 1998-2002 (529 cases). Population data came from the Chilean census (2002). Standardized incidence rates per 100 000 inhabitants (SIR) using the world population, cumulative risk of developing cancer before age 75, and rate ratios by sex, age, ethnicity and social factors were estimated. Relative survival (Ederer II method) and age-standardized estimates (Brenner method) were calculated. Specific survival rates (Kaplan-Meier) were measured at 3 and 5 years and survival curves were analyzed with the Logrank and Breslow tests. Survival was studied in relation to demographics, clinical presentation, laboratory results and medical management of the cases. Those variables significantly associated with survival were later included in a Cox multivariate model. RESULTS: Between 1998 and 2002, 529 primary gastric cancers occurred in Valdivia (crude incidence rate 29.2 per 100 000 inhabitants). Most cases were male (69.0%), residents of urban areas (57.5%) and Hispanic (83.2%), with a low education level (84.5% < 8 school years). SC SIR was higher in men than women (40.8 and 14.8 respectively, P < 0.001), risk factors were low education RR 4.4 (95% CI: 2.9-6.8) and 1.6, (95% CI: 1.1-2.1) for women and men respectively and Mapuche ethnicity only significant for women (RR 2.2, 95% CI: 1.2-3.7). Of all cases, 76.4% were histologically confirmed, 11.5% had a death certificate only (DCO), 56.1% were TNM stage IV; 445 cases (84.1%) were eligible for survival analysis, all completed five years follow-up; 42 remained alive, 392 died of SC and 11 died from other causes. Specific 5-year survival, excluding cases

  20. Gene by Environment Investigation of Incident Lung Cancer Risk in African-Americans

    PubMed Central

    David, Sean P.; Wang, Ange; Kapphahn, Kristopher; Hedlin, Haley; Desai, Manisha; Henderson, Michael; Yang, Lingyao; Walsh, Kyle M.; Schwartz, Ann G.; Wiencke, John K.; Spitz, Margaret R.; Wenzlaff, Angela S.; Wrensch, Margaret R.; Eaton, Charles B.; Furberg, Helena; Mark Brown, W.; Goldstein, Benjamin A.; Assimes, Themistocles; Tang, Hua; Kooperberg, Charles L.; Quesenberry, Charles P.; Tindle, Hilary; Patel, Manali I.; Amos, Christopher I.; Bergen, Andrew W.; Swan, Gary E.; Stefanick, Marcia L.

    2016-01-01

    Background Genome-wide association studies have identified polymorphisms linked to both smoking exposure and risk of lung cancer. The degree to which lung cancer risk is driven by increased smoking, genetics, or gene–environment interactions is not well understood. Methods We analyzed associations between 28 single nucleotide polymorphisms (SNPs) previously associated with smoking quantity and lung cancer in 7156 African-American females in the Women's Health Initiative (WHI), then analyzed main effects of top nominally significant SNPs and interactions between SNPs, cigarettes per day (CPD) and pack-years for lung cancer in an independent, multi-center case–control study of African-American females and males (1078 lung cancer cases and 822 controls). Findings Nine nominally significant SNPs for CPD in WHI were associated with incident lung cancer (corrected p-values from 0.027 to 6.09 × 10− 5). CPD was found to be a nominally significant effect modifier between SNP and lung cancer for six SNPs, including CHRNA5 rs2036527[A](betaSNP*CPD = − 0.017, p = 0.0061, corrected p = 0.054), which was associated with CPD in a previous genome-wide meta-analysis of African-Americans. Interpretation These results suggest that chromosome 15q25.1 variants are robustly associated with CPD and lung cancer in African-Americans and that the allelic dose effect of these polymorphisms on lung cancer risk is most pronounced in lighter smokers. PMID:26981579

  1. Sternal wound infection after cardiac surgery: incidence and risk factors according to clinical presentation.

    PubMed

    Lemaignen, A; Birgand, G; Ghodhbane, W; Alkhoder, S; Lolom, I; Belorgey, S; Lescure, F-X; Armand-Lefevre, L; Raffoul, R; Dilly, M-P; Nataf, P; Lucet, J C

    2015-07-01

    The incidence of surgical site infection (SSI) after cardiac surgery depends on the definition used. A distinction is generally made between mediastinitis, as defined by the US Centers for Disease Control and Prevention (CDC), and superficial SSI. Our objective was to decipher these entities in terms of presentation and risk factors. We performed a 7-year single centre analysis of prospective surveillance of patients with cardiac surgery via median sternotomy. SSI was defined as the need for reoperation due to infection. Among 7170 patients, 292 (4.1%) developed SSI, including 145 CDC-defined mediastinitis (CDC-positive SSI, 2.0%) and 147 superficial SSI without associated bloodstream infection (CDC-negative SSI, 2.1%). Median time to reoperation for CDC-negative SSI was 18 days (interquartile range, 14-26) and 16 (interquartile range, 11-24) for CDC-positive SSI (p 0.02). Microorganisms associated with CDC-negative SSI were mainly skin commensals (62/147, 41%) or originated in the digestive tract (62/147, 42%); only six were due to Staphylococcus aureus (4%), while CDC-positive SSI were mostly due to S. aureus (52/145, 36%) and germs from the digestive tract (52/145, 36%). Risk factors for SSI were older age, obesity, chronic obstructive bronchopneumonia, diabetes mellitus, critical preoperative state, postoperative vasopressive support, transfusion or prolonged ventilation and coronary artery bypass grafting, especially if using both internal thoracic arteries in female patients. The number of internal thoracic arteries used and factors affecting wound healing were primarily associated with CDC-negative SSI, whereas comorbidities and perioperative complications were mainly associated with CDC-positive SSI. These 2 entities differed in time to revision surgery, bacteriology and risk factors, suggesting a differing pathophysiology. PMID:25882356

  2. Breast cancer in Denmark. Incidence, risk factors, and characteristics of survival.

    PubMed

    Ewertz, M

    1993-01-01

    In Denmark, incidence of female breast cancer remained constant from 1943 to around 1960, whereafter a steady increase has occurred, the level today being about 50% higher than in 1960. No equivalent rise has been observed for breast cancer mortality. Influence of hormonal and dietary factors on breast cancer risk and survival was evaluated in a combined population-based case-control and follow-up study, including 2,445 women, aged less than 70 years, diagnosed with breast cancer in Denmark between 1 March 1983 and 31 August 1984, identified from the files of the nation-wide clinical trial of the Danish Breast Cancer Co-operative Group (DBCG) and the Danish Cancer Registry. The control group was an age-stratified random sample of the general female population, selected from the Central Population Register. Data on risk factors were collected by self-administered questionnaires. Clinical and pathological tumour characteristics derived from DBCG. The case-control analysis confirmed an overall increased risk of breast cancer associated with urban residence, high social status, nulliparity, early age at menarche, late age at natural menopause, hormonal replacement therapy, high dietary fat intake, and high alcohol consumption in a subgroup. It failed to detect an association with age at first childbirth, oral contraceptives, smoking, intake of vegetables, tea, coffee, and sweeteners. Survival was determined by tumour size, skin invasion, number of positive lymph nodes, and grade. There was no relation between survival and reproductive or hormonal factors, dietary variables, alcohol consumption, or smoking. However, a complex relationship may exist between survival and body mass index. PMID:8260176

  3. Incidence And Risk Factors For 30-Day Readmissions After Hip Fracture Surgery

    PubMed Central

    Martin, Christopher T; Gao, Yubo; Pugely, Andrew J.

    2016-01-01

    Background Unplanned hospital readmission following orthopedic procedures results in significant expenditures for the Medicare population. In order to reduce expenditures, hospital readmission has become an important quality metric for Medicare patients. The purpose of the present study is to determine the incidence and risk factors for 30-day readmissions after hip fracture surgery. Methods Patients over the age of 18 years who underwent hip fracture surgery, including open reduction internal fixation (ORIF), intramedullary nailing, hemi-arthroplasty, or total hip arthroplasty, between the years 2012 and 2013 were identified from the American College of Surgeons National Surgical Quality improvement Program (NSQIP) database. Overall, 17,765 patients were identified. Univariate and multivariate analyses were performed in order to determine patient and surgical factors associated with 30-day readmission. Results There were 1503 patients (8.4%) readmitted within 30-days of their index procedure. Of the patients with a reason listed for readmission, 27.4% were for procedurally related reasons, including wound complications (16%), peri-prosthetic fractures (4.5%) and prosthetic dislocations (6%). 72.6% of readmissions were for medical reasons, including sepsis (7%), pneumonia (14%), urinary tract infection (6.3%), myocardial infarction (2.7%), renal failure (2.7%), and stroke (2.3%). In the subsequent multivariate analysis, pre-operative dyspnea, COPD, hypertension, disseminated cancer, a bleeding disorder, pre-operative hematocrit of <36, pre-operative creatinine of >1.2, an ASA class of 3 or 4, and the operative procedure type were each independently associated with readmissions risk (p<0.05 for each). Conclusions The overall rate of readmission following hip fracture surgery was moderate. Surgeons should consider discharge optimization in the at risk cohorts identified here, particularly patients with multiple medical comorbidities or an elevated ASA class, and

  4. Hierarchical Bayesian modeling of spatio-temporal patterns of lung cancer incidence risk in Georgia, USA: 2000-2007

    NASA Astrophysics Data System (ADS)

    Yin, Ping; Mu, Lan; Madden, Marguerite; Vena, John E.

    2014-10-01

    Lung cancer is the second most commonly diagnosed cancer in both men and women in Georgia, USA. However, the spatio-temporal patterns of lung cancer risk in Georgia have not been fully studied. Hierarchical Bayesian models are used here to explore the spatio-temporal patterns of lung cancer incidence risk by race and gender in Georgia for the period of 2000-2007. With the census tract level as the spatial scale and the 2-year period aggregation as the temporal scale, we compare a total of seven Bayesian spatio-temporal models including two under a separate modeling framework and five under a joint modeling framework. One joint model outperforms others based on the deviance information criterion. Results show that the northwest region of Georgia has consistently high lung cancer incidence risk for all population groups during the study period. In addition, there are inverse relationships between the socioeconomic status and the lung cancer incidence risk among all Georgian population groups, and the relationships in males are stronger than those in females. By mapping more reliable variations in lung cancer incidence risk at a relatively fine spatio-temporal scale for different Georgian population groups, our study aims to better support healthcare performance assessment, etiological hypothesis generation, and health policy making.

  5. Alcohol use, Mycoplasma genitalium and other STIs associated with HIV incidence among women at high risk in Kampala, Uganda

    PubMed Central

    Vandepitte, Judith; Weiss, Helen A; Bukenya, Justine; Nakubulwa, Susan; Mayanja, Yunia; Matovu, Godfrey; Kyakuwa, Nassim; Hughes, Peter; Hayes, Richard; Grosskurth, Heiner

    2012-01-01

    Background In 2008, the first clinic for women involved in high risk sexual behaviour was established in Kampala, offering targeted HIV prevention. This paper describes rates, determinants and trends of HIV incidence over 3 years. Methods 1027 women at high risk were enrolled into a closed cohort. At 3-monthly visits, data were collected on socio-demographic variables and risk behaviour; biological samples were tested for HIV and other STIs. Hazard ratios (HR) for HIV incidence were estimated using Cox proportional hazards regression, among the 646 women HIV negative at enrolment. Results HIV incidence was 3.66/100pyr and declined from 6.80/100pyr in the first calendar year to 2.24/100pyr and 2.53/100pyr in the following years (P-trend=0.003). Socio-demographic and behavioural factors independently associated with HIV incidence were younger age, younger age at first sex, alcohol use (including frequency of use and binge drinking), number of paying clients in the past month, inconsistent condom use with clients, and not being pregnant. HIV incidence was also independently associated with M. genitalium infection at enrolment (aHR=2.28, 95%CI: 1.15-4.52), and with N. gonorrhoeae (aHR=5.91, 95%CI: 3.04-11.49) and T. vaginalis infections at the most recent visit (aHR=2.72, 95%CI: 1.27-5.84). The PAF of HIV incidence for alcohol use was 63.5% (95%CI 6.5%-85.8%), and for treatable STI/RTI was 70.0% (95%CI 18.8%-87.5%). Conclusions Alcohol use and STIs remain important risk factors for HIV acquisition, which call for more intensive control measures in women at high risk. Further longitudinal studies are needed to confirm the association between Mycoplasma genitalium and HIV acquisition. PMID:23075920

  6. Early infections are associated with increased risk for celiac disease: an incident case-referent study

    PubMed Central

    2012-01-01

    Background Celiac disease is defined as a ‘chronic small intestinal immune-mediated enteropathy precipitated by exposure to dietary gluten in genetically predisposed individuals’. Sweden has experienced an “epidemic” of celiac disease in children below two years of age. Celiac disease etiology is considered multifactorial; however, little is known regarding potential risk- or protecting factors. We present data on the possible association between early infectious episodes and celiac disease, including their possible contribution to the Swedish celiac disease epidemic. Methods A population-based incident case-referent study (475 cases, 950 referents) with exposure information obtained via a questionnaire (including family characteristics, infant feeding, and the child’s general health) was performed. Celiac disease cases were diagnosed before two years of age, fulfilling the diagnostic criteria of the European Society for Pediatric Gastroenterology, Hepatology and Nutrition. Referents were randomly selected from the national population register after fulfilling matching criteria. The final analyses included 954 children, 373 (79%) cases and 581 (61%) referents, with complete information on main variables of interest in a matched set of one case with one or two referents. Results Having three or more parental-reported infectious episodes, regardless of type of infection, during the first six months of life was associated with a significantly increased risk for later celiac disease, and this remained after adjusting for infant feeding and socioeconomic status (odds ratio [OR] 1.5; 95% confidence interval [CI], 1.1-2.0; P=0.014). The celiac disease risk increased synergistically if, in addition to having several infectious episodes, infants were introduced to dietary gluten in large amounts, compared to small or medium amounts, after breastfeeding was discontinued (OR 5.6; 95% CI, 3.1-10; P<0.001). Conclusion This study suggests that having repeated

  7. Incidence and Risk Factors for Atrial Fibrillation in Korea: the National Health Insurance Service Database (2002–2010)

    PubMed Central

    Son, Mi Kyoung; Lim, Nam-Kyoo; Cho, Myeong-Chan

    2016-01-01

    Background and Objectives Atrial fibrillation (AF) is a common arrhythmia that is known as an important independent risk factor for stroke. However, limited information is available on AF in Korea. This study evaluated the incidence of AF, its associated co-morbidities and risk factors for AF in Korea. Subjects and Methods The National Health Insurance Service database between 2002 and 2010 was used in the study. Individuals<30 years old and those diagnosed with AF between 2002 and 2004 were excluded. Hazard ratios (HRs) according to co-morbidities and risk factors for AF were determined using a Cox proportional hazard model. Population attributable fractions (PAFs) of AF risk factors were determined. Results During a 6-year follow-up period, 3517 (1.7%) developed AF. The incidence rates in men and women aged 30-39 years were 0.82 and 0.55 per 1000 person-years, respectively; the incidence rates further increased with age to 13.09 and 11.54 per 1000 person-years in men and women aged≥80 years, respectively. The risk factors for incident AF were age, sex, body mass index (BMI), hypertension, ischemic heart disease (IHD) and heart failure. After adjusting for variables related to AF, the risk of AF was significantly associated with hypertension (HR 1.667), IHD (HR 1.639), heart failure (HR 1.521), and the PAFs for age, sex, BMI, hypertension, IHD, heart failure and diabetes mellitus were 30.6%, 10.1%, 3.4%, 16.6%, 8.2%, 5.3% and 0.8%, respectively. Conclusion Incidence of AF increased with age and was higher in men than in women. A larger proportion of AF events was attributable to hypertension than to other co-morbidities. PMID:27482260

