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Sample records for all-cause hazard ratio

  1. Waist circumference and waist/hip ratio in relation to all-cause mortality, cancer and sleep apnea.

    PubMed

    Seidell, J C

    2010-01-01

    Abdominal obesity assessed by waist or waist/hip ratio are both related to increased risk of all-cause mortality throughout the range of body mass index (BMI). The relative risks (RRs) seem to be relatively stronger in younger than in older adults and in those with relatively low BMI compared with those with high BMI. Absolute risks and risk differences are preferable measures of risk in a public health context but these are rarely presented. There is a great lack of studies in ethnic groups (groups of African and Asian descent particularly). Current cut-points as recommended by the World Health Organization seem appropriate, although it may be that BMI-specific and ethnic-specific waist cut-points may be warranted. Waist alone could replace both waist-hip ratio and BMI as a single risk factor for all-cause mortality. There is much less evidence for waist to replace BMI for cancer risk mainly because of the relative lack of prospective cohort studies on waist and cancer risk. Obesity is also a risk factor for sleep apnoea where neck circumference seems to give the strongest association, and waist-hip ratio is a risk factor especially in severe obstructive sleep apnoea syndrome. The waist circumference and waist-hip ratio seem to be better indicators of all-cause mortality than BMI.

  2. Elevated AST-to-platelet ratio index is associated with increased all-cause mortality among HIV-infected adults in Zambia

    PubMed Central

    Vinikoor, Michael J.; Sinkala, Edford; Mweemba, Aggrey; Zanolini, Arianna; Mulenga, Lloyd; Sikazwe, Izukanji; Fried, Michael W.; Eron, Joseph J.; Wandeler, Gilles; Chi, Benjamin H.

    2015-01-01

    Background and Aims We investigated the association between significant liver fibrosis, determined by AST-to-platelet ratio index (APRI), and all-cause mortality among HIV-infected patients prescribed antiretroviral therapy (ART) in Zambia Methods Among HIV-infected adults who initiated ART, we categorized baseline APRI scores according to established thresholds for significant hepatic fibrosis (APRI ≥1.5) and cirrhosis (APRI ≥2.0). Using multivariable logistic regression we identified risk factors for elevated APRI including demographic characteristics, body mass index (BMI), HIV clinical and immunologic status, and tuberculosis. In the subset tested for hepatitis B surface antigen (HBsAg), we investigated the association of hepatitis B virus co-infection with APRI score. Using Kaplan-Meier analysis and Cox proportional hazards regression we determined the association of elevated APRI with death during ART. Results Among 20,308 adults in the analysis cohort, 1,027 (5.1%) had significant liver fibrosis at ART initiation including 616 (3.0%) with cirrhosis. Risk factors for significant fibrosis or cirrhosis included male sex, BMI <18, WHO clinical stage 3 or 4, CD4+ count <200 cells/mm3, and tuberculosis. Among the 237 (1.2%) who were tested, HBsAg-positive patients had four times the odds (adjusted odds ratio, 4.15; 95% CI, 1.71–10.04) of significant fibrosis compared HBsAg-negatives. Both significant fibrosis (adjusted hazard ratio 1.41, 95% CI, 1.21–1.64) and cirrhosis (adjusted hazard ratio 1.57, 95% CI, 1.31–1.89) were associated with increased all-cause mortality. Conclusion Liver fibrosis may be a risk factor for mortality during ART among HIV-infected individuals in Africa. APRI is an inexpensive and potentially useful test for liver fibrosis in resource-constrained settings. PMID:25581487

  3. Dietary sodium-to-potassium ratio as a risk factor for stroke, cardiovascular disease and all-cause mortality in Japan: the NIPPON DATA80 cohort study

    PubMed Central

    Okayama, Akira; Okuda, Nagako; Miura, Katsuyuki; Okamura, Tomonori; Hayakawa, Takehito; Akasaka, Hiroshi; Ohnishi, Hirofumi; Saitoh, Shigeyuki; Arai, Yusuke; Kiyohara, Yutaka; Takashima, Naoyuki; Yoshita, Katsushi; Fujiyoshi, Akira; Zaid, Maryam; Ohkubo, Takayoshi; Ueshima, Hirotsugu

    2016-01-01

    Objectives To evaluate the impact of dietary sodium and potassium (Na–K) ratio on mortality from total and subtypes of stroke, cardiovascular disease (CVD) and all causes, using 24-year follow-up data of a representative sample of the Japanese population. Setting Prospective cohort study. Participants In the 1980 National Cardiovascular Survey, participants were followed for 24 years (NIPPON DATA80, National Integrated Project for Prospective Observation of Non-communicable Disease And its Trends in the Aged). Men and women aged 30–79 years without hypertensive treatment, history of stroke or acute myocardial infarction (n=8283) were divided into quintiles according to dietary Na–K ratio assessed by a 3-day weighing dietary record at baseline. Age-adjusted and multivariable-adjusted HRs were calculated using the Mantel-Haenszel method and Cox proportional hazards model. Primary outcome measures Mortality from total and subtypes of stroke, CVD and all causes. Results A total of 1938 deaths from all causes were observed over 176 926 person-years. Na–K ratio was significantly and non-linearly related to mortality from all stroke (p=0.002), CVD (p=0.005) and total mortality (p=0.001). For stroke subtypes, mortality from haemorrhagic stroke was positively related to Na–K ratio (p=0.024). Similar relationships were observed for men and women. The observed relationships remained significant after adjustment for other risk factors. Quadratic non-linear multivariable-adjusted HRs (95% CI) in the highest quintile versus the lowest quintile of Na–K ratio were 1.42 (1.07 to 1.90) for ischaemic stroke, 1.57 (1.05 to 2.34) for haemorrhagic stroke, 1.43 (1.17 to 1.76) for all stroke, 1.39 (1.20 to 1.61) for CVD and 1.16 (1.06 to 1.27) for all-cause mortality. Conclusions Dietary Na–K ratio assessed by a 3-day weighing dietary record was a significant risk factor for mortality from haemorrhagic stroke, all stroke, CVD and all causes among a Japanese population

  4. Statin Use Reduces Prostate Cancer All-Cause Mortality

    PubMed Central

    Sun, Li-Min; Lin, Ming-Chia; Lin, Cheng-Li; Chang, Shih-Ni; Liang, Ji-An; Lin, I-Ching; Kao, Chia-Hung

    2015-01-01

    Abstract Studies have suggested that statin use is related to cancer risk and prostate cancer mortality. We conducted a population-based cohort study to determine whether using statins in prostate cancer patients is associated with reduced all-cause mortality rates. Data were obtained from the Taiwan National Health Insurance Research Database. The study cohort comprised 5179 patients diagnosed with prostate cancer who used statins for at least 6 months between January 1, 1998 and December 31, 2010. To form a comparison group, each patient was randomly frequency-matched (according to age and index date) with a prostate cancer patient who did not use any type of statin-based drugs during the study period. The study endpoint was mortality. The hazard ratio (HR) and 95% confidence interval (CI) were estimated using Cox regression models. Among prostate cancer patients, statin use was associated with significantly decreased all-cause mortality (adjusted HR = 0.65; 95% CI = 0.60–0.71). This phenomenon was observed among various types of statin, age groups, and treatment methods. Analyzing the defined daily dose of statins indicated that both low- and high-dose groups exhibited significantly decreased death rates compared with nonusers, suggesting a dose–response relationship. The results of this population-based cohort study suggest that using statins reduces all-cause mortality among prostate cancer patients, and a dose–response relationship may exist. PMID:26426656

  5. High-Efficiency Postdilution Online Hemodiafiltration Reduces All-Cause Mortality in Hemodialysis Patients

    PubMed Central

    Moreso, Francesc; Pons, Mercedes; Ramos, Rosa; Mora-Macià, Josep; Carreras, Jordi; Soler, Jordi; Torres, Ferran; Campistol, Josep M.; Martinez-Castelao, Alberto

    2013-01-01

    Retrospective studies suggest that online hemodiafiltration (OL-HDF) may reduce the risk of mortality compared with standard hemodialysis in patients with ESRD. We conducted a multicenter, open-label, randomized controlled trial in which we assigned 906 chronic hemodialysis patients either to continue hemodialysis (n=450) or to switch to high-efficiency postdilution OL-HDF (n=456). The primary outcome was all-cause mortality, and secondary outcomes included cardiovascular mortality, all-cause hospitalization, treatment tolerability, and laboratory data. Compared with patients who continued on hemodialysis, those assigned to OL-HDF had a 30% lower risk of all-cause mortality (hazard ratio [HR], 0.70; 95% confidence interval [95% CI], 0.53–0.92; P=0.01), a 33% lower risk of cardiovascular mortality (HR, 0.67; 95% CI, 0.44–1.02; P=0.06), and a 55% lower risk of infection-related mortality (HR, 0.45; 95% CI, 0.21–0.96; P=0.03). The estimated number needed to treat suggested that switching eight patients from hemodialysis to OL-HDF may prevent one annual death. The incidence rates of dialysis sessions complicated by hypotension and of all-cause hospitalization were lower in patients assigned to OL-HDF. In conclusion, high-efficiency postdilution OL-HDF reduces all-cause mortality compared with conventional hemodialysis. PMID:23411788

  6. High-efficiency postdilution online hemodiafiltration reduces all-cause mortality in hemodialysis patients.

    PubMed

    Maduell, Francisco; Moreso, Francesc; Pons, Mercedes; Ramos, Rosa; Mora-Macià, Josep; Carreras, Jordi; Soler, Jordi; Torres, Ferran; Campistol, Josep M; Martinez-Castelao, Alberto

    2013-02-01

    Retrospective studies suggest that online hemodiafiltration (OL-HDF) may reduce the risk of mortality compared with standard hemodialysis in patients with ESRD. We conducted a multicenter, open-label, randomized controlled trial in which we assigned 906 chronic hemodialysis patients either to continue hemodialysis (n=450) or to switch to high-efficiency postdilution OL-HDF (n=456). The primary outcome was all-cause mortality, and secondary outcomes included cardiovascular mortality, all-cause hospitalization, treatment tolerability, and laboratory data. Compared with patients who continued on hemodialysis, those assigned to OL-HDF had a 30% lower risk of all-cause mortality (hazard ratio [HR], 0.70; 95% confidence interval [95% CI], 0.53-0.92; P=0.01), a 33% lower risk of cardiovascular mortality (HR, 0.67; 95% CI, 0.44-1.02; P=0.06), and a 55% lower risk of infection-related mortality (HR, 0.45; 95% CI, 0.21-0.96; P=0.03). The estimated number needed to treat suggested that switching eight patients from hemodialysis to OL-HDF may prevent one annual death. The incidence rates of dialysis sessions complicated by hypotension and of all-cause hospitalization were lower in patients assigned to OL-HDF. In conclusion, high-efficiency postdilution OL-HDF reduces all-cause mortality compared with conventional hemodialysis.

  7. The relation of ambulatory heart rate with all-cause mortality among middle-aged men: a prospective cohort study.

    PubMed

    Korshøj, Mette; Lidegaard, Mark; Kittel, France; Van Herck, Koen; De Backer, Guy; De Bacquer, Dirk; Holtermann, Andreas; Clays, Els

    2015-01-01

    The aim of this study was to investigate the association between average 24-hour ambulatory heart rate and all-cause mortality, while adjusting for resting clinical heart rate, cardiorespiratory fitness, occupational and leisure time physical activity as well as classical risk factors. A group of 439 middle-aged male workers free of baseline coronary heart disease from the Belgian Physical Fitness Study was included in the analysis. Data were collected by questionnaires and clinical examinations from 1976 to 1978. All-cause mortality was collected from the national mortality registration with a mean follow-up period of 16.5 years, with a total of 48 events. After adjustment for all before mentioned confounders in a Cox proportional hazards regression analysis, a significant increased risk for all-cause mortality was found among the tertile of workers with highest average ambulatory heart rate compared to the tertile with lowest ambulatory heart rate (Hazard ratio = 3.21, 95% confidence interval: 1.22-8.44). No significant independent association was found between resting clinic heart rate and all-cause mortality. The study indicates that average 24-hour ambulatory heart rate is a strong predictor of all-cause mortality independent from resting clinic heart rate, cardiorespiratory fitness, occupational and leisure time physical activity and other classical risk factors among healthy middle-aged workers.

  8. Osteoarthritis and all-cause mortality in worldwide populations: grading the evidence from a meta-analysis

    PubMed Central

    Xing, Dan; Xu, Yuankun; Liu, Qiang; Ke, Yan; Wang, Bin; Li, Zhichang; Lin, Jianhao

    2016-01-01

    The objective of this study is to investigate the association between osteoarthritis (OA) and all-cause mortality in worldwide populations and to develop recommendations according to GRADE evidence levels. Literature search through Nov 2015 was performed using the electronic databases (including MEDLINE, EMBASE, EBSCO and Cochrane library). The prospective cohort trials that investigated the association between the symptomatic OA (SxOA) or radiological OA (ROA) and all-cause mortality were identified. Hazard ratios (HR) of all-cause mortality in patients with RxOA or ROA were pooled respectively. The evidence quality was evaluated using the GRADE system, while the recommendations were taken according to the quality. Nine of the published literature met the eligible criteria. Meta-analysis revealed that there was no significant difference in the association between SxOA and all-cause mortality (HR = 0.91, 95% CI: 0.68–1.23) and between ROA and all-cause mortality (HR = 1.13, 95% CI: 0.95–1.35). The overall GARDE evidence quality was very low, which will lower our confidence in taking recommendations. To summarize, there was no reliable and confident evidence existed currently in respect of the association between OA and all-cause mortality. Due to the very low level of evidence quality currently, high-quality studies are still required. PMID:27087682

  9. Symmetric Dimethylarginine as Predictor of Graft loss and All-Cause Mortality in Renal Transplant Recipients

    PubMed Central

    Pihlstrøm, Hege; Mjøen, Geir; Dahle, Dag Olav; Pilz, Stefan; Midtvedt, Karsten; März, Winfried; Abedini, Sadollah; Holme, Ingar; Fellström, Bengt; Jardine, Alan; Holdaas, Hallvard

    2014-01-01

    Background Elevated symmetric dimethylarginine (SDMA) has been shown to predict cardiovascular events and all cause mortality in diverse populations. The potential role of SDMA as a risk marker in renal transplant recipients (RTR) has not been investigated. Methods We analyzed SDMA in the placebo arm of the Assessment of Lescol in Renal Transplantation study, a randomized controlled trial of fluvastatin in RTR. Mean follow-up was 5.1 years. Patients were grouped into quartiles based on SDMA levels at study inclusion. Relationships between SDMA and traditional risk factors for graft function and all-cause mortality were analyzed in 925 RTR using univariate and multivariate survival analyses. Results In univariate analysis, SDMA was significantly associated with renal graft loss, all-cause death, and major cardiovascular events. After adjustment for established risk factors including estimated glomerular filtration rate, an elevated SDMA-level (4th quartile, >1.38 μmol/L) was associated with renal graft loss; hazard ratio (HR), 5.51; 95% confidence interval (CI), 1.95–15.57; P=0.001, compared to the 1st quartile. Similarly, SDMA in the 4th quartile was independently associated with all-cause mortality (HR, 4.56; 95% CI, 2.15–9.71; P<0.001), and there was a strong borderline significant trend for an association with cardiovascular mortality (HR, 2.86; 95% CI, 0.99–8.21; P=0.051). Conclusion In stable RTR, an elevated SDMA level is independently associated with increased risk of all-cause mortality and renal graft loss. PMID:24999963

  10. Aspirin Is Associated With Reduced Cardiovascular and All-Cause Mortality in Type 2 Diabetes in a Primary Prevention Setting

    PubMed Central

    Ong, Greg; Davis, Timothy M.E.; Davis, Wendy A.

    2010-01-01

    OBJECTIVE To determine whether regular aspirin use (≥75 mg/day) is independently associated with cardiovascular disease (CVD) and all-cause mortality in community-based patients with type 2 diabetes and no history of CVD. RESEARCH DESIGN AND METHODS Of the type 2 diabetic patients recruited to the longitudinal observational Fremantle Diabetes Study, 651 (50.3%) with no prior CVD history at entry between 1993 and 1996 were followed until death or the end of June 2007, representing a total of 7,537 patient-years (mean ± SD 11.6 ± 2.9 years). Cox proportional hazards modeling was used to determine independent baseline predictors of CVD and all-cause mortality including regular aspirin use. RESULTS There were 160 deaths (24.6%) during follow-up, with 70 (43.8%) due to CVD. In Kaplan-Meier survival analysis, there was no difference in either CVD or all-cause mortality in aspirin users versus nonusers (P = 0.52 and 0.94, respectively, by log-rank test). After adjustment for significant variables in the most parsimonious Cox models, regular aspirin use at baseline independently predicted reduced CVD and all-cause mortality (hazard ratio [HR] 0.30 [95% CI 0.09–0.95] and 0.53 [0.28–0.98[, respectively; P ≤ 0.044). In subgroup analyses, aspirin use was independently associated with reduced all-cause mortality in those aged ≥65 years and men. CONCLUSIONS Regular low-dose aspirin may reduce all-cause and CVD mortality in a primary prevention setting in type 2 diabetes. All-cause mortality reductions are greatest in men and in those aged ≥65 years. The present observational data support recommendations that aspirin should be used in primary CVD prevention in all but the lowest risk patients. PMID:19918016

  11. Moving beyond the hazard ratio in quantifying the between-group difference in survival analysis.

    PubMed

    Uno, Hajime; Claggett, Brian; Tian, Lu; Inoue, Eisuke; Gallo, Paul; Miyata, Toshio; Schrag, Deborah; Takeuchi, Masahiro; Uyama, Yoshiaki; Zhao, Lihui; Skali, Hicham; Solomon, Scott; Jacobus, Susanna; Hughes, Michael; Packer, Milton; Wei, Lee-Jen

    2014-08-01

    In a longitudinal clinical study to compare two groups, the primary end point is often the time to a specific event (eg, disease progression, death). The hazard ratio estimate is routinely used to empirically quantify the between-group difference under the assumption that the ratio of the two hazard functions is approximately constant over time. When this assumption is plausible, such a ratio estimate may capture the relative difference between two survival curves. However, the clinical meaning of such a ratio estimate is difficult, if not impossible, to interpret when the underlying proportional hazards assumption is violated (ie, the hazard ratio is not constant over time). Although this issue has been studied extensively and various alternatives to the hazard ratio estimator have been discussed in the statistical literature, such crucial information does not seem to have reached the broader community of health science researchers. In this article, we summarize several critical concerns regarding this conventional practice and discuss various well-known alternatives for quantifying the underlying differences between groups with respect to a time-to-event end point. The data from three recent cancer clinical trials, which reflect a variety of scenarios, are used throughout to illustrate our discussions. When there is not sufficient information about the profile of the between-group difference at the design stage of the study, we encourage practitioners to consider a prespecified, clinically meaningful, model-free measure for quantifying the difference and to use robust estimation procedures to draw primary inferences. PMID:24982461

  12. Skipping Breakfast and Risk of Mortality from Cancer, Circulatory Diseases and All Causes: Findings from the Japan Collaborative Cohort Study

    PubMed Central

    Yokoyama, Yae; Onishi, Kazunari; Hosoda, Takenobu; Amano, Hiroki; Otani, Shinji; Kurozawa, Youichi; Tamakoshi, Akiko

    2016-01-01

    Background Breakfast eating habits are a dietary pattern marker and appear to be a useful predictor of a healthy lifestyle. Many studies have reported the unhealthy effects of skipping breakfast. However, there are few studies on the association between skipping breakfast and mortality. In the present study, we examined the association between skipping breakfast and mortality from cancer, circulatory diseases and all causes using data from a large-scale cohort study, the Japan Collaborative Cohort Study (JACC) Study. Methods A cohort study of 34,128 men and 49,282 women aged 40–79 years was conducted, to explore the association between lifestyle and cancer in Japan. Participants completed a baseline survey during 1988 to 1990 and were followed until the end of 2009. We classified participants into two groups according to dietary habits with respect to eating or skipping breakfast and carried out intergroup comparisons of lifestyle. Multivariate analysis was performed using the Cox proportional hazard regression model. Results There were 5,768 deaths from cancer and 5,133 cases of death owing to circulatory diseases and 17,112 cases for all causes of mortality during the median 19.4 years follow-up. Skipping breakfast was related to unhealthy lifestyle habits. After adjusting for confounding factors, skipping breakfast significantly increased the risk of mortality from circulatory diseases [hazard ratio (HR) = 1.42] and all causes (HR = 1.43) in men and all causes mortality (HR = 1.34) in women. Conclusion Our findings showed that skipping breakfast is associated with increasing risk of mortality from circulatory diseases and all causes among men and all causes mortality among women in Japan. PMID:27046951

  13. Fatty liver disease: Disparate predictive ability for cardiometabolic risk and all-cause mortality

    PubMed Central

    Onat, Altan; Can, Günay; Kaya, Ayşem; Akbaş, Tuğba; Özpamuk-Karadeniz, Fatma; Şimşek, Barış; Çakır, Hakan; Yüksel, Hüsniye

    2015-01-01

    AIM: To assess the association of a surrogate of fatty liver disease (FLD) with incident type-2 diabetes, coronary heart disease, and all-cause mortality. METHODS: In a prospective population-based study on 1822 middle-aged adults, stratified to gender, we used an algorithm of fatty liver index (FLI) to identify associations with outcomes. An index ≥ 60 indicated the presence of FLD. In Cox regression models, adjusted for age, smoking status, high-density lipoprotein cholesterol, and systolic blood pressure, we assessed the predictive value of FLI for incident diabetes, coronary heart disease (CHD), and all-cause mortality. RESULTS: At a mean 8 year follow-up, 218 and 285 incident cases of diabetes and CHD, respectively, and 193 deaths were recorded. FLD was significantly associated in each gender with blood pressure, total cholesterol, apolipoprotein B, uric acid, and C-reactive protein; weakly with fasting glucose; and inversely with high-density lipoprotein-cholesterol and sex hormone-binding globulin. In adjusted Cox models, FLD was (with a 5-fold HR) the major determinant of diabetes development. Analyses further disclosed significant independent prediction of CHD by FLD in combined gender [hazard ratio (HR) = 1.72, 95% confidence interval (CI): 1.17-2.53] and men (HR = 2.35, 95%CI: 1.25-4.43). Similarly-adjusted models for all-cause mortality proved, however, not to confer risk, except for a tendency in prediabetics and diabetic women. CONCLUSION: A surrogate of FLD conferred significant high risk of diabetes and coronary heart disease, independent of some metabolic syndrome traits. All-cause mortality was not associated with FLD, except likely in the prediabetic state. Such a FLI may reliably be used in epidemiologic studies. PMID:26730168

  14. A balanced hazard ratio for risk group evaluation from survival data.

    PubMed

    Branders, Samuel; Dupont, Pierre

    2015-07-30

    Common clinical studies assess the quality of prognostic factors, such as gene expression signatures, clinical variables or environmental factors, and cluster patients into various risk groups. Typical examples include cancer clinical trials where patients are clustered into high or low risk groups. Whenever applied to survival data analysis, such groups are intended to represent patients with similar survival odds and to select the most appropriate therapy accordingly. The relevance of such risk groups, and of the related prognostic factors, is typically assessed through the computation of a hazard ratio. We first stress three limitations of assessing risk groups through the hazard ratio: (1) it may promote the definition of arbitrarily unbalanced risk groups; (2) an apparently optimal group hazard ratio can be largely inconsistent with the p-value commonly associated to it; and (3) some marginal changes between risk group proportions may lead to highly different hazard ratio values. Those issues could lead to inappropriate comparisons between various prognostic factors. Next, we propose the balanced hazard ratio to solve those issues. This new performance metric keeps an intuitive interpretation and is as simple to compute. We also show how the balanced hazard ratio leads to a natural cut-off choice to define risk groups from continuous risk scores. The proposed methodology is validated through controlled experiments for which a prescribed cut-off value is defined by design. Further results are also reported on several cancer prognosis studies, and the proposed methodology could be applied more generally to assess the quality of any prognostic markers.

  15. Housework Reduces All-Cause and Cancer Mortality in Chinese Men

    PubMed Central

    Yu, Ruby; Leung, Jason; Woo, Jean

    2013-01-01

    Background Leisure time physical activity has been extensively studied. However, the health benefits of non-leisure time physical activity, particular those undertaken at home on all-cause and cancer mortality are limited, particularly among the elderly. Methods We studied physical activity in relation to all-cause and cancer mortality in a cohort of 4,000 community-dwelling elderly aged 65 and older. Leisure time physical activity (sport/recreational activity and lawn work/yard care/gardening) and non-leisure time physical activity (housework, home repairs and caring for another person) were self-reported on the Physical Activity Scale for the Elderly. Subjects with heart diseases, stroke, cancer or diabetes at baseline were excluded (n = 1,133). Results Among the 2,867 subjects with a mean age of 72 years at baseline, 452 died from all-cause and 185 died from cancer during the follow-up period (2001–2012). With the adjustment for age, education level and lifestyle factors, we found an inverse association between risk of all-cause mortality and heavy housework among men, with the adjusted hazard ratio (HR) of 0.72 (95%CI = 0.57–0.92). Further adjustment for BMI, frailty index, living arrangement, and leisure time activity did not change the result (HR = 0.71, 95%CI = 0.56–0.91). Among women, however, heavy housework was not associated with all-cause mortality. The risk of cancer mortality was significantly lower among men who participated in heavy housework (HR = 0.52, 95%CI = 0.35–0.78), whereas among women the risk was not significant. Men participated in light housework also were at lower risk of cancer mortality than were their counterparts, however, the association was not significant. Leisure time physical activity was not related to all-cause or cancer mortality in either men or women. Conclusion Heavy housework is associated with reduced mortality and cancer deaths over a 9-year period. The underlying mechanism needs further

  16. Syndecan-4 Is an Independent Predictor of All-Cause as Well as Cardiovascular Mortality in Hemodialysis Patients

    PubMed Central

    Jaroszyński, Andrzej J.; Jaroszyńska, Anna; Przywara, Stanisław; Zaborowski, Tomasz; Książek, Andrzej; Dąbrowski, Wojciech

    2016-01-01

    Background Left ventricular hypertrophy is associated withincreased mortality in hemodialysis (HD) patients.Syndecan-4 plays a role in many processes that are involved in the heart fibrosis and hypertrophy.We designed this study to prospectively determine whether syndecan-4 was predictive of mortality in a group of HD patients. Methods In total, 191 HD patients were included. Clinical, biochemical and echocardiographic parameters were recorded. HD patients were followed-up for 23.18 ± 4.02 months. Results Syndecan-4 levels correlated strongly with geometrical echocardiographic parameters and ejection fraction. Relations with pressure-related parameters were weak and only marginally significant. Using the receiver operating characteristics the optimal cut-off points in predicting all-cause as well as cardiovascular (CV) mortality were evaluated and patients were divided into low and high syndecan-4 groups. A Kaplan–Meier analysis showed that the cumulative incidences of all-cause as well as CV mortality were higher in high serum syndecan-4 group compared with those with low serum syndecan-4 (p<0.001 in both cases).A multivariate Cox proportional hazards regression analysis revealed syndecan-4 concentration to be an independent and significant predictor of all-cause (hazard ratio, 2.99; confidence interval, 2.34 to 3.113; p<0.001)as well as CV mortality (hazard ratio, 2.81;confidence interval, 2.28to3.02; p<0.001). Conclusions Serum syndecan-4 concentration reflects predominantly geometrical echocardiographic parameters. In HD patients serum syndecan-4 concentration is independently associated with all-cause as well as CV mortality. PMID:27685148

  17. Kidney Function, Albuminuria, and All-Cause Mortality in the REGARDS (Reasons for Geographic and Racial Differences in Stroke) Study

    PubMed Central

    Warnock, David G.; Muntner, Paul; McCullough, Peter A.; Zhang, Xiao; McClure, Leslie A.; Zakai, Neil; Cushman, Mary; Newsome, Britt B.; Kewalramani, Reshma; Steffes, Michael W.; Howard, George; McClellan, William M.

    2010-01-01

    Background Chronic kidney disease (CKD) and albuminuria are associated with increased risk of all-cause mortality. Study Design Prospective observational cohort study Setting and Participants 17,393 participants (mean age, 64.3 ± 9.6 years) in the REGARDS (Reasons for Geographic and Racial Differences in Stroke) Study. Predictor Estimated glomerular filtration rate (eGFR), urinary albumin-creatinine ratio (ACR). Outcome All-cause mortality (710 deaths); median duration of follow-up: 3.6 years. Measurements and Analysis Categories of eGFR (90– <120, 60–<90, 45–<60, 30–<45, and 15–<30 mL/min/1.73 m2) and urinary ACR (<10 mg/g or normal, 10–<30 mg/g or high normal, 30–300 mg/g or high, and >300 mg/g or very high). Cox’s proportional hazards models were adjusted for demographic factors, cardiovascular covariates, and hemoglobin. Results The background all-cause mortality rate for participants with normal ACR, eGFR of 90–<120 mL/min/1.73 m2 and no CHD was 4.3 deaths/1,000 person-years. Higher ACR was associated with an increased multivariable adjusted hazard ratio for all-cause mortality within each eGFR category. Reduced eGFR was associated with higher adjusted hazard ratio for all-cause mortality for participants with high normal (P value = 0.01) and high (P value <0.001) ACR values, but not for those with normal or very high ACR values. Limitations Only one laboratory assessment for serum creatinine and ACR was available Conclusions Increased albuminuria was an independent risk factor for all-cause mortality. Reduced eGFR was associated with increased mortality risk among those with high normal and high ACR. The mortality rate was low in the normal ACR group and increased in the very high ACR group but did not vary with eGFR in these groups. PMID:20692752

  18. Sleep Apnea as an Independent Risk Factor for All-Cause Mortality: The Busselton Health Study

    PubMed Central

    Marshall, Nathaniel S.; Wong, Keith K. H.; Liu, Peter Y.; Cullen, Stewart R. J.; Knuiman, Matthew W.; Grunstein, Ronald R.

    2008-01-01

    Background: Previously published cohort studies in clinical populations have suggested that obstructive sleep apnea (OSA) is a risk factor for mortality associated with cardiovascular disease. However, it is unknown whether sleep apnea is an independent risk factor for all-cause mortality in a community-based sample free from clinical referral bias. Methods: Residents of the Western Australian town of Busselton underwent investigation with a home sleep apnea monitoring device (MESAM IV). OSA was quantified via the respiratory disturbance index (RDI). Mortality status was determined in 397/400 participants (99.3%) after up to 14 years (mean follow-up 13.4 years) by data matching with the Australian National Death Index and the Western Australian Death Register. Univariate analyses and multivariate Cox proportional hazards modelling were used to ascertain the association between sleep apnea and mortality after adjustment for age, gender, body mass index, mean arterial pressure, total cholesterol, high-density lipoprotein cholesterol, diabetes, and medically diagnosed angina in those free from heart attack or stroke at baseline (n = 380). Results: Among the 380 participants, 18 had moderate-severe OSA (RDI ≥15/hr, 6 deaths) and 77 had mild OSA (RDI 5 to <15/hr, 5 deaths). Moderate-to-severe OSA was independently associated with greater risk of all-cause mortality (fully adjusted hazard ratio [HR] = 6.24, 95% CL 2.01, 19.39) than non-OSA (n = 285, 22 deaths). Mild OSA (RDI 5 to <15/hr) was not an independent risk factor for higher mortality (HR = 0.47, 95% CL 0.17, 1.29). Conclusions: Moderate-to-severe sleep apnea is independently associated with a large increased risk of all-cause mortality in this community-based sample. Citation: Marshall NS; Wong KKH; Liu PY; Cullen SRJ; Knuiman MW; Grunstein RR. Sleep apnea as an independent risk factor for all-cause mortality: The Busselton Health Study. SLEEP 2008;31(8):1079-1085. PMID:18714779

  19. Cumulative Hazard Ratio Estimation for Treatment Regimes in Sequentially Randomized Clinical Trials

    PubMed Central

    Tang, Xinyu; Wahed, Abdus S.

    2014-01-01

    The proportional hazards model is widely used in survival analysis to allow adjustment for baseline covariates. The proportional hazard assumption may not be valid for treatment regimes that depend on intermediate responses to prior treatments received, and it is not clear how such a model can be adapted to clinical trials employing more than one randomization. Besides, since treatment is modified post-baseline, the hazards are unlikely to be proportional across treatment regimes. Although Lokhnygina and Helterbrand (Biometrics 63: 422–428, 2007) introduced the Cox regression method for two-stage randomization designs, their method can only be applied to test the equality of two treatment regimes that share the same maintenance therapy. Moreover, their method does not allow auxiliary variables to be included in the model nor does it account for treatment effects that are not constant over time. In this article, we propose a model that assumes proportionality across covariates within each treatment regime but not across treatment regimes. Comparisons among treatment regimes are performed by testing the log ratio of the estimated cumulative hazards. The ratio of the cumulative hazard across treatment regimes is estimated using a weighted Breslow-type statistic. A simulation study was conducted to evaluate the performance of the estimators and proposed tests. PMID:26085847

  20. The Effect of Neurobehavioral Test Performance on the All-Cause Mortality among US Population.

    PubMed

    Peng, Tao-Chun; Chen, Wei-Liang; Wu, Li-Wei; Chen, Ying-Jen; Liaw, Fang-Yih; Wang, Gia-Chi; Wang, Chung-Ching; Yang, Ya-Hui

    2016-01-01

    Evidence of the association between global cognitive function and mortality is much, but whether specific cognitive function is related to mortality is unclear. To address the paucity of knowledge on younger populations in the US, we analyzed the association between specific cognitive function and mortality in young and middle-aged adults. We analyzed data from 5,144 men and women between 20 and 59 years of age in the Third National Health and Nutrition Examination Survey (1988-94) with mortality follow-up evaluation through 2006. Cognitive function tests, including assessments of executive function/processing speed (symbol digit substitution) and learning recall/short-term memory (serial digit learning), were performed. All-cause mortality was the outcome of interest. After adjusting for multiple variables, total mortality was significantly higher in males with poorer executive function/processing speed (hazard ratio (HR) 2.02; 95% confidence interval 1.36 to 2.99) and poorer recall/short-term memory (HR 1.47; 95% confidence interval 1.02 to 2.12). After adjusting for multiple variables, the mortality risk did not significantly increase among the females in these two cognitive tests groups. In this sample of the US population, poorer executive function/processing speed and poorer learning recall/short-term memory were significantly associated with increased mortality rates, especially in males. This study highlights the notion that poorer specific cognitive function predicts all-cause mortality in young and middle-aged males. PMID:27595105

  1. The Effect of Neurobehavioral Test Performance on the All-Cause Mortality among US Population

    PubMed Central

    Wu, Li-Wei; Liaw, Fang-Yih; Wang, Gia-Chi; Wang, Chung-Ching

    2016-01-01

    Evidence of the association between global cognitive function and mortality is much, but whether specific cognitive function is related to mortality is unclear. To address the paucity of knowledge on younger populations in the US, we analyzed the association between specific cognitive function and mortality in young and middle-aged adults. We analyzed data from 5,144 men and women between 20 and 59 years of age in the Third National Health and Nutrition Examination Survey (1988–94) with mortality follow-up evaluation through 2006. Cognitive function tests, including assessments of executive function/processing speed (symbol digit substitution) and learning recall/short-term memory (serial digit learning), were performed. All-cause mortality was the outcome of interest. After adjusting for multiple variables, total mortality was significantly higher in males with poorer executive function/processing speed (hazard ratio (HR) 2.02; 95% confidence interval 1.36 to 2.99) and poorer recall/short-term memory (HR 1.47; 95% confidence interval 1.02 to 2.12). After adjusting for multiple variables, the mortality risk did not significantly increase among the females in these two cognitive tests groups. In this sample of the US population, poorer executive function/processing speed and poorer learning recall/short-term memory were significantly associated with increased mortality rates, especially in males. This study highlights the notion that poorer specific cognitive function predicts all-cause mortality in young and middle-aged males.

  2. The Effect of Neurobehavioral Test Performance on the All-Cause Mortality among US Population

    PubMed Central

    Wu, Li-Wei; Liaw, Fang-Yih; Wang, Gia-Chi; Wang, Chung-Ching

    2016-01-01

    Evidence of the association between global cognitive function and mortality is much, but whether specific cognitive function is related to mortality is unclear. To address the paucity of knowledge on younger populations in the US, we analyzed the association between specific cognitive function and mortality in young and middle-aged adults. We analyzed data from 5,144 men and women between 20 and 59 years of age in the Third National Health and Nutrition Examination Survey (1988–94) with mortality follow-up evaluation through 2006. Cognitive function tests, including assessments of executive function/processing speed (symbol digit substitution) and learning recall/short-term memory (serial digit learning), were performed. All-cause mortality was the outcome of interest. After adjusting for multiple variables, total mortality was significantly higher in males with poorer executive function/processing speed (hazard ratio (HR) 2.02; 95% confidence interval 1.36 to 2.99) and poorer recall/short-term memory (HR 1.47; 95% confidence interval 1.02 to 2.12). After adjusting for multiple variables, the mortality risk did not significantly increase among the females in these two cognitive tests groups. In this sample of the US population, poorer executive function/processing speed and poorer learning recall/short-term memory were significantly associated with increased mortality rates, especially in males. This study highlights the notion that poorer specific cognitive function predicts all-cause mortality in young and middle-aged males. PMID:27595105

  3. Fitness vs. fatness on all-cause mortality: a meta-analysis.

    PubMed

    Barry, Vaughn W; Baruth, Meghan; Beets, Michael W; Durstine, J Larry; Liu, Jihong; Blair, Steven N

    2014-01-01

    The purpose of this study was to quantify the joint association of cardiorespiratory fitness (CRF) and weight status on mortality from all causes using meta-analytical methodology. Studies were included if they were (1) prospective, (2) objectively measured CRF and body mass index (BMI), and (3) jointly assessed CRF and BMI with all-cause mortality. Ten articles were included in the final analysis. Pooled hazard ratios were assessed for each comparison group (i.e. normal weight-unfit, overweight-unfit and -fit, and obese-unfit and -fit) using a random-effects model. Compared to normal weight-fit individuals, unfit individuals had twice the risk of mortality regardless of BMI. Overweight and obese-fit individuals had similar mortality risks as normal weight-fit individuals. Furthermore, the obesity paradox may not influence fit individuals. Researchers, clinicians, and public health officials should focus on physical activity and fitness-based interventions rather than weight-loss driven approaches to reduce mortality risk.

  4. Milk Consumption and Mortality from All Causes, Cardiovascular Disease, and Cancer: A Systematic Review and Meta-Analysis

    PubMed Central

    Larsson, Susanna C.; Crippa, Alessio; Orsini, Nicola; Wolk, Alicja; Michaëlsson, Karl

    2015-01-01

    Results from epidemiological studies of milk consumption and mortality are inconsistent. We conducted a systematic review and meta-analysis of prospective studies assessing the association of non-fermented and fermented milk consumption with mortality from all causes, cardiovascular disease, and cancer. PubMed was searched until August 2015. A two-stage, random-effects, dose-response meta-analysis was used to combine study-specific results. Heterogeneity among studies was assessed with the I2 statistic. During follow-up periods ranging from 4.1 to 25 years, 70,743 deaths occurred among 367,505 participants. The range of non-fermented and fermented milk consumption and the shape of the associations between milk consumption and mortality differed considerably between studies. There was substantial heterogeneity among studies of non-fermented milk consumption in relation to mortality from all causes (12 studies; I2 = 94%), cardiovascular disease (five studies; I2 = 93%), and cancer (four studies; I2 = 75%) as well as among studies of fermented milk consumption and all-cause mortality (seven studies; I2 = 88%). Thus, estimating pooled hazard ratios was not appropriate. Heterogeneity among studies was observed in most subgroups defined by sex, country, and study quality. In conclusion, we observed no consistent association between milk consumption and all-cause or cause-specific mortality. PMID:26378576

  5. Smoking increases the risk of all-cause and cardiovascular mortality in patients with chronic kidney disease.

    PubMed

    Nakamura, Koshi; Nakagawa, Hideaki; Murakami, Yoshitaka; Kitamura, Akihiko; Kiyama, Masahiko; Sakata, Kiyomi; Tsuji, Ichiro; Miura, Katsuyuki; Ueshima, Hirotsugu; Okamura, Tomonori

    2015-11-01

    Little is known about the magnitude and nature of the combined effect of chronic kidney disease (CKD) and smoking on cardiovascular diseases. We studied this in a Japanese population using a pooled analysis of 15,468 men and 19,154 women aged 40-89 years enrolled in 8 cohort studies. The risk of mortality from all-causes and cardiovascular disease was compared in 6 gender-specific categories of baseline CKD status (non-CKD or CKD) and smoking habits (lifelong never smoked, former smokers, or currently smoking). CKD was defined as a decreased level of estimated glomerular filtration rate (under 60 ml/min per 1.73 m(2)) and/or dipstick proteinuria. Hazard ratios were estimated for each category, relative to never smokers without CKD. During the follow-up period (mean 14.8 years), there were 6771 deaths, 1975 of which were due to cardiovascular diseases. In both men and women, current or former smokers with CKD had the first or second highest crude mortality rates from all-cause and cardiovascular diseases among the 6 categories. After adjustment for age and other major cardiovascular risk factors, the hazard ratios in male and female current smokers with CKD were 2.26 (95% confidence interval, 1.95-2.63) and 1.78 (1.36-2.32) for all-causes, and 2.66 (2.04-3.47) and 1.71 (1.10-2.67) for cardiovascular diseases, respectively. Thus, coexistence of CKD and smoking may markedly increase the risk of all-cause and cardiovascular mortality.

  6. Cardiovascular Health Metrics and All-cause and Cardiovascular Disease Mortality Among Middle-aged Men in Korea: The Seoul Male Cohort Study

    PubMed Central

    Kim, Ji Young; Ko, Young-Jin; Rhee, Chul Woo; Park, Byung-Joo; Kim, Dong-Hyun; Bae, Jong-Myon; Shin, Myung-Hee; Lee, Moo-Song; Li, Zhong Min

    2013-01-01

    Objectives This study estimated the association of cardiovascular health behaviors with the risk of all-cause and cardiovascular disease (CVD) mortality in middle-aged men in Korea. Methods In total, 12 538 men aged 40 to 59 years were enrolled in 1993 and followed up through 2011. Cardiovascular health metrics defined the following lifestyle behaviors proposed by the American Heart Association: smoking, physical activity, body mass index, diet habit score, total cholesterol, blood pressure, and fasting blood glucose. The cardiovascular health metrics score was calculated as a single categorical variable, by assigning 1 point to each ideal healthy behavior. A Cox proportional hazards regression model was used to estimate the hazard ratio of cardiovascular health behavior. Population attributable risks (PARs) were calculated from the significant cardiovascular health metrics. Results There were 1054 total and 171 CVD deaths over 230 690 person-years of follow-up. The prevalence of meeting all 7 cardiovascular health metrics was 0.67%. Current smoking, elevated blood pressure, and high fasting blood glucose were significantly associated with all-cause and CVD mortality. The adjusted PARs for the 3 significant metrics combined were 35.2% (95% confidence interval [CI], 21.7 to 47.4) and 52.8% (95% CI, 22.0 to 74.0) for all-cause and CVD mortality, respectively. The adjusted hazard ratios of the groups with a 6-7 vs. 0-2 cardiovascular health metrics score were 0.42 (95% CI, 0.31 to 0.59) for all-cause mortality and 0.10 (95% CI, 0.03 to 0.29) for CVD mortality. Conclusions Among cardiovascular health behaviors, not smoking, normal blood pressure, and recommended fasting blood glucose levels were associated with reduced risks of all-cause and CVD mortality. Meeting a greater number of cardiovascular health metrics was associated with a lower risk of all-cause and CVD mortality. PMID:24349653

  7. Does cytomegalovirus infection contribute to socioeconomic disparities in all-cause mortality?

    PubMed

    Feinstein, Lydia; Douglas, Christian E; Stebbins, Rebecca C; Pawelec, Graham; Simanek, Amanda M; Aiello, Allison E

    2016-09-01

    The social patterning of cytomegalovirus (CMV) and its implication in aging suggest that the virus may partially contribute to socioeconomic disparities in mortality. We used Cox regression and inverse odds ratio weighting to quantify the proportion of the association between socioeconomic status (SES) and all-cause mortality that was attributable to mediation by CMV seropositivity. Data were from the National Health and Nutrition Examination Survey (NHANES) III (1988-1994), with mortality follow-up through December 2011. SES was assessed as household income (income-to-poverty ratio ≤1.30;>1.30 to≤1.85;>1.85 to≤3.50;>3.50) and education (high school). We found strong associations between low SES and increased mortality: hazard ratio (HR) 1.80; 95% confidence interval (CI): 1.57, 2.06 comparing the lowest versus highest income groups and HR 1.29; 95% CI: 1.13, 1.48 comparing high school education. 65% of individuals were CMV seropositive, accounting for 6-15% of the SES-mortality associations. Age modified the associations between SES, CMV, and mortality, with CMV more strongly associated with mortality in older individuals. Our findings suggest that cytomegalovirus may partially contribute to persistent socioeconomic disparities in mortality, particularly among older individuals. PMID:27268074

  8. Estimating the relative hazard by the ratio of logarithms of event-free proportions.

    PubMed

    Perneger, Thomas V

    2008-09-01

    Clinical trials typically examine associations between an intervention and the occurrence of a clinical event. The association is often reported as a relative risk, more rarely as an odds ratio. Unfortunately, when the scientific interest lies with the ratio of incidence rates, both these statistics are inaccurate: the odds ratio is too extreme, and the relative risk too conservative. These biases are particularly strong when the outcomes are common. This paper describes an alternative statistic, the ratio of logarithms of event-free proportions (or relative log survival), which is simple to compute yet unbiased vis-à-vis the relative hazard. A formula to compute the sampling error of this statistic is also provided. Multivariate analysis can be conducted using complementary log-log regression. Precise knowledge of event occurrence times is not required for these analyses. Relative log survival may be particularly useful for meta-analyses of trials in which the proportion of events varies between studies.

  9. Association of resting heart rate and hypertension stages on all-cause and cardiovascular mortality among elderly Koreans: the Kangwha Cohort Study

    PubMed Central

    Ryu, Mikyung; Bayasgalan, Gombojav; Kimm, Heejin; Nam, Chung Mo; Ohrr, Heechoul

    2016-01-01

    Background Elevated resting heart rate and hypertension independently increase the risk of mortality. However, their combined effect on mortality in stages of hypertension according to updated clinical guidelines among elderly population is unclear. Methods We followed a cohort of 6100 residents (2600 males and 3500 females) of Kangwha County, Korea, ranging from 55 to 99 year-olds as of March 1985, for all-cause and cardiovascular mortality for 20.8 years until December 31, 2005. Mortality data were collected through telephone calls and visits (to 1991), and were confirmed by death record matching with the National Statistical Office (1992−2005). Hazard ratios were calculated for all-cause and cardiovascular mortality by resting heart rate and hypertension defined by Eighth Joint National Committee criteria using the Cox proportional hazard model after controlling for confounding factors. Results The hazard ratios associated with resting heart rate > 80 beats/min were higher in hypertensive men compared with normotensives with heart rate of 61–79 beats/min, with hazard ratios values of 1.43 (95% CI: 1.00−1.92) on all-cause mortality for prehypertension, 3.01 (95% CI: 1.07–8.28) on cardiovascular mortality for prehypertension, and 8.34 (95% CI: 2.52−28.19) for stage 2 hypertension. Increased risk (HR: 3.54, 95% CI: 1.16–9.21) was observed among those with both a resting heart rate ≥ 80 beats/min and prehypertension on cardiovascular mortality in women. Conclusions Individuals with coexisting elevated resting heart rate and hypertension, even in prehypertension, have a greater risk for all-cause and cardiovascular mortality compared to those with elevated resting heart rate or hypertension alone. These findings suggest that elevated resting heart rate should not be regarded as a less serious risk factor in elderly hypertensive patients. PMID:27605937

  10. All-cause mortality increased by environmental cadmium exposure in the Japanese general population in cadmium non-polluted areas.

    PubMed

    Suwazono, Yasushi; Nogawa, Kazuhiro; Morikawa, Yuko; Nishijo, Muneko; Kobayashi, Etsuko; Kido, Teruhiko; Nakagawa, Hideaki; Nogawa, Koji

    2015-07-01

    The aim of the present study was to evaluate the effect of environmental cadmium (Cd) exposure indicated by urinary Cd on all-cause mortality in the Japanese general population. A 19-year cohort study was conducted in 1067 men and 1590 women aged 50 years or older who lived in three cadmium non-polluted areas in Japan. The subjects were divided into four quartiles based on creatinine adjusted U-Cd (µg g(-1) cre). The hazard ratio (HR) and 95% confidence interval (CI) for continuous U-Cd or the quartiles of U-Cd were estimated for all-cause mortality using a proportional hazards regression.The all-cause mortality rates per 1000 person years were 31.2 and 15.1 in men and women, respectively. Continuous U-Cd (+1 µg g(-1) cre) was significantly related to the all-cause mortality in men (HR 1.05, 95% CI: 1.02-1.09) and women (HR 1.04, 95% CI: 1.01-1.07). Furthermore in men, the third (1.96-3.22 µg g(-1) cre) and fourth quartile (≥3.23 µg g(-1) cre) of U-Cd showed a significant, positive HR (third: HR 1.35, 95% CI: 1.03-1.77, fourth: HR 1.64, 95% CI: 1.26-2.14) for all-cause mortality compared with the first quartile (<1.14 µg g(-1) cre). In women, the fourth quartile of U-Cd (≥4.66 µg g(-1) cre) also showed a significant HR (1.49, 95% CI 1.11-2.00) for all-cause mortality compared with the first quartile (<1.46 µg g(-1) cre).In the present study, U-Cd was significantly associated with increased mortality in the Japanese general population, indicating that environmental Cd exposure adversely affects the life prognosis in Cd non-polluted areas in Japan.

  11. Apolipoprotein E-related all-cause mortality in hospitalized elderly patients.

    PubMed

    Matera, Maria G; Sancarlo, Daniele; Panza, Francesco; Gravina, Carolina; D'Onofrio, Grazia; Frisardi, Vincenza; Longo, Grazia; D'Ambrosio, Luigi P; Addante, Filomena; Copetti, Massimiliano; Solfrizzi, Vincenzo; Seripa, Davide; Pilotto, Alberto

    2010-09-01

    The most common apolipoprotein E (APOE) allelic variation is implicated in many age-related diseases and human longevity with controversial findings. We investigated the effect of APOE gene polymorphism on all-cause mortality in elderly patients taking into consideration the functional disability, cognitive impairment, malnutrition, and the occurrence of common age-related diseases. APOE genotypes were determined in 2,124 geriatric hospitalized patients (46.5% men and 53.5% women; mean age, 78.2 +/- 7.1 years; range, 65-100 years). At hospital admission, all patients underwent a comprehensive geriatric assessment to evaluate functional disability, cognitive status, nutritional status, and comorbidity. The main and secondary diagnoses at hospital discharge were also recorded. Mortality status was evaluated in all patients after a maximum follow-up of 5 years (range, from 1.26 to 5.23 years; median, 2.86 years). During the study period, 671 patients died (32.0%). At hospital admission, these patients showed a significant higher prevalence of cardiovascular diseases (56.3% vs 53.4%; p = 0.007), neoplasias (32.3% vs 13.7%; p < 0.001), and lower prevalence of neurodegenerative diseases (17.7% vs 20.7%; p < 0.001) than survived patients. Moreover, they also showed an higher prevalence of disability (52.0% vs 25.6%; p < 0.001), cognitive impairment (31.0% vs 18.8%; p < 0.001), and malnutrition (74.0% vs 46.1%; p < 0.001) than survived patients. In the overall study population, the APOE epsilon2 allele was significantly associated to neurodegenerative diseases (odds ratio = 0.59; 95% confidence interval (CI), 0.37-0.94). No significant association between the APOE polymorphism and disability, malnutrition, co-morbidity status, and with all-cause mortality was observed. In patients with cardiovascular diseases, however, a decreased risk of all-cause mortality was found in the epsilon2 allele carriers (hazard ratio = 0.56; 95% CI, 0.36-0.88). In this population, APOE allele

  12. Can environmental or occupational hazards alter the sex ratio at birth? A systematic review

    PubMed Central

    Terrell, Metrecia L.; Hartnett, Kathleen P.; Marcus, Michele

    2011-01-01

    More than 100 studies have examined whether environmental or occupational exposures of parents affect the sex ratio of their offspring at birth. For this review, we searched Medline and Web of Science using the terms ‘sex ratio at birth’ and ‘sex ratio and exposure’ for all dates, and reviewed bibliographies of relevant studies to find additional articles. This review focuses on exposures that have been the subject of at least four studies including polychlorinated biphenyls (PCBs), dioxins, pesticides, lead and other metals, radiation, boron, and g-forces. For paternal exposures, only dioxins and PCBs were consistently associated with sex ratios higher or lower than the expected 1.06. Dioxins were associated with a decreased proportion of male births, whereas PCBs were associated with an increased proportion of male births. There was limited evidence for a decrease in the proportion of male births after paternal exposure to DBCP, lead, methylmercury, non-ionizing radiation, ionizing radiation treatment for childhood cancer, boron, or g-forces. Few studies have found higher or lower sex ratios associated with maternal exposures. Studies in humans and animals have found a reduction in the number of male births associated with lower male fertility, but the mechanism by which environmental hazards might change the sex ratio has not yet been established. PMID:24149027

  13. Mark-specific Hazard Ratio Model with Multivariate Continuous Marks: An Application to Vaccine Efficacy

    PubMed Central

    Gilbert, P. B.

    2014-01-01

    Summary In randomized placebo-controlled preventive HIV vaccine efficacy trials, an objective is to evaluate the relationship between vaccine efficacy to prevent infection and genetic distances of the exposing HIV strains to the multiple HIV sequences included in the vaccine construct, where the set of genetic distances is considered as the continuous multivariate ‘mark’ observed in infected subjects only. This research develops a multivariate mark-specific hazard ratio model in the competing risks failure time analysis framework for the assessment of mark-specific vaccine efficacy. It allows improved efficiency of estimation by employing the semiparametric method of maximum profile likelihood estimation in the vaccine-to-placebo mark density ratio model. The model also enables the use of a more efficient estimation method for the overall log hazard ratio in the Cox model. Additionally, we propose testing procedures to evaluate two relevant hypotheses concerning mark-specific vaccine efficacy. The asymptotic properties and finite-sample performance of the inferential procedures are investigated. Finally, we apply the proposed methods to data collected in the Thai RV144 HIV vaccine efficacy trial. PMID:23421613

  14. The performance of different propensity score methods for estimating marginal hazard ratios.

    PubMed

    Austin, Peter C

    2013-07-20

    Propensity score methods are increasingly being used to reduce or minimize the effects of confounding when estimating the effects of treatments, exposures, or interventions when using observational or non-randomized data. Under the assumption of no unmeasured confounders, previous research has shown that propensity score methods allow for unbiased estimation of linear treatment effects (e.g., differences in means or proportions). However, in biomedical research, time-to-event outcomes occur frequently. There is a paucity of research into the performance of different propensity score methods for estimating the effect of treatment on time-to-event outcomes. Furthermore, propensity score methods allow for the estimation of marginal or population-average treatment effects. We conducted an extensive series of Monte Carlo simulations to examine the performance of propensity score matching (1:1 greedy nearest-neighbor matching within propensity score calipers), stratification on the propensity score, inverse probability of treatment weighting (IPTW) using the propensity score, and covariate adjustment using the propensity score to estimate marginal hazard ratios. We found that both propensity score matching and IPTW using the propensity score allow for the estimation of marginal hazard ratios with minimal bias. Of these two approaches, IPTW using the propensity score resulted in estimates with lower mean squared error when estimating the effect of treatment in the treated. Stratification on the propensity score and covariate adjustment using the propensity score result in biased estimation of both marginal and conditional hazard ratios. Applied researchers are encouraged to use propensity score matching and IPTW using the propensity score when estimating the relative effect of treatment on time-to-event outcomes.

  15. Diabetes treatments and risk of heart failure, cardiovascular disease, and all cause mortality: cohort study in primary care

    PubMed Central

    Coupland, Carol

    2016-01-01

    Objective To assess associations between risks of cardiovascular disease, heart failure, and all cause mortality and different diabetes drugs in people with type 2 diabetes, particularly newer agents, including gliptins and thiazolidinediones (glitazones). Design Open cohort study. Setting 1243 general practices contributing data to the QResearch database in England. Participants 469 688 people with type 2 diabetes aged 25-84 years between 1 April 2007 and 31 January 2015. Exposures Diabetes drugs (glitazones, gliptins, metformin, sulphonylureas, insulin, other) alone and in combination. Main outcome measure First recorded diagnoses of cardiovascular disease, heart failure, and all cause mortality recorded on the patients’ primary care, mortality, or hospital record. Cox proportional hazards models were used to estimate hazard ratios for diabetes treatments, adjusting for potential confounders. Results During follow-up, 21 308 patients (4.5%) received prescriptions for glitazones and 32 533 (6.9%) received prescriptions for gliptins. Compared with non-use, gliptins were significantly associated with an 18% decreased risk of all cause mortality, a 14% decreased risk of heart failure, and no significant change in risk of cardiovascular disease; corresponding values for glitazones were significantly decreased risks of 23% for all cause mortality, 26% for heart failure, and 25% for cardiovascular disease. Compared with no current treatment, there were no significant associations between monotherapy with gliptins and risk of any complications. Dual treatment with gliptins and metformin was associated with a decreased risk of all three outcomes (reductions of 38% for heart failure, 33% for cardiovascular disease, and 48% for all cause mortality). Triple treatment with metformin, sulphonylureas, and gliptins was associated with a decreased risk of all three outcomes (reductions of 40% for heart failure, 30% for cardiovascular disease, and 51% for all cause

  16. Fitness and fatness as predictors of mortality from all causes and from cardiovascular disease in men and women in the lipid research clinics study.

    PubMed

    Stevens, June; Cai, Jianwen; Evenson, Kelly R; Thomas, Ratna

    2002-11-01

    The relative size of the effects of fitness and fatness on longevity has been studied in only one cohort. The authors examined this issue using data from 2,506 women and 2,860 men in the Lipid Research Clinics Study. The mean age was 46.6 years in women and 45.1 years in men at baseline (1972-1976). Fitness was assessed using a treadmill test, and fatness was assessed as body mass index calculated from measured height and weight. Participants were followed for vital status through 1998. Hazard ratios were calculated using proportional hazard models that included covariates for age, education, smoking, alcohol intake, and the dietary Keys score. Fitness and fatness were both associated with mortality from all causes and from cardiovascular disease. For mortality from all causes, the adjusted hazard ratios were 1.32 among the fit-fat, 1.30 among the unfit-not fat, and 1.57 among the unfit-fat women compared with fit-not fat women. Among men the same hazard ratios were 1.25, 1.44, and 1.49 [corrected]. There were no significant interactions between fitness and fatness in either men or women. The authors conclude that both fitness and fatness are risk factors for mortality, and that being fit does not completely reverse the increased risk associated with excess adiposity.

  17. Alcohol, drinking pattern and all-cause, cardiovascular and alcohol-related mortality in Eastern Europe.

    PubMed

    Bobak, Martin; Malyutina, Sofia; Horvat, Pia; Pajak, Andrzej; Tamosiunas, Abdonas; Kubinova, Ruzena; Simonova, Galina; Topor-Madry, Roman; Peasey, Anne; Pikhart, Hynek; Marmot, Michael G

    2016-01-01

    Alcohol has been implicated in the high mortality in Central and Eastern Europe but the magnitude of its effect, and whether it is due to regular high intake or episodic binge drinking remain unclear. The aim of this paper was to estimate the contribution of alcohol to mortality in four Central and Eastern European countries. We used data from the Health, Alcohol and Psychosocial factors in Eastern Europe is a prospective multi-centre cohort study in Novosibirsk (Russia), Krakow (Poland), Kaunas (Lithuania) and six Czech towns. Random population samples of 34,304 men and women aged 45-69 years in 2002-2005 were followed up for a median 7 years. Drinking volume, frequency and pattern were estimated from the graduated frequency questionnaire. Deaths were ascertained using mortality registers. In 230,246 person-years of follow-up, 2895 participants died from all causes, 1222 from cardiovascular diseases (CVD), 672 from coronary heart disease (CHD) and 489 from pre-defined alcohol-related causes (ARD). In fully-adjusted models, abstainers had 30-50% increased mortality risk compared to light-to-moderate drinkers. Adjusted hazard ratios (HR) in men drinking on average ≥60 g of ethanol/day (3% of men) were 1.23 (95% CI 0.95-1.59) for all-cause, 1.38 (0.95-2.02) for CVD, 1.64 (1.02-2.64) for CHD and 2.03 (1.28-3.23) for ARD mortality. Corresponding HRs in women drinking on average ≥20 g/day (2% of women) were 1.92 (1.25-2.93), 1.74 (0.76-3.99), 1.39 (0.34-5.76) and 3.00 (1.26-7.10). Binge drinking increased ARD mortality in men only. Mortality was associated with high average alcohol intake but not binge drinking, except for ARD in men.

  18. Alcohol, drinking pattern and all-cause, cardiovascular and alcohol-related mortality in Eastern Europe.

    PubMed

    Bobak, Martin; Malyutina, Sofia; Horvat, Pia; Pajak, Andrzej; Tamosiunas, Abdonas; Kubinova, Ruzena; Simonova, Galina; Topor-Madry, Roman; Peasey, Anne; Pikhart, Hynek; Marmot, Michael G

    2016-01-01

    Alcohol has been implicated in the high mortality in Central and Eastern Europe but the magnitude of its effect, and whether it is due to regular high intake or episodic binge drinking remain unclear. The aim of this paper was to estimate the contribution of alcohol to mortality in four Central and Eastern European countries. We used data from the Health, Alcohol and Psychosocial factors in Eastern Europe is a prospective multi-centre cohort study in Novosibirsk (Russia), Krakow (Poland), Kaunas (Lithuania) and six Czech towns. Random population samples of 34,304 men and women aged 45-69 years in 2002-2005 were followed up for a median 7 years. Drinking volume, frequency and pattern were estimated from the graduated frequency questionnaire. Deaths were ascertained using mortality registers. In 230,246 person-years of follow-up, 2895 participants died from all causes, 1222 from cardiovascular diseases (CVD), 672 from coronary heart disease (CHD) and 489 from pre-defined alcohol-related causes (ARD). In fully-adjusted models, abstainers had 30-50% increased mortality risk compared to light-to-moderate drinkers. Adjusted hazard ratios (HR) in men drinking on average ≥60 g of ethanol/day (3% of men) were 1.23 (95% CI 0.95-1.59) for all-cause, 1.38 (0.95-2.02) for CVD, 1.64 (1.02-2.64) for CHD and 2.03 (1.28-3.23) for ARD mortality. Corresponding HRs in women drinking on average ≥20 g/day (2% of women) were 1.92 (1.25-2.93), 1.74 (0.76-3.99), 1.39 (0.34-5.76) and 3.00 (1.26-7.10). Binge drinking increased ARD mortality in men only. Mortality was associated with high average alcohol intake but not binge drinking, except for ARD in men. PMID:26467937

  19. Risks of all-cause and site-specific fractures among hospitalized patients with COPD

    PubMed Central

    Liao, Kuang-Ming; Liang, Fu-Wen; Li, Chung-Yi

    2016-01-01

    Abstract Patients with chronic obstructive pulmonary disease (COPD) have a high prevalence of osteoporosis. The clinical sequel of osteoporosis is fracture. Patients with COPD who experience a fracture also have increased morbidity and mortality. Currently, the types of all-cause and site-specific fracture among patients with COPD are unknown. Thus, we elucidated the all-cause and site-specific fractures among patients with COPD. A retrospective, population-based, cohort study was conducted utilizing the Taiwan Longitudinal Health Insurance Database. Patients with COPD were defined as those who were hospitalized with an International Classification of Diseases, Ninth Revision, Clinical Modification code of 490 to 492 or 496 between 2001 and 2011. The index date was set as the date of discharge. The study patients were followed from the index date to the date when they sought care for any type of fracture, date of death, date of health insurance policy termination, or the last day of 2013. The types of fracture analyzed in this study included vertebral, rib, humeral, radial and ulnar/wrist, pelvic, femoral, and tibial and fibular fractures. The cohort consisted of 11,312 patients with COPD. Among these patients, 1944 experienced fractures. The most common site-specific fractures were vertebral, femoral, rib, and forearm fractures (radius, ulna, and wrist) at 32.4%, 31%, 12%, and 11.8%, respectively. The adjusted hazard ratios of fracture were 1.71 [95% confidence interval (95% CI) = 1.56–1.87] for female patient with COPD and 1.50 (95% CI = 1.39–1.52) for patients with osteoporosis after covariate adjustment. Vertebral and hip fractures are common among patients with COPD, especially among males with COPD. Many comorbidities contribute to the high risk of fracture among patients with COPD. PMID:27749576

  20. The Cohort Study on Prediction of Incidence of All-Cause Mortality by Metabolic Syndrome

    PubMed Central

    Li, Zhixia; Yang, Xinghua; Yang, Jun; Yang, Zhirong; Wang, Shengfeng

    2016-01-01

    Aim The aim was to evaluate the impact of metabolic syndrome (MS), MS individual components and 32 kinds of MS specific component combinations on all-cause mortality risk in a fixed cohort of MJ check-up population. Methods We observed the events of death in a fixed cohort, where the population was composed of 45,542 individuals aged 35–74 who were examined at MJ Health check-up Center in 1997 as baseline examination, and were followed up to 2005. Median duration of follow-up was 7.44 years. MS was defined according to the National Cholesterol Educational Program (the revised NCEP-ATPIII for Asian in 2004), the prevalence of MS was standardized according to China’s fifth census data. We constructed common Cox regression model, simultaneously adjusting the classic risk factors (such as age, sex, smoking, alcohol drinking, physical activity, family history, etc.) to examine the relationship between MS, MS individual components and 32 kinds of MS specific component combinations on the occurrence of death with the fixed cohort. Results The standardized prevalence of MS was 29.75% (male: 30.36%, female: 29.51%). There were 1,749 persons who died during the median 7.44-years follow-up, the mortality rate was 46 per 10,000 person years. The mortality rates were 71 and 35 per 10,000 person years for those with and without MS, respectively. After adjustment for age, sex and classical risk factors, compared with subjects without MS, the hazard ratio of all-cause mortality was 1.26 (95% CI: 1.14–1.40). The all-cause mortality were more highly significant than other combinations (P <0.05) when the following combinations exist: “elevated blood pressure”, “elevated fasting plasma glucose + low high-density lipoprotein cholesterol”, “elevated blood pressure + elevated triglyceride + elevated fasting plasma glucose”, “elevated fasting plasma glucose + low high-density lipoprotein cholesterol + elevated blood pressure + elevated triglyceride”. After adjusting

  1. Association Between Tooth Loss, Body Mass Index, and All-Cause Mortality Among Elderly Patients in Taiwan

    PubMed Central

    Hu, Hsiao-Yun; Lee, Ya-Ling; Lin, Shu-Yi; Chou, Yi-Chang; Chung, Debbie; Huang, Nicole; Chou, Yiing-Jenq; Wu, Chen-Yi

    2015-01-01

    Abstract To date, the effect of tooth loss on all-cause mortality among elderly patients with a different weight group has not been assessed. This retrospective cohort study evaluated the data obtained from a government-sponsored, annual physical examination program for elderly citizens residing in Taipei City during 2005 to 2007, and follow-up to December 31, 2010. We recruited 55,651 eligible citizens of Taipei City aged ≥65 years, including 29,572 men and 26,079 women, in our study. Their mortality data were ascertained based on the national death files. The number of missing teeth was used as a representative of oral health status. We used multivariate Cox proportional hazards regression analysis to determine the association between tooth loss and all-cause mortality. After adjustment for all confounders, the hazard ratios (HRs) of all-cause mortality in participants with no teeth, 1 to 9 teeth, and 10 to 19 teeth were 1.36 [95% confidence interval (CI): 1.15–1.61], 1.24 (95% CI: 1.08–1.42), and 1.19 (95% CI: 1.09–1.31), respectively, compared with participants with 20 or more teeth. A significant positive correlation of body mass index (BMI) with all-cause mortality was found in underweight and overweight elderly patients and was represented as a U-shaped curve. Subgroup analysis revealed a significant positive correlation in underweight (no teeth: HR = 1.49, 95% CI: 1.21–1.83; 1–9 teeth: HR = 1.23, 95% CI: 1.03–1.47; 10–19 teeth: HR = 1.20, 95% CI: 1.06–1.36) and overweight participants (no teeth: HR = 1.37, 95% CI: 1.05–1.79; 1–9 teeth: HR = 1.27, 95% CI: 1.07–1.52). The number of teeth lost is associated with an increased risk of all-cause mortality, particularly for participants with underweight and overweight. PMID:26426618

  2. Apple intake is inversely associated with all-cause and disease-specific mortality in elderly women.

    PubMed

    Hodgson, Jonathan M; Prince, Richard L; Woodman, Richard J; Bondonno, Catherine P; Ivey, Kerry L; Bondonno, Nicola; Rimm, Eric B; Ward, Natalie C; Croft, Kevin D; Lewis, Joshua R

    2016-03-14

    Higher fruit intake is associated with lower risk of all-cause and disease-specific mortality. However, data on individual fruits are limited, and the generalisability of these findings to the elderly remains uncertain. The objective of this study was to examine the association of apple intake with all-cause and disease-specific mortality over 15 years in a cohort of women aged over 70 years. Secondary analyses explored relationships of other fruits with mortality outcomes. Usual fruit intake was assessed in 1456 women using a FFQ. Incidence of all-cause and disease-specific mortality over 15 years was determined through the Western Australian Hospital Morbidity Data system. Cox regression was used to determine the hazard ratios (HR) for mortality. During 15 years of follow-up, 607 (41·7%) women died from any cause. In the multivariable-adjusted analysis, the HR for all-cause mortality was 0·89 (95% CI 0·81, 0·97) per sd (53 g/d) increase in apple intake, HR 0·80 (95% CI 0·65, 0·98) for consumption of 5-100 g/d and HR 0·65 (95% CI 0·48, 0·89) for consumption of >100 g/d (an apple a day), compared with apple intake of <5 g/d (P for trend=0·03). Our analysis also found that higher apple intake was associated with lower risk for cancer mortality, and that higher total fruit and banana intakes were associated lower risk of CVD mortality (P<0·05). Our results support the view that regular apple consumption may contribute to lower risk of mortality. PMID:26787402

  3. Apple intake is inversely associated with all-cause and disease-specific mortality in elderly women.

    PubMed

    Hodgson, Jonathan M; Prince, Richard L; Woodman, Richard J; Bondonno, Catherine P; Ivey, Kerry L; Bondonno, Nicola; Rimm, Eric B; Ward, Natalie C; Croft, Kevin D; Lewis, Joshua R

    2016-03-14

    Higher fruit intake is associated with lower risk of all-cause and disease-specific mortality. However, data on individual fruits are limited, and the generalisability of these findings to the elderly remains uncertain. The objective of this study was to examine the association of apple intake with all-cause and disease-specific mortality over 15 years in a cohort of women aged over 70 years. Secondary analyses explored relationships of other fruits with mortality outcomes. Usual fruit intake was assessed in 1456 women using a FFQ. Incidence of all-cause and disease-specific mortality over 15 years was determined through the Western Australian Hospital Morbidity Data system. Cox regression was used to determine the hazard ratios (HR) for mortality. During 15 years of follow-up, 607 (41·7%) women died from any cause. In the multivariable-adjusted analysis, the HR for all-cause mortality was 0·89 (95% CI 0·81, 0·97) per sd (53 g/d) increase in apple intake, HR 0·80 (95% CI 0·65, 0·98) for consumption of 5-100 g/d and HR 0·65 (95% CI 0·48, 0·89) for consumption of >100 g/d (an apple a day), compared with apple intake of <5 g/d (P for trend=0·03). Our analysis also found that higher apple intake was associated with lower risk for cancer mortality, and that higher total fruit and banana intakes were associated lower risk of CVD mortality (P<0·05). Our results support the view that regular apple consumption may contribute to lower risk of mortality.

  4. Association between various sedentary behaviours and all-cause, cardiovascular disease and cancer mortality: the Multiethnic Cohort Study

    PubMed Central

    Kim, Yeonju; Wilkens, Lynne R; Park, Song-Yi; Goodman, Marc T; Monroe, Kristine R; Kolonel, Laurence N

    2013-01-01

    Background It has been proposed that time spent sitting increases all-cause mortality, but evidence to support this hypothesis, especially the relative effects of various sitting activities alone or in combination, is very limited. Methods The association between various sedentary behaviours (time spent: sitting watching television (TV); in other leisure activities; in a car/bus; at work; and at meals) and mortality (all-cause and cause-specific) was examined in the Multiethnic Cohort Study, which included 61 395 men and 73 201 women aged 45–75 years among five racial/ethnic groups (African American, Latino, Japanese American, Native Hawaiian and White) from Hawaii and Los Angeles, USA. Results Median follow-up was 13.7 years and 19 143 deaths were recorded. Total daily sitting was not associated with mortality in men, whereas in women the longest sitting duration (≥10 h/day vs <5 h/day) was associated with increased all-cause (11%) and cardiovascular (19%) mortality. Multivariate hazard ratios (HR) for ≥5 h/day vs <1 h/day of sitting watching TV were 1.19 in men (95% confidence interval (CI) 1.10–1.29) and 1.32 in women (95% CI 1.21–1.44) for all-cause mortality. This association was consistent across four racial/ethnic groups, but was not seen in Japanese Americans. Sitting watching TV was associated with an increased risk for cardiovascular mortality, but not for cancer mortality. Time spent sitting in a car/bus and at work was not related to mortality. Conclusions Leisure time spent sitting, particularly watching television, may increase overall and cardiovascular mortality. Sitting at work or during transportation was not related to mortality. PMID:24062293

  5. Structural stigma and all-cause mortality in sexual minority populations.

    PubMed

    Hatzenbuehler, Mark L; Bellatorre, Anna; Lee, Yeonjin; Finch, Brian K; Muennig, Peter; Fiscella, Kevin

    2014-02-01

    Stigma operates at multiple levels, including intrapersonal appraisals (e.g., self-stigma), interpersonal events (e.g., hate crimes), and structural conditions (e.g., community norms, institutional policies). Although prior research has indicated that intrapersonal and interpersonal forms of stigma negatively affect the health of the stigmatized, few studies have addressed the health consequences of exposure to structural forms of stigma. To address this gap, we investigated whether structural stigma-operationalized as living in communities with high levels of anti-gay prejudice-increases risk of premature mortality for sexual minorities. We constructed a measure capturing the average level of anti-gay prejudice at the community level, using data from the General Social Survey, which was then prospectively linked to all-cause mortality data via the National Death Index. Sexual minorities living in communities with high levels of anti-gay prejudice experienced a higher hazard of mortality than those living in low-prejudice communities (Hazard Ratio [HR] = 3.03, 95% Confidence Interval [CI] = 1.50, 6.13), controlling for individual and community-level covariates. This result translates into a shorter life expectancy of approximately 12 years (95% C.I.: 4-20 years) for sexual minorities living in high-prejudice communities. Analysis of specific causes of death revealed that suicide, homicide/violence, and cardiovascular diseases were substantially elevated among sexual minorities in high-prejudice communities. Strikingly, there was an 18-year difference in average age of completed suicide between sexual minorities in the high-prejudice (age 37.5) and low-prejudice (age 55.7) communities. These results highlight the importance of examining structural forms of stigma and prejudice as social determinants of health and longevity among minority populations.

  6. Suicidal Ideation is Associated With All-Cause Mortality.

    PubMed

    Shiner, Brian; Riblet, Natalie; Westgate, Christine Leonard; Young-Xu, Yinong; Watts, Bradley V

    2016-09-01

    Suicidal ideation may be associated with all-cause mortality. Available research shows that treatment of depression reduces the risk of all-cause mortality in patients with suicidal ideation. However, this finding has not been replicated in a clinical population, where patients have various mental health conditions. We examined the association between suicidal ideation and all-cause mortality in a clinical cohort. We stratified patients presenting to a mental health clinic from January 2005 through December 2007 based upon their degree of suicidal ideation and obtained vital status information through June 2015. We compared groups using survival analysis, adjusting for patient characteristics and treatment receipt. Among 1,869 patients who completed the initial assessment, there were 363 deaths. Patients with the highest levels of suicidal ideation died at increased rates. Cause-of-death data in the year following the initial assessment indicates that the difference in mortality is not likely attributable to suicide. Accounting for patient characteristics and treatment, which included medical care and mental health care, did not meaningfully diminish the relationship between suicidal ideation and all-cause mortality. Additional research is needed to determine specific treatment elements that may moderate the relationship between suicidal ideation and all-cause mortality. PMID:27612350

  7. A gender based analysis of predictors of all cause death after transcatheter aortic valve implantation.

    PubMed

    Conrotto, Federico; D'Ascenzo, Fabrizio; Salizzoni, Stefano; Presbitero, Patrizia; Agostoni, Pierfrancesco; Tamburino, Corrado; Tarantini, Giuseppe; Bedogni, Francesco; Nijhoff, Freek; Gasparetto, Valeria; Napodano, Massimo; Ferrante, Giuseppe; Rossi, Marco Luciano; Stella, Pieter; Brambilla, Nedy; Barbanti, Marco; Giordana, Francesca; Grasso, Costanza; Biondi Zoccai, Giuseppe; Moretti, Claudio; D'Amico, Maurizio; Rinaldi, Mauro; Gaita, Fiorenzo; Marra, Sebastiano

    2014-10-15

    The impact of gender-related pathophysiologic features of severe aortic stenosis on transcatheter aortic valve implantation (TAVI) outcomes remains to be determined, as does the consistency of predictors of mortality between the genders. All consecutive patients who underwent TAVI at 6 institutions were enrolled in this study and stratified according to gender. Midterm all-cause mortality was the primary end point, with events at 30 days and at midterm as secondary end points. All events were adjudicated according to Valve Academic Research Consortium definitions. Eight hundred thirty-six patients were enrolled, 464 (55.5%) of whom were female. At midterm follow-up (median 365 days, interquartile range 100 to 516) women had similar rates of all-cause mortality compared with men (18.1% vs 22.6%, p = 0.11) and similar incidence of myocardial infarction and cerebrovascular accident. Gender did not affect mortality also on multivariate analysis. Among clinical and procedural features, glomerular filtration rate <30 ml/min/1.73 m(2) (hazard ratio [HR] 2.55, 95% confidence interval [CI] 1.36 to 4.79) and systolic pulmonary arterial pressure >50 mm Hg (HR 2.26, 95% CI 1.26 to 4.02) independently predicted mortality in women, while insulin-treated diabetes (HR 3.45, 95% CI 1.47 to 8.09), previous stroke (HR 3.42, 95% CI 1.43 to 8.18), and an ejection fraction <30% (HR 3.82, 95% CI 1.41 to 10.37) were related to mortality in men. Postprocedural aortic regurgitation was independently related to midterm mortality in the 2 groups (HR 11.19, 95% CI 3.3 to 37.9). In conclusion, women and men had the same life expectancy after TAVI, but different predictors of adverse events stratified by gender were demonstrated. These findings underline the importance of a gender-tailored clinical risk assessment in TAVI patients. PMID:25159239

  8. Serum Calcification Propensity Is a Strong and Independent Determinant of Cardiac and All-Cause Mortality in Kidney Transplant Recipients.

    PubMed

    Dahle, D O; Åsberg, A; Hartmann, A; Holdaas, H; Bachtler, M; Jenssen, T G; Dionisi, M; Pasch, A

    2016-01-01

    Calcification of the vasculature is associated with cardiovascular disease and death in kidney transplant recipients. A novel functional blood test measures calcification propensity by quantifying the transformation time (T50 ) from primary to secondary calciprotein particles. Accelerated T50 indicates a diminished ability of serum to resist calcification. We measured T50 in 1435 patients 10 weeks after kidney transplantation during 2000-2003 (first era) and 2009-2012 (second era). Aortic pulse wave velocity (APWV) was measured at week 10 and after 1 year in 589 patients from the second era. Accelerated T50 was associated with diabetes, deceased donor, first transplant, rejection, stronger immunosuppression, first era, higher serum phosphate and lower albumin. T50 was not associated with progression of APWV. During a median follow-up of 5.1 years, 283 patients died, 70 from myocardial infarction, cardiac failure or sudden death. In Cox regression models, accelerated T50 was strongly and independently associated with both all-cause and cardiac mortality, low versus high T50 quartile: hazard ratio 1.60 (95% confidence interval [CI] 1.00-2.57), ptrend   = 0.03, and 3.60 (95% CI 1.10-11.83), ptrend   = 0.02, respectively. In conclusion, calcification propensity (T50 ) was strongly associated with all-cause and cardiac mortality of kidney transplant recipients, potentially via a cardiac nonAPWV-related pathway. Whether therapeutic improvement of T50 improves outcome awaits clarification in a randomized trial. PMID:26375609

  9. Birth characteristics and all-cause mortality: a sibling analysis using the Uppsala birth cohort multigenerational study.

