Attributable fraction of work accidents related to occupational noise exposure in a Southeastern city of Brazil.

PubMed

Dias, Adriano; Cordeiro, Ricardo

2007-07-01

Noise is the most frequent type of occupational exposure and can lead to both auditory and extra-auditory dysfunction as well as increasing the risk of work accidents. The purpose of this study was to estimate the attributable fraction of work accidents related to occupational noise exposure in a medium-sized city in Southeast Brazil. In this hospital-based case-control study, including 600 cases and 822 controls, the odds ratio of work accidents (controlled for several covariables) was obtained classifying occupational noise exposure into four levels and determining the prevalence at each level. Based on these data, the calculated attributable fraction was 0.3041 (95%CI: 0.2341-0.3676), i.e., 30% of work accidents in the study area were statistically associated with occupational noise exposure. The authors discuss the causes of this association and the implications for the prevention of work accidents.

Attributable causes of cancer in Japan in 2005--systematic assessment to estimate current burden of cancer attributable to known preventable risk factors in Japan.

PubMed

Inoue, M; Sawada, N; Matsuda, T; Iwasaki, M; Sasazuki, S; Shimazu, T; Shibuya, K; Tsugane, S

2012-05-01

To contribute to evidence-based policy decision making for national cancer control, we conducted a systematic assessment to estimate the current burden of cancer attributable to known preventable risk factors in Japan in 2005. We first estimated the population attributable fractions (PAFs) of each cancer attributable to known risk factors from relative risks derived primarily from Japanese pooled analyses and large-scale cohort studies and the prevalence of exposure in the period around 1990. Using nationwide vital statistics records and incidence estimates, we then estimated the attributable cancer incidence and mortality in 2005. In 2005, ≈ 55% of cancer among men was attributable to preventable risk factors in Japan. The corresponding figure was lower among women, but preventable risk factors still accounted for nearly 30% of cancer. In men, tobacco smoking had the highest PAF (30% for incidence and 35% for mortality, respectively) followed by infectious agents (23% and 23%). In women, in contrast, infectious agents had the highest PAF (18% and 19% for incidence and mortality, respectively) followed by tobacco smoking (6% and 8%). In Japan, tobacco smoking and infections are major causes of cancer. Further control of these factors will contribute to substantial reductions in cancer incidence and mortality in Japan.

Coarse particles and hospital admissions due to respiratory diseases in children. An ecological time series study.

PubMed

César, Ana Cristina Gobbo; Nascimento, Luiz Fernando

2018-06-25

Exposure to particulate matter (PM) is associated with hospitalizations due to respiratory diseases among children. An ecological time series study was carried out to identify the role of coarse fractions of particulate matter (PM10-2.5) in hospitalizations among children up to 10 years of age, in Piracicaba (SP) in the year 2015. A generalized additive model of Poisson regression was used to estimate the risk of hospitalization due to acute laryngitis and tracheitis, pneumonia, bronchitis, bronchiolitis and asthma. Lags of 0 to 7 days were considered, and the model was adjusted for the temperature and relative humidity of the air and controlled for short and long-term exposure. Proportional attributable ratios, population-attributable fractions and hospital costs were calculated with increasing concentrations of these pollutants. 638 hospitalizations were evaluated during this period, with a mean of 1.75 cases per day (standard deviation, SD = 1.86). The daily averages were 22.45 µg/m3 (SD = 13.25) for the coarse fraction (PM10-2.5) and 13.32 µg/m3 (SD = 6.38) for the fine fraction. Significant risks of PM10-2.5 exposure were only observed at lag 0, with relative risk (RR) = 1.012, and at lag 6, with RR = 1.011. An increase of 5 µg/m3 in the coarse fraction concentration implied an increase in the relative risk of hospitalizations of up to 4.8%, with an excess of 72 hospitalizations and excess expenditure of US$ 17,000 per year. This study showed the impact of coarse-fraction exposure on hospital admissions among children due to respiratory diseases.

A Systematic Approach of Employing Quality by Design Principles: Risk Assessment and Design of Experiments to Demonstrate Process Understanding and Identify the Critical Process Parameters for Coating of the Ethylcellulose Pseudolatex Dispersion Using Non-Conventional Fluid Bed Process.

PubMed

Kothari, Bhaveshkumar H; Fahmy, Raafat; Claycamp, H Gregg; Moore, Christine M V; Chatterjee, Sharmista; Hoag, Stephen W

2017-05-01

The goal of this study was to utilize risk assessment techniques and statistical design of experiments (DoE) to gain process understanding and to identify critical process parameters for the manufacture of controlled release multiparticulate beads using a novel disk-jet fluid bed technology. The material attributes and process parameters were systematically assessed using the Ishikawa fish bone diagram and failure mode and effect analysis (FMEA) risk assessment methods. The high risk attributes identified by the FMEA analysis were further explored using resolution V fractional factorial design. To gain an understanding of the processing parameters, a resolution V fractional factorial study was conducted. Using knowledge gained from the resolution V study, a resolution IV fractional factorial study was conducted; the purpose of this IV study was to identify the critical process parameters (CPP) that impact the critical quality attributes and understand the influence of these parameters on film formation. For both studies, the microclimate, atomization pressure, inlet air volume, product temperature (during spraying and curing), curing time, and percent solids in the coating solutions were studied. The responses evaluated were percent agglomeration, percent fines, percent yield, bead aspect ratio, median particle size diameter (d50), assay, and drug release rate. Pyrobuttons® were used to record real-time temperature and humidity changes in the fluid bed. The risk assessment methods and process analytical tools helped to understand the novel disk-jet technology and to systematically develop models of the coating process parameters like process efficiency and the extent of curing during the coating process.

Quantitative cancer risk assessment and local mortality burden for ambient air pollution in an eastern Mediterranean City.

PubMed

Dhaini, Hassan R; Salameh, Thérèse; Waked, Antoine; Sauvage, Stéphane; Borbon, Agnès; Formenti, Paola; Doussin, Jean-François; Locoge, Nadine; Afif, Charbel

2017-06-01

Health risks posed by ambient air pollutants to the urban Lebanese population have not been well characterized. The aim of this study is to assess cancer risk and mortality burden of non-methane hydrocarbons (NMHCs) and particulates (PM) based on two field-sampling campaigns conducted during summer and winter seasons in Beirut. Seventy NMHCs were analyzed by TD-GC-FID. PM 2.5 elemental carbon (EC) components were examined using a Lab OC-EC aerosol Analyzer, and polycyclic aromatic hydrocarbons were analyzed by GC-MS. The US EPA fraction-based approach was used to assess non-cancer hazard and cancer risk for the hydrocarbon mixture, and the UK Committee on Medical Effects of Air Pollutants (COMEAP) guidelines were followed to determine the PM 2.5 attributable mortality burden. The average cumulative cancer risk exceeded the US EPA acceptable level (10 -6 ) by 40-fold in the summer and 30-fold in the winter. Benzene was found to be the highest contributor to cancer risk (39-43%), followed by 1,3-butadiene (25-29%), both originating from traffic gasoline evaporation and combustion. The EC attributable average mortality fraction was 7.8-10%, while the average attributable number of deaths (AD) and years of life lost (YLL) were found to be 257-327 and 3086-3923, respectively. Our findings provide a baseline for future air monitoring programs, and for interventions aiming at reducing cancer risk in this population.

Cancers in Australia in 2010 attributable to and prevented by the use of combined oral contraceptives.

PubMed

Jordan, Susan J; Wilson, Louise F; Nagle, Christina M; Green, Adele C; Olsen, Catherine M; Bain, Christopher J; Pandeya, Nirmala; Whiteman, David C; Webb, Penelope M

2015-10-01

To estimate the proportion and number of cancers occurring in Australia in 2010 attributable to combined oral contraceptive pill (OCP) use. We estimated the population attributable fraction (PAF) for cancers causally associated with combined OCP use (breast, cervix), and the proportion of endometrial and ovarian cancers prevented (prevented fraction [PF]). We used standard formulae incorporating prevalence of combined OCP use in the Australian population, relative risks of cancer associated with this exposure and cancer incidence. An estimated 105 breast and 52 cervical cancers (0.7% and 6.4% of each cancer, respectively) in Australia in 2010 were attributable to current use of combined OCP. Past combined OCP use was estimated to have prevented 1,032 endometrial and 308 ovarian cancers in 2010, reducing the number of cancers that would otherwise have occurred by 31% and 19%, respectively. A small proportion of breast and cervical cancers is attributable to combined OCP use; OCP use is likely to have prevented larger numbers of endometrial and ovarian cancers. Women seeking contraceptive advice should be told of potential adverse effects, but should also be told that - along with reproductive health benefits - combined OCP use can reduce long-term risks of ovarian and endometrial cancers. © 2015 The Authors.

Impact of Dietary and Metabolic Risk Factors on Cardiovascular and Diabetes Mortality in South Asia: Analysis From the 2010 Global Burden of Disease Study.

PubMed

Yakoob, Mohammad Y; Micha, Renata; Khatibzadeh, Shahab; Singh, Gitanjali M; Shi, Peilin; Ahsan, Habibul; Balakrishna, Nagalla; Brahmam, Ginnela N V; Chen, Yu; Afshin, Ashkan; Fahimi, Saman; Danaei, Goodarz; Powles, John W; Ezzati, Majid; Mozaffarian, Dariush

2016-12-01

To quantify cardiovascular disease and diabetes deaths attributable to dietary and metabolic risks by country, age, sex, and time in South Asian countries. We used the 2010 Global Burden of Disease national surveys to characterize risk factor levels by age and sex. We derived etiological effects of risk factors-disease endpoints, by age, from meta-analyses. We defined optimal levels. We combined these inputs with cause-specific mortality rates to compute population-attributable fractions as a percentage of total cardiometabolic deaths. Suboptimal diet was the leading cause of cardiometabolic mortality in 4 of 5 countries, with population-attributable fractions from 40.7% (95% uncertainty interval = 37.4, 44.1) in Bangladesh to 56.9% (95% uncertainty interval = 52.4, 61.5) in Pakistan. High systolic blood pressure was the second leading cause, except in Bangladesh, where it superseded suboptimal diet. This was followed in all nations by high fasting plasma glucose, low fruit intake, and low whole grain intake. Other prominent burdens were more variable, such as low intake of vegetables, low omega-3 fats, and high sodium intake in India, Nepal, and Pakistan. Important similarities and differences are evident in cardiometabolic mortality burdens of modifiable dietary and metabolic risks across these countries, informing health policy and program priorities.

Socioeconomic status and risk of infant death. A population-based study of trends in Norway, 1967-1998.

PubMed

Arntzen, Annett; Samuelsen, Sven Ove; Bakketeig, Leiv S; Stoltenberg, Camilla

2004-04-01

The aim of this study was to examine the association between socioeconomic status and risk of infant death in Norway from 1967 to 1998. Information from the Medical Birth Registry of Norway on all live births and infant deaths was linked to information from Statistics Norway on parents' education. There were 1777364 eligible live births and 15517 infant deaths. Differences between education groups were estimated as risk differences, relative risks, population attributable fractions, and index of inequality ratios. The risk of infant death decreased in all education groups, and the level of education increased over time. The trends differed for neonatal and postneonatal death. For neonatal death the risk difference between infants whose mothers had high and low education was reduced from 3.5/1000 in the 1970s to 0.9/1000 in the 1990s. The relative index of inequality (RII) for maternal education decreased from 1.72 to1.32. The proportion of neonatal deaths that could be attributed to <13 years of education decreased from 22.3 to 8.4. For postneonatal death the risk difference between infants whose mothers had high and low education increased from 0.7/1000 in the 1970s to 2.0/1000 in the 1990s. The RII for maternal education increased from 1.31 to 4.00. The population attributable fraction increased from 9.7 to 39.5. An inverse association between socioeconomic status and risk of postneonatal death persists, albeit there was a considerable reduction in risk between 1967 and 1998.

Semi-parametric regression model for survival data: graphical visualization with R

PubMed Central

2016-01-01

Cox proportional hazards model is a semi-parametric model that leaves its baseline hazard function unspecified. The rationale to use Cox proportional hazards model is that (I) the underlying form of hazard function is stringent and unrealistic, and (II) researchers are only interested in estimation of how the hazard changes with covariate (relative hazard). Cox regression model can be easily fit with coxph() function in survival package. Stratified Cox model may be used for covariate that violates the proportional hazards assumption. The relative importance of covariates in population can be examined with the rankhazard package in R. Hazard ratio curves for continuous covariates can be visualized using smoothHR package. This curve helps to better understand the effects that each continuous covariate has on the outcome. Population attributable fraction is a classic quantity in epidemiology to evaluate the impact of risk factor on the occurrence of event in the population. In survival analysis, the adjusted/unadjusted attributable fraction can be plotted against survival time to obtain attributable fraction function. PMID:28090517

Quantile-based bias correction and uncertainty quantification of extreme event attribution statements

DOE PAGES

Jeon, Soyoung; Paciorek, Christopher J.; Wehner, Michael F.

2016-02-16

Extreme event attribution characterizes how anthropogenic climate change may have influenced the probability and magnitude of selected individual extreme weather and climate events. Attribution statements often involve quantification of the fraction of attributable risk (FAR) or the risk ratio (RR) and associated confidence intervals. Many such analyses use climate model output to characterize extreme event behavior with and without anthropogenic influence. However, such climate models may have biases in their representation of extreme events. To account for discrepancies in the probabilities of extreme events between observational datasets and model datasets, we demonstrate an appropriate rescaling of the model output basedmore » on the quantiles of the datasets to estimate an adjusted risk ratio. Our methodology accounts for various components of uncertainty in estimation of the risk ratio. In particular, we present an approach to construct a one-sided confidence interval on the lower bound of the risk ratio when the estimated risk ratio is infinity. We demonstrate the methodology using the summer 2011 central US heatwave and output from the Community Earth System Model. In this example, we find that the lower bound of the risk ratio is relatively insensitive to the magnitude and probability of the actual event.« less

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

PubMed

Hutchings, Sally; Rushton, Lesley

2011-05-01

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

Alcohol-attributable morbidity and resulting health care costs in Canada in 2002: recommendations for policy and prevention.

PubMed

Taylor, Benjamin; Rehm, Jürgen; Patra, Jayadeep; Popova, Svetlana; Baliunas, Dolly

2007-01-01

Alcohol is one of the most important risk factors for burden of disease, particularly in high-income countries such as Canada. The purpose of this article was to estimate the number of hospitalizations, hospital days, and the resulting costs attributable to alcohol for Canada in 2002. Exposure distribution was taken from the Canadian Addiction Survey and corrected for per capita consumption from production and sales. For chronic disease, risk relations were taken from the published literature and combined with exposure to calculate age- and gender-specific alcohol-attributable fractions. For injury, alcohol-attributable fractions were taken directly from available statistics. Data on the most responsible diagnosis, length of stay for hospitalizations, and costs were obtained from the national Canadian databases. For Canada in 2002, there were 195,970 alcohol-related diagnoses among acute care hospitalizations, 2,058 alcohol-attributable psychiatric hospitalizations, and 183,589 alcohol-attributable admissions to specialized treatment centers. These accounted for 1,246,945 hospital days in acute care facilities, 54,114 hospital days in psychiatric hospitals, and 3,018,688 hospital days in specialized treatment centers (inpatient and outpatient). The main causes of alcohol-attributable morbidity were neuropsychiatric conditions, cardiovascular disease, and unintentional injuries. In total, Can. $2.29 billion were spent on alcohol-related health care. Alcohol poses a heavy burden of disease as well as a financial strain on Canadian society. However, there are evidence-based effective and cost-effective policy and legislative interventions as well as measures to better enforce these laws.

Application of probabilistic event attribution in the summer heat extremes in the western US to emissions traced to major industrial carbon producers

NASA Astrophysics Data System (ADS)

Mera, R. J.; Allen, M. R.; Mote, P.; Ekwurzel, B.; Frumhoff, P. C.; Rupp, D. E.

2015-12-01

Heat waves in the western US have become progressively more severe due to increasing relative humidity and nighttime temperatures, increasing the health risks of vulnerable portions of the population, including Latino farmworkers in California's Central Valley and other socioeconomically disadvantaged communities. Recent research has shown greenhouse gas emissions doubled the risk of the hottest summer days during the 2000's in the Central Valley, increasing public health risks and costs, and raising the question of which parties are responsible for paying these costs. It has been argued that these costs should not be taken up solely by the general public through taxation, but that additional parties can be considered, including multinational corporations who have extracted and marketed a large proportion of carbon-based fuels. Here, we apply probabilistic event attribution (PEA) to assess the contribution of emissions traced to the world's 90 largest major industrial carbon producers to the severity and frequency of these extreme heat events. Our research uses very large ensembles of regional climate model simulations to calculate fractional attribution of policy-relevant extreme heat variables. We compare a full forcings world with observed greenhouse gases, sea surface temperatures and sea ice extent to a counter-factual world devoid of carbon pollution from major industrial carbon producers. The results show a discernable fraction of record-setting summer temperatures in the western US during the 2000's can be attributed to emissions sourced from major carbon producers.

Estimating the burden of disease attributable to four selected environmental risk factors in South Africa.

PubMed

Norman, Rosana; Bradshaw, Debbie; Lewin, Simon; Cairncross, Eugene; Nannan, Nadine; Vos, Theo

2010-01-01

The first South African National Burden of Disease study quantified the underlying causes of premature mortality and morbidity experienced in South Africa in the year 2000. This was followed by a Comparative Risk Assessment to estimate the contributions of 17 selected risk factors to burden of disease in South Africa. This paper describes the health impact of exposure to four selected environmental risk factors: unsafe water, sanitation and hygiene; indoor air pollution from household use of solid fuels; urban outdoor air pollution and lead exposure. The study followed World Health Organization comparative risk assessment methodology. Population-attributable fractions were calculated and applied to revised burden of disease estimates (deaths and disability adjusted life years, [DALYs]) from the South African Burden of Disease study to obtain the attributable burden for each selected risk factor. The burden attributable to the joint effect of the four environmental risk factors was also estimated taking into account competing risks and common pathways. Monte Carlo simulation-modeling techniques were used to quantify sampling, uncertainty. Almost 24 000 deaths were attributable to the joint effect of these four environmental risk factors, accounting for 4.6% (95% uncertainty interval 3.8-5.3%) of all deaths in South Africa in 2000. Overall the burden due to these environmental risks was equivalent to 3.7% (95% uncertainty interval 3.4-4.0%) of the total disease burden for South Africa, with unsafe water sanitation and hygiene the main contributor to joint burden. The joint attributable burden was especially high in children under 5 years of age, accounting for 10.8% of total deaths in this age group and 9.7% of burden of disease. This study highlights the public health impact of exposure to environmental risks and the significant burden of preventable disease attributable to exposure to these four major environmental risk factors in South Africa. Evidence-based policies and programs must be developed and implemented to address these risk factors at individual, household, and community levels.

The burden of cancer attributable to modifiable risk factors: the Australian cancer-PAF cohort consortium.

PubMed

Arriaga, Maria E; Vajdic, Claire M; Canfell, Karen; MacInnis, Robert; Hull, Peter; Magliano, Dianna J; Banks, Emily; Giles, Graham G; Cumming, Robert G; Byles, Julie E; Taylor, Anne W; Shaw, Jonathan E; Price, Kay; Hirani, Vasant; Mitchell, Paul; Adelstein, Barbara-Ann; Laaksonen, Maarit A

2017-06-14

To estimate the Australian cancer burden attributable to lifestyle-related risk factors and their combinations using a novel population attributable fraction (PAF) method that accounts for competing risk of death, risk factor interdependence and statistical uncertainty. 365 173 adults from seven Australian cohort studies. We linked pooled harmonised individual participant cohort data with population-based cancer and death registries to estimate exposure-cancer and exposure-death associations. Current Australian exposure prevalence was estimated from representative external sources. To illustrate the utility of the new PAF method, we calculated fractions of cancers causally related to body fatness or both tobacco and alcohol consumption avoidable in the next 10 years by risk factor modifications, comparing them with fractions produced by traditional PAF methods. Over 10 years of follow-up, we observed 27 483 incident cancers and 22 078 deaths. Of cancers related to body fatness (n=9258), 13% (95% CI 11% to 16%) could be avoided if those currently overweight or obese had body mass index of 18.5-24.9 kg/m 2 . Of cancers causally related to both tobacco and alcohol (n=4283), current or former smoking explains 13% (11% to 16%) and consuming more than two alcoholic drinks per day explains 6% (5% to 8%). The two factors combined explain 16% (13% to 19%): 26% (21% to 30%) in men and 8% (4% to 11%) in women. Corresponding estimates using the traditional PAF method were 20%, 31% and 10%. Our PAF estimates translate to 74 000 avoidable body fatness-related cancers and 40 000 avoidable tobacco- and alcohol-related cancers in Australia over the next 10 years (2017-2026). Traditional PAF methods not accounting for competing risk of death and interdependence of risk factors may overestimate PAFs and avoidable cancers. We will rank the most important causal factors and their combinations for a spectrum of cancers and inform cancer control activities. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Occurrence and factors associated with bovine cysticercosis recorded in cattle at meat inspection in Denmark in 2004-2011.

PubMed

Calvo-Artavia, F F; Nielsen, L R; Dahl, J; Clausen, D M; Alban, L

2013-06-01

Current EU regulation requires that every bovine carcass is examined for bovine cysticercosis (BC) at meat inspection. This is costly and might be superfluous at low BC prevalence. However, from a consumer view-point it may be important to identify and manage infected carcasses to avoid human infection. If relevant data could be effectively used to classify animals with respect to their risk of being infected, then the current meat inspection could be replaced by a more cost-effective system targeting high-risk animals. This study aimed to (1) describe the distribution of BC cases in the Danish cattle population, (2) estimate the animal level prevalence (3) provide descriptive statistics of potential risk factors for BC, and (4) determine attributable risks and fractions of selected risk factors potentially useful for a future risk-based meat inspection system. In total, 348 cases of BC were recorded among all cattle slaughtered (n=4,090,661) in Denmark between 2004 and 2011. The true animal level prevalence of BC was estimated to be 0.06%. The herd of origin of the cases were defined as the herd in which the animals spent most of their lifetimes. The detected cases were found to originate from 328 herds, with a maximum of two cases per herd indicating sporadic occurrence. Even though organic farming was associated with a higher risk (RR=1.9 in univariable analysis) of BC-positive animals being detected at slaughter, the population attributable fraction showed that only 5% of the animals with BC could be attributed to organic farming practices at the level of organic farming practiced in Denmark in the study period. Thus, organic farming status was not a suitable risk factor to use to target future risk-based meat inspection. However, 54% of the animals with BC in the cattle population were attributed to female gender. Increasing age at slaughter was also associated with high risk of BC. There may be overlaps between these effects in animals with multiple risk factors. Other underlying factors such as grazing patterns might explain the risk factors and attribution results found in this study. However, grazing practices are currently not recorded in the Danish cattle database. Therefore, animal level risk factors such as age and gender together with other risk factors such as grazing practices might be included as food chain information, required to be provided by the farmer prior to slaughter. The challenges and opportunities of this approach should be investigated further. Copyright © 2012 Elsevier B.V. All rights reserved.

Undernutrition as an underlying cause of child deaths associated with diarrhea, pneumonia, malaria, and measles.

PubMed

Caulfield, Laura E; de Onis, Mercedes; Blössner, Monika; Black, Robert E

2004-07-01

Previous analyses derived the relative risk (RR) of dying as a result of low weight-for-age and calculated the proportion of child deaths worldwide attributable to underweight. The objectives were to examine whether the risk of dying because of underweight varies by cause of death and to estimate the fraction of deaths by cause attributable to underweight. Data were obtained from investigators of 10 cohort studies with both weight-for-age category (<-3 SDs, -3 to <-2 SDs, -2 to <-1 SD, and >-1 SD) and cause of death information. All 10 studies contributed information on weight-for-age and risk of diarrhea, pneumonia, and all-cause mortality; however, only 6 studies contributed information on deaths because of measles, and only 3 studies contributed information on deaths because of malaria or fever. With use of weighted random effects models, we related the log mortality rate by cause and anthropometric status in each study to derive cause-specific RRs of dying because of undernutrition. Prevalences of each weight-for-age category were obtained from analyses of 310 national nutrition surveys. With use of the RR and prevalence information, we then calculated the fraction of deaths by cause attributable to undernutrition. The RR of mortality because of low weight-for-age was elevated for each cause of death and for all-cause mortality. Overall, 52.5% of all deaths in young children were attributable to undernutrition, varying from 44.8% for deaths because of measles to 60.7% for deaths because of diarrhea. A significant proportion of deaths in young children worldwide is attributable to low weight-for-age, and efforts to reduce malnutrition should be a policy priority.

Population attributable risk of modifiable risk factors associated with invasive breast cancer in women aged 45-69 years in Queensland, Australia.

PubMed

Wilson, Louise F; Page, Andrew N; Dunn, Nathan A M; Pandeya, Nirmala; Protani, Melinda M; Taylor, Richard J

2013-12-01

To quantify the population attributable risk of key modifiable risk factors associated with breast cancer incidence in Queensland, Australia. Population attributable fractions (PAFs) for high body mass index (BMI), use of hormone replacement therapy (HRT), alcohol consumption and inadequate physical activity were calculated, using prevalence data from a representative survey of women attending mammographic screening at BreastScreen Queensland in 2008 and relative risk estimates sourced from published literature. Attributable cancers were calculated using 'underlying' breast cancer incidence data for 2008 based on Poisson regression models, adjusting for the inflation of incidence due to the effects of mammographic screening. Attributable burden of breast cancer due to high body mass index (BMI), use of hormone replacement therapy (HRT), alcohol consumption and inadequate physical activity. In Queensland women aged 45-69 years, an estimated 12.1% (95% CI: 11.6-12.5%) of invasive breast cancers were attributable to high BMI in post-menopausal women who have never used HRT; 2.8% (95% CI: 2.7-2.9%) to alcohol consumption; 7.6% (95% CI: 7.4-7.9%) to inadequate physical activity in post-menopausal women and 6.2% (95% CI: 5.5-7.0%) to current use of HRT after stratification by BMI and type of HRT used. Combined, just over one quarter (26.0%; 95% CI: 25.4-26.6%) of all invasive breast cancers in Queensland women aged 45-69 years in 2008 were attributable to these modifiable risk factors. There is benefit in targeting prevention strategies to modify lifestyle behaviours around BMI, physical activity, HRT use and alcohol consumption, as a reduction in these risk factors could decrease invasive breast cancer incidence in the Queensland population. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Using reference values to define disease based on the lower limit of normal biased the population attributable fraction, but not the population excess risk: the example of chronic airflow obstruction.

PubMed

Burney, Peter; Minelli, Cosetta

2018-01-01

The impact of disease on population health is most commonly estimated by the population attributable fraction (PAF), or less commonly by the excess risk, an alternative measure that estimates the absolute risk of disease in the population that can be ascribed to the exposure. Using chronic airflow obstruction as an example, we examined the impact on these estimates of defining disease based on different "normal" values. We estimated PAF and the excess risk in scenarios in which the true rate of disease was 10% in the exposed and 5% in the unexposed, and where either 50% or 20% of the population was exposed. Disease definition was based on a "lower limit of normal", using the 5th, 1st and 0.2nd centile of values in a "normal" population as thresholds to define normality. Where normality is defined by centiles of values in a "normal" population, PAF is strongly influenced by which centile is selected to define normality. This is not true for the population excess risk. Care should be taken when interpreting estimates of PAF when disease is defined from a centile of a normal population. Copyright © 2017 Elsevier Inc. All rights reserved.

Occupational risk factors have to be considered in the definition of high-risk lung cancer populations.

PubMed

Wild, P; Gonzalez, M; Bourgkard, E; Courouble, N; Clément-Duchêne, C; Martinet, Y; Févotte, J; Paris, C

2012-03-27

The aim of this study was to compute attributable fractions (AF) to occupational factors in an area in North-Eastern France with high lung cancer rates and a past of mining and steel industry. A population-based case-control study among males aged 40-79 was conducted, including confirmed primary lung cancer cases from all hospitals of the study region. Controls were stratified by broad age-classes, district and socioeconomic classes. Detailed occupational and personal risk factors were obtained in face-to-face interviews. Cumulative occupational exposure indices were obtained from the questionnaires. Attributable fractions were computed from multiple unconditional logistic regression models. A total of 246 cases and 531 controls were included. The odds ratios (ORs) adjusted on cumulative smoking and family history of lung cancer increased significantly with the cumulative exposure indices to asbestos, polycyclic aromatic hydrocarbons and crystalline silica, and with exposure to diesel motor exhaust. The AF for occupational factors exceeded 50%, the most important contributor being crystalline silica and asbestos. These AFs are higher than most published figures. This can be because of the highly industrialised area or methods for exposure assessments. Occupational factors are important risk factors and should not be forgotten when defining high-risk lung cancer populations.

Cardiovascular disease, chronic kidney disease, and diabetes mortality burden of cardiometabolic risk factors from 1980 to 2010: a comparative risk assessment.

PubMed

2014-08-01

High blood pressure, blood glucose, serum cholesterol, and BMI are risk factors for cardiovascular diseases and some of these factors also increase the risk of chronic kidney disease and diabetes. We estimated mortality from cardiovascular diseases, chronic kidney disease, and diabetes that was attributable to these four cardiometabolic risk factors for all countries and regions from 1980 to 2010. We used data for exposure to risk factors by country, age group, and sex from pooled analyses of population-based health surveys. We obtained relative risks for the effects of risk factors on cause-specific mortality from meta-analyses of large prospective studies. We calculated the population attributable fractions for each risk factor alone, and for the combination of all risk factors, accounting for multicausality and for mediation of the effects of BMI by the other three risks. We calculated attributable deaths by multiplying the cause-specific population attributable fractions by the number of disease-specific deaths. We obtained cause-specific mortality from the Global Burden of Diseases, Injuries, and Risk Factors 2010 Study. We propagated the uncertainties of all the inputs to the final estimates. In 2010, high blood pressure was the leading risk factor for deaths due to cardiovascular diseases, chronic kidney disease, and diabetes in every region, causing more than 40% of worldwide deaths from these diseases; high BMI and glucose were each responsible for about 15% of deaths, and high cholesterol for more than 10%. After accounting for multicausality, 63% (10·8 million deaths, 95% CI 10·1-11·5) of deaths from these diseases in 2010 were attributable to the combined effect of these four metabolic risk factors, compared with 67% (7·1 million deaths, 6·6-7·6) in 1980. The mortality burden of high BMI and glucose nearly doubled from 1980 to 2010. At the country level, age-standardised death rates from these diseases attributable to the combined effects of these four risk factors surpassed 925 deaths per 100 000 for men in Belarus, Kazakhstan, and Mongolia, but were less than 130 deaths per 100 000 for women and less than 200 for men in some high-income countries including Australia, Canada, France, Japan, the Netherlands, Singapore, South Korea, and Spain. The salient features of the cardiometabolic disease and risk factor epidemic at the beginning of the 21st century are high blood pressure and an increasing effect of obesity and diabetes. The mortality burden of cardiometabolic risk factors has shifted from high-income to low-income and middle-income countries. Lowering cardiometabolic risks through dietary, behavioural, and pharmacological interventions should be a part of the global response to non-communicable diseases. UK Medical Research Council, US National Institutes of Health. Copyright © 2014 Elsevier Ltd. All rights reserved.

Attributable risk and potential impact of interventions to reduce household air pollution associated with under-five mortality in South Asia.

PubMed

Naz, Sabrina; Page, Andrew; Agho, Kingsley Emwinyore

2018-01-01

Solid fuel use is the major source of household air pollution (HAP) and accounts for a substantial burden of morbidity and mortality in low and middle income countries. To evaluate and compare childhood mortality attributable to HAP in four South Asian countries. A series of Demographic and Health Survey (DHS) datasets for Bangladesh, India, Nepal and Pakistan were used for analysis. Estimates of relative risk and exposure prevalence relating to use of cooking fuel and under-five mortality were used to calculate population attributable fractions (PAFs) for each country. Potential impact fractions (PIFs) were also calculated assessing theoretical scenarios based on published interventions aiming to reduce exposure prevalence. There are an increased risk of under-five mortality in those exposed to cooking fuel compared to those not exposed in the four South Asian countries (OR = 1.30, 95% CI = 1.07-1.57, P  = 0.007). Combined PAF estimates for South Asia found that 66% (95% CI: 43.1-81.5%) of the 13,290 estimated cases of under-five mortality was attributable to HAP. Joint PIF estimates (assuming achievable reductions in HAP reported in intervention studies conducted in South Asia) indicates 47% of neonatal and 43% of under-five mortality cases associated with HAP could be avoidable in the four South Asian countries studied. Elimination of exposure to use of cooking fuel in the household targeting valuable intervention strategies (such as cooking in separate kitchen, improved cook stoves) could reduce substantially under-five mortality in South Asian countries.

Diseases Burden of Chronic Obstructive Pulmonary Disease (COPD) Attributable to Ground-Level Ozone in Thailand: Estimates Based on Surface Monitoring Measurements Data.

PubMed

Pinichka, Chayut; Bundhamcharoen, Kanitta; Shibuya, Kenji

2015-05-14

Ambient ozone (O3) pollution has increased globally since preindustrial times. At present, O3 is one of the major air pollution concerns in Thailand, and is associated with health impacts such as chronic obstructive pulmonary disease (COPD). The objective of our study is to estimate the burden of disease attributed to O3 in 2009 in Thailand based on empirical evidence. We estimated disability-adjusted life years (DALYs) attributable to O3 using the comparative risk assessment framework in the Global Burden of Diseases (GBD) study. We quantified the population attributable fraction (PAF), integrated from Geographic Information Systems (GIS)-based spatial interpolation, the population distribution of exposure, and the exposure-response coefficient to spatially characterize exposure to ambient O3 pollution on a national scale. Exposure distribution was derived from GIS-based spatial interpolation O3 exposure model using Pollution Control Department Thailand (PCD) surface air pollution monitor network sources. Relative risk (RR) and population attributable fraction (PAF) were determined using health impact function estimates for O3. PAF (%) of COPD attributable to O3 were determined by region: at approximately, Northern=2.1, Northeastern=7.1, Central=9.6, Eastern=1.75, Western=1.47 and Southern=1.74. The total COPD burden attributable to O3 for Thailand in 2009 was 61,577 DALYs. Approximately 0.6% of the total DALYs in Thailand is male: 48,480 DALYs; and female: 13,097 DALYs. This study provides the first empirical evidence on the health burden (DALYs) attributable to O3 pollution in Thailand. Varying across regions, the disease burden attributable to O3 was 0.6% of the total national burden in 2009. Better empirical data on local specific sites, e.g. urban and rural areas, alternative exposure assessment, e.g. land use regression (LUR), and a local concentration-response coefficient are required for future studies in Thailand.

Cancers in Australia in 2010 attributable to insufficient physical activity

PubMed Central

Olsen, Catherine M; Wilson, Louise F; Nagle, Christina M; Kendall, Bradley J; Bain, Christopher J; Pandeya, Nirmala; Webb, Penelope M; Whiteman, David C

2015-01-01

Objectives To estimate the proportion and numbers of cancers occurring in Australia in 2010 attributable to insufficient levels of physical activity. Methods We estimated the population attributable fraction (PAF) of cancers causally associated with insufficient physical activity (colon, post-menopausal breast and endometrium) using standard formulae incorporating prevalence of insufficient physical activity (<60 minutes at least 5 days/week), relative risks associated with physical activity and cancer incidence. We also estimated the proportion change in cancer incidence (potential impact fraction [PIF]) that may have occurred assuming that everyone with insufficient activity levels increased their exercise by 30 minutes/week. Results An estimated 1,814 cases of colon, post-menopausal breast and endometrial cancer were attributable to insufficient levels of physical activity: 707 (6.5%) colon; 971 (7.8%) post-menopausal breast; and 136 (6.0%) endometrial cancers. If those exercising below the recommended level had increased their activity level by 30 minutes/week, we estimate 314 fewer cancers (17% of those attributable to insufficient physical activity) would have occurred in 2010. Conclusions More than 1,500 cancers were attributable to insufficient levels of physical activity in the Australian population. Implications Increasing the proportion of Australians who exercise could reduce the incidence of several common cancers. PMID:26437732

Lifetime number of years of menstruation as a risk index for postmenopausal endometrial cancer in the Norwegian Women and Cancer Study.

PubMed

Gavrilyuk, Oxana; Braaten, Tonje; Weiderpass, Elisabete; Licaj, Idlir; Lund, Eiliv

2018-05-21

Lifetime number of years of menstruation (LNYM) reflects a woman's cumulative exposure to endogenous estrogen and can be used as a measure of the combined effect of reproductive factors related to endometrial cancer (EC) risk. We aimed to study the association between LNYM and EC risk among postmenopausal women and calculate the population attributable fraction of EC for different LNYM categories. Our study sample consisted of 117 589 women from the Norwegian Women and Cancer (NOWAC) Study. All women were aged 30-70 years at enrollment and completed a baseline questionnaire between 1991 and 2006. Women were followed up for EC through December 2014 via linkages to national registries. We used Cox proportional hazards models to estimate hazard ratios with 95% confidence intervals (CIs), adjusted for potential confounders. Altogether, 720 women developed EC. We found a statistically significant, positive dose-response relationship between LNYM and EC, with a 9.1% higher risk for each additional year of LNYM (p for trend <0.001). Using the LNYM category ≥40 as a reference, the hazard ratios for LNYM <25, 25-29, 30-34, 35-39 were 0.17 (95% CI 0.22-0.27), 0.25 (95% CI 0.17-0.36), 0.43 (95% CI 0.32-0.58), and 0.68 (95% CI 0.51-0.92), respectively. The association between LNYM and EC was independent of incomplete pregnancies, menopausal hormone therapy, diabetes and body mass index. When considering population attributable fraction, 67% of EC was estimated to be attributable to LNYM ≥25. Our study supports that increasing LNYM is an important and independent predictor of EC risk. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Mortality and Burden of Disease Attributable to Cigarette Smoking in Qingdao, China.

PubMed

Wang, Yani; Qi, Fei; Jia, Xiaorong; Lin, Peng; Liu, Hui; Geng, Meiyun; Liu, Yunning; Li, Shanpeng; Tan, Jibin

2016-09-09

In China, smoking is the leading preventable cause of deaths by a disease. Estimating the disease burden attributable to smoking contributes to an evaluation of the adverse impact of smoking. To aid in policy change and implementation, this study estimated the population-attributable fractions (PAFs) of smoking, the all-cause mortality and the loss of life expectancy attributable to smoking in 2014 of Qingdao. PAFs were calculated using the smoking impact ratio (SIR) or current smoking rate (P) and relative risk (RR). We determined the smoking-attributable mortality by multiplying the smoking-attributable fraction by the total mortality. This study used the method of an abridged life table to calculate the loss of life expectancy caused by smoking. Smoking caused about 8635 deaths (6883 males, 1752 females), and accounted for 16% of all deaths; 22% in males and 8% in females. The leading causes of deaths attributable to smoking were lung cancer (38%), ischemic heart disease (19%) and chronic obstructive pulmonary disease (COPD, 12%). The PAF for all causes was 22%; 30% in males and 10% in females. Tobacco use may cause a reduction of about 2.01 years of the loss of life expectancy; 3 years in males and 0.87 years in females. The findings highlight the need for taking effective measures to prevent initiation and induce cessation.

Mortality and Burden of Disease Attributable to Cigarette Smoking in Qingdao, China

PubMed Central

Wang, Yani; Qi, Fei; Jia, Xiaorong; Lin, Peng; Liu, Hui; Geng, Meiyun; Liu, Yunning; Li, Shanpeng; Tan, Jibin

2016-01-01

In China, smoking is the leading preventable cause of deaths by a disease. Estimating the disease burden attributable to smoking contributes to an evaluation of the adverse impact of smoking. To aid in policy change and implementation, this study estimated the population-attributable fractions (PAFs) of smoking, the all-cause mortality and the loss of life expectancy attributable to smoking in 2014 of Qingdao. PAFs were calculated using the smoking impact ratio (SIR) or current smoking rate (P) and relative risk (RR). We determined the smoking-attributable mortality by multiplying the smoking-attributable fraction by the total mortality. This study used the method of an abridged life table to calculate the loss of life expectancy caused by smoking. Smoking caused about 8635 deaths (6883 males, 1752 females), and accounted for 16% of all deaths; 22% in males and 8% in females. The leading causes of deaths attributable to smoking were lung cancer (38%), ischemic heart disease (19%) and chronic obstructive pulmonary disease (COPD, 12%). The PAF for all causes was 22%; 30% in males and 10% in females. Tobacco use may cause a reduction of about 2.01 years of the loss of life expectancy; 3 years in males and 0.87 years in females. The findings highlight the need for taking effective measures to prevent initiation and induce cessation. PMID:27618084

Attributable risk of carpal tunnel syndrome according to industry and occupation in a general population.

PubMed

Roquelaure, Yves; Ha, Catherine; Nicolas, Guillaume; Pélier-Cady, Marie-Christine; Mariot, Camille; Descatha, Alexis; Leclerc, Annette; Raimbeau, Guy; Goldberg, Marcel; Imbernon, Ellen

2008-09-15

An epidemiologic surveillance network for carpal tunnel syndrome (CTS) was set up in the general population of a French region to assess the proportion of CTS cases attributable to work in high-risk industries and occupations. Cases of CTS occurring among patients ages 20-59 years living in the Maine and Loire region were included prospectively from 2002 to 2004. Medical and occupation history was gathered by mailed questionnaire for 815 women and 320 men. Age-adjusted relative risks of CTS and the attributable risk fractions of CTS among exposed persons (AFEs) were computed in relation to industry sectors and occupation categories. Twenty-one industry sectors and 8 occupational categories for women and 10 sectors and 6 occupational categories for men were characterized by a significant excess risk of CTS. High AFE values were observed in the manufacturing (42-93% for both sexes), construction (66% for men), and personal service industries (66% for women) and in the trade and commerce sectors (49% for women). High AFE values were observed in lower-grade white-collar occupations for women (43-67%) and blue-collar occupations for men (60-74%) and women (48-88%). The attributable proportions of CTS cases among workers employed in industry sectors and occupation categories identified at high risk of CTS varied between 36% and 93%.

The Population Impact of Childhood Health Conditions on Dropout from Upper-Secondary Education.

PubMed

Mikkonen, Janne; Moustgaard, Heta; Remes, Hanna; Martikainen, Pekka

2018-05-01

To quantify how large a part of educational dropout is due to adverse childhood health conditions and to estimate the risk of dropout across various physical and mental health conditions. A registry-based cohort study was conducted on a 20% random sample of Finns born in 1988-1995 (n = 101 284) followed for school dropout at ages 17 and 21. Four broad groups of health conditions (any, somatic, mental, and injury) and 25 specific health conditions were assessed from inpatient and outpatient care records at ages 10-16 years. We estimated the immediate and more persistent risks of dropout due to health conditions and calculated population-attributable fractions to quantify the population impact of childhood health on educational dropout, while accounting for a wide array of sociodemographic confounders and comorbidity. Children with any health condition requiring inpatient or outpatient care at ages 10-16 years were more likely to be dropouts at ages 17 years (risk ratio 1.71, 95% CI 1.61-1.81) and 21 years (1.46, 1.37-1.54) following adjustment for individual and family sociodemographic factors. A total of 30% of school dropout was attributable to health conditions at age 17 years and 21% at age 21 years. Mental disorders alone had an attributable fraction of 11% at age 21 years, compared with 5% for both somatic conditions and injuries. Adjusting for the presence of mental disorders reduced the effects of somatic conditions. More than one fifth of educational dropout is attributable to childhood health conditions. Early-onset mental disorders emerge as key targets in reducing dropout. Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.

HIV Due to Female Sex Work: Regional and Global Estimates

PubMed Central

Prüss-Ustün, Annette; Wolf, Jennyfer; Driscoll, Tim; Degenhardt, Louisa; Neira, Maria; Calleja, Jesus Maria Garcia

2013-01-01

Introduction Female sex workers (FSWs) are at high risk of HIV infection. Our objective was to determine the proportion of HIV prevalence in the general female adult population that is attributable to the occupational exposure of female sex work, due to unprotected sexual intercourse. Methods Population attributable fractions of HIV prevalence due to female sex work were estimated for 2011. A systematic search was conducted to retrieve required input data from available sources. Data gaps of HIV prevalence in FSWs for 2011 were filled using multilevel modeling and multivariate linear regression. The fraction of HIV attributable to female sex work was estimated as the excess HIV burden in FSWs deducting the HIV burden in FSWs due to injecting drug use. Results An estimated fifteen percent of HIV in the general female adult population is attributable to (unsafe) female sex work. The region with the highest attributable fraction is Sub Saharan Africa, but the burden is also substantial for the Caribbean, Latin America and South and Southeast Asia. We estimate 106,000 deaths from HIV are a result of female sex work globally, 98,000 of which occur in Sub-Saharan Africa. If HIV prevalence in other population groups originating from sexual contact with FSWs had been considered, the overall attributable burden would probably be much larger. Discussion Female sex work is an important contributor to HIV transmission and the global HIV burden. Effective HIV prevention measures exist and have been successfully targeted at key populations in many settings. These must be scaled up. Conclusion FSWs suffer from high HIV burden and are a crucial core population for HIV transmission. Surveillance, prevention and treatment of HIV in FSWs should benefit both this often neglected vulnerable group and the general population. PMID:23717432

Solar radiation and out-of-hospital cardiac arrest in Japan.

PubMed

Onozuka, Daisuke; Hagihara, Akihito

2017-11-01

Although several studies have estimated the effects of temperature on mortality and morbidity, little is known regarding the burden of out-of-hospital cardiac arrest (OHCA) attributable to solar radiation. We obtained data for all cases of OHCA and meteorological data reported between 2011 and 2014 in 3 Japanese prefectures: Hokkaido, Ibaraki, and Fukuoka. We first examined the relationship between daily solar radiation and OHCA risk for each prefecture using time-varying distributed lag non-linear models and then pooled the results in a multivariate random-effects meta-analysis. The attributable fractions of OHCA were calculated for low and high solar radiation, defined as solar radiation below and above the minimum morbidity solar radiation, respectively. The minimum morbidity solar radiation was defined as the specific solar radiation associated with the lowest morbidity risk. A total of 49,892 cases of OHCA occurred during the study period. The minimum morbidity solar radiation for each prefecture was the 100th percentile (72.5 MJ/m 2 ) in Hokkaido, the 83rd percentile (59.7 MJ/m 2 ) in Ibaraki, and the 70th percentile (53.8 MJ/m 2 ) in Fukuoka. Overall, 20.00% (95% empirical confidence interval [eCI]: 10.97-27.04) of the OHCA cases were attributable to daily solar radiation. The attributable fraction for low solar radiation was 19.50% (95% eCI: 10.00-26.92), whereas that for high solar radiation was 0.50% (95% eCI: -0.07-1.01). Low solar radiation was associated with a substantial attributable risk for OHCA. Our findings suggest that public health efforts to reduce OHCA burden should consider the solar radiation level. Large prospective studies with longitudinal collection of individual data is required to more conclusively assess the impact of solar radiation on OHCA. Copyright © 2017 Elsevier Ltd. All rights reserved.

Cancer incidence due to excess body weight and leisure-time physical inactivity in Canada: implications for prevention.

PubMed

Brenner, Darren R

2014-09-01

This analysis aimed to estimate the number of incident cases of various cancers attributable to excess body weight (overweight, obesity) and leisure-time physical inactivity annually in Canada. The number of attributable cancers was estimated using the population attributable fraction (PAF), risk estimates from recent meta-analyses and population exposure prevalence estimates obtained from the Canadian Community Health Survey (2000). Age-sex-site-specific cancer incidence was obtained from Statistics Canada tables for the most up-to-date year with full national data, 2007. Where the evidence for association has been deemed sufficient, we estimated the number of incident cases of the following cancers attributable to obesity: colon, breast, endometrium, esophagus (adenocarcinomas), gallbladder, pancreas and kidney; and to physical inactivity: colon, breast, endometrium, prostate, lung and/or bronchus, and ovarian. Overall, estimates of all cancer incidence in 2007 suggest that at least 3.5% (n=5771) and 7.9% (n=12,885) are attributed to excess body weight and physical inactivity respectively. For both risk factors the burden of disease was greater among women than among men. Thousands of incident cases of cancer could be prevented annually in Canada as good evidence exists for effective interventions to reduce these risk factors in the population. Copyright © 2014. Published by Elsevier Inc.

Hearing difficulty attributable to employment by industry and occupation: an analysis of the National Health Interview Survey--United States, 1997 to 2003.

PubMed

Tak, SangWoo; Calvert, Geoffrey M

2008-01-01

To estimate the national burden of hearing difficulty among workers in US industries and occupations. Data on 130,102 employed National Health Interview Survey respondents between the ages of 18 to 65 years who were interviewed between 1997 and 2003 were analyzed to estimate the population prevalence, adjusted prevalence ratios, and fractions of hearing difficulty attributable to employment. The estimated population prevalence of hearing difficulty was 11.4% (24% attributable to employment). The adjusted prevalence ratios of hearing difficulty were highest for railroads, mining, and primary metal manufacturing industry. Occupations with increased risk of hearing difficulty were mechanics/repairers, machine operators, and transportation equipment operators. Hearing difficulty was differentially distributed across various industries. In industries with high rates, employers and workers should take preventive action to reduce the risk of occupational hearing loss.

Occupation and cancer in Britain

PubMed Central

Rushton, L; Bagga, S; Bevan, R; Brown, T P; Cherrie, J W; Holmes, P; Fortunato, L; Slack, R; Van Tongeren, M; Young, C; Hutchings, S J

2010-01-01

Background: Prioritising control measures for occupationally related cancers should be evidence based. We estimated the current burden of cancer in Britain attributable to past occupational exposures for International Agency for Research on Cancer (IARC) group 1 (established) and 2A (probable) carcinogens. Methods: We calculated attributable fractions and numbers for cancer mortality and incidence using risk estimates from the literature and national data sources to estimate proportions exposed. Results: 5.3% (8019) cancer deaths were attributable to occupation in 2005 (men, 8.2% (6362); women, 2.3% (1657)). Attributable incidence estimates are 13 679 (4.0%) cancer registrations (men, 10 063 (5.7%); women, 3616 (2.2%)). Occupational attributable fractions are over 2% for mesothelioma, sinonasal, lung, nasopharynx, breast, non-melanoma skin cancer, bladder, oesophagus, soft tissue sarcoma, larynx and stomach cancers. Asbestos, shift work, mineral oils, solar radiation, silica, diesel engine exhaust, coal tars and pitches, occupation as a painter or welder, dioxins, environmental tobacco smoke, radon, tetrachloroethylene, arsenic and strong inorganic mists each contribute 100 or more registrations. Industries and occupations with high cancer registrations include construction, metal working, personal and household services, mining, land transport, printing/publishing, retail/hotels/restaurants, public administration/defence, farming and several manufacturing sectors. 56% of cancer registrations in men are attributable to work in the construction industry (mainly mesotheliomas, lung, stomach, bladder and non-melanoma skin cancers) and 54% of cancer registrations in women are attributable to shift work (breast cancer). Conclusion: This project is the first to quantify in detail the burden of cancer and mortality due to occupation specifically for Britain. It highlights the impact of occupational exposures, together with the occupational circumstances and industrial areas where exposures to carcinogenic agents occurred in the past, on population cancer morbidity and mortality; this can be compared with the impact of other causes of cancer. Risk reduction strategies should focus on those workplaces where such exposures are still occurring. PMID:20424618

Occupation and cancer in Britain.

PubMed

Rushton, L; Bagga, S; Bevan, R; Brown, T P; Cherrie, J W; Holmes, P; Fortunato, L; Slack, R; Van Tongeren, M; Young, C; Hutchings, S J

2010-04-27

Prioritising control measures for occupationally related cancers should be evidence based. We estimated the current burden of cancer in Britain attributable to past occupational exposures for International Agency for Research on Cancer (IARC) group 1 (established) and 2A (probable) carcinogens. We calculated attributable fractions and numbers for cancer mortality and incidence using risk estimates from the literature and national data sources to estimate proportions exposed. 5.3% (8019) cancer deaths were attributable to occupation in 2005 (men, 8.2% (6362); women, 2.3% (1657)). Attributable incidence estimates are 13 679 (4.0%) cancer registrations (men, 10 063 (5.7%); women, 3616 (2.2%)). Occupational attributable fractions are over 2% for mesothelioma, sinonasal, lung, nasopharynx, breast, non-melanoma skin cancer, bladder, oesophagus, soft tissue sarcoma, larynx and stomach cancers. Asbestos, shift work, mineral oils, solar radiation, silica, diesel engine exhaust, coal tars and pitches, occupation as a painter or welder, dioxins, environmental tobacco smoke, radon, tetrachloroethylene, arsenic and strong inorganic mists each contribute 100 or more registrations. Industries and occupations with high cancer registrations include construction, metal working, personal and household services, mining, land transport, printing/publishing, retail/hotels/restaurants, public administration/defence, farming and several manufacturing sectors. 56% of cancer registrations in men are attributable to work in the construction industry (mainly mesotheliomas, lung, stomach, bladder and non-melanoma skin cancers) and 54% of cancer registrations in women are attributable to shift work (breast cancer). This project is the first to quantify in detail the burden of cancer and mortality due to occupation specifically for Britain. It highlights the impact of occupational exposures, together with the occupational circumstances and industrial areas where exposures to carcinogenic agents occurred in the past, on population cancer morbidity and mortality; this can be compared with the impact of other causes of cancer. Risk reduction strategies should focus on those workplaces where such exposures are still occurring.

Cancers in Australia in 2010 attributable to the consumption of alcohol.

PubMed

Pandeya, Nirmala; Wilson, Louise F; Webb, Penelope M; Neale, Rachel E; Bain, Christopher J; Whiteman, David C

2015-10-01

To estimate the proportion and numbers of cancers occurring in Australia in 2010 that are attributable to alcohol consumption. We estimated the population attributable fraction (PAF) of cancers causally associated with alcohol consumption using standard formulae incorporating prevalence of alcohol consumption and relative risks associated with consumption and cancer. We also estimated the proportion change in cancer incidence (potential impact fraction [PIF]) that might have occurred under the hypothetical scenario that an intervention reduced alcohol consumption, so that no-one drank >2 drinks/day. An estimated 3,208 cancers (2.8% of all cancers) occurring in Australian adults in 2010 could be attributed to alcohol consumption. The greatest numbers were for cancers of the colon (868) and female breast cancer (830). The highest PAFs were for squamous cell carcinomas of the oral cavity/pharynx (31%) and oesophagus (25%). The incidence of alcohol-associated cancer types could have been reduced by 1,442 cases (4.3%)--from 33,537 to 32,083--if no Australian adult consumed >2 drinks/day. More than 3,000 cancers were attributable to alcohol consumption and thus were potentially preventable. Strategies that limit alcohol consumption to guideline levels could prevent a large number of cancers in Australian adults. © 2015 The Authors.

Alcohol consumption as a risk factor for tuberculosis: meta-analyses and burden of disease

PubMed Central

Shield, Kevin D.; Roerecke, Michael; Samokhvalov, Andriy V.; Lönnroth, Knut; Rehm, Jürgen

2017-01-01

Meta-analyses of alcohol use, alcohol dosage and alcohol-related problems as risk factors for tuberculosis incidence were undertaken. The global alcohol-attributable tuberculosis burden of disease was also re-estimated. Systematic searches were conducted, reference lists were reviewed and expert consultations were held to identify studies. Cohort and case-control studies were included if there were no temporal violations of exposure and outcome. Risk relations (RRs) were pooled by using categorical and dose-response meta-analyses. The alcohol-attributable tuberculosis burden of disease was estimated by using alcohol-attributable fractions. 36 of 1108 studies were included. RRs for alcohol use and alcohol-related problems were 1.35 (95% CI 1.09–1.68; I2: 83%) and 3.33 (95% CI 2.14–5.19; 87%), respectively. Concerning alcohol dosage, tuberculosis risk rose as ethanol intake increased, with evidence of a threshold effect. Alcohol consumption caused 22.02 incident cases (95% CI 19.70–40.77) and 2.35 deaths (95% CI 2.05–4.79) per 100 000 people from tuberculosis in 2014. Alcohol-attributable tuberculosis incidence increased between 2000 and 2014 in most high tuberculosis burden countries, whereas mortality decreased. Alcohol consumption was associated with an increased risk of tuberculosis in all meta-analyses. It was consequently a major contributor to the tuberculosis burden of disease. PMID:28705945

Cancers in Australia in 2010 attributable to overweight and obesity.

PubMed

Kendall, Bradley J; Wilson, Louise F; Olsen, Catherine M; Webb, Penelope M; Neale, Rachel E; Bain, Christopher J; Whiteman, David C

2015-10-01

To estimate the proportion and number of cancers occurring in Australia in 2010 attributable to overweight/obesity. We estimated the population attributable fraction (PAF) and number of cancers causally associated with overweight/obesity. We used standard formulae incorporating Australian prevalence data for body mass index (BMI), relative risks associated with BMI and cancer. We also estimated the proportion change in cancer incidence (potential impact fraction [PIF]) that may have occurred assuming that the prevalence of overweight/obesity had remained at 1990 levels. An estimated 3,917 cancer cases (3.4% of all cancers) diagnosed in 2010 were attributable to overweight/obesity, including 1,101 colon cancers, 971 female post-menopausal breast cancers and 595 endometrial cancers (PAFs of 10%, 8% and 26%, respectively). Highest PAFs were observed for oesophageal adenocarcinoma (31%), endometrial cancer (26%) and kidney cancer (19%). If the prevalence of overweight/obesity in Australia had remained at levels prevailing in 1990, we estimate there would have been 820 fewer cancers diagnosed in 2010 (PIF 2%). Overweight/obesity causes a substantial number of cancers in Australia. Public health strategies to reduce the prevalence of overweight and obesity will reduce the incidence of cancer, particularly of the colon, breast and endometrium. © 2015 The Authors.

Tuberculosis incidence in prisons: a systematic review.

PubMed

Baussano, Iacopo; Williams, Brian G; Nunn, Paul; Beggiato, Marta; Fedeli, Ugo; Scano, Fabio

2010-12-21

Transmission of tuberculosis (TB) in prisons has been reported worldwide to be much higher than that reported for the corresponding general population. A systematic review has been performed to assess the risk of incident latent tuberculosis infection (LTBI) and TB disease in prisons, as compared to the incidence in the corresponding local general population, and to estimate the fraction of TB in the general population attributable (PAF%) to transmission within prisons. Primary peer-reviewed studies have been searched to assess the incidence of LTBI and/or TB within prisons published until June 2010; both inmates and prison staff were considered. Studies, which were independently screened by two reviewers, were eligible for inclusion if they reported the incidence of LTBI and TB disease in prisons. Available data were collected from 23 studies out of 582 potentially relevant unique citations. Five studies from the US and one from Brazil were available to assess the incidence of LTBI in prisons, while 19 studies were available to assess the incidence of TB. The median estimated annual incidence rate ratio (IRR) for LTBI and TB were 26.4 (interquartile range [IQR]: 13.0-61.8) and 23.0 (IQR: 11.7-36.1), respectively. The median estimated fraction (PAF%) of tuberculosis in the general population attributable to the exposure in prisons for TB was 8.5% (IQR: 1.9%-17.9%) and 6.3% (IQR: 2.7%-17.2%) in high- and middle/low-income countries, respectively. The very high IRR and the substantial population attributable fraction show that much better TB control in prisons could potentially protect prisoners and staff from within-prison spread of TB and would significantly reduce the national burden of TB. Future studies should measure the impact of the conditions in prisons on TB transmission and assess the population attributable risk of prison-to-community spread. Please see later in the article for the Editors' Summary.

The potential impact of a social redistribution of specific risk factors on socioeconomic inequalities in mortality: illustration of a method based on population attributable fractions.

PubMed

Hoffmann, Rasmus; Eikemo, Terje Andreas; Kulhánová, Ivana; Dahl, Espen; Deboosere, Patrick; Dzúrová, Dagmar; van Oyen, Herman; Rychtaríková, Jitka; Strand, Bjørn Heine; Mackenbach, Johan P

2013-01-01

Socioeconomic differences in health are a major challenge for public health. However, realistic estimates to what extent they are modifiable are scarce. This problem can be met through the systematic application of the population attributable fraction (PAF) to socioeconomic health inequalities. The authors used cause-specific mortality data by educational level from Belgium, Norway and Czech Republic and data on the prevalence of smoking, alcohol, lack of physical activity and high body mass index from national health surveys. Information on the impact of these risk factors on mortality comes from the epidemiological literature. The authors calculated PAFs to quantify the impact on socioeconomic health inequalities of a social redistribution of risk factors. The authors developed an Excel tool covering a wide range of possible scenarios and the authors compare the results of the PAF approach with a conventional regression. In a scenario where the whole population gets the risk factor prevalence currently seen among the highly educated inequalities in mortality can be reduced substantially. According to the illustrative results, the reduction of inequality for all risk factors combined varies between 26% among Czech men and 94% among Norwegian men. Smoking has the highest impact for both genders, and physical activity has more impact among women. After discussing the underlying assumptions of the PAF, the authors concluded that the approach is promising for estimating the extent to which health inequalities can be potentially reduced by interventions on specific risk factors. This reduction is likely to differ substantially between countries, risk factors and genders.

Smoking rate and periodontal disease prevalence: 40-year trends in Sweden 1970-2010.

PubMed

Bergstrom, Jan

2014-10-01

To investigate the relationship between smoking rate and periodontal disease prevalence in Sweden. National smoking rates were found from Swedish National Statistics on smoking habits. Based on smoking rates for the years 1970-2010, periodontal disease prevalence estimates were calculated for the age bracket 40-70 years and smoking-associated relative risks between 2.0 and 20.0. The impact of smoking on the population was estimated according to the concept of population attributable fraction. The age-standardized smoking rate in Sweden declined from 44% in 1970 to 15% in 2010. In parallel with the smoking decline the calculated prevalence estimate of periodontal disease dropped from 26% to 12% assuming a 10-fold smoking-associated relative risk. Even at more moderate magnitudes of the relative risk, e.g. 2-fold or 5-fold, the prevalence decrease was quite tangible, suggesting that the current prevalence in Sweden is about 20-50% of the level 40 years ago. The population attributable fraction, estimating the portion of the disease that would have been avoided in the absence of smoking, was 80% in 1970 and 58% in 2010 at a ten-fold relative risk. Calculated estimates of periodontal disease prevalence are closely related to real changes in smoking rate. As smoking rate drops periodontal disease prevalence will drop. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Heat or Cold: Which One Exerts Greater Deleterious Effects on Health in a Basin Climate City? Impact of Ambient Temperature on Mortality in Chengdu, China.

PubMed

Cui, Yan; Yin, Fei; Deng, Ying; Volinn, Ernest; Chen, Fei; Ji, Kui; Zeng, Jing; Zhao, Xing; Li, Xiaosong

2016-12-10

Background : Although studies from many countries have estimated the impact of ambient temperature on mortality, few have compared the relative impacts of heat and cold on health, especially in basin climate cities. We aimed to quantify the impact of ambient temperature on mortality, and to compare the contributions of heat and cold in a large basin climate city, i.e., Chengdu (Sichuan Province, China); Methods : We estimated the temperature-mortality association with a distributed lag non-linear model (DLNM) with a maximum lag-time of 21 days while controlling for long time trends and day of week. We calculated the mortality risk attributable to heat and cold, which were defined as temperatures above and below an "optimum temperature" that corresponded to the point of minimum mortality. In addition, we explored effects of individual characteristics; Results : The analysis provides estimates of the overall mortality burden attributable to temperature, and then computes the components attributable to heat and cold. Overall, the total fraction of deaths caused by both heat and cold was 10.93% (95%CI: 7.99%-13.65%). Taken separately, cold was responsible for most of the burden (estimate 9.96%, 95%CI: 6.90%-12.81%), while the fraction attributable to heat was relatively small (estimate 0.97%, 95%CI: 0.46%-2.35%). The attributable risk (AR) of respiratory diseases was higher (19.69%, 95%CI: 14.45%-24.24%) than that of cardiovascular diseases (11.40%, 95%CI: 6.29%-16.01%); Conclusions : In Chengdu, temperature was responsible for a substantial fraction of deaths, with cold responsible for a higher proportion of deaths than heat. Respiratory diseases exert a larger effect on death than other diseases especially on cold days. There is potential to reduce respiratory-associated mortality especially among the aged population in basin climate cities when the temperature deviates beneath the optimum. The result may help to comprehensively assess the impact of ambient temperature in basin cities, and further facilitate an appropriate estimate of the health consequences of various climate-change scenarios.

Heat or Cold: Which One Exerts Greater Deleterious Effects on Health in a Basin Climate City? Impact of Ambient Temperature on Mortality in Chengdu, China

PubMed Central

Cui, Yan; Yin, Fei; Deng, Ying; Volinn, Ernest; Chen, Fei; Ji, Kui; Zeng, Jing; Zhao, Xing; Li, Xiaosong

2016-01-01

Background: Although studies from many countries have estimated the impact of ambient temperature on mortality, few have compared the relative impacts of heat and cold on health, especially in basin climate cities. We aimed to quantify the impact of ambient temperature on mortality, and to compare the contributions of heat and cold in a large basin climate city, i.e., Chengdu (Sichuan Province, China); Methods: We estimated the temperature-mortality association with a distributed lag non-linear model (DLNM) with a maximum lag-time of 21 days while controlling for long time trends and day of week. We calculated the mortality risk attributable to heat and cold, which were defined as temperatures above and below an “optimum temperature” that corresponded to the point of minimum mortality. In addition, we explored effects of individual characteristics; Results: The analysis provides estimates of the overall mortality burden attributable to temperature, and then computes the components attributable to heat and cold. Overall, the total fraction of deaths caused by both heat and cold was 10.93% (95%CI: 7.99%–13.65%). Taken separately, cold was responsible for most of the burden (estimate 9.96%, 95%CI: 6.90%–12.81%), while the fraction attributable to heat was relatively small (estimate 0.97%, 95%CI: 0.46%–2.35%). The attributable risk (AR) of respiratory diseases was higher (19.69%, 95%CI: 14.45%–24.24%) than that of cardiovascular diseases (11.40%, 95%CI: 6.29%–16.01%); Conclusions: In Chengdu, temperature was responsible for a substantial fraction of deaths, with cold responsible for a higher proportion of deaths than heat. Respiratory diseases exert a larger effect on death than other diseases especially on cold days. There is potential to reduce respiratory-associated mortality especially among the aged population in basin climate cities when the temperature deviates beneath the optimum. The result may help to comprehensively assess the impact of ambient temperature in basin cities, and further facilitate an appropriate estimate of the health consequences of various climate-change scenarios. PMID:27973401

Estimating the burden of disease attributable to physical inactivity in South Africa in 2000.

PubMed

Joubert, Jané; Norman, Rosana; Lambert, Estelle V; Groenewald, Pam; Schneider, Michelle; Bull, Fiona; Bradshaw, Debbie

2007-08-01

To quantify the burden of disease attributable to physical inactivity in persons 15 years or older, by age group and sex, in South Africa for 2000. The global comparative risk assessment (CRA) methodology of the World Health Organization was followed to estimate the disease burden attributable to physical inactivity. Levels of physical activity for South Africa were obtained from the World Health Survey 2003. A theoretical minimum risk exposure of zero, associated outcomes, relative risks, and revised burden of disease estimates were used to calculate population-attributable fractions and the burden attributed to physical inactivity. Monte Carlo simulation-modelling techniques were used for the uncertainty analysis. South Africa. Adults >or= 15 years. Deaths and disability-adjusted life years (DALYs) from ischaemic heart disease, ischaemic stroke, breast cancer, colon cancer, and type 2 diabetes mellitus. Overall in adults >or= 15 years in 2000, 30% of ischaemic heart disease, 27% of colon cancer, 22% of ischaemic stroke, 20% of type 2 diabetes, and 17% of breast cancer were attributable to physical inactivity. Physical inactivity was estimated to have caused 17,037 (95% uncertainty interval 11,394 - 20,407), or 3.3% (95% uncertainty interval 2.2 - 3.9%) of all deaths in 2000, and 176,252 (95% uncertainty interval 133,733 - 203,628) DALYs, or 1.1% (95% uncertainty interval 0.8 - 1.3%) of all DALYs in 2000. Compared with other regions and the global average, South African adults have a particularly high prevalence of physical inactivity. In terms of attributable deaths, physical inactivity ranked 9th compared with other risk factors, and 12th in terms of DALYs. There is a clear need to assess why South Africans are particularly inactive, and to ensure that physical activity/inactivity is addressed as a national health priority.

High population attributable fractions of myocardial infarction associated with waist–hip ratio

PubMed Central

Igland, Jannicke; Vollset, Stein Emil; Sulo, Gerhard; Eide, Geir Egil; Tell, Grethe S.

2016-01-01

Objective To estimate population attributable fractions (PAF) of acute myocardial infarction (AMI) associated with anthropometric measures by sex and age. Methods The Cohort of Norway study identified 140,790 participants free of cardiovascular disease, 1994‐2003. Participants were followed for AMI through 2009 by record linkages through the Cardiovascular Disease in Norway Project. PAFs were adjusted for age, smoking, systolic blood pressure, diabetes, and the ratio of total cholesterol to high‐density lipoprotein cholesterol. Results The PAFs associated with a waist–hip ratio (WHR) in the top two quintiles were 26.1% (95% confidence interval, CI 14.6–36.1) for middle‐aged women (<60 years, mean of 41 years) and 9.3% (95% CI 3.0–15.1) for similarly aged men after adjustment for body mass index (BMI) and conventional risk factors. However, PAFs associated with anthropometric measures in elderly participants (≥ 60 years, mean of 70 years) were non‐significant in multivariable analyses. Also, WHR was a significant predictor of AMI among men and women without an enlarged waist circumference (<102 cm for men and < 88 cm for women) in adjusted analyses. Conclusions WHR measurements could improve identification of at‐risk individuals above and beyond that of conventional risk factors, BMI, or an enlarged waist circumference. PMID:27030172

The contribution of benzene to smoking-induced leukemia.

PubMed

Korte, J E; Hertz-Picciotto, I; Schulz, M R; Ball, L M; Duell, E J

2000-04-01

Cigarette smoking is associated with an increased risk of leukemia; benzene, an established leukemogen, is present in cigarette smoke. By combining epidemiologic data on the health effects of smoking with risk assessment techniques for low-dose extrapolation, we assessed the proportion of smoking-induced total leukemia and acute myeloid leukemia (AML) attributable to the benzene in cigarette smoke. We fit both linear and quadratic models to data from two benzene-exposed occupational cohorts to estimate the leukemogenic potency of benzene. Using multiple-decrement life tables, we calculated lifetime risks of total leukemia and AML deaths for never, light, and heavy smokers. We repeated these calculations, removing the effect of benzene in cigarettes based on the estimated potencies. From these life tables we determined smoking-attributable risks and benzene-attributable risks. The ratio of the latter to the former constitutes the proportion of smoking-induced cases attributable to benzene. Based on linear potency models, the benzene in cigarette smoke contributed from 8 to 48% of smoking-induced total leukemia deaths [95% upper confidence limit (UCL), 20-66%], and from 12 to 58% of smoking-induced AML deaths (95% UCL, 19-121%). The inclusion of a quadratic term yielded results that were comparable; however, potency models with only quadratic terms resulted in much lower attributable fractions--all < 1%. Thus, benzene is estimated to be responsible for approximately one-tenth to one-half of smoking-induced total leukemia mortality and up to three-fifths of smoking-related AML mortality. In contrast to theoretical arguments that linear models substantially overestimate low-dose risk, linear extrapolations from empirical data over a dose range of 10- to 100-fold resulted in plausible predictions.

Green Space and Deaths Attributable to the Urban Heat Island Effect in Ho Chi Minh City.

PubMed

Dang, Tran Ngoc; Van, Doan Quang; Kusaka, Hiroyuki; Seposo, Xerxes T; Honda, Yasushi

2018-04-01

To quantify heat-related deaths in Ho Chi Minh City, Vietnam, caused by the urban heat island (UHI) and explore factors that may alleviate the impact of UHIs. We estimated district-specific meteorological conditions from 2010 to 2013 using the dynamic downscaling model and calculated the attributable fraction and number of mortalities resulting from the total, extreme, and mild heat in each district. The difference in attributable fraction of total heat between the central and outer districts was classified as the attributable fraction resulting from the UHI. The association among attributable fraction, attributable number with a green space, population density, and budget revenue of each district was then explored. The temperature-mortality relationship between the central and outer areas was almost identical. The attributable fraction resulting from the UHI was 0.42%, which was contributed by the difference in temperature distribution between the 2 areas. Every 1-square-kilometer increase in green space per 1000 people can prevent 7.4 deaths caused by heat. Green space can alleviate the impacts of UHIs, although future studies conducting a heath economic evaluation of tree planting are warranted.

Green Space and Deaths Attributable to the Urban Heat Island Effect in Ho Chi Minh City

PubMed Central

Van, Doan Quang; Kusaka, Hiroyuki; Seposo, Xerxes T.; Honda, Yasushi

2018-01-01

Objectives. To quantify heat-related deaths in Ho Chi Minh City, Vietnam, caused by the urban heat island (UHI) and explore factors that may alleviate the impact of UHIs. Methods. We estimated district-specific meteorological conditions from 2010 to 2013 using the dynamic downscaling model and calculated the attributable fraction and number of mortalities resulting from the total, extreme, and mild heat in each district. The difference in attributable fraction of total heat between the central and outer districts was classified as the attributable fraction resulting from the UHI. The association among attributable fraction, attributable number with a green space, population density, and budget revenue of each district was then explored. Results. The temperature–mortality relationship between the central and outer areas was almost identical. The attributable fraction resulting from the UHI was 0.42%, which was contributed by the difference in temperature distribution between the 2 areas. Every 1-square-kilometer increase in green space per 1000 people can prevent 7.4 deaths caused by heat. Conclusions. Green space can alleviate the impacts of UHIs, although future studies conducting a heath economic evaluation of tree planting are warranted. PMID:29072938

On estimation of time-dependent attributable fraction from population-based case-control studies.

PubMed

Zhao, Wei; Chen, Ying Qing; Hsu, Li

2017-09-01

Population attributable fraction (PAF) is widely used to quantify the disease burden associated with a modifiable exposure in a population. It has been extended to a time-varying measure that provides additional information on when and how the exposure's impact varies over time for cohort studies. However, there is no estimation procedure for PAF using data that are collected from population-based case-control studies, which, because of time and cost efficiency, are commonly used for studying genetic and environmental risk factors of disease incidences. In this article, we show that time-varying PAF is identifiable from a case-control study and develop a novel estimator of PAF. Our estimator combines odds ratio estimates from logistic regression models and density estimates of the risk factor distribution conditional on failure times in cases from a kernel smoother. The proposed estimator is shown to be consistent and asymptotically normal with asymptotic variance that can be estimated empirically from the data. Simulation studies demonstrate that the proposed estimator performs well in finite sample sizes. Finally, the method is illustrated by a population-based case-control study of colorectal cancer. © 2017, The International Biometric Society.

Lung cancer risk from PAHs emitted from biomass combustion.

PubMed

Sarigiannis, Dimosthenis Α; Karakitsios, Spyros P; Zikopoulos, Dimitrios; Nikolaki, Spyridoula; Kermenidou, Marianthi

2015-02-01

This study deals with the assessment of the cancer risk attributable to PAH exposure, attributable to the increased use of biomass for space heating in Greece in the winter of 2012-2013. Three fractions of particulates (PM1, PM2.5 and PM10) were measured in two sampling sites (urban/residential and traffic-influenced) followed by chemical analysis of 19 PAHs and levoglucosan (used as a biomarker tracer). PAH-induced lung cancer risk was estimated by a comprehensive methodology that incorporated human respiratory tract deposition modelling in order to estimate the toxic equivalent concentration (TEQ) at each target tissue. This allowed us to further differentiate internal exposure and risk by age groups. Results showed that all PM fractions are higher in Greece during the cold months of the year, mainly due to biomass use for space heating. PAH and levoglucosan levels were highly correlated, indicating that particles emitted from biomass combustion are more toxic than PM emitted from other sources. The estimated lung cancer risk was non-negligible for residents close to the urban background monitoring site. Higher risk was estimated for infants and children, due to the higher bodyweight normalized dose and the human respiratory tract (HRT) physiology. HRT structure and physiology in youngsters favor deposition of particles that are smaller and more toxic per unit mass. In all cases, the estimated risk (5.7E-07 and 1.4E-06 for the urban background site and 1.4E-07 to 5.0E-07 for the traffic site) was lower to the one estimated by the conventional methodology (2.8E-06 and 9.7E-07 for the urban background and the traffic site respectively) that is based on Inhalation Unit Risk; the latter assumes that all PAHs adsorbed on particles are taken up by humans. With the methodology proposed herein, the estimated risk presents a 5-7 times difference between the two sampling sites (depending on the age group). These differences could not have been identified had we relied only on conventional risk assessment method. Consequently, the actual cancer risk attributable to PAHs on PM emitted from biomass burning would have been significantly underestimated. Copyright © 2014 Elsevier Inc. All rights reserved.

Lamb and kid mortality in village flocks in the coastal savanna zone of Ghana.

PubMed

Turkson, P K

2003-12-01

A cohort study was designed to observe and follow up mortality in lambs and kids in 88 flocks of sheep and goats under the traditional production system in five villages within the coastal savanna zone of Ghana over a 2-year period. The overall mortality rates for kids and lambs were 30.8% and 33.5%, respectively. Significantly higher proportions of kids (80.2%) and lambs (75.6%) up to 3 months of age died compared to kids and lambs from 4 to 12 months of age. The differences in mortality rates, either between male and female kids and lambs or between single-born and multiple-birth kids and lambs, were not significant. The odds ratio (OR) and relative risks (RR) for lambs and kids, on the basis of sex and birth types, were not significant; neither were the values obtained for attributable risk, attributable fraction, population attributable risk and population attributable fraction. The overall mortality rate on the basis of species of animal was not significant. At the village level, significant differences in the proportions of mortality on the basis of sex were seen in two villages. At Akotokyir, more male lambs (54.2%) died compared to females (27.6%), while at Apewosika more female lambs (42.2%) died compared to males (16.7%). The only significant difference in mortality proportions on the basis of birth type at the village level was seen at Apewosika, where more single-born kids died (52.8%) compared to kids born with sibling(s) (28.4%). The significant ORs for mortalities were 3.10 for male lambs at Akotokyir, 3.35 for female lambs at Apewosika and 2.82 for single-born kids at Apewosika. The corresponding RRs were equally significant. On the basis of species, significantly more lambs died at Akotokyir (44.2%) and Kwesimprah (44.7%) compared to kids. The implications of these findings are discussed.

Sexual assault while too intoxicated to resist: a general population study of Norwegian teenage girls.

PubMed

Pape, Hilde

2014-04-28

Underage drinking is widespread, but studies on alcohol-related sexual victimization among teenage girls are almost non-existent. Research on individual correlates and risk factors of sexual victimization more generally is also meager. This study focuses on sexual assault while incapacitated due to drunkenness among 15-18 year-old girls and examines how age, drinking behavior, impulsivity and involvement in norm-violating activities are associated with such victimization experiences. Data stemmed from a school survey (response rate: 85%) in 16 Norwegian municipalities. Almost all analyses were restricted to girls who had been intoxicated in the past year (n = 2701). In addition to bivariate associations, adjusted odds ratios and relative risks of incapacitated sexual assault (ISA) were estimated. Further, population-attributable fractions were calculated to explore how the prevalence of ISA victimization was likely to be affected if effective preventive measures were targeted solely at high-risk groups. The majority of the girls (71%) had been intoxicated in the past year, of which 7% had experienced ISA victimization in the same period. The proportion of victims decreased by age within the group that had been intoxicated, reflecting that the youngest girls were more likely to get severely drunk. Impulsivity and involvement in norm-violating behaviors were identified as potential risk factors, but the population-attributable fractions indicated that the groups with the highest risk of ISA victimization accounted for only a minority of all the cases of such victimization. Sexual assault against teenage girls who are too drunk to resist seems to be prevalent in Norway - notably among the youngest girls who engage in heavy episodic drinking. This study also suggests that one should reconsider the notion that no individual attributes are related to females' sexual assault victimization. It also indicates that a high risk approach to prevention, targeting groups with a high level of impulsivity or behavioral problems, may have limited effect on the prevalence of ISA victimization. Thus, from a public health perspective, it may be advisable to give priority to universal preventive measures to curb young girls' risk of being sexually assaulted in a state of alcohol-induced incapacitation.

Population attributable burden of Helicobacter pylori-related gastric cancer, coronary heart disease, and ischemic stroke in China.

PubMed

Jiang, J; Chen, Y; Shi, J; Song, C; Zhang, J; Wang, K

2017-02-01

Helicobacter pylori, a risk factor of cancer and chronic diseases, remains highly prevalent in China. This review aims to systematically evaluate the H. pylori-attributable burden for gastric cancer (GC), coronary heart disease (CHD), and ischemic stroke (IS) in the Chinese population. Helicobacter pylori prevalence was updated by pooling the results reported in studies across China. The population attributable fraction (PAF) was calculated based on the H. pylori prevalence 10 years ago and relative risks of specific disease by reviewing the prospective studies published from 2000 through 2015. In China, the nationwide average prevalence of H. pylori was estimated to be 42.06 % in the general population during 2009-2013. The fixed effects pooled relative risk (RR) of 1.89 [95 % confidence interval (CI): 1.57-2.26] was obtained for gastric cancer and H. pylori infection. Helicobacter pylori infection was responsible for around 37.38 % of noncardia GC, corresponding to about 105,536 cases in 2012. As for extra-gastric disorders, H. pylori infections had higher risk of CHD (RR = 1.55, 95 % CI: 1.37-1.76) and IS (RR = 1.54, 95 % CI: 1.42-1.66). About 23.15 % of CHD and 22.29 % of IS were attributable to H. pylori infection. The estimates of H. pylori-attributable burden reveal a great potential of reducing H. pylori-related chronic disease burden by H. pylori eradication. Large prospective studies are warranted to identify which H. pylori strains, which subtypes of the disease, and which subgroups of the population have the greatest risk of relevant diseases and the effect of H. pylori eradication on the prevention of H. pylori-related diseases.

Distillation fraction-specific ecotoxicological evaluation of a paraffin-rich crude oil.

PubMed

Erlacher, Elisabeth; Loibner, Andreas P; Kendler, Romana; Scherr, Kerstin E

2013-03-01

Crude oil is a complex mixture of petroleum hydrocarbons (PHC) with distinct chemical, physical and toxicological properties relevant for contaminated site risk assessment. Ecotoxicological effects of crude oil distillation fractions on luminescent bacteria (Vibrio fischeri), earthworms (Dendrobaena hortensis) and invertebrates (Heterocypris incongruens) were tested using two spiked soils and their elutriates. Fraction 2 (F2) had an equivalent carbon number (ECN) range of >10 to 16, and F3 from >16 to 39. F2 showed a substantially higher ecotoxicological effect than F3 for Vibrio and Dendrobaena. In contrast, severe inhibition of Heterocypris by the poorly soluble F3 is attributed to mechanical organ blockage. Immediate sequestration of PHC to the organic matter-rich soil effected reduced toxicity for all organisms. This study indicates that a more differentiated consideration (i) of PHC mixtures based on ECN range and (ii) of model soil properties employed for ecotoxicity testing should be included into PHC-contaminated site risk assessment. Copyright © 2012 Elsevier Ltd. All rights reserved.

Population attributable fractions of psychopathology and suicidal behaviour associated with childhood adversities in Northern Ireland.

PubMed

McLafferty, Margaret; O'Neill, Siobhan; Murphy, Sam; Armour, Cherie; Bunting, Brendan

2018-03-01

Childhood adversities are strong predictors of psychopathology and suicidality. However, specific adversities are associated with different outcomes, with cross-national variations reported. The current study examined rates of adversities reported in Northern Ireland (NI), and associations between adverse childhood experiences and psychopathology and suicidal behaviour were explored. Data was obtained from the Northern Ireland Study of Health and Stress (NISHS), conducted as part of the World Mental Health (WMH) survey initiative (2004-2008); response rate 68.4% (n = 1,986). The on-line survey used, the WHO Composite International Diagnostic Interview (CIDI) to examine psychopathology and associated risk factors in the NI population. Prevalence rates of retrospectively reported childhood adversities were calculated, with gender and age variations explored. Females were more likely to experience sexual abuse. Individuals who grew up during the worst years of the civil conflict in NI experienced elevated levels of childhood adversities. Participants who endured childhood adversities were more likely to have mental health problems but variations in risk factors were found for different disorders. Parental mental illness was associated with all disorders however, with ORs ranging from 2.20 for mood disorders to 4.07 for anxiety disorders. Population attributable fractions (PAF) estimated the reduction in psychopathology and suicidal behaviour in the population if exposure to adverse childhood events had not occurred. The highest PAF values were revealed for parental mental illness and sexual abuse. The findings indicate that a substantial proportion of psychopathology and suicide risk in NI are attributable to childhood adversities, providing support for early intervention and prevention initiatives. Copyright © 2017 Elsevier Ltd. All rights reserved.

Health Care Expenditures Attributable to Smoking in Military Veterans

PubMed Central

Hamlett-Berry, Kim; Sung, Hai-Yen; Max, Wendy

2015-01-01

Introduction: The health effects of cigarette smoking have been estimated to account for between 6%–8% of U.S. health care expenditures. We estimated Veterans Health Administration (VHA) health care costs attributable to cigarette smoking. Methods: VHA survey and administrative data provided the number of Veteran enrollees, current and former smoking prevalence, and the cost of 4 types of care for groups defined by age, gender, and region. Cost and smoking status could not be linked at the enrollee level, so we used smoking attributable fractions estimated in sample of U.S. residents where the linkage could be made. Results: The 7.7 million Veterans enrolled in VHA received $40.2 billion in VHA provided health services in 2010. We estimated that $2.7 billion in VHA costs were attributable to the health effects of smoking. This was 7.6% of the $35.3 billion spent on the types of care for which smoking-attributable fractions could be determined. The fraction of inpatient costs that was attributable to smoking (11.4%) was greater than the fraction of ambulatory care cost attributable to smoking (5.3%). More cost was attributable to current smokers ($1.7 billion) than to former smokers ($983 million). Conclusions: The fraction of VHA costs attributable to smoking is similar to that of other health care systems. Smoking among Veterans is slowly decreasing, but prevalence remains high in Veterans with psychiatric and substance use disorders, and in younger and female Veterans. VHA has adopted a number of smoking cessation programs that have the potential for reducing future smoking-attributable costs. PMID:25239960

[Estimation of the population attributable fraction due to obesity in hospital admissions for flu valued according to Body Mass Index (BMI) and CUN-BAE].

PubMed

Dávila-Batista, V; Carriedo, D; Díez, F; Pueyo Bastida, A; Martínez Durán, B; Martin, V

2018-03-01

The obesity pandemic together with the influenza pandemic could lead to a significant burden of disease. The body mass index (BMI) does not discriminate obesity appropriately. The CUN-BAE has recently been used as an estimate of body fatness for Caucasians, including BMI, gender, and age. The aim of this study is to assess the population attributable fraction of hospital admissions due to influenza, due to the body fatness measured with the BMI, and the CUN-BAE. A multicentre study was conducted using matched case-controls. Cases were hospital admissions with the influenza confirmed by the RT-PCR method between 2009 and 2011. The risk of hospital admission and the population attribuible fraction were calculated using the BMI or the CUN-BAE for each adiposity category in a conditional logical regression analysis adjusted for confounding variables. The analyzes were estimated in the total sample, in unvaccinated people, and those less than 65 years-old. A total of 472 hospitalised cases and 493 controls were included in the study. Compared to normal weight, the aOR of influenza hospital admissions increases with each level of BMI (aOR=1.26; 2.06 and 11.64) and CUN-BAE (aOR=2.78; 4.29; 5.43 and 15.18). The population attributable fraction of influenza admissions using CUN-BAE is 3 times higher than that estimated with BMI (0,72 vs. 0,27), with the differences found being similar the non-vaccinated and under 65 year-olds. The BMI could be underestimating the burden of disease attributable to obesity in individuals hospitalised with influenza. There needs to be an appropriate assessment of the impact of obesity and vaccine recommendation criteria. Copyright © 2017 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.

HYPERSAMP - HYPERGEOMETRIC ATTRIBUTE SAMPLING SYSTEM BASED ON RISK AND FRACTION DEFECTIVE

NASA Technical Reports Server (NTRS)

De, Salvo L. J.

1994-01-01

HYPERSAMP is a demonstration of an attribute sampling system developed to determine the minimum sample size required for any preselected value for consumer's risk and fraction of nonconforming. This statistical method can be used in place of MIL-STD-105E sampling plans when a minimum sample size is desirable, such as when tests are destructive or expensive. HYPERSAMP utilizes the Hypergeometric Distribution and can be used for any fraction nonconforming. The program employs an iterative technique that circumvents the obstacle presented by the factorial of a non-whole number. HYPERSAMP provides the required Hypergeometric sample size for any equivalent real number of nonconformances in the lot or batch under evaluation. Many currently used sampling systems, such as the MIL-STD-105E, utilize the Binomial or the Poisson equations as an estimate of the Hypergeometric when performing inspection by attributes. However, this is primarily because of the difficulty in calculation of the factorials required by the Hypergeometric. Sampling plans based on the Binomial or Poisson equations will result in the maximum sample size possible with the Hypergeometric. The difference in the sample sizes between the Poisson or Binomial and the Hypergeometric can be significant. For example, a lot size of 400 devices with an error rate of 1.0% and a confidence of 99% would require a sample size of 400 (all units would need to be inspected) for the Binomial sampling plan and only 273 for a Hypergeometric sampling plan. The Hypergeometric results in a savings of 127 units, a significant reduction in the required sample size. HYPERSAMP is a demonstration program and is limited to sampling plans with zero defectives in the sample (acceptance number of zero). Since it is only a demonstration program, the sample size determination is limited to sample sizes of 1500 or less. The Hypergeometric Attribute Sampling System demonstration code is a spreadsheet program written for IBM PC compatible computers running DOS and Lotus 1-2-3 or Quattro Pro. This program is distributed on a 5.25 inch 360K MS-DOS format diskette, and the program price includes documentation. This statistical method was developed in 1992.

Alcohol and Road Traffic Injuries in Latin America and the Caribbean: A Case-Crossover Study.

PubMed

Borges, Guilherme; Monteiro, Maristela; Cherpitel, Cheryl J; Orozco, Ricardo; Ye, Yu; Poznyak, Vladimir; Peden, Margie; Pechansky, Flavio; Cremonte, Mariana; Reid, Sandra D; Mendez, Jesus

2017-10-01

This study reports dose-response estimates for the odds ratio (OR) and population attributable risk of acute alcohol use and road traffic injury (RTI). Data were analyzed on 1,119 RTI patients arriving at 16 emergency departments (EDs) in Argentina, Brazil, Costa Rica, Dominican Republic, Guatemala, Guyana, Mexico, Nicaragua, Panama, and Trinidad and Tobago. Case-crossover analysis, pair-matching the number of standard drinks consumed within the 6 hours prior to the RTI with 2 control periods (prior d/wk), was performed using fractional polynomial analysis for dose-response. About 1 in 6 RTI patients in EDs were positive for self-reported alcohol 6 hours prior to the injury (country range 8.6 to 24.1%). The likelihood of an RTI with any drinking prior (compared to not drinking) was 5 times higher (country range OR 2.50 to 15.00) and the more a person drinks the higher the risk. Every drink (12.8 g alcohol) increased the risk of an RTI by 13%, even 1 to 2 drinks were associated with a sizable increase in risk of an RTI and a dose-response was found. Differences in ORs for drivers (OR = 3.51; 95% CI = 2.25 to 5.45), passengers (OR = 8.12; 95% CI = 4.22 to 15.61), and pedestrians (OR = 6.30; 95% CI = 3.14 to 12.64) and attributable fractions were noted. Acute use of alcohol was attributable to 14% of all RTIs, varying from 7% for females to 19% for being injured as a passenger. The finding that the presence of alcohol increases risk among drivers and nondrivers alike may further help to urge interventions targeting passengers and pedestrians. Routine screening and brief interventions in all health services could also have a beneficial impact in decreasing rates of RTIs. Higher priority should be given to alcohol as a risk factor for RTIs, particularly in Latin America and the Caribbean. Copyright © 2017 by the Research Society on Alcoholism.

Fraction of stroke mortality attributable to alcohol consumption in Russia.

PubMed

Y E, Razvodovsky

2014-01-01

Stroke is an international health problem with high associated human and economic costs. The mortality rate from stroke in Russia is one of the highest in the world. Risk factors identification is therefore a high priority from the public health perspective. Epidemiological evidence suggests that binge drinking is an important determinant of high stroke mortality rate in Russia. The aim of the present study was to estimate the premature stroke mortality attributable to alcohol abuse in Russia on the basis of aggregate-level data of stroke mortality and alcohol consumption. Age-standardized sex-specific male and female stroke mortality data for the period 1980-2005 and data on overall alcohol consumption were analyzed by means ARIMA time series analysis. The results of the analysis suggest that 26.8% of all male stroke deaths and 18.4% female stroke deaths in Russia could be attributed to alcohol. The estimated alcohol-attributable fraction for men ranged from 16.2% (75+ age group) to 57,5% (30-44 age group) and for women from 21.7% (60-74 age group) and 43.5% (30- 44 age group). The outcomes of this study provide support for the hypothesis that alcohol is an important contributor to the high stroke mortality rate in Russian Federation. Therefore prevention of alcohol-attributable harm should be a major public health priority in Russia. Given the distribution of alcohol-related stroke deaths, interventions should be focused on the young and middle-aged men and women.

Asthma, other atopic conditions and risk of infections in 105 519 general population never and ever smokers.

PubMed

Helby, J; Nordestgaard, B G; Benfield, T; Bojesen, S E

2017-09-01

Individuals with atopic conditions may have increased susceptibility to infections outside the organs directly affected by their atopic condition. We tested the hypothesis that atopic conditions overall, and stratified by smoking history, are associated with increased risk of hospitalization for infections. We collected information on smoking history and self-reported atopic conditions from 105 519 individuals from the general population and followed them for up to 23 years for infectious disease hospitalizations and deaths. For asthma, we focused on never smokers with asthma diagnosed before age 50 (early asthma) to minimize confounding by chronic obstructive pulmonary disease. During follow-up, 11 160 individuals had infections. Never smokers with early asthma versus no atopic conditions had significantly increased risks of any infection (hazard ratio 1.65; 95% confidence interval 1.40-1.94), pneumonia (2.44; 1.92-3.11) and any non-respiratory tract infection (1.36; 1.11-1.67); results were similar in ever smokers. Never smokers with any asthma had significantly increased risks of any infection (1.44; 1.24-1.66) and pneumonia (1.99; 1.62-2.44). Neither atopic dermatitis (1.00; 0.91-1.10) nor hay fever (1.00; 0.93-1.07) was associated with risk of any infection. In never smokers, risk estimates for any infection were comparable between asthma and diabetes, as were the population attributable fractions of 2.2% for any asthma and 2.9% for diabetes. Early asthma was associated with significantly increased risks of any infection, pneumonia and any non-respiratory tract infection in never and ever smokers. In never smokers, risk estimates as well as population attributable fractions for any infection were comparable between asthma and diabetes, suggesting that asthma may be a substantial risk factor for infections in the general population. © 2017 The Association for the Publication of the Journal of Internal Medicine.

Estrogenic activity of isoflavonoids from the stem bark of the tropical tree Amphimas pterocarpoides, a source of traditional medicines.

PubMed

Tchoumtchoua, Job; Makropoulou, Maria; Ateba, Sylvain Benjamin; Boulaka, Athina; Halabalaki, Maria; Lambrinidis, George; Meligova, Aggeliki K; Mbanya, Jean Claude; Mikros, Emmanuel; Skaltsounis, Alexios-Leandros; Mitsiou, Dimitra J; Njamen, Dieudonne; Alexis, Michael N

2016-04-01

Various preparations of the African tree Amphimas pterocarpoides Harms are traditionally used to treat endocrine- related adverse health conditions. In the ovariectomized rat, the enriched in phenolics fraction of the methanol extract of stem bark of A. pterocarpoides acted as vaginotrophic agent of considerably weaker uterotrophic activity compared to estradiol. Evaluation of the fraction and 11 isoflavonoids isolated therefrom using Ishikawa cells and estrogen receptor (ER) isotype-specific reporter cells suggested that the estrogenic activity of the fraction could be attributed primarily to daidzein and dihydroglycitein and secondarily to glycitein. The potency-based selectivity of daidzein, dihydroglycitein and glycitein for gene expression through ERβ versus ERα, expressed relative to estradiol, was 37, 27 and 20, respectively. However, the rank order of relative-to-estradiol potencies of induction of alkaline phosphatase in Ishikawa cells, a reliable marker of estrogenic activity, was daidzein>dihydroglycitein>glycitein. The considerably higher estrogenic activity of dihydroglycitein compared to glycitein could be attributed to the partial agonist/antagonist activity of dihydroglycitein through ERβ. Calculation of theoretical free energies of binding predicted the partial agonism/antagonism of dihydroglycitein through ERβ. The fraction and the isolated isoflavonoids promoted lactogenic differentiation of HC11 mammary epithelial cells at least as effectively as premenopausal levels of estradiol. This data suggests that the estrogenic activity of the fraction likely depends on the metabolism of glycitein to dihydroglycitein; that the fraction could exert vaginotrophic activity likely without challenging endocrine cancer risk more than estrogen-alone supplementation; and that the fraction's safety for the reproductive track warrants a more detailed evaluation. Copyright © 2015 Elsevier Ltd. All rights reserved.

Contribution of placenta accreta to the incidence of postpartum hemorrhage and severe postpartum hemorrhage.