  8. Incidence, clinical impact and risk of bleeding during oral anticoagulation therapy

    PubMed Central

    Rubboli, Andrea; Becattini, Cecilia; Verheugt, Freek WA

    2011-01-01

    Bleeding is the most important complication of oral anticoagulation (OAC) with vitamin K-antagonists. Whilst bleeding is unavoidably related to OAC, it may have a great impact on the prognosis of treated subjects by leading to discontinuation of treatment, permanent disability or death. The yearly incidence of bleeding during OAC is 2%-5% for major bleeding, 0.5%-1% for fatal bleeding, and 0.2%-0.4% for intracranial bleeding. While OAC interruption and/or antagonism, as well as administration of coagulation factors, represent the necessary measures for the management of bleeding, proper stratification of the individual risk of bleeding prior to start OAC is of paramount importance. Several factors, including advanced age, female gender, poor control and higher intensity of OAC, associated diseases and medications, as well as genetic factors, have been proven to be associated with an increased risk of bleeding. Most of these factors have been included in the development of bleeding prediction scores, which should now be used by clinicians when prescribing and monitoring OAC. Owing to the many limitations of OAC, including a narrow therapeutic window, cumbersome management, and wide inter- and intra-individual variability, novel oral anticoagulants, such as factor Xa inhibitors and direct thrombin inhibitors, have been recently developed. These agents can be given in fixed doses, have little interaction with foods and drugs, and do not require regular monitoring of anticoagulation. While the novel oral anticoagulants show promise for effective thromboprophylaxis in atrial fibrillation and venous thromboembolism, definitive data on their safety and efficacy are awaited. PMID:22125670

  9. Incidence and Risk Factors of Homicide–Suicide in Swiss Households: National Cohort Study

    PubMed Central

    Panczak, Radoslaw; Zwahlen, Marcel; Spoerri, Adrian; Tal, Kali; Killias, Martin; Egger, Matthias

    2013-01-01

    Background Homicide–suicides are rare but catastrophic events. This study examined the epidemiology of homicide-suicide in Switzerland. Methods The study identified homicide–suicide events 1991–2008 in persons from the same household in the Swiss National Cohort, which links census and mortality records. The analysis examined the association of the risk of dying in a homicide–suicide event with socio-demographic variables, measured at the individual-level, household composition variables and area-level variables. Proportional hazards regression models were calculated for male perpetrators and female victims. Results are presented as age-adjusted hazard ratios (HR) with 95% confidence intervals (95%CI). Results The study identified 158 deaths from homicide–suicide events, including 85 murder victims (62 women, 4 men, 19 children and adolescents) and 68 male and 5 female perpetrators. The incidence was 3 events per million households and year. Firearms were the most prominent method for both homicides and suicides. The risk of perpetrating homicide-suicide was higher in divorced than in married men (HR 3.64; 95%CI 1.56–8.49), in foreigners without permanent residency compared to Swiss citizens (HR 3.95; 1.52–10.2), higher in men without religious affiliations than in Catholics (HR 2.23; 1.14–4.36) and higher in crowded households (HR 4.85; 1.72–13.6 comparing ≥2 with <1 persons/room). There was no association with education, occupation or nationality, the number of children, the language region or degree of urbanicity. Associations were similar for female victims. Conclusions This national longitudinal study shows that living conditions associated with psychological stress and lower levels of social support are associated with homicide-suicide events in Switzerland. PMID:23326491

  10. Circadian activity rhythms and risk of incident dementia and MCI in older women

    PubMed Central

    Tranah, Gregory J.; Blackwell, Terri; Stone, Katie L.; Ancoli-Israel, Sonia; Paudel, Misti L.; Ensrud, Kristine E.; Cauley, Jane A.; Redline, Susan; Hillier, Teresa A.; Cummings, Steven R; Yaffe, Kristine

    2011-01-01

    Objective Previous cross-sectional studies have observed alterations in activity rhythms in dementia patients but the direction of causation is unclear. We determined whether circadian activity rhythms measured in community-dwelling older women are prospectively associated with incident dementia or mild cognitive impairment (MCI). Method Activity rhythm data were collected from 1,282 healthy community-dwelling women from the Study of Osteoporotic Fractures cohort (mean age 83 years) with wrist actigraphy for a minimum of three 24-hour periods. Each participant completed a neuropsychological test battery and had clinical cognitive status (dementia, MCI, normal) adjudicated by an expert panel approximately 5 years later. All analyses were adjusted for demographics, BMI, functional status, depression, medications, alcohol, caffeine, smoking, health status, and co-morbidities. Results After 4.9 years of follow-up, 195 (15%) women had developed dementia and 302 (24%) had developed MCI. Older women with decreased activity rhythms had a higher likelihood of developing dementia or MCI when comparing those in the lowest quartiles of amplitude (Odds ratio[OR]=1.57,95% CI,1.09–2.25) or rhythm robustness (OR=1.57,95%CI,1.10–2.26) to women in the highest quartiles. An increased risk of dementia or MCI (OR=1.83,95% CI,1.29–2.61) was found for women whose timing of peak activity occurred later in the day (after 3:51PM) when compared to those with average timing (1:34PM–3:51PM). Interpretation Older, healthy women with decreased circadian activity rhythm amplitude and robustness, and delayed rhythms have increased odds of developing dementia and MCI. If confirmed, future studies should examine whether interventions (physical activity, bright light exposure) that influence activity rhythms will reduce the risk of cognitive deterioration in the elderly. PMID:22162057

  11. The incidence, risk factors, and outcome of transfusion-related acute lung injury in a cohort of cardiac surgery patients: a prospective nested case-control study.

    PubMed

    Vlaar, Alexander P J; Hofstra, Jorrit J; Determann, Rogier M; Veelo, Denise P; Paulus, Frederique; Kulik, Wim; Korevaar, Johanna; de Mol, Bas A; Koopman, Marianne M W; Porcelijn, Leendert; Binnekade, Jan M; Vroom, Margreeth B; Schultz, Marcus J; Juffermans, Nicole P

    2011-04-21

    Transfusion-related acute lung injury (TRALI) is the leading cause of transfusion-related morbidity and mortality. Both antibodies and bioactive lipids that have accumulated during storage of blood have been implicated in TRALI pathogenesis. In a single-center, nested, case-control study, patients were prospectively observed for onset of TRALI according to the consensus definition. Of 668 patients, 16 patients (2.4%) developed TRALI. Patient-related risk factors for onset of TRALI were age and time on the cardiopulmonary bypass. Transfusion-related risk factors were total amount of blood products (odds ratio [OR] = 1.2; 95% confidence interval [CI], 1.03-1.44), number of red blood cells stored more than 14 days (OR = 1.6; 95% CI, 1.04-2.37), total amount of plasma (OR = 1.2; 95% CI, 1.03-1.44), presence of antibodies in donor plasma (OR = 8.8; 95% CI, 1.8-44), and total amount of transfused bioactive lipids (OR = 1.0; 95% CI, 1.00-1.07). When adjusted for patient risk factors, only the presence of antibodies in the associated blood products remained a risk factor for TRALI (OR = 14.2; 95% CI, 1.5-132). In-hospital mortality of TRALI was 13% compared with 0% and 3% in transfused and nontransfused patients, respectively (P < .05). In conclusion, the incidence of TRALI is high in cardiac surgery patients and associated with adverse outcome. Our results suggest that cardiac surgery patients may benefit from exclusion of blood products containing HLA/HNA antibodies. PMID:21325598

  12. Usual choline and betaine dietary intake and incident coronary heart disease: the Atherosclerosis Risk in Communities (ARIC) Study

    PubMed Central

    Bidulescu, Aurelian; Chambless, Lloyd E; Siega-Riz, Anna Maria; Zeisel, Steven H; Heiss, Gerardo

    2007-01-01

    Background Low dietary intake of the essential nutrient choline and its metabolite betaine may increase atherogenesis both through effects on homocysteine methylation pathways as well as through choline's antioxidants properties. Nutrient values for many common foods for choline and betaine have recently become available in the U.S. nutrient composition database. Our objective was to assess the association of dietary intake of choline and betaine with incident coronary heart disease (CHD), adjusting for dietary intake measurement error. Methods We conducted a prospective investigation of the relation between usual intake of choline and betaine with the risk of CHD in 14,430 middle-aged men and women of the biethnic Atherosclerosis Risk in Communities study. A semi-quantitative food frequency questionnaire was used to assess nutrient intake. Proportional hazard regression models were used to calculate the risk of incident CHD. A regression calibration method was used to adjust for measurement error. Results During an average 14 years of follow-up (1987–2002), 1,072 incident CHD events were documented. Compared with the lowest quartile of intake, incident CHD risk was slightly and non-significantly higher in the highest quartile of choline and choline plus betaine, HR = 1.22 (0.91, 1.64) and HR = 1.14 (0.85, 1.53), controlling for age, sex, education, total energy intake, dietary intakes of folate, methionine and vitamin B6. No association was found between dietary choline intake and incident CHD when correcting for measurement error. Conclusion Higher intakes of choline and betaine were not protective for incident CHD. Similar investigations in other populations are of interest. PMID:17629908

  13. Ophthalmic lymphoma: epidemiology and pathogenesis.

    PubMed

    Sjö, Lene Dissing

    2009-02-01

    with relapse. Furthermore, we found that the frequency of translocations involving the MALT1- and IGH-gene loci is low in ocular region MALT lymphoma (2 of 42, 5%), but may predict increased risk of relapse (Sjo et al. 2008b). In conclusion the incidence of ophthalmic lymphoma is increasing at a high rate in Denmark. Ophthalmic lymphoma consists primarily of MALT lymphoma. The molecular pathogenesis of MALT lymphoma arising in the ocular region rarely involves translocations in the MALT1- and IGH-gene loci. PMID:19178392

  14. Benzodiazepine use and risk of incident dementia or cognitive decline: prospective population based study

    PubMed Central

    Dublin, Sascha; Yu, Onchee; Walker, Rod; Anderson, Melissa; Hubbard, Rebecca A; Crane, Paul K; Larson, Eric B

    2016-01-01

    Objective To determine whether higher cumulative use of benzodiazepines is associated with a higher risk of dementia or more rapid cognitive decline. Design Prospective population based cohort. Setting Integrated healthcare delivery system, Seattle, Washington. Participants 3434 participants aged ≥65 without dementia at study entry. There were two rounds of recruitment (1994-96 and 2000-03) followed by continuous enrollment beginning in 2004. Main outcomes measures The cognitive abilities screening instrument (CASI) was administered every two years to screen for dementia and was used to examine cognitive trajectory. Incident dementia and Alzheimer’s disease were determined with standard diagnostic criteria. Benzodiazepine exposure was defined from computerized pharmacy data and consisted of the total standardized daily doses (TSDDs) dispensed over a 10 year period (a rolling window that moved forward in time during follow-up). The most recent year was excluded because of possible use for prodromal symptoms. Multivariable Cox proportional hazard models were used to examine time varying use of benzodiazepine and dementia risk. Analyses of cognitive trajectory used linear regression models with generalized estimating equations. Results Over a mean follow-up of 7.3 years, 797 participants (23.2%) developed dementia, of whom 637 developed Alzheimer’s disease. For dementia, the adjusted hazard ratios associated with cumulative benzodiazepine use compared with non-use were 1.25 (95% confidence interval 1.03 to 1.51) for 1-30 TSDDs; 1.31 (1.00 to 1.71) for 31-120 TSDDs; and 1.07 (0.82 to 1.39) for ≥121 TSDDs. Results were similar for Alzheimer’s disease. Higher benzodiazepine use was not associated with more rapid cognitive decline. Conclusion The risk of dementia is slightly higher in people with minimal exposure to benzodiazepines but not with the highest level of exposure. These results do not support a causal association between benzodiazepine use and

  15. Incidence and Risk Factors for Tuberculosis in People Living with HIV: Cohort from HIV Referral Health Centers in Recife, Brazil

    PubMed Central

    Batista, Joanna d’Arc Lyra; de Albuquerque, Maria de Fátima Pessoa Militão; Maruza, Magda; Ximenes, Ricardo Arraes de Alencar; Santos, Marcela Lopes; Montarroyos, Ulisses Ramos; de Barros Miranda-Filho, Demócrito; Lacerda, Heloisa Ramos; Rodrigues, Laura Cunha

    2013-01-01

    Objective To identify the incidence of and risk factors for tuberculosis in people living with HIV (PLHIV). Design Observational, prospective cohort study. Methods A total of 2069 HIV-infected patients was observed between July 2007 and December 2010. The Kaplan-Meier method was used to estimate the probability of survival free of tuberculosis, and Cox regression analysis to identify risk factors associated with the development of tuberculosis. Results Survival free of tuberculosis (TB) was 91%. The incidence rate of tuberculosis was 2.8 per 100 persons/years. Incidence of tuberculosis was higher when subjects had CD4 cell count <200 cells/mm3; were not on antiretroviral therapy; in those who had, a body mass index <18.5 kg/m2, anemia (or were not tested for it), were illiterate or referred previous tuberculosis treatment at entry into the cohort. Those not treated for latent TB infection had a much higher risk (HR = 7.9) of tuberculosis than those with a negative tuberculin skin test (TST). Having a TST≥5 mm but not being treated for latent TB infection increased the risk of incident tuberculosis even in those with a history of previous tuberculosis. Conclusions Preventive actions to reduce the risk of TB in people living with HIV should include an appropriate HAART and treatment for latent TB infection in those with TST≥5 mm. The actions towards enabling rigorous implementation of treatment of latent TB infection and targeting of PLHIV drug users both at the individual and in public health level can reduce substantially the incidence of TB in PLHIV. PMID:23675515

  16. Incidence, Characteristics and Risk Factors of Acute Kidney Injury among Dengue Patients: A Retrospective Analysis

    PubMed Central

    Mallhi, Tauqeer Hussain; Khan, Amer Hayat; Adnan, Azreen Syazril; Sarriff, Azmi; Khan, Yusra Habib; Jummaat, Fauziah

    2015-01-01

    Background Dengue induced acute kidney injury (AKI) imposes heavy burden of illness in terms of morbidity and mortality. A retrospective study was conducted to investigate incidence, characteristics, risk factors and clinical outcomes of AKI among dengue patients. Methodology A total 667 dengue patients (2008–2013) were retrospectively evaluated and were stratified into AKI and non-AKI groups by using AKIN criteria. Two groups were compared by using appropriate statistical methods. Results There were 95 patients (14.2%) who had AKI, with AKIN-I, AKIN-II and AKIN-III in 76.8%, 16.8% and 6.4% patients, respectively. Significant differences (P<0.05) in demographics and clinico-laboratory characteristics were observed between patients with and without AKI. Presence of dengue hemorrhagic fever [OR (95% CI): 8.0 (3.64–17.59), P<0.001], rhabdomyolysis [OR (95% CI): 7.9 (3.04–20.49)], multiple organ dysfunction [OR (95% CI): 34.6 (14.14–84.73), P<0.001], diabetes mellitus [OR (95% CI): 4.7 (1.12–19.86), P = 0.034], late hospitalization [OR (95% CI): 2.1 (1.12–19.86), P = 0.033] and use of nephrotoxic drugs [OR (95% CI): 2.9 (1.12–19.86), P = 0.006] were associated with AKI. Longer hospital stay (>3 days) was also observed among AKI patients (OR = 1.3, P = 0.044). Additionally, 48.4% AKI patients had renal insufficiencies at discharge that were signicantly associated with severe dengue, secondary infection and diabetes mellitus. Overall mortality was 1.2% and all fatal cases had AKI. Conclusions The incidence of AKI is high at 14.2% among dengue patients, and those with AKI portended significant morbidity, mortality, longer hospital stay and poor renal outcomes. Our findings suggest that AKI in dengue is likely to increase healthcare burden that underscores the need of clinicians’ alertness to this highly morbid and potentially fatal complication for optimal prevention and management. PMID:26421839

  17. Incidence and Risk Factors Associated with Readmission After Surgical Treatment for Adrenocortical Carcinoma

    PubMed Central

    Valero-Elizondo, Javier; Kim, Yuhree; Prescott, Jason D.; Margonis, Georgios A.; Tran, Thuy B.; Postlewait, Lauren M.; Maithel, Shishir K.; Wang, Tracy S.; Glenn, Jason A.; Hatzaras, Ioannis; Shenoy, Rivfka; Phay, John E.; Keplinger, Kara; Fields, Ryan C.; Jin, Linda X.; Weber, Sharon M.; Salem, Ahmed; Sicklick, Jason K.; Gad, Shady; Yopp, Adam C.; Mansour, John C.; Duh, Quan-Yang; Seiser, Natalie; Solorzano, Carmen C.; Kiernan, Colleen M.; Votanopoulos, Konstantinos I.; Levine, Edward A.; Poultsides, George A.