    PubMed

    Juárez, S; Goodman, A; De Stavola, B; Koupil, I

    2016-08-01

    This paper investigates the association between perinatal health and all-cause mortality for specific age intervals, assessing the contribution of maternal socioeconomic characteristics and the presence of maternal-level confounding. Our study is based on a cohort of 12,564 singletons born between 1915 and 1929 at the Uppsala University Hospital. We fitted Cox regression models to estimate age-varying hazard ratios of all-cause mortality for absolute and relative birth weight and for gestational age. We found that associations with mortality vary by age and according to the measure under scrutiny, with effects being concentrated in infancy, childhood or early adult life. For example, the effect of low birth weight was greatest in the first year of life and then continued up to 44 years of age (HR between 2.82 and 1.51). These associations were confirmed in within-family analyses, which provided no evidence of residual confounding by maternal characteristics. Our findings support the interpretation that policies oriented towards improving population health should invest in birth outcomes and hence in maternal health. PMID:27138055

  10. Vascular Disease and Risk Stratification for Ischemic Stroke and All-Cause Death in Heart Failure Patients without Diagnosed Atrial Fibrillation: A Nationwide Cohort Study

    PubMed Central

    Melgaard, Line; Gorst-Rasmussen, Anders; Rasmussen, Lars Hvilsted; Lip, Gregory Y. H.; Larsen, Torben Bjerregaard

    2016-01-01

    Background Stroke and mortality risk among heart failure patients previously diagnosed with different manifestations of vascular disease is poorly described. We conducted an observational study to evaluate the stroke and mortality risk among heart failure patients without diagnosed atrial fibrillation and with peripheral artery disease (PAD) or prior myocardial infarction (MI). Methods Population-based cohort study of patients diagnosed with incident heart failure during 2000–2012 and without atrial fibrillation, identified by record linkage between nationwide registries in Denmark. Hazard rate ratios of ischemic stroke and all-cause death after 1 year of follow-up were used to compare patients with either: a PAD diagnosis; a prior MI diagnosis; or no vascular disease. Results 39,357 heart failure patients were included. When compared to heart failure patients with no vascular disease, PAD was associated with a higher 1-year rate of ischemic stroke (adjusted hazard rate ratio [HR]: 1.34, 95% confidence interval [CI]: 1.08–1.65) and all-cause death (adjusted HR: 1.47, 95% CI: 1.35–1.59), whereas prior MI was not (adjusted HR: 1.00, 95% CI: 0.86–1.15 and 0.94, 95% CI: 0.89–1.00, for ischemic stroke and all-cause death, respectively). When comparing patients with PAD to patients with prior MI, PAD was associated with a higher rate of both outcomes. Conclusions Among incident heart failure patients without diagnosed atrial fibrillation, a previous diagnosis of PAD was associated with a significantly higher rate of the ischemic stroke and all-cause death compared to patients with no vascular disease or prior MI. Prevention strategies may be particularly relevant among HF patients with PAD. PMID:27015524

  11. Wound healing and all-cause mortality in 958 wound patients treated in home care.

    PubMed

    Zarchi, Kian; Martinussen, Torben; Jemec, Gregor B E

    2015-09-01

    Skin wounds are associated with significant morbidity and mortality. Data are, however, not readily available for benchmarking, to allow prognostic evaluation, and to suggest when involvement of wound-healing experts is indicated. We, therefore, conducted an observational cohort study to investigate wound healing and all-cause mortality associated with different types of skin wounds. Consecutive skin wound patients who received wound care by home-care nurses from January 2010 to December 2011 in a district in Eastern Denmark were included in this study. Patients were followed until wound healing, death, or the end of follow-up on December 2012. In total, 958 consecutive patients received wound care by home-care nurses, corresponding to a 1-year prevalence of 1.2% of the total population in the district. During the study, wound healing was achieved in 511 (53.3%), whereas 90 (9.4%) died. During the first 3 weeks of therapy, healing was most likely to occur in surgical wounds (surgical vs. other wounds: adjusted hazard ratio [AHR] 2.21, 95% confidence interval 1.50-3.23), while from 3 weeks to 3 months of therapy, cancer wounds, and pressure ulcers were least likely to heal (cancer vs. other wounds: AHR 0.12, 0.03-0.50; pressure vs. other wounds: AHR 0.44, 0.27-0.74). Cancer wounds and pressure ulcers were further associated with a three times increased probability of mortality compared with other wounds (cancer vs. other wounds: AHR 3.19, 1.35-7.50; pressure vs. other wounds: AHR 2.91, 1.56-5.42). In summary, the wound type was found to be a significant predictor of healing and mortality with cancer wounds and pressure ulcers being associated with poor prognosis.

  12. High Blood Pressure and All-Cause and Cardiovascular Disease Mortalities in Community-Dwelling Older Adults.

    PubMed

    Wu, Chen-Yi; Hu, Hsiao-Yun; Chou, Yiing-Jenq; Huang, Nicole; Chou, Yi-Chang; Li, Chung-Pin

    2015-11-01

    Although hypertension is common among older adults, the optimal blood pressure (BP) for survival in older adults remains unclear. We attempt to use a large cohort to assess the relationship between BP and mortality and to gain insight into what level of BP is required for optimal survival in older adults.A total of 77,389 community-dwelling adults, aged ≥65 years, were followed between 2006 and 2010. Mortality was determined using matching cohort identifications with national death files. Cox proportional hazards regression models were used to evaluate the relationship of BP with all-cause, cardiovascular disease (CVD), and expanded-CVD mortalities.The mortality risks of the stage 2-3 hypertension group were substantial (all-cause mortality: hazard ratio [HR]: 1.23; 95% confidence interval [CI]: 1.10-1.37; CVDs mortality: HR: 1.31; 95% CI: 1.05-1.64; expanded-CVDs mortality: HR: 1.40; 95% CI: 1.15-1.71). The cardiovascular and expanded-cardiovascular mortality risks were lowest when systolic blood pressures were 120 to 129 mm Hg, and increased significantly when systolic blood pressures (SBPs) were ≥160 mm Hg or diastolic BPs were ≥90 mm Hg. A J-curve phenomenon for SBP on CVD and expanded-CVD mortality was observed. The impacts of stage 2-3 hypertension on mortality risks were significantly increased among women. The mortality risks of hypertension were not attenuated with older age.This study provides insight for identifying the optimal BP for survival in older adults, and extends the knowledge of the impacts of hypertension on mortality risks among women and the older adults.

  13. Body mass index before and after breast cancer diagnosis: Associations with all-cause, breast cancer, and cardiovascular disease mortality

    PubMed Central

    Nichols, Hazel B.; Trentham-Dietz, Amy; Egan, Kathleen M.; Titus-Ernstoff, Linda; Holmes, Michelle D.; Bersch, Andrew J.; Holick, Crystal N.; Hampton, John M.; Stampfer, Meir J.; Willett, Walter C.; Newcomb, Polly A.

    2009-01-01

    Background Factors related to improving outcomes in breast cancer survivors are of increasing public health significance. We examined post-diagnosis weight change in relation to mortality risk in a cohort of breast cancer survivors. Methods We analyzed data from a cohort of 3,993 women aged 20−79 living in New Hampshire, Massachusetts or Wisconsin with invasive, nonmetastatic breast cancers diagnosed in 1988−1999 identified through state registries. Participants completed a structured telephone interview 1−2 years after diagnosis and returned a mailed follow-up questionnaire in 1998−2001 that addressed post-diagnosis weight and other factors. Vital status information was obtained from the National Death Index through December 2005. Hazard ratios (HR) and 95% confidence intervals (CI) were estimated from Cox proportional hazards models and adjusted for pre-diagnosis weight, age, stage, smoking, physical activity and other important covariates. Results During an average 6.3 years of follow-up from the post-diagnosis questionnaire, we identified 421 total deaths, including 121 deaths from breast cancer and 95 deaths from cardiovascular disease. Increasing post-diagnosis weight gain and weight loss were each associated with greater all-cause mortality. Among women who gained weight after breast cancer diagnosis, each 5 kg gain was associated with a 12% increase in all-cause mortality (p=0.004), a 13% increase in breast cancer-specific mortality (p=0.01), and a 19% increase in cardiovascular disease mortality (p=0.04). Associations with breast cancer mortality were not modified by pre-diagnosis menopausal status, cigarette smoking, or body mass index. Conclusion These findings suggest that efforts to minimize weight gain after a breast cancer diagnosis may improve survival. PMID:19366908

  14. High Blood Pressure and All-Cause and Cardiovascular Disease Mortalities in Community-Dwelling Older Adults

    PubMed Central

    Wu, Chen-Yi; Hu, Hsiao-Yun; Chou, Yiing-Jenq; Huang, Nicole; Chou, Yi-Chang; Li, Chung-Pin

    2015-01-01

    Abstract Although hypertension is common among older adults, the optimal blood pressure (BP) for survival in older adults remains unclear. We attempt to use a large cohort to assess the relationship between BP and mortality and to gain insight into what level of BP is required for optimal survival in older adults. A total of 77,389 community-dwelling adults, aged ≥65 years, were followed between 2006 and 2010. Mortality was determined using matching cohort identifications with national death files. Cox proportional hazards regression models were used to evaluate the relationship of BP with all-cause, cardiovascular disease (CVD), and expanded-CVD mortalities. The mortality risks of the stage 2–3 hypertension group were substantial (all-cause mortality: hazard ratio [HR]: 1.23; 95% confidence interval [CI]: 1.10–1.37; CVDs mortality: HR: 1.31; 95% CI: 1.05–1.64; expanded-CVDs mortality: HR: 1.40; 95% CI: 1.15–1.71). The cardiovascular and expanded-cardiovascular mortality risks were lowest when systolic blood pressures were 120 to 129 mm Hg, and increased significantly when systolic blood pressures (SBPs) were ≥160 mm Hg or diastolic BPs were ≥90 mm Hg. A J-curve phenomenon for SBP on CVD and expanded-CVD mortality was observed. The impacts of stage 2–3 hypertension on mortality risks were significantly increased among women. The mortality risks of hypertension were not attenuated with older age. This study provides insight for identifying the optimal BP for survival in older adults, and extends the knowledge of the impacts of hypertension on mortality risks among women and the older adults. PMID:26632749

  15. Prospective study of coffee consumption and all-cause, cancer, and cardiovascular mortality in Swedish women.

    PubMed

    Löf, Marie; Sandin, Sven; Yin, Li; Adami, Hans-Olov; Weiderpass, Elisabete

    2015-09-01

    We investigated whether coffee consumption was associated with all-cause, cancer, or cardiovascular mortality in a prospective cohort of 49,259 Swedish women. Of the 1576 deaths that occurred in the cohort, 956 were due to cancer and 158 were due to cardiovascular disease. We used Cox proportional hazard models with adjustment for potential confounders to estimate multivariable relative risks (RR) and 95 % confidence intervals (CI). Compared to a coffee consumption of 0-1 cups/day, the RR for all cause-mortality was 0.81 (95 % CI 0.69-0.94) for 2-5 cups/day and 0.88 (95 % CI 0.74-1.05) for >5 cups/day. Coffee consumption was not associated with cancer mortality or cardiovascular mortality when analyzed in the entire cohort. However, in supplementary analyses of women over 50 years of age, the RR for all cause-mortality was 0.74 (95 % CI 0.62-0.89) for 2-5 cups/day and 0.86 (95 % CI 0.70-1.06) for >5 cups/day when compared to 0-1 cups/day. In this same subgroup, the RRs for cancer mortality were 1.06 (95 % CI 0.81-1.38) for 2-5 cups/day and 1.40 (95 % CI 1.05-1.89) for >5 cups/day when compared to 0-1 cups/day. No associations between coffee consumption and all-cause mortality, cancer mortality, or cardiovascular mortality were observed among women below 50 years of age. In conclusion, higher coffee consumption was associated with lower all-cause mortality when compared to a consumption of 0-1 cups/day. Furthermore, coffee may have differential effects on mortality before and after 50 years of age.

  16. All-Cause and External Mortality in Released Prisoners: Systematic Review and Meta-Analysis

    PubMed Central

    Zlodre, Jakov

    2012-01-01

    Objectives. We systematically reviewed studies of mortality following release from prison and examined possible demographic and methodological factors associated with variation in mortality rates. Methods. We searched 5 computer-based literature indexes to conduct a systematic review of studies that reported all-cause, drug-related, suicide, and homicide deaths of released prisoners. We extracted and meta-analyzed crude death rates and standardized mortality ratios by age, gender, and race/ethnicity, where reported. Results. Eighteen cohorts met review criteria reporting 26 163 deaths with substantial heterogeneity in rates. The all-cause crude death rates ranged from 720 to 2054 per 100 000 person-years. Male all-cause standardized mortality ratios ranged from 1.0 to 9.4 and female standardized mortality ratios from 2.6 to 41.3. There were higher standardized mortality ratios in White, female, and younger prisoners. Conclusions. Released prisoners are at increased risk for death following release from prison, particularly in the early period. Aftercare planning for released prisoners could potentially have a large public health impact, and further work is needed to determine whether certain groups should be targeted as part of strategies to reduce mortality. PMID:23078476

  17. Effect of Urate-Lowering Therapy on All-Cause and Cardiovascular Mortality in Hyperuricemic Patients without Gout: A Case-Matched Cohort Study

    PubMed Central

    Chen, Jiunn-Horng; Lan, Joung-Liang; Cheng, Chi-Fung; Liang, Wen-Miin; Lin, Hsiao-Yi; Tsay, Gregory J; Yeh, Wen-Ting; Pan, Wen-Harn

    2015-01-01

    Objectives An increased risk of mortality in patients with hyperuricemia has been reported. We examined (1) the risk of all-cause and cardiovascular disease (CVD) mortality in untreated hyperuricemic patients who did not receive urate-lowering therapy (ULT), and (2) the impact of ULT on mortality risk in patients with hyperuricemia. Methods In this retrospective case-matched cohort study during a mean follow-up of 6.4 years, 40,118 Taiwanese individuals aged ≥17 years who had never used ULT and who had never had gout were examined. The mortality rate was compared between 3,088 hyperuricemic patients who did not receive ULT and reference subjects (no hyperuricemia, no gout, no ULT) matched for age and sex (1:3 hyperuricemic patients/reference subjects), and between 1,024 hyperuricemic patients who received ULT and 1,024 hyperuricemic patients who did not receive ULT (matched 1:1 based on their propensity score and the index date of ULT prescription). Cox proportional hazard modeling was used to estimate the respective risk of all-cause and CVD (ICD-9 code 390–459) mortality. Results After adjustment, hyperuricemic patients who did not receive ULT had increased risks of all-cause (hazard ratio, 1.24; 95% confidence interval, 0.97–1.59) and CVD (2.13; 1.34–3.39) mortality relative to the matched reference subjects. Hyperuricemic patients treated with ULT had a lower risk of all-cause death (0.60; 0.41–0.88) relative to hyperuricemic patients who did not receive ULT. Conclusion Under-treatment of hyperuricemia has serious negative consequences. Hyperuricemic patients who received ULT had potentially better survival than patients who did not. PMID:26683302

  18. Past recreational physical activity, body size, and all-cause mortality following breast cancer diagnosis: results from the Breast Cancer Family Registry

    PubMed Central

    Keegan, Theresa H. M.; Milne, Roger L.; Andrulis, Irene L.; Chang, Ellen T.; Sangaramoorthy, Meera; Phillips, Kelly-Anne; Giles, Graham G.; Goodwin, Pamela J.; Apicella, Carmel; Hopper, John L.; Whittemore, Alice S.; John, Esther M.

    2010-01-01

    Few studies have considered the joint association of body mass index (BMI) and physical activity, two modifiable factors, with all-cause mortality after breast cancer diagnosis. Women diagnosed with invasive breast cancer (n=4,153) between 1991 and 2000 were enrolled in the Breast Cancer Family Registry through population-based sampling in Northern California, USA; Ontario, Canada; and Melbourne and Sydney, Australia. During a median follow-up of 7.8 years, 725 deaths occurred. Baseline questionnaires assessed moderate and vigorous recreational physical activity and BMI prior to diagnosis. Associations with all-cause mortality were assessed using Cox proportional hazards regression, adjusting for established prognostic factors. Compared with no physical activity, any recreational activity during the three years prior to diagnosis was associated with a 34% lower risk of death (hazard ratio (HR) = 0.66, 95% confidence interval (CI): 0.51-0.85) for women with estrogen receptor (ER)-positive tumors, but not those with ER-negative tumors; this association did not appear to differ by race/ethnicity or BMI. Lifetime physical activity was not associated with all-cause mortality. BMI was positively associated with all-cause mortality for women diagnosed at age ≥50 years with ER-positive tumors (compared with normal-weight women, HR for overweight = 1.39, 95% CI: 0.90-2.15; HR for obese = 1.77, 95% CI: 1.11-2.82). BMI associations did not appear to differ by race/ethnicity. Our findings suggest that physical activity and BMI exert independent effects on overall mortality after breast cancer. PMID:20140702

  19. All-cause, cardiovascular, and cancer mortality rates in postmenopausal white, black, Hispanic, and Asian women with and without diabetes in the United States: the Women's Health Initiative, 1993-2009.

    PubMed

    Ma, Yunsheng; Hébert, James R; Balasubramanian, Raji; Wedick, Nicole M; Howard, Barbara V; Rosal, Milagros C; Liu, Simin; Bird, Chloe E; Olendzki, Barbara C; Ockene, Judith K; Wactawski-Wende, Jean; Phillips, Lawrence S; Lamonte, Michael J; Schneider, Kristin L; Garcia, Lorena; Ockene, Ira S; Merriam, Philip A; Sepavich, Deidre M; Mackey, Rachel H; Johnson, Karen C; Manson, Joann E

    2013-11-15

    Using data from the Women's Health Initiative (1993-2009; n = 158,833 participants, of whom 84.1% were white, 9.2% were black, 4.1% were Hispanic, and 2.6% were Asian), we compared all-cause, cardiovascular, and cancer mortality rates in white, black, Hispanic, and Asian postmenopausal women with and without diabetes. Cox proportional hazard models were used for the comparison from which hazard ratios and 95% confidence intervals were computed. Within each racial/ethnic subgroup, women with diabetes had an approximately 2-3 times higher risk of all-cause, cardiovascular, and cancer mortality than did those without diabetes. However, the hazard ratios for mortality outcomes were not significantly different between racial/ethnic subgroups. Population attributable risk percentages (PARPs) take into account both the prevalence of diabetes and hazard ratios. For all-cause mortality, whites had the lowest PARP (11.1, 95% confidence interval (CI): 10.1, 12.1), followed by Asians (12.9, 95% CI: 4.7, 20.9), blacks (19.4, 95% CI: 15.0, 23.7), and Hispanics (23.2, 95% CI: 14.8, 31.2). To our knowledge, the present study is the first to show that hazard ratios for mortality outcomes were not significantly different between racial/ethnic subgroups when stratified by diabetes status. Because of the "amplifying" effect of diabetes prevalence, efforts to reduce racial/ethnic disparities in the rate of death from diabetes should focus on prevention of diabetes.

  20. Association Between Interstitial Lung Abnormalities and All-Cause Mortality

    PubMed Central

    Putman, Rachel K.; Hatabu, Hiroto; Araki, Tetsuro; Gudmundsson, Gunnar; Gao, Wei; Nishino, Mizuki; Okajima, Yuka; Dupuis, Josée; Latourelle, Jeanne C.; Cho, Michael H.; El-Chemaly, Souheil; Coxson, Harvey O.; Celli, Bartolome R.; Fernandez, Isis E.; Zazueta, Oscar E.; Ross, James C.; Harmouche, Rola; Estépar, Raúl San José; Diaz, Alejandro A.; Sigurdsson, Sigurdur; Gudmundsson, Elías F.; Eiríksdottír, Gudny; Aspelund, Thor; Budoff, Matthew J.; Kinney, Gregory L.; Hokanson, John E.; Williams, Michelle C; Murchison, John T.; MacNee, William; Hoffmann, Udo; O’Donnell, Christopher J.; Launer, Lenore J.; Harrris, Tamara B.; Gudnason, Vilmundur; Silverman, Edwin K.; O’Connor, George T.; Washko, George R.; Rosas, Ivan O.; Hunninghake, Gary M.

    2016-01-01

    IMPORTANCE Interstitial lung abnormalities have been associated with decreased six-minute walk distance, diffusion capacity for carbon monoxide and total lung capacity; however to our knowledge, an association with mortality has not been previously investigated. OBJECTIVE To investigate whether interstitial lung abnormalities are associated with increased mortality. DESIGN, SETTING, POPULATION Prospective cohort studies of 2633 participants from the Framingham Heart Study (FHS) (CT scans obtained 9/08–3/11), 5320 from the Age Gene/Environment Susceptibility (AGES)-Reykjavik (recruited 1/02–2/06), 2068 from COPDGene (recruited 11/07–4/10), and 1670 from the Evaluation of COPD Longitudinally to Identify Predictive Surrogate End-points (ECLIPSE) (between 12/05–12/06). EXPOSURES Interstitial lung abnormality status as determined by chest CT evaluation. MAIN OUTCOMES AND MEASURES All cause mortality over approximately 3 to 9 year median follow up time. Cause-of-death information was also examined in the AGES-Reykjavik cohort. RESULTS Interstitial lung abnormalities were present in 177 (7%) of the participants from FHS, 378 (7%) from AGES-Reykjavik, 156 (8%) from COPDGene, and in 157 (9%) from ECLIPSE. Over median follow-up times of ~3–9 years there were more deaths (and a greater absolute rate of mortality) among those with interstitial lung abnormalities compared to those without interstitial lung abnormalities in each cohort; 7% compared to 1% in FHS (6% difference, 95% confidence interval [CI] 2%, 10%), 56% compared to 33% in AGES-Reykjavik (23% difference, 95% CI 18%, 28%), 16% compared to 11% in COPDGene (5% difference, 95% CI −1%, 11%) and 11% compared to 5% in ECLIPSE (6% difference, 95% CI 1%, 11%). After adjustment for covariates, interstitial lung abnormalities were associated with an increase in the risk of death in the FHS (HR=2.7, 95% CI, 1.1–65, P=0.030), AGES-Reykjavik (HR 1.3, 95% CI 1.2–1.4, P<0.001), COPDGene (HR=1.8, 95% CI, 1.1, 2

  1. Relation of digoxin use in atrial fibrillation and the risk of all-cause mortality in patients ≥65 years of age with versus without heart failure.

    PubMed

    Shah, Mitesh; Avgil Tsadok, Meytal; Jackevicius, Cynthia A; Essebag, Vidal; Behlouli, Hassan; Pilote, Louise

    2014-08-01

    Previous studies on digoxin use in patients with atrial fibrillation (AF) and the risk of all-cause mortality found conflicting results. We conducted a population-based, retrospective, cohort study of patients aged ≥65 years admitted to a hospital with a primary or secondary diagnosis of AF, in Quebec province, Canada, from 1998 to 2012. The AF cohort was grouped into patients with and without heart failure (HF) and into digoxin and no-digoxin users according to the first prescription filled for digoxin within 30 days after AF hospital discharge. We derived propensity score-matched digoxin and no-digoxin treatment groups for the groups of patients with and without HF, respectively, and conducted multivariable Cox proportional hazards regression analyses to determine association between digoxin use and all-cause mortality. The AF propensity score-matched cohorts of patients with and without HF were well balanced on baseline characteristics. In the propensity score-matched HF group, digoxin use was associated with a 14% greater risk of all-cause mortality (adjusted hazard ratio 1.14, 95% confidence interval 1.10 to 1.17). In the propensity score-matched no-HF group, digoxin use was associated with a 17% greater risk of all-cause mortality (adjusted hazard ratio 1.17, 95% confidence interval 1.14 to 1.19). In conclusion, our retrospective analyses found that digoxin use was associated with a greater risk for all-cause mortality in patients aged ≥65 years with AF regardless of concomitant HF. Large, multicenter, randomized controlled trials or prospective cohort studies are required to clarify this issue.

  2. Depression or anxiety and all-cause mortality in adults with atrial fibrillation – A cohort study in Swedish primary care

    PubMed Central

    Wändell, Per; Carlsson, Axel C.; Gasevic, Danijela; Wahlsträm, Lars; Sundquist, Jan; Sundquist, Kristina

    2016-01-01

    Objective Our aim was to study depression and anxiety in atrial fibrillation (AF) patients as risk factors for all-cause mortality in a primary care setting. Methods The study population included adults (n = 12 283) of 45 years and older diagnosed with AF in 75 primary care centres in Sweden. The association between depression or anxiety and all-cause mortality was explored using Cox regression analysis, with hazard ratios (HRs) and 95% confidence intervals (95% CIs). Analyses were conducted in men and women, adjusted for age, educational level, marital status, neighborhood socio-economic status (SES), change of neighborhood status and anxiety or depression, respectively, and cardiovascular co-morbidities. As a secondary analysis, background factors and their association with depression or anxiety were explored. Results The risk of all-cause mortality was higher among men with depression compared to their counterparts without depression even after full adjustment (HR = 1.28, 95% CI 1.08–1.53). For anxiety among men and anxiety or depression among women with AF, no associations were found. Cerebrovascular disease was more common among depressed AF patients. Conclusions Increased awareness of the higher mortality among men with AF and subsequent depression is called for. We suggest a tight follow-up and treatment of both ailments in clinical practice. PMID:26758363

  3. Beyond Core Indicators of Retention in HIV Care: Missed Clinic Visits Are Independently Associated With All-Cause Mortality

    PubMed Central

    Mugavero, Michael J.; Westfall, Andrew O.; Cole, Stephen R.; Geng, Elvin H.; Crane, Heidi M.; Kitahata, Mari M.; Mathews, W. Christopher; Napravnik, Sonia; Eron, Joseph J.; Moore, Richard D.; Keruly, Jeanne C.; Mayer, Kenneth H.; Giordano, Thomas P.; Raper, James L.

    2014-01-01

    Background. The continuum of care is at the forefront of the domestic human immunodeficiency virus (HIV) agenda, with the Institute of Medicine (IOM) and Department of Health and Human Services (DHHS) recently releasing clinical core indicators. Core indicators for retention in care are calculated based on attended HIV care clinic visits. Beyond these retention core indicators, we evaluated the additional prognostic value of missed clinic visits for all-cause mortality. Methods. We conducted a multisite cohort study of 3672 antiretroviral-naive patients initiating antiretroviral therapy (ART) during 2000–2010. Retention in care was measured by the IOM and DHHS core indicators (2 attended visits at defined intervals per 12-month period), and also as a count of missed primary HIV care visits (no show) during a 24-month measurement period following ART initiation. All-cause mortality was ascertained by query of the Social Security Death Index and/or National Death Index, with adjusted survival analyses starting at 24 months after ART initiation. Results. Among participants, 64% and 59% met the IOM and DHHS retention core indicators, respectively, at 24 months. Subsequently, 332 patients died during 16 102 person-years of follow-up. Failure to achieve the IOM and DHHS indicators through 24 months following ART initiation increased mortality (hazard ratio [HR] = 2.23; 95% confidence interval [CI], 1.79–2.80 and HR = 2.36; 95% CI, 1.89–2.96, respectively). Among patients classified as retained by the IOM or DHHS clinical core indicators, >2 missed visits further increased mortality risk (HR = 3.61; 95% CI, 2.35–5.55 and HR = 3.62; 95% CI, 2.30–5.68, respectively). Conclusions. Beyond HIV retention core indicators, missed clinic visits were independently associated with all-cause mortality. Caution is warranted in relying solely upon retention in care core indicators for policy, clinical, and programmatic purposes. PMID:25091306

  4. The combined relationship of occupational and leisure-time physical activity with all-cause mortality among men, accounting for physical fitness.

    PubMed

    Clays, Els; Lidegaard, Mark; De Bacquer, Dirk; Van Herck, Koen; De Backer, Guy; Kittel, France; de Smet, Patrick; Holtermann, Andreas

    2014-03-01

    The aim of this study was to assess the combined relationship of occupational physical activity and leisure-time physical activity with all-cause mortality among men, while accounting for physical fitness. The prospective Belgian Physical Fitness Study included 1,456 male workers aged 40-55 years who were free of coronary heart disease at baseline. Baseline data were collected through questionnaires and clinical examinations from 1976 to 1978. To estimate physical fitness, a submaximal graded exercise test was performed on a bicycle ergometer. Total mortality was registered during a mean follow-up period of 16.9 years. Main results were obtained through Cox proportional hazards regression analysis. A total of 145 deaths were registered during follow-up. After adjustment for confounders, a significantly increased mortality rate was observed in workers who had low levels of both physical activity types (hazard ratio = 2.07, 95% confidence interval: 1.03, 4.19) but also in workers combining high occupational physical activity and low leisure-time physical activity (hazard ratio = 2.04, 95% confidence interval: 1.07, 3.91); the latter finding was particularly pronounced among workers with a low physical fitness level. The present results confirm the existence of a complex interplay among different physical activity settings and fitness levels in predicting mortality.

  5. All-cause mortality risk in elderly individuals with disabilities: a retrospective observational study

    PubMed Central

    Wu, Li-Wei; Chen, Wei-Liang; Peng, Tao-Chun; Chiang, Sheng-Ta; Yang, Hui-Fang; Sun, Yu-Shan; Chan, James Yi-Hsin; Kao, Tung-Wei

    2016-01-01

    Objectives Disability is considered an important issue that affects the elderly population. This study aimed to explore the relationship between disability and all-cause mortality in US elderly individuals. Design Retrospective and longitudinal designs. Setting Data from the National Health and Nutrition Examination Survey (NHANES 1999–2002) conducted by the National Center for Health Statistics of the Centers for Disease Control and Prevention. Participants A total of 1834 participants in the age range 60–84 years from NHANES 1999–2002. Main outcome measures We acquired five major domains of disability (activities of daily living (ADL), general physical activities (GPA), instrumental ADL (IADL), lower extremity mobility (LEM) and leisure and social activities (LSA)) through self-reporting. We applied an extended-model approach with Cox (proportional hazards) regression analysis to investigate the relationship between different features of disability and all-cause mortality risk in the study population. Results During a mean follow-up of 5.7 years, 77 deaths occurred. An increased risk of all-cause mortality was identified in elderly individuals with disability after adjustment for potential confounders (HR 2.23; 95% CI 1.29 to 3.85; p=0.004). Participants with more than one domain of disability were associated with a higher risk of mortality (ptrend=0.047). Adjusted HRs and 95% CIs for each domain of disability were 2.53 (1.49 to 4.31), 1.99 (0.93 to 4.29), 1.74 (0.72 to 4.16), 1.57 (0.76 to 3.27) and 1.52 (0.93 to 2.48) for LEM, LSA, ADL, IADL and GPA, respectively. Conclusions The results of this study support an increased association between disability and all-cause mortality in the elderly in the USA. Disability in LEM may be a good predictor of high risk of all-cause mortality in elderly subjects. PMID:27625055

  6. Changes in Traffic Exposure and the Risk of Incident Myocardial Infarction and All-Cause Mortality

    PubMed Central

    Hart, Jaime E.; Rimm, Eric B.; Rexrode, Kathryn M.; Laden, Francine

    2014-01-01

    Background Traffic related exposures, such as air pollution and noise, have been associated with increased cardiovascular morbidity and mortality. Few studies, however, have been able to examine the effects of changes in exposure on changes in risk. Our objective was to explore the associations of changes in traffic exposure with changes in risk 1990–2008 in the Nurses’ Health Study. Methods Incident myocardial infarction (MI) and all-cause mortality were prospectively identified. As a proxy for traffic exposure, we calculated residential distance to roads at all residential addresses 1986–2006, and considered addresses to be “close” or “far” based on distance and road type. To examine the effect of changes in exposure, each consecutive pair of addresses was categorized as: (1) consistently close, (2) consistently far, (3) change from close to far, and (4) change from far to close. We also examined the change in NO2 levels between address pairs. Results In time-varying Cox proportional hazards models adjusted for a variety of risk factors, women living at residences consistently close to traffic were at a higher risk of an incident MI (HR= 1.11; 95% confidence interval = 1.01 – 1.22) and a higher risk of all-cause mortality (1.05; 1.00 – 1.10), compared with those consistently far. The highest risks were seen among women who moved from being far from traffic to close (incident MI: HR=1.50 (95%CI: (1.11–2.03); all-cause mortality: HR=1.17 (95%CI: 1.00–1.37)). Each 1ppb increase in NO2 compared with the previous address was associated with a HR=1.22 for incident MI (95%CI: 0.99–1.50). 1.03 for all-cause mortality (95%CI: 0.92–1.15). Conclusions Our results suggest that changes in traffic exposure (measured as roadway proximity or change in NO2 levels) are associated with changes in risk of MI and all-cause mortality. PMID:23877047

  7. Change of Nutritional Status Assessed Using Subjective Global Assessment Is Associated With All-Cause Mortality in Incident Dialysis Patients

    PubMed Central

    Kwon, Young Eun; Kee, Youn Kyung; Yoon, Chang-Yun; Han, In Mee; Han, Seung Gyu; Park, Kyoung Sook; Lee, Mi Jung; Park, Jung Tak; Han, Seung H.; Yoo, Tae-Hyun; Kim, Yong-Lim; Kim, Yon Su; Yang, Chul Woo; Kim, Nam-Ho; Kang, Shin-Wook

    2016-01-01

    Abstract Subjective global assessment (SGA) is associated with mortality in end-stage renal disease (ESRD) patients. However, little is known whether improvement or deterioration of nutritional status after dialysis initiation influences the clinical outcome. We aimed to elucidate the association between changes in nutritional status determined by SGA during the first year of dialysis and all-cause mortality in incident ESRD patients. This was a multicenter, prospective cohort study. Incident dialysis patients with available SGA data at both baseline and 12 months after dialysis commencement (n = 914) were analyzed. Nutritional status was defined as well nourished (WN, SGA A) or malnourished (MN, SGA B or C). The patients were divided into 4 groups according to the change in nutritional status between baseline and 12 months after dialysis commencement: group 1, WN to WN; group 2, MN to WN; group 3, WN to MN; and group 4, MN to MN. Cox proportional hazard analysis was performed to clarify the association between changes in nutritional status and mortality. Being in the MN group at 12 months after dialysis initiation, but not at baseline, was a significant risk factor for mortality. There was a significant difference in the 3-year survival rates among the groups (group 1, 92.2%; group 2, 86.0%; group 3, 78.2%; and group 4, 63.5%; log-rank test, P < 0.001). Multivariate Cox regression analysis revealed that the mortality risk was significantly higher in group 3 than in group 1 (hazard ratio [HR] 2.77, 95% confidence interval [CI] 1.27–6.03, P = 0.01) whereas the mortality risk was significantly lower in group 2 compared with group 4 (HR 0.35, 95% CI 0.17–0.71, P < 0.01) even after adjustment for confounding factors. Moreover, mortality risk of group 3 was significantly higher than in group 2 (HR 2.89, 95% CI 1.22–6.81, P = 0.02); there was no significant difference between groups 1 and 2. The changes in nutritional status assessed by SGA

  8. Change of Nutritional Status Assessed Using Subjective Global Assessment Is Associated With All-Cause Mortality in Incident Dialysis Patients.

    PubMed

    Kwon, Young Eun; Kee, Youn Kyung; Yoon, Chang-Yun; Han, In Mee; Han, Seung Gyu; Park, Kyoung Sook; Lee, Mi Jung; Park, Jung Tak; Han, Seung H; Yoo, Tae-Hyun; Kim, Yong-Lim; Kim, Yon Su; Yang, Chul Woo; Kim, Nam-Ho; Kang, Shin-Wook

    2016-02-01

    Subjective global assessment (SGA) is associated with mortality in end-stage renal disease (ESRD) patients. However, little is known whether improvement or deterioration of nutritional status after dialysis initiation influences the clinical outcome. We aimed to elucidate the association between changes in nutritional status determined by SGA during the first year of dialysis and all-cause mortality in incident ESRD patients. This was a multicenter, prospective cohort study. Incident dialysis patients with available SGA data at both baseline and 12 months after dialysis commencement (n = 914) were analyzed. Nutritional status was defined as well nourished (WN, SGA A) or malnourished (MN, SGA B or C). The patients were divided into 4 groups according to the change in nutritional status between baseline and 12 months after dialysis commencement: group 1, WN to WN; group 2, MN to WN; group 3, WN to MN; and group 4, MN to MN. Cox proportional hazard analysis was performed to clarify the association between changes in nutritional status and mortality. Being in the MN group at 12 months after dialysis initiation, but not at baseline, was a significant risk factor for mortality. There was a significant difference in the 3-year survival rates among the groups (group 1, 92.2%; group 2, 86.0%; group 3, 78.2%; and group 4, 63.5%; log-rank test, P < 0.001). Multivariate Cox regression analysis revealed that the mortality risk was significantly higher in group 3 than in group 1 (hazard ratio [HR] 2.77, 95% confidence interval [CI] 1.27-6.03, P = 0.01) whereas the mortality risk was significantly lower in group 2 compared with group 4 (HR 0.35, 95% CI 0.17-0.71, P < 0.01) even after adjustment for confounding factors. Moreover, mortality risk of group 3 was significantly higher than in group 2 (HR 2.89, 95% CI 1.22-6.81, P = 0.02); there was no significant difference between groups 1 and 2. The changes in nutritional status assessed by SGA during the first

  9. The combined impact of adherence to five lifestyle factors on all-cause, cancer and cardiovascular mortality: a prospective cohort study among Danish men and women.

    PubMed

    Petersen, Kristina E N; Johnsen, Nina F; Olsen, Anja; Albieri, Vanna; Olsen, Lise K H; Dragsted, Lars O; Overvad, Kim; Tjønneland, Anne; Egeberg, Rikke

    2015-03-14

    Individual lifestyle factors have been associated with lifestyle diseases and premature mortality by an accumulating body of evidence. The impact of a combination of lifestyle factors on mortality has been investigated in several studies, but few have applied a simple index taking national guidelines into account. The objective of the present prospective cohort study was to investigate the combined impact of adherence to five lifestyle factors (smoking, alcohol intake, physical activity, waist circumference and diet) on all-cause, cancer and cardiovascular mortality based on international and national health recommendations. A Cox proportional hazards model was used to estimate hazard ratios (HR) with 95 % CI. During a median follow-up of 14 years, 3941 men and 2827 women died. Among men, adherence to one additional health recommendation was associated with an adjusted HR of 0·73 (95 % CI 0·71, 0·75) for all-cause mortality, 0·74 (95 % CI 0·71, 0·78) for cancer mortality and 0·70 (95 % CI 0·65, 0·75) for cardiovascular mortality. Among women, the corresponding HR was 0·72 (95 % CI 0·70, 0·75) for all-cause mortality, 0·76 (95 % CI 0·73, 0·80) for cancer mortality and 0·63 (95 % CI 0·57, 0·70) for cardiovascular mortality. In the present study, adherence to merely one additional health recommendation had a protective effect on mortality risk, indicating a huge potential in enhancing healthy lifestyle behaviours of the population. PMID:25690300

  10. Relation of resting heart rate to risk for all-cause mortality by gender after considering exercise capacity (the Henry Ford exercise testing project).

    PubMed

    Aladin, Amer I; Whelton, Seamus P; Al-Mallah, Mouaz H; Blaha, Michael J; Keteyian, Steven J; Juraschek, Stephen P; Rubin, Jonathan; Brawner, Clinton A; Michos, Erin D

    2014-12-01

    Whether resting heart rate (RHR) predicts mortality independent of fitness is not well established, particularly among women. We analyzed data from 56,634 subjects (49% women) without known coronary artery disease or atrial fibrillation who underwent a clinically indicated exercise stress test. Baseline RHR was divided into 5 groups with <60 beats/min as reference. The Social Security Death Index was used to ascertain vital status. Cox hazard models were performed to determine the association of RHR with all-cause mortality, major adverse cardiovascular events, myocardial infarction, or revascularization after sequential adjustment for demographics, cardiovascular disease risk factors, medications, and fitness (metabolic equivalents). The mean age was 53 ± 12 years and mean RHR was 73 ± 12 beats/min. More than half of the participants were referred for chest pain; 81% completed an adequate stress test and mean metabolic equivalents achieved was 9.2 ± 3. There were 6,255 deaths over 11.0-year mean follow-up. There was an increased risk of all-cause mortality with increasing RHR (p trend <0.001). Compared with the lowest RHR group, participants with an RHR ≥90 beats/min had a significantly increased risk of mortality even after adjustment for fitness (hazard ratio 1.22, 95% confidence interval 1.10 to 1.35). This relationship remained significant for men, but not significant for women after adjustment for fitness (p interaction <0.001). No significant associations were seen for men or women with major adverse cardiovascular events, myocardial infarction, or revascularization after accounting for fitness. In conclusion, after adjustment for fitness, elevated RHR was an independent risk factor for all-cause mortality in men but not women, suggesting gender differences in the utility of RHR for risk stratification. PMID:25439450

  11. Losing Life and Livelihood: A Systematic Review and Meta-Analysis of Unemployment and All-Cause Mortality

    PubMed Central

    Roelfs, David J.; Shor, Eran; Davidson, Karina W.; Schwartz, Joseph E.

    2011-01-01

    Unemployment rates in the United States remain near a 25-year high and global unemployment is rising. Previous studies have shown that unemployed persons have an increased risk of death, but the magnitude of the risk and moderating factors have not been explored. The study is a random-effects meta-analysis and meta-regression designed to assess the association between unemployment and all-cause mortality among working-age persons. We extracted 235 mortality risk estimates from 42 studies, providing data on more than 20 million persons. The mean hazard ratio (HR) for mortality was 1.63 among HRs adjusted for age and additional covariates. The mean effect was higher for men than for women. Unemployment was associated with an increased mortality risk for those in their early and middle careers, but less for those in their late-career. The risk of death was highest during the first 10 years of follow up, but decreased subsequently. The mean HR was 24% lower among the subset of studies controlling for health-related behaviors. Public health initiatives could target unemployed persons for more aggressive cardiovascular screening and interventions aimed at reducing risk-taking behaviors. PMID:21330027

  12. Losing life and livelihood: a systematic review and meta-analysis of unemployment and all-cause mortality.

    PubMed

    Roelfs, David J; Shor, Eran; Davidson, Karina W; Schwartz, Joseph E

    2011-03-01

    Unemployment rates in the United States remain near a 25-year high and global unemployment is rising. Previous studies have shown that unemployed persons have an increased risk of death, but the magnitude of the risk and moderating factors have not been explored. The study is a random effects meta-analysis and meta-regression designed to assess the association between unemployment and all-cause mortality among working-age persons. We extracted 235 mortality risk estimates from 42 studies, providing data on more than 20 million persons. The mean hazard ratio (HR) for mortality was 1.63 among HRs adjusted for age and additional covariates. The mean effect was higher for men than for women. Unemployment was associated with an increased mortality risk for those in their early and middle careers, but less for those in their late career. The risk of death was highest during the first 10 years of follow-up, but decreased subsequently. The mean HR was 24% lower among the subset of studies controlling for health-related behaviors. Public health initiatives could target unemployed persons for more aggressive cardiovascular screening and interventions aimed at reducing risk-taking behaviors.

  13. Smoking and Risk of All-cause Deaths in Younger and Older Adults: A Population-based Prospective Cohort Study Among Beijing Adults in China.

    PubMed

    Li, Kuibao; Yao, Chonghua; Di, Xuan; Yang, Xinchun; Dong, Lei; Xu, Li; Zheng, Meili

    2016-01-01

    Cigarette smoking is the leading preventable cause of death worldwide. Few studies, however, have examined the modified effects of age on the association between smoking and all-cause mortality.In the current study, the authors estimated the association between smoking and age-specific mortality in adults from Beijing, China. This is a large community-based prospective cohort study comprising of 6209 Beijing adults (aged ≥40 years) studied for approximately 8 years (1991-1999). Hazard ratios (HRs) and attributable fractions associated with smoking were estimated by Cox proportional hazard models, adjusting for age, sex, alcohol intake, body mass index, systolic blood pressure, hypertension, and heart rate.The results showed, compared with nonsmokers, the multivariable-adjusted HRs for all-cause mortality were 2.7(95% confidence interval (CI):1.56-4.69) in young adult smokers (40-50 years) and 1.31 (95% CI: 1.13-1.52) in old smokers (>50 years); and the interaction term between smoking and age was significant (P = 0.026). Attributable fractions for all-cause mortality in young and old adults were 63% (95% CI: 41%-85%) and 24% (95% CI: 12%-36%), respectively. The authors estimated multivariate adjusted absolute risk (mortality) by Poisson regression and calculated risk differences and 95% CI by bootstrap estimation. Mortality differences (/10,000 person-years) were 15.99 (95% CI: 15.34-16.64) in the young and 74.61(68.57-80.65) in the old. Compared with current smokers, the HRs of all-cause deaths for former smokers in younger and older adults were 0.57 (95% CI: 0.23-1.42) and 0.96 (95% CI: 0.73-1.26), respectively.The results indicate smoking significantly increases the risks of all-cause mortality in both young and old Beijing adults from the relative and absolute risk perspectives. Smoking cessation could also reduce the excess risk of mortality caused by continuing smoking in younger adults compared with older individuals.

  14. Smoking and Risk of All-cause Deaths in Younger and Older Adults: A Population-based Prospective Cohort Study Among Beijing Adults in China.

    PubMed

    Li, Kuibao; Yao, Chonghua; Di, Xuan; Yang, Xinchun; Dong, Lei; Xu, Li; Zheng, Meili

    2016-01-01

    Cigarette smoking is the leading preventable cause of death worldwide. Few studies, however, have examined the modified effects of age on the association between smoking and all-cause mortality.In the current study, the authors estimated the association between smoking and age-specific mortality in adults from Beijing, China. This is a large community-based prospective cohort study comprising of 6209 Beijing adults (aged ≥40 years) studied for approximately 8 years (1991-1999). Hazard ratios (HRs) and attributable fractions associated with smoking were estimated by Cox proportional hazard models, adjusting for age, sex, alcohol intake, body mass index, systolic blood pressure, hypertension, and heart rate.The results showed, compared with nonsmokers, the multivariable-adjusted HRs for all-cause mortality were 2.7(95% confidence interval (CI):1.56-4.69) in young adult smokers (40-50 years) and 1.31 (95% CI: 1.13-1.52) in old smokers (>50 years); and the interaction term between smoking and age was significant (P = 0.026). Attributable fractions for all-cause mortality in young and old adults were 63% (95% CI: 41%-85%) and 24% (95% CI: 12%-36%), respectively. The authors estimated multivariate adjusted absolute risk (mortality) by Poisson regression and calculated risk differences and 95% CI by bootstrap estimation. Mortality differences (/10,000 person-years) were 15.99 (95% CI: 15.34-16.64) in the young and 74.61(68.57-80.65) in the old. Compared with current smokers, the HRs of all-cause deaths for former smokers in younger and older adults were 0.57 (95% CI: 0.23-1.42) and 0.96 (95% CI: 0.73-1.26), respectively.The results indicate smoking significantly increases the risks of all-cause mortality in both young and old Beijing adults from the relative and absolute risk perspectives. Smoking cessation could also reduce the excess risk of mortality caused by continuing smoking in younger adults compared with older individuals. PMID:26817876

  15. Association of blood pressure with all-cause mortality and stroke in Japanese hemodialysis patients: the Japan Dialysis Outcomes and Practice Pattern Study.

    PubMed

    Inaba, Masaaki; Karaboyas, Angelo; Akiba, Takashi; Akizawa, Tadao; Saito, Akira; Fukuhara, Shunichi; Combe, Christian; Robinson, Bruce M

    2014-07-01

    The association of low blood pressure (BP) with high mortality is a characteristic for hemodialysis patients. This analysis clarifies the association of BP with mortality and stroke in Japanese hemodialysis (HD) patients and examines the association separately for patients with and without antihypertensive medication (BP meds). We analyzed 9134 patients from Japan in phases 1-4 (1999-2011) of the Dialysis Outcomes and Practice Patterns Study (DOPPS), a prospective cohort study of in-center HD patients. The association of patient systolic (SBP) and diastolic (DBP) blood pressure with all-cause and cause-specific mortality was assessed using adjusted Cox regression. A U-shaped association between BP and all-cause mortality was observed, with lowest mortality for baseline SBP 140-159 mmHg and DBP 65-74 mmHg. Both SBP and DBP were positively and monotonically associated with stroke-related death: hazard ratio (95% confidence interval) was 1.24 (1.01-1.53) per 20 mmHg higher SBP and 1.23 (1.05-1.44) per 10 mmHg higher DBP. No evidence of interaction was found between SBP and use of BP meds regarding all-cause mortality (P for interaction = 0.97); the association between SBP and stroke-related death was slightly stronger among patients not on BP meds than patients on BP meds (P for interaction = 0.09). In Japanese HD patients, both low and high BP are associated with all-cause mortality. This analysis also documents a positive and monotonic association of BP with stroke-related deaths. Although our analysis indicates that the prescription of BP meds to hypertensive patients might protect against stroke-related death, additional study is warranted. PMID:24629041

  16. Cereal fibre intake and risk of mortality from all causes, CVD, cancer and inflammatory diseases: a systematic review and meta-analysis of prospective cohort studies.

    PubMed

    Hajishafiee, Maryam; Saneei, Parvane; Benisi-Kohansal, Sanaz; Esmaillzadeh, Ahmad

    2016-07-01

    Dietary fibre intake has been associated with a lower risk of mortality; however, findings on the association of different sources of dietary fibre with mortality are conflicting. We performed a systematic review and meta-analysis of the prospective cohort studies to assess the relation between cereal fibre intake and cause-specific mortality. Medline/PubMed, SCOPUS, EMBASE, ISI web of Science and Google scholar were searched up to April 2015. Eligible prospective cohort studies were included if they provided hazard ratios (HR) or relative risks (RR) and corresponding 95 % CI for the association of cereal fibre intake and mortality from all causes, CVD, cancer and inflammatory diseases. The study-specific HR were pooled by using the random-effects model. In total, fourteen prospective studies that examined the association of cereal fibre intake with mortality from all causes (n 48 052 death), CVD (n 16 882 death), cancer (n 19 489 death) and inflammatory diseases (n 1092 death) were included. The pooled adjusted HR of all-cause mortality for the highest v. the lowest category of cereal fibre intake was 0·81 (95 % CI 0·79, 0·83). Consumption of cereal fibre intake was associated with an 18 % lower risk of CVD mortality (RR 0·82; 95 % CI 0·78, 0·86). Moreover, an inverse significant association was observed between cereal fibre intake and risk of death from cancer (RR 0·85; 95 % CI 0·81, 0·89). However, no significant association was seen between cereal fibre intake and inflammation-related mortality. This meta-analysis provides further evidence that cereal fibre intake was protectively associated with mortality from all causes, CVD and cancer. PMID:27193606

  17. Risks of all-cause and suicide mortality in mental disorders: a meta-review

    PubMed Central

    Chesney, Edward; Goodwin, Guy M; Fazel, Seena

    2014-01-01

    A meta-review, or review of systematic reviews, was conducted to explore the risks of all-cause and suicide mortality in major mental disorders. A systematic search generated 407 relevant reviews, of which 20 reported mortality risks in 20 different mental disorders and included over 1.7 million patients and over a quarter of a million deaths. All disorders had an increased risk of all-cause mortality compared with the general population, and many had mortality risks larger than or comparable to heavy smoking. Those with the highest all-cause mortality ratios were substance use disorders and anorexia nervosa. These higher mortality risks translate into substantial (10-20 years) reductions in life expectancy. Borderline personality disorder, anorexia nervosa, depression and bipolar disorder had the highest suicide risks. Notable gaps were identified in the review literature, and the quality of the included reviews was typically low. The excess risks of mortality and suicide in all mental disorders justify a higher priority for the research, prevention, and treatment of the determinants of premature death in psychiatric patients. PMID:24890068

  18. Late-Life Risk Factors for All-Cause Dementia and Differential Dementia Diagnoses in Women: A Prospective Cohort Study.

    PubMed

    Neergaard, Jesper Skov; Dragsbæk, Katrine; Hansen, Henrik Bo; Henriksen, Kim; Christiansen, Claus; Karsdal, Morten Asser

    2016-03-01

    Since the first evidence of a decline in dementia incidence was reported in 2011, the focus on modifiable risk factors has increased. The possibility of risk factor intervention as a prevention strategy has been widely discussed; however, further evidence in relation to risk factors is still needed. The Prospective Epidemiologic Risk Factor (PERF I) study was an observational prospective study of postmenopausal Danish women who were initially examined between 1999 and 2001 (n = 5855). Follow-up data on diagnosis and survival as of December 31, 2014 was retrieved from the National Danish Patient Registry and the National Danish Causes of Death Registry. Cox proportional hazards regression model was applied to calculate adjusted hazard ratios (HR) for selected risk factors for dementia. Of 5512 eligible subjects, 592 developed dementia within the follow-up period of maximum 15 years. The independent factors associated with increased risk of all-cause dementia were depression (HR = 1.75 [95% CI 1.32-2.34]) and impaired fasting glucose levels. A dose-response relationship was observed between fasting glucose level and risk of dementia with HRs of 1.25 [1.05-1.49] and 1.45 [1.03-2.06] for impaired (5.6-6.9 mmol/L) and hyperglycemic (≥7.0 mmol/L) glucose levels, respectively. The factors associated with a decreased risk of dementia were overweight in late-life (HR = 0.75 [0. 62-0.89]) and physical activity at least once weekly (HR = 0.77 [0.61-0.96]). The identified risk factors for dementia in women in late-life are all considered modifiable. This supports the notion that prevention strategies may improve the poor future prospects for dementias in the ageing population.

  19. Racial disparities in all-cause mortality among younger commercially insured women with incident metastatic breast cancer.

    PubMed

    Leopold, Christine; Wagner, Anita K; Zhang, Fang; Lu, Christine Y; Earle, Craig; Nekhlyudov, Larissa; Degnan, Dennis-Ross; Frank Wharam, J

    2016-07-01

    Racial disparities in breast cancer mortality persist and are likely related to multiple factors. Over the past decade, progress has been made in treating metastatic breast cancer, particularly in younger women. Whether disparities exist in this population is unknown. Using administrative claims data between 2000 and 2011 (OptumInsight, Eden Prairie, MN) of members insured through a large national US health insurer, we identified women aged 25-64 years diagnosed with incident metastatic breast cancer diagnosed between November 1, 2000, and December 31, 2008. We examined time from diagnosis to death, with up to 3 years of follow-up. We stratified analyses by geocoded race and socio-economic status, age-at-diagnosis, morbidity score, US region of residence, urban/non-urban, and years of diagnosis. We constructed Kaplan-Meier survival plots and analyzed all-cause mortality using multivariate Cox proportional hazard models. Among 6694 women with incident metastatic breast cancer (78 % Caucasian, 4 % African American, and 18 % other), we found higher mortality rates among women residing in predominantly African American versus Caucasian neighborhoods (hazard ratio (HR) 1.84; 95 % confidence interval, CI 1.39-2.45), women with high versus lower morbidity (HR 1.30 [1.12-1.51]), and women whose incident metastatic diagnosis was during 2000-2004 versus 2005-2008 (HR 1.60 [1.39-1.83]). Caucasian (HR 0.61 [0.52-0.71]) but not African American women (HR not significant) experienced improved mortality in 2005-2008 versus 2000-2004. Despite insured status, African American women and women with multi-morbidity had poorer survival. Only Caucasian women had improved mortality over time. Modifiable risk factors for increased mortality need to be addressed in order to reduce disparities. PMID:27342456

  20. Work and family demands: predictors of all-cause sickness absence in the GAZEL cohort

    PubMed Central

    Sabbath, Erika L.; Melchior, Maria; Goldberg, Marcel; Zins, Marie

    2012-01-01

    Background: The aim of this study is to assess the impact of combined work and family demands on all-cause sickness absence and to examine variation in this relationship by occupational grade and gender. Methods: The study sample consists of 13 179 employees of Electricité de France-Gaz de France (EDF-GDF) who were members of the GAZEL occupational cohort in 1995. Combined work and family demands are assessed based on measures of job strain and number of dependants assessed at baseline (1995). Covariates include occupational grade and demographic, behavioural and social variables assessed at baseline. Ratios of sickness absence days to total person-days contributed by each employee were established from administrative data between baseline and the end of follow-up in 2003. Rate ratios across levels of work–family demands were then calculated. Effect modification by gender and grade of employment was tested. Results: In fully adjusted models, individuals with the highest work–family demands had a rate ratio of sickness absence of 1.78 (95% CI 1.47–2.14) compared with low-demand workers. This association was independent of occupational grade and did not vary with gender. Results were not attributable solely to psychiatric sickness absences. Conclusion: High work–family demands at baseline predict long-term all-cause sickness absence across a socio-economically diverse occupational cohort. PMID:21558153

  1. Relation of blood pressure and all-cause mortality in 180,000 Japanese participants: pooled analysis of 13 cohort studies.

    PubMed

    Murakami, Yoshitaka; Hozawa, Atsushi; Okamura, Tomonori; Ueshima, Hirotsugu

    2008-06-01

    Hypertension is a leading cause of death because of cardiovascular disease and predominantly affects total mortality. To reduce avoidable deaths from hypertension, we need to collect blood pressure data and assess their impact on total mortality. To examine this issue, a meta-analysis of 13 cohort studies was conducted in Japan. Poisson regression was used for estimating all-cause mortality rates and ratios. In the model, blood pressure data were treated as continuous (10-mm Hg increase) and categorical (every 10 mm Hg) according to recommendations of the Seventh Joint National Committee on Prevention, Detection, Evaluation, and Treatment of Hypertension. Potential confounders included body mass index, smoking, drinking, and cohort. The impact of hypertension was measured by the population-attributable fraction. After excluding participants with cardiovascular disease history, 176 389 participants were examined in the analysis. Adjusted mortality rates became larger as the blood pressure increased, and these were more distinct in younger men and women. Hazard ratios also showed the same trends, and these trends were more apparent in younger men (hazard ratio [unit: 10-mm Hg increase] aged 40 to 49 years: systolic blood pressure 1.37 (range: 1.15 to 1.62); diastolic blood pressure 1.46 [range: 1.05 to 2.03]) than older ones (hazard ratio: aged 80 to 89 years: systolic blood pressure 1.09 [range: 1.05 to 1.13]and diastolic blood pressure 1.12 [range: 1.03 to 1.22]). Population-attributable fraction of hypertension was approximately 20% when the normal category was used as a reference level and was 10% when we included the prehypertension group in the reference level. In conclusion, high blood pressure raised the risk of total mortality, and this trend was higher in the younger Japanese population.

  2. Cooking Coal Use and All-Cause and Cause-Specific Mortality in a Prospective Cohort Study of Women in Shanghai, China

    PubMed Central

    Kim, Christopher; Seow, Wei Jie; Shu, Xiao-Ou; Bassig, Bryan A.; Rothman, Nathaniel; Chen, Bingshu E.; Xiang, Yong-Bing; Hosgood, H. Dean; Ji, Bu-Tian; Hu, Wei; Wen, Cuiju; Chow, Wong-Ho; Cai, Qiuyin; Yang, Gong; Gao, Yu-Tang; Zheng, Wei; Lan, Qing

    2016-01-01

    Background: Nearly 4.3 million deaths worldwide were attributable to exposure to household air pollution in 2012. However, household coal use remains widespread. Objectives: We investigated the association of cooking coal and all-cause and cause-specific mortality in a prospective cohort of primarily never-smoking women in Shanghai, China. Methods: A cohort of 74,941 women were followed from 1996 through 2009 with annual linkage to the Shanghai vital statistics database. Cause-specific mortality was identified through 2009. Use of household coal for cooking was assessed through a residential history questionnaire. Cox proportional hazards models estimated the risk of mortality associated with household coal use. Results: In this cohort, 63% of the women ever used coal (n = 46,287). Compared with never coal use, ever use of coal was associated with mortality from all causes [hazard ratio (HR) = 1.12; 95% confidence interval (CI): 1.05, 1.21], cancer (HR = 1.14; 95% CI: 1.03, 1.27), and ischemic heart disease (overall HR = 1.61; 95% CI: 1.14, 2.27; HR for myocardial infarction specifically = 1.80; 95% CI: 1.16, 2.79). The risk of cardiovascular mortality increased with increasing duration of coal use, compared with the risk in never users. The association between coal use and ischemic heart disease mortality diminished with increasing years since cessation of coal use. Conclusions: Evidence from this study suggests that past use of coal among women in Shanghai is associated with excess all-cause mortality, and from cardiovascular diseases in particular. The decreasing association with cardiovascular mortality as the time since last use of coal increased emphasizes the importance of reducing use of household coal where use is still widespread. Citation: Kim C, Seow WJ, Shu XO, Bassig BA, Rothman N, Chen BE, Xiang YB, Hosgood HD III, Ji BT, Hu W, Wen C, Chow WH, Cai Q, Yang G, Gao YT, Zheng W, Lan Q. 2016. Cooking coal use and all-cause and cause-specific mortality in

  3. All-cause and cause-specific mortality of different migrant populations in Europe.

    PubMed

    Ikram, Umar Z; Mackenbach, Johan P; Harding, Seeromanie; Rey, Grégoire; Bhopal, Raj S; Regidor, Enrique; Rosato, Michael; Juel, Knud; Stronks, Karien; Kunst, Anton E

    2016-07-01

    This study aimed to examine differences in all-cause mortality and main causes of death across different migrant and local-born populations living in six European countries. We used data from population and mortality registers from Denmark, England & Wales, France, Netherlands, Scotland, and Spain. We calculated age-standardized mortality rates for men and women aged 0-69 years. Country-specific data were pooled to assess weighted mortality rate ratios (MRRs) using Poisson regression. Analyses were stratified by age group, country of destination, and main cause of death. In six countries combined, all-cause mortality was lower for men and women from East Asia (MRRs 0.66; 95 % confidence interval 0.62-0.71 and 0.76; 0.69-0.82, respectively), and Other Latin America (0.44; 0.42-0.46 and 0.56; 0.54-0.59, respectively) than local-born populations. Mortality rates were similar for those from Turkey. All-cause mortality was higher in men and women from North Africa (1.09; 1.08-1.11 and 1.19; 1.17-1.22, respectively) and Eastern Europe (1.30; 1.27-1.33 and 1.05; 1.01-1.08, respectively), and women from Sub-Saharan Africa (1.34; 1.30-1.38). The pattern differed by age group and country of destination. Most migrants had higher mortality due to infectious diseases and homicide while cancer mortality and suicide were lower. CVD mortality differed by migrant population. To conclude, mortality patterns varied across migrant populations in European countries. Future research should focus both on migrant populations with favourable and less favourable mortality pattern, in order to understand this heterogeneity and to drive policy at the European level. PMID:26362812

  4. All-cause and cause-specific mortality of different migrant populations in Europe.

    PubMed

    Ikram, Umar Z; Mackenbach, Johan P; Harding, Seeromanie; Rey, Grégoire; Bhopal, Raj S; Regidor, Enrique; Rosato, Michael; Juel, Knud; Stronks, Karien; Kunst, Anton E

    2016-07-01

    This study aimed to examine differences in all-cause mortality and main causes of death across different migrant and local-born populations living in six European countries. We used data from population and mortality registers from Denmark, England & Wales, France, Netherlands, Scotland, and Spain. We calculated age-standardized mortality rates for men and women aged 0-69 years. Country-specific data were pooled to assess weighted mortality rate ratios (MRRs) using Poisson regression. Analyses were stratified by age group, country of destination, and main cause of death. In six countries combined, all-cause mortality was lower for men and women from East Asia (MRRs 0.66; 95 % confidence interval 0.62-0.71 and 0.76; 0.69-0.82, respectively), and Other Latin America (0.44; 0.42-0.46 and 0.56; 0.54-0.59, respectively) than local-born populations. Mortality rates were similar for those from Turkey. All-cause mortality was higher in men and women from North Africa (1.09; 1.08-1.11 and 1.19; 1.17-1.22, respectively) and Eastern Europe (1.30; 1.27-1.33 and 1.05; 1.01-1.08, respectively), and women from Sub-Saharan Africa (1.34; 1.30-1.38). The pattern differed by age group and country of destination. Most migrants had higher mortality due to infectious diseases and homicide while cancer mortality and suicide were lower. CVD mortality differed by migrant population. To conclude, mortality patterns varied across migrant populations in European countries. Future research should focus both on migrant populations with favourable and less favourable mortality pattern, in order to understand this heterogeneity and to drive policy at the European level.

  5. Traffic air pollution and mortality from cardiovascular disease and all causes: a Danish cohort study

    PubMed Central

    2012-01-01

    Background Traffic air pollution has been linked to cardiovascular mortality, which might be due to co-exposure to road traffic noise. Further, personal and lifestyle characteristics might modify any association. Methods We followed up 52 061 participants in a Danish cohort for mortality in the nationwide Register of Causes of Death, from enrollment in 1993–1997 through 2009, and traced their residential addresses from 1971 onwards in the Central Population Registry. We used dispersion-modelled concentration of nitrogen dioxide (NO2) since 1971 as indicator of traffic air pollution and used Cox regression models to estimate mortality rate ratios (MRRs) with adjustment for potential confounders. Results Mean levels of NO2 at the residence since 1971 were significantly associated with mortality from cardiovascular disease (MRR, 1.26; 95% confidence interval [CI], 1.06–1.51, per doubling of NO2 concentration) and all causes (MRR, 1.13; 95% CI, 1.04–1.23, per doubling of NO2 concentration) after adjustment for potential confounders. For participants who ate < 200 g of fruit and vegetables per day, the MRR was 1.45 (95% CI, 1.13–1.87) for mortality from cardiovascular disease and 1.25 (95% CI, 1.11–1.42) for mortality from all causes. Conclusions Traffic air pollution is associated with mortality from cardiovascular diseases and all causes, after adjustment for traffic noise. The association was strongest for people with a low fruit and vegetable intake. PMID:22950554

  6. Objectively Measured Daily Steps and Subsequent Long Term All-Cause Mortality: The Tasped Prospective Cohort Study

    PubMed Central

    Dwyer, Terence; Pezic, Angela; Sun, Cong; Cochrane, Jenny; Venn, Alison; Srikanth, Velandai; Jones, Graeme; Shook, Robin; Sui, Xuemei; Ortaglia, Andrew; Blair, Steven; Ponsonby, Anne-Louise

    2015-01-01

    Background Self–reported physical activity has been inversely associated with mortality but the effect of objectively measured step activity on mortality has never been evaluated. The objective is to determine the prospective association of daily step activity on mortality among free-living adults. Methods and Findings Cohort study of free-living adults residing in Tasmania, Australia between 2000 and 2005 who participated in one of three cohort studies (n = 2 576 total participants). Daily step activity by pedometer at baseline at a mean of 58.8 years of age, and for a subset, repeated monitoring was available 3.7 (SD 1.3) years later (n = 1 679). All-cause mortality (n = 219 deaths) was ascertained by record-linkage to the Australian National Death Index; 90% of participants were followed-up over ten years, until June 2011. Higher daily step count at baseline was linearly associated with lower all-cause mortality (adjusted hazard ratio AHR, 0.94; 95% CI, 0.90 to 0.98 per 1 000 steps; P = 0.004). Risk was altered little by removing deaths occurring in the first two years. Increasing baseline daily steps from sedentary to 10 000 steps a day was associated with a 46% (95% CI, 18% to 65%; P = 0.004) lower risk of mortality in the decade of follow-up. In addition, those who increased their daily steps over the monitoring period had a substantial reduction in mortality risk, after adjusting for baseline daily step count (AHR, 0.39; 95% CI, 0.22 to 0.72; P = 0.002), or other factors (AHR, 0.38; 95% CI, 0.21–0.70; P = 0.002). Conclusions Higher daily step count was linearly associated with subsequent long term mortality among free living adults. These data are the first to quantify mortality reductions using an objective measure of physical activity in a free living population. They strongly underscore the importance of physical inactivity as a major public health problem. PMID:26536618

  7. Evidence for a black-white crossover in all-cause and coronary heart disease mortality in an older population: the North Carolina EPESE.

    PubMed Central

    Corti, M C; Guralnik, J M; Ferrucci, L; Izmirlian, G; Leveille, S G; Pahor, M; Cohen, H J; Pieper, C; Havlik, R J

    1999-01-01

    OBJECTIVES: This cohort study evaluated racial differences in mortality among Blacks and Whites 65 years and older. METHODS: A total of 4136 men and women (1875 Whites and 2261 Blacks) living in North Carolina were interviewed in 1986 and followed up for mortality until 1994. Hazard ratios (HRs) for all-cause and cause-specific mortality were calculated, with adjustment for sociodemographic and coronary heart disease (CHD) risk factors. RESULTS: Black persons had higher mortality rates than Whites at young-old age (65-80 years) but had significantly lower mortality rates after age 80. Black persons age 80 or older had a significantly lower risk of all-cause mortality (HR of Blacks vs Whites, 0.75; 95% confidence interval [CI] = 0.62, 0.90) and of CHD mortality (HR 0.44: 95% CI = 0.30, 0.66). These differences were not observed for other causes of death. CONCLUSIONS: Racial differences in mortality are modified by age. This mortality crossover could be attributed to selective survival of the healthiest oldest Blacks or to other biomedical factors affecting longevity after age 80. Because the crossover was observed for CHD deaths only, age overreporting by Black older persons seems an unlikely explanation of the mortality differences. PMID:10076478

  8. Low-Risk Lifestyle Behaviors and All-Cause Mortality: Findings From the National Health and Nutrition Examination Survey III Mortality Study

    PubMed Central

    Zhao, Guixiang; Tsai, James; Li, Chaoyang

    2011-01-01

    Objectives. We examined the relationship between 4 low-risk behaviors—never smoked, healthy diet, adequate physical activity, and moderate alcohol consumption—and mortality in a representative sample of people in the United States. Methods. We used data from 16958 participants aged 17 years and older in the National Health and Nutrition Examination Survey III Mortality Study from 1988 to 2006. Results. The number of low-risk behaviors was inversely related to the risk for mortality. Compared with participants who had no low-risk behaviors, those who had all 4 experienced reduced all-cause mortality (adjusted hazard ratio [AHR]=0.37; 95% confidence interval [CI]=0.28, 0.49), mortality from malignant neoplasms (AHR=0.34; 95% CI=0.20, 0.56), major cardiovascular disease (AHR=0.35; 95% CI=0.24, 0.50), and other causes (AHR=0.43; 95% CI=0.25, 0.74). The rate advancement periods, representing the equivalent risk from a certain number of years of chronological age, for participants who had all 4 high-risk behaviors compared with those who had none were 11.1 years for all-cause mortality, 14.4 years for malignant neoplasms, 9.9 years for major cardiovascular disease, and 10.6 years for other causes. Conclusions. Low-risk lifestyle factors exert a powerful and beneficial effect on mortality. PMID:21852630

  9. Association between physical performance and all-cause mortality in CKD.

    PubMed

    Roshanravan, Baback; Robinson-Cohen, Cassianne; Patel, Kushang V; Ayers, Ernest; Littman, Alyson J; de Boer, Ian H; Ikizler, T Alp; Himmelfarb, Jonathan; Katzel, Leslie I; Kestenbaum, Bryan; Seliger, Stephen

    2013-04-01

    In older adults, measurements of physical performance assess physical function and associate with mortality and disability. Muscle wasting and diminished physical performance often accompany CKD, resembling physiologic aging, but whether physical performance associates with clinical outcome in CKD is unknown. We evaluated 385 ambulatory, stroke-free participants with stage 2-4 CKD enrolled in clinic-based cohorts at the University of Washington and University of Maryland and Veterans Affairs Maryland Healthcare systems. We compared handgrip strength, usual gait speed, timed up and go (TUAG), and 6-minute walking distance with normative values and constructed Cox proportional hazards models and receiver operating characteristic curves to test associations with all-cause mortality. Mean age was 61 years and the mean estimated GFR was 41 ml/min per 1.73 m(2). Measures of lower extremity performance were at least 30% lower than predicted, but handgrip strength was relatively preserved. Fifty deaths occurred during the median 3-year follow-up period. After adjustment, each 0.1-m/s decrement in gait speed associated with a 26% higher risk for death, and each 1-second longer TUAG associated with an 8% higher risk for death. On the basis of the receiver operating characteristic analysis, gait speed and TUAG more strongly predicted 3-year mortality than kidney function or commonly measured serum biomarkers. Adding gait speed to a model that included estimated GFR significantly improved the prediction of 3-year mortality. In summary, impaired physical performance of the lower extremities is common in CKD and strongly associates with all-cause mortality. PMID:23599380

  10. Ratio

    NASA Astrophysics Data System (ADS)

    Webster, Nathan A. S.; Pownceby, Mark I.; Madsen, Ian C.; Studer, Andrew J.; Manuel, James R.; Kimpton, Justin A.

    2014-12-01

    Effects of basicity, B (CaO:SiO2 ratio) on the thermal range, concentration, and formation mechanisms of silico-ferrite of calcium and aluminum (SFCA) and SFCA-I iron ore sinter bonding phases have been investigated using an in situ synchrotron X-ray diffraction-based methodology with subsequent Rietveld refinement-based quantitative phase analysis. SFCA and SFCA-I phases are the key bonding materials in iron ore sinter, and improved understanding of the effects of processing parameters such as basicity on their formation and decomposition may assist in improving efficiency of industrial iron ore sintering operations. Increasing basicity significantly increased the thermal range of SFCA-I, from 1363 K to 1533 K (1090 °C to 1260 °C) for a mixture with B = 2.48, to ~1339 K to 1535 K (1066 °C to 1262 °C) for a mixture with B = 3.96, and to ~1323 K to 1593 K (1050 °C to 1320 °C) at B = 4.94. Increasing basicity also increased the amount of SFCA-I formed, from 18 wt pct for the mixture with B = 2.48 to 25 wt pct for the B = 4.94 mixture. Higher basicity of the starting sinter mixture will, therefore, increase the amount of SFCA-I, considered to be more desirable of the two phases. Basicity did not appear to significantly influence the formation mechanism of SFCA-I. It did, however, affect the formation mechanism of SFCA, with the decomposition of SFCA-I coinciding with the formation of a significant amount of additional SFCA in the B = 2.48 and 3.96 mixtures but only a minor amount in the highest basicity mixture. In situ neutron diffraction enabled characterization of the behavior of magnetite after melting of SFCA produced a magnetite plus melt phase assemblage.

  11. Aortic arch calcification and risk of cardiovascular or all-cause and mortality in dialysis patients: A meta-analysis

    PubMed Central

    Zhang, Ao; Wang, Shiji; Li, Hongxiang; Yang, Juan; Wu, Hui

    2016-01-01

    Studies on aortic arch calcification (AAC) and mortality risk in maintenance dialysis patients have yielded conflicting findings. We conducted this meta-analysis to investigate the association between the presence of AAC and cardiovascular or all-cause and mortality risk in maintenance dialysis patients. Observational studies evaluating baseline AAC and cardiovascular or all-cause mortality risk in maintenance dialysis patients were searched through the PubMed and Embase, CNKI, VIP and Wanfang databases until January 2016. A total of 8 studies with 3,256 dialysis patients were identified. Compared with patients without AAC, the presence of AAC was associated with greater risk of cardiovascular mortality (hazard risk [HR] 2.30; 95% confidence intervals [CI] 1.78–2.97) and all-cause mortality (HR 1.44; 95% CI 1.19–1.75). Subgroup analyses indicated that the pooled HR for cardiovascular and all-cause mortality was 2.31 (95% CI 1.57–3.40) and 1.45 (95% CI 1.08–1.96) for the grade 2/3 AAC. Peritoneal dialysis patients with AAC had greater cardiovascular (HR 3.93 vs. HR 2.10) and all-cause mortality (HR 2.36 vs. HR 1.33) than hemodialysis patients. The AAC appears to be independently associated with excessive cardiovascular and all-cause mortality in maintenance dialysis patients. Regular follow-up AAC might be helpful to stratify mortality risk in dialysis patients. PMID:27748417

  12. Mediterranean diet and other lifestyle factors in relation to 20-year all-cause mortality: a cohort study in an Italian population.

    PubMed

    Prinelli, Federica; Yannakoulia, Mary; Anastasiou, Costas A; Adorni, Fulvio; Di Santo, Simona G; Musicco, Massimo; Scarmeas, Nikolaos; Correa Leite, Maria L

    2015-03-28

    The aim of the present analysis was to evaluate the association of the Mediterranean diet (MeDi), smoking habits and physical activity with all-cause mortality in an Italian population during a 20-year follow-up study. A total of 1693 subjects aged 40-74 who enrolled in the study in 1991-5 were asked about dietary and other lifestyle information at baseline. Adherence to the MeDi was evaluated by the Mediterranean dietary score (MedDietScore). A healthy lifestyle score was computed by assigning 1 point each for a medium or high adherence to the MedDietScore, non-smoking and physical activity. Cox models were used to assess the associations between lifestyle factors and healthy lifestyle scores and all-cause mortality, adjusting for potential confounders. The final sample included 974 subjects with complete data and without chronic disease at baseline. During a median of 17·4 years of follow-up, 193 people died. Subjects with high adherence to the MedDietScore (hazard ratio (HR) 0·62, 95 % CI 0·43, 0·89)), non-smokers (HR 0·71, 95 % CI 0·51, 0·98) and physically active subjects (HR 0·55, 95 % CI 0·36, 0·82) were at low risk of death. Each point increase in the MedDietScore was associated with a significant 5 % reduction of death risk. Subjects with 1, 2 or 3 healthy lifestyle behaviours had a significantly 39, 56, and 73 % reduced risk of death, respectively. A high adherence to MeDi, non-smoking and physical activity were strongly associated with a reduced risk of all-cause mortality in healthy subjects after long-term follow-up. This reduction was even stronger when the healthy lifestyle behaviours were combined. PMID:25746109

  13. Association between Body Mass Index and All-Cause Mortality in Hypertensive Adults: Results from the China Stroke Primary Prevention Trial (CSPPT)

    PubMed Central

    Yang, Wei; Li, Jian-Ping; Zhang, Yan; Fan, Fang-Fang; Xu, Xi-Ping; Wang, Bin-Yan; Xu, Xin; Qin, Xian-Hui; Xing, Hou-Xun; Tang, Gen-Fu; Zhou, Zi-Yi; Gu, Dong-Feng; Zhao, Dong; Huo, Yong

    2016-01-01

    The association between elevated body mass index (BMI) and risk of death has been reported in many studies. However, the association between BMI and all-cause mortality for hypertensive Chinese adults remains unclear. We conducted a post-hoc analysis using data from the China Stroke Primary Prevention Trial (CSPPT). Cox regression analysis was performed to determine the significance of the association of BMI with all-cause mortality. During a mean follow-up duration of 4.5 years, 622 deaths (3.0%) occurred among the 20,694 participants aged 45–75 years. A reversed J-shaped relationship was observed between BMI and all-cause mortality. The hazard ratios (HRs) for underweight (<18.5 kg/m2), overweight (24.0–27.9 kg/m2), and obesity (≥28.0 kg/m2) were calculated relative to normal weight (18.5–23.9 kg/m2). The summary HRs were 1.56 (95% CI, 1.11–2.18) for underweight, 0.78 (95% CI 0.64–0.95) for overweight and 0.64 (95% CI, 0.48–0.85) for obesity. In sex-age-specific analyses, participants over 60 years of age had optimal BMI in the obesity classification and the results were consistent in both males and females. Relative to normal weight, underweight was associated with significantly higher mortality. Excessive weight was not associated with increased risk of mortality. Chinese hypertensive adults had the lowest mortality in grade 1 obesity. PMID:27338470

  14. Mediterranean diet and other lifestyle factors in relation to 20-year all-cause mortality: a cohort study in an Italian population.