PubMed

Mehrabadi, Azar; Hutcheon, Jennifer A; Liu, Shiliang; Bartholomew, Sharon; Kramer, Michael S; Liston, Robert M; Joseph, K S

2015-04-01

To quantify the contribution of placenta accreta to the rate of postpartum hemorrhage and severe postpartum hemorrhage. All hospital deliveries in Canada (excluding Quebec) for the years 2009 and 2010 (N=570,637) were included in a retrospective cohort study using data from the Canadian Institute for Health Information. Placenta accreta included placental adhesion to the uterine wall, musculature, and surrounding organs (accreta, increta, or percreta). Severe postpartum hemorrhage included postpartum hemorrhage with blood transfusion, hysterectomy, or other procedures to control bleeding (including uterine suturing and ligation or embolization of pelvic arteries). Rates, rate ratios, population-attributable fractions (ie, incidence of postpartum hemorrhage attributable to placenta accreta), and 95% confidence intervals (CIs) were estimated. Logistic regression was used to quantify associations between placenta accreta and risk factors. The incidence of placenta accreta was 14.4 (95% CI 13.4-15.4) per 10,000 deliveries (819 cases among 570,637 deliveries), whereas the incidence of placenta accreta with postpartum hemorrhage was 7.2 (95% CI 6.5-8.0) per 10,000 deliveries. Postpartum hemorrhage among women with placenta accreta was predominantly third-stage hemorrhage (41% of all cases). Although placenta accreta was strongly associated with postpartum hemorrhage (rate ratio 8.3, 95% CI 7.7-8.9), its low frequency resulted in a small population-attributable fraction (1.0%, 95% CI 0.93-1.16). However, the strong association between placenta accreta and postpartum hemorrhage with hysterectomy (rate ratio 286, 95% CI 226-361) resulted in a population-attributable fraction of 29.0% (95% CI 24.3-34.3). Placenta accreta is too infrequent to account for the recent temporal increase in postpartum hemorrhage but contributes substantially to the proportion of postpartum hemorrhage with hysterectomy.

Assessment of TREM2 rs75932628 association with Alzheimer's disease in a population-based sample: the Cache County Study.

PubMed

Gonzalez Murcia, Josue D; Schmutz, Cameron; Munger, Caitlin; Perkes, Ammon; Gustin, Aaron; Peterson, Michael; Ebbert, Mark T W; Norton, Maria C; Tschanz, Joann T; Munger, Ronald G; Corcoran, Christopher D; Kauwe, John S K

2013-12-01

Recent studies have identified the rs75932628 (R47H) variant in TREM2 as an Alzheimer's disease risk factor with estimated odds ratio ranging from 2.9 to 5.1. The Cache County Memory Study is a large, population-based sample designed for the study of memory and aging. We genotyped R47H in 2974 samples (427 cases and 2540 control subjects) from the Cache County study using a custom TaqMan assay. We observed 7 heterozygous cases and 12 heterozygous control subjects with an odds ratio of 3.5 (95% confidence interval, 1.3-8.8; p = 0.0076). The minor allele frequency and population attributable fraction for R47H were 0.0029 and 0.004, respectively. This study replicates the association between R47H and Alzheimer's disease risk in a large, population-based sample, and estimates the population frequency and attributable risk of this rare variant. Copyright © 2013 Elsevier Inc. All rights reserved.

Indoor tanning and non-melanoma skin cancer: systematic review and meta-analysis.

PubMed

Wehner, Mackenzie R; Shive, Melissa L; Chren, Mary-Margaret; Han, Jiali; Qureshi, Abrar A; Linos, Eleni

2012-10-02

To synthesise the literature on indoor tanning and non-melanoma skin cancer. Systematic review and meta-analysis. PubMed (1966 to present), Embase (1974 to present), and Web of Science (1898 to present). All articles that reported an original effect statistic for indoor tanning and non-melanoma skin cancer were included. Articles that presented no data, such as review articles and editorials, were excluded, as were articles in languages other than English. Two investigators independently extracted data. Random effects meta-analysis was used to summarise the relative risk of ever use versus never use of indoor tanning. Dose-response effects and exposure to indoor tanning during early life were also examined. The population attributable risk fraction for the United States population was calculated. 12 studies with 9328 cases of non-melanoma skin cancer were included. Among people who reported ever using indoor tanning compared with those who never used indoor tanning, the summary relative risk for squamous cell carcinoma was 1.67 (95% confidence interval 1.29 to 2.17) and that for basal cell carcinoma was 1.29 (1.08 to 1.53). No significant heterogeneity existed between studies. The population attributable risk fraction for the United States was estimated to be 8.2% for squamous cell carcinoma and 3.7% for basal cell carcinoma. This corresponds to more than 170 000 cases of non-melanoma skin cancer each year attributable to indoor tanning. On the basis of data from three studies, use of indoor tanning before age 25 was more strongly associated with both squamous cell carcinoma (relative risk 2.02, 0.70 to 5.86) and basal cell carcinoma (1.40, 1.29 to 1.52). Indoor tanning is associated with a significantly increased risk of both basal and squamous cell skin cancer. The risk is higher with use in early life (<25 years). This modifiable risk factor may account for hundreds of thousands of cases of non-melanoma skin cancer each year in the United States alone and many more worldwide. These findings contribute to the growing body of evidence on the harms of indoor tanning and support public health campaigns and regulation to reduce exposure to this carcinogen.

Evaluation of the social and economic burden of road traffic noise-attributed myocardial infarction in Bulgarian urban population.

PubMed

Dzhambov, Angel M; Dimitrova, Donka D

2015-03-01

Road traffic noise is a widely studied environmental risk factor for ischaemic heart disease and myocardial infarction in particular. Given that myocardial infarction is a leading disability and mortality cause in Bulgaria and that a significant proportion of the urban population is exposed to high noise levels, quantification of the burden of disease attributable to traffic noise is essential for environmental health policy making and noise control engineering. This study aimed at estimating the burden of the myocardial infarction cases attributable to road traffic noise in the Bulgarian urban population. We used the methodology for estimating the burden of disease attributable to environmental noise outlined by the World Health Organization. Risk data were extracted from a recently published meta-analysis providing updated exposure-response relationship between traffic noise and the risk for myocardial infarction. Based on these data we calculated the fraction of myocardial infarction cases attributable to traffic noise, loss of quality-adjusted life-years (QALYs), and the economic burden, assuming € 12,000 per QALY. About 2.9 % or 101 of all myocardial infarction cases could be attributed to road traffic noise. Fifty-five of these were fatal. Nine hundred and sixty-eight QALYs were lost to these cases. The monetary value of these QALYs was about € 11.6 million. Although the measures used in this study are crude and give only an approximation of the real burden of disease from road traffic noise, they are indicative of the important social and economic aspect of noise pollution in Bulgaria. Hopefully, these results will direct the attention of epidemiologists, environmental hygienists, and health economists to this pivotal environmental issue.

[Estimates of Attributable Fraction of occupational cancers in the recent epidemiological literature].

PubMed

Merler, Enzo

2009-01-01

The article reviews the estimates of Attributable Fraction (AF) of occupational cancers. Because of their relevance, it starts with a synthesis and a comment on the estimates of avoidable cancers, and among these of cancers due to occupation, as expressed in 1981 by Doll and Peto. The main studies that have brought back into the epidemiological pathway the exercise of producing FA are quoted and the results of the new studies reviewed. The dimension of occupational cancers is of public health importance, because caused by exposures assumed to be avoidable. However, the estimates of AF are prone to uncertainties and limitations. Occupational cancers represent the major killer among deaths due to occupational diseases and injuries and a relevant fraction, especially among males, of total cancers. When related to developed countries, estimates may underestimate the risks, because of the insufficient data on exposures for workers in small firms, the lack of information on exposures in agriculture, the scanty availability of epidemiological studies on cancer risks among women. The trend towards a reduction of employees in industrial activities, the elimination or control of some exposures should suggest, instead, a reduction for occupational cancer. However, the more recent estimates of AF of occupational cancers are still in line with the estimates expressed more that 20 years ago. In developing countries, the estimates of AF are plenty of assumptions. In addition, some characteristics (i.e. the younger age of starting work, the extension of work at older age) suggest the need of better data, whereas information on exposures and events are dramatically lacking.

The burden of disease attributable to cannabis use in Canada in 2012.

PubMed

Imtiaz, Sameer; Shield, Kevin D; Roerecke, Michael; Cheng, Joyce; Popova, Svetlana; Kurdyak, Paul; Fischer, Benedikt; Rehm, Jürgen

2016-04-01

Cannabis use is associated with several adverse health effects. However, little is known about the cannabis-attributable burden of disease. This study quantified the age-, sex- and adverse health effect-specific cannabis-attributable (1) mortality, (2) years of life lost due to premature mortality (YLLs), (3) years of life lost due to disability (YLDs) and (4) disability-adjusted life years (DALYs) in Canada in 2012. Epidemiological modeling. Canada. Canadians aged ≥ 15 years in 2012. Using comparative risk assessment methodology, cannabis-attributable fractions were computed using Canadian exposure data and risk relations from large studies or meta-analyses. Outcome data were obtained from Canadian databases and the World Health Organization. The 95% confidence intervals (CIs) were computed using Monte Carlo methodology. Cannabis use was estimated to have caused 287 deaths (95% CI = 108, 609), 10,533 YLLs (95% CI = 4760, 20,833), 55,813 YLDs (95% CI = 38,175, 74,094) and 66,346 DALYs (95% CI = 47,785, 87,207), based on causal impacts on cannabis use disorders, schizophrenia, lung cancer and road traffic injuries. Cannabis-attributable burden of disease was highest among young people, and males accounted for twice the burden than females. Cannabis use disorders were the most important single cause of the cannabis-attributable burden of disease. The cannabis-attributable burden of disease in Canada in 2012 included 55,813 years of life lost due to disability, caused mainly by cannabis use disorders. Although the cannabis-attributable burden of disease was substantial, it was much lower compared with other commonly used legal and illegal substances. Moreover, the evidence base for cannabis-attributable harms was smaller. © 2015 Society for the Study of Addiction.

Work environment as predictor of long-term sickness absence: linkage of self-reported DWECS data with the DREAM register.

PubMed

Burr, Hermann; Pedersen, Jacob; Hansen, Jørgen Vinsløv

2011-07-01

The present overview discusses ten papers dealing with four research topics using self-reported work environment in the Danish Work Environment Cohort Study (DWECS) linked with register data on long-term sickness absence (LTSA) in the Danish Register for Evaluation of Marginalisation (DREAM). Research relied on self-reported data among 3000-5000 employees linked with registered LTSA data. Analyses were performed with Cox regression models. Risk groups: Kindergarten teachers and daycare workers were at high risk for LTSA. Mainly physical exposures but also psychosocial factors were risk factors for LTSA. Attributable fractions: A quarter of LTSA spells could be attributed to the physical work environment. Most of the association between social class and LTSA was explained by physical work environment and smoking. Mechanisms: Depressive symptoms, severe pain in hands, and low back and pain intensity were risk factors for LTSA. Only in work sites with traditional leadership did health problems predict LTSA. The linking of DWECS with DREAM has made it possible to estimate the importance of work environment factors for LTSA. Future research should deal with possible risk factors such as health problems and organisational factors.

Smoking and Adverse Maternal and Child Health Outcomes in Brazil

PubMed Central

2013-01-01

Introduction: Numerous studies from high-income countries document the causal relationship between cigarette smoking during pregnancy and adverse maternal and child health (MCH) outcomes. Less research has been conducted in low and middle income countries, but a burgeoning literature can be found for Brazil. Methods: We review Brazilian studies of the prevalence of maternal smoking, the relative risk of smoking-attributable adverse MCH outcomes, and present new estimates for these outcomes, using the attributable fraction method. Results: We found that Brazilian studies of the relative risks of smoking-attributable adverse MCH outcomes were broadly consistent with previous reviews. Based on a comparison of maternal smoking over time, smoking during pregnancy has declined by about 50% over the last 20 years in Brazil. For 2008, we estimate that 5,352 cases of spontaneous abortion, 10,929 cases of preterm birth, 20,717 cases of low birth weight, and 29 cases of sudden infant death syndrome are attributable to maternal smoking. Between 1989 and 2008, the percent of smoking-attributable adverse MCH outcomes in Brazil was at least halved. Conclusions: The results show that over a 20-year period, during which Brazil implemented numerous effective tobacco control measures, the country experienced a dramatic decrease in both maternal smoking prevalence and smoking-attributable adverse MCH outcomes. Countries that implement effective tobacco control measures can expect to reduce both maternal smoking and adverse MCH outcomes, thereby improving the public health. PMID:23873977

Estimated Deaths Attributable to Social Factors in the United States

PubMed Central

Tracy, Melissa; Hoggatt, Katherine J.; DiMaggio, Charles; Karpati, Adam

2011-01-01

Objectives. We estimated the number of deaths attributable to social factors in the United States. Methods. We conducted a MEDLINE search for all English-language articles published between 1980 and 2007 with estimates of the relation between social factors and adult all-cause mortality. We calculated summary relative risk estimates of mortality, and we obtained and used prevalence estimates for each social factor to calculate the population-attributable fraction for each factor. We then calculated the number of deaths attributable to each social factor in the United States in 2000. Results. Approximately 245 000 deaths in the United States in 2000 were attributable to low education, 176 000 to racial segregation, 162 000 to low social support, 133 000 to individual-level poverty, 119 000 to income inequality, and 39 000 to area-level poverty. Conclusions. The estimated number of deaths attributable to social factors in the United States is comparable to the number attributed to pathophysiological and behavioral causes. These findings argue for a broader public health conceptualization of the causes of mortality and an expansive policy approach that considers how social factors can be addressed to improve the health of populations. PMID:21680937

Attributing anthropogenic impact on regional heat wave events using CAM5 model large ensemble simulations

NASA Astrophysics Data System (ADS)

Lo, S. H.; Chen, C. T.

2017-12-01

Extreme heat waves have serious impacts on society. It was argued that the anthropogenic forcing might substantially increase the risk of extreme heat wave events (e.g. over western Europe in 2003 and over Russia in 2010). However, the regional dependence of such anthropogenic impact and the sensitivity of the attributed risk to the definition of heat wave still require further studies. In our research framework, the change in the frequency and severity of a heat wave event under current conditions is calculated and compared with the probability and magnitude of the event if the effects of particular external forcing, such as due to human influence, had been absent. In our research, we use the CAM5 large ensemble simulation from the CLIVAR C20C+ Detection and Attribution project (http://portal.nersc.gov/c20c/main.html, Folland et al. 2014) to detect the heat wave events occurred in both historical all forcing run and natural forcing only run. The heat wave events are identified by partial duration series method (Huth et al., 2000). We test the sensitivity of heat wave thresholds from daily maximum temperature (Tmax) in warm season (from May to September) between 1959 and 2013. We consider the anthropogenic effect on the later period (2000-2013) when the warming due to human impact is more evident. Using Taiwan and surrounding area as our preliminary research target, We found the anthropogenic effect will increase the heat wave day per year from 30 days to 75 days and make the mean starting(ending) day for heat waves events about 15-30 days earlier(later). Using the Fraction of Attribution Risk analysis to estimate the risk of frequency of heat wave day, our results show the anthropogenic forcing very likely increase the heat wave days over Taiwan by more than 50%. Further regional differences and sensitivity of the attributed risk to the definition of heat wave will be compared and discussed.

Attributing the Risk of Late Onset of the Rainy Season in Southern Africa to Climate Change

NASA Astrophysics Data System (ADS)

Wolski, P.; Stone, D. A.; Tadross, M. A.; Hewitson, B.; Wehner, M. F.

2015-12-01

Rainfed subsistence agriculture in Sub-Saharan Africa accounts for approximately 96% of all cropland. This, combined with strong intra-seasonal and interannual variability of rains makes food production sensitive to climate variations, and increases the potential and frequent occurrence of climate-triggered famines. Farmers often identify the timing of the onset of the growing season (in many areas dependent predominantly on rainfall) as a key climate characteristic which influences crop yields, influences planting activities, and can be used to adapt to changing seasonal conditions without requiring additional resources. It is thus important to understand factors affecting the timing of the onset of rains, particularly how anthropogenic climate change may increase the risk of later onsets. Here, we present a study designed to assess the level of influence of anthropogenic CO2 emissions on the risk of late onset in southern Africa. Considering numerous definitions of rainy season onset, we use one that describes onset related to the growing of maize, as it is the most wide-ranging and consumed staple in the region. Attribution is done using a risk-based event attribution methodology in which we use dedicated simulations by AGCMs (HadAM3p-N96 and CAM5.1-1degree) performed in the framework of the Climate of the 20th Century Plus (C20C+) Detection and Attribution Project. These simulations enable comparison of event (in our case the timing of the onset of a particular rainy season) probabilities under real world climates with those under a climate that might have been had human activities not emitted greenhouse gases. The fraction of risk of later onsets, attributable to an increase in greenhouse gases, is done in a spatially-explicit way for onset events derived from observed and reanalysis data for the 2007-2014 period.

Suicidal Ideation Among Korean Elderly: Risk Factors and Population Attributable Fractions.

PubMed

Park, Jong-Il; Yang, Jong-Chul; Han, Changsu; Park, Tae Won; Chung, Sang-Keun

2016-01-01

The objective of this study was to investigate the risk factors of suicidal ideation and their population attributable fraction (PAF) in a representative sample of the elderly population in Korea. We examined the data set from the Survey of Living Conditions and Welfare Needs of Korean Older Persons, which was conducted by the Korea Institute for Health and Social Affairs (KIHASA) in 2011. In that survey, 10,674 participants were randomly selected from those older than age 65. Simultaneous multivariate logistic regression was used to investigate the risk factors of suicidal ideation in terms of their sociodemographic and health-related variables. Subsequently, the PAF was calculated with adjustment for other risk factors. The weighted prevalences of depression and suicidal ideation were 30.3% and 11.2%, respectively. In multivariate analysis, factors significantly associated with decreased risk of suicidal ideation included old-old age (odds ratio [OR] = 0.66 for 75 to 79 years, OR = 0.52 for 80 to 84 years, OR = 0.32 for older than 85 years), economic status (OR = 0.59 for 5th quintile; more than US$25,700 per year), whereas those associated with increased risk included poor social support (OR = 1.28), currently smoking (OR = 1.42), sleep problems (OR = 1.74), chronic illness (OR = 1.40), poor subjective health (OR = 1.56), functional impairment (OR = 1.45), and depression (OR = 4.36). Depression was associated with a fully adjusted PAF of 45.7%, followed by chronic illness (19.4%), poor subjective health status (18.9%), sleep problems (14.1%), functional impairment (4.9%), poor social support (4.2%), and currently smoking (3.6%). Preventive strategies focused particularly on depression might reduce the impact of suicidal ideation in the elderly population. Also, specific mental health centers focused on the specific needs of the elderly population should be established to manage suicidal risk.

A prospective cohort study on hospital mortality due to Clostridium difficile infection.

PubMed

Wenisch, J M; Schmid, D; Tucek, G; Kuo, H-W; Allerberger, F; Michl, V; Tesik, P; Laferl, H; Wenisch, C

2012-10-01

Although an increase in burden of disease has frequently been reported for Clostridium difficile infection (CDI), specific data on the effect of CDI on a patient's risk of death or overall hospital mortality are scarce. Therefore, we performed a prospective cohort study to analyse the effect of CDI on the risk of pre-discharge all-cause death in all inpatients with CDI compared to all inpatients without CDI during 2009 in a single hospital. Clostridium difficile infection was defined as by the European Society of Clinical Microbiology and Infectious Diseases. Data were collected from the medical charts of CDI patients and from the hospital discharge data of non-CDI and CDI patients. The effect measures of CDI used to compute the risk of pre-discharge all-cause death were risk ratio, attributable risk, mortality fraction (%) and population attributable risk percentage. Co-morbidity was categorized using the Charlson co-morbidity score in which a value of ≤2 was defined as low co-morbidity and that of >2 as moderate/severe co-morbidity. A stratified analysis and a Poisson regression model were applied to adjust for the effects of the risk factors sex, age and severity of co-morbidity. A total of 185 hospitalized patients with CDI were compared to 38,644 other hospitalized patients without CDI admitted between 1 January 2009 and 31 December 2009. The mean age of the CDI and non-CDI patients was 74.3 (range 72.3-76.4) and 51.9 (range 51.6-52.1) years, respectively. Of the 185 CDI, 136 (73.5%) and 49 (26.5%) were categorized with low and high co-morbidity, respectively, versus 32,107 (83.4%) and 6,352 (16.5%), respectively, in non-CDI patients. Overall, 24 of the 185 CDI patients (13%) versus 1,021 of the 38,459 non-CDI patients (2.7%) died during their hospital stay, resulting in a relative risk of pre-discharge death of 4.89 [95% confidence interval (CI) 3.35-7.13] for CDI patients, a CDI attributable risk of death of 10.3 per 100 patients and a CDI attributable fraction of 79.5 % (95% CI 70.1-86 %). After adjustment for age, sex and co-morbidity the relative risk of pre-discharge death was 2.74 (95% CI 1.82-4.10; p < 0.0001) for patients with CDI, and the proportion of hospital deaths due to CDI was 1.72 (95% CI 1.22-2.05). The results of this study lead to the conclusion that hospitalized patients with CDI are--independent of age, sex and co-morbidity severity--2.74-fold more likely to die during their hospital stay than all other hospitalized patients. The eradication of CDI in the hospital could have prevented 1.72% of in-hospital deaths in our study population during the 1 year of the study.

Cancers in Australia in 2010 attributable to and prevented by the use of menopausal hormone therapy.

PubMed

Jordan, Susan J; Wilson, Louise F; Nagle, Christina M; Green, Adele C; Olsen, Catherine M; Bain, Christopher J; Pandeya, Nirmala; Whiteman, David C; Webb, Penelope M

2015-10-01

To estimate the proportion and number of cancers occurring in Australia in 2010 attributable to menopausal hormone therapy (MHT) use. We estimated the population attributable fraction for cancers causally associated with MHT (breast, endometrium, ovary), and the proportion of colorectal cancers prevented by MHT. We used standard formulae incorporating Australian prevalence data, relative risks of cancer associated with MHT and cancer incidence. We also estimated potential change in cancer incidence under two hypothetical scenarios whereby 25% fewer Australian women used MHT, or women exclusively used oestrogen-only MHT. An estimated 539 cancers in Australia in 2010 were attributable to MHT: 453 breast, 67 endometrial and 19 ovarian cancers equating to 3.4%, 3.1% and 1.6% of each cancer type, respectively. In contrast, MHT may have prevented 52 colorectal cancers. If 25% fewer women used MHT, then 141 cancers may have been avoided. If women exclusively used oestrogen-only MHT then 240 cancers may have been avoided. MHT use caused more than 500 cancers in Australian women in 2010 and prevented ∼50 colorectal cancers. MHT use continues to cause an excess of cancers. The risks, benefits, regimen and treatment duration should be carefully considered for each woman before MHT is commenced. © 2015 The Authors.

An evaluation of the 25 by 25 goal for premature cardiovascular disease mortality in Taiwan: an age-period-cohort analysis, population attributable fraction and national population-based study.

PubMed

Su, Shih-Yung; Lee, Wen-Chung; Chen, Tzu-Ting; Wang, Hao-Chien; Su, Ta-Chen; Jeng, Jiann-Shing; Tu, Yu-Kang; Liao, Shu-Fen; Lu, Tzu-Pin; Chien, Kuo-Liong

2017-01-01

The aim of the 25 by 25 goal is to reduce mortality from premature non-communicable diseases by 25% before 2025. Studies have evaluated the 25 by 25 goal in many countries, but not in Taiwan. The aim of this study was to estimate the 25 by 25 goal for premature mortality from cardiovascular diseases in Taiwan. We applied the age-period-cohort model to project the incidence of premature death from cardiovascular disease from 2015 to 2024 and used the population attributable fraction to estimate the contributions of targeted risk factors. The probability of death was used to estimate the percent change. The percent change in business-as-usual trend during 2010-2024 was only a 6% (range 1.7-10.7%) lower risk of premature mortality from cardiovascular disease among men. The greatest reduction in the risk of mortality occurred with a 30% reduction in the prevalence of smoking; however, there was only a 14.5% (10.6-18.3%) decrease in percent change and in the corresponding number of men (3706: range 3543-3868) who were prevented from dying. More than a 25% reduction in the percent change of premature cardiovascular disease mortality among women was achieved without control of any risk factor. To reach a 25% reduction in men before 2025, there needs to be a 70% reduction in the prevalence of smoking to reduce mortality by 26.2% (22.9-29.3%). Cigarette smoking is the primary target in the prevention of cardiovascular disease. Through the stringent control of smoking, the goal of a 25% reduction in premature mortality from cardiovascular disease may be achieved before 2025 in Taiwan.

The role of job strain in understanding midlife common mental disorder: a national birth cohort study.

PubMed

Harvey, Samuel B; Sellahewa, Dilan A; Wang, Min-Jung; Milligan-Saville, Josie; Bryan, Bridget T; Henderson, Max; Hatch, Stephani L; Mykletun, Arnstein

2018-06-01

Long-standing concerns exist about reverse causation and residual confounding in the prospective association between job strain and risk of future common mental disorders. We aimed to address these concerns through analysis of data collected in the UK National Child Development Study, a large British cohort study. Data from the National Child Development Study (n=6870) were analysed by use of multivariate logistic regression to investigate the prospective association between job strain variables at age 45 years and risk of future common mental disorders at age 50 years, controlling for lifetime psychiatric history and a range of other possible confounding variables across the lifecourse. Population attributable fractions were calculated to estimate the public health effect of job strain on midlife mental health. In the final model, adjusted for all measured confounders, high job demands (odds ratio 1·70, 95% CI 1·25-2·32; p=0·0008), low job control (1·89, 1·29-2·77; p=0·0010), and high job strain (2·22, 1·59-3·09; p<0·0001) remained significant independent predictors of future onset of common mental disorder. If causality is assumed, our findings suggest that 14% of new cases of common mental disorder could have been prevented through elimination of high job strain (population attributable fraction 0·14, 0·06-0·20). High job strain appears to independently affect the risk of future common mental disorders in midlife. These findings suggest that modifiable work-related risk factors might be an important target in efforts to reduce the prevalence of common mental disorders. iCare Foundation and Mental Health Branch, NSW Health. Copyright © 2018 Elsevier Ltd. All rights reserved.

Pregnancy-Related Risk Factors Are Associated With a Significant Burden of Treated Hypertension Within 10 Years of Delivery: Findings From a Population-Based Norwegian Cohort.

PubMed

Egeland, Grace M; Skurtveit, Svetlana; Staff, Anne Cathrine; Eide, Geir Egil; Daltveit, Anne-Kjersti; Klungsøyr, Kari; Trogstad, Lill; Magnus, Per M; Brantsæter, Anne Lise; Haugen, Margaretha

2018-05-13

The association between pregnancy complications and women's later cardiovascular disease has, primarily, been evaluated in studies lacking information on important covariates. This report evaluates the prospective associations between pregnancy-related risk factors (preeclampsia/eclampsia, gestational hypertension, pregestational and gestational diabetes mellitus, preterm delivery, and fetal growth restriction) and pharmacologically treated hypertension within 10 years after pregnancy, while adjusting for a wide range of covariates. Prepregnancy normotensive women participating in the MoBa (Norwegian Mother and Child Cohort Study) from January 2004 through July 2009 were linked to the Norwegian Prescription Database to identify women with pharmacologically treated hypertension beyond the postpartum period of 3 months. The burden of hypertension associated with pregnancy-related risk factors was evaluated using an attributable fraction method. A total of 1480 women developed pharmacologically treated hypertension within the follow-up among 60 027 women (rate of hypertension, 3.6/1000 person-years). The proportion of hypertension associated with a history of preeclampsia/eclampsia, gestational hypertension, preterm delivery, and pregestational or gestational diabetes mellitus was 28.6% (95% confidence interval, 25.5%-31.6%) on the basis of multivariable analyses adjusting for numerous covariates. The proportion was similar for women with a healthy prepregnancy body mass index (18.5-24.9 kg/m 2 ; attributable fraction (AF)% 25.9%; 95% confidence interval, 21.3%-30.3%), but considerably higher for nulliparous women at baseline within the first 5 years of follow-up. Small-for-gestational age, however, did not increase subsequent hypertension risk in multivariable analyses. A structured postpartum follow-up of high-risk women identified through pregnancy-related risk factors would facilitate personalized preventive strategies to postpone or avoid onset of premature cardiovascular events. © 2018 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

Prescription medicines and the risk of road traffic crashes: a French registry-based study.

PubMed

Orriols, Ludivine; Delorme, Bernard; Gadegbeku, Blandine; Tricotel, Aurore; Contrand, Benjamin; Laumon, Bernard; Salmi, Louis-Rachid; Lagarde, Emmanuel

2010-11-16

In recent decades, increased attention has been focused on the impact of disabilities and medicinal drug use on road safety. The aim of our study was to investigate the association between prescription medicines and the risk of road traffic crashes, and estimate the attributable fraction. We extracted and matched data from three French nationwide databases: the national health care insurance database, police reports, and the national police database of injurious crashes. Drivers identified by their national health care number involved in an injurious crash in France, between July 2005 and May 2008, were included in the study. Medicines were grouped according to the four risk levels of the French classification system (from 0 [no risk] to 3 [high risk]). We included 72,685 drivers involved in injurious crashes. Users of level 2 (odds ratio [OR]  = 1.31 [1.24-1.40]) and level 3 (OR  = 1.25 [1.12-1.40]) prescription medicines were at higher risk of being responsible for a crash. The association remained after adjustment for the presence of a long-term chronic disease. The fraction of road traffic crashes attributable to levels 2 and 3 medications was 3.3% [2.7%-3.9%]. A within-person case-crossover analysis showed that drivers were more likely to be exposed to level 3 medications on the crash day than on a control day, 30 days earlier (OR  = 1.15 [1.05-1.27]). The use of prescription medicines is associated with a substantial number of road traffic crashes in France. In light of the results, warning messages appear to be relevant for level 2 and 3 medications and questionable for level 1 medications. A follow-up study is needed to evaluate the impact of the warning labeling system on road traffic crash prevention.

Prescription Medicines and the Risk of Road Traffic Crashes: A French Registry-Based Study

PubMed Central

Orriols, Ludivine; Delorme, Bernard; Gadegbeku, Blandine; Tricotel, Aurore; Contrand, Benjamin; Laumon, Bernard; Salmi, Louis-Rachid; Lagarde, Emmanuel

2010-01-01

Background In recent decades, increased attention has been focused on the impact of disabilities and medicinal drug use on road safety. The aim of our study was to investigate the association between prescription medicines and the risk of road traffic crashes, and estimate the attributable fraction. Methods and Findings We extracted and matched data from three French nationwide databases: the national health care insurance database, police reports, and the national police database of injurious crashes. Drivers identified by their national health care number involved in an injurious crash in France, between July 2005 and May 2008, were included in the study. Medicines were grouped according to the four risk levels of the French classification system (from 0 [no risk] to 3 [high risk]). We included 72,685 drivers involved in injurious crashes. Users of level 2 (odds ratio [OR]  = 1.31 [1.24–1.40]) and level 3 (OR  = 1.25 [1.12–1.40]) prescription medicines were at higher risk of being responsible for a crash. The association remained after adjustment for the presence of a long-term chronic disease. The fraction of road traffic crashes attributable to levels 2 and 3 medications was 3.3% [2.7%–3.9%]. A within-person case-crossover analysis showed that drivers were more likely to be exposed to level 3 medications on the crash day than on a control day, 30 days earlier (OR  = 1.15 [1.05–1.27]). Conclusion The use of prescription medicines is associated with a substantial number of road traffic crashes in France. In light of the results, warning messages appear to be relevant for level 2 and 3 medications and questionable for level 1 medications. A follow-up study is needed to evaluate the impact of the warning labeling system on road traffic crash prevention. Please see later in the article for the Editors' Summary PMID:21125020

Environmental attributable fractions in remote Australia: the potential of a new approach for local public health action.

PubMed

McMullen, Cheryl; Eastwood, Ashley; Ward, Jeanette

2016-04-01

To determine local values for environmental attributable fractions and explore their applicability and potential for public health advocacy. Using World Health Organization (WHO) values for environmental attributable fractions, responses from a practitioner survey (73% response rate) were considered by a smaller skills-based panel to determine consensus values for Kimberley environmental attributable fractions (KEAFs). Applied to de-identified data from 17 remote primary healthcare facilities over two years, numbers and proportions of reasons for attendance directly attributable to the environment were calculated for all ages and children aged 0-4 years, including those for Aboriginal patients. Of 150,357 reasons for attendance for patients of all ages, 31,775 (21.1%) were directly attributable to the environment. The proportion of these directly due to the environment was significantly higher for Aboriginal patients than others (23.1% v 14.6%; p<0.001). Of 29,706 reasons for attendance by Aboriginal children aged 0-4 years, 7,599 (25.6%) were directly attributable to the environment, significantly higher than for non-Aboriginal children aged 0-4 years (25.6% v 18.6%; p<0.001). By addressing environmental factors, 20% of total primary healthcare demand could be prevented and, importantly, some 25% of presentations by Aboriginal children. KEAFs have potential to monitor impact of local environmental investments. © 2015 Public Health Association of Australia.

Lung cancer risk due to residential radon exposures: estimation and prevention.

PubMed

Truta, L A; Hofmann, W; Cosma, C

2014-07-01

Epidemiological studies proved that cumulative exposure to radon is the second leading cause of lung cancer, the world's most common cancer. The objectives of the present study are (i) to analyse lung cancer risk for chronic, low radon exposures based on the transformation frequency-tissue response (TF-TR) model formulated in terms of alpha particle hits in cell nuclei; (ii) to assess the percentage of attributable lung cancers in six areas of Transylvania where the radon concentration was measured and (iii) to point out the most efficient remediation measures tested on a pilot house in Stei, Romania. Simulations performed with the TF-TR model exhibit a linear dose-effect relationship for chronic, residential radon exposures. The fraction of lung cancer cases attributed to radon ranged from 9 to 28% for the investigated areas. Model predictions may represent a useful tool to complement epidemiological studies on lung cancer risk and to establish reasonable radiation protection regulations for human safety. © The Author 2014. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Burden of Cancer from Chemicals in North Carolina Drinking Water

NASA Astrophysics Data System (ADS)

DeFelice, N.

2013-12-01

Monitoring programs required by the U.S. Safe Drinking Water Act (SDWA) currently do not consider potential differences in chemical exposure patterns and human health risks. Rather, U.S. agencies establish monitoring requirements based on the type of water system and the number of people the system serves; within categories of systems, all potentially carcinogenic chemicals must be monitored with equal frequency, regardless of the potential level of risk these chemicals pose. To inform future policies concerning contaminant monitoring under the SDWA, we examined the potential health threats in North Carolina from the 34 carcinogenic chemicals covered under the SDWA. We analyzed reported contaminant concentration data for all community water systems (CWSs) for the years 1998-2011. We employed an attributable fraction approach that uses probabilistic inputs to evaluate the percent of cancer cases that may be attributable to chemical exposure in drinking water. We found that cancer risks are dominated by 3 of the 34 chemicals and chemical classes (total trihalomethanes (TTHMs), arsenic and gross alpha particles); all other chemicals contribute to less than one cancer case per year in the state. We showed that around 840 cases of cancer annually (2% of annual cancer cases) are attributable to contaminated drinking water. The majority cases are due to TTHMs, arsenic and gross alpha particles, which contributed 810 (95% CI 560-1,280), 14 (95% CI 3 -32), and 13 (95% CI 2-48) cases, respectively. Sixty-seven counties had annual cancer rates higher than 1 in 10,000 attributable to community water systems. Annual cancer rate attributable to chemicals found in drinking water that are regulated under the safe drinking water act.

The population impact of obesity, sedentary lifestyle, and tobacco and alcohol consumption on the prevalence of type 2 diabetes: Analysis of a health population survey in Chile, 2010.

PubMed

Bertoglia, María P; Gormaz, Juan G; Libuy, Matías; Sanhueza, Dérgica; Gajardo, Abraham; Srur, Andrea; Wallbaum, Magdalena; Erazo, Marcia

2017-01-01

To estimate the impact of tobacco use, sedentary lifestyle, obesity and alcohol consumption on type 2 diabetes mellitus (T2DM) prevalence in the Chilean population. The study-included 5,293 subjects with fasting glycaemia levels from the nationwide cross-sectional health survey in 2010, commissioned by the Ministry of Health, Chile. Crude and Adjusted Odds Ratio to T2DM and its corresponding 95% confidence interval were estimated through logistic regressions. Attributable fractions and population attributable fractions were estimated. T2DM prevalence was 9.5%. Sedentary lifestyles and obesity were significant risk factors for T2DM. 52,4% of T2DM could be avoided if these individuals were not obese, and at a population level, 23% of T2DM could be preventable if obesity did not exist. A 64% of T2DM is explained by sedentariness, and if people would become active, a 62,2% of the cases of diabetes could be avoided. About 79% of T2DM cases in Chile could be prevented with cost-effective strategies focused on preventing sedentary lifestyle and obesity. It's therefore urgent to implement evidence-based public health polices, aimed to decrease the prevalence of T2DM, by controlling its risk factors and consequently, reducing the complications from T2DM.

Estimating the attributable fraction for melanoma: a meta-analysis of pigmentary characteristics and freckling.

PubMed

Olsen, Catherine M; Carroll, Heidi J; Whiteman, David C

2010-11-15

Epidemiologic research has demonstrated convincingly that certain pigmentary characteristics are associated with increased relative risks of melanoma; however there has been no comprehensive review to rank these characteristics in order of their importance on a population level. We conducted a systematic review of the literature and meta-analysis to quantify the contribution of pigmentary characteristics to melanoma, estimated by the population-attributable fraction (PAF). Eligible studies were those that permitted quantitative assessment of the association between histologically confirmed melanoma and hair colour, eye colour, skin phototype and presence of freckling; we identified 66 such studies using citation databases, followed by manual review of retrieved references. We calculated summary relative risks using weighted averages of the log RR, taking into account random effects, and used these to estimate the PAF. The pooled RRs for pigmentary characteristics were: 2.64 for red/red-blond, 2.0 for blond and 1.46 for light brown hair colour (vs. dark); 1.57 for blue/blue-grey and 1.51 for green/grey/hazel eye colour (vs. dark); 2.27, 1.99 and 1.35 for skin phototypes I, II and III respectively (vs. IV); and 1.99 for presence of freckling. The highest PAFs were observed for skin phototypes 1/II (0.27), presence of freckling (0.23), and blond hair colour (0.23). For eye colour, the PAF for blue/blue-grey eye colour was higher than for green/grey/hazel eye colour (0.18 vs. 0.13). The PAF of melanoma associated with red hair colour was 0.10. These estimates of melanoma burden attributable to pigmentary characteristics provide a basis for designing prevention strategies for melanoma.

Population attributable fraction of incident HIV infections associated with alcohol consumption in fishing communities around Lake Victoria, Uganda

PubMed Central

Kiwanuka, Noah; Ssetaala, Ali; Ssekandi, Ismail; Nalutaaya, Annet; Kitandwe, Paul Kato; Ssempiira, Julius; Bagaya, Bernard Ssentalo; Balyegisawa, Apolo; Kaleebu, Pontiano; Hahn, Judith; Lindan, Christina; Sewankambo, Nelson Kaulukusi

2017-01-01

Background Although the association between alcohol consumption and HIV risk is well documented, few studies have examined the magnitude of new HIV infections that could be prevented by controlling alcohol use. We report the population attributable fraction (PAF) of incident HIV infections due to alcohol consumption among the HIV high-risk population of fishing communities along Lake Victoria, Uganda. Methods In a community-based cohort study, 1607 HIV sero-negative participants aged 18–49 years were enrolled from eight fishing communities along Lake Victoria, Uganda. At follow up 12 months later, 1288 (80.1%) were seen and interviewed. At baseline and follow-up visits, participants completed interviewer-administered questionnaires on alcohol consumption, demographics, and sexual risk behavior, and were tested for HIV infection. HIV incidence and adjusted incident rate ratios (adjusted IRRs) were estimated using Poisson regression models; the crude and adjusted PAFs of incident HIV infections associated with alcohol consumption were calculated using the Greenland and Drescher method for cohort studies. Results Among the 1288 participants seen at follow up, 53.5% reported drinking alcohol of whom 24.4% drank occasionally (2 days a week or less) and 29.1% drank regularly (3–7 days a week). Forty eight incident HIV infections occurred giving an incidence rate of 3.39/100 person years at-risk (pyar) (95% CI, 2.55–4.49). Compared to non-drinkers, the adjusted IRR of HIV was 3.09 (1.13–8.46) among occasional drinkers and 5.34 (2.04–13.97) among regular drinkers. The overall adjusted PAF of incident HIV infections due alcohol was 64.1 (95% CI; 23.5–83.1); ranging from 52.3 (11.9–74.2) among Muslims to 71.2 (32.6–87.7) for participants who reported ≥ 2 sexual partners in the past 12 months. Conclusion In fishing communities along Lake Victoria, Uganda, 64% of new HIV infections can be attributed to drinking alcohol. Interventions to reduce alcohol consumption should be integrated in HIV/AIDS prevention activities for populations in whom both HIV and alcohol consumption are highly prevalent. PMID:28207844

Disability Pensions due to Skin Diseases: A Cohort Study in Swedish Construction Workers.

PubMed

Meding, Birgitta; Wrangsjö, Karin; Burdorf, Alex; Järvholm, Bengt

2016-02-01

Disability pensions due to skin diseases in Swedish male construction workers were studied by linking data from pension registers and an occupational health service. Incidence rates of disability pensions for cement workers, painters and plumbers were compared with 2 control groups. A total of 623 disability pensions were granted during 4 decades of follow-up. The main diagnoses were eczema (36%) and psoriasis (49%). Pensions were mostly granted in the age range 55-64 years. Among painters, cement workers and plumbers the incidence rates for disability pensions were 33.3, 24.5 and 20.4 cases/100,000 person-years, respectively, compared with 13.7 and 9.2 cases/100,000 person-years in control groups. Relative risks were highest for eczema, and were notable for psoriasis. Attributable fractions for eczema were 90% in cement workers and painters and 75% in plumbers compared with control groups. Attributable fractions for psoriasis in the occupational groups studied were in the range 54-67%. In conclusion, eczema and psoriasis have a high impact on loss of work ability, as reflected by disability pensions.

Influence of smoking combined with another risk factor on the risk of mortality from coronary heart disease and stroke: pooled analysis of 10 Japanese cohort studies.

PubMed

Nakamura, Koshi; Nakagawa, Hideaki; Sakurai, Masaru; Murakami, Yoshitaka; Irie, Fujiko; Fujiyoshi, Akira; Okamura, Tomonori; Miura, Katsuyuki; Ueshima, Hirotsugu

2012-01-01

In spite of the importance of a multifactorial approach to preventing cardiovascular disease in smokers, most information on the combined adverse effects of smoking and hypertension or high serum cholesterol on cardiovascular disease has been derived from Western populations, and coronary heart disease was often used as the only endpoint. Therefore, the present large-scale pooled analysis attempted to provide reliable information on the adverse effects of the coexistence of smoking and hypertension or high serum cholesterol on the risk of mortality from coronary heart disease and stroke in both, individuals and the entire population in Japan. A total of 27,385 male and 39,207 female participants aged 40-89 years were enrolled from 10 well-qualified Japanese cohort studies with a mean follow-up of 10.1 years. Hazard ratios and their corresponding 95% confidence intervals in smokers who had hypertension or high serum cholesterol were estimated for men and women separately using a Cox proportional hazards regression model that included age, body mass index, cohort and either serum total cholesterol or systolic blood pressure as covariates. Fractions of deaths attributable to the coexistence of these risk factors were also calculated. The multivariate-adjusted hazard ratios in male and female current smokers with hypertension, compared with those with neither factor were 2.57 (95% confidence intervals, 1.51-4.38) and 6.14 (3.49-10.79) for coronary heart disease, and 3.28 (1.89-5.71) and 1.61 (0.81-3.18) for cerebral infarction, respectively. The fractions of deaths attributable to the coexistence of current smoking and hypertension in men and women were 24.6 and 9.6% for coronary heart disease and 28.1 and 2.0% for cerebral infarction, respectively. Smokers with high serum cholesterol were broadly comparable to hypertensive smokers only with respect to coronary mortality risk; the hazard ratios, compared with those with neither factor were 4.19 (2.33-7.53) for men and 3.90 (1.57-9.67) for women. The fraction of coronary deaths attributable to the coexistence of current smoking and high serum cholesterol was 6.3% in men and 2.2% in women. There was no interaction between smoking habit and blood pressure or serum total cholesterol for these two subtypes in both men and women. Particular attention should be given to smokers who have concomitant hypertension or high serum cholesterol for preventing deaths due to cardiovascular disease. From a public health perspective in Japan, priority should be given to hypertensive smokers, since this group makes a large contribution to the burden of both coronary and cerebral infarction deaths. Copyright © 2012 S. Karger AG, Basel.

Long-Term Disease-Free Survival of Non-Metastatic Breast Cancer Patients in Iran: A Survival Model with Competing Risks Taking Cure Fraction and Frailty into Account

PubMed

Ghavami, Vahid; Mahmoudi, Mahmood; Rahimi Foroushani, Abbas; Baghishani, Hossein; Homaei Shandiz, Fatemeh; Yaseri, Mehdi

2017-10-26

Introduction: Survival modeling is a very important tool to detect risk factors and provide a basis for health care planning. However, cancer data may have properties leading to distorted results with routine methods. Therefore, this study aimed to cover specific factors (competing risk, cure fraction and heterogeneity) with a real dataset of Iranian breast cancer patients using a competing risk-cure-frailty model. Materials and methods: For this historical cohort study, information for 550 Iranian breast cancer patients who underwent surgery for tumor removal from 2001 to 2007 and were followed up to March 2017, was analyzed using R 3.2 software. Results: In contrast to T-stage and N-stage, hormone receptor status did not have any significant effect on the cure fraction (long-term disease-free survival). However, T-stage, N-stage and hormone receptor status all had a significant effect on short-term disease-free survival so that the hazard of loco-regional relapse or distant metastasis in cases positive for a hormone receptor was only 0.3 times that for their negative hormone receptor counterparts. The likelihood of locoregional relapse in the first quartile of follow up was nearly twice that of other quartiles. The least cumulative incidence of time to locoregional relapse was for cases with a positive hormone receptor, low N stage and low T stage. The effect of frailty term was significant in this study and a model with frailty appeared more appropriate than a model without, based on the Akaike information criterion (AIC); values for the frailty model and one without the frailty parameter were 1370.39 and 1381.46, respectively. Conclusions: The data from this study indicate ae necessity to consider competing risk, cure fraction and heterogeneity in survival modeling. The competing risk-cure-frailty model can cover complex situations with survival data. Creative Commons Attribution License

Crude estimates of cannabis-attributable mortality and morbidity in Canada-implications for public health focused intervention priorities.

PubMed

Fischer, Benedikt; Imtiaz, Sameer; Rudzinski, Katherine; Rehm, Jürgen

2016-03-01

Cannabis is the most commonly used drug in Canada; while its use is currently controlled by criminal prohibition, debates about potential control reforms are intensifying. There is substantive evidence about cannabis-related risks to health in various key outcome domains; however, little is known about the actual extent of these harms specifically in Canada. Based on epidemiological data (e.g. prevalence of relevant cannabis use rates and relevant risk behaviors; risk ratios; and annual numbers of morbidity/mortality cases in relevant domains), and applying the methodology of comparative risk assessment, we estimated attributable fractions for cannabis-related morbidity and mortality, specifically for: (i) motor-vehicle accidents (MVAs); (ii) use disorders; (iii) mental health (psychosis) and (iv) lung cancer. MVAs and lung cancer are the only domains where cannabis-attributable mortality is estimated to occur. While cannabis use results in morbidity in all domains, MVAs and use disorders by far outweigh the other domains in the number of cases; the popularly debated mental health consequences (e.g., psychosis) translate into relatively small case numbers. The present crude estimates should guide and help prioritize public health-oriented interventions for the cannabis-related health burden in the population in Canada; formal burden of disease calculations should be conducted. © The Author 2015. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Preliminary lung cancer risk assessment of exposure to radon progeny for Transylvania, Romania.

PubMed

Truta-Popa, Lucia-Adina; Dinu, Alexandra; Dicu, Tiberius; Szacsvai, Kinga; Cosma, Constantin; Hofmann, Werner

2010-09-01

The objective of the present study was to assess the lung cancer risk induced by exposures to radon progeny of people living in some areas of Transylvania, Romania. Indoor radon concentrations were measured in 667 dwellings of Stei area, Cluj, Bistrita-Nasaud, Sibiu, and Alba counties. Measurements were performed using CR-39 track detectors, exposed for a minimum of 3 mo. Average annual radon concentrations were 232, 114, 71, 62, and 161 Bq m for Stei area, Cluj, Bistrita-Nasaud, Sibiu, and Alba, respectively. The linear risk model of Darby was used to simulate the dose-effect relationship and relative lung cancer risk at low doses of alpha particles specific to residential radon exposures. Predicted relative risks at the measured exposure levels, together with information on the total number of reported lung cancer deaths and the number of people living in these regions, enabled us to estimate the fraction of lung cancer cases in each area that is attributable to radon. These percentages are 16.67% for Stei area, 9.09% for Cluj, 5.66% for Bistrita-Nasaud, 4.76% for Sibiu, and 12.28% for Alba county among lifetime non-smokers. Assuming that the smoking rates are similar for the investigated regions (10.72% smokers among men and 5.95% among women), around 64 to 69% of the total number of annual lung cancer deaths, stratified by sex, would be attributed to radon and occur among smoking male population, and around 35 to 44% would be attributed to radon and occur among smoking female population.

Proportion of cancer in a Middle eastern country attributable to established risk factors.

PubMed

Charafeddine, Maya A; Olson, Sara H; Mukherji, Deborah; Temraz, Sally N; Abou-Alfa, Ghassan K; Shamseddine, Ali I

2017-05-18

Providing an estimate of the percentage of cancer in Lebanon by 2018 that is due to the exposure to risk factors in 2008. Factors include: smoking, body mass index (BMI), physical inactivity, dietary factors, alcohol consumption, infections, and air pollution in adults. Population Attributable Fraction (PAF) was calculated using the proportion of the population exposed and relative risks for each risk factor from meta-analyses. The PAF estimates the proportion of cases in which exposure may have played a causal role. Smoking caused most cancer cases, and it will further add a total of 1800 new cases by 2018. Among many other cancers, lung cancer had the largest proportion attributable of around 75%. BMI is expected to increase colorectal, liver and gastric cardia carcinoma specifically in males. High physical activity has a an average of 15% protection rate on cancer on colorectal cancer. Minimal adherence to Mediterranean diet will affect gastric cancer incidence by 7%. Cases of oropharyngeal and esophageal cancer will be the result of alcohol consumption mainly in males. H.Pylori infection is expected to result in half of the gastric cases by 2018. The high exposure to air pollution is expected to contribute by 13% to lung cancer cases in 2018. The highest benefits can be achieved by controlling tobacco smoking. Interrelated and small changes in weight, physical activity and healthy diet with limited alcohol consumption can protect against several GI cancers in the long run. These results can be used to determine public health interventions that target important risk factors in the general population.

Factors other than risks in the workplace as determinants of socioeconomic differences in health in Italy.

PubMed

Mamo, Carlo; Marinacci, Chiara; Demaria, Moreno; Mirabelli, Dario; Costa, Giuseppe

2005-01-01

To evaluate differences in mortality by social class and to determine the impacts of socioeconomic factors on health inequalities in Italy, mortality data from 1981-2001 were analyzed as a function of social class in Turin, controlling for occupational risks, housing conditions, and education. For general and cause-specific mortality, the weight of each socioeconomic indicator was evaluated on population-attributable fraction to social class. Among men, mortality risk was significantly higher in unskilled blue-collar workers (RR = 1.45). Among women, the differences by social class were slighter. Education and economic status mostly explain the mortality differences by social class in men, while economic status showed the highest contribution in women.

Cancers in Australia in 2010 attributable to inadequate consumption of fruit, non-starchy vegetables and dietary fibre.

PubMed

Nagle, Christina M; Wilson, Louise F; Hughes, Maria Celia B; Ibiebele, Torukiri I; Miura, Kyoko; Bain, Christopher J; Whiteman, David C; Webb, Penelope M

2015-10-01

To estimate the number and proportion of cancers occurring in Australia in 2010 attributable to consumption deficits in fruit, non-starchy vegetables and dietary fibre. We estimated the population attributable fraction (PAF) for cancers causally associated with inadequate intake of fruit and non-starchy vegetables (oral cavity, pharynx, oesophageal squamous cell carcinoma, stomach, larynx); inadequate intake of fruit (lung); and insufficient intake of fibre (colorectum). We used standard formulae incorporating prevalence of exposure (1995 National Nutrition Survey) and relative risks from independent studies. Overall, 1,555 (1.4% of all) and 311 (0.3% of all) cancers were attributable to inadequate intakes of fruit and non-starchy vegetables, respectively. A further 2,609 colorectal cancers (18% of colorectal) were attributable to insufficient fibre intake. If Australians increased their fibre intake by eating the recommended daily intakes of fruit and vegetables, an estimated 1,293 (8.8%) colorectal cancers could be prevented. One in six colorectal cancer cases was attributable to inadequate intake of dietary fibre and about 1,800 cancers at other sites were attributable to insufficient fruit and non-starchy vegetable consumption. Increasing the proportion of Australians who consume the recommended intake of fruit, vegetables and fibre could prevent up to 4% of all cancers. © 2015 The Authors.

Deaths and years of life lost due to suboptimal breast-feeding among children in the developing world: a global ecological risk assessment.

PubMed

Lauer, Jeremy A; Betrán, Ana Pilar; Barros, Aluísio J D; de Onís, Mercedes

2006-09-01

We estimate attributable fractions, deaths and years of life lost among infants and children < or = 2 years of age due to suboptimal breast-feeding in developing countries. We compare actual practices to a minimum exposure pattern consisting of exclusive breast-feeding for infants < or = 6 months of age and continued breast-feeding for older infants and children < or = 2 years of age. For infants, we consider deaths due to diarrhoeal disease and lower respiratory tract infections, and deaths due to all causes are considered in the second year of life. Outcome measures are attributable fractions, deaths, years of life lost and offsetting deaths potentially caused by mother-to-child transmission of HIV through breast-feeding. Developing countries. Infants and children < or = 2 years of age. Attributable fractions for deaths due to diarrhoeal disease and lower respiratory tract infections are 55% and 53%, respectively, for the first six months of infancy, 20% and 18% for the second six months, and are 20% for all-cause deaths in the second year of life. Globally, as many as 1.45 million lives (117 million years of life) are lost due to suboptimal breast-feeding in developing countries. Offsetting deaths caused by mother-to-child transmission of HIV through breast-feeding could be as high as 242,000 (18.8 million years of life lost) if relevant World Health Organization recommendations are not followed. The size of the gap between current practice and recommendations is striking when one considers breast-feeding involves no out-of-pocket costs, that there exists universal consensus on best practices, and that implementing current international recommendations could potentially save 1.45 million children's lives each year.

Myocardial infarction among Danish HIV-infected individuals: population-attributable fractions associated with smoking.

PubMed

Rasmussen, Line D; Helleberg, Marie; May, Margaret T; Afzal, Shoaib; Kronborg, Gitte; Larsen, Carsten S; Pedersen, Court; Gerstoft, Jan; Nordestgaard, Børge G; Obel, Niels

2015-05-01

Human immunodeficiency virus-infected individuals have increased risk of myocardial infarction (MI); however, the contribution from smoking and potentiating effects of HIV are controversial. From the Danish HIV Cohort Study and the Copenhagen General Population Study, we identified 3251 HIV-infected individuals and 13 004 population controls matched on age and gender. Data on MI were obtained from the National Hospital Registry and the National Registry of Causes of Death. We calculated adjusted incidence rate ratios (aIRR) for risk of MI and population-attributable fractions (PAF) of MI associated with smoking. In never smokers, HIV was not associated with an increased risk of MI (aIRR, 1.01; 95% confidence interval [CI], .41-2.54). In previous and current smokers, HIV was associated with a substantially increased risk of MI (aIRR, 1.78; 95% CI, .75-4.24 and aIRR, 2.83; 95% CI, 1.71-4.70). The PAF associated with ever smoking (previous or current) was 72% (95% CI, 55%-82%) for HIV-infected individuals and 24% (95% CI, 3%-40%) for population controls. If all current smokers stopped smoking, 42% (95% CI, 21%-57%) and 21% (95% CI, 12%-28%) of all MIs could potentially be avoided in these 2 populations. Smoking is associated with a higher risk of MI in the HIV-infected population than in the general population. Approximately 3 of 4 MIs among HIV-infected individuals are associated with ever smoking compared with only 1 of 4 MIs among population controls. Smoking cessation could potentially prevent more than 40% of MIs among HIV-infected individuals, and smoking cessation should be a primary focus in modern HIV care. © The Author 2015. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

The Burden Attributable to Mental and Substance Use Disorders as Risk Factors for Suicide: Findings from the Global Burden of Disease Study 2010

PubMed Central

Ferrari, Alize J.; Norman, Rosana E.; Freedman, Greg; Baxter, Amanda J.; Pirkis, Jane E.; Harris, Meredith G.; Page, Andrew; Carnahan, Emily; Degenhardt, Louisa; Vos, Theo; Whiteford, Harvey A.

2014-01-01

Background The Global Burden of Disease Study 2010 (GBD 2010) identified mental and substance use disorders as the 5th leading contributor of burden in 2010, measured by disability adjusted life years (DALYs). This estimate was incomplete as it excluded burden resulting from the increased risk of suicide captured elsewhere in GBD 2010's mutually exclusive list of diseases and injuries. Here, we estimate suicide DALYs attributable to mental and substance use disorders. Methods Relative-risk estimates of suicide due to mental and substance use disorders and the global prevalence of each disorder were used to estimate population attributable fractions. These were adjusted for global differences in the proportion of suicide due to mental and substance use disorders compared to other causes then multiplied by suicide DALYs reported in GBD 2010 to estimate attributable DALYs (with 95% uncertainty). Results Mental and substance use disorders were responsible for 22.5 million (14.8–29.8 million) of the 36.2 million (26.5–44.3 million) DALYs allocated to suicide in 2010. Depression was responsible for the largest proportion of suicide DALYs (46.1% (28.0%–60.8%)) and anorexia nervosa the lowest (0.2% (0.02%–0.5%)). DALYs occurred throughout the lifespan, with the largest proportion found in Eastern Europe and Asia, and males aged 20–30 years. The inclusion of attributable suicide DALYs would have increased the overall burden of mental and substance use disorders (assigned to them in GBD 2010 as a direct cause) from 7.4% (6.2%–8.6%) to 8.3% (7.1%–9.6%) of global DALYs, and would have changed the global ranking from 5th to 3rd leading cause of burden. Conclusions Capturing the suicide burden attributable to mental and substance use disorders allows for more accurate estimates of burden. More consideration needs to be given to interventions targeted to populations with, or at risk for, mental and substance use disorders as an effective strategy for suicide prevention. PMID:24694747

The burden attributable to mental and substance use disorders as risk factors for suicide: findings from the Global Burden of Disease Study 2010.

PubMed

Ferrari, Alize J; Norman, Rosana E; Freedman, Greg; Baxter, Amanda J; Pirkis, Jane E; Harris, Meredith G; Page, Andrew; Carnahan, Emily; Degenhardt, Louisa; Vos, Theo; Whiteford, Harvey A

2014-01-01

The Global Burden of Disease Study 2010 (GBD 2010) identified mental and substance use disorders as the 5th leading contributor of burden in 2010, measured by disability adjusted life years (DALYs). This estimate was incomplete as it excluded burden resulting from the increased risk of suicide captured elsewhere in GBD 2010's mutually exclusive list of diseases and injuries. Here, we estimate suicide DALYs attributable to mental and substance use disorders. Relative-risk estimates of suicide due to mental and substance use disorders and the global prevalence of each disorder were used to estimate population attributable fractions. These were adjusted for global differences in the proportion of suicide due to mental and substance use disorders compared to other causes then multiplied by suicide DALYs reported in GBD 2010 to estimate attributable DALYs (with 95% uncertainty). Mental and substance use disorders were responsible for 22.5 million (14.8-29.8 million) of the 36.2 million (26.5-44.3 million) DALYs allocated to suicide in 2010. Depression was responsible for the largest proportion of suicide DALYs (46.1% (28.0%-60.8%)) and anorexia nervosa the lowest (0.2% (0.02%-0.5%)). DALYs occurred throughout the lifespan, with the largest proportion found in Eastern Europe and Asia, and males aged 20-30 years. The inclusion of attributable suicide DALYs would have increased the overall burden of mental and substance use disorders (assigned to them in GBD 2010 as a direct cause) from 7.4% (6.2%-8.6%) to 8.3% (7.1%-9.6%) of global DALYs, and would have changed the global ranking from 5th to 3rd leading cause of burden. Capturing the suicide burden attributable to mental and substance use disorders allows for more accurate estimates of burden. More consideration needs to be given to interventions targeted to populations with, or at risk for, mental and substance use disorders as an effective strategy for suicide prevention.

Fractionation of heavy metals and assessment of contamination of the sediments of Lake Titicaca.

PubMed

Cáceres Choque, Luis Fernando; Ramos Ramos, Oswaldo E; Valdez Castro, Sulema N; Choque Aspiazu, Rigoberto R; Choque Mamani, Rocío G; Fernández Alcazar, Samuel G; Sracek, Ondra; Bhattacharya, Prosun

2013-12-01

Chemical weathering is one of the major geochemical processes that control the mobilization of heavy metals. The present study provides the first report on heavy metal fractionation in sediments (8-156 m) of Lake Titicaca (3,820 m a.s.l.), which is shared by the Republic of Peru and the Plurinational State of Bolivia. Both contents of total Cu, Fe, Ni, Co, Mn, Cd, Pb, and Zn and also the fractionation of these heavy metals associated with four different fractions have been determined following the BCR scheme. The principal component analysis suggests that Co, Ni, and Cd can be attributed to natural sources related to the mineralized geological formations. Moreover, the sources of Cu, Fe, and Mn are effluents and wastes generated from mining activities, while Pb and Zn also suggest that their common source is associated to mining activities. According to the Risk Assessment Code, there is a moderate to high risk related to Zn, Pb, Cd, Mn, Co, and Ni mobilization and/or remobilization from the bottom sediment to the water column. Furthermore, the Geoaccumulation Index and the Enrichment Factor reveal that Zn, Pb, and Cd are enriched in the sediments. The results suggest that the effluents from various traditional mining waste sites in both countries are the main source of heavy metal contamination in the sediments of Lake Titicaca.

Influence of Schistosoma mansoni and Hookworm Infection Intensities on Anaemia in Ugandan Villages.

PubMed

Chami, Goylette F; Fenwick, Alan; Bulte, Erwin; Kontoleon, Andreas A; Kabatereine, Narcis B; Tukahebwa, Edridah M; Dunne, David W

2015-01-01

The association of anaemia with intestinal schistosomiasis and hookworm infections are poorly explored in populations that are not limited to children or pregnant women. We sampled 1,832 individuals aged 5-90 years from 30 communities in Mayuge District, Uganda. Demographic, village, and parasitological data were collected. Infection risk factors were compared in ordinal logistic regressions. Anaemia and infection intensities were analyzed in multilevel models, and population attributable fractions were estimated. Household and village-level predictors of Schistosoma mansoni and hookworm were opposite in direction or significant for single infections. S. mansoni was found primarily in children, whereas hookworm was prevalent amongst the elderly. Anaemia was more prevalent in individuals with S. mansoni and increased by 2.86 fold (p-value<0.001) with heavy S. mansoni infection intensity. Individuals with heavy hookworm were 1.65 times (p-value = 0.008) more likely to have anaemia than uninfected participants. Amongst individuals with heavy S. mansoni infection intensity, 32.0% (p-value<0.001) of anaemia could be attributed to S. mansoni. For people with heavy hookworm infections, 23.7% (p-value = 0.002) of anaemia could be attributed to hookworm. A greater fraction of anaemia (24.9%, p-value = 0.002) was attributable to heavy hookworm infections in adults (excluding pregnant women) as opposed to heavy hookworm infections in school-aged children and pregnant women (20.2%, p-value = 0.001). Community-based surveys captured anaemia in children and adults affected by S. mansoni and hookworm infections. For areas endemic with schistosomiasis or hookworm infections, WHO guidelines should include adults for treatment in helminth control programmes.

Risk factor modifications and depression incidence: a 4-year longitudinal Canadian cohort of the Montreal Catchment Area Study

PubMed Central

Meng, Xiangfei; Brunet, Alain; Turecki, Gustavo; Liu, Aihua; D'Arcy, Carl; Caron, Jean

2017-01-01

Objective Few studies have examined the effect of risk factor modifications on depression incidence. This study was to explore psychosocial risk factors for depression and quantify the effect of risk factor modifications on depression incidence in a large-scale, longitudinal population-based study. Methods Data were from the Montreal Longitudinal Catchment Area study (N=2433). Multivariate modified Poisson regression was used to estimate relative risk (RR). Population attributable fractions were also used to estimate the potential impact of risk factor modifications on depression incidence. Results The cumulative incidence rate of major depressive disorder at the 2-year follow-up was 4.8%, and 6.6% at the 4-year follow-up. Being a younger adult, female, widowed, separated or divorced, Caucasian, poor, occasional drinker, having a family history of mental health problems, having less education and living in areas with higher unemployment rates and higher proportions of visible minorities, more cultural community centres and community organisations, were consistently associated with the increased risk of incident major depressive disorder. Although only 5.1% of the disease incidence was potentially attributable to occasional drinking (vs abstainers) at the 2-year follow-up, the attribution of occasional drinking doubled at the 4-year follow-up. A 10% reduction in the prevalence of occasional drinking in this population could potentially prevent half of incident cases. Conclusions Modifiable risk factors, both individual and societal, could be the targets for public depression prevention programmes. These programmes should also be gender-specific, as different risk factors have been identified for men and women. Public health preventions at individual levels could focus on the better management of occasional drinking, as it explained around 5%~10% of incident major depressive disorders. Neighbourhood characteristics could also be the target for public prevention programmes. However, this could be very challenging. A cost-effectiveness analysis of a variety of prevention efforts is warranted. PMID:28601831

Attribution of the 2015 record high sea surface temperatures over the central equatorial Pacific and tropical Indian Ocean

NASA Astrophysics Data System (ADS)

Park, In-Hong; Min, Seung-Ki; Yeh, Sang-Wook; Weller, Evan; Kim, Seon Tae

2017-04-01

This study assessed the anthropogenic contribution to the 2015 record-breaking high sea surface temperatures (SSTs) observed in the central equatorial Pacific and tropical Indian Ocean. Considering a close link between extreme warm events in these regions, we conducted a joint attribution analysis using a fraction of attributable risk approach. Probability of occurrence of such extreme anomalies and long-term trends for the two oceanic regions were compared between CMIP5 multi-model simulations with and without anthropogenic forcing. Results show that the excessive warming in both regions is well beyond the range of natural variability and robustly attributable to human activities due to greenhouse gas increase. We further explored associated mechanisms including the Bjerknes feedback and background anthropogenic warming. It is concluded that background warming was the main contribution to the 2015 extreme SST event over the central equatorial Pacific Ocean on a developing El Niño condition, which in turn induced the extreme SST event over the tropical Indian Ocean through the atmospheric bridge effect.

NMR signal analysis to attribute the components to the solid/liquid phases present in mixes and ice creams.

PubMed

Mariette, François; Lucas, Tiphaine

2005-03-09

The NMR relaxation signals from complex products such as ice cream are hard to interpret because of the multiexponential behavior of the relaxation signal and the difficulty of attributing the NMR relaxation components to specific molecule fractions. An attribution of the NMR relaxation parameters is proposed, however, based on an approach that combines quantitative analysis of the spin-spin and spin-lattice relaxation times and the signal intensities with characterization of the ice cream components. We have been able to show that NMR can be used to describe the crystallized and liquid phases separately. The first component of the spin-spin and spin-lattice relaxation describes the behavior of the protons of the crystallized fat in the mix. The amount of fat crystals can then be estimated. In the case of ice cream, only the spin-lattice relaxation signal from the crystallized fraction is relevant. However, it enables the ice protons and the protons of the crystallized fat to be distinguished. The spin-lattice relaxation time can be used to describe the mobility of the protons in the different crystallized phases and also to quantify the amount of ice crystals and fat crystals in the ice cream. The NMR relaxation of the liquid phase of the mix has a biexponential behavior. A first component is attributable to the liquid fraction of the fat and to the sugars, while a second component is attributable to the aqueous phase. Overall, the study shows that despite the complexity of the NMR signal from ice cream, a number of relevant parameters can be extracted to study the influence of the formulation and of the process stages on the ice fraction, the crystallized fat fraction, and the liquid aqueous fraction.

Population-attributable fraction of tubal factor infertility associated with chlamydia.

PubMed

Gorwitz, Rachel J; Wiesenfeld, Harold C; Chen, Pai-Lien; Hammond, Karen R; Sereday, Karen A; Haggerty, Catherine L; Johnson, Robert E; Papp, John R; Kissin, Dmitry M; Henning, Tara C; Hook, Edward W; Steinkampf, Michael P; Markowitz, Lauri E; Geisler, William M

2017-09-01

Chlamydia trachomatis infection is highly prevalent among young women in the United States. Prevention of long-term sequelae of infection, including tubal factor infertility, is a primary goal of chlamydia screening and treatment activities. However, the population-attributable fraction of tubal factor infertility associated with chlamydia is unclear, and optimal measures for assessing tubal factor infertility and prior chlamydia in epidemiological studies have not been established. Black women have increased rates of chlamydia and tubal factor infertility compared with White women but have been underrepresented in prior studies of the association of chlamydia and tubal factor infertility. The objectives of the study were to estimate the population-attributable fraction of tubal factor infertility associated with Chlamydia trachomatis infection by race (Black, non-Black) and assess how different definitions of Chlamydia trachomatis seropositivity and tubal factor infertility affect population-attributable fraction estimates. We conducted a case-control study, enrolling infertile women attending infertility practices in Birmingham, AL, and Pittsburgh, PA, during October 2012 through June 2015. Tubal factor infertility case status was primarily defined by unilateral or bilateral fallopian tube occlusion (cases) or bilateral fallopian tube patency (controls) on hysterosalpingogram. Alternate tubal factor infertility definitions incorporated history suggestive of tubal damage or were based on laparoscopic evidence of tubal damage. We aimed to enroll all eligible women, with an expected ratio of 1 and 3 controls per case for Black and non-Black women, respectively. We assessed Chlamydia trachomatis seropositivity with a commercial assay and a more sensitive research assay; our primary measure of seropositivity was defined as positivity on either assay. We estimated Chlamydia trachomatis seropositivity and calculated Chlamydia trachomatis-tubal factor infertility odds ratios and population-attributable fraction, stratified by race. We enrolled 107 Black women (47 cases, 60 controls) and 620 non-Black women (140 cases, 480 controls). Chlamydia trachomatis seropositivity by either assay was 81% (95% confidence interval, 73-89%) among Black and 31% (95% confidence interval, 28-35%) among non-Black participants (P < .001). Using the primary Chlamydia trachomatis seropositivity and tubal factor infertility definitions, no significant association was detected between chlamydia and tubal factor infertility among Blacks (odds ratio, 1.22, 95% confidence interval, 0.45-3.28) or non-Blacks (odds ratio, 1.41, 95% confidence interval, 0.95-2.09), and the estimated population-attributable fraction was 15% (95% confidence interval, -97% to 68%) among Blacks and 11% (95% confidence interval, -3% to 23%) among non-Blacks. Use of alternate serological measures and tubal factor infertility definitions had an impact on the magnitude of the chlamydia-tubal factor infertility association and resulted in a significant association among non-Blacks. Low population-attributable fraction estimates suggest factors in addition to chlamydia contribute to tubal factor infertility in the study population. However, high background Chlamydia trachomatis seropositivity among controls, most striking among Black participants, could have obscured an association with tubal factor infertility and resulted in a population-attributable fraction that underestimates the true etiological role of chlamydia. Choice of chlamydia and tubal factor infertility definitions also has an impact on the odds ratio and population-attributable fraction estimates. Published by Elsevier Inc.

Cigarette smoking and smoking-attributable diseases among Estonian physicians: a cross-sectional study.

PubMed

Raag, Mait; Pärna, Kersti

2018-01-30

Smoking is a risk factor for several diseases. Physicians are role models for their patients. Physicians who smoke underestimate the health risks of smoking and may be less likely to offer advice to help their patients to quit. The aim of this study was to: provide an overview of smoking behaviour among Estonian physicians; assess the relationship between smoking and ischaemic heart disease (IHD), chronic bronchitis (CB), and lung emphysema (LE); and estimate fractions of prevalences of the three diseases attributable to smoking. Self-administered questionnaires were sent to practising physicians (n = 5666) in Estonia in 2014. Prevalence of smoking and relative risks for IHD, CB and LE as well as the risks of IHD, CB and LE attributable to smoking were calculated by age and sex. Post-stratification was used to compensate non-response. There were 535 male and 2404 female physicians participating. The prevalence of daily smoking was 12.4% (95% CI 10.4-14.4%) among men and 5.0% (95% CI 4.4-5.6%) among women. Mean duration of smoking among male and female daily smokers was 28.6 (95% CI 26.1-31.1) and 28.6 (95% CI 27.1-30.2) years. Compared to lifelong non-smokers, the age-adjusted risk for IHD was 1.29 times (95% CI 0.88-1.89) higher for men, but 1.69 times (95% CI 1.17-2.40) lower for all women who have ever smoked. The risk for CB was 2.29 (95% CI 1.30-4.03) times higher for smokers among men and, 1.32 (95% CI 0.95-1.82) among women; the risk ratio for LE was 4.92 (95% CI 1.14-21.1) among men and 2.45 (95% CI 0.63-9.52) among women. The smoking-attributable risk for IHD was 3.2% (95% CI 2.3-4.1%) among men and - 0.1% (95% CI -0.7-0.4%) among women; for CB 6.9% (95% CI 6.0-7.8%) and 4.2% (95% CI 3.5-4.8%); and for LE 18.8% (95% CI 17.0-22.5%) and 22.6% (95% CI 18.5-26.9%), respectively. Prevalence of daily smoking was relatively low among Estonian physicians (and twice lower among female physicians). The risk attributable to smoking was higher for LE and CB than for IHD.

The impact of delayed maternity on foetal growth in Spain: An assessment by population attributable fraction.

PubMed

Varea, Carlos; Terán, José Manuel; Bernis, Cristina; Bogin, Barry

2017-09-18

Delayed childbearing is considered a risk factor for maternal-foetal health. As in other higher-income countries, in Spain age at maternity has steadily increased during the last two decades. To quantify the impact of the delay in the age at maternity on small for gestational age (SGA) categories of <3rd, 3rd-5th and 5th-10th percentiles. 2,672,350 singleton live births born to Spanish mothers in 2007-2015 were analysed. Adjusted relative risk was calculated to estimate the adjusted partial population attributable fractions (PAF p ) for mothers aged 35-39 and ≥40 years for each category of SGA considering the interaction between age at maternity and parity. Primipara 35-39 years old mothers have the highest PAF p in the three categories of SGA, with the maximum value for SGA <3rd percentile (2.57%, 95% CI 2.25, 2.88). PAF p for both primipara and multipara ≥40 years old mothers were less than 1%. PAF p for primipara older mothers increased significantly in 2007-2015 for the three categories of SGA, more clearly among those aged 35-39 years. The contribution of multipara mothers of both age groups did not increase significantly during the period. Delayed maternity is a significant adjusted risk factor for SGA, contributing to the increase of its prevalence. However, results also suggest a limited clinical impact of delayed maternity on foetal growth. Positive changes in maternal profile associated with the shift in maternal age might contribute to explain the limited impact of mothers aged 35 years and older on negative birth outcome in Spain. Copyright © 2017 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

The impact of workplace risk factors on the occurrence of neck and upper limb pain: a general population study.

PubMed

Sim, Julius; Lacey, Rosie J; Lewis, Martyn

2006-09-19

Work-related neck and upper limb pain has mainly been studied in specific occupational groups, and little is known about its impact in the general population. The objectives of this study were to estimate the prevalence and population impact of work-related neck and upper limb pain. A cross-sectional survey was conducted of 10,000 adults in North Staffordshire, UK, in which there is a common local manual industry. The primary outcome measure was presence or absence of neck and upper limb pain. Participants were asked to give details of up to five recent jobs, and to report exposure to six work activities involving the neck or upper limbs. Psychosocial measures included job control, demand and support. Odds ratios (ORs) and population attributable fractions were calculated for these risk factors. The age-standardized one-month period prevalence of neck and upper limb pain was 44%. There were significant independent associations between neck and upper limb pain and: repeated lifting of heavy objects (OR = 1.4); prolonged bending of neck (OR = 2.0); working with arms at/above shoulder height (OR = 1.3); little job control (OR = 1.6); and little supervisor support (OR = 1.3). The population attributable fractions were 0.24 (24%) for exposure to work activities and 0.12 (12%) for exposure to psychosocial factors. Neck and upper limb pain is associated with both physical and psychosocial factors in the work environment. Inferences of cause-and-effect from cross-sectional studies must be made with caution; nonetheless, our findings suggest that modification of the work environment might prevent up to one in three of cases of neck and upper limb pain in the general population, depending on current exposures to occupational risk.

The population impact of obesity, sedentary lifestyle, and tobacco and alcohol consumption on the prevalence of type 2 diabetes: Analysis of a health population survey in Chile, 2010

PubMed Central

Gormaz, Juan G.; Libuy, Matías; Sanhueza, Dérgica; Gajardo, Abraham; Srur, Andrea; Wallbaum, Magdalena

2017-01-01

Aim To estimate the impact of tobacco use, sedentary lifestyle, obesity and alcohol consumption on type 2 diabetes mellitus (T2DM) prevalence in the Chilean population. Methods The study-included 5,293 subjects with fasting glycaemia levels from the nationwide cross-sectional health survey in 2010, commissioned by the Ministry of Health, Chile. Crude and Adjusted Odds Ratio to T2DM and its corresponding 95% confidence interval were estimated through logistic regressions. Attributable fractions and population attributable fractions were estimated. Results T2DM prevalence was 9.5%. Sedentary lifestyles and obesity were significant risk factors for T2DM. 52,4% of T2DM could be avoided if these individuals were not obese, and at a population level, 23% of T2DM could be preventable if obesity did not exist. A 64% of T2DM is explained by sedentariness, and if people would become active, a 62,2% of the cases of diabetes could be avoided. Interpretation About 79% of T2DM cases in Chile could be prevented with cost-effective strategies focused on preventing sedentary lifestyle and obesity. It’s therefore urgent to implement evidence-based public health polices, aimed to decrease the prevalence of T2DM, by controlling its risk factors and consequently, reducing the complications from T2DM. PMID:28542472

Burden of cancer associated with type 2 diabetes mellitus in Japan, 2010-2030.

PubMed

Saito, Eiko; Charvat, Hadrien; Goto, Atsushi; Matsuda, Tomohiro; Noda, Mitsuhiko; Sasazuki, Shizuka; Inoue, Manami

2016-04-01

Diabetes mellitus constitutes a major disease burden globally, and the prevalence of diabetes continues to increase worldwide. We aimed to estimate the burden of cancer associated with type 2 diabetes mellitus in Japan between 2010 and 2030. In this study, we estimated the population attributable fraction of cancer risk associated with type 2 diabetes in 2010 and 2030 using the prevalence estimates of type 2 diabetes in Japan from 1990 to 2030, summary hazard ratios of diabetes and cancer risk from a pooled analysis of eight large-scale Japanese cohort studies, observed incidence/mortality of cancer in 2010 and predicted incidence/mortality for 2030 derived from the age-period-cohort model. Our results showed that between 2010 and 2030, the total numbers of cancer incidence and mortality were predicted to increase by 38.9% and 10.5% in adults aged above 20 years, respectively. In the number of excess incident cancer cases associated with type 2 diabetes, an increase of 26.5% in men and 53.2% in women is expected between 2010 and 2030. The age-specific analysis showed that the population attributable fraction of cancer will increase in adults aged >60 years over time, but will not change in adults aged 20-59 years. In conclusion, this study suggests a modest but steady increase in cancers associated with type 2 diabetes. © 2016 The Authors. Cancer Science published by John Wiley & Sons Australia, Ltd on behalf of Japanese Cancer Association.

Analysis of Risk and Burden of Dysentery Associated with Floods from 2004 to 2010 in Nanning, China

PubMed Central

Liu, Zhidong; Ding, Guoyong; Zhang, Ying; Xu, Xin; Liu, Qiyong; Jiang, Baofa

2015-01-01

This study aimed to examine the association between floods and the morbidity of dysentery and to quantify the burden of dysentery due to floods in Nanning, China. A generalized additive mixed model was conducted to assess the relationship between monthly morbidity of dysentery and floods from 2004 to 2010. The years lived with disability (YLDs) of dysentery attributable to floods were then estimated based on the WHO framework of the burden of disease study for calculating the potential impact fraction. The relative risk (RR) of floods on the morbidity of dysentery was 1.44 (95% confidence interval [CI] = 1.18–1.75). The models suggest that a potential 1-day rise in flood duration may lead to 8% (RR = 1.08, 95% CI = 1.04–1.12) increase in the morbidity of dysentery. The average attributable YLD per 1,000 of dysentery caused by floods were 0.013 in males, 0.005 in females, and 0.009 in persons. Our study confirms that floods have significantly increased the risk and the burden of dysentery in the study area. Public health action should be taken to prevent and control the potential risk of dysentery after floods. Vulnerable groups such as males and children should be paid more attention. PMID:26416103

Variation across Canada in the economic burden attributable to excess weight, tobacco smoking and physical inactivity.

PubMed

Krueger, Hans; Krueger, Joshua; Koot, Jacqueline

2015-04-30

Tobacco smoking, excess weight and physical inactivity contribute substantially to the preventable disease burden in Canada. The purpose of this paper is to determine the potential reduction in economic burden if all provinces achieved prevalence rates of these three risk factors (RFs) equivalent to those of the province with the lowest rates, and to update and address a limitation noted in our previous model. We used a previously developed approach based on population attributable fractions to estimate the economic burden associated with these RFs. Sex-specific relative risk and age-/sex-specific prevalence data were used in the modelling. The previous model was updated using the most current data for developing resource allocation weights. In 2012, the prevalence of tobacco smoking, excess weight and physical inactivity was the lowest in British Columbia. If age- and sex-specific prevalence rates from BC were applied to populations living in the other provinces, the annual economic burden attributable to these three RFs would be reduced by $5.3 billion. Updating the model resulted in a considerable shift in economic burden from smoking to excess weight, with the estimated annual economic burden attributable to excess weight now 25% higher compared to that of tobacco smoking ($23.3 vs. $18.7 billion). Achieving RF prevalence rates equivalent to those of the province with the lowest rates would result in a 10% reduction in economic burden attributable to excess weight, smoking and physical inactivity in Canada. This study shows that using current resource use data is important for this type of economic modelling.

Burden of lung cancer attributable to occupational diesel engine exhaust exposure in Canada.

PubMed

Kim, Joanne; Peters, Cheryl E; Arrandale, Victoria H; Labrèche, France; Ge, Calvin B; McLeod, Christopher B; Song, Chaojie; Lavoué, Jérôme; Davies, Hugh W; Nicol, Anne-Marie; Pahwa, Manisha; Demers, Paul A

2018-04-28

To estimate the population attributable fraction (PAF) and number of incident and fatal lung cancers in Canada from occupational exposure to diesel engine exhaust (DEE). DEE exposure prevalence and level estimates were used with Canadian Census and Labour Force Survey data to model the exposed population across the risk exposure period (REP, 1961-2001). Relative risks of lung cancer were calculated based on a meta-regression selected from the literature. PAFs were calculated using Levin's equation and applied to the 2011 lung cancer statistics obtained from the Canadian Cancer Registry. We estimated that 2.4% (95% CI 1.6% to 6.6%) of lung cancers in Canada are attributable to occupational DEE exposure, corresponding to approximately 560 (95% CI 380 to 1570) incident and 460 (95% CI 310 to 1270) fatal lung cancers in 2011. Overall, 1.6 million individuals alive in 2011 were occupationally exposed to DEE during the REP, 97% of whom were male. Occupations with the highest burden were underground miners, truck drivers and mechanics. Half of the attributable lung cancers occurred among workers with low exposure. This is the first study to quantify the burden of lung cancer attributable to occupational DEE exposure in Canada. Our results underscore a large potential for prevention, and a large public health impact from occupational exposure to low levels of DEE. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Driving-while-intoxicated history as a risk marker for general aviation pilots.

PubMed

Li, Guohua; Baker, Susan P; Qiang, Yandong; Grabowski, Jurek G; McCarthy, Melissa L

2005-01-01

The Federal Aviation Administration conducts background checking for driving-while-intoxicated (DWI) convictions on all pilots. This study examined the association between DWI history and crash risk in a cohort of 335,672 general aviation pilots. These pilots were followed up from 1994 to 2000 through the aviation crash surveillance system of the National Transportation Safety Board. At baseline, 3.4% of the pilots had a DWI history. DWI history was associated with a 43% increased risk of crash involvement (adjusted relative risk: 1.43; 95% confidence interval: 1.15-1.77). The population-attributable risk fraction for DWI history was estimated as 1.4%. In addition to DWI history, male gender, older age, and inexperience were associated with significantly increased risk of crash involvement. The results of this study support DWI history as a valid risk marker for general aviation pilots. The safety benefit of background checking for DWI history needs to be further evaluated.

The costs of alcohol, illegal drugs, and tobacco in Canada, 2002.

PubMed

Rehm, Jürgen; Gnam, William; Popova, Svetlana; Baliunas, Dolly; Brochu, Serge; Fischer, Benedikt; Patra, Jayadeep; Sarnocinska-Hart, Anna; Taylor, Benjamin

2007-11-01

The aim of this study was to estimate costs attributable to substance use and misuse in Canada in 2002. Based on information about prevalence of exposure and risk relations for more than 80 disease categories, deaths, years of life lost, and hospitalizations attributable to substance use and misuse were estimated. In addition, substance-attributable fractions for criminal justice expenditures were derived. Indirect costs were estimated using a modified human capital approach. Costs of substance use and misuse totaled almost Can. $40 billion in 2002. The total cost per capita for substance use and misuse was about Can. $1,267: Can. $463 for alcohol, Can. $262 for illegal drugs, and Can. $541 for tobacco. Legal substances accounted for the vast majority of these costs (tobacco: almost 43% of total costs; alcohol: 37%). Indirect costs or productivity losses were the largest cost category (61%), followed by health care (22%) and law enforcement costs (14%). More than 40,000 people died in Canada in 2002 because of substance use and misuse: 37,209 deaths were attributable to tobacco, 4,258 were attributable to alcohol, and 1,695 were attributable to illegal drugs. A total of about 3.8 million hospital days were attributable to substance use and misuse, again mainly to tobacco. Substance use and misuse imposes a considerable economic toll on Canadian society and requires more preventive efforts.

[Impact of high salt consumption of blood pressure on a non-hypertensive population].

PubMed

Domínguez Cancino, Karen; Paredes Escobar, María Cristina

2017-12-01

Background There is conflicting evidence regarding the role of salt intake in blood pressure (BP). Aim To estimate the impact of salt consumption on the BP level of a non-hypertensive population aged between 15 and 64 years. Material and Methods Analytical-observational study using data from the National Health Survey 2009-2010. A BP cut-off point at 120/80 mmHg BP was considered to determine risk. Salt consumption was divided into four strata. The prevalence ratios (PR) were determined using the Poisson model with robust variance. The formulas of the studies of Dal Grande and Walter for the estimation of population attributable fraction (PAF) were used. Results The sample was constituted by 1,263 individuals and 24.3% had BP at risk. A statistically significant association was observed between high salt intake and risk BP with PR of 1.91 (95% confidence intervals (CI) 1.44-2.57) in the consumption stratum of 11 g / day and more. It was estimated that 4.7% (95% CI 4.2-5.2) of BP risk can be attributed to salt consumption, when controlling by age group, sex and educational level. Conclusions The 4.7% PAF is lower than the figure of 30% reported abroad. Interventions to reduce salt consumption in the entire population and the identification of risk groups are recommended.

Estimating the Proportion of Childhood Cancer Cases and Costs Attributable to the Environment in California.

PubMed

Nelson, Lauren; Valle, Jhaqueline; King, Galatea; Mills, Paul K; Richardson, Maxwell J; Roberts, Eric M; Smith, Daniel; English, Paul

2017-05-01

To estimate the proportion of cases and costs of the most common cancers among children aged 0 to 14 years (leukemia, lymphoma, and brain or central nervous system tumors) that were attributable to preventable environmental pollution in California in 2013. We conducted a literature review to identify preventable environmental hazards associated with childhood cancer. We combined risk estimates with California-specific exposure prevalence estimates to calculate hazard-specific environmental attributable fractions (EAFs). We combined hazard-specific EAFs to estimate EAFs for each cancer and calculated an overall EAF. Estimated economic costs included annual (indirect and direct medical) and lifetime costs. Hazards associated with childhood cancer risks included tobacco smoke, residential exposures, and parental occupational exposures. Estimated EAFs for leukemia, lymphoma, and brain or central nervous system cancer were 21.3% (range = 11.7%-30.9%), 16.1% (range = 15.0%-17.2%), and 2.0% (range = 1.7%-2.2%), respectively. The combined EAF was 15.1% (range = 9.4%-20.7%), representing $18.6 million (range = $11.6 to $25.5 million) in annual costs and $31 million in lifetime costs. Reducing environmental hazards and exposures in California could substantially reduce the human burden of childhood cancer and result in significant annual and lifetime savings.

The attributable risk of chronic obstructive pulmonary disease due to ambient fine particulate pollution among older adults.

PubMed

Lin, Hualiang; Qian, Zhengmin Min; Guo, Yanfei; Zheng, Yang; Ai, Siqi; Hang, Jian; Wang, Xiaojie; Zhang, Lingli; Liu, Tao; Guan, Weijie; Li, Xing; Xiao, Jianpeng; Zeng, Weilin; Xian, Hong; Howard, Steven W; Ma, Wenjun; Wu, Fan

2018-04-01

The linkage between ambient fine particle pollution (PM 2.5 ) and chronic obstructive pulmonary disease (COPD) and the attributable risk remained largely unknown. This study determined the cross-sectional association between ambient PM 2.5 and prevalence of COPD among adults ≥50 years of age. We surveyed 29,290 participants aged 50 years and above in this study. The annual average concentrations of PM 2.5 derived from satellite data were used as the exposure indicator. A mixed effect model was applied to determine the associations and the burden of COPD attributable to PM 2.5. RESULTS: Among the participants, 1872 (6.39%) were classified as COPD cases. Our analysis observed a threshold concentration of 30 μg/m 3 in the PM 2.5 -COPD association, above which we found a linear positive exposure-response association between ambient PM 2.5 and COPD. The odds ratio (OR) for each 10 μg/m 3 increase in ambient PM 2.5 was 1.21(95% CI: 1.13, 1.30). Stratified analyses suggested that males, older subjects (65 years and older) and those with lower education attainment might be the vulnerable subpopulations. We further estimated that about 13.79% (95% CI: 7.82%, 21.62%) of the COPD cases could be attributable to PM 2.5 levels higher than 30 μg/m 3 in the study population. Our analysis indicates that ambient PM 2.5 exposure could increase the risk of COPD and accounts for a substantial fraction of COPD among the study population. Copyright © 2018. Published by Elsevier Ltd.

Methodology to Estimate the Longitudinal Average Attributable Fraction of Guideline-recommended Medications for Death in Older Adults With Multiple Chronic Conditions

PubMed Central

Zhan, Yilei; Cohen, Andrew B.; Tinetti, Mary E.; Trentalange, Mark; McAvay, Gail

2016-01-01

Background: Persons with multiple chronic conditions receive multiple guideline-recommended medications to improve outcomes such as mortality. Our objective was to estimate the longitudinal average attributable fraction for 3-year survival of medications for cardiovascular conditions in persons with multiple chronic conditions and to determine whether heterogeneity occurred by age. Methods: Medicare Current Beneficiary Survey participants (N = 8,578) with two or more chronic conditions, enrolled from 2005 to 2009 with follow-up through 2011, were analyzed. We calculated the longitudinal extension of the average attributable fraction for oral medications (beta blockers, renin–angiotensin system blockers, and thiazide diuretics) indicated for cardiovascular conditions (atrial fibrillation, coronary artery disease, heart failure, and hypertension), on survival adjusted for 18 participant characteristics. Models stratified by age (≤80 and >80 years) were analyzed to determine heterogeneity of both cardiovascular conditions and medications. Results: Heart failure had the greatest average attributable fraction (39%) for mortality. The fractional contributions of beta blockers, renin–angiotensin system blockers, and thiazides to improve survival were 10.4%, 9.3%, and 7.2% respectively. In age-stratified models, of these medications thiazides had a significant contribution to survival only for those aged 80 years or younger. The effects of the remaining medications were similar in both age strata. Conclusions: Most cardiovascular medications were attributed independently to survival. The two cardiovascular conditions contributing independently to death were heart failure and atrial fibrillation. The medication effects were similar by age except for thiazides that had a significant contribution to survival in persons younger than 80 years. PMID:26748093

Estimating the social cost of respiratory cancer cases attributable to occupational exposures in France.

PubMed

Serrier, Hassan; Sultan-Taieb, Hélène; Luce, Danièle; Bejean, Sophie

2014-07-01

The objective of this article was to estimate the social cost of respiratory cancer cases attributable to occupational risk factors in France in 2010. According to the attributable fraction method and based on available epidemiological data from the literature, we estimated the number of respiratory cancer cases due to each identified risk factor. We used the cost-of-illness method with a prevalence-based approach. We took into account the direct and indirect costs. We estimated the cost of production losses due to morbidity (absenteeism and presenteeism) and mortality costs (years of production losses) in the market and nonmarket spheres. The social cost of lung, larynx, sinonasal and mesothelioma cancer caused by exposure to asbestos, chromium, diesel engine exhaust, paint, crystalline silica, wood and leather dust in France in 2010 were estimated at between 917 and 2,181 million euros. Between 795 and 2,011 million euros (87-92%) of total costs were due to lung cancer alone. Asbestos was by far the risk factor representing the greatest cost to French society in 2010 at between 531 and 1,538 million euros (58-71%), ahead of diesel engine exhaust, representing an estimated social cost of between 233 and 336 million euros, and crystalline silica (119-229 million euros). Indirect costs represented about 66% of total costs. Our assessment shows the magnitude of the economic impact of occupational respiratory cancers. It allows comparisons between countries and provides valuable information for policy-makers responsible for defining public health priorities.

Sleep deficiency and motor vehicle crash risk in the general population: a prospective cohort study.

PubMed

Gottlieb, Daniel J; Ellenbogen, Jeffrey M; Bianchi, Matt T; Czeisler, Charles A

2018-03-20

Insufficient sleep duration and obstructive sleep apnea, two common causes of sleep deficiency in adults, can result in excessive sleepiness, a well-recognized cause of motor vehicle crashes, although their contribution to crash risk in the general population remains uncertain. The objective of this study was to evaluate the relation of sleep apnea, sleep duration, and excessive sleepiness to crash risk in a community-dwelling population. This was a prospective observational cohort study nested within the Sleep Heart Health Study, a community-based study of the health consequences of sleep apnea. The participants were 1745 men and 1456 women aged 40-89 years. Sleep apnea was measured by home polysomnography and questionnaires were used to assess usual sleep duration and daytime sleepiness. A follow-up questionnaire 2 years after baseline ascertained driving habits and motor vehicle crash history. Logistic regression analysis was used to examine the relation of sleep apnea and sleep duration at baseline to the occurrence of motor vehicle crashes during the year preceding the follow-up visit, adjusting for relevant covariates. The population-attributable fraction of motor vehicle crashes was estimated from the sample proportion of motor vehicle crashes and the adjusted odds ratios for motor vehicle crash within each exposure category. Among 3201 evaluable participants, 222 (6.9%) reported at least one motor vehicle crash during the prior year. A higher apnea-hypopnea index (p < 0.01), fewer hours of sleep (p = 0.04), and self-reported excessive sleepiness (p < 0.01) were each significantly associated with crash risk. Severe sleep apnea was associated with a 123% increased crash risk, compared to no sleep apnea. Sleeping 6 hours per night was associated with a 33% increased crash risk, compared to sleeping 7 or 8 hours per night. These associations were present even in those who did not report excessive sleepiness. The population-attributable fraction of motor vehicle crashes was 10% due to sleep apnea and 9% due to sleep duration less than 7 hours. Sleep deficiency due to either sleep apnea or insufficient sleep duration is strongly associated with motor vehicle crashes in the general population, independent of self-reported excessive sleepiness.

Risk factors for chronic undernutrition among children in India: Estimating relative importance, population attributable risk and fractions.

PubMed

Corsi, Daniel J; Mejía-Guevara, Iván; Subramanian, S V

2016-05-01

Nearly 40% of the world's stunted children live in India and the prevalence of undernutrition has been persistently high in recent decades. Given numerous available interventions for reducing undernutrition in children, it is not clear of the relative importance of each within a multifactorial framework. We assess the simultaneous contribution of 15 known risk factors for child chronic undernutrition in India. Data are from the 3rd Indian National Family Health Survey (NFHS-3), a nationally representative cross-sectional survey undertaken in 2005-2006. The study population consisted of children aged 6-59 months [n = 26,842 (stunting/low height-for-age), n = 27,483 (underweight/low weight-for-age)]. Risk factors examined for their association with undernutrition were: vitamin A supplementation, vaccination, use of iodized salt, household air quality, improved sanitary facilities, safe disposal of stools, improved drinking water, prevalence of infectious disease, initiation of breastfeeding, dietary diversity, age at marriage, maternal BMI, height, education, and household wealth. Age/sex-adjusted and multivariable adjusted effect sizes (odds ratios) were calculated for risk factors along with Population Attributable Risks (PAR) and Fractions (PAF) using logistic regression. In the mutually adjusted models, the five most important predictors of childhood stunting/underweight were short maternal stature, mother having no education, households in lowest wealth quintile, poor dietary diversity, and maternal underweight. These five factors had a combined PAR of 67.2% (95% CI: 63.3-70.7) and 69.7% (95% CI: 66.3-72.8) for stunting and underweight, respectively. The remaining factors were associated with a combined PAR of 11.7% (95% CI: 6.0-17.4) and 15.1% (95% CI: 8.9-21.3) for stunting and underweight, respectively. Implementing strategies focused on broader progress on social circumstances and infrastructural domains as well as investments in nutrition specific programs to promote dietary adequacy and diversity are required to ensure a long term trajectory of optimal child growth and development in India. Copyright © 2015 Elsevier Ltd. All rights reserved.