    2016-01-01

    Background Adrenocortical carcinoma (ACC) is a rare disease with a poor prognosis. Given the lack of data on readmission after resection of ACC, the objective of the current study was to define the incidence of readmission, as well as identify risk factors associated with readmission among patients with ACC who underwent surgical resection. Methods Two hundred nine patients who underwent resection of ACC between January 1993 and December 2014 at 1 of 13 major centers in the USA were identified. Demographic and clinicopathological data were collected and analyzed relative to readmission. Results Median patient age was 52 years, and 62 % of the patients were female. Median tumor size was 12 cm, and the majority of patients had an American Society of Anesthesiologists (ASA) class of 3–4 (n=85, 56 %). The overall incidence of readmission within 90 days from surgery was 18 % (n=38). Factors associated with readmission included high ASA class (odds ratio (OR), 4.88 (95 % confidence interval (CI), 1.75–13.61); P=0.002), metastatic disease on presentation (OR, 2.98 (95 % CI, 1.37–6.46); P=0.006), EBL (>700 mL: OR, 2.75 (95 % CI, 1.16–6.51); P=0.02), complication (OR, 1.91 (95 % CI, 1.20–3.05); P=0.007), and prolonged length of stay (LOS; ≥9 days: OR, 4.12 (95 % CI, 1.88–9.01); P<0.001). On multivariate logistic regression, a high ASA class (OR, 4.01 (95 % CI, 1.44–11.17); P=0.008) and metastatic disease on presentation (OR, 3.44 (95 % CI, 1.34–8.84); P=0.01) remained independently associated with higher odds of readmission. Conclusion Readmission following surgery for ACC was common as one in five patients experienced a readmission. Patients with a high ASA class and metastatic disease on presentation were over four and three times more likely to be readmitted after surgical treatment for ACC, respectively. PMID:26286367

  18. Clinical and community risk models of incident tooth loss in postmenopausal women from the Buffalo Osteo Perio Study

    PubMed Central

    Bole, Christopher; Wactawski-Wende, Jean; Hovey, Kathleen; Genco, Robert J.; Hausmann, Ernest

    2010-01-01

    Objectives While risk factors for tooth loss in adults have been identified, limited studies describing factors associated with incident tooth loss in postmenopausal women exist. This study assessed both clinical and non-clinical risk factors for incident tooth loss. Methods Postmenopausal women (N= 1,341) were recruited between 1997–2000 from 1847 eligible Observational Study participants of the Buffalo, NY center of the Women’s Health Initiative who had complete dental examinations to assess alveolar bone height, soft tissue attachment and general oral health, and completed questionnaires concerning demographics, general health, lifestyle and oral health (72.6% participation rate). Five years later (2002–2005), 1021 women (76.1%) repeated these examinations and questionnaires. Incident tooth loss was determined by oral examination Results After an average 5.1 years of follow-up (SD, 0.38), a total of 323 teeth were lost in 293 women, resulting in 28.7% of women with incident loss of at least one tooth. In multivariable models, diabetes history, gum disease history, smoking, previous tooth loss, BMI and plaque index, baseline clinical measures including alveolar crestal height (ACH) (OR=1.22 per mm loss, 95% CI 1.11, 1.35), clinical attachment loss (CAL) (OR=1.13 per mm loss, 95% CI 1.05, 1.23) and pocket depth (PD) (OR=1.26 per mm loss, 95% CI 1.13, 1.41) were significant risk factors of incident tooth loss. In a community model that included no clinical measures, diabetes history (OR=2.45, 95% CI 1.26, 4.77), prior gum disease (OR=1.97, 95% CI 1.43, 2.70), ever smoking (OR=1.42, 95% CI 1,06, 1.89), number of teeth lost at baseline (OR=1.05 per tooth, 95% CI 1.02, 1.08) and BMI (OR=1.15 per 5 km/m2 increase, 95% CI 1.01, 1.33) were associated with an increased risk of incident tooth loss. Conclusions Clinical and questionnaire based models were found to provide similar risk estimates for incident tooth loss in postmenopausal women. These models identified

  19. A Model for Predicting the Future Risk of Incident Erosive Esophagitis in an Asymptomatic Population Undergoing Regular Check-ups.

    PubMed

    Kang, Soo Hoon; Lim, Yaeji; Lee, Hyuk; Kim, Joungyoun; Chi, Sangah; Min, Yang Won; Min, Byung-Hoon; Lee, Jun Haeng; Son, Hee Jung; Ryu, Seungho; Rhee, Poong-Lyul; Kim, Jae J

    2016-01-01

    Erosive esophagitis is a major risk factor for Barrett esophagus and esophageal adenocarcinoma. Information regarding the putative risk factors for developing erosive esophagitis is considerably heterogeneous; thus, a risk model is required to clinically predict the incidence of erosive esophagitis. This study was to derive and validate a predictive model for the incidence of developing erosive esophagitis after negative index endoscopy in a population subjected to routine health check-ups. This retrospective cohort study of health check-ups included 11,535 patients who underwent repeated screening endoscopy after >3 years from a negative index endoscopy. We used logistic regression analysis to predict the incidence of erosive esophagitis, and a Simple Prediction of Erosive Esophagitis Development score for risk assessment was developed and internally validated using the split-sample approach. The development and validation cohorts included 5765 patients (675 with erosive esophagitis [11.7%]) and 5770 patients (670 with erosive esophagitis [11.6%]), respectively. The final model included sex, smoking behavior, body mass index, hypertension, and the triglyceride level as variables. This model predicted 667 cases of erosive esophagitis, yielding an expected-to-observed ratio of 1.00 (95% confidence interval [CI], 0.92-1.07). A simplified 5-item risk scoring system based on coefficients was developed, with a risk of erosive esophagitis of 6.2% (95% CI, 5.2-7.1) for the low-risk group (score ≤2), 15.1% (95% CI, 13.5-16.6) for the intermediate-risk group (score ≤3, 4), and 18.2% (95% CI, 15.2-21.3) for the high-risk group (score ≥5). The discriminative performance of the risk-prediction score was consistent in the derivation cohort and validation cohort (c-statistics 0.68 and 0.64, respectively); the calibration was good (Brier score 0.099 and 0.1, respectively). In conclusion, a simple risk-scoring model using putative risk factors can predict the future

  20. Health Risk Factor Modification Predicts Incidence of Diabetes in an Employee Population: Results of an 8-Year Longitudinal Cohort Study

    PubMed Central

    Rolando, Lori; Byrne, Daniel W.; McGown, Paula W.; Goetzel, Ron Z.; Elasy, Tom; Yarbrough, Mary I.

    2013-01-01

    Objective To understand risk factor modification effect on Type 2 Diabetes incidence in a workforce population. Methods Annual Health Risk Assessment (HRA) data (n=3125) in years 1 through 4 were used to predict diabetes development in years 5 through 8. Results Employees who reduced their BMI from ≥30 to < 30 decreased their chances of developing diabetes (OR 0.22, 95% CI 0.05 to 0.93), while those who became obese increased their diabetes risk (OR 8.85, 95% CI 2.53 to 31.0). Conclusions Weight reduction observed over a long period can result in clinically important reductions in diabetes incidence. Workplace health promotion programs may prevent diabetes among workers by encouraging weight loss and adoption of healthy lifestyle habits. PMID:23532193

  1. 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

  2. Inflammatory bowel disease: Pathogenesis

    PubMed Central

    Zhang, Yi-Zhen; Li, Yong-Yu

    2014-01-01

    Inflammatory bowel disease (IBD), including Crohn’s disease and ulcerative colitis, is characterized by chronic relapsing intestinal inflammation. It has been a worldwide health-care problem with a continually increasing incidence. It is thought that IBD results from an aberrant and continuing immune response to the microbes in the gut, catalyzed by the genetic susceptibility of the individual. Although the etiology of IBD remains largely unknown, it involves a complex interaction between the genetic, environmental or microbial factors and the immune responses. Of the four components of IBD pathogenesis, most rapid progress has been made in the genetic study of gut inflammation. The latest internationally collaborative studies have ascertained 163 susceptibility gene loci for IBD. The genes implicated in childhood-onset and adult-onset IBD overlap, suggesting similar genetic predispositions. However, the fact that genetic factors account for only a portion of overall disease variance indicates that microbial and environmental factors may interact with genetic elements in the pathogenesis of IBD. Meanwhile, the adaptive immune response has been classically considered to play a major role in the pathogenesis of IBD, as new studies in immunology and genetics have clarified that the innate immune response maintains the same importance in inducing gut inflammation. Recent progress in understanding IBD pathogenesis sheds lights on relevant disease mechanisms, including the innate and adaptive immunity, and the interactions between genetic factors and microbial and environmental cues. In this review, we provide an update on the major advances that have occurred in above areas. PMID:24415861

  3. An evaluation of early countermeasures to reduce the risk of internal radiation exposure after the Fukushima nuclear incident in Japan.

    PubMed

    Nomura, Shuhei; Tsubokura, Masaharu; Gilmour, Stuart; Hayano, Ryugo S; Watanabe, Yuni N; Kami, Masahiro; Kanazawa, Yukio; Oikawa, Tomoyoshi

    2016-05-01

    After a radiation-release incident, intake of radionuclides in the initial stage immediately following the incident may be the major contributor to total internal radiation exposure for individuals in affected areas. However, evaluation of early internal contamination risk is greatly lacking. This study assessed the relationship between initial stage evacuation/indoor sheltering and internal radiation contamination levels 4 months after the 2011 Fukushima nuclear incident in Japan and estimated potential pathways of the contamination. The study population comprised 525 participants in the internal radiation screening program at Minamisoma Municipal General Hospital, 23 km north of the Fukushima nuclear plant. The analysed dataset included the results of a screening performed in July 2011, 4 months after the incident, and of a questionnaire on early-incident response behaviours, such as sheltering indoors and evacuations, completed by participants. Association between such early countermeasures and internal contamination levels of cesium-134 were assessed using Tobit multiple regression analyses. Our study shows that individuals who evacuated to areas outside Fukushima Prefecture had similar contamination levels of cesium-134 to individuals who stayed in Fukushima (relative risk: 0.86; 95% confidence interval: 0.74-0.99). Time spent outdoors had no significant relationship with contamination levels. The effects of inhalation from radiological plumes released from the nuclear plant on total internal radiation contamination might be so low as to be undetectable by the whole-body counting unit used to examine participants. Given the apparent limited effectiveness of evacuation and indoor sheltering on internal contamination, the decision to implement such early responses to a radiation-release incident should be made by carefully balancing their potential benefits and health risks. PMID:26363171

  4. Retinopathy of Prematurity among Very-Low-Birth-Weight Infants in Korea: Incidence, Treatment, and Risk Factors.

    PubMed

    Hwang, Jong Hee; Lee, Eun Hee; Kim, Ellen Ai-Rhan

    2015-10-01

    This study was conducted to describe the incidence, risk factors, and current treatment status of retinopathy of prematurity (ROP) in very-low-birth-weight (VLBW) infants registered in the Korean Neonatal Network database. Medical records of 2,009 VLBW infants born between January 2013 and June 2014 who underwent examination by an ophthalmologist were reviewed. The total incidence of ROP was 34.1%. Of the patients, 11.6% showed ROP stage ≥ 3 and 11.5% received treatment of VLBW. Among all infants who received treatment of ROP, 63.6% underwent operation only; 16.9%, anti-vascular endothelial growth factor (anti-VEGF) treatment only; and 19.5%, both operation and anti-VEGF treatment. The mean gestational age (GA) and birth weight (BW) were significantly lower and the prevalence rates of respiratory distress syndrome, patent ductus arteriosus (PDA), invasive ventilator duration, and sepsis were significantly higher in the VLBW infants with ROP than in those without ROP. In the multivariable logistic regression analysis, PDA (odd ratio [OR], 2.1; 95% confidence interval [CI], 1.11-3.79) and invasive ventilator duration (OR, 1.0; 95% CI, 1.00-1.02) were significant risk factors of ROP and ROP stage ≥ 3. In conclusion, the high incidence of ROP is associated with low GA and BW, and attempt to reduce the aforementioned risk factors could reduce the incidence of ROP stage ≥ 3 in VLBW infants. PMID:26566363

  5. Retinopathy of Prematurity among Very-Low-Birth-Weight Infants in Korea: Incidence, Treatment, and Risk Factors

    PubMed Central

    Hwang, Jong Hee; Lee, Eun Hee

    2015-01-01

    This study was conducted to describe the incidence, risk factors, and current treatment status of retinopathy of prematurity (ROP) in very-low-birth-weight (VLBW) infants registered in the Korean Neonatal Network database. Medical records of 2,009 VLBW infants born between January 2013 and June 2014 who underwent examination by an ophthalmologist were reviewed. The total incidence of ROP was 34.1%. Of the patients, 11.6% showed ROP stage ≥ 3 and 11.5% received treatment of VLBW. Among all infants who received treatment of ROP, 63.6% underwent operation only; 16.9%, anti-vascular endothelial growth factor (anti-VEGF) treatment only; and 19.5%, both operation and anti-VEGF treatment. The mean gestational age (GA) and birth weight (BW) were significantly lower and the prevalence rates of respiratory distress syndrome, patent ductus arteriosus (PDA), invasive ventilator duration, and sepsis were significantly higher in the VLBW infants with ROP than in those without ROP. In the multivariable logistic regression analysis, PDA (odd ratio [OR], 2.1; 95% confidence interval [CI], 1.11-3.79) and invasive ventilator duration (OR, 1.0; 95% CI, 1.00-1.02) were significant risk factors of ROP and ROP stage ≥ 3. In conclusion, the high incidence of ROP is associated with low GA and BW, and attempt to reduce the aforementioned risk factors could reduce the incidence of ROP stage ≥ 3 in VLBW infants. PMID:26566363

  6. Incidence and Risk Factors of Thromboembolism with Multiple Myeloma in the Presence of Death as a Competing Risk: An Empirical Comparison of Statistical Methodologies

    PubMed Central

    Brown, Joshua D.; Adams, Val R.