    PubMed

    Prinelli, Federica; Yannakoulia, Mary; Anastasiou, Costas A; Adorni, Fulvio; Di Santo, Simona G; Musicco, Massimo; Scarmeas, Nikolaos; Correa Leite, Maria L

    2015-03-28

    The aim of the present analysis was to evaluate the association of the Mediterranean diet (MeDi), smoking habits and physical activity with all-cause mortality in an Italian population during a 20-year follow-up study. A total of 1693 subjects aged 40-74 who enrolled in the study in 1991-5 were asked about dietary and other lifestyle information at baseline. Adherence to the MeDi was evaluated by the Mediterranean dietary score (MedDietScore). A healthy lifestyle score was computed by assigning 1 point each for a medium or high adherence to the MedDietScore, non-smoking and physical activity. Cox models were used to assess the associations between lifestyle factors and healthy lifestyle scores and all-cause mortality, adjusting for potential confounders. The final sample included 974 subjects with complete data and without chronic disease at baseline. During a median of 17·4 years of follow-up, 193 people died. Subjects with high adherence to the MedDietScore (hazard ratio (HR) 0·62, 95 % CI 0·43, 0·89)), non-smokers (HR 0·71, 95 % CI 0·51, 0·98) and physically active subjects (HR 0·55, 95 % CI 0·36, 0·82) were at low risk of death. Each point increase in the MedDietScore was associated with a significant 5 % reduction of death risk. Subjects with 1, 2 or 3 healthy lifestyle behaviours had a significantly 39, 56, and 73 % reduced risk of death, respectively. A high adherence to MeDi, non-smoking and physical activity were strongly associated with a reduced risk of all-cause mortality in healthy subjects after long-term follow-up. This reduction was even stronger when the healthy lifestyle behaviours were combined.

  15. Body Mass Index (BMI) and All-Cause Mortality Pooling Project

    Cancer.gov

    The BMI and All-Cause Mortality Pooling Project quantified the risk associated with being overweight and the extent to which the relationship between BMI and all-cause mortality varies by certain factors.

  16. Risk of All-Cause and Prostate Cancer-Specific Mortality After Brachytherapy in Men With Small Prostate Size

    SciTech Connect

    Nguyen, Paul L.; Chen, Ming H.; Choueiri, Toni K.; Hoffman, Karen E.; Hu, Jim C.; Martin, Neil E.; Beard, Clair J.; Dosoretz, Daniel E.; Moran, Brian J.; Katin, Michael J.; Braccioforte, Michelle H.; Ross, Rudi; Salenius, Sharon A.; Kantoff, Philip W.; D'Amico, Anthony V.

    2011-04-01

    Background: Brachytherapy for prostate cancer can be technically challenging in men with small prostates ({<=}20 cc), but it is unknown whether their outcomes are different than those of men with larger prostates. Methods and Materials: We studied 6,416 men treated with brachytherapy in one of 21 community-based practices. Cox regression and Fine and Gray's regression were used to determine whether volume {<=}20 cc was associated with a higher risk of all-cause mortality (ACM) or prostate cancer-specific mortality (PCSM), respectively, after adjustment for other known prognostic factors. Results: 443 patients (6.9%) had a prostate volume {<=}20 cc. After a median follow-up of 2.91 years (interquartile range, 1.06-4.79), volume {<=}20 cc was associated with a significantly higher risk of ACM (adjusted hazard ratio = 1.33 [95% CI 1.08-1.65], p = 0.0085) with 3-year estimates of ACM for {<=}20 cc vs. >20 cc of 13.0% vs. 6.9% (p = 0.028). Only 23 men (0.36%) have died of prostate cancer, and no difference was seen in PCSM by volume (p = 0.4). Conclusion: Men with small prostates at the time of implant had a 33% higher risk of ACM, and the underlying cause of this remains uncertain. No increase in PCSM was observed in men with volume {<=}20cc, suggesting that a small prostate should not in itself be a contraindication for brachytherapy, but inasmuch as absolute rates of PCSM were small, further follow-up will be needed to confirm this finding.

  17. Is the adiposity-associated FTO gene variant related to all-cause mortality independent of adiposity? Meta-analysis of data from 169,551 Caucasian adults

    PubMed Central

    Mirza, S. S.; Zhao, J. H.; Chasman, D. I.; Fischer, K.; Qi, Q.; Smith, A. V.; Thinggaard, M.; Jarczok, M. N.; Nalls, M. A.; Trompet, S.; Timpson, N. J.; Schmidt, B.; Jackson, A. U.; Lyytikäinen, L. P.; Verweij, N.; Mueller-Nurasyid, M.; Vikström, M.; Marques-Vidal, P.; Wong, A.; Meidtner, K.; Middelberg, R. P.; Strawbridge, R. J.; Christiansen, L.; Kyvik, K. O.; Hamsten, A.; Jääskeläinen, T.; Tjønneland, A.; Eriksson, J. G.; Whitfield, J. B.; Boeing, H.; Hardy, R.; Vollenweider, P.; Leander, K.; Peters, A.; van der Harst, P.; Kumari, M.; Lehtimäki, T.; Meirhaeghe, A.; Tuomilehto, J.; Jöckel, K.-H.; Ben-Shlomo, Y.; Sattar, N.; Baumeister, S. E.; Smith, G. Davey; Casas, J. P.; Houston, D. K.; März, W.; Christensen, K.; Gudnason, V.; Hu, F. B.; Metspalu, A.; Ridker, P. M.; Wareham, N. J.; Loos, R. J. F.; Tiemeier, H.; Sonestedt, E.; Sørensen, T. I. A.

    2015-01-01

    Summary Previously, a single nucleotide polymorphism (SNP), rs9939609, in the FTO gene showed a much stronger association with all-cause mortality than expected from its association with body mass index (BMI), body fat mass index (FMI) and waist circumference (WC). This finding implies that the SNP has strong pleiotropic effects on adiposity and adiposity-independent pathological pathways that leads to increased mortality. To investigate this further, we conducted a meta-analysis of similar data from 34 longitudinal studies including 169,551 adult Caucasians among whom 27,100 died during follow-up. Linear regression showed that the minor allele of the FTO SNP was associated with greater BMI (n = 169,551; 0.32 kg m−2; 95% CI 0.28–0.32, P < 1 × 10−32), WC (n = 152,631; 0.76 cm; 0.68–0.84, P < 1 × 10−32) and FMI (n = 48,192; 0.17 kg m−2; 0.13–0.22, P = 1.0 × 10−13). Cox proportional hazard regression analyses for mortality showed that the hazards ratio (HR) for the minor allele of the FTO SNPs was 1.02 (1.00–1.04, P = 0.097), but the apparent excess risk was eliminated after adjustment for BMI and WC (HR: 1.00; 0.98–1.03, P = 0.662) and for FMI (HR: 1.00; 0.96–1.04, P = 0.932). In conclusion, this study does not support that the FTO SNP is associated with all-cause mortality independently of the adiposity phenotypes. PMID:25752329

  18. All-Cause Mortality of Low Birthweight Infants in Infancy, Childhood, and Adolescence: Population Study of England and Wales

    PubMed Central

    Watkins, W. John; Kotecha, Sarah J.; Kotecha, Sailesh

    2016-01-01

    Background Low birthweight (LBW) is associated with increased mortality in infancy, but its association with mortality in later childhood and adolescence is less clear. We investigated the association between birthweight and all-cause mortality and identified major causes of mortality for different birthweight groups. Methods and Findings We conducted a population study of all live births occurring in England and Wales between 1 January 1993 and 31 December 2011. Following exclusions, the 12,355,251 live births were classified by birthweight: 500–1,499 g (very LBW [VLBW], n = 139,608), 1,500–2,499 g (LBW, n = 759,283), 2,500–3,499 g (n = 6,511,411), and ≥3,500 g (n = 4,944,949). The association of birthweight group with mortality in infancy (<1 y of age) and childhood/adolescence (1–18 y of age) was quantified, with and without covariates, through hazard ratios using Cox regression. International Classification of Diseases codes identified causes of death. In all, 74,890 (0.61%) individuals died between birth and 18 y of age, with 23% of deaths occurring after infancy. Adjusted hazard ratios for infant deaths were 145 (95% CI 141, 149) and 9.8 (95% CI 9.5, 10.1) for the VLBW and LBW groups, respectively, compared to the ≥3,500 g group. The respective hazard ratios for death occurring at age 1–18 y were 6.6 (95% CI 6.1, 7.1) and 2.9 (95% CI 2.8, 3.1). Male gender, the youngest and oldest maternal age bands, multiple births, and deprivation (Index of Multiple Deprivation score) also contributed to increased deaths in the VLBW and LBW groups in both age ranges. In infancy, perinatal factors, particularly respiratory issues and infections, explained 84% and 31% of deaths in the VLBW and LBW groups, respectively; congenital malformations explained 36% and 23% in the LBW group and ≥2,500 g groups (2,500–3,499 g and ≥3,500 g groups combined), respectively. Central nervous system conditions explained 20% of deaths in childhood/adolescence in the VLBW

  19. Usual walking speed and all-cause mortality risk in older people: A systematic review and meta-analysis.

    PubMed

    Liu, Bing; Hu, Xinhua; Zhang, Qiang; Fan, Yichuan; Li, Jun; Zou, Rui; Zhang, Ming; Wang, Xiuqi; Wang, Junpeng

    2016-02-01

    The purpose of this study was to investigate the relationship between slow usual walking speed and all-cause mortality risk in older people by conducting a meta-analysis. We searched through the Pubmed, Embase and Cochrane Library database up to March 2015. Only prospective observational studies that investigating the usual walking speed and all-cause mortality risk in older adulthood approaching age 65 years or more were included. Walking speed should be specifically assessed as a single-item tool over a short distance. Pooled adjusted risk ratio (RR) and 95% confidence interval (CI) were computed for the lowest versus the highest usual walking speed category. A total of 9 studies involving 12,901 participants were included. Meta-analysis with random effect model showed that the pooled adjusted RR of all-cause mortality was 1.89 (95% CI 1.46-2.46) comparing the lowest to the highest usual walk speed. Subgroup analyses indicated that risk of all-cause mortality for slow usual walking speed appeared to be not significant among women (RR 1.45; 95% CI 0.95-2.20). Slow usual walking speed is an independent predictor of all-cause mortality in men but not in women among older adulthood approaching age 65 years or more. PMID:27004653

  20. Adherence to a healthy diet according to the World Health Organization guidelines and all-cause mortality in elderly adults from Europe and the United States.

    PubMed

    Jankovic, Nicole; Geelen, Anouk; Streppel, Martinette T; de Groot, Lisette C P G M; Orfanos, Philippos; van den Hooven, Edith H; Pikhart, Hynek; Boffetta, Paolo; Trichopoulou, Antonia; Bobak, Martin; Bueno-de-Mesquita, H B; Kee, Frank; Franco, Oscar H; Park, Yikyung; Hallmans, Göran; Tjønneland, Anne; May, Anne M; Pajak, Andrzej; Malyutina, Sofia; Kubinova, Růžena; Amiano, Pilar; Kampman, Ellen; Feskens, Edith J

    2014-11-15

    The World Health Organization (WHO) has formulated guidelines for a healthy diet to prevent chronic diseases and postpone death worldwide. Our objective was to investigate the association between the WHO guidelines, measured using the Healthy Diet Indicator (HDI), and all-cause mortality in elderly men and women from Europe and the United States. We analyzed data from 396,391 participants (42% women) in 11 prospective cohort studies who were 60 years of age or older at enrollment (in 1988-2005). HDI scores were based on 6 nutrients and 1 food group and ranged from 0 (least healthy diet) to 70 (healthiest diet). Adjusted cohort-specific hazard ratios were derived by using Cox proportional hazards regression and subsequently pooled using random-effects meta-analysis. During 4,497,957 person-years of follow-up, 84,978 deaths occurred. Median HDI scores ranged from 40 to 54 points across cohorts. For a 10-point increase in HDI score (representing adherence to an additional WHO guideline), the pooled adjusted hazard ratios were 0.90 (95% confidence interval (CI): 0.87, 0.93) for men and women combined, 0.89 (95% CI: 0.85, 0.92) for men, and 0.90 (95% CI: 0.85, 0.95) for women. These estimates translate to an increased life expectancy of 2 years at the age of 60 years. Greater adherence to the WHO guidelines is associated with greater longevity in elderly men and women in Europe and the United States.

  1. Interferon-Based Treatment of Hepatitis C Virus Infection Reduces All-Cause Mortality in Patients With End-Stage Renal Disease

    PubMed Central

    Hsu, Yueh-Han; Hung, Peir-Haur; Muo, Chih-Hsin; Tsai, Wen-Chen; Hsu, Chih-Cheng; Kao, Chia-Hung

    2015-01-01

    Abstract The long-term survival of end-stage renal disease (ESRD) patients with hepatitis C virus (HCV) infection who received interferon treatment has not been extensively evaluated. The HCV cohort was the ESRD patients with de novo HCV infection from 2004 to 2011; they were classified into treated and untreated groups according to interferon therapy records. Patients aged <20 years and those with a history of hepatitis B, kidney transplantation, or cancer were excluded. The control cohort included ESRD patients without HCV infection matched 4:1 to the HCV cohort by age, sex, and year of ESRD registration. We followed up all study participants until kidney transplantation, death, or the end of 2011, whichever came first. We assessed risk of all-cause mortality by using the multivariate Cox proportional hazard model with time-dependent covariate. In the HCV cohort, 134 patients (6.01%) received interferon treatment. Compared with the uninfected control cohort, the treated group had a lower risk of death (hazard ratio 0.47, 95% confidence interval [CI] 0.22–0.99). The untreated group had a 2.62-fold higher risk (95% CI 1.24–5.55) of death compared with the treated group. For the HCV cohort without cirrhosis or hepatoma, the risk of death in the treated group was further markedly reduced (hazard ratio 0.17, 95% CI 0.04–0.68) compared with that in the control cohort. For ESRD patients with HCV infection, receiving interferon treatment is associated with a survival advantage. Such an advantage is more prominent in HCV patients without cirrhosis or hepatoma. PMID:26632730

  2. Prospective associations between household-, work-, and leisure-based physical activity and all-cause mortality among older Taiwanese adults.

    PubMed

    Chen, Li-Jung; Fox, Kenneth R; Ku, Po-Wen; Sun, Wen-Jung; Chou, Pesus

    2012-09-01

    Most studies on the health effects of leisure time physical activity have focused on mortality. There has been limited research regarding physical activity undertaken at work or around the home and mortality. This study assessed the associations between leisure, work, and household physical activity and subsequent all-cause mortality among older adults aged 65 years and older (n = 2133) in Taiwan, over 8 years. Physical activity was evaluated with the Physical Activity Scale for the Elderly. Cox proportional hazard models were used to estimate the association of physical activity with the risk of mortality. This study demonstrated that a low level of total physical activity is predictive of increased all-cause mortality in both men and women in an East Asian population. It also indicates that leisure- and household-related but not work-related activity are significant contributors to this relationship.

  3. Association between all-cause mortality and insurance status transition among the elderly population in a rural area in Korea: Kangwha Cohort Study.

    PubMed

    Jang, Sung-In; Yi, Sang-Wook; Sull, Jae-Woong; Park, Eun-Cheol; Kim, Jae-Hyun; Ohrr, Heechoul

    2015-05-01

    The study purpose was to examine the association between health insurance transition and all-cause mortality. 3206 residents in Korea who participated in two surveys in 1985 and 1994, were followed-up during 1994-2008. Adjusted hazard ratios (aHR) were calculated using Cox hazard model. Participants were divided into four groups by insurance transition (the "National Health Insurance (NHI)-NHI", "NHI-Medicaid", "Medicaid-NHI", and "Medicaid-Medicaid" groups), where NHI-Medicaid means participants covered by NHI in 1985 but by Medicaid in 1994. For men covered by NHI in 1985, the mortality risk in the NHI-Medicaid was higher (aHR=1.47) than in the NHI-NHI. For men and women, covered by Medicaid in 1985, aHR was non-significantly lower in the Medicaid-NHI than in the Medicaid-Medicaid. When four groups were analyzed together, men in the Medicaid-Medicaid (aHR=1.67) and NHI-Medicaid (aHR=1.46) groups had higher mortality risk than males in the NHI-NHI, whereas no significant difference was observed for females. In conclusion, transition from NHI to Medicaid increases mortality risk, and transition from Medicaid to NHI may mitigate risk, while remaining on Medicaid pose the greatest risk, especially for men. Therefore, policy makers should strengthen coverage for Medicaid. The weak effects of transition from NHI to Medicaid on mortality for women require validation.

  4. Shadow of diabetes over cardiovascular disease: comparative quantification of population-attributable all-cause and cardiovascular mortality

    PubMed Central

    2012-01-01

    Background We contrasted impacts on all-cause and cardiovascular disease (CVD) mortality of diabetes vs. CVD. Methods Among participants the Tehran lipid and glucose study aged ≥ 30 years (n = 9752), we selected those who participated in the follow-up study until 20 March 2009 (n = 8795). Complete data on covariate were available for 8, 469 participants, contributing to a 67935 person-year follow up. In the analysis of outcomes (all-cause and CVD mortality), diabetes and CVD were assessed using Cox proportional hazard regression model adjusting for established CVD risk factors. We used population attributable hazard fraction (PAHF) and rate advancement period (RAP) that expresses how much sooner a given mortality rate is reached among exposed than among unexposed individuals. Results Ten percent of the participants self-reported to have pervious CVD, and diabetes was ascertained in 17% of participants at baseline examination. During a median follow-up of 9 years 386 participants died of which 184 were due to CVD. All-cause and CVD mortality rate (95% CIs) were 5.5 (5.0-6.1) and 2.6 (2.3-3.0) per 1000 person-year, respectively. The PAHF of all-cause mortality for diabetes 9.2 (7.3-11.1) was greater than the one for CVD 3.5 (1.1-5.5). RAP estimates for all-cause mortality associated with diabetes ranged from 7.4 to 8.6 years whereas the RAP estimates for all-cause mortality associated with CVD ranged from 3.1 to 4.3 years. The PAHF of CVD mortality for diabetes 9.4 (6.8-12.0) was greater than the one for CVD 4.5 (1.8-7.0). RAP estimates for CVD mortality associated with diabetes ranged from 8.2 to 9.8 years whereas the RAP estimates for CVD mortality associated with CVD ranged from 4.7 to 6.7 years. Conclusions We demonstrated that diabetes, which was shown to be keeping pace with prevalent CVD in terms of conferring excess risk of incident CVD, is currently causing more deaths in the population than does CVD. PMID:22704235

  5. Examining Non-Linear Associations between Accelerometer-Measured Physical Activity, Sedentary Behavior, and All-Cause Mortality Using Segmented Cox Regression.

    PubMed

    Lee, Paul H

    2016-01-01

    Healthy adults are advised to perform at least 150 min of moderate-intensity physical activity weekly, but this advice is based on studies using self-reports of questionable validity. This study examined the dose-response relationship of accelerometer-measured physical activity and sedentary behaviors on all-cause mortality using segmented Cox regression to empirically determine the break-points of the dose-response relationship. Data from 7006 adult participants aged 18 or above in the National Health and Nutrition Examination Survey waves 2003-2004 and 2005-2006 were included in the analysis and linked with death certificate data using a probabilistic matching approach in the National Death Index through December 31, 2011. Physical activity and sedentary behavior were measured using ActiGraph model 7164 accelerometer over the right hip for 7 consecutive days. Each minute with accelerometer count <100; 1952-5724; and ≥5725 were classified as sedentary, moderate-intensity physical activity, and vigorous-intensity physical activity, respectively. Segmented Cox regression was used to estimate the hazard ratio (HR) of time spent in sedentary behaviors, moderate-intensity physical activity, and vigorous-intensity physical activity and all-cause mortality, adjusted for demographic characteristics, health behaviors, and health conditions. Data were analyzed in 2016. During 47,119 person-year of follow-up, 608 deaths occurred. Each additional hour per day of sedentary behaviors was associated with a HR of 1.15 (95% CI 1.01, 1.31) among participants who spend at least 10.9 h per day on sedentary behaviors, and each additional minute per day spent on moderate-intensity physical activity was associated with a HR of 0.94 (95% CI 0.91, 0.96) among participants with daily moderate-intensity physical activity ≤14.1 min. Associations of moderate physical activity and sedentary behaviors on all-cause mortality were independent of each other. To conclude, evidence from this

  6. Changes in physical activity and all-cause mortality in COPD.

    PubMed

    Vaes, Anouk W; Garcia-Aymerich, Judith; Marott, Jacob L; Benet, Marta; Groenen, Miriam T J; Schnohr, Peter; Franssen, Frits M E; Vestbo, Jørgen; Wouters, Emiel F M; Lange, Peter; Spruit, Martijn A

    2014-11-01

    Little is known about changes in physical activity in subjects with chronic obstructive pulmonary disease (COPD) and its impact on mortality. Therefore, we aimed to study changes in physical activity in subjects with and without COPD and the impact of physical activity on mortality risk. Subjects from the Copenhagen City Heart Study with at least two consecutive examinations were selected. Each examination included a self-administered questionnaire and clinical examination. 1270 COPD subjects and 8734 subjects without COPD (forced expiratory volume in 1 s 67±18 and 91±15% predicted, respectively) were included. COPD subjects with moderate or high baseline physical activity who reported low physical activity level at follow-up had the highest hazard ratios of mortality (1.73 and 2.35, respectively; both p<0.001). In COPD subjects with low baseline physical activity, no differences were found in survival between unchanged or increased physical activity at follow-up. In addition, subjects without COPD with low physical activity at follow-up had the highest hazard ratio of mortality, irrespective of baseline physical activity level (p≤0.05). A decline to low physical activity at follow-up was associated with an increased mortality risk in subjects with and without COPD. These observational data suggest that it is important to assess and encourage physical activity in the earliest stages of COPD in order to maintain a physical activity level that is as high as possible, as this is associated with better prognosis.

  7. Cohort study of all-cause mortality among tobacco users in Mumbai, India.

    PubMed Central

    Gupta, P. C.; Mehta, H. C.

    2000-01-01

    INTRODUCTION: Overall mortality rates are higher among cigarette smokers than non-smokers. However, very little is known about the health effects of other forms of tobacco use widely prevalent in India, such as bidi smoking and various forms of smokeless tobacco (e.g. chewing betel-quid). We therefore carried out a cohort study in the city of Mumbai, India, to estimate the relative risks for all-cause mortality among various kinds of tobacco users. METHODS: A baseline survey of all individuals aged > or = 35 years using voters' lists as a selection frame was conducted using a house-to-house approach and face-to-face interviews. RESULTS: Active follow-up of 52,568 individuals in the cohort was undertaken 5-6 years after the baseline study, and 97.6% were traced. A total of 4358 deaths were recorded among these individuals. The annual age-adjusted mortality rates were 18.4 per 1000 for men and 12.4 per 1000 for women. For men the mortality rates for smokers were higher than those of non-users of tobacco across all age groups, with the difference being greater for lower age groups (35-54 years). The relative risk was 1.39 for cigarette smokers and 1.78 for bidi smokers, with an apparent dose-response relationship for frequency of smoking. Women were basically smokeless tobacco users, with the relative risk among such users being 1.35 and a suggestion of a dose-response relationship. DISCUSSION: These findings establish bidi smoking as no less hazardous than cigarette smoking and indicate that smokeless tobacco use may also cause higher mortality. Further studies should be carried out to obtain cause-specific mortality rates and relative risks. PMID:10994260

  8. Symptoms of depression and all-cause mortality in farmers, a cohort study: the HUNT study, Norway

    PubMed Central

    Letnes, Jon Magne; Hilt, Bjørn; Bjørngaard, Johan Håkon; Krokstad, Steinar

    2016-01-01

    Objectives To explore all-cause mortality and the association between symptoms of depression and all-cause mortality in farmers compared with other occupational groups, using a prospective cohort design. Methods We included adult participants with a known occupation from the second wave of the Nord-Trøndelag Health Study (Helseundersøkelsen i Nord-Trøndelag 2 (HUNT2) 1995–1997), Norway. Complete information on emigration and death from all causes was obtained from the National Registries. We used the depression subscale of the Hospital Anxiety and Depression Scale (HADS) to measure symptoms of depression. We compared farmers to 4 other occupational groups. Our baseline study population comprised 32 618 participants. Statistical analyses were performed using the Cox proportional hazards models. Results The estimated mortality risk in farmers was lower than in all other occupations combined, with a sex and age-adjusted HR (0.91, 95% CI 0.82 to 1.00). However, farmers had an 11% increased age-adjusted and sex-adjusted mortality risk compared with the highest ranked socioeconomic group (HR 1.11, 95% CI 0.98 to 1.25). In farmers, symptoms of depression were associated with a 13% increase in sex-adjusted and age-adjusted mortality risk (HR 1.13, 95% CI 0.88 to 1.45). Compared with other occupations this was the lowest HR, also after adjusting for education, marital status, long-lasting limiting somatic illness and lifestyle factors (HR 1.08, 95% CI 0.84 to 1.39). Conclusions Farmers had lower all-cause mortality compared with the other occupational groups combined. Symptoms of depression were associated with an increased mortality risk in farmers, but the risk increase was smaller compared with the other occupational groups. PMID:27188811

  9. The novel marker LTBP2 predicts all-cause and pulmonary death in patients with acute dyspnoea.

    PubMed

    Breidthardt, Tobias; Vanpoucke, Griet; Potocki, Mihael; Mosimann, Tamina; Ziller, Ronny; Thomas, Gregoire; Laroy, Wouter; Moerman, Piet; Socrates, Thenral; Drexler, Beatrice; Mebazaa, Alexandre; Kas, Koen; Mueller, Christian

    2012-11-01

    The risk stratification in patients presenting with acute dyspnoea remains a challenge. We therefore conducted a prospective, observational cohort study enrolling 292 patients presenting to the emergency department with acute dyspnoea. A proteomic approach for antibody-free targeted protein quantification based on high-end MS was used to measure LTBP2 [latent TGF (transforming growth factor)-binding protein 2] levels. Final diagnosis and death during follow-up were adjudicated blinded to LTBP2 levels. AHF (acute heart failure) was the final diagnosis in 54% of patients. In both AHF (P<0.001) and non-AHF (P=0.015) patients, LTBP2 levels at presentation were significantly higher in non-survivors compared with survivors with differences on median levels being 2.2- and 1.5-fold respectively. When assessing the cause of death, LTBP2 levels were significantly higher in patients dying from pulmonary causes (P=0.0005). Overall, LTBP2 powerfully predicted early pulmonary death {AUC (area under the curve), 0.95 [95% CI (confidence interval), 0.91-0.98]}. In ROC (receiver operating characteristic) curve analyses for the prediction of 1-year mortality LTBP2 achieved an AUC of 0.77 (95% CI, 0.71-0.84); comparable with the predictive potential of NT-proBNP [N-terminal pro-B-type natriuruetic peptide; 0.77 (95% CI, 0.72-0.82)]. Importantly, the predictive potential of LTBP2 persisted in patients with AHF as the cause of dypnea (AUC 0.78) and was independent of renal dysfunction (AUC 0.77). In a multivariate Cox regression analysis, LTBP2 was the strongest independent predictor of death [HR (hazard ratio), 3.76 (95% CI, 2.13-6.64); P<0.0001]. In conclusion, plasma levels of LTBP2 present a novel and powerful predictor of all-cause mortality, and particularly pulmonary death. Cause-specific prediction of death would enable targeted prevention, e.g. with pre-emptive antibiotic therapy.

  10. Nonalcoholic Fatty Liver Disease Is Associated With Higher 1-year All-Cause Rehospitalization Rates in Patients Admitted for Acute Heart Failure

    PubMed Central

    Valbusa, Filippo; Bonapace, Stefano; Grillo, Cristina; Scala, Luca; Chiampan, Andrea; Rossi, Andrea; Zoppini, Giacomo; Lonardo, Amedeo; Arcaro, Guido; Byrne, Christopher D.; Targher, Giovanni

    2016-01-01

    Abstract Repeat hospitalization due to acute heart failure (HF) is a global public health problem that markedly impacts on health resource use. Identifying novel predictors of rehospitalization would help physicians to determine the optimal postdischarge plan for preventing HF rehospitalization. Nonalcoholic fatty liver disease (NAFLD) is an emerging risk factor for many heart diseases, including HF. We assessed whether NAFLD at hospital admission predicts 1-year all-cause rehospitalization in patients with acute HF. We enrolled all patients consecutively admitted for acute HF to our General Medicine Division, from January 2013 to April 2014, after excluding patients with acute myocardial infarction, severe heart valve diseases, malignancy, known liver diseases, and those with volume overload related to extracardiac causes. NAFLD was diagnosed by ultrasonography and exclusion of competing etiologies. The primary outcome of the study was the 1-year all-cause rehospitalization rate. Among the 107 patients enrolled in the study, the cumulative rehospitalization rate was 12.1% at 1 month, 25.2% at 3 months, 29.9% at 6 months, and 38.3% at 1 year. Patients with NAFLD had markedly higher 1-year rehospitalization rates than those without NAFLD (58% vs 21% at 1 y; P < 0.001 by the log-rank test). Cox regression analysis revealed that NAFLD was associated with a 5.5-fold increased risk of rehospitalization (adjusted hazard ratio 5.56, 95% confidence interval 2.46–12.1, P < 0.001) after adjustment for multiple HF risk factors and potential confounders. In conclusion, NAFLD was independently associated with higher 1-year rehospitalization in patients hospitalized for acute HF. PMID:26886619

  11. Geographic Inequalities in All-Cause Mortality in Japan: Compositional or Contextual?

    PubMed Central

    Suzuki, Etsuji; Kashima, Saori; Kawachi, Ichiro; Subramanian, S. V.

    2012-01-01

    Background A recent study from Japan suggested that geographic inequalities in all-cause premature adult mortality have increased since 1995 in both sexes even after adjusting for individual age and occupation in 47 prefectures. Such variations can arise from compositional effects as well as contextual effects. In this study, we sought to further examine the emerging geographic inequalities in all-cause mortality, by exploring the relative contribution of composition and context in each prefecture. Methods We used the 2005 vital statistics and census data among those aged 25 or older. The total number of decedents was 524,785 men and 455,863 women. We estimated gender-specific two-level logistic regression to model mortality risk as a function of age, occupation, and residence in 47 prefectures. Prefecture-level variance was used as an estimate of geographic inequalities in mortality, and prefectures were ranked by odds ratios (ORs), with the reference being the grand mean of all prefectures (value  = 1). Results Overall, the degree of geographic inequalities was more pronounced when we did not account for the composition (i.e., age and occupation) in each prefecture. Even after adjusting for the composition, however, substantial differences remained in mortality risk across prefectures with ORs ranging from 0.870 (Okinawa) to 1.190 (Aomori) for men and from 0.864 (Shimane) to 1.132 (Aichi) for women. In some prefectures (e.g., Aomori), adjustment for composition showed little change in ORs, while we observed substantial attenuation in ORs in other prefectures (e.g., Akita). We also observed qualitative changes in some prefectures (e.g., Tokyo). No clear associations were observed between prefecture-level socioeconomic status variables and the risk of mortality in either sex. Conclusions Geographic disparities in mortality across prefectures are quite substantial and cannot be fully explained by differences in population composition. The relative contribution

  12. Predictive Value of Carotid Distensibility Coefficient for Cardiovascular Diseases and All-Cause Mortality: A Meta-Analysis

    PubMed Central

    Yuan, Chuang; Wang, Jing; Ying, Michael

    2016-01-01

    Aims The aim of the present study is to determine the pooled predictive value of carotid distensibility coefficient (DC) for cardiovascular (CV) diseases and all-cause mortality. Background Arterial stiffness is associated with future CV events. Aortic pulse wave velocity is a commonly used predictor for CV diseases and all-cause mortality; however, its assessment requires specific devices and is not always applicable in all patients. In addition to the aortic artery, the carotid artery is also susceptible to atherosclerosis, and is highly accessible because of the surficial property. Thus, carotid DC, which indicates the intrinsic local stiffness of the carotid artery and may be determined using ultrasound and magnetic resonance imaging, is of interest for the prediction. However, the role of carotid DC in the prediction of CV diseases and all-cause mortality has not been thoroughly characterized, and the pooled predictive value of carotid DC remains unclear. Methods A meta-analysis, which included 11 longitudinal studies with 20361 subjects, was performed. Results Carotid DC significantly predicted future total CV events, CV mortality and all-cause mortality. The pooled risk ratios (RRs) of CV events, CV mortality and all-cause mortality were 1.19 (1.06–1.35, 95%CI, 9 studies with 18993 subjects), 1.09 (1.01–1.18, 95%CI, 2 studies with 2550 subjects) and 1.65 (1.15–2.37, 95%CI, 6 studies with 3619 subjects), respectively, for the subjects who had the lowest quartile of DC compared with their counterparts who had higher quartiles. For CV events, CV mortality and all-cause mortality, a decrease in DC of 1 SD increased the risk by 13%, 6% and 41% respectively, whereas a decrease in DC of 1 unit increased the risk by 3%, 1% and 6% respectively. Conclusions Carotid DC is a significant predictor of future CV diseases and all-cause mortality, which may facilitate the identification of high-risk patients for the early diagnosis and prompt treatment of CV diseases

  13. Anti-Gay Prejudice and All-Cause Mortality Among Heterosexuals in the United States

    PubMed Central

    Bellatorre, Anna; Muennig, Peter

    2014-01-01

    Objectives. We determined whether individuals who harbor antigay prejudice experience elevated mortality risk. Methods. Data on heterosexual sexual orientation (n = 20 226, aged 18–89 years), antigay attitudes, and mortality risk factors came from the General Social Survey, which was linked to mortality data from the National Death Index (1988–2008). We used Cox proportional hazard models to examine whether antigay prejudice was associated with mortality risk among heterosexuals. Results. Heterosexuals who reported higher levels of antigay prejudice had higher mortality risk than those who reported lower levels (hazard ratio [HR] = 1.25; 95% confidence interval [CI] = 1.09, 1.42), with control for multiple risk factors for mortality, including demographics, socioeconomic status, and fair or poor self-rated health. This result translates into a life expectancy difference of approximately 2.5 years (95% CI = 1.0, 4.0 years) between individuals with high versus low levels of antigay prejudice. Furthermore, in sensitivity analyses, antigay prejudice was specifically associated with increased risk of cardiovascular-related causes of death in fully adjusted models (HR = 1.29; 95% CI = 1.04, 1.60). Conclusions. The findings contribute to a growing body of research suggesting that reducing prejudice may improve the health of both minority and majority populations. PMID:24328664

  14. Increased All-Cause, Liver, and Cardiac Mortality among Hepatitis C Virus-seropositive Blood Donors

    PubMed Central

    Guiltinan, Anne M.; Kaidarova, Zhanna; Custer, Brian; Orland, Jennie; Strollo, Angela; Cyrus, Sherri; Busch, Michael P.; Murphy, Edward L.

    2010-01-01

    Hospital-based studies suggest that hepatitis C virus (HCV) infection causes frequent cirrhosis, hepatocellular carcinoma, and mortality, but epidemiologic studies have shown less morbidity and mortality. The authors performed a retrospective cohort study of 10,259 recombinant immunoblot assay-confirmed, HCV antibody-positive (HCV+), allogeneic blood donors from 1991 to 2002 and 10,259 HCV antibody-negative (HCV−) donors matched for year of donation, age, gender, and Zone Improvement Plan Code (ZIP Code). Vital status through 2003 was obtained from the US National Death Index, and hazard ratios with 95% confidence intervals were calculated by survival analysis. After a mean follow-up of 7.7 years, there were 601 (2.92%) deaths: 453 HCV+ and 148 HCV− (hazard ratio (HR) = 3.13, 95% confidence interval (CI): 2.60, 3.76). Excess mortality in the HCV+ group was greatest in liver-related (HR = 45.99, 95% CI: 11.32, 186.74), drug- or alcohol-related (HR = 10.81, 95% CI: 4.68, 24.96), and trauma/suicide (HR = 2.99, 95% CI: 2.05, 4.36) causes. There was also an unexpected increase in cardiovascular mortality among the HCV+ donors (HR = 2.21, 95% CI: 1.41, 3.46). HCV infection is associated with a significant, threefold increase in overall mortality among former blood donors, including significantly increased mortality from liver and cardiovascular causes. High rates of mortality from drug/alcohol and trauma/suicide causes are likely due to lifestyle factors and may be at least partially preventable. PMID:18203734

  15. Association between Insulin Monotherapy versus Insulin plus Metformin and the Risk of All-Cause Mortality and Other Serious Outcomes: A Retrospective Cohort Study

    PubMed Central

    Holden, Sarah E.; Jenkins-Jones, Sara; Currie, Craig J.

    2016-01-01

    Aims To determine if concomitant metformin reduced the risk of death, major adverse cardiac events (MACE), and cancer in people with type 2 diabetes treated with insulin. Methods For this retrospective cohort study, people with type 2 diabetes who progressed to insulin with or without metformin from 2000 onwards were identified from the UK Clinical Practice Research Datalink (≈7% sample of the UK population). The risks of all-cause mortality, MACE and incident cancer were evaluated using multivariable Cox models comparing insulin monotherapy with insulin plus metformin. We accounted for insulin dose. Results 12,020 subjects treated with insulin were identified, including 6,484 treated with monotherapy. There were 1,486 deaths, 579 MACE (excluding those with a history of large vessel disease), and 680 cancer events (excluding those in patients with a history of cancer). Corresponding event rates were 41.5 (95% CI 39.4–43.6) deaths, 20.8 (19.2–22.5) MACE, and 21.6 (20.0–23.3) cancer events per 1,000 person-years. The adjusted hazard ratios (aHRs) for people prescribed insulin plus metformin versus insulin monotherapy were 0.60 (95% CI 0.52–0.68) for all-cause mortality, 0.75 (0.62–0.91) for MACE, and 0.96 (0.80–1.15) for cancer. For patients who were propensity-score matched, the corresponding aHRs for all-cause mortality and cancer were 0.62 (0.52–0.75) and 0.99 (0.78–1.26), respectively. For MACE, the aHR was 1.06 (0.75–1.49) prior to 1,275 days and 1.87 (1.22–2.86) after 1,275 days post-index. Conclusions People with type 2 diabetes treated with insulin plus concomitant metformin had a reduced risk of death and MACE compared with people treated with insulin monotherapy. There was no statistically significant difference in the risk of cancer between people treated with insulin as monotherapy or in combination with metformin. PMID:27152598

  16. Arsenic exposure from drinking water, and all-cause and chronic-disease mortalities in Bangladesh (HEALS): a prospective cohort study

    PubMed Central

    Argos, Maria; Kalra, Tara; Rathouz, Paul J; Chen, Yu; Pierce, Brandon; Parvez, Faruque; Islam, Tariqul; Ahmed, Alauddin; Rakibuz-Zaman, Muhammad; Hasan, Rabiul; Sarwar, Golam; Slavkovich, Vesna; van Geen, Alexander; Graziano, Joseph; Ahsan, Habibul

    2014-01-01

    Summary Background Millions of people worldwide are chronically exposed to arsenic through drinking water, including 35–77 million people in Bangladesh. The association between arsenic exposure and mortality rate has not been prospectively investigated by use of individual-level data. We therefore prospectively assessed whether chronic and recent changes in arsenic exposure are associated with all-cause and chronic-disease mortalities in a Bangladeshi population. Methods In the prospective cohort Health Effects of Arsenic Longitudinal Study (HEALS), trained physicians unaware of arsenic exposure interviewed in person and clinically assessed 11 746 population-based participants (aged 18–75 years) from Araihazar, Bangladesh. Participants were recruited from October, 2000, to May, 2002, and followed-up biennially. Data for mortality rates were available throughout February, 2009. We used Cox proportional hazards model to estimate hazard ratios (HRs) of mortality, with adjustment for potential confounders, at different doses of arsenic exposure. Findings 407 deaths were ascertained between October, 2000, and February, 2009. Multivariate adjusted HRs for all-cause mortality in a comparison of arsenic at concentrations of 10·1–50·0 μg/L, 50·1–150·0 μg/L, and 150·1–864·0 μg/L with at least 10·0 μg/L in well water were 1·34 (95% CI 0·99–1·82), 1·09 (0·81–1·47), and 1·68 (1·26–2·23), respectively. Results were similar with daily arsenic dose and total arsenic concentration in urine. Recent change in exposure, measurement of total arsenic concentrations in urine repeated biennially, did not have much effect on the mortality rate. Interpretation Chronic arsenic exposure through drinking water was associated with an increase in the mortality rate. Follow-up data from this cohort will be used to assess the long-term effects of arsenic exposure and how they might be affected by changes in exposure. However, solutions and resources are urgently

  17. Low Systolic Blood Pressure and Mortality From All Causes and Vascular Diseases Among Older Middle-aged Men: Korean Veterans Health Study

    PubMed Central

    Yi, Sang-Wook; Ohrr, Heechoul

    2015-01-01

    Objectives: Recently, low systolic blood pressure (SBP) was found to be associated with an increased risk of death from vascular diseases in a rural elderly population in Korea. However, evidence on the association between low SBP and vascular diseases is scarce. The aim of this study was to prospectively examine the association between low SBP and mortality from all causes and vascular diseases in older middle-aged Korean men. Methods: From 2004 to 2010, 94 085 Korean Vietnam War veterans were followed-up for deaths. The adjusted hazard ratios (aHR) were calculated using the Cox proportional hazard model. A stratified analysis was conducted by age at enrollment. SBP was self-reported by a postal survey in 2004. Results: Among the participants aged 60 and older, the lowest SBP (<90 mmHg) category had an elevated aHR for mortality from all causes (aHR, 1.9; 95% confidence interval [CI], 1.2 to 3.1) and vascular diseases (International Classification of Disease, 10th revision, I00-I99; aHR, 3.2; 95% CI, 1.2 to 8.4) compared to those with an SBP of 100 to 119 mmHg. Those with an SBP below 80 mmHg (aHR, 4.5; 95% CI, 1.1 to 18.8) and those with an SBP of 80 to 89 mmHg (aHR, 3.1; 95% CI, 0.9 to 10.2) also had an increased risk of vascular mortality, compared to those with an SBP of 90 to 119 mmHg. This association was sustained when excluding the first two years of follow-up or preexisting vascular diseases. In men younger than 60 years, the association of low SBP was weaker than that in those aged 60 years or older. Conclusions: Our findings suggest that low SBP (<90 mmHg) may increase vascular mortality in Korean men aged 60 years or older. PMID:25857648

  18. Whole-grain products and whole-grain types are associated with lower all-cause and cause-specific mortality in the Scandinavian HELGA cohort.

    PubMed

    Johnsen, Nina F; Frederiksen, Kirsten; Christensen, Jane; Skeie, Guri; Lund, Eiliv; Landberg, Rikard; Johansson, Ingegerd; Nilsson, Lena M; Halkjær, Jytte; Olsen, Anja; Overvad, Kim; Tjønneland, Anne

    2015-08-28

    No study has yet investigated the intake of different types of whole grain (WG) in relation to all-cause and cause-specific mortality in a healthy population. The aim of the present study was to investigate the intake of WG products and WG types in relation to all-cause and cause-specific mortality in a large Scandinavian HELGA cohort that, in 1992-8, included 120 010 cohort members aged 30-64 years from the Norwegian Women and Cancer Study, the Northern Sweden Health and Disease Study, and the Danish Diet Cancer and Health Study. Participants filled in a FFQ from which data on the intake of WG products were extracted. The estimation of daily intake of WG cereal types was based on country-specific products and recipes. Mortality rate ratios (MRR) and 95 % CI were estimated using the Cox proportional hazards model. A total of 3658 women and 4181 men died during the follow-up (end of follow-up was 15 April 2008 in the Danish sub-cohort, 15 December 2009 in the Norwegian sub-cohort and 15 February 2009 in the Swedish sub-cohort). In the analyses of continuous WG variables, we found lower all-cause mortality with higher intake of total WG products (women: MRR 0·89 (95 % CI 0·86, 0·91); men: MRR 0·89 (95 % CI 0·86, 0·91) for a doubling of intake). In particular, intake of breakfast cereals and non-white bread was associated with lower mortality. We also found lower all-cause mortality with total intake of different WG types (women: MRR 0·88 (95 % CI 0·86, 0·92); men: MRR 0·88 (95 % CI 0·86, 0·91) for a doubling of intake). In particular, WG oat, rye and wheat were associated with lower mortality. The associations were found in both women and men and for different causes of deaths. In the analyses of quartiles of WG intake in relation to all-cause mortality, we found lower mortality in the highest quartile compared with the lowest for breakfast cereals, non-white bread, total WG products, oat, rye (only men), wheat and total WG types. The MRR for highest v

  19. Whole-grain products and whole-grain types are associated with lower all-cause and cause-specific mortality in the Scandinavian HELGA cohort.

    PubMed

    Johnsen, Nina F; Frederiksen, Kirsten; Christensen, Jane; Skeie, Guri; Lund, Eiliv; Landberg, Rikard; Johansson, Ingegerd; Nilsson, Lena M; Halkjær, Jytte; Olsen, Anja; Overvad, Kim; Tjønneland, Anne

    2015-08-28

    No study has yet investigated the intake of different types of whole grain (WG) in relation to all-cause and cause-specific mortality in a healthy population. The aim of the present study was to investigate the intake of WG products and WG types in relation to all-cause and cause-specific mortality in a large Scandinavian HELGA cohort that, in 1992-8, included 120 010 cohort members aged 30-64 years from the Norwegian Women and Cancer Study, the Northern Sweden Health and Disease Study, and the Danish Diet Cancer and Health Study. Participants filled in a FFQ from which data on the intake of WG products were extracted. The estimation of daily intake of WG cereal types was based on country-specific products and recipes. Mortality rate ratios (MRR) and 95 % CI were estimated using the Cox proportional hazards model. A total of 3658 women and 4181 men died during the follow-up (end of follow-up was 15 April 2008 in the Danish sub-cohort, 15 December 2009 in the Norwegian sub-cohort and 15 February 2009 in the Swedish sub-cohort). In the analyses of continuous WG variables, we found lower all-cause mortality with higher intake of total WG products (women: MRR 0·89 (95 % CI 0·86, 0·91); men: MRR 0·89 (95 % CI 0·86, 0·91) for a doubling of intake). In particular, intake of breakfast cereals and non-white bread was associated with lower mortality. We also found lower all-cause mortality with total intake of different WG types (women: MRR 0·88 (95 % CI 0·86, 0·92); men: MRR 0·88 (95 % CI 0·86, 0·91) for a doubling of intake). In particular, WG oat, rye and wheat were associated with lower mortality. The associations were found in both women and men and for different causes of deaths. In the analyses of quartiles of WG intake in relation to all-cause mortality, we found lower mortality in the highest quartile compared with the lowest for breakfast cereals, non-white bread, total WG products, oat, rye (only men), wheat and total WG types. The MRR for highest v

  20. All-cause and cause-specific mortality among Black and White North Carolina state prisoners, 1995-2005

    PubMed Central

    Wohl, David A.; Schoenbach, Victor J.

    2011-01-01

    Purpose We compared mortality rates among state prisoners and other state residents to identify prisoners’ healthcare needs Methods We linked North Carolina prison records with state death records for 1995-2005 to estimate all-cause and cause-specific death rates among Black and White male prisoners aged 20-79 years, and used standardized mortality ratios (SMRs) to compare these observed deaths with the expected number based on death rates among state residents Results The all-cause SMR of Black prisoners was 0.52 (95%CI: 0.48 0.57), with fewer deaths than expected from accidents, homicides, cardiovascular disease and cancer. The all-cause SMR of White prisoners was 1.12 (95%CI: 1.01, 1.25) with fewer deaths than expected for accidents, but more deaths than expected from viral hepatitis, liver disease, cancer, chronic lower respiratory disease, and HIV. Conclusions Mortality of Black prisoners was lower than that of Black state residents for both traumatic and chronic causes of death. Mortality of White prisoners was lower than that of White state residents for accidents, but higher for several chronic causes of death. Future studies should investigate the effect of prisoners’ pre-incarceration and in-prison morbidity, the prison environment, and prison healthcare on prisoners’ patterns of mortality. PMID:21737304

  1. Red meat and processed meat consumption and all-cause mortality: a meta-analysis.

    PubMed

    Larsson, Susanna C; Orsini, Nicola

    2014-02-01

    High consumption of red meat and processed meat has been associated with increased risk of several chronic diseases. We conducted a meta-analysis to summarize the evidence from prospective studies on red meat and processed meat consumption in relationship to all-cause mortality. Pertinent studies were identified by searching PubMed through May 2013 and by reviewing the reference lists of retrieved articles. Prospective studies that reported relative risks with 95% confidence intervals for the association of red meat or processed meat consumption with all-cause mortality were eligible. Study-specific results were combined by using a random-effects model. Nine prospective studies were included in the meta-analysis. The summary relative risks of all-cause mortality for the highest versus the lowest category of consumption were 1.10 (95% confidence interval (CI): 0.98, 1.22; n = 6 studies) for unprocessed red meat, 1.23 (95% CI: 1.17, 1.28; n = 6 studies) for processed meat, and 1.29 (95% CI: 1.24, 1.35; n = 5 studies) for total red meat. In a dose-response meta-analysis, consumption of processed meat and total red meat, but not unprocessed red meat, was statistically significantly positively associated with all-cause mortality in a nonlinear fashion. These results indicate that high consumption of red meat, especially processed meat, may increase all-cause mortality.

  2. Effects of Running on Chronic Diseases and Cardiovascular and All-Cause Mortality.

    PubMed

    Lavie, Carl J; Lee, Duck-chul; Sui, Xuemei; Arena, Ross; O'Keefe, James H; Church, Timothy S; Milani, Richard V; Blair, Steven N

    2015-11-01

    Considerable evidence has established the link between high levels of physical activity (PA) and all-cause and cardiovascular disease (CVD)-specific mortality. Running is a popular form of vigorous PA that has been associated with better overall survival, but there is debate about the dose-response relationship between running and CVD and all-cause survival. In this review, we specifically reviewed studies published in PubMed since 2000 that included at least 500 runners and 5-year follow-up so as to analyze the relationship between vigorous aerobic PA, specifically running, and major health consequences, especially CVD and all-cause mortality. We also made recommendations on the optimal dose of running associated with protection against CVD and premature mortality, as well as briefly discuss the potential cardiotoxicity of a high dose of aerobic exercise, including running (eg, marathons). PMID:26362561

  3. The impact of prescription opioids on all-cause mortality in Canada.

    PubMed

    Imtiaz, Sameer; Rehm, Jürgen

    2016-01-01

    An influential study from the United States generated considerable discussion and debate. This study documented rising morbidity and mortality in midlife among white non-Hispanic Americans in the 21st century, with clear linkages of all-cause mortality to increasing rates of poisonings, suicides and chronic liver disease deaths. All of these causes of deaths are strongly related to the use of legal and illegal substances, but the study stressed the importance of prescription opioids. Given the similarities between the United States and Canada in prescription opioid use, the assessment of similar all-cause mortality trends is relevant for Canada. As this commentary highlights, the all-cause mortality shifts seen in the United States cannot be seen in Canada for either sex or age groups. The exact reasons for the differences between the two countries are not clear, but it is important for public health to further explore this question. PMID:27476513

  4. Sodium and potassium intake and risk of cardiovascular events and all-cause mortality: the Rotterdam Study

    PubMed Central

    Witteman, Jacqueline C. M.; Stijnen, Theo; Kloos, Margot W.; Hofman, Albert; Grobbee, Diederick E.

    2007-01-01

    Background Dietary electrolytes influence blood pressure, but their effect on clinical outcomes remains to be established. We examined sodium and potassium intake in relation to cardiovascular disease (CVD) and mortality in an unselected older population. Methods A case–cohort analysis was performed in the Rotterdam Study among subjects aged 55 years and over, who were followed for 5 years. Baseline urinary samples were analyzed for sodium and potassium in 795 subjects who died, 206 with an incident myocardial infarction and 181 subjects with an incident stroke, and in 1,448 randomly selected subjects. For potassium, dietary data were additionally obtained by food-frequency questionnaire for 78% of the cohort. Results There was no consistent association of urinary sodium, potassium, or sodium/potassium ratio with CVD and all-cause mortality over the range of intakes observed in this population. Dietary potassium estimated by food frequency questionnaire, however, was associated with a lower risk of all-cause mortality in subjects initially free of CVD and hypertension (RR = 0.71 per standard deviation increase; 95% confidence interval: 0.51–1.00). We observed a significant positive association between urinary sodium/potassium ratio and all-cause mortality, but only in overweight subjects who were initially free of CVD and hypertension (RR = 1.19 (1.02–1.39) per unit). Conclusion The effect of sodium and potassium intake on CVD morbidity and mortality in Western societies remains to be established. PMID:17902026

  5. Associations Between the Serum Metabolome and All-Cause Mortality Among African Americans in the Atherosclerosis Risk in Communities (ARIC) Study.

    PubMed

    Yu, Bing; Heiss, Gerardo; Alexander, Danny; Grams, Morgan E; Boerwinkle, Eric

    2016-04-01

    Early and accurate identification of people at high risk of premature death may assist in the targeting of preventive therapies in order to improve overall health. To identify novel biomarkers for all-cause mortality, we performed untargeted metabolomics in the Atherosclerosis Risk in Communities (ARIC) Study. We included 1,887 eligible ARIC African Americans, and 671 deaths occurred during a median follow-up period of 22.5 years (1987-2011). Chromatography and mass spectroscopy identified and quantitated 204 serum metabolites, and Cox proportional hazards models were used to analyze the longitudinal associations with all-cause and cardiovascular mortality. Nine metabolites, including cotinine, mannose, glycocholate, pregnendiol disulfate, α-hydroxyisovalerate, N-acetylalanine, andro-steroid monosulfate 2, uridine, and γ-glutamyl-leucine, showed independent associations with all-cause mortality, with an average risk change of 18% per standard-deviation increase in metabolite level (P < 1.23 × 10(-4)). A metabolite risk score, created on the basis of the weighted levels of the identified metabolites, improved the predictive ability of all-cause mortality over traditional risk factors (bias-corrected Harrell's C statistic 0.752 vs. 0.730). Mannose and glycocholate were associated with cardiovascular mortality (P < 1.23 × 10(-4)), but predictive ability was not improved beyond the traditional risk factors. This metabolomic analysis revealed potential novel biomarkers for all-cause mortality beyond the traditional risk factors.

  6. Weight change and all-cause mortality in older adults: A meta-analysis

    Technology Transfer Automated Retrieval System (TEKTRAN)

    This meta-analysis of observational cohort studies examined the association between weight change (weight loss, weight gain, and weight fluctuation) and all-cause mortality among older adults. We used PubMed (MEDLINE), Web of Science, and Cochrane Library to identify prospective studies published in...

  7. Associations of high HDL cholesterol level with all-cause mortality in patients with heart failure complicating coronary heart disease

    PubMed Central

    Cai, Anping; Li, Xida; Zhong, Qi; Li, Minming; Wang, Rui; Liang, Yingcong; Chen, Wenzhong; Huang, Tehui; Li, Xiaohong; Zhou, Yingling; Li, Liwen

    2016-01-01

    Abstract The aim of the present study was to evaluate the association between HDL cholesterol level and all-cause mortality in patients with ejection fraction reduced heart failure (EFrHF) complicating coronary heart disease (CHD). A total of 323 patients were retrospectively recruited. Patients were divided into low and high HDL cholesterol groups. Between-group differences and associations between HDL cholesterol level and all-cause mortality were assessed. Patients in the high HDL cholesterol group had higher HDL cholesterol level and other lipid components (P <0.05 for all comparison). Lower levels of alanine aminotransferase (ALT), high-sensitivity C-reactive protein (Hs-CRP), and higher albumin (ALB) level were observed in the high HDL cholesterol group (P <0.05 for all comparison). Although left ventricular ejection fraction (LVEF) were comparable (28.8 ± 4.5% vs 28.4 ± 4.6%, P = 0.358), mean mortality rate in the high HDL cholesterol group was significantly lower (43.5% vs 59.1%, P = 0.007). HDL cholesterol level was positively correlated with ALB level, while inversely correlated with ALT, Hs-CRP, and NYHA classification. Logistic regression analysis revealed that after extensively adjusted for confounding variates, HDL cholesterol level remained significantly associated with all-cause mortality although the magnitude of association was gradually attenuated with odds ratio of 0.007 (95% confidence interval 0.001–0.327, P = 0.012). Higher HDL cholesterol level is associated with better survival in patients with EFrHF complicating CHD, and future studies are necessary to demonstrate whether increasing HDL cholesterol level will confer survival benefit in these populations of patients. PMID:27428188

  8. Serum calcification propensity predicts all-cause mortality in predialysis CKD.

    PubMed

    Smith, Edward R; Ford, Martin L; Tomlinson, Laurie A; Bodenham, Emma; McMahon, Lawrence P; Farese, Stefan; Rajkumar, Chakravarthi; Holt, Stephen G; Pasch, Andreas

    2014-02-01

    Medial arterial calcification is accelerated in patients with CKD and strongly associated with increased arterial rigidity and cardiovascular mortality. Recently, a novel in vitro blood test that provides an overall measure of calcification propensity by monitoring the maturation time (T50) of calciprotein particles in serum was described. We used this test to measure serum T50 in a prospective cohort of 184 patients with stages 3 and 4 CKD, with a median of 5.3 years of follow-up. At baseline, the major determinants of serum calcification propensity included higher serum phosphate, ionized calcium, increased bone osteoclastic activity, and lower free fetuin-A, plasma pyrophosphate, and albumin concentrations, which accounted for 49% of the variation in this parameter. Increased serum calcification propensity at baseline independently associated with aortic pulse wave velocity in the complete cohort and progressive aortic stiffening over 30 months in a subgroup of 93 patients. After adjustment for demographic, renal, cardiovascular, and biochemical covariates, including serum phosphate, risk of death among patients in the lowest T50 tertile was more than two times the risk among patients in the highest T50 tertile (adjusted hazard ratio, 2.2; 95% confidence interval, 1.1 to 5.4; P=0.04). This effect was lost, however, after additional adjustment for aortic stiffness, suggesting a shared causal pathway. Longitudinally, serum calcification propensity measurements remained temporally stable (intraclass correlation=0.81). These results suggest that serum T50 may be helpful as a biomarker in designing methods to improve defenses against vascular calcification.

  9. Serum 25(OH)D Is a 2-Year Predictor of All-Cause Mortality, Cardiac Death and Sudden Cardiac Death in Chest Pain Patients from Northern Argentina

    PubMed Central

    Naesgaard, Patrycja A.; León De La Fuente, Ricardo A.; Nilsen, Stein Tore; Woie, Leik; Aarsland, Torbjoern; Brede, Cato; Staines, Harry; Nilsen, Dennis W. T.

    2012-01-01

    Background Several studies have shown an association between vitamin D deficiency and cardiovascular risk. Vitamin D status is assessed by determination of 25-hydroxyvitamin D [25(OH)D] in serum. Methods We assessed the prognostic utility of 25(OH)D in 982 chest-pain patients with suspected acute coronary syndrome (ACS) from Salta, Northern Argentina. 2-year follow-up data including all-cause mortality, cardiac death and sudden cardiac death were analyzed in quartiles of 25(OH)D, applying univariate and multivariate analysis. Results There were statistically significant changes in seasonal 25(OH)D levels. At follow-up, 119 patients had died. The mean 25(OH)D levels were significantly lower among patients dying than in long-term survivors, both in the total population and in patients with a troponin T (TnT) release (n = 388). When comparing 25(OH)D in the highest quartile to the lowest quartile in a multivariable Cox regression model for all-cause mortality, the hazard ratio (HR) for cardiac death and sudden cardiac death in the total population was 0.37 (95% CI, 0.19–0.73), p = 0.004, 0.23 (95% CI, 0.08–0.67), p = 0.007, and 0.32 (95% CI, 0.11–0.94), p = 0.038, respectively. In patients with TnT release, the respective HR was 0.24 (95% CI, 0.10–0.54), p = 0.001, 0.18 (95% CI, 0.05–0.60), p = 0.006 and 0.25 (95% CI, 0.07–0.89), p = 0.033. 25(OH)D had no prognostic value in patients with no TnT release. Conclusion Vitamin D was shown to be a useful biomarker for prediction of mortality when obtained at admission in chest pain patients with suspected ACS. Trial registration ClinicalTrials.gov NCT01377402 PMID:22970121

  10. Influence of Androgen Deprivation Therapy on All-Cause Mortality in Men With High-Risk Prostate Cancer and a History of Congestive Heart Failure or Myocardial Infarction

    SciTech Connect

    Nguyen, Paul L.; Chen, Ming-Hui; Beckman, Joshua A.; Beard, Clair J.; Martin, Neil E.; Choueiri, Toni K.; Hu, Jim C.; Dosoretz, Daniel E.; Moran, Brian J.; Salenius, Sharon A.; Braccioforte, Michelle H.; Kantoff, Philip W.; D'Amico, Anthony V.; Ennis, Ronald D.

    2012-03-15

    Purpose: It is unknown whether the excess risk of all-cause mortality (ACM) observed when androgen deprivation therapy (ADT) is added to radiation for men with prostate cancer and a history of congestive heart failure (CHF) or myocardial infarction (MI) also applies to those with high-risk disease. Methods and Materials: Of 14,594 men with cT1c-T3aN0M0 prostate cancer treated with brachytherapy-based radiation from 1991 through 2006, 1,378 (9.4%) with a history of CHF or MI comprised the study cohort. Of these, 22.6% received supplemental external beam radiation, and 42.9% received a median of 4 months of neoadjuvant ADT. Median age was 71.8 years. Median follow-up was 4.3 years. Cox multivariable analysis tested for an association between ADT use and ACM within risk groups, after adjusting for treatment factors, prognostic factors, and propensity score for ADT. Results: ADT was associated with significantly increased ACM (adjusted hazard ratio [AHR] = 1.76; 95% confidence interval [CI], 1.32-2.34; p = 0.0001), with 5-year estimates of 22.71% with ADT and 11.62% without ADT. The impact of ADT on ACM by risk group was as follows: high-risk AHR = 2.57; 95% CI, 1.17-5.67; p = 0.019; intermediate-risk AHR = 1.75; 95% CI, 1.13-2.73; p = 0.012; low-risk AHR = 1.52; 95% CI, 0.96-2.43; p = 0.075). Conclusions: Among patients with a history of CHF or MI treated with brachytherapy-based radiation, ADT was associated with increased all-cause mortality, even for patients with high-risk disease. Although ADT has been shown in Phase III studies to improve overall survival in high-risk disease, the small subgroup of high-risk patients with a history of CHF or MI, who represented about 9% of the patients, may be harmed by ADT.

  11. Association of body mass index with all-cause mortality in patients with diabetes: a systemic review and meta-analysis

    PubMed Central

    Chang, Hsiao-Wen; Li, Yi-Hwei; Hsieh, Chang-Hsun; Liu, Pang-Yen

    2016-01-01

    Background The obesity paradox phenomenon has been found in different populations, such as heart failure and coronary heart disease, which suggest that patients with established cardiovascular disease (CVD) and with normal weight had higher risk of mortality than those with overweight or obesity. However, the obesity paradox is controversial among patients with diabetes which has been considered as the coronary heart disease equivalent. The aim of our study was to summarize current findings on the relationship between body mass index (BMI) and all-cause mortality in patients with diabetes and make a meta-analysis. Methods We searched previous studies from MEDLINE, EMBASE, and the Cochrane databases using the keywords: BMI, mortality, diabetes, and obesity paradox or reverse epidemiology. Finally, sixteen studies were identified and 385,925 patients were included. Patients were divided into five groups based on BMI (kg/m2) levels: underweight (<18.5), normal weight (18.5–24.9), overweight (25–29.9), mild obesity (30–34.9), and morbid obesity (>35). A random effect meta-analysis was performed by the inverse variance method. Results As compared with the normal weight, the underweight had higher risk of mortality [hazard ratio (HR): 1.59, 95% confidence interval (CI): 1.32–1.91]. In contrast, the overweight and the mild obesity had lower risk of mortality than the normal weight (HR: 0.86, 95% CI: 0.78–0.96, and 0.88, 95% CI: 0.78–1.00, respectively), but the morbid obesity did not (HR: 0.99, 95% CI: 0.84–1.16). In addition, the subgroup analysis by sex showed that the overweight had the lowest mortality as compared with the normal weight (HR: 0.82, 95% CI: 0.74–0.90) and the obesity in males, but the risk of mortality did not differ among groups in females. Notably, the heterogeneity was significant in most of group comparisons. Conclusions Our meta-analysis showed a U-shaped relationship between BMI and all-cause mortality in patients with diabetes

  12. Reduction of drinking in problem drinkers and all-cause mortality.

    PubMed

    Rehm, J; Roerecke, M

    2013-01-01

    Alcohol consumption has been linked with considerable mortality, and reduction of drinking, especially of heavy drinking, has been suggested as one of the main measures to reduce alcohol-attributable mortality. Aggregate-level studies including but not limited to natural experiments support this suggestion; however, causality cannot be established in ecological analysis. The results of individual-level cohort studies are ambiguous. On the other hand, randomized clinical trials with problem drinkers show that brief interventions leading to a reduction of average drinking also led to a reduction of all-cause mortality within 1 year. The results of these studies were pooled and a model for reduction of drinking in heavy drinkers and its consequences for all-cause mortality risk was estimated. Ceteris paribus, the higher the level of drinking, the stronger the effects of a given reduction. Implications for interventions and public health are discussed. PMID:23531718

  13. Use of the p,p'-DDD: p,p'-DDE concentration ratio to trace contaminant migration from a hazardous waste site.

    PubMed

    Pinkney, Alfred E; McGowan, Peter C

    2006-09-01

    For approximately 50 years, beginning in the 1920s, hazardous wastes were disposed in an 11-hectare area of the Marine Corps Base (MCB) Quantico, Virginia, USA known as the Old Landfill. Polychlorinated biphenyls (PCBs) and DDT compounds were the primary contaminants of concern. These contaminants migrated into the sediments of a 78-hectare area of the Potomac River, the Quantico Embayment. Fish tissue contamination resulted in the MCB posting signs along the embayment shoreline warning fishermen to avoid consumption. In this paper, we interpret total PCB (t-PCBs) and total DDT (t-DDT, sum of six DDT, DDD, and DDE isomers) data from monitoring studies. We use the ratio of p,p'-DDD to p,p'-DDE concentrations as a tracer to distinguish site-related from regional contamination. The median DDD/DDE ratio in Quantico Embayment sediments (3.5) was significantly higher than the median ratio (0.71) in sediments from nearby Powells Creek, used as a reference area. In general, t-PCBs and t-DDT concentrations were significantly higher in killifish (Fundulus diaphanus) and carp (Cyprinus carpio) from the Quantico Embayment compared with Powells Creek. For both species, Quantico Embayment fish had mean or median DDD/DDE ratios greater than one. Median ratios were significantly higher in Quantico Embayment (4.6) than Powells Creek (0.28) whole body carp. In contrast, t-PCBs and t-DDT in channel catfish (Ictalurus punctatus) fillets were similar in Quantico Embayment and Powells Creek collections, with median ratios of 0.34 and 0.26, respectively. Differences between species may be attributable to movement (carp and killifish being more localized) and feeding patterns (carp ingesting sediment while feeding). We recommend that environmental scientists use this ratio when investigating sites with DDT contamination.

  14. High diet quality is associated with a lower risk of cardiovascular disease and all-cause mortality in older men.

    PubMed

    Atkins, Janice L; Whincup, Peter H; Morris, Richard W; Lennon, Lucy T; Papacosta, Olia; Wannamethee, S Goya

    2014-05-01

    Although diet quality is implicated in cardiovascular disease (CVD) risk, few studies have investigated the relation between diet quality and the risks of CVD and mortality in older adults. This study examined the prospective associations between dietary scores and risk of CVD and all-cause mortality in older British men. A total of 3328 men (aged 60-79 y) from the British Regional Heart Study, free from CVD at baseline, were followed up for 11.3 y for CVD and mortality. Baseline food-frequency questionnaire data were used to generate 2 dietary scores: the Healthy Diet Indicator (HDI), based on WHO dietary guidelines, and the Elderly Dietary Index (EDI), based on a Mediterranean-style dietary intake, with higher scores indicating greater compliance with dietary recommendations. Cox proportional hazards regression analyses assessed associations between quartiles of HDI and EDI and risk of all-cause mortality, CVD mortality, CVD events, and coronary heart disease (CHD) events. During follow-up, 933 deaths, 327 CVD deaths, 582 CVD events, and 307 CHD events occurred. Men in the highest compared with the lowest EDI quartile had significantly lower risks of all-cause mortality (HR: 0.75; 95% CI: 0.60, 0.94; P-trend = 0.03), CVD mortality (HR: 0.63; 95% CI: 0.42, 0.94; P-trend = 0.03), and CHD events (HR: 0.66; 95% CI: 0.45, 0.97; P-trend = 0.05) but not CVD events (HR: 0.79; 95% CI: 0.60, 1.05; P-trend = 0.16) after adjustment for sociodemographic, behavioral, and cardiovascular risk factors. The HDI was not significantly associated with any of the outcomes. The EDI appears to be more useful than the HDI for assessing diet quality in relation to CVD and morality risk in older men. Encouraging older adults to adhere to the guidelines inherent in the EDI criteria may have public health benefits.

  15. Trajectory of body shape in early and middle life and all cause and cause specific mortality: results from two prospective US cohort studies

    PubMed Central

    Hu, Frank B; Wu, Kana; Must, Aviva; Chan, Andrew T; Willett, Walter C; Giovannucci, Edward L

    2016-01-01

    Objective To assess body shape trajectories in early and middle life in relation to risk of mortality. Design Prospective cohort study. Setting Nurses’ Health Study and Health Professionals Follow-up Study. Population 80 266 women and 36 622 men who recalled their body shape at ages 5, 10, 20, 30, and 40 years and provided body mass index at age 50, followed from age 60 over a median of 15-16 years for death. Main outcome measures All cause and cause specific mortality. Results Using a group based modeling approach, five distinct trajectories of body shape from age 5 to 50 were identified: lean-stable, lean-moderate increase, lean-marked increase, medium-stable/increase, and heavy-stable/increase. The lean-stable group was used as the reference. Among never smokers, the multivariable adjusted hazard ratio for death from any cause was 1.08 (95% confidence interval 1.02 to 1.14) for women and 0.95 (0.88 to 1.03) for men in the lean-moderate increase group, 1.43 (1.33 to 1.54) for women and 1.11 (1.02 to 1.20) for men in the lean-marked increase group, 1.04 (0.97 to 1.12) for women and 1.01 (0.94 to 1.09) for men in the medium-stable/increase group, and 1.64 (1.49 to 1.81) for women and 1.19 (1.08 to 1.32) for men in the heavy-stable/increase group. For cause specific mortality, participants in the heavy-stable/increase group had the highest risk, with a hazard ratio among never smokers of 2.30 (1.88 to 2.81) in women and 1.45 (1.23 to 1.72) in men for cardiovascular disease, 1.37 (1.14 to 1.65) in women and 1.07 (0.89 to 1.30) in men for cancer, and 1.59 (1.38 to 1.82) in women and 1.10 (0.95 to 1.29) in men for other causes. The trajectory-mortality association was generally weaker among ever smokers than among never smokers (for all cause mortality: P for interaction <0.001 in women and 0.06 in men). When participants were classified jointly according to trajectories and history of type 2 diabetes, the increased risk of death associated with heavier

  16. HbA1c and Risks of All-Cause and Cause-Specific Death in Subjects without Known Diabetes: A Dose-Response Meta-Analysis of Prospective Cohort Studies

    PubMed Central

    Zhong, Guo-Chao; Ye, Ming-Xin; Cheng, Jia-Hao; Zhao, Yong; Gong, Jian-Ping

    2016-01-01

    Whether HbA1c levels are associated with mortality in subjects without known diabetes remains controversial. Moreover, the shape of the dose–response relationship on this topic is unclear. Therefore, a dose–response meta-analysis was conducted. PubMed and EMBASE were searched. Summary hazard ratios (HRs) were calculated using a random-effects model. Twelve studies were included. The summary HR per 1% increase in HbA1c level was 1.03 [95% confidence interval (CI) = 1.01–1.04] for all-cause mortality, 1.05 [95% CI = 1.02–1.07) for cardiovascular disease (CVD) mortality, and 1.02 (95% CI = 0.99–1.07) for cancer mortality. After excluding subjects with undiagnosed diabetes, the aforementioned associations remained significant for CVD mortality only. After further excluding subjects with prediabetes, all aforementioned associations presented non-significance. Evidence of a non-linear association between HbA1c and mortality from all causes, CVD and cancer was found (all Pnon-linearity < 0.05). The dose–response curves were relatively flat for HbA1c less than around 5.7%, and rose steeply thereafter. In conclusion, higher HbA1c level is associated with increased mortality from all causes and CVD among subjects without known diabetes. However, this association is driven by those with undiagnosed diabetes or prediabetes. The results regarding cancer mortality should be treated with caution due to limited studies. PMID:27045572

  17. Neighborhood racial composition, social capital and black all-cause mortality in Philadelphia.

    PubMed

    Hutchinson, Rebbeca N; Putt, Mary A; Dean, Lorraine T; Long, Judith A; Montagnet, Chantal A; Armstrong, Katrina

    2009-05-01

    Neighborhood characteristics such as racial composition and social capital have been widely linked to health outcomes, but the direction of the relationship between these characteristics and health of minority populations is controversial. Given this uncertainty, we examined the relationship between neighborhood racial composition, social capital, and black all-cause mortality between 1997 and 2000 in 68 Philadelphia neighborhoods. Data from the U.S. Census, the Philadelphia Health Management Corporation's 2004 Southeast Pennsylvania Community Health Survey, and city vital statistics were linked by census tract and then aggregated into neighborhoods, which served as the unit of analysis. Neighborhood social capital was measured by a summative score of respondent assessments of: the livability of their community, the likelihood of neighbors helping one another, their sense of belonging, and the trustworthiness of their neighbors. After adjustment for the sociodemographic characteristics of neighborhood residents, black age-adjusted all-cause mortality was significantly higher in neighborhoods that had lower proportion of black residents. Neighborhood social capital was also associated with lower black mortality, with the strongest relationship seen for neighborhoods in the top half of social capital scores. There was a significant interaction between racial composition and social capital, so that the effect of social capital on mortality was greatest in neighborhoods with a higher proportion of black residents and the effect of racial composition was greatest in neighborhoods with high social capital. These results demonstrate that age-adjusted all-cause black mortality is lowest in mostly black neighborhoods with high levels of social capital in Philadelphia. PMID:19324485

  18. Vitamin D status and incident cardiovascular disease and all-cause mortality: a general population study.

    PubMed

    Skaaby, Tea; Husemoen, Lise Lotte Nystrup; Pisinger, Charlotta; Jørgensen, Torben; Thuesen, Betina Heinsbæk; Fenger, Mogens; Linneberg, Allan

    2013-06-01

    Low vitamin D status has been associated with cardiovascular disease (CVD) and mortality primarily in selected groups, smaller studies, or with self-reported vitamin D intake. We investigated the association of serum vitamin D status with the incidence of a registry-based diagnosis of ischemic heart disease (IHD), stroke, and all-cause mortality in a large sample of the general population. A total of 9,146 individuals from the two population-based studies, Monica10 and Inter99, were included. Measurements of serum 25-hydroxyvitamin D at baseline were carried out using the IDS ISYS immunoassay system in Monica10 and High-performance liquid chromatography in Inter99. Information on CVDs and causes of death was obtained from Danish registries until 31 December 2008. There were 478 cases of IHD, 316 cases of stroke, and 633 deaths during follow-up (mean follow-up 10 years). Cox regression analyses with age as underlying time axis showed a significant association between vitamin D status and all-cause mortality with a HR = 0.95 (P = 0.005) per 10 nmol/l higher vitamin D level. We found no association between vitamin D status and incidence of IHD or stroke (HR = 1.01, P = 0.442 and HR = 1.00, P = 0.920, respectively). In this large general population study, the observed inverse association between serum vitamin D status and all-cause mortality was not explained by a similar inverse association with IHD or stroke. PMID:23015273

  19. Interferon-Based Treatment of Hepatitis C Virus Infection Reduces All-Cause Mortality in Patients With End-Stage Renal Disease: An 8-Year Nationwide Cohort Study in Taiwan.

    PubMed

    Hsu, Yueh-Han; Hung, Peir-Haur; Muo, Chih-Hsin; Tsai, Wen-Chen; Hsu, Chih-Cheng; Kao, Chia-Hung

    2015-11-01

    The long-term survival of end-stage renal disease (ESRD) patients with hepatitis C virus (HCV) infection who received interferon treatment has not been extensively evaluated.The HCV cohort was the ESRD patients with de novo HCV infection from 2004 to 2011; they were classified into treated and untreated groups according to interferon therapy records. Patients aged <20 years and those with a history of hepatitis B, kidney transplantation, or cancer were excluded. The control cohort included ESRD patients without HCV infection matched 4:1 to the HCV cohort by age, sex, and year of ESRD registration. We followed up all study participants until kidney transplantation, death, or the end of 2011, whichever came first. We assessed risk of all-cause mortality by using the multivariate Cox proportional hazard model with time-dependent covariate.In the HCV cohort, 134 patients (6.01%) received interferon treatment. Compared with the uninfected control cohort, the treated group had a lower risk of death (hazard ratio 0.47, 95% confidence interval [CI] 0.22-0.99). The untreated group had a 2.62-fold higher risk (95% CI 1.24-5.55) of death compared with the treated group. For the HCV cohort without cirrhosis or hepatoma, the risk of death in the treated group was further markedly reduced (hazard ratio 0.17, 95% CI 0.04-0.68) compared with that in the control cohort.For ESRD patients with HCV infection, receiving interferon treatment is associated with a survival advantage. Such an advantage is more prominent in HCV patients without cirrhosis or hepatoma.

  20. Differences between immigrants at various durations of residence and host population in all-cause mortality, Canada 1991-2006.

    PubMed

    Omariba, D Walter Rasugu; Ng, Edward; Vissandjée, Bilkis

    2014-01-01

    We used data from the 1991-2006 Canadian Census Mortality and Cancer Follow-up Study to compare all-cause mortality for immigrants with that of the Canadian-born population. The study addressed two related questions. First, do immigrants have a mortality advantage over the Canadian-born? Second, if immigrants have a mortality advantage, does it persist as their duration of residence increases? The analysis fitted sex-stratified hazard regression models for the overall sample and for selected countries of birth (UK, China, India, Philippines, and the Caribbean). Predictors were assessed at baseline. Mortality was lower among immigrants than the Canadian-born even after adjusting for a selected group of socio-demographic and socio-economic factors. The mortality differences persisted even after long residence in Canada, but appeared to be dependent on the age of the individual and the country of origin. Interpreted in light of known explanations of immigrant mortality advantage, the results mostly reflect selection effects.

  1. Development and Validation of a Clinical Risk-Assessment Tool Predictive of All-Cause Mortality

    PubMed Central

    Bello, Ghalib A; Dumancas, Gerard G; Gennings, Chris

    2015-01-01

    In clinical settings, the diagnosis of medical conditions is often aided by measurement of various serum biomarkers through the use of laboratory tests. These biomarkers provide information about different aspects of a patient’s health and overall function of multiple organ systems. We have developed a statistical procedure that condenses the information from a variety of health biomarkers into a composite index, which could be used as a risk score for predicting all-cause mortality. It could also be viewed as a holistic measure of overall physiological health status. This health status metric is computed as a function of standardized values of each biomarker measurement, weighted according to their empirically determined relative strength of association with mortality. The underlying risk model was developed using the biomonitoring and mortality data of a large sample of US residents obtained from the National Health and Nutrition Examination Survey (NHANES) and the National Death Index (NDI). Biomarker concentration levels were standardized using spline-based Cox regression models, and optimization algorithms were used to estimate the weights. The predictive accuracy of the tool was optimized by bootstrap aggregation. We also demonstrate how stacked generalization, a machine learning technique, can be used for further enhancement of the prediction power. The index was shown to be highly predictive of all-cause mortality and long-term outcomes for specific health conditions. It also exhibited a robust association with concurrent chronic conditions, recent hospital utilization, and current health status as assessed by self-rated health. PMID:26380550

  2. Aspect Ratio Plays a Role in the Hazard Potential of CeO2 Nanoparticles in Mouse Lung and Zebrafish Gastrointestinal Tract

    PubMed Central

    Lin, Sijie; Wang, Xiang; Ji, Zhaoxia; Chang, Chong Hyun; Dong, Yuan; Meng, Huan; Liao, Yu-Pei; Wang, Meiying; Song, Tze-Bin; Kohan, Sirus; Xia, Tian; Zink, Jeffrey I.; Lin, Shuo; Nel, André E.

