Communicating the risk of injury in schoolboy rugby: using Poisson probability as an alternative presentation of the epidemiology.

PubMed

Parekh, Nikesh; Hodges, Stewart D; Pollock, Allyson M; Kirkwood, Graham

2012-06-01

The communication of injury risk in rugby and other sports is underdeveloped and parents, children and coaches need to be better informed about risk. A Poisson distribution was used to transform population based incidence of injury into average probabilities of injury to individual players. The incidence of injury in schoolboy rugby matches range from 7 to 129.8 injuries per 1000 player-hours; these rates translate to average probabilities of injury to a player of between 12% and 90% over a season. Incidence of injury and average probabilities of injury over a season should be published together in all future epidemiological studies on school rugby and other sports. More research is required on informing and communicating injury risks to parents, staff and children and how it affects monitoring, decision making and prevention strategies.

Impairment of functioning and substance use in a Latino population.

PubMed

Mercado, Alfonso; Talavera Garza, Liza; Popan, Jason; Finn-Nguyen, Kim; Sharma, Rachita; Colunga-Rodriguez, Cecilia

2017-12-20

This study investigated the association of academic outcomes, romantic relationships, and substance use (tobacco, marijuana, cocaine) with alcohol dependence in a sample of Latino (N = 1,143) college students. Secondary data analysis was conducted on measures of grade point average in college, relationship satisfaction, drug use, and alcohol dependence. Latino college students who reported alcohol dependency had significant relational dissatisfaction and poor academic outcomes. Thus, lower grade point average and relationship dissatisfaction were associated with alcohol dependence. By focusing specifically on a Mexican American population, this study adds important information to current research regarding the commonality and differences across cultural groups regarding drug use and dependence and further clarifies the risk factors associated with substance use and dependency in a population that is vulnerable for at-risk behaviors. This study also offers insight into potential targets of treatment and intervention for this cultural group.

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.

Investigating maternal risk factors as potential targets of intervention to reduce socioeconomic inequality in small for gestational age: a population-based study.

PubMed

Hayward, Irene; Malcoe, Lorraine Halinka; Cleathero, Lesley A; Janssen, Patricia A; Lanphear, Bruce P; Hayes, Michael V; Mattman, Andre; Pampalon, Robert; Venners, Scott A

2012-06-13

The major aim of this study was to investigate whether maternal risk factors associated with socioeconomic status and small for gestational age (SGA) might be viable targets of interventions to reduce differential risk of SGA by socioeconomic status (socioeconomic SGA inequality) in the metropolitan area of Vancouver, Canada. This study included 59,039 live, singleton births in the Vancouver Census Metropolitan Area (Vancouver) from January 1, 2006 to September 17, 2009. To identify an indicator of socioeconomic SGA inequality, we used hierarchical logistic regression to model SGA by area-level variables from the Canadian census. We then modelled SGA by area-level average income plus established maternal risk factors for SGA and calculated population attributable SGA risk percentages (PAR%) for each variable. Associations of maternal risk factors for SGA with average income were investigated to identify those that might contribute to SGA inequality. Finally, we estimated crude reductions in the percentage and absolute differences in SGA risks between highest and lowest average income quintiles that would result if interventions on maternal risk factors successfully equalized them across income levels or eliminated them altogether. Average income produced the most linear and statistically significant indicator of socioeconomic SGA inequality with 8.9% prevalence of SGA in the lowest income quintile compared to 5.6% in the highest. The adjusted PAR% of SGA for variables were: bottom four quintiles of height (51%), first birth (32%), bottom four quintiles of average income (14%), oligohydramnios (7%), underweight or hypertension, (6% each), smoking (3%) and placental disorder (1%). Shorter height, underweight and smoking during pregnancy had higher prevalence in lower income groups. Crude models assuming equalization of risk factors across income levels or elimination altogether indicated little potential change in relative socioeconomic SGA inequality and reduction in absolute SGA inequality for shorter height only. Our findings regarding maternal height may indicate trans-generational aetiology for socioeconomic SGA inequalities and/or that adult height influences social mobility. Conditions affecting foetal and childhood growth might be viable targets to reduce absolute socioeconomic SGA inequality in future generations, but more research is needed to determine whether such an approach is appropriate.

Risk of Advanced Neoplasia in First-Degree Relatives with Colorectal Cancer: A Large Multicenter Cross-Sectional Study

PubMed Central

Quintero, Enrique; Gargallo, Carla; Lanas, Angel; Bujanda, Luis; Gimeno-García, Antonio Z.; Hernández-Guerra, Manuel; Nicolás-Pérez, David; Alonso-Abreu, Inmaculada; Morillas, Juan Diego; Balaguer, Francesc; Muriel, Alfonso

2016-01-01

Background First-degree relatives (FDR) of patients with colorectal cancer have a higher risk of developing colorectal cancer than the general population. For this reason, screening guidelines recommend colonoscopy every 5 or 10 y, starting at the age of 40, depending on whether colorectal cancer in the index-case is diagnosed at <60 or ≥60 y, respectively. However, studies on the risk of neoplastic lesions are inconclusive. The aim of this study was to determine the risk of advanced neoplasia (three or more non-advanced adenomas, advanced adenoma, or invasive cancer) in FDR of patients with colorectal cancer compared to average-risk individuals (i.e., asymptomatic adults 50 to 69 y of age with no family history of colorectal cancer). Methods and Findings This cross-sectional analysis includes data from 8,498 individuals undergoing their first lifetime screening colonoscopy between 2006 and 2012 at six Spanish tertiary hospitals. Of these individuals, 3,015 were defined as asymptomatic FDR of patients with colorectal cancer (“familial-risk group”) and 3,038 as asymptomatic with average-risk for colorectal cancer (“average-risk group”). The familial-risk group was stratified as one FDR, with one family member diagnosed with colorectal cancer at ≥60 y (n = 1,884) or at <60 y (n = 831), and as two FDR, with two family members diagnosed with colorectal cancer at any age (n = 300). Multiple logistic regression analysis was used for between-group comparisons after adjusting for potential confounders (age, gender, and center). Compared with the average-risk group, advanced neoplasia was significantly more prevalent in individuals having two FDR with colorectal cancer (odds ratio [OR] 1.90; 95% confidence interval [CI] 1.36–2.66, p < 0.001), but not in those having one FDR with colorectal cancer diagnosed at ≥60 y (OR 1.03; 95% CI 0.83–1.27, p = 0.77) and <60 y (OR 1.19; 95% CI 0.90–1.58, p = 0.20). After the age of 50 y, men developed advanced neoplasia over two times more frequently than women and advanced neoplasia appeared at least ten y earlier. Fewer colonoscopies by 2-fold were required to detect one advanced neoplasia in men than in women. Major limitations of this study were first that although average-risk individuals were consecutively included in a randomized control trial, this was not the case for all individuals in the familial-risk cohort; and second, the difference in age between the average-risk and familial-risk cohorts. Conclusions Individuals having two FDR with colorectal cancer showed an increased risk of advanced neoplasia compared to those with average-risk for colorectal cancer. Men had over 2-fold higher risk of advanced neoplasia than women, independent of family history. These data suggest that screening colonoscopy guidelines should be revised in the familial-risk population. PMID:27138769

Space Radiation Cancer, Circulatory Disease and CNS Risks for Near Earth Asteroid and Mars Missions: Uncertainty Estimates for Never-Smokers

NASA Technical Reports Server (NTRS)

Cucinotta, Francis A.; Chappell, Lori J.; Wang, Minli; Kim, Myung-Hee

2011-01-01

The uncertainties in estimating the health risks from galactic cosmic rays (GCR) and solar particle events (SPE) are a major limitation to the length of space missions and the evaluation of potential risk mitigation approaches. NASA limits astronaut exposures to a 3% risk of exposure induced cancer death (REID), and protects against uncertainties in risks projections using an assessment of 95% confidence intervals after propagating the error from all model factors (environment and organ exposure, risk coefficients, dose-rate modifiers, and quality factors). Because there are potentially significant late mortality risks from diseases of the circulatory system and central nervous system (CNS) which are less well defined than cancer risks, the cancer REID limit is not necessarily conservative. In this report, we discuss estimates of lifetime risks from space radiation and new estimates of model uncertainties are described. The key updates to the NASA risk projection model are: 1) Revised values for low LET risk coefficients for tissue specific cancer incidence, with incidence rates transported to an average U.S. population to estimate the probability of Risk of Exposure Induced Cancer (REIC) and REID. 2) An analysis of smoking attributable cancer risks for never-smokers that shows significantly reduced lung cancer risk as well as overall cancer risks from radiation compared to risk estimated for the average U.S. population. 3) Derivation of track structure based quality functions depends on particle fluence, charge number, Z and kinetic energy, E. 4) The assignment of a smaller maximum in quality function for leukemia than for solid cancers. 5) The use of the ICRP tissue weights is shown to over-estimate cancer risks from SPEs by a factor of 2 or more. Summing cancer risks for each tissue is recommended as a more accurate approach to estimate SPE cancer risks. 6) Additional considerations on circulatory and CNS disease risks. Our analysis shows that an individual s history of smoking exposure has a larger impact on GCR risk estimates than amounts of radiation shielding or age at exposure (amongst adults). Risks for never-smokers compared to the average U.S. population are estimated to be reduced between 30% and 60% dependent on model assumptions. Lung cancer is the major contributor to the reduction for never-smokers, with additional contributions from circulatory diseases and cancers of the stomach, liver, bladder, oral cavity and esophagus, and leukemia. The relative contribution of CNS risks to the overall space radiation detriment is potentially increased for never-smokers such as most astronauts. Problems in estimating risks for former smokers and the influence of second-hand smoke are discussed. Compared to the LET approximation, the new track structure derived radiation quality functions lead to a reduced risk for relativistic energy particles and increased risks for intermediate energy particles. Revised estimates for the number of safe days in space at solar minimum for heavy shielding conditions are described for never-smokers and the average U.S. population. Results show that missions to near Earth asteroids (NEA) or Mars violate NASA's radiation safety standards with the current levels of uncertainties. Greater improvements in risk estimates for never-smokers are possible, and would be dependent on improved understanding of risk transfer models, and elucidating the role of space radiation on the various stages of disease formation (e.g. initiation, promotion, and progression).

Global methylmercury exposure from seafood consumption and risk of developmental neurotoxicity: a systematic review

PubMed Central

Burke, Thomas A; Navas-Acien, Ana; Breysse, Patrick N; McGready, John; Fox, Mary A

2014-01-01

Abstract Objective To examine biomarkers of methylmercury (MeHg) intake in women and infants from seafood-consuming populations globally and characterize the comparative risk of fetal developmental neurotoxicity. Methods A search was conducted of the published literature reporting total mercury (Hg) in hair and blood in women and infants. These biomarkers are validated proxy measures of MeHg, a neurotoxin found primarily in seafood. Average and high-end biomarkers were extracted, stratified by seafood consumption context, and pooled by category. Medians for average and high-end pooled distributions were compared with the reference level established by a joint expert committee of the Food and Agriculture Organization (FAO) and the World Health Organization (WHO). Findings Selection criteria were met by 164 studies of women and infants from 43 countries. Pooled average biomarkers suggest an intake of MeHg several times over the FAO/WHO reference in fish-consuming riparians living near small-scale gold mining and well over the reference in consumers of marine mammals in Arctic regions. In coastal regions of south-eastern Asia, the western Pacific and the Mediterranean, average biomarkers approach the reference. Although the two former groups have a higher risk of neurotoxicity than the latter, coastal regions are home to the largest number at risk. High-end biomarkers across all categories indicate MeHg intake is in excess of the reference value. Conclusion There is a need for policies to reduce Hg exposure among women and infants and for surveillance in high-risk populations, the majority of which live in low-and middle-income countries. PMID:24700993

Global methylmercury exposure from seafood consumption and risk of developmental neurotoxicity: a systematic review.

PubMed

Sheehan, Mary C; Burke, Thomas A; Navas-Acien, Ana; Breysse, Patrick N; McGready, John; Fox, Mary A

2014-04-01

To examine biomarkers of methylmercury (MeHg) intake in women and infants from seafood-consuming populations globally and characterize the comparative risk of fetal developmental neurotoxicity. A search was conducted of the published literature reporting total mercury (Hg) in hair and blood in women and infants. These biomarkers are validated proxy measures of MeHg, a neurotoxin found primarily in seafood. Average and high-end biomarkers were extracted, stratified by seafood consumption context, and pooled by category. Medians for average and high-end pooled distributions were compared with the reference level established by a joint expert committee of the Food and Agriculture Organization (FAO) and the World Health Organization (WHO). Selection criteria were met by 164 studies of women and infants from 43 countries. Pooled average biomarkers suggest an intake of MeHg several times over the FAO/WHO reference in fish-consuming riparians living near small-scale gold mining and well over the reference in consumers of marine mammals in Arctic regions. In coastal regions of south-eastern Asia, the western Pacific and the Mediterranean, average biomarkers approach the reference. Although the two former groups have a higher risk of neurotoxicity than the latter, coastal regions are home to the largest number at risk. High-end biomarkers across all categories indicate MeHg intake is in excess of the reference value. There is a need for policies to reduce Hg exposure among women and infants and for surveillance in high-risk populations, the majority of which live in low-and middle-income countries.

Religiosity and Risky Sexual Behaviors among an African American Church-based Population

PubMed Central

Hawes, Starlyn M.; Berkley-Patton, Jannette Y.

2014-01-01

African Americans are disproportionately burdened by STDs and HIV in the US. This study examined the relationships between demographics, religiosity, and sexual risk behaviors among 255 adult African American church-based participants. Although participants were highly religious, they reported an average of seven lifetime sex partners and most inconsistently used condoms. Several demographic variables and religiosity significantly predicted lifetime HIV-related risk factors. Taken together, findings indicated that this population is at risk for HIV. Future research should continue to identify correlates of risky sexual behavior among African American parishioners to facilitate the development of HIV risk reduction interventions in their church settings. PMID:23054481

Quantifying the utility of single nucleotide polymorphisms to guide colorectal cancer screening

PubMed Central

Jenkins, Mark A; Makalic, Enes; Dowty, James G; Schmidt, Daniel F; Dite, Gillian S; MacInnis, Robert J; Ait Ouakrim, Driss; Clendenning, Mark; Flander, Louisa B; Stanesby, Oliver K; Hopper, John L; Win, Aung K; Buchanan, Daniel D

2016-01-01

Aim: To determine whether single nucleotide polymorphisms (SNPs) can be used to identify people who should be screened for colorectal cancer. Methods: We simulated one million people with and without colorectal cancer based on published SNP allele frequencies and strengths of colorectal cancer association. We estimated 5-year risks of colorectal cancer by number of risk alleles. Results: We identified 45 SNPs with an average 1.14-fold increase colorectal cancer risk per allele (range: 1.05–1.53). The colorectal cancer risk for people in the highest quintile of risk alleles was 1.81-times that for the average person. Conclusion: We have quantified the extent to which known susceptibility SNPs can stratify the population into clinically useful colorectal cancer risk categories. PMID:26846999

The Hellenic Longitudinal Investigation of Aging and Diet (HELIAD): rationale, study design, and cohort description.

PubMed

Dardiotis, Efthimios; Kosmidis, Mary H; Yannakoulia, Mary; Hadjigeorgiou, Georgios M; Scarmeas, Nikolaos

2014-01-01

Accumulating epidemiological evidence from several populations supports the important role of the Mediterranean-type diet (MeDi) in reducing the risk for age-related diseases such as Alzheimer's disease (AD). However, the relevant literature is clearly deficient for most Mediterranean countries that more closely adhere to the originally described MeDi. Greece resides in the Mediterranean basin, and older generations traditionally adhere to a MeDi. We here present the design and the preliminary baseline characteristics of the Hellenic Longitudinal Investigation of Aging and Diet (HELIAD). The HELIAD is a population-based, multidisciplinary, collaborative study designed to estimate the prevalence and incidence of AD, other dementias, mild cognitive impairment, and other neuropsychiatric conditions of aging in the Greek population and to investigate associations between nutrition and cognitive dysfunction/age-related neuropsychiatric diseases in this Mediterranean population. The study also ascertains several demographic, medical, social, environmental, clinical, nutritional, and neuropsychological determinants and lifestyle activities. In total, 1,050 participants of a random sample have already completed the initial evaluation. The subjects were, on average, 73.4 (SD = 6.0) years old, 60% of the sample were female, and most of the participants were poorly educated with an average of 5.41 (SD = 3.5) years of education. The performance on the neuropsychological tests was equivalent to the average scores of previous normative Greek samples. More than one third of the population under investigation was considered to be at high risk for malnutrition. The HELIAD may provide important data for expanding our knowledge regarding the prevalence, incidence, and risk factors of AD and several other neuropsychiatric diseases in the Mediterranean region. © 2014 S. Karger AG, Basel.

Inbreeding among Caribbean Hispanics from the Dominican Republic and its effects on risk of Alzheimer disease.

PubMed

Vardarajan, Badri N; Schaid, Daniel J; Reitz, Christiane; Lantigua, Rafael; Medrano, Martin; Jiménez-Velázquez, Ivonne Z; Lee, Joseph H; Ghani, Mahdi; Rogaeva, Ekaterina; St George-Hyslop, Peter; Mayeux, Richard P

2015-08-01

Inbreeding can be associated with a modification of disease risk due to excess homozygosity of recessive alleles affecting a wide range of phenotypes. We estimated the inbreeding coefficient in Caribbean Hispanics and examined its effects on risk of late-onset Alzheimer disease. The inbreeding coefficient was calculated in 3,392 subjects (1,451 late-onset Alzheimer disease patients and 1,941 age-matched healthy controls) of Caribbean Hispanic ancestry using 177,997 nearly independent single-nucleotide polymorphisms from genome-wide array. The inbreeding coefficient was estimated using the excess homozygosity method with and without adjusting for admixture. The average inbreeding coefficient in Caribbean Hispanics without accounting for admixture was F = 0.018 (±0.048), suggesting a mating equivalent to that of second cousins or second cousins once removed. Adjusting for admixture from three parent populations, the average inbreeding coefficient was found to be 0.0034 (±0.019) or close to third-cousin mating. Inbreeding coefficient was a significant predictor of Alzheimer disease when age, sex, and APOE genotype were used as adjusting covariates (P = 0.03). The average inbreeding coefficient of this population is significantly higher than that of the general Caucasian populations in North America. The high rate of inbreeding resulting in increased frequency of recessive variants is advantageous for the identification of rare variants associated with late-onset Alzheimer disease.Genet Med 17 8, 639-643.

[Impact of Morbidity on Health Care Costs of a Department of Health through Clinical Risk Groups. Valencian Community, Spain].

PubMed

Caballer Tarazona, Vicent; Guadalajara Olmeda, Natividad; Vivas Consuelo, David; Clemente Collado, Antonio

2016-06-08

Risk adjustment systems based on diagnosis stratify the population according to the observed morbidity. The aim of this study was to analyze the total health expenditure in a health area, relating to age, gender and morbidity observed in the population. Observational cross-sectional study of population and area of health care costs in the Health District of Denia-Marina Salud (Alicante) in 2013. Population (N=156,811) were stratified by Clinical Risk Groups into 9 states of health, state 1 being healthy, and state 9 the highest disease burden. Each inhabitant was charged with the hospital costs, primary care and outpatient pharmacy to obtain the total costs. Health status and severity by age and gender, as well as the costs of each group were analysed. The statistical tests, student t and χ2 were applied to verify the existence of significant differences between and intra groups. The average cost per inhabitant was 983 euros which increased from 240 euros to 42,881 at the state 9 and severity level 6. Patients of health states 5 and 6 caused the largest expenditure by concentration of the population, but health states 8 and 9 had the highest average expenditure, with 80% of hospitalised cost. A different composition of health expenditure per individual morbidity was corroborated, with an exponential growth in hospital spending.

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

PubMed Central

Smith, Jim T

2007-01-01

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

Comprehensive Population-Specific Marker Panel for Early Prostate Cancer Diagnostics and Risk Assessment

DTIC Science & Technology

2012-06-01

electronic signature for the eval-uation of Ganna Chornokur) 01/03/2012 09:15AM Manager: Date: Catherine Phelan C.P. ( electronic signature for...all tobacco products On average, how many cigarettes ( cigars Part 5, #l(e): note the number Part VI, A(l): table, raw "on average, how etc) did you

Cancer in populations living in regions with radioecological problems in Bulgaria.

PubMed

Chobanova, N; Genchev, G; Yagova, A; Georgieva, L

2003-01-01

To analyse the incidence and mortality of some malignant diseases among the population living in regions of past uranium extraction in Bulgaria. A retrospective study on cancer incidence and mortality in the population living around two regions with radioecological problems was conducted. According to the expected individual annual effective doses for the population, regions with expected highest radiation risk (average effective dose > 10 mSv per year) were the villages Yana, Eleshnitza and Seslavtzi (group A), and with expected relatively high radiation risk (average effective dose > 5 mSv per year) were the town of Buhovo, and the villages Dolni Bogrov and Gorni Bogrov (group B). The ecologically clean village German was chosen as a control settlement. The incidence and mortality of gastrointestinal tract cancers, bronchus and lung cancer, breast cancer, thyroid cancer, and myeloid leukaemia for the period 1995- 2001 were studied. The incidence of the gastrointestinal tract cancers in the population of German was significantly lower than those for Bulgaria and for group B. The mortality from this disease of groups A, B and Bulgaria were significantly higher than in the control settlement. Standardized mortality of lung cancer in the population of the villages with highest and relatively high radiation risk was significantly higher than in German and Bulgaria. The incidence and mortality changes of diseases studied are a consequence of the impact of many factors. Moreover, they do not characterize the impact of the radiation factor.

Community risk indicators for dental caries in school children: an ecologic study.

PubMed

Amstutz, R D; Rozier, R G

1995-06-01

A statewide survey of NC schoolchildren found wide variation in dental caries prevalence among sampled classrooms. This study examined factors associated with this variation using classrooms as a surrogate for the larger community, in order to identify community risk indicators (CRI). In all, 172 classrooms (3400 students) in Grades K-6 were available for analysis. Initially, 56 sociodemographic, environmental, health system, and clinical factors were evaluated for their association with caries prevalence (K-3: average dfs + DMFS; 4-6: average DMFS) using univariate and bivariate analyses. Of these, 21 factors met our criteria for evaluation using WLS multivariate regression. For Grades K-3 (n = 108), population density, parental education, and coastal residence were negatively associated with caries scores, while age, and medical and dental, Medicaid expenditures were positive. For Grades 4--6 (n = 64), age and fs:dfs ratio were positively associated with caries scores while population density, population:dentist ratio, and years of natural fluoride exposure were negative. CRIs for both models, when compared to individual models, explained a substantial portion of the variation in caries prevalence, 31% for Grades K-3 and 51% for Grades 4-6. Results suggest that a risk assessment model based on community rather than individual variables is feasible and further refinement may reveal factors useful in identifying high risk communities.

[Cardiovascular diseases risk factors knowledge among soldiers of the Polish army].

PubMed

Olszewski, Robert; Grabysa, Radosław; Kwasiborski, Przemysław J; Makowski, Tomasz; Warmiński, Janusz; Szczechowicz, Robert; Kubik, Leszek

2009-10-01

Cardiovascular diseases (CVDs) are the main cause of death and disability in Poland. There are many risk factors of CVD which are modifiable due to preventive strategies. Knowledge about these factors among population at risk of CVD is the most important condition for success of them. To evaluate the knowledge of CVD risk factors among soldiers of the Polish Army and try to identify a demographic factors influenced on them. Authors investigated the level of knowledge about CVD risk factors among 644 soldiers (aged between 18 to 62 years) using the special questionnaire. Whole group was analyzed according to a place of origin: city, town and village and according to a function: professionals and conscripts. Soldiers achieved a total score of 58.4% correct answers. Commonly known risk factors of CVD (average 82% of correct answers) in studied group were: obesity, tobacco smoking, high level of cholesterol and hypertension. Knowledge about above risk factors was significantly higher (p < 0.01) than about other. Lesser known risk factors (average 54% of correct answers) were: male gender, abnormal diet, sedentary lifestyle, family history of CVDs, diabetes, family history of heart infarction below 55 yrs and peripheral atherosclerosis. residents achieved 64.5% correct answers, town--61.5%, and village--58%. Professionals achieved 65.1% vs. 58.8% for conscripts. The level of knowledge about CVD risk factors are significantly higher among professionals than in urban population. Our data confirm the need of continuation and developing new CVDs preventive strategies in Poland, especially among poor educated and village populations. There is a need to emphasize the role of lesser known, modifiable CVD risk factors (e.g., obesity, sedentary lifestyle) in existing and future health programs.

The estimated risk for coronary heart disease and prevalence of dyslipidemia among workers of information technology industries in Taiwan.

PubMed

Yang, Shao-Chi; Chien, Kuo-Liong; Tsai, Wei-I; Ho, Yi-Lwun; Chen, Ming-Fong

2011-03-18

Individuals working in information technology (IT) industries suffer from high work stress, possibly causing adverse impacts on their health. However, studies of cardiovascular risk factors among these workers are lacking. The aims of this study were to evaluate the estimated risk for coronary heart disease (CHD) and prevalence of dyslipidemia among IT workers. A total of 941 employees from 11 IT companies were enrolled and the anthropometrics and serum lipid profiles were measured. The 10-year risk for CHD was calculated based on the Framingham risk score. Compared with lipid profiles in a representative sample (n=6589), IT workers had a significantly higher prevalence of obesity, hypercholesterolemia, low level of HDL-C, and high level of LDL-C in each age group. Their overall estimated 10-year risk for CHD was higher than the average risk of an age- and gender-matched population (2.91% vs. 2.79%, p=0.027). Working for more than 10h/day was associated with a higher estimated CHD risk (3.62% vs. 2.54%, p<0.01). A higher prevalence of hyperlipidemia was noted among IT workers. Their estimated 10-year CHD risk was also higher than average. More aggressive interventions to reduce the risk of CHD in this population are needed. Copyright © 2010 Elsevier B.V. All rights reserved.

[Sexual behavior characteristics of clients attending the Israel AIDS Task Force anonymous clinic in Tel Aviv].

PubMed

Bar-On, Yaeli; Perry, Zvi H; Nof, Einav; Shiber, Asher; Risenberg, Klaris; Ben Zion, Itzhak

2014-09-01

Until now, research on sexual behavior and HIV in Israel has been carried out mainly on the general population, and focused primarily on defining populations at risk, without adequate consideration given to the reasons bringing these populations to be tested, and their specific sexual behaviors. In Israel, one can choose whether to take an HIV test in confidential centers (giving one's name under medical confidentiality) or in anonymous centers (Israel AIDS Task Force in Tel Aviv and Beer Sheva, Levinsky Clinic in Tel Aviv and Haparsim Clinic in Haifa]. At least 21% of the clients of the anonymous testing centers in Israel belong to a high risk population in contrast to 2.6% in confidential clinics, and so, in this study, we hypothesize that characterization of sexual behavior patterns in anonymous testing centers might enable us to better characterize sexual behavior patterns in high risk populations. In this cross-sectional study, we used questionnaires distributed in the clinics by the Israel AIDS Task Force in order to characterize their clinic's clients. The questionnaires were completed by the Israel AIDS Task Force consultants during the consultation period at which the anonymous test was performed. Data collected included: gender, age, testing history, specific sexual behaviors and reasons for applying for the current test. A total of 926 questionnaires were collected; 29.9% of them were of female patients. The average age was 29.47 years (1±8.66]; 21.3% of the clients were men who have sex with men [MSM]; only 2.3% of the clients belonged to other high risk populations. In all groups, the majority of the patients reported high risk sexual behavior (any sexual contact without a condom) and the average age for the first test was much higher than the average age of first sexual intercourse common in Israel. Women reported more participation in unprotected vaginal intercourse than heterosexual men, and a substantial part of MSM reported performing unprotected anal intercourse. More heterosexuals than MSM stated a new relationship as a reason for applying for the test, and more MSM than heterosexuals reported arriving for a routine check-up. There is a need for comprehensive programs encouraging testing for HIV in all age groups, focusing on Sthe ages 18-25 years, and encouraging the use of a condom as a preventive measure in all populations, especially women. We feel it is essential to emphasize the need for educational programs tailored for each sub-population's psychosocial characteristics and specific issues.

Cancer incidence attributable to air pollution in Alberta in 2012

PubMed Central

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

2017-01-01

Background: The International Agency for Research on Cancer has classified outdoor air pollution (fine particulate matter [PM2.5]) as a Group 1 lung carcinogen in humans. We aimed to estimate the proportion of lung cancer cases attributable to PM2.5 exposure in Alberta in 2012. Methods: Annual average concentrations of PM2.5 in 2011 for 22 communities across Alberta were extracted from the Clean Air Strategic Alliance Data Warehouse and were population-weighted across the province. Using 7.5 µg/m3 and 3.18 µg/m3 as the annual average theoretical minimum risk concentrations of PM2.5, we estimated the proportion of the population above this cut-off to determine the population attributable risk of lung cancer due to PM2.5 exposure. Results: The mean population-weighted concentration of PM2.5 for Alberta in 2011 was 10.03 µg/m3. We estimated relative risks of 1.02 and 1.06 for theoretical minimum risk PM2.5 concentration thresholds of 7.5 µg/m3 and 3.18 µg/m3, respectively. About 1.87%-5.69% of incident lung cancer cases in Alberta were estimated to be attributable to PM2.5 exposure. Interpretation: Our estimate of attributable burden is low compared to that reported in studies in other areas of the world owing to the relatively low levels of PM2.5 recorded in Alberta. Reducing PM2.5 emissions in Alberta should continue to be a priority to help decrease the burden of lung cancer in the population. PMID:28659352

A Cost Analysis of a Pancreatic Cancer Screening Protocol in High-Risk Populations

PubMed Central

Bruenderman, Elizabeth; Martin, Robert CG

2016-01-01

Background Pancreatic cancer is the 4th leading cause of cancer death in the U.S. A screening protocol is needed to catch early stage, resectable disease. This study suggests a protocol for high-risk individuals and assesses the cost in the context of the Affordable Care Act. Methods Medicare and national average pricing were used for cost analysis of a protocol using MRI/MRCP biannually in high-risk groups. Results: ‘ Costs per year of life added’ based on Medicare and national average costs, respectively, are: $638.62 and $2542.37 for Peutz-Jehgers Syndrome, $945.33 and $3763.44 for Hereditary Pancreatitis, $1141.77 and $4545.45 for Familial Pancreatic Cancer and p16-Leiden mutations, and $356.42 and $1418.92 for new-onset diabetes over age 50 with weight loss or smoking. Conclusion A screening program using MRI/MRCP is affordable in high-risk populations. The U.S. Preventive Services Task Force must reevaluate its pancreatic cancer screening guidelines to make screening more cost-effective for the individual. PMID:26003200

Human Body Burden and Dietary Methylmercury Intake: The Relationship in a Rice-Consuming Population.

PubMed

Li, Ping; Feng, Xinbin; Chan, Hing-Man; Zhang, Xiaofeng; Du, Buyun

2015-08-18

Rice can be the main route of methylmercury (MeHg) exposure for rice-consuming populations living in area where mercury (Hg) is mined. However, the current risk assessment paradigm for MeHg exposure is based on epidemiological data collected from fish-consuming populations. This study was designed to evaluate the relationship between dietary MeHg intake and human body burden in a rice -consuming population from the Wanshan Hg mining area in China. Hair MeHg concentrations averaged 2.07 ± 1.79 μg/g, and the average blood MeHg concentration across the study area ranged from 2.20 to 9.36 μg/L. MeHg constituted 52.8 ± 17.5% and 71.7 ± 18.2% of total Hg (THg) on average in blood and hair samples, respectively. Blood and hair MeHg concentrations, rather than THg, can be used as a proxy of human MeHg exposure. Hair MeHg levels showed no significant monthly variation; however, hair THg can be impacted by inorganic Hg exposure. The toxicokinetic model of MeHg exposure based on fish consumption underestimated the human hair MeHg levels, and this may be a consequence of the high hair-to-blood MeHg ratio (361 ± 105) in the studied rice-consuming population. The use of risk assessment models based on fish consumption may not be appropriate for inland mining areas where rice is the staple food.

COLLABORATIVE MODELING OF THE BENEFITS AND HARMS ASSOCIATED WITH DIFFERENT U.S. BREAST CANCER SCREENING STRATEGIES

PubMed Central

Mandelblatt, Jeanne S.; Stout, Natasha K.; Schechter, Clyde B.; van den Broek, Jeroen J.; Miglioretti, Diana; Krapcho, Martin; Trentham-Dietz, Amy; Munoz, Diego; Lee, Sandra J.; Berry, Donald A.; van Ravesteyn, Nicolien T.; Alagoz, Oguzhan; Kerlikowske, Karla; Tosteson, Anna N.A.; Near, Aimee M.; Hoeffken, Amanda; Chang, Yaojen; Heijnsdijk, Eveline A.; Chisholm, Gary; Huang, Xuelin; Huang, Hui; Ergun, Mehmet Ali; Gangnon, Ronald; Sprague, Brian L.; Plevritis, Sylvia; Feuer, Eric; de Koning, Harry J.; Cronin, Kathleen A.

2016-01-01

Background Controversy persists about optimal mammography screening strategies. Objective To evaluate mammography strategies considering screening and treatment advances. Design Collaboration of six simulation models. Data Sources National data on incidence, risk, breast density, digital mammography performance, treatment effects, and other-cause mortality. Target Population An average-risk cohort. Time Horizon Lifetime. Perspective Societal. Interventions Mammograms from age 40, 45 or 50 to 74 at annual or biennial intervals, or annually from 40 or 45 to 49 then biennially to 74, assuming 100% screening and treatment adherence. Outcome Measures Screening benefits (vs. no screening) include percent breast cancer mortality reduction, deaths averted, and life-years gained. Harms include number of mammograms, false-positives, benign biopsies, and overdiagnosis. Results for Average-Risk Women Biennial strategies maintain 79.8%-81.3% (range across strategies and models: 68.3–98.9%) of annual screening benefits with almost half the false-positives and fewer overdiagnoses. Screening biennially from ages 50–74 achieves a median 25.8% (range: 24.1%-31.8%) breast cancer mortality reduction; annual screening from ages 40–74 years reduces mortality an additional 12.0% (range: 5.7%-17.2%) vs. no screening, but yields 1988 more false-positives and 7 more overdiagnoses per 1000 women screened. Annual screening from ages 50–74 had similar benefits as other strategies but more harms, so would not be recommended. Sub-population Results Annual screening starting at age 40 for women who have a two- to four-fold increase in risk has a similar balance of harms and benefits as biennial screening of average-risk women from 50–74. Limitations We do not consider other imaging technologies, polygenic risk, or non-adherence. Conclusion These results suggest that biennial screening is efficient for average-risk groups, but decisions on strategies depend on the weight given to the balance of harms and benefits. Primary Funding Source National Institutes of Health PMID:26756606

Economic status and temperature-related mortality in Asia

NASA Astrophysics Data System (ADS)

Lim, Youn-Hee; Bell, Michelle L.; Kan, Haidong; Honda, Yasushi; Guo, Yue-Liang Leon; Kim, Ho

2015-10-01

In developed countries, low latitude and high temperature are positively associated with the population's ability to adapt to heat. However, few studies have examined the effect of economic status on the relationship between long-term exposure to high temperature and health. We compared heterogeneous temperature-related mortality effects relative to the average summer temperature in high-socioeconomic-status (SES) cities to temperature-related effects in low-SES cities. In the first stage of the research, we conducted a linear regression analysis to quantify the mortality effects of high temperature (at or above the 95th percentile) in 32 cities in Taiwan, China, Japan, and Korea. In the second stage, we used a meta-regression to examine the association between mortality risk with average summer temperature and gross domestic product (GDP) per capita. In cities with a low GDP per capita (less than 20,000 USD), the effects of temperature were detrimental to the population if the long-term average summer temperature was high. In contrast, in cities with a high GDP per capita, temperature-related mortality risk was not significantly related to average summer temperature. The relationship between long-term average summer temperature and the short-term effects of high temperatures differed based on the city-level economic status.

Life Expectancy in Police Officers: A Comparison with the U.S. General Population

PubMed Central

Violanti, John M.; Hartley, Tara A.; Gu, Ja K.; Fekedulegn, Desta; Andrew, Michael E.; Burchfiel, Cecil M.

2016-01-01

Previous epidemiological research indicates that police officers have an elevated risk of death relative to the general population overall and for several specific causes. Despite the increased risk for mortality found in previous research, controversy still exists over the life expectancy of police officers. The goal of the present study was to compare life expectancy of male police officers from Buffalo New York with the U.S. general male population utilizing an abridged life table method. On average, the life expectancy of Buffalo police officers in our sample was significantly lower than the U.S. population (mean difference in life expectancy =21.9 years; 95% CI: 14.5-29.3; p<0.0001). Life expectancy of police officers was shorter and differences were more pronounced in younger age categories. Additionally, police officers had a significantly higher average probability of death than did males in the general population (mean difference= 0.40; 95% CI: 0.26,-0.54; p<0.0001). The years of potential life lost (YPLL) for police officers was 21 times larger than that of the general population (Buffalo male officers vs. U.S. males = 21.7, 95% CI: 5.8-37.7). Possible reasons for shorter life expectancy among police are discussed, including stress, shift work, obesity, and hazardous environmental work exposures. PMID:24707585

Cumulative Risk of Guillain–Barré Syndrome Among Vaccinated and Unvaccinated Populations During the 2009 H1N1 Influenza Pandemic

PubMed Central

Iqbal, Shahed; Stewart, Brock; Tokars, Jerome; DeStefano, Frank

2014-01-01

Objectives. We sought to assess risk of Guillain–Barré syndrome (GBS) among influenza A (H1N1) 2009 monovalent (pH1N1) vaccinated and unvaccinated populations at the end of the 2009 pandemic. Methods. We applied GBS surveillance data from a US population catchment area of 45 million from October 15, 2009, through May 31, 2010. GBS cases meeting Brighton Collaboration criteria were included. We calculated the incidence density ratio (IDR) among pH1N1 vaccinated and unvaccinated populations. We also estimated cumulative GBS risk using life table analysis. Additionally, we used vaccine coverage data and census population estimates to calculate denominators. Results. There were 392 GBS cases; 64 (16%) occurred after pH1N1vaccination. The vaccinated population had lower average risk (IDR = 0.83, 95% confidence interval = 0.63, 1.08) and lower cumulative risk (6.6 vs 9.2 cases per million persons, P = .012) of GBS. Conclusions. Our findings suggest that at the end of the influenza season cumulative GBS risk was less among the pH1N1vaccinated than the unvaccinated population, suggesting the benefit of vaccination as it relates to GBS. The observed potential protective effect on GBS attributed to vaccination warrants further study. PMID:24524517

[Assessment of non-carcinogenic risk for the health of the child population under the consumption of drinking water].

PubMed

Stepanova, N V; Valeeva, E R; Fomina, S F; Ziyatdinova, A I

In the article there are given results of the evaluation of non-carcinogenic risks for the health of the child population residing in different areas (districts) of the city of Kazan with the aim of the subsequent comprehensive assessment of the pollutants in drinking water. Assessment of the risk for the human health was performed correspondingly to with the P 2.1.10.1920-04 for oral route of exposure in accordance to the chemical composition of drinking water with account for the standard and regional factors of the exposure. The results of the risk assessment under the consumption of drinking tap water by the child population with localized place of residence permit to reveal areas with a high level of health risk in the city. The screening assessment of carcinogenic risk due to the consumption of chemicals with drinking water revealed differences in regional and standard values of the exposure factors. This affects both on the value of the chronic average daily intake of chemical contaminants in drinking water and the level of risk under the consumption of drinking water by the child population.

Costing the cascade: estimating the cost of increased obstetric intervention in childbirth using population data.

PubMed

Tracy, Sally K; Tracy, Mark B

2003-08-01

To estimate the cost of "the cascade" of obstetric interventions introduced during labour for low risk women. A cost formula derived from population data. New South Wales, Australia. All 171,157 women having a live baby during 1996 and 1997. Four groups of interventions that occur during labour were identified. A cost model was constructed using the known age-adjusted rates for low risk women having one of three birth outcomes following these pre-specified interventions. Costs were based on statewide averages for the cost of labour and birth in hospital. The outcome measure is an "average cost unit per woman" for low risk women, predicted by the level of intervention during labour. Obstetric care is classified as either private obstetric care in a private or public hospital, or routine public hospital care. The relative cost of birth increased by up to 50% for low risk primiparous women and up to 36% for low risk multiparous women as labour interventions accumulated. An epidural was associated with a sharp increase in cost of up to 32% for some primiparous low risk women, and up to 36% for some multiparous low risk women. Private obstetric care increased the overall relative cost by 9% for primiparous low risk women and 4% for multiparous low risk women. The initiation of a cascade of obstetric interventions during labour for low risk women is costly to the health system. Private obstetric care adds further to the cost of care for low risk women.

The Prevalence and Incidence of Juvenile Rheumatiod Arthritis in an Urban Black Population.

ERIC Educational Resources Information Center

Hochberg, Marc C.; And Others

1983-01-01

Research conducted in an urban Black population in Baltimore, Maryland, suggests that the Black race is not associated with significantly increased risk of development of juvenile rheumatiod arthritis. The prevalence rate was estimated as 0.26 per 1,000 and the average annual incidence as 6.6 per 100,000/year. (GC)

Unhealthy Behaviours: An International Comparison.

PubMed

Ferretti, Fabrizio

2015-01-01

In the current global economy, chronic non-communicable diseases (NCDs) have become the leading cause of death and a major health concern for both developed and developing countries. Among other factors, the worldwide spread of NCDs is driven by the globalisation of unhealthy habits. The purpose of this paper is to develop a simple statistic to measure, at the national level, the average population's exposure to the main NCDs modifiable risk factors. The approach and methodology followed by the United Nations Development Programme to compute the Human Development Index (HDI) is applied to four basic indicators of NCD-related preventable risk factors (alcohol consumption, excess caloric intake, non-balanced diet and tobacco use) in 112 countries worldwide in 2012-14. We obtain a summary composite index, which we call the Unhealthy Behaviour Index (UBI), which ranks countries by the average level of the unhealthy habits (drinking, eating and smoking) of their populations. We find that Belarus and Russian federation are the two countries with the unhealthiest NCD-related lifestyle. With the exception of Canada, the first twenty populations more exposed to the main NCDs preventable risk factors all live in European countries, and mainly in countries of Eastern Europe. Overall, the UBI tends to increase along with the level of human development. In medium, high and very high HDI countries, however, the same level of human development may be associated with very different kinds of NCD-related lifestyles. Finally, economic growth may push populations toward either more unhealthy or healthy habits, depending on the countries' level of development; the elasticity of unhealthy habits with respect to income per capita is positive (but less than one: on average 0.6) until $30,000, decreases as income rises, and becomes negative (around -0.3) in very high income countries.

Incidence of ovarian cancer after hysterectomy: a nationwide controlled follow up.

PubMed

Loft, A; Lidegaard, O; Tabor, A

1997-11-01

To estimate the risk of developing ovarian cancer after abdominal (total or subtotal) hysterectomy on benign indication. Prospective historical cohort study with 12.5 years of follow up. Denmark, nationwide. All Danish women (aged 0 to 99 years) having undergone hysterectomy with conservation of at least one ovary for a benign indication from 1977 to 1981 (n = 22,135). Follow up was conducted from 1977 to 1991. The reference group included all Danish women who had not undergone hysterectomy, age-standardised according to the hysterectomy group (n = 2,554,872). Registry data derived from the Danish National Register of Patients (diagnoses and operation codes) and the Civil Registration System (information about general population, including time of death). Incidence rate of ovarian cancer, lifetime risk of ovarian cancer, relative risk of ovarian cancer. Seventy-one women developed ovarian cancer on average 7.0 years after hysterectomy and 10,659 women in the reference group had ovarian cancer diagnosed after on average 6.4 years. The incidence rate of ovarian cancer was 0.27 per 1000 person-years in the group that had undergone hysterectomy and 0.34 per 1000 person-years in the general population (age-standardised). The extrapolated lifetime risk of developing ovarian cancer was 2.1% after hysterectomy and 2.7% in the general population (RR 0.78; 95% CI 0.60-0.96). The risk of ovarian cancer is lower among women who have undergone hysterectomy compared with those who have not. The protection seems to decrease with time.

A case study of population health improvement at a Midwest regional hospital employer.

PubMed

Long, D Adam; Sheehan, Paula

2010-06-01

This article reviews the population health improvement initiative of a Midwest regional hospital employer. Services included health risk assessments, health education, and motivational health coaching conducted telephonically. Outcomes categories for this program evaluation comprised participation rates, participant satisfaction, health status and behavior change, productivity change, health care claims savings, and return on investment. Participation rates varied widely with incentive structure, although retention of participants in coaching programs averaged 89%. The participant satisfaction rate for the last 14 months of interventions was 96%. Four years of population health status and behavior trending showed significant improvements in smoking status, dietary fat and fiber intake, exercise, mental health (ie, stress, effects depressive symptoms in the past year, life satisfaction), readiness to change (ie, diet, exercise, stress, smoking, body weight), perceptions of overall health, an index of good health habits, sum of lifestyle health risks, and sum of risks and chronic conditions. Body mass index showed nonsignificant improvements during the years of greatest participation (years 2 to 4). Indicators of productivity demonstrated improvements as well. These gains were noted for employees across all health risk statuses, which suggests population health improvement strategies can influence productivity even for healthy employees. Program year 3 was evaluated for health care claims savings using a 2-stage multivariate regression approach. Stage 1 was a computation of propensity-to-participate scores. Stage 2 was an estimation of per member per month (PMPM) claims savings for participant cohorts using a propensity score-weighted linear regression analysis. Participants averaged $40.65 PMPM savings over the control population. Program return on investment, including incentive costs and vendor fees, was 2.87:1.

Lipid profile, cardiovascular disease and mortality in a Mediterranean high-risk population: The ESCARVAL-RISK study

PubMed Central

Orozco-Beltran, Domingo; Gil-Guillen, Vicente F.; Redon, Josep; Martin-Moreno, Jose M.; Pallares-Carratala, Vicente; Navarro-Perez, Jorge; Valls-Roca, Francisco; Sanchis-Domenech, Carlos; Fernandez-Gimenez, Antonio; Perez-Navarro, Ana; Bertomeu-Martinez, Vicente; Bertomeu-Gonzalez, Vicente; Cordero, Alberto; Pascual de la Torre, Manuel; Trillo, Jose L.; Carratala-Munuera, Concepcion; Pita-Fernandez, Salvador; Uso, Ruth; Durazo-Arvizu, Ramon; Cooper, Richard; Sanz, Gines; Castellano, Jose M.; Ascaso, Juan F.; Carmena, Rafael; Tellez-Plaza, Maria

2017-01-01

Introduction The potential impact of targeting different components of an adverse lipid profile in populations with multiple cardiovascular risk factors is not completely clear. This study aims to assess the association between different components of the standard lipid profile with all-cause mortality and hospitalization due to cardiovascular events in a high-risk population. Methods This prospective registry included high risk adults over 30 years old free of cardiovascular disease (2008–2012). Diagnosis of hypertension, dyslipidemia or diabetes mellitus was inclusion criterion. Lipid biomarkers were evaluated. Primary endpoints were all-cause mortality and hospital admission due to coronary heart disease or stroke. We estimated adjusted rate ratios (aRR), absolute risk differences and population attributable risk associated with adverse lipid profiles. Results 51,462 subjects were included with a mean age of 62.6 years (47.6% men). During an average follow-up of 3.2 years, 919 deaths, 1666 hospitalizations for coronary heart disease and 1510 hospitalizations for stroke were recorded. The parameters that showed an increased rate for total mortality, coronary heart disease and stroke hospitalization were, respectively, low HDL-Cholesterol: aRR 1.25, 1.29 and 1.23; high Total/HDL-Cholesterol: aRR 1.22, 1.38 and 1.25; and high Triglycerides/HDL-Cholesterol: aRR 1.21, 1.30, 1.09. The parameters that showed highest population attributable risk (%) were, respectively, low HDL-Cholesterol: 7.70, 11.42, 8.40; high Total/HDL-Cholesterol: 6.55, 12.47, 8.73; and high Triglycerides/HDL-Cholesterol: 8.94, 15.09, 6.92. Conclusions In a population with cardiovascular risk factors, HDL-cholesterol, Total/HDL-cholesterol and triglycerides/HDL-cholesterol ratios were associated with a higher population attributable risk for cardiovascular disease compared to other common biomarkers. PMID:29045483

Lipid profile, cardiovascular disease and mortality in a Mediterranean high-risk population: The ESCARVAL-RISK study.

PubMed

Orozco-Beltran, Domingo; Gil-Guillen, Vicente F; Redon, Josep; Martin-Moreno, Jose M; Pallares-Carratala, Vicente; Navarro-Perez, Jorge; Valls-Roca, Francisco; Sanchis-Domenech, Carlos; Fernandez-Gimenez, Antonio; Perez-Navarro, Ana; Bertomeu-Martinez, Vicente; Bertomeu-Gonzalez, Vicente; Cordero, Alberto; Pascual de la Torre, Manuel; Trillo, Jose L; Carratala-Munuera, Concepcion; Pita-Fernandez, Salvador; Uso, Ruth; Durazo-Arvizu, Ramon; Cooper, Richard; Sanz, Gines; Castellano, Jose M; Ascaso, Juan F; Carmena, Rafael; Tellez-Plaza, Maria

2017-01-01

The potential impact of targeting different components of an adverse lipid profile in populations with multiple cardiovascular risk factors is not completely clear. This study aims to assess the association between different components of the standard lipid profile with all-cause mortality and hospitalization due to cardiovascular events in a high-risk population. This prospective registry included high risk adults over 30 years old free of cardiovascular disease (2008-2012). Diagnosis of hypertension, dyslipidemia or diabetes mellitus was inclusion criterion. Lipid biomarkers were evaluated. Primary endpoints were all-cause mortality and hospital admission due to coronary heart disease or stroke. We estimated adjusted rate ratios (aRR), absolute risk differences and population attributable risk associated with adverse lipid profiles. 51,462 subjects were included with a mean age of 62.6 years (47.6% men). During an average follow-up of 3.2 years, 919 deaths, 1666 hospitalizations for coronary heart disease and 1510 hospitalizations for stroke were recorded. The parameters that showed an increased rate for total mortality, coronary heart disease and stroke hospitalization were, respectively, low HDL-Cholesterol: aRR 1.25, 1.29 and 1.23; high Total/HDL-Cholesterol: aRR 1.22, 1.38 and 1.25; and high Triglycerides/HDL-Cholesterol: aRR 1.21, 1.30, 1.09. The parameters that showed highest population attributable risk (%) were, respectively, low HDL-Cholesterol: 7.70, 11.42, 8.40; high Total/HDL-Cholesterol: 6.55, 12.47, 8.73; and high Triglycerides/HDL-Cholesterol: 8.94, 15.09, 6.92. In a population with cardiovascular risk factors, HDL-cholesterol, Total/HDL-cholesterol and triglycerides/HDL-cholesterol ratios were associated with a higher population attributable risk for cardiovascular disease compared to other common biomarkers.

Fetal head circumference, operative delivery, and fetal outcomes: a multi-ethnic population-based cohort study

PubMed Central

2013-01-01

Background Operative delivery procedures, such as primary cesarean section, vacuum-assisted, and forceps-assisted vaginal delivery increase maternal and fetal morbidity, and the cost of care. We evaluated whether large fetal head circumference (FHC) independently increases risk of such interventions, as well as fetal distress or low Apgar score, in anatomically normal infants. Methods We conducted a population-based retrospective cohort study using Washington State birth certificate data. We included singleton, term infants born to nulliparous mothers from 2003–2009. We compared mode of delivery and fetal outcomes in 10,750 large-FHC (37-41 cm) infants relative to 10,750 average-FHC (34 cm) infants, frequency matched by birth-year. Results Large-FHC infants were nearly twice as likely to be delivered by primary cesarean section as average-FHC infants (unadjusted relative risk [RR] 1.84, 95% confidence interval [CI]: 1.77, 1.92). The RR for primary cesarean section associated with large-FHC was largest for mothers aged 19 years or less (RR 2.28; 95% CI: 1.99, 2.61), and smallest for mothers aged 35 years or greater (RR 1.51; 95% CI: 1.37, 1.66) [test of homogeneity, p < 0.001]. Large-FHC infants were at increased risk of vacuum-assisted vaginal delivery (RR 1.55; 95% CI: 1.43, 1.69), and forceps-assisted vaginal delivery (RR 1.61; 95% CI: 1.32, 1.97). There was no difference in risk of fetal distress (RR 0.97; 95% CI: 0.89, 1.07) for large-FHC versus average-FHC infants. Risk estimates were unaffected by adjustment for potential confounders. Conclusions Nulliparous mothers of large-FHC infants are at increased risk of primary cesarean section, vacuum-assisted and forceps-assisted vaginal delivery relative to mothers of average-FHC infants. Maternal age modifies the association between FHC and primary cesarean section. PMID:23651454

A survey of kidney disease and risk-factor information on the World Wide Web.

PubMed

Calderón, José Luis; Zadshir, Ashraf; Norris, Keith

2004-11-11

Chronic kidney disease (CKD) is epidemic, and informing those at risk is a national health priority. However, the discrepancy between the readability of health information and the literacy skills of those it targets is a recognized barrier to communicating health information that may promote good health outcomes. Because the World Wide Web has become one of the most important sources of health information, we sought to assess the readability of commonly available CKD information. Twelve highly cited English-language, kidney disease Web sites were identified with 4 popular search engines. Each Web site was reviewed for the availability of 6 domains of information germane to CKD and risk-factor information. We estimated readability scores with the Flesch-Kincaid and Flesch Reading Ease Index methods. The deviation of readability scores for CKD information from readability appropriate to average literacy skills and the limited literacy skills of vulnerable populations (low socioeconomic status, health disparities, and elderly) were calculated. Eleven Web sites met the inclusion criteria. Six of 11 sites provided information on all 6 domains of CKD and risk-factor information. Mean readability scores for all 6 domains of CKD information exceeded national average literacy skills and far exceeded the fifth-grade-level readability desired for informing vulnerable populations. Information about CKD and diabetes consistently had higher readability scores. Information on the World Wide Web about CKD and its risk factors may not be readable for comprehension by the general public, especially by underserved minority populations with limited literacy skills. Barriers to health communication may be important contributors to the rising CKD epidemic and disparities in CKD health status experienced by minority populations.

Estimated Daily Average Per Capita Water Ingestion by Child and Adult Age Categories Based on USDA's 1994-96 and 1998 Continuing Survey of Food Intakes by Individuals (Journal Article)

EPA Science Inventory

Current water ingestion estimates are important for the assessment of risk to human populations of exposure to water-borne pollutants. This paper reports mean and percentile estimates of the distributions of daily average per capita water ingestion for 12 age range groups. The a...