    2016-01-01

    Multiple myeloma (MM) has an inherent high risk of thromboembolic events associated with patient as well as disease- and treatment-related factors. Previous studies have assessed the association of MM-related thromboembolism using “traditional” Kaplan–Meier (KM) and/or Cox proportional hazard (PH) regression. In the presence of high incidence of death, as would be the case in cancer patients with advanced age, these statistical models will produce bias estimates. Instead, a competing risk framework should be used. This study assessed the baseline patient demographic and clinical characteristics associated with MM-related thromboembolism and compared the cumulative incidence and the measures of association obtained using each statistical approach. The cumulative incidence of thromboembolism was 9.2% using the competing risk framework and nearly 12% using the KM approach. Bias in the measures of covariate risk associations was highest for factors related to risk of death such as increased age (75% bias) and severe liver disease (50%) for the Cox PH model compared to the competing risk model. These results show that correct specification of statistical techniques can have a large impact on the results obtained. PMID:27417604

  7. Propensity score methods for estimating relative risks in cluster randomized trials with low-incidence binary outcomes and selection bias.

    PubMed

    Leyrat, Clémence; Caille, Agnès; Donner, Allan; Giraudeau, Bruno

    2014-09-10

    Despite randomization, selection bias may occur in cluster randomized trials. Classical multivariable regression usually allows for adjusting treatment effect estimates with unbalanced covariates. However, for binary outcomes with low incidence, such a method may fail because of separation problems. This simulation study focused on the performance of propensity score (PS)-based methods to estimate relative risks from cluster randomized trials with binary outcomes with low incidence. The results suggested that among the different approaches used (multivariable regression, direct adjustment on PS, inverse weighting on PS, and stratification on PS), only direct adjustment on the PS fully corrected the bias and moreover had the best statistical properties. PMID:24771662

  8. Brief Report: Incidence of and Risk Factors for Autistic Disorder in Neonatal Intensive Care Unit Survivors.

    ERIC Educational Resources Information Center

    Matsuishi, Toyojiro; Yamashita, Yushiro; Ohtani, Yasuyo; Ornitz, Edward; Kuriya, Norikazu; Murakami, Yoshihiko; Fukuda, Seiichi; Hashimoto, Takeo; Yamashita, Fumio

    1999-01-01

    Analysis of the incidence of autistic disorder (AD) among 5,271 children in a neonatal intensive care unit in Japan found that 18 children were later diagnosed with AD, an incidence more than twice as high as previously reported. Children with AD had a significantly higher history of the meconium aspiration syndrome than the controls. (Author/DB)

  9. Monte Carlo mixture model of lifetime cancer incidence risk from radiation exposure on shuttle and international space station

    NASA Technical Reports Server (NTRS)

    Peterson, L. E.; Cucinotta, F. A.; Wilson, J. W. (Principal Investigator)

    1999-01-01

    Estimating uncertainty in lifetime cancer risk for human exposure to space radiation is a unique challenge. Conventional risk assessment with low-linear-energy-transfer (LET)-based risk from Japanese atomic bomb survivor studies may be inappropriate for relativistic protons and nuclei in space due to track structure effects. This paper develops a Monte Carlo mixture model (MCMM) for transferring additive, National Institutes of Health multiplicative, and multiplicative excess cancer incidence risks based on Japanese atomic bomb survivor data to determine excess incidence risk for various US astronaut exposure profiles. The MCMM serves as an anchor point for future risk projection methods involving biophysical models of DNA damage from space radiation. Lifetime incidence risks of radiation-induced cancer for the MCMM based on low-LET Japanese data for nonleukemia (all cancers except leukemia) were 2.77 (90% confidence limit, 0.75-11.34) for males exposed to 1 Sv at age 45 and 2.20 (90% confidence limit, 0.59-10.12) for males exposed at age 55. For females, mixture model risks for nonleukemia exposed separately to 1 Sv at ages of 45 and 55 were 2.98 (90% confidence limit, 0.90-11.70) and 2.44 (90% confidence limit, 0.70-10.30), respectively. Risks for high-LET 200 MeV protons (LET=0.45 keV/micrometer), 1 MeV alpha-particles (LET=100 keV/micrometer), and 600 MeV iron particles (LET=180 keV/micrometer) were scored on a per particle basis by determining the particle fluence required for an average of one particle per cell nucleus of area 100 micrometer(2). Lifetime risk per proton was 2.68x10(-2)% (90% confidence limit, 0.79x10(-3)%-0. 514x10(-2)%). For alpha-particles, lifetime risk was 14.2% (90% confidence limit, 2.5%-31.2%). Conversely, lifetime risk per iron particle was 23.7% (90% confidence limit, 4.5%-53.0%). Uncertainty in the DDREF for high-LET particles may be less than that for low-LET radiation because typically there is very little dose-rate dependence

  10. Monte Carlo mixture model of lifetime cancer incidence risk from radiation exposure on shuttle and international space station.

    PubMed

    Peterson, L E; Cucinotta, F A

    1999-12-01

    Estimating uncertainty in lifetime cancer risk for human exposure to space radiation is a unique challenge. Conventional risk assessment with low-linear-energy-transfer (LET)-based risk from Japanese atomic bomb survivor studies may be inappropriate for relativistic protons and nuclei in space due to track structure effects. This paper develops a Monte Carlo mixture model (MCMM) for transferring additive, National Institutes of Health multiplicative, and multiplicative excess cancer incidence risks based on Japanese atomic bomb survivor data to determine excess incidence risk for various US astronaut exposure profiles. The MCMM serves as an anchor point for future risk projection methods involving biophysical models of DNA damage from space radiation. Lifetime incidence risks of radiation-induced cancer for the MCMM based on low-LET Japanese data for nonleukemia (all cancers except leukemia) were 2.77 (90% confidence limit, 0.75-11.34) for males exposed to 1 Sv at age 45 and 2.20 (90% confidence limit, 0.59-10.12) for males exposed at age 55. For females, mixture model risks for nonleukemia exposed separately to 1 Sv at ages of 45 and 55 were 2.98 (90% confidence limit, 0.90-11.70) and 2.44 (90% confidence limit, 0.70-10.30), respectively. Risks for high-LET 200 MeV protons (LET=0.45 keV/micrometer), 1 MeV alpha-particles (LET=100 keV/micrometer), and 600 MeV iron particles (LET=180 keV/micrometer) were scored on a per particle basis by determining the particle fluence required for an average of one particle per cell nucleus of area 100 micrometer(2). Lifetime risk per proton was 2.68x10(-2)% (90% confidence limit, 0.79x10(-3)%-0. 514x10(-2)%). For alpha-particles, lifetime risk was 14.2% (90% confidence limit, 2.5%-31.2%). Conversely, lifetime risk per iron particle was 23.7% (90% confidence limit, 4.5%-53.0%). Uncertainty in the DDREF for high-LET particles may be less than that for low-LET radiation because typically there is very little dose-rate dependence

  11. Incidence of and significant risk factors for aminoglycoside-associated nephrotoxicity in patients dosed by using individualized pharmacokinetic monitoring.

    PubMed

    Bertino, J S; Booker, L A; Franck, P A; Jenkins, P L; Franck, K R; Nafziger, A N

    1993-01-01

    Incidence of and risk factors for aminoglycoside-associated nephrotoxicity (AAN) were evaluated in 1489 patients prospectively monitored with individualized pharmacokinetic monitoring (IPM). Incidence of AAN was 7.9% with individual (univariate) risk factors including advanced age, decreased albumin, poor nutritional status, pneumonia, concurrent furosemide, amphotericin B, vancomycin, cephalosporin, or piperacillin, intensive care unit treatment, leukemia, rapidly fatal illness, liver or renal disease, reduced aminoglycoside clearance, elevated initial steady-state trough concentration (Cminss), volume of distribution or half-life, duration of therapy, total dose, fever, male gender, shock, pleural effusion, and ascites. Multiple logistic regression revealed that Cminss, concurrent clindamycin, vancomycin, piperacillin, or cephalosporin, ascites, advanced age, male gender, decreased albumin, duration of therapy, and leukemia were significant independent risk factors for AAN. Positive predictive value of the model was 30.8%; negative predictive value was 91.7%. No identifiable risk factor alone or in combination was of sufficient sensitivity to reliably predict AAN, but use of IPM may lower the incidence of AAN. PMID:8418164

  12. The cumulative incidence of conventional risk factors of cardiovascular disease and their population attributable risk in an Iranian population: The Isfahan Cohort Study

    PubMed Central

    Sadeghi, Masoumeh; Talaei, Mohammad; Oveisgharan, Shahram; Rabiei, Katayoun; Dianatkhah, Minoo; Bahonar, Ahmad; Sarrafzadegan, Nizal

    2014-01-01

    Background: Cardiovascular diseases (CVDs) are the leading cause of death in Iran. The present study evaluated the 7-year incidence of CVD risk factors among the participants of Isfahan cohort study (ICS). Materials and Methods: ICS was a longitudinal study on adults over 35 years of age from the urban and rural areas in three counties in central Iran. Data on clinical examination and blood measurements were collected in 2001. Subjects were followed and similar data were collected in 2007. Cumulative incidence was calculated through dividing new cases of each risk factor by the population free of that risk factor at baseline. Incidence proportion was determined for major CVD risk factors including hypertension (HTN), hypercholesterolemia (HC), hypertriglyceridemia (HTg), obesity, diabetes mellitus (DM), metabolic syndrome (MetS), and smoking. Results: A total number of 6323 adults free of CVDs were recruited. After 7 years of follow-up, 3283 individuals were re-evaluated in 2007. The participants’ age was 49.2 ± 10.3 years in 2001 (mean ± SD). The 7-year cumulative incidence of HTN, HC, HTg, overweight, obesity, DM, MetS, and smoking was 22.8%, 37.4%, 28.0%, 26.3%, 7.4%, 9.5%, 23.9%, and 5.9% in men and 22.2%, 55.4%, 33.5%, 35.0%, 18.8%, 11.3%, 36.1%, and 0.7% in women, respectively. Among those with overweight or obesity, 14.7% of men and 7.9% of women decreased their weight up to the normal level. Conclusions: The present study revealed a high incidence of CVD risk factors especially dyslipidemia, obesity, MetS and HTN. Therefore, the application of life-style modification interventions seems necessary. PMID:25538928

  13. Egg consumption and risk of incident type 2 diabetes: a dose-response meta-analysis of prospective cohort studies.

    PubMed

    Tamez, Martha; Virtanen, Jyrki K; Lajous, Martin

    2016-06-01

    Experimental data suggest that egg intake could have a beneficial impact on several risk factors for type 2 diabetes. In contrast, some recent epidemiological studies have concluded that egg consumption may increase diabetes risk. We performed a dose-response meta-analysis of prospective cohorts on the relation of egg consumption with incident type 2 diabetes. We searched for cohort studies that assessed egg consumption and diabetes risk up to June 2015. We identified 416 articles and extracted data independently and in duplicate from ten eligible studies. We used random-effects generalised least squares models for pooled dose-response estimation based on thirteen estimates. Our study included 251 213 individuals and 12 156 incident type 2 diabetes cases. Egg intake was associated with incident type 2 diabetes (risk ratio (RR)/egg per d 1·13; 95 % CI 1·04, 1·22). We identified study location as a major source of heterogeneity. For studies conducted in the USA, we observed a stronger association (RR 1·47; 95 % CI 1·32, 1·64), whereas results were null for studies conducted elsewhere. Studies considered to be of high quality yielded null findings (RR 0·94; 95 % CI 0·74, 1·19). The association of egg intake with increased risk of incident type 2 diabetes may be restricted to US cohort studies. There are limited data to support a biological mechanism that could underlie this association; thus, the possibility that these results may be due to residual confounding by dietary behaviours restricted to certain populations cannot be excluded. PMID:27108219

  14. Spatial patterns of Lyme disease risk in California based on disease incidence data and modeling of vector-tick exposure.

    PubMed

    Eisen, Rebecca J; Lane, Robert S; Fritz, Curtis L; Eisen, Lars

    2006-10-01

    Ixodes pacificus, particularly the nymphal life stage, is the primary vector to humans of the Lyme disease agent Borrelia burgdorferi in California. During 2004, we collected I. pacificus nymphs from 78 woodland sites in ecologically diverse Mendocino County, which has a moderately high incidence of Lyme disease. Within this county, nymphal density was elevated in forested areas with a growing degree day range of 2,600-3,000 (10 degrees C base). Using a geographic information systems approach, we identified all areas in California sharing these environmental characteristics and thus projected to pose high acarologic risk of exposure to host-seeking nymphal ticks. Such areas were most commonly detected in the northwestern part of the state and along the Sierra Nevada foothills in the northeast, but the analysis also identified isolated areas with high acarologic risk in southern California. This mirrors the spatial distribution of endemic Lyme disease during 1993-2005; most cases occurred in counties to the northwest (58%) or northeast (26%), whereas fewer cases were reported from southern California (16%). Southern zip-codes from which Lyme disease cases had been reported were commonly located in close proximity to areas with high projected acarologic risk. Overall, Lyme disease incidence in zip code areas containing habitat with high projected acarologic risk was 10-fold higher than in zip code areas lacking such habitat and 27 times higher than for zip code areas without this habitat type within 50 km. A comparison of spatial Lyme disease incidence patterns based on county versus zip code units showed that calculating and displaying disease incidence at the zip code scale is a useful method to detect small, isolated areas with elevated disease risk that otherwise may go undetected. PMID:17038692

  15. Quantifying the contributions of behavioral and biological risk factors to socioeconomic disparities in coronary heart disease incidence: The MORGEN study

    PubMed Central

    Kershaw, Kiarri N.; Droomers, Mariël; Robinson, Whitney R.; Carnethon, Mercedes R.; Daviglus, Martha L.; Verschuren, W.M. Monique

    2013-01-01

    Quantifying the impact of different modifiable behavioral and biological risk factors on socioeconomic disparities in coronary heart disease (CHD) may help inform targeted, population-specific strategies to reduce the unequal distribution of the disease. Previous studies have used analytic approaches that limit our ability to disentangle the relative contributions of these risk factors to CHD disparities. The goal of this study was to assess mediation of the effect of low education on incident CHD by multiple risk factors simultaneously. Analyses are based on 15,067 participants of the Dutch Monitoring Project on Risk Factors for Chronic Diseases aged 20–65 years examined 1994–1997 and followed for events until January 1, 2008. Path analysis was used to quantify and test mediation of the low education-CHD association by behavioral (current cigarette smoking, heavy alcohol use, poor diet, and physical inactivity) and biological (obesity, hypertension, diabetes, and hypercholesterolemia) risk factors. Behavioral and biological risk factors accounted for 56.6% (95% CI: 42.6%–70.8%) of the low education-incident CHD association. Smoking was the strongest mediator, accounting for 27.3% (95% CI: 17.7%–37.4%) of the association, followed by obesity (10.2%; 95% CI: 4.5%–16.1%), physical inactivity (6.3%; 95% CI: 2.7%–10.0%), and hypertension (5.3%; 95% CI: 2.8%–8.0%). In summary, in a Dutch cohort, the majority of the relationship between low education and incident CHD was mediated by traditional behavioral and biological risk factors. Addressing barriers to smoking cessation, blood pressure and weight management, and physical activity may be the most effective approaches to eliminating socioeconomic inequalities in CHD. PMID:24037117