    2014-01-01

    We have previously demonstrated that there is a relationship between the aspect ratio (AR) of CeO2 nanoparticles and in vitro hazard potential. CeO2 nanorods with AR ≥ 22 induced lysosomal damage and progressive effects on IL-1β production and cytotoxicity in the human myeloid cell line, THP-1. In order to determine whether this toxicological paradigm for long aspect ratio (LAR) CeO2 is also relevant in vivo, we performed comparative studies in the mouse lung and gastrointestinal tract (GIT) of zebrafish larvae. Although oropharyngeal aspiration could induce acute lung inflammation for CeO2 nanospheres and nanorods, only the nanorods with the highest AR (C5) induced significant IL-1β and TGF-β1 production in the bronchoalveolar lavage fluid (BALF) at 21 days but not inducing pulmonary fibrosis. However, after a longer duration (44 days) exposure to 4 mg/kg of the C5 nanorods, more collagen production was seen with CeO2 nanorods vs. nanospheres after correcting for Ce lung burden. Using an oral-exposure model in zebrafish larvae, we demonstrated that C5 nanorods also induced significant growth inhibition, a decrease in body weight, and delayed vertebral calcification. In contrast, CeO2 nanospheres and shorter nanorods had no effect. Histological and transmission electron microscopy (TEM) analyses showed that the key injury mechanism of C5 was in the epithelial lining of the GIT, which demonstrated blunted microvilli and compromised digestive function. All considered, these data demonstrate that, similar to cellular studies, LAR CeO2 nanorods exhibit more toxicity in the lung and GIT, which could be relevant to inhalation and environmental hazard potential. PMID:24720650

  3. A systematic review and meta-analysis of nut consumption and incident risk of CVD and all-cause mortality.

    PubMed

    Mayhew, Alexandra J; de Souza, Russell J; Meyre, David; Anand, Sonia S; Mente, Andrew

    2016-01-28

    Dietary patterns containing nuts are associated with a lower risk of CVD mortality, and increased nut consumption has been shown to have beneficial effects on CVD risk factors including serum lipid levels. Recent studies have reported on the relationship between nut intake and CVD outcomes and mortality. Our objective was to systematically review the literature and quantify associations between nut consumption and CVD outcomes and all-cause mortality. Five electronic databases (through July 2015), previous reviews and bibliographies of qualifying articles were searched. In the twenty included prospective cohort studies (n 467 389), nut consumption was significantly associated with a lower risk of all-cause mortality (ten studies; risk ratio (RR) 0·81; 95 % CI 0·77, 0·85 for highest v. lowest quantile of intake, P het=0·04, I 2=43 %), CVD mortality (five studies; RR 0·73; 95 % CI 0·68, 0·78; P het=0·31, I 2=16 %), all CHD (three studies; RR 0·66; 95 % CI 0·48, 0·91; P het=0·0002, I 2=88 %) and CHD mortality (seven studies; RR 0·70; 95 % CI 0·64, 0·76; P het=0·65, I 2=0 %), as well as a statistically non-significant reduction in the risk of non-fatal CHD (three studies; RR 0·71; 95 % CI 0·49, 1·03; P het=0·03, I 2=72 %) and stroke mortality (three studies; RR 0·83; 95 % CI 0·69, 1·00; P het=0·54, I 2=0 %). No evidence of association was found for total stroke (two studies; RR 1·05; 95 % CI 0·69, 1·61; P het=0·04, I 2=77 %). Data on total CVD and sudden cardiac death were available from one cohort study, and they were significantly inversely associated with nut consumption. In conclusion, we found that higher nut consumption is associated with a lower risk of all-cause mortality, total CVD, CVD mortality, total CHD, CHD mortality and sudden cardiac death.

  4. All-Cause and Cause-Specific Risk of Emergency Transport Attributable to Temperature

    PubMed Central

    Onozuka, Daisuke; Hagihara, Akihito

    2015-01-01

    Abstract Although several studies have estimated the associations between mortality or morbidity and extreme temperatures in terms of relative risk, few studies have investigated the risk of emergency transport attributable to the whole temperature range nationwide. We acquired data on daily emergency ambulance dispatches in all 47 prefectures of Japan from 2007 to 2010. We examined the relationship between emergency transport and temperature for each prefecture using a Poisson regression model in a distributed lag nonlinear model with adjustment for time trends. A random-effect multivariate meta-analysis was then applied to pool the estimates at the national level. Attributable morbidity was calculated for high and low temperatures, which were defined as those above or below the optimum temperature (ie, the minimum morbidity temperature) and for moderate and also extreme temperatures, which were defined using cutoffs at the 2.5th and 97.5th temperature percentiles. A total of 15,868,086 cases of emergency transport met the inclusion criteria. The emergency transport was attributable to nonoptimal temperature. The median minimum morbidity percentile was in the 79th percentile for all causes, the 96th percentile for cardiovascular disease, and the 92th percentile for respiratory disease. The fraction attributable to low temperature was 6.94% (95% eCI: 5.93–7.70) for all causes, 17.93% (95% eCI: 16.10–19.25) for cardiovascular disease, and 12.19% (95% eCI: 9.90–13.66) for respiratory disease, whereas the fraction attributable to high temperature was small (all causes = 1.01%, 95% eCI: 0.90–1.11; cardiovascular disease = 0.10%, 95% eCI: 0.04–0.14; respiratory disease = 0.29%, 95% eCI: 0.07–0.50). The all-cause morbidity risk that was attributable to temperature was related to moderate cold, with an overall estimate of 6.41% (95% eCI: 5.47–7.20). Extreme temperatures were responsible for a small fraction, which corresponded to 0.57% (95% e

  5. The association of clinical indication for exercise stress testing with all-cause mortality: the FIT Project

    PubMed Central

    Kim, Joonseok; Al-Mallah, Mouaz; Juraschek, Stephen P.; Brawner, Clinton; Keteyian, Steve J.; Nasir, Khurram; Dardari, Zeina A.; Blumenthal, Roger S.

    2016-01-01

    Introduction We hypothesized that the indication for stress testing provided by the referring physician would be an independent predictor of all-cause mortality. Material and methods We studied 48,914 patients from The Henry Ford Exercise Testing Project (The FIT Project) without known congestive heart failure who were referred for a clinical treadmill stress test and followed for 11 ±4.7 years. The reason for stress test referral was abstracted from the clinical test order, and should be considered the primary concerning symptom or indication as stated by the ordering clinician. Hierarchical multivariable Cox proportional hazards regression was performed, after controlling for potential confounders including demographics, risk factors, and medication use as well as additional adjustment for exercise capacity in the final model. Results A total of 67% of the patients were referred for chest pain, 12% for shortness of breath (SOB), 4% for palpitations, 3% for pre-operative evaluation, 6% for abnormal prior testing, and 7% for risk factors only. There were 6,211 total deaths during follow-up. Compared to chest pain, those referred for palpitations (HR = 0.72, 95% CI: 0.60–0.86) and risk factors only (HR = 0.72, 95% CI: 0.63–0.82) had a lower risk of all-cause mortality, whereas those referred for SOB (HR = 1.15, 95% CI: 1.07–1.23) and pre-operative evaluation (HR = 2.11, 95% CI: 1.94–2.30) had an increased risk. In subgroup analysis, referral for palpitations was protective only in those without coronary artery disease (CAD) (HR = 0.75, 95% CI: 0.62–0.90), while SOB increased mortality risk only in those with established CAD (HR = 1.25, 95% CI: 1.10–1.44). Conclusions The indication for stress testing is an independent predictor of mortality, showing an interaction with CAD status. Importantly, SOB may be associated with higher mortality risk than chest pain, particularly in patients with CAD. PMID:27186173

  6. Independent and joint effects of sedentary time and cardiorespiratory fitness on all-cause mortality: the Cooper Center Longitudinal Study

    PubMed Central

    Shuval, Kerem; Finley, Carrie E; Barlow, Carolyn E; Nguyen, Binh T; Njike, Valentine Y; Pettee Gabriel, Kelley

    2015-01-01

    Objectives To examine the independent and joint effects of sedentary time and cardiorespiratory fitness (fitness) on all-cause mortality. Design, setting, participants A prospective study of 3141 Cooper Center Longitudinal Study participants. Participants provided information on television (TV) viewing and car time in 1982 and completed a maximal exercise test during a 1-year time frame; they were then followed until mortality or through 2010. TV viewing, car time, total sedentary time and fitness were the primary exposures and all-cause mortality was the outcome. The relationship between the exposures and outcome was examined utilising Cox proportional hazard models. Results A total of 581 deaths occurred over a median follow-up period of 28.7 years (SD=4.4). At baseline, participants’ mean age was 45.0 years (SD=9.6), 86.5% were men and their mean body mass index was 24.6 (SD=3.0). Multivariable analyses revealed a significant linear relationship between increased fitness and lower mortality risk, even while adjusting for total sedentary time and covariates (p=0.02). The effects of total sedentary time on increased mortality risk did not quite reach statistical significance once fitness and covariates were adjusted for (p=0.05). When examining this relationship categorically, in comparison to the reference category (≤10 h/week), being sedentary for ≥23 h weekly increased mortality risk by 29% without controlling for fitness (HR=1.29, 95% CI 1.03 to 1.63); however, once fitness and covariates were taken into account this relationship did not reach statistical significance (HR=1.20, 95% CI 0.95 to 1.51). Moreover, spending >10 h in the car weekly significantly increased mortality risk by 27% in the fully adjusted model. The association between TV viewing and mortality was not significant. Conclusions The relationship between total sedentary time and higher mortality risk is less pronounced when fitness is taken into account. Increased car time, but

  7. Psycho-socioeconomic bio-behavioral associations on all-cause mortality: cohort study

    PubMed Central

    Loprinzi, Paul D.; Davis, Robert E.

    2016-01-01

    Background: The purpose of this study was to examine the cumulative effects of psychological,socioeconomic, biological and behavioral parameters on mortality. Methods: A prospective design was employed. Data from the 2005-2006 National Health and Nutrition Examination Survey (NHANES) were used (analyzed in 2015); follow-up mortality status evaluated in 2011. Psychological function was assessed from the Patient Health Questionnaire-9 (PHQ-9) as a measure of depression. Socioeconomic risk was assessed from poverty level, education, minority status, and social living status. Biological parameters included cholesterol, weight status, diabetes, hypertension and systemic inflammation. Behavioral parameters assessed included physical activity (accelerometry), dietary behavior, smoking status (cotinine) and sleep. These 14 psycho-socioeconomic bio-behavioral (PSBB) parameters allowed for the calculation of an overall PSBB Index, ranging from 0-14. Results: Among the evaluated 2530 participants, 161 died over the unweighted median follow-up period of 70.0 months. After adjustment, for every 1 increase in the overall PSBB index score,participants had a 15% reduced risk of all-cause mortality (HR = 0.85; 95% CI: 0.76-0.96). After adjustment, the Behavioral Index (HR = 0.73; 95% CI: 0.60-0.88) and the Socioeconomic Index(HR = 0.82; 95% CI: 0.68-0.99) were significant, but the Psychological Index (HR = 0.67; 95%CI: 0.29-1.51) and the Biological Index (HR = 1.03; 95% CI: 0.89-1.18) were not. Conclusion: Those with a worse PSBB score had an increased risk of all-cause mortality.Promotion of concurrent health behaviors may help to promote overall well-being and prolong survival. PMID:27386420

  8. Daytime Napping and the Risk of Cardiovascular Disease and All-Cause Mortality: A Prospective Study and Dose-Response Meta-Analysis

    PubMed Central

    Yamada, Tomohide; Hara, Kazuo; Shojima, Nobuhiro; Yamauchi, Toshimasa; Kadowaki, Takashi

    2015-01-01

    Study Objectives: To summarize evidence about the association between daytime napping and the risk of cardiovascular disease and all-cause mortality, and to quantify the potential dose-response relation. Design: Meta-analysis of prospective cohort studies. Methods and Results: Electronic databases were searched for articles published up to December 2014 using the terms nap, cardiovascular disease, and all-cause mortality. We selected well-adjusted prospective cohort studies reporting risk estimates for cardiovascular disease and all-cause mortality related to napping. Eleven prospective cohort studies were identified with 151,588 participants (1,625,012 person-years) and a mean follow-up period of 11 years (60% women, 5,276 cardiovascular events, and 18,966 all-cause deaths). Pooled analysis showed that a long daytime nap (≥ 60 min/day) was associated with a higher risk of cardiovascular disease (rate ratio [RR]: 1.82 [1.22–2.71], P = 0.003, I2 = 37%) compared with not napping. All-cause mortality was associated with napping for ≥ 60 min/day (RR: 1.27 [1.11–1.45], P < 0.001, I2 = 0%) compared with not napping. In contrast, napping for < 60 min/day was not associated with cardiovascular disease (P = 0.98) or all-cause mortality (P = 0.08). Meta-analysis demonstrated a significant J-curve dose-response relation between nap time and cardiovascular disease (P for nonlinearity = 0.01). The RR initially decreased from 0 to 30 min/day. Then it increased slightly until about 45 min/day, followed by a sharp increase at longer nap times. There was also a positive linear relation between nap time and all-cause mortality (P for non-linearity = 0.97). Conclusions: Nap time and cardiovascular disease may be associated via a J-curve relation. Further studies are needed to confirm the efficacy of a short nap. Citation: Yamada T, Hara K, Shojima N, Yamauchi T, Kadowaki T. Daytime napping and the risk of cardiovascular disease and all-cause mortality: a prospective study and

  9. All-Cause and Cause-Specific Mortality Associated with Bariatric Surgery: A Review.

    PubMed

    Adams, Ted D; Mehta, Tapan S; Davidson, Lance E; Hunt, Steven C

    2015-12-01

    The question of whether or not nonsurgical intentional or voluntary weight loss results in reduced mortality has been equivocal, with long-term mortality following weight loss being reported as increased, decreased, and not changed. In part, inconsistent results have been attributed to the uncertainty of whether the intentionality of weight loss is accurately reported in large population studies and also that achieving significant and sustained voluntary weight loss in large intervention trials is extremely difficult. Bariatric surgery has generally been free of these conflicts. Patients voluntarily undergo surgery and the resulting weight is typically significant and sustained. These elements, combined with possible non-weight loss-related mechanisms, have resulted in improved comorbidities, which likely contribute to a reduction in long-term mortality. This paper reviews the association between bariatric surgery and long-term mortality. From these studies, the general consensus is that bariatric surgical patients have: 1) significantly reduced long-term all-cause mortality when compared to severely obese non-bariatric surgical control groups; 2) greater mortality when compared to the general population, with the exception of one study; 3) reduced cardiovascular-, stroke-, and cancer-caused mortality when compared to severely obese non-operated controls; and 4) increased risk for externally caused death such as suicide.

  10. Can all cause readmission policy improve quality or lower expenditures? A historical perspective on current initiatives.

    PubMed

    Burgess, James F; Hockenberry, Jason M

    2014-04-01

    All-cause readmission to inpatient care is of wide policy interest in the United States and a number of other countries (Centers for Medicare and Medicaid Services, in the United Kingdom by the National Centre for Health Outcomes Development, and in Australia by the Australian Institute of Health and Welfare). Contemporary policy efforts, including high powered incentives embedded in the current US Hospital Readmission Reduction Program, and the organizationally complex interventions derived in anticipation of this policy, have been touted based on potential cost savings. Strong incentives and resulting interventions may not enjoy the support of a strong theoretical model or the empirical research base that are typical of strong incentive schemes. We examine the historical broad literature on the issue, lay out a 'full' conceptual organizational model of patient transitions as they relate to the hospital, and discuss the strengths and weaknesses of previous and proposed policies. We use this to set out a research and policy agenda on this critical issue rather than attempt to conduct a comprehensive structured literature review. We assert that researchers and policy makers should consider more fundamental societal issues related to health, social support and health literacy if progress is going to be made in reducing readmissions. PMID:23987089

  11. Can all cause readmission policy improve quality or lower expenditures? A historical perspective on current initiatives.

    PubMed

    Burgess, James F; Hockenberry, Jason M

    2014-04-01

    All-cause readmission to inpatient care is of wide policy interest in the United States and a number of other countries (Centers for Medicare and Medicaid Services, in the United Kingdom by the National Centre for Health Outcomes Development, and in Australia by the Australian Institute of Health and Welfare). Contemporary policy efforts, including high powered incentives embedded in the current US Hospital Readmission Reduction Program, and the organizationally complex interventions derived in anticipation of this policy, have been touted based on potential cost savings. Strong incentives and resulting interventions may not enjoy the support of a strong theoretical model or the empirical research base that are typical of strong incentive schemes. We examine the historical broad literature on the issue, lay out a 'full' conceptual organizational model of patient transitions as they relate to the hospital, and discuss the strengths and weaknesses of previous and proposed policies. We use this to set out a research and policy agenda on this critical issue rather than attempt to conduct a comprehensive structured literature review. We assert that researchers and policy makers should consider more fundamental societal issues related to health, social support and health literacy if progress is going to be made in reducing readmissions.

  12. All-Cause and Cause-Specific Mortality Among Men Released From State Prison, 1980–2005

    PubMed Central

    Rosen, David L.; Wohl, David A.

    2008-01-01

    Objectives. We compared mortality of ex-prisoners and other state residents to identify unmet health care needs among former prisoners. Methods. We linked North Carolina prison records with state death records for 1980 to 2005 to estimate the number of overall and cause-specific deaths among male ex-prisoners aged 20 to 69 years and used standardized mortality ratios (SMRs) to compare these observed deaths with the number of expected deaths had they experienced the same age-, race-, and cause-specific death rates as other state residents. Results. All-cause mortality among White (SMR = 2.08; 95% confidence interval [CI] = 2.04, 2.13) and Black (SMR = 1.03; 95% CI = 1.01, 1.05) ex-prisoners was greater than for other male NC residents. Ex-prisoners' deaths from homicide, accidents, substance use, HIV, liver disease, and liver cancer were greater than the expected number of deaths estimated using death rates among other NC residents. Deaths from cardiovascular disease, lung cancer, respiratory diseases, and diabetes were at least 30% greater than expected for White ex-prisoners, but less than expected for Black ex-prisoners. Conclusions. Ex-prisoners experienced more deaths than would have been expected among other NC residents. Excess deaths from injuries and medical conditions common to prison populations highlight ex-prisoners' medical vulnerability and the need to improve correctional and community preventive health services. PMID:18923131

  13. Estimating the Time-Varying Joint Effects of Obesity and Smoking on All-Cause Mortality Using Marginal Structural Models.

    PubMed

    Banack, Hailey R; Kaufman, Jay S

    2016-01-15

    Obesity and smoking are independently associated with a higher mortality risk, but previous studies have reported conflicting results about the relationship between these 2 time-varying exposures. Using prospective longitudinal data (1987-2007) from the Atherosclerosis Risk in Communities Study, our objective in the present study was to estimate the joint effects of obesity and smoking on all-cause mortality and investigate whether there were additive or multiplicative interactions. We fit a joint marginal structural Poisson model to account for time-varying confounding affected by prior exposure to obesity and smoking. The incidence rate ratios from the joint model were 2.00 (95% confidence interval (CI): 1.79, 2.24) for the effect of smoking on mortality among nonobese persons, 1.31 (95% CI: 1.13, 1.51) for the effect of obesity on mortality among nonsmokers, and 1.97 (95% CI: 1.73, 2.22) for the joint effect of smoking and obesity on mortality. The negative product term from the exponential model revealed a submultiplicative interaction between obesity and smoking (β = -0.28, 95% CI: -0.45, -0.11; P < 0.001). The relative excess risk of interaction was -0.34 (95% CI: -0.60, -0.07), indicating the presence of subadditive interaction. These results provide important information for epidemiologists, clinicians, and public health practitioners about the harmful impact of smoking and obesity.

  14. All-Cause Mortality for Diabetics or Individuals with Hyperglycemia Applying for Life Insurance.

    PubMed

    Freitas, Stephen A; MacKenzie, Ross; Wylde, David N; Roudebush, Bradley T; Bergstrom, Richard L; Holowaty, J Carl; Hart, Anna; Rigatti, Steven J; Gill, Stacy J

    2016-01-01

    Diabetics and individuals with lab results consistent with a diagnosis of diabetes or hyperglycemia were extracted from data covering US residents who applied for life insurance between January 2007 and January 2014. Information about these applicants was matched to the Social Security Death Master File (SSDMF) and another commercially available death source file to determine vital status. Due to the inconsistencies of reporting within the death files, there were two cohorts of death cases, one including the imputed year of birth (full cohort of deaths), and the second where the date of birth was known (reduced cohort of deaths). The study had approximately 8.5 million person-years of exposure. Actual to expected (A/E) mortality ratios were calculated using the Society of Actuaries 2008 Valuation Basic Table (2008VBT) select table, age last birthday and the 2010 US population as expected mortality rates. With the 2008VBT as an expected basis, the overall A/E mortality ratio was 3.15 for the full cohort of deaths and 2.56 for the reduced cohort of deaths. Using the US population as the expected basis, the overall A/E mortality ratio was 0.98 for the full cohort of deaths and 0.79 for the reduced cohort. Since there was no smoking status information in this study, all expected bases were not smoker distinct. A/E mortality ratios varied by disease treatment category and were considerably higher in individuals using insulin. A/E mortality ratios decreased with increasing age and took on a J-shaped distribution with increasing BMI (Body Mass Index). The lowest mortality ratios were observed for overweight and obese individuals. The A/E mortality ratio based on the 2008VBT decreased with the increase in applicant duration, which was defined as the time since initial life insurance application. PMID:27562107

  15. All-Cause Mortality for Diabetics or Individuals with Hyperglycemia Applying for Life Insurance.

    PubMed

    Freitas, Stephen A; MacKenzie, Ross; Wylde, David N; Roudebush, Bradley T; Bergstrom, Richard L; Holowaty, J Carl; Hart, Anna; Rigatti, Steven J; Gill, Stacy J

    2016-01-01

    Diabetics and individuals with lab results consistent with a diagnosis of diabetes or hyperglycemia were extracted from data covering US residents who applied for life insurance between January 2007 and January 2014. Information about these applicants was matched to the Social Security Death Master File (SSDMF) and another commercially available death source file to determine vital status. Due to the inconsistencies of reporting within the death files, there were two cohorts of death cases, one including the imputed year of birth (full cohort of deaths), and the second where the date of birth was known (reduced cohort of deaths). The study had approximately 8.5 million person-years of exposure. Actual to expected (A/E) mortality ratios were calculated using the Society of Actuaries 2008 Valuation Basic Table (2008VBT) select table, age last birthday and the 2010 US population as expected mortality rates. With the 2008VBT as an expected basis, the overall A/E mortality ratio was 3.15 for the full cohort of deaths and 2.56 for the reduced cohort of deaths. Using the US population as the expected basis, the overall A/E mortality ratio was 0.98 for the full cohort of deaths and 0.79 for the reduced cohort. Since there was no smoking status information in this study, all expected bases were not smoker distinct. A/E mortality ratios varied by disease treatment category and were considerably higher in individuals using insulin. A/E mortality ratios decreased with increasing age and took on a J-shaped distribution with increasing BMI (Body Mass Index). The lowest mortality ratios were observed for overweight and obese individuals. The A/E mortality ratio based on the 2008VBT decreased with the increase in applicant duration, which was defined as the time since initial life insurance application.

  16. Hazard Ratio and Repeat Injury for Dementia in Patients With and Without a History of Traumatic Brain Injury: A Population-Based Secondary Data Analysis in Taiwan.

    PubMed

    Chu, Shu-Fen; Chiu, Wen-Ta; Lin, Hui-Wen; Chiang, Yung-Hsiao; Liou, Tsan-Hon

    2016-09-01

    The impact of traumatic brain injury (TBI) on the pathogenic hazard ratio (HR) for dementia patients is still controversial. Some studies have supported the association between TBI and dementia, especially for Alzheimer's disease, and our study determined that the HR of dementia patients with and without a history of TBI or repeated TBI (RTBI). We determined the HR for dementia patients with a diagnosis of TBI (n = 12931) and a comparative cohort with age- and gender-matched controls (n = 51724) during 2004-2005, using Taiwan's National Health Insurance Research Database. The adjusted HR (HR = 3.21) for dementia patients with TBI showed that they were more likely to develop dementia than the comparison cohort. The HR for dementia patients with RTBI was increased to 3.62. The results of this large-scale study suggested that TBI increases dementia risk. Future studies using animal models and epidemiological databases could elucidate medical and biological mechanisms linking TBI and the development of dementia. PMID:27614252

  17. Racial Disparities in All-Cause Mortality Among Veterans with Type 2 Diabetes

    PubMed Central

    Lynch, Cheryl P.; Gebregziabher, Mulugeta; Echols, Carrae; Gilbert, Gregory E.; Zhao, Yumin

    2010-01-01

    BACKGROUND Racial differences in mortality among veterans with diabetes are less well characterized than those in the general population. OBJECTIVE To examine racial differences in all-cause mortality in a large sample of veterans with diabetes. DESIGN A retrospective cohort. PARTICIPANTS Participants comprised 8,812 veterans with type 2 diabetes. MEASUREMENTS The main outcome measure was time to death. The main predictor was race/ethnicity. Other risk factors (or covariates) included age, gender, marital status, employment, glycosylated hemoglobin (HgbA1c), and several ICD-9 coded physical and mental health comorbidities. RESULTS Average follow-up was 4.5 years; 64% of veterans were non-Hispanic whites (NHW), 97% male, and 84% at least 50 years old. The overall mortality rate was 15% and was significantly lower for non-Hispanic blacks (NHB). Baseline HgbA1c values also differed for NHW (mean = 7.05) and NHB (mean = 7.65) (p < 0.001). In sequentially-built models NHB race was associated with a lower risk of mortality with HR ranging 0.80-0.92. After adjusting for all significant covariates, the risk of mortality remained lower for NHB (HR = 0.84, 95% CI: 0.75, 0.94). Increased mortality risk was associated with age, not being employed or retired, poor glycemic control, cancer, Coronary Heart Disease (CHD), and anxiety disorder; while a lower risk was associated with being female and ever being married. CONCLUSIONS The risk of death among NHB veterans with diabetes remained significantly lower than that of NHW after controlling for important confounding variables. Future studies in the VA need to examine detailed contributions of patient, provider and system-level factors on racial differences in mortality in adults with diabetes, especially if the findings of this study are replicated at other sites or using national VA data. PMID:20532659

  18. All cause mortality and incidence of cancer in workers in bauxite mines and alumina refineries.

    PubMed

    Fritschi, Lin; Hoving, Jan Lucas; Sim, Malcolm R; Del Monaco, Anthony; MacFarlane, Ewan; McKenzie, Dean; Benke, Geza; de Klerk, Nicholas

    2008-08-15

    Bauxite is a reddish clay that is refined to produce alumina, which is then reduced to aluminium. There have been studies examining the health of workers in aluminium smelters, but not workers in bauxite mining and alumina refining. A cohort of employees of 1 large aluminium company since 1983 was assembled (n = 6,485, 5,828 men). Deaths and incident cancers to 2002 were ascertained by linkage to national and state cancer and death registries. SIRs and SMRs were calculated compared to national rates standardizing for calendar year, sex and 5-year age group. The mortality from all causes (SMR 0.68, 95% CI: 0.60-0.77), and from circulatory and respiratory diseases, all cancers combined and injury in the male cohort were lower than in the Australian male population and were similar across work groups and with duration of employment. The only significant increased mortality risk was from pleural mesothelioma. The incidence of all cancers combined was similar to the Australian rate. The cohort had a lower risk of incident lymphohaematopoietic cancer (SIR 0.50, 95% CI: 0.31-0.88) and a higher risk of melanoma (SIR 1.30, 95% CI: 1.00-1.69) although no dose-responses were seen. There was also an increased risk of mesothelioma (SIR 3.49, 95% CI: 1.82-6.71), which was associated with exposures outside the aluminium industry. This study is the first to examine cancer and mortality amongst workers in bauxite mines and alumina refineries and found little evidence for increased cancer incidence or mortality in these workers.

  19. Occupational class inequalities in all-cause and cause-specific mortality among middle-aged men in 14 European populations during the early 2000s.

    PubMed

    Toch-Marquardt, Marlen; Menvielle, Gwenn; Eikemo, Terje A; Kulhánová, Ivana; Kulik, Margarete C; Bopp, Matthias; Esnaola, Santiago; Jasilionis, Domantas; Mäki, Netta; Martikainen, Pekka; Regidor, Enrique; Lundberg, Olle; Mackenbach, Johan P

    2014-01-01

    This study analyses occupational class inequalities in all-cause mortality and four specific causes of death among men, in Europe in the early 2000s, and is the most extensive comparative analysis of occupational class inequalities in mortality in Europe so far. Longitudinal data, obtained from population censuses and mortality registries in 14 European populations, from around the period 2000-2005, were used. Analyses concerned men aged 30-59 years and included all-cause mortality and mortality from all cancers, all cardiovascular diseases (CVD), all external, and all other causes. Occupational class was analysed according to five categories: upper and lower non-manual workers, skilled and unskilled manual workers, and farmers and self-employed combined. Inequalities were quantified with mortality rate ratios, rate differences, and population attributable fractions (PAF). Relative and absolute inequalities in all-cause mortality were more pronounced in Finland, Denmark, France, and Lithuania than in other populations, and the same countries (except France) also had the highest PAF values for all-cause mortality. The main contributing causes to these larger inequalities differed strongly between countries (e.g., cancer in France, all other causes in Denmark). Relative and absolute inequalities in CVD mortality were markedly lower in Southern European populations. We conclude that relative and absolute occupational class differences in all-cause and cause specific mortality have persisted into the early 2000's, although the magnitude differs strongly between populations. Comparisons with previous studies suggest that the relative gap in mortality between occupational classes has further widened in some Northern and Western European populations.

  20. Occupational Class Inequalities in All-Cause and Cause-Specific Mortality among Middle-Aged Men in 14 European Populations during the Early 2000s

    PubMed Central

    Toch-Marquardt, Marlen; Menvielle, Gwenn; Eikemo, Terje A.; Kulhánová, Ivana; Kulik, Margarete C.; Bopp, Matthias; Esnaola, Santiago; Jasilionis, Domantas; Mäki, Netta; Martikainen, Pekka; Regidor, Enrique; Lundberg, Olle; Mackenbach, Johan P.

    2014-01-01

    This study analyses occupational class inequalities in all-cause mortality and four specific causes of death among men, in Europe in the early 2000s, and is the most extensive comparative analysis of occupational class inequalities in mortality in Europe so far. Longitudinal data, obtained from population censuses and mortality registries in 14 European populations, from around the period 2000–2005, were used. Analyses concerned men aged 30–59 years and included all-cause mortality and mortality from all cancers, all cardiovascular diseases (CVD), all external, and all other causes. Occupational class was analysed according to five categories: upper and lower non-manual workers, skilled and unskilled manual workers, and farmers and self-employed combined. Inequalities were quantified with mortality rate ratios, rate differences, and population attributable fractions (PAF). Relative and absolute inequalities in all-cause mortality were more pronounced in Finland, Denmark, France, and Lithuania than in other populations, and the same countries (except France) also had the highest PAF values for all-cause mortality. The main contributing causes to these larger inequalities differed strongly between countries (e.g., cancer in France, all other causes in Denmark). Relative and absolute inequalities in CVD mortality were markedly lower in Southern European populations. We conclude that relative and absolute occupational class differences in all-cause and cause specific mortality have persisted into the early 2000's, although the magnitude differs strongly between populations. Comparisons with previous studies suggest that the relative gap in mortality between occupational classes has further widened in some Northern and Western European populations. PMID:25268702

  1. Oxidative Stress Predicts All-Cause Mortality in HIV-Infected Patients

    PubMed Central

    Masiá, Mar; Padilla, Sergio; Fernández, Marta; Rodríguez, Carmen; Moreno, Ana; Oteo, Jose A.; Antela, Antonio; Moreno, Santiago; del Amo, Julia; Gutiérrez, Félix

    2016-01-01

    Objective We aimed to assess whether oxidative stress is a predictor of mortality in HIV-infected patients. Methods We conducted a nested case-control study in CoRIS, a contemporary, multicentre cohort of HIV-infected patients, antiretroviral-naïve at entry, launched in 2004. Cases were patients who died with available stored plasma samples collected. Two age and sex-matched controls for each case were selected. We measured F2-isoprostanes (F2-IsoPs) and malondialdehyde (MDA) plasma levels in the first blood sample obtained after cohort engagement. Results 54 cases and 93 controls were included. Median F2-IsoPs and MDA levels were significantly higher in cases than in controls. When adjustment was performed for age, HIV-transmission category, CD4 cell count and HIV viral load at cohort entry, and subclinical inflammation measured with highly-sensitive C-reactive protein (hsCRP), the association of F2-IsoPs with mortality remained significant (adjusted OR per 1 log10 increase, 2.34 [1.23–4.47], P = 0.009). The association of MDA with mortality was attenuated after adjustment: adjusted OR (95% CI) per 1 log10 increase, 2.05 [0.91–4.59], P = 0.080. Median hsCRP was also higher in cases, and it also proved to be an independent predictor of mortality in the adjusted analysis: OR (95% CI) per 1 log10 increase, 1.39 (1.01–1.91), P = 0.043; and OR (95% CI) per 1 log10 increase, 1.46 (1.07–1.99), P = 0.014, respectively, when adjustment included F2-IsoPs and MDA. Conclusion Oxidative stress is a predictor of all-cause mortality in HIV-infected patients. For plasma F2-IsoPs, this association is independent of HIV-related factors and subclinical inflammation. PMID:27111769

  2. Frailty Index Predicts All-Cause Mortality for Middle-Aged and Older Taiwanese: Implications for Active-Aging Programs

    PubMed Central

    Lin, Shu-Yu; Lee, Wei-Ju; Chou, Ming-Yueh; Peng, Li-Ning; Chiou, Shu-Ti; Chen, Liang-Kung

    2016-01-01

    Background Frailty Index, defined as an individual’s accumulated proportion of listed health-related deficits, is a well-established metric used to assess the health status of old adults; however, it has not yet been developed in Taiwan, and its local related structure factors remain unclear. The objectives were to construct a Taiwan Frailty Index to predict mortality risk, and to explore the structure of its factors. Methods Analytic data on 1,284 participants aged 53 and older were excerpted from the Social Environment and Biomarkers of Aging Study (2006), in Taiwan. A consensus workgroup of geriatricians selected 159 items according to the standard procedure for creating a Frailty Index. Cox proportional hazard modeling was used to explore the association between the Taiwan Frailty Index and mortality. Exploratory factor analysis was used to identify structure factors and produce a shorter version–the Taiwan Frailty Index Short-Form. Results During an average follow-up of 4.3 ± 0.8 years, 140 (11%) subjects died. Compared to those in the lowest Taiwan Frailty Index tertile (< 0.18), those in the uppermost tertile (> 0.23) had significantly higher risk of death (Hazard ratio: 3.2; 95% CI 1.9–5.4). Thirty-five items of five structure factors identified by exploratory factor analysis, included: physical activities, life satisfaction and financial status, health status, cognitive function, and stresses. Area under the receiver operating characteristic curves (C-statistics) of the Taiwan Frailty Index and its Short-Form were 0.80 and 0.78, respectively, with no statistically significant difference between them. Conclusion Although both the Taiwan Frailty Index and Short-Form were associated with mortality, the Short-Form, which had similar accuracy in predicting mortality as the full Taiwan Frailty Index, would be more expedient in clinical practice and community settings to target frailty screening and intervention. PMID:27537684

  3. The Impact of Superoxide Dismutase-1 Genetic Variation on Cardiovascular and All-Cause Mortality in a Prospective Cohort Study: The Yamagata (Takahata) Study

    PubMed Central

    Otaki, Yoichiro; Watanabe, Tetsu; Nishiyama, Satoshi; Takahashi, Hiroki; Arimoto, Takanori; Shishido, Tetsuro; Miyamoto, Takuya; Konta, Tsuneo; Shibata, Yoko; Sato, Hidenori; Kawasaki, Ryo; Daimon, Makoto; Ueno, Yoshiyuki; Kato, Takeo; Kayama, Takamasa; Kubota, Isao

    2016-01-01

    Background Oxidative stress is a major cause of cardiovascular disease. Superoxide dismutase-1 (SOD1) is an antioxidant that protects against oxidative stress. Deoxyribonucleic acid (DNA) variations such as single nucleotide polymorphism (SNP) or haplotypes within the SOD gene are reportedly associated with the development of cardiovascular disease. However, it remains to be determined whether SOD1 variability is associated with cardiovascular or all-cause mortality in the general population. Methods and Results This prospective cohort study included 2799 subjects who participated in a community-based health study with a 10-year follow-up. We genotyped 639 SNPs and found the association of SNP rs1041740 and rs17880487 within a SOD1 gene with cardiovascular mortality. There were 193 deaths during the follow-up period including 57 cardiovascular deaths. Multivariate Cox proportional hazard regression analysis revealed that the homozygous T-allele of rs1041740 was associated with all-cause and cardiovascular deaths after adjusting for confounding factors. The net reclassification index was significantly improved by adding rs1041740 as a cardiovascular risk factor. On the other hand, cardiovascular death was not observed in homozygous T-allele carriers of rs17880487. Haplotype analysis identified the haplotype with T-allele of rs1041740 and that with T-allele of rs17880487 as increasing and decreasing susceptibility for cardiovascular mortality, and it had complementary SNP sequences. Conclusion Variation in the SOD1 gene was associated with cardiovascular deaths in the general population. PMID:27755600

  4. Hospital-Acquired Clostridium difficile Infections Estimating All-Cause Mortality and Length of Stay

    PubMed Central

    Lofgren, Eric T.; Cole, Stephen R.; Weber, David J.; Anderson, Deverick J.; Moehring, Rebekah W.

    2014-01-01

    Background Clostridium difficile is a health care–associated infection of increasing importance. The purpose of this study was to estimate the time until death from any cause and time until release among patients with C. difficile, comparing the burden of those in the intensive care unit (ICU) with those in the general hospital population. Methods A parametric mixture model was used to estimate event times, as well as the case-fatality ratio in ICU and non-ICU patients within a cohort of 609 adult incident cases of C. difficile in the Southeastern United States between 1 July 2009 and 31 December 2010. Results ICU patients had twice the median time to death (relative time = 1.97 [95% confidence interval (CI) = 0.96–4.01]) and nearly twice the median time to release (1.88 [1.40–2.51]) compared with non-ICU patients. ICU patients also experienced 3.4 times the odds of mortality (95% CI = 1.8–6.2). Cause-specific competing risks analysis underestimated the relative survival time until death (0.65 [0.36–1.17]) compared with the mixture model. Conclusions Patients with C. difficile in the ICU experienced higher mortality and longer lengths of stay within the hospital. ICU patients with C. difficile infection represent a population in need of particular attention, both to prevent adverse patient outcomes and to minimize transmission of C. difficile to other hospitalized patients. PMID:24815305

  5. Resting heart rate and all-cause and cardiovascular mortality in the general population: a meta-analysis

    PubMed Central

    Zhang, Dongfeng; Shen, Xiaoli; Qi, Xin

    2016-01-01

    Background: Data on resting heart rate and risk of all-cause and cardiovascular mortality are inconsistent; the magnitude of associations between resting heart rate and risk of all-cause and cardiovascular mortality varies across studies. We performed a meta-analysis of prospective cohort studies to quantitatively evaluate the associations in the general population. Methods: We searched PubMed, Embase and MEDLINE from inception to Jan. 1, 2015. We used a random-effects model to combine study-specific relative risks and 95% confidence intervals (CIs). We used restricted cubic spline functions to assess the dose–response relation. Results: A total of 46 studies were included in the meta-analysis, involving 1 246 203 patients and 78 349 deaths for all-cause mortality, and 848 320 patients and 25 800 deaths for cardiovascular mortality. The relative risk with 10 beats/min increment of resting heart rate was 1.09 (95% CI 1.07–1.12) for all-cause mortality and 1.08 (95% CI 1.06–1.10) for cardiovascular mortality. Compared with the lowest category, patients with a resting heart rate of 60–80 beats/min had a relative risk of 1.12 (95% CI 1.07–1.17) for all-cause mortality and 1.08 (95% CI 0.99–1.17) for cardiovascular mortality, and those with a resting heart rate of greater than 80 beats/min had a relative risk of 1.45 (95% CI 1.34–1.57) for all-cause mortality and 1.33 (95% CI 1.19–1.47) for cardiovascular mortality. Overall, the results did not differ after adjustment for traditional risk factors for cardiovascular disease. Compared with 45 beats/min, the risk of all-cause mortality increased significantly with increasing resting heart rate in a linear relation, but a significantly increased risk of cardiovascular mortality was observed at 90 beats/min. Substantial heterogeneity and publication bias were detected. Interpretation: Higher resting heart rate was independently associated with increased risks of all-cause and cardiovascular mortality. This

  6. A Retrospective Study of the Clinical Burden of Hospitalized All-Cause and Pneumococcal Pneumonia in Canada

    PubMed Central

    McNeil, Shelly A.; Qizilbash, Nawab; Ye, Jian; Gray, Sharon; Zanotti, Giovanni; Munson, Samantha; Dartois, Nathalie; Laferriere, Craig

    2016-01-01

    Background. Routine vaccination against Streptococcus pneumoniae is recommended in Canada for infants, the elderly, and individuals with chronic comorbidity. National incidence and burden of all-cause and pneumococcal pneumonia in Canada (excluding Quebec) were assessed. Methods. Incidence, length of stay, and case-fatality rates of hospitalized all-cause and pneumococcal pneumonia were determined for 2004–2010 using ICD-10 discharge data from the Canadian Institutes for Health Information Discharge Abstract Database. Population-at-risk data were obtained from the Statistics Canada census. Temporal changes in pneumococcal and all-cause pneumonia rates in adults ≥65 years were analyzed by logistic regression. Results. Hospitalization for all-cause pneumonia was highest in children <5 years and in adults >70 years and declined significantly from 1766/100,000 to 1537/100,000 per year in individuals aged ≥65 years (P < 0.001). Overall hospitalization for pneumococcal pneumonia also declined from 6.40/100,000 to 5.08/100,000 per year. Case-fatality rates were stable (11.6% to 12.3%). Elderly individuals had longer length of stay and higher case-fatality rates than younger groups. Conclusions. All-cause and pneumococcal pneumonia hospitalization rates declined between 2004 and 2010 in Canada (excluding Quebec). Direct and indirect effects from pediatric pneumococcal immunization may partly explain some of this decline. Nevertheless, the burden of disease from pneumonia remains high. PMID:27445530

  7. Coffee consumption and mortality from all causes, cardiovascular disease, and cancer: a dose-response meta-analysis.

    PubMed

    Crippa, Alessio; Discacciati, Andrea; Larsson, Susanna C; Wolk, Alicja; Orsini, Nicola

    2014-10-15

    Several studies have analyzed the relationship between coffee consumption and mortality, but the shape of the association remains unclear. We conducted a dose-response meta-analysis of prospective studies to examine the dose-response associations between coffee consumption and mortality from all causes, cardiovascular disease (CVD), and all cancers. Pertinent studies, published between 1966 and 2013, were identified by searching PubMed and by reviewing the reference lists of the selected articles. Prospective studies in which investigators reported relative risks of mortality from all causes, CVD, and all cancers for 3 or more categories of coffee consumption were eligible. Results from individual studies were pooled using a random-effects model. Twenty-one prospective studies, with 121,915 deaths and 997,464 participants, met the inclusion criteria. There was strong evidence of nonlinear associations between coffee consumption and mortality for all causes and CVD (P for nonlinearity < 0.001). The largest risk reductions were observed for 4 cups/day for all-cause mortality (16%, 95% confidence interval: 13, 18) and 3 cups/day for CVD mortality (21%, 95% confidence interval: 16, 26). Coffee consumption was not associated with cancer mortality. Findings from this meta-analysis indicate that coffee consumption is inversely associated with all-cause and CVD mortality.

  8. [Differences of mortality risk for all causes and for cardiovascular diseases among occupational classes in men living the Northern Italy].

    PubMed

    Ferrario, M; Porati, S; Chiodini, P; Taborelli, S; Toso, C; Borchini, R; Maretti, A; Cesana, G

    2003-01-01

    To assess socio-occupational (SO) class differences in 8-year risk of all-cause and cardiovascular (CVD) death in an North Italian prospective epidemiological study, five cohorts (four population-based and one factory-based) were investigated at baseline from 1986 to 1995. Follow-up procedures allow to sensor 4339 35-74 years old men up to the end of 1998 for all-cause and cardiovascular deaths. Coronary risk factors were measures according to the standardised methods of MONICA Project. Five SO classes were identified according to the method proposed by Erikson, Golthorpe e Portocarero. Results shows an inverse associations between SO classes and death risk for all-cause and cancer. The higher SO classes showed higher risk of cardiovascular death risk. Possible explanations include high level of job stress among employed managers and professionals.

  9. Tea consumption and mortality of all cancers, CVD and all causes: a meta-analysis of eighteen prospective cohort studies.

    PubMed

    Tang, Jun; Zheng, Ju-Sheng; Fang, Ling; Jin, Yongxin; Cai, Wenwen; Li, Duo

    2015-09-14

    Epidemiological studies have demonstrated inconsistent associations between tea consumption and mortality of all cancers, CVD and all causes. To obtain quantitative overall estimates, we conducted a dose-response meta-analysis of prospective cohort studies. A literature search in PubMed and Embase up to April 2015 was conducted for all relevant papers published. Random-effects models were used to calculate pooled relative risks (RR) with 95 % CI. In eighteen prospective studies, there were 12 221, 11 306 and 55 528 deaths from all cancers, CVD and all causes, respectively. For all cancer mortality, the summary RR for the highest v. lowest category of green tea and black tea consumption were 1·06 (95 % CI 0·98, 1·15) and 0·79 (95 % CI 0·65, 0·97), respectively. For CVD mortality, the summary RR for the highest v. lowest category of green tea and black tea consumption were 0·67 (95 % CI 0·46, 0·96) and 0·88 (95 % CI 0·77, 1·01), respectively. For all-cause mortality, the summary RR for the highest v. lowest category of green tea and black tea consumption were 0·80 (95 % CI 0·68, 0·93) and 0·90 (95 % CI 0·83, 0·98), respectively. The dose-response analysis indicated that one cup per d increment of green tea consumption was associated with 5 % lower risk of CVD mortality and with 4 % lower risk of all-cause mortality. Green tea consumption was significantly inversely associated with CVD and all-cause mortality, whereas black tea consumption was significantly inversely associated with all cancer and all-cause mortality.

  10. Relationships between cold-temperature indices and all causes and cardiopulmonary morbidity and mortality in a subtropical island.

    PubMed

    Lin, Yu-Kai; Wang, Yu-Chun; Lin, Pay-Liam; Li, Ming-Hsu; Ho, Tsung-Jung

    2013-09-01

    This study aimed to identify optimal cold-temperature indices that are associated with the elevated risks of mortality from, and outpatient visits for all causes and cardiopulmonary diseases during the cold seasons (November to April) from 2000 to 2008 in Northern, Central and Southern Taiwan. Eight cold-temperature indices, average, maximum, and minimum temperatures, and the temperature humidity index, wind chill index, apparent temperature, effective temperature (ET), and net effective temperature and their standardized Z scores were applied to distributed lag non-linear models. Index-specific cumulative 26-day (lag 0-25) mortality risk, cumulative 8-day (lag 0-7) outpatient visit risk, and their 95% confidence intervals were estimated at 1 and 2 standardized deviations below the median temperature, comparing with the Z score of the lowest risks for mortality and outpatient visits. The average temperature was adequate to evaluate the mortality risk from all causes and circulatory diseases. Excess all-cause mortality increased for 17-24% when average temperature was at Z=-1, and for 27-41% at Z=-2 among study areas. The cold-temperature indices were inconsistent in estimating risk of outpatient visits. Average temperature and THI were appropriate indices for measuring risk for all-cause outpatient visits. Relative risk of all-cause outpatient visits increased slightly by 2-7% when average temperature was at Z=-1, but no significant risk at Z=-2. Minimum temperature estimated the strongest risk associated with outpatient visits of respiratory diseases. In conclusion, the relationships between cold temperatures and health varied among study areas, types of health event, and the cold-temperature indices applied. Mortality from all causes and circulatory diseases and outpatient visits of respiratory diseases has a strong association with cold temperatures in the subtropical island, Taiwan. PMID:23764675

  11. Relationships between cold-temperature indices and all causes and cardiopulmonary morbidity and mortality in a subtropical island.

    PubMed

    Lin, Yu-Kai; Wang, Yu-Chun; Lin, Pay-Liam; Li, Ming-Hsu; Ho, Tsung-Jung

    2013-09-01

    This study aimed to identify optimal cold-temperature indices that are associated with the elevated risks of mortality from, and outpatient visits for all causes and cardiopulmonary diseases during the cold seasons (November to April) from 2000 to 2008 in Northern, Central and Southern Taiwan. Eight cold-temperature indices, average, maximum, and minimum temperatures, and the temperature humidity index, wind chill index, apparent temperature, effective temperature (ET), and net effective temperature and their standardized Z scores were applied to distributed lag non-linear models. Index-specific cumulative 26-day (lag 0-25) mortality risk, cumulative 8-day (lag 0-7) outpatient visit risk, and their 95% confidence intervals were estimated at 1 and 2 standardized deviations below the median temperature, comparing with the Z score of the lowest risks for mortality and outpatient visits. The average temperature was adequate to evaluate the mortality risk from all causes and circulatory diseases. Excess all-cause mortality increased for 17-24% when average temperature was at Z=-1, and for 27-41% at Z=-2 among study areas. The cold-temperature indices were inconsistent in estimating risk of outpatient visits. Average temperature and THI were appropriate indices for measuring risk for all-cause outpatient visits. Relative risk of all-cause outpatient visits increased slightly by 2-7% when average temperature was at Z=-1, but no significant risk at Z=-2. Minimum temperature estimated the strongest risk associated with outpatient visits of respiratory diseases. In conclusion, the relationships between cold temperatures and health varied among study areas, types of health event, and the cold-temperature indices applied. Mortality from all causes and circulatory diseases and outpatient visits of respiratory diseases has a strong association with cold temperatures in the subtropical island, Taiwan.

  12. Change of Serum BNP Between Admission and Discharge After Acute Decompensated Heart Failure Is a Better Predictor of 6-Month All-Cause Mortality Than the Single BNP Value Determined at Admission

    PubMed Central

    De Vecchis, Renato; Ariano, Carmelina; Giandomenico, Giuseppe; Di Maio, Marco; Baldi, Cesare

    2016-01-01

    Background B-type natriuretic peptide (BNP) is regarded as a reliable predictor of outcome in patients with acute decompensated heart failure (ADHF). However, according to some scholars, a single isolated measurement of serum BNP at the time of hospital admission would not be sufficient to provide reliable prognostic information. Methods A retrospective study was carried out on patients hospitalized for ADHF, who had then undergone follow-up of at least 6 months, in order to see if there was any difference in midterm mortality among patients with rising BNP at discharge as compared to those with decreasing BNP at discharge. Medical records had to be carefully examined to divide the case records into two groups, the former characterized by an increase in BNP during hospitalization, and the latter showing a decrease in BNP from the time of admission to the time of discharge. Results Ultimately, 177 patients were enrolled in a retrospective study. Among them, 53 patients (29.94%) had increased BNPs at the time of discharge relative to admission, whereas 124 (70.06%) exhibited decreases in serum BNP during their hospital stay. The group with patients who exhibited BNP increases at the time of discharge had higher degree of congestion evident in the higher frequency of persistent jugular venous distention (odds ratio: 3.72; P = 0.0001) and persistent orthopnea at discharge (odds ratio: 2.93; P = 0.0016). Moreover, patients with increased BNP at the time of discharge had a lower reduction in inferior vena cava maximum diameter (1.58 ± 2.2 mm vs. 6.32 ± 1.82 mm; P = 0.001 (one-way ANOVA)). In contrast, there was no significant difference in weight loss when patients with increased BNP at discharge were compared to those with no such increase. A total of 14 patients (7.9%) died during the 6-month follow-up period. Cox proportional hazard analysis revealed that BNP increase at the time of discharge was an independent predictor of 6-month all-cause mortality after

  13. Change of Serum BNP Between Admission and Discharge After Acute Decompensated Heart Failure Is a Better Predictor of 6-Month All-Cause Mortality Than the Single BNP Value Determined at Admission

    PubMed Central

    De Vecchis, Renato; Ariano, Carmelina; Giandomenico, Giuseppe; Di Maio, Marco; Baldi, Cesare

    2016-01-01

    Background B-type natriuretic peptide (BNP) is regarded as a reliable predictor of outcome in patients with acute decompensated heart failure (ADHF). However, according to some scholars, a single isolated measurement of serum BNP at the time of hospital admission would not be sufficient to provide reliable prognostic information. Methods A retrospective study was carried out on patients hospitalized for ADHF, who had then undergone follow-up of at least 6 months, in order to see if there was any difference in midterm mortality among patients with rising BNP at discharge as compared to those with decreasing BNP at discharge. Medical records had to be carefully examined to divide the case records into two groups, the former characterized by an increase in BNP during hospitalization, and the latter showing a decrease in BNP from the time of admission to the time of discharge. Results Ultimately, 177 patients were enrolled in a retrospective study. Among them, 53 patients (29.94%) had increased BNPs at the time of discharge relative to admission, whereas 124 (70.06%) exhibited decreases in serum BNP during their hospital stay. The group with patients who exhibited BNP increases at the time of discharge had higher degree of congestion evident in the higher frequency of persistent jugular venous distention (odds ratio: 3.72; P = 0.0001) and persistent orthopnea at discharge (odds ratio: 2.93; P = 0.0016). Moreover, patients with increased BNP at the time of discharge had a lower reduction in inferior vena cava maximum diameter (1.58 ± 2.2 mm vs. 6.32 ± 1.82 mm; P = 0.001 (one-way ANOVA)). In contrast, there was no significant difference in weight loss when patients with increased BNP at discharge were compared to those with no such increase. A total of 14 patients (7.9%) died during the 6-month follow-up period. Cox proportional hazard analysis revealed that BNP increase at the time of discharge was an independent predictor of 6-month all-cause mortality after

  14. All-cause mortality in the cohorts of the Spanish AIDS Research Network (RIS) compared with the general population: 1997–2010

    PubMed Central

    2013-01-01

    Background Combination antiretroviral therapy (cART) has produced significant changes in mortality of HIV-infected persons. Our objective was to estimate mortality rates, standardized mortality ratios and excess mortality rates of cohorts of the AIDS Research Network (RIS) (CoRIS-MD and CoRIS) compared to the general population. Methods We analysed data of CoRIS-MD and CoRIS cohorts from 1997 to 2010. We calculated: (i) all-cause mortality rates, (ii) standardized mortality ratio (SMR) and (iii) excess mortality rates for both cohort for 100 person-years (py) of follow-up, comparing all-cause mortality with that of the general population of similar age and gender. Results Between 1997 and 2010, 8,214 HIV positive subjects were included, 2,453 (29.9%) in CoRIS-MD and 5,761 (70.1%) in CoRIS and 294 deaths were registered. All-cause mortality rate was 1.02 (95% CI 0.91-1.15) per 100 py, SMR was 6.8 (95% CI 5.9-7.9) and excess mortality rate was 0.8 (95% CI 0.7-0.9) per 100 py. Mortality was higher in patients with AIDS, hepatitis C virus (HCV) co-infection, and those from CoRIS-MD cohort (1997–2003). Conclusion Mortality among HIV-positive persons remains higher than that of the general population of similar age and sex, with significant differences depending on the history of AIDS or HCV coinfection. PMID:23961924

  15. APOL1 associations with nephropathy, atherosclerosis, and all-cause mortality in African Americans with type 2 diabetes.

    PubMed

    Freedman, Barry I; Langefeld, Carl D; Lu, Lingyi; Palmer, Nicholette D; Smith, S Carrie; Bagwell, Benjamin M; Hicks, Pamela J; Xu, Jianzhao; Wagenknecht, Lynne E; Raffield, Laura M; Register, Thomas C; Carr, J Jeffrey; Bowden, Donald W; Divers, Jasmin

    2015-01-01

    Albuminuria and reduced estimated glomerular filtration rate (eGFR) associate with two apolipoprotein L1 gene (APOL1) variants in nondiabetic African Americans (AAs). Whether APOL1 associates with subclinical atherosclerosis and survival remains unclear. To determine this, 717 African American-Diabetes Heart Study participants underwent computed tomography to determine coronary artery-, carotid artery-, and aorta-calcified atherosclerotic plaque mass scores in addition to the urine albumin:creatinine ratio (UACR), eGFR, and C-reactive protein (CRP). Associations between mass scores and APOL1 were assessed adjusting for age, gender, African ancestry, body mass index (BMI), hemoglobin A1c, smoking, hypertension, use of statins and angiotensin-converting enzyme inhibitors, albuminuria, and eGFR. Participants were 58.9% female with mean age 56.5 years, eGFR 89.5 ml/min per 1.73 m(2), UACR 169.6 mg/g, and coronary artery-, carotid artery-, and aorta-calcified plaque mass scores of 610, 171, and 5378, respectively. In fully adjusted models, APOL1 risk variants were significantly associated with lower levels of carotid artery-calcified plaque (β=-0.42, s.e. 0.18; dominant model) and marginally lower coronary artery plaque (β=-0.36, s.e. 0.21; dominant model), but not with aorta-calcified plaque, CRP, UACR, or eGFR. By the end of a mean follow-up of 5.0 years, 89 participants had died. APOL1 nephropathy risk variants were significantly associated with improved survival (hazard ratio 0.67 for one copy; 0.44 for two copies). Thus, APOL1 nephropathy variants associate with lower levels of subclinical atherosclerosis and reduced risk of death in AAs with type 2 diabetes mellitus. PMID:25054777

  16. APOL1 associations with nephropathy, atherosclerosis, and all-cause mortality in African Americans with type 2 diabetes.

    PubMed

    Freedman, Barry I; Langefeld, Carl D; Lu, Lingyi; Palmer, Nicholette D; Smith, S Carrie; Bagwell, Benjamin M; Hicks, Pamela J; Xu, Jianzhao; Wagenknecht, Lynne E; Raffield, Laura M; Register, Thomas C; Carr, J Jeffrey; Bowden, Donald W; Divers, Jasmin

    2015-01-01

    Albuminuria and reduced estimated glomerular filtration rate (eGFR) associate with two apolipoprotein L1 gene (APOL1) variants in nondiabetic African Americans (AAs). Whether APOL1 associates with subclinical atherosclerosis and survival remains unclear. To determine this, 717 African American-Diabetes Heart Study participants underwent computed tomography to determine coronary artery-, carotid artery-, and aorta-calcified atherosclerotic plaque mass scores in addition to the urine albumin:creatinine ratio (UACR), eGFR, and C-reactive protein (CRP). Associations between mass scores and APOL1 were assessed adjusting for age, gender, African ancestry, body mass index (BMI), hemoglobin A1c, smoking, hypertension, use of statins and angiotensin-converting enzyme inhibitors, albuminuria, and eGFR. Participants were 58.9% female with mean age 56.5 years, eGFR 89.5 ml/min per 1.73 m(2), UACR 169.6 mg/g, and coronary artery-, carotid artery-, and aorta-calcified plaque mass scores of 610, 171, and 5378, respectively. In fully adjusted models, APOL1 risk variants were significantly associated with lower levels of carotid artery-calcified plaque (β=-0.42, s.e. 0.18; dominant model) and marginally lower coronary artery plaque (β=-0.36, s.e. 0.21; dominant model), but not with aorta-calcified plaque, CRP, UACR, or eGFR. By the end of a mean follow-up of 5.0 years, 89 participants had died. APOL1 nephropathy risk variants were significantly associated with improved survival (hazard ratio 0.67 for one copy; 0.44 for two copies). Thus, APOL1 nephropathy variants associate with lower levels of subclinical atherosclerosis and reduced risk of death in AAs with type 2 diabetes mellitus.

  17. Night-shift work increases morbidity of breast cancer and all-cause mortality: a meta-analysis of 16 prospective cohort studies.

    PubMed

    Lin, Xiaoti; Chen, Weiyu; Wei, Fengqin; Ying, Mingang; Wei, Weidong; Xie, Xiaoming

    2015-11-01

    Night-shift work (NSW) has previously been related to incidents of breast cancer and all-cause mortality, but many published studies have reported inconclusive results. The aim of the present study was to quantify a potential dose-effect relationship between NSW and morbidity of breast cancer, and to evaluate the association between NSW and risk of all-cause mortality. The outcomes included NSW, morbidity of breast cancer, cardiovascular mortality, cancer-related mortality, and all-cause mortality. Sixteen investigations were included, involving 2,020,641 participants, 10,004 incident breast cancer cases, 7185 cancer-related deaths, 4820 cardiovascular end points, and 2480 all-cause mortalities. The summary risk ratio (RR) of incident breast cancer for an increase of NSW was 1.057 [95% confidence interval (CI) 1.014-1.102; test for heterogeneity p = 0.358, I(2) = 9.2%]. The combined RR (95% CI) of breast cancer risk for NSW vs daytime work was: 1.029 (0.969-1.093) in the <5-year subgroup, 1.019 (1.001-1.038) for 5-year incremental risk, 1.025 (1.006-1.044) for 5- to 10-year exposure times, 1.074 (1.010-1.142) in the 10- to 20-year subgroup, and 1.088 (1.012-1.169) for >20-year exposure lengths. The overall RR was 1.089 (95% CI 1.016-1.166) in a fixed-effects model (test for heterogeneity p = 0.838, I(2) = 0%) comparing rotating NSW and day work. Night-shift work was associated with an increased risk of cardiovascular death (RR 1.027, 95% CI 1.001-1.053), and all-cause death 1.253 (95% CI 0.786-1.997). In summary, NSW increased the risk of breast cancer morbidity by: 1.9% for 5 years, 2.5% for 5-10 years, 7.4% for 10-20 years, and 8.8% for >20-years of NSW. Additionally, rotating NSW enhanced the morbidity of breast cancer by 8.9%. Moreover, NSW was associated with a 2.7% increase in cardiovascular death.

  18. Dietary, circulating beta-carotene and risk of all-cause mortality: a meta-analysis from prospective studies.

    PubMed

    Zhao, Long-Gang; Zhang, Qing-Li; Zheng, Jia-Li; Li, Hong-Lan; Zhang, Wei; Tang, Wei-Guo; Xiang, Yong-Bing

    2016-01-01

    Observational studies evaluating the relation between dietary or circulating level of beta-carotene and risk of total mortality yielded inconsistent results. We conducted a comprehensive search on publications of PubMed and EMBASE up to 31 March 2016. Random effect models were used to combine the results. Potential publication bias was assessed using Egger's and Begg's test. Seven studies that evaluated dietary beta-carotene intake in relation to overall mortality, indicated that a higher intake of beta-carotene was related to a significant lower risk of all-cause mortality (RR for highest vs. lowest group = 0.83, 95%CI: 0.78-0.88) with no evidence of heterogeneity between studies (I(2) = 1.0%, P = 0.416). A random-effect analysis comprising seven studies showed high beta-carotene level in serum or plasma was associated with a significant lower risk of all-cause mortality (RR for highest vs. lowest group = 0.69, 95%CI: 0.59-0.80) with low heterogeneity (I(2) = 37.1%, P = 0.145). No evidence of publication bias was detected by Begg's and Egger's regression tests. In conclusion, dietary or circulating beta-carotene was inversely associated with risk of all-cause mortality. More studies should be conducted to clarify the dose-response relationship between beta-carotene and all-cause mortality. PMID:27243945

  19. Population-level associations between antiretroviral therapy scale-up and all-cause mortality in South Africa.

    PubMed

    Larson, Elysia; Bendavid, Eran; Tuoane-Nkhasi, Maletela; Mbengashe, Thobile; Goldman, Thurma; Wilson, Melinda; Klausner, Jeffrey D

    2014-08-01

    Our aim was to describe the association between increasing access to antiretroviral therapy and all-cause mortality in South Africa from 2005 to 2009. We undertook a longitudinal, population-level study, using antiretroviral monitoring data reported by PEPFAR implementing partners and province-level and national all-cause mortality records from Statistics South Africa (provider of official South African government statistics) to analyse the association between antiretroviral therapy and mortality. Using mixed effects models with a random intercept for province, we estimated the contemporaneous and lagging association between antiretroviral therapy and all-cause mortality in South Africa. We also conducted subgroup analyses and estimated the number of deaths averted. For each 100 HIV-infected individuals on antiretroviral therapy reported by PEPFAR implementing partners in South African treatment programmes, there was an associated 2.9 fewer deaths that year (95% CI: 1.5, 4.2) and 6.3 fewer deaths the following year (95% CI: 4.6, 8.0). The associated decrease in mortality the year after treatment reporting was seen in both adults and children, and men and women. Treatment provided from 2005 to 2008 was associated with 28,305 deaths averted from 2006 to 2009. The scale-up of antiretroviral therapy in South Africa was associated with a significant reduction in national all-cause mortality.

  20. Modeling the sssociation between 25[OH]D and all-cause mortality in a representative US population sample

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Vitamin D has been identified as a potential key risk factor for several chronic diseases and mortality. The association between all-cause mortality and circulating levels of 25-ydroxyvitamin D (25[OH]D) has been described as non-monotonic with excess mortality at both low and high levels (1). Howev...

  1. Predictors, Including Blood, Urine, Anthropometry, and Nutritional Indices, of All-Cause Mortality among Institutionalized Individuals with Intellectual Disability

    ERIC Educational Resources Information Center

    Ohwada, Hiroko; Nakayama, Takeo; Tomono, Yuji; Yamanaka, Keiko

    2013-01-01

    As the life expectancy of people with intellectual disability (ID) increases, it is becoming necessary to understand factors affecting survival. However, predictors that are typically assessed among healthy people have not been examined. Predictors of all-cause mortality, including blood, urine, anthropometry, and nutritional indices, were…

  2. Abdominal obesity modifies the risk of hypertriglyceridemia for all-cause and cardiovascular mortality in hemodialysis patients.

    PubMed

    Postorino, Maurizio; Marino, Carmen; Tripepi, Giovanni; Zoccali, Carmine

    2011-04-01

    Hypertriglyceridemia is the most prevalent lipid alteration in end-stage renal disease, and we studied the relationship between serum triglycerides and all-cause and cardiovascular death in these patients. Since abdominal fat modifies the effect of lipids on atherosclerosis, we analyzed the interaction between serum lipids and waist circumference (WC) as a metric of abdominal obesity. In a cohort of 537 hemodialysis patients, 182 died, 113 from cardiovascular causes, over an average follow-up of 29 months. In Cox models that included traditional and nontraditional risk factors, there were significant strong interactions between triglycerides and WC to both all-cause and cardiovascular death. A fixed (50 mg/dl) excess in triglycerides was associated with a progressive lower risk of all-cause and cardiovascular mortality in patients with threshold WC <95 cm but with a progressive increased risk in those above this threshold. A significant interaction between cholesterol and WC with all-cause and cardiovascular death emerged only in models excluding the triglycerides-WC interaction. Neither high-density lipoprotein (HDL) nor non-HDL cholesterol or their interaction terms with WC were associated with study outcomes. Thus, the predictive value of triglycerides and cholesterol for survival and atherosclerotic complications in hemodialysis patients is critically dependent on WC. Hence, intervention studies in end-stage renal disease should specifically target patients with abdominal obesity and hyperlipidemia.

  3. Association Between Television Viewing Time and All-Cause Mortality: A Meta-Analysis of Cohort Studies.

    PubMed

    Sun, Jiang-Wei; Zhao, Long-Gang; Yang, Yang; Ma, Xiao; Wang, Ying-Ying; Xiang, Yong-Bing

    2015-12-01

    Findings on the association between television (TV) viewing and all-cause mortality in epidemiologic studies have been inconsistent. Therefore, we conducted a meta-analysis of data from prospective cohort studies to quantify this association. Relevant articles were identified by searching MEDLINE (PubMed; National Library of Medicine, Bethesda, Maryland) and EMBASE (Elsevier B.V., Amsterdam, the Netherlands) from inception to March 1, 2015, and reviewing the reference lists of retrieved articles. Study-specific results were pooled using a random-effects model. Of 2,578 citations identified by the search strategy, 10 cohort studies (61,494 deaths among 647,475 individuals) met the inclusion criteria. The summary relative risk of all-cause mortality for the highest category of TV viewing time versus the lowest was 1.33 (95% confidence interval: 1.20, 1.47), with heterogeneity among studies (I(2) = 66.7%, P(heterogeneity) = 0.001). In dose-response meta-analysis, TV viewing time was statistically significantly associated with all-cause mortality risk in a J-shaped fashion (P(nonlinearity) = 0.001). These results indicate that prolonged TV viewing time might increase the risk of all-cause mortality. Given the high prevalence of excessive TV viewing, public health recommendations or interventions aimed at decreasing the amount of TV viewing time in modern societies are warranted.

  4. Investigation of Gender Heterogeneity in the Associations of Serum Phosphorus with Incident Coronary Artery Disease and All-Cause Mortality

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Serum phosphorus levels are associated with increased morbidity and mortality in patients with chronic kidney disease. We examined whether serum phosphorus is associated with all-cause mortality and incident myocardial infarction in the general population using 13,998 middle age subjects from the At...

  5. Delayed Effects of Obese and Overweight Population Conditions on All-Cause Adult Mortality Rate in the USA

    PubMed Central

    Okunade, Albert A.; Rubin, Rose M.; Okunade, Adeyinka K.

    2016-01-01

    Currently, there are few studies separating the linkage of pathological obese and overweight body mass indices (BMIs) to the all-cause mortality rate in adults. Consequently, this paper, using annual Behavioral Risk Factor Surveillance System data of the 50 US states and the District of Columbia, estimates empirical regression models linking the US adult overweight (25 ≤ BMI < 30) and obesity (BMI ≥ 30) rates to the all-cause deaths rate. The biochemistry of multi-period cumulative adiposity (saturated fatty acid) from unexpended caloric intakes (net energy storage) provides the natural theoretical foundation for tracing unhealthy BMI to all-cause mortality. Cross-sectional and panel data regression models are separately estimated for the delayed effects of obese and overweight BMIs on the all-cause mortality rate. Controlling for the independent effects of economic, socio-demographic, and other factors on the all-cause mortality rate, our findings confirm that the estimated panel data models are more appropriate. The panel data regression results reveal that the obesity-mortality link strengthens significantly after multiple years in the condition. The faster mortality response to obesity detected here is conjectured to arise from the significantly more obese. Compared with past studies postulating a static (rather than delayed) effects, the statistically significant lagged effects of adult population BMI pathology in this study are novel and insightful. And, as expected, these lagged effects are more severe in the obese than overweight population segment. Public health policy implications of this social science study findings agree with those of the clinical sciences literature advocating timely lifestyle modification interventions (e.g., smoking cessation) to slow premature mortality linked with unhealthy BMIs. PMID:27734013

  6. The Association between Sulfonylurea Use and All-Cause and Cardiovascular Mortality: A Meta-Analysis with Trial Sequential Analysis of Randomized Clinical Trials

    PubMed Central

    Varvaki Rados, Dimitris; Catani Pinto, Lana; Reck Remonti, Luciana; Bauermann Leitão, Cristiane; Gross, Jorge Luiz

    2016-01-01

    Background Sulfonylureas are an effective and inexpensive treatment for type 2 diabetes. There is conflicting data about the safety of these drugs regarding mortality and cardiovascular outcomes. The objective of the present study was to evaluate the safety of the sulfonylureas most frequently used and to use trial sequential analysis (TSA) to analyze whether the available sample was powered enough to support the results. Methods and Findings Electronic databases were reviewed from 1946 (Embase) or 1966 (MEDLINE) up to 31 December 2014. Randomized clinical trials (RCTs) of at least 52 wk in duration evaluating second- or third-generation sulfonylureas in the treatment of adults with type 2 diabetes and reporting outcomes of interest were included. Primary outcomes were all-cause and cardiovascular mortality. Additionally, myocardial infarction and stroke events were evaluated. Data were summarized with Peto odds ratios (ORs), and the reliability of the results was evaluated with TSA. Forty-seven RCTs with 37,650 patients and 890 deaths in total were included. Sulfonylureas were not associated with all-cause (OR 1.12 [95% CI 0.96 to 1.30]) or cardiovascular mortality (OR 1.12 [95% CI 0.87 to 1.42]). Sulfonylureas were also not associated with increased risk of myocardial infarction (OR 0.92 [95% CI 0.76 to 1.12]) or stroke (OR 1.16 [95% CI 0.81 to 1.66]). TSA could discard an absolute difference of 0.5% between the treatments, which was considered the minimal clinically significant difference. The major limitation of this review was the inclusion of studies not designed to evaluate safety outcomes. Conclusions Sulfonylureas are not associated with increased risk for all-cause mortality, cardiovascular mortality, myocardial infarction, or stroke. Current evidence supports the safety of sulfonylureas; an absolute risk of 0.5% could be firmly discarded. Review registration PROSPERO CRD42014004330 PMID:27071029

  7. The Effect of Coffee and Quantity of Consumption on Specific Cardiovascular and All-Cause Mortality: Coffee Consumption Does Not Affect Mortality.

    PubMed

    Loomba, Rohit S; Aggarwal, Saurabh; Arora, Rohit R

    2016-01-01

    Previous studies have examined whether or not an association exists between the consumption of caffeinated coffee to all-cause and cardiovascular mortality. This study aimed to delineate this association using population representative data from the National Health and Nutrition Examination Survey III. Patients were included in the study if all the following criteria were met: (1) follow-up mortality data were available, (2) age of at least 45 years, and (3) reported amount of average coffee consumption. A total of 8608 patients were included, with patients stratified into the following groups of average daily coffee consumption: (1) no coffee consumption, (2) less than 1 cup, (3) 1 cup a day, (4) 2-3 cups, (5) 4-5 cups, (6) more than 6 cups a day. Odds ratios, 95% confidence intervals, and P values were calculated for univariate analysis to compare the prevalence of all-cause mortality, ischemia-related mortality, congestive heart failure-related mortality, and stroke-related mortality, using the no coffee consumption group as reference. These were then adjusted for confounding factors for a multivariate analysis. P < 0.05 were considered statistically significant. Univariate analysis demonstrated an association between coffee consumption and mortality, although this became insignificant on multivariate analysis. Coffee consumption, thus, does not seem to impact all-cause mortality or specific cardiovascular mortality. These findings do differ from those of recently published studies. Coffee consumption of any quantity seems to be safe without any increased mortality risk. There may be some protective effects but additional data are needed to further delineate this.

  8. All-cause, drug-related, and HIV-related mortality risk by trajectories of jail incarceration and homelessness among adults in New York City.

    PubMed

    Lim, Sungwoo; Harris, Tiffany G; Nash, Denis; Lennon, Mary Clare; Thorpe, Lorna E

    2015-02-15

    We studied a cohort of 15,620 adults who had experienced at least 1 jail incarceration and 1 homeless shelter stay in 2001-2003 in New York City to identify trajectories of these events and tested whether a particular trajectory was associated with all-cause, drug-related, or human immunodeficiency virus (HIV)-related mortality risk in 2004-2005. Using matched data on jail time, homeless shelter stays, and vital statistics, we performed sequence analysis and assessed mortality risk using standardized mortality ratios (SMRs) and marginal structural modeling. We identified 6 trajectories. Sixty percent of the cohort members had a temporary pattern, which was characterized by sporadic experiences of brief incarceration and homelessness, whereas the rest had the other 5 patterns, which reflected experiences of increasing, decreasing, or persistent jail or shelter stays. Mortality risk among individuals with a temporary pattern was significantly higher than those of adults who had not been incarcerated or stayed in a homeless shelter during the study period (all-cause SMR: 1.35, 95% confidence interval (CI): 1.14, 1.59; drug-related SMR: 4.60, 95% CI: 3.17, 6.46; HIV-related SMR: 1.54, 95% CI: 1.03, 2.21); all-cause and HIV-related SMRs in other patterns were not statistically significantly different. When we compared all 6 trajectories, the temporary pattern was more strongly associated with higher mortality risk than was the continuously homelessness pattern. Institutional interventions to reduce recurrent cycles of incarceration and homelessness are needed to augment behavioral interventions to reduce mortality risk.

  9. Television Viewing and Risk of Type 2 Diabetes, Cardiovascular Disease, and All-Cause Mortality A Meta-analysis

    PubMed Central

    Grøntved, Anders; Hu, Frank B.

    2015-01-01

    Context Prolonged television (TV) viewing is the most prevalent and pervasive sedentary behavior in industrialized countries and has been associated with morbidity and mortality. However, a systematic and quantitative assessment of published studies is not available. Objective To perform a meta-analysis of all prospective cohort studies to determine the association between TV viewing and risk of type 2 diabetes, fatal or nonfatal cardiovascular disease, and all-cause mortality. Data Sources and Study Selection Relevant studies were identified by searches of the MEDLINE database from 1970 to March 2011 and the EMBASE database from 1974 to March 2011 without restrictions and by reviewing reference lists from retrieved articles. Cohort studies that reported relative risk estimates with 95% confidence intervals (CIs) for the associations of interest were included. Data Extraction Data were extracted independently by each author and summary estimates of association were obtained using a random-effects model. Data Synthesis Of the 8 studies included, 4 reported results on type 2 diabetes (175 938 individuals; 6428 incident cases during 1.1 million person-years of follow-up), 4 reported on fatal or nonfatal cardiovascular disease (34 253 individuals; 1052 incident cases), and 3 reported on all-cause mortality (26 509 individuals; 1879 deaths during 202 353 person-years of follow-up). The pooled relative risks per 2 hours of TV viewing per day were 1.20 (95% CI, 1.14-1.27) for type 2 diabetes, 1.15 (95% CI, 1.06-1.23) for fatal or nonfatal cardiovascular disease, and 1.13 (95% CI, 1.07-1.18) for all-cause mortality. While the associations between time spent viewing TV and risk of type 2 diabetes and cardiovascular disease were linear, the risk of all-cause mortality appeared to increase with TV viewing duration of greater than 3 hours per day. The estimated absolute risk differences per every 2 hours of TV viewing per day were 176 cases of type 2 diabetes per 100 000

  10. Dietary, circulating beta-carotene and risk of all-cause mortality: a meta-analysis from prospective studies

    PubMed Central

    Zhao, Long-Gang; Zhang, Qing-Li; Zheng, Jia-Li; Li, Hong-Lan; Zhang, Wei; Tang, Wei-Guo; Xiang, Yong-Bing

    2016-01-01

    Observational studies evaluating the relation between dietary or circulating level of beta-carotene and risk of total mortality yielded inconsistent results. We conducted a comprehensive search on publications of PubMed and EMBASE up to 31 March 2016. Random effect models were used to combine the results. Potential publication bias was assessed using Egger’s and Begg’s test. Seven studies that evaluated dietary beta-carotene intake in relation to overall mortality, indicated that a higher intake of beta-carotene was related to a significant lower risk of all-cause mortality (RR for highest vs. lowest group = 0.83, 95%CI: 0.78–0.88) with no evidence of heterogeneity between studies (I2 = 1.0%, P = 0.416). A random-effect analysis comprising seven studies showed high beta-carotene level in serum or plasma was associated with a significant lower risk of all-cause mortality (RR for highest vs. lowest group = 0.69, 95%CI: 0.59–0.80) with low heterogeneity (I2 = 37.1%, P = 0.145). No evidence of publication bias was detected by Begg’s and Egger’s regression tests. In conclusion, dietary or circulating beta-carotene was inversely associated with risk of all-cause mortality. More studies should be conducted to clarify the dose-response relationship between beta-carotene and all-cause mortality. PMID:27243945

  11. Association of sarcopenic obesity with the risk of all-cause mortality: A meta-analysis of prospective cohort studies.

