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Sample records for adjusted relative risk

  1. 45 CFR 153.350 - Risk adjustment data validation standards.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... CARE ACCESS STANDARDS RELATED TO REINSURANCE, RISK CORRIDORS, AND RISK ADJUSTMENT UNDER THE AFFORDABLE CARE ACT State Standards Related to the Risk Adjustment Program § 153.350 Risk adjustment...

  2. 45 CFR 153.350 - Risk adjustment data validation standards.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... CARE ACCESS STANDARDS RELATED TO REINSURANCE, RISK CORRIDORS, AND RISK ADJUSTMENT UNDER THE AFFORDABLE CARE ACT State Standards Related to the Risk Adjustment Program § 153.350 Risk adjustment...

  3. Relations of Growth in Effortful Control to Family Income, Cumulative Risk, and Adjustment in Preschool-age Children

    PubMed Central

    Lengua, Liliana J.; Moran, Lyndsey; Zalewski, Maureen; Ruberry, Erika; Kiff, Cara; Thompson, Stephanie

    2014-01-01

    The study examined growth in effortful control (executive control, delay ability) in relation to income, cumulative risk (aggregate of demographic and psychosocial risk factors), and adjustment in 306 preschool-age children (50% girls, 50% boys) from families representing a range of income (29% at- or near-poverty; 28% lower-income; 25% middle-income; 18% upper-income), with 4 assessments starting at 36–40 mos. Income was directly related to levels of executive control and delay ability. Cumulative risk accounted for the effects of income on delay ability but not executive control. Higher initial executive control and slope of executive control and delay ability predicted academic readiness, whereas levels, but not growth, of executive control and delay ability predicted social competence and adjustment problems. Low income is a marker for lower effortful control, which demonstrates additive or mediating effects in the relation of income to children’s preschool adjustment. PMID:25253079

  4. Relations of growth in effortful control to family income, cumulative risk, and adjustment in preschool-age children.

    PubMed

    Lengua, Liliana J; Moran, Lyndsey; Zalewski, Maureen; Ruberry, Erika; Kiff, Cara; Thompson, Stephanie

    2015-05-01

    The study examined growth in effortful control (executive control, delay ability) in relation to income, cumulative risk (aggregate of demographic and psychosocial risk factors), and adjustment in 306 preschool-age children (50 % girls, 50 % boys) from families representing a range of income (29 % at- or near-poverty; 28 % lower-income; 25 % middle-income; 18 % upper-income), with 4 assessments starting at 36-40 month. Income was directly related to levels of executive control and delay ability. Cumulative risk accounted for the effects of income on delay ability but not executive control. Higher initial executive control and slope of executive control and delay ability predicted academic readiness, whereas levels, but not growth, of executive control and delay ability predicted social competence and adjustment problems. Low income is a marker for lower effortful control, which demonstrates additive or mediating effects in the relation of income to children's preschool adjustment. PMID:25253079

  5. Risk-adjusting outcomes of mental health and substance-related care: a review of the literature.

    PubMed

    Hermann, Richard C; Rollins, Caitlin K; Chan, Jeffrey A

    2007-01-01

    Risk adjustment is increasingly recognized as crucial to refining health care reimbursement and to comparing provider performance in terms of quality and outcomes of care. Risk adjustment for mental and substance use conditions has lagged behind other areas of medicine, but model development specific to these conditions has accelerated in recent years. After describing outcomes of mental health and substance-related care and associated risk factors, we review research studies on risk adjustment meeting the following criteria: (1) publication in a peer-reviewed journal between 1980 and 2002, (2) evaluation of one or more multivariate models used to risk-adjust comparisons of utilization, cost, or clinical outcomes of mental or substance use conditions across providers, and (3) quantitative assessment of the proportion of variance explained by patient characteristics in the model (e.g., R(2) or c-statistic). We identified 36 articles that included 72 models addressing utilization, 74 models of expenditures, and 15 models of clinical outcomes. Models based on diagnostic and sociodemographic information available from administrative data sets explained an average 6.7% of variance, whereas models using more detailed sources of data explained a more robust 22.8%. Results are appraised in the context of the mental health care system's needs for risk adjustment; we assess what has been accomplished, where gaps remain, and directions for future development. PMID:17454175

  6. Vigilance adjustments in relation to long- and short term risk in wild fallow deer (Dama dama).

    PubMed

    Bergvall, Ulrika A; Svensson, Lisa; Kjellander, Petter

    2016-07-01

    The risk allocation hypothesis predicts that vigilance should be adjusted to the temporal variation in risk. We test this hypothesis in wild fallow deer exposed to short term (disturbance) and long term (presence of a fawn after parturition) changes in risk. We recorded the proportion, frequency and type of vigilance and size of used area before and after parturition, in GPS-collared wild female fallow deer. Vigilance was divided in two main groups: "non-grazing vigilance" and "grazing vigilance". The latter group was divided into "grazing vigilance while chewing" and a "grazing vigilance when chewing was interrupted". By recording external disturbance in form of passing cars, we were able to investigate if this altered the amount, and type of vigilance. We found that females increased the proportion and frequency of "grazing vigilance stop chewing" after parturition. The "grazing vigilance chewing" was unaffected, but "non-grazing vigilance" decreased. Disturbance increased the proportion "grazing vigilance stop chewing" to the same extent before and after parturition. We found a clear decrease in female home range size after parturition as a possible behavioural adjustment. The increase in "grazing vigilance stop chewing" after parturition is a rarely described but expected cost of reproduction. PMID:27094230

  7. Effortful control as a moderator of the relation between contextual risk factors and growth in adjustment problems

    PubMed Central

    LENGUA, LILIANA J.; BUSH, NICOLE R.; LONG, ANNA C.; KOVACS, ERICA A.; TRANCIK, ANIKA M.

    2014-01-01

    Effortful control was examined as a moderator of the relations of three domains of contextual risk factors to growth in internalizing and externalizing problems in a community sample (N = 189) of children (8–12 years at Time 1). Socioeconomic, maternal, and environmental risk factors were examined as predictors of initial levels and growth in children’s adjustment problems across 3 years. The effects of the risk factors depended on children’s level of effortful control. For children lower in effortful control, socioeconomic risk was related to significantly higher initial levels of internalizing and externalizing problems and decreases over time. However, children lower in effortful control had higher levels of problems at all three time points than children higher in effortful control. Maternal risk was associated with increases in internalizing for children lower in effortful control, and environmental risk was related to increases in internalizing and externalizing problems for children lower in effortful control, but not those higher in effortful control. Children who were lower in effortful control appeared to experience more adverse effects of contextual risk than those higher in effortful control, suggesting that interventions aimed at improving children’s effortful control might serve to protect children from increased risk of adjustment problems associated with contextual risk factors. PMID:18423092

  8. Effortful control as a moderator of the relation between contextual risk factors and growth in adjustment problems.

    PubMed

    Lengua, Liliana J; Bush, Nicole R; Long, Anna C; Kovacs, Erica A; Trancik, Anika M

    2008-01-01

    Effortful control was examined as a moderator of the relations of three domains of contextual risk factors to growth in internalizing and externalizing problems in a community sample (N = 189) of children (8-12 years at Time 1). Socioeconomic, maternal, and environmental risk factors were examined as predictors of initial levels and growth in children's adjustment problems across 3 years. The effects of the risk factors depended on children's level of effortful control. For children lower in effortful control, socioeconomic risk was related to significantly higher initial levels of internalizing and externalizing problems and decreases over time. However, children lower in effortful control had higher levels of problems at all three time points than children higher in effortful control. Maternal risk was associated with increases in internalizing for children lower in effortful control, and environmental risk was related to increases in internalizing and externalizing problems for children lower in effortful control, but not those higher in effortful control. Children who were lower in effortful control appeared to experience more adverse effects of contextual risk than those higher in effortful control, suggesting that interventions aimed at improving children's effortful control might serve to protect children from increased risk of adjustment problems associated with contextual risk factors. PMID:18423092

  9. 45 CFR 153.310 - Risk adjustment administration.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 45 Public Welfare 1 2014-10-01 2014-10-01 false Risk adjustment administration. 153.310 Section... ACCESS STANDARDS RELATED TO REINSURANCE, RISK CORRIDORS, AND RISK ADJUSTMENT UNDER THE AFFORDABLE CARE ACT State Standards Related to the Risk Adjustment Program § 153.310 Risk adjustment...

  10. 45 CFR 153.310 - Risk adjustment administration.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 45 Public Welfare 1 2013-10-01 2013-10-01 false Risk adjustment administration. 153.310 Section... ACCESS STANDARDS RELATED TO REINSURANCE, RISK CORRIDORS, AND RISK ADJUSTMENT UNDER THE AFFORDABLE CARE ACT State Standards Related to the Risk Adjustment Program § 153.310 Risk adjustment...

  11. 45 CFR 153.320 - Federally certified risk adjustment methodology.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... TO HEALTH CARE ACCESS STANDARDS RELATED TO REINSURANCE, RISK CORRIDORS, AND RISK ADJUSTMENT UNDER THE AFFORDABLE CARE ACT State Standards Related to the Risk Adjustment Program § 153.320 Federally certified...

  12. 45 CFR 153.610 - Risk adjustment issuer requirements.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... CARE ACCESS STANDARDS RELATED TO REINSURANCE, RISK CORRIDORS, AND RISK ADJUSTMENT UNDER THE AFFORDABLE CARE ACT Health Insurance Issuer Standards Related to the Risk Adjustment Program § 153.610...

  13. 45 CFR 153.620 - Compliance with risk adjustment standards.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... CARE ACCESS STANDARDS RELATED TO REINSURANCE, RISK CORRIDORS, AND RISK ADJUSTMENT UNDER THE AFFORDABLE CARE ACT Health Insurance Issuer Standards Related to the Risk Adjustment Program § 153.620...

  14. 45 CFR 153.620 - Compliance with risk adjustment standards.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... CARE ACCESS STANDARDS RELATED TO REINSURANCE, RISK CORRIDORS, AND RISK ADJUSTMENT UNDER THE AFFORDABLE CARE ACT Health Insurance Issuer Standards Related to the Risk Adjustment Program § 153.620...

  15. 45 CFR 153.310 - Risk adjustment administration.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 153.310 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS STANDARDS RELATED TO REINSURANCE, RISK CORRIDORS, AND RISK ADJUSTMENT UNDER THE AFFORDABLE CARE ACT State Standards Related to the Risk Adjustment Program § 153.310 Risk adjustment...

  16. 45 CFR 153.365 - General oversight requirements for State-operated risk adjustment programs.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... Services REQUIREMENTS RELATING TO HEALTH CARE ACCESS STANDARDS RELATED TO REINSURANCE, RISK CORRIDORS, AND RISK ADJUSTMENT UNDER THE AFFORDABLE CARE ACT State Standards Related to the Risk Adjustment...

  17. 45 CFR 153.330 - State alternate risk adjustment methodology.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 45 Public Welfare 1 2014-10-01 2014-10-01 false State alternate risk adjustment methodology. 153... HEALTH CARE ACCESS STANDARDS RELATED TO REINSURANCE, RISK CORRIDORS, AND RISK ADJUSTMENT UNDER THE AFFORDABLE CARE ACT State Standards Related to the Risk Adjustment Program § 153.330 State alternate...

  18. 45 CFR 153.320 - Federally certified risk adjustment methodology.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 45 Public Welfare 1 2013-10-01 2013-10-01 false Federally certified risk adjustment methodology... TO HEALTH CARE ACCESS STANDARDS RELATED TO REINSURANCE, RISK CORRIDORS, AND RISK ADJUSTMENT UNDER THE AFFORDABLE CARE ACT State Standards Related to the Risk Adjustment Program § 153.320 Federally certified...

  19. Adjusting for car occupant injury liability in relation to age, speed limit, and gender-specific driver crash involvement risk.

    PubMed

    Keall, Michael; Frith, William

    2004-12-01

    It is well established that older drivers' fragility is an important factor associated with higher levels of fatal crash involvement for older drivers. There has been less research on age-related fragility with respect to the sort of minor injuries that are more common in injury crashes. This study estimates a quantity that is related to injury fragility: the probability that a driver or a passenger of that driver will be injured in crashes involving two cars. The effects of other factors apart from drivers' fragility are included in this measure, including the fragility of the passengers, the crashworthiness of cars driven, seatbelt use by the occupants, and characteristics of crashes (including configuration and impact speed). The car occupant injury liability estimates appropriately includes these factors to adjust risk curves by age, gender, and speed limit accounting for overrepresentation in crashes associated with fragility and these other factors. PMID:15545071

  20. Risk adjustment for pediatric quality indicators.

    PubMed

    Kuhlthau, Karen; Ferris, Timothy G G; Iezzoni, Lisa I

    2004-01-01

    The movement to measure medical care quality has been accelerating, spurred on by evidence of poor quality of care and trials of interventions to improve care. Appropriate measurement of quality of care is an essential aspect of improving the quality of care, yet some quality measures may be influenced by patients' attributes unrelated to quality of care. Risk adjustment is the term commonly applied to those methods that account for patient-related attributes, making measurement of health care quality as comparable as possible across providers or organizations seeing different mixes of patients. The measurement of quality of care for children poses specific challenges. In addition to these measurement challenges, analysts must ensure that quality comparisons among doctors, groups of doctors, hospitals, or health plans are not adversely affected by the likelihood that different types of patients seek care in different places. Although some techniques designed to adjust performance measures for case mix were developed for both adults and children, other systems are specific to childhood circumstances. The theoretical issues involved in risk-adjusting childhood outcomes measures for newborns in the neonatal intensive care unit were reviewed recently. Here, we go beyond the neonatal intensive care unit setting to consider risk adjustment for pediatric quality measures more broadly. In particular, we 1) review the conceptual background for risk-adjusting quality measures, 2) present policy issues related to adjusting pediatric quality measures, and 3) catalog existing risk-adjustment methodologies for pediatric quality measures. We conclude with an overall assessment of the status of risk adjustment for pediatric quality measures and recommendations for additional research and application. PMID:14702503

  1. 45 CFR 153.330 - State alternate risk adjustment methodology.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... HEALTH CARE ACCESS STANDARDS RELATED TO REINSURANCE, RISK CORRIDORS, AND RISK ADJUSTMENT UNDER THE AFFORDABLE CARE ACT State Standards Related to the Risk Adjustment Program § 153.330 State alternate risk... methodology: (i) Accurately explains the variation in health care costs of a given population; (ii) Links...

  2. 45 CFR 153.330 - State alternate risk adjustment methodology.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... HEALTH CARE ACCESS STANDARDS RELATED TO REINSURANCE, RISK CORRIDORS, AND RISK ADJUSTMENT UNDER THE AFFORDABLE CARE ACT State Standards Related to the Risk Adjustment Program § 153.330 State alternate risk... methodology: (i) Accurately explains the variation in health care costs of a given population; (ii) Links...

  3. 45 CFR 153.340 - Data collection under risk adjustment.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 45 Public Welfare 1 2012-10-01 2012-10-01 false Data collection under risk adjustment. 153.340 Section 153.340 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS STANDARDS RELATED TO REINSURANCE, RISK CORRIDORS, AND RISK ADJUSTMENT UNDER THE AFFORDABLE CARE ACT State Standards Related to the...

  4. 45 CFR 153.610 - Risk adjustment issuer requirements.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... or a plan not subject to 45 CFR 147.102, 147.104, 147.106, 156.80, and subpart B of part 156) must... 45 Public Welfare 1 2013-10-01 2013-10-01 false Risk adjustment issuer requirements. 153.610... CARE ACCESS STANDARDS RELATED TO REINSURANCE, RISK CORRIDORS, AND RISK ADJUSTMENT UNDER THE...

  5. 45 CFR 153.610 - Risk adjustment issuer requirements.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... or a plan not subject to 45 CFR 147.102, 147.104, 147.106, 156.80, and subpart B of part 156) must... 45 Public Welfare 1 2014-10-01 2014-10-01 false Risk adjustment issuer requirements. 153.610... CARE ACCESS STANDARDS RELATED TO REINSURANCE, RISK CORRIDORS, AND RISK ADJUSTMENT UNDER THE...

  6. 45 CFR 153.360 - Application of risk adjustment to the small group market.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... RELATING TO HEALTH CARE ACCESS STANDARDS RELATED TO REINSURANCE, RISK CORRIDORS, AND RISK ADJUSTMENT UNDER THE AFFORDABLE CARE ACT State Standards Related to the Risk Adjustment Program § 153.360...

  7. 45 CFR 153.360 - Application of risk adjustment to the small group market.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... RELATING TO HEALTH CARE ACCESS STANDARDS RELATED TO REINSURANCE, RISK CORRIDORS, AND RISK ADJUSTMENT UNDER THE AFFORDABLE CARE ACT State Standards Related to the Risk Adjustment Program § 153.360...

  8. How should risk adjustment data be collected?

    PubMed

    Kessler, Daniel P

    2012-01-01

    Risk adjustment has broad general application and is a key part of the Patient Protection and Affordable Care Act (ACA). Yet, little has been written on how data required to support risk adjustment should be collected. This paper offers analytical support for a distributed approach, in which insurers retain possession of claims but pass on summary statistics to the risk adjustment authority as needed. It shows that distributed approaches function as well as or better than centralized ones-where insurers submit raw claims data to the risk adjustment authority-in terms of the goals of risk adjustment. In particular, it shows how distributed data analysis can be used to calibrate risk adjustment models and calculate payments, both in theory and in practice--drawing on the experience of distributed models in other contexts. In addition, it explains how distributed methods support other goals of the ACA, and can support projects requiring data aggregation more generally. It concludes that states should seriously consider distributed methods to implement their risk adjustment programs. PMID:22931020

  9. Risk-adjusted monitoring of survival times

    SciTech Connect

    Sego, Landon H.; Reynolds, Marion R.; Woodall, William H.

    2009-02-26

    We consider the monitoring of clinical outcomes, where each patient has a di®erent risk of death prior to undergoing a health care procedure.We propose a risk-adjusted survival time CUSUM chart (RAST CUSUM) for monitoring clinical outcomes where the primary endpoint is a continuous, time-to-event variable that may be right censored. Risk adjustment is accomplished using accelerated failure time regression models. We compare the average run length performance of the RAST CUSUM chart to the risk-adjusted Bernoulli CUSUM chart, using data from cardiac surgeries to motivate the details of the comparison. The comparisons show that the RAST CUSUM chart is more efficient at detecting a sudden decrease in the odds of death than the risk-adjusted Bernoulli CUSUM chart, especially when the fraction of censored observations is not too high. We also discuss the implementation of a prospective monitoring scheme using the RAST CUSUM chart.

  10. Overpaying morbidity adjusters in risk equalization models.

    PubMed

    van Kleef, R C; van Vliet, R C J A; van de Ven, W P M M

    2016-09-01

    Most competitive social health insurance markets include risk equalization to compensate insurers for predictable variation in healthcare expenses. Empirical literature shows that even the most sophisticated risk equalization models-with advanced morbidity adjusters-substantially undercompensate insurers for selected groups of high-risk individuals. In the presence of premium regulation, these undercompensations confront consumers and insurers with incentives for risk selection. An important reason for the undercompensations is that not all information with predictive value regarding healthcare expenses is appropriate for use as a morbidity adjuster. To reduce incentives for selection regarding specific groups we propose overpaying morbidity adjusters that are already included in the risk equalization model. This paper illustrates the idea of overpaying by merging data on morbidity adjusters and healthcare expenses with health survey information, and derives three preconditions for meaningful application. Given these preconditions, we think overpaying may be particularly useful for pharmacy-based cost groups. PMID:26420555

  11. Implementation of Risk Adjustment for Medicare

    PubMed Central

    Ingber, Melvin J.

    2000-01-01

    The Health Care Financing Administration (HCFA) implemented risk adjustment for Medicare capitated organizations January 2000. The risk adjustment system used, the Principal Inpatient Diagnostic Cost Group (PIPDCG) method, had to be incorporated into the payment structure mandated by the Balanced Budget Act of 1997 (BBA). This article describes how risk adjustment was integrated into the payment system within the rules of the BBA, and how fee-for-service (FFS) and health maintenance organization (HMO) data are collected and used in the determination of payment. PMID:11481750

  12. 42 CFR 422.310 - Risk adjustment data.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 3 2014-10-01 2014-10-01 false Risk adjustment data. 422.310 Section 422.310... Organizations § 422.310 Risk adjustment data. (a) Definition of risk adjustment data. Risk adjustment data are all data that are used in the development and application of a risk adjustment payment model. (b)...

  13. 42 CFR 422.310 - Risk adjustment data.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 3 2012-10-01 2012-10-01 false Risk adjustment data. 422.310 Section 422.310... Organizations § 422.310 Risk adjustment data. (a) Definition of risk adjustment data. Risk adjustment data are all data that are used in the development and application of a risk adjustment payment model. (b)...

  14. 42 CFR 422.310 - Risk adjustment data.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 3 2011-10-01 2011-10-01 false Risk adjustment data. 422.310 Section 422.310....310 Risk adjustment data. (a) Definition of risk adjustment data. Risk adjustment data are all data that are used in the development and application of a risk adjustment payment model. (b)...

  15. Fetal Risks, Relative Risks, and Relatives' Risks.

    PubMed

    Minkoff, Howard; Marshall, Mary Faith

    2016-01-01

    Several factors related to fetal risk render it more or less acceptable in justifying constraints on the behavior of pregnant women. Risk is an unavoidable part of pregnancy and childbirth, one that women must balance against other vital personal and family interests. Two particular issues relate to the fairness of claims that pregnant women are never entitled to put their fetuses at risk: relative risks and relatives' risks. The former have been used-often spuriously-to advance arguments against activities, such as home birth, that may incur risk; the latter implicate the nature of relationships in determining the acceptability of coercing or precluding activities. Motivated reasoning by clinicians and judges leads to inaccurate risk assessments, and judgments based on false claims to objectivity. Such judgments undermine the moral and legal standing of pregnant women and do not advance the interests of fetuses, pregnant women, families, or states. PMID:26832079

  16. Risk adjustment for a children's capitation rate.

    PubMed

    Newhouse, J P; Sloss, E M; Manning, W G; Keeler, E B

    1993-01-01

    Few capitation arrangements vary premiums by a child's health characteristics, yielding an incentive to discriminate against children with predictably high expenditures from chronic diseases. In this article, we explore risk adjusters for the 35 percent of the variance in annual out-patient expenditure we find to be potentially predictable. Demographic factors such as age and gender only explain 5 percent of such variance; health status measures explain 25 percent, prior use and health status measures together explain 65 to 70 percent. The profit from risk selection falls less than proportionately with improved ability to adjust for risk. Partial capitation rates may be necessary to mitigate skimming and dumping. PMID:10133708

  17. 45 CFR 153.350 - Risk adjustment data validation standards.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... implementation of any risk adjustment software and ensure proper validation of a statistically valid sample of... respect to implementation of risk adjustment software or as a result of data validation conducted pursuant... implementation of risk adjustment software or data validation....

  18. Adjusting Population Risk for Functional Health Status.

    PubMed

    Fuller, Richard L; Hughes, John S; Goldfield, Norbert I

    2016-04-01

    Risk adjustment accounts for differences in population mix by reducing the likelihood of enrollee selection by managed care plans and providing a correction to otherwise biased reporting of provider or plan performance. Functional health status is not routinely included within risk-adjustment methods, but is believed by many to be a significant enhancement to risk adjustment for complex enrollees and patients. In this analysis a standardized measure of functional health was created using 3 different source functional assessment instruments submitted to the Medicare program on condition of payment. The authors use a 5% development sample of Medicare claims from 2006 and 2007, including functional health assessments, and develop a model of functional health classification comprising 9 groups defined by the interaction of self-care, mobility, incontinence, and cognitive impairment. The 9 functional groups were used to augment Clinical Risk Groups, a diagnosis-based patient classification system, and when using a validation set of 100% of Medicare data for 2010 and 2011, this study found the use of the functional health module to improve the fit of observed enrollee cost, measured by the R(2) statistic, by 5% across all Medicare enrollees. The authors observed complex nonlinear interactions across functional health domains when constructing the model and caution that functional health status needs careful handling when used for risk adjustment. The addition of functional health status within existing risk-adjustment models has the potential to improve equitable resource allocation in the financing of care costs for more complex enrollees if handled appropriately. (Population Health Management 2016;19:136-144). PMID:26348621

  19. Risk-Adjusted Models for Adverse Obstetric Outcomes and Variation in Risk Adjusted Outcomes Across Hospitals

    PubMed Central

    Bailit, Jennifer L.; Grobman, William A.; Rice, Madeline Murguia; Spong, Catherine Y.; Wapner, Ronald J.; Varner, Michael W.; Thorp, John M.; Leveno, Kenneth J.; Caritis, Steve N.; Shubert, Phillip J.; Tita, Alan T. N.; Saade, George; Sorokin, Yoram; Rouse, Dwight J.; Blackwell, Sean C.; Tolosa, Jorge E.; Van Dorsten, J. Peter

    2014-01-01

    Objective Regulatory bodies and insurers evaluate hospital quality using obstetrical outcomes, however meaningful comparisons should take pre-existing patient characteristics into account. Furthermore, if risk-adjusted outcomes are consistent within a hospital, fewer measures and resources would be needed to assess obstetrical quality. Our objective was to establish risk-adjusted models for five obstetric outcomes and assess hospital performance across these outcomes. Study Design A cohort study of 115,502 women and their neonates born in 25 hospitals in the United States between March 2008 and February 2011. Hospitals were ranked according to their unadjusted and risk-adjusted frequency of venous thromboembolism, postpartum hemorrhage, peripartum infection, severe perineal laceration, and a composite neonatal adverse outcome. Correlations between hospital risk-adjusted outcome frequencies were assessed. Results Venous thromboembolism occurred too infrequently (0.03%, 95% CI 0.02% – 0.04%) for meaningful assessment. Other outcomes occurred frequently enough for assessment (postpartum hemorrhage 2.29% (95% CI 2.20–2.38), peripartum infection 5.06% (95% CI 4.93–5.19), severe perineal laceration at spontaneous vaginal delivery 2.16% (95% CI 2.06–2.27), neonatal composite 2.73% (95% CI 2.63–2.84)). Although there was high concordance between unadjusted and adjusted hospital rankings, several individual hospitals had an adjusted rank that was substantially different (as much as 12 rank tiers) than their unadjusted rank. None of the correlations between hospital adjusted outcome frequencies was significant. For example, the hospital with the lowest adjusted frequency of peripartum infection had the highest adjusted frequency of severe perineal laceration. Conclusions Evaluations based on a single risk-adjusted outcome cannot be generalized to overall hospital obstetric performance. PMID:23891630

  20. Risk selection, risk adjustment and choice: concepts and lessons from the Americas.

    PubMed

    Ellis, Randall P; Fernandez, Juan Gabriel

    2013-11-01

    Interest has grown worldwide in risk adjustment and risk sharing due to their potential to contain costs, improve fairness, and reduce selection problems in health care markets. Significant steps have been made in the empirical development of risk adjustment models, and in the theoretical foundations of risk adjustment and risk sharing. This literature has often modeled the effects of risk adjustment without highlighting the institutional setting, regulations, and diverse selection problems that risk adjustment is intended to fix. Perhaps because of this, the existing literature and their recommendations for optimal risk adjustment or optimal payment systems are sometimes confusing. In this paper, we present a unified way of thinking about the organizational structure of health care systems, which enables us to focus on two key dimensions of markets that have received less attention: what choices are available that may lead to selection problems, and what financial or regulatory tools other than risk adjustment are used to influence these choices. We specifically examine the health care systems, choices, and problems in four countries: the US, Canada, Chile, and Colombia, and examine the relationship between selection-related efficiency and fairness problems and the choices that are allowed in each country, and discuss recent regulatory reforms that affect choices and selection problems. In this sample, countries and insurance programs with more choices have more selection problems. PMID:24284351

  1. Risk Selection, Risk Adjustment and Choice: Concepts and Lessons from the Americas

    PubMed Central

    Ellis, Randall P.; Fernandez, Juan Gabriel

    2013-01-01

    Interest has grown worldwide in risk adjustment and risk sharing due to their potential to contain costs, improve fairness, and reduce selection problems in health care markets. Significant steps have been made in the empirical development of risk adjustment models, and in the theoretical foundations of risk adjustment and risk sharing. This literature has often modeled the effects of risk adjustment without highlighting the institutional setting, regulations, and diverse selection problems that risk adjustment is intended to fix. Perhaps because of this, the existing literature and their recommendations for optimal risk adjustment or optimal payment systems are sometimes confusing. In this paper, we present a unified way of thinking about the organizational structure of health care systems, which enables us to focus on two key dimensions of markets that have received less attention: what choices are available that may lead to selection problems, and what financial or regulatory tools other than risk adjustment are used to influence these choices. We specifically examine the health care systems, choices, and problems in four countries: the US, Canada, Chile, and Colombia, and examine the relationship between selection-related efficiency and fairness problems and the choices that are allowed in each country, and discuss recent regulatory reforms that affect choices and selection problems. In this sample, countries and insurance programs with more choices have more selection problems. PMID:24284351

  2. Risk adjustment: where are we now?

    PubMed

    Newhouse, J P

    1998-01-01

    Risk adjustment is intended to minimize selection of patients or enrollees in health plans. Current efforts generally are recognized as inadequate, but improvement is difficult. The greatest short-term gain will come from introducing diagnostic information, though outpatient diagnosis data are unreliable. Initial efforts may use inpatient data, but this creates incentives to hospitalize people. Even exploiting diagnosis information leaves substantial imperfections. Partial capitation, common in behavioral health, reduces incentives to select patients and stent on services, but current policy resists it, perhaps because policymakers misinterpret the lesson of the Prospective Payment System. Theoretically, not paying plans more for providing additional services is optimal only if consumers are well informed. PMID:9719781

  3. 45 CFR 153.630 - Data validation requirements when HHS operates risk adjustment.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 45 Public Welfare 1 2014-10-01 2014-10-01 false Data validation requirements when HHS operates risk adjustment. 153.630 Section 153.630 Public Welfare Department of Health and Human Services REQUIREMENTS RELATING TO HEALTH CARE ACCESS STANDARDS RELATED TO REINSURANCE, RISK CORRIDORS, AND RISK ADJUSTMENT UNDER THE AFFORDABLE CARE ACT...

  4. Personality, emotional adjustment, and cardiovascular risk: marriage as a mechanism.

    PubMed

    Smith, Timothy W; Baron, Carolynne E; Grove, Jeremy L

    2014-12-01

    A variety of aspects of personality and emotional adjustment predict the development and course of coronary heart disease (CHD), as do indications of marital quality (e.g., satisfaction, conflict, strain, disruption). Importantly, the personality traits and aspects of emotional adjustment that predict CHD are also related to marital quality. In such instances of correlated risk factors, traditional epidemiological and clinical research typically either ignores the potentially overlapping effects or examines independent associations through statistical controls, approaches that can misrepresent the key components and mechanisms of psychosocial effects on CHD. The interpersonal perspective in personality and clinical psychology provides an alternative and integrative approach, through its structural and process models of interpersonal behavior. We present this perspective on psychosocial risk and review research on its application to the integration of personality, emotional adjustment, and marital processes as closely interrelated influences on health and disease. PMID:24118013

  5. The structure of risk adjustment for private plans in Medicare.

    PubMed

    Newhouse, Joseph P; Huang, Jie; Brand, Richard J; Fung, Vicki; Hsu, John T

    2011-06-01

    Medicare bases its risk adjustment method for Medicare Advantage plan payment on the relative costs of treating various diagnoses in traditional Medicare. However, there are many reasons to doubt that the relative cost of treating different diagnoses is similar between Medicare Advantage plans and traditional Medicare, including the varying applicability of care management methods to different diagnoses and the varying degrees of market power among suppliers of services to plans. We use internal cost data from a large health plan to compare its cost of treating various diagnoses with Medicare's reimbursement. We find substantial variability across diagnoses, implying that the current risk adjustment system creates incentives for Medicare Advantage plans to favor beneficiaries with certain diagnoses, but find no consistent relationship between the costliness of the diagnosis and the difference between reimbursement and cost. PMID:21756017

  6. 12 CFR 615.5210 - Risk-adjusted assets.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 12 Banks and Banking 6 2010-01-01 2010-01-01 false Risk-adjusted assets. 615.5210 Section 615.5210... POLICIES AND OPERATIONS, AND FUNDING OPERATIONS Capital Adequacy § 615.5210 Risk-adjusted assets. (a... appropriate credit conversion factor in § 615.5212, is assigned to one of the risk categories specified...

  7. 12 CFR 615.5210 - Risk-adjusted assets.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 12 Banks and Banking 7 2014-01-01 2014-01-01 false Risk-adjusted assets. 615.5210 Section 615.5210... POLICIES AND OPERATIONS, AND FUNDING OPERATIONS Capital Adequacy § 615.5210 Risk-adjusted assets. (a... appropriate credit conversion factor in § 615.5212, is assigned to one of the risk categories specified...

  8. 12 CFR 615.5210 - Risk-adjusted assets.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 12 Banks and Banking 7 2012-01-01 2012-01-01 false Risk-adjusted assets. 615.5210 Section 615.5210... POLICIES AND OPERATIONS, AND FUNDING OPERATIONS Capital Adequacy § 615.5210 Risk-adjusted assets. (a... appropriate credit conversion factor in § 615.5212, is assigned to one of the risk categories specified...

  9. 12 CFR 615.5210 - Risk-adjusted assets.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 12 Banks and Banking 7 2013-01-01 2013-01-01 false Risk-adjusted assets. 615.5210 Section 615.5210... POLICIES AND OPERATIONS, AND FUNDING OPERATIONS Capital Adequacy § 615.5210 Risk-adjusted assets. (a... appropriate credit conversion factor in § 615.5212, is assigned to one of the risk categories specified...

  10. Psychological adjustment of children with congenital hypothyroidism and phenylketonuria as related to parental psychological adjustment.

    PubMed

    Jusiene, Roma; Kucinskas, Vaidutis

    2004-01-01

    Phenylketonuria and congenital hypothyroidism are the inherited metabolic diseases that can be diagnosed and successfully treated early from birth. Nevertheless, children with phenylketonuria and congenital hypothyroidism are found to be in the risk for psychological maladjustment. Parental adjustment - as significant condition for child's psychological adjustment--and related factors are explored in this study. Parents of 63 children with congenital hypothyroidism and phenylketonuria (age 2 to 14 years) answered the Child Behavior Checklist, Coping Strategies Questionnaire and the questionnaire on reactions to child's disease, relations with a sick child, with the spouse and other people. Severity of the disease and child's age are considered as well. Results of the study show that parental emotional (maladaptive) coping and indulgence of a sick child account for the higher rates of internalizing problems of children with phenylketonuria and congenital hypothyroidism. In addition, the higher rates of children's psychological problems are related to parental feelings of guilt as a reaction to child's disease. PMID:15252232

  11. 77 FR 21775 - Risk Adjustment Meeting-May 7, 2012 and May 8, 2012

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-04-11

    ... following topics: The risk adjustment model, calculation of plan average actuarial risk, calculation of... risk adjustment model, calculation of plan average actuarial risk, calculation of payments and...

  12. 12 CFR 615.5210 - Risk-adjusted assets.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 12 Banks and Banking 6 2011-01-01 2011-01-01 false Risk-adjusted assets. 615.5210 Section 615.5210 Banks and Banking FARM CREDIT ADMINISTRATION FARM CREDIT SYSTEM FUNDING AND FISCAL AFFAIRS, LOAN POLICIES AND OPERATIONS, AND FUNDING OPERATIONS Capital Adequacy § 615.5210 Risk-adjusted assets. (a) Computation. Each asset on the...

  13. Case‐mix adjustment in non‐randomised observational evaluations: the constant risk fallacy

    PubMed Central

    Nicholl, Jon

    2007-01-01

    Observational studies comparing groups or populations to evaluate services or interventions usually require case‐mix adjustment to account for imbalances between the groups being compared. Simulation studies have, however, shown that case‐mix adjustment can make any bias worse. One reason this can happen is if the risk factors used in the adjustment are related to the risk in different ways in the groups or populations being compared, and ignoring this commits the “constant risk fallacy”. Case‐mix adjustment is particularly prone to this problem when the adjustment uses factors that are proxies for the real risk factors. Interactions between risk factors and groups should always be examined before case‐mix adjustment in observational studies. PMID:17933961

  14. Affordable Care Act risk adjustment: overview, context, and challenges.

    PubMed

    Kautter, John; Pope, Gregory C; Keenan, Patricia

    2014-01-01

    Beginning in 2014, individuals and small businesses will be able to purchase private health insurance through competitive marketplaces. The Affordable Care Act (ACA) provides for a program of risk adjustment in the individual and small group markets in 2014 as Marketplaces are implemented and new market reforms take effect. The purpose of risk adjustment is to lessen or eliminate the influence of risk selection on the premiums that plans charge and the incentive for plans to avoid sicker enrollees. This article--the first of three in the Medicare & Medicaid Research Review--describes the key program goal and issues in the Department of Health and Human Services (HHS) developed risk adjustment methodology, and identifies key choices in how the methodology responds to these issues. The goal of the HHS risk adjustment methodology is to compensate health insurance plans for differences in enrollee health mix so that plan premiums reflect differences in scope of coverage and other plan factors, but not differences in health status. The methodology includes a risk adjustment model and a risk transfer formula that together address this program goal as well as three issues specific to ACA risk adjustment: 1) new population; 2) cost and rating factors; and 3) balanced transfers within state/market. The risk adjustment model, described in the second article, estimates differences in health risks taking into account the new population and scope of coverage (actuarial value level). The transfer formula, described in the third article, calculates balanced transfers that are intended to account for health risk differences while preserving permissible premium differences. PMID:25364625

  15. Children's Adjustment Following Divorce: Risk and Resilience Perspectives.

    ERIC Educational Resources Information Center

    Kelly, Joan B.; Emery, Robert E.

    2003-01-01

    Reviews the empirical literature on the longer-term adjustment of children of divorce from the perspective of (a) the stressors and elevated risks that divorce presents for children and (b) protective factors associated with better adjustment. The resiliency demonstrated by the majority of children is discussed, as are controversies regarding the…

  16. Social Cognition and Adjustment in Children at Risk for Psychopathology.

    ERIC Educational Resources Information Center

    Downey, Geraldine; Walker, Elaine

    1989-01-01

    Tested 2 models of the effect of social cognition on the link between child adjustment and the 2 family risk factors of maltreatment and parental psychopathology. In 83 subjects of 7-14 years, maltreatment predicted aggression and peer rejection, but parental psychopathology did not. Adjustment of subjects with a disturbed parent depended on…

  17. 42 CFR 422.310 - Risk adjustment data.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... all data that are used in the development and application of a risk adjustment payment model. (b) Data... quality review and improvement activities, and for Medicare coverage purposes. (g) Deadlines...

  18. AAHKS Risk Adjustment Initiative: Why Is It Important?

    PubMed

    Fehring, Thomas K

    2016-06-01

    Risk adjustment is critical when any comparison of hospital performance or surgeon performance on patient outcomes is being measured. The purpose of risk adjustment is to level the playing field in making comparisons of outcome either against the benchmark or across individual providers, hospitals, or provider groups. The consequences of not leveling the playing field may lead to the inappropriate inference of high quality, that is outcomes are better not because of better quality but because the patients are healthy. Additional consequence of not leveling the playing field is the inappropriate inference of low quality, that is outcomes are worse not because of lower quality but because patients are less healthy at the onset. Therefore, it is critically important that risk adjustment is done properly so that access for the patients with the most severe problems will be maintained. Surgeons and hospitals should not be discouraged from providing care for these individuals for fear of publicly reporting outcomes that are not properly risk adjusted. To that end, American Association of Hip and Knee Surgeons created a Risk Adjustment Task Force to collaborate with Center for Medicare and Medicaid Services in creating a more robust risk adjustment model to take into account clinical factors and severity of orthopedic disease. PMID:27157277

  19. Why people do what they do to protect against earthquake risk: perceptions of hazard adjustment attributes.

    PubMed

    Lindell, Michael K; Arlikatti, Sudha; Prater, Carla S

    2009-08-01

    This study examined respondents' self-reported adoption of 16 hazard adjustments (preimpact actions to reduce danger to persons and property), their perceptions of those adjustments' attributes, and the correlations of those perceived attributes with respondents' demographic characteristics. The sample comprised 561 randomly selected residents from three cities in Southern California prone to high seismic risk and three cities from Western Washington prone to moderate seismic risks. The results show that the hazard adjustment perceptions were defined by hazard-related attributes and resource-related attributes. More significantly, the respondents had a significant degree of consensus in their ratings of those attributes and used them to differentiate among the hazard adjustments, as indicated by statistically significant differences among the hazard adjustment profiles. Finally, there were many significant correlations between respondents' demographic characteristics and the perceived characteristics of hazard adjustments, but there were few consistent patterns among these correlations. PMID:19508448

  20. Integrating Risk Adjustment and Enrollee Premiums in Health Plan Payment

    PubMed Central

    McGuire, Thomas G.; Glazer, Jacob; Newhouse, Joseph P.; Normand, Sharon-Lise; Shi, Julie; Sinaiko, Anna D.; Zuvekas, Samuel

    2013-01-01

    In two important health policy contexts – private plans in Medicare and the new state-run “Exchanges” created as part of the Affordable Care Act (ACA) – plan payments come from two sources: risk-adjusted payments from a Regulator and premiums charged to individual enrollees. This paper derives principles for integrating risk-adjusted payments and premium policy in individual health insurance markets based on fitting total plan payments to health plan costs per person as closely as possible. A least squares regression including both health status and variables used in premiums reveals the weights a Regulator should put on risk adjusters when markets determine premiums. We apply the methods to an Exchange-eligible population drawn from the Medical Expenditure Panel Survey (MEPS). PMID:24308878

  1. Risk adjusting capitation: applications in employed and disabled populations.

    PubMed

    Madden, C W; Mackay, B P; Skillman, S M; Ciol, M; Diehr, P K

    2000-02-01

    Risk adjustment may be a sensible strategy to reduce selection bias because it links managed care payment directly to the costs of providing services. In this paper we compare risk adjustment models in two populations (public employees and their dependents, and publicly-insured low income individuals with disabilities) in Washington State using two statistical approaches and three health status measures. We conclude that a two-part logistic/GLM statistical model performs better in populations with large numbers of individuals who do not use health services. This model was successfully implemented in the employed population, but the managed care program for the publicly insured population was terminated before risk adjustment could be applied. The choice of the most appropriate health status measure depends on purchasers' principles and desired outcomes. PMID:10780278

  2. Integrating risk adjustment and enrollee premiums in health plan payment.

    PubMed

    McGuire, Thomas G; Glazer, Jacob; Newhouse, Joseph P; Normand, Sharon-Lise; Shi, Julie; Sinaiko, Anna D; Zuvekas, Samuel H

    2013-12-01

    In two important health policy contexts - private plans in Medicare and the new state-run "Exchanges" created as part of the Affordable Care Act (ACA) - plan payments come from two sources: risk-adjusted payments from a Regulator and premiums charged to individual enrollees. This paper derives principles for integrating risk-adjusted payments and premium policy in individual health insurance markets based on fitting total plan payments to health plan costs per person as closely as possible. A least squares regression including both health status and variables used in premiums reveals the weights a Regulator should put on risk adjusters when markets determine premiums. We apply the methods to an Exchange-eligible population drawn from the Medical Expenditure Panel Survey (MEPS). PMID:24308878

  3. Risk-adjusted outcomes in Medicare inpatient nephrectomy patients.

    PubMed

    Fry, Donald E; Pine, Michael; Nedza, Susan M; Locke, David G; Reband, Agnes M; Pine, Gregory

    2016-09-01

    Without risk-adjusted outcomes of surgical care across both the inpatient and postacute period of time, hospitals and surgeons cannot evaluate the effectiveness of current performance in nephrectomy and other operations, and will not have objective metrics to gauge improvements from care redesign efforts.We compared risk-adjusted hospital outcomes following elective total and partial nephrectomy to demonstrate differences that can be used to improve care. We used the Medicare Limited Dataset for 2010 to 2012 for total and partial nephrectomy for benign and malignant neoplasms to create prediction models for the adverse outcomes (AOs) of inpatient deaths, prolonged length-of-stay outliers, 90-day postdischarge deaths without readmission, and 90-day relevant readmissions. From the 4 prediction models, total predicted adverse outcomes were determined for each hospital in the dataset that met a minimum of 25 evaluable cases for the study period. Standard deviations (SDs) for each hospital were used to identify specific z-scores. Risk-adjusted adverse outcomes rates were computed to permit benchmarking each hospital's performance against the national standard. Differences between best and suboptimal performing hospitals defined the potential margin of preventable adverse outcomes for this operation.A total of 449 hospitals with 23,477 patients were evaluated. Overall AO rate was 20.8%; 17 hospitals had risk-adjusted AO rates that were 2 SDs poorer than predicted and 8 were 2 SDs better. The top performing decile of hospitals had a risk-adjusted AO rate of 10.2% while the lowest performing decile had 32.1%. With a minimum of 25 cases for each study hospital, no statistically valid improvement in outcomes was seen with increased case volume.Inpatient and 90-day postdischarge risk-adjusted adverse outcomes demonstrated marked variability among study hospitals and illustrate the opportunities for care improvement. This analytic design is applicable for comparing provider

  4. Risk adjusting community rated health plan premiums: a survey of risk assessment literature and policy applications.

    PubMed

    Giacomini, M; Luft, H S; Robinson, J C

    1995-01-01

    This paper surveys recent health care reform debates and empirical evidence regarding the potential role for risk adjusters in addressing the problem of competitive risk segmentation under capitated financing. We discuss features of health plan markets affecting risk selection, methodological considerations in measuring it, and alternative approaches to financial correction for risk differentials. The appropriate approach to assessing risk differences between health plans depends upon the nature of market risk selection allowed under a given reform scenario. Because per capita costs depend on a health plan's population risk, efficiency, and quality of service, risk adjustment will most strongly promote efficiency in environments with commensurately strong incentives for quality care. PMID:7639879

  5. Adolescent Adjustment Before and After HIV-Related Parental Death.

    ERIC Educational Resources Information Center

    Rotheram-Borus, Mary Jane; Weiss, Robert; Alber, Susan; Lester, Patricia

    2005-01-01

    The impact of HIV-related parental death on 414 adolescents was examined over a period of 6 years. The adjustment of bereaved adolescents was compared over 4 time periods relative to parental death and was also compared with the adjustment of nonbereaved adolescents. Bereaved adolescents had significantly more emotional distress, negative life…

  6. The risk-adjusted cost evaluation of electric resource alternatives

    SciTech Connect

    Duane, T.P.

    1989-01-01

    Partial deregulation of the electric utility industry has occurred under the Public Utilities Regulatory Policies Act of 1978 (PURPA), which shifts the balance of both costs and risks between rate payers and electric utilities. Cost comparisons of potential electric resource Alternatives currently rely on techniques which do not explicitly incorporate risk consideration. This reflects the traditional role of regulation for rate stabilization. Risk-averse residential rate payers with low demand elasticities may highly value price risk reduction, but risk is not explicitly considered by present planning systems. There is a need to quantify the value of such price risk reduction. This research attempts to develop a Risk-Adjusted Cost Evaluation (RACE) methodology for direct comparisons of competing alternatives by a single risk-adjusted cost criterion. Methodologies have previously been developed for risk pricing in financial and commodities markets, and those techniques are evaluated for extension to the electricity market problem. Each has important deficiencies in the institutional context of electricity markets under PURPA; each also offers important insights for development of a simplified RACE methodology synthesizing those models. The methodology is applied to a large California utility, and major implementation problems are identified. The approach requires strict limiting conditions, and price risk reduction does not have a significant value to residential customers of PG and E. This may be less true for less well-diversified utilities, and several conditions are identified where more detailed assessment of risk implications is warranted. Future risk analyses research should instead focus on large, asymmetric risks. Suggestions are made for assessment of such risks through an insurance market metaphor and decision analysis methods.

  7. Sensitivity of health risk estimates to air quality adjustment procedure

    SciTech Connect

    Whitfield, R.G.

    1997-06-30

    This letter is a summary of risk results associated with exposure estimates using two-parameter Weibull and quadratic air quality adjustment procedures (AQAPs). New exposure estimates were developed for children and child-occurrences, six urban areas, and five alternative air quality scenarios. In all cases, the Weibull and quadratic results are compared to previous results, which are based on a proportional AQAP.

  8. After Divorce: Personality Factors Related to the Process of Adjustment.

    ERIC Educational Resources Information Center

    Thomas, Sandra Paul

    1982-01-01

    Considered personality variables related to postdivorce adjustment using a sample of 58 females and 31 males. Found persons with the best adjustment scored significantly higher on dominance/assertiveness, self-assurance, intelligence, creativity/imagination, social boldness, liberalism, self-sufficiency, ego strength and tranquility. (Author/JAC)

  9. Asian Indian Immigrants in America: Factors Related to Adjustment.

    ERIC Educational Resources Information Center

    Sodowsky, Gargi Roysircar; Carey, John C.

    1987-01-01

    Examines unique adjustment problems faced by Asian Indian immigrants to the United States. Looks at the impact of higher education; pretransition factors of religion and family roles; posttransition factors related to social adjustment (middle class status, voluntary migration, ethnic social support, assimilation, intergenerational conflict); and…

  10. Continuing Bonds, Risk Factors for Complicated Grief, and Adjustment to Bereavement

    ERIC Educational Resources Information Center

    Field, Nigel P.; Filanosky, Charles

    2010-01-01

    This study examined type of continuing bonds (CB) expression in relation to risk factors for complicated grief and measures of bereavement-related adjustment. Externalized CB expressions involving illusions and hallucinations with the deceased were distinguished from internalized CB expressions involving use of the deceased as an autonomy…

  11. The Relation of Age to Personality Adjustment among DWI Offenders.

    ERIC Educational Resources Information Center

    Meck, Donald S.; Baither, Rick

    1980-01-01

    Involved the assessment of perceived adjustment among individuals court assigned to DWI (Driving While Intoxicated) classes. Individuals 25 years and younger reported significantly higher levels of perceived maladjustment and emotional upset. Sex was related to interpersonal behavior. (Author)

  12. Continuing bonds, risk factors for complicated grief, and adjustment to bereavement.

    PubMed

    Field, Nigel P; Filanosky, Charles

    2010-01-01

    This study examined type of continuing bonds (CB) expression in relation to risk factors for complicated grief and measures of bereavement-related adjustment. Externalized CB expressions involving illusions and hallucinations with the deceased were distinguished from internalized CB expressions involving use of the deceased as an autonomy promoting secure base. 502 bereaved participants completed over the internet a CB measure assessing externalized and internalized CB along with various known risk-factor measures that included cause of death (i.e., violent vs. non-violent death), responsibility for the death, and attachment style as well as measures of psychological adjustment that included complicated grief symptoms, perceived physical health, and personal growth. As predicted, externalized CB was positively associated with violent death and responsibility for the death, whereas internalized CB was negatively associated with these risk factors as well as uniquely positively linked to personal growth. The implications of the findings for the role of CB in adjustment are discussed. PMID:24479173

  13. Volcanic risk perception and adjustment in a multi-hazard environment

    NASA Astrophysics Data System (ADS)

    Perry, Ronald W.; Lindell, Michael K.

    2008-05-01

    Hazard risk perceptions and protective behaviors are examined for wildfires, earthquakes and volcanic activity. Data were gathered in two northern California (USA) communities that are exposed to all three hazard types. It was found that resident risk perceptions approximated the risks calculated by experts. Personal risks associated with fires were significantly lower than property risks associated with the same threat. The discrepancy between person and property risks for earthquakes and volcanic activity was much smaller. In general, it was found that the number of protective adjustments undertaken for each hazard was small (averaging about half of the possible number measured). When combined in a regression analysis, risk perception was not a statistically significant predictor of number of adjustments for any of the three hazards. Resident's sense of responsibility for self-protection and experience with property damage were significant predictors of adjustment for all three hazards. Information seeking behavior was significantly related to protective actions for earthquakes and volcanic activity, but not for fire hazards. In general, an insufficient number of residents reported experience with personal injury or harm to make meaningful assessments of the effect of this variable on adjustments.

  14. Risk-adjusted monitoring of binary surgical outcomes.

    PubMed

    Steiner, S H; Cook, R J; Farewell, V T

    2001-01-01

    A graphical procedure suitable for prospectively monitoring surgical performance is proposed. The approach is based on accumulating evidence from the outcomes of all previous surgical patients in a series using a new type of cumulative sum chart. Cumulative sum procedures are designed to "signal" if sufficient evidence has accumulated that the surgical failure rate has changed substantially. In this way, the chart rapidly detects deterioration (or improvement) in surgical performance while not overreacting to the expected fluctuations due to chance. Through the use of a likelihood-based scoring method, the cumulative sum procedure is adapted so that it adjusts for the surgical risk of each patient estimated preoperatively. The procedure is therefore applicable in situations where it is desirable to adjust for a mix of patients. Signals of the chart lead to investigations of the cause and to the timely introduction of remedial measures designed to avoid unnecessary future failures. PMID:11386623

  15. Effects of Relational Authenticity on Adjustment to College

    ERIC Educational Resources Information Center

    Lenz, A. Stephen; Holman, Rachel L.; Lancaster, Chloe; Gotay, Stephanie G.

    2016-01-01

    The authors examined the association between relational health and student adjustment to college. Data were collected from 138 undergraduate students completing their 1st semester at a large university in the mid-southern United States. Regression analysis indicated that higher levels of relational authenticity were a predictor of success during…

  16. 78 FR 32255 - HHS-Operated Risk Adjustment Data Validation Stakeholder Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-05-29

    ...This notice announces a public meeting on the Affordable Care Act HHS-operated risk adjustment data validation process. The purpose of this public meeting is to provide opportunity to discuss the HHS risk adjustment data validation process that will be conducted when HHS operates the risk adjustment program on behalf of a state under the Affordable Care Act. The meeting will provide......

  17. Factors Related to the Achievement and Adjustment of Young African American Children.

    ERIC Educational Resources Information Center

    Luster, Tom; McAdoo, Harriette Pipes

    1994-01-01

    Data from the National Longitudinal Survey of Youth were used to examine factors related to the achievement and adjustment of 378 African American children in the early elementary grades. Consistent with past research, there was a positive relationship between the number of risk factors children were exposed to and the probability that they were…

  18. Response monitoring and adjustment: differential relations with psychopathic traits.

    PubMed

    Bresin, Konrad; Finy, M Sima; Sprague, Jenessa; Verona, Edelyn

    2014-08-01

    Studies on the relation between psychopathy and cognitive functioning often show mixed results, partially because different factors of psychopathy have not been considered fully. Based on previous research, we predicted divergent results based on a 2-factor model of psychopathy (interpersonal-affective traits and impulsive-antisocial traits). Specifically, we predicted that the unique variance of interpersonal-affective traits would be related to increased monitoring (i.e., error-related negativity) and adjusting to errors (i.e., posterror slowing), whereas impulsive-antisocial traits would be related to reductions in these processes. Three studies using a diverse selection of assessment tools, samples, and methods are presented to identify response monitoring correlates of the 2 main factors of psychopathy. In Studies 1 (undergraduates), 2 (adolescents), and 3 (offenders), interpersonal-affective traits were related to increased adjustment following errors and, in Study 3, to enhanced monitoring of errors. Impulsive-antisocial traits were not consistently related to error adjustment across the studies, although these traits were related to a deficient monitoring of errors in Study 3. The results may help explain previous mixed findings and advance implications for etiological models of psychopathy. PMID:24933282

  19. Response Monitoring and Adjustment: Differential Relations with Psychopathic Traits

    PubMed Central

    Bresin, Konrad; Finy, M. Sima; Sprague, Jenessa; Verona, Edelyn

    2014-01-01

    Studies on the relation between psychopathy and cognitive functioning often show mixed results, partially because different factors of psychopathy have not been considered fully. Based on previous research, we predicted divergent results based on a two-factor model of psychopathy (interpersonal-affective traits and impulsive-antisocial traits). Specifically, we predicted that the unique variance of interpersonal-affective traits would be related to increased monitoring (i.e., error-related negativity) and adjusting to errors (i.e., post-error slowing), whereas impulsive-antisocial traits would be related to reductions in these processes. Three studies using a diverse selection of assessment tools, samples, and methods are presented to identify response monitoring correlates of the two main factors of psychopathy. In Studies 1 (undergraduates), 2 (adolescents), and 3 (offenders), interpersonal-affective traits were related to increased adjustment following errors and, in Study 3, to enhanced monitoring of errors. Impulsive-antisocial traits were not consistently related to error adjustment across the studies, although these traits were related to a deficient monitoring of errors in Study 3. The results may help explain previous mixed findings and advance implications for etiological models of psychopathy. PMID:24933282

  20. Level of education and multiple sclerosis risk after adjustment for known risk factors: The EnvIMS study

    PubMed Central

    Bjørnevik, Kjetil; Riise, Trond; Cortese, Marianna; Holmøy, Trygve; Kampman, Margitta T; Magalhaes, Sandra; Myhr, Kjell-Morten; Wolfson, Christina; Pugliatti, Maura

    2016-01-01

    Background: Several recent studies have found a higher risk of multiple sclerosis (MS) among people with a low level of education. This has been suggested to reflect an effect of smoking and lower vitamin D status in the social class associated with lower levels of education. Objective: The objective of this paper is to investigate the association between level of education and MS risk adjusting for the known risk factors smoking, infectious mononucleosis, indicators of vitamin D levels and body size. Methods: Within the case-control study on Environmental Factors In MS (EnvIMS), 953 MS patients and 1717 healthy controls from Norway reported educational level and history of exposure to putative environmental risk factors. Results: Higher level of education were associated with decreased MS risk (p trend = 0.001) with an OR of 0.53 (95% CI 0.41–0.68) when comparing those with the highest and lowest level of education. This association was only moderately reduced after adjusting for known risk factors (OR 0.61, 95% CI 0.44–0.83). The estimates remained similar when cases with disease onset before age 28 were excluded. Conclusion: These findings suggest that factors related to lower socioeconomic status other than established risk factors are associated with MS risk. PMID:26014605

  1. Assessing geomorphic sensitivity in relation to river capacity for adjustment

    NASA Astrophysics Data System (ADS)

    Reid, H. E.; Brierley, G. J.

    2015-12-01

    River sensitivity describes the nature and rate of channel adjustments. An approach to analysis of geomorphic river sensitivity outlined in this paper relates potential sensitivity based on the expected capacity of adjustment for a river type to the recent history of channel adjustment. This approach was trialled to assess low, moderate and high geomorphic sensitivity for four different types of river (10 reaches in total) along the Lower Tongariro River, North Island, New Zealand. Building upon the River Styles framework, river types were differentiated based upon valley setting (width and confinement), channel planform, geomorphic unit assemblages and bed material size. From this, the behavioural regime and potential for adjustment (type and extent) were determined. Historical maps and aerial photographs were geo-rectified and the channel planform digitised to assess channel adjustments for each reach from 1928 to 2007. Floodplain width controlled by terraces, exerted a strong influence upon reach scale sensitivity for the partly-confined, wandering, cobble-bed river. Although forced boundaries occur infrequently, the width of the active channel zone is constrained. An unconfined braided river reach directly downstream of the terrace-confined section was the most geomorphically sensitive reach. The channel in this reach adjusted recurrently to sediment inputs that were flushed through more confined, better connected upstream reaches. A meandering, sand-bed river in downstream reaches has exhibited negligible rates of channel migration. However, channel narrowing in this reach and the associated delta indicate that the system is approaching a threshold condition, beyond which channel avulsion is likely to occur. As this would trigger more rapid migration, this reach is considered to be more geomorphically sensitive than analysis of its low migration rate alone would indicate. This demonstrates how sensitivity is fashioned both by the behavioural regime of a reach

  2. Change point detection in risk adjusted control charts.

    PubMed

    Assareh, Hassan; Smith, Ian; Mengersen, Kerrie

    2015-12-01

    Precise identification of the time when a change in a clinical process has occurred enables experts to identify a potential special cause more effectively. In this article, we develop change point estimation methods for a clinical dichotomous process in the presence of case mix. We apply Bayesian hierarchical models to formulate the change point where there exists a step change in the odds ratio and logit of risk of a Bernoulli process. Markov Chain Monte Carlo is used to obtain posterior distributions of the change point parameters including location and magnitude of changes and also corresponding probabilistic intervals and inferences. The performance of the Bayesian estimator is investigated through simulations and the result shows that precise estimates can be obtained when they are used in conjunction with the risk-adjusted CUSUM and EWMA control charts. In comparison with alternative EWMA and CUSUM estimators, more accurate and precise estimates are obtained by the Bayesian estimator. These superiorities enhance when probability quantification, flexibility and generaliability of the Bayesian change point detection model are also considered. The Deviance Information Criterion, as a model selection criterion in the Bayesian context, is applied to find the best change point model for a given dataset where there is no prior knowledge about the change type in the process. PMID:22025415

  3. Effect of Risk Adjustment Method on Comparisons of Health Care Utilization Between Complementary and Alternative Medicine Users and Nonusers

    PubMed Central

    Gerkovich, Mary M.; Cherkin, Daniel C.; Deyo, Richard A.; Sherman, Karen J.; Lafferty, William E.

    2013-01-01

    Abstract Objectives Complementary and alternative medicine (CAM) providers are becoming more integrated into the United States health care system. Because patients self-select CAM use, risk adjustment is needed to make the groups more comparable when analyzing utilization. This study examined how the choice of risk adjustment method affects assessment of CAM use on overall health care utilization. Design and subjects Insurance claims data for 2000–2003 from Washington State, which mandates coverage of CAM providers, were analyzed. Three (3) risk adjustment methods were compared in patients with musculoskeletal conditions: Adjusted Clinical Groups (ACG), Diagnostic Cost Groups (DCG), and the Charlson Index. Relative Value Units (RVUs) were used as a proxy for expenditures. Two (2) sets of median regression models were created: prospective, which used risk adjustments from the previous year to predict RVU in the subsequent year, and concurrent, which used risk adjustment measures to predict RVU in the same year. Results The sample included 92,474 claimants. Prospective models showed little difference in the effect of CAM use on RVU among the three risk adjustment methods, and all models had low predictive power (R2 ≤0.05). In the concurrent models, coefficients were similar in direction and magnitude for all risk adjustment methods, but in some models the predicted effect of CAM use on RVU differed by as much as double between methods. Results of DCG and ACG models were similar and were stronger than Charlson models. Conclusions Choice of risk adjustment method may have a modest effect on the outcome of interest. PMID:23036140

  4. 77 FR 17219 - Patient Protection and Affordable Care Act; Standards Related to Reinsurance, Risk Corridors and...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-03-23

    ... and the RFC, where relevant. On July 15, 2011, we published in the Federal Register (76 FR 41950-41956... Affordable Care Act; Standards Related to Reinsurance, Risk Corridors and Risk Adjustment; Final Rule #0;#0...; Standards Related to Reinsurance, Risk Corridors and Risk Adjustment AGENCY: Department of Health and...

  5. Relations of SARS-related stressors and coping to Chinese college students' psychological adjustment during the 2003 Beijing SARS epidemic.

    PubMed

    Main, Alexandra; Zhou, Qing; Ma, Yue; Luecken, Linda J; Liu, Xin

    2011-07-01

    This study examined the main and interactive relations of stressors and coping related to severe acute respiratory syndrome (SARS) with Chinese college students' psychological adjustment (psychological symptoms, perceived general health, and life satisfaction) during the 2003 Beijing SARS epidemic. All the constructs were assessed by self-report in an anonymous survey during the final period of the outbreak. Results showed that the relations of stressors and coping to psychological adjustment varied by domain of adjustment. Regression analyses suggested that the number of stressors and use of avoidant coping strategies positively predicted psychological symptoms. Active coping positively predicted life satisfaction when controlling for stressors. Moreover, all types of coping served as a buffer against the negative impact of stressors on perceived general health. These findings hold implications for university counseling services during times of acute, large-scale stressors. In particular, effective screening procedures should be developed to identify students who experience a large number of stressors and thus are at high risk for developing mental health problems. Intervention efforts that target coping should be adapted to take account of the uncontrollability of stressors and clients' cultural preferences for certain coping strategies. A multidimensional battery of psychological adjustment should be used to monitor clients' psychological adjustment to stressors and evaluate the efficacy of intervention. PMID:21574694

  6. Adjustment of Children Born to Teenage Mothers: The Contribution of Risk and Protective Factors.

    ERIC Educational Resources Information Center

    Dubow, Eric F.; Luster, Tom

    1990-01-01

    Examined contribution of risk and protective factors in adjustment of 721 children, age 8-15, born to teenage mothers. Results showed that exposure to increasing number of risk factors (poverty, urban residence, mother's self-esteem) was associated with greater vulnerability to adjustment problems, while protective factors (intelligence,…

  7. Cumulative Family Risk Predicts Increases in Adjustment Difficulties across Early Adolescence

    ERIC Educational Resources Information Center

    Buehler, Cheryl; Gerard, Jean M.