  16. Risks to emergency medical responders at terrorist incidents: a narrative review of the medical literature.

    PubMed

    Thompson, Julian; Rehn, Marius; Lossius, Hans Morten; Lockey, David

    2014-01-01

    As the threat of international terrorism rises, there is an increasing requirement to provide evidence-based information and training for the emergency personnel who will respond to terrorist incidents. Current major incident training advises that emergency responders prioritize their own personal safety above that of the 'scene and survivors'. However, there is limited information available on the nature of these threats and how they may be accurately evaluated. This study reviews the published medical literature to identify the hazards experienced by emergency responders who have attended previous terrorist incidents. A PubMed literature search identified 10,894 articles on the subject of 'terrorism', and there was a dramatic increase in publications after the 9/11 attacks in 2001. There is heterogeneity in the focus and quality of this literature, and 307 articles addressing the subject of scene safety were assessed for information regarding the threats encountered at terrorist incidents. These articles demonstrate that emergency responders have been exposed to both direct terrorist threats and environmental scene hazards, including airborne particles, structural collapse, fire, and psychological stress. The emphasis of training and preparedness for terrorist incidents has been primarily on the direct threats, but the published literature suggests that the dominant causes of mortality and morbidity in responders after such incidents are the indirect environmental hazards. If the medical response to terrorist incidents is to be based on evidence rather than anecdote, analysis of the current literature should be incorporated into major incident training, and consistent collection of key data from future incidents is required. PMID:25323086

  17. Comparison of Accuracy of Diabetes Risk Score and Components of the Metabolic Syndrome in Assessing Risk of Incident Type 2 Diabetes in Inter99 Cohort

    PubMed Central

    Shafizadeh, Tracy B.; Moler, Edward J.; Kolberg, Janice A.; Nguyen, Uyen Thao; Hansen, Torben; Jorgensen, Torben; Pedersen, Oluf; Borch-Johnsen, Knut

    2011-01-01

    Background Given the increasing worldwide incidence of diabetes, methods to assess diabetes risk which would identify those at highest risk are needed. We compared two risk-stratification approaches for incident type 2 diabetes mellitus (T2DM); factors of metabolic syndrome (MetS) and a previously developed diabetes risk score, PreDx® Diabetes Risk Score (DRS). DRS assesses 5 yr risk of incident T2DM based on the measurement of 7 biomarkers in fasting blood. Methodology/Principal Findings DRS was evaluated in baseline serum samples from 4,128 non-diabetic subjects in the Inter99 cohort (Danes aged 30–60) for whom diabetes outcomes at 5 years were known. Subjects were classified as having MetS based on the presence of at least 3 MetS risk factors in baseline clinical data. The sensitivity and false positive rate for predicting diabetes using MetS was compared to DRS. When the sensitivity was fixed to match MetS, DRS had a significantly lower false positive rate. Similarly, when the false positive rate was fixed to match MetS, DRS had a significantly higher specificity. In further analyses, subjects were classified by presence of 0–2, 3 or 4–5 risk factors with matching proportions of subjects distributed among three DRS groups. Comparison between the two risk stratification schemes, MetS risk factors and DRS, were evaluated using Net Reclassification Improvement (NRI). Comparing risk stratification by DRS to MetS factors in the total population, the NRI was 0.146 (p = 0.008) demonstrating DRS provides significantly improved stratification. Additionally, the relative risk of T2DM differed by 15 fold between the low and high DRS risk groups, but only 8-fold between the low and high risk MetS groups. Conclusions/Significance DRS provides a more accurate assessment of risk for diabetes than MetS. This improved performance may allow clinicians to focus preventive strategies on those most in need of urgent intervention. PMID:21829540

  18. Does Older Age Confer an Increased Risk of Incident Neurocognitive Disorders Among Persons Living with HIV Disease?

    PubMed Central

    Sheppard, David P.; Woods, Steven Paul; Bondi, Mark W.; Gilbert, Paul E.; Massman, Paul J.; Doyle, Katie L.

    2015-01-01

    Objective This study aimed to determine the combined effects of age and HIV infection on the risk of incident neurocognitive disorders. Method A total of 146 neurocognitively normal participants were enrolled at baseline into one of four groups based on age (≤ 40 years and ≥ 50 years) and HIV serostatus resulting in 24 younger HIV−, 27 younger HIV+, 39 older HIV−, and 56 older HIV+ individuals. All participants were administered a standardized clinical neuropsychological battery at baseline and 14.3 ±0.2 months later. Results A logistic regression predicting incident neurocognitive disorders from HIV, age group, and their interaction was significant (χ2[4] = 13.56, p = .009), with a significant main effect of HIV serostatus (χ2[1] = 5.01, p = .025), but no main effect of age or age by HIV interaction (ps > .10). Specifically, 15.7 percent of the HIV+ individuals had an incident neurocognitive disorder as compared to 3.2 percent of the HIV− group (odds ratio = 4.8 [1.2, 32.6]). Among older HIV+ adults, lower baseline cognitive reserve, prospective memory, and verbal fluency each predicted incident neurocognitive disorders at follow-up. Conclusions Independent of age, HIV infection confers a nearly 5-fold risk for developing a neurocognitive disorder over approximately one year. Individuals with lower cognitive reserve and mild weaknesses in higher-order neurocognitive functions may be targeted for closer clinical monitoring and preventative measures. PMID:26367342

  19. HIV Incidence Rates and Risk Factors for Urban Women in Zambia: Preparing for a Microbicide Clinical Trial

    PubMed Central

    Kapina, Muzala; Reid, Cheri; Roman, Karisse; Cyrus-Cameron, Elena; Kwiecien, Antonia; Weiss, Stephen; Vermund, Sten H.

    2009-01-01

    Objectives A preparedness study was conducted to evaluate the suitability of sites and populations following the same study procedures intended for a larger scale microbicide efficacy trial. In the process the study evaluated human immunodeficiency virus (HIV) incidence, prevalence, and risk profiles for HIV-acquisition among young women in urban Zambia. Methods Women aged 16 to 49 years were screened for participation in the study that involved HIV/sexually transmitted infection testing and the assessment of sexual behavioral characteristics. Two hundred thirty-nine eligible women were enrolled and followed up for 12 months. Results Baseline HIV prevalence at screening was 38.7% (95% CI: 34.2%–43.3%). The highest age-specific prevalence of HIV was 54.1% (95% CI: 46.3%–61.8%) seen in women aged 26 to 34 years. HIV incidence was 2.6% per 100 woman years. Pregnancy rates were high at 17.4 per 100 woman years (95% CI: 12.2–24.1). Conclusion It was concluded that our general population sample, characterized by high HIV prevalence and ongoing incidence rates despite receiving regular risk reduction counseling and free condoms qualifies for future microbicide studies. A microbicide preparedness study conducted in Lusaka, Zambia found high HIV prevalence and appreciable HIV incidence in a population of women in an urban setting. PMID:19174729

  20. Dietary patterns are associated with incident stroke and contribute to excess risk of stroke in Black Americans

    PubMed Central

    Judd, Suzanne E; Gutiérrez, Orlando M.; Newby, PK; Howard, George; Howard, Virginia J; Locher, Julie L; Kissela, Brett M; Shikany, James M

    2014-01-01

    Background and Purpose Black Americans and residents of the Southeastern United States, are at increased risk of stroke. Diet is one of many potential factors proposed that might explain these racial and regional disparities. Methods Between 2003–2007, the REasons for Geographic and Racial Differences in Stroke (REGARDS) cohort study enrolled 30,239 black and white Americans aged 45 years or older. Dietary patterns were derived using factor analysis and foods from food frequency data. Incident strokes were adjudicated using medical records by a team of physicians. Cox proportional hazards models were used to examine risk of stroke. Results Over 5.7 years, 490 incident strokes were observed. In a multivariable-adjusted analysis, greater adherence to the Plant-based pattern was associated with lower stroke risk (HR=0.71; 95% CI=0.56–0.91; ptrend=0.005). This association was attenuated after addition of income, education, total energy intake, smoking, and sedentary behavior. Participants with a higher adherence to the Southern pattern experienced a 39% increased risk of stroke (HR=1.39; 95% CI=1.05, 1.84), with a significant (p = 0.009) trend across quartiles. Including Southern pattern in the model mediated the black-white risk of stroke by 63%. Conclusions These data suggest that adherence to a Southern style diet may increase the risk of stroke while adherence to a more plant-based diet may reduce stroke risk. Given the consistency of finding a dietary impact on stroke risk across studies, discussing nutrition patterns during risk screening may be an important step in reducing stroke. PMID:24159061

  1. Decreased incidence of sexually transmitted diseases among trucking company workers in Kenya: results of a behavioural risk-reduction programme.

    PubMed

    Jackson, D J; Rakwar, J P; Richardson, B A; Mandaliya, K; Chohan, B H; Bwayo, J J; Ndinya-Achola, J O; Martin, H L; Moses, S; Kreiss, J K

    1997-06-01

    556 male HIV-seronegative male employees of trucking companies in Mombasa, Kenya, were exposed to HIV serological testing, individual counseling, condom promotion, and sexually transmitted disease (STD) diagnosis and management, and returned for at least one follow-up visit in a prospective study to measure changes in sexual behavior and STD incidence after the intervention. There was a significant decrease in sex with high-risk partners over the 1-year period of follow-up, but no change in condom use among study participants; 30% of men reported consistent condom use during extramarital sex throughout the study period. The change in heterosexual risk behavior was accompanied by a significant decrease in the incidence of gonorrhea, nongonococcal urethritis, and genital ulcer disease. The percentage of men reporting extramarital sex decreased from 49% to 36%, while contact with female prostitutes declined from 12% to 6%. PMID:9189216

  2. Incidence and Risk Factors for Developing Dengue-Associated Hemophagocytic Lymphohistiocytosis in Puerto Rico, 2008 - 2013

    PubMed Central

    Ellis, Esther M.; Pérez-Padilla, Janice; González, Liza; Poole-Smith, B. Katherine; Lebo, Emmaculate; Baker, Charlotte; Delorey, Mark J.; Torres-Velasquez, Brenda; Ochoa, Eduardo; Rivera-Garcia, Brenda; Díaz-Pinto, Hector; Clavell, Luis; Puig-Ramos, Anabel; Janka, Gritta E.; Tomashek, Kay M.

    2016-01-01

    Background Hemophagocytic lymphohistiocytosis (HLH) is a rare, potentially fatal disorder characterized by fever, pancytopenia, hepatosplenomegaly, and increased serum ferritin. HLH is being increasingly reported as a complication of dengue, a common tropical acute febrile illness. Methodology/Principal Findings After a cluster of pediatric dengue-associated HLH patients was identified during the 2012–2013 dengue epidemic in Puerto Rico, active surveillance and a case-control investigation was conducted at four referral hospitals to determine the incidence of HLH in children and identify risk factors for HLH following dengue. Patients with dengue-associated HLH (cases) were matched by month of illness onset and admission hospital to dengue patients that did not develop HLH (controls). During 2008–2013, a total of 33 HLH patients were identified, of which 22 (67%) were associated with dengue and 1 died (dengue-associated HLH case-fatality rate: 4.5%). Two patients with dengue-associated HLH had illness onset in 2009, none had illness onset during the 2010 dengue epidemic, and 20 had illness onset during the 2012–2013 epidemic. Frequency of infection with either dengue virus (DENV)-1 or DENV-4 did not differ between cases and controls. Cases were younger than controls (median age: 1 vs. 13 years, p < 0.01), were hospitalized longer (18 vs. 5 days, p < 0.01), and were admitted more frequently to pediatric intensive care units (100% vs. 16%, p < 0.01). Cases had co-infection (18.2% vs. 4.5%, p = 0.04), recent influenza-like illness (54.5% vs. 25.0%, p = 0.01), and longer duration of fever (7 vs. 5 days; p < 0.01). Cases were more likely to have lymphadenopathy, hepatomegaly, splenomegaly, anemia, and elevated liver transaminases (p ≤ 0.02). Conclusions/Significance During this cluster of dengue-associated HLH cases that was temporally associated with the 2012–2013 epidemic, most patients with dengue-associated HLH were infants and had higher morbidity than

  3. Risk Factors for Incident Diabetes in a Cohort Taking First-Line Nonnucleoside Reverse Transcriptase Inhibitor-Based Antiretroviral Therapy.

    PubMed

    Karamchand, Sumanth; Leisegang, Rory; Schomaker, Michael; Maartens, Gary; Walters, Lourens; Hislop, Michael; Dave, Joel A; Levitt, Naomi S; Cohen, Karen

    2016-03-01

    Efavirenz is the preferred nonnucleoside reverse transcriptase inhibitor (NNRTI) in first-line antiretroviral therapy (ART) regimens in low- and middle-income countries, where the prevalence of diabetes is increasing. Randomized control trials have shown mild increases in plasma glucose in participants in the efavirenz arms, but no association has been reported with overt diabetes. We explored the association between efavirenz exposure and incident diabetes in a large Southern African cohort commencing NNRTI-based first-line ART. Our cohort included HIV-infected adults starting NNRTI-based ART in a private sector HIV disease management program from January 2002 to December 2011. Incident diabetes was identified by the initiation of diabetes treatment. Patients with prevalent diabetes were excluded. We included 56,298 patients with 113,297 patient-years of follow-up (PYFU) on first-line ART. The crude incidence of diabetes was 13.24 per 1000 PYFU. Treatment with efavirenz rather than nevirapine was associated with increased risk of developing diabetes (hazard ratio 1.27 (95% confidence interval (CI): 1.10-1.46)) in a multivariate analysis adjusting for age, sex, body mass index, baseline CD4 count, viral load, NRTI backbone, and exposure to other diabetogenic medicines. Zidovudine and stavudine exposure were also associated with an increased risk of developing diabetes. We found that treatment with efavirenz, as well as stavudine and zidovudine, increased the risk of incident diabetes. Interventions to detect and prevent diabetes should be implemented in ART programs, and use of antiretrovirals with lower risk of metabolic complications should be encouraged. PMID:26945366

  4. Risk Factors for Incident Diabetes in a Cohort Taking First-Line Nonnucleoside Reverse Transcriptase Inhibitor-Based Antiretroviral Therapy

    PubMed Central

    Karamchand, Sumanth; Leisegang, Rory; Schomaker, Michael; Maartens, Gary; Walters, Lourens; Hislop, Michael; Dave, Joel A.; Levitt, Naomi S.; Cohen, Karen