    PubMed

    Tian, Simiao; Xu, Yang

    2016-02-01

    Many prospective studies have investigated the relationship between sarcopenic obesity (SO) and risk of mortality. However, the results have been controversial. The aim of the present study was to evaluate the association between SO and all-cause mortality in adults by a meta-analysis of prospective cohort studies. A systematic literature search was carried out through electronic databases up to September 2014. A total of nine articles with 12 prospective cohort studies, including 35 287 participants and 14 306 deaths, were included in the meta-analysis. Overall, compared with healthy subjects, subjects with SO had a significant increased risk of all-cause mortality (pooled HR 1.24, 95% CI 1.12-1.37, P < 0.001), with significant heterogeneity among studies (I(2)  = 53.18%, P = 0.0188), but no indication for publication bias (P = 0.7373). Heterogeneity became low and no longer significant in the subgroup analyses by three SO definitions. More importantly, SO, defined by mid-arm muscle circumference and muscle strength criteria, significantly increased the risk of mortality (HR 1.46, 95% CI 1.23-1.73 and 1.23, 1.09-1.38, respectively). The risk of all-cause mortality did not appreciably change considering the geography (USA cohorts and non-USA cohorts) or the duration of follow up (≥10 years and <10 years). However, the risk estimate was only significant in men (HR 1.23, 95% CI 1.08-1.41, P = 0.0017), not in women (HR 1.16, P = 0.1332). The results of the present study show that subjects with SO are associated with a 24% increase risk of all-cause mortality, compared with those without SO, in particular in men; the significant association was found independent of geographical location and duration of follow up. PMID:26271226

  12. Risk of All-Cause Mortality in Alcohol-Dependent Individuals: A Systematic Literature Review and Meta-Analysis☆

    PubMed Central

    Laramée, Philippe; Leonard, Saoirse; Buchanan-Hughes, Amy; Warnakula, Samantha; Daeppen, Jean-Bernard; Rehm, Jürgen

    2015-01-01

    Background Alcohol dependence (AD) carries a high mortality burden, which may be mitigated by reduced alcohol consumption. We conducted a systematic literature review and meta-analysis investigating the risk of all-cause mortality in alcohol-dependent subjects. Methods MEDLINE, MEDLINE In-Process, Embase and PsycINFO were searched from database conception through 26th June 2014. Eligible studies reported all-cause mortality in both alcohol-dependent subjects and a comparator population of interest. Two individuals independently reviewed studies. Of 4540 records identified, 39 observational studies were included in meta-analyses. Findings We identified a significant increase in mortality for alcohol-dependent subjects compared with the general population (27 studies; relative risk [RR] = 3.45; 95% CI [2.96, 4.02]; p < 0.0001). The mortality increase was also significant compared to subjects qualifying for a diagnosis of alcohol abuse or subjects without alcohol use disorders (AUDs). Alcohol-dependent subjects continuing to drink heavily had significantly greater mortality than alcohol-dependent subjects who reduced alcohol intake, even if abstainers were excluded (p < 0.05). Interpretation AD was found to significantly increase an individual's risk of all-cause mortality. While abstinence in alcohol-dependent subjects led to greater mortality reduction than non-abstinence, this study suggests that alcohol-dependent subjects can significantly reduce their mortality risk by reducing alcohol consumption. PMID:26629534

  13. Vitamin D Predicts All-Cause and Cardiac Mortality in Females with Suspected Acute Coronary Syndrome: A Comparison with Brain Natriuretic Peptide and High-Sensitivity C-Reactive Protein

    PubMed Central

    Naesgaard, Patrycja A.; León de la Fuente, Ricardo A.; Nilsen, Stein Tore; Woie, Leik; Aarsland, Torbjoern; Staines, Harry; Nilsen, Dennis W. T.

    2013-01-01

    Vitamin D may not only reflect disease but may also serve as a prognostic indicator. Our aim was to assess the gender-specific utility of vitamin D measured as 25-hydroxy-vitamin D [25(OH)D] to predict all-cause and cardiac death in patients with suspected acute coronary syndrome (ACS) and to compare its prognostic utility to brain natriuretic peptide (BNP) and high-sensitivity C-reactive protein (hsCRP). Blood samples were harvested on admission in 982 patients. Forty percent were women (65.9 ± 12.6 years). Mortality was evaluated in quartiles of 25(OH)D, BNP, and hsCRP, respectively, during a 5-year follow-up, applying univariate and multivariate analyses. One hundred and seventy-three patients died; 78 were women. In 92 patients (37 women), death was defined as cardiac. In women, the univariate hazard ratio (HR) for total death of 25(OH)D in Quartile (Q) 2 versus Q1, Q3 versus Q1, and Q4 versus Q1 was 0.55 (95% CI 0.33–0.93), 0.29 (95% CI 0.15–0.55), and 0.13 (95% CI 0.06–0.32), respectively. In females, it was an independent predictor of total and cardiac death, whereas BNP and hsCRP were less gender-specific. No gender differences in 25(OH)D were noted in a reference material. Accordingly, vitamin D independently predicts mortality in females with suspected ACS. PMID:24349821

  14. Low-speed wind-tunnel investigation of forward-located spoilers and trailing splines as trailing-vortex hazard-alleviation devices on an aspect-ratio-8 wing model

    NASA Technical Reports Server (NTRS)

    Croom, D. R.

    1975-01-01

    An investigation was made in the Langley V/STOL tunnel in order to determine, by the trailing-wing sensor technique, the effectiveness of either a forward-mounted spoiler or a tip-mounted spline as trailing-vortex attenuation devices on an unswept aspect-ratio-8 wing model. The trailing-wing rolling-moment data taken in the tunnel diffuser section show good agreement with the data taken in the tunnel test section. This agreement indicates that reasonable results may be obtained in the Langley V/STOL tunnel in experimental investigations of the trailing-vortex hazard at relatively great distances behind aircraft models.

  15. Diet Quality Scores and Prediction of All-Cause, Cardiovascular and Cancer Mortality in a Pan-European Cohort Study

    PubMed Central

    Lassale, Camille; Gunter, Marc J.; Romaguera, Dora; Peelen, Linda M.; Van der Schouw, Yvonne T.; Beulens, Joline W. J.; Freisling, Heinz; Muller, David C.; Ferrari, Pietro; Huybrechts, Inge; Fagherazzi, Guy; Boutron-Ruault, Marie-Christine; Affret, Aurélie; Overvad, Kim; Dahm, Christina C.; Olsen, Anja; Roswall, Nina; Tsilidis, Konstantinos K.; Katzke, Verena A.; Kühn, Tilman; Buijsse, Brian; Quirós, José-Ramón; Sánchez-Cantalejo, Emilio; Etxezarreta, Nerea; Huerta, José María; Barricarte, Aurelio; Bonet, Catalina; Khaw, Kay-Tee; Key, Timothy J.; Trichopoulou, Antonia; Bamia, Christina; Lagiou, Pagona; Palli, Domenico; Agnoli, Claudia; Tumino, Rosario; Fasanelli, Francesca; Panico, Salvatore; Bueno-de-Mesquita, H. Bas; Boer, Jolanda M. A.; Sonestedt, Emily; Nilsson, Lena Maria; Renström, Frida; Weiderpass, Elisabete; Skeie, Guri; Lund, Eiliv; Moons, Karel G. M.; Riboli, Elio; Tzoulaki, Ioanna

    2016-01-01

    Scores of overall diet quality have received increasing attention in relation to disease aetiology; however, their value in risk prediction has been little examined. The objective was to assess and compare the association and predictive performance of 10 diet quality scores on 10-year risk of all-cause, CVD and cancer mortality in 451,256 healthy participants to the European Prospective Investigation into Cancer and Nutrition, followed-up for a median of 12.8y. All dietary scores studied showed significant inverse associations with all outcomes. The range of HRs (95% CI) in the top vs. lowest quartile of dietary scores in a composite model including non-invasive factors (age, sex, smoking, body mass index, education, physical activity and study centre) was 0.75 (0.72–0.79) to 0.88 (0.84–0.92) for all-cause, 0.76 (0.69–0.83) to 0.84 (0.76–0.92) for CVD and 0.78 (0.73–0.83) to 0.91 (0.85–0.97) for cancer mortality. Models with dietary scores alone showed low discrimination, but composite models also including age, sex and other non-invasive factors showed good discrimination and calibration, which varied little between different diet scores examined. Mean C-statistic of full models was 0.73, 0.80 and 0.71 for all-cause, CVD and cancer mortality. Dietary scores have poor predictive performance for 10-year mortality risk when used in isolation but display good predictive ability in combination with other non-invasive common risk factors. PMID:27409582

  16. Level of incongruence during cardiac rehabilitation and prediction of future CVD-related hospitalizations plus all-cause mortality.

    PubMed

    Meyer, Fiorenza A; Stauber, Stefanie; Wilhelm, Matthias; Znoj, Hansjörg; von Känel, Roland

    2015-01-01

    Independent of traditional risk factors, psychosocial risk factors increase the risk of cardiovascular disease (CVD). Studies in the field of psychotherapy have shown that the construct of incongruence (meaning a discrepancy between desired and achieved goals) affects the outcome of therapy. We prospectively measured the impact of incongruence in patients after undergoing a cardiac rehabilitation program. We examined 198 CVD patients enrolled in a 8-12 week comprehensive cardiac rehabilitation program. Patients completed the German short version of the Incongruence Questionnaire and the SF-36 Health Questionnaire to measure quality of life (QoL) at discharge of rehabilitation. Endpoints at follow-up were CVD-related hospitalizations plus all-cause mortality. During a mean follow-up period of 54.3 months, 29 patients experienced a CVD-related hospitalization and 3 patients died. Incongruence at discharge of rehabilitation was independent of traditional risk factors a significant predictor for CVD-related hospitalizations plus all-cause mortality (HR 2.03, 95% CI 1.29-3.20, p = .002). We also found a significant interaction of incongruence with mental QoL (HR .96, 95% CI .92-.99, p = .027), i.e. incongruence predicted poor prognosis if QoL was low (p = .017), but not if QoL was high (p = .74). Incongruence at discharge predicted future CVD-related hospitalizations plus all-cause mortality and mental QoL moderated this relationship. Therefore, incongruence should be considered for effective treatment planning and outcome measurement.

  17. Diet Quality Scores and Prediction of All-Cause, Cardiovascular and Cancer Mortality in a Pan-European Cohort Study.

    PubMed

    Lassale, Camille; Gunter, Marc J; Romaguera, Dora; Peelen, Linda M; Van der Schouw, Yvonne T; Beulens, Joline W J; Freisling, Heinz; Muller, David C; Ferrari, Pietro; Huybrechts, Inge; Fagherazzi, Guy; Boutron-Ruault, Marie-Christine; Affret, Aurélie; Overvad, Kim; Dahm, Christina C; Olsen, Anja; Roswall, Nina; Tsilidis, Konstantinos K; Katzke, Verena A; Kühn, Tilman; Buijsse, Brian; Quirós, José-Ramón; Sánchez-Cantalejo, Emilio; Etxezarreta, Nerea; Huerta, José María; Barricarte, Aurelio; Bonet, Catalina; Khaw, Kay-Tee; Key, Timothy J; Trichopoulou, Antonia; Bamia, Christina; Lagiou, Pagona; Palli, Domenico; Agnoli, Claudia; Tumino, Rosario; Fasanelli, Francesca; Panico, Salvatore; Bueno-de-Mesquita, H Bas; Boer, Jolanda M A; Sonestedt, Emily; Nilsson, Lena Maria; Renström, Frida; Weiderpass, Elisabete; Skeie, Guri; Lund, Eiliv; Moons, Karel G M; Riboli, Elio; Tzoulaki, Ioanna

    2016-01-01

    Scores of overall diet quality have received increasing attention in relation to disease aetiology; however, their value in risk prediction has been little examined. The objective was to assess and compare the association and predictive performance of 10 diet quality scores on 10-year risk of all-cause, CVD and cancer mortality in 451,256 healthy participants to the European Prospective Investigation into Cancer and Nutrition, followed-up for a median of 12.8y. All dietary scores studied showed significant inverse associations with all outcomes. The range of HRs (95% CI) in the top vs. lowest quartile of dietary scores in a composite model including non-invasive factors (age, sex, smoking, body mass index, education, physical activity and study centre) was 0.75 (0.72-0.79) to 0.88 (0.84-0.92) for all-cause, 0.76 (0.69-0.83) to 0.84 (0.76-0.92) for CVD and 0.78 (0.73-0.83) to 0.91 (0.85-0.97) for cancer mortality. Models with dietary scores alone showed low discrimination, but composite models also including age, sex and other non-invasive factors showed good discrimination and calibration, which varied little between different diet scores examined. Mean C-statistic of full models was 0.73, 0.80 and 0.71 for all-cause, CVD and cancer mortality. Dietary scores have poor predictive performance for 10-year mortality risk when used in isolation but display good predictive ability in combination with other non-invasive common risk factors.

  18. Sleep Duration and All-Cause Mortality: A Systematic Review and Meta-Analysis of Prospective Studies

    PubMed Central

    Cappuccio, Francesco P.; D'Elia, Lanfranco; Strazzullo, Pasquale; Miller, Michelle A.

    2010-01-01

    Background: Increasing evidence suggests an association between both short and long duration of habitual sleep with adverse health outcomes. Objectives: To assess whether the population longitudinal evidence supports the presence of a relationship between duration of sleep and all-cause mortality, to investigate both short and long sleep duration and to obtain an estimate of the risk. Methods: We performed a systematic search of publications using MEDLINE (1966-2009), EMBASE (from 1980), the Cochrane Library, and manual searches without language restrictions. We included studies if they were prospective, had follow-up >3 years, had duration of sleep at baseline, and all-cause mortality prospectively. We extracted relative risks (RR) and 95% confidence intervals (CI) and pooled them using a random effect model. We carried out sensitivity analyses and assessed heterogeneity and publication bias. Results: Overall, the 16 studies analyzed provided 27 independent cohort samples. They included 1,382,999 male and female participants (follow-up range 4 to 25 years), and 112,566 deaths. Sleep duration was assessed by questionnaire and outcome through death certification. In the pooled analysis, short duration of sleep was associated with a greater risk of death (RR: 1.12; 95% CI 1.06 to 1.18; P < 0. 01) with no evidence of publication bias (P = 0.74) but heterogeneity between studies (P = 0.02). Long duration of sleep was also associated with a greater risk of death (1.30; [1.22 to 1.38]; P < 0.0001) with no evidence of publication bias (P = 0.18) but significant heterogeneity between studies (P < 0.0001). Conclusion: Both short and long duration of sleep are significant predictors of death in prospective population studies. Citation: Cappuccio FP; D'Elia L; Strazzullo P; Miller MA. Sleep duration and all-cause mortality: a systematic review and meta-analysis of prospective studies. SLEEP 2010;33(5):585-592. PMID:20469800

  19. Hearing impairment and incident disability and all-cause mortality in older British community-dwelling men

    PubMed Central

    Liljas, Ann E. M.; Wannamethee, S. Goya; Whincup, Peter H.; Papacosta, Olia; Walters, Kate; Iliffe, Steve; Lennon, Lucy T.; Carvalho, Livia A.; Ramsay, Sheena E.

    2016-01-01

    Background and objective: hearing impairment is common in older adults and has been implicated in the risk of disability and mortality. We examined the association between hearing impairment and risk of incident disability and all-cause mortality. Design and setting: prospective cohort of community-dwelling older men aged 63–85 followed up for disability over 2 years and for all-cause mortality for 10 years in the British Regional Heart Study. Methods: data were collected on self-reported hearing impairment including hearing aid use, and disability assessed as mobility limitations (problems walking/taking stairs), difficulties with activities of daily living (ADL) and instrumental ADL (IADL). Mortality data were obtained from the National Health Service register. Results: among 3,981 men, 1,074 (27%) reported hearing impairment. Compared with men with no hearing impairment, men who could hear and used a hearing aid, and men who could not hear despite a hearing aid had increased risks of IADL difficulties (age-adjusted OR 1.86, 95% CI 1.29–2.70; OR 2.74, 95% CI 1.53–4.93, respectively). The associations remained after further adjustment for covariates including social class, lifestyle factors, co-morbidities and social engagement. Associations of hearing impairment with incident mobility limitations, incident ADL difficulties and all-cause mortality were attenuated on adjustment for covariates. Conclusion: this study suggests that hearing problems in later life could increase the risk of having difficulties performing IADLs, which include more complex everyday tasks such as shopping and light housework. However, further studies are needed to determine the associations observed including the underlying pathways. PMID:27146303

  20. Road traffic noise is associated with increased cardiovascular morbidity and mortality and all-cause mortality in London

    PubMed Central

    Halonen, Jaana I.; Hansell, Anna L.; Gulliver, John; Morley, David; Blangiardo, Marta; Fecht, Daniela; Toledano, Mireille B.; Beevers, Sean D.; Anderson, Hugh Ross; Kelly, Frank J.; Tonne, Cathryn

    2015-01-01

    Aims Road traffic noise has been associated with hypertension but evidence for the long-term effects on hospital admissions and mortality is limited. We examined the effects of long-term exposure to road traffic noise on hospital admissions and mortality in the general population. Methods and results The study population consisted of 8.6 million inhabitants of London, one of Europe's largest cities. We assessed small-area-level associations of day- (7:00–22:59) and nighttime (23:00–06:59) road traffic noise with cardiovascular hospital admissions and all-cause and cardiovascular mortality in all adults (≥25 years) and elderly (≥75 years) through Poisson regression models. We adjusted models for age, sex, area-level socioeconomic deprivation, ethnicity, smoking, air pollution, and neighbourhood spatial structure. Median daytime exposure to road traffic noise was 55.6 dB. Daytime road traffic noise increased the risk of hospital admission for stroke with relative risk (RR) 1.05 [95% confidence interval (CI): 1.02–1.09] in adults, and 1.09 (95% CI: 1.04–1.14) in the elderly in areas >60 vs. <55 dB. Nighttime noise was associated with stroke admissions only among the elderly. Daytime noise was significantly associated with all-cause mortality in adults [RR 1.04 (95% CI: 1.00–1.07) in areas >60 vs. <55 dB]. Positive but non-significant associations were seen with mortality for cardiovascular and ischaemic heart disease, and stroke. Results were similar for the elderly. Conclusions Long-term exposure to road traffic noise was associated with small increased risks of all-cause mortality and cardiovascular mortality and morbidity in the general population, particularly for stroke in the elderly. PMID:26104392

  1. Sexual Orientation and All-Cause Mortality Among US Adults Aged 18 to 59 Years, 2001–2011

    PubMed Central

    Björkenstam, Charlotte; Mays, Vickie M.

    2016-01-01

    To determine whether sexual minorities have an earlier mortality than do heterosexuals, we investigated associations between sexual orientation assessed in the 2001 to 2010 National Health and Nutrition Examination Surveys (NHANES) and mortality in the 2011 NHANES-linked mortality file. Mortality follow-up time averaged 69.6 months after NHANES. By 2011, 338 individuals had died. Sexual minorities evidenced greater all-cause mortality than did heterosexuals after adjusting for demographic confounding. These effects generally disappeared with further adjustment for NHANES-detected health and behavioral differences. PMID:26985610

  2. Is poor oral health a risk marker for incident cardiovascular disease hospitalisation and all-cause mortality? Findings from 172 630 participants from the prospective 45 and Up Study

    PubMed Central

    Joshy, Grace; Arora, Manish; Korda, Rosemary J; Chalmers, John; Banks, Emily

    2016-01-01

    Objective To investigate the relationship between oral health and incident hospitalisation for ischaemic heart disease (IHD), heart failure (HF), ischaemic stroke and peripheral vascular disease (PVD) and all-cause mortality. Design Prospective population-based study of Australian men and women aged 45 years or older, who were recruited to the 45 and Up Study between January 2006 and April 2009; baseline questionnaire data were linked to hospitalisations and deaths up to December 2011. Study exposures include tooth loss and self-rated health of teeth and gums at baseline. Setting New South Wales, Australia. Participants Individuals aged 45–75 years, excluding those with a history of cancer/cardiovascular disease (CVD) at baseline; n=172 630. Primary outcomes Incident hospitalisation for IHD, HF, ischaemic stroke and PVD and all-cause mortality. Results During a median follow-up of 3.9 years, 3239 incident hospitalisations for IHD, 212 for HF, 283 for ischaemic stroke and 359 for PVD, and 1908 deaths, were observed. Cox proportional hazards models examined the relationship between oral health indicators and incident hospitalisation for CVD and all-cause mortality, adjusting for potential confounding factors. All-cause mortality and incident CVD hospitalisation risk increased significantly with increasing tooth loss for all outcomes except ischaemic stroke (ptrend<0.05). In those reporting no teeth versus ≥20 teeth left, risks were increased for HF (HR, 95% CI 1.97, 1.27 to 3.07), PVD (2.53, 1.81 to 3.52) and all-cause mortality (1.60, 1.37 to 1.87). The risk of IHD, PVD and all-cause mortality (but not HF or ischaemic stroke) increased significantly with worsening self-rated health of teeth and gums (ptrend<0.05). In those reporting poor versus very good health of teeth and gums, risks were increased for IHD (1.19, 1.03 to 1.38), PVD (1.66, 1.13 to 2.43) and all-cause mortality (1.76, 1.50 to 2.08). Conclusions Tooth loss and, to a lesser extent, self

  3. Thymic function failure and C-reactive protein levels are independent predictors of all-cause mortality in healthy elderly humans.

    PubMed

    Ferrando-Martínez, Sara; Romero-Sánchez, María Concepción; Solana, Rafael; Delgado, Juan; de la Rosa, Rafael; Muñoz-Fernández, Ma Angeles; Ruiz-Mateos, Ezequiel; Leal, Manuel

    2013-02-01

    Relationship between thymic function and elderly survival has been suspected, despite the fact that formal proof is elusive due to technical limitations of thymic function-related markers. The newly described sj/β-TREC ratio allows now, by overcoming these limitations, an accurate measurement of thymic output in elderly humans. Thus, the aim of this study was to determine the impact of thymic function and inflammatory markers on healthy elderly human survival. Healthy volunteers (n = 151), aged over 65, were asked to participate (CARRERITAS cohort). Subjects were excluded if diagnosed of dementia or, during the last 6 months, had clinical data of infection, hospital admission, antitumor therapy, or any treatment that could influence the immune status. Thymic function (sj/β-TREC ratio), CD4:CD8 T cell ratio, C-reactive protein, interleukin-6, and neutrophilia were determined from basal samples. All basal variables and age were associated with 2-year all-cause mortality. Multivariate analysis showed that only thymic function and C-reactive protein were independently associated with time to death. In conclusion, we show, for the first time, the direct role of thymic function in human survival. C-reactive protein raise is also a marker of mortality in the healthy elderly, in a thymic-independent way.

  4. Meta-analysis on the risk of all-cause mortality and cardiovascular death in the early stage of hypertension.

    PubMed

    Yue, Menglin; Zhang, Huimin; Li, Rong

    2016-07-01

    To evaluate the relationship among the early stage of hypertension, cardiovascular death, the mortality of coronary heart disease and stroke. Two researchers searched online data of PubMed, Embase and Cochrane library databases and other related papers and manual retrieval conference papers. A prospective cohort study of relative risks and 95% CIs about the comparison with ideal blood pressure, the pre-hypertension and the all-cause mortality or the death of cardiovascular that corrected a variety of risk factors. Compared with ideal blood pressure, the corrected risk factors, the pre-hypertension couldn't increase the RR of the all caused mortality; but it could increase remarkably the mortality of cardiovascular, coronary heart disease and stroke, and there was a significant difference between the two later (P<0.001). Compared with the ideal blood pressure, the pre-hypertension still increased the risk of death of cardiovascular disease and the death rate of the stroke was higher than coronary heart disease. PMID:27592484

  5. Hazardous Waste

    MedlinePlus

    ... you throw these substances away, they become hazardous waste. Some hazardous wastes come from products in our homes. Our garbage can include such hazardous wastes as old batteries, bug spray cans and paint ...

  6. Higher diet quality is associated with decreased risk of all-cause, cardiovascular disease, and cancer mortality among older adults.

    PubMed

    Reedy, Jill; Krebs-Smith, Susan M; Miller, Paige E; Liese, Angela D; Kahle, Lisa L; Park, Yikyung; Subar, Amy F

    2014-06-01

    Increased attention in dietary research and guidance has been focused on dietary patterns, rather than on single nutrients or food groups, because dietary components are consumed in combination and correlated with one another. However, the collective body of research on the topic has been hampered by the lack of consistency in methods used. We examined the relationships between 4 indices--the Healthy Eating Index-2010 (HEI-2010), the Alternative Healthy Eating Index-2010 (AHEI-2010), the alternate Mediterranean Diet (aMED), and Dietary Approaches to Stop Hypertension (DASH)--and all-cause, cardiovascular disease (CVD), and cancer mortality in the NIH-AARP Diet and Health Study (n = 492,823). Data from a 124-item food-frequency questionnaire were used to calculate scores; adjusted HRs and 95% CIs were estimated. We documented 86,419 deaths, including 23,502 CVD- and 29,415 cancer-specific deaths, during 15 y of follow-up. Higher index scores were associated with a 12-28% decreased risk of all-cause, CVD, and cancer mortality. Specifically, comparing the highest with the lowest quintile scores, adjusted HRs for all-cause mortality for men were as follows: HEI-2010 HR: 0.78 (95% CI: 0.76, 0.80), AHEI-2010 HR: 0.76 (95% CI: 0.74, 0.78), aMED HR: 0.77 (95% CI: 0.75, 0.79), and DASH HR: 0.83 (95% CI: 0.80, 0.85); for women, these were HEI-2010 HR: 0.77 (95% CI: 0.74, 0.80), AHEI-2010 HR: 0.76 (95% CI: 0.74, 0.79), aMED HR: 0.76 (95% CI: 0.73, 0.79), and DASH HR: 0.78 (95% CI: 0.75, 0.81). Similarly, high adherence on each index was protective for CVD and cancer mortality examined separately. These findings indicate that multiple scores reflect core tenets of a healthy diet that may lower the risk of mortality outcomes, including federal guidance as operationalized in the HEI-2010, Harvard's Healthy Eating Plate as captured in the AHEI-2010, a Mediterranean diet as adapted in an Americanized aMED, and the DASH Eating Plan as included in the DASH score.

  7. All-Cause and Cause-Specific Risk of Emergency Transport Attributable to Temperature: A Nationwide Study.

    PubMed

    Onozuka, Daisuke; Hagihara, Akihito

    2015-12-01

    Although several studies have estimated the associations between mortality or morbidity and extreme temperatures in terms of relative risk, few studies have investigated the risk of emergency transport attributable to the whole temperature range nationwide.We acquired data on daily emergency ambulance dispatches in all 47 prefectures of Japan from 2007 to 2010. We examined the relationship between emergency transport and temperature for each prefecture using a Poisson regression model in a distributed lag nonlinear model with adjustment for time trends. A random-effect multivariate meta-analysis was then applied to pool the estimates at the national level. Attributable morbidity was calculated for high and low temperatures, which were defined as those above or below the optimum temperature (ie, the minimum morbidity temperature) and for moderate and also extreme temperatures, which were defined using cutoffs at the 2.5th and 97.5th temperature percentiles.A total of 15,868,086 cases of emergency transport met the inclusion criteria. The emergency transport was attributable to nonoptimal temperature. The median minimum morbidity percentile was in the 79th percentile for all causes, the 96th percentile for cardiovascular disease, and the 92th percentile for respiratory disease. The fraction attributable to low temperature was 6.94% (95% eCI: 5.93-7.70) for all causes, 17.93% (95% eCI: 16.10-19.25) for cardiovascular disease, and 12.19% (95% eCI: 9.90-13.66) for respiratory disease, whereas the fraction attributable to high temperature was small (all causes = 1.01%, 95% eCI: 0.90-1.11; cardiovascular disease = 0.10%, 95% eCI: 0.04-0.14; respiratory disease = 0.29%, 95% eCI: 0.07-0.50). The all-cause morbidity risk that was attributable to temperature was related to moderate cold, with an overall estimate of 6.41% (95% eCI: 5.47-7.20). Extreme temperatures were responsible for a small fraction, which corresponded to 0.57% (95% eCI: 0.50-0.62) for extreme

  8. Socio-economic inequalities in all-cause mortality in Europe: an exploration of the role of heightened social mobility.

    PubMed

    Simons, Audrey M W; Groffen, Daniëlle A I; Bosma, Hans

    2013-12-01

    The larger than expected socio-economic inequalities in health in more egalitarian countries might be explained by a heightened social mobility in these countries. Therefore, the aim of this explorative study was to examine the associations between country-level social mobility, income inequality and socio-economic differences in all-cause mortality, using country-level secondary data from 12 European countries. Both income equality and social mobility were found to be associated with larger socio-economic differences in mortality, particularly in women. These findings suggest that social mobility and income equality, beside their shiny side of improving population health, might have a shady side of increasing socio-economic health inequalities.

  9. The effect of atmospheric thermal conditions and urban thermal pollution on all-cause and cardiovascular mortality in Bangladesh.

    PubMed

    Burkart, Katrin; Schneider, Alexandra; Breitner, Susanne; Khan, Mobarak Hossain; Krämer, Alexander; Endlicher, Wilfried

    2011-01-01

    This study assessed the effect of temperature and thermal atmospheric conditions on all-cause and cardiovascular mortality in Bangladesh. In particular, differences in the response to elevated temperatures between urban and rural areas were investigated. Generalized additive models (GAMs) for daily death counts, adjusted for trend, season, day of the month and age were separately fitted for urban and rural areas. Breakpoint models were applied for determining the increase in mortality above and below a threshold (equivalent) temperature. Generally, a 'V'-shaped (equivalent) temperature-mortality curve with increasing mortality at low and high temperatures was observed. Particularly, urban areas suffered from heat-related mortality with a steep increase above a specific threshold. This adverse heat effect may well increase with ongoing urbanization and the intensification of the urban heat island due to the densification of building structures. Moreover, rising temperatures due to climate change could aggravate thermal stress.

  10. [Indirect, population effect of mass pneumococcal vaccinations (PCV7) on all-cause pneumonia incidence in Kielce, Poland].

    PubMed

    Patrzałek, Marian; Albrecht, Piotr; Sobczyński, Maciej

    2011-01-01

    In these article they made analysis of indirect, population effects of mass, free of charge, pneumococcal vaccinations (PCV7) on all-cause pneumonia incidence in Kielce, Poland. The strongest and significant fall (p=0.00079) in all-cause pneumonia incidence in the analyzed period 2005-2009 compared with remaining groups were observed in the group of children under 2 of years of life. He amounted to the 74% (around 25/1000 in 2005; 6/1000 in 2009). In the entire ancient group 0-29, embracing children under 2 yrs of life the fall of pneumonia incidence rate amounted to the 48% (from 2.8/1000 in 2005; 1.5/1000 in 2009). In the age 65+ group the fall in the incidence amounted to the 45% (19/1000 in 2005; <11/1000 in 2009 r.). At the moment they didn't observe, of such a fall in age groups 30-49 yrs and 50-64 yrs. Presented results are pointing population effectiveness of applied in Kielce mass vaccination in a 2+1 scheme. Analyzing only pneumonia requiring the hospitalization they tried at work to estimate, in the definitely simplified way, financial effects of mass pneumococcal vaccination in Kielce. Analysis showed at children up to 2 yrs frugalities of the row of the 174,420 zloty annually. In the group above 1 year of life analogous analysis showed frugalities of row 789,480 zloty. Results presented by us should, in our opinion, to induce decision-makers for free of charge mass pneumococcal vaccinations to entire Poland.

  11. Fruit and vegetable consumption and all-cause, cancer and CVD mortality: analysis of Health Survey for England data

    PubMed Central

    Oyebode, Oyinlola; Gordon-Dseagu, Vanessa; Walker, Alice; Mindell, Jennifer S

    2014-01-01

    Background Governments worldwide recommend daily consumption of fruit and vegetables. We examine whether this benefits health in the general population of England. Methods Cox regression was used to estimate HRs and 95% CI for an association between fruit and vegetable consumption and all-cause, cancer and cardiovascular mortality, adjusting for age, sex, social class, education, BMI, alcohol consumption and physical activity, in 65 226 participants aged 35+ years in the 2001–2008 Health Surveys for England, annual surveys of nationally representative random samples of the non-institutionalised population of England linked to mortality data (median follow-up: 7.7 years). Results Fruit and vegetable consumption was associated with decreased all-cause mortality (adjusted HR for 7+ portions 0.67 (95% CI 0.58 to 0.78), reference category <1 portion). This association was more pronounced when excluding deaths within a year of baseline (0.58 (0.46 to 0.71)). Fruit and vegetable consumption was associated with reduced cancer (0.75 (0.59–0.96)) and cardiovascular mortality (0.69 (0.53 to 0.88)). Vegetables may have a stronger association with mortality than fruit (HR for 2 to 3 portions 0.81 (0.73 to 0.89) and 0.90 (0.82 to 0.98), respectively). Consumption of vegetables (0.85 (0.81 to 0.89) per portion) or salad (0.87 (0.82 to 0.92) per portion) were most protective, while frozen/canned fruit consumption was apparently associated with increased mortality (1.17 (1.07 to 1.28) per portion). Conclusions A robust inverse association exists between fruit and vegetable consumption and mortality, with benefits seen in up to 7+ portions daily. Further investigations into the effects of different types of fruit and vegetables are warranted. PMID:24687909

  12. All-Cause and Cause-Specific Mortality among Users of Basal Insulins NPH, Detemir, and Glargine

    PubMed Central

    Strandberg, Timo E.; Christopher, Solomon; Haukka, Jari; Korhonen, Pasi

    2016-01-01

    Background Insulin therapy in type 2 diabetes may increase mortality and cancer incidence, but the impact of different types of basal insulins on these endpoints is unclear. Compared to the traditional NPH insulin, the newer, longer-acting insulin analogues detemir and glargine have shown benefits in randomized controlled trials. Whether these advantages translate into lower mortality among users in real life is unknown. Objective To estimate the differences in all-cause and cause-specific mortality rates between new users of basal insulins in a population-based study in Finland. Methods 23 751 individuals aged ≥40 with type 2 diabetes, who initiated basal insulin therapy in 2006–2009 were identified from national registers, with comprehensive data for mortality, causes of death, and background variables. Propensity score matching was performed on characteristics. Follow-up time was up to 4 years (median 1.7 years). Results 2078 deaths incurred. With NPH as reference, the adjusted HRs for all-cause mortality were 0.39 (95% CI, 0.30–0.50) for detemir, and 0.55 (95% CI, 0.44–0.69) for glargine. As compared to glargine, the HR was 0.71 (95% CI, 0.54–0.93) among detemir users. Compared to NPH, the mortality risk for both cardiovascular causes as well as cancer were also significantly lower for glargine, and especially for detemir in adjusted analysis. Furthermore, the results were robust in various sensitivity analyses. Conclusion In real clinical practice, mortality was substantially higher among users of NPH insulin as compared to insulins detemir or glargine. Considering the large number of patients who require insulin therapy, this difference in risk may have major clinical and public health implications. Due to limitations of the observational study design, further investigation using an interventional study design is warranted. PMID:27031113

  13. Physical activity and all-cause mortality among older Brazilian adults: 11-year follow-up of the Bambuí Health and Aging Study

    PubMed Central

    Ramalho, Juciany RO; Mambrini, Juliana VM; César, Cibele C; de Oliveira, César M; Firmo, Josélia OA; Lima-Costa, Maria Fernanda; Peixoto, Sérgio V

    2015-01-01

    Objective To investigate the association between physical activity (eg, energy expenditure) and survival over 11 years of follow-up in a large representative community sample of older Brazilian adults with a low level of education. Furthermore, we assessed sex as a potential effect modifier of this association. Materials and methods A population-based prospective cohort study was conducted on all the ≥60-year-old residents in Bambuí city (Brazil). A total of 1,606 subjects (92.2% of the population) enrolled, and 1,378 (85.8%) were included in this study. Type, frequency, and duration of physical activity were assessed in the baseline survey questionnaire, and the metabolic equivalent task tertiles were estimated. The follow-up time was 11 years (1997–2007), and the end point was mortality. Deaths were reported by next of kin during the annual follow-up interview and ascertained through the Brazilian System of Information on Mortality, Brazilian Ministry of Health. Hazard ratios (95% confidence intervals [CIs]) were estimated by Cox proportional-hazard models, and potential confounders were considered. Results A statistically significant interaction (P<0.03) was found between sex and energy expenditure. Among older men, increases in levels of physical activity were associated with reduced mortality risk. The hazard ratios were 0.59 (95% CI 0.43–0.81) and 0.47 (95% CI 0.34–0.66) for the second and third tertiles, respectively. Among older women, there was no significant association between physical activity and mortality. Conclusion It was possible to observe the effect of physical activity in reducing mortality risk, and there was a significant interaction between sex and energy expenditure, which should be considered in the analysis of this association in different populations. PMID:25931817

  14. European Regional Differences in All-Cause Mortality and Length of Stay for Patients with Hip Fracture.

    PubMed

    Medin, Emma; Goude, Fanny; Melberg, Hans Olav; Tediosi, Fabrizio; Belicza, Eva; Peltola, Mikko

    2015-12-01

    The objective of this study was to compare healthcare performance for the surgical treatment of hip fractures across and within Finland, Hungary, Italy, the Netherlands, Norway, Scotland, and Sweden. Differences in age-adjusted and sex-adjusted 30-day and one-year all-cause mortality rates following hip fracture, as well as the length of stay of the first hospital episode in acute care and during a follow up of 365 days, were investigated, and associations between selected country-level and regional-level factors with mortality and length of stay were assessed. Hungary showed the highest one-year mortality rate (mean 39.7%) and the lowest length of stay in one year (12.7 days), whereas Italy had the lowest one-year mortality rate (mean 19.1 %) and the highest length of stay (23.3 days). The observed variations were largely explained by country-specific effects rather than by regional-level factors. The results show that there should still be room for efficiency gains in the acute treatment of hip fracture, and clinicians, healthcare managers, and politicians should learn from best practices. This study demonstrates that an international comparison of acute hospital care is possible using pooled individual-level administrative data. PMID:26633868

  15. Relative Hazard Calculation Methodology

    SciTech Connect

    DL Strenge; MK White; RD Stenner; WB Andrews

    1999-09-07

    The methodology presented in this document was developed to provide a means of calculating the RH ratios to use in developing useful graphic illustrations. The RH equation, as presented in this methodology, is primarily a collection of key factors relevant to understanding the hazards and risks associated with projected risk management activities. The RH equation has the potential for much broader application than generating risk profiles. For example, it can be used to compare one risk management activity with another, instead of just comparing it to a fixed baseline as was done for the risk profiles. If the appropriate source term data are available, it could be used in its non-ratio form to estimate absolute values of the associated hazards. These estimated values of hazard could then be examined to help understand which risk management activities are addressing the higher hazard conditions at a site. Graphics could be generated from these absolute hazard values to compare high-hazard conditions. If the RH equation is used in this manner, care must be taken to specifically define and qualify the estimated absolute hazard values (e.g., identify which factors were considered and which ones tended to drive the hazard estimation).

  16. A Prospective Longitudinal Cohort to Investigate the Effects of Early Life Giardiasis on Growth and All Cause Diarrhea

    PubMed Central

    Donowitz, Jeffrey R.; Alam, Masud; Kabir, Mamun; Ma, Jennie Z.; Nazib, Forida; Platts-Mills, James A.; Bartelt, Luther A.; Haque, Rashidul; Petri, William A.

    2016-01-01

    Background. Growth stunting in children under 2 years of age in low-income countries is common. Giardia is a ubiquitous pathogen in this age group but studies investigating Giardia's effect on both growth and diarrhea have produced conflicting results. Methods. We conducted a prospective longitudinal birth cohort study in Dhaka, Bangladesh, with monthly Giardia and continuous diarrheal surveillance. Results. 629 children were enrolled within the first 72 hours of life, and 445 completed 2 years of the study. 12% of children were stunted at birth with 57% stunted by 2 years. 7% of children had a Giardia positive surveillance stool in the first 6 months of life, whereas 74% had a positive stool by 2 years. The median time to first Giardia positive surveillance stool was 17 months. Presence of Giardia in a monthly surveillance stool within the first 6 months of life decreased length-for-age Z score at 2 years by 0.4 (95% confidence interval, −.80 to −.001; P value .05) whereas total number of Giardia positive months over the 2-year period of observation did not. Neither variable was associated with weight-for-age Z score at 2 years. In our model to examine predictors of diarrhea only exclusive breastfeeding was significantly associated with decreased diarrhea (P value <.001). Concomitant giardiasis was neither a risk factor nor protective. Conclusions. Early life Giardia was a risk factor for stunting at age 2 but not poor weight gain. Presence of Giardia neither increased nor decreased odds of acute all cause diarrhea. PMID:27313261

  17. Low all-cause mortality despite high cardiovascular risk in elderly Greek-born Australians: attenuating potential of diet?

    PubMed

    Kouris-Blazos, Antigone; Itsiopoulos, Catherine

    2014-01-01

    Elderly Greek-born Australians (GA) consistently show lower rates of all-cause and CVD mortality compared with Australian-born. Paradoxically, however, this is in spite of a higher prevalence of CVD risk factors. This paper reviews the findings from the Food Habits in Later Life (FHILL) study, other studies on Greek migrants to Australia and clinical studies investigating dietary mechanisms which may explain the "morbidity mortality paradox". The FHILL study collected data between 1988 and 1991 on diet, health and psycho-social variables on 818 people aged 70 and over from Sweden, Greece, Australia (Greeks and Anglo-Celts), Japan and were followed up for 5-7 years to determine survival status. The FHILL study was the first to develop a score which captured the key features of a traditional plant-based Mediterranean diet pattern (MDPS). A higher score improved overall survival in both Greek and non-Greek elderly reducing the risk of death by 50% after 5-7 years. Of the 5 cohorts studied, elderly GA had the lowest risk of death, even though they had the highest rates of obesity and other CVD risk factors (developed in the early years of migration with the introduction of energy dense foods). GA appeared to be "getting away" with these CVD risk factors because of their continued adherence in old age to a Mediterranean diet, especially legumes. We propose that the Mediterranean diet may, in part, be operating to reduce the risk of death and attenuate established CVD risk factors in GA by beneficially altering the gut microbiome and its metabolites. PMID:25516310

  18. Optimal Dietary and Plasma Magnesium Statuses Depend on Dietary Quality for a Reduction in the Risk of All-Cause Mortality in Older Adults.

    PubMed

    Huang, Yi-Chen; Wahlqvist, Mark L; Kao, Mei-Ding; Wang, Jui-Lien; Lee, Meei-Shyuan

    2015-07-13

    The association between dietary or plasma magnesium (Mg) with diabetes incidence and with mortality in free-living elderly was investigated. A total of 1400 participants from the Taiwanese Nutrition Survey, aged ≥ 65 years, and diabetes-free from the 1999-2000 were assessed. The dietary intake and plasma Mg concentration were obtained through 24h dietary recall and health examination at baseline. Participants were classified by quartiles (Q) of dietary Mg or by the plasma Mg normal range (0.75-0.95 mmol/L). Dietary diversity score (DDS, range 1-6) represented the dietary quality. During 8 and 10 years, 231 incident diabetes cases and 475 deaths were identified. Cox's proportional-hazards regression was used to evaluate the association between Mg and health outcomes. The hazard ratios (95% confidence interval) for death in Q2 and Q3 of Mg intakes with DDS > 4 were 0.57 (0.44-0.74) and 0.59 (0.39-0.88), respectively, compared with the lowest intake and DDS ≤ 4 participants. Participants with normal and high plasma Mg in conjunction with high DDS had relative risks of 0.58 (0.37-0.89) and 0.46 (0.25-0.85) in mortality compared with low plasma Mg and lower DDS. Optimal dietary Mg intake and plasma Mg depend on dietary quality to reduce the mortality risk in older adults.

  19. A review and meta-analysis of the effect of weight loss on all-cause mortality risk.

    PubMed

    Harrington, Mary; Gibson, Sigrid; Cottrell, Richard C

    2009-06-01

    Overweight and obesity are associated with increased morbidity and mortality, although the range of body weights that is optimal for health is controversial. It is less clear whether weight loss benefits longevity and hence whether weight reduction is justified as a prime goal for all individuals who are overweight (normally defined as BMI>25 kg/m2). The purpose of the present review was to examine the evidence base for recommending weight loss by diet and lifestyle change as a means of prolonging life. An electronic search identified twenty-six eligible prospective studies that monitored subsequent mortality risk following weight loss by lifestyle change, published up to 2008. Data were extracted and further analysed by meta-analysis, giving particular attention to the influence of confounders. Moderator variables such as reason for weight loss (intentional, unintentional), baseline health status (healthy, unhealthy), baseline BMI (normal, overweight, obese), method used to estimate weight loss (measured weight loss, reported weight loss) and whether models adjusted for physical activity (adjusted data, unadjusted data) were used to classify subgroups for separate analysis. Intentional weight loss per se had a neutral effect on all-cause mortality (relative risk (RR) 1.01; P = 0.89), while weight loss which was unintentional or ill-defined was associated with excess risk of 22 to 39 %. Intentional weight loss had a small benefit for individuals classified as unhealthy (with obesity-related risk factors) (RR 0.87 (95 % CI 0.77, 0.99); P = 0.028), especially unhealthy obese (RR 0.84 (95 % CI 0.73, 0.97); P = 0.018), but appeared to be associated with slightly increased mortality for healthy individuals (RR 1.11 (95 % CI 1.00, 1.22); P = 0.05), and for those who were overweight but not obese (RR 1.09 (95 % CI 1.02, 1.17); P = 0.008). There was no evidence for weight loss conferring either benefit or risk among healthy obese. In conclusion, the available evidence does

  20. The Influence of Source of Social Support and Size of Social Network on All-Cause Mortality

    PubMed Central

    Becofsky, Katie M.; Shook, Robin P.; Sui, Xuemei; Wilcox, Sara; Lavie, Carl J.; Blair, Steven N.

    2015-01-01

    Objective To examine associations between relative, friend, and partner support, as well as size and source of weekly social network, on mortality risk in the Aerobics Center Longitudinal Study (ACLS). Patients and Methods In a mail-back survey completed between January 1, 1990 and December 31, 1990, adult ACLS participants (n=12,709) answered questions regarding whether they received social support from relatives, friends, and spouse/partner (yes or no for each), and the number of friends and relatives they had contact with at least once per week. Participants were followed until December 31, 2003 or death. Cox proportional hazard regression evaluated the strength of the associations, controlling for covariates. Results Participants (25% women) averaged 53.0 years at baseline. During a median 13.5 years of follow-up, 1,139 deaths occurred. Receiving social support from relatives reduced mortality risk 19% (HR 0.81, 95% CI 0.68–0.95). Receiving spousal/partner support also reduced mortality risk 19% (HR 0.81, 95% CI 0.66-.99). Receiving social support from friends was not associated with mortality risk (HR 0.90, 95% CI 0.75–1.09), however, participants reporting social contact with 6 or 7 friends on a weekly basis had a 24% lower mortality risk than those in contact with ≤ 1 friend (HR 0.76, 95% CI 0.58–0.98). Contact with 2–5 or ≥8 friends was not associated with mortality risk, nor was number of weekly relative contacts. Conclusions Receiving social support from one’s spouse/partner and relatives and maintaining weekly social interaction with 6–7 friends reduced mortality risk. Such data may inform interventions to improve long-term survival. PMID:26055526

  1. Asymmetric dimethylarginine Correlates with Measures of Disease Severity, Major Adverse Cardiovascular Events and All-Cause Mortality in Patients with Peripheral Arterial Disease

    PubMed Central

    Wilson, Andrew M; Shin, David S; Weatherby, Carlton; Harada, Randall K; Ng, Martin K; Nair, Nandini; Kielstein, Jan; Cooke, John P

    2011-01-01

    Background Peripheral arterial disease (PAD) is associated with major cardiovascular morbidity and mortality. Abnormalities in nitric oxide metabolism due to excess of the NO synthase inhibitor asymmetric dimethylarginine (ADMA) may be pathogenic in PAD. We explored the association between ADMA levels and markers of atherosclerosis, function, and prognosis. Methods and Results 133 patients with symptomatic PAD were enrolled. Ankle brachial index (ABI), walking time, vascular function measures (arterial compliance and flow-mediated vasodilatation) and plasma ADMA level were assessed for each patient at baseline. ADMA correlated inversely with ABI (r = −0.238, p=0.003) and walking time (r = −0.255, p = 0.001), independent of other vascular risk factors. We followed up 125 (94%) of our 133 initial subjects with baseline measurements (mean 35 months). Subjects with ADMA levels in the highest quartile (>0.84 μmol/L) showed significantly greater occurrence of MACE compared to those with ADMA levels in the lower 3 quartiles (p = 0.001). Cox proportional-hazards regression analysis revealed that ADMA was a significant predictor of MACE, independent of other risk factors including age, gender, blood pressure, smoking history, diabetes and ABI (Hazard ratio = 5.1, p<0.001). Measures of vascular function, such as compliance, FMVD and blood pressure, as well as markers of PAD severity, including ABI and walking time, were not predictive. Conclusion Circulating levels of ADMA correlate independently with measures of disease severity and major adverse cardiovascular events. Agents that target this pathway may be useful for this patient population. PMID:20484311

  2. Hazardous materials

    MedlinePlus

    ... people how to work with hazardous materials and waste. There are many different kinds of hazardous materials, including: Chemicals, like some that are used for cleaning Drugs, like chemotherapy to treat cancer Radioactive material that is used for x-rays or ...

  3. Physical activity and all-cause mortality across levels of overall and abdominal adiposity in European men and women: the European Prospective Investigation into Cancer and Nutrition Study (EPIC)123456

    PubMed Central

    Ward, Heather A; Norat, Teresa; Luan, Jian’an; May, Anne M; Weiderpass, Elisabete; Sharp, Stephen J; Overvad, Kim; Østergaard, Jane Nautrup; Tjønneland, Anne; Johnsen, Nina Føns; Mesrine, Sylvie; Fournier, Agnès; Fagherazzi, Guy; Trichopoulou, Antonia; Lagiou, Pagona; Trichopoulos, Dimitrios; Li, Kuanrong; Kaaks, Rudolf; Ferrari, Pietro; Licaj, Idlir; Jenab, Mazda; Bergmann, Manuela; Boeing, Heiner; Palli, Domenico; Sieri, Sabina; Panico, Salvatore; Tumino, Rosario; Vineis, Paolo; Peeters, Petra H; Monnikhof, Evelyn; Bueno-de-Mesquita, H Bas; Quirós, J Ramón; Agudo, Antonio; Sánchez, María-José; Huerta, José María; Ardanaz, Eva; Arriola, Larraitz; Hedblad, Bo; Wirfält, Elisabet; Sund, Malin; Johansson, Mattias; Key, Timothy J; Travis, Ruth C; Khaw, Kay-Tee; Brage, Søren; Wareham, Nicholas J; Riboli, Elio

    2015-01-01

    Background: The higher risk of death resulting from excess adiposity may be attenuated by physical activity (PA). However, the theoretical number of deaths reduced by eliminating physical inactivity compared with overall and abdominal obesity remains unclear. Objective: We examined whether overall and abdominal adiposity modified the association between PA and all-cause mortality and estimated the population attributable fraction (PAF) and the years of life gained for these exposures. Design: This was a cohort study in 334,161 European men and women. The mean follow-up time was 12.4 y, corresponding to 4,154,915 person-years. Height, weight, and waist circumference (WC) were measured in the clinic. PA was assessed with a validated self-report instrument. The combined associations between PA, BMI, and WC with mortality were examined with Cox proportional hazards models, stratified by center and age group, and adjusted for sex, education, smoking, and alcohol intake. Center-specific PAF associated with inactivity, body mass index (BMI; in kg/m2) (>30), and WC (≥102 cm for men, ≥88 cm for women) were calculated and combined in random-effects meta-analysis. Life-tables analyses were used to estimate gains in life expectancy for the exposures. Results: Significant interactions (PA × BMI and PA × WC) were observed, so HRs were estimated within BMI and WC strata. The hazards of all-cause mortality were reduced by 16–30% in moderately inactive individuals compared with those categorized as inactive in different strata of BMI and WC. Avoiding all inactivity would theoretically reduce all-cause mortality by 7.35% (95% CI: 5.88%, 8.83%). Corresponding estimates for avoiding obesity (BMI >30) were 3.66% (95% CI: 2.30%, 5.01%). The estimates for avoiding high WC were similar to those for physical inactivity. Conclusion: The greatest reductions in mortality risk were observed between the 2 lowest activity groups across levels of general and abdominal adiposity, which

  4. Childhood Club Participation and All-cause Mortality in Adulthood: A 65-year Follow-up Study of a Population-representative Sample in Scotland

    PubMed Central

    Calvin, Catherine M.; Batty, G. David; Brett, Caroline E.; Deary, Ian J.

    2015-01-01

    Objective Social participation in middle- and older-age is associated with lower mortality risk across many prospective cohort studies. However there is a paucity of evidence on social participation in youth in relation to mortality, which could help inform an understanding of the origin of the association, and give credence to causality. The present study investigates the relation of early life club membership—a proxy measure of social participation—with mortality risk in older age in a nationally representative sample. Methods We linked historical data collected on the 6-Day Sample of the Scottish Mental Survey 1947 during the period 1947-1963 with vital status records up to April 2014. Analyses were based on 1059 traced participants (446 deceased). Results Club membership at age 18 years was associated with lower mortality risk by age 78 years (hazard ratio=0.54, 95% CI 0.44 to 0.68, p<.001). Club membership remained a significant predictor in models that included early life health, socioeconomic status (SES), measured intelligence, and teachers’ ratings of dependability in personality. Conclusion In a study which circumvented the problem of reverse causality, a proxy indicator of social participation in youth was related to lower mortality risk. The association may be mediated by several behavioural and neurobiological factors, which prospective ageing cohort studies could address. PMID:26176775

  5. Carbon Structure Hazard Control

    NASA Technical Reports Server (NTRS)

    Yoder, Tommy; Greene, Ben; Porter, Alan

    2015-01-01

    Carbon composite structures are widely used in virtually all advanced technology industries for a multitude of applications. The high strength-to-weight ratio and resistance to aggressive service environments make them highly desirable. Automotive, aerospace, and petroleum industries extensively use, and will continue to use, this enabling technology. As a result of this broad range of use, field and test personnel are increasingly exposed to hazards associated with these structures. No single published document exists to address the hazards and make recommendations for the hazard controls required for the different exposure possibilities from damaged structures including airborne fibers, fly, and dust. The potential for personnel exposure varies depending on the application or manipulation of the structure. The effect of exposure to carbon hazards is not limited to personnel, protection of electronics and mechanical equipment must be considered as well. The various exposure opportunities defined in this document include pre-manufacturing fly and dust, the cured structure, manufacturing/machining, post-event cleanup, and post-event test and/or evaluation. Hazard control is defined as it is applicable or applied for the specific exposure opportunity. The carbon exposure hazard includes fly, dust, fiber (cured/uncured), and matrix vapor/thermal decomposition products. By using the recommendations in this document, a high level of confidence can be assured for the protection of personnel and equipment.

  6. The effects of control of systolic and diastolic hypertension on cardiovascular and all-cause mortality in a community-based population cohort.

    PubMed

    Barengo, N C; Antikainen, R; Kastarinen, M; Laatikainen, T; Tuomilehto, J

    2013-11-01

    The objective of this study (follow-up of 26,113 people) was to investigate differences in the risk of cardiovascular disease (CVD) and all-cause mortality among hypertensive people according to the control of systolic blood pressure (SBP) and diastolic blood pressure (DBP). People with a history of coronary heart disease, heart failure, cancer or incomplete data at baseline (n=1113) were excluded from the study. The participants were classified into six groups according to their blood pressure status. Treated hypertensive individuals with controlled SBP and DBP did not experience an increase in all-cause mortality compared with normotensive people. The increase in all-cause mortality was 1.48-fold (95% confidence interval (CI) 1.09-2.01) among those who were treated with antihypertensive drugs and had only their DBP controlled and 1.45-fold (95% CI 1.04-2.02) among those who were treated and had only their SBP controlled. Treated patients with both SBP and DBP controlled did not have an increased risk of CVD mortality when compared with normotensive people. The risk of CVD mortality was statistically significantly higher in treated hypertensive people with SBP alone, DBP alone or both SBP and DBP uncontrolled. Our study indicates that uncontrolled SBP alone and DBP alone are risk factors of all-cause and CVD mortality.

  7. The reverse J shaped association between serum total 25- hydroxyvitamin D and all-cause mortality: The impact of assay standardization

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The impact of standardizing the originally measured serum total 25-hydroxyvitamin D [25(OH)D] values from Third National Health and Nutrition Examination Survey (NHANES III, 1988-1994) on the association between 25(OH)D and rate of all-cause mortality was evaluated. Values were standardized to gold ...

  8. Habitual Sleep Duration and Insomnia and the Risk of Cardiovascular Events and All-cause Death: Report from a Community-Based Cohort

    PubMed Central

    Chien, Kuo-Liong; Chen, Pei-Chung; Hsu, Hsiu-Ching; Su, Ta-Chen; Sung, Fung-Chang; Chen, Ming-Fong; Lee, Yuan-Teh

    2010-01-01

    Study Objectives: To investigate the relationship between sleep duration and insomnia severity and the risk of all-cause death and cardiovascular disease (CVD) events Design: Prospective cohort study Setting: Community-based Participants: A total of 3,430 adults aged 35 years or older Intervention: None Measurements and Results: During a median 15.9 year (interquartile range, 13.1 to 16.9) follow-up period, 420 cases developed cardiovascular disease and 901 cases died. A U-shape association between sleep duration and all-cause death was found: the age and gender-adjusted relative risks (95% confidence interval [CI]) of all-cause death (with 7 h of daily sleep being considered for the reference group) for individuals reporting ≤ 5 h, 6 h, 8 h, and ≥ 9 h were 1.15 (0.91–1.45), 1.02 (0.85–1.25), 1.05 (0.88–1.27), and 1.43 (1.16–1.75); P for trend, 0.019. However, the relationship between sleep duration and risk of CVD were linear. The multivariate-adjusted relative risk (95% CI) for all-cause death (using individuals without insomnia) were 1.02 (0.86–1.20) for occasional insomnia, 1.15 (0.92–1.42) for frequent insomnia, and 1.70 (1.16–2.49) for nearly everyday insomnia (P for trend, 0.028). The multivariate adjusted relative risk (95% CI) was 2.53 (1.71–3.76) for all-cause death and 2.07 (1.11–3.85) for CVD rate in participants sleeping ≥9 h and for those with frequent insomnia. Conclusions: Sleep duration and insomnia severity were associated with all-cause death and CVD events among ethnic Chinese in Taiwan. Our data indicate that an optimal sleep duration (7–8 h) predicted fewer deaths. Citation: Chien K; Chen P; Hsu H; Su T; Sung F; Chen M; Lee Y. Habitual sleep duration and insomnia and the risk of cardiovascular events and all-cause death: report from a community-based cohort. SLEEP 2010;33(2):177–184. PMID:20175401

  9. Reproductive Hazards

    MedlinePlus

    ... and female reproductive systems play a role in pregnancy. Problems with these systems can affect fertility and ... a reproductive hazard can cause different effects during pregnancy, depending on when she is exposed. During the ...

  10. Coastal Hazards.

    ERIC Educational Resources Information Center

    Vandas, Steve

    1998-01-01

    Focuses on hurricanes and tsunamis and uses these topics to address other parts of the science curriculum. In addition to a discussion on beach erosion, a poster is provided that depicts these natural hazards that threaten coastlines. (DDR)

  11. Cardiac troponin and C-reactive protein for predicting all-cause and cardiovascular mortality in patients with chronic kidney disease: A meta-analysis

    PubMed Central

    Li, Wei-Jie; Chen, Xu-Miao; Nie, Xiao-Ying; Zhang, Jing; Cheng, Yun-Jiu; Lin, Xiao-Xiong; Wu, Su-Hua

    2015-01-01

    Elevated serum levels of cardiac troponin and C-reactive protein are associated with all-cause and cardiovascular mortality in patients with end-stage renal disease. However, the relationship between these two biomarker levels and mortality in patients with chronic kidney disease remains unclear. We conducted a meta-analysis to quantify the association of cardiac troponin and C-reactive protein levels with all-cause and cardiovascular mortality in patients with chronic kidney disease. Relevant studies were identified by searching the MEDLINE database through November 2013. Studies were included in the meta-analysis if they reported the long-term all-cause or cardiovascular mortality of chronic kidney disease patients with abnormally elevated serum levels of cardiac troponin or C-reactive protein. Summary estimates of association were obtained using a random-effects model. Thirty-two studies met our inclusion criteria. From the pooled analysis, cardiac troponin and C-reactive protein were significantly associated with all-cause (HR 2.93, 95% CI 1.97-4.33 and HR 1.21, 95% CI 1.14-1.29, respectively) and cardiovascular (HR 3.27, 95% CI 1.67-6.41 and HR 1.19, 95% CI 1.10-1.28, respectively) mortality. In the subgroup analysis of cardiac troponin and C-reactive protein, significant heterogeneities were found among the subgroups of population for renal replacement therapy and for the proportion of smokers and the C-reactive protein analysis method. Elevated serum levels of cardiac troponin and C-reactive protein are significant associated with higher risks of all-cause and cardiovascular mortality in patients with chronic kidney disease. Further studies are warranted to explore the risk stratification in chronic kidney disease patients. PMID:26017799

  12. N-3 long-chain polyunsaturated fatty acids and risk of all-cause mortality among general populations: a meta-analysis

    PubMed Central

    Chen, Guo-Chong; Yang, Jing; Eggersdorfer, Manfred; Zhang, Weiguo; Qin, Li-Qiang

    2016-01-01

    Prospective observational studies have shown inconsistent associations of dietary or circulating n-3 long-chain polyunsaturated fatty acids (LCPUFA) with risk of all-cause mortality. A meta-analysis was performed to evaluate the associations. Potentially eligible studies were identified by searching PubMed and EMBASE databases. The summary relative risks (RRs) with 95% confidence intervals (CIs) were calculated using the random-effects model. Eleven prospective studies involving 371 965 participants from general populations and 31 185 death events were included. The summary RR of all-cause mortality for high-versus-low n-3 LCPUFA intake was 0.91 (95% CI: 0.84–0.98). The summary RR for eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) intake was 0.83 (95% CI: 0.75–0.92) and 0.81 (95% CI: 0.74–0.95), respectively. In the dose-response analysis, each 0.3 g/d increment in n-3 LCPUFA intake was associated with 6% lower risk of all-cause mortality (RR = 0.94, 95% CI: 0.89–0.99); and each 1% increment in the proportions of circulating EPA and DHA in total fatty acids in blood was associated with 20% (RR = 0.80, 95% CI: 0.65–0.98) and 21% (RR = 0.79, 95% CI: 0.63–0.99) decreased risk of all-cause mortality, respectively. Moderate to high heterogeneity was observed across our anlayses. Our findings suggest that both dietary and circulating LCPUFA are inversely associated with all-cause mortality. PMID:27306836

  13. Reporting Hazards: Their Benefits and Costs.

    ERIC Educational Resources Information Center

    Singer, Eleanor; Endreny, Phyllis

    1987-01-01

    Analyzes the kind and amount of information the media provide about risks and benefits for various hazards. Indicates that the media emphasize hazards that are relatively serious and rare--the combination gives the punch. Ratio of benefits to costs depends upon the particular hazard being covered and reflects general cycles of optimism and…

  14. IQ in late adolescence/early adulthood, risk factors in middle age and later all-cause mortality in men: the Vietnam Experience Study

    PubMed Central

    Batty, G D; Shipley, M J; Mortensen, L H; Boyle, S H; Barefoot, J; Grønbæk, M; Gale, C R; Deary, I J

    2013-01-01

    Objective To examine the role of potential mediating factors in explaining the IQ–mortality relation. Design, setting and participants A total of 4316 male former Vietnam-era US army personnel with IQ test results at entry into the service in late adolescence/early adulthood in the 1960/1970s (mean age at entry 20.4 years) participated in a telephone survey and medical examination in middle age (mean age 38.3 years) in 1985–6. They were then followed up for mortality experience for 15 years. Main results In age-adjusted analyses, higher IQ scores were associated with reduced rates of total mortality (hazard ratio (HR)per SD increase in IQ 0.71; 95% CI 0.63 to 0.81). This relation did not appear to be heavily confounded by early socioeconomic position or ethnicity. The impact of adjusting for some potentially mediating risk indices measured in middle age on the IQ–mortality relation (marital status, alcohol consumption, systolic and diastolic blood pressure, pulse rate, blood glucose, body mass index, psychiatric and somatic illness at medical examination) was negligible (<10% attenuation in risk). Controlling for others (cigarette smoking, lung function) had a modest impact (10–17%). Education (0.79; 0.69 to 0.92), occupational prestige (0.77; 0.68 to 0.88) and income (0.86; 0.75 to 0.98) yielded the greatest attenuation in the IQ–mortality gradient (21–52%); after their collective adjustment, the IQ–mortality link was effectively eliminated (0.92; 0.79 to 1.07). Conclusions In this cohort, socioeconomic position in middle age might lie on the pathway linking earlier IQ with later mortality risk but might also partly act as a surrogate for cognitive ability. PMID:18477751

  15. Usefulness of Beta2-Microglobulin as a Predictor of All-Cause and Nonculprit Lesion-Related Cardiovascular Events in Acute Coronary Syndromes (from the PROSPECT Study).

    PubMed

    Möckel, Martin; Muller, Reinhold; Searle, Julia; Slagman, Anna; De Bruyne, Bernard; Serruys, Patrick; Weisz, Giora; Xu, Ke; Holert, Fabian; Müller, Christian; Maehara, Akiko; Stone, Gregg W

    2015-10-01

    In the Providing Regional Observations to Study Predictors of Events in the Coronary Tree (PROSPECT) study, plaque burden, plaque composition, and minimal luminal area were associated with an increased risk of adverse cardiovascular events arising from untreated atherosclerotic lesions (vulnerable plaques) in patients with acute coronary syndromes (ACS). We sought to evaluate the utility of biomarker profiling and clinical risk factors to predict 3-year all-cause and nonculprit lesion-related major adverse cardiac events (MACEs). Of 697 patients who underwent successful percutaneous coronary intervention (PCI) for ACS, an array of 28 baseline biomarkers was analyzed. Median follow-up was 3.4 years. Beta2-microglobulin displayed the strongest predictive power of all variables assessed for all-cause and nonculprit lesion-related MACE. In a classification and regression tree analysis, patients with beta2-microglobulin >1.92 mg/L had an estimated 28.7% 3-year incidence of all-cause MACE; C-peptide <1.32 ng/ml was associated with a further increase in MACE to 51.2%. In a classification and regression tree analysis for untreated nonculprit lesion-related MACE, beta2-microglobulin >1.92 mg/L identified a cohort with a 3-year rate of 18.5%, and C-peptide <2.22 ng/ml was associated with a further increase to 25.5%. By multivariable analysis, beta2-microglobulin was the strongest predictor of all-cause and nonculprit MACE during follow-up. High-density lipoprotein (HDL), transferrin, and history of angina pectoris were also independent predictors of all-cause MACE, and HDL was an independent predictor of nonculprit MACE. In conclusion, in the PROSPECT study, beta2-microglobulin strongly predicted all-cause and nonculprit lesion-related MACE within 3 years after PCI in ACS. C-peptide and HDL provided further risk stratification to identify angiographically mild nonculprit lesions prone to future MACE.

  16. Usefulness of Beta2-Microglobulin as a Predictor of All-Cause and Nonculprit Lesion-Related Cardiovascular Events in Acute Coronary Syndromes (from the PROSPECT Study).

    PubMed

    Möckel, Martin; Muller, Reinhold; Searle, Julia; Slagman, Anna; De Bruyne, Bernard; Serruys, Patrick; Weisz, Giora; Xu, Ke; Holert, Fabian; Müller, Christian; Maehara, Akiko; Stone, Gregg W

    2015-10-01

    In the Providing Regional Observations to Study Predictors of Events in the Coronary Tree (PROSPECT) study, plaque burden, plaque composition, and minimal luminal area were associated with an increased risk of adverse cardiovascular events arising from untreated atherosclerotic lesions (vulnerable plaques) in patients with acute coronary syndromes (ACS). We sought to evaluate the utility of biomarker profiling and clinical risk factors to predict 3-year all-cause and nonculprit lesion-related major adverse cardiac events (MACEs). Of 697 patients who underwent successful percutaneous coronary intervention (PCI) for ACS, an array of 28 baseline biomarkers was analyzed. Median follow-up was 3.4 years. Beta2-microglobulin displayed the strongest predictive power of all variables assessed for all-cause and nonculprit lesion-related MACE. In a classification and regression tree analysis, patients with beta2-microglobulin >1.92 mg/L had an estimated 28.7% 3-year incidence of all-cause MACE; C-peptide <1.32 ng/ml was associated with a further increase in MACE to 51.2%. In a classification and regression tree analysis for untreated nonculprit lesion-related MACE, beta2-microglobulin >1.92 mg/L identified a cohort with a 3-year rate of 18.5%, and C-peptide <2.22 ng/ml was associated with a further increase to 25.5%. By multivariable analysis, beta2-microglobulin was the strongest predictor of all-cause and nonculprit MACE during follow-up. High-density lipoprotein (HDL), transferrin, and history of angina pectoris were also independent predictors of all-cause MACE, and HDL was an independent predictor of nonculprit MACE. In conclusion, in the PROSPECT study, beta2-microglobulin strongly predicted all-cause and nonculprit lesion-related MACE within 3 years after PCI in ACS. C-peptide and HDL provided further risk stratification to identify angiographically mild nonculprit lesions prone to future MACE. PMID:26254706

  17. Population density, socioeconomic environment and all-cause mortality: a multilevel survival analysis of 2.7 million individuals in Denmark.

    PubMed

    Meijer, Mathias; Kejs, Anne Mette; Stock, Christiane; Bloomfield, Kim; Ejstrud, Bo; Schlattmann, Peter

    2012-03-01

    This study examines the relative effects of population density and area-level SES on all-cause mortality in Denmark. A shared frailty model was fitted with 2.7 million persons aged 30-81 years in 2,121 parishes. Residence in areas with high population density increased all-cause mortality for all age groups. For older age groups, residence in areas with higher proportions of unemployed persons had an additional effect. Area-level factors explained considerably more variation in mortality among the elderly than among younger generations. Overall this study suggests that structural prevention efforts in neighborhoods could help reduce mortality when mediating processes between area-level socioeconomic status, population density and mortality are found.

  18. Incident Comorbidities and All-Cause Mortality among Five-Year Survivors of Stage I and II Breast Cancer Diagnosed at Age 65 or Older: A Prospective Matched Cohort Study

    PubMed Central

    Jordan, Jennifer H.; Thwin, Soe Soe; Lash, Timothy L.; Buist, Diana S.M.; Field, Terry S.; Haque, Reina; Pawloski, Pamala A.; Petersen, Hans V.; Prout, Marianne N.; Quinn, Virginia P.; Yood, Marianne Ulcickas; Silliman, Rebecca A.; Geiger, Ann M.

    2014-01-01

    Purpose Five-year breast cancer survivors, diagnosed after 65 years of age, may develop more incident comorbidities than similar populations free of cancer. We investigated if older breast cancer survivors have a similar comorbidity burden 6–15 years after cancer diagnosis to matched women free of breast cancer at start of follow-up and if incident comorbidities are associated with all-cause mortality. Methods In this prospective cohort study, 1,361 older five-year early stage breast cancer survivors diagnosed between 1990 and 1994 and 1,361 age- and health system-matched women were followed for ten years. Adjudicated medical record review captured prevalent and incident comorbidities during follow-up or until death as collected from the National Death Index. Results Older five-year breast cancer survivors did not acquire incident comorbidities more often than matched women free of breast cancer in the subsequent 10 years (HR=1.0, 95%CI: 0.93,1.1). Adjusted for cohort membership, women with incident comorbidities had a higher mortality rate than those without incident comorbidities (HR=4.8, 95%CI: 4.1,5.6). A breast cancer history continued to be a hazard for mortality 6–15 years after diagnosis (HR=1.3, 95%CI: 1.1,1.4). Conclusions We found that older breast cancer survivors who developed comorbidities had an increased all-cause mortality rate even after adjusting for age and prevalent comorbidity burden. Additionally, survivors acquire comorbidities at a rate similar to older women free of breast cancer. These results highlight the association between comorbidity burden and long-term mortality risk among older breast cancer survivors and their need for appropriate oncology and primary care follow-up. PMID:24939060

  19. Meta-analysis: low-dose intake of vitamin E combined with other vitamins or minerals may decrease all-cause mortality.

    PubMed

    Jiang, Shan; Pan, Zhenyu; Li, Hui; Li, Fenglan; Song, Yanyan; Qiu, Yu

    2014-01-01

    It has been suggested that vitamin E alone or combined with other vitamins or minerals can prevent oxidative stress and slow oxidative injury-related diseases, such as cardiovascular disease and cancer. A comprehensive search of PubMed/MEDLINE, EMBASE and the Cochrane Library was performed. Relative risk was used as an effect measure to compare the intervention and control groups. A total of 33 trials were included in the meta-analysis. Neither vitamin E intake alone (RR=1.01; 95% CI, 0.97 to 1.04; p=0.77) nor vitamin E intake combined with other agents (RR=0.97; 95% CI, 0.89 to 1.06; p=0.55) was correlated with all-cause mortality. Subgroup analyses revealed that low-dose vitamin E supplementation combined with other agents is associated with a statistically significant reduction in all-cause mortality (RR=0.92; 95% CI, 0.86 to 0.98; p=0.01), and vitamin E intake combined with other agents is associated with a statistically significant reduction in mortality rates among individuals without probable or confirmed diseases (RR=0.92; 95% CI, 0.86 to 0.99; p=0.02). Neither vitamin E intake alone nor combined with other agents is associated with a reduction in all-cause mortality. But a low dose (<400 IU/d) of vitamin E combined with other agents is correlated with a reduction in all-cause mortality, and vitamin E intake combined with other agents is correlated with a reduction in the mortality rate among individuals without probable or confirmed diseases.

  20. Examining the association between serum lactic dehydrogenase and all-cause mortality in patients with metabolic syndrome: a retrospective observational study

    PubMed Central

    Wu, Li-Wei; Kao, Tung-Wei; Lin, Chien-Ming; Yang, Hui-Fang; Sun, Yu-Shan; Liaw, Fang-Yih; Wang, Chung-Ching; Peng, Tao-Chun; Chen, Wei-Liang

    2016-01-01

    Objectives Emerging evidence indicates that elevated serum lactic dehydrogenase (LDH) levels are associated with increased cardiovascular mortality, but the mechanisms for this relationship remain uncertain. Since metabolic syndrome (MetS) is correlated with a higher risk of cardiovascular complications, we investigated the joint association between serum LDH levels and all-cause mortality in the US general population with MetS. Design Retrospective study. Setting The USA. Participants A retrospective observational study of 3872 adults with MetS and 7516 adults without MetS in the National Health and Nutrition Examination Survey III was performed. Main outcome measures Participants with and without MetS were both divided into 3 groups according to their serum LDH level. Multivariable Cox regression analyses and Kaplan-Meier survival probabilities were used to jointly relate all-cause, cardiovascular and cancer mortality risk to different serum LDH levels. Results For all-cause mortality in participants with MetS, multivariable adjusted HRs were 1.006 (95% CI 0.837 to 1.210; p=0.947) for serum LDH of 149–176 U/L compared with 65–149 U/L, and 1.273 (95% CI 1.049 to 1.547; p=0.015) for serum LDH of 176–668 U/L compared with 65–149 U/L. Conclusions Results support a positive association between higher level of serum LDH and mortality from all causes in individuals with MetS. PMID:27217285

  1. Short-term effect of dust storms on the risk of mortality due to respiratory, cardiovascular and all-causes in Kuwait.

    PubMed

    Al-Taiar, Abdullah; Thalib, Lukman

    2014-01-01

    This study aimed to investigate the impact of dust storms on short-term mortality in Kuwait. We analyzed respiratory and cardiovascular mortality as well as all-cause mortality in relation to dust storm events over a 5-year study period, using data obtained through a population-based retrospective ecological time series study. Dust storm days were identified when the national daily average of PM10 exceeded 200 μg/m(3). Generalized additive models with Poisson link were used to estimate the relative risk (RR) of age-stratified daily mortality associated with dust events, after adjusting for potential confounders including weather variables and long-term trends. There was no significant association between dust storm events and same-day respiratory mortality (RR = 0.96; 95%CI 0.88-1.04), cardiovascular mortality (RR = 0.98; 95%CI 0.96-1.012) or all-cause mortality (RR = 0.99; 95%CI 0.97-1.00). Overall our findings suggest that local dust, that most likely originates from crustal materials, has little impact on short-term respiratory, cardiovascular or all-cause mortality. PMID:23329278

  2. Association between Highly Active Antiretroviral Therapy and Type of Infectious Respiratory Disease and All-Cause In-Hospital Mortality in Patients with HIV/AIDS: A Case Series

    PubMed Central

    Báez-Saldaña, Renata; Villafuerte-García, Adriana; Cruz-Hervert, Pablo; Delgado-Sánchez, Guadalupe; Ferreyra-Reyes, Leticia; Ferreira-Guerrero, Elizabeth; Mongua-Rodríguez, Norma; Montero-Campos, Rogelio; Melchor-Romero, Ada; García-García, Lourdes

    2015-01-01

    Background Respiratory manifestations of HIV disease differ globally due to differences in current availability of effective highly active antiretroviral therapy (HAART) programs and epidemiology of infectious diseases. Objective To describe the association between HAART and discharge diagnosis and all-cause in-hospital mortality among hospitalized patients with infectious respiratory disease and HIV/AIDS. Material and Methods We retrospectively reviewed the records of patients hospitalized at a specialty hospital for respiratory diseases in Mexico City between January 1st, 2010 and December 31st, 2011. We included patients whose discharge diagnosis included HIV or AIDS and at least one infectious respiratory diagnosis. The information source was the clinical chart. We analyzed the association between HAART for 180 days or more and type of respiratory disease using polytomous logistic regression and all-cause hospital mortality by multiple logistic regressions. Results We studied 308 patients, of whom 206 (66.9%) had been diagnosed with HIV infection before admission to the hospital. The CD4+ lymphocyte median count was 68 cells/mm3 [interquartile range (IQR): 30–150]. Seventy-five (24.4%) cases had received HAART for more than 180 days. Pneumocystis jirovecii pneumonia (PJP) (n = 142), tuberculosis (n = 63), and bacterial community-acquired pneumonia (n = 60) were the most frequent discharge diagnoses. Receiving HAART for more than 180 days was associated with a lower probability of PJP [Adjusted odd ratio (aOR): 0.245, 95% Confidence Interval (CI): 0.08–0.8, p = 0.02], adjusted for sociodemographic and clinical covariates. HAART was independently associated with reduced odds (aOR 0.214, 95% CI 0.06–0.75) of all-cause in-hospital mortality, adjusting for HIV diagnosis previous to hospitalization, age, access to social security, low socioeconomic level, CD4 cell count, viral load, and discharge diagnoses. Conclusions HAART for 180 days or more was associated

  3. Variation in prescribing of lipid-lowering medication in primary care is associated with incidence of cardiovascular disease and all-cause mortality in people with screen-detected diabetes: findings from the ADDITION-Denmark trial

    PubMed Central

    Simmons, R K; Carlsen, A H; Griffin, S J; Charles, M; Christiansen, J S; Borch-Johnsen, K; Sandbæk, A; Lauritzen, T

    2014-01-01

    Aims To examine variation between general practices in the prescription of lipid-lowering treatment to people with screen-detected Type 2 diabetes, and associations with practice and participant characteristics and risk of cardiovascular events and all-cause mortality. Methods Observational cohort analysis of data from 1533 people with screen-detected Type 2 diabetes aged 40–69 years from the ADDITION-Denmark study. One hundred and seventy-four general practices were cluster randomized to receive: (1) routine diabetes care according to national guidelines (623 individuals), or (2) intensive multifactorial target-driven management (910 individuals). Multivariable logistic regression was used to quantify the association between the proportion of individuals in each practice who redeemed prescriptions for lipid-lowering medication in the two years following diabetes diagnosis and a composite cardiovascular disease (CVD) outcome, adjusting for age, sex, prevalent chronic disease, baseline CVD risk factors, smoking and lipid-lowering medication, and follow-up time. Results The proportion of individuals treated with lipid-lowering medication varied widely between practices (0–100%). There were 118 CVD events over 9431 person-years of follow-up. For the whole trial cohort, the risk of CVD was significantly higher in practices in the lowest compared with the highest quartile for prescribing lipid-lowering medication [adjusted odds ratio (OR) 3.4, 95% confidence interval (CI) 1.6–7.3]. Similar trends were found for all-cause mortality. Conclusions More frequent prescription of lipid-lowering treatment was associated with a lower incidence of CVD and all-cause mortality. Improved understanding of factors underlying practice variation in prescribing may enable more frequent use of lipid-lowering treatment. The results highlight the benefits of intensive treatment of people with screen-detected diabetes (Clinical Trials Registry No; NCT 00237549). What's new Despite

  4. Impact of diabetes mellitus on risk of cardiovascular disease and all-cause mortality: Evidence on health outcomes and antidiabetic treatment in United States adults

    PubMed Central

    Liu, Longjian; Simon, Barbara; Shi, Jinggaofu; Mallhi, Arshpreet Kaur; Eisen, Howard J

    2016-01-01

    AIM To examine the epidemic of diabetes mellitus (DM) and its impact on mortality from all-cause and cardiovascular disease (CVD), and to test the effect of antidiabetic therapy on the mortality in United States adults. METHODS The analysis included a randomized population sample of 272149 subjects ages ≥ 18 years who participated in the National Health Interview Surveys (NHIS) in 2000-2009. Chronic conditions (hypertension, DM and CVD) were classified by participants’ self-reports of physician diagnosis. NHIS-Mortality Linked Files, and NHIS-Medical Expenditure Panel Survey Linkage Files on prescribed medicines for patients with DM were used to test the research questions. χ2, Poisson and Cox’s regression models were applied in data analysis. RESULTS Of all participants, 22305 (8.2%) had DM. The prevalence of DM significantly increased from 2000 to 2009 in all age groups (P < 0.001). Within an average 7.39 (SD = 3) years of follow-up, male DM patients had 1.56 times higher risk of death from all-cause (HR = 1.56, 95%CI: 1.49-1.64), 1.72 times higher from heart disease [1.72 (1.53-1.93)], 1.48 times higher from cerebrovascular disease [1.48 (1.18-1.85)], and 1.67 times higher from CVD [1.67 (1.51-1.86)] than subjects without DM, respectively. Similar results were observed in females. In males, 10% of DM patients did not use any antidiabetic medications, 38.1% used antidiabetic monotherapy, and 51.9% used ≥ 2 antidiabetic medications. These corresponding values were 10.3%, 40.4% and 49.4% in females. A significant protective effect of metformin monotherapy or combination therapy (except for insulin) on all-cause mortality and a protective but non-significant effect on CVD mortality were observed. CONCLUSION This is the first study using data from multiple linkage files to confirm a significant increased prevalence of DM in the last decade in the United States. Patients with DM have significantly higher risk of death from all-cause and CVD than those without

  5. Inter-Ethnic Differences in Quantified Coronary Artery Disease Severity and All-Cause Mortality among Dutch and Singaporean Percutaneous Coronary Intervention Patients

    PubMed Central

    Gijsberts, Crystel M.; Seneviratna, Aruni; Hoefer, Imo E.; Agostoni, Pierfrancesco; Rittersma, Saskia Z. H.; Pasterkamp, Gerard; Hartman, Mikael; Pinto de Carvalho, Leonardo; Richards, A. Mark; Asselbergs, Folkert W.; de Kleijn, Dominique P. V.; Chan, Mark Y.