Immediately modifiable risk factors attributable to colorectal cancer in Malaysia.

PubMed

Naing, Cho; Lai, Pei Kuan; Mak, Joon Wah

2017-08-04

This study aimed to estimate potential reductions in case incidence of colorectal cancer attributable to the modifiable risk factors such as alcohol consumption, overweight and physical inactivity amongst the Malaysian population. Gender specific population-attributable fractions (PAFs) for colorectal cancer in Malaysia were estimated for the three selected risk factors (physical inactivity, overweight, and alcohol consumptions). Exposure prevalence were sourced from a large-scale national representative survey. Risk estimates of the relationship between the exposure of interest and colorectal cancer were obtained from published meta-analyses. The overall PAF was then estimated, using the 2013 national cancer incidence data from the Malaysian Cancer Registry. Overall, the mean incidence rate for colorectal cancer in Malaysia from 2008 to 2013 was 21.3 per 100,000 population, with the mean age of 61.6 years (±12.7) and the majority were men (56.6%). Amongst 369 colorectal cancer cases in 2013, 40 cases (20 men, 20 women), 10 cases (9 men, 1 woman) or 20 cases (16 men,4 women) would be prevented, if they had done physical exercises, could reduce their body weight to normal level or avoided alcohol consumption, assuming that these factors are causally related to colorectal cancer. It was estimated that 66 (17.8%;66/369) colorectal cancer cases (42 men, 24 women) who had all these three risk factors for the last 10 years would have been prevented, if they could control these three risk factors through effective preventive measures. Findings suggest that approximately 18% of colorectal cancer cases in Malaysia would be prevented through appropriate preventive measures such as doing regular physical exercises, reducing their body weight to normal level and avoiding alcohol consumption, if these factors are causally related to colorectal cancer. Scaling-up nationwide public health campaigns tailored to increase physical activity, controlling body weight within normal limits and avoid alcohol intake are recommended. Future studies with other site-specific cancers and additional risk factors are needed.

The impact of dietary habits and metabolic risk factors on cardiovascular and diabetes mortality in countries of the Middle East and North Africa in 2010: a comparative risk assessment analysis.

PubMed

Afshin, Ashkan; Micha, Renata; Khatibzadeh, Shahab; Fahimi, Saman; Shi, Peilin; Powles, John; Singh, Gitanjali; Yakoob, Mohammad Yawar; Abdollahi, Morteza; Al-Hooti, Suad; Farzadfar, Farshad; Houshiar-Rad, Anahita; Hwalla, Nahla; Koksal, Eda; Musaiger, Abdulrahman; Pekcan, Gulden; Sibai, Abla Mehio; Zaghloul, Sahar; Danaei, Goodarz; Ezzati, Majid; Mozaffarian, Dariush

2015-05-20

We conducted a comparative risk assessment analysis to estimate the cardiometabolic disease (CMD) mortality attributable to 11 dietary and 4 metabolic risk factors in 20 countries of the Middle East by age, sex and time. The national exposure distributions were obtained from a systematic search of multiple databases. Missing exposure data were estimated using a multilevel Bayesian hierarchical model. The aetiological effect of each risk factor on disease-specific mortality was obtained from clinical trials and observational studies. The number of disease-specific deaths was obtained from the 2010 Global Burden of Disease mortality database. Mortality due to each risk factor was determined using the population attributable fraction and total number of disease-specific deaths. Adult population in the Middle East by age, sex, country and time. Suboptimal diet was the leading risk factor for CMD mortality in 11 countries accounting for 48% (in Morocco) to 72% (in the United Arab Emirates) of CMD deaths. Non-optimal systolic blood pressure was the leading risk factor for CMD deaths in eight countries causing 45% (in Bahrain) to 68% (in Libya) of CMD deaths. Non-optimal body mass index and fasting plasma glucose were the third and fourth leading risk factors for CMD mortality in most countries. Among individual dietary factors, low intake of fruits accounted for 8% (in Jordan) to 21% (in Palestine) of CMD deaths and low intake of whole grains was responsible for 7% (in Palestine) to 22% (in the United Arab Emirates) of CMD deaths. Between 1990 and 2010, the CMD mortality attributable to most risk factors had decreased except for body mass index and trans-fatty acids. Our findings highlight key similarities and differences in the impact of the dietary and metabolic risk factors on CMD mortality in the countries of the Middle East and inform priorities for policy measures to prevent CMD. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

The impact of dietary habits and metabolic risk factors on cardiovascular and diabetes mortality in countries of the Middle East and North Africa in 2010: a comparative risk assessment analysis

PubMed Central

Afshin, Ashkan; Micha, Renata; Khatibzadeh, Shahab; Fahimi, Saman; Shi, Peilin; Powles, John; Singh, Gitanjali; Yakoob, Mohammad Yawar; Abdollahi, Morteza; Al-Hooti, Suad; Farzadfar, Farshad; Houshiar-rad, Anahita; Hwalla, Nahla; Koksal, Eda; Musaiger, Abdulrahman; Pekcan, Gulden; Sibai, Abla Mehio; Zaghloul, Sahar; Danaei, Goodarz; Ezzati, Majid; Mozaffarian, Dariush

2015-01-01

Objective/design We conducted a comparative risk assessment analysis to estimate the cardiometabolic disease (CMD) mortality attributable to 11 dietary and 4 metabolic risk factors in 20 countries of the Middle East by age, sex and time. The national exposure distributions were obtained from a systematic search of multiple databases. Missing exposure data were estimated using a multilevel Bayesian hierarchical model. The aetiological effect of each risk factor on disease-specific mortality was obtained from clinical trials and observational studies. The number of disease-specific deaths was obtained from the 2010 Global Burden of Disease mortality database. Mortality due to each risk factor was determined using the population attributable fraction and total number of disease-specific deaths. Setting/population Adult population in the Middle East by age, sex, country and time. Results Suboptimal diet was the leading risk factor for CMD mortality in 11 countries accounting for 48% (in Morocco) to 72% (in the United Arab Emirates) of CMD deaths. Non-optimal systolic blood pressure was the leading risk factor for CMD deaths in eight countries causing 45% (in Bahrain) to 68% (in Libya) of CMD deaths. Non-optimal body mass index and fasting plasma glucose were the third and fourth leading risk factors for CMD mortality in most countries. Among individual dietary factors, low intake of fruits accounted for 8% (in Jordan) to 21% (in Palestine) of CMD deaths and low intake of whole grains was responsible for 7% (in Palestine) to 22% (in the United Arab Emirates) of CMD deaths. Between 1990 and 2010, the CMD mortality attributable to most risk factors had decreased except for body mass index and trans-fatty acids. Conclusions Our findings highlight key similarities and differences in the impact of the dietary and metabolic risk factors on CMD mortality in the countries of the Middle East and inform priorities for policy measures to prevent CMD. PMID:25995236

Influence of Schistosoma mansoni and Hookworm Infection Intensities on Anaemia in Ugandan Villages

PubMed Central

Chami, Goylette F.; Fenwick, Alan; Bulte, Erwin; Kontoleon, Andreas A.; Kabatereine, Narcis B.; Tukahebwa, Edridah M.; Dunne, David W.

2015-01-01

Background The association of anaemia with intestinal schistosomiasis and hookworm infections are poorly explored in populations that are not limited to children or pregnant women. Methods We sampled 1,832 individuals aged 5–90 years from 30 communities in Mayuge District, Uganda. Demographic, village, and parasitological data were collected. Infection risk factors were compared in ordinal logistic regressions. Anaemia and infection intensities were analyzed in multilevel models, and population attributable fractions were estimated. Findings Household and village-level predictors of Schistosoma mansoni and hookworm were opposite in direction or significant for single infections. S. mansoni was found primarily in children, whereas hookworm was prevalent amongst the elderly. Anaemia was more prevalent in individuals with S. mansoni and increased by 2.86 fold (p-value<0.001) with heavy S. mansoni infection intensity. Individuals with heavy hookworm were 1.65 times (p-value = 0.008) more likely to have anaemia than uninfected participants. Amongst individuals with heavy S. mansoni infection intensity, 32.0% (p-value<0.001) of anaemia could be attributed to S. mansoni. For people with heavy hookworm infections, 23.7% (p-value = 0.002) of anaemia could be attributed to hookworm. A greater fraction of anaemia (24.9%, p-value = 0.002) was attributable to heavy hookworm infections in adults (excluding pregnant women) as opposed to heavy hookworm infections in school-aged children and pregnant women (20.2%, p-value = 0.001). Conclusion Community-based surveys captured anaemia in children and adults affected by S. mansoni and hookworm infections. For areas endemic with schistosomiasis or hookworm infections, WHO guidelines should include adults for treatment in helminth control programmes. PMID:26513151

Developing a method to derive alcohol-attributable fractions for HIV/AIDS mortality based on alcohol's impact on adherence to antiretroviral medication

PubMed Central

2011-01-01

Background Alcohol consumption is causally linked to nonadherence to antiretroviral treatment that in turn causes an increase in HIV/AIDS mortality. This article presents a method to calculate the percentage of HIV/AIDS deaths attributable to alcohol consumption and the associated uncertainty. Methods By combining information on risk relations from a number of published sources, we estimated alcohol-attributable fractions (AAFs) of HIV/AIDS in a stepwise procedure. First, we estimated the effect of alcohol consumption on adherence to antiretroviral treatment, and then we combined this estimate with the impact of nonadherence on death. The 95% uncertainty intervals were computed by estimating the variance of the AAFs using Taylor series expansions of one and multiple variables. AAFs were determined for each of the five Global Burden of Disease regions of Africa, based on country-specific treatment and alcohol consumption data from 2005. Results The effects of alcohol on HIV/AIDS in the African Global Burden of Disease regions range from 0.03% to 0.34% for men and from 0% to 0.17% for women, depending on region and age category. The detrimental effect of alcohol consumption was statistically significant in every region and age category except for the North Africa/Middle East region. Conclusions Although the method has its limitations, it was shown to be feasible and provided estimates of the impact of alcohol use on the mortality outcome of HIV/AIDS. PMID:21320310

Body mass index and type 2 diabetes in Thai adults: defining risk thresholds and population impacts.

PubMed

Papier, Keren; D'Este, Catherine; Bain, Chris; Banwell, Cathy; Seubsman, Sam-Ang; Sleigh, Adrian; Jordan, Susan

2017-09-15

Body mass index (BMI) cut-off values (>25 and >30) that predict diabetes risk have been well validated in Caucasian populations but less so in Asian populations. We aimed to determine the BMI threshold associated with increased type 2 diabetes (T2DM) risk and to calculate the proportion of T2DM cases attributable to overweight and obesity in the Thai population. Participants were those from the Thai Cohort Study who were diabetes-free in 2005 and were followed-up in 2009 and 2013 (n = 39,021). We used multivariable logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the BMI-T2DM association. We modelled non-linear associations using restricted cubic splines. We estimated population attributable fractions (PAF) and the number of T2DM incident cases attributed to overweight and obesity. We also calculated the impact of reducing the prevalence of overweight and obesity on T2DM incidence in the Thai population. Non-linear modelling indicated that the points of inflection where the BMI-T2DM association became statistically significant compared to a reference of 20.00 kg/m 2 were 21.60 (OR = 1.27, 95% CI 1.00-1.61) and 20.03 (OR = 1.02, 95% CI 1.02-1.03) for men and women, respectively. Approximately two-thirds of T2DM cases in Thai adults could be attributed to overweight and obesity. Annually, if prevalent obesity was 5% lower, ~13,000 cases of T2DM might be prevented in the Thai population. A BMI cut-point of 22 kg/m 2 , one point lower than the current 23 kg/m 2 , would be justified for defining T2DM risk in Thai adults. Lowering obesity prevalence would greatly reduce T2DM incidence.

Race and ethnic differences in the epidemiology and risk factors for graft failure after heart transplantation.

PubMed

Morris, Alanna A; Kalogeropoulos, Andreas P; Zhao, Liping; Owen, Melissa; Raja Laskar, S; David Vega, J; Smith, Andrew; Butler, Javed

2015-06-01

Contemporary epidemiology of chronic graft failure (GF) after heart transplantation (HT) is not well described. Moreover, differences in the epidemiology of GF based on race/ethnicity remain poorly understood, despite clear evidence of inferior survival of ethnic minorities after HT. The incidence of GF and the population-attributable risk (PAR) of independent risk factors for GF were assessed in 15,255 patients (76% men; mean age 52 ± 12 years) who underwent primary HT from 2004 to 2012. During a median follow-up of 4.7 years (interquartile range, 2.3-7.1 years), GF developed in 2,926 patients (19.2%), corresponding to an incidence rate of 39.8/1,000 person-years (95% confidence interval, 38.4-41.3). Blacks were more likely to develop GF than Hispanics or whites, with incidence rates of 55.1, 42.2, and 36.5/1,000 person-years, respectively. After multivariable adjustment, black race was associated with a higher risk of GF (hazard ratio, 1.4; 95% confidence interval, 1.2-1.6; p < 0.001). Blacks and Hispanics were more likely to have risk factors for GF, including low education, public insurance, allosensitization, higher human leukocyte antigen mismatch, non-adherence, and history of rejection requiring hospitalization (all p < 0.001). Rejection requiring hospitalization carried the highest population-attributable risk in all groups, with the highest fraction in blacks (25.8%) compared with whites (18.6%) and Hispanics (15.6%). Socioeconomic and donor risk factors conferred relatively less risk of GF. Black HT recipients have the highest risk of GF, with immunologic factors conferring the greatest proportion of that risk. Racial differences in risk factors for GF after HT require further study. Published by Elsevier Inc.

Clustering of risk factors and the risk of incident cardiovascular disease in Asian and Caucasian populations: results from the Asia Pacific Cohort Studies Collaboration

PubMed Central

Peters, Sanne A E; Wang, Xin; Lam, Tai-Hing; Kim, Hyeon Chang; Ho, Suzanne; Ninomiya, Toshiharu; Knuiman, Matthew; Vaartjes, Ilonca; Bots, Michael L; Woodward, Mark

2018-01-01

Objective To assess the relationship between risk factor clusters and cardiovascular disease (CVD) incidence in Asian and Caucasian populations and to estimate the burden of CVD attributable to each cluster. Setting Asia Pacific Cohort Studies Collaboration. Participants Individual participant data from 34 population-based cohorts, involving 314 024 participants without a history of CVD at baseline. Outcome measures Clusters were 11 possible combinations of four individual risk factors (current smoking, overweight, blood pressure (BP) and total cholesterol). Cox regression models were used to obtain adjusted HRs and 95% CIs for CVD associated with individual risk factors and risk factor clusters. Population-attributable fractions (PAFs) were calculated. Results During a mean follow-up of 7 years, 6203 CVD events were recorded. The ranking of HRs and PAFs was similar for Australia and New Zealand (ANZ) and Asia; clusters including BP consistently showed the highest HRs and PAFs. The BP–smoking cluster had the highest HR for people with two risk factors: 4.13 (3.56 to 4.80) for Asia and 3.07 (2.23 to 4.23) for ANZ. Corresponding PAFs were 24% and 11%, respectively. For individuals with three risk factors, the BP–smoking–cholesterol cluster had the highest HR (4.67 (3.92 to 5.57) for Asia and 3.49 (2.69 to 4.53) for ANZ). Corresponding PAFs were 13% and 10%. Conclusions Risk factor clusters act similarly on CVD risk in Asian and Caucasian populations. Clusters including elevated BP were associated with the highest excess risk of CVD. PMID:29511013

Consumption of sugar sweetened beverages, artificially sweetened beverages, and fruit juice and incidence of type 2 diabetes: systematic review, meta-analysis, and estimation of population attributable fraction

PubMed Central

O’Connor, Laura; Ye, Zheng; Mursu, Jaakko; Hayashino, Yasuaki; Bhupathiraju, Shilpa N; Forouhi, Nita G

2015-01-01

Objectives To examine the prospective associations between consumption of sugar sweetened beverages, artificially sweetened beverages, and fruit juice with type 2 diabetes before and after adjustment for adiposity, and to estimate the population attributable fraction for type 2 diabetes from consumption of sugar sweetened beverages in the United States and United Kingdom. Design Systematic review and meta-analysis. Data sources and eligibility PubMed, Embase, Ovid, and Web of Knowledge for prospective studies of adults without diabetes, published until February 2014. The population attributable fraction was estimated in national surveys in the USA, 2009-10 (n=4729 representing 189.1 million adults without diabetes) and the UK, 2008-12 (n=1932 representing 44.7 million). Synthesis methods Random effects meta-analysis and survey analysis for population attributable fraction associated with consumption of sugar sweetened beverages. Results Prespecified information was extracted from 17 cohorts (38 253 cases/10 126 754 person years). Higher consumption of sugar sweetened beverages was associated with a greater incidence of type 2 diabetes, by 18% per one serving/day (95% confidence interval 9% to 28%, I2 for heterogeneity=89%) and 13% (6% to 21%, I2=79%) before and after adjustment for adiposity; for artificially sweetened beverages, 25% (18% to 33%, I2=70%) and 8% (2% to 15%, I2=64%); and for fruit juice, 5% (−1% to 11%, I2=58%) and 7% (1% to 14%, I2=51%). Potential sources of heterogeneity or bias were not evident for sugar sweetened beverages. For artificially sweetened beverages, publication bias and residual confounding were indicated. For fruit juice the finding was non-significant in studies ascertaining type 2 diabetes objectively (P for heterogeneity=0.008). Under specified assumptions for population attributable fraction, of 20.9 million events of type 2 diabetes predicted to occur over 10 years in the USA (absolute event rate 11.0%), 1.8 million would be attributable to consumption of sugar sweetened beverages (population attributable fraction 8.7%, 95% confidence interval 3.9% to 12.9%); and of 2.6 million events in the UK (absolute event rate 5.8%), 79 000 would be attributable to consumption of sugar sweetened beverages (population attributable fraction 3.6%, 1.7% to 5.6%). Conclusions Habitual consumption of sugar sweetened beverages was associated with a greater incidence of type 2 diabetes, independently of adiposity. Although artificially sweetened beverages and fruit juice also showd positive associations with incidence of type 2 diabetes, the findings were likely to involve bias. None the less, both artificially sweetened beverages and fruit juice were unlikely to be healthy alternatives to sugar sweetened beverages for the prevention of type 2 diabetes. Under assumption of causality, consumption of sugar sweetened beverages over years may be related to a substantial number of cases of new onset diabetes. PMID:26199070

Consumption of sugar sweetened beverages, artificially sweetened beverages, and fruit juice and incidence of type 2 diabetes: systematic review, meta-analysis, and estimation of population attributable fraction

PubMed Central

Imamura, Fumiaki; O'Connor, Laura; Ye, Zheng; Mursu, Jaakko; Hayashino, Yasuaki; Bhupathiraju, Shilpa N; Forouhi, Nita G

2016-01-01

Objectives To examine the prospective associations between consumption of sugar sweetened beverages, artificially sweetened beverages, and fruit juice with type 2 diabetes before and after adjustment for adiposity, and to estimate the population attributable fraction for type 2 diabetes from consumption of sugar sweetened beverages in the United States and United Kingdom. Design Systematic review and meta-analysis. Data sources and eligibility PubMed, Embase, Ovid, and Web of Knowledge for prospective studies of adults without diabetes, published until February 2014. The population attributable fraction was estimated in national surveys in the USA, 2009–10 (n=4729 representing 189.1 million adults without diabetes) and the UK, 2008–12 (n=1932 representing 44.7 million). Synthesis methods Random effects meta-analysis and survey analysis for population attributable fraction associated with consumption of sugar sweetened beverages. Results Prespecified information was extracted from 17 cohorts (38 253 cases/10 126 754 person years). Higher consumption of sugar sweetened beverages was associated with a greater incidence of type 2 diabetes, by 18% per one serving/day (95% confidence interval 9% to 28%, I2 for heterogeneity=89%) and 13% (6% to 21%, I2=79%) before and after adjustment for adiposity; for artificially sweetened beverages, 25% (18% to 33%, I2=70%) and 8% (2% to 15%, I2=64%); and for fruit juice, 5% (−1% to 11%, I2=58%) and 7% (1% to 14%, I2=51%). Potential sources of heterogeneity or bias were not evident for sugar sweetened beverages. For artificially sweetened beverages, publication bias and residual confounding were indicated. For fruit juice the finding was non-significant in studies ascertaining type 2 diabetes objectively (P for heterogeneity=0.008). Under specified assumptions for population attributable fraction, of 20.9 million events of type 2 diabetes predicted to occur over 10 years in the USA (absolute event rate 11.0%), 1.8 million would be attributable to consumption of sugar sweetened beverages (population attributable fraction 8.7%, 95% confidence interval 3.9% to 12.9%); and of 2.6 million events in the UK (absolute event rate 5.8%), 79 000 would be attributable to consumption of sugar sweetened beverages (population attributable fraction 3.6%, 1.7% to 5.6%). Conclusions Habitual consumption of sugar sweetened beverages was associated with a greater incidence of type 2 diabetes, independently of adiposity. Although artificially sweetened beverages and fruit juice also showd positive associations with incidence of type 2 diabetes, the findings were likely to involve bias. None the less, both artificially sweetened beverages and fruit juice were unlikely to be healthy alternatives to sugar sweetened beverages for the prevention of type 2 diabetes. Under assumption of causality, consumption of sugar sweetened beverages over years may be related to a substantial number of cases of new onset diabetes. PMID:27044603

Consumption of sugar sweetened beverages, artificially sweetened beverages, and fruit juice and incidence of type 2 diabetes: systematic review, meta-analysis, and estimation of population attributable fraction.

PubMed

Imamura, Fumiaki; O'Connor, Laura; Ye, Zheng; Mursu, Jaakko; Hayashino, Yasuaki; Bhupathiraju, Shilpa N; Forouhi, Nita G

2015-07-21

To examine the prospective associations between consumption of sugar sweetened beverages, artificially sweetened beverages, and fruit juice with type 2 diabetes before and after adjustment for adiposity, and to estimate the population attributable fraction for type 2 diabetes from consumption of sugar sweetened beverages in the United States and United Kingdom. Systematic review and meta-analysis. PubMed, Embase, Ovid, and Web of Knowledge for prospective studies of adults without diabetes, published until February 2014. The population attributable fraction was estimated in national surveys in the USA, 2009-10 (n = 4729 representing 189.1 million adults without diabetes) and the UK, 2008-12 (n = 1932 representing 44.7 million). Random effects meta-analysis and survey analysis for population attributable fraction associated with consumption of sugar sweetened beverages. Prespecified information was extracted from 17 cohorts (38,253 cases/10,126,754 person years). Higher consumption of sugar sweetened beverages was associated with a greater incidence of type 2 diabetes, by 18% per one serving/day (95% confidence interval 9% to 28%, I(2) for heterogeneity = 89%) and 13% (6% to 21%, I(2) = 79%) before and after adjustment for adiposity; for artificially sweetened beverages, 25% (18% to 33%, I(2) = 70%) and 8% (2% to 15%, I(2) = 64%); and for fruit juice, 5% (-1% to 11%, I(2) = 58%) and 7% (1% to 14%, I(2) = 51%). Potential sources of heterogeneity or bias were not evident for sugar sweetened beverages. For artificially sweetened beverages, publication bias and residual confounding were indicated. For fruit juice the finding was non-significant in studies ascertaining type 2 diabetes objectively (P for heterogeneity = 0.008). Under specified assumptions for population attributable fraction, of 20.9 million events of type 2 diabetes predicted to occur over 10 years in the USA (absolute event rate 11.0%), 1.8 million would be attributable to consumption of sugar sweetened beverages (population attributable fraction 8.7%, 95% confidence interval 3.9% to 12.9%); and of 2.6 million events in the UK (absolute event rate 5.8%), 79,000 would be attributable to consumption of sugar sweetened beverages (population attributable fraction 3.6%, 1.7% to 5.6%). Habitual consumption of sugar sweetened beverages was associated with a greater incidence of type 2 diabetes, independently of adiposity. Although artificially sweetened beverages and fruit juice also showed positive associations with incidence of type 2 diabetes, the findings were likely to involve bias. None the less, both artificially sweetened beverages and fruit juice were unlikely to be healthy alternatives to sugar sweetened beverages for the prevention of type 2 diabetes. Under assumption of causality, consumption of sugar sweetened beverages over years may be related to a substantial number of cases of new onset diabetes. © Imamura et al 2015.

Global burden of cancer attributable to high body-mass index in 2012: a population-based study

PubMed Central

Byrnes, Graham; Renehan, Prof Andrew G; Stevens, Gretchen A; Ezzati, Prof Majid; Ferlay, Jacques; Miranda, J. Jaime; Romieu, Isabelle; Dikshit, Rajesh; Forman, David; Soerjomataram, Isabelle

2015-01-01

Background Excess body mass index (BMI) is associated with increased risk of cancer. To inform public health policyand future research, we estimated the global burden of cancer attributable to excess BMI. Methods Population attributable fractions (PAFs) were derived using relative risks and BMI estimates in adults by age, sex and country. Assuming a10-year lag-period, PAFs were calculated using BMI estimates in 2002. GLOBOCAN2012 was used to compute numbers of new cancer cases attributable to excess BMI. In an alternative scenario, we computed the proportion of potentially avoidable cancers assuming that populations maintained their BMI-level observed in 1982. Secondary analyses were performed to test the model and estimate the impactof hormone replacement therapy (HRT) and smoking. Findings Worldwide, we estimated that 481,000 or 3·6% of all new cancer cases in 2012 were attributable to excess BMI. PAFs were greater in women compared with men (5·4% versus 1·9%). The burden was concentrated in countries with very high and high human development index (HDI, PAF: 5·3% and 4·8%) compared with countries with moderate and low HDI (PAF: 1·6% and 1·0%). Corpus uteri, post-menopausal breast and colon cancers accounted for approximately two-thirds (64%) of excess BMI attributable cancers. One fourth (~118,000) of all cases related to excess BMI in 2012 could be attributed to the rising BMI since 1982. Interpretation These findings further underpin the need for a global effort to abate the rising trends in population-level excess weight. Assuming that the relationship between excess BMI and cancer is causal and the current pattern of population weight gain continues, this will likely augment the future burden of cancer. Funding World Cancer Research Fund, Marie Currie Fellowship, the National Health and Medical Research Council Australia and US NIH. PMID:25467404

Population-attributable causes of cancer in Korea: obesity and physical inactivity.

PubMed

Park, Sohee; Kim, Yeonju; Shin, Hai-Rim; Lee, Boram; Shin, Aesun; Jung, Kyu-Won; Jee, Sun Ha; Kim, Dong Hyun; Yun, Young Ho; Park, Sue Kyung; Boniol, Mathieu; Boffetta, Paolo

2014-01-01

Changes in lifestyle including obesity epidemic and reduced physical activity influenced greatly to increase the cancer burden in Korea. The purpose of the current study was to perform a systematic assessment of cancers attributable to obesity and physical inactivity in Korea. Gender- and cancer site-specific population-attributable fractions (PAF) were estimated using the prevalence of overweight and obesity in 1992-1995 from a large-scale prospective cohort study, the prevalence of low physical activity in 1989 from a Korean National Health Examination Survey, and pooled relative risk estimates from Korean epidemiological studies. The overall PAF was then estimated using 2009 national cancer incidence data from the Korea Central Cancer Registry. Excess body weight was responsible for 1,444 (1.5%) and 2,004 (2.2%) cancer cases among men and women, respectively, in 2009 in Korea. Among men, 6.8% of colorectal, 2.9% of pancreatic, and 16.0% of kidney cancer was attributable to excess body weight. In women, 6.6% of colorectal, 3.9% of pancreatic, 18.7% of kidney, 8.2% of postmenopausal breast, and 32.7% of endometrial cancer was attributable to excess body weight. Low leisure-time physical activity accounted for 8.8% of breast cancer, whereas the PAF for overall cancer was low (0.1% in men, 1.4% in women). Projections suggest that cancers attributable to obesity will increase by 40% in men and 16% in women by 2020. With a significantly increasing overweight and physically inactive population, and increasing incidence of breast and colorectal cancers, Korea faces a large cancer burden attributable to these risk factors. Had the obese population of Korea remained stable, a large portion of obesity-related cancers could have been avoided. Efficient cancer prevention programs that aim to reduce obesity- and physical inactivity-related health problems are essential in Korea.

Population-Attributable Causes of Cancer in Korea: Obesity and Physical Inactivity

PubMed Central

Shin, Hai-Rim; Lee, Boram; Shin, Aesun; Jung, Kyu-Won; Jee, Sun Ha; Kim, Dong Hyun; Yun, Young Ho; Park, Sue Kyung; Boniol, Mathieu; Boffetta, Paolo

2014-01-01

Background Changes in lifestyle including obesity epidemic and reduced physical activity influenced greatly to increase the cancer burden in Korea. The purpose of the current study was to perform a systematic assessment of cancers attributable to obesity and physical inactivity in Korea. Methodology/Principal Findings Gender- and cancer site-specific population-attributable fractions (PAF) were estimated using the prevalence of overweight and obesity in 1992–1995 from a large-scale prospective cohort study, the prevalence of low physical activity in 1989 from a Korean National Health Examination Survey, and pooled relative risk estimates from Korean epidemiological studies. The overall PAF was then estimated using 2009 national cancer incidence data from the Korea Central Cancer Registry. Excess body weight was responsible for 1,444 (1.5%) and 2,004 (2.2%) cancer cases among men and women, respectively, in 2009 in Korea. Among men, 6.8% of colorectal, 2.9% of pancreatic, and 16.0% of kidney cancer was attributable to excess body weight. In women, 6.6% of colorectal, 3.9% of pancreatic, 18.7% of kidney, 8.2% of postmenopausal breast, and 32.7% of endometrial cancer was attributable to excess body weight. Low leisure-time physical activity accounted for 8.8% of breast cancer, whereas the PAF for overall cancer was low (0.1% in men, 1.4% in women). Projections suggest that cancers attributable to obesity will increase by 40% in men and 16% in women by 2020. Conclusions/Significance With a significantly increasing overweight and physically inactive population, and increasing incidence of breast and colorectal cancers, Korea faces a large cancer burden attributable to these risk factors. Had the obese population of Korea remained stable, a large portion of obesity-related cancers could have been avoided. Efficient cancer prevention programs that aim to reduce obesity- and physical inactivity-related health problems are essential in Korea. PMID:24722008

Early risk of mortality after coronary artery revascularization in patients with left ventricular dysfunction and potential role of the wearable cardioverter defibrillator.

PubMed

Zishiri, Edwin T; Williams, Sarah; Cronin, Edmond M; Blackstone, Eugene H; Ellis, Stephen G; Roselli, Eric E; Smedira, Nicholas G; Gillinov, A Marc; Glad, Jo Ann; Tchou, Patrick J; Szymkiewicz, Steven J; Chung, Mina K

2013-02-01

Implantation of implantable cardioverter defibrillator for prevention of sudden cardiac death is deferred for 90 days after coronary revascularization, but mortality may be highest early after cardiac procedures in patients with ventricular dysfunction. We determined mortality risk in postrevascularization patients with left ventricular ejection fraction ≤35% and compared survival with those discharged with a wearable cardioverter defibrillator (WCD). Hospital survivors after surgical (coronary artery bypass graft surgery) or percutaneous (percutaneous coronary intervention [PCI]) revascularization with left ventricular ejection fraction ≤35% were included from Cleveland Clinic and national WCD registries. Kaplan-Meier, Cox proportional hazards, propensity score-matched survival, and hazard function analyses were performed. Early mortality hazard was higher among 4149 patients discharged without a defibrillator compared with 809 with WCDs (90-day mortality post-coronary artery bypass graft surgery 7% versus 3%, P=0.03; post-PCI 10% versus 2%, P<0.0001). WCD use was associated with adjusted lower risks of long-term mortality in the total cohort (39%, P<0.0001) and both post-coronary artery bypass graft surgery (38%, P=0.048) and post-PCI (57%, P<0.0001) cohorts (mean follow-up, 3.2 years). In propensity-matched analyses, WCD use remained associated with lower mortality (58% post-coronary artery bypass graft surgery, P=0.002; 67% post-PCI, P<0.0001). Mortality differences were not attributable solely to therapies for ventricular arrhythmia. Only 1.3% of the WCD group had a documented appropriate therapy. Patients with left ventricular ejection fraction ≤35% have higher early compared to late mortality after coronary revascularization, particularly after PCI. As early hazard seemed less marked in WCD users, prospective studies in this high-risk population are indicated to confirm whether WCD use as a bridge to left ventricular ejection fraction improvement or implantable cardioverter defibrillator implantation can improve outcomes after coronary revascularization.

Fraction of gestational diabetes mellitus attributable to overweight and obesity by race/ethnicity, California, 2007-2009.

PubMed

Kim, Shin Y; Saraiva, Carina; Curtis, Michael; Wilson, Hoyt G; Troyan, Jennifer; Sharma, Andrea J

2013-10-01

We calculated the racial/ethnic-specific percentages of gestational diabetes mellitus (GDM) attributable to overweight and obesity. We analyzed 1 228 265 records of women aged 20 years or older with a live, singleton birth in California during 2007 to 2009. Using logistic regression, we estimated the magnitude of the association between prepregnancy body mass index and GDM and calculated the percentages of GDM attributable to overweight and obesity overall and by race/ethnicity. The overall estimated GDM prevalence ranged from 5.4% among White women to 11.9% among Asian/Pacific Islander women. The adjusted percentages of GDM deliveries attributable to overweight and obesity were 17.8% among Asians/Pacific Islander, 41.2% among White, 44.2% among Hispanic, 51.2% among Black, and 57.8% among American Indian women. Select Asian subgroups, such as Vietnamese (13.0%), Asian Indian (14.0%), and Filipino (14.2%), had the highest GDM prevalence, but the lowest percentage attributable to obesity. Elevated prepregnancy body mass index contributed to GDM in all racial/ethnic groups, which suggests that decreasing overweight and obesity among women of reproductive age could reduce GDM, associated delivery complications, and future risk of diabetes in both the mother and offspring.

Estimation of Cancer Burden Attributable to Infection in Asia

PubMed Central

Huang, He; Hu, Xiao-Feng; Zhao, Fang-Hui; Garland, Suzanne M.; Bhatla, Neerja; Qiao, You-Lin

2015-01-01

Background Some infectious agents have been shown to be human carcinogens. The current study focused on estimation of cancer burden attributable to infection in different regions of Asia. Methods By systematically reviewing previous studies of the infection prevalence data of 13 countries in Asia and relative risks of specific cancers, we calculated the population attributable fraction of carcinogenic infections. Using data from GLOBOCAN 2012, the overall country-specific and gender-specific number of new cancer cases and deaths resulting from infection were estimated. Results Across 13 principal Asian countries, the average prevalence and range was 6.6% (0.5% in Japanese women to 15.0% in Vietnamese men) for hepatitis B virus (HBV), 2.6% (0.3% in Iran to 5.1% in Saudi Arabia) for hepatitis C virus (HCV), 7.9% (2.8% in Pakistan to 17.7% in China) for human papillomavirus (HPV), and 61.8% (12.8% in Indonesia to 91.7% in Bangladesh) for Helicobacter pylori (HP). The estimated total number of cancer cases and deaths caused by infection in these 13 countries were 1 212 026 (19.6% of all new cancer cases) and 908 549 (22.0% of all deaths from cancer). The fractions of cancer incidence attributable to infection were 19.7% and 19.5% in men and women, respectively. The percentages of cancer deaths attributable to infection were 21.9% and 22.1% in men and women, respectively. Among the main infectious agents, HP was responsible for 31.5% of infection-related cancer cases and 32.8% of infection-related cancer deaths, followed by HBV (28.6% of new cases and 23.8% of deaths), HPV (22.0% of new cases and 27.3% of deaths), and HCV (12.2% of new cases and 10.6% of deaths). Conclusions Approximately one quarter of all cancer cases and deaths were infection-associated in Asia, which could be effectively prevented if appropriate long-term controls of infectious agents were applied. PMID:26399446

Use of case-time-control design in pharmacovigilance applications: exploration with high-risk medications and unplanned hospital admissions in the Western Australian elderly.

PubMed

Price, Sylvie D; Holman, C D'Arcy J; Sanfilippo, Frank M; Emery, Jon D

2013-11-01

To use a case-time-control design to derive preliminary estimates of unplanned hospitalisations attributable to suspected high-risk medications in elderly Western Australians. Using pharmaceutical claims linked to inpatient and other health records, the study applied a case-time-control design and conditional logistic regression to estimate odds ratios (ORs) for unplanned hospital admissions associated with anticoagulants, antirheumatics, opioids, corticosteroids and four major groups of cardiovascular drugs. Attributable fractions (AFs) were derived from the ORs to estimate the number and proportion of admissions associated with drug exposure. Results were compared with those obtained from a more conventional method using International Classification of Diseases (ICD) external cause codes to identify admissions related to adverse drug events. The study involved 1 899 699 index hospital admissions. Six of the eight drug groups were associated with an increased risk of unplanned hospitalisation, opioids (adjusted OR = 1.81, 95%CI 1.75-1.88; AF = 44.9%) and corticosteroids (1.48, 1.42-1.54; 32.2%) linked with the highest risks. For all six, the estimated number of hospitalisations attributed to the medication in the exposed was higher (two to 31-fold) when derived from the case-time-control design compared with identification from ICD codes. This study provides an alternative approach for identifying potentially harmful medications and suggests that the use of ICD external causes may underestimate adverse drug events. It takes drug exposure into account, can be applied to individual medications and may overcome under-reporting issues associated with conventional methods. The approach shows great potential as part of a post-marketing pharmacovigilance monitoring system in Australia and elsewhere. Copyright © 2013 John Wiley & Sons, Ltd.

Teens’ Attention to Crime and Emergency Programs on Television as a Predictor and Mediator of Increased Risk Perceptions Regarding Alcohol-Related Injuries

PubMed Central

Slater, Michael D.; Jain, Parul

2011-01-01

This study examined the hypotheses that media exposure and attention would predict, and partially mediate, the effects of various individual-difference variables on alcohol-related risk perceptions among teen viewers of crime and emergency (e.g. medical drama) shows on television. Risk perceptions including perceived severity, perceived alcohol-attributable fraction of incidents involving alcohol, controllability, and concern regarding alcohol-related crime, assaults, and other injuries were the outcome measures. Attention to crime and emergency shows was predictive of increased concern and other risk perceptions regarding alcohol-related incidents. Attention also partially mediated the effects of demographic and other individual difference variables on adolescents’ risk perceptions regarding alcohol-related injuries. The findings a) suggest emergency and medical drama television narratives can at times have incidental positive impacts on health-related attitudes and b) provide further evidence regarding the endogenous nature of media use variables in influencing such attitudes. PMID:21240701

Teens' attention to crime and emergency programs on television as a predictor and mediator of increased risk perceptions regarding alcohol-related injuries.

PubMed

Slater, Michael D; Jain, Parul

2011-01-01

This study examined the hypotheses that media exposure and attention would predict, and partially mediate, the effects of various individual-difference variables on alcohol-related risk perceptions among teen viewers of crime and emergency (e.g., medical drama) shows on television. Risk perceptions including perceived severity, perceived alcohol-attributable fraction of incidents involving alcohol, controllability, and concern regarding alcohol-related crime, assaults, and other injuries were the outcome measures. Attention to crime and emergency shows was predictive of increased concern and other risk perceptions regarding alcohol-related incidents. Attention also partially mediated the effects of demographic and other individual difference variables on adolescents' risk perceptions regarding alcohol-related injuries. The findings (a) suggest emergency and medical drama television narratives can at times have incidental positive impacts on health-related attitudes and (b) provide further evidence regarding the endogenous nature of media use variables in influencing such attitudes.

Risk factor modifications and depression incidence: a 4-year longitudinal Canadian cohort of the Montreal Catchment Area Study.

PubMed

Meng, Xiangfei; Brunet, Alain; Turecki, Gustavo; Liu, Aihua; D'Arcy, Carl; Caron, Jean

2017-06-10

Few studies have examined the effect of risk factor modifications on depression incidence. This study was to explore psychosocial risk factors for depression and quantify the effect of risk factor modifications on depression incidence in a large-scale, longitudinal population-based study. Data were from the Montreal Longitudinal Catchment Area study (N=2433). Multivariate modified Poisson regression was used to estimate relative risk (RR). Population attributable fractions were also used to estimate the potential impact of risk factor modifications on depression incidence. The cumulative incidence rate of major depressive disorder at the 2-year follow-up was 4.8%, and 6.6% at the 4-year follow-up. Being a younger adult, female, widowed, separated or divorced, Caucasian, poor, occasional drinker, having a family history of mental health problems, having less education and living in areas with higher unemployment rates and higher proportions of visible minorities, more cultural community centres and community organisations, were consistently associated with the increased risk of incident major depressive disorder. Although only 5.1% of the disease incidence was potentially attributable to occasional drinking (vs abstainers) at the 2-year follow-up, the attribution of occasional drinking doubled at the 4-year follow-up. A 10% reduction in the prevalence of occasional drinking in this population could potentially prevent half of incident cases. Modifiable risk factors, both individual and societal, could be the targets for public depression prevention programmes. These programmes should also be gender-specific, as different risk factors have been identified for men and women. Public health preventions at individual levels could focus on the better management of occasional drinking, as it explained around 5%~10% of incident major depressive disorders. Neighbourhood characteristics could also be the target for public prevention programmes. However, this could be very challenging. A cost-effectiveness analysis of a variety of prevention efforts is warranted. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Analysis of Risk and Burden of Dysentery Associated with Floods from 2004 to 2010 in Nanning, China.

PubMed

Liu, Zhidong; Ding, Guoyong; Zhang, Ying; Xu, Xin; Liu, Qiyong; Jiang, Baofa

2015-11-01

This study aimed to examine the association between floods and the morbidity of dysentery and to quantify the burden of dysentery due to floods in Nanning, China. A generalized additive mixed model was conducted to assess the relationship between monthly morbidity of dysentery and floods from 2004 to 2010. The years lived with disability (YLDs) of dysentery attributable to floods were then estimated based on the WHO framework of the burden of disease study for calculating the potential impact fraction. The relative risk (RR) of floods on the morbidity of dysentery was 1.44 (95% confidence interval [CI] = 1.18-1.75). The models suggest that a potential 1-day rise in flood duration may lead to 8% (RR = 1.08, 95% CI = 1.04-1.12) increase in the morbidity of dysentery. The average attributable YLD per 1,000 of dysentery caused by floods were 0.013 in males, 0.005 in females, and 0.009 in persons. Our study confirms that floods have significantly increased the risk and the burden of dysentery in the study area. Public health action should be taken to prevent and control the potential risk of dysentery after floods. Vulnerable groups such as males and children should be paid more attention. © The American Society of Tropical Medicine and Hygiene.

Environmental Risks to Public Health in the United Arab Emirates: A Quantitative Assessment and Strategic Plan

PubMed Central

Farah, Zeinab S.

2012-01-01

Background: Environmental risks to health in the United Arab Emirates (UAE) have shifted rapidly from infectious to noninfectious diseases as the nation has developed at an unprecedented rate. In response to public concerns over newly emerging environmental risks, the Environment Agency–Abu Dhabi commissioned a multidisciplinary environmental health strategic planning project. Objectives: In order to develop the environmental health strategic plan, we sought to quantify the illnesses and premature deaths in the UAE attributable to 14 environmental pollutant categories, prioritize these 14 risk factors, and identify interventions. Methods: We estimated the disease burden imposed by each risk factor using an attributable fraction approach, and we prioritized the risks using an empirically tested stakeholder engagement process. We then engaged government personnel, scientists, and other stakeholders to identify interventions. Results: The UAE’s environmental disease burden is low by global standards. Ambient air pollution is the leading contributor to premature mortality [~ 650 annual deaths; 95% confidence interval (CI): 140, 1,400]. Risk factors leading to > 10,000 annual health care facility visits included occupational exposures, indoor air pollution, drinking water contamination, seafood contamination, and ambient air pollution. Among the 14 risks considered, on average, outdoor air pollution was ranked by the stakeholders as the highest priority (mean rank, 1.4; interquartile range, 1–2) and indoor air pollution as the second-highest priority (mean rank 3.3; interquartile range, 2–4). The resulting strategic plan identified 216 potential interventions for reducing environmental risks to health. Conclusions: The strategic planning exercise described here provides a framework for systematically deciding how to invest public funds to maximize expected returns in environmental health, where returns are measured in terms of reductions in a population’s environmental burden of disease. PMID:22357098

Which postoperative complications matter most after bariatric surgery? Prioritizing quality improvement efforts to improve national outcomes.

PubMed

Daigle, Christopher R; Brethauer, Stacy A; Tu, Chao; Petrick, Anthony T; Morton, John M; Schauer, Philip R; Aminian, Ali

2018-05-01

National quality programs have been implemented to decrease the burden of adverse events on key outcomes in bariatric surgery. However, it is not well understood which complications have the most impact on patient health. To quantify the impact of specific bariatric surgery complications on key clinical outcomes. The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database. Data from patients who underwent primary bariatric procedures were retrieved from the MBSAQIP 2015 participant use file. The impact of 8 specific complications (bleeding, venous thromboembolism [VTE], leak, wound infection, pneumonia, urinary tract infection, myocardial infarction, and stroke) on 5 main 30-day outcomes (end-organ dysfunction, reoperation, intensive care unit admission, readmission, and mortality) was estimated using risk-adjusted population attributable fractions. The population attributable fraction is a calculated measure taking into account the prevalence and severity of each complication. The population attributable fractions represents the percentage reduction in a given outcome that would occur if that complication were eliminated. In total, 135,413 patients undergoing sleeve gastrectomy (67%), Roux-en-Y gastric bypass (29%), adjustable gastric banding (3%), and duodenal switch (1%) were included. The most common complications were bleeding (.7%), wound infection (.5%), urinary tract infection (.3%), VTE (.3%), and leak (.2%). Bleeding and leak were the largest contributors to 3 of 5 examined outcomes. VTE had the greatest effect on readmission and mortality. This study quantifies the impact of specific complications on key surgical outcomes after bariatric surgery. Bleeding and leak were the complications with the largest overall effect on end-organ dysfunction, reoperation, and intensive care unit admission after bariatric surgery. Furthermore, our findings suggest that an initiative targeting reduction of post-bariatric surgery VTE has the greatest potential to reduce mortality and readmission rates. Copyright © 2018 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

Health risk assessment due to biomass smoke exposure in Indian indoor environment: An empirical approach using lung deposition model.

PubMed

Tigala, Snehlata; Sharma, Anu Rani; Sachdeva, Kamna

2018-06-04

The paper subsumes a framework that assesses health risk due to exposure to different fuel combustion through articulation of modern microscopic techniques, empirical equations, lung diagnostic tools and a pre-existing model that has been extrapolated to futuristic aspects (within controlled conditions). The framework was tested on 132 household cooks belonging to different age groups and using different types of fuel. The inhalable fraction released during fuel combustion varied in morphological characteristics and deposition site. Micrographs obtained using Scanning Electron Microscope (SEM) analysis of (biomass smoke) soot indicates aggregate formation attributing to a higher level of health risk. Further, abnormal ventilatory function along with higher risk (RR > 1) was more evident within biomass fuel users. The condition further exacerbates while using dung cakes due to high levels of emissions (294.3 particles/liter) that deposit in the upper respiratory tract (0.0899). Further, the population attributable risk percent (79%) calculated on the basis of cooking behavior suggests a 'rural culture' health determinant as clean fuel usage is not practiced as an outcome of low literacy and poor income in the region. These preliminary findings highlight the drudgery of impuissant women who are exposed to high particulate emissions on a regular basis which results in reduced lung function. Nevertheless, further cogitation is required to eliminate the limitations in this study and explore further linkages between exposure and vulnerable group to generate meaningful policy recommendations. Copyright © 2018 Elsevier B.V. All rights reserved.

Poor early childhood outcomes attributable to maternal depression in Mexican women.

PubMed

de Castro, Filipa; Place, Jean Marie; Villalobos, Aremis; Rojas, Rosalba; Barrientos, Tonatiuh; Frongillo, Edward A

2017-08-01

We aimed to estimate the population fraction of poor early child health and developmental outcomes attributable to maternal depressive symptoms (DS) contrasting it between low- and middle/high-income households. We used a nationally representative probabilistic sample of 4240 children younger than 5 years old and their mothers, derived from the Mexican National Health and Nutrition Survey Data (ENSANUT 2012). Complex survey design, sampling, and analytic weights were taken into account in analyses. DS was measured by CESD-7. Child outcomes were as follows: breastfeeding, attending well-child check-ups, respiratory disease, diarrhea and general health problems, immunization, accidents, growth, obesity, and food insecurity. Prevalence of DS among mothers was 21.36%. In low-SES households, DS was associated with higher risk of never being breastfed (RR = 1.77; p < .05), health problems (RR = 1.37; p < .05), acute respiratory disease (RR = 1.51; p < .05), accidents requiring child hospitalization (RR = 2.16; p < .01), and moderate or severe food insecurity (RR = 1.58; p < .001). In medium- or high-SES households, DS was associated with higher risk of never attending a developmental check-up (RR = 2.14; p < .05) and moderate or severe food insecurity (RR = 1.75; p < .01). Population risks attributable to DS ranged from 2.30 to 17.45%. Prevention of DS could lead to reduction of problematic early childhood outcomes in both low and medium/high SES.

Climate Change Attribution: When Is It Appropriate to Accept New Methods?

NASA Astrophysics Data System (ADS)

Lloyd, Elisabeth A.; Oreskes, Naomi

2018-03-01

The most common approaches to detection and attribution (D&A) of extreme weather events using fraction of attributable risk or risk ratio answer a particular form of research question, namely "What is the probability of a certain class of weather events, given global climate change, relative to a world without?" In a set of recent papers, Trenberth et al. (2015, https://doi.org/10.1038/nclimate2657) and Shepherd (2016, https://doi.org/10.1007/s40641-016-0033-y) have argued that this is not always the best tool for analyzing causes, or for communicating with the public about climate events and extremes. Instead, they promote the idea of a "storyline" approach, which asks complementary questions, such as "How much did climate change affect the severity of a given storm?" From the vantage of history and philosophy of science, a proposal to introduce a new approach or to answer different research questions—especially those of public interest—does not appear particularly controversial. However, the proposal proved highly controversial, with the majority of D&A scientists reacting in a very negative and even personal manner. Some suggested the proposed alternatives amount to a weakening of standards, or an abandonment of scientific method. Here, we address the question: Why is this such a controversial proposition? We argue that there is no "right" or "wrong" approach to D&A in any absolute sense, but rather that in different contexts, society may have a greater or lesser concern with errors of a particular type. How we view the relative risk of overestimation versus underestimation of harm is context-dependent.

Consumption of sugar sweetened beverages, artificially sweetened beverages, and fruit juice and incidence of type 2 diabetes: systematic review, meta-analysis, and estimation of population attributable fraction.

PubMed

Imamura, Fumiaki; O'Connor, Laura; Ye, Zheng; Mursu, Jaakko; Hayashino, Yasuaki; Bhupathiraju, Shilpa N; Forouhi, Nita G

2016-04-01

To examine the prospective associations between consumption of sugar sweetened beverages, artificially sweetened beverages, and fruit juice with type 2 diabetes before and after adjustment for adiposity, and to estimate the population attributable fraction for type 2 diabetes from consumption of sugar sweetened beverages in the United States and United Kingdom. Systematic review and meta-analysis. PubMed, Embase, Ovid, and Web of Knowledge for prospective studies of adults without diabetes, published until February 2014. The population attributable fraction was estimated in national surveys in the USA, 2009-10 (n=4729 representing 189.1 million adults without diabetes) and the UK, 2008-12 (n=1932 representing 44.7 million). Random effects meta-analysis and survey analysis for population attributable fraction associated with consumption of sugar sweetened beverages. Prespecified information was extracted from 17 cohorts (38,253 cases/10,126,754 person years). Higher consumption of sugar sweetened beverages was associated with a greater incidence of type 2 diabetes, by 18% per one serving/day (95% confidence interval 9% to 28%, I(2) for heterogeneity=89%) and 13% (6% to 21%, I(2)=79%) before and after adjustment for adiposity; for artificially sweetened beverages, 25% (18% to 33%, I(2)=70%) and 8% (2% to 15%, I(2)=64%); and for fruit juice, 5% (-1% to 11%, I(2)=58%) and 7% (1% to 14%, I(2)=51%). Potential sources of heterogeneity or bias were not evident for sugar sweetened beverages. For artificially sweetened beverages, publication bias and residual confounding were indicated. For fruit juice the finding was non-significant in studies ascertaining type 2 diabetes objectively (P for heterogeneity=0.008). Under specified assumptions for population attributable fraction, of 20.9 million events of type 2 diabetes predicted to occur over 10 years in the USA (absolute event rate 11.0%), 1.8 million would be attributable to consumption of sugar sweetened beverages (population attributable fraction 8.7%, 95% confidence interval 3.9% to 12.9%); and of 2.6 million events in the UK (absolute event rate 5.8%), 79,000 would be attributable to consumption of sugar sweetened beverages (population attributable fraction 3.6%, 1.7% to 5.6%). Habitual consumption of sugar sweetened beverages was associated with a greater incidence of type 2 diabetes, independently of adiposity. Although artificially sweetened beverages and fruit juice also showed positive associations with incidence of type 2 diabetes, the findings were likely to involve bias. None the less, both artificially sweetened beverages and fruit juice were unlikely to be healthy alternatives to sugar sweetened beverages for the prevention of type 2 diabetes. Under assumption of causality, consumption of sugar sweetened beverages over years may be related to a substantial number of cases of new onset diabetes. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Efficient estimation of the attributable fraction when there are monotonicity constraints and interactions.

PubMed

Traskin, Mikhail; Wang, Wei; Ten Have, Thomas R; Small, Dylan S

2013-01-01

The PAF for an exposure is the fraction of disease cases in a population that can be attributed to that exposure. One method of estimating the PAF involves estimating the probability of having the disease given the exposure and confounding variables. In many settings, the exposure will interact with the confounders and the confounders will interact with each other. Also, in many settings, the probability of having the disease is thought, based on subject matter knowledge, to be a monotone increasing function of the exposure and possibly of some of the confounders. We develop an efficient approach for estimating logistic regression models with interactions and monotonicity constraints, and apply this approach to estimating the population attributable fraction (PAF). Our approach produces substantially more accurate estimates of the PAF in some settings than the usual approach which uses logistic regression without monotonicity constraints.

The burden of occupationally-related cutaneous malignant melanoma in Britain due to solar radiation.

PubMed

Rushton, Lesley; J Hutchings, Sally

2017-02-14

Increasing evidence highlights the association of occupational exposure and cutaneous malignant melanoma (CMM). We estimated the burden of CMM and total skin cancer burden in Britain due to occupational solar radiation exposure. Attributable fractions (AF) and numbers were estimated for CMM mortality and incidence using risk estimates from the published literature and national data sources for proportions exposed. We extended existing methods to account for the exposed population age structure. The estimated total AF for CMM is 2.0% (95% CI: 1.4-2.7%), giving 48 (95% CI: 33-64) deaths in (2012) and 241 (95% CI: 168-325) registrations (in 2011) attributable to occupational exposure to solar radiation. Higher exposure and larger numbers exposed led to much higher numbers for men than women. Industries of concern are construction, agriculture, public administration and defence, and land transport. These results emphasise the urgent need to develop appropriate strategies to reduce this burden.

[The cost of tobacco-related diseases for Brazil's Unified National Health System].

PubMed

Pinto, Márcia; Ugá, Maria Alicia Domínguez

2010-06-01

This study aimed to identify the direct costs of hospitalizations due to three smoking-related groups of diseases - cancer and circulatory and respiratory diseases - in Brazil's Unified National Health System (SUS) in 2005. For cancer, the cost of chemotherapy was also included. The study derived cost estimates using administrative databases, relative risks, smoking prevalence, and smoking-attributable fraction. According to the estimates, smoking- attributable medical expenditures for the three disease groups amounted to R$338,692,516.02 (approximately U$185 million), accounting for 27.6% of total medical expenditures. Considering all hospitalizations and chemotherapy provided by the National Health System, tobacco-related diseases accounted for 7.7% of total medical expenditures. These costs also represented 0.9% of expenditures by federally funded public health services. This study provides a conservative estimate of smoking-related costs and suggests the need for continued research on comprehensive approaches to measure the total burden of smoking for society.

Cancer-specific mortality, cure fraction, and noncancer causes of death among diffuse large B-cell lymphoma patients in the immunochemotherapy era.

PubMed

Howlader, Nadia; Mariotto, Angela B; Besson, Caroline; Suneja, Gita; Robien, Kim; Younes, Naji; Engels, Eric A

2017-09-01

Survival after the diagnosis of diffuse large B-cell lymphoma (DLBCL) has been increasing since 2002 because of improved therapies; however, long-term outcomes for these patients in the modern treatment era are still unknown. Using Surveillance, Epidemiology, and End Results data, this study first assessed factors associated with DLBCL-specific mortality during 2002-2012. An epidemiologic risk profile, based on clinical and demographic characteristics, was used to stratify DLBCL cases into low-, medium-, and high-risk groups. The proportions of DLBCL cases that might be considered cured in these 3 risk groups was estimated. Risks of death due to various noncancer causes among DLBCL cases versus the general population were also calculated with standardized mortality ratios (SMRs). Overall, 8274 deaths were recorded among 18,047 DLBCL cases; 76% of the total deaths were attributed to DLBCL, and 24% were attributed to noncancer causes. The 10-year survival rates for the low-, medium-, and high-risk groups were 80%, 60%, and 36%, respectively. The estimated cure proportions for the low-, medium-, and high-risk groups were 73%, 49%, and 27%, respectively; however, these cure estimates were uncertain because of the need to extrapolate the survival curves beyond the follow-up time. Mortality risks calculated with SMRs were elevated for conditions including vascular diseases (SMR, 1.3), infections (SMR, 3.1), gastrointestinal diseases (SMR, 2.5), and blood diseases (SMR, 4.6). These mortality risks were especially high within the initial 5 years after the diagnosis and declined after 5 years. Some DLBCL patients may be cured of their cancer, but they continue to experience excess mortality from lymphoma and other noncancer causes. Cancer 2017;123:3326-34. © 2017 American Cancer Society. © 2017 American Cancer Society.

[Health effects of living habits].

PubMed

Vuori, Ilkka

2015-01-01

Single healthy living habits such as non-smoking and regular physical activity decrease the risk of common non-communicable diseases, unsuccessful aging and premature death to a small to moderate degree. Their cumulative effects are, however, large. Only a small minority of people adhere well to all healthy living habits or even the healthiest ones. Consequently, the population attributable fractions of major public health problems due to unhealthy lifestyles are large. Substantial improvement of public health calls for policies and programs to influence the root causes of the lifestyles in the multiple environments and systems where they are developed, maintained, and changed.

Cancers attributable to excess body weight in Canada in 2010.

PubMed

Zakaria, Dianne; Shaw, Amanda

2017-07-01

Excess body weight (body mass index [BMI] ≥ 25.00 kg/m2) is an established risk factor for diabetes, hypertension and cardiovascular disease, but its relationship to cancer is lesser-known. This study used population attributable fractions (PAFs) to estimate the cancer burden attributable to excess body weight in Canadian adults (aged 25+ years) in 2010. We estimated PAFs using relative risk (RR) estimates from the World Cancer Research Fund International Continuous Update Project, BMI-based estimates of overweight (25.00 kg/m2-29.99 kg/m2) and obesity (30.00+ kg/m2) from the 2000-2001 Canadian Community Health Survey, and cancer case counts from the Canadian Cancer Registry. PAFs were based on BMI corrected for the bias in self-reported height and weight. In Canada in 2010, an estimated 9645 cancer cases were attributable to excess body weight, representing 5.7% of all cancer cases (males 4.9%, females 6.5%). When limiting the analysis to types of cancer associated with high BMI, the PAF increased to 14.9% (males 17.5%, females 13.3%). Types of cancer with the highest PAFs were esophageal adenocarcinoma (42.2%), kidney (25.4%), gastric cardia (20.7%), liver (20.5%), colon (20.5%) and gallbladder (20.2%) for males, and esophageal adenocarcinoma (36.1%), uterus (35.2%), gallbladder (23.7%) and kidney (23.0%) for females. Types of cancer with the greatest number of attributable cases were colon (1445), kidney (780) and advanced prostate (515) for males, and uterus (1825), postmenopausal breast (1765) and colon (675) for females. Irrespective of sex or type of cancer, PAFs were highest in the Prairies (except Alberta) and the Atlantic region and lowest in British Columbia and Quebec. The cancer burden attributable to excess body weight is substantial and will continue to rise in the near future because of the rising prevalence of overweight and obesity in Canada.

Population attributable fraction of type 2 diabetes due to physical inactivity in adults: a systematic review.

PubMed

Al Tunaiji, Hashel; Davis, Jennifer C; Mackey, Dawn C; Khan, Karim M

2014-05-18

Physical inactivity is a global pandemic. The population attributable fraction (PAF) of type 2 diabetes mellitus (T2DM) associated with physical inactivity ranges from 3% to 40%. The purpose of this systematic review was to determine the best estimate of PAF for T2DM attributable to physical inactivity and absence of sport participation or exercise for men and women. We conducted a systematic review that included a comprehensive search of MEDLINE, EMBASE, SportDiscus, and CINAHL (1946 to April 30 2013) limited by the terms adults and English. Two reviewers screened studies, extracted PAF related data and assessed the quality of the selected studies. We reconstructed 95% CIs for studies missing these data using a substitution method. Of the eight studies reporting PAF in T2DM, two studies included prospective cohort studies (3 total) and six were reviews. There were distinct variations in quality of defining and measuring physical inactivity, T2DM and adjusting for confounders. In the US, PAFs for absence of playing sport ranged from 13% (95% CI: 3, 22) in men and 29% (95% CI: 17, 41) in women. In Finland, PAFs for absence of exercise ranged from 3% (95% CI: -11, 16) in men to 7% (95% CI: -9, 20) in women. The PAF of physical inactivity due to T2DM is substantial. Physical inactivity is a modifiable risk factor for T2DM. The contribution of physical inactivity to T2DM differs by sex; PAF also differs if physical inactivity is defined as the absence of 'sport' or absence of 'exercise'.

Mortality Attributable to Secondhand Smoke Exposure in Spain (2011).

PubMed

López, Maria J; Pérez-Ríos, Mónica; Schiaffino, Anna; Fernández, Esteve

2016-05-01

The objective of this study was to assess the mortality attributable to secondhand smoke (SHS) exposure among never-smokers in Spain in 2011, after the implementation of the Spanish smoking law. Data on SHS exposure were obtained from a computer-assisted telephone survey carried out in a representative sample of the adult Spanish population. We included the two main diseases widely associated with SHS exposure: lung cancer and ischaemic heart disease. The relative risks for these diseases were selected from previously published meta-analyses. The number of deaths attributable to SHS was calculated by applying the population attributable fraction to mortality not attributable to active smoking in 2011. The analyses were stratified by sex, age and setting of exposure (home, workplace, and both combined). In addition, a sensitivity analysis was performed for distinct scenarios. In 2011, a total of 586 deaths in men and 442 deaths in women would be attributable to SHS exposure. The total number of deaths from lung cancer attributable to SHS exposure would be 124, while the total number of deaths from ischaemic heart disease would be 904. The inclusion of ex-smokers or SHS exposure in leisure time in the study would considerably increase the total number of attributable deaths (by 20% and 130%, respectively). The total number of deaths attributable to SHS exposure at home and at work in Spain would be 1028 in 2011. Efforts are still needed to reduce the current prevalence of exposure-mainly due to exposure in nonregulated settings such as homes or cars and some outdoor spaces-and the associated morbidity and mortality. © The Author 2015. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Estimation of Breast Cancer Incident Cases and Medical Care Costs Attributable to Alcohol Consumption Among Insured Women Aged <45 Years in the U.S.

PubMed

Ekwueme, Donatus U; Allaire, Benjamin T; Parish, William J; Thomas, Cheryll C; Poehler, Diana; Guy, Gery P; Aldridge, Arnie P; Lahoti, Sejal R; Fairley, Temeika L; Trogdon, Justin G

2017-09-01

This study estimated the percentage of breast cancer cases, total number of incident cases, and total annual medical care costs attributable to alcohol consumption among insured younger women (aged 18-44 years) by type of insurance and stage at diagnosis. The study used the 2012-2013 National Survey on Drug Use and Health, cancer incidence data from two national registry programs, and published relative risk measures to estimate the: (1) alcohol-attributable fraction of breast cancer cases among younger women by insurance type; (2) total number of breast cancer incident cases attributable to alcohol consumption by stage at diagnosis and insurance type among younger women; and (3) total annual medical care costs of treating breast cancer incident cases attributable to alcohol consumption among younger women. Analyses were conducted in 2016; costs were expressed in 2014 U.S. dollars. Among younger women enrolled in Medicaid, private insurance, and both groups, 8.7% (95% CI=7.4%, 10.0%), 13.8% (95% CI=13.3%, 14.4%), and 12.3% (95% CI=11.4%, 13.1%) of all breast cancer cases, respectively, were attributable to alcohol consumption. Localized stage was the largest proportion of estimated attributable incident cases. The estimated total number of breast cancer incident alcohol-attributable cases was 1,636 (95% CI=1,570, 1,703) and accounted for estimated total annual medical care costs of $148.4 million (95% CI=$140.6 million, $156.1 million). Alcohol-attributable breast cancer has estimated medical care costs of nearly $150 million per year. The current findings could be used to support evidence-based interventions to reduce alcohol consumption in younger women. Published by Elsevier Inc.

Personal attributions for melanoma risk in melanoma-affected patients and family members

PubMed Central

Hay, Jennifer; DiBonaventura, Marco; Baser, Raymond; Press, Nancy; Shoveller, Jeanne; Bowen, Deborah

2010-01-01

Personal attributions for cancer risk involve factors that individuals believe contribute to their risk for developing cancer. Understanding personal risk attributions for melanoma may dictate gene-environment melanoma risk communication strategies. We examined attributions for melanoma risk in a population-based sample of melanoma survivors, first degree family members, and family members who are also parents (N=939). We conducted qualitative examination of open-ended risk attributions and logistic regression examining predictors (demographics, family member type, perceived risk) of the attributions reported (ultraviolet radiation [UVR] exposure, heredity/genetics, phenotype, personal melanoma history, miscellaneous). We found a predominance of risk attributions to UVR and heredity/genetics (80% and 45% of the sample, respectively). Those reporting higher education levels were more likely to endorse attributions to heredity/genetics, as well as to phenotype, than those of lower education levels. First-degree relatives and parent family members were more likely to endorse heredity/genetic attributions than melanoma survivors; melanoma survivors were more likely to endorse personal history of melanoma attributions compared to first-degree relatives and parent family members. These findings inform the development of risk communication interventions for melanoma families. PMID:20809355

Risk of hospitalisation with fever following MenB vaccination: self-controlled case series analysis.

PubMed

Murdoch, Heather; Wallace, Lynn; Bishop, Jennifer; Robertson, Chris; Claire Cameron, J

2017-10-01

To investigate a possible association between fever admissions and 4 component Meningococcal B (4CMenB). 4CMenB is given at 8 and 16 weeks in the first year of life. Self-controlled case series using linked routinely collected healthcare data, where the risk period was the 3 days immediately following receipt of a vaccine dose. Children aged under 1 year in Scotland preintroduction and postintroduction of 4CMenB vaccine (pre-September 2014 to August 2015 and post-September 2015 to June 2016). Hospitalisations for fever attributable to 4CMenB vaccine. The postintroduction model showed an increased risk in the 3 days after dose 1 (relative incidence (RI), 10.78; 95% CI: 8.31 to 14.00) and dose 3 (RI, 9.80; 95% CI: 7.10 to 13.62), with a smaller increased risk after dose 2 (RI, 2.20; 95% CI: 1.27 to 3.82). The magnitude of these effects was greater than in the preintroduction model. The attributable fractions were 90.7%, 54.8% and 89.7%, equating to 162, 14 and 84 vaccine attributable cases per 100 000 doses, respectively.This is equivalent to 102 extra hospitalisations in Scotland annually, based on a birth cohort of 55 100 and extrapolated to 1430 across the UK based on a birth cohort of 777 165. There is an increased risk of hospital admission with fever within 3 days of the routine childhood immunisations at 8 and 16 weeks following introduction of 4CMenB vaccine. The results indicate that further understanding of the current use of prophylactic paracetamol is needed. Communication to parents and health professionals may also need to be re-examined, and guidance on the use of prophylactic paracetamol reinforced. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Risk as an attribute in discrete choice experiments: a systematic review of the literature.

PubMed

Harrison, Mark; Rigby, Dan; Vass, Caroline; Flynn, Terry; Louviere, Jordan; Payne, Katherine

2014-01-01

Discrete choice experiments (DCEs) are used to elicit preferences of current and future patients and healthcare professionals about how they value different aspects of healthcare. Risk is an integral part of most healthcare decisions. Despite the use of risk attributes in DCEs consistently being highlighted as an area for further research, current methods of incorporating risk attributes in DCEs have not been reviewed explicitly. This study aimed to systematically identify published healthcare DCEs that incorporated a risk attribute, summarise and appraise methods used to present and analyse risk attributes, and recommend best practice regarding including, analysing and transparently reporting the methodology supporting risk attributes in future DCEs. The Web of Science, MEDLINE, EMBASE, PsycINFO and Econlit databases were searched on 18 April 2013 for DCEs that included a risk attribute published since 1995, and on 23 April 2013 to identify studies assessing risk communication in the general (non-DCE) health literature. Healthcare-related DCEs with a risk attribute mentioned or suggested in the title/abstract were obtained and retained in the final review if a risk attribute meeting our definition was included. Extracted data were tabulated and critically appraised to summarise the quality of reporting, and the format, presentation and interpretation of the risk attribute were summarised. This review identified 117 healthcare DCEs that incorporated at least one risk attribute. Whilst there was some evidence of good practice incorporated into the presentation of risk attributes, little evidence was found that developing methods and recommendations from other disciplines about effective methods and validation of risk communication were systematically applied to DCEs. In general, the reviewed DCE studies did not thoroughly report the methodology supporting the explanation of risk in training materials, the impact of framing risk, or exploring the validity of risk communication. The primary limitation of this review was that the methods underlying presentation, format and analysis of risk attributes could only be appraised to the extent that they were reported. Improvements in reporting and transparency of risk presentation from conception to the analysis of DCEs are needed. To define best practice, further research is needed to test how the process of communicating risk affects the way in which people value risk attributes in DCEs.

Negative life events in childhood as risk indicators of labour market participation in young adulthood: a prospective birth cohort study.

PubMed

Lund, Thomas; Andersen, Johan Hviid; Winding, Trine Nøhr; Biering, Karin; Labriola, Merete

2013-01-01

Most previous studies on reliance on social benefits have focused on health, sickness absence, work environment and socioeconomic status in adulthood. Extending the focus to include early life circumstances may improve our understanding of processes leading to educational and occupational marginalisation and exclusion. The aim of this study was to investigate if multiple negative life events in childhood determined future labour market participation, and to identify important negative life events for labour market participation in young adulthood. Of a cohort of 3,681 born in 1989 in the county of Ringkjoebing, Denmark, 3,058 (83%) completed a questionnaire in 2004. They were followed in a register on social benefits for 12 months in 2010-2011. Logistic regression analyses were used to investigate associations between negative life events in childhood and future labour market participation, taking into account effects of socio-economic position, school performance, educational plans, vocational expectations and general health. A total of 17.1% (19.9% males, 14.4% females) received social benefits for at least 4 weeks during follow-up. Labour market participation decreased with number of negative life events, especially for females: Females who had experienced their parents' divorce, had been abused, or had witnessed a violent event, showed decreased labour market participation, when adjusting for SES, school performance, educational plans, vocational expectations and general health at baseline. Attributable fractions ranged from 2.4% (parents' alcohol/drug abuse) to 16.1% (parents' divorce) for women. For men, risk estimates were lower and insignificant in the most adjusted models. Attributable fractions ranged from 1.0% (parents' alcohol/drug abuse) to 4.9% for witnessing a violent event. Information on childhood conditions may increase the understanding of determinants of labour market participation for young adults. Knowledge of negative life events in childhood should be taken into account when considering determinants of labour market participation and identifying high-risk groups.

Usefulness of cancer-free survival in estimating the lifetime attributable risk of cancer incidence from radiation exposure.

PubMed

Seo, Songwon; Lee, Dal Nim; Jin, Young Woo; Lee, Won Jin; Park, Sunhoo

2018-05-11

Risk projection models estimating the lifetime cancer risk from radiation exposure are generally based on exposure dose, age at exposure, attained age, gender and study-population-specific factors such as baseline cancer risks and survival rates. Because such models have mostly been based on the Life Span Study cohort of Japanese atomic bomb survivors, the baseline risks and survival rates in the target population should be considered when applying the cancer risk. The survival function used in the risk projection models that are commonly used in the radiological protection field to estimate the cancer risk from medical or occupational exposure is based on all-cause mortality. Thus, it may not be accurate for estimating the lifetime risk of high-incidence but not life-threatening cancer with a long-term survival rate. Herein, we present the lifetime attributable risk (LAR) estimates of all solid cancers except thyroid cancer, thyroid cancer, and leukemia except chronic lymphocytic leukemia in South Korea for lifetime exposure to 1 mGy per year using the cancer-free survival function, as recently applied in the Fukushima health risk assessment by the World Health Organization. Compared with the estimates of LARs using an overall survival function solely based on all-cause mortality, the LARs of all solid cancers except thyroid cancer, and thyroid cancer evaluated using the cancer-free survival function, decreased by approximately 13% and 1% for men and 9% and 5% for women, respectively. The LAR of leukemia except chronic lymphocytic leukemia barely changed for either gender owing to the small absolute difference between its incidence and mortality. Given that many cancers have a high curative rate and low mortality rate, using a survival function solely based on all-cause mortality may cause an overestimation of the lifetime risk of cancer incidence. The lifetime fractional risk was robust against the choice of survival function.

Potential impact of pre-exposure prophylaxis for female sex workers and men who have sex with men in Bangalore, India: a mathematical modelling study.

PubMed

Mitchell, Kate M; Prudden, Holly J; Washington, Reynold; Isac, Shajy; Rajaram, Subramanian P; Foss, Anna M; Terris-Prestholt, Fern; Boily, Marie-Claude; Vickerman, Peter

2016-01-01

In Bangalore, new HIV infections of female sex workers and men who have sex with men continue to occur, despite high condom use. Pre-exposure prophylaxis (PrEP) has high anti-HIV efficacy for men who have sex with men. PrEP demonstration projects are underway amongst Indian female sex workers. We estimated the impact and efficiency of prioritizing PrEP to female sex workers and/or men who have sex with men in Bangalore. A mathematical model of HIV transmission and treatment for female sex workers, clients, men who have sex with men and low-risk groups was parameterized and fitted to Bangalore data. The proportion of transmission attributable (population attributable fraction) to commercial sex and sex between men was calculated. PrEP impact (infections averted, life-years gained) and efficiency (life-years gained/infections averted per 100 person-years on PrEP) were estimated for different levels of PrEP adherence, coverage and prioritization strategies (female sex workers, high-risk men who have sex with men, both female sex workers and high-risk men who have sex with men, or female sex workers with lower condom use), under current conditions and in a scenario with lower baseline condom use amongst key populations. Population attributable fractions for commercial sex and sex between men have declined over time, and they are predicted to account for 19% of all new infections between 2016 and 2025. PrEP could prevent a substantial proportion of infections amongst female sex workers and men who have sex with men in this setting (23%/27% over 5/10 years, with 60% coverage and 50% adherence), which could avert 2.9%/4.3% of infections over 5/10 years in the whole Bangalore population. Impact and efficiency in the whole population was greater if female sex workers were prioritized. Efficiency increased, but impact decreased, if only female sex workers with lower condom use were given PrEP. Greater impact and efficiency was predicted for the scenario with lower condom use. PrEP could be beneficial for female sex workers and men who have sex with men in Bangalore, and give some benefits in the general population, especially in similar settings with lower condom use levels.

Targeting Human Papillomavirus to Reduce the Burden of Cervical, Vulvar and Vaginal Cancer and Pre-Invasive Neoplasia: Establishing the Baseline for Surveillance

PubMed Central

Nygård, Mari; Hansen, Bo Terning; Dillner, Joakim; Munk, Christian; Oddsson, Kristján; Tryggvadottir, Laufey; Hortlund, Maria; Liaw, Kai-Li; Dasbach, Erik J.; Kjær, Susanne Krüger

2014-01-01

Background Infection with high-risk human papillomavirus (HPV) is causally related to cervical, vulvar and vaginal pre-invasive neoplasias and cancers. Highly effective vaccines against HPV types 16/18 have been available since 2006, and are currently used in many countries in combination with cervical cancer screening to control the burden of cervical cancer. We estimated the overall and age-specific incidence rate (IR) of cervical, vulvar and vaginal cancer and pre-invasive neoplasia in Denmark, Iceland, Norway and Sweden in 2004–2006, prior to the availability of HPV vaccines, in order to establish a baseline for surveillance. We also estimated the population attributable fraction to determine roughly the expected effect of HPV16/18 vaccination on the incidence of these diseases. Methods Information on incident cervical, vulvar and vaginal cancers and high-grade pre-invasive neoplasias was obtained from high-quality national population-based registries. A literature review was conducted to define the fraction of these lesions attributable to HPV16/18, i.e., those that could be prevented by HPV vaccination. Results Among the four countries, the age-standardised IR/105 of cervical, vaginal and vulvar cancer ranged from 8.4–13.8, 1.3–3.1 and 0.2–0.6, respectively. The risk for cervical cancer was highest in women aged 30–39, while vulvar and vaginal cancers were most common in women aged 70+. Age-standardised IR/105 of cervical, vulvar and vaginal pre-invasive neoplasia ranged between 138.8−183.2, 2.5−8.8 and 0.5−1.3, respectively. Women aged 20−29 had the highest risk for cervical pre-invasive neoplasia, while vulvar and vaginal pre-invasive neoplasia peaked in women aged 40−49 and 60−69, respectively. Over 50% of the observed 47,820 incident invasive and pre-invasive cancer cases in 2004−2006 can be attributed to HPV16/18. Conclusion In the four countries, vaccination against HPV 16/18 could prevent approximately 8500 cases of gynecological cancer and pre-cancer annually. Population-based cancer and vaccination registries are essential to assess the predicted public health effects of HPV vaccination. PMID:24505474

What matters in type 2 diabetes mellitus oral treatment? A discrete choice experiment to evaluate patient preferences.

PubMed

Mühlbacher, Axel; Bethge, Susanne

2016-12-01

The aim of this empirical study is to evaluate patient preferences for different characteristics of oral type 2 diabetes mellitus (T2DM) treatment. As T2DM treatment requires strict adherence, patient needs and preferences should be taken into consideration. Based on a qualitative and quantitative analysis, a discrete choice experiment (DCE) was applied to identify patient preferences. Apart from six identical attributes (adjustment of glycated hemoglobin [HbA1c], prevention of hypoglycemia, risk of genital infection, risk of gastrointestinal problems, risk of urinary tract infection, and weight change), one continuous variable of either "additional healthy life years" (AHY) or "additional costs" attribute (AC) was included. The DCE was conducted using a fractional factorial design, and the statistical data analysis used random effect logit models. In total, N = 626 (N = 318 AHY + N = 308 AC) T2DM patients participated in the survey. The estimation revealed a clear dominance for prevention of hypoglycemia (coefficient 0.937) and adjustment of HbA1c (coefficient 0.541). The attributes, "additional healthy life years" (coefficient 0.458) or "additional costs" (coefficient 0.420), were in the middle rank and both of significant impact. The side effects, risk of genital infection (coefficient 0.301), risk of gastrointestinal problems (coefficient 0.296), and risk of urinary tract infection (coefficient 0.241) followed in this respective order. Possible weight change (coefficient 0.047) was of less importance (last rank) to the patients in this evaluation. These survey results demonstrate how much a (hypothetical) T2DM oral treatment characteristic affects the treatment decision. The preference data can be used for risk-benefit assessment, cost-benefit assessment, and the establishment of patient-oriented evidence. Understanding how patients perceive and value different aspects of diabetes oral treatment is vital to the optimal design and evaluation of treatment options. The present results can be an additional source of information for design, assessment, and decision in T2DM treatment regimes. As such, more effective and efficient care of patients can be achieved, thereby increasing adherence.

Emergence of heat extremes attributable to anthropogenic influences

NASA Astrophysics Data System (ADS)

King, Andrew D.; Black, Mitchell T.; Min, Seung-Ki; Fischer, Erich M.; Mitchell, Daniel M.; Harrington, Luke J.; Perkins-Kirkpatrick, Sarah E.

2016-04-01

Climate scientists have demonstrated that a substantial fraction of the probability of numerous recent extreme events may be attributed to human-induced climate change. However, it is likely that for temperature extremes occurring over previous decades a fraction of their probability was attributable to anthropogenic influences. We identify the first record-breaking warm summers and years for which a discernible contribution can be attributed to human influence. We find a significant human contribution to the probability of record-breaking global temperature events as early as the 1930s. Since then, all the last 16 record-breaking hot years globally had an anthropogenic contribution to their probability of occurrence. Aerosol-induced cooling delays the timing of a significant human contribution to record-breaking events in some regions. Without human-induced climate change recent hot summers and years would be very unlikely to have occurred.

Emperical Tests of Acceptance Sampling Plans

NASA Technical Reports Server (NTRS)

White, K. Preston, Jr.; Johnson, Kenneth L.

2012-01-01

Acceptance sampling is a quality control procedure applied as an alternative to 100% inspection. A random sample of items is drawn from a lot to determine the fraction of items which have a required quality characteristic. Both the number of items to be inspected and the criterion for determining conformance of the lot to the requirement are given by an appropriate sampling plan with specified risks of Type I and Type II sampling errors. In this paper, we present the results of empirical tests of the accuracy of selected sampling plans reported in the literature. These plans are for measureable quality characteristics which are known have either binomial, exponential, normal, gamma, Weibull, inverse Gaussian, or Poisson distributions. In the main, results support the accepted wisdom that variables acceptance plans are superior to attributes (binomial) acceptance plans, in the sense that these provide comparable protection against risks at reduced sampling cost. For the Gaussian and Weibull plans, however, there are ranges of the shape parameters for which the required sample sizes are in fact larger than the corresponding attributes plans, dramatically so for instances of large skew. Tests further confirm that the published inverse-Gaussian (IG) plan is flawed, as reported by White and Johnson (2011).

Contribution of prepregnancy body mass index and gestational weight gain to adverse neonatal outcomes: population attributable fractions for Canada.

PubMed

Dzakpasu, Susie; Fahey, John; Kirby, Russell S; Tough, Suzanne C; Chalmers, Beverley; Heaman, Maureen I; Bartholomew, Sharon; Biringer, Anne; Darling, Elizabeth K; Lee, Lily S; McDonald, Sarah D

2015-02-05

Low or high prepregnancy body mass index (BMI) and inadequate or excess gestational weight gain (GWG) are associated with adverse neonatal outcomes. This study estimates the contribution of these risk factors to preterm births (PTBs), small-for-gestational age (SGA) and large-for-gestational age (LGA) births in Canada compared to the contribution of prenatal smoking, a recognized perinatal risk factor. We analyzed data from the Canadian Maternity Experiences Survey. A sample of 5,930 women who had a singleton live birth in 2005-2006 was weighted to a nationally representative population of 71,200 women. From adjusted odds ratios, we calculated population attributable fractions to estimate the contribution of BMI, GWG and prenatal smoking to PTB, SGA and LGA infants overall and across four obstetric groups. Overall, 6% of women were underweight (<18.5 kg/m(2)) and 34.4% were overweight or obese (≥25.0 kg/m(2)). More than half (59.4%) gained above the recommended weight for their BMI, 18.6% gained less than the recommended weight and 10.4% smoked prenatally. Excess GWG contributed more to adverse outcomes than BMI, contributing to 18.2% of PTB and 15.9% of LGA. Although the distribution of BMI and GWG was similar across obstetric groups, their impact was greater among primigravid women and multigravid women without a previous PTB or pregnancy loss. The contributions of BMI and GWG to PTB and SGA exceeded that of prenatal smoking. Maternal weight, and GWG in particular, contributes significantly to the occurrence of adverse neonatal outcomes in Canada. Indeed, this contribution exceeds that of prenatal smoking for PTB and SGA, highlighting its public health importance.

Effect of Exposure to Smoking in Movies on Young Adult Smoking in New Zealand.

PubMed

Gendall, Philip; Hoek, Janet; Edwards, Richard; Glantz, Stanton

2016-01-01

Tobacco advertising has been prohibited in New Zealand since 1990, and the government has set a goal of becoming a smokefree nation by 2025. However, tobacco marketing persists indirectly through smoking in motion pictures, and there is strong evidence that exposure to onscreen smoking causes young people to start smoking. We investigated the relationship between exposure to smoking in movies and youth smoking initiation among New Zealand young adults. Data from an online survey of 419 smokers and non-smokers aged 18 to 25 were used to estimate respondents' exposure to smoking occurrences in 50 randomly-selected movies from the 423 US top box office movies released between 2008 and 2012. Analyses involved calculating movie smoking exposure (MSE) for each respondent, using logistic regression to analyse the relationship between MSE and current smoking behaviour, and estimating the attributable fraction due to smoking in movies. Exposure to smoking occurrences in movies was associated with current smoking status. After allowing for the influence of family, friends and co-workers, age and rebelliousness, respondents' likelihood of smoking increased by 11% for every 100-incident increase in exposure to smoking incidents, (aOR1.11; p< .05). The estimated attributable fraction due to smoking in movies was 54%; this risk could be substantially reduced by eliminating smoking from movies currently rated as appropriate for youth. We conclude that exposure to smoking in movies remains a potent risk factor associated with smoking among young adults, even in a progressive tobacco control setting such as New Zealand. Harmonising the age of legal tobacco purchase (18) with the age at which it is legal to view smoking in movies would support New Zealand's smokefree 2025 goal.

A multifactorial evaluation of illness risk factors in athletes preparing for the Summer Olympic Games.

PubMed

Drew, Michael K; Vlahovich, Nicole; Hughes, David; Appaneal, Renee; Peterson, Kirsten; Burke, Louise; Lundy, Bronwen; Toomey, Mary; Watts, David; Lovell, Gregory; Praet, Stephan; Halson, Shona; Colbey, Candice; Manzanero, Silvia; Welvaert, Marijke; West, Nic; Pyne, David B; Waddington, Gordon

2017-08-01

Illness can disrupt training and competition performance of athletes. Few studies have quantified the relative contribution of the known medical, behavioural and lifestyle risk factors. Cross-sectional. Olympic athletes from 11 sports (n=221) were invited to complete questionnaires administered nine months before the Rio 2016 Olympic Games. These included the Depression, Anxiety and Stress Questionnaire (DASS-21), Perceived Stress Scale (PSS), Dispositional Resilience Scale (DRS), Recovery-Stress Questionnaire (REST-Q-52 item), Low Energy in Females Questionnaire (LEAF-Q), a modified Personal and Household Hygiene questionnaire, Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index, and custom-made questionnaires on probiotic usage and travel. An illness (case) was defined as an event which limited training or competition for greater hours in the prior month. Odds ratios and attributable fractions in the population (AFP) were utilised for categorical variables with independent t-tests or Wilcoxon rank-sum for continuous variables. Eighty-one athletes responded (male, n=26; female, n=55). There were 16 illness cases and 65 controls. Female athletes were at higher odds of illness (OR=9.4, 95%CI 1.3-410, p=0.01, AFP=0.84). Low energy availability (LEAF-Q score ≥8: OR=7.4, 95%CI 0.78-352, p=0.04, AFP=0.76), depression symptoms (DASS-21: depression score >4, OR=8.4, 95%CI 1.1-59, p<0.01; AFP=0.39) and higher perceived stress (PSS: 10-item, p=0.04) were significantly associated with illness. Female sex, low energy availability, and mental health are associated with sports incapacity (time loss) due to illness. Low energy availability had high attributable fractions in the population and stands out as a primary association with illness. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

Fast deuterium fractionation in magnetized and turbulent filaments

NASA Astrophysics Data System (ADS)

Körtgen, B.; Bovino, S.; Schleicher, D. R. G.; Stutz, A.; Banerjee, R.; Giannetti, A.; Leurini, S.

2018-04-01

Deuterium fractionation is considered as an important process to infer the chemical ages of prestellar cores in filaments. We present here the first magneto-hydrodynamical simulations including a chemical network to study deuterium fractionation in magnetized and turbulent filaments, with a line-mass of Mlin = 42 M⊙ pc-1 within a radius of R = 0.1 pc, and their substructures. The filaments typically show widespread deuterium fractionation with average values ≳ 0.01. For individual cores of similar age, we observe the deuteration fraction to increase with time, but also to be independent of their average properties such as density, virial or mass-to-magnetic flux ratio. We further find a correlation of the deuteration fraction with core mass, average H2 density and virial parameter only at late evolutionary stages of the filament and attribute this to the lifetime of the individual cores. Specifically, chemically old cores reveal higher deuteration fractions. Within the radial profiles of selected cores, we notice differences in the structure of the deuteration fraction or surface density, which we can attribute to their different turbulent properties. High deuteration fractions of the order 0.01 - 0.1 may be reached within approximately 200 kyrs, corresponding to two free-fall times, as defined for cylindrical systems, of the filaments.

Fast deuterium fractionation in magnetized and turbulent filaments

NASA Astrophysics Data System (ADS)

Körtgen, B.; Bovino, S.; Schleicher, D. R. G.; Stutz, A.; Banerjee, R.; Giannetti, A.; Leurini, S.

2018-07-01

Deuterium fractionation is considered as an important process to infer the chemical ages of prestellar cores in filaments. We present here the first magnetohydrodynamical simulations including a chemical network to study deuterium fractionation in magnetized and turbulent filaments, with a line-mass of Mlin = 42 M⊙ pc-1 within a radius of R= 0.1 pc, and their sub-structures. The filaments typically show widespread deuterium fractionation with average values ≳0.01. For individual cores of similar age, we observe the deuteration fraction to increase with time, but also to be independent of their average properties such as density, virial, or mass-to-magnetic flux ratio. We further find a correlation of the deuteration fraction with core mass, average H2 density, and virial parameter only at late evolutionary stages of the filament and attribute this to the lifetime of the individual cores. Specifically, chemically old cores reveal higher deuteration fractions. Within the radial profiles of selected cores, we notice differences in the structure of the deuteration fraction or surface density, which we can attribute to their different turbulent properties. High deuteration fractions of the order of 0.01-0.1 may be reached within approximately 200 kyr, corresponding to two free-fall times, as defined for cylindrical systems, of the filaments.

[Disability attributable to excess weight in Spain].

PubMed

Martín-Ramiro, José Javier; Alvarez-Martín, Elena; Gil-Prieto, Ruth

2014-08-19

To estimate the disability attributable to higher than optimal body mass index in the Spanish population in 2006. Excess body weight prevalence data were obtained from the 2006 National Health Survey (NHS), while the prevalence of associated morbidities was extracted from the 2006 NHS and from a national hospital data base. Population attributable fractions were applied and disability attributable was expressed as years life with disability (YLD). In 2006, in the Spanish population aged 35-79 years, 791.650 YLD were lost due to higher than optimal body mass index (46.7% in males and 53.3% in females). Overweight (body mass index 25-29.9) accounted for 45.7% of total YLD. Males YLD were higher than females under 60. The 35-39 quinquennial group showed a difference for males of 16.6% while in the 74-79 group the difference was 23.8% for women. Osteoarthritis and chronic back pain accounted for 60% of YLD while hypertensive disease and type 2 diabetes mellitus were responsible of 37%. Excess body weight is a health risk related to the development of various diseases with an important associated disability burden and social and economical cost. YLD analysis is a useful monitor tool for disease control interventions. Copyright © 2013 Elsevier España, S.L. All rights reserved.

Regional-level estimation of expected years of life lost attributable to overweight and obesity among Mexican adults.

PubMed

Murillo-Zamora, Efrén; García-Ceballos, Raúl; Delgado-Enciso, Iván; Garza-Guajardo, Raquel; Barboza-Quintana, Oralia; Rodríguez-Sánchez, Irám P; Mendoza-Cano, Oliver

2016-01-01

Excess body weight has become a major public health problem worldwide, and the burden of overweight and obesity was calculated in this work from a health economics perspective. To estimate the burden of disease attributable to overweight and obesity among males and females aged 20 years and older using years of life lost (YLL) and age-standardized YLL rates (ASYLL), and to rank the leading causes of premature death. A cross-sectional study took place (2010-2014) and 6,054 deaths were analyzed. Thirteen basic causes of death associated with overweight or obesity were included. The population attributable fraction (PAF), YLL, and ASYLL were calculated. The overall burden attributable to overweight and obesity was 36,087 YLL, and the estimated ASYLL per 10,000 persons was 1,098 and 1,029 in males and females, respectively. Type 2 diabetes mellitus was the main cause of premature death (males, 968 ASYLL; females, 772 ASYLL). Overweight and obesity are major risk factors of chronic diseases that are main causes of premature death in the study population. Strategies for preventing overweight and obesity may decrease the incidence and mortality associated with these non-communicable diseases. ASYLL seems to be an indicator that is particularly well adapted to decision-making in public health.

Plasmodium vivax infection: a major determinant of severe anaemia in infancy.

PubMed

Kenangalem, Enny; Karyana, Muhammad; Burdarm, Lenny; Yeung, Shunmay; Simpson, Julie A; Tjitra, Emiliana; Anstey, Nicholas M; Poespoprodjo, Jeanne Rini; Price, Ric N; Douglas, Nicholas M

2016-06-16

Most malarious countries outside of Africa are co-endemic for Plasmodium falciparum and Plasmodium vivax. The comparative burden of anaemia in the community caused by these two species is incompletely characterized. A three-stage, cross-sectional, community survey was used to determine the proportion of moderate or severe anaemia (haemoglobin <7 g/dL) attributable to patent P. vivax, P. falciparum and mixed parasitaemia in Papua, Indonesia. Adjusted population-attributable fractions were calculated from multivariable logistic regression models. Eight hundred and twenty-five households were surveyed with a total of 5255 occupants, 3890 (74 %) of whom were present and provided a blood sample. Plasmodium falciparum parasitaemia was present in 8.1 % (n = 315) of participants, P. vivax in 6.4 % (n = 250) and mixed infections in 1.9 % (n = 72). Overall, P. falciparum was associated with a mean reduction in haemoglobin of 1.16 g/dL compared to those without patent parasitaemia [95 % confidence interval (95 % CI) 0.91, 1.41 g/dL]. The corresponding values for P. vivax and mixed infections were 0.66 g/dL (95 % CI 0.35, 0.96) and 1.25 g/dL (0.71, 1.80), respectively. Overall, 16.7 % (95 % CI 8.52, 24.2 %) of haemoglobin concentrations <7 g/dL in the community were estimated to be attributable to patent parasitaemia. The fractions for infants and 1-5 years old were 34.4 % (95 % CI -3.30, 58.3 %) and 23.2 % (95 % CI 3.34, 39.0 %), respectively. Plasmodium vivax was associated with a greater than threefold higher attributable fraction of anaemia in infants compared with P. falciparum [27.6 % (95 % CI -3.20, 49.2 %) versus 7.94 % (-5.87, 20.0 %)]. Despite comparatively low-level endemicity, malaria is associated with a significant proportion of all cases of community anaemia in southern Papua. Contrary to its benign reputation, P. vivax is an important and preventable risk factor for anaemia during infancy-a probable consequence of relapsing disease prior to the development of immunity.

Bioassay of plant growth from soils varying in active C and N fractions

USDA-ARS?s Scientific Manuscript database

Biologically active soil C and N fractions are important attributes of healthy soil. As a bioassay, we hypothesized that active soil C and N fractions would relate with plant dry matter production from unamended soil. Four replicate soil samples from 22 tall fescue fields in North Carolina and Virgi...

Air pollution attributable postneonatal infant mortality in U.S. metropolitan areas: a risk assessment study

PubMed Central

Kaiser, Reinhard; Romieu, Isabelle; Medina, Sylvia; Schwartz, Joel; Krzyzanowski, Michal; Künzli, Nino

2004-01-01

Background The impact of outdoor air pollution on infant mortality has not been quantified. Methods Based on exposure-response functions from a U.S. cohort study, we assessed the attributable risk of postneonatal infant mortality in 23 U.S. metropolitan areas related to particulate matter <10 μm in diameter (PM10) as a surrogate of total air pollution. Results The estimated proportion of all cause mortality, sudden infant death syndrome (normal birth weight infants only) and respiratory disease mortality (normal birth weight) attributable to PM10 above a chosen reference value of 12.0 μg/m3 PM10 was 6% (95% confidence interval 3–11%), 16% (95% confidence interval 9–23%) and 24% (95% confidence interval 7–44%), respectively. The expected number of infant deaths per year in the selected areas was 106 (95% confidence interval 53–185), 79 (95% confidence interval 46–111) and 15 (95% confidence interval 5–27), respectively. Approximately 75% of cases were from areas where the current levels are at or below the new U.S. PM2.5 standard of 15 μg/m3 (equivalent to 25 μg/m3 PM10). In a country where infant mortality rates and air pollution levels are relatively low, ambient air pollution as measured by particulate matter contributes to a substantial fraction of infant death, especially for those due to sudden infant death syndrome and respiratory disease. Even if all counties would comply to the new PM2.5 standard, the majority of the estimated burden would remain. Conclusion Given the inherent limitations of risk assessments, further studies are needed to support and quantify the relationship between infant mortality and air pollution. PMID:15128459

Physiographic and land cover attributes of the Puget Lowland and the active streamflow gaging network, Puget Sound Basin

USGS Publications Warehouse

Konrad, Christopher; Sevier, Maria

2014-01-01

Geospatial information for the active streamflow gaging network in the Puget Sound Basin was compiled to support regional monitoring of stormwater effects to small streams. The compilation includes drainage area boundaries and physiographic and land use attributes that affect hydrologic processes. Three types of boundaries were used to tabulate attributes: Puget Sound Watershed Characterization analysis units (AU); the drainage area of active streamflow gages; and the catchments of Regional Stream Monitoring Program (RSMP) sites. The active streamflow gaging network generally includes sites that represent the ranges of attributes for lowland AUs, although there are few sites with low elevations (less than 60 meters), low precipitation (less than 1 meter year), or high stream density (greater than 5 kilometers per square kilometers). The active streamflow gaging network can serve to provide streamflow information in some AUs and RSMP sites, particularly where the streamflow gage measures streamflow generated from a part of the AU or that drains to the RSMP site, and that part of the AU or RSMP site is a significant fraction of the drainage area of the streamgage. The maximum fraction of each AU or RSMP catchment upstream of a streamflow gage and the maximum fraction of any one gaged basin in an AU or RSMP along with corresponding codes are provided in the attribute tables.