    2016-01-01

    Abstract Efavirenz is the preferred nonnucleoside reverse transcriptase inhibitor (NNRTI) in first-line antiretroviral therapy (ART) regimens in low- and middle-income countries, where the prevalence of diabetes is increasing. Randomized control trials have shown mild increases in plasma glucose in participants in the efavirenz arms, but no association has been reported with overt diabetes. We explored the association between efavirenz exposure and incident diabetes in a large Southern African cohort commencing NNRTI-based first-line ART. Our cohort included HIV-infected adults starting NNRTI-based ART in a private sector HIV disease management program from January 2002 to December 2011. Incident diabetes was identified by the initiation of diabetes treatment. Patients with prevalent diabetes were excluded. We included 56,298 patients with 113,297 patient-years of follow-up (PYFU) on first-line ART. The crude incidence of diabetes was 13.24 per 1000 PYFU. Treatment with efavirenz rather than nevirapine was associated with increased risk of developing diabetes (hazard ratio 1.27 (95% confidence interval (CI): 1.10–1.46)) in a multivariate analysis adjusting for age, sex, body mass index, baseline CD4 count, viral load, NRTI backbone, and exposure to other diabetogenic medicines. Zidovudine and stavudine exposure were also associated with an increased risk of developing diabetes. We found that treatment with efavirenz, as well as stavudine and zidovudine, increased the risk of incident diabetes. Interventions to detect and prevent diabetes should be implemented in ART programs, and use of antiretrovirals with lower risk of metabolic complications should be encouraged. PMID:26945366

  5. Incidence and risk of hypertension with vandetanib in cancer patients: a systematic review and meta-analysis of clinical trials

    PubMed Central

    Qi, Wei-Xiang; Shen, Zan; Lin, Feng; Sun, Yuan-jue; Min, Da-liu; Tang, Li-Na; He, Ai-Na; Yao, Yang

    2013-01-01

    Aim To perform a systematic review and meta-analysis of published clinical trials to determine incidence rate and overall risk of hypertension with vandetanib in cancer patients. Methods A comprehensive literature search for studies published up to March 2012 was performed. Summary incidence rates, relative risk (RR), and 95% confidence intervals (CI) were calculated employing fixed- or random-effects models depending on the heterogeneity of the included trials. Results A total of 11 trials with 3154 patients were included for the meta-analysis. The summary incidences of all-grade and high-grade hypertension in patients with cancer were 24.2% [95% confidence interval (CI), 18.1–30.2%] and 6.4% (95% CI, 3.3–9.5%), respectively. Subgroup analysis demonstrated that the pooled incidences of all-grade and high-grade hypertension were 21.8% [95% CI, 15–30.5%] and 7.6% (95% CI, 2.8–18.8%), respectively, among non-small-cell lung cancer (NSCLC) patients, and 32.1% (95% CI: 27.3–37.3%) and 8.8% (5.9%–12.9%), respectively, among MTC patients, and 15.4 (95% CI: 3.2–33.7%) and 3.4% (95% CI: 1%–11.1%) respectively, among non-MTC/NSCLC tumors patients. Furthermore, vandetanib was associated with a significant increased risk of all-grade hypertension (RR 5.1, 95% CI: 3.76–6.92, P = 0.000) and high-grade hypertension (RR 8.06, 95% CI: 3.41–19.04, P = 0.000) in comparison with controls. Conclusions There is a significant risk of developing hypertension in cancer patients receiving vandetanib. Appropriate monitoring and treatment is strongly recommended to prevent cardiovascular complications. PMID:22882307

  6. Assessing Incidence and Risk Factors of Cervical Spine Injury in Blunt Trauma Patients Using the National Trauma Data Bank.

    PubMed

    Young, Andrew J; Wolfe, Luke; Tinkoff, Glenn; Duane, Therese M

    2015-09-01

    Despite the potentially devastating impact of missed cervical spine injuries (CI), there continues to be a large disparity in how institutions attempt to make the diagnosis. To better streamline the approach among institutions, understanding incidence and risk factors across the country is paramount. We evaluated the incidence and risk factors of CI using the National Trauma Databank for 2008 and 2009. We performed a retrospective review of the National Trauma Databank for 2008 and 2009 comparing patients with and without CI. We then performed subset analysis separating injury by patients with and without fracture and ligamentous injury. There were a total of 591,138 patients included with a 6.2 per cent incidence of CI. Regression found that age, Injury Severity Score, alcohol intoxication, and specific mechanisms of motor vehicle crash (MVC), motorcycle crash (MCC), fall, pedestrian stuck, and bicycle were independent risk factors for overall injury (P < 0.0001). Patients with CI had longer intensive care unit (8.5 12.5 vs 5.1 7.7) and hospital lengths of stay (days) (9.6 14.2 vs 5.3 8.1) and higher mortality (1.2 per cent vs 0.3%), compared with those without injury (P < 0.0001). There were 33,276 patient with only fractures for an incidence of 5.6 per cent and 1875 patients with ligamentous injury. Just over 6 per cent of patients suffer some form of CI after blunt trauma with the majority being fractures. Higher Injury Severity Score and MVC were consistent risk factors in both groups. This information will assist in devising an algorithm for clearance that can be used nationally allowing for more consistency among trauma providers. PMID:26350665

  7. Incidence and Risk of QTc Interval Prolongation among Cancer Patients Treated with Vandetanib: A Systematic Review and Meta-analysis

    PubMed Central

    Xu, Xudong; Bai, Jie; Ding, Caicui; Chang, Yue; Yue, Long; Kang, Enming; He, Jia

    2012-01-01

    Background Vandetanib is a multikinase inhibitor that is under assessment for the treatment of various cancers. QTc interval prolongation is one of the major adverse effects of this drug, but the reported incidence varies substantially among clinical trials. We performed a systematic review and meta-analysis to obtain a better understanding in the risk of QTc interval prolongation among cancer patients administered vandetanib. Methodology and Principal Findings Eligible studies were phase II and III prospective clinical trials that involved cancer patients who were prescribed vandetanib 300 mg/d and that included data on QTc interval prolongation. The overall incidence and risk of QTc interval prolongation were calculated using random-effects or fixed-effects models, depending on the heterogeneity of the included studies. Nine trials with 2,188 patients were included for the meta-analysis. The overall incidence of all-grade and high-grade QTc interval prolongation was 16.4% (95% CI, 8.1–30.4%) and 3.7% (8.1–30.4%), respectively, among non-thyroid cancer patients, and 18.0% (10.7–28.6%) and 12.0% (4.5–28.0%), respectively, among thyroid cancer patients. Patients with thyroid cancer who had longer treatment duration also had a higher incidence of high-grade events, with a relative risk of 3.24 (1.57–6.71), than patients who had non-thyroid cancer. Vandetanib was associated with a significantly increased risk of all-grade QTc interval prolongation with overall Peto odds ratios of 7.26 (4.36–12.09) and 5.70 (3.09–10.53) among patients with non-thyroid cancer and thyroid cancer, respectively, compared to the controls. Conclusions/Significance Treatment with vandetanib is associated with a significant increase in the overall incidence and risk of QTc interval prolongation. Different cancer types and treatment durations may affect the risk of developing high-grade QTc interval prolongation. PMID:22363427

  8. Incidence and risk factors for early renal dysfunction after liver transplantation

    PubMed Central

    Wiesen, Patricia; Massion, Paul B; Joris, Jean; Detry, Olivier; Damas, Pierre

    2016-01-01

    AIM: To determine renal dysfunction post liver transplantation, its incidence and risk factors in patients from a Belgian University Hospital. METHODS: Orthotopic liver transplantations performed from January 2006 until September 2012 were retrospectively reviewed (n = 187). Patients with no renal replacement therapy (RRT) before transplantation were classified into four groups according to their highest creatinine plasma level during the first postoperative week. The first group had a peak creatinine level below 12 mg/L, the second group between 12 and 20 mg/L, the third group between 20 and 35 mg/L, and the fourth above 35 mg/L. In addition, patients who needed RRT during the first week after transplantation were also classified into the fourth group. Perioperative parameters were recorded as risk factors, namely age, sex, body mass index (BMI), length of preoperative hospital stay, prior bacterial infection within one month, preoperative ascites, preoperative treatment with β-blocker, angiotensin-converting enzyme inhibitor or non steroidal anti-inflammatory drugs, preoperative creatinine and bilirubin levels, donor status (cardiac death or brain death), postoperative lactate level, need for intraoperative vasopressive drugs, surgical revision, mechanical ventilation for more than 24 h, postoperative bilirubin and transaminase peak levels, postoperative hemoglobin level, amount of perioperative blood transfusions and type of immunosuppression. Univariate and multivariate analysis were performed using logistic ordinal regression method. Post hoc analysis of the hemostatic agent used was also done. RESULTS: There were 78 patients in group 1 (41.7%), 46 in group 2 (24.6%), 38 in group 3 (20.3%) and 25 in group 4 (13.4%). Twenty patients required RRT: 13 (7%) during the first week after transplantation. Using univariate analysis, the severity of renal dysfunction was correlated with presence of ascites and prior bacterial infection, preoperative bilirubin, urea and

  9. Individual and Population Level Impact of Key HIV Risk Factors on HIV Incidence Rates in Durban, South Africa

    PubMed Central

    Ramjee, Gita; Moonsamy, Suri; Abbai, Nathlee Samantha; Wand, Handan

    2016-01-01

    We aimed to estimate the individual and joint impact of age, marital status and diagnosis with sexually transmitted infections (STIs) on HIV acquisition among young women at a population level in Durban, KwaZulu-Natal, South Africa. A total of 3,978 HIV seronegative women were recruited for four biomedical intervention trials from 2002–2009. Point and interval estimates of partial population attributable risk (PAR) were used to quantify the proportion of HIV seroconversions which can be prevented if a combination of risk factors is eliminated from a target population. More than 70% of the observed HIV acquisitions were collectively attributed to the three risk factors: younger age (<25 years old), unmarried and not cohabiting with a stable/regular partner and diagnosis with STIs. Addressing these risks requires targeted structural, behavioural, biomedical and cultural interventions in order to impact on unacceptably high HIV incidence rates among young women and the population as a whole. PMID:27104835

  10. Incident Vertebral Fractures and Risk Factors in the First Three Years Following Glucocorticoid Initiation Among Pediatric Patients With Rheumatic Disorders.

    PubMed

    LeBlanc, Claire M A; Ma, Jinhui; Taljaard, Monica; Roth, Johannes; Scuccimarri, Rosie; Miettunen, Paivi; Lang, Bianca; Huber, Adam M; Houghton, Kristin; Jaremko, Jacob L; Ho, Josephine; Shenouda, Nazih; Matzinger, Mary Ann; Lentle, Brian; Stein, Robert; Sbrocchi, Anne Marie; Oen, Kiem; Rodd, Celia; Jurencak, Roman; Cummings, Elizabeth A; Couch, Robert; Cabral, David A; Atkinson, Stephanie; Alos, Nathalie; Rauch, Frank; Siminoski, Kerry; Ward, Leanne M

    2015-09-01

    Vertebral fractures are an important yet underrecognized manifestation of osteoporosis in children with chronic, glucocorticoid-treated illnesses. Our goal was to determine the incidence and clinical predictors of vertebral fractures in the 3 years following glucocorticoid initiation among pediatric patients with rheumatic disorders. Incident vertebral fractures were evaluated according to the Genant semiquantitative method on lateral radiographs at baseline and then annually in the 3 years following glucocorticoid initiation. Extended Cox models were used to assess the association between vertebral fractures and clinical risk predictors. A total of 134 children with rheumatic disorders were enrolled in the study (mean ± standard deviation (SD) age 9.9 ± 4.4 years; 65% girls). The unadjusted vertebral fracture incidence rate was 4.4 per 100 person-years, with a 3-year incidence proportion of 12.4%. The highest annual incidence occurred in the first year (6.0%; 95% confidence interval (CI) 2.9% to 11.7%). Almost one-half of the patients with fractures were asymptomatic. Every 0.5 mg/kg increase in average daily glucocorticoid (prednisone equivalents) dose was associated with a twofold increased fracture risk (hazard ratio (HR) 2.0; 95% CI 1.1 to 3.5). Other predictors of increased vertebral fracture risk included: (1) increases in disease severity scores between baseline and 12 months; (2) increases in body mass index Z-scores in the first 6 months of each 12-month period preceding the annual fracture assessment; and (3) decreases in lumbar spine bone mineral density Z-scores in the first 6 months of glucocorticoid therapy. As such, we observed that a clinically significant number of children with rheumatic disorders developed incident vertebral fractures in the 3 years following glucocorticoid initiation. Almost one-half of the children were asymptomatic and thereby would have been undiagnosed in the absence of radiographic monitoring. In addition, discrete

  11. The Incidence and Risk of Herpes Zoster in Patients With Sleep Disorders: A Population-Based Cohort Study.

    PubMed

    Chung, Wei-Sheng; Lin, Hsuan-Hung; Cheng, Nan-Cheng

    2016-03-01

    Lack of sleep can compromise the immune system, which may reactivate latent varicella-zoster virus. Studies on sleep disorders and the risk of herpes zoster (HZ) are scant.We conducted a population-based cohort study to evaluate the risk of HZ in patients with sleep disorders and potential risk factors for HZ development. We identified patients with sleep disorders without apnea from 2002 to 2005 by using the Taiwan Longitudinal Health Insurance Database. The patients without sleep disorders were randomly selected and frequency matched with patients with sleep disorders according to age, sex, and index year. We estimated the follow-up time in person-years for the patients from the entry date until HZ diagnosis, loss to follow-up, or the end of 2010. We used Cox proportional hazards regression models and a sensitivity analysis to estimate the risk of HZ while controlling for demographic characteristics and comorbidities. A total of 131,001 study participants (follow-up, 948,177 person-years; mean age, 51.2 ± 16.5 years; 62.2% women) were included in the study. Patients with sleep disorders exhibited a higher incidence of HZ compared with a comparison cohort when stratified by age, sex, and comorbidities. After adjustment for covariates, the sleep disorder cohort exhibited a 1.23-fold greater risk of HZ compared with the comparison cohort (95% confidence interval [CI] = 1.17-1.30). The incidence of HZ increased with age. Adults ages 65 years and older exhibited a 6.11-fold greater risk of HZ development compared with their younger counterparts (95% CI = 5.34-7.00). Cancers and autoimmune diseases were independent risk factors of HZ development. The patients with sleep disorders may carry an increased risk of developing HZ. PMID:26986095

  12. Loss to Follow-Up as a Competing Risk in an Observational Study of HIV-1 Incidence

    PubMed Central

    Graham, Susan M.; Raboud, Janet; McClelland, R. Scott; Jaoko, Walter; Ndinya-Achola, Jeckoniah; Mandaliya, Kishor; Overbaugh, Julie; Bayoumi, Ahmed M.