    2015-01-01

    Background Coronary artery disease (CAD) is a global problem with increasing incidence in Asia. Prior studies reported inter-ethnic differences in the prevalence of CAD rather than the severity of CAD. The angiographic “synergy between percutaneous coronary intervention (PCI) with taxus and cardiac surgery” (SYNTAX) score quantifies CAD severity and predicts outcomes. We studied CAD severity and all-cause mortality in four globally populous ethnic groups: Caucasians, Chinese, Indians and Malays. Methods We quantified SYNTAX scores of 1,000 multi-ethnic patients undergoing PCI in two tertiary hospitals in the Netherlands (Caucasians) and Singapore (Chinese, Indians and Malays). Within each ethnicity we studied 150 patients with stable CAD and 100 with ST-elevated myocardial infarction (STEMI). We made inter-ethnic comparisons of SYNTAX scores and all-cause mortality. Results Despite having a younger age (mean age Indians: 56.8 and Malays: 57.7 vs. Caucasians: 63.7 years), multivariable adjusted SYNTAX scores were significantly higher in Indians and Malays than Caucasians with stable CAD: 13.4 [11.9-14.9] and 13.4 [12.0-14.8] vs. 9.4 [8.1-10.8], p<0.001. Among STEMI patients, SYNTAX scores were highest in Chinese and Malays: 17.7 [15.9-19.5] and 18.8 [17.1-20.6] vs. 15.5 [13.5-17.4] and 12.7 [10.9-14.6] in Indians and Caucasians, p<0.001. Over a median follow-up of 709 days, 67 deaths (stable CAD: 37, STEMI: 30) occurred. Among STEMI patients, the SYNTAX score independently predicted all-cause mortality: HR 2.5 [1.7-3.8], p<0.001 for every 10-point increase. All-cause mortality was higher in Indian and Malay STEMI patients than Caucasians, independent of SYNTAX score (adjusted HR 7.2 [1.5-34.7], p=0.01 and 5.8 [1.2-27.2], p=0.02). Conclusion Among stable CAD and STEMI patients requiring PCI, CAD is more severe in Indians and Malays than in Caucasians, despite having a younger age. Moreover, Indian and Malay STEMI patients had a greater adjusted risk of all-cause

  6. Drugs with anticholinergic effects and cognitive impairment, falls and all-cause mortality in older adults: A systematic review and meta-analysis

    PubMed Central

    Ruxton, Kimberley; Woodman, Richard J; Mangoni, Arduino A

    2015-01-01

    Aim The aim was to investigate associations between drugs with anticholinergic effects (DACEs) and cognitive impairment, falls and all-cause mortality in older adults. Methods A literature search using CINAHL, Cochrane Library, Embase and PubMed databases was conducted for randomized controlled trials, prospective and retrospective cohort and case-control studies examining the use of DACEs in subjects ≥65 years with outcomes on falls, cognitive impairment and all-cause mortality. Retrieved articles were published on or before June 2013. Anticholinergic exposure was investigated using drug class, DACE scoring systems (anticholinergic cognitive burden scale, ACB; anticholinergic drug scale, ADS; anticholinergic risk scale, ARS; anticholinergic component of the drug burden index, DBIAC) or assessment of individual DACEs. Meta-analyses were performed to pool the results from individual studies. Results Eighteen studies fulfilled the inclusion criteria (total 124 286 participants). Exposure to DACEs as a class was associated with increased odds of cognitive impairment (OR 1.45, 95% CI 1.16, 1.73). Olanzapine and trazodone were associated with increased odds and risk of falls (OR 2.16, 95% CI 1.05, 4.44; RR 1.79, 95% CI 1.60, 1.97, respectively), but amitriptyline, paroxetine and risperidone were not (RR 1.73, 95% CI 0.81, 2.65; RR 1.80, 95% CI 0.81, 2.79; RR 1.39, 95% CI 0.59, 3.26, respectively). A unit increase in the ACB scale was associated with a doubling in odds of all-cause mortality (OR 2.06, 95% CI 1.82, 2.33) but there were no associations with the DBIAC (OR 0.88, 95% CI 0.55, 1.42) or the ARS (OR 3.56, 95% CI 0.29, 43.27). Conclusions Certain individual DACEs or increased overall DACE exposure may increase the risks of cognitive impairment, falls and all-cause mortality in older adults. PMID:25735839

  7. Whole grain consumption and risk of cardiovascular disease, cancer, and all cause and cause specific mortality: systematic review and dose-response meta-analysis of prospective studies

    PubMed Central

    Keum, NaNa; Giovannucci, Edward; Fadnes, Lars T; Boffetta, Paolo; Greenwood, Darren C; Tonstad, Serena; Vatten, Lars J; Riboli, Elio; Norat, Teresa

    2016-01-01

    Objective To quantify the dose-response relation between consumption of whole grain and specific types of grains and the risk of cardiovascular disease, total cancer, and all cause and cause specific mortality. Data sources PubMed and Embase searched up to 3 April 2016. Study selection Prospective studies reporting adjusted relative risk estimates for the association between intake of whole grains or specific types of grains and cardiovascular disease, total cancer, all cause or cause specific mortality. Data synthesis Summary relative risks and 95% confidence intervals calculated with a random effects model. Results 45 studies (64 publications) were included. The summary relative risks per 90 g/day increase in whole grain intake (90 g is equivalent to three servings—for example, two slices of bread and one bowl of cereal or one and a half pieces of pita bread made from whole grains) was 0.81 (95% confidence interval 0.75 to 0.87; I2=9%, n=7 studies) for coronary heart disease, 0.88 (0.75 to 1.03; I2=56%, n=6) for stroke, and 0.78 (0.73 to 0.85; I2=40%, n=10) for cardiovascular disease, with similar results when studies were stratified by whether the outcome was incidence or mortality. The relative risks for morality were 0.85 (0.80 to 0.91; I2=37%, n=6) for total cancer, 0.83 (0.77 to 0.90; I2=83%, n=11) for all causes, 0.78 (0.70 to 0.87; I2=0%, n=4) for respiratory disease, 0.49 (0.23 to 1.05; I2=85%, n=4) for diabetes, 0.74 (0.56 to 0.96; I2=0%, n=3) for infectious diseases, 1.15 (0.66 to 2.02; I2=79%, n=2) for diseases of the nervous system disease, and 0.78 (0.75 to 0.82; I2=0%, n=5) for all non-cardiovascular, non-cancer causes. Reductions in risk were observed up to an intake of 210-225 g/day (seven to seven and a half servings per day) for most of the outcomes. Intakes of specific types of whole grains including whole grain bread, whole grain breakfast cereals, and added bran, as well as total bread and total breakfast cereals were also associated

  8. Higher Diet Quality Is Associated with Decreased Risk of All-Cause, Cardiovascular Disease, and Cancer Mortality among Older Adults12

    PubMed Central

    Reedy, Jill; Krebs-Smith, Susan M.; Miller, Paige E.; Liese, Angela D.; Kahle, Lisa L.; Park, Yikyung; Subar, Amy F.

    2014-01-01

    Increased attention in dietary research and guidance has been focused on dietary patterns, rather than on single nutrients or food groups, because dietary components are consumed in combination and correlated with one another. However, the collective body of research on the topic has been hampered by the lack of consistency in methods used. We examined the relationships between 4 indices—the Healthy Eating Index–2010 (HEI-2010), the Alternative Healthy Eating Index–2010 (AHEI-2010), the alternate Mediterranean Diet (aMED), and Dietary Approaches to Stop Hypertension (DASH)—and all-cause, cardiovascular disease (CVD), and cancer mortality in the NIH-AARP Diet and Health Study (n = 492,823). Data from a 124-item food-frequency questionnaire were used to calculate scores; adjusted HRs and 95% CIs were estimated. We documented 86,419 deaths, including 23,502 CVD- and 29,415 cancer-specific deaths, during 15 y of follow-up. Higher index scores were associated with a 12–28% decreased risk of all-cause, CVD, and cancer mortality. Specifically, comparing the highest with the lowest quintile scores, adjusted HRs for all-cause mortality for men were as follows: HEI-2010 HR: 0.78 (95% CI: 0.76, 0.80), AHEI-2010 HR: 0.76 (95% CI: 0.74, 0.78), aMED HR: 0.77 (95% CI: 0.75, 0.79), and DASH HR: 0.83 (95% CI: 0.80, 0.85); for women, these were HEI-2010 HR: 0.77 (95% CI: 0.74, 0.80), AHEI-2010 HR: 0.76 (95% CI: 0.74, 0.79), aMED HR: 0.76 (95% CI: 0.73, 0.79), and DASH HR: 0.78 (95% CI: 0.75, 0.81). Similarly, high adherence on each index was protective for CVD and cancer mortality examined separately. These findings indicate that multiple scores reflect core tenets of a healthy diet that may lower the risk of mortality outcomes, including federal guidance as operationalized in the HEI-2010, Harvard’s Healthy Eating Plate as captured in the AHEI-2010, a Mediterranean diet as adapted in an Americanized aMED, and the DASH Eating Plan as included in the DASH score. PMID

  9. Prognostic value of physicians' assessment of compliance regarding all-cause mortality in patients with type 2 diabetes: primary care follow-up study

    PubMed Central

    Rothenbacher, Dietrich; Rüter, Gernot; Brenner, Hermann

    2006-01-01

    Background Whether the primary care physician's assessment of patient compliance is a valuable prognostic marker to identify patients who are at increased risk of death, or merely reflects measurement of various treatment parameters such as HbA1C or other laboratory markers is unclear. The objective of this prospective cohort study was to investigate the prognostic value of the physicians' assessment of patient compliance and other factors with respect to all-cause mortality during a one year follow-up period. Methods A prospective cohort study was conducted among 1014 patients with type 2 diabetes aged 40 and over (mean age 69 years, SD 10.4, 45% male) who were under medical treatment in 11 participating practices of family physicians and internists working in primary care in a defined region in South Germany between April and June 2000. Baseline data were gathered from patients and physicians by standardized questionnaire. The physician's assessment of patient compliance was assessed by means of a 4-point Likert scale (very good, rather good, rather bad, very bad). In addition, we carried out a survey among physicians by means of a questionnaire to find out which aspects for the assessment of patient compliance were of importance to make this assessment. Active follow-up of patients was conducted after one year to determine mortality. Results During the one year follow-up 48 (4.7%) of the 1014 patients died. Among other factors such as patient type (patients presenting at office, nursing home or visited patients), gender, age and a history of macrovascular disease, the physician's assessment of patient compliance was an important predictor of all-cause mortality. Patients whose compliance was assessed by the physician as "very bad" (6%) were significantly more likely to die during follow-up (OR = 2.67, 95% CI 1.02–6.97) after multivariable adjustment compared to patients whose compliance was assessed as "rather good" (45%) or "very good" (18%). The HbA1C

  10. NASA Hazard Analysis Process

    NASA Technical Reports Server (NTRS)

    Deckert, George

    2010-01-01

    This viewgraph presentation reviews The NASA Hazard Analysis process. The contents include: 1) Significant Incidents and Close Calls in Human Spaceflight; 2) Subsystem Safety Engineering Through the Project Life Cycle; 3) The Risk Informed Design Process; 4) Types of NASA Hazard Analysis; 5) Preliminary Hazard Analysis (PHA); 6) Hazard Analysis Process; 7) Identify Hazardous Conditions; 8) Consider All Interfaces; 9) Work a Preliminary Hazard List; 10) NASA Generic Hazards List; and 11) Final Thoughts

  11. Neighbourhood Characteristics and Long-Term Air Pollution Levels Modify the Association between the Short-Term Nitrogen Dioxide Concentrations and All-Cause Mortality in Paris

    PubMed Central

    Deguen, Séverine; Petit, Claire; Delbarre, Angélique; Kihal, Wahida; Padilla, Cindy; Benmarhnia, Tarik; Lapostolle, Annabelle; Chauvin, Pierre; Zmirou-Navier, Denis

    2015-01-01

    Background While a great number of papers have been published on the short-term effects of air pollution on mortality, few have tried to assess whether this association varies according to the neighbourhood socioeconomic level and long-term ambient air concentrations measured at the place of residence. We explored the effect modification of 1) socioeconomic status, 2) long-term NO2 ambient air concentrations, and 3) both combined, on the association between short-term exposure to NO2 and all-cause mortality in Paris (France). Methods A time-stratified case-crossover analysis was performed to evaluate the effect of short-term NO2 variations on mortality, based on 79,107 deaths having occurred among subjects aged over 35 years, from 2004 to 2009, in the city of Paris. Simple and double interactions were statistically tested in order to analyse effect modification by neighbourhood characteristics on the association between mortality and short-term NO2 exposure. The data was estimated at the census block scale (n=866). Results The mean of the NO2 concentrations during the five days prior to deaths were associated with an increased risk of all-cause mortality: overall Excess Risk (ER) was 0.94% (95%CI=[0.08;1.80]. A higher risk was revealed for subjects living in the most deprived census blocks in comparison with higher socioeconomic level areas (ER=3.14% (95%CI=[1.41-4.90], p<0.001). Among these deprived census blocks, excess risk was even higher where long-term average NO2 concentrations were above 55.8 μg/m3 (the top tercile of distribution): ER=4.84% (95%CI=[1.56;8.24], p for interaction=0.02). Conclusion Our results show that people living in census blocks characterized by low socioeconomic status are more vulnerable to air pollution episodes. There is also an indication that people living in these disadvantaged census blocks might experience even higher risk following short-term air pollution episodes, when they are also chronically exposed to higher NO2 levels

  12. Nighttime sleep duration, 24-hour sleep duration and risk of all-cause mortality among adults: a meta-analysis of prospective cohort studies

    PubMed Central

    Shen, Xiaoli; Wu, Yili; Zhang, Dongfeng

    2016-01-01

    A dose-response meta-analysis was conducted to summarize evidence from prospective cohort studies about the association of nighttime sleep duration and 24-hour sleep duration with risk of all-cause mortality among adults. Pertinent studies were identified by a search of Embase and PubMed databases to March 2015. A two-stage random-effects dose–response meta-analysis was used to combine study-specific relative risks and 95% confidence intervals [RRs (95% CIs)]. Thirty-five articles were included. Compared with 7 hours/day, the RRs (95% CIs) of all-cause mortality were 1.07 (1.03–1.13), 1.04 (1.01–1.07), 1.01 (1.00–1.02), 1.07 (1.06–1.09), 1.21 (1.18–1.24), 1.37 (1.32–1.42) and 1.55 (1.47–1.63) for 4, 5, 6, 8, 9, 10 and 11 hours/day of nighttime sleep, respectively (146,830 death cases among 1,526,609 participants), and the risks were 1.09 (1.04–1.14), 1.05 (1.02–1.09), 1.02 (1.00–1.03), 1.08 (1.05–1.10), 1.27 (1.20–1.36), 1.53 (1.38–1.70) and 1.84 (1.59–2.13) for 4, 5, 6, 8, 9, 10 and 11 hours/day of 24-hour sleep, respectively (101,641 death cases among 903,727 participants). The above relationships were also found in subjects without cardiovascular diseases and cancer at baseline, and other covariates did not influence the relationships substantially. The results suggested that 7 hours/day of sleep duration should be recommended to prevent premature death among adults. PMID:26900147

  13. Role of body mass index in the prediction of all cause mortality in over 62,000 men and women. The Italian RIFLE Pooling Project. Risk Factor and Life Expectancy

    PubMed Central

    Seccareccia, F.; Lanti, M.; Menotti, A.; Scanga, M.

    1998-01-01

    STUDY OBJECTIVE: To evaluate the relation of body mass index (BMI) to short-term mortality in a large Italian population sample. DESIGN: Within the Italian RIFLE pooling project, BMI was measured in 47 population samples made of 32,741 men and 30,305 women ages 20-69 years (young 20-44, mature 45-69). Data on mortality were collected for the next six years. MAIN OUTCOME MEASURES: Age adjusted death rates in quintile classes of BMI and Cox proportional hazards models with six year all causes mortality as end point, BMI as covariate and age, smoking, systolic blood pressure as possible confounders were computed. Multivariate analysis was tested in all subjects and after the exclusion of smokers, early (first two years) deaths, and both categories. RESULTS: The univariate analysis failed to demonstrate in all cases a U or inverse J shaped relation. The Cox coefficients for the linear and quadratic terms of BMI proved significant for both young and mature women. The minimum of the curve was located at 27.0 (24.0, 30.0, 95% confidence limits, CL) and 31.8 (25.5, 38.2, 95% CL) units of BMI, for young and mature women respectively. Similar findings were obtained even when exclusion were performed. No relation was found for young men while for mature adult men only the model for all subjects retained significant curvilinear relation (minimum 29.3; 22.4, 36.2, 95% CL). CONCLUSION: These uncommon high values of BMI carrying the minimum risk of death seems to be in contrast with weight guidelines. A confirmation of these findings in other population groups might induce the consideration of changes in the suggested healthy values of BMI.   PMID:9604037

  14. Straight Metalworking Fluids and All-Cause and Cardiovascular Mortality Analyzed by Using G-Estimation of an Accelerated Failure Time Model With Quantitative Exposure: Methods and Interpretations.

    PubMed

    Picciotto, Sally; Ljungman, Petter L; Eisen, Ellen A

    2016-04-01

    Straight metalworking fluids have been linked to cardiovascular mortality in analyses using binary exposure metrics, accounting for healthy worker survivor bias by using g-estimation of accelerated failure time models. A cohort of 38,666 Michigan autoworkers was followed (1941-1994) for mortality from all causes and ischemic heart disease. The structural model chosen here, using continuous exposure, assumes that increasing exposure from 0 to 1 mg/m(3) in any single year would decrease survival time by a fixed amount. Under that assumption, banning the fluids would have saved an estimated total of 8,468 (slope-based 95% confidence interval: 2,262, 28,563) person-years of life in this cohort. On average, 3.04 (slope-based 95% confidence interval: 0.02, 25.98) years of life could have been saved for each exposed worker who died from ischemic heart disease. Estimates were sensitive to both model specification for predicting exposure (multinomial or logistic regression) and characterization of exposure as binary or continuous in the structural model. Our results provide evidence supporting the hypothesis of a detrimental relationship between straight metalworking fluids and mortality, particularly from ischemic heart disease, as well as an instructive example of the challenges in obtaining and interpreting results from accelerated failure time models using a continuous exposure in the presence of competing risks. PMID:26968943

  15. Change in incidence of clinic visits for all-cause and rotavirus gastroenteritis in young children following the introduction of universal rotavirus vaccination in Israel.

    PubMed

    Muhsen, Khitam; Chodick, Gabriel; Goren, Sophy; Anis, Emilia; Ziv-Baran, Tomer; Shalev, Varda; Cohen, Dani

    2015-01-01

    Both rotavirus vaccines RotaTeq and Rotarix were efficacious against severe rotavirus gastroenteritis in clinical trials; yet real-world data on the effect of rotavirus vaccines on mild to moderate disease are limited. We used a large computerised database of Maccabi Health Services Health Maintenance Organisation (HMO), the second largest HMO in Israel covering 25% of the Israeli population, to compare the incidence of acute gastroenteritis (AGE) clinic visits in community settings (n=302,445) before (2005-10) and after (2011-13) the introduction of universal rotavirus immunisation in Israel. We retrieved laboratory results of rotavirus antigen tests (n=18,133) and using a weighted analysis, we estimated the impact of rotavirus immunisation on the disease burden of rotavirus AGE clinic visits. Following the introduction of universal rotavirus immunisation, the typical winter peaks of rotavirus AGE were substantially lower and significant reductions of 14.8% (95% confidence interval (CI): 13.5-16.1) in all-cause AGE clinic visits and of 59.7% (95% CI: 59.8-62.6) in rotavirus AGE clinic visits were observed. The decrease was observed in all age groups, but it was greater in children aged 0 to 23 months than those aged 24 to 59 months. Continued rotavirus laboratory surveillance is warranted to monitor the sustainability of these changes.

  16. Change in incidence of clinic visits for all-cause and rotavirus gastroenteritis in young children following the introduction of universal rotavirus vaccination in Israel.

    PubMed

    Muhsen, Khitam; Chodick, Gabriel; Goren, Sophy; Anis, Emilia; Ziv-Baran, Tomer; Shalev, Varda; Cohen, Dani

    2015-01-01

    Both rotavirus vaccines RotaTeq and Rotarix were efficacious against severe rotavirus gastroenteritis in clinical trials; yet real-world data on the effect of rotavirus vaccines on mild to moderate disease are limited. We used a large computerised database of Maccabi Health Services Health Maintenance Organisation (HMO), the second largest HMO in Israel covering 25% of the Israeli population, to compare the incidence of acute gastroenteritis (AGE) clinic visits in community settings (n=302,445) before (2005-10) and after (2011-13) the introduction of universal rotavirus immunisation in Israel. We retrieved laboratory results of rotavirus antigen tests (n=18,133) and using a weighted analysis, we estimated the impact of rotavirus immunisation on the disease burden of rotavirus AGE clinic visits. Following the introduction of universal rotavirus immunisation, the typical winter peaks of rotavirus AGE were substantially lower and significant reductions of 14.8% (95% confidence interval (CI): 13.5-16.1) in all-cause AGE clinic visits and of 59.7% (95% CI: 59.8-62.6) in rotavirus AGE clinic visits were observed. The decrease was observed in all age groups, but it was greater in children aged 0 to 23 months than those aged 24 to 59 months. Continued rotavirus laboratory surveillance is warranted to monitor the sustainability of these changes. PMID:26538450

  17. Hazards of conveyor belt fires

    SciTech Connect

    Perzak, F.J.; Litton, C.D.; Mura, K.E.; Lazzara, C.P.

    1995-12-31

    This report describes a US Bureau of Mines study on the hazards of large-scale conveyor belt fires in underground coal mines, as a function of both air velocity and distance from belt surface to gallery roof. The fire hazards considered were smoke obscuration, toxic effects of carbon monoxide (CO), and elevated air temperatures downstream of the fire. All of these hazards scale with the ratio of fire intensity to ventilation airflow. These hazards were all found to be greater at the lower belt-to-roof distance, owing to the greater fire intensities that resulted. The hazards of smoke obscuration and elevated CO levels were greater at lower air velocities. Smoke obscuration was found to be the earliest hazard, reaching critical levels before the stages of flame spread. Fire growth rates during rapid flame spread were much greater than rates measured during the early stages of flame spread. Fire growth rates during rapid flame spread were much greater than rates measured during the early stages of belt burning. Data were analyzed to determine the early-warning capability of fire sensors. Smoke sensors provided the earliest warning, followed closely by CO sensors. Thermal sensors did not exhibit any early warning capability.

  18. Early Fungicidal Activity as a Candidate Surrogate Endpoint for All-Cause Mortality in Cryptococcal Meningitis: A Systematic Review of the Evidence

    PubMed Central

    Montezuma-Rusca, Jairo M.; Powers, John H.; Follmann, Dean; Wang, Jing; Sullivan, Brigit; Williamson, Peter R.

    2016-01-01

    Background Cryptococcal meningitis (CM) is a leading cause of HIV-associated mortality. In clinical trials evaluating treatments for CM, biomarkers of early fungicidal activity (EFA) in cerebrospinal fluid (CSF) have been proposed as candidate surrogate endpoints for all- cause mortality (ACM). However, there has been no systematic evaluation of the group-level or trial-level evidence for EFA as a candidate surrogate endpoint for ACM. Methods We conducted a systematic review of randomized trials in treatment of CM to evaluate available evidence for EFA measured as culture negativity at 2 weeks/10 weeks and slope of EFA as candidate surrogate endpoints for ACM. We performed sensitivity analysis on superiority trials and high quality trials as determined by Cochrane measures of trial bias. Results Twenty-seven trials including 2854 patients met inclusion criteria. Mean ACM was 15.8% at 2 weeks and 27.0% at 10 weeks with no overall significant difference between test and control groups. There was a statistically significant group-level correlation between average EFA and ACM at 10 weeks but not at 2 weeks. There was also no statistically significant group-level correlation between CFU culture negativity at 2weeks/10weeks or average EFA slope at 10 weeks. A statistically significant trial-level correlation was identified between EFA slope and ACM at 2 weeks, but is likely misleading, as there was no treatment effect on ACM. Conclusions Mortality remains high in short time periods in CM clinical trials. Using published data and Institute of Medicine criteria, evidence for use of EFA as a surrogate endpoint for ACM is insufficient and could provide misleading results from clinical trials. ACM should be used as a primary endpoint evaluating treatments for cryptococcal meningitis. PMID:27490100

  19. Socioeconomic inequalities in all-cause mortality in the Czech Republic, Russia, Poland and Lithuania in the 2000s: findings from the HAPIEE Study

    PubMed Central

    Vandenheede, Hadewijch; Vikhireva, Olga; Pikhart, Hynek; Kubinova, Ruzena; Malyutina, Sofia; Pajak, Andrzej; Tamosiunas, Abdonas; Peasey, Anne; Simonova, Galina; Topor-Madry, Roman; Marmot, Michael; Bobak, Martin

    2014-01-01

    Background Relatively large socioeconomic inequalities in health and mortality have been observed in Central and Eastern Europe (CEE) and the former Soviet Union (FSU). Yet comparative data are sparse and virtually all studies include only education. The aim of this study is to quantify and compare socioeconomic inequalities in all-cause mortality during the 2000s in urban population samples from four CEE/FSU countries, by three different measures of socioeconomic position (SEP) (education, difficulty buying food and household amenities), reflecting different aspects of SEP. Methods Data from the prospective population-based HAPIEE (Health, Alcohol, and Psychosocial factors in Eastern Europe) study were used. The baseline survey (2002–2005) included 16 812 men and 19 180 women aged 45–69 years in Novosibirsk (Russia), Krakow (Poland), Kaunas (Lithuania) and seven Czech towns. Deaths in the cohorts were identified through mortality registers. Data were analysed by direct standardisation and Cox regression, quantifying absolute and relative SEP differences. Results Mortality inequalities by the three SEP indicators were observed in all samples. The magnitude of inequalities varied according to gender, country and SEP measure. As expected, given the high mortality rates in Russian men, largest absolute inequalities were found among Russian men (educational slope index of inequality was 19.4 per 1000 person-years). Largest relative inequalities were observed in Czech men and Lithuanian subjects. Disadvantage by all three SEP measures remained strongly associated with increased mortality after adjusting for the other SEP indicators. Conclusions The results emphasise the importance of all SEP measures for understanding mortality inequalities in CEE/FSU. PMID:24227051

  20. Health Hazard Evaluations

    MedlinePlus

    ... Products Programs Contact NIOSH HHE Media Health Hazard Evaluations (HHEs) Language: English en Español Recommend on Facebook ... or employers can ask the NIOSH Health Hazard Evaluation (HHE) Program to help learn whether health hazards ...

  1. Personality Facets and All-Cause Mortality Among Medicare Patients Aged 66 to 102: A Follow-on Study of Weiss and Costa (2005)

    PubMed Central

    Costa, Paul T.; Weiss, Alexander; Duberstein, Paul R.; Friedman, Bruce; Siegler, Ilene C.

    2014-01-01

    Objectives To investigate associations between the personality factors and survival during 8 years follow-up. Methods Domains of personality and selected facet scores were assessed in 597 Medicare recipients (aged 66 to 102 years) who were followed up for approximately 8 years. Personality domains and factors were assessed using the Revised NEO Personality Inventory (NEO-PI-R). Using proportional hazards regression, the present study builds on a previous analysis of the NEO-PI-R domains and selected facet scores, which revealed that the Neuroticism facet Impulsiveness, Agreeableness facet Straightforwardness, and Conscientiousness facet Self-Discipline were related to longer life during 4 years of follow-up. In the present study, we extended the follow-up period by an additional 4 years, examining all 30 facets, and using accelerated failure time (AFT) modeling as an additional analytic approach. Unlike proportional hazards regression, AFT permits inferences about the median survival length conferred by predictors. Each facet was tested in a model that included health-related covariates and NEO-PI-R factor scores for dimensions that did not include that facet. Results Over the 8-year mortality surveillance period, Impulsiveness was not significant, but Straightforwardness and Self-Discipline remained significant predictors of longevity. When dichotomized, being high versus average or low on Self-Discipline was associated with an approximately 34% increase in median lifespan. Longer mortality surveillance also revealed that each standard deviation of Altruism, Compliance, Tender-Mindedness, and Openness to Fantasy was associated with an estimated 9–11% increase in median survival time. Conclusions After extending the follow-up period from 4 to 8 years, Self-Discipline remained a powerful predictor of survival. Facets associated with imagination, generosity, and higher quality interpersonal interactions become increasingly important when the follow-up period was

  2. All-cause and cause specific mortality in a cohort of 20 000 construction workers; results from a 10 year follow up

    PubMed Central

    Arndt, V; Rothenbacher, D; Daniel, U; Zschenderlein, B; Schuberth, S; Brenner, H

    2004-01-01

    Background: Construction workers are potentially exposed to many health hazards, including human carcinogens such as asbestos, silica, and other so-called "bystander" exposures from shared work places. The construction industry is also a high risk trade with respect to accidents. Methods: A total of 19 943 male employees from the German construction industry who underwent occupational health examinations between 1986 and 1992 were followed up until 1999/2000. Results: A total of 818 deaths occurred during the 10 year follow up (SMR 0.71; 95% CI 0.66 to 0.76). Among those were 299 deaths due to cancer (SMR 0.89; 95% CI 0.79 to 1.00) and 312 deaths due to cardiovascular diseases (SMR 0.59; 95% CI 0.51 to 0.68). Increased risk of mortality was found for non-transport accidents (SMR 1.61; 95% CI 1.15 to 2.27), especially due to falls (SMR 1.87; 95% CI 1.18 to 2.92) and being struck by falling objects (SMR 1.90; 95% CI 0.88 to 3.64). Excess mortality due to non-transport accidents was highest among labourers and young and middle-aged workers. Risk of getting killed by falling objects was especially high for foreign workers (SMR 4.28; 95% CI 1.17 to 11.01) and labourers (SMR 6.01; 95% CI 1.63 to 15.29). Conclusion: Fatal injuries due to falls and being struck by falling objects pose particular health hazards among construction workers. Further efforts are necessary to reduce the number of fatal accidents and should address young and middle-aged, semi-skilled and foreign workers, in particular. The lower than expected cancer mortality deserves careful interpretation and futher follow up of the cohort. PMID:15090662

  3. Occupational Hazards of Farming

    PubMed Central

    White, Gill; Cessna, Allan

    1989-01-01

    A number of occupational hazards exist for the farmer and farm worker. They include the hazards of farm machinery, biologic and chemical hazards, and social and environmental stresses. Recognizing of these hazards will help the family physician care for farmers and their families. PMID:21248929

  4. A dose-response meta-analysis of the impact of body mass index on stroke and all-cause mortality in stroke patients: a paradox within a paradox.

    PubMed

    Bagheri, M; Speakman, J R; Shabbidar, S; Kazemi, F; Djafarian, K

    2015-05-01

    The obesity paradox is often attributed to fat acting as a buffer to protect individuals in fragile metabolic states. If this was the case, one would predict that the reverse epidemiology would be apparent across all causes of mortality including that of the particular disease state. We performed a dose-response meta-analysis to assess the impact of body mass index (BMI) on all-cause and stroke-specific mortality among stroke patients. Data from relevant studies were identified by systematically searching PubMed, OVID and Scopus databases and were analysed using a random-effects dose-response model. Eight cohort studies on all-cause mortality (with 20,807 deaths of 95,651 stroke patients) and nine studies of mortality exclusively because of stroke (with 8,087 deaths of 28,6270 patients) were evaluated in the meta-analysis. Non-linear associations of BMI with all-cause mortality (P < 0.0001) and mortality by stroke (P = 0.05) were observed. Among overweight and obese stroke patients, the risk of all-cause mortality increased, while the risk of mortality by stroke declined, with an increase in BMI. Increasing BMI had opposite effects on all-cause mortality and stroke-specific mortality in stroke patients. Further investigations are needed to examine how mortality by stroke is influenced by a more accurate indicator of obesity than BMI.

  5. Hazard function theory for nonstationary natural hazards

    NASA Astrophysics Data System (ADS)

    Read, L.; Vogel, R. M.

    2015-12-01

    Studies from the natural hazards literature indicate that many natural processes, including wind speeds, landslides, wildfires, precipitation, streamflow and earthquakes, show evidence of nonstationary behavior such as trends in magnitudes through time. Traditional probabilistic analysis of natural hazards based on partial duration series (PDS) generally assumes stationarity in the magnitudes and arrivals of events, i.e. that the probability of exceedance is constant through time. Given evidence of trends and the consequent expected growth in devastating impacts from natural hazards across the world, new methods are needed to characterize their probabilistic behavior. The field of hazard function analysis (HFA) is ideally suited to this problem because its primary goal is to describe changes in the exceedance probability of an event over time. HFA is widely used in medicine, manufacturing, actuarial statistics, reliability engineering, economics, and elsewhere. HFA provides a rich theory to relate the natural hazard event series (x) with its failure time series (t), enabling computation of corresponding average return periods and reliabilities associated with nonstationary event series. This work investigates the suitability of HFA to characterize nonstationary natural hazards whose PDS magnitudes are assumed to follow the widely applied Poisson-GP model. We derive a 2-parameter Generalized Pareto hazard model and demonstrate how metrics such as reliability and average return period are impacted by nonstationarity and discuss the implications for planning and design. Our theoretical analysis linking hazard event series x, with corresponding failure time series t, should have application to a wide class of natural hazards.

  6. Household Hazards to Pets

    MedlinePlus

    ... health by becoming aware of the most common health hazards found in many pet-owning households. Hazards in the Kitchen Foods Many foods are perfectly safe for humans, but could be harmful or potentially deadly to ...

  7. Bringing the individual back to small-area variation studies: a multilevel analysis of all-cause mortality in Andalusia, Spain.

    PubMed

    Merlo, Juan; Viciana-Fernández, Francisco J; Ramiro-Fariñas, Diego

    2012-10-01

    We performed a multilevel analysis (including individuals, households, census tracts, municipalities and provinces) on a 10% sample (N=230,978) from the Longitudinal Database of the Andalusian Population (LDAP). We aimed to investigate place effects on 8-year individual mortality risk. Moreover, besides calculating association (yielding odds ratios, ORs) between area socio-economic circumstances and individual risk, we wanted to estimate variance and clustering using the variance partition coefficient (VPC). We explicitly proclaim the relevance of considering general contextual effects (i.e. the degree to which the context, as a whole, affects individual variance in mortality risk) under at least two circumstances. The first of these concerns the interpretation of specific contextual effects (i.e. the association between a particular area characteristic and individual risk) obtained from multilevel regression analyses. The second involves the interpretation of geographical variance obtained from classic ecological spatial analyses. The so-called "ecological fallacy" apart, the lack of individual-level information renders geographical variance unrelated to the total individual variation and, therefore, difficult to interpret. Finally, we stress the importance of considering the familial household in multilevel analyses. We observed an association between percentage of people with a low educational level in the census tract and individual mortality risk (OR, highest v. lowest quintile=1.14; 95% confidence interval, CI 1.08-1.20). However, only a minor proportion of the total individual variance in the probability of dying was at the municipality (M) and census tract (CT) levels (VPC(M)=0.2% and VPC(CT)=0.3%). Conversely, the household (H) level appeared much more relevant (VPC(H)=18.6%) than the administrative geographical areas. Without considering general contextual effects, both multilevel analyses of specific contextual effects and ecological studies of small

  8. Hazard function theory for nonstationary natural hazards

    NASA Astrophysics Data System (ADS)

    Read, L. K.; Vogel, R. M.

    2015-11-01

    Impact from natural hazards is a shared global problem that causes tremendous loss of life and property, economic cost, and damage to the environment. Increasingly, many natural processes show evidence of nonstationary behavior including wind speeds, landslides, wildfires, precipitation, streamflow, sea levels, and earthquakes. Traditional probabilistic analysis of natural hazards based on peaks over threshold (POT) generally assumes stationarity in the magnitudes and arrivals of events, i.e. that the probability of exceedance of some critical event is constant through time. Given increasing evidence of trends in natural hazards, new methods are needed to characterize their probabilistic behavior. The well-developed field of hazard function analysis (HFA) is ideally suited to this problem because its primary goal is to describe changes in the exceedance probability of an event over time. HFA is widely used in medicine, manufacturing, actuarial statistics, reliability engineering, economics, and elsewhere. HFA provides a rich theory to relate the natural hazard event series (X) with its failure time series (T), enabling computation of corresponding average return periods, risk and reliabilities associated with nonstationary event series. This work investigates the suitability of HFA to characterize nonstationary natural hazards whose POT magnitudes are assumed to follow the widely applied Generalized Pareto (GP) model. We derive the hazard function for this case and demonstrate how metrics such as reliability and average return period are impacted by nonstationarity and discuss the implications for planning and design. Our theoretical analysis linking hazard event series X, with corresponding failure time series T, should have application to a wide class of natural hazards with rich opportunities for future extensions.

  9. Hazard function theory for nonstationary natural hazards

    NASA Astrophysics Data System (ADS)

    Read, Laura K.; Vogel, Richard M.

    2016-04-01

    Impact from natural hazards is a shared global problem that causes tremendous loss of life and property, economic cost, and damage to the environment. Increasingly, many natural processes show evidence of nonstationary behavior including wind speeds, landslides, wildfires, precipitation, streamflow, sea levels, and earthquakes. Traditional probabilistic analysis of natural hazards based on peaks over threshold (POT) generally assumes stationarity in the magnitudes and arrivals of events, i.e., that the probability of exceedance of some critical event is constant through time. Given increasing evidence of trends in natural hazards, new methods are needed to characterize their probabilistic behavior. The well-developed field of hazard function analysis (HFA) is ideally suited to this problem because its primary goal is to describe changes in the exceedance probability of an event over time. HFA is widely used in medicine, manufacturing, actuarial statistics, reliability engineering, economics, and elsewhere. HFA provides a rich theory to relate the natural hazard event series (X) with its failure time series (T), enabling computation of corresponding average return periods, risk, and reliabilities associated with nonstationary event series. This work investigates the suitability of HFA to characterize nonstationary natural hazards whose POT magnitudes are assumed to follow the widely applied generalized Pareto model. We derive the hazard function for this case and demonstrate how metrics such as reliability and average return period are impacted by nonstationarity and discuss the implications for planning and design. Our theoretical analysis linking hazard random variable X with corresponding failure time series T should have application to a wide class of natural hazards with opportunities for future extensions.

  10. Hazard function theory for nonstationary natural hazards

    DOE PAGES

    Read, Laura K.; Vogel, Richard M.

    2016-04-11

    Impact from natural hazards is a shared global problem that causes tremendous loss of life and property, economic cost, and damage to the environment. Increasingly, many natural processes show evidence of nonstationary behavior including wind speeds, landslides, wildfires, precipitation, streamflow, sea levels, and earthquakes. Traditional probabilistic analysis of natural hazards based on peaks over threshold (POT) generally assumes stationarity in the magnitudes and arrivals of events, i.e., that the probability of exceedance of some critical event is constant through time. Given increasing evidence of trends in natural hazards, new methods are needed to characterize their probabilistic behavior. The well-developed field ofmore » hazard function analysis (HFA) is ideally suited to this problem because its primary goal is to describe changes in the exceedance probability of an event over time. HFA is widely used in medicine, manufacturing, actuarial statistics, reliability engineering, economics, and elsewhere. HFA provides a rich theory to relate the natural hazard event series (X) with its failure time series (T), enabling computation of corresponding average return periods, risk, and reliabilities associated with nonstationary event series. This work investigates the suitability of HFA to characterize nonstationary natural hazards whose POT magnitudes are assumed to follow the widely applied generalized Pareto model. We derive the hazard function for this case and demonstrate how metrics such as reliability and average return period are impacted by nonstationarity and discuss the implications for planning and design. As a result, our theoretical analysis linking hazard random variable X with corresponding failure time series T should have application to a wide class of natural hazards with opportunities for future extensions.« less

  11. Hazardous Waste Roundup

    ERIC Educational Resources Information Center

    Farenga, Stephen J.; Joyce, Beverly A.; Ness, Daniel

    2004-01-01

    According to the Environmental Protection Agency (EPA), Americans generate approximately 1.6 million tons of hazardous household waste every year. When most people think of hazardous waste, they generally think of materials used in construction, the defense industry, mining, manufacturing, and agriculture. Few people think of hazardous substances…

  12. Automated Hazard Analysis

    2003-06-26

    The Automated Hazard Analysis (AHA) application is a software tool used to conduct job hazard screening and analysis of tasks to be performed in Savannah River Site facilities. The AHA application provides a systematic approach to the assessment of safety and environmental hazards associated with specific tasks, and the identification of controls regulations, and other requirements needed to perform those tasks safely. AHA is to be integrated into existing Savannah River site work control andmore » job hazard analysis processes. Utilization of AHA will improve the consistency and completeness of hazard screening and analysis, and increase the effectiveness of the work planning process.« less

  13. Hazard Analysis Database Report

    SciTech Connect

    GRAMS, W.H.

    2000-12-28

    The Hazard Analysis Database was developed in conjunction with the hazard analysis activities conducted in accordance with DOE-STD-3009-94, Preparation Guide for U S . Department of Energy Nonreactor Nuclear Facility Safety Analysis Reports, for HNF-SD-WM-SAR-067, Tank Farms Final Safety Analysis Report (FSAR). The FSAR is part of the approved Authorization Basis (AB) for the River Protection Project (RPP). This document describes, identifies, and defines the contents and structure of the Tank Farms FSAR Hazard Analysis Database and documents the configuration control changes made to the database. The Hazard Analysis Database contains the collection of information generated during the initial hazard evaluations and the subsequent hazard and accident analysis activities. The Hazard Analysis Database supports the preparation of Chapters 3 ,4 , and 5 of the Tank Farms FSAR and the Unreviewed Safety Question (USQ) process and consists of two major, interrelated data sets: (1) Hazard Analysis Database: Data from the results of the hazard evaluations, and (2) Hazard Topography Database: Data from the system familiarization and hazard identification.

  14. Hazard Analysis Database Report

    SciTech Connect

    GAULT, G.W.

    1999-10-13

    The Hazard Analysis Database was developed in conjunction with the hazard analysis activities conducted in accordance with DOE-STD-3009-94, Preparation Guide for US Department of Energy Nonreactor Nuclear Facility Safety Analysis Reports, for the Tank Waste Remediation System (TWRS) Final Safety Analysis Report (FSAR). The FSAR is part of the approved TWRS Authorization Basis (AB). This document describes, identifies, and defines the contents and structure of the TWRS FSAR Hazard Analysis Database and documents the configuration control changes made to the database. The TWRS Hazard Analysis Database contains the collection of information generated during the initial hazard evaluations and the subsequent hazard and accident analysis activities. The database supports the preparation of Chapters 3,4, and 5 of the TWRS FSAR and the USQ process and consists of two major, interrelated data sets: (1) Hazard Evaluation Database--Data from the results of the hazard evaluations; and (2) Hazard Topography Database--Data from the system familiarization and hazard identification.

  15. Combined Usefulness of the Platelet-to-Lymphocyte Ratio and the Neutrophil-to-Lymphocyte Ratio in Predicting the Long-Term Adverse Events in Patients Who Have Undergone Percutaneous Coronary Intervention with a Drug-Eluting Stent

    PubMed Central

    Cho, Kyoung Im; Ann, Soe Hee; Singh, Gillian Balbir; Her, Ae-Young; Shin, Eun-Seok

    2015-01-01

    Objectives The aim of this study was to investigate the combined usefulness of platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR) in predicting the long-term adverse events in patients who have undergone percutaneous coronary intervention (PCI) with a drug-eluting stent (DES). Methods 798 patients with stable angina, unstable angina and non-ST elevated myocardial infarction (NSTEMI) who underwent elective successful PCI with DES were consecutively enrolled. The value of PLR and NLR in predicting adverse coronary artery disease (CAD) events and the correlations between these markers and adverse events (all-cause mortality, cardiac death, and nonfatal myocardial infarction) were analyzed. Results The follow-up period was 62.8 ± 28.8 months. When patients were classified into four groups according to the optimal cut-off values for the PLR and NLR on receiver operating characteristic analysis, patients with a high PLR (>128) and high NLR (>2.6) had the highest occurrence of adverse events among the groups. On Cox multivariate analysis, the NLR >2.6 [hazard ratio (HR) 2.352, 95% confidence interval (CI) 1.286 to 4.339, p = 0.006] and the PLR >128 (HR 2.372, 95% CI 1.305 to 3.191, p = 0.005) were independent predictors of long-term adverse events after adjusting for cardiovascular risk factors. Moreover, both a PLR >128 and a NLR >2.6 were the strongest predictors of adverse events (HR 2.686, 95% CI 1.452 to 4.970, p = 0.002). Conclusion High pre-intervention PLR and NLR, especially when combined, are independent predictors of long-term adverse clinical outcomes such as all-cause mortality, cardiac death, and myocardial infarction in patients with unstable angina and NSTEMI who have undergone successful PCI with DES. PMID:26207383

  16. Migration and Environmental Hazards

    PubMed Central

    Hunter, Lori M.

    2011-01-01

    Losses due to natural hazards (e.g., earthquakes, hurricanes) and technological hazards (e.g., nuclear waste facilities, chemical spills) are both on the rise. One response to hazard-related losses is migration, with this paper offering a review of research examining the association between migration and environmental hazards. Using examples from both developed and developing regional contexts, the overview demonstrates that the association between migration and environmental hazards varies by setting, hazard types, and household characteristics. In many cases, however, results demonstrate that environmental factors play a role in shaping migration decisions, particularly among those most vulnerable. Research also suggests that risk perception acts as a mediating factor. Classic migration theory is reviewed to offer a foundation for examination of these associations. PMID:21886366

  17. Software safety hazard analysis

    SciTech Connect

    Lawrence, J.D.

    1996-02-01

    Techniques for analyzing the safety and reliability of analog-based electronic protection systems that serve to mitigate hazards in process control systems have been developed over many years, and are reasonably well understood. An example is the protection system in a nuclear power plant. The extension of these techniques to systems which include digital computers is not well developed, and there is little consensus among software engineering experts and safety experts on how to analyze such systems. One possible technique is to extend hazard analysis to include digital computer-based systems. Software is frequently overlooked during system hazard analyses, but this is unacceptable when the software is in control of a potentially hazardous operation. In such cases, hazard analysis should be extended to fully cover the software. A method for performing software hazard analysis is proposed in this paper.

  18. Hazard baseline documentation

    SciTech Connect

    Not Available

    1994-08-01

    This DOE limited technical standard establishes uniform Office of Environmental Management (EM) guidance on hazards baseline documents that identify and control radiological and nonradiological hazards for all EM facilities. It provides a road map to the safety and health hazard identification and control requirements contained in the Department`s orders and provides EM guidance on the applicability and integration of these requirements. This includes a definition of four classes of facilities (nuclear, non-nuclear, radiological, and other industrial); the thresholds for facility hazard classification; and applicable safety and health hazard identification, controls, and documentation. The standard applies to the classification, development, review, and approval of hazard identification and control documentation for EM facilities.

  19. Migration and Environmental Hazards.

    PubMed

    Hunter, Lori M

    2005-03-01

    Losses due to natural hazards (e.g., earthquakes, hurricanes) and technological hazards (e.g., nuclear waste facilities, chemical spills) are both on the rise. One response to hazard-related losses is migration, with this paper offering a review of research examining the association between migration and environmental hazards. Using examples from both developed and developing regional contexts, the overview demonstrates that the association between migration and environmental hazards varies by setting, hazard types, and household characteristics. In many cases, however, results demonstrate that environmental factors play a role in shaping migration decisions, particularly among those most vulnerable. Research also suggests that risk perception acts as a mediating factor. Classic migration theory is reviewed to offer a foundation for examination of these associations.

  20. Volcano Hazards Program

    USGS Publications Warehouse

    Venezky, Dina Y.; Myers, Bobbie; Driedger, Carolyn

    2008-01-01

    Diagram of common volcano hazards. The U.S. Geological Survey Volcano Hazards Program (VHP) monitors unrest and eruptions at U.S. volcanoes, assesses potential hazards, responds to volcanic crises, and conducts research on how volcanoes work. When conditions change at a monitored volcano, the VHP issues public advisories and warnings to alert emergency-management authorities and the public. See http://volcanoes.usgs.gov/ to learn more about volcanoes and find out what's happening now.

  1. Structural pluralism and all-cause mortality.

    PubMed Central

    Young, F W; Lyson, T A

    2001-01-01

    OBJECTIVES: This study tested the hypothesis that "structural pluralism" reduces age-standardized mortality rates. Structural pluralism is defined as the potential for political competition in communities. METHODS: US counties were the units of analysis. Multiple regression techniques were used to test the hypothesis. RESULTS: Structural pluralism is a stronger determinant of lower mortality than any of the other variables examined--specifically, income, education, and medical facilities. CONCLUSIONS: These findings support the case for a new structural variable, pluralism, as a possible cause of lower mortality, and they indirectly support the significance of comparable ecologic dimensions, such as social trust. PMID:11189808

  2. Hazardous waste tracking issues

    SciTech Connect

    Marvin, R. )

    1993-08-01

    The concept of cradle-to-grave oversight of hazardous waste was established in 1976 under RCRA. Since then, the multicopy Uniform Hazardous Waste Manifest has been a key component in the federal tracking system. The manifests ensure that generators, transporters and TSDFs maintain documentation of hazardous waste shipments. To a large extent, the tracking system has served its intended purpose; nevertheless, certain shortcomings exist. Anyone involved in shipping hazardous waste should be aware of the system's weaknesses and take appropriate measures to compensate for them.

  3. A Multidimensional Prognostic Index (MPI) based on a comprehensive geriatric assessment predicts short- and long-term all-cause mortality in older hospitalized patients with transient ischemic attack.

    PubMed

    Sancarlo, Daniele; Pilotto, Andrea; Panza, Francesco; Copetti, Massimiliano; Longo, Maria Grazia; D'Ambrosio, Piero; D'Onofrio, Grazia; Ferrucci, Luigi; Pilotto, Alberto

    2012-04-01

    A multidimensional impairment may influence the clinical outcome of acute diseases in older patients. The aim of the current study was to evaluate whether a Multidimensional Prognostic Index (MPI) based on a comprehensive geriatric assessment (CGA) predicts short- and long-term all-cause mortality in older patients hospitalized for transient ischemic attack (TIA). In this prospective study with 1-year follow-up, 654 patients aged 65 and older with a diagnosis of TIA according to the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM 435.x) were enrolled. A standardized CGA that included information on functional (activities of daily living, ADL, and Instrumental ADL), cognitive status (Short Portable Mental Status Questionnaire), nutrition (Mini Nutritional Assessment), risk of pressure sores (Exton-Smith Scale), comorbidities (Cumulative Illness Rating Scale), medications and co-habitation status was used to calculate the MPI for mortality using a previously validated algorithm. Higher MPI values were significantly associated with higher 1-month all-cause mortality (incidence rates: MPI-1 low risk = 0.32%, MPI-2 moderate risk = 5.36%, MPI-3 high risk = 10.42%; p < 0.001), 6-month all-cause mortality (MPI-1 = 1.95%, MPI-2 = 9.77%, MPI-3 = 27.22%; p < 0.001) and 12-month all-cause mortality (MPI-1 = 5.19%, MPI-2 = 16.47%, MPI-3 = 44.32%; p < 0.001). Age- and gender-adjusted Cox regression analyses demonstrated that MPI was a significant predictor of all-cause mortality. MPI showed a significant high discriminatory power with an area under the receiver operating characteristics (ROC) curve of 0.819, 95% CI = 0.749-0.888 for 1-month mortality, 0.799, 95% CI = 0.738-0.861 for 6-month mortality and 0.770, 95% CI = 0.716-0.824 for 12-month mortality. The MPI, calculated from information collected in a standardized CGA, appeared to be effective in estimating short- and long-term all-cause mortality in

  4. A Windshear Hazard Index

    NASA Technical Reports Server (NTRS)

    Proctor, Fred H.; Hinton, David A.; Bowles, Roland L.

    2000-01-01

    An aircraft exposed to hazardous low-level windshear may suffer a critical loss of airspeed and altitude, thus endangering its ability to remain airborne. In order to characterize this hazard, a nondimensional index was developed based oil aerodynamic principals and understanding of windshear phenomena, 'This paper reviews the development and application of the Bowles F-tactor. which is now used by onboard sensors for the detection of hazardous windshear. It was developed and tested during NASA/I:AA's airborne windshear program and is now required for FAA certification of onboard radar windshear detection systems. Reviewed in this paper are: 1) definition of windshear and description of atmospheric phenomena that may cause hazardous windshear. 2) derivation and discussion of the F-factor. 3) development of the F-factor hazard threshold, 4) its testing during field deployments, and 5) its use in accident reconstructions,

  5. Natural hazards science strategy

    USGS Publications Warehouse

    Holmes, Jr., Robert R.; Jones, Lucile M.; Eidenshink, Jeffery C.; Godt, Jonathan W.; Kirby, Stephen H.; Love, Jeffrey J.; Neal, Christina A.; Plant, Nathaniel G.; Plunkett, Michael L.; Weaver, Craig S.; Wein, Anne; Perry, Suzanne C.

    2012-01-01

    The mission of the U.S. Geological Survey (USGS) in natural hazards is to develop and apply hazard science to help protect the safety, security, and economic well-being of the Nation. The costs and consequences of natural hazards can be enormous, and each year more people and infrastructure are at risk. USGS scientific research - founded on detailed observations and improved understanding of the responsible physical processes - can help to understand and reduce natural hazard risks and to make and effectively communicate reliable statements about hazard characteristics, such as frequency, magnitude, extent, onset, consequences, and where possible, the time of future events. To accomplish its broad hazard mission, the USGS maintains an expert workforce of scientists and technicians in the earth sciences, hydrology, biology, geography, social and behavioral sciences, and other fields, and engages cooperatively with numerous agencies, research institutions, and organizations in the public and private sectors, across the Nation and around the world. The scientific expertise required to accomplish the USGS mission in natural hazards includes a wide range of disciplines that this report refers to, in aggregate, as hazard science. In October 2010, the Natural Hazards Science Strategy Planning Team (H-SSPT) was charged with developing a long-term (10-year) Science Strategy for the USGS mission in natural hazards. This report fulfills that charge, with a document hereinafter referred to as the Strategy, to provide scientific observations, analyses, and research that are critical for the Nation to become more resilient to natural hazards. Science provides the information that decisionmakers need to determine whether risk management activities are worthwhile. Moreover, as the agency with the perspective of geologic time, the USGS is uniquely positioned to extend the collective experience of society to prepare for events outside current memory. The USGS has critical statutory

  6. Hazard potential ranking of hazardous waste landfill sites and risk of congenital anomalies

    PubMed Central

    Vrijheid, M; Dolk, H; Armstrong, B; Boschi, G; Busby, A; Jorgensen, T; Pointer, P

    2002-01-01

    Background: A 33% increase in the risk of congenital anomalies has been found among residents near hazardous waste landfill sites in a European collaborative study (EUROHAZCON). Aims: To develop and evaluate an expert panel scoring method of the hazard potential of EUROHAZCON landfill sites, and to investigate whether sites classified as posing a greater potential hazard are those with a greater risk of congenital anomaly among nearby residents relative to more distant residents. Methods: A total of 1270 cases of congenital anomaly and 2308 non-malformed control births were selected in 14 study areas around 20 landfill sites. An expert panel of four landfill specialists scored each site in three categories—overall, water, and air hazard—based on readily available, documented data on site characteristics. Tertiles of the average ranking scores defined low, medium, and high hazard sites. Calculation of odds ratios was based on distance of residence from the sites, comparing a 0–3 km "proximate" with a 3–7 km "distant" zone. Results: Agreement between experts measured by intraclass correlation coefficients was 0.50, 0.44, and 0.20 for overall, water, and air hazard before a consensus meeting and 0.60, 0.56, and 0.53 respectively after this meeting. There was no evidence for a trend of increasing odds ratios with increasing overall hazard or air hazard. For non-chromosomal anomalies, odds ratios by water hazard category showed an increasing trend of borderline statistical significance (p = 0.06) from 0.79 in the low hazard category, 1.43 in the medium, to 1.60 in the high water hazard category. Conclusions: There is little evidence for a relation between risk of congenital anomaly in proximate relative to distant zones and hazard potential of landfill sites as classified by the expert panel, but without external validation of the hazard potential scoring method interpretation is difficult. Potential misclassification of sites may have reduced our ability to

  7. Elimination of the hazards from hazardous wastes.

    PubMed Central

    Gloyna, E F; Taylor, R D

    1978-01-01

    The "hazard" associated with a waste essentially controls the overall engineering approach to finding suitable alternatives for solving potential disposal problems. It should be recognized that all factors affecting environmental equilibrium must be considered, including product sales, process design, financing, pre- and end-of-pipe treatment, residuals management, and ultimate bioaccumulation of residuals. To meet this challenge, a systems approach to waste treatment and residuals disposal provides a logical approach, but this management concept requires a thorough understanding of the important physical and chemical aspects of the problem, as well as many social implications of the resulting decisions. Thus waste management within a plant necessarily involves process control, pretreatment and end-of-pipe treatment. Further, it follows that residuals management from a disposal point-of-view must ultimately embrace what is called the "multi-barrier concept." In essence, hazard elimination occurs in varying degrees during each phase of a properly engineered system. PMID:738249

  8. Probabilistic Seismic Hazard Analysis

    SciTech Connect

    Not Available

    1988-01-01

    The purpose of Probabilistic Seismic Hazard Analysis (PSHA) is to evaluate the hazard of seismic ground motion at a site by considering all possible earthquakes in the area, estimating the associated shaking at the site, and calculating the probabilities of these occurrences. The Panel on Seismic Hazard Analysis is charged with assessment of the capabilities, limitations, and future trends of PSHA in the context of alternatives. The report identifies and discusses key issues of PSHA and is addressed to decision makers with a modest scientific and technical background and to the scientific and technical community. 37 refs., 19 figs.

  9. Hazardous substance liability insurance

    SciTech Connect

    Not Available

    1982-03-01

    The study was carried out to meet requirements of the Comprehensive Environmental Response, Compensation and Liability Act of 1980. It considers the adequacy and feasibility of private insurance to protect owners and operators of ships covered by the Act and for post-closure financial responsibility for hazardous waste disposal facilities. The report is in three parts: Pt. 1 is an introduction to the hazardous substance insurance problem; Pt. 2 considers the adequacy of private insurance for owners and operators of vessels and facilities; Pt. 3 focuses on the problem of a private insurance alternative to the Post-Closure Liability Fund for 'inactive' hazardous waste disposal facilities.

  10. Parametric Hazard Function Estimation.

    1999-09-13

    Version 00 Phaze performs statistical inference calculations on a hazard function (also called a failure rate or intensity function) based on reported failure times of components that are repaired and restored to service. Three parametric models are allowed: the exponential, linear, and Weibull hazard models. The inference includes estimation (maximum likelihood estimators and confidence regions) of the parameters and of the hazard function itself, testing of hypotheses such as increasing failure rate, and checking ofmore » the model assumptions.« less

  11. Space Debris Hazard Evaluation

    NASA Technical Reports Server (NTRS)

    Davison, Elmer H.; Winslow, Paul C., Jr.

    1961-01-01

    The hazard to space vehicles from natural space debris has been explored. A survey of the available information pertinent to this problem is presented. The hope is that this presentation gives a coherent picture of the knowledge to date in terms of the topic covered. The conclusion reached is that a definite hazard exists but that it can only be poorly assessed on the basis of present information. The need for direct measurement of this hazard is obvious, and some of the problems involved in making these direct measurements have been explored.

  12. B-type natriuretic peptide and high sensitive C-reactive protein predict 2-year all cause mortality in chest pain patients: a prospective observational study from Salta, Argentina

    PubMed Central

    2011-01-01

    Background Several mechanisms are involved in the pathophysiology of the Acute Coronary Syndrome (ACS). We have addressed whether B-type natriuretic peptide (BNP) and high-sensitive C-reactive protein (hsCRP) in admission samples may improve risk stratification in chest pain patients with suspected ACS. Methods We included 982 patients consecutively admitted with chest pain and suspected ACS at nine hospitals in Salta, Northern Argentina. Total and cardiac mortality were recorded during a 2-year follow up period. Patients were divided into quartiles according to BNP and hsCRP levels, respectively, and inter quartile differences in mortality were statistically evaluated applying univariate and multivariate analyses. Results 119 patients died, and the BNP and hsCRP levels were significantly higher among these patients than in survivors. In a multivariable Cox regression model for total death and cardiac death in all patients, the hazard ratio (HR) in the highest quartile (Q4) as compared to the lowest quartile (Q1) of BNP was 2.32 (95% confidence interval (CI), 1.24-4.35), p = 0.009 and 3.34 (95% CI, 1.26-8.85), p = 0.015, respectively. In the TnT positive patients (TnT > 0.01 ng/mL), the HR for total death and cardiac death in Q4 as compared to Q1 was 2.12 (95% CI, 1.07-4.18), p = 0.031 and 3.42 (95% CI, 1.13-10.32), p = 0.029, respectively. The HR for total death for hsCRP in Q4 as compared to Q1 was 1.97 (95% CI, 1.17-3.32), p = 0.011, but this biomarker did not predict cardiac death (p = 0.21). No prognostic impact of these two biomarkers was found in the TnT negative patients. Conclusion BNP and hsCRP may act as clinically useful biomarkers when obtained at admission in a population with suspected ACS. Trial Registration ClinicalTrials.gov Identifier: NCT01377402. PMID:21958326

  13. Intake of saturated and trans unsaturated fatty acids and risk of all cause mortality, cardiovascular disease, and type 2 diabetes: systematic review and meta-analysis of observational studies

    PubMed Central

    de Souza, Russell J; Mente, Andrew; Maroleanu, Adriana; Cozma, Adrian I; Kishibe, Teruko; Uleryk, Elizabeth; Budylowski, Patrick; Schünemann, Holger; Beyene, Joseph

    2015-01-01

    Objective To systematically review associations between intake of saturated fat and trans unsaturated fat and all cause mortality, cardiovascular disease (CVD) and associated mortality, coronary heart disease (CHD) and associated mortality, ischemic stroke, and type 2 diabetes. Design Systematic review and meta-analysis. Data sources Medline, Embase, Cochrane Central Registry of Controlled Trials, Evidence-Based Medicine Reviews, and CINAHL from inception to 1 May 2015, supplemented by bibliographies of retrieved articles and previous reviews. Eligibility criteria for selecting studies Observational studies reporting associations of saturated fat and/or trans unsaturated fat (total, industrially manufactured, or from ruminant animals) with all cause mortality, CHD/CVD mortality, total CHD, ischemic stroke, or type 2 diabetes. Data extraction and synthesis Two reviewers independently extracted data and assessed study risks of bias. Multivariable relative risks were pooled. Heterogeneity was assessed and quantified. Potential publication bias was assessed and subgroup analyses were undertaken. The GRADE approach was used to evaluate quality of evidence and certainty of conclusions. Results For saturated fat, three to 12 prospective cohort studies for each association were pooled (five to 17 comparisons with 90 501-339 090 participants). Saturated fat intake was not associated with all cause mortality (relative risk 0.99, 95% confidence interval 0.91 to 1.09), CVD mortality (0.97, 0.84 to 1.12), total CHD (1.06, 0.95 to 1.17), ischemic stroke (1.02, 0.90 to 1.15), or type 2 diabetes (0.95, 0.88 to 1.03). There was no convincing lack of association between saturated fat and CHD mortality (1.15, 0.97 to 1.36; P=0.10). For trans fats, one to six prospective cohort studies for each association were pooled (two to seven comparisons with 12 942-230 135 participants). Total trans fat intake was associated with all cause mortality (1.34, 1.16 to 1.56), CHD mortality

  14. Barrier Island Hazard Mapping.

    ERIC Educational Resources Information Center

    Pilkey, Orrin H.; Neal, William J.

    1980-01-01

    Describes efforts to evaluate and map the susceptibility of barrier islands to damage from storms, erosion, rising sea levels and other natural phenomena. Presented are criteria for assessing the safety and hazard potential of island developments. (WB)

  15. Automated Standard Hazard Tool

    NASA Technical Reports Server (NTRS)

    Stebler, Shane

    2014-01-01

    The current system used to generate standard hazard reports is considered cumbersome and iterative. This study defines a structure for this system's process in a clear, algorithmic way so that standard hazard reports and basic hazard analysis may be completed using a centralized, web-based computer application. To accomplish this task, a test server is used to host a prototype of the tool during development. The prototype is configured to easily integrate into NASA's current server systems with minimal alteration. Additionally, the tool is easily updated and provides NASA with a system that may grow to accommodate future requirements and possibly, different applications. Results of this project's success are outlined in positive, subjective reviews complete by payload providers and NASA Safety and Mission Assurance personnel. Ideally, this prototype will increase interest in the concept of standard hazard automation and lead to the full-scale production of a user-ready application.

  16. California's potential volcanic hazards

    SciTech Connect

    Jorgenson, P. )

    1989-01-01

    Although volcanic eruptions have occurred infrequently in California during the last few thousand years, the potential danger to life and property from volcanoes in the state is great enough to be of concern, according to a recent U.S. Geological Survey (USGS) publication. The 17-page bulletin, Potential Hazards from Future Volcanic Eruptions in California, gives a brief history of volcanic activity in California during the past 100,000 years, descriptions of the types of volcanoes in the state, the types of potentially hazardous volcanic events that could occur, and hazard-zonation maps and tables depicting six areas of the state where volcanic eruptions might occur. The six areas and brief descriptions of their past volcanic history and potential for future volcanic hazards are briefly summarized here.

  17. Hazardous material control

    SciTech Connect

    Not Available

    1990-01-01

    This book covers the following topics. Waste exchange and recycling, the New York State experience. Department of defense hazardous waste minimazation, Recovery of heavy metals from electric arc furnace steelmaking dusts, Small generator cooperative effects economical recycling.

  18. Health Care Wide Hazards

    MedlinePlus

    ... Employee Downloads Additional Information Latex Allergy Legionnaires' Disease Mercury Needlesticks Noise Other Hazards (Lack of) PPE Slips/ ... Staphylococcus aureus Latex Allergy Legionnaires' Disease Needlesticks Noise Mercury Inappropriate PPE Slips/Trips/Falls Stress Tuberculosis Lack ...

  19. Developing hazardous waste programs

    NASA Astrophysics Data System (ADS)

    Showstack, Randy

    Developing a fully operational hazardous waste regulatory system requires at least 10 to 15 years—even in countries with strong legal and bureaucratic institutions, according to a report on "The Evolution of Hazardous Waste Programs," which was funded by Resources for the Future (RFF) and the World Bank's South Asia Environment Group, and issued on June 4.The report, which compares the experiences of how four developed and four developing countries have created hazardous waste programs, indicates that hazardous waste issues usually do not become a pressing environmental issue until after countries have dealt with more direct threats to public health, such as contaminated drinking water and air pollution. The countries examined include Indonesia, Thailand, Germany, and the United States.

  20. Probabilistic Tsunami Hazard Analysis

    NASA Astrophysics Data System (ADS)

    Thio, H. K.; Ichinose, G. A.; Somerville, P. G.; Polet, J.

    2006-12-01

    The recent tsunami disaster caused by the 2004 Sumatra-Andaman earthquake has focused our attention to the hazard posed by large earthquakes that occur under water, in particular subduction zone earthquakes, and the tsunamis that they generate. Even though these kinds of events are rare, the very large loss of life and material destruction caused by this earthquake warrant a significant effort towards the mitigation of the tsunami hazard. For ground motion hazard, Probabilistic Seismic Hazard Analysis (PSHA) has become a standard practice in the evaluation and mitigation of seismic hazard to populations in particular with respect to structures, infrastructure and lifelines. Its ability to condense the complexities and variability of seismic activity into a manageable set of parameters greatly facilitates the design of effective seismic resistant buildings but also the planning of infrastructure projects. Probabilistic Tsunami Hazard Analysis (PTHA) achieves the same goal for hazards posed by tsunami. There are great advantages of implementing such a method to evaluate the total risk (seismic and tsunami) to coastal communities. The method that we have developed is based on the traditional PSHA and therefore completely consistent with standard seismic practice. Because of the strong dependence of tsunami wave heights on bathymetry, we use a full waveform tsunami waveform computation in lieu of attenuation relations that are common in PSHA. By pre-computing and storing the tsunami waveforms at points along the coast generated for sets of subfaults that comprise larger earthquake faults, we can efficiently synthesize tsunami waveforms for any slip distribution on those faults by summing the individual subfault tsunami waveforms (weighted by their slip). This efficiency make it feasible to use Green's function summation in lieu of attenuation relations to provide very accurate estimates of tsunami height for probabilistic calculations, where one typically computes

  1. The Impact of Educational Status on 10-Year (2004-2014) Cardiovascular Disease Prognosis and All-cause Mortality Among Acute Coronary Syndrome Patients in the Greek Acute Coronary Syndrome (GREECS) Longitudinal Study

    PubMed Central

    Notara, Venetia; Kogias, Yannis; Stravopodis, Petros; Antonoulas, Antonis; Zombolos, Spyros; Mantas, Yannis; Pitsavos, Christos

    2016-01-01

    Objectives: The association between educational status and 10-year risk for acute coronary syndrome (ACS) and all-cause mortality was evaluated. Methods: From October 2003 to September 2004, 2172 consecutive ACS patients from six Greek hospitals were enrolled. In 2013 to 2014, a 10-year follow-up (2004-2014) assessment was performed for 1918 participants (participation rate, 88%). Each patient’s educational status was classified as low (<9 years of school), intermediate (9 to 14 years), or high (>14 years). Results: Overall all-cause mortality was almost twofold higher in the low-education group than in the intermediate-education and high-education groups (40% vs. 22% and 19%, respectively, p<0.001). Additionally, 10-year recurrent ACS events (fatal and non-fatal) were more common in the low-education group than in the intermediate-education and high-education groups (42% vs. 30% and 35%, p<0.001), and no interactions between sex and education on the investigated outcomes were observed. Moreover, patients in the high-education group were more physically active, had a better financial status, and were less likely to have hypertension, diabetes, or ACS than the participants with the least education (p<0.001); however, when those characteristics and lifestyle habits were accounted for, no moderating effects regarding the relationship of educational status with all-cause mortality and ACS events were observed. Conclusions: A U-shaped association may be proposed for the relationship between ACS prognosis and educational status, with participants in the low-education and high-education groups being negatively affected by other factors (e.g., job stress, depression, or loneliness). Public health policies should be aimed at specific social groups to reduce the overall burden of cardiovascular disease morbidity. PMID:27499164

  2. K Basin Hazard Analysis

    SciTech Connect

    PECH, S.H.

    2000-08-23

    This report describes the methodology used in conducting the K Basins Hazard Analysis, which provides the foundation for the K Basins Final Safety Analysis Report. This hazard analysis was performed in accordance with guidance provided by DOE-STD-3009-94, Preparation Guide for U. S. Department of Energy Nonreactor Nuclear Facility Safety Analysis Reports and implements the requirements of DOE Order 5480.23, Nuclear Safety Analysis Report.

  3. K Basins Hazard Analysis

    SciTech Connect

    WEBB, R.H.

    1999-12-29

    This report describes the methodology used in conducting the K Basins Hazard Analysis, which provides the foundation for the K Basins Safety Analysis Report (HNF-SD-WM-SAR-062, Rev.4). This hazard analysis was performed in accordance with guidance provided by DOE-STD-3009-94, Preparation Guide for U. S. Department of Energy Nonreactor Nuclear Facility Safety Analysis Reports and implements the requirements of DOE Order 5480.23, Nuclear Safety Analysis Report.

  4. Geomorphology and natural hazards

    NASA Astrophysics Data System (ADS)

    Gares, Paul A.; Sherman, Douglas J.; Nordstrom, Karl F.

    1994-08-01

    Natural hazards research was initiated in the 1960's by Gilbert White and his students who promulgated a research paradigm that involved assessing risk from a natural event, identifying adjustments to cope with the hazard, determining people's perception of the event, defining the process by which people choose adjustments, and estimating the effects of public policy on the choice process. Studies of the physical system played an important role in early research, but criticismsof the paradigm resulted in a shift to a prominence of social science. Geomorphologists are working to fill gaps in knowledge of the physical aspects of individual hazards, but use of the information by social scientists will only occur if information is presented in a format that is useful to them. One format involves identifying the hazard according to seven physical parameters established by White and his colleagues: magnitude, frequency, duration, areal extent, speed of onset, spatial dispersion, and temporal spacing. Geomorphic hazards are regarded as related to landscape changes that affect human systems. The processes that produce the changes are rarely geomorphic in nature, but are better regarded as atmospheric or hydrologic. An examination of geomorphic hazards in four fields — soil erosion, mass movement, coastal erosion and fluvial erosion — demonstrates that advances in those fields may be evaluated in terms of the seven parameters. Geomorphologists have contributed to hazard research by focusing on the dynamics of the landforms. The prediction of occurence, the determination of spatial and temporal characteristics, the impact of physical characteristics on people's perception, and the impact of physical characteristics on adjustment formulation. Opportunities for geomorphologists to improve our understanding of geomorphic hazards include research into the characteristics of the events particularly with respect to predicting the occurence, and increased evaluation of the

  5. Transportation of Hazardous Materials Emergency Preparedness Hazards Assessment

    SciTech Connect

    Blanchard, A.

    2000-02-28

    This report documents the Emergency Preparedness Hazards Assessment (EPHA) for the Transportation of Hazardous Materials (THM) at the Department of Energy (DOE) Savannah River Site (SRS). This hazards assessment is intended to identify and analyze those transportation hazards significant enough to warrant consideration in the SRS Emergency Management Program.

  6. Two models for evaluating landslide hazards

    USGS Publications Warehouse

    Davis, J.C.; Chung, C.-J.; Ohlmacher, G.C.

    2006-01-01

    Two alternative procedures for estimating landslide hazards were evaluated using data on topographic digital elevation models (DEMs) and bedrock lithologies in an area adjacent to the Missouri River in Atchison County, Kansas, USA. The two procedures are based on the likelihood ratio model but utilize different assumptions. The empirical likelihood ratio model is based on non-parametric empirical univariate frequency distribution functions under an assumption of conditional independence while the multivariate logistic discriminant model assumes that likelihood ratios can be expressed in terms of logistic functions. The relative hazards of occurrence of landslides were estimated by an empirical likelihood ratio model and by multivariate logistic discriminant analysis. Predictor variables consisted of grids containing topographic elevations, slope angles, and slope aspects calculated from a 30-m DEM. An integer grid of coded bedrock lithologies taken from digitized geologic maps was also used as a predictor variable. Both statistical models yield relative estimates in the form of the proportion of total map area predicted to already contain or to be the site of future landslides. The stabilities of estimates were checked by cross-validation of results from random subsamples, using each of the two procedures. Cell-by-cell comparisons of hazard maps made by the two models show that the two sets of estimates are virtually identical. This suggests that the empirical likelihood ratio and the logistic discriminant analysis models are robust with respect to the conditional independent assumption and the logistic function assumption, respectively, and that either model can be used successfully to evaluate landslide hazards. ?? 2006.

  7. Chemical process hazards analysis

    SciTech Connect

    1996-02-01

    The Office of Worker Health and Safety (EH-5) under the Assistant Secretary for the Environment, Safety and Health of the US Department (DOE) has published two handbooks for use by DOE contractors managing facilities and processes covered by the Occupational Safety and Health Administration (OSHA) Rule for Process Safety Management of Highly Hazardous Chemicals (29 CFR 1910.119), herein referred to as the PSM Rule. The PSM Rule contains an integrated set of chemical process safety management elements designed to prevent chemical releases that can lead to catastrophic fires, explosions, or toxic exposures. The purpose of the two handbooks, ``Process Safety Management for Highly Hazardous Chemicals`` and ``Chemical Process Hazards Analysis,`` is to facilitate implementation of the provisions of the PSM Rule within the DOE. The purpose of this handbook ``Chemical Process Hazards Analysis,`` is to facilitate, within the DOE, the performance of chemical process hazards analyses (PrHAs) as required under the PSM Rule. It provides basic information for the performance of PrHAs, and should not be considered a complete resource on PrHA methods. Likewise, to determine if a facility is covered by the PSM rule, the reader should refer to the handbook, ``Process Safety Management for Highly Hazardous Chemicals`` (DOE- HDBK-1101-96). Promulgation of the PSM Rule has heightened the awareness of chemical safety management issues within the DOE. This handbook is intended for use by DOE facilities and processes covered by the PSM rule to facilitate contractor implementation of the PrHA element of the PSM Rule. However, contractors whose facilities and processes not covered by the PSM Rule may also use this handbook as a basis for conducting process hazards analyses as part of their good management practices. This handbook explains the minimum requirements for PrHAs outlined in the PSM Rule. Nowhere have requirements been added beyond what is specifically required by the rule.

  8. The California Hazards Institute

    NASA Astrophysics Data System (ADS)

    Rundle, J. B.; Kellogg, L. H.; Turcotte, D. L.