The Incidence of Malignant Tumors in Environmentally Disadvantaged Regions of Kazakhstan

PubMed

Mamyrbayev, Arstan; Djarkenov, Timur; Dosbayev, Askar; Dusembayeva, Nailya; Shpakov, Anatolyi; Umarova, Gulmira; Drobchenko, Yelena; Kunurkulzhayev, Temirgali; Zhaylybaev, Mukhtar; Isayeva, Gulnar

2016-12-01

Objective: To explore the prevalence of malignant tumors in the adult population through 2003-2014 in parts of the Aral Sea region: a zone of ecological disaster, a zone of ecological crisis and a zone of precritical conditions. Methods: The long-time average annual levels of cancer morbidity stratified by zones of the Aral Sea region and trends of long-time average annual incidence indicators of malignant tumors were identified. Leading cancer localizations in the adult population was established and associations between cancer incidence and environmental pollution were analyzed. In addition, associations between individual risk factors and cancer incidence in the adult population was established. Correlations between a hazard index and the cancer incidence in the adult population were calculated. Results: In all three Aral Sea regions, as well as in Zhanaarkinskii district, leading cancer in adult population was esophageal, stomach, tracheal, lung, hepatobiliary, and breast. Long-time average annual levels of cancer morbidity in adult population living in the Aral sea region is 1.5 times higher comparing to the control region. In particular, long-time average annual levels of cancer morbidity in adult population living in the zone of ecological disaster was 57.2% higher, in the zone of ecological crisis - 61.9% higher, and in the zone of precritical condition – 16.8% higher. Long-time average annual levels in the adult population of the Aral Sea region significantly exceeded control levels for brain and central nervous system cancer, cancer of bone and articular cartilage, and thyroid cancer. Conclusion: It has was established that the total cancer morbidity depended on the total hazard index associated with the inhalation of nickel and the combined cadmium intake (r=0.8). Creative Commons Attribution License

The Incidence of Malignant Tumors in Environmentally Disadvantaged Regions of Kazakhstan

PubMed Central

Mamyrbayev, Arstan; Djarkenov, Timur; Dosbayev, Askar; Dusembayeva, Nailya; Shpakov, Anatolyi; Umarova, Gulmira; Drobchenko, Yelena; Kunurkulzhayev, Temirgali; Zhaylybaev, Mukhtar; Isayeva, Gulnar

2016-01-01

Objective: To explore the prevalence of malignant tumors in the adult population through 2003-2014 in parts of the Aral Sea region: a zone of ecological disaster, a zone of ecological crisis and a zone of precritical conditions. Methods: The long-time average annual levels of cancer morbidity stratified by zones of the Aral Sea region and trends of long-time average annual incidence indicators of malignant tumors were identified. Leading cancer localizations in the adult population was established and associations between cancer incidence and environmental pollution were analyzed. In addition, associations between individual risk factors and cancer incidence in the adult population was established. Correlations between a hazard index and the cancer incidence in the adult population were calculated. Results: In all three Aral Sea regions, as well as in Zhanaarkinskii district, leading cancer in adult population was esophageal, stomach, tracheal, lung, hepatobiliary, and breast. Long-time average annual levels of cancer morbidity in adult population living in the Aral sea region is 1.5 times higher comparing to the control region. In particular, long-time average annual levels of cancer morbidity in adult population living in the zone of ecological disaster was 57.2% higher, in the zone of ecological crisis - 61.9% higher, and in the zone of precritical condition – 16.8% higher. Long-time average annual levels in the adult population of the Aral Sea region significantly exceeded control levels for brain and central nervous system cancer, cancer of bone and articular cartilage, and thyroid cancer. Conclusion: It has was established that the total cancer morbidity depended on the total hazard index associated with the inhalation of nickel and the combined cadmium intake (r=0.8). PMID:28125862

Implementing an Internet-Delivered Skin Cancer Genetic Testing Intervention to Improve Sun Protection Behavior in a Diverse Population: Protocol for a Randomized Controlled Trial

PubMed Central

Zielaskowski, Kate; White, Kirsten AM; Rodríguez, Vivian M; Robers, Erika; Guest, Dolores D; Sussman, Andrew; Talamantes, Yvonne; Schwartz, Matthew R; Greb, Jennie; Bigney, Jessica; Kaphingst, Kimberly A; Hunley, Keith; Buller, David B

2017-01-01

Background Limited translational genomic research currently exists to guide the availability, comprehension, and appropriate use of personalized genomics in diverse general population subgroups. Melanoma skin cancers are preventable, curable, common in the general population, and disproportionately increasing in Hispanics. Objective Variants in the melanocortin-1 receptor (MC1R) gene are present in approximately 50% of the population, are major factors in determining sun sensitivity, and confer a 2-to-3-fold increase in melanoma risk in the general population, even in populations with darker skin. Therefore, feedback regarding MC1R risk status may raise risk awareness and protective behavior in the general population. Methods We are conducting a randomized controlled trial examining Internet presentation of the risks and benefits of personalized genomic testing for MC1R gene variants that are associated with increased melanoma risk. We will enroll a total of 885 participants (462 participants are currently enrolled), who will be randomized 6:1 to personalized genomic testing for melanoma risk versus waiting list control. Control participants will be offered testing after outcome assessments. Participants will be balanced across self-reported Hispanic versus non-Hispanic ethnicity (n=750 in personalized genomic testing for melanoma risk arm; n=135 in control arm), and will be recruited from a general population cohort in Albuquerque, New Mexico, which is subject to year-round sun exposure. Baseline surveys will be completed in-person with study staff and follow-up measures will be completed via telephone. Results Aim 1 of the trial will examine the personal utility of personalized genomic testing for melanoma risk in terms of short-term (3-month) sun protection and skin screening behaviors, family and physician communication, and melanoma threat and control beliefs (ie, putative mediators of behavior change). We will also examine potential unintended consequences of testing among those who receive average-risk personalized genomic testing for melanoma risk findings, and examine predictors of sun protection at 3 months as the outcome. These findings will be used to develop messages for groups that receive average-risk feedback. Aim 2 will compare rates of test consideration in Hispanics versus non-Hispanics, including consideration of testing pros and cons and registration of a decision to either accept or decline testing. Aim 3 will examine personalized genomic testing for melanoma risk feedback comprehension, recall, satisfaction, and cancer-related distress in those who undergo testing, and whether these outcomes differ by ethnicity (Hispanic vs non-Hispanic), or sociocultural or demographic factors. Final outcome data collection is anticipated to be complete by October 2017, at which point data analysis will commence. Conclusions This study has important implications for personalized genomics in the context of melanoma risk, and may be broadly applicable as a model for delivery of personalized genomic feedback for other health conditions. PMID:28442450

Childhood lead poisoning prevention through prenatal housing inspection and remediation in St. Louis, MO.

PubMed

Berg, Daniel R; Eckstein, Erin T; Steiner, Matt S; Gavard, Jeffrey A; Gross, Gilad A

2012-03-01

We assessed the screening and remediation of home lead hazards prenatally in a high-risk population, hypothesizing that average blood-lead level and the number of poisonings would drop by 25%. One hundred fifty-two women underwent prenatal home inspections by certified lead inspectors. The hazards that were identified were remediated. The blood-lead levels of children of participating women were compared with matched control subjects. Blood-lead levels were obtained from 60 children and compared with matched control subjects. The average blood-lead level of children in the treatment group was 2.70 μg/dL vs 3.73 μg/dL in control subjects (P = .019). The percentage of children with levels >10 μg/dL in the treatment group was 0% vs 4.2% in control subjects (P = .128). Screening and remediation of houses of pregnant women is effective to reduce the average blood-lead level and number of children that exceed the federal level of concern for lead poisoning in a high-risk population. Copyright © 2012 Mosby, Inc. All rights reserved.

Disabling and fatal occupational claim rates, risks, and costs in the Oregon construction industry 1990-1997.

PubMed

Horwitz, Irwin B; McCall, Brian P

2004-10-01

This study estimated injury and illness rates, risk factors, and costs associated with construction work in Oregon from 1990-1997 using all accepted workers' compensation claims by Oregon construction employees (N = 20,680). Claim rates and risk estimates were estimated using a baseline calculated from Current Population Survey data of the Oregon workforce. The average annual rate of lost-time claims was 3.5 per 100 workers. More than 50% of claims were by workers under 35 years and with less than 1 year of tenure. The majority of claimants (96.1%) were male. There were 52 total fatalities reported over the period examined, representing an average annual death rate of 8.5 per 100,000 construction workers. Average claim cost was $10,084 and mean indemnity time was 57.3 days. Structural metal workers had the highest average days of indemnity of all workers (72. 1), highest average costs per claim ($16,472), and highest odds ratio of injury of all occupations examined. Sprains were the most frequently reported injury type, constituting 46.4% of all claims. The greatest accident risk occurred during the third hour of work. Training interventions should be extensively utilized for inexperienced workers, and prework exercises could potentially reduce injury frequency and severity.

Inorganic arsenic in Chinese food and its cancer risk.

PubMed

Li, Gang; Sun, Guo-Xin; Williams, Paul N; Nunes, Luis; Zhu, Yong-Guan

2011-10-01

Even moderate arsenic exposure may lead to health problems, and thus quantifying inorganic arsenic (iAs) exposure from food for different population groups in China is essential. By analyzing the data from the China National Nutrition and Health Survey (CNNHS) and collecting reported values of iAs in major food groups, we developed a framework of calculating average iAs daily intake for different regions of China. Based on this framework, cancer risks from iAs in food was deterministically and probabilistically quantified. The article presents estimates for health risk due to the ingestion of food products contaminated with arsenic. Both per individual and for total population estimates were obtained. For the total population, daily iAs intake is around 42 μg day(-1), and rice is the largest contributor of total iAs intake accounting for about 60%. Incremental lifetime cancer risk from food iAs intake is 106 per 100,000 for adult individuals and the median population cancer risk is 177 per 100,000 varying between regions. Population in the Southern region has a higher cancer risk than that in the Northern region and the total population. Sensitive analysis indicated that cancer slope factor, ingestion rates of rice, aquatic products and iAs concentration in rice were the most relevant variables in the model, as indicated by their higher contribution to variance of the incremental lifetime cancer risk. We conclude that rice may be the largest contributor of iAs through food route for the Chinese people. The population from the South has greater cancer risk than that from the North and the whole population. Copyright © 2011 Elsevier Ltd. All rights reserved.

Anal intraepithelial neoplasia: A review of diagnosis and management

PubMed Central

Roberts, Joseph R; Siekas, Lacey L; Kaz, Andrew M

2017-01-01

Anal intraepithelial neoplasia (AIN) is a premalignant lesion of the anal mucosa that is a precursor to anal cancer. Although anal cancer is relatively uncommon, rates of this malignancy are steadily rising in the United States, and among certain high risk populations the incidence of anal cancer may exceed that of colon cancer. Risk factors for AIN and anal cancer consist of clinical factors and behaviors that are associated with the acquisition and persistence of human papilloma virus (HPV) infection. The strongest HPV-associated risk factors are HIV infection, receptive anal intercourse, and high risk sexual behavior. A history of HPV-mediated genital cancer, which suggests infection with an oncogenic HPV strain, is another risk factor for AIN/anal cancer. Because progression of AIN to anal cancer is known to occur in some individuals over several years, screening for AIN and early anal cancer, as well as treatment of advanced AIN lesions, is reasonable in certain high-risk populations. Although randomized controlled trials evaluating screening and treatment outcomes are lacking, experts support routine screening for AIN in high risk populations. Screening is performed using anal cytological exams, similar to those performed in cervical cancer screening programs, along with direct tissue evaluation and biopsy via high resolution anoscopy. AIN can be treated using topical therapies such as imiquimod, 5-flurouracil, and trichloroacetic acid, as well as ablative therapies such as electrocautery and laser therapy. Reductions in AIN and anal cancer rates have been shown in studies where high-risk populations were vaccinated against the oncogenic strains of HPV. Currently, the CDC recommends both high-risk and average-risk populations be vaccinated against HPV infection using the quadrivalent or nonavalent vaccines. It is important for clinicians to be familiar with AIN and the role of HPV vaccination, particularly in high risk populations. PMID:28255426

Anal intraepithelial neoplasia: A review of diagnosis and management.

PubMed

Roberts, Joseph R; Siekas, Lacey L; Kaz, Andrew M

2017-02-15

Anal intraepithelial neoplasia (AIN) is a premalignant lesion of the anal mucosa that is a precursor to anal cancer. Although anal cancer is relatively uncommon, rates of this malignancy are steadily rising in the United States, and among certain high risk populations the incidence of anal cancer may exceed that of colon cancer. Risk factors for AIN and anal cancer consist of clinical factors and behaviors that are associated with the acquisition and persistence of human papilloma virus (HPV) infection. The strongest HPV-associated risk factors are HIV infection, receptive anal intercourse, and high risk sexual behavior. A history of HPV-mediated genital cancer, which suggests infection with an oncogenic HPV strain, is another risk factor for AIN/anal cancer. Because progression of AIN to anal cancer is known to occur in some individuals over several years, screening for AIN and early anal cancer, as well as treatment of advanced AIN lesions, is reasonable in certain high-risk populations. Although randomized controlled trials evaluating screening and treatment outcomes are lacking, experts support routine screening for AIN in high risk populations. Screening is performed using anal cytological exams, similar to those performed in cervical cancer screening programs, along with direct tissue evaluation and biopsy via high resolution anoscopy. AIN can be treated using topical therapies such as imiquimod, 5-flurouracil, and trichloroacetic acid, as well as ablative therapies such as electrocautery and laser therapy. Reductions in AIN and anal cancer rates have been shown in studies where high-risk populations were vaccinated against the oncogenic strains of HPV. Currently, the CDC recommends both high-risk and average-risk populations be vaccinated against HPV infection using the quadrivalent or nonavalent vaccines. It is important for clinicians to be familiar with AIN and the role of HPV vaccination, particularly in high risk populations.

Validation of a multifactorial risk factor model used for predicting future caries risk with Nevada adolescents.

PubMed

Ditmyer, Marcia M; Dounis, Georgia; Howard, Katherine M; Mobley, Connie; Cappelli, David

2011-05-20

The objective of this study was to measure the validity and reliability of a multifactorial Risk Factor Model developed for use in predicting future caries risk in Nevada adolescents in a public health setting. This study examined retrospective data from an oral health surveillance initiative that screened over 51,000 students 13-18 years of age, attending public/private schools in Nevada across six academic years (2002/2003-2007/2008). The Risk Factor Model included ten demographic variables: exposure to fluoridation in the municipal water supply, environmental smoke exposure, race, age, locale (metropolitan vs. rural), tobacco use, Body Mass Index, insurance status, sex, and sealant application. Multiple regression was used in a previous study to establish which significantly contributed to caries risk. Follow-up logistic regression ascertained the weight of contribution and odds ratios of the ten variables. Researchers in this study computed sensitivity, specificity, positive predictive value (PVP), negative predictive value (PVN), and prevalence across all six years of screening to assess the validity of the Risk Factor Model. Subjects' overall mean caries prevalence across all six years was 66%. Average sensitivity across all six years was 79%; average specificity was 81%; average PVP was 89% and average PVN was 67%. Overall, the Risk Factor Model provided a relatively constant, valid measure of caries that could be used in conjunction with a comprehensive risk assessment in population-based screenings by school nurses/nurse practitioners, health educators, and physicians to guide them in assessing potential future caries risk for use in prevention and referral practices.

Cardiovascular disease (CVD) risk factors in Kraków and in the whole Poland adult population. Results from the WOBASZ study and Polish arm of the HAPIEE project.

PubMed

Doryńska, Agnieszka; Polak, Maciej; Kozela, Magdalena; Szafraniec, Krystyna; Piotrowski, Walerian; Bielecki, Wojciech; Drygas, Wojciech; Kozakiewicz, Krystyna; Piwoński, Jerzy; Tykarski, Andrzej; Zdrojewski, Tomasz; Pająk, Andrzej

2015-01-01

In Kraków, the second largest town in Poland, cardiovascular disease (CVD) mortality rate is lower than in most top largest towns in Poland and lower than the rate for total Polish population. The aim of the present analysis was to compare socioeconomic status (SES), prevalence of CVD risk factors and SCORE assessment of risk in Krakow with residents of other big towns in Poland and with general Polish population. We used data from the two large, population studies which used comparable methods for risk factors assessment: 1) Polish part of the HAPIEE Project in which 10 615 residents of Krakow at age between 45-69 years were examined, and (2) The WOBASZ Study which contributed with a sub-sample 6 888 of residents of Poland at corresponding age group. WOBASZ sample included 992 residents of big towns other than Krakow. Age-standardized proportions of persons with CVD risk factors were compared between Krakow and the other big towns in Poland and between Krakow and the whole Poland using χ2 test. The striking observation was that in Krakow proportions of participants with university education were substantially higher than average for the other big towns and the whole Poland. Also, the proportion of occupationally active men and women was the highest in Krakow. In both sexes, prevalence of smoking, hypercholesterolemia and hypertension in Krakow was similar to the other big towns but the prevalence of hypercholesterolemia and hypertension (in men only) was lower than average for Poland. The distribution by SCORE risk categories were similar in all three samples studied. In general, the distribution by BMI categories was less favourable but the prevalence of central obesity was lower among residents of Kraków than among residents of the other big towns and citizens of the whole Poland. Prevalence of diabetes was higher in Krakow than in the other samples studied. The differences between population of Krakow and population of other parts of Poland in the exposure to the main risk factors were found diverse and not big enough to be followed by differences in the distribution by the categories of SCORE risk assessment. The study suggested the importance of obesity and diabetes which are not used for the SCORE risk assessment and especially the importance of psychosocial and economic factors which may influence CVD risk and contribute more to the explanation of the regional differences in CVD mortality.

[Risk behavior for the health of students at the State University of North Paraná, Brazil--proposal for online intervention].

PubMed

Mello, Marcus Vinícius de Oliveira; Bernardelli Junior, Rinaldo; Menossi, Berlis Ribeiro dos Santos; Vieira, Fabio da Silva Ferreira

2014-01-01

Getting to know the lifestyles of university students provides important input for possible decision-making for the implementation of intervention programs within the university environment. The objective of this study was to analyze the prevalence of risk behaviors to health in a representative sample of UENP students and, in accordance with the information obtained, indicate specific actions using means that can assist in reducing such behaviors. The survey of the main risk factors for the health of the population in question was performed by database analysis. The orientation was conducted through social networks, with online control over access to and interactions with members of the networks using information made available by the research. More than 200 messages were posted, trying to put this population on the path towards factors related to healthy habits. A viewing average of 471.2 ± 128.16 people accessed the page and an average of 12,915.07 ± 6,517.45 people saw the posts per week. Given the above, we suggest actions in UENP to encourage healthy habits, and the social networks proved to be a viable tool for this though other media may be offered, seeking to encourage this population to adopt a more active and health lifestyle.

Assessment of Sociodemographic and Geographic Disparities in Cancer Risk from Air Toxics in South Carolina

PubMed Central

Wilson, Sacoby; Burwell-Naney, Kristen; Jiang, Chengsheng; Zhang, Hongmei; Samantapudi, Ashok; Murray, Rianna; Dalemarre, Laura; Rice, LaShanta; Williams, Edith

2015-01-01

Populations of color and low-income communities are often disproportionately burdened by exposures to various environmental contaminants, including air pollution. Some air pollutants have carcinogenic properties that are particularly problematic in South Carolina (SC), a state that consistently has high rates of cancer mortality for all sites. The purpose of this study was to assess cancer risk disparities in SC by linking risk estimates from the U.S. Environmental Protection Agency’s 2005 National Air Toxics Assessment (NATA) with sociodemographic data from the 2000 US Census Bureau. Specifically, NATA risk data for varying risk categories were linked by tract ID and analyzed with sociodemographic variables from the 2000 census using R. The average change in cancer risk from all sources by sociodemographic variable was quantified using multiple linear regression models. Spatial methods were further employed using ArcGIS 10 to assess the distribution of all source risk and percent non-white at each census tract level. The relative risk estimates of the proportion of high cancer risk tracts (defined as the top 10% of cancer risk in SC) and their respective 95% confidence intervals (CIs) were calculated between the first and latter three quartiles defined by sociodemographic factors, while the variance in the percentage of high cancer risk between quartile groups was tested using Pearson’s chi-square. The average total cancer risk for SC was 26.8 people/million (ppl/million). The risk from on-road sources was approximately 5.8 ppl/million, higher than the risk from major, area, and non-road sources (1.8, 2.6, and 1.3 ppl/million), respectively. Based on our findings, addressing on-road sources may decrease the disproportionate cancer risk burden among low-income populations and communities of color in SC. PMID:26037107

Evaluation of the risk of noise-induced hearing loss among unscreened male industrial workers.

PubMed

Prince, Mary M; Gilbert, Stephen J; Smith, Randall J; Stayner, Leslie T

2003-02-01

Variability in background risk and distribution of various risk factors for hearing loss may explain some of the diversity in excess risk of noise-induced hearing loss (NIHL). This paper examines the impact of various risk factors on excess risk estimates of NIHL using data from the 1968-1972 NIOSH Occupational Noise and Hearing Survey (ONHS). Previous analyses of a subset of these data focused on 1172 highly "screened" workers. In the current analysis, an additional 894 white males (609 noise-exposed and 285 controls), who were excluded for various reasons (i.e., nonoccupational noise exposure, otologic or medical conditions affecting hearing, prior occupational noise exposure) have been added 2066) to assess excess risk of noise-induced material impairment in an unscreened population. Data are analyzed by age, duration of exposure, and sound level (8-h TWA) for four different definitions of noise-induced hearing impairment, defined as the binaural pure-tone average (PTA) hearing threshold level greater than 25 dB for the following frequencies: (a) 1-4 kHz (PTA1234), (b) 1-3 kHz (PTA123), (c) 0.5, 1, and 2 kHz (PTA512), and (d) 3, 4, and 6 kHz (PTA346). Results indicate that populations with higher background risks of hearing loss may show lower excess risks attributable to noise relative to highly screened populations. Estimates of lifetime excess risk of hearing impairment were found to be significantly different between screened and unscreened population for noise levels greater than 90 dBA. Predicted age-related risk of material hearing impairment in the ONHS unscreened population was similar to that predicted from Annex B and C of ANSI S3.44 for ages less than 60 years. Results underscore the importance of understanding differential risk patterns for hearing loss and the use of appropriate reference (control) populations when evaluating risk of noise-induced hearing impairment among contemporary industrial populations.

Premature greying of the hair is not associated with low bone mineral density.

PubMed

Beardsworth, S A; Kearney, C E; Steel, S A; Newman, J; Purdie, D W

1999-01-01

In two recent case-control studies premature greying of the hair was associated with a lowering of bone mineral density (BMD) and osteopenia, suggesting that this might be a clinically useful risk marker for osteoporosis. We report a further re-examination of this proposal in 52 prematurely grey-haired women from East Yorkshire who responded to an advertisement inviting them for bone densitometry. Thirty-five had no clinical or drug history that could influence bone density. All were Caucasian with a mean age of 52.8 years. In the group as a whole the mean BMD values at the lumbar spine and femoral neck were no different from those of a young adult, but there was a trend toward a greater than average BMD than that of the local age-matched population (p = 0.097 and 0.218, respectively). Twenty women were premenopausal, with an average age of 45.3 years. Mean BMD values at the lumbar spine and femoral neck in this group were no different from those of young adults. There was, however, a trend toward a BMD greater than that of the local age-matched population at the femoral neck (p = 0.117). Fifteen women were postmenopausal with an average age of 62.9 years and an average age at menopause of 51.1 years. Mean BMD values at both the lumbar spine and femoral neck in this group were lower than those of young adults, but no different from those of the local age-matched population. In conclusion, our group of prematurely grey-haired women had average BMD for their age, and we are therefore unable to support the proposed clinical usefulness of premature greying as a risk marker for osteoporosis.

Identification of 23 new prostate cancer susceptibility loci using the iCOGS custom genotyping array

PubMed Central

Eeles, Rosalind A; Olama, Ali Amin Al; Benlloch, Sara; Saunders, Edward J; Leongamornlert, Daniel A; Tymrakiewicz, Malgorzata; Ghoussaini, Maya; Luccarini, Craig; Dennis, Joe; Jugurnauth-Little, Sarah; Dadaev, Tokhir; Neal, David E; Hamdy, Freddie C; Donovan, Jenny L; Muir, Ken; Giles, Graham G; Severi, Gianluca; Wiklund, Fredrik; Gronberg, Henrik; Haiman, Christopher A; Schumacher, Fredrick; Henderson, Brian; Le Marchand, Loic; Lindstrom, Sara; Kraft, Peter; Hunter, David J; Gapstur, Susan; Chanock, Stephen J; Berndt, Sonja I; Albanes, Demetrius; Andriole, Gerald; Schleutker, Johanna; Weischer, Maren; Canzian, Federico; Riboli, Elio; Key, Tim J; Travis, Ruth; Campa, Daniele; Ingles, Sue A; John, Esther M; Hayes, Richard B; Pharoah, Paul DP; Pashayan, Nora; Khaw, Kay-Tee; Stanford, Janet; Ostrander, Elaine A; Signorello, Lisa B; Thibodeau, Stephen N; Schaid, Dan; Maier, Christiane; Vogel, Walther; Kibel, Adam S; Cybulski, Cezary; Lubinski, Jan; Cannon-Albright; Brenner, Hermann; Park, Jong Y; Kaneva, Radka; Batra, Jyotsna; Spurdle, Amanda B; Clements, Judith A; Teixeira, Manuel R; Dicks, Ed; Lee, Andrew; Dunning, Alison; Baynes, Caroline; Conroy, Don; Maranian, Melanie J; Ahmed, Shahana; Govindasami, Koveela; Guy, Michelle; Wilkinson, Rosemary A; Sawyer, Emma J; Morgan, Angela; Dearnaley, David P; Horwich, Alan; Huddart, Robert A; Khoo, Vincent S; Parker, Christopher C; Van As, Nicholas J; Woodhouse, J; Thompson, Alan; Dudderidge, Tim; Ogden, Chris; Cooper, Colin; Lophatananon, Artitaya; Cox, Angela; Southey, Melissa; Hopper, John L; English, Dallas R; Aly, Markus; Adolfsson, Jan; Xu, Jiangfeng; Zheng, Siqun; Yeager, Meredith; Kaaks, Rudolf; Diver, W Ryan; Gaudet, Mia M; Stern, Mariana; Corral, Roman; Joshi, Amit D; Shahabi, Ahva; Wahlfors, Tiina; Tammela, Teuvo J; Auvinen, Anssi; Virtamo, Jarmo; Klarskov, Peter; Nordestgaard, Børge G; Røder, Andreas; Nielsen, Sune F; Bojesen, Stig E; Siddiq, Afshan; FitzGerald, Liesel; Kolb, Suzanne; Kwon, Erika; Karyadi, Danielle; Blot, William J; Zheng, Wei; Cai, Qiuyin; McDonnell, Shannon K; Rinckleb, Antje; Drake, Bettina; Colditz, Graham; Wokolorczyk, Dominika; Stephenson, Robert A; Teerlink, Craig; Muller, Heiko; Rothenbacher, Dietrich; Sellers, Thomas A; Lin, Hui-Yi; Slavov, Chavdar; Mitev, Vanio; Lose, Felicity; Srinivasan, Srilakshmi; Maia, Sofia; Paulo, Paula; Lange, Ethan; Cooney, Kathleen A; Antoniou, Antonis; Vincent, Daniel; Bacot, François; Tessier; Kote-Jarai, Zsofia; Easton, Douglas F

2013-01-01

Prostate cancer is the most frequently diagnosed cancer in males in developed countries. To identify common prostate cancer susceptibility alleles, we genotyped 211,155 SNPs on a custom Illumina array (iCOGS) in blood DNA from 25,074 prostate cancer cases and 24,272 controls from the international PRACTICAL Consortium. Twenty-three new prostate cancer susceptibility loci were identified at genome-wide significance (P < 5 × 10−8). More than 70 prostate cancer susceptibility loci, explaining ~30% of the familial risk for this disease, have now been identified. On the basis of combined risks conferred by the new and previously known risk loci, the top 1% of the risk distribution has a 4.7-fold higher risk than the average of the population being profiled. These results will facilitate population risk stratification for clinical studies. PMID:23535732

Risk-based indicators of Canadians' exposures to environmental carcinogens.

PubMed

Setton, Eleanor; Hystad, Perry; Poplawski, Karla; Cheasley, Roslyn; Cervantes-Larios, Alejandro; Keller, C Peter; Demers, Paul A

2013-02-12

Tools for estimating population exposures to environmental carcinogens are required to support evidence-based policies to reduce chronic exposures and associated cancers. Our objective was to develop indicators of population exposure to selected environmental carcinogens that can be easily updated over time, and allow comparisons and prioritization between different carcinogens and exposure pathways. We employed a risk assessment-based approach to produce screening-level estimates of lifetime excess cancer risk for selected substances listed as known carcinogens by the International Agency for Research on Cancer. Estimates of lifetime average daily intake were calculated using population characteristics combined with concentrations (circa 2006) in outdoor air, indoor air, dust, drinking water, and food and beverages from existing monitoring databases or comprehensive literature reviews. Intake estimates were then multiplied by cancer potency factors from Health Canada, the United States Environmental Protection Agency, and the California Office of Environmental Health Hazard Assessment to estimate lifetime excess cancer risks associated with each substance and exposure pathway. Lifetime excess cancer risks in excess of 1 per million people are identified as potential priorities for further attention. Based on data representing average conditions circa 2006, a total of 18 carcinogen-exposure pathways had potential lifetime excess cancer risks greater than 1 per million, based on varying data quality. Carcinogens with moderate to high data quality and lifetime excess cancer risk greater than 1 per million included benzene, 1,3-butadiene and radon in outdoor air; benzene and radon in indoor air; and arsenic and hexavalent chromium in drinking water. Important data gaps were identified for asbestos, hexavalent chromium and diesel exhaust in outdoor and indoor air, while little data were available to assess risk for substances in dust, food and beverages. The ability to track changes in potential population exposures to environmental carcinogens over time, as well as to compare between different substances and exposure pathways, is necessary to support comprehensive, evidence-based prevention policy. We used estimates of lifetime excess cancer risk as indicators that, although based on a number of simplifying assumptions, help to identify important data gaps and prioritize more detailed data collection and exposure assessment needs.

Refinement of arsenic attributable health risks in rural Pakistan using population specific dietary intake values.

PubMed

Rasheed, Hifza; Slack, Rebecca; Kay, Paul; Gong, Yun Yun

2017-02-01

Previous risk assessment studies have often utilised generic consumption or intake values when evaluating ingestion exposure pathways. If these values do not accurately reflect the country or scenario in question, the resulting risk assessment will not provide a meaningful representation of cancer risks in that particular country/scenario. This study sought to determine water and food intake parameters for one region in South Asia, rural Pakistan, and assess the role population specific intake parameters play in cancer risk assessment. A questionnaire was developed to collect data on sociodemographic features and 24-h water and food consumption patterns from a rural community. The impact of dietary differences on cancer susceptibility linked to arsenic exposure was evaluated by calculating cancer risks using the data collected in the current study against standard water and food intake levels for the USA, Europe and Asia. A probabilistic cancer risk was performed for each set of intake values of this study. Average daily total water intake based on drinking direct plain water and indirect water from food and beverages was found to be 3.5Lday -1 (95% CI: 3.38, 3.57) exceeding the US Environmental Protection Agency's default (2.5Lday -1 ) and World Health Organization's recommended intake value (2Lday -1 ). Average daily rice intake (469gday -1 ) was found to be lower than in India and Bangladesh whereas wheat intake (402gday -1 ) was higher than intake reported for USA, Europe and Asian sub-regions. Consequently, arsenic-associated cumulative cancer risks determined for daily water intake was found to be 17 chances in children of 3-6years (95% CI: 0.0014, 0.0017), 14 in children of age 6-16years (95% CI: 0.001, 0.0011) and 6 in adults of 16-67years (95% CI: 0.0006, 0.0006) in a population size of 10,000. This is higher than the risks estimated using the US Environmental Protection Agency and World Health Organization's default recommended water intake levels. Rice intake data showed early life cumulative cancer risks of 15 chances in 10,000 for children of 3-6years (95% CI: 0.0012, 0.0015), 14 in children of 6-16years (95% CI: 0.0011, 0.0014) and later life risk of 8 adults (95% CI: 0.0008, 0.0008) in a population of 10,000. This is lower than the cancer risks in countries with higher rice intake and elevated arsenic levels (Bangladesh and India). Cumulative cancer risk from arsenic exposure showed the relative risk contribution from total water to be 51%, from rice to be 44% and 5% from wheat intake. The study demonstrates the need to use population specific dietary information for risk assessment and risk management studies. Probabilistic risk assessment concluded the importance of dietary intake in estimating cancer risk, along with arsenic concentrations in water or food and age of exposed rural population. Copyright © 2016 Elsevier Ltd. All rights reserved.

Average household exposure to newspaper coverage about the harmful effects of hormone therapy and population-based declines in hormone therapy use.

PubMed

Haas, Jennifer S; Miglioretti, Diana L; Geller, Berta; Buist, Diana S M; Nelson, David E; Kerlikowske, Karla; Carney, Patricia A; Dash, Sarah; Breslau, Erica S; Ballard-Barbash, Rachel

2007-01-01

The news media facilitated the rapid dissemination of the findings from the estrogen plus progestin therapy arm of the Women's Health Initiative (EPT-WHI). To examine the relationship between the potential exposure to newspaper coverage and subsequent hormone therapy (HT) use. DESIGN/POPULATION: Population-based cohort of women receiving mammography at 7 sites (327,144 postmenopausal women). The outcome was the monthly prevalence of self-reported HT use. Circulation data for local, regional, and national newspapers was used to create zip-code level measures of the estimated average household exposure to newspaper coverage that reported the harmful effects of HT in July 2002. Women had an average potential household exposure of 1.4 articles. There was substantial variation in the level of average household exposure to newspaper coverage; women from rural sites received less than women from urban sites. Use of HT declined for all average potential exposure groups after the publication of the EPT-WHI. HT prevalence among women who lived in areas where there was an average household exposure of at least 3 articles declined significantly more (45 to 27%) compared to women who lived in areas with <1 article (43 to 31%) during each of the subsequent 5 months (relative risks 0.86-0.92; p < .006 for all). Greater average household exposure to newspaper coverage about the harms associated with HT was associated with a large population-based decline in HT use. Further studies should examine whether media coverage directly influences the health behavior of individual women.

Air pollution characteristics and health risks in Henan Province, China.

PubMed

Shen, Fuzhen; Ge, Xinlei; Hu, Jianlin; Nie, Dongyang; Tian, Li; Chen, Mindong

2017-07-01

Events of severe air pollution occurred frequently in China recently, thus understanding of the air pollution characteristics and its health risks is very important. In this work, we analyzed a two-year dataset (March 2014 - February 2016) including daily concentrations of six criteria pollutants (PM 2.5 , PM 10 , CO, SO 2 , NO 2 , and O 3 ) from 18 cities in Henan province. Results reveal the serious air pollution status in Henan province, especially the northern part, and Zhengzhou is the city with the worst air quality. Annual average PM 2.5 concentrations exceed the second grade of Chinese Ambient Air Quality Standard (75μg/m 3 ) at both 2014 and 2015. PM 2.5 is typically the major pollutant, but ozone pollution can be significant during summer. Furthermore, as the commonly used air quality index (AQI) neglects the mutual health effects from multiple pollutants, we introduced the aggregate air quality index (AAQI) and health-risk based air quality index (HAQI) to evaluate the health risks. Results show that based on HAQI, the current AQI system likely significantly underestimate the health risks of air pollution, highlighting that the general public may need stricter health protection measures. The population-weighted two-year average HAQI data further demonstrates that all population in the studied cities in Henan province live with polluted air - 72% of the population is exposed to air that is unhealthy for sensitive people, while 28% of people is exposed to air that can be harmful to healthy people; and the health risks are much greater during winter than during other seasons. Future works should further improve the HAQI algorithm, and validate the links between the clinical/epidemiologic data and the HAQI values. Copyright © 2017 Elsevier Inc. All rights reserved.

Use of a genealogical database demonstrates heritability of pulmonary fibrosis.

PubMed

Scholand, Mary Beth; Coon, Hilary; Wolff, Roger; Cannon-Albright, Lisa

2013-10-01

Pulmonary fibrosis (PF) is a progressive fatal disease of unknown etiology. Identification of risk genes and pathways will enhance our understanding of this disease. Analysis of Utah genealogical resources has shown previously strong evidence for a genetic contribution to other disease, such as cancer. This approach has led to gene discovery in diseases, such as breast cancer and colon cancer and is used here for PF to quantify the heritability. We hypothesize that there is a heritable contribution to death from PF and use existing genealogic and death certificate data to examine patterns of relatedness amongst individuals who have died of PF. We analyzed familial clustering of individuals who died from PF using the Utah Population Database, a unique population-based genealogical resource that has been linked to death certificates dating from 1904. We identified 1,000 individuals with at least three generations of genealogy data and a cause of death documented as PF (cases). We estimated the relative risk (RR) of death from PF among the first-, second-, and third-degree relatives of cases. We also tested the hypothesis of excess relatedness among the cases by comparing the average pairwise relatedness of all cases to the average pair-wise relatedness of 1,000 sets of matched controls. We observed significantly increased risk for death from PF among the first- (RR = 4.69), second- (RR = 1.92), and third-degree relatives (RR = 1.14) of cases. The average relatedness of the 1,000 cases was significantly higher than the expected average relatedness of matched control sets (p < 0.001). When close (first- and second-degree) relationships were ignored, significantly increased relatedness remained (p = 0.002). Our results demonstrate significant clustering among both close and distant relatives, providing strong support for genetic contributions to death from PF. High-risk pedigrees derived from this unique resource may help identify new risk genes and gene pathways.

Cadmium exposure and risk of lung cancer: a meta-analysis of cohort and case-control studies among general and occupational populations.

PubMed

Chen, Cheng; Xun, Pengcheng; Nishijo, Muneko; He, Ka

2016-09-01

The association between cadmium exposure and risk of lung cancer is still unclear. We quantitatively reviewed the observational studies that investigated the association between cadmium exposure and lung cancer risk in both general and occupational populations published through April 2015. The final data set is comprised of three cohort studies in the general population totaling 22,551 participants (354 events) with a mean follow-up of 15 years, five occupational cohort studies including 4205 individuals (180 events) with an average follow-up of 31 years, and three occupational case-control studies including 4740 cases and 6268 controls. Comparing the highest to the lowest category of cadmium exposure, the weighted relative risk and 95% confidence interval of lung cancer in the general population was 1.42 (95% CI (0.91, 2.23)); the weighted risk estimates (95% CIs) of lung cancer in three occupational cohort studies and three case-control studies were 0.68 (95% CI (0.33, 1.41)) and 1.61 (95% CI (0.94, 2.75)), respectively. No linear association was found. When comparing participants exposed to cadmium with non-exposed based on available data, the association became statistically significant. According to findings from this meta-analysis, the possibility that cadmium exposure may increase risk of lung cancer cannot be completely ruled out in either general or occupational population.

[Implementation of intervention programs on AIDS-related sexual transmission in China].

PubMed

Dong, Wei; Zhou, Chu; Ge, Lin; Li, Dongmin; Wu, Zunyou; Rou, Keming

2015-12-01

To analyze the implementation of intervention programs targeted on AIDS high risk sexual transmission groups since 2008, when the relative prevention and control information systems on HIV/AIDS were developed. Data from both aggregated interventions and sentinel surveillance programs from 2008 to the end of 2014 were used. Descriptive statistics were performed to analyze the trends of implementation on high risk groups including men who have sex with men, female sex workers (FSW) and migrant workers. From 2008 to 2012, the monthly average numbers receiving intervention programs and the average monthly coverage rate on intervention for MSM, increased from 49 000 to 252 000, and from 8.6% to 78.5% respectively. The FSW related indicators increased from 329 000 to 625 000, and from 30.9% to 87.0% respectively. Above indexes on the two populations had dropped slightly in 2013 and 2014. Sentinel surveillance data showed that knowledge and behavior indicators observed from the MSM and FSW populations increased annually. The coverage of intervention programs on migrant workers increased from 4.7% to almost 10.0%, but the surveillance data on migrant men showed that the knowledge and behavior indicators were still lower than the other high-risk groups. Intervention related to sexual transmission on HIV/AIDS among high-risk populations were effectively implemented, with some achievements seen. However, as sexual contact currently became the main route of AIDS epidemic, new challenges called for serious attention.

Assessment of exposures and potential risks to the US adult population from wear (attrition and abrasion) of gold and ceramic dental restorations.

PubMed

Richardson, G Mark; Clemow, Scott R; Peters, Rachel E; James, Kyle J; Siciliano, Steven D

2016-01-01

Little has been published on the chemical exposures and risks of dental restorative materials other than from dental amalgam and composite resins. Here we provide the first exposure and risk assessment for gold (Au) alloy and ceramic restorative materials. Based on the 2001-2004 US National Health and Nutrition Examination Survey (NHANES), we assessed the exposure of US adults to the components of Au alloy and ceramic dental restorations owing to dental material wear. Silver (Ag) is the most problematic component of Au alloy restorations, owing to a combination of toxicity and proportional composition. It was estimated that adults could possess an average of four tooth surfaces restored with Au alloy before exceeding, on average, the reference exposure level (REL) for Ag. Lithium (Li) is the most problematic component of dental ceramics. It was estimated that adults could possess an average of 15 tooth surfaces restored with ceramics before exceeding the REL for Li. Relative risks of chemical exposures from dental materials decrease in the following order: Amalgam>Au alloys>ceramics>composite resins.

Area characteristics and admission rates of people with schizophrenia and affective disorders in a German rural catchment area.

PubMed

Losert, C; Schmauß, M; Becker, T; Kilian, R

2012-12-01

Studies in urban areas identified environmental risk factors for mental illness, but little research on this topic has been performed in rural areas. Hospital admission rates were computed for 174 rural municipalities in the catchment area of the state psychiatric hospital in Günzburg in years 2006 to 2009 and combined with structural and socio-economic data. Relationships of overall and diagnosis-specific admission rates with municipality characteristics were analysed by means of negative binomial regression models. Admission rates of patients with a diagnosis of schizophrenia and affective disorder combined decrease with increasing population growth, population density, average income and green areas, while admission rates are positively correlated with commuter balance, income inequality, unemployment rates and traffic areas. Admission rates for schizophrenia are negatively related to population growth, average income and agricultural areas, but positively related to mobility index, income inequality and unemployment rate. Admission rates for affective disorders are negatively related to population growth, population density, average income and green areas, while higher admission rates are correlated with commuter balance, high income inequality, unemployment rate and traffic-related areas. Effects of wealth, economic inequality, population density and structural area characteristics influence psychiatric admission rates also in rural areas.

Geographical Detector-Based Risk Factors Assessment of the Hand-Foot-Mouth Disease in China

NASA Astrophysics Data System (ADS)

Huang, J.

2017-12-01

Background: Hand, foot and mouth disease(HFMD) is a common infectious disease, causing thousands of deaths among children in China. This study focused on analyzing the impacts of different populations and different industry structures on HFMD incidence in China. Methods: We collected HFMD cases from 2307 counties during May 2008 in China. The potential risk factors included: monthly mean temperature, monthly mean relative humidity, monthly precipitation, different population density, different industry structures. Geographical detector technique was used to analyze the main and interactive effect of potential risk factors on HFMD incidence. Result: Using risk detector, we found the most serious HFMD incidence mainly located in the Yangtze River delta and the Pearl River delta. When the temperature was high, the incidence of HFMD was also high. This finding indicates that there is a correlation between monthly mean temperature and the incidence of HFMD. Similar analysis was undertaken to analyze the correlation between other variables and the incidence of HFMD using the risk detector. Using factor detector, we found the effect of risk factors on the incidence of HFMD, and this was ranked by PD value as follows: density of children aged 0-9 years (0.25) > tertiary industry (0.23) > GDP (0.20) >middle school student density (0.13) > relative humidity (0.12) >average temperature (0.11) >first industry (0.05). Using ecological detector, we found that child density, tertiary industry, and GDP had a strong effect on the incidence of HFMD. Using interactive detector, we found that the interactive PD value of tertiary industry and child population density was 0.42, which of GDP and tertiary industry was 0.34, that of child population density and GDP was 0.35, and that of average temperature and relative humidity was 0.28. All of these interactive PD values appeared to be higher than any PD value of sole risk factors. The combinations of the above-mentioned risk factors could effectively explain spatial variability of the incidence of HFMD in China.

The Perinatal Risk Index: Early Risks Experienced by Domestic Adoptees in the United States.

PubMed

Marceau, Kristine; De Araujo-Greecher, Marielena; Miller, Emily S; Massey, Suena H; Mayes, Linda C; Ganiban, Jody M; Reiss, David; Shaw, Daniel S; Leve, Leslie D; Neiderhiser, Jenae M

2016-01-01

We aimed to assess comprehensively the prevalence of perinatal risks experienced by a potentially high-risk yet understudied population of children domestically adopted in the United States. Data are from participant report and medical records from mothers (n = 580) who completed a domestic adoption placement with nonrelatives at or near birth (Mean placement age = 7 days). We describe a comprehensive measure of perinatal risks, including divergences from previous assessment tools and the incorporation of multiple reporters, and report the prevalence of various types of perinatal risks. The prevalence of each specific risk factor was generally low, although several risks were more prevalent in this sample than estimates from nationally representative publicly available data. Nearly the entire sample (99%) experienced some type of risk exposure. Birth mothers who placed their children for adoption domestically in the US experience higher levels of perinatal risks than the national average, but not for all specific types of risk. Thus, the developmental trajectories of children adopted domestically may systematically differ from the general population to the extent that these specific perinatal risks impact development.

Implementing an Internet-Delivered Skin Cancer Genetic Testing Intervention to Improve Sun Protection Behavior in a Diverse Population: Protocol for a Randomized Controlled Trial.

PubMed

Hay, Jennifer L; Berwick, Marianne; Zielaskowski, Kate; White, Kirsten Am; Rodríguez, Vivian M; Robers, Erika; Guest, Dolores D; Sussman, Andrew; Talamantes, Yvonne; Schwartz, Matthew R; Greb, Jennie; Bigney, Jessica; Kaphingst, Kimberly A; Hunley, Keith; Buller, David B

2017-04-25

Limited translational genomic research currently exists to guide the availability, comprehension, and appropriate use of personalized genomics in diverse general population subgroups. Melanoma skin cancers are preventable, curable, common in the general population, and disproportionately increasing in Hispanics. Variants in the melanocortin-1 receptor (MC1R) gene are present in approximately 50% of the population, are major factors in determining sun sensitivity, and confer a 2-to-3-fold increase in melanoma risk in the general population, even in populations with darker skin. Therefore, feedback regarding MC1R risk status may raise risk awareness and protective behavior in the general population. We are conducting a randomized controlled trial examining Internet presentation of the risks and benefits of personalized genomic testing for MC1R gene variants that are associated with increased melanoma risk. We will enroll a total of 885 participants (462 participants are currently enrolled), who will be randomized 6:1 to personalized genomic testing for melanoma risk versus waiting list control. Control participants will be offered testing after outcome assessments. Participants will be balanced across self-reported Hispanic versus non-Hispanic ethnicity (n=750 in personalized genomic testing for melanoma risk arm; n=135 in control arm), and will be recruited from a general population cohort in Albuquerque, New Mexico, which is subject to year-round sun exposure. Baseline surveys will be completed in-person with study staff and follow-up measures will be completed via telephone. Aim 1 of the trial will examine the personal utility of personalized genomic testing for melanoma risk in terms of short-term (3-month) sun protection and skin screening behaviors, family and physician communication, and melanoma threat and control beliefs (ie, putative mediators of behavior change). We will also examine potential unintended consequences of testing among those who receive average-risk personalized genomic testing for melanoma risk findings, and examine predictors of sun protection at 3 months as the outcome. These findings will be used to develop messages for groups that receive average-risk feedback. Aim 2 will compare rates of test consideration in Hispanics versus non-Hispanics, including consideration of testing pros and cons and registration of a decision to either accept or decline testing. Aim 3 will examine personalized genomic testing for melanoma risk feedback comprehension, recall, satisfaction, and cancer-related distress in those who undergo testing, and whether these outcomes differ by ethnicity (Hispanic vs non-Hispanic), or sociocultural or demographic factors. Final outcome data collection is anticipated to be complete by October 2017, at which point data analysis will commence. This study has important implications for personalized genomics in the context of melanoma risk, and may be broadly applicable as a model for delivery of personalized genomic feedback for other health conditions. ©Jennifer L Hay, Marianne Berwick, Kate Zielaskowski, Kirsten AM White, Vivian M Rodríguez, Erika Robers, Dolores D Guest, Andrew Sussman, Yvonne Talamantes, Matthew R Schwartz, Jennie Greb, Jessica Bigney, Kimberly A Kaphingst, Keith Hunley, David B Buller. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 25.04.2017.

Association between zolpidem use and glaucoma risk: a Taiwanese population-based case-control study.

PubMed

Ho, Yi-Hao; Chang, Yue-Cune; Huang, Wei-Cheng; Chen, Hsin-Yi; Lin, Che-Chen; Sung, Fung-Chang

2015-01-01

To date, the relationship between zolpidem use and subsequent risk of glaucoma in a Taiwanese population has not been assessed. We used data from the National Health Insurance system to investigate whether zolpidem use was related to glaucoma risk. A 1:4 matched case-control study was conducted. The cases were patients newly diagnosed with glaucoma from 2001 to 2010. The controls were randomly selected non-glaucoma subjects matched by sex and age (± 5 years). Zolpidem exposure and/or the average dosage of zolpidem used (mg/year) were evaluated. Medical comorbidities were considered as confounding factors. Multiple logistic regression models were used to evaluate the potential risk of zolpidem exposure on glaucoma with/without adjustment for the effects of confounding variables. The exposure rate of zolpidem use in the glaucoma group was significantly higher than that of the control group (2.8% vs. 2.0%, P < 0.0001). The adjusted odds ratio (OR) of the risk of glaucoma for those with zolpidem use vs. those without was 1.19 (95% confidence interval [CI], 1.02-1.38). Compared to non-zolpidem users, zolpidem users with an average dose of more than 200 mg/year had significantly increased risk of glaucoma (OR 1.31, 95% CI 1.03-1.68). This study suggests that the use of zolpidem might increase the risk of subsequent glaucoma. Further confirmatory studies are recommended to clarify this important issue.

Association Between Zolpidem Use and Glaucoma Risk: A Taiwanese Population-Based Case-Control Study

PubMed Central

Ho, Yi-Hao; Chang, Yue-Cune; Huang, Wei-Cheng; Chen, Hsin-Yi; Lin, Che-Chen; Sung, Fung-Chang

2015-01-01

Background To date, the relationship between zolpidem use and subsequent risk of glaucoma in a Taiwanese population has not been assessed. Methods We used data from the National Health Insurance system to investigate whether zolpidem use was related to glaucoma risk. A 1:4 matched case-control study was conducted. The cases were patients newly diagnosed with glaucoma from 2001 to 2010. The controls were randomly selected non-glaucoma subjects matched by sex and age (±5 years). Zolpidem exposure and/or the average dosage of zolpidem used (mg/year) were evaluated. Medical comorbidities were considered as confounding factors. Multiple logistic regression models were used to evaluate the potential risk of zolpidem exposure on glaucoma with/without adjustment for the effects of confounding variables. Results The exposure rate of zolpidem use in the glaucoma group was significantly higher than that of the control group (2.8% vs. 2.0%, P < 0.0001). The adjusted odds ratio (OR) of the risk of glaucoma for those with zolpidem use vs. those without was 1.19 (95% confidence interval [CI], 1.02–1.38). Compared to non-zolpidem users, zolpidem users with an average dose of more than 200 mg/year had significantly increased risk of glaucoma (OR 1.31, 95% CI 1.03–1.68). Conclusions This study suggests that the use of zolpidem might increase the risk of subsequent glaucoma. Further confirmatory studies are recommended to clarify this important issue. PMID:25720944

Association Between Zolpidem Use and Glaucoma Risk: A Taiwanese Population-Based Case-Control Study.

PubMed

Ho, Yi-Hao; Chang, Yue-Cune; Huang, Wei-Cheng; Chen, Hsin-Yi; Lin, Che-Chen; Sung, Fung-Chang

2014-08-23

Background: To date, the relationship between zolpidem use and subsequent risk of glaucoma in a Taiwanese population has not been assessed.Methods: We used data from the National Health Insurance system to investigate whether zolpidem use was related to glaucoma risk. A 1:4 matched case-control study was conducted. The cases were patients newly diagnosed with glaucoma from 2001 to 2010. The controls were randomly selected non-glaucoma subjects matched by sex and age (±5 years). Zolpidem exposure and/or the average dosage of zolpidem used (mg/year) were evaluated. Medical comorbidities were considered as confounding factors. Multiple logistic regression models were used to evaluate the potential risk of zolpidem exposure on glaucoma with/without adjustment for the effects of confounding variables.Results: The exposure rate of zolpidem use in the glaucoma group was significantly higher than that of the control group (2.8% vs. 2.0%, P < 0.0001). The adjusted odds ratio (OR) of the risk of glaucoma for those with zolpidem use vs. those without was 1.19 (95% confidence interval [CI], 1.02-1.38). Compared to non-zolpidem users, zolpidem users with an average dose of more than 200 mg/year had significantly increased risk of glaucoma (OR 1.31, 95% CI 1.03-1.68).Conclusions: This study suggests that the use of zolpidem might increase the risk of subsequent glaucoma. Further confirmatory studies are recommended to clarify this important issue.

[Greenhouse gardeners and sickness absence. A questionnaire study among greenhouse gardeners in Aarhus region].

PubMed

Pallesen, Ellen; Nielsen, Claus Vinther; Drews, Birgit Mammen

2007-02-26

The aim of the study was to examine sickness absence and risk factors for sickness absence in a population of greenhouse gardeners in the county of Arhus. The study was cross sectional and based on data from questionnaires sent to all employees and greenhouse gardens in the county. Greenhouse gardeners had an average of four days of sickness absence a year. Self-rated health was poorer than average of the Danish population in general. Female gender, age below 40 years, troublesome relationships to family and friends, "poor" physical working environment and job insecurity were all predictors for increased risk of sickness absence lasting more than two weeks a year. Sickness absence was low compared to the average of the Danish labour market. Considering poorer self-rated health and frequent occurrence of some of the above-mentioned predictors for increased risk of sickness absence--female gender, age below 40 years and for women, high exposure to "poor" physical working environment--an average sickness absence of only four days was a puzzle. The data from the study were not sufficient to explain this paradox. It might be due to compensating factors at work or at a personal level. It might be due to information bias, as sickness absence could be underestimated, but agreement between reported sickness absence from employees and greenhouse gardens diminished that probability. It might have been a consequence of selection bias, the "healthy workers'" effect. Employees with considerable sickness absence might have been dismissed for long-term absence or might have quit the job because they were not able to cope with it.

The conversion of exposures due to radon into the effective dose: the epidemiological approach.

PubMed

Beck, T R

2017-11-01

The risks and dose conversion coefficients for residential and occupational exposures due to radon were determined with applying the epidemiological risk models to ICRP representative populations. The dose conversion coefficient for residential radon was estimated with a value of 1.6 mSv year -1 per 100 Bq m -3 (3.6 mSv per WLM), which is significantly lower than the corresponding value derived from the biokinetic and dosimetric models. The dose conversion coefficient for occupational exposures with applying the risk models for miners was estimated with a value of 14 mSv per WLM, which is in good accordance with the results of the dosimetric models. To resolve the discrepancy regarding residential radon, the ICRP approaches for the determination of risks and doses were reviewed. It could be shown that ICRP overestimates the risk for lung cancer caused by residential radon. This can be attributed to a wrong population weighting of the radon-induced risks in its epidemiological approach. With the approach in this work, the average risks for lung cancer were determined, taking into account the age-specific risk contributions of all individuals in the population. As a result, a lower risk coefficient for residential radon was obtained. The results from the ICRP biokinetic and dosimetric models for both, the occupationally exposed working age population and the whole population exposed to residential radon, can be brought in better accordance with the corresponding results of the epidemiological approach, if the respective relative radiation detriments and a radiation-weighting factor for alpha particles of about ten are used.

Assessing the underlying breast cancer risk of Chinese females contributed by dietary intake of residual DDT from agricultural soils.

PubMed

Tang, Mengling; Zhao, Meirong; Zhou, Shanshan; Chen, Kun; Zhang, Chunlong; Liu, Weiping

2014-12-01

The greatest concern over DDT exposure in China arose since the early 1990s for the rising breast cancer incidence, and the cause still remains to be elucidated. An extensive survey of DDT background in agricultural soils, covered the entire region of China, was conducted. DDT at concentrations greater than 100 ng/g (the China's Farmland Environmental Quality Evaluation Standards for Edible Agricultural Products) was found to impact 42.3 million Chinese population. Considering the geographical differences with diverse DDT contributions and different diet products and habits, the average daily dietary intake was modeled and estimated to be 0.34 μg/kg p,p'-DDE (the main bioactive constituent in DDT). Population attributable fraction derived from a case-control study from 78 women with breast cancer and 72 controls was used to assess the DDT exposure risk to breast cancer. Based on the estimated population attributable fraction with a median value of 0.6% (IQR 0.23-2.11%), the excess annual breast cancer incidence rate attributable to p,p'-DDE exposure averaged 0.06×10(-5) with significant spatial variations varying from 0.00021×10(-5) to 11.05×10(-5) in Chinese females. Exposure to DDT is a contributor to breast cancer, but the overall limited relative risk and population attributable fraction imply confounding factors for breast cancer in Chinese females. Exposure risk in a regional scale helps understand the cause and prevention of breast cancer. Our mapping and modeling method could be used to assess other environmental carcinogens and related cancer diseases. Copyright © 2014 Elsevier Ltd. All rights reserved.

[Melanoma in organ transplant patients].

PubMed

Lévêque, L; Dalac, S; Dompmartin, A; Louvet, S; Euvrard, S; Catteau, B; Hazan, M; Schollhamer, M; Aubin, F; Dreno, B; Daguin, P; Chevrant-Breton, J; Frances, C; Bismuth, M J; Tanter, Y; Lambert, D

2000-02-01

The incidence of cutaneous melanoma has rapidly increased in the white population over the last decades. It has been estimated that the incidence doubles world-wide every 10 years. Different risk factors have been identified, including immunosuppression. The aim of our study-was to determine the relative risk of developing melanoma in the organ transplant population and the clinical and histological features of their melanomas. This retrospective study was conducted with the collaboration of 9 University Hospital Centers: Besançon, Brest, Caen, Dijon, Lille, Lyon, Nantes, Paris (Pitié-Salpétrière) and Rennes. A questionnaire was sent to the different departments of dermatology of these hospitals to obtain information on patients who had presented a melanoma after a transplantation between 1971 and 1997. During this period, there were 12,477 organ transplant recipients in the transplantation units of these 9 hospitals. Average follow-up for these patients was about 5 years and the average duration of immunosuppressive therapy was about 4.5 years. Among 12,477 organ transplant recipients, we found 17 cases of melanoma but no data could be obtain on one case: 14 occurred in renal transplant recipients and 3 in cardiac transplant recipients. Clinical and histological data were only available in 16 patients. The average time between transplantation and diagnosis of melanoma was 63 months, but it was 5 times shorter for 2 patients who had a past history of melanoma before transplantation. Two patients had a mucosal melanoma; for the cutaneous melanomas, 2 appeared on Dubreuilh melanosis, 2 were in situ melanomas, 7 were superficial spreading melanomas and 3 were nodular melanomas. The histological review of 11 cutaneous melanomas revealed a precursor nevus in 6 cases and a weak or no stroma reaction in 7/7 cases. Complete excision of the melanoma was performed in all patients except one with anorectal melanoma. Four patients died of visceral metastasis within a mean 15 months. The other 12 patients are still alive with a mean 3 year course since tumor treatment. We tried to determine the relative risk of developing melanoma in the renal transplant population (14 cases). The number of expected cases of melanoma was 5.54, giving a relative risk of 2.5. Only 4 studies have shown an increase in the incidence of melanoma in the renal transplant population: approximately 2 to 5-fold. In our study, the 2.5-fold increase in melanoma was estimated with an average 5 year follow-up and an average 5 year immunosuppressive therapy. This is probably an underestimation of risk because we were unable to make an exhaustive collection of cases of melanomas even though transplant recipients undergo more physical examinations than a reference population. The mean latency period from transplantation to melanoma diagnosis was 63 months, as in other studies. Histological examination showed that a precursor nevus is frequent with weak host cellular response to the tumor. The prognosis of these melanomas remains difficult to predict, but in our study, it would not appear to be as poor as expected. Discontinuation of immunosuppressive therapy would not appear to be necessary except in the presence of metastasis. Finally, our study demonstrates the importance of good patient follow-up, even after graft rejection due to the persistent risk of melanoma.

Mortality after radiotherapy for ringworm of the scalp

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ron, E.; Modan, B.; Boice, J.D. Jr.