    2013-01-01

    Family is an important socialization context for youth as they move through early adolescence. A significant feature of this complex socialization context is the accumulation of potential family risk factors that may compromise youth adjustment. This study examined cumulative family risk and adolescents' adjustment difficulties in 416 two-parent…

  8. Do insurers respond to risk adjustment? A long-term, nationwide analysis from Switzerland.

    PubMed

    von Wyl, Viktor; Beck, Konstantin

    2016-03-01

    Community rating in social health insurance calls for risk adjustment in order to eliminate incentives for risk selection. Swiss risk adjustment is known to be insufficient, and substantial risk selection incentives remain. This study develops five indicators to monitor residual risk selection. Three indicators target activities of conglomerates of insurers (with the same ownership), which steer enrollees into specific carriers based on applicants' risk profiles. As a proxy for their market power, those indicators estimate the amount of premium-, health care cost-, and risk-adjustment transfer variability that is attributable to conglomerates. Two additional indicators, derived from linear regression, describe the amount of residual cost differences between insurers that are not covered by risk adjustment. All indicators measuring conglomerate-based risk selection activities showed increases between 1996 and 2009, paralleling the establishment of new conglomerates. At their maxima in 2009, the indicator values imply that 56% of the net risk adjustment volume, 34% of premium variability, and 51% cost variability in the market were attributable to conglomerates. From 2010 onwards, all indicators decreased, coinciding with a pre-announced risk adjustment reform implemented in 2012. Likewise, the regression-based indicators suggest that the volume and variance of residual cost differences between insurers that are not equaled out by risk adjustment have decreased markedly since 2009 as a result of the latest reform. Our analysis demonstrates that risk-selection, especially by conglomerates, is a real phenomenon in Switzerland. However, insurers seem to have reduced risk selection activities to optimize their losses and gains from the latest risk adjustment reform. PMID:25663430

  9. Latino risk-adjusted mortality in the men screened for the Multiple Risk Factor Intervention Trial.

    PubMed

    Thomas, Avis J; Eberly, Lynn E; Neaton, James D; Smith, George Davey

    2005-09-15

    Latinos are now the largest minority in the United States, but their distinctive health needs and mortality patterns remain poorly understood. Proportional hazards regressions were used to compare Latino versus White risk- and income-adjusted mortality over 25 years' follow-up from 5,846 Latino and 300,647 White men screened for the Multiple Risk Factor Intervention Trial. Men were aged 35-57 years and residing in 14 states when screened in 1973-1975. Data on coronary heart disease risk factors, self-reported race/ethnicity, and home addresses were obtained at baseline; income was estimated by linking addresses to census data. Mortality follow-up through 1999 was obtained using the National Death Index. The fully adjusted Latino/White hazard ratio for all-cause mortality was 0.82 (95% confidence interval (CI): 0.77, 0.87), based on 1,085 Latino and 73,807 White deaths; this pattern prevailed over time and across states (thus, likely across Latino subgroups). Hazard ratios were significantly greater than one for stroke (hazard ratio = 1.30, 95% CI: 1.01, 1.68), liver cancer (hazard ratio = 2.02, 95% CI: 1.21, 3.37), and infection (hazard ratio = 1.69, 95% CI: 1.24, 2.32). A substudy found only minor racial/ethnic differences in the quality of Social Security numbers, birth dates, soundex-adjusted names, and National Death Index searches. Results were not likely an artifact of return migration or incomplete mortality data. PMID:16076831

  10. 48 CFR 201.109 - Statutory acquisition-related dollar thresholds-adjustment for inflation.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ...-related dollar thresholds-adjustment for inflation. 201.109 Section 201.109 Federal Acquisition...-adjustment for inflation. (a) Section 814(b) of the National Defense Authorization Act for Fiscal Year 2012... adjustment for inflation in accordance with the requirements of 41 U.S.C. 1908, and is adjusted pursuant...

  11. 48 CFR 201.109 - Statutory acquisition-related dollar thresholds-adjustment for inflation.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ...-related dollar thresholds-adjustment for inflation. 201.109 Section 201.109 Federal Acquisition...-adjustment for inflation. (a) Section 814(b) of the National Defense Authorization Act for Fiscal Year 2012... adjustment for inflation in accordance with the requirements of 41 U.S.C. 1908, and is adjusted pursuant...

  12. 48 CFR 201.109 - Statutory acquisition-related dollar thresholds-adjustment for inflation.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ...-related dollar thresholds-adjustment for inflation. 201.109 Section 201.109 Federal Acquisition...-adjustment for inflation. (a) Section 814(b) of the National Defense Authorization Act for Fiscal Year 2012... adjustment for inflation in accordance with the requirements of 41 U.S.C. 1908, and is adjusted pursuant...

  13. Risk Adjustment and Primary Health Care in Chile

    PubMed Central

    Vargas, Veronica; Wasem, Juergen

    2006-01-01

    Aim To offer a capitation formula with greater capacity for guiding resource spending on population with poorer health and lower socioeconomic status in the context of financing and equity in primary health care. Methods We collected two years of data on a sample of 10 000 individuals from a region in Chile, Valdivia and Temuco and evaluated three models to estimate utilization and expenditures per capita. The first model included age and sex; the second one included age, sex, and the presence of two key diagnoses; and the third model included age, sex, and the presence of seven key diagnoses. Regression results were evaluated by R2 and predictive ratios to select the best specifications. Results Per-capita expenditures by age and sex confirmed international trends, where children under five, women, and the elderly were the main users of primary health care services. Women sought health advice twice as much as men. Clear differences by socioeconomic status were observed for the indigent population aged ≥65 years who under-utilized primary health care services. From the three models, major improvement in the predictive power occurred from the demographic (adjusted R2, 9%) to the demographic plus two diagnoses model (adjusted R2, 27%). Improvements were modest when five other diagnoses were added (adjusted R2, 28%). Conclusion The current formula that uses municipality’s financial power and geographic location of health centers to adjust capitation payments provides little incentive to appropriate care for the indigent and people with chronic conditions. A capitation payment that adjusts for age, sex, and the presence of diabetes and hypertension will better guide resource allocation to those with poorer health and lower socioeconomic status. PMID:16758525

  14. A clinical economics workstation for risk-adjusted health care cost management.

    PubMed Central

    Eisenstein, E. L.; Hales, J. W.

    1995-01-01

    This paper describes a healthcare cost accounting system which is under development at Duke University Medical Center. Our approach differs from current practice in that this system will dynamically adjust its resource usage estimates to compensate for variations in patient risk levels. This adjustment is made possible by introducing a new cost accounting concept, Risk-Adjusted Quantity (RQ). RQ divides case-level resource usage variances into their risk-based component (resource consumption differences attributable to differences in patient risk levels) and their non-risk-based component (resource consumption differences which cannot be attributed to differences in patient risk levels). Because patient risk level is a factor in estimating resource usage, this system is able to simultaneously address the financial and quality dimensions of case cost management. In effect, cost-effectiveness analysis is incorporated into health care cost management. PMID:8563361

  15. Teacher-child relationships and behavioral adjustment: transactional links for preschool boys at risk.

    PubMed

    Roorda, Debora L; Verschueren, Karine; Vancraeyveldt, Caroline; Van Craeyevelt, Sanne; Colpin, Hilde

    2014-10-01

    In this short-term longitudinal study, transactional links between teacher-child relationships and behavioral adjustment were investigated in a sample of preschool boys (N=175) at risk for developing externalizing problems. Teachers (N=175) reported about the quality of the teacher-child relationship (i.e., Closeness, Conflict, and Dependency) and about children's behavioral adjustment (i.e., Externalizing Behavior, Internalizing Behavior, and Prosocial Behavior) at three occasions within one school year. Cross-lagged path-analytic models showed positive bidirectional associations between Conflict and both Externalizing and Internalizing Behavior from Time 1 to Time 2, but not from Time 2 to Time 3. In addition, there was a transactional sequence with more Conflict at Time 1 leading to less Prosocial Behavior at Time 2 which, in turn, predicted more Conflict at Time 3. Closeness was reciprocally and positively related to Prosocial Behavior over time, and was positively and unidirectionally predicted by Internalizing Behavior. Dependency showed positive reciprocal links with Internalizing Behavior over time, and negatively and unidirectionally predicted Prosocial Behavior. These findings suggest that interventions may be most effective if they adjust their focus and strategy depending on children's specific behavioral and relational needs. PMID:25267171

  16. 48 CFR 215.404-71-3 - Contract type risk and working capital adjustment.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... assessment shall include any reduced contractor risk on both the contract before definitization and the... 48 Federal Acquisition Regulations System 3 2010-10-01 2010-10-01 false Contract type risk and... CONTRACTING BY NEGOTIATION Contract Pricing 215.404-71-3 Contract type risk and working capital adjustment....

  17. 48 CFR 1.109 - Statutory acquisition-related dollar thresholds-adjustment for inflation.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ...-related dollar thresholds-adjustment for inflation. 1.109 Section 1.109 Federal Acquisition Regulations..., Issuance 1.109 Statutory acquisition-related dollar thresholds—adjustment for inflation. (a) 41 U.S.C. 431a... the FAR for inflation, except as provided in paragraph (c) of this section. This adjustment...

  18. 48 CFR 1.109 - Statutory acquisition-related dollar thresholds-adjustment for inflation.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ...-related dollar thresholds-adjustment for inflation. 1.109 Section 1.109 Federal Acquisition Regulations..., Issuance 1.109 Statutory acquisition-related dollar thresholds—adjustment for inflation. (a) 41 U.S.C. 1908... the FAR for inflation, except as provided in paragraph (c) of this section. This adjustment...

  19. 48 CFR 1.109 - Statutory acquisition-related dollar thresholds-adjustment for inflation.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ...-related dollar thresholds-adjustment for inflation. 1.109 Section 1.109 Federal Acquisition Regulations..., Issuance 1.109 Statutory acquisition-related dollar thresholds—adjustment for inflation. (a) 41 U.S.C. 431a... the FAR for inflation, except as provided in paragraph (c) of this section. This adjustment...

  20. 48 CFR 1.109 - Statutory acquisition-related dollar thresholds-adjustment for inflation.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ...-related dollar thresholds-adjustment for inflation. 1.109 Section 1.109 Federal Acquisition Regulations..., Issuance 1.109 Statutory acquisition-related dollar thresholds—adjustment for inflation. (a) 41 U.S.C. 431a... the FAR for inflation, except as provided in paragraph (c) of this section. This adjustment...

  1. 48 CFR 1.109 - Statutory acquisition-related dollar thresholds-adjustment for inflation.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ...-related dollar thresholds-adjustment for inflation. 1.109 Section 1.109 Federal Acquisition Regulations..., Issuance 1.109 Statutory acquisition-related dollar thresholds—adjustment for inflation. (a) 41 U.S.C. 431a... the FAR for inflation, except as provided in paragraph (c) of this section. This adjustment...

  2. Sickle Cell Disease Pain: Relation of Coping Strategies to Adjustment.

    ERIC Educational Resources Information Center

    Gil, Karen M.; And Others

    1989-01-01

    Examined pain coping strategies in 79 adult sickle cell disease (SCD) patients. Results revealed that coping strategies factors were important predictors of pain and adjustment. Subjects high on Negative Thinking and Passive Adherence had more severe pain, were less active and more distressed, and used more health services. Individuals high on…

  3. Who Moved My Cheese? Adjusting to Age-Related Changes

    ERIC Educational Resources Information Center

    Langer, Nieli

    2012-01-01

    The popular book, Who Moved My Cheese? (Johnson, 1998) is a metaphor for change. This parable-like story has particular resonance with older adults who face many potential life-altering changes. The four characters in the book are looking for their cheese in a maze. Cheese represents whatever makes people happy. How each character adjusts to the…

  4. Friendship Expectations and Children's Friendship-Related Behavior and Adjustment

    ERIC Educational Resources Information Center

    MacEvoy, Julie Paquette; Papadakis, Alison A.; Fedigan, Shea K.; Ash, Sarah E.

    2016-01-01

    Although relationship expectations are thought to influence all social interactions, little is known about the function of children's friendship expectations. This study examined the associations among children's friendship expectations and their behavior within their friendships, their friendship adjustment, and their socioemotional functioning.…

  5. Adjustment of lifetime risks of space radiation-induced cancer by the healthy worker effect and cancer misclassification.

    PubMed

    Peterson, Leif E; Kovyrshina, Tatiana

    2015-12-01

    Background. The healthy worker effect (HWE) is a source of bias in occupational studies of mortality among workers caused by use of comparative disease rates based on public data, which include mortality of unhealthy members of the public who are screened out of the workplace. For the US astronaut corp, the HWE is assumed to be strong due to the rigorous medical selection and surveillance. This investigation focused on the effect of correcting for HWE on projected lifetime risk estimates for radiation-induced cancer mortality and incidence. Methods. We performed radiation-induced cancer risk assessment using Poisson regression of cancer mortality and incidence rates among Hiroshima and Nagasaki atomic bomb survivors. Regression coefficients were used for generating risk coefficients for the excess absolute, transfer, and excess relative models. Excess lifetime risks (ELR) for radiation exposure and baseline lifetime risks (BLR) were adjusted for the HWE using standardized mortality ratios (SMR) for aviators and nuclear workers who were occupationally exposed to ionizing radiation. We also adjusted lifetime risks by cancer mortality misclassification among atomic bomb survivors. Results. For all cancers combined ("Nonleukemia"), the effect of adjusting the all-cause hazard rate by the simulated quantiles of the all-cause SMR resulted in a mean difference (not percent difference) in ELR of 0.65% and mean difference of 4% for mortality BLR, and mean change of 6.2% in BLR for incidence. The effect of adjusting the excess (radiation-induced) cancer rate or baseline cancer hazard rate by simulated quantiles of cancer-specific SMRs resulted in a mean difference of [Formula: see text] in the all-cancer mortality ELR and mean difference of [Formula: see text] in the mortality BLR. Whereas for incidence, the effect of adjusting by cancer-specific SMRs resulted in a mean change of [Formula: see text] for the all-cancer BLR. Only cancer mortality risks were adjusted by

  6. 48 CFR 201.109 - Statutory acquisition-related dollar thresholds-adjustment for inflation.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 48 Federal Acquisition Regulations System 3 2010-10-01 2010-10-01 false Statutory acquisition-related dollar thresholds-adjustment for inflation. 201.109 Section 201.109 Federal Acquisition...-adjustment for inflation. (d) A matrix showing the most recent escalation adjustments of...

  7. 48 CFR 201.109 - Statutory acquisition-related dollar thresholds-adjustment for inflation.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 48 Federal Acquisition Regulations System 3 2011-10-01 2011-10-01 false Statutory acquisition-related dollar thresholds-adjustment for inflation. 201.109 Section 201.109 Federal Acquisition...-adjustment for inflation. (d) A matrix showing the most recent escalation adjustments of...

  8. The Relation of Parental Marital Status and Perceived Family Conflict to Adjustment in White Adolescents.

    ERIC Educational Resources Information Center

    Enos, Diane M.; Handal, Paul J.

    1986-01-01

    Examined two contrasting views of divorce and long-term adjustment of children. Failed to support physical-wholeness position; parental marital status was not significantly related to psychological adjustment or social life satisfaction. Results provided strong support for psychological-wholeness position: adolescents' psychological adjustment and…

  9. A methodological approach to identify external factors for indicator-based risk adjustment illustrated by a cataract surgery register

    PubMed Central

    2014-01-01

    Background Risk adjustment is crucial for comparison of outcome in medical care. Knowledge of the external factors that impact measured outcome but that cannot be influenced by the physician is a prerequisite for this adjustment. To date, a universal and reproducible method for identification of the relevant external factors has not been published. The selection of external factors in current quality assurance programmes is mainly based on expert opinion. We propose and demonstrate a methodology for identification of external factors requiring risk adjustment of outcome indicators and we apply it to a cataract surgery register. Methods Defined test criteria to determine the relevance for risk adjustment are “clinical relevance” and “statistical significance”. Clinical relevance of the association is presumed when observed success rates of the indicator in the presence and absence of the external factor exceed a pre-specified range of 10%. Statistical significance of the association between the external factor and outcome indicators is assessed by univariate stratification and multivariate logistic regression adjustment. The cataract surgery register was set up as part of a German multi-centre register trial for out-patient cataract surgery in three high-volume surgical sites. A total of 14,924 patient follow-ups have been documented since 2005. Eight external factors potentially relevant for risk adjustment were related to the outcome indicators “refractive accuracy” and “visual rehabilitation” 2–5 weeks after surgery. Results The clinical relevance criterion confirmed 2 (“refractive accuracy”) and 5 (“visual rehabilitation”) external factors. The significance criterion was verified in two ways. Univariate and multivariate analyses revealed almost identical external factors: 4 were related to “refractive accuracy” and 7 (6) to “visual rehabilitation”. Two (“refractive accuracy”) and 5 (“visual rehabilitation”) factors

  10. Psychological Adjustment to Spinal Cord Injury as Related to Manner of Onset of Disability.

    ERIC Educational Resources Information Center

    Athelstan, Gary T.; Crewe, Nancy M.

    1979-01-01

    People with spinal cord injury have behavioral tendencies that place them at-risk of such injuries. This study investigated the relationship between personality characteristics as suggested by manner of onset of injury and long-term medical, vocational, and psychological adjustment. Imprudent subjects tended to be better adjusted at follow-up than…

  11. Child effects and child care: Implications for risk and adjustment.

    PubMed

    Snell, Emily K; Hindman, Annemarie H; Belsky, Jay

    2015-11-01

    Evocative effects of child characteristics on the quality and quantity of child care were assessed in two studies using longitudinal data from the NICHD Study of Early Child Care. We focus on the influence of child characteristics on two important aspects of the child care experience: language stimulation provided by caregivers and quantity of care. In Study 1, associations between the developmental status of children aged 15 to 54 months and the language stimulation provided by their caregivers were examined using path models, and longitudinal child effects were detected across the earliest time points of the study. In Study 2, the associations among child behavior, temperament, development, and time in care were examined. Little evidence was found for such child effects on time in care. The results are discussed in terms of the effects of child care on child development and implications for developmental processes, particularly for children at greatest risk for developmental delay or psychopathology. PMID:26439062

  12. Daily mood and sleep: reciprocal relations and links with adjustment problems.

    PubMed

    Kouros, Chrystyna D; El-Sheikh, Mona

    2015-02-01

    Children's sleep problems are common and associated with increased risk for adjustment problems. We examined daily links between children's sleep and mood, using a daily diary method and actigraphy. We also tested children's daily mood as a mediator of relations among sleep and children's broader internalizing and externalizing symptoms. A community sample of 142 children (mean age = 10.69 years; 57% girls; 69% European American, 31% African American) and their parents participated. For 1 week, children wore actigraphs and parents completed a daily telephone interview about their child's mood. Following the week of actigraphy, mothers and fathers reported on their child's adjustment. Multi-level models indicated within-person relations between children's mood and subsequent sleep fragmentation (indicated by increased activity) and sleep latency, and between-person relations between sleep latency and subsequent mood on the next day. Significant indirect effects were found such that a more negative daily mood (aggregated across diary days) mediated relations between poor sleep efficiency and longer sleep latency and parent-reported internalizing and externalizing symptoms. Findings extend previous research by highlighting disruptions to children's daily mood as a potential mechanism linking sleep problems to children's mental health. PMID:25212526

  13. The Experience of Risk-Adjusted Capitation Payment for Family Physicians in Iran: A Qualitative Study

    PubMed Central

    Esmaeili, Reza; Hadian, Mohammad; Rashidian, Arash; Shariati, Mohammad; Ghaderi, Hossien

    2016-01-01

    Background When a country’s health system is faced with fundamental flaws that require the redesign of financing and service delivery, primary healthcare payment systems are often reformed. Objectives This study was conducted with the purpose of exploring the experiences of risk-adjusted capitation payment of urban family physicians in Iran when it comes to providing primary health care (PHC). Materials and Methods This is a qualitative study using the framework method. Data were collected via digitally audio-recorded semi-structured interviews with 24 family physicians and 5 executive directors in two provinces of Iran running the urban family physician pilot program. The participants were selected using purposive and snowball sampling. The codes were extracted using inductive and deductive methods. Results Regarding the effects of risk-adjusted capitation on the primary healthcare setting, five themes with 11 subthemes emerged, including service delivery, institutional structure, financing, people’s behavior, and the challenges ahead. Our findings indicated that the health system is enjoying some major changes in the primary healthcare setting through the implementation of risk-adjusted capitation payment. Conclusions With regard to the current challenges in Iran’s health system, using risk-adjusted capitation as a primary healthcare payment system can lead to useful changes in the health system’s features. However, future research should focus on the development of the risk-adjusted capitation model. PMID:27340558

  14. Personality drives physiological adjustments and is not related to survival

    PubMed Central

    Bijleveld, Allert I.; Massourakis, Georgina; van der Marel, Annemarie; Dekinga, Anne; Spaans, Bernard; van Gils, Jan A.; Piersma, Theunis

    2014-01-01

    The evolutionary function and maintenance of variation in animal personality is still under debate. Variation in the size of metabolic organs has recently been suggested to cause and maintain variation in personality. Here, we examine two main underlying notions: (i) that organ sizes vary consistently between individuals and cause consistent behavioural patterns, and (ii) that a more exploratory personality is associated with reduced survival. Exploratory behaviour of captive red knots (Calidris canutus, a migrant shorebird) was negatively rather than positively correlated with digestive organ (gizzard) mass, as well as with body mass. In an experiment, we reciprocally reduced and increased individual gizzard masses and found that exploration scores were unaffected. Whether or not these birds were resighted locally over the 19 months after release was negatively correlated with their exploration scores. Moreover, a long-term mark–recapture effort on free-living red knots with known gizzard masses at capture confirmed that local resighting probability (an inverse measure of exploratory behaviour) was correlated with gizzard mass without detrimental effects on survival. We conclude that personality drives physiological adjustments, rather than the other way around, and suggest that physiological adjustments mitigate the survival costs of exploratory behaviour. Our results show that we need to reconsider hypotheses explaining personality variation based on organ sizes and differential survival. PMID:24671971

  15. Improved hospital-level risk adjustment for surveillance of healthcare-associated bloodstream infections: a retrospective cohort study

    PubMed Central

    2009-01-01

    Background To allow direct comparison of bloodstream infection (BSI) rates between hospitals for performance measurement, observed rates need to be risk adjusted according to the types of patients cared for by the hospital. However, attribute data on all individual patients are often unavailable and hospital-level risk adjustment needs to be done using indirect indicator variables of patient case mix, such as hospital level. We aimed to identify medical services associated with high or low BSI rates, and to evaluate the services provided by the hospital as indicators that can be used for more objective hospital-level risk adjustment. Methods From February 2001-December 2007, 1719 monthly BSI counts were available from 18 hospitals in Queensland, Australia. BSI outcomes were stratified into four groups: overall BSI (OBSI), Staphylococcus aureus BSI (STAPH), intravascular device-related S. aureus BSI (IVD-STAPH) and methicillin-resistant S. aureus BSI (MRSA). Twelve services were considered as candidate risk-adjustment variables. For OBSI, STAPH and IVD-STAPH, we developed generalized estimating equation Poisson regression models that accounted for autocorrelation in longitudinal counts. Due to a lack of autocorrelation, a standard logistic regression model was specified for MRSA. Results Four risk services were identified for OBSI: AIDS (IRR 2.14, 95% CI 1.20 to 3.82), infectious diseases (IRR 2.72, 95% CI 1.97 to 3.76), oncology (IRR 1.60, 95% CI 1.29 to 1.98) and bone marrow transplants (IRR 1.52, 95% CI 1.14 to 2.03). Four protective services were also found. A similar but smaller group of risk and protective services were found for the other outcomes. Acceptable agreement between observed and fitted values was found for the OBSI and STAPH models but not for the IVD-STAPH and MRSA models. However, the IVD-STAPH and MRSA models successfully discriminated between hospitals with higher and lower BSI rates. Conclusion The high model goodness-of-fit and the higher

  16. Potential of adjustable height carts in reducing the risk of low back injury in grocery stockers.

    PubMed

    Davis, Kermit G; Orta Anés, Lida

    2014-03-01

    While the workers of the Wholesale and Retail Trade industrial sector suffer from musculoskeletal disorders at an alarming rate, there have been few investigative studies into potential effective interventions to reduce the ergonomic stress. The objective of the study was to determine whether a cart with an adjustable shelf could reduce awkward postures and motions while stocking products in a grocery store. Fifteen workers at a small grocery store in Puerto Rico completed stocking tasks with two types of carts: traditional and adjustable height cart or Ergo Cart. Trunk kinematics, LBD risk index, NIOSH lifting index, subjective ratings, and productivity indicators were collected during four typical stocking tasks. The Adjustable Ergo Cart reduced the sagittal trunk flexion by 7° and velocity by about 5°/s but increased twisting by about 2° and twist velocity by 4°/s as compared to the traditional cart. The LBD risk index was reduced by a small 2.4% in probability although greater reductions were found for larger items (e.g. bags of dog food and 2-L of Soda). The consensus among workers was that the adjustable cart would be easier to use. Overall, the study provides objective evidence that an ergonomically designed cart (e.g. adjustable height) has some potential to reduce sagittal trunk flexion, LBD risk index, and the NIOSH lift index. Overall, the results indicate that any intervention such as an adjustable cart can only have marginal effectiveness unless the entire systems perspective is considered. PMID:23664243

  17. Dynamic probability control limits for risk-adjusted Bernoulli CUSUM charts.

    PubMed

    Zhang, Xiang; Woodall, William H

    2015-11-10

    The risk-adjusted Bernoulli cumulative sum (CUSUM) chart developed by Steiner et al. (2000) is an increasingly popular tool for monitoring clinical and surgical performance. In practice, however, the use of a fixed control limit for the chart leads to a quite variable in-control average run length performance for patient populations with different risk score distributions. To overcome this problem, we determine simulation-based dynamic probability control limits (DPCLs) patient-by-patient for the risk-adjusted Bernoulli CUSUM charts. By maintaining the probability of a false alarm at a constant level conditional on no false alarm for previous observations, our risk-adjusted CUSUM charts with DPCLs have consistent in-control performance at the desired level with approximately geometrically distributed run lengths. Our simulation results demonstrate that our method does not rely on any information or assumptions about the patients' risk distributions. The use of DPCLs for risk-adjusted Bernoulli CUSUM charts allows each chart to be designed for the corresponding particular sequence of patients for a surgeon or hospital. PMID:26037959

  18. Effect of Wound Classification on Risk-Adjustment in American College of Surgeons NSQIP

    PubMed Central

    Ju, Mila H.; Cohen, Mark E.; Bilimoria, Karl Y.; Latus, Melissa S.; Scholl, Lisa M.; Schwab, Bradley J.; Byrd, Claudia M.; Ko, Clifford Y.; Dellinger, E. Patchen; Hall, Bruce L.

    2014-01-01

    Background Surgical wound classification has been used in risk-adjustment models. However, it can be subjective and potentially improperly bias hospital quality comparisons. The objective is to examine the effect of wound classification on hospital performance risk-adjustment models. Study Design Retrospective review of the 2011 ACS NSQIP database was conducted for wound classification categories: clean, clean/contaminated, contaminated, and dirty/infected. To assess the influence of wound classification on risk-adjustment, two models were developed for each outcome: one including and one excluding wound classification. For each model, hospital postoperative complications were estimated using hierarchical multivariable regression methods. Absolute changes in hospital rank, correlations of odds-ratios, and outlier status agreement between models were examined. Results Of the 442,149 cases performed in 315 hospitals: 53.6% were classified as clean; 34.2% clean/contaminated; 6.7% contaminated; and 5.5% dirty/infected. The surgical site infection (SSI) rate was highest in dirty/infected (8.5%) and lowest in clean (1.8%) cases. For overall SSI, the absolute change in risk-adjusted hospital performance rank between models including vs. excluding wound classification was minimal (mean 4.5 out of 315 positions). The correlations between odds ratios of the two performance models were nearly perfect (R=0.9976, P<0.0001), and outlier status agreement was excellent (Kappa=0.9508, P<0.0001). Similar findings were observed in models of subgroups of SSI and other postoperative outcomes. Conclusions In circumstances where alternate information is available for risk-adjustment, there appear to be minimal differences in performance models that include vs. exclude wound classification. Therefore, ACS NSQIP is critically evaluating the continued use of wound classification in hospital performance risk-adjustment models. PMID:25053222

  19. Odds per adjusted standard deviation: comparing strengths of associations for risk factors measured on different scales and across diseases and populations.

    PubMed

    Hopper, John L

    2015-11-15

    How can the "strengths" of risk factors, in the sense of how well they discriminate cases from controls, be compared when they are measured on different scales such as continuous, binary, and integer? Given that risk estimates take into account other fitted and design-related factors-and that is how risk gradients are interpreted-so should the presentation of risk gradients. Therefore, for each risk factor X0, I propose using appropriate regression techniques to derive from appropriate population data the best fitting relationship between the mean of X0 and all the other covariates fitted in the model or adjusted for by design (X1, X2, … , Xn). The odds per adjusted standard deviation (OPERA) presents the risk association for X0 in terms of the change in risk per s = standard deviation of X0 adjusted for X1, X2, … , Xn, rather than the unadjusted standard deviation of X0 itself. If the increased risk is relative risk (RR)-fold over A adjusted standard deviations, then OPERA = exp[ln(RR)/A] = RR(s). This unifying approach is illustrated by considering breast cancer and published risk estimates. OPERA estimates are by definition independent and can be used to compare the predictive strengths of risk factors across diseases and populations. PMID:26520360

  20. The HHS-HCC Risk Adjustment Model for Individual and Small Group Markets under the Affordable Care Act

    PubMed Central

    Kautter, John; Pope, Gregory C; Ingber, Melvin; Freeman, Sara; Patterson, Lindsey; Cohen, Michael; Keenan, Patricia

    2014-01-01

    Beginning in 2014, individuals and small businesses are able to purchase private health insurance through competitive Marketplaces. The Affordable Care Act (ACA) provides for a program of risk adjustment in the individual and small group markets in 2014 as Marketplaces are implemented and new market reforms take effect. The purpose of risk adjustment is to lessen or eliminate the influence of risk selection on the premiums that plans charge. The risk adjustment methodology includes the risk adjustment model and the risk transfer formula. This article is the second of three in this issue of the Review that describe the Department of Health and Human Services (HHS) risk adjustment methodology and focuses on the risk adjustment model. In our first companion article, we discuss the key issues and choices in developing the methodology. In this article, we present the risk adjustment model, which is named the HHS-Hierarchical Condition Categories (HHS-HCC) risk adjustment model. We first summarize the HHS-HCC diagnostic classification, which is the key element of the risk adjustment model. Then the data and methods, results, and evaluation of the risk adjustment model are presented. Fifteen separate models are developed. For each age group (adult, child, and infant), a model is developed for each cost sharing level (platinum, gold, silver, and bronze metal levels, as well as catastrophic plans). Evaluation of the risk adjustment models shows good predictive accuracy, both for individuals and for groups. Lastly, this article provides examples of how the model output is used to calculate risk scores, which are an input into the risk transfer formula. Our third companion paper describes the risk transfer formula. PMID:25360387

  1. The HHS-HCC risk adjustment model for individual and small group markets under the Affordable Care Act.

    PubMed

    Kautter, John; Pope, Gregory C; Ingber, Melvin; Freeman, Sara; Patterson, Lindsey; Cohen, Michael; Keenan, Patricia

    2014-01-01

    Beginning in 2014, individuals and small businesses are able to purchase private health insurance through competitive Marketplaces. The Affordable Care Act (ACA) provides for a program of risk adjustment in the individual and small group markets in 2014 as Marketplaces are implemented and new market reforms take effect. The purpose of risk adjustment is to lessen or eliminate the influence of risk selection on the premiums that plans charge. The risk adjustment methodology includes the risk adjustment model and the risk transfer formula. This article is the second of three in this issue of the Review that describe the Department of Health and Human Services (HHS) risk adjustment methodology and focuses on the risk adjustment model. In our first companion article, we discuss the key issues and choices in developing the methodology. In this article, we present the risk adjustment model, which is named the HHS-Hierarchical Condition Categories (HHS-HCC) risk adjustment model. We first summarize the HHS-HCC diagnostic classification, which is the key element of the risk adjustment model. Then the data and methods, results, and evaluation of the risk adjustment model are presented. Fifteen separate models are developed. For each age group (adult, child, and infant), a model is developed for each cost sharing level (platinum, gold, silver, and bronze metal levels, as well as catastrophic plans). Evaluation of the risk adjustment models shows good predictive accuracy, both for individuals and for groups. Lastly, this article provides examples of how the model output is used to calculate risk scores, which are an input into the risk transfer formula. Our third companion paper describes the risk transfer formula. PMID:25360387

  2. Migrants' Adjustment to Career: An Analysis in Relation to Nicholson's Theory

    ERIC Educational Resources Information Center

    Tharmaseelan, Nithiyaluxmy

    2008-01-01

    This study addressed career transitions in view of new environments along with the mobility of individuals across cultural territories. It paid attention to various adjustments individuals can make in their career in relation to their new environment and analysed those adjustment modes in relation to Nicholson's theory of work role transitions.…

  3. Relational aggression, victimization, and adjustment during middle childhood.

    PubMed

    Ostrov, Jamie M; Godleski, Stephanie A

    2013-08-01

    A secondary analysis of the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development was conducted to test the mechanisms by which relational aggression in third grade was associated both directly and indirectly with relational victimization in sixth grade. A large sample (N = 1,035; 522 girls; M = 8.3 years old; SD = 0.23) and multiple informants (teacher, child, and parent report) and methods were used to test several theoretically driven hypotheses. Our path analysis model suggested evidence for both direct and indirect pathways consistent with the sequential social process model of peer harassment. Relational aggression was significantly associated with future relational victimization even after controlling for physical aggression and gender. Loneliness mediated the direct association between relational aggression and peer victimization. A second model testing the reverse direction of effect revealed that relational victimization in third grade predicted relational aggression in sixth grade and was associated with loneliness and depressive symptoms in fifth grade, but there was no evidence for any of the indirect pathways. PMID:23880393

  4. Risk-Adjusted Analysis of Relevant Outcome Drivers for Patients after More Than Two Kidney Transplants

    PubMed Central

    Kousoulas, Lampros; Vondran, Florian W. R.; Syryca, Paulina; Klempnauer, Juergen; Schrem, Harald; Lehner, Frank

    2015-01-01

    Renal transplantation is the treatment of choice for patients suffering end-stage renal disease, but as the long-term renal allograft survival is limited, most transplant recipients will face graft loss and will be considered for a retransplantation. The goal of this study was to evaluate the patient and graft survival of the 61 renal transplant recipients after second or subsequent renal transplantation, transplanted in our institution between 1990 and 2010, and to identify risk factors related to inferior outcomes. Actuarial patient survival was 98.3%, 94.8%, and 88.2% after one, three, and five years, respectively. Actuarial graft survival was 86.8%, 80%, and 78.1% after one, three, and five years, respectively. Risk-adjusted analysis revealed that only age at the time of last transplantation had a significant influence on patient survival, whereas graft survival was influenced by multiple immunological and surgical factors, such as the number of HLA mismatches, the type of immunosuppression, the number of surgical complications, need of reoperation, primary graft nonfunction, and acute rejection episodes. In conclusion, third and subsequent renal transplantation constitute a valid therapeutic option, but inferior outcomes should be expected among elderly patients, hyperimmunized recipients, and recipients with multiple operations at the site of last renal transplantation. PMID:25722883

  5. What's the Risk? A Simple Approach for Estimating Adjusted Risk Measures from Nonlinear Models Including Logistic Regression

    PubMed Central

    Kleinman, Lawrence C; Norton, Edward C

    2009-01-01

    Objective To develop and validate a general method (called regression risk analysis) to estimate adjusted risk measures from logistic and other nonlinear multiple regression models. We show how to estimate standard errors for these estimates. These measures could supplant various approximations (e.g., adjusted odds ratio [AOR]) that may diverge, especially when outcomes are common. Study Design Regression risk analysis estimates were compared with internal standards as well as with Mantel–Haenszel estimates, Poisson and log-binomial regressions, and a widely used (but flawed) equation to calculate adjusted risk ratios (ARR) from AOR. Data Collection Data sets produced using Monte Carlo simulations. Principal Findings Regression risk analysis accurately estimates ARR and differences directly from multiple regression models, even when confounders are continuous, distributions are skewed, outcomes are common, and effect size is large. It is statistically sound and intuitive, and has properties favoring it over other methods in many cases. Conclusions Regression risk analysis should be the new standard for presenting findings from multiple regression analysis of dichotomous outcomes for cross-sectional, cohort, and population-based case–control studies, particularly when outcomes are common or effect size is large. PMID:18793213

  6. Measuring Profitability Impacts of Information Technology: Use of Risk Adjusted Measures.

    ERIC Educational Resources Information Center

    Singh, Anil; Harmon, Glynn

    2003-01-01

    Focuses on understanding how investments in information technology are reflected in the income statements and balance sheets of firms. Shows that the relationship between information technology investments and corporate profitability is much better explained by using risk-adjusted measures of corporate profitability than using the same measures…

  7. School Adjustment of Pupils with ADHD: Cognitive, Emotional and Temperament Risk Factors

    ERIC Educational Resources Information Center

    Sanchez-Perez, Noelia; Gonzalez-Salinas, Carmen

    2013-01-01

    From different research perspectives, the cognitive and emotional characteristics associated with ADHD in children have been identified as risk factors for the development of diverse adjustment problems in the school context. Research in nonclinical population can additionally help in understanding ADHD deficits, since children with specific…

  8. Comparison of the Properties of Regression and Categorical Risk-Adjustment Models

    PubMed Central

    Averill, Richard F.; Muldoon, John H.; Hughes, John S.

    2016-01-01

    Clinical risk-adjustment, the ability to standardize the comparison of individuals with different health needs, is based upon 2 main alternative approaches: regression models and clinical categorical models. In this article, we examine the impact of the differences in the way these models are constructed on end user applications. PMID:26945302

  9. 48 CFR 215.404-71-3 - Contract type risk and working capital adjustment.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 48 Federal Acquisition Regulations System 3 2014-10-01 2014-10-01 false Contract type risk and working capital adjustment. 215.404-71-3 Section 215.404-71-3 Federal Acquisition Regulations System DEFENSE ACQUISITION REGULATIONS SYSTEM, DEPARTMENT OF DEFENSE CONTRACTING METHODS AND CONTRACT TYPES CONTRACTING BY NEGOTIATION Contract Pricing...

  10. Assessing At-Risk Youth Using the Reynolds Adolescent Adjustment Screening Inventory with a Latino Population

    ERIC Educational Resources Information Center

    Balkin, Richard S.; Cavazos, Javier, Jr.; Hernandez, Arthur E.; Garcia, Roberto; Dominguez, Denise L.; Valarezo, Alexandra

    2013-01-01

    Factor analyses were conducted on scores from the Reynolds Adolescent Adjustment Screening Inventory (RAASI; Reynolds, 2001) representing at-risk Latino youth. The 4-factor model of the RAASI did not exhibit a good fit. However, evidence of generalizability for Latino youth was noted. (Contains 3 tables.)

  11. Risk adjustment of Medicare capitation payments using the CMS-HCC model.

    PubMed

    Pope, Gregory C; Kautter, John; Ellis, Randall P; Ash, Arlene S; Ayanian, John Z; Lezzoni, Lisa I; Ingber, Melvin J; Levy, Jesse M; Robst, John

    2004-01-01

    This article describes the CMS hierarchical condition categories (HCC) model implemented in 2004 to adjust Medicare capitation payments to private health care plans for the health expenditure risk of their enrollees. We explain the model's principles, elements, organization, calibration, and performance. Modifications to reduce plan data reporting burden and adaptations for disabled, institutionalized, newly enrolled, and secondary payer subpopulations are discussed. PMID:15493448

  12. Cumulative Socioeconomic Status Risk, Allostatic Load, and Adjustment: A Prospective Latent Profile Analysis With Contextual and Genetic Protective Factors

    PubMed Central

    Brody, Gene H.; Yu, Tianyi; Chen, Yi-fu; Kogan, Steven M.; Evans, Gary W.; Beach, Steven R. H.; Windle, Michael; Simons, Ronald L.; Gerrard, Meg; Gibbons, Frederick X.; Philibert, Robert A.

    2012-01-01

    The health disparities literature identified a common pattern among middle-aged African Americans that includes high rates of chronic disease along with low rates of psychiatric disorders despite exposure to high levels of cumulative SES risk. The current study was designed to test hypotheses about the developmental precursors to this pattern. Hypotheses were tested with a representative sample of 443 African American youths living in the rural South. Cumulative SES risk and protective processes were assessed at 11-13 years; psychological adjustment was assessed at ages 14-18 years; genotyping at the 5-HTTLPR was conducted at age 16 years; and allostatic load (AL) was assessed at age 19 years. A Latent Profile Analysis identified 5 profiles that evinced distinct patterns of SES risk, AL, and psychological adjustment, with 2 relatively large profiles designated as focal profiles: a physical health vulnerability profile characterized by high SES risk/high AL/low adjustment problems, and a resilient profile characterized by high SES risk/low AL/low adjustment problems. The physical health vulnerability profile mirrored the pattern found in the adult health disparities literature. Multinomial logistic regression analyses indicated that carrying an s allele at the 5-HTTLPR and receiving less peer support distinguished the physical health vulnerability profile from the resilient profile. Protective parenting and planful self-regulation distinguished both focal profiles from the other 3 profiles. The results suggest the public health importance of preventive interventions that enhance coping and reduce the effects of stress across childhood and adolescence. PMID:22709130

  13. Longitudinal Relations Between Parenting and Child Adjustment in Young Children

    ERIC Educational Resources Information Center

    Gadeyne, Els; Ghesquiere, Pol; Onghena, Patrick

    2004-01-01

    The authors studied the predictive relations between reports of parenting behavior on the one hand and academic achievement and reported behavior problems of young children on the other hand. Data were gathered for 352 children and their parents from kindergarten to 2nd grade. The results indicated that in the academic domain, low supportive and…

  14. Association between firearm ownership, firearm-related risk and risk reduction behaviours and alcohol-related risk behaviours.

    PubMed

    Wintemute, Garen J

    2011-12-01

    Alcohol use and firearm ownership are risk factors for violent injury and death. To determine whether firearm ownership and specific firearm-related behaviours are associated with alcohol-related risk behaviours, the author conducted a cross-sectional study using Behavioral Risk Factor Surveillance System data for eight states in the USA from 1996 to 1997 (the most recent data available). Altogether, 15 474 respondents provided information on firearm exposure. After adjustment for demographics and state of residence, firearm owners were more likely than those with no firearms at home to have ≥5 drinks on one occasion (OR 1.32; 95% CI 1.16 to 1.50), to drink and drive (OR 1.79; 95% CI 1.34 to 2.39) and to have ≥60 drinks per month (OR 1.45; 95% CI 1.14 to 1.83). Heavy alcohol use was most common among firearm owners who also engaged in behaviours such as carrying a firearm for protection against other people and keeping a firearm at home that was both loaded and not locked away. The author concludes that firearm ownership and specific firearm-related behaviours are associated with alcohol-related risk behaviours. PMID:21670071

  15. Relation between Severity of Chronic Illness and Adjustment in Children and Adolescents with Sickle Cell Disease.

    ERIC Educational Resources Information Center

    Hurtig, Anita Landau; And Others

    1989-01-01

    The study with 70 children and adolescents with sickle cell disease did not support the hypothesis that illness severity (measured by frequency of hospitalization) would affect adjustment (measured by IQ, self-esteem, social and personal adjustment, behavioral problems, school performance, and peer relations). (Author/DB)

  16. Uncertainty Orientation in Chinese Children: Relations with School and Psychological Adjustment

    ERIC Educational Resources Information Center

    Wang, Zhengyan; Chen, Xinyin; Sorrentino, Richard; Szeto, Andrew C. H.

    2008-01-01

    The purpose of this study was to examine uncertainty orientation and its relations with school and psychological adjustment in Chinese children. A sample of elementary school children in P.R. China, aged 10 to 12 years, participated in the study. Data concerning uncertainty orientation, academic performance and socio-emotional adjustment were…

  17. 76 FR 74700 - Revision of Patent Term Adjustment Provisions Relating to Information Disclosure Statements

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-12-01

    ... 2000. See Changes to Implement Patent Term Adjustment Under Twenty- Year Patent ] Term, 65 FR 56366... Provisions Relating to Appellate Review and Information Disclosure Statements, 76 FR 18990 (Apr. 6, 2011... adjustment if the applicant failed to engage in reasonable efforts to conclude prosecution of the...

  18. A population health approach to reducing observational intensity bias in health risk adjustment: cross sectional analysis of insurance claims

    PubMed Central

    Sharp, Sandra M; Bevan, Gwyn; Skinner, Jonathan S; Gottlieb, Daniel J

    2014-01-01

    the standard HCC index, 0.21 for the population health index, 0.12 for the poverty index, and 0.07 for the visit corrected HCC index, implying that only a modest amount of the variation in spending can be explained by factors most closely related to mortality. Further, once the HCC index is visit corrected it accounts for almost none of the residual variation in age, sex, and race adjusted spending. Conclusion Health risk adjustment using either the poverty index or the population health index performed substantially better in terms of explaining actual mortality than the indices that relied on diagnoses from administrative databases; the population health index explained the majority of residual variation in age, sex, and race adjusted mortality. Owing to the influence of observational intensity on diagnoses from administrative databases, the standard HCC index over-adjusts for regional differences in spending. Research to improve health risk adjustment methods should focus on developing measures of risk that do not depend on observation influenced diagnoses recorded in administrative databases. PMID:24721838

  19. Bias in calculation of attributable fractions using relative risks from non-smokers only

    PubMed Central

    Flegal, Katherine M.

    2016-01-01

    Studies of weight and mortality sometimes state that the mortality relative risks for obesity from non-smokers are valid estimates of the relative risks for obesity in both smokers and non-smokers. Extending this idea, several influential articles have used relative risks for obesity from non-smokers and attributable fraction methods for unadjusted risks to estimate attributable fractions of deaths in the entire population (smokers and non-smokers combined). However, stratification by smoking is a form of adjustment for confounding. Simplified examples show that the use of relative risks from only one stratum to estimate attributable fractions, without incorporating data on the stratification variable, gives incorrect results for the entire population. Even if the mortality relative risks for obesity from non-smokers are indeed valid in both smokers and non-smokers, these relative risks nonetheless need to be treated as adjusted relative risks for the purpose of calculating attributable fractions for the whole sample. PMID:25210928

  20. ADJUSTMENT AMONG CHILDREN WITH RELATIVES WHO PARTICIPATED IN THE MANHUNT FOLLOWING THE BOSTON MARATHON ATTACK

    PubMed Central

    Comer, Jonathan S.; Kerns, Caroline E.; Elkins, R. Meredith; Edson, Aubrey L.; Chou, Tommy; Dantowitz, Annie; Miguel, Elizabeth; Brown, Bonnie; Coxe, Stefany; Green, Jennifer Greif

    2014-01-01

    Background Following the Boston Marathon attack, the extraordinary interagency manhunt and shelter-in-place made for a truly unprecedented experience for area families. Although research on Boston youth has found robust associations between manhunt-related experiences and post-attack functioning, such work does little to identify the specific needs of a particularly vulnerable population—i.e., children with a relative who participated in the manhunt. Understanding the adjustment of these youth is critical for informing clinical efforts. Methods Survey of Boston-area parents/caretakers (N = 460) reporting on their child’s attack/manhunt-related experiences, as well as psychosocial functioning in the first six post-attack months; analyses compared youth with and without a relative in law enforcement or the armed services who participated in the manhunt. Results The proportion of youth with likely PTSD was 5.7 times higher among youth with relatives in the manhunt than among youth without. After accounting for child demographics, blast exposure, and children’s own exposure to manhunt events (e.g., hearing/seeing gunfire/explosions, having officers enter/search home), having a relative in the manhunt significantly predicted child PTSD symptoms, emotional symptoms, and hyperactivity/inattention. Fear during the manhunt that a loved one could be hurt mediated relationships between having a relative in the manhunt and clinical outcomes; living within the zone of greatest manhunt activity did not moderate observed relationships. Conclusions Children with relatives called upon to participate in the unprecedented interagency manhunt following the Boston Marathon attack carried a particularly heavy mental health burden. Continued research is needed to clarify the clinical needs of youth with relatives in high-risk occupations. PMID:24865569

  1. The Relation between Parenting Transitions and Adjustment in Young Adolescents: A Multisample Investigation.

    ERIC Educational Resources Information Center

    Kurdek, Lawrence A.; And Others

    1994-01-01

    Investigated the effects of and relationship between the number of parenting transitions (divorce, remarriage) and adjustment in three samples of adolescent girls and boys not identified as being at risk for problems. Found qualified evidence of a negative linear relationship between the number of parenting transitions experienced and child…

  2. Risk-adjusted antibiotic consumption in 34 public acute hospitals in Ireland, 2006 to 2014.

    PubMed

    Oza, Ajay; Donohue, Fionnuala; Johnson, Howard; Cunney, Robert

    2016-08-11

    As antibiotic consumption rates between hospitals can vary depending on the characteristics of the patients treated, risk-adjustment that compensates for the patient-based variation is required to assess the impact of any stewardship measures. The aim of this study was to investigate the usefulness of patient-based administrative data variables for adjusting aggregate hospital antibiotic consumption rates. Data on total inpatient antibiotics and six broad subclasses were sourced from 34 acute hospitals from 2006 to 2014. Aggregate annual patient administration data were divided into explanatory variables, including major diagnostic categories, for each hospital. Multivariable regression models were used to identify factors affecting antibiotic consumption. Coefficient of variation of the root mean squared errors (CV-RMSE) for the total antibiotic usage model was very good (11%), however, the value for two of the models was poor (> 30%). The overall inpatient antibiotic consumption increased from 82.5 defined daily doses (DDD)/100 bed-days used in 2006 to 89.2 DDD/100 bed-days used in 2014; the increase was not significant after risk-adjustment. During the same period, consumption of carbapenems increased significantly, while usage of fluoroquinolones decreased. In conclusion, patient-based administrative data variables are useful for adjusting hospital antibiotic consumption rates, although additional variables should also be employed. PMID:27541730

  3. Approaches to risk-adjusting outcome measures applied to criminal justice involvement after community service.

    PubMed

    Banks, S M; Pandiani, J A; Bramley, J

    2001-08-01

    The ethic of fairness in program evaluation requires that measures of behavioral health agency performance be sensitive to differences in those agencies' caseload composition. The authors describe two traditional approaches to the statistical risk adjustment of outcome measures (stratification weighting and pre-post measurement) that are designed to account for differences in caseload composition and introduce a method that incorporates the strengths of both approaches. Procedures for deriving each of these measures are described in detail and demonstrated in the evaluation of a statewide system of community-based behavioral health care programs. This evaluation examines the degree to which service recipients get into trouble with the law after treatment. Three measures are recommended for inclusion in outcome-oriented "report cards," and the interpretation of each measure is discussed. Finally, the authors suggest formats for graphic and tabular presentation of the risk-adjusted evaluation for sharing findings with diverse stakeholder groups. PMID:11497020

  4. Positioning resilience for 2015: the role of resistance, incremental adjustment and transformation in disaster risk management policy.

    PubMed

    Matyas, David; Pelling, Mark

    2015-01-01

    Resilience is a ubiquitous term in disaster risk management and is an increasingly prominent concept in early discussions focused on elaborating the post-2015 international policy landscape. Riddled with competing meanings and diverse policy implications, however, it is a concept caught between the abstract and operational. This paper provides a review of the rise to prominence of the concept of resilience and advances an elaboration of the related concepts of resistance, incremental adjustment and transformation. We argue that these concepts can contribute to decision-making by offering three distinct options for risk management policy. In order to deliberately and effectively choose among these options, we suggest that critical reflexivity is a prerequisite, necessitating improved decision-making capacity if varied perspectives (including those of the most vulnerable) are to be involved in the selection of the best approach to risk management. PMID:25494954

  5. Evolving Adjustments to External (Gamma) Slope Factors for CERCLA Risk and Dose Assessments - 12290

    SciTech Connect

    Walker, Stuart

    2012-07-01

    To model the external exposure pathway in risk and dose assessments of radioactive contamination at Superfund sites, the U.S. Environmental Protection Agency (EPA) uses slope factors (SFs), also known as risk coefficients, and dose conversion factors (DCFs). Without any adjustment these external radiation exposure pathways effectively assumes that an individual is exposed to a source geometry that is effectively an infinite slab. The concept of an 'infinite slab' means that the thickness of the contaminated zone and its aerial extent are so large that it behaves as if it were infinite in its physical dimensions. EPA has been making increasingly complex adjustments to account for the extent of the contamination and its corresponding radiation field to provide more accurate risk and dose assessment modeling when using its calculators. In most instances, the more accurate modeling results derived from these gamma adjustments are less conservative. The notable exception are for some radionuclides in rooms with contaminated walls, ceiling, and floors, and the receptor is in location of the room with the highest amount of radiation exposure, usually the corner of small rooms and the center of large conference rooms. (authors)

  6. A risk-adjusted approach to comparing the return on investment in health care programs.

    PubMed

    Sendi, Pedram; Al, Maiwenn J; Zimmermann, Heinz

    2004-09-01

    The league table approach to rank ordering health care programs according to the incremental cost-effectiveness ratio is a common method to guide policy makers in setting priorities for resource allocation. In the presence of uncertainty, however, ranking programs is complicated by the degree of variability associated with each program. Confidence intervals for cost-effectiveness ratios may be overlapping. Moreover, confidence intervals may include negative ratios and the interpretation of negative cost-effectiveness ratios is ambiguous. We suggest to rank mutually exclusive health care programs according to their rate of return which is defined as the net monetary benefit over the costs of the program. However, how does a program with a higher expected return but higher uncertainty compare to a program with a lower expected return but lower risk? In the present paper we propose a risk-adjusted measure to compare the return on investment in health care programs. Financing a health care program is treated as an investment in a risky asset. The risky asset is combined with a risk-free asset in order to construct a combined portfolio. The weights attributed to the risk-free and risky assets are chosen in such a manner that all programs under consideration exhibit the same degree of uncertainty. We can then compare the performance of the individual programs by constructing a risk-adjusted league table of expected returns. PMID:15277778

  7. The public health hazards of risk avoidance associated with public reporting of risk adjusted outcomes in coronary intervention

    PubMed Central

    Resnic, Frederic S.; Welt, Frederick G. P.

    2009-01-01

    Public reporting of risk adjusted outcomes for percutaneous coronary interventional (PCI) procedures has been mandated in New York State for more than a decade. Over that time there has been a significant decline in the unadjusted mortality following such procedures. Massachusetts joined New York in 2003 as only the second state to require case level reporting of every coronary interventional procedure performed. In this review, we explore the differences in the populations reported by the two states, and consider possible risks of public reporting of clinical outcomes following PCI procedures including the risk of increasing conservatism in the treatment of the sickest patients. We offer a conceptual framework to understand the potential risk-averse behavior of interventional cardiologists subject to public reporting, and offer several proposals to counteract this potential deleterious effect of reporting programs. PMID:19264236

  8. Social risk and protective factors for African American children's academic achievement and adjustment during the transition to middle school.

    PubMed

    Burchinal, Margaret R; Roberts, Joanne E; Zeisel, Susan A; Rowley, Stephanie J

    2008-01-01

    The transition to middle school is often marked by decreased academic achievement and increased emotional stress, and African American children exposed to social risk may be especially vulnerable during this transition. To identify mediators and protective factors, the authors related severity and timing of risk exposure to academic achievement and adjustment between 4th and 6th grade in 74 African American children. Longitudinal analyses indicated that severity more than timing of risk exposure was negatively related to all outcomes and that language skills mediated the pathway from risk for most outcomes. Transition to middle school was related to lower math scores and to more externalizing problems when children experienced higher levels of social risk. Language skills and parenting served as protective factors, whereas expectations of racial discrimination was a vulnerability factor. Results imply that promoting parenting and, especially, language skills, and decreasing expectations of racial discrimination provide pathways to academic success for African American children during the transition from elementary to middle school, especially those exposed to adversity. PMID:18194027

  9. Testing a Social Ecological Model for Relations between Political Violence and Child Adjustment in Northern Ireland

    PubMed Central

    Cummings, E. Mark; Merrilees, Christine E.; Schermerhorn, Alice C.; Goeke-Morey, Marcie C.; Shirlow, Peter; Cairns, Ed

    2013-01-01

    Relations between political violence and child adjustment are matters of international concern. Past research demonstrates the significance of community, family and child psychological processes in child adjustment, supporting study of inter-relations between multiple social ecological factors and child adjustment in contexts of political violence. Testing a social ecological model, 300 mothers and their children (M= 12.28 years, SD = 1.77) from Catholic and Protestant working class neighborhoods in Belfast, Northern Ireland completed measures of community discord, family relations, and children’s regulatory processes (i.e., emotional security) and outcomes. Historical political violence in neighborhoods based on objective records (i.e., politically motivated deaths) were related to family members’ reports of current sectarian and non-sectarian antisocial behavior. Interparental conflict and parental monitoring and children’s emotional security about both the community and family contributed to explanatory pathways for relations between sectarian antisocial behavior in communities and children’s adjustment problems. The discussion evaluates support for social ecological models for relations between political violence and child adjustment and its implications for understanding relations in other parts of the world. PMID:20423550

  10. Marital violence, co-parenting, and family-level processes in relation to children's adjustment.

    PubMed

    Katz, Lynn Fainsilber; Low, Sabina M

    2004-06-01

    A multimethod approach was used to examine relations between marital violence, coparenting, and family-level processes and children's adjustment in a community-based sample of marital violence. Two hypotheses were tested, one in which family-level and co-parenting processes mediate relations between marital violence and child functioning and one in which marital violence and family-level/co-parenting processes function relatively independently in influencing children's adjustment. Observations of family processes were made within a triadic parent-child interaction, and several dimensions of children's socioemotional adjustment (i.e., peer relations, behavior problems) were examined. Results indicated that hostile-withdrawn co-parenting mediated the relations between marital violence and children's anxiety and depression. Marital violence, co-parenting, and family-level processes also functioned independently in predicting child outcome. Findings are discussed in terms of the family dynamics present in maritally violent homes. PMID:15222844

  11. Testing a social ecological model for relations between political violence and child adjustment in Northern Ireland.

    PubMed

    Cummings, E Mark; Merrilees, Christine E; Schermerhorn, Alice C; Goeke-Morey, Marcie C; Shirlow, Peter; Cairns, Ed

    2010-05-01

    Relations between political violence and child adjustment are matters of international concern. Past research demonstrates the significance of community, family, and child psychological processes in child adjustment, supporting study of interrelations between multiple social ecological factors and child adjustment in contexts of political violence. Testing a social ecological model, 300 mothers and their children (M = 12.28 years, SD = 1.77) from Catholic and Protestant working class neighborhoods in Belfast, Northern Ireland, completed measures of community discord, family relations, and children's regulatory processes (i.e., emotional security) and outcomes. Historical political violence in neighborhoods based on objective records (i.e., politically motivated deaths) were related to family members' reports of current sectarian antisocial behavior and nonsectarian antisocial behavior. Interparental conflict and parental monitoring and children's emotional security about both the community and family contributed to explanatory pathways for relations between sectarian antisocial behavior in communities and children's adjustment problems. The discussion evaluates support for social ecological models for relations between political violence and child adjustment and its implications for understanding relations in other parts of the world. PMID:20423550

  12. Development and Validation of a Risk-Adjustment Tool in Acute Asthma

    PubMed Central

    Tsai, Chu-Lin; Clark, Sunday; Sullivan, Ashley F; Camargo, Carlos A

    2009-01-01

    Objective To develop and prospectively validate a risk-adjustment tool in acute asthma. Data Sources Data were obtained from two large studies on acute asthma, the Multicenter Airway Research Collaboration (MARC) and the National Emergency Department Safety Study (NEDSS) cohorts. Both studies involved >60 emergency departments (EDs) and were performed during 1996–2001 and 2003–2006, respectively. Both included patients aged 18–54 years presenting to the ED with acute asthma. Study Design Retrospective cohort studies. Data Collection Clinical information was obtained from medical record review. The risk index was derived in the MARC cohort and then was prospectively validated in the NEDSS cohort. Principle Findings There were 3,515 patients in the derivation cohort and 3,986 in the validation cohort. The risk index included nine variables (age, sex, current smoker, ever admitted for asthma, ever intubated for asthma, duration of symptoms, respiratory rate, peak expiratory flow, and number of beta-agonist treatments) and showed satisfactory discrimination (area under the receiver operating characteristic curve, 0.75) and calibration (p=.30 for Hosmer–Lemeshow test) when applied to the validation cohort. Conclusions We developed and validated a novel risk-adjustment tool in acute asthma. This tool can be used for health care provider profiling to identify outliers for quality improvement purposes. PMID:19619246

  13. Variation In Accountable Care Organization Spending And Sensitivity To Risk Adjustment: Implications For Benchmarking.

    PubMed

    Rose, Sherri; Zaslavsky, Alan M; McWilliams, J Michael

    2016-03-01

    Spending targets (or benchmarks) for accountable care organizations (ACOs) participating in the Medicare Shared Savings Program must be set carefully to encourage program participation while achieving fiscal goals and minimizing unintended consequences, such as penalizing ACOs for serving sicker patients. Recently proposed regulatory changes include measures to make benchmarks more similar for ACOs in the same area with different historical spending levels. We found that ACOs vary widely in how their spending levels compare with those of other local providers after standard case-mix adjustments. Additionally adjusting for survey measures of patient health meaningfully reduced the variation in differences between ACO spending and local average fee-for-service spending, but substantial variation remained, which suggests that differences in care efficiency between ACOs and local non-ACO providers vary widely. Accordingly, measures to equilibrate benchmarks between high- and low-spending ACOs--such as setting benchmarks to risk-adjusted average fee-for-service spending in an area--should be implemented gradually to maintain participation by ACOs with high spending. Use of survey information also could help mitigate perverse incentives for risk selection and upcoding and limit unintended consequences of new benchmarking methodologies for ACOs serving sicker patients. PMID:26953298

  14. Comparative coronary risks of apixaban, rivaroxaban and dabigatran: a meta-analysis and adjusted indirect comparison

    PubMed Central

    Loke, Yoon K; Pradhan, Shiva; Yeong, Jessica Ka-yan; Kwok, Chun Shing

    2014-01-01

    Aims There are concerns regarding increased risk of acute coronary syndrome with dabigatran. We aimed to assess whether alternative treatment options such as rivaroxaban or apixaban carry a similar risk as compared with dabigatran. Methods We searched MEDLINE and EMBASE for randomized controlled trials of apixaban, dabigatran or rivaroxaban against control (placebo, heparin or vitamin K antagonist). We pooled odds ratios (OR) for adverse coronary events (acute coronary syndrome or myocardial infarction) using fixed effect meta-analysis and assessed heterogeneity with I2. We conducted adjusted indirect comparisons to compare risk of adverse coronary events with apixaban or rivaroxaban vs. dabigatran. Results Twenty-seven randomized controlled trials met the inclusion criteria. Dabigatran was associated with a significantly increased risk of adverse coronary events in pooled analysis of nine trials (OR 1.45, 95% CI 1.14, 1.86). There was no signal for coronary risk with apixaban from nine trials (pooled OR 0.89, 95% CI 0.78, 1.03) or rivaroxaban from nine trials (pooled OR 0.81, 95% CI 0.72, 0.93). Overall, adjusted indirect comparison suggested that both apixaban (OR 0.61, 95% CI 0.44, 0.85) and rivaroxaban (OR 0.54; 95% CI 0.39, 0.76) were associated with lower coronary risk than dabigatran. Restricting the indirect comparison to a vitamin K antagonist as a common control, yielded similar findings, OR 0.57 (95% CI 0.39, 0.85) for apixaban vs. dabigatran and 0.53 (95% CI 0.37, 0.77) for rivaroxaban vs. dabigatran. Conclusions There are significant differences in the comparative safety of apixaban, rivaroxaban and dabigatran with regards to acute coronary adverse events. PMID:24617578

  15. 75 FR 45072 - Defense Federal Acquisition Regulation Supplement; Inflation Adjustment of Acquisition-Related...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-08-02

    ... (71 FR 75891). This is the second review of DFARS acquisition-related thresholds. DoD published a proposed rule on January 20, 2010 (75 FR 3187). The preamble to the proposed rule contained a detailed...; Inflation Adjustment of Acquisition-Related Thresholds (DFARS Case 2009-D003) AGENCY: Defense...