    2006-12-01

    California's abundant resources are linked with its natural hazards. Earthquakes, landslides, wildfires, floods, tsunamis, volcanic eruptions, severe storms, fires, and droughts afflict the state regularly. These events have the potential to become great disasters, like the San Francisco earthquake and fire of 1906, that overwhelm the capacity of society to respond. At such times, the fabric of civic life is frayed, political leadership is tested, economic losses can dwarf available resources, and full recovery can take decades. A patchwork of Federal, state and local programs are in place to address individual hazards, but California lacks effective coordination to forecast, prevent, prepare for, mitigate, respond to, and recover from, the harmful effects of natural disasters. Moreover, we do not know enough about the frequency, size, time, or locations where they may strike, nor about how the natural environment and man-made structures would respond. As California's population grows and becomes more interdependent, even moderate events have the potential to trigger catastrophes. Natural hazards need not become natural disasters if they are addressed proactively and effectively, rather than reactively. The University of California, with 10 campuses distributed across the state, has world-class faculty and students engaged in research and education in all fields of direct relevance to hazards. For that reason, the UC can become a world leader in anticipating and managing natural hazards in order to prevent loss of life and property and degradation of environmental quality. The University of California, Office of the President, has therefore established a new system-wide Multicampus Research Project, the California Hazards Institute (CHI), as a mechanism to research innovative, effective solutions for California. The CHI will build on the rich intellectual capital and expertise of the Golden State to provide the best available science, knowledge and tools for

  9. IDENTIFICATION OF AIRCRAFT HAZARDS

    SciTech Connect

    K.L. Ashley

    2005-03-23

    Aircraft hazards were determined to be potentially applicable to a repository at Yucca Mountain in the ''Monitored Geological Repository External Events Hazards Screening Analysis'' (BSC 2004, Section 6.4.1). That determination was conservatively based on limited knowledge of flight data in the area of concern and on crash data for aircraft of the type flying near Yucca Mountain. The purpose of this report is to identify specific aircraft hazards that may be applicable to a Monitored Geologic Repository (MGR) at Yucca Mountain using NUREG-0800, ''Standard Review Plan for the Review of Safety Analysis Reports for Nuclear Power Plants'' (NRC 1987, Section 3.5.1.6), as guidance for the inclusion or exclusion of identified aircraft hazards. NUREG-0800 is being used here as a reference because some of the same considerations apply. The intended use of this report is to provide inputs for further screening and analysis of the identified aircraft hazards based on the criteria that apply to Category 1 and 2 event sequence analyses as defined in 10 CFR 63.2 (see Section 4). The scope of this technical report includes the evaluation of military, private, and commercial use of airspace in the 100-mile regional setting of the MGR at Yucca Mountain with the potential for reducing the regional setting to a more manageable size after consideration of applicable screening criteria (see Section 7).

  10. Identification of Aircraft Hazards

    SciTech Connect

    K. Ashley

    2006-12-08

    Aircraft hazards were determined to be potentially applicable to a repository at Yucca Mountain in ''Monitored Geological Repository External Events Hazards Screening Analysis'' (BSC 2005 [DIRS 174235], Section 6.4.1). That determination was conservatively based upon limited knowledge of flight data in the area of concern and upon crash data for aircraft of the type flying near Yucca Mountain. The purpose of this report is to identify specific aircraft hazards that may be applicable to a monitored geologic repository (MGR) at Yucca Mountain, using NUREG-0800, ''Standard Review Plan for the Review of Safety Analysis Reports for Nuclear Power Plants'' (NRC 1987 [DIRS 103124], Section 3.5.1.6), as guidance for the inclusion or exclusion of identified aircraft hazards. The intended use of this report is to provide inputs for further screening and analysis of identified aircraft hazards based upon the criteria that apply to Category 1 and Category 2 event sequence analyses as defined in 10 CFR 63.2 [DIRS 176544] (Section 4). The scope of this report includes the evaluation of military, private, and commercial use of airspace in the 100-mile regional setting of the repository at Yucca Mountain with the potential for reducing the regional setting to a more manageable size after consideration of applicable screening criteria (Section 7).

  11. Seismic hazard in the eastern United States

    USGS Publications Warehouse

    Mueller, Charles; Boyd, Oliver; Petersen, Mark D.; Moschetti, Morgan P.; Rezaeian, Sanaz; Shumway, Allison

    2015-01-01

    The U.S. Geological Survey seismic hazard maps for the central and eastern United States were updated in 2014. We analyze results and changes for the eastern part of the region. Ratio maps are presented, along with tables of ground motions and deaggregations for selected cities. The Charleston fault model was revised, and a new fault source for Charlevoix was added. Background seismicity sources utilized an updated catalog, revised completeness and recurrence models, and a new adaptive smoothing procedure. Maximum-magnitude models and ground motion models were also updated. Broad, regional hazard reductions of 5%–20% are mostly attributed to new ground motion models with stronger near-source attenuation. The revised Charleston fault geometry redistributes local hazard, and the new Charlevoix source increases hazard in northern New England. Strong increases in mid- to high-frequency hazard at some locations—for example, southern New Hampshire, central Virginia, and eastern Tennessee—are attributed to updated catalogs and/or smoothing.

  12. Hazardous materials dictionary

    SciTech Connect

    Coleman, R.J.

    1987-01-01

    Parallel growth of the chemical industry of emergency response capabilities in the public and private sectors has created a new need for improved communications. A new vocabulary of important terms is emerging in each of the industries that transport, store and handle hazardous materials. This dictionary, representing a compilation of words and phrases from many relevant sources, will help document and standardize the nomenclature of hazardous materials. The authors have screened the technical discourse of the chemical, transportation, petroleum and medical fields, both governmental and private, to determine the most current expressions and their uses. The lexicographic goal has been to identify key terms, ambiguous and multiple meaning words, acronyms, symbols and even slang referring to hazardous materials reactions, storing and handling procedures.

  13. Moral Hazard in Pediatrics.

    PubMed

    Brunnquell, Donald; Michaelson, Christopher M

    2016-07-01

    "Moral hazard" is a term familiar in economics and business ethics that illuminates why rational parties sometimes choose decisions with bad moral outcomes without necessarily intending to behave selfishly or immorally. The term is not generally used in medical ethics. Decision makers such as parents and physicians generally do not use the concept or the word in evaluating ethical dilemmas. They may not even be aware of the precise nature of the moral hazard problem they are experiencing, beyond a general concern for the patient's seemingly excessive burden. This article brings the language and logic of moral hazard to pediatrics. The concept reminds us that decision makers in this context are often not the primary party affected by their decisions. It appraises the full scope of risk at issue when decision makers decide on behalf of others and leads us to separate, respect, and prioritize the interests of affected parties. PMID:27292845

  14. Evaluation of 5 Prognostic Scores for Prediction of Stroke, Thromboembolic and Coronary Events, All-Cause Mortality, and Major Adverse Cardiac Events in Patients With Atrial Fibrillation and Coronary Stenting.

    PubMed

    Fauchier, Laurent; Lecoq, Coralie; Ancedy, Yann; Stamboul, Karim; Saint Etienne, Christophe; Ivanes, Fabrice; Angoulvant, Denis; Babuty, Dominique; Cottin, Yves; Lip, Gregory Y H

    2016-09-01

    Management of antithrombotic therapy in patients with atrial fibrillation (AF) and coronary stenting remains challenging, and there is a need for efficient tools to predict their risk of different types of cardiovascular events and death. Several scores exist such as the CHA2DS2-VASc score, the Global Registry of Acute Coronary Events (GRACE) score, the Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score, the Anatomical and Clinical Syntax II Score and the Reduction of Atherothrombosis for Continued Health score. These 5 scores were investigated in patients with AF with coronary stenting with the aim of determining which was most predictive for stroke/thromboembolic (TE) events, nonlethal coronary events, all-cause mortality, and major adverse cardiac events (MACE). Among 845 patients with AF with coronary stenting seen from 2000 to 2014, 440 (52%) were admitted for acute coronary syndrome and 405 (48%) for elective percutaneous coronary intervention. The rate of cardiovascular complication was at 14.1% per year, and nonlethal coronary events were the most frequent complications with a yearly rate of 6.5%. CHA2DS2-VASc score was the best predictor of stroke/TE events with a c-statistic of 0.604 (95% CI 0.567 to 0.639) and a best cut-off point of 5. SYNTAX score was better to predict nonlethal coronary events and MACE with c-statistics of 0.634 (95% CI 0.598 to 0.669) and 0.612 (95% CI 0.575 to 0.647), respectively, with a best cut-off point of 9. GRACE score appeared to be the best to predict all-cause mortality with a c-statistic of 0.682 (95% CI 0.646 to 0.717) and a best cut-off point of 153. In conclusions, among validated scores, none is currently robust enough to simultaneously predict stroke/TE events, nonlethal coronary events, death, and MACE in patients with AF with stents. The CHA2DS2-VASc score remained the best score to assess stroke/TE risk, as was the SYNTAX score for nonlethal coronary events and MACE

  15. Hazardous-Materials Robot

    NASA Technical Reports Server (NTRS)

    Stone, Henry W.; Edmonds, Gary O.

    1995-01-01

    Remotely controlled mobile robot used to locate, characterize, identify, and eventually mitigate incidents involving hazardous-materials spills/releases. Possesses number of innovative features, allowing it to perform mission-critical functions such as opening and unlocking doors and sensing for hazardous materials. Provides safe means for locating and identifying spills and eliminates risks of injury associated with use of manned entry teams. Current version of vehicle, called HAZBOT III, also features unique mechanical and electrical design enabling vehicle to operate safely within combustible atmosphere.

  16. Hazard Communication Standard

    SciTech Connect

    Sichak, S.

    1991-01-01

    The current rate of technological advances has brought with it an overwhelming increase in the usage of chemicals in the workplace and in the home. Coupled to this increase has been a heightened awareness in the potential for acute and chronic injuries attributable to chemical insults. The Hazard Communication Standard has been introduced with the desired goal of reducing workplace exposures to hazardous substances and thereby achieving a corresponding reduction in adverse health effects. It was created and proclaimed by the US Department of Labor and regulated by the Occupational Safety and Health Administration. 1 tab.

  17. Geothermal hazards - Mercury emission

    NASA Technical Reports Server (NTRS)

    Siegel, S. M.; Siegel, B. Z.

    1975-01-01

    Enthusiasm for intensified geothermal exploration may induce many participants to overlook a long-term potential toxicity hazard possibly associated with the tapping of magmatic steam. The association of high atmospheric Hg levels with geothermal activity has been established both in Hawaii and Iceland, and it has been shown that mercury can be introduced into the atmosphere from fumaroles, hot springs, and magmatic sources. These arguments, extended to thallium, selenium, and other hazardous elements, underscore the need for environmental monitoring in conjunction with the delivery of magmatic steam to the surface.

  18. Lightning hazards to aircraft

    NASA Technical Reports Server (NTRS)

    Corn, P. B.

    1978-01-01

    Lightning hazards and, more generally, aircraft static electricity are discussed by a representative for the Air Force Flight Dynamics Laboratory. An overview of these atmospheric electricity hazards to aircraft and their systems is presented with emphasis on electrical and electronic subsystems. The discussion includes reviewing some of the characteristics of lightning and static electrification, trends in weather and lightning-related mishaps, some specific threat mechanisms and susceptible aircraft subsystems and some of the present technology gaps. A roadmap (flow chart) is presented to show the direction needed to address these problems.

  19. Cables and fire hazards

    NASA Technical Reports Server (NTRS)

    Zanelli, C.; Philbrick, S.; Beretta, G.

    1986-01-01

    Besides describing the experiments conducted to develop a nonflammable cable, this article discusses several considerations regarding other hazards which might result from cable fires, particularly the toxicity and opacity of the fumes emitted by the burning cable. In addition, this article examines the effects of using the Oxygen Index as a gauge of quality control during manufacture.

  20. Earthquake hazard hunt

    USGS Publications Warehouse

    MacCabe, M. P.

    1980-01-01

    The Earthquake Hazard Hunt should begin at home, with all family members participating. Foresight, imagination, and commonsense are all that are needed as you go from room to room and imagine what would happen when the Earth and house started to shake. 

  1. Hazardous solvent substitution

    SciTech Connect

    Twitchell, K.E.

    1995-11-01

    Eliminating hazardous solvents is good for the environment, worker safety, and the bottom line. However, even though we are motivated to find replacements, the big question is `What can we use as replacements for hazardous solvents?`You, too, can find replacements for your hazardous solvents. All you have to do is search for them. Search through the vendor literature of hundreds of companies with thousands of products. Ponder the associated material safety data sheets, assuming of course that you can obtain them and, having obtained them, that you can read them. You will want to search the trade magazines and other sources for product reviews. You will want to talk to users about how well the product actually works. You may also want to check US Environmental Protection Agency (EPA) and other government reports for toxicity and other safety information. And, of course, you will want to compare the product`s constituent chemicals with the many hazardous constituency lists to ensure the safe and legal use of the product in your workplace.

  2. Hazardous Wastes from Homes.

    ERIC Educational Resources Information Center

    Lord, John

    The management of waste materials has become more complex with the increase in human population and the development of new substances. This illustrated booklet traces the history of waste management and provides guidelines for individuals and communities in disposing of certain hazardous wastes safely. It addresses such topics as: (1) how people…

  3. PERMITTING HAZARDOUS WASTE INCINERATORS

    EPA Science Inventory

    This publication is a compilation of information presented at a seminar series designed to address the issues that affect the issuance of hazardous waste incineration permits and to improve the overall understanding of trial burn testing. pecifically, the document provides guidan...

  4. Managing Academe's Hazardous Materials.

    ERIC Educational Resources Information Center

    Thompson, Fay

    1991-01-01

    Those responsible for planning and management of colleges and universities must plan comprehensively for hazardous waste disposal. Federal and state regulations are increasing, landfill area is becoming scarce, and incineration costs are rising fast. High-level institutional commitment to a sound campus environment policy is essential. (MSE)

  5. Hazards of Mercury.

    ERIC Educational Resources Information Center

    Environmental Research, 1971

    1971-01-01

    Common concern for the protection and improvement of the environment and the enhancement of human health and welfare underscore the purpose of this special report on the hazards of mercury directed to the Secretary's Pesticide Advisory Committee, Department of Health, Education, and Welfare. The report summarizes the findings of a ten-member study…

  6. The Impact Hazard

    NASA Technical Reports Server (NTRS)

    Morrison, David

    1994-01-01

    The Earth has been subject to hypervelocity impacts from comets and asteroids since its formation, and such impacts have played an important role in the evolution of life on our planet. We now recognize not only the historical role of impacts, but the contemporary hazard posed by such events. In the absence of a complete census of potentially threatening Earth-crossing asteroids or comets (called collectively Near Earth Objects, or NEOs), or even of a comprehensive cur-rent search program to identify NEOs, we can consider the hazard only from a probabilistic perspective. We know the steep power-law relationship between NEO numbers and size, with many more small bodies than large ones. We also know that few objects less than about 50 m in diameter (with kinetic energy near 10 megatons) penetrate the atmosphere and are capable of doing surface damage. But there is a spectrum of possible impact hazards associated with objects from this 10-megaton threshold all the way up to NEOs 5 km or larger in diameter, which are capable of inflicting severe damage on the environment, leading to mass extinction's of species. Detailed analysis has shown that, in general, the larger the object the greater the hazard, even when allowance is made for the infrequency of large impacts. Most of the danger to human life is associated with impacts by objects roughly 2 km or larger (energy greater than 1 million megatons), which can inject sufficient submicrometer dust into the atmosphere to produce a severe short-term global cooling with subsequent loss of crops, leading to starvation. Hazard estimates suggest that the chance of such an event occurring during a human lifetime is about 1:5000, and the global probability of death from such impacts is of the order of 1:20000, values that can be compared with risks associated with other natural hazards such as earthquakes, volcanic eruptions, and severe storms. However, the impact hazard differs from the others in that it can be largely

  7. Prognostic Utility of Neutrophil-to-Lymphocyte Ratio on Adverse Clinical Outcomes in Patients with Severe Calcific Aortic Stenosis

    PubMed Central

    Cho, Kyoung Im; Cho, Sang Hoon; Her, Ae-Young; Singh, Gillian Balbir; Shin, Eun-Seok

    2016-01-01

    Background Inflammation is an important factor in the pathogenesis of calcific aortic stenosis (AS). We aimed to evaluate the association between an inflammatory marker, neutrophil-to-lymphocyte ratio (NLR) and major adverse cardiovascular events (MACE) in patients with severe calcific AS. Methods A total of 336 patients with isolated severe calcific AS newly diagnosed between 2010 and 2015 were enrolled in this study. Using Cox proportional hazards (PH) regression models, we investigated the prognostic value of NLR adjusted for baseline covariates including logistic European System for Cardiac Operative Risk Evaluation score (EuroSCORE-I) and undergoing aortic valve replacement (AVR). We also evaluated the clinical relevance of NLR risk groups (divided into low, intermediate, high risk) as categorized by NLR cutoff values. MACE was defined as a composite of all-cause mortality, cardiac death and non-fatal myocardial infarction during the follow-up period. Results The inflammatory marker NLR was an independent prognostic factor most significantly associated with MACE [hazard ratio (HR), 1.06; 95% confidence interval (CI), 1.04–1.09; p-value <0.001]. The goodness-of-fit and discriminability of the model including EuroSCORE-I and AVR (loglikelihood difference, 15.49; p-value <0.001; c-index difference, 0.035; p-value = 0.03) were significantly improved when NLR was incorporated into the model. The estimated Kaplan-Meier survival rates at 5 years for the NLR risk groups were 84.6% for the low risk group (NLR ≤ 2), 67.7% for the intermediate risk group (2 < NLR ≤ 9), and 42.6% for the high risk group (NLR > 9), respectively. Conclusion The findings of the present study demonstrate the potential utility of NLR in risk stratification of patients with severe calcific AS. PMID:27548384

  8. Tank farms hazards assessment

    SciTech Connect

    Broz, R.E.

    1994-09-30

    Hanford contractors are writing new facility specific emergency procedures in response to new and revised US Department of Energy (DOE) Orders on emergency preparedness. Emergency procedures are required for each Hanford facility that has the potential to exceed the criteria for the lowest level emergency, an Alert. The set includes: (1) a facility specific procedure on Recognition and Classification of Emergencies, (2) area procedures on Initial Emergency Response and, (3) an area procedure on Protective Action Guidance. The first steps in developing these procedures are to identify the hazards at each facility, identify the conditions that could release the hazardous material, and calculate the consequences of the releases. These steps are called a Hazards Assessment. The final product is a document that is similar in some respects to a Safety Analysis Report (SAR). The document could br produced in a month for a simple facility but could take much longer for a complex facility. Hanford has both types of facilities. A strategy has been adopted to permit completion of the first version of the new emergency procedures before all the facility hazards Assessments are complete. The procedures will initially be based on input from a task group for each facility. This strategy will but improved emergency procedures in place sooner and therefore enhance Hanford emergency preparedness. The purpose of this document is to summarize the applicable information contained within the Waste Tank Facility ``Interim Safety Basis Document, WHC-SD-WM-ISB-001`` as a resource, since the SARs covering Waste Tank Operations are not current in all cases. This hazards assessment serves to collect, organize, document and present the information utilized during the determination process.

  9. The Golden Ratio

    ERIC Educational Resources Information Center

    Hyde, Hartley

    2004-01-01

    The Golden Ratio is sometimes called the "Golden Section" or the "Divine Proportion", in which three points: A, B, and C, divide a line in this proportion if AC/AB = AB/BC. "Donald in Mathmagicland" includes a section about the Golden Ratio and the ratios within a five-pointed star or pentagram. This article presents two computing exercises that…

  10. Counterfactual Volcano Hazard Analysis

    NASA Astrophysics Data System (ADS)

    Woo, Gordon

    2013-04-01

    The historical database of past disasters is a cornerstone of catastrophe risk assessment. Whereas disasters are fortunately comparatively rare, near-misses are quite common for both natural and man-made hazards. The word disaster originally means 'an unfavourable aspect of a star'. Except for astrologists, disasters are no longer perceived fatalistically as pre-determined. Nevertheless, to this day, historical disasters are treated statistically as fixed events, although in reality there is a large luck element involved in converting a near-miss crisis situation into a disaster statistic. It is possible to conceive a stochastic simulation of the past to explore the implications of this chance factor. Counterfactual history is the exercise of hypothesizing alternative paths of history from what actually happened. Exploring history from a counterfactual perspective is instructive for a variety of reasons. First, it is easy to be fooled by randomness and see regularity in event patterns which are illusory. The past is just one realization of a variety of possible evolutions of history, which may be analyzed through a stochastic simulation of an array of counterfactual scenarios. In any hazard context, there is a random component equivalent to dice being rolled to decide whether a near-miss becomes an actual disaster. The fact that there may be no observed disaster over a period of time may belie the occurrence of numerous near-misses. This may be illustrated using the simple dice paradigm. Suppose a dice is rolled every month for a year, and an event is recorded if a six is thrown. There is still an 11% chance of no events occurring during the year. A variety of perils may be used to illustrate the use of near-miss information within a counterfactual disaster analysis. In the domain of natural hazards, near-misses are a notable feature of the threat landscape. Storm surges are an obvious example. Sea defences may protect against most meteorological scenarios. However

  11. BMI and all cause mortality: systematic review and non-linear dose-response meta-analysis of 230 cohort studies with 3.74 million deaths among 30.3 million participants

    PubMed Central

    Sen, Abhijit; Prasad, Manya; Norat, Teresa; Janszky, Imre; Tonstad, Serena; Romundstad, Pål; Vatten, Lars J

    2016-01-01

    Objective To conduct a systematic review and meta-analysis of cohort studies of body mass index (BMI) and the risk of all cause mortality, and to clarify the shape and the nadir of the dose-response curve, and the influence on the results of confounding from smoking, weight loss associated with disease, and preclinical disease. Data sources PubMed and Embase databases searched up to 23 September 2015. Study selection Cohort studies that reported adjusted risk estimates for at least three categories of BMI in relation to all cause mortality. Data synthesis Summary relative risks were calculated with random effects models. Non-linear associations were explored with fractional polynomial models. Results 230 cohort studies (207 publications) were included. The analysis of never smokers included 53 cohort studies (44 risk estimates) with >738 144 deaths and >9 976 077 participants. The analysis of all participants included 228 cohort studies (198 risk estimates) with >3 744 722 deaths among 30 233 329 participants. The summary relative risk for a 5 unit increment in BMI was 1.18 (95% confidence interval 1.15 to 1.21; I2=95%, n=44) among never smokers, 1.21 (1.18 to 1.25; I2=93%, n=25) among healthy never smokers, 1.27 (1.21 to 1.33; I2=89%, n=11) among healthy never smokers with exclusion of early follow-up, and 1.05 (1.04 to 1.07; I2=97%, n=198) among all participants. There was a J shaped dose-response relation in never smokers (Pnon-linearity <0.001), and the lowest risk was observed at BMI 23-24 in never smokers, 22-23 in healthy never smokers, and 20-22 in studies of never smokers with ≥20 years’ follow-up. In contrast there was a U shaped association between BMI and mortality in analyses with a greater potential for bias including all participants, current, former, or ever smokers, and in studies with a short duration of follow-up (<5 years or <10 years), or with moderate study quality scores. Conclusion Overweight and obesity is associated

  12. Autonomous Landing Hazard Avoidance Technology

    NASA Video Gallery

    Future NASA space crafts will be able to safely land on the Moon, Marsand even an asteroid, in potentially hazardous terrain areas, allautonomously. And NASA’s Autonomous Landing Hazard Avoidan...

  13. Seismic hazard maps for Haiti

    USGS Publications Warehouse

    Frankel, Arthur; Harmsen, Stephen; Mueller, Charles; Calais, Eric; Haase, Jennifer

    2011-01-01

    We have produced probabilistic seismic hazard maps of Haiti for peak ground acceleration and response spectral accelerations that include the hazard from the major crustal faults, subduction zones, and background earthquakes. The hazard from the Enriquillo-Plantain Garden, Septentrional, and Matheux-Neiba fault zones was estimated using fault slip rates determined from GPS measurements. The hazard from the subduction zones along the northern and southeastern coasts of Hispaniola was calculated from slip rates derived from GPS data and the overall plate motion. Hazard maps were made for a firm-rock site condition and for a grid of shallow shear-wave velocities estimated from topographic slope. The maps show substantial hazard throughout Haiti, with the highest hazard in Haiti along the Enriquillo-Plantain Garden and Septentrional fault zones. The Matheux-Neiba Fault exhibits high hazard in the maps for 2% probability of exceedance in 50 years, although its slip rate is poorly constrained.

  14. Hazardous waste management

    SciTech Connect

    Miller, S.

    1981-12-01

    An international meeting held at the State Department in Washington, DC on hazardous waste management is discussed. The conference was held by the Committee on the Challenges to Modern Society of the North Atlantic Treaty Organization. Among the wastes considered at the meeting were chromium wastes, lead wastes, pesticides, mercury wastes, nickel wastes, oil refinery wastes, PCBs, cadmium wastes, and others. Radioactive wastes were not considered. Legislation, landfill use, recycling, and the Common Market's approach to these wastes were also discussed. (JMT)

  15. Publication: Evansville hazard maps

    USGS Publications Warehouse

    ,

    2012-01-01

    The Evansville (Indiana) Area Earthquake Hazards Mapping Project was completed in February 2012. It was a collaborative effort among the U.S. Geological Survey and regional partners Purdue University; the Center for Earthquake Research and Information at the University of Memphis; the state geologic surveys of Kentucky, Illinois, and Indiana; the Southwest Indiana Disaster Resistant Community Corporation; and the Central U.S. Earthquake Consortium state geologists.

  16. California's potential volcanic hazards

    USGS Publications Warehouse

    Jorgenson, P.

    1989-01-01

    This is a summary of "Potential Hazards from Future Volcanic Eruptions in California' (USGS Bulletin No. 1847: price $4.75). The chief areas of danger are Lassen Peak, Mount Shasta and Medicine Lake Highland in the north; Clear Lake, Mono Lake and Long Valley in the centre; and Owen's River-Death Valley, Amboy Crater and the Saltan Butter in the south of the State. -A.Scarth

  17. Hazardous factories: Nigerian evidence.

    PubMed

    Oloyede, Olajide

    2005-06-01

    The past 15 years have seen an increasing governmental and corporate concern for the environment worldwide. For governments, information about the environmental performance of the industrial sector is required to inform macro-level decisions about environmental targets such as those required to meet UN directives. However, in many African, Asian, and Latin American countries, researching and reporting company environmental performance is limited. This article serves as a contribution to filling the gap by presenting evidence of physical and chemical risk in Nigerian factories. One hundred and three factories with a total of 5,021 workers were studied. One hundred and twenty physical and chemical hazards were identified and the result shows a high number of workers exposed to such hazards. The study also reveals that workers' awareness level of chemical hazards was high. Yet the danger was perceived in behavioral terms, especially by manufacturing firms, which tend to see environmental investment in an increasingly global economy as detrimental to profitability. PMID:16022703

  18. PUREX facility hazards assessment

    SciTech Connect

    Sutton, L.N.

    1994-09-23

    This report documents the hazards assessment for the Plutonium Uranium Extraction Plant (PUREX) located on the US Department of Energy (DOE) Hanford Site. Operation of PUREX is the responsibility of Westinghouse Hanford Company (WHC). This hazards assessment was conducted to provide the emergency planning technical basis for PUREX. DOE Order 5500.3A requires an emergency planning hazards assessment for each facility that has the potential to reach or exceed the lowest level emergency classification. In October of 1990, WHC was directed to place PUREX in standby. In December of 1992 the DOE Assistant Secretary for Environmental Restoration and Waste Management authorized the termination of PUREX and directed DOE-RL to proceed with shutdown planning and terminal clean out activities. Prior to this action, its mission was to reprocess irradiated fuels for the recovery of uranium and plutonium. The present mission is to establish a passively safe and environmentally secure configuration at the PUREX facility and to preserve that condition for 10 years. The ten year time frame represents the typical duration expended to define, authorize and initiate follow-on decommissioning and decontamination activities.

  19. Identifying and modeling safety hazards

    SciTech Connect

    DANIELS,JESSE; BAHILL,TERRY; WERNER,PAUL W.

    2000-03-29

    The hazard model described in this paper is designed to accept data over the Internet from distributed databases. A hazard object template is used to ensure that all necessary descriptors are collected for each object. Three methods for combining the data are compared and contrasted. Three methods are used for handling the three types of interactions between the hazard objects.

  20. Hazard Maps in the Classroom.

    ERIC Educational Resources Information Center

    Cross, John A.

    1988-01-01

    Emphasizes the use of geophysical hazard maps and illustrates how they can be used in the classroom from kindergarten to college level. Depicts ways that hazard maps of floods, landslides, earthquakes, volcanoes, and multi-hazards can be integrated into classroom instruction. Tells how maps may be obtained. (SLM)

  1. Historical analysis of US pipeline accidents triggered by natural hazards

    NASA Astrophysics Data System (ADS)

    Girgin, Serkan; Krausmann, Elisabeth

    2015-04-01

    Natural hazards, such as earthquakes, floods, landslides, or lightning, can initiate accidents in oil and gas pipelines with potentially major consequences on the population or the environment due to toxic releases, fires and explosions. Accidents of this type are also referred to as Natech events. Many major accidents highlight the risk associated with natural-hazard impact on pipelines transporting dangerous substances. For instance, in the USA in 1994, flooding of the San Jacinto River caused the rupture of 8 and the undermining of 29 pipelines by the floodwaters. About 5.5 million litres of petroleum and related products were spilled into the river and ignited. As a results, 547 people were injured and significant environmental damage occurred. Post-incident analysis is a valuable tool for better understanding the causes, dynamics and impacts of pipeline Natech accidents in support of future accident prevention and mitigation. Therefore, data on onshore hazardous-liquid pipeline accidents collected by the US Pipeline and Hazardous Materials Safety Administration (PHMSA) was analysed. For this purpose, a database-driven incident data analysis system was developed to aid the rapid review and categorization of PHMSA incident reports. Using an automated data-mining process followed by a peer review of the incident records and supported by natural hazard databases and external information sources, the pipeline Natechs were identified. As a by-product of the data-collection process, the database now includes over 800,000 incidents from all causes in industrial and transportation activities, which are automatically classified in the same way as the PHMSA record. This presentation describes the data collection and reviewing steps conducted during the study, provides information on the developed database and data analysis tools, and reports the findings of a statistical analysis of the identified hazardous liquid pipeline incidents in terms of accident dynamics and

  2. Volcanic hazards to airports

    USGS Publications Warehouse

    Guffanti, M.; Mayberry, G.C.; Casadevall, T.J.; Wunderman, R.

    2009-01-01

    Volcanic activity has caused significant hazards to numerous airports worldwide, with local to far-ranging effects on travelers and commerce. Analysis of a new compilation of incidents of airports impacted by volcanic activity from 1944 through 2006 reveals that, at a minimum, 101 airports in 28 countries were affected on 171 occasions by eruptions at 46 volcanoes. Since 1980, five airports per year on average have been affected by volcanic activity, which indicates that volcanic hazards to airports are not rare on a worldwide basis. The main hazard to airports is ashfall, with accumulations of only a few millimeters sufficient to force temporary closures of some airports. A substantial portion of incidents has been caused by ash in airspace in the vicinity of airports, without accumulation of ash on the ground. On a few occasions, airports have been impacted by hazards other than ash (pyroclastic flow, lava flow, gas emission, and phreatic explosion). Several airports have been affected repeatedly by volcanic hazards. Four airports have been affected the most often and likely will continue to be among the most vulnerable owing to continued nearby volcanic activity: Fontanarossa International Airport in Catania, Italy; Ted Stevens Anchorage International Airport in Alaska, USA; Mariscal Sucre International Airport in Quito, Ecuador; and Tokua Airport in Kokopo, Papua New Guinea. The USA has the most airports affected by volcanic activity (17) on the most occasions (33) and hosts the second highest number of volcanoes that have caused the disruptions (5, after Indonesia with 7). One-fifth of the affected airports are within 30 km of the source volcanoes, approximately half are located within 150 km of the source volcanoes, and about three-quarters are within 300 km; nearly one-fifth are located more than 500 km away from the source volcanoes. The volcanoes that have caused the most impacts are Soufriere Hills on the island of Montserrat in the British West Indies

  3. [Relations of landslide and debris flow hazards to environmental factors].

    PubMed

    Zhang, Guo-ping; Xu, Jing; Bi, Bao-gui

    2009-03-01

    To clarify the relations of landslide and debris flow hazards to environmental factors is of significance to the prediction and evaluation of landslide and debris flow hazards. Base on the latitudinal and longitudinal information of 18431 landslide and debris flow hazards in China, and the 1 km x 1 km grid data of elevation, elevation difference, slope, slope aspect, vegetation type, and vegetation coverage, this paper analyzed the relations of landslide and debris flow hazards in this country to above-mentioned environmental factors by the analysis method of frequency ratio. The results showed that the landslide and debris flow hazards in China more occurred in lower elevation areas of the first and second transitional zones. When the elevation difference within a 1 km x 1 km grid cell was about 300 m and the slope was around 30 degree, there was the greatest possibility of the occurrence of landslide and debris hazards. Mountain forest land and slope cropland were the two land types the hazards most easily occurred. The occurrence frequency of the hazards was the highest when the vegetation coverage was about 80%-90%.

  4. Radiation Hazard Detector

    NASA Technical Reports Server (NTRS)

    1978-01-01

    NASA technology has made commercially available a new, inexpensive, conveniently-carried device for protection, of people exposed to potentially dangerous levels of microwave radiation. Microwaves are radio emissions of extremely high frequency. They can be hazardous but the degree of hazard is not yet well understood. Generally, it is believed that low intensity radiation of short duration is not harmful but that exposure to high levels can induce deep internal burns, affecting the circulatory and nervous systems, and particularly the eyes. The Department of Labor's Occupational Safety and Health Administration (OSHA) has established an allowable safe threshold of exposure. However, people working near high intensity sources of microwave energy-for example, radar antennas and television transmitters-may be unknowingly exposed to radiation levels beyond the safe limit. This poses not only a personal safety problem but also a problem for employers in terms of productivity loss, workman's compensation claims and possible liability litigation. Earlier-developed monitoring devices which warn personnel of dangerous radiation levels have their shortcomings. They can be cumbersome and awkward to use while working. They also require continual visual monitoring to determine if a person is in a dangerous area of radiation, and they are relatively expensive, another deterrent to their widespread adoption. In response to the need for a cheaper and more effective warning system, Jet Propulsion Laboratory developed, under NASA auspices, a new, battery-powered Microwave Radiation Hazard Detector. To bring the product to the commercial market, California Institute Research Foundation, the patent holder, granted an exclusive license to Cicoil Corporation, Chatsworth, California, an electronic components manufacturer.

  5. Compression Ratio Adjuster

    NASA Technical Reports Server (NTRS)

    Akkerman, J. W.

    1982-01-01

    New mechanism alters compression ratio of internal-combustion engine according to load so that engine operates at top fuel efficiency. Ordinary gasoline, diesel and gas engines with their fixed compression ratios are inefficient at partial load and at low-speed full load. Mechanism ensures engines operate as efficiently under these conditions as they do at highload and high speed.

  6. Offer/Acceptance Ratio.

    ERIC Educational Resources Information Center

    Collins, Mimi

    1997-01-01

    Explores how human resource professionals, with above average offer/acceptance ratios, streamline their recruitment efforts. Profiles company strategies with internships, internal promotion, cooperative education programs, and how to get candidates to accept offers. Also discusses how to use the offer/acceptance ratio as a measure of program…

  7. Detecting isotopic ratio outliers

    SciTech Connect

    Bayne, C.K.; Smith, D.H.

    1985-01-01

    An alternative method is proposed for improving isotopic ratio estimates. This method mathematically models pulse-count data and uses iterative reweighted Poisson regression to estimate model parameters to calculate the isotopic ratios. This computer-oriented approach provides theoretically better methods than conventional techniques to establish error limits and to identify outliers. 6 refs., 3 figs., 3 tabs.

  8. Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013

    PubMed Central

    2015-01-01

    Summary Background Up-to-date evidence on levels and trends for age-sex-specific all-cause and cause-specific mortality is essential for the formation of global, regional, and national health policies. In the Global Burden of Disease Study 2013 (GBD 2013) we estimated yearly deaths for 188 countries between 1990, and 2013. We used the results to assess whether there is epidemiological convergence across countries. Methods We estimated age-sex-specific all-cause mortality using the GBD 2010 methods with some refinements to improve accuracy applied to an updated database of vital registration, survey, and census data. We generally estimated cause of death as in the GBD 2010. Key improvements included the addition of more recent vital registration data for 72 countries, an updated verbal autopsy literature review, two new and detailed data systems for China, and more detail for Mexico, UK, Turkey, and Russia. We improved statistical models for garbage code redistribution. We used six different modelling strategies across the 240 causes; cause of death ensemble modelling (CODEm) was the dominant strategy for causes with sufficient information. Trends for Alzheimer’s disease and other dementias were informed by meta-regression of prevalence studies. For pathogen-specific causes of diarrhoea and lower respiratory infections we used a counterfactual approach. We computed two measures of convergence (inequality) across countries: the average relative difference across all pairs of countries (Gini coefficient) and the average absolute difference across countries. To summarise broad findings, we used multiple decrement life-tables to decompose probabilities of death from birth to exact age 15 years, from exact age 15 years to exact age 50 years, and from exact age 50 years to exact age 75 years, and life expectancy at birth into major causes. For all quantities reported, we computed 95% uncertainty intervals (UIs). We constrained cause-specific fractions within each age

  9. Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013

    PubMed Central

    2015-01-01

    Summary Background Up-to-date evidence on levels and trends for age-sex-specific all-cause and cause-specific mortality is essential for the formation of global, regional, and national health policies. In the Global Burden of Disease Study 2013 (GBD 2013) we estimated yearly deaths for 188 countries between 1990, and 2013. We used the results to assess whether there is epidemiological convergence across countries. Methods We estimated age-sex-specific all-cause mortality using the GBD 2010 methods with some refinements to improve accuracy applied to an updated database of vital registration, survey, and census data. We generally estimated cause of death as in the GBD 2010. Key improvements included the addition of more recent vital registration data for 72 countries, an updated verbal autopsy literature review, two new and detailed data systems for China, and more detail for Mexico, UK, Turkey, and Russia. We improved statistical models for garbage code redistribution. We used six different modelling strategies across the 240 causes; cause of death ensemble modelling (CODEm) was the dominant strategy for causes with sufficient information. Trends for Alzheimer’s disease and other dementias were informed by meta-regression of prevalence studies. For pathogen-specific causes of diarrhoea and lower respiratory infections we used a counterfactual approach. We computed two measures of convergence (inequality) across countries: the average relative difference across all pairs of countries (Gini coefficient) and the average absolute difference across countries. To summarise broad findings, we used multiple decrement life-tables to decompose probabilities of death from birth to exact age 15 years, from exact age 15 years to exact age 50 years, and from exact age 50 years to exact age 75 years, and life expectancy at birth into major causes. For all quantities reported, we computed 95% uncertainty intervals (UIs). We constrained cause-specific fractions within each age

  10. Rocket plume burn hazard.

    PubMed

    Stoll, A M; Piergallini, J R; Chianta, M A

    1980-05-01

    By use of miniature rocket engines, the burn hazard posed by exposure to ejection seat rocket plume flames was determined in the anaesthetized rat. A reference chart is provided for predicting equivalent effects in human skin based on extrapolation of earlier direct measurements of heat input for rat and human burns. The chart is intended to be used in conjunction with thermocouple temperature measurements of the plume environment for design and modification of escape seat system to avoid thermal injury on ejection from multiplace aircraft. PMID:7387571

  11. Landing Hazard Avoidance Display

    NASA Technical Reports Server (NTRS)

    Abernathy, Michael Franklin (Inventor); Hirsh, Robert L. (Inventor)

    2016-01-01

    Landing hazard avoidance displays can provide rapidly understood visual indications of where it is safe to land a vehicle and where it is unsafe to land a vehicle. Color coded maps can indicate zones in two dimensions relative to the vehicles position where it is safe to land. The map can be simply green (safe) and red (unsafe) areas with an indication of scale or can be a color coding of another map such as a surface map. The color coding can be determined in real time based on topological measurements and safety criteria to thereby adapt to dynamic, unknown, or partially known environments.

  12. Toxic Hazards Research Unit

    NASA Technical Reports Server (NTRS)

    Macewen, J. D.; Vernot, E. H.

    1971-01-01

    The activities of the Toxic Hazards Research Unit (THRU) for the period of June 1970 through May 1971 reviewed. Modification of the animal exposure facilities primarily for improved human safety but also for experimental integrity and continuity are discussed. Acute toxicity experiments were conducted on hydrogen fluoride (HF), hydrogen chloride (HCl), nitrogen dioxide (NO2), and hydrogen cyanide (HCN) both singly and in combination with carbon dioxide (CO). Additional acute toxicity experiments were conducted on oxygen difluoride (OF2) and chlorine pentafluoride (ClF5). Subacute toxicity studies were conducted on methylisobutylketone and dichloromethane (methylene dichloride). The interim results of further chronic toxicity experiments on monomethylhydrazine (MMH) are also described.

  13. Hazards of geomagnetic storms

    USGS Publications Warehouse

    Herzog, D.C.

    1992-01-01

    Geomagnetic storms are large and sometimes rapid fluctuations in the Earth's magnetic field that are related to disturbances on the Sun's surface. Although it is not widely recognized, these transient magnetic disturbances can be a significant hazard to people and property. Many of us know that the intensity of the auroral lights increases during magnetic storms, but few people realize that these storms can also cause massive power outages, interrupt radio communications and satellite operations, increase corrosion in oil and gas pipelines, and lead to spuriously high rejection rates in the manufacture of sensitive electronic equipment. 

  14. Specialized ratio analysis.

    PubMed

    Wyer, J C; Salzinger, F H

    1983-01-01

    Many common management techniques have little use in managing a medical group practice. Ratio analysis, however, can easily be adapted to the group practice setting. Acting as broad-gauge indicators, financial ratios provide an early warning of potential problems and can be very useful in planning for future operations. The author has gathered a collection of financial ratios which were developed by participants at an education seminar presented for the Virginia Medical Group Management Association. Classified according to the human element, system component, and financial factor, the ratios provide a good sampling of measurements relevant to medical group practices and can serve as an example for custom-tailoring a ratio analysis system for your medical group.

  15. Communication in hazardous environments

    SciTech Connect

    Rankin, W N; Herold, T R

    1986-01-01

    Radios were investigated for use in hazardous environments where protective breathing equipment such as plastic suits and respirators interfere with communication. A radio system, manufactured by Communications-Applied technology (C-AT), was identified that was designed specifically for hazardous environment communications. This equipment had been used successfully by the US Army and NASA for several years. C-AT equipment was evaluated in plantwide applications at the Savannah River Plant (SRP) using temporary frequencies obtained by the Department of Energy-Savannah River (DOE-SR). Radios performed well in all applications, which included a tritium facility, high-level caves, a nuclear reactor building, tank farm, and a canyon building interior. Permanent frequencies were obtained by DOE-SR for two complete six-man C-AT systems at SRP. Because of the relatively short range of these systems, replicates will cover all applications of this type of equipment plantwide. Twelve radio systems are currently being used successfully in plantwide applications.

  16. Hazards assessment for the Hazardous Waste Storage Facility

    SciTech Connect

    Knudsen, J.K.; Calley, M.B.

    1994-04-01

    This report documents the hazards assessment for the Hazardous Waste Storage Facility (HWSF) located at the Idaho National Engineering Laboratory. The hazards assessment was performed to ensure that this facility complies with DOE and company requirements pertaining to emergency planning and preparedness for operational emergencies. The hazards assessment identifies and analyzes hazards that are significant enough to warrant consideration in a facility`s operational emergency management program. The area surrounding HWSF, the buildings and structures at HWSF, and the processes used at HWSF are described in this report. All nonradiological hazardous materials at the HWSF were identified (radiological hazardous materials are not stored at HWSF) and screened against threshold quantities according to DOE Order 5500.3A guidance. Two of the identified hazardous materials exceeded their specified threshold quantity. This report discusses the potential release scenarios and consequences associated with an accidental release for each of the two identified hazardous materials, lead and mercury. Emergency considerations, such as emergency planning zones, emergency classes, protective actions, and emergency action levels, are also discussed based on the analysis of potential consequences. Evaluation of the potential consequences indicated that the highest emergency class for operational emergencies at the HWSF would be a Site Area Emergency.

  17. Birthweight ratio revisited.

    PubMed Central

    Brownlee, K G; Ng, P C; Roussounis, S H; Dear, P R

    1991-01-01

    In order to test the hypothesis suggested in a recent report that the birthweight ratio might be a useful predictor of several important clinical outcome measures in babies of less than 31 weeks' gestation, we examined the association between the birthweight ratio and aspects of both short and long term outcome in 436 Leeds babies of less than 31 weeks' gestation. Unlike the report, and contrary to what we had expected, we were unable to find any significant association between birthweight ratio and length of time on the ventilator, mortality, neurological outcome, or intellectual outcome. PMID:2025035

  18. Risk assessment of mortality for all-cause, ischemic heart disease, cardiopulmonary disease, and lung cancer due to the operation of the world's largest coal-fired power plant

    NASA Astrophysics Data System (ADS)

    Kuo, Pei-Hsuan; Tsuang, Ben-Jei; Chen, Chien-Jen; Hu, Suh-Woan; Chiang, Chun-Ju; Tsai, Jeng-Lin; Tang, Mei-Ling; Chen, Guan-Jie; Ku, Kai-Chen

    2014-10-01

    Based on recent understanding of PM2.5 health-related problems from fossil-fueled power plants emission inventories collected in Taiwan, we have determined the loss of life expectancy (LLE) and the lifetime (75-year) risks for PM2.5 health-related mortalities as attributed to the operation of the world's largest coal-fired power plant; the Taichung Power Plant (TCP), with an installed nominal electrical capacity of 5780 MW in 2013. Five plausible scenarios (combinations of emission controls, fuel switch, and relocation) and two risk factors were considered. It is estimated that the lifetime (75-y) risk for all-cause mortality was 0.3%-0.6% for males and 0.2%-0.4% for females, and LLE at 84 days in 1997 for the 23 million residents of Taiwan. The risk has been reduced to one-fourth at 0.05%-0.10% for males and 0.03%-0.06% for females, and LLE at 15 days in 2007, which was mainly attributed to the installation of desulfurization and de-NOx equipment. Moreover, additional improvements can be expected if we can relocate the power plant to a downwind site on Taiwan, and convert the fuel source from coal to natural gas. The risk can be significantly reduced further to one-fiftieth at 0.001%-0.002% for males and 0.001% for females, and LLE at 0.3 days. Nonetheless, it is still an order higher than the commonly accepted elevated-cancer risk at 0.0001% (10-6), indicating that the PM2.5 health-related risk for operating such a world-class power plant is not negligible. In addition, this study finds that a better-chosen site (involving moving the plant to the leeward side of Taiwan) can reduce the risk significantly as opposed to solely transitioning the fuel source to natural gas. Note that the fuel cost of using natural gas (0.11 USD/kWh in 2013) in Taiwan is about twice the price of using coal fuel (0.05 USD/kWh in 2013).

  19. Anxiety and Depressive Symptoms as Predictors of All-Cause Mortality among People with Insulin-Naïve Type 2 Diabetes: 17-Year Follow-Up of the Second Nord-Trøndelag Health Survey (HUNT2), Norway

    PubMed Central

    Nefs, Giesje; Tell, Grethe S.; Espehaug, Birgitte; Midthjell, Kristian; Graue, Marit; Pouwer, Frans

    2016-01-01

    Aim To examine whether elevated anxiety and/or depressive symptoms are related to all-cause mortality in people with Type 2 diabetes, not using insulin. Methods 948 participants in the community-wide Nord-Trøndelag Health Survey conducted during 1995–97 completed the Hospital Anxiety and Depression Scale with subscales of anxiety (HADS-A) and depression (HADS-D). Elevated symptoms were defined as HADS-A or HADS-D ≥8. Participants with type 2 diabetes, not using insulin, were followed until November 21, 2012 or death. Cox regression analyses were used to estimate associations between baseline elevated anxiety symptoms, elevated depressive symptoms and mortality, adjusting for sociodemographic factors, HbA1c, cardiovascular disease and microvascular complications. Results At baseline, 8% (n = 77/948) reported elevated anxiety symptoms, 9% (n = 87/948) elevated depressive symptoms and 10% (n = 93/948) reported both. After a mean follow-up of 12 years (SD 5.1, range 0–17), 541 participants (57%) had died. Participants with elevated anxiety symptoms only had a decreased mortality risk (unadjusted HR 0.66, 95% CI 0.46–0.96). Adjustment for HbA1c attenuated this relation (HR 0.73, 95% CI 0.50–1.07). Those with elevated depression symptoms alone had an increased mortality risk (fully adjusted model HR 1.39, 95% CI 1.05–1.84). Having both elevated anxiety and depressive symptoms was not associated with increased mortality risk (adjusted HR 1.30, 95% CI 0.96–1.74). Conclusions Elevated depressive symptoms were associated with excess mortality risk in people with Type 2 diabetes not using insulin. No significant association with mortality was found among people with elevated anxiety symptoms. Having both elevated anxiety and depressive symptoms was not associated with mortality. The hypothesis that elevated levels of anxiety symptoms leads to behavior that counteracts the adverse health effects of Type 2 diabetes needs further investigation. PMID:27537359

  20. Hazard assessment of selenium to endangered razorback suckers (Xyrauchen texanus)

    USGS Publications Warehouse

    Hamilton, S.J.; Holley, K.M.; Buhl, K.J.

    2002-01-01

    A hazard assessment was conducted based on information derived from two reproduction studies conducted with endangered razorback suckers (Xyrauchen texanus) at three sites near Grand Junction, CO, USA. Selenium contamination of the upper and lower Colorado River basin has been documented in water, sediment, and biota in studies by US Department of the Interior agencies and academia. Concern has been raised that this selenium contamination may be adversely affecting endangered fish in the upper Colorado River basin. The reproduction studies with razorback suckers revealed that adults readily accumulated selenium in various tissues including eggs, and that 4.6 ??g/g of selenium in food organisms caused increased mortality of larvae. The selenium hazard assessment protocol resulted in a moderate hazard at the Horsethief site and high hazards at the Adobe Creek and North Pond sites. The selenium hazard assessment was considered conservative because an on-site toxicity test with razorback sucker larvae using 4.6 ??g/g selenium in zooplankton caused nearly complete mortality, in spite of the moderate hazard at Horsethief. Using the margin of uncertainty ratio also suggested a high hazard for effects on razorback suckers from selenium exposure. Both assessment approaches suggested that selenium in the upper Colorado River basin adversely affects the reproductive success of razorback suckers. ?? 2002 Elsevier Science B.V. All rights reserved.

  1. Hazard assessment of selenium to endangered razorback suckers (Xyrauchen texanus).

    PubMed

    Hamilton, Steven J; Holley, Kathleen M; Buhl, Kevin J

    2002-05-27

    A hazard assessment was conducted based on information derived from two reproduction studies conducted with endangered razorback suckers (Xyrauchen texanus) at three sites near Grand Junction, CO, USA. Selenium contamination of the upper and lower Colorado River basin has been documented in water, sediment, and biota in studies by US Department of the Interior agencies and academia. Concern has been raised that this selenium contamination may be adversely affecting endangered fish in the upper Colorado River basin. The reproduction studies with razorback suckers revealed that adults readily accumulated selenium in various tissues including eggs, and that 4.6 microg/g of selenium in food organisms caused increased mortality of larvae. The selenium hazard assessment protocol resulted in a moderate hazard at the Horsethief site and high hazards at the Adobe Creek and North Pond sites. The selenium hazard assessment was considered conservative because an on-site toxicity test with razorback sucker larvae using 4.6 microg/g selenium in zooplankton caused nearly complete mortality, in spite of the moderate hazard at Horsethief. Using the margin of uncertainty ratio also suggested a high hazard for effects on razorback suckers from selenium exposure. Both assessment approaches suggested that selenium in the upper Colorado River basin adversely affects the reproductive success of razorback suckers. PMID:12150431

  2. Hazardous solvent source reduction

    SciTech Connect

    Callahan, M.S.; Green, B.

    1995-09-01

    This book is written for the managers, production leaders, and operations staff tasked with the job of eliminating hazardous cleaning solvents from their workplace. Information regarding the location, evaluation, and implementation of environmentally preferred cleaning technologies is offered for a broad range of applications. These include: removal of grease and grime from a piece of equipment during maintenance, cleaning small parts before assembly, defluxing printed circuit boards and assemblies, and stripping paint from field vehicles and aircraft. Moving beyond the limits of source reduction alone, this book provides complete information on the planning, staffing, and execution of a pollution prevention program, alternative and in-use cleaner testing, waste recycling and treatment, air emission control, replacement system design, and system economics. For the environmental specialist, this book helps to bridge the gap between regulatory requirements and shop-floor constraints.

  3. New hazardous waste solutions

    SciTech Connect

    Krukowski, J.

    1993-05-15

    From data supplied by industrial laboratories, from academia, and from the EPA's Superfund Innovative Site Evaluation (SITE) program, this paper presents an informal look at some new and innovative hazardous waste treatment processes. These processes show promise for sparing users off-site disposal costs as well as for remediation of contamination at Superfund or RCRA sites. Included are the following: equipment that will biodegrade water-based paint wastes and pesticide wastes; recycling of potliner and furnace dusts for metal recovery; a process that reduces PCBs and PAHs to lighter hydrocarbons such as methane. Finally, two radiofrequency (RF) processes are described that can be used to remove soil contaminants such as pentachlorophenols, Aroclor 1242, solvents, oils, jet fuel, and pesticides.

  4. Sports: The Infectious Hazards.

    PubMed

    Minooee, Arezou; Wang, Jeff; Gupta, Geeta K

    2015-10-01

    Although the medical complications of sports are usually traumatic in nature, infectious hazards also arise. While blood-borne pathogens such as HIV, hepatitis B, and hepatitis C, cause significant illness, the risk of acquiring these agents during sporting activities is minimal. Skin infections are more commonplace, arising from a variety of microbial agents including bacterial, fungal, and viral pathogens. Sports involving water contact can lead to enteric infections, eye infections, or disseminated infections such as leptospirosis. Mumps, measles, and influenza are vaccine-preventable diseases that have been transmitted during sporting events, both in players and in spectators. Prevention is the key to many of these infections. Players should be vaccinated and should not participate in sports if their infection can be spread by contact, airborne, or droplet transmission.

  5. Secondary impact hazard assessment

    NASA Technical Reports Server (NTRS)

    1986-01-01

    A series of light gas gun shots (4 to 7 km/sec) were performed with 5 mg nylon and aluminum projectiles to determine the size, mass, velocity, and spatial distribution of spall and ejecta from a number of graphite/epoxy targets. Similar determinations were also performed on a few aluminum targets. Target thickness and material were chosen to be representative of proposed Space Station structure. The data from these shots and other information were used to predict the hazard to Space Station elements from secondary particles resulting from impacts of micrometeoroids and orbital debris on the Space Station. This hazard was quantified as an additional flux over and above the primary micrometeoroid and orbital debris flux that must be considered in the design process. In order to simplify the calculations, eject and spall mass were assumed to scale directly with the energy of the projectile. Other scaling systems may be closer to reality. The secondary particles considered are only those particles that may impact other structure immediately after the primary impact. The addition to the orbital debris problem from these primary impacts was not addressed. Data from this study should be fed into the orbital debris model to see if Space Station secondaries make a significant contribution to orbital debris. The hazard to a Space Station element from secondary particles above and beyond the micrometeoroid and orbital debris hazard is categorized in terms of two factors: (1) the 'view factor' of the element to other Space Station structure or the geometry of placement of the element, and (2) the sensitivity to damage, stated in terms of energy. Several example cases were chosen, the Space Station module windows, windows of a Shuttle docked to the Space Station, the habitat module walls, and the photovoltaic solar cell arrays. For the examples chosen the secondary flux contributed no more than 10 percent to the total flux (primary and secondary) above a given calculated

  6. Runoff inundation hazard cartography

    NASA Astrophysics Data System (ADS)

    Pineux, N.; Degré, A.

    2012-04-01

    Between 1998 and 2004, Europe suffered from more than hundred major inundations, responsible for some 700 deaths, for the moving of about half a million of people and the economic losses of at least 25 billions Euros covered by the insurance policies. Within this context, EU launched the 2007/60/CE directive. The inundations are natural phenomenon. They cannot be avoided. Nevertheless this directive permits to better evaluate the risks and to coordinate the management measures taken at member states level. In most countries, inundation maps only include rivers' overflowing. In Wallonia, overland flows and mudflows also cause huge damages, and must be included in the flood hazard map. Indeed, the cleaning operations for a village can lead to an estimated cost of 11 000 €. Average construction cost of retention dams to control off-site damage caused by floods and muddy flows was valued at 380 000€, and yearly dredging costs associated with these retention ponds at 15 000€. For a small city for which a study was done in a more specific way (Gembloux), the mean annual cost for the damages that can generate the runoff is about 20 000€. This cost consists of the physical damages caused to the real estate and movable properties of the residents as well as the emergency operations of the firemen and the city. On top of damages to public infrastructure (clogging of trenches, silting up of retention ponds) and to private property by muddy flows, runoff generates a significant loss of arable land. Yet, the soil resource is not an unlimited commodity. Moreover, sediments' transfer to watercourses alters their physical and chemical quality. And that is not to mention the increased psychological stress for people. But to map overland flood and mud flow hazard is a real challenge. This poster will present the methodology used to in Wallonia. The methodology is based on 3 project rainfalls: 25, 50 and 100 years return period (consistency with the cartography of the

  7. Landslide Hazard in Georgia

    NASA Astrophysics Data System (ADS)

    Gaprindashvili, G.; Tsereteli, E.; Gaprindashvili, M.

    2013-12-01

    In the last decades of the XX century, protect the population from geological hazards, to maintain land and safe operation of the engineering facilities has become the most important social - economic, demographic, political and environmental problems for the whole world. Georgia, with its scales of origination of the natural-catastrophic processes (landslide, mudflow, rockfall, erosion and etc.), their re-occurrence and with the negative results inflicted by these processes to the population, agricultural lands and engineering objects, is one of the most complex mountainous region. The extremely sensitive conditions were conditioned by: 1. Activation of highly intense earthquakes; 2. Activation of the negative meteorological events provoking the disaster processes on the background of global climatic changes and their abnormally frequent occurrence (mostly increased atmospheric precipitations, temperature and humidity); 3. Large-scale Human impact on the environment. Following the problem urgency, a number of departmental and research institutions have made their operations more intense in the given direction within the limits of their competence. First of all, the activity of the Department of Geology of Georgia (which is at present included in the National Environmental Agency of the Ministry of Environment and Natural Resources Protection), which mapped, identified and cataloged the hazardous processes on the territory of the country and identified the spatial limits and developmental regularities of these processes for tens of years. The increased risk of Geological catastrophes in Georgia first of all is caused by insufficient information between society and responsible persons toward this event. The existed situation needs the base assessment of natural disasters level, the identification of events, to determine their caused reasons, to develop special maps in GIS system, and continuous functioning of geo monitoring researches for develop safety early

  8. Landslide Hazard in Georgia

    NASA Astrophysics Data System (ADS)

    Gaprindashvili, George; Tsereteli, Emil; Gaprindashvili, Merab

    2014-05-01

    In the last decades of the XX century, protect the population from geological hazards, to maintain land and safe operation of the engineering facilities has become the most important social - economic, demographic, political and environmental problems for the whole world. Georgia, with its scales of origination of the natural-catastrophic processes (landslide, mudflow, rockfall, erosion and etc.), their re-occurrence and with the negative results inflicted by these processes to the population, agricultural lands and engineering objects, is one of the most complex mountainous region. The extremely sensitive conditions were conditioned by: 1. Activation of highly intense earthquakes; 2. Activation of the negative meteorological events provoking the disaster processes on the background of global climatic changes and their abnormally frequent occurrence (mostly increased atmospheric precipitations, temperature and humidity); 3. Large-scale Human impact on the environment. Following the problem urgency, a number of departmental and research institutions have made their operations more intense in the given direction within the limits of their competence. First of all, the activity of the Department of Geology of Georgia (which is at present included in the National Environmental Agency of the Ministry of Environment and Natural Resources Protection), which mapped, identified and cataloged the hazardous processes on the territory of the country and identified the spatial limits and developmental regularities of these processes for tens of years. The increased risk of Geological catastrophes in Georgia first of all is caused by insufficient information between society and responsible persons toward this event. The existed situation needs the base assessment of natural disasters level, the identification of events, to determine their caused reasons, to develop special maps in GIS system, and continuous functioning of geo monitoring researches for develop safety early

  9. Informing Workers of Chemical Hazards: The OSHA Hazard Communication Standard.

    ERIC Educational Resources Information Center

    American Chemical Society, Washington, DC.

    Practical information on how to implement a chemical-related safety program is outlined in this publication. Highlights of the federal Occupational Safety and Health Administrations (OSHA) Hazard Communication Standard are presented and explained. These include: (1) hazard communication requirements (consisting of warning labels, material safety…

  10. Earthquake Hazard and Risk Assessment for Turkey

    NASA Astrophysics Data System (ADS)

    Betul Demircioglu, Mine; Sesetyan, Karin; Erdik, Mustafa

    2010-05-01

    Using a GIS-environment to present the results, seismic risk analysis is considered as a helpful tool to support the decision making for planning and prioritizing seismic retrofit intervention programs at large scale. The main ingredients of seismic risk analysis consist of seismic hazard, regional inventory of buildings and vulnerability analysis. In this study, the assessment of the national earthquake hazard based on the NGA ground motion prediction models and the comparisons of the results with the previous models have been considered, respectively. An evaluation of seismic risk based on the probabilistic intensity ground motion prediction for Turkey has been investigated. According to the Macroseismic approach of Giovinazzi and Lagomarsino (2005), two alternative vulnerability models have been used to estimate building damage. The vulnerability and ductility indices for Turkey have been taken from the study of Giovinazzi (2005). These two vulnerability models have been compared with the observed earthquake damage database. A good agreement between curves has been clearly observed. In additional to the building damage, casualty estimations based on three different methods for each return period and for each vulnerability model have been presented to evaluate the earthquake loss. Using three different models of building replacement costs, the average annual loss (AAL) and probable maximum loss ratio (PMLR) due to regional earthquake hazard have been provided to form a basis for the improvement of the parametric insurance model and the determination of premium rates for the compulsory earthquake insurance in Turkey.

  11. Motorcycling experience and hazard perception.

    PubMed

    Crundall, David; van Loon, Editha; Stedmon, Alex W; Crundall, Elizabeth

    2013-01-01

    Studies of hazard perception skills in car drivers suggest that the ability to spot hazards improves with driving experience. Is this the case with motorcyclists? Sixty-one motorcyclists, split across three groups (novice, experienced and advanced riders) were tested on a hazard perception test containing video clips filmed from the perspective of a motorcyclist. Response times to hazards revealed that the advanced riders (who had completed an advanced riding course) were the fastest, and the experienced riders were the slowest to respond to hazards, with novice riders falling in-between. Advanced riders were also found to make more internal attributions regarding the causes of the hazards than novice riders (though on a general measure of Locus of Control there was no difference between groups). The results demonstrate a link between advanced training and motorcycling hazard perception skill, but raise important concerns about the effects of mere experience on rider safety. This challenges previous conceptions that simply extrapolated from our understanding of the hazard perception skills of car drivers to this particularly vulnerable group of road users.

  12. Michigan Household Hazardous Substance Handbook.

    ERIC Educational Resources Information Center

    Senior, Janet; Stone Nancy

    Common household hazardous substances include cleansers, drain cleaners, automotive products, paints, solvents, and pesticides. This handbook was designed to serve as a resource for people frequently contacted by the public for information on household hazardous substances and wastes. Included in the handbook are: (1) an introduction to Michigan's…

  13. Hazard Tree Management for Camps.

    ERIC Educational Resources Information Center

    Kong, Earl

    2002-01-01

    The principles behind a camp's hazard tree program are, first, identifying and removing those hazards that offer a clear, immediate threat, and then creating a management plan for the other trees. The plan should be written and contain goals and objectives, field evaluations, and treatments. Follow-up evaluations should be done annually and after…

  14. Hazardous waste: cleanup and prevention

    USGS Publications Warehouse

    Vandas, Stephen; Cronin, Nancy L.; Farrar, Frank; Serrano, Guillermo Eliezer Ávila; Yajimovich, Oscar Efraín González; Muñoz, Aurora R.; Rivera, María del C.

    1996-01-01

    Our lifestyles are supported by complex Industrial activities that produce many different chemicals and chemical wastes. The Industries that produce our clothing, cars, medicines, paper, food, fuels, steel, plastics, and electric components use and discard thousands of chemicals every year. At home we may use lawn chemicals, solvents, disinfectants, cleaners, and auto products to Improve our quality of life. A chemical that presents a threat or unreasonable risk to people or the environment Is a hazardous material. When a hazardous material can no longer be used, It becomes a hazardous waste. Hazardous wastes come from a variety of sources, from both present and past activities. Impacts to human health and the environment can result from Improper handling and disposal of hazardous waste.

  15. A Recipe for Ratio

    ERIC Educational Resources Information Center

    Moffett, Pamela

    2012-01-01

    Many learners still struggled to appreciate, and understand the difference between, the concepts of fractions and ratio. This is not just a UK phenomenon, which is demonstrated here by the use of a resource developed by the Wisconsin Centre for Education, in association with the Freudenthal Institute of the University of Utrecht, with a group of…

  16. Area Ratios of Quadrilaterals.

    ERIC Educational Resources Information Center

    Anderson, David R.; Arcidiacono, Michael J.

    1989-01-01

    Shows that the ratio of the area of the quadrilateral formed by joining the kth points to the area of the original quadrilateral is constant whether it is convex or concave quadrilateral. Presents many geoboard or dot paper diagrams and geometrical expresssions. (YP)

  17. Hamburger hazards and emotions.

    PubMed

    Olsen, Nina Veflen; Røssvoll, Elin; Langsrud, Solveig; Scholderer, Joachim

    2014-07-01

    Previous studies indicate that many consumers eat rare hamburgers and that information about microbiological hazards related to undercooked meat not necessarily leads to more responsible behavior. With this study we aim to investigate whether consumers' willingness to eat hamburgers depends on the emotions they experience when confronted with the food. A representative sample of 1046 Norwegian consumers participated in an online experiment. In the first part, participants were randomly divided into two groups. One group was confronted with a picture of a rare hamburger, whereas the other group was confronted with a picture of a well-done hamburger. The respondents were instructed to imagine that they were served the hamburger on the picture and then to indicate which emotions they experienced: fear, disgust, surprise, interest, pleasure, or none of these. In part two, all respondents were confronted with four pictures of hamburgers cooked to different degrees of doneness (rare, medium rare, medium well-done, well-done), and were asked to state their likelihood of eating. We analyzed the data by means of a multivariate probit model and two linear fixed-effect models. The results show that confrontation with rare hamburgers evokes more fear and disgust than confrontation with well-done hamburgers, that all hamburgers trigger pleasure and interest, and that a consumer's willingness to eat rare hamburgers depends on the particular type of emotion evoked. These findings indicate that emotions play an important role in a consumer's likelihood of eating risky food, and should be considered when developing food safety strategies.

  18. Phytoremediation of hazardous wastes

    SciTech Connect

    McCutcheon, S.C.; Wolfe, N.L.; Carreria, L.H.; Ou, T.Y.

    1995-11-01

    A new and innovative approach to phytoremediation (the use of plants to degrade hazardous contaminants) was developed. The new approach to phytoremediation involves rigorous pathway analyses, mass balance determinations, and identification of specific enzymes that break down trinitrotoluene (TNT), other explosives (RDX and HMX), nitrobenzene, and chlorinated solvents (e.g., TCE and PCE) (EPA 1994). As a good example, TNT is completely and rapidly degraded by nitroreductase and laccase enzymes. The aromatic ring is broken and the carbon in the ring fragments is incorporated into new plant fiber, as part of the natural lignification process. Half lives for TNT degradation approach 1 hr or less under ideal laboratory conditions. Continuous-flow pilot studies indicate that scale up residence times in created wetlands may be two to three times longer than in laboratory batch studies. The use of created wetlands and land farming techniques guided by rigorous field biochemistry and ecology promises to be a vital part of a newly evolving field, ecological engineering.

  19. Contaminant Hazard Reviews (compilation)

    USGS Publications Warehouse

    Eisler, R.; Munro, R.E.; Loges, L.M.; Boone, K.; Paul, M.M.; Garrett, L.J.

    2000-01-01

    This compact disc (CD) contains the 35 reports in the Contaminant Hazard Reviews (CHR) that were published originally between 1985 and 1999 in the U.S. Department of the Interior Biological Report series. The CD was produced because printed supplies of these reviews--a total of 105,000--became exhausted and demand remained high. Each review was prepared at the request of environmental specialists of the U.S. Fish and Wildlife Service and each contained specific information on the following: mirex, cadmium, carbofuran, toxaphene, selenium, chromium, polychlorinated biphenyls, dioxins, diazinon, mercury, polycyclic aromatic hydrocarbons, arsenic, chlorpyrifos, lead, tin, index issue, pentachlorophenol, atrazine, molybdenum, boron, chlordane, paraquat, cyanide, fenvalerate, diflubenzuron, zinc, famphur, acrolein, radiation, sodium monofluoroacetate, planar PCBs, silver, copper, nickel, and a cumulative index to chemicals and species. Each report reviewed and synthesized the technical literature on a single contaminant and its effects on terrestrial plants and invertebrates, aquatic plants and animals, avian and mammalian wildlife, and other natural resources. The subtopics include contaminant sources and uses; physical, chemical, and metabolic properties; concentrations in field collections of abiotic materials and living organisms; deficiency effects, where appropriate; lethal and sublethal effects, including effects on survival, growth, reproduction, metabolism, mutagenicity, teratogenicity, and carcinogenicity; proposed criteria for the protection of human health and sensitive natural resources; and recommendations for additional research.

  20. Handbook of hazard communication and OSHA requirements

    SciTech Connect

    Lowry, G.G.

    1985-01-01

    This guide gives an understanding of the OSHA Hazard Communication Standard which regulates hazardous materials in the workplace. Contents include: how to identify hazards in the workplace; characterization of hazards; label design and content; written hazard communication program; employee training; legal responsibilities including penalties and consequences; and a MSDS form.

  1. 49 CFR 386.72 - Imminent hazard.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 5 2010-10-01 2010-10-01 false Imminent hazard. 386.72 Section 386.72... Injunctions and Imminent Hazards § 386.72 Imminent hazard. (a) Whenever it is determined that an imminent hazard exists as a result of the transportation by motor vehicle of a particular hazardous material,...

  2. A low aspect ratio tokamak transmutation system

    NASA Astrophysics Data System (ADS)

    Qiu, L. J.; Wu, Y. C.; Xiao, B. J.; Xu, Q.; Huang, Q. Y.; Wu, B.; Chen, Y. X.; Xu, W. N.; Chen, Y. P.; Liu, X. P.

    2000-03-01

    A low aspect ratio tokamak transmutation system is proposed as an alternative application of fusion energy on the basis of a review of previous studies. This system includes: (1) a low aspect ratio tokamak as fusion neutron driver, (2) a radioactivity-clean nuclear power system as blanket, and (3) a novel concept of liquid metal centre conductor post as part of the toroidal field coils. In the conceptual design, a driver of 100 MW fusion power under 1 MW/m2 neutron wall loading can transmute the amount of high level waste (including minor actinides and fission products) produced by ten standard pressurized water reactors of 1 GW electrical power output. Meanwhile, the system can produce tritium on a self-sustaining basis and an output of about 2 GW of electrical energy. After 30 years of operation, the biological hazard potential level of the whole system will decrease by two orders of magnitude.

  3. 78 FR 42998 - Hazardous Materials: Improving the Safety of Railroad Transportation of Hazardous Materials

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-07-18

    ... TRANSPORTATION Federal Railroad Administration Hazardous Materials: Improving the Safety of Railroad Transportation of Hazardous Materials AGENCY: Pipeline and Hazardous Materials, Safety Administration (PHMSA... participate in a public meeting addressing the transportation of hazardous materials by rail. FRA and......

  4. Development of evaluation method for software hazard identification techniques

    SciTech Connect

    Huang, H. W.; Chen, M. H.; Shih, C.; Yih, S.; Kuo, C. T.; Wang, L. H.; Yu, Y. C.; Chen, C. W.

    2006-07-01

    This research evaluated the applicable software hazard identification techniques nowadays, such as, Preliminary Hazard Analysis (PHA), Failure Modes and Effects Analysis (FMEA), Fault Tree Analysis (FTA), Markov chain modeling, Dynamic Flow-graph Methodology (DFM), and simulation-based model analysis; and then determined indexes in view of their characteristics, which include dynamic capability, completeness, achievability, detail, signal/noise ratio, complexity, and implementation cost. By this proposed method, the analysts can evaluate various software hazard identification combinations for specific purpose. According to the case study results, the traditional PHA + FMEA + FTA (with failure rate) + Markov chain modeling (with transfer rate) combination is not competitive due to the dilemma for obtaining acceptable software failure rates. However, the systematic architecture of FTA and Markov chain modeling is still valuable for realizing the software fault structure. The system centric techniques, such as DFM and simulation-based model-analysis, show the advantage on dynamic capability, achievability, detail, signal/noise ratio. However, their disadvantages are the completeness complexity and implementation cost. This evaluation method can be a platform to reach common consensus for the stakeholders. Following the evolution of software hazard identification techniques, the evaluation results could be changed. However, the insight of software hazard identification techniques is much more important than the numbers obtained by the evaluation. (authors)

  5. 40 CFR 63.5330 - How do I determine the compliance ratio?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... National Emission Standards for Hazardous Air Pollutants for Leather Finishing Operations Compliance Requirements § 63.5330 How do I determine the compliance ratio? (a) When your source has processed leather...

  6. Hazard interaction analysis for multi-hazard risk assessment: a systematic classification based on hazard-forming environment

    NASA Astrophysics Data System (ADS)

    Liu, B.; Siu, Y. L.; Mitchell, G.

    2015-12-01

    This paper develops a systematic hazard interaction classification based on the geophysical environment that natural hazards arise from - the hazard-forming environment. According to their contribution to natural hazards, geophysical environmental factors in the hazard-forming environment were categorized into two types. The first are relatively stable factors which construct the precondition for the occurrence of natural hazards, whilst the second are trigger factors, which determine the frequency and magnitude of hazards. Different combinations of geophysical environmental factors induce different hazards. Based on these geophysical environmental factors for some major hazards, the stable factors are used to identify which kinds of natural hazards influence a given area, and trigger factors are used to classify the relationships between these hazards into four types: independent, mutex, parallel and series relationships. This classification helps to ensure all possible hazard interactions among different hazards are considered in multi-hazard risk assessment. This can effectively fill the gap in current multi-hazard risk assessment methods which to date only consider domino effects. In addition, based on this classification, the probability and magnitude of multiple interacting natural hazards occurring together can be calculated. Hence, the developed hazard interaction classification provides a useful tool to facilitate improved multi-hazard risk assessment.

  7. Hazard interaction analysis for multi-hazard risk assessment: a systematic classification based on hazard-forming environment

    NASA Astrophysics Data System (ADS)

    Liu, Baoyin; Siu, Yim Ling; Mitchell, Gordon

    2016-03-01

    This paper develops a systematic hazard interaction classification based on the geophysical environment that natural hazards arise from - the hazard-forming environment. According to their contribution to natural hazards, geophysical environmental factors in the hazard-forming environment were categorized into two types. The first are relatively stable factors which construct the precondition for the occurrence of natural hazards, whilst the second are trigger factors, which determine the frequency and magnitude of hazards. Different combinations of geophysical environmental factors induce different hazards. Based on these geophysical environmental factors for some major hazards, the stable factors are used to identify which kinds of natural hazards influence a given area, and trigger factors are used to classify the relationships between these hazards into four types: independent, mutex, parallel and series relationships. This classification helps to ensure all possible hazard interactions among different hazards are considered in multi-hazard risk assessment. This can effectively fill the gap in current multi-hazard risk assessment methods which to date only consider domino effects. In addition, based on this classification, the probability and magnitude of multiple interacting natural hazards occurring together can be calculated. Hence, the developed hazard interaction classification provides a useful tool to facilitate improved multi-hazard risk assessment.

  8. Infrasound Monitoring of Natural Hazards

    NASA Astrophysics Data System (ADS)

    Arrowsmith, S.

    2015-12-01

    Infrasound is generated by a wide variety of energetic natural and anthropogenic phenomena that originate in the solid earth, ocean, and atmosphere. Because the absorption of infrasound is low, it can propagate long distances through atmospheric waveguides, making it a valuable tool for remote monitoring of hazards. Advances in using infrasound for monitoring energetic events in the solid earth, oceans, and atmosphere are being driven by the wealth of new datasets in addition to advances in modeling source and propagation physics. This presentation provides an overview of recent advances in infrasound monitoring of natural hazards, focusing on selected hazards in the earth (earthquakes and volcanoes), ocean (tsunamis), and atmosphere (meteoroids).

  9. 78 FR 52954 - Final Flood Hazard Determinations

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-08-27

    ... SECURITY Federal Emergency Management Agency Final Flood Hazard Determinations AGENCY: Federal Emergency Management Agency, DHS. ACTION: Final notice. SUMMARY: Flood hazard determinations, which may include additions or modifications of Base Flood Elevations (BFEs), base flood depths, Special Flood Hazard...

  10. 78 FR 52953 - Final Flood Hazard Determinations

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-08-27

    ... SECURITY Federal Emergency Management Agency Final Flood Hazard Determinations AGENCY: Federal Emergency Management Agency, DHS. ACTION: Final Notice. SUMMARY: Flood hazard determinations, which may include additions or modifications of Base Flood Elevations (BFEs), base flood depths, Special Flood Hazard...

  11. 78 FR 5820 - Final Flood Hazard Determinations

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-01-28

    ... SECURITY Federal Emergency Management Agency Final Flood Hazard Determinations AGENCY: Federal Emergency Management Agency, DHS. ACTION: Final Notice. SUMMARY: Flood hazard determinations, which may include additions or modifications of Base Flood Elevations (BFEs), base flood depths, Special Flood Hazard...

  12. 78 FR 5821 - Final Flood Hazard Determinations

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-01-28

    ... SECURITY Federal Emergency Management Agency Final Flood Hazard Determinations AGENCY: Federal Emergency Management Agency, DHS. ACTION: Final Notice. SUMMARY: Flood hazard determinations, which may include additions or modifications of Base Flood Elevations (BFEs), base flood depths, Special Flood Hazard...

  13. 78 FR 21143 - Final Flood Hazard Determinations

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-04-09

    ... SECURITY Federal Emergency Management Agency Final Flood Hazard Determinations AGENCY: Federal Emergency Management Agency, DHS. ACTION: Final notice. SUMMARY: Flood hazard determinations, which may include additions or modifications of Base Flood Elevations (BFEs), base flood depths, Special Flood Hazard...

  14. An Introduction to Hazardous Material Management.

    ERIC Educational Resources Information Center

    Reinhardt, Peter A.; And Others

    1987-01-01

    Colleges must have a system to safely control the ordering, delivery, transport, storage, and use of hazardous material. Information on hazardous material management is excerpted from "Managing Hazardous Waste at Educational Institutions. (MLW)

  15. Estimating differences and ratios in median times to event

    PubMed Central

    Rogawski, Elizabeth T.; Westreich, Daniel J.; Kang, Gagandeep; Ward, Honorine D.; Cole, Stephen R.

    2016-01-01

    Time differences and time ratios are often more interpretable estimates of effect than hazard ratios for time-to-event data, especially for common outcomes. We developed a SAS macro for estimating time differences and time ratios between baseline-fixed binary exposure groups based on inverse probability weighted Kaplan-Meier curves. The macro uses pooled logistic regression to calculate inverse probability of censoring and exposure weights, draws Kaplan-Meier curves based on the weighted data, and estimates the time difference and time ratio at a user-defined survival proportion. The macro also calculates the risk difference and risk ratio at a user-specified time. Confidence intervals are constructed by bootstrap. We provide an example assessing the effect of exclusive breastfeeding during diarrhea on the incidence of subsequent diarrhea in children followed from birth to 3 years in Vellore, India. The SAS macro provided here should facilitate the wider reporting of time differences and time ratios. PMID:27465526

  16. RCRA hazardous waste contingency plans

    SciTech Connect

    Wagner, T.P. )

    1991-10-01

    This paper reports that the Resource Conservation and Recovery Act (RCRA) requires hazardous waste treatment, storage and disposal facilities (TSDFs) to prepare a contingency plan. The plan is a blueprint for emergency response, and must be designed to minimize health and environmental hazards resulting from fires, explosions or other unplanned hazardous releases. Hazardous waste contingency plans often are neglected and considered an unnecessary regulatory exercise by facility operators. However, an effective contingency plan is a valuable tool for reducing liability, protecting workers and the community, and avoiding costly shutdowns. The requirement under Title III of the Superfund Amendments and Reauthorization Act (SARA) that regulated facilities report to EPA annually on releases to the environment has caused regulators to renew emphasis on the importance of RCRA contingency plans. However, regulatory agencies historically have provided insufficient information on the elements of an adequate contingency plan. Nevertheless, facility operators seriously should consider going beyond minimum regulatory requirements and create a comprehensive contingency plan.