Heart rate and outcome in heart failure with reduced ejection fraction: Differences between atrial fibrillation and sinus rhythm-A CIBIS II analysis.

PubMed

Mulder, Bart A; Damman, Kevin; Van Veldhuisen, Dirk J; Van Gelder, Isabelle C; Rienstra, Michiel

2017-09-01

Heart rate has been associated with prognosis in patients with heart failure with reduced ejection fraction (HFREF) and sinus rhythm; whether this also holds true in patients with atrial fibrillation (AF) is unknown. To evaluate cardiac rhythm and baseline heart rate and the influence of outcome in patients with HFREF enrolled in the Cardiac Insufficiency Bisoprolol Study II. In total, 2539 patients were stratified according to their baseline heart rhythm (AF or sinus rhythm) and into quartiles of heart rate (≤70 bpm, 71-78 bpm, 79-90 bpm, and >90 bpm). The primary outcome was all-cause mortality. Mean follow-up was 1.3 years. Mean age was 61 years, mean left ventricular ejection fraction was 28%, and 80% were male. A total of 521 (21%) patients had AF at baseline. The risk associated with all-cause mortality for each 5 bpm increase in heart rate in patients with sinus rhythm (hazard ratio [HR]: 1.06, 95% confidence interval [CI]: 1.01-1.11, P = 0.012) was significantly different from those with AF (HR: 1.00, 95% CI: 0.94-1.07, P = 0.90, P for interaction = 0.041). The risk associated with higher heart rate in sinus rhythm was primarily attributable to excess risk in the highest quartile (HR: 1.64, 95% CI: 1.18-2.30, P = 0.003). Allocation to bisoprolol did not modify the interaction between heart rate, rhythm and outcome. In HFREF patients with AF, a higher heart rate is not associated with increased event rates in contrast to HFREF patients with sinus rhythm. © 2017 Wiley Periodicals, Inc.

Impacts of ambient temperature on the burden of bacillary dysentery in urban and rural Hefei, China.

PubMed

Cheng, J; Xie, M Y; Zhao, K F; Wu, J J; Xu, Z W; Song, J; Zhao, D S; Li, K S; Wang, X; Yang, H H; Wen, L Y; Su, H; Tong, S L

2017-06-01

Bacillary dysentery continues to be a major health issue in developing countries and ambient temperature is a possible environmental determinant. However, evidence about the risk of bacillary dysentery attributable to ambient temperature under climate change scenarios is scarce. We examined the attributable fraction (AF) of temperature-related bacillary dysentery in urban and rural Hefei, China during 2006-2012 and projected its shifting pattern under climate change scenarios using a distributed lag non-linear model. The risk of bacillary dysentery increased with the temperature rise above a threshold (18·4 °C), and the temperature effects appeared to be acute. The proportion of bacillary dysentery attributable to hot temperatures was 18·74% (95 empirical confidence interval (eCI): 8·36-27·44%). Apparent difference of AF was observed between urban and rural areas, with AF varying from 26·87% (95% eCI 16·21-36·68%) in urban area to -1·90% (95 eCI -25·03 to 16·05%) in rural area. Under the climate change scenarios alone (1-4 °C rise), the AF from extreme hot temperatures (>31·2 °C) would rise greatly accompanied by the relatively stable AF from moderate hot temperatures (18·4-31·2 °C). If climate change proceeds, urban area may be more likely to suffer from rapidly increasing burden of disease from extreme hot temperatures in the absence of effective mitigation and adaptation strategies.

Analysis of intervention strategies for inhalation exposure to polycyclic aromatic hydrocarbons and associated lung cancer risk based on a Monte Carlo population exposure assessment model.

PubMed

Zhou, Bin; Zhao, Bin

2014-01-01

It is difficult to evaluate and compare interventions for reducing exposure to air pollutants, including polycyclic aromatic hydrocarbons (PAHs), a widely found air pollutant in both indoor and outdoor air. This study presents the first application of the Monte Carlo population exposure assessment model to quantify the effects of different intervention strategies on inhalation exposure to PAHs and the associated lung cancer risk. The method was applied to the population in Beijing, China, in the year 2006. Several intervention strategies were designed and studied, including atmospheric cleaning, smoking prohibition indoors, use of clean fuel for cooking, enhancing ventilation while cooking and use of indoor cleaners. Their performances were quantified by population attributable fraction (PAF) and potential impact fraction (PIF) of lung cancer risk, and the changes in indoor PAH concentrations and annual inhalation doses were also calculated and compared. The results showed that atmospheric cleaning and use of indoor cleaners were the two most effective interventions. The sensitivity analysis showed that several input parameters had major influence on the modeled PAH inhalation exposure and the rankings of different interventions. The ranking was reasonably robust for the remaining majority of parameters. The method itself can be extended to other pollutants and in different places. It enables the quantitative comparison of different intervention strategies and would benefit intervention design and relevant policy making.

Methylenetetrahydrofolate reductase polymorphisms and therapy response in pediatric acute lymphoblastic leukemia.

PubMed

Aplenc, Richard; Thompson, Jennifer; Han, Peggy; La, Mei; Zhao, Huaqing; Lange, Beverly; Rebbeck, Timothy

2005-03-15

A significant portion of patients treated for pediatric acute lymphoblastic leukemia (ALL) relapse. We hypothesized that common polymorphisms with moderate effect sizes and large attributive risks could explain an important fraction of ALL relapses. Methylenetetrahydrofolate reductase (MTHFR) is central to folate metabolism and has two common functional polymorphisms (C677T and A1298G). Methotrexate (MTX), which interrupts folate metabolism, is a mainstay of pediatric ALL therapy. MTX inhibits the synthesis of dTMP needed for DNA replication by blocking the conversion of 5,10-methylenetetrahydrofolate to 5-methyltetrahydrofolate by MTHFR. We hypothesized that a deactivating MTHFR allele would increase ALL relapse risk by potentially increasing 5,10-methylenetetrahydrofolate and dTMP, enhancing DNA synthesis and thus opposing MTX. To test this hypothesis, we genotyped 520 patients on the Children's Cancer Study Group ALL study, CCG-1891. The MTHFR C677T variant allele was statistically significantly associated with relapse (chi2 = 4.38, P = 0.036). This association remained significant (hazard ratio = 1.82, P = 0.008), controlling for important covariates, and was more predictive of relapse than other predictors, including day 7 bone marrow response. The MTHFR C677T variant allele was not associated with an increased risk of toxicity or infection. The MTHFR A1298G polymorphism was not associated with altered risks of relapse, toxicity, or infection. Haplotype analysis showed six common haplotypes that did not provide additional information predictive for relapse. These data provide evidence that the MTHFR C677T polymorphism is a common genetic variant conferring a moderate relative risk and a high attributable risk for relapse in pediatric ALL patients.

Metabolic syndrome and ischemic stroke risk: Northern Manhattan Study.

PubMed

Boden-Albala, Bernadette; Sacco, Ralph L; Lee, Hye-Sueng; Grahame-Clarke, Cairistine; Rundek, Tanja; Elkind, Mitchell V; Wright, Clinton; Giardina, Elsa-Grace V; DiTullio, Marco R; Homma, Shunichi; Paik, Myunghee C

2008-01-01

More than 47 million individuals in the United States meet the criteria for the metabolic syndrome. The relation between the metabolic syndrome and stroke risk in multiethnic populations has not been well characterized. As part of the Northern Manhattan Study, 3298 stroke-free community residents were prospectively followed up for a mean of 6.4 years. The metabolic syndrome was defined according to guidelines established by the National Cholesterol Education Program Adult Treatment Panel III. Cox proportional-hazards models were used to calculate hazard ratios (HRs) and 95% CIs for ischemic stroke and vascular events (ischemic stroke, myocardial infarction, or vascular death). The etiologic fraction estimates the proportion of events attributable to the metabolic syndrome. More than 44% of the cohort had the metabolic syndrome (48% of women vs 38% of men, P<0.0001), which was more prevalent among Hispanics (50%) than whites (39%) or blacks (37%). The metabolic syndrome was associated with increased risk of stroke (HR=1.5; 95% CI, 1.1 to 2.2) and vascular events (HR=1.6; 95% CI, 1.3 to 2.0) after adjustment for sociodemographic and risk factors. The effect of the metabolic syndrome on stroke risk was greater among women (HR=2.0; 95% CI, 1.3 to 3.1) than men (HR=1.1; 95% CI, 0.6 to 1.9) and among Hispanics (HR=2.0; 95% CI, 1.2 to 3.4) compared with blacks and whites. The etiologic fraction estimates suggest that elimination of the metabolic syndrome would result in a 19% reduction in overall stroke, a 30% reduction of stroke in women; and a 35% reduction of stroke among Hispanics. The metabolic syndrome is an important risk factor for ischemic stroke, with differential effects by sex and race/ethnicity.

Modifiable Risk Factors for Pneumonia Requiring Hospitalization among Community-Dwelling Older Adults: The Health, Aging, and Body Composition Study

PubMed Central

Juthani-Mehta, Manisha; De Rekeneire, Nathalie; Allore, Heather; Chen, Shu; O’Leary, John R.; Bauer, Douglas C.; Harris, Tamara B.; Newman, Anne B.; Yende, Sachin; Weyant, Robert J.; Kritchevsky, Stephen; Quagliarello, Vincent

2013-01-01

Background Pneumonia requiring hospitalization remains a major public health problem among community-dwelling older adults. Impaired oral hygiene is a modifiable risk factor for healthcare-associated pneumonia, but its role in community-acquired pneumonia is unclear. Objectives To identify novel modifiable risk factors, focusing on oral hygiene, for pneumonia requiring hospitalization among community-dwelling older adults. Design Prospective observational cohort study Setting Memphis, Tennessee and Pittsburgh, Pennsylvania Participants Of 3075 well-functioning community-dwelling adults aged 70–79 years enrolled in the Health, Aging, and Body Composition Study from 1997–1998, 1441 had complete data, dental exam within six months of baseline, and were eligible for this study. Measurements The primary outcome was pneumonia requiring hospitalization through 2008. Results Of 1441 participants, 193 were hospitalized for pneumonia. In a multivariable model, male gender (HR 2.07, 95%CI 1.51–2.83), white race (HR 1.44, 95%CI 1.03–2.01), history of pneumonia (HR 3.09, 95%CI 1.86–5.14), pack-years of smoking (HR 1.006, 95%CI 1.001–1.011), and percent predicted FEV1 (moderate vs. mild/normal lung function [HR 1.78, 95%CI 1.28–2.48], severe vs. mild/normal lung function [HR 2.90, 95%CI 1.51–5.57]) were non-modifiable risk factors for pneumonia. Incident mobility limitation (HR 1.77, 95%CI 1.32–2.38) and higher mean oral plaque score (HR 1.29, 95%CI 1.02–1.64) were modifiable risk factors for pneumonia. Average Attributable Fractions revealed that 11.5% of pneumonias were attributed to incident mobility limitation and 10.3% to mean oral plaque score ≥1. Conclusion Incident mobility limitation and higher mean oral plaque score were two modifiable risk factors attributable for 22% of pneumonias requiring hospitalization. These data suggest innovative opportunities for pneumonia prevention among community-dwelling older adults. PMID:23772872

Estimating the causal effects of smoking.

PubMed

Rubin, D B

An important application of statistics in recent years has been to address the causal effects of smoking. There is little doubt that there are health risks associated with smoking. However, more general issues concern the causal effects due to the alleged misconduct of the tobacco industry or due to programmes designed to curtail tobacco use. To address any such causal question, assumptions must be made. Although some of the issues are well known in the statistical and epidemiological literature, there does not appear to be a unified treatment that provides prescriptive guidance on the estimation of these causal effects with explication of the needed assumptions. A 'conduct attributable fraction' is derived, which allows for arbitrary changes in smoking and non-smoking health care expenditure related factors in a counterfactual world without the alleged misconduct, and therefore generalizes the traditional 'smoking attributable fraction'. The formulation presented here, although described for the problem of estimating excess health care expenditures due to the alleged misconduct of the tobacco industry, is more general. It can be applied to any outcome, such as mortality, morbidity, or income from excise taxes, as well as to any situation in which consequences due to alleged misconduct (for example, of two entities, such as the tobacco and the asbestos industries) or due to hypothetical programmes (for example, extra smoking reduction initiatives) are to be estimated. Copyright 2001 John Wiley & Sons, Ltd.

Particle size fractionation of high-amylose rice (Goami 2) flour as an oil barrier in a batter-coated fried system

USDA-ARS?s Scientific Manuscript database

The particle size effects of high-amylose rice (Goami 2) flour on quality attributes of frying batters were characterized in terms of physicochemical, rheological, and oil-resisting properties. High-amylose rice flours were fractionated into four fractions (70, 198, 256, and 415 µm) of which morpho...

Attribution of UK Winter Floods to Anthropogenic Forcing

NASA Astrophysics Data System (ADS)

Schaller, N.; Alison, K.; Sparrow, S. N.; Otto, F. E. L.; Massey, N.; Vautard, R.; Yiou, P.; van Oldenborgh, G. J.; van Haren, R.; Lamb, R.; Huntingford, C.; Crooks, S.; Legg, T.; Weisheimer, A.; Bowery, A.; Miller, J.; Jones, R.; Stott, P.; Allen, M. R.

2014-12-01

Many regions of southern UK experienced severe flooding during the 2013/2014 winter. Simultaneously, large areas in the USA and Canada were struck by prolonged cold weather. At the time, the media and public asked whether the general rainy conditions over northern Europe and the cold weather over North America were caused by climate change. Providing an answer to this question is not trivial, but recent studies show that probabilistic event attribution is feasible. Using the citizen science project weather@home, we ran over 40'000 perturbed initial condition simulations of the 2013/2014 winter. These simulations fall into two categories: one set aims at simulating the world with climate change using observed sea surface temperatures while the second set is run with sea surface temperatures corresponding to a world that might have been without climate change. The relevant modelled variables are then downscaled by a hydrological model to obtain river flows. First results show that anthropogenic climate change led to a small but significant increase in the fractional attributable risk for 30-days peak flows for the river Thames. A single number can summarize the final result from probabilistic attribution studies indicating, for example, an increase, decrease or no change to the risk of the event occurring. However, communicating this to the public, media and other scientists remains challenging. The assumptions made in the chain of models used need to be explained. In addition, extreme events, like the UK floods of the 2013/2014 winter, are usually caused by a range of factors. While heavy precipitation events can be caused by dynamic and/or thermodynamic processes, floods occur only partly as a response to heavy precipitation. Depending on the catchment, they can be largely due to soil properties and conditions of the previous months. Probabilistic attribution studies are multidisciplinary and therefore all aspects need to be communicated properly.

Estimating the burden of disease attributable to vitamin A deficiency in South Africa in 2000.

PubMed

Nojilana, Beatrice; Norman, Rosana; Bradshaw, Debbie; van Stuijvenberg, Martha E; Dhansay, Muhammad A; Labadorios, Demetre

2007-08-01

To estimate the burden of disease attributable to vitamin A deficiency in children aged 0 - 4 years and pregnant women aged 15 - 49 years in South Africa in 2000. The framework adopted for the most recent World Health Organization comparative risk assessment (CRA) methodology was followed. Population-attributable fractions were calculated from South African Vitamin A Consultative Group (SAVACG) survey data on the prevalence of vitamin A deficiency in children and the relative risks of associated health problems, applied to revised burden of disease estimates for South Africa in the year 2000. Small community studies were used to derive the prevalence in pregnant women. Monte Carlo simulation-modelling techniques were used for the uncertainty analysis. South Africa. Children under 5 years and pregnant women 15 - 49 years. Direct sequelae of vitamin A deficiency, including disability-adjusted life years (DALYs), as well as mortality associated with measles, diarrhoeal diseases and other infections, and mortality and DALYs associated with malaria in children and all-cause maternal mortality. One-third of children aged 0 - 4 years and 1 - 6% of pregnant women were vitamin A-deficient. Of deaths among young children aged 0 - 4 years in 2000, about 28% of those resulting from diarrhoeal diseases, 23% of those from measles, and 21% of those from malaria were attributed to vitamin A deficiency, accounting for some 3,000 deaths. Overall, about 110,467 ( 95% uncertainty interval 86,388 - 136,009) healthy years of life lost, or between 0.5% and 0.8% of all DALYs in South Africa in 2000 were attributable to vitamin A deficiency. The vitamin A supplementation programme for children and the recent food fortification programme introduced in South Africa in 2003 should prevent future morbidity and mortality related to vitamin A deficiency. Monitoring the effectiveness of these interventions is strongly recommended.

Geographical variation in the progression of type 2 diabetes in Peru: The CRONICAS Cohort Study

PubMed Central

Bernabé-Ortiz, Antonio; Carrillo-Larco, Rodrigo M.; Gilman, Robert H.; Miele, Catherine H.; Checkley, William; Wells, Jonathan C.; Smeeth, Liam; Miranda, J. Jaime

2016-01-01

Background The study aims were to estimate the incidence and risk factors for T2D in four settings with different degree of urbanization and altitude in Peru. Methods Prospective cohort study conducted in urban, semi-urban, and rural areas in Peru. An age- and sex-stratified random sample of participants was taken from the most updated census. T2D was defined as fasting blood glucose ⩾7.0 mmol/L or taking anti-diabetes medication. Exposures were divided into two groups: geographical variables (urbanization and altitude), and modifiable risk factors. Incidence, relative risks (RR), 95% confidence intervals (95%CI), and population attributable fractions (PAF) were estimated. Results Data from 3135 participants, 48.8% males, mean age 55.6 years, was analyzed. Overall baseline prevalence of T2D was 7.1% (95%CI 6.2–8.0%). At follow-up, including 6207 person-years of follow-up, a total of 121 new T2D cases were accrued, equating to an incidence of 1.95 (95%CI 1.63–2.33) per 100 person-years. There was no urban to rural gradient in the T2D incidence; however, compared to sea level sites, participants living in high altitude had a higher incidence of diabetes (RR = 1.58; 95%CI 1.01–2.48). Obesity had the highest attributable risk for developing T2D, although results varied by setting, ranging from 14% to 80% depending on urbanization and altitude. Conclusions Our results suggest that the incidence of T2D was greater in high altitude sites. New cases of diabetes were largely attributed to obesity, but with substantial variation in the contribution of obesity depending on the environment. These findings can inform appropriate context-specific strategies to reduce the incidence of diabetes. PMID:27710820

Geographical variation in the progression of type 2 diabetes in Peru: The CRONICAS Cohort Study.

PubMed

Bernabé-Ortiz, Antonio; Carrillo-Larco, Rodrigo M; Gilman, Robert H; Miele, Catherine H; Checkley, William; Wells, Jonathan C; Smeeth, Liam; Miranda, J Jaime

2016-11-01

The study aims were to estimate the incidence and risk factors for T2D in four settings with different degree of urbanization and altitude in Peru. Prospective cohort study conducted in urban, semi-urban, and rural areas in Peru. An age- and sex-stratified random sample of participants was taken from the most updated census. T2D was defined as fasting blood glucose ⩾7.0mmol/L or taking anti-diabetes medication. Exposures were divided into two groups: geographical variables (urbanization and altitude), and modifiable risk factors. Incidence, relative risks (RR), 95% confidence intervals (95%CI), and population attributable fractions (PAF) were estimated. Data from 3135 participants, 48.8% males, mean age 55.6years, was analyzed. Overall baseline prevalence of T2D was 7.1% (95%CI 6.2-8.0%). At follow-up, including 6207 person-years of follow-up, a total of 121 new T2D cases were accrued, equating to an incidence of 1.95 (95%CI 1.63-2.33) per 100 person-years. There was no urban to rural gradient in the T2D incidence; however, compared to sea level sites, participants living in high altitude had a higher incidence of diabetes (RR=1.58; 95%CI 1.01-2.48). Obesity had the highest attributable risk for developing T2D, although results varied by setting, ranging from 14% to 80% depending on urbanization and altitude. Our results suggest that the incidence of T2D was greater in high altitude sites. New cases of diabetes were largely attributed to obesity, but with substantial variation in the contribution of obesity depending on the environment. These findings can inform appropriate context-specific strategies to reduce the incidence of diabetes. Copyright © 2016 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

Disparities in Maternal Child and Health Outcomes Attributable to Prenatal Tobacco Use.

PubMed

Mohlman, Mary Katherine; Levy, David T

2016-03-01

Previous estimates of smoking-attributable adverse outcomes, such as preterm births (PTBs), low birth weight (LBW) and Sudden Infant Death Syndrome (SIDs) generally do not address disparities by maternal age, racial/ethnic group or socioeconomic status (SES). This study develops estimates of smoking-attributable PTB, LBW and SIDS for the US by age, SES and racial/ethnic groupings. Data on the number of births and the prevalence of PTB, LBW and SIDS were used to develop the number of outcomes by age, race/ethnicity, and SES. The prevalence of prenatal smoking by age, race/ethnic and education and the relative risk of outcomes for smokers were used to calculate smoking-attributable fractions of outcomes. Prenatal smoking among ages 15-24 is above 12 %, with 20-24 year olds representing at least 35 % of PTB, LBW SIDS cases. Women with a high school education or less represented more than 50 % of PTB and LBW births, and 44 % of SIDS cases. While non-Hispanic Whites had the majority of smoking-attributable outcomes, non-Hispanic Blacks represented a disproportionately high percentage of PTBs (18 %), LBW births (22 %), and SIDS cases (13 %). Reducing prenatal smoking has the potential to reduce adverse birth outcomes and costs with long-term implications, especially among the young, non-Hispanic Blacks and those of lower SES. Stricter tobacco control policies, especially higher cigarette taxes, higher minimum purchase ages for tobacco and improved cessation interventions can help reduce disparities and the cost to insurers, especially public costs through Medicaid.

Cancer incidence attributable to lifestyle and environmental factors in Alberta in 2012: summary of results

PubMed Central

Grundy, Anne; Poirier, Abbey E.; Khandwala, Farah; Grevers, Xin; Friedenreich, Christine M.; Brenner, Darren R.

2017-01-01

Background: Estimates of the proportion of cancer cases that can be attributed to modifiable risk factors are not available for Canada and, more specifically, Alberta. The purpose of this study was to estimate the total proportion of cancer cases in Alberta in 2012 that could be attributed to a set of 24 modifiable lifestyle and environmental risk factors. Methods: We estimated summary population attributable risk estimates for 24 risk factors (smoking [both passive and active], overweight and obesity, inadequate physical activity, diet [inadequate fruit and vegetable consumption, inadequate fibre intake, excess red and processed meat consumption, salt consumption, inadequate calcium and vitamin D intake], alcohol, hormones [oral contraceptives and hormone therapy], infections [Epstein-Barr virus, hepatitis B and C viruses, human papillomavirus, Helicobacter pylori], air pollution, natural and artificial ultraviolet radiation, radon and water disinfection by-products) by combining population attributable risk estimates for each of the 24 factors that had been previously estimated. To account for the possibility that individual cancer cases were the result of a combination of multiple risk factors, we subtracted the population attributable risk for the first factor from 100% and then applied the population attributable risk for the second factor to the remaining proportion that was not attributable to the first factor. We repeated this process in sequential order for all relevant exposures. Results: Overall, an estimated 40.8% of cancer cases in Alberta in 2012 were attributable to modifiable lifestyle and environmental risk factors. The largest proportion of cancers were estimated to be attributable to tobacco smoking, physical inactivity and excess body weight. The summary population attributable risk estimate was slightly higher among women (42.4%) than among men (38.7%). Interpretation: About 41% of cancer cases in Alberta may be attributable to known modifiable lifestyle and environmental risk factors. Reducing the prevalence of these factors in the Alberta population has the potential to substantially reduce the provincial cancer burden. PMID:28687643

Distribution of light and heavy fractions of soil organic carbon as related to land use and tillage practice

USGS Publications Warehouse

Tan, Zhengxi; Lal, R.; Owens, L.; Izaurralde, R. C.

2007-01-01

Mass distributions of different soil organic carbon (SOC) fractions are influenced by land use and management. Concentrations of C and N in light- and heavy fractions of bulk soils and aggregates in 0–20 cm were determined to evaluate the role of aggregation in SOC sequestration under conventional tillage (CT), no-till (NT), and forest treatments. Light- and heavy fractions of SOC were separated using 1.85 g mL−1 sodium polytungstate solution. Soils under forest and NT preserved, respectively, 167% and 94% more light fraction than those under CT. The mass of light fraction decreased with an increase in soil depth, but significantly increased with an increase in aggregate size. C concentrations of light fraction in all aggregate classes were significantly higher under NT and forest than under CT. C concentrations in heavy fraction averaged 20, 10, and 8 g kg−1 under forest, NT, and CT, respectively. Of the total SOC pool, heavy fraction C accounted for 76% in CT soils and 63% in forest and NT soils. These data suggest that there is a greater protection of SOC by aggregates in the light fraction of minimally disturbed soils than that of disturbed soil, and the SOC loss following conversion from forest to agriculture is attributed to reduction in C concentrations in both heavy and light fractions. In contrast, the SOC gain upon conversion from CT to NT is primarily attributed to an increase in C concentration in the light fraction.

ERICA: prevalences of hypertension and obesity in Brazilian adolescents

PubMed Central

Bloch, Katia Vergetti; Klein, Carlos Henrique; Szklo, Moyses; Kuschnir, Maria Cristina C; Abreu, Gabriela de Azevedo; Barufaldi, Laura Augusta; da Veiga, Gloria Valeria; Schaan, Beatriz; da Silva, Thiago Luiz Nogueira; de Vasconcellos, Maurício Teixeira Leite

2016-01-01

ABSTRACT OBJECTIVE To estimate the prevalence of arterial hypertension and obesity and the population attributable fraction of hypertension that is due to obesity in Brazilian adolescents. METHODS Data from participants in the Brazilian Study of Cardiovascular Risks in Adolescents (ERICA), which was the first national school-based, cross-section study performed in Brazil were evaluated. The sample was divided into 32 geographical strata and clusters from 32 schools and classes, with regional and national representation. Obesity was classified using the body mass index according to age and sex. Arterial hypertension was defined when the average systolic or diastolic blood pressure was greater than or equal to the 95th percentile of the reference curve. Prevalences and 95% confidence intervals (95%CI) of arterial hypertension and obesity, both on a national basis and in the macro-regions of Brazil, were estimated by sex and age group, as were the fractions of hypertension attributable to obesity in the population. RESULTS We evaluated 73,399 students, 55.4% female, with an average age of 14.7 years (SD = 1.6). The prevalence of hypertension was 9.6% (95%CI 9.0-10.3); with the lowest being in the North, 8.4% (95%CI 7.7-9.2) and Northeast regions, 8.4% (95%CI 7.6-9.2), and the highest being in the South, 12.5% (95%CI 11.0-14.2). The prevalence of obesity was 8.4% (95%CI 7.9-8.9), which was lower in the North region and higher in the South region. The prevalences of arterial hypertension and obesity were higher in males. Obese adolescents presented a higher prevalence of hypertension, 28.4% (95%CI 25.5-31.2), than overweight adolescents, 15.4% (95%CI 17.0-13.8), or eutrophic adolescents, 6.3% (95%CI 5.6-7.0). The fraction of hypertension attributable to obesity was 17.8%. CONCLUSIONS ERICA was the first nationally representative Brazilian study providing prevalence estimates of hypertension in adolescents. Regional and sex differences were observed. The study indicates that the control of obesity would lower the prevalence of hypertension among Brazilian adolescents by 1/5. PMID:26910553

Risk factors for stillbirth in developing countries: a systematic review of the literature.

PubMed

Di Mario, Simona; Say, Lale; Lincetto, Ornella

2007-07-01

To identify risk factors for stillbirth in developing countries and to measure their impact by calculating the population attributable fraction (PAF) for each risk factor. Systematic review of published studies on risk factors for stillbirth within 3 broadly defined categories: infections, other clinical conditions, and context-dependent conditions such as socioeconomic status, maternal literacy, and receipt of antenatal care. Where statistically significant associations were found between a risk factor and occurrence of stillbirth, the PAF (the proportion of cases occurring in the total population that would be avoided if the exposure was removed) was calculated. A total of 33 studies, conducted in 31 developing countries, were included in the review. The definition of stillbirth varied widely in these studies. Risk factors for stillbirth having a PAF higher than 50% were maternal syphilis, chorioamnionitis, maternal malnutrition, lack of antenatal care, and maternal socioeconomic disadvantage. Maternal syphilis prevention, screening and treatment together with other interventions targeting universal use of antenatal care (that includes screening for syphilis) and improving the socioeconomic conditions including nutritional status of the mother, could effectively contribute towards reducing the unacceptably high burden due to stillbirth in developing countries.

Impact on the Japanese atomic bomb survivors of radiation received from the bombs.

PubMed

Cullings, Harry M

2014-02-01

The Radiation Effects Research Foundation (RERF) studies various cohorts of Japanese atomic bomb survivors, the largest being the Life Span Study (LSS), which includes 93,741 persons who were in Hiroshima or Nagasaki at the times of the bombings; there are also cohorts of persons who were exposed in utero and survivors' children. This presentation attempts to summarize the total impact of the radiation from the bombs on the survivors from both an individual perspective (both age-specific and integrated lifetime risk, along with a measure of life expectancy that describes how the risk affects the individual given age at exposure) and a group perspective (estimated numbers of excess occurrences in the cohort), including both early and late effects. As survivors' doses ranged well into the acutely lethal range at closer distances, some of them experienced acute signs and symptoms of radiation exposure in addition to being at risk of late effects. Although cancer has always been a primary concern among late effects, estimated numbers of excess cancers and hematopoietic malignancies in the LSS are a small fraction of the total due to the highly skewed dose distribution, with most survivors receiving small doses. For example, in the latest report on cancer incidence, 853 of 17,448 incident solid cancers were estimated to be attributable to radiation from the bombs. RERF research indicates that risk of radiation-associated cancer varies among sites and that some benign tumors such as uterine myoma are also associated with radiation. Noncancer late effects appear to be in excess in proportion to radiation dose but with an excess relative risk about one-third that of solid cancer and a correspondingly small overall fraction of cases attributable to radiation. Specific risks were found for some subcategories, particularly circulatory disease, including stroke and precedent conditions such as hypertension. Radiation-related cataract in the atomic bomb survivors is well known, with evidence in recent years of risk at lower dose levels than previously appreciated. In addition to somatic effects, survivors experienced psychosocial effects such as uncertainty, social stigma, or rejection, and other social pressures. Developmental deficits associated with in utero exposure, notably cognitive impairment, have also been described. Interaction of radiation with other risk factors has been demonstrated in relation to both cancer and noncancer diseases. Current research interests include whether radiation increases risk of diabetes or conditions of the eye apart from cataract, and there continues to be keen interest as to whether there are heritable effects in survivors' children, despite negative findings to date. Introduction of Impact on the Japanese Atomic- Bomb Survivors (Video 1:52, http://links.lww.com/HP/A29).

Risk factors for unsuccessful dog ownership: an epidemiologic study in Taiwan.

PubMed

Weng, Hsin-Yi; Kass, Philip H; Hart, Lynette A; Chomel, Bruno B

2006-11-17

This retrospective study of 259 Taiwanese dog owners in 2004 addressed one of the major contributors to dog overpopulation in Taiwan: unsuccessful dog ownership. We found an inverse association between age of the dog at acquisition and risk of unsuccessful dog ownership: the younger the dog at acquisition the higher the risk. The incidence-proportion ratios (IPRs) of unsuccessful dog ownership for the owners who had a history of pet abandonment or losing a pet compared with those without such a history were 1.8 (95% confidence interval (CI)=1.1, 3.0) and 2.1 (95% CI=1.3, 3.3), respectively. Soiling (IPR=2.0, 95% CI=1.3, 3.1) and barking (IPR=1.6, 95% CI=1.0, 2.6) problems had the strongest effects on unsuccessful dog ownership among the post-acquisition variables studied. Preventing owners with a history of unsuccessful dog ownership from acquiring dogs was predicted to yield the largest reduction of risk of unsuccessful dog ownership among the investigated variables (population attributable fraction=33%, 95% CI=11%, 50%).

Disparities in Smoking-Related Mortality Among American Indians/Alaska Natives.

PubMed

Mowery, Paul D; Dube, Shanta R; Thorne, Stacy L; Garrett, Bridgette E; Homa, David M; Nez Henderson, Patricia

2015-11-01

Smoking-related disparities continue to be a public health problem among American Indian/Alaska Native (AI/AN) population groups and data documenting the health burden of smoking in this population are sparse. The purpose of this study was to assess mortality attributable to cigarette smoking among AI/AN adults relative to non-Hispanic white adults (whites) by calculating and comparing smoking-attributable fractions and mortality. Smoking-attributable fractions and mortality among AI/ANs (n=1.63 million AI/ANs) and whites were calculated for people living in 637 Indian Health Service Contract Health Service Delivery Area counties in the U.S., from mortality data collected during 2001-2009. Differences in smoking-attributable mortality between AI/ANs and whites for five major causes of smoking-related deaths were examined. All data analyses were carried out in 2013-2014. Overall, from 2001 to 2009, age-adjusted death rates, smoking-attributable fractions, and smoking-attributable mortality for all-cause mortality were higher among AI/ANs than among whites for adult men and women aged ≥35 years. Smoking caused 21% of ischemic heart disease, 15% of other heart disease, and 17% of stroke deaths in AI/AN men, compared with 15%, 10%, and 9%, respectively, for white men. Among AI/AN women, smoking caused 18% of ischemic heart disease deaths, 13% of other heart diseases deaths, and 20% of stroke deaths, compared with 9%, 7%, and 10%, respectively, among white women. These findings underscore the need for comprehensive tobacco control and prevention efforts that can effectively reach and impact the AI/AN population to prevent and reduce smoking. Copyright © 2015 American Journal of Preventive Medicine. All rights reserved.

Design and statistical problems in prevention.

PubMed

Gullberg, B

1996-01-01

Clinical and epidemiological research in osteoporosis can benefit from using the methods and techniques established in the area of chronic disease epidemiology. However, attention has to be given to the special characteristics such as the multifactorial nature and the fact that the subjects usually are of high ages. In order to evaluate prevention it is of course first necessary to detect and confirm reversible risk factors. The advantage and disadvantage of different design (cross-sectional, cohort and case-control) are well known. The effects of avoidable biases, e.g. selection, observation and confounding have to be balanced against practical conveniences like time, expenses, recruitment etc. The translation of relative risks into population attributable risks (etiologic fractions, prevented fractions) are complex and are usually performed under unrealistic, simplified assumptions. The consequences of interactions (synergy) between risk factors are often neglected. The multifactorial structure requires application of more advanced multi-level statistical techniques. The common strategy in prevention to target a cluster of risk factors in order to avoid the multifactorial nature implies that in the end it is impossible to separate each unique factor. Experimental designs for evaluating prevention like clinical trials and intervention have to take into account the distinction between explanatory and pragmatic studies. An explanatory approach is similar to an idealized laboratory trial while the pragmatic design is more realistic, practical and has a general public health perspective. The statistical techniques to be used in osteoporosis research are implemented in easy available computer-packages like SAS, SPSS, BMDP and GLIM. In addition to the traditional logistic regression methods like Cox analysis and Poisson regression also analysis of repeated measurement and cluster analysis are relevant.

National and subnational mortality and disability-adjusted life years (DALYs) attributable to 17 occupational risk factors in Iran, 1990-2015.

PubMed

Abtahi, Mehrnoosh; Koolivand, Ali; Dobaradaran, Sina; Yaghmaeian, Kamyar; Khaloo, Shokooh Sadat; Jorfi, Sahand; Keshmiri, Saeed; Nafez, Amir Hossein; Saeedi, Reza

2018-04-26

We estimated age-sex specific and cause-specific mortality, years of life lost due to premature mortality (YLLs), years lived with disability (YLDs) and disability-adjusted life years (DALYs) attributable to 17 individual occupational risks in Iran at the national and subnational levels in 1990-2015 based on the Global Burden of Disease Study 2015 (GBD 2015). The burden of disease attributable to occupational risk factors was calculated using the comparative risk assessment methodology based on 10 outcomes and 21 risk-outcome pairs. The temporal changes in the attributable burden of disease were decomposed into the contribution of population growth, population ageing, risk-deleted DALY rate, and risk exposure. National DALYs attributable to occupational risks at the national level in 1990, 2005, and 2015 were 138,210 (95% uncertainty interval 64,429-223,028), 193,243 (91,645-310,281), and 228,310 (106,782-371,709), respectively indicating a total increase of 65% (65-67) during the study period. Between 1990 and 2015, the share of the attributable DALYs for women rose by 55% (51-58) from 13% (12-14) to 20% (19-21). The proportion of YLLs in national DALYs attributable to occupational risks during the study period slightly decreased from 24% in 1990 to 23% in 2015. The five occupational risks with the highest contributions in the national attributable DALYs in 2015 were ergonomic factors (107,490), noise (52,122), exposure to particulate matter, gases, and fumes (26,847), asthmagens (19,347), and exposure to asbestos (7842). From 1990 to 2015, the increase in total DALYs attributable to occupational carcinogens (112%) was higher than that for other occupational risks. During the study period, changes in risk deleted DALY rate and risk exposure led to decreases in total DALYs attributable to occupational risks by 14% and 30%, respectively. Based on the Gini coefficient, spatial inequality in DALY rate attributable to occupational risks at the provincial level decreased during 1990-2015. A comprehensive plan for management of exposure to occupational risks, especially occupational carcinogens can cause an important effect for control of the increasing trend of occupational health losses. Copyright © 2018 Elsevier Inc. All rights reserved.

Dispersion, Speciation, and Pollution Assessment of Heavy Metals Pb and Zn in Surface Sediment from Disturbed Ecosystem of Jeneberang Waters

NASA Astrophysics Data System (ADS)

Najamuddin; Surahman

2017-10-01

Surface sediments were collected from seventeen stations in Jeneberang waters (riverine, estuarine, and marine). Lead (Pb) and zinc (Zn) concentrations were determined by atomic absorption spectrometry, and the speciation of metals was obtained by a sequential extraction procedure. Dispersion of Pb and Zn were found higher in the riverine and marine samples than the estuarine samples. Following speciation, the metals were found similar composition of fraction in the riverine and estuarine samples but any different in the marine samples. The results indicated that there is a change of dispersion pattern and speciation composition of metals due to the presence of the dam that lies at the boundary between the estuary and the river. The toxicity unit was indicated low toxicity level; pollution level was in weakly to moderately polluted while the aquatic environment risk attributed were no risky to light risk.

Substance use disorders, psychiatric disorders, and mortality after release from prison: a nationwide longitudinal cohort study

PubMed Central

Chang, Zheng; Lichtenstein, Paul; Larsson, Henrik; Fazel, Seena

2015-01-01

Summary Background High mortality rates have been reported in people released from prison compared with the general population. However, few studies have investigated potential risk factors associated with these high rates, especially psychiatric determinants. We aimed to investigate the association between psychiatric disorders and mortality in people released from prison in Sweden. Methods We studied all people who were imprisoned since Jan 1, 2000, and released before Dec 31, 2009, in Sweden for risks of all-cause and external-cause (accidents, suicide, homicide) mortality after prison release. We obtained data for substance use disorders and other psychiatric disorders, and criminological and sociodemographic factors from population-based registers. We calculated hazard ratios (HRs) by Cox regression, and then used them to calculate population attributable fractions for post-release mortality. To control for potential familial confounding, we compared individuals in the study with siblings who were also released from prison, but without psychiatric disorders. We tested whether any independent risk factors improved the prediction of mortality beyond age, sex, and criminal history. Findings We identified 47 326 individuals who were imprisoned. During a median follow-up time of 5·1 years (IQR 2·6–7·5), we recorded 2874 (6%) deaths after release from prison. The overall all-cause mortality rate was 1205 deaths per 100 000 person-years. Substance use disorders significantly increased the rate of all-cause mortality (alcohol use: adjusted HR 1·62, 95% CI 1·48–1·77; drug use: 1·67, 1·53–1·83), and the association was independent of sociodemographic, criminological, and familial factors. We identified no strong evidence that other psychiatric disorders increased mortality after we controlled for potential confounders. In people released from prison, 925 (34%) of all-cause deaths in men and 85 (50%) in women were potentially attributable to substance use disorders. Substance use disorders were also an independent determinant of external-cause mortality, with population attributable fraction estimates at 42% in men and 70% in women. Substance use disorders significantly improved the prediction of external-cause mortality, in addition to sociodemographic and criminological factors. Interpretation Interventions to address substance use disorders could substantially decrease the burden of excess mortality in people released from prison, but might need to be provided beyond the immediate period after release. Funding Wellcome Trust, Swedish Research Council, and the Swedish Research Council for Health, Working Life and Welfare. PMID:26360286

Impacts of Illiteracy on the Risk of Dementia: A Global Health Perspective.

PubMed

Suh, Seung Wan; Han, Ji Won; Park, Jae Young; Hong, Jong Woo; Kim, Kayoung; Kim, Taehyun; Lee, Kyoung Hwan; Han, Guehee; Jeong, Hyeon; Seo, Jiyeong; Kim, Tae Hui; Lee, Dong Young; Lee, Dong Woo; Ryu, Seung-Ho; Kim, Shin-Gyeom; Youn, Jong Chul; Jhoo, Jin Hyeong; Kim, Jeong Lan; Lee, Seok Bum; Lee, Jung Jae; Kwak, Kyung Phil; Kim, Bong-Jo; Moon, Seok Woo; Park, Joon Hyuk; Kim, Ki Woong

2016-05-23

Despite its significance as a contributing factor for late-life dementia risk, illiteracy is frequently underappreciated in the management of dementia. In this study, we estimated the proportion of dementia cases attributable to illiteracy using the population attributable fraction (PAF), and calculated to what extent the monetary cost of dementia could be saved in the future by reducing illiteracy from the South Korean, Latin American, South Asian/Middle Eastern, and African populations. We collected necessary data from the 2011 United Nations Human Development Report and prevalence studies conducted in these regions. Additional variables not included in the above sources were estimated using a logit model under a "trend scenario"-based assumption. Around 16% of the total number of dementia cases in South Korea in 2015 can be attributed to illiteracy, with this figure predicted to decline to around 2% by 2050. This translates to a saving in dementia care costs of approximately 52 billion USD, providing we are successful in theoretically eradicating illiteracy as of 2015, in the population aged 65 years or under. Likewise, reducing illiteracy to 50% in Latin America, South Asia/The Middle East, and Africa by 2050 could generate further cost savings of between 71 and 244 billion, 13 and 94 billion, and 17 and 78 billion USD, respectively. Even public policies aimed solely at reducing illiteracy in the childhood, adolescent, or middle-aged population could potentially have a role in the primary prevention of dementia. Moving forward, governments will need to address this issue in a purposeful and systematic manner.

Acute Gastrointestinal Illness Risks in North Carolina Community Water Systems: A Methodological Comparison.

PubMed

DeFelice, Nicholas B; Johnston, Jill E; Gibson, Jacqueline MacDonald

2015-08-18

The magnitude and spatial variability of acute gastrointestinal illness (AGI) cases attributable to microbial contamination of U.S. community drinking water systems are not well characterized. We compared three approaches (drinking water attributable risk, quantitative microbial risk assessment, and population intervention model) to estimate the annual number of emergency department visits for AGI attributable to microorganisms in North Carolina community water systems. All three methods used 2007-2013 water monitoring and emergency department data obtained from state agencies. The drinking water attributable risk method, which was the basis for previous U.S. Environmental Protection Agency national risk assessments, estimated that 7.9% of annual emergency department visits for AGI are attributable to microbial contamination of community water systems. However, the other methods' estimates were more than 2 orders of magnitude lower, each attributing 0.047% of annual emergency department visits for AGI to community water system contamination. The differences in results between the drinking water attributable risk method, which has been the main basis for previous national risk estimates, and the other two approaches highlight the need to improve methods for estimating endemic waterborne disease risks, in order to prioritize investments to improve community drinking water systems.

Quantitative analysis and reduction of the eco-toxicity risk of heavy metals for the fine fraction of automobile shredder residue (ASR) using H2O2.

PubMed

Singh, Jiwan; Yang, Jae-Kyu; Chang, Yoon-Young

2016-02-01

Automobile shredder residue (ASR) fraction (size <0.25mm) can be considered as hazardous due to presence of high concentrations of heavy metals. Hydrogen peroxide combined with nitric acid has been used for the recovery of heavy metals (Zn, Cu, Mn, Fe, Ni, Pb, Cd and Cr) from the fine fraction of ASR. A sequential extraction procedure has also been used to determine the heavy metal speciation in the fine fraction of ASR before and after treatment. A risk analysis of the fine fraction of ASR before and after treatment was conducted to assess the bioavailability and eco-toxicity of heavy metals. These results showed that the recovery of heavy metals from ASR increased with an increase in the hydrogen peroxide concentration. A high concentration of heavy metals was found to be present in Cbio fractions (the sum of the exchangeable and carbonate fractions) in the fine fraction of ASR, indicating high toxicity risk. The Cbio rate of all selected heavy metals was found to range from 8.6% to 33.4% of the total metal content in the fine fraction of ASR. After treatment, Cbio was reduced to 0.3-3.3% of total metal upon a treatment with 2.0% hydrogen peroxide. On the basis of the risk assessment code (RAC), the environmental risk values for heavy metals in the fine fraction of ASR reflect high risk/medium risk. However, after treatment, the heavy metals would be categorized as low risk/no risk. The present study concludes that hydrogen peroxide combined with nitric acid is a promising treatment for the recovery and reduction of the eco-toxicity risk of heavy metals in ASR. Copyright © 2015 Elsevier Ltd. All rights reserved.

Stated preferences for anti-malarial drug characteristics in Zomba, a malaria endemic area of Malawi

PubMed Central

2014-01-01

Background The evidence on determinants of individuals’ choices for anti-malarial drug treatments is scarce. This study sought to measure the strength of preference for adult antimalarial drug treatment attributes of heads of urban, rural and peri-urban households in a resource-limited malaria-endemic area of sub-Saharan Africa. Methods Discrete choice experiments were conducted with 508 heads of household interviewed face-to-face for a household population survey of health-seeking behavior in Zomba District, Malawi. The interviews were held in Chichewa and the choice experiment questions were presented with cartoon aids. The anti-malarial drug attributes included in the stated preference experiment were: speed of fever resolution, side effects (pruritus) risk, protection (duration of prophylactic effect), price, duration of treatment course and recommendation by a health professional. Sixteen treatment profiles from a fractional factorial design by orthogonal array were paired into choice scenarios, and scenarios were randomly assigned to participants so that each participant was presented with a series of eight pairwise choice scenarios. Respondents had the option to state indifference between the two profiles or decline to choose. Data were analysed in a mixed logit model, with normally distributed coefficients for all six attributes. Results The sex ratio was balanced in urban areas, whereas 63% of participants in rural areas were male. The proportion of individuals with no education was considerably higher in the rural group (25%) than in the urban (5%) and peri-urban (6%) groups. All attributes investigated had the expected influence, and traded-off in most respondents’ choices. There were heterogeneous effects of price, pruritus risk, treatment recommendation by a professional, and duration of prophylaxis across respondents, only partly explained by their differences in education, household per capita expenditure, sex and age. Individuals´ demand elasticity (simulated median, inter-quartile range) was highest (most responsive) to speed of symptom resolution (0.88, 0.80-0.89) and pruritus risk (0.25, 0.08-0.62). Conclusions Most adult antimalarial users are willing to use treatments without recommendation from health professional, and may be influenced by price. Future studies should investigate the magnitude of differences in price and treatment attribute sensitivity between adult anti-malarial drug users in rural, peri-urban and urban areas in order to determine optimal price subsidies. PMID:25005466

Quantification of alcohol-related mortality in Sweden.

PubMed

Sjögren, H; Eriksson, A; Broström, G; Ahlm, K

2000-01-01

The main aim of the present study was to estimate total alcohol-related mortality in Sweden. For natural deaths, a meta-analysis carried out in Australia was updated to the end of March 1998, and pooled estimates of the relative risks were calculated for different diseases based on data from scientific studies that have been published in the international literature. The proportion of current alcohol drinkers from recent Swedish surveys, and the pooled relative risk estimates were used to estimate disease-specific alcohol-attributable fractions. Natural deaths 'caused' or 'prevented' by alcohol were estimated for the period 1992-1996. For unnatural deaths, all cases from 1992 through 1996 in Sweden were analysed (n = 23 132). Alcohol was regarded to attribute to the death: if the deceased was a 'known alcoholic'; if the underlying or contributing cause of death was alcohol-related; if the deceased had an alcohol-related in-patient diagnosis during a 3-year period prior to death; if the case tested positive for blood alcohol. Person years of life lost/gained (<70 years) due to alcohol were also assessed. The assumptions underlying the attributable risk methods used to analyse alcohol-related mortality due to natural causes need to be borne in mind when interpreting the results on natural deaths. Moreover, the preventive effect of alcohol on coronary heart disease and stroke is still controversial. The findings of alcohol-related mortality due to unnatural causes were much more reliable. About 3.5% of deaths were attributed to alcohol; alcohol involvement was more than twice as common in deaths of males (4.8%) than in those of females (2.0%). About one-quarter of the deaths in those aged below 50 years were attributed to alcohol. In those (

Analysis of Intervention Strategies for Inhalation Exposure to Polycyclic Aromatic Hydrocarbons and Associated Lung Cancer Risk Based on a Monte Carlo Population Exposure Assessment Model

PubMed Central

Zhou, Bin; Zhao, Bin

2014-01-01

It is difficult to evaluate and compare interventions for reducing exposure to air pollutants, including polycyclic aromatic hydrocarbons (PAHs), a widely found air pollutant in both indoor and outdoor air. This study presents the first application of the Monte Carlo population exposure assessment model to quantify the effects of different intervention strategies on inhalation exposure to PAHs and the associated lung cancer risk. The method was applied to the population in Beijing, China, in the year 2006. Several intervention strategies were designed and studied, including atmospheric cleaning, smoking prohibition indoors, use of clean fuel for cooking, enhancing ventilation while cooking and use of indoor cleaners. Their performances were quantified by population attributable fraction (PAF) and potential impact fraction (PIF) of lung cancer risk, and the changes in indoor PAH concentrations and annual inhalation doses were also calculated and compared. The results showed that atmospheric cleaning and use of indoor cleaners were the two most effective interventions. The sensitivity analysis showed that several input parameters had major influence on the modeled PAH inhalation exposure and the rankings of different interventions. The ranking was reasonably robust for the remaining majority of parameters. The method itself can be extended to other pollutants and in different places. It enables the quantitative comparison of different intervention strategies and would benefit intervention design and relevant policy making. PMID:24416436

Burden of disease attributed to ambient air pollution in Thailand: A GIS-based approach.

PubMed

Pinichka, Chayut; Makka, Nuttapat; Sukkumnoed, Decharut; Chariyalertsak, Suwat; Inchai, Puchong; Bundhamcharoen, Kanitta

2017-01-01

Growing urbanisation and population requiring enhanced electricity generation as well as the increasing numbers of fossil fuel in Thailand pose important challenges to air quality management which impacts on the health of the population. Mortality attributed to ambient air pollution is one of the sustainable development goals (SDGs). We estimated the spatial pattern of mortality burden attributable to selected ambient air pollution in 2009 based on the empirical evidence in Thailand. We estimated the burden of disease attributable to ambient air pollution based on the comparative risk assessment (CRA) framework developed by the World Health Organization (WHO) and the Global Burden of Disease study (GBD). We integrated geographical information systems (GIS)-based exposure assessments into spatial interpolation models to estimate ambient air pollutant concentrations, the population distribution of exposure and the concentration-response (CR) relationship to quantify ambient air pollution exposure and associated mortality. We obtained air quality data from the Pollution Control Department (PCD) of Thailand surface air pollution monitoring network sources and estimated the CR relationship between relative risk (RR) and concentration of air pollutants from the epidemiological literature. We estimated 650-38,410 ambient air pollution-related fatalities and 160-5,982 fatalities that could have been avoided with a 20 reduction in ambient air pollutant concentrations. The summation of population-attributable fraction (PAF) of the disease burden for all-causes mortality in adults due to NO2 and PM2.5 were the highest among all air pollutants at 10% and 7.5%, respectively. The PAF summation of PM2.5 for lung cancer and cardiovascular disease were 16.8% and 14.6% respectively and the PAF summations of mortality attributable to PM10 was 3.4% for all-causes mortality, 1.7% for respiratory and 3.8% for cardiovascular mortality, while the PAF summation of mortality attributable to NO2 was 7.8% for respiratory mortality in Thailand. Mortality due to ambient air pollution in Thailand varies across the country. Geographical distribution estimates can identify high exposure areas for planners and policy-makers. Our results suggest that the benefits of a 20% reduction in ambient air pollution concentration could prevent up to 25% of avoidable fatalities each year in all-causes, respiratory and cardiovascular categories. Furthermore, our findings can provide guidelines for future epidemiological investigations and policy decisions to achieve the SDGs.

Attributions, affect, and behavior in abuse-risk mothers: a laboratory study.

PubMed

Dadds, Mark R; Mullins, Miranda J; McAllister, Ross A; Atkinson, Erin

2003-01-01

There were two main aims: first, to assess parental attributions about child behavior in abuse-risk and nonclinic parents. Second, to assess how attributions predict affective and behavioral reactions to child behavior. Internal-external attributions relating to the causes of child behavior were compared across mothers at-risk of child abuse (n = 40) and mothers who reported no significant parental or child conduct or behavior problems (n = 20). Mothers' attributions about the causes of the behavior of their own child and an unfamiliar child were recorded in response to the presentation of videotaped excerpts of the behavior. Results highlighted that compared with nonclinic mothers, abuse-risk mothers had a tendency to attribute positive child behavior to more external causes and negative child behavior to more internal causes. Differences were also found between parental cognitions about clearly positive, clearly naughty, and ambiguous child behavior. In the abuse-risk group, positive child behavior predicted coercive parenting when it elicited angry feelings in the mother; ambiguous and naughty child behavior led to coercive parenting through valence ratings of "deviant" and attributions of "internality." Analyses within the abuse-risk group showed that parental attributions are predictive of parental coerciveness for unfamiliar behavior. As behavior becomes more familiar, ratings of its valence and the affect it elicits override attributional activity. Parental attributions about the causes of child behavior differ according to the valence and familiarity of that behavior, and discriminate between parents at risk for child abuse. Further, attributions are predictive of the affective and behavioral responses the parent makes to the child's behavior for ambiguous or unfamiliar behavior. Evidence was found for the validity of using videotaped stimuli of the behavior of known and unknown children as a method of assessing parental attributions. Copyright 2002 Elsevier Science Ltd.

Proportion of patients in south London with first-episode psychosis attributable to use of high potency cannabis: a case-control study.

PubMed

Di Forti, Marta; Marconi, Arianna; Carra, Elena; Fraietta, Sara; Trotta, Antonella; Bonomo, Matteo; Bianconi, Francesca; Gardner-Sood, Poonam; O'Connor, Jennifer; Russo, Manuela; Stilo, Simona A; Marques, Tiago Reis; Mondelli, Valeria; Dazzan, Paola; Pariante, Carmine; David, Anthony S; Gaughran, Fiona; Atakan, Zerrin; Iyegbe, Conrad; Powell, John; Morgan, Craig; Lynskey, Michael; Murray, Robin M

2015-03-01

The risk of individuals having adverse effects from drug use (eg, alcohol) generally depends on the frequency of use and potency of the drug used. We aimed to investigate how frequent use of skunk-like (high-potency) cannabis in south London affected the association between cannabis and psychotic disorders. We applied adjusted logistic regression models to data from patients aged 18-65 years presenting to South London and Maudsley NHS Foundation Trust with first-episode psychosis and population controls recruited from the same area of south London (UK) to estimate the effect of the frequency of use, and type of cannabis used on the risk of psychotic disorders. We then calculated the proportion of new cases of psychosis attributable to different types of cannabis use in south London. Between May 1, 2005, and May 31, 2011, we obtained data from 410 patients with first-episode psychosis and 370 population controls. The risk of individuals having a psychotic disorder showed a roughly three-times increase in users of skunk-like cannabis compared with those who never used cannabis (adjusted odds ratio [OR] 2·92, 95% CI 1·52-3·45, p=0·001). Use of skunk-like cannabis every day conferred the highest risk of psychotic disorders compared with no use of cannabis (adjusted OR 5·4, 95% CI 2·81-11·31, p=0·002). The population attributable fraction of first-episode psychosis for skunk use for our geographical area was 24% (95% CI 17-31), possibly because of the high prevalence of use of high-potency cannabis (218 [53%] of 410 patients) in our study. The ready availability of high potency cannabis in south London might have resulted in a greater proportion of first onset psychosis cases being attributed to cannabis use than in previous studies. UK National Institute of Health Research (NIHR) Specialist Biomedical Research Centre for Mental Health, SLaM and the Institute of Psychiatry at King's College London, Psychiatry Research Trust, Maudsley Charity Research Fund, and th European Community's Seventh Framework Program grant (agreement No. HEALTH-F2-2009-241909 [Project EU-GEI]). Copyright © 2015 Di Forti et al. Open Access article distributed under the terms of CC BY. Published by Elsevier Ltd.. All rights reserved.

Perception of risk and the attribution of responsibility for accidents.

PubMed

Rickard, Laura N

2014-03-01

Accidents, one often hears, "happen"; we accept, and even expect, that they will be part of daily life. But in situations in which injury or death result, judgments of responsibility become critical. How might our perceptions of risk influence the ways in which we allocate responsibility for an accident? Drawing from attribution and risk perception theory, this study investigates how perceived controllability and desirability of risk, in addition to perceived danger and recreational risk-taking, relate to attributions of responsibility for the cause of unintentional injury in a unique setting: U.S. national parks. Three parks, Mount Rainier, Olympic, and Delaware Water Gap, provide the setting for this survey-based study, which considers how park visitors (N = 447) attribute responsibility for the cause of a hypothetical visitor accident. Results suggest that respondents tended to make more internal (i.e., related to characteristics of the victim), rather than external (i.e., related to characteristics of the park, or park management) attributions. As respondents viewed park-related risk as controllable, they were more likely to attribute the cause of the accident to the victim. Moreover, among other significant variables, having experienced a similar accident predicted lower internal causal attribution. Opportunities for future research linking risk perception and attribution variables, as well as practical implications for the management of public outdoor settings, are presented. © 2013 Society for Risk Analysis.

Impact of changing US cigarette smoking patterns on incident cancer: risks of 20 smoking-related cancers among the women and men of the NIH-AARP cohort

PubMed Central

Freedman, Neal D; Abnet, Christian C; Caporaso, Neil E; Fraumeni, Joseph F; Murphy, Gwen; Hartge, Patricia; Hollenbeck, Albert R; Park, Yikyung; Shiels, Meredith S; Silverman, Debra T

2016-01-01

Abstract Background: Historically, US women started smoking at a later age than men and had lower relative risks for smoking-related cancers. However, more recent birth cohorts of women and men have similar smoking histories and have now reached the high-risk age for cancer. The impact of these changes on cancer incidence has not been systematically examined. Methods: Relative risks (RR), 95% confidence intervals (CI) and attributable fractions were calculated for cigarette smoking and incidence of 20 smoking-related cancers in 186 057 women and 266 074 men of the National Institutes of Health-AARP cohort, aged 50 to 71 years in 1995 and followed for 11 years. Results: In the cohort, which included participants born between 1924 and 1945, most women and men started smoking as teenagers. RRs for current vs never smoking were similar in women and men for the following cancers: lung squamous-cell (RR women: 121.4, 95% CI: 57.3–257.4; RR men:114.6, 95% CI: 61.2–214.4), lung adenocarcinoma (RR women: 11.7, 95% CI: 9.8–14.0; RR men: 15.6, 95% CI: 12.5–19.6), laryngeal (RR women: 37.0, 95% CI: 14.9–92.3; RR men: 13.8, 95% CI: 9.3–20.2), oral cavity-pharyngeal (RR women:4.4, 95% CI: 3.3–6.0; RR men: 3.8, 95% CI: 3.0–4.7), oesophageal squamous cell (RR women: 7.3, 95% CI: 3.5–15.5; RR men: 6.2, 95% CI: 2.8–13.7), bladder (RR women: 4.7, 95% CI: 3.7–5.8; RR men: 4.0, 95% CI: 3.5–4.5), colon (RR women: 1.3, 95% CI: 1.2–1.5; RR men: 1.3, 95% CI: 1.1–1.4), and at other sites, with similar attributable fractions. Conclusions: RRs for current smoking and incidence of many smoking-related cancers are now similar in US women and men, likely reflecting converging smoking patterns. PMID:26411408

Intake fraction of PM2.5 and NOX from vehicle emissions in Beijing based on personal exposure data

NASA Astrophysics Data System (ADS)

Du, Xuan; Wu, Ye; Fu, Lixin; Wang, Shuxiao; Zhang, Shaojun; Hao, Jiming

2012-09-01

The intake fraction (iF) is the portion of attributable population intake of a source emissions, and is used to link pollutant emissions and population exposure. This study is the first work that reported individual intake fraction of PM2.5 and NOX from vehicle emissions based on personal exposure data in China. We employed PM2.5 and NOX measurement data from 24-h personal exposure sampling and concentration monitoring in traffic environments in the urban area of Beijing to estimate the individual intake fraction (iFi). iFi distributions are presented in microenvironments (traffic, work, home) for adults and children. The individual results are used to calculate the intake fraction for the children group and the adults group in the urban area of Beijing. The iF of PM2.5 for the whole population of these two groups in Beijing is 153 per million, which is significantly higher than those estimates in the United States (1-50 per million) and Mexico (23-120 per million). The iF of NOX is 70 per million, among which the intake in the traffic micro-environment ranks first compared to the iF in the home and office due to a high accumulation of NOX concentration in vehicles. PM2.5 and NOX intake fraction values from vehicle emissions in this study are from at least several times to one order of magnitude higher than those from other industry sources in China. This strongly suggests the health risk from vehicle emissions is significantly higher. Therefore, to protect human health, especially for the large number of people living in the cities of China, controlling vehicle emissions should be the highest priority.

Disparities in Maternal Child and Health Outcomes Attributable to Prenatal Tobacco Use

PubMed Central

Mohlman, Mary Katherine; Levy, David T.

2015-01-01

Objectives Previous estimates of smoking-attributable adverse outcomes, such as preterm births (PTBs), low birth weight (LBW) and Sudden Infant Death Syndrome (SIDs) generally do not address disparities by maternal age, racial/ethnic group or socioeconomic status (SES). This study develops estimates of smoking-attributable PTB, LBW and SIDS for the US by age, SES and racial/ethnic groupings. Methods Data on the number of births and the prevalence of PTB, LBW and SIDS were used to develop the number of outcomes by age, race/ethnicity, and SES. The prevalence of prenatal smoking by age, race/ethnic and education and the relative risk of outcomes for smokers were used to calculate smoking-attributable fractions of outcomes. Results Prenatal smoking among ages 15-24 is above 12%, with 20-24 year olds representing at least 35% of PTB, LBW SIDS cases. Women with a high school education or less represented more than 50% of PTB and LBW births, and 44% of SIDS cases. While non-Hispanic Whites had the majority of smoking-attributable outcomes, non-Hispanic Blacks represented a disproportionately high percentage of PTBs (18%), LBW births (22%), and SIDS cases (13%). Conclusions: Reducing prenatal smoking has the potential to reduce adverse birth outcomes and costs with long-term implications, especially among the young, non-Hispanic Blacks and those of lower SES. Stricter tobacco control policies, especially higher cigarette taxes, higher minimum purchase ages for tobacco and improved cessation interventions can help reduce disparities and the cost to insurers, especially public costs through Medicaid. PMID:26645613

Estimating the burden of disease attributable to lead exposure in South Africa in 2000.

PubMed

Norman, Rosana; Mathee, Angela; Barnes, Brendon; van der Merwe, Lize; Bradshaw, Debbie

2007-08-01

To estimate the burden of disease attributable to lead exposure in South Africa in 2000. World Health Organization comparative risk assessment (CRA) methodology was followed. Recent community studies were used to derive mean blood lead concentrations in adults and children in urban and rural areas. Population-attributable fractions were calculated and applied to revised burden of disease estimates for the relevant disease categories for South Africa in the year 2000. Monte Carlo simulation-modelling techniques were used for the uncertainty analysis. South Africa. Children under 5 and adults 30 years and older. Cardiovascular mortality and disability-adjusted life years (DALYs) in adults 30 years and older and mild mental disability DALYs in children under 5 years. Lead exposure was estimated to cause 1,428 deaths (95% uncertainty interval 1,086-1,772) or 0.27% (95% uncertainty interval: 0.21 - 0.34%) of all deaths in South Africa in 2000. Burden of disease attributed to lead exposure was dominated by mild mental disability in young children, accounting for 75% of the total 58,939 (95% uncertainty interval 55,413 - 62,500) attributable DALYs. Cardiovascular disease in adults accounted for the remainder of the burden. Even with the phasing out of leaded petrol, exposure to lead from its ongoing addition to paint, para-occupational exposure and its use in backyard 'cottage industries' will continue to be an important public health hazard in South Africa for decades. Young children, especially those from disadvantaged communities, remain particularly vulnerable to lead exposure and poisoning.

Characterization of taste-active fractions in red wine combining HPLC fractionation, sensory analysis and ultra performance liquid chromatography coupled with mass spectrometry detection.

PubMed

Sáenz-Navajas, María-Pilar; Ferreira, Vicente; Dizy, Marta; Fernández-Zurbano, Purificación

2010-07-19

Five Tempranillo wines exhibiting marked differences in taste and/or astringency were selected for the study. In each wine the non-volatile extract was obtained by freeze-drying and further liquid extraction in order to eliminate remaining volatile compounds. This extract was fractionated by semipreparative C18-reverse phase-high performance liquid chromatography (C18-RP-HPLC) into nine fractions which were freeze-dried, reconstituted with water and sensory assessed for taste attributes and astringency by a specifically trained sensory panel. Results have shown that wine bitterness and astringency cannot be easily related to the bitter and astringent character of the HPLC fractions, what can be due to the existence of perceptual and physicochemical interactions. While the bitter character of the bitterest fractions may be attributed to some flavonols (myricetin, quercetin and their glycosides) the development of a sensitive UPLC-MS method to quantify astringent compounds present in wines has made it possible to demonstrate that proanthocyanidins monomers, dimers, trimers and tetramers, both galloylated or non-galloylated are not relevant compounds for the perceived astringency of the fractions, while cis-aconitic acid, and secondarily vainillic, and syringic acids and ethyl syringate, are the most important molecules driving astringency in two of the fractions (F5 and F6). The identity of the chemicals responsible for the astringency of the third fraction could be assigned to some proanthocyanidins (higher than the tetramer) capable to precipitate with ovalbumin. 2010 Elsevier B.V. All rights reserved.

Message Formats, Numeracy, Risk Perceptions of Alcohol-Attributable Cancer, and Intentions for Binge Drinking among College Students

ERIC Educational Resources Information Center

Chen, Yixin; Yang, Z. Janet

2015-01-01

We conducted an experiment to examine whether risk perceptions of alcohol-attributable cancer influence college students' binge-drinking intention and to explore how message formats (text, table, and graph) and numeracy influence risk perceptions of alcohol-attributable cancer. We found that a majority of participants (87%) perceive some risks of…

Health care and lost productivity costs of overweight and obesity in New Zealand.

PubMed

Lal, Anita; Moodie, Marj; Ashton, Toni; Siahpush, Mohammad; Swinburn, Boyd

2012-12-01

To estimate the costs of health care and lost productivity attributable to overweight and obesity in New Zealand (NZ) in 2006. A prevalence-based approach to costing was used in which costs were calculated for all cases of disease in the year 2006. Population attributable fractions (PAFs) were calculated based on the relative risks obtained from large cohort studies and the prevalence of overweight and obesity. For each disease, the PAF was multiplied by the total health care cost. The costs of lost productivity associated with premature mortality were estimated using both the Human Capital approach (HCA) and Friction Cost approach (FCA). Health care costs attributable to overweight and obesity were estimated to be NZ$686m or 4.5% of New Zealand's total health care expenditure in 2006. The costs of lost productivity using the FCA were estimated to be NZ$98m and NZ$225m using the HCA. The combined costs of health care and lost productivity using the FCA were $784m and $911m using the HCA. The cost burden of overweight and obesity in NZ is considerable. Policies and interventions are urgently needed to reduce the prevalence of obesity thereby decreasing these substantial costs. © 2012 The Authors. ANZJPH © 2012 Public Health Association of Australia.

Prevalence of frailty and contributory factors in three Chinese populations with different socioeconomic and healthcare characteristics.

PubMed

Woo, Jean; Zheng, Zheng; Leung, Jason; Chan, Piu

2015-12-09

Frailty predicts dependence and mortality, and is an important health indicator for aging populations. Comparing frailty prevalence between populations of the same ethnicity but different socioeconomic, lifestyle, health and social care systems, and environmental characteristics would address the role of these factors in contributing to frailty. We compare frailty prevalence and contributory factors across three Chinese populations: Beijing rural, Beijing urban, and Hong Kong (urban). Older people aged 65 years and above living in the community were invited to respond to a general health questionnaire covering demographic, socioeconomic, medical and drug histories, geriatric syndromes, assessment of physical and cognitive functioning, psychological wellbeing and nutritional status. Frailty is defined as an index calculated from multiple deficits > = 0.25 (FI). The ratio of FI/life expectancy at birth was used as an indicator of compression of morbidity. Risk factors and attributable fraction for frailty were compared across the three cohorts. The prevalence of frailty increases with age in all three cohorts, and was lower among rural compared with urban (Beijing and Hong Kong) populations. The highest FI/LE ratio was observed in the Beijing urban population, followed by Hong Kong, with the Beijing rural population having the lowest ratio. Risk factors for frailty were similar in all three populations. Those having the highest ORs were multi-morbidity (number of diseases > = 3), polypharmacy (number of drugs > = 4), age 85+, female gender, followed by low education level, and physical inactivity. For all three cohorts, age and multi-morbidity constitute the highest attributable fraction, and were highest in the Beijing rural cohort. A major difference between the Beijing and Hong Kong cohorts is the high AF from polypharmacy in Beijing and the 'protective' contribution of being married; and the effect of being a teetotaler in the Hong Kong cohort. This comparison draws attention to the importance of frailty prevention for ageing populations.

Role of mucosal high-risk human papillomavirus types in head and neck cancers in central India.

PubMed

Gheit, Tarik; Anantharaman, Devasena; Holzinger, Dana; Alemany, Laia; Tous, Sara; Lucas, Eric; Prabhu, Priya Ramesh; Pawlita, Michael; Ridder, Ruediger; Rehm, Susanne; Bogers, Johannes; Maffini, Fausto; Chiocca, Susanna; Lloveras, Belén; Kumar, Rekha Vijay; Somanathan, Thara; de Sanjosé, Silvia; Castellsagué, Xavier; Arbyn, Marc; Brennan, Paul; Sankaranarayanan, Rengaswamy; Pillai, Madhavan Radhakrishna; Gangane, Nitin; Tommasino, Massimo

2017-07-01

Mucosal high-risk (HR) human papillomaviruses (HPV) cause a subset of head and neck cancers (HNC). The HPV-attributable fraction of HNC varies substantially between countries. Although HNC has a very high incidence in the Indian subcontinent, information on the contribution of HPV infection is limited. Here, we evaluated the HPV-attributable fraction in HNC (N = 364) collected in a central region of India. HNC from three different anatomical subsites were included, namely, oral cavity (n = 252), oropharynx (n = 53) and hypopharynx/larynx (n = 59). In this retrospective study, HPV-driven HNC were defined by presence of both viral DNA and RNA. Overexpression of p16 INK4a was also evaluated. HR-HPV DNA was detected in 13.7% of the cases; however, only 2.7% were positive for both HPV DNA and RNA. The highest percentage of HPV DNA/RNA double positivity was found in oropharynx (9.4%), followed by larynx (1.7%) and oral cavity (1.6%) (p = 0.02). More than half of HPV DNA/RNA-positive cases were p16 INK4a -negative, while a considerable number of HPV RNA-negative cases were p16 INK4a -positive (17.9%). HPV16 was the major type associated with HNC (60.0%), although cases positive for HPV18, 35 and 56 were also detected. Our data indicate that the proportion and types of mucosal HR-HPV associated with HNC in this central Indian region differ from those in other (developed) parts of the world. This may be explained by differences in smoking and/or sexual behaviour compared with North America and northern Europe. Moreover, we show that p16 INK4a staining appeared not to be a good surrogate marker of HPV transformation in the Indian HNC cases. © 2017 UICC.

County Poverty Concentration and Disparities in Unintentional Injury Deaths: A Fourteen-Year Analysis of 1.6 Million U.S. Fatalities

PubMed Central

Karb, Rebecca A.; Subramanian, S. V.; Fleegler, Eric W.

2016-01-01

Unintentional injury is the fourth leading cause of death in the United States, and mortality due to injury has risen over the past decade. The social determinants behind these rising trends have not been well documented. This study examines the relationship between county-level poverty and unintentional injury mortality in the United States from 1999–2012. Complete annual compressed mortality and population data for 1999–2012 were obtained from the National Center for Health Statistics and linked with census yearly county poverty measures. The outcomes examined were unintentional injury fatalities, overall and by six specific mechanisms: motor vehicle collisions, falls, accidental discharge of firearms, drowning, exposure to smoke or fire, and unintentional poisoning. Age-adjusted mortality rates and time trends for county poverty categories were calculated, and multivariate negative binomial regression was used to determine changes over time in both the relative risk of living in high poverty concentration areas and the population attributable fraction. Age-adjusted mortality rates for counties with > 20% poverty were 66% higher mortality in 1999 compared with counties with < 5% poverty (45.25 vs. 27.24 per 100,000; 95% CI for rate difference 15.57,20.46), and that gap widened in 2012 to 79% (44.54 vs. 24.93; 95% CI for rate difference 17.13,22.09). The relative risk of living in the highest poverty counties has increased for all injury mechanisms with the exception of accidental discharge of firearms. The population attributable fraction for all unintentional injuries rose from 0.22 (95% CI 0.13,0.30) in 1999 to 0.35 (95% CI 0.22,0.45) in 2012. This is the first study that uses comprehensive mortality data to document the associations between county poverty and injury mortality rates for the entire US population over a 14 year period. This study suggests that injury reduction interventions should focus on areas of high or increasing poverty. PMID:27144919

Effect of Exposure to Smoking in Movies on Young Adult Smoking in New Zealand

PubMed Central

Gendall, Philip; Hoek, Janet; Edwards, Richard; Glantz, Stanton

2016-01-01

Onscreen Smoking Is a Form of Tobacco Marketing Tobacco advertising has been prohibited in New Zealand since 1990, and the government has set a goal of becoming a smokefree nation by 2025. However, tobacco marketing persists indirectly through smoking in motion pictures, and there is strong evidence that exposure to onscreen smoking causes young people to start smoking. We investigated the relationship between exposure to smoking in movies and youth smoking initiation among New Zealand young adults. Data from an online survey of 419 smokers and non-smokers aged 18 to 25 were used to estimate respondents’ exposure to smoking occurrences in 50 randomly-selected movies from the 423 US top box office movies released between 2008 and 2012. Analyses involved calculating movie smoking exposure (MSE) for each respondent, using logistic regression to analyse the relationship between MSE and current smoking behaviour, and estimating the attributable fraction due to smoking in movies. Effect of Smoking in Movies on New Zealand Youth Exposure to smoking occurrences in movies was associated with current smoking status. After allowing for the influence of family, friends and co-workers, age and rebelliousness, respondents’ likelihood of smoking increased by 11% for every 100-incident increase in exposure to smoking incidents, (aOR1.11; p< .05). The estimated attributable fraction due to smoking in movies was 54%; this risk could be substantially reduced by eliminating smoking from movies currently rated as appropriate for youth. We conclude that exposure to smoking in movies remains a potent risk factor associated with smoking among young adults, even in a progressive tobacco control setting such as New Zealand. Harmonising the age of legal tobacco purchase (18) with the age at which it is legal to view smoking in movies would support New Zealand’s smokefree 2025 goal. PMID:26960189

County Poverty Concentration and Disparities in Unintentional Injury Deaths: A Fourteen-Year Analysis of 1.6 Million U.S. Fatalities.

PubMed

Karb, Rebecca A; Subramanian, S V; Fleegler, Eric W

2016-01-01

Unintentional injury is the fourth leading cause of death in the United States, and mortality due to injury has risen over the past decade. The social determinants behind these rising trends have not been well documented. This study examines the relationship between county-level poverty and unintentional injury mortality in the United States from 1999-2012. Complete annual compressed mortality and population data for 1999-2012 were obtained from the National Center for Health Statistics and linked with census yearly county poverty measures. The outcomes examined were unintentional injury fatalities, overall and by six specific mechanisms: motor vehicle collisions, falls, accidental discharge of firearms, drowning, exposure to smoke or fire, and unintentional poisoning. Age-adjusted mortality rates and time trends for county poverty categories were calculated, and multivariate negative binomial regression was used to determine changes over time in both the relative risk of living in high poverty concentration areas and the population attributable fraction. Age-adjusted mortality rates for counties with > 20% poverty were 66% higher mortality in 1999 compared with counties with < 5% poverty (45.25 vs. 27.24 per 100,000; 95% CI for rate difference 15.57,20.46), and that gap widened in 2012 to 79% (44.54 vs. 24.93; 95% CI for rate difference 17.13,22.09). The relative risk of living in the highest poverty counties has increased for all injury mechanisms with the exception of accidental discharge of firearms. The population attributable fraction for all unintentional injuries rose from 0.22 (95% CI 0.13,0.30) in 1999 to 0.35 (95% CI 0.22,0.45) in 2012. This is the first study that uses comprehensive mortality data to document the associations between county poverty and injury mortality rates for the entire US population over a 14 year period. This study suggests that injury reduction interventions should focus on areas of high or increasing poverty.

Integration of second cancer risk calculations in a radiotherapy treatment planning system

NASA Astrophysics Data System (ADS)

Hartmann, M.; Schneider, U.

2014-03-01

Second cancer risk in patients, in particular in children, who were treated with radiotherapy is an important side effect. It should be minimized by selecting an appropriate treatment plan for the patient. The objectives of this study were to integrate a risk model for radiation induced cancer into a treatment planning system which allows to judge different treatment plans with regard to second cancer induction and to quantify the potential reduction in predicted risk. A model for radiation induced cancer including fractionation effects which is valid for doses in the radiotherapy range was integrated into a treatment planning system. From the three-dimensional (3D) dose distribution the 3D-risk equivalent dose (RED) was calculated on an organ specific basis. In addition to RED further risk coefficients like OED (organ equivalent dose), EAR (excess absolute risk) and LAR (lifetime attributable risk) are computed. A risk model for radiation induced cancer was successfully integrated in a treatment planning system. Several risk coefficients can be viewed and used to obtain critical situations were a plan can be optimised. Risk-volume-histograms and organ specific risks were calculated for different treatment plans and were used in combination with NTCP estimates for plan evaluation. It is concluded that the integration of second cancer risk estimates in a commercial treatment planning system is feasible. It can be used in addition to NTCP modelling for optimising treatment plans which result in the lowest possible second cancer risk for a patient.

Spatial-temporal distribution and risk assessment of mercury in different fractions in surface sediments from the Yangtze River estuary.

PubMed

Wang, Qingrui; Liu, Ruimin; Men, Cong; Xu, Fei; Guo, Lijia; Shen, Zhenyao

2017-11-15

The temporal and spatial distributions of mercury in different fractions and its potential ecological risk were investigated in sediments from the Yangtze River estuary (YRE) by analyzing data collected from the study area. The results showed that mercury in the organic and residual fractions had dominant proportions, from 15.2% to 48.52% and from 45.96% to 81.59%, respectively. The fractions were more susceptible to seasonal changes than other fractions. Higher proportions of mercury in organic fraction were found in wet seasons; the opposite was true for mercury in residual fraction. With respect to the spatial distribution, the concentration mercury in exchangeable, carbonate and Fe-Mn oxide fractions showed a decreasing trend from the inner estuary to the outer estuary, but no obvious trends were found in the distributions of mercury in the organic and residual fractions. The risk assessment code (RAC) was used to evaluate the potential ecological risk in the study area based on the proportions of exchangeable and carbonate fractions. The average RAC values during the four periods were 6.00%, 2.20%, 2.83%, and 0.61%. Although these values show that the risk in the study area is generally low, the distribution of RAC values indicates that the inner estuary has a medium risk, with a value up to 10%. Copyright © 2017 Elsevier Ltd. All rights reserved.

Distribution patterns of phthalic acid esters in soil particle-size fractions determine biouptake in soil-cereal crop systems

NASA Astrophysics Data System (ADS)

Tan, Wenbing; Zhang, Yuan; He, Xiaosong; Xi, Beidou; Gao, Rutai; Mao, Xuhui; Huang, Caihong; Zhang, Hui; Li, Dan; Liang, Qiong; Cui, Dongyu; Alshawabkeh, Akram N.

2016-08-01

The use of wastewater irrigation for food crops can lead to presence of bioavailable phthalic acid esters (PAEs) in soils, which increase the potential for human exposure and adverse carcinogenic and non-cancer health effects. This study presents the first investigation of the occurrence and distribution of PAEs in a maize-wheat double-cropping system in a wastewater-irrigated area in the North China Plain. PAE levels in maize and wheat were found to be mainly attributed to PAE stores in soil coarse (250-2000 μm) and fine sand (53-250 μm) fractions. Soil particle-size fractions with higher bioavailability (i.e., coarse and fine sands) showed greater influence on PAE congener bioconcentration factors compared to PAE molecular structures for both maize and wheat tissues. More PAEs were allocated to maize and wheat grains with increased soil PAE storages from wastewater irrigation. Additional findings showed that levels of both non-cancer and carcinogenic risk for PAE congeners in wheat were higher than those in maize, suggesting that wheat food security should be prioritized. In conclusion, increased soil PAE concentrations specifically in maize and wheat grains indicate that wastewater irrigation can pose a contamination threat to food resources.

Distribution patterns of phthalic acid esters in soil particle-size fractions determine biouptake in soil-cereal crop systems

PubMed Central

Tan, Wenbing; Zhang, Yuan; He, Xiaosong; Xi, Beidou; Gao, Rutai; Mao, Xuhui; Huang, Caihong; Zhang, Hui; Li, Dan; Liang, Qiong; Cui, Dongyu; Alshawabkeh, Akram N.

2016-01-01

The use of wastewater irrigation for food crops can lead to presence of bioavailable phthalic acid esters (PAEs) in soils, which increase the potential for human exposure and adverse carcinogenic and non-cancer health effects. This study presents the first investigation of the occurrence and distribution of PAEs in a maize-wheat double-cropping system in a wastewater-irrigated area in the North China Plain. PAE levels in maize and wheat were found to be mainly attributed to PAE stores in soil coarse (250–2000 μm) and fine sand (53–250 μm) fractions. Soil particle-size fractions with higher bioavailability (i.e., coarse and fine sands) showed greater influence on PAE congener bioconcentration factors compared to PAE molecular structures for both maize and wheat tissues. More PAEs were allocated to maize and wheat grains with increased soil PAE storages from wastewater irrigation. Additional findings showed that levels of both non-cancer and carcinogenic risk for PAE congeners in wheat were higher than those in maize, suggesting that wheat food security should be prioritized. In conclusion, increased soil PAE concentrations specifically in maize and wheat grains indicate that wastewater irrigation can pose a contamination threat to food resources. PMID:27555553

Particulate Matter Exposure and Preterm Birth: Estimates of U.S. Attributable Burden and Economic Costs

PubMed Central

Trasande, Leonardo; Malecha, Patrick; Attina, Teresa M.

2016-01-01

Background: Preterm birth (PTB) rates (11.4% in 2013) in the United States remain high and are a substantial cause of morbidity. Studies of prenatal exposure have associated particulate matter ≤ 2.5 μm in diameter (PM2.5) and other ambient air pollutants with adverse birth outcomes; yet, to our knowledge, burden and costs of PM2.5-attributable PTB have not been estimated in the United States. Objectives: We aimed to estimate burden of PTB in the United States and economic costs attributable to PM2.5 exposure in 2010. Methods: Annual deciles of PM2.5 were obtained from the U.S. Environmental Protection Agency. We converted PTB odds ratio (OR), identified in a previous meta-analysis (1.15 per 10 μg/m3 for our base case, 1.07–1.16 for low- and high-end scenarios) to relative risk (RRs), to obtain an estimate that better represents the true relative risk. A reference level (RL) of 8.8 μg/m3 was applied. We then used the RR estimates and county-level PTB prevalence to quantify PM2.5-attributable PTB. Direct medical costs were obtained from the 2007 Institute of Medicine report, and lost economic productivity (LEP) was estimated using a meta-analysis of PTB-associated IQ loss, and well-established relationships of IQ loss with LEP. All costs were calculated using 2010 dollars. Results: An estimated 3.32% of PTBs nationally (corresponding to 15,808 PTBs) in 2010 could be attributed to PM2.5 (PM2.5 > 8.8 μg/m3). Attributable PTBs cost were estimated at $5.09 billion [sensitivity analysis (SA): $2.43–9.66 B], of which $760 million were spent for medical care (SA: $362 M–1.44 B). The estimated PM2.5 attributable fraction (AF) of PTB was highest in urban counties, with highest AFs in the Ohio Valley and the southern United States. Conclusions: PM2.5 may contribute substantially to burden and costs of PTB in the United States, and considerable health and economic benefits could be achieved through environmental regulatory interventions that reduce PM2.5 exposure in pregnancy. Citation: Trasande L, Malecha P, Attina TM. 2016. Particulate matter exposure and preterm birth: estimates of U.S. attributable burden and economic costs. Environ Health Perspect 124:1913–1918; http://dx.doi.org/10.1289/ehp.1510810 PMID:27022947

Particulate Matter Exposure and Preterm Birth: Estimates of U.S. Attributable Burden and Economic Costs.

PubMed

Trasande, Leonardo; Malecha, Patrick; Attina, Teresa M

2016-12-01

Preterm birth (PTB) rates (11.4% in 2013) in the United States remain high and are a substantial cause of morbidity. Studies of prenatal exposure have associated particulate matter ≤ 2.5 μm in diameter (PM2.5) and other ambient air pollutants with adverse birth outcomes; yet, to our knowledge, burden and costs of PM2.5-attributable PTB have not been estimated in the United States. We aimed to estimate burden of PTB in the United States and economic costs attributable to PM2.5 exposure in 2010. Annual deciles of PM2.5 were obtained from the U.S. Environmental Protection Agency. We converted PTB odds ratio (OR), identified in a previous meta-analysis (1.15 per 10 μg/m3 for our base case, 1.07-1.16 for low- and high-end scenarios) to relative risk (RRs), to obtain an estimate that better represents the true relative risk. A reference level (RL) of 8.8 μg/m3 was applied. We then used the RR estimates and county-level PTB prevalence to quantify PM2.5-attributable PTB. Direct medical costs were obtained from the 2007 Institute of Medicine report, and lost economic productivity (LEP) was estimated using a meta-analysis of PTB-associated IQ loss, and well-established relationships of IQ loss with LEP. All costs were calculated using 2010 dollars. An estimated 3.32% of PTBs nationally (corresponding to 15,808 PTBs) in 2010 could be attributed to PM2.5 (PM2.5 > 8.8 μg/m3). Attributable PTBs cost were estimated at $5.09 billion [sensitivity analysis (SA): $2.43-9.66 B], of which $760 million were spent for medical care (SA: $362 M-1.44 B). The estimated PM2.5 attributable fraction (AF) of PTB was highest in urban counties, with highest AFs in the Ohio Valley and the southern United States. PM2.5 may contribute substantially to burden and costs of PTB in the United States, and considerable health and economic benefits could be achieved through environmental regulatory interventions that reduce PM2.5 exposure in pregnancy. Citation: Trasande L, Malecha P, Attina TM. 2016. Particulate matter exposure and preterm birth: estimates of U.S. attributable burden and economic costs. Environ Health Perspect 124:1913-1918; http://dx.doi.org/10.1289/ehp.1510810.

Survival or Mortality: Does Risk Attribute Framing Influence Decision-Making Behavior in a Discrete Choice Experiment?

PubMed

Veldwijk, Jorien; Essers, Brigitte A B; Lambooij, Mattijs S; Dirksen, Carmen D; Smit, Henriette A; de Wit, G Ardine

2016-01-01

To test how attribute framing in a discrete choice experiment (DCE) affects respondents' decision-making behavior and their preferences. Two versions of a DCE questionnaire containing nine choice tasks were distributed among a representative sample of the Dutch population aged 55 to 65 years. The DCE consisted of four attributes related to the decision regarding participation in genetic screening for colorectal cancer (CRC). The risk attribute included was framed positively as the probability of surviving CRC and negatively as the probability of dying from CRC. Panel mixed-logit models were used to estimate the relative importance of the attributes. The data of the positively and negatively framed DCE were compared on the basis of direct attribute ranking, dominant decision-making behavior, preferences, and importance scores. The majority (56%) of the respondents ranked survival as the most important attribute in the positively framed DCE, whereas only a minority (8%) of the respondents ranked mortality as the most important attribute in the negatively framed DCE. Respondents made dominant choices based on survival significantly more often than based on mortality. The framing of the risk attribute significantly influenced all attribute-level estimates and resulted in different preference structures among respondents in the positively and negatively framed data set. Risk framing affects how respondents value the presented risk. Positive risk framing led to increased dominant decision-making behavior, whereas negative risk framing led to risk-seeking behavior. Attribute framing should have a prominent part in the expert and focus group interviews, and different types of framing should be used in the pilot version of DCEs as well as in actual DCEs to estimate the magnitude of the effect of choosing different types of framing. Copyright © 2016 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Population attributable risk of factors associated with the repetition of self-harm behaviour in young people presenting to clinical services: a systematic review and meta-analysis.

PubMed

Witt, Katrina; Milner, Allison; Spittal, Matthew J; Hetrick, Sarah; Robinson, Jo; Pirkis, Jane; Carter, Gregory

2018-02-03

The repetition of hospital-treated self-harm by young people is common. However, little work has summarised the modifiable factors associated with this. A thorough understanding of those factors most strongly associated with repetition could guide the development of relevant clinical interventions. We systematically reviewed four databases (EMBASE, Medline, PubMed and PsycINFO) until 15 April 2016 to identify all observational studies of factors for the repetition of self-harm or suicide reattempts (together referred to as 'self-harm behaviour') in young people. We quantified the magnitude of association with odds ratios (OR) and 95% confidence intervals (CIs) and calculated the population attributable risk (PAR) and population preventable fraction (PPF) for modifiable factors to provide an indication of the potential impact in reducing subsequent self-harm behaviour in this population. Seventeen studies were included comprising 10,726 participants. Borderline personality disorder (OR 3.47, 95% CI 1.84-6.53; PAR 42.4%), any personality disorder (OR 2.54, 95% CI 1.71-3.78; PAR 16.3%), and any mood disorder (OR 2.16, 95% CI 1.09-4.29; PAR 42.2%) are important modifiable risk factors. Severity of hopelessness (OR 2.95, 95% CI 1.74-5.01), suicidal ideation (OR 2.01, 95% CI 1.43-2.81), and previous sexual abuse (OR 1.52, 95% CI 1.02-2.28; PAR 12.8%) are also associated with repetition of self-harm. We recommend that clinical services should focus on identifying key modifiable risk factors at the individual patient level, whilst the reduction of exposure to child and adolescent sexual abuse would also be a useful goal for public health interventions.

Anaemia in infancy in rural Bangladesh: contribution of iron deficiency, infections and poor feeding practices.

PubMed

Rawat, Rahul; Saha, Kuntal Kumar; Kennedy, Andrew; Rohner, Fabian; Ruel, Marie; Menon, Purnima

2014-01-14

Few data exist on the aetiology of anaemia and Fe deficiency (ID) during early infancy in South Asia. The present study aimed to determine the contribution of ID, infections and feeding practices to anaemia in Bangladeshi infants aged 6-11 months. Baseline data from 1600 infants recruited into a cluster-randomised trial testing the effectiveness of micronutrient powder sales by frontline health workers on the prevalence of anaemia were used. Multivariate logistic regression was used to identify risk factors for anaemia and ID, and population attributable fractions (PAF) were computed to estimate the proportion of anaemia that might be prevented by the elimination of individual risk factors. It was found that 68 % of the infants were anaemic, 56 % were Fe deficient, and one-third had evidence of subclinical infections. The prevalence of anaemia and ID increased rapidly, until 8-9 months of age, while that of subclinical infections was constant. ID (adjusted OR (AOR) 2·6-5·0; P< 0·001) and subclinical infections (AOR 1·4-1·5; P< 0·01) were major risk factors for anaemia, in addition to age and male sex. Similarly, subclinical infections, age and male sex were significant risk factors for ID. Previous-day consumption of Fe-rich foods was very low and not associated with anaemia or ID. The PAF of anaemia attributable to ID was 67 % (95 % CI 62, 71) and that of subclinical infections was 16 % (95 % CI 11, 20). These results suggest that a multipronged strategy that combines improvements in dietary Fe intake alongside infection control strategies is needed to prevent anaemia during infancy in Bangladesh.

Ischaemic heart disease in the former Soviet Union 1990–2015 according to the Global Burden of Disease 2015 Study

PubMed Central

Murphy, Adrianna; Johnson, Catherine O; Roth, Gregory A; Forouzanfar, Mohammad H; Naghavi, Mohsen; Ng, Marie; Pogosova, Nana; Vos, Theo; Murray, Christopher J L; Moran, Andrew E

2018-01-01

Objective The objective of this study was to compare ischaemic heart disease (IHD) mortality and risk factor burden across former Soviet Union (fSU) and satellite countries and regions in 1990 and 2015. Methods The fSU and satellite countries were grouped into Central Asian, Central European and Eastern European regions. IHD mortality data for men and women of any age were gathered from national vital registration, and age, sex, country, year-specific IHD mortality rates were estimated in an ensemble model. IHD morbidity and mortality burden attributable to risk factors was estimated by comparative risk assessment using population attributable fractions. Results In 2015, age-standardised IHD death rates in Eastern European and Central Asian fSU countries were almost two times that of satellite states of Central Europe. Between 1990 and 2015, rates decreased substantially in Central Europe (men −43.5% (95% uncertainty interval −45.0%, −42.0%); women −42.9% (−44.0%, −41.0%)) but less in Eastern Europe (men −5.6% (−9.0, –3.0); women −12.2% (−15.5%, −9.0%)). Age-standardised IHD death rates also varied within regions: within Eastern Europe, rates decreased −51.7% in Estonian men (−54.0, −47.0) but increased +19.4% in Belarusian men (+12.0, +27.0). High blood pressure and cholesterol were leading risk factors for IHD burden, with smoking, body mass index, dietary factors and ambient air pollution also ranking high. Conclusions Some fSU countries continue to experience a high IHD burden, while others have achieved remarkable reductions in IHD mortality. Control of blood pressure, cholesterol and smoking are IHD prevention priorities. PMID:28883037

Impact of occupational carcinogens on lung cancer risk in a general population

PubMed Central

De Matteis, Sara; Consonni, Dario; Lubin, Jay H; Tucker, Margaret; Peters, Susan; Vermeulen, Roel CH; Kromhout, Hans; Bertazzi, Pier Alberto; Caporaso, Neil E; Pesatori, Angela C; Wacholder, Sholom; Landi, Maria Teresa

2012-01-01

Background Exposure to occupational carcinogens is an important preventable cause of lung cancer. Most of the previous studies were in highly exposed industrial cohorts. Our aim was to quantify lung cancer burden attributable to occupational carcinogens in a general population. Methods We applied a new job–exposure matrix (JEM) to translate lifetime work histories, collected by personal interview and coded into standard job titles, into never, low and high exposure levels for six known/suspected occupational lung carcinogens in the Environment and Genetics in Lung cancer Etiology (EAGLE) population-based case–control study, conducted in Lombardy region, Italy, in 2002–05. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated in men (1537 cases and 1617 controls), by logistic regression adjusted for potential confounders, including smoking and co-exposure to JEM carcinogens. The population attributable fraction (PAF) was estimated as impact measure. Results Men showed an increased lung cancer risk even at low exposure to asbestos (OR: 1.76; 95% CI: 1.42–2.18), crystalline silica (OR: 1.31; 95% CI: 1.00–1.71) and nickel–chromium (OR: 1.18; 95% CI: 0.90–1.53); risk increased with exposure level. For polycyclic aromatic hydrocarbons, an increased risk (OR: 1.64; 95% CI: 0.99–2.70) was found only for high exposures. The PAFs for any exposure to asbestos, silica and nickel–chromium were 18.1, 5.7 and 7.0%, respectively, equivalent to an overall PAF of 22.5% (95% CI: 14.1–30.0). This corresponds to about 1016 (95% CI: 637–1355) male lung cancer cases/year in Lombardy. Conclusions These findings support the substantial role of selected occupational carcinogens on lung cancer burden, even at low exposures, in a general population. PMID:22467291

Impact of occupational carcinogens on lung cancer risk in a general population.