1988-04-01

The mortality experience of 10,834 children treated with x-rays for ringworm of the scalp between 1948 and 1960, 10,834 matched comparison subjects, and 5392 siblings was evaluated over an average follow-up period of 26 years. Mortality was ascertained by linking unique personal identification numbers of study subjects with the national death registry. Radiotherapy in childhood was associated with an increased risk of death due to tumors of the head and neck (relative risk (RR) = 3) and leukemia (RR = 2.3). No other causes of death were significantly elevated after irradiation. The excess of brain tumors (average intracranial dose =more » 150 rads) confirms that the central nervous system of the child is sensitive to the induction of cancers by radiation. The bone marrow dose averaged over the entire body was approximately 30 rad, and the estimated risk coefficient of 0.9 excess leukemias per million per year per rad is consistent with other studies of whole-body exposure. A significant excess of bone and soft tissue sarcomas (RR = 9) was also observed. The pattern of cancer risk over time was bimodal; an early peak due to excess leukemias occurred within a few years of exposure, whereas excesses of solid tumors were most apparent after about 15 years. Despite the excess of cancers among exposed persons, over 50% of the deaths in the entire study population were from external events, mainly accidents or events related to military service. An estimate of the total impact of radiogenic cancer after childhood irradiation will require additional years of observation since the population irradiated is just now entering the age ranges normally associated with high cancer risk.« less

Air pollution and daily mortality: A new approach to an old problem

NASA Astrophysics Data System (ADS)

Lipfert, Frederick W.; Murray, Christian J.

2012-08-01

Many time-series studies find associations between acute health effects and ambient air quality under current conditions. However, few such studies link mortality with morbidity to provide rational bases for improving public health. This paper describes a research project that developed and validated a new modeling approach directly addressing changes in life expectancies and the prematurity of deaths associated with transient changes in air quality. We used state-space modeling and Kalman filtering of elderly Philadelphia mortality counts from 1974-88 to estimate the size of the population at highest risk of imminent death. This subpopulation appears stable over time but is sensitive to season and to environmental factors: ambient temperature, ozone, and total suspended particulate matter (TSP), as an index of airborne particles in this demonstration of methodology. This population at extreme risk averages fewer than 0.1% of the elderly. By considering successively longer lags or moving averages of TSP, we find that cumulative short-term effects on entry to the at-risk pool tend to level off and decrease as periods of exposure longer than a few days are considered. These estimated environmental effects on the elderly are consistent with previous analyses using conventional time-series methods. However, this new model suggests that such environmentally linked deaths comprise only about half of the subjects whose frailty is associated with environmental factors. The average life expectancy of persons in the at-risk pool is estimated to be 5-7 days, which may be reduced by less than one day by environmental effects. These results suggest that exposures leading up to severe acute frailty and subsequent risk of imminent death may be more important from a public health perspective than those directly associated with subsequent mortality.

The average cumulative risks of breast and ovarian cancer for carriers of mutations in BRCA1 and BRCA2 attending genetic counseling units in Spain.

PubMed

Milne, Roger L; Osorio, Ana; Cajal, Teresa Ramón Y; Vega, Ana; Llort, Gemma; de la Hoya, Miguel; Díez, Orland; Alonso, M Carmen; Lazaro, Conxi; Blanco, Ignacio; Sánchez-de-Abajo, Ana; Caldés, Trinidad; Blanco, Ana; Graña, Begoña; Durán, Mercedes; Velasco, Eladio; Chirivella, Isabel; Cardeñosa, Eva Esteban; Tejada, María-Isabel; Beristain, Elena; Miramar, María-Dolores; Calvo, María-Teresa; Martínez, Eduardo; Guillén, Carmen; Salazar, Raquel; San Román, Carlos; Antoniou, Antonis C; Urioste, Miguel; Benítez, Javier

2008-05-01

It is not clear that the published estimates of the breast and ovarian cancer penetrances of mutations in BRCA1 and BRCA2 can be used in genetic counseling in countries such as Spain, where the incidence of breast cancer in the general population is considerably lower, the prevalence of BRCA2 mutations seems to be higher, and a distinct spectrum of recurrent mutations exists for both genes. We aimed to estimate these penetrances for women attending genetic counseling units in Spain. We collected phenotype and genotype data on 155 BRCA1 and 164 BRCA2 mutation carrier families from 12 centers across the country. Average age-specific cumulative risks of breast cancer and ovarian cancer were estimated using a modified segregation analysis method. The estimated average cumulative risk of breast cancer to age 70 years was estimated to be 52% [95% confidence interval (95% CI), 26-69%] for BRCA1 mutation carriers and 47% (95% CI, 29-60%) for BRCA2 mutation carriers. The corresponding estimates for ovarian cancer were 22% (95% CI, 0-40%) and 18% (95% CI, 0-35%), respectively. There was some evidence (two-sided P = 0.09) that 330A>G (R71G) in BRCA1 may have lower breast cancer penetrance. These results are consistent with those from a recent meta-analysis of practically all previous penetrance studies, suggesting that women with BRCA1 and BRCA2 mutations attending genetic counseling services in Spain have similar risks of breast and ovarian cancer to those published for other Caucasian populations. Carriers should be fully informed of their mutation- and age-specific risks to make appropriate decisions regarding prophylactic interventions such as oophorectomy.

A novel metric that quantifies risk stratification for evaluating diagnostic tests: The example of evaluating cervical-cancer screening tests across populations.

PubMed

Katki, Hormuzd A; Schiffman, Mark

2018-05-01

Our work involves assessing whether new biomarkers might be useful for cervical-cancer screening across populations with different disease prevalences and biomarker distributions. When comparing across populations, we show that standard diagnostic accuracy statistics (predictive values, risk-differences, Youden's index and Area Under the Curve (AUC)) can easily be misinterpreted. We introduce an intuitively simple statistic for a 2 × 2 table, Mean Risk Stratification (MRS): the average change in risk (pre-test vs. post-test) revealed for tested individuals. High MRS implies better risk separation achieved by testing. MRS has 3 key advantages for comparing test performance across populations with different disease prevalences and biomarker distributions. First, MRS demonstrates that conventional predictive values and the risk-difference do not measure risk-stratification because they do not account for test-positivity rates. Second, Youden's index and AUC measure only multiplicative relative gains in risk-stratification: AUC = 0.6 achieves only 20% of maximum risk-stratification (AUC = 0.9 achieves 80%). Third, large relative gains in risk-stratification might not imply large absolute gains if disease is rare, demonstrating a "high-bar" to justify population-based screening for rare diseases such as cancer. We illustrate MRS by our experience comparing the performance of cervical-cancer screening tests in China vs. the USA. The test with the worst AUC = 0.72 in China (visual inspection with acetic acid) provides twice the risk-stratification (i.e. MRS) of the test with best AUC = 0.83 in the USA (human papillomavirus and Pap cotesting) because China has three times more cervical precancer/cancer. MRS could be routinely calculated to better understand the clinical/public-health implications of standard diagnostic accuracy statistics. Published by Elsevier Inc.

Evaluation on the cost-effective threshold of osteoporosis treatment on elderly women in China using discrete event simulation model.

PubMed

Ni, W; Jiang, Y

2017-02-01

This study used a simulation model to determine the cost-effective threshold of fracture risk to treat osteoporosis among elderly Chinese women. Osteoporosis treatment is cost-effective among average-risk women who are at least 75 years old and above-average-risk women who are younger than 75 years old. Aging of the Chinese population is imposing increasing economic burden of osteoporosis. This study evaluated the cost-effectiveness of osteoporosis treatment among the senior Chinese women population. A discrete event simulation model using age-specific probabilities of hip fracture, clinical vertebral fracture, wrist fracture, humerus fracture, and other fracture; costs (2015 US dollars); and quality-adjusted life years (QALYs) was used to assess the cost-effectiveness of osteoporosis treatment. Incremental cost-effectiveness ratio (ICER) was calculated. The willingness to pay (WTP) for a QALY in China was compared with the calculated ICER to decide the cost-effectiveness. To determine the absolute 10-year hip fracture probability at which the osteoporosis treatment became cost-effective, average age-specific probabilities for all fractures were multiplied by a relative risk (RR) that was systematically varied from 0 to 10 until the WTP threshold was observed for treatment relative to no intervention. Sensitivity analyses were also performed to evaluate the impacts from WTP and annual treatment costs. In baseline analysis, simulated ICERs were higher than the WTP threshold among Chinese women younger than 75, but much lower than the WTP among the older population. Sensitivity analyses indicated that cost-effectiveness could vary due to a higher WTP threshold or a lower annual treatment cost. A 30 % increase in WTP or a 30 % reduction in annual treatment costs will make osteoporosis treatment cost-effective for Chinese women population from 55 to 85. The current study provides evidence that osteoporosis treatment is cost-effective among a subpopulation of Chinese senior women. The results also indicate that the cost-effectiveness of using osteoporosis treatment is sensitive to the WTP threshold and annual treatment costs.

Awareness of cancer risk factors among ethnic minority groups in England.

PubMed

Marlow, L A V; Robb, K A; Simon, A E; Waller, J; Wardle, J

2012-08-01

To explore awareness of cancer risk factors in ethnic minority men and women living in England. Cross-sectional survey. Men and women were recruited from the six largest ethnic minority groups in the UK proportional to the population distribution: Indian (n = 467); Pakistani (n = 333); Bangladeshi (n = 126); Caribbean (n = 252); African (n = 216); and Chinese (n = 106). Participants responded to an open-ended question about cancer risk factors. Analyses were adjusted for age, gender, socio-economic class and language. The most commonly cited cancer risk factors were smoking (55%), diet (20%), genetics (20%), drinking alcohol (19%) and lifestyle (17%). On average, participants who were able to name cancer risk factors (91% of respondents) cited 2.13 factors. There were some differences between broad ethnic groups (Asian, Black and Chinese), but fewer differences within them (e.g. between Indian, Pakistani and Bangladeshi, or African and Caribbean). Awareness of risk factors (particularly diet and exercise) was lower in this sample than in previous population representative samples in the UK. Interventions aimed at raising awareness of cancer risk factors are likely to be beneficial across the whole ethnic minority population. Any ethnically targeted interventions should consider risk factor awareness levels as well as cancer risk. Copyright © 2012 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Unhealthy Behaviours: An International Comparison

PubMed Central

Ferretti, Fabrizio

2015-01-01

In the current global economy, chronic non-communicable diseases (NCDs) have become the leading cause of death and a major health concern for both developed and developing countries. Among other factors, the worldwide spread of NCDs is driven by the globalisation of unhealthy habits. The purpose of this paper is to develop a simple statistic to measure, at the national level, the average population’s exposure to the main NCDs modifiable risk factors. The approach and methodology followed by the United Nations Development Programme to compute the Human Development Index (HDI) is applied to four basic indicators of NCD-related preventable risk factors (alcohol consumption, excess caloric intake, non-balanced diet and tobacco use) in 112 countries worldwide in 2012–14. We obtain a summary composite index, which we call the Unhealthy Behaviour Index (UBI), which ranks countries by the average level of the unhealthy habits (drinking, eating and smoking) of their populations. We find that Belarus and Russian federation are the two countries with the unhealthiest NCD-related lifestyle. With the exception of Canada, the first twenty populations more exposed to the main NCDs preventable risk factors all live in European countries, and mainly in countries of Eastern Europe. Overall, the UBI tends to increase along with the level of human development. In medium, high and very high HDI countries, however, the same level of human development may be associated with very different kinds of NCD-related lifestyles. Finally, economic growth may push populations toward either more unhealthy or healthy habits, depending on the countries’ level of development; the elasticity of unhealthy habits with respect to income per capita is positive (but less than one: on average 0.6) until $30,000, decreases as income rises, and becomes negative (around -0.3) in very high income countries. PMID:26512717

Bacterial Populations Associated with Smokeless Tobacco Products

PubMed Central

Han, Jing; Sanad, Yasser M.; Deck, Joanna; Sutherland, John B.; Li, Zhong; Walters, Matthew J.; Duran, Norma; Holman, Matthew R.

2016-01-01

ABSTRACT There are an estimated 8 million users of smokeless tobacco products (STPs) in the United States, and yet limited data on microbial populations within these products exist. To better understand the potential microbiological risks associated with STP use, a study was conducted to provide a baseline microbiological profile of STPs. A total of 90 samples, representing 15 common STPs, were purchased in metropolitan areas in Little Rock, AR, and Washington, DC, in November 2012, March 2013, and July 2013. Bacterial populations were evaluated using culture, pyrosequencing, and denaturing gradient gel electrophoresis (DGGE). Moist-snuff products exhibited higher levels of bacteria (average of 1.05 × 106 CFU/g STP) and diversity of bacterial populations than snus (average of 8.33 × 101 CFU/g STP) and some chewing tobacco products (average of 2.54 × 105 CFU/g STP). The most common species identified by culturing were Bacillus pumilus, B. licheniformis, B. safensis, and B. subtilis, followed by members of the genera Oceanobacillus, Staphylococcus, and Tetragenococcus. Pyrosequencing analyses of the 16S rRNA genes identified the genera Tetragenococcus, Carnobacterium, Lactobacillus, Geobacillus, Bacillus, and Staphylococcus as the predominant taxa. Several species identified are of possible concern due to their potential to cause opportunistic infections and reported abilities to reduce nitrates to nitrites, which may be an important step in the formation of carcinogenic tobacco-specific N′-nitrosamines. This report provides a microbiological baseline to help fill knowledge gaps associated with microbiological risks of STPs and to inform potential regulations regarding manufacture and testing of STPs. IMPORTANCE It is estimated that there 8 million users of smokeless tobacco products (STPs) in the United States; however, there are limited data on microbial populations that exist within these products. The current study was undertaken to better understand the potential microbiological risks associated with STP use and provide a baseline microbiological profile of STPs. Several bacterial species were identified that are of possible concern due to their potential to cause opportunistic infections. In addition, some species have abilities to reduce nitrates to nitrites, which may be an important step in the formation of carcinogenic tobacco-specific N′-nitrosamines. Overall, this report provides a microbiological baseline to help fill knowledge gaps related to the microbiological risks of STPs and to inform potential regulations regarding the manufacture and testing of STPs. PMID:27565615

The Application Law of Large Numbers That Predicts The Amount of Actual Loss in Insurance of Life

NASA Astrophysics Data System (ADS)

Tinungki, Georgina Maria

2018-03-01

The law of large numbers is a statistical concept that calculates the average number of events or risks in a sample or population to predict something. The larger the population is calculated, the more accurate predictions. In the field of insurance, the Law of Large Numbers is used to predict the risk of loss or claims of some participants so that the premium can be calculated appropriately. For example there is an average that of every 100 insurance participants, there is one participant who filed an accident claim, then the premium of 100 participants should be able to provide Sum Assured to at least 1 accident claim. The larger the insurance participant is calculated, the more precise the prediction of the calendar and the calculation of the premium. Life insurance, as a tool for risk spread, can only work if a life insurance company is able to bear the same risk in large numbers. Here apply what is called the law of large number. The law of large numbers states that if the amount of exposure to losses increases, then the predicted loss will be closer to the actual loss. The use of the law of large numbers allows the number of losses to be predicted better.

[Prevalence of asthma and determination of symptoms as risk indicators].

PubMed

Mancilla-Hernández, Eleazar; Medina-Ávalos, Miguel Alejandro; Barnica-Alvarado, Raúl Humberto; Soto-Candia, Diego; Guerrero-Venegas, Rosario; Zecua-Nájera, Yahvéh

2015-01-01

Asthma is a chronic inflammatory airway disease whose prevalence has increased, especially in developed countries; the results of studies of asthma prevalence vary in different populations and even within the same country; in Mexico we observed fluctuations in prevalence of asthma from 7% to 33%. To determine the prevalence of asthma and severity of symptoms as risk indicators in school population in cities in various states of Mexico. A descriptive study of detection of asthma prevalence and analytical-comparative observational study of determination of symptoms of asthma. The surveys were applied to preschool, elementary, middle and high school population, in the cities of Puebla, Puebla; Tulancingo, Hidalgo; Tlaxcala, Tlaxcala, and Cancún, Quintana Roo; new validated questionnaire was used as instrument: Asthma Diagnostic Questionnaire for Epidemiologic Studies, consisting of eight questions with summation value for diagnosis. 8,754 surveys showed a 14% prevalence in Puebla, 17% in Tulancingo, 7% in Tlaxcala, and 14% in Cancún; average in four cities surveyed was 13%; the strength of association with asthma symptoms in descending order with significant odds ratio were: recurrent wheezing, breathlessness, chest tightness, recurrent cough, cough cold, recurrent cold symptoms, predominantly nocturnal cough, cough that increases with exercise. The average prevalence of asthma in the surveyed cities was 13% and the main symptoms indicators of risk of asthma in school children were: recurrent wheezing, breathlessness, chest tightness and recurrent cough.

Prioritizing Avian Species for Their Risk of Population-Level Consequences from Wind Energy Development

PubMed Central

Beston, Julie A.; Diffendorfer, Jay E.; Loss, Scott R.; Johnson, Douglas H.

2016-01-01

Recent growth in the wind energy industry has increased concerns about its impacts on wildlife populations. Direct impacts of wind energy include bird and bat collisions with turbines whereas indirect impacts include changes in wildlife habitat and behavior. Although many species may withstand these effects, species that are long-lived with low rates of reproduction, have specialized habitat preferences, or are attracted to turbines may be more prone to declines in population abundance. We developed a prioritization system to identify the avian species most likely to experience population declines from wind facilities based on their current conservation status and their expected risk from turbines. We developed 3 metrics of turbine risk that incorporate data on collision fatalities at wind facilities, population size, life history, species’ distributions relative to turbine locations, number of suitable habitat types, and species’ conservation status. We calculated at least 1 measure of turbine risk for 428 avian species that breed in the United States. We then simulated 100,000 random sets of cutoff criteria (i.e., the metric values used to assign species to different priority categories) for each turbine risk metric and for conservation status. For each set of criteria, we assigned each species a priority score and calculated the average priority score across all sets of criteria. Our prioritization system highlights both species that could potentially experience population decline caused by wind energy and species at low risk of population decline. For instance, several birds of prey, such as the long-eared owl, ferruginous hawk, Swainson’s hawk, and golden eagle, were at relatively high risk of population decline across a wide variety of cutoff values, whereas many passerines were at relatively low risk of decline. This prioritization system is a first step that will help researchers, conservationists, managers, and industry target future study and management activity. PMID:26963254

Prioritizing avian species for their risk of population-level consequences from wind energy development

USGS Publications Warehouse

Beston, Julie A.; Diffendorfer, James E.; Loss, Scott; Johnson, Douglas H.

2016-01-01

Recent growth in the wind energy industry has increased concerns about its impacts on wildlife populations. Direct impacts of wind energy include bird and bat collisions with turbines whereas indirect impacts include changes in wildlife habitat and behavior. Although many species may withstand these effects, species that are long-lived with low rates of reproduction, have specialized habitat preferences, or are attracted to turbines may be more prone to declines in population abundance. We developed a prioritization system to identify the avian species most likely to experience population declines from wind facilities based on their current conservation status and their expected risk from turbines. We developed 3 metrics of turbine risk that incorporate data on collision fatalities at wind facilities, population size, life history, species’ distributions relative to turbine locations, number of suitable habitat types, and species’ conservation status. We calculated at least 1 measure of turbine risk for 428 avian species that breed in the United States. We then simulated 100,000 random sets of cutoff criteria (i.e., the metric values used to assign species to different priority categories) for each turbine risk metric and for conservation status. For each set of criteria, we assigned each species a priority score and calculated the average priority score across all sets of criteria. Our prioritization system highlights both species that could potentially experience population decline caused by wind energy and species at low risk of population decline. For instance, several birds of prey, such as the long-eared owl, ferruginous hawk, Swainson’s hawk, and golden eagle, were at relatively high risk of population decline across a wide variety of cutoff values, whereas many passerines were at relatively low risk of decline. This prioritization system is a first step that will help researchers, conservationists, managers, and industry target future study and management activity.

Prioritizing Avian Species for Their Risk of Population-Level Consequences from Wind Energy Development.

PubMed

Beston, Julie A; Diffendorfer, Jay E; Loss, Scott R; Johnson, Douglas H

2016-01-01

Recent growth in the wind energy industry has increased concerns about its impacts on wildlife populations. Direct impacts of wind energy include bird and bat collisions with turbines whereas indirect impacts include changes in wildlife habitat and behavior. Although many species may withstand these effects, species that are long-lived with low rates of reproduction, have specialized habitat preferences, or are attracted to turbines may be more prone to declines in population abundance. We developed a prioritization system to identify the avian species most likely to experience population declines from wind facilities based on their current conservation status and their expected risk from turbines. We developed 3 metrics of turbine risk that incorporate data on collision fatalities at wind facilities, population size, life history, species' distributions relative to turbine locations, number of suitable habitat types, and species' conservation status. We calculated at least 1 measure of turbine risk for 428 avian species that breed in the United States. We then simulated 100,000 random sets of cutoff criteria (i.e., the metric values used to assign species to different priority categories) for each turbine risk metric and for conservation status. For each set of criteria, we assigned each species a priority score and calculated the average priority score across all sets of criteria. Our prioritization system highlights both species that could potentially experience population decline caused by wind energy and species at low risk of population decline. For instance, several birds of prey, such as the long-eared owl, ferruginous hawk, Swainson's hawk, and golden eagle, were at relatively high risk of population decline across a wide variety of cutoff values, whereas many passerines were at relatively low risk of decline. This prioritization system is a first step that will help researchers, conservationists, managers, and industry target future study and management activity.

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

NASA Astrophysics Data System (ADS)

Listo, Fabrizio de Luiz Rosito; Carvalho Vieira, Bianca

2012-10-01

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

A statistical approach to rank multiple priorities in environmental epidemiology: an example from high-risk areas in Sardinia, Italy.

PubMed

Catelan, Dolores; Biggeri, Annibale

2008-11-01

In environmental epidemiology, long lists of relative risk estimates from exposed populations are compared to a reference to scrutinize the dataset for extremes. Here, inference on disease profiles for given areas, or for fixed disease population signatures, are of interest and summaries can be obtained averaging over areas or diseases. We have developed a multivariate hierarchical Bayesian approach to estimate posterior rank distributions and we show how to produce league tables of ranks with credibility intervals useful to address the above mentioned inferential problems. Applying the procedure to a real dataset from the report "Environment and Health in Sardinia (Italy)" we selected 18 areas characterized by high environmental pressure for industrial, mining or military activities investigated for 29 causes of deaths among male residents. Ranking diseases highlighted the increased burdens of neoplastic (cancerous), and non-neoplastic respiratory diseases in the heavily polluted area of Portoscuso. The averaged ranks by disease over areas showed lung cancer among the three highest positions.

Identifying populations sensitive to environmental chemicals by simulating toxicokinetic variability.

PubMed

Ring, Caroline L; Pearce, Robert G; Setzer, R Woodrow; Wetmore, Barbara A; Wambaugh, John F

2017-09-01

The thousands of chemicals present in the environment (USGAO, 2013) must be triaged to identify priority chemicals for human health risk research. Most chemicals have little of the toxicokinetic (TK) data that are necessary for relating exposures to tissue concentrations that are believed to be toxic. Ongoing efforts have collected limited, in vitro TK data for a few hundred chemicals. These data have been combined with biomonitoring data to estimate an approximate margin between potential hazard and exposure. The most "at risk" 95th percentile of adults have been identified from simulated populations that are generated either using standard "average" adult human parameters or very specific cohorts such as Northern Europeans. To better reflect the modern U.S. population, we developed a population simulation using physiologies based on distributions of demographic and anthropometric quantities from the most recent U.S. Centers for Disease Control and Prevention National Health and Nutrition Examination Survey (NHANES) data. This allowed incorporation of inter-individual variability, including variability across relevant demographic subgroups. Variability was analyzed with a Monte Carlo approach that accounted for the correlation structure in physiological parameters. To identify portions of the U.S. population that are more at risk for specific chemicals, physiologic variability was incorporated within an open-source high-throughput (HT) TK modeling framework. We prioritized 50 chemicals based on estimates of both potential hazard and exposure. Potential hazard was estimated from in vitro HT screening assays (i.e., the Tox21 and ToxCast programs). Bioactive in vitro concentrations were extrapolated to doses that produce equivalent concentrations in body tissues using a reverse dosimetry approach in which generic TK models are parameterized with: 1) chemical-specific parameters derived from in vitro measurements and predicted from chemical structure; and 2) with physiological parameters for a virtual population. For risk-based prioritization of chemicals, predicted bioactive equivalent doses were compared to demographic-specific inferences of exposure rates that were based on NHANES urinary analyte biomonitoring data. The inclusion of NHANES-derived inter-individual variability decreased predicted bioactive equivalent doses by 12% on average for the total population when compared to previous methods. However, for some combinations of chemical and demographic groups the margin was reduced by as much as three quarters. This TK modeling framework allows targeted risk prioritization of chemicals for demographic groups of interest, including potentially sensitive life stages and subpopulations. Published by Elsevier Ltd.

Cardiopulmonary events during primary colonoscopy screening in an average risk population.

PubMed

Khalid-de Bakker, C A; Jonkers, D M; Hameeteman, W; de Ridder, R J; Masclee, A A; Stockbrügger, R W

2011-04-01

Large colorectal cancer screening studies using primary colonoscopy have reported a low risk of major complications. Studies on diagnostic and therapeutic colonoscopy have pointed to a frequent occurrence of(minor) cardiopulmonary events, and with the steady increase of colonoscopy screening, it is important to investigate their occurrence in colonoscopy screening. This study describes the frequency of bradycardia(pulse rate <60 min-1), hypotension (systolic blood pressure(SB P) <90 mmHg), hypoxaemia (blood oxygenation, SaO2<90%) and ECG changes during colonoscopy screening in an average-risk population (hospital personnel, n=214,mean age 54.0±3.8, 39.3% male), without significant comorbidity) and aims at identifying subject-related and/or endoscopic factors associated with their occurrence. All data were collected prospectively. During 214 consecutive primary screening colonoscopies under conscious sedation(midazolam and pethidine), on top of pulse rate and SaO2,blood pressure and a three-channel ECG were recorded every five minutes. No major complications or relevant ECG changes occurred. Hypoxaemia occurred in 119 (55.6%),hypotension in 19 (8.9%) and bradycardia in 12 subjects(5.6%). In multivariate analysis, the sedation level 3 increased the risk of hypoxaemia (OR 4.8, CI 1.7-13.7), and incomplete colonoscopy (OR 5.3, CI 1.6-18.1) was associated with hypotension. Subjects with bradycardia had a longer mean procedure time (38±12 vs. 29±12 min, p<0.05), which did not turn out as a risk factor in a multivariate analysis. Mainly procedure-related and not subject-related factors were found to be associated with the occurrence of cardiopulmonary events in primary colonoscopy screening in this relatively healthy screening population.

Insights from epidemiological game theory into gender-specific vaccination against rubella.

PubMed

Shim, Eunha; Kochin, Beth; Galvani, Alison

2009-10-01

Rubella is a highly contagious childhood disease that causes relatively mild symptoms. However, rubella can result in severe congenital defects, known as congenital rubella syndrome (CRS), if transmitted from a mother to a fetus. Consequently, women have higher incentive to vaccinate against rubella than men do. Within the population vaccination reduces transmission but also increases the average age of infection and possibly the risk of CRS among unvaccinated females. To evaluate how the balance among these factors results in optimal coverage of vaccination, we developed a game theoretic age-structured epidemiological model of rubella transmission and vaccination. We found that high levels of vaccination for both genders are most effective in maximizing average utility across the population by decreasing the risk of CRS and reducing transmission of rubella. By contrast, the demands for vaccines driven by self-interest among males and females are 0% and 100% acceptance, respectively, if the cost of vaccination is relatively low. Our results suggest that the rubella vaccination by males that is likely to be achieved on voluntary basis without additional incentives would have been far lower than the population optimum, if rubella vaccine were offered separately instead of combined with measles and mumps vaccination as the MMR vaccine.

Why is the age-standardized incidence of low-trauma fractures rising in many elderly populations?

PubMed

Kannus, Pekka; Niemi, Seppo; Parkkari, Jari; Palvanen, Mika; Heinonen, Ari; Sievänen, Harri; Järvinen, Teppo; Khan, Karim; Järvinen, Markku

2002-08-01

Low-trauma fractures of elderly people are a major public health burden worldwide, and as the number and mean age of older adults in the population continue to increase, the number of fractures is also likely to increase. Epidemiologically, however, an additional concern is that, for unknown reasons, the age-standardized incidence (average individual risk) of fracture has also risen in many populations during the recent decades. Possible reasons for this rise include a birth cohort effect, deterioration in the average bone strength by time, and increased average risk of (serious) falls. Literature provides evidence that the rise is not due to a birth cohort effect, whereas no study shows whether bone fragility has increased during this relatively short period of time. This osteoporosis hypothesis could, however, be tested if researchers would now repeat the population measurements of bone mass and density that were made in the late 1980s and the 1990s. If such studies proved that women's and men's age-standardized mean values of bone mass and density have declined over time, the osteoporosis hypothesis would receive scientific support. The third explanation is based on the hypothesis that the number and/or severity of falls has risen in elderly populations during the recent decades. Although no study has directly tested this hypothesis, a great deal of indirect epidemiologic evidence supports this contention. For example, the age-standardized incidence of fall-induced severe head injuries, bruises and contusions, and joint distortions and dislocations has increased among elderly people similarly to the low-trauma fractures. The fall hypothesis could also be tested in the coming years because the 1990s saw many research teams reporting age- and sex-specific incidences of falling for elderly populations, and the same could be done now to provide data comparing the current incidence rates of falls with the earlier ones.

Disparities in cigarette tax exposure by race, ethnicity, poverty status and sexual orientation, 2006-2014, USA.

PubMed

Golden, Shelley D; Kong, Amanda Y; Lee, Joseph G L; Ribisl, Kurt M

2018-03-01

Cigarette excise taxes are an effective tobacco control strategy but they vary geographically due to differences in state and local taxation. There are also pronounced sociodemographic differences in community composition, suggesting that different population groups might face vastly different cigarette excise tax rates. In this study, we examine how cigarette excise tax rates differ for population groups defined by race, ethnicity, poverty status, and sexual orientation, and how these differences have evolved over time. We constructed annual cigarette tax rates in 109 mutually exclusive jurisdictions within the United States (U.S.) between 2006 and 2014. After merging with Census sociodemographic data, we calculated annual cigarette excise tax exposures for each population group as the average of each place-based tax, weighted by the proportion of the group living there. In 2014, the average U.S. resident was required to pay $2.68 in cigarette taxes, more than 60% of which was due to state and local taxation. On average, Asian/Native Hawaiian and Other Pacific Islander populations faced the highest average tax ($2.95), which was $0.44 more than American Indian populations. Local taxes disproportionately augmented state and federal taxes for non-White populations, same-sex couples, and people living in poverty. Geographic variation in cigarette excise taxes produces sociodemographic variation in cigarette tax exposure. Raising cigarette taxes specifically in those places where groups at risk for tobacco-related disease are more likely to live, or otherwise creating geographically uniform tax levels, could reduce important disparities in cigarette smoking. Copyright © 2017. Published by Elsevier Inc.

Natural disturbance reduces disease risk in endangered rainforest frog populations

PubMed Central

Roznik, Elizabeth A.; Sapsford, Sarah J.; Pike, David A.; Schwarzkopf, Lin; Alford, Ross A.

2015-01-01

Natural disturbances can drive disease dynamics in animal populations by altering the microclimates experienced by hosts and their pathogens. Many pathogens are highly sensitive to temperature and moisture, and therefore small changes in habitat structure can alter the microclimate in ways that increase or decrease infection prevalence and intensity in host populations. Here we show that a reduction of rainforest canopy cover caused by a severe tropical cyclone decreased the risk of endangered rainforest frogs (Litoria rheocola) becoming infected by a fungal pathogen (Batrachochytrium dendrobatidis). Reductions in canopy cover increased the temperatures and rates of evaporative water loss in frog microhabitats, which reduced B. dendrobatidis infection risk in frogs by an average of 11–28% in cyclone-damaged areas, relative to unaffected areas. Natural disturbances to the rainforest canopy can therefore provide an immediate benefit to frogs by altering the microclimate in ways that reduce infection risk. This could increase host survival and reduce the probability of epidemic disease outbreaks. For amphibian populations under immediate threat from this pathogen, targeted manipulation of canopy cover could increase the availability of warmer, drier microclimates and therefore tip the balance from host extinction to coexistence. PMID:26294048

Natural disturbance reduces disease risk in endangered rainforest frog populations.

PubMed

Roznik, Elizabeth A; Sapsford, Sarah J; Pike, David A; Schwarzkopf, Lin; Alford, Ross A

2015-08-21

Natural disturbances can drive disease dynamics in animal populations by altering the microclimates experienced by hosts and their pathogens. Many pathogens are highly sensitive to temperature and moisture, and therefore small changes in habitat structure can alter the microclimate in ways that increase or decrease infection prevalence and intensity in host populations. Here we show that a reduction of rainforest canopy cover caused by a severe tropical cyclone decreased the risk of endangered rainforest frogs (Litoria rheocola) becoming infected by a fungal pathogen (Batrachochytrium dendrobatidis). Reductions in canopy cover increased the temperatures and rates of evaporative water loss in frog microhabitats, which reduced B. dendrobatidis infection risk in frogs by an average of 11-28% in cyclone-damaged areas, relative to unaffected areas. Natural disturbances to the rainforest canopy can therefore provide an immediate benefit to frogs by altering the microclimate in ways that reduce infection risk. This could increase host survival and reduce the probability of epidemic disease outbreaks. For amphibian populations under immediate threat from this pathogen, targeted manipulation of canopy cover could increase the availability of warmer, drier microclimates and therefore tip the balance from host extinction to coexistence.

Dietary exposure and risk assessment of polychlorinated dibenzo-p-dioxins, polychlorinated dibenzofurans and dioxin-like polychlorinated biphenyls of the population in the Region of Valencia (Spain).

PubMed

Quijano, Leyre; Marín, Silvia; Millan, Encarnación; Yusà, Vicent; Font, Guillermina; Pardo, Olga

2018-04-01

Dietary exposure of the Valencia Region population to polychlorinated dibenzo-p-dioxins (PCDDs), polychlorinated dibenzofurans (PCDFs) and PCBs was assessed in the Region of Valencia in 2010-2011. A total of 7700 food samples were collected. Occurrence data were combined with consumption data to estimate dietary exposure in adults (>15 years of age) and young people (6-15 years of age). The estimated intake was calculated by a probabilistic approach. Average intake levels (upper-bound scenario) were 1.58 and 2.76 pg toxic equivalent (TEQ) kg -1 body weight (bw) day -1 for adults and young people, respectively. These average intakes are within range of the tolerable daily intake of 1-4 pg WHO-TEQ kg -1 bw day -1 recommended by WHO, and slightly above the tolerable weekly intake (TWI) of 14 pg TEQ kg -1 bw week -1 and the Provisional tolerable monthly intake of 70 pg TEQ kg -1 bw month -1 set by the Scientific Committee on Food and the Joint FAO/WHO Expert Committee on Food, respectively. These results show that the contamination levels in food and therefore the exposure of the general population to PCDD/Fs and PCBs have declined in this region and therefore show the efficiency of the European risk-management measures. In terms of risk characterisation, the results showed that, under the upper-bound scenario, 22% of the adult and 58% of the young people population could exceed the TWI.

CHILDREN HOSPITALIZED WITH LOWER EXTREMITY FRACTURES IN THE UNITED STATES IN 2006: A POPULATION-BASED APPROACH

PubMed Central

Gao, Yubo

2011-01-01

OBJECTIVE The purpose of this study was to examine the demographic and hospitalization characteristics of children hospitalized with lower extremity fractures in the United States in 2006. METHODS Children aged 0 to 20 years with a diagnosis of lower extremity fracture in the 2006 Healthcare Cost and Utilization Project Kids’ Inpatient Database (KID) were included. Lower extremity fractures were defined by International Classification of Diseases, 9th Revision, Clinical Modification codes 820-829 under “Injury and Poisoning (800-999).” Patient demographic and hospitalization-related data were analyzed by chi-square testing and unbalanced analysis of variance. RESULTS There were more boys than girls with lower extremity fractures and 53% had private insurance as their primary payer. About one half of the children were between the ages of 13 and 20 years, but all ages were represented from age 0 to 20. White children accounted for 56%. Urban hospitalizations accounted for 93% of cases and 66 percent of admissions were to teaching hospitals. All patients had an average length of stay (LOS) 4.04 days, and infant patients had the longest average LOS of 5.46 days. The average number of diagnoses per patient was 3.07, and the average number of procedures per patient was 2.21. The average charge per discharge was $35,236, and the oldest patients had the largest average charge of $41,907. The average number of comorbidities increased with increasing patient age. There was a 55.6% greater mortality risk in non-teaching hospitals than in teaching hospitals and there was at least ten times the mortality risk in rural hospitals than in urban hospitals. CONCLUSIONS This study provides an understanding of the demographic and hospitalization characteristics of children with lower extremity fractures in the United States in 2006. This information may be useful in implementing measures to help prevent similar injuries in the future. Further research is required to determine causality of the associations found including increased mortality risk for this population at rural and non-teaching hospitals. PMID:22096438

Children hospitalized with lower extremity fractures in the United States in 2006: a population-based approach.

PubMed

Gao, Yubo

2011-01-01

The purpose of this study was to examine the demographic and hospitalization characteristics of children hospitalized with lower extremity fractures in the United States in 2006. Children aged 0 to 20 years with a diagnosis of lower extremity fracture in the 2006 Healthcare Cost and Utilization Project Kids' Inpatient Database (KID) were included. Lower extremity fractures were defined by International Classification of Diseases, 9th Revision, Clinical Modification codes 820-829 under "Injury and Poisoning (800-999)." Patient demographic and hospitalization-related data were analyzed by chi-square testing and unbalanced analysis of variance. There were more boys than girls with lower extremity fractures and 53% had private insurance as their primary payer. About one half of the children were between the ages of 13 and 20 years, but all ages were represented from age 0 to 20. White children accounted for 56%. Urban hospitalizations accounted for 93% of cases and 66 percent of admissions were to teaching hospitals. All patients had an average length of stay (LOS) 4.04 days, and infant patients had the longest average LOS of 5.46 days. The average number of diagnoses per patient was 3.07, and the average number of procedures per patient was 2.21. The average charge per discharge was $35,236, and the oldest patients had the largest average charge of $41,907. The average number of comorbidities increased with increasing patient age. There was a 55.6% greater mortality risk in non-teaching hospitals than in teaching hospitals and there was at least ten times the mortality risk in rural hospitals than in urban hospitals. This study provides an understanding of the demographic and hospitalization characteristics of children with lower extremity fractures in the United States in 2006. This information may be useful in implementing measures to help prevent similar injuries in the future. Further research is required to determine causality of the associations found including increased mortality risk for this population at rural and non-teaching hospitals.

Differential risk of injury in child occupants by passenger car classification.

PubMed

Kallan, Michael J; Durbin, Dennis R; Elliott, Michael R; Menon, Rajiv A; Winston, Flaura K

2003-01-01

In the United States, passenger cars are the most common passenger vehicle, yet they vary widely in size and crashworthiness. Using data collected from a population-based sample of crashes in State Farm-insured vehicles, we quantified the risk of injury to child occupants by passenger car size and classification. Injury risk is predicted by vehicle weight; however, there is an increased risk in both Large vs. Luxury and Sports vs. Small cars, despite similar average vehicle weights in both comparisons. Parents who are purchasing passenger cars should strongly consider the size of the vehicle and its crashworthiness.

Differential Risk of Injury in Child Occupants by Passenger Car Classification

PubMed Central

Kallan, Michael J.; Durbin, Dennis R.; Elliott, Michael R.; Menon, Rajiv A.; Winston, Flaura K.

2003-01-01

In the United States, passenger cars are the most common passenger vehicle, yet they vary widely in size and crashworthiness. Using data collected from a population-based sample of crashes in State Farm-insured vehicles, we quantified the risk of injury to child occupants by passenger car size and classification. Injury risk is predicted by vehicle weight; however, there is an increased risk in both Large vs. Luxury and Sports vs. Small cars, despite similar average vehicle weights in both comparisons. Parents who are purchasing passenger cars should strongly consider the size of the vehicle and its crashworthiness. PMID:12941234

Genome-wide association study of ancestry-specific TB risk in the South African Coloured population

PubMed Central

Chimusa, Emile R.; Zaitlen, Noah; Daya, Michelle; Möller, Marlo; van Helden, Paul D.; Mulder, Nicola J.; Price, Alkes L.; Hoal, Eileen G.

2014-01-01

The worldwide burden of tuberculosis (TB) remains an enormous problem, and is particularly severe in the admixed South African Coloured (SAC) population residing in the Western Cape. Despite evidence from twin studies suggesting a strong genetic component to TB resistance, only a few loci have been identified to date. In this work, we conduct a genome-wide association study (GWAS), meta-analysis and trans-ethnic fine mapping to attempt the replication of previously identified TB susceptibility loci. Our GWAS results confirm the WT1 chr11 susceptibility locus (rs2057178: odds ratio = 0.62, P = 2.71e−06) previously identified by Thye et al., but fail to replicate previously identified polymorphisms in the TLR8 gene and locus 18q11.2. Our study demonstrates that the genetic contribution to TB risk varies between continental populations, and illustrates the value of including admixed populations in studies of TB risk and other complex phenotypes. Our evaluation of local ancestry based on the real and simulated data demonstrates that case-only admixture mapping is currently impractical in multi-way admixed populations, such as the SAC, due to spurious deviations in average local ancestry generated by current local ancestry inference methods. This study provides insights into identifying disease genes and ancestry-specific disease risk in multi-way admixed populations. PMID:24057671

Prediction impact curve is a new measure integrating intervention effects in the evaluation of risk models.

PubMed

Campbell, William; Ganna, Andrea; Ingelsson, Erik; Janssens, A Cecile J W

2016-01-01

We propose a new measure of assessing the performance of risk models, the area under the prediction impact curve (auPIC), which quantifies the performance of risk models in terms of their average health impact in the population. Using simulated data, we explain how the prediction impact curve (PIC) estimates the percentage of events prevented when a risk model is used to assign high-risk individuals to an intervention. We apply the PIC to the Atherosclerosis Risk in Communities (ARIC) Study to illustrate its application toward prevention of coronary heart disease. We estimated that if the ARIC cohort received statins at baseline, 5% of events would be prevented when the risk model was evaluated at a cutoff threshold of 20% predicted risk compared to 1% when individuals were assigned to the intervention without the use of a model. By calculating the auPIC, we estimated that an average of 15% of events would be prevented when considering performance across the entire interval. We conclude that the PIC is a clinically meaningful measure for quantifying the expected health impact of risk models that supplements existing measures of model performance. Copyright © 2016 Elsevier Inc. All rights reserved.

Study of epidemiological risk of lung cancer in Mexico due indoor radon exposure

NASA Astrophysics Data System (ADS)

Ángeles, A.; Espinosa, G.

2014-07-01

In this work the lifetime relative risks (LRR) of lung cancer due to exposure to indoor 222Rn on the Mexican population is calculated. Cigarette smoking is the number one risk factor for lung cancer (LC), because that, to calculate the number of cases of LC due to exposure to 222Rn is necessary considers the number of cases of LC for smoking cigarette. The lung cancer mortality rates published by the "Secretaría de Salud" (SSA), the mexican population data published by the "Consejo Nacional de Población" (CONAPO), smoking data in the mexican population, published by the "Comisión Nacional Contra las Adicciones" (CONADIC), the "Organización Panamericana de la Salud" (OPS) and indoor 222Rn concentrations in Mexico published in several recent studies are used. To calculate the lifetime relative risks (LRR) for different segments of the Mexican population, firstly the Excess Relative Risk (ERR) is calculated using the method developed by the BEIR VI committee and subsequently modified by the USEPA and published in the report "EPA Assessment of Risks from Radon in Homes". The excess relative risks were then used to calculate the corresponding lifetime relative risks, again using the method developed by the BEIR VI committee. The lifetime relative risks for Mexican male and female eversmokers and Mexican male and female never-smokers were calculated for radon concentrations spanning the range found in recent studies of indoor radon concentrations in Mexico. The lifetime relative risks of lung cancer induced by lifetime exposure to the mexican average indoor radon concentration were estimated to be 1.44 and 1.40 for never-smokers mexican females and males respectively, and 1.19 and 1.17 for ever-smokers Mexican females and males respectively. The Mexican population LRR values obtained in relation to the USA and Canada LRR published values in ever-smokers for both gender are similar with differences less than 4%, in case of never-smokers in relation with Canada population the differences in LRR values are less than 2% and in never-smokers for the USA population the differences in LRR values compared with the Mexican population are about 10%.

The "Let's Get Alarmed!" initiative: a smoke alarm giveaway programme.

PubMed

DiGuiseppi, C; Slater, S; Roberts, I; Adams, L; Sculpher, M; Wade, A; McCarthy, M

1999-09-01

To reduce fires and fire related injuries by increasing the prevalence of functioning smoke alarms in high risk households. The programme was delivered in an inner London area with above average material deprivation and below average smoke alarm ownership. The target population included low income and rental households and households with elderly persons or young children. Forty wards, averaging 4000 households each, were randomised to intervention or control status. Free smoke alarms and fire safety information were distributed in intervention wards by community groups and workers as part of routine activities and by paid workers who visited target neighbourhoods. Recipients provided data on household age distribution and housing tenure. Programme costs were documented from a societal perspective. Data are being collected on smoke alarm ownership and function, and on fires and related injuries and their costs. Community and paid workers distributed 20,050 smoke alarms, potentially sufficient to increase smoke alarm ownership by 50% in intervention wards. Compared with the total study population, recipients included greater proportions of low income and rental households and households including children under 5 years or adults aged 65 and older. Total programme costs were 145,087 Pounds. It is possible to implement a large scale smoke alarm giveaway programme targeted to high risk households in a densely populated, multicultural, materially deprived community. The programme's effects on the prevalence of installed and functioning alarms and the incidence of fires and fire related injuries, and its cost effectiveness, are being evaluated as a randomized controlled trial.

Herd-level bovine tuberculosis risk factors: assessing the role of low-level badger population disturbance.

PubMed

Wright, David M; Reid, Neil; Ian Montgomery, W; Allen, Adrian R; Skuce, Robin A; Kao, Rowland R

2015-08-17

Bovine TB (bTB) is endemic in Irish cattle and has eluded eradication despite considerable expenditure, amid debate over the relative roles of badgers and cattle in disease transmission. Using a comprehensive dataset from Northern Ireland (>10,000 km(2); 29,513 cattle herds), we investigated interactions between host populations in one of the first large-scale risk factor analyses for new herd breakdowns to combine data on both species. Cattle risk factors (movements, international imports, bTB history, neighbours with bTB) were more strongly associated with herd risk than area-level measures of badger social group density, habitat suitability or persecution (sett disturbance). Highest risks were in areas of high badger social group density and high rates of persecution, potentially representing both responsive persecution of badgers in high cattle risk areas and effects of persecution on cattle bTB risk through badger social group disruption. Average badger persecution was associated with reduced cattle bTB risk (compared with high persecution areas), so persecution may contribute towards sustaining bTB hotspots; findings with important implications for existing and planned disease control programmes.

Alcohol drinking patterns and risk of diabetes: a cohort study of 70,551 men and women from the general Danish population.

PubMed

Holst, Charlotte; Becker, Ulrik; Jørgensen, Marit E; Grønbæk, Morten; Tolstrup, Janne S

2017-10-01

Alcohol consumption is inversely associated with diabetes, but little is known about the role of drinking patterns. We examined the association between alcohol drinking patterns and diabetes risk in men and women from the general Danish population. This cohort study was based on data from the Danish Health Examination Survey 2007-2008. Of the 76,484 survey participants, 28,704 men and 41,847 women were eligible for this study. Participants were followed for a median of 4.9 years. Self-reported questionnaires were used to obtain information on alcohol drinking patterns, i.e. frequency of alcohol drinking, frequency of binge drinking, and consumption of wine, beer and spirits, from which we calculated beverage-specific and overall average weekly alcohol intake. Information on incident cases of diabetes was obtained from the Danish National Diabetes Register. Cox proportional hazards model was applied to estimate HRs and 95% CIs. During follow-up, 859 men and 887 women developed diabetes. The lowest risk of diabetes was observed at 14 drinks/week in men (HR 0.57 [95% CI 0.47, 0.70]) and at 9 drinks/week in women (HR 0.42 [95% CI 0.35, 0.51]), relative to no alcohol intake. Compared with current alcohol consumers consuming <1 day/week, consumption of alcohol on 3-4 days weekly was associated with significantly lower risk for diabetes in men (HR 0.73 [95% CI 0.59, 0.94]) and women (HR 0.68 [95% CI 0.53, 0.88]) after adjusting for confounders and average weekly alcohol amount. Our findings suggest that alcohol drinking frequency is associated with risk of diabetes and that consumption of alcohol over 3-4 days per week is associated with the lowest risk of diabetes, even after taking average weekly alcohol consumption into account.

Temporal and Spatial Simulation of Atmospheric Pollutant PM2.5 Changes and Risk Assessment of Population Exposure to Pollution Using Optimization Algorithms of the Back Propagation-Artificial Neural Network Model and GIS

PubMed Central

Zhang, Ping; Hong, Bo; He, Liang; Cheng, Fei; Zhao, Peng; Wei, Cailiang; Liu, Yunhui

2015-01-01

PM2.5 pollution has become of increasing public concern because of its relative importance and sensitivity to population health risks. Accurate predictions of PM2.5 pollution and population exposure risks are crucial to developing effective air pollution control strategies. We simulated and predicted the temporal and spatial changes of PM2.5 concentration and population exposure risks, by coupling optimization algorithms of the Back Propagation-Artificial Neural Network (BP-ANN) model and a geographical information system (GIS) in Xi’an, China, for 2013, 2020, and 2025. Results indicated that PM2.5 concentration was positively correlated with GDP, SO2, and NO2, while it was negatively correlated with population density, average temperature, precipitation, and wind speed. Principal component analysis of the PM2.5 concentration and its influencing factors’ variables extracted four components that accounted for 86.39% of the total variance. Correlation coefficients of the Levenberg-Marquardt (trainlm) and elastic (trainrp) algorithms were more than 0.8, the index of agreement (IA) ranged from 0.541 to 0.863 and from 0.502 to 0.803 by trainrp and trainlm algorithms, respectively; mean bias error (MBE) and Root Mean Square Error (RMSE) indicated that the predicted values were very close to the observed values, and the accuracy of trainlm algorithm was better than the trainrp. Compared to 2013, temporal and spatial variation of PM2.5 concentration and risk of population exposure to pollution decreased in 2020 and 2025. The high-risk areas of population exposure to PM2.5 were mainly distributed in the northern region, where there is downtown traffic, abundant commercial activity, and more exhaust emissions. A moderate risk zone was located in the southern region associated with some industrial pollution sources, and there were mainly low-risk areas in the western and eastern regions, which are predominantly residential and educational areas. PMID:26426030

Temporal and Spatial Simulation of Atmospheric Pollutant PM2.5 Changes and Risk Assessment of Population Exposure to Pollution Using Optimization Algorithms of the Back Propagation-Artificial Neural Network Model and GIS.

PubMed

Zhang, Ping; Hong, Bo; He, Liang; Cheng, Fei; Zhao, Peng; Wei, Cailiang; Liu, Yunhui

2015-09-29

PM2.5 pollution has become of increasing public concern because of its relative importance and sensitivity to population health risks. Accurate predictions of PM2.5 pollution and population exposure risks are crucial to developing effective air pollution control strategies. We simulated and predicted the temporal and spatial changes of PM2.5 concentration and population exposure risks, by coupling optimization algorithms of the Back Propagation-Artificial Neural Network (BP-ANN) model and a geographical information system (GIS) in Xi'an, China, for 2013, 2020, and 2025. Results indicated that PM2.5 concentration was positively correlated with GDP, SO₂, and NO₂, while it was negatively correlated with population density, average temperature, precipitation, and wind speed. Principal component analysis of the PM2.5 concentration and its influencing factors' variables extracted four components that accounted for 86.39% of the total variance. Correlation coefficients of the Levenberg-Marquardt (trainlm) and elastic (trainrp) algorithms were more than 0.8, the index of agreement (IA) ranged from 0.541 to 0.863 and from 0.502 to 0.803 by trainrp and trainlm algorithms, respectively; mean bias error (MBE) and Root Mean Square Error (RMSE) indicated that the predicted values were very close to the observed values, and the accuracy of trainlm algorithm was better than the trainrp. Compared to 2013, temporal and spatial variation of PM2.5 concentration and risk of population exposure to pollution decreased in 2020 and 2025. The high-risk areas of population exposure to PM2.5 were mainly distributed in the northern region, where there is downtown traffic, abundant commercial activity, and more exhaust emissions. A moderate risk zone was located in the southern region associated with some industrial pollution sources, and there were mainly low-risk areas in the western and eastern regions, which are predominantly residential and educational areas.

Epidemic of Lung Cancer in Patients With HIV Infection

PubMed Central

Winstone, Tiffany A.; Man, S. F. Paul; Hull, Mark; Montaner, Julio S.

2013-01-01

The survival of patients with HIV infection has improved dramatically over the past 20 years, largely owing to a significant reduction in opportunistic infections and AIDs-defining malignancies, such as lymphoma and Kaposi sarcoma. However, with improved survival, patients with HIV are experiencing morbidity and mortality from other (non-AIDs-defining) complications, such as solid organ malignancies. Of these, the leading cause of mortality in the HIV-infected population is lung cancer, accounting for nearly 30% of all cancer deaths and 10% of all non-HIV-related deaths. Importantly, the average age of onset of lung cancer in the HIV-infected population is 25 to 30 years earlier than that in the general population and at lower exposure to cigarette smoke. This article provides an overview of the epidemiology of lung cancer in the HIV-infected population and discusses some of the important risk factors and pathways that may enhance the risk of lung cancer in this population. PMID:23381313

Perception of Lung Cancer Risk: Impact of Smoking Status and Nicotine Dependence.

PubMed

Greillier, Laurent; Cortot, Alexis B; Viguier, Jérôme; Brignoli-Guibaudet, Lysel; Lhomel, Christine; Eisinger, François; Morère, Jean-François; Couraud, Sébastien

2018-03-05

The general population is nowadays well aware that tobacco smoking dramatically increases the risk of developing lung cancer. We hypothesized that a personal history of smoking and the level of nicotine dependence in current smokers may affect the perception of this risk among healthy individuals. The fourth French nationwide observational survey, EDIFICE 4, was conducted by telephone among a representative sample of individuals (N = 1602) aged between 40 and 75 years. Interviewees were asked about their smoking habits, perception of the risk of lung cancer, and nicotine dependence (Fagerström test). Regardless of their smoking status or level of nicotine dependence, the majority (96%) of our study population (N = 1463) acknowledged that tobacco smoking is a major risk factor for lung cancer. For 34% of all respondents, smoking ≤ 10 cigarettes per day does not carry any risk of lung cancer. Only half the current smokers considered themselves to be at higher risk of lung cancer than the average-risk population. The majority of current cigarette smokers with a nicotine dependence considered themselves to be at higher risk for lung cancer while only 37% of non-nicotine-dependent individuals had the same perception (P < 0.01). Current smokers were more likely to consider a screening examination than former smokers and never-smokers. However, the intention to undergo screening was not significantly affected by the level of nicotine dependence. Awareness campaigns may first have to overcome misconceptions about light smoking and, secondly, to target specific populations (heavy smokers, those with a long history, highly dependent smokers).

High coffee consumption and different brewing methods in relation to postmenopausal endometrial cancer risk in the Norwegian women and cancer study: a population-based prospective study.

PubMed

Gavrilyuk, Oxana; Braaten, Tonje; Skeie, Guri; Weiderpass, Elisabete; Dumeaux, Vanessa; Lund, Eiliv

2014-03-25

Coffee and its compounds have been proposed to inhibit endometrial carcinogenesis. Studies in the Norwegian population can be especially interesting due to the high coffee consumption and increasing incidence of endometrial cancer in the country. A total of 97 926 postmenopausal Norwegian women from the population-based prospective Norwegian Women and Cancer (NOWAC) Study, were included in the present analysis. We evaluated the general association between total coffee consumption and endometrial cancer risk as well as the possible impact of brewing method. Multivariate Cox regression analysis was used to estimate risks, and heterogeneity tests were performed to compare brewing methods. During an average of 10.9 years of follow-up, 462 incident endometrial cancer cases were identified. After multivariate adjustment, significant risk reduction was found among participants who drank ≥8 cups/day of coffee with a hazard ratio of 0.52 (95% confidence interval, CI 0.34-0.79). However, we did not observe a significant dose-response relationship. No significant heterogeneity in risk was found when comparing filtered and boiled coffee brewing methods. A reduction in endometrial cancer risk was observed in subgroup analyses among participants who drank ≥8 cups/day and had a body mass index ≥25 kg/m2, and in current smokers. These data suggest that in this population with high coffee consumption, endometrial cancer risk decreases in women consuming ≥8 cups/day, independent of brewing method.

Did it fall or was it pushed? The contribution of trends in established risk factors to the decline in premature coronary heart disease mortality in New Zealand.