  17. Toxic hazards of underground excavation

    SciTech Connect

    Smith, R.; Chitnis, V.; Damasian, M.; Lemm, M.; Popplesdorf, N.; Ryan, T.; Saban, C.; Cohen, J.; Smith, C.; Ciminesi, F.

    1982-09-01

    Inadvertent intrusion into natural or man-made toxic or hazardous material deposits as a consequence of activities such as mining, excavation or tunnelling has resulted in numerous deaths and injuries in this country. This study is a preliminary investigation to identify and document instances of such fatal or injurious intrusion. An objective is to provide useful insights and information related to potential hazards due to future intrusion into underground radioactive-waste-disposal facilities. The methodology used in this study includes literature review and correspondence with appropriate government agencies and organizations. Key categories of intrusion hazards are asphyxiation, methane, hydrogen sulfide, silica and asbestos, naturally occurring radionuclides, and various mine or waste dump related hazards.

  18. Portable sensor for hazardous waste

    SciTech Connect

    Piper, L.G.; Fraser, M.E.; Davis, S.J.

    1995-10-01

    We are beginning the second phase of a three and a half year program designed to develop a portable monitor for sensitive hazardous waste detection. The ultimate goal of the program is to develop our concept to the prototype instrument level. Our monitor will be a compact, portable instrument that will allow real-time, in situ, monitoring of hazardous wastes. This instrument will be able to provide the means for rapid field screening of hazardous waste sites to map the areas of greatest contamination. Remediation efforts can then focus on these areas. Further, our instrument can show whether cleanup technologies are successful at reducing hazardous materials concentrations below regulated levels, and will provide feedback to allow changes in remediation operations, if necessary, to enhance their efficacy.

  19. Transportation of Hazardous Evidentiary Material.

    SciTech Connect

    Osborn, Douglas.

    2005-06-01

    This document describes the specimen and transportation containers currently available for use with hazardous and infectious materials. A detailed comparison of advantages, disadvantages, and costs of the different technologies is included. Short- and long-term recommendations are also provided.3 DraftDraftDraftExecutive SummaryThe Federal Bureau of Investigation's Hazardous Materials Response Unit currently has hazardous material transport containers for shipping 1-quart paint cans and small amounts of contaminated forensic evidence, but the containers may not be able to maintain their integrity under accident conditions or for some types of hazardous materials. This report provides guidance and recommendations on the availability of packages for the safe and secure transport of evidence consisting of or contaminated with hazardous chemicals or infectious materials. Only non-bulk containers were considered because these are appropriate for transport on small aircraft. This report will addresses packaging and transportation concerns for Hazardous Classes 3, 4, 5, 6, 8, and 9 materials. If the evidence is known or suspected of belonging to one of these Hazardous Classes, it must be packaged in accordance with the provisions of 49 CFR Part 173. The anthrax scare of several years ago, and less well publicized incidents involving unknown and uncharacterized substances, has required that suspicious substances be sent to appropriate analytical laboratories for analysis and characterization. Transportation of potentially hazardous or infectious material to an appropriate analytical laboratory requires transport containers that maintain both the biological and chemical integrity of the substance in question. As a rule, only relatively small quantities will be available for analysis. Appropriate transportation packaging is needed that will maintain the integrity of the substance, will not allow biological alteration, will not react chemically with the substance being

  20. FIRE HAZARDS ANALYSIS - BUSTED BUTTE

    SciTech Connect

    R. Longwell; J. Keifer; S. Goodin

    2001-01-22

    The purpose of this fire hazards analysis (FHA) is to assess the risk from fire within individual fire areas at the Busted Butte Test Facility and to ascertain whether the DOE fire safety objectives are met. The objective, identified in DOE Order 420.1, Section 4.2, is to establish requirements for a comprehensive fire and related hazards protection program for facilities sufficient to minimize the potential for: (1) The occurrence of a fire related event. (2) A fire that causes an unacceptable on-site or off-site release of hazardous or radiological material that will threaten the health and safety of employees. (3) Vital DOE programs suffering unacceptable interruptions as a result of fire and related hazards. (4) Property losses from a fire and related events exceeding limits established by DOE. Critical process controls and safety class systems being damaged as a result of a fire and related events.

  1. Exporting hazards to developing countries.

    PubMed

    Menkes, D B

    1998-01-01

    The health of people in developing countries is threatened by the importation of hazardous products, wastes and industrial processes from the developed world. Combating this menace is a facet of environmental protection and management of the planet's resources. PMID:10050169

  2. MGR External Events Hazards Analysis

    SciTech Connect

    L. Booth

    1999-11-06

    The purpose and objective of this analysis is to apply an external events Hazards Analysis (HA) to the License Application Design Selection Enhanced Design Alternative 11 [(LADS EDA II design (Reference 8.32))]. The output of the HA is called a Hazards List (HL). This analysis supersedes the external hazards portion of Rev. 00 of the PHA (Reference 8.1). The PHA for internal events will also be updated to the LADS EDA II design but under a separate analysis. Like the PHA methodology, the HA methodology provides a systematic method to identify potential hazards during the 100-year Monitored Geologic Repository (MGR) operating period updated to reflect the EDA II design. The resulting events on the HL are candidates that may have potential radiological consequences as determined during Design Basis Events (DBEs) analyses. Therefore, the HL that results from this analysis will undergo further screening and analysis based on the criteria that apply during the performance of DBE analyses.

  3. Natural Hazards - A National Threat

    USGS Publications Warehouse

    Geological Survey, U.S.

    2007-01-01

    The USGS Role in Reducing Disaster Losses -- In the United States each year, natural hazards cause hundreds of deaths and cost billions of dollars in disaster aid, disruption of commerce, and destruction of homes and critical infrastructure. Although the number of lives lost to natural hazards each year generally has declined, the economic cost of major disaster response and recovery continues to rise. Each decade, property damage from natural hazards events doubles or triples. The United States is second only to Japan in economic damages resulting from natural disasters. A major goal of the U.S. Geological Survey (USGS) is to reduce the vulnerability of the people and areas most at risk from natural hazards. Working with partners throughout all sectors of society, the USGS provides information, products, and knowledge to help build more resilient communities.

  4. Hazardous Wastes--New Developments.

    ERIC Educational Resources Information Center

    Rogers, Harvey W.

    1979-01-01

    The need for effective disposal of hazardous medical and pathological wastes is discussed and the results of a test of five different models of incinerators in disposing of such wastes is presented. (MJB)

  5. Ocular hazards of light

    NASA Technical Reports Server (NTRS)

    Sliney, David H.

    1994-01-01

    The eye is protected against bright light by the natural aversion response to viewing bright light sources. The aversion response normally protects the eye against injury from viewing bright light sources such as the sun, arc lamps and welding arcs, since this aversion limits the duration of exposure to a fraction of a second (about 0.25 s). The principal retinal hazard resulting from viewing bright light sources is photoretinitis, e.g., solar retinitis with an accompanying scotoma which results from staring at the sun. Solar retinitis was once referred to as 'eclipse blindness' and associated 'retinal burn'. Only in recent years has it become clear that photoretinitis results from a photochemical injury mechanism following exposure of the retina to shorter wavelengths in the visible spectrum, i.e., violet and blue light. Prior to conclusive animal experiments at that time, it was thought to be a thermal injury mechanism. However, it has been shown conclusively that an intense exposure to short-wavelength light (hereafter referred to as 'blue light') can cause retinal injury. The product of the dose-rate and the exposure duration always must result in the same exposure dose (in joules-per-square centimeter at the retina) to produce a threshold injury. Blue-light retinal injury (photoretinitis) can result from viewing either an extremely bright light for a short time, or a less bright light for longer exposure periods. This characteristic of photochemical injury mechanisms is termed reciprocity and helps to distinguish these effects from thermal burns, where heat conduction requires a very intense exposure within seconds to cause a retinal coagulation otherwise, surrounding tissue conducts the heat away from the retinal image. Injury thresholds for acute injury in experimental animals for both corneal and retinal effects have been corroborated for the human eye from accident data. Occupational safety limits for exposure to UVR and bright light are based upon this

  6. Preliminary hazards analysis -- vitrification process

    SciTech Connect

    Coordes, D.; Ruggieri, M.; Russell, J.; TenBrook, W.; Yimbo, P.

    1994-06-01

    This paper presents a Preliminary Hazards Analysis (PHA) for mixed waste vitrification by joule heating. The purpose of performing a PHA is to establish an initial hazard categorization for a DOE nuclear facility and to identify those processes and structures which may have an impact on or be important to safety. The PHA is typically performed during and provides input to project conceptual design. The PHA is then followed by a Preliminary Safety Analysis Report (PSAR) performed during Title 1 and 2 design. The PSAR then leads to performance of the Final Safety Analysis Report performed during the facility`s construction and testing. It should be completed before routine operation of the facility commences. This PHA addresses the first four chapters of the safety analysis process, in accordance with the requirements of DOE Safety Guidelines in SG 830.110. The hazards associated with vitrification processes are evaluated using standard safety analysis methods which include: identification of credible potential hazardous energy sources; identification of preventative features of the facility or system; identification of mitigative features; and analyses of credible hazards. Maximal facility inventories of radioactive and hazardous materials are postulated to evaluate worst case accident consequences. These inventories were based on DOE-STD-1027-92 guidance and the surrogate waste streams defined by Mayberry, et al. Radiological assessments indicate that a facility, depending on the radioactive material inventory, may be an exempt, Category 3, or Category 2 facility. The calculated impacts would result in no significant impact to offsite personnel or the environment. Hazardous materials assessment indicates that a Mixed Waste Vitrification facility will be a Low Hazard facility having minimal impacts to offsite personnel and the environment.

  7. USGS National Seismic Hazard Maps

    USGS Publications Warehouse

    Frankel, A.D.; Mueller, C.S.; Barnhard, T.P.; Leyendecker, E.V.; Wesson, R.L.; Harmsen, S.C.; Klein, F.W.; Perkins, D.M.; Dickman, N.C.; Hanson, S.L.; Hopper, M.G.

    2000-01-01

    The U.S. Geological Survey (USGS) recently completed new probabilistic seismic hazard maps for the United States, including Alaska and Hawaii. These hazard maps form the basis of the probabilistic component of the design maps used in the 1997 edition of the NEHRP Recommended Provisions for Seismic Regulations for New Buildings and Other Structures, prepared by the Building Seismic Safety Council arid published by FEMA. The hazard maps depict peak horizontal ground acceleration and spectral response at 0.2, 0.3, and 1.0 sec periods, with 10%, 5%, and 2% probabilities of exceedance in 50 years, corresponding to return times of about 500, 1000, and 2500 years, respectively. In this paper we outline the methodology used to construct the hazard maps. There are three basic components to the maps. First, we use spatially smoothed historic seismicity as one portion of the hazard calculation. In this model, we apply the general observation that moderate and large earthquakes tend to occur near areas of previous small or moderate events, with some notable exceptions. Second, we consider large background source zones based on broad geologic criteria to quantify hazard in areas with little or no historic seismicity, but with the potential for generating large events. Third, we include the hazard from specific fault sources. We use about 450 faults in the western United States (WUS) and derive recurrence times from either geologic slip rates or the dating of pre-historic earthquakes from trenching of faults or other paleoseismic methods. Recurrence estimates for large earthquakes in New Madrid and Charleston, South Carolina, were taken from recent paleoliquefaction studies. We used logic trees to incorporate different seismicity models, fault recurrence models, Cascadia great earthquake scenarios, and ground-motion attenuation relations. We present disaggregation plots showing the contribution to hazard at four cities from potential earthquakes with various magnitudes and

  8. Progress in NTHMP Hazard Assessment

    USGS Publications Warehouse

    Gonzalez, F.I.; Titov, V.V.; Mofjeld, H.O.; Venturato, A.J.; Simmons, R.S.; Hansen, R.; Combellick, R.; Eisner, R.K.; Hoirup, D.F.; Yanagi, B.S.; Yong, S.; Darienzo, M.; Priest, G.R.; Crawford, G.L.; Walsh, T.J.

    2005-01-01

    The Hazard Assessment component of the U.S. National Tsunami Hazard Mitigation Program has completed 22 modeling efforts covering 113 coastal communities with an estimated population of 1.2 million residents that are at risk. Twenty-three evacuation maps have also been completed. Important improvements in organizational structure have been made with the addition of two State geotechnical agency representatives to Steering Group membership, and progress has been made on other improvements suggested by program reviewers. ?? Springer 2005.

  9. Probabilistic analysis of tsunami hazards

    USGS Publications Warehouse

    Geist, E.L.; Parsons, T.

    2006-01-01

    Determining the likelihood of a disaster is a key component of any comprehensive hazard assessment. This is particularly true for tsunamis, even though most tsunami hazard assessments have in the past relied on scenario or deterministic type models. We discuss probabilistic tsunami hazard analysis (PTHA) from the standpoint of integrating computational methods with empirical analysis of past tsunami runup. PTHA is derived from probabilistic seismic hazard analysis (PSHA), with the main difference being that PTHA must account for far-field sources. The computational methods rely on numerical tsunami propagation models rather than empirical attenuation relationships as in PSHA in determining ground motions. Because a number of source parameters affect local tsunami runup height, PTHA can become complex and computationally intensive. Empirical analysis can function in one of two ways, depending on the length and completeness of the tsunami catalog. For site-specific studies where there is sufficient tsunami runup data available, hazard curves can primarily be derived from empirical analysis, with computational methods used to highlight deficiencies in the tsunami catalog. For region-wide analyses and sites where there are little to no tsunami data, a computationally based method such as Monte Carlo simulation is the primary method to establish tsunami hazards. Two case studies that describe how computational and empirical methods can be integrated are presented for Acapulco, Mexico (site-specific) and the U.S. Pacific Northwest coastline (region-wide analysis).

  10. Directional gear ratio transmissions

    NASA Technical Reports Server (NTRS)

    Lafever, A. E. (Inventor)

    1984-01-01

    Epicyclic gear transmissions which transmit output at a gear ratio dependent only upon the input's direction are considered. A transmission housing envelops two epicyclic gear assemblies, and has shafts extending from it. One shaft is attached to a sun gear within the first epicyclic gear assembly. Planet gears are held symmetrically about the sun gear by a planet gear carrier and are in mesh with both the sun gear and a ring gear. Two unidirectional clutches restrict rotation of the first planet gear carrier and ring gear to one direction. A connecting shaft drives a second sun gear at the same speed and direction as the first planet gear carrier while a connecting portion drives a second planet gear carrier at the same speed and direction as the first ring gear. The transmission's output is then transmitted by the second ring gear to the second shaft. Input is transmitted at a higher gear ratio and lower speed for all inputs in the first direction than in the opposite direction.

  11. Peak power ratio generator

    DOEpatents

    Moyer, R.D.

    A peak power ratio generator is described for measuring, in combination with a conventional power meter, the peak power level of extremely narrow pulses in the gigahertz radio frequency bands. The present invention in a preferred embodiment utilizes a tunnel diode and a back diode combination in a detector circuit as the only high speed elements. The high speed tunnel diode provides a bistable signal and serves as a memory device of the input pulses for the remaining, slower components. A hybrid digital and analog loop maintains the peak power level of a reference channel at a known amount. Thus, by measuring the average power levels of the reference signal and the source signal, the peak power level of the source signal can be determined.

  12. Peak power ratio generator

    DOEpatents

    Moyer, Robert D.

    1985-01-01

    A peak power ratio generator is described for measuring, in combination with a conventional power meter, the peak power level of extremely narrow pulses in the gigahertz radio frequency bands. The present invention in a preferred embodiment utilizes a tunnel diode and a back diode combination in a detector circuit as the only high speed elements. The high speed tunnel diode provides a bistable signal and serves as a memory device of the input pulses for the remaining, slower components. A hybrid digital and analog loop maintains the peak power level of a reference channel at a known amount. Thus, by measuring the average power levels of the reference signal and the source signal, the peak power level of the source signal can be determined.

  13. 14 CFR 437.29 - Hazard analysis.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 14 Aeronautics and Space 4 2011-01-01 2011-01-01 false Hazard analysis. 437.29 Section 437.29... Documentation § 437.29 Hazard analysis. (a) An applicant must perform a hazard analysis that complies with § 437.55(a). (b) An applicant must provide to the FAA all the results of each step of the hazard...

  14. 14 CFR 437.29 - Hazard analysis.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 14 Aeronautics and Space 4 2014-01-01 2014-01-01 false Hazard analysis. 437.29 Section 437.29... Documentation § 437.29 Hazard analysis. (a) An applicant must perform a hazard analysis that complies with § 437.55(a). (b) An applicant must provide to the FAA all the results of each step of the hazard...

  15. 14 CFR 437.29 - Hazard analysis.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 14 Aeronautics and Space 4 2013-01-01 2013-01-01 false Hazard analysis. 437.29 Section 437.29... Documentation § 437.29 Hazard analysis. (a) An applicant must perform a hazard analysis that complies with § 437.55(a). (b) An applicant must provide to the FAA all the results of each step of the hazard...

  16. 14 CFR 437.29 - Hazard analysis.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 14 Aeronautics and Space 4 2012-01-01 2012-01-01 false Hazard analysis. 437.29 Section 437.29... Documentation § 437.29 Hazard analysis. (a) An applicant must perform a hazard analysis that complies with § 437.55(a). (b) An applicant must provide to the FAA all the results of each step of the hazard...

  17. 16 CFR 1500.5 - Hazardous mixtures.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 16 Commercial Practices 2 2014-01-01 2014-01-01 false Hazardous mixtures. 1500.5 Section 1500.5... HAZARDOUS SUBSTANCES AND ARTICLES; ADMINISTRATION AND ENFORCEMENT REGULATIONS § 1500.5 Hazardous mixtures. For a mixture of substances, the determination of whether the mixture is a “hazardous substance”...

  18. 16 CFR 1500.5 - Hazardous mixtures.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 16 Commercial Practices 2 2010-01-01 2010-01-01 false Hazardous mixtures. 1500.5 Section 1500.5... HAZARDOUS SUBSTANCES AND ARTICLES; ADMINISTRATION AND ENFORCEMENT REGULATIONS § 1500.5 Hazardous mixtures. For a mixture of substances, the determination of whether the mixture is a “hazardous substance”...

  19. 16 CFR 1500.5 - Hazardous mixtures.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 16 Commercial Practices 2 2011-01-01 2011-01-01 false Hazardous mixtures. 1500.5 Section 1500.5... HAZARDOUS SUBSTANCES AND ARTICLES; ADMINISTRATION AND ENFORCEMENT REGULATIONS § 1500.5 Hazardous mixtures. For a mixture of substances, the determination of whether the mixture is a “hazardous substance”...

  20. 16 CFR 1500.5 - Hazardous mixtures.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 16 Commercial Practices 2 2013-01-01 2013-01-01 false Hazardous mixtures. 1500.5 Section 1500.5... HAZARDOUS SUBSTANCES AND ARTICLES; ADMINISTRATION AND ENFORCEMENT REGULATIONS § 1500.5 Hazardous mixtures. For a mixture of substances, the determination of whether the mixture is a “hazardous substance”...

  1. 16 CFR 1500.5 - Hazardous mixtures.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 16 Commercial Practices 2 2012-01-01 2012-01-01 false Hazardous mixtures. 1500.5 Section 1500.5... HAZARDOUS SUBSTANCES AND ARTICLES; ADMINISTRATION AND ENFORCEMENT REGULATIONS § 1500.5 Hazardous mixtures. For a mixture of substances, the determination of whether the mixture is a “hazardous substance”...

  2. BEHAVIORAL HAZARD IN HEALTH INSURANCE*

    PubMed Central

    Baicker, Katherine; Mullainathan, Sendhil; Schwartzstein, Joshua

    2015-01-01

    A fundamental implication of standard moral hazard models is overuse of low-value medical care because copays are lower than costs. In these models, the demand curve alone can be used to make welfare statements, a fact relied on by much empirical work. There is ample evidence, though, that people misuse care for a different reason: mistakes, or “behavioral hazard.” Much high-value care is underused even when patient costs are low, and some useless care is bought even when patients face the full cost. In the presence of behavioral hazard, welfare calculations using only the demand curve can be off by orders of magnitude or even be the wrong sign. We derive optimal copay formulas that incorporate both moral and behavioral hazard, providing a theoretical foundation for value-based insurance design and a way to interpret behavioral “nudges.” Once behavioral hazard is taken into account, health insurance can do more than just provide financial protection—it can also improve health care efficiency. PMID:23930294

  3. Hydrothermal Liquefaction Treatment Preliminary Hazard Analysis Report

    SciTech Connect

    Lowry, Peter P.; Wagner, Katie A.

    2015-08-31

    A preliminary hazard assessment was completed during February 2015 to evaluate the conceptual design of the modular hydrothermal liquefaction treatment system. The hazard assessment was performed in 2 stages. An initial assessment utilizing Hazard Identification and Preliminary Hazards Analysis (PHA) techniques identified areas with significant or unique hazards (process safety-related hazards) that fall outside of the normal operating envelope of PNNL and warranted additional analysis. The subsequent assessment was based on a qualitative What-If analysis. This analysis was augmented, as necessary, by additional quantitative analysis for scenarios involving a release of hazardous material or energy with the potential for affecting the public.

  4. High-Ratio Gear Train

    NASA Technical Reports Server (NTRS)

    Lefever, A. E.

    1982-01-01

    Proposed arrangement of two connected planetary differentials results in gear ratio many times that obtainable in conventional series gear assembly of comparable size. Ratios of several thousand would present no special problems. Selection of many different ratios is available with substantially similar gear diameters. Very high gear ratios would be obtained from small mechanism.

  5. Ensemble of ground subsidence hazard maps using fuzzy logic

    NASA Astrophysics Data System (ADS)

    Park, Inhye; Lee, Jiyeong; Saro, Lee

    2014-06-01

    Hazard maps of ground subsidence around abandoned underground coal mines (AUCMs) in Samcheok, Korea, were constructed using fuzzy ensemble techniques and a geographical information system (GIS). To evaluate the factors related to ground subsidence, a spatial database was constructed from topographic, geologic, mine tunnel, land use, groundwater, and ground subsidence maps. Spatial data, topography, geology, and various ground-engineering data for the subsidence area were collected and compiled in a database for mapping ground-subsidence hazard (GSH). The subsidence area was randomly split 70/30 for training and validation of the models. The relationships between the detected ground-subsidence area and the factors were identified and quantified by frequency ratio (FR), logistic regression (LR) and artificial neural network (ANN) models. The relationships were used as factor ratings in the overlay analysis to create ground-subsidence hazard indexes and maps. The three GSH maps were then used as new input factors and integrated using fuzzy-ensemble methods to make better hazard maps. All of the hazard maps were validated by comparison with known subsidence areas that were not used directly in the analysis. As the result, the ensemble model was found to be more effective in terms of prediction accuracy than the individual model.

  6. Variable compression ratio control

    SciTech Connect

    Johnson, K.A.

    1988-04-19

    In a four cycle engine that includes a crankshaft having a plural number of main shaft sections defining the crankshaft rotational axis and a plural number of crank arms defining orbital shaft sections, a plural number of combustion cylinders, a movable piston within each cylinder, each cylinder and its associated piston defining a combustion chamber, a connecting rod connecting each piston to an orbital shaft section of the crankshaft, and a plural number of stationary support walls spaced along the crankshaft axis for absorbing crankshaft forces: the improvement is described comprising means for adjustably supporting the crankshaft on the stationary walls such that the crankshaft rotational axis is adjustable along the piston-cylinder axis for the purpose of varying a resulting engine compression ratio; the adjustable support means comprising a circular cavity in each stationary wall. A circular disk swivably is seated in each cavity, each circular disk having a circular opening therethrough eccentric to the disk center. The crankshaft is arranged so that respective ones of its main shaft sections are located within respective ones of the circular openings; means for rotating each circular disk around its center so that the main shaft sections of the crankshaft are adjusted toward and away from the combustion chamber; a pinion gear on an output end of the crankshaft in axial alignment with and positioned beyond the respective ones of the main shaft sections, and a rotary output gear located about and engaged with teeth extending from the pinion gear.

  7. Household hazardous waste in Massachusetts

    SciTech Connect

    Stanek, E.J. 3d.; Tuthill, R.W.; Willis, C.; Moore, G.S.

    1987-03-01

    Household wastes, when disposed of improperly, are hazardous to health. This paper reports a random digit dial telephone survey of Massachusetts households concerning household hazardous waste (HHW) disposal with a 54% response. Of the automotive oil disposed of by 33% of survey households, 57% was deposited in the ground, sewer, or landfill. Annually by household oil disposal in Massachusetts is estimated to be 8.8 million quarts. Four percent of hazardous waste generated in Massachusetts is from households. Improper disposal makes it a major environmental contaminant. More households (41.5%) in smaller communities disposed of oil compared with 26% of households in larger communities. Paint and pesticides were disposed of by 10% of the households, but were dumped on the ground sewer or landfills more than 90% of the time.

  8. Hazard Communication Project: reference manual

    SciTech Connect

    Not Available

    1989-03-01

    This reference manual covers the following course objectives: to inform employees of their employer's requirements under the OSHA Hazard Communication Standard (29 CFR 1910.1200); to instruct employees on the procedures for obtaining and using information on hazardous materials, including understanding labeling systems and the material safety data sheet (MSDS) information; to provide information on 11 classes of chemicals, including their common uses, potential physical and health hazards, detection methods, and safety measures to follow. There are 14 lessons, ranging in length from 30 minutes to 1 (one) hour. The lessons are contained on 6 disks that are programmed to run on an IBM-compatible PC with an EGA graphics card and monitor. The program will not run on monochrome or CGA systems.

  9. Hazards of solar blue light

    SciTech Connect

    Okuno, Tsutomu

    2008-06-01

    Short-wavelength visible light (blue light) of the Sun has caused retinal damage in people who have stared fixedly at the Sun without adequate protection. The author quantified the blue-light hazard of the Sun according to the International Commission on Non-Ionizing Radiation Protection (ICNIRP) guidelines by measuring the spectral radiance of the Sun. The results showed that the exposure limit for blue light can be easily exceeded when people view the Sun and that the solar blue-light hazard generally increases with solar elevation, which is in accordance with a model of the atmospheric extinction of sunlight. Viewing the Sun can be very hazardous and therefore should be avoided except at very low solar elevations.

  10. Portable sensor for hazardous waste

    SciTech Connect

    Piper, L.G.; Fraser, M.E.; Davis, S.J.

    1995-12-01

    We are beginning the second phase of a three and a half year program designed to develop a portable monitor for sensitive hazardous waste detection. The ultimate goal of the program is to develop our concept to the prototype instrument level. Our monitor will be a compact, portable instrument that will allow real-time, in situ, monitoring of hazardous wastes. Further, our instrument can show whether cleanup technologies are successful at reducing hazardous materials concentrations below regulated levels, and will provide feedback to allow changes in remediation operations, if necessary, to enhance their efficacy. Our approach is to excite atomic and molecular fluorescence by the technique of active nitrogen energy transfer (ANET). The active nitrogen is made in a dielectric-barrier (D-B) discharge in nitrogen at atmospheric pressure. Only a few emission lines or bands are excited for each hazardous species, so spectral resolution requirements are greatly simplified over those of other spectroscopic techniques. The dielectric-barrier discharge is compact, 1 to 2 cm in diameter and 1 to 10 cm long. During the first phase of the program we demonstrated that a variety of hazardous species could be detected by the technique of active nitrogen energy transfer (ANET) excitation of atomic and molecular fluorescence. Species investigated included heavy metals, Hg, Cr, and Se, both chlorinated and non-chlorinated organics, and uranyl compounds. For most of these species we demonstrated sensitivity limits for their detection at parts per billion (ppb) levels. Our principal goals for this second phase of the program are to develop and breadboard test instrument components and to design a prototype instrument suitable for construction and evaluation in the final phase of the program. A secondary goal is to extend the ANET technology to encompass a greater number of hazardous species, primarily additional heavy metals and radionuclides.

  11. 49 CFR 173.2 - Hazardous materials classes and index to hazard class definitions.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    .... Division No. (if any) Name of class or division 49 CFR reference for definitions None Forbidden materials... 49 Transportation 2 2014-10-01 2014-10-01 false Hazardous materials classes and index to hazard... classes and index to hazard class definitions. The hazard class of a hazardous material is...

  12. Seismic Hazard and Public Safety

    NASA Astrophysics Data System (ADS)

    Marzocchi, Warner

    2013-07-01

    The recent destructive earthquakes in Wenchuan (China), L'Aquila (Italy), Port-au-Prince (Haiti), Christchurch (New Zealand), and Tohoku (Japan) have reignited the discussion over seismic safety. Several scientists [e.g., Stein et al., 2012; Wyss et al., 2012] have questioned the reliability of some seismic hazard maps based on the probabilistic seismic hazard analysis (PSHA)—a widely used probabilistic approach that estimates the likelihood of various levels of ground shaking occurring at a given location in a given future time period—raising an intense discussion on this specific point [Hanks et al., 2012; Frankel, 2013; Stein et al., 2013].

  13. KSC VAB Aeroacoustic Hazard Assessment

    NASA Technical Reports Server (NTRS)

    Oliveira, Justin M.; Yedo, Sabrina; Campbell, Michael D.; Atkinson, Joseph P.

    2010-01-01

    NASA Kennedy Space Center (KSC) carried out an analysis of the effects of aeroacoustics produced by stationary solid rocket motors in processing areas at KSC. In the current paper, attention is directed toward the acoustic effects of a motor burning within the Vehicle Assembly Building (VAB). The analysis was carried out with support from ASRC Aerospace who modeled transmission effects into surrounding facilities. Calculations were done using semi-analytical models for both aeroacoustics and transmission. From the results it was concluded that acoustic hazards in proximity to the source of ignition and plume can be severe; acoustic hazards in the far-field are significantly lower.

  14. Hazardous materials package performance regulations

    SciTech Connect

    Russell, N. A.; Glass, R. E.; McClure, J. D.; Finley, N. C.

    1991-01-01

    This paper discusses a hazardous materials Hazmat Packaging Performance Evaluation (HPPE) project being conducted at Sandia National Laboratories for the US Department of Transportation Research Special Programs Administration (DOT-RSPA) to look at the subset of bulk packagings that are larger than 2000 gallons. The objectives of this project are to evaluate current hazmat specification packagings and develop supporting documentation for determining performance requirements for packagings in excess of 2000 gallons that transport hazardous materials that have been classified as extremely toxic by inhalation (METBI).

  15. The Relative Severity of Single Hazards within a Multi-Hazard Framework

    NASA Astrophysics Data System (ADS)

    Gill, Joel C.; Malamud, Bruce D.

    2013-04-01

    Here we present a description of the relative severity of single hazards within a multi-hazard framework, compiled through examining, quantifying and ranking the extent to which individual hazards trigger or increase the probability of other hazards. Hazards are broken up into six major groupings (geophysical, hydrological, shallow earth processes, atmospheric, biophysical and space), with the interactions for 21 different hazard types examined. These interactions include both one primary hazard triggering a secondary hazard, and one primary hazard increasing the probability of a secondary hazard occurring. We identify, through a wide-ranging review of grey- and peer-review literature, >90 interactions. The number of hazard-type linkages are then summed for each hazard in terms of their influence (the number of times one hazard type triggers another type of hazard, or itself) and their sensitivity (the number of times one hazard type is triggered by other hazard types, or itself). The 21 different hazards are then ranked based on (i) influence and (ii) sensitivity. We found, by quantification and ranking of these hazards, that: (i) The strongest influencers (those triggering the most secondary hazards) are volcanic eruptions, earthquakes and storms, which when taken together trigger almost a third of the possible hazard interactions identified; (ii) The most sensitive hazards (those being triggered by the most primary hazards) are identified to be landslides, volcanic eruptions and floods; (iii) When sensitivity rankings are adjusted to take into account the differential likelihoods of different secondary hazards being triggered, the most sensitive hazards are found to be landslides, floods, earthquakes and ground heave. We believe that by determining the strongest influencing and the most sensitive hazards for specific spatial areas, the allocation of resources for mitigation measures might be done more effectively.

  16. Changing tides: Adaptive monitoring, assessment, and management of pharmaceutical hazards in the environment through time.

    PubMed

    Gaw, Sally; Brooks, Bryan W

    2016-04-01

    Pharmaceuticals are ubiquitous contaminants in aquatic ecosystems. Adaptive monitoring, assessment, and management programs will be required to reduce the environmental hazards of pharmaceuticals of concern. Potentially underappreciated factors that drive the environmental dose of pharmaceuticals include regulatory approvals, marketing campaigns, pharmaceutical subsidies and reimbursement schemes, and societal acceptance. Sales data for 5 common antidepressants (duloxetine [Cymbalta], escitalopram [Lexapro], venlafaxine [Effexor], bupropion [Wellbutrin], and sertraline [Zoloft]) in the United States from 2004 to 2008 were modeled to explore how environmental hazards in aquatic ecosystems changed after patents were obtained or expired. Therapeutic hazard ratios for Effexor and Lexapro did not exceed 1; however, the therapeutic hazard ratio for Zoloft declined whereas the therapeutic hazard ratio for Cymbalta increased as a function of patent protection and sale patterns. These changes in therapeutic hazard ratios highlight the importance of considering current and future drivers of pharmaceutical use when prioritizing pharmaceuticals for water quality monitoring programs. When urban systems receiving discharges of environmental contaminants are examined, water quality efforts should identify, prioritize, and select target analytes presently in commerce for effluent monitoring and surveillance.

  17. Changing tides: Adaptive monitoring, assessment, and management of pharmaceutical hazards in the environment through time.

    PubMed

    Gaw, Sally; Brooks, Bryan W

    2016-04-01

    Pharmaceuticals are ubiquitous contaminants in aquatic ecosystems. Adaptive monitoring, assessment, and management programs will be required to reduce the environmental hazards of pharmaceuticals of concern. Potentially underappreciated factors that drive the environmental dose of pharmaceuticals include regulatory approvals, marketing campaigns, pharmaceutical subsidies and reimbursement schemes, and societal acceptance. Sales data for 5 common antidepressants (duloxetine [Cymbalta], escitalopram [Lexapro], venlafaxine [Effexor], bupropion [Wellbutrin], and sertraline [Zoloft]) in the United States from 2004 to 2008 were modeled to explore how environmental hazards in aquatic ecosystems changed after patents were obtained or expired. Therapeutic hazard ratios for Effexor and Lexapro did not exceed 1; however, the therapeutic hazard ratio for Zoloft declined whereas the therapeutic hazard ratio for Cymbalta increased as a function of patent protection and sale patterns. These changes in therapeutic hazard ratios highlight the importance of considering current and future drivers of pharmaceutical use when prioritizing pharmaceuticals for water quality monitoring programs. When urban systems receiving discharges of environmental contaminants are examined, water quality efforts should identify, prioritize, and select target analytes presently in commerce for effluent monitoring and surveillance. PMID:26412644

  18. Crossing Hazard Functions in Common Survival Models

    PubMed Central

    Zhang, Jiajia; Peng, Yingwei

    2010-01-01

    Crossing hazard functions have extensive applications in modeling survival data. However, existing studies in the literature mainly focus on comparing crossed hazard functions and estimating the time at which the hazard functions cross, and there is little theoretical work on conditions under which hazard functions from a model will have a crossing. In this paper, we investigate crossing status of hazard functions from the proportional hazards (PH) model, the accelerated hazard (AH) model, and the accelerated failure time (AFT) model. We provide and prove conditions under which the hazard functions from the AH and the AFT models have no crossings or a single crossing. A few examples are also provided to demonstrate how the conditions can be used to determine crossing status of hazard functions from the three models. PMID:20613974

  19. INTERNAL HAZARDS ANALYSIS FOR LICENSE APPLICATION

    SciTech Connect

    R.J. Garrett

    2005-02-17

    The purpose of this internal hazards analysis is to identify and document the internal hazards and potential initiating events associated with preclosure operations of the repository at Yucca Mountain. Internal hazards are those hazards presented by the operation of the facility and by its associated processes that can potentially lead to a radioactive release or cause a radiological hazard. In contrast to external hazards, internal hazards do not involve natural phenomena and external man-made hazards. This internal hazards analysis was performed in support of the preclosure safety analysis and the License Application for the Yucca Mountain Project. The methodology for this analysis provides a systematic means to identify internal hazards and potential initiating events that may result in a radiological hazard or radiological release during the repository preclosure period. These hazards are documented in tables of potential internal hazards and potential initiating events (Section 6.6) for input to the repository event sequence categorization process. The results of this analysis will undergo further screening and analysis based on the criteria that apply to the performance of event sequence analyses for the repository preclosure period. The evolving design of the repository will be re-evaluated periodically to ensure that internal hazards that have not been previously evaluated are identified.

  20. Mercury as a health hazard.

    PubMed

    Curtis, H A; Ferguson, S D; Kell, R L; Samuel, A H

    1987-03-01

    Pink disease has virtually disappeared since teething powders were withdrawn. We describe a case in a boy who was exposed to metallic mercury vapour. We discuss the potential health hazard of spilled elemental mercury in the house and the difficulties of removing it from the environment.

  1. Electrocution Hazards on the Farm

    MedlinePlus

    ... by overhead power lines, standby generators, and general operating procedures of electrical systems at the farm work site. Electrocution hazards The ... electricity generated by a farm operation’s emergency power system from entering the ... operating precautions, equipment can come in contact with electrical ...

  2. Chemical hazards in the organisation.

    PubMed

    Winder, Chris

    2012-01-01

    The use of hazardous chemicals in organisations represents a substantial risk to occupational health, safety and the environment (OHSE). Organisational directors and managers have a responsibility to provide and maintain organisational management systems that manage these risks. The risk management approach of establishing organisational considerations, identifying chemical hazards (health and environmental), assessing and controlling risks and evaluating management activities has become the de facto means of managing organisational hazards in general and may be satisfactorily applied to the management of chemicals in the organisation. The Globally Harmonized System for the Classification and Labelling of Chemicals (GHS) is now at the forefront of major regulatory issues facing the chemicals manufacturing industry and downstream users of chemicals. The GHS offers one system for the classification of all dangerous, toxic and environmental (ecotoxic) effects of chemicals. Organisations should develop occupational health, safety and environment (OHSE) management systems which contain programs and procedures that contain systems for inventory control, hazard communication, competency training, risk assessment and control, transport and storage, monitoring and health surveillance, chemical emergencies (including accident investigation), waste minimisation and disposal, record keeping and management system review. PMID:22945564

  3. Title III hazardous air pollutants

    SciTech Connect

    Todd, R.

    1995-12-31

    The author presents an overview of the key provisions of Title III of the Clean Air Act Amendments of 1990. The key provisions include the following: 112(b) -- 189 Hazardous Air Pollutants (HAP); 112(a) -- Major Source: 10 TPY/25 TPY; 112(d) -- Application of MACT; 112(g) -- Modifications; 112(I) -- State Program; 112(j) -- The Hammer; and 112(r) -- Accidental Release Provisions.

  4. Modeling lahar behavior and hazards

    USGS Publications Warehouse

    Manville, Vernon; Major, Jon J.; Fagents, Sarah A.

    2013-01-01

    Lahars are highly mobile mixtures of water and sediment of volcanic origin that are capable of traveling tens to > 100 km at speeds exceeding tens of km hr-1. Such flows are among the most serious ground-based hazards at many volcanoes because of their sudden onset, rapid advance rates, long runout distances, high energy, ability to transport large volumes of material, and tendency to flow along existing river channels where populations and infrastructure are commonly concentrated. They can grow in volume and peak discharge through erosion and incorporation of external sediment and/or water, inundate broad areas, and leave deposits many meters thick. Furthermore, lahars can recur for many years to decades after an initial volcanic eruption, as fresh pyroclastic material is eroded and redeposited during rainfall events, resulting in a spatially and temporally evolving hazard. Improving understanding of the behavior of these complex, gravitationally driven, multi-phase flows is key to mitigating the threat to communities at lahar-prone volcanoes. However, their complexity and evolving nature pose significant challenges to developing the models of flow behavior required for delineating their hazards and hazard zones.

  5. Poor People as Environmental Hazards.

    ERIC Educational Resources Information Center

    Douw, John

    1979-01-01

    In the United States Court of Appeals decision which ruled against New York City's plan to build 160 units of public housing in its West Side Urban Renewal Area, low income people were viewed as a threat to the environment in the same way as more familiar kinds of hazards protected against by federal environmental law. (Author/EB)

  6. Proportional Hazards Models of Graduation

    ERIC Educational Resources Information Center

    Chimka, Justin R.; Reed-Rhoads, Teri; Barker, Kash

    2008-01-01

    Survival analysis is a statistical tool used to describe the duration between events. Many processes in medical research, engineering, and economics can be described using survival analysis techniques. This research involves studying engineering college student graduation using Cox proportional hazards models. Among male students with American…

  7. Medical waste: a minimal hazard.

    PubMed

    Keene, J H

    1991-11-01

    Medical waste is a subset of municipal waste, and regulated medical waste comprises less than 1% of the total municipal waste volume in the United States. As part of the overall waste stream, medical waste does contribute in a relative way to the aesthetic damage of the environment. Likewise, some small portion of the total release of hazardous chemicals and radioactive materials is derived from medical wastes. These comments can be made about any generated waste, regulated or unregulated. Healthcare professionals, including infection control personnel, microbiologists, public health officials, and others, have unsuccessfully argued that there is no evidence that past methods of treatment and disposal of regulated medical waste constitute any public health hazard. Historically, discovery of environmental contamination by toxic chemical disposal has followed assurances that the material was being disposed of in a safe manner. Therefore, a cynical public and its elected officials have demanded proof that the treatment and disposal of medical waste (i.e., infectious waste) do not constitute a public health hazard. Existent studies on municipal waste provide that proof. In order to argue that the results of these municipal waste studies are demonstrative of the minimal potential infectious environmental impact and lack of public health hazard associated with medical waste, we must accept the following: that the pathogens are the same whether they come from the hospital or the community, and that the municipal waste studied contained waste materials we now define as regulated medical waste.(ABSTRACT TRUNCATED AT 250 WORDS)

  8. 77 FR 17573 - Hazard Communication

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-03-26

    ... 1983 and covered the manufacturing sector of industry (48 FR 53280, Nov. 25, 1983). (Please note: The... where employees are potentially exposed to hazardous chemicals (52 FR 31852, Aug. 24, 1987). Although... actions, the rule has been fully enforced in all industries regulated by OSHA since March 17, 1989 (54...

  9. Tephra transport, sedimentation and hazards

    NASA Astrophysics Data System (ADS)

    Volentik, Alain C. M.

    Tephra deposits are one of the possible outcomes of explosive volcanic eruptions and are the result of vertical settling of volcanic particles that have been expelled from the volcanic vent into the atmosphere, following magma fragmentation within the volcanic conduit. Tephra fallout represents the main volcanic hazard to populated areas and critical facilities. Therefore, it is crucial to better understand processes that lead to tephra transport, sedimentation and hazards. In this study, and based on detailed mapping and sampling of the tephra deposit of the 2450BP Plinian eruption of Pululagua volcano (Ecuador), I investigate tephra deposits through a variety of approaches, including empirical and analytical modeling of tephra thickness and grain size data to infer important eruption source parameters (e.g. column height, total mass ejected, total grain size distribution of the deposit). I also use a statistical approach (smoothed bootstrap with replacement method) to assess the uncertainty in the eruptive parameters. The 2450BP Pululagua volcanic plume dynamics were also explored through detailed grain size analysis and 1D modeling of tephra accumulation. Finally, I investigate the influence of particle shape on tephra accumulation on the ground through a quantitative and comprehensive study of the shape of volcanic ash. As the global need for energy is expected to grow in the future, many future natural hazard studies will likely involve the assessment of volcanic hazards at critical facilities, including nuclear power plants. I address the potential hazards from tephra fallout, pyroclastic flows and lahars for the Bataan Nuclear Power Plant (Philippines) posed by three nearby volcanoes capable of impacting the site during an explosive eruption. I stress the need for good constraints (stratigraphic analysis and events dating) on past eruptive events to better quantify the probability of future events at potentially active volcanoes, the need for probabilistic

  10. Portable sensor for hazardous waste

    SciTech Connect

    Piper, L.G.; Hunter, A.J.R.; Fraser, M.E.; Davis, S.J.

    1996-12-31

    We are part-way through the second phase of a 4-year program designed to develop a portable monitor for sensitive hazardous waste detection. The ultimate goal of the program is to develop our concept to the prototype instrument level. Our monitor will be a compact, portable instrument that will allow real-time, in situ, monitoring of hazardous wastes. This instrument will be able to provide the means for rapid field screening of hazardous waste sites to map the areas of greatest contamination. Remediation efforts can then focus on these areas. Our analysis approach is to excite atomic and molecular fluorescence by the technique of active nitrogen energy transfer (ANET). The active nitrogen is made in a dielectric-barrier (D-B) discharge in nitrogen at atmospheric pressure. Only a few emission lines or bands are excited for each hazardous species, so spectral resolution requirements are greatly simplified over those of other spectroscopic techniques. The D-B discharge is compact, 1 to 2 cm in diameter and 1 to 10 cm long. Furthermore, the discharge power requirements are quite modest, so that the unit can be powered by batteries. Thus an instrument based on ANET can readily be made portable. Our results indicate that ANET is a very sensitive technique for monitoring heavy metals and chlorinated hydrocarbons. We have demonstrated an overall detection sensitivity for most species that is at or below ppb levels. ANET alone, however, appears to be most successful in treating hazardous species that have been atomized. We are therefore developing a hybrid technique which combines a miniature, solid-state laser for sample collection and vaporization with ANET for subsequent detection. This approach requires no special sample preparation, can operate continuously, and lends itself well to compact packaging.

  11. The Integrated Hazard Analysis Integrator

    NASA Technical Reports Server (NTRS)

    Morris, A. Terry; Massie, Michael J.

    2009-01-01

    Hazard analysis addresses hazards that arise in the design, development, manufacturing, construction, facilities, transportation, operations and disposal activities associated with hardware, software, maintenance, operations and environments. An integrated hazard is an event or condition that is caused by or controlled by multiple systems, elements, or subsystems. Integrated hazard analysis (IHA) is especially daunting and ambitious for large, complex systems such as NASA s Constellation program which incorporates program, systems and element components that impact others (International Space Station, public, International Partners, etc.). An appropriate IHA should identify all hazards, causes, controls and verifications used to mitigate the risk of catastrophic loss of crew, vehicle and/or mission. Unfortunately, in the current age of increased technology dependence, there is the tendency to sometimes overlook the necessary and sufficient qualifications of the integrator, that is, the person/team that identifies the parts, analyzes the architectural structure, aligns the analysis with the program plan and then communicates/coordinates with large and small components, each contributing necessary hardware, software and/or information to prevent catastrophic loss. As viewed from both Challenger and Columbia accidents, lack of appropriate communication, management errors and lack of resources dedicated to safety were cited as major contributors to these fatalities. From the accident reports, it would appear that the organizational impact of managers, integrators and safety personnel contributes more significantly to mission success and mission failure than purely technological components. If this is so, then organizations who sincerely desire mission success must put as much effort in selecting managers and integrators as they do when designing the hardware, writing the software code and analyzing competitive proposals. This paper will discuss the necessary and

  12. Hemoglobin Screening Independently Predicts All-Cause Mortality.

    PubMed

    Fulks, Michael; Dolan, Vera F; Stout, Robert L

    2015-01-01

    Objective .- Determine if the addition of hemoglobin testing improves risk prediction for life insurance applicants. Method .- Hemoglobin results for insurance applicants tested from 1993 to 2007, with vital status determined by Social Security Death Master File follow-up in 2011, were analyzed by age and sex with and without accounting for the contribution of other test results. Results .- Hemoglobin values ≤12.0 g/dL (and possibly ≤13.0 g/dL) in females age 50+ (but not age <50) and hemoglobin values ≤13.0 g/dL in all males are associated with progressively increasing mortality risk independent of the contribution of other test values. Increased risk is also noted for hemoglobin values >15.0 g/dL (and possibly >14.0 g/dL) for all females and for hemoglobin values >16.0 g/dL for males. Conclusion .- Hemoglobin testing can add additional independent risk assessment to that obtained from other laboratory testing, BP and build in this relatively healthy insurance applicant population. Multiple studies support this finding at older ages, but data (and the prevalence of diseases impacting hemoglobin levels) are limited at younger ages. PMID:27584842

  13. Hemoglobin Screening Independently Predicts All-Cause Mortality.

    PubMed

    Fulks, Michael; Dolan, Vera F; Stout, Robert L

    2015-01-01

    Objective .- Determine if the addition of hemoglobin testing improves risk prediction for life insurance applicants. Method .- Hemoglobin results for insurance applicants tested from 1993 to 2007, with vital status determined by Social Security Death Master File follow-up in 2011, were analyzed by age and sex with and without accounting for the contribution of other test results. Results .- Hemoglobin values ≤12.0 g/dL (and possibly ≤13.0 g/dL) in females age 50+ (but not age <50) and hemoglobin values ≤13.0 g/dL in all males are associated with progressively increasing mortality risk independent of the contribution of other test values. Increased risk is also noted for hemoglobin values >15.0 g/dL (and possibly >14.0 g/dL) for all females and for hemoglobin values >16.0 g/dL for males. Conclusion .- Hemoglobin testing can add additional independent risk assessment to that obtained from other laboratory testing, BP and build in this relatively healthy insurance applicant population. Multiple studies support this finding at older ages, but data (and the prevalence of diseases impacting hemoglobin levels) are limited at younger ages.

  14. Updated Colombian Seismic Hazard Map

    NASA Astrophysics Data System (ADS)

    Eraso, J.; Arcila, M.; Romero, J.; Dimate, C.; Bermúdez, M. L.; Alvarado, C.

    2013-05-01

    The Colombian seismic hazard map used by the National Building Code (NSR-98) in effect until 2009 was developed in 1996. Since then, the National Seismological Network of Colombia has improved in both coverage and technology providing fifteen years of additional seismic records. These improvements have allowed a better understanding of the regional geology and tectonics which in addition to the seismic activity in Colombia with destructive effects has motivated the interest and the need to develop a new seismic hazard assessment in this country. Taking advantage of new instrumental information sources such as new broad band stations of the National Seismological Network, new historical seismicity data, standardized global databases availability, and in general, of advances in models and techniques, a new Colombian seismic hazard map was developed. A PSHA model was applied. The use of the PSHA model is because it incorporates the effects of all seismic sources that may affect a particular site solving the uncertainties caused by the parameters and assumptions defined in this kind of studies. First, the seismic sources geometry and a complete and homogeneous seismic catalog were defined; the parameters of seismic rate of each one of the seismic sources occurrence were calculated establishing a national seismotectonic model. Several of attenuation-distance relationships were selected depending on the type of seismicity considered. The seismic hazard was estimated using the CRISIS2007 software created by the Engineering Institute of the Universidad Nacional Autónoma de México -UNAM (National Autonomous University of Mexico). A uniformly spaced grid each 0.1° was used to calculate the peak ground acceleration (PGA) and response spectral values at 0.1, 0.2, 0.3, 0.5, 0.75, 1, 1.5, 2, 2.5 and 3.0 seconds with return periods of 75, 225, 475, 975 and 2475 years. For each site, a uniform hazard spectrum and exceedance rate curves were calculated. With the results, it is

  15. The hazards of the changing hazard of dialysis modalities.

    PubMed

    Argyropoulos, Christos P; Unruh, Mark L

    2014-11-01

    The impact of the dialysis modality on patient survival has received considerable epidemiological attention, with most studies suggesting an early benefit favoring peritoneal dialysis over hemodialysis. Kumar et al. report the relative outcomes of the two modalities in incident patients followed by an accountable care organization. Using advanced statistical techniques for non-proportional hazards survival models, the authors corroborate the early benefit of peritoneal dialysis for the first 3 years and equivalent outcomes thereafter.

  16. Seismic hazard assessment: Issues and alternatives

    USGS Publications Warehouse

    Wang, Z.

    2011-01-01

    Seismic hazard and risk are two very important concepts in engineering design and other policy considerations. Although seismic hazard and risk have often been used inter-changeably, they are fundamentally different. Furthermore, seismic risk is more important in engineering design and other policy considerations. Seismic hazard assessment is an effort by earth scientists to quantify seismic hazard and its associated uncertainty in time and space and to provide seismic hazard estimates for seismic risk assessment and other applications. Although seismic hazard assessment is more a scientific issue, it deserves special attention because of its significant implication to society. Two approaches, probabilistic seismic hazard analysis (PSHA) and deterministic seismic hazard analysis (DSHA), are commonly used for seismic hazard assessment. Although PSHA has been pro-claimed as the best approach for seismic hazard assessment, it is scientifically flawed (i.e., the physics and mathematics that PSHA is based on are not valid). Use of PSHA could lead to either unsafe or overly conservative engineering design or public policy, each of which has dire consequences to society. On the other hand, DSHA is a viable approach for seismic hazard assessment even though it has been labeled as unreliable. The biggest drawback of DSHA is that the temporal characteristics (i.e., earthquake frequency of occurrence and the associated uncertainty) are often neglected. An alternative, seismic hazard analysis (SHA), utilizes earthquake science and statistics directly and provides a seismic hazard estimate that can be readily used for seismic risk assessment and other applications. ?? 2010 Springer Basel AG.

  17. Flood hazard, vulnerability, and risk assessment for human life

    NASA Astrophysics Data System (ADS)

    Pan, T.; Chang, T.; Lai, J.; Hsieh, M.; Tan, Y.; Lin, Y.

    2011-12-01

    Flood risk assessment is an important issue for the countries suffering tropical cyclones and monsoon. Taiwan is located in the hot zone of typhoon tracks in the Western Pacific. There are three to five typhoons landing Taiwan every year. Typhoons and heavy rainfalls often cause inundation disaster rising with the increase of population and the development of social economy. The purpose of this study is to carry out the flood hazard, vulnerability and risk in term of human life. Based on the concept that flood risk is composed by flood hazard and vulnerability, a inundation simulation is performed to evaluate the factors of flood hazard for human life according to base flood (100-year return period). The flood depth, velocity and rising ratio are the three factors of flood hazards. Furthermore, the factors of flood vulnerability are identified in terms of human life that are classified into two main factors, residents and environment. The sub factors related to residents are the density of population and the density of vulnerable people including elders, youngers and disabled persons. The sub factors related to environment include the the number of building floors, the locations of buildings, the and distance to rescue center. The analytic hierarchy process (AHP) is adopted to determine the weights of these factors. The risk matrix is applied to show the risk from low to high based on the evaluation of flood hazards and vulnerabilities. The Tseng-Wen River watershed is selected as the case study because a serious flood was induced by Typhoon Morakot in 2009, which produced a record-breaking rainfall of 2.361mm in 48 hours in the last 50 years. The results of assessing the flood hazard, vulnerability and risk in term of human life could improve the emergency operation for flood disaster to prepare enough relief goods and materials during typhoon landing.

  18. Ratios of internal conversion coefficients

    SciTech Connect

    Raman, S.; Ertugrul, M.; Nestor, C.W. . E-mail: CNestorjr@aol.com; Trzhaskovskaya, M.B.

    2006-03-15

    We present here a database of available experimental ratios of internal conversion coefficients for different atomic subshells measured with an accuracy of 10% or better for a number of elements in the range 26 {<=} Z {<=} 100. The experimental set involves 414 ratios for pure and 1096 ratios for mixed-multipolarity nuclear transitions in the transition energy range from 2 to 2300 keV. We give relevant theoretical ratios calculated in the framework of the Dirac-Fock method with and without regard for the hole in the atomic subshell after conversion. For comparison, the ratios obtained within the relativistic Hartree-Fock-Slater approximation are also presented. In cases where several ratios were measured for the same transition in a given isotope in which two multipolarities were involved, we present the mixing ratio {delta} {sup 2} obtained by a least squares fit.

  19. 78 FR 5822 - Proposed Flood Hazard Determinations

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-01-28

    ... SECURITY Federal Emergency Management Agency Proposed Flood Hazard Determinations AGENCY: Federal Emergency Management Agency, DHS. ACTION: Notice. SUMMARY: Comments are requested on proposed flood hazard determinations, which may include additions or modifications of any Base Flood Elevation (BFE), base flood...

  20. 77 FR 18846 - Proposed Flood Hazard Determinations

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-03-28

    ... SECURITY Federal Emergency Management Agency Proposed Flood Hazard Determinations AGENCY: Federal Emergency Management Agency, DHS. ACTION: Notice. SUMMARY: Comments are requested on proposed flood hazard determinations, which may include additions or modifications of any Base Flood Elevation (BFE), base flood...

  1. 77 FR 18844 - Proposed Flood Hazard Determinations

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-03-28

    ... SECURITY Federal Emergency Management Agency Proposed Flood Hazard Determinations AGENCY: Federal Emergency Management Agency, DHS. ACTION: Notice. SUMMARY: Comments are requested on proposed flood hazard determinations, which may include additions or modifications of any Base Flood Elevation (BFE), base flood...

  2. 77 FR 18841 - Proposed Flood Hazard Determinations

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-03-28

    ... SECURITY Federal Emergency Management Agency Proposed Flood Hazard Determinations AGENCY: Federal Emergency Management Agency, DHS. ACTION: Notice. SUMMARY: Comments are requested on proposed flood hazard determinations, which may include additions or modifications of any Base Flood Elevation (BFE), base flood...

  3. 78 FR 5826 - Proposed Flood Hazard Determinations

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-01-28

    ... SECURITY Federal Emergency Management Agency Proposed Flood Hazard Determinations AGENCY: Federal Emergency Management Agency, DHS. ACTION: Notice. SUMMARY: Comments are requested on proposed flood hazard determinations, which may include additions or modifications of any Base Flood Elevation (BFE), base flood...

  4. 78 FR 5824 - Proposed Flood Hazard Determinations

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-01-28

    ... SECURITY Federal Emergency Management Agency Proposed Flood Hazard Determinations AGENCY: Federal Emergency Management Agency, DHS. ACTION: Notice. SUMMARY: Comments are requested on proposed flood hazard determinations, which may include additions or modifications of any Base Flood Elevation (BFE), base flood...

  5. 78 FR 49278 - Proposed Flood Hazard Determinations

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-08-13

    ... SECURITY Federal Emergency Management Agency Proposed Flood Hazard Determinations AGENCY: Federal Emergency Management Agency, DHS. ACTION: Notice. SUMMARY: Comments are requested on proposed flood hazard determinations, which may include additions or modifications of any Base Flood Elevation (BFE), base flood...

  6. 78 FR 21143 - Proposed Flood Hazard Determinations

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-04-09

    ... SECURITY Federal Emergency Management Agency Proposed Flood Hazard Determinations AGENCY: Federal Emergency Management Agency, DHS. ACTION: Notice. SUMMARY: Comments are requested on proposed flood hazard determinations, which may include additions or modifications of any Base Flood Elevation (BFE), base flood...

  7. 77 FR 18839 - Proposed Flood Hazard Determinations

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-03-28

    ... SECURITY Federal Emergency Management Agency Proposed Flood Hazard Determinations AGENCY: Federal Emergency Management Agency, DHS. ACTION: Notice. SUMMARY: Comments are requested on proposed flood hazard determinations, which may include additions or modifications of any Base Flood Elevation (BFE), base flood...

  8. 77 FR 18842 - Proposed Flood Hazard Determinations

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-03-28

    ... SECURITY Federal Emergency Management Agency Proposed Flood Hazard Determinations AGENCY: Federal Emergency Management Agency, DHS. ACTION: Notice. SUMMARY: Comments are requested on proposed flood hazard determinations, which may include additions or modifications of any Base Flood Elevation (BFE), base flood...

  9. 77 FR 18835 - Proposed Flood Hazard Determinations

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-03-28

    ... SECURITY Federal Emergency Management Agency Proposed Flood Hazard Determinations AGENCY: Federal Emergency Management Agency, DHS. ACTION: Notice. SUMMARY: Comments are requested on proposed flood hazard determinations, which may include additions or modifications of any Base Flood Elevation (BFE), base flood...

  10. 78 FR 49277 - Proposed Flood Hazard Determinations

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-08-13

    ... SECURITY Federal Emergency Management Agency Proposed Flood Hazard Determinations AGENCY: Federal Emergency Management Agency, DHS. ACTION: Notice. SUMMARY: Comments are requested on proposed flood hazard determinations, which may include additions or modifications of any Base Flood Elevation (BFE), base flood...

  11. 77 FR 18837 - Proposed Flood Hazard Determinations

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-03-28

    ... SECURITY Federal Emergency Management Agency Proposed Flood Hazard Determinations AGENCY: Federal Emergency Management Agency, DHS. ACTION: Notice. SUMMARY: Comments are requested on proposed flood hazard determinations, which may include additions or modifications of any Base Flood Elevation (BFE), base flood...

  12. Safety VI: Hazards in Physics Laboratories.

    ERIC Educational Resources Information Center

    Orton, R. J. J.

    1985-01-01

    Summarizes advice from the Laboratory Safeguards Subcommittee of the Association for Science Education related to flames and heat, hazardous chemicals, electricity and dangerous voltages, and mechanical hazards. Knowledge is cited as the key to preventing accidents in physics laboratories. (DH)

  13. Models of volcanic eruption hazards

    SciTech Connect

    Wohletz, K.H.

    1992-01-01

    Volcanic eruptions pose an ever present but poorly constrained hazard to life and property for geothermal installations in volcanic areas. Because eruptions occur sporadically and may limit field access, quantitative and systematic field studies of eruptions are difficult to complete. Circumventing this difficulty, laboratory models and numerical simulations are pivotal in building our understanding of eruptions. For example, the results of fuel-coolant interaction experiments show that magma-water interaction controls many eruption styles. Applying these results, increasing numbers of field studies now document and interpret the role of external water eruptions. Similarly, numerical simulations solve the fundamental physics of high-speed fluid flow and give quantitative predictions that elucidate the complexities of pyroclastic flows and surges. A primary goal of these models is to guide geologists in searching for critical field relationships and making their interpretations. Coupled with field work, modeling is beginning to allow more quantitative and predictive volcanic hazard assessments.

  14. Landslide Hazards - A National Threat

    USGS Publications Warehouse

    ,

    2005-01-01

    Landslides occur and can cause damage in all 50 States. Severe storms, earthquakes, volcanic activity, coastal wave attack, and wildfires can cause widespread slope instability. Landslide danger may be high even as emergency personnel are providing rescue and recovery services. To address landslide hazards, several questions must be considered: Where and when will landslides occur? How big will the landslides be? How fast and how far will they move? What areas will the landslides affect or damage? How frequently do landslides occur in a given area? Answers to these questions are needed to make accurate landslide hazard maps and forecasts of landslide occurrence, and to provide information on how to avoid or mitigate landslide impacts. The U.S. Geological Survey develops methods to answer these questions to help protect U.S. communities from the dangers of landslides.

  15. Magnetohydrodynamics and its hazard assessment

    NASA Astrophysics Data System (ADS)

    Chan, W.-T.

    1981-11-01

    Potential occupational and environmental hazards of a typical combined open-cycle MHD/steam cycle power plant are critically assessed on the basis of direct/indirect research information. Among the potential occupational hazards, explosion at the coal feed system or at the superconducting magnet; combustor rupture in a confined pit; high intensity dc magnetic field exposure at the channel; and combustion products leakage from the pressurized systems are of primary concern. While environmental emissions of SO(x), NO(x) and fine particulates are considered under control in experimental scale, control effectiveness at high capacity operation remains uncertain. Gaseous emission of some highly toxic trace elements including radioactive species may be of concern without gas cleaning device in the MHD design.

  16. Hazardous occupations in Great Britain.

    PubMed

    Roberts, Stephen E

    2002-08-17

    The aim of this study was to investigate the most hazardous of all occupations in Great Britain. The causes of all deaths in British merchant seafaring and trawler fishing, traditionally the two most dangerous occupations, were established for the period between 1976 and 1995 and compared with official mortality statistics for other occupations. Fishermen were 52.4 times more likely to have a fatal accident at work (95% CI 42.9-63.8), and seafarers were 26.2 times more likely (19.8-34.7), compared with other British workers. Although the number of work-related deaths has decreased in recent decades, in relative terms the occupations of fishing and seafaring remain as hazardous as before. If mortality rates in these occupations are to decrease, unsafe working practices, especially unnecessary operations in treacherous conditions, should be reduced. PMID:12241660

  17. Earthquake hazards: a national threat

    USGS Publications Warehouse

    ,

    2006-01-01

    Earthquakes are one of the most costly natural hazards faced by the Nation, posing a significant risk to 75 million Americans in 39 States. The risks that earthquakes pose to society, including death, injury, and economic loss, can be greatly reduced by (1) better planning, construction, and mitigation practices before earthquakes happen, and (2) providing critical and timely information to improve response after they occur. As part of the multi-agency National Earthquake Hazards Reduction Program, the U.S. Geological Survey (USGS) has the lead Federal responsibility to provide notification of earthquakes in order to enhance public safety and to reduce losses through effective forecasts based on the best possible scientific information.

  18. Robots Working with Hazardous Materials

    SciTech Connect

    Amai, W.; Fahrenholtz, J.

    1999-01-06

    While many research and development activities take place at Sandia National Laboratories' Intelligent Systems and Robotics Center (ISRC), where the "rubber meets the road" is in the ISRC'S delivered systems. The ISRC has delivered several systems over the last few years that handle hazardous materials on a daily basis, and allow human workers to move to a safer, supervisory role than the "hands-on" operations that they used to perform. The ISRC at Sandia performs a large range of research and development activities, including development and delivery of one-of-a-kind robotic systems for use with hazardous materials. Our mission is to create systems for operations where people can't or don't want to perform the operations by hand, and the systems described in this article are several of our first-of-a-kind deliveries to achieve that mission.

  19. [Occupational hazards and bladder cancer].

    PubMed

    Nizamova, R S

    1991-01-01

    Occupational exposure to health hazards was studied in 258 industrial workers who had developed cancer of the bladder against 454 matched controls. All the test subjects and controls were residents of the Tambov Province centers of chemical industry. Statistical significance (relative risk-4.7) was established for exposure to aromatic amines. For those contacting with aniline dyes the relative risk (RR) made up 2.4. The risk to develop bladder cancer in powder shops (RR-3.2) was attributed to the hazards of dyes and diphenylamine. In leather-shoe and textile industry the exposure to dyes was not safe (RR-6.1), neither was it to chemicals, oil products, pesticides, overheating (RR-3.2, 1.6, 3.2 and 2.9, respectively). It is stated that in line with a significant risk to develop bladder cancer at exposure to aromatic amines there exist a number of occupational factors contributing to this risk.

  20. Hazardous solid waste from agriculture.

    PubMed Central

    Loehr, R C

    1978-01-01

    Large quantities of food processing, crop, forestry, and animal solid wastes are generated in the United States each year. The major components of these wastes are biodegradable. However, they also contain components such as nitrogen, human and animal pathogens, medicinals, feed additives, salts, and certain metals, that under uncontrolled conditions can be detrimental to aquatic, plant, animal, or human life. The most common method of disposal of these wastes is application to the land. Thus the major pathways for transmission of hazards are from and through the soil. Use of these wastes as animal feed also can be a pathway. While at this time there are no crises associated with hazardous materials in agricultural solid wastes, the potential for problems should not be underestimated. Manpower and financial support should be provided to obtain more detailed information in this area, esepcially to better delineate transport and dispersal and to determine and evaluate risks. PMID:367770

  1. Occupational health hazards in mining: an overview.

    PubMed

    Donoghue, A M

    2004-08-01

    This review article outlines the physical, chemical, biological, ergonomic and psychosocial occupational health hazards of mining and associated metallurgical processes. Mining remains an important industrial sector in many parts of the world and although substantial progress has been made in the control of occupational health hazards, there remains room for further risk reduction. This applies particularly to traumatic injury hazards, ergonomic hazards and noise. Vigilance is also required to ensure exposures to coal dust and crystalline silica remain effectively controlled.

  2. Occupational health hazards in mining: an overview.

    PubMed

    Donoghue, A M

    2004-08-01

    This review article outlines the physical, chemical, biological, ergonomic and psychosocial occupational health hazards of mining and associated metallurgical processes. Mining remains an important industrial sector in many parts of the world and although substantial progress has been made in the control of occupational health hazards, there remains room for further risk reduction. This applies particularly to traumatic injury hazards, ergonomic hazards and noise. Vigilance is also required to ensure exposures to coal dust and crystalline silica remain effectively controlled. PMID:15289583

  3. Computer Model Locates Environmental Hazards

    NASA Technical Reports Server (NTRS)

    2008-01-01

    Catherine Huybrechts Burton founded San Francisco-based Endpoint Environmental (2E) LLC in 2005 while she was a student intern and project manager at Ames Research Center with NASA's DEVELOP program. The 2E team created the Tire Identification from Reflectance model, which algorithmically processes satellite images using turnkey technology to retain only the darkest parts of an image. This model allows 2E to locate piles of rubber tires, which often are stockpiled illegally and cause hazardous environmental conditions and fires.

  4. Submarine landslides hazard offshore Israel

    NASA Astrophysics Data System (ADS)

    Katz, Oded

    2016-04-01

    Submarine landslides pose significant natural hazards. They can damage seafloor infrastructure, such as that used to recover oil and gas or seafloor telecommunication cables, and even generate tsunamis. We recently mapped 447 submarine landslides across the east Mediterranean continental slope, offshore Israel (hereafter the studied area). The mapped landslides are found at water depths of 130 m to 1,000 m and their volume ranges 10-5 - 100 km3. Landslide scars are typically related to a critical slope angle of >4° . Landslides at the northern part of the studied area are spatially associated with fault scarps and are smaller than the ones on the southern part. In this work we evaluate the potential hazard to population and to on- and off- shore facilities posed by submarine landslides across the studied area. We integrate three independent probabilities: (1) the probability for a landslide event of a given volume, based on the size distribution of the mapped landslides; (2) the probability for a landslide event in a given time, based on the reoccurrence time of triggering earthquakes with M >7, and on a 50,000 years general time frame derived from submarine landslides identified across the Mediterranean Sea; (3) the probability for a landslide event in a given area, based on the distribution of slopes exceeding the critical angle. Overall, the fraction of potentially destructive landslides (size > 0.1 km3) is small, 0.05. Thus, considering typical planning time scales of less than 100 years, the calculated hazard is only moderate. The small fraction of landslides with tsunamogenic potential (size > 1 km3), suggests that the hazard for landslide-induced tsunamis along the open slope part of the studied area is small. Landslides in the southern part of the studied area are larger and thus present a somewhat bigger potential source of tsunami waves.

  5. Volcanic hazards and aviation safety

    USGS Publications Warehouse

    Casadevall, Thomas J.; Thompson, Theodore B.; Ewert, John W.; ,

    1996-01-01

    An aeronautical chart was developed to determine the relative proximity of volcanoes or ash clouds to the airports and flight corridors that may be affected by volcanic debris. The map aims to inform and increase awareness about the close spatial relationship between volcanoes and aviation operations. It shows the locations of the active volcanoes together with selected aeronautical navigation aids and great-circle routes. The map mitigates the threat that volcanic hazards pose to aircraft and improves aviation safety.

  6. Magnetic storms and induction hazards

    USGS Publications Warehouse

    Love, Jeffrey J.; Rigler, E. Joshua; Pulkkinen, Antti; Balch, Christopher

    2014-01-01

    Magnetic storms are potentially hazardous to the activities and technological infrastructure of modern civilization. This reality was dramatically demonstrated during the great magnetic storm of March 1989, when surface geoelectric fields, produced by the interaction of the time-varying geomagnetic field with the Earth's electrically conducting interior, coupled onto the overlying Hydro-Québec electric power grid in Canada. Protective relays were tripped, the grid collapsed, and about 9 million people were temporarily left without electricity [Bolduc, 2002].

  7. Detection device for hazardous materials

    DOEpatents

    Partin, Judy K.; Grey, Alan E.

    1994-04-05

    A detection device that is activated by the interaction of a hazardous chcal with a coating interactive with said chemical on an optical fiber thereby reducing the amount of light passing through the fiber to a light detector. A combination of optical filters separates the light into a signal beam and a reference beam which after detection, appropriate amplification, and comparison with preset internal signals, activates an alarm means if a predetermined level of contaminant is observed.

  8. Detection device for hazardous materials

    DOEpatents

    Partin, Judy K.; Grey, Alan E.

    1994-01-01

    A detection device that is activated by the interaction of a hazardous chcal with a coating interactive with said chemical on an optical fiber thereby reducing the amount of light passing through the fiber to a light detector. A combination of optical filters separates the light into a signal beam and a reference beam which after detection, appropriate amplification, and comparison with preset internal signals, activates an alarm means if a predetermined level of contaminant is observed.

  9. Chemical hazards in aeromedical aircraft.

    PubMed

    Tupper, C R

    1989-01-01

    Several potentially hazardous chemicals are required to make modern military aircraft fly. With each airevac mission, the possibility exists for structural failure of a fluid system, resulting in contamination to flight/medical crews, patients, and passengers. Aeromedical Evacuation Crewmembers (AECMs) need to be aware of the hazardous chemicals used in aircraft and areas where there is an increased risk to those in and around the aircraft. This study identified potential areas for chemical leakage, such as refuel receptacles, hydraulic reservoirs, hydraulic motors, doors, ramps, engines, and more. Further, it identified the basic first aid procedures to perform on people contaminated with jet fuel, hydraulic fluid, engine oil, fire extinguisher agents, LOX and other fluids. First aid procedures are basic and can be performed with supplies and equipment on a routine aeromedical evacuation mission, AECMs trained in a basic awareness of hazardous aircraft chemicals will result in crews better prepared to cope with the unique risks of transporting patients in a complicated military aircraft.

  10. Chemical hazards in aeromedical aircraft.

    PubMed

    Tupper, C R

    1989-01-01

    Several potentially hazardous chemicals are required to make modern military aircraft fly. With each airevac mission, the possibility exists for structural failure of a fluid system, resulting in contamination to flight/medical crews, patients, and passengers. Aeromedical Evacuation Crewmembers (AECMs) need to be aware of the hazardous chemicals used in aircraft and areas where there is an increased risk to those in and around the aircraft. This study identified potential areas for chemical leakage, such as refuel receptacles, hydraulic reservoirs, hydraulic motors, doors, ramps, engines, and more. Further, it identified the basic first aid procedures to perform on people contaminated with jet fuel, hydraulic fluid, engine oil, fire extinguisher agents, LOX and other fluids. First aid procedures are basic and can be performed with supplies and equipment on a routine aeromedical evacuation mission, AECMs trained in a basic awareness of hazardous aircraft chemicals will result in crews better prepared to cope with the unique risks of transporting patients in a complicated military aircraft. PMID:2923600

  11. Health hazards of welding fumes.

    PubMed

    Meo, Sultan A; Al-Khlaiwi, Thamir

    2003-11-01

    Even in the twenty-first century, welding is still a common and a highly skilled occupation. The hazardous agents associated with welding processes are acetylene, carbon monoxide, oxides of nitrogen, ozone, phosgene, tungsten, arsenic, beryllium, cadmium, chromium, cobalt, copper, iron, lead, manganese, nickel, silver, tin, and zinc. All welding processes involve the potential hazards for inhalation exposures that may lead to acute or chronic respiratory diseases. According to literature described earlier it has been suggested that welding fumes cause the lung function impairment, obstructive and restrictive lung disease, cough, dyspnea, rhinitis, asthma, pneumonitis, pneumoconiosis, carcinoma of the lungs. In addition, welding workers suffer from eye irritation, photokeratitis, cataract, skin irritation, erythema, pterygium, non-melanocytic skin cancer, malignant melanoma, reduced sperm count, motility and infertility. Most of the studies have been attempted previously to evaluate the effects of welding fumes. However, no collectively effort illuminating the general effects of welding fumes on different organs or systems or both in human has not been published. Therefore, the aim of this review is to gather the potential toxic effects of welding fumes documented by individual efforts and provide informations to community on hazards of welding.

  12. Asbestos products, hazards, and regulation.

    PubMed

    Castleman, Barry

    2006-01-01

    Asbestos is present in the United States in a multitude of products used in past decades, and in some products that continue to be imported and domestically produced. We have limited information on the hazards posed by some of these individual products and no information at all on most of them. Legal discovery of corporate documents has shed some light on the use of asbestos in some products and exposures from asbestos in others, sometimes adding considerably to what was in the published literature. But liability concerns have motivated corporate efforts to curtail governmental public health guidance on long-recognized hazards to workers. Liability considerations have also evidently led, in the case of asbestos brake linings, to the support of publication in the scientific literature of review articles denying in the 21st century what had been widely accepted and established in health policy in the 20th century. This report is an effort to illustrate the suppression and emergence of scientific knowledge in a climate of regulation and liability. Examples discussed are vinyl-asbestos flooring, feminine hygiene products, automotive friction materials, and asbestos contamination of other minerals such as talc and vermiculite. Global efforts to deal with the hazards of continuing marketing of asbestos products are also discussed. PMID:16878394

  13. Hazardous Compounds in Tobacco Smoke

    PubMed Central

    Talhout, Reinskje; Schulz, Thomas; Florek, Ewa; van Benthem, Jan; Wester, Piet; Opperhuizen, Antoon

    2011-01-01

    Tobacco smoke is a toxic and carcinogenic mixture of more than 5,000 chemicals. The present article provides a list of 98 hazardous smoke components, based on an extensive literature search for known smoke components and their human health inhalation risks. An electronic database of smoke components containing more than 2,200 entries was generated. Emission levels in mainstream smoke have been found for 542 of the components and a human inhalation risk value for 98 components. As components with potential carcinogenic, cardiovascular and respiratory effects have been included, the three major smoke-related causes of death are all covered by the list. Given that the currently used Hoffmann list of hazardous smoke components is based on data from the 1990s and only includes carcinogens, it is recommended that the current list of 98 hazardous components is used for regulatory purposes instead. To enable risk assessment of components not covered by this list, thresholds of toxicological concern (TTC) have been established from the inhalation risk values found: 0.0018 μg day−1 for all risks, and 1.2 μg day−1 for all risks excluding carcinogenicity, the latter being similar to previously reported inhalation TTCs. PMID:21556207

  14. 14 CFR 417.413 - Hazard areas.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 14 Aeronautics and Space 4 2014-01-01 2014-01-01 false Hazard areas. 417.413 Section 417.413... TRANSPORTATION LICENSING LAUNCH SAFETY Ground Safety § 417.413 Hazard areas. (a) General. A launch operator must define a hazard area that confines the adverse effects of a hardware system should an event occur...

  15. 14 CFR 437.55 - Hazard analysis.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 14 Aeronautics and Space 4 2013-01-01 2013-01-01 false Hazard analysis. 437.55 Section 437.55... TRANSPORTATION LICENSING EXPERIMENTAL PERMITS Safety Requirements § 437.55 Hazard analysis. (a) A permittee must... safety of property resulting from each permitted flight. This hazard analysis must— (1) Identify...

  16. 14 CFR 437.55 - Hazard analysis.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 14 Aeronautics and Space 4 2011-01-01 2011-01-01 false Hazard analysis. 437.55 Section 437.55... TRANSPORTATION LICENSING EXPERIMENTAL PERMITS Safety Requirements § 437.55 Hazard analysis. (a) A permittee must... safety of property resulting from each permitted flight. This hazard analysis must— (1) Identify...

  17. 14 CFR 437.55 - Hazard analysis.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 14 Aeronautics and Space 4 2012-01-01 2012-01-01 false Hazard analysis. 437.55 Section 437.55... TRANSPORTATION LICENSING EXPERIMENTAL PERMITS Safety Requirements § 437.55 Hazard analysis. (a) A permittee must... safety of property resulting from each permitted flight. This hazard analysis must— (1) Identify...