PubMed

De Matteis, Sara; Consonni, Dario; Lubin, Jay H; Tucker, Margaret; Peters, Susan; Vermeulen, Roel Ch; Kromhout, Hans; Bertazzi, Pier Alberto; Caporaso, Neil E; Pesatori, Angela C; Wacholder, Sholom; Landi, Maria Teresa

2012-06-01

Exposure to occupational carcinogens is an important preventable cause of lung cancer. Most of the previous studies were in highly exposed industrial cohorts. Our aim was to quantify lung cancer burden attributable to occupational carcinogens in a general population. We applied a new job-exposure matrix (JEM) to translate lifetime work histories, collected by personal interview and coded into standard job titles, into never, low and high exposure levels for six known/suspected occupational lung carcinogens in the Environment and Genetics in Lung cancer Etiology (EAGLE) population-based case-control study, conducted in Lombardy region, Italy, in 2002-05. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated in men (1537 cases and 1617 controls), by logistic regression adjusted for potential confounders, including smoking and co-exposure to JEM carcinogens. The population attributable fraction (PAF) was estimated as impact measure. Men showed an increased lung cancer risk even at low exposure to asbestos (OR: 1.76; 95% CI: 1.42-2.18), crystalline silica (OR: 1.31; 95% CI: 1.00-1.71) and nickel-chromium (OR: 1.18; 95% CI: 0.90-1.53); risk increased with exposure level. For polycyclic aromatic hydrocarbons, an increased risk (OR: 1.64; 95% CI: 0.99-2.70) was found only for high exposures. The PAFs for any exposure to asbestos, silica and nickel-chromium were 18.1, 5.7 and 7.0%, respectively, equivalent to an overall PAF of 22.5% (95% CI: 14.1-30.0). This corresponds to about 1016 (95% CI: 637-1355) male lung cancer cases/year in Lombardy. These findings support the substantial role of selected occupational carcinogens on lung cancer burden, even at low exposures, in a general population.

[Deaths and life expectancy losses attributable to diet high in sodium in China].

PubMed

Liu, S W; Cai, Y; Zeng, X Y; Yin, P; Qi, J L; Liu, Y N; Liu, J M; Zhao, Z P; Zhang, M; Wang, L M; Wang, L J; Xue, M; Zhou, M G

2017-08-10

Objective: To quantitatively estimate the deaths and life expectancy losses attributable to diet high in sodium in China, and examine the gains and shifts under different control scenarios of sodium consumption. Methods: Based on data from the cause-of-death through the National Mortality Surveillance System, and 24 hours urinary sodium values from Global Burden of Disease study on Chinese's estimates, population attributable fractions with the framework of comparative risk assessment were used to analyze the deaths and life expectancy losses due to diet high in sodium. The same methods were followed to examine the gains and shifts under different control scenarios of sodium consumption. Results: In 2013, 1 430 (940 for men and 490 for women) thousand deaths were attributable to diet high in sodium, accounting for 15.6% (17.4% for men and 13.0% for women) of all-cause deaths in China, which causing 2.17 (2.49 for men and 1.71 for women) years of life expectancy loss. Diet with high sodium in 2013 caused 1 200, 50 and 180 thousand deaths from cardiovascular disease, chronic kidney disease and stomach cancer respectively, accounting for 31.5%, 30.8% and 64.8% of those specific causes. Comparing to the baseline in 2013, if the targets of 10% decrease of sodium consumption by 2020 and 15% by 2030 for Chinese chronic disease prevention and treatment planning, and 30% decrease by 2030 for WHO non-communicable disease monitoring framework are achieved, 220, 340 and 730 thousand deaths will be averted, which may gain 0.30, 0.45 and 0.95 years of life expectancy, respectively. Conclusions: As one of the leading risk factors, diet high in sodium had caused heavy burden of disease from cardiovascular disease, chronic kidney disease and stomach cancer on Chinese residents. Intervention programs on sodium-reduction are urgently needed in China and related cost-effectiveness is highly expected.

Sociodemographic and geographical inequalities in notifiable infectious diseases in Australia: a retrospective analysis of 21 years of national disease surveillance data.

PubMed

Gibney, Katherine B; Cheng, Allen C; Hall, Robert; Leder, Karin

2017-01-01

Australia is a high-income country with a well established and largely publicly funded health-care system. However, some populations within Australia have shorter life expectancy and worse health outcomes than others. We explored geographical variations and sociodemographic inequities in infectious disease notifications in Australia. In this retrospective study, we analysed National Notifiable Diseases Surveillance System (NNDSS) notifications from 1991-2011 (n=2·4 million). We assessed the effect of socioeconomic disadvantage and remoteness of residence on national notification incidence. We calculated Gini coefficients, adjusted relative risks (aRRs), population attributable fractions (PAFs), and attributable notifications. We reported aRRs for Indigenous status in three jurisdictions with more than 75% completeness of Indigenous status reporting from the Northern Territory, South Australia, and Western Australia. Of the eight most commonly notified diseases from Jan 1, 1991, to Dec 31, 2011, gonococcal infection was the most geographically unequal and campylobacteriosis was the most evenly distributed across the country. Overall, notification incidence was higher in remote and very remote areas than in major cities (aRR 3·37), and higher in the most socioeconomically disadvantaged quintiles compared with less disadvantaged quintiles (aRR 1·15). The PAF for socioeconomic disadvantage was high for blood-borne viral hepatitis but decreased in other disease groups. In 2011, sexually transmitted infections had 11 093 notifications attributed to remoteness and 5597 notifications attributable to socioeconomic disadvantage. Notification incidence was higher in Indigenous than in non-Indigenous Australians (aRR 5·3). All diseases had differing geographical concentration and sociodemographic risk. Overall, sociodemographic inequities in infectious disease notifications have decreased, but remain unacceptably high. National communicable disease control is complex, requiring both targeted and population-wide interventions. None. Copyright © 2017 Elsevier Ltd. All rights reserved.

Screening of Tanzanian women of childbearing age for urinary schistosomiasis: validity of urine reagent strip readings and self-reported symptoms.

PubMed Central

Poggensee, G.; Krantz, I.; Kiwelu, I.; Feldmeier, H.

2000-01-01

The screening of women of childbearing age for haematuria, leukocyturia and proteinuria to detect urinary schistosomiasis can be confounded by several factors such as menstruation, pregnancy and genitourinary infections. We therefore undertook a study in an area endemic for Schistosoma haematobium in the United Republic of Tanzania to carry out the following: assess the sensitivity, specificity and predictive values--in women of childbearing age--of indirect indicators of urinary schistosomiasis, as measured by urine reagent strip readings; assess the predictive values of self-reported symptoms; and finally to estimate the morbidity attributable to S. haematobium. A total of 303 women (128 and 175, respectively, living in high- and low-risk sites) participated in the study. Haematuria was more frequent among women excreting S. haematobium eggs than among those who did not (65% versus 32%). The predictive potential of all indirect disease markers was poor in the highly endemic site, while in the sites with low endemicity the negative predictive values were high. Among infected women, 54% of haematuria could be attributed to S. haematobium, but for patients with more than 10 eggs/10 ml the attributable fraction rose to 70%. Symptoms of "bloody urine" and "pain while urinating" were recalled significantly more often by women living in the highly endemic site. On a population level, one-third of the self-reported cases with bloody urine could be attributed to urinary schistosomiasis. Screening of women of childbearing age for urinary schistosomiasis using urine reagent strips can be biased in two directions. The prevalence of S. haematobium will be overestimated if other causes of haematuria, such as reproductive tract infections, are highly endemic. On the other hand, women with light or very light infections will be missed and will not be treated. This is of concern because genital schistosomiasis, a possible risk factor for the transmission of HIV, occurs among women even with light infections. PMID:10885183

Using Blocked Fractional Factorial Designs to Construct Discrete Choice Experiments for Health Care Studies

PubMed Central

Jaynes, Jessica; Wong, Weng Kee; Xu, Hongquan

2016-01-01

Discrete choice experiments (DCEs) are increasingly used for studying and quantifying subjects preferences in a wide variety of health care applications. They provide a rich source of data to assess real-life decision making processes, which involve trade-offs between desirable characteristics pertaining to health and health care, and identification of key attributes affecting health care. The choice of the design for a DCE is critical because it determines which attributes’ effects and their interactions are identifiable. We apply blocked fractional factorial designs to construct DCEs and address some identification issues by utilizing the known structure of blocked fractional factorial designs. Our design techniques can be applied to several situations including DCEs where attributes have different number of levels. We demonstrate our design methodology using two health care studies to evaluate (1) asthma patients’ preferences for symptom-based outcome measures, and (2) patient preference for breast screening services. PMID:26823156

Motivation to change risky drinking and motivation to seek help for alcohol risk drinking among general hospital inpatients with problem drinking and alcohol-related diseases.

PubMed

Lau, Katharina; Freyer-Adam, Jennis; Gaertner, Beate; Rumpf, Hans-Jürgen; John, Ulrich; Hapke, Ulfert

2010-01-01

The objective of this study was to analyze motivation to change drinking behavior and motivation to seek help in general hospital inpatients with problem drinking and alcohol-related diseases. The sample consisted of 294 general hospital inpatients aged 18-64 years. Inpatients with alcohol-attributable disease were classified according to its alcohol-attributable fraction (AAF; AAF=1, AAF<1 and AAF=0). Baseline differences in alcohol-related variables, demographics and motivation between the AAF groups were analyzed. Furthermore, differences in motivation to change, in motivation to seek help and in the amount of alcohol consumed from baseline to follow-up between the AAF groups were evaluated. During hospital stay, motivation to change was higher among inpatients with alcohol-attributable diseases than among inpatients who had no alcohol-attributable diseases [F(2)=18.40, P<.001]. Motivation to seek help was higher among inpatients with AAF=1 than among inpatients with AAF<1 and AAF=0 [F(2)=21.66, P<.001]. While motivation to change drinking behavior remained stable within 12 months of hospitalization, motivation to seek help decreased. The amount of alcohol consumed decreased in all three AAF groups. Data suggest that hospital stay seems to be a "teachable moment." Screening for problem drinking and motivation differentiated by AAFs might be a tool for early intervention. Copyright 2010 Elsevier Inc. All rights reserved.

Infant mortality in South Africa - distribution, associations and policy implications, 2007: an ecological spatial analysis

PubMed Central

2011-01-01

Background Many sub-Saharan countries are confronted with persistently high levels of infant mortality because of the impact of a range of biological and social determinants. In particular, infant mortality has increased in sub-Saharan Africa in recent decades due to the HIV/AIDS epidemic. The geographic distribution of health problems and their relationship to potential risk factors can be invaluable for cost effective intervention planning. The objective of this paper is to determine and map the spatial nature of infant mortality in South Africa at a sub district level in order to inform policy intervention. In particular, the paper identifies and maps high risk clusters of infant mortality, as well as examines the impact of a range of determinants on infant mortality. A Bayesian approach is used to quantify the spatial risk of infant mortality, as well as significant associations (given spatial correlation between neighbouring areas) between infant mortality and a range of determinants. The most attributable determinants in each sub-district are calculated based on a combination of prevalence and model risk factor coefficient estimates. This integrated small area approach can be adapted and applied in other high burden settings to assist intervention planning and targeting. Results Infant mortality remains high in South Africa with seemingly little reduction since previous estimates in the early 2000's. Results showed marked geographical differences in infant mortality risk between provinces as well as within provinces as well as significantly higher risk in specific sub-districts and provinces. A number of determinants were found to have a significant adverse influence on infant mortality at the sub-district level. Following multivariable adjustment increasing maternal mortality, antenatal HIV prevalence, previous sibling mortality and male infant gender remained significantly associated with increased infant mortality risk. Of these antenatal HIV sero-prevalence, previous sibling mortality and maternal mortality were found to be the most attributable respectively. Conclusions This study demonstrates the usefulness of advanced spatial analysis to both quantify excess infant mortality risk at the lowest administrative unit, as well as the use of Bayesian modelling to quantify determinant significance given spatial correlation. The "novel" integration of determinant prevalence at the sub-district and coefficient estimates to estimate attributable fractions further elucidates the "high impact" factors in particular areas and has considerable potential to be applied in other locations. The usefulness of the paper, therefore, not only suggests where to intervene geographically, but also what specific interventions policy makers should prioritize in order to reduce the infant mortality burden in specific administration areas. PMID:22093084

Missed Opportunities along the Prevention of Mother-to-Child Transmission Services Cascade in South Africa: Uptake, Determinants, and Attributable Risk (the SAPMTCTE)

PubMed Central

Woldesenbet, Selamawit; Jackson, Debra; Lombard, Carl; Dinh, Thu-Ha; Puren, Adrian; Sherman, Gayle; Ramokolo, Vundli; Doherty, Tanya; Mogashoa, Mary; Bhardwaj, Sanjana; Chopra, Mickey; Shaffer, Nathan; Pillay, Yogan; Goga, Ameena

2015-01-01

Objectives We examined uptake of prevention of mother-to-child HIV transmission (PMTCT) services, predictors of missed opportunities, and infant HIV transmission attributable to missed opportunities along the PMTCT cascade across South Africa. Methods A cross-sectional survey was conducted among 4–8 week old infants receiving first immunisations in 580 nationally representative public health facilities in 2010. This included maternal interviews and testing infants’ dried blood spots for HIV. A weighted analysis was performed to assess uptake of antenatal and perinatal PMTCT services along the PMTCT cascade (namely: maternal HIV testing, CD4 count test/result, and receiving maternal and infant antiretroviral treatment) and predictors of dropout. The population attributable fraction associated with dropouts at each service point are estimated. Results Of 9,803 mothers included, 31.7% were HIV-positive as identified by reactive infant antibody tests. Of these 80.4% received some form of maternal and infant antiretroviral treatment. More than a third (34.9%) of mothers dropped out from one or more steps in the PMTCT service cascade. In a multivariable analysis, the following characteristics were associated with increased dropout from the PMTCT cascade: adolescent (<20 years) mothers, low socioeconomic score, low education level, primiparous mothers, delayed first antenatal visit, homebirth, and non-disclosure of HIV status. Adolescent mothers were twice (adjusted odds ratio: 2.2, 95% confidence interval: 1.5–3.3) as likely to be unaware of their HIV-positive status and had a significantly higher rate (85.2%) of unplanned pregnancies compared to adults aged ≥20 years (55.5%, p = 0.0001). A third (33.8%) of infant HIV infections were attributable to dropout in one or more steps in the cascade. Conclusion A third of transmissions attributable to missed opportunities of PMTCT services can be prevented by optimizing the uptake of PMTCT services. Identified risk factors for low PMTCT service uptake should be addressed through health facility and community-level interventions, including raising awareness, promoting women education, adolescent focused interventions, and strengthening linkages/referral-system between communities and health facilities. PMID:26147598

Metabolic Syndrome and Ischemic Stroke Risk Northern Manhattan Study

PubMed Central

Boden-Albala, Bernadette; Sacco, Ralph L.; Lee, Hye-Sueng; Grahame-Clarke, Cairistine; Rundek, Tanja; Elkind, Mitchell V.; Wright, Clinton; Giardina, Elsa-Grace V.; DiTullio, Marco R.; Homma, Shunichi; Paik, Myunghee C.

2009-01-01

Background and Purpose More than 47 million individuals in the United States meet the criteria for the metabolic syndrome. The relation between the metabolic syndrome and stroke risk in multiethnic populations has not been well characterized. Methods As part of the Northern Manhattan Study, 3298 stroke-free community residents were prospectively followed up for a mean of 6.4 years. The metabolic syndrome was defined according to guidelines established by the National Cholesterol Education Program Adult Treatment Panel III. Cox proportional-hazards models were used to calculate hazard ratios (HRs) and 95% CIs for ischemic stroke and vascular events (ischemic stroke, myocardial infarction, or vascular death). The etiologic fraction estimates the proportion of events attributable to the metabolic syndrome. Results More than 44% of the cohort had the metabolic syndrome (48% of women vs 38% of men, P<0.0001), which was more prevalent among Hispanics (50%) than whites (39%) or blacks (37%). The metabolic syndrome was associated with increased risk of stroke (HR=1.5; 95% CI, 1.1 to 2.2) and vascular events (HR=1.6; 95% CI, 1.3 to 2.0) after adjustment for sociodemographic and risk factors. The effect of the metabolic syndrome on stroke risk was greater among women (HR=2.0; 95% CI, 1.3 to 3.1) than men (HR=1.1; 95% CI, 0.6 to 1.9) and among Hispanics (HR=2.0; 95% CI, 1.2 to 3.4) compared with blacks and whites. The etiologic fraction estimates suggest that elimination of the metabolic syndrome would result in a 19% reduction in overall stroke, a 30% reduction of stroke in women; and a 35% reduction of stroke among Hispanics. Conclusions The metabolic syndrome is an important risk factor for ischemic stroke, with differential effects by sex and race/ethnicity. PMID:18063821

A porcine model of hypertensive cardiomyopathy: implications for heart failure with preserved ejection fraction.

PubMed

Schwarzl, Michael; Hamdani, Nazha; Seiler, Sebastian; Alogna, Alessio; Manninger, Martin; Reilly, Svetlana; Zirngast, Birgit; Kirsch, Alexander; Steendijk, Paul; Verderber, Jochen; Zweiker, David; Eller, Philipp; Höfler, Gerald; Schauer, Silvia; Eller, Kathrin; Maechler, Heinrich; Pieske, Burkert M; Linke, Wolfgang A; Casadei, Barbara; Post, Heiner

2015-11-01

Heart failure with preserved ejection fraction (HFPEF) evolves with the accumulation of risk factors. Relevant animal models to identify potential therapeutic targets and to test novel therapies for HFPEF are missing. We induced hypertension and hyperlipidemia in landrace pigs (n = 8) by deoxycorticosteroneacetate (DOCA, 100 mg/kg, 90-day-release subcutaneous depot) and a Western diet (WD) containing high amounts of salt, fat, cholesterol, and sugar for 12 wk. Compared with weight-matched controls (n = 8), DOCA/WD-treated pigs showed left ventricular (LV) concentric hypertrophy and left atrial dilatation in the absence of significant changes in LV ejection fraction or symptoms of heart failure at rest. The LV end-diastolic pressure-volume relationship was markedly shifted leftward. During simultaneous right atrial pacing and dobutamine infusion, cardiac output reserve and LV peak inflow velocities were lower in DOCA/WD-treated pigs at higher LV end-diastolic pressures. In LV biopsies, we observed myocyte hypertrophy, a shift toward the stiffer titin isoform N2B, and reduced total titin phosphorylation. LV superoxide production was increased, in part attributable to nitric oxide synthase (NOS) uncoupling, whereas AKT and NOS isoform expression and phosphorylation were unchanged. In conclusion, we developed a large-animal model in which loss of LV capacitance was associated with a titin isoform shift and dysfunctional NOS, in the presence of preserved LV ejection fraction. Our findings identify potential targets for the treatment of HFPEF in a relevant large-animal model. Copyright © 2015 the American Physiological Society.

Use of Angle Model to Understand Addition and Subtraction of Fractions

ERIC Educational Resources Information Center

Mukwambo, Muzwangowenyu; Ngcoza, Kenneth; Ramasike, Lineo Florence

2018-01-01

Learners in lower primary and even some in upper primary grades grapple to perform mathematical operations which involve fractions. Failure to solve these mathematical operations creates a gap in the teaching and learning processes of mathematics. We opine that this is attributed to use of traditional mathematical approaches of teaching and…

Mechanically fractionated flour isolated from green bananas (M. cavendishii var. nanica) as a tool to increase the dietary fiber and phytochemical bioactivity of layer and sponge cakes.

PubMed

Segundo, Cristina; Román, Laura; Gómez, Manuel; Martínez, Mario M

2017-03-15

This article describes the effect of mechanically fractionated flours from green bananas on the nutritional, physical and sensory attributes of two types of cakes (sponge and layer). A plausible 30% replacement of banana flour in the formulation of layer cakes is demonstrated, finding only a small decline in the sensory perception. On the contrary, sponge cakes were noticeable worsened with the use of banana flours (lower specific volume, worse sensory attributes and higher hardness), which was minimized when using fine flour. Both layer and sponge cakes exhibited an enhancement of the resistant starch and dietary fiber content with the replacement of green banana flour (up to a fivefold improvement in RS performance). Moreover, sponge cakes yielded more polyphenols and antioxidant capacity with banana flours, especially with the coarse fraction. Therefore, results showed that a mechanical fractionation allowed a feasible nutritional enhancement of cakes with the use of banana flours. Copyright © 2016 Elsevier Ltd. All rights reserved.

Job strain and cardiovascular disease risk factors: meta-analysis of individual-participant data from 47,000 men and women.

PubMed

Nyberg, Solja T; Fransson, Eleonor I; Heikkilä, Katriina; Alfredsson, Lars; Casini, Annalisa; Clays, Els; De Bacquer, Dirk; Dragano, Nico; Erbel, Raimund; Ferrie, Jane E; Hamer, Mark; Jöckel, Karl-Heinz; Kittel, France; Knutsson, Anders; Ladwig, Karl-Heinz; Lunau, Thorsten; Marmot, Michael G; Nordin, Maria; Rugulies, Reiner; Siegrist, Johannes; Steptoe, Andrew; Westerholm, Peter J M; Westerlund, Hugo; Theorell, Töres; Brunner, Eric J; Singh-Manoux, Archana; Batty, G David; Kivimäki, Mika

2013-01-01

Job strain is associated with an increased coronary heart disease risk, but few large-scale studies have examined the relationship of this psychosocial characteristic with the biological risk factors that potentially mediate the job strain - heart disease association. We pooled cross-sectional, individual-level data from eight studies comprising 47,045 participants to investigate the association between job strain and the following cardiovascular disease risk factors: diabetes, blood pressure, pulse pressure, lipid fractions, smoking, alcohol consumption, physical inactivity, obesity, and overall cardiovascular disease risk as indexed by the Framingham Risk Score. In age-, sex-, and socioeconomic status-adjusted analyses, compared to those without job strain, people with job strain were more likely to have diabetes (odds ratio 1.29; 95% CI: 1.11-1.51), to smoke (1.14; 1.08-1.20), to be physically inactive (1.34; 1.26-1.41), and to be obese (1.12; 1.04-1.20). The association between job strain and elevated Framingham risk score (1.13; 1.03-1.25) was attributable to the higher prevalence of diabetes, smoking and physical inactivity among those reporting job strain. In this meta-analysis of work-related stress and cardiovascular disease risk factors, job strain was linked to adverse lifestyle and diabetes. No association was observed between job strain, clinic blood pressure or blood lipids.

The effects of lead sources on oral bioaccessibility in soil and implications for contaminated land risk management.

PubMed

Palmer, Sherry; McIlwaine, Rebekka; Ofterdinger, Ulrich; Cox, Siobhan F; McKinley, Jennifer M; Doherty, Rory; Wragg, Joanna; Cave, Mark

2015-03-01

Lead (Pb) is a non-threshold toxin capable of inducing toxic effects at any blood level but availability of soil screening criteria for assessing potential health risks is limited. The oral bioaccessibility of Pb in 163 soil samples was attributed to sources through solubility estimation and domain identification. Samples were extracted following the Unified BARGE Method. Urban, mineralisation, peat and granite domains accounted for elevated Pb concentrations compared to rural samples. High Pb solubility explained moderate-high gastric (G) bioaccessible fractions throughout the study area. Higher maximum G concentrations were measured in urban (97.6 mg kg(-1)) and mineralisation (199.8 mg kg(-1)) domains. Higher average G concentrations occurred in mineralisation (36.4 mg kg(-1)) and granite (36.0 mg kg(-1)) domains. Findings suggest diffuse anthropogenic and widespread geogenic contamination could be capable of presenting health risks, having implications for land management decisions in jurisdictions where guidance advises these forms of pollution should not be regarded as contaminated land. Copyright © 2015 Elsevier Ltd. All rights reserved.

Pulmonary Tuberculosis Is Associated With Biomass Fuel Use Among Rural Women in Pakistan: An Age- and Residence-Matched Case-Control Study.

PubMed

Rabbani, Unaib; Sahito, Ambreen; Nafees, Asaad Ahmed; Kazi, Ambreen; Fatmi, Zafar

2017-04-01

Facility-based, age- and residential area-matched case-control study was conducted in Sindh, Pakistan to determine association between biomass fuel use for cooking and pulmonary tuberculosis (TB). Cases were women with pulmonary TB, and controls were those suffering from other diseases. Current users of biomass fuel were at higher risk of pulmonary TB (adjusted matched odds ratio [mOR] = 3.0; 95% CI = 1.1-4.9) compared with nonusers. In comparison with former biomass users (women not using biomass for >10 years), recent biomass users (women who switched from biomass to nonbiomass ≤10 years ago), and current (lifetime) users were at a higher risk in a dose-response manner (adjusted mOR = 2.8, 95% CI = 0.9-8.2 and adjusted mOR = 3.9, 95% CI = 1.4-10.7, respectively). Population attributable fraction for TB related to biomass fuel use was 40.6% (95% CI = 35.5%-45.7%). This study strengthens the evidence that biomass fuel use for cooking is associated with pulmonary TB and risk increases with duration of exposure.

Effect of flour particle size on microstructural, rheological and physico-sensory characteristics of bread and south Indian parotta.

PubMed

Sakhare, Suresh D; Inamdar, Aashitosh A; Soumya, C; Indrani, D; Rao, G Venkateswara

2014-12-01

Wheat flour fractioned by sieving into four different particle size fractions namely finer fractions (<75 and 75-118 μm), coarser fractions (118-150 and >150 μm) were analyzed for their chemical, rheological, bread & parotta making characteristics. The finer fractions had lower ash, higher dry gluten, damaged starch and sodium dodecysulphate (SDS)-sedimentation value than the coarser fractions. The flour from finer fractions gave bread with best sensory and textural attributes. The parottas from finer fractions showed significantly higher sensory scores for colour, texture, layers, mouthfeel and overall quality score than the coarser fractions. In the micrograph of finer flour fractions, higher number of loosened single starch granules than the aggregates of starch and protein matrix were seen as compared to coarser fractions. These studies indicate that the flour from the finer fractions produce higher quality bread, parotta owing to the presence of higher damaged starch content, quantity and quality of protein in these fractions than coarser fractions.

Genetic variants in PNPLA3 and TM6SF2 predispose to the development of hepatocellular carcinoma in individuals with alcohol-related cirrhosis.

PubMed

Stickel, Felix; Buch, Stephan; Nischalke, Hans Dieter; Weiss, Karl Heinz; Gotthardt, Daniel; Fischer, Janett; Rosendahl, Jonas; Deltenre, Pierre; Marot, Astrid; Elamly, Mona; Casper, Markus; Lammert, Frank; McQuillin, Andrew; Zopf, Steffen; Spengler, Ulrich; Marhenke, Silke; Kirstein, Martha M; Vogel, Arndt; Eyer, Florian; von Felden, Johann; Wege, Henning; Buch, Thorsten; Schafmayer, Clemens; Braun, Felix; Berg, Thomas; Morgan, Marsha Y; Hampe, Jochen

2018-03-13

Variants in patatin-like phospholipase domain-containing 3 (PNPLA3; rs738409), transmembrane 6 superfamily member 2 (TM6SF2; rs58542926), and membrane bound O-acyltransferase domain containing 7 (MBOAT7; rs641738) are risk factors for the development of alcohol-related cirrhosis. Within this population, PNPLA3 rs738409 is also an established risk factor for the development of hepatocellular carcinoma (HCC). The aim of this study was to explore possible risk associations of TM6SF2 rs58542926 and MBOAT7 rs641738 with HCC. Risk variants in PNPLA3, TM6SF2, and MBOAT7 were genotyped in 751 cases with alcohol-related cirrhosis and HCC and in 1165 controls with alcohol-related cirrhosis without HCC. Association with the risk of developing HCC was analyzed using multivariate logistic regression. The development of HCC was independently associated with PNPLA3 rs738409 (OR adjusted 1.84 [95% CI 1.55-2.18], p = 1.85 × 10 -12 ) and TM6SF2 rs58542926 (OR adjusted 1.66 [1.30-2.13], p = 5.13 × 10 -05 ), using an additive model, and controlling the sex, age, body mass index, and type 2 diabetes mellitus; the risk associated with carriage of MBOAT7 rs641738 (OR adjusted 1.04 [0.88-1.24], p = 0.61) was not significant. The population-attributable fractions were 43.5% for PNPLA3 rs738409, 11.5% for TM6SF2 rs58542926, and 49.9% for the carriage of both the variants combined. Carriage of TM6SF2 rs58542926 is an additional risk factor for the development of HCC in people with alcohol-related cirrhosis. Carriage of both PNPLA3 rs738409 and TM6SF2 rs58542926 accounts for half of the attributable risk for HCC in this population. Genotyping will allow for more precise HCC risk-stratification of patients with alcohol-related cirrhosis, and genotype-guided screening algorithms would optimize patient care.

The Contribution of Smoking to Black-White Differences in U.S. Mortality

PubMed Central

Ho, Jessica Y.; Elo, Irma T.

2012-01-01

Smoking has significantly impacted American mortality and remains a major cause of morbidity and mortality. No previous study has systematically examined the contribution of smoking-attributable deaths to mortality trends among blacks or to black-white mortality differences at older ages over time in the United States. In this article, we employ multiple methods and data sources to provide a comprehensive assessment of this contribution. We find that smoking has contributed to the black-white gap in life expectancy at age 50 for males, accounting for 20 % to 48 % of the gap between 1980 and 2005, but not for females. The fraction of deaths attributable to smoking at ages above 50 is greater for black males than for white males; and among men, current smoking status explains about 20 % of the black excess relative risk in all-cause mortality at ages above 50 without adjustment for socioeconomic characteristics. These findings advance our understanding of the contribution of smoking to contemporary mortality trends and differences and reinforce the need for interventions that better address the needs of all groups. PMID:23086667

The burden of disease from indoor air pollution in developing countries: comparison of estimates.

PubMed

Smith, Kirk R; Mehta, Sumi

2003-08-01

Four different methods have been applied to estimate the burden of disease due to indoor air pollution from household solid fuel use in developing countries (LDCs). The largest number of estimates involves applying exposure-response information from urban ambient air pollution studies to estimate indoor exposure concentrations of particulate air pollution. Another approach is to construct child survival curves using the results of large-scale household surveys, as has been done for India. A third approach involves cross-national analyses of child survival and household fuel use. The fourth method, referred to as the 'fuel-based' approach, which is explored in more depth here, involves applying relative risk estimates from epidemiological studies that use exposure surrogates, such as fuel type, to estimates of household solid fuel use to determine population attributable fractions by disease and age group. With this method and conservative assumptions about relative risks, 4-5 percent of the global LDC totals for both deaths and DALYs (disability adjusted life years) from acute respiratory infections, chronic obstructive pulmonary disease, tuberculosis, asthma, lung cancer, ischaemic heart disease, and blindness can be attributed to solid fuel use in developing countries. Acute respiratory infections in children under five years of age are the largest single category of deaths (64%) and DALYs (81%) from indoor air pollution, apparently being responsible globally for about 1.2 million premature deaths annually in the early 1990s.

Worldwide burden of cancer attributable to HPV by site, country and HPV type

PubMed Central

Plummer, Martyn; Vignat, Jerome; Franceschi, Silvia

2017-01-01

HPV is the cause of almost all cervical cancer and is responsible for a substantial fraction of other anogenital cancers and oropharyngeal cancers. Understanding the HPV‐attributable cancer burden can boost programs of HPV vaccination and HPV‐based cervical screening. Attributable fractions (AFs) and the relative contributions of different HPV types were derived from published studies reporting on the prevalence of transforming HPV infection in cancer tissue. Maps of age‐standardized incidence rates of HPV‐attributable cancers by country from GLOBOCAN 2012 data are shown separately for the cervix, other anogenital tract and head and neck cancers. The relative contribution of HPV16/18 and HPV6/11/16/18/31/33/45/52/58 was also estimated. 4.5% of all cancers worldwide (630,000 new cancer cases per year) are attributable to HPV: 8.6% in women and 0.8% in men. AF in women ranges from <3% in Australia/New Zealand and the USA to >20% in India and sub‐Saharan Africa. Cervix accounts for 83% of HPV‐attributable cancer, two‐thirds of which occur in less developed countries. Other HPV‐attributable anogenital cancer includes 8,500 vulva; 12,000 vagina; 35,000 anus (half occurring in men) and 13,000 penis. In the head and neck, HPV‐attributable cancers represent 38,000 cases of which 21,000 are oropharyngeal cancers occurring in more developed countries. The relative contributions of HPV16/18 and HPV6/11/16/18/31/33/45/52/58 are 73% and 90%, respectively. Universal access to vaccination is the key to avoiding most cases of HPV‐attributable cancer. The preponderant burden of HPV16/18 and the possibility of cross‐protection emphasize the importance of the introduction of more affordable vaccines in less developed countries. PMID:28369882

Occupational burden of asbestos-related cancer in Argentina, Brazil, Colombia, and Mexico.

PubMed

Pasetto, Roberto; Terracini, Benedetto; Marsili, Daniela; Comba, Pietro

2014-01-01

An estimate at the national level of the occupational cancer burden brought about by the industrial use of asbestos requires detailed routine information on such uses as well as on vital statistics of good quality. A causal association with asbestos exposure has been established for mesothelioma and cancers of the lung, larynx, and ovary. The aim of this study was to provide estimates of the occupational burden of asbestos-related cancer for the Latin American countries that are or have been the highest asbestos consumers in the region: Argentina, Brazil, Colombia, and Mexico. The burden of multifactorial cancers has been estimated through the approach suggested for the World Health Organization using the population attributable fraction. The following data were used: Proportion of workforce employed in each economic sector. Proportion of workers exposed to asbestos in each sector. Occupational turnover. Levels of exposure. Proportion of the population in the workforce. Relative risk for each considered disease for 1 or more levels of exposure. Data on the proportion of workers exposed to asbestos in each sector are not available for Latin American countries; therefore, data from the European CAREX database (carcinogen exposure database) were used. Using mortality data of the World Health Organization Health Statistics database for the year 2009 and applying the estimated values for population attributable fractions, the number of estimated deaths in 5 years for mesothelioma and for lung, larynx, and ovary cancers attributable to occupational asbestos exposures, were respectively 735, 233, 29, and 14 for Argentina; 340, 611, 68, and 43 for Brazil; 255, 97, 14, and 9 for Colombia, and 1075, 219, 18, and 22 for Mexico. The limitations in compiling the estimates highlight the need for improvement in the quality of asbestos-related environmental and health data. Nevertheless, the figures are already usable to promote a ban on asbestos use. Copyright © 2014 Icahn School of Medicine at Mount Sinai. Published by Elsevier Inc. All rights reserved.

Evaluating the Properties of Poly(lactic-co-glycolic acid) Nanoparticle Formulations Encapsulating a Hydrophobic Drug by Using the Quality by Design Approach.

PubMed

Kozaki, Masato; Kobayashi, Shin-Ichiro; Goda, Yukihiro; Okuda, Haruhiro; Sakai-Kato, Kumiko

2017-01-01

We applied the Quality by Design (QbD) approach to the development of poly(lactic-co-glycolic acid) (PLGA) nanoparticle formulations encapsulating triamcinolone acetonide, and the critical process parameters (CPPs) were identified to clarify the correlations between critical quality attributes and CPPs. Quality risk management was performed by using an Ishikawa diagram and experiments with a fractional factorial design (ANOVA). The CPPs for particle size were PLGA concentration and rotation speed, and the CPP for relative drug loading efficiency was the poor solvent to good solvent volume ratio. By assessing the mutually related factors in the form of ratios, many factors could be efficiently considered in the risk assessment. We found a two-factor interaction between rotation speed and rate of addition of good solvent by using a fractional factorial design with resolution V. The system was then extended by using a central composite design, and the results obtained were visualized by using the response surface method to construct a design space. Our research represents a case study of the application of the QbD approach to pharmaceutical development, including formulation screening, by taking actual production factors into consideration. Our findings support the feasibility of using a similar approach to nanoparticle formulations under development. We could establish an efficient method of analyzing the CPPs of PLGA nanoparticles by using a QbD approach.

Occupational asthma in the developing and industrialised world: a review.

PubMed

Jeebhay, M F; Quirce, S

2007-02-01

Occupational asthma is the most common occupational lung disease in industrialised countries, and the second most common occupational lung disease reported after pneumoconioses in developing countries. The median proportion of adult cases of asthma attributable to occupational exposure is between 10% and 15%. The population attributable fraction appears to be similar in industrialised and developing countries characterised by rapid industrialisation (13-15%), but lower in less industrialised developing countries (6%). The high-risk occupations and industries associated with the development of occupational asthma vary depending on the dominant industrial sectors in a particular country. High-risk exposure to cleaning agents and pesticide exposure in developing countries appear to be as important as exposure to isocyanates, cereal flour/grain dust, welding fumes, wood dust and, more recently, hairdressing chemicals, commonly reported in industrialised countries. The reported mean annual incidence of occupational asthma in developing countries is less than 2 per 100 000 population, compared to very high rates of up to 18/100 000 in Scandinavian countries. While occupational asthma remains under-recognised, especially in developing countries, it remains poorly diagnosed and managed and inadequately compensated worldwide. Primary and secondary preventive strategies should be directed at controlling workplace exposures, accompanied by intense educational and managerial improvements. Appropriate treatment remains early removal from exposure to ensure that the worker has no further exposure to the causal agent, with preservation of income. However, up to one third of workers with occupational asthma continue to remain exposed to the causative agent or suffer prolonged work disruption, discrimination and risk of unemployment.

Drug Violations and Aviation Accidents: Findings from the U.S. Mandatory Drug Testing Programs

PubMed Central

Li, Guohua; Baker, Susan P.; Zhao, Qi; Brady, Joanne E.; Lang, Barbara H.; Rebok, George W.; DiMaggio, Charles

2012-01-01

Aims To assess the role of drug violations in aviation accidents. Design Case-control analysis. Setting Commercial aviation in the United States. Participants Aviation employees who were tested for drugs during 1995 through 2005 under the post-accident testing program (cases, n=4,977) or under the random testing program (controls, n=1,129,922). Measurements Point prevalence of drug violations, odds ratio of accident involvement, and attributable risk in the population. A drug violation was defined as a confirmed positive test for marijuana (≥ 50 ng/ml), cocaine (≥ 300 ng/ml), amphetamines (≥1000 ng/ml), opiates (≥ 2000 ng/ml), or phencyclidine (≥ 25 ng/ml). Findings The prevalence of drug violations was 0.64% [95% confidence interval (CI), 0.62–0.65%] in random drug tests and 1.82% (95% CI, 1.47–2.24%) in post-accident tests. The odds of accident involvement for employees who tested positive for drugs was almost three times the odds for those who tested negative (odds ratio 2.90, 95% CI, 2.35–3.57), with an estimated attributable risk of 1.2%. Marijuana accounted for 67.3% of the illicit drugs detected. The proportion of illicit drugs represented by amphetamines increased progressively during the study period, from 3.4% in 1995 to 10.3% in 2005 (p<0.0001). Conclusions Use of illicit drugs by aviation employees is associated with a significantly increased risk of accident involvement. Due to the very low prevalence, drug violations contribute to only a small fraction of aviation accidents. PMID:21306594

Assessment of public health impact of work-related asthma.

PubMed

Jaakkola, Maritta S; Jaakkola, Jouni J K

2012-03-05

Asthma is among the most common chronic diseases in working-aged populations and occupational exposures are important causal agents. Our aims were to evaluate the best methods to assess occurrence, public health impact, and burden to society related to occupational or work-related asthma and to achieve comparable estimates for different populations. We addressed three central questions: 1: What is the best method to assess the occurrence of occupational asthma? We evaluated: 1) assessment of the occurrence of occupational asthma per se, and 2) assessment of adult-onset asthma and the population attributable fractions due to specific occupational exposures. 2: What are the best methods to assess public health impact and burden to society related to occupational or work-related asthma? We evaluated methods based on assessment of excess burden of disease due to specific occupational exposures. 3: How to achieve comparable estimates for different populations? We evaluated comparability of estimates of occurrence and burden attributable to occupational asthma based on different methods. Assessment of the occurrence of occupational asthma per se can be used in countries with good coverage of the identification system for occupational asthma, i.e. countries with well-functioning occupational health services. Assessment based on adult-onset asthma and population attributable fractions due to specific occupational exposures is a good approach to estimate the occurrence of occupational asthma at the population level. For assessment of public health impact from work-related asthma we recommend assessing excess burden of disease due to specific occupational exposures, including excess incidence of asthma complemented by an assessment of disability from it. International comparability of estimates can be best achieved by methods based on population attributable fractions. Public health impact assessment for occupational asthma is central in prevention and health policy planning and could be improved by purposeful development of methods for assessing health benefits from preventive actions. Registry-based methods are suitable for evaluating time-trends of occurrence at a given population but for international comparisons they face serious limitations. Assessment of excess burden of disease due to specific occupational exposure is a useful measure, when there is valid information on population exposure and attributable fractions.

[Estimation of the impact of risk factors control on non-communicable diseases mortality, life expectancy and the labor force lost in China in 2030].

PubMed

Zeng, X Y; Li, Y C; Liu, J M; Liu, Y N; Liu, S W; Qi, J L; Zhou, M G

2017-12-06

Objective: To estimate the impact of risk factors control on non-communicable diseases (NCDs) mortality, life expectancy and the numbers of labor force lost in China in 2030. Methods: We used the results of China from Global Burden of Disease Study 2013, according to the correlation between death of NCDs and exposure of risk factors and the comparative risk assessment theory, to calculate population attributable fraction (PAF) and disaggregate deaths of NCDs into parts attributable and un-attributable. We used proportional change model to project risk factors exposure and un-attributable deaths of NCDs in 2030, then to get deaths of NCDs in 2030. Simulated scenarios according to the goals of global main NCDs risk factors control proposed by WHO were constructed to calculate the impact of risk factors control on NCDs death, life expectancy and the numbers of labor force lost. Results: If the risk factors exposure changed according to the trend of 1990 to 2013, compared to the numbers (8.499 million) and mortality rate (613.5/100 000) of NCDs in 2013, the death number (12.161 million) and mortality rate (859.2/100 000) would increase by 43.1% and 40.0% respectively in 2030, among which, ischemic stroke (increasing by 103.3% for death number and 98.8% for mortality rate) and ischemic heart disease (increasing by 85.0% for death number and 81.0% for mortality rate) would increase most quickly. If the risk factors get the goals in 2030, the NCDs deaths would reduce 2 631 thousands. If only one risk factor gets the goal, blood pressure (1 484 thousands NCDs deaths reduction), smoking (717 thousands reduction) and BMI (274 thousands reduction) would be the most important factors affecting NCDs death. Blood pressure control would have greater impact on ischemic heart disease (662 thousands reduction) and hemorrhagic stroke (449 thousands reduction). Smoking control would have the greatest effect on lung cancer (251 thousands reduction) and chronic obstructive pulmonary disease (201 thousands reduction). BMI control would have the greatest impact on ischemic heart disease (86 thousands reduction) and hypertensive heart disease (45 thousands reduction). If the risk factors exposure changed according to the trend of 1990 to 2013, in 2030, the life expectancy of Chinese population would reach to 79.0 years old, compared to 2013, increasing by 3.3 years old, the labor force at the age of 15-64 years old would loss 1.932 million. If the risk factors get the goals in 2030, life expectancy would increase to 81.7 years old and the number of labor force lost would decrease to 1.467 million. Blood pressure, smoking and BMI control would have much greater impact on life expectancy (4.9, 4.0 and 3.8 years old respectively) and labor force lost (630 thousands, 496 thousands and 440 thousands respectively). Conclusion: Risk factors control would play an important role in reducing NCD death, improving life expectancy of residents and reducing loss of labor force. Among them, the control of blood pressure raising, smoking and BMI raising would have a greater contribution to the improvement of population health status.

Assessment of radiation-induced second cancer risks in proton therapy and IMRT for organs inside the primary radiation field

NASA Astrophysics Data System (ADS)

Paganetti, Harald; Athar, Basit S.; Moteabbed, Maryam; Adams, Judith A.; Schneider, Uwe; Yock, Torunn I.

2012-10-01

There is clinical evidence that second malignancies in radiation therapy occur mainly within the beam path, i.e. in the medium or high-dose region. The purpose of this study was to assess the risk for developing a radiation-induced tumor within the treated volume and to compare this risk for proton therapy and intensity-modulated photon therapy (IMRT). Instead of using data for specific patients we have created a representative scenario. Fully contoured age- and gender-specific whole body phantoms (4 year and 14 year old) were uploaded into a treatment planning system and tumor volumes were contoured based on patients treated for optic glioma and vertebral body Ewing's sarcoma. Treatment plans for IMRT and proton therapy treatments were generated. Lifetime attributable risks (LARs) for developing a second malignancy were calculated using a risk model considering cell kill, mutation, repopulation, as well as inhomogeneous organ doses. For standard fractionation schemes, the LAR for developing a second malignancy from radiation therapy alone was found to be up to 2.7% for a 4 year old optic glioma patient treated with IMRT considering a soft-tissue carcinoma risk model only. Sarcoma risks were found to be below 1% in all cases. For a 14 year old, risks were found to be about a factor of 2 lower. For Ewing's sarcoma cases the risks based on a sarcoma model were typically higher than the carcinoma risks, i.e. LAR up to 1.3% for soft-tissue sarcoma. In all cases, the risk from proton therapy turned out to be lower by at least a factor of 2 and up to a factor of 10. This is mainly due to lower total energy deposited in the patient when using proton beams. However, the comparison of a three-field and four-field proton plan also shows that the distribution of the dose, i.e. the particular treatment plan, plays a role. When using different fractionation schemes, the estimated risks roughly scale with the total dose difference in%. In conclusion, proton therapy can significantly reduce the risk for developing an in-field second malignancy. The risk depends on treatment planning parameters, i.e. an analysis based on our formalism could be applied within treatment planning programs to guide treatment plans for pediatric patients.

Socioeconomic Inequalities in Hearing Loss in a Healthy Population Sample: The HUNT Study

PubMed Central

Krokstad, Steinar; Tambs, Kristian

2009-01-01

We assessed socioeconomic position and hearing loss in a Norwegian population of 17 593 men and women aged 30–54 years in 1984–1986 who were followed for 11 years. We used analysis of variance, logistic regression, and population-attributable fraction analyses to examine associations. Significant socioeconomic inequalities in hearing loss were found among men. Adjusted odds ratios for hearing loss were approximately 1.3 to 1.9 for semi- and unskilled manual workers compared with participants with high occupational class; the population-attributable fraction of the prevalence of hearing loss over the cutpoint in the high-frequency (3, 4, 6, and 8 kHz) range was 35%. PMID:19542048

Colorectal Cancer Deaths Attributable to Nonuse of Screening in the United States

PubMed Central

Meester, Reinier G.S.; Doubeni, Chyke A.; Lansdorp-Vogelaar, Iris; Goede, S.L.; Levin, Theodore R.; Quinn, Virginia P.; van Ballegooijen, Marjolein; Corley, Douglas A.; Zauber, Ann G.

2015-01-01

Purpose Screening is a major contributor to colorectal cancer (CRC) mortality reductions in the U.S., but is underutilized. We estimated the fraction of CRC deaths attributable to nonuse of screening to demonstrate the potential benefits from targeted interventions. Methods The established MISCAN-colon microsimulation model was used to estimate the population attributable fraction (PAF) in people aged ≥50 years. The model incorporates long-term patterns and effects of screening by age and type of screening test. PAF for 2010 was estimated using currently available data on screening uptake; PAF was also projected assuming constant future screening rates to incorporate lagged effects from past increases in screening uptake. We also computed PAF using Levin's formula to gauge how this simpler approach differs from the model-based approach. Results There were an estimated 51,500 CRC deaths in 2010, about 63% (N∼32,200) of which were attributable to non-screening. The PAF decreases slightly to 58% in 2020. Levin's approach yielded a considerably more conservative PAF of 46% (N∼23,600) for 2010. Conclusions The majority of current U.S. CRC deaths are attributable to non-screening. This underscores the potential benefits of increasing screening uptake in the population. Traditional methods of estimating PAF underestimated screening effects compared with model-based approaches. PMID:25721748

Estimating the harms and costs of cannabis-attributable collisions in the Canadian provinces.

PubMed

Wettlaufer, Ashley; Florica, Roxana O; Asbridge, Mark; Beirness, Douglas; Brubacher, Jeffrey; Callaghan, Russell; Fischer, Benedikt; Gmel, Gerrit; Imtiaz, Sameer; Mann, Robert E; McKiernan, Anna; Rehm, Jürgen

2017-04-01

In 2012, 10% of Canadians used cannabis and just under half of those who use cannabis were estimated to have driven under the influence of cannabis. Substantial evidence has accumulated to indicate that driving after cannabis use increases collision risk significantly; however, little is known about the extent and costs associated with cannabis-related traffic collisions. This study quantifies the costs of cannabis-related traffic collisions in the Canadian provinces. Province and age specific cannabis-attributable fractions (CAFs) were calculated for traffic collisions of varying severity. The CAFs were applied to traffic collision data in order to estimate the total number of persons involved in cannabis-attributable fatal, injury and property damage only collisions. Social cost values, based on willingness-to-pay and direct costs, were applied to estimate the costs associated with cannabis-related traffic collisions. The 95% confidence intervals were calculated using Monte Carlo methodology. Cannabis-attributable traffic collisions were estimated to have caused 75 deaths (95% CI: 0-213), 4407 injuries (95% CI: 20-11,549) and 7794 people (95% CI: 3107-13,086) were involved in property damage only collisions in Canada in 2012, totalling $1,094,972,062 (95% CI: 37,069,392-2,934,108,175) with costs being highest among younger people. The cannabis-attributable driving harms and costs are substantial. The harm and cost of cannabis-related collisions is an important factor to consider as Canada looks to legalize and regulate the sale of cannabis. This analysis provides evidence to help inform Canadian policy to reduce the human and economic costs of drug-impaired driving. Copyright © 2017 Canadian Centre on Substance Abuse. Published by Elsevier B.V. All rights reserved.

Measurement Approach to Teaching Fractions: A Design Experiment in a Pre-Service Course for Elementary Teachers

ERIC Educational Resources Information Center

Bobos, Georgeana; Sierpinska, Anna

2017-01-01

In this paper, we present a design experiment in a "Teaching Mathematics" course for prospective elementary teachers where we sought to develop a "measurement approach" to fractions. We focus on the conceptualization of the mathematical content of the approach. We attribute our progress in the conceptualization to our efforts…

Pneumococcal Acquisition Among Infants Exposed to HIV in Rural Malawi: A Longitudinal Household Study

PubMed Central

Heinsbroek, Ellen; Tafatatha, Terence; Chisambo, Christina; Phiri, Amos; Mwiba, Oddie; Ngwira, Bagrey; Crampin, Amelia C.; Read, Jonathan M.; French, Neil

2016-01-01

The prevalence of Streptococcus pneumoniae (pneumococcus) carriage is higher in adults who are infected with human immunodeficiency virus (HIV) than in adults who are not. We hypothesized that infants exposed to HIV become carriers of nasopharyngeal pneumococcus earlier and more frequently than infants who are not exposed to HIV. We compared infant pneumococcal acquisition by maternal HIV status and household exposure in Karonga District, Malawi, in 2009–2011, before the introduction of pneumococcal conjugate vaccine. Nasopharyngeal swabs were collected every 4–6 weeks in the first year of life from infants with known HIV-exposure status, their mothers, and other household members. We studied infant pneumococcal acquisition by maternal HIV status, serotype-specific household exposure, and other risk factors, including seasonality. We recruited 54 infants who were exposed to HIV and 131 infants who were not. There was no significant difference in pneumococcal acquisition by maternal HIV status (adjusted rate ratio (aRR) = 1.00, 95% confidence interval (CI): 0.87, 1.15). Carriage by the mother was associated with greater acquisition of the same serotype (aRR = 3.09, 95% CI: 1.47, 6.50), but the adjusted population attributable fraction was negligible (1.9%, 95% CI: 0.0, 4.3). Serotype-specific exposure to children under 5 years of age was associated with higher acquisition (aRR = 4.30, 95% CI: 2.80, 6.60; adjusted population attributable fraction = 8.8%, 95% CI: 4.0, 13.4). We found no evidence to suggest that maternal HIV infection would affect the impact of pneumococcal vaccination on colonization in this population. PMID:26628514

Russia-specific relative risks and their effects on the estimated alcohol-attributable burden of disease.

PubMed

Shield, Kevin D; Rehm, Jürgen

2015-05-10

Alcohol consumption is a major risk factor for the burden of disease globally. This burden is estimated using Relative Risk (RR) functions for alcohol from meta-analyses that use data from all countries; however, for Russia and surrounding countries, country-specific risk data may need to be used. The objective of this paper is to compare the estimated burden of alcohol consumption calculated using Russia-specific alcohol RRs with the estimated burden of alcohol consumption calculated using alcohol RRs from meta-analyses. Data for 2012 on drinking indicators were calculated based on the Global Information System on Alcohol and Health. Data for 2012 on mortality, Years of Life Lost, Years Lived with Disability, and Disability-Adjusted Life Years (DALYs) lost by cause were obtained by country from the World Health Organization. Alcohol Population-Attributable Fractions (PAFs) were calculated based on a risk modelling methodology from Russia. These PAFs were compared to PAFs calculated using methods applied for all other countries. The 95% Uncertainty Intervals (UIs) for the alcohol PAFs were calculated using a Monte Carlo-like method. Using Russia-specific alcohol RR functions, in Russia in 2012 alcohol caused an estimated 231,900 deaths (95% UI: 185,600 to 278,200) (70,800 deaths among women and 161,100 deaths among men) and 13,295,000 DALYs lost (95% UI: 11,242,000 to 15,348,000) (3,670,000 DALYs lost among women and 9,625,000 DALYs lost among men) among people 0 to 64 years of age. This compares to an estimated 165,600 deaths (95% UI: 97,200 to 228,100) (29,700 deaths among women and 135,900 deaths among men) and 10,623,000 DALYs lost (95% UI: 7,265,000 to 13,754,000) (1,783,000 DALYs lost among women and 8,840,000 DALYs lost among men) among people 0 to 64 years of age caused by alcohol when non-Russia-specific alcohol RRs were used. Results indicate that if the Russia-specific RRs are used when estimating the health burden attributable to alcohol consumption in Russia, then the total estimated burden will be more than if RRs from meta-analyses are used. Furthermore, additional research is needed to understand which aspects of the Russian style of drinking cause the most harm.

Bioanalytical effect-balance model to determine the bioavailability of organic contaminants in sediments affected by black and natural carbon.

PubMed

Bräunig, Jennifer; Tang, Janet Y M; Warne, Michael St J; Escher, Beate I

2016-08-01

In sediments several binding phases dictate the fate and bioavailability of organic contaminants. Black carbon (BC) has a high sorptive capacity for organic contaminants and can limit their bioavailability, while the fraction bound to organic carbon (OC) is considered to be readily desorbable and bioavailable. We investigated the bioavailability and mixture toxicity of sediment-associated contaminants by combining different extraction techniques with in vitro bioanalytical tools. Sediments from a harbour with high fraction of BC, and sediments from remote, agricultural and urban areas with lower BC were treated with exhaustive solvent extraction, Tenax extraction and passive sampling to estimate total, bioaccessible and bioavailable fractions, respectively. The extracts were characterized with cell-based bioassays that measure dioxin-like activity (AhR-CAFLUX) and the adaptive stress response to oxidative stress (AREc32). Resulting bioanalytical equivalents, which are effect-scaled concentrations, were applied in an effect-balance model, consistent with a mass balance-partitioning model for single chemicals. Sediments containing BC had most of the bioactivity associated to the BC fraction, while the OC fraction played a role for sediments with lower BC. As effect-based sediment-water distribution ratios demonstrated, most of the bioactivity in the AhR-CAFLUX was attributable to hydrophobic chemicals while more hydrophilic chemicals activated AREc32, even though bioanalytical equivalents in the aqueous phase remained negligible. This approach can be used to understand the fate and effects of mixtures of diverse organic contaminants in sediments that would not be possible if single chemicals were targeted by chemical analysis; and make informed risk-based decisions concerning the management of contaminated sediments. Copyright © 2016 Elsevier Ltd. All rights reserved.

Burden of disease attributed to ambient air pollution in Thailand: A GIS-based approach

PubMed Central

Pinichka, Chayut; Makka, Nuttapat; Sukkumnoed, Decharut; Chariyalertsak, Suwat; Inchai, Puchong

2017-01-01

Background Growing urbanisation and population requiring enhanced electricity generation as well as the increasing numbers of fossil fuel in Thailand pose important challenges to air quality management which impacts on the health of the population. Mortality attributed to ambient air pollution is one of the sustainable development goals (SDGs). We estimated the spatial pattern of mortality burden attributable to selected ambient air pollution in 2009 based on the empirical evidence in Thailand. Methods We estimated the burden of disease attributable to ambient air pollution based on the comparative risk assessment (CRA) framework developed by the World Health Organization (WHO) and the Global Burden of Disease study (GBD). We integrated geographical information systems (GIS)-based exposure assessments into spatial interpolation models to estimate ambient air pollutant concentrations, the population distribution of exposure and the concentration-response (CR) relationship to quantify ambient air pollution exposure and associated mortality. We obtained air quality data from the Pollution Control Department (PCD) of Thailand surface air pollution monitoring network sources and estimated the CR relationship between relative risk (RR) and concentration of air pollutants from the epidemiological literature. Results We estimated 650–38,410 ambient air pollution-related fatalities and 160–5,982 fatalities that could have been avoided with a 20 reduction in ambient air pollutant concentrations. The summation of population-attributable fraction (PAF) of the disease burden for all-causes mortality in adults due to NO2 and PM2.5 were the highest among all air pollutants at 10% and 7.5%, respectively. The PAF summation of PM2.5 for lung cancer and cardiovascular disease were 16.8% and 14.6% respectively and the PAF summations of mortality attributable to PM10 was 3.4% for all-causes mortality, 1.7% for respiratory and 3.8% for cardiovascular mortality, while the PAF summation of mortality attributable to NO2 was 7.8% for respiratory mortality in Thailand. Conclusion Mortality due to ambient air pollution in Thailand varies across the country. Geographical distribution estimates can identify high exposure areas for planners and policy-makers. Our results suggest that the benefits of a 20% reduction in ambient air pollution concentration could prevent up to 25% of avoidable fatalities each year in all-causes, respiratory and cardiovascular categories. Furthermore, our findings can provide guidelines for future epidemiological investigations and policy decisions to achieve the SDGs. PMID:29267319

Medical-device risk management and public safety: using cost-benefit as a measurement of effectiveness

NASA Astrophysics Data System (ADS)

Hughes, Allen A.

1994-12-01

Public safety can be enhanced through the development of a comprehensive medical device risk management. This can be accomplished through case studies using a framework that incorporates cost-benefit analysis in the evaluation of risk management attributes. This paper presents a framework for evaluating the risk management system for regulatory Class III medical devices. The framework consists of the following sixteen attributes of a comprehensive medical device risk management system: fault/failure analysis, premarket testing/clinical trials, post-approval studies, manufacturer sponsored hospital studies, product labeling, establishment inspections, problem reporting program, mandatory hospital reporting, medical literature surveillance, device/patient registries, device performance monitoring, returned product analysis, autopsy program, emergency treatment funds/interim compensation, product liability, and alternative compensation mechanisms. Review of performance histories for several medical devices can reveal the value of information for many attributes, and also the inter-dependencies of the attributes in generating risk information flow. Such an information flow network is presented as a starting point for enhancing medical device risk management by focusing on attributes with high net benefit values and potential to spur information dissemination.

Multimethod Prediction of Physical Parent-Child Aggression Risk in Expectant Mothers and Fathers with Social Information Processing Theory

PubMed Central

Rodriguez, Christina M.; Smith, Tamika L.; Silvia, Paul J.

2015-01-01

The Social Information Processing (SIP) model postulates that parents undergo a series of stages in implementing physical discipline that can escalate into physical child abuse. The current study utilized a multimethod approach to investigate whether SIP factors can predict risk of parent-child aggression (PCA) in a diverse sample of expectant mothers and fathers. SIP factors of PCA attitudes, negative child attributions, reactivity, and empathy were considered as potential predictors of PCA risk; additionally, analyses considered whether personal history of PCA predicted participants’ own PCA risk through its influence on their attitudes and attributions. Findings indicate that, for both mothers and fathers, history influenced attitudes but not attributions in predicting PCA risk, and attitudes and attributions predicted PCA risk; empathy and reactivity predicted negative child attributions for expectant mothers, but only reactivity significantly predicted attributions for expectant fathers. Path models for expectant mothers and fathers were remarkably similar. Overall, the findings provide support for major aspects of the SIP model. Continued work is needed in studying the progression of these factors across time for both mothers and fathers as well as the inclusion of other relevant ecological factors to the SIP model. PMID:26631420

Fast-track extreme event attribution: How fast can we disentangle thermodynamic (forced) and dynamic (internal) contributions?

NASA Astrophysics Data System (ADS)

Haustein, Karsten; Otto, Friederike; Uhe, Peter; Allen, Myles; Cullen, Heidi

2016-04-01

Within the last decade, extreme weather event attribution has emerged as a new field of science and garnered increasing attention from the wider scientific community and the public. Numerous methods have been put forward to determine the contribution of anthropogenic climate change to individual extreme weather events. So far nearly all such analyses were done months after an event has happened. First, we present our newly established method which can assess the fraction of attributable risk (FAR) of a severe weather event due to an external driver in real-time. The method builds on a large ensemble of atmosphere-only GCM/RCM simulations forced by seasonal forecast sea surface temperatures (SSTs). Taking the UK 2013/14 winter floods as an example, we demonstrate that the change in risk for heavy rainfall during the England floods due to anthropogenic climate change is of similar magnitude using either observed or seasonal forecast SSTs. While FAR is assumed to be independent from event-specific dynamic contributions due to anomalous circulation patterns as a first approximation, the risk of an event to occur under current conditions is clearly a function of the state of the atmosphere. The shorter the event, the more it is a result of chaotic internal weather variability. Hence we are interested to (1) attribute the event to thermodynamic and dynamic causes and to (2) establish a sensible time-scale for which we can make a useful and potentially robust attribution statement with regard to event-specific dynamics. Having tested the dynamic response of our model to SST conditions in January 2014, we find that observed SSTs are required to establish a discernible link between anomalous ocean temperatures and the atmospheric circulation over the North Atlantic in general and the UK in particular. However, for extreme events occurring under strongly anomalous SST patterns, associated with known low-frequency climate modes such as El Nino or La Nina, forecast SSTs can provide sufficient guidance to determine the dynamic contribution to the event on the basis of monthly mean values. No such link can be made (North Atlantic/Western Europe region) for shorter time-scales, unless the observed state of the circulation is taken as reference for the model analysis (e.g. Christidis et al. 2014). We present results from our most recent attribution analysis for the December 2015 UK floods (Storm Desmond and Eva), during which we find a robust teleconnection link between Pacific SSTs and North Atlantic Jetstream anomalies. This is true for both experiments, with forecast and observed SSTs. We propose a fast and simple analysis method based on the comparison of current climatological circulation patterns with actual and natural conditions. Alternative methods are discussed and analysed regarding their potential for fast-track attribution of the role of dynamics. Also, we briefly revisit the issue of internal vs forced dynamic contributions.

The burden of cancer at work: estimation as the first step to prevention.

PubMed

Rushton, L; Hutchings, S; Brown, T

2008-12-01

Work-related cancers are largely preventable. The overall aim of this project is to estimate the current burden of cancer in Great Britain attributable to occupational factors, and identify carcinogenic agents, industries and occupations for targeting risk prevention. Attributable fractions and numbers were estimated for mortality and incidence for bladder, lung, non-melanoma skin, and sinonasal cancers, leukaemia and mesothelioma for agents and occupations classified as International Agency for Research on Cancer (IARC) Group 1 and 2A carcinogens with "strong" or "suggestive" evidence for carcinogenicity at the specific cancer site in humans. Risk estimates were obtained from published literature and national data sources used for estimating proportions exposed. In 2004, 78,237 men and 71,666 women died from cancer in Great Britain. Of these, 7317 (4.9%) deaths (men: 6259 (8%); women: 1058 (1.5%)) were estimated to be attributable to work-related carcinogens for the six cancers assessed. Incidence estimates were 13,338 (4.0%) registrations (men: 11,284 (6.7%); women 2054 (1.2%)). Asbestos contributed over half the occupational attributable deaths, followed by silica, diesel engine exhaust, radon, work as a painter, mineral oils in metal workers and in the printing industry, environmental tobacco smoke (non-smokers), work as a welder and dioxins. Occupational exposure to solar radiation, mineral oils and coal tars/pitches contributed 2557, 1867 and 550 skin cancer registrations, respectively. Industries/occupations with large numbers of deaths and/or registrations include construction, metal working, personal and household services, mining (not metals), land transport and services allied to transport, roofing, road repair/construction, printing, farming, the Armed Forces, some other service industry sectors and manufacture of transport equipment, fabricated metal products, machinery, non-ferrous metals and metal products, and chemicals. Estimates for all but leukaemia are greater than those currently used in UK health and safety strategy planning and contrast with small numbers (200-240 annually) from occupational accidents. Sources of uncertainty in the estimates arise principally from approximate data and methodological issues. On balance, the estimates are likely to be a conservative estimate of the true risk. Long latency means that past high exposures will continue to give substantial numbers in the near future. Although levels of many exposures have reduced, recent measurements of others, such as wood dust and respirable quartz, show continuing high levels.

Attributional style as a mediator between parental abuse risk and child internalizing symptomatology.

PubMed

Rodriguez, Christina M

2006-05-01

This study examined a model wherein children's attributional style mediates the relationship between parental physical child-abuse risk and children's internalizing problems. Using structural equation modeling, three indices of abuse risk were selected (child abuse potential, physical discipline use, and dysfunctional parenting style) and two indices of children's internalizing problems (depression and anxiety). The sample included 75 parent-child dyads, in which parents reported on their abuse risk and children independently completed measures of depressive and anxious symptomatology and a measure on their attributional style. Findings supported the model that children's attributional style for positive events (but not negative events) partially mediated the relationship between abuse risk and internalizing symptoms, with significant direct and indirect effects of abuse risk on internalizing symptomatology. Future directions to continue evaluating additional mediators and other possible contextual variables are discussed.

Cardiovascular disease mortality and years of life lost attributable to non-optimal systolic blood pressure and hypertension in northeastern Iran.

PubMed

Sepanlou, Sadaf G; Newson, Roger B; Poustchi, Hossein; Malekzadeh, Masoud M; Rezanejad Asl, Parisa; Etemadi, Arash; Khademi, Hooman; Islami, Farhad; Pourshams, Akram; Pharoah, Paul D; Abnet, Christian C; Brennan, Paul; Bofetta, Paolo; Dawsey, Sanford M; Kamangar, Farin; Malekzadeh, Reza

2015-03-01

High blood pressure is the second most important risk factor of cardiovascular diseases (CVDs) in Iran. It is imperative to estimate the burden of CVDs that can be averted if high blood pressure is controlled at the population level. The aim of the current study was to estimate the avertable CVD mortality in the setting of Golestan Cohort Study (GCS). Over 50,000 participants were recruited and followed for a median of 7 years. The exposures of interest in this study were non-optimal systolic blood pressure (SBP) and hypertension measured at baseline. Deaths by cause have been precisely recorded. The Population Attributable Fraction (PAF) of deaths and Years of Life Lost (YLLs) due to CVDs attributable to exposures of interest were calculated. Overall, 223 deaths due to ischemic heart disease (IHD), 207 deaths due to cerebrovascular accidents (CVA), and 460 deaths due to all CVDs could be averted if the SBP of all subjects in the study were optimal. Similarly, 5,560 YLLs due to IHD, 4,771 YLLs due to CVA, and 11,135 YLLs due to CVDs could be prevented if SBP were optimal. In all age groups, the avertable deaths and YLLs were higher due to IHD compared with CVA. Deaths and YLLs attributable to non-optimal SBP in women were less than men. A very large proportion of CVD deaths can be averted if blood pressure is controlled in Iran. Effective interventions in primary and secondary health care setting are mandatory to be implemented as early as possible.

Estimating the burden of disease attributable to diabetes in South Africa in 2000.

PubMed

Bradshaw, Debbie; Norman, Rosana; Pieterse, Desiréé; Levitt, Naomi S

2007-08-01

To estimate the burden of disease attributable to diabetes by sex and age group in South Africa in 2000. The framework adopted for the most recent World Health Organization comparative risk assessment (CRA) methodology was followed. Small community studies used to derive the prevalence of diabetes by population group were weighted proportionately for a national estimate. Population-attributable fractions were calculated and applied to revised burden of disease estimates. Monte Carlo simulation-modelling techniques were used for uncertainty analysis. South Africa. Adults 30 years and older. Mortality and disability-adjusted life years (DALYs) for ischaemic heart disease (IHD), stroke, hypertensive disease and renal failure. Of South Africans aged >or= 30 years, 5.5% had diabetes which increased with age. Overall, about 14% of IHD, 10% of stroke, 12% of hypertensive disease and 12% of renal disease burden in adult males and females (30+ years) were attributable to diabetes. Diabetes was estimated to have caused 22,412 (95% uncertainty interval 20,755 - 24,872) or 4.3% (95% uncertainty interval 4.0 - 4.8%) of all deaths in South Africa in 2000. Since most of these occurred in middle or old age, the loss of healthy life years comprises a smaller proportion of the total 258,028 DALYs (95% uncertainty interval 236,856 - 290,849) in South Africa in 2000, accounting for 1.6% (95% uncertainty interval 1.5 - 1.8%) of the total burden. Diabetes is an important direct and indirect cause of burden in South Africa. Primary prevention of the disease through multi-level interventions and improved management at primary health care level are needed.

Estimating source-attributable health impacts of ambient fine particulate matter exposure: global premature mortality from surface transportation emissions in 2005

NASA Astrophysics Data System (ADS)

Chambliss, S. E.; Silva, R.; West, J. J.; Zeinali, M.; Minjares, R.

2014-10-01

Exposure to ambient fine particular matter (PM2.5) was responsible for 3.2 million premature deaths in 2010 and is among the top ten leading risk factors for early death. Surface transportation is a significant global source of PM2.5 emissions and a target for new actions. The objective of this study is to estimate the global and national health burden of ambient PM2.5 exposure attributable to surface transportation emissions. This share of health burden is called the transportation attributable fraction (TAF), and is assumed equal to the proportional decrease in modeled ambient particulate matter concentrations when surface transportation emissions are removed. National population-weighted TAFs for 190 countries are modeled for 2005 using the MOZART-4 global chemical transport model. Changes in annual average concentration of PM2.5 at 0.5 × 0.67 degree horizontal resolution are based on a global emissions inventory and removal of all surface transportation emissions. Global population-weighted average TAF was 8.5 percent or 1.75 μg m-3 in 2005. Approximately 242 000 annual premature deaths were attributable to surface transportation emissions, dominated by China, the United States, the European Union and India. This application of TAF allows future Global Burden of Disease studies to estimate the sector-specific burden of ambient PM2.5 exposure. Additional research is needed to capture intraurban variations in emissions and exposure, and to broaden the range of health effects considered, including the effects of other pollutants.

Intimate partner violence, relationship power inequity, and incidence of HIV infection in young women in South Africa: a cohort study.

PubMed

Jewkes, Rachel K; Dunkle, Kristin; Nduna, Mzikazi; Shai, Nwabisa

2010-07-03

Cross-sectional studies have shown that intimate partner violence and gender inequity in relationships are associated with increased prevalence of HIV in women. Yet temporal sequence and causality have been questioned, and few HIV prevention programmes address these issues. We assessed whether intimate partner violence and relationship power inequity increase risk of incident HIV infection in South African women. We did a longitudinal analysis of data from a previously published cluster-randomised controlled trial undertaken in the Eastern Cape province of South Africa in 2002-06. 1099 women aged 15-26 years who were HIV negative at baseline and had at least one additional HIV test over 2 years of follow-up were included in the analysis. Gender power equity and intimate partner violence were measured by a sexual relationship power scale and the WHO violence against women instrument, respectively. Incidence rate ratios (IRRs) of HIV acquisition at 2 years were derived from Poisson models, adjusted for study design and herpes simplex virus type 2 infection, and used to calculate population attributable fractions. 128 women acquired HIV during 2076 person-years of follow-up (incidence 6.2 per 100 person-years). 51 of 325 women with low relationship power equity at baseline acquired HIV (8.5 per 100 person-years) compared with 73 of 704 women with medium or high relationship power equity (5.5 per 100 person-years); adjusted multivariable Poisson model IRR 1.51, 95% CI 1.05-2.17, p=0.027. 45 of 253 women who reported more than one episode of intimate partner violence at baseline acquired HIV (9.6 per 100 person-years) compared with 83 of 846 who reported one or no episodes (5.2 per 100 person-years); adjusted multivariable Poisson model IRR 1.51, 1.04-2.21, p=0.032. The population attributable fractions were 13.9% (95% CI 2.0-22.2) for relationship power equity and 11.9% (1.4-19.3) for intimate partner violence. Relationship power inequity and intimate partner violence increase risk of incident HIV infection in young South African women. Policy, interventions, and programmes for HIV prevention must address both of these risk factors and allocate appropriate resources. National Institute of Mental Health and South African Medical Research Council. Copyright 2010 Elsevier Ltd. All rights reserved.

Smoking-attributable medical expenditures by age, sex, and smoking status estimated using a relative risk approach☆

PubMed Central

Maciosek, Michael V.; Xu, Xin; Butani, Amy L.; Pechacek, Terry F.

2015-01-01

Objective To accurately assess the benefits of tobacco control interventions and to better inform decision makers, knowledge of medical expenditures by age, gender, and smoking status is essential. Method We propose an approach to distribute smoking-attributable expenditures by age, gender, and cigarette smoking status to reflect the known risks of smoking. We distribute hospitalization days for smoking-attributable diseases according to relative risks of smoking-attributable mortality, and use the method to determine national estimates of smoking-attributable expenditures by age, sex, and cigarette smoking status. Sensitivity analyses explored assumptions of the method. Results Both current and former smokers ages 75 and over have about 12 times the smoking-attributable expenditures of their current and former smoker counterparts 35–54 years of age. Within each age group, the expenditures of formers smokers are about 70% lower than current smokers. In sensitivity analysis, these results were not robust to large changes to the relative risks of smoking-attributable mortality which were used in the calculations. Conclusion Sex- and age-group-specific smoking expenditures reflect observed disease risk differences between current and former cigarette smokers and indicate that about 70% of current smokers’ excess medical care costs is preventable by quitting. PMID:26051203

Racial and ethnic disparities in hospital care resulting from air pollution in excess of federal standards.

PubMed

Hackbarth, Andrew D; Romley, John A; Goldman, Dana P

2011-10-01

This study investigates racial and ethnic disparities in hospital admission and emergency room visit rates resulting from exposure to ozone and fine particulate matter levels in excess of federal standards ("excess attributable risk"). We generate zip code-level ambient pollution exposures and hospital event rates using state datasets, and use pollution impact estimates in the epidemiological literature to calculate excess attributable risk for racial/ethnic groups in California over 2005-2007. We find that black residents experienced roughly 2.5 times the excess attributable risk of white residents. Hispanic residents were exposed to the highest levels of pollution, but experienced similar excess attributable risk to whites. Asian/Pacific Islander residents had substantially lower excess attributable risk compared to white. We estimate the distinct contributions of exposure and other factors to these results, and find that factors other than exposure can be critical determinants of pollution-related disparities. Copyright © 2011 Elsevier Ltd. All rights reserved.

Risk Factors for Campylobacteriosis of Chicken, Ruminant, and Environmental Origin: A Combined Case-Control and Source Attribution Analysis

PubMed Central

Wagenaar, Jaap A.; de Boer, Albert G.; Havelaar, Arie H.; Friesema, Ingrid H. M.; French, Nigel P.; Busani, Luca; van Pelt, Wilfrid

2012-01-01

Background Campylobacteriosis contributes strongly to the disease burden of food-borne pathogens. Case-control studies are limited in attributing human infections to the different reservoirs because they can only trace back to the points of exposure, which may not point to the original reservoirs because of cross-contamination. Human Campylobacter infections can be attributed to specific reservoirs by estimating the extent of subtype sharing between strains from humans and reservoirs using multilocus sequence typing (MLST). Methodology/Principal Findings We investigated risk factors for human campylobacteriosis caused by Campylobacter strains attributed to different reservoirs. Sequence types (STs) were determined for 696 C. jejuni and 41 C. coli strains from endemic human cases included in a case-control study. The asymmetric island model, a population genetics approach for modeling Campylobacter evolution and transmission, attributed these cases to four putative animal reservoirs (chicken, cattle, sheep, pig) and to the environment (water, sand, wild birds) considered as a proxy for other unidentified reservoirs. Most cases were attributed to chicken (66%) and cattle (21%), identified as the main reservoirs in The Netherlands. Consuming chicken was a risk factor for campylobacteriosis caused by chicken-associated STs, whereas consuming beef and pork were protective. Risk factors for campylobacteriosis caused by ruminant-associated STs were contact with animals, barbecuing in non-urban areas, consumption of tripe, and never/seldom chicken consumption. Consuming game and swimming in a domestic swimming pool during springtime were risk factors for campylobacteriosis caused by environment-associated STs. Infections with chicken- and ruminant-associated STs were only partially explained by food-borne transmission; direct contact and environmental pathways were also important. Conclusion/Significance This is the first case-control study in which risk factors for campylobacteriosis are investigated in relation to the attributed reservoirs based on MLST profiles. Combining epidemiological and source attribution data improved campylobacteriosis risk factor identification and characterization, generated hypotheses, and showed that genotype-based source attribution is epidemiologically sensible. PMID:22880049

Comparison of cluster-based and source-attribution methods for estimating transmission risk using large HIV sequence databases.

PubMed

Le Vu, Stéphane; Ratmann, Oliver; Delpech, Valerie; Brown, Alison E; Gill, O Noel; Tostevin, Anna; Fraser, Christophe; Volz, Erik M

2018-06-01

Phylogenetic clustering of HIV sequences from a random sample of patients can reveal epidemiological transmission patterns, but interpretation is hampered by limited theoretical support and statistical properties of clustering analysis remain poorly understood. Alternatively, source attribution methods allow fitting of HIV transmission models and thereby quantify aspects of disease transmission. A simulation study was conducted to assess error rates of clustering methods for detecting transmission risk factors. We modeled HIV epidemics among men having sex with men and generated phylogenies comparable to those that can be obtained from HIV surveillance data in the UK. Clustering and source attribution approaches were applied to evaluate their ability to identify patient attributes as transmission risk factors. We find that commonly used methods show a misleading association between cluster size or odds of clustering and covariates that are correlated with time since infection, regardless of their influence on transmission. Clustering methods usually have higher error rates and lower sensitivity than source attribution method for identifying transmission risk factors. But neither methods provide robust estimates of transmission risk ratios. Source attribution method can alleviate drawbacks from phylogenetic clustering but formal population genetic modeling may be required to estimate quantitative transmission risk factors. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

Multimethod prediction of physical parent-child aggression risk in expectant mothers and fathers with Social Information Processing theory.

PubMed

Rodriguez, Christina M; Smith, Tamika L; Silvia, Paul J

2016-01-01

The Social Information Processing (SIP) model postulates that parents undergo a series of stages in implementing physical discipline that can escalate into physical child abuse. The current study utilized a multimethod approach to investigate whether SIP factors can predict risk of parent-child aggression (PCA) in a diverse sample of expectant mothers and fathers. SIP factors of PCA attitudes, negative child attributions, reactivity, and empathy were considered as potential predictors of PCA risk; additionally, analyses considered whether personal history of PCA predicted participants' own PCA risk through its influence on their attitudes and attributions. Findings indicate that, for both mothers and fathers, history influenced attitudes but not attributions in predicting PCA risk, and attitudes and attributions predicted PCA risk; empathy and reactivity predicted negative child attributions for expectant mothers, but only reactivity significantly predicted attributions for expectant fathers. Path models for expectant mothers and fathers were remarkably similar. Overall, the findings provide support for major aspects of the SIP model. Continued work is needed in studying the progression of these factors across time for both mothers and fathers as well as the inclusion of other relevant ecological factors to the SIP model. Copyright © 2015 Elsevier Ltd. All rights reserved.

Contribution of overweight and obesity to adverse pregnancy outcomes among immigrant and non-immigrant women in Berlin, Germany.

PubMed

Reiss, Katharina; Breckenkamp, Jürgen; Borde, Theda; Brenne, Silke; David, Matthias; Razum, Oliver

2015-10-01

Maternal excessive weight and smoking are associated with an increased risk of pregnancy complications and adverse pregnancy outcomes. In Germany, immigrant women have a higher prevalence of pre-pregnancy overweight/obesity compared with autochthonous women. We compared the contribution of pre-pregnancy overweight/obesity to adverse pregnancy outcomes among immigrant and autochthonous women in Berlin/Germany. Data from 2586 immigrant women (from Turkey, Lebanon, other countries of origin) and 2676 autochthonous women delivering in three maternity hospitals of Berlin within 12 months (2011/2012) was used. Cox regression models were applied to estimate the association between overweight/obesity and smoking with the outcomes large-for-gestational-age (LGA), small-for-gestational-age (SGA), preterm birth (PTB) and extreme preterm-birth (E-PTB). Population attributive fractions (PAF) were calculated to quantify the proportion of the outcomes attributable to overweight/obesity and smoking, respectively. Prevalence of overweight and obesity was 33.4% among autochthonous and 53.6% among Turkish women. Prevalence risk ratios of excessive weight were highest for LGA infants among immigrant and autochthonous women. The PAFs were -11.8% (SGA), +16.3% (LGA), +3.6% (PTB) and +16.5% (E-PTB) for the total study population. Overweight/obesity is strongly associated with an increased risk of delivering an LGA infant among both immigrant and autochthonous women. Compared with autochthonous women, the contribution of excessive weight to LGA is even higher among immigrant women, in whom PAFs of overweight/obesity even exceed those of smoking for some outcomes. © The Author 2015. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

Expected number of asbestos-related lung cancers in the Netherlands in the next two decades: a comparison of methods.

PubMed

Van der Bij, Sjoukje; Vermeulen, Roel C H; Portengen, Lützen; Moons, Karel G M; Koffijberg, Hendrik

2016-05-01

Exposure to asbestos fibres increases the risk of mesothelioma and lung cancer. Although the vast majority of mesothelioma cases are caused by asbestos exposure, the number of asbestos-related lung cancers is less clear. This number cannot be determined directly as lung cancer causes are not clinically distinguishable but may be estimated using varying modelling methods. We applied three different modelling methods to the Dutch population supplemented with uncertainty ranges (UR) due to uncertainty in model input values. The first method estimated asbestos-related lung cancer cases directly from observed and predicted mesothelioma cases in an age-period-cohort analysis. The second method used evidence on the fraction of lung cancer cases attributable (population attributable risk (PAR)) to asbestos exposure. The third method incorporated risk estimates and population exposure estimates to perform a life table analysis. The three methods varied substantially in incorporated evidence. Moreover, the estimated number of asbestos-related lung cancer cases in the Netherlands between 2011 and 2030 depended crucially on the actual method applied, as the mesothelioma method predicts 17 500 expected cases (UR 7000-57 000), the PAR method predicts 12 150 cases (UR 6700-19 000), and the life table analysis predicts 6800 cases (UR 6800-33 850). The three different methods described resulted in absolute estimates varying by a factor of ∼2.5. These results show that accurate estimation of the impact of asbestos exposure on the lung cancer burden remains a challenge. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Cigarette smoking, educational level and total and site-specific cancer: a cohort study in men in Lithuania.

PubMed

Everatt, Rūta; Kuzmickienė, Irena; Virvičiūtė, Dalia; Tamošiūnas, Abdonas

2014-11-01

Smoking is an established risk factor for cancer. However, most studies have been carried out on western populations, and less is known about the impact in central and eastern Europe. Our objective was to investigate the association between cigarette smoking, educational level and risk of cancer in a Lithuanian population-based cohort study. The study included 6976 men initially free from cancer. During the follow-up (1978-2008), 1780 cancer cases were identified. Cox proportional hazards models were used to estimate hazard ratios (HRs) and corresponding 95% confidence intervals (95% CIs). In addition, the burden of cancer attributable to smoking was assessed by the population attributable fraction. Following adjustment for age, education, alcohol consumption and BMI, for current compared with never smokers, highly significant and strongly elevated estimates were found for total (HR=1.79, 95% CI 1.59-2.02), tobacco-related (HR=2.52, 95% CI 2.16-2.95), upper aerodigestive tract (UADT) (HR=5.77, 95% CI 2.73-12.21), lung (HR=10.47, 95% CI 6.74-16.25), bladder (HR=3.31, 95% CI 1.71-6.41) and liver (HR=4.64, 95% CI 1.53-14.08) cancer. Findings suggest a lower risk of prostate cancer in current smokers. In addition, the occurrence of lung and UADT cancer was significantly elevated in men in the lowest educational attainment category. If smoking had not occurred, ∼23% of total cancer, 37% of tobacco-related, 77% of lung, 58% of UADT, 43% of liver and 45% of bladder cancer cases could have been prevented in this cohort of men. Cancer-control strategies focused on reducing smoking should be a public health priority.

Alcohol Consumption and Chronic Liver Disease Mortality in New Mexico and the United States, 1999-2013.

PubMed

Tomedi, Laura E; Roeber, Jim; Landen, Michael

Current chronic liver disease (CLD) mortality surveillance methods may not adequately capture data on all causes of CLD mortality. The objective of this study was to calculate and compare CLD death rates in New Mexico and the United States by using both an expanded definition of CLD and estimates of the fractional impact of alcohol on CLD deaths. We defined CLD mortality as deaths due to alcoholic liver disease, cirrhosis, viral hepatitis, and other liver conditions. We estimated alcohol-attributable CLD deaths by using national and state alcohol-attributable fractions from the Centers for Disease Control and Prevention's Alcohol-Related Disease Impact application. We classified causes of CLD death as being alcohol-attributable, non-alcohol-attributable, or hepatitis C. We calculated average annual age-adjusted CLD death rates during five 3-year periods from 1999 through 2013, and we stratified those rates by sex, age, and race/ethnicity. By cause of death, CLD death rates were highest for alcohol-attributable CLD. By sex and race/ethnicity, CLD death rates per 100 000 population increased from 1999-2001 to 2011-2013 among American Indian men in New Mexico (67.4-90.6) and the United States (38.9-49.4), American Indian women in New Mexico (48.4-63.0) and the United States (27.5-39.5), Hispanic men in New Mexico (48.6-52.0), Hispanic women in New Mexico (16.9-24.0) and the United States (12.8-13.1), non-Hispanic white men in New Mexico (17.4-21.3) and the United States (15.9-18.4), and non-Hispanic white women in New Mexico (9.7-11.6) and the United States (7.6-9.7). CLD death rates decreased among Hispanic men in the United States (30.5-27.4). An expanded CLD definition and alcohol-attributable fractions can be used to create comprehensive data on CLD mortality. When stratified by CLD cause and demographic characteristics, these data may help states and jurisdictions improve CLD prevention programs.

Patient Preferences for Attributes of Multiple Sclerosis Disease-Modifying Therapies

PubMed Central

Loucks, Aimee; Gipson, Gregory; Zhong, Lixian; Bui, Christine; Miller, Elizabeth; Owen, Mary; Pelletier, Daniel; Goodin, Douglas; Waubant, Emmanuelle; McCulloch, Charles E.

2015-01-01

Background: Timely individualized treatment is essential to improving relapsing-remitting multiple sclerosis (RRMS) patient health outcomes, yet little is known about how patients make treatment decisions. We sought to evaluate RRMS patient preferences for risks and benefits of treatment. Methods: Fifty patients with RRMS completed conjoint analysis surveys with 16 hypothetical disease-modifying therapy (DMT) medication profiles developed using a fractional factorial design. Medication profiles were assigned preference ratings from 0 (not acceptable) to 10 (most favorable). Medication attributes included a range of benefits, adverse effects, administration routes, and market durations. Analytical models used linear mixed-effects regression. Results: Participants showed the highest preference for medication profiles that would improve their symptoms (β = 0.81–1.03, P < .001), not a proven DMT outcome. Preventing relapses, the main clinical trial outcome, was not associated with significant preferences (P = .35). Each year of preventing magnetic resonance imaging changes and disease symptom progression showed DMT preferences of 0.17 point (β = 0.17, P = .002) and 0.12 point (β = 0.12, P < .001), respectively. Daily oral administration was preferred over all parenteral routes (P < .001). A 1% increase in death or severe disability decreased relative DMT preference by 1.15 points (P < .001). Conclusions: Patient preference focused on symptoms and prevention of progression but not on relapse prevention, the proven drug outcome. Patients were willing to accept some level of serious risk for certain types and amounts of benefits, and they strongly preferred daily oral administration over all other options. PMID:25892977

The influence of environmental hazard maps on risk beliefs, emotion, and health-related behavioral intentions.

PubMed

Severtson, Dolores J

2013-08-01

To test a theoretical explanation of how attributes of mapped environmental health hazards influence health-related behavioral intentions and how beliefs and emotion mediate the influences of attributes, 24 maps were developed that varied by four attributes of a residential drinking water hazard: level, proximity, prevalence, and density. In a factorial design, student participants (N = 446) answered questions about a subset of maps. Hazard level and proximity had the largest influences on intentions to test water and mitigate exposure. Belief in the problem's seriousness mediated attributes' influence on intention to test drinking water, and perceived susceptibility mediated the influence of attributes on intention to mitigate risk. Maps with carefully illustrated attributes of hazards may promote appropriate health-related risk beliefs, intentions, and behavior. Copyright © 2013 Wiley Periodicals, Inc.

Negligible impact of rare autoimmune-locus coding-region variants on missing heritability.

PubMed

Hunt, Karen A; Mistry, Vanisha; Bockett, Nicholas A; Ahmad, Tariq; Ban, Maria; Barker, Jonathan N; Barrett, Jeffrey C; Blackburn, Hannah; Brand, Oliver; Burren, Oliver; Capon, Francesca; Compston, Alastair; Gough, Stephen C L; Jostins, Luke; Kong, Yong; Lee, James C; Lek, Monkol; MacArthur, Daniel G; Mansfield, John C; Mathew, Christopher G; Mein, Charles A; Mirza, Muddassar; Nutland, Sarah; Onengut-Gumuscu, Suna; Papouli, Efterpi; Parkes, Miles; Rich, Stephen S; Sawcer, Steven; Satsangi, Jack; Simmonds, Matthew J; Trembath, Richard C; Walker, Neil M; Wozniak, Eva; Todd, John A; Simpson, Michael A; Plagnol, Vincent; van Heel, David A

2013-06-13

Genome-wide association studies (GWAS) have identified common variants of modest-effect size at hundreds of loci for common autoimmune diseases; however, a substantial fraction of heritability remains unexplained, to which rare variants may contribute. To discover rare variants and test them for association with a phenotype, most studies re-sequence a small initial sample size and then genotype the discovered variants in a larger sample set. This approach fails to analyse a large fraction of the rare variants present in the entire sample set. Here we perform simultaneous amplicon-sequencing-based variant discovery and genotyping for coding exons of 25 GWAS risk genes in 41,911 UK residents of white European origin, comprising 24,892 subjects with six autoimmune disease phenotypes and 17,019 controls, and show that rare coding-region variants at known loci have a negligible role in common autoimmune disease susceptibility. These results do not support the rare-variant synthetic genome-wide-association hypothesis (in which unobserved rare causal variants lead to association detected at common tag variants). Many known autoimmune disease risk loci contain multiple, independently associated, common and low-frequency variants, and so genes at these loci are a priori stronger candidates for harbouring rare coding-region variants than other genes. Our data indicate that the missing heritability for common autoimmune diseases may not be attributable to the rare coding-region variant portion of the allelic spectrum, but perhaps, as others have proposed, may be a result of many common-variant loci of weak effect.

Modeling the role of public transportation in sustaining tuberculosis transmission in South Africa.

PubMed

Andrews, Jason R; Morrow, Carl; Wood, Robin

2013-03-15

Current tuberculosis notification rates in South Africa are among the highest ever recorded. Although the human immunodeficiency virus epidemic has been a critical factor, the density of respiratory contacts in high-risk environments may be an important and underappreciated driver. Using a modified Wells-Riley model for airborne disease transmission, we estimated the risk of tuberculosis transmission on 3 modes of public transit (minibus taxis, buses, and trains) in Cape Town, South Africa, using exhaled carbon dioxide as a natural tracer gas to evaluate air exchange. Carbon dioxide measurements were performed between October and December of 2011. Environmental risk, reflected in the rebreathed fraction of air, was highest in minibus taxis and lowest in trains; however, the average number of passengers sharing an indoor space was highest in trains and lowest in minibus taxis. Among daily commuters, the annual risk of tuberculosis infection was projected to be 3.5%-5.0% and was highest among minibus taxi commuters. Assuming a duration of infectiousness of 1 year, the basic reproductive number attributable to transportation was more than 1 in all 3 modes of transportation. Given its poor ventilation and high respiratory contact rates, public transportation may play a critical role in sustaining tuberculosis transmission in South African cities.

Modeling the Role of Public Transportation in Sustaining Tuberculosis Transmission in South Africa

PubMed Central

Andrews, Jason R.; Morrow, Carl; Wood, Robin

2013-01-01

Current tuberculosis notification rates in South Africa are among the highest ever recorded. Although the human immunodeficiency virus epidemic has been a critical factor, the density of respiratory contacts in high-risk environments may be an important and underappreciated driver. Using a modified Wells-Riley model for airborne disease transmission, we estimated the risk of tuberculosis transmission on 3 modes of public transit (minibus taxis, buses, and trains) in Cape Town, South Africa, using exhaled carbon dioxide as a natural tracer gas to evaluate air exchange. Carbon dioxide measurements were performed between October and December of 2011. Environmental risk, reflected in the rebreathed fraction of air, was highest in minibus taxis and lowest in trains; however, the average number of passengers sharing an indoor space was highest in trains and lowest in minibus taxis. Among daily commuters, the annual risk of tuberculosis infection was projected to be 3.5%–5.0% and was highest among minibus taxi commuters. Assuming a duration of infectiousness of 1 year, the basic reproductive number attributable to transportation was more than 1 in all 3 modes of transportation. Given its poor ventilation and high respiratory contact rates, public transportation may play a critical role in sustaining tuberculosis transmission in South African cities. PMID:23423215

The economic burden of ill health due to diet, physical inactivity, smoking, alcohol and obesity in the UK: an update to 2006-07 NHS costs.

PubMed

Scarborough, Peter; Bhatnagar, Prachi; Wickramasinghe, Kremlin K; Allender, Steve; Foster, Charlie; Rayner, Mike

2011-12-01

Estimates of the economic cost of risk factors for chronic disease to the NHS provide evidence for prioritization of resources for prevention and public health. Previous comparable estimates of the economic costs of poor diet, physical inactivity, smoking, alcohol and overweight/obesity were based on economic data from 1992-93. Diseases associated with poor diet, physical inactivity, smoking, alcohol and overweight/obesity were identified. Risk factor-specific population attributable fractions for these diseases were applied to disease-specific estimates of the economic cost to the NHS in the UK in 2006-07. In 2006-07, poor diet-related ill health cost the NHS in the UK £5.8 billion. The cost of physical inactivity was £0.9 billion. Smoking cost was £3.3 billion, alcohol cost £3.3 billion, overweight and obesity cost £5.1 billion. The estimates of the economic cost of risk factors for chronic disease presented here are based on recent financial data and are directly comparable. They suggest that poor diet is a behavioural risk factor that has the highest impact on the budget of the NHS, followed by alcohol consumption, smoking and physical inactivity.

Coronary Heart Disease and Stroke Attributable to Major Risk Factors is Similar in Argentina and the United States: the Coronary Heart Disease Policy Model

PubMed Central

Moran, Andrew; DeGennaro, Vincent; Ferrante, Daniel; Coxson, Pamela G.; Palmas, Walter; Mejia, Raul; Perez-Stable, Eliseo J.; Goldman, Lee

2011-01-01

Background Cardiovascular disease is the leading cause of death in Argentina and the U.S. Argentina is 92% urban, with cardiovascular disease risk factor levels approximating the U.S. Methods The Coronary Heart Disease (CHD) Policy Model is a national-scale computer model of CHD and stroke. Risk factor data were obtained from the Cardiovascular Risk Factor Multiple Evaluation in Latin America Study (2003–04), Argentina National Risk Factor Survey (2005) and U.S. national surveys. Proportions of cardiovascular events over 2005–2015 attributable to risk factors were simulated by setting risk factors to optimal exposure levels [systolic blood pressure (SBP) 115 mm Hg, low-density lipoprotein cholesterol (LDL) 2.00 mmol/l (78 mg/dl), high-density lipoprotein cholesterol (HDL) 1.03 mmol/l (60 mg/dl), absence of diabetes, and smoking]. Cardiovascular disease attributable to body mass index (BMI) > 21 kg/m2 was assumed mediated through SBP, LDL, HDL, and diabetes. Results Cardiovascular disease attributable to major risk factors was similar between Argentina and the U.S., except for elevated SBP in men (CHD 8 % points higher in Argentine men, 6% higher for stroke). CHD attributable to BMI > 21 kg/m2 was substantially higher in the U.S. (men 10–11 % points higher; women CHD 13–14% higher). Conclusions Projected cardiovascular disease attributable to major risk factors appeared similar in Argentina and the U.S., though elevated BMI may be responsible for more of U.S. cardiovascular disease. A highly urbanized middle-income nation can have cardiovascular disease rates and risk factor levels comparable to a high income nation, but fewer resources for fighting the epidemic. PMID:21550675

Anti-tumour potential of a gallic acid-containing phenolic fraction from Oenothera biennis.

PubMed

Pellegrina, Chiara Dalla; Padovani, Giorgia; Mainente, Federica; Zoccatelli, Gianni; Bissoli, Gaetano; Mosconi, Silvia; Veneri, Gianluca; Peruffo, Angelo; Andrighetto, Giancarlo; Rizzi, Corrado; Chignola, Roberto

2005-08-08

A phenolic fraction purified form defatted seeds of Oenothera biennis promoted selective apoptosis of human and mouse bone marrow-derived cell lines following first-order kinetics through a caspase-dependent pathway. In non-leukemia tumour cell lines, such as human colon carcinoma CaCo(2) cells and mouse fibrosarcoma WEHI164 cells, this fraction inhibited (3)H-thymidine incorporation but not cell death or cell cycle arrest. Human peripheral blood mononuclear cells showed low sensitivity to treatment. Single bolus injection of the phenolic fraction could delay the growth of established myeloma tumours in syngeneic animals. HPLC and mass spectrometry analysis revealed that the fraction contains gallic acid. However, the biological activity of the fraction differs from the activity of this phenol and hence it should be attributed to other co-purified molecules which remain still unidentified.