    2013-01-01

    Objective Conventional survival estimates may be biased if loss to follow-up (LTF) is associated with the outcome of interest. Our goal was to assess whether the association between sexual risk behavior and HIV-1 acquisition changed after accounting for LTF with competing risks regression. Methods HIV-1-seronegative women who enrolled in a Kenyan sex worker cohort from 1993–2007 were followed prospectively and tested for HIV at monthly clinic visits. Our primary predictor was self-reported sexual risk behavior in the past week, analyzed as a time-dependent covariate. Outcomes included HIV-1 acquisition and LTF. We analyzed the data using Cox proportional hazards regression and competing risks regression, in which LTF was treated as a competing event. Results A total of 1,513 women contributed 4,150 person-years (py), during which 198 (13.1%) acquired HIV-1 infection (incidence, 4.5 per 100 py) and 969 (64.0%) were LTF (incidence, 23.4 per 100 py). After adjusting for potential confounders, women reporting unprotected sex with multiple partners were less likely to be lost to follow-up (adjusted sub-hazard ratio (aSHR) 0.50, 95% confidence interval (CI) 0.32–0.76, relative to no sexual activity). The risk of HIV-1 acquisition after reporting unprotected sex with multiple partners was similar with Cox regression (adjusted hazard ratio (aHR) 2.41, 95% CI 1.36–4.27) and competing risks regression (aSHR 2.47, 95% CI 1.33–4.58). Conclusions Unprotected sex with multiple partners was associated with higher HIV-1 acquisition risk, but lower attrition. This differential attrition did not substantially bias Cox regression estimates when compared to competing risks regression results. PMID:23555041

  13. A Prospective Study of Gynecological Cancer Risk in Relation to Adiposity Factors: Cumulative Incidence and Association with Plasma Adipokine Levels

    PubMed Central

    Wu, Meei-Maan; You, San-Lin; Cheng, Wen-Fang; Chen, Chi-An; Lee, Te-Chang; Chen, Chien-Jen

    2014-01-01

    Background Associations of obesity and obesity-related metabolic factors (adiposity factors) with uterine corpus cancer (UCC) and ovarian cancer (OVC) risk have been described. Still, a cause-effect relationship and the underlying mediators remain unclear, particularly for low-incidence populations. We aimed to prospectively determine whether adiposity factors could predict the development of UCC and OVC in Taiwanese women. To explore the biological mediators linking adiposity factors to cancer risk, we examined the association of two adipokines, leptin and adiponectin, with the gynecological cancers. Methods Totally, 11,258 women, aged 30–65, were recruited into the Community-Based Cancer Screening Program (CBCSP) study during 1991–1993, and were followed for UCC and OVC cases until December 31, 2011. Cox proportional hazard models were used to estimate hazard ratios (HRs). Adiposity factors and risk covariates were assessed at recruitment. Newly-developed cancer cases were determined from data in the government’s National Cancer Registry and Death Certification System. For adipokienes study, a nested case-control study was conducted within the cohort. Baseline plasma samples of 40 incident gynecological cancer cases and 240 age-menopause-matched controls were assayed for adipokines levels. Findings There were 38 and 30 incident cases of UCC and OVC, respectively, diagnosed during a median 19.9 years of follow-up. Multivariate analysis showed that alcohol intake (HR = 16.00, 95% = 4.83–53.00), high triglyceride levels (HR = 2.58, 95% = 1.28–5.17), and years of endogenous estrogen exposure per 5-year increment (HR = 1.91, 95% = 1.08–3.38) were associated with increased UCC risk. High body mass index (BMI≥27 kg/m2, HR = 2.90, 95% = 1.30–6.46) was associated with increased OVC risk. Analysis further showed an independent effect of adipokines on UCC and OVC risk after adjustment of the risk covariates. Conclusion We

  14. Calculating Hematopoietic-Mode-Lethality Risk Avoidance Associated with Radionuclide Decorporation Countermeasures Related to a Radiological Terrorism Incident

    PubMed Central

    Scott, Bobby R.

    2009-01-01

    This paper provides theoretical health-risk-assessment tools that are designed to facilitate planning for and managing radiological terrorism incidents that involve ingestion exposure to bone-seeking radionuclides (e.g., radiostrontium nuclides). The focus is on evaluating lethality risk avoidance (RAV; i.e., the decrease in risk) that is associated with radionuclide decorporation countermeasures employed to remove ingested bone-seeking beta and/or gamma-emitting radionuclides from the body. To illustrate the application of tools presented, hypothetical radiostrontium decorporation scenarios were considered that involved evaluating the hematopoietic-mode-lethality RAV. For evaluating the efficacy of specific decorporation countermeasures, the lethality risk avoidance proportion (RAP; which is the RAV divided by the total lethality risk in the absence of protective countermeasures) is introduced. The lethality RAP is expected to be a useful tool for designing optimal radionuclide decorporation schemes and for identifying green, yellow and red dose-rate zones. For the green zone, essentially all of the lethality risk is expected to be avoided (RAP = 1) as a consequence of the radionuclide decorporation scheme used. For the yellow zone, some but not all of the lethality risk is expected to be avoided. For the red zone, none of the lethality risk (which equals 1) is expected to be avoided. PMID:20011652

  15. Incidence and Mortality Risks of Cancer in Patients with Type 2 Diabetes: A Retrospective Study in Shanghai, China

    PubMed Central

    Gu, Yunjuan; Hou, Xuhong; Zheng, Ying; Wang, Chunfang; Zhang, Lei; Li, Jie; Huang, Zhezhou; Han, Ming; Bao, Yuqian; Zhong, Weijian; Jia, Weiping; Cui, Shiwei

    2016-01-01

    Background: Evidence from epidemiologic investigation indicates that people with type 2 diabetes (T2DM) are at a significantly higher risk of many types of cancer and mortality. The aim of this study was to investigate the incidence and mortality risks of cancer in patients with T2DM compared with the general population in Shanghai, China. Methods: Based on the Shanghai Diabetes Registry (SDR) database linking to the Shanghai Cancer Registry and Surveillance System (SCRSS), a total of 12,276 T2DM patients without cancer were defined and followed up from 1 December 2001 to 31 July 2011. Standardized incidence ratio (SIR) and standardized mortality ratio (SMR) with 95% confidence interval (CI) were calculated using the whole gender and age-matched general population of Shanghai as a reference during the same period. Results: The overall cancer risk was found higher in both males and females T2DM patients, with the SIR of 3.14 (95% CI 2.73–3.56) and 4.29 (95% CI 3.64–4.94), respectively. The overall mortality risk of cancer also significantly increased with the SMR of 2.27 (95% CI 1.86–2.68) and 1.86 (95% CI 1.46–2.26), respectively. Pancreatic cancer was with the highest SIR and SMR in both genders. Conclusions: Compared with the general population, patients with T2DM were associated with higher incidence and mortality risks of cancer, especially pancreatic cancer. PMID:27271648

  16. The incidence of deep venous thrombosis in high-risk Indian neurosurgical patients: Need for early chemoprophylaxis?

    PubMed Central

    George, Ajith John; Nair, Shalini; Karthic, Jayanthi Chinnaiya; Joseph, Mathew

    2016-01-01

    Introduction: Deep venous thrombosis (DVT) is thought to be less common in Asians than in Caucasian population. The incidence of DVT in high-risk groups, especially the neurosurgical (NS) patients, has not been well studied. This leaves no firm basis for the start of early prophylactic anticoagulation within first 5 postoperative days in Indian NS patients. This is a prospective observational study to determine the early occurrence of DVT in the NS patients. Patients and Methods: We screened 137 consecutive high-risk NS patients based on inclusion and exclusion criteria. The femoral veins were screened using Doppler ultrasound on day 1, 3, and 5 of admission into the NS Intensive Care Unit (ICU) at tertiary center from South India. Results: Among 2887 admissions to NICU 147 patients met inclusion criteria. One hundred thirty seven were screened for DVT. There was a 4.3% (6/137) incidence of DVT with none of the six patients having signs or symptoms of pulmonary embolism. Among the risk factors studied, there was a significant association with femoral catheterization and a probable association with weakness/paraparesis/paraplegia. The mortality in the study group was 10.8% with none attributable to DVT or pulmonary embolism. Conclusion: There is a low incidence of DVT among the high risk neurosurgical population evaluated within the first 5 days of admission to NICU, limiting the need for early chemical thrombo-prophylaxis in these patients. With strict protocols for mechanical prophylaxis with passive leg exercise, early mobilization and serial femoral Doppler screening, heparin anticoagulation can be restricted within the first 5 days of ICU admission in high risk patients. PMID:27555696

  17. Childhood and early adult predictors of risk of incident back pain: Ontario Child Health Study 2001 follow-up.

    PubMed

    Mustard, C A; Kalcevich, C; Frank, J W; Boyle, M

    2005-10-15

    Musculoskeletal disorders of the back and spine are a leading cause of disability in working-age populations. There is limited information on the potential consequences of childhood socioeconomic and health status on the risk of incident back pain in early adulthood. The authors describe factors associated with having had a first episode of back pain during the past year in the Ontario Child Health Study, a prospective cohort study of children who were aged 4-16 years at the time of enrollment in 1983 and were resurveyed in 2001. Respondents reporting a first episode of back pain (n=143) were compared with respondents who had never experienced back pain (n=896). The annual incidence of a first episode of back pain in this sample of young adults was 74.7/1,000. Following adjustment for age, sex, childhood conditions, childhood health status, and measures of early adult health, behavior, socioeconomic status, and work environment, the risk of incident back pain was associated with both low (odds ratio (OR)=1.86, 95% confidence interval (CI): 1.14, 3.03) and moderate/high (OR=1.85, 95% CI: 1.07, 3.02) levels of psychological distress, current heavy smoking (OR=1.85, 95% CI: 1.10, 3.10), lower levels of parental education in childhood (OR=1.72, 95% CI: 1.06, 2.80), and emotional or behavioral disorders in childhood (OR=1.87, 95% CI: 1.02, 3.41). The associations of low childhood socioeconomic status and childhood emotional and behavioral disorders with risk of incident back pain in early adulthood are important findings with implications for better understanding the etiology of soft-tissue disorders. PMID:16150891

  18. Pathogenesis, Diagnosis, and Management of Cholangiocarcinoma

    PubMed Central

    Rizvi, Sumera; Gores, Gregory J.

    2013-01-01

    Cholangiocarcinomas (CCAs) are hepatobiliary cancers with features of cholangiocyte differentiation; they can be classified anatomically as intrahepatic (iCCA), perihilar (pCCA), or distal CCA (dCCA). These subtypes differ not only in their anatomic location but in epidemiology, origin, etiology, pathogenesis, and treatment. The incidence and mortality of iCCA has been increasing over the past 3 decades, and only a low percentage of patients survive until 5 y after diagnosis. Geographic variations in the incidence of CCA are related to variations in risk factors. Changes in oncogene and inflammatory signaling pathways, as well as genetic and epigenetic alterations and chromosome aberrations, have been shown to contribute to development of CCA. Furthermore, CCAs are surrounded by a dense stroma that contains many cancer-associated fibroblasts, which promotes their progression. We have gained a better understanding of the imaging characteristics of iCCAs and have developed advanced cytologic techniques to detect pCCAs. Patients with iCCAs are usually treated surgically, whereas liver transplantation following neoadjuvant chemoradiation is an option for a subset of patients with pCCAs. We review recent developments in our understanding of the epidemiology, pathogenesis, of CCA, along with advances in classification, diagnosis and treatment. PMID:24140396

  19. WCRF/AICR recommendation adherence and breast cancer incidence among postmenopausal women with and without non-modifiable risk factors.

    PubMed

    Nomura, Sarah J O; Inoue-Choi, Maki; Lazovich, DeAnn; Robien, Kim

    2016-06-01

    Taller height, family history of breast cancer, greater number of years of potential fertility and nulliparity are established non-modifiable risk factors for postmenopausal breast cancer. Greater adherence to the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) diet, physical activity and body weight recommendations has previously been shown to be associated with lower breast cancer risk. However, no prior studies have evaluated whether women with non-modifiable risk factors receive similar benefits from recommendation adherence compared to women without these risk factors. In the Iowa Women's Health Study prospective cohort, we investigated whether associations of WCRF/AICR recommendation adherence differed by the presence/absence of non-modifiable breast cancer risk factors. Baseline (1986) questionnaire data from 36,626 postmenopausal women were used to create adherence scores for the WCRF/AICR recommendations (maximum score = 8.0). Overall and single recommendation adherence in relation to breast cancer risk (n = 3,189 cases) across levels of non-modifiable risk factors were evaluated using proportional hazards regression. Mean adherence score was 5.0 points (range: 0.5-8.0). Higher adherence scores (score ≥ 6.0 vs. ≤ 3.5, HR = 0.76, 95% CI = 0.67-0.87), and adherence to the individual recommendations for body weight and alcohol intake were associated with a lower breast cancer incidence. While not statistically significant among women with more non-modifiable risk factors (score ≥ 6.0 vs. ≤ 3.5, HR = 0.76, 95% CI = 0.36-1.63), hazard ratios were comparable to women with the no non-modifiable risk factors (score ≥ 6.0 vs. ≤ 3.5, HR = 0.74, 95% CI = 0.49-0.93) (p-interaction = 0.57). WCRF/AICR recommendation adherence is associated with lower breast cancer risk, regardless of non-modifiable risk factor status. PMID:26756307

  20. Residential radon exposure and risk of incident hematologic malignancies in the Cancer Prevention Study-II Nutrition Cohort.

    PubMed

    Teras, Lauren R; Diver, W Ryan; Turner, Michelle C; Krewski, Daniel; Sahar, Liora; Ward, Elizabeth; Gapstur, Susan M

    2016-07-01

    Dosimetric models show that radon, an established cause of lung cancer, delivers a non-negligible dose of alpha radiation to the bone marrow, as well as to lymphocytes in the tracheobronchial epithelium, and therefore could be related to risk of hematologic cancers. Studies of radon and hematologic cancer risk, however, have produced inconsistent results. To date there is no published prospective, population-based study of residential radon exposure and hematologic malignancy incidence. We used data from the American Cancer Society Cancer Prevention Study-II Nutrition Cohort established in 1992, to examine the association between county-level residential radon exposure and risk of hematologic cancer. The analytic cohort included 140,652 participants (66,572 men, 74,080 women) among which 3019 incident hematologic cancer cases (1711 men, 1308 women) were identified during 19 years of follow-up. Cox proportional hazard regression was used to calculate multivariable-adjusted hazard ratios (HRs) and corresponding 95% confidence intervals (CIs) for radon exposure and hematologic cancer risk. Women living in counties with the highest mean radon concentrations (>148Bq/m(3)) had a statistically significant higher risk of hematologic cancer compared to those living in counties with the lowest (<74Bq/m(3)) radon levels (HR=1.63, 95% CI:1.23-2.18), and there was evidence of a dose-response relationship (HRcontinuous=1.38, 95% CI:1.15-1.65 per 100Bq/m(3); p-trend=0.001). There was no association between county-level radon and hematologic cancer risk among men. The findings of this large, prospective study suggest residential radon may be a risk factor for lymphoid malignancies among women. Further study is needed to confirm these findings. PMID:27015563

  1. Use of risk projection models to estimate mortality and incidence from radiation-induced breast cancer in screening programs

    NASA Astrophysics Data System (ADS)

    Ramos, M.; Ferrer, S.; Villaescusa, J. I.; Verdú, G.; Salas, M. D.; Cuevas, M. D.