  16. Relational Victimization: The Association between Recalled Adolescent Social Experiences and Emotional Adjustment in Early Adulthood

    ERIC Educational Resources Information Center

    Dempsey, Allison G.; Storch, Eric A.

    2008-01-01

    Although the relationship between relational victimization and psychosocial adjustment in adolescence has been established, it is unknown whether it extends into early adulthood. The current retrospective study investigated the relationship between recall of adolescent relational victimization and symptoms of depression, social anxiety, and…

  17. Relational Aggression in Peer and Dating Relationships: Links to Psychological and Behavioral Adjustment

    ERIC Educational Resources Information Center

    Ellis, Wendy E.; Crooks, Claire V.; Wolfe, David A.

    2009-01-01

    We examined the contribution of relational aggression in adolescents' peer and dating relationships to their psychological and behavioral adjustment. In the Fall and again four months later, 1279 (646 female) grade 9 students reported on relational aggression perpetration and victimization in their romantic and peer relationships,…

  18. Adjustment of costly extra-group paternity according to inbreeding risk in a cooperative mammal

    PubMed Central

    Cant, Michael A.; Sanderson, Jennifer L.

    2015-01-01

    Females of many animal species seek mating opportunities with multiple males, despite being able to obtain sufficient sperm to father their offspring from a single male. In animals that live in stable social groups, females often choose to mate outside their group resulting in extra-group paternity (EGP). One reason proposed to explain female choice for extra-group males is to obtain compatible genes, for example, in order to avoid inbreeding depression in offspring. The benefits of such extra-group paternities could be substantial if they result in fitter, outbred offspring. However, avoiding inbreeding in this way could be costly for females, for example, through retaliation by cuckolded males or through receiving aggression while prospecting for extra-group mating opportunities. We investigate the costs and benefits of EGP in the banded mongoose Mungos mungo, a cooperatively breeding mammal in which within-group mates are sometimes close relatives. We find that pups born to females that mate with extra-group males are more genetically heterozygous are heavier and are more likely to survive to independence than pups born to females that mate within their group. However, extra-group matings also involve substantial costs as they occur during violent encounters that sometimes result in injury and death. This appears to lead femalebanded mongooses to adaptively adjust EGP levels according to the current risk of inbreeding associated with mating within the group. For group-living animals, the costs of intergroup interactions may help to explain variation in both inbreeding rates and EGP within and between species. PMID:26609201

  19. Cross-lagged relations among parenting, children's emotion regulation, and psychosocial adjustment in early adolescence.

    PubMed

    Otterpohl, Nantje; Wild, Elke

    2015-01-01

    Numerous studies have reported substantive correlations between indicators of parenting, children's emotion regulation (ER), and children's psychosocial adjustment. However, studies on underlying mechanisms are scarce. Particularly in early adolescence, it is still unclear whether relations between parenting and ER are caused by adolescent behavior, by parent behavior, or by reciprocal processes. Moreover, it is unclear whether ER can be seen as an antecedent or a consequence of psychosocial adjustment. The aim of this study was to examine predictive relations among parenting and adolescents' ER, and adolescents' ER and psychosocial adjustment, respectively. We collected longitudinal, multiple informant data at two measurement occasions (Grade 6, Grade 7). All told, 1,100 adolescents (10-14 years) and their parents filled out questionnaires assessing responsiveness and psychological control, adolescents' anger regulation, and adolescents' problem and prosocial behavior. Cross-lagged analyses revealed reciprocal effects between parenting, ER, and adjustment for the parent and boys', but not for the girls', report. Moreover, relations were different for adolescents with versus without clinically elevated symptoms of psychopathology. Our findings support the assumption that reciprocal relations between parenting, ER, and psychosocial adjustment are likely to persist until early adolescence. Nevertheless, the moderating role of gender and psychopathology should be taken into account. Possible reasons for the different findings, and practical implications, are discussed. PMID:24320075

  20. 12 CFR Appendix B to Part 3 - Risk-Based Capital Guidelines; Market Risk Adjustment

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... the Board's Regulation EE (12 CFR part 231); or (2) If the transaction does not meet the criteria set... daily management process. (3) The bank's policies and procedures must identify, and the bank must... across risk categories, provided that the bank's process for measuring correlations is sound. In...

  1. 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

  2. Relations of SARS-Related Stressors and Coping to Chinese College Students' Psychological Adjustment during the 2003 Beijing SARS Epidemic

    ERIC Educational Resources Information Center

    Main, Alexandra; Zhou, Qing; Ma, Yue; Luecken, Linda J.; Liu, Xin

    2011-01-01

    This study examined the main and interactive relations of stressors and coping related to severe acute respiratory syndrome (SARS) with Chinese college students' psychological adjustment (psychological symptoms, perceived general health, and life satisfaction) during the 2003 Beijing SARS epidemic. All the constructs were assessed by self-report…

  3. The relation of leptin and insulin with obesity-related cardiovascular risk factors in US adults.

    PubMed

    Reis, Jared P; Macera, Caroline A; Wingard, Deborah L; Araneta, Maria Rosario G; Lindsay, Suzanne P; Marshall, Simon J

    2008-09-01

    Previous studies of leptin with cardiovascular disease (CVD) risk factors have been limited by clinical samples or lack of representation of the general population. This cross-sectional study, designed to examine whether leptin or insulin may mediate the endogenous relation of obesity with metabolic, inflammatory, and thrombogenic cardiovascular risk factors, included 522 men and 514 women aged >or=40 years who completed a physical examination during the third National Health and Nutrition Examination Survey. Participants were free of existing CVD, cancer (except non-melanoma skin cancer), diabetes, or respiratory disease. In multivariable analyses adjusted for race/ethnicity and lifestyle factors, waist circumference (WC) was positively associated with blood pressure, triglyceride, LDL cholesterol, total cholesterol:HDL ratio, apolipoprotein B, C-reactive protein (CRP), and fibrinogen concentrations, and negatively associated with HDL cholesterol and apolipoprotein A1 levels. The associations of WC with the metabolic CVD risk factors were largely attenuated after adjustment for insulin levels, while the associations of WC with the inflammatory and thrombogenic factors (CRP and fibrinogen, respectively) were largely explained by adjustment for leptin concentrations. However, leptin levels were not independently associated with CRP and fibrinogen in men and CRP in women when adjusted for WC. Positive associations of leptin and insulin with fibrinogen in women, independent of WC, were noted. These results suggest that insulin may be an important mediator of the association of obesity with metabolic but not inflammatory or thrombogenic CVD risk factors, while leptin does not appear to influence cardiovascular risk through a shared association with these risk factors. However, we cannot rule out the possibility that leptin and insulin influence cardiovascular risk in women through independent effects on fibrinogen concentrations. PMID:18160070

  4. Assessment and Indirect Adjustment for Confounding by Smoking in Cohort Studies Using Relative Hazards Models

    PubMed Central

    Richardson, David B.; Laurier, Dominique; Schubauer-Berigan, Mary K.; Tchetgen, Eric Tchetgen; Cole, Stephen R.

    2014-01-01

    Workers' smoking histories are not measured in many occupational cohort studies. Here we discuss the use of negative control outcomes to detect and adjust for confounding in analyses that lack information on smoking. We clarify the assumptions necessary to detect confounding by smoking and the additional assumptions necessary to indirectly adjust for such bias. We illustrate these methods using data from 2 studies of radiation and lung cancer: the Colorado Plateau cohort study (1950–2005) of underground uranium miners (in which smoking was measured) and a French cohort study (1950–2004) of nuclear industry workers (in which smoking was unmeasured). A cause-specific relative hazards model is proposed for estimation of indirectly adjusted associations. Among the miners, the proposed method suggests no confounding by smoking of the association between radon and lung cancer—a conclusion supported by adjustment for measured smoking. Among the nuclear workers, the proposed method suggests substantial confounding by smoking of the association between radiation and lung cancer. Indirect adjustment for confounding by smoking resulted in an 18% decrease in the adjusted estimated hazard ratio, yet this cannot be verified because smoking was unmeasured. Assumptions underlying this method are described, and a cause-specific proportional hazards model that allows easy implementation using standard software is presented. PMID:25245043

  5. 20 CFR 418.1230 - What is the effective date of an income-related monthly adjustment amount initial determination...

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ...-related monthly adjustment amount initial determination that is based on a more recent tax year? 418.1230... Income-Related Monthly Adjustment Amount Determinations Using A More Recent Tax Year's Modified Adjusted... initial determination that is based on a more recent tax year? (a) When you make your request prior...

  6. 20 CFR 418.2125 - How will the income-related monthly adjustment amount affect your total Medicare prescription...

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... monthly premium as described in 42 CFR 423.286; plus (3) Your income-related monthly adjustment amount. (b... adjustment amount affect your total Medicare prescription drug coverage premium? 418.2125 Section 418.2125 Employees' Benefits SOCIAL SECURITY ADMINISTRATION MEDICARE SUBSIDIES Income-Related Monthly Adjustments...

  7. 20 CFR 418.2125 - How will the income-related monthly adjustment amount affect your total Medicare prescription...

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... monthly premium as described in 42 CFR 423.286; plus (3) Your income-related monthly adjustment amount. (b... adjustment amount affect your total Medicare prescription drug coverage premium? 418.2125 Section 418.2125 Employees' Benefits SOCIAL SECURITY ADMINISTRATION MEDICARE SUBSIDIES Income-Related Monthly Adjustments...

  8. 20 CFR 418.2125 - How will the income-related monthly adjustment amount affect your total Medicare prescription...

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... monthly premium as described in 42 CFR 423.286; plus (3) Your income-related monthly adjustment amount. (b... adjustment amount affect your total Medicare prescription drug coverage premium? 418.2125 Section 418.2125 Employees' Benefits SOCIAL SECURITY ADMINISTRATION MEDICARE SUBSIDIES Income-Related Monthly Adjustments...

  9. Psychosocial Adjustment and Sibling Relationships in Siblings of Children with Autism Spectrum Disorder: Risk and Protective Factors

    ERIC Educational Resources Information Center

    Walton, Katherine M.; Ingersoll, Brooke R.

    2015-01-01

    This study compared sibling adjustment and relationships in siblings of children with Autism Spectrum Disorder (ASD-Sibs; n = 69) and siblings of children with typical development (TD-Sibs; n = 93). ASD-Sibs and TD-Sibs demonstrated similar emotional/behavioral adjustment. Older male ASD-Sibs were at increased risk for difficulties. Sibling…

  10. International note: Maternal warmth, behavioral control, and psychological control: Relations to adjustment of Ghanaian early adolescents.

    PubMed

    Salaam, Braima; Mounts, Nina S

    2016-06-01

    This investigation addressed the relation between maternal warmth, behavioral control, psychological control, and psychological adjustment in a sample of 119 Ghanaian adolescents (42% boys) living in an urban area (mean age = 14.19). Adolescents in the sample reported clinically elevated levels of depression and anxiety. Significant associations were found between warmth, behavioral control, and psychological control and adolescents' anxiety, physical aggression, relational aggression, positive friendship quality, and conflict with friends. Warmth moderated the effect of behavioral control on anxiety, physical aggression, and relational aggression such that higher levels of warmth in combination with higher levels of behavioral control were related to more positive adjustment. Higher levels of warmth in conjunction with higher psychological control were related to higher levels of anxiety. Boys who reported lower levels of warmth in combination with higher behavioral control reported higher levels of physical aggression. For boys reporting higher levels of warmth, higher behavioral control was associated with lower physical aggression. PMID:27038973

  11. Behavioural Adjustment in Response to Increased Predation Risk: A Study in Three Duck Species

    PubMed Central

    Zimmer, Cédric; Boos, Mathieu; Bertrand, Frédéric; Robin, Jean-Patrice; Petit, Odile

    2011-01-01

    Predation directly triggers behavioural decisions designed to increase immediate survival. However, these behavioural modifications can have long term costs. There is therefore a trade-off between antipredator behaviours and other activities. This trade-off is generally considered between vigilance and only one other behaviour, thus neglecting potential compensations. In this study, we considered the effect of an increase in predation risk on the diurnal time-budget of three captive duck species during the wintering period. We artificially increased predation risk by disturbing two groups of 14 mallard and teals at different frequencies, and one group of 14 tufted ducks with a radio-controlled stressor. We recorded foraging, vigilance, preening and sleeping durations the week before, during and after disturbance sessions. Disturbed groups were compared to an undisturbed control group. We showed that in all three species, the increase in predation risk resulted in a decrease in foraging and preening and led to an increase in sleeping. It is worth noting that contrary to common observations, vigilance did not increase. However, ducks are known to be vigilant while sleeping. This complex behavioural adjustment therefore seems to be optimal as it may allow ducks to reduce their predation risk. Our results highlight the fact that it is necessary to encompass the whole individual time-budget when studying behavioural modifications under predation risk. Finally, we propose that studies of behavioural time-budget changes under predation risk should be included in the more general framework of the starvation-predation risk trade-off. PMID:21533055

  12. Socio-Emotional Adjustment in Adolescence and the Perception of Family Relations.

    ERIC Educational Resources Information Center

    Koopmans, Matthijs

    This paper presents results of a study of how family dysfunction contributes to adjustment of adolescents. The question is considered from two disciplinary vantage points: (1) structural anthropology, which considers dysfunction in terms of the affirmation of kinship relations; and (2) a family systems approach which emphasizes the role of factors…

  13. Acculturation and Social Support in Relation to Psychosocial Adjustment of Adolescent Refugees Resettled in Australia

    ERIC Educational Resources Information Center

    Kovacev, Lydia; Shute, Rosalyn

    2004-01-01

    This study examined how different modes of acculturation and perceived social support are related to adolescent refugee psychosocial adjustment, as measured by global self-worth and peer social acceptance. The 83 participants, aged between 12 and 19 and now resident in Australia, were from the former Republic of Yugoslavia. Those who had the most…

  14. 75 FR 53129 - Federal Acquisition Regulation; Inflation Adjustment of Acquisition-Related Thresholds

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-08-30

    ...-033 during FY 2005. The final rule for the first review was published in the Federal Register at 71 FR..., and NASA published a proposed rule in the Federal Register at 75 FR 5716, February 4, 2010. The... Regulation; Inflation Adjustment of Acquisition--Related Thresholds AGENCY: Department of Defense...

  15. 75 FR 3187 - Defense Federal Acquisition Regulation Supplement: Inflation Adjustment of Acquisition-Related...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-01-20

    ... case 2004-D022. The final rule was published in the Federal Register on December 19, 2006 (71 FR 75891..., 232, 237, 246, 250, 252 Defense Federal Acquisition Regulation Supplement: Inflation Adjustment of...-related thresholds for inflation using the Consumer Price Index (CPI) for all-urban consumers....

  16. Relations between Parent-Child Acculturation Differences and Adjustment within Immigrant Chinese Families

    ERIC Educational Resources Information Center

    Costigan, Catherine L.; Dokis, Daphn P.

    2006-01-01

    The relations between parent and child acculturation and family and child adjustment were examined among 91 immigrant Chinese families in Canada with early adolescents (average age of 12). Acculturation was assessed in public (e.g., language use) and private (e.g., values) domains separately in Chinese and Canadian cultures. With one exception,…

  17. Parental Expressivity and Parenting Styles in Chinese Families: Prospective and Unique Relations to Children's Psychological Adjustment.

    PubMed

    Chen, Stephen H; Zhou, Qing; Eisenberg, Nancy; Valiente, Carlos; Wang, Yun

    2011-01-01

    OBJECTIVES: Parents from different cultures differ in how frequently they express emotions. However, the generalizability of the relations between parental expressivity and child adjustment in non-Western cultures has not been extensively studied. The goal of the present study was to investigate prospective relations between parental expressivity within the family (positive, negative dominant, and negative submissive expressivity) and Chinese children's psychological adjustment, above and beyond parenting styles. DESIGN: The study used two waves (3.8 years apart) of longitudinal data from a sample (n= 425) of children in Beijing (mean ages = 7.7 years at T1 and 11.6 years at T2). Parental expressivity and parenting styles were self-reported. To reduce the potential measurement overlap, items that tap parental expression of emotions toward the child were removed from the parenting style measure. Children's adjustment was measured with parents', teachers', and peers' or children's reports. RESULTS: Consistent with findings with European American samples, parental negative dominant expressivity uniquely and positively predicted Chinese children's externalizing problems controlling for prior externalizing problems, parenting styles, and family SES. Neither parental expressivity nor parenting styles uniquely predicted social competence. CONCLUSIONS: Despite previously reported cultural differences in the mean levels of parental expressivity, some of the socialization functions of parental expressivity found in Western countries can be generalized to Chinese families. Although parental expressivity and parenting styles are related constructs, their unique relations to child's adjustment suggest that they should be examined as distinct processes. PMID:23226715

  18. Individual Skill Predictors of the School- and Career-Related Adjustment of Adolescents with Disabilities

    ERIC Educational Resources Information Center

    Pinkney, Christopher J.; Murray, Christopher J.; Lind, John R.

    2012-01-01

    In this investigation, the authors examine the relationship between individual skills (i.e., career locus of control [LOC], social skills [SOC], and social problem-solving skills [SPSS]) and the school- and perceived career-related adjustment of 211 students with disabilities. Data pertaining to individual skills were gathered from student…

  19. Reciprocal Relations between Children's Sleep and Their Adjustment over Time

    ERIC Educational Resources Information Center

    Kelly, Ryan J.; El-Sheikh, Mona

    2014-01-01

    Child sleep and adjustment research with community samples is on the rise with a recognized need of explicating this association. We examined reciprocal relations between children's sleep and their internalizing and externalizing symptoms using 3 waves of data spanning 5 years. Participants included 176 children at Time 1 (M = 8.68 years; 69%…

  20. Social Cognition and Its Relation to Psychosocial Adjustment in Children with Nonverbal Learning Disabilities

    ERIC Educational Resources Information Center

    Galway, Tanya M.; Metsala, Jamie L.

    2011-01-01

    The current study examined social cognitive skills in children with nonverbal learning disabilities (NLD) compared to normally achieving (NA) children. The relation between social cognitive skills and psychosocial adjustment was also investigated. There were no group differences on children's ability to represent orally presented social vignettes.…

  1. Children's Responses to Daily Social Stressors: Relations with Parenting, Children's Effortful Control, and Adjustment

    ERIC Educational Resources Information Center

    Valiente, Carlos; Lemery-Chalfant, Kathryn; Swanson, Jodi

    2009-01-01

    Background: We examined children's coping and involuntary stress responses as mediators of the relations between parenting or children's effortful control (EC) and adjustment. Method: Two hundred and forty primarily Mexican American 7- to 12-year-old children reported on their EC, coping, involuntary stress responses, and problem behaviors.…

  2. Developmental Trajectories of Chinese Children's Relational and Physical Aggression: Associations with Social-Psychological Adjustment Problems

    ERIC Educational Resources Information Center

    Kawabata, Yoshito; Tseng, Wan-Ling; Murray-Close, Dianna; Crick, Nicki R.

    2012-01-01

    The purpose of this short-term longitudinal study was to examine Chinese children's trajectories of physical and relational aggression and their association with social-psychological adjustment problems (i.e., depressive symptoms and delinquency) and gender. Fourth and fifth grade children in Taiwan (n = 739, age 9-11) were followed across 1 year.…

  3. Relations between Political Violence and Child Adjustment: A Four-Wave Test of the Role of Emotional Insecurity about Community

    PubMed Central

    Cummings, E. Mark; Taylor, Laura K.; Merrilees, Christine E.; Goeke-Morey, Marcie C.; Shirlow, Peter; Cairns, Ed

    2015-01-01

    This study further explored the impact of sectarian violence and children’s emotional insecurity about community on child maladjustment using a four-wave longitudinal design. The study included 999 mother-child dyads in Belfast, Northern Ireland (482 boys, 517 girls). Across the four-waves, child mean age was 12.19 (SD = 1.82), 13.24 (SD = 1.83), 13.61 (SD = 1.99), and 14.66 years (SD = 1.96), respectively. Building on previous studies of the role of emotional insecurity in child adjustment, the current study examines within-person change in emotional insecurity using latent growth curve analyses. The results showed that children’s trajectories of emotional insecurity about community were related to risk for developing conduct and emotion problems. These findings controlled for earlier adjustment problems, age and gender, and took into account the time-varying nature of experience with sectarian violence. Discussion considers the implications for children’s emotional insecurity about community for relations between political violence and children’s adjustment, including the significance of trajectories of emotional insecurity over time. PMID:23527495

  4. Autonomy, Self-Realization, and Self-Advocacy and the School- and Career-Related Adjustment of Adolescent Girls with Disabilities

    ERIC Educational Resources Information Center

    Doren, Bonnie; Kang, Hyun Ju

    2016-01-01

    The purpose of the current study was to identify component elements of self-determination that may promote positive or buffer negative school- and career-related adjustment of adolescent girls with disabilities or with multiple risk factors. Autonomy, self-realization, and self-advocacy were examined together to ascertain both their cumulative and…

  5. Relative Hazard and Risk Measure Calculation Methodology

    SciTech Connect

    Stenner, Robert D.; Strenge, Dennis L.; Elder, Matthew S.

    2004-03-20

    The relative hazard (RH) and risk measure (RM) methodology and computer code is a health risk-based tool designed to allow managers and environmental decision makers the opportunity to readily consider human health risks (i.e., public and worker risks) in their screening-level analysis of alternative cleanup strategies. Environmental management decisions involve consideration of costs, schedules, regulatory requirements, health hazards, and risks. The RH-RM tool is a risk-based environmental management decision tool that allows managers the ability to predict and track health hazards and risks over time as they change in relation to mitigation and cleanup actions. Analysis of the hazards and risks associated with planned mitigation and cleanup actions provides a baseline against which alternative strategies can be compared. This new tool allows managers to explore “what if scenarios,” to better understand the impact of alternative mitigation and cleanup actions (i.e., alternatives to the planned actions) on health hazards and risks. This new tool allows managers to screen alternatives on the basis of human health risk and compare the results with cost and other factors pertinent to the decision. Once an alternative or a narrow set of alternatives are selected, it will then be more cost-effective to perform the detailed risk analysis necessary for programmatic and regulatory acceptance of the selected alternative. The RH-RM code has been integrated into the PNNL developed Framework for Risk Analysis In Multimedia Environmental Systems (FRAMES) to allow the input and output data of the RH-RM code to be readily shared with the more comprehensive risk analysis models, such as the PNNL developed Multimedia Environmental Pollutant Assessment System (MEPAS) model.

  6. Risk adjustment for health care financing in chronic disease: What are we missing by failing to account for disease severity?

    PubMed Central

    Omachi, Theodore A.; Gregorich, Steven E.; Eisner, Mark D.; Penaloza, Renee A.; Tolstykh, Irina V.; Yelin, Edward H.; Iribarren, Carlos; Dudley, R. Adams; Blanc, Paul D.

    2013-01-01

    BACKGROUND Adjustment for differing risks among patients is usually incorporated into newer payment approaches, and current risk models rely on age, gender, and diagnosis codes. It is unknown the extent to which controlling additionally for disease severity improves cost prediction. Failure to adjust for within-disease variation may create incentives to avoid sicker patients. We address this issue among patients with chronic obstructive pulmonary disease (COPD). METHODS Cost and clinical data were collected prospectively from 1,202 COPD patients at Kaiser Permanente. Baseline analysis included age, gender, and diagnosis codes (using the Diagnostic Cost Group Relative Risk Score [RRS]) in a general linear model predicting total medical costs in the following year. We determined whether adding COPD severity measures—FEV1, 6 minute walk test, dyspnea score, body-mass index, and BODE Index (composite of the other four measures)—improved predictions. Separately, we examined household income as a cost predictor. RESULTS Mean costs were $12,334/year. Controlling for RRS, each ½ standard deviation worsening in COPD severity factor was associated with $629 to $1,135 in increased annual costs (all p<0.01). The lowest stratum of FEV1 (<30% normal) predicted $4,098 (95%CI $576–$8,773) additional costs. Household income predicted excess costs when added to the baseline model (p=0.038), but this became non-significant when also incorporating BODE Index. CONCLUSIONS Disease severity measures explain significant cost variations beyond current risk models, and adding them to such models appears important to fairly compensate organizations that accept responsibility for sicker COPD patients. Appropriately controlling for disease severity also accounts for costs otherwise associated with lower socioeconomic status. PMID:23703646

  7. Relating space radiation environments to risk estimates

    SciTech Connect

    Curtis, S.B.

    1991-10-01

    This lecture will provide a bridge from the physical energy or LET spectra as might be calculated in an organ to the risk of carcinogenesis, a particular concern for extended missions to the moon or beyond to Mars. Topics covered will include (1) LET spectra expected from galactic cosmic rays, (2) probabilities that individual cell nuclei in the body will be hit by heavy galactic cosmic ray particles, (3) the conventional methods of calculating risks from a mixed environment of high and low LET radiation, (4) an alternate method which provides certain advantages using fluence-related risk coefficients (risk cross sections), and (5) directions for future research and development of these ideas.

  8. The who, what, and why of risk adjustment: a technology on the cusp of adoption.

    PubMed

    Blumenthal, David; Weissman, Joel S; Wachterman, Melissa; Weil, Evette; Stafford, Randall S; Perrin, James M; Ferris, Timothy G; Kuhlthau, Karen; Kaushal, Rainu; Iezzoni, Lisa I

    2005-06-01

    Risk adjustment (RA) consists of a series of techniques that account for the health status of patients when predicting or explaining costs of health care for defined populations or for evaluating retrospectively the performance of providers who care for them. Although the federal government seems to have settled on an approach to RA for Medicare Advantage programs, adoption and implementation of RA techniques elsewhere have proceeded much more slowly than was anticipated. This article examines factors affecting the adoption and use of RA outside the Medicare program using case studies in six U.S. health care markets (Baltimore, Seattle, Denver, Cleveland, Phoenix, and Atlanta) as of 2001. We found that for purchasing decisions, RA was used exclusively by public agencies. In the private sector, use of risk adjustment was uncommon and scattered and assumed informal and unexpected forms. The most common private sector use of RA was by health plans, which occasionally employed RA in negotiations with purchasers or to allocate resources internally among providers. The article uses classic technology diffusion theory to explain the adoption and use of RA in these six markets and derives lessons for health policy generally and for the future of RA in particular. For health policy generally, the differing experiences of public and private actors with RA serve as markers of the divergent paths that public and private health care sectors are pursuing with respect to managed care and risk sharing. For the future of RA in particular, its history suggests the need for health service researchers to consider barriers to use adoption and new analytic technologies as they develop them. PMID:16089112

  9. Assessing the Relative Risk of Aerocapture Using Probabalistic Risk Assessment

    NASA Technical Reports Server (NTRS)

    Percy, Thomas K.; Bright, Ellanee; Torres, Abel O.

    2005-01-01

    A recent study performed for the Aerocapture Technology Area in the In-Space Propulsion Technology Projects Office at the Marshall Space Flight Center investigated the relative risk of various capture techniques for Mars missions. Aerocapture has been proposed as a possible capture technique for future Mars missions but has been perceived by many in the community as a higher risk option as compared to aerobraking and propulsive capture. By performing a probabilistic risk assessment on aerocapture, aerobraking and propulsive capture, a comparison was made to uncover the projected relative risks of these three maneuvers. For mission planners, this knowledge will allow them to decide if the mass savings provided by aerocapture warrant any incremental risk exposure. The study focuses on a Mars Sample Return mission currently under investigation at the Jet Propulsion Laboratory (JPL). In each case (propulsive, aerobraking and aerocapture), the Earth return vehicle is inserted into Martian orbit by one of the three techniques being investigated. A baseline spacecraft was established through initial sizing exercises performed by JPL's Team X. While Team X design results provided the baseline and common thread between the spacecraft, in each case the Team X results were supplemented by historical data as needed. Propulsion, thermal protection, guidance, navigation and control, software, solar arrays, navigation and targeting and atmospheric prediction were investigated. A qualitative assessment of human reliability was also included. Results show that different risk drivers contribute significantly to each capture technique. For aerocapture, the significant drivers include propulsion system failures and atmospheric prediction errors. Software and guidance hardware contribute the most to aerobraking risk. Propulsive capture risk is mainly driven by anomalous solar array degradation and propulsion system failures. While each subsystem contributes differently to the risk of

  10. Increased Risk of Dementia Among Sleep-Related Movement Disorders

    PubMed Central

    Lin, Chun-Chieh; Chou, Chung-Hsing; Fan, Yu-Ming; Yin, Jiu-Haw; Chung, Chi-Hsiang; Chien, Wu-Chien; Sung, Yueh-Feng; Tsai, Chia-Kuang; Lin, Guan-Yu; Lin, Yu-Kai; Lee, Jiunn-Tay

    2015-01-01

    Abstract Sleep-related movement disorders (SRMD) are sleep disorders. As poor sleep quality is associated with cognitive impairment, we hypothesized that SRMD patients were exposed to a great risk for developing dementia. The present study was aimed to retrospectively examine the association of SRMD and dementia risk. A retrospective longitudinal study was conducted using the data obtained from the Longitudinal Health Insurance Database (LHID) in Taiwan. The study cohort enrolled 604 patients with SRMD who were initially diagnosed and 2416 patients who were randomly selected and age/gender matched with the study group. SRMD, dementia, and other confounding factors were defined according to International Classification of Diseases Clinical Modification Codes. Cox proportional-hazards regressions were employed to examine adjusted hazard ratios (HR) after adjusting with confounding factors. Our data revealed that patients with SRMD had a 3.952 times (95% CI = 1.124–4.767) higher risk to develop all-cause dementia compared with individuals without SRMD. The results showed that SRMD patients aged 45 to 64 exhibited highest risk of developing all-cause dementia (HR: 5.320, 95% CI = 1.770–5.991), followed by patients age ≥65 (HR: 4.123, 95% CI = 2.066–6.972) and <45 (HR: 3.170, 95% CI = 1.050–4.128), respectively. Females with SRMD were at greater risk to develop all-cause dementia (HR: 4.372, 95% CI = 1.175–5.624). The impact of SRMD on dementia risk was progressively increased by various follow-up time intervals (<1 year, 1–2 years, and ≥2 years). The results suggest that SRMD is linked to an increased risk for dementia with gender-dependent and time-dependent characteristics. PMID:26705224

  11. Longitudinal Relations between Sectarian and non-Sectarian Community Violence and Child Adjustment in Northern Ireland

    PubMed Central

    Cummings, E. Mark; Merrilees, Christine E.; Taylor, Laura K.; Shirlow, Peter; Goeke-Morey, Marcie C.; Cairns, Ed

    2015-01-01

    Although relations between political violence and child adjustment are well-documented, long-term longitudinal research is needed to adequately address the many questions remaining about the contexts and developmental trajectories underlying the effects on children in areas of political violence. The present study examined relations between sectarian and non-sectarian community violence and adolescent adjustment problems over four consecutive years for mother-child dyads (total N = 1015, 485 boys, 517 girls) living in socially deprived neighborhoods in a context of historical and ongoing political violence, that is, Belfast, Northern Ireland. Both sectarian and non-sectarian community violence predicted youth adjustment across four years, consistent with the hypothesis that both of these elements of the social ecology merit consideration with regard to children's well-being in contexts of political violence. The impact of sectarian community violence on adolescent adjustment was further accentuated in neighborhoods characterized by higher crime rates. Discussion considers the implications for evaluating social ecologies pertinent to the impact of political violence on children. PMID:23880380

  12. The Impact of Ecological Risk and Perceived Discrimination on the Psychological Adjustment of African American and European American Youth

    ERIC Educational Resources Information Center

    Prelow, Hazel M.; Danoff-Burg, Sharon; Swenson, Rebecca R.; Pulgiano, Dana

    2004-01-01

    The purpose of the present study was to examine the role of cumulative ecological risk (i.e., neighborhood disadvantage and ecologically salient stressful events) and perceived discrimination on the psychological adjustment of urban African American and European American youth. Findings indicated that both cumulative ecological risk and perceived…

  13. Emotional adjustment and distressed interpersonal relations among low-income African American mothers: moderating effects of demanding kin relations.

    PubMed

    Taylor, Ronald D; Budescu, Mia

    2013-01-01

    Association of mothers' emotional adjustment and negative kin relations with distressed interpersonal relations was examined. Among 115 low-income African American mothers, relationship of depressive symptoms, self-esteem, and demanding kin relations with psychological control and stressful interpersonal relations was assessed. Depressive symptoms and demanding kin relations were positively associated with mothers' use of psychological control in parenting. Interaction of self-esteem with demanding kin relations revealed that self-esteem was negatively associated with psychological control for mothers with high-demanding kin relations but not for mothers with low-demanding kin relations. Mothers' depressive symptoms and demanding kin relations were positively associated with their stressful interpersonal relations. Findings were discussed in terms of the need for research on the beneficial and detrimental aspects of families' social network. PMID:23356357

  14. Risk and protection factors in the peer context: how do other children contribute to the psychosocial adjustment of the adolescent?

    PubMed

    Véronneau, Marie-Hélène; Trempe, Sophie-Caroline; Paiva, Alexandra Oliveira

    2014-03-01

    As children become adolescents, peers assume greater importance in their lives. Peer experiences can either help them thrive or negatively affect their psychosocial adjustment. In this review article definitions for the types of peer experiences are provided followed by an overview of common psychosocial issues encountered by adolescents. Past research that has pointed to risk and protection factors that emerge from peer experiences during adolescence and the role of peer influences in the context of current issues relevant to adolescent education are discussed. Research suggests that friendships with deviant peers, involvement in bullying and the experience of rejection from the overall peer group are related to adjustment problems, whereas friendships with prosocial and academically oriented peers and social acceptance in the peer group are related to healthy development. Friendship quality, popularity among peers, and involvement in friendship cliques cannot be clearly categorized as either positive or negative influences, because they interact with other factors in shaping the development of adolescents. The promotion of social skills and positive youth leadership as an integral part of the student's learning process in school is recommended. PMID:24714885

  15. Desirability of Outcome Ranking (DOOR) and Response Adjusted for Duration of Antibiotic Risk (RADAR).

    PubMed

    Evans, Scott R; Rubin, Daniel; Follmann, Dean; Pennello, Gene; Huskins, W Charles; Powers, John H; Schoenfeld, David; Chuang-Stein, Christy; Cosgrove, Sara E; Fowler, Vance G; Lautenbach, Ebbing; Chambers, Henry F

    2015-09-01

    Clinical trials that compare strategies to optimize antibiotic use are of critical importance but are limited by competing risks that distort outcome interpretation, complexities of noninferiority trials, large sample sizes, and inadequate evaluation of benefits and harms at the patient level. The Antibacterial Resistance Leadership Group strives to overcome these challenges through innovative trial design. Response adjusted for duration of antibiotic risk (RADAR) is a novel methodology utilizing a superiority design and a 2-step process: (1) categorizing patients into an overall clinical outcome (based on benefits and harms), and (2) ranking patients with respect to a desirability of outcome ranking (DOOR). DOORs are constructed by assigning higher ranks to patients with (1) better overall clinical outcomes and (2) shorter durations of antibiotic use for similar overall clinical outcomes. DOOR distributions are compared between antibiotic use strategies. The probability that a randomly selected patient will have a better DOOR if assigned to the new strategy is estimated. DOOR/RADAR represents a new paradigm in assessing the risks and benefits of new strategies to optimize antibiotic use. PMID:26113652

  16. The Relationship of Medicaid Payment Rates, Bed Constraint Policies, and Risk-Adjusted Pressure Ulcers

    PubMed Central

    Grabowski, David C; Angelelli, Joseph J

    2004-01-01

    Objective To examine the effect of Medicaid reimbursement rates on nursing home quality in the presence of certificate-of-need (CON) and construction moratorium laws. Data Sources/Study Setting A single cross-section of Medicaid certified nursing homes in 1999 (N=13,736). Study Design A multivariate regression model was used to examine the effect of Medicaid payment rates and other explanatory variables on risk-adjusted pressure ulcer incidence. The model is alternatively considered for all U.S. nursing home markets, those most restrictive markets, and those high-Medicaid homes to isolate potentially resource-poor environments. Data Extraction Methods A merged data file was constructed with resident-level information from the Minimum Data Set, facility-level information from the On-Line, Survey, Certification, and Reporting (OSCAR) system and market- and state-level information from various published sources. Principal Findings In the analysis of all U.S. markets, there was a positive relationship between the Medicaid payment rate and nursing home quality. The results from this analysis imply that a 10 percent increase in Medicaid payment was associated with a 1.5 percent decrease in the incidence of risk-adjusted pressure ulcers. However, there was a limited association between Medicaid payment rates and quality in the most restrictive markets. Finally, there was a strong relationship between Medicaid payment and quality in high-Medicaid homes providing strong evidence that the level of Medicaid payment is especially important within resource poor facilities. Conclusions These findings provide support for the idea that increased Medicaid reimbursement may be an effective means toward improving nursing home quality, although CON and moratorium laws may mitigate this relationship. PMID:15230928

  17. Characterization of the human kinetic adjustment factor for the health risk assessment of environmental contaminants.

    PubMed

    Valcke, Mathieu; Krishnan, Kannan

    2014-03-01

    A default uncertainty factor of 3.16 (√10) is applied to account for interindividual variability in toxicokinetics when performing non-cancer risk assessments. Using relevant human data for specific chemicals, as WHO/IPCS suggests, it is possible to evaluate, and replace when appropriate, this default factor by quantifying chemical-specific adjustment factors for interindividual variability in toxicokinetics (also referred to as the human kinetic adjustment factor, HKAF). The HKAF has been determined based on the distributions of pharmacokinetic parameters (e.g., half-life, area under the curve, maximum blood concentration) in relevant populations. This article focuses on the current state of knowledge of the use of physiologically based algorithms and models in characterizing the HKAF for environmental contaminants. The recent modeling efforts on the computation of HKAF as a function of the characteristics of the population, chemical and its mode of action (dose metrics), as well as exposure scenario of relevance to the assessment are reviewed here. The results of these studies, taken together, suggest the HKAF varies as a function of the sensitive subpopulation and dose metrics of interest, exposure conditions considered (route, duration, and intensity), metabolic pathways involved and theoretical model underlying its computation. The HKAF seldom exceeded the default value of 3.16, except in very young children (i.e., <≈ 3 months) and when the parent compound is the toxic moiety. Overall, from a public health perspective, the current state of knowledge generally suggest that the default uncertainty factor is sufficient to account for human variability in non-cancer risk assessments of environmental contaminants. PMID:24038072

  18. [Colombian healthcare reform: a proposal for adjusting healthcare-related insurance and financing].

    PubMed

    García-Ubaque, Juan C; García-Ubaque, César A; Benítez, Luisa F C

    2012-10-01

    Colombian healthcare system reform (incorporated over fifteen years ago) has been the frequent object of analysis and the system currently seems to be facing one of its most serious crises. This has led to large-scale change being suggested from many social, professional and academic spaces, ranging from varied adjustments to the healthcare-related insurance model's total elimination. Research over the last ten years has suggested a balance of what may have been central to the current problem and has suggested that, although adjustment must be made from a wide national consensus, it is reasonable to maintain a healthcare-related insurance model as long as this reflects the learning achieved to date. Precautions and the necessary control measures must be taken to impede a fresh wave of frustration regarding the aim of ensuring a healthcare system which would be more equitable for all. PMID:24652366

  19. The mediational role of adolescents' friends in relations between activity breadth and adjustment.

    PubMed

    Simpkins, Sandra D; Eccles, Jacquelynne S; Becnel, Jennifer N

    2008-07-01

    This investigation addresses the mediational role of friends' characteristics between adolescents' activity breadth (i.e., variety in activity participation) and their later adjustment. Data were drawn from 2 longitudinal studies: the Childhood and Beyond (CAB; N = 925) study and the Maryland Adolescent Development in Context Study (MADICS; N = 1,338). Adolescents at Time 2 in each study (8th, 9th, and 11th graders in CAB and 8th graders in MADICS) reported on the breadth of their participation across 5 activity settings: sports, religious, volunteering, community, and school. Friends' characteristics and adolescent adjustment were reported by adolescents at Times 1 and 3. Friends' positive characteristics significantly mediated relations between activity breadth and adolescent depressive affect, self-worth, alcohol use, and problem behavior in both studies. Friends' negative characteristics significantly mediated these relations in CAB, but not in MADICS. PMID:18605836

  20. Relations between aggression and adjustment in chinese children: moderating effects of academic achievement.

    PubMed

    Yang, Fan; Chen, Xinyin; Wang, Li

    2014-01-01

    The primary purpose of the study was to examine the moderating effects of academic achievement on relations between aggressive behavior and social and psychological adjustment in Chinese children. A sample of children (N = 1,171; 591 boys, 580 girls; initial M age = 9 years) in China participated in the study. Two waves of longitudinal data were collected in Grades 3 and 4 from multiple sources including peer nominations, teacher ratings, self-reports, and school records. The results indicated that the main effects of aggression on adjustment were more evident than those of adjustment on aggression. Moreover, aggression was negatively associated with later leadership status and positively associated with later peer victimization, mainly for high-achieving children. The results suggested that consistent with the resource-potentiating model, academic achievement served to enhance the positive development of children with low aggression. On the other hand, although the findings indicated fewer main effects of adjustment on aggression, loneliness, depression, and perceived social incompetence positively predicted later aggression for low-achieving, but not high-achieving, children, which suggested that consistent with the stress-buffering model, academic achievement protected children with psychological difficulties from developing aggressive behavior. The results indicate that academic achievement is involved in behavioral and socioemotional development in different manners in Chinese children. Researchers should consider an integrative approach based on children's behavioral, psychological, and academic functions in designing prevention and intervention programs. PMID:23557214

  1. Differences between school classes in preschoolers' psychosocial adjustment: evidence for the importance of children's interpersonal relations.

    PubMed

    van den Oord, E J; Rispens, J

    1999-03-01

    We examined differences between school classes with respect to three aspects of psychosocial adjustment at school, namely the extent that children in the class liked to play with each other, the number of teacher-reported behaviour problems, and children's feelings of wellbeing at school. The sample consisted of 1282 4- to 5-year-olds from 94 school classes and 51 schools, but due to nonresponse actual sample sizes were somewhat smaller for most analyses. Multilevel analyses showed that on average 87% of the variance was at the child level, 11% at the class level, and 3% at the school level. This indicated that a non-negligible amount of variance could not be accounted for by factors at the child level. Furthermore, this variance was mainly associated with differences between classes instead of differences between schools. A set of variables that pertained to sociodemographic characteristics of schools, school facilities, organisational aspects of classrooms, and the teacher did not provide an adequate explanation for the differences in adjustment levels. In contrast to these traditional variables, social network indices yielded substantial correlations, showed consistent trends across the different adjustment measures, and fulfilled the necessary requirement that to explain differences between school classes the predictor variables themselves should differ for classes within the same school. These results suggested that aspects of the interpersonal relations of children in the classroom such as proximity, integration, and the amount of contact could be determinants of differences between school classes in psychosocial adjustment. PMID:10190343

  2. Are Chinese consumers at risk due to exposure to metals in crayfish? A bioaccessibility-adjusted probabilistic risk assessment.

    PubMed

    Peng, Qian; Nunes, Luís M; Greenfield, Ben K; Dang, Fei; Zhong, Huan

    2016-03-01

    Freshwater crayfish, the world's third largest crustacean species, has been reported to accumulate high levels of metals, while the current knowledge of potential risk associated with crayfish consumption lags behind that of finfish. We provide the first estimate of human health risk associated with crayfish (Procambarus clarkii) consumption in China, the world's largest producer and consumer of crayfish. We performed Monte Carlo Simulation on a standard risk model parameterized with local data on metal concentrations, bioaccessibility (φ), crayfish consumption rate, and consumer body mass. Bioaccessibility of metals in crayfish was found to be variable (68-95%) and metal-specific, suggesting a potential influence of metal bioaccessibility on effective metal intake. However, sensitivity analysis suggested risk of metals via crayfish consumption was predominantly explained by consumption rate (explaining >92% of total risk estimate variability), rather than metals concentration, bioaccessibility, or body mass. Mean metal concentrations (As, Cd, Cu, Ni, Pb, Se and Zn) in surveyed crayfish samples from 12 provinces in China conformed to national safety standards. However, risk calculation of φ-modified hazard quotient (HQ) and hazard index (HI) suggested that crayfish metals may pose a health risk for very high rate consumers, with a HI of over 24 for the highest rate consumers. Additionally, the φ-modified increased lifetime risk (ILTR) for carcinogenic effects due to the presence of As was above the acceptable level (10(-5)) for both the median (ILTR=2.5×10(-5)) and 90th percentile (ILTR=1.8×10(-4)), highlighting the relatively high risk of As in crayfish. Our results suggest a need to consider crayfish when assessing human dietary exposure to metals and associated health risks, especially for high crayfish-consuming populations, such as in China, USA and Sweden. PMID:26773397

  3. Cancer risks related to electricity production.

    PubMed

    Boffetta, P; Cardis, E; Vainio, H; Coleman, M P; Kogevinas, M; Nordberg, G; Parkin, D M; Partensky, C; Shuker, D; Tomatis, L

    1991-01-01

    The International Agency for Research on Cancer has previously evaluated the cancer risks associated with fossil fuel-based industrial processes such as coal gastification and coke production, substances and mixtures such as coal tars, coal tar pitch and mineral oils, and a number of substances emitted from fossil-fuelled plants such as benzo[a]pyrene and other polycyclic aromatic hydrocarbons, arsenic, beryllium, cadmium, chromium, nickel, lead and formaldehyde. Based on these evaluations and other evidence from the literature, the carcinogenic risks to the general population and occupational groups from the fossil fuel cycle, the nuclear fuel cycle and renewable cycles are reviewed. Cancer risks from waste disposal, accidents and misuses, and electricity distribution are also considered. No cycle appears to be totally free from cancer risk, but the quantification of the effects of such exposures (in particular of those involving potential exposure to large amounts of carcinogens, such as coal, oil and nuclear) requires the application of methods which are subject to considerable margins of error. Uncertainties due to inadequate data and unconfirmed assumptions are discussed. Cancer risks related to the operation of renewable energy sources are negligible, although there may be some risks from construction of such installations. The elements of knowledge at our disposal do not encourage any attempt toward a quantitative comparative risk assessment. However, even in the absence of an accurate quantification of risk, qualitative indication of carcinogenic hazards should lead to preventive measures. PMID:1835869

  4. Risk Prediction for Prostate Cancer Recurrence Through Regularized Estimation with Simultaneous Adjustment for Nonlinear Clinical Effects*

    PubMed Central

    Long, Qi; Chung, Matthias; Moreno, Carlos S.; Johnson, Brent A.

    2011-01-01

    In biomedical studies, it is of substantial interest to develop risk prediction scores using high-dimensional data such as gene expression data for clinical endpoints that are subject to censoring. In the presence of well-established clinical risk factors, investigators often prefer a procedure that also adjusts for these clinical variables. While accelerated failure time (AFT) models are a useful tool for the analysis of censored outcome data, it assumes that covariate effects on the logarithm of time-to-event are linear, which is often unrealistic in practice. We propose to build risk prediction scores through regularized rank estimation in partly linear AFT models, where high-dimensional data such as gene expression data are modeled linearly and important clinical variables are modeled nonlinearly using penalized regression splines. We show through simulation studies that our model has better operating characteristics compared to several existing models. In particular, we show that there is a non-negligible effect on prediction as well as feature selection when nonlinear clinical effects are misspecified as linear. This work is motivated by a recent prostate cancer study, where investigators collected gene expression data along with established prognostic clinical variables and the primary endpoint is time to prostate cancer recurrence. We analyzed the prostate cancer data and evaluated prediction performance of several models based on the extended c statistic for censored data, showing that 1) the relationship between the clinical variable, prostate specific antigen, and the prostate cancer recurrence is likely nonlinear, i.e., the time to recurrence decreases as PSA increases and it starts to level off when PSA becomes greater than 11; 2) correct specification of this nonlinear effect improves performance in prediction and feature selection; and 3) addition of gene expression data does not seem to further improve the performance of the resultant risk

  5. Antimicrobial Stewardship in Long-Term Care: Metrics and Risk Adjustment.

    PubMed

    Mylotte, Joseph M

    2016-07-01

    An antimicrobial stewardship program (ASP) has been recommended for long-term care facilities because of the increasing problem of antibiotic resistance in this setting to improve prescribing and decrease adverse events. Recommendations have been made for the components of such a program, but there is little evidence to support any specific methodology at the present time. The recommendations make minimal reference to metrics, an essential component of any ASP, to monitor the results of interventions. This article focuses on the role of antibiotic use metrics as part of an ASP for long-term care. Studies specifically focused on development of antibiotic use metrics for long-term care are reviewed. It is stressed that these metrics should be considered as an integral part of an ASP in long-term care. In order to develop benchmarks for antibiotic use for long-term care, there must be appropriate risk adjustment for interfacility comparisons and quality improvement. Studies that have focused on resident functional status as a risk factor for infection and antibiotic use are reviewed. Recommendations for the potentially most useful and feasible metrics for long-term care are provided along with recommendations for future research. PMID:27233489

  6. Population-Adjusted Street Connectivity, Urbanicity and Risk of Obesity in the U.S

    PubMed Central

    Wang, Fahui; Wen, Ming; Xu, Yanqing

    2013-01-01

    Street connectivity, defined as the number of (3-way or more) intersections per area unit, is an important index of built environments as a proxy for walkability in a neighborhood. This paper examines its geographic variations across the rural-urban continuum (urbanicity), major racial-ethnic groups and various poverty levels. The population-adjusted street connectivity index is proposed as a better measure than the regular index for a large area such as county due to likely concentration of population in limited space within the large area. Based on the data from the Behavioral Risk Factor Surveillance System (BRFSS), this paper uses multilevel modeling to analyze its association with physical activity and obesity while controlling for various individual and county-level variables. Analysis of data subsets indicates that the influences of individual and county-level variables on obesity risk vary across areas of different urbanization levels. The positive influence of street connectivity on obesity control is limited to the more but not the mostly urbanized areas. This demonstrates the value of obesogenic environment research in different geographic settings, helps us reconcile and synthesize some seemingly contradictory results reported in different studies, and also promotes that effective policies need to be highly sensitive to the diversity of demographic groups and geographically adaptable. PMID:23667278

  7. Maternal Adjustment and Infant Outcome in Medically Defined High-Risk Pregnancy.

    ERIC Educational Resources Information Center

    Levy-Shiff, Rachel; Lerman, Maya; Har-Even, Dov; Hod, Moshe

    2002-01-01

    Explored relation of biological and psychosocial risk factors to infant development among pregnant women who had pregestational diabetes, gestational diabetes, or were nondiabetic. Found that infants of diabetic mothers scored lower on the Bayley Scales at 1 year and revealed fewer positive and more negative behaviors than infants of nondiabetic…

  8. Infant temperament moderates relations between maternal parenting in early childhood and children's adjustment in first grade.

    PubMed

    Stright, Anne Dopkins; Gallagher, Kathleen Cranley; Kelley, Ken

    2008-01-01

    A differential susceptibility hypothesis proposes that children may differ in the degree to which parenting qualities affect aspects of child development. Infants with difficult temperaments may be more susceptible to the effects of parenting than infants with less difficult temperaments. Using latent change curve analyses to analyze data from the National Institute of Child Health and Human Development Study of Early Child Care, the current study found that temperament moderated associations between maternal parenting styles during early childhood and children's first-grade academic competence, social skills, and relationships with teachers and peers. Relations between parenting and first-grade outcomes were stronger for difficult than for less difficult infants. Infants with difficult temperaments had better adjustment than less difficult infants when parenting quality was high and poorer adjustment when parenting quality was lower. PMID:18269517

  9. 75 FR 5716 - Federal Acquisition Regulation; FAR Case 2008-024, Inflation Adjustment of Acquisition-Related...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-02-04

    ... the Federal Register on September 28, 2006 (71 FR 57363). B. Analysis 1. What is an acquisition... Acquisition Regulation; FAR Case 2008-024, Inflation Adjustment of Acquisition-Related Thresholds AGENCIES... Act requires an adjustment every 5 years of acquisition- related thresholds for inflation using...

  10. 77 FR 73456 - Update to the TR-12 Fuel Related Rate Adjustment Policy (SDDC Fuel Surcharge Policy)

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-12-10

    ... Department of the Army Update to the TR-12 Fuel Related Rate Adjustment Policy (SDDC Fuel Surcharge Policy...: Reference: TR-12 Fuel Related Rate Adjustment Policy. Background: The following FRA policy applies to... increases in diesel fuel prices. Miscellaneous: A copy of the TR-12 FRA Policy can be accessed via the...

  11. Craniosynostosis and Risk Factors Related to Thyroid Dysfunction

    PubMed Central

    Carmichael, S. L.; Ma, C.; Rasmussen, S. A.; Cunningham, M. L.; Browne, M. L.; Dosiou, C.; Lammer, E. J.; Shaw, G. M.

    2016-01-01

    Thyroid disease is a common problem among women of reproductive age but often goes undiagnosed. Maternal thyroid disease has been associated with increased risk of craniosynostosis. We hypothesized that known risk factors for thyroid disease would be associated with risk of craniosynostosis among women not diagnosed with thyroid disease. Analyses included mothers of 1,067 cases and 8,494 population-based controls who were interviewed for the National Birth Defects Prevention Study. We used multivariable logistic regression to estimate adjusted odds ratios (AOR) and 95% confidence intervals (CI). After excluding women with diagnosed thyroid disease, younger maternal age (AOR 0.7, 95% CI 0.6–0.9, for <25 years versus 25–29), black or other race-ethnicity (AOR 0.3, 95% CI 0.2–0.4 and AOR 0.6, 95% CI 0.4–0.8, respectively, relative to non-Hispanic whites), fertility medications or procedures (AOR 1.5, 95% CI 1.2–2.0), and alcohol consumption (AOR 0.8, 95% CI 0.7–0.9) were associated with risk of craniosynostosis, based on confidence intervals that excluded 1.0. These associations with craniosynostosis are consistent with the direction of their association with thyroid dysfunction (i.e., younger age, black race-ethnicity and alcohol consumption are associated with reduced risk and fertility problems are associated with increased risk of thyroid disease). This study thus provides support for the hypothesis that risk factors associated with thyroid dysfunction are also associated with risk of craniosynostosis. Improved understanding of the potential association between maternal thyroid function and craniosynostosis among offspring is important given that craniosynostosis carries significant morbidity and that thyroid disease is under-diagnosed and potentially modifiable. PMID:25655789

  12. [Operative risk related to tobacco in gynecology].

    PubMed

    Yaribakht, S; Malartic, C; Grange, G; Morel, O

    2014-05-01

    If tobacco has been recognized for many years as a major risk factor for cardiovascular, lung diseases and cancer in the general population, women are insufficiently aware of the consequences and the specific gynecological operative risks related to this intoxication. Thus, a regular tobacco consumption increases the risk for many gynecological conditions may require surgical treatment with in addition a significant negative impact on the healing process and the risk of postoperative complications. The operative risk must be explained by surgeons in daily practice gynecological, pelvic surgery or breast screening. The issue of smoking cessation should precede surgery has been established by a consensus conference of experts on perioperative smoking held in 2005. The implementation of these recommendations during the preoperative period requires improvement of staff training and better practices to allow smoking cessation effective and sustainable. It is lawful in this context to delay scheduled surgery of 6 to 8 weeks to allow an optimal smoking cessation and to continue smoking cessation for the time necessary for healing to reduce the excess operative risk associated with smoking. PMID:24787606

  13. Temperament as a moderator of the relation between neighborhood and children's adjustment.

    PubMed

    Bush, Nicole R; Lengua, Liliana J; Colder, Craig R

    2010-09-01

    Although proposed by bioecological models, there has been minimal empirical examination of whether children's individual differences moderate neighborhood effects on development. We used an urban community sample (8-12 years, N = 316) to examine interactions among neighborhood characteristics (problems and social organization) and children's temperament (fear, irritability and impulsivity) in predicting psychosocial adjustment. The main effects of neighborhood and temperament on outcomes were consistent with previous research. Findings show that development is challenging in disadvantaged neighborhoods whatever one's temperament, however, some effects of neighborhood were conditioned by temperament, particularly children's fear and irritability. Neighborhood problems were more strongly related to lower social competence for fearful and for less irritable children. Neighborhood problems were more strongly related to higher internalizing problems for low-fear children. Neighborhood social organization was more strongly related to greater social competence for low-fear children. Findings are discussed in relation to "diathesis-stress" and "differential responsiveness" models of temperament. PMID:20948973

  14. Multivariate Risk Adjustment of Primary Care Patient Panels in a Public Health Setting: A Comparison of Statistical Models.

    PubMed

    Hirozawa, Anne M; Montez-Rath, Maria E; Johnson, Elizabeth C; Solnit, Stephen A; Drennan, Michael J; Katz, Mitchell H; Marx, Rani

    2016-01-01

    We compared prospective risk adjustment models for adjusting patient panels at the San Francisco Department of Public Health. We used 4 statistical models (linear regression, two-part model, zero-inflated Poisson, and zero-inflated negative binomial) and 4 subsets of predictor variables (age/gender categories, chronic diagnoses, homelessness, and a loss to follow-up indicator) to predict primary care visit frequency. Predicted visit frequency was then used to calculate patient weights and adjusted panel sizes. The two-part model using all predictor variables performed best (R = 0.20). This model, designed specifically for safety net patients, may prove useful for panel adjustment in other public health settings. PMID:27576054

  15. Anticipatory postural adjustments during cutting manoeuvres in football and their consequences for knee injury risk.

    PubMed

    Mornieux, Guillaume; Gehring, Dominic; Fürst, Patrick; Gollhofer, Albert

    2014-01-01

    Anticipatory postural adjustments (APAs), i.e. preparatory positioning of the head, the trunk and the foot, are essential to initiate cutting manoeuvres during football games. The aim of the present study was to determine how APA strategies during cutting manoeuvres are influenced by a reduction of the time available to prepare the movement. Thirteen football players performed different cutting tasks, with directions of cutting either known prior to the task or indicated by a light signal occurring 850, 600 or 500 ms before ground contact. With less time available to prepare the cutting manoeuvre, the head was less orientated towards the cutting direction (P = 0.033) and the trunk was even more rotated in the opposite direction (P = 0.002), while the foot placement was not significantly influenced. Moreover, the induced higher lateral trunk flexion correlated with the increased knee abduction moment (r = 0.41; P = 0.009). Increasing lateral trunk flexion is the main strategy used to successfully perform a cutting manoeuvre when less time is available to prepare the movement. However, higher lateral trunk flexion was associated with an increased knee abduction moment and therefore an increased knee injury risk. Reducing lateral trunk flexion during cutting manoeuvres should be part of training programs seeking the optimisation of APAs. PMID:24742137

  16. Abuse and HIV-related risk.

    PubMed

    Benson, J D

    1995-04-01

    Research has been conducted on the effects of childhood abuse that may lead to HIV risk-taking behaviors in adolescence and adulthood. There is evidence of a higher incidence of childhood abuse among HIV-infected individuals and those at highest risk, but not enough evidence to confirm childhood abuse as a root cause of risk-taking. Research is beginning to show important connections between psychological trauma and risk, and to suggest therapeutic approaches. The trauma of childhood sexual abuse is retained by the victims, which can cause dissociative defenses and damaging feelings of self-efficacy which may affect safer sex practices. To identify sexual abuse as an issue in therapy, it is advised that counselors develop client histories regarding relationships, sexual expression and identity, substance use, suicidality, and other recurring self-destructive patterns of thought and behavior. The treatment goal is to assist the patient in understanding how abuse has affected feelings, thoughts, and relationship styles, and to recognize patterns that lead directly to HIV-related risk or that set the stage for risky activities. The critical aspect of treatment is to accurately assess the patient's coping skills when determining the course of treatment. ¿¿¿¿¿¿¿ PMID:11362459

  17. Risk Factors for Age-Related Maculopathy

    PubMed Central

    Connell, Paul P.; Keane, Pearse A.; O'Neill, Evelyn C.; Altaie, Rasha W.; Loane, Edward; Neelam, Kumari; Nolan, John M.; Beatty, Stephen

    2009-01-01

    Age-related maculopathy (ARM) is the leading cause of blindness in the elderly. Although beneficial therapeutic strategies have recently begun to emerge, much remains unclear regarding the etiopathogenesis of this disorder. Epidemiologic studies have enhanced our understanding of ARM, but the data, often conflicting, has led to difficulties with drawing firm conclusions with respect to risk for this condition. As a consequence, we saw a need to assimilate the published findings with respect to risk factors for ARM, through a review of the literature appraising results from published cross-sectional studies, prospective cohort studies, case series, and case control studies investigating risk for this condition. Our review shows that, to date, and across a spectrum of epidemiologic study designs, only age, cigarette smoking, and family history of ARM have been consistently demonstrated to represent risk for this condition. In addition, genetic studies have recently implicated many genes in the pathogenesis of age-related maculopathy, including Complement Factor H, PLEKHA 1, and LOC387715/HTRA1, demonstrating that environmental and genetic factors are important for the development of ARM suggesting that gene-environment interaction plays an important role in the pathogenesis of this condition. PMID:20339564

  18. Rodents in open space adjust their behavioral response to the different risk levels during barn-owl attack

    PubMed Central

    Edut, Shahaf; Eilam, David

    2003-01-01

    Background Previous studies have revealed that the response of prey species to predatory risk comprised either freezing (when the prey remained immobile), or fleeing (when it ran frantically in order to remove itself from the vicinity of the predator). Other studies, however, have suggested that the prey will adjust its behavior to risk level. The present study was designed to follow the attacks of a barn owl (Tyto alba) on common spiny mice (Acomys cahirinus) and social voles (Microtus socialis guntherei), in order to reveal the correspondence between the behavior of the owl, the risk level at each phase of the owl's attack, and the defensive behavior of the rodents. Results Spiny mice dramatically increased the traveled distance upon the appearance of the owl, and kept moving during its attack while taking long trajectories of locomotion. Defensive response in voles dichotomized: in some voles traveled distance dropped when the owl appeared, reaching zero during its attack. In other voles, traveled distance dramatically increased once the owl appeared and further increased under its attack. These defensive responses developed by gradual tuning of normal locomotor behavior in accordance with the level of risk. Conclusions The phenotypic difference in defensive behavior between voles and spiny mice probably stems from their different habitats and motor capacities. Agility and running capacity, together with a relatively sheltered natural habitat, make fleeing the most appropriate response for spiny mice during owl attack. Clumsiness and relatively limited motor capacities, together with an open natural habitat, account for the dichotomy to freezing or fleeing in voles. Thus, the apparent species-specific anti-predator response in spiny mice and voles is based on species-specific normal locomotor behavior, which depends on the species-specific ecology and motor capacity, and behaviors like defensive attack or escape jump that are specific to life threat. The latter

  19. Violence and Victimization During Incarceration: Relations to Psychosocial Adjustment During Reentry to the Community.