PubMed

Tobias, Martin; Taylor, Richard; Yeh, Li-Chia; Huang, Ken; Mann, Stewart; Sharpe, Norman

2008-04-01

To estimate the contribution of trends in three risk factors--systolic blood pressure (SBP), total blood cholesterol (TBC) and cigarette smoking--to the decline in premature coronary heart disease (CHD) mortality in New Zealand from 1980-2004. Risk factor prevalence data by 10-year age group (35-64 years) and sex was sourced from six national or Auckland regional health surveys and three population censuses (the latter only for smoking). The data were smoothed using two-point moving averages, then further smoothed by fitting quadratic regression equations (SBP and TBC) or splines (smoking). Risk factor/CHD mortality hazard ratios estimated by expert working groups for the World Health Organization Global Burden of Disease Study 2001 were used to translate average annual changes in risk factor prevalences to the corresponding percentage changes in premature CHD mortality. The expected trends in CHD mortality were then compared with the observed trend to estimate the contribution of each risk factor to the decline. Approximately 80% (73% for males, 87% for females) of the decline in premature CHD mortality from 1980 to 2004 is estimated to have resulted from the joint trends in population SBP and TBC distributions and smoking prevalence. Overall, approximately 42%, 36% and 22% of the joint risk factor effect was contributed by trends in SBP, TBC and smoking respectively. Our estimate for the joint risk factor contribution to the CHD mortality decline of 80% exceeds those of two earlier New Zealand studies, but agrees closely with a similar Australian study. This provides an indicator of the scope that still remains for further reduction in CHD mortality through primary and secondary prevention.

Dietary exposure to trace elements and health risk assessment in the region of Valencia, Spain: a total diet study.

PubMed

Marín, Silvia; Pardo, Olga; Báguena, Rosario; Font, Guillermina; Yusà, Vicent

2017-02-01

Dietary exposure of the Valencian region population to lead, cadmium, inorganic arsenic (iAs), chromium, copper, tin and methylmercury (meHg) was assessed in a total diet study carried out in the region of Valencia in 2010-11. A total of 8100 food samples were collected and analysed. Occurrence data were combined with consumption data to estimate dietary exposure in adults (> 15 years of age) and young children (6-15 years of age). The estimated intake was calculated by a probabilistic approach. Average intake levels (optimistic scenario) for lead, iAs, chromium and tin were 0.21, 0.08, 1.79 and 1.87 µg kg - 1 bw day -1 respectively; for Cd and meHg average intake levels were 0.77 and 0.54 µg kg - 1 bw week -1 , respectively, and for Cu, 1.60 mg day -1 . In terms of risk characterisation, the results showed that 2.84% of the adult population may exceed the BMDL 10 (benchmark dose lower confidence limit) established for Pb, which is linked to renal effects; whereas 28.01% of the young children population may exceed the BMDL 01 related to neurodevelopment effects. In addition, 8.47% of the adult population and 12.32% of young children exceeded the meHg tolerable weekly intake (TWI).

The impact of folic acid fortification of enriched grains on an elderly population: the New Mexico Aging Process Study.

PubMed

Sisk, E R; Lockner, D W; Wold, R; Waters, D L; Baumgartner, R N

2004-01-01

Fortification of enriched grains with synthetic folic acid is a potential concern for the elderly population who is at higher risk for Vitamin B12 deficiency. Consuming excess amounts of naturally occurring folate or synthetic folic acid can precipitate a deficiency of Vitamin B12, resulting in neurological damage. The purpose of this study was to determine the increase in folate intake in an elderly population due to the fortification of enriched grains. Three-day diet records of 320 participants (average age 76.8 years) were evaluated for total folate intake from food and supplements before and after the fortification of enriched grains. There was a significant mean daily folate intake increase of 63.8 microg due to fortification (p < 0.0001), raising the intake of total folate to 359 microg (89.8% of RDA). Supplements containing folic acid were consumed by 66% of the participants, raising the average total folate intake of supplement users to 793 microg per day. Only 5 participants exceeded the UL of 1,000 microg folic acid per day, with all 5 of these individuals consuming more than 1,000 microg folic acid per day from supplements alone. Folic acid fortification of grains does not appear to have increased the risk of excess folic acid in this population.

Physical Confirmation and Comparative Genomics of the Rat Mammary carcinoma susceptibility 3 Quantitative Trait Locus.

PubMed

Le, Saasha; Martin, Zachary C; Samuelson, David J

2017-06-07

Human breast and rat mammary cancer susceptibility are complex phenotypes where complete sets of risk associated loci remain to be identified for both species. We tested multiple congenic rat strains to physically confirm and positionally map rat Mammary carcinoma susceptibility 3 ( Mcs3 )-a mammary cancer resistance allele previously predicted at Rattus norvegicus chromosome 1 ( RNO1 ). The mammary cancer susceptible Wistar Furth (WF) strain was the recipient, and the mammary cancer resistant Copenhagen (Cop) strain was the RNO1 -segment donor for congenics. Inbred WF females averaged 6.3 carcinogen-induced mammary carcinomas per rat. Two WF.Cop congenic strains averaged 2.8 and 3.4 mammary carcinomas per rat, which confirmed Mcs3 as an independently acting allele. Two other WF.Cop congenic strains averaged 6.6 and 8.1 mammary carcinomas per rat, and, thus, did not contain Mcs3 Rat Mcs3 was delimited to 27.8 Mb of RNO1 from rs8149408 to rs105131702 ( RNO1 :143700228-171517317 of RGSC 6.0/rn6). Human genetic variants with p values for association to breast cancer risk below 10 -7 had not been reported for Mcs3 orthologous loci; however, human variants located in Mcs3 -orthologous regions with potential association to risk (10 -7  <  p  < 10 -3 ) were listed in some population-based studies. Further, rat Mcs3 contains sequence orthologous to human 11q13/14 -a region frequently amplified in female breast cancer. We conclude that Mcs3 is an independently acting mammary carcinoma resistance allele. Human population-based, genome-targeted association studies interrogating Mcs3 orthologous loci may yield novel breast cancer risk associated variants and genes. Copyright © 2017 Le et al.

Magnetic Resonance Imaging as an Adjunct to Mammography for Breast Cancer Screening in Women at Less Than High Risk for Breast Cancer: A Health Technology Assessment

PubMed Central

Nikitovic-Jokic, Milica; Holubowich, Corinne

2016-01-01

Background Screening with mammography can detect breast cancer early, before clinical symptoms appear. Some cancers, however, are not captured with mammography screening alone. Among women at high risk for breast cancer, magnetic resonance imaging (MRI) has been suggested as a safe adjunct (supplemental) screening tool that can detect breast cancers missed on screening mammography, potentially reducing the number of deaths associated with the disease. However, the use of adjunct screening tests may also increase the number of false-positive test results, which may lead to unnecessary follow-up testing, as well as patient stress and anxiety. We investigated the benefits and harms of MRI as an adjunct to mammography compared with mammography alone for screening women at less than high risk (average or higher than average risk) for breast cancer. Methods We searched Ovid MEDLINE, Ovid Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects (DARE), Centre for Reviews and Dissemination (CRD) Health Technology Assessment Database, and National Health Service (NHS) Economic Evaluation Database, from January 2002 to January 2016, for evidence of effectiveness, harms, and diagnostic accuracy. Only studies evaluating the use of screening breast MRI as an adjunct to mammography in the specified populations were included. Results No studies in women at less than high risk for breast cancer met our inclusion criteria. Conclusions It remains uncertain if the use of adjunct screening breast MRI in women at less than high risk (average or higher than average risk) for breast cancer will reduce breast cancer–related mortality without significant increases in unnecessary follow-up testing and treatment. PMID:27990198

Do Ontarians drink in moderation? a baseline assessment against Canadian low risk drinking guidelines.

PubMed

Bondy, S J; Ashley, M J; Rehm, J T; Walsh, G

1999-01-01

We used the 1997 Ontario Drug Monitor, a population-based, random-digit dialing survey of 2,776 adults, to obtain a baseline assessment of alcohol drinking by Ontarians against the 1997 low-risk drinking guidelines of the Addiction Research Foundation and the Canadian Centre on Substance Abuse. Average weekly alcohol consumption and the frequency of exceeding the daily limit, estimated using the graduated frequency scale, were determined for the population overall, and by sex and age group (18-44 and 45+ years). Most Ontarians drank alcohol in a pattern associated with a low risk of health consequences. About 10% of women and 25% of men drank in a style associated with some increase in acute or long-term risk. Younger men were most likely to drink in a risky pattern. Most drinkers of middle age or older, for whom cardiovascular disease is a significant health risk, consumed alcohol in a pattern associated with cardiovascular benefit.

A Practical Risk Stratification Approach for Implementing a Primary Care Chronic Disease Management Program in an Underserved Community.

PubMed

Xu, Junjun; Williams-Livingston, Arletha; Gaglioti, Anne; McAllister, Calvin; Rust, George

2018-01-01

The use of value metrics is often dependent on payer-initiated health care management incentives. There is a need for practices to define and manage their own patient panels regardless of payer to participate effectively in population health management. A key step is to define a panel of primary care patients with high comorbidity profiles. Our sample included all patients seen in an urban academic family medicine clinic over a two-year period. The simplified risk stratification was built using internal electronic health record and billing system data based on ICD-9 codes. There were 347 patients classified as high-risk out of the 5,364 patient panel. Average age was 59 years (SD 15). Hypertension (90%), hyperlipidemia (62%), and depression (55%) were the most common conditions among high-risk patients. Simplified risk stratification provides a feasible option for our team to understand and respond to the nuances of population health in our underserved community.

Risk and protective factors for recidivism among juveniles who have offended sexually.

PubMed

Spice, Andrew; Viljoen, Jodi L; Latzman, Natasha E; Scalora, Mario J; Ullman, Daniel

2013-08-01

Literature on risk factors for recidivism among juveniles who have sexually offended (JSOs) is limited. In addition, there have been no studies published concerning protective factors among this population. The purpose of this study was to examine the relationship of risk and protective factors to sexual and nonsexual recidivism among a sample of 193 male JSOs (mean age = 15.26). Youths were followed for an average of 7.24 years following discharge from a residential sex offender treatment program. The risk factor opportunities to reoffend, as coded based on the Estimate of Risk of Adolescent Sexual Offense Recidivism, was associated with sexual recidivism. Several risk factors (e.g., prior offending; peer delinquency) were associated with nonsexual recidivism. No protective factors examined were associated with sexual recidivism, although strong attachments and bonds as measured by the Structured Assessment of Violence Risk in Youth was negatively related to nonsexual recidivism. These findings indicate that risk factors for nonsexual recidivism may be consistent across both general adolescent offender populations and JSOs, but that there may be distinct protective factors that apply to sexual recidivism among JSOs. Results also indicate important needs for further research on risk factors, protective factors, and risk management strategies for JSOs.

Age at Death in Individuals with Intellectual Disabilities.

PubMed

Arvio, Maria; Salokivi, Tommi; Bjelogrlic-Laakso, Nina

2017-07-01

We aimed to ascertain the average age at death (AD) in the intellectual disability population for each gender and compare them to those of the general population during 1970-2012. By analysing medical records, we calculated the ADs of all deceased clients (N = 1236) of two district organizations responsible for intellectual disability services. Statistics Finland's database generated data regarding ADs of all inhabitants who had died after having resided in same district. During the follow-up, average ADs for the intellectual disability population and general population increased, and simultaneously the AD difference between these populations decreased. In the 2000s, the AD difference between the intellectual disability population and the whole population was 22 years for men (95% CI: -24 to -20) and 30 years for women (95% CI: -33 to -27). In 2000s, the mean AD of those with mild-to-moderate intellectual disability (IQ 50-69) for women and men was 56 (SD17) and 54 (SD18), and those with severe to profound intellectual disability (IQ<50), 44 (SD23) and 43 (SD21). Intellectual disability is still a considerable risk factor for early death. Among the intellectual disability population, unlike in general population, the lifespans of women and men are equal. © 2016 John Wiley & Sons Ltd.

State-space modeling of the relationship between air quality and mortality.

PubMed

Murray, C J; Nelson, C R

2000-07-01

A portion of a population is assumed to be at risk, with the mortality hazard varying with atmospheric conditions including total suspended particulates (TSP). This at-risk population is not observed and the hazard function is unknown; we wish to estimate these from mortality count and atmospheric variables. Consideration of population dynamics leads to a state-space representation, allowing the Kalman Filter (KF) to be used for estimation. A harvesting effect is thus implied; high mortality is followed by lower mortality until the population is replenished by new arrivals. The model is applied to daily data for Philadelphia, PA, 1973-1990. The estimated hazard function rises with the level of TSP and at extremes of temperature and also reflects a positive interaction between TSP and temperature. The estimated at-risk population averages about 480 and varies seasonally. We find that lags of TSP are statistically significant, but the presence of negative coefficients suggests their role may be partially statistical rather than biological. In the population dynamics framework, the natural metric for health damage from air pollution is its impact on life expectancy. The range of hazard rates over the sample period is 0.07 to 0.085, corresponding to life expectancies of 14.3 and 11.8 days, respectively.

Hip protector compliance: a 13-month study on factors and cost in a long-term care facility.

PubMed

Burl, Jeffrey B; Centola, James; Bonner, Alice; Burque, Colleen

2003-01-01

To determine if a high compliance rate for wearing external hip protectors could be achieved and sustained in a long-term care population. A 13-month prospective study of daytime use of external hip protectors in an at-risk long-term care population. One hundred-bed not-for-profit long-term care facility. Thirty-eight ambulatory residents having at least 1 of 4 risk factors (osteoporosis, recent fall, positive fall screen, previous fracture). The rehabilitation department coordinated an implementation program. Members of the rehabilitation team met with eligible participants, primary caregivers, families, and other support staff for educational instruction and a description of the program. The rehabilitation team assumed overall responsibility for measuring and ordering hip protectors and monitoring compliance. By the end of the third month, hip protector compliance averaged greater than 90% daily wear. The average number of falls per month in the hip protector group was 3.9 versus 1.3 in nonparticipants. Estimated total indirect staff time was 7.75 hours. The total cost of the study (hip protectors and indirect staff time) was 6,300 US dollars. High hip protector compliance is both feasible and sustainable in an at-risk long-term care population. Achieving high compliance requires an interdisciplinary approach with one department acting as a champion. The cost of protectors could be a barrier to widespread use. Facilities might be unable to cover the cost until the product is paid for by third-party payers.

Association of Overcrowding and Turnover with Self-Harm in a Swiss Pre-Trial Prison.

PubMed

Baggio, Stéphanie; Gétaz, Laurent; Tran, Nguyen Toan; Peigné, Nicolas; Chacowry Pala, Komal; Golay, Diane; Heller, Patrick; Bodenmann, Patrick; Wolff, Hans

2018-03-27

Self-harm is a common issue in detention and includes both suicidal and non-suicidal behaviours. Beyond well-known individual risk factors, institutional factors such as overcrowding (i.e., when the prison population exceeds its capacity) and turnover (i.e., the rate at which the prison population is renewed), may also increase the risk of self-harm. However, these factors are understudied or previous studies reported inconsistent findings. This study investigated the association of self-harm with overcrowding and turnover in the largest pre-trial Swiss prison in Geneva. Data were collected yearly between 2011 and 2017. Measures included self-harm (all kinds of self-injuring acts requiring medical attention, including self-strangulations and self-hangings). We performed meta-regressions to analyse the relationships between self-harm and institutional factors. Self-harm events were frequent, with a prevalence estimate of 26.4%. Overcrowding and turnover were high (average occupation rate of 177% and average turnover of 73%, respectively). Overcrowding and turnover were significantly associated with self-harm (respectively b = 0.068, p < 0.001 and (b = 1.257, p < 0.001). In both cases, self-harm was higher when overcrowding and turnover increased. Overcrowding and turnover raise important human rights concerns and have damaging effects on the health of people living in detention. Identification of and care for this vulnerable population at risk of self-harm are needed and institutional factors should be addressed.

Sensitivity Analysis of Median Lifetime on Radiation Risks Estimates for Cancer and Circulatory Disease amongst Never-Smokers

NASA Technical Reports Server (NTRS)

Chappell, Lori J.; Cucinotta, Francis A.

2011-01-01

Radiation risks are estimated in a competing risk formalism where age or time after exposure estimates of increased risks for cancer and circulatory diseases are folded with a probability to survive to a given age. The survival function, also called the life-table, changes with calendar year, gender, smoking status and other demographic variables. An outstanding problem in risk estimation is the method of risk transfer between exposed populations and a second population where risks are to be estimated. Approaches used to transfer risks are based on: 1) Multiplicative risk transfer models -proportional to background disease rates. 2) Additive risk transfer model -risks independent of background rates. In addition, a Mixture model is often considered where the multiplicative and additive transfer assumptions are given weighted contributions. We studied the influence of the survival probability on the risk of exposure induced cancer and circulatory disease morbidity and mortality in the Multiplicative transfer model and the Mixture model. Risks for never-smokers (NS) compared to the average U.S. population are estimated to be reduced between 30% and 60% dependent on model assumptions. Lung cancer is the major contributor to the reduction for NS, with additional contributions from circulatory diseases and cancers of the stomach, liver, bladder, oral cavity, esophagus, colon, a portion of the solid cancer remainder, and leukemia. Greater improvements in risk estimates for NS s are possible, and would be dependent on improved understanding of risk transfer models, and elucidating the role of space radiation on the various stages of disease formation (e.g. initiation, promotion, and progression).

Spatial Analysis of Severe Fever with Thrombocytopenia Syndrome Virus in China Using a Geographically Weighted Logistic Regression Model

PubMed Central

Wu, Liang; Deng, Fei; Xie, Zhong; Hu, Sheng; Shen, Shu; Shi, Junming; Liu, Dan

2016-01-01

Severe fever with thrombocytopenia syndrome (SFTS) is caused by severe fever with thrombocytopenia syndrome virus (SFTSV), which has had a serious impact on public health in parts of Asia. There is no specific antiviral drug or vaccine for SFTSV and, therefore, it is important to determine the factors that influence the occurrence of SFTSV infections. This study aimed to explore the spatial associations between SFTSV infections and several potential determinants, and to predict the high-risk areas in mainland China. The analysis was carried out at the level of provinces in mainland China. The potential explanatory variables that were investigated consisted of meteorological factors (average temperature, average monthly precipitation and average relative humidity), the average proportion of rural population and the average proportion of primary industries over three years (2010–2012). We constructed a geographically weighted logistic regression (GWLR) model in order to explore the associations between the selected variables and confirmed cases of SFTSV. The study showed that: (1) meteorological factors have a strong influence on the SFTSV cover; (2) a GWLR model is suitable for exploring SFTSV cover in mainland China; (3) our findings can be used for predicting high-risk areas and highlighting when meteorological factors pose a risk in order to aid in the implementation of public health strategies. PMID:27845737

Polycyclic aromatic hydrocarbons (PAHs) in atmospheric dustfall from the industrial corridor in Hubei Province, Central China.

PubMed

Zhang, Jiaquan; Qu, Chengkai; Qi, Shihua; Cao, Junji; Zhan, Changlin; Xing, Xinli; Xiao, Yulun; Zheng, Jingru; Xiao, Wensheng

2015-10-01

Thirty atmospheric dustfall samples collected from an industrial corridor in Hubei Province, central China, were analyzed for 16 USEPA priority polycyclic aromatic hydrocarbons (PAHs) to investigate their concentrations, spatial distributions, sources, and health risks. Total PAH concentrations (ΣPAHs) ranged from 1.72 to 13.17 µg/g and averaged 4.91 µg/g. High molecular weight (4-5 rings) PAHs averaged 59.67% of the ΣPAHs. Individual PAH concentrations were not significantly correlated with total organic carbon, possibly due to the semi-continuous inputs from anthropogenic sources. Source identification studies suggest that the PAHs were mainly from motor vehicles and biomass/coal combustion. The incremental lifetime cancer risks associated with exposure to PAHs in the dustfall ranged from 10(-4) to 10(-6); these indicate potentially serious carcinogenic risks for exposed populations in the industrial corridor.

High-risk population health management--achieving improved patient outcomes and near-term financial results.

PubMed

Lynch, J P; Forman, S A; Graff, S; Gunby, M C

2000-07-01

A managed care organization sought to achieve efficiencies in care delivery and cost savings by anticipating and better caring for its frail and least stable members. Time sequence case study of program intervention across an entire managed care population in its first year compared with the prior baseline year. Key attributes of the intervention included predictive registries of at-risk members based on existing data, relentless focus on the high-risk group, an integrated clinical and psychosocial approach to assessments and are planning, a reengineered care management process, secured Internet applications enabling rapid implementation and broad connectivity, and population-based outcomes metrics derived from widely used measures of resource utilization and functional status. Concentrating on the highest-risk group, which averaged just 1.1% prevalence in the total membership, yielded bottom line results. When the year before program implementation (July 1997 through June 1998) was compared with the subsequent year, the total population's annualized commercial admission rate was reduced 5.3%, and seniors' was reduced 3.0%. A claims-paid analysis exclusively of the highest-risk group revealed that their efficiencies and savings overwhelmingly contributed to the membershipwide effect. This subgroup's costs dropped 35.7% from preprogram levels of $2590 per member per month (excluding pharmaceuticals). During the same time, patient-derived cross-sectional functional status rose 12.5%. A sharply focused, Internet-deployed case management strategy achieved economic and functional status results on a population basis and produced systemwide savings in its first year of implementation.

Contemporary Primary Prevention Aspirin Use by Cardiovascular Disease Risk: Impact of US Preventive Services Task Force Recommendations, 2007-2015: A Serial, Cross-sectional Study.

PubMed

Van't Hof, Jeremy R; Duval, Sue; Walts, Adrienne; Kopecky, Stephen L; Luepker, Russell V; Hirsch, Alan T

2017-10-03

No previous study has evaluated the impact of past US Preventive Services Task Force statements on primary prevention (PP) aspirin use in a primary care setting. The aim of this study was to evaluate temporal changes in PP aspirin use in a primary care population, stratifying patients by their 10-year global cardiovascular disease risk, in response to the 2009 statement. This study estimated biannual aspirin use prevalence using electronic health record data from primary care clinics within the Fairview Health System (Minnesota) from 2007 to 2015. A total of 94 270 patient encounters had complete data to estimate a 10-year cardiovascular disease risk score using the 2013 American College of Cardiology/American Heart Association global risk estimator. Patients were stratified into low- (<10%), intermediate- (10-20%), and high- (≥20%) risk groups. Over the 9-year period, PP aspirin use averaged 43%. When stratified by low, intermediate and high risk, average PP aspirin use was 41%, 63%, and 73%, respectively. Average PP aspirin use decreased after the publication of the 2009 US Preventive Services Task Force recommendation statement: from 45% to 40% in the low-risk group; from 66% to 62% in the intermediate-risk group; and from 76% to 73% in the high-risk group, before and after the guideline. Publication of the 2009 US Preventive Services Task Force recommendation was not associated with an increase in aspirin use. High risk PP patients utilized aspirin at high rates. Patients at intermediate risk were less intensively treated, and patients at low risk used aspirin at relatively high rates. These data may inform future aspirin guideline dissemination. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

Association of anthropometric characteristics with the risk of malignant lymphoma and plasma cell myeloma in a Japanese population: a population-based cohort study.

PubMed

Kanda, Junya; Matsuo, Keitaro; Inoue, Manami; Iwasaki, Motoki; Sawada, Norie; Shimazu, Taichi; Yamaji, Taiki; Sasazuki, Shizuka; Tsugane, Shoichiro

2010-06-01

Although Asian and Western populations differ markedly in anthropometric characteristics and the incidence of malignant lymphoma and plasma cell myeloma, few studies have evaluated the associations between these variables among Asian populations. We conducted a large-scale, population-based prospective study in a Japanese cohort that included 45,007 men and 49,540 women ages 40 to 69 years at baseline. During an average follow-up period of 13 years, 257 cases of malignant lymphoma and 88 of plasma cell myeloma were identified. Hazard ratios (HR) and 95% confidence intervals (95% CI) were estimated with the use of a Cox regression model adjusted for potential confounders. Compared with the 1st quartile, categorization in the 4th quartile for height showed a positive association with lymphoid neoplasm risk (HR, 1.38; 95% CI, 1.00-1.91), and the association was significant among men (HR, 1.72; 95% CI, 1.11-2.66). A similar trend was observed for subcategories of malignant lymphoma, plasma cell myeloma, and non-Hodgkin lymphoma, albeit the associations were weak due to the small number of subjects in each category. In contrast, weight and body mass index were not associated with risk of lymphoid neoplasm. Height was positively associated with risk of lymphoid neoplasm in a Japanese population. Our data suggested that early life exposure to growth-related hormones, such as insulin-like growth factors and growth hormones, or genetic factors relating to height may affect the risk of lymphoid neoplasm. Copyright 2010 AACR.

Cardiovascular risk and blood pressure control in a Spanish hypertensive population attended in a Primary Care setting. Data from the PRESCAP 2006 study.

PubMed

Rodriguez-Roca, Gustavo C; Llisterri-Caro, Jose L; Barrios-Alonso, Vivencio; Alonso-Moreno, Francisco J; Lou-Arnal, Salvador; Prieto-Diaz, Miguel A; Sanchez-Ruiz, Tomas; Dura-Belinchon, Rafael; Santos-Rodriguez, Jose A; Divison-Garrote, Juan A; Gonzalez-Segura, Diego; Banegas-Banegas, Jose R

2009-01-01

To analyse the cardiovascular risk of a broad sample of hypertensive patients and to examine whether there are differences in blood pressure control and associated factors according to the different cardiovascular risk categories. A total of 10,520 patients > or = 18 years old were included (mean age 64.6+/-11.3 years; 53.7% women). In this cohort, 3.3% were average risk, 22.6% low added risk, 22.2% moderate added risk, 33.5% high added risk and 18.4% very high added risk. Blood pressure was controlled in 41.4% (95% CI 40.5-42.4) of the total population, in 91.7% of patients with low added risk, in 19.4% with moderate added risk, in 27.4% with high added risk and in 6.8% with very high added risk. Diabetes was the factor most strongly associated with poor blood pressure control in patients with high to very high added risk (OR=7.2; p<0.0001). More than half of the hypertensive patients treated in primary health care have a high or very high added cardiovascular risk. In these patients, blood pressure control is inadequate and diabetes is associated with a sevenfold increase in the likelihood of poor blood pressure control.

Exploring the Determinants of the Perceived Risk of Food Allergies in Canada

PubMed Central

Harrington, Daniel W.; Elliott, Susan J.; Clarke, Ann E.; Ben-Shoshan, Moshe; Godefroy, Samuel

2012-01-01

Food allergies are emerging health risks in much of the Western world, and some evidence suggests prevalence is increasing. Despite lacking scientific consensus around prevalence and management, policies and regulations are being implemented in public spaces (e.g., schools). These policies have been criticized as extreme in the literature, in the media, and by the non-allergic population. Backlash appears to be resulting from different perceptions of risk between different groups. This article uses a recently assembled national dataset (n = 3,666) to explore how Canadians perceive the risks of food allergy. Analyses revealed that almost 20% self-report having an allergic person in the household, while the average respondent estimated the prevalence of food allergies in Canada to be 30%. Both of these measures overestimate the true clinically defined prevalence (7.5%), indicating an inflated public understanding of the risks of food allergies. Seventy percent reported food allergies to be substantial risks to the Canadian population. Multivariate logistic regression models revealed important determinants of risk perception including demographic, experience-based, attitudinal, and regional predictors. Results are discussed in terms of understanding emerging health risks in the post-industrial era, and implications for both policy and risk communication. PMID:23172987

Prevalence of coronary artery disease risk factors in Iran: a population based survey

PubMed Central

Hatmi, ZN; Tahvildari, S; Gafarzadeh Motlag, A; Sabouri Kashani, A

2007-01-01

Background Coronary artery disease (CAD) is a leading cause of mortality, morbidity, and disability with high health care cost in Iran. It accounts for nearly 50 percent of all deaths per year. Yet little is known about CAD and CAD risk factors in the Iranian population. We aimed to assess the prevalence of different CAD risk factors in an Iranian population. Methods A descriptive cross sectional survey was conducted involving 3000 healthy adults at 18 years of age or above who were recruited with cluster random sampling. Demographic data and risk factors were determined by taking history, physical examination and laboratory tests. Results The average age was 36.23 ± 15.26. There was 1381 female (46%) and 1619 male (54%) out of which 6.3% were diabetic, 21.6% were smoker, and 15% had positive familial heart disease history. 61% had total cholesterol level > 200 mg/dL, 32% triglyceride > 200 mg/dl, 47.5% LDL-c > 130 mg/dl, 5.4% HDL-c < 35 mg/dl, 13.7% systolic blood pressure > 140 mmHg, 9.1% diastolic blood pressure > 90 mmHg and 87% of them were physically inactive. Conclusion Clinical and Para-clinical data indicated that Iranian adult population are of a high level of CAD risk factors, which may require urgent decision making to address national control measures regarding CAD. PMID:17971195

Daytime Napping and the Risk of All-Cause and Cause-Specific Mortality: A 13-Year Follow-up of a British Population

PubMed Central

Leng, Yue; Wainwright, Nick W. J.; Cappuccio, Francesco P.; Surtees, Paul G.; Hayat, Shabina; Luben, Robert; Brayne, Carol; Khaw, Kay-Tee

2014-01-01

Epidemiologic studies have reported conflicting results on the relationship between daytime napping and mortality risk, and there are few data on the potential association in the British population. We investigated the associations between daytime napping and all-cause or cause-specific mortality in the European Prospective Investigation Into Cancer-Norfolk study, a British population-based cohort study. Among the 16,374 men and women who answered questions on napping habits between 1998 and 2000, a total of 3,251 died during the 13-year follow-up. Daytime napping was associated with an increased risk of all-cause mortality (for napping less than 1 hour per day on average, hazard ratio = 1.14, 95% confidence interval: 1.02, 1.27; for napping 1 hour or longer per day on average, hazard ratio = 1.32, 95% confidence interval: 1.04, 1.68), independent of age, sex, social class, educational level, marital status, employment status, body mass index, physical activity level, smoking status, alcohol intake, depression, self-reported general health, use of hypnotic drugs or other medications, time spent in bed at night, and presence of preexisting health conditions. This association was more pronounced for death from respiratory diseases (for napping less than 1 hour, hazard ratio = 1.40, 95% confidence interval: 0.95, 2.05; for napping 1 hour or more, hazard ratio = 2.56, 95% confidence interval: 1.34, 4.86) and in individuals 65 years of age or younger. Excessive daytime napping might be a useful marker of underlying health risk, particularly of respiratory problems, especially among those 65 years of age or younger. Further research is required to clarify the nature of the observed association. PMID:24685532

Daytime napping and the risk of all-cause and cause-specific mortality: a 13-year follow-up of a British population.

PubMed

Leng, Yue; Wainwright, Nick W J; Cappuccio, Francesco P; Surtees, Paul G; Hayat, Shabina; Luben, Robert; Brayne, Carol; Khaw, Kay-Tee

2014-05-01

Epidemiologic studies have reported conflicting results on the relationship between daytime napping and mortality risk, and there are few data on the potential association in the British population. We investigated the associations between daytime napping and all-cause or cause-specific mortality in the European Prospective Investigation Into Cancer-Norfolk study, a British population-based cohort study. Among the 16,374 men and women who answered questions on napping habits between 1998 and 2000, a total of 3,251 died during the 13-year follow-up. Daytime napping was associated with an increased risk of all-cause mortality (for napping less than 1 hour per day on average, hazard ratio = 1.14, 95% confidence interval: 1.02, 1.27; for napping 1 hour or longer per day on average, hazard ratio = 1.32, 95% confidence interval: 1.04, 1.68), independent of age, sex, social class, educational level, marital status, employment status, body mass index, physical activity level, smoking status, alcohol intake, depression, self-reported general health, use of hypnotic drugs or other medications, time spent in bed at night, and presence of preexisting health conditions. This association was more pronounced for death from respiratory diseases (for napping less than 1 hour, hazard ratio = 1.40, 95% confidence interval: 0.95, 2.05; for napping 1 hour or more, hazard ratio = 2.56, 95% confidence interval: 1.34, 4.86) and in individuals 65 years of age or younger. Excessive daytime napping might be a useful marker of underlying health risk, particularly of respiratory problems, especially among those 65 years of age or younger. Further research is required to clarify the nature of the observed association.

Arsenic Exposure and Age- and Sex-Specific Risk for Skin Lesions: A Population-Based Case–Referent Study in Bangladesh

PubMed Central

Rahman, Mahfuzar; Vahter, Marie; Sohel, Nazmul; Yunus, Muhammad; Wahed, Mohammad Abdul; Streatfield, Peter Kim; Ekström, Eva-Charlotte; Persson, Lars Åke

2006-01-01

Background The objective of this population-based case–referent study in Matlab, Bangladesh, was to assess the susceptibility to arsenic-induced skin lesions by age and sex, in a population drinking water from As-contaminated tube wells. Methods Identification of As-related skin lesions was carried out in three steps: a) screening of the entire population > 4 years of age (n = 166,934) by trained field teams; b) diagnosis of suspected As-related cases by physicians; and c) confirmation by experts based on physicians’ records and photographs. A total of 504 cases with skin lesions were confirmed. We randomly selected 2,201 referents from the Matlab health and demographic surveillance system; 1,955 were eligible, and 1,830 (94%) were available for participation in the study. Individual history of As exposure was based on information obtained during interviews and included all drinking-water sources used since 1970 and concentrations of As (assessed by atomic absorption spectrophotometry) in all the tube wells used. Results Cases had been exposed to As more than referents (average exposure since 1970: male cases, 200 μg/L; female cases, 211 μg/L; male referents, 143 μg/L; female referents, 155 μg/L). We found a dose–response relationship for both sexes (p < 0.001) and increased risk with increasing socioeconomic status. Males had a higher risk of obtaining skin lesions than females (odds ratio 10.9 vs. 5.78) in the highest average exposure quintile (p = 0.005). Start of As exposure (cumulative exposure) before 1 year of age was not associated with higher risk of obtaining skin lesions compared to start of As exposure later in life. Conclusions The results demonstrate that males are more susceptible than females to develop skin lesions when exposed to As in water from tube wells. PMID:17185274

An epidemiologic perspective on a case management program.

PubMed

Kahler, Deborah; Salber, Patricia; Wilson, Thomas

2010-01-01

to improve a case management (CM) program using the principles and tools of epidemiology. Specifically, to use epidemiology to describe the population being managed, to analyze factors influencing outcomes, to assess the degree to which the CM process (or intervention) is related to those outcomes, to utilize the findings in order to make recommendations (to take action) for both better evaluation and improved and more efficient CM process, to provide an estimate of the impact of the CM program based on the comparison of pre-CM and post-CM interventions, and finally to discuss the caveat that pre-CM period probably does not provide a prediction of patterns to be expected in the post-CM period had CM not been present (an ideal, but difficult-to-find referent population for this kind of effectiveness analysis). a Medicare Advantage health plan. there were a total of 12,185 individuals who met the continuous enrollment requirement of 6 months (28 days) prior to initial contact with the CM department and 6 months after the contact date: 53% were female; the average age was 73.9 (standard deviation = ± 9.5). There was a linear relationship between the average "dose" of CM-as measured by the number of times a case manager had contact with a case-and the risk profile of the case-as measured by a standard risk assessment tool provided by the Centers for Medicare & Medicaid Services. The month-to-month costs for the study population prior to CM showed a sharp rise in the month prior to the initial contact with CM and a sharp decline beginning before the contact. This pattern was consistent across different risk profiles and our operational definition of CM "dose."The average costs 6 months prior to CM were higher than the average costs 6 months after the CM. The difference in cost varied by "dose" category. When coupled with the number of cases per dosage category, the greatest value for the CM program was in the management of moderate risk cases called two to four times.However, some of the overall decline that begins prior to the initial CM contact is likely attributed to "regression to the mean" (i.e., costs may have shown a decline in spite of CM) but not all. Subsequent studies will be designed to assess the degree to which this is the case by including an equivalent referent; ideally, one that has not experienced CM or, in the absence of that, one that experienced a different kind of CM so that a valid "comparative effectiveness" study can be conducted. the "dose" of CM to its cases was in synch with an independent assessment of risk of the cases. This implies that case managers were directing their resources to those in need. However, case managers and CM processes are a limited resource and it is of interest for management to allocate those CM resources in the most efficient way possible. Methods of assessment based on individual experiences of case managers can be improved with structured, population-based assessment. These population-based tools, according to the principles of epidemiology, will be used to better allocate CM resources for optimized impact on patient populations in the future.

The role of climate and out-of-Africa migration in the frequencies of risk alleles for 21 human diseases.

PubMed

Blair, Lily M; Feldman, Marcus W

2015-07-14

Demography and environmental adaptation can affect the global distribution of genetic variants and possibly the distribution of disease. Population heterozygosity of single nucleotide polymorphisms has been shown to decrease strongly with distance from Africa and this has been attributed to the effect of serial founding events during the migration of humans out of Africa. Additionally, population allele frequencies have been shown to change due to environmental adaptation. Here, we investigate the relationship of Out-of-Africa migration and climatic variables to the distribution of risk alleles for 21 diseases. For each disease, we computed the regression of average heterozygosity and average allele frequency of the risk alleles with distance from Africa and 9 environmental variables. We compared these regressions to a null distribution created by regressing statistics for SNPs not associated with disease on distance from Africa and these environmental variables. Additionally, we used Bayenv 2.0 to assess the signal of environmental adaptation associated with individual risk SNPs. For those SNPs in HGDP and HapMap that are risk alleles for type 2 diabetes, we cannot reject that their distribution is as expected from Out-of-Africa migration. However, the allelic statistics for many other diseases correlate more closely with environmental variables than would be expected from the serial founder effect and show signals of environmental adaptation. We report strong environmental interactions with several autoimmune diseases, and note a particularly strong interaction between asthma and summer humidity. Additionally, we identified several risk genes with strong environmental associations. For most diseases, migration does not explain the distribution of risk alleles and the worldwide pattern of allele frequencies for some diseases may be better explained by environmental associations, which suggests that some selection has acted on these diseases.

Gender differences in cardiovascular diseases risk for physical education teachers.

PubMed

Misigoj-Duraković, Marjeta; Duraković, Zijad; Ruzić, Lana; Findak, Vladimir

2004-01-01

The aim of the study was to evaluate the level of habitual physical activity in Croatian physical education (PE) teachers, as well as the existence of some other risk factors for the development of cardiovascular diseases (CVD). The sample consisted of 191 PE teachers aged 24 to 59 years (122 men, mean age 42.6+/-8.76 and 69 women, mean age 40.3+/-8.84;p=0.09). In order to assess the level of habitual physical activity, the teachers were asked to fill in Baecke's questionnaire. The questionnaire comprises 16 items testing physical loads at work, during sport activity and during leisure time. The questionnaire also contains 8 items, each of them representing a certain cardiovascular risk factor. In comparison to average adult employed population, PE teachers have a significantly higher level of sport and leisure time activity, which could have a favorable impact on the incidence of particular risk factors, such as overweight/obesity, systolic hypertension and blood cholesterol level. This is more obvious in females PE teachers who pay more attention to the principles of healthy life style: optimal body weight regulation, low fat diet and higher amount of leisure time physical activity (significantly higher than in male teachers). Female PE teachers who have maintained their active life style decrease the risk of CVD, particularly after the age of 55. Although it is necessary to keep in mind all the limitations of a questionnaire study, this preliminary report leads to the conclusion that male PE teachers, although physically active at job, have still kept sedentary habits, often have maintained heavy smoking habits, are slightly overweight, thus minimizing the positive effects of their demanding workplace. Consequently, average male PE teachers' risk for CVD development corresponds to the risk of general male population.

Mortality in traffic accidents with older adults in Colombia

PubMed Central

Cardona, Angela Maria Segura; Arango, Doris Cardona; Fernández, Dedsy Yajaira Berbesí; Martínez, Alejandra Agudelo

2017-01-01

ABSTRACT OBJECTIVE To analyze the traffic accident mortality in the Colombian older adults during the 1998-2012 period and show the loss of productive years and mortality from this cause. METHODS Quantitative study of the trend analysis of deaths in Colombia in traffic accidents, from 1998 to 2012, according to death records and population projected by the Colombian National Administrative Department of Statistics. Frequency distribution profile of the deceased, death rates per hundred thousand inhabitants, potential years of life lost and calculation of excess mortality by age in the over 60 were made. RESULTS In the study period 100,758 deaths occurred in traffic accidents, 6,717 annual average, of which 18.5% occurred in people aged 60 years and over. The predominated deaths were men; the risk of dying was 32.15 per hundred thousand people in this age range, with double risk of dying those under 60 years. CONCLUSIONS The young population has a higher proportion of deaths, but those over 60 years are at increased risk of death, leading to the need to turn our gaze to the improvement of road infrastructure and standards, to educate the population in self-care and compliance with safety measures and prepare society for an ever more adult population, more numerous and more prone to take risks. PMID:28355347

Sodium intake among persons aged >=2 years – United States, 2013-2014

USDA-ARS?s Scientific Manuscript database

High sodium consumption can increase hypertension, a major risk factor for cardiovascular diseases. Reducing sodium intake can reduce blood pressure, and population-wide reductions of 40% over 10 years are projected to save at least 280,000 lives. Average U.S. sodium intake remains in excess of He...

Epidemiologic and environmental risk factors of rift valley fever in southern Africa from 2008 to 2011

USDA-ARS?s Scientific Manuscript database

BACKGROUND: Rift Valley fever outbreaks have been associated with periods of widespread and above average rainfall over several months which allows for the virus infected mosquito vector populations to emerge and propagate. This has provided basis to develop complex models based on environmental fa...

The Intellectual Disability Mortality Disadvantage: Diminishing with Age?

ERIC Educational Resources Information Center

Landes, Scott D.

2017-01-01

On average, adults with intellectual disability (ID) have higher mortality risk than their peers in the general population. However, the effect of age on this mortality disadvantage has received minimal attention. Using data from the 1986-2011 National Health Interview Survey-Linked Mortality Files (NHIS-LMF), discrete time hazard models were used…

Trends in Clinical Diagnoses of Rocky Mountain Spotted Fever among American Indians, 2001–2008

PubMed Central

Folkema, Arianne M.; Holman, Robert C.; McQuiston, Jennifer H.; Cheek, James E.

2012-01-01

American Indians are at greater risk for Rocky Mountain spotted fever (RMSF) than the general U.S. population. The epidemiology of RMSF among American Indians was examined by using Indian Health Service inpatient and outpatient records with an RMSF International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis. For 2001–2008, 958 American Indian patients with clinical diagnoses of RMSF were reported. The average annual RMSF incidence was 94.6 per 1,000,000 persons, with a significant increasing incidence trend from 24.2 in 2001 to 139.4 in 2008 (P = 0.006). Most (89%) RMSF hospital visits occurred in the Southern Plains and Southwest regions, where the average annual incidence rates were 277.2 and 49.4, respectively. Only the Southwest region had a significant increasing incidence trend (P = 0.005), likely linked to the emergence of brown dog ticks as an RMSF vector in eastern Arizona. It is important to continue monitoring RMSF infection to inform public health interventions that target RMSF reduction in high-risk populations. PMID:22232466

Trends in clinical diagnoses of Rocky Mountain spotted fever among American Indians, 2001-2008.

PubMed

Folkema, Arianne M; Holman, Robert C; McQuiston, Jennifer H; Cheek, James E

2012-01-01

American Indians are at greater risk for Rocky Mountain spotted fever (RMSF) than the general U.S. population. The epidemiology of RMSF among American Indians was examined by using Indian Health Service inpatient and outpatient records with an RMSF International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis. For 2001-2008, 958 American Indian patients with clinical diagnoses of RMSF were reported. The average annual RMSF incidence was 94.6 per 1,000,000 persons, with a significant increasing incidence trend from 24.2 in 2001 to 139.4 in 2008 (P = 0.006). Most (89%) RMSF hospital visits occurred in the Southern Plains and Southwest regions, where the average annual incidence rates were 277.2 and 49.4, respectively. Only the Southwest region had a significant increasing incidence trend (P = 0.005), likely linked to the emergence of brown dog ticks as an RMSF vector in eastern Arizona. It is important to continue monitoring RMSF infection to inform public health interventions that target RMSF reduction in high-risk populations.

Decreasing population blood pressure is not mediated by changes in habitual physical activity. Results from 15 years of follow-up.

PubMed

Andersen, Ulla Overgaard; Jensen, Gorm

2007-01-01

Population blood pressure (PBP) is the average BP shared by all members of a population. In PBP research, the main focus is on the great majority of individuals who are healthy in respect to blood pressure. From previous studies, we know that PBP decreased 2 mmHg during 15 years of follow-up. This decrease leads to significant reductions in cardiovascular (CV) and cerebrovascular risk. The major aim of the present study was to evaluate the effect of habitual physical activity on PBP. Copenhagen City Heart Study is a longitudinal epidemiological study of CV risk in a random population sample. Three surveys were performed with 15 years of follow-up. BP was measured under standardized circumstances. A questionnaire concerning physical exercise was completed. Two scales were used, describing physical activity at work and during leisure-time, respectively. Most of the subjects belonged to the sedentary or low physical activity categories. The population did not change physical activity habits during the observation time. There was no significant difference in either systolic or diastolic BP between the categories. The previously observed reduction in PBP is not explained by a change in the population physical activity habits. This fact illustrates the difference between the high-risk strategy and the population strategy. In the first, the preventive strategy identifies hypertensive individuals and offers them antihypertensive medication and lifestyle modulation such as more and regular physical activity to improve blood pressure and lower individual CV and cerebrovascular risk. In contrast, the "population strategy" seeks to control the determinants of incidence in the population as a whole. This paper demonstrates that physical activity is not a determinant of PBP.

Living alone, obesity, and smoking increase risk for suicide independently of depressive mood findings from the population-based MONICA/KORA Augsburg cohort study.

PubMed

Schneider, Barbara; Lukaschek, Karoline; Baumert, Jens; Meisinger, Christa; Erazo, Natalia; Ladwig, Karl-Heinz

2014-01-01

Suicide is strongly associated with mental disorders, particularly with depression. There is insufficient knowledge to what extent sociodemographic and behavioral characteristics contribute to suicide risk. A population-based cohort study on three independent cross-sectional MONICA/KORA Augsburg surveys with 12,888 subjects (6456 men, 6432 women) was followed up on average for 12.0 years. Information on sociodemographic characteristics, chronic disease conditions, smoking habits, alcohol consumption, depressive symptoms, personality type, and other psychodiagnostic parameters was assessed by standardized interviews. Cox proportional hazards regression analyses were used to compute hazard ratios (HRs) as estimates of relative risks for suicide mortality. Additionally, population-attributable risks were calculated. Within the follow-up period, a total of 1449 persons had died, 38 of them by suicide. Although several variables were associated with increased risk in the basic analyses, only obesity (HR=2.73), smoking (HR=2.23), and living alone (HR=2.19) remained significantly associated with suicide additionally to male sex (HR=3.57) and depressed mood (HR=2.01) in a multivariate analysis. The generalization of our findings to countries with different social, economic or cultural conditions may be questioned. Our findings extend the knowledge about sociodemographic and behavioral risk factors for suicide in the general population: Suicide prevention measures should not consider only subjects with mental disorders but also address other adverse conditions. © 2013 Published by Elsevier B.V.

Carcinogenic and neurotoxic risks of acrylamide consumed through caffeinated beverages among the lebanese population.

PubMed

El-Zakhem Naous, Ghada; Merhi, Areej; Abboud, Martine I; Mroueh, Mohamad; Taleb, Robin I

2018-06-06

The present study aims to quantify acrylamide in caffeinated beverages including American coffee, Lebanese coffee, espresso, instant coffee and hot chocolate, and to determine their carcinogenic and neurotoxic risks. A survey was carried for this purpose whereby 78% of the Lebanese population was found to consume at least one type of caffeinated beverages. Gas Chromatography Mass Spectrometry analysis revealed that the average acrylamide level in caffeinated beverages is 29,176 μg/kg sample. The daily consumption of acrylamide from Lebanese coffee (10.9 μg/kg-bw/day), hot chocolate (1.2 μg/kg-bw/day) and Espresso (7.4 μg/kg-bw/day) was found to be higher than the risk intake for carcinogenicity and neurotoxicity as set by World Health Organization (WHO; 0.3-2 μg/kg-bw/day) at both the mean (average consumers) and high (high consumers) dietary exposures. On the other hand, American coffee (0.37 μg/kg-bw/day) was shown to pose no carcinogenic or neurotoxic risks among the Lebanese community for consumers with a mean dietary exposure. The study shows alarming results that call for regulating the caffeinated product industry by setting legislations and standard protocols for product preparation in order to limit the acrylamide content and protect consumers. In order to avoid carcinogenic and neurotoxic risks, we propose that WHO/FAO set acrylamide levels in caffeinated beverages to 7000 μg acrylamide/kg sample, a value which is 4-folds lower than the average acrylamide levels of 29,176 μg/kg sample found in caffeinated beverages sold in the Lebanese market. Alternatively, consumers of caffeinated products, especially Lebanese coffee and espresso, would have to lower their daily consumption to 0.3-0.4 cups/day. Copyright © 2018 Elsevier Ltd. All rights reserved.

Selected Cardiovascular Risk Markers in Vegetarians and Subjects of General Population.

PubMed

Valachovičová, Martina; Príbojová, Jana; Urbánek, Vladimír; Bírošová, Lucia

2017-12-01

Besides genetic factors there are environmental effects including nutritional habits which can influence the risk of age-related diseases. The aim of the study was to assess the age dependence of selected cardiovascular risk markers in two groups of subjects with different nutritional pattern. In 470 long-term vegetarians and 478 subjects of general population the following indicators were measured: total cholesterol, HDL-cholesterol, triacylglycerol, glucose, insulin concentrations, LDL-cholesterol, atherogenic index and insulin resistance IR(HOMA) were also calculated in studied subjects. Obtained data were evaluated according to age decades. Vegetarian vs. non-vegetarian concentrations of total cholesterol, LDL-cholesterol, insulin, and values of atherogenic index and IR(HOMA) were significantly reduced in all age decades. Vegetarian vs. non-vegetarian triacalglycerol concentrations were significantly reduced from 4th–7th decade. Vegetarian average decade values of all lipid parameters were in reference range. In non-vegetarian group, the risk average values of total cholesterol (>5.2 mmol/l) were found from 5th–7th decade, LDL-cholesterol (>3.3 mmol/l) in 7th decade and atherogenic index (>4) in 6th–7th decade. In vegetarians vs. non-vegetarians were noted the average decade values for total cholesterol ranging from 4.01–4.59 vs. 4.48–5.67 mmol/l, for triacylglycerols 1.00–1.33 vs. 1.13–1.74 mmol/l, for LDL-cholesterol 2.03–2.58 vs. 2.43–3.49 mmol/l, for atherogenic index 2.72–3.31 vs. 3.05–4.21 and for IR(HOMA) 0.99–1.15 vs. 1.15–1.84. Our data show significantly reduced mean age decade values of lipid and non-lipid cardiovascular risk markers in all adult vegetarians. Smaller changes of markers between decades compared to non-vegetarians document a protective effect of vegetarian nutrition in prevention of cardiovascular disease. Copyright© by the National Institute of Public Health, Prague 2017

Engaging with local stakeholders: some lessons from Fukushima for recovery.

PubMed

Hayano, R S

2015-06-01

The Fukushima Daiichi nuclear power plant accident contaminated the soil of densely populated regions in Fukushima prefecture with radioactive caesium, which poses significant risks of internal and external exposure to the residents. Applying the knowledge of post-Chernobyl accident studies, internal exposures in excess of a few mSv per year would be expected to be common in Fukushima. However, extensive whole-body-counter surveys have shown that the internal exposure levels of residents are much lower than estimated; in 2012-2013, the Cs-137 detection percentages (the detection limit being ∼300 Bq body(-1)) were approximately 1% for adults and practically 0% for children. These results are consistent with those of many other measurements/studies conducted to date in Fukushima. As a consequence, risks from external exposure assume greater importance for the majority of residents in Fukushima due to the lower contribution from internal exposure. In both cases, average doses remain low, although some residents are exposed to higher-than-average risks; it is these members of the population who need to be identified and followed-up. Consequently, it is essential to re-establish communication at all levels in society. © The International Society for Prosthetics and Orthotics Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Gaps in Incorporating Germline Genetic Testing Into Treatment Decision-Making for Early-Stage Breast Cancer.

PubMed

Kurian, Allison W; Li, Yun; Hamilton, Ann S; Ward, Kevin C; Hawley, Sarah T; Morrow, Monica; McLeod, M Chandler; Jagsi, Reshma; Katz, Steven J

2017-07-10

Purpose Genetic testing for breast cancer risk is evolving rapidly, with growing use of multiple-gene panels that can yield uncertain results. However, little is known about the context of such testing or its impact on treatment. Methods A population-based sample of patients with breast cancer diagnosed in 2014 to 2015 and identified by two SEER registries (Georgia and Los Angeles) were surveyed about genetic testing experiences (N = 3,672; response rate, 68%). Responses were merged with SEER data. A patient subgroup at higher pretest risk of pathogenic mutation carriage was defined according to genetic testing guidelines. Patients' attending surgeons were surveyed about genetic testing and results management. We examined patterns and correlates of genetic counseling and testing and the impact of results on bilateral mastectomy (BLM) use. Results Six hundred sixty-six patients reported genetic testing. Although two thirds of patients were tested before surgical treatment, patients without private insurance more often experienced delays. Approximately half of patients (57% at higher pretest risk, 42% at average risk) discussed results with a genetic counselor. Patients with pathogenic mutations in BRCA1/2 or another gene had the highest rates of BLM (higher risk, 80%; average risk, 85%); however, BLM was also common among patients with genetic variants of uncertain significance (VUS; higher risk, 43%; average risk, 51%). Surgeons' confidence in discussing testing increased with volume of patients with breast cancer, but many surgeons (higher volume, 24%; lower volume, 50%) managed patients with BRCA1/2 VUS the same as patients with BRCA1/2 pathogenic mutations. Conclusion Many patients with breast cancer are tested without ever seeing a genetic counselor. Half of average-risk patients with VUS undergo BLM, suggesting a limited understanding of results that some surgeons share. These findings emphasize the need to address challenges in personalized communication about genetic testing.

Using an autologistic regression model to identify spatial risk factors and spatial risk patterns of hand, foot and mouth disease (HFMD) in Mainland China

PubMed Central

2014-01-01

Background There have been large-scale outbreaks of hand, foot and mouth disease (HFMD) in Mainland China over the last decade. These events varied greatly across the country. It is necessary to identify the spatial risk factors and spatial distribution patterns of HFMD for public health control and prevention. Climate risk factors associated with HFMD occurrence have been recognized. However, few studies discussed the socio-economic determinants of HFMD risk at a space scale. Methods HFMD records in Mainland China in May 2008 were collected. Both climate and socio-economic factors were selected as potential risk exposures of HFMD. Odds ratio (OR) was used to identify the spatial risk factors. A spatial autologistic regression model was employed to get OR values of each exposures and model the spatial distribution patterns of HFMD risk. Results Results showed that both climate and socio-economic variables were spatial risk factors for HFMD transmission in Mainland China. The statistically significant risk factors are monthly average precipitation (OR = 1.4354), monthly average temperature (OR = 1.379), monthly average wind speed (OR = 1.186), the number of industrial enterprises above designated size (OR = 17.699), the population density (OR = 1.953), and the proportion of student population (OR = 1.286). The spatial autologistic regression model has a good goodness of fit (ROC = 0.817) and prediction accuracy (Correct ratio = 78.45%) of HFMD occurrence. The autologistic regression model also reduces the contribution of the residual term in the ordinary logistic regression model significantly, from 17.25 to 1.25 for the odds ratio. Based on the prediction results of the spatial model, we obtained a map of the probability of HFMD occurrence that shows the spatial distribution pattern and local epidemic risk over Mainland China. Conclusions The autologistic regression model was used to identify spatial risk factors and model spatial risk patterns of HFMD. HFMD occurrences were found to be spatially heterogeneous over the Mainland China, which is related to both the climate and socio-economic variables. The combination of socio-economic and climate exposures can explain the HFMD occurrences more comprehensively and objectively than those with only climate exposures. The modeled probability of HFMD occurrence at the county level reveals not only the spatial trends, but also the local details of epidemic risk, even in the regions where there were no HFMD case records. PMID:24731248

A Decrease in Temperature and Humidity Precedes Human Rhinovirus Infections in a Cold Climate.

PubMed

Ikäheimo, Tiina M; Jaakkola, Kari; Jokelainen, Jari; Saukkoriipi, Annika; Roivainen, Merja; Juvonen, Raija; Vainio, Olli; Jaakkola, Jouni J K

2016-09-02

Both temperature and humidity may independently or jointly contribute to the risk of human rhinovirus (HRV) infections, either through altered survival and spread of viruses in the environment or due to changes in host susceptibility. This study examined the relationship between short-term variations in temperature and humidity and the risk of HRV infections in a subarctic climate. We conducted a case-crossover study among conscripts (n = 892) seeking medical attention due to respiratory symptoms during their military training and identified 147 HRV cases by real-time PCR. An average temperature, a decline in daily ambient temperature and absolute humidity (AH) during the three preceding days of the onset (hazard period) and two reference periods (a week prior and after the onset) were obtained. The average daily temperature preceding HRV infections was -9.9 ± 4.9 °C and the average AH was 2.2 ± 0.9 g/m³. An average (odds ratios (OR) 1.07 (95% confidence interval (CI) 1.00-1.15)) and maximal (OR 1.08 (1.01-1.17)) change in temperature increased the risk of HRV infections by 8% per 1 °C decrease. An average (OR 1.20 (CI 1.03-1.40)) and maximal decrease (OR 1.13 (CI 0.96-1.34)) in AH increased the risk of HRV infection by 13% and 20% per 0.5 g/m³ decrease. A higher average temperature during the three preceding days was positively associated with HRV infections (OR 1.07 (CI 1.00-1.15)). A decrease rather than low temperature and humidity per se during the preceding few days increases the risk of HRV infections in a cold climate. The information is applicable to populations residing in cold climates for appropriate personal protection and prevention of adverse health effects.

A Decrease in Temperature and Humidity Precedes Human Rhinovirus Infections in a Cold Climate

PubMed Central

Ikäheimo, Tiina M.; Jaakkola, Kari; Jokelainen, Jari; Saukkoriipi, Annika; Roivainen, Merja; Juvonen, Raija; Vainio, Olli; Jaakkola, Jouni J.K.