    2005-02-01

    The authors report on a method to calculate radiological risks, applicable to breast screening programs and other controlled medical exposures to ionizing radiation. In particular, it has been applied to make a risk assessment in the Valencian Breast Cancer Early Detection Program (VBCEDP) in Spain. This method is based on a parametric approach, through Markov processes, of hazard functions for radio-induced breast cancer incidence and mortality, with mean glandular breast dose, attained age and age-at-exposure as covariates. Excess relative risk functions of breast cancer mortality have been obtained from two different case-control studies exposed to ionizing radiation, with different follow-up time: the Canadian Fluoroscopy Cohort Study (1950-1987) and the Life Span Study (1950-1985 and 1950-1990), whereas relative risk functions for incidence have been obtained from the Life Span Study (1958-1993), the Massachusetts tuberculosis cohorts (1926-1985 and 1970-1985), the New York post-partum mastitis patients (1930-1981) and the Swedish benign breast disease cohort (1958-1987). Relative risks from these cohorts have been transported to the target population undergoing screening in the Valencian Community, a region in Spain with about four and a half million inhabitants. The SCREENRISK software has been developed to estimate radiological detriments in breast screening. Some hypotheses corresponding to different screening conditions have been considered in order to estimate the total risk associated with a woman who takes part in all screening rounds. In the case of the VBCEDP, the total radio-induced risk probability for fatal breast cancer is in a range between [5 × 10-6, 6 × 10-4] versus the natural rate of dying from breast cancer in the Valencian Community which is 9.2 × 10-3. The results show that these indicators could be included in quality control tests and could be adequate for making comparisons between several screening programs.

  2. Longitudinal Patterns of Change in Systolic Blood Pressure and Incidence of Cardiovascular Disease: The Atherosclerosis Risk in Communities Study.

    PubMed

    Petruski-Ivleva, Natalia; Viera, Anthony J; Shimbo, Daichi; Muntner, Paul; Avery, Christy L; Schneider, Andrea L C; Couper, David; Kucharska-Newton, Anna

    2016-06-01

    Elevated blood pressure in midlife contributes significantly to the risk of cardiovascular disease. However, patterns of blood pressure increase may differ among individuals and may result in differential risk. Our goal was to examine the contribution of longitudinal patterns of blood pressure change to incidence of heart failure, coronary heart disease, stroke, and cardiovascular disease mortality. Latent class growth models were used to identify patterns of change in blood pressure across 4 clinical examinations (1987-1998) among 9845 Atherosclerosis Risk in Communities (ARIC) cohort participants (mean age, 53.7 [SD 5.7] years). Patterns of change in systolic blood pressure included slowly and steeply increasing, a decreasing and a sustained elevated blood pressure. Changes in diastolic and mid-blood pressure (½ systolic+½ diastolic) were less pronounced. The association of blood pressure pattern group membership with incidence of clinical outcomes was examined in follow-up from the fourth clinical examination (1996-1998) to December 31, 2011, using Poisson regression models adjusted for demographic and metabolic characteristics, and hypertension medication use. A gradient of rates of all events was observed across the identified patterns. Associations were attenuated after adjustment for covariates. Cumulative systolic blood pressure load, rather than the temporal pattern of change in systolic blood pressure itself, plays a role in determining the risk of cardiovascular disease, in particular, of heart failure and cardiovascular disease mortality, independent of blood pressure level measured at one point in time. PMID:27045024

  3. Fruit and vegetable intakes and risk of colorectal cancer and incident and recurrent adenomas in the PLCO cancer screening trial.

    PubMed

    Kunzmann, Andrew T; Coleman, Helen G; Huang, Wen-Yi; Cantwell, Marie M; Kitahara, Cari M; Berndt, Sonja I

    2016-04-15

    The roles of fruits and vegetables in colorectal cancer development are unclear. Few prospective studies have assessed the association with adenoma, a known precursor to colorectal cancer. Our aim was to evaluate the association between fruit and vegetable intake and colorectal cancer development by evaluating the risk of incident and recurrent colorectal adenoma and colorectal cancer. Study participants were identified from the intervention arm of the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial. Fruit and vegetable intake was measured using a self-reported dietary questionnaire. Total fruit and vegetable intake was not associated with reduced incident or recurrent adenoma risk overall, but a protective association was observed for multiple adenomas (Odds ratio 3rd tertile vs. 1st tertile = 0.61, 95% confidence interval (CI): 0.38, 1.00). Higher fruit and vegetable intakes were associated with a borderline reduced risk of colorectal cancer (Hazard ratio (HR) 3rd tertile vs. 1st tertile = 0.82, 95% CI: 0.67, 1.01), which reached significance amongst individuals with high processed meat intakes (HR = 0.74, 95% CI: 0.55, 0.99). Our results suggest that increased fruit and vegetable intake may protect against multiple adenoma development and may reduce the detrimental effects of high processed meat intakes on colorectal cancer risk. PMID:26559156

  4. Co-Trimoxazole Prophylaxis Is Associated with Reduced Risk of Incident Tuberculosis in Participants in the Swiss HIV Cohort Study

    PubMed Central

    Walker, A. Sarah; Fehr, Jan; Furrer, Hansjakob; Hoffmann, Matthias; Battegay, Manuel; Calmy, Alexandra; Fellay, Jacques; Di Benedetto, Caroline; Weber, Rainer; Ledergerber, Bruno

    2014-01-01

    Co-trimoxazole reduces mortality in HIV-infected adults with tuberculosis (TB), and in vitro data suggest potential antimycobacterial activity of co-trimoxazole. We aimed to evaluate whether prophylaxis with co-trimoxazole is associated with a decreased risk of incident TB in Swiss HIV Cohort Study (SHCS) participants. We determined the incidence of TB per 1,000 person-years from January 1992 to December 2012. Rates were analyzed separately in participants with current or no previous antiretroviral treatment (ART) using Poisson regression adjusted for CD4 cell count, sex, region of origin, injection drug use, and age. A total of 13,431 cohort participants contributed 107,549 person-years of follow-up: 182 patients had incident TB—132 (73%) before and 50 (27%) after ART initiation. The multivariable incidence rate ratios for cumulative co-trimoxazole exposure per year for persons with no previous ART and current ART were 0.70 (95% confidence interval [CI], 0.55 to 0.89) and 0.87 (95% CI, 0.74 to 1.0), respectively. Co-trimoxazole may prevent the development of TB among HIV-positive persons, especially among those with no previous ART. PMID:24514096

  5. The Incidence, Clinical Outcomes, and Risk Factors of Thrombocytopenia in Intra-Abdominal Infection Patients: A Retrospective Cohort Study

    PubMed Central

    Wu, Qin; Ren, Jianan; Wang, Gefei; Li, Guanwei; Gu, Guosheng; Wu, Xiuwen; Li, Yuan; Chen, Jun; Zhao, Yunzhao; Li, Jieshou

    2016-01-01

    Background Studies on the incidence and risk factors of thrombocytopenia among intra-abdominal infection patients remain absent, hindering efficacy assessments regarding thrombocytopenia prevention strategies. Methods We retrospectively studied 267 consecutively enrolled patients with intra-abdominal infections. Occurrence of thrombocytopenia was scanned for all patients. All-cause 28-day mortality was recorded. Variables from univariate analyses that were associated with occurrence of hospital-acquired thrombocytopenia were included in a multivariable logistic regression analysis to determine thrombocytopenia predictors. Results Median APACHE II score and SOFA score of the whole cohort was 12 and 3 respectively. The overall ICU mortality was 7.87% and the 28-day mortality was 8.98%. The incidence of thrombocytopenia among intra-abdominal infection patients was 21.73%. Regardless of preexisting or hospital-acquired one, thrombocytopenia is associated with an increased ICU mortality and 28-day mortality as well as length of ICU or hospital stay. A higher SOFA and ISTH score at admission were significant hospital-acquired thrombocytopenia risk factors. Conclusions This is the first study to identify a high incidence of thrombocytopenia in patients with intra-abdominal infections. Our findings suggest that the inflammatory milieu of intra-abdominal infections may uniquely predispose those patients to thrombocytopenia. More effective thrombocytopenia prevention strategies are necessary in intra-abdominal infection patients. PMID:26808492

  6. Incidence, risk factors and microbiology of central vascular catheter-related bloodstream infection in an intensive care unit.

    PubMed

    Hajjej, Zied; Nasri, Mourad; Sellami, Walid; Gharsallah, Hedi; Labben, Iheb; Ferjani, Mustapha

    2014-03-01

    Although there are many studies about catheter related infection in industrialized countries, very few have analyzed it in emerging countries. The aim of our study was to determine the incidence, microbiological profile and risk factors for catheter-related bloodstream infection (CRBSI) in a Tunisian medical intensive care unit. Over eight months (1 January 2012-30 August 2012) a prospective, observational study was performed in an 18-bed medical surgical intensive care unit at Tunis military hospital. Patients who required central venous catheter (CVC) placement for a duration greater than 48 h were included in the study. Two hundred sixty patients, with a total of 482 CVCs were enrolled. The mean duration of catheterization was 9.6 ± 6.2 days. The incidence for CRBSI and catheter colonization (CC) was 2.4 and 9.3 per 1000 catheter days, respectively. Risk factors independently associated with CRBSI were diabetes mellitus, long duration of catheterization, sepsis at insertion and administration of one or more antibiotics before insertion. The mortality rate among the CRBSI group was 21.8%. The predominant microorganisms isolated from CRBSI and CC episodes were Gram negative bacilli. All Gram negative organisms isolated among dead patients in CRBSI group were Extensive Drug Resistant (XDR). In our study the mortality rate among patients with CRBSI was high despite a low incidence of CRBSI. This high rate can be explained by the high-virulent status of Gram negative bacteria involved in CRBSI. PMID:24508422

  7. Post-intravitreal anti-VEGF endophthalmitis in the United Kingdom: incidence, features, risk factors, and outcomes

    PubMed Central

    Lyall, D A M; Tey, A; Foot, B; Roxburgh, S T D; Virdi, M; Robertson, C; MacEwen, C J

    2012-01-01

    Purpose To describe the incidence, features, management, and risk factors of post-intravitreal anti-VEGF endophthalmitis (PIAE) in patients undergoing treatment for exudative age-related macular degeneration in the United Kingdom. Methods Prospective observational case control study. Forty-seven cases of PIAE were identified through the British Ophthalmological Surveillance Unit from January 2009 to March 2010. Data collected at diagnosis and at 6 months follow-up included patient demographics, intravitreal injection details, pre- and post-injection management, visual acuity, clinical features and management of PIAE, causative organisms, and clinical outcomes. Details were compared with 200 control cases from 10 control centres to identify potential risk factors. Results Estimated PIAE was 0.025%. Culture-positive PIAE incidence was 0.015%. Mean age of presentation was 78 years. Mean number of intravitreal injections before PIAE was 5. Mean days to presentation was 5 (range 1–39). Positive microbiology culture was found in 59.6%. The majority of causative organisms were Gram positive (92.8%). Significant risk factors were failure to administer topical antibiotics immediately after the injection (P=0.001), blepharitis (P=0.006), subconjunctival anaesthesia (P=0.021), patient squeezing during the injection (P=0.021), and failure to administer topical antibiotics before anti-VEGF injection (P=0.05). Discussion The incidence of PIAE in the United Kingdom is comparable to other studies at a rate of 0.025%. The most common causative organisms were Gram positive. Measures to minimise the risk of PIAE include treatment of blepharitis before injection, avoidance of subconjunctival anaesthesia, topical antibiotic administration immediately after injection with consideration to administering topical antibiotics before injection. PMID:23060022

  8. Is Pulse Pressure an Independent Risk Factor for Incident Stroke, REasons for Geographic And Racial Differences in Stroke

    PubMed Central

    Halberg, Daniel L.; Sands, Charles D.; Mosher, Aleena; Muntner, Paul M.; Howard, George

    2015-01-01

    BACKGROUND Pulse pressure (PP) is a potential risk factor of stroke. The relationship of incident stroke with systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and PP was examined. METHODS Data were from the REasons for Geographic And Racial Differences in Stroke national cohort study of 30,239 black and white participants aged ≥45 years, enrolled between 2003 and 2007. PP (SBP−DBP) and MAP (MAP = DBP + 1/3*PP) were calculated. Telephone follow-up occurred every six months for self or proxy-reported suspected stroke events, confirmed using expert adjudication. Cox-proportional hazards models examined the association of incident stroke for the different BP measurements with multivariable adjustment for sociodemographic and clinical risk factors including gender and race. RESULTS Men and women without prevalent stroke at baseline were analyzed (n = 25,462). During follow-up (mean 6.3±2.3 years, maximum 10 years), 916 strokes occurred. Unadjusted PP (hazard ratio [HR] = 1.30; 95% confidence interval [CI] 1.24–1.35), SBP (HR = 1.22; 95% CI 1.18–1.32), MAP (HR = 1.24; 95% CI 1.16–1.32), and DBP (HR = 1.09; 95% CI 1.01–1.17) were associated with stroke risk; however, after adjustment for SBP and other risk factors, the association with PP was attenuated (HR = 0.98; 95% CI 0.90–1.07), whereas SBP persisted as a predictor (HR = 1.14; 95% CI 1.06–1.23). These associations were consistent across age (younger vs. older >70 years) and race (black vs. white). CONCLUSIONS PP is positively associated with incident stroke, but not independently from SBP; and, there were no significant gender, racial, or regional differences in that association. PMID:25588699

  9. Climatic and psychosocial risks of heat illness incidents on construction site.

    PubMed

    Jia, Yunyan Andrea; Rowlinson, Steve; Ciccarelli, Marina

    2016-03-01

    The study presented in this paper aims to identify prominent risks leading to heat illness in summer among construction workers that can be prioritised for developing effective interventions. Samples are 216 construction workers' cases at the individual level and 26 construction projects cases at the organisation level. A grounded theory is generated to define the climatic heat and psychosocial risks and the relationships between risks, timing and effectiveness of interventions. The theoretical framework is then used to guide content analysis of 36 individual onsite heat illness cases to identify prominent risks. The results suggest that heat stress risks on construction site are socially constructed and can be effectively managed through elimination at supply chain level, effective engineering control, proactive control of the risks through individual interventions and reactive control through mindful recognition and response to early symptoms. The role of management infrastructure as a base for effective interventions is discussed. PMID:26674401

  10. Predicted risks of second malignant neoplasm incidence and mortality due to secondary neutrons in a girl and boy receiving proton craniospinal irradiation

    NASA Astrophysics Data System (ADS)

    Taddei, Phillip J.; Mahajan, Anita; Mirkovic, Dragan; Zhang, Rui; Giebeler, Annelise; Kornguth, David; Harvey, Mark; Woo, Shiao; Newhauser, Wayne D.

    2010-12-01

    The purpose of this study was to compare the predicted risks of second malignant neoplasm (SMN) incidence and mortality from secondary neutrons for a 9-year-old girl and a 10-year-old boy who received proton craniospinal irradiation (CSI). SMN incidence and mortality from neutrons were predicted from equivalent doses to radiosensitive organs for cranial, spinal and intracranial boost fields. Therapeutic proton absorbed dose and equivalent dose from neutrons were calculated using Monte Carlo simulations. Risks of SMN incidence and mortality in most organs and tissues were predicted by applying risks models from the National Research Council of the National Academies to the equivalent dose from neutrons; for non-melanoma skin cancer, risk models from the International Commission on Radiological Protection were applied. The lifetime absolute risks of SMN incidence due to neutrons were 14.8% and 8.5%, for the girl and boy, respectively. The risks of a fatal SMN were 5.3% and 3.4% for the girl and boy, respectively. The girl had a greater risk for any SMN except colon and liver cancers, indicating that the girl's higher risks were not attributable solely to greater susceptibility to breast cancer. Lung cancer predominated the risk of SMN mortality for both patients. This study suggests that the risks of SMN incidence and mortality from neutrons may be greater for girls than for boys treated with proton CSI.