    PubMed

    Schappell, Ashley; Docherty, Meagan; Boxer, Paul

    2016-01-01

    We surveyed male ex-offenders (N = 100) about their experiences during and prior to incarceration to assess the role of these factors in psychosocial adjustment postrelease. Participants completed measures of preincarceration mental health problems and severe victimization and feelings of safety during incarceration; they also self-reported emotional distress, antisocial behavior, and posttraumatic stress (PTS). Moderator analyses of PTS outcomes revealed two key interactions between preincarceration mental health problems and severe victimization during incarceration as well as preincarceration mental health problems by feelings of safety during incarceration. In those without preincarceration mental health problems, victimization and PTS were significantly positively related; this was not the case for those with preexisting mental problems. Furthermore, the positive relation between feeling unsafe and PTS was stronger among those with preexisting mental problems. Findings are discussed with respect to implications for reentry services. PMID:26830297

  20. The contribution of the anaesthetist to risk-adjusted mortality after cardiac surgery.

    PubMed

    Papachristofi, O; Sharples, L D; Mackay, J H; Nashef, S A M; Fletcher, S N; Klein, A A

    2016-02-01

    It is widely accepted that the performance of the operating surgeon affects outcomes, and this has led to the publication of surgical results in the public domain. However, the effect of other members of the multidisciplinary team is unknown. We studied the effect of the anaesthetist on mortality after cardiac surgery by analysing data collected prospectively over ten years of consecutive cardiac surgical cases from ten UK centres. Casemix-adjusted outcomes were analysed in models that included random-effects for centre, surgeon and anaesthetist. All cardiac surgical operations for which the EuroSCORE model is appropriate were included, and the primary outcome was in-hospital death up to three months postoperatively. A total of 110 769 cardiac surgical procedures conducted between April 2002 and March 2012 were studied, which included 127 consultant surgeons and 190 consultant anaesthetists. The overwhelming factor associated with outcome was patient risk, accounting for 95.75% of the variation for in-hospital mortality. The impact of the surgeon was moderate (intra-class correlation coefficient 4.00% for mortality), and the impact of the anaesthetist was negligible (0.25%). There was no significant effect of anaesthetist volume above ten cases per year. We conclude that mortality after cardiac surgery is primarily determined by the patient, with small but significant differences between surgeons. Anaesthetists did not appear to affect mortality. These findings do not support public disclosure of cardiac anaesthetists' results, but substantially validate current UK cardiac anaesthetic training and practice. Further research is required to establish the potential effects of very low anaesthetic caseloads and the effect of cardiac anaesthetists on patient morbidity. PMID:26511481

  1. Is low IQ related to risk of death by homicide? Testing a hypothesis using data from the Vietnam Experience Study.

    PubMed

    Batty, George David; Mortensen, Laust H; Gale, Catharine R; Deary, Ian J

    2008-10-30

    Lower IQ test scores are related to an increased risk of violent assault. We tested the relation between IQ and death by homicide. In a prospective cohort study of 14,537 men (21 homicides), the association between lower IQ and an increased risk of homicide was lost after multiple adjustment. PMID:18718672

  2. 76 FR 18990 - Revision of Patent Term Extension and Adjustment Provisions Relating to Appellate Review and...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-04-06

    ... and Provisional Applications, 60 FR 20195 (Apr. 25, 1995) (twenty-year patent term final rule). The... Term, 65 FR 56365 (Sept. 18, 2000) (patent term adjustment final rule). The patent term adjustment... May 29, 2000. See Changes to Implement Patent Term Adjustment Under Twenty-Year Patent Term, 65 FR...

  3. Adolescent RSA responses during an anger discussion task: Relations to emotion regulation and adjustment.

    PubMed

    Cui, Lixian; Morris, Amanda Sheffield; Harrist, Amanda W; Larzelere, Robert E; Criss, Michael M; Houltberg, Benjamin J

    2015-06-01

    The current study examined associations between adolescent respiratory sinus arrhythmia (RSA) during an angry event discussion task and adolescents' emotion regulation and adjustment. Data were collected from 206 adolescents (10-18 years of age, M age = 13.37). Electrocardiogram (ECG) and respiration data were collected from adolescents, and RSA values and respiration rates were computed. Adolescents reported on their own emotion regulation, prosocial behavior, and aggressive behavior. Multilevel latent growth modeling was employed to capture RSA responses across time (i.e., linear and quadratic changes; time course approach), and adolescent emotion regulation and adjustment variables were included in the model to test their links to RSA responses. Results indicated that high RSA baseline was associated with more adolescent prosocial behavior. A pattern of initial RSA decreases (RSA suppression) in response to angry event recall and subsequent RSA increases (RSA rebound) were related to better anger and sadness regulation and more prosocial behavior. However, RSA was not significantly linked to adolescent aggressive behavior. We also compared the time course approach with the conventional linear approach and found that the time course approach provided more meaningful and rich information. The implications of adaptive RSA change patterns are discussed. PMID:25642723

  4. Adolescent RSA Responses during an Anger Discussion Task: Relations to Emotion Regulation and Adjustment

    PubMed Central

    Cui, Lixian; Morris, Amanda Sheffield; Harrist, Amanda W.; Larzelere, Robert E.; Criss, Michael M.; Houltberg, Benjamin J.

    2015-01-01

    The current study examined associations between adolescent respiratory sinus arrhythmia (RSA) during an angry event discussion task and adolescents’ emotion regulation and adjustment. Data were collected from 206 adolescents (10–18 years old, M age = 13.37). Electrocardiogram (ECG) and respiration data were collected from adolescents, and RSA values and respiration rates were computed. Adolescents reported on their own emotion regulation, prosocial behavior, and aggressive behavior. Multi-level latent growth modeling was employed to capture RSA responses across time (i.e., linear and quadratic changes; time course approach), and adolescent emotion regulation and adjustment variables were included in the model to test their links to RSA responses. Results indicated that high RSA baseline was associated with more adolescent prosocial behavior. A pattern of initial RSA decreases (RSA suppression) in response to angry event recall and subsequent RSA increases (RSA rebound) were related to better anger and sadness regulation and more prosocial behavior. However, RSA was not significantly linked to adolescent aggressive behavior. We also compared the time course approach with the conventional linear approach and found that the time course approach provided more meaningful and rich information. The implications of adaptive RSA change patterns are discussed. PMID:25642723

  5. Comparison of Rx-defined morbidity groups and diagnosis- based risk adjusters for predicting healthcare costs in Taiwan

    PubMed Central

    2010-01-01

    Background Medication claims are commonly used to calculate the risk adjustment for measuring healthcare cost. The Rx-defined Morbidity Groups (Rx-MG) which combine the use of medication to indicate morbidity have been incorporated into the Adjusted Clinical Groups (ACG) Case Mix System, developed by the Johns Hopkins University. This study aims to verify that the Rx-MG can be used for adjusting risk and for explaining the variations in the healthcare cost in Taiwan. Methods The Longitudinal Health Insurance Database 2005 (LHID2005) was used in this study. The year 2006 was chosen as the baseline to predict healthcare cost (medication and total cost) in 2007. The final sample size amounted to 793 239 (81%) enrolees, and excluded any cases with discontinued enrolment. Two different kinds of models were built to predict cost: the concurrent model and the prospective model. The predictors used in the predictive models included age, gender, Aggregated Diagnosis Groups (ADG, diagnosis- defined morbidity groups), and Rx-defined Morbidity Groups. Multivariate OLS regression was used in the cost prediction modelling. Results The concurrent model adjusted for Rx-defined Morbidity Groups for total cost, and controlled for age and gender had a better predictive R-square = 0.618, compared to the model adjusted for ADGs (R2 = 0.411). The model combined with Rx-MGs and ADGs performed the best for concurrently predicting total cost (R2 = 0.650). For prospectively predicting total cost, the model combined Rx-MGs and ADGs (R2 = 0.382) performed better than the models adjusted by Rx-MGs (R2 = 0.360) or ADGs (R2 = 0.252) only. Similarly, the concurrent model adjusted for Rx-MGs predicting pharmacy cost had a better performance (R-square = 0.615), than the model adjusted for ADGs (R2 = 0.431). The model combined with Rx-MGs and ADGs performed the best in concurrently as well as prospectively predicting pharmacy cost (R2 = 0.638 and 0.505, respectively). The prospective models showed a

  6. Relative Age Effects in Athletic Sprinting and Corrective Adjustments as a Solution for Their Removal

    PubMed Central

    2015-01-01

    Relative Age Effects (RAEs) refer to the selection and performance differentials between children and youth who are categorized in annual-age groups. In the context of Swiss 60m athletic sprinting, 7761 male athletes aged 8 – 15 years were analysed, with this study examining whether: (i) RAE prevalence changed across annual age groups and according to performance level (i.e., all athletes, Top 50%, 25% & 10%); (ii) whether the relationship between relative age and performance could be quantified, and corrective adjustments applied to test if RAEs could be removed. Part one identified that when all athletes were included, typical RAEs were evident, with smaller comparative effect sizes, and progressively reduced with older age groups. However, RAE effect sizes increased linearly according to performance level (i.e., all athletes – Top 10%) regardless of age group. In part two, all athletes born in each quartile, and within each annual age group, were entered into linear regression analyses. Results identified that an almost one year relative age difference resulted in mean expected performance differences of 10.1% at age 8, 8.4% at 9, 6.8% at 10, 6.4% at 11, 6.0% at 12, 6.3% at 13, 6.7% at 14, and 5.3% at 15. Correction adjustments were then calculated according to day, month, quarter, and year, and used to demonstrate that RAEs can be effectively removed from all performance levels, and from Swiss junior sprinting more broadly. Such procedures could hold significant implications for sport participation as well as for performance assessment, evaluation, and selection during athlete development. PMID:25844642

  7. Heterogeneity of variation of relative risk by age at exposure in the Japanese atomic bomb survivors.

    PubMed

    Little, Mark P

    2009-08-01

    General reductions in cancer relative risk with increasing age at exposure are observed in the Japanese atomic bomb survivors and in other groups. However, there has been little evidence of heterogeneity in such trends by cancer type within the Japanese cohort, nor for cancer-type variations in other factors (sex, attained age) that modify relative risk. A recent report on the Japanese atomic bomb survivors published by Preston et al. in 2007 suggests that solid cancer relative risk exhibits a U-shaped relationship with age at exposure, and is initially decreasing and then increasing at older exposure ages. In this report, we reanalyse the latest Japanese atomic bomb survivor solid cancer mortality and incidence data analysed by Preston and co-workers, stratifying by cancer subtype where possible, the stratification being both in relation to the baseline and the radiation-associated excess. We find highly statistically significant (P < 0.001) variations of relative risk by cancer type, and statistically significant variations by cancer type in the adjustments for sex (P = 0.010) and age at exposure (P = 0.013) to the relative risk. There is no statistically significant (P > 0.2) variation by cancer type in the adjustment of relative risk for attained age. Although, for all incident solid cancers, there is marginally statistically significant (P = 0.033) variation of relative risk with a quadratic log-linear function of age at exposure, there is much weaker variation in the relative risk of solid cancer mortality (P > 0.1). However, the manner in which relative risk varies with age at exposure is qualitatively similar for incidence and mortality, so one should not make too much of these differences between the two datasets. Stratification by solid cancer type slightly weakens the evidence for quadratic variation in relative risk by age at exposure (P = 0.060). PMID:19471953

  8. Risk-adjusted comparison of blood pressure and Low-Density (LDL) non-control in primary care offices

    PubMed Central

    Hammermeister, Karl; Bronsert, Michael; Henderson, William G.; Coombs, Letoynia; Hosokawa, Patrick; Brandt, Elias; Bryan, Cathy; Valuck, Robert; West, David; Liaw, Winston; Ho, Michael; Pace, Wilson

    2014-01-01

    Background Population-level control of modifiable cardiovascular disease (CVD) risk factors is suboptimal. Objectives 1) To demonstrate the use of electronically downloaded electronic health record (EHR) data to assess guideline concordance in a large cohort of primary care patients, 2) To provide a contemporary assessment of BP and LDL non-control in primary care, and 3) To demonstrate the effect of risk adjustment of rates of non-control of BP and LDL for differences in patient mix on these clinic-level performance measures. Design Observational comparative effectiveness. Patients All 232,172 adult patients ≥age 18 with ≥1 visit within two years in 33 primary care clinics with electronic health records (EHR). Interventions None. Main Measures Rates of BP and LDL non-control, based on current guidelines, were calculated from electronically downloaded EHR data. Non-control rates were risk-adjusted using multi-variable models of patient-level variables. Key Results Overall, 16.0% of the 227,122 patients with known BP and 14.9% of the 136,771 patients with known LDL were uncontrolled. Clinic-level risk-adjusted BP non-control ranged from 7.7% to 26.5%, while that for LDL ranged from 5.8% to 23.6%. Non-control rates exceeded an achievable benchmark for 85% (28/33) and 79% (26/33) of clinics for BP and LDL, respectively. Risk-adjustment significantly influences clinic rank order for rate of non-control. Conclusions We have demonstrated that the use of electronic collection of data on a large number of patients from fee-for-services, primary care clinics required for the audit and feedback of BP and LDL non-control is feasible. Non-control rates for most clinics are substantially higher than that achievable. Risk-adjustment of non-control rates results in very different clinic rank-order of clinics from non-adjusted data. PMID:24204062

  9. Toward the Development of Integrative Risk-Adjusted Measures of Quality Using Large Clinical Data Bases: The Case of Anesthesia Services.

    ERIC Educational Resources Information Center

    Fleming, Steven T.

    1992-01-01

    The concept of risk-adjusted measures of quality is discussed, and a methodology is proposed for risk-adjusting and integrating multiple adverse outcomes of anesthesia services into measures for quality assurance and quality improvement programs. Although designed for a new anesthesiology database, the methods should apply to other health…

  10. Parental dysphoria and children's adjustment: marital conflict styles, children's emotional security, and parenting as mediators of risk.

    PubMed

    Du Rocher Schudlich, Tina D; Cummings, E Mark

    2007-08-01

    Dimensions of martial conflict, children's emotional security regarding interparental conflict, and parenting style were examined as mediators between parental dysphoria and child adjustment. A community sample of 262 children, ages 8-16, participated with their parents. Behavioral observations were made of parents' interactions during marital conflict resolution tasks, which children later observed to assess their emotional security. Questionnaires assessed parents' dysphoria, parenting, and children's adjustment. Structural equation modeling indicated that parental dysphoria was linked with child adjustment through specific and distinct mediating family processes, including marital conflict and parenting. Children's emotional security in the context of particular marital conflict styles also mediated relations between parental dysphoria and child adjustment problems, with similar pathways found for mothers and fathers. These pathways remained significant even after significant parenting contributions were considered. PMID:17390219

  11. Pressure and performance: buffering capacity and the cyclical impact of accreditation inspections on risk-adjusted mortality.

    PubMed

    Towers, Tyler J; Clark, Jonathan

    2014-01-01

    The Joint Commission's move toward unannounced site visits in 2006 clearly underscores its goal to ensure more consistent compliance with its standards among accredited hospitals between site visits. As Joint Commission standards are intended to inform a host of practices associated with preventing adverse patient outcomes, and accreditation is intended to signal a satisfactory level of adoption of these practices, there should be no significant fluctuation in patient outcomes if hospital compliance remains sufficiently consistent before, during, and after an accreditation site visit, ceteris paribus. However, prior research on the implementation of practices in healthcare organizations (especially those practices related to quality improvement) points to the likelihood of inconsistency in the use of such practices, even after they have been "adopted." This inconsistency may emerge from shifts in manager attention patterns that may be driven by (1) resource constraints that preclude managers from dedicating consistent and perpetual attention to any given program or initiative and (2) accreditation pressures that are predictably cyclical even when site visits are, technically, unannounced. If these shifts in organizational attention patterns are sufficiently salient, we might expect to see patient outcomes ebb and flow with accreditation site visits. In this study, we explore this possibility by examining monthly patterns in risk-adjusted mortality rates around accreditation site visits. As shifts in organizational attention may be linked to resource constraints, we also explore the role of slack resources in shielding healthcare organizations from the ebbs and flows of external pressures, a capability we term buffering capacity. PMID:25647951

  12. 48 CFR 215.404-71-3 - Contract type risk and working capital adjustment.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ...) Description. The contract type risk factor focuses on the degree of cost risk accepted by the contractor under... Base (item 20) Profit objective 24. CONTRACT type risk (1) (2) (3) Cost financed Length factor Interest...., cost and performance incentives) that place a high degree of risk on the contractor; (iv) FMS...

  13. 48 CFR 215.404-71-3 - Contract type risk and working capital adjustment.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ...) Description. The contract type risk factor focuses on the degree of cost risk accepted by the contractor under... Base (item 20) Profit objective 24. CONTRACT type risk (1) (2) (3) Cost financed Length factor Interest...., cost and performance incentives) that place a high degree of risk on the contractor; (iv) FMS...

  14. 48 CFR 215.404-71-3 - Contract type risk and working capital adjustment.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ...) Description. The contract type risk factor focuses on the degree of cost risk accepted by the contractor under... Base (item 20) Profit objective 24. CONTRACT type risk (1) (2) (3) Cost financed Length factor Interest...., cost and performance incentives) that place a high degree of risk on the contractor; (iv) FMS...

  15. GPS and Relative Sea-level Constraints on Glacial Isostatic Adjustment in North America

    NASA Astrophysics Data System (ADS)

    James, T. S.; Simon, K.; Henton, J. A.; Craymer, M.

    2015-12-01

    Recently, new GIA models have been developed for the Innuitian Ice Sheet and for the north-central portion of the Laurentide Ice Sheet (Simon, 2014; Simon et al., 2015). This new combined model, herein called Innu-Laur15, was developed from the ICE-5G model and load adjustments were made to improve the fit to relative sea-level observations and to GPS-constrained vertical crustal motion in the Canadian Arctic Archipelago and around Hudson Bay. Here, the predictions of Innu-Laur15 are compared to observations and other GIA models over an extended region comprising much of North America east of the Rocky Mountains. GIA predictions are made using compressible Maxwell Earth models with gravitationally self-consistent ocean loading, changing coastlines, and ocean-water inundation where marine ice retreats or floats. For this study, GPS time series are the NA12 solution (Blewitt et al., 2013) downloaded from http://geodesy.unr.edu/NGLStationPages/GlobalStationList and fit with a linear trend, annual and semi-annual terms, and offsets as indicated by station logs and by inspection of the time series. For example, a comparison of GPS observations of vertical crustal motion from the NA12 solution at 360 sites gives root-mean-square (RMS) residuals of 3.2 mm/yr (null hypothesis), 1.8 mm/yr (Innu-Laur15), and 2.9 mm/yr (ICE-5G) for the VM5a Earth model. Preliminary comparisons with other Earth models give similar patterns where Innu-Laur15 provides a better fit than ICE-5G. Further adjustments to the Innu-Laur15 ice sheet history could improve the fit to GPS rates in other regions of North America.

  16. Association between Variants in Atopy-Related Immunologic Candidate Genes and Pancreatic Cancer Risk

    PubMed Central

    Cotterchio, Michelle; Lowcock, Elizabeth; Bider-Canfield, Zoe; Lemire, Mathieu; Greenwood, Celia; Gallinger, Steven; Hudson, Thomas

    2015-01-01

    Background Many epidemiology studies report that atopic conditions such as allergies are associated with reduced pancreas cancer risk. The reason for this relationship is not yet understood. This is the first study to comprehensively evaluate the association between variants in atopy-related candidate genes and pancreatic cancer risk. Methods A population-based case-control study of pancreas cancer cases diagnosed during 2011-2012 (via Ontario Cancer Registry), and controls recruited using random digit dialing utilized DNA from 179 cases and 566 controls. Following an exhaustive literature review, SNPs in 180 candidate genes were pre-screened using dbGaP pancreas cancer GWAS data; 147 SNPs in 56 allergy-related immunologic genes were retained and genotyped. Logistic regression was used to estimate age-adjusted odd ratio (AOR) for each variant and false discovery rate was used to adjust Wald p-values for multiple testing. Subsequently, a risk allele score was derived based on statistically significant variants. Results 18 SNPs in 14 candidate genes (CSF2, DENND1B, DPP10, FLG, IL13, IL13RA2, LRP1B, NOD1, NPSR1, ORMDL3, RORA, STAT4, TLR6, TRA) were significantly associated with pancreas cancer risk. After adjustment for multiple comparisons, two LRP1B SNPs remained statistically significant; for example, LRP1B rs1449477 (AA vs. CC: AOR=0.37, 95% CI: 0.22-0.62; p (adjusted)=0.04). Furthermore, the risk allele score was associated with a significant reduction in pancreas cancer risk (p=0.0007). Conclusions Preliminary findings suggest certain atopy-related variants may be associated with pancreas cancer risk. Further studies are needed to replicate this, and to elucidate the biology behind the growing body of epidemiologic evidence suggesting allergies may reduce pancreatic cancer risk. PMID:25945796

  17. Using risk adjustment approaches in child welfare performance measurement: Applications and insights from health and mental health settings

    PubMed Central

    Raghavan, Ramesh

    2014-01-01

    Federal policymaking in the last decade has dramatically expanded performance measurement within child welfare systems, and states are currently being fiscally penalized for poor performance on defined outcomes. However, in contrast to performance measurement in health settings, current policy holds child welfare systems solely responsible for meeting outcomes, largely without taking into account the effects of factors at the level of the child, and his or her social ecology, that might undermine the performance of child welfare agencies. Appropriate measurement of performance is predicated upon the ability to disentangle individual, as opposed to organizational, determinants of outcomes, which is the goal of risk adjustment methodologies. This review briefly conceptualizes and examines risk adjustment approaches in health and child welfare, suggests approaches to expanding its use to appropriately measure the performance of child welfare agencies, and highlights research gaps that diminish the appropriate use of risk adjustment approaches – and which consequently suggest the need for caution – in policymaking around performance measurement of child welfare agencies. PMID:25253917

  18. Bearded Reedlings Adjust Their Pair-Bond Behaviour in Relation to the Sex and Attractiveness of Unpaired Conspecifics

    PubMed Central

    Hoi, Herbert; Griggio, Matteo

    2012-01-01

    An individual's investment in mating or keeping a pair bond intact may be influenced not only by the attractiveness of its current mate, but also by that of other potential mates. In this study, we investigated the effect of relative attractiveness on pair-bond behaviour in bearded reedlings, Panurus biarmicus. We showed that mate attractiveness, in terms of beard length in males and tail length in females, influenced courtship behaviour when the pair was kept isolated. In the presence of a conspecific, contact initiations within a pair increased. This increment was mainly related to the sex of the unpaired conspecific, however, and less to differences in attractiveness between the current partner and the unpaired conspecific. Female contact initiations towards potential extra mates were independent of male attractiveness, whereas male contact behaviour was significantly influenced by female attractiveness. However, females displayed more contact initiations to their current mate when they were less attractive than the unpaired females. Males decreased their overtures towards other females with increasing attractiveness of their current mates. Overall, our results suggested that, when there was a risk of losing their mate, bearded reedlings adjust their pair-bond investment mainly in response to the presence or absence of a competitor, and fine-tune investment to a lesser extent in response to the attractiveness of that potential competitor. PMID:22393449

  19. Maternal depression across the first years of life compromises child psychosocial adjustment; relations to child HPA-axis functioning.

    PubMed

    Apter-Levi, Yael; Pratt, Maayan; Vakart, Adam; Feldman, Michal; Zagoory-Sharon, Orna; Feldman, Ruth

    2016-02-01

    Maternal depression across the first years of life negatively impacts children's development. One pathway of vulnerability may involve functioning of the hypothalamic-pituitary-adrenal (HPA) axis. We utilize a community cohort of 1983 women with no comorbid risk repeatedly assessed for depression from birth to six years to form two groups; chronically depressed (N=40) and non-depressed (N=91) women. At six years, mother and child underwent psychiatric diagnosis, child salivary cortisol (CT) was assessed three times during a home-visit, mother-child interaction was videotaped, and child empathy was coded from behavioral paradigms. Latent Growth curve Model using Structural Equation Modeling (SEM) estimated the links between maternal depression and mother's negative parenting and three child outcomes; psychopathology, social withdrawal, and empathy as related to child CT baseline and variability. Depressed mothers displayed more negative parenting and their children showed more Axis-I psychopathology and social withdrawal. SEM analysis revealed that maternal depression was associated with reduced CT variability, which predicted higher child psychopathology and social withdrawal. Whereas all children exhibited similar initial levels of CT, children of controls reduced CT levels over time while children of depressed mothers maintained high, non-flexible levels. Mother negativity was related to lower initial CT levels, which predicted decreased empathy. Findings suggest that chronic maternal depression may compromise children's social-emotional adjustment by diminishing HPA-system flexibility as well as limiting the mother's capacity to provide attuned and predictable caregiving. PMID:26610204

  20. Relations of Effortful Control, Reactive Undercontrol, and Anger to Chinese Children’s Adjustment

    PubMed Central

    Eisenberg, Nancy; Ma, Yue; Chang, Lei; Zhou, Qing; West, Stephen G.; Aiken, Leona

    2006-01-01

    The purpose of the study was to examine the zero-order and unique relations of effortful attentional and behavioral regulation, reactive impulsivity, and anger/frustration to Chinese first and second graders’ internalizing and externalizing symptoms, as well as the prediction of adjustment from the interaction of anger/frustration and effortful control or impulsivity. A parent and teacher reported on children’s anger/frustration, effortful control, and impulsivity; parents reported on children’s internalizing symptoms; and teachers and peers reported on children’s externalizing symptoms. Children were classified as relatively high on externalizing (or comorbid), internalizing, or nondisordered. High impulsivity and teacher-reported anger/frustration, and low effortful control, were associated with externalizing problems whereas low effortful control and high parent-reported anger were predictive of internalizing problems. Unique prediction from effortful and reactive control was obtained and these predictors (especially when reported by teachers) often interacted with anger/frustration when predicting problem behavior classification. PMID:17459176

  1. Cortical delta activity reflects reward prediction error and related behavioral adjustments, but at different times.

    PubMed

    Cavanagh, James F

    2015-04-15

    Recent work has suggested that reward prediction errors elicit a positive voltage deflection in the scalp-recorded electroencephalogram (EEG); an event sometimes termed a reward positivity. However, a strong test of this proposed relationship remains to be defined. Other important questions remain unaddressed: such as the role of the reward positivity in predicting future behavioral adjustments that maximize reward. To answer these questions, a three-armed bandit task was used to investigate the role of positive prediction errors during trial-by-trial exploration and task-set based exploitation. The feedback-locked reward positivity was characterized by delta band activities, and these related EEG features scaled with the degree of a computationally derived positive prediction error. However, these phenomena were also dissociated: the computational model predicted exploitative action selection and related response time speeding whereas the feedback-locked EEG features did not. Compellingly, delta band dynamics time-locked to the subsequent bandit (the P3) successfully predicted these behaviors. These bandit-locked findings included an enhanced parietal to motor cortex delta phase lag that correlated with the degree of response time speeding, suggesting a mechanistic role for delta band activities in motivating action selection. This dissociation in feedback vs. bandit locked EEG signals is interpreted as a differentiation in hierarchically distinct types of prediction error, yielding novel predictions about these dissociable delta band phenomena during reinforcement learning and decision making. PMID:25676913

  2. Affect and Acceptability: Exploring Teachers' Technology-Related Risk Perceptions

    ERIC Educational Resources Information Center

    Howard, Sarah K.

    2011-01-01

    Educational change, such as technology integration, involves risk. Teachers are encouraged to "take risks", but what risks they are asked to take and how do they perceive these risks? Developing an understanding of teachers' technology-related risk perceptions can help explain their choices and behaviours. This paper presents a way to understand…

  3. A toolbox for health risk related decisions

    SciTech Connect

    Easterly, C.E.; Jones, T.D.

    1996-10-01

    Development efforts since the late 1970s have resulted in a generalized method for ranking health hazards. This method provides the basis for a wide range of applications where decisions are needed for allocating resources on the basis of health risk considerations. It has been used for more than a decade to solve real problems, and it is supported by 23 publications in the open literature. The diversity of this generalized methodology allows us to provide support in a great number of problem areas. we give four examples in this manuscript: the relative toxicities of petroleum mixtures; a method to derive Emergency Response Planning Guides; an estimate of the possible carcinogenic potency of tungsten, an alternative material to depleted uranium for heavy armor penetrators; and an approach to low dose extrapolation. Our experience suggests that many more applications of the original concept and variations on it can be of utility in military situations. Some potentially fruitful areas may be in the: development of a health-risk-ranking system for alternative solutions to manufacturing, waste management, and remediation; provision of a basis for identifying levels of hazardous agents which are below health concerns, or which should be of concern; development of a framework for evaluating chemicals and radioactive materials on the same basis, and in the development of a battery of in vitro bioassays which could take the place of long-term whole animal tests.

  4. Interpersonal circumplex descriptions of psychosocial risk factors for physical illness: application to hostility, neuroticism, and marital adjustment.

    PubMed

    Smith, Timothy W; Traupman, Emily K; Uchino, Bert N; Berg, Cynthia A

    2010-06-01

    Personality risk factors for physical illness are typically studied individually and apart from risk factors reflecting the social environment, potentially fostering a piecemeal understanding of psychosocial influences on health. Because it can be used to describe both personality and social relationship processes, the interpersonal circumplex (IPC) provides an integrative approach to psychosocial risk. In 301 married couples we examined IPC correlates of 3 risk factor domains: anger, hostility, and aggressiveness; neuroticism; and marital adjustment. Risk factors displayed IPC locations ranging from hostile dominance (e.g., verbal aggressiveness, marital conflict) to hostility (e.g., anger) to hostile submissiveness (e.g., anxiety, depression); protective factors (marital satisfaction and support) reflected warmth or friendliness in the IPC. Similar descriptions were found using self-reports and spouse ratings of IPC dimensions, indicating that interpersonal styles associated with risk factors do not simply reflect common method variance. Findings identify interpersonal processes reflecting low affiliation or high hostility as a common component of risk and indicate distinctions among risk factors along the dominance dimension. PMID:20573134

  5. 77 FR 49354 - Revision of Patent Term Adjustment Provisions Relating to Appellate Review

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-08-16

    ... Implement 20-Year Patent Term and Provisional Applications, 60 FR 20195 (Apr. 25, 1995) (twenty-year patent... September of 2000. See Changes to Implement Patent Term Adjustment Under Twenty-Year Patent Term, 65 FR..., 2000. See Changes to Implement Patent Term Adjustment Under Twenty-Year Patent Term, 65 FR at...

  6. Evaluating the Investment Benefit of Multinational Enterprises' International Projects Based on Risk Adjustment: Evidence from China

    ERIC Educational Resources Information Center

    Chen, Chong

    2016-01-01

    This study examines the international risks faced by multinational enterprises to understand their impact on the evaluation of investment projects. Moreover, it establishes a 'three-dimensional' theoretical framework of risk identification to analyse the composition of international risk indicators of multinational enterprises based on the theory…

  7. Disability and risk of school related injury

    PubMed Central

    Ramirez, M; Peek-Asa, C; Kraus, J

    2004-01-01

    Objective: Approximately six million children with disabilities attend school in the United States. Cognitive and physical limitations may compromise their ability to handle environmental hazards and hence increase their risk for injury. The objective of this study was to describe the epidemiology of school related injury among children enrolled in 17 special education schools in one large, urban school district. Design: Altogether 6769 schoolchildren with disabilities were followed up from 1994–98. Injury and population data were collected from pupil accident reports and existing school records. Associations were estimated through generalized estimating equations. Results: A total of 697 injuries were reported for a rate of 4.7/100 students per year. Children with multiple disabilities had a 70% increased odds of injury compared with the developmentally disabled (odds ratio (OR) 1.7, 95% confidence interval (CI) 1.3 to 2.3). The physically disabled (OR 1.4, 95% CI 1.0 to 1.9) had a modest increased odds of injury. Cuts, bruises, and abrasions composed almost three fourths of all injuries; almost half of these injuries were to the face. Falls (34%) and insults by other students (31%) were the most common external causes. More than a fourth of injuries were sports related, and 21% occurred on the playground/athletic field. Injury patterns differed across disabilities. Conclusions: Although limited to one school district, the population studied is the largest cohort thus far of schoolchildren with disabilities. With this large study base, potentially high risk groups were identified and circumstances of injury described. This information is imperative for developing and improving school based injury prevention measures. PMID:14760022

  8. Do Cardiometabolic Risk Factors Relative Risks Differ for the Occurrence of Ischemic Heart Disease and Stroke?

    PubMed Central

    Aalami Harandi, Samaneh; Sarrafzadegan, Nizal; Sadeghi, Masoumeh; Talaei, Mohammad; Dianatkhah, Mino; Oveisgharan, Shahram; Pourmoghaddas, Ali; Salehi, Asma; Sedighifard, Zohre

    2016-01-01

    Background: The effects of the risk factors of ischemic heart disease (IHD) and stroke on the occurrence of these diseases differ between different populations. Objectives: To study the difference in the effects of different cardiovascular (CVD) risk factors on the incidence of IHD and stroke in an Iranian adult population. Patients and Methods: The Isfahan Cohort Study (ICS) is a longitudinal study that followed up 6323 subjects older than 35 years with no history of CVD since 2001. Of the original sample, only 5431 participants were contacted and followed up until 2011. The end points were the occurrence of IHD (defined as fatal and non-fatal myocardial infarction, unstable angina, and sudden cardiac death) and stroke. After 10 years of follow-up, 564 new cases of IHD and 141 new cases of stroke were detected. The relative risks (RRs) of cardiometabolic risk factors such as hypertension, diabetes, hypercholesterolemia, hypertriglyceridemia, high low-density lipoprotein cholesterol (LDL-C) level, low high-density lipoprotein cholesterol (HDL-C) level, current smoking, obesity, high waist-to-hip ratio, family history of CVD, and metabolic syndrome were compared between IHD and stroke patients. The ratio of relative risks (RRR) was calculated for comparing two RRs and estimated adjusted RRR was calculated by using generalized linear regression with a log link and binomial distribution. Results: The RRs of the occurrence of IHD and stroke in diabetic patients were 1.94 and 3.26, respectively, and the difference was statistically different (P = 0.016). The RR of high LDL-C was significantly higher for IHD than for stroke (P = 0.045), while all the other risk factors showed similar RRs for IHD and stroke, with no significant difference in their RRR, including hypertension. Diabetes and hypertension had the highest RRs for IHD, followed by diabetes, metabolic syndrome, and hypertension for stroke. Conclusions: The effect of diabetes mellitus on stroke was more

  9. Pathways of Parenting Style on Adolescents' College Adjustment, Academic Achievement, and Alcohol Risk

    ERIC Educational Resources Information Center

    Kenney, Shannon R.; Lac, Andrew; Hummer, Justin F.; Grimaldi, Elizabeth M.; LaBrie, Joseph W.

    2015-01-01

    This study examined the pathways of parenting style (permissive, authoritarian, and authoritative) to alcohol consumption and consequences through the mediators of college adjustment and academic achievement (grade point average [GPA]). Participants were 289 students from a private, mid-size, West Coast university (mean age 19.01 years, 58.8%…

  10. Uncertainties in projected climate changes of the rainy season over West Africa related to bias adjustment

    NASA Astrophysics Data System (ADS)

    Nikulin, Grigory; Bosshard, Thomas; Wilcke, Renate; Yang, Wei; Kjellström, Erik; Bärring, Lars

    2015-04-01

    Bias adjustment has become an integral part of pre-processing of climate simulations for use in impact modeling studies. Considered now as a necessary step to deal with inability of climate models to accurately simulate the present/recent climate, bias adjustment is a statistical approach missing physical arguments. Even if bias adjustment is widely used nowadays it is still a topic for debates and criticism. One of the main questions is what level of uncertainty does bias adjustment introduce to future climate projections? In this study, using an ensemble of the CORDEX-Africa simulations, we investigate potential impact of bias adjustment on the simulated rainy season in West Africa. A number of characteristics reflecting different aspects of the rainy season are used, namely: onset and cessation of the rainy season, mean intensity, total amount of precipitation and intra-seasonal variability within the rainy season. All these characteristics are evaluated in the original CORDEX-Africa simulations and in bias-adjusted ones for a reference period first and then future climate projections of these characteristics are compared between two ensembles. Additionally, we examine how bias adjustment may impact selection of a smaller more manageable ensemble of regional climate simulations from a grand one.

  11. Exposure to Conflict and Violence across Contexts: Relations to Adjustment among Palestinian Children

    PubMed Central

    Dubow, Eric F.; Boxer, Paul; Huesmann, L. Rowell; Shikaki, Khalil; Landau, Simha; Gvirsman, Shira Dvir; Ginges, Jeremy

    2009-01-01

    Despite extensive literatures on the impact on children of exposure to violence in families, neighborhoods, and peer groups, there has been relatively little effort evaluating their cumulative impact. There also has been less attention to the effects of exposure to political conflict and violence. We collected data from a representative sample of 600 Palestinian youths (three age cohorts: 8, 11, and 14 years old) to evaluate the relation of exposure to political conflict and violence, and violence in the family, community, and school, to post-traumatic stress symptoms (PTS) and aggressive behavior. Results highlight the additive effects of exposure to political conflict and violence, suggesting that interventionists should consider the full spectrum of sources of environmental risk for PTS symptoms and aggressive behavior. PMID:20390802

  12. Do diagnosis-related group-based payments incentivise hospitals to adjust output mix?

    PubMed

    Liang, Li-Lin

    2015-04-01

    This study investigates whether the diagnosis-related group (DRG)-based payment method motivates hospitals to adjust output mix in order to maximise profits. The hypothesis is that when there is an increase in profitability of a DRG, hospitals will increase the proportion of that DRG (own-price effects) and decrease those of other DRGs (cross-price effects), except in cases where there are scope economies in producing two different DRGs. This conjecture is tested in the context of the case payment scheme (CPS) under Taiwan's National Health Insurance programme over the period of July 1999 to December 2004. To tackle endogeneity of DRG profitability and treatment policy, a fixed-effects three-stage least squares method is applied. The results support the hypothesised own-price and cross-price effects, showing that DRGs which share similar resources appear to be complements rather substitutes. For-profit hospitals do not appear to be more responsive to DRG profitability, possibly because of their institutional characteristics and bonds with local communities. The key conclusion is that DRG-based payments will encourage a type of 'product-range' specialisation, which may improve hospital efficiency in the long run. However, further research is needed on how changes in output mix impact patient access and pay-outs of health insurance. PMID:24519749

  13. Changes in academic adjustment and relational self-worth across the transition to middle school.

    PubMed

    Ryan, Allison M; Shim, Sungok Serena; Makara, Kara A

    2013-09-01

    Moving from elementary to middle school is a time of great transition for many early adolescents. The present study examined students' academic adjustment and relational self-worth at 6-month intervals for four time points spanning the transition from elementary school to middle school (N = 738 at time 1; 53 % girls; 54 % African American, 46 % European American). Grade point average (G.P.A.), intrinsic value for schoolwork, self-worth around teachers, and self-worth around friends were examined at every time point. The overall developmental trajectory indicated that G.P.A. and intrinsic value for schoolwork declined. The overall decline in G.P.A. was due to changes at the transition and across the first year in middle school. Intrinsic value declined across all time points. Self-worth around teachers was stable. The developmental trends were the same regardless of gender or ethnicity except for self-worth around friends, which was stable for European American students and increased for African American students due to an ascent at the transition into middle school. Implications for the education of early adolescents in middle schools are discussed. PMID:23873280

  14. Assessing changes in socioemotional adjustment across early school transitions-new national scales for children at risk.

    PubMed

    McDermott, Paul A; Watkins, Marley W; Rovine, Michael J; Rikoon, Samuel H

    2013-02-01

    This article reports the development and evidence for validity and application of the Adjustment Scales for Early Transition in Schooling (ASETS). Based on primary analyses of data from the Head Start Impact Study, a nationally representative sample (N=3077) of randomly selected children from low-income households is configured to inform developmental-transitional stability and change in socioemotional adjustment. Longitudinal exploratory and confirmatory factor analysis of the ASETS revealed behavioral dimensions of Aggression, Attention Seeking, Reticence/Withdrawal, Low Energy, and higher-order dimensions of Overactivity and Underactivity. Each dimension was vertically equated through IRT, with Bayesian scoring across 2 years of prekindergarten, kindergarten, and 1st grade. Multilevel modeling provides evidence for concurrent validity, assessment of future risk, and detection of differential growth trajectories across the 4 years of early school transition. PMID:23375175

  15. Risk and Protective Factors for Psychological Adjustment among Low-Income, African American Children

    ERIC Educational Resources Information Center

    Gabalda, Megan K.; Thompson, Martie P.; Kaslow, Nadine J.

    2010-01-01

    This investigation identifies unique risk and protective factors for internalizing and externalizing problems among 8- to 12-year-old, low-income, African American children and tests cumulative risk and protective models. A total of 152 mother-child dyads complete questionnaires. Receipt of food stamps, mother's distress, and child maltreatment…

  16. Why and when is ethnic harassment a risk for immigrant adolescents' school adjustment? understanding the processes and conditions.

    PubMed

    Bayram Özdemir, Sevgi; Stattin, Håkan

    2014-08-01

    Ethnically harassed immigrant youth are at risk for experiencing a wide range of school adjustment problems. However, it is still unclear why and under what conditions experiencing ethnic harassment leads to school adjustment difficulties. To address this limitation in the literature, we examined two important questions. First, we investigated whether self-esteem and/or depressive symptoms would mediate the associations between ethnic harassment and poor school adjustment among immigrant youth. Second, we examined whether immigrant youths' perception of school context would play a buffering role in the pathways between ethnic harassment and school adjustment difficulties. The sample (n = 330; M age = 14.07, SD = .90; 49% girls at T1) was drawn from a longitudinal study in Sweden. The results revealed that experiencing ethnic harassment led to a decrease in immigrant youths' self-esteem over time, and that youths' expectations of academic failure increased. Further, youths' relationships with their teachers and their perceptions of school democracy moderated the mediation processes. Specifically, when youth had poor relationships with their teachers or perceived their school context as less democratic, being exposed to ethnic harassment led to a decrease in their self-esteem. In turn, they reported low school satisfaction and perceived themselves as being unsuccessful in school. Such indirect effects were not observed when youth had high positive relationships with their teachers or perceived their school as offering a democratic environment. These findings highlight the importance of understanding underlying processes and conditions in the examination of the effects of ethnic devaluation experiences in order to reach a more comprehensive understanding of immigrant youths' school adjustment. PMID:24132501

  17. Medicare determinations and income-related monthly adjustment amounts to Medicare Part B premiums; conforming changes to regulations. Final rule.

    PubMed

    2014-03-01

    This final rule adopts, without change, the interim final rule with request for comments we published in the Federal Register on September 18, 2013. The interim final rule modified our rules regarding Medicare Part B income-related monthly adjustment amounts to conform to changes made to the Social Security Act (Act) and Internal Revenue Code by the Affordable Care Act. We also removed provisions that phased in income-related monthly adjustment amounts between 2007 and 2009 and updated a citation to reflect the transfer of authority for hearing appeals under title XVIII of the Act from the Social Security Administration to the Department of Health and Human Services. PMID:24611211

  18. Socially anxious mothers' narratives to their children and their relation to child representations and adjustment.

    PubMed

    Murray, Lynne; Pella, Jeff E; De Pascalis, Leonardo; Arteche, Adriane; Pass, Laura; Percy, Ray; Creswell, Catharine; Cooper, Peter J

    2014-11-01

    Anxious mothers' parenting, particularly transfer of threat information, has been considered important in their children's risk for social anxiety disorder (SAnxD), and maternal narratives concerning potential social threat could elucidate this contribution. Maternal narratives to their preschool 4- to 5-year-old children, via a picture book about starting school, were assessed in socially anxious (N = 73), and nonanxious (N = 63) mothers. Child representations of school were assessed via doll play (DP). After one school term, mothers (Child Behavior Checklist [CBCL]) and teachers (Teacher Report Form) reported on child internalizing problems, and child SAnxD was assessed via maternal interview. Relations between these variables, infant behavioral inhibition, and attachment, were examined. Socially anxious mothers showed more negative (higher threat attribution) and less supportive (lower encouragement) narratives than controls, and their children's DP representations SAnxD and CBCL scores were more adverse. High narrative threat predicted child SAnxD; lower encouragement predicted negative child CBCL scores and, particularly for behaviorally inhibited children, Teacher Report Form scores and DP representations. In securely attached children, CBCL scores and risk for SAnxD were affected by maternal anxiety and threat attributions, respectively. Low encouragement mediated the effects of maternal anxiety on child DP representations and CBCL scores. Maternal narratives are affected by social anxiety and contribute to adverse child outcome. PMID:25422977

  19. Effortful Control, Behavior Problems and Peer Relations: What Predicts Academic Adjustment in Kindergarteners from Low-income Families?

    PubMed Central

    Morris, Amanda Sheffield; John, Aesha; Halliburton, Amy L.; Morris, Michael D. S.; Robinson, Lara R.; Myers, Sonya S.; Aucoin, Katherine J.; Keyes, Angela W.; Terranova, Andrew

    2013-01-01

    This study examined the role of effortful control, behavior problems, and peer relations in the academic adjustment of 74 kindergarten children from primarily low-income families using a short-term longitudinal design. Teachers completed standardized measures of children’s effortful control, internalizing and externalizing problems, school readiness, and academic skills. Children participated in a sociometric interview to assess peer relations. Research Findings: Correlational analyses indicate that children’s effortful control, behavior problems in school, and peer relations are associated with academic adjustment variables at the end of the school year, including school readiness, reading skills, and math skills. Results of regression analyses indicate that household income and children’s effortful control primarily account for variation in children’s academic adjustment. The associations between children’s effortful control and academic adjustment did not vary across sex of the child or ethnicity. Mediational analyses indicate an indirect effect of effortful control on school readiness, through children’s internalizing problems. Practice or Policy: Effortful control emerged as a strong predictor of academic adjustment among kindergarten children from low-income families. Strategies for enhancing effortful control and school readiness among low-income children are discussed. PMID:24163572

  20. [Lifestyle-related risk factors for dementia].

    PubMed

    Phung, Thien Kieu Thi; Andersen, Kjeld; Kessing, Lars Vedel; Waldemar, Gunhild

    2006-10-01

    Emerging knowledge about modifiable risk factors for dementia has given rise to interventions that can potentially prevent or delay the onset of dementia and the possible target periods for intervention extend from prenatal period to old age. Factors during early life such as nutrition, education, and parental socioeconomic status can influence the development of dementia later in life. From mid to late life, a physically, socially, and intellectually active lifestyle is associated with reduced risk for dementia. Moreover, modification of cardiovascular risk factors during this period can potentially reduce risk for dementia. PMID:17032603

  1. Patient mobility for cardiac problems: a risk-adjusted analysis in Italy

    PubMed Central

    2013-01-01

    Background The Italian National Health System was revised in the last 20 years, introducing new elements such as efficacy, efficiency and competitiveness. Devolution to regional authorities has created a quasi-market system where patients can choose the hospital in which to be treated. Patient mobility therefore becomes an indicator of perceived hospital quality and of financial flows between the regions of Italy. Previous studies analyzed patient mobility in general or by specific disease/diagnosis-related groups but there is a lack of research on the influence of severity of patient condition. The aim of the study was to describe patient mobility, crude and stratified by disease severity, in cardiac surgery units of three health areas (HAs) in Tuscany (Italy). Methods In this retrospective observational study, data was gathered from hospital discharge records obtained from the Tuscan Regional Health Agency, Italy. The three HAs (HA1, HA2, HA3) recorded 25,017 planned hospitalizations in cardiac surgery units in the period 2001–2007. Patients were stratified in four All Patient Refined Diagnosis Related Group (APR-DRG) severity levels. Gandy’s nomogram was used to describe how HAs met health care demand and their capacity to attract patients. Cuzick’s test was used to identify significant differences in time trends. Results Raw data showed that the HAs met their own local health care demand. Stratifying by APR-DRG severity, it emerged that capacity to meet local demand remained unchanged for zero-to-minor severity levels, but one HA was less able to meet demand for moderate severity levels or to attract patients from other HAs and Regions of Italy. In fact, HA3 showed a decrease in admissions of local residents. Conclusions The study highlights important differences between the three HAs that were only revealed by severity stratification: unlike HA3, HA1 and HA2 seemed able to deal with local demand, even after severity stratification. Planners and

  2. The Relation of Marital Adjustment and Family Functions With Quality of Life in Women

    PubMed Central

    Basharpoor, Sajjad; Sheykholeslami, Ali

    2015-01-01

    Given the immense importance of marital relationships in the quality of life, this research was conducted in order to investigate the relationships between marital adjustment and family functions with quality of life in women. The design of the current study was correlational. Seven hundred and thirty women were selected randomly among all women living in the province of Western Azerbaijan (Iran) and participated in this study. The sample responded to the Family Assessment Device, Dyadic Adjustment scale and Quality of Life questionnaire, individually in their homes. Collected data were analyzed by Pearson’s correlation and multiple regression tests. The results showed that all dimensions of family functions and dyadic adjustment were positively correlated with quality of life in women. Results of multiple regression also revealed that 33 percent of total quality of life can be explained by family functions and 24 percent of this variable can be explained by dyadic adjustment. Our study demonstrated that women’s quality of life was affected by family functions and marital adjustment in family. PMID:27247668

  3. Risk-Adjusted Impact of Administrative Costs on the Distribution of Terminal Wealth for Long-Term Investment

    PubMed Central

    Guillén, Montserrat; Jarner, Søren Fiig; Pérez-Marín, Ana M.

    2014-01-01

    The impact of administrative costs on the distribution of terminal wealth is approximated using a simple formula applicable to many investment situations. We show that the reduction in median returns attributable to administrative fees is usually at least twice the amount of the administrative costs charged for most investment funds, when considering a risk-adjustment correction over a reasonably long-term time horizon. The example we present covers a number of standard cases and can be applied to passive investments, mutual funds, and hedge funds. Our results show investors the potential losses they face in performance due to administrative costs. PMID:25180200

  4. Parent birds assess nest predation risk and adjust their reproductive strategies

    USGS Publications Warehouse

    Fontaine, J.J.; Martin, T.E.

    2006-01-01

    Avian life history theory has long assumed that nest predation plays a minor role in shaping reproductive strategies. Yet, this assumption remains conspicuously untested by broad experiments that alter environmental risk of nest predation, despite the fact that nest predation is a major source of reproductive failure. Here, we examined whether parents can assess experimentally reduced nest predation risk and alter their reproductive strategies. We experimentally reduced nest predation risk and show that in safer environments parents increased investment in young through increased egg size, clutch mass, and the rate they fed nestlings. Parents also increased investment in female condition by increasing the rates that males fed incubating females at the nest, and decreasing the time that females spent incubating. These results demonstrate that birds can assess nest predation risk at large and that nest predation plays a key role in the expression of avian reproductive strategies. ?? 2006 Blackwell Publishing Ltd/CNRS.

  5. Risk of spontaneous preterm birth in relation to maternal experience of serious life events during pregnancy

    PubMed Central

    Barrios, Yasmin V; Sanchez, Sixto E; Qiu, Chunfang; Gelaye, Bizu; Williams, Michelle A

    2014-01-01

    Background The purpose of this study was to examine the risk of preterm birth (PTB) in relation to serious life events experienced during pregnancy in Peruvian women. Methods This case-control study included 479 PTB cases and 480 term controls. In-person interviews asked information regarding sociodemographics, medical and reproductive histories, and serious life events experienced during pregnancy. Multivariate logistic regression procedures were used to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs). Results Compared with women who did not experience a serious life event during pregnancy, those who experienced the following life events had a more than two-fold increased odds of PTB: death of first-degree relative (adjusted OR 2.10; 95% CI 1.38–3.20), divorce or separation (adjusted OR 2.09; 95% CI 1.10–4.00), financial troubles (adjusted OR 2.70; 95% CI 1.85–3.94), or serious fight with partner (adjusted OR 2.40; 95% CI 1.78–3.17). Women who experienced any serious life events during pregnancy had higher odds (adjusted OR 2.29; 95% CI 1.65–3.18) of suffering spontaneous preterm labor and preterm premature rupture of membranes (adjusted OR 2.19; 95% CI 1.56–3.08), compared with women who did not experience any such events. Associations of similar directions and extent were observed for severity of PTB (ie, very, moderate, or late PTB). The magnitude of the associations increased as increased frequency of serious life events (Ptrend <0.001). Conclusion Experiencing serious life events during pregnancy was associated with increased odds of PTB among Peruvian women. Interventions aimed at assisting women experiencing serious life events may reduce the risk of PTB. Future studies should include objective measures of stress and stress response to understand better the biological underpinnings of these associations. PMID:24591850

  6. Parental warmth, control, and indulgence and their relations to adjustment in Chinese children: a longitudinal study.

    PubMed

    Chen, X; Liu, M; Li, D

    2000-09-01

    A sample of children, initially 12 years old, in the People's Republic of China participated in this 2-year longitudinal study. Data on parental warmth, control, and indulgence were collected from children's self-reports. Information concerning social, academic, and psychological adjustment was obtained from multiple sources. The results indicated that parenting styles might be a function of child gender and change with age. Regression analyses revealed that parenting styles of fathers and mothers predicted different outcomes. Whereas maternal warmth had significant contributions to the prediction of emotional adjustment, paternal warmth significantly predicted later social and school achievement. It was also found that paternal, but not maternal, indulgence significantly predicted children's adjustment difficulties. The contributions of the parenting variables might be moderated by the child's initial conditions. PMID:11025932

  7. Social Risk and Protective Factors for African American Children's Academic Achievement and Adjustment during the Transition to Middle School

    ERIC Educational Resources Information Center

    Burchinal, Margaret R.; Roberts, Joanne E.; Zeisel, Susan A.; Rowley, Stephanie J.

    2008-01-01

    The transition to middle school is often marked by decreased academic achievement and increased emotional stress, and African American children exposed to social risk may be especially vulnerable during this transition. To identify mediators and protective factors, the authors related severity and timing of risk exposure to academic achievement…

  8. Exponentially weighted moving average charts to compare observed and expected values for monitoring risk-adjusted hospital indicators.

    PubMed

    Cook, D A; Coory, M; Webster, R A

    2011-06-01

    OBJECTIVE To introduce a new type of risk-adjusted (RA) exponentially weighted moving average (EWMA) chart and to compare it to a commonly used type of variable life adjusted display chart for analysis of patient outcomes. DATA Routine inpatient data on mortality following admission for acute myocardial infarction, from all public and private hospitals in Queensland, Australia. METHODS The RA-EWMA plots the EWMA of the observed and predicted values. Predicted values were obtained from a logistic regression model for all hospitals in Queensland. The EWMA of the predicted values is a moving centre line, reflecting current patient case mix at a particular hospital. Thresholds around this moving centre line provide a scale by which to assess the importance of trends in the EWMA of the observed values. RESULTS The RA-EWMA chart can be designed to have equivalent performance, in terms of average run lengths, as variable life adjusted display chart. The advantages of the RA-EWMA are that it communicates information about the current level of an indicator in a direct and understandable way, and it explicitly displays information about the current patient case mix. Also, because it is not reset, the RA-EWMA is a more natural chart to use in health, where it is exceedingly rare to stop or dramatically and abruptly alter a process of care. CONCLUSION The RA-EWMA chart is a direct and intuitive way to display information about an indicator while accounting for differences in case mix. PMID:21209145

  9. 20 CFR 418.1201 - When will we determine your income-related monthly adjustment amount based on the modified...

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... more recent tax year? 418.1201 Section 418.1201 Employees' Benefits SOCIAL SECURITY ADMINISTRATION... Recent Tax Year's Modified Adjusted Gross Income § 418.1201 When will we determine your income-related... more recent tax year? We will use a more recent tax year than the years described in § 418.1135(a)...

  10. An Examination of Relations among Taiwanese Elementary-Aged Children's Effortful Control, Social Relationships, and Adjustment at School

    ERIC Educational Resources Information Center

    Huang, Chin-Fang

    2010-01-01

    The purpose of the present study was to examine the relations among Taiwanese elementary school children's effortful control, social relationships and their adjustment at school. Data were gathered on 407 third- to sixth-grade children (81 third graders, 79 fourth graders, 116 fifth graders, and 131 sixth graders) attending three low- to…

  11. Family Relations and the Adjustment of Young Children of Mexican Descent: Do Family Cultural Values Moderate These Associations?

    ERIC Educational Resources Information Center

    Gamble, Wendy C.; Modry-Mandell, Kerri

    2008-01-01

    This study examined the role of family cultural values as moderators of the association between family relations and the adjustment of young children. Fifty-five families of Mexican descent with young children enrolled in Head Start programs in the Southwest participated. Mothers provided information about closeness of the mother-child…

  12. Self-Perceptions of Competence in Brazilian, Canadian, Chinese and Italian Children: Relations with Social and School Adjustment

    ERIC Educational Resources Information Center

    Chen, Xinyin; Zappulla, Carla; Coco, Alida Lo; Schneider, Barry; Kaspar, Violet; De Oliveira, Ana Maria; He, Yunfeng; Li, Dan; Li, Boshu; Bergeron, Natasha; Tse, Hennis Chi-Hang; DeSouza, Amanda

    2004-01-01

    The purpose of the present study was to examine relations between self-perceptions of competence and social, behavioural, and school adjustment in Brazilian, Canadian, Chinese, and Italian children. Self-perception data were collected through children's self-reports. Information about social behaviours, peer acceptance, and school achievement was…

  13. Reactive and Proactive Subtypes of Relational and Physical Aggression in Middle Childhood: Links to Concurrent and Longitudinal Adjustment

    ERIC Educational Resources Information Center

    Mathieson, Lindsay C.; Crick, Nicki R.

    2010-01-01

    Peer aggression in children is a serious issue that school psychologists often encounter on a daily basis. To develop a better understanding of aggression, it is important to look at specific subtypes of aggression and how they are related to adjustment difficulties. Past research has examined the links between reactive and proactive physical…

  14. 20 CFR 418.2322 - How will a Medicare Part B income-related monthly adjustment amount determination for the...

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 20 Employees' Benefits 2 2014-04-01 2014-04-01 false How will a Medicare Part B income-related monthly adjustment amount determination for the effective year affect your Medicare prescription drug coverage? 418.2322 Section 418.2322 Employees' Benefits SOCIAL SECURITY ADMINISTRATION MEDICARE...

  15. 20 CFR 418.1322 - How will a Medicare prescription drug coverage income-related monthly adjustment amount...

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 20 Employees' Benefits 2 2012-04-01 2012-04-01 false How will a Medicare prescription drug coverage income-related monthly adjustment amount determination for the effective year affect your Medicare Part B? 418.1322 Section 418.1322 Employees' Benefits SOCIAL SECURITY ADMINISTRATION MEDICARE...

  16. 20 CFR 418.2322 - How will a Medicare Part B income-related monthly adjustment amount determination for the...

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 20 Employees' Benefits 2 2011-04-01 2011-04-01 false How will a Medicare Part B income-related monthly adjustment amount determination for the effective year affect your Medicare prescription drug coverage? 418.2322 Section 418.2322 Employees' Benefits SOCIAL SECURITY ADMINISTRATION MEDICARE...

  17. 20 CFR 418.1322 - How will a Medicare prescription drug coverage income-related monthly adjustment amount...

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 20 Employees' Benefits 2 2014-04-01 2014-04-01 false How will a Medicare prescription drug coverage income-related monthly adjustment amount determination for the effective year affect your Medicare Part B? 418.1322 Section 418.1322 Employees' Benefits SOCIAL SECURITY ADMINISTRATION MEDICARE...

  18. 20 CFR 418.2322 - How will a Medicare Part B income-related monthly adjustment amount determination for the...

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 20 Employees' Benefits 2 2012-04-01 2012-04-01 false How will a Medicare Part B income-related monthly adjustment amount determination for the effective year affect your Medicare prescription drug coverage? 418.2322 Section 418.2322 Employees' Benefits SOCIAL SECURITY ADMINISTRATION MEDICARE...

  19. 20 CFR 418.1322 - How will a Medicare prescription drug coverage income-related monthly adjustment amount...

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 20 Employees' Benefits 2 2011-04-01 2011-04-01 false How will a Medicare prescription drug coverage income-related monthly adjustment amount determination for the effective year affect your Medicare Part B? 418.1322 Section 418.1322 Employees' Benefits SOCIAL SECURITY ADMINISTRATION MEDICARE...

  20. Attitudes about Help-Seeking Mediate the Relation between Parent Attachment and Academic Adjustment in First-Year College Students

    ERIC Educational Resources Information Center

    Holt, Laura J.

    2014-01-01

    Although numerous studies have documented an association between parent attachment and college student adjustment, less is known about the mechanisms that underlie this relation. Accordingly, this short-term longitudinal study examined first-year college students' attitudes about academic help-seeking as one possible mechanism. As predicted,…

  1. The Psychosocial Adjustment of African American Youth from Single Mother Homes: The Relative Contribution of Parents and Peers

    ERIC Educational Resources Information Center

    Chester, Charlene; Jones, Deborah J.; Zalot, Alecia; Sterrett, Emma

    2007-01-01

    This study examined the relative roles of parents and peers in the psychosocial adjustment of African American youth (7-15 years old) from single mother homes (N = 242). Main effects of both positive parenting and peer relationship quality were found for youth depressive symptoms. In addition, a main effect of peer relationship quality and an…

  2. 26 CFR 301.6362-4 - Rules for adjustments relating to qualified resident taxes.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ..., cash-basis taxpayer, is a resident of State X throughout the taxable year. For such year, his adjusted... employment in State X, $5,000 derived from employment in State Y. $15,000 derived from employment in State Z... Y nonresident income tax, and $1,400 for the State Z nonresident income tax. State X, which has...

  3. Direct and Relational Bullying among Children and Adolescents: Coping and Psychological Adjustment

    ERIC Educational Resources Information Center

    Hampel, Petra; Manhal, Simone; Hayer, Tobias

    2009-01-01

    Previous research highlighted that pupils actively involved in bullying and victimization are prone to develop diverse psychological problems. The overall aim of our study was to investigate effects of different forms of bullying and victimization on coping with interpersonal stressors and psychological adjustment among children and adolescents.…

  4. "Try Walking in Our Shoes": Teaching Acculturation and Related Cultural Adjustment Processes through Role-Play

    ERIC Educational Resources Information Center

    Zamboanga, Byron L.; Ham, Lindsay S.; Tomaso, Cara C.; Audley, Shannon; Pole, Nnamdi

    2016-01-01

    In this article, we describe several role-playing exercises on acculturation and relevant cultural adjustment processes that we incorporated into Tomcho and Foel's classroom activity on acculturation, and we report data that examine subsequent changes in students' responses on pretest and posttest measures shortly after the activity and present…

  5. Emotional and organizational supports for preschoolers' emotion regulation: Relations with school adjustment.

    PubMed

    Bailey, Craig S; Denham, Susanne A; Curby, Timothy W; Bassett, Hideko H

    2016-03-01

    Preschool teachers, like parents, support children in ways that promote the regulation capacities that drive school adjustment, especially for children struggling to succeed in the classroom. The purpose of this study was to explore the emotionally and organizationally supportive classroom processes that contribute to the development of children's emotion regulation and executive control. Emotion regulation and executive control were assessed in 312 3-, 4- and 5-year-old children. The 44 teachers of these children completed questionnaires asking about 3 components of children's school adjustment: Positive/Engaged, Independent/Motivated, and Prosocial/Connected. Observations of classroom emotional and organizational supports were conducted. Results of multilevel models indicated emotion regulation was significantly associated with the Positive/Engaged school adjustment component, but only when teachers' emotional and organizational supports were taken into account. Children with lower levels of emotion regulation, who were also in less supportive classrooms, had the lowest scores on the Positive/Engaged component. Children's executive control was associated with the Independent/Motivated and Prosocial/Connected components independently of teacher effects. In general, moderate support was found for the notion that teachers' supports can be particularly helpful for children struggling to regulate their emotions to be better adjusted to school. Children's emotionally salient classroom behaviors, and teachers' emotion scaffolding, are discussed. PMID:26479772

  6. Sex Similarities and Differences in Locus of Control in Relation to Academic Adjustment Measures

    ERIC Educational Resources Information Center

    Keller, John M.; Pugh, Richard C.

    1976-01-01

    Correlations between Rotter's Internal-External (I-E) Control of Reinforcement Scale and the Omnibus Personality Inventory (OPI) were predicted based on previous research and a theoretical expectation of a relationship between I-E and adjustment. These findings have implications for counseling and further research using the I-E variable. (Author)

  7. Relation between Assertiveness, Academic Self-Efficacy, and Psychosocial Adjustment among International Graduate Students.

    ERIC Educational Resources Information Center

    Poyrazli, Senel; Arbona, Consuelo; Nora, Amaury; McPherson, Robert; Pisecco, Stewart

    2002-01-01

    Rathus Assertiveness Schedule, Academic Self-Efficacy Scale, The Inventory for Student Adjustment Strain, and UCLA Loneliness Scale were used to examine a total of 122 graduate international students. Findings indicate that English proficiency, assertiveness, and academic self-efficacy contributed uniquely to the variance in students' general…

  8. Preschoolers' Emotion Expression and Regulation: Relations with School Adjustment

    ERIC Educational Resources Information Center

    Herndon, Kristina J.; Bailey, Craig S.; Shewark, Elizabeth A.; Denham, Susanne A.; Bassett, Hideko H.