2016-01-01

Both temperature and humidity may independently or jointly contribute to the risk of human rhinovirus (HRV) infections, either through altered survival and spread of viruses in the environment or due to changes in host susceptibility. This study examined the relationship between short-term variations in temperature and humidity and the risk of HRV infections in a subarctic climate. We conducted a case-crossover study among conscripts (n = 892) seeking medical attention due to respiratory symptoms during their military training and identified 147 HRV cases by real-time PCR. An average temperature, a decline in daily ambient temperature and absolute humidity (AH) during the three preceding days of the onset (hazard period) and two reference periods (a week prior and after the onset) were obtained. The average daily temperature preceding HRV infections was −9.9 ± 4.9 °C and the average AH was 2.2 ± 0.9 g/m3. An average (odds ratios (OR) 1.07 (95% confidence interval (CI) 1.00–1.15)) and maximal (OR 1.08 (1.01–1.17)) change in temperature increased the risk of HRV infections by 8% per 1 °C decrease. An average (OR 1.20 (CI 1.03–1.40)) and maximal decrease (OR 1.13 (CI 0.96–1.34)) in AH increased the risk of HRV infection by 13% and 20% per 0.5 g/m3 decrease. A higher average temperature during the three preceding days was positively associated with HRV infections (OR 1.07 (CI 1.00–1.15)). A decrease rather than low temperature and humidity per se during the preceding few days increases the risk of HRV infections in a cold climate. The information is applicable to populations residing in cold climates for appropriate personal protection and prevention of adverse health effects. PMID:27598190

Lung cancer risk of airborne particles for Italian population

DOE Office of Scientific and Technical Information (OSTI.GOV)

Buonanno, G., E-mail: buonanno@unicas.it; International Laboratory for Air Quality and Health, Queensland University of Technology, 2 George Street 2, 4001 Brisbane, Qld.; Giovinco, G., E-mail: giovinco@unicas.it

Airborne particles, including both ultrafine and supermicrometric particles, contain various carcinogens. Exposure and risk-assessment studies regularly use particle mass concentration as dosimetry parameter, therefore neglecting the potential impact of ultrafine particles due to their negligible mass compared to supermicrometric particles. The main purpose of this study was the characterization of lung cancer risk due to exposure to polycyclic aromatic hydrocarbons and some heavy metals associated with particle inhalation by Italian non-smoking people. A risk-assessment scheme, modified from an existing risk model, was applied to estimate the cancer risk contribution from both ultrafine and supermicrometric particles. Exposure assessment was carried outmore » on the basis of particle number distributions measured in 25 smoke-free microenvironments in Italy. The predicted lung cancer risk was then compared to the cancer incidence rate in Italy to assess the number of lung cancer cases attributed to airborne particle inhalation, which represents one of the main causes of lung cancer, apart from smoking. Ultrafine particles are associated with a much higher risk than supermicrometric particles, and the modified risk-assessment scheme provided a more accurate estimate than the conventional scheme. Great attention has to be paid to indoor microenvironments and, in particular, to cooking and eating times, which represent the major contributors to lung cancer incidence in the Italian population. The modified risk assessment scheme can serve as a tool for assessing environmental quality, as well as setting up exposure standards for particulate matter. - Highlights: • Lung cancer risk for non-smoking Italian population due to particle inhalation. • The average lung cancer risk for Italian population is equal to 1.90×10{sup −2}. • Ultrafine particle is the aerosol metric mostly contributing to lung cancer risk. • B(a)P is the main (particle-bounded) compound contributing to lung cancer risk. • Cooking activities represent the principal contributor to the lung cancer risk.« less

Glaucoma Suspect: Diagnosis and Management.

PubMed

Chang, Robert T; Singh, Kuldev

2016-01-01

Glaucoma suspect is a diagnosis reserved for individuals who do not definitively have glaucoma at the present time but have characteristics suggesting that they are at high risk of developing the disease in the future based on a variety of factors. This review provides a practical approach to individuals classified as glaucoma suspects caused by one or more of the following risk factors or indicators of disease: ocular hypertension, optic nerve features suggestive of glaucoma, visual field abnormalities, and other characteristics placing them at greater risk than the average population. In addition to diagnostic considerations, this overview provides information on therapeutic approaches to the glaucoma suspect.

The prevalence of metabolic syndrome in an employed population and the impact on health and productivity.

PubMed

Burton, Wayne N; Chen, Chin-Yu; Schultz, Alyssa B; Edington, Dee W

2008-10-01

To investigate the prevalence of metabolic syndrome in an employed population and its association with health risks, health perception, illness days, work limitation (presenteeism), and short-term disability (STD). Five thousand five hundred twelve employees of a financial services company responded to an on-site health risk appraisal which included measured waist circumference and biometric results. The metabolic syndrome criteria were based on the 2005 AHA/NHLBI scientific statement on the diagnosis and management of metabolic syndrome. Perceived health, illness days, and presenteeism were self-reported; STD days were obtained from claims data. In this employee population (61% women, average age 41 years), 22.6% met the criteria for metabolic syndrome and were more likely to report more health risks, poorer health perception, and more absent days due to illness. There was no clear association with presenteeism or STD incidence. However, as the number of metabolic risk factors increased, there was an increase in STD incidence, decrease in health perception, and increase in illness days. No association was found with number of metabolic risk factors and presenteeism. Metabolic syndrome was associated with poor perceived health, increased illness days, and an increased trend of STD incidence. Worksite health promotion programs could be useful in helping employees and employers to identify metabolic syndrome risks and take steps to reduce risk and potential productivity losses.

Prevalence of poor sleep quality, sleepiness and obstructive sleep apnoea risk factors in athletes.

PubMed

Swinbourne, Richard; Gill, Nicholas; Vaile, Joanna; Smart, Daniel

2016-10-01

Despite the perceived importance of sleep for athletes, little is known regarding athlete sleep quality, their prevalence of daytime sleepiness or risk factors for obstructive sleep apnoea (OSA) such as snoring and witnessed apnoeic episodes. The purpose of the present study was to characterise normative sleep quality among highly trained team sport athletes. 175 elite or highly trained rugby sevens, rugby union and cricket athletes completed the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Score (ESS) and Quality of Life questionnaires and an OSA risk factor screen. On average, athletes reported 7.9 ± 1.3 h of sleep per night. The average PSQI score was 5.9 ± 2.6, and 50% of athletes were found to be poor sleepers (PSQI > 5). Daytime sleepiness was prevalent throughout the population (average global score of 8.5) and clinically significant (ESS score of ≥10) in 28% of athletes. OSA may be an important clinical consideration within athletic populations, as a considerable number of athletes (38%) defined themselves as snorers and 8% reported having a witnessed apnoeic episode. The relationship between self-rated sleep quality and actual PSQI score was strong (Pearson correlation of 0.4 ± 0.1, 90% confidence limits). These findings suggest that this cohort of team sport athletes suffer a preponderance of poor sleep quality, with associated high levels of daytime sleepiness. Athletes should receive education about how to improve sleep wake schedules, extend total sleep time and improve sleep quality.

Organochlorines in urban soils from Central India: probabilistic health hazard and risk implications to human population.

PubMed

Kumar, Bhupander; Mishra, Meenu; Verma, V K; Rai, Premanjali; Kumar, Sanjay

2018-04-21

This study presents distribution of organochlorines (OCs) including HCH, DDT and PCBs in urban soils, and their environmental and human health risk. Forty-eight soil samples were extracted using ultrasonication, cleaned with modified silica gel chromatography and analyzed by GC-ECD. The observed concentrations of ∑HCH, ∑DDT and ∑PCBs in soils ranged between < 0.01-2.54, 1.30-27.41 and < 0.01-62.8 µg kg -1 , respectively, which were lower than the recommended soil quality guidelines. Human health risk was estimated following recommended guidelines. Lifetime average daily dose (LADD), non-cancer risk or hazard quotient (HQ) and incremental lifetime cancer risk (ILCR) for humans due to individual and total OCs were estimated and presented. Estimated LADD were lower than acceptable daily intake and reference dose. Human health risk estimates were lower than safe limit of non-cancer risk (HQ < 1.0) and the acceptable distribution range of ILCR (10 -6 -10 -4 ). Therefore, this study concluded that present levels of OCs (HCH, DDT and PCBs) in studied soils were low, and subsequently posed low health risk to human population in the study area.

Iowa radon leukaemia study: a hierarchical population risk model for spatially correlated exposure measured with error.

PubMed

Smith, Brian J; Zhang, Lixun; Field, R William

2007-11-10

This paper presents a Bayesian model that allows for the joint prediction of county-average radon levels and estimation of the associated leukaemia risk. The methods are motivated by radon data from an epidemiologic study of residential radon in Iowa that include 2726 outdoor and indoor measurements. Prediction of county-average radon is based on a geostatistical model for the radon data which assumes an underlying continuous spatial process. In the radon model, we account for uncertainties due to incomplete spatial coverage, spatial variability, characteristic differences between homes, and detector measurement error. The predicted radon averages are, in turn, included as a covariate in Poisson models for incident cases of acute lymphocytic (ALL), acute myelogenous (AML), chronic lymphocytic (CLL), and chronic myelogenous (CML) leukaemias reported to the Iowa cancer registry from 1973 to 2002. Since radon and leukaemia risk are modelled simultaneously in our approach, the resulting risk estimates accurately reflect uncertainties in the predicted radon exposure covariate. Posterior mean (95 per cent Bayesian credible interval) estimates of the relative risk associated with a 1 pCi/L increase in radon for ALL, AML, CLL, and CML are 0.91 (0.78-1.03), 1.01 (0.92-1.12), 1.06 (0.96-1.16), and 1.12 (0.98-1.27), respectively. Copyright 2007 John Wiley & Sons, Ltd.

Prevalence of obesity and diabetes in patients with schizophrenia.

PubMed

Annamalai, Aniyizhai; Kosir, Urska; Tek, Cenk

2017-08-15

To compare the prevalence of diabetes in patients with schizophrenia treated at a community mental health center with controls in the same metropolitan area and to examine the effect of antipsychotic exposure on diabetes prevalence in schizophrenia patients. The study was a comprehensive chart review of psychiatric notes of patients with schizophrenia and schizoaffective disorder treated at a psychosis program in a community mental health center. Data collected included psychiatric diagnoses, diabetes mellitus diagnosis, medications, allergies, primary care status, height, weight, body mass index (BMI), substance use and mental status exam. Local population data was downloaded from the Centers for Disease Control Behavioral Risk Factor Surveillance System. Statistical methods used were χ 2 test, Student's t test, general linear model procedure and binary logistic regression analysis. The study sample included 326 patients with schizophrenia and 1899 subjects in the population control group. Demographic data showed control group was on average 7.6 years older ( P = 0.000), more Caucasians (78.7% vs 38.3%, P = 0.000), and lower percentage of males (40.7% vs 58.3%, P = 0.000). Patients with schizophrenia had a higher average BMI than the subjects in the population control (32.11, SD = 7.72 vs 27.62, SD = 5.93, P = 0.000). Patients with schizophrenia had a significantly higher percentage of obesity (58.5% vs 27%, P = 0.000) than the population group. The patients with schizophrenia also had a much higher rate of diabetes compared to population control (23.9% vs 12.2%, P = 0.000). After controlling for age sex, and race, having schizophrenia was still associated with increased risk for both obesity (OR = 3.25, P = 0.000) and diabetes (OR = 2.42, P = 0.000). The increased risk for diabetes remained even after controlling for obesity (OR = 1.82, P = 0.001). There was no difference in the distribution of antipsychotic dosage, second generation antipsychotic use or multiple antipsychotic use within different BMI categories or with diabetes status in the schizophrenia group. This study demonstrates the high prevalence of obesity and diabetes in schizophrenia patients and indicates that antipsychotics may not be the only contributor to this risk.

Light to Moderate Alcohol Consumption Is Associated With Lower Risk of Aortic Valve Sclerosis: The Study of Health in Pomerania (SHIP).

PubMed

Markus, Marcello Ricardo Paulista; Lieb, Wolfgang; Stritzke, Jan; Siewert, Ulrike; Troitzsch, Paulina; Koch, Manja; Dörr, Marcus; Felix, Stephan Burkhard; Völzke, Henry; Schunkert, Heribert; Baumeister, Sebastian Edgar

2015-05-01

In developed countries, sclerotic and calcific degeneration of the aortic valve is a common disorder showing pathophysiologic similarities with atherothrombotic coronary disease. Light to moderate alcohol consumption has been associated with a lower risk for atherothrombotic coronary disease and mortality. Whether alcohol consumption affects the development of aortic valve sclerosis (AVS) is not well known. In the present study, we aim to analyze the cross-sectional association between average daily alcohol consumption and AVS in the general population. We analyzed cross-sectional data from 2022 men and women, aged 45 to 81 years, from the population-based Study of Health in Pomerania. We used a computer-assisted interview that included beverage-specific questions about quantity and frequency of alcohol over the last 30 days to calculate the average quantity of alcohol consumption (in grams of ethanol per day). AVS was ascertained by echocardiography. The prevalence of AVS was 32.3%. Average daily alcohol intake displayed a J-type relation with AVS (fully adjusted P value: 0.005). Compared with individuals with an average consumption of 10 g of alcohol per day, multivariable-adjusted odds ratios were 1.60 (95% confidence interval, 1.19-2.14) among current abstainers and 1.56 (95% confidence interval, 1.01-2.41) among individuals with an average consumption of 60 g per day. Our findings indicate that light to moderate alcohol consumption was associated with a lower odd of having AVS. Prospective data need to address whether alcohol consumption and related changes over time in several biological markers affect the progression of AVS. © 2015 American Heart Association, Inc.

High coffee consumption and different brewing methods in relation to postmenopausal endometrial cancer risk in the Norwegian Women and Cancer Study: a population-based prospective study

PubMed Central

2014-01-01

Background Coffee and its compounds have been proposed to inhibit endometrial carcinogenesis. Studies in the Norwegian population can be especially interesting due to the high coffee consumption and increasing incidence of endometrial cancer in the country. Methods A total of 97 926 postmenopausal Norwegian women from the population-based prospective Norwegian Women and Cancer (NOWAC) Study, were included in the present analysis. We evaluated the general association between total coffee consumption and endometrial cancer risk as well as the possible impact of brewing method. Multivariate Cox regression analysis was used to estimate risks, and heterogeneity tests were performed to compare brewing methods. Results During an average of 10.9 years of follow-up, 462 incident endometrial cancer cases were identified. After multivariate adjustment, significant risk reduction was found among participants who drank ≥8 cups/day of coffee with a hazard ratio of 0.52 (95% confidence interval, CI 0.34-0.79). However, we did not observe a significant dose-response relationship. No significant heterogeneity in risk was found when comparing filtered and boiled coffee brewing methods. A reduction in endometrial cancer risk was observed in subgroup analyses among participants who drank ≥8 cups/day and had a body mass index ≥25 kg/m2, and in current smokers. Conclusions These data suggest that in this population with high coffee consumption, endometrial cancer risk decreases in women consuming ≥8 cups/day, independent of brewing method. PMID:24666820

A case-control study to assess the impact of mammographic density on breast cancer risk in women aged 40-49 at intermediate familial risk.

PubMed

Assi, Valentina; Massat, Nathalie J; Thomas, Susan; MacKay, James; Warwick, Jane; Kataoka, Masako; Warsi, Iqbal; Brentnall, Adam; Warren, Ruth; Duffy, Stephen W

2015-05-15

Mammographic density is a strong risk factor for breast cancer, but its potential application in risk management is not clear, partly due to uncertainties about its interaction with other breast cancer risk factors. We aimed to quantify the impact of mammographic density on breast cancer risk in women aged 40-49 at intermediate familial risk of breast cancer (average lifetime risk of 23%), in particular in premenopausal women, and to investigate its relationship with other breast cancer risk factors in this population. We present the results from a case-control study nested with the FH01 cohort study of 6,710 women mostly aged 40-49 at intermediate familial risk of breast cancer. One hundred and three cases of breast cancer were age-matched to one or two controls. Density was measured by semiautomated interactive thresholding. Absolute density, but not percent density, was a significant risk factor for breast cancer in this population after adjusting for area of nondense tissue (OR per 10 cm(2) = 1.07, 95% CI 1.00-1.15, p = 0.04). The effect was stronger in premenopausal women, who made up the majority of the study population. Absolute density remained a significant predictor of breast cancer risk after adjusting for age at menarche, age at first live birth, parity, past or present hormone replacement therapy, and the Tyrer-Cuzick 10-year relative risk estimate of breast cancer. Absolute density can improve breast cancer risk stratification and delineation of high-risk groups alongside the Tyrer-Cuzick 10-year relative risk estimate. © 2014 UICC.

[Fruit and vegetables intake among the Chinese migrant population aged 18 to 59 years old in 2012].

PubMed

Zhang, Mei; Wang, Linhong; Deng, Qian; Zhao, Yinjun; Huang, Zhengjing; Li, Yichong; Jiang, Yong; Wang, Limin

2014-11-01

To describe the intake of fruit and vegetables among employed migrant population aged 18 to 59 year-olds in China. Data from the Migrant Population Survey related to China Chronic Disease and Risk Factor Surveillance that conducted in 170 counties/districts in 31 provinces, 2012, was used. Information on non-communicable diseases and related risk factors among migrant population were collected through face-to-face questionnaire interview, physical measurement and lab tests. A total of 48 704 subjects aged 18 to 59 years old were included in our study. Sample was standardized by age and sex. Information on average daily fruit and vegetables intake, prevalence of low fruit and vegetables intake, grouped by sex, age, industries, and education level were analyzed. The average daily intakes of vegetables and fruits were 353.7 (95%CI:351.3-356.2) g and 125.1 (95%CI:123.4-126.9) g respectively, among the employed migrant population aged 18-59 years old in China. Prevalence of low fruit and vegetables intake was 44.1% (95% CI:43.5%-44.6% ) among employed migrant population, 46.2% (95% CI: 45.5%-47.0%)for males and 41.2% (95% CI:40.3%-42.0%)for females (χ(2) = 82.19, P < 0.05). Among different professions, the prevalence of low fruit and vegetables intake was the highest among people working in accommodation and restaurants (46.2%, 95%CI:45.0%-47.3%) while the lowest seen among those working in social services (42.5%, 95%CI:41.4%-43.7%,χ(2) = 15.81, P < 0.05). The prevalence of low fruit and vegetables intake showed a decrease along with the increase of education levels (χ(2) = 22.29, P < 0.05). In 2012, more than 40% of the employed migrant population aged 18 to 59 years old in China had low fruit and vegetables intake. Being male and with low education level were risk factors linked with the higher prevalence of low fruit and vegetables intake.

Nutritional status and dietary habits of the population of the Calchaqui Valleys of Tucuman, Argentina.

PubMed

Bassett, Maria Natalia; Romaguera, Dora; Samman, Norma

2011-01-01

To assess the nutritional status and dietary habits of the adult population of the Calchaqui Valleys of Tucuman. A cross-sectional nutritional survey that included one 24-h recall, a semiquantitative food-frequency questionnaire, and anthropometric measurements was conducted in a representative sample of 113 adult participants. Pregnant and lactating women were excluded. Overweight and obesity were assessed according to body mass index, and the percentage of individuals with cardiovascular risk according to waist circumference and waist-to-hip circumference ratio was determined. Dietary habits were described according to the mean nutrient and food intakes of men and women. Means ± standard deviations for total energy intake of men and women were 1856 ± 859 and 1589 ± 799 kcal/d, respectively. The average body mass indices of men and women were 26.8 and 26.7 kg/m(2), respectively. Thirty-seven percent of the population was overweight and 22.8% was obese, whereas 1.8% of the population was undernourished. Central adiposity was high (mean waist circumferences 99.8 and 87.3 cm in men and women, respectively). Despite the low average energy intake, the population under study showed a high prevalence of overweight and obesity and a high risk of cardiovascular disease according to the central adiposity values. These findings could be explained by the introduction of new high-energy foods and a sedentary lifestyle or the possibility that the biological characteristics of these individuals make them more predisposed to a rapid increase in adiposity. Copyright © 2011. Published by Elsevier Inc.

Consequences of actively managing a small Bull Trout population in a fragmented landscape

USGS Publications Warehouse

Al-Chokhachy, Robert K.; Moran, Sean; McHugh, Peter; Bernall, Shana; Fredenberg, Wade; DosSantos, Joseph M.

2015-01-01

Habitat fragmentation, which affects many native salmonid species, is one of the major factors contributing to the declines in distribution and abundance of Bull Trout Salvelinus confluentus. Increasingly, managers are considering options to maintain and enhance the persistence of isolated local populations through active management strategies. Understanding the ecological consequences of such actions is a necessary step in conservation planning. We used an individual-based model to evaluate the consequences of an ongoing management program aimed at mitigating the anthropogenic fragmentation of the lower Clark Fork River in Montana. Under this program juvenile Bull Trout are trapped and transported from small, headwater source populations to Lake Pend Oreille, Idaho, for rearing, and adults are subsequently recaptured in their upstream migration and returned to the natal population for spawning. We examined one of these populations and integrated empirical estimates of demographic parameters to simulate different management scenarios where moderate (n = 4) and high (n = 8) numbers of age-2, age-3, or age-4 Bull Trout were removed for transport with variable return rates under both demographic stochasticity and environmental perturbations. Our results indicated the risks from removal with no returns increased substantially when removal totals and age of Bull Trout removed from the simulated population increased. Specifically, removing eight age-3 or age-4 individuals resulted in 26% and 62% reductions in average adult population size, respectively, across simulations. We found the risks of transport were not likely alleviated with low (3%) or moderate (6%) return rates, and there were considerable risks of declines for the source population even when return rates were extremely high (>12%). Our simulations indicated little risk of declines for the source population with removals of age-2 Bull Trout, and any risks were alleviated with low return rates. However, we found higher return rates were particularly beneficial in the presence of large, density-independent perturbations.

Admixture in Hispanic Americans: its impact on ITGAM association and implications for admixture mapping in SLE.

PubMed

Molineros, J E; Kim-Howard, X; Deshmukh, H; Jacob, C O; Harley, J B; Nath, S K

2009-07-01

Systemic Lupus Erythematosus (SLE) disproportionately affects minorities, such as Hispanic Americans (HA). Prevalence of SLE is 3-5 times higher in HA than in European-derived populations and have more active disease at the time of diagnosis, with more serious organ system involvement. HA is an admixed population, it is possible that there is an effect of admixture on the relative risk of the disease. This admixture can create substantial increase of linkage disequilibrium (LD) in both magnitude and range, which can provide a unique opportunity for admixture mapping. The main objectives of this study are to (a) estimate hidden population structure in HA individuals; (b) estimate individual ancestry proportions and its impact on SLE risk; (c) assess impact of admixture on ITGAM association, a recently identified SLE susceptibility gene; and (d) estimate power of admixture mapping in HA. Our dataset contained 1125 individuals, of whom 884 (657 SLE cases and 227 controls) were self-classified as HA. Using 107 unlinked ancestry informative markers (AIMs), we estimated hidden population structure and individual ancestry in HA. Out of 5671 possible pairwise LD, 54% were statistically significant, indicating recent population admixture. The best-fitted model for HA was a four-population model with average ancestry of European (48%), American-Indian (AI) (40%), African (8%) and a fourth population (4%) with unknown ancestry. We also identified significant higher risk associated with AI ancestry (odds ratio (OR)=4.84, P=0.0001, 95% CI (confidence interval)=2.14-10.95) on overall SLE. We showed that ITGAM is associated as a risk factor for SLE (OR=2.06, P=8.74 x 10(-5), 95% CI=1.44-2.97). This association is not affected by population substructure or admixture. We have shown that HA have great potential and are an appropriate population for admixture mapping. As expected, the case-only design is more powerful than case-control design, for any given admixture proportion or ancestry risk ratio.

Assessing health risk due to exposure to arsenic in drinking water in Hanam Province, Vietnam.

PubMed

Huy, Tung Bui; Tuyet-Hanh, Tran Thi; Johnston, Richard; Nguyen-Viet, Hung

2014-07-24

We assessed health risks related to Arsenic (As) in contaminated drinking water in Hanam, applying the Australian Environmental Health Risk Assessment Framework, which promotes stakeholder involvement in risk assessments. As concentrations in 300 tube-well water samples, before and after filtration, were analyzed and the water consumption levels in 150 households were estimated. Skin cancer risk was characterized using Cancer Slope Factor index and lifetime average daily dose with a probabilistic approach. The results showed that arsenic concentrations in tube-well water ranged from 8-579 ppb (mean 301 ppb) before filtration and current sand filters used by the households did not meet the standard for As removal. Arsenic daily consumption of 40% of the adults exceeded the level of TDI (Tolerable Daily Intake) at 1 µg/kg/day. The average skin cancer risk in adults due to consuming filtered tube-well water for drinking purpose were 25.3 × 10-5 (using only well water) and 7.6 × 10-5 (using both well and rain water). The skin cancer risk would be 11.5 times higher if the water was not filtered. Improvement of filtration measures or the replacement of the current drinking water sources to minimize the health risks to the local population is urgently needed.

Assessing Health Risk due to Exposure to Arsenic in Drinking Water in Hanam Province, Vietnam

PubMed Central

Bui Huy, Tung; Tuyet-Hanh, Tran Thi; Johnston, Richard; Nguyen-Viet, Hung

2014-01-01

We assessed health risks related to Arsenic (As) in contaminated drinking water in Hanam, applying the Australian Environmental Health Risk Assessment Framework, which promotes stakeholder involvement in risk assessments. As concentrations in 300 tube-well water samples, before and after filtration, were analyzed and the water consumption levels in 150 households were estimated. Skin cancer risk was characterized using Cancer Slope Factor index and lifetime average daily dose with a probabilistic approach. The results showed that arsenic concentrations in tube-well water ranged from 8–579 ppb (mean 301 ppb) before filtration and current sand filters used by the households did not meet the standard for As removal. Arsenic daily consumption of 40% of the adults exceeded the level of TDI (Tolerable Daily Intake) at 1 µg/kg/day. The average skin cancer risk in adults due to consuming filtered tube-well water for drinking purpose were 25.3 × 10−5 (using only well water) and 7.6 × 10−5 (using both well and rain water). The skin cancer risk would be 11.5 times higher if the water was not filtered. Improvement of filtration measures or the replacement of the current drinking water sources to minimize the health risks to the local population is urgently needed. PMID:25062276

Global assessment of human losses due to earthquakes

USGS Publications Warehouse

Silva, Vitor; Jaiswal, Kishor; Weatherill, Graeme; Crowley, Helen

2014-01-01

Current studies have demonstrated a sharp increase in human losses due to earthquakes. These alarming levels of casualties suggest the need for large-scale investment in seismic risk mitigation, which, in turn, requires an adequate understanding of the extent of the losses, and location of the most affected regions. Recent developments in global and uniform datasets such as instrumental and historical earthquake catalogues, population spatial distribution and country-based vulnerability functions, have opened an unprecedented possibility for a reliable assessment of earthquake consequences at a global scale. In this study, a uniform probabilistic seismic hazard assessment (PSHA) model was employed to derive a set of global seismic hazard curves, using the open-source software OpenQuake for seismic hazard and risk analysis. These results were combined with a collection of empirical fatality vulnerability functions and a population dataset to calculate average annual human losses at the country level. The results from this study highlight the regions/countries in the world with a higher seismic risk, and thus where risk reduction measures should be prioritized.

The effects of socioeconomic status on stroke risk and outcomes.

PubMed

Marshall, Iain J; Wang, Yanzhong; Crichton, Siobhan; McKevitt, Christopher; Rudd, Anthony G; Wolfe, Charles D A

2015-12-01

The latest evidence on socioeconomic status and stroke shows that stroke not only disproportionately affects low-income and middle-income countries, but also socioeconomically deprived populations within high-income countries. These disparities are reflected not only in risk of stroke but also in short-term and long-term outcomes after stroke. Increased average levels of conventional risk factors (eg, hypertension, hyperlipidaemia, excessive alcohol intake, smoking, obesity, and sedentary lifestyle) in populations with low socioeconomic status account for about half of these effects. In many countries, evidence shows that people with lower socioeconomic status are less likely to receive good-quality acute hospital and rehabilitation care than people with higher socioeconomic status. For clinical practice, better implementation of well established treatments, effective management of risk factors, and equity of access to high-quality acute stroke care and rehabilitation will probably reduce inequality substantially. Overcoming barriers and adapting evidence-based interventions to different countries and health-care settings remains a research priority. Copyright © 2015 Elsevier Ltd. All rights reserved.

The Burden of Cholera in Uganda

PubMed Central

Bwire, Godfrey; Malimbo, Mugagga; Maskery, Brian; Kim, Young Eun; Mogasale, Vittal; Levin, Ann

2013-01-01

Introduction In 2010, the World Health Organization released a new cholera vaccine position paper, which recommended the use of cholera vaccines in high-risk endemic areas. However, there is a paucity of data on the burden of cholera in endemic countries. This article reviewed available cholera surveillance data from Uganda and assessed the sufficiency of these data to inform country-specific strategies for cholera vaccination. Methods The Uganda Ministry of Health conducts cholera surveillance to guide cholera outbreak control activities. This includes reporting the number of cases based on a standardized clinical definition plus systematic laboratory testing of stool samples from suspected cases at the outset and conclusion of outbreaks. This retrospective study analyzes available data by district and by age to estimate incidence rates. Since surveillance activities focus on more severe hospitalized cases and deaths, a sensitivity analysis was conducted to estimate the number of non-severe cases and unrecognized deaths that may not have been captured. Results Cholera affected all ages, but the geographic distribution of the disease was very heterogeneous in Uganda. We estimated that an average of about 11,000 cholera cases occurred in Uganda each year, which led to approximately 61–182 deaths. The majority of these cases (81%) occurred in a relatively small number of districts comprising just 24% of Uganda's total population. These districts included rural areas bordering the Democratic Republic of Congo, South Sudan, and Kenya as well as the slums of Kampala city. When outbreaks occurred, the average duration was about 15 weeks with a range of 4–44 weeks. Discussion There is a clear subdivision between high-risk and low-risk districts in Uganda. Vaccination efforts should be focused on the high-risk population. However, enhanced or sentinel surveillance activities should be undertaken to better quantify the endemic disease burden and high-risk populations prior to introducing the vaccine. PMID:24340106

Heat-related Emergency Hospitalizations for Respiratory Diseases in the Medicare Population

PubMed Central

Anderson, G. Brooke; Dominici, Francesca; Wang, Yun; McCormack, Meredith C.; Bell, Michelle L.

2013-01-01

Rationale: The heat-related risk of hospitalization for respiratory diseases among the elderly has not been quantified in the United States on a national scale. With climate change predictions of more frequent and more intense heat waves, it is of paramount importance to quantify the health risks related to heat, especially for the most vulnerable. Objectives: To estimate the risk of hospitalization for respiratory diseases associated with outdoor heat in the U.S. elderly. Methods: An observational study of approximately 12.5 million Medicare beneficiaries in 213 United States counties, January 1, 1999 to December 31, 2008. We estimate a national average relative risk of hospitalization for each 10°F (5.6°C) increase in daily outdoor temperature using Bayesian hierarchical models. Measurements and Main Results: We obtained daily county-level rates of Medicare emergency respiratory hospitalizations (International Classification of Diseases, Ninth Revision, 464–466, 480–487, 490–492) in 213 U.S. counties from 1999 through 2008. Overall, each 10°F increase in daily temperature was associated with a 4.3% increase in same-day emergency hospitalizations for respiratory diseases (95% posterior interval, 3.8, 4.8%). Counties’ relative risks were significantly higher in counties with cooler average summer temperatures. Conclusions: We found strong evidence of an association between outdoor heat and respiratory hospitalizations in the largest population of elderly studied to date. Given projections of increasing temperatures from climate change and the increasing global prevalence of chronic pulmonary disease, the relationship between heat and respiratory morbidity is a growing concern. PMID:23491405

Mobile population dynamics and malaria vulnerability: a modelling study in the China-Myanmar border region of Yunnan Province, China.

PubMed

Chen, Tian-Mu; Zhang, Shao-Sen; Feng, Jun; Xia, Zhi-Gui; Luo, Chun-Hai; Zeng, Xu-Can; Guo, Xiang-Rui; Lin, Zu-Rui; Zhou, Hong-Ning; Zhou, Shui-Sen

2018-04-29

The China-Myanmar border region presents a great challenge in malaria elimination in China, and it is essential to understand the relationship between malaria vulnerability and population mobility in this region. A community-based, cross-sectional survey was performed in five villages of Yingjiang county during September 2016. Finger-prick blood samples were obtained to identify asymptomatic infections, and imported cases were identified in each village (between January 2013 and September 2016). A stochastic simulation model (SSM) was used to test the relationship between population mobility and malaria vulnerability, according to the mechanisms of malaria importation. Thirty-two imported cases were identified in the five villages, with a 4-year average of 1 case/year (range: 0-5 cases/year). No parasites were detected in the 353 blood samples from 2016. The median density of malaria vulnerability was 0.012 (range: 0.000-0.033). The average proportion of mobile members of the study population was 32.56% (range: 28.38-71.95%). Most mobile individuals lived indoors at night with mosquito protection. The SSM model fit the investigated data (χ 2  = 0.487, P = 0.485). The average probability of infection in the members of the population that moved to Myanmar was 0.011 (range: 0.0048-0.1585). The values for simulated vulnerability increased with greater population mobility in each village. A high proportion of population mobility was associated with greater malaria vulnerability in the China-Myanmar border region. Mobile population-specific measures should be used to decrease the risk of malaria re-establishment in China.

Prevalence and determinants of hypertension and associated cardiovascular risk factors: data from a population-based, cross-sectional survey in Saint Louis, Senegal.

PubMed

Pessinaba, Soulemane; Mbaye, Alassane; Yabeta, Grace-A-Dieu; Kane, Adama; Ndao, Cheikh Tidiane; Ndiaye, Mouhamadou Bamba; Harouna, Habibou; Bodian, Malick; Diao, Maboury; Mbaye, Maimouna Ndour; Diagne, Maimouna Ndour; Diack, Bouna; Kane, Moussa; Niang, Khadim; Mathieu, Jean-Baptiste Sy; Kane, Abdoul

2013-06-01

The incidence of cardiovascular disease is growing worldwide and this is of major public health concern. In sub-Saharan Africa, there is a lack of epidemiological data on the prevalence and distribution of risk factors of cardiovascular disease. This study aimed at assessing the prevalence of hypertension and other cardiovascular risk factors among an urban Senegalese population. Using an adaptation of the WHO STEPwise approach to chronic disease risk-factor surveillance, we conducted a population-based, cross-sectional survey from 3 to 30 May 2010 on 1 424 participants aged over 15 years. Socio-demographic and behavioural risk factors were collected in step 1. Physical anthropometryc measurements and blood pressure were documented in step 2. Blood tests (cholesterol, fasting blood glucose, and creatinine levels) were carried out in step 3. The prevalence of hypertension was 46% (95% CI: 43.4-48%), with a higher prevalence in females (47.9%) than males (41.7%) (p = 0.015), and 50% of these hypertensive were previously undiagnosed. Mean age was 53.6 years (SD: 15.8). In known cases of hypertension, the average length of its evolution was 6 years 9 months (range 1 month to 60 years). Hypertension was significantly associated with age (p = 0.001), socio-professional category (p = 0.003), dyslipidaemia (p < 0.001), obesity (p < 0.001), physical inactivity (p < 0.001), diabetes (p < 0.001) and stroke (p < 0.001). We found a high prevalence of hypertension and other cardiovascular risk factors in this population. There is need of a specific programme for the management and prevention of cardiovascular disease in this population.

Design of a randomized trial of diabetes genetic risk testing to motivate behavior change: the Genetic Counseling/lifestyle Change (GC/LC) Study for Diabetes Prevention.

PubMed

Grant, Richard W; Meigs, James B; Florez, Jose C; Park, Elyse R; Green, Robert C; Waxler, Jessica L; Delahanty, Linda M; O'Brien, Kelsey E

2011-10-01

The efficacy of diabetes genetic risk testing to motivate behavior change for diabetes prevention is currently unknown. This paper presents key issues in the design and implementation of one of the first randomized trials (The Genetic Counseling/Lifestyle Change (GC/LC) Study for Diabetes Prevention) to test whether knowledge of diabetes genetic risk can motivate patients to adopt healthier behaviors. Because individuals may react differently to receiving 'higher' vs 'lower' genetic risk results, we designed a 3-arm parallel group study to separately test the hypotheses that: (1) patients receiving 'higher' diabetes genetic risk results will increase healthy behaviors compared to untested controls, and (2) patients receiving 'lower' diabetes genetic risk results will decrease healthy behaviors compared to untested controls. In this paper we describe several challenges to implementing this study, including: (1) the application of a novel diabetes risk score derived from genetic epidemiology studies to a clinical population, (2) the use of the principle of Mendelian randomization to efficiently exclude 'average' diabetes genetic risk patients from the intervention, and (3) the development of a diabetes genetic risk counseling intervention that maintained the ethical need to motivate behavior change in both 'higher' and 'lower' diabetes genetic risk result recipients. Diabetes genetic risk scores were developed by aggregating the results of 36 diabetes-associated single nucleotide polymorphisms. Relative risk for type 2 diabetes was calculated using Framingham Offspring Study outcomes, grouped by quartiles into 'higher', 'average' (middle two quartiles) and 'lower' genetic risk. From these relative risks, revised absolute risks were estimated using the overall absolute risk for the study group. For study efficiency, we excluded all patients receiving 'average' diabetes risk results from the subsequent intervention. This post-randomization allocation strategy was justified because genotype represents a random allocation of parental alleles ('Mendelian randomization'). Finally, because it would be unethical to discourage participants to participate in diabetes prevention behaviors, we designed our two diabetes genetic risk counseling interventions (for 'higher' and 'lower' result recipients) so that both groups would be motivated despite receiving opposing results. For this initial assessment of the clinical implementation of genetic risk testing we assessed intermediate outcomes of attendance at a 12-week diabetes prevention course and changes in self-reported motivation. If effective, longer term studies with larger sample sizes will be needed to assess whether knowledge of diabetes genetic risk can help patients prevent diabetes. We designed a randomized clinical trial designed to explore the motivational impact of disclosing both higher than average and lower than average genetic risk for type 2 diabetes. This design allowed exploration of both increased risk and false reassurance, and has implications for future studies in translational genomics.

Demographics of an ornate box turtle population experiencing minimal human-induced disturbances

USGS Publications Warehouse

Converse, S.J.; Iverson, J.B.; Savidge, J.A.

2005-01-01

Human-induced disturbances may threaten the viability of many turtle populations, including populations of North American box turtles. Evaluation of the potential impacts of these disturbances can be aided by long-term studies of populations subject to minimal human activity. In such a population of ornate box turtles (Terrapene ornata ornata) in western Nebraska, we examined survival rates and population growth rates from 1981-2000 based on mark-recapture data. The average annual apparent survival rate of adult males was 0.883 (SE = 0.021) and of adult females was 0.932 (SE = 0.014). Minimum winter temperature was the best of five climate variables as a predictor of adult survival. Survival rates were highest in years with low minimum winter temperatures, suggesting that global warming may result in declining survival. We estimated an average adult population growth rate (????) of 1.006 (SE = 0.065), with an estimated temporal process variance (????2) of 0.029 (95% CI = 0.005-0.176). Stochastic simulations suggest that this mean and temporal process variance would result in a 58% probability of a population decrease over a 20-year period. This research provides evidence that, unless unknown density-dependent mechanisms are operating in the adult age class, significant human disturbances, such as commercial harvest or turtle mortality on roads, represent a potential risk to box turtle populations. ?? 2005 by the Ecological Society of America.

Differences between seven measures of self-reported numbers of clients of female sex workers in southern India: implications for individual- and population-level analysis.

PubMed

Deering, Kathleen N; Vickerman, P; Pickles, M; Moses, S; Blanchard, J F; Ramesh, B M; Isac, S; Boily, M-C

2013-02-01

Quantifying sexual activity of sub-populations with high-risk sexual behaviour is important in understanding HIV epidemiology. This study examined inconsistency of seven outcomes measuring self-reported clients per month (CPM) of female sex workers (FSWs) in southern India and implications for individual/population-level analysis. Multivariate negative binomial regression was used to compare key social/environmental factors associated with each outcome. A transmission dynamics model was used to assess the impact of differences between outcomes on population-level FSW/client HIV prevalence. Outcomes based on 'clients per last working day' produced lower estimates than those based on 'clients per typical day'. Although the outcomes were strongly correlated, their averages differed by approximately two-fold (range 39.0-79.1 CPM). The CPM measure chosen did not greatly influence standard epidemiological 'risk factor' analysis. Differences across outcomes influenced HIV prevalence predictions. Due to this uncertainty, we recommend basing population-based estimates on the range of outcomes, particularly when assessing the impact of interventions.

Association of BMI and height with the risk of endometrial cancer, overall and by histological subtype: a population-based prospective cohort study in Japan.

PubMed

Kawachi, Asuka; Shimazu, Taichi; Budhathoki, Sanjeev; Sawada, Norie; Yamaji, Taiki; Iwasaki, Motoki; Inoue, Manami; Tsugane, Shoichiro

2018-04-18

Evidence on the association between BMI, height, and endometrial cancer risk, including by subtypes, among Asian populations remains limited. We evaluated the impact of BMI and height on the risk of endometrial cancer, overall and by histological subtype. We prospectively investigated 53 651 Japanese women aged 40-69 years. With an average follow-up duration of 18.6 years, 180 newly diagnosed endometrial cancers were reported, including 119 type 1 and 21 type 2. The association between BMI, height, and endometrial cancer risk was assessed using a Cox proportional hazards regression model with adjustment for potential confounders. Overweight and obesity were associated positively with the risk of endometrial cancer. Compared with BMI of 23.0-24.9 kg/m, hazard ratios (HRs) (95% confidence intervals) were 1.93 (1.17-3.16) for BMI of 27.0-29.9 kg/m and 2.37 (1.20-4.66) for BMI of at least 30.0 kg/m. On analysis by histological subtype, with each increase in BMI of 5 U, the estimated HR of type 1 endometrial cancer increased (HR=1.54, 95% confidence interval: 1.21-1.98), but HR of type 2 endometrial cancer was unaffected. There was no statistically significant association between height and endometrial cancer risk. In conclusion, the risk of endometrial cancer was elevated in women with a BMI of at least 27.0 kg/m. By histological subtype, BMI was associated with type 1, but not type 2 endometrial cancer risk among a population with a relatively low BMI compared with western populations.

Fall risk in Chinese community-dwelling older adults: A physiological profile assessment study.

PubMed

Siong, Kar-Ho; Kwan, Marcella Mun-San; Lord, Stephen R; Lam, Andrew Kwok-Cheung; Tsang, William Wai-Nam; Cheong, Allen Ming-Yan

2016-02-01

The short-form Physiological Profile Assessment (PPA) is increasingly used in clinical practice for assessing fall risk in older people. However, a normative database is only available for Caucasian populations. The purpose of the present study was to develop a normative database for Hong Kong Chinese older people and examine the fall risk profile of this population. A total of 622 participants aged 60-95 years were recruited. Participants underwent the PPA (containing tests of contrast sensitivity, proprioception, quadriceps strength, reaction time and sway), and composite fall risk scores were computed. Participants were then followed up for falls for 1 year. Quadriceps strength and lower limb proprioception scores were comparable with those reported for Caucasian populations. However, contrast sensitivity, simple reaction time and postural sway scores were relatively poor. The average composite fall risk score was 1.7 ± 1.5, showing a "moderate" fall risk when compared with the Caucasian norms. Despite the relatively poor physical performances and moderately high fall risk scores, the incidence of one plus falls in the 1-year follow-up period was just 16.4%, with just 2.6% reporting two plus falls. The area under the curve for composite fall risk scores in discriminating fallers from non-fallers was 0.53 (95% CI 0.45-0.60). Despite poorer performance in PPA tests, the incidence of prospective falls in a Hong Kong Chinese population was low. In consequence, the PPA could not discriminate well between fallers and non-fallers. The present study provided normality data for short-form PPA measures for older Chinese people as a reference for further studies. © 2015 Japan Geriatrics Society.

Comparative measurement and quantitative risk assessment of alcohol consumption through wastewater-based epidemiology: An international study in 20 cities.

PubMed

Ryu, Yeonsuk; Barceló, Damià; Barron, Leon P; Bijlsma, Lubertus; Castiglioni, Sara; de Voogt, Pim; Emke, Erik; Hernández, Félix; Lai, Foon Yin; Lopes, Alvaro; de Alda, Miren López; Mastroianni, Nicola; Munro, Kelly; O'Brien, Jake; Ort, Christoph; Plósz, Benedek G; Reid, Malcolm J; Yargeau, Viviane; Thomas, Kevin V

2016-09-15

Quantitative measurement of drug consumption biomarkers in wastewater can provide objective information on community drug use patterns and trends. This study presents the measurement of alcohol consumption in 20 cities across 11 countries through the use of wastewater-based epidemiology (WBE), and reports the application of these data for the risk assessment of alcohol on a population scale using the margin of exposure (MOE) approach. Raw 24-h composite wastewater samples were collected over a one-week period from 20 cities following a common protocol. For each sample a specific and stable alcohol consumption biomarker, ethyl sulfate (EtS) was determined by liquid chromatography coupled to tandem mass spectrometry. The EtS concentrations were used for estimation of per capita alcohol consumption in each city, which was further compared with international reports and applied for risk assessment by MOE. The average per capita consumption in 20 cities ranged between 6.4 and 44.3L/day/1000 inhabitants. An increase in alcohol consumption during the weekend occurred in all cities, however the level of this increase was found to differ. In contrast to conventional data (sales statistics and interviews), WBE revealed geographical differences in the level and pattern of actual alcohol consumption at an inter-city level. All the sampled cities were in the "high risk" category (MOE<10) and the average MOE for the whole population studied was 2.5. These results allowed direct comparisons of alcohol consumption levels, patterns and risks among the cities. This study shows that WBE can provide timely and complementary information on alcohol use and alcohol associated risks in terms of exposure at the community level. Copyright © 2016 Elsevier B.V. All rights reserved.

Emergence of social cooperation in threshold public goods games with collective risk

NASA Astrophysics Data System (ADS)

Wang, Jing; Fu, Feng; Wu, Te; Wang, Long

2009-07-01

In real situations, people are often faced with the option of voluntary contribution to achieve a collective goal, for example, building a dam or a fence, in order to avoid an unfavorable loss. Those who do not donate, however, can free ride on others’ sacrifices. As a result, cooperation is difficult to maintain, leading to an enduring collective-risk social dilemma. To address this issue, here we propose a simple yet effective theoretical model of threshold public goods game with collective risk and focus on the effect of risk on the emergence of social cooperation. To do this, we consider the population dynamics represented by replicator equation for two simplifying scenarios, respectively: one with fair sharers, who contribute the minimum average amount versus defectors and the other with altruists contributing more than average versus defectors. For both cases, we find that the dilemma is relieved in high-risk situations where cooperation is likely to persist and dominate defection in the population. Large initial endowment to individuals also encourages the risk-averse action, which means that, as compared to poor players (with small initial endowment), wealthy individuals (with large initial endowment) are more likely to cooperate in order to protect their private accounts. In addition, we show that small donation amount and small threshold (collective target) can encourage and sustain cooperation. Furthermore, for other parameters fixed, the impacts of group size act differently on the two scenarios because of distinct mechanisms: in the former case where the cost of cooperation depends on the group size, large size of group readily results in defection, while easily maintains cooperation in the latter case where the cost of cooperation is fixed irrespective of the group size. Our theoretical results of the replicator dynamics are in excellent agreement with the individual based simulation results.

Coffee consumption and the incidence of type 2 diabetes in men and women with normal glucose tolerance: The Strong Heart Study

PubMed Central

Zhang, Ying; Lee, Elisa T.; Cowan, Linda D.; Fabsitz, Richard R.; Howard, Barbara V.

2009-01-01

Background and aims It was reported that high coffee consumption was related to decreased diabetes risk. The aim of this study is to examine the association between coffee consumption and the incidence of type 2 diabetes in persons with normal glucose tolerance in a population with a high incidence and prevalence of diabetes. Methods and results In a prospective cohort study, information about daily coffee consumption was collected at the baseline examination (1989-1992) in a population-based sample of American Indian men and women 45-74 years of age. Participants with normal glucose tolerance (N=1141) at the baseline examination were followed for an average of 7.6 years. The incidence of diabetes was compared across the categories of daily coffee consumption. The hazard ratios of diabetes related to coffee consumption were calculated using Cox proportional hazards models, adjusted for potential confounders. Levels of coffee consumption were positively related to levels of current smoking and inversely related to body mass index, waist circumference, female gender, and hypertension. Compared to those who did not drink coffee, participants who drank 12 or more cups of coffee daily had 67% less risk of developing diabetes during the follow-up (hazard ratio: 0.33, 95% confidence interval: 0.13, 0.81). Conclusion In this population, a high level of coffee consumption was associated with a reduced risk of deterioration of glucose metabolism over an average 7.6 years of follow-up. More work is needed to understand whether there is a plausible biological mechanism for this observation. PMID:20171062

Bayesian spatial modelling and the significance of agricultural land use to scrub typhus infection in Taiwan.

PubMed

Wardrop, Nicola A; Kuo, Chi-Chien; Wang, Hsi-Chieh; Clements, Archie C A; Lee, Pei-Fen; Atkinson, Peter M

2013-11-01

Scrub typhus is transmitted by the larval stage of trombiculid mites. Environmental factors, including land cover and land use, are known to influence breeding and survival of trombiculid mites and, thus, also the spatial heterogeneity of scrub typhus risk. Here, a spatially autoregressive modelling framework was applied to scrub typhus incidence data from Taiwan, covering the period 2003 to 2011, to provide increased understanding of the spatial pattern of scrub typhus risk and the environmental and socioeconomic factors contributing to this pattern. A clear spatial pattern in scrub typhus incidence was observed within Taiwan, and incidence was found to be significantly correlated with several land cover classes, temperature, elevation, normalized difference vegetation index, rainfall, population density, average income and the proportion of the population that work in agriculture. The final multivariate regression model included statistically significant correlations between scrub typhus incidence and average income (negatively correlated), the proportion of land that contained mosaics of cropland and vegetation (positively correlated) and elevation (positively correlated). These results highlight the importance of land cover on scrub typhus incidence: mosaics of cropland and vegetation represent a transitional land cover type which can provide favourable habitats for rodents and, therefore, trombiculid mites. In Taiwan, these transitional land cover areas tend to occur in less populated and mountainous areas, following the frontier establishment and subsequent partial abandonment of agricultural cultivation, due to demographic and socioeconomic changes. Future land use policy decision-making should ensure that potential public health outcomes, such as modified risk of scrub typhus, are considered.

Colorectal Cancer Screening in Average Risk Populations: Evidence Summary.

PubMed

Tinmouth, Jill; Vella, Emily T; Baxter, Nancy N; Dubé, Catherine; Gould, Michael; Hey, Amanda; Ismaila, Nofisat; McCurdy, Bronwen R; Paszat, Lawrence

2016-01-01

Introduction. The objectives of this systematic review were to evaluate the evidence for different CRC screening tests and to determine the most appropriate ages of initiation and cessation for CRC screening and the most appropriate screening intervals for selected CRC screening tests in people at average risk for CRC. Methods. Electronic databases were searched for studies that addressed the research objectives. Meta-analyses were conducted with clinically homogenous trials. A working group reviewed the evidence to develop conclusions. Results. Thirty RCTs and 29 observational studies were included. Flexible sigmoidoscopy (FS) prevented CRC and led to the largest reduction in CRC mortality with a smaller but significant reduction in CRC mortality with the use of guaiac fecal occult blood tests (gFOBTs). There was insufficient or low quality evidence to support the use of other screening tests, including colonoscopy, as well as changing the ages of initiation and cessation for CRC screening with gFOBTs in Ontario. Either annual or biennial screening using gFOBT reduces CRC-related mortality. Conclusion. The evidentiary base supports the use of FS or FOBT (either annual or biennial) to screen patients at average risk for CRC. This work will guide the development of the provincial CRC screening program.

[Risk analysis of nitrate contamination in wells supplying drinking water in a rural area of Chile].

PubMed

Arumi, José Luis; Núñez, Jorge; Salgado, Luis; Claret, Marcelino

2006-12-01

To assess the risk associated with nitrate contamination of wells that supply drinking water in the rural, Parral region of central Chile. The nitrate concentration levels were determined using water samples from 94 wells. An analysis of the distribution of nitrate concentration levels was performed in order to assess possible geographic correlations. For the risk analysis, two exposure situations were identified among the population (for adults and for infants), and the health risks were mapped. Fourteen percent of the wells studied had nitrate concentration levels greater than what the Chilean health standards allow for drinking water. There was no geographic correlation for the nitrate concentration levels. The mean hazard quotient (HQ) for adults in the study area was 0.12, indicating an absence of risk for this population group. For infants, the HQ values had a maximum value of 3.1 in some locations, but the average was 0.69 (still below 1.0), indicating that the well water in the study area was generally not hazardous for infants. In the Parral region of Chile, nitrate contamination of wells is primarily linked to certain factors such as construction practices and the proximity of livestock. These factors affect the quality of drinking water in isolated cases. There was no risk found for the adult population, but there was for infants fed on formula mixed with water coming from the contaminated wells.

Risk factors of tuberculosis among health care workers in Sabah, Malaysia.

PubMed

Jelip, Jenarun; Mathew, George G; Yusin, Tanrang; Dony, Jiloris F; Singh, Nirmal; Ashaari, Musa; Lajanin, Noitie; Shanmuga Ratnam, C; Yusof Ibrahim, Mohd; Gopinath, Deyer

2004-01-01

Tuberculosis (TB) is one of the main public health problems in Sabah; 30% of the total number of TB cases reported in Malaysia every year occur in Sabah. The average incidence of TB among health care workers over the past 5 years is 280.4 per 100,000 population (1, Annual Report of Sabah State TB Control Programme, 1998). At present, there are no specific measures for the prevention of TB transmission in health care facilities. A case-control study was conducted among health care workers in Sabah in 2000-2001. Cases were health care workers with TB diagnosed between January 1990 and June 2000. Controls were health care workers without TB and working in the same facility as cases during the disease episode. The study attempted to identify risk factors for TB among the study population. Data were collected through structured interviews and review of patients' records. The notification rate of TB among health care workers was significantly higher than that to the general population (Z=4.893, p<0.01). The average notification rate of TB among health care workers over the last 5 years was two times higher than in the general population (280.4/100,000 compared to 153.9/100,000). Regression results showed that ethnicity, designation, family contact and TB related knowledge did not significantly contribute to the risk of contracting TB in this study. However, after controlling for the above factors, age, gender, history of TB contact outside the workplace (other than family contact), duration of service and failure to use respiratory protection when performing high-risk procedures, were the main risk factors of TB among health care workers. This study succeeded in identifying some of the risk factors of TB among health care workers. We managed to include the large ratio of controls to case (3:1) and those cases spanned over a period of 10 years. However, the findings from the study have to be applied with caution due to the limitations of this study, which include recall bias, dropouts, and small sample size. Based on the study findings, we recommend that health care workers in the first 10 years of service should take extra precautions, such as using respiratory protection when performing procedures that are considered to be of high risk with respect to TB infection. They should also undergo TB screening at least once every 2 years and, if symptomatic, offered prophylactic treatment. The Respiratory Protection Programme should be fully implemented to help reduce the risk of TB among health care workers in Sabah.

[Estimating the year of eradication of tuberculosis in Japan].

PubMed

Ohmori, M

1991-12-01

The time of eradication of tuberculosis has been discussed for several countries, and based on those results, a new strategic plan and goals have been elaborated. Considering such developments, and in order to make a new tuberculosis control strategy, it is important to determine the point at which eradication of tuberculosis would be achieved in Japan. Styblo proposed the two conventional definitions of eradication of tuberculosis, namely that the incidence of smear-positive tuberculosis has fallen below 1 per million population or that the prevalence of tuberculosis infection in the general population has fallen below 1% and continues to decrease. The bacteriological results of new cases have been reported since 1975 in Japan. However, those results are still of doubtful validity and reliability. Therefore, the author estimated the year of eradication of tuberculosis, according to the criterion that tuberculosis is eradicated when the proportion of the population infected with tubercle bacilli is less than 1%. If the risk of infection is changing at a regular rate, it is possible to estimate the risk of infection at any time in the past and in the future. Once the risk of infection is determined, it is also possible to calculate the age-specific prevalence of infection and the proportion of the population infected with tubercle bacilli at various times in the past and in the future. In Japan, the risk of infection before World War II was assumed to be around 4% and not to vary with calendar year. And based on the data from the prevalence surveys in Okinawa in 1968 and 1973, the risk of infection was estimated 0.3% in 1968 and has declined on average, by 10 to 11% annually. At that time, Okinawa was the only area free from BCG vaccination in Japan. The incidence rate in Japan also has declined, on average, by 10% annually. However, since late 1970s, the annual speed of decline of the incidence rate has been slowed down. Therefore, I assumed that the recent trend of the infection risk is the same as the trend of the recent incidence rate among the 0-29 year age-group. The size of the effect of age on the risk of infection has been discussed. The author also considered age-effects in the model. The weight applied to the risk of infection by age was determined by examining the age-specific positive rate in the 1930s before the era when BCG vaccination was widely used.(ABSTRACT TRUNCATED AT 400 WORDS)

Identifying hidden sexual bridging communities in Chicago.