Risk assessment for the mercury polluted site near a pesticide plant in Changsha, Hunan, China.

PubMed

Dong, Haochen; Lin, Zhijia; Wan, Xiang; Feng, Liu

2017-02-01

The distribution characteristics of mercury fractions at the site near a pesticide plant was investigated, with the total mercury concentrations ranging from 0.0250 to 44.3 mg kg -1 . The mercury bound to organic matter and residual mercury were the main fractions, and the most mobile fractions accounted for only 5.9%-9.7%, indicating a relatively low degree of potential risk. The relationships between mercury fractions and soil physicochemical properties were analysed. The results demonstrated that organic matter was one of the most important factors in soil fraction distribution, and both OM and soil pH appeared to have a significant influence on the Fe/Mn oxides of mercury. Together with the methodology of partial correlation analysis, the concept and model of delayed geochemical hazard (DGH) was introduced to reveal the potential transformation paths and chain reactions among different mercury fractions and therefore to have a better understanding of risk development. The results showed that the site may be classified as a low-risk site of mercury DGH with a probability of 10.5%, but it had an easy trend in mercury DGH development due to low critical points of DGH burst. In summary, this study provides a methodology for site risk assessment in terms of static risk and risk development. Copyright © 2016 Elsevier Ltd. All rights reserved.

Determination of a risk management primer at petroleum-contaminated sites: developing new human health risk assessment strategy.

PubMed

Park, In-Sun; Park, Jae-Woo

2011-01-30

Total petroleum hydrocarbon (TPH) is an important environmental contaminant that is toxic to human and environmental receptors. However, human health risk assessment for petroleum, oil, and lubricant (POL)-contaminated sites is especially challenging because TPH is not a single compound, but rather a mixture of numerous substances. To address this concern, this study recommends a new human health risk assessment strategy for POL-contaminated sites. The strategy is based on a newly modified TPH fractionation method and includes an improved analytical protocol. The proposed TPH fractionation method is composed of ten fractions (e.g., aliphatic and aromatic EC8-10, EC10-12, EC12-16, EC16-22 and EC22-40). Physicochemical properties and toxicity values of each fraction were newly defined in this study. The stepwise ultrasonication-based analytical process was established to measure TPH fractions. Analytical results were compared with those from the TPH Criteria Working Group (TPHCWG) Direct Method. Better analytical efficiencies in TPH, aliphatic, and aromatic fractions were achieved when contaminated soil samples were analyzed with the new analytical protocol. Finally, a human health risk assessment was performed based on the developed tiered risk assessment framework. Results showed that a detailed quantitative risk assessment should be conducted to determine scientifically and economically appropriate cleanup target levels, although the phase II process is useful for determining the potency of human health risks posed by POL-contamination. Copyright © 2010 Elsevier B.V. All rights reserved.

Tuberculosis and poverty: why are the poor at greater risk in India?

PubMed

Oxlade, Olivia; Murray, Megan

2012-01-01

Although poverty is widely recognized as an important risk factor for tuberculosis (TB) disease, the specific proximal risk factors that mediate this association are less clear. The objective of our study was to investigate the mechanisms by which poverty increases the risk of TB. Using individual level data from 198,754 people from the 2006 Demographic Health Survey (DHS) for India, we assessed self-reported TB status, TB determinants and household socioeconomic status. We used these data to calculate the population attributable fractions (PAF) for each key TB risk factor based on the prevalence of determinants and estimates of the effect of these risk factors derived from published sources. We conducted a mediation analysis using principal components analysis (PCA) and regression to demonstrate how the association between poverty and TB prevalence is mediated. The prevalence of self-reported TB in the 2006 DHS for India was 545 per 100,000 and ranged from 201 in the highest quintile to 1100 in the lowest quintile. Among those in the poorest population, the PAFs for low body mass index (BMI) and indoor air pollution were 34.2% and 28.5% respectively. The PCA analysis also showed that low BMI had the strongest mediating effect on the association between poverty and prevalent TB (12%, p = 0.019). TB control strategies should be targeted to the poorest populations that are most at risk, and should address the most important determinants of disease--specifically low BMI and indoor air pollution.

Risks for depression onset in primary care elderly patients: potential targets for preventive interventions.

PubMed

Lyness, Jeffrey M; Yu, Qin; Tang, Wan; Tu, Xin; Conwell, Yeates

2009-12-01

Prevention of late-life depression, a common, disabling condition with often poor outcomes in primary care, requires identification of seniors at highest risk of incident episodes. The authors examined a broad range of clinical, functional, and psychosocial predictors of incident depressive episodes in a well-characterized cohort of older primary care patients. In this observational cohort study, patients age >/=65 years without current major depression, recruited from practices in general internal medicine, geriatrics, and family medicine, received annual follow-up assessments over a period of 1 to 4 years. Of 617 enrolled subjects, 405 completed the 1-year follow-up evaluation. The Structured Clinical Interview for DSM-IV (SCID) determined incident major depressive episodes. Each risk indicator's predictive utility was examined by calculating the risk exposure rate, incident risk ratio, and population attributable fraction, leading to determination of the number needed to treat in order to prevent incident depression. A combination of risks, including minor or subsyndromal depression, impaired functional status, and history of major or minor depression, identified a group in which fully effective treatment of five individuals would prevent one new case of incident depression. Indicators routinely assessed in primary care identified a group at very high risk for onset of major depressive episodes. Such markers may inform current clinical care by fostering the early detection and intervention critical to improving patient outcomes and may serve as the basis for future studies refining the recommendations for screening and determining the effectiveness of preventive interventions.

Asthma caused by occupational exposures is common – A systematic analysis of estimates of the population-attributable fraction

PubMed Central

Torén, Kjell; Blanc, Paul D

2009-01-01

Background The aim of this paper is to highlight emerging data on occupational attributable risk in asthma. Despite well documented outbreaks of disease and the recognition of numerous specific causal agents, occupational exposures previously had been relegated a fairly minor role relative to other causes of adult onset asthma. In recent years there has been a growing recognition of the potential importance of asthma induced by work-related exposures Methods We searched Pub Med from June 1999 through December 2007. We identified six longitudinal general population-based studies; three case-control studies and eight cross-sectional analyses from seven general population-based samples. For an integrated analysis we added ten estimates prior to 1999 included in a previous review. Results The longitudinal studies indicate that 16.3% of all adult-onset asthma is caused by occupational exposures. In an overall synthesis of all included studies the overall median PAR value was 17.6%. Conclusion Clinicians should consider the occupational history when evaluating patients in working age who have asthma. At a societal level, these findings underscore the need for further preventive action to reduce the occupational exposures to asthma-causing agents. PMID:19178702

Occupational Lymphohematopoietic Cancer in Korea

PubMed Central

Lee, Won Jin; Son, Mia; Kang, Seong-Kyu

2010-01-01

The purpose of this study was to review the existing studies on lymphohematopoietic (LHP) cancer in Korea, estimate the prevalence of workers exposed to carcinogens, and determine the population attributable fraction (PAF) of leukemia. Two case series and 4 case reports were reviewed. Using official statistics, the prevalence of benzene exposure and ionizing radiation exposure was estimated. Based on the prevalence of exposure and the relative risk, The PAF of leukemia was calculated. Between 1996 and 2005, 51 cases of LHP cancer were reported from the compensation system. Greater than 50% of occupational LHP cancer was leukemia, and the most important cause was benzene. In a cohort study, the standardized incidence ratio was 2.71 (95% CI, 0.56-7.91). The prevalence of exposure was 2.5% and 2.2% in 1995 and 2000, respectively. Using the 1995 prevalence, 3.6-4.8% and 0.1% of cases with leukemia were attributable to benzene and ionizing radiation exposure, respectively, which resulted in 39.7-51.4 cases per year. Benzene is the most important cause of occupational leukemia in Korea. Considering the estimated PAF in this study, the annual number of occupational LHP cancer (51 cases during 10-yr period), might be underreported within the compensation system. PMID:21258598

Maternal anemia and risk of adverse birth and health outcomes in low- and middle-income countries: systematic review and meta-analysis.

PubMed

Rahman, Md Mizanur; Abe, Sarah Krull; Rahman, Md Shafiur; Kanda, Mikiko; Narita, Saki; Bilano, Ver; Ota, Erika; Gilmour, Stuart; Shibuya, Kenji

2016-02-01

Anemia is a leading cause of maternal deaths and adverse pregnancy outcomes in developing countries. We conducted a systematic review and meta-analysis to estimate the pooled prevalence of anemia, the association between maternal anemia and pregnancy outcomes, and the population-attributable fraction (PAF) of these outcomes that are due to anemia in low- and middle-income countries. PubMed, EMBASE, CINAHL, and the British Nursing Index were searched from inception to May 2015 to identify cohort studies of the association between maternal anemia and pregnancy outcomes. The anemic group was defined as having hemoglobin concentrations <10 or <11 g/dL or hematocrit values <33% or <34% depending on the study. A metaregression and stratified analysis were performed to assess the effects of study and participant characteristics on adverse pregnancy risk. The pooled prevalence of anemia in pregnant women by region and country-income category was calculated with the use of a random-effects meta-analysis. Of 8182 articles reviewed, 29 studies were included in the systematic review, and 26 studies were included in the meta-analysis. Overall, 42.7% (95% CI: 37.0%, 48.4%) of women experienced anemia during pregnancy in low- and middle-income countries. There were significantly higher risks of low birth weight (RR: 1.31; 95% CI: 1.13, 1.51), preterm birth (RR: 1.63; 95% CI: 1.33, 2.01), perinatal mortality (RR: 1.51; 95% CI: 1.30, 1.76), and neonatal mortality (RR: 2.72; 95% CI: 1.19, 6.25) in pregnant women with anemia. South Asian, African, and low-income countries had a higher pooled anemia prevalence than did other Asian and upper-middle-income countries. Overall, in low- and middle-income countries, 12% of low birth weight, 19% of preterm births, and 18% of perinatal mortality were attributable to maternal anemia. The proportion of adverse pregnancy outcomes attributable to anemia was higher in low-income countries and in the South Asian region. Maternal anemia remains a significant health problem in low- and middle-income countries. © 2016 American Society for Nutrition.

Sedentary behaviour and physical activity in South Asian women: time to review current recommendations?

PubMed

Waidyatilaka, Indu; Lanerolle, Pulani; Wickremasinghe, Rajitha; Atukorala, Sunethra; Somasundaram, Noel; de Silva, Angela

2013-01-01

Our aims were to describe activity and sedentary behaviours in urban Asian women, with dysglycaemia (diagnosed at recruitment), and without dysglycaemia and examine the relative contribution of these parameters to their glycaemic status. 2800 urban women (30-45 years) were selected by random cluster sampling and screened for dysglycaemia for a final sample of 272 newly diagnosed, drug naive dysglycaemic and 345 normoglycaemic women. Physical activity and sedentary behaviours were assessed by the International Physical Activity Questionnaire (IPAQ). Demographic data, diet and anthropometry were recorded. Logistic regression analysis assessed contribution of all parameters to dysglycaemia and exposure attributable fractions were calculated. The mean energy expenditure on walking (2648.5±1023.7 MET-min/week) and on moderate and vigorous physical activity (4342.3±1768.1 MET-min/week) for normoglycemic women and dysglycaemic women (walking;1046.4±728.4 MET-min/week, moderate and vigorous physical activity; 1086.7±1184.4 MET-min/week) was above the recommended amount of physical activity per week. 94.3% of women spent >1000 MET-minutes/week on activity. Mean sitting and TV time for normoglycaemic and dysglycaemic women were 154.3±62.8, 38.4±31.9, 312.6±116.7 and 140.2±56.5 minutes per day respectively. Physical activity and sedentary behaviour contributed to dysglycaemia after adjustment for family history, diet, systolic blood pressure and Body Mass Index. Exposure attributable fractions for dysglycaemia were; lower physical activity: 78%, higher waist circumference: 94%, and TV viewing time: 85%. Urban South Asian women are at risk of dysglycaemia at lower levels of sedentary behaviour and greater physical activity than western populations, indicating the need for re-visiting current physical activity guidelines for South Asians.

The population attributable fraction of low education for mortality in South Korea with improvement in educational attainment and no improvement in mortality inequalities.

PubMed

Lim, Dohee; Kong, Kyoung Ae; Lee, Hye Ah; Lee, Won Kyung; Park, Su Hyun; Baik, Sun Jung; Park, Hyesook; Jung-Choi, Kyunghee

2015-03-31

The educational attainment of Koreans has greatly increased, which was expected to reduce the magnitude of the population attributable fraction (PAF) of mortality associated with low education levels. However, increase in the relative risk (RR) of mortality among those with lower educational levels actually increased the PAF. The purpose of this study was to examine the change in the PAF of lower educational levels for mortality in Korea, where educational attainment has improved and is associated with the exacerbation of inequalities in mortality levels. National census data were used to derive educational levels. The mortality-associated RR of lower educational levels was calculated by reference to national census and death certificate data from 1995, 2000, 2005, and 2010. PAFs were calculated for all-cause mortality, malignant neoplasms, cerebrovascular disease, heart disease, and suicide by gender and age group (30-44 and 45-59 years). The PAF of low educational level in terms of total mortality has decreased since 1995 in both genders. This trend was more prominent among those aged 30-44 years. However, the PAFs of suicide in younger females (30-44 years) and of cerebrovascular disease in older males (45-59 years) have increased. The RRs of all-cause mortality and those of the four leading causes of death in those with the lowest educational levels have increased, especially in females aged 30-44 years. The consistent and sharp increase in the attainment of education has contributed to the reduction in the PAFs of lower education for mortality, despite the fact that mortality inequalities have not improved. Efforts to reduce health inequalities must promote healthy public policy and address public health policies.

Population-attributable fraction of hypertension associated with obesity, abdominal obesity, and the joint effect of both in the Central Provinces of Iran.

PubMed

Mohammadi, Masoud; Mirzaei, Masoud

2017-03-01

The prevalence of obesity has been increasing in Iran over the past decade. This study aimed to determine the population-attributable fraction (PAF) of hypertension associated with obesity, abdominal obesity, and the joint effect of both in the central provinces of Iran. Prevalence of hypertension was extracted from the Iranian Ministry of Health Non-Communicable Disease Risk Factor InfoBase 2009. Measure of association between obesity and hypertension was extracted from Tehran Lipid and Glucose Study, for males and females, in order to calculate the PAF of hypertension associated with obesity. Age standardization of the reported prevalence of obesity was done using the World Health Organization method. The PAF of hypertension associated with the joint effect of obesity and abdominal obesity in females was highest in Semnan Province: 22.7 [95% confidence interval (CI): 4.2-35.6], followed by Qom 21.09 (95% CI: 3.7-33.1), and Yazd 20.3 (95% CI: 3.5-32.1). In males, the highest PAF was observed in Qom Province 31.07 (95% CI: 16.7-41.1), followed by Semnan 29.6 (95% CI: 15.9-39.3), Qazvin 25.9 (95% CI: 13.7-34.5), Tehran 24.2 (95% CI: 12.7-32.3), and Isfahan 20.4 (95% CI: 3.5-27.4). Prevalence of hypertension is higher in more developed provinces. PAFs suggest that a sizable share of hypertension in these provinces is associated with obesity. It is recommended that health promotion programs focus on obesity in the provinces with a higher share of hypertension due to obesity. Copyright © 2016 Ministry of Health, Saudi Arabia. Published by Elsevier Ltd. All rights reserved.

Attribution of human infections with Shiga toxin-producing Escherichia coli (STEC) to livestock sources and identification of source-specific risk factors, The Netherlands (2010-2014).

PubMed

Mughini-Gras, L; van Pelt, W; van der Voort, M; Heck, M; Friesema, I; Franz, E

2018-02-01

Shiga toxin-producing Escherichia coli (STEC) is a zoonotic pathogen of public health concern whose sources and transmission routes are difficult to trace. Using a combined source attribution and case-control analysis, we determined the relative contributions of four putative livestock sources (cattle, small ruminants, pigs, poultry) to human STEC infections and their associated dietary, animal contact, temporal and socio-econo-demographic risk factors in the Netherlands in 2010/2011-2014. Dutch source data were supplemented with those from other European countries with similar STEC epidemiology. Human STEC infections were attributed to sources using both the modified Dutch model (mDM) and the modified Hald model (mHM) supplied with the same O-serotyping data. Cattle accounted for 48.6% (mDM) and 53.1% (mHM) of the 1,183 human cases attributed, followed by small ruminants (mDM: 23.5%; mHM: 25.4%), pigs (mDM: 12.5%; mHM: 5.7%) and poultry (mDM: 2.7%; mHM: 3.1%), whereas the sources of the remaining 12.8% of cases could not be attributed. Of the top five O-serotypes infecting humans, O157, O26, O91 and O103 were mainly attributed to cattle (61%-75%) and O146 to small ruminants (71%-77%). Significant risk factors for human STEC infection as a whole were the consumption of beef, raw/undercooked meat or cured meat/cold cuts. For cattle-attributed STEC infections, specific risk factors were consuming raw meat spreads and beef. Consuming raw/undercooked or minced meat were risk factors for STEC infections attributed to small ruminants. For STEC infections attributed to pigs, only consuming raw/undercooked meat was significant. Consuming minced meat, raw/undercooked meat or cured meat/cold cuts were associated with poultry-attributed STEC infections. Consuming raw vegetables was protective for all STEC infections. We concluded that domestic ruminants account for approximately three-quarters of reported human STEC infections, whereas pigs and poultry play a minor role and that risk factors for human STEC infection vary according to the attributed source. © 2017 Blackwell Verlag GmbH.

Organo-iodine formation in soils and aquifer sediments at ambient concentrations.

PubMed

Schwehr, K A; Santschi, P H; Kaplan, D J; Yeager, C M; Brinkmeyer, R

2009-10-01

One of the key risk drivers at radioactive waste disposal facilities is radioiodine, especially 129I. As iodine mobility varies greatly with iodine speciation, experiments with 129I-contaminated aquifer sediments from the Savannah River Site located in Aiken, SC, were carried out to test iodine interactions with soils and aquifer sediments. Using tracer 125I- and stable 127I- additions, it was shown that such interactions were highly dependent on I- concentrations added to sediment suspensions, contact time with the sediment, and organic carbon (OC) content, resulting in an empirical particle-water partition coefficient (Kd) that was an inverse power function of the added I- concentration. However, Kd values of organically bound 127I were 3 orders of magnitude higher than those determined after 1-2 weeks of tracer equilibration, approaching those of OC. Under ambient conditions, organo-iodine (OI) was a major fraction (67%) of the total iodine in the dissolved phase and by implication of the particulate phase. As the total concentration of amended I- increased, the fraction of detectable dissolved OI decreased. This trend, attributed to OC becoming the limiting factor in the aquifer sediment explains why at elevated I-concentrations OI is often not detected.

Estimation of effective dose and lifetime attributable risk from multiple head CT scans in ventriculoperitoneal shunted children.

PubMed

Aw-Zoretic, J; Seth, D; Katzman, G; Sammet, S

2014-10-01

The purpose of this review is to determine the averaged effective dose and lifetime attributable risk factor from multiple head computed tomography (CT) dose data on children with ventriculoperitoneal shunts (VPS). A total of 422 paediatric head CT exams were found between October 2008 and January 2011 and retrospectively reviewed. The CT dose data was weighted with the latest IRCP 103 conversion factor to obtain the effective dose per study and the averaged effective dose was calculated. Estimates of the lifetime attributable risk were also calculated from the averaged effective dose using a conversion factor from the latest BEIR VII report. Our study found the highest effective doses in neonates and the lowest effective doses were observed in the 10-18 years age group. We estimated a 0.007% potential increase risk in neonates and 0.001% potential increased risk in teenagers over the base risk. Multiple head CTs in children equates to a slight potential increase risk in lifetime attributable risk over the baseline risk for cancer, slightly higher in neonates relative to teenagers. The potential risks versus clinical benefit must be assessed. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Antibacterial activity of polyphenolic fraction of Kombucha against Vibrio cholerae: targeting cell membrane.

PubMed

Bhattacharya, D; Ghosh, D; Bhattacharya, S; Sarkar, S; Karmakar, P; Koley, H; Gachhui, R

2018-02-01

The present study was undertaken to determine the mechanism of antibacterial activity of a polyphenolic fraction, composed of mainly catechin and isorhamnetin, previously isolated from Kombucha, a 14-day fermented beverage of sugared black tea, against the enteropathogen Vibrio cholerae N16961. Bacterial growth was found to be seriously impaired by the polyphenolic fraction in a dose-dependent manner. Scanning Electron Microscopy demonstrated morphological alterations in bacterial cells when exposed to the polyphenolic fraction in a concentration-dependent manner. Permeabilization assays confirmed that the fraction disrupted bacterial membrane integrity in both time- and dose-dependent manners, which were proportional to the production of intracellular reactive oxygen species (ROS). Furthermore, each of the polyphenols catechin and isorhamnetin showed the ability to permeate bacterial cell membranes by generating oxidative stress, thereby suggesting their role in the antibacterial potential of Kombucha. Thus, the basic mechanism of antibacterial activity of the Kombucha polyphenolic fraction against V. cholerae involved bacterial membrane permeabilization and morphological changes, which might be due to the generation of intracellular ROS. To the best of our knowledge, this is the first report on the investigation of antibacterial mechanism of Kombucha, which is mostly attributed to its polyphenolic content. The emergence of multidrug-resistant Vibrio cholerae strains has hindered an efficient anti-Vibrio therapy. This study has demonstrated the membrane damage-mediated antibacterial mechanism of Kombucha, a popular fermented beverage of sugared tea, which is mostly attributed to its polyphenolic content. This study also implies the exploitation of Kombucha as a potential new source of bioactive polyphenols against V. cholerae. © 2017 The Society for Applied Microbiology.

Atrial Electrogram Fractionation Distribution before and after Pulmonary Vein Isolation in Human Persistent Atrial Fibrillation-A Retrospective Multivariate Statistical Analysis.

PubMed

Almeida, Tiago P; Chu, Gavin S; Li, Xin; Dastagir, Nawshin; Tuan, Jiun H; Stafford, Peter J; Schlindwein, Fernando S; Ng, G André

2017-01-01

Purpose: Complex fractionated atrial electrograms (CFAE)-guided ablation after pulmonary vein isolation (PVI) has been used for persistent atrial fibrillation (persAF) therapy. This strategy has shown suboptimal outcomes due to, among other factors, undetected changes in the atrial tissue following PVI. In the present work, we investigate CFAE distribution before and after PVI in patients with persAF using a multivariate statistical model. Methods: 207 pairs of atrial electrograms (AEGs) were collected before and after PVI respectively, from corresponding LA regions in 18 persAF patients. Twelve attributes were measured from the AEGs, before and after PVI. Statistical models based on multivariate analysis of variance (MANOVA) and linear discriminant analysis (LDA) have been used to characterize the atrial regions and AEGs. Results: PVI significantly reduced CFAEs in the LA (70 vs. 40%; P < 0.0001). Four types of LA regions were identified, based on the AEGs characteristics: (i) fractionated before PVI that remained fractionated after PVI (31% of the collected points); (ii) fractionated that converted to normal (39%); (iii) normal prior to PVI that became fractionated (9%) and; (iv) normal that remained normal (21%). Individually, the attributes failed to distinguish these LA regions, but multivariate statistical models were effective in their discrimination ( P < 0.0001). Conclusion: Our results have unveiled that there are LA regions resistant to PVI, while others are affected by it. Although, traditional methods were unable to identify these different regions, the proposed multivariate statistical model discriminated LA regions resistant to PVI from those affected by it without prior ablation information.

The Burden of Cardiovascular Disease Attributable to Major Modifiable Risk Factors in Indonesia.

PubMed

Hussain, Mohammad Akhtar; Al Mamun, Abdullah; Peters, Sanne Ae; Woodward, Mark; Huxley, Rachel R

2016-10-05

In Indonesia, coronary heart disease (CHD) and stroke are estimated to cause more than 470 000 deaths annually. In order to inform primary prevention policies, we estimated the sex- and age-specific burden of CHD and stroke attributable to five major and modifiable vascular risk factors: cigarette smoking, hypertension, diabetes, elevated total cholesterol, and excess body weight. Population attributable risks for CHD and stroke attributable to these risk factors individually were calculated using summary statistics obtained for prevalence of each risk factor specific to sex and to two age categories (<55 and ≥55 years) from a national survey in Indonesia. Age- and sex-specific relative risks for CHD and stroke associated with each of the five risk factors were derived from prospective data from the Asia-Pacific region. Hypertension was the leading vascular risk factor, explaining 20%-25% of all CHD and 36%-42% of all strokes in both sexes and approximately one-third of all CHD and half of all strokes across younger and older age groups alike. Smoking in men explained a substantial proportion of vascular events (25% of CHD and 17% of strokes). However, given that these risk factors are likely to be strongly correlated, these population attributable risk proportions are likely to be overestimates and require verification from future studies that are able to take into account correlation between risk factors. Implementation of effective population-based prevention strategies aimed at reducing levels of major cardiovascular risk factors, especially blood pressure, total cholesterol, and smoking prevalence among men, could reduce the growing burden of CVD in the Indonesian population.

Smoking and Mortality in Eastern Europe: Results From the PrivMort Retrospective Cohort Study of 177 376 Individuals.

PubMed

Stefler, Denes; Murphy, Michael; Irdam, Darja; Horvat, Pia; Jarvis, Martin; King, Lawrence; McKee, Martin; Bobak, Martin

2018-05-03

The estimated prevalence of smoking and proportion of deaths due to tobacco in Eastern European countries are among the highest in the world. Existing estimates of mortality attributable to smoking in the region are mostly indirect. The aim of this analysis was to calculate the proportion of tobacco-attributed deaths in three Eastern European countries using individual level cohort data. The PrivMort project established a cohort of relatives of participants in population sample surveys in Russia, Belarus and Hungary. Survey participants provided data on smoking habits and vital statistics of their close relatives between 1982 and 2013. Population attributable risk fractions (PARF) in men (n = 99528) and women (n = 77848) aged 40-79 years were calculated from the prevalence rates of smoking and hazard ratios of mortality for smokers versus non-smokers. Trends in PARF over four 8-year time periods (1982-1989, 1990-1997, 1998-2005, and 2006-2013) were examined. In men in the most recent period (2006-2013), the proportions of deaths attributable to tobacco were 23% in Russia, 22% in Belarus, and 22% in Hungary. The respective estimates in women were lower (2%, 2%, and 13%), possibly due to underestimation of smoking prevalence. PARF estimates have declined slightly since the early 1990s in men but increased in women. Consistently with existing indirect estimates, our results based on individual level cohort data suggest that over one fifth of all deaths in men aged 40-79 years are attributable to tobacco. While these proportions are lower in women, the increasing trend is a major concern. This is the first large scale, individual-level cohort study that estimated the mortality attributable to tobacco smoking directly in Eastern European population samples. The results confirm previous indirect estimates and show that more than 20% of all deaths in Eastern European men can be attributed to tobacco. The study also confirms the increasing trend in smoking-related deaths among women. These findings emphasize the importance of targeted policy interventions in Eastern European countries.

Fractionation, Bioaccessibility, and Risk Assessment of Heavy Metals in the Soil of an Urban Recreational Area Amended with Composted Sewage Sludge

PubMed Central

Zhang, Tao; Shao, Yanqiu; Tian, Chao; Cattle, Stephen R.; Zhu, Ying; Song, Jinjuan

2018-01-01

A composted sewage sludge (CSS) was added to the soil of an urban garden at 5%, 10%, and 25% (w/w soil) and stabilised for 180 days. Samples were then collected and analysed for total heavy metal concentrations, chemical fractions, and bioaccessibility, together with some physicochemical properties. The results showed that the total chromium (Cr), copper (Cu), lead (Pb), and zinc (Zn) concentrations were increased with CSS addition rate. The CSS addition decreased the residual fractions of these four elements. The exchangeable Cr, Cu, and Pb fractions were very small or not detected, while Zn exhibited an increasing trend in its exchangeable fraction with CSS addition rate. The bioaccessibility of these four elements was increased with the CSS addition rate. Moreover, the Cr, Cu, and Zn bioaccessibility correlated positively with the total concentration, while the bioaccessibility of these four elements exhibited a negative correlation with the residual fraction. The fractionation and bioaccessibility of heavy metals may have also been influenced by pH, cation exchange capacity, and organic matter. The risk assessment code reflected the amended soil showed no or low environmental risks for Cr, Cu, and Pb and a medium risk for Zn. The hazardous index values and cancer risk levels indicated that the heavy metals in the soil amended with 25% CSS posed negligible potential noncarcinogenic and carcinogenic risks to children and adults via incidental ingestion. PMID:29597244

The road traffic crashes as a neglected public health concern; an observational study from Iranian population.

PubMed

Bakhtiyari, Mahmood; Delpisheh, Ali; Monfared, Ayad Bahadori; Kazemi-Galougahi, Mohammad Hassan; Mehmandar, Mohammad Reza; Riahi, Mohammad; Salehi, Masoud; Mansournia, Mohammad Ali

2015-01-01

Traffic crashes are multifactorial events caused by human factors, technical issues, and environmental conditions. The present study aimed to determine the role of human factors in traffic crashes in Iran using the proportional odds regression model. The database of all traffic crashes in Iran in 2010 (n = 592, 168) registered through the "COM.114" police forms was investigated. Human risk factors leading to traffic crashes were determined and the odds ratio (OR) of each risk factor was estimated using an ordinal regression model and adjusted for potential confounding factors such as age, gender, and lighting status within and outside of cities. The drivers' mean age ± standard deviation was 34.1 ± 14.0 years. The most prevalent risk factors leading to death within cities were disregarding traffic rules and regulations (45%), driver rushing (31%), and alcohol consumption (12.3%). Using the proportional odds regression model, alcohol consumption was the most significant human risk factor in traffic crashes within cities (OR = 6.5, 95% confidence interval [CI], 4.88-8.65) and outside of cities (OR = 1.73, 95% CI, 1.22-3.29). Public health strategies and preventive policies should be focused on more common human risk factors such as disregarding traffic rules and regulations, drivers' rushing, and alcohol consumption due to their greater population attributable fraction and more intuitive impacts on society.

Relationship between Attributional Errors and At-Risk Behaviors among Juvenile Delinquents.

ERIC Educational Resources Information Center

Daley, Christine E.; Onwuegbuzie, Anthony J.

The purpose of this study was to determine whether at-risk behaviors (e.g., substance abuse, gun ownership, sexual activity, and gang membership) are associated with violence attribution errors, as measured by Daley and Onwuegbuzie's (1995) Violence Attribution Survey, among 82 incarcerated male juvenile delinquents. Analysis revealed that the…

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

PubMed

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

2009-08-01

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

Improving prediction of outcomes in African Americans with normal stress echocardiograms using a risk scoring system.

PubMed

Sutter, David A; Thomaides, Athanasios; Hornsby, Kyle; Mahenthiran, Jothiharan; Feigenbaum, Harvey; Sawada, Stephen G

2013-06-01

Cardiovascular mortality is high in African Americans, and those with normal results on stress echocardiography remain at increased risk. The aim of this study was to develop a risk scoring system to improve the prediction of cardiovascular events in African Americans with normal results on stress echocardiography. Clinical data and rest echocardiographic measurements were obtained in 548 consecutive African Americans with normal results on rest and stress echocardiography and ejection fractions ≥50%. Patients were followed for myocardial infarction and death for 3 years. Predictors of cardiovascular events were determined with Cox regression, and hazard ratios were used to determine the number of points in the risk score attributed to each independent predictor. During follow-up of 3 years, 47 patients (8.6%) had events. Five variables-age (≥45 years in men, ≥55 years in women), history of coronary disease, history of smoking, left ventricular hypertrophy, and exercise intolerance (<7 METs in men, <5 METs in women, or need for dobutamine stress)-were independent predictors of events. A risk score was derived for each patient (ranging from 0 to 8 risk points). The area under the curve for the risk score was 0.82 with the optimum cut-off risk score of 6. Among patients with risk scores ≥6, 30% had events, compared with 3% with risk score <6 (p <0.001). In conclusion, African Americans with normal results on stress echocardiography remain at significant risk for cardiovascular events. A risk score can be derived from clinical and echocardiographic variables, which can accurately distinguish high- and low-risk patients. Copyright © 2013 Elsevier Inc. All rights reserved.

Socioeconomic status and the 25 × 25 risk factors as determinants of premature mortality: a multicohort study and meta-analysis of 1·7 million men and women.

PubMed

Stringhini, Silvia; Carmeli, Cristian; Jokela, Markus; Avendaño, Mauricio; Muennig, Peter; Guida, Florence; Ricceri, Fulvio; d'Errico, Angelo; Barros, Henrique; Bochud, Murielle; Chadeau-Hyam, Marc; Clavel-Chapelon, Françoise; Costa, Giuseppe; Delpierre, Cyrille; Fraga, Silvia; Goldberg, Marcel; Giles, Graham G; Krogh, Vittorio; Kelly-Irving, Michelle; Layte, Richard; Lasserre, Aurélie M; Marmot, Michael G; Preisig, Martin; Shipley, Martin J; Vollenweider, Peter; Zins, Marie; Kawachi, Ichiro; Steptoe, Andrew; Mackenbach, Johan P; Vineis, Paolo; Kivimäki, Mika

2017-03-25

In 2011, WHO member states signed up to the 25 × 25 initiative, a plan to cut mortality due to non-communicable diseases by 25% by 2025. However, socioeconomic factors influencing non-communicable diseases have not been included in the plan. In this study, we aimed to compare the contribution of socioeconomic status to mortality and years-of-life-lost with that of the 25 × 25 conventional risk factors. We did a multicohort study and meta-analysis with individual-level data from 48 independent prospective cohort studies with information about socioeconomic status, indexed by occupational position, 25 × 25 risk factors (high alcohol intake, physical inactivity, current smoking, hypertension, diabetes, and obesity), and mortality, for a total population of 1 751 479 (54% women) from seven high-income WHO member countries. We estimated the association of socioeconomic status and the 25 × 25 risk factors with all-cause mortality and cause-specific mortality by calculating minimally adjusted and mutually adjusted hazard ratios [HR] and 95% CIs. We also estimated the population attributable fraction and the years of life lost due to suboptimal risk factors. During 26·6 million person-years at risk (mean follow-up 13·3 years [SD 6·4 years]), 310 277 participants died. HR for the 25 × 25 risk factors and mortality varied between 1·04 (95% CI 0·98-1·11) for obesity in men and 2 ·17 (2·06-2·29) for current smoking in men. Participants with low socioeconomic status had greater mortality compared with those with high socioeconomic status (HR 1·42, 95% CI 1·38-1·45 for men; 1·34, 1·28-1·39 for women); this association remained significant in mutually adjusted models that included the 25 × 25 factors (HR 1·26, 1·21-1·32, men and women combined). The population attributable fraction was highest for smoking, followed by physical inactivity then socioeconomic status. Low socioeconomic status was associated with a 2·1-year reduction in life expectancy between ages 40 and 85 years, the corresponding years-of-life-lost were 0·5 years for high alcohol intake, 0·7 years for obesity, 3·9 years for diabetes, 1·6 years for hypertension, 2·4 years for physical inactivity, and 4·8 years for current smoking. Socioeconomic circumstances, in addition to the 25 × 25 factors, should be targeted by local and global health strategies and health risk surveillance to reduce mortality. European Commission, Swiss State Secretariat for Education, Swiss National Science Foundation, the Medical Research Council, NordForsk, Portuguese Foundation for Science and Technology. Copyright © 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY license. Published by Elsevier Ltd.. All rights reserved.

Canadian military personnel's population attributable fractions of mental disorders and mental health service use associated with combat and peacekeeping operations.

PubMed

Sareen, Jitender; Belik, Shay-Lee; Afifi, Tracie O; Asmundson, Gordon J G; Cox, Brian J; Stein, Murray B

2008-12-01

We investigated mental disorders, suicidal ideation, self-perceived need for treatment, and mental health service utilization attributable to exposure to peacekeeping and combat operations among Canadian military personnel. With data from the Canadian Community Health Survey Cycle 1.2 Canadian Forces Supplement, a cross-sectional population-based survey of active Canadian military personnel (N = 8441), we estimated population attributable fractions (PAFs) of adverse mental health outcomes. Exposure to either combat or peacekeeping operations was associated with posttraumatic stress disorder (men: PAF = 46.6%; 95% confidence interval [CI] = 27.3, 62.7; women: PAF = 23.6%; 95% CI = 9.2, 40.1), 1 or more mental disorder assessed in the survey (men: PAF = 9.3%; 95% CI = 0.4, 18.1; women: PAF = 6.1%; 95% CI = 0.0, 13.4), and a perceived need for information (men: PAF = 12.3%; 95% CI = 4.1, 20.6; women: PAF = 7.9%; 95% CI = 1.3, 15.5). A substantial proportion, but not the majority, of mental health-related outcomes were attributable to combat or peacekeeping deployment. Future studies should assess traumatic events and their association with physical injury during deployment, premilitary factors, and postdeployment psychosocial factors that may influence soldiers' mental health.

Stomach Cancer Following Hodgkin Lymphoma, Testicular Cancer and Cervical Cancer: A Pooled Analysis of Three International Studies with a Focus on Radiation Effects.

PubMed

Gilbert, Ethel S; Curtis, Rochelle E; Hauptmann, Michael; Kleinerman, Ruth A; Lynch, Charles F; Stovall, Marilyn; Smith, Susan A; Weathers, Rita; Andersson, Michael; Dores, Graça M; Fraumeni, Joseph F; Fossa, Sophie D; Hall, Per; Hodgson, David C; Holowaty, Eric J; Joensuu, Heikki; Johannesen, Tom B; Langmark, Froydis; Kaijser, Magnus; Pukkala, Eero; Rajaraman, Preetha; Storm, Hans H; Vaalavirta, Leila; van den Belt-Dusebout, Alexandra W; Aleman, Berthe M; Travis, Lois B; Morton, Lindsay M; van Leeuwen, Flora E

2017-02-01

To further understand the risk of stomach cancer after fractionated high-dose radiotherapy, we pooled individual-level data from three recent stomach cancer case-control studies. These studies were nested in cohorts of five-year survivors of first primary Hodgkin lymphoma (HL), testicular cancer (TC) or cervical cancer (CX) from seven countries. Detailed data were abstracted from patient records and radiation doses were reconstructed to the site of the stomach cancer for cases and to the corresponding sites for matched controls. Among 327 cases and 678 controls, mean doses to the stomach were 15.3 Gy, 24.7 Gy and 1.9 Gy, respectively, for Hodgkin lymphoma, testicular cancer and cervical cancer survivors, with an overall mean dose of 10.3 Gy. Risk increased with increasing radiation dose to the stomach cancer site (P < 0.001) with no evidence of nonlinearity or of a downturn at the highest doses (≥35 Gy). The pooled excess odds ratio per Gy (EOR/Gy) was 0.091 [95% confidence interval (CI): 0.036-0.20] with estimates of 0.049 (95% CI: 0.007-0.16) for Hodgkin lymphoma, 0.27 (95% CI: 0.054-1.44) for testicular cancer and 0.096 (95% CI: -0.002-0.39) for cervical cancer (P homogeneity = 0.25). The EOR/Gy increased with time since exposure (P trend = 0.004), with an EOR/Gy of 0.38 (95% CI: 0.12-1.04) for stomach cancer occurring ≥20 years postirradiation corresponding to odds ratios of 4.8 and 10.5 at radiation doses to the stomach of 10 and 25 Gy, respectively. Of 111 stomach cancers occurring ≥20 years after radiotherapy, 63.8 (57%) could be attributed to radiotherapy. Our findings differ from those based on Japanese atomic-bomb survivors, where the overall EOR/Gy was higher and where there was no evidence of an increase with time since exposure. By pooling data from three studies, we demonstrated a clear increase in stomach cancer risk over a wide range of doses from fractionated radiotherapy with the highest risks occurring many years after exposure. These findings highlight the need to directly evaluate the health effects of high-dose fractionated radiotherapy rather than relying on the data of persons exposed at low and moderate acute doses.

Fractionation of radioactivity in the milk of goats administered UC-aflatoxin B1

DOE Office of Scientific and Technical Information (OSTI.GOV)

Goto, T.; Hsieh, D.P.

A detailed fractionation of radioactivity in the milk of goats administered UC-aflatoxin B1 at low doses was performed. The milk collected in the first 24 h following dosing contained radioactivity equivalent to 0.45-1.1% of the dose given. The radioactivity in each sample was partitioned into 4 fractions: ether, protein, dichloromethane, and water-alcohol. Over 80% of the radioactivity was detected in the dichloromethane fraction, of which over 95% was attributable to aflatoxin M1. No aflatoxin B1 or other known aflatoxin metabolites were detected in any fraction. The results indicate that the major metabolite of aflatoxin B1 in goat milk is aflatoxinmore » M1 and that other metabolites, including conjugates, are of minor significance.« less

Quantitative analysis of burden of bacillary dysentery associated with floods in Hunan, China.

PubMed

Liu, Xuena; Liu, Zhidong; Zhang, Ying; Jiang, Baofa

2016-03-15

Jishou and Huaihua, two cities in the west of Hunan Province, had suffered from severe floods because of long-lasting and heavy rainfall during the end of June and July 2012. However, the Disability Adjusted of Life Years (DALYs) of bacillary dysentery caused by the floods have not been examined before. The study aimed to quantify the impact of the floods on the burden of bacillary dysentery in Hunan, China. A unidirectional case-crossover study was firstly conducted to determine the relationship between daily cases of bacillary dysentery and the floods in Jishou and Huaihua of Hunan Province in 2012. Odds ratios (ORs) estimated by conditional logistic regression were used to quantify the risk of the floods on the disease. The years lived with disability (YLDs) of bacillary dysentery attributable to floods were then estimated based on the WHO framework to calculate potential impact fraction in the Burden of Disease study. Multivariable analysis showed that floods were significantly associated with an increased risk of the number of cases of bacillary dysentery (OR=3.270, 95% CI: 1.299-8.228 in Jishou; OR=2.212, 95% CI: 1.052-4.650 in Huaihua). The strongest effect was shown with a 1-day lag in Jishou and a 4-day lag in Huaihua. Attributable YLD per 1000 of bacillary dysentery due to the floods was 0.0296 in Jishou and 0.0157 in Huaihua. Our study confirms that floods have significantly increased the risks of bacillary dysentery in the study areas. In addition, a sudden and severe flooding with a shorter duration may cause more burdens of bacillary dysentery than a persistent and moderate flooding. Public health preparation and intervention programs should be taken to reduce and prevent a potential risk of bacillary dysentery epidemics after floods. Copyright © 2016 Elsevier B.V. All rights reserved.

Linguistic Multi-Attribute Group Decision Making with Risk Preferences and Its Use in Low-Carbon Tourism Destination Selection.

PubMed

Lin, Hui; Wang, Zhou-Jing

2017-09-17

Low-carbon tourism plays an important role in carbon emission reduction and environmental protection. Low-carbon tourism destination selection often involves multiple conflicting and incommensurate attributes or criteria and can be modelled as a multi-attribute decision-making problem. This paper develops a framework to solve multi-attribute group decision-making problems, where attribute evaluation values are provided as linguistic terms and the attribute weight information is incomplete. In order to obtain a group risk preference captured by a linguistic term set with triangular fuzzy semantic information, a nonlinear programming model is established on the basis of individual risk preferences. We first convert individual linguistic-term-based decision matrices to their respective triangular fuzzy decision matrices, which are then aggregated into a group triangular fuzzy decision matrix. Based on this group decision matrix and the incomplete attribute weight information, a linear program is developed to find an optimal attribute weight vector. A detailed procedure is devised for tackling linguistic multi-attribute group decision making problems. A low-carbon tourism destination selection case study is offered to illustrate how to use the developed group decision-making model in practice.

Linguistic Multi-Attribute Group Decision Making with Risk Preferences and Its Use in Low-Carbon Tourism Destination Selection

PubMed Central

Lin, Hui; Wang, Zhou-Jing

2017-01-01

Low-carbon tourism plays an important role in carbon emission reduction and environmental protection. Low-carbon tourism destination selection often involves multiple conflicting and incommensurate attributes or criteria and can be modelled as a multi-attribute decision-making problem. This paper develops a framework to solve multi-attribute group decision-making problems, where attribute evaluation values are provided as linguistic terms and the attribute weight information is incomplete. In order to obtain a group risk preference captured by a linguistic term set with triangular fuzzy semantic information, a nonlinear programming model is established on the basis of individual risk preferences. We first convert individual linguistic-term-based decision matrices to their respective triangular fuzzy decision matrices, which are then aggregated into a group triangular fuzzy decision matrix. Based on this group decision matrix and the incomplete attribute weight information, a linear program is developed to find an optimal attribute weight vector. A detailed procedure is devised for tackling linguistic multi-attribute group decision making problems. A low-carbon tourism destination selection case study is offered to illustrate how to use the developed group decision-making model in practice. PMID:28926985

The Influence of Environmental Hazard Maps on Risk Beliefs, Emotion, and Health-related Behavioral Intentions

PubMed Central

Severtson, Dolores

2013-01-01

To test a theoretical explanation of how attributes of mapped environmental health hazards influence health-related behavioral intentions and how beliefs and emotion mediate the influences of attributes, 24 maps were developed that varied by four attributes of a residential drinking water hazard: level, proximity, prevalence, and density. In a factorial design, student participants (N=446) answered questions for a subset of maps. Hazard level and proximity had the largest influences on intentions to test water and mitigate exposure. Belief in the problem’s seriousness mediated attributes’ influence on intention to test drinking water, and perceived susceptibility mediated the influence of attributes on intention to mitigate risk. Maps with carefully illustrated attributes of hazards may promote appropriate health-related risk beliefs, intentions, and behavior. PMID:23533022

Near-Roadway Air Pollution and Coronary Heart Disease: Burden of Disease and Potential Impact of a Greenhouse Gas Reduction Strategy in Southern California.

PubMed

Ghosh, Rakesh; Lurmann, Frederick; Perez, Laura; Penfold, Bryan; Brandt, Sylvia; Wilson, John; Milet, Meredith; Künzli, Nino; McConnell, Rob

2016-02-01

Several studies have estimated the burden of coronary heart disease (CHD) mortality from ambient regional particulate matter ≤ 2.5 μm (PM2.5). The burden of near-roadway air pollution (NRAP) generally has not been examined, despite evidence of a causal link with CHD. We investigated the CHD burden from NRAP and compared it with the PM2.5 burden in the California South Coast Air Basin for 2008 and under a compact urban growth greenhouse gas reduction scenario for 2035. We estimated the population attributable fraction and number of CHD events attributable to residential traffic density, proximity to a major road, elemental carbon (EC), and PM2.5 compared with the expected disease burden if the population were exposed to background levels of air pollution. In 2008, an estimated 1,300 CHD deaths (6.8% of the total) were attributable to traffic density, 430 deaths (2.4%) to residential proximity to a major road, and 690 (3.7%) to EC. There were 1,900 deaths (10.4%) attributable to PM2.5. Although reduced exposures in 2035 should result in smaller fractions of CHD attributable to traffic density, EC, and PM2.5, the numbers of estimated deaths attributable to each of these exposures are anticipated to increase to 2,500, 900, and 2,900, respectively, due to population aging. A similar pattern of increasing NRAP-attributable CHD hospitalizations was estimated to occur between 2008 and 2035. These results suggest that a large burden of preventable CHD mortality is attributable to NRAP and is likely to increase even with decreasing exposure by 2035 due to vulnerability of an aging population. Greenhouse gas reduction strategies developed to mitigate climate change offer unexploited opportunities for air pollution health co-benefits.

Fractionation and risk assessment of Fe and Mn in surface sediments from coastal sites of Sonora, Mexico (Gulf of California).

PubMed

Jara-Marini, Martín E; García-Camarena, Raúl; Gómez-Álvarez, Agustín; García-Rico, Leticia

2015-07-01

The aim of this study was to evaluate Fe and Mn distribution in geochemical fractions of the surface sediment of four oyster culture sites in the Sonora coast, Mexico. A selective fractionation scheme to obtain five fractions was adapted for the microwave system. Surface sediments were analyzed for carbonates, organic matter contents, and Fe and Mn in geochemical fractions. The bulk concentrations of Fe ranged from 10,506 to 21,918 mg/kg (dry weight, dry wt), and the bulk concentrations of Mn ranged from 185.1 to 315.9 mg/kg (dry wt) in sediments, which was low and considered as non-polluted in all of the sites. The fractionation study indicated that the major geochemical phases for the metals were the residual, as well as the Fe and Mn oxide fractions. The concentrations of metals in the geochemical fractions had the following order: residual > Fe and Mn oxides > organic matter > carbonates > interchangeable. Most of the Fe and Mn were linked to the residual fraction. Among non-residual fractions, high percentages of Fe and Mn were linked to Fe and Mn oxides. The enrichment factors (EFs) for the two metals were similar in the four studied coasts, and the levels of Fe and Mn are interpreted as non-enrichment (EF < 1) because the metals concentrations were within the baseline concentrations. According to the environmental risk assessment codes, Fe and Mn posed no risk and low risk, respectively. Although the concentrations of Fe and Mn were linked to the residual fraction, the levels in non-residual fractions may significantly result in the transference of other metals, depending on several physico-chemical and biological factors.

Smoking-attributable burden of lung cancer in the Philippines.

PubMed

Bilano, Ver Luanni Feliciano; Borja, Maridel P; Cruz, Eduardo L; Tan, Alvin G; Mortera, Lalaine L; Reganit, Paul Ferdinand M

2015-05-01

In the Philippines, smoking is highly prevalent and tobacco control policies fail to fully implement the WHO Framework Convention on Tobacco Control provisions. To aid in policy change, intervention implementation, monitoring and evaluation, this study aimed to provide the first internally consistent and latest Philippine estimates of the following: disability-adjusted life-years (DALYs) lost due to lung cancer; population-attributable fractions (PAFs) of smoking; and smoking-attributable lung cancer DALYs. This study applied the Global Burden of Disease and Comparative Risk Assessment frameworks to secondary data, supplemented by expert opinion. A comprehensive internally consistent assessment of disease epidemiology was conducted using DISMOD II and disease impact was quantified as DALYs. PAFs were calculated using the smoking impact ratio and Monte Carlo uncertainty analyses were conducted. For 2008, lung cancer incidence and mortality estimates were 10 871 cases and 9871 deaths respectively. Lung cancer accounted for an estimated 267 787 DALYs lost, 99% of which were due to years of life lost. Overall, the PAF of smoking was 65% and a total of 173 103 DALYs were smoking-attributable. There were increasing trends in incidence, mortality and DALY rates with age. The majority of incidence (72%), mortality (71%) and disease burden (72%) occurred among men, who also had higher PAF estimates. Considerable health gains could be achieved if smoking exposure were reduced in the Philippines. Strong enforcement of measures like increasing taxation to the WHO-endorsed rate, expanding smoke-free environments, and requiring large graphic warnings within a comprehensive tobacco control programme is recommended. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

[Mortality and life expectancy that attributable to high blood pressure in Chinese people in 2013].

PubMed

Zeng, X Y; Liu, S W; Wang, L J; Zhang, M; Yin, P; Liu, Y N; Zhao, Z P; Wang, L M

2017-08-10

Objective: To estimate the deaths (mortality) and life expectancy that attributable to high blood pressure in people from different regions and gender, in China in 2013. Methods: Data was from the 'China Chronic Disease Risk Factor Surveillance 2013' and the 'China National Mortality Surveillance 2013'. According to the comparative risk assessment theory, population attributable fraction ( PAF ) of high blood pressure by gender, urban-rural, east-central-west regions was calculated before the estimations on deaths (mortality) and life expectancy attributable to high blood pressure was made. Results: In 2013, among the Chinese people aged 25 years old and above, the mean SBP was (129.48±20.27) mmHg. High blood pressure[SBP>(115±6) mmHg]caused 20.879 million deaths and accounted for 22.78% of the total deaths. SBP, deaths, mortality rate and standardized mortality rate that attributable to high blood pressure all appeared higher in men [(131.15±18.73) mmHg, 11.517 million, 165.56/100 000 and 106.97/100 000, respectively]than in women[(127.79±21.60) mmHg, 9.362 million, 141.99/100 000 and 68.93/100 000, respectively]. SBP, deaths, mortality rate and PAF were all seen higher in rural[(130.25±20.66) mmHg, 11.234 million, 178.58/100 000 and 23.59%, respectively]than in urban[(128.58±19.77) mmHg, 9.645 million, 132.87/100 000 and 21.54%, respectively]areas. However, levels of SBP were similar in the east, central or west regions, with attributable deaths, attributable mortality rate and PAF the highest as 7.658 million 179.93/100 000, and 26.72% respectively. In 2013, among the Chinese people aged 25 years old and above, deaths caused by cardiovascular disease and chronic kidney disease attributable to high blood pressure were 19.912 million and 0.966 million, accounting for 52.31% of the total deaths due to cardiovascular diseases and 62.11% to the total chronic kidney diseases. The top three deaths attributable to high blood pressure were ischemic heart disease (6.656 million), hemorrhagic stroke (5.331 million) and ischemic stroke (3.593 million). When the effect of high blood pressure had been eliminated, the life expectancy per capita would have increased by 2.86 years old, with higher in women than in men (3.07 and 2.64 years old, respectively), higher in central than in east and west (3.48, 2.56 and 2.58 years, respectively) areas, in rural than in urban (2.97 and 2.59 years, respectively) areas. Conclusions: In 2013, the number of deaths attributable to high blood pressure was around 20.9 million, accounting for 22.78% of the total deaths, and appeared higher in men than in women, in rural than in urban, in central than in east and west areas. The mortality burden induced by ischemic heart disease, hemorrhagic stroke and ischemic stroke was most serious since the high blood pressure brought about 2.86 years of lost in life expectancy.

Comparison of the population excess fraction of Chlamydia trachomatis infection on pelvic inflammatory disease at 12-months in the presence and absence of chlamydia testing and treatment: Systematic review and retrospective cohort analysis

PubMed Central

Turner, Katy M. E.; Leung, Stella; Yu, B. Nancy; Frølund, Maria; Benfield, Thomas; Blanchard, James; Westh, Henrik; Ward, Helen

2017-01-01

Background The impact of Chlamydia trachomatis (chlamydia) control on the incidence of pelvic inflammatory disease (PID) is theoretically limited by the proportion of PID caused by chlamydia. We estimate the population excess fraction (PEF) of treated chlamydia infection on PID at 12-months in settings with widespread chlamydia control (testing and treatment) and compare this to the estimated PEF of untreated chlamydia. Methods We used two large retrospective population-based cohorts of women of reproductive age from settings with widespread chlamydia control to calculate the PEF of treated chlamydia on PID at 12-months. We undertook a systematic review to identify further studies that reported the risk of PID in women who were tested for chlamydia (infected and uninfected). We used the same method to calculate the PEF in eligible studies then compared all estimates of PEF. Results The systematic review identified a single study, a randomised controlled trial of chlamydia screening (POPI-RCT). In the presence of testing and treatment <10% of PID at 12-months was attributable to treated (baseline) chlamydia infections (Manitoba: 8.86%(95%CI 7.15–10.75); Denmark: 3.84%(3.26–4.45); screened-arm POPI-RCT: 0.99%(0.00–29.06)). In the absence of active chlamydia treatment 26.44%(11.57–46.32) of PID at 12-months was attributable to untreated (baseline) chlamydia infections (deferred-arm POPI-RCT). The PEFs suggest that eradicating baseline chlamydia infections could prevent 484 cases of PID at 12-months per 100,000 women in the untreated setting and 13–184 cases of PID per 100,000 tested women in the presence of testing and treatment. Conclusion Testing and treating chlamydia reduced the PEF of chlamydia on PID by 65% compared to the untreated setting. But in the presence of testing and treatment over 90% of PID could not be attributed to a baseline chlamydia infection. More information is needed about the aetiology of PID to develop effective strategies for improving the reproductive health of women. PMID:28199392

Mitochondria: A Common Target for Genetic Mutations and Environmental Toxicants in Parkinson’s Disease

PubMed Central

Helley, Martin P.; Pinnell, Jennifer; Sportelli, Carolina; Tieu, Kim

2017-01-01

Parkinson’s disease (PD) is a devastating neurological movement disorder. Since its first discovery 200 years ago, genetic and environmental factors have been identified to play a role in PD development and progression. Although genetic studies have been the predominant driving force in PD research over the last few decades, currently only a small fraction of PD cases can be directly linked to monogenic mutations. The remaining cases have been attributed to other risk associated genes, environmental exposures and gene–environment interactions, making PD a multifactorial disorder with a complex etiology. However, enormous efforts from global research have yielded significant insights into pathogenic mechanisms and potential therapeutic targets for PD. This review will highlight mitochondrial dysfunction as a common pathway involved in both genetic mutations and environmental toxicants linked to PD. PMID:29204154

Heavy Metal Pollution, Fractionation, and Potential Ecological Risks in Sediments from Lake Chaohu (Eastern China) and the Surrounding Rivers

PubMed Central

Zhang, Lei; Liao, Qianjiahua; Shao, Shiguang; Zhang, Nan; Shen, Qiushi; Liu, Cheng

2015-01-01

Heavy metal (Cr, Ni, Cu, Zn, Cd, and Pb) pollution, fractionation, and ecological risks in the sediments of Lake Chaohu (Eastern China), its eleven inflowing rivers and its only outflowing river were studied. An improved BCR (proposed by the European Community Bureau of Reference) sequential extraction procedure was applied to fractionate heavy metals within sediments, a geoaccumulation index was used to assess the extent of heavy metal pollution, and a risk assessment code was applied to evaluate potential ecological risks. Heavy metals in the Shuangqiao and Nanfei Rivers were generally higher than the other studied sites. Of the three Lake Chaohu sites, the highest concentrations were identified in western Chaohu. Heavy metal pollution and ecological risks in the lake’s only outflowing river were similar to those in the eastern region of the lake, to which the river is connected. Heavy metal concentrations occurred in the following order: Cd > Zn > Cu > Pb ≈ Ni ≈ Cr. Cr, Ni, and Cu made up the largest proportion of the residual fraction, while Cd was the most prominent metal in the exchangeable and carbonate-included fraction. Cd posed the greatest potential ecological risk; the heavy metals generally posed risks in the following order: Cd > Zn > Cu > Ni > Pb > Cr. PMID:26561822

Tobacco-, Alcohol-, and Drug-Attributable Deaths and Their Contribution to Mortality Disparities in a Cohort of Homeless Adults in Boston

PubMed Central

Chang, Yuchiao; Singer, Daniel E.; Porneala, Bianca C.; Gaeta, Jessie M.; O’Connell, James J.; Rigotti, Nancy A.

2015-01-01

Objectives. We quantified tobacco-, alcohol-, and drug-attributable deaths and their contribution to mortality disparities among homeless adults. Methods. We ascertained causes of death among 28 033 adults seen at the Boston Health Care for the Homeless Program in 2003 to 2008. We calculated population-attributable fractions to estimate the proportion of deaths attributable to tobacco, alcohol, or drug use. We compared attributable mortality rates with those for Massachusetts adults using rate ratios and differences. Results. Of 1302 deaths, 236 were tobacco-attributable, 215 were alcohol-attributable, and 286 were drug-attributable. Fifty-two percent of deaths were attributable to any of these substances. In comparison with Massachusetts adults, tobacco-attributable mortality rates were 3 to 5 times higher, alcohol-attributable mortality rates were 6 to 10 times higher, and drug-attributable mortality rates were 8 to 17 times higher. Disparities in substance-attributable deaths accounted for 57% of the all-cause mortality gap between the homeless cohort and Massachusetts adults. Conclusions. In this clinic-based cohort of homeless adults, over half of all deaths were substance-attributable, but this did not fully explain the mortality disparity with the general population. Interventions should address both addiction and non-addiction sources of excess mortality. PMID:25521869

An assessment of recharge possibility to North-Western Sahara Aquifer System (NWSAS) using environmental isotopes

NASA Astrophysics Data System (ADS)

Al-Gamal, Samir Anwar

2011-02-01

SummaryA comprehensive understanding of the groundwater dynamics of a transboundary aquifer system is highly needed for any successful transboundary cooperation policy. Moreover, an analysis of the NWSAS can be of particular interest for policy makers and researchers. This paper aims to reveals and to assess the renewability of North-Western Sahara Aquifer System (NWSAS) as one of the major transboundary multi-layered aquifer system, in North Africa, shared by Algeria, Tunisia, and Libya and is often referred to as the Système Aquifère du Sahara Septentrional (SASS). The paper is primarily intended for exploring whether it receives a considerable fraction of modern water as recharge or it is at risk of being depleted and excessively pumped, where the main challenge for NWSAS, is that it should be abstracted rationally for equitable use. Environmental isotopes data of δ 18O, δ 2H, 3H, 14C as well as characteristics of d-excess are used to illustrate whether NSWAS is renewable or non-renewable resource. Geochemical, hydrological and statistical evidences supporting the renewability of NWSAS are provided through pairs of cross-plots. The study has clearly indicated that NWSAS is receiving a considerable fraction of modern water as recharge to the aquifer because of the following reasons: Firstly, the moderately depleted delta values of δ 18O and δ 2H of water from Sahara Atlas in Algeria and the Dahar and the Dj. Nefoussa in Tunisia and Libya with δ 18O content (-6.0‰ to -5.0‰) compared with that of palaeowater (-7.0‰ to -9.0‰) indicate an appreciable fraction of modern water recharging NWSAS. This appreciable fraction of modern water should be attributed to originate from the present-day precipitation (-6.5‰). Secondly, the presence of significant amount of 14C > 2% and 3H > 5 TU, frequently found in data should be attributed to a mixing with shallow and modern water, where old water practically contains no 14C. The foregoing facts are in good agreement with the results of conventional hydrologic approach. This would contradict the assumption that the NWSAS is non-renewable water resource. In this context, the NWSAS is being located in one of the driest regions on the planet; these huge resources have been recognized to be of great importance to the socio-economic development of its riparian countries. So the present paper addresses the necessity of identifying specific cooperation problems which evolve out of these hydro geological attributes and prevalent use patterns. Accordingly, the description of NWSAS as non-renewable, devoid of any meaningful recharge, a rather stagnant water body, disconnected from any surface water body in addition to its classification as "non-renewable" would therefore be misleading and represents one of the most obvious inaccuracy as well.

Recharge Mechanism to North-Western Sahara Aquifer System (NWSAS) Using Environmental Isotopes

NASA Astrophysics Data System (ADS)

Al-Gamal, Samir

2010-05-01

A comprehensive understanding is highly needed for any successful transboundary cooperation policy. Moreover, an analysis of the NWSAS can be of particular interest for policy makers and researchers. This paper aims to reveals and to assess the renewability of North Western Sahara Aquifer System(NWSAS) as one of the major transboundary multi-layered aquifer system, in North Africa, shared by Algeria, Tunisia, and Libya and is often referred to as the Système Aquifère du Sahara Septentrional (SASS).The paper is primarily intended for exploring whether it receives a considerable fraction of modern water as recharge or it is at risk of being depleted and excessively pumped, where the main challenge for NWSAS ,is that it should be abstracted rationally for equitable use. Environmental isotopes data of δ18O, δ2H, 3H ,14C as well as characteristics of d-excess are used to illustrate whether NSWAS is renewable or non-renewable resource.Geochemical, hydrological and statistical evidences supporting the renewability of NWSAS are provided through pairs of cross-plots . The study has clearly indicated that NWSAS is receiving a considerable fraction of modern water as recharge to the aquifer because of the following reasons; Firstly, the moderately depleted delta values of O-18 and H-2 of water from Sahara Atlas in Algeria and the Dahar and the Dj. Nefoussa in Tunisia and Libya with δ18O content (- 6.0‰ to -5.0‰) compared with that of palaeowater (-7.0 to -9.0 ‰) indicate a considerable fraction of modern water recharging NWSAS.This considerable fraction of modern water should be attributed to originate from the present-day precipitation (-6.5‰).Secondly, the presence of significant amount of 14C >2 % and 3H > 5TU., frequently found in data should be attributed to a mixing with shallow and modern water, where old water practically contains no 14C. The foregoing facts are in good agreement with the results of conventional hydrologic approach. This would contradicts the assumption that the NWSAS is non-renewable water resource. In this context, the NWSAS is being located in one of the driest regions on the planet, these huge resources have been recognized to be of great importance to the socio-economic development of its riparian countries. So the present paper addresses the necessity of identifying specific cooperation problems which evolve out of these hydrogeological attributes and prevalent use patterns. Accordingly, the description of NWSAS as non renewable, devoid of any meaningful recharge , a rather stagnant water body, disconnected from any surface water body in addition to its classification as "non-renewable" would therefore be misleading and represents one of the most obvious inaccuracy as well. Keywords stable isotopes of 18O and 2H, unstable isotopes of 14C and 3H.renewal , socio-economic development, Riparian,

Copper leaching of MSWI bottom ash co-disposed with refuse: effect of short-term accelerated weathering.

PubMed

Su, Lianghu; Guo, Guangzhai; Shi, Xinlong; Zuo, Minyu; Niu, Dongjie; Zhao, Aihua; Zhao, Youcai

2013-06-01

Co-disposal of refuse with municipal solid waste incinerator (MSWI) bottom ash (IBA) either multi-layered as landfill cover or mixed with refuse could pose additional risk to the environment because of enhanced leaching of heavy metals, especially Cu. This study applied short-term accelerated weathering to IBA, and monitored the mineralogical and chemical properties of IBA during the weathering process. Cu extractability of the weathered IBA was then evaluated using standard leaching protocols (i.e. SPLP and TCLP) and co-disposal leaching procedure. The results showed that weathering had little or no beneficial effect on Cu leaching in SPLP and TCLP, which can be explained by the adsorption and complexation of Cu with DOM. However, the Cu leaching of weathered IBA was reduced significantly when situated in fresh simulated landfill leachate. This was attributed to weakening Cu complexation with fulvic acid or hydrophilic fractions and/or intensifying Cu absorption to neoformed hydr(oxide) minerals in weathered IBA. The amount of total leaching Cu and Cu in free or labile complex fraction (the fraction with the highest mobility and bio-toxicity) of the 408-h weathered IBA were remarkably decreased by 86.3% and 97.6% in the 15-day co-disposal leaching test. Accelerated weathering of IBA may be an effective pretreatment method to decrease Cu leaching prior to its co-disposal with refuse. Copyright © 2013 Elsevier Ltd. All rights reserved.

IMPACT OF SPECIFIC PHOBIA ON THE RISK OF ONSET OF MENTAL DISORDERS: A 10-YEAR PROSPECTIVE-LONGITUDINAL COMMUNITY STUDY OF ADOLESCENTS AND YOUNG ADULTS.

PubMed

Lieb, Roselind; Miché, Marcel; Gloster, Andrew T; Beesdo-Baum, Katja; Meyer, Andrea H; Wittchen, Hans-Ulrich

2016-07-01

The role of specific phobia as a potentially important psychopathological precursor condition to more severe mental disorders is understudied. We examined the prospective-longitudinal association of early childhood/adolescent phobia with subsequent mental disorders and the proportion of outcome disease incidence attributable to specific phobia simultaneously for a broad range of disorders. N = 2210 14- to 24-year-old community subjects were followed up for 10 years. DSM-IV-specific phobia as exposure and a broad range of DSM-IV mental disorders as outcomes were assessed with the DSM-IV/M-CIDI. Logistic regressions, adjusting for confounders, were used to estimate the associations of specific phobia with the subsequent onset of outcome disorders. Baseline specific phobia predicted the subsequent first onset of anxiety disorders [panic disorder: risk ratio (RR) = 4.38, 95% confidence interval (2.34, 8.21); generalized anxiety disorder: RR = 4.10 (2.19, 7.69); posttraumatic stress disorder: RR = 2.15 (1.13, 4.10); obsessive-compulsive disorder: RR = 3.79 (1.63, 8.82)], affective disorders [major depression: RR = 1.54 (1.16, 2.03); bipolar disorder: RR = 2.20 (1.10, 4.41); dysthymia: RR = 2.75 (1.48, 5.11)], pain disorder: RR = 1.52 (1.14, 2.02), and eating disorders: RR = 2.27 (1.14, 4.51). Population attributable fractions (PAFs; i.e., proportion of outcome disease incidence in the total population attributable to specific phobia) were highest for panic disorder (PAF = 22.9), generalized anxiety disorder (PAF = 32.3), and obsessive-compulsive disorders (PAF = 30.2). This study provides strong evidence that specific phobia is an early onset disorder predicting the subsequent onset of a range of disorders. Future studies should examine the underlying mechanisms and the potential of using specific phobia as a target for prevention of subsequent psychopathology. © 2016 Wiley Periodicals, Inc.

Predicting Parent-Child Aggression Risk: Cognitive Factors and Their Interaction With Anger.

PubMed

Rodriguez, Christina M

2018-02-01

Several cognitive elements have previously been proposed to elevate risk for physical child abuse. To predict parent-child aggression risk, the current study evaluated the role of approval of parent-child aggression, perceptions of children as poorly behaved, and discipline attributions. Several dimensions of attributions specifically tied to parents' discipline practices were targeted. In addition, anger experienced during discipline episodes was considered a potential moderator of these cognitive processes. Using a largely multiple-indicator approach, a sample of 110 mothers reported on these cognitive and affective aspects that may occur when disciplining their children as well as responding to measures of parent-child aggression risk. Findings suggest that greater approval of parent-child aggression, negative perceptions of their child's behavior, and discipline attributions independently predicted parent-child aggression risk, with anger significantly interacting with mothers' perception of their child as more poorly behaved to exacerbate their parent-child aggression risk. Of the discipline attribution dimensions evaluated, mothers' sense of external locus of control and believing their child deserved their discipline were related to increase parent-child aggression risk. Future work is encouraged to comprehensively evaluate how cognitive and affective components contribute and interact to increase risk for parent-child aggression.

Minimizing metastatic risk in radiotherapy fractionation schedules

NASA Astrophysics Data System (ADS)

Badri, Hamidreza; Ramakrishnan, Jagdish; Leder, Kevin

2015-11-01

Metastasis is the process by which cells from a primary tumor disperse and form new tumors at distant anatomical locations. The treatment and prevention of metastatic cancer remains an extremely challenging problem. This work introduces a novel biologically motivated objective function to the radiation optimization community that takes into account metastatic risk instead of the status of the primary tumor. In this work, we consider the problem of developing fractionated irradiation schedules that minimize production of metastatic cancer cells while keeping normal tissue damage below an acceptable level. A dynamic programming framework is utilized to determine the optimal fractionation scheme. We evaluated our approach on a breast cancer case using the heart and the lung as organs-at-risk (OAR). For small tumor α /β values, hypo-fractionated schedules were optimal, which is consistent with standard models. However, for relatively larger α /β values, we found the type of schedule depended on various parameters such as the time when metastatic risk was evaluated, the α /β values of the OARs, and the normal tissue sparing factors. Interestingly, in contrast to standard models, hypo-fractionated and semi-hypo-fractionated schedules (large initial doses with doses tapering off with time) were suggested even with large tumor α/β values. Numerical results indicate the potential for significant reduction in metastatic risk.

The Non-Linear Relationship between BMI and Health Care Costs and the Resulting Cost Fraction Attributable to Obesity.

PubMed

Laxy, Michael; Stark, Renée; Peters, Annette; Hauner, Hans; Holle, Rolf; Teuner, Christina M

2017-08-30

This study aims to analyse the non-linear relationship between Body Mass Index (BMI) and direct health care costs, and to quantify the resulting cost fraction attributable to obesity in Germany. Five cross-sectional surveys of cohort studies in southern Germany were pooled, resulting in data of 6757 individuals (31-96 years old). Self-reported information on health care utilisation was used to estimate direct health care costs for the year 2011. The relationship between measured BMI and annual costs was analysed using generalised additive models, and the cost fraction attributable to obesity was calculated. We found a non-linear association of BMI and health care costs with a continuously increasing slope for increasing BMI without any clear threshold. Under the consideration of the non-linear BMI-cost relationship, a shift in the BMI distribution so that the BMI of each individual is lowered by one point is associated with a 2.1% reduction of mean direct costs in the population. If obesity was eliminated, and the BMI of all obese individuals were lowered to 29.9 kg/m², this would reduce the mean direct costs by 4.0% in the population. Results show a non-linear relationship between BMI and health care costs, with very high costs for a few individuals with high BMI. This indicates that population-based interventions in combination with selective measures for very obese individuals might be the preferred strategy.

Estimation of disease burdens on preterm births and low birth weights attributable to maternal fine particulate matter exposure in Shanghai, China.

PubMed

Liu, Anni; Qian, Naisi; Yu, Huiting; Chen, Renjie; Kan, Haidong

2017-12-31

Studies have shown that maternal exposure to particulate matter ≤2.5μm in aerodynamic diameter (PM 2.5 ) was associated with adverse birth outcomes such as preterm birth (PTB) and low birth weight (LBW). However, the burdens of PTB and LBW attributable to PM 2.5 were rarely evaluated, especially in developing countries. To estimate the burdens of PTBs and LBWs attributable to outdoor PM 2.5 in Shanghai, China. We collected annual-average PM 2.5 concentrations, concentration-response relationships between PM 2.5 exposure during pregnancy and PTBs and LBWs, rates of PTB and LBW, number of live births, and population sizes in grids of 10km×10km in Shanghai in 2013. Then, they were combined to estimate the odds ratios (ORs), relative risks (RRs), attributable fractions (AFs), and numbers of PTBs and LBWs associated with PM 2.5 exposure. The population-weighted annual-average concentration of PM 2.5 in Shanghai was 56.19μg/m 3 in 2013. According to the first-class limit of PM 2.5 (15μg/m 3 ) in the Ambient Air Quality Standards of China, the weighted RRs of PTBs or LBWs associated with PM 2.5 in Shanghai were 1.49 [95% confidence interval (CI): 1.16-1.80] and 1.31 (95% CI: 1.04-1.67), respectively. There might be 32.61% (95% CI: 13.93%-44.42%) or 4160 (95% CI: 1778-5667) PTBs and 23.36% (95% CI: 3.86%-40.02%) or 1882 (95% CI: 311-3224) LBWs attributable to PM 2.5 exposure. The estimates varied appreciably among different districts of Shanghai. Our analysis suggested that outdoor PM 2.5 air pollution might have led to considerable burdens of PTBs and LBWs in Shanghai, China. Copyright © 2017. Published by Elsevier B.V.

Spatial variation in attributable risks.

PubMed

Congdon, Peter

2015-01-01

The attributable risk (AR) measures the contribution of a particular risk factor to a disease, and allows estimation of disease rates specific to that risk. While previous studies consider variability in ARs over demographic categories, this paper considers the extent of spatial variability in ARs estimated from multilevel data with confounders both at individual and geographic levels. A case study considers the AR for diabetes in relation to elevated BMI, and area rates for diabetes attributable to excess weight. Contextual adjustment includes known area variables, and unobserved spatially clustered influences, while spatial heterogeneity (effect modification) is considered in terms of varying effects of elevated BMI by neighbourhood deprivation category. The application is to patient register data in London, with clear evidence of spatial variation in ARs, and in small area diabetes rates attributable to excess weight. Copyright © 2015 Elsevier Ltd. All rights reserved.

Error Patterns in Ordering Fractions among At-Risk Fourth-Grade Students

ERIC Educational Resources Information Center

Malone, Amelia Schneider; Fuchs, Lynn S.

2015-01-01

The 3 purposes of this study were to: (a) describe fraction ordering errors among at-risk 4th-grade students; (b) assess the effect of part-whole understanding and accuracy of fraction magnitude estimation on the probability of committing errors; and (c) examine the effect of students' ability to explain comparing problems on the probability of…

Error Patterns in Ordering Fractions among At-Risk Fourth-Grade Students

ERIC Educational Resources Information Center

Malone, Amelia S.; Fuchs, Lynn S.

2017-01-01

The three purposes of this study were to (a) describe fraction ordering errors among at-risk fourth grade students, (b) assess the effect of part-whole understanding and accuracy of fraction magnitude estimation on the probability of committing errors, and (c) examine the effect of students' ability to explain comparing problems on the probability…

Relationship between alcohol-attributable disease and socioeconomic status, and the role of alcohol consumption in this relationship: a systematic review and meta-analysis.

PubMed

Jones, Lisa; Bates, Geoff; McCoy, Ellie; Bellis, Mark A

2015-04-18

Studies show that alcohol consumption appears to have a disproportionate impact on people of low socioeconomic status. Further exploration of the relationship between alcohol consumption, socioeconomic status and the development of chronic alcohol-attributable diseases is therefore important to inform the development of effective public health programmes. We used systematic review methodology to identify published studies of the association between socioeconomic factors and mortality and morbidity for alcohol-attributable conditions. To attempt to quantify differences in the impact of alcohol consumption for each condition, stratified by SES, we (i) investigated the relationship between SES and risk of mortality or morbidity for each alcohol-attributable condition, and (ii) where, feasible explored alcohol consumption as a mediating or interacting variable in this relationship. We identified differing relationships between a range of alcohol-attributable conditions and socioeconomic indicators. Pooled analyses showed that low, relative to high socioeconomic status, was associated with an increased risk of head and neck cancer and stroke, and in individual studies, with hypertension and liver disease. Conversely, risk of female breast cancer tended to be associated with higher socioeconomic status. These findings were attenuated but held when adjusted for a number of known risk factors and other potential confounding factors. A key finding was the lack of studies that have explored the interaction between alcohol-attributable disease, socioeconomic status and alcohol use. Despite some limitations to our review, we have described relationships between socioeconomic status and a range of alcohol-attributable conditions, and explored the mediating and interacting effects of alcohol consumption where feasible. However, further research is needed to better characterise the relationship between socioeconomic status alcohol consumption and alcohol-attributable disease risk so as to gain a greater understanding of the mechanisms and pathways that influence the differential risk in harm between people of low and high socioeconomic status.

Maternal and perinatal mortality by place of delivery in sub-Saharan Africa: a meta-analysis of population-based cohort studies.

PubMed

Chinkhumba, Jobiba; De Allegri, Manuela; Muula, Adamson S; Robberstad, Bjarne

2014-09-28

Facility-based delivery has gained traction as a key strategy for reducing maternal and perinatal mortality in developing countries. However, robust evidence of impact of place of delivery on maternal and perinatal mortality is lacking. We aimed to estimate the risk of maternal and perinatal mortality by place of delivery in sub-Saharan Africa. We conducted a systematic review of population-based cohort studies reporting on risk of maternal or perinatal mortality at the individual level by place of delivery in sub-Saharan Africa. Newcastle-Ottawa Scale was used to assess study quality. Outcomes were summarized in pooled analyses using fixed and random effects models. We calculated attributable risk percentage reduction in mortality to estimate exposure effect. We report mortality ratios, crude odds ratios and associated 95% confidence intervals. We found 9 population-based cohort studies: 6 reporting on perinatal and 3 on maternal mortality. The mean study quality score was 10 out of 15 points. Control for confounders varied between the studies. A total of 36,772 pregnancy episodes were included in the analyses. Overall, perinatal mortality is 21% higher for home compared to facility-based deliveries, but the difference is only significant when produced with a fixed effects model (OR 1.21, 95% CI: 1.02-1.46) and not when produced by a random effects model (OR 1.21, 95% CI: 0.79-1.84). Under best settings, up to 14 perinatal deaths might be averted per 1000 births if the women delivered at facilities instead of homes. We found significantly increased risk of maternal mortality for facility-based compared to home deliveries (OR 2.29, 95% CI: 1.58-3.31), precluding estimates of attributable risk fraction. Evaluating the impact of facility-based delivery strategy on maternal and perinatal mortality using population-based studies is complicated by selection bias and poor control of confounders. Studies that pool data at an individual level may overcome some of these problems and provide better estimates of relative effectiveness of place of delivery in the region.

Patient preferences for attributes of multiple sclerosis disease-modifying therapies: development and results of a ratings-based conjoint analysis.

PubMed

Wilson, Leslie S; Loucks, Aimee; Gipson, Gregory; Zhong, Lixian; Bui, Christine; Miller, Elizabeth; Owen, Mary; Pelletier, Daniel; Goodin, Douglas; Waubant, Emmanuelle; McCulloch, Charles E

2015-01-01

Timely individualized treatment is essential to improving relapsing-remitting multiple sclerosis (RRMS) patient health outcomes, yet little is known about how patients make treatment decisions. We sought to evaluate RRMS patient preferences for risks and benefits of treatment. Fifty patients with RRMS completed conjoint analysis surveys with 16 hypothetical disease-modifying therapy (DMT) medication profiles developed using a fractional factorial design. Medication profiles were assigned preference ratings from 0 (not acceptable) to 10 (most favorable). Medication attributes included a range of benefits, adverse effects, administration routes, and market durations. Analytical models used linear mixed-effects regression. Participants showed the highest preference for medication profiles that would improve their symptoms (β = 0.81-1.03, P < .001), not a proven DMT outcome. Preventing relapses, the main clinical trial outcome, was not associated with significant preferences (P = .35). Each year of preventing magnetic resonance imaging changes and disease symptom progression showed DMT preferences of 0.17 point (β = 0.17, P = .002) and 0.12 point (β = 0.12, P < .001), respectively. Daily oral administration was preferred over all parenteral routes (P < .001). A 1% increase in death or severe disability decreased relative DMT preference by 1.15 points (P < .001). Patient preference focused on symptoms and prevention of progression but not on relapse prevention, the proven drug outcome. Patients were willing to accept some level of serious risk for certain types and amounts of benefits, and they strongly preferred daily oral administration over all other options.

The economic burden of inadequate consumption of vegetables and fruit in Canada.

PubMed

Ekwaru, John Paul; Ohinmaa, Arto; Loehr, Sarah; Setayeshgar, Solmaz; Thanh, Nguyen Xuan; Veugelers, Paul J

2017-02-01

Public health decision makers not only consider health benefits but also economic implications when articulating and issuing lifestyle recommendations. Whereas various estimates exist for the economic burden of physical inactivity, excess body weight and smoking, estimates of the economic burden associated with our diet are rare. In the present study, we estimated the economic burden attributable to the inadequate consumption of vegetables and fruit in Canada. We accessed the Canadian Community Health Survey to assess the inadequacy in the consumption of vegetables and fruit and published meta-analyses to assemble risk estimates for chronic diseases. Based on these inadequacy and risk estimates, we calculated the population-attributable fraction and avoidable direct and indirect costs to society. Direct costs include those for hospital care, physician services and drugs in 2015. About 80 % of women and 89 % of men consume inadequate amounts of vegetables and fruit. We estimated this to result in an economic burden of $CAN 3·3 billion per year, of which 30·5 % is direct health-care costs and 69·5 % is indirect costs due to productivity losses. A modest 1 percentage point annual reduction in the prevalence of inadequate vegetables and fruit consumption over the next 20 years would avoid approximately $CAN 10·8 billion, and an increase of one serving of vegetables and fruit per day would avoid approximately $CAN 9·2 billion. Further investments in the promotion of vegetables and fruit will prevent chronic disease and substantially reduce direct and indirect health-care costs.

The Familial Co-Aggregation of Attention-Deficit/Hyperactivity Disorder and Intellectual Disability: A Register-Based Family Study.

PubMed

Faraone, Stephen V; Ghirardi, Laura; Kuja-Halkola, Ralf; Lichtenstein, Paul; Larsson, Henrik

2017-02-01

Although many studies document an association between attention-deficit/hyperactivity disorder (ADHD) and intellectual disability (ID), little is known about the etiology of this comorbidity and how it should be addressed in clinical settings. We sought to clarify this issue. All individuals born in Sweden between 1987 and 2006 (n = 2,049,587) were identified using the Medical Birth Register (MBR). From this we selected 7 cohorts of relatives: 1,899,654 parent-offspring pairs, 4,180 monozygotic twin pairs, 12,655 dizygotic twin pairs, 914,848 full sibling pairs, 136,962 maternal half-sibling pairs, 134,502 paternal half-sibling pairs, and 2,790,164 full cousin pairs. We used within-individual and within-family analyses to assess the association between ADHD and ID. Individuals with ID were at increased risk for ADHD compared to those without ID, and relatives of participants with ID were at increased risk of ADHD compared with relatives of those without ID. The magnitude of this association was positively associated with the fraction of the genome shared by the relative pair and was lower for severe compared with mild and moderate ID. Model-fitting analyses demonstrated that 91% of the correlation between the liabilities of ADHD and ID was attributable to genetic factors. These data provide evidence that nearly all of the comorbidity between ADHD and ID can be attributed to genetic factors, which has implications for diagnostic practice. Copyright © 2016 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.

Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

PubMed Central

2017-01-01

Summary Background The Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) provides a comprehensive assessment of risk factor exposure and attributable burden of disease. By providing estimates over a long time series, this study can monitor risk exposure trends critical to health surveillance and inform policy debates on the importance of addressing risks in context. Methods We used the comparative risk assessment framework developed for previous iterations of GBD to estimate levels and trends in exposure, attributable deaths, and attributable disability-adjusted life-years (DALYs), by age group, sex, year, and location for 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks from 1990 to 2016. This study included 481 risk-outcome pairs that met the GBD study criteria for convincing or probable evidence of causation. We extracted relative risk (RR) and exposure estimates from 22 717 randomised controlled trials, cohorts, pooled cohorts, household surveys, census data, satellite data, and other sources, according to the GBD 2016 source counting methods. Using the counterfactual scenario of theoretical minimum risk exposure level (TMREL), we estimated the portion of deaths and DALYs that could be attributed to a given risk. Finally, we explored four drivers of trends in attributable burden: population growth, population ageing, trends in risk exposure, and all other factors combined. Findings Since 1990, exposure increased significantly for 30 risks, did not change significantly for four risks, and decreased significantly for 31 risks. Among risks that are leading causes of burden of disease, child growth failure and household air pollution showed the most significant declines, while metabolic risks, such as body-mass index and high fasting plasma glucose, showed significant increases. In 2016, at Level 3 of the hierarchy, the three leading risk factors in terms of attributable DALYs at the global level for men were smoking (124·1 million DALYs [95% UI 111·2 million to 137·0 million]), high systolic blood pressure (122·2 million DALYs [110·3 million to 133·3 million], and low birthweight and short gestation (83·0 million DALYs [78·3 million to 87·7 million]), and for women, were high systolic blood pressure (89·9 million DALYs [80·9 million to 98·2 million]), high body-mass index (64·8 million DALYs [44·4 million to 87·6 million]), and high fasting plasma glucose (63·8 million DALYs [53·2 million to 76·3 million]). In 2016 in 113 countries, the leading risk factor in terms of attributable DALYs was a metabolic risk factor. Smoking remained among the leading five risk factors for DALYs for 109 countries, while low birthweight and short gestation was the leading risk factor for DALYs in 38 countries, particularly in sub-Saharan Africa and South Asia. In terms of important drivers of change in trends of burden attributable to risk factors, between 2006 and 2016 exposure to risks explains an 9·3% (6·9–11·6) decline in deaths and a 10·8% (8·3–13·1) decrease in DALYs at the global level, while population ageing accounts for 14·9% (12·7–17·5) of deaths and 6·2% (3·9–8·7) of DALYs, and population growth for 12·4% (10·1–14·9) of deaths and 12·4% (10·1–14·9) of DALYs. The largest contribution of trends in risk exposure to disease burden is seen between ages 1 year and 4 years, where a decline of 27·3% (24·9–29·7) of the change in DALYs between 2006 and 2016 can be attributed to declines in exposure to risks. Interpretation Increasingly detailed understanding of the trends in risk exposure and the RRs for each risk-outcome pair provide insights into both the magnitude of health loss attributable to risks and how modification of risk exposure has contributed to health trends. Metabolic risks warrant particular policy attention, due to their large contribution to global disease burden, increasing trends, and variable patterns across countries at the same level of development. GBD 2016 findings show that, while it has huge potential to improve health, risk modification has played a relatively small part in the past decade. Funding The Bill & Melinda Gates Foundation, Bloomberg Philanthropies. PMID:28919119

Risks for Depression Onset in Primary Care Elderly Patients: Potential Targets for Preventive Interventions

PubMed Central

Lyness, Jeffrey M.; Yu, Qin; Tang, Wan; Tu, Xin; Conwell, Yeates

2010-01-01

Objective Prevention of late-life depression, a common, disabling condition with often poor outcomes in primary care, requires identification of seniors at highest risk of incident episodes. The authors examined a broad range of clinical, functional, and psychosocial predictors of incident depressive episodes in a well-characterized cohort of older primary care patients. Method In this observational cohort study, patients age ≥65 years without current major depression, recruited from practices in general internal medicine, geriatrics, and family medicine, received annual follow-up assessments over a period of 1 to 4 years. Of 617 enrolled subjects, 405 completed the 1-year follow-up evaluation. The Structured Clinical Interview for DSM-IV (SCID) determined incident major depressive episodes. Each risk indicator’s predictive utility was examined by calculating the risk exposure rate, incident risk ratio, and population attributable fraction, leading to determination of the number needed to treat in order to prevent incident depression. Results A combination of risks, including minor or subsyndromal depression, impaired functional status, and history of major or minor depression, identified a group in which fully effective treatment of five individuals would prevent one new case of incident depression. Conclusions Indicators routinely assessed in primary care identified a group at very high risk for onset of major depressive episodes. Such markers may inform current clinical care by fostering the early detection and intervention critical to improving patient outcomes and may serve as the basis for future studies refining the recommendations for screening and determining the effectiveness of preventive interventions. PMID:19833788

Long-term sickness absence from combined factors related to physical work demands: prospective cohort study.

PubMed

Andersen, Lars L; Thorsen, Sannie V; Flyvholm, Mari-Ann; Holtermann, Andreas

2018-05-05

The working environment plays an important role in public health. This study investigates the risk for long-term sickness absence (LTSA) from the combination of factors related to physical work demands. Employees (n = 22 740) of the general population (the Danish Work Environment & Health study 2012) were followed for two years in the Danish Register for Evaluation of Marginalisation. Using Cox regression analyses we determined the risk of LTSA from four factors; (i) physical work demands, (ii) physical exertion during work, (iii) fatigue after work and (iv) work-limiting pain. During follow-up 10.2% experienced LTSA. Each of the four factors increased the risk of LTSA with hazard ratios (HR) ranging from 1.30 to 1.57. Scoring high on one (30.3% of the respondents), two (24.4%), three (19.9%) and all four factors (9.2%) gradually increased the risk of LTSA (HR's of 1.39 [95% CI 1.16-1.66], 1.66 [95% CI 1.39-1.99], 1.90 [95% CI 1.57-2.29] and 3.02 [95% CI 2.47-3.68], respectively). Risk estimates remained robust in stratified analyses of age, sex and socioeconomic position. Population attributable fractions were high across all subgroups; 39% (general population), 36% (younger workers), 45% (older workers), 36% (men), 41% (women), 30% (higher socioeconomic position) and 45% (lower socioeconomic position). The risk of LTSA gradually increased with number of factors related to high physical work demands, underlining the importance of targeting combined factors in risk assessment and preventive interventions.

Atmospheric trace metals measured at a regional background site (Welgegund) in South Africa

NASA Astrophysics Data System (ADS)

Venter, Andrew D.; van Zyl, Pieter G.; Beukes, Johan P.; Josipovic, Micky; Hendriks, Johan; Vakkari, Ville; Laakso, Lauri

2017-03-01

Atmospheric trace metals can cause a variety of health-related and environmental problems. Only a few studies on atmospheric trace metal concentrations have been conducted in South Africa. Therefore the aim of this study was to determine trace metal concentrations in aerosols collected at a regional background site, i.e. Welgegund, South Africa. PM1, PM1-2. 5 and PM2. 5-10 samples were collected for 13 months, and 31 atmospheric trace metal species were detected. Atmospheric iron (Fe) had the highest concentrations in all three size fractions, while calcium (Ca) was the second-most-abundant species. Chromium (Cr) and sodium (Na) concentrations were the third- and fourth-most-abundant species, respectively. The concentrations of the trace metal species in all three size ranges were similar, with the exception of Fe, which had higher concentrations in the PM1 size fraction. With the exception of titanium (Ti), aluminium (Al) and manganese (Mg), 70 % or more of the trace metal species detected were in the smaller size fractions, which indicated the influence of industrial activities. However, the large influence of wind-blown dust was reflected by 30 % or more of trace metals being present in the PM2. 5-10 size fraction. Comparison of trace metals determined at Welgegund to those in the western Bushveld Igneous Complex indicated that at both locations similar species were observed, with Fe being the most abundant. However, concentrations of these trace metal species were significantly higher in the western Bushveld Igneous Complex. Fe concentrations at the Vaal Triangle were similar to levels thereof at Welgegund, while concentrations of species associated with pyrometallurgical smelting were lower. Annual average Ni was 4 times higher, and annual average As was marginally higher than their respective European standard values, which could be attributed to regional influence of pyrometallurgical industries in the western Bushveld Igneous Complex. All three size fractions indicated elevated trace metal concentrations coinciding with the end of the dry season, which could partially be attributed to decreased wet removal and increases in wind generation of particulates. Principal component factor analysis (PCFA) revealed four meaningful factors in the PM1 size fraction, i.e. crustal, pyrometallurgical-related and Au slimes dams. No meaningful factors were determined for the PM1-2. 5 and PM2. 5-10 size fractions, which was attributed to the large influence of wind-blown dust on atmospheric trace metals determined at Welgegund. Pollution roses confirmed the influence of wind-blown dust on trace metal concentrations measured at Welgegund, while the impact of industrial activities was also substantiated.

Chemical fractionation of arsenic and heavy metals in fine particle matter and its implications for risk assessment: A case study in Nanjing, China

NASA Astrophysics Data System (ADS)

Li, Huiming; Wang, Jinhua; Wang, Qin'geng; Qian, Xin; Qian, Yu; Yang, Meng; Li, Fengying; Lu, Hao; Wang, Cheng

2015-02-01

A four-step sequential extraction procedure was used to study the chemical fractionation of As and heavy metals (Cd, Cr, Cu, Fe, Mn, Ni, Pb and Zn) in fine particulate matter (PM2.5) collected from Nanjing, China. The mass concentrations of most PM2.5 samples exceeded the 24 h standard (75 μg/m3) recommended by the new national ambient air quality standard of China. The most abundant elements were Fe, Zn and Pb, while As and Cd were present at the lowest concentrations. As, Cd, Cu, Mn, Pb and Zn were mostly present in the two mobile fractions, including the soluble and exchangeable fraction (F1), and carbonates, oxides and reducible fraction (F2). Fe had the highest proportion present in the residual fraction (F4). Relatively high proportions of the metals Ni and Cr were present in the oxidizable and sulfidic fraction (F3). High proportions of Zn, As and Cu and lower proportions of Cd, Cr and Fe were present in the potentially mobile phases. The enrichment factor, contamination factor and risk assessment code were calculated to analyze the main sources and assess the environmental risks of the metals in PM2.5. The carcinogenic risks of As, Cd, Ni and Pb were all lower than the accepted criterion of 10-6, whereas the carcinogenic risks of Cr for children and As and Cr for adults were higher than 10-6. The non-carcinogenic health risk of As and heavy metals because of PM2.5 exposure for children and adults were lower than but close to the safe level of 1.

Heavy metal concentrations in particle size fractions from street dust of Murcia (Spain) as the basis for risk assessment.

PubMed

Acosta, Jose A; Faz, Ángel; Kalbitz, Karsten; Jansen, Boris; Martínez-Martínez, Silvia

2011-11-01

Street dust has been sampled from six different types of land use of the city of Murcia (Spain). The samples were fractionated into eleven particle size fractions (<2, 2-10, 10-20, 20-50, 50-75, 75-106, 106-150, 150-180, 180-425, 425-850 μm and 850-2000 μm) and analyzed for Pb, Cu, Zn and Cd. The concentrations of these four potentially toxic metals were assessed, as well as the effect of particle size on their distribution. A severe enrichment of all metals was observed for all land-uses (industrial, suburban, urban and highways), with the concentration of all metals affected by the type of land-use. Coarse and fine particles in all cases showed concentrations of metals higher than those found in undisturbed areas. However, the results indicated a preferential partitioning of metals in fine particle size fractions in all cases, following a logarithmic distribution. The accumulation in the fine fractions was higher when the metals had an anthropogenic origin. The strong overrepresentation of metals in particles <10 μm indicates that if the finest fractions are removed by a vacuum-assisted dry sweeper or a regenerative-air sweeper the risk of metal dispersion and its consequent risk for humans will be highly reduced. Therefore, we recommend that risk assessment programs include monitoring of metal concentrations in dust where each land-use is separately evaluated. The finest particle fractions should be examined explicitly in order to apply the most efficient measures for reducing the risk of inhalation and ingestion of dust for humans and risk for the environment.