    2013-01-01

    Children's expression and regulation of emotions are building blocks of their experiences in classrooms. Thus, the authors' primary goal was to investigate whether preschoolers' expression or ability to regulate emotions were associated with teachers' ratings of school adjustment. A secondary goal was to investigate how boys…

  9. 76 FR 81432 - Revision of Patent Term Adjustment Provisions Relating to Appellate Review

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-12-28

    ... of Patent Appeals and Interferences in Ex Parte Appeals 76 FR 72270, 72273 (November 22, 2011... published in April of 1995. See Changes to Implement 20-Year Patent Term and Provisional Applications, 60 FR... September of 2000. See Changes to Implement Patent Term Adjustment Under Twenty-Year Patent Term, 65...

  10. Age-Adjustment and Related Epidemiology Rates in Education and Research

    ERIC Educational Resources Information Center

    Baker, John D.; Kruckman, Laurence; George, Joyce

    2006-01-01

    A quick review of introductory textbooks reveals that while gerontology authors and instructors introduce some aspect of demography and epidemiology data, there is limited focus on age adjustment or other important epidemiology rates. The goal of this paper is to reintroduce a variety of basic epidemiology strategies such as incidence, prevalence,…

  11. The Mediational Role of Adolescents' Friends in Relations between Activity Breadth and Adjustment

    ERIC Educational Resources Information Center

    Simpkins, Sandra D.; Eccles, Jacquelynne S.; Becnel, Jennifer N.

    2008-01-01

    This investigation addresses the mediational role of friends' characteristics between adolescents' activity breadth (i.e., variety in activity participation) and their later adjustment. Data were drawn from 2 longitudinal studies: the Childhood and Beyond (CAB; N = 925) study and the Maryland Adolescent Development in Context Study (MADICS; N =…

  12. Peer Relations and Social Adjustment of Latino and Chinese Children in Head Start Classrooms

    ERIC Educational Resources Information Center

    Lee, Linda S.

    2016-01-01

    Research Findings: The present study investigated the role of ethnic similarity in the peer preferences and play quality of Latino and Chinese children enrolled in Head Start classrooms and the relationship between peer acceptance and social adjustment in these groups. Participants were 244 children (M = 4.6 years old) from Head Start preschools…

  13. Socioenvironmental Risk and Adjustment in Latino Youth: The Mediating Effects of Family Processes and Social Competence

    ERIC Educational Resources Information Center

    Prelow, Hazel M.; Loukas, Alexandra; Jordan-Green, Lisa

    2007-01-01

    The direct and mediated effects of socioenvironmental risk on internalizing and externalizing problems among Latino youth aged 10-14 were examined using prospective analyses. Participants in this study were 464 Latino mother and child dyads surveyed as part of the "Welfare, Children & Families: A Three City Study." It was hypothesized that…

  14. Youth at risk of physical inactivity may benefit more from activity-related support than youth not at risk

    PubMed Central

    Davison, Kirsten Krahnstoever; Schmalz, Dorothy L

    2006-01-01

    Background This study examines whether associations between activity-related support and adolescents' physical activity differ for adolescents at high versus low risk of physical inactivity. Methods: Participants included 202 middle-school-aged girls (N = 92) and boys (N = 110). Physical activity was assessed using three self-report questionnaires. Activity-related support from mothers, fathers, siblings, and peers was assessed using the Activity Support Scale. Perceived sport competence was assessed using the Physical Activity Self Description Questionnaire. Participants' height and weight were measured and used to calculate their age- and sex-adjusted Body Mass Index percentile. Participants were classified as being at high risk for physical inactivity if they fulfilled two of the following three criteria: (1) overweight; (2) female; or (3) having low perceived sport competence. Results: Activity-related support from all sources was associated with higher levels of physical activity among adolescents. A stronger association between activity support and physical activity was found for adolescents at high risk for physical inactivity in comparison to adolescents at low risk. Conclusions: Findings from this study suggest that the activity-related support from family and friends may be an effective tool in promoting physical activity among youth at risk of physical inactivity. PMID:16566842

  15. Risk Factors for Violence and Relational Aggression in Adolescence

    ERIC Educational Resources Information Center

    Herrenkohl, Todd I.; McMorris, Barbara J.; Catalano, Richard F.; Abbott, Robert D.; Hemphill, Sheryl A.; Toumbourou, John W.

    2007-01-01

    Analyses examined risk factors for seventh- and ninth-grade youth categorized as nonoffenders, physically violent, relationally aggressive, and both violent and relationally aggressive. Bivariate and multivariate results showed that relationally aggressive youth were elevated on most risks above levels for nonoffenders but lower than those for…

  16. Age-adjustment and related epidemiology rates in education and research.

    PubMed

    Baker, John D; Kruckman, Laurence; George, Joyce

    2006-01-01

    A quick review of introductory textbooks reveals that while gerontology authors and instructors introduce some aspect of demography and epidemiology data, there is limited focus on age adjustment or other important epidemiology rates. The goal of this paper is to reintroduce a variety of basic epidemiology strategies such as incidence, prevalence, crude, age-specific and age-adjustment rates into the gerontology classroom. Background information and formulas for each rate, as well as examples of how they can be applied are provided. A recent change, encouraged by the U.S. Department of Health and Human Services, from a 1940 to a 2000 "standard million population" for ageadjusted rates, is reviewed. Finally, a teaching module with answers is provided for use in the gerontology classroom. PMID:16873207

  17. Betaine deficiency in maize: Metabolic basis and relation to osmotic adjustment

    SciTech Connect

    Rhodes, D. ); Hanson, A.D. ); Lerma, C.; Bolanos, J.

    1990-05-01

    A single recessive gene causes betaine deficiency in certain maize inbred lines. As betaine may act as a cytosolic osmolyte, deficiency might be expected to reduce osmotic adjustment. Two near-isogenic maize lines differing for betaine, as well as groups of diverse betaine-containing and deficient inbreds, were tested under field water-stress conditions. The betaine-deficient isogenic line, and the group of deficient inbreds as a whole, showed significantly (P<0.05) less osmotic adjustment than their respective betaine-containing counterparts. When leaves from field-grown plants of the isogenic lines were supplied with ({sup 14}C)choline, the betaine-containing line produced ({sup 14}C)betaine whereas the deficient line did not.

  18. Understanding relative risk, odds ratio, and related terms: as simple as it can get.

    PubMed

    Andrade, Chittaranjan

    2015-07-01

    Risk, and related measures of effect size (for categorical outcomes) such as relative risks and odds ratios, are frequently presented in research articles. Not all readers know how these statistics are derived and interpreted, nor are all readers aware of their strengths and limitations. This article examines several measures, including absolute risk, attributable risk, attributable risk percent, population attributable risk percent, relative risk, odds, odds ratio, and others. The concept and method of calculation are explained for each of these in simple terms and with the help of examples. The interpretation of each is presented in plain English rather than in technical language. Clinically useful notes are provided, wherever necessary. PMID:26231012

  19. Theta and Alpha Band Modulations Reflect Error-Related Adjustments in the Auditory Condensation Task

    PubMed Central

    Novikov, Nikita A.; Bryzgalov, Dmitri V.; Chernyshev, Boris V.

    2015-01-01

    Error commission leads to adaptive adjustments in a number of brain networks that subserve goal-directed behavior, resulting in either enhanced stimulus processing or increased motor threshold depending on the nature of errors committed. Here, we studied these adjustments by analyzing post-error modulations of alpha and theta band activity in the auditory version of the two-choice condensation task, which is highly demanding for sustained attention while involves no inhibition of prepotent responses. Errors were followed by increased frontal midline theta (FMT) activity, as well as by enhanced alpha band suppression in the parietal and the left central regions; parietal alpha suppression correlated with the task performance, left central alpha suppression correlated with the post-error slowing, and FMT increase correlated with both behavioral measures. On post-error correct trials, left-central alpha band suppression started earlier before the response, and the response was followed by weaker FMT activity, as well as by enhanced alpha band suppression distributed over the entire scalp. These findings indicate that several separate neuronal networks are involved in post-error adjustments, including the midfrontal performance monitoring network, the parietal attentional network, and the sensorimotor network. Supposedly, activity within these networks is rapidly modulated after errors, resulting in optimization of their functional state on the subsequent trials, with corresponding changes in behavioral measures. PMID:26733266

  20. Effect of time-activity adjustment on exposure assessment for traffic-related ultrafine particles

    PubMed Central

    Lane, Kevin J; Levy, Jonathan I; Scammell, Madeleine Kangsen; Patton, Allison P; Durant, John L; Mwamburi, Mkaya; Zamore, Wig; Brugge, Doug

    2015-01-01

    Exposures to ultrafine particles (<100 nm, estimated as particle number concentration, PNC) differ from ambient concentrations because of the spatial and temporal variability of both PNC and people. Our goal was to evaluate the influence of time-activity adjustment on exposure assignment and associations with blood biomarkers for a near-highway population. A regression model based on mobile monitoring and spatial and temporal variables was used to generate hourly ambient residential PNC for a full year for a subset of participants (n=140) in the Community Assessment of Freeway Exposure and Health study. We modified the ambient estimates for each hour using personal estimates of hourly time spent in five micro-environments (inside home, outside home, at work, commuting, other) as well as particle infiltration. Time-activity adjusted (TAA)-PNC values differed from residential ambient annual average (RAA)-PNC, with lower exposures predicted for participants who spent more time away from home. Employment status and distance to highway had a differential effect on TAA-PNC. We found associations of RAA-PNC with high sensitivity C-reactive protein and Interleukin-6, although exposure-response functions were non-monotonic. TAA-PNC associations had larger effect estimates and linear exposure-response functions. Our findings suggest that time-activity adjustment improves exposure assessment for air pollutants that vary greatly in space and time. PMID:25827314

  1. Risk Taking in Late Adolescence: Relations between Sociomoral Reasoning, Risk Stance, and Behavior

    ERIC Educational Resources Information Center

    Shaw, Leigh A.; Amsel, Eric; Schillo, Joshua

    2011-01-01

    This study explored relations among late adolescents' sociomoral reasoning about risk taking, risk stance, and behavior. One-hundred and thirty-two participants (18-20-year-olds) were surveyed about their own risk stance (Avoidant, Opportunistic, Curious, Risk Seeking) and behavior in three realms (Alcohol Use, Drug Use, Reckless Driving), and…

  2. Rate adjusters for Medicare under capitation

    PubMed Central

    Newhouse, Joseph P.

    1986-01-01

    This article addresses three issues related to capitation. First, the average adjusted per capita cost (AAPCC) fluctuates with the mix of risks in the fee-for-service system. More sensitive adjusters in the AAPCC are needed. Second, the AAPCC, as now estimated, exhibits large geographic variance; so-called shrinkage estimators may help. Third, the AAPCC requires new adjusters to yield more homogeneous risk classes. Otherwise, the portion of the Medicare population under capitation may experience access problems at alternative delivery systems: Until such adjusters are developed, it seems better to rely upon a blend of capitation and fee-for-service than the present AAPCC. PMID:10311926

  3. The HeartMate II Risk Score: An Adjusted Score for Evaluation of All Continuous-Flow Left Ventricular Assist Devices.

    PubMed

    Cowger, Jennifer Ann; Castle, Lindsay; Aaronson, Keith David; Slaughter, Mark S; Moainie, Sina; Walsh, Mary; Salerno, Christopher

    2016-01-01

    The aim of this study was to evaluate the performance of an adjusted HeartMate II risk score (HMRS) in Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS; n = 9,733) and in HeartWare Ventricular Assist Device (HVAD) bridge to transplant (BTT) trial patients (n = 360). Interagency Registry for Mechanically Assisted Circulatory Support data were used to calculate an adjusted HMRS, omitting center volume, for all patients on continuous-flow left ventricular assist device (LVAD) support. Ninety day mortality was then evaluated in INTERMACS and HVAD-BTT patients. Four risk groups were identified based on INTERMACS patient-adjusted HMRS: very low (<5%, 90 day mortality; score <0.20), low (5-10%, 90 day mortality; score 0.20-1.97), medium (10-20%, 90 day mortality; score 1.98-4.48), and high risk (>20%, 90 day mortality; score >4.48). Within INTERMACS, there were significant differences in survival between all-adjusted HMRS risk groups (p < 0.001 in pairwise comparisons). Controlling for known mortality correlates, the adjusted HMRS mortality hazard ratio was 1.19 (1.25-1.23) per unit HMRS increase. The HVAD cohort was a low-risk cohort with 90 day survivals for very low-, low-, and medium-risk patients of 100%, 97 ± 1.1%, and 90 ± 3.6%, respectively (p = 0.007). Patients in the very low- and low-risk group had significantly improved survival compared with medium-risk patients, respectively (both p < 0.05). The adjusted HMRS appropriately risk stratified a large cohort of INTERMACS patients and was predictive of survival in HeartWare-supported patients. PMID:26955002

  4. Relating space radiation environments to risk estimates

    NASA Technical Reports Server (NTRS)

    Curtis, Stanley B.

    1993-01-01

    A number of considerations must go into the process of determining the risk of deleterious effects of space radiation to travelers. Among them are (1) determination of the components of the radiation environment (particle species, fluxes and energy spectra) which will encounter, (2) determination of the effects of shielding provided by the spacecraft and the bodies of the travelers which modify the incident particle spectra and mix of particles, and (3) determination of relevant biological effects of the radiation in the organs of interest. The latter can then lead to an estimation of risk from a given space scenario. Clearly, the process spans many scientific disciplines from solar and cosmic ray physics to radiation transport theeory to the multistage problem of the induction by radiation of initial lesions in living material and their evolution via physical, chemical, and biological processes at the molecular, cellular, and tissue levels to produce the end point of importance.

  5. Relating space radiation environments to risk estimates

    SciTech Connect

    Curtis, S.B. ||

    1993-12-31

    A number of considerations must go into the process of determining the risk of deleterious effects of space radiation to travelers. Among them are (1) determination of the components of the radiation environment (particle species, fluxes and energy spectra) which will encounter, (2) determination of the effects of shielding provided by the spacecraft and the bodies of the travelers which modify the incident particle spectra and mix of particles, and (3) determination of relevant biological effects of the radiation in the organs of interest. The latter can then lead to an estimation of risk from a given space scenario. Clearly, the process spans many scientific disciplines from solar and cosmic ray physics to radiation transport theeory to the multistage problem of the induction by radiation of initial lesions in living material and their evolution via physical, chemical, and biological processes at the molecular, cellular, and tissue levels to produce the end point of importance.

  6. 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

  7. Adjustments of the Pesticide Risk Index Used in Environmental Policy in Flanders

    PubMed Central

    Fevery, Davina; Peeters, Bob; Lenders, Sonia; Spanoghe, Pieter

    2015-01-01

    Indicators are used to quantify the pressure of pesticides on the environment. Pesticide risk indicators typically require weighting environmental exposure by a no effect concentration. An indicator based on spread equivalents (ΣSeq) is used in environmental policy in Flanders (Belgium). The pesticide risk for aquatic life is estimated by weighting active ingredient usage by the ratio of their maximum allowable concentration and their soil halflife. Accurate estimates of total pesticide usage in the region are essential in such calculations. Up to 2012, the environmental impact of pesticides was estimated on sales figures provided by the Federal Government. Since 2013, pesticide use is calculated based on results from the Farm Accountancy Data Network (FADN). The estimation of pesticide use was supplemented with data for non-agricultural use based on sales figures of amateur use provided by industry and data obtained from public services. The Seq-indicator was modified to better reflect reality. This method was applied for the period 2009-2012 and showed differences between estimated use and sales figures of pesticides. The estimated use of pesticides based on accountancy data is more accurate compared to sales figures. This approach resulted in a better view on pesticide use and its respective environmental impact in Flanders. PMID:26046655

  8. Willingness to pay for a quality-adjusted life year: an evaluation of attitudes towards risk and preferences

    PubMed Central

    2014-01-01

    Background This paper examines the Willingness to Pay (WTP) for a quality-adjusted life year (QALY) expressed by people who attended the healthcare system as well as the association of attitude towards risk and other personal characteristics with their response. Methods Health-state preferences, measured by EuroQol (EQ-5D-3L), were combined with WTP for recovering a perfect health state. WTP was assessed using close-ended, iterative bidding, contingent valuation method. Data on demographic and socioeconomic characteristics, as well as usage of health services by the subjects were collected. The attitude towards risk was evaluated by collecting risky behaviors data, by the subject’s self-evaluation, and through lottery games. Results Six hundred and sixty two subjects participated and 449 stated a utility inferior to 1. WTP/QALY ratios varied significantly when payments with personal money (mean €10,119; median €673) or through taxes (mean €28,187; median €915) were suggested. Family income, area income, higher education level, greater use of healthcare services, and the number of co-inhabitants were associated with greater WTP/QALY ratios. Age and female gender were associated with lower WTP/QALY ratios. Risk inclination was independently associated with a greater WTP/QALY when “out of pocket” payments were suggested. Clear discrepancies were demonstrated between linearity and neutrality towards risk assumptions and experimental results. Conclusions WTP/QALY ratios vary noticeably based on demographic and socioeconomic characteristics of the subject, but also on their attitude towards risk. Knowing the expression of preferences by patients from this outcome measurement can be of interest for health service planning. PMID:24989615

  9. Reference data file for neutron spectrum adjustment and related radiation damage calculations

    SciTech Connect

    Zsolnay, E.M. ); Nolthenius, H.J.; Greenwood, L.R.; Szondi, E.J. )

    1990-08-01

    The REAL-88 interlaboratory exercise organized by IAEA resulted in a neutron metrology file. (NMF-90) comprising problem dependent data for benchmark neutron fields, furthermore, nuclear data and computer programs for neutron spectrum adjustment and radiation damage parameter calculations for the service life assessment of nuclear facilities. Calculation results of some experienced laboratories are also present. This paper describes and analyses the content of the neutron metrology file and outlines the most important problems and tasks to be solved in the field of radiation damage parameter calculations. 14 refs., 2 figs., 1 tab.

  10. Adjustment Disorders as a Stress-Related Disorder: A Longitudinal Study of the Associations among Stress, Resources, and Mental Health

    PubMed Central

    Kocalevent, Rüya-Daniela; Mierke, Annett; Danzer, Gerhard; Klapp, Burghard F.

    2014-01-01

    Objective Adjustment disorders are re-conceptualized in the DSM-5 as a stress-related disorder; however, besides the impact of an identifiable stressor, the specification of a stress concept, remains unclear. This study is the first to examine an existing stress-model from the general population, in patients diagnosed with adjustment disorders, using a longitudinal design. Methods The study sample consisted of 108 patients consecutively admitted for adjustment disorders. Associations of stress perception, emotional distress, resources, and mental health were measured at three time points: the outpatients’ presentation, admission for inpatient treatment, and discharge from the hospital. To evaluate a longitudinal stress model of ADs, we examined whether stress at admission predicted mental health at each of the three time points using multiple linear regressions and structural equation modeling. A series of repeated-measures one-way analyses of variance (rANOVAs) was performed to assess change over time. Results Significant within-participant changes from baseline were observed between hospital admission and discharge with regard to mental health, stress perception, and emotional distress (p<0.001). Stress perception explained nearly half of the total variance (44%) of mental health at baseline; the adjusted R2 increased (0.48), taking emotional distress (i.e., depressive symptoms) into account. The best predictor of mental health at discharge was the level of emotional distress (i.e., anxiety level) at baseline (β = −0.23, R2corr = 0.56, p<0.001). With a CFI of 0.86 and an NFI of 0.86, the fit indices did not allow for acceptance of the stress-model (Cmin/df = 15.26; RMSEA = 0.21). Conclusions Stress perception is an important predictor in adjustment disorders, and mental health-related treatment goals are dependent on and significantly impacted by stress perception and emotional distress. PMID:24825165

  11. Disparities and relative risk ratio of preterm birth in six Central and Eastern European centers

    PubMed Central

    Arora, Chander P; Kacerovsky, Marian; Zinner, Balazs; Ertl, Tibor; Ceausu, Iuliana; Rusnak, Igor; Shurpyak, Serhiy; Sandhu, Meenu; Hobel, Calvin J; Dumesic, Daniel A; Vari, Sandor G

    2015-01-01

    Aim To identify characteristic risk factors of preterm birth in Central and Eastern Europe and explore the differences from other developed countries. Method Data on 33 794 term and 3867 preterm births (<37 wks.) were extracted in a retrospective study between January 1, 2007 and December 31, 2009. The study took place in 6 centers in 5 countries: Czech Republic, Hungary (two centers), Romania, Slovakia, and Ukraine. Data on historical risk factors, pregnancy complications, and special testing were gathered. Preterm birth frequencies and relevant risk factors were analyzed using Statistical Analysis System (SAS) software. Results All the factors selected for study (history of smoking, diabetes, chronic hypertension, current diabetes, preeclampsia, progesterone use, current smoking, body mass index, iron use and anemia during pregnancy), except the history of diabetes were predictive of preterm birth across all participating European centers. Preterm birth was at least 2.4 times more likely with smoking (history or current), three times more likely with preeclampsia, 2.9 times more likely with hypertension after adjusting for other covariates. It had inverse relationship with the significant predictor body mass index, with adjusted risk ratio of 0.8 to 1.0 in three sites. Iron use and anemia, though significant predictors of preterm birth, indicated mixed patterns for relative risk ratio. Conclusion Smoking, preeclampsia, hypertension and body mass index seem to be the foremost risk factors of preterm birth. Implications of these factors could be beneficial for design and implementation of interventions and improve the birth outcome. PMID:25891871

  12. Case-control study of diabetes-related genetic variants and pancreatic cancer risk in Japan

    PubMed Central

    Kuruma, Sawako; Egawa, Naoto; Kurata, Masanao; Honda, Goro; Kamisawa, Terumi; Ueda, Junko; Ishii, Hiroshi; Ueno, Makoto; Nakao, Haruhisa; Mori, Mitsuru; Matsuo, Keitaro; Hosono, Satoyo; Ohkawa, Shinichi; Wakai, Kenji; Nakamura, Kozue; Tamakoshi, Akiko; Nojima, Masanori; Takahashi, Mami; Shimada, Kazuaki; Nishiyama, Takeshi; Kikuchi, Shogo; Lin, Yingsong

    2014-01-01

    AIM: To examine whether diabetes-related genetic variants are associated with pancreatic cancer risk. METHODS: We genotyped 7 single-nucleotide polymorphisms (SNPs) in PPARG2 (rs1801282), ADIPOQ (rs1501299), ADRB3 (rs4994), KCNQ1 (rs2237895), KCNJ11 (rs5219), TCF7L2 (rs7903146), and CDKAL1 (rs2206734), and examined their associations with pancreatic cancer risk in a multi-institute case-control study including 360 cases and 400 controls in Japan. A self-administered questionnaire was used to collect detailed information on lifestyle factors. Genotyping was performed using Fluidigm SNPtype assays. Unconditional logistic regression methods were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the association between these diabetes-associated variants and pancreatic cancer risk. RESULTS: With the exception of rs1501299 in the ADIPOQ gene (P = 0.09), no apparent differences in genotype frequencies were observed between cases and controls. Rs1501299 in the ADPIOQ gene was positively associated with pancreatic cancer risk; compared with individuals with the AA genotype, the age- and sex-adjusted OR was 1.79 (95%CI: 0.98-3.25) among those with the AC genotype and 1.86 (95%CI: 1.03-3.38) among those with the CC genotype. The ORs remained similar after additional adjustment for body mass index and cigarette smoking. In contrast, rs2237895 in the KCNQ1 gene was inversely related to pancreatic cancer risk, with a multivariable-adjusted OR of 0.62 (0.37-1.04) among individuals with the CC genotype compared with the AA genotype. No significant associations were noted for other 5 SNPs. CONCLUSION: Our case-control study indicates that rs1501299 in the ADIPOQ gene may be associated with pancreatic cancer risk. These findings should be replicated in additional studies. PMID:25516658

  13. The relations of temperament reactivity and effortful control to children's adjustment problems in China and the United States.

    PubMed

    Zhou, Qing; Lengua, Liliana J; Wang, Yun

    2009-05-01

    The relations of parents' and teachers' reports of temperament anger-irritability, positive emotionality, and effortful control (attention focusing and inhibitory control) to children's externalizing and internalizing problems were examined in Chinese (N = 382) and U.S. (N = 322) samples of school-age children. Results suggested that in both cultures, low effortful control and high anger-irritability were associated with high externalizing problems, although the relations were stronger in the Chinese sample than in the U.S. sample. Low positive emotionality was associated with high internalizing problems in both cultures. However, high positive emotionality was associated with noncomorbid externalizing problems (teachers' reports) in the Chinese sample but not in the U.S. sample. These findings suggest that there are considerable cross-cultural similarities in the temperament-adjustment associations, although some cross-cultural differences might exist. Implications of the findings for the detection and intervention of adjustment problems in Chinese children are discussed. PMID:19413428

  14. Risk Analysis Related to Quality Management Principles

    NASA Astrophysics Data System (ADS)

    Vykydal, David; Halfarová, Petra; Nenadál, Jaroslav; Plura, Jiří; Hekelová, Edita

    2012-12-01

    Efficient and effective implementation of quality management principles asks for a responsible approach from top managers' perspectives. A study of the current state of affairs in Czech organizations discovers a lot of shortcomings in this field that can be changed to vary managerial risks. The article identifies and analyses some of them and gives short guidance for appropriate treatment. Text of the article reflects the authors' experience as well as knowledge obtained from the systematic analysis of industrial companies' environments.

  15. Adjustments of ejaculation rates in response to risk of sperm competition in a fish, the bitterling (Rhodeus sericeus).

    PubMed Central

    Candolin, Ulrika; Reynolds, John D

    2002-01-01

    Game theory models of sperm competition predict that within species, males should increase their sperm expenditure when they have one competitor, but decrease expenditure with increasing numbers of competitors. So far, there have been few tests or support for this prediction. Here, we show that males of a freshwater fish, the European bitterling, Rhodeus sericeus, do indeed adjust their ejaculation rate to the number of male competitors by first increasing and then decreasing their ejaculation rates as the number of competitors increases. However, this occurred only under restricted conditions. Specifically, the prediction was upheld as long as no female had deposited eggs in the live mussels that are used as spawning sites. After one or more females had spawned, males did not decrease their ejaculation rates with the number of competitors, but instead they became more aggressive. This indicates that decreased ejaculation rate and increased aggression are alternative responses to increased risk of sperm competition. PMID:12184824

  16. Dietary Flavonoid Intake and Smoking-Related Cancer Risk: A Meta-Analysis

    PubMed Central

    Woo, Hae Dong; Kim, Jeongseon

    2013-01-01

    Purpose To systematically investigate the effects of dietary flavonoids and flavonoid subclasses on the risk of smoking-related cancer in observational studies. Methods Summary estimates and corresponding standard errors were calculated using the multivariate-adjusted odds ratio (OR) or relative risk (RR) and 95% CI of selected studies and weighted by the inverse variance. Results A total of 35 studies, including 19 case-controls (9,525 cases and 15,835 controls) and 15 cohort studies (988,082 subjects and 8,161 cases), were retrieved for the meta-analysis. Total dietary flavonoids and most of the flavonoid subclasses were inversely associated with smoking-related cancer risk (OR: 0.82, 95% CI: 0.72-0.93). In subgroup analyses by cancer site, significant associations were observed in aerodigestive tract and lung cancers. Total dietary flavonoid intake was significantly associated with aerodigestive tract cancer risk (OR: 0.67, 95% CI: 0.54-0.83) marginally associated with lung cancer risk (OR: 0.84, 95% CI: 0.71-1.00). Subgroup analyses by smoking status showed significantly different results. The intake of total flavonoids, flavonols, flavones, and flavanones, as well as the flavonols quercetin and kaempferol was significantly associated with decreased risk of smoking-related cancer in smokers, whereas no association was observed in non-smokers, except for flavanones. In meta-analysis for the effect of subclasses of dietary flavonoids by cancer type, aerodigestive tract cancer was inversely associated with most flavonoid subclasses. Conclusion The protective effects of flavonoids on smoking-related cancer risk varied across studies, but the overall results indicated that intake of dietary flavonoids, especially flavonols, was inversely associated with smoking-related cancer risk. The protective effects of flavonoids on smoking-related cancer risk were more prominent in smokers. PMID:24069431

  17. Executive Functioning and School Adjustment: The Mediational Role of Pre-kindergarten Learning-related Behaviors

    PubMed Central

    Sasser, Tyler R.; Bierman, Karen L.; Heinrichs, Brenda

    2016-01-01

    164 four-year-old children (14% Latino American, 30% African American, 56% European American; 57% girls) in 22 Head Start classrooms were followed through third grade. Growth curve models were used to estimate the predictive associations between pre-kindergarten executive function (EF) skills and trajectories of academic skill development (math, literacy, overall academic functioning) and social-emotional adjustment at school (social competence, aggression), controlling for child sex, race, verbal IQ, and pre-kindergarten baseline scores. Direct developmental pathways were examined, along with indirect pathways, in which the association between preschool EF and elementary school adjustment was mediated by classroom learning behaviors. Preschool EF significantly predicted later math skills, academic functioning, and social competence, and marginally predicted later literacy skills. Preschool learning behaviors fully mediated the association between EF and later literacy skills and social competence, but did not mediate associations between EF and later math skills or academic functioning. Implications for developmental theory and early education are discussed. PMID:27231409

  18. Parental Expressivity and Parenting Styles in Chinese Families: Prospective and Unique Relations to Children’s Psychological Adjustment

    PubMed Central

    Chen, Stephen H.; Zhou, Qing; Eisenberg, Nancy; Valiente, Carlos; Wang, Yun

    2012-01-01

    SYNOPSIS Objectives Parents from different cultures differ in how frequently they express emotions. However, the generalizability of the relations between parental expressivity and child adjustment in non-Western cultures has not been extensively studied. The goal of the present study was to investigate prospective relations between parental expressivity within the family (positive, negative dominant, and negative submissive expressivity) and Chinese children’s psychological adjustment, above and beyond parenting styles. Design The study used two waves (3.8 years apart) of longitudinal data from a sample (n= 425) of children in Beijing (mean ages = 7.7 years at T1 and 11.6 years at T2). Parental expressivity and parenting styles were self-reported. To reduce the potential measurement overlap, items that tap parental expression of emotions toward the child were removed from the parenting style measure. Children’s adjustment was measured with parents’, teachers’, and peers’ or children’s reports. Results Consistent with findings with European American samples, parental negative dominant expressivity uniquely and positively predicted Chinese children’s externalizing problems controlling for prior externalizing problems, parenting styles, and family SES. Neither parental expressivity nor parenting styles uniquely predicted social competence. Conclusions Despite previously reported cultural differences in the mean levels of parental expressivity, some of the socialization functions of parental expressivity found in Western countries can be generalized to Chinese families. Although parental expressivity and parenting styles are related constructs, their unique relations to child’s adjustment suggest that they should be examined as distinct processes. PMID:23226715

  19. The New Friends Vignettes: Measuring Parental Psychological Control that Confers Risk for Anxious Adjustment in Preschoolers

    ERIC Educational Resources Information Center

    McShane, Kelly E.; Hastings, Paul D.

    2009-01-01

    This investigation examined the links between preschoolers' internalizing problems and anxiety-related social difficulties and two aspects of maternal and paternal psychological control: overprotection and critical control. Some 115 mothers and 92 fathers completed the New Friends Vignettes (NFV), a new measure of psychological control and…

  20. Quantile Regression Adjusting for Dependent Censoring from Semi-Competing Risks

    PubMed Central

    Li, Ruosha; Peng, Limin

    2014-01-01

    Summary In this work, we study quantile regression when the response is an event time subject to potentially dependent censoring. We consider the semi-competing risks setting, where time to censoring remains observable after the occurrence of the event of interest. While such a scenario frequently arises in biomedical studies, most of current quantile regression methods for censored data are not applicable because they generally require the censoring time and the event time be independent. By imposing rather mild assumptions on the association structure between the time-to-event response and the censoring time variable, we propose quantile regression procedures, which allow us to garner a comprehensive view of the covariate effects on the event time outcome as well as to examine the informativeness of censoring. An efficient and stable algorithm is provided for implementing the new method. We establish the asymptotic properties of the resulting estimators including uniform consistency and weak convergence. The theoretical development may serve as a useful template for addressing estimating settings that involve stochastic integrals. Extensive simulation studies suggest that the proposed method performs well with moderate sample sizes. We illustrate the practical utility of our proposals through an application to a bone marrow transplant trial. PMID:25574152

  1. Determining the Relative Criticality of Diverse Exploration Risks in NASA's Human Research Program

    NASA Technical Reports Server (NTRS)

    Kundrot, Craig E.; Edwards, J. Michelle; Anton, Wilma; Robotham, Kwesi

    2009-01-01

    The mission of NASA s Human Research Program (HRP) is to understand and reduce the risk to crew health and performance in exploration missions. The HRP addresses 27 specific risks, primarily in the context of Continuous Risk Management. Each risk is evaluated in terms of two missions (a six month stay on the Moon and a thirty month round trip to Mars) and three types of consequences (in-mission crew health, post-mission crew health, and in-mission performance). The lack of a common metric between the three consequence scales, such as financial costs or quality adjusted life years lost, makes it difficult to compare the relative criticality of the risks. We are, therefore, exploring the use of a ternary scale of criticality based on the common metric of influencing an operational decision. The three levels correspond to the level of concern the risk generates for a "go/no-go" decision to launch a mission: 1) no-go; 2) go with significant reservations; 3) go. The criticality of each of the 27 risks is scored for the three types of consequence in both types of mission. The scores are combined to produce an overall criticality rating for each risk. The overall criticality rating can then be used to guide the prioritization of resources to affect the greatest amount of risk reduction.

  2. Quantifying the relative risk of sex offenders: risk ratios for static-99R.

    PubMed

    Hanson, R Karl; Babchishin, Kelly M; Helmus, Leslie; Thornton, David

    2013-10-01

    Given the widespread use of empirical actuarial risk tools in corrections and forensic mental health, it is important that evaluators and decision makers understand how scores relate to recidivism risk. In the current study, we found strong evidence for a relative risk interpretation of Static-99R scores using 8 samples from Canada, United Kingdom, and Western Europe (N = 4,037 sex offenders). Each increase in Static-99R score was associated with a stable and consistent increase in relative risk (as measured by an odds ratio or hazard ratio of approximately 1.4). Hazard ratios from Cox regression were used to calculate risk ratios that can be reported for Static-99R. We recommend that evaluators consider risk ratios as a useful, nonarbitrary metric for quantifying and communicating risk information. To avoid misinterpretation, however, risk ratios should be presented with recidivism base rates. PMID:23264543

  3. Suicidal behavior in relatives or associates moderates the strength of common risk factors for suicide

    PubMed Central

    Tong, Yongsheng; Phillips, Michael R.; Duberstein, Paul; Zhan, Weihai

    2014-01-01

    The prevalence and odds ratios of different suicide risk factors were compared in three pairs of decedents: 80 suicides and 25 injury decedents with blood-relatives with suicidal behavior history (biologically-exposed); 259 suicides and 126 injury decedents with unrelated acquaintances with suicidal behavior history (socially-exposed); and 471 suicides and 523 injury decedents with neither relatives nor acquaintances with suicidal behavior history (unexposed). Negative life events and high psychological stress were more common in socially-exposed suicides than in other suicides. The adjusted odds ratios of most established suicide risk factors were higher in unexposed decedents than in biologically- or socially-exposed decedents, suggesting that the predictive value of established risk factors wanes in individuals who have been exposed to suicidal behavior in family or friends. PMID:25443455

  4. [Quality of relations between gay couples and high-risk sexual behavior].

    PubMed

    Julien, D; Pizzamiglio, M T; Brault, M; Léveillé, S

    1992-01-01

    This study examines the hypotheses by which quality relationships among gay couples is closely related to the adoption of low-risk sexual behaviours, in monogamous and non-monogamous situations. Data was collected from 29 homosexual couples (58 men) of the Montréal area. The survey, which graded sexual conduct as well as adjustments made within the relationship, confirmed the author's hypothesis. Indeed, the distribution of couples according to a multifactorial risk index does in fact establish a connection between the couple's happiness and the level of risk during sexual relations within and outside the couple. These conclusions are discussed in light of existing data pertaining to the link between health and the quality of a relationship among heterosexual couples. PMID:1515524

  5. Humorous Relations: Attentiveness, Pleasure and Risk

    ERIC Educational Resources Information Center

    Mayo, Cris

    2014-01-01

    This article focuses on the structures of humor and joke telling that require particular kinds of attentiveness and particular relationships between speaker and audience, or more specifically, between classmates. First, I will analyze the pedagogical and relational preconditions that are necessary for humor to work. If humor is to work well, the…

  6. The Role of Preschool Relational and Physical Aggression in the Transition to Kindergarten: Links with Social-Psychological Adjustment

    PubMed Central

    Gower, Amy L.; Lingras, Katherine A.; Mathieson, Lindsay C.; Kawabata, Yoshito; Crick, Nicki R.

    2014-01-01

    Research Findings The transition to kindergarten has important ramifications for future achievement and psychosocial outcomes. Research suggests that physical aggression may be related to difficulty during school transitions, yet no studies to date have examined the role of relational aggression in these transitions. This paper examined how engagement in preschool physical and relational aggression predicted psychosocial adjustment during the kindergarten school year. Observations and teacher reports of aggression were collected in preschool, and kindergarten teachers reported on student-teacher relationship quality, child internalizing problems, and peer acceptance in kindergarten. Results suggested that preschool physical aggression predicted reduced peer acceptance and increased conflict with the kindergarten teacher. High levels of relational aggression, when not combined with physical aggression, were related to more positive transitions to kindergarten in the domains assessed. Practice or Policy These data lend support to the need for interventions among physically aggressive preschoolers to target not only concurrent behavior but also future aggression and adjustment in kindergarten. Thus, educators should work to encourage social influence in more prosocial ways amongst aggressive preschoolers. PMID:26146468

  7. Behavioral adjustment to avian flu in Europe during spring 2006: the roles of knowledge and proximity to risk.

    PubMed

    Rudisill, Caroline; Costa-Font, Joan; Mossialos, Elias

    2012-10-01

    The threat of a widespread avian flu influenza outbreak represented a significant public health challenge for the European region during late 2005 and early 2006. Little is known, however, about how individuals learn about new global-level health risks, especially influenza outbreaks. We empirically test the hypothesis that knowledge about and geographic proximity to avian flu play a role in individuals' consumption behavior regarding this health risk. This article employs Eurobarometer survey data collected in spring 2006 to examine how Europeans (from 27 European Union countries plus Croatia and Turkey) altered their consumption of poultry, eggs and egg-based products during the virus' emergence in Europe. Our findings are consistent with the hypothesis that behavioral change indeed depends on proximity to those risks. Significant differences emerged between individuals' likelihood of behavioral change in countries where avian flu had been found in humans either in individuals' countries of residence or in bordering countries. Furthermore, we find that those who were more knowledgeable about avian flu risks were less likely to have reduced their consumption of poultry, eggs or egg-related products in the spring of 2006 compared to six months prior. Yet, the influence knowledge has on consumption behavior is found to change depending on proximity to avian flu risks. These findings have implications for our larger understanding of how individuals alter their behavior in the face of new health risks. PMID:22835921

  8. A Study of Social-Emotional Adjustment Levels of Preschool Children in Relation to Peer Relationships

    ERIC Educational Resources Information Center

    Gülay, Hülya; Önder, Alev

    2013-01-01

    The aim of this research is to study social--emotional adaptation levels of 5-to 6-year old preschool children in relation to peer relationships. One hundred and forty-four children aged between 5 and 6 joined in this relational survey study. According to the results of the research analysing the relationship between the social-emotional…

  9. Shyness, Sociability, and Parental Support for the College Transition: Relation to Adolescents' Adjustment

    ERIC Educational Resources Information Center

    Mounts, Nina S.; Valentiner, David P.; Anderson, Katherine L.; Boswell, Michelle K.

    2006-01-01

    A path model was tested in an ethnically diverse sample of 350 college students in which shyness, sociability, and parental support for the college transition were related to loneliness and friendship quality. Furthermore, friendship quality and loneliness were related to depression and anxiety. High levels of shyness, low levels of sociability,…

  10. The Writing Activities of Public Relations Professionals: An Assessment for Curriculum Design and Adjustment.

    ERIC Educational Resources Information Center

    Napoli, Philip M.; Powers, Gerald

    Public relations writing curricula must accurately reflect the writing responsibilities of public relations (PR) practitioners. This study provides descriptive information on the types of writing tasks conducted by PR practitioners. The study also investigates whether the type of writing and overall time spent writing vary with years of…

  11. High cost pool or high cost groups-How to handle high(est) cost cases in a risk adjustment mechanism?

    PubMed

    Schillo, Sonja; Lux, Gerald; Wasem, Juergen; Buchner, Florian

    2016-02-01

    Competitive social health insurance systems (at least) in Western Europe have implemented systems of morbidity based risk adjustment to set a level playing field for insurers. However, many high cost insured still are heavily underfunded despite risk adjustment, leaving incentives for risk selection. In most of these health care systems, there is an ongoing debate about how to deal with such underpaid high cost cases. This study develops four distinct concepts by adding variables to risk adjustment or by setting up a high cost pool for underpaid insured besides the risk adjustment system. Their features, incentives and distributional effects are discussed. With a data set of 6 million insured, performance is demonstrated for Germany. All models achieve a substantial improvement in model fit, measured in terms of R(2) as well as CPM. As the results of the various models are different in different dimensions, the trade-offs that have to be dealt with and should be addressed, when implementing a model to reduce underfunding of high cost cases. PMID:26806676

  12. Study finds increases in risk of leukemias related to treatment

    Cancer.gov

    A new study describes the pattern of risk for chemotherapy-related acute myeloid leukemia among adult cancer survivors over the past three decades who have previously been treated with chemotherapy for other cancers. These patterns coincide with major shi

  13. [Application of spatial relative risk estimation in communicable disease risk evaluation].

    PubMed

    Zhang, Yewu; Guo, Qing; Wang, Xiaofeng; Yu, Meng; Su, Xuemei; Dong, Yan; Zhang, Chunxi

    2015-05-01

    This paper summaries the application of adaptive kernel density algorithm in the spatial relative risk estimation of communicable diseases by using the reported data of infectious diarrhea (other than cholera, dysentery, typhoid and paratyphoid) in Ludian county and surrounding area in Yunnan province in 2013. Statistically significant fluctuations in an estimated risk function were identified through the use of asymptotic tolerance contours, and finally these data were visualized though disease mapping. The results of spatial relative risk estimation and disease mapping showed that high risk areas were in southeastern Shaoyang next to Ludian. Therefore, the spatial relative risk estimation of disease by using adaptive kernel density algorithm and disease mapping technique is a powerful method in identifying high risk population and areas. PMID:26080648

  14. Risk for work-related fatigue among the employees on semiconductor manufacturing lines.

    PubMed

    Lin, Yu-Cheng; Chen, Yen-Cheng; Hsieh, Hui-I; Chen, Pau-Chung

    2015-03-01

    To examine the potential risk factors for work-related fatigue (WRF) among workers in modern industries, the authors analyzed the records of need-for-recovery questionnaires and health checkup results for 1545 employees. Compared with regular daytime workers, and after adjusting for confounders, the workers adapting to day-and-night rotating shift work (RSW) had a 4.0-fold (95% confidence interval [CI] = 2.7-5.9) increased risk for WRF, higher than the 2.2-fold risk (95% CI = 1.5-3.3) for persistent shift workers. Based on highest education level, the male employees with university degrees had the highest adjusted odds ratio (a-OR) 2.8 (95% CI = 1.0-7.8) for complaining of WRF versus compulsory education group. For female workers, currently married/cohabiting status was inversely associated with WRF (a-OR = 0.5; 95% CI = 0.2-0.9), and child-rearing responsibility moderately increased WRF risk (a-OR = 1.9; 95% CI = 1.0-3.7). Day-and-night RSW and the adaptation, educational levels of males, and domestic factors for females contributed to WRF among semiconductor manufacturing employees. PMID:23761590

  15. Parenting Styles as They Relate to Self-Esteem and Adjustment.

    ERIC Educational Resources Information Center

    Sigward, Timothy M.; And Others

    This study was conducted to examine the relationships between parental styles and the components of self-esteem that correspond to Damon and Hart's conceptualization of the self. Specifically, high levels of both parental control and parent acceptance were hypothesized to be positively related to self-esteem. Undergraduate students (N=225) rated…

  16. Psychosocial Adjustment in Siblings of Children with War-Related Injuries

    ERIC Educational Resources Information Center

    Khamis, Vivian

    2013-01-01

    The study assessed the prevalence and predictors of post-traumatic symptomatology and emotional and behavioral difficulties in siblings of children who incurred war-related injuries. It was predicted that injury severity, gender and attributional style would account for a significant amount of the variance in post-traumatic stress symptoms and…

  17. Exposure to Conflict and Violence across Contexts: Relations to Adjustment among Palestinian Children

    ERIC Educational Resources Information Center

    Dubow, Eric F.; Boxer, Paul; Huesmann, L. Rowell; Shikaki, Khalil; Landau, Simha; Gvirsman, Shira Dvir; Ginges, Jeremy

    2010-01-01

    Despite extensive literatures on the impact on children of exposure to violence in families, neighborhoods, and peer groups, there has been relatively little effort evaluating their cumulative impact. There also has been less attention to the effects of exposure to political conflict and violence. We collected data from a representative sample of…

  18. Relations of Maternal Socialization and Toddlers' Effortful Control to Children's Adjustment and Social Competence

    ERIC Educational Resources Information Center

    Spinrad, Tracy L.; Eisenberg, Nancy; Gaertner, Bridget; Popp, Tierney; Smith, Cynthia L.; Kupfer, Anne; Greving, Karissa; Liew, Jeffrey; Hofer, Claire

    2007-01-01

    The authors examined the relations of maternal supportive parenting to effortful control and internalizing problems (i.e., separation distress, inhibition to novelty), externalizing problems, and social competence when toddlers were 18 months old (n = 256) and a year later (n = 230). Mothers completed the Coping With Toddlers' Negative Emotions…

  19. The Effectiveness of Functional Family Therapy in Reducing Adolescent Mental Health Risk and Family Adjustment Difficulties in an Irish Context.

    PubMed

    Hartnett, Dan; Carr, Alan; Sexton, Thomas

    2016-06-01

    To evaluate the effectiveness of Functional Family Therapy (FFT) 42 cases were randomized to FFT and 55 to a waiting-list control group. Minimization procedures controlled the effects of potentially confounding baseline variables. Cases were treated by a team of five therapists who implemented FFT with a moderate degree of fidelity. Rates of clinical recovery were significantly higher in the FFT group than in the control group. Compared to the comparison group, parents in the FFT group reported significantly greater improvement in adolescent problems on the Strengths and Difficulties Questionnaire (SDQ) and both parents and adolescents reported improvements in family adjustment on the Systemic Clinical Outcomes and Routine Evaluation (SCORE). In addition, 93% of youth and families in the treatment condition completed FFT. Improvements shown immediately after treatment were sustained at 3-month follow-up. Results provide a current demonstration of FFT's effectiveness for youth with behavior problems in community-based settings, expand our understanding of the range of positive outcomes of FFT to include mental health risk and family-defined problem severity and impact, and suggests that it is an effective intervention when implemented in an Irish context. PMID:26542420

  20. Children's Positive Adjustment to First Grade in Risk-Filled Communities: A Case Study of the Role of School Ecologies in South Africa and Finland

    ERIC Educational Resources Information Center

    Kumpulainen, Kristiina; Theron, Linda; Kahl, Carlien; Bezuidenhout, Carla; Mikkola, Anna; Salmi, Saara; Khumalo, Tumi; Uusitalo-Malmivaara, Lotta

    2016-01-01

    This article presents a comparative case study on the ways in which children's school ecologies facilitate their adjusting positively to first grade in risk-filled contexts in South Africa and Finland. The insights of two children (one South African, one Finnish) from socio-economically disadvantaged communities, their teachers, parents and…

  1. Clearing the Air: Summarizing the Smoking-related Relative Risks of Bladder and Kidney Cancer.

    PubMed

    Purdue, Mark P; Silverman, Debra T

    2016-09-01

    This Platinum Priority editorial discusses the strengths and limitations of a recent meta-analysis summarizing the published smoking-related relative risks for bladder cancer and kidney cancer. PMID:27130147

  2. The Relations of Temperament Reactivity and Effortful Control to Children’s Adjustment Problems in China and the United States

    PubMed Central

    Zhou, Qing; Lengua, Liliana J.; Wang, Yun

    2014-01-01

    The relations of parents’ and teachers’ reports of temperament anger-irritability, positive emotionality, and effortful control (attention focusing and inhibitory control) to children’s externalizing and internalizing problems were examined in Chinese (N = 382) and U.S. (N = 322) samples of school-age children. Results suggested that in both cultures, low effortful control and high anger–irritability were associated with high externalizing problems, although the relations were stronger in the Chinese sample than in the U.S. sample. Low positive emotionality was associated with high internalizing problems in both cultures. However, high positive emotionality was associated with noncomorbid externalizing problems (teachers’ reports) in the Chinese sample but not in the U.S. sample. These findings suggest that there are considerable cross-cultural similarities in the temperament-adjustment associations, although some cross-cultural differences might exist. Implications of the findings for the detection and intervention of adjustment problems in Chinese children are discussed. PMID:19413428

  3. Social Support: Main and Moderating Effects on the Relation between Financial Stress and Adjustment among College Students with Disabilities

    ERIC Educational Resources Information Center

    Murray, Christopher; Lombardi, Allison; Bender, Franklin; Gerdes, Hillary

    2013-01-01

    Students with disabilities are underrepresented in 4-year colleges and universities in the United States and those that do attend are at an increased risk of performing poorly in these settings. These difficulties for college students with disabilities may be compounded by additional stress related to financial concerns. The current study was…

  4. Relational Psychotherapy Mothers’ Group: A developmentally informed intervention for at-risk mothers

    PubMed Central

    Luthar, Suniya S.; Suchman, Nancy E.

    2012-01-01

    The Relational Psychotherapy Mothers’ Group (RPMG), a developmentally informed, supportive psychotherapy designed to serve heroin-addicted mothers with children up to 16 years of age, aims at addressing psychosocial vulnerabilities, and facilitating optimal parenting, among at-risk mothers. We present preliminary evidence on the efficacy of RPMG as an “add on” treatment in comparison with standard methadone counseling alone. At the end of the 24-week treatment period, mothers receiving RPMG plus standard methadone counseling demonstrated lower levels of risk for child maltreatment, greater involvement with their children, and more positive psychosocial adjustment than women who received methadone counseling alone. Children of RPMG participants also reflected fewer problems in multiple areas. At 6 months posttreatment, RPMG recipients continued to be at a relative advantage, although the magnitude of group differences was often attenuated. Notably, urinalyses indicated that RPMG mothers showed greater improvements in levels of opioid use over time than comparison mothers. PMID:10847626

  5. Continued Increases in the Relative Risk of Death From Smoking

    PubMed Central

    Preston, Samuel

    2012-01-01

    Objectives. We examined changes in the relative risk of death among current and former smokers over recent decades in the United States. Methods. Data from the National Health Interview Survey (NHIS) and National Health and Nutrition Examination Survey (NHANES) were linked to subsequent deaths. We calculated age-standardized death rates by gender and smoking status, and estimated multivariate discrete time logit regression models. Results. The risk of death for a smoker compared with that for a never-smoker increased by 25.4% from 1987 to 2006 based on NHIS data. Analysis of NHANES data from 1971 to 2006 showed an even faster annual increase in the relative risk of death for current smokers. Former smokers also showed an increasing relative risk of death, although the increase was slower than that among current smokers and not always statistically significant. These trends were not related to increasing educational selectivity of smokers or increased smoking intensity or duration among current smokers. Smokers may have become more adversely selected on other health-related variables. Conclusions. A continuing increase in the relative risk of death for current and former smokers suggests that the contribution of smoking to national mortality patterns is not decreasing as rapidly as would be implied by the decreasing prevalence of smoking among Americans. PMID:23050582

  6. Regulations regarding income-related monthly adjustment amounts to Medicare beneficiaries' prescription drug coverage premiums. Interim final rule with request for comments.

    PubMed

    2010-12-01

    We are adding a new subpart to our regulations, which contains the rules we will apply to determine the income-related monthly adjustment amount for Medicare prescription drug coverage premiums. This new subpart implements changes made to the Social Security Act (Act) by the Affordable Care Act. These rules parallel the rules in subpart B of this part, which describes the rules we apply when we determine the income-related monthly adjustment amount for certain Medicare Part B (medical insurance) beneficiaries. These rules describe the new subpart; what information we will use to determine whether you will pay an income-related monthly adjustment amount and the amount of the adjustment when applicable; when we will consider a major life-changing event that results in a significant reduction in your modified adjusted gross income; and how you can appeal our determination about your income-related monthly adjustment amount. These rules will allow us to implement the provisions of the Affordable Care Act on time that relate to the income-related monthly adjustment amount for Medicare prescription drug coverage premiums, when they go into effect on January 1, 2011. PMID:21137594

  7. Obesity related risk of sudden cardiac death in the atherosclerosis risk in communities study

    PubMed Central

    Adabag, Selcuk; Huxley, Rachel R; Lopez, Faye L; Chen, Lin Y; Sotoodehnia, Nona; Siscovick, David; Deo, Rajat; Konety, Suma; Alonso, Alvaro; Folsom, Aaron R

    2016-01-01

    Objective To examine the association of body mass index (BMI), waist circumference (WC) and waist hip ratio (WHR) with sudden cardiac death (SCD) in community dwelling individuals. Methods Data from a multicentre, prospective, cohort study of 14 941 men and women (African American, and white), aged 45–64 years, participating in the Atherosclerosis Risk in Communities study was analysed. Obesity measures were assessed at baseline (1987–1989). SCD was adjudicated by a committee. Results At enrolment mean±SD age of the participants was 54±6 years (55% female; 26% African American). During 12.6±2.5 years of follow-up, 253 SCD occurred (incidence rate 1.34/100 person-years). The association between obesity and SCD differed by smoking status (interaction p≤0.01). In models adjusting for age, sex, race, study centre and education level, SCD risk was positively associated (p<0.001) with BMI, WC and WHR in non-smokers, but not in smokers. WHR was more strongly associated with SCD in non-smokers than was BMI or WC (HR per SD increment (95% CI) 2.00 (1.65 to 2.42); 1.34 (1.15 to 1.56) and 1.49 (1.28 to 1.74), respectively). After adjustment for potential mediators (hypertension, diabetes, lipid profile, prevalent coronary heart disease, heart failure, and LV hypertrophy), non-smokers in the highest WHR category (>0.95 in women; >1.01 in men) had double the risk of SCD (HR 2.03, 95% CI 1.19 to 3.46; incidence rate 1.43/1000 person-years) versus those with normal WHR. Conclusions General obesity is associated with increased risk of SCD in middle-aged, non-smoking individuals, mediated by traditional cardiovascular risk factors. Central obesity, however, is independently associated with SCD by pathways that remain to be elucidated. PMID:25410499

  8. Impact of work-related cancers in Taiwan-Estimation with QALY (quality-adjusted life year) and healthcare costs.

    PubMed

    Lee, Lukas Jyuhn-Hsiarn; Lin, Cheng-Kuan; Hung, Mei-Chuan; Wang, Jung-Der

    2016-12-01

    This study estimates the annual numbers of eight work-related cancers, total losses of quality-adjusted life years (QALYs), and lifetime healthcare expenditures that possibly could be saved by improving occupational health in Taiwan. Three databases were interlinked: the Taiwan Cancer Registry, the National Mortality Registry, and the National Health Insurance Research Database. Annual numbers of work-related cancers were estimated based on attributable fractions (AFs) abstracted from a literature review. The survival functions for eight cancers were estimated and extrapolated to lifetime using a semi-parametric method. A convenience sample of 8846 measurements of patients' quality of life with EQ-5D was collected for utility values and multiplied by survival functions to estimate quality-adjusted life expectancies (QALEs). The loss-of-QALE was obtained by subtracting the QALE of cancer from age- and sex-matched referents simulated from national vital statistics. The lifetime healthcare expenditures were estimated by multiplying the survival probability with mean monthly costs paid by the National Health Insurance for cancer diagnosis and treatment and summing this for the expected lifetime. A total of 3010 males and 726 females with eight work-related cancers were estimated in 2010. Among them, lung cancer ranked first in terms of QALY loss, with an annual total loss-of-QALE of 28,463 QALYs and total lifetime healthcare expenditures of US$36.6 million. Successful prevention of eight work-related cancers would not only avoid the occurrence of 3736 cases of cancer, but would also save more than US$70 million in healthcare costs and 46,750 QALYs for the Taiwan society in 2010. PMID:27413666

  9. Heterosexual gender relations in and around childhood risk and safety.

    PubMed

    Brussoni, Mariana; Olsen, Lise L; Creighton, Genevieve; Oliffe, John L

    2013-10-01

    Injuries are a leading cause of child death, and safety interventions frequently target mothers. Fathers are largely ignored despite their increasing childcare involvement. In our qualitative study with 18 Canadian heterosexual couples parenting children 2 to 7 years old, we examined dyadic decision making and negotiations related to child safety and risk engagement in recreational activities. Parents viewed recreation as an important component of men's childcare, but women remained burdened with mundane tasks. Most couples perceived men as being more comfortable with risk than women, and three negotiation patterns emerged: fathers as risk experts; mothers countering fathers' risk; and fathers acknowledging mothers' safety concerns but persisting in risk activities. Our findings suggest that contemporary involved fathering practices privilege men in the outdoors and can erode women's control for protecting children from unintentional injury. We recommend promoting involved fathering that empowers both parents and developing injury-prevention strategies incorporating both fathers' and mothers' perspectives. PMID:24043348

  10. The relative risk in a cohort study with Poisson cases.

    PubMed

    Mulder, P G

    1988-01-01

    This paper deals with making statistical inference about the relative risk (or risk ratio) in a cohort (or prospective) study with dichotomous exposure when the number of cases is a Poisson distributed variable. The exact procedure for testing the null hypothesis for the relative risk and the exact computation of its confidence interval for a single 2 X 2 table is presented. Maximum likelihood methods and the homogeneity test are presented for the common risk ratio when data is stratified in several 2 X 2 tables. These methods are based upon a sufficient statistic and therefore are considered proper statistical alternatives to the more descriptive epidemiological measures such as (in)directly standardized mortality (morbidity) ratios. All computations can be done on a programmable pocket calculator. With the HP-41 CV more than 70 strata can be distinguished. PMID:3180748

  11. Nighttime Parenting Strategies and Sleep-Related Risks to Infants

    PubMed Central

    Volpe, Lane E.; Ball, Helen L.; McKenna, James J.

    2012-01-01

    A large social science and public health literature addresses infant sleep safety, with implications for infant mortality in the context of accidental deaths and Sudden Infant Death Syndrome (SIDS). As part of risk reduction campaigns in the USA, parents are encouraged to place infants supine and to alter infant bedding and elements of the sleep environment, and are discouraged from allowing infants to sleep unsupervised, from bed-sharing either at all or under specific circumstances, or from sofa-sharing. These recommendations are based on findings from large-scale epidemiological studies that generate odds ratios or relative risk statistics for various practices; however, detailed behavioural data on nighttime parenting and infant sleep environments are limited. To address this issue, this paper presents and discusses the implications of four case studies based on overnight observations conducted with first-time mothers and their four-month old infants. These case studies were collected at the Mother-Baby Behavioral Sleep Lab at the University of Notre Dame USA between September 2002 and June 2004.Each case study provides a detailed description based on video analysis of sleep-related risks observed while mother-infant dyads spent the night in a sleep lab. The case studies provide examples of mothers engaged in the strategic management of nighttime parenting for whom sleep-related risks to infants arose as a result of these strategies. Although risk reduction guidelines focus on eliminating potentially risky infant sleep practices as if the probability of death from each were equal, the majority of instances in which these occur are unlikely to result in infant mortality. Therefore, we hypothesise that mothers assess potential costs and benefits within margins of risk which are not acknowledged by risk-reduction campaigns. Exploring why mothers might choose to manage sleep and nighttime parenting in ways that appear to increase potential risks to infants may help

  12. Nighttime parenting strategies and sleep-related risks to infants.

    PubMed

    Volpe, Lane E; Ball, Helen L; McKenna, James J

    2013-02-01

    A large social science and public health literature addresses infant sleep safety, with implications for infant mortality in the context of accidental deaths and Sudden Infant Death Syndrome (SIDS). As part of risk reduction campaigns in the USA, parents are encouraged to place infants supine and to alter infant bedding and elements of the sleep environment, and are discouraged from allowing infants to sleep unsupervised, from bed-sharing either at all or under specific circumstances, or from sofa-sharing. These recommendations are based on findings from large-scale epidemiological studies that generate odds ratios or relative risk statistics for various practices; however, detailed behavioural data on nighttime parenting and infant sleep environments are limited. To address this issue, this paper presents and discusses the implications of four case studies based on overnight observations conducted with first-time mothers and their four-month old infants. These case studies were collected at the Mother-Baby Behavioral Sleep Lab at the University of Notre Dame USA between September 2002 and June 2004. Each case study provides a detailed description based on video analysis of sleep-related risks observed while mother-infant dyads spent the night in a sleep lab. The case studies provide examples of mothers engaged in the strategic management of nighttime parenting for whom sleep-related risks to infants arose as a result of these strategies. Although risk reduction guidelines focus on eliminating potentially risky infant sleep practices as if the probability of death from each were equal, the majority of instances in which these occur are unlikely to result in infant mortality. Therefore, we hypothesise that mothers assess potential costs and benefits within margins of risk which are not acknowledged by risk-reduction campaigns. Exploring why mothers might choose to manage sleep and nighttime parenting in ways that appear to increase potential risks to infants may

  13. Risk of human papillomavirus-related cancers among kidney transplant recipients and patients receiving chronic dialysis - an observational cohort study

    PubMed Central

    2013-01-01

    Background Individuals with end-stage renal disease (ESRD) have excess risk of various cancer types. However, the total burden of human papillomavirus-related cancers remains unknown. Methods We performed a nationwide observational cohort study during 1994–2010. For each person with ESRD, we sampled 19 population controls (without ESRD) matched on age, gender and municipality. Participants were followed until first diagnosis of human papillomavirus-related cancer, death, emigration, or 31 December 2010, whichever came first. Human papillomavirus-related cancers were extracted from Danish medical administrative databases. We considered cancers of the cervix, vulva, vagina, penis, anus, and subsets of head and neck cancers as human papillomavirus-related. We calculated incidence rates of human papillomavirus-related cancer and used Poisson regression to identify risk factors for human papillomavirus-related cancer. Results Among 12,293 persons with ESRD and 229,524 population controls we identified 62 and 798 human papillomavirus-related cancers, respectively. Incidence rates of human papillomavirus-related- cancer were 102 per 100,000 person-years (95% confidence interval [CI]; 79.5-131) among persons with ESRD and 40.8 per 100,000 person-years (95% CI; 38.1-43.7) among population controls. ESRD patients had 4.54 (95% CI, 2.48-8.31) fold increased risk of anal cancer and 5.81 fold (95% CI; 3.36-10.1) increased risk of vulvovaginal cancer. Adjusted for age, comorbidity, and sex, ESRD patients had 2.41 (95% CI; 1.83-3.16) fold increased risk of any human papillomavirus-related cancer compared with population controls. Compared with dialysis patients renal transplant recipients had an age-adjusted non-significant 1.53 (95% CI, 0.91-2.58) fold higher risk of human papillomavirus-related cancer. Conclusions Persons with ESRD have excess risk of potentially vaccine-preventable human papillomavirus-related cancers. PMID:23834996

  14. Age-related deficit accumulation and the risk of late-life dementia

    PubMed Central

    2014-01-01

    Introduction Many age-related health problems have been associated with dementia, leading to the hypothesis that late-life dementia may be determined less by specific risk factors, and more by the operation of multiple health deficits in the aggregate. Our study addressed (a) how the predictive value of dementia risk varies by the number of deficits considered and (b) how traditional (for example. vascular risks) and nontraditional risk factors (for example, foot problems, nasal congestion) compare in their predictive effects. Methods Older adults in the Canadian Study of Health and Aging who were cognitively healthy at baseline were analyzed (men, 2,902; women, 4,337). Over a 10-year period, 44.8% of men and 33.4% of women died; 7.4% of men and 9.1% of women without baseline cognitive impairment developed dementia. Self-rated health problems, including, but not restricted to, dementia risk factors, were coded as deficit present/absent. Different numbers of randomly selected variables were used to calculate various iterations of the index (that is, the proportion of deficits present in an individual. Risks for 10-year mortality and dementia outcomes were evaluated separately for men and women by using logistic regression, adjusted for age. The prediction accuracy was evaluated by using C-statistics. Results Age-adjusted odds ratios per additional deficit were 1.22 (95% confidence interval (CI), 1.18 to 1.26) in men and 1.14 (1.11 to 1.16) in women in relation to death, and 1.18 (1.12 to 1.25) in men and 1.08 (1.04 to 1.11) in women in relation to dementia. The predictive value increased with the number (n) of deficits considered, regardless of whether they were known dementia risks, and stabilized at n > 25. The all-factor index best predicted dementia (C-statistics, 0.67 ± 0.03). Conclusions The variety of items associated with dementias suggests that some part of the risk might relate more to aberrant repair processes, than to specifically toxic results

  15. Estimating the Roles of Genetic Risk, Perinatal Risk, and Marital Hostility on Early Childhood Adjustment: Medical Records and Self-Reports.