PubMed

Youm, Yoosik; Mackesy-Amiti, Mary Ellen; Williams, Chyvette T; Ouellet, Lawrence J

2009-07-01

Bridge populations can play a central role in the spread of human immunodeficiency virus (HIV) by providing transmission links between higher and lower prevalence populations. While social network methods are well suited to the study of bridge populations, analyses tend to focus on dyads (i.e., risk between drug and/or sex partners) and ignore bridges between distinct subpopulations. This study takes initial steps toward moving the analysis of sexual network linkages beyond individual and risk group levels to a community level in which Chicago's 77 community areas are examined as subpopulations for the purpose of identifying potential bridging communities. Of particular interest are "hidden" bridging communities; that is, areas with above-average levels of sexual ties with other areas but whose below-average AIDS prevalence may hide their potential importance for HIV prevention. Data for this analysis came from the first wave of recruiting at the Chicago Sexual Acquisition and Transmission of HIV Cooperative Agreement Program site. Between August 2005 through October 2006, respondent-driven sampling was used to recruit users of heroin, cocaine, or methamphetamine, men who have sex with men regardless of drug use, the sex partners of these two groups, and sex partners of the sex partners. In this cross-sectional study of the sexual transmission of HIV, participants completed a network-focused computer-assisted self-administered interview, which included questions about the geographic locations of sexual contacts with up to six recent partners. Bridging scores for each area were determined using a matrix representing Chicago's 77 community areas and were assessed using two measures: non-redundant ties and flow betweenness. Bridging measures and acquired immunodeficiency syndrome (AIDS) case prevalence rates were plotted for each community area on charts representing four conditions: below-average bridging and AIDS prevalence, below-average bridging and above-average AIDS prevalence, above-average bridging and AIDS prevalence, and above-average bridging and below-average AIDS prevalence (hidden bridgers). The majority of the 1,068 study participants were male (63%), African American (74%), and very poor, and the median age was 44 years. Most (85%) were sexually active, and 725 provided useable geographic information regarding 1,420 sexual partnerships that involved 57 Chicago community areas. Eight community areas met or came close to meeting the definition of hidden bridgers. Six areas were near the city's periphery, and all eight areas likely had high inflows or outflows of low-income persons displaced by gentrification. The results suggest that further research on this method is warranted, and we propose a means for public health officials in other cities to duplicate the analysis.

Childhood predictors of lung function trajectories and future COPD risk: a prospective cohort study from the first to the sixth decade of life.

PubMed

Bui, Dinh S; Lodge, Caroline J; Burgess, John A; Lowe, Adrian J; Perret, Jennifer; Bui, Minh Q; Bowatte, Gayan; Gurrin, Lyle; Johns, David P; Thompson, Bruce R; Hamilton, Garun S; Frith, Peter A; James, Alan L; Thomas, Paul S; Jarvis, Deborah; Svanes, Cecilie; Russell, Melissa; Morrison, Stephen C; Feather, Iain; Allen, Katrina J; Wood-Baker, Richard; Hopper, John; Giles, Graham G; Abramson, Michael J; Walters, Eugene H; Matheson, Melanie C; Dharmage, Shyamali C

2018-04-05

Lifetime lung function is related to quality of life and longevity. Over the lifespan, individuals follow different lung function trajectories. Identification of these trajectories, their determinants, and outcomes is important, but no study has done this beyond the fourth decade. We used six waves of the Tasmanian Longitudinal Health Study (TAHS) to model lung function trajectories measured at 7, 13, 18, 45, 50, and 53 years. We analysed pre-bronchodilator FEV 1 z-scores at the six timepoints using group-based trajectory modelling to identify distinct subgroups of individuals whose measurements followed a similar pattern over time. We related the trajectories identified to childhood factors and risk of chronic obstructive pulmonary disease (COPD) using logistic regression, and estimated population-attributable fractions of COPD. Of the 8583 participants in the original cohort, 2438 had at least two waves of lung function data at age 7 years and 53 years and comprised the study population. We identified six trajectories: early below average, accelerated decline (97 [4%] participants); persistently low (136 [6%] participants); early low, accelerated growth, normal decline (196 [8%] participants); persistently high (293 [12%] participants); below average (772 [32%] participants); and average (944 [39%] participants). The three trajectories early below average, accelerated decline; persistently low; and below average had increased risk of COPD at age 53 years compared with the average group (early below average, accelerated decline: odds ratio 35·0, 95% CI 19·5-64·0; persistently low: 9·5, 4·5-20·6; and below average: 3·7, 1·9-6·9). Early-life predictors of the three trajectories included childhood asthma, bronchitis, pneumonia, allergic rhinitis, eczema, parental asthma, and maternal smoking. Personal smoking and active adult asthma increased the impact of maternal smoking and childhood asthma, respectively, on the early below average, accelerated decline trajectory. We identified six potential FEV 1 trajectories, two of which were novel. Three trajectories contributed 75% of COPD burden and were associated with modifiable early-life exposures whose impact was aggravated by adult factors. We postulate that reducing maternal smoking, encouraging immunisation, and avoiding personal smoking, especially in those with smoking parents or low childhood lung function, might minimise COPD risk. Clinicians and patients with asthma should be made aware of the potential long-term implications of non-optimal asthma control for lung function trajectory throughout life, and the role and benefit of optimal asthma control on improving lung function should be investigated in future intervention trials. National Health and Medical Research Council of Australia; European Union's Horizon 2020; The University of Melbourne; Clifford Craig Medical Research Trust of Tasmania; The Victorian, Queensland & Tasmanian Asthma Foundations; The Royal Hobart Hospital; Helen MacPherson Smith Trust; and GlaxoSmithKline. Copyright © 2018 Elsevier Ltd. All rights reserved.

[Risk factors for absenteeism due to sick leave in the petroleum industry].

PubMed

Oenning, Nágila Soares Xavier; Carvalho, Fernando Martins; Lima, Veronica Maria Cadena

2014-02-01

To identify risk factors for absenteeism among workers with sick leave in an oil company. A case-control study (120 cases and 656 controls) nested in a retrospective cohort study following up all employees of an oil company in the North-Northeast of Brazil from 2007 to 2009. The response variable used to represent absenteeism with sick leave was the average incidence of sick leave, defined as the ratio between total sick days and potential working days in the period. Logistic regression techniques were used to investigate the association between average incidence of sick leave > 5.0% over the period and the variables sex, position, age, time at work, shift work, smoking, arterial hypertension, body mass index, physical activity, coronary risk, sleep, glycemia, non-managed diabetes, cardiovascular, digestive, musculoskeletal, neurological and neoplastic diseases, straining body positioning during work, satisfaction at work, relationship with management, and concentrated attention at work. Average incidence of sick leave higher than 5.0% in the cohort period was 15.5%. The logistic model revealed that workers with average incidence of sick leave higher than 5.0% were 2.6 times more likely to be female; 2.0 time more likely to be smokers; 1.8 time more likely to be former smokers; 2.2 times more likely to report abnormal sleep and 10.5 times more likely to report dissatisfaction with their than workers with average incidence of sick leave ≤ 5.0% in the period. In this population, female gender, being a smoker or a former smoker, reporting dissatisfaction with the job and reporting abnormal sleep are good predictors of occupational absenteeism with sick leave. To identify risk factors for absenteeism among workers with sick leave in an oil company. A case-control study (120 cases and 656 controls) nested in a retrospective cohort study following up all employees of an oil company in the North-Northeast of Brazil from 2007 to 2009. The response variable used to represent absenteeism with sick leave was the average incidence of sick leave, defined as the ratio between total sick days and potential working days in the period. Logistic regression techniques were used to investigate the association between average incidence of sick leave > 5.0% over the period and the variables sex, position, age, time at work, shift work, smoking, arterial hypertension, body mass index, physical activity, coronary risk, sleep, glycemia, non-managed diabetes, cardiovascular, digestive, musculoskeletal, neurological and neoplastic diseases, straining body positioning during work, satisfaction at work, relationship with management, and concentrated attention at work. Average incidence of sick leave higher than 5.0% in the cohort period was 15.5%. The logistic model revealed that workers with average incidence of sick leave higher than 5.0% were 2.6 times more likely to be female; 2.0 time more likely to be smokers; 1.8 time more likely to be former smokers; 2.2 times more likely to report abnormal sleep and 10.5 times more likely to report dissatisfaction with their than workers with average incidence of sick leave ≤ 5.0% in the period. In this population, female gender, being a smoker or a former smoker, reporting dissatisfaction with the job and reporting abnormal sleep are good predictors of occupational absenteeism with sick leave.

ESTIMATING RISK TO CALIFORNIA ENERGY INFRASTRUCTURE FROM PROJECTED CLIMATE CHANGE

DOE Office of Scientific and Technical Information (OSTI.GOV)

Sathaye, Jayant; Dale, Larry; Larsen, Peter

2011-06-22

This report outlines the results of a study of the impact of climate change on the energy infrastructure of California and the San Francisco Bay region, including impacts on power plant generation; transmission line and substation capacity during heat spells; wildfires near transmission lines; sea level encroachment upon power plants, substations, and natural gas facilities; and peak electrical demand. Some end-of-century impacts were projected:Expected warming will decrease gas-fired generator efficiency. The maximum statewide coincident loss is projected at 10.3 gigawatts (with current power plant infrastructure and population), an increase of 6.2 percent over current temperature-induced losses. By the end ofmore » the century, electricity demand for almost all summer days is expected to exceed the current ninetieth percentile per-capita peak load. As much as 21 percent growth is expected in ninetieth percentile peak demand (per-capita, exclusive of population growth). When generator losses are included in the demand, the ninetieth percentile peaks may increase up to 25 percent. As the climate warms, California's peak supply capacity will need to grow faster than the population.Substation capacity is projected to decrease an average of 2.7 percent. A 5C (9F) air temperature increase (the average increase predicted for hot days in August) will diminish the capacity of a fully-loaded transmission line by an average of 7.5 percent.The potential exposure of transmission lines to wildfire is expected to increase with time. We have identified some lines whose probability of exposure to fire are expected to increase by as much as 40 percent. Up to 25 coastal power plants and 86 substations are at risk of flooding (or partial flooding) due to sea level rise.« less

Admission EEG findings in diverse paediatric cerebral malaria populations predict outcomes.

PubMed

Postels, Douglas G; Wu, Xiaoting; Li, Chenxi; Kaplan, Peter W; Seydel, Karl B; Taylor, Terrie E; Kousa, Youssef A; Idro, Richard; Opoka, Robert; John, Chandy C; Birbeck, Gretchen L

2018-05-22

Electroencephalography at hospital presentation may offer important insights regarding prognosis that can inform understanding of cerebral malaria (CM) pathophysiology and potentially guide patient selection and risk stratification for future clinical trials. Electroencephalogram (EEG) findings in children with CM in Uganda and Malawi were compared and associations between admission EEG findings and outcome across this diverse population were assessed. Demographic, clinical and admission EEG data from Ugandan and Malawian children admitted from 2009 to 2012 with CM were gathered, and survivors assessed for neurological abnormalities at discharge. 281 children were enrolled (Uganda n = 122, Malawi n = 159). The Malawian population was comprised only of retinopathy positive children (versus 72.5% retinopathy positive in Uganda) and were older (4.2 versus 3.7 years; p = 0.046), had a higher HIV prevalence (9.0 versus 2.8%; p = 0.042), and worse hyperlactataemia (7.4 versus 5.2 mmol/L; p < 0.001) on admission compared to the Ugandan children. EEG findings differed between the two groups in terms of average voltage and frequencies, reactivity, asymmetry, and the presence/absence of sleep architecture. In univariate analyses pooling EEG and outcomes data for both sites, higher average and maximum voltages, faster dominant frequencies, and retained reactivity were associated with survival (all p < 0.05). Focal slowing was associated with death (OR 2.93; 95% CI 1.77-7.30) and a lower average voltage was associated with neurological morbidity in survivors (p = 0.0032). Despite substantial demographic and clinical heterogeneity between subjects in Malawi and Uganda as well as different EEG readers at each site, EEG findings on admission predicted mortality and morbidity. For CM clinical trials aimed at decreasing mortality or morbidity, EEG may be valuable for risk stratification and/or subject selection.

PACE and the Medicare+Choice risk-adjusted payment model.

PubMed

Temkin-Greener, H; Meiners, M R; Gruenberg, L

2001-01-01

This paper investigates the impact of the Medicare principal inpatient diagnostic cost group (PIP-DCG) payment model on the Program of All-Inclusive Care for the Elderly (PACE). Currently, more than 6,000 Medicare beneficiaries who are nursing home certifiable receive care from PACE, a program poised for expansion under the Balanced Budget Act of 1997. Overall, our analysis suggests that the application of the PIP-DCG model to the PACE program would reduce Medicare payments to PACE, on average, by 38%. The PIP-DCG payment model bases its risk adjustment on inpatient diagnoses and does not capture adequately the risk of caring for a population with functional impairments.

Heavy metals in food, house dust, and water from an e-waste recycling area in South China and the potential risk to human health.

PubMed

Zheng, Jing; Chen, Ke-hui; Yan, Xiao; Chen, She-Jun; Hu, Guo-Cheng; Peng, Xiao-Wu; Yuan, Jian-gang; Mai, Bi-Xian; Yang, Zhong-Yi

2013-10-01

Concentrations of heavy metals (Cd, Pb, Cu, Zn, and Ni) were measured in the foodstuffs, house dust, underground/drinking water, and soil from an electronic waste (e-waste) area in South China. Elevated concentrations of these potentially toxic metals were observed in the samples but not in drinking water. The health risks for metal exposure via food consumption, dust ingestion, and drinking water were evaluated for local residents. For the average residents in the e-waste area, the non-carcinogenic risks arise predominantly from rice (hazard index=3.3), vegetables (2.2), and house dust (1.9) for adults, while the risks for young children are dominated by house dust (15). Drinking water may provide a negligible contribution to risk. However, local residents who use groundwater as a water supply source are at high non-carcinogenic risk. The potential cancer risks from oral intake of Pb are 8×10(-5) and 3×10(-4) for average adults and children, and thus groundwater would have a great potential to induce cancer (5×10(-4) and 1×10(-3)) in a highly exposed population. The results also reveal that the risk from oral exposure is much higher than the risk from inhalation and dermal contact with house dust. Copyright © 2013 Elsevier Inc. All rights reserved.

Influence of terrestrial radionuclides on environmental gamma exposure in a uranium deposit in Paraíba, Brazil.

PubMed

Araújo Dos Santos Júnior, José; Dos Santos Amaral, Romilton; Simões Cezar Menezes, Rômulo; Reinaldo Estevez Álvarez, Juan; Marques do Nascimento Santos, Josineide; Herrero Fernández, Zahily; Dias Bezerra, Jairo; Antônio da Silva, Alberto; Francys Rodrigues Damascena, Kennedy; de Almeida Maciel Neto, José

2017-07-01

One of the main natural uranium deposits in Brazil is located in the municipality of Espinharas, in the State of Paraíba. This area may present high levels of natural radioactivity due to the presence of these radionuclides. Since this is a populated area, there is need for a radioecological dosimetry assessment to investigate the possible risks to the population. Based on this problem, the objective of this study was to estimate the environmental effective dose outdoors in inhabited areas influenced by the uranium deposit, using the specific activities of equivalent uranium, equivalent thorium and 40 K and conversion factors. The environmental assessment was carried using gamma spectroscopy in sixty-two points within the municipality, with a high-resolution gamma spectrometer with HPGe semiconductor detector and Be window. The results obtained ranged from 0.01 to 19.11 mSv y -1 , with an average of 2.64 mSv y -1 . These levels are, on average, 23 times higher than UNSCEAR reference levels and up to 273 times the reference value of the earth's crust for primordial radionuclides. Therefore, given the high radioactivity levels found, we conclude that there is need for further investigation to evaluate the levels of radioactivity in indoor environments, which will reflect more closely the risks of the local population. Copyright © 2017 Elsevier Inc. All rights reserved.

Recovery and Growth Potential of Listeria monocytogenes in Temperature Abused Milkshakes Prepared from Naturally Contaminated Ice Cream Linked to a Listeriosis Outbreak.

PubMed

Chen, Yi; Allard, Emma; Wooten, Anna; Hur, Minji; Sheth, Ishani; Laasri, Anna; Hammack, Thomas S; Macarisin, Dumitru

2016-01-01

The recovery and growth potential of Listeria monocytogenes was evaluated in three flavors of milkshakes (vanilla, strawberry, and chocolate) that were prepared from naturally contaminated ice cream linked to a listeriosis outbreak in the U.S. in 2015, and were subsequently held at room temperature for 14 h. The average lag phase duration of L. monocytogenes was 9.05 h; the average generation time was 1.67 h; and the average population level increase per sample at 14 h was 1.14 log CFU/g. Milkshake flavors did not significantly affect these parameters. The average lag phase duration of L. monocytogenes in milkshakes with initial contamination levels ≤ 3 CFU/g (9.50 h) was significantly longer (P < 0.01) than that with initial contamination levels > 3 CFU/g (8.60 h). The results highlight the value of using samples that are contaminated with very low levels of L. monocytogenes for recovery and growth evaluations. The behavior of L. monocytogenes populations in milkshakes prepared from naturally contaminated ice cream linked to the listeriosis outbreak should be taken into account when performing risk based analysis using this outbreak as a case study.

Recovery and Growth Potential of Listeria monocytogenes in Temperature Abused Milkshakes Prepared from Naturally Contaminated Ice Cream Linked to a Listeriosis Outbreak

PubMed Central

Chen, Yi; Allard, Emma; Wooten, Anna; Hur, Minji; Sheth, Ishani; Laasri, Anna; Hammack, Thomas S.; Macarisin, Dumitru

2016-01-01

The recovery and growth potential of Listeria monocytogenes was evaluated in three flavors of milkshakes (vanilla, strawberry, and chocolate) that were prepared from naturally contaminated ice cream linked to a listeriosis outbreak in the U.S. in 2015, and were subsequently held at room temperature for 14 h. The average lag phase duration of L. monocytogenes was 9.05 h; the average generation time was 1.67 h; and the average population level increase per sample at 14 h was 1.14 log CFU/g. Milkshake flavors did not significantly affect these parameters. The average lag phase duration of L. monocytogenes in milkshakes with initial contamination levels ≤ 3 CFU/g (9.50 h) was significantly longer (P < 0.01) than that with initial contamination levels > 3 CFU/g (8.60 h). The results highlight the value of using samples that are contaminated with very low levels of L. monocytogenes for recovery and growth evaluations. The behavior of L. monocytogenes populations in milkshakes prepared from naturally contaminated ice cream linked to the listeriosis outbreak should be taken into account when performing risk based analysis using this outbreak as a case study. PMID:27242775

Population distribution of traditional and the emerging cardiovascular risk factors carotid plaque and IMT: the REFINE-Reykjavik study with comparison with the Tromsø study

PubMed Central

Thorsson, Bolli; Eiriksdottir, Gudny; Sigurdsson, Sigurdur; Gudmundsson, Elias Freyr; Bots, Michael L; Aspelund, Thor; Arntzen, Kjell Arne; Mathiesen, Ellisiv B; Gudnason, Vilmundur

2018-01-01

Objectives Population statistics for carotid plaque and cardiovascular risk factors reported in scientific journals are usually presented as averages for the population or age and sex adjusted, rather than sex and age groups. Important population differences about atherosclerosis and cardiovascular risk factors may thus be missed. We compare the distribution of cardiovascular risk factors, carotids plaque and carotid intima-media thickness (CIMT) in two population-based studies. Methods Carotid artery atherosclerotic plaque prevalence and risk factors levels for cardiovascular disease by sex in 5-year age groups from the Risk Evaluation For Infarct Estimates Reykjavik study (REFINE-Reykjavik study) were compared with data from the Tromsø 6 study. Results The threshold of carotid plaque presence in the Tromsø 6 study fell between minimal and moderate plaque defined in the REFINE-Reykjavik study reflecting carotid plaque prevalence. The prevalence of minimal carotid plaque in the REFINE-Reykjavik study was 47% in men (40–69 years old) and 38% in women and 11% in men and 7% in women of moderate plaque. The prevalence of any plaque in the Tromsø 6 study was 35% in men and 27% in women. The mean (CIMT) was similar in the studies. In the Tromsø 6 study mean systolic blood pressure was 8 mm Hg higher in men and 10 mm Hg higher in women, mean low-density lipoprotein was 0.5 mmol/L higher in men and 0.3 mmol/L higher in women and the prevalence of smoking was 4% higher in men and 9% higher in women. However, body mass index was 0.8 kg/m2 higher in men and 0.9 kg/m2 in women in the REFINE-Reykjavik study. Conclusion Comparison between Iceland and Norway revealed differences in the prevalence of carotid plaque, which was assumed to be due to different definition of plaque. However, clinically significant differences in conventional cardiovascular risk factors were seen. This underscores the importance of detailed comparison of population data across different populations. PMID:29858406

Additive Prognostic Value of Left Ventricular Systolic Dysfunction in a Population-Based Cohort.

PubMed

Kuznetsova, Tatiana; Cauwenberghs, Nicholas; Knez, Judita; Yang, Wen-Yi; Herbots, Lieven; D'hooge, Jan; Haddad, Francois; Thijs, Lutgarde; Voigt, Jens-Uwe; Staessen, Jan A

2016-07-01

Techniques of 2-dimensional speckle tracking enable the measurement of myocardial deformation (strain) during systole. Recent clinical studies explored the prognostic role of left ventricular global longitudinal strain (GLS). However, there are few data on the association between cardiovascular outcome and GLS in the community. Therefore, we hypothesized that GLS contains additive prognostic information over and beyond traditional cardiovascular risk factors in a large, population-based cohort. We measured GLS by 2-dimensional speckle tracking in the apical 4-chamber view in 791 participants (mean age 50.9 years). We calculated multivariable adjusted hazard ratios for midwall, endocardial, and epicardial GLS, while accounting for family cluster and cardiovascular risk factors. Median follow-up was 7.9 years (5th to 95th percentile, 3.7-9.6). In continuous analysis, with adjustments applied for covariables, midwall, endocardial, and epicardial GLS were significant predictors of fatal and nonfatal cardiovascular (n=96; P<0.0001) and cardiac events (n=68; P≤0.001). In the sex-specific low quartile of midwall GLS (<18.8% in women and <17.4% in men), the risk was significantly higher than the average population risk for cardiovascular (128%, P<0.0001) and cardiac (94%, P=0.0007) events. We also noticed that the risk for cardiovascular events increased with increasing number of left ventricular abnormalities, such as low GLS, diastolic dysfunction, and hypertrophy (log-rank P<0.0001). Low GLS measured by 2-dimensional speckle tracking predicts future cardiovascular events independent of conventional risk factors. Left ventricular midwall strain represents a simple echocardiographic measure, which might be used for assessing cardiovascular risk in a population-based cohort. © 2016 American Heart Association, Inc.

Effect of increased concentrations of atmospheric carbon dioxide on the global threat of zinc deficiency: a modelling study.

PubMed

Myers, Samuel S; Wessells, K Ryan; Kloog, Itai; Zanobetti, Antonella; Schwartz, Joel

2015-10-01

Increasing concentrations of atmospheric carbon dioxide (CO2) lower the content of zinc and other nutrients in important food crops. Zinc deficiency is currently responsible for large burdens of disease globally, and the populations who are at highest risk of zinc deficiency also receive most of their dietary zinc from crops. By modelling dietary intake of bioavailable zinc for the populations of 188 countries under both an ambient CO2 and elevated CO2 scenario, we sought to estimate the effect of anthropogenic CO2 emissions on the global risk of zinc deficiency. We estimated per capita per day bioavailable intake of zinc for the populations of 188 countries at ambient CO2 concentrations (375-384 ppm) using food balance sheet data for 2003-07 from the Food and Agriculture Organization. We then used previously published data from free air CO2 enrichment and open-top chamber experiments to model zinc intake at elevated CO2 concentrations (550 ppm, which is the concentration expected by 2050). Estimates developed by the International Zinc Nutrition Consultative Group were used for country-specific theoretical mean daily per-capita physiological requirements for zinc. Finally, we used these data on zinc bioavailability and population-weighted estimated average zinc requirements to estimate the risk of inadequate zinc intake among the populations of the different nations under the two scenarios (ambient and elevated CO2). The difference between the population at risk at elevated and ambient CO2 concentrations (ie, population at new risk of zinc deficiency) was our measure of impact. The total number of people estimated to be placed at new risk of zinc deficiency by 2050 was 138 million (95% CI 120-156). The people likely to be most affected live in Africa and South Asia, with nearly 48 million (32-63) residing in India alone. Global maps of increased risk show significant heterogeneity. Our results indicate that one heretofore unquantified human health effect associated with anthropogenic CO2 emissions will be a significant increase in the human population at risk of zinc deficiency. Our country-specific findings can be used to help guide interventions aimed at reducing this vulnerability. Bill & Melinda Gates Foundation, Winslow Foundation. Copyright © 2015 Myers et al. Open access article published under the terms of CC BY-NC-ND. Published by Elsevier Ltd.. All rights reserved.

Risk factors for tuberculosis in Greenland: case-control study.

PubMed

Ladefoged, K; Rendal, T; Skifte, T; Andersson, M; Søborg, B; Koch, A

2011-01-01

Despite several efforts aiming at disease control, the incidence of tuberculosis (TB) remains high in Greenland, averaging 131 per 100,000 population during the period 1998-2007. The purpose of the present study was to disclose risk factors for TB. A case-control study was performed among 146 patients diagnosed with TB in the period 2004-2006. For each patient, four healthy age- and sex-matched control persons living in the same district were included. All participants completed a questionnaire regarding socio-demographic and lifestyle factors. Risk factor analyses were carried out using logistic regression models. Factors associated with TB were Inuit ethnicity, living in a small settlement, unemployment, no access to tap water, no bathroom or flushing toilet, underweight, smoking, frequent intake of alcohol and immunosuppressive treatment. The multivariate model showed that Inuit ethnicity (OR 15.3), living in a settlement (OR 5.1), being unemployed (OR 4.1) and frequent alcohol use (OR 3.1) were independent determinants of risk. Unemployment was associated with the highest population-attributable risk (29%). Risk factors associated with living in a settlement should be further explored and an investigation of genetic susceptibility is warranted.

Barriers to colorectal cancer screening: inadequate knowledge by physicians.

PubMed

Gennarelli, Melissa; Jandorf, Lina; Cromwell, Caroline; Valdimarsdottir, Heiddis; Redd, William; Itzkowitz, Steven

2005-01-01

The rate of colorectal cancer (CRC) screening remains relatively low. One potential barrier to higher rates is the lack of physician knowledge regarding CRC screening. The purpose of this study was to assess physicians' knowledge of (a) American Cancer Society (ACS) CRC screening guidelines for average-risk and high-risk patients, and (b) general colorectal cancer facts which support these guidelines. We administered a questionnaire to internal medicine residents, internal medicine attendings and medical students who provide care to patients in a low-income, predominantly minority community, to compare their levels of knowledge regarding CRC screening. Mean knowledge scores were calculated based on the number of correct responses. Knowledge of ACS guidelines for average-risk patients was low, although it did increase directly with level of training: medical students obtained a mean score of 32%, residents 49%, and attendings 56% (p<0.001). Knowledge scores for high-risk patients were even lower, with fewer than half of the respondents offering correct answers. Mean knowledge scores of general CRC screening facts increased with level of training: medical students scored 31%, residents 38% and attendings 42% (p<0.001). Knowledge of CRC screening guidelines for both average- and high-risk patients was suboptimal among the medical students, residents and attendings studied. Lack of knowledge about CRC is one barrier to screening that may contribute to underutilization of screening for minority populations. Further educational efforts should be targeted to these health care professionals.

Instrumental Variable Analysis with a Nonlinear Exposure–Outcome Relationship

PubMed Central

Davies, Neil M.; Thompson, Simon G.

2014-01-01

Background: Instrumental variable methods can estimate the causal effect of an exposure on an outcome using observational data. Many instrumental variable methods assume that the exposure–outcome relation is linear, but in practice this assumption is often in doubt, or perhaps the shape of the relation is a target for investigation. We investigate this issue in the context of Mendelian randomization, the use of genetic variants as instrumental variables. Methods: Using simulations, we demonstrate the performance of a simple linear instrumental variable method when the true shape of the exposure–outcome relation is not linear. We also present a novel method for estimating the effect of the exposure on the outcome within strata of the exposure distribution. This enables the estimation of localized average causal effects within quantile groups of the exposure or as a continuous function of the exposure using a sliding window approach. Results: Our simulations suggest that linear instrumental variable estimates approximate a population-averaged causal effect. This is the average difference in the outcome if the exposure for every individual in the population is increased by a fixed amount. Estimates of localized average causal effects reveal the shape of the exposure–outcome relation for a variety of models. These methods are used to investigate the relations between body mass index and a range of cardiovascular risk factors. Conclusions: Nonlinear exposure–outcome relations should not be a barrier to instrumental variable analyses. When the exposure–outcome relation is not linear, either a population-averaged causal effect or the shape of the exposure–outcome relation can be estimated. PMID:25166881

Physician Knowledge and Awareness of CA-125 As a Screen for Ovarian Cancer in the Asymptomatic, Average-Risk Population

ERIC Educational Resources Information Center

Stewart, Sherri L.; Rim, Sun Hee; Gelb, Cynthia A.

2012-01-01

Effective early detection strategies for ovarian cancer do not exist. Current screening guidelines recommend against routine screening using CA-125 alone or in combination with transvaginal ultrasonography (TVS). In this study, the authors used the 2008 "DocStyles" survey to measure clinician beliefs about the effectiveness of CA-125 and…

Sperm competition games: the risk model can generate higher sperm allocation to virgin females.

PubMed

Ball, M A; Parker, G A

2007-03-01

We examine the risk model in sperm competition games for cases where female fertility increases significantly with sperm numbers (sperm limitation). Without sperm competition, sperm allocation increases with sperm limitation. We define 'average risk' as the probability q that females in the population mate twice, and 'perceived risk' as the information males gain about the sperm competition probability with individual females. If males obtain no information from individual females, sperm numbers increase with q unless sperm limitation is high and one of the two competing ejaculates is strongly disfavoured. If males can distinguish between virgin and mated females, greater sperm allocation to virgins is favoured by high sperm limitation, high q, and by the second male's ejaculate being disfavoured. With high sperm limitation, sperm allocation to virgins increases and to mated females decreases with q at high q levels. With perfect information about female mating pattern, sperm allocation (i) to virgins that will mate again exceeds that to mated females and to virgins that will mate only once, (ii) to virgins that mate only once exceeds that for mated females if q is high and there is high second male disadvantage and (iii) to each type of female can decrease with q if sperm limitation is high, although the average allocation increases at least across low q levels. In general, higher sperm allocation to virgins is favoured by: strong disadvantage to the second ejaculate, high sperm limitation, high average risk and increased information (perceived risk). These conditions may apply in a few species, especially spiders.

Stratifying empiric risk of schizophrenia among first degree relatives using multiple predictors in two independent Indian samples.

PubMed

Bhatia, Triptish; Gettig, Elizabeth A; Gottesman, Irving I; Berliner, Jonathan; Mishra, N N; Nimgaonkar, Vishwajit L; Deshpande, Smita N

2016-12-01

Schizophrenia (SZ) has an estimated heritability of 64-88%, with the higher values based on twin studies. Conventionally, family history of psychosis is the best individual-level predictor of risk, but reliable risk estimates are unavailable for Indian populations. Genetic, environmental, and epigenetic factors are equally important and should be considered when predicting risk in 'at risk' individuals. To estimate risk based on an Indian schizophrenia participant's family history combined with selected demographic factors. To incorporate variables in addition to family history, and to stratify risk, we constructed a regression equation that included demographic variables in addition to family history. The equation was tested in two independent Indian samples: (i) an initial sample of SZ participants (N=128) with one sibling or offspring; (ii) a second, independent sample consisting of multiply affected families (N=138 families, with two or more sibs/offspring affected with SZ). The overall estimated risk was 4.31±0.27 (mean±standard deviation). There were 19 (14.8%) individuals in the high risk group, 75 (58.6%) in the moderate risk and 34 (26.6%) in the above average risk (in Sample A). In the validation sample, risks were distributed as: high (45%), moderate (38%) and above average (17%). Consistent risk estimates were obtained from both samples using the regression equation. Familial risk can be combined with demographic factors to estimate risk for SZ in India. If replicated, the proposed stratification of risk may be easier and more realistic for family members. Copyright © 2016. Published by Elsevier B.V.

Aircraft noise and cardiovascular disease near Heathrow airport in London: small area study.

PubMed

Hansell, Anna L; Blangiardo, Marta; Fortunato, Lea; Floud, Sarah; de Hoogh, Kees; Fecht, Daniela; Ghosh, Rebecca E; Laszlo, Helga E; Pearson, Clare; Beale, Linda; Beevers, Sean; Gulliver, John; Best, Nicky; Richardson, Sylvia; Elliott, Paul

2013-10-08

To investigate the association of aircraft noise with risk of stroke, coronary heart disease, and cardiovascular disease in the general population. Small area study. 12 London boroughs and nine districts west of London exposed to aircraft noise related to Heathrow airport in London. About 3.6 million residents living near Heathrow airport. Risks for hospital admissions were assessed in 12 110 census output areas (average population about 300 inhabitants) and risks for mortality in 2378 super output areas (about 1500 inhabitants). Risk of hospital admissions for, and mortality from, stroke, coronary heart disease, and cardiovascular disease, 2001-05. Hospital admissions showed statistically significant linear trends (P<0.001 to P<0.05) of increasing risk with higher levels of both daytime (average A weighted equivalent noise 7 am to 11 pm, L(Aeq),16 h) and night time (11 pm to 7 am, Lnight) aircraft noise. When areas experiencing the highest levels of daytime aircraft noise were compared with those experiencing the lowest levels (>63 dB v ≤ 51 dB), the relative risk of hospital admissions for stroke was 1.24 (95% confidence interval 1.08 to 1.43), for coronary heart disease was 1.21 (1.12 to 1.31), and for cardiovascular disease was 1.14 (1.08 to 1.20) adjusted for age, sex, ethnicity, deprivation, and a smoking proxy (lung cancer mortality) using a Poisson regression model including a random effect term to account for residual heterogeneity. Corresponding relative risks for mortality were of similar magnitude, although with wider confidence limits. Admissions for coronary heart disease and cardiovascular disease were particularly affected by adjustment for South Asian ethnicity, which needs to be considered in interpretation. All results were robust to adjustment for particulate matter (PM10) air pollution, and road traffic noise, possible for London boroughs (population about 2.6 million). We could not distinguish between the effects of daytime or night time noise as these measures were highly correlated. High levels of aircraft noise were associated with increased risks of stroke, coronary heart disease, and cardiovascular disease for both hospital admissions and mortality in areas near Heathrow airport in London. As well as the possibility of causal associations, alternative explanations such as residual confounding and potential for ecological bias should be considered.

Major Cardiovascular Risk Factors in Latin America: A Comparison with the United States. The Latin American Consortium of Studies in Obesity (LASO)

PubMed Central

Chirinos, Julio A.; Gómez, Luis F.; Perel, Pablo; Pichardo, Rafael; González, Angel; Sánchez, José R.; Ferreccio, Catterina; Aguilera, Ximena; Silva, Eglé; Oróstegui, Myriam; Medina-Lezama, Josefina; Pérez, Cynthia M.; Suárez, Erick; Ortiz, Ana P.; Rosero, Luis; Schapochnik, Noberto; Ortiz, Zulma; Ferrante, Daniel; Casas, Juan P.

2013-01-01

Background Limited knowledge on the prevalence and distribution of risk factors impairs the planning and implementation of cardiovascular prevention programs in the Latin American and Caribbean (LAC) region. Methods and Findings Prevalence of hypertension, diabetes mellitus, abnormal lipoprotein levels, obesity, and smoking were estimated from individual-level patient data pooled from population-based surveys (1998–2007, n = 31,009) from eight LAC countries and from a national survey of the United States (US) population (1999–2004) Age and gender specific prevalence were estimated and age-gender adjusted comparisons between both populations were conducted. Prevalence of diabetes mellitus, hypertension, and low high-density lipoprotein (HDL)-cholesterol in LAC were 5% (95% confidence interval [95% CI]: 3.4, 7.9), 20.2% (95% CI: 12.5, 31), and 53.3% (95% CI: 47, 63.4), respectively. Compared to LAC region’s average, the prevalence of each risk factor tended to be lower in Peru and higher in Chile. LAC women had higher prevalence of obesity and low HDL-cholesterol than men. Obesity, hypercholesterolemia, and hypertriglyceridemia were more prevalent in the US population than in LAC population (31 vs. 16.1%, 16.8 vs. 8.9%, and 36.2 vs. 26.5%, respectively). However, the prevalence of low HDL-cholesterol was higher in LAC than in the US (53.3 vs. 33.7%). Conclusions Major cardiovascular risk factors are highly prevalent in LAC region, in particular low HDL-cholesterol. In addition, marked differences do exist in this prevalence profile between LAC and the US. The observed patterns of obesity-related risk factors and their current and future impact on the burden of cardiovascular diseases remain to be explained. PMID:23349785

Major cardiovascular risk factors in Latin America: a comparison with the United States. The Latin American Consortium of Studies in Obesity (LASO).

PubMed

Miranda, J Jaime; Herrera, Victor M; Chirinos, Julio A; Gómez, Luis F; Perel, Pablo; Pichardo, Rafael; González, Angel; Sánchez, José R; Ferreccio, Catterina; Aguilera, Ximena; Silva, Eglé; Oróstegui, Myriam; Medina-Lezama, Josefina; Pérez, Cynthia M; Suárez, Erick; Ortiz, Ana P; Rosero, Luis; Schapochnik, Noberto; Ortiz, Zulma; Ferrante, Daniel; Casas, Juan P; Bautista, Leonelo E

2013-01-01

Limited knowledge on the prevalence and distribution of risk factors impairs the planning and implementation of cardiovascular prevention programs in the Latin American and Caribbean (LAC) region. Prevalence of hypertension, diabetes mellitus, abnormal lipoprotein levels, obesity, and smoking were estimated from individual-level patient data pooled from population-based surveys (1998-2007, n=31,009) from eight LAC countries and from a national survey of the United States (US) population (1999-2004) Age and gender specific prevalence were estimated and age-gender adjusted comparisons between both populations were conducted. Prevalence of diabetes mellitus, hypertension, and low high-density lipoprotein (HDL)-cholesterol in LAC were 5% (95% confidence interval [95% CI]: 3.4, 7.9), 20.2% (95% CI: 12.5, 31), and 53.3% (95% CI: 47, 63.4), respectively. Compared to LAC region's average, the prevalence of each risk factor tended to be lower in Peru and higher in Chile. LAC women had higher prevalence of obesity and low HDL-cholesterol than men. Obesity, hypercholesterolemia, and hypertriglyceridemia were more prevalent in the US population than in LAC population (31 vs. 16.1%, 16.8 vs. 8.9%, and 36.2 vs. 26.5%, respectively). However, the prevalence of low HDL-cholesterol was higher in LAC than in the US (53.3 vs. 33.7%). Major cardiovascular risk factors are highly prevalent in LAC region, in particular low HDL-cholesterol. In addition, marked differences do exist in this prevalence profile between LAC and the US. The observed patterns of obesity-related risk factors and their current and future impact on the burden of cardiovascular diseases remain to be explained.

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.

Ionizing radiation: future etiologic research and preventive strategies.

PubMed

Darby, S C; Inskip, P D

1995-11-01

Estimates of cancer risks following exposure to ionizing radiation traditionally have been based on the experience of populations exposed to substantial (and known) doses delivered over short periods of time. Examples include survivors of the atomic bombings at Hiroshima and Nagasaki, and persons treated with radiation for benign or malignant disease. Continued follow-up of these populations is important to determine the long-term effects of exposure in childhood, to characterize temporal patterns of excess risk for different types of cancer, and to understand better the interactions between radiation and other host and environmental factors. Most population exposure to radiation occurs at very low dose rates. For low linear energy transfer (LET) radiations, it often has been assumed that cancer risks per unit dose are lower following protracted exposure than following acute exposure. Studies of nuclear workers chronically exposed over a working lifetime provide data that can be used to test this hypothesis, and preliminary indications are that the risks per unit dose for most cancers other than leukemia are similar to those for acute exposure. However, these results are subject to considerable uncertainty, and further information on this question is needed. Residential radon is the major source of population exposure to high-LET radiation. Current estimates of the risk of lung cancer due to residential exposure to radon and radon daughters are based on the experience of miners exposed to much higher concentrations. Data indicate that lung cancer risk among miners is inversely associated with exposure rate, and also is influenced by the presence of other lung carcinogens such as arsenic in the mine environment. Further study of populations of radon-exposed miners would be informative, particularly those exposed at below-average levels. More direct evidence on the effects of residential exposure to radon also is desirable but might be difficult to come by, as risks associated with radon levels found in most homes might be too low to be quantified accurately in epidemiological studies.

Ionizing radiation: future etiologic research and preventive strategies.

PubMed Central

Darby, S C; Inskip, P D

1995-01-01

Estimates of cancer risks following exposure to ionizing radiation traditionally have been based on the experience of populations exposed to substantial (and known) doses delivered over short periods of time. Examples include survivors of the atomic bombings at Hiroshima and Nagasaki, and persons treated with radiation for benign or malignant disease. Continued follow-up of these populations is important to determine the long-term effects of exposure in childhood, to characterize temporal patterns of excess risk for different types of cancer, and to understand better the interactions between radiation and other host and environmental factors. Most population exposure to radiation occurs at very low dose rates. For low linear energy transfer (LET) radiations, it often has been assumed that cancer risks per unit dose are lower following protracted exposure than following acute exposure. Studies of nuclear workers chronically exposed over a working lifetime provide data that can be used to test this hypothesis, and preliminary indications are that the risks per unit dose for most cancers other than leukemia are similar to those for acute exposure. However, these results are subject to considerable uncertainty, and further information on this question is needed. Residential radon is the major source of population exposure to high-LET radiation. Current estimates of the risk of lung cancer due to residential exposure to radon and radon daughters are based on the experience of miners exposed to much higher concentrations. Data indicate that lung cancer risk among miners is inversely associated with exposure rate, and also is influenced by the presence of other lung carcinogens such as arsenic in the mine environment. Further study of populations of radon-exposed miners would be informative, particularly those exposed at below-average levels. More direct evidence on the effects of residential exposure to radon also is desirable but might be difficult to come by, as risks associated with radon levels found in most homes might be too low to be quantified accurately in epidemiological studies. PMID:8741792

Traffic-related air pollution and risk for leukaemia of an adult population.

PubMed

Raaschou-Nielsen, Ole; Ketzel, Matthias; Harbo Poulsen, Aslak; Sørensen, Mette

2016-03-01

Air pollution causes lung cancer, but associations with other cancers have not been established. We investigated whether long-term exposure to traffic-related air pollution is associated with the risk of the general population for leukaemia. We identified 1,967 people in whom leukaemia was diagnosed in 1992-2010 from a nation-wide cancer registry and selected 3,381 control people at random, matched on sex and year of birth, from the entire Danish population. Residential addresses since 1971 were traced in a population registry, and outdoor concentrations of NOx and NO2 , as indicators of traffic-related air pollution, were calculated at each address in a dispersion model. We used conditional logistic regression to estimate the risk for leukaemia after adjustment for income, educational level, cohabitation status and co-morbidity. In linear analyses, we found odds ratios for acute myeloid leukaemia of 1.20 (95% confidence interval: 1.04-1.38) per 20 µg/m(3) increase in NOx and 1.31 (1.02-1.68) per 10 µg/m(3) increase in NO2 , calculated as time-weighted average exposure at all addresses since 1971. We found no association with chronic myeloid or lymphocytic leukaemia. This study indicates an association between long-term exposure to traffic-related air pollution and acute myeloid leukaemia in the general population, but not for other subtypes of leukaemia. © 2015 UICC.

Screening and surveillance for second malignant neoplasms in adult survivors of childhood cancer: a report from the childhood cancer survivor study.

PubMed

Nathan, Paul Craig; Ness, Kirsten Kimberlie; Mahoney, Martin Christopher; Li, Zhenghong; Hudson, Melissa Maria; Ford, Jennifer Sylene; Landier, Wendy; Stovall, Marilyn; Armstrong, Gregory Thomas; Henderson, Tara Olive; Robison, Leslie L; Oeffinger, Kevin Charles

2010-10-05

Survivors of childhood cancer may develop a second malignant neoplasm during adulthood and therefore require regular surveillance. To examine adherence to population cancer screening guidelines by survivors at average risk for a second malignant neoplasm and adherence to cancer surveillance guidelines by survivors at high risk for a second malignant neoplasm. Retrospective cohort study. The Childhood Cancer Survivor Study (CCSS), a 26-center study of long-term survivors of childhood cancer that was diagnosed between 1970 and 1986. 4329 male and 4018 female survivors of childhood cancer who completed a CCSS questionnaire assessing screening and surveillance for new cases of cancer. Patient-reported receipt and timing of mammography, Papanicolaou smear, colonoscopy, or skin examination was categorized as adherent to the U.S. Preventive Services Task Force guidelines for survivors at average risk for breast or cervical cancer or the Children's Oncology Group guidelines for survivors at high risk for breast, colorectal, or skin cancer as a result of cancer therapy. In average-risk female survivors, 2743 of 3392 (80.9%) reported having a Papanicolaou smear within the recommended period, and 140 of 209 (67.0%) reported mammography within the recommended period. In high-risk survivors, rates of recommended mammography among women were only 241 of 522 (46.2%) and the rates of colonoscopy and complete skin examinations among both sexes were 91 of 794 (11.5%) and 1290 of 4850 (26.6%), respectively. Data were self-reported. Participants in the CCSS are a selected group of survivors, and their adherence may not be representative of all survivors of childhood cancer. Female survivors at average risk for a second malignant neoplasm show reasonable rates of screening for cervical and breast cancer. However, surveillance for new cases of cancer is very low in survivors at the highest risk for colon, breast, or skin cancer, suggesting that survivors and their physicians need education about their risks and recommended surveillance. The National Cancer Institute, National Institutes of Health, and the American Lebanese Syrian Associated Charities.

Demographics of an experimentally released population of elk in Great Smoky Mountains National Park

USGS Publications Warehouse

Murrow, Jennifer L.; Clark, Joseph D.; Delozier, E. Kim

2009-01-01

We assessed the potential for reestablishing elk (Cervus elaphus) in Great Smoky Mountains National Park (GSMNP), USA, by estimating vital rates of experimentally released animals from 2001 to 2006. Annual survival rates for calves ranged from 0.333 to 1.0 and averaged 0.592. Annual survival for subadult and adult elk (i.e., ≥1 yr of age) ranged from 0.690 to 0.933, depending on age and sex. We used those and other vital rates to model projected population growth and viability using a stochastic individual-based model. The annual growth rate (λ) of the modeled population over a 25-year period averaged 0.996 and declined from 1.059 the first year to 0.990 at year 25. The modeled population failed to attain a positive 25-year mean growth rate in 46.0% of the projections. Poor calf recruitment was an important determinant of low population growth. Predation by black bears (Ursus americanus) was the dominant calf mortality factor. Most of the variance of growth projections was due to demographic variation resulting from the small population size (n  =  61). Management actions such as predator control may help increase calf recruitment, but our projections suggest that the GSMNP elk population may be at risk for some time because of high demographic variation.

Validity of the Framingham point scores in the elderly: results from the Rotterdam study.

PubMed

Koller, Michael T; Steyerberg, Ewout W; Wolbers, Marcel; Stijnen, Theo; Bucher, Heiner C; Hunink, M G Myriam; Witteman, Jacqueline C M

2007-07-01

The National Cholesterol Education Program recommends assessing 10-year risk of coronary heart disease (CHD) in individuals free of established CHD with the Framingham Point Scores (FPS). Individuals with a risk >20% are classified as high risk and are candidates for preventive intervention. We aimed to validate the FPS in a European population of elderly subjects. Subjects free of established CHD at baseline were selected from the Rotterdam study, a population-based cohort of subjects 55 years or older in The Netherlands. We studied calibration, discrimination (c-index), and the accuracy of high-risk classifications. Events consisted of fatal CHD and nonfatal myocardial infarction. Among 6795 subjects, 463 died because of CHD and 336 had nonfatal myocardial infarction. Predicted 10-year risk of CHD was on average well calibrated for women (9.9% observed vs 10.1% predicted) but showed substantial overestimation in men (14.3% observed vs 19.8% predicted), particularly with increasing age. This resulted in substantial number of false-positive classifications (specificity 70%) in men. In women, discrimination of the FPS was better than that in men (c-index 0.73 vs 0.63, respectively). However, because of the low baseline risk of CHD and limited discriminatory power, only 33% of all CHD events occurred in women classified as high risk. The FPS need recalibration for elderly men with better incorporation of the effect of age. In elderly women, FPS perform reasonably well. However, maintaining the rational of the high-risk threshold requires better performing models for a population with low incidence of CHD.

Clinal patterns in genetic variation for northern leopard frog (Rana pipiens): Conservation status and population histories

USGS Publications Warehouse

Stockwell, Craig A.; Fisher, Justin D.L.; McLean, Kyle I.

2016-01-01

The security of the northern leopard frog (Rana pipiens) varies spatially with populations east and west of North Dakota considered as secure and at risk, respectively. We used genetic markers to characterize the conservation status of northern leopard frog populations across North Dakota. We used multiple regression analyses and model selection to evaluate correlations of expected heterozygosity (HE) with the direct and additive effects of: i) geographic location,ii) wetland density and iii) average annual precipitation. There was lower genetic diversity in the western portion of the state due to lower levels of diversity for populations southwest of the Missouri River. This may reflect a refugial/colonization signature for the only non-glaciated area of North Dakota. Genetic diversity was also positively associated with wetland densities which is consistent with the reliance of this species on a mosaic of wetlands. Our findings suggest that populations in the southwestern part of North Dakota are of higher conservation concern, a finding consistent with the higher risk noted for northern leopard frog populations in most states west of North Dakota. Our findings also pose the hypothesis that climate change induced changes in wetland densities will reduce genetic diversity of northern leopard frog populations.

Marginal bone level in two Danish cross-sectional population samples in 1997-1998 and 2007-2008.

PubMed

Bahrami, Golnosh; Vaeth, Michael; Wenzel, Ann; Isidor, Flemming

2018-04-12

The aim of this study was to compare the marginal bone level of two randomly selected population samples from 1997/1998 and 2007/2008, with special emphasis on the role of smoking habits and gender. Two cross-sectional randomly selected population samples [1997/1998 (N = 616) and 2007/2008 (N = 396)] were analysed with respect to the marginal bone level. The marginal bone level was measured in full-mouth intraoral radiographs. Information on smoking was gathered using questionnaires. Multiple regression analysis was used in order to adjust for correlating factors (gender, age, smoking habits and number of teeth). After adjusting for confounding factors, the population sample from 2007/2008 had on average a slightly, but statistically significantly, more reduced average marginal bone level (0.15 mm) than the population sample from 1997/1998. Men had more reduced marginal bone level than women (0.12 mm). Smokers in both population samples had more reduced marginal bone level than non-smokers (0.39 mm and 0.12 mm for 1997/1998; 0.65 mm and 0.16 mm for 2007/2008). In these populations, sampled 10 years apart, the 2007/2008 population sample had a slightly more reduced marginal bone level than the 1997/1998 population sample. Men had more reduced marginal bone level than women, and smoking is considered a major risk factor for a reduced marginal bone level.

Sensation seeking moderates the effects of alcohol and drug use prior to sex on sexual risk in young men who have sex with men.

PubMed

Newcomb, Michael E; Clerkin, Elise M; Mustanski, Brian

2011-04-01

Men who have sex with men (MSM) account for more than half of all new HIV/AIDS diagnoses in the United States each year, and young MSM (ages 13-24) have the highest increases in new infections. Identifying which young MSM engage in sexual risk-taking in which contexts is critical in developing effective behavioral intervention strategies for this population. While studies have consistently found positive associations between the use of certain drugs and sexual risk, research on alcohol use as a predictor of risk has been less consistent. Participants included 114 young MSM from a longitudinal study of LGBT youth (ages 16-20 at baseline). Participants reported number of unprotected sex acts with up to nine partners across three waves of data collection spanning a reporting window of 18 months, for a total of 406 sexual partners. Sensation seeking was evaluated as a moderator of the effects of both alcohol and drug use prior to sex on sexual risk. Higher levels of sensation seeking were found to significantly increase the positive associations between frequency of unprotected sex and frequency of both alcohol use and drug use with partners. Follow-up analysis found that average rates of alcohol use moderated the association between alcohol use prior to sex and sexual risk, such that decreases in average alcohol use increased the positive association between these variables. Results suggest that while drug use with partners increased sexual risk for all young MSM, the effects of alcohol use prior to sex were limited in low sensation-seeking young MSM as well as those who are high alcohol consumers on average. Implications for future research and behavioral interventions are discussed.

Associations between cardiovascular disease and its risk factors with hearing loss-A cross-sectional analysis.

PubMed

Tan, H E; Lan, N S R; Knuiman, M W; Divitini, M L; Swanepoel, D W; Hunter, M; Brennan-Jones, C G; Hung, J; Eikelboom, R H; Santa Maria, P L

2018-02-01

To investigate the relationship between hearing loss and cardiovascular disease risk factors. Cross-sectional study. Participants were recruited between May 2010 and December 2015 and answered a health and risk factor questionnaire. Physical and biochemical assessments were performed. A community-based population. A total of 5107 participants born within the years 1946-1964 enrolled in the Busselton Healthy Ageing Study. Hearing was assessed behaviourally through the best ear pure-tone average (500, 1000, 2000, 4000 Hz), low-frequency average (250, 500, 1000 Hz) and high-frequency average (4000, 8000 Hz). Self-reported hearing loss, tinnitus and hyperacusis were assessed via questionnaire. Cardiovascular risk factors were assessed via a patient-completed questionnaire and objective measurements including blood pressure, body mass index, waist circumference, lipid profile and glycated haemoglobin. Of the participants, 54% were female, with the mean age of 58 years (range 45-69 years). Age, sex and family history of hearing loss were consistently strong determinants of hearing loss outcomes. After adjusting for these, obesity, current smoking, peripheral arterial disease and history of cardiovascular disease were significantly associated with pure-tone, low-frequency and high-frequency hearing loss. In addition, high blood pressure, triglyceride and glycated haemoglobin were significantly associated with low-frequency hearing loss. There was a graded association between hearing loss and Framingham Risk Score for cardiovascular risk (P<0.001). Established cardiovascular disease and individual and combined cardiovascular disease risk factors were found to be associated with hearing loss. Future research should prospectively investigate whether targeting cardiovascular disease can prevent hearing loss. © 2017 John Wiley & Sons Ltd.

Improving coeliac disease risk prediction by testing non-HLA variants additional to HLA variants.

PubMed

Romanos, Jihane; Rosén, Anna; Kumar, Vinod; Trynka, Gosia; Franke, Lude; Szperl, Agata; Gutierrez-Achury, Javier; van Diemen, Cleo C; Kanninga, Roan; Jankipersadsing, Soesma A; Steck, Andrea; Eisenbarth, Georges; van Heel, David A; Cukrowska, Bozena; Bruno, Valentina; Mazzilli, Maria Cristina; Núñez, Concepcion; Bilbao, Jose Ramon; Mearin, M Luisa; Barisani, Donatella; Rewers, Marian; Norris, Jill M; Ivarsson, Anneli; Boezen, H Marieke; Liu, Edwin; Wijmenga, Cisca

2014-03-01

The majority of coeliac disease (CD) patients are not being properly diagnosed and therefore remain untreated, leading to a greater risk of developing CD-associated complications. The major genetic risk heterodimer, HLA-DQ2 and DQ8, is already used clinically to help exclude disease. However, approximately 40% of the population carry these alleles and the majority never develop CD. We explored whether CD risk prediction can be improved by adding non-HLA-susceptible variants to common HLA testing. We developed an average weighted genetic risk score with 10, 26 and 57 single nucleotide polymorphisms (SNP) in 2675 cases and 2815 controls and assessed the improvement in risk prediction provided by the non-HLA SNP. Moreover, we assessed the transferability of the genetic risk model with 26 non-HLA variants to a nested case-control population (n=1709) and a prospective cohort (n=1245) and then tested how well this model predicted CD outcome for 985 independent individuals. Adding 57 non-HLA variants to HLA testing showed a statistically significant improvement compared to scores from models based on HLA only, HLA plus 10 SNP and HLA plus 26 SNP. With 57 non-HLA variants, the area under the receiver operator characteristic curve reached 0.854 compared to 0.823 for HLA only, and 11.1% of individuals were reclassified to a more accurate risk group. We show that the risk model with HLA plus 26 SNP is useful in independent populations. Predicting risk with 57 additional non-HLA variants improved the identification of potential CD patients. This demonstrates a possible role for combined HLA and non-HLA genetic testing in diagnostic work for CD.

Risk of colorectal cancer in patients with ulcerative colitis: a meta-analysis of population-based cohort studies.

PubMed

Jess, Tine; Rungoe, Christine; Peyrin-Biroulet, Laurent

2012-06-01

Patients with ulcerative colitis (UC) have an increased risk of developing colorectal cancer (CRC). Studies examining the magnitude of this association have yielded conflicting results. We performed a meta-analysis of population-based cohort studies to determine the risk of CRC in patients with UC. We used MEDLINE, EMBASE, Cochrane, and CINAHL to perform a systematic literature search. We included 8 studies in the meta-analysis on the basis of strict inclusion and exclusion criteria. We calculated pooled standardized incidence ratios (SIRs) with 95% confidence intervals (CIs) for risk of CRC in patients with UC and performed meta-regression analyses of the effect of cohort size, calendar period, observation time, percentage with proctitis, and rates of colectomy on the risk of CRC. An average of 1.6% of patients with UC was diagnosed with CRC during 14 years of follow-up. SIRs ranged from 1.05 to 3.1, with a pooled SIR of 2.4 (95% CI, 2.1-2.7). Men with UC had a greater risk of CRC (SIR, 2.6; 95% CI, 2.2-3.0) than women (SIR, 1.9; 95% CI, 1.5-2.3). Young age was a risk factor for CRC (SIR, 8.6; 95% CI, 3.8-19.5; although this might have resulted from small numbers), as was extensive colitis (SIR, 4.8; 95% CI, 3.9-5.9). In meta-regression analyses, only cohort size was associated with risk of CRC. In population-based cohorts, UC increases the risk of CRC 2.4-fold. Male sex, young age at diagnosis with UC, and extensive colitis increase the risk. Copyright © 2012 AGA Institute. Published by Elsevier Inc. All rights reserved.