Estimation of the burden of cardiovascular disease attributable to modifiable risk factors and cost-effectiveness analysis of preventative interventions to reduce this burden in Argentina

PubMed Central

2010-01-01

Background Cardiovascular disease (CVD) is the primary cause of mortality and morbidity in Argentina representing 34.2% of deaths and 12.6% of potential years of life lost (PYLL). The aim of the study was to estimate the burden of acute coronary heart disease (CHD) and stroke and the cost-effectiveness of preventative population-based and clinical interventions. Methods An epidemiological model was built incorporating prevalence and distribution of high blood pressure, high cholesterol, hyperglycemia, overweight and obesity, smoking, and physical inactivity, obtained from the Argentine Survey of Risk Factors dataset. Population Attributable Fraction (PAF) of each risk factor was estimated using relative risks from international sources. Total fatal and non-fatal events, PYLL and Disability Adjusted Life Years (DALY) were estimated. Costs of event were calculated from local utilization databases and expressed in international dollars (I$). Incremental cost-effectiveness ratios (ICER) were estimated for six interventions: reducing salt in bread, mass media campaign to promote tobacco cessation, pharmacological therapy of high blood pressure, pharmacological therapy of high cholesterol, tobacco cessation therapy with bupropion, and a multidrug strategy for people with an estimated absolute risk > 20% in 10 years. Results An estimated total of 611,635 DALY was lost due to acute CHD and stroke for 2005. Modifiable risk factors explained 71.1% of DALY and more than 80% of events. Two interventions were cost-saving: lowering salt intake in the population through reducing salt in bread and multidrug therapy targeted to persons with an absolute risk above 20% in 10 years; three interventions had very acceptable ICERs: drug therapy for high blood pressure in hypertensive patients not yet undergoing treatment (I$ 2,908 per DALY saved), mass media campaign to promote tobacco cessation amongst smokers (I$ 3,186 per DALY saved), and lowering cholesterol with statin drug therapy (I$ 14,432 per DALY saved); and one intervention was not found to be cost-effective: tobacco cessation with bupropion (I$ 59,433 per DALY saved) Conclusions Most of the interventions selected were cost-saving or very cost-effective. This study aims to inform policy makers on resource-allocation decisions to reduce the burden of CVD in Argentina. PMID:20961456

Rare, evolutionarily unlikely missense substitutions in CHEK2 contribute to breast cancer susceptibility: results from a breast cancer family registry case-control mutation-screening study.

PubMed

Le Calvez-Kelm, Florence; Lesueur, Fabienne; Damiola, Francesca; Vallée, Maxime; Voegele, Catherine; Babikyan, Davit; Durand, Geoffroy; Forey, Nathalie; McKay-Chopin, Sandrine; Robinot, Nivonirina; Nguyen-Dumont, Tù; Thomas, Alun; Byrnes, Graham B; Hopper, John L; Southey, Melissa C; Andrulis, Irene L; John, Esther M; Tavtigian, Sean V

2011-01-18

Both protein-truncating variants and some missense substitutions in CHEK2 confer increased risk of breast cancer. However, no large-scale study has used full open reading frame mutation screening to assess the contribution of rare missense substitutions in CHEK2 to breast cancer risk. This absence has been due in part to a lack of validated statistical methods for summarizing risk attributable to large numbers of individually rare missense substitutions. Previously, we adapted an in silico assessment of missense substitutions used for analysis of unclassified missense substitutions in BRCA1 and BRCA2 to the problem of assessing candidate genes using rare missense substitution data observed in case-control mutation-screening studies. The method involves stratifying rare missense substitutions observed in cases and/or controls into a series of grades ordered a priori from least to most likely to be evolutionarily deleterious, followed by a logistic regression test for trends to compare the frequency distributions of the graded missense substitutions in cases versus controls. Here we used this approach to analyze CHEK2 mutation-screening data from a population-based series of 1,303 female breast cancer patients and 1,109 unaffected female controls. We found evidence of risk associated with rare, evolutionarily unlikely CHEK2 missense substitutions. Additional findings were that (1) the risk estimate for the most severe grade of CHEK2 missense substitutions (denoted C65) is approximately equivalent to that of CHEK2 protein-truncating variants; (2) the population attributable fraction and the familial relative risk explained by the pool of rare missense substitutions were similar to those explained by the pool of protein-truncating variants; and (3) post hoc power calculations implied that scaling up case-control mutation screening to examine entire biochemical pathways would require roughly 2,000 cases and controls to achieve acceptable statistical power. This study shows that CHEK2 harbors many rare sequence variants that confer increased risk of breast cancer and that a substantial proportion of these are missense substitutions. The study validates our analytic approach to rare missense substitutions and provides a method to combine data from protein-truncating variants and rare missense substitutions into a one degree of freedom per gene test.

Mental disease-related emergency admissions attributable to hot temperatures.

PubMed

Lee, Suji; Lee, Hwanhee; Myung, Woojae; Kim, E Jin; Kim, Ho

2018-03-01

The association between high temperature and mental disease has been the focus of several studies worldwide. However, no studies have focused on the mental disease burden attributable to hot temperature. Here, we aim to quantify the risk attributed to hot temperatures based on the exposure-lag-response relationship between temperature and mental diseases. From data on daily temperature and emergency admissions (EA) for mental diseases collected from 6 major cities (Seoul, Incheon, Daejeon, Daegu, Busan, and Gwangju in South Korea) over a period of 11years (2003-2013), we estimated temperature-disease associations using a distributed lag non-linear model, and we pooled the data by city through multivariate meta-analysis. Cumulative relative risk and attributable risks were calculated for extreme hot temperatures, defined as the 99th percentile relative to the 50th percentile of temperatures. The strongest association between mental disease and high temperature was seen within a period of 0-4days of high temperature exposure. Our results reveal that 14.6% of EA for mental disease were due to extreme hot temperatures, and the elderly were more susceptible (19.1%). Specific mental diseases, including anxiety, dementia, schizophrenia, and depression, also showed significant risk attributed to hot temperatures. Of all EA for anxiety, 31.6% were attributed to extremely hot temperatures. High temperature was responsible for an attributable risk for mental disease, and the burden was higher in the elderly. This finding has important implications for designing appropriate public health policies to minimize the impact of high temperature on mental health. Copyright © 2017 Elsevier B.V. All rights reserved.

The burden of COPD mortality due to ambient air pollution in Guangzhou, China

NASA Astrophysics Data System (ADS)

Li, Li; Yang, Jun; Song, Yun-Feng; Chen, Ping-Yan; Ou, Chun-Quan

2016-05-01

Few studies have investigated the chronic obstructive pulmonary disease (COPD) mortality fraction attributable to air pollution and modification by individual characteristics of air pollution effects. We applied distributed lag non-linear models to assess the associations between air pollution and COPD mortality in 2007-2011 in Guangzhou, China, and the total COPD mortality fraction attributable to air pollution was calculated as well. We found that an increase of 10 μg/m3 in particulate matter with an aerodynamic diameter of 10 μm or less (PM10), sulfur dioxide (SO2) and nitrogen dioxide (NO2) was associated with a 1.58% (95% confidence interval (CI): 0.12-3.06%), 3.45% (95% CI: 1.30-5.66%) and 2.35% (95% CI: 0.42-4.32%) increase of COPD mortality over a lag of 0-15 days, respectively. Greater air pollution effects were observed in the elderly, males and residents with low educational attainment. The results showed 10.91% (95% CI: 1.02-9.58%), 12.71% (95% CI: 5.03-19.85%) and 13.38% (95% CI: 2.67-22.84%) COPD mortality was attributable to current PM10, SO2 and NO2 exposure, respectively. In conclusion, the associations between air pollution and COPD mortality differed by individual characteristics. There were remarkable COPD mortality burdens attributable to air pollution in Guangzhou.

Estimates of cancer deaths attributable to behavioural risk factors in Italy, 2013.

PubMed

Battisti, Francesca; Carreras, Giulia; Grassi, Tommaso; Chellini, Elisabetta; Gorini, Giuseppe

2017-01-01

"Non-communicable diseases cause more than 80% of deaths in europe and, among these, 20% are caused by cancer. Modifiable lifestyle factors considered in the italian national programme "Guadagnare salute" (Gaining health), such as tobacco smoking, unhealthy diet, physical inactivity, overweight, and excessive alcohol use, are amongst the major causes of cancer deaths. The aims of this study was to estimate the number of deaths attributable to lifestyle factors for italy and for italian regions in 2013 and to describe its variation in relation to the regional prevalence of risk factors exposure. For Italy and for each italian region, deaths attributable to lifestyle factors were estimated using the methodology of the Global Burden of disease (GBd) study. italian mortality data of 2013 and risks attributable to these lifestyle factors for each cancer site for italy from the GBd study were used. Prevalence of exposure to lifestyles in Italy and in each Italian Region was collected for the period 2008-2013. In 2013, at least 66,605 cancer deaths in italy were attributable to lifestyle factors, accounting for 37.9% of all cancer deaths: 34.1% of cancer deaths in men and 9.0% in women were attributable to smoking; in men and women, respectively, 3.3% and 2.8% were attributable to excessive alcohol consumption; 5.3 % and 6.7% to overweight; 10.1% and 7.1% to dietary risk factors; 1.9% and 4.2% to physical inactivity. A moderate variability of percentage of deaths attributable to modifi able lifestyle factors by region was also detected due to different prevalence values of exposure to lifestyles occurred in last decades. At least 45,000 cancer deaths in men and 21,000 in women occurred in 2013 were attributable to modifi able risk factors, whose prevalence varied by region and which could be averted through the implementation of primary prevention interventions."

Risk factors for head and neck cancer in young adults: a pooled analysis in the INHANCE consortium.

PubMed

Toporcov, Tatiana Natasha; Znaor, Ariana; Zhang, Zuo-Feng; Yu, Guo-Pei; Winn, Deborah M; Wei, Qingyi; Vilensky, Marta; Vaughan, Thomas; Thomson, Peter; Talamini, Renato; Szeszenia-Dabrowska, Neonila; Sturgis, Erich M; Smith, Elaine; Shangina, Oxana; Schwartz, Stephen M; Schantz, Stimson; Rudnai, Peter; Richiardi, Lorenzo; Ramroth, Heribert; Purdue, Mark P; Olshan, Andrew F; Eluf-Neto, José; Muscat, Joshua; Moyses, Raquel Ajub; Morgenstern, Hal; Menezes, Ana; McClean, Michael; Matsuo, Keitaro; Mates, Dana; Macfarlane, Tatiana V; Lissowska, Jolanta; Levi, Fabio; Lazarus, Philip; La Vecchia, Carlo; Lagiou, Pagona; Koifman, Sergio; Kjaerheim, Kristina; Kelsey, Karl; Holcatova, Ivana; Herrero, Rolando; Healy, Claire; Hayes, Richard B; Franceschi, Silvia; Fernandez, Leticia; Fabianova, Eleonora; Daudt, Alexander W; Curioni, Otávio Alberto; Maso, Luigino Dal; Curado, Maria Paula; Conway, David I; Chen, Chu; Castellsague, Xavier; Canova, Cristina; Cadoni, Gabriella; Brennan, Paul; Boccia, Stefania; Antunes, José Leopoldo Ferreira; Ahrens, Wolfgang; Agudo, Antonio; Boffetta, Paolo; Hashibe, Mia; Lee, Yuan-Chin Amy; Filho, Victor Wünsch

2015-02-01

Increasing incidence of head and neck cancer (HNC) in young adults has been reported. We aimed to compare the role of major risk factors and family history of cancer in HNC in young adults and older patients. We pooled data from 25 case-control studies and conducted separate analyses for adults ≤ 45 years old ('young adults', 2010 cases and 4042 controls) and >45 years old ('older adults', 17700 cases and 22 704 controls). Using logistic regression with studies treated as random effects, we estimated adjusted odds ratios (ORs) and 95% confidence intervals (CIs). The young group of cases had a higher proportion of oral tongue cancer (16.0% in women; 11.0% in men) and unspecified oral cavity / oropharynx cancer (16.2%; 11.1%) and a lower proportion of larynx cancer (12.1%; 16.6%) than older adult cases. The proportions of never smokers or never drinkers among female cases were higher than among male cases in both age groups. Positive associations with HNC and duration or pack-years of smoking and drinking were similar across age groups. However, the attributable fractions (AFs) for smoking and drinking were lower in young when compared with older adults (AFs for smoking in young women, older women, young men and older men, respectively, = 19.9% (95% CI=9.8%, 27.9%), 48.9% (46.6%, 50.8%), 46.2% (38.5%, 52.5%), 64.3% (62.2%, 66.4%); AFs for drinking=5.3% (-11.2%, 18.0%), 20.0% (14.5%, 25.0%), 21.5% (5.0%, 34.9%) and 50.4% (46.1%, 54.3%). A family history of early-onset cancer was associated with HNC risk in the young [OR=2.27 (95% CI=1.26, 4.10)], but not in the older adults [OR=1.10 (0.91, 1.31)]. The attributable fraction for family history of early-onset cancer was 23.2% (8.60% to 31.4%) in young compared with 2.20% (-2.41%, 5.80%) in older adults. Differences in HNC aetiology according to age group may exist. The lower AF of cigarette smoking and alcohol drinking in young adults may be due to the reduced length of exposure due to the lower age. Other characteristics, such as those that are inherited, may play a more important role in HNC in young adults compared with older adults. © The Author 2015; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association.

Risk factors for head and neck cancer in young adults: a pooled analysis in the INHANCE consortium

PubMed Central

Toporcov, Tatiana Natasha; Znaor, Ariana; Zhang, Zuo-Feng; Yu, Guo-Pei; Winn, Deborah M; Wei, Qingyi; Vilensky, Marta; Vaughan, Thomas; Thomson, Peter; Talamini, Renato; Szeszenia-Dabrowska, Neonila; Sturgis, Erich M; Smith, Elaine; Shangina, Oxana; Schwartz, Stephen M; Schantz, Stimson; Rudnai, Peter; Richiardi, Lorenzo; Ramroth, Heribert; Purdue, Mark P; Olshan, Andrew F; Eluf-Neto, José; Muscat, Joshua; Moyses, Raquel Ajub; Morgenstern, Hal; Menezes, Ana; McClean, Michael; Matsuo, Keitaro; Mates, Dana; Macfarlane, Tatiana V; Lissowska, Jolanta; Levi, Fabio; Lazarus, Philip; Vecchia, Carlo La; Lagiou, Pagona; Koifman, Sergio; Kjaerheim, Kristina; Kelsey, Karl; Holcatova, Ivana; Herrero, Rolando; Healy, Claire; Hayes, Richard B; Franceschi, Silvia; Fernandez, Leticia; Fabianova, Eleonora; Daudt, Alexander W; Curioni, Otávio Alberto; Maso, Luigino Dal; Curado, Maria Paula; Conway, David I; Chen, Chu; Castellsague, Xavier; Canova, Cristina; Cadoni, Gabriella; Brennan, Paul; Boccia, Stefania; Antunes, José Leopoldo Ferreira; Ahrens, Wolfgang; Agudo, Antonio; Boffetta, Paolo; Hashibe, Mia; Lee, Yuan-Chin Amy; Filho, Victor Wünsch

2015-01-01

Background: Increasing incidence of head and neck cancer (HNC) in young adults has been reported. We aimed to compare the role of major risk factors and family history of cancer in HNC in young adults and older patients. Methods: We pooled data from 25 case-control studies and conducted separate analyses for adults ≤45 years old (‘young adults’, 2010 cases and 4042 controls) and >45 years old (‘older adults’, 17 700 cases and 22 704 controls). Using logistic regression with studies treated as random effects, we estimated adjusted odds ratios (ORs) and 95% confidence intervals (CIs). Results: The young group of cases had a higher proportion of oral tongue cancer (16.0% in women; 11.0% in men) and unspecified oral cavity / oropharynx cancer (16.2%; 11.1%) and a lower proportion of larynx cancer (12.1%; 16.6%) than older adult cases. The proportions of never smokers or never drinkers among female cases were higher than among male cases in both age groups. Positive associations with HNC and duration or pack-years of smoking and drinking were similar across age groups. However, the attributable fractions (AFs) for smoking and drinking were lower in young when compared with older adults (AFs for smoking in young women, older women, young men and older men, respectively, = 19.9% (95% CI = 9.8%, 27.9%), 48.9% (46.6%, 50.8%), 46.2% (38.5%, 52.5%), 64.3% (62.2%, 66.4%); AFs for drinking = 5.3% (−11.2%, 18.0%), 20.0% (14.5%, 25.0%), 21.5% (5.0%, 34.9%) and 50.4% (46.1%, 54.3%). A family history of early-onset cancer was associated with HNC risk in the young [OR = 2.27 (95% CI = 1.26, 4.10)], but not in the older adults [OR = 1.10 (0.91, 1.31)]. The attributable fraction for family history of early-onset cancer was 23.2% (8.60% to 31.4%) in young compared with 2.20% (−2.41%, 5.80%) in older adults. Conclusions: Differences in HNC aetiology according to age group may exist. The lower AF of cigarette smoking and alcohol drinking in young adults may be due to the reduced length of exposure due to the lower age. Other characteristics, such as those that are inherited, may play a more important role in HNC in young adults compared with older adults. PMID:25613428

Herd-level risk factors for bovine tuberculosis in French cattle herds.

PubMed

Marsot, Maud; Béral, Marina; Scoizec, Axelle; Mathevon, Yoann; Durand, Benoit; Courcoul, Aurélie

2016-09-01

Although officially free of bovine tuberculosis (bTB), France has been experiencing a slight increase in the incidence and geographical spread of the infection. Eradication of bTB requires determining the infection risk factors. Although several studies identifying bTB risk factors have been conducted in the United Kingdom and Spain, no information is currently available regarding bTB risk factors in French cattle. The objective of this work was thus to study the factors associated with the risk of bTB in cattle herds in three French administrative divisions (départements of Ardennes, Côte d'Or and Dordogne). A case-control study was conducted to compare herds having experienced a bTB outbreak between 2012 and early 2014 with randomly selected control herds of the three study départements. A questionnaire of farming practices, inter-herd contacts (e.g. at pasture or via vehicles or materials), and the presence of other domestic species was carried out in the selected herds. Data on other variables of interest included animal movements between farms and potential contacts between cattle and wildlife (e.g. badger and wild boar abundances) were also collected. Multivariable logistic regression and multimodel inference methods were used to assess risk factors related to bTB. A total of 216 herds (72 cases and 144 controls) were analyzed. The two main risk factors were the presence of a recent neighboring outbreak, being defined as a neighboring herd at pasture reported as infected in the past two years (odds ratio (OR)=3.6; population attributable fraction (PAF)=30.7%) and the presence of a farm building for cattle housing or for feed storage located at more than 300-m from inhabited areas (OR=2.3; PAF=27.6%). Another risk factor was related to sharing water points at pasture with a recent neighboring outbreak. Results illustrated the multifactorial nature of bTB dynamics. The risk factors related to recently infected neighboring herds could be attributable to between-herd contacts at pasture and/or to exposure to a common source of infection (environment or wildlife). Moreover, the use of remote farm buildings by wildlife may also play a role in the bTB spread in the French départements studied. The identification of the main risk factors help better understand bTB dynamics and are useful for implementing appropriate and targeted surveillance, biosecurity and control measures in France. Copyright © 2016 Elsevier B.V. All rights reserved.

Fast-track extreme event attribution: General methods and techniques to determine the dynamic contribution to an event.

NASA Astrophysics Data System (ADS)

Otto, F. E. L.; Haustein, K.; Uhe, P.; Massey, N.; Rimi, R.; Allen, M. R.; Cullen, H. M.

2016-12-01

Extreme weather event attribution has become an accepted part of the atmospheric sciences with numerous methods having been put forward over the last decade. We have recently established a new framework which allows for event attribution in quasi-real-time. Here we present the methodology with which we can assess the fraction of attributable risk (FAR) of a severe weather event due to an external driver (Haustein et al. 2016). The method builds on a large ensemble of atmosphere-only GCM simulations forced by seasonal forecast SSTs (actual conditions) that are contrasted with ensembles forced by counterfactual SSTs (natural conditions). Having an associated 30 year actual and natural climatology in place, we are able to put the current event into a climatological context and determine the dynamic contribution that lead to the event as opposed to the thermodynamic contribution which would have made such an event more likely regardless of the synoptic situation. As a second independent method (also applicable in near-real-time), we apply pattern correlation to separate thermodynamic and dynamic contributions. Finally, using reanalysis data, we test whether our attributed dynamic contribution is also detectable in the observations. Despite the high monthly variability, ENSO related teleconnection patterns can be detected fairly robustly as we will demonstrate with a recent example during El Nino. The more consistent the 3 methods are, the more robust our results will be. We note that the choice of time scale matters a lot when determining the dynamic contribution as well as estimating the FAR (Uhe et al. 2016). The weather@home ensemble prediction approach is accompanied by two more methods based on observational data and the CMIP5 ensemble. If the FAR across 3 methods is consistent, we have reason to trust our central attribution statement. Two recent examples will be shown in order to demonstrate the feasibility (van Oldenborgh et al. 2016a/2016b), complemented by new results from South Asia where we also investigate the effects of anthropogenic aerosols.

An Investigation on Attributes of Ambient Temperature and Diurnal Temperature Range on Mortality in Five East-Asian Countries.

PubMed

Lee, Whan-Hee; Lim, Youn-Hee; Dang, Tran Ngoc; Seposo, Xerxes; Honda, Yasushi; Guo, Yue-Liang Leon; Jang, Hye-Min; Kim, Ho

2017-08-31

Interest in the health effects of extremely low/high ambient temperature and the diurnal temperature range (DTR) on mortality as representative indices of temperature variability is growing. Although numerous studies have reported on these indices independently, few studies have provided the attributes of ambient temperature and DTR related to mortality, concurrently. In this study, we aimed to investigate and compare the mortality risk attributable to ambient temperature and DTR. The study included data of 63 cities in five East-Asian countries/regions during various periods between 1972 and 2013. The attributable risk of non-accidental death to ambient temperature was 9.36% (95% confidence interval [CI]: 8.98-9.69%) and to DTR was 0.59% (95% CI: 0.53-0.65%). The attributable cardiovascular mortality risks to ambient temperature (15.63%) and DTR (0.75%) are higher than the risks to non-accidental/respiratory-related mortality. We verified that ambient temperature plays a larger role in temperature-associated mortality, and cardiovascular mortality is susceptible to ambient temperature and DTR.

The Concept of Magnitude and What It Tells Us About How Struggling Students Learn Fractions.

PubMed

Woodward, John

This commentary summarizes emerging research into fractions instruction for students who are at risk for failure. Each of the three articles emphasizes a measure conception of fractions. Teaching fractions as measurement helps students learn the magnitude of rational numbers. However, measurement is only part of the way that students should conceptualize fractions. Instruction also needs to emphasize fractions as division. The article also draws attention to the teaching qualifications of those who typically instruct at-risk students in Tier 2 and 3 settings. More often than not, these individuals lack the pedagogical content knowledge needed to adapt instruction and address student misconceptions. This is a critical issue going forward as the field attempts to balance procedural understanding with key underlying fractional ideas such a measurement and division.

Attribution of trends in global vegetation greenness from 1982 to 2011

NASA Astrophysics Data System (ADS)

Zhu, Z.; Xu, L.; Bi, J.; Myneni, R.; Knyazikhin, Y.

2012-12-01

Time series of remotely sensed vegetation indices data provide evidence of changes in terrestrial vegetation activity over the past decades in the world. However, it is difficult to attribute cause-and-effect to vegetation trends because variations in vegetation productivity are driven by various factors. This study investigated changes in global vegetation productivity first, and then attributed the global natural vegetation with greening trend. Growing season integrated normalized difference vegetation index (GSI NDVI) derived from the new GIMMS NDVI3g dataset (1982-2011was analyzed. A combined time series analysis model, which was developed from simper linear trend model (SLT), autoregressive integrated moving average model (ARIMA) and Vogelsang's t-PST model shows that productivity of all vegetation types except deciduous broadleaf forest predominantly showed increasing trends through the 30-year period. The evolution of changes in productivity in the last decade was also investigated. Area of greening vegetation monotonically increased through the last decade, and both the browning and no change area monotonically decreased. To attribute the predominant increase trend of productivity of global natural vegetation, trends of eight climate time series datasets (three temperature, three precipitation and two radiation datasets) were analyzed. The attribution of trends in global vegetation greenness was summarized as relaxation of climatic constraints, fertilization and other unknown reasons. Result shows that nearly all the productivity increase of global natural vegetation was driven by relaxation of climatic constraints and fertilization, which play equally important role in driving global vegetation greenness.; Area fraction and productivity change fraction of IGBP vegetation land cover classes showing statistically significant (10% level) trend in GSI NDVIt;

Metal contamination and fractionation in sediments from the lower basin of the Vale do Ribeira (SE, Brazil).

PubMed

Bonnail, Estefanía; Buruaem, Lucas M; Morais, Lucas G; Abessa, Denis M S; Sarmiento, Aguasanta M; DelValls, T Ángel

2017-06-01

The sediment quality of Ribeira de Iguape River is affected by former Pb extraction mining. Some studies affirm the restoration status of the basin, however, mobility of metals and its associated risk is still questioned. This study integrates the metal concentrations in the lower part of the basin with different contamination source to determine the existence of risks associated with the mobile fractions of the geochemical matrix. Despite concentrations of metals were low and the environmental risk factor values were negative, our results indicated that As, Mn, Pb, and V were present in the most labile forms. The multivariate analysis conducted using metal concentrations, environmental risk factor values and speciation suggested that any risk would be associated with the labile fractions of the analyzed elements, especially for Pb. The station from Registro was stressed by Co, Pb and Zn; with Pb under the reactive fraction that could be associated with high mobility and potential bioavailability.

Impact of Stress and Mitigating Information on Evaluations, Attributions, Affect, Disciplinary Choices, and Expectations of Compliance in Mothers at High and Low Risk for Child Physical Abuse

ERIC Educational Resources Information Center

De Paul, Joaquin; Asla, Nagore; Perez-Albeniz, Alicia; De Cadiz, Barbara Torres-Gomez

2006-01-01

The objective is to know if high-risk mothers for child physical abuse differ in their evaluations, attributions, negative affect, disciplinary choices for children's behavior, and expectations of compliance. The effect of a stressor and the introduction of mitigating information are analyzed. Forty-seven high-risk and 48 matched low-risk mothers…

Quantitative Assessment of Liver Fat with Magnetic Resonance Imaging and Spectroscopy

PubMed Central

Reeder, Scott B.; Cruite, Irene; Hamilton, Gavin; Sirlin, Claude B.

2011-01-01

Hepatic steatosis is characterized by abnormal and excessive accumulation of lipids within hepatocytes. It is an important feature of diffuse liver disease, and the histological hallmark of non-alcoholic fatty liver disease (NAFLD). Other conditions associated with steatosis include alcoholic liver disease, viral hepatitis, HIV and genetic lipodystrophies, cystic fibrosis liver disease, and hepatotoxicity from various therapeutic agents. Liver biopsy, the current clinical gold standard for assessment of liver fat, is invasive and has sampling errors, and is not optimal for screening, monitoring, clinical decision making, or well-suited for many types of research studies. Non-invasive methods that accurately and objectively quantify liver fat are needed. Ultrasound (US) and computed tomography (CT) can be used to assess liver fat but have limited accuracy as well as other limitations. Magnetic resonance (MR) techniques can decompose the liver signal into its fat and water signal components and therefore assess liver fat more directly than CT or US. Most magnetic resonance (MR) techniques measure the signal fat-fraction (the fraction of the liver MR signal attributable to liver fat), which may be confounded by numerous technical and biological factors and may not reliably reflect fat content. By addressing the factors that confound the signal fat-fraction, advanced MR techniques measure the proton density fat-fraction (the fraction of the liver proton density attributable to liver fat), which is a fundamental tissue property and a direct measure of liver fat content. These advanced techniques show promise for accurate fat quantification and are likely to be commercially available soon. PMID:22025886

Phenolics and antioxidant capacity of table grape (Vitis vinifera L.) cultivars grown in Chile.

PubMed

Lutz, Mariane; Jorquera, Katterin; Cancino, Beatriz; Ruby, Rene; Henriquez, Carolina

2011-09-01

Grapes (Vitis vinifera L.) possess health-promoting effects attributed to their supply of a wide variety of bioactive phenolics. Juice and skin fractions of 4 varieties of table grapes: Red Globe, Crimson Seedless, Autumn Royal, and Ribier were prepared to determine and compare their total phenolics content, antioxidant capacity (DPPH, FRAP, and ORAC), anthocyanins, and specific phenolics (caffeic acid, gallic acid, resveratrol, and catechin) content, since a series of positive health benefits are expected from the intake of any of these fractions. Higher amounts of total phenolics and antioxidant capacity were observed in the skin fractions (P < 0.05). Blue grapes (Autumn Royal and Ribier) exhibited higher phenolics content and antioxidant capacity (P < 0.05) than red grapes. The most abundant phenolic compound observed was catechin (P < 0.05). Significant correlations between the antioxidant capacity and total phenolics were observed in grape juice and skin fractions. Autumn Royal juice provides a very high amount of phenolics, anthocyanins, and exhibits the highest antioxidant capacity, offering the best health promoting properties compared with the other grape varieties studied. Grapes possess health-promoting effects attributed to their supply of a wide variety of bioactive phenolics. Grape juice made with blue grapes (Autumn Royal, Ribier) exhibit higher phenolics content and antioxidant capacity than juice elaborated with red grapes (Red Globe, Crimson Seedless). The skin is a good source of phenolics and has a high antioxidant capacity. Specific health-promoting phenolics are more abundant in blue grapes, mainly in their skin fraction, which should not be discarded. © 2011 Institute of Food Technologists®

Effects of Three Depression Prevention Interventions on Risk for Depressive Disorder Onset in the Context of Depression Risk Factors

PubMed Central

Rohde, Paul; Stice, Eric; Gau, Jeff M.

2013-01-01

Study aims were to identify subgroups of adolescents with elevated depressive symptoms who had the highest likelihood of developing future major/minor depressive disorder on the basis of depression risk factors and participation in three depression prevention programs, with the goal of evaluating the preventive effect of indicated prevention interventions in the context of known risk factors. Adolescents (N = 341) with elevated depressive symptoms were randomized to one of four prevention intervention conditions (cognitive-behavioral group, supportive-expressive group, cognitive-behavioral bibliotherapy, educational brochure control). By 2-year follow-up, 14% showed onset of major/minor depressive disorders. Classification tree analysis (CTA) revealed that negative attributional style was the most important risk factor: youth with high scores showed a 4-fold increase in depression onset compared to youth who did not endorse this attributional style. For adolescents with negative attributional style, prevention condition emerged as the most important predictor: those receiving bibliotherapy showed a 5-fold reduction in depression disorder onset relative to adolescents in the three other intervention conditions. For adolescents who reported low negative attributional style scores, elevated levels of depressive symptoms at baseline emerged as the most potent predictor. Results implicate two key pathways to depression involving negative attributional style and elevated depressive symptoms in this population, and suggest that bibliotherapy may offset the risk conveyed by the most important depression risk factor in this sample. PMID:22932745

Effects of three depression prevention interventions on risk for depressive disorder onset in the context of depression risk factors.

PubMed

Rohde, Paul; Stice, Eric; Gau, Jeff M

2012-12-01

Study aims were to identify subgroups of adolescents with elevated depressive symptoms who had the highest likelihood of developing future major/minor depressive disorder on the basis of depression risk factors and participation in three depression prevention programs, with the goal of evaluating the preventive effect of indicated prevention interventions in the context of known risk factors. Adolescents (N = 341) with elevated depressive symptoms were randomized to one of four prevention intervention conditions (cognitive-behavioral group, supportive-expressive group, cognitive-behavioral bibliotherapy, educational brochure control). By 2-year follow-up, 14% showed onset of major/minor depressive disorders. Classification tree analysis (CTA) revealed that negative attributional style was the most important risk factor: Youth with high scores showed a 4-fold increase in depression onset compared to youth who did not endorse this attributional style. For adolescents with negative attributional style, prevention condition emerged as the most important predictor: Those receiving bibliotherapy showed a 5-fold reduction in depression disorder onset relative to adolescents in the three other intervention conditions. For adolescents who reported low negative attributional style scores, elevated levels of depressive symptoms at baseline emerged as the most potent predictor. Results implicate two key pathways to depression involving negative attributional style and elevated depressive symptoms in this population, and suggest that bibliotherapy may offset the risk conveyed by the most important depression risk factor in this sample.

Sensor Technologies for Particulate Detection and Characterization

NASA Technical Reports Server (NTRS)

Greenberg, Paul S.

2008-01-01

Planned Lunar missions have resulted in renewed attention to problems attributable to fine particulates. While the difficulties experienced during the sequence of Apollo missions did not prove critical in all cases, the comparatively long duration of impending missions may present a different situation. This situation creates the need for a spectrum of particulate sensing technologies. From a fundamental perspective, an improved understanding of the properties of the dust fraction is required. Described here is laboratory-based reference instrumentation for the measurement of fundamental particle size distribution (PSD) functions from 2.5 nanometers to 20 micrometers. Concomitant efforts for separating samples into fractional size bins are also presented. A requirement also exists for developing mission compatible sensors. Examples include provisions for air quality monitoring in spacecraft and remote habitation modules. Required sensor attributes such as low mass, volume, and power consumption, autonomy of operation, and extended reliability cannot be accommodated by existing technologies.

The role of chondrules in nebular fractionations of volatiles and other elements

NASA Technical Reports Server (NTRS)

Grossman, J. N.

1994-01-01

For at least 30 years, cosmochemists have been grappling with the question of how and why groups of geochemically and volatility related elements became fractionated in the major chondrite groups. At least five relatively independent fractionations are known. Virtually everyone who has thought about these facts has been attempted to attribute at least some of the fractionations to the physical separation or mixing of the visible components. By far the most abundant of these components in meteorites is chondrules, and indeed chondrules have long been suspected of playing a direct role in fractionation of volatile elements. The question addressed here is whether chondrules formed before or after chemical components became separated is of fundamental importance to our understanding of the early solar system, as the answer constrains how, when, where, and from what chondrules formed, and tells us about how materials were processed in the nebula.

Effects of Intervention to Improve At-Risk Fourth Graders' Understanding, Calculations, and Word Problems with Fractions

ERIC Educational Resources Information Center

Fuchs, Lynn S.; Schumacher, Robin F.; Long, Jessica; Namkung, Jessica; Malone, Amelia S.; Wang, Amber; Hamlett, Carol L.; Jordan, Nancy C.; Siegler, Robert S.; Changas, Paul

2016-01-01

The purposes of this study were to (a) investigate the efficacy of a core fraction intervention program on understanding and calculation skill and (b) isolate the effects of different forms of fraction word-problem (WP) intervention delivered as part of the larger program. At-risk 4th graders (n = 213) were randomly assigned at the individual…

Effects of Intervention to Improve At-Risk Fourth Graders' Understanding, Calculations, and Word Problems with Fractions

ERIC Educational Resources Information Center

Fuchs, Lynn S.; Schumacher, Robin F.; Long, Jessica; Namkung, Jessica; Malone, Amelia S.; Wang, Amber; Hamlett, Carol L.; Jordan, Nancy C.; Siegler, Robert S.; Changas, Paul

2016-01-01

The purposes of this study were to (a) investigate the efficacy of a core fraction intervention program on understanding and calculation skill and (b) isolate the effects of different forms of fraction word-problem (WP) intervention. At-risk fourth graders (n = 213) were randomly assigned to the school's business-as-usual program, or one of two…

Dose-Fractionation Sensitivity of Prostate Cancer Deduced From Radiotherapy Outcomes of 5,969 Patients in Seven International Institutional Datasets: {alpha}/{beta} = 1.4 (0.9-2.2) Gy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Miralbell, Raymond, E-mail: Raymond.Miralbell@hcuge.ch; Institut Oncologic Teknon, Barcelona; Roberts, Stephen A.

2012-01-01

Purpose: There are reports of a high sensitivity of prostate cancer to radiotherapy dose fractionation, and this has prompted several trials of hypofractionation schedules. It remains unclear whether hypofractionation will provide a significant therapeutic benefit in the treatment of prostate cancer, and whether there are different fractionation sensitivities for different stages of disease. In order to address this, multiple primary datasets have been collected for analysis. Methods and Materials: Seven datasets were assembled from institutions worldwide. A total of 5969 patients were treated using external beams with or without androgen deprivation (AD). Standard fractionation (1.8-2.0 Gy per fraction) was usedmore » for 40% of the patients, and hypofractionation (2.5-6.7 Gy per fraction) for the remainder. The overall treatment time ranged from 1 to 8 weeks. Low-risk patients comprised 23% of the total, intermediate-risk 44%, and high-risk 33%. Direct analysis of the primary data for tumor control at 5 years was undertaken, using the Phoenix criterion of biochemical relapse-free survival, in order to calculate values in the linear-quadratic equation of k (natural log of the effective target cell number), {alpha} (dose-response slope using very low doses per fraction), and the ratio {alpha}/{beta} that characterizes dose-fractionation sensitivity. Results: There was no significant difference between the {alpha}/{beta} value for the three risk groups, and the value of {alpha}/{beta} for the pooled data was 1.4 (95% CI = 0.9-2.2) Gy. Androgen deprivation improved the bNED outcome index by about 5% for all risk groups, but did not affect the {alpha}/{beta} value. Conclusions: The overall {alpha}/{beta} value was consistently low, unaffected by AD deprivation, and lower than the appropriate values for late normal-tissue morbidity. Hence the fractionation sensitivity differential (tumor/normal tissue) favors the use of hypofractionated radiotherapy schedules for all risk groups, which is also very beneficial logistically in limited-resource settings.« less

The impact of alcohol consumption on African people in 2012: an analysis of burden of disease.

PubMed

Ferreira-Borges, Carina; Rehm, Jürgen; Dias, Sónia; Babor, Thomas; Parry, Charles D H

2016-01-01

To determine the impact of alcohol consumption on deaths and disability in Africa. We estimated alcohol exposure for 2012, and its impact on deaths and disability in Africa using estimates from the WHO Global Health Estimates for outcome data, and the WHO Global Status Report on Alcohol and Health 2014 for risk relations. We provide a scenario that includes the impact of alcohol on HIV/AIDS incidence, and qualitative predictions on future exposure and harm. Overall, alcohol consumption has a large impact on burden of disease and mortality in African countries. Alcohol-attributable disease burden is more important when the impact of alcohol consumption on the incidence and course of HIV/AIDS is taken into account, with alcohol being responsible, in 2012, for 6.4% of all deaths and 4.7% of all DALYs lost in the African region. Alcohol exposure is expected to increase in the next years, and thus alcohol-attributable fractions. The weight of new evidence, especially of alcohol's role in the incidence and course of HIV/AIDS, is particularly relevant to African countries and points to the need for a strong policy response to reduce the alcohol-related burden of disease on the continent. © 2015 John Wiley & Sons Ltd.

What proportion of cancer deaths in the contemporary United States is attributable to cigarette smoking?

PubMed

Jacobs, Eric J; Newton, Christina C; Carter, Brian D; Feskanich, Diane; Freedman, Neal D; Prentice, Ross L; Flanders, W Dana

2015-03-01

The proportion of cancer deaths in the contemporary United States caused by cigarette smoking (the population attributable fraction [PAF]) is not well documented. The PAF of all cancer deaths due to active cigarette smoking among adults 35 years and older in the United States in 2010 was calculated using age- and sex-specific smoking prevalence from the National Health Interview Survey (NHIS) and age- and sex-specific relative risks from the Cancer Prevention Study-II (for ages 35-54 years) and from the Pooled Contemporary Cohort data set (for ages 55 years and older). The PAF for active cigarette smoking was 28.7% when estimated conservatively, including only deaths from the 12 cancers currently formally established as caused by smoking by the US Surgeon General. The PAF was 31.7% when estimated more comprehensively, including excess deaths from all cancers. These estimates do not include additional potential cancer deaths from environmental tobacco smoke or other type of tobacco use such as cigars, pipes, or smokeless tobacco. Cigarette smoking causes a large proportion of cancer deaths in the contemporary United States. Reducing smoking prevalence as rapidly as possible should be a top priority for the US public health efforts to prevent cancer deaths. Copyright © 2015 Elsevier Inc. All rights reserved.

Effect of physical inactivity on major noncommunicable diseases and life expectancy in Brazil.

PubMed

de Rezende, Leandro Fornias Machado; Rabacow, Fabiana Maluf; Viscondi, Juliana Yukari Kodaira; Luiz, Olinda do Carmo; Matsudo, Victor Keihan Rodrigues; Lee, I-Min

2015-03-01

In Brazil, one-fifth of the population reports not doing any physical activity. This study aimed to assess the impact of physical inactivity on major noncommunicable diseases (NCDs), all-cause mortality and life expectancy in Brazil, by region and sociodemographic profile. We estimated the population attributable fraction (PAF) for physical inactivity associated with coronary heart disease, type 2 diabetes, breast cancer, colon cancer, and all-cause mortality. To calculate the PAF, we used the physical inactivity prevalence from the 2008 Brazilian Household Survey and relative risk data in the literature. In Brazil, physical inactivity is attributable to 3% to 5% of all major NCDs and 5.31% of all-cause mortality, ranging from 5.82% in the southeastern region to 2.83% in the southern region. Eliminating physical inactivity would increase the life expectancy by an average of 0.31 years. This reduction would affect mainly individuals with ≥ 15 years of schooling, male, Asian, elderly, residing in an urban area and earning ≥ 2 times the national minimum wage. In Brazil, physical inactivity has a major impact on NCDs and mortality, principally in the southeastern and central-west regions. Public policies and interventions promoting physical activity will significantly improve the health of the population.

Adherence to optimal heart rate control in heart failure with reduced ejection fraction: insight from a survey of heart rate in heart failure in Sweden (HR-HF study).

PubMed

Fu, M; Ahrenmark, U; Berglund, S; Lindholm, C J; Lehto, A; Broberg, A Månsson; Tasevska-Dinevska, G; Wikstrom, G; Ågard, A; Andersson, B

2017-12-01

Despite that heart rate (HR) control is one of the guideline-recommended treatment goals for heart failure (HF) patients, implementation has been painstakingly slow. Therefore, it would be important to identify patients who have not yet achieved their target heart rates and assess possible underlying reasons as to why the target rates are not met. The survey of HR in patients with HF in Sweden (HR-HF survey) is an investigator-initiated, prospective, multicenter, observational longitudinal study designed to investigate the state of the art in the control of HR in HF and to explore potential underlying mechanisms for suboptimal HR control with focus on awareness of and adherence to guidelines for HR control among physicians who focus on the contributing role of beta-blockers (BBs). In 734 HF patients the mean HR was 68 ± 12 beats per minute (bpm) (37.2% of the patients had a HR >70 bpm). Patients with HF with reduced ejection fraction (HFrEF) (n = 425) had the highest HR (70 ± 13 bpm, with 42% >70 bpm), followed by HF with preserved ejection fraction and HF with mid-range ejection fraction. Atrial fibrillation, irrespective of HF type, had higher HR than sinus rhythm. A similar pattern was observed with BB treatment. Moreover, non-achievement of the recommended target HR (<70 bpm) in HFrEF and sinus rhythm was unrelated to age, sex, cardiovascular risk factors, cardiovascular diseases, and comorbidities, but was related to EF and the clinical decision of the physician. Approximately 50% of the physicians considered a HR of >70 bpm optimal and an equal number considered a HR of >70 bpm too high, but without recommending further action. Furthermore, suboptimal HR control cannot be attributed to the use of BBs because there was neither a difference in use of BBs nor an interaction with BBs for HR >70 bpm compared with HR <70 bpm. Suboptimal control of HR was noted in HFrEF with sinus rhythm, which appeared to be attributable to physician decision making rather than to the use of BBs. Therefore, our results underline the need for greater attention to HR control in patients with HFrEF and sinus rhythm and thus a potential for improved HF care.

Solar disinfection of water reduces diarrhoeal disease: an update

PubMed Central

Conroy, R.; Meegan, M. E.; Joyce, T.; McGuigan, K.; Barnes, J.

1999-01-01

349 Maasai children younger than 6 years old were randomised by alternate household to drink water either left in plastic bottles exposed to sunlight on the roof of the house or kept indoors (control). The trial was run in Maasai by Maasai community elders. Children drinking solar disinfected water had a significantly lower risk of severe diarrhoeal disease over 8705 two weekly follow up visits; two week period prevalence was 48.8% compared with 58.1% in controls, corresponding to an attributable fraction of 16.0%. While this reduction is modest, it was sustained over a year in free living children. It confirms solar disinfection as effective in vivo as a free, low technology, point of consumption method of improving water quality. The continuing use of solar disinfection by the community underlines the value of community participation in research.

 PMID:10490440

Occupation and male lung cancer: a case-control study in northern Sweden.

PubMed Central

Damber, L A; Larsson, L G

1987-01-01

Using a case-control study comprising about 600 men with lung cancer in northern Sweden the potential risk of different occupations and groups of occupations was studied. Longitudinal data concerning occupation, employment, and smoking habits were obtained by questionnaires. Some occupational groups (underground miners, copper smelter workers, electricians, and plumbers) exposed to previously known lung carcinogenic agents such as radon daughters, arsenic, and asbestos, had considerably increased odds ratios, which persisted after adjustment for smoking. A slightly raised odds ratio was observed in a group of blue collar workers potentially exposed to lung carcinogenic agents; this rise in the group as a whole mainly disappeared after adjustment for smoking. Farmers and foresters had strikingly low odds ratios, which could only partly be explained by their more moderate smoking habits. The population aetiological fraction attributable to occupation was estimated as 9%. PMID:3620367

Economic Burden of Human Papillomavirus-Related Diseases in Italy

PubMed Central

Baio, Gianluca; Capone, Alessandro; Marcellusi, Andrea; Mennini, Francesco Saverio; Favato, Giampiero

2012-01-01

Introduction Human papilloma virus (HPV) genotypes 6, 11, 16, and 18 impose a substantial burden of direct costs on the Italian National Health Service that has never been quantified fully. The main objective of the present study was to address this gap: (1) by estimating the total direct medical costs associated with nine major HPV-related diseases, namely invasive cervical cancer, cervical dysplasia, cancer of the vulva, vagina, anus, penis, and head and neck, anogenital warts, and recurrent respiratory papillomatosis, and (2) by providing an aggregate measure of the total economic burden attributable to HPV 6, 11, 16, and 18 infection. Methods For each of the nine conditions, we used available Italian secondary data to estimate the lifetime cost per case, the number of incident cases of each disease, the total economic burden, and the relative prevalence of HPV types 6, 11, 16, and 18, in order to estimate the aggregate fraction of the total economic burden attributable to HPV infection. Results The total direct costs (expressed in 2011 Euro) associated with the annual incident cases of the nine HPV-related conditions included in the analysis were estimated to be €528.6 million, with a plausible range of €480.1–686.2 million. The fraction attributable to HPV 6, 11, 16, and 18 was €291.0 (range €274.5–315.7 million), accounting for approximately 55% of the total annual burden of HPV-related disease in Italy. Conclusions The results provided a plausible estimate of the significant economic burden imposed by the most prevalent HPV-related diseases on the Italian welfare system. The fraction of the total direct lifetime costs attributable to HPV 6, 11, 16, and 18 infections, and the economic burden of noncervical HPV-related diseases carried by men, were found to be cost drivers relevant to the making of informed decisions about future investments in programmes of HPV prevention. PMID:23185412

In vitro anti-MRSA activity of Couroupita guianensis extract and its component Tryptanthrin.

PubMed

Costa, Danielle Cristina Machado; Azevedo, Mariana Maria Barros de; Silva, Davi Oliveira E; Romanos, Maria Teresa Villela; Souto-Padrón, Thais Cristina Baeta Soares; Alviano, Celuta Sales; Alviano, Daniela Sales

2017-09-01

Couroupita guianensis is known in Brazil as 'Abricó-de-Macaco' and it has some attributes such as: antihypertensive, analgesic and anti-inflammatory activities. This study evaluated the antimicrobial activity of ethanolic extract and fractions of C. guianensis flowers and isolation of bioactive component. These extracts and fractions were subjected to agar diffusion, MIC, TLC and bioautography to bacteria, filamentous fungi and yeasts. Among the fractions of EtOH extract, the DCM fraction was the most active, particularly against Methicillin-resistant Staphylococcus aureus (MRSA) with MIC of 156 μg/mL. The active compound in this fraction was identified as Tryptanthrin, which showed promising antibacterial activity for MRSA showing MIC of 62.5 μg/mL. Ultrastructural analysis of MRSA incubated in the presence of Tryptanthrin by transmission electron microscope showed significant alterations in the cellular structure. Cytotoxicity tests demonstrated that DCM fraction and Tryptanthrin showed low toxicity, which makes it a promising candidate for alternative therapies to control and combat diseases.

[Antiinflammatory activity of extracts and fractions obtained from Physalis peruviana L. calyces].

PubMed

Franco, Luis A; Matiz, Germán E; Calle, Jairo; Pinzón, Roberto; Ospina, Luis F

2007-03-01

Cape gooseberry calyces (Physalis peruviana) have been used in folk medicine for their medicinal properties including anticancer, antimycobacterial, antipyretic, diuretic, immunomodulatory and antiinflammatory properties. The antiinflammatory effect was evaluated for extracts and fractions obtained from Physalis peruviana calyces in a mice model of acute inflammation. The fractions responsible for antiinflammatory activity were extracted for possible identification. The Physalis peruviana calyces were extracted by percolation with organic solvents. The primary hydroalcoholic fraction was purified by column chromatography. The antiinflammatory effect of extracts and fractions was evaluated using the 12-O-tetradecanoylphorbol-13-acetate-induced mouse model of ear edema. Thirty-eight secondary fractions were obtained by column chromatography of primary hydroalcoholic fraction. Six fractions, evaluated in 12-O-tetradecanoylphorbol-13-acetate-induced inflammation assay, showed significant antiinflammatory activity (p<0.05). The major fraction, Pp-D28-LF, showed a significant dose-dependent response at doses over 250 microg/ear. The antiinflammatory activity attributed to Physalis peruviana calyces was confirmed and validated its use in folk medicine. Fractions responsible for the antiinflammatory action were identified and seem promising for phytomedicinal development. Further studies are needed to isolate and identify the active constituents of these fractions as well as to ascertain the mechanisms involved in the antiinflammatory effect.

Risk Factors for Human Salmonellosis Originating from Pigs, Cattle, Broiler Chickens and Egg Laying Hens: A Combined Case-Control and Source Attribution Analysis

PubMed Central

Mughini-Gras, Lapo; Enserink, Remko; Friesema, Ingrid; Heck, Max; van Duynhoven, Yvonne; van Pelt, Wilfrid

2014-01-01

Several case-control studies have investigated risk factors for human salmonellosis while others have used Salmonella subtyping to attribute human infections to different food and animal reservoirs. This study combined case-control and source attribution data into a single analysis to explore risk factors at the point of exposure for human salmonellosis originating from four putative food-producing animal reservoirs (pigs, cattle, broilers and layers/eggs) in the Netherlands. We confirmed that most human cases (∼90%) were attributable to layers/eggs and pigs. Layers/eggs and broilers were the most likely reservoirs of salmonellosis in adults, in urban areas, and in spring/summer, whereas pigs and cattle were the most likely reservoirs of salmonellosis in children, in rural areas, and in autumn/winter. Several reservoir-specific risk factors were identified. Not using a chopping board for raw meat only and consuming raw/undercooked meat were risk factors for infection with salmonellas originating from pigs, cattle and broilers. Consuming raw/undercooked eggs and by-products were risk factors for layer/egg-associated salmonellosis. Using antibiotics was a risk factor for pig- and cattle-associated salmonellosis and using proton-pump inhibitors for salmonellosis attributable to any reservoir. Pig- and cattle-associated infections were also linked to direct contact with animals and environmental exposure (e.g. playing in sandboxes). Eating fish, meat in pastry, and several non-meat foods (fruit, vegetables and pasteurized dairy products) were protective factors. Consuming pork and occupational exposure to animals and/or raw meats were protective against layer/egg-associated salmonellosis. We concluded that individuals acquiring salmonellosis from different reservoirs have different associated risk factors, suggesting that salmonellas may infect humans through various transmission pathways depending on their original reservoirs. The outcome of classical case-control studies can be enhanced by incorporating source attribution data and vice versa. PMID:24503703

Occurrence and fractionation of Cr along the Loushan River affected by a chromium slag heap in East China.

PubMed

Chen, Youyuan; Dong, Bingbing; Xin, Jia

2017-06-01

This study investigated the chromium (Cr) occurrence and distribution along the Loushan River adjacent to a chromium slag heap. The speciation and chemical fractionation of Cr in different environmental media were determined. The potential ecological risks for the surrounding environment were assessed on the basis of both potential ecological risk index (RI) and risk assessment code (RAC). The results show that the surface soil experienced severe Cr contamination with Cr(T) and Cr(VI) values of 3220 ± 6266 and 64 ± 94 mg/kg, respectively, even though the chromium slag heap had already been removed. The chromium slag enhanced the Cr concentration level in the surface soil, water, and sediment samples more than the background level to different extents, which indicates that Cr released from the chromium slag actually affects the surrounding environment. The spatial distribution variety of Cr implies that their transport might have been affected by soil leaking, atmospheric transport, and fluvial hydraulics. The chemical fractionation results demonstrate that the residual fraction was the dominant form, accounting for 54.6 and 66.1% Cr(T) in surface soil and sediment samples, respectively. The content of bioavailable exchangeable Cr fraction correlated with the organic matter (OM), cation exchange capacity (CEC), and pH value. The ecological risk assessment suggests no considerable ecological risk toward the biota despite a relatively high Cr(T) level. Nevertheless, attention should be paid to the potential long-term risks owing to the slow release of oxidizable and residual fractions.

Development and Validation of the Masculine Attributes Questionnaire

PubMed Central

Cho, Junhan; Kogan, Steven M.

2017-01-01

The present study describes the development and validation of the Masculine Attributes Questionnaire (MAQ). The purpose of this study was to develop a theoretically and empirically grounded measure of masculine attributes for sexual health research with African American young men. Consistent with Whitehead’s theory, the MAQ items were hypothesized to comprise two components representing reputation-based and respect-based attributes. The sample included 505 African American men aged 19 to 22 years (M = 20.29, SD = 1.10) living in resource-poor communities in the rural South. Convergent and discriminant validity of the MAQ were assessed by examining the associations of masculinity attributes with psychosocial factors. Criterion validity was assessed by examining the extent to which the MAQ subscales predicted sexual risk behavior outcomes. Consistent with study hypotheses, the MAQ was composed of (a) reputation-based attributes oriented toward sexual prowess, toughness, and authority-defying behavior and (b) respect-based attributes oriented toward economic independence, socially approved levels of hard work and education, and committed romantic relationships. Reputation-based attributes were associated positively with street code and negatively related to academic orientation, vocational engagement, and self-regulation, whereas respect-based attributes were associated positively with academic and vocational orientations and self-regulation. Finally, reputation-based attributes predicted sexual risk behaviors including concurrent sexual partnerships, multiple sexual partners, marijuana use, and incarceration, net of the influence of respect-based attributes. The development of the MAQ provides a new measure that permits systematic quantitative investigation of the associations between African American men’s masculinity ideology and sexual risk behavior. PMID:28413906

Development and Validation of the Masculine Attributes Questionnaire.

PubMed

Cho, Junhan; Kogan, Steven M

2017-07-01

The present study describes the development and validation of the Masculine Attributes Questionnaire (MAQ). The purpose of this study was to develop a theoretically and empirically grounded measure of masculine attributes for sexual health research with African American young men. Consistent with Whitehead's theory, the MAQ items were hypothesized to comprise two components representing reputation-based and respect-based attributes. The sample included 505 African American men aged 19 to 22 years ( M = 20.29, SD = 1.10) living in resource-poor communities in the rural South. Convergent and discriminant validity of the MAQ were assessed by examining the associations of masculinity attributes with psychosocial factors. Criterion validity was assessed by examining the extent to which the MAQ subscales predicted sexual risk behavior outcomes. Consistent with study hypotheses, the MAQ was composed of (a) reputation-based attributes oriented toward sexual prowess, toughness, and authority-defying behavior and (b) respect-based attributes oriented toward economic independence, socially approved levels of hard work and education, and committed romantic relationships. Reputation-based attributes were associated positively with street code and negatively related to academic orientation, vocational engagement, and self-regulation, whereas respect-based attributes were associated positively with academic and vocational orientations and self-regulation. Finally, reputation-based attributes predicted sexual risk behaviors including concurrent sexual partnerships, multiple sexual partners, marijuana use, and incarceration, net of the influence of respect-based attributes. The development of the MAQ provides a new measure that permits systematic quantitative investigation of the associations between African American men's masculinity ideology and sexual risk behavior.

Association of blood pressure in late adolescence with subsequent mortality: cohort study of Swedish male conscripts

PubMed Central

Neovius, Martin; Tynelius, Per; Rasmussen, Finn

2011-01-01

Objective To investigate the nature and magnitude of relations of systolic and diastolic blood pressures in late adolescence to mortality. Design Nationwide cohort study. Setting General community in Sweden. Participants Swedish men (n=1 207 141) who had military conscription examinations between 1969 and 1995 at a mean age of 18.4 years, followed up for a median of 24 (range 0-37) years. Main outcome measures Total mortality, cardiovascular mortality, and non-cardiovascular mortality. Results During follow-up, 28 934 (2.4%) men died. The relation of systolic blood pressure to total mortality was U shaped, with the lowest risk at a systolic blood pressure of about 130 mm Hg. This pattern was driven by the relation to non-cardiovascular mortality, whereas the relation to cardiovascular mortality was monotonically increasing (higher risk with higher blood pressure). The relation of diastolic blood pressure to mortality risk was monotonically increasing and stronger than that of systolic blood pressure, in terms of both relative risk and population attributable fraction (deaths that could be avoided if blood pressure was in the optimal range). Relations to cardiovascular and non-cardiovascular mortality were similar, with an apparent risk threshold at a diastolic blood pressure of about 90 mm Hg, below which diastolic blood pressure and mortality were unrelated, and above which risk increased steeply with higher diastolic blood pressures. Conclusions In adolescent men, the relation of diastolic blood pressure to mortality was more consistent than that of systolic blood pressure. Considering current efforts for earlier detection and prevention of risk, these observations emphasise the risk associated with high diastolic blood pressure in young adulthood. PMID:21343202

Neonatal vitamin D status and risk of schizophrenia: a population-based case-control study.

PubMed

McGrath, John J; Eyles, Darryl W; Pedersen, Carsten B; Anderson, Cameron; Ko, Pauline; Burne, Thomas H; Norgaard-Pedersen, Bent; Hougaard, David M; Mortensen, Preben B

2010-09-01

Clues from the epidemiology of schizophrenia suggest that low levels of developmental vitamin D may be associated with increased risk of schizophrenia. To directly examine the association between neonatal vitamin D status and risk of schizophrenia. Individually matched case-control study drawn from a population-based cohort. Danish national health registers and neonatal biobank. A total of 424 individuals with schizophrenia and 424 controls matched for sex and date of birth. The concentration of 25 hydroxyvitamin D(3) (25[OH]D3) was assessed from neonatal dried blood samples using a highly sensitive liquid chromatography tandem mass spectroscopy method. Relative risks were calculated for the matched pairs when examined for quintiles of 25(OH)D3. Compared with neonates in the fourth quintile (with 25[OH]D3 concentrations between 40.5 and 50.9 nmol/L), those in each of the lower 3 quintiles had a significantly increased risk of schizophrenia (2-fold elevated risk). Unexpectedly, those in the highest quintile also had a significantly increased risk of schizophrenia. Based on this analysis, the population-attributable fraction associated with neonatal vitamin D status was 44%. The relationship was not explained by a wide range of potential confounding or interacting variables. Both low and high concentrations of neonatal vitamin D are associated with increased risk of schizophrenia, and it is feasible that this exposure could contribute to a sizeable proportion of cases in Denmark. In light of the substantial public health implications of this finding, there is an urgent need to further explore the effect of vitamin D status on brain development and later mental health.

Risk of cancer among HIV-infected individuals compared to the background population: impact of smoking and HIV.

PubMed

Helleberg, Marie; Gerstoft, Jan; Afzal, Shoaib; Kronborg, Gitte; Larsen, Carsten S; Pedersen, Court; Bojesen, Stig E; Nordestgaard, Børge G; Obel, Niels

2014-06-19

The relative impact of immune deficiency and lifestyle-related factors on risk of cancer in the HIV-infected population is controversial. We aimed to estimate the population-attributable fractions (PAFs) associated with smoking, being HIV-infected and with immune deficiency. In a Danish, nationwide, population-based cohort study (1995-2011), incidences of cancer were compared between an HIV-infected cohort and a population-based matched cohort in analyses stratified on cancer category, smoking status and for HIV patients: low CD4 cell count. We included 3503 HIV patients [baseline CD4+ 450 cells/μl (inter-quartile range 310-630)] and 12,979 population controls. Smoking-related and virological cancers accounted for 23 and 43% of cancers in the HIV-infected population. The risk of these cancers were higher among HIV patients compared to controls [incidence rate ratio (IRR) 2.8, 95% confidence interval (CI) 1.6-4.9; and IRR 11.5, 95% CI 6.5-20.5], whereas the risk of other cancers did not differ (IRR 1.0, 95% CI 0.7-1.3). Non-smoking HIV patients did not have increased risk of non-virological cancers compared to non-smoking controls (IRR 1.2, 95% CI 0.7-2.1). The PAFs of cancer associated with smoking and with being HIV-infected were 27 and 49%, respectively. For cancers not strongly related to smoking or viral infections, the PAFs associated with being HIV-infected and with immune deficiency were 0%. The risk of cancer is increased in HIV patients compared to the background population. In absence of smoking, the increase in risk is confined to cancers related to viral infections, whereas the risk of other cancers is not elevated and does not seem to be associated with immune deficiency.

Intervening to reduce the future burden of occupational cancer in britain: what could work?

PubMed

Hutchings, Sally; Cherrie, John W; Van Tongeren, Martie; Rushton, Lesley

2012-10-01

In Britain, 14 carcinogenic agents and occupational circumstances currently account for 86% of estimated occupation attributable cancer. The future burden associated with these carcinogens has been forecast, using attributable fractions for forecast scenarios representing patterns of past and predicted future exposure, and exposure levels representing the introduction of new occupational exposure limits, increased levels of compliance with these limits and other reductions in worker exposure. Without intervention, occupational attributable cancers are forecast to remain at more than 10,000 by 2060. With modest intervention over 2,600, or with stricter interventions more than 8,200 cancers could be avoided by 2060 although because of long latency no impact will be seen until at least 10 years after intervention. Effective interventions assessed in this study include reducing workplace exposure limits and improving compliance with these limits. Cancers associated with asbestos, diesel engine exhaust, polycyclic aromatic hydrocarbons, work as a painter, radon, and solar radiation are forecast to continue, with construction remaining the prime industry of concern. Although exposure levels to the established carcinogens are falling, workers are remaining exposed at low levels at which there is still a cancer risk, although the aging population also contributes to rising cancer numbers, These forecasts can be used to assess the relative costs to society of different occupational carcinogenic agents, and the relative merits and savings associated with alternative intervention strategies. The methods are adaptable for different data circumstances, other types of interventions and could be extended to environmental carcinogens and other chronic diseases.

Adherence to the Mediterranean diet and nasopharyngeal cancer risk in Italy.

PubMed

Turati, Federica; Bravi, Francesca; Polesel, Jerry; Bosetti, Cristina; Negri, Eva; Garavello, Werner; Taborelli, Martina; Serraino, Diego; Libra, Massimo; Montella, Maurizio; Decarli, Adriano; Ferraroni, Monica; La Vecchia, Carlo

2017-02-01

Few studies investigated the role of diet on nasopharyngeal cancer (NPC) risk in non-endemic areas. The aim of this study was to assess the association between adherence to the traditional Mediterranean diet and NPC risk in a southern European low-risk population. We conducted a hospital-based case-control study in Italy, including 198 histologically confirmed NPC cases and 594 matched controls. Dietary habits were collected by means of a validated food-frequency questionnaire, including 83 foods, food groups, or beverages. Adherence to the traditional Mediterranean diet was assessed through a Mediterranean Diet Score (MDS), based on nine dietary components characterizing this dietary profile, i.e., high intake of vegetables, fruits and nuts, cereals, legumes, and fish; low intake of dairy products and meat; high monounsaturated to saturated fatty acid ratio; and moderate alcohol intake. We estimated odds ratios (ORs) of NPC, and the corresponding 95% confidence intervals (CIs), for increasing MDS (i.e., increasing adherence) using multiple logistic regression models, adjusted for major confounding factors. As compared to MDS ≤ 4, the ORs of NPC were 0.83 (95% CI: 0.54-1.25) for MDS of 5 and 0.66 (95% CI: 0.44-0.99) for MDS ≥ 6, with a significant trend of decreasing risk (p 0.043). The corresponding population attributable fraction was 22%, indicating that 22% of NPC cases in this population would be avoided by shifting all subjects to a score ≥6. Our study supports a favorable role of the Mediterranean diet on NPC risk.

Occupational Diesel Exposure, Duration of Employment, and Lung Cancer

PubMed Central

Picciotto, Sally; Costello, Sadie; Eisen, Ellen A.

2016-01-01

Background: If less healthy workers terminate employment earlier, thus accumulating less exposure, yet remain at greater risk of the health outcome, estimated health effects of cumulative exposure will be biased downward. If exposure also affects termination of employment, then the bias cannot be addressed using conventional methods. We examined these conditions as a prelude to a reanalysis of lung cancer mortality in the Diesel Exhaust in Miners Study. Methods: We applied an accelerated failure time model to assess the effect of exposures to respirable elemental carbon (a surrogate for diesel) on time to termination of employment among nonmetal miners who ever worked underground (n = 8,307). We then applied the parametric g-formula to assess how possible interventions setting respirable elemental carbon exposure limits would have changed lifetime risk of lung cancer, adjusting for time-varying employment status. Results: Median time to termination was 36% shorter (95% confidence interval = 33%, 39%), per interquartile range width increase in respirable elemental carbon exposure. Lung cancer risk decreased with more stringent interventions, with a risk ratio of 0.8 (95% confidence interval = 0.5, 1.1) comparing a limit of ≤25 µg/m3 respirable elemental carbon to no intervention. The fraction of cases attributable to diesel exposure was 27% in this population. Conclusions: The g-formula controlled for time-varying confounding by employment status, the signature of healthy worker survivor bias, which was also affected by diesel exposure. It also offers an alternative approach to risk assessment for estimating excess cumulative risk, and the impact of interventions based entirely on an observed population. PMID:26426944

Risk factors for disability discharge in enlisted active duty Army soldiers.

PubMed

Piccirillo, Amanda L; Packnett, Elizabeth R; Cowan, David N; Boivin, Michael R

2016-04-01

The rate of permanent disability retirement in U.S. Army soldiers and the prevalence of combat-related disabilities have significantly increased over time. Prior research on risk factors associated with disability retirement included soldiers retired prior to conflicts in Iraq and Afghanistan. To identify risk factors for disability discharge among soldiers enlisted in the U.S. Army during military operations in Iraq and Afghanistan. In this case-control study, cases included active duty soldiers evaluated for disability discharge. Controls, randomly selected from soldiers with no history of disability evaluation, were matched to cases based on enlistment year and sex. Conditional logistic regression models calculated odds of disability discharge. Attributable fractions estimated burden of disability for specific pre-existing condition categories. Poisson regression models compared risk of disability discharge related to common disability types by deployment and combat status. Characteristics at military enlistment with increased odds of disability discharge included a pre-existing condition, increased age or body mass index, white race, and being divorced. Musculoskeletal conditions and overweight contributed the largest proportion of disabilities. Deployment was protective against disability discharge or receiving a musculoskeletal-related disability, but significantly increased the risk of disability related to a psychiatric or neurological condition. Soldiers with a pre-existing condition at enlistment, particularly a musculoskeletal condition, had increased odds of disability discharge. Risk of disability was dependent on condition category when stratified by deployment and combat status. Additional research examining conditions during pre-disability hospitalizations could provide insight on specific conditions that commonly lead to disability discharge. Copyright © 2016 Elsevier Inc. All rights reserved.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Andrei, Mariana Lucia, E-mail: marianaluciaandrei@yahoo.com; Babes-Bolyai University, Environmental Science and Engineering Faculty, 30 Fantanele, 400294, Cluj-Napoca; Senila, Marin

The Cu and Pb partitioning in nonferrous mine tailings was investigated using the Tessier sequential extraction scheme. The contents of Cu and Pb found in the five operationally defined fractions were determined by inductively coupled plasma optical emission spectrometry. The results showed different partitioning patterns for Cu and Pb in the studied tailings. The total Cu and Pb contents were higher in tailings from Brazesti than in those from Saliste, while the Cu contents in the first two fractions considered as mobile were comparable and the content of mobile Pb was the highest in Brazesti tailings. In the tailings frommore » Saliste about 30% of Cu and 3% of Pb were found in exchangeable fraction, while in those from Brazesti no metals were found in the exchangeable fraction, but the percent of Cu and Pb found in the bound to carbonate fraction were high (20% and 26%, respectively). The highest Pb content was found in the residual fraction in Saliste tailings and in bound to Fe and Mn oxides fraction in Brazesti tailings, while the highest Cu content was found in the fraction bound to organic matter in Saliste tailings and in the residual fraction in Brazesti tailings. In case of tailings of Brazesti medium environmental risk was found both for Pb and Cu, while in case of Saliste tailings low risk for Pb and high risk for Cu were found.« less

Job strain — Attributable depression in a sample of working Australians: Assessing the contribution to health inequalities

PubMed Central

LaMontagne, Anthony D; Keegel, Tessa; Vallance, Deborah; Ostry, Aleck; Wolfe, Rory

2008-01-01

Background The broad aim of this study was to assess the contribution of job strain to mental health inequalities by (a) estimating the proportion of depression attributable to job strain (low control and high demand jobs), (b) assessing variation in attributable risk by occupational skill level, and (c) comparing numbers of job strain–attributable depression cases to numbers of compensated 'mental stress' claims. Methods Standard population attributable risk (PAR) methods were used to estimate the proportion of depression attributable to job strain. An adjusted Odds Ratio (OR) of 1.82 for job strain in relation to depression was obtained from a recently published meta-analysis and combined with exposure prevalence data from the Australian state of Victoria. Job strain exposure prevalence was determined from a 2003 population-based telephone survey of working Victorians (n = 1101, 66% response rate) using validated measures of job control (9 items, Cronbach's alpha = 0.80) and psychological demands (3 items, Cronbach's alpha = 0.66). Estimates of absolute numbers of prevalent cases of depression and successful stress-related workers' compensation claims were obtained from publicly available Australian government sources. Results Overall job strain-population attributable risk (PAR) for depression was 13.2% for males [95% CI 1.1, 28.1] and 17.2% [95% CI 1.5, 34.9] for females. There was a clear gradient of increasing PAR with decreasing occupational skill level. Estimation of job strain–attributable cases (21,437) versus "mental stress" compensation claims (696) suggest that claims statistics underestimate job strain–attributable depression by roughly 30-fold. Conclusion Job strain and associated depression risks represent a substantial, preventable, and inequitably distributed public health problem. The social patterning of job strain-attributable depression parallels the social patterning of mental illness, suggesting that job strain is an important contributor to mental health inequalities. The numbers of compensated 'mental stress' claims compared to job strain-attributable depression cases suggest that there is substantial under-recognition and under-compensation of job strain-attributable depression. Primary, secondary, and tertiary intervention efforts should be substantially expanded, with intervention priorities based on hazard and associated health outcome data as an essential complement to claims statistics. PMID:18505559

Analysis of dust samples from the Middle East using high-density resequencing micro-array RPM-TEI

NASA Astrophysics Data System (ADS)

Leski, T. A.; Gregory, M. J.; Malanoski, A. P.; Smith, J. P.; Glaven, R. H.; Wang, Z.; Stenger, D. A.; Lin, B.

2010-04-01

A previously developed resequencing microarray, "Tropical and Emerging Infections (RPM-TEI v.1.0 chip)", designed to identify and discriminate between tropical diseases and other potential biothreat agents, their near-neighbor species, and/or potential confounders, was used to characterize the microbes present in the silt/clay fraction of surface soils and airborne dust collected from the Middle East. Local populations and U.S. military personnel deployed to the Middle East are regularly subjected to high levels of airborne desert dust containing a significant fraction of inhalable particles and some portion require clinical aid. Not all of the clinical symptoms can be directly attributed to the physical action of material in the human respiratory tract. To better understand the potential health effects of the airborne dust, the composition of the microbial communities associated with surface soil and/or airborne dust (air filter) samples from 19 different sites in Iraq and Kuwait was identified using RPM-TEI v.1.0. Results indicated that several microorganisms including a class of rapidly growing Mycobacterium, Bacillus, Brucella, Clostridium and Coxiella burnetti, were present in the samples. The presence of these organisms in the surface soils and the inhalable fraction of airborne dust analyzed may pose a human health risk and warrants further investigation. Better understanding of the factors influencing the composition of these microbial communities is important to address questions related to human health and is critical to achieving Force Health Protection for the Warfighter operating in the Middle East, Afghanistan, North Africa and other arid regions.

Tannin-rich fraction from pomegranate rind damages membrane of Listeria monocytogenes.

PubMed

Li, Guanghui; Xu, Yunfeng; Wang, Xin; Zhang, Baigang; Shi, Chao; Zhang, Weisong; Xia, Xiaodong

2014-04-01

Pomegranate rind has been reported to inhibit several foodborne pathogens, and its antimicrobial activity has been attributed mainly to its tannin fraction. This study aimed to investigate the antimicrobial activity of the tannin-rich fraction from pomegranate rind (TFPR) against Listeria monocytogenes and its mechanism of action. The tannin-related components of TFPR were analyzed by high-performance liquid chromatography and liquid chromatography-mass spectrometry, and the minimum inhibitory concentration (MIC) of TFPR was determined using the agar dilution method. Extracellular potassium concentration, the release of cell constituents, intra- and extracellular ATP concentrations, membrane potential, and intracellular pH (pHin) were measured to elucidate a possible antibacterial mechanism. Punicalagin (64.2%, g/g) and ellagic acid (3.1%, g/g) were detected in TFPR, and the MICs of TFPR were determined to be 1.25-5.0 mg/mL for different L. monocytogenes strains. Treatment with TFPR induced a decrease of the intracellular ATP concentration, an increase of the extracellular concentrations of potassium and ATP, and the release of cell constituents. A reduction of pHin and cell membrane hyperpolarization were observed after treatment. Electron microscopic observations showed that the cell membrane structures of L. monocytogenes were apparently impaired by TFPR. It is concluded that TFPR could destroy the integrity of the cell membrane of L. monocytogenes, leading to a loss of cell homeostasis. These findings indicate that TFPR has the potential to be used as a food preservative in order to control L. monocytogenes contamination in food and reduce the risk of listeriosis.

Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016.

PubMed

2017-09-16

The Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) provides a comprehensive assessment of risk factor exposure and attributable burden of disease. By providing estimates over a long time series, this study can monitor risk exposure trends critical to health surveillance and inform policy debates on the importance of addressing risks in context. We used the comparative risk assessment framework developed for previous iterations of GBD to estimate levels and trends in exposure, attributable deaths, and attributable disability-adjusted life-years (DALYs), by age group, sex, year, and location for 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks from 1990 to 2016. This study included 481 risk-outcome pairs that met the GBD study criteria for convincing or probable evidence of causation. We extracted relative risk (RR) and exposure estimates from 22 717 randomised controlled trials, cohorts, pooled cohorts, household surveys, census data, satellite data, and other sources, according to the GBD 2016 source counting methods. Using the counterfactual scenario of theoretical minimum risk exposure level (TMREL), we estimated the portion of deaths and DALYs that could be attributed to a given risk. Finally, we explored four drivers of trends in attributable burden: population growth, population ageing, trends in risk exposure, and all other factors combined. Since 1990, exposure increased significantly for 30 risks, did not change significantly for four risks, and decreased significantly for 31 risks. Among risks that are leading causes of burden of disease, child growth failure and household air pollution showed the most significant declines, while metabolic risks, such as body-mass index and high fasting plasma glucose, showed significant increases. In 2016, at Level 3 of the hierarchy, the three leading risk factors in terms of attributable DALYs at the global level for men were smoking (124·1 million DALYs [95% UI 111·2 million to 137·0 million]), high systolic blood pressure (122·2 million DALYs [110·3 million to 133·3 million], and low birthweight and short gestation (83·0 million DALYs [78·3 million to 87·7 million]), and for women, were high systolic blood pressure (89·9 million DALYs [80·9 million to 98·2 million]), high body-mass index (64·8 million DALYs [44·4 million to 87·6 million]), and high fasting plasma glucose (63·8 million DALYs [53·2 million to 76·3 million]). In 2016 in 113 countries, the leading risk factor in terms of attributable DALYs was a metabolic risk factor. Smoking remained among the leading five risk factors for DALYs for 109 countries, while low birthweight and short gestation was the leading risk factor for DALYs in 38 countries, particularly in sub-Saharan Africa and South Asia. In terms of important drivers of change in trends of burden attributable to risk factors, between 2006 and 2016 exposure to risks explains an 9·3% (6·9-11·6) decline in deaths and a 10·8% (8·3-13·1) decrease in DALYs at the global level, while population ageing accounts for 14·9% (12·7-17·5) of deaths and 6·2% (3·9-8·7) of DALYs, and population growth for 12·4% (10·1-14·9) of deaths and 12·4% (10·1-14·9) of DALYs. The largest contribution of trends in risk exposure to disease burden is seen between ages 1 year and 4 years, where a decline of 27·3% (24·9-29·7) of the change in DALYs between 2006 and 2016 can be attributed to declines in exposure to risks. Increasingly detailed understanding of the trends in risk exposure and the RRs for each risk-outcome pair provide insights into both the magnitude of health loss attributable to risks and how modification of risk exposure has contributed to health trends. Metabolic risks warrant particular policy attention, due to their large contribution to global disease burden, increasing trends, and variable patterns across countries at the same level of development. GBD 2016 findings show that, while it has huge potential to improve health, risk modification has played a relatively small part in the past decade. The Bill & Melinda Gates Foundation, Bloomberg Philanthropies. Copyright © 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.

Mortality risk attributable to smoking, hypertension and diabetes among English and Brazilian older adults (The ELSA and Bambui cohort ageing studies)

PubMed Central

Marmot, Michael G.; Demakakos, Panayotes; Vaz de Melo Mambrini, Juliana; Peixoto, Sérgio Viana; Lima-Costa, Maria Fernanda

2016-01-01

Background: The main aim of this study was to quantify and compare 6-year mortality risk attributable to smoking, hypertension and diabetes among English and Brazilian older adults. This study represents a rare opportunity to approach the subject in two different social and economic contexts. Methods: Data from the data from the English Longitudinal Study of Ageing (ELSA) and the Bambuí Cohort Study of Ageing (Brazil) were used. Deaths in both cohorts were identified through mortality registers. Risk factors considered in this study were baseline smoking, hypertension and diabetes mellitus. Both age–sex adjusted hazard ratios and population attributable risks (PAR) of all-cause mortality and their 95% confidence intervals for the association between risk factors and mortality were estimated using Cox proportional hazards models. Results: Participants were 3205 English and 1382 Brazilians aged 60 years and over. First, Brazilians showed much higher absolute risk of mortality than English and this finding was consistent in all age, independently of sex. Second, as a rule, hazard ratios for mortality to smoking, hypertension and diabetes showed more similarities than differences between these two populations. Third, there was strong difference among English and Brazilians on attributable deaths to hypertension. Conclusions: The findings indicate that, despite of being in more recent transitions, the attributable deaths to one or more risk factors was twofold among Brazilians relative to the English. These findings call attention for the challenge imposed to health systems to prevent and treat non-communicable diseases, particularly in populations with low socioeconomic level. PMID:26666869

Air pollution, health and social deprivation: A fine-scale risk assessment.

PubMed

Morelli, Xavier; Rieux, Camille; Cyrys, Josef; Forsberg, Bertil; Slama, Rémy

2016-05-01

Risk assessment studies often ignore within-city variations of air pollutants. Our objective was to quantify the risk associated with fine particulate matter (PM2.5) exposure in 2 urban areas using fine-scale air pollution modeling and to characterize how this risk varied according to social deprivation. In Grenoble and Lyon areas (0.4 and 1.2 million inhabitants, respectively) in 2012, PM2.5 exposure was estimated on a 10×10m grid by coupling a dispersion model to population density. Outcomes were mortality, lung cancer and term low birth weight incidences. Cases attributable to air pollution were estimated overall and stratifying areas according to the European Deprivation Index (EDI), taking 10µg/m(3) yearly average as reference (counterfactual) level. Estimations were repeated assuming spatial homogeneity of air pollutants within urban area. Median PM2.5 levels were 18.1 and 19.6μg/m(3) in Grenoble and Lyon urban areas, respectively, corresponding to 114 (5.1% of total, 95% confidence interval, CI, 3.2-7.0%) and 491 non-accidental deaths (6.0% of total, 95% CI 3.7-8.3%) attributable to long-term exposure to PM2.5, respectively. Attributable term low birth weight cases represented 23.6% of total cases (9.0-37.1%) in Grenoble and 27.6% of cases (10.7-42.6%) in Lyon. In Grenoble, 6.8% of incident lung cancer cases were attributable to air pollution (95% CI 3.1-10.1%). Risk was lower by 8 to 20% when estimating exposure through background stations. Risk was highest in neighborhoods with intermediate to higher social deprivation. Risk assessment studies relying on background stations to estimate air pollution levels may underestimate the attributable risk. Copyright © 2016 Elsevier Inc. All rights reserved.

Mortality attributable to excess adiposity in England and Wales in 2003 and 2015: explorations with a spreadsheet implementation of the Comparative Risk Assessment methodology.

PubMed

Kelly, Christopher; Pashayan, Nora; Munisamy, Sreetharan; Powles, John W

2009-06-30

Our aim was to estimate the burden of fatal disease attributable to excess adiposity in England and Wales in 2003 and 2015 and to explore the sensitivity of the estimates to the assumptions and methods used. A spreadsheet implementation of the World Health Organization's (WHO) Comparative Risk Assessment (CRA) methodology for continuously distributed exposures was used. For our base case, adiposity-related risks were assumed to be minimal with a mean (SD) BMI of 21 (1) Kg m-2. All cause mortality risks for 2015 were taken from the Government Actuary and alternative compositions by cause derived. Disease-specific relative risks by BMI were taken from the CRA project and varied in sensitivity analyses. Under base case methods and assumptions for 2003, approximately 41,000 deaths and a loss of 1.05 years of life expectancy were attributed to excess adiposity. Seventy-seven percent of all diabetic deaths, 23% of all ischaemic heart disease deaths and 14% of all cerebrovascular disease deaths were attributed to excess adiposity. Predictions for 2015 were found to be more sensitive to assumptions about the future course of mortality risks for diabetes than to variation in the assumed trend in BMI. On less favourable assumptions the attributable loss of life expectancy in 2015 would rise modestly to 1.28 years. Excess adiposity appears to contribute materially but modestly to mortality risks in England and Wales and this contribution is likely to increase in the future. Uncertainty centres on future trends of associated diseases, especially diabetes. The robustness of these estimates is limited by the lack of control for correlated risks by stratification and by the empirical uncertainty surrounding the effects of prolonged excess adiposity beginning in adolescence.

Error Patterns in Ordering Fractions among At-Risk Fourth-Grade Students

PubMed Central

Malone, Amelia S.; Fuchs, Lynn S.

2016-01-01

The 3 purposes of this study were to: (a) describe fraction ordering errors among at-risk 4th-grade students; (b) assess the effect of part-whole understanding and accuracy of fraction magnitude estimation on the probability of committing errors; and (c) examine the effect of students' ability to explain comparing problems on the probability of committing errors. Students (n = 227) completed a 9-item ordering test. A high proportion (81%) of problems were completed incorrectly. Most (65% of) errors were due to students misapplying whole number logic to fractions. Fraction-magnitude estimation skill, but not part-whole understanding, significantly predicted the probability of committing this type of error. Implications for practice are discussed. PMID:26966153

Antihepatoma Activity of Artocarpus communis Is Higher in Fractions with High Artocarpin Content

PubMed Central

Tzeng, Cheng-Wei; Yen, Feng-Lin; Lee, Chiang-Wen; Yen, Ming-Hong; Tzeng, Wen-Sheng; Lin, Chun-Ching

2014-01-01

Extracts from natural plants have been used in traditional medicine for many centuries worldwide. Artocarpus communis is one such plant that has been used to treat liver cirrhosis, hypertension, and diabetes. To our knowledge, this study is the first to investigate the antihepatoma activity of A. communis toward HepG2 and PLC/PRF/5 cells and the first to explore the relationship between antihepatoma activity and the active compound artocarpin content in different fractions of A. communis. A. communis methanol extract and fractions induced dose-dependent reduction of tumor cell viability. DNA laddering analysis revealed that A. communis extract and fractions did not induce apoptosis in HepG2 and PLC/PRF/5 cells. Instead, acridine orange staining revealed that A. communis triggered autophagic cell death in a dose-dependent manner. The antihepatoma activity of A. communis is attributable to artocarpin. The fractions with the highest artocarpin content were also the fractions with the highest antihepatoma activity in the following order: dichloromethane fraction > methanol extract > ethyl acetate fraction > n-butanol fraction > n-hexane fraction. Taken together, A. communis showed antihepatoma activity through autophagic cell death. The effect was related to artocarpin content. Artocarpin could be considered an indicator of the anticancer potential of A. communis extract. PMID:25133268

Stomach Cancer Following Hodgkin Lymphoma, Testicular Cancer and Cervical Cancer: A Pooled Analysis of Three International Studies with a Focus on Radiation Effects

PubMed Central

Gilbert, Ethel S.; Curtis, Rochelle E.; Hauptmann, Michael; Kleinerman, Ruth A.; Lynch, Charles F.; Stovall, Marilyn; Smith, Susan A.; Weathers, Rita; Andersson, Michael; Dores, Graça M.; Fraumeni, Joseph F.; Fossa, Sophie D.; Hall, Per; Hodgson, David C.; Holowaty, Eric J.; Joensuu, Heikki; Johannesen, Tom B.; Langmark, Froydis; Kaijser, Magnus; Pukkala, Eero; Rajaraman, Preetha; Storm, Hans H.; Vaalavirta, Leila; van den Belt-Dusebout, Alexandra W.; Aleman, Berthe M.; Travis, Lois B.; Morton, Lindsay M.; van Leeuwen, Flora E.

2017-01-01

To further understand the risk of stomach cancer after fractionated high-dose radiotherapy, we pooled individual-level data from three recent stomach cancer case-control studies. These studies were nested in cohorts of five-year survivors of first primary Hodgkin lymphoma (HL), testicular cancer (TC) or cervical cancer (CX) from seven countries. Detailed data were abstracted from patient records and radiation doses were reconstructed to the site of the stomach cancer for cases and to the corresponding sites for matched controls. Among 327 cases and 678 controls, mean doses to the stomach were 15.3 Gy, 24.7 Gy and 1.9 Gy, respectively, for Hodgkin lymphoma, testicular cancer and cervical cancer survivors, with an overall mean dose of 10.3 Gy. Risk increased with increasing radiation dose to the stomach cancer site (P < 0.001) with no evidence of nonlinearity or of a downturn at the highest doses (≥35 Gy). The pooled excess odds ratio per Gy (EOR/Gy) was 0.091 [95% confidence interval (CI): 0.036–0.20] with estimates of 0.049 (95% CI: 0.007–0.16) for Hodgkin lymphoma, 0.27 (95% CI: 0.054–1.44) for testicular cancer and 0.096 (95% CI: −0.002–0.39) for cervical cancer (P homogeneity = 0.25). The EOR/Gy increased with time since exposure (P trend = 0.004), with an EOR/Gy of 0.38 (95% CI: 0.12–1.04) for stomach cancer occurring ≥20 years postirradiation corresponding to odds ratios of 4.8 and 10.5 at radiation doses to the stomach of 10 and 25 Gy, respectively. Of 111 stomach cancers occurring ≥20 years after radiotherapy, 63.8 (57%) could be attributed to radiotherapy. Our findings differ from those based on Japanese atomic-bomb survivors, where the overall EOR/Gy was higher and where there was no evidence of an increase with time since exposure. By pooling data from three studies, we demonstrated a clear increase in stomach cancer risk over a wide range of doses from fractionated radiotherapy with the highest risks occurring many years after exposure. These findings highlight the need to directly evaluate the health effects of high-dose fractionated radiotherapy rather than relying on the data of persons exposed at low and moderate acute doses. PMID:28118119

Tobacco Smoking Status and the Contribution to Burden of Diseases in Iran, 1990-2010: findings from the Global Burden of Disease Study 2010.

PubMed

Ghasemian, Anoosheh; Rezaei, Nazila; Saeedi Moghaddam, Sahar; Mansouri, Anita; Parsaeian, Mahboubeh; Delavari, Alireza; Jamshidi, Hamid Reza; Sharifi, Farshad; Naderimagham, Shohreh

2015-08-01

Tobacco smoking and exposure to second-hand smoke in the indoor environment are major public health risks worldwide. The aim of this paper is to report and critique a global assessment of smoking prevalence, smoking-attributable deaths, and disability adjusted life years (DALYs) extracted from GBD study 2010, by sex and age in Iran from 1990 to 2010. The Global Burden of Disease (GBD) Study 2010 estimated the distributions of exposure and relative risks per unit of exposure by systematically reviewing and analyzing published and unpublished data. These assessments were used, together with estimates of death and DALYs due to specific risk factors, to calculate the attributed burden for each risk factor exposure compared with the theoretical-minimum-risk exposure. Uncertainties in the distribution of exposure, relative risks, and relevant outcomes were incorporated into estimates of attributable mortality and burden. In this study, our aim was to reformulate the GBD data, produce new graphs, and explain the results for Iran in greater detail. Between 1990 and 2010, the prevalence of tobacco smoking at all ages increased by 1% in men and declined by 2% in women in Iran, but the overall prevalence in the general population was unchanged (12%). A reduction was observed in the age-standardized death and DALY rates (per 100,000 population) attributed to tobacco smoking, including second-hand smoke. The attributed DALY rate was greater for Iranian men than for Iranian women. The highest rates of DALYs because of tobacco smoking were found in smoker men and women aged 70+, but exposure to second-hand smoke had the most significant burden in children under 5 years old. In 1990, the three leading disease burdens attributed to tobacco smoking, including second-hand smoke, were ischemic heart disease; communicable, maternal, neonatal, and nutritional disorders; and chronic respiratory diseases. In 2010, three leading burden of diseases attributed to tobacco smoking belonged to ischemic heart disease, chronic respiratory disease, and, and cerebrovascular disease, respectively. Despite a reduction in the rate of tobacco smoking, including second-hand smoke, since 1990, smoking exposure remained the fifth leading risk factor for deaths and DALYs in Iran in 2010. Overall, our data clearly show the need for new efforts in Iran to reduce the mortality and burden attributed to tobacco smoking.

A Mixed Method to Evaluate Burden of Malaria Due to Flooding and Waterlogging in Mengcheng County, China: A Case Study

PubMed Central

Ding, Guoyong; Gao, Lu; Li, Xuewen; Zhou, Maigeng; Liu, Qiyong; Ren, Hongyan; Jiang, Baofa

2014-01-01

Background Malaria is a highly climate-sensitive vector-borne infectious disease that still represents a significant public health problem in Huaihe River Basin. However, little comprehensive information about the burden of malaria caused by flooding and waterlogging is available from this region. This study aims to quantitatively assess the impact of flooding and waterlogging on the burden of malaria in a county of Anhui Province, China. Methods A mixed method evaluation was conducted. A case-crossover study was firstly performed to evaluate the relationship between daily number of cases of malaria and flooding and waterlogging from May to October 2007 in Mengcheng County, China. Stratified Cox models were used to examine the lagged time and hazard ratios (HRs) of the risk of flooding and waterlogging on malaria. Years lived with disability (YLDs) of malaria attributable to flooding and waterlogging were then estimated based on the WHO framework of calculating potential impact fraction in the Global Burden of Disease study. Results A total of 3683 malaria were notified during the study period. The strongest effect was shown with a 25-day lag for flooding and a 7-day lag for waterlogging. Multivariable analysis showed that an increased risk of malaria was significantly associated with flooding alone [adjusted hazard ratio (AHR)  = 1.467, 95% CI = 1.257, 1.713], waterlogging alone (AHR = 1.879, 95% CI = 1.696, 2.121), and flooding and waterlogging together (AHR = 2.926, 95% CI = 2.576, 3.325). YLDs per 1000 of malaria attributable to flooding alone, waterlogging alone and flooding and waterlogging together were 0.009 per day, 0.019 per day and 0.022 per day, respectively. Conclusion Flooding and waterlogging can lead to higher burden of malaria in the study area. Public health action should be taken to avoid and control a potential risk of malaria epidemics after these two weather disasters. PMID:24830808

A mixed method to evaluate burden of malaria due to flooding and waterlogging in Mengcheng County, China: a case study.

PubMed

Ding, Guoyong; Gao, Lu; Li, Xuewen; Zhou, Maigeng; Liu, Qiyong; Ren, Hongyan; Jiang, Baofa

2014-01-01

Malaria is a highly climate-sensitive vector-borne infectious disease that still represents a significant public health problem in Huaihe River Basin. However, little comprehensive information about the burden of malaria caused by flooding and waterlogging is available from this region. This study aims to quantitatively assess the impact of flooding and waterlogging on the burden of malaria in a county of Anhui Province, China. A mixed method evaluation was conducted. A case-crossover study was firstly performed to evaluate the relationship between daily number of cases of malaria and flooding and waterlogging from May to October 2007 in Mengcheng County, China. Stratified Cox models were used to examine the lagged time and hazard ratios (HRs) of the risk of flooding and waterlogging on malaria. Years lived with disability (YLDs) of malaria attributable to flooding and waterlogging were then estimated based on the WHO framework of calculating potential impact fraction in the Global Burden of Disease study. A total of 3683 malaria were notified during the study period. The strongest effect was shown with a 25-day lag for flooding and a 7-day lag for waterlogging. Multivariable analysis showed that an increased risk of malaria was significantly associated with flooding alone [adjusted hazard ratio (AHR)  = 1.467, 95% CI = 1.257, 1.713], waterlogging alone (AHR = 1.879, 95% CI = 1.696, 2.121), and flooding and waterlogging together (AHR = 2.926, 95% CI = 2.576, 3.325). YLDs per 1000 of malaria attributable to flooding alone, waterlogging alone and flooding and waterlogging together were 0.009 per day, 0.019 per day and 0.022 per day, respectively. Flooding and waterlogging can lead to higher burden of malaria in the study area. Public health action should be taken to avoid and control a potential risk of malaria epidemics after these two weather disasters.

Quantitative analysis of burden of infectious diarrhea associated with floods in northwest of anhui province, china: a mixed method evaluation.

PubMed

Ding, Guoyong; Zhang, Ying; Gao, Lu; Ma, Wei; Li, Xiujun; Liu, Jing; Liu, Qiyong; Jiang, Baofa

2013-01-01

Persistent and heavy rainfall in the upper and middle Huaihe River of China brought about severe floods during the end of June and July 2007. However, there has been no assessment on the association between the floods and infectious diarrhea. This study aimed to quantify the impact of the floods in 2007 on the burden of disease due to infectious diarrhea in northwest of Anhui Province. A time-stratified case-crossover analysis was firstly conducted to examine the relationship between daily cases of infectious diarrhea and the 2007 floods in Fuyang and Bozhou of Anhui Province. Odds ratios (ORs) of the flood risk were quantified by conditional logistic regression. The years lived with disability (YLDs) of infectious diarrhea attributable to floods were then estimated based on the WHO framework of the calculating potential impact fraction in the Burden of Disease study. A total of 197 infectious diarrheas were notified during the exposure and control periods in the two study areas. The strongest effect was shown with a 2-day lag in Fuyang and a 5-day lag in Bozhou. Multivariable analysis showed that floods were significantly associated with an increased risk of the number cases of infectious diarrhea (OR = 3.175, 95%CI: 1.126-8.954 in Fuyang; OR = 6.754, 95%CI: 1.954-23.344 in Bozhou). Attributable YLD per 1000 of infectious diarrhea resulting from the floods was 0.0081 in Fuyang and 0.0209 in Bozhou. Our findings confirm that floods have significantly increased the risks of infectious diarrhea in the study areas. In addition, prolonged moderate flood may cause more burdens of infectious diarrheas than severe flood with a shorter duration. More attention should be paid to particular vulnerable groups, including younger children and elderly, in developing public health preparation and intervention programs. Findings have significant implications for developing strategies to prevent and reduce health impact of floods.

Identifying and Targeting Mortality Disparities: A Framework for Sub-Saharan Africa Using Adult Mortality Data from South Africa

PubMed Central

Sartorius, Benn; Sartorius, Kurt

2013-01-01

Background Health inequities in developing countries are difficult to eradicate because of limited resources. The neglect of adult mortality in Sub-Saharan Africa (SSA) is a particular concern. Advances in data availability, software and analytic methods have created opportunities to address this challenge and tailor interventions to small areas. This study demonstrates how a generic framework can be applied to guide policy interventions to reduce adult mortality in high risk areas. The framework, therefore, incorporates the spatial clustering of adult mortality, estimates the impact of a range of determinants and quantifies the impact of their removal to ensure optimal returns on scarce resources. Methods Data from a national cross-sectional survey in 2007 were used to illustrate the use of the generic framework for SSA and elsewhere. Adult mortality proportions were analyzed at four administrative levels and spatial analyses were used to identify areas with significant excess mortality. An ecological approach was then used to assess the relationship between mortality “hotspots” and various determinants. Population attributable fractions were calculated to quantify the reduction in mortality as a result of targeted removal of high-impact determinants. Results Overall adult mortality rate was 145 per 10,000. Spatial disaggregation identified a highly non-random pattern and 67 significant high risk local municipalities were identified. The most prominent determinants of adult mortality included HIV antenatal sero-prevalence, low SES and lack of formal marital union status. The removal of the most attributable factors, based on local area prevalence, suggest that overall adult mortality could be potentially reduced by ∼90 deaths per 10,000. Conclusions The innovative use of secondary data and advanced epidemiological techniques can be combined in a generic framework to identify and map mortality to the lowest administration level. The identification of high risk mortality determinants allows health authorities to tailor interventions at local level. This approach can be replicated elsewhere. PMID:23967209

Heavy metal fractions and ecological risk assessment in sediments from urban, rural and reclamation-affected rivers of the Pearl River Estuary, China.