    PubMed

    Neiderhiser, Jenae M; Marceau, Kristine; De Araujo-Greecher, Marielena; Ganiban, Jody M; Mayes, Linda C; Shaw, Daniel S; Reiss, David; Leve, Leslie D

    2016-05-01

    A wide variety of perinatal risk factors have been linked to later developmental outcomes in children. Much of this work has relied on either birth/medical records or mothers' self-reports collected after delivery, and there has been an ongoing debate about which strategy provides the most accurate and reliable data. This report uses a parent-offspring adoption design (N = 561 families) to (1) examine the correspondence between medical record data and self-report data, (2) examine how perinatal risk factors may influence child internalizing and externalizing behavior at age 4.5 years, and (3) explore interactions among genetic, perinatal risk, and rearing environment on child internalizing and externalizing behavior during early childhood. The agreement of self-reports and medical records data was relatively high (51-100 %), although there was some variation based on the construct. There were few main effects of perinatal risk on child outcomes; however, there were several 2- and 3-way interactions suggesting that the combined influences of genetic, perinatal, and rearing environmental risks are important, particularly for predicting whether children exhibit internalizing versus externalizing symptoms at age 4.5 years. PMID:27075497

  16. Risk factors for chronic undernutrition among children in India: Estimating relative importance, population attributable risk and fractions.

    PubMed

    Corsi, Daniel J; Mejía-Guevara, Iván; Subramanian, S V

    2016-05-01

    Nearly 40% of the world's stunted children live in India and the prevalence of undernutrition has been persistently high in recent decades. Given numerous available interventions for reducing undernutrition in children, it is not clear of the relative importance of each within a multifactorial framework. We assess the simultaneous contribution of 15 known risk factors for child chronic undernutrition in India. Data are from the 3rd Indian National Family Health Survey (NFHS-3), a nationally representative cross-sectional survey undertaken in 2005-2006. The study population consisted of children aged 6-59 months [n = 26,842 (stunting/low height-for-age), n = 27,483 (underweight/low weight-for-age)]. Risk factors examined for their association with undernutrition were: vitamin A supplementation, vaccination, use of iodized salt, household air quality, improved sanitary facilities, safe disposal of stools, improved drinking water, prevalence of infectious disease, initiation of breastfeeding, dietary diversity, age at marriage, maternal BMI, height, education, and household wealth. Age/sex-adjusted and multivariable adjusted effect sizes (odds ratios) were calculated for risk factors along with Population Attributable Risks (PAR) and Fractions (PAF) using logistic regression. In the mutually adjusted models, the five most important predictors of childhood stunting/underweight were short maternal stature, mother having no education, households in lowest wealth quintile, poor dietary diversity, and maternal underweight. These five factors had a combined PAR of 67.2% (95% CI: 63.3-70.7) and 69.7% (95% CI: 66.3-72.8) for stunting and underweight, respectively. The remaining factors were associated with a combined PAR of 11.7% (95% CI: 6.0-17.4) and 15.1% (95% CI: 8.9-21.3) for stunting and underweight, respectively. Implementing strategies focused on broader progress on social circumstances and infrastructural domains as well as investments in nutrition specific

  17. Discrimination and adjustment for Mexican American adolescents: A prospective examination of the benefits of culturally-related values

    PubMed Central

    Berkel, Cady; Knight, George P.; Zeiders, Katharine H.; Tein, Jenn-Yun; Roosa, Mark W.; Gonzales, Nancy A.; Saenz, Delia

    2009-01-01

    Mexican American adolescents face disparities in mental health and academic achievement, perhaps in part because of discrimination experiences. However, culturally-related values, fostered by ethnic pride and socialization, may serve to mitigate the negative impact of discrimination. Guided by the Stress Process Model, the current study examined risk and protective processes using a 2-wave multi-informant study with 750 Mexican American families. Specifically, we examined two possible mechanisms by which Mexican American values may support positive outcomes in the context of discrimination; as a protective factor (moderator) or risk reducer (mediator). Analyses supported the role of Mexican American values as a risk reducer. This study underscores the importance of examining multiple mechanisms of protective processes in understanding Mexican American adolescent resilience. PMID:21359093

  18. Setting health care capitations through diagnosis-based risk adjustment: a suitable model for the English NHS?

    PubMed

    Asthana, Sheena; Gibson, Alex

    2011-07-01

    The English system of health resource allocation has been described as the apotheosis of the area-level approach to setting health care capitations. However, recent policy developments have changed the scale at which commissioning decisions are made (and budgets allocated) with important implications for resource allocation. Doubts concerning the legitimacy of applying area-based formulae used to distribute resources between Primary Care Trusts (PCTs) to the much smaller scale required by Practice Based Commissioning (PBC) led the English Department of Health (DH) to introduce a new approach to setting health care budgets. To this end, practice-level allocations for acute services are now calculated using a diagnosis-based capitation model of the kind used in the United States and several other systems of competitive social health insurance. The new Coalition Government has proposed that these budgets are directly allocated to GP 'consortia', the new commissioning bodies in the NHS. This paper questions whether this is an appropriate development for a health system in which the major objective of resource allocation is to promote equal opportunity of access for equal needs. The chief reservation raised is that of circularity and the perpetuation of resource bias, the concern being that an existing social, demographic and geographical bias in the use of health care resources will be reinforced through the use of historic utilisation data. Demonstrating that there are legitimate reasons to suspect that this will be the case, the paper poses the question whether health systems internationally should more openly address the key limitations of empirical methods that select risk adjusters on the basis of existing patterns of health service utilisation. PMID:21093953

  19. Are All Risks Equal? Early Experiences of Poverty-Related Risk and Children’s Functioning

    PubMed Central

    Roy, Amanda L.; Raver, C. Cybele

    2014-01-01

    Using cumulative risk and latent class analysis (LCA) models, this research examines how exposure to deep poverty (income-to-needs ratio <.50) and four poverty-related risks (single-parent household, residential crowding, caregiver depression, and multiple life stressors) in preschool is related to children’s future difficulty in school in a longitudinal sample of 602 Head-Start enrolled, low-income families. Results from the LCA revealed four risk profiles: low risk, deep poverty and single, single and stressed, and deep poverty and crowded household. Tests of measurement invariance across racial/ethnic groups established that although patterns of risk are similar across groups (i.e. risks co-vary in the same way), the prevalence of risk profiles differ. African American families were over-represented in the ‘deep poverty and single’ profile while Latino and White families were over-represented in the ‘deep poverty and crowded’ profile. Finally, children’s third grade functioning in three domains (academic performance, behavior problems, self-regulatory skills) was predicted using a cumulative risk index and LCA identified risk profiles. Both approaches demonstrated that children who experienced higher levels of risk in preschool had worse school performance than children with low levels of risk. However, the LCA also revealed that children who experienced ‘single and stressed’ family settings had more behavior problems than low risk children while children who experienced ‘deep poverty and crowded’ family settings had worse academic performance. The results indicate that all risks are not equal for children’s development and highlight the utility of LCA for tailoring intervention efforts to best meet the needs of target populations. PMID:24749652

  20. Are all risks equal? Early experiences of poverty-related risk and children's functioning.

    PubMed

    Roy, Amanda L; Raver, C Cybele

    2014-06-01

    Using cumulative risk and latent class analysis (LCA) models, we examined how exposure to deep poverty (income-to-needs ratio <0.50) and 4 poverty-related risks (i.e., single-parent household, residential crowding, caregiver depression, and multiple life stressors) in preschool is related to children's future difficulty in school in a longitudinal sample of 602 Head Start-enrolled, low-income families. Results from the LCA revealed 4 risk profiles: low risk, deep poverty and single, single and stressed, and deep poverty and crowded household. Tests of measurement invariance across racial/ethnic groups established that, although patterns of risk are similar across groups (i.e., risks covary in the same way), the prevalence of risk profiles differs. African American families were overrepresented in the "deep poverty and single" profile while Latino and White families were overrepresented in the "deep poverty and crowded" profile. Finally, children's third grade functioning in 3 domains (i.e., academic performance, behavior problems, and self-regulatory skills) was predicted using a cumulative risk index and LCA-identified risk profiles. Both approaches demonstrated that children who experienced higher levels of risk in preschool had worse school performance than children with low levels of risk. However, LCA also revealed that children who experienced "single and stressed" family settings had more behavior problems than low-risk children while children who experienced "deep poverty and crowded" family settings had worse academic performance. The results indicate that all risks are not equal for children's development and highlight the utility of LCA for tailoring intervention efforts to best meet the needs of target populations. PMID:24749652

  1. Police-related experiences and HIV risk among female sex workers in Andhra Pradesh, India.

    PubMed

    Erausquin, Jennifer Toller; Reed, Elizabeth; Blankenship, Kim M

    2011-12-01

    Research suggests experiences with police are related to human immunodeficiency virus (HIV) sexual risk among women working as sex workers. However, little is known about the links between specific police-related behaviors and HIV vulnerability. We examine whether 5 police-related experiences are associated with measures of HIV risk and violence among a sample of female sex workers (FSWs) in Andhra Pradesh, India, and consider the implications for HIV prevention. FSWs at least 18 years of age (n = 835) were recruited through respondent-driven sampling for a cross-sectional survey conducted as part of Avahan, the India AIDS Initiative. Using logistic regression models adjusted for age, age at start of sex work, and sex work venue, we assessed police-related experiences reported by FSWs in relation to HIV risk behaviors and violence. Results showed having sex with police to avoid trouble, giving gifts to police to avoid trouble, having police take condoms away, experiencing a workplace raid, and being arrested were associated with sexually transmitted infection symptoms, inconsistent condom use, acceptance of more money for sex without a condom, and experience of client violence. These findings suggest a need for interventions targeting police-FSW interactions to reduce HIV vulnerability among FSWs. PMID:22043036

  2. A Probabilistic Risk Assessment of Groundwater-Related Risks at Excavation Sites

    NASA Astrophysics Data System (ADS)

    Jurado, A.; de Gaspari, F.; Vilarrasa, V.; Sanchez-Vila, X.; Fernandez-Garcia, D.; Tartakovsky, D. M.; Bolster, D.

    2010-12-01

    Excavation sites such as those associated with the construction of subway lines, railways and highway tunnels are hazardous places, posing risks to workers, machinery and surrounding buildings. Many of these risks can be groundwater related. In this work we develop a general framework based on a probabilistic risk assessment (PRA) to quantify such risks. This approach is compatible with standard PRA practices and it employs many well-developed risk analysis tools, such as fault trees. The novelty and computational challenges of the proposed approach stem from the reliance on stochastic differential equations, rather than reliability databases, to compute the probabilities of basic events. The general framework is applied to a specific case study in Spain. It is used to estimate and minimize risks for a potential construction site of an underground station for the new subway line in the Barcelona metropolitan area.

  3. Structure of the Weinberger Adjustment Inventory Self-Restraint scale and its relation to problem behaviors in adolescence.

    PubMed

    Farrell, A D; Sullivan, T N

    2000-12-01

    The authors examined the structure of the Weinberger Adjustment Inventory (WAI) Self-Restraint scale in derivation (n = 1,286) and cross-validation (n = 1,154) samples of mostly African American 6th graders in 3 urban schools. Four models were compared: (a) a 1-factor model; (b) a hierarchical model in which factors representing Impulse Control, Suppression of Aggression, Responsibility, and Consideration of Others were subsumed by a higher order factor; (c) a model that represented these 4 factors as correlated but distinct constructs; and (d) a model that excluded Consideration of Others from the higher order factor. Consistent support was found for the last model based on confirmatory factor analyses and latent-variable analyses examining the relations among self-restraint scales, drug use, delinquency, and aggression. These findings have implications for using the WAI, particularly in studies of adolescent problem behaviors. PMID:11147106

  4. The psychosocial adjustment of African American youth from single mother homes: the relative contribution of parents and peers.

    PubMed

    Chester, Charlene; Jones, Deborah J; Zalot, Alecia; Sterrett, Emma

    2007-01-01

    This study examined the relative roles of parents and peers in the psychosocial adjustment of African American youth (7-15 years old) from single mother homes (N = 242). Main effects of both positive parenting and peer relationship quality were found for youth depressive symptoms. In addition, a main effect of peer relationship quality and an interaction of Positive Parenting x Peer Relationship Quality emerged for youth externalizing symptoms. When mothers engaged in higher levels of positive parenting behavior, peer relationship quality was not associated with youth externalizing symptomatology. When mothers engaged in lower levels of positive parenting behavior, however, higher peer relationship quality was associated with greater youth externalizing symptomatology. Clinical implications and future research directions are discussed. PMID:17658980

  5. Ecological risk assessment of water environment for Luanhe River Basin based on relative risk model.

    PubMed

    Liu, Jingling; Chen, Qiuying; Li, Yongli

    2010-11-01

    The relative risk model (RRM) was applied in regional ecological risk assessments successfully. In this study, the RRM was developed through increasing the data of risk source and introducing the source-stressor-habitat exposure filter (SSH), the endpoint-habitat exposure filter (EH) and the stressor-endpoint effect filter (SE) to reflect the meaning of exposure and effect more explicit. Water environment which include water quality, water quantity and aquatic ecosystems was selected as the ecological risk assessment endpoints. The Luanhe River Basin located in the North China was selected as model case. The results showed that there were three low risk regions, one medium risk region and two high risk regions in the Luanhe River Basin. The results also indicated habitat destruction was the largest stressor with the risk scores as high as 11.87 for the Luanhe water environment, the second was oxygen consuming organic pollutants (9.28) and the third was nutrients (7.78). So these three stressors were the main influencing factors of the ecological pressure in the study area. Furthermore, animal husbandry was the biggest source with the risk scores as high as 20.38, the second was domestic sewage (14.00), and the third was polluting industry (9.96). For habitats, waters and farmland were enduring the bigger pressure and should be taken considerable attention. Water deterioration and ecological service values damaged were facing the biggest risk pressure, and secondly was biodiversity decreased and landscape fragmentation. PMID:20683654

  6. HIV-Related Stigma, Shame, and Avoidant Coping: Risk Factors for Internalizing Symptoms Among Youth Living with HIV?

    PubMed

    Bennett, David S; Hersh, Jill; Herres, Joanna; Foster, Jill

    2016-08-01

    Youth living with HIV (YLH) are at elevated risk of internalizing symptoms, although there is substantial individual variability in adjustment. We examined perceived HIV-related stigma, shame-proneness, and avoidant coping as risk factors of internalizing symptoms among YLH. Participants (N = 88; ages 12-24) completed self-report measures of these potential risk factors and three domains of internalizing symptoms (depressive, anxiety, and PTSD) during a regularly scheduled HIV clinic visit. Hierarchical regressions were conducted for each internalizing symptoms domain, examining the effects of age, gender, and maternal education (step 1), HIV-related stigma (step 2), shame- and guilt-proneness (step 3), and avoidant coping (step 4). HIV-related stigma, shame-proneness, and avoidant coping were each correlated with greater depressive, anxiety, and PTSD symptoms. Specificity was observed in that shame-proneness, but not guilt-proneness, was associated with greater internalizing symptoms. In multivariable analyses, HIV-related stigma and shame-proneness were each related to greater depressive and PTSD symptoms. Controlling for the effects of HIV-related stigma and shame-proneness, avoidant coping was associated with PTSD symptoms. The current findings highlight the potential importance of HIV-related stigma, shame, and avoidant coping on the adjustment of YLH, as interventions addressing these risk factors could lead to decreased internalizing symptoms among YLH. PMID:26458909

  7. The Risk of Infection-Related Hospitalization With Decreased Kidney Function

    PubMed Central

    Dalrymple, Lorien S.; Katz, Ronit; Kestenbaum, Bryan; de Boer, Ian H.; Fried, Linda; Sarnak, Mark J.; Shlipak, Michael G.

    2011-01-01

    Background Moderate kidney disease may predispose to infection. We sought to determine whether decreased kidney function, as estimated by serum cystatin C, was associated with the risk of infection-related hospitalization in older individuals. Study Design Cohort Study. Setting & Participants 5,142 Cardiovascular Health Study participants with measured serum creatinine and cystatin C and without eGFR <15 ml/min/1.73 m2 at enrollment. Predictor The primary exposure of interest was estimated glomerular filtration rate using serum cystatin C (eGFRSCysC). Outcome Infection-related hospitalizations during a median follow-up of 11.5 years. Results In adjusted analyses, eGFRSCysC categories of 60–89, 45–59, and 15–44 ml/min/1.73 m2 were associated with 16%, 37%, and 64% greater risk of all-cause infection-related hospitalization, respectively, compared with an eGFRSCysC ≥90 ml/min/1.73 m2. When cause specific infection was examined, an eGFRSCysC of 15–44 ml/min/1.73 m2 was associated with an 80% greater risk of pulmonary and 160% greater risk of genitourinary infection compared with an eGFRSCysC ≥90 ml/min/1.73 m2. Limitations No measures of urinary protein, study limited to principal discharge diagnosis. Conclusions Lower kidney function, estimated using cystatin C, was associated with a linear and graded risk of infection-related hospitalization. These findings highlight that even moderate degrees of reduced kidney function are associated with clinically significant higher risks of serious infection in older individuals. PMID:21906862

  8. [Protective and family risk factors related to adolescent drug use].

    PubMed

    Cid-Monckton, Patricia; Pedrão, Luiz Jorge

    2011-06-01

    This cross-sectional and quantitative study aimed to verify the family's protective and risk factors related to drugs use in adolescents, considering the interaction patterns developed in the family, their degree of adaptability and vulnerability. Participants in this study were 80 female adolescents, from the 1st to 4th grade of high school, who answered a questionnaire. The most relevant risk and protective factors that would influence the situation were established, such as patterns of interaction, degree of adaptability, way of coping with problems, family resources and values. The major risk factors that emerged were the way people confront problems and, within these, lack of religious support and professional support, besides communication difficulties within families. The lowest risks were values, such as personal effort. The results highlight that nurses should assume psychosocial interventions as part of their role, especially among school-age children as, thus, they would be acting as agents in the prevention of drugs use. PMID:21739055

  9. Cancer-related fatigue: Mechanisms, risk factors, and treatments

    PubMed Central

    Bower, Julienne E.

    2015-01-01

    Fatigue is one of the most common and distressing side effects of cancer and its treatment, and may persist for years after treatment completion in otherwise healthy survivors. Cancer-related fatigue causes disruption in all aspects of quality of life and may be a risk factor for reduced survival. The prevalence and course of fatigue in cancer patients has been well characterized, and there is growing understanding of underlying biological mechanisms. Inflammation has emerged as a key biological pathway for cancer-related fatigue, with studies documenting links between markers of inflammation and fatigue before, during, and particularly after treatment. There is considerable variability in the experience of cancer-related fatigue that is not explained by disease- or treatment-related characteristics, suggesting that host factors may play an important role in the development and persistence of this symptom. Indeed, longitudinal studies have begun to identify genetic, biological, psychosocial, and behavioral risk factors for cancer-related fatigue. Given the multi-factorial nature of cancer-related fatigue, a variety of intervention approaches have been examined in randomized controlled trials, including physical activity, psychosocial, mind-body, and pharmacological treatments. Although there is currently no gold standard for treating fatigue, several of these approaches have shown beneficial effects and can be recommended to patients. This report provides a state of the science review of mechanisms, risk factors, and interventions for cancer-related fatigue, with a focus on recent longitudinal studies and randomized trials that have targeted fatigued patients. PMID:25113839

  10. A systematic review of patient-related risk factors for catheter-related thrombosis.

    PubMed

    Leung, Amy; Heal, Clare; Perera, Marlon; Pretorius, Casper

    2015-10-01

    To identify patient-related risk factors for venous thrombosis in patients with central venous catheters (CVC) or peripherally inserted central catheters (PICC). We performed a systematic review of the literature assessing patient-related risk factors for thrombosis related to CVC or PICC. The databases PubMed, Ovid and the Cochrane library were searched for observational studies pertaining to patient-related risk factors for CVC and PICC-related thrombosis. The initial search through PubMed, Ovid and the Cochrane library yielded 516 results. After 71 duplicates were removed, 445 articles were assessed for eligibility based on title and abstract. Four hundred and eleven articles were then excluded and 33 full text articles were manually assessed for eligibility. Eight articles were eliminated as they did not contain content relevant to the review. Twenty-five studies were then selected to assess 20 risk factors. There were no consistent significant associations for catheter-related thrombosis across the twenty-five studies. Multiple studies identified age, malignancy, diabetes, obesity, chemotherapy, thrombophilia and a history of thrombosis as significant risk factors for catheter-related thrombosis. Inconsistent findings among studies make it difficult to establish which patient-related risk factors are associated with catheter-related thrombosis. Future studies could include larger sample sizes and more cases of catheter-related thrombosis to produce more significant results. Identification of patient-related risk factors could lead to early recognition of upper limb deep vein thrombosis in patients with catheters, thereby preventing complications. PMID:25680892

  11. Folate, vitamin B(6) , vitamin B(12) , methionine and alcohol intake in relation to ovarian cancer risk.

    PubMed

    Harris, Holly R; Cramer, Daniel W; Vitonis, Allison F; DePari, Mary; Terry, Kathryn L

    2012-08-15

    Folate, methionine, vitamin B(6) and vitamin B(12) may influence carcinogenesis due to their roles in the one-carbon metabolism pathway, which is critical for DNA synthesis, methylation and repair. Low intake of these nutrients has been associated with an increased risk of breast, colon and endometrial cancers. Previous studies that have examined the relation between these nutrients and ovarian cancer risk have been inconsistent and have had limited power to examine the relation by histologic subtype. We investigated the association between folate, methionine, vitamin B(6) , vitamin B(12) and alcohol among 1910 women with ovarian cancer and 1989 controls from a case-control study conducted in eastern Massachusetts and New Hampshire from 1992 to 2008. Diet was assessed via food frequency questionnaire. Participants were asked to recall diet one-year before diagnosis or interview. Logistic regression models were used to calculate odds ratios (OR) and 95% confidence intervals (95% CIs). We also examined whether the associations varied by ovarian cancer histologies using polytomous logistic regression. We observed an inverse association between dietary vitamin B(6) (covariate-adjusted OR = 0.76, 95% CI 0.64-0.92; p(trend) = 0.002) and methionine intake (covariate-adjusted OR = 0.72, 95% CI = 0.60-0.87; p(trend) < 0.001) and ovarian cancer risk comparing the highest to lowest quartile. The association with dietary vitamin B(6) was strongest for serous borderline (covariate-adjusted OR = 0.49, 95% CI = 0.32-0.77; p(trend) = 0.001) and serous invasive (covariate-adjusted OR = 0.74, 95% CI = 0.58-0.94; p(trend) = 0.012) subtypes. Overall, we observed no significant association between folate and ovarian cancer risk. One-carbon metabolism related nutrients, especially vitamin B(6) and methionine, may lower ovarian cancer risk. PMID:21953625

  12. Disability-adjusted life years in the assessment of health effects of traffic-related air pollution.

    PubMed

    Adamkiewicz, Ł; Badyda, A J; Gayer, A; Mucha, D

    2015-01-01

    Traffic-related air pollutants have an impact on human health and have been recognized as one of the main stressors that cause mortality and morbidity in urban areas. Research confirms that citizens living in the vicinity of main roads are strongly exposed to high concentrations of numerous air pollutants. In the present study the measurements of traffic-related parameters such as density, velocity, and structure were performed for cross-sections of selected street canyons in Warsaw, the capital city of Poland. In addition, the results of the general traffic measurements were used to describe the number of cars crossing the border of the city. Vehicle emissions of PM10 were calculated for the whole city area and changes of the PM10 concentration were modeled to present the exposure to this pollutant that could be attributable to traffic. The principles of the environmental burden of disease (EBD) were used. The assessment of the impact of traffic-related air pollutants on human health was made. The results, presented in disability-adjusted life years (DALY), were based on the outcomes of the study conducted in 2008-2012 in Warsaw, one the most congested agglomerations in Europe, and included the health damage effect of the exposure to high concentrations of air pollutants. DALY calculations were performed in accordance to the methodologies used in renowned international scientific research on EBD. PMID:25310938

  13. Spatial Relative Risk Patterns of Autism Spectrum Disorders in Utah

    ERIC Educational Resources Information Center

    Bakian, Amanda V.; Bilder, Deborah A.; Coon, Hilary; McMahon, William M.

    2015-01-01

    Heightened areas of spatial relative risk for autism spectrum disorders (ASD), or ASD hotspots, in Utah were identified using adaptive kernel density functions. Children ages four, six, and eight with ASD from multiple birth cohorts were identified by the Utah Registry of Autism and Developmental Disabilities. Each ASD case was gender-matched to…

  14. Flavonoid intake and the risk of age-related cataract in China's Heilongjiang Province

    PubMed Central

    Ma, Yingna; Gao, Weiqi; Wu, Kun; Bao, Yongping

    2015-01-01

    Background/objectives Epidemiological evidence suggests that diets rich in flavonoids may reduce the risk of developing age-related cataract (ARC). Flavonoids are widely distributed in foods of plant origin, and the objective of this study was to evaluate retrospectively the association between the intakes of the five flavonoid subclasses and the risk of ARC. Subjects/methods A population-based case-control study (249 cases and 66 controls) was carried out in Heilongjiang province, which is located in the northeast of China, and where intakes and availability of fresh vegetables and fruits can be limited. Dietary data gathered by food-frequency questionnaire (FFQ) were used to calculate flavonoid intake. Adjusted odds ratio (OR) and 95% confidence interval (CI) were estimated by logistic regression. Results No linear associations between risk of developing ARC and intakes of total dietary flavonoids, anthocyanidins, flavon-3-ol, flavanone, total flavones or total flavonols were found, but quercetin and isorhamnetin intake was inversely associated with ARC risk (OR 11.78, 95% CI: 1.62–85.84, p<0.05, and OR 6.99, 95% CI: 1.12–43.44, p<0.05, quartile 4 vs. quartile 1, respectively). Conclusion As quercetin is contained in many plant foods and isorhamnetin in very few foods, we concluded that higher quercetin intake may be an important dietary factor in the reduction of the risk of ARC. PMID:26652740

  15. Family history of hypertension and diabetes in relation to preeclampsia risk in Peruvian women.

    PubMed

    Sanchez, Sixto E; Zhang, Cuilin; Qiu, Chun-Fang; Williams, Michelle A

    2003-01-01

    In a case-control study of 169 preeclamptics and 201 controls, we assessed maternal parental history of chronic hypertension and diabetes in relation to preeclampsia risk among Peruvian women. Participants provided information on parental history of the two conditions and other covariates during postpartum interviews. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) adjusted for confounding by age, parity and prepregnancy adiposity. In this population, women were more likely to know the diabetes status of their parents than their hypertension status. Compared with women without a parental history of hypertension, women with a parental history of hypertension experienced a 20% increased risk of preeclampsia (OR = 1.2; 95% CI 0.7-2.2) that did not reach statistical significance. Women with a positive parental history for diabetes had a 3.4-fold increased risk of preeclampsia (95% CI 1.4-8.4). Women with a positive parental history of both hypertension and diabetes, as compared with those whose parents had neither condition, experienced a 4.6- fold increased risk of preeclampsia (OR = 4.6; 95% CI 0.9-23.0). Our results are generally consistent with the thesis that parental history of hypertension and diabetes reflects genetic and behavioral factors whereby women may be predisposed to an increased risk of preeclampsia. PMID:14530611

  16. Explanatory risk factors in the relations between schizotypy and indicators of suicide risk.

    PubMed

    Jahn, Danielle R; DeVylder, Jordan E; Hilimire, Matthew R

    2016-04-30

    Schizotypy has been linked to suicide risk, but it is not known whether established suicide-related risk factors mediate this relation. The aim of this study was to assess the mediating effects of depressive symptoms, social anxiety, self-esteem, and intimate disclosure in peer relationships in the relation between interpersonal schizotypy and suicide ideation or lifetime suicide attempts. This aim was tested in 590 young adults using a nonparametric bootstrapping procedure. After inclusion of the mediators, interpersonal schizotypy was no longer directly associated with either suicide ideation or lifetime suicide attempts. Depression and self-esteem mediated the relation between interpersonal schizotypy and suicide ideation. No variables mediated the relation between interpersonal schizotypy and lifetime suicide attempts, and there were no significant direct relations when mediators were included. Schizotypy appears to be a distal risk factor for suicidal behavior; assessing depressive symptoms and self-esteem may provide more proximal information about suicide risk, and may be targets for mitigating suicide risk in individuals with schizotypy. PMID:27086213

  17. Risk for endometrial cancer in relation to occupational physical activity: a nationwide cohort study in Sweden.

    PubMed

    Moradi, T; Nyrén, O; Bergström, R; Gridley, G; Linet, M; Wolk, A; Dosemeci, M; Adami, H O

    1998-05-29

    Notwithstanding its biologic plausibility, the association between physical activity and endometrial cancer has been analyzed in only a few epidemiological studies. Retrospective assessment of exposure and small sample size often hampers interpretation of published data. We studied risk for endometrial cancer in relation to physical activity at work in a large cohort of Swedish women identified in the nationwide censuses in 1960 and 1970, with jobs that could be consistently classified into one of 4 levels of physical demands. Follow-up from 1971 through 1989 was accomplished through record linkages. Multivariate Poisson regression models were used to estimate relative risk. The risk for endometrial cancer increased regularly with decreasing level of occupational physical activity (p for trend < 0.001), and was associated more strongly with activity in 1970 than in 1960. In multivariate analyses, adjusted for age at follow-up, place of residence, calendar year of follow-up, and social class, the relative risk among women with the same physical activity level in 1960 and in 1970 was 30% higher for sedentary as compared with high/very high activity level; (p for trend=0.04). The protective effect of physical activity appeared to be confined to women aged 50 to 69, among whom sedentary work was associated with a 60% higher risk than that observed among women estimated to be physically most active. The excess seemed to disappear within 10 years after a change in physical activity level. Although confounding cannot be ruled out in our data, occupational physical activity appears to reduce the risk for endometrial cancer. PMID:9610723

  18. Increased Risk Taking in Relation to Chronic Stress in Adults

    PubMed Central

    Ceccato, Smarandita; Kudielka, Brigitte M.; Schwieren, Christiane

    2016-01-01

    Chronic stress is a public health problem that affects a significant part of the population. While the physiological damage it causes is under ongoing scrutiny, its behavioral effects have been overlooked. This is one of the first studies to examine the relation between chronic stress and decision-making, using a standard lottery paradigm. We measured risk taking in the gain domain through binary choices between financially incentivized lotteries. We then measured self-reported chronic stress with the Trier Inventory for the Assessment of Chronic Stress (TICS). We additionally collected hair samples in a subsample of volunteers, in order to quantify accumulation of the stress hormone cortisol. We discovered a significant positive, though modest, correlation between self-reported chronic stress and risk taking that is stronger for women than for men. This confirms part of the findings in acute stress research that show a connection between higher stress and increased risk taking. However, unlike the biologically-based results from acute stress research, we did not identify a significant relation between hair cortisol and behavior. In line with previous literature, we found a clear gender difference in risk taking and self-reports: women generally take less risk and report slightly higher stress levels than men. We conclude that perceived chronic stress can impact behavior in risky situations. PMID:26858663

  19. Genetic risk factors and age-related macular degeneration (AMD)

    PubMed Central

    Mousavi, Maryam; Armstrong, Richard A.

    2013-01-01

    Age related macular degeneration (AMD) is the leading cause of blindness in individuals older than 65 years of age. It is a multifactorial disorder and identification of risk factors enables individuals to make lifestyle choices that may reduce the risk of disease. Collaboration between geneticists, ophthalmologists, and optometrists suggests that genetic risk factors play a more significant role in AMD than previously thought. The most important genes are associated with immune system modulation and the complement system, e.g., complement factor H (CFH), factor B (CFB), factor C3, and serpin peptidase inhibitor (SERPING1). Genes associated with membrane transport, e.g., ATP-binding cassette protein (ABCR) and voltage-dependent calcium channel gamma 3 (CACNG3), the vascular system, e.g., fibroblast growth factor 2 (FGF2), fibulin-5, lysyl oxidase-like gene (LOXL1) and selectin-P (SELP), and with lipid metabolism, e.g., apolipoprotein E (APOE) and hepatic lipase (LIPC) have also been implicated. In addition, several other genes exhibit some statistical association with AMD, e.g., age-related maculopathy susceptibility protein 2 (ARMS2) and DNA excision repair protein gene (ERCC6) but more research is needed to establish their significance. Modifiable risk factors for AMD should be discussed with patients whose lifestyle and/or family history place them in an increased risk category. Furthermore, calculation of AMD risk using current models should be recommended as a tool for patient education. It is likely that AMD management in future will be increasingly influenced by assessment of genetic risk as such screening methods become more widely available.

  20. Body fatness, related biomarkers and cancer risk: an epidemiological perspective.

    PubMed

    Nimptsch, Katharina; Pischon, Tobias

    2015-05-01

    Higher body fatness is not only associated with a higher risk of hypertension, type 2 diabetes, and coronary heart disease but also with certain types of cancer. The scope of this review is to summarize the epidemiological evidence for an association between body fatness and specific types of cancer and to outline the mediating role of obesity-related biomarkers in this context. Epidemiological studies have gathered convincing evidence that greater body fatness is associated with a higher risk of colorectal cancer, postmenopausal breast cancer, endometrial cancer, esophageal adenocarcinoma, renal cell carcinoma, and pancreatic cancer. Further, evidence for an association between higher body fatness and higher risk of ovarian cancer, advanced prostate cancer, and hepatocellular carcinoma is growing. Abdominal obesity is an independent risk factor for colorectal cancer beyond general obesity, whereas an independent role is less clear for other obesity-related cancer types. Epidemiological biomarker studies have shown that the positive association between body fatness and risk of cancer may be partly explained by hyperinsulinemia and altered concentrations in adipokines and sex-steroid hormones. In addition, obesity-associated low-grade inflammation plays a role in colorectal carcinogenesis. While epidemiology has contributed substantially to the understanding of the role of higher body fatness and related metabolic alterations in the development of cancer, further epidemiological biomarker studies are necessary to elucidate the complex interrelations between mediating pathways as well as to study novel pathways. Knowledge resulting from this research may help identify an obesity phenotype that is particularly strongly associated with cancer risk and thus pave the way for targeted prevention of cancer morbidity and mortality. PMID:25781710

  1. Relative risk factors in detecting adolescent drug abuse.

    PubMed

    Swadi, H

    1992-02-01

    Detecting adolescent drug abuse remains to be a difficult proposition because of its secret nature. This paper investigates the significance of other factors as indicators of possible drug use by an adolescent. Peer drug use, suspension at school, law infringements, truancy, conflict with parents, alcohol use and cigarette smoking were the relative risk factors investigated among 953 adolescents. The most predictive of those was peer drug use. The more of those factors were present in an adolescent, the higher the risk of possible drug use. PMID:1559431

  2. Risk factors influencing non-use of condoms at sexual relations in populations under heightened risk.

    PubMed

    Medić, Alan; Dzelalija, Boris; Koźul, Karlo; Novosel, Iva Pem; Dijanić, Tomislav

    2014-09-01

    To determine risk factors for non-use of condoms when engaging in sexual intercourse among high-risk population groups for acquiring HIV/STIs. We collected the data obtained by interviews in the period from 2005 to 2011 in the Voluntary Counseling and Testing Center for HIV/AIDS at the Institute of Public Health of Zadar County. Four hundred ninety four respondents were divided into risk and control groups. The majority of the respondents in our population does not consistently use condoms, in the risk group as much as 89.9%, and in the control group 65.7% of them (p< 0.001). Persons consuming alcohol when having sexual relations use condoms about 5x less often compared to those not consuming alcohol at all (OR=5.00; CI=1.69-14.29). There are significant differences among women and men in the risk group regarding reasons for non-use of condoms. The main reason with women is "I trust mypartners" 33.7% while men "do not like having sex with condoms, 53.6% of them (p < 0.001). The main risk factors for non-use of condoms are alcohol consumption at sexual relations, non-use of condoms in a casual relationship. Having in mind the non-use of condoms among populations of high-risk groups of acquiring HIV there are significant differences among genders. PMID:25507355

  3. Risk factors influencing non-use of condoms at sexual relations in populations under heightened risk.

    PubMed

    Medić, Alan; Dzelalija, Boris; Koźul, Karlo; Novosel, Iva Pem; Dijanić, Tomislav

    2014-09-01

    To determine risk factors for non-use of condoms when engaging in sexual intercourse among high-risk population groups for acquiring HIV/STIs. We collected the data obtained by interviews in the period from 2005 to 2011 in the Voluntary Counseling and Testing Center for HIV/AIDS at the Institute of Public Health of Zadar County. Four hundred ninety four respondents were divided into risk and control groups. The majority of the respondents in our population does not consistently use condoms, in the risk group as much as 89.9%, and in the control group 65.7% of them (p< 0.001). Persons consuming alcohol when having sexual relations use condoms about 5x less often compared to those not consuming alcohol at all (OR=5.00; CI=1.69-14.29). There are significant differences among women and men in the risk group regarding reasons for non-use of condoms. The main reason with women is "I trust mypartners" 33.7% while men "do not like having sex with condoms, 53.6% of them (p < 0.001). The main risk factors for non-use of condoms are alcohol consumption at sexual relations, non-use of condoms in a casual relationship. Having in mind the non-use of condoms among populations of high-risk groups of acquiring HIV there are significant differences among genders. PMID:25420371

  4. Chronotropic response during treadmill exercise and subclinical carotid atherosclerosis after adjusting for the calibrated SCORE risk classification: a cross-sectional study.

    PubMed

    Liontou, Catherine; Chrysohoou, Christina; Skoumas, John; Panagiotakos, Demosthenes B; Pitsavos, Christos; Stefanadis, Christodoulos

    2016-02-01

    Carotid atherosclerosis (CA) and chronotropic incompetence (CI) during exercise are two independent cardiovascular risk factors. Aim of the current study was to investigate the possible association between them, in apparently healthy individuals, after adjusting for the 10-year cardiovascular disease (CVD) risk score. This cross-sectional study consisted of 139 apparently healthy subjects, 40-65 years old, who underwent treadmill exercise test (Bruce protocol used), which showed no evidence of ischemia. Heart rate reserve (HR reserve) was calculated to assess chronotropic response; a value of ≤ 0.80 is considered CI. CA was assessed by the presence of carotid plaque(s) in common and internal carotid arteries and carotid bulb bilaterally, using B-mode ultrasound. A calibrated version of SCORE (i.e., HellenicSCORE) was used to estimate the 10-year fatal CVD risk; participants were classified into low-, moderate- or high-risk group. CI was present in 7.9 % and CA in 18.7 % of the participants. After adjusting for 10-year CVD risk and other key confounders, odds of CA were 8.6 times higher in subjects with CI compared to their counterparts with normal chronotropic response to exercise. The results of the study indicate that CI during exercise can lead to high clinical suspicion of CA in apparently healthy individuals. PMID:25252777

  5. Same-Sex Peer Relations and Romantic Relationships during Early Adolescence: Interactive Links to Emotional, Behavioral, and Academic Adjustment.

    ERIC Educational Resources Information Center

    Brendgen, Mara; Vitaro, Frank; Doyle, Anna Beth; Markiewicz, Dorothy; Bukowski, William M.

    2002-01-01

    Examined the relationship between early adolescents' involvement in romantic relationships and their emotional, behavioral, and academic adjustment, depending on same-sex peer relationships. Found a negative relationship between romantic involvement and emotional and behavioral adjustment for adolescents who were unpopular with same-sex peers.…

  6. Sleep and Adjustment in Preschool Children: Sleep Diary Reports by Mothers Relate to Behavior Reports by Teachers.

    ERIC Educational Resources Information Center

    Bates, John E.; Viken, Richard J.; Alexander, Douglas B.; Beyers, Jennifer; Stockton, Lesley

    2002-01-01

    Investigated the relationship between sleep patterns and behavioral adjustment with 4- to 5-year-old children from low-income families. Found that disrupted child sleep patterns, including variability in parentally reported amount of sleep, variability in bedtime, and lateness of bedtime, predicted less optimal adjustment in preschool, even after…

  7. Radiation-related cancer risks from CT colonography screening: a risk-benefit analysis

    PubMed Central

    de González, Amy Berrington; Kim, Kwang Pyo; Knudsen, Amy B.; Lansdorp-Vogelaar, Iris; Rutter, Carolyn M.; Smith-Bindman, Rebecca; Yee, Judy; Kuntz, Karen M.; van Ballegooijen, Marjolein; Zauber, Ann G.; Berg, Christine D.

    2012-01-01

    Objective The purpose of this study was to estimate the ratio of cancers prevented to induced (benefit-risk ratio) for CT colonography screening every five years from age 50-80. Materials and methods Radiation-related cancer risk was estimated using risk projection models based on the National Research Council's BEIR VII committee's report and screening protocols from the American College of Radiology Imaging Network's National CT Colonography Trial. Uncertainty limits (UL) were estimated using Monte-Carlo simulation methods. Comparative modelling with three colorectal cancer microsimulation models was used to estimate the potential reduction in colorectal cancer cases and deaths. Results The estimated mean effective dose per CT colonography screen was 8mSv for females and 7mSv for males. The estimated number of radiation-related cancers from CT colonography screening every 5 years from age 50-80 was 150 cases/100,000 individuals (95%UL:80-280) for males and females. The estimated number of colorectal cancers prevented by CT colonography every 5 years from age 50-80 ranged across the three microsimulation models from 3580 to 5190/100,000, yielding a benefit-risk ratio that varied from 24:1(95%UL=13:1-45:1) to 35:1(95%UL=19:1-65:1). The benefit-risk ratio for cancer deaths was even higher than the ratio for cancer cases. Inclusion of radiation-related cancer risks from CT scans following-up extracolonic findings did not materially alter the results. Conclusions Concerns have been raised about recommending CT colonography as a routine screening tool because of the potential harms, including the radiation risks. Based on these models the benefits from CT colonography screening every five years from age 50-80 clearly outweigh the radiation risks. PMID:21427330

  8. The Predictive Relationship between Temperament, School Adjustment, and Academic Achievement: A 2-Year Longitudinal Study of Children At-Risk

    ERIC Educational Resources Information Center

    Al-Hendawi, Maha

    2010-01-01

    Individual differences in temperament can be a risk or a protective factor for a child, especially for children at-risk who possess single or multiple risk factors that may interfere with their educational success and affect their healthy development and their life-long outcomes. This research study examined the concurrent and longitudinal…

  9. Modifiable risk factors for age-related macular degeneration.

    PubMed

    Guymer, Robyn H; Chong, Elaine Wei-Tinn

    2006-05-01

    Age-related macular degeneration (AMD) is the leading cause of irreversible blindness in Australia and other Western countries. As there is no cure for AMD, and treatments to stop its progression have met with limited success, there is an interest in identifying modifiable risk factors to prevent or slow disease progression. To date, smoking is the only proven modifiable risk factor for AMD. Other factors under study include (i) cardiovascular risk factors such as hypertension, body mass index, and atherosclerosis; and (ii) dietary risk factors including fat and antioxidant intake, but so far these studies have produced conflicting results. Dietary fat in relation to AMD has recently attracted media attention. Despite very limited work supporting an association between vegetable fat and AMD, widespread publicity advocating margarine as a cause of AMD and encouraging use of butter instead has caused confusion and anxiety among sufferers of AMD and the general public, as well as concern among health professionals. The antioxidant carotenoids--lutein and zeaxanthin--found in dark green or yellow vegetables exist in high concentrations in the macula and are hypothesised to play a protective role. Of nine controlled trials of supplementation with carotenoids and other antioxidants, three suggested that various combinations of antioxidants and carotenoids were protective. While a low-fat diet rich in dark green and yellow vegetables is advocated in general, any specific recommendations regarding certain fats or antioxidant supplementation and AMD are not based on consistent findings at this stage. PMID:16646746

  10. Educational Aspiration-Expectation Discrepancies: Relation to Socioeconomic and Academic Risk-Related Factors

    ERIC Educational Resources Information Center

    Boxer, Paul; Goldstein, Sara E.; DeLorenzo, Tahlia; Savoy, Sarah; Mercado, Ignacio

    2011-01-01

    This study examines whether disconnection between educational aspirations and expectations is associated with socioeconomic status, academic performance, academic risk-related behaviors and related psychosocial factors in an ethnically and economically diverse sample of early adolescents from a public middle school (N = 761). Results suggest that…

  11. Relative Risk Appraisal, the September 11 Attacks, and Terrorism-Related Fears

    PubMed Central

    Marshall, Randall D.; Bryant, Richard A.; Amsel, Lawrence; Suh, Eun Jung; Cook, Joan M.; Neria, Yuval

    2013-01-01

    There are now replicated findings that posttraumatic stress disorder (PTSD) symptoms related to the September 11, 2001, attacks occurred in large numbers of persons who did not fit the traditional definition of exposure to a traumatic event. These data are not explained by traditional epidemiologic “bull’s eye” disaster models, which assume the psychological effects are narrowly, geographically circumscribed, or by existing models of PTSD onset. In this article, the authors develop a researchable model to explain these and other terrorism-related phenomena by synthesizing research and concepts from the cognitive science, risk appraisal, traumatic stress, and anxiety disorders literatures. They propose the new term relative risk appraisal to capture the psychological function that is the missing link between the event and subjective response in these and other terrorism-related studies to date. Relative risk appraisal highlights the core notion from cognitive science that human perception is an active, multidimensional process, such that for unpredictable societal threats, proximity to the event is only one of several factors that influence behavioral responses. Addressing distortions in relative risk appraisal effectively could reduce individual and societal vulnerability to a wide range of adverse economic and ethnopolitical consequences to terrorist attacks. The authors present ways in which these concepts and related techniques can be helpful in treating persons with September 11– or terrorism-related distress or psychopathology. PMID:17516775

  12. Building-related risk factors and work-related lower respiratory symptoms in 80 office buildings

    SciTech Connect

    Mendell, M.J.; Naco, G.M.; Wilcox, T.G.; Sieber, W.K.

    2002-01-01

    We assessed building-related risk factors for lower respiratory symptoms in office workers. The National Institute for Occupational Safety and Health in 1993 collected data during indoor environmental health investigations of workplaces. We used multivariate logistic regression analyses to assess relationships between lower respiratory symptoms in office workers and risk factors plausibly related to microbiologic contamination. Among 2,435 occupants in 80 office buildings, frequent, work-related multiple lower respiratory symptoms were strongly associated, in multivariate models, with two risk factors for microbiologic contamination: poor pan drainage under cooling coils and debris in outside air intake. Associations tended to be stronger among those with a history of physician-diagnosed asthma. These findings suggest that adverse lower respiratory health effects from indoor work environments, although unusual, may occur in relation to poorly designed or maintained ventilation systems, particularly among previously diagnosed asthmatics. These findings require confirmation in more representative buildings.

  13. Spatial relative risk patterns of Autism Spectrum Disorders in Utah

    PubMed Central

    Bakian, Amanda V.; Bilder, Deborah; Coon, Hilary; McMahon, William

    2015-01-01

    Heightened areas of spatial relative risk for ASD, or ASD hotspots, in Utah were identified using adaptive kernel density functions. Children ages four, six and eight with ASD from multiple birth cohorts were identified by the Utah Registry of Autism and Developmental Disabilities (URADD). Each ASD case was gender-matched to 20 birth cohort controls. Demographic and socioeconomic characteristics of children born inside versus outside ASD hotspots were compared. ASD hotspots were found in the surveillance area for all but one birth cohort and age group sample; maximum relative risk in these hotspots ranged from 1.8 to 3.0. Associations were found between higher socioeconomic status (SES) and birth residence in an ASD hotspot in five out of six birth cohort and age group samples. PMID:25241009

  14. Relative deprivation and risk factors for obesity in Canadian adolescents

    PubMed Central

    Elgar, Frank J.; Xie, Annie; Pförtner, Timo-Kolja; White, James; Pickett, Kate E.

    2016-01-01

    Research on socioeconomic differences in overweight and obesity and on the ecological association between income inequality and obesity prevalence suggests that relative deprivation may contribute to lifestyle risk factors for obesity independently of absolute affluence. We tested this hypothesis using data on 25,980 adolescents (11–15 years) in the 2010 Canadian Health Behaviour in School-aged Children (HBSC) study. The Yitzhaki index of relative deprivation was applied to the HBSC Family Affluence Scale, an index of common material assets, with more affluent schoolmates representing the comparative reference group. Regression analysis tested the associations between relative deprivation and four obesity risk factors (skipping breakfasts, physical activity, and healthful and unhealthful food choices) plus dietary restraint. Relative deprivation uniquely related to skipping breakfasts, less physical activity, fewer healthful food choices (e.g., fruits, vegetables, whole grain breads), and a lower likelihood of dieting to lose weight. Consistent with Runciman's (1966) theory of relative deprivation and with psychosocial interpretations of the health consequences of income inequality, the results indicate that having mostly better off schoolmates can contribute to poorer health behaviours independently of school-level affluence and subjective social status. We discuss the implications of these findings for understanding the social origins of obesity and targeting health interventions. PMID:26851410

  15. Relative deprivation and risk factors for obesity in Canadian adolescents.

    PubMed

    Elgar, Frank J; Xie, Annie; Pförtner, Timo-Kolja; White, James; Pickett, Kate E

    2016-03-01

    Research on socioeconomic differences in overweight and obesity and on the ecological association between income inequality and obesity prevalence suggests that relative deprivation may contribute to lifestyle risk factors for obesity independently of absolute affluence. We tested this hypothesis using data on 25,980 adolescents (11-15 years) in the 2010 Canadian Health Behaviour in School-aged Children (HBSC) study. The Yitzhaki index of relative deprivation was applied to the HBSC Family Affluence Scale, an index of common material assets, with more affluent schoolmates representing the comparative reference group. Regression analysis tested the associations between relative deprivation and four obesity risk factors (skipping breakfasts, physical activity, and healthful and unhealthful food choices) plus dietary restraint. Relative deprivation uniquely related to skipping breakfasts, less physical activity, fewer healthful food choices (e.g., fruits, vegetables, whole grain breads), and a lower likelihood of dieting to lose weight. Consistent with Runciman's (1966) theory of relative deprivation and with psychosocial interpretations of the health consequences of income inequality, the results indicate that having mostly better off schoolmates can contribute to poorer health behaviours independently of school-level affluence and subjective social status. We discuss the implications of these findings for understanding the social origins of obesity and targeting health interventions. PMID:26851410

  16. Adjustment of interaural time difference in head related transfer functions based on listeners' anthropometry and its effect on sound localization

    NASA Astrophysics Data System (ADS)

    Suzuki, Yôiti; Watanabe, Kanji; Iwaya, Yukio; Gyoba, Jiro; Takane, Shouichi

    2005-04-01

    Because the transfer functions governing subjective sound localization (HRTFs) show strong individuality, sound localization systems based on synthesis of HRTFs require suitable HRTFs for individual listeners. However, it is impractical to obtain HRTFs for all listeners based on measurements. Improving sound localization by adjusting non-individualized HRTFs to a specific listener based on that listener's anthropometry might be a practical method. This study first developed a new method to estimate interaural time differences (ITDs) using HRTFs. Then correlations between ITDs and anthropometric parameters were analyzed using the canonical correlation method. Results indicated that parameters relating to head size, and shoulder and ear positions are significant. Consequently, it was attempted to express ITDs based on listener's anthropometric data. In this process, the change of ITDs as a function of azimuth angle was parameterized as a sum of sine functions. Then the parameters were analyzed using multiple regression analysis, in which the anthropometric parameters were used as explanatory variables. The predicted or individualized ITDs were installed in the nonindividualized HRTFs to evaluate sound localization performance. Results showed that individualization of ITDs improved horizontal sound localization.

  17. Assessing Changes in Socioemotional Adjustment across Early School Transitions--New National Scales for Children at Risk

    ERIC Educational Resources Information Center

    McDermott, Paul A.; Watkins, Marley W.; Rovine, Michael J.; Rikoon, Samuel H.

    2013-01-01

    This article reports the development and evidence for validity and application of the Adjustment Scales for Early Transition in Schooling (ASETS). Based on primary analyses of data from the Head Start Impact Study, a nationally representative sample (N = 3077) of randomly selected children from low-income households is configured to inform…

  18. Early Developmental and Psychosocial Risks and Longitudinal Behavioral Adjustment Outcomes for Preschool-Age Girls Adopted from China

    ERIC Educational Resources Information Center

    Tan, Tony Xing; Marfo, Kofi; Dedrick, Robert F.

    2010-01-01

    The central goal of this longitudinal study was to examine behavioral adjustment outcomes in a sample of preschool-age adopted Chinese girls. Research examining the effects of institutional deprivation on post-adoption behavioral outcomes for internationally adopted children has been constrained by the frequent unavailability of data on the…

  19. Some computer simulations based on the linear relative risk model

    SciTech Connect

    Gilbert, E.S.

    1991-10-01

    This report presents the results of computer simulations designed to evaluate and compare the performance of the likelihood ratio statistic and the score statistic for making inferences about the linear relative risk mode. The work was motivated by data on workers exposed to low doses of radiation, and the report includes illustration of several procedures for obtaining confidence limits for the excess relative risk coefficient based on data from three studies of nuclear workers. The computer simulations indicate that with small sample sizes and highly skewed dose distributions, asymptotic approximations to the score statistic or to the likelihood ratio statistic may not be adequate. For testing the null hypothesis that the excess relative risk is equal to zero, the asymptotic approximation to the likelihood ratio statistic was adequate, but use of the asymptotic approximation to the score statistic rejected the null hypothesis too often. Frequently the likelihood was maximized at the lower constraint, and when this occurred, the asymptotic approximations for the likelihood ratio and score statistics did not perform well in obtaining upper confidence limits. The score statistic and likelihood ratio statistics were found to perform comparably in terms of power and width of the confidence limits. It is recommended that with modest sample sizes, confidence limits be obtained using computer simulations based on the score statistic. Although nuclear worker studies are emphasized in this report, its results are relevant for any study investigating linear dose-response functions with highly skewed exposure distributions. 22 refs., 14 tabs.

  20. Relation of anthropometric variables to coronary artery disease risk factors

    PubMed Central

    Patil, Virendra C.; Parale, G. P.; Kulkarni, P. M.; Patil, Harsha V.

    2011-01-01

    Background and Objectives: Anthropometric variables and their relation to conventional coronary artery disease (CAD) risk factors in railway employees have been inadequately studied in India. This cross-sectional survey was carried out in the Solapur division of the Central railway in the year 2004, to assess the anthropometric variables in railway employees and their relation to conventional CAD risk factors. Materials and Methods: A total of 995 railway employees, with 872 males and 123 females participated in this cross-sectional study. All subjects underwent anthropometric measurements, fasting lipid profile, and blood sugar level. Various anthropometric indices were calculated for body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), and abdominal volume index (AVI). Statistical analysis was done by EPI Info 6 statistical software. Results: Compared to all other obesity indices, WHtR was most prevalent in both genders. High WHtR was present in 699 (80.16%) males and 103 (83.73%) females. Age ≥45 years, high systolic BP, high diastolic BP, low HDL, high triglyceride, and diabetes mellitus were positively correlated with high BMI, high WC, high WHR, high WHtR, and high AVI. High BMI, high WC, high WHR, high WHtR, and high AVI were negatively associated with physical inactivity. Conclusions: Over all, anthropometric variables in both genders were significantly deranged in subjects with coronary risk factors. Compared to all other anthropometric variables, WHtR was statistically significantly associated with a majority of coronary artery risk factors. Hence we recommend inclusion of WHtR as a parameter of obesity to predict coronary artery disease risk factor along with WC, WHR, and BMI in epidemiologic studies. PMID:21584164

  1. Increased Waist-to-height Ratio May Contribute to Age-related Increase in Cardiovascular Risk Factors

    PubMed Central

    Akhlaghi, Masoumeh; Kamali, Majid; Dastsouz, Farideh; Sadeghi, Fatemeh; Amanat, Sassan

    2016-01-01

    Background: The risk of cardiovascular diseases (CVDs) increases with age. The objective was to determine whether lifestyle and dietary behaviors and anthropometric measures, which are affected by these behaviors, contribute to the increase of CVD risk factors across age categories of 20–50-year-old. Methods: In a cross-sectional design, 437 adults aged 20–50-year-old were selected from households living in Shiraz. Risk factors of CVD, including body mass index (BMI), waist-to-height ratio (WHtR), blood pressure, fasting blood glucose (FBG), serum triglycerides, total cholesterol, and low- and high-density lipoprotein cholesterol (LDL-C and HDL-C, respectively) as well as lifestyle behaviors (physical activity and smoking), dietary habits, and food intakes were assessed across the age categories of 20–29, 30–39, and 40–50 years. Linear regression was used to examine the contribution of different variables to the age-related increase of CVD risk factors. Results: All CVD risk factors, except for HDL-C, significantly increased across age categories. Older subjects had healthier dietary habits and food intakes, but they possessed nonsignificantly lower physical activity and higher smoking rate compared to younger adults. Adjusting for physical activity, smoking, and BMI did not change the significant positive association between age and CVD risk factors but adjusting for WHtR disappeared associations for blood pressure, triglycerides, and metabolic syndrome although significant associations remained for FBG and total and LDL-C. Conclusions: Age-related increase of CVD risk factors occurred independent of lifestyle habits. WHtR, but not BMI, may partially contribute to the age-related increase in CVD risk factors. PMID:27195100

  2. Relative radiological risks derived from different TENORM wastes in Malaysia.

    PubMed

    Ismail, B; Teng, I L; Muhammad Samudi, Y

    2011-11-01

    In Malaysia technologically enhanced naturally occurring radioactive materials (TENORM) wastes are mainly the product of the oil and gas industry and mineral processing. Among these TENORM wastes are tin tailing, tin slag, gypsum and oil sludge. Mineral processing and oil and gas industries produce large volume of TENORM wastes that has become a radiological concern to the authorities. A study was carried out to assess the radiological risk related to workers working at these disposal sites and landfills as well as to the members of the public should these areas be developed for future land use. Radiological risk was assessed based on the magnitude of radiation hazard, effective dose rates and excess cancer risks. Effective dose rates and excess cancer risks were estimated using RESRAD 6.4 computer code. All data on the activity concentrations of NORM in wastes and sludges used in this study were obtained from the Atomic Energy Licensing Board, Malaysia, and they were collected over a period of between 5 and 10 y. Results obtained showed that there was a wide range in the total activity concentrations (TAC) of nuclides in the TENORM wastes. With the exception of tin slag and tin tailing-based TENORM wastes, all other TENORM wastes have TAC values comparable to that of Malaysia's soil. Occupational Effective Dose Rates estimated in all landfill areas were lower than the 20 mSv y(-1) permissible dose limit. The average Excess Cancer Risk Coefficient was estimated to be 2.77×10(-3) risk per mSv. The effective dose rates for residents living on gypsum and oil sludge-based TENORM wastes landfills were estimated to be lower than the permissible dose limit for members of the public, and was also comparable to that of the average Malaysia's ordinary soils. The average excess cancer risk coefficient was estimated to be 3.19×10(-3) risk per mSv. Results obtained suggest that gypsum and oil sludge-based TENORM wastes should be exempted from any radiological regulatory

  3. A prospective cohort study on the relation between meat consumption and the risk of colon cancer.

    PubMed

    Goldbohm, R A; van den Brandt, P A; van 't Veer, P; Brants, H A; Dorant, E; Sturmans, F; Hermus, R J

    1994-02-01

    The high incidence of colon cancer in affluent societies has often been attributed to a high fat diet and, more in particular, the consumption of meat. The association of the consumption of meat and the intake of fat with risk of colon cancer was investigated in a prospective cohort study on diet and cancer, which is being conducted in the Netherlands since 1986 among 120,852 men and women, aged 55-69. The analysis was based on 215 incident cases of colon cancer (105 men and 110 women) accumulated in 3.3 years of follow-up, excluding cases diagnosed in the first year of follow-up. Dietary habits were assessed at baseline with a 150-item semiquantitative food frequency questionnaire. No trends in relative rates of colon cancer were detected for intake of energy or for the energy-adjusted intake of fats, protein, fat from meat, and protein from meat. Consumption of total fresh meat, beef, pork, minced meat, chicken, and fish was not associated with risk of colon cancer either. Processed meats, however, were associated with an increased risk in men and women (relative rate, 1.17 per increment of 15 g/day; 95% confidence interval, 1.03-1.33). The increased risk appeared to be attributable to one of the five questionnaire items on processed meat, which comprised mainly sausages. This study does not support a role of fresh meat and dietary fat in the etiology of colon cancer in this population. As an exception, some processed meats may increase the risk, but the mechanism is not yet clear. PMID:8306333

  4. Serum and dietary vitamin E in relation to prostate cancer risk.

    PubMed

    Weinstein, Stephanie J; Wright, Margaret E; Lawson, Karla A; Snyder, Kirk; Männistö, Satu; Taylor, Philip R; Virtamo, Jarmo; Albanes, Demetrius

    2007-06-01

    Alpha-tocopherol supplementation (50 mg daily for 5-8 years) reduced prostate cancer incidence by 32% in the alpha-Tocopherol, beta-Carotene Cancer Prevention Study. We investigated whether serum alpha-tocopherol or intake of vitamin E (eight tocopherols and tocotrienols) was associated with prostate cancer risk with up to 19 years of follow-up in the alpha-Tocopherol, beta-Carotene Cancer Prevention Study cohort. Of the 29,133 Finnish male smokers, ages 50 to 69 years recruited into the study, 1,732 were diagnosed with incident prostate cancer between 1985 and 2004. Baseline serum alpha-tocopherol was measured by high-performance liquid chromatography and the components of vitamin E intake were estimated based on a 276-item food frequency questionnaire and food chemistry analyses. Proportional hazard models were used to determine multivariate-adjusted relative risks (RR) and 95% confidence intervals (95% CI). Higher serum alpha-tocopherol was associated with reduced risk of prostate cancer (RR, 0.80; 95% CI, 0.66-0.96 for highest versus lowest quintile; Ptrend = 0.03) and was strongly and inversely related to the risk of developing advanced disease (RR, 0.56; 95% CI, 0.36-0.85; Ptrend = 0.002). The inverse serum alpha-tocopherol-prostate cancer association was greater among those who were supplemented with either alpha-tocopherol or beta-carotene during the trial. There were no associations between prostate cancer and the individual dietary tocopherols and tocotrienols. In summary, higher prediagnostic serum concentrations of alpha-tocopherol, but not dietary vitamin E, was associated with lower risk of developing prostate cancer, particularly advanced prostate cancer. PMID:17548693

  5. Family history of hypertension and type 2 diabetes in relation to preeclampsia risk.

    PubMed

    Qiu, Chunfang; Williams, Michelle A; Leisenring, Wendy M; Sorensen, Tanya K; Frederick, Ihunnaya O; Dempsey, Jennifer C; Luthy, David A

    2003-03-01

    In a case-control study of 190 preeclamptic patients and 373 control subjects, we assessed maternal family history of chronic hypertension and type 2 diabetes in relation to preeclampsia risk. Participants provided information on first-degree family history of the 2 conditions and other covariates during postpartum interviews. Logistic regression was used to estimate odds ratios and 95% confidence intervals adjusted for confounding by age, race, and obesity. Compared with women with no parental history of hypertension, women with maternal only (odds ratio=1.9), paternal only (odds ratio=1.8), or both maternal and paternal history of hypertension (odds ratio=2.6) had a statistically significant increased risk of preeclampsia. The odds ratio for women with at least one hypertensive parent and a hypertensive sibling was 4.7 (95% confidence interval, 1.9 to 11.6). Both maternal only (odds ratio=2.1; 95% confidence interval, 0.9 to 4.6) and paternal only (odds ratio=1.9; 95% confidence interval, 1.0 to 3.2) history of diabetes was associated with an increased risk of preeclampsia. Women with a diabetic sibling had a 4.7-fold increased risk of preeclampsia (95% confidence interval, 1.1 to 19.8). For women with at least one hypertensive parent and at least one diabetic parent, relative to those with parents with neither diagnosis, the odds ratio for preeclampsia was 3.2 (95% confidence interval, 1.6 to 6.2). Our results are consistent with the thesis that family history of hypertension and diabetes reflects genetic and behavioral factors whereby women may be predisposed to an increased preeclampsia risk. PMID:12623936

  6. Single nucleotide polymorphism in hMLH1 promoter and risk of tobacco-related oral carcinoma in high-risk Asian Indians.