PTEN IDENTIFIED AS IMPORTANT RISK FACTOR OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE

PubMed Central

Hosgood, H Dean; Menashe, Idan; He, Xingzhou; Chanock, Stephen; Lan, Qing

2009-01-01

Common genetic variation may play an important role in altering chronic obstructive pulmonary disease (COPD) risk. In Xuanwei, China, the COPD rate is more than twice the Chinese national average, and COPD is strongly associated with in-home coal use. To identify genetic variation that may be associated with COPD in a population with substantial in-home coal smoke exposures, we evaluated 1,261 single nucleotide polymorphisms (SNPs) in 380 candidate genes potentially relevant for cancer and other human diseases in a population-based case-control study in Xuanwei (53 cases; 107 controls). PTEN was the most significantly associated gene with COPD in a minP analysis using 20,000 permutations (P = 0.00005). SNP-based analyses found that homozygote variant carriers of PTEN rs701848 (ORTT = 0.12, 95%CI = 0.03 - 0.47) had a significant decreased risk of COPD. PTEN, or phosphatase and tensin homolog, is an important regulator of cell cycle progression and cellular survival via the AKT signaling pathway. Our exploratory analysis suggests that genetic variation in PTEN may be an important risk factor of COPD in Xuanwei. However, due to the small sample size, additional studies are needed to evaluate these associations within Xuanwei and other populations with coal smoke exposures. PMID:19625176

[Rising infant mortality in down syndrome in Chile from 1997 to 2013].

PubMed

Donoso, Enrique; Vera, Claudio

2016-11-01

Down syndrome (DS) is associated with higher child mortality especially due to cardiac malformations. To describe the trend in Chilean infant mortality in DS in the period 1997-2013 as compared to the general population without DS. Raw data on infant deaths were extracted from the yearbooks of vital statistics of the National Institute of Statistics. The mortality risk associated to DS, relative to population without DS was estimated. There were 456 deaths in infants with DS during the study period (59 early neonatal deaths, 70 late neonatal deaths and 327 post-neonatal deaths). The trend in infant mortality rate in DS was ascending (r: 0.53, p = 0.03), with an average annual percentage change of 4.6% (95% confidence interval (CI) 0.4-9.0%; p < 0.01). Compared to the population without DS, the risk of early neonatal death was lower in DS (Odds ratio (OR) 0.14, 95% CI 0.11-0.19; p < 0.01) whereas the risk of post-neonatal death was higher (OR 4.74, 95% CI 3.85-5.85; p < 0.01). Infant mortality in Down syndrome has an increasing trend. We postulate that these children are not accessing timely cardiac surgery, the main therapeutic tool to reduce the death risk in the first year of life.

Mortality among the homeless: Causes and meteorological relationships.

PubMed

Romaszko, Jerzy; Cymes, Iwona; Dragańska, Ewa; Kuchta, Robert; Glińska-Lewczuk, Katarzyna

2017-01-01

The homeless constitute a subpopulation particularly exposed to atmospheric conditions, which, in the temperate climate zone, can result in both cold and heat stress leading to the increased mortality hazard. Environmental conditions have become a significant independent risk factor for mortality from specific causes, including circulatory or respiratory diseases. It is known that this group is particularly prone to some addictions, has a shorter life span, its members often die of different causes than those of the general population and may be especially vulnerable to the influence of weather conditions. The retrospective analysis is based on data concerning 615 homeless people, out of which 176 died in the analyzed period (2010-2016). Data for the study was collected in the city of Olsztyn, located in north-east Poland, temperate climatic zone of transitional type. To characterize weather conditions, meteorological data including daily minimum and maximum temperatures and the Universal Thermal Climate Index (UTCI) were used. The average life span of a homeless person was shorter by about 17.5 years than that recorded for the general population. The average age at death of a homeless male was 56.27 years old (SD 10.38), and 52.00 years old (SD 9.85) of a homeless female. The most frequent causes of death were circulatory system diseases (33.80%). A large number of deaths were attributable to smoking (47.18%), whereas a small number was caused by infectious diseases, while a relatively large proportion of deaths were due to tuberculosis (2.15%). Most deaths occurred in the conditions of cold stress (of different intensity). Deaths caused by hypothermia were thirteen-fold more frequently recorded among the homeless than for the general population. A relative risk of death for a homeless person even in moderate cold stress conditions is higher (RR = 1.84) than in thermoneutral conditions. Our results indicate excessive mortality among the homeless as well as the weak and rather typical influence of atmospheric conditions on mortality rates in this subpopulation, except for a greater risk of cold related deaths than in the general population. UTCI may serve as a useful tool to predict death risk in this group of people.

The effect of father's age in fertile, subfertile, and assisted reproductive technology pregnancies: a population based cohort study.

PubMed

Stern, Judy E; Luke, Barbara; Hornstein, Mark D; Cabral, Howard; Gopal, Daksha; Diop, Hafsatou; Kotelchuck, Milton

2014-11-01

To compare ages of mothers and of fathers at delivery in couples who are fertile, subfertile, and subfertile treated with assisted reproductive technology (ART) and to characterize birth outcomes in the ART population according to paternal age. Live birth deliveries in Massachusetts between July, 2004 and December, 2008 were identified from vital records and categorized by maternal fertility status and treatment as ART, subfertile or fertile. The ART births were linked to the Society for Assisted Reproductive Technology Clinic Outcome Reporting System (SART CORS) database to obtain cycle-specific treatment data. Parental ages were obtained from birth certificates. Age of mothers and fathers were compared using ANOVA for continuous measures and χ (2) for categories. Risks of prematurity (<37 weeks), low birthweight (<2,500 g), and low birthweight z-score (small for gestatational age, SGA) were modeled using logistic regression by categories of paternal age as adjusted odds ratios and 95 % CI. The study population included 9,092 ART, 6,238 subfertile, and 318,816 fertile deliveries. Paternal ages in the ART and subfertile groups were similar and differed significantly from those of the fertile group. Maternal age in the ART and subfertile groups averaged 5-6 years older than their fertile counterparts and fathers averaged 4-5 years older with twice as many being older than 37. The risks for prematurity, low birthweight and SGA did not increase with increasing paternal age. Fathers in ART- treated and subfertile couples are older than in their fertile counterparts. Older paternal age was not assoicated with increased risk for prematurity, low birthweight, or SGA.

The Prevalence of Anemia and Moderate-Severe Anemia in the US Population (NHANES 2003-2012)

PubMed Central

2016-01-01

Since anemia is associated with poor health outcomes, the prevalence of anemia is a significant public health indicator. Even though anemia is primarily caused by iron deficiency, low oxygen-carrying capacity may result from other conditions such as chronic diseases, which remain a relevant health concern in the United States. However, studies examining current rates of anemia in the total US population and in more specific subgroups are limited. Data from five National Health and Nutrition Examination Surveys (NHANES) from 2003 to 2012 were analyzed to assess two outcomes: anemia and moderate-severe anemia, which were based upon serum hemoglobin levels (Hb) as per World Health Organization (WHO) definitions. Statistical analysis using SAS examined temporal trends and the prevalence of anemia among sexes, age groups, and races/ethnicities. The study estimated that an average of 5.6% of the U.S. population met the criteria for anemia and 1.5% for moderate-severe anemia during this 10-year period. High-risk groups such as pregnant women, elderly persons, women of reproductive age, non-Hispanic blacks, and Hispanics were identified, and relationships between multiple risk factors were examined. Rates of anemia in men increased monotonically with age, while that of women increased bimodally with peaks in age group 40–49 years and 80–85 years. The effect of risk factors was observed to compound. For instance, the prevalence of anemia in black women aged 80–85 years was 35.6%, 6.4 times higher than the population average. Moreover, anemia is a growing problem because of the increased prevalence of anemia (4.0% to 7.1%) and moderate-severe anemia (1.0% to 1.9%), which nearly doubled from 2003–2004 to 2011–2012. Thus, these results augment the current knowledge on anemia prevalence, severity, and distribution among subgroups in the US and raised anemia as an issue that requires urgent public health intervention. PMID:27846276

The Prevalence of Anemia and Moderate-Severe Anemia in the US Population (NHANES 2003-2012).

PubMed

Le, Chi Huu Hong

2016-01-01

Since anemia is associated with poor health outcomes, the prevalence of anemia is a significant public health indicator. Even though anemia is primarily caused by iron deficiency, low oxygen-carrying capacity may result from other conditions such as chronic diseases, which remain a relevant health concern in the United States. However, studies examining current rates of anemia in the total US population and in more specific subgroups are limited. Data from five National Health and Nutrition Examination Surveys (NHANES) from 2003 to 2012 were analyzed to assess two outcomes: anemia and moderate-severe anemia, which were based upon serum hemoglobin levels (Hb) as per World Health Organization (WHO) definitions. Statistical analysis using SAS examined temporal trends and the prevalence of anemia among sexes, age groups, and races/ethnicities. The study estimated that an average of 5.6% of the U.S. population met the criteria for anemia and 1.5% for moderate-severe anemia during this 10-year period. High-risk groups such as pregnant women, elderly persons, women of reproductive age, non-Hispanic blacks, and Hispanics were identified, and relationships between multiple risk factors were examined. Rates of anemia in men increased monotonically with age, while that of women increased bimodally with peaks in age group 40-49 years and 80-85 years. The effect of risk factors was observed to compound. For instance, the prevalence of anemia in black women aged 80-85 years was 35.6%, 6.4 times higher than the population average. Moreover, anemia is a growing problem because of the increased prevalence of anemia (4.0% to 7.1%) and moderate-severe anemia (1.0% to 1.9%), which nearly doubled from 2003-2004 to 2011-2012. Thus, these results augment the current knowledge on anemia prevalence, severity, and distribution among subgroups in the US and raised anemia as an issue that requires urgent public health intervention.

Length of stay, hospitalization cost, and in-hospital mortality in US adult inpatients with immune thrombocytopenic purpura, 2006-2012.

PubMed

An, Ruopeng; Wang, Peizhong Peter

2017-01-01

In this study, we examined the length of stay, hospitalization cost, and risk of in-hospital mortality among US adult inpatients with immune thrombocytopenic purpura (ITP). We analyzed nationally representative data obtained from Nationwide/National Inpatient Sample database of discharges from 2006 to 2012. In the US, there were an estimated 296,870 (95% confidence interval [CI]: 284,831-308,909) patient discharges recorded for ITP from 2006 to 2012, during which ITP-related hospitalizations had increased steadily by nearly 30%. The average length of stay for an ITP-related hospitalization was found to be 6.02 days (95% CI: 5.93-6.10), which is 28% higher than that of the overall US discharge population (4.70 days, 95% CI: 4.66-4.74). The average cost of ITP-related hospitalizations was found to be US$16,594 (95% CI: US$16,257-US$16,931), which is 48% higher than that of the overall US discharge population (US$11,200; 95% CI: US$11,033-US$11,368). Gender- and age-adjusted mortality risk in inpatients with ITP was 22% (95% CI: 19%-24%) higher than that of the overall US discharge population. Across diagnosis related groups, length of stay for ITP-related hospitalizations was longest for septicemia (7.97 days, 95% CI: 7.55-8.39) and splenectomy (7.40 days, 95% CI: 6.94-7.86). Splenectomy (US$25,262; 95% CI: US$24,044-US$26,481) and septicemia (US$18,430; 95% CI: US$17,353-US$19,507) were associated with the highest cost of hospitalization. The prevalence of mortality in ITP-related hospitalizations was highest for septicemia (11.11%, 95% CI: 9.60%-12.63%) and intracranial hemorrhage (9.71%, 95% CI: 7.65%-11.77%). Inpatients with ITP had longer hospital stay, bore higher costs, and faced greater risk of mortality than the overall US discharge population.

Youth health risk behavior assessment in Fiji: The reliability of Global School-based Health Survey content adapted for ethnic Fijian girls

PubMed Central

Becker, Anne E.; Roberts, Andrea L.; Perloe, Alexandra; Bainivualiku, Asenaca; Richards, Lauren K.; Gilman, Stephen E.; Striegel-Moore, Ruth H.

2010-01-01

Objective The Global School-based Student Health Survey (GSHS) is an assessment for adolescent health risk behaviors and exposures, supported by the World Health Organization. Although already widely implemented—and intended for youth assessment across diverse ethnic and national contexts—no reliability data have yet been reported for GSHS-based assessment in any ethnicity or country-specific population. This study reports test-retest reliability for GSHS content adapted for a female adolescent ethnic Fijian study sample in Fiji. Design We adapted and translated GSHS content to assess health risk behaviors as part of a larger study investigating the impact of social transition on ethnic Fijian secondary schoolgirls in Fiji. In order to evaluate the performance of this measure for our ethnic Fijian study sample (n=523), we examined its test-retest reliability with kappa coefficients, % agreement, and prevalence estimates in a sub-sample (n=81). Reliability among strata defined by topic, age, and language was also examined. Results Average agreement between test and retest was 77%, and average Cohen's kappa was 0.47. Mean kappas for questions from core modules about alcohol use, tobacco use, and sexual behavior were substantial, and higher than those for modules relating to other risk behaviors. Conclusions Although test-retest reliability of responses within this country-specific version of GSHS content was substantial in several topical domains for this ethnic Fijian sample, only fair reliability for the module assessing dietary behaviors and other individual items suggests that population-specific psychometric evaluation is essential to interpreting language and country-specific GSHS data. PMID:20234961

Colon Cancer Screening Programs: Impact of an Organized Screening Strategy Assessed by the EDIFICE Surveys.

PubMed

Viguier, Jérôme; Morère, Jean-François; Brignoli-Guibaudet, Lysel; Lhomel, Christine; Couraud, Sébastien; Eisinger, François

2018-03-05

The aim of EDIFICE surveys is to improve insight into the behavior of the French population with regard to cancer prevention and participation in screening programs. Via the colorectal cancer screening program, all average-risk individuals in the 50-74-year age group are invited every 2 years to do a guaiac-based or, since April 2015, an immunochemical fecal occult blood test. The fifth edition of the nationwide observational survey was conducted by phone interviews using the quota method. A representative sample of 1299 individuals with no history of cancer (age, 50-74 years) was interviewed between 22 November and 7 December 2016. The present analysis focuses on minimum lifetime uptake of screening tests, compliance to recommended repeat-screening intervals, and reasons for non-participation. In 2016, 64% survey participants had been screened at least once and 38% had been screened in the previous 2 years, suggesting a trend towards increasing participation rates, particularly in the younger age categories and among men. The 2016 data also suggest that the newly implemented FIT-based screening program has been well perceived by the population. Up to one in four individuals cited "no risk factors" as the reason for not undergoing screening. This reveals ignorance of the fact that the colorectal cancer screening program actually targets all average-risk individuals in a given age group, without individual risk factors. We suggest the next step should be dedicated to educational approaches to explain exactly what screening involves and to persuasive messages targeting those who to date have remained unreceptive to information campaigns.

Admixture in Hispanic-Americans: Its impact on ITGAM association and implications for admixture mapping in SLE

PubMed Central

Molineros, Julio E.; Kim-Howard, Xana; Deshmukh, Harshal; Jacob, Chaim O.; Harley, John B.; Nath, Swapan K.

2009-01-01

Systemic Lupus Erythematosus (SLE) disproportionately affects minorities, such as Hispanic-Americans. Prevalence of SLE is 3–5 times higher in Hispanic Americans (HA) than European derived populations, and have more active disease at the time of diagnosis, with more serious organ system involvement. HA is an admixed population, it is possible that there is an effect of admixture on the relative risk of disease. This admixture can create substantial increase of linkage disequilibrium (LD) in both magnitude and range, which can provide a unique opportunity for admixture mapping. Main objectives of this study are to (a) estimate hidden population structure in HA individuals; (b) estimate individual ancestry proportions and its impact on SLE risk; (c) assess impact of admixture on ITGAM association, a recently identified SLE susceptibility gene; and (d) estimate power of admixture mapping in HA. Our dataset contained 1,125 individuals, of whom 884 (657 SLE cases and 227 controls) were self classified as HA. Using 107 unlinked ancestry informative markers (AIMs) we estimated hidden population structure and individual ancestry in HA. Out of 5,671 possible pair-wise LD, 54% were statistically significant, indicating recent population admixture. The best fitted model for HA was a four population model with average ancestry of European (48%), American-Indian (40%), African (8%) and a fourth population (4%) with unknown ancestry. We also identified significant higher risk associated with American-Indian ancestry (OR=4.84, P=0.0001, 95%CI=2.14—10.95) on overall SLE. We showed that ITGAM is associated as a risk factor for SLE (OR= 2.06, P=8.74×10−5, 95%CI=1.44–2.97). This association is not affected by population substructure or admixture. We have demonstrated that HA have great potential and are an 3 appropriate population for admixture mapping. As expected, the case-only design is more powerful than case-control design, for any given admixture proportion or ancestry risk ratio. PMID:19387459

The Epidemiology of Urolithiasis in an Ethnically Diverse Population Living in The Same Area.

PubMed

Cook, James; Lamb, Benjamin W; Lettin, Joanna E; Graham, Stuart J

2016-08-25

Little is known about whether migrants retain the risk of urolithiasis seen in their indigenous populations. We sought to evaluate the risk of renal colic between different ethnic groups among a diverse population in London. Data on a cohort of 100 consecutive patients presenting to our emergency department with acute renal colic over a 6 month period was collected retrospectively. Data was extracted from electronic patient record review, trust data and the 2011 census. Risk ratios were calculated and comparisons between groups were made with Chi-Squared test using SPSS. The odds of renal colic among Turkish (odds ratio (OR) 6.57, 95% confidence interval (CI) 3.31-13.04, P < .001), Bulgarian (OR 4.94, 95% CI 1.82-13.44, P = .001), Romanian (OR 4.53, 95% CI 2.10-9.77, P < .001), Indian (OR 2.42, 95% CI 1.17-4.98, P = .013) and Pakistani (OR 2.25, 95% CI 1.38-3.67, P = .001) patients were significantly higher than the population average. The odds of colic among Black-Caribbean (OR 0.27, 95% CI 0.07 - 1.07, P = .045), Black-African (OR 0.27, 95% CI 0.07-1.07, P = .046), White-British (OR 0.44, 95% CI 0.30 - 0.66, P < .001) patients were significantly lower than the general population. This study suggests that migrants from countries known to have higher incidence of urolithiasis tend to retain this increased risk once in London. Such ethnic groups may benefit from targeted intervention to reduce the incidence of stone disease. Further research is needed with greater numbers in a range of populations to confirm this hypothesis. .

Atlas Based Segmentation and Mapping of Organs at Risk from Planning CT for the Development of Voxel-Wise Predictive Models of Toxicity in Prostate Radiotherapy

NASA Astrophysics Data System (ADS)

Acosta, Oscar; Dowling, Jason; Cazoulat, Guillaume; Simon, Antoine; Salvado, Olivier; de Crevoisier, Renaud; Haigron, Pascal

The prediction of toxicity is crucial to managing prostate cancer radiotherapy (RT). This prediction is classically organ wise and based on the dose volume histograms (DVH) computed during the planning step, and using for example the mathematical Lyman Normal Tissue Complication Probability (NTCP) model. However, these models lack spatial accuracy, do not take into account deformations and may be inappropiate to explain toxicity events related with the distribution of the delivered dose. Producing voxel wise statistical models of toxicity might help to explain the risks linked to the dose spatial distribution but is challenging due to the difficulties lying on the mapping of organs and dose in a common template. In this paper we investigate the use of atlas based methods to perform the non-rigid mapping and segmentation of the individuals' organs at risk (OAR) from CT scans. To build a labeled atlas, 19 CT scans were selected from a population of patients treated for prostate cancer by radiotherapy. The prostate and the OAR (Rectum, Bladder, Bones) were then manually delineated by an expert and constituted the training data. After a number of affine and non rigid registration iterations, an average image (template) representing the whole population was obtained. The amount of consensus between labels was used to generate probabilistic maps for each organ. We validated the accuracy of the approach by segmenting the organs using the training data in a leave one out scheme. The agreement between the volumes after deformable registration and the manually segmented organs was on average above 60% for the organs at risk. The proposed methodology provides a way to map the organs from a whole population on a single template and sets the stage to perform further voxel wise analysis. With this method new and accurate predictive models of toxicity will be built.

The contribution of social behaviour to the transmission of influenza A in a human population.

PubMed

Kucharski, Adam J; Kwok, Kin O; Wei, Vivian W I; Cowling, Benjamin J; Read, Jonathan M; Lessler, Justin; Cummings, Derek A; Riley, Steven

2014-06-01

Variability in the risk of transmission for respiratory pathogens can result from several factors, including the intrinsic properties of the pathogen, the immune state of the host and the host's behaviour. It has been proposed that self-reported social mixing patterns can explain the behavioural component of this variability, with simulated intervention studies based on these data used routinely to inform public health policy. However, in the absence of robust studies with biological endpoints for individuals, it is unclear how age and social behaviour contribute to infection risk. To examine how the structure and nature of social contacts influenced infection risk over the course of a single epidemic, we designed a flexible disease modelling framework: the population was divided into a series of increasingly detailed age and social contact classes, with the transmissibility of each age-contact class determined by the average contacts of that class. Fitting the models to serologically confirmed infection data from the 2009 Hong Kong influenza A/H1N1p pandemic, we found that an individual's risk of infection was influenced strongly by the average reported social mixing behaviour of their age group, rather than by their personal reported contacts. We also identified the resolution of social mixing that shaped transmission: epidemic dynamics were driven by intense contacts between children, a post-childhood drop in risky contacts and a subsequent rise in contacts for individuals aged 35-50. Our results demonstrate that self-reported social contact surveys can account for age-associated heterogeneity in the transmission of a respiratory pathogen in humans, and show robustly how these individual-level behaviours manifest themselves through assortative age groups. Our results suggest it is possible to profile the social structure of different populations and to use these aggregated data to predict their inherent transmission potential.

Stock price analysis of sustainable foreign investment companies in Indonesia

NASA Astrophysics Data System (ADS)

Fachrudin, Khaira Amalia

2018-03-01

The stock price is determined by demand and supply in the stock market. Stock price reacts to information. Sustainable investment is an investment that considers environmental sustainability and human rights. This study aims to predict the probability of above average stock price by including the sustainability index as one of its variables. The population is all foreign investment companies in Indonesia. The target population is companies that distribute dividends – also as a sample. The analysis tool is a logistic regression. At 5% alpha, it was found that sustainability index did not have the probability to increase stock price average. The significant effects are free cash flow and cost of debt. However, sustainability index can increase the Negelkarke R square. The implication is that the awareness of sustainability is still necesary to be improved because from the research result it can be seen that investors only consider the risk and return.

Polycyclic Aromatic Hydrocarbons Concentrations in Drinking Water in Villages along the Huai River in China and Their Association with High Cancer Incidence in Local Population.

PubMed

Pan, En Chun; Sun, Hong; Xu, Qiu Jin; Zhang, Qin; Liu, Lin Fei; Chen, Xiao Dong; Xu, Yan

2015-01-01

This study aims to evaluate the carcinogenic risk of PAHs in the drinking water of counties along the Huai River in China and study their associations with high cancer incidence in local population. We investigated 20 villages with high cancer incidence rates as the risk group and 20 villages with low rates as the control group. Water samples from each village were collected in the winter and summer seasons to analyze the concentrations of 16 PAHs. The carcinogenic risks of the PAHs were calculated for each village using a health risk assessment approach. Results showed that PAHs concentrations in 27.2% of the water samples were higher than the allowable values in China. However, no significant difference in water PAHs concentrations was observed between the risk and control groups (P > 0.05), and no correlation was found between water PAHs concentrations and cancer incidence in these villages. The average upper bound carcinogenic risks were less than 1 × 10(-4) in both groups. In conclusion, PAHs were present in the drinking water of the studied villages, but their carcinogenic risks remained within acceptable limits. PAHs in local drinking water might not be the major environmental cause of the high cancer incidences.

Polycyclic Aromatic Hydrocarbons Concentrations in Drinking Water in Villages along the Huai River in China and Their Association with High Cancer Incidence in Local Population

PubMed Central

Pan, En chun; Sun, Hong; Xu, Qiu jin; Zhang, Qin; Liu, Lin fei; Chen, Xiao dong; Xu, Yan

2015-01-01

This study aims to evaluate the carcinogenic risk of PAHs in the drinking water of counties along the Huai River in China and study their associations with high cancer incidence in local population. We investigated 20 villages with high cancer incidence rates as the risk group and 20 villages with low rates as the control group. Water samples from each village were collected in the winter and summer seasons to analyze the concentrations of 16 PAHs. The carcinogenic risks of the PAHs were calculated for each village using a health risk assessment approach. Results showed that PAHs concentrations in 27.2% of the water samples were higher than the allowable values in China. However, no significant difference in water PAHs concentrations was observed between the risk and control groups (P > 0.05), and no correlation was found between water PAHs concentrations and cancer incidence in these villages. The average upper bound carcinogenic risks were less than 1 × 10−4 in both groups. In conclusion, PAHs were present in the drinking water of the studied villages, but their carcinogenic risks remained within acceptable limits. PAHs in local drinking water might not be the major environmental cause of the high cancer incidences. PMID:26688818

A study based on whole-genome sequencing yields a rare variant at 8q24 associated with prostate cancer

PubMed Central

Gudmundsson, Julius; Sulem, Patrick; Gudbjartsson, Daniel F.; Masson, Gisli; Agnarsson, Bjarni A.; Benediktsdottir, Kristrun R.; Sigurdsson, Asgeir; Magnusson, Olafur Th.; Gudjonsson, Sigurjon A.; Magnusdottir, Droplaug N.; Johannsdottir, Hrefna; Helgadottir, Hafdis Th.; Stacey, Simon N.; Jonasdottir, Adalbjorg; Olafsdottir, Stefania B.; Thorleifsson, Gudmar; Jonasson, Jon G.; Tryggvadottir, Laufey; Navarrete, Sebastian; Fuertes, Fernando; Helfand, Brian T.; Hu, Qiaoyan; Csiki, Irma E.; Mates, Ioan N.; Jinga, Viorel; Aben, Katja K. H.; van Oort, Inge M.; Vermeulen, Sita H.; Donovan, Jenny L.; Hamdy, Freddy C.; Ng, Chi-Fai; Chiu, Peter K.F.; Lau, Kin-Mang; Ng, Maggie C.Y.; Gulcher, Jeffrey R.; Kong, Augustine; Catalona, William J.; Mayordomo, Jose I.; Einarsson, Gudmundur V.; Barkardottir, Rosa B.; Jonsson, Eirikur; Mates, Dana; Neal, David E.; Kiemeney, Lambertus A.; Thorsteinsdottir, Unnur; Rafnar, Thorunn; Stefansson, Kari

2013-01-01

Western countries, prostate cancer is the most prevalent cancer of men, and one of the leading causes of cancer-related death in men. Several genome-wide association studies have yielded numerous common variants conferring risk of prostate cancer. In the present study we analyzed 32.5 million variants discovered by whole-genome sequencing 1,795 Icelanders. One variant was found to be associated with prostate cancer in European populations: rs188140481[A] (OR = 2.90, Pcomb = 6.2×10−34) located on 8q24, with an average risk allele control frequency of 0.54%. This variant is only very weakly correlated (r2 ≤ 0.06) with previously reported risk variants on 8q24, and remains significant after adjustment for all of them. Carriers of rs188140481[A] were diagnosed with prostate cancer 1.26 years younger than non-carriers (P = 0.0059). We also report results for the previously described HOXB13 mutation (rs138213197[T]), confirming it as prostate cancer risk variant in populations from all over Europe. PMID:23104005

Gait and balance in the aging population: Fall prevention using innovation and technology.

PubMed

Khanuja, Kavisha; Joki, Jaclyn; Bachmann, Gloria; Cuccurullo, Sara

2018-04-01

On a global basis, adults 65 years of age and older experience falls more frequently than younger individuals, and these often result in severe injuries as well as increased healthcare costs. Gait and balance disorders in this population are among the most common causes of falls and negatively influence quality of life and survivorship. Although falls are a major public health problem and guidelines/recommendations are available to physicians, many are fully aware of different assessments, tools, and resources available for intervention. Given the risk for potentially devastating outcomes if severe injuries occur secondary to a fall, fall prevention strategies in clinical offices is a timely consideration in today's health care landscape. This paper presents a three-tier model, comprising assessment, prevention, and intervention, to highlight methods, proactive programs, and innovative tools and technology that have been developed for fall prevention. Awareness of these resources will enhance the clinician's ability to accurately assess balance and gait, which can improve physical function, and decrease the risk of falls for both average-risk and high-risk older adults. Copyright © 2018 Elsevier B.V. All rights reserved.

Disease invasion risk in a growing population.

PubMed

Yuan, Sanling; van den Driessche, P; Willeboordse, Frederick H; Shuai, Zhisheng; Ma, Junling

2016-09-01

The spread of an infectious disease may depend on the population size. For simplicity, classic epidemic models assume homogeneous mixing, usually standard incidence or mass action. For standard incidence, the contact rate between any pair of individuals is inversely proportional to the population size, and so the basic reproduction number (and thus the initial exponential growth rate of the disease) is independent of the population size. For mass action, this contact rate remains constant, predicting that the basic reproduction number increases linearly with the population size, meaning that disease invasion is easiest when the population is largest. In this paper, we show that neither of these may be true on a slowly evolving contact network: the basic reproduction number of a short epidemic can reach its maximum while the population is still growing. The basic reproduction number is proportional to the spectral radius of a contact matrix, which is shown numerically to be well approximated by the average excess degree of the contact network. We base our analysis on modeling the dynamics of the average excess degree of a random contact network with constant population input, proportional deaths, and preferential attachment for contacts brought in by incoming individuals (i.e., individuals with more contacts attract more incoming contacts). In addition, we show that our result also holds for uniform attachment of incoming contacts (i.e., every individual has the same chance of attracting incoming contacts), and much more general population dynamics. Our results show that a disease spreading in a growing population may evade control if disease control planning is based on the basic reproduction number at maximum population size.

Human health risk assessment with spatial analysis: study of a population chronically exposed to arsenic through drinking water from Argentina.

PubMed

Navoni, J A; De Pietri, D; Olmos, V; Gimenez, C; Bovi Mitre, G; de Titto, E; Villaamil Lepori, E C

2014-11-15

Arsenic (As) is a ubiquitous element widely distributed in the environment. This metalloid has proven carcinogenic action in man. The aim of this work was to assess the health risk related to As exposure through drinking water in an Argentinean population, applying spatial analytical techniques in addition to conventional approaches. The study involved 650 inhabitants from Chaco and Santiago del Estero provinces. Arsenic in drinking water (Asw) and urine (UAs) was measured by hydride generation atomic absorption spectrophotometry. Average daily dose (ADD), hazard quotient (HQ), and carcinogenic risk (CR) were estimated, geo-referenced and integrated with demographical data by a health composite index (HI) applying geographic information system (GIS) analysis. Asw covered a wide range of concentration: from non-detectable (ND) to 2000 μg/L. More than 90% of the population was exposed to As, with UAs levels above the intervention level of 100 μg/g creatinine. GIS analysis described an expected level of exposure lower than the observed, indicating possible additional source/s of exposure to inorganic arsenic. In 68% of the locations, the population had a HQ greater than 1, and the CR ranged between 5·10(-5) and 2,1·10(-2). An environmental exposure area through ADD geo-referencing defined a baseline scenario for space-time risk assessment. The time of residence, the demographic density and the potential health considered outcomes helped characterize the health risk in the region. The geospatial analysis contributed to delimitate and analyze the change tendencies of risk in the region, broadening the scopes of the results for a decision-making process. Copyright © 2014 Elsevier B.V. All rights reserved.

Estimation of genetic diversity in Gute sheep: pedigree and microsatellite analyses of an ancient Swedish breed.

PubMed

Rochus, Christina M; Johansson, Anna M

2017-01-01

Breeds with small population size are in danger of an increased inbreeding rate and loss of genetic diversity, which puts them at risk for extinction. In Sweden there are a number of local breeds, native breeds which have adapted to specific areas in Sweden, for which efforts are being made to keep them pure and healthy over time. One example of such a breed is the Swedish Gute sheep. The objective of this study was to estimate inbreeding and genetic diversity of Swedish Gute sheep. Three datasets were analysed: pedigree information of the whole population, pedigree information for 100 animals of the population, and microsatellite genotypes for 94 of the 100 animals. The average inbreeding coefficient for lambs born during a six year time period (2007-2012) did not increase during that time period. The inbreeding calculated from the entire pedigree (0.038) and for a sample of the population (0.018) was very low. Sheep were more heterozygous at the microsatellite markers than expected (average multilocus heterozygosity and Ritland inbreeding estimates 1.01845 and -0.03931) and five of seven microsatellite markers were not in Hardy Weinberg equilibrium due to heterozygosity excess. The total effective population size estimated from the pedigree information was 155.4 and the average harmonic mean effective population size estimated from microsatellites was 88.3. Pedigree and microsatellite genotype estimations of inbreeding were consistent with a breeding program with the purpose of reducing inbreeding. Our results showed that current breeding programs of the Swedish Gute sheep are consistent with efforts of keeping this breed viable and these breeding programs are an example for other small local breeds in conserving breeds for the future.

Development of a mobile application for oral cancer screening.

PubMed

Gomes, Mayra Sousa; Bonan, Paulo Rogério Ferreti; Ferreira, Vitor Yuri Nicolau; de Lucena Pereira, Laudenice; Correia, Ricardo João Cruz; da Silva Teixeira, Hélder Bruno; Pereira, Daniel Cláudio; Bonan, Paulo

2017-01-01

To develop a mobile application (app) for oral cancer screening. The app was developed using Android system version 4.4.2, with JAVA language. Information concerning sociodemographic data and risk factors for oral cancer development, e.g., tobacco and alcohol use, sun exposure and other contributing factors, such as unprotected oral sex, oral pain and denture use, were included. We surveyed a population at high risk for oral cancer development and then evaluated the sensitivity/specificity/accuracy and predictive values of clinical oral diagnosis between two blinded trained examiners, who used movies and data from the app, and in loco oral examination as gold-standard. A total of 55 individuals at high risk for oral cancer development were surveyed. Of these, 31% presented homogeneous/heterogeneous white lesions with potential of malignancy. The clinical diagnoses performed by the two examiners using videos were found to have sensitivity of 82%-100% (average 91%), specificity of 81%-100% (average 90.5%), and accuracy of 87.27%-95.54% (average 90.90%), as compared with the gold-standard. The Kappa agreement value between the gold-standard and the examiner with the best agreement was 0.597. Mobile apps including videos and data collection interfaces could be an interesting alternative in oral cancer research development.

Risk assessment of population inhalation exposure to volatile organic compounds and carbonyls in urban China.

PubMed

Du, Zhengjian; Mo, Jinhan; Zhang, Yinping

2014-12-01

Over the past three decades, China has experienced rapid urbanization. The risks to its urban population posed by inhalation exposure to hazardous air pollutants (HAPs) have not been well characterized. Here, we summarize recent measurements of 16 highly prevalent HAPs in urban China and compile their distribution inputs. Based on activity patterns of urban Chinese working adults, we derive personal exposures. Using a probabilistic risk assessment method, we determine cancer and non-cancer risks for working females and males. We also assess the uncertainty associated with risk estimates using Monte Carlo simulation, accounting for variations in HAP concentrations, cancer potency factors (CPFs) and inhalation rates. Average total lifetime cancer risks attributable to HAPs are 2.27×10(-4) (2.27 additional cases per 10,000 people exposed) and 2.93×10(-4) for Chinese urban working females and males, respectively. Formaldehyde, 1,4-dichlorobenzene, benzene and 1,3-butadiene are the major risk contributors yielding the highest median cancer risk estimates, >1×10(-5). About 70% of the risk is due to exposures occurring in homes. Outdoor sources contribute most to the risk of benzene, ethylbenzene and carbon tetrachloride, while indoor sources dominate for all other compounds. Chronic exposure limits are not exceeded for non-carcinogenic effects, except for formaldehyde. Risks are overestimated if variation is not accounted for. Sensitivity analyses demonstrate that the major contributors to total variance are range of inhalation rates, CPFs of formaldehyde, 1,4-dichlorobenzene, benzene and 1,3-butadiene, and indoor home concentrations of formaldehyde and benzene. Despite uncertainty, risks exceeding the acceptable benchmark of 1×10(-6) suggest actions to reduce exposures. Future efforts should be directed toward large-scale measurements of air pollutant concentrations, refinement of CPFs and investigation of population exposure parameters. The present study is a first effort to estimate carcinogenic and non-carcinogenic risks of inhalation exposure to HAPs for the large working populations of Chinese cites. Copyright © 2014 Elsevier Ltd. All rights reserved.

State Dependent Valuation: The Effect of Deprivation on Risk Preferences

PubMed Central

Levy, Dino J.; Thavikulwat, Amalie C.; Glimcher, Paul W.

2013-01-01

The internal state of an organism affects its choices. Previous studies in various non-human animals have demonstrated a complex, and in some cases non-monotonic, interaction between internal state and risk preferences. Our aim was to examine the systematic effects of deprivation on human decision-making across various reward types. Using both a non-parametric approach and a classical economic analysis, we asked whether the risk attitudes of human subjects towards money, food and water rewards would change as a function of their internal metabolic state. Our findings replicate some previous work suggesting that, on average, humans become more risk tolerant in their monetary decisions, as they get hungry. However, our specific approach allowed us to make two novel observations about the complex interaction between internal state and risk preferences. First, we found that the change in risk attitude induced by food deprivation is a general phenomenon, affecting attitudes towards both monetary and consumable rewards. But much more importantly, our data indicate that rather than each subject becoming more risk tolerant as previously hypothesized based on averaging across subjects, we found that as a population of human subjects becomes food deprived the heterogeneity of their risk attitudes collapses towards a fixed point. Thus subjects who show high-risk aversion while satiated shift towards moderate risk aversion when deprived but subjects who are risk tolerant become more risk averse. These findings demonstrate a more complicated interaction between internal state and risk preferences and raise some interesting implications for both day-to-day decisions and financial market structures. PMID:23358126

State dependent valuation: the effect of deprivation on risk preferences.

PubMed

Levy, Dino J; Thavikulwat, Amalie C; Glimcher, Paul W

2013-01-01

The internal state of an organism affects its choices. Previous studies in various non-human animals have demonstrated a complex, and in some cases non-monotonic, interaction between internal state and risk preferences. Our aim was to examine the systematic effects of deprivation on human decision-making across various reward types. Using both a non-parametric approach and a classical economic analysis, we asked whether the risk attitudes of human subjects towards money, food and water rewards would change as a function of their internal metabolic state. Our findings replicate some previous work suggesting that, on average, humans become more risk tolerant in their monetary decisions, as they get hungry. However, our specific approach allowed us to make two novel observations about the complex interaction between internal state and risk preferences. First, we found that the change in risk attitude induced by food deprivation is a general phenomenon, affecting attitudes towards both monetary and consumable rewards. But much more importantly, our data indicate that rather than each subject becoming more risk tolerant as previously hypothesized based on averaging across subjects, we found that as a population of human subjects becomes food deprived the heterogeneity of their risk attitudes collapses towards a fixed point. Thus subjects who show high-risk aversion while satiated shift towards moderate risk aversion when deprived but subjects who are risk tolerant become more risk averse. These findings demonstrate a more complicated interaction between internal state and risk preferences and raise some interesting implications for both day-to-day decisions and financial market structures.

Alcohol consumption and cardiorespiratory fitness in five population-based studies.

PubMed

Baumeister, Sebastian E; Finger, Jonas D; Gläser, Sven; Dörr, Marcus; Markus, Marcello Rp; Ewert, Ralf; Felix, Stephan B; Grabe, Hans-Jörgen; Bahls, Martin; Mensink, Gert Bm; Völzke, Henry; Piontek, Katharina; Leitzmann, Michael F

2018-01-01

Background Poor cardiorespiratory fitness is a risk factor for cardiovascular morbidity. Alcohol consumption contributes substantially to the burden of disease, but its association with cardiorespiratory fitness is not well described. We examined associations between average alcohol consumption, heavy episodic drinking and cardiorespiratory fitness. Design The design of this study was as a cross-sectional population-based random sample. Methods We analysed data from five independent population-based studies (Study of Health in Pomerania (2008-2012); German Health Interview and Examination Survey (2008-2011); US National Health and Nutrition Examination Survey (NHANES) 1999-2000; NHANES 2001-2002; NHANES 2003-2004) including 7358 men and women aged 20-85 years, free of lung disease or asthma. Cardiorespiratory fitness, quantified by peak oxygen uptake, was assessed using exercise testing. Information regarding average alcohol consumption (ethanol in grams per day (g/d)) and heavy episodic drinking (5+ or 6+ drinks/occasion) was obtained from self-reports. Fractional polynomial regression models were used to determine the best-fitting dose-response relationship. Results Average alcohol consumption displayed an inverted U-type relation with peak oxygen uptake ( p-value<0.0001), after adjustment for age, sex, education, smoking and physical activity. Compared to individuals consuming 10 g/d (moderate consumption), current abstainers and individuals consuming 50 and 60 g/d had significantly lower peak oxygen uptake values (ml/kg/min) (β coefficients = -1.90, β = -0.06, β = -0.31, respectively). Heavy episodic drinking was not associated with peak oxygen uptake. Conclusions Across multiple adult population-based samples, moderate drinkers displayed better fitness than current abstainers and individuals with higher average alcohol consumption.

Evaluating the risk of death via the hematopoietic syndrome mode for prolonged exposure of nuclear workers to radiation delivered at very low rates.

PubMed

Scott, B R; Lyzlov, A F; Osovets, S V

1998-05-01

During a Phase-I effort, studies were planned to evaluate deterministic (nonstochastic) effects of chronic exposure of nuclear workers at the Mayak atomic complex in the former Soviet Union to relatively high levels (> 0.25 Gy) of ionizing radiation. The Mayak complex has been used, since the late 1940's, to produce plutonium for nuclear weapons. Workers at Site A of the complex were involved in plutonium breeding using nuclear reactors, and some were exposed to relatively large doses of gamma rays plus relatively small neutron doses. The Weibull normalized-dose model, which has been set up to evaluate the risk of specific deterministic effects of combined, continuous exposure of humans to alpha, beta, and gamma radiations, is here adapted for chronic exposure to gamma rays and neutrons during repeated 6-h work shifts--as occurred for some nuclear workers at Site A. Using the adapted model, key conclusions were reached that will facilitate a Phase-II study of deterministic effects among Mayak workers. These conclusions include the following: (1) neutron doses may be more important for Mayak workers than for Japanese A-bomb victims in Hiroshima and can be accounted for using an adjusted dose (which accounts for neutron relative biological effectiveness); (2) to account for dose-rate effects, normalized dose X (a dimensionless fraction of an LD50 or ED50) can be evaluated in terms of an adjusted dose; (3) nonlinear dose-response curves for the risk of death via the hematopoietic mode can be converted to linear dose-response curves (for low levels of risk) using a newly proposed dimensionless dose, D = X(V), in units of Oklad (where D is pronounced "deh"), and V is the shape parameter in the Weibull model; (4) for X < or = Xo, where Xo is the threshold normalized dose, D = 0; (5) unlike absorbed dose, the dose D can be averaged over different Mayak workers in order to calculate the average risk of death via the hematopoietic mode for the population exposed at Site A; and (6) the expected cases of death via the hematopoietic syndrome mode for Mayak workers chronically exposed during work shifts at Site A to gamma rays and neutrons can be predicted using ln(2)B M[D]; where B (pronounced "beh") is the number of workers at risk (criticality accident victims excluded); and M[D] is the average (mean) value of D (averaged over the worker population at risk, for Site A, for the time period considered). These results can be used to facilitate a Phase II study of deterministic radiation effects among Mayak workers chronically exposed to gamma rays and neutrons.

Assessing the risk for dengue fever based on socioeconomic and environmental variables in a geographical information system environment.

PubMed

Khormi, Hassan M; Kumar, Lalit

2012-05-01

An important option in preventing the spread of dengue fever (DF) is to control and monitor its vector (Aedes aegypti) as well as to locate and destroy suitable mosquito breeding environments. The aim of the present study was to use a combination of environmental and socioeconomic variables to model areas at risk of DF. These variables include clinically confirmed DF cases, mosquito counts, population density in inhabited areas, total populations per district, water access, neighbourhood quality and the spatio-temporal risk of DF based on the average, weekly frequency of DF incidence. Out of 111 districts investigated, 17 (15%), covering a total area of 121 km2, were identified as of high risk, 25 (22%), covering 133 km2, were identified as of medium risk, 18 (16%), covering 180 km2, were identified as of low risk and 51 (46%), covering 726 km2, were identified as of very low risk. The resultant model shows that most areas at risk of DF were concentrated in the central part of Jeddah county, Saudi Arabia. The methods used can be implemented as routine procedures for control and prevention. A concerted intervention in the medium- and high-risk level districts identified in this study could be highly effective in reducing transmission of DF in the area as a whole.

Developing a Screening Model to Establish Human Risk from Glacial Meltwater Release of Legacy Organochlorine Pollutants at the Silvretta Glacier in the Swiss Alps

NASA Astrophysics Data System (ADS)

Miner, K. R.

2017-12-01

Organochlorine pollutants (OCPs) banned globally by the Stockholm Convention in 2004 are reemerging from melting glaciers in numerous alpine ecosystems. Despite the known OCP influx from glaciers, a study of human risk from uptake of pesticides in glacial meltwater has never been attempted. Our study qualifies human uptake routes and quantifies risk utilizing published meltwater data from the Silvretta Glacier in the Swiss Alps in combination with methodology established by the US Environmental Protection Agency (EPA). Relatively high concentrations of OCPs in Silvretta glacier meltwater reflect proximity to use near high density populations and provide the best estimate of a 95th percentile human risk scenario. This screening level model assesses direct PCB risk to humans through consumption of fish tissue and meltwater. Our model shows a risk for both cancer and non-cancer disease impacts to children with lifetime exposure to glacial meltwater and an average local fish consumption. For adults with an abbreviated 30 year exposure timeframe, the risk for non-cancer effects is negligible and cancer effects are only barely above screening level. Populations that consume higher quantities of local fish are at greater risk, with additional challenges borne by children. Further direct study into the individual level risk to Swiss residents from glacial meltwater pollution is deemed necessary by our screening study.

Improving Reading and Language Arts Skills of At-Risk First Graders through Direct Instruction of Print Awareness, Phoneme Awareness, and Phonological Processing.

ERIC Educational Resources Information Center

Bump, Sandra K.; Swedberg, Trina L.; Yates, Carol R.

This report describes a program to improve reading and language arts skills. The targeted population consisted of students in 2 first grade classrooms (average class size 25) from a midwestern elementary school in a predominantly white, middle to upper-middle class neighborhood. Data documenting the problem was obtained from the previous year's…

[Repetitive movement of the upper limbs: results of exposure evaluation and clinical investigation during jar packaging of preserved vegetables].

PubMed

Panzone, I; Carra, G; Melosi, A; Rappazzo, G; Innocenti, A

1996-01-01

In order to assess the prevalence of work-related musculo-skeletal disorders of the upper limbs, a total population of 29 female workers in an industrial vegetable preserving plant were examined. The average age of the workers was 41.3 years (SD = 9.2), and their average length of service was 16.7 years (SD = 7.2). Only 20% of the workers were anamnestically negative, whilst 80% had one or more disorders attributable to repetitive trauma of the upper limbs. The disorders showed no prevalence for the right side, a finding in line with the risk analysis which indicated that both limbs were equally used. The results of the risk analysis and clinical assessment confirm that high-frequency actions, combined with improper posture and a shortage of suitable recovery times, play a causal role in determining the onset of the disorders studied.

MO-E-17A-09: Has Cancer Risk for Pediatric CT Increased Or Decreased? An Analysis of Cohort Data From 2004-2013

DOE Office of Scientific and Technical Information (OSTI.GOV)

Brady, S; Kaufman, R

Purpose: To analyze CT radiation dosimetry trends in a pediatric population imaged with modern (2004-2013) CT technology Methods: The institutional review board approved this retrospective review. Two cohorts of pediatric patients that received CT scans for treatment or surveillance for Wilms tumor (n=73) or Neuroblastoma (n=74) from 2004–2013 were included in this study. Patients were scanned during this time period on a GE Ultra (8 slice; 2004–2007), a GE VCT (2008–2011), or a GE VCT-XTe (2011–2013). Each patient's individual or combined chest, abdomen, and pelvic CT exams (n=4138) were loaded onto a PACS workstation (Intelerad, Canada) and measured to calculatemore » their effective diameter and SSDE. Patient SSDE was used to estimate patient organ dosimetry based on previously published data. Patient's organ dosimetry were sorted by gender, weight, age, scan protocol (i.e., chest, abdomen, or pelvis), and CT scanner technology and averaged accordingly to calculate population averaged absolute and effective dose values. Results: Patient radiation dose burden calculated for all genders, weights, and ages decreased at a rate of 0.2 mSv/year (4.2 mGy/year; average organ dose) from 2004–2013; overall levels decreased by 50% from 3.0 mSv (60.0 mGy) to 1.5 mSv (25.9 mGy). Patient dose decreased at equal rates for both male and female, and for individual scan protocols. The greatest dose savings was found for patients between 0–4 years old (65%) followed by 5-9 years old (45%), 10–14 years old (30%), and > 14 years old (21%). Conclusion: Assuming a linear-nothreshold model, there always will be potential risk of cancer induction from CT. However, as demonstrated among these patient populations, effective and organ dose has decreased over the last decade; thus, potential risk of long-term side effects from pediatric CT examinations has also been reduced.« less

[Chronic pulmonary heart disease and its risk factors among a worker population in Teheran].

PubMed

Daneshpajouh, M; Bahrami, F; Chafii, A; Kavoussi, N; Pirouzmande, B

1976-01-01

Because of the high frequency of chronic cor pulmonale in workers admitted to the cardiology department of the Khazaneh Hospital in Teheran, we studied the clinical aspect and the risk factors of this disease in 66 male patients. The average age of patients was 56.1 years and they often had a long history of bronchitis isolated or associated with emphysema. The ECG analysis showed that most abnormalities were localized on the QRST wave. Tobacco and a polluted working environment were the factors most frequently met in our patients. The opium habit probably acted as a risk factor for chronic bronchopneumopathy, but further studies are necessary to ascertain the fact.

Environmental risk assessment of arsenic and fluoride in the Chaco Province, Argentina: research advances.

PubMed

Buchhamer, Edgar E; Blanes, Patricia S; Osicka, Rosa M; Giménez, M Cecilia

2012-01-01

The arsenic (As) and fluoride (F⁻) concentration in groundwater and potential adverse human health risk was investigated in the Central-West Region of the Chaco Province, northern Argentina. The mean concentration of As in shallow groundwater was 95 μg/L, where 76% of samples exceeded the World Health Organization (WHO) guideline value of 10 μg/L, while in deep groundwater it was 90 μg/L, where 63% samples exceeded 10 μg/L. For As health risk assessment, the average daily dose, hazard quotient (HQ), and cancer risk were calculated. The values of HQ were found to be >1 in 77% of samples. This level of contamination is considered to constitute a high chronic risk compared with U.S. Environmental Protection Agency (EPA) guidelines. Further, a significant portion of the population has lifetime carcinogenic risk >10⁻⁴ and may suffer from cancer. A positive correlation was observed between As and F⁻ in groundwater. The Código Alimentario Argentino (CAA) suggested a limit of F⁻ in drinking water as low as 0.8 mg/L under tropical environmental conditions; however, in shallow (39%) and deep groundwater (32%), samples exceeded these values. Exposure to F⁻ was calculated and compared with the adequate intake of minimal safe level exposure dose of 0.05 mg/kg/d and it was noted that 42% of population may be at high risk of fluorosis. Chronic exposure to high As and F⁻ levels in this population represents a concern due to possible adverse health effects attributed to these elements.

Dairy products intake and the risk of incident cataracts surgery in an elderly Mediterranean population: results from the PREDIMED study.

PubMed

Camacho-Barcia, Lucía; Bulló, Mònica; García-Gavilán, Jesús F; Martínez-González, Miguel A; Corella, Dolores; Estruch, Ramón; Fitó, Montse; Gómez-Gracia, Enrique; Arós, Fernando; Fiol, Miquel; Santos-Lozano, José M; Serra-Majem, Lluís; Pintó, Xavier; Basora, Josep; Toledo, Estefanía; Muñoz, Miguel A; Zanon-Moreno, Vicente; García-Layana, Alfredo; Salas-Salvadó, Jordi

2018-03-27

The aim of this study was to examine the association between the consumption of total and specific types of dairy products and the risk of incident cataracts in an elderly Mediterranean population at high cardiovascular risk. We prospectively analyzed 5860 subjects from the PREvención con DIeta MEDiterránea (PREDIMED) Study. The time to cataract surgery was calculated as the time between recruitment and the date of the surgery, last visit of the follow-up, date of death, or until the end of the study. Dairy products intake was assessed using validated food frequency questionnaires. We used Cox proportional hazard regression to assess the risk of cataract surgery according to average dietary energy-adjusted total dairy products, milk, yogurt and cheese consumption. We documented a total of 768 new cataract events after a median of 5.6 years of follow-up. Subjects in the second [hazard ratio (HR) 0.62; 95% CI 0.52, 0.74] and third tertile (HR: 0.71; 95% CI 0.60, 0.85) of skimmed yogurt intake had a significantly lower risk of cataracts after adjusting for potential confounders. No significant associations were observed for total dairy products, whole and skimmed milk, whole yogurt and cheese consumption. The intake of skimmed yogurt was associated with a reduced risk of cataracts in an elderly Mediterranean population with high cardiovascular risk. No significant associations were observed for other type of dairy product. International Standard Randomized Controlled Trial Number (ISRCTN): 35739639. Registration date: 5 October 2005.

The town of Cabar, Croatia, familiar pseudocluster for multiple sclerosis--descriptive epidemiological study.

PubMed

Perković, Olivio; Jurjević, Ante; Antoncić, Igor; Dunatov, Sinisa; Bralić, Marina; Ristić, Smiljana

2010-04-01

Previous descriptive surveys in the town of Cabar, Croatia carried out by our own epidemiological research group, have established that this area is at high risk for MS. To confirm the above assumption and to update MS frequency in this area we conducted a community-based intensive prevalence and incidence study. On December 31st 2001, the average prevalence was 205.7 per 100,000 with prevailing age-specific prevalence in the group of patients between 30 and 49 years of age. The average incidence (1948-2004) was 5.52/100.000 population per year (95% CI = 3.27-8.72), average mortality in the year was 2.76/100 000 inhabitants (95% CI = 1.26-5.24). Sexual index stood at 1:11, starting time was 10:04 +/- 28.53 in the year, and the average duration of the disease to the prevalence 11:11 +/- 27.26 years.

T wave alternans as a predictor of recurrent ventricular tachyarrhythmias in ICD recipients: prospective comparison with conventional risk markers

NASA Technical Reports Server (NTRS)

Hohnloser, S. H.; Klingenheben, T.; Li, Y. G.; Zabel, M.; Peetermans, J.; Cohen, R. J.

1998-01-01

INTRODUCTION: The current standard for arrhythmic risk stratification is electrophysiologic (EP) testing, which, due to its invasive nature, is limited to patients already known to be at high risk. A number of noninvasive tests, such as determination of left ventricular ejection fraction (LVEF) or heart rate variability, have been evaluated as additional risk stratifiers. Microvolt T wave alternans (TWA) is a promising new risk marker. Prospective evaluation of noninvasive risk markers in low- or moderate-risk populations requires studies involving very large numbers of patients, and in such studies, documentation of the occurrence of ventricular tachyarrhythmias is difficult. In the present study, we identified a high-risk population, recipients of an implantable cardioverter defibrillator (ICD), and prospectively compared microvolt TWA with invasive EP testing and other risk markers with respect to their ability to predict recurrence of ventricular tachyarrhythmias as documented by ICD electrograms. METHODS AND RESULTS: Ninety-five patients with a history of ventricular tachyarrhythmias undergoing implantation of an ICD underwent EP testing, assessment of TWA, as well as determination of LVEF, baroreflex sensitivity, signal-averaged ECG, analysis of 24-hour Holter monitoring, and QT dispersion from the 12-lead surface ECG. The endpoint of the study was first appropriate ICD therapy for electrogram-documented ventricular fibrillation or tachycardia during follow-up. Kaplan-Meier survival analysis revealed that TWA (P < 0.006) and LVEF (P < 0.04) were the only significant univariate risk stratifiers. EP testing was not statistically significant (P < 0.2). Multivariate Cox regression analysis revealed that TWA was the only statistically significant independent risk factor. CONCLUSIONS: Measurement of microvolt TWA compared favorably with both invasive EP testing and other currently used noninvasive risk assessment methods in predicting recurrence of ventricular tachyarrhythmias in ICD recipients. This study suggests that TWA might also be a powerful tool for risk stratification in low- or moderate-risk patients, and needs to be prospectively evaluated in such populations.

Prevalence of BRCA1/BRCA2 mutations in a Brazilian population sample at-risk for hereditary breast cancer and characterization of its genetic ancestry

PubMed Central

Paula, André E.; Pereira, Rui; Andrade, Carlos E.; Felicio, Paula S.; Souza, Cristiano P.; Mendes, Deise R.P.; Volc, Sahlua; Berardinelli, Gustavo N.; Grasel, Rebeca S.; Sabato, Cristina S.; Viana, Danilo V.; Machado, José Carlos; Costa, José Luis; Mauad, Edmundo C.; Scapulatempo-Neto, Cristovam; Arun, Banu; Reis, Rui M.; Palmero, Edenir I.