PubMed

Zhang, Guangliang; Bai, Junhong; Xiao, Rong; Zhao, Qingqing; Jia, Jia; Cui, Baoshan; Liu, Xinhui

2017-10-01

Rapid urbanization and reclamation processes in coastal areas have resulted in serious pollution to the aquatic environment. Less is known on the geochemical fractions and ecological risks in river sediment under various human activities pressures, which is essential for addressing the connections between heavy metal pollution and anthropogenic influences. River sediments were collected from different landscapes (i.e., urban, rural and reclamation areas) to investigate the impacts of urbanization and reclamation on the metallic pollution levels and ecological risks in the Pear River Estuary of China. Results showed that Cd, Zn and Cu with high total contents and geoaccumulation index (I geo ) were the primary metals in the Peal River sediments. Generally, urban river sediments, especially the surface sediment layer (0-10 cm), exhibited higher metallic pollution levels. As for geochemical fractions, reducible and residual fractions were the dominant forms for six determined metals. And the percentage of heavy metals bound to Fe-Mn oxides decreased with increasing soil depth but the reverse tendency was observed for residual fractions. Compared with rural river sediments, heavy metals were highly associated with the exchangeable and carbonate fractions in both urban and reclamation-affected river sediments, suggesting that anthropogenic activities mainly increased the active forms of metals. Approximately 80% of Cd existed in the non-residual fraction and posed medium to high ecological risk according to the risk assessment code (RAC) values. The redundancy analysis (RDA) revealed that both urbanization and reclamation processes would cause similar metallic characteristics, and sediment organic matter (SOC) might be the prominent influencing factor. Copyright © 2017 Elsevier Ltd. All rights reserved.

Effect of ZnO facet on ethanol steam reforming over Co/ZnO

DOE Office of Scientific and Technical Information (OSTI.GOV)

Yu, Ning; Zhang, He; Davidson, Stephen D.

2016-01-01

The effects of ZnO facets on ethanol steam reforming (ESR) were investigated over Co/ZnO catalysts synthesized using ZnO with different fractions of (10-10) non-polar facet. Co supported on ZnO with a higher fraction of (10-10) non-polar facet shows higher C-C cleavage activity and higher selectivity to CO2 (lower selectivity to CO) compared with Co supported on ZnO with less (10-10) non-polar facet exposed. The improved ethanol steam reforming performances are attributed to the high fraction of metallic Co stabilized by the ZnO (10-10) non-polar facet, which enhanced C-C cleavage and water-gas-shift (WGS) activities.

Gas/particle partitioning and particle size distribution of PCDD/Fs and PCBs in urban ambient air.

PubMed

Barbas, B; de la Torre, A; Sanz, P; Navarro, I; Artíñano, B; Martínez, M A

2018-05-15

Urban ambient air samples, including gas-phase (PUF), total suspended particulates (TSP), PM 10 , PM 2.5 and PM 1 airborne particle fractions were collected to evaluate gas-particle partitioning and size particle distribution of polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs) and polychlorinated biphenyls (PCBs). Clausius-Clapeyron equation, regressions of logKp vs logP L and logK OA, and human respiratory risk assessment were used to evaluate local or long-distance transport sources, gas-particle partitioning sorption mechanisms, and implications for health. Total ambient air levels (gas phase+particulate phase) of TPCBs and TPCDD/Fs, were 437 and 0.07pgm -3 (median), respectively. Levels of PCDD/F in the gas phase (0.004-0.14pgm -3 , range) were significantly (p<0.05) lower than those found in the particulate phase (0.02-0.34pgm -3 ). The concentrations of PCDD/Fs were higher in winter. In contrast, PCBs were mainly associated to the gas phase, and displayed maximum levels in warm seasons, probably due to an increase in evaporation rates, supported by significant and strong positive dependence on temperature observed for several congeners. No significant differences in PCDD/Fs and PCBs concentrations were detected between the different particle size fractions considered (TSP, PM 10 , PM 2.5 and PM 1 ), reflecting that these chemicals are mainly bounded to PM 1 . The toxic content of samples was also evaluated. Total toxicity (PUF+TSP) attributable to dl-PCBs (13.4fg-TEQ 05 m -3 , median) was higher than those reported for PCDD/Fs (6.26fg-TEQ 05 m -3 ). The inhalation risk assessment concluded that the inhalation of PCDD/Fs and dl-PCBs pose a low cancer risk in the studied area. Copyright © 2017 Elsevier B.V. All rights reserved.

Preventive fraction of physical fitness on risk factors in cardiac patients: Retrospective epidemiological study.

PubMed

Caru, Maxime; Kern, Laurence; Bousquet, Marc; Curnier, Daniel

2018-04-26

To quantify the preventive fraction of physical fitness on the risk factors in patients with cardiovascular diseases (CVDs). A total of 249 subjects (205 men and 44 women) suffering from CVD were categorized into four groups, according to their percentage of physical fitness. We calculated the odds ratio to obtain the preventive fraction in order to evaluate the impact of the physical fitness level on the risk factors ( i.e ., abdominal obesity, depression, diabetes, dyslipidemia, hypertension, obesity, overweight and smoking). It is observed that a normal physical fitness level is sufficient to induce a preventive action on abdominal obesity (38%), diabetes (12%), hypertension (33%), obesity (12%) and overweight (11%). Also, the preventive fraction increases with the level of physical fitness, in particular for hypertension (36%) and overweight (16%). A high physical fitness level does not necessarily induce a preventive action in most risk factors, excluding depression. This is the first study which demonstrates that reaching a normal physical fitness level is enough to induce a protection for some risk factors, despite having a CVD.

Preventive fraction of physical fitness on risk factors in cardiac patients: Retrospective epidemiological study

PubMed Central

Caru, Maxime; Kern, Laurence; Bousquet, Marc; Curnier, Daniel

2018-01-01

AIM To quantify the preventive fraction of physical fitness on the risk factors in patients with cardiovascular diseases (CVDs). METHODS A total of 249 subjects (205 men and 44 women) suffering from CVD were categorized into four groups, according to their percentage of physical fitness. We calculated the odds ratio to obtain the preventive fraction in order to evaluate the impact of the physical fitness level on the risk factors (i.e., abdominal obesity, depression, diabetes, dyslipidemia, hypertension, obesity, overweight and smoking). RESULTS It is observed that a normal physical fitness level is sufficient to induce a preventive action on abdominal obesity (38%), diabetes (12%), hypertension (33%), obesity (12%) and overweight (11%). Also, the preventive fraction increases with the level of physical fitness, in particular for hypertension (36%) and overweight (16%). A high physical fitness level does not necessarily induce a preventive action in most risk factors, excluding depression. CONCLUSION This is the first study which demonstrates that reaching a normal physical fitness level is enough to induce a protection for some risk factors, despite having a CVD. PMID:29707165

Cancer incidence attributable to insufficient fibre consumption in Alberta in 2012

PubMed Central

Grundy, Anne; Poirier, Abbey E.; Khandwala, Farah; McFadden, Alison; Friedenreich, Christine M.; Brenner, Darren R.

2017-01-01

Background: Insufficient fibre consumption has been associated with a increased risk of colorectal cancer. The purpose of this study was to estimate the proportion and absolute number of cancers in Alberta that could be attributed to insufficient fibre consumption in 2012. Methods: The number and proportion of colorectal cancers in Alberta attributable to insufficient fibre consumption were estimated using the population attributable risk. Relative risks were obtained from the World Cancer Research Fund's 2011 Continuous Update Project on colorectal cancer, and the prevalence of insufficient fibre consumption (< 23 g/d) was estimated using dietary data from Alberta's Tomorrow Project. Age- and sex-specific colorectal cancer incidence data for 2012 were obtained from the Alberta Cancer Registry. Results: Between 66% and 67% of men and between 73% and 78% of women reported a diet with insufficient fibre consumption. Population attributable risk estimates for colorectal cancer were marginally higher in men, ranging from 6.3% to 6.8% across age groups, whereas in women they ranged from 5.0% to 5.5%. Overall, 6.0% of colorectal cancers or 0.7% of all cancers in Alberta in 2012 were estimated to be attributable to insufficient fibre consumption. Interpretation: Insufficient fibre consumption accounted for 6.0% of colorectal cancers in Alberta in 2012. Increasing fibre consumption in Alberta has the potential to reduce to the future burden of colorectal cancer in the province. PMID:28401112

The burden of COPD mortality due to ambient air pollution in Guangzhou, China

PubMed Central

Li, Li; Yang, Jun; Song, Yun-Feng; Chen, Ping-Yan; Ou, Chun-Quan

2016-01-01

Few studies have investigated the chronic obstructive pulmonary disease (COPD) mortality fraction attributable to air pollution and modification by individual characteristics of air pollution effects. We applied distributed lag non-linear models to assess the associations between air pollution and COPD mortality in 2007–2011 in Guangzhou, China, and the total COPD mortality fraction attributable to air pollution was calculated as well. We found that an increase of 10 μg/m3 in particulate matter with an aerodynamic diameter of 10 μm or less (PM10), sulfur dioxide (SO2) and nitrogen dioxide (NO2) was associated with a 1.58% (95% confidence interval (CI): 0.12–3.06%), 3.45% (95% CI: 1.30–5.66%) and 2.35% (95% CI: 0.42–4.32%) increase of COPD mortality over a lag of 0–15 days, respectively. Greater air pollution effects were observed in the elderly, males and residents with low educational attainment. The results showed 10.91% (95% CI: 1.02–9.58%), 12.71% (95% CI: 5.03–19.85%) and 13.38% (95% CI: 2.67–22.84%) COPD mortality was attributable to current PM10, SO2 and NO2 exposure, respectively. In conclusion, the associations between air pollution and COPD mortality differed by individual characteristics. There were remarkable COPD mortality burdens attributable to air pollution in Guangzhou. PMID:27195597

A quality-by-design study for an immediate-release tablet platform: examining the relative impact of active pharmaceutical ingredient properties, processing methods, and excipient variability on drug product quality attributes.

PubMed

Kushner, Joseph; Langdon, Beth A; Hicks, Ian; Song, Daniel; Li, Fasheng; Kathiria, Lalji; Kane, Anil; Ranade, Gautam; Agarwal, Kam

2014-02-01

The impact of filler-lubricant particle size ratio variation (3.4-41.6) on the attributes of an immediate-release tablet was compared with the impacts of the manufacturing method used (direct compression or dry granulation) and drug loading (1%, 5%, and 25%), particle size (D[4,3]: 8-114 μm), and drug type (theophylline or ibuprofen). All batches were successfully manufactured, except for direct compression of 25% drug loading of 8 μm (D[4,3]) drug, which exhibited very poor flow properties. All manufactured tablets possessed adequate quality attributes: tablet weight uniformity <4% RSD, tablet potency: 94%-105%, content uniformity <6% RSD, acceptance value ≤ 15, solid fraction: 0.82-0.86, tensile strength >1 MPa, friability ≤ 0.2% weight loss, and disintegration time < 4 min. The filler-lubricant particle size ratio exhibited the greatest impact on blend and granulation particle size and granulation flow, whereas drug property variation dominated blend flow, ribbon solid fraction, and tablet quality attributes. Although statistically significant effects were observed, the results of this study suggest that the manufacturability and performance of this immediate-release tablet formulation is robust to a broad range of variation in drug properties, both within-grade and extra-grade excipient particle size variations, and the choice of manufacturing method. © 2013 Wiley Periodicals, Inc. and the American Pharmacists Association.

Fractionation and ecological risk of metals in urban river sediments in Zhongshan City, Pearl River Delta.

PubMed

Cai, Jiannan; Cao, Yingzi; Tan, Haijian; Wang, Yanman; Luo, Jiaqi

2011-09-01

Surface sediments collected from nine urban rivers located in Zhongshan City, Pearl River Delta, were analyzed for total concentration of metals with digestion and chemical fractionation adopting the modified European Community Bureau of Reference (BCR) sequential extraction procedure. The results showed that concentration and fractionation of metals varied significantly among the rivers. The total concentration of eight metals in most rivers did not exceed the China Environmental Quality Standard for Soil, Grade III. The potential ecological risk of metals to rivers were related to the land use patterns, in the order of manufacturing areas > residential areas > agriculture areas. The concentration of Pb in the reducible fraction was relatively high (60.0-84.3%). The dominant proportions of Cd, Zn and Cu were primary in the non-residual fraction (67.0%, 71.8% and 81.4% on average respectively), while the percentages of the residual fractions of Cr and Ni varied over a wide range (43-85% and 24-71% respectively). The approaches of the Håkanson ecological risk index and Secondary Phase Enrichment Factor were applied for ecological risk assessment and metal enrichment calculation. The results indicated Hg and Cd had posed high potential ecological risk to urban rivers in this region. Meanwhile, there was widespread pollution and high enrichment of Cu in river sediments in this region. Multiple regression analysis showed that five water quality parameters (pH, DO, COD(Mn), NH(4)(+)-N, TP) had little influence on the distribution of metal fractionation. This result revealed that the ecological risk of metals was not eliminated along with the improvement in water quality. Correlation studies showed that among the metals, Group A (Cd, As, Pb, Zn Hg, r = 0.730-0.924) and Group B (Cr, Cu, Ni, r = 0.815-0.948) were obtained, and the metal contaminations were from industrial activities rather than residential.

Negative parental attributions mediate associations between risk factors and dysfunctional parenting: A replication and extension.

PubMed

Beckerman, Marieke; van Berkel, Sheila R; Mesman, Judi; Alink, Lenneke R A

2018-05-12

The primary goal of the current study was to replicate our previous study in which was found that negative maternal attributions mediate the association between parenting stress and harsh and abusive discipline. In addition, we investigated this association in fathers, and added observational parenting data. During two home visits mothers and fathers were observed with their children (age 1.5-6.0 years), filled in questionnaires, and completed the Parental Attributions of Child behavior Task (PACT; a computerized attribution task). Similar to our previous study, negative parental attributions mediated the relation between parenting stress and self-reported harsh and abusive parenting for both mothers and fathers. For mothers, this mediation effect was also found in the relation between parenting stress and lower levels of observed supportive parenting in a challenging disciplinary task. In addition, the relation of partner-related stress and abuse risk with harsh, abusive, and (low) supportive parenting were also mediated by maternal negative attributions. When parenting stress, partner-related stress, and abuse risk were studied in one model, only parenting stress remained significant. Results are discussed in terms of the importance of targeting parental attributions for prevention and intervention purposes in families experiencing stress. Copyright © 2018 Elsevier Ltd. All rights reserved.

Distribution of heavy metals and metalloids in bulk and particle size fractions of soils from coal-mine brownfield and implications on human health.

PubMed

Li, Hongxia; Ji, Hongbing; Shi, Chunjing; Gao, Yang; Zhang, Yan; Xu, Xiangyu; Ding, Huaijian; Tang, Lei; Xing, Yuxin

2017-04-01

Heavy metals (HMs) and metalloids migrate into their surroundings, thus increasing environmental risks and threatening human health. Current studies on coal-mine brownfields, however, have not thoroughly investigated soil-associated HMs and metalloids produced by coal mining. Therefore, this study explored the spatial and particle fraction distribution and human health implications of HMs and metalloids. The soil-associated HMs and metalloids are Arsenic (As), Cadmium (Cd), Chromium (Cr), Copper (Cu), Mercury (Hg), Manganese (Mn), Nickel (Ni), Lead (Pb), Scandium (Sc), Titanium (Ti) and Zinc (Zn). Results showed that Cd, Cu, Pb, and Ni were enriched in bulk soils. Cadmium, Cu and Pb from anthropogenic source were mainly found at entrance roadsides and in sites closest to coal mines. HMs and metalloids primarily accumulated in fine fractions (<1, 1-5, and 5-10 μm). Moreover, HM and metalloid loadings substantially accumulated in the 75-250 μm and 250-1000 μm fractions. Most fine soil fractions showed moderate to strong potential ecological risks, whereas all the coarse particle fractions (50-75, 75-250, and 250-1000 μm) presented slight potential ecological risk. Exposure to soil-associated HMs and metalloids mainly occurred via ingestion. The total non-carcinogenic risks to children and adults fell below the safe level of 1, whereas the total carcinogenic risks to these individuals were higher than that of the maximum acceptable level set by the United States Environmental Protection Agency (USEPA, 1 × 10 -4 ). The total carcinogenic risk was mainly contributed by Cd and Ni through ingestion and dermal access. Therefore, hygiene and food security in areas should be emphasized. Copyright © 2017 Elsevier Ltd. All rights reserved.

Characterisation of taste-active extracts from raw Brassica oleracea vegetables.

PubMed

Zabaras, Dimitrios; Roohani, Mahshid; Krishnamurthy, Raju; Cochet, Maeva; Delahunty, Conor M

2013-04-25

Chemical and sensory characterisation of whole and fractionated myrosinase-free extracts from selected Australian-grown, raw Brassica vegetables (broccoli, cauliflower, Brussels sprouts and red cabbage) was carried out to determine the contribution of key phytochemicals (i.e. glucosinolates, free sugars, phenolics) to the taste profiles of these vegetables. Glucosinolate (GS) and phenolic profiles were determined by liquid chromatography coupled with photodiode array detection and mass spectrometry. Ten glucosinolates (GS) were quantified across the vegetables investigated. Brussels sprouts (186.3 μg g(-1) FW) followed by broccoli (164.1 μg g(-1) FW) were found to contain the most GS. The phenolic profiles of all samples were dominated by hydroxycinnamic acid derivatives. As expected, red cabbage was the only vegetable with a significant anthocyanin signal (574.0 μg g(-1) FW). Red cabbage (26.7 mg g(-1) FW) and cauliflower (18.7 mg g(-1) FW) were found to contain a higher concentration of free sugars than Brussels sprouts (12.6 mg g(-1) FW) and broccoli (10.2 mg g(-1) FW). Descriptive sensory analysis of the whole extracts found sweetness (cauliflower and red cabbage sweeter than broccoli and Brussels sprouts) and bitterness (Brussels sprouts more bitter than others) as the most discriminating attributes. A hydrophilic fraction with sweetness, umami and saltiness as the main attributes was the most taste active fraction across all Brassica whole extracts. Sub-fractionation showed that this fraction was also bitter but the presence of sugars counteracted bitterness. Several components within each extract were found to contribute to the bitterness of whole Brassica extracts. The total and individual GS content alone could not explain the perceived bitterness of these extracts. Phenolics and/or other components are likely to be contributing to the bitterness associated with these vegetables.

Soybean plant-based toxicity assessment and phytoremediation of soils contaminated by vegetable and mineral oils used in power electrical transformers.

PubMed

Sanderson, Karina; Módenes, Aparecido Nivaldo; Espinoza-Quiñones, Fernando Rodolfo; Trigueros, Daniela Estelita Goes; Júnior, Luiz Antônio Zanão; Schuelter, Adilson Ricken; Neves, Camila Vargas; Kroumov, Alexander Dimitrov

2018-04-01

In this work, deleterious effects in soils due to the presence of dielectric fluids were investigated. For this purpose, vegetable (Envirotemp ® FR3) and mineral (Lubrax AV 66 IN) oils were used for simulating a set of soils contaminated in different oil contents (0.5, 1.0, 2.0, 2.5, 5.0, 7.5 and 10%) in which three 120-days soybean crop periods (SCP) were carried out using the species Glycine max (L.) Merr. Both soil and soybean plant samples were analysed on following the changes on chemical attributes, content of oils and greases (COG) in soils and phytotechnical characteristics of soybean plant. No significant changes on soil chemical attributes were found. For a 0.5% vegetable oil fraction, COG removals of 35, 60 and 90% were observed after the 1st, 2nd, and 3rd SCPs, respectively, whereas removals of 25, 40 and 70% were observed for 0.5% mineral oil fraction after the 1st, 2nd, and 3rd SCPs, respectively. There was an effectively accumulated removal on all tested oil fractions as being proportional to the integrated 120-days SCPs, suggesting a lesser number of crops for a complete abatement of oil fraction in soil. A 100% recovery on the seedlings emergence fractions was also evidenced, revealing that at least a number of 7 and 9 SCPs should be applied continuously in soils contaminated by vegetable and mineral oils, respectively, in order to no longer jeopardize soybean plant growth. Finally, an empirical prediction of the number of SCPs necessary for the complete removal of oil from the soil was proposed. Copyright © 2018 Elsevier Ltd. All rights reserved.

A cross sectional study of the prevalence, risk factors and population attributable fractions for limb and body lesions in lactating sows on commercial farms in England

PubMed Central

KilBride, Amy L; Gillman, Claire E; Green, Laura E

2009-01-01

Background Lesions on sows' limbs and bodies are an abnormality that might impact on their welfare. The prevalence of and risks for limb and body lesions on lactating sows on commercial English pig farms were investigated using direct observation of the sows and their housing. Results The prevalence of lesions on the limbs and body were 93% (260/279) and 20% (57/288) respectively. The prevalence of limb and body lesions was significantly lower in outdoor-housed sows compared with indoor-housed sows. Indoor-housed sows had an increased risk of wounds (OR 6.8), calluses (OR 8.8) and capped hock (OR 3.8) on their limbs when housed on fully slatted floors compared with solid concrete floors. In addition, there was an increased risk of bursitis (OR 2.7), capped hock (OR 2.3) and shoulder lesions (OR 4.8) in sows that were unwilling to rise to their feet. There was a decreased risk of shoulder lesions (OR 0.3) and lesions elsewhere on the body (OR 0.2) in sows with more than 20 cm between their tail and the back of the crate compared with sows with less than 10 cm. Conclusion The sample of outdoor housed sows in this study had the lowest prevalence of limb and body lesions. In lactating sows housed indoors there was a general trend for an increased risk of limb and body lesions in sows housed on slatted floors compared with those housed on solid concrete floors with bedding. Sows that were less responsive to human presence and sows that had the least space to move within their crates had an additional increased risk of lesions. PMID:19703273

Incidence of surgically treated osteoarthritis in the hip and knee in male construction workers.

PubMed

Järvholm, B; From, C; Lewold, S; Malchau, H; Vingård, E

2008-04-01

Occupational workload has been associated with an increased risk of osteoarthritis. The objective was to further examine the association between workload and occurrence of osteoarthritis and in particular to study whether heavy workload has similar importance as a causative factor for osteoarthritis of the hip and knee. In a cohort study, the authors investigated the incidence of surgically treated osteoarthritis in the hip and knee among men employed in the Swedish construction industry (n = 204 741). Incident cases were found by linkage with the Swedish hospital discharge register between 1987 and 1998. Incidence rates adjusted for age and BMI were compared between different occupational groups. The incidence rates for osteoarthritis in hip and knee were positively correlated (r = 0.62; p = 0.01). There was a significantly increased risk of surgically treated osteoarthritis in the knee among floor layers, asphalt workers, sheet-metal workers, rock workers, plumbers, brick layers, wood workers and concrete workers. Even if there was a trend towards increased relative risks for osteoarthritis in the hip in floor layers, asphalt workers, wood workers and concrete workers they were not statistically significant. The relative risk for surgically treated osteoarthritis of the knee was 4.7 (95% CI 1.8 to 12.3) among floor layers, indicating an attributable fraction for work factors of 79%. This study shows that some work-related factors seem to be risk factors for osteoarthritis both in the knee and hip. However, the risk factors seem to be of greater importance for osteoarthritis in the knee compared with the hip. This study indicates that at least 50% of the cases of severe osteoarthritis of the knee can be prevented through decreasing occupational risk factors in some occupational groups.

HIV, antiretroviral treatment, hypertension, and stroke in Malawian adults

PubMed Central

Corbett, Elizabeth L.; Connor, Myles D.; Mzinganjira, Henry; Kampondeni, Sam; Choko, Augustine; Hopkins, Mark; Emsley, Hedley C.A.; Bryer, Alan; Faragher, Brian; Heyderman, Robert S.; Allain, Theresa J.; Solomon, Tom

2016-01-01

Objective: To investigate HIV, its treatment, and hypertension as stroke risk factors in Malawian adults. Methods: We performed a case-control study of 222 adults with acute stroke, confirmed by MRI in 86%, and 503 population controls, frequency-matched for age, sex, and place of residence, using Global Positioning System for random selection. Multivariate logistic regression models were used for case-control comparisons. Results: HIV infection (population attributable fraction [PAF] 15%) and hypertension (PAF 46%) were strongly linked to stroke. HIV was the predominant risk factor for young stroke (≤45 years), with a prevalence of 67% and an adjusted odds ratio (aOR) (95% confidence interval) of 5.57 (2.43–12.8) (PAF 42%). There was an increased risk of a stroke in patients with untreated HIV infection (aOR 4.48 [2.44–8.24], p < 0.001), but the highest risk was in the first 6 months after starting antiretroviral therapy (ART) (aOR 15.6 [4.21–46.6], p < 0.001); this group had a lower median CD4+ T-lymphocyte count (92 vs 375 cells/mm3, p = 0.004). In older participants (HIV prevalence 17%), HIV was associated with stroke, but with a lower PAF than hypertension (5% vs 68%). There was no interaction between HIV and hypertension on stroke risk. Conclusions: In a population with high HIV prevalence, where stroke incidence is increasing, we have shown that HIV is an important risk factor. Early ART use in immunosuppressed patients poses an additional and potentially treatable stroke risk. Immune reconstitution inflammatory syndrome may be contributing to the disease mechanisms. PMID:26683649

HIV, antiretroviral treatment, hypertension, and stroke in Malawian adults: A case-control study.

PubMed

Benjamin, Laura A; Corbett, Elizabeth L; Connor, Myles D; Mzinganjira, Henry; Kampondeni, Sam; Choko, Augustine; Hopkins, Mark; Emsley, Hedley C A; Bryer, Alan; Faragher, Brian; Heyderman, Robert S; Allain, Theresa J; Solomon, Tom

2016-01-26

To investigate HIV, its treatment, and hypertension as stroke risk factors in Malawian adults. We performed a case-control study of 222 adults with acute stroke, confirmed by MRI in 86%, and 503 population controls, frequency-matched for age, sex, and place of residence, using Global Positioning System for random selection. Multivariate logistic regression models were used for case-control comparisons. HIV infection (population attributable fraction [PAF] 15%) and hypertension (PAF 46%) were strongly linked to stroke. HIV was the predominant risk factor for young stroke (≤45 years), with a prevalence of 67% and an adjusted odds ratio (aOR) (95% confidence interval) of 5.57 (2.43-12.8) (PAF 42%). There was an increased risk of a stroke in patients with untreated HIV infection (aOR 4.48 [2.44-8.24], p < 0.001), but the highest risk was in the first 6 months after starting antiretroviral therapy (ART) (aOR 15.6 [4.21-46.6], p < 0.001); this group had a lower median CD4(+) T-lymphocyte count (92 vs 375 cells/mm(3), p = 0.004). In older participants (HIV prevalence 17%), HIV was associated with stroke, but with a lower PAF than hypertension (5% vs 68%). There was no interaction between HIV and hypertension on stroke risk. In a population with high HIV prevalence, where stroke incidence is increasing, we have shown that HIV is an important risk factor. Early ART use in immunosuppressed patients poses an additional and potentially treatable stroke risk. Immune reconstitution inflammatory syndrome may be contributing to the disease mechanisms. © 2015 American Academy of Neurology.

Rural-to-urban migration and risk of hypertension: longitudinal results of the PERU MIGRANT study

PubMed Central

Bernabe-Ortiz, A; Sanchez, J F; Carrillo-Larco, R M; Gilman, R H; Poterico, J A; Quispe, R; Smeeth, L; Miranda, J J

2017-01-01

Urbanization can be detrimental to health in populations due to changes in dietary and physical activity patterns. The aim of this study was to determine the effect of migration on the incidence of hypertension. Participants of the PERU MIGRANT study, that is, rural, urban and rural-to-urban migrants, were re-evaluated after 5 years after baseline assessment. The outcome was incidence of hypertension; and the exposures were study group and other well-known risk factors. Incidence rates, relative risks (RRs) and population attributable fractions (PAFs) were calculated. At baseline, 201 (20.4%), 589 (59.5%) and 199 (20.1%) participants were rural, rural-to-urban migrant and urban subjects, respectively. Overall mean age was 47.9 (s.d.±12.0) years, and 522 (52.9%) were female. Hypertension prevalence at baseline was 16.0% (95% confidence interval (CI) 13.7–18.3), being more common in urban group; whereas pre-hypertension was more prevalent in rural participants (P<0.001). Follow-up rate at 5 years was 94%, 895 participants were re-assessed and 33 (3.3%) deaths were recorded. Overall incidence of hypertension was 1.73 (95%CI 1.36–2.20) per 100 person-years. In multivariable model and compared with the urban group, rural group had a greater risk of developing hypertension (RR 3.58; 95%CI 1.42–9.06). PAFs showed high waist circumference as the leading risk factor for the hypertension development in rural (19.1%), migrant (27.9%) and urban (45.8%) participants. Subjects from rural areas are at higher risk of developing hypertension relative to rural–urban migrant or urban groups. Central obesity was the leading risk factor for hypertension incidence in the three population groups. PMID:26865219

Impact of stress and mitigating information on evaluations, attributions, affect, disciplinary choices, and expectations of compliance in mothers at high and low risk for child physical abuse.

PubMed

De Paúl, Joaquín; Asla, Nagore; Pérez-Albéniz, Alicia; de Cádiz, Bárbara Torres-Gómez

2006-08-01

The objective is to know if high-risk mothers for child physical abuse differ in their evaluations, attributions, negative affect, disciplinary choices for children's behavior, and expectations of compliance. The effect of a stressor and the introduction of mitigating information are analyzed. Forty-seven high-risk and 48 matched low-risk mothers participated in the study. Mothers' information processing and disciplinary choices were examined using six vignettes depicting a child engaging in different transgressions. A four-factor design with repeated measures on the last two factors was used. High-risk mothers reported more hostile intent, global and internal attributions, more use of power assertion discipline, and less induction. A risk group by child transgression interaction and a risk group by mitigating information interaction were found. Results support the social information-processing model of child physical abuse, which suggests that high-risk mothers process child-related information differently and use more power assertive and less inductive disciplinary techniques.

Estimating the Economic Benefits of Eliminating Job Strain as a Risk Factor for Depression.

PubMed

Cocker, Fiona; Sanderson, Kristy; LaMontagne, Anthony D

2017-01-01

The aim of this study was to quantify the economic benefits of eliminating job strain as a risk factor for depression, using published population-attributable risk estimates of depression attributable to job strain (13.2% for men, 17.2% for women). Cohort simulation using state-transition Markov modeling estimated costs and health outcomes for employed persons who met criteria for lifetime DSM-IV major depression. A societal perspective over 1-year and lifetime time horizons was used. Among employed Australians, $890 million (5.8%) of the annual societal cost of depression was attributable to job strain. Employers bore the brunt of these costs, as they arose from lost productive time and increased risk of job turnover among employees experiencing depression. Proven, practicable means exist to reduce job strain. The findings demonstrate likely financial benefits to employers for expanding psychosocial risk management, providing a financial incentive to complement and reinforce legal and ethical directives.

Association between maternal dental periapical infections and pregnancy outcomes: results from a cross-sectional study in Malawi.

PubMed

Harjunmaa, Ulla; Järnstedt, Jorma; Alho, Lotta; Dewey, Kathryn G; Cheung, Yin Bun; Deitchler, Megan; Ashorn, Ulla; Maleta, Kenneth; Klein, Nigel J; Ashorn, Per

2015-11-01

Maternal infections are associated with intrauterine growth restriction (IUGR) and preterm birth (PTB). Dental infections are common in low-income settings, but their contribution to adverse pregnancy outcomes is unknown. We studied the epidemiology of dental periapical infections among pregnant women and their association to foetal growth restriction and the duration of pregnancy in a rural sub-Saharan African population. This was a cross-sectional study on the association between maternal dental periapical infections and birth outcomes, in Malawi, Africa. We assessed oral health clinically and radiologically among recently delivered women with known duration of pregnancy and measured birthweight (BW), length and head circumference of their infants. Of 1024 analysed participants, 23.5% had periapical infections. Mean duration of pregnancy was 39.4 weeks, BW 2979 g and length 49.7 cm. Women with periapical infection had mean (95% CI) pregnancy duration 0.4 weeks (0.1-0.8) shorter and delivered infants with 79 g (13-145) lower BW and 0.5 cm (0.2-0.9) shorter neonatal length than women without periapical infection. The incidence of PTB was 10.0% among women with periapical infection and 7.3% among those without (adjusted difference 3.5%, 95% CI -1.1-8.1%). Corresponding prevalences for stunting were 20.9% and 14.2% (adjusted difference 9.0%, 95% CI 2.7%-15.2%). The population-attributable risk fraction attributable to periapical infection was 9.7% for PTB and 12.8% for stunting. Periapical infection was associated with shorter pregnancy duration and IUGR in the study area; interventions addressing this risk factor may improve birth outcomes in low-income settings. © 2015 John Wiley & Sons Ltd.

Visual Impairment, Undercorrected Refractive Errors, and Activity Limitations in Older Adults: Findings From the Three-City Alienor Study.

PubMed

Naël, Virginie; Pérès, Karine; Carrière, Isabelle; Daien, Vincent; Scherlen, Anne-Catherine; Arleo, Angelo; Korobelnik, Jean-Francois; Delcourt, Cécile; Helmer, Catherine

2017-04-01

As vision is required in almost all activities of daily living, visual impairment (VI) may be one of the major treatable factors for preventing activity limitations. We aimed to evaluate the attributable risk of VI associated with activity limitations and the extent to which limitations are avoidable with optimal optical correction of undercorrected refractive errors. We analyzed 709 older adults from the Three-City-Alienor population-based study. VI was defined by presenting distance visual acuity in the better-seeing eye. Multivariate modified Poisson regressions were used to estimate the associations between vision, activity limitations, and social participation restrictions. Population attributable risk (PAR) and generalized impact fraction (GIF) were estimated. Bootstrapping was used to estimate 95% confidence intervals (CI). After adjustment for potential confounders, VI was associated with each domain of activity limitations, except basic activities of daily living (ADL) limitations. These associations were found for even minimal levels of VI. PAR was estimated at 10.1% (95% CI: 5.2-10.6) for mobility limitations, at 26.0% (95% CI: 13.5-41.2) for instrumental ADL (IADL) limitations, and at 24.9% (95% CI: 10.5-47.1) for social participation restrictions. GIF for improvement of undercorrected refractive errors was 6.1% (95% CI: 3.8-8.5) for mobility limitations, 15.8% (95% CI: 11.5-20.1) for IADL limitations and 21.4% (95% CI: 13.8-28.5) for social participation restrictions. About one-sixth of IADL limitations and one-fifth of social participation restrictions could be prevented by an optimal optical correction. These results underline the importance of eye examinations in older adults to prevent disability.

Evaluation of the Impact of Ambient Temperatures on Occupational Injuries in Spain.

PubMed

Martínez-Solanas, Èrica; López-Ruiz, María; Wellenius, Gregory A; Gasparrini, Antonio; Sunyer, Jordi; Benavides, Fernando G; Basagaña, Xavier

2018-06-01

Extreme cold and heat have been linked to an increased risk of occupational injuries. However, the evidence is still limited to a small number of studies of people with relatively few injuries and with a limited geographic extent, and the corresponding economic effect has not been studied in detail. We assessed the relationship between ambient temperatures and occupational injuries in Spain along with its economic effect. The daily number of occupational injuries that caused at least one day of leave and the daily maximum temperature were obtained for each Spanish province for the years 1994-2013. We estimated temperature-injuries associations with distributed lag nonlinear models, and then pooled the results using a multivariate meta-regression model. We calculated the number of injuries attributable to cold and heat, the corresponding workdays lost, and the resulting economic effect. The study included 15,992,310 occupational injuries. Overall, 2.72% [95% confidence interval (CI): 2.44-2.97] of all occupational injuries were attributed to nonoptimal ambient temperatures, with moderate heat accounting for the highest fraction. This finding corresponds to an estimated 0.67 million (95% CI: 0.60-0.73) person-days of work lost every year in Spain due to temperature, or an annual average of 42 d per 1,000 workers. The estimated annual economic burden is €370 million, or 0.03% of Spain's GDP (€2,015). Our findings suggest that extreme ambient temperatures increased the risk of occupational injuries, with substantial estimated health and economic costs. These results call for public health interventions to protect workers in the context of climate change. https://doi.org/10.1289/EHP2590.

Characterization of Fine Particulate Matter and Associated Health Burden in Nanjing.

PubMed

Nie, Dongyang; Chen, Mindong; Wu, Yun; Ge, Xinlei; Hu, Jianlin; Zhang, Kai; Ge, Pengxiang

2018-03-27

Particulate matter (PM) air pollution has become a serious environmental problem in Nanjing and poses great health risks to local residents. In this study, characteristics of particulate matter with an aerodynamic diameter less than 2.5 μm (PM 2.5 ) over Nanjing were analyzed using hourly and daily averaged PM 2.5 concentrations and meteorological parameters collected from nine national monitoring sites during the period of March 2014 to February 2017. Then, the integrated exposure-response (IER) model was applied to assess premature mortality, years of life lost (YLL) attributable to PM 2.5 , and mortality benefits due to PM 2.5 reductions. The concentrations of PM 2.5 varied among hours, seasons and years, which can be explained by differences in emission sources, secondary formations and meteorological conditions. The decreased ratio of PM 2.5 to CO suggested that secondary contributions decreased while the relative contributions of vehicle exhaust increased from increased CO data. According to the values of attributable fractions (AF), stroke was the major cause of death, followed by ischemic heart disease (IHD), lung cancer (LC) and chronic obstructive pulmonary disease (COPD). The estimated total deaths in Nanjing due to PM 2.5 were 12,055 and 10,771, leading to 98,802 and 87,647 years of life lost in 2014 and 2015, respectively. The elderly and males had higher health risks than youngsters and females. When the PM 2.5 concentrations meet the World Health Organization (WHO) Air Quality Guidelines (AQG) of 10 μg/m³, 84% of the premature deaths would be avoided, indicating that the Nanjing government needs to adopt more stringent measure to reduce PM pollution and enhance the health benefits.

Characterization of Fine Particulate Matter and Associated Health Burden in Nanjing

PubMed Central

Nie, Dongyang; Chen, Mindong; Ge, Xinlei; Zhang, Kai; Ge, Pengxiang

2018-01-01

Particulate matter (PM) air pollution has become a serious environmental problem in Nanjing and poses great health risks to local residents. In this study, characteristics of particulate matter with an aerodynamic diameter less than 2.5 μm (PM2.5) over Nanjing were analyzed using hourly and daily averaged PM2.5 concentrations and meteorological parameters collected from nine national monitoring sites during the period of March 2014 to February 2017. Then, the integrated exposure-response (IER) model was applied to assess premature mortality, years of life lost (YLL) attributable to PM2.5, and mortality benefits due to PM2.5 reductions. The concentrations of PM2.5 varied among hours, seasons and years, which can be explained by differences in emission sources, secondary formations and meteorological conditions. The decreased ratio of PM2.5 to CO suggested that secondary contributions decreased while the relative contributions of vehicle exhaust increased from increased CO data. According to the values of attributable fractions (AF), stroke was the major cause of death, followed by ischemic heart disease (IHD), lung cancer (LC) and chronic obstructive pulmonary disease (COPD). The estimated total deaths in Nanjing due to PM2.5 were 12,055 and 10,771, leading to 98,802 and 87,647 years of life lost in 2014 and 2015, respectively. The elderly and males had higher health risks than youngsters and females. When the PM2.5 concentrations meet the World Health Organization (WHO) Air Quality Guidelines (AQG) of 10 μg/m3, 84% of the premature deaths would be avoided, indicating that the Nanjing government needs to adopt more stringent measure to reduce PM pollution and enhance the health benefits. PMID:29584626

The future of smoking-attributable mortality: the case of England & Wales, Denmark and the Netherlands.

PubMed

Stoeldraijer, Lenny; Bonneux, Luc; van Duin, Coen; van Wissen, Leo; Janssen, Fanny

2015-02-01

We formally estimate future smoking-attributable mortality up to 2050 for the total national populations of England & Wales, Denmark and the Netherlands, providing an update and extension of the descriptive smoking-epidemic model. We used smoking prevalence and population-level lung cancer mortality data for England & Wales, Denmark and the Netherlands, covering the period 1950-2009. To estimate the future smoking-attributable mortality fraction (SAF) we: (i) project lung cancer mortality by extrapolating age-period-cohort trends, using the observed convergence of smoking prevalence and similarities in past lung cancer mortality between men and women as input; and (ii) add other causes of death attributable to smoking by applying a simplified version of the indirect Peto-Lopez method to the projected lung cancer mortality. The SAF for men in 2009 was 19% (44 872 deaths) in England & Wales, 22% (5861 deaths) in Denmark and 25% (16 385 deaths) in the Netherlands. In our projections, these fractions decline to 6, 12 and 14%, respectively, in 2050. The SAF for women peaked at 14% (38 883 deaths) in 2008 in England & Wales, and is expected to peak in 2028 in Denmark (22%) and in 2033 in the Netherlands (23%). By 2050, a decline to 9, 17 and 19%, respectively, is foreseen. Different indirect estimation methods of the SAF in 2050 yield a range of 1-8% (England & Wales), 8-13% (Denmark) and 11-16% (the Netherlands) for men, and 7-16, 12-26 and 13-31% for women. From northern European data we project that smoking-attributable mortality will remain important for the future, especially for women. Whereas substantial differences between countries remain, the age-specific evolution of smoking-attributable mortality remains similar across countries and between sexes. © 2014 Society for the Study of Addiction.

What causes breast cancer? A systematic review of causal attributions among breast cancer survivors and how these compare to expert-endorsed risk factors.

PubMed

Dumalaon-Canaria, Jo Anne; Hutchinson, Amanda D; Prichard, Ivanka; Wilson, Carlene

2014-07-01

The aim of this paper was to review published research that analyzed causal attributions for breast cancer among women previously diagnosed with breast cancer. These attributions were compared with risk factors identified by published scientific evidence in order to determine the level of agreement between cancer survivors' attributions and expert opinion. A comprehensive search for articles, published between 1982 and 2012, reporting studies on causal attributions for breast cancer among patients and survivors was undertaken. Of 5,135 potentially relevant articles, 22 studies met the inclusion criteria. Two additional articles were sourced from reference lists of included studies. Results indicated a consistent belief among survivors that their own breast cancer could be attributed to family history, environmental factors, stress, fate, or chance. Lifestyle factors were less frequently identified, despite expert health information highlighting the importance of these factors in controlling and modifying cancer risk. This review demonstrated that misperceptions about the contribution of modifiable lifestyle factors to the risk of breast cancer have remained largely unchanged over the past 30 years. The findings of this review indicate that beliefs about the causes of breast cancer among affected women are not always consistent with the judgement of experts. Breast cancer survivors did not regularly identify causal factors supported by expert consensus such as age, physical inactivity, breast density, alcohol consumption, and reproductive history. Further research examining psychological predictors of attributions and the impact of cancer prevention messages on adjustment and well-being of cancer survivors is warranted.

Potential health effects of indoor radon exposure.

PubMed Central

Radford, E P

1985-01-01

Radon-222 is a ubiquitous noble gas arising from decay of radium-226 normally present in the earth's crust. Alpha radiation from inhaled short-lived daughters of radon readily irradiates human bronchial epithelium, and there is now good evidence of excess risk of lung cancer in underground miners exposed to higher concentrations. In homes, radon levels are highly variable, showing approximately log-normal distributions and often a small fraction of homes with high concentrations of radon and radon daughters. Factors affecting indoor concentrations include type of bedrock under dwellings, house foundation characteristics, radon dissolved in artesian water, and ventilation and degree of air movement in living spaces. Despite much recent work, exposures to radon daughters by the general public are not well defined. From application of risk assessments in miners to home conditions, it appears that about 25% or more of lung cancers among nonsmokers over the age of 60, and about 5% in smokers, may be attributable to exposure to radon daughters at home. It may be necessary to take remedial action to reduce this hazard in those dwellings with elevated levels of radon, and new construction should take account of this problem. PMID:4085431

The value of counting BCG scars for interpretation of tuberculin skin tests in a tuberculosis hyperendemic shanty-town, Peru

PubMed Central

Saito, M.; Bautista, C. T.; Gilman, R. H.; Bowering, A.; Levy, M. Z.; Evans, C. A.

2010-01-01

SUMMARY SETTING The tuberculin skin test (TST) is widely used as a diagnostic or screening test for Mycobacterium tuberculosis infection and disease. A peri-urban shanty-town in the desert hills of south Lima, Peru, highly endemic for tuberculosis, and where bacille Calmette-Guérin (BCG) vaccine had been given in multiple doses until 1995. OBJECTIVE To analyze the effect of multiple BCG vaccines on TST in a community-based setting. DESIGN Point-prevalence survey of TST reactions of 572 people aged 6–26 years from 255 households. TST reactions were compared to the observed number of BCG scars and other potential risk factors (age, living with a TST-positive person, and contact with active tuberculosis). RESULT People with two or more scars had significantly larger reactions, even after adjusting for potential risk factors. The adjusted population attributable fraction of being TST-positive and having two or more BCG scars was 26%. CONCLUSION There is no demonstrated benefit of repeat BCG vaccination. We therefore recommend that physicians take into consideration the number of BCG scars when interpreting the TST and that programs give no more than one BCG vaccination. PMID:15260275

Consumer preferences for food allergen labeling.

PubMed

Marra, Carlo A; Harvard, Stephanie; Grubisic, Maja; Galo, Jessica; Clarke, Ann; Elliott, Susan; Lynd, Larry D

2017-01-01

Food allergen labeling is an important tool to reduce risk of exposure and prevent anaphylaxis for individuals with food allergies. Health Canada released a Canadian food allergen labeling regulation (2008) and subsequent update (2012) suggesting that research is needed to guide further iterations of the regulation to improve food allergen labeling and reduce risk of exposure. The primary objective of this study was to examine consumer preferences in food labeling for allergy avoidance and anaphylaxis prevention. A secondary objective was to identify whether different subgroups within the consumer population emerged. A discrete choice experiment using a fractional factorial design divided into ten different versions with 18 choice-sets per version was developed to examine consumer preferences for different attributes of food labeling. Three distinct subgroups of Canadian consumers with different allergen considerations and food allergen labeling needs were identified. Overall, preferences for standardized precautionary and safety symbols at little or no increased cost emerged. While three distinct groups with different preferences were identified, in general the results revealed that the current Canadian food allergen labeling regulation can be improved by enforcing the use of standardized precautionary and safety symbols and educating the public on the use of these symbols.

and Sporadic Breast Cancer Patients in Rwanda

PubMed

Habyarimana, Thierry; Attaleb, Mohammed; Mugenzi, Pacifique; Mazarati, Jean Baptiste; Bakri, Youssef; El Mzibri, Mohammed

2018-02-26

Worldwide, breast cancer is the most frequent neoplasm and the second leading cause of cancer death among females. It dominates in both developed and developing countries and represents a major public health problem. The etiology is multifactorial and involves exogenous agents as well as endogenous factors. Although they account for only a small fraction of the breast cancer burden, mutations in the BRCA1 and BRCA2 genes are known to confer a high risk predisposition. Mutations in moderate/low-penetrance genes may also contribute to breast cancer risk. Previous studies have shown that mutations in the CHEK2 gene are involved in breast cancer susceptibility due to its impact on DNA repair processes and replication checkpoints. This study was conducted to evaluate the frequencies of three germline mutations in CHEK2 gene (c.1100delC, R145W and I157T) in breast cancers in Rwanda. Using direct DNA sequencing, we analyzed 41 breast cancer patients and 42 normal breast controls but could not detect any positives. CHEK2 mutations may be a rare event in Rwandan population and may only play a minor if an role in breast cancer predisposition among familial and sporadic cases. Creative Commons Attribution License

CANCER RISKS ATTRIBUTABLE TO LOW DOSES OF IONIZING RADIATION - ASSESSING WHAT WE REALLY KNOW?

EPA Science Inventory

Cancer Risks Attributable to Low Doses of Ionizing Radiation - What Do We Really Know?

Abstract
High doses of ionizing radiation clearly produce deleterious consequences in humans including, but not exclusively, cancer induction. At very low radiation doses the situatio...

Burden of Severe Pneumonia, Pneumococcal Pneumonia and Pneumonia Deaths in Indian States: Modelling Based Estimates

PubMed Central

Farooqui, Habib; Jit, Mark; Heymann, David L.; Zodpey, Sanjay

2015-01-01

The burden of severe pneumonia in terms of morbidity and mortality is unknown in India especially at sub-national level. In this context, we aimed to estimate the number of severe pneumonia episodes, pneumococcal pneumonia episodes and pneumonia deaths in children younger than 5 years in 2010. We adapted and parameterized a mathematical model based on the epidemiological concept of potential impact fraction developed CHERG for this analysis. The key parameters that determine the distribution of severe pneumonia episode across Indian states were state-specific under-5 population, state-specific prevalence of selected definite pneumonia risk factors and meta-estimates of relative risks for each of these risk factors. We applied the incidence estimates and attributable fraction of risk factors to population estimates for 2010 of each Indian state. We then estimated the number of pneumococcal pneumonia cases by applying the vaccine probe methodology to an existing trial. We estimated mortality due to severe pneumonia and pneumococcal pneumonia by combining incidence estimates with case fatality ratios from multi-centric hospital-based studies. Our results suggest that in 2010, 3.6 million (3.3–3.9 million) episodes of severe pneumonia and 0.35 million (0.31–0.40 million) all cause pneumonia deaths occurred in children younger than 5 years in India. The states that merit special mention include Uttar Pradesh where 18.1% children reside but contribute 24% of pneumonia cases and 26% pneumonia deaths, Bihar (11.3% children, 16% cases, 22% deaths) Madhya Pradesh (6.6% children, 9% cases, 12% deaths), and Rajasthan (6.6% children, 8% cases, 11% deaths). Further, we estimated that 0.56 million (0.49–0.64 million) severe episodes of pneumococcal pneumonia and 105 thousand (92–119 thousand) pneumococcal deaths occurred in India. The top contributors to India’s pneumococcal pneumonia burden were Uttar Pradesh, Bihar, Madhya Pradesh and Rajasthan in that order. Our results highlight the need to improve access to care and increase coverage and equity of pneumonia preventing vaccines in states with high pneumonia burden. PMID:26086700

Silencing of the sulfur rich α-gliadin storage protein family in wheat grains (Triticum aestivum L.) causes no unintended side-effects on other metabolites

PubMed Central

Zörb, Christian; Becker, Dirk; Hasler, Mario; Mühling, Karl H.; Gödde, Victoria; Niehaus, Karsten; Geilfus, Christoph-Martin

2013-01-01

Wheat is an important source of proteins and metabolites for human and animal nutrition. To assess the nutritional quality of wheat products, various protein and diverse metabolites have to be evaluated. The grain storage protein family of the α-gliadins are suggested to be the primary initiator of the inflammatory response to gluten in Celiac disease patients. With the technique of RNAi, the α-gliadin storage protein fraction in wheat grains was recently knocked down. From a patient's perspective, this is a desired approach, however, this study aims to evaluate whether such a down-regulation of these problematic α-gliadins also has unintended side-effects on other plant metabolites. Such uncontrolled and unknown arbitrary effects on any metabolite in plants designated for food production would surely represent an avoidable risk for the consumer. In general, α-gliadins are rich in sulfur, making their synthesis and content depended of the sulfur supply. For this reason, the influence of the application of increasing sulfur amounts on the metabolome of α-gliadin-deficient wheat was additionally investigated because it might be possible that e.g., considerable high/low amounts of S might increase or even induce such unintended effects that are not observable under moderate S nutrition. By silencing the α-gliadin genes, a recently developed wheat line that lacks the set of 75 corresponding α-gliadin proteins has become available. The plants were subsequently tested for RNAi-induced effects on metabolites that were not directly attributable to the specific effects of the RNAi-approach on the α-gliadin proteins. For this, GC-MS-based metabolite profiles were recorded. A comparison of wild type with gliadin-deficient plants cultivated in pot experiments revealed no differences in all 109 analyzed metabolites, regardless of the S-nutritional status. No unintended effects attributable to the RNAi-based specific genetic deletion of a storage protein fraction were observed. PMID:24062763

Parainfluenza Virus Infection Among Human Immunodeficiency Virus (HIV)-Infected and HIV-Uninfected Children and Adults Hospitalized for Severe Acute Respiratory Illness in South Africa, 2009–2014

PubMed Central

Cohen, Adam L.; Sahr, Philip K.; Treurnicht, Florette; Walaza, Sibongile; Groome, Michelle J.; Kahn, Kathleen; Dawood, Halima; Variava, Ebrahim; Tempia, Stefano; Pretorius, Marthi; Moyes, Jocelyn; Olorunju, Steven A. S.; Malope-Kgokong, Babatyi; Kuonza, Lazarus; Wolter, Nicole; von Gottberg, Anne; Madhi, Shabir A.; Venter, Marietjie; Cohen, Cheryl

2015-01-01

Background. Parainfluenza virus (PIV) is a common cause of acute respiratory tract infections, but little is known about PIV infection in children and adults in Africa, especially in settings where human immunodeficiency virus (HIV) prevalence is high. Methods. We conducted active, prospective sentinel surveillance for children and adults hospitalized with severe acute respiratory illness (SARI) from 2009 to 2014 in South Africa. We enrolled controls (outpatients without febrile or respiratory illness) to calculate the attributable fraction for PIV infection. Respiratory specimens were tested by multiplex real-time reverse-transcription polymerase chain reaction assay for parainfluenza types 1, 2, and 3. Results. Of 18 282 SARI cases enrolled, 1188 (6.5%) tested positive for any PIV type: 230 (19.4%) were type 1; 168 (14.1%) were type 2; 762 (64.1%) were type 3; and 28 (2.4%) had coinfection with 2 PIV types. After adjusting for age, HIV serostatus, and respiratory viral coinfection, the attributable fraction for PIV was 65.6% (95% CI [confidence interval], 47.1–77.7); PIV contributed to SARI among HIV-infected and -uninfected children <5 years of age and among individuals infected with PIV types 1 and 3. The observed overall incidence of PIV-associated SARI was 38 (95% CI, 36–39) cases per 100 000 population and was highest in children <1 year of age (925 [95% CI, 864–989] cases per 100 000 population). Compared with persons without HIV, persons with HIV had an increased relative risk of PIV hospitalization (9.4; 95% CI, 8.5–10.3). Conclusions. Parainfluenza virus causes substantial severe respiratory disease in South Africa among children <5 years of age, especially those that are infected with HIV. PMID:26566534

THE ROLE OF PRE-EVENT CANOPY STORAGE IN THROUGHFALL AND STEMFLOW USING ISOTOPIC TRACERS

EPA Science Inventory

Stable isotopes can be a valuable tool for tracing the redistribution, storage, and evaporation of water associated with canopy interception of rainfall. Isotopic differences between throughfall and rainfall have been attributed to three mechanisms: evaporative fractionation, iso...

Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015.

PubMed

2016-10-08

The Global Burden of Diseases, Injuries, and Risk Factors Study 2015 provides an up-to-date synthesis of the evidence for risk factor exposure and the attributable burden of disease. By providing national and subnational assessments spanning the past 25 years, this study can inform debates on the importance of addressing risks in context. We used the comparative risk assessment framework developed for previous iterations of the Global Burden of Disease Study to estimate attributable deaths, disability-adjusted life-years (DALYs), and trends in exposure by age group, sex, year, and geography for 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks from 1990 to 2015. This study included 388 risk-outcome pairs that met World Cancer Research Fund-defined criteria for convincing or probable evidence. We extracted relative risk and exposure estimates from randomised controlled trials, cohorts, pooled cohorts, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. We developed a metric that allows comparisons of exposure across risk factors-the summary exposure value. Using the counterfactual scenario of theoretical minimum risk level, we estimated the portion of deaths and DALYs that could be attributed to a given risk. We decomposed trends in attributable burden into contributions from population growth, population age structure, risk exposure, and risk-deleted cause-specific DALY rates. We characterised risk exposure in relation to a Socio-demographic Index (SDI). Between 1990 and 2015, global exposure to unsafe sanitation, household air pollution, childhood underweight, childhood stunting, and smoking each decreased by more than 25%. Global exposure for several occupational risks, high body-mass index (BMI), and drug use increased by more than 25% over the same period. All risks jointly evaluated in 2015 accounted for 57·8% (95% CI 56·6-58·8) of global deaths and 41·2% (39·8-42·8) of DALYs. In 2015, the ten largest contributors to global DALYs among Level 3 risks were high systolic blood pressure (211·8 million [192·7 million to 231·1 million] global DALYs), smoking (148·6 million [134·2 million to 163·1 million]), high fasting plasma glucose (143·1 million [125·1 million to 163·5 million]), high BMI (120·1 million [83·8 million to 158·4 million]), childhood undernutrition (113·3 million [103·9 million to 123·4 million]), ambient particulate matter (103·1 million [90·8 million to 115·1 million]), high total cholesterol (88·7 million [74·6 million to 105·7 million]), household air pollution (85·6 million [66·7 million to 106·1 million]), alcohol use (85·0 million [77·2 million to 93·0 million]), and diets high in sodium (83·0 million [49·3 million to 127·5 million]). From 1990 to 2015, attributable DALYs declined for micronutrient deficiencies, childhood undernutrition, unsafe sanitation and water, and household air pollution; reductions in risk-deleted DALY rates rather than reductions in exposure drove these declines. Rising exposure contributed to notable increases in attributable DALYs from high BMI, high fasting plasma glucose, occupational carcinogens, and drug use. Environmental risks and childhood undernutrition declined steadily with SDI; low physical activity, high BMI, and high fasting plasma glucose increased with SDI. In 119 countries, metabolic risks, such as high BMI and fasting plasma glucose, contributed the most attributable DALYs in 2015. Regionally, smoking still ranked among the leading five risk factors for attributable DALYs in 109 countries; childhood underweight and unsafe sex remained primary drivers of early death and disability in much of sub-Saharan Africa. Declines in some key environmental risks have contributed to declines in critical infectious diseases. Some risks appear to be invariant to SDI. Increasing risks, including high BMI, high fasting plasma glucose, drug use, and some occupational exposures, contribute to rising burden from some conditions, but also provide opportunities for intervention. Some highly preventable risks, such as smoking, remain major causes of attributable DALYs, even as exposure is declining. Public policy makers need to pay attention to the risks that are increasingly major contributors to global burden. Bill & Melinda Gates Foundation. Copyright © 2016 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY license. Published by Elsevier Ltd.. All rights reserved.

Consumer preferences and brand equity measurement of Spanish national daily newspapers: a conjoint analysis approach.

PubMed

Varela Mallou, J; Rial Boubeta, A; Braña Tobío, T

2001-05-01

Brand is a product attribute that, for many types of goods or services, makes a major contribution to consumer preferences. Conjoint analysis is a useful technique for the assessment of brand values for a given consumer or group of consumers. In this paper, an application of conjoint analysis to the estimation of brand values in the Spanish daily newspaper market is reported. Four newspaper attributes were considered: brand (i.e., newspaper name), price (0.60, 1.05, or 1.50 euros), Sunday supplement (yes/no), and daily pullout (yes/no). A total of 510 regular readers of the national press, stratified by age and sex, were asked to rank 16 profiles representing an orthogonal fraction of the possible attribute-level combinations. Brand was by far the most important attribute, whereas price had negligible effect. More generally, the results confirm the utility of conjoint analysis for assessing brand equity in the newspaper market and for estimating the relative importance of the various attributes to different subgroups of consumers.

Polycyclic aromatic hydrocarbons are enriched but bioaccessibility reduced in brownfield soils adhered to human hands.

PubMed

Siciliano, Steven D; Laird, B D; Lemieux, C L

2010-08-01

The health risk associated with exposure to urban brownfields is often driven by the incidental ingestion of soil by humans. Recent evidence found that humans likely ingest the fraction of soil that passes a 45-microm sieve, which is the particle size adhered to the hands. We evaluated if PAH concentrations were enriched in this soil fraction compared to the bulk soil and if this enrichment lead to an increase in bioaccessibility and thus an increase in incremental lifetime cancer risk for exposed persons. Soils (n=18) with PAH concentrations below the current Canadian soil quality guidelines for human health were collected from an Arctic urban site and were sieved to pass a 45-microm sieve. Soil PAH profiles were measured and bioaccessibility was assessed using the Simulator of the Human Intestinal Microbial Ecosystem (SHIME). PAHs were significantly enriched in the <45 microm size fraction (3.7-fold) and this enrichment could be predicted according to the fugacity capacity of soil (Enrichment=2.18-0.055Zsoil, r2=0.65, p<0.001). PAH release in the stomach and small intestine compartments of the SHIME was low (8%) and could not be predicted by PAH concentrations in 45-microm sieved soil. In fact, PAH release in the SHIME was lower from the <45 microm size fraction despite the fact that this fraction had higher levels of PAHs than the bulk soil. We postulate that this occurs because PAHs adsorbed to soil did not reach equilibrium with the small intestinal fluid. In contrast, PAH release in the colonic compartment of the SHIME reached equilibrium and was linked to soil concentration. Bioaccessibility in the SHIME colon could be predicted by the ratio of fugacity capacity of soil to water for a PAH (Bioaccessibility=0.15e(-6.4x10E-7Zsoil/Zwater), r2=0.53, p<0.01). The estimated incremental lifetime cancer risk was significantly greater for the <45 microm soil fraction compared to the bulk fraction; however, when bioaccessible PAH concentrations in a simulated small intestine were used in the risk assessment calculations, cancer risk was slightly lower in the <45 microm soil fraction for these soils. Our results highlight the importance of using a small soil size fraction, e.g. 45 microm, for contaminated site human health risk assessment. However, further work is needed to estimate the bioavailability of this size fraction in an in vivo model and to assess the correlation between in vitro and in vivo gastrointestinal models. Copyright (c) 2010 Elsevier Ltd. All rights reserved.

Occupational exposures and colorectal cancers: A quantitative overview of epidemiological evidence

PubMed Central

Oddone, Enrico; Modonesi, Carlo; Gatta, Gemma

2014-01-01

A traditional belief widespread across the biomedical community was that dietary habits and genetic predisposition were the basic factors causing colorectal cancer. In more recent times, however, a growing evidence has shown that other determinants can be very important in increasing (or reducing) incidence of this malignancy. The hypothesis that environmental and occupational risk factors are associated with colorectal cancer is gaining ground, and high risks of colorectal cancer have been reported among workers in some industrial branches. The aim of this study was to investigate the epidemiologic relationship between colorectal cancer and occupational exposures to several industrial activities, by means of a scientific literature review and meta-analysis. This work pointed out increased risks of colorectal cancer for labourers occupied in industries with a wide use of chemical compounds, such as leather (RR = 1.70, 95%CI: 1.24-2.34), basic metals (RR = 1.32, 95%CI: 1.07-1.65), plastic and rubber manufacturing (RR = 1.30, 95%CI: 0.98-1.71 and RR = 1.27, 95%CI: 0.92-1.76, respectively), besides workers in the sector of repair and installation of machinery exposed to asbestos (RR = 1.40, 95%CI: 1.07-1.84). Based on our results, the estimated crude excess risk fraction attributable to occupational exposure ranged from about 11% to about 15%. However, homogeneous pattern of association between colorectal cancer and industrial branches did not emerge from this review. PMID:25253943

Risk factors for atopic and non-atopic asthma in a rural area of Ecuador.

PubMed

Moncayo, Ana Lucia; Vaca, Maritza; Oviedo, Gisela; Erazo, Silvia; Quinzo, Isabel; Fiaccone, Rosemeire L; Chico, Martha E; Barreto, Mauricio L; Cooper, Philip J

2010-05-01

BACKGROUND Asthma has emerged as an important public health problem of urban populations in Latin America. Epidemiological data suggest that a minority of asthma cases in Latin America may be associated with allergic sensitisation and that other mechanisms causing asthma have been overlooked. The aim of the present study was to investigate risk factors for atopic and non-atopic asthma in school-age children. METHODS A cross-sectional study was conducted among 3960 children aged 6-16 years living in Afro-Ecuadorian rural communities in Esmeraldas province in Ecuador. Allergic diseases and risk factors were assessed by questionnaire and allergic sensitisation by allergen skin prick reactivity. RESULTS A total of 390 (10.5%) children had wheeze within the previous 12 months, of whom 14.4% had at least one positive skin test. The population-attributable fraction for recent wheeze associated with atopy was 2.4%. Heavy Trichuris trichiura infections were strongly inversely associated with atopic wheeze. Non-atopic wheeze was positively associated with maternal allergic symptoms and sedentarism (watching television (>3 h/day)) but inversely associated with age and birth order. CONCLUSIONS The present study showed a predominance of non-atopic compared with atopic wheeze among schoolchildren living in a poor rural region of tropical Latin America. Distinct risk factors were associated with the two wheeze phenotypes and may indicate different causal mechanisms. Future preventive strategies in such populations may need to be targeted at the causes of non-atopic wheeze.

Public Response to a Near-Miss Nuclear Accident Scenario Varying in Causal Attributions and Outcome Uncertainty.

PubMed

Cui, Jinshu; Rosoff, Heather; John, Richard S

2018-05-01

Many studies have investigated public reactions to nuclear accidents. However, few studies focused on more common events when a serious accident could have happened but did not. This study evaluated public response (emotional, cognitive, and behavioral) over three phases of a near-miss nuclear accident. Simulating a loss-of-coolant accident (LOCA) scenario, we manipulated (1) attribution for the initial cause of the incident (software failure vs. cyber terrorist attack vs. earthquake), (2) attribution for halting the incident (fail-safe system design vs. an intervention by an individual expert vs. a chance coincidence), and (3) level of uncertainty (certain vs. uncertain) about risk of a future radiation leak after the LOCA is halted. A total of 773 respondents were sampled using a 3 × 3 × 2 between-subjects design. Results from both MANCOVA and structural equation modeling (SEM) indicate that respondents experienced more negative affect, perceived more risk, and expressed more avoidance behavioral intention when the near-miss event was initiated by an external attributed source (e.g., earthquake) compared to an internally attributed source (e.g., software failure). Similarly, respondents also indicated greater negative affect, perceived risk, and avoidance behavioral intentions when the future impact of the near-miss incident on people and the environment remained uncertain. Results from SEM analyses also suggested that negative affect predicted risk perception, and both predicted avoidance behavior. Affect, risk perception, and avoidance behavior demonstrated high stability (i.e., reliability) from one phase to the next. © 2017 Society for Risk Analysis.

Cyclic AMP-receptor proteins in heart muscle of rats flown on Cosmos 1887

NASA Technical Reports Server (NTRS)

Mednieks, Maija I.; Popova, Irina A.; Grindeland, Richard E.

1991-01-01

The cellular compartmentalization of the cyclic AMP-receptor proteins in heart ventricular tissue obtained from rats flown on the Cosmos 1887 is determined. Photoaffinity labeling of soluble and particular cell fractions with a (32P)-8-azido analog of cyclic AMP is followed by electrophoretic separation of the proteins and by autoradiographic identification of the labeled isoforms of cAPK R subunits. It is shown that RII in the particulate subcellular fraction was significantly decreased in heart cells from rats in the flight group when compared to controls. Protein banding patterns in both the cytoplasmic fraction and in a fraction enriched in chromatin-bound proteins exhibited some variability in tissues of individual animals, but showed no changes that could be directly attributed to flight conditions. No significant change was apparent in the distribution of RI or RII cyclic AMP binding in the soluble fractions. It is inferred that the cardiac cell integrity or its protein content is not compromised under flight conditions.

The economic burden of not meeting food recommendations in Canada: The cost of doing nothing.

PubMed

Lieffers, Jessica R L; Ekwaru, John Paul; Ohinmaa, Arto; Veugelers, Paul J

2018-01-01

Few studies have estimated the economic burden of chronic diseases (e.g., type 2 diabetes, cardiovascular diseases, cancers) attributable to unhealthy eating. In this study, we estimated the economic burden of chronic disease attributable to not meeting Canadian food recommendations. We first obtained chronic disease risk estimates for intakes of both protective (1. vegetables; 2. fruit; 3. whole grains; 4. milk; 5. nuts and seeds) and harmful (6. processed meat; 7. red meat; 8. sugar-sweetened beverages) foods from the Global Burden of Disease Study, and food intakes from the 2004 Canadian Community Health Survey 24-hour dietary recalls (n = 33,932 respondents). We then calculated population attributable fractions (PAFs) for all relevant food-chronic disease combinations by age and sex groups. These PAFs were then mathematically combined for each disease for each age and sex group. We then estimated attributable costs by multiplying these combined PAFs with estimated 2014 annual direct health care (hospital, drug, physician) and indirect (human capital approach) costs for each disease. We found that not meeting recommendations for the eight foods was responsible for CAD$13.8 billion/year (direct health care: CAD$5.1 billion, indirect: CAD$8.7 billion). Nuts and seeds and whole grains were the top cost contributors rather than vegetables and fruit. Our findings suggest that unhealthy eating constitutes a tremendous economic burden to Canada that is similar in magnitude to the burden of smoking and larger than that of physical inactivity which were estimated using similar approaches. A status quo in promotion of healthy eating will allow this burden to continue. Interventions to reduce the health and economic burden of unhealthy eating in Canada may be more effective if they are broad in focus and include promotion of nuts and seeds and whole grains along with vegetables and fruit rather than have a narrow focus such as primarily on vegetables and fruit.

Years of life lost and morbidity cases attributable to transportation noise and air pollution: A comparative health risk assessment for Switzerland in 2010.

PubMed

Vienneau, Danielle; Perez, Laura; Schindler, Christian; Lieb, Christoph; Sommer, Heini; Probst-Hensch, Nicole; Künzli, Nino; Röösli, Martin

2015-08-01

There is growing evidence that chronic exposure to transportation related noise and air pollution affects human health. However, health burden to a country of these two pollutants have been rarely compared. As an input for external cost quantification, we estimated the cardiorespiratory health burden from transportation related noise and air pollution in Switzerland, incorporating the most recent findings related to the health effects of noise. Spatially resolved noise and air pollution models for the year 2010 were derived for road, rail and aircraft sources. Average day-evening-night sound level (Lden) and particulate matter (PM10) were selected as indicators, and population-weighted exposures derived by transportation source. Cause-specific exposure-response functions were derived from a meta-analysis for noise and literature review for PM10. Years of life lost (YLL) were calculated using life table methods; population attributable fraction was used for deriving attributable cases for hospitalisations, respiratory illnesses, visits to general practitioners and restricted activity days. The mean population weighted exposure above a threshold of 48dB(A) was 8.74dB(A), 1.89dB(A) and 0.37dB(A) for road, rail and aircraft noise. Corresponding mean exposure contributions were 4.4, 0.54, 0.12μg/m(3) for PM10. We estimated that in 2010 in Switzerland transportation caused 6000 and 14,000 YLL from noise and air pollution exposure, respectively. While there were a total of 8700 cardiorespiratory hospital days attributed to air pollution exposure, estimated burden due to noise alone amounted to 22,500 hospital days. YLL due to transportation related pollution in Switzerland is dominated by air pollution from road traffic, whereas consequences for morbidity and indicators of quality of life are dominated by noise. In terms of total external costs the burden of noise equals that of air pollution. Copyright © 2015 Elsevier GmbH. All rights reserved.

Comparative lifecycle assessment of alternatives for waste management in Rio de Janeiro - Investigating the influence of an attributional or consequential approach.

PubMed

Bernstad Saraiva, A; Souza, R G; Valle, R A B

2017-10-01

The environmental impacts from three management alternatives for organic fraction of municipal solid waste were compared using lifecycle assessment methodology. The alternatives (sanitary landfill, selective collection of organic waste for anaerobic digestion and anaerobic digestion after post-separation of organic waste) were modelled applying an attributional as well as consequential approach, in parallel with the aim of identifying if and how these approaches can affect results and conclusions. The marginal processes identified in the consequential modelling were in general associated with higher environmental impacts than average processes modelled with an attributional approach. As all investigated waste management alternatives result in net-substitution of energy and in some cases also materials, the consequential modelling resulted in lower absolute environmental impacts in five of the seven environmental impact categories assessed in the study. In three of these, the chosen modelling approach can alter the hierarchy between compared waste management alternatives. This indicates a risk of underestimating potential benefits from efficient energy recovery from waste when applying attributional modelling in contexts in which electricity provision historically has been dominated by technologies presenting rather low environmental impacts, but where projections point at increasing impacts from electricity provision in coming years. Thus, in the present case study, the chosen approach affects both absolute and relative results from the comparison. However, results were largely related to the processes identified as affected by investigated changes, and not merely the chosen modelling approach. The processes actually affected by future choices between different waste management alternatives are intrinsically uncertain. The study demonstrates the benefits of applying different assumptions regarding the processes affected by investigated choices - both for provision of energy and materials substituted by waste management processes in consequential LCA modelling, in order to present outcomes that are relevant as decision support within the waste management sector. Copyright © 2017 Elsevier Ltd. All rights reserved.

Changes and Attribution of Extreme Precipitation in Climate Models: Subdaily and Daily Scales

NASA Astrophysics Data System (ADS)

Zhang, W.; Villarini, G.; Scoccimarro, E.; Vecchi, G. A.

2017-12-01

Extreme precipitation events are responsible for numerous hazards, including flooding, soil erosion, and landslides. Because of their significant socio-economic impacts, the attribution and projection of these events is of crucial importance to improve our response, mitigation and adaptation strategies. Here we present results from our ongoing work.In terms of attribution, we use idealized experiments [pre-industrial control experiment (PI) and 1% per year increase (1%CO2) in atmospheric CO2] from ten general circulation models produced under the Coupled Model Intercomparison Project Phase 5 (CMIP5) and the fraction of attributable risk to examine the CO2 effects on extreme precipitation at the sub-daily and daily scales. We find that the increased CO2 concentration substantially increases the odds of the occurrence of sub-daily precipitation extremes compared to the daily scale in most areas of the world, with the exception of some regions in the sub-tropics, likely in relation to the subsidence of the Hadley Cell. These results point to the large role that atmospheric CO2 plays in extreme precipitation under an idealized framework. Furthermore, we investigate the changes in extreme precipitation events with the Community Earth System Model (CESM) climate experiments using the scenarios consistent with the 1.5°C and 2°C temperature targets. We find that the frequency of annual extreme precipitation at a global scale increases in both 1.5°C and 2°C scenarios until around 2070, after which the magnitudes of the trend become much weaker or even negative. Overall, the frequency of global annual extreme precipitation is similar between 1.5°C and 2°C for the period 2006-2035, and the changes in extreme precipitation in individual seasons are consistent with those for the entire year. The frequency of extreme precipitation in the 2°C experiments is higher than for the 1.5°C experiment after the late 2030s, particularly for the period 2071-2100.

Tropical High Cloud Fraction Controlled by Cloud Lifetime Rather Than Clear-sky Convergence

NASA Astrophysics Data System (ADS)

Seeley, J.; Jeevanjee, N.; Romps, D. M.

2016-12-01

Observations and simulations show a peak in cloud fraction below the tropopause. This peak is usually attributed to a roughly co-located peak in radiatively-driven clear-sky convergence, which is presumed to force convective detrainment and thus promote large cloud fraction. Using simulations of radiative-convective equilibrium forced by various radiative cooling profiles, we refute this mechanism by showing that an upper-tropospheric peak in cloud fraction persists even in simulations with no peak in clear-sky convergence. Instead, cloud fraction profiles seem to be controlled by cloud lifetimes — i.e., how long it takes for clouds to dissipate after they have detrained. A simple model of cloud evaporation shows that the small saturation deficit in the upper troposphere greatly extends cloud lifetimes there, while the large saturation deficit in the lower troposphere causes condensate to evaporate quickly. Since cloud mass flux must go to zero at the tropopause, a peak in cloud fraction emerges at a "sweet spot" below the tropopause where cloud lifetimes are long and there is still sufficient mass flux to be detrained.

Theoretical impact of simulated workplace-based primary prevention of carpal tunnel syndrome in a French region.

PubMed

Roquelaure, Yves; Fouquet, Natacha; Chazelle, Emilie; Descatha, Alexis; Evanoff, Bradley; Bodin, Julie; Petit, Audrey

2018-04-02

Carpal tunnel syndrome (CTS) is the most common nerve entrapment neuropathy in the working-age population. The reduction of CTS incidence in the workforce is a priority for policy makers due to the human, social and economic costs. To assess the theoretical impact of workplace-based primary interventions designed to reduce exposure to personal and/or work-related risk factors for CTS. Surgical CTS were assessed using regional hospital discharge records for persons aged 20-59 in 2009. Using work-related attributable fractions (AFEs), we estimated the number of work-related CTS (WR-CTS) in high-risk jobs. We simulated three theoretical scenarios of workplace-based primary prevention for jobs at risk: a mono-component work-centered intervention reducing the incidence of WR-CTS arbitrarily by 10% (10%-WI), and multicomponent global interventions reducing the incidence of all surgical CTS by 5% and 10% by targeting personal and work risk factors. A limited proportion of CTS were work-related in the region's population. WR-CTS were concentrated in nine jobs at high risk of CTS, amounting to 1603 [1137-2212] CTS, of which 906 [450-1522] were WR-CTS. The 10%-WI, 5%-GI and 10%-GI hypothetically prevented 90 [46-153], 81 [58-111] and 159 [114-223] CTS, respectively. The 10%-GI had the greatest impact regardless of the job. The impact of the 10%-WI interventions was high only in jobs at highest risk and AFEs (e.g. food industry jobs). The 10%-WI and 5%-GI had a similar impact for moderate-risk jobs (e.g. healthcare jobs). The impact of simulated workplace-based interventions suggests that prevention efforts to reduce exposure to work-related risk factors should focus on high-risk jobs. Reducing CTS rates will also require integrated strategies to reduce personal risk factors, particularly in jobs with low levels of work-related risk of CTS.

Mothers' depressive symptoms and children's externalizing behavior: Children's negative emotionality in the development of hostile attributions.

PubMed

Wang, Yiji; Dix, Theodore

2017-03-01

This study examined processes that might account for why negatively emotional children are at high risk for externalizing behavior problems when raised by mothers with depressive symptoms. Because negative emotionality regulates adaptation to stress, we predicted that it would undermine children's adjustment to mothers' depressive symptoms by increasing child emotions likely to elicit reciprocal negativity from depressed mothers, bias negatively children's attributions about others, and activate difficult-to-control oppositional responses. In a large sample (N = 1,082) evaluated from 6 months to second grade, results showed that, when mothers had depressive symptoms early in the child's development, children who were high in negative emotionality-but not those who were low-displayed increased risk for externalizing problems in second grade. This risk reflected tendencies for negatively emotional children, when raised by mothers with depressive symptoms, to develop hostile attributions about others and poor self-regulation of the negativity these attributions promote. The findings suggest that, when mothers with depressive symptoms raise negatively emotional children, children's risk for externalizing behavior problems may reflect tendencies for high negative emotion in children and reciprocal negativity in the dyad to undermine the development of attributional and self-regulatory processes. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Field and laboratory measurements of biomass burning and vehicle exhaust using a PTR-MS

NASA Astrophysics Data System (ADS)

VanderSchelden, Graham Samuel

The Proton Transfer Reaction Mass Spectrometer (PTR-MS) is a powerful tool for analyzing organic compounds in air and has been applied in field and laboratory applications to assess emissions from biomass burning and vehicles. Biomass burning is an important source of air pollution globally in the form of wild fires, burning of crop stubble, and combustion of organic material for home energy. In the United States, residential wood combustion combined with low inversion heights in winter time has caused air quality problems. Through field deployment of the PTR-MS in Xi'an China during August of 2011, it was determined that 27%, 16%, 26%, and 12% of ambient carbon monoxide (CO), acetaldehyde, benzene, and toluene could be attributed to biomass burning. The PTR-MS was also deployed to Yakima, Washington in January of 2013, finding that residential wood combustion was a substantial source of air toxics and PM. Residential wood combustion contributed 100%, 73%, 69%, 55%, 36%, 19%, 19%, and 17% of organic PM1, formaldehyde, acetaldehyde, black carbon, benzene, toluene, C2-alkylbenzenes, and CO respectively. Diesel vehicles are becoming a larger fraction of the vehicle fleet and can be held responsible for a substantial fraction of air pollution emissions from on and off road mobile sources. Diesel engines are a source of low volatility products that are difficult to measure and are thought to be important in the formation of secondary organic aerosol (SOA). This work focuses on measuring important diesel exhaust compounds with the PTR-MS and assessing oxidation processes of these compounds. When the PTR-MS was deployed to the field along with a thermal desorption pre-concentration system, we estimated that diesel vehicles were about 3-15% of the vehicle activity influencing our study site in Yakima, WA using the ratio of m/z 157 to m/z 129. SOA yields of diesel exhaust compounds were assessed and about 48% of the SOA was attributed to compounds measured by the PTR-MS; with 21% attributed to alkylbenzenes, 20% attributed to alkanes, 3% attributed to alkylnaphthalenes, 3% attributed to molecular weight 178 polycyclic aromatic hydrocarbons, and 1% attributable to cycloalkanes.

Very Low Birthweight: Dysregulated gestation versus evolutionary adaptation

PubMed Central

Catalano, Ralph; Karasek, Deborah; Gemmill, Alison; Falconi, April; Goodman, Julia; Magganas, Aristotle; Hartig, Terry

2015-01-01

Much medical literature attributes persistently high rates of very low birthweight (VLBW) to “dysregulated” gestation. We offer the alternative view that natural selection conserved well-regulated, though nonconscious, decisional biology that protects the reproductive fitness of women by spontaneously aborting gestations that would otherwise yield frail infants, particularly small males. Modern obstetric practice, however, converts some fraction of these erstwhile spontaneous abortions into live births of very small infants. We further propose that the nonconscious decisional biology of gestation exhibits preferences also seen in consciously made decisions. We hypothesize that the incidence of VLBW among male infants should vary with the population's self-reported intentions to assume financial risk. We apply time-series modeling to monthly birth counts by sex and weight from the Swedish Medical Birth Registry between January 1993 and December 2010. We gauge risk aversion with monthly data from the Micro Index of the Swedish Consumer Tendency Survey (MISCT). Consistent with our argument that nonconscious decisional biology shares risk aversion with conscious decisions, we find that the incidence of VLBW among male infants in Sweden varies with the population's self-reported intentions to assume financial risk. We find increases above expected odds of a very low weight infant among males born 1 month after increases above expected levels of self-reported risk aversion in the Swedish population. We offer this finding as support for the argument that persistently high rates of VLBW arise, at least in part, from a combination of medical interventions and mechanisms conserved by natural selection to protect reproductive fitness. PMID:24593927

Transesophageal echocardiography in cryptogenic stroke and patent foramen ovale: analysis of putative high-risk features from the risk of paradoxical embolism database.

PubMed

Wessler, Benjamin S; Thaler, David E; Ruthazer, Robin; Weimar, Christian; Di Tullio, Marco R; Elkind, Mitchell S V; Homma, Shunichi; Lutz, Jennifer S; Mas, Jean-Louis; Mattle, Heinrich P; Meier, Bernhard; Nedeltchev, Krassen; Papetti, Federica; Di Angelantonio, Emanuele; Reisman, Mark; Serena, Joaquín; Kent, David M

2014-01-01

Patent foramen ovale (PFO) is associated with cryptogenic stroke (CS), although the pathogenicity of a discovered PFO in the setting of CS is typically unclear. Transesophageal echocardiography features such as PFO size, associated hypermobile septum, and presence of a right-to-left shunt at rest have all been proposed as markers of risk. The association of these transesophageal echocardiography features with other markers of pathogenicity has not been examined. We used a recently derived score based on clinical and neuroimaging features to stratify patients with PFO and CS by the probability that their stroke is PFO-attributable. We examined whether high-risk transesophageal echocardiography features are seen more frequently in patients more likely to have had a PFO-attributable stroke (n=637) compared with those less likely to have a PFO-attributable stroke (n=657). Large physiologic shunt size was not more frequently seen among those with probable PFO-attributable strokes (odds ratio [OR], 0.92; P=0.53). The presence of neither a hypermobile septum nor a right-to-left shunt at rest was detected more often in those with a probable PFO-attributable stroke (OR, 0.80; P=0.45; OR, 1.15; P=0.11, respectively). We found no evidence that the proposed transesophageal echocardiography risk markers of large PFO size, hypermobile septum, and presence of right-to-left shunt at rest are associated with clinical features suggesting that a CS is PFO-attributable. Additional tools to describe PFOs may be useful in helping to determine whether an observed PFO is incidental or pathogenically related to CS.

Bayesian Estimation of Pneumonia Etiology: Epidemiologic Considerations and Applications to the Pneumonia Etiology Research for Child Health Study

PubMed Central

Fu, Wei; Shi, Qiyuan; Prosperi, Christine; Wu, Zhenke; Hammitt, Laura L.; Feikin, Daniel R.; Baggett, Henry C.; Howie, Stephen R.C.; Scott, J. Anthony G.; Murdoch, David R.; Madhi, Shabir A.; Thea, Donald M.; Brooks, W. Abdullah; Kotloff, Karen L.; Li, Mengying; Park, Daniel E.; Lin, Wenyi; Levine, Orin S.; O’Brien, Katherine L.; Zeger, Scott L.

2017-01-01

Abstract In pneumonia, specimens are rarely obtained directly from the infection site, the lung, so the pathogen causing infection is determined indirectly from multiple tests on peripheral clinical specimens, which may have imperfect and uncertain sensitivity and specificity, so inference about the cause is complex. Analytic approaches have included expert review of case-only results, case–control logistic regression, latent class analysis, and attributable fraction, but each has serious limitations and none naturally integrate multiple test results. The Pneumonia Etiology Research for Child Health (PERCH) study required an analytic solution appropriate for a case–control design that could incorporate evidence from multiple specimens from cases and controls and that accounted for measurement error. We describe a Bayesian integrated approach we developed that combined and extended elements of attributable fraction and latent class analyses to meet some of these challenges and illustrate the advantage it confers regarding the challenges identified for other methods. PMID:28575370

Relationship between Classroom Absenteeism and Stress Risk/Buffer Factors, Depressogenic Attributional Style, Depression and Classroom Academic Performance.

ERIC Educational Resources Information Center

Slem, Charles M.

The relationship between classroom absenteeism and academic performance has been well documented. To assess the relationship between absenteeism and traditional stress risk/buffer factors, depressogenic attributional style, depression and academic performance, 68 students completed the Internal-External Control Scale, two versions of life event…

Mineralogical, chemical and toxicological characterization of urban air particles.

PubMed

Čupr, Pavel; Flegrová, Zuzana; Franců, Juraj; Landlová, Linda; Klánová, Jana

2013-04-01

Systematic characterization of morphological, mineralogical, chemical and toxicological properties of various size fractions of the atmospheric particulate matter was a main focus of this study together with an assessment of the human health risks they pose. Even though near-ground atmospheric aerosols have been a subject of intensive research in recent years, data integrating chemical composition of particles and health risks are still scarce and the particle size aspect has not been properly addressed yet. Filling this gap, however, is necessary for reliable risk assessment. A high volume ambient air sampler equipped with a multi-stage cascade impactor was used for size specific particle collection, and all 6 fractions were a subject of detailed characterization of chemical (PAHs) and mineralogical composition of the particles, their mass size distribution and genotoxic potential of organic extracts. Finally, the risk level for inhalation exposure associated to the carcinogenic character of the studied PAHs has been assessed. The finest fraction (<0.45 μm) exhibited the highest mass, highest active surface, highest amount of associated PAHs and also highest direct and indirect genotoxic potentials in our model air sample. Risk assessment of inhalation scenario indicates the significant cancer risk values in PM 1.5 size fraction. This presented new approach proved to be a useful tool for human health risk assessment in the areas with significant levels of air dust concentration. Copyright © 2013 Elsevier Ltd. All rights reserved.

Polymorphic Transformation in Mixtures of High- and Low-Melting Fractions of Milk Fat

DOE Office of Scientific and Technical Information (OSTI.GOV)

Cisneros,A.; Mazzanti, G.; Campos, R.

2006-01-01

The kinetics of crystallization of high-melting fraction (HMF) and a mixture of 40% HMF and 60% low-melting fraction (LMF) of milk fat were studied at 5 C by time-resolved in-situ synchrotron X-ray diffraction. HMF crystallized in the {alpha} polymorph, had a longer lifetime than the ones previously reported in pure milk fat, and was almost completely solid. The HMF/LMF mixture crystallized initially in the {alpha} form and transformed into the {beta}' polymorph, with a solid fat content much lower than that of HMF. The polymorphic change was therefore attributed to a delayed sudden formation of {beta}' mixed crystals from themore » uncrystallized melt. These findings are important for the food industry and as fundamental knowledge to improve our understanding of the origin of the macroscopic physical properties of solid milk fat fractions used in many manufacturing processes.« less

What Matters to Women When Making Decisions About Breast Cancer Chemoprevention?

PubMed

Martinez, Kathryn A; Fagerlin, Angela; Witteman, Holly O; Holmberg, Christine; Hawley, Sarah T

2016-04-01

Despite the effectiveness of chemoprevention (tamoxifen and raloxifene) in preventing breast cancer among women at high risk for the disease, uptake is low. The objective of this study was to determine the tradeoff preferences for various attributes associated with chemoprevention among women not currently taking the drugs. We used rating-based conjoint analysis to evaluate the relative importance of a number of attributes associated with chemoprevention, including risk of side effects, drug effectiveness, time needed to take the drugs, and availability of a blood test to see if the drugs were working in an Internet sample of women. We generated mean importance values and part-worth utilities for all attribute levels associated with taking chemoprevention. We then used multivariable linear regression to examine attribute importance scores controlling for participant age, race, Hispanic ethnicity, educational level, and a family history of breast cancer. Overall interest in taking chemoprevention was low among the 1094 women included in the analytic sample, even for the scenario in which participants would receive the greatest benefit and fewest risks associated with taking the drugs. Time needed to take the pill for it to work and 5-year risk of breast cancer were the most important attributes driving tradeoff preferences between the chemoprevention scenarios. Interest in taking chemoprevention among this sample of women at average risk was low. Addressing women's concerns about the time needed to take chemoprevention for it to work may help clinicians improve uptake of the drugs among those likely to benefit.

Cancer incidence attributable to inadequate physical activity in Alberta in 2012

PubMed Central

Brenner, Darren R.; Poirier, Abbey E.; Grundy, Anne; Khandwala, Farah; McFadden, Alison; Friedenreich, Christine M.

2017-01-01

Background: Physical inactivity has been consistently associated with increased risk of colorectal, endometrial, breast (in postmenopausal women), prostate, lung and ovarian cancers. The objective of the current analysis was to estimate the proportion and absolute number of site-specific cancer cases attributable to inadequate physical activity in Alberta in 2012. Methods: We used population attributable risks to estimate the proportion of each site-specific cancer attributable to inactivity. Relative risk estimates were obtained from the epidemiological literature, and prevalence estimates were calculated with the use of data from the Canadian Community Health Survey cycle 2.1 (2003). Respondents who acquired 1.5-2.9 kcal/kg per day and less than 1.5 kcal/kg per day of physical activity were classified as moderately active and inactive, respectively, and both levels were considered inadequate for mitigating cancer risks. We obtained age-, sex- and site-specific cancer incidence data from the Alberta Cancer Registry for 2012. Results: About 59%-75% of men and 69%-78% of women did not engage in adequate physical activity. Overall, 13.8% of cancers across all associated cancers were estimated to be attributable to inadequate physical activity, representing 7.2% of all cancers diagnosed in Alberta in 2012. Suboptimal levels of physical activity had a greater impact among women: the proportion of all associated cancers attributable to inadequate physical activity was 18.3% for women and 9.9% for men. Interpretation: A substantial proportion of cancer cases diagnosed in Alberta were estimated to be attributable to inadequate physical activity. With the high prevalence of physical inactivity among adults in the province, developing strategies to increase physical activity levels could have a notable impact on reducing future cancer burden in Alberta. PMID:28468830

Cerebral radiation necrosis: incidence, outcomes, and risk factors with emphasis on radiation parameters and chemotherapy.

PubMed

Ruben, Jeremy D; Dally, Michael; Bailey, Michael; Smith, Robin; McLean, Catriona A; Fedele, Pasqual

2006-06-01

To investigate radiation necrosis in patients treated for glioma in terms of incidence, outcomes, predictive and prognostic factors. Records were reviewed for 426 patients followed up until death or for at least 3 years. Logistic regression analysis was performed to identify predictive and prognostic factors. Multivariate survival analysis was conducted using Cox proportional hazards regression. Separate analyses were performed for the subset of 352 patients who received a biologically effective dose (BED) > or =85.5 Gy2 (> or =45 Gy/25 fractions) who were at highest risk for radionecrosis. Twenty-one patients developed radionecrosis (4.9%). Actuarial incidence plateaued at 13.3% after 3 years. In the high-risk subset, radiation parameters confirmed as risk factors included total dose (p < 0.001), BED (p < 0.005), neuret (p < 0.001), fraction size (p = 0.028), and the product of total dose and fraction size (p = 0.001). No patient receiving a BED <96 Gy2 developed radionecrosis. Subsequent chemotherapy significantly increased the risk of cerebral necrosis (p = 0.001) even when adjusted for BED (odds ratio [OR], 5.8; 95% confidence interval [CI], 1.6-20.3) or length of follow-up (OR, 5.4; 95% CI, 1.5-19.3). Concurrent use of valproate appeared to delay the onset of necrosis (p = 0.013). The development of radionecrosis did not affect survival (p = 0.09). Cerebral necrosis is unlikely at doses below 50 Gy in 25 fractions. The risk increases significantly with increasing radiation dose, fraction size, and the subsequent administration of chemotherapy.

CYP2D6 activity and the risk of recurrence of Plasmodium vivax malaria in the Brazilian Amazon: a prospective cohort study.

PubMed

Brasil, Larissa W; Rodrigues-Soares, Fernanda; Santoro, Ana B; Almeida, Anne C G; Kühn, Andrea; Ramasawmy, Rajendranath; Lacerda, Marcus V G; Monteiro, Wuelton M; Suarez-Kurtz, Guilherme

2018-02-01

CYP2D6 pathway mediates the activation of primaquine into active metabolite(s) in hepatocytes. CYP2D6 is highly polymorphic, encoding CYP2D6 isoforms with normal, reduced, null or increased activity. It is hypothesized that Plasmodium vivax malaria patients with defective CYP2D6 function would be at increased risk for primaquine failure to prevent recurrence. The aim of this study was to investigate the association of CYP2D6 polymorphisms and inferred CYP2D6 phenotypes with malaria recurrence in patients from the Western Brazilian Amazon, following chloroquine/primaquine combined therapy. The prospective cohort consisted of P. vivax malaria patients who were followed for 6 months after completion of the chloroquine/primaquine therapy. Recurrence was defined as one or more malaria episodes, 28-180 days after the initial episode. Genotyping for nine CYP2D6 SNPs and copy number variation was performed using TaqMan assays in a Fast 7500 Real-Time System. CYP2D6 star alleles (haplotypes), diplotypes and CYP2D6 phenotypes were inferred, and the activity score system was used to define the functionality of the CYP2D6 diplotypes. CYP2D6 activity scores (AS) were dichotomized at ≤ 1 (gPM, gIM and gNM-S phenotypes) and ≥ 1.5 (gNM-F and gUM phenotypes). Genotyping was successfully performed in 190 patients (44 with recurrence and 146 without recurrences). Recurrence incidence was higher in individuals presenting reduced activity CYP2D6 phenotypes (adjusted relative risk = 1.89, 95% CI 1.01-3.70; p = 0.049). Attributable risk and population attributable fraction were 11.5 and 9.9%, respectively. The time elapsed from the first P. vivax malaria episode until the recurrence did not differ between patients with AS of ≤ 1 versus ≥ 1.5 (p = 0.917). The results suggest that CYP2D6 polymorphisms are associated with increased risk of recurrence of vivax malaria, following chloroquine-primaquine combined therapy. This association is interpreted as the result of reduced conversion of primaquine into its active metabolites in patients with reduced CYP2D6 enzymatic activity.

Post-neonatal mortality in Norway 1969-95: a cause-specific analysis.

PubMed

Arntzen, Annett; Samuelsen, Sven Ove; Daltveit, Anne Kjersti; Stoltenberg, Camilla

2006-08-01

We recently reported increased social inequality for post-neonatal death. The aim of the present study was to investigate the association between socioeconomic status and cause-specific post-neonatal death. All 1,483,857 live births recorded in the Medical Birth Registry of Norway from 1969-95 with information on parents' education were included. During the post-neonatal period (from 28 to 364 days of life) 4,464 infants died. Differences between education groups were estimated as risk differences, relative risks, population attributable fractions, and relative index of inequality. The major causes of death were congenital conditions, sudden infant death syndrome (SIDS), and infections. Post-neonatal mortality declined from 3.2/1,000 in the 1970s to 1.9/1,000 in the 1990s, mainly due to reduced mortality from congenital conditions. The absolute risk for SIDS increased by 0.51/1,000 in the same period among infants whose mothers had low education, while it decreased by 0.56/1,000 for those whose mothers had high education. The relative risk for SIDS among infants whose mothers had low education increased from 1.02 in the 1970s to 2.39 in the 1980s and 5.63 in the 1990s. Among infants whose fathers were not recorded in the Birth Registry, the absolute risk of SIDS increased by 0.79/1,000 from the 1970s to the 1990s. Increased social inequality for post-neonatal death was primarily due to increases in the absolute and relative risks of SIDS among infants whose mothers have low education. Social inequality widened during the study period for SIDS and deaths caused by infections.

In Vitro Study on Glucose Utilization Capacity of Bioactive Fractions of Houttuynia cordata in Isolated Rat Hemidiaphragm and Its Major Phytoconstituent

PubMed Central

Kumar, Manish; Prasad, Satyendra K.; Hemalatha, Siva

2016-01-01

Objective. The whole plant of Houttuynia cordata has been reported to have potent antihyperglycemic activity. Therefore, the present study was undertaken to investigate the glucose utilization capacity of bioactive fractions of ethanol extract of Houttuynia cordata (HC) in isolated rat hemidiaphragm. Methods. All the fractions, that is, aqueous (AQ), hexane (HEX), chloroform (CHL), and ethyl acetate (EA), obtained from ethanol extract of H. cordata were subjected to phytochemical standardization use in quercetin as a marker with the help of HPTLC. Further, glucose utilization capacity by rat hemidiaphragm was evaluated in 12 different sets of in vitro experiments. In the study, different fractions from H. cordata as mentioned above were evaluated, where insulin was used as standard and quercetin as a biological standard. Results. Among all the tested fractions, AQ and EA significantly increased glucose uptake by isolated rat hemidiaphragm compared to negative control. Moreover, AQ fractions enhanced the uptake of glucose significantly (p < 0.05) and was found to be more effective than insulin. Conclusions. The augmentation in glucose uptake by hemidiaphragm in presence of AQ and EA fractions may be attributed to the presence of quercetin, which was found to be 7.1 and 3.2% w/w, respectively, in both the fractions. PMID:26925100