    PubMed

    Jha, Ritu; Gaur, Poonam; Sharma, Suresh Chandra; Das, Satya Narayan

    2013-09-10

    hMLH1 is a member of mismatch repair genes (MMR) that plays a crucial role in correcting replication errors, cell cycle arrest, apoptosis and oxidative stress. We explored the risk associated with hMLH1 -93 A>G (rs 1800734) single nucleotide polymorphism (SNP) with the oral squamous cell carcinoma (OSCC) in Asian Indians. We genotyped 242 patients with tobacco-related OSCC and 205 healthy controls by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) technique. The frequency of AA genotype was found to be significantly (Pc<0.0006) lower in patients as compared to the controls (21.49% vs. 47.8%) while GG genotype showed significantly higher (Pc<0.0006) prevalence in patients as compared to the healthy controls (41.32% vs. 13.66%). In logistic regression analysis AG (adjusted OR=1.95, 95% CI=0.72-5.26) and GG genotype (adjusted OR=4.5, 95% CI=1.54-13.16, P=0.006) appeared susceptible when compared with the wild-type AA genotype. The allelic distribution showed that variant G allele is significantly higher (Pc<0.0004) in patients and associated with increased risk (adjusted OR=2.36, 95% CI=1.33-4.19, P=0.003) as compared to the wild-type A allele. Altogether, our results suggest that the hMLH1 -93 A>G polymorphism is associated with the higher risk of tobacco-related OSCC in Asian Indians and could be useful in screening population at a higher risk. PMID:23727610

  7. Relative Importance and Additive Effects of Maternal and Infant Risk Factors on Childhood Asthma

    PubMed Central

    Rosas-Salazar, Christian; James, Kristina; Escobar, Gabriel; Gebretsadik, Tebeb; Li, Sherian Xu; Carroll, Kecia N.; Walsh, Eileen; Mitchel, Edward; Das, Suman; Kumar, Rajesh; Yu, Chang; Dupont, William D.; Hartert, Tina V.

    2016-01-01

    Background Environmental exposures that occur in utero and during early life may contribute to the development of childhood asthma through alteration of the human microbiome. The objectives of this study were to estimate the cumulative effect and relative importance of environmental exposures on the risk of childhood asthma. Methods We conducted a population-based birth cohort study of mother-child dyads who were born between 1995 and 2003 and were continuously enrolled in the PRIMA (Prevention of RSV: Impact on Morbidity and Asthma) cohort. The individual and cumulative impact of maternal urinary tract infections (UTI) during pregnancy, maternal colonization with group B streptococcus (GBS), mode of delivery, infant antibiotic use, and older siblings at home, on the risk of childhood asthma were estimated using logistic regression. Dose-response effect on childhood asthma risk was assessed for continuous risk factors: number of maternal UTIs during pregnancy, courses of infant antibiotics, and number of older siblings at home. We further assessed and compared the relative importance of these exposures on the asthma risk. In a subgroup of children for whom maternal antibiotic use during pregnancy information was available, the effect of maternal antibiotic use on the risk of childhood asthma was estimated. Results Among 136,098 singleton birth infants, 13.29% developed asthma. In both univariate and adjusted analyses, maternal UTI during pregnancy (odds ratio [OR] 1.2, 95% confidence interval [CI] 1.18, 1.25; adjusted OR [AOR] 1.04, 95%CI 1.02, 1.07 for every additional UTI) and infant antibiotic use (OR 1.21, 95%CI 1.20, 1.22; AOR 1.16, 95%CI 1.15, 1.17 for every additional course) were associated with an increased risk of childhood asthma, while having older siblings at home (OR 0.92, 95%CI 0.91, 0.93; AOR 0.85, 95%CI 0.84, 0.87 for each additional sibling) was associated with a decreased risk of childhood asthma, in a dose-dependent manner. Compared with vaginal

  8. The Relationship between Musculoskeletal Symptoms and Work-related Risk Factors in Hotel Workers

    PubMed Central

    2013-01-01

    musculoskeletal symptoms. Conclusion This study focused on structural risk factors in the working environment, such as the gender-based division of labor, shift work and labor intensity, that demonstrated a statistically significant correlation with the work-related musculoskeletal symptoms of hotel workers. Both men and women reported different prevalence rates of work-related musculoskeletal symptoms among different departments. This could indicate that a gender-based division of labor produces different ergonomic risk factors for each gender group. However, only females displayed a statistically significant correlation between shift work and labor intensity and musculoskeletal symptoms. Thus, minimizing ergonomic risk factors alone does not suffice to effectively prevent musculoskeletal diseases among hotel workers. Instead, work assignments should be based on gender, department, working hours and work intensity should be adjusted to address multi-dimensional musculoskeletal risk factors. In addition, an approach that seeks to minimize shift work is needed to reduce the incidence of musculoskeletal disorders. PMID:24472690

  9. MicroRNA Related Polymorphisms and Breast Cancer Risk

    PubMed Central

    Khan, Sofia; Greco, Dario; Michailidou, Kyriaki; Milne, Roger L.; Muranen, Taru A.; Heikkinen, Tuomas; Aaltonen, Kirsimari; Dennis, Joe; Bolla, Manjeet K.; Liu, Jianjun; Hall, Per; Irwanto, Astrid; Humphreys, Keith; Li, Jingmei; Czene, Kamila; Chang-Claude, Jenny; Hein, Rebecca; Rudolph, Anja; Seibold, Petra; Flesch-Janys, Dieter; Fletcher, Olivia; Peto, Julian; dos Santos Silva, Isabel; Johnson, Nichola; Gibson, Lorna; Aitken, Zoe; Hopper, John L.; Tsimiklis, Helen; Bui, Minh; Makalic, Enes; Schmidt, Daniel F.; Southey, Melissa C.; Apicella, Carmel; Stone, Jennifer; Waisfisz, Quinten; Meijers-Heijboer, Hanne; Adank, Muriel A.; van der Luijt, Rob B.; Meindl, Alfons; Schmutzler, Rita K.; Müller-Myhsok, Bertram; Lichtner, Peter; Turnbull, Clare; Rahman, Nazneen; Chanock, Stephen J.; Hunter, David J.; Cox, Angela; Cross, Simon S.; Reed, Malcolm W. R.; Schmidt, Marjanka K.; Broeks, Annegien; Veer, Laura J. V. a. n't.; Hogervorst, Frans B.; Fasching, Peter A.; Schrauder, Michael G.; Ekici, Arif B.; Beckmann, Matthias W.; Bojesen, Stig E.; Nordestgaard, Børge G.; Nielsen, Sune F.; Flyger, Henrik; Benitez, Javier; Zamora, Pilar M.; Perez, Jose I. A.; Haiman, Christopher A.; Henderson, Brian E.; Schumacher, Fredrick; Le Marchand, Loic; Pharoah, Paul D. P.; Dunning, Alison M.; Shah, Mitul; Luben, Robert; Brown, Judith; Couch, Fergus J.; Wang, Xianshu; Vachon, Celine; Olson, Janet E.; Lambrechts, Diether; Moisse, Matthieu; Paridaens, Robert; Christiaens, Marie-Rose; Guénel, Pascal; Truong, Thérèse; Laurent-Puig, Pierre; Mulot, Claire; Marme, Frederick; Burwinkel, Barbara; Schneeweiss, Andreas; Sohn, Christof; Sawyer, Elinor J.; Tomlinson, Ian; Kerin, Michael J.; Miller, Nicola; Andrulis, Irene L.; Knight, Julia A.; Tchatchou, Sandrine; Mulligan, Anna Marie; Dörk, Thilo; Bogdanova, Natalia V.; Antonenkova, Natalia N.; Anton-Culver, Hoda; Darabi, Hatef; Eriksson, Mikael; Garcia-Closas, Montserrat; Figueroa, Jonine; Lissowska, Jolanta; Brinton, Louise; Devilee, Peter; Tollenaar, Robert A. E. M.; Seynaeve, Caroline; van Asperen, Christi J.; Kristensen, Vessela N.; Slager, Susan; Toland, Amanda E.; Ambrosone, Christine B.; Yannoukakos, Drakoulis; Lindblom, Annika; Margolin, Sara; Radice, Paolo; Peterlongo, Paolo; Barile, Monica; Mariani, Paolo; Hooning, Maartje J.; Martens, John W. M.; Collée, J. Margriet; Jager, Agnes; Jakubowska, Anna; Lubinski, Jan; Jaworska-Bieniek, Katarzyna; Durda, Katarzyna; Giles, Graham G.; McLean, Catriona; Brauch, Hiltrud; Brüning, Thomas; Ko, Yon-Dschun; Brenner, Hermann; Dieffenbach, Aida Karina; Arndt, Volker; Stegmaier, Christa; Swerdlow, Anthony; Ashworth, Alan; Orr, Nick; Jones, Michael; Simard, Jacques; Goldberg, Mark S.; Labrèche, France; Dumont, Martine; Winqvist, Robert; Pylkäs, Katri; Jukkola-Vuorinen, Arja; Grip, Mervi; Kataja, Vesa; Kosma, Veli-Matti; Hartikainen, Jaana M.; Mannermaa, Arto; Hamann, Ute; Chenevix-Trench, Georgia; Blomqvist, Carl; Aittomäki, Kristiina; Easton, Douglas F.; Nevanlinna, Heli

    2014-01-01

    Genetic variations, such as single nucleotide polymorphisms (SNPs) in microRNAs (miRNA) or in the miRNA binding sites may affect the miRNA dependent gene expression regulation, which has been implicated in various cancers, including breast cancer, and may alter individual susceptibility to cancer. We investigated associations between miRNA related SNPs and breast cancer risk. First we evaluated 2,196 SNPs in a case-control study combining nine genome wide association studies (GWAS). Second, we further investigated 42 SNPs with suggestive evidence for association using 41,785 cases and 41,880 controls from 41 studies included in the Breast Cancer Association Consortium (BCAC). Combining the GWAS and BCAC data within a meta-analysis, we estimated main effects on breast cancer risk as well as risks for estrogen receptor (ER) and age defined subgroups. Five miRNA binding site SNPs associated significantly with breast cancer risk: rs1045494 (odds ratio (OR) 0.92; 95% confidence interval (CI): 0.88–0.96), rs1052532 (OR 0.97; 95% CI: 0.95–0.99), rs10719 (OR 0.97; 95% CI: 0.94–0.99), rs4687554 (OR 0.97; 95% CI: 0.95–0.99, and rs3134615 (OR 1.03; 95% CI: 1.01–1.05) located in the 3′ UTR of CASP8, HDDC3, DROSHA, MUSTN1, and MYCL1, respectively. DROSHA belongs to miRNA machinery genes and has a central role in initial miRNA processing. The remaining genes are involved in different molecular functions, including apoptosis and gene expression regulation. Further studies are warranted to elucidate whether the miRNA binding site SNPs are the causative variants for the observed risk effects. PMID:25390939

  10. MicroRNA related polymorphisms and breast cancer risk.

    PubMed

    Khan, Sofia; Greco, Dario; Michailidou, Kyriaki; Milne, Roger L; Muranen, Taru A; Heikkinen, Tuomas; Aaltonen, Kirsimari; Dennis, Joe; Bolla, Manjeet K; Liu, Jianjun; Hall, Per; Irwanto, Astrid; Humphreys, Keith; Li, Jingmei; Czene, Kamila; Chang-Claude, Jenny; Hein, Rebecca; Rudolph, Anja; Seibold, Petra; Flesch-Janys, Dieter; Fletcher, Olivia; Peto, Julian; dos Santos Silva, Isabel; Johnson, Nichola; Gibson, Lorna; Aitken, Zoe; Hopper, John L; Tsimiklis, Helen; Bui, Minh; Makalic, Enes; Schmidt, Daniel F; Southey, Melissa C; Apicella, Carmel; Stone, Jennifer; Waisfisz, Quinten; Meijers-Heijboer, Hanne; Adank, Muriel A; van der Luijt, Rob B; Meindl, Alfons; Schmutzler, Rita K; Müller-Myhsok, Bertram; Lichtner, Peter; Turnbull, Clare; Rahman, Nazneen; Chanock, Stephen J; Hunter, David J; Cox, Angela; Cross, Simon S; Reed, Malcolm W R; Schmidt, Marjanka K; Broeks, Annegien; Van't Veer, Laura J; Hogervorst, Frans B; Fasching, Peter A; Schrauder, Michael G; Ekici, Arif B; Beckmann, Matthias W; Bojesen, Stig E; Nordestgaard, Børge G; Nielsen, Sune F; Flyger, Henrik; Benitez, Javier; Zamora, Pilar M; Perez, Jose I A; Haiman, Christopher A; Henderson, Brian E; Schumacher, Fredrick; Le Marchand, Loic; Pharoah, Paul D P; Dunning, Alison M; Shah, Mitul; Luben, Robert; Brown, Judith; Couch, Fergus J; Wang, Xianshu; Vachon, Celine; Olson, Janet E; Lambrechts, Diether; Moisse, Matthieu; Paridaens, Robert; Christiaens, Marie-Rose; Guénel, Pascal; Truong, Thérèse; Laurent-Puig, Pierre; Mulot, Claire; Marme, Frederick; Burwinkel, Barbara; Schneeweiss, Andreas; Sohn, Christof; Sawyer, Elinor J; Tomlinson, Ian; Kerin, Michael J; Miller, Nicola; Andrulis, Irene L; Knight, Julia A; Tchatchou, Sandrine; Mulligan, Anna Marie; Dörk, Thilo; Bogdanova, Natalia V; Antonenkova, Natalia N; Anton-Culver, Hoda; Darabi, Hatef; Eriksson, Mikael; Garcia-Closas, Montserrat; Figueroa, Jonine; Lissowska, Jolanta; Brinton, Louise; Devilee, Peter; Tollenaar, Robert A E M; Seynaeve, Caroline; van Asperen, Christi J; Kristensen, Vessela N; Slager, Susan; Toland, Amanda E; Ambrosone, Christine B; Yannoukakos, Drakoulis; Lindblom, Annika; Margolin, Sara; Radice, Paolo; Peterlongo, Paolo; Barile, Monica; Mariani, Paolo; Hooning, Maartje J; Martens, John W M; Collée, J Margriet; Jager, Agnes; Jakubowska, Anna; Lubinski, Jan; Jaworska-Bieniek, Katarzyna; Durda, Katarzyna; Giles, Graham G; McLean, Catriona; Brauch, Hiltrud; Brüning, Thomas; Ko, Yon-Dschun; Brenner, Hermann; Dieffenbach, Aida Karina; Arndt, Volker; Stegmaier, Christa; Swerdlow, Anthony; Ashworth, Alan; Orr, Nick; Jones, Michael; Simard, Jacques; Goldberg, Mark S; Labrèche, France; Dumont, Martine; Winqvist, Robert; Pylkäs, Katri; Jukkola-Vuorinen, Arja; Grip, Mervi; Kataja, Vesa; Kosma, Veli-Matti; Hartikainen, Jaana M; Mannermaa, Arto; Hamann, Ute; Chenevix-Trench, Georgia; Blomqvist, Carl; Aittomäki, Kristiina; Easton, Douglas F; Nevanlinna, Heli

    2014-01-01

    Genetic variations, such as single nucleotide polymorphisms (SNPs) in microRNAs (miRNA) or in the miRNA binding sites may affect the miRNA dependent gene expression regulation, which has been implicated in various cancers, including breast cancer, and may alter individual susceptibility to cancer. We investigated associations between miRNA related SNPs and breast cancer risk. First we evaluated 2,196 SNPs in a case-control study combining nine genome wide association studies (GWAS). Second, we further investigated 42 SNPs with suggestive evidence for association using 41,785 cases and 41,880 controls from 41 studies included in the Breast Cancer Association Consortium (BCAC). Combining the GWAS and BCAC data within a meta-analysis, we estimated main effects on breast cancer risk as well as risks for estrogen receptor (ER) and age defined subgroups. Five miRNA binding site SNPs associated significantly with breast cancer risk: rs1045494 (odds ratio (OR) 0.92; 95% confidence interval (CI): 0.88-0.96), rs1052532 (OR 0.97; 95% CI: 0.95-0.99), rs10719 (OR 0.97; 95% CI: 0.94-0.99), rs4687554 (OR 0.97; 95% CI: 0.95-0.99, and rs3134615 (OR 1.03; 95% CI: 1.01-1.05) located in the 3' UTR of CASP8, HDDC3, DROSHA, MUSTN1, and MYCL1, respectively. DROSHA belongs to miRNA machinery genes and has a central role in initial miRNA processing. The remaining genes are involved in different molecular functions, including apoptosis and gene expression regulation. Further studies are warranted to elucidate whether the miRNA binding site SNPs are the causative variants for the observed risk effects. PMID:25390939

  11. Availability of High Quality TRMM Ground Validation Data from Kwajalein, RMI: A Practical Application of the Relative Calibration Adjustment Technique

    NASA Technical Reports Server (NTRS)

    Marks, David A.; Wolff, David B.; Silberstein, David S.; Tokay, Ali; Pippitt, Jason L.; Wang, Jianxin

    2008-01-01

    Since the Tropical Rainfall Measuring Mission (TRMM) satellite launch in November 1997, the TRMM Satellite Validation Office (TSVO) at NASA Goddard Space Flight Center (GSFC) has been performing quality control and estimating rainfall from the KPOL S-band radar at Kwajalein, Republic of the Marshall Islands. Over this period, KPOL has incurred many episodes of calibration and antenna pointing angle uncertainty. To address these issues, the TSVO has applied the Relative Calibration Adjustment (RCA) technique to eight years of KPOL radar data to produce Ground Validation (GV) Version 7 products. This application has significantly improved stability in KPOL reflectivity distributions needed for Probability Matching Method (PMM) rain rate estimation and for comparisons to the TRMM Precipitation Radar (PR). In years with significant calibration and angle corrections, the statistical improvement in PMM distributions is dramatic. The intent of this paper is to show improved stability in corrected KPOL reflectivity distributions by using the PR as a stable reference. Inter-month fluctuations in mean reflectivity differences between the PR and corrected KPOL are on the order of 1-2 dB, and inter-year mean reflectivity differences fluctuate by approximately 1 dB. This represents a marked improvement in stability with confidence comparable to the established calibration and uncertainty boundaries of the PR. The practical application of the RCA method has salvaged eight years of radar data that would have otherwise been unusable, and has made possible a high-quality database of tropical ocean-based reflectivity measurements and precipitation estimates for the research community.

  12. Prediagnostic Sex Steroid Hormones in Relation to Male Breast Cancer Risk

    PubMed Central

    Brinton, Louise A.; Key, Tim J.; Kolonel, Laurence N.; Michels, Karin B.; Sesso, Howard D.; Ursin, Giske; Van Den Eeden, Stephen K.; Wood, Shannon N.; Falk, Roni T.; Parisi, Dominick; Guillemette, Chantal; Caron, Patrick; Turcotte, Véronique; Habel, Laurel A.; Isaacs, Claudine J.; Riboli, Elio; Weiderpass, Elisabete; Cook, Michael B.

    2015-01-01

    Purpose Although previous studies have implicated a variety of hormone-related risk factors in the etiology of male breast cancers, no previous studies have examined the effects of endogenous hormones. Patients and Methods Within the Male Breast Cancer Pooling Project, an international consortium comprising 21 case-control and cohort investigations, a subset of seven prospective cohort studies were able to contribute prediagnostic serum or plasma samples for hormone quantitation. Using a nested case-control design, multivariable unconditional logistic regression analyses estimated odds ratios and 95% CIs for associations between male breast cancer risk and 11 individual estrogens and androgens, as well as selected ratios of these analytes. Results Data from 101 cases and 217 matched controls were analyzed. After adjustment for age and date of blood draw, race, and body mass index, androgens were found to be largely unrelated to risk, but circulating estradiol levels showed a significant association. Men in the highest quartile had an odds ratio of 2.47 (95% CI, 1.10 to 5.58) compared with those in the lowest quartile (trend P = .06). Assessment of estradiol as a ratio to various individual androgens or sum of androgens showed no further enhancement of risk. These relations were not significantly modified by either age or body mass index, although estradiol was slightly more strongly related to breast cancers occurring among younger (age < 67 years) than older men. Conclusion Our results support the notion of an important role for estradiol in the etiology of male breast cancers, similar to female breast cancers. PMID:25964249

  13. Depressive Symptoms and Behavior-Related Risk Factors, Italian Population-Based Surveillance System, 2013

    PubMed Central

    Gigantesco, Antonella; Baldissera, Sandro; Masocco, Maria

    2015-01-01

    Introduction Depression may increase the likelihood of adopting behaviors risky to health. Population studies investigating the association between depressive symptoms and behavior-related risk factors are lacking in Italy. The aim of this study was to estimate the prevalence of various self-reported behavior-related risk factors and to study their associations with current depressive symptoms in the Italian adult general population. Methods Data collected in 2013 from people aged 18 to 69 years participating in the Italian behavioral risk factor surveillance system were used for the analysis. Indicators of no leisure-time physical activity, obesity, cigarette smoking, and excessive alcohol consumption were investigated. Depressive symptoms were explored through the Patient Health Questionnaire-2. Results In the survey sample of 39,463 participants, 34.4% of adults engaged in no leisure-time physical activity, 26.2% were cigarette smokers, 11.5% were excessive alcohol consumers, and 10.3% were obese. The prevalence of depressive symptoms was 6.2%. People with depressive symptoms were more likely to be physically inactive (adjusted prevalence ratio [APR], 1.13), cigarette smokers (APR, 1.34), obese (APR, 1.27) and excessive alcohol consumers (APR, 1.43) than those without depressive symptoms. Conclusion The contribution of this study to the existing evidence lies not just in confirming the association between depression and behavior-related risk factors in the Italian context but also in suggesting that programs for simultaneously improving people’s mental and physical health should be developed and implemented. PMID:26513439

  14. Glacial isostatic adjustment, relative sea level history and mantle viscosity: reconciling relative sea level model predictions for the U.S. East coast with geological constraints

    NASA Astrophysics Data System (ADS)

    Roy, Keven; Peltier, W. R.

    2015-05-01

    Models of the glacial isostatic adjustment process, which is dominated by the influence of the Late Pleistocene cycle of glaciation and deglaciation, depend on two fundamental inputs: a history of ice-sheet loading and a model of the radial variation of mantle viscosity. These models may be tested and refined by comparing their local predictions of relative sea level history to geological inferences based upon appropriate sea level indicators. The U.S. Atlantic coast is a region of particular interest in this regard, due to the fact that data from the length of this coast provides a transect of the forebulge associated with the former Laurentide ice sheet. High-quality relative sea level histories from this region are employed herein to explore the ability of current models of mantle viscosity to explain the inferred evolution of relative sea level that have accompanied forebulge collapse following deglaciation. Existing misfits are characterized, and alternatives are explored for their reconciliation. It is demonstrated that a new model of mantle viscosity, referred to herein as VM6, when coupled with the latest model of deglaciation history ICE-6G_C, is able to eliminate the majority of these misfits, while continuing to reconcile a wide range of other important geophysical observables, as well as additional relative sea level data from the North American. West coast which also record the collapse of the forebulge but which have not been employed in tuning the viscosity profile to enable ICE-6G_C (VM6) to fit the East coast data set.

  15. Traffic-related air pollution and risk for leukaemia of an adult population.

    PubMed

    Raaschou-Nielsen, Ole; Ketzel, Matthias; Harbo Poulsen, Aslak; Sørensen, Mette

    2016-03-01

    Air pollution causes lung cancer, but associations with other cancers have not been established. We investigated whether long-term exposure to traffic-related air pollution is associated with the risk of the general population for leukaemia. We identified 1,967 people in whom leukaemia was diagnosed in 1992-2010 from a nation-wide cancer registry and selected 3,381 control people at random, matched on sex and year of birth, from the entire Danish population. Residential addresses since 1971 were traced in a population registry, and outdoor concentrations of NOx and NO2 , as indicators of traffic-related air pollution, were calculated at each address in a dispersion model. We used conditional logistic regression to estimate the risk for leukaemia after adjustment for income, educational level, cohabitation status and co-morbidity. In linear analyses, we found odds ratios for acute myeloid leukaemia of 1.20 (95% confidence interval: 1.04-1.38) per 20 µg/m(3) increase in NOx and 1.31 (1.02-1.68) per 10 µg/m(3) increase in NO2 , calculated as time-weighted average exposure at all addresses since 1971. We found no association with chronic myeloid or lymphocytic leukaemia. This study indicates an association between long-term exposure to traffic-related air pollution and acute myeloid leukaemia in the general population, but not for other subtypes of leukaemia. PMID:26415047

  16. Reward, attention, and HIV-related risk in HIV+ individuals.

    PubMed

    Anderson, Brian A; Kronemer, Sharif I; Rilee, Jessica J; Sacktor, Ned; Marvel, Cherie L

    2016-08-01

    Human immunodeficiency virus (HIV) is often contracted through engaging in risky reward-motivated behaviors such as needle sharing and unprotected sex. Understanding the factors that make an individual more vulnerable to succumbing to the temptation to engage in these risky behaviors is important to limiting the spread of HIV. One potential source of this vulnerability concerns the degree to which an individual is able to resist paying attention to irrelevant reward information. In the present study, we examine this possible link by characterizing individual differences in value-based attentional bias in a sample of HIV+ individuals with varying histories of risk-taking behavior. Participants learned associations between experimental stimuli and monetary reward outcome. The degree of attentional bias for these reward-associated stimuli, reflected in their ability to capture attention when presented as task-irrelevant distractors, was then assessed both immediately and six months following reward learning. Value-driven attentional capture was related to substance abuse history and non-planning impulsiveness during the time leading up to contraction of HIV as measured via self-report. These findings suggest a link between the ability to ignore reward-associated information and prior HIV-related risk-taking behavior. Additionally, particular aspects of HIV-associated neurocognitive disorders were related to attentional bias, including motor deficits commonly associated with HIV-induced damage to the basal ganglia. PMID:26484383

  17. Sex differences in relations among remembered parental behavior in childhood, adults' current psychological adjustment, and career indecision.

    PubMed

    Rohner, Ronald P; Rising, David G; Sayre-Scibona, Jessica

    2009-04-01

    The goal was to assess sex differences in career indecision's association with different levels of self-reported psychological adjustment and with different remembrances of maternal and paternal acceptance and behavioral control in childhood. 126 participants responded to the Career Decision Scale, the Adult version of the Parental Acceptance-Rejection/Control Questionnaire, and the Adult version of the Personality Assessment Questionnaire. Results showed that career indecision among women but not men was significantly correlated with remembered maternal and paternal acceptance in childhood, as well as with self-reported psychological adjustment and age. Only women's self-reported psychological adjustment made a unique contribution to variance in reported career indecision. No predictor variables were significantly associated with career indecision among men. PMID:19610486

  18. Understanding the relative importance of global dengue risk factors.

    PubMed

    Lowe, Rachel

    2015-10-01

    Dengue is a mosquito-transmitted viral infection of major international public health concern. Global environmental and socio-economic change has created ideal conditions for the global expansion of dengue transmission. Innovative modelling tools help in understanding the global determinants of dengue risk and the relative impact of environmental and socio-economic factors on dengue transmission and spread. While climatic factors may act as a limiting factor on the global scale, other processes may play a dominant role at the local level. Understanding the spatial scales at which environmental and socio-economic factors dominate can help to target appropriate dengue control and prevention strategies. PMID:26311416

  19. Evaluation of HLA Polymorphisms in Relation to Schizophrenia Risk and Infectious Exposure

    PubMed Central

    Nimgaonkar, Vishwajit L.

    2012-01-01

    Background: Genome-wide association studies (GWAS) implicate single nucleotide polymorphisms (SNPs) on chromosome 6p21.3-22.1, the human leukocyte antigen (HLA) region, as common risk factors for schizophrenia (SZ). Other studies implicate viral and protozoan exposure. Our study tests chromosome 6p SNPs for effects on SZ risk with and without exposure. Method: GWAS-significant SNPs and ancestry-informative marker SNPs were analyzed among African American patients with SZ (n = 604) and controls (n = 404). Exposure to herpes simplex virus, type 1 (HSV-1), cytomegalovirus (CMV), and Toxoplasma gondii (TOX) was assayed using specific antibody assays. Results: Five SNPs were nominally associated with SZ, adjusted for population admixture (P < .05, uncorrected for multiple comparisons). These SNPs were next analyzed in relation to infectious exposure. Multivariate analysis indicated significant association between rs3130297 genotype and HSV-1 exposure; the associated allele was different from the SZ risk allele. Conclusions: We propose a model for the genesis of SZ incorporating genomic variation in the HLA region and neurotropic viral exposure for testing in additional, independent African American samples. PMID:22966150

  20. Harmonisation of standards related to limiting chemical risk associated with work processes.

    PubMed

    Bostan, Ionel

    2013-01-01

    The presented paper tackles the issue of risk factors specific to work processes that involve the presence of chemicals. The reason that supports the present approach is the fact that the risks most likely to affect health in the workplace have been lately associated with the exposure of workers engaged in industrial activities to aggressive chemical agents. In order to tackle this problem, we shall resort to the normative regulations that have been adjusted upon Romania's inclusion in the European Union. The harmonization and alignment of the national standards--applied to the work systems that make use of various chemical substances likely to affect the health of the human resource--to the European guidelines and regulations has brought about a significant improvement in workplace security practices. Consequently, the arguments and demonstrations in the presented study are based on elements of the European acquis and the Romanian regulations which are all related to the chemical risk factors generated by harmful chemicals, or the potentially accident-prone properties of the substances used in work processes. PMID:24069850

  1. Recreational amphetamine use and risk of HIV-related non-Hodgkin lymphoma

    PubMed Central

    Chao, Chun; Jacobson, Lisa P.; Tashkin, Donald; Martínez-Maza, Otoniel; Roth, Michael D.; Margolick, Joseph B.; Chmiel, Joan S.; Holloway, Marcy N.; Detels, Roger

    2010-01-01

    The results of many laboratory studies suggest that amphetamine use may lead to altered immune function and cytokine expression, both of which are implicated in HIV-related lymphomagenesis. We examined the hypothesis that use of amphetamines modifies risk of non-Hodgkin lymphoma (NHL) in HIV-infected men in the Multicenter AIDS Cohort Study. Data on amphetamine use were collected every six months during the follow-up period between 1984 and 2002. A total of 171 NHL cases were diagnosed from the 19,250 person-years accrued. Multivariable Cox models were used to estimate the effects of baseline exposures, time-varying recent exposures, and three years lagged exposures on risk of NHL adjusting for potential confounders such as demographics, use of other substances, and risky sexual behaviors. We found that weekly or more frequent use of amphetamines was associated with an increased risk of NHL, with hazard ratios of 1.75 (95% CI = 0.81–3.77) for use at baseline, 4.73 (1.41–15.81) for recent use, and 3.05 (1.19–7.82) for three years prior use. Similar associations were observed when we separately examined systemic NHL and diffuse large B-cell lymphoma. Given these observations, the impact of amphetamines on lymphomagenesis among HIV-infected populations should be assessed more thoroughly. PMID:19011979

  2. Nutritional Risk Factors for Age-Related Macular Degeneration

    PubMed Central

    Ersoy, Lebriz; Lechanteur, Yara T.; Hoyng, Carel B.; Kirchhof, Bernd; den Hollander, Anneke I.

    2014-01-01

    Purpose. To evaluate the role of nutritional factors, serum lipids, and lipoproteins in late age-related macular degeneration (late AMD). Methods. Intake of red meat, fruit, fish, vegetables, and alcohol, smoking status, and body mass index (BMI) were ascertained questionnaire-based in 1147 late AMD cases and 1773 controls from the European Genetic Database. Serum levels of lipids and lipoproteins were determined. The relationship between nutritional factors and late AMD was assessed using logistic regression. Based on multivariate analysis, area-under-the-curve (AUC) was calculated by receiver-operating-characteristics (ROC). Results. In a multivariate analysis, besides age and smoking, obesity (odds ratio (OR): 1.44, P = 0.014) and red meat intake (daily: OR: 2.34, P = 8.22 × 10−6; 2–6x/week: OR: 1.67, P = 7.98 × 10−5) were identified as risk factors for developing late AMD. Fruit intake showed a protective effect (daily: OR: 0.52, P = 0.005; 2–6x/week: OR: 0.58, P = 0.035). Serum lipid and lipoprotein levels showed no significant association with late AMD. ROC for nutritional factors, smoking, age, and BMI revealed an AUC of 0.781. Conclusion. Red meat intake and obesity were independently associated with increased risk for late AMD, whereas fruit intake was protective. A better understanding of nutritional risk factors is necessary for the prevention of AMD. PMID:25101280

  3. Energy Use and Related Risk Management Problems in CEE Countries

    NASA Astrophysics Data System (ADS)

    Ney, R.; Michna, J.; Ekmanis, J.; Zeltins, N.; Zebergs, V.

    2008-03-01

    Nowadays, the efficiency of energy use in the Central and East-European (CEE) countries is insufficient, being much lower than in the "Old Europe". The problem becomes increasingly pressing due to non-stop increasing prices of energy carriers (especially of crude oil). The authors trace the development of research activities in this sphere, classifying the revealed changes in parameters of energy consumption processes in particular time intervals into deterministic, probabilistic, and fuzzy. The paper presents a thorough analysis of decision-making in the energy management at its different levels - normative, strategic, and operative. Particular attention is given to the management under uncertainty conditions - i.e. to the risk management. The most wanted research directions in this area proposed by the energy and environment policy (EEP) Center specially created for CEE countries concern management under risk connected with innovations, international activities, loss of reputation, etc. The authors consider in detail the risk management with insufficient knowledge (non-knowledge) and under chaos. Much consideration is given to the scenario management and the game theory principles as related to the sphere of energy use.

  4. Abrasive blasting agents: designing studies to evaluate relative risk.

    PubMed

    Hubbs, Ann; Greskevitch, Mark; Kuempel, Eileen; Suarez, Fernando; Toraason, Mark

    Workers exposed to respirable crystalline silica used in abrasive blasting are at increased risk of developing a debilitating and often fatal fibrotic lung disease called silicosis. The National Institute for Occupational Safety and Health (NIOSH) recommends that silica sand be prohibited as abrasive blasting material and that less hazardous materials be used in blasting operations. However, data are needed on the relative risks associated with exposure to abrasive blasting materials other than silica. NIOSH has completed acute studies in rats (Hubbs et al., 2001; Porter et al., 2002). To provide dose-response data applicable to making recommendation for occupational exposure limits, NIOSH has collaborated with the National Toxicology Program (NTP) to design longer term studies with silica substitutes. For risk assessment purposes, selected doses will include concentrations that are relevant to human exposures. Rat lung burdens achieved should be comparable to those estimated in humans with working lifetime exposures, even if this results in "overloading" doses in rats. To quantify both dose and response, retained particle burdens in the lungs and lung-associated lymph nodes will be measured, as well as biochemical and pathological indices of pulmonary response. This design will facilitate assessment of the pulmonary fibrogenic potential of inhaled abrasive blasting agents at occupationally relevant concentrations. PMID:16020188

  5. Effects of Maternal Depression on Youth Adjustment.

    ERIC Educational Resources Information Center

    Alexander, Jennifer

    Depressive disorders are chronic illnesses affecting women and their families for extended periods of time. This paper summarizes research related to the effects of maternal depression on children's short and long term adjustment. Children of depressed mothers are at risk for internalizing and externalizing disorders. Genetics account for a small…

  6. Optimism as a Mediator of the Relation between Perceived Parental Authoritativeness and Adjustment among Adolescents: Finding the Sunny Side of the Street

    ERIC Educational Resources Information Center

    Jackson, Lynne M.; Pratt, Michael W.; Hunsberger, Bruce; Pancer, S. Mark

    2005-01-01

    Authoritative parenting has been associated with positive outcomes for children and adolescents, but less is known about the mechanisms responsible for such effects. Two longitudinal studies examined the hypothesis that the relation between authoritative parenting and adolescents' adjustment is mediated by adolescents' level of dispositional…

  7. The Peer Group as a Context: Moderating Effects on Relations between Maternal Parenting and Social and School Adjustment in Chinese Children

    ERIC Educational Resources Information Center

    Chen, Xinyin; Chang, Lei; He, Yunfeng; Liu, Hongyun

    2005-01-01

    This 2-year longitudinal study examined, in a sample of Chinese children (initial M age=11 years), the moderating effects of the peer group on relations between maternal supportive parenting and social and school adjustment. Data were collected from multiple sources including peer assessments, teacher ratings, school records, and maternal reports.…

  8. 20 CFR 418.1125 - How will the income-related monthly adjustment amount affect your total Medicare Part B premium?

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... Part B standard monthly premium, determined using the rules in 42 CFR 408.20; plus (2) Any applicable increase in the Medicare Part B standard monthly premium as described in 42 CFR 408.22; plus (3) Your... 42 CFR 408.20 does not apply to individuals who must pay an income-related monthly adjustment...

  9. 45 CFR 153.540 - Compliance with risk corridors standards.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... CARE ACCESS STANDARDS RELATED TO REINSURANCE, RISK CORRIDORS, AND RISK ADJUSTMENT UNDER THE AFFORDABLE CARE ACT Health Insurance Issuer Standards Related to the Risk Corridors Program § 153.540...

  10. Rural Worker Adjustment to Urban Life: An Assessment of the Research. Policy Papers in Human Resources and Industrial Relations 15.

    ERIC Educational Resources Information Center

    Fuller, Varden

    This document is a compilation resulting from studies of how well the rural labor force has adjusted to the urban setting. Topics presented include: (1) Concepts, Definitions, and Magnitude, (2) The Basic Expellant: Agricultural Technological Advance, (3) Opportunities and Uncertainties in the Economic Environment for Off-Farm Migrants, (4)…

  11. Relations between life satisfaction, adjustment to illness, and emotional distress in a sample of men with ischemic cardiopathy.

    PubMed

    Ruiz, María Angeles; Sanjuan, Pilar; Pérez-García, Ana M; Rueda, Beatriz

    2011-05-01

    Fifty-two men who had suffered a first episode ischemic heart disease reported their degree of life satisfaction, the strategies they used to adjust to the illness, and the symptoms of anxiety and depression they felt. The multiple regression analyses carried out indicated that emotional distress was associated with a lower level of life satisfaction. In the analyses of anxiety symptoms, the use of negative adjustment strategies was also a significant predictor. Lastly, a significant Life Satisfaction x Type of Adjustment interaction was obtained. According to this, the patients who felt more satisfaction with their lives used more positive strategies to adjust to the illness and fewer negative ones, than the group of patients who were less satisfied. In conclusion, life satisfaction predicts emotional wellbeing of patients with ischemic heart disease and it enhances the implementation of appropriate strategies to cope with the disease. Moreover, although life satisfaction has been considered a stable measure, we suggest it may change as the experience of illness limits individuals' important goals. PMID:21568192

  12. Predicting School Adjustment in Early Elementary School: Impact of Teacher-Child Relationship Quality and Relational Classroom Climate

    ERIC Educational Resources Information Center

    Buyse, Evelien; Verschueren, Karine; Verachtert, Pieter; Van Damme, Jan

    2009-01-01

    This longitudinal study evaluated the impact of dyadic and classroom-level teacher-child relationship quality in first grade on children's psychosocial and academic adjustment in first (N = 3,784), second (N = 3,666), and third (N = 3,582) grade, controlling for several child features, namely, child demographics and children's initial levels of…

  13. Anxiousness, Frustration, and Effortful Control as Moderators of the Relation between Parenting and Adjustment in Middle-Childhood

    ERIC Educational Resources Information Center

    Lengua, Liliana J.

    2008-01-01

    Interactions among multiple dimensions of child temperament and parenting were tested as predictors of change in child adjustment problems using a community sample (N = 188) of children (8-12 years). Significant interactions suggested that the effect of parenting on changes in problems were dependent upon temperament and, in some cases, child sex.…

  14. Is body mass index sensitively related to socio-economic status and to economic adjustment? A case study from the Congo.

    PubMed

    Delpeuch, F; Cornu, A; Massamba, J P; Traissac, P; Maire, B

    1994-11-01

    Several nutritional surveys based on representative samples from various urban and rural situations show that the Congo presents a situation of nutritional transition. There is a large prevalence of low body mass index (BMI) in adults from rural zones and this increases with age. There is, however, a large prevalence of high BMI in urban populations despite the persistence of some degree of chronic energy deficiency (CED), particularly at younger ages. Correspondence analysis and logistic regression were used to construct a socio-economic index and measure adjusted risk factors for CED. In rural areas, the major risk factors were old age, sex (women) and the absence of schooling; low economic status, a commonly shared factor, did not differentiate between households for CED. In Brazzaville, CED was linked to a young age (< 30 years) and, clearly, to poverty. The change in the prevalence of CED in mothers from the capital city during a period of economic adjustment showed an increased incidence in young mothers, and also showed that the disparity between low and high economic levels regarding CED had grown. Finally, there was a high level of correspondence between the mean values for the weight-for-height of children and the BMI categories of the mothers. There is a parallel evolution during the period of economic adjustment between the increase of wasting in infants and the increase of CED in mothers. Therefore BMI appears to be a potential core indicator for use in nutritional surveillance in the Congo. PMID:7843151

  15. A prospective cohort study on the association between coffee drinking and risk of non-gallstone-related acute pancreatitis.

    PubMed

    Oskarsson, Viktor; Sadr-Azodi, Omid; Orsini, Nicola; Wolk, Alicja

    2016-05-28

    Only one previous study has examined the association between coffee consumption and risk of acute pancreatitis, and it found a reduced risk for alcohol-related episodes among high consumers of coffee. Therefore, we examined (1) the association between coffee consumption and risk of non-gallstone-related acute pancreatitis and (2) whether this association was modified by alcohol intake. Data were obtained from two prospective cohorts, the Cohort of Swedish Men and the Swedish Mammography Cohort, including 76 731 men and women (born 1914-1952). Coffee consumption was assessed at baseline with a FFQ, and the cohorts were followed up between 1998 and 2012 via linkage to national health registries. Hazard ratios were estimated using Cox models, with adjustment for potential confounding factors. During 1 035 881 person-years of total follow-up, 383 cases (246 in men and 137 in women) of incident non-gallstone-related acute pancreatitis were identified. Overall, and irrespective of whether a categorical or a continuous exposure model was used, we observed no association between coffee consumption and risk of non-gallstone-related acute pancreatitis (e.g. the multivariable-adjusted hazard ratio for each 1 cup/d increase in coffee consumption was 0·97; 95 % CI 0·92, 1·03). There was no evidence of effect modification by alcohol intake (P interaction=0·77). In conclusion, coffee consumption was not associated with risk of non-gallstone-related acute pancreatitis in this large prospective cohort study. Because of the limited number of epidemiological studies and their conflicting results, further research is needed to elucidate this potential association. PMID:26987519

  16. Time Dependent Relative Risks in Life Insurance Medical Underwriting.

    PubMed

    Kneepkens, Robert F

    2015-01-01

    Introduction .- Life insurance medicine focuses on mortality hazards in specified periods. People are free to insure their lives for shorter or longer terms. Because the chosen terms range from 1 year to a life time, life insurers have to take into account the fact that the predictive value of risk indicators can and will change over time. The time a risk indicator keeps its predictive value, will be dependent on its biological effects, volatility, and treatability. For a given applicant this implies that the relative hazard (RH) calculated for his/her medical condition should be dependent on the term of the insurance. The main objective of this study is to determine if some commonly used risk indicators - previously used to study age dependency of relative risks - have a predictive value that increases with the observation period. (1) Methods .- This population-based cohort study uses NHANES-data files from the Third National Health and Nutrition Examination Survey (NHANES III) and the NHANES Linked Mortality Files 2010. Only participants aged 20 to 69 that were examined in mobile examination centers, without a history of some prevalent high risk diseases were included. The observed mortality was compared to the expected mortality in a Generalized Linear Model (GLM) with Poisson error structure with two reference populations, which both can serve as preferred reference for life insurers: The United States Life Tables 2008 (USLT) and the 2008 Valuation Basic Tables (VBT) based on the insured population of 35 US Life insurers. The time dependency of the RHs of the systolic blood pressure (SBP), aspartate aminotransferase (ASAT), lactate dehydrogenase (LDH), serum albumin and albuminuria, was assessed, with correction for ethnicity, household income, history of diabetes mellitus, BMI and serum cholesterol. To be able to compare the results with the results of the Age Dependency Study (ADS), the same data, risk indicators, statistical analysis method, and the

  17. The relations of Arab Jordanian adolescents' perceived maternal parenting to teacher-rated adjustment and problems: the intervening role of perceived need satisfaction.

    PubMed

    Ahmad, Ikhlas; Vansteenkiste, Maarten; Soenens, Bart

    2013-01-01

    Although the effects of important parenting dimensions, such as responsiveness and psychological control, are well documented among Western populations, research has only recently begun to systematically identify psychological processes that may account for the cross-cultural generalization of these effects. A first aim of this study was to examine whether perceived maternal responsiveness and psychological control would relate differentially to teacher ratings of adolescent adjustment in a vertical-collectivist society (i.e., Jordan). The most important aim of this study was to examine, on the basis of self-determination theory, whether these associations would be accounted for by perceived satisfaction of the basic psychological needs for autonomy, competence, and relatedness. Results in a large sample of Jordanian adolescents (N = 545) showed that perceived maternal psychological control and responsiveness yielded, respectively, a positive and negative association with teacher-rated problems, whereas psychological control was negatively related to teacher-rated adjustment. Further, these 2 parenting dimensions related to adjustment and problems via perceived satisfaction of the basic psychological needs for autonomy and competence (but not relatedness). The findings are discussed in light of the ongoing debate between universalistic and relativistic perspectives on parenting and adolescent adjustment. PMID:22468568

  18. Accounting for smoking in the radon-related lung cancer risk among German uranium miners: results of a nested case-control study.

    PubMed

    Schnelzer, Maria; Hammer, Gaël P; Kreuzer, Michaela; Tschense, Annemarie; Grosche, Bernd

    2010-01-01

    The possible confounding effect of smoking on radon-associated risk for lung cancer mortality was investigated in a case-control study nested in the cohort of German uranium miners. The study included 704 miners who died of lung cancer and 1,398 controls matched individually for birth year and attained age. Smoking status was reconstructed from questionnaires and records from the mining company's health archives for 421 cases and 620 controls. Data on radon exposure were taken from a job-exposure matrix. Smoking adjusted odds ratios for lung cancer in relation to cumulative radon exposure have been calculated with conditional logistic regression. The increase in risk per Working Level Month (WLM) was assessed with a linear excess relative risk (ERR) model taking smoking into account as a multiplicative factor. In addition, the potential impact of temporal factors on the ERR per WLM was examined. Lung cancer mortality risk increased with increasing radon exposure, yielding a crude ERR per WLM of 0.25% (95% CI: 0.13-0.46%). Adjustment for smoking led only to marginal changes of the radon-associated lung cancer risks. The adjusted ERR per WLM was very similar (0.23%, 95%-CI: 0.11-0.46%) to the crude risk and to the risk found in the Wismut cohort study. This stability of the radon-related lung cancer risks with and without adjustment for smoking suggests that smoking does not act as a major confounder in this study and presumably also not in the cohort study. PMID:19959947

  19. Risk of flood-related mortality in Nepal.

    PubMed

    Pradhan, Elizabeth Kimbrough; West, Keith P; Katz, Joanne; LeClerq, Steven C; Khatry, Subarna K; Shrestha, Sharada Ram

    2007-03-01

    In July 1993, severe flooding devastated Sarlahi district in Nepal. The next month, a follow-up study of a large population cohort was undertaken. The study is unique in that a prospective research database was used to verify residency prior to the flood and to confirm vital status afterwards. It evaluated 41,501 children aged between two and nine years and adults aged 15-70 in 7,252 households. Flood-related fatality rates were 13.3 per 1,000 for girls and 9.4 per 1,000 for boys, 6.1 per 1,000 for women and 4.1 per 1,000 for men. Flood-related fatality rates for children were six times higher than mortality rates in the same villages a year before the flood (relative risk (RR) = 5.9, 95 per cent confidence interval (CI) 5.0-6.8). Flood-related fatality was associated with low socio-economic status preflood (RR = 6.4, 95 per cent CI 2.7-20.0), and having a house constructed of thatch (RR = 5.1, 95 per cent CI 1.7-24.5). PMID:17367374

  20. Baseball Pitching Biomechanics in Relation to Injury Risk and Performance

    PubMed Central

    Fortenbaugh, Dave; Fleisig, Glenn S.; Andrews, James R.

    2009-01-01

    Context: Baseball pitching kinematics, kinetics, ball velocity, and injuries at the shoulder and elbow are related. Evidence Acquisition: PubMed and Sport Discus were searched for original studies published between 1994 and 2008. Relevant references in these studies were retrieved. Inferential studies that tested relationships between kinematics and kinetics were included, as were studies that tested relationships between kinematics and ball velocity. Descriptive studies that simply quantified kinematics and/or kinetics were excluded. Results: Several kinematic parameters at the instant of foot contact were associated with increased upper extremity kinetics: front foot position, front foot orientation, shoulder abduction, and shoulder horizontal adduction. The timing of shoulder external rotation, pelvis rotation, and upper trunk rotation was associated with increased kinetics and decreased ball velocity. Low braking force of the lead leg and a short stride were associated with decreased ball velocity. Decreased maximum shoulder external rotation, shoulder abduction, knee extension, and trunk tilt were also associated with decreased ball velocity. As pitchers develop, kinematic values remain similar, their variability reduces, and kinetic values gradually increase. Slight kinematic variations were seen among pitch types, although the kinetics of fastballs and curveballs were relatively the same; changeup kinetics were the lowest. As pitchers fatigued, kinetic values remained constant, but increases in arm pain were reported. Conclusions: Several kinematic parameters were related to joint kinetics and ball velocity. To enhance performance and reduce injury risk, pitchers need to learn proper fastball mechanics at an early age. A changeup is recommended as a safe secondary pitch to complement the fastball; the curveball can be added after fastball and changeup mechanics are mastered. Avoiding overuse and pitching while fatigued is necessary to minimize the risk of

  1. Cumulative Socioeconomic Status Risk, Allostatic Load, and Adjustment: A Prospective Latent Profile Analysis with Contextual and Genetic Protective Factors

    ERIC Educational Resources Information Center

    Brody, Gene H.; Yu, Tianyi; Chen, Yi-Fu; Kogan, Steven M.; Evans, Gary W.; Beach, Steven R. H.; Windle, Michael; Simons, Ronald L.; Gerrard, Meg; Gibbons, Frederick X.; Philibert, Robert A.

    2013-01-01

    The health disparities literature has identified a common pattern among middle-aged African Americans that includes high rates of chronic disease along with low rates of psychiatric disorders despite exposure to high levels of cumulative socioeconomic status (SES) risk. The current study was designed to test hypotheses about the developmental…

  2. Acculturation and Adjustment in Latino Adolescents: How Cultural Risk Factors and Assets Influence Multiple Domains of Adolescent Mental Health

    ERIC Educational Resources Information Center

    Smokowski, Paul; Buchanan, Rachel L.; Bacallao, Martica L.

    2009-01-01

    The purpose of this study was to examine the relationships among risk factors, cultural assets, and Latino adolescent mental health outcomes. We extend past research by using a longitudinal design and evaluating direct and moderated acculturation effects across a range of internalizing, externalizing, and academic engagement outcomes. The sample…

  3. Free markets and the marriage market: structural adjustment, gender relations, and working conditions among Dominican women workers.

    PubMed

    Safa, H I

    1999-02-01

    The relationship between economic conditions and marriage patterns in the Dominican Republic is analyzed using data collected in 1994 on women working in a free-trade zone. The author concludes that changes associated with structural adjustment appear to have contributed to a deterioration of the job market and a greater prevalence of female-headed households. It is shown that "structural adjustment increases the need for women to work, because of cuts in government programs, declining real wages, growing inflation, and a deterioration in male employment, which weakens the man's role as principal breadwinner and increases the importance and visibility of women's contribution to the household economy. This change in the gender composition of the labor force has encouraged some women to resist marriage and/or remarriage because the ¿marriage market' of eligible men willing and able to support a family has been reduced, contributing to greater marital instability." PMID:12294805

  4. Apparatus and methods for installing, removing and adjusting an inner turbine shell section relative to an outer turbine shell section

    DOEpatents

    Leach, David; Bergendahl, Peter Allen; Waldo, Stuart Forrest; Smith, Robert Leroy; Phelps, Robert Kim

    2001-01-01

    A turbine includes upper and lower inner shell sections mounting the nozzles and shrouds and which inner shell is supported by pins secured to a surrounding outer shell. To disassemble the turbine for access to the inner shell sections and rotor, an alignment fixture is secured to the lower outer shell section and has pins engaging the inner shell section. To disassemble the turbine, the inner shell weight is transferred to the lower outer shell section via the alignment fixture and cradle pins. Roller assemblies are inserted through access openings vacated by support pins to permit rotation of the lower inner shell section out of and into the lower outer shell section during disassembly and assembly. The alignment fixture includes adjusting rods for adjusting the inner shell axially, vertically, laterally and about a lateral axis. A roller over-cage is provided to rotate the inner shell and a dummy shell to facilitate assembly and disassembly in the field.

  5. School-related risk and protective factors associated with truancy among urban youth placed at risk.

    PubMed

    Henry, Kimberly L; Huizinga, David H

    2007-11-01

    Truancy is a serious concern in the United States. Its negative effects are so pervasive that in 2003 the Office of Juvenile Justice and Delinquency Prevention named truancy prevention a national priority. Effective prevention of truancy requires a thorough understanding of the characteristics that describe truant youth as well as factors that may put them at risk for truancy. Unfortunately, surprisingly little is known about the correlates and/or causes of truancy. In this paper we explore associations between truancy and several salient school-related risk and protective factors among a sample of youth who grew up in socially disorganized neighborhoods of Denver, CO. We demonstrate that several school-related risk and protective factors are associated with truancy. Perhaps most importantly, we identify that the two most robust predictors are school performance and involvement with delinquent peers, and that these two variables form a synergistic relationship in which the relationship between delinquent peer association and truancy is mitigated among students who perform well in school. EDITORS' STRATEGIC IMPLICATIONS: The authors use data from a large probability sample drawn from neighborhoods with high crime rates to identify key correlates of truancy. They also draw attention to the dearth of efficacious truancy prevention efforts in spite of the magnitude of the problem. PMID:18004658

  6. Social Cohesion, Social Participation, and HIV Related Risk among Female Sex Workers in Swaziland

    PubMed Central

    Fonner, Virginia A.; Kerrigan, Deanna; Mnisi, Zandile; Ketende, Sosthenes; Kennedy, Caitlin E.; Baral, Stefan

    2014-01-01

    Social capital is important to disadvantaged groups, such as sex workers, as a means of facilitating internal group-related mutual aid and support as well as access to broader social and material resources. Studies among sex workers have linked higher social capital with protective HIV-related behaviors; however, few studies have examined social capital among sex workers in sub-Saharan Africa. This cross-sectional study examined relationships between two key social capital constructs, social cohesion among sex workers and social participation of sex workers in the larger community, and HIV-related risk in Swaziland using respondent-driven sampling. Relationships between social cohesion, social participation, and HIV-related risk factors were assessed using logistic regression. HIV prevalence among the sample was 70.4% (223/317). Social cohesion was associated with consistent condom use in the past week (adjusted odds ratio [AOR]  = 2.25, 95% confidence interval [CI]: 1.30–3.90) and was associated with fewer reports of social discrimination, including denial of police protection. Social participation was associated with HIV testing (AOR = 2.39, 95% CI: 1.36–4.03) and using condoms with non-paying partners (AOR = 1.99, 95% CI: 1.13–3.51), and was inversely associated with reported verbal or physical harassment as a result of selling sex (AOR = 0.55, 95% CI: 0.33–0.91). Both social capital constructs were significantly associated with collective action, which involved participating in meetings to promote sex worker rights or attending HIV-related meetings/ talks with other sex workers. Social- and structural-level interventions focused on building social cohesion and social participation among sex workers could provide significant protection from HIV infection for female sex workers in Swaziland. PMID:24498125

  7. Social cohesion, social participation, and HIV related risk among female sex workers in Swaziland.

    PubMed

    Fonner, Virginia A; Kerrigan, Deanna; Mnisi, Zandile; Ketende, Sosthenes; Kennedy, Caitlin E; Baral, Stefan

    2014-01-01

    Social capital is important to disadvantaged groups, such as sex workers, as a means of facilitating internal group-related mutual aid and support as well as access to broader social and material resources. Studies among sex workers have linked higher social capital with protective HIV-related behaviors; however, few studies have examined social capital among sex workers in sub-Saharan Africa. This cross-sectional study examined relationships between two key social capital constructs, social cohesion among sex workers and social participation of sex workers in the larger community, and HIV-related risk in Swaziland using respondent-driven sampling. Relationships between social cohesion, social participation, and HIV-related risk factors were assessed using logistic regression. HIV prevalence among the sample was 70.4% (223/317). Social cohesion was associated with consistent condom use in the past week (adjusted odds ratio [AOR] = 2.25, 95% confidence interval [CI]: 1.30-3.90) and was associated with fewer reports of social discrimination, including denial of police protection. Social participation was associated with HIV testing (AOR = 2.39, 95% CI: 1.36-4.03) and using condoms with non-paying partners (AOR = 1.99, 95% CI: 1.13-3.51), and was inversely associated with reported verbal or physical harassment as a result of selling sex (AOR = 0.55, 95% CI: 0.33-0.91). Both social capital constructs were significantly associated with collective action, which involved participating in meetings to promote sex worker rights or attending HIV-related meetings/ talks with other sex workers. Social- and structural-level interventions focused on building social cohesion and social participation among sex workers could provide significant protection from HIV infection for female sex workers in Swaziland. PMID:24498125

  8. Educational aspiration-expectation discrepancies: relation to socioeconomic and academic risk-related factors.

    PubMed

    Boxer, Paul; Goldstein, Sara E; DeLorenzo, Tahlia; Savoy, Sarah; Mercado, Ignacio

    2011-08-01

    This study examines whether disconnection between educational aspirations and expectations is associated with socioeconomic status, academic performance, academic risk-related behaviors and related psychosocial factors in an ethnically and economically diverse sample of early adolescents from a public middle school (N = 761). Results suggest that students who aspire to achieve more than they expect to achieve also are likely to have more economically disadvantaged backgrounds and poorer academic performance. These students also show a variety of academic and social risks. Specifically, students whose aspirations exceeded their expectations reported lower levels of school bonding, higher levels of test/performance anxiety, and elevated behavioral/emotional difficulties. Results are discussed in terms of social-cognitive theory as well as applications for promoting student social and academic success. PMID:21036390

  9. The Ecology of Early Childhood Risk: A Canonical Correlation Analysis of Children’s Adjustment, Family, and Community Context in a High-Risk Sample

    PubMed Central

    Aiyer, Sophie M.; Wilson, Melvin N.; Shaw, Daniel S.; Dishion, Thomas J.

    2013-01-01

    The ecology of the emergence of psycho-pathology in early childhood is often approached by the analysis of a limited number of contextual risk factors. In the present study, we provide a comprehensive analysis of ecological risk by conducting a canonical correlation analysis of 13 risk factors at child age 2 and seven narrow-band scales of internalizing and externalizing problem behaviors at child age 4, using a sample of 364 geographically and ethnically diverse, disadvantaged primary caregivers, alternative caregivers, and preschool-age children. Participants were recruited from Special Supplemental Nutrition Program for Women, Infants, and Children sites and were screened for family risk. Canonical correlation analysis revealed that (1) a first latent combination of family and individual risks of caregivers predicted combinations of child emotional and behavioral problems, and that (2) a second latent combination of contextual and structural risks predicted child somatic complaints. Specifically, (1) the combination of chaotic home, conflict with child, parental depression, and parenting hassles predicted a co-occurrence of internalizing and externalizing behaviors, and (2) the combination of father absence, perceived discrimination, neighborhood danger, and fewer children living in the home predicted child somatic complaints. The research findings are discussed in terms of the development of psychopathology, as well as the potential prevention needs of families in high-risk contexts. PMID:23700232

  10. Relative energy risk: Is solar energy riskier than nuclear

    NASA Astrophysics Data System (ADS)

    Inhaber, H.

    The discussion of risk analysis is divided into three parts: (1) a discussion of the methodology which can be used; (2) a listing of some of the major assumptions; and (3) the results of a comparison of eleven energy systems. The energy systems considered are divided into two groups: conventional, i.e., those in fairly widespread use, like coal or nuclear, and nonconventional, i.e., all others, like solar and wind. Compared to some conventional systems like natural gas and nuclear, technologies like solar and windpower have relatively high risk. Because of the dilute nature of the energy they handle, solar and wind systems, when compared on the quality of their energy production, require a considerable amount of apparatus as compared to other systems. In turn, this apparatus requires a large amount of material and construction labor to build and install. Associated with each ton of material and hour of labor is a definite number of accidents, diseases and deaths, according to labor statistics.

  11. Relative risk in the news media: a quantification of misrepresentation.

    PubMed Central

    Frost, K; Frank, E; Maibach, E

    1997-01-01

    OBJECTIVES: This study quantifies the representativeness with which the print news media depict mortality. METHODS: The proportion of mortality-related copy in samples of national print media was compared with the proportion of actual deaths attributable to the leading causes of US mortality over a 1-year period. RESULTS: For every tested cause of death, a significant disproportion was found between amount of text devoted to the cause and the actual number of attributable deaths. Underrepresented causes included tobacco use (23% of expected copy) and heart disease (33%); overrepresented causes included illicit use of drugs (1740%), motor vehicles (1280%), and toxic agents (1070%). CONCLUSIONS: The news media significantly misrepresent the prevalence of leading causes of death and their risk factors. This misrepresentation may contribute to the public's distorted perceptions of health threats. PMID:9184517

  12. Cardiovascular Risks in Relation to Daidzein Metabolizing Phenotypes among Chinese Postmenopausal Women

    PubMed Central

    Liu, Zhao-min; Ho, Suzanne C.; Chen, Yu-ming; Liu, Jun; Woo, Jean

    2014-01-01

    Background Studies suggested that the inter-individual differences in metabolizing isoflavone daidzein to equol or O-desmethylangolensin (ODMA) might explain the inconsistency of the soy/isoflavones efficacy on cardiovascular health. Objectives The study aims to evaluate the relationship between equol and ODMA phenotypes and cardiovascular risks with habitual isoflavone consumption in Chinese postmenopausal women. Methods This is a cross-sectional study among 726 prehypertensive postmenopal women who were screened for a randomized controlled trial. 648 women returned a daidzein-challenged urine samples for determination of equol and O-DMA production. 595 attended clinic visits for assessment of cardiovascular risks including body composition, blood pressure (BP), serum lipids, uric acid, high sensitivity C-reactive protein (hs-CRP), fasting glucose and free fatty acid (FFA). Results The prevalences of equol and O-DMA producers were 53.2% and 60.9% respectively. Equol producers had higher fat free mass (p = 0.001), lower systolic (p = 0.01) and diastolic (p = 0.01) BP, serum triglyceride (p = 0.023), hs-CRP (p = 0.015) and FFA (p = 0.001) than non-producers. O-DMA producers had lower body fat% (p = 0.032), SBP (p = 0.02), total cholesterol (p = 0.002) than non-producers. The significant differences remained after further adjustment for potential confounders. The habitual soy isoflavones intake had little relation to cardiovascular risk factors in either equol/O-DMA producer phenotypes. Conclusion Equol/O-DMA producers had more favorable cardiovascular risk profiles than non-producers in prehypertensive postmenopausal women. PMID:24533060

  13. Repeated measures of body mass index and risk of health related outcomes.

    PubMed

    Claessen, Heiner; Brenner, Hermann; Drath, Christoph; Arndt, Volker

    2012-03-01

    Most studies examining the association between body mass index (BMI) and mortality neglected changes in weight over time, which may have led to underestimation of the true association. The aim of this study is to examine the relationship between BMI and health related outcomes while accounting for variations of BMI over time. The association between BMI and both mortality and occupational disability was examined in a follow-up of 5,554 male construction workers in Württemberg/Germany, who participated at least two times in routine occupational health examinations between 1986 and 2005. Using Cox proportional hazards model with time dependent variables, hazard ratios were calculated with normal weight (<25 kg/m²) as reference after adjustment for potential confounding factors. Overall, an U-shaped association between baseline BMI and mortality (370 events) as well as occupational disability (658 events) was observed, with lowest risk at BMI levels between 25 and 30 kg/m². Men with a baseline BMI ≥ 30 kg/m² experienced a 10% higher mortality and disability risk than normal weight men. The association between BMI and occupational disability became stronger after accounting for temporal variability of BMI with a significant increased risk of 1.26 (95% confidence interval: 1.01-1.56) among obese men. In contrast, the association between BMI and mortality did not materially change after accounting for time dependent effects. Stable obesity as defined by a BMI of 30 kg/m² and above increases risk of disability in male construction workers. Accounting for changes of BMI over time is crucial for disclosing full impact of obesity. PMID:22388768

  14. Adjustment disorder

    MedlinePlus

    American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington, Va: American Psychiatric Publishing. 2013. Powell AD. Grief, bereavement, and adjustment disorders. In: Stern TA, Rosenbaum ...

  15. Association between vitamin D status and age-related macular degeneration by genetic risk

    PubMed Central

    Millen, Amy E.; Meyers, Kristin J; Liu, Zhe; Engelman, Corinne D; Wallace, Robert B; LeBlanc, Erin S; Tinker, Lesley F.; Iyengar, Sudha K; Robinson, Jennifer; Sarto, Gloria E.; Mares, Julie A

    2016-01-01

    Importance Deficient 25-hydroxyvitamin D [25(OH)D] concentrations have been associated with increased odds of age-related macular degeneration (AMD). Objective We examined 1) whether this association is modified by genetic risk for AMD and 2) if there is an association between AMD and single nucleotide polymorphisms (SNPs) of genes involved in vitamin D transport, metabolism and genomic function. Design, Setting and Participants Women were postmenopausal and participants of the Carotenoids in Age-Related Eye Disease Study (CAREDS) (54 to <75 years) with available serum 25(OH)D concentrations (assessed from 1994–1998), genetic data, and measures of AMD (n=142) assessed at CAREDS baseline from 2001–2004 (n=913). Main Outcomes and Measures Prevalent early or late AMD was determined from graded, stereoscopic fundus photographs. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for AMD by the joint effects of 25(OH)D (<30, ≥30 to <50, ≥50 to <75, and ≥75 nmol/L) and risk genotype (noncarrier, one, or two risk alleles). The referent group was noncarriers with adequate vitamin D status (≥75 nmol/L). Joint effect ORs were adjusted for age, smoking, iris pigmentation, self-reported cardiovascular disease, self-reported diabetes status, and hormone use. Additive and multiplicative interactions were assessed using the Synergy Index (SI) and an interaction term, respectively. Results We observed a 6.7-fold increased odds of AMD (95% CI=1.6, 28.2) among women with deficient vitamin D status (25(OH)D<30 nmol/L) and two risk alleles for complement factor H (CFH) Y402H (SI for additive interaction=1.4, 95% CI=1.1, 1.7; p for multiplicative interaction=0.25,. A significant additive (SI=1.4, 95% CI=1.1, 1.7) and multiplicative interaction (p=0.02) was observed for deficient women with two high risk complement factor I (CFI) (rs10033900) alleles (OR=6.3, 95% CI=1.6, 24.2). The odds of AMD did not differ by genotype of candidate

  16. Compensatory Postural Adjustments in an Oculus Virtual Reality Environment and the Risk of Falling in Alzheimer's Disease

    PubMed Central

    Gago, Miguel F.; Yelshyna, Darya; Bicho, Estela; Silva, Hélder David; Rocha, Luís; Lurdes Rodrigues, Maria; Sousa, Nuno

    2016-01-01

    Background/Aims Alzheimer's disease (AD) patients have an impaired ability to quickly reweight central sensory dependence in response to unexpected body perturbations. Herein, we aim to study provoked compensatory postural adjustments (CPAs) in a conflicting sensory paradigm with unpredictable visual displacements using virtual reality goggles. Methods We used kinematic time-frequency analyses of two frequency bands: a low-frequency band (LB; 0.3-1.5 Hz; mechanical strategy) and a high-frequency band (HB; 1.5-3.5 Hz; cognitive strategy). We enrolled 19 healthy subjects (controls) and 21 AD patients, divided according to their previous history of falls. Results The AD faller group presented higher-power LB CPAs, reflecting their worse inherent postural stability. The AD patients had a time lag in their HB CPA reaction. Conclusion The slower reaction by CPA in AD may be a reflection of different cognitive resources including body schema self-perception, visual motion, depth perception, or a different state of fear and/or anxiety. PMID:27489559

  17. The relationship between effectiveness and costs measured by a risk-adjusted case-mix system: multicentre study of Catalonian population data bases

    PubMed Central

    Sicras-Mainar, Antoni; Navarro-Artieda, Ruth; Blanca-Tamayo, Milagrosa; Velasco-Velasco, Soledad; Escribano-Herranz, Esperanza; Llopart-López, Josep Ramon; Violan-Fors, Concepción; Vilaseca-Llobet, Josep Maria; Sánchez-Fontcuberta, Encarna; Benavent-Areu, Jaume; Flor-Serra, Ferran; Aguado-Jodar, Alba; Rodríguez-López, Daniel; Prados-Torres, Alejandra; Estelrich-Bennasar, Jose

    2009-01-01

    Background The main objective of this study is to measure the relationship between morbidity, direct health care costs and the degree of clinical effectiveness (resolution) of health centres and health professionals by the retrospective application of Adjusted Clinical Groups in a Spanish population setting. The secondary objectives are to determine the factors determining inadequate correlations and the opinion of health professionals on these instruments. Methods/Design We will carry out a multi-centre, retrospective study using patient records from 15 primary health care centres and population data bases. The main measurements will be: general variables (age and sex, centre, service [family medicine, paediatrics], and medical unit), dependent variables (mean number of visits, episodes and direct costs), co-morbidity (Johns Hopkins University Adjusted Clinical Groups Case-Mix System) and effectiveness. The totality of centres/patients will be considered as the standard for comparison. The efficiency index for visits, tests (laboratory, radiology, others), referrals, pharmaceutical prescriptions and total will be calculated as the ratio: observed variables/variables expected by indirect standardization. The model of cost/patient/year will differentiate fixed/semi-fixed (visits) costs of the variables for each patient attended/year (N = 350,000 inhabitants). The mean relative weights of the cost of care will be obtained. The effectiveness will be measured using a set of 50 indicators of process, efficiency and/or health results, and an adjusted synthetic index will be constructed (method: percentile 50). The correlation between the efficiency (relative-weights) and synthetic (by centre and physician) indices will be established using the coefficient of determination. The opinion/degree of acceptance of physicians (N = 1,000) will be measured using a structured questionnaire including various dimensions. Statistical analysis: multiple regression analysis (procedure

  18. Risk Factors Associated with Breast Cancer-Related Lymphedema in the WHEL Study

    PubMed Central

    Dominick, Sally A.; Madlensky, Lisa; Natarajan, Loki; Pierce, John P.

    2012-01-01

    Introduction Lymphedema is a significant health problem faced by a large percentage of breast cancer survivors. The Women’s Healthy Eating and Living (WHEL) Study has a unique data set collected after the completion of breast cancer treatment, which allowed a focused analysis of risk factors for breast cancer-related lymphedema. Methods Participant characteristics, treatment modalities, and health behaviors were examined as potential predictors of lymphedema among breast cancer survivors with univariate analyses and multivariate logistic regression. Results Lymphedema status was assessed for 83% of the study cohort (2431 of the 2917 WHEL participants). Among these respondents, 692 (28.5%) women reported yes to either a physician’s diagnosis of lymphedema or a question on arm/hand swelling. When compared to other participants, women with lymphedema were diagnosed at a younger age, more likely to have a higher body mass index, had a larger tumor size, had more lymph nodes removed, more likely to have a mastectomy with radiation therapy, and more likely to have chemotherapy. In the final multivariate-adjusted model, body mass index greater than 25 kg/m2 (p<0.01), the removal of 11 or more lymph nodes (p<0.01), and breast cancer surgery plus radiation therapy (p<0.01) showed a strong independent association with developing breast cancer-related lymphedema. Conclusions The results of this study highlight the importance of educating breast cancer survivors about the modifiable risk factors (e.g., body mass index) associated with the development of lymphedema. Implications for Cancer Survivors Breast cancer survivors at risk for lymphedema may benefit from interventions aimed at achieving or maintaining a healthy body weight. PMID:23212606

  19. Risk of second primary cancer after a first potentially-human papillomavirus-related cancer: A population-based study.

    PubMed

    Neumann, Florent; Jégu, Jérémie; Mougin, Christiane; Prétet, Jean-Luc; Guizard, Anne-Valérie; Lapôtre-Ledoux, Bénédicte; Bara, Simona; Bouvier, Véronique; Colonna, Marc; Troussard, Xavier; Trétarre, Brigitte; Grosclaude, Pascale; Velten, Michel; Woronoff, Anne-Sophie

    2016-09-01

    Human papillomaviruses (HPV) are involved in the development of anogenital and head and neck cancers. The purpose of this study was to assess the risk of developing a second primary cancer (SPC) after a first potentially-HPV-related cancer, and to analyze the sites where SPCs most frequently occurred in these patients. All patients with a first cancer diagnosed between 1989 and 2004, as recorded by 10 French cancer registries, were followed up until December 31, 2007. Only invasive potentially-HPV-related cancers (namely, cervical, vagina, vulva, anal canal, penile, oropharynx, tongue and tonsil) were included. Standardized Incidence Ratios (SIRs) were calculated to assess the risk of SPC. A multivariate Poisson regression model was used to model SIRs separately by gender, adjusted for the characteristics of the first cancer. 10,127 patients presented a first potentially-HPV-related cancer. The overall SIR was 2.48 (95% CI, 2.34-2.63). The SIR was 3.59 (95% CI, 3.33-3.86) and 1.61 (95% CI, 1.46-1.78) in men and women respectively. The relative risk of potentially-HPV-related SPC was high among these patients (SIR=13.74; 95% CI, 8.80-20.45 and 6.78; 95% CI, 4.61-9.63 for men and women, respectively). Women diagnosed in the most recent period (2000-2004) showed a 40% increase of their relative risk of SPC as compared with women diagnosed between 1989 and 1994 (ratio of SIRs=1.40; 95% CI, 1.06-1.85). HPV cancer survivors face an increased risk of SPC, especially second cancer. Clinicians may consider this increased risk of developing HPV-related SPC during follow-up to improve subsequent cancer prevention in these patients. PMID:27370167

  20. Risk factors for age-related maculopathy are associated with a relative lack of macular pigment.

    PubMed

    Nolan, John M; Stack, Jim; O' Donovan, Orla; Loane, Edward; Beatty, Stephen

    2007-01-01

    Macular pigment (MP) is composed of the two dietary carotenoids lutein (L) and zeaxanthin (Z), and is believed to protect against age-related maculopathy (ARM). This study was undertaken to investigate MP optical density with respect to risk factors for ARM, in 828 healthy subjects from an Irish population. MP optical density was measured psychophysically using heterochromatic flicker photometry, serum L and Z were quantified by HPLC, and dietary intake of L and Z was assessed using a validated food-frequency questionnaire. Clinical and personal details were also recorded, with particular attention directed towards risk factors for ARM. We report a statistically significant age-related decline in MP optical density (r2=0.082, p<0.01). Current and past smokers had lower average MP optical density than never smokers and this difference was statistically significant (p<0.01). Subjects with a confirmed family history of ARM had significantly lower levels of MP optical density than subjects with no known family history of disease (p<0.01). For each of these established risk factors, their statistically significant negative association with MP persisted after controlling for the other two, and also after controlling for other potentially confounding variables such as sex, cholesterol, dietary and serum L (p<0.01). In the absence of retinal pathology, and in advance of disease onset, the relative lack of MP seen in association with increasing age, tobacco use and family history of ARM supports the hypothesis that the enhanced risk that these variables represent for ARM may be attributable, at least in part, to a parallel deficiency of macular carotenoids. PMID:17083932

  1. Sleep duration and obesity-related risk factors in the rural Midwest

    PubMed Central

    Stamatakis, Katherine A.; Brownson, Ross C.

    2015-01-01

    Objective Habitual short sleep duration is a common practice linked to weight gain and risk of obesity. Our objective was to examine the association between sleep duration with other behaviors, such as physical activity and nutrition, which are important for obesity prevention efforts. Methods We used cross-sectional data from rural communities in Missouri, Tennessee and Arkansas (n=1,203). Controlling for covariates, we assessed the association between short sleep duration (<7 hours vs. 7-8 hours) and obesity, not meeting vigorous physical activity requirements, low fruit and vegetable consumption, high fat consumption and frequently eating at fast food restaurants. Results The proportion of participants with habitual sleep duration of <7 hours, 7-8 hours and ≥9 hours was 36.2%, 57.3%, and 6.4%, respectively. After multivariable adjustment, short sleep duration was associated with certain obesity-related behaviors, particularly lower physical activity and lower fruit and vegetable consumption. Conclusions Short sleep duration is associated with risk behaviors that are known to promote weight gain and obesity. Interventions aimed at promoting physical activity and improved nutrition may benefit by considering adequate sleep duration as a potentially modifiable behavior that may impact the effectiveness of efforts to prevent obesity. PMID:18155130

  2. Problem gambling patterns among Australian young adults: Associations with prospective risk and protective factors and adult adjustment.

    PubMed

    Scholes-Balog, Kirsty E; Hemphill, Sheryl A; Toumbourou, John W; Dowling, Nicki A

    2016-04-01

    There is instability in the developmental course of problem gambling [PG] over time; however, studies that examine PG at an aggregate level obscure these variations. The current study employed data from a longitudinal study of Australian young adults to investigate: 1) PG patterns (i.e., resistance, persistence, desistence, and new incidence); 2) prospective risk and protective factors for these patterns; and 3) behavioural outcomes associated with these patterns. A sample of 2261 young adults (55.73% female) from Victoria, Australia, who were part of the International Youth Development Study completed a survey in 2010 (T1, age 21) and 2012 (T2, age 23) measuring PG (two items based on established measures), risk and protective factors, and behavioural outcomes. The majority of the sample (91.69%) were resistors (no PG at T1 and T2), 3.62% were new incidence PG cases, 2.63% were desistors (PG at T1 but not T2), and 2.07% reported persistent PG at T1 and T2. Individual civic activism was protective of new incidence PG, while affiliation with antisocial peers and frequent alcohol use increased the risk of persistence. Persistent problem gamblers also experienced the greatest number of poor behavioural outcomes at T2. New incidence was associated with internalising symptoms at T2, while desistance was not associated with any behavioural outcomes. In conclusion, each PG pattern was associated with different predictors and outcomes, highlighting the need to consider variation in the course of young adult PG in order to provide efficacious prevention and intervention approaches, and to protect against relapse. PMID:26790138

  3. Accounting for time- and space-varying changes in the gravity field to improve the network adjustment of relative-gravity data

    USGS Publications Warehouse

    Kennedy, Jeffrey R.; Ferre, Ty P.A.

    2015-01-01

    The relative gravimeter is the primary terrestrial instrument for measuring spatially and temporally varying gravitational fields. The background noise of the instrument—that is, non-linear drift and random tares—typically requires some form of least-squares network adjustment to integrate data collected during a campaign that may take several days to weeks. Here, we present an approach to remove the change in the observed relative-gravity differences caused by hydrologic or other transient processes during a single campaign, so that the adjusted gravity values can be referenced to a single epoch. The conceptual approach is an example of coupled hydrogeophysical inversion, by which a hydrologic model is used to inform and constrain the geophysical forward model. The hydrologic model simulates the spatial variation of the rate of change of gravity as either a linear function of distance from an infiltration source, or using a 3-D numerical groundwater model. The linear function can be included in and solved for as part of the network adjustment. Alternatively, the groundwater model is used to predict the change of gravity at each station through time, from which the accumulated gravity change is calculated and removed from the data prior to the network adjustment. Data from a field experiment conducted at an artificial-recharge facility are used to verify our approach. Maximum gravity change due to hydrology (observed using a superconducting gravimeter) during the relative-gravity field campaigns was up to 2.6 μGal d−1, each campaign was between 4 and 6 d and one month elapsed between campaigns. The maximum absolute difference in the estimated gravity change between two campaigns, two months apart, using the standard network adjustment method and the new approach, was 5.5 μGal. The maximum gravity change between the same two campaigns was 148 μGal, and spatial variation in gravity change revealed zones of preferential infiltration and areas of relatively

  4. Accounting for time- and space-varying changes in the gravity field to improve the network adjustment of relative-gravity data

    NASA Astrophysics Data System (ADS)

    Kennedy, Jeffrey R.; Ferré, Ty P. A.

    2016-02-01

    The relative gravimeter is the primary terrestrial instrument for measuring spatially and temporally varying gravitational fields. The background noise of the instrument-that is, non-linear drift and random tares-typically requires some form of least-squares network adjustment to integrate data collected during a campaign that may take several days to weeks. Here, we present an approach to remove the change in the observed relative-gravity differences caused by hydrologic or other transient processes during a single campaign, so that the adjusted gravity values can be referenced to a single epoch. The conceptual approach is an example of coupled hydrogeophysical inversion, by which a hydrologic model is used to inform and constrain the geophysical forward model. The hydrologic model simulates the spatial variation of the rate of change of gravity as either a linear function of distance from an infiltration source, or using a 3-D numerical groundwater model. The linear function can be included in and solved for as part of the network adjustment. Alternatively, the groundwater model is used to predict the change of gravity at each station through time, from which the accumulated gravity change is calculated and removed from the data prior to the network adjustment. Data from a field experiment conducted at an artificial-recharge facility are used to verify our approach. Maximum gravity change due to hydrology (observed using a superconducting gravimeter) during the relative-gravity field campaigns was up to 2.6 μGal d-1, each campaign was between 4 and 6 d and one month elapsed between campaigns. The maximum absolute difference in the estimated gravity change between two campaigns, two months apart, using the standard network adjustment method and the new approach, was 5.5 μGal. The maximum gravity change between the same two campaigns was 148 μGal, and spatial variation in gravity change revealed zones of preferential infiltration and areas of relatively high

  5. Australian Adolescents' Perceptions of Health-Related Risks.

    ERIC Educational Resources Information Center

    Moore, Susan M.; Rosenthal, Doreen A.

    1992-01-01

    Evaluates the perceptions of adolescents (n=189) of their risks and ascertains the relationship between risk perception and actual risky behavior in five areas: AIDS, STDs, serious car accidents, lung cancer, and skin cancer. Results indicated that although late-adolescent students underestimated risk behavior, they were able to make judgments…

  6. Dietary fiber is related to metabolic risk factors in the Framingham Offspring Cohort

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Metabolic and epidemiological evidence suggests that high fiber diets improve glucose and lipid metabolism. We examined the association between energy-adjusted dietary fiber intake and several metabolic markers of disease risk in X men and Y women in the Framingham Offspring Cohort. Dietary fiber ...

  7. Excimer laser coronary angioplasty: relative risk analysis of clinical results

    NASA Astrophysics Data System (ADS)

    Bittl, John A.

    1992-08-01

    Reports of successful use of excimer laser coronary angioplasty for complex coronary artery disease abound, yet firm indications for its use have not been defined. We attempted to treat 858 coronary stenoses in 764 consecutive patients (mean age 61 years; range 32 - 91 years; 75% men; 76% with Class III or IV angina) with excimer laser angioplasty at 308 nm. Successful treatment was achieved in 86% of patients, as indicated by relative risk analysis. This showed that certain angiographic features, such as lesions at a vessel bifurcation (odds ratio, OR equals 0.46; 95% confidence interval 0.23, 0.88; P equals 0.017;) or in a tortuous segment (OR equals 0.54; 95% CI equals 0.34, 0.88; P equals 0.041), have decreased likelihood of clinical success. On the other hand, ostial stenoses (OR equals 1.06; 95% CI equals 0.44, 2.56, P equals 0.903) and saphenous vein graft lesions (OR equals 2.17; 95% CI equals 0.98, 4.82; P equals 0.051) have acceptable success rates. Diffuse disease (> 20 mm), total occlusions and calcified lesions were treated as successfully as all other lesion types. Successful treatment with excimer laser coronary angioplasty was also achieved in almost all patients (15/16) who had a prior unsuccessful attempt at balloon angioplasty in the lesion was crossed with a guidewire yet resists either balloon catheter passage or full dilatation. Follow-up angiography was obtained in 70% of eligible patients. Angiographic restenosis, defined by > 50% stenosis, was seen in 60% of patients. Relative risk analysis showed an increased risk of restenosis when adjunctive balloon angioplasty was not used (OR equals 1.68; 95% CI equals 1.02, 2.28; P equals 0.039). Other variables known to affect the outcome of balloon angioplasty, such as lesion length or stenosis in degenerated saphenous vein bypass graft, did not influence the

  8. Relative cancer risks of chemical contaminants in the great lakes

    NASA Astrophysics Data System (ADS)

    Bro, Kenneth M.; Sonzogni, William C.; Hanson, Mark E.

    1987-08-01

    Anyone who drinks water or eats fish from the Great Lakes consumes potentially carcinogenic chemicals. In choosing how to respond to such pollution, it is important to put the risks these contaminants pose in perspective. Based on recent measurements of carcinogens in Great Lakes fish and water, calculations of lifetime risks of cancer indicate that consumers of sport fish face cancer risks from Great Lakes contaminants that are several orders of magnitude higher than the risks posed by drinking Great Lakes water. But drinking urban groundwater and breathing urban air may be as hazardous as frequent consumption of sport fish from the Great Lakes. Making such comparisons is difficult because of variation in types and quality of information available and in the methods for estimating risk. Much uncertainty pervades the risk assessment process in such areas as estimating carcinogenic potency and human exposure to contaminants. If risk assessment is to be made more useful, it is important to quantify this uncertainty.

  9. Severity of disease estimation and risk-adjustment for comparison of outcomes in mechanically ventilated patients using electronic routine care data.

    PubMed

    van Mourik, Maaike S M; Moons, Karel G M; Murphy, Michael V; Bonten, Marc J M; Klompas, Michael

    2015-07-01

    BACKGROUND Valid comparison between hospitals for benchmarking or pay-for-performance incentives requires accurate correction for underlying disease severity (case-mix). However, existing models are either very simplistic or require extensive manual data collection. OBJECTIVE To develop a disease severity prediction model based solely on data routinely available in electronic health records for risk-adjustment in mechanically ventilated patients. DESIGN Retrospective cohort study. PARTICIPANTS Mechanically ventilated patients from a single tertiary medical center (2006-2012). METHODS Predictors were extracted from electronic data repositories (demographic characteristics, laboratory tests, medications, microbiology results, procedure codes, and comorbidities) and assessed for feasibility and generalizability of data collection. Models for in-hospital mortality of increasing complexity were built using logistic regression. Estimated disease severity from these models was linked to rates of ventilator-associated events. RESULTS A total of 20,028 patients were initiated on mechanical ventilation, of whom 3,027 deceased in hospital. For models of incremental complexity, area under the receiver operating characteristic curve ranged from 0.83 to 0.88. A simple model including demographic characteristics, type of intensive care unit, time to intubation, blood culture sampling, 8 common laboratory tests, and surgical status achieved an area under the receiver operating characteristic curve of 0.87 (95% CI, 0.86-0.88) with adequate calibration. The estimated disease severity was associated with occurrence of ventilator-associated events. CONCLUSIONS Accurate estimation of disease severity in ventilated patients using electronic, routine care data was feasible using simple models. These estimates may be useful for risk-adjustment in ventilated patients. Additional research is necessary to validate and refine these models. PMID:25881675

  10. About some aspects of weather related risks in Spanish Agriculture

    NASA Astrophysics Data System (ADS)

    Anton, J. M.; Tarquis, A. M.; Grau, J. B.; Saa, A.; Diaz, M. C.

    2009-04-01

    aggressive floods in 1500-1800 era, and actual added trends of "climate change" are towards higher temperatures, less water and higher perturbations. These long term risks are rather poorly predictable and will be handled mostly by improvements in agriculture and also by social and economic adaptations, but at shorter delays and specific areas active policies are possible and exist. An agribusiness can set his production plans lowering his global risk. Sometimes it might use prudently some financial instruments, such as "orange juice futures". When using decision making models, some utility functions may consider that severe losses have higher effects than good profits, letting ranges for business margins for insurers to be limited by concurrence at correct levels. Correct availability of credits is necessary for bad periods, and also state policies for rare bad situations, concerning agribusiness survival and also alimentary safety. Insurance products are effective aids for a growing variety of well definite natural risks, such as in cases of hailstorm, that have probabilities of occurrence measurable from previous events data, and a variety of adequate professional models are continuously made for them. Related to Universidad Politecnica de Madrid the CEIGRAM institute has started recently and is involved in agricultural insurance, being connected with insurers through ENESA and AGROMUTUA. That world is active, important, evolving, and is regulated by diverse laws.

  11. Increased Asthma Risk and Asthma-Related Health Care Complications Associated With Childhood Obesity

    PubMed Central

    Black, Mary Helen; Zhou, Hui; Takayanagi, Miwa; Jacobsen, Steven J.; Koebnick, Corinna

    2013-01-01

    Asthma is the most common chronic condition of childhood, yet the relationship between obesity and asthma risk and the impact of obesity on clinical asthma outcomes are not well understood. For this population-based, longitudinal study, demographic and clinical data were extracted from administrative and electronic health records of 623,358 patients aged 6–19 years who were enrolled in the Kaiser Permanente Southern California health plan in 2007–2011. Crude asthma incidence ranged from 16.9 per 1,000 person-years among normal-weight youth to 22.3 per 1,000 person-years among extremely obese youth. The adjusted risks of asthma for overweight, moderately obese, and extremely obese youth relative to those of normal weight youth were 1.16 (95% confidence interval: 1.13, 1.20), 1.23 (95% confidence interval: 1.19, 1.28), and 1.37 (95% confidence interval: 1.32, 1.42), respectively (Ptrend < 0.0001). The relationship between obesity and asthma risk was strongest in Asian/Pacific Islanders and in the youngest girls (aged 6–10 years), compared with other groups. Among youth who developed asthma, those who were moderately or extremely obese had more frequent asthma exacerbations requiring emergency department services and/or treatment with oral corticosteroids. In conclusion, obese youth are not only more likely to develop asthma, but they may be more likely to have severe asthma, resulting in a greater need for health care utilization and aggressive asthma treatment. PMID:23924576

  12. Sex-related alcohol expectancies and high-risk sexual behavior among drinking adults in Kampala, Uganda

    PubMed Central

    Nash, Scott D.; Katamba, Achilles; Mafigiri, David Kaawa; Mbulaiteye, Sam M.; Sethi, Ajay K

    2015-01-01

    Alcohol consumption, a risk factor for HIV transmission in sub-Saharan Africa, is considered high in Uganda. The study was conducted to determine whether sex-related expectations about the effects of alcohol help explain the association between alcohol use and risky sexual behaviors in a population-based sample of adults in Kampala. A two-stage sampling procedure was used to identify residents in one division of Kampala for a cross-sectional study. Associations between alcohol use (current and higher-risk drinking) and high-risk sexual behaviors (multiple regular partners and casual sex) were tested. Final models included a sex-related alcohol outcome expectancy (AOE) summary score. In age-sex-adjusted models, having multiple regular partners was associated with current drinking (Odds Ratio (OR)=2.76, 95% Confidence Intervals (CI)=1.15, 6.63) and higher-risk drinking (OR=3.35, 95%CI=1.28,8.71). Associations were similar but not statistically significant for having a causal sex partner. Sex-related AOE were associated with both alcohol use and high-risk sexual behavior and attenuated relationships between multiple regular partners and both current drinking (OR=1.94, 95%CI=0.57,6.73) and higher-risk drinking (OR=2.44, 95%CI=0.68,8.80). In this setting sexual behaviors related with alcohol consumption were explained, in part, by sex-related expectations about the effects of alcohol. These expectations could be an important component to target in HIV education campaigns. PMID:26315308

  13. Genome-wide association analyses of genetic, phenotypic, and environmental risks in the age-related eye disease study

    PubMed Central

    Ryu, Euijung; Fridley, Brooke L.; Tosakulwong, Nirubol; Bailey, Kent R.

    2010-01-01

    Purpose To present genome-wide association analyses of genotypic and environmental risks on age-related macular degeneration (AMD) using 593 subjects from the age-related eye disease study (AREDS), after adjusting for population stratification and including questionable controls. Methods Single nucleotide polymorphism (SNP) associations with AMD for the non-Hispanic white population were investigated using a log-additive model after adjusting for population stratification. Replication of possible SNP-disease association was performed by genotyping an independent group of 444 AMD case and 300 control subjects. Logistic regression models were used to assess interaction effects between smoking and SNPs associated with AMD. Independent genetic risk effects among the disease-associated SNPs were also investigated using multiple logistic regression models. Results Population stratification was observed among the individuals having a self-reported race of non-Hispanic white. Risk allele frequencies at established AMD loci demonstrated that questionable control subjects were similar to control subjects in the AREDS, suggesting that they could be used as true controls in the analyses. Genetic loci (complement factor H [CFH], complement factor B [CFB], the age-related maculopathy susceptibility 2 locus containing the hypothetical gene [LOC387715]/the high-temperature requirement A-1 [HTRA1], and complement component 3 [C3]) that were already known to be associated with AMD were identified. An additional 26 novel SNPs potentially associated with AMD were identified, but none were definitely replicated in a second independent group of subjects. Smoking did not interact with known AMD loci, but was associated with late AMD. Statistically independent genetic signals were observed within the Pleckstrin homology domain-containing family A member 1 (PLEKHA1) region near LOC387715/HTRA1 and within a haplotype spanning exon 19 of the C3 gene. Conclusions Population stratification

  14. Response bias, weighting adjustments, and design effects in the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS)

    PubMed Central

    Kessler, Ronald C.; Heeringa, Steven G.; Colpe, Lisa J.; Fullerton, Carol S.; Gebler, Nancy; Hwang, Irving; Naifeh, James A.; Nock, Matthew K.; Sampson, Nancy A.; Schoenbaum, Michael; Zaslavsky, Alan M.; Stein, Murray B.; Ursano, Robert J.

    2014-01-01

    The Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) is a multi-component epidemiological and neurobiological study designed to generate actionable recommendations to reduce U.S. Army suicides and increase knowledge about determinants of suicidality. Three Army STARRS component studies are large-scale surveys: one of new soldiers prior to beginning Basic Combat Training (BCT; n=50,765 completed self-administered questionnaires); another of other soldiers exclusive of those in BCT (n=35,372); and a third of three Brigade Combat Teams about to deploy to Afghanistan who are being followed multiple times after returning from deployment (n= 9,421). Although the response rates in these surveys are quite good (72.0-90.8%), questions can be raised about sample biases in estimating prevalence of mental disorders and suicidality, the main outcomes of the surveys based on evidence that people in the general population with mental disorders are under-represented in community surveys. This paper presents the results of analyses designed to determine whether such bias exists in the Army STARRS surveys and, if so, to develop weights to correct for these biases. Data are also presented on sample inefficiencies introduced by weighting and sample clustering and on analyses of the trade-off between bias and efficiency in weight trimming. PMID:24318218

  15. Relative risk site evaluations for Yakima Training Center

    SciTech Connect

    Smith, R.M.; Whelan, G.

    1996-11-01

    All 20 U.S. Army Yakima Training Center (YTC) sites evaluated were given a `low` relative risk. At Solid Waste Management Unit (SWMU) 22, a `minimum` soils contaminant hazard factor was assigned even though 6,700 mg/kg TPH-diesel was found in surface soil. SWMU 22 is physically located on top of and with the fence surrounding Area of Concern (AOC) 4. Because the diesel is most likely associated with AOC 4, and plans are to clean up AOC 4, any further actions regarding these contaminated soils should be addressed as part of the planned actions for AOC 4. Contaminant hazard factors of `moderate` were assigned to the soil pathway for SWMUs 4 and 7 because dieldrin and arsenic, respectively, were found in surface soil samples at concentrations exceeding standards. A `moderate` contaminant hazard factor was also assigned to the sediment pathway for AOC 1 because arsenic detected in sediments in `Larry`s Swimming Pool` exceeded the standard. All other contaminant hazard factors were rated as minimal. The receptor factor for all sites and pathways was rated `limited,` except for SWMU 54 in which the groundwater receptor factor was rated `potential.` A `potential` rating was assigned to the groundwater pathway at this site to be conservative. The site is located on the south side of the syncline axis where the unconfined aquifer may be present and there are no monitoring wells at the site to confirm or deny the presence of groundwater contamination.

  16. Prospective Study of Plasma Homocysteine Level and Risk of Age-related Macular Degeneration in Women

    PubMed Central

    Christen, William G.; Cook, Nancy R.; Ridker, Paul M.; Buring, Julie E.

    2014-01-01

    Purpose Prospective data to examine the association of homocysteine and age-related macular degeneration (AMD) are limited. We examined the prospective relation of plasma homocysteine level and AMD in a large cohort of apparently healthy women. Methods We evaluated the relationship between baseline levels of plasma homocysteine and incident AMD among 27,479 female health professionals aged 40 years or older. Main outcome measures were total AMD, defined as a self-report documented by medical record evidence of an initial diagnosis after randomization, and visually significant AMD, defined as confirmed incident AMD with visual acuity of 20/30 or worse attributable to this condition. Results During an average of 10 years of follow-up, a total of 452 cases of AMD, including 182 cases of visually-significant AMD, were documented. Women in the highest versus lowest quartile of plasma homocysteine had modestly, but statistically non-significant, increased risks of total (hazard ratio [HR], 1.24; 95% confidence interval [CI], 0.95–1.63; p for trend, 0.07) and visually-significant AMD (HR, 1.41; 95% CI, 0.92–2.17; p for trend, 0.052) in age- and treatment-adjusted analyses. Conclusions These prospective data from a large cohort of apparently-healthy women do not support a strong role for homocysteine in AMD occurrence. PMID:25777307

  17. A four-culture study of self-enhancement and adjustment using the social relations model: do alternative conceptualizations and indices make a difference?

    PubMed

    Church, A Timothy; Katigbak, Marcia S; Mazuera Arias, Rina; Rincon, Brigida Carolina; Vargas-Flores, José de Jesús; Ibáñez-Reyes, Joselina; Wang, Lei; Alvarez, Juan M; Wang, Congcong; Ortiz, Fernando A

    2014-06-01

    In the self-enhancement literature, 2 major controversies remain--whether self-enhancement is a cultural universal and whether it is healthy or maladaptive. Use of the social relations model (SRM; Kenny, 1994) might facilitate resolution of these controversies. We applied the SRM with a round-robin design in both friend and family contexts in 4 diverse cultures: the United States (n = 399), Mexico (n = 413), Venezuela (n = 290), and China (n = 222). Results obtained with social comparison, self-insight, and SRM conceptualizations and indices of self-enhancement were compared for both agentic traits (i.e., egoistic bias) and communal traits (i.e., moralistic bias). Conclusions regarding cultural differences in the prevalence of self-enhancement vs. self-effacement tendencies, and the relationship between self-enhancement and adjustment, varied depending on the index of self-enhancement used. For example, consistent with cultural psychology perspectives, Chinese showed a greater tendency to self-efface than self-enhance using social comparison and self-insight indices, particularly on communal traits in the friend context. However, no cultural differences were observed when perceiver and target effects were controlled using the SRM indices. In all cultures, self-enhancement indices were moderately consistent across friend and family contexts, suggesting traitlike tendencies. To a similar extent in all 4 cultures, self-enhancement tendencies, as measured by the SRM indices, were moderately related to self-rated adjustment, but unrelated, or less so, to observer-rated adjustment. PMID:24841101

  18. Adjustable microforceps.

    PubMed

    Bao, J Y

    1991-04-01

    The commonly used microforceps have a much greater opening distance and spring resistance than needed. A piece of plastic ring or rubber band can be used to adjust the opening distance and reduce most of the spring resistance, making the user feel more comfortable and less fatigued. PMID:2051437

  19. A prospective study of the effects of marital status and family relations on young children's adjustment among African American and European American families.

    PubMed

    Shaw, D S; Winslow, E B; Flanagan, C

    1999-01-01

    The present study investigated the effects of divorce and family relations on young children's development prospectively, using an ethnically diverse sample of approximately 300 low-income families. We also were able to examine the moderating effects of ethnicity on child adjustment in always two-parent, to-be-divorced, already-divorced, and always single-parent families. Results indicated that to-be-divorced European American and African American families demonstrated higher rates of preschool-age behavior problems, and already-divorced families showed similar trends. Parental conflict and behavior problems accounted for predivorce differences in child behavior problems, whereas rejecting parenting accounted for differences in problem behavior between always single-parent and always two-parent families. The results are discussed in terms of the importance of ethnicity in influencing young, low-income children's adjustment to different family structures. PMID:10368919

  20. Medicare determinations and income-related monthly adjustment amounts to Medicare Part B premiums; conforming changes to regulations. Interim final rule with request for comments.

    PubMed

    2013-09-18

    We are modifying our regulations regarding Medicare Part B income-related monthly adjustment amounts (IRMAA) in order to conform to changes made to the Social Security Act (Act) by the Affordable Care Act. This rule freezes the modified adjusted gross income threshold and ranges from 2011 through 2019 and removes the requirement that beneficiaries consent to our release of Internal Revenue Service (IRS) information to the U.S. Department of Health and Human Services (HHS) for the purpose of adjudicating any appeal of an IRMAA to the Part B premium subsidy. We are also removing provisions that phased in IRMAA between 2007 and 2009 and updating a citation to reflect the transfer of authority for hearing appeals under Title XVIII of the Act from the Social Security Administration to HHS. PMID:24046882

  1. Dietary fiber and fiber-rich food intake in relation to risk of stroke in male smokers

    PubMed Central

    Larsson, Susanna C; Männistö, Satu; Virtanen, Mikko J.; Kontto, Jukka; Albanes, Demetrius; Virtamo, Jarmo

    2012-01-01

    Background/Objectives There is convincing evidence that a high dietary fiber intake may lower the risk of coronary heart disease. However, the role of fiber in the prevention of stroke is unclear. We examined the associations of dietary fiber and fiber-rich food intake with risk of stroke within the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study. Subjects/Methods Between 1985 and 1988, 26 556 Finnish male smokers aged 50–69 years who had no history of stroke completed a dietary questionnaire. During a mean follow-up of 13.6 years, 2702 cerebral infarctions, 383 intracerebral hemorrhages, and 196 subarachnoid hemorrhages were ascertained. Results After adjustment for cardiovascular risk factors and folate and magnesium intakes, there was no significant association between intake of total fiber, water-soluble fiber, water-insoluble fiber, or fiber derived from fruit or cereal sources and risk of any stroke subtype. Vegetable fiber intake as well as consumption of fruit, vegetables, and cereals were inversely associated with risk of cerebral infarction; the multivariate relative risks (RR) for the highest quintile of intake compared with the lowest were 0.86 (95% confidence interval (CI): 0.76–0.99) for vegetable fiber, 0.82 (95% CI: 0.73–0.93) for fruit, 0.75 (95% CI: 0.66–0.85) for vegetables, and 0.87 (95% CI: 0.74–1.03) for cereals. Vegetable consumption was inversely associated with risk of subarachnoid hemorrhage (RR for highest versus lowest quintile: 0.62; 95% CI: 0.40–0.98) and cereal consumption was inversely associated with risk of intracerebral hemorrhage (RR: 0.64; 95% CI: 0.41–1.01). Conclusions These findings suggest a beneficial effect of consumption of fruits, vegetables, and cereals on stroke risk. PMID:19319150

  2. RELATIVE PROLIFERATION RISKS FOR NUCLEAR FUEL LEASING ARRANGEMENT

    SciTech Connect

    CHENG,L.Y.; YUE, M.; BARI, R.A.

    2007-10-01

    The present study demonstrates a probabilistic approach to quantify the proliferation risks of fuel leasing and recycling. A Markov model approach is applied to evaluate the probability of proliferation success by diversion or theft. Proliferation risk is calculated as a product of the probability of success and the corresponding consequences.

  3. Reactor siting risk comparisons related to recommendations of NUREG-0625

    SciTech Connect

    Barsell, A.W.; Dombek, F.S.; Orvis, D.D.

    1980-11-01

    This document evaluates how implementing the remote siting recommendations for nuclear reactors (NUREG-0625) made by the Siting Policy Task Force of the US Nuclear Regulatory Commission (NRC) can reduce potential public risk. The document analyzes how population density affects site-specific risk for both light water reactors (LWRs) and high-temperature gas-cooled reactors (HTGRs).

  4. Disparity of risk-adjusted inpatient outcomes among African American and white patients hospitalized with community-acquired pneumonia.

    PubMed

    Dickerson, Justin B; Smith, Matthew Lee

    2012-08-01

    The objectives of this study were to examine the associations between inpatient pneumonia outcomes, health care factors, and sociodemographics with an emphasis on race. African American and white patients from the 2008 National Hospital Discharge Survey who were admitted to nonprofit and for-profit hospitals with a principal diagnosis of pneumonia were sampled (n=1924). Three outcomes were measured: length of hospital stay, discharge to home, and deceased at discharge. Length of hospital stay was measured with negative binomial regression including incidence rate ratios (IRRs), while the remaining 2 outcomes were measured with logistic regression including odds ratios (ORs). Patients with longer hospital stays relative to peers were likely older (IRR=1.01, 95% confidence interval [CI]=1.01-1.01, P<0.001) and African American (IRR=1.19, 95% CI=1.10-1.30, P<0.001), but had fewer comorbidities (IRR=0.97, 95% CI=0.94-0.99, P=0.016). Patients were less likely to be discharged to home if they were older (OR=0.96, 95% CI=0.95-0.96, P<0.001), African American (OR=0.68, 95% CI=0.52-0.90, P=0.006), and had government insurance (OR=0.59, 95% CI=0.44-0.79, P<0.001). Patients deceased at discharge were more likely to be older (OR=1.03, 95% CI=1.01-1.05, P=0.001), African American (OR=1.97, 95% CI=1.10-3.53, P=0.023), and to have fewer comorbidities (OR=0.71, 95% CI=0.57-0.88, P=0.002). African Americans with pneumonia experience inequitable inpatient pneumonia-related outcomes relative to whites. Hospital interventions addressing equity are needed. PMID:22401151

  5. Disruptions in ovarian function are related to depression and cardio-metabolic risk during pre-menopause

    PubMed Central

    Bleil, Maria E.; Bromberger, Joyce T.; Latham, Melissa D.; Adler, Nancy E.; Pasch, Lauri A.; Gregorich, Steven E.; Rosen, Mitchell P.; Cedars, Marcelle I.

    2012-01-01

    Objective To evaluate the extent to which mild disruptions in ovarian function indexed by changes in menstrual cycle length may relate to cardio-metabolic and psychological health in pre-menopausal women. Methods Among 804 healthy, regularly-cycling women (ages 25–45, M=35.5 [5.5]), patterns of any change (shortening, lengthening, or increased variability) versus no change in menstrual cycle length were examined in relation to a composite of cardio-metabolic risk and individual risk factors (high-density lipoprotein [HDL], triglycerides, waist circumference, glucose, hypertensive status) as well as in relation to depression indicators (Center for Epidemiologic Studies Depression [CESD] score ≥16 [yes/no], lifetime depression diagnosis [yes/no], lifetime anti-depressant medication use [yes/no]). Models were also explored to test whether changes in menstrual cycle length mediated relations between depression history and cardio-metabolic risk. Results In covariate-adjusted models, compared to no change, any change in menstrual cycle length was associated with higher cardio-metabolic risk composite scores and lower HDL (p’s<.05). In addition, compared to no change, any change in menstrual cycle length was associated with a CESD score ≥16, having received a depression diagnosis, and having used an anti-depressant medication (p’s<.05). In exploratory analyses, any change in menstrual cycle length partially mediated the relation between depression history and cardio-metabolic risk (b=0.152, p=.040) which attenuated (b=0.129, p=.083) when any change in menstrual cycle length was covaried. Conclusions Findings suggest disruptions in ovarian function marked by subtle changes in menstrual cycle length may relate to aspects of cardio-metabolic, and psychological health among healthy, pre-menopausal women. PMID:23715377

  6. Development of relative risk model for regional groundwater risk assessment: a case study in the lower Liaohe River Plain, China.

    PubMed

    Li, Xianbo; Zuo, Rui; Teng, Yanguo; Wang, Jinsheng; Wang, Bin

    2015-01-01

    Increasing pressure on water supply worldwide, especially in arid areas, has resulted in groundwater overexploitation and contamination, and subsequent deterioration of the groundwater quality and threats to public health. Environmental risk assessment of regional groundwater is an important tool for groundwater protection. This study presents a new approach for assessing the environmental risk assessment of regional groundwater. It was carried out with a relative risk model (RRM) coupled with a series of indices, such as a groundwater vulnerability index, which includes receptor analysis, risk source analysis, risk exposure and hazard analysis, risk characterization, and management of groundwater. The risk map is a product of the probability of environmental contamination and impact. The reliability of the RRM was verified using Monte Carlo analysis. This approach was applied to the lower Liaohe River Plain (LLRP), northeastern China, which covers 23604 km2. A spatial analysis tool within GIS which was used to interpolate and manipulate the data to develop environmental risk maps of regional groundwater, divided the level of risk from high to low into five ranks (V, IV, III, II, I). The results indicate that areas of relative risk rank (RRR) V cover 2324 km2, covering 9.8% of the area; RRR IV covers 3986 km2, accounting for 16.9% of the area. It is a new and appropriate method for regional groundwater resource management and land use planning, and is a rapid and effective tool for improving strategic decision making to protect groundwater and reduce environmental risk. PMID:26020518

  7. Development of Relative Risk Model for Regional Groundwater Risk Assessment: A Case Study in the Lower Liaohe River Plain, China

    PubMed Central

    Li, Xianbo; Zuo, Rui; Teng, Yanguo; Wang, Jinsheng; Wang, Bin

    2015-01-01

    Increasing pressure on water supply worldwide, especially in arid areas, has resulted in groundwater overexploitation and contamination, and subsequent deterioration of the groundwater quality and threats to public health. Environmental risk assessment of regional groundwater is an important tool for groundwater protection. This study presents a new approach for assessing the environmental risk assessment of regional groundwater. It was carried out with a relative risk model (RRM) coupled with a series of indices, such as a groundwater vulnerability index, which includes receptor analysis, risk source analysis, risk exposure and hazard analysis, risk characterization, and management of groundwater. The risk map is a product of the probability of environmental contamination and impact. The reliability of the RRM was verified using Monte Carlo analysis. This approach was applied to the lower Liaohe River Plain (LLRP), northeastern China, which covers 23604 km2. A spatial analysis tool within GIS which was used to interpolate and manipulate the data to develop environmental risk maps of regional groundwater, divided the level of risk from high to low into five ranks (V, IV, III, II, I). The results indicate that areas of relative risk rank (RRR) V cover 2324 km2, covering 9.8% of the area; RRR IV covers 3986 km2, accounting for 16.9% of the area. It is a new and appropriate method for regional groundwater resource management and land use planning, and is a rapid and effective tool for improving strategic decision making to protect groundwater and reduce environmental risk. PMID:26020518

  8. Coffee, tea, and alcohol intake in relation to risk of type 2 diabetes in African American women1234

    PubMed Central

    Boggs, Deborah A; Rosenberg, Lynn; Ruiz-Narvaez, Edward A; Palmer, Julie R

    2010-01-01

    Background: Numerous studies have reported inverse associations of coffee, tea, and alcohol intake with risk of type 2 diabetes, but none has reported results separately among African American women. Objective: We prospectively examined the relation of coffee, tea, and alcohol consumption to diabetes risk in African American women. Design: The study included 46,906 Black Women's Health Study participants aged 30–69 y at baseline in 1995. Dietary intake was assessed in 1995 and 2001 by using a validated food-frequency questionnaire. During 12 y of follow-up, there were 3671 incident cases of type 2 diabetes. Relative risks (RRs) and 95% CIs were estimated by using Cox proportional hazards models adjusted for diabetes risk factors. Results: Multivariable RRs for intakes of 0–1, 1, 2–3, and ≥4 cups of caffeinated coffee/d relative to no coffee intake were 0.94 (95% CI: 0.86, 1.04), 0.90 (95% CI: 0.81, 1.01), 0.82 (95% CI: 0.72, 0.93), and 0.83 (95% CI: 0.69, 1.01), respectively (P for trend = 0.003). Multivariable RRs for intakes of 1–3, 4–6, 7–13, and ≥14 alcoholic drinks/wk relative to never consumption were 0.90 (95% CI: 0.82, 1.00), 0.68 (95% CI: 0.57, 0.81), 0.78 (95% CI: 0.63, 0.96), and 0.72 (95% CI: 0.53, 0.98), respectively (P for trend < 0.0001). Intakes of decaffeinated coffee and tea were not associated with risk of diabetes. Conclusion: Our results suggest that African American women who drink moderate amounts of caffeinated coffee or alcohol have a reduced risk of type 2 diabetes. PMID:20826625

  9. Relative Risk of Acute Myocardial Infarction in People with Schizophrenia and Bipolar Disorder: A Population-Based Cohort Study

    PubMed Central

    Wu, Shu-I; Chen, Su-Chiu; Liu, Shen-Ing; Sun, Fang-Ju; Juang, Jimmy J. M.; Lee, Hsin-Chien; Kao, Kai-Liang; Dewey, Michael E.; Prince, Martin; Stewart, Robert

    2015-01-01

    Objective Despite high mortality associated with serious mental illness, risk of acute myocardial infarction (AMI) remains unclear, especially for patients with bipolar disorder. The main objective was to investigate the relative risk of AMI associated with schizophrenia and bipolar disorders in a national sample. Method Using nationwide administrative data, an 11-year historic cohort study was assembled, comprised of cases aged 18 and above who had received a diagnosis of schizophrenia or bipolar disorder, compared to a random sample of all other adults excluding those with diagnoses of serious mental illness. Incident AMI as a primary diagnosis was ascertained. Hazard ratios stratified by age and gender were calculated and Cox regression models were used to adjust for other covariates. Results A total of 70,225 people with schizophrenia or bipolar disorder and 207,592 people without serious mental illness were compared. Hazard ratios in men adjusted for age, income and urbanization were 1.15 (95% CI 1.01~1.32) for schizophrenia and 1.37 (1.08~1.73)for bipolar disorder, and in women, 1.85 (1.58~2.18) and 1.88(1.47~2.41) respectively. Further adjustment for treated hypertension, diabetes and hyperlipidaemia attenuated the hazard ratio for men with schizophrenia but not the other comparison groups. Hazard ratios were significantly stronger in women than men and were stronger in younger compared to older age groups for both disorders; however, gender modification was only significant in people with schizophrenia, and age modification only significant in people with bipolar disorder. Conclusions In this large national sample, schizophrenia and bipolar disorder were associated with raised risk of AMI in women and in the younger age groups although showed differences in potential confounding and modifying factors. PMID:26270347

  10. Changes in sexual and drug-related risk behavior following antiretroviral therapy initiation among HIV-infected injection drug users

    PubMed Central

    Fu, Tsung-chieh; Westergaard, Ryan P.; Lau, Bryan; Celentano, David D.; Vlahov, David; Mehta, Shruti H.; Kirk, Gregory D.

    2013-01-01

    Objective To evaluate whether HAART is associated with subsequent sexual and drug-related risk behavior compensation among injection drug users (IDUs). Design A community-based cohort study of 362 HIV-infected IDUs initiating HAART in Baltimore, Maryland. Methods HAART use and risk behavior was assessed at 8316 biannual study visits (median 23). Using logistic regression with generalized estimating equations (GEE), we examined the effect of HAART initiation on changes in risk behavior while adjusting for sociodemographics, alcohol use, CD4+ cell count, year of initiation and consistency of HAART use. Results At HAART initiation, participants were a median of 44.4 years old, 71.3% men and 95.3% African–American. In multivariable analysis, HAART initiation was associated with a 75% reduction in the likelihood of unprotected sex [adjusted odds ratio (aOR) 0.25; 95% confidence interval (CI), 0.19–0.32] despite no change in overall sexual activity (aOR 0.95; 0.80–1.12). Odds of any injecting decreased by 38% (aOR 0.62; 0.51–0.75) after HAART initiation. Among the subset of persistent injectors, needle-sharing increased nearly two-fold (aOR 1.99; 1.57–2.52). Behavioral changes were sustained for more than 5 years after HAART initiation and did not differ by consistency of HAART use. Reporting specific high-risk behaviors in the year prior to initiation was a robust predictor of engaging in those behaviors subsequent to HAART. Conclusion Overall, substantial declines in sexual risk-taking and active injecting argue against significant behavioral compensation among IDUs following HAART initiation. These data also provide evidence to support identifying persons with risky pre-HAART behavior for targeted behavioral intervention. PMID:23079804

  11. Radiologists Don't Face Higher Risk of Radiation-Related Death: Study

    MedlinePlus

    ... Don't Face Higher Risk of Radiation-Related Death: Study Efforts to improve monitoring and protective equipment ... after 1940 are not at greater risk of death from chronic exposure to low levels of radiation, ...

  12. Three Studies Point to Same Risk Gene for Age-Related Macular Degeneration

    MedlinePlus

    ... macular degeneration Three studies point to same risk gene for age-related macular degeneration NIH-funded research ... in Nature Genetics have converged on the same gene as a rare, but powerful risk factor for ...

  13. Longitudinal persistence with secondary prevention therapies relative to patient risk after myocardial infarction

    PubMed Central

    Shore, Supriya; Jones, Philip G.; Maddox, Thomas M.; Bradley, Steven M.; Stolker, Joshua M.; Arnold, Suzanne V.; Parashar, Susmita; Peterson, Pamela; Bhatt, Deepak L.; Spertus, John; Ho, P. Michael

    2016-01-01

    Background Prior studies have demonstrated that high-risk AMI patients are less likely to receive guideline-directed medications during hospitalization. It is unknown if this paradox persists following discharge. We aimed to assess if persistence with guideline-directed medications post-discharge varies by patients’ risk following acute myocardial infarction (AMI). Methods Data were analyzed from two prospective, multicenter U.S. AMI registries. The primary outcome was persistence with all prescribed guideline-directed medications (aspirin, beta-blockers, statins, angiotensin-antagonists) at 1, 6, and 12-months post-discharge. The association between risk and medication persistence post-discharge was assessed using multivariable mixed-effect models. Results Among 6434 AMI patients discharged home, 2824 were considered low-risk, 2014 intermediate-risk and 1596 high-risk for death based upon their GRACE 6-month risk score. High-risk was associated with a lower likelihood of receiving all appropriate therapies at discharge compared with low-risk patients (RR 0.90; 95% CI 0.87–0.94). At 12-months, the rate of persistence with all prescribed therapies was 61.5%, 57.9% and 45.9% among low-, intermediate- and high-risk patients respectively. After multivariable adjustment, high-risk was associated with lower persistence with all prescribed medications (RR 0.87; 95% CI 0.82–0.92) over follow-up. Similar associations were seen for individual medications. Over the 5 years of the study, persistence with prescribed therapies post-discharge improved modestly among high-risk patients (RR 1.05; 95% CI 1.03–1.08 per year). Conclusion High-risk AMI patients have a lower likelihood of persistently taking prescribed medications post-discharge as compared with low-risk patients. Continued efforts are needed to improve the use of guideline-directed medications in high-risk patients. PMID:25801001

  14. Shaft adjuster

    DOEpatents

    Harry, Herbert H.

    1989-01-01

    Apparatus and method for the adjustment and alignment of shafts in high power devices. A plurality of adjacent rotatable angled cylinders are positioned between a base and the shaft to be aligned which when rotated introduce an axial offset. The apparatus is electrically conductive and constructed of a structurally rigid material. The angled cylinders allow the shaft such as the center conductor in a pulse line machine to be offset in any desired alignment position within the range of the apparatus.

  15. Women’s Stress, Depression, and Relationship Adjustment Profiles as They Relate to Intimate Partner Violence and Mental Health During Pregnancy and Postpartum

    PubMed Central

    Flanagan, Julianne C.; Gordon, Kristina Coop; Moore, Todd M.; Stuart, Gregory L.

    2014-01-01

    Objective This study applied latent class analysis to examine whether homogeneous subgroups of women emerged based on their self-reported stress, depression, and relationship adjustment during pregnancy. We also examined whether women in different groups experienced different intimate partner violence (IPV) and mental health symptoms during pregnancy and postpartum. Method 180 women completed assessments during the first 18 weeks of pregnancy and 122 completed follow-up assessments six weeks postpartum. Results A two-class solution best fit the data. One group reported higher mean stress and depression and poorer relationship adjustment compared to the other group. The high severity class reported more psychological IPV victimization and perpetration and more physical IPV victimization during pregnancy compared to the low severity class. Membership in the high severity class was associated with higher postpartum depression. Conclusions Findings highlight the associations between different profiles of mental and relational health during pregnancy and postpartum. Future studies should explore the utility of dyadic interventions aimed at reducing stress, depression, and IPV, and improving relationship adjustment as a means to improve women’s health during pregnancy and postpartum. These findings also highlight the potential utility of applying person-centered analytic approaches to the study of women’s and couples’ health during this time period. PMID:25642352

  16. Parental Knowledge as a Mediator of the Relation between Adolescent Summer Care Arrangement Configurations and Adjustment the Following School Year

    ERIC Educational Resources Information Center

    Parente, Maria E.; Sheppard, Adam; Mahoney, Joseph L.

    2012-01-01

    Through secondary data analysis of a nationally representative sample, the study explored the relations between adolescent summer arrangements and associated developmental outcomes (well-being, externalizing behavior, body mass index, and academic performance). The study also examined if these relations were mediated by parental knowledge of youth…

  17. The Role of Preschool Relational and Physical Aggression in the Transition to Kindergarten: Links with Social-Psychological Adjustment

    ERIC Educational Resources Information Center

    Gower, Amy L.; Lingras, Katherine A.; Mathieson, Lindsay C.; Kawabata, Yoshito; Crick, Nicki R.

    2014-01-01

    Research Findings: The transition to kindergarten has important ramifications for future achievement and psychosocial outcomes. Research suggests that physical aggression may be related to difficulty during school transitions, yet no studies to date have examined the role of relational aggression in these transitions. This article examines how…

  18. Outcomes of pharmacist-assisted management of antiretroviral therapy in patients with HIV infection: A risk-adjusted analysis

    PubMed Central

    Nevo, Ofir Noah; Lesko, Catherine R.; Colwell, Bradford; Ballard, Craig; Cole, Stephen R.; Mathews, W. Christopher

    2016-01-01

    Purpose The impact of pharmacist-assisted management (PAM) of pharmacotherapy for patients with human immunodeficiency virus (HIV) infection was investigated. Methods A retrospective cohort analysis was conducted to evaluate antiretroviral therapy (ART) outcomes in treatment-naive patients initiated on ART at an HIV clinic. Eligible patients enrolled in the clinic during the period 1999–2013 were classified into two groups: those referred to a clinic-based HIV pharmacist for initiation of ART (the PAM group) and those managed by a primary care provider (the control group). The primary study objective was the median time to viral suppression; secondary objectives included the durability of response to the first ART regimen. Relative hazards for the events of interest were estimated using a marginal structural Cox proportional hazards model and Kaplan–Meier curves, with inverse probability weights used to control for selection and confounding bias. Results Patients referred for PAM services (n = 819) typically had higher baseline viral loads and lower CD4+ cell counts than those in the control group (n = 436). The likelihood of viral suppression during the first two years after ART initiation was significantly higher in the PAM group versus the control group (hazard ratio, 1.37; 95% confidence interval, 1.18–1.59; p < 0.0001). The median durability of the first ART regimen was 100 months in the PAM group versus 44 months in the control group (p > 0.05). Conclusion In treatment-naive patients, suppression of HIV viral load occurred earlier when pharmacists assisted with initiating ART than when ART was initiated without that assistance. PMID:26294239

  19. Food Composition of the Diet in Relation to Changes in Waist Circumference Adjusted for Body Mass Index

    PubMed Central

    Romaguera, Dora; Ängquist, Lars; Du, Huaidong; Jakobsen, Marianne Uhre; Forouhi, Nita G.; Halkjær, Jytte; Feskens, Edith J. M.; van der A, Daphne L.; Masala, Giovanna; Steffen, Annika; Palli, Domenico; Wareham, Nicholas J.; Overvad, Kim; Tjønneland, Anne; Boeing, Heiner; Riboli, Elio; Sørensen, Thorkild I.

    2011-01-01

    Background Dietary factors such as low energy density and low glycemic index were associated with a lower gain in abdominal adiposity. A better understanding of which food groups/items contribute to these associations is necessary. Objective To ascertain the association of food groups/items consumption on prospective annual changes in “waist circumference for a given BMI” (WCBMI), a proxy for abdominal adiposity. Design We analyzed data from 48,631 men and women from 5 countries participating in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. Anthropometric measurements were obtained at baseline and after a median follow-up time of 5.5 years. WCBMI was defined as the residuals of waist circumference regressed on BMI, and annual change in WCBMI (ΔWCBMI, cm/y) was defined as the difference between residuals at follow-up and baseline, divided by follow-up time. The association between food groups/items and ΔWCBMI was modelled using centre-specific adjusted linear regression, and random-effects meta-analyses to obtain pooled estimates. Results Higher fruit and dairy products consumption was associated with a lower gain in WCBMI whereas the consumption of white bread, processed meat, margarine, and soft drinks was positively associated with ΔWCBMI. When these six food groups/items were analyzed in combination using a summary score, those in the highest quartile of the score – indicating a more favourable dietary pattern –showed a ΔWCBMI of −0.11 (95% CI −0.09 to −0.14) cm/y compared to those in the lowest quartile. Conclusion A dietary pattern high in fruit and dairy and low in white bread, processed meat, margarine, and soft drinks may help to prevent abdominal fat accumulation. PMID:21858094

  20. Serum Vitamin D status and its relations to body fatness and fitness and risk factors in young adults

    PubMed Central

    Park, Jinkook; Gong, Jiyoung; Hong, Hyeryun; Ha, Changduk; Kang, Hyunsik

    2013-01-01

    The study examined the relations of serum vitamin D levels to body fatness, cardiorespiratory fitness (CRF), and metabolic risk factors in young adults in Korea. A total of 593 young men completed a health examination, body fatness, maximal treadmill exercise test, and assessment of metabolic risk factors. Participants were classified by serum vitamin D levels as deficient (< 20 ng/mL), insufficient (20~30 ng/mL), and sufficient (> 30 ng/mL). Body fatness, CRF, and metabolic risk factors were evaluated according to serum vitamin D classification. Significant inverse trends in body fatness and metabolic risk factors were observed, as was a significant linear trend for CRF across incremental vitamin D categories in this study population. Serum vitamin D levels were negatively associated with body fatness parameters, blood pressures, total cholesterol, triglycerides, and insulin and positively associated with high-density lipoprotein cholesterol and CRF. Compared to the BMI-based lean group, the obese groups had significantly higher odds ratio for serum vitamin D insufficiency before and after adjusting for age, CRF, and physical activity. Similarly, compared to percent body fat- and waist circumference-based lean groups, the obese groups had significant higher odds ratios for serum vitamin D insufficiency. In conclusion, the current findings of the study suggest that along with vitamin D intakes, body fat loss and outdoor physical activity should be promoted as non-pharmacologic means to improve metabolic risk factors in young adults. PMID:25566425