2016-01-01

Background There are very few data about the mutational profile of families at-risk for hereditary breast and ovarian cancer (HBOC) from Latin America (LA) and especially from Brazil, the largest and most populated country in LA. Results Of the 349 probands analyzed, 21.5% were BRCA1/BRCA2 mutated, 65.3% at BRCA1 and 34.7% at BRCA2 gene. The mutation c.5266dupC (former 5382insC) was the most frequent alteration, representing 36.7% of the BRCA1 mutations and 24.0% of all mutations identified. Together with the BRCA1 c.3331_3334delCAAG mutation, these mutations constitutes about 35% of the identified mutations and more than 50% of the BRCA1 pathogenic mutations. Interestingly, six new mutations were identified. Additionally, 39 out of the 44 pathogenic mutations identified were not previously reported in the Brazilian population. Besides, 36 different variants of unknown significance (VUS) were identified. Regarding ancestry, average ancestry proportions were 70.6% European, 14.5% African, 8.0% Native American and 6.8% East Asian. Materials and methods This study characterized 349 Brazilian families at-risk for HBOC regarding their germline BRCA1/BRCA2 status and genetic ancestry. Conclusions This is the largest report of BRCA1/BRCA2 assessment in an at-risk HBOC Brazilian population. We identified 21.5% of patients harboring BRCA1/BRCA2 mutations and characterized the genetic ancestry of a sample group at-risk for hereditary breast cancer showing once again how admixed is the Brazilian population. No association was found between genetic ancestry and mutational status. The knowledge of the mutational profile in a population can contribute to the definition of more cost-effective strategies for the identification of HBOC families. PMID:27741520

Meals ready to eat: a brief history and clinical vignette with discussion on civilian applications.

PubMed

Feagans, Jacob M; Jahann, Darius A; Barkin, Jamie S

2010-03-01

Meals ready to eat (MRE) have undergone many revisions of their origins in the trench ration from World War I. The MRE was implemented in 1980. Its design allows extended storage and easy, safe meal preparation. MRE sodium content varies by meal and may range from 1.6 g/meal to 2.3 g/meal. The average MRE contains 1,200 kcal. When consumed as intended, MREs are adequate for maintaining a soldier's physical parameters without undesirable consequences. The average soldier has a healthy cardiovascular system, has the ability to excrete high sodium loads, and has high insensible losses. The American Heart Association recommends limiting sodium to 2.3 g/day for the general population. Additionally, those with heart failure should limit sodium to 2 g/day. Excess intake of calories and electrolytes may lead to adverse outcomes in certain populations. We describe a case of heart failure exacerbated by regular MRE consumption and the "perfect storm" of risk factors encountered with postdisaster distribution of MREs to a civilian population.

Population data on calcium in drinking water and hip fracture: An association may depend on other minerals in water. A NOREPOS study.

PubMed

Dahl, Cecilie; Søgaard, Anne Johanne; Tell, Grethe S; Forsén, Lisa; Flaten, Trond Peder; Hongve, Dag; Omsland, Tone Kristin; Holvik, Kristin; Meyer, Haakon E; Aamodt, Geir

2015-12-01

The Norwegian population has among the highest hip fracture rates in the world. The incidence varies geographically, also within Norway. Calcium in drinking water has been found to be beneficially associated with bone health in some studies, but not in all. In most previous studies, other minerals in water have not been taken into account. Trace minerals, for which drinking water can be an important source and even fulfill the daily nutritional requirement, could act as effect-modifiers in the association between calcium and hip fracture risk. The aim of the present study was to investigate the association between calcium in drinking water and hip fracture, and whether other water minerals modified this association. A survey of trace metals in 429 waterworks, supplying 64% of the population in Norway, was linked geographically to the home addresses of patients with incident hip fractures (1994-2000). Drinking water mineral concentrations were divided into "low" (below and equal waterworks average) and "high" (above waterworks average). Poisson regression models were fitted, and all incidence rate ratios (IRRs) were adjusted for age, geographic region, urbanization degree, type of water source, and pH of the water. Effect modifications were examined by stratification, and interactions between calcium and magnesium, copper, zinc, iron and manganese were tested both on the multiplicative and the additive scale. Analyses were stratified on gender. Among those supplied from the 429 waterworks (2,110,916 person-years in men and 2,397,217 person-years in women), 5433 men and 13,493 women aged 50-85 years suffered a hip fracture during 1994-2000. Compared to low calcium in drinking water, a high level was associated with a 15% lower hip fracture risk in men (IRR=0.85, 95% CI: 0.78, 0.91) but no significant difference was found in women (IRR=0.98, 95%CI: 0.93-1.02). There was interaction between calcium and copper on hip fracture risk in men (p=0.051); the association between calcium and hip fracture risk was stronger when the copper concentration in water was high (IRR=0.52, 95% CI: 0.35, 0.78) as opposed to when it was low (IRR=0.88, 95% CI: 0.81, 0.94). This pattern persisted also after including potential confounding factors and other minerals in the model. No similar variation in risk was found in women. In this large, prospective population study covering two thirds of the Norwegian population and comprising 19,000 hip fractures, we found an inverse association between calcium in drinking water and hip fracture risk in men. The association was stronger when the copper concentration in the water was high. Copyright © 2015 Elsevier Inc. All rights reserved.

Drinking water consumption patterns among adults-SMS as a novel tool for collection of repeated self-reported water consumption.

PubMed

Säve-Söderbergh, Melle; Toljander, Jonas; Mattisson, Irene; Åkesson, Agneta; Simonsson, Magnus

2018-03-01

Studies have shown that the average drinking water consumption ranges between 0.075 and 3 L/day for adults with both national and regional differences. For exposure assessment of drinking water hazards, country-specific drinking water consumption data including sources of the consumed water may therefore be warranted. To estimate the amount and source of drinking water consumed among adults in Sweden, we collected self-reported estimates using both traditional methods (telephone interviews, web questionnaire) and a novel method (Short Message Service, SMS questionnaires) in a population from an average sized Swedish municipality. Monthly SMS questionnaires were sent out during one year to obtain longitudinal information as well. SMS showed to be a promising tool for collecting self-reported consumption, as most citizens could participate and the method showed high response rate. Data collected via the SMS questionnaire shows an average consumption of cold tap water of 4.9 glasses/24 h (one glass=200 ml), while the average estimates of cold tap water collected by the traditional methods range from 4.5 to 7.0 glasses/24 h. For statistical distributions, the mean daily consumption of cold tap water for the population was best fitted to a gamma distribution. About 70% of the cold tap water is consumed at home. Based on the results from the SMS study, we suggest using 1 l/day for the average adult population and 2.5 l/day for high consumers for risk assessment of cold tap water consumption. As 46% of the tap water consumed is heated, we suggest using 1.85 l/day for total tap water consumption.

Drinking water consumption patterns among adults—SMS as a novel tool for collection of repeated self-reported water consumption

PubMed Central

Säve-Söderbergh, Melle; Toljander, Jonas; Mattisson, Irene; Åkesson, Agneta; Simonsson, Magnus

2018-01-01

Studies have shown that the average drinking water consumption ranges between 0.075 and 3 L/day for adults with both national and regional differences. For exposure assessment of drinking water hazards, country-specific drinking water consumption data including sources of the consumed water may therefore be warranted. To estimate the amount and source of drinking water consumed among adults in Sweden, we collected self-reported estimates using both traditional methods (telephone interviews, web questionnaire) and a novel method (Short Message Service, SMS questionnaires) in a population from an average sized Swedish municipality. Monthly SMS questionnaires were sent out during one year to obtain longitudinal information as well. SMS showed to be a promising tool for collecting self-reported consumption, as most citizens could participate and the method showed high response rate. Data collected via the SMS questionnaire shows an average consumption of cold tap water of 4.9 glasses/24 h (one glass=200 ml), while the average estimates of cold tap water collected by the traditional methods range from 4.5 to 7.0 glasses/24 h. For statistical distributions, the mean daily consumption of cold tap water for the population was best fitted to a gamma distribution. About 70% of the cold tap water is consumed at home. Based on the results from the SMS study, we suggest using 1 l/day for the average adult population and 2.5 l/day for high consumers for risk assessment of cold tap water consumption. As 46% of the tap water consumed is heated, we suggest using 1.85 l/day for total tap water consumption. PMID:28612838

Heavy metals in estuarine surface sediments of the Hai River Basin, variation characteristics, chemical speciation and ecological risk.

PubMed

Lei, Pei; Zhang, Hong; Shan, Baoqing; Lv, Shucong; Tang, Wenzhong

2016-04-01

The Hai River Basin (HRB) is considered to be one of the most polluted areas in China due to the high regional population density and rapid economic development. The estuaries of the HRB, which receive pollutants from terrestrial rivers, may subsequently suffer potential pollution and result in ecological risk of heavy metals. Six heavy metals (Cd, Cr, Cu, Ni, Pb, and Zn) were measured in estuarine surface sediments from 10 estuaries of the HRB to investigate their variation characteristics and ecological risks. The spatial difference of Cr, Ni, Pb, and Zn in sediments was higher than that of the rest two elements. The Yongdingxin Estuary (YDX) and Ziyaxin Estuary (ZYX) in the Northern Hai River System (NHRS) were the most severe in terms of heavy metal contamination. According to the Risk Assessment Code (RAC) classification, Cd associated with the exchangeable and carbonate fraction (the average of 21.3 %) indicated medium risk to high risk. More than 50 % of Cr, Cu, Ni, and Zn on average were associated with the residual fraction. Based on the sum of the first three fractions (exchangeable and carbonate + reducible + oxidizable), the mobility order of these heavy metals was Cd >Pb > Zn ≈ Cu > Ni > Cr. Compared to the background values of cinnamon soil, the potential ecological risk index (RI) values ranged from 25.6 to 168, with an average of 91.2, indicating a low ecological risk in estuarine sites of the HRB. Cd and Pb were the dominant contributors to the toxic-response factor (45.8 and 25.5 %, respectively). The results give insight into the different control measures pertaining to heavy metal pollution and risk for both relatively clean estuaries and urban seriously polluted areas, respectively, for the formation of protect strategies of aquatic environment in the HRB.

The impact of cancer prevention guideline adherence on overall mortality in a high-risk cohort of women from the New York site of the Breast Cancer Family Registry.

PubMed

Cloud, Ann J; Thai, Ashley; Liao, Yuyan; Terry, Mary Beth

2015-01-01

The American Cancer Society (ACS) recommends at least 150 min of moderate intensity physical activity per week, alcohol intake of ≤1 drink per day, and maintaining a body mass index (BMI) of <25 kg/m(2) for breast cancer prevention. Adherence to these guidelines has been linked to lower overall mortality in average-risk populations, it is not known if mortality reduction extends to women at higher risk given their family history of breast cancer. We followed 2,905 women from a high-risk Breast Cancer Family Registry in New York, of which 77 % were white non-Hispanic and 23 % were Hispanic. We collected information on BMI, physical activity, and alcohol intake at baseline and prospectively followed our cohort for outcomes based on questionnaires and National Death Index linkage. We used Cox regression to examine the relation between adherence to ACS guidelines and overall mortality and examined effect modification by race, age, and BRCA status. There were 312 deaths after an average of 9.2 ± 4.1 years of follow-up. Adherence to all three ACS recommendations was associated with 44-53 % lower mortality in women unaffected with breast cancer at baseline [Hazard Ratio (HR) 0.56, 95 % CI (0.33-0.93)] and in women affected with breast cancer at baseline [HR 0.47, 95 % CI (0.30-0.74)]. These associations remained after stratification by age, race, and BRCA status {e.g., BRCA1 and/or BRCA2 carriers [HR 0.39, 95 % CI (0.16-0.97)]}. These results support that women at high risk, similar to women at average risk, may also have substantial benefits from maintaining the ACS guidelines.

Recovery and Growth Potential of Listeria monocytogenes in Temperature Abused Milkshakes Prepared from Naturally Contaminated Ice Cream Linked to a Listeriosis Outbreak

DOE PAGES

Chen, Yi; Allard, Emma; Wooten, Anna; ...

2016-05-18

The recovery and growth potential of Listeria monocytogenes was evaluated in three flavors of milkshakes (vanilla, strawberry, and chocolate) that were prepared from naturally contaminated ice cream linked to a listeriosis outbreak in the U.S. in 2015, and were subsequently held at room temperature for 14 h. The average lag phase duration of L. monocytogenes was 9.05 h; the average generation time was 1.67 h; and the average population level increase per sample at 14 h was 1.14 log CFU/g. Milkshake flavors did not significantly affect these parameters. The average lag phase duration of L. monocytogenes in milkshakes with initialmore » contamination levels ≤ 3 CFU/g (9.50 h) was significantly longer (P < 0.01) than that with initial contamination levels > 3 CFU/g (8.60 h). The results highlight the value of using samples that are contaminated with very low levels of L. monocytogenes for recovery and growth evaluations. The behavior of L. monocytogenes populations in milkshakes prepared from naturally contaminated ice cream linked to the listeriosis outbreak should be taken into account when performing risk based analysis using this outbreak as a case study.« less

Recovery and Growth Potential of Listeria monocytogenes in Temperature Abused Milkshakes Prepared from Naturally Contaminated Ice Cream Linked to a Listeriosis Outbreak

DOE Office of Scientific and Technical Information (OSTI.GOV)

Chen, Yi; Allard, Emma; Wooten, Anna

The recovery and growth potential of Listeria monocytogenes was evaluated in three flavors of milkshakes (vanilla, strawberry, and chocolate) that were prepared from naturally contaminated ice cream linked to a listeriosis outbreak in the U.S. in 2015, and were subsequently held at room temperature for 14 h. The average lag phase duration of L. monocytogenes was 9.05 h; the average generation time was 1.67 h; and the average population level increase per sample at 14 h was 1.14 log CFU/g. Milkshake flavors did not significantly affect these parameters. The average lag phase duration of L. monocytogenes in milkshakes with initialmore » contamination levels ≤ 3 CFU/g (9.50 h) was significantly longer (P < 0.01) than that with initial contamination levels > 3 CFU/g (8.60 h). The results highlight the value of using samples that are contaminated with very low levels of L. monocytogenes for recovery and growth evaluations. The behavior of L. monocytogenes populations in milkshakes prepared from naturally contaminated ice cream linked to the listeriosis outbreak should be taken into account when performing risk based analysis using this outbreak as a case study.« less

The population in China’s earthquake-prone areas has increased by over 32 million along with rapid urbanization

NASA Astrophysics Data System (ADS)

He, Chunyang; Huang, Qingxu; Dou, Yinyin; Tu, Wei; Liu, Jifu

2016-07-01

Accurate assessments of the population exposed to seismic hazard are crucial in seismic risk mapping. Recent rapid urbanization in China has resulted in substantial changes in the size and structure of the population exposed to seismic hazard. Using the latest population census data and seismic maps, this work investigated spatiotemporal changes in the exposure of the population in the most seismically hazardous areas (MSHAs) in China from 1990 to 2010. In the context of rapid urbanization and massive rural-to-urban migration, nearly one-tenth of the Chinese population in 2010 lived in MSHAs. From 1990 to 2010, the MSHA population increased by 32.53 million at a significantly higher rate of change (33.6%) than the national average rate (17.7%). The elderly population in MSHAs increased by 81.4%, which is much higher than the group’s national growth rate of 58.9%. Greater attention should be paid to the demographic changes in earthquake-prone areas in China.

Hepatitis C Virus in the US Military Retiree Population: To Screen, or Not to Screen?

PubMed

Laufer, Christin B; Carroll, Matthew B

2015-10-01

In 2012, the Centers for Disease Control (CDC) recommended hepatitis C virus (HCV) screening for those born between 1945 and 1965. Prior recommendations endorsed screening based on risk factors (RFs). Because United States (US) military retirees have had at least 20 years of access to free comprehensive health care, mandatory physical fitness tests, periodic health assessments and mandatory drug screening, we hypothesized that the prevalence of HCV amongst military retirees is lower than the national average. Thus the new CDC screening guidelines may not be applicable or cost effective in this particular population. A quality improvement (QI) initiative implemented the new birth-cohort CDC screening guidelines for the internal medicine (IM) clinic of our hospital (QI group). An age-matched group from the same IM clinic, screened based on RFs for HCV infection, served as the comparator (RF group). The prevalence of the anti-HCV antibody and chronic infection was determined and compared with each other and with the national average. The prevalence of the HCV antibody was 2.1% and 2.3% in the QI and RF groups, respectively (odds ratio (OR): 1.08, 95% CI: 0.37 - 3.21, P = 1.000). The prevalence of chronic infection was 0.4% and 1.8% in the QI and RF groups, respectively (OR: 4.39, 95% CI: 0.80 - 24.13, P = 0.083). When our data were compared with the national average, there were no statistical differences in the prevalence of the HCV antibody; however, there was statistically more viral clearance, and subsequently less chronic infection, in the QI group versus the national average. The military retiree population did not have a lower prevalence of the HCV antibody than the American populace whether screened based on age or traditional RFs. Thus, the CDC guidelines are applicable in this population. One interesting finding of this study is the higher rate of viral clearance in military retirees when compared with the national average. It is therefore possible that military retirees may be more likely to have natural viral eradication than the civilian population.

Intrinsic bacterial burden associated with intensive care unit hospital beds: effects of disinfection on population recovery and mitigation of potential infection risk.

PubMed

Attaway, Hubert H; Fairey, Sarah; Steed, Lisa L; Salgado, Cassandra D; Michels, Harold T; Schmidt, Michael G

2012-12-01

Commonly touched items are likely reservoirs from which patients, health care workers, and visitors may encounter and transfer microbes. A quantitative assessment was conducted of the risk represented by the intrinsic bacterial burden associated with bed rails in a medical intensive care unit (MICU), and how disinfection might mitigate this risk. Bacteria present on the rails from 36 patient beds in the MICU were sampled immediately before cleaning and at 0.5, 2.5, 4.5, and 6.5 hours after cleaning. Beds were sanitized with either a bottled disinfectant (BD; CaviCide) or an automated bulk-diluted disinfectant (ABDD; Virex II 256). The majority of bacteria recovered from the bed rails in the MICU were staphylococci, but not methicillin-resistant Staphylococcus aureus. Vancomycin-resistant enterococci were recovered from 3 beds. Bottled disinfectant reduced the average bacterial burden on the rails by 99%. However, the burden rebounded to 30% of that found before disinfection by 6.5 hours after disinfection. ABDD reduced the burden by an average of 45%, but levels rebounded within 2.5 hours. The effectiveness of both disinfectants was reflected in median reductions to burden of 98% for BD and 95% for ABDD. Cleaning with hospital-approved disinfectants reduced the intrinsic bacterial burden on bed rail surfaces by up to 99%, although the population, principally staphylococci, rebounded quickly to predisinfection levels. Copyright © 2012 Association for Professionals in Infection Control and Epidemiology, Inc. All rights reserved.

Derivation and Evaluation of a Risk-Scoring Tool to Predict Participant Attrition in a Lifestyle Intervention Project.

PubMed

Jiang, Luohua; Yang, Jing; Huang, Haixiao; Johnson, Ann; Dill, Edward J; Beals, Janette; Manson, Spero M; Roubideaux, Yvette

2016-05-01

Participant attrition in clinical trials and community-based interventions is a serious, common, and costly problem. In order to develop a simple predictive scoring system that can quantify the risk of participant attrition in a lifestyle intervention project, we analyzed data from the Special Diabetes Program for Indians Diabetes Prevention Program (SDPI-DP), an evidence-based lifestyle intervention to prevent diabetes in 36 American Indian and Alaska Native communities. SDPI-DP participants were randomly divided into a derivation cohort (n = 1600) and a validation cohort (n = 801). Logistic regressions were used to develop a scoring system from the derivation cohort. The discriminatory power and calibration properties of the system were assessed using the validation cohort. Seven independent factors predicted program attrition: gender, age, household income, comorbidity, chronic pain, site's user population size, and average age of site staff. Six factors predicted long-term attrition: gender, age, marital status, chronic pain, site's user population size, and average age of site staff. Each model exhibited moderate to fair discriminatory power (C statistic in the validation set: 0.70 for program attrition, and 0.66 for long-term attrition) and excellent calibration. The resulting scoring system offers a low-technology approach to identify participants at elevated risk for attrition in future similar behavioral modification intervention projects, which may inform appropriate allocation of retention resources. This approach also serves as a model for other efforts to prevent participant attrition.

The association between dietary zinc intake and risk of pancreatic cancer: a meta-analysis.

PubMed

Li, Li; Gai, Xuesong

2017-06-30

Previous reports have suggested a potential association on dietary zinc intake with the risk of pancreatic cancer. Since the associations between different studies were controversial, we therefore conducted a meta-analysis to reassess the relationship between dietary zinc intake and pancreatic cancer risk. A comprehensive search from the databases of PubMed, Embase, Web of Science, and Medline was performed until January 31, 2017. Relative risk (RR) with 95% confidence intervals (CI) derived by using random effect model was used. Sensitivity analysis and publication bias were conducted. Our meta-analysis was based on seven studies involving 1659 cases, including two prospective cohort studies and five case-control studies. The total RR of pancreatic cancer risk for the highest versus the lowest categories of dietary zinc intake was 0.798 (0.621-0.984), with its significant heterogeneity among studies ( I 2 =58.2%, P =0.026). The average Newcastle-Ottawa scale (NOS) score was 7.29, suggesting a high quality. There was no publication bias in the meta-analysis about dietary zinc intake on the risk of pancreatic cancer. Subgroup analyses showed that dietary zinc intake could reduce the risk of pancreatic cancer in case-control studies and among American populations. In conclusion, we found that highest category of dietary zinc intake can significantly reduce the risk of pancreatic cancer, especially among American populations. © 2017 The Author(s).

Risk factors for conduct disorder among Navajo Indian men and women.

PubMed

Kunitz, S J; Gabriel, K R; Levy, J E; Henderson, E; Lampert, K; McCloskey, J; Quintero, G; Russell, S; Vince, A

1999-04-01

To describe the risk factors for conduct disorder before age 15 among Navajo Indians. The study was based on a survey of a stratified random sample of adult Navajo Indians between the ages of 21 and 65 living on and adjacent to two different areas of the Navajo Reservation. There were 531 male and 203 female respondents. The average age (SD) of the men was 38.7 (10.5) years and of the women 35.5 (9.0) years. Conduct disorder was diagnosed retrospectively using the Diagnostic Interview Schedule first developed for the Epidemiological Catchment Area study. The responses were combined into a continuous scale. Significant risk factors for increased scores on the conduct disorder scale were: histories of physical and sexual abuse in childhood; abusive maternal drinking; a small number of households per camp; younger age; and being male rather than female. Measures of social status and religion in which subjects were raised were not significant. Many of the risk factors that are associated with conduct disorder in other populations are also risk factors in the Navajo population. There is suggestive evidence that some of these risk factors have become more common since World War II, raising the possibility that conduct disorder has become more prevalent, as is thought to be the case nationwide.

A population-based study of risk factors for severe hypoglycaemia in a contemporary cohort of childhood-onset type 1 diabetes.

PubMed

Cooper, Matthew N; O'Connell, Susan M; Davis, Elizabeth A; Jones, Timothy W

2013-10-01

Severe hypoglycaemia is a major barrier to optimising glycaemic control. Recent changes in therapy, however, may have altered the epidemiology of severe hypoglycaemia and its associated risk factors. The aim of this study was to examine the incidence rates and risk factors associated with severe hypoglycaemia in a contemporary cohort of children and adolescents with type 1 diabetes. Subjects were identified from a population-based register containing data on >99% of patients (<16 years of age) who were being treated for type 1 diabetes in Western Australia. Patients attend the clinic approximately every 3 months, where data pertaining to diabetes management, demographics and complications including hypoglycaemia are prospectively recorded. A severe hypoglycaemic event was defined as an episode of coma or convulsion associated with hypoglycaemia. Risk factors assessed included age, duration of diabetes, glycaemic control, sex, insulin therapy, socioeconomic status and calendar year. Clinical visit data from 1,770 patients, providing 8,214 patient-years of data between 2000 and 2011 were analysed. During follow-up, 841 episodes of severe hypoglycaemia were observed. No difference in risk of severe hypoglycaemia was observed between age groups. Good glycaemic control (HbA1c <7% [53 mmol/mol]) compared with the cohort average (HbA1c 8-9% [64-75 mmol/mol]) was not associated with an increased risk of severe hypoglycaemia. When compared with patients on injection regimens, subjects aged 12-18 years on pump therapy were at reduced risk of severe hypoglycaemia (incidence risk ratio 0.6; 95% CI 0.4, 0.9). In this population-based sample of children and adolescents with type 1 diabetes, contemporary therapy is associated with a changed pattern and incidence of severe hypoglycaemia.

Coffee, tea, caffeine, and risk of hypertension: The Singapore Chinese Health Study.

PubMed

Chei, Choy-Lye; Loh, Julian Kenrick; Soh, Avril; Yuan, Jian-Min; Koh, Woon-Puay

2018-06-01

The relationship between coffee and tea, and risk of hypertension remains controversial in Western populations. We investigated these associations in an Asian population. The Singapore Chinese Health Study is a population-based prospective cohort that recruited 63,257 Chinese aged 45-74 years and residing in Singapore from 1993 to 1998. Information on consumption of coffee, tea, and other lifestyle factors was collected at baseline, and self-reported physician-diagnosed hypertension was assessed during two follow-up interviews (1999-2004, 2006-2010). We identified 13,658 cases of incident hypertension after average 9.5 years. Compared to those who drank one cup of coffee/day, the hazard ratios (HR) and 95% confidence intervals (CI) were 0.87 (0.83-0.91) for

Prognostic Value of Electrocardiographic Left Ventricular Hypertrophy on Cardiovascular Risk in a Non-hypertensive Community-based Population.

PubMed

Tanaka, Kentaro; Tanaka, Fumitaka; Onoda, Toshiyuki; Tanno, Kozo; Ohsawa, Masaki; Sakata, Kiyomi; Omama, Shinichi; Ogasawara, Kuniaki; Ishibashi, Yasuhiro; Itai, Kazuyoshi; Kuribayashi, Toru; Okayama, Akira; Nakamura, Motoyuki

2018-04-06

The appearance of left ventricular hypertrophy on 12-lead electrocardiography (ECG-LVH) has been clarified to be associated with the risk of incidence of cardiovascular events (CVEs) in hypertensive individuals and the general population, but not enough in non-hypertensive individuals. A total of 4,927 non-hypertensive individuals ≥ 40 years of age who were free of CVE in the general population were followed for the incidence of CVE. ECG-LVH was defined according to criteria of the Sokolow-Lyon (SL) voltage, Cornell voltage (CV), or Cornell voltage product (CP). During the average 9.8 ± 2.0 years of follow-up, 267 individuals (5.4%) had their first CVE. The hazard ratio (HR) for the incidence of CVE after full adjustment by potential confounders significantly increased in the individuals with ECG-LVH by any criteria of the SL voltage, CV, and CP (HR = 1.77, p < 0.001) compared to those with no ECG-LVH. This association was significant also in individuals without any of obesity, dyslipidemia, and diabetes mellitus or those with systolic BP <120 mmHg and diastolic BP < 80mmHg. Furthermore, ECG-LVH by each criteria provided the reclassification improvement for the CVE risk prediction model by the Framingham 10-year risk score (the net reclassification improvement = 0.17 to 0.22, each p value < 0.010). In the absence of hypertension, ECG-LVH parameters are associated with the increased risk of developed CVEs independent of the established risk factors and provide the additional prognostic value in an assessment of the CVE risk using the traditional risk factors.

Population distribution of traditional and the emerging cardiovascular risk factors carotid plaque and IMT: the REFINE-Reykjavik study with comparison with the Tromsø study.

PubMed

Thorsson, Bolli; Eiriksdottir, Gudny; Sigurdsson, Sigurdur; Gudmundsson, Elias Freyr; Bots, Michael L; Aspelund, Thor; Arntzen, Kjell Arne; Mathiesen, Ellisiv B; Gudnason, Vilmundur

2018-05-31

Population statistics for carotid plaque and cardiovascular risk factors reported in scientific journals are usually presented as averages for the population or age and sex adjusted, rather than sex and age groups. Important population differences about atherosclerosis and cardiovascular risk factors may thus be missed. We compare the distribution of cardiovascular risk factors, carotids plaque and carotid intima-media thickness (CIMT) in two population-based studies. Carotid artery atherosclerotic plaque prevalence and risk factors levels for cardiovascular disease by sex in 5-year age groups from the Risk Evaluation For Infarct Estimates Reykjavik study (REFINE-Reykjavik study) were compared with data from the Tromsø 6 study. The threshold of carotid plaque presence in the Tromsø 6 study fell between minimal and moderate plaque defined in the REFINE-Reykjavik study reflecting carotid plaque prevalence. The prevalence of minimal carotid plaque in the REFINE-Reykjavik study was 47% in men (40-69 years old) and 38% in women and 11% in men and 7% in women of moderate plaque. The prevalence of any plaque in the Tromsø 6 study was 35% in men and 27% in women. The mean (CIMT) was similar in the studies. In the Tromsø 6 study mean systolic blood pressure was 8 mm Hg higher in men and 10 mm Hg higher in women, mean low-density lipoprotein was 0.5 mmol/L higher in men and 0.3 mmol/L higher in women and the prevalence of smoking was 4% higher in men and 9% higher in women. However, body mass index was 0.8 kg/m 2 higher in men and 0.9 kg/m 2 in women in the REFINE-Reykjavik study. Comparison between Iceland and Norway revealed differences in the prevalence of carotid plaque, which was assumed to be due to different definition of plaque. However, clinically significant differences in conventional cardiovascular risk factors were seen. This underscores the importance of detailed comparison of population data across different populations. © 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.

Geostatistical analysis of disease data: accounting for spatial support and population density in the isopleth mapping of cancer mortality risk using area-to-point Poisson kriging

PubMed Central

Goovaerts, Pierre

2006-01-01

Background Geostatistical techniques that account for spatially varying population sizes and spatial patterns in the filtering of choropleth maps of cancer mortality were recently developed. Their implementation was facilitated by the initial assumption that all geographical units are the same size and shape, which allowed the use of geographic centroids in semivariogram estimation and kriging. Another implicit assumption was that the population at risk is uniformly distributed within each unit. This paper presents a generalization of Poisson kriging whereby the size and shape of administrative units, as well as the population density, is incorporated into the filtering of noisy mortality rates and the creation of isopleth risk maps. An innovative procedure to infer the point-support semivariogram of the risk from aggregated rates (i.e. areal data) is also proposed. Results The novel methodology is applied to age-adjusted lung and cervix cancer mortality rates recorded for white females in two contrasted county geographies: 1) state of Indiana that consists of 92 counties of fairly similar size and shape, and 2) four states in the Western US (Arizona, California, Nevada and Utah) forming a set of 118 counties that are vastly different geographical units. Area-to-point (ATP) Poisson kriging produces risk surfaces that are less smooth than the maps created by a naïve point kriging of empirical Bayesian smoothed rates. The coherence constraint of ATP kriging also ensures that the population-weighted average of risk estimates within each geographical unit equals the areal data for this unit. Simulation studies showed that the new approach yields more accurate predictions and confidence intervals than point kriging of areal data where all counties are simply collapsed into their respective polygon centroids. Its benefit over point kriging increases as the county geography becomes more heterogeneous. Conclusion A major limitation of choropleth maps is the common biased visual perception that larger rural and sparsely populated areas are of greater importance. The approach presented in this paper allows the continuous mapping of mortality risk, while accounting locally for population density and areal data through the coherence constraint. This form of Poisson kriging will facilitate the analysis of relationships between health data and putative covariates that are typically measured over different spatial supports. PMID:17137504

Contrast Medium Exposure During Computed Tomography and Risk of Development of End-Stage Renal Disease in Patients With Chronic Kidney Disease

PubMed Central

Hsieh, Ming-Shun; Chiu, Chien-Shan; How, Chorng-Kuang; Chiang, Jen-Huai; Sheu, Meei-Ling; Chen, Wen-Chi; Lin, Hsuan-Jen; Hsieh, Vivian Chia-Rong; Hu, Sung-Yuan

2016-01-01

Abstract The aim of the study was to investigate the long-term association between contrast medium exposure during computed tomography (CT) and the subsequent development of end-stage renal disease (ESRD) in patients with chronic kidney disease (CKD). We conducted a population-based cohort study using Taiwan's National Health Insurance Research Database. A total of 7100 patients with nonadvanced CKD who underwent contrast medium-enhanced CT were identified and served as the study cohort. To avoid selection bias, we used the propensity score to match 7100 nonadvanced CKD patients, who underwent noncontrast medium-enhanced CT to serve as the comparison cohort. The age, sex, index year, and frequency of undergoing CTs were also matched between the study and comparison cohorts. Participants were followed until a new diagnosis of ESRD or December 31, 2011. Hazard ratios (HRs) with 95% confidence interval (95% CI) were calculated using the Cox proportional hazards regression. Contrast medium exposure was not identified as a risk factor for developing ESRD in nonadvanced CKD patients after confounders adjustment (adjusted HR = 0.91; 95% CI, 0.66–1.26; P = 0.580). We further divided the patients who underwent CTs with contrast medium use into ≤1 exposure per year on average, >1 and <2 exposure per year on average, and ≥2 exposure per year on average. After adjusting for confounders, we identified a much higher risk for developing ESRD in the 2 groups of >1 and <2 exposure per year on average and ≥2 exposure per year on average (adjusted HR = 8.13; 95% CI, 5.57–11.87 and adjusted HR = 12.08; 95% CI, 7.39–19.75, respectively) compared with the patients who underwent CTs without contrast medium use. This long-term follow-up study demonstrated that contrast medium exposure was not associated with an increased risk of ESRD development in nonadvanced CKD patients. PMID:27100424

Long-Term Blood Pressure Variability, New-Onset Diabetes Mellitus, and New-Onset Chronic Kidney Disease in the Japanese General Population.

PubMed

Yano, Yuichiro; Fujimoto, Shouichi; Kramer, Holly; Sato, Yuji; Konta, Tsuneo; Iseki, Kunitoshi; Iseki, Chiho; Moriyama, Toshiki; Yamagata, Kunihiro; Tsuruya, Kazuhiko; Narita, Ichiei; Kondo, Masahide; Kimura, Kenjiro; Asahi, Koichi; Kurahashi, Issei; Ohashi, Yasuo; Watanabe, Tsuyoshi

2015-07-01

Whether long-term blood pressure (BP) variability among individuals without diabetes mellitus is associated with new-onset chronic kidney disease (CKD) risk, independently of other BP parameters (eg, mean BP, cumulative exposure to BP) and metabolic profile changes during follow-up, remains uncertain. We used data from a nationwide study of 48 587 Japanese adults aged 40 to 74 years (mean age, 61.7 years; 39% men) without diabetes mellitus or CKD (estimated glomerular filtration rate <60 mL/min per 1.73 m2 or proteinuria by dipstick). BP was measured at baseline and during 3 annual follow-up visits (4 visits). BP variability was defined as standard deviation (SD) and average real variability during the 4 visits. At the year 3 follow-up visit, 6.3% of the population had developed CKD. In multivariable-adjusted logistic regression models, 1 SD increases in SDSBP (per 5 mmHg), SDDBP (per 3 mmHg), average real variabilitySBP (per 6 mmHg), and average real variabilityDBP (per 4 mmHg) were associated with new-onset CKD (odds ratios [ORs] and 95% confidence intervals, 1.15 [1.11-1.20], 1.08 [1.04-1.12], 1.13 [1.09-1.17], 1.06 [1.02-1.10], respectively; all P<0.01) after adjustment for clinical characteristics, and with mean BP from year 0 to year 3. The associations of SDBP and average real variabilityBP with CKD remained significant after additional adjustments for metabolic parameter changes during follow-up (ORs, 1.06-1.15; all P<0.01). Sensitivity analyses by sex, antihypertensive medication use, and the presence of hypertension showed similar conclusions. Among those in the middle-aged and elderly general population without diabetes mellitus, long-term BP variability during 3 years was associated with new-onset CKD risk, independently of mean or cumulative exposure to BP and metabolic profile changes during follow-up. © 2015 American Heart Association, Inc.

Risk factors for absenteeism due to sick leave in the petroleum industry

PubMed Central

Oenning, Nágila Soares Xavier; Carvalho, Fernando Martins; Lima, Veronica Maria Cadena

2014-01-01

OBJECTIVE To identify risk factors for absenteeism among workers with sick leave in an oil company. METHODS A case-control study (120 cases and 656 controls) nested in a retrospective cohort study following up all employees of an oil company in the North-Northeast of Brazil from 2007 to 2009. The response variable used to represent absenteeism with sick leave was the average incidence of sick leave, defined as the ratio between total sick days and potential working days in the period. Logistic regression techniques were used to investigate the association between average incidence of sick leave > 5.0% over the period and the variables sex, position, age, time at work, shift work, smoking, arterial hypertension, body mass index, physical activity, coronary risk, sleep, glycemia, non-managed diabetes, cardiovascular, digestive, musculoskeletal, neurological and neoplastic diseases, straining body positioning during work, satisfaction at work, relationship with management, and concentrated attention at work. RESULTS Average incidence of sick leave higher than 5.0% in the cohort period was 15.5%. The logistic model revealed that workers with average incidence of sick leave higher than 5.0% were 2.6 times more likely to be female; 2.0 time more likely to be smokers; 1.8 time more likely to be former smokers; 2.2 times more likely to report abnormal sleep and 10.5 times more likely to report dissatisfaction with their than workers with average incidence of sick leave ≤ 5.0% in the period. CONCLUSIONS In this population, female gender, being a smoker or a former smoker, reporting dissatisfaction with the job and reporting abnormal sleep are good predictors of occupational absenteeism with sick leave. PMID:24789643

Accounting for shared and unshared dosimetric uncertainties in the dose response for ultrasound-detected thyroid nodules after exposure to radioactive fallout.

PubMed

Land, Charles E; Kwon, Deukwoo; Hoffman, F Owen; Moroz, Brian; Drozdovitch, Vladimir; Bouville, André; Beck, Harold; Luckyanov, Nicholas; Weinstock, Robert M; Simon, Steven L

2015-02-01

Dosimetic uncertainties, particularly those that are shared among subgroups of a study population, can bias, distort or reduce the slope or significance of a dose response. Exposure estimates in studies of health risks from environmental radiation exposures are generally highly uncertain and thus, susceptible to these methodological limitations. An analysis was published in 2008 concerning radiation-related thyroid nodule prevalence in a study population of 2,994 villagers under the age of 21 years old between August 1949 and September 1962 and who lived downwind from the Semipalatinsk Nuclear Test Site in Kazakhstan. This dose-response analysis identified a statistically significant association between thyroid nodule prevalence and reconstructed doses of fallout-related internal and external radiation to the thyroid gland; however, the effects of dosimetric uncertainty were not evaluated since the doses were simple point "best estimates". In this work, we revised the 2008 study by a comprehensive treatment of dosimetric uncertainties. Our present analysis improves upon the previous study, specifically by accounting for shared and unshared uncertainties in dose estimation and risk analysis, and differs from the 2008 analysis in the following ways: 1. The study population size was reduced from 2,994 to 2,376 subjects, removing 618 persons with uncertain residence histories; 2. Simulation of multiple population dose sets (vectors) was performed using a two-dimensional Monte Carlo dose estimation method; and 3. A Bayesian model averaging approach was employed for evaluating the dose response, explicitly accounting for large and complex uncertainty in dose estimation. The results were compared against conventional regression techniques. The Bayesian approach utilizes 5,000 independent realizations of population dose vectors, each of which corresponds to a set of conditional individual median internal and external doses for the 2,376 subjects. These 5,000 population dose vectors reflect uncertainties in dosimetric parameters, partly shared and partly independent, among individual members of the study population. Risk estimates for thyroid nodules from internal irradiation were higher than those published in 2008, which results, to the best of our knowledge, from explicitly accounting for dose uncertainty. In contrast to earlier findings, the use of Bayesian methods led to the conclusion that the biological effectiveness for internal and external dose was similar. Estimates of excess relative risk per unit dose (ERR/Gy) for males (177 thyroid nodule cases) were almost 30 times those for females (571 cases) and were similar to those reported for thyroid cancers related to childhood exposures to external and internal sources in other studies. For confirmed cases of papillary thyroid cancers (3 in males, 18 in females), the ERR/Gy was also comparable to risk estimates from other studies, but not significantly different from zero. These findings represent the first reported dose response for a radiation epidemiologic study considering all known sources of shared and unshared errors in dose estimation and using a Bayesian model averaging (BMA) method for analysis of the dose response.

Minerals Intake Distributions in a Large Sample of Iranian at-Risk Population Using the National Cancer Institute Method: Do They Meet Their Requirements?

PubMed

Heidari, Zahra; Feizi, Awat; Azadbakht, Leila; Sarrafzadegan, Nizal

2015-01-01

Minerals are required for the body's normal function. The current study assessed the intake distribution of minerals and estimated the prevalence of inadequacy and excess among a representative sample of healthy middle aged and elderly Iranian people. In this cross-sectional study, the second follow up to the Isfahan Cohort Study (ICS), 1922 generally healthy people aged 40 and older were investigated. Dietary intakes were collected using 24 hour recalls and two or more consecutive food records. Distribution of minerals intake was estimated using traditional (averaging dietary intake days) and National Cancer Institute (NCI) methods, and the results obtained from the two methods, were compared. The prevalence of minerals intake inadequacy or excess was estimated using the estimated average requirement (EAR) cut-point method, the probability approach and the tolerable upper intake levels (UL). There were remarkable differences between values obtained using traditional and NCI methods, particularly in the lower and upper percentiles of the estimated intake distributions. A high prevalence of inadequacy of magnesium (50 - 100 %), calcium (21 - 93 %) and zinc (30 - 55 % for males > 50 years) was observed. Significant gender differences were found regarding inadequate intakes of calcium (21 - 76 % for males vs. 45 - 93 % for females), magnesium (92 % vs. 100 %), iron (0 vs. 15 % for age group 40 - 50 years) and zinc (29 - 55 % vs. 0 %) (all; p < 0.05). Severely imbalanced intakes of magnesium, calcium and zinc were observed among the middle-aged and elderly Iranian population. Nutritional interventions and population-based education to improve healthy diets among the studied population at risk are needed.

The Effect on Cumulative Language Acquisition Increase for English Language Learner Students in Kindergarten through Third Grade Who Attended Multiple Years of Summer Remediation Programs

ERIC Educational Resources Information Center

Baker, Gregory A.

2013-01-01

Already academically at risk, students in the rapidly growing English Language Learner (ELL) student population in the United States face additional challenges due to regression of English language acquisition over the average ten-week agrarian summer break when they return to homes in which Spanish was the primary language spoken. While the…

Adaptive web sampling.

PubMed

Thompson, Steven K

2006-12-01

A flexible class of adaptive sampling designs is introduced for sampling in network and spatial settings. In the designs, selections are made sequentially with a mixture distribution based on an active set that changes as the sampling progresses, using network or spatial relationships as well as sample values. The new designs have certain advantages compared with previously existing adaptive and link-tracing designs, including control over sample sizes and of the proportion of effort allocated to adaptive selections. Efficient inference involves averaging over sample paths consistent with the minimal sufficient statistic. A Markov chain resampling method makes the inference computationally feasible. The designs are evaluated in network and spatial settings using two empirical populations: a hidden human population at high risk for HIV/AIDS and an unevenly distributed bird population.

Dietary mineral supplies in Africa

PubMed Central

Joy, Edward J M; Ander, E Louise; Young, Scott D; Black, Colin R; Watts, Michael J; Chilimba, Allan D C; Chilima, Benson; Siyame, Edwin W P; Kalimbira, Alexander A; Hurst, Rachel; Fairweather-Tait, Susan J; Stein, Alexander J; Gibson, Rosalind S; White, Philip J; Broadley, Martin R

2014-01-01

Dietary micronutrient deficiencies (MNDs) are widespread, yet their prevalence can be difficult to assess. Here, we estimate MND risks due to inadequate intakes for seven minerals in Africa using food supply and composition data, and consider the potential of food-based and agricultural interventions. Food Balance Sheets (FBSs) for 46 countries were integrated with food composition data to estimate per capita supply of calcium (Ca), copper (Cu), iron (Fe), iodine (I), magnesium (Mg), selenium (Se) and zinc (Zn), and also phytate. Deficiency risks were quantified using an estimated average requirement (EAR) ‘cut-point’ approach. Deficiency risks are highest for Ca (54% of the population), followed by Zn (40%), Se (28%) and I (19%, after accounting for iodized salt consumption). The risk of Cu (1%) and Mg (<1%) deficiency are low. Deficiency risks are generally lower in the north and west of Africa. Multiple MND risks are high in many countries. The population-weighted mean phytate supply is 2770 mg capita−1 day−1. Deficiency risks for Fe are lower than expected (5%). However, ‘cut-point’ approaches for Fe are sensitive to assumptions regarding requirements; e.g. estimates of Fe deficiency risks are 43% under very low bioavailability scenarios consistent with high-phytate, low-animal protein diets. Fertilization and breeding strategies could greatly reduce certain MNDs. For example, meeting harvestplus breeding targets for Zn would reduce dietary Zn deficiency risk by 90% based on supply data. Dietary diversification or direct fortification is likely to be needed to address Ca deficiency risks. PMID:24524331

Comparative study on the epidemiological aspects of enterohemorrhagic Escherichia coli infections between Korea and Japan, 2006 to 2010.

PubMed

Lee, Won-Chang; Kwon, Young Hwan

2016-05-01

To compare the epidemiological aspects of enterohemorrhagic Escherichia coli (EHEC) between Korea and Japan by analyzing the current state of EHEC infection outbreaks and related risk factors. We investigated the epidemiological aspects of EHEC infection cases between Korea and Japan from 2006 to 2010. The following factors were analyzed: national prevalence rate (PR), regional prevalence rate, epidemic aspects (i.e., Cases related to gender), male to female morbidity ratio, age, and seasonal distribution. In total, there were 254 cases of EHEC with an average PR of 0.11 per 100,000 populations in Korea from 2006 to 2010. During the same period in Japan, there were 20,883 cases of EHEC with an average PR of 3.26 per 100,000 populations. The PR in Japan was significantly higher than that in Korea (p < 0.01). In both countries, more females than males had EHEC infections, with the highest incidence of infections (> 50%) observed for individuals younger than 9 years. EHEC is an emerging zoonosis and may be caused by consumption of raw or undercooked meat products from ruminants. This study provides a quantitative analysis of the epidemiological aspects and risk factors of EHEC infections in Korea and Japan and will provide insight on effective future strategies to reduce these infections.

Ambulatory blood pressure monitoring for risk stratification in obese and non-obese subjects from 10 populations.

PubMed

Hansen, T W; Thijs, L; Li, Y; Boggia, J; Liu, Y; Asayama, K; Kikuya, M; Björklund-Bodegård, K; Ohkubo, T; Jeppesen, J; Torp-Pedersen, C; Dolan, E; Kuznetsova, T; Stolarz-Skrzypek, K; Tikhonoff, V; Malyutina, S; Casiglia, E; Nikitin, Y; Lind, L; Sandoya, E; Kawecka-Jaszcz, K; Filipovský, J; Imai, Y; Wang, J; O'Brien, E; Staessen, J A

2014-09-01

Overweight clusters with high blood pressure (BP), but the independent contribution of both risk factors remains insufficiently documented. In a prospective population study involving 8467 participants (mean age 54.6 years; 47.0% women) randomly recruited from 10 populations, we studied the contribution of body mass index (BMI) to risk over and beyond BP, taking advantage of the superiority of ambulatory over conventional BP. Over 10.6 years (median), 1271 participants (15.0%) died and 1092 (12.9%), 637 (7.5%) and 443 (5.2%) experienced a fatal or nonfatal cardiovascular, cardiac or cerebrovascular event. Adjusted for sex and age, low BMI (<20.7 kg m(-2)) predicted death (hazard ratio (HR) vs average risk, 1.52; P<0.0001) and high BMI (> or = 30.9 kg m(-2)) predicted the cardiovascular end point (HR, 1.27; P=0.006). With adjustments including 24-h systolic BP, these HRs were 1.50 (P<0.001) and 0.98 (P=0.91), respectively. Across quartiles of the BMI distribution, 24-h and nighttime systolic BP predicted every end point (1.13 < or = standardized HR < or = 1.67; 0.046 < or = P<0.0001). The interaction between systolic BP and BMI was nonsignificant (P > or = .22). Excluding smokers removed the contribution of BMI categories to the prediction of mortality. In conclusion, BMI only adds to BP in risk stratification for mortality but not for cardiovascular outcomes. Smoking probably explains the association between increased mortality and low BMI.

Modeling the impact of the indigenous microbial population on the maximum population density of Salmonella on alfalfa.

PubMed

Rijgersberg, Hajo; Franz, Eelco; Nierop Groot, Masja; Tromp, Seth-Oscar

2013-07-01

Within a microbial risk assessment framework, modeling the maximum population density (MPD) of a pathogenic microorganism is important but often not considered. This paper describes a model predicting the MPD of Salmonella on alfalfa as a function of the initial contamination level, the total count of the indigenous microbial population, the maximum pathogen growth rate and the maximum population density of the indigenous microbial population. The model is parameterized by experimental data describing growth of Salmonella on sprouting alfalfa seeds at inoculum size, native microbial load and Pseudomonas fluorescens 2-79. The obtained model fits well to the experimental data, with standard errors less than ten percent of the fitted average values. The results show that the MPD of Salmonella is not only dictated by performance characteristics of Salmonella but depends on the characteristics of the indigenous microbial population like total number of cells and its growth rate. The model can improve the predictions of microbiological growth in quantitative microbial risk assessments. Using this model, the effects of preventive measures to reduce pathogenic load and a concurrent effect on the background population can be better evaluated. If competing microorganisms are more sensitive to a particular decontamination method, a pathogenic microorganism may grow faster and reach a higher level. More knowledge regarding the effect of the indigenous microbial population (size, diversity, composition) of food products on pathogen dynamics is needed in order to make adequate predictions of pathogen dynamics on various food products.

Population-based estimate of trauma-related deaths for law enforcement personnel: Risks for death are higher and increasing over time.

PubMed

Eastman, Alexander L; Cripps, Michael W; Abdelfattah, Kareem R; Inaba, Kenji; Weiser, Thomas G; Spain, David A; Staudenmayer, Kristan L

2017-08-01

Trauma-related deaths remain an important public health problem. One group susceptible to death due to traumatic mechanisms is US law enforcement (LE). We hypothesized that LE officers experienced a higher chance of violent death compared with the general US population and that risks have increased over time. The National Institute on Occupational Safety and Health National Occupational Mortality Surveillance is a population-based survey of occupational deaths. It includes data for workers who died during 1985 to 1998 in one of 30 US states (EARLY period). Additional deaths were added from 23 US states in 1999, 2003 to 2004, 2007 to 2010 (LATE period). Mortality rates are estimated by calculating proportionate mortality ratios (PMR). A PMR above 100 is considered to exceed the average background risk for all occupations. All adults older than 18 years whose primary occupation was listed as "law enforcement worker" were included in the analysis. Law enforcement personnel were more likely to die from an injury compared with the general population (Fig. 1). The overall PMR for injury in EARLY was 111 (95% confidence interval [CI], 108-114; p < 0.01), and for LATE was 118 (95% CI, 110-127; p < 0.01). Four mechanisms of death reached statistical significance: motor vehicle traffic (MVT)-driver, MVT-other, intentional self-harm, and assault/homicide. The highest PMR in EARLY was associated with firearms (PMR, 272; 95% CI, 207-350; p < 0.01). The highest PMR in LATE was associated with death due to being a driver in an MVT (PMR, 194; 95% CI, 169-222; p < 0.01). There were differences in risk of death by race and sex. White females had the highest PMR due to assault and homicide (PMR, 317; 95% CI, 164-554; p < 0.01). All groups had similar risks of death due to intentional self-harm (PMR, 130-171). The risk of death for US LE officers is high and increasing over time, suggesting an at-risk population that requires further interventions. Targeted efforts based on risk factors, such as sex and race, may assist with the development of prevention programs for this population. Epidemiologic study, level II.

Variations in influenza vaccination coverage among the high-risk population in Sweden in 2003/4 and 2004/5: a population survey

PubMed Central

Kroneman, Madelon W; van Essen, Gerrit A

2007-01-01

Background In Sweden, the vaccination campaign is the individual responsibility of the counties, which results in different arrangements. The aim of this study was to find out whether influenza vaccination coverage rates (VCRs) had increased between 2003/4 and 2004/5 among population at high risk and to find out the influence of personal preferences, demographic characteristics and health care system characteristics on VCRs. Methods An average sample of 2500 persons was interviewed each season (2003/4 and 2004/5). The respondents were asked whether they had had an influenza vaccination, whether they suffered from chronic conditions and the reasons of non-vaccination. For every county the relevant health care system characteristics were collected via a questionnaire sent to the medical officers of communicable diseases. Results No difference in VCR was found between the two seasons. Personal invitations strongly increased the chance of having had a vaccination. For the elderly, the number of different health care professionals in a region involved in administering vaccines decreased this chance. Conclusion Sweden remained below the WHO-recommendations for population at high risk due to disease. To meet the 2010 WHO-recommendation further action may be necessary to increase vaccine uptake. Increasing the number of personal invitations and restricting the number of different administrators responsible for vaccination may be effective in increasing VCRs among the elderly. PMID:17570837

Factors Influencing Cancer Risk Perception in High Risk Populations: A Systematic Review

PubMed Central

2011-01-01

Background Patients at higher than average risk of heritable cancer may process risk information differently than the general population. However, little is known about clinical, demographic, or psychosocial predictors that may impact risk perception in these groups. The objective of this study was to characterize factors associated with perceived risk of developing cancer in groups at high risk for cancer based on genetics or family history. Methods We searched Ovid MEDLINE, Ovid Embase, Ovid PsycInfo, and Scopus from inception through April 2009 for English-language, original investigations in humans using core concepts of "risk" and "cancer." We abstracted key information and then further restricted articles dealing with perceived risk of developing cancer due to inherited risk. Results Of 1028 titles identified, 53 articles met our criteria. Most (92%) used an observational design and focused on women (70%) with a family history of or contemplating genetic testing for breast cancer. Of the 53 studies, 36 focused on patients who had not had genetic testing for cancer risk, 17 included studies of patients who had undergone genetic testing for cancer risk. Family history of cancer, previous prophylactic tests and treatments, and younger age were associated with cancer risk perception. In addition, beliefs about the preventability and severity of cancer, personality factors such as "monitoring" personality, the ability to process numerical information, as well as distress/worry also were associated with cancer risk perception. Few studies addressed non-breast cancer or risk perception in specific demographic groups (e.g. elderly or minority groups) and few employed theory-driven analytic strategies to decipher interrelationships of factors. Conclusions Several factors influence cancer risk perception in patients at elevated risk for cancer. The science of characterizing and improving risk perception in cancer for high risk groups, although evolving, is still relatively undeveloped in several key topic areas including cancers other than breast and in specific populations. Future rigorous risk perception research using experimental designs and focused on cancers other than breast would advance the field. PMID:21595959

Predictors of non-vertebral fracture in older Chinese males and females: Mr. OS and Ms. OS (Hong Kong).

PubMed

Kwok, Timothy Chi Yui; Su, Yi; Khoo, Chyi Chyi; Leung, Jason; Kwok, Anthony; Orwoll, Eric; Woo, Jean; Leung, Ping Chung

2017-05-01

Clinical risk factors to predict fracture are useful in guiding management of patients with osteoporosis or falls. Clinical predictors may however be population specific because of differences in lifestyle, environment and ethnicity. Four thousand community-dwelling Chinese males and females with average ages of 72.4 and 72.6 years were followed up for incident fractures, with an average of 6.5 and 8.8 years, respectively. Clinical information was collected, and bone mineral density (BMD) measurements were carried out at baseline. Stepwise Cox regression models were used to identify risk factors of nonvertebral fractures, with BMD as covariate. Areas under the receiver-operating characteristic (ROC) curve (AUC) were compared among different risk models. The incidence rates of nonvertebral fractures were 10.3 and 20.5 per 1000 person years in males and females, respectively. In males, age ≥80, history of a fall in the past year, fracture history, chronic obstructive pulmonary disease, impaired visual depth perception and low physical health-related quality of life were significant fracture risk factors, independent of BMD. In females, the significant factors were fracture history, low visual acuity and slow narrow walking speed. The clinical risk factors had a significant influence on fracture risk irrespective of osteoporosis status, even having a better risk discrimination than BMD alone, especially in males. The best risk prediction model consisted both BMD and clinical risk factors. Clinical risk factors have additive value to hip BMD in predicting nonvertebral fractures in older Chinese people and may predict them better than BMD alone in older Chinese males.

Impact of a reduced red and processed meat dietary pattern on disease risks and greenhouse gas emissions in the UK: a modelling study.

PubMed

Aston, Louise M; Smith, James N; Powles, John W

2012-01-01

Consumption of red and processed meat (RPM) is a leading contributor to greenhouse gas (GHG) emissions, and high intakes of these foods increase the risks of several leading chronic diseases. The aim of this study was to use newly derived estimates of habitual meat intakes in UK adults to assess potential co-benefits to health and the environment from reduced RPM consumption. Modelling study using dietary intake data from the National Diet and Nutrition Survey of British Adults. British general population. Respondents were divided into fifths by energy-adjusted RPM intakes, with vegetarians constituting a sixth stratum. GHG emitted in supplying the diets of each stratum was estimated using data from life-cycle analyses. A feasible counterfactual UK population was specified, in which the proportion of vegetarians measured in the survey population doubled, and the remainder adopted the dietary pattern of the lowest fifth of RPM consumers. Reductions in risks of coronary heart disease, diabetes and colorectal cancer, and GHG emissions, under the counterfactual. Habitual RPM intakes were 2.5 times higher in the top compared with the bottom fifth of consumers. Under the counterfactual, statistically significant reductions in population aggregate risks ranged from 3.2% (95% CI 1.9 to 4.7) for diabetes in women to 12.2% (6.4 to 18.0) for colorectal cancer in men, with those moving from the highest to lowest consumption levels gaining about twice these averages. The expected reduction in GHG emissions was 0.45 tonnes CO(2) equivalent/person/year, about 3% of the current total, giving a reduction across the UK population of 27.8 million tonnes/year. Reduced consumption of RPM would bring multiple benefits to health and environment.

Boldness in two perch populations - long-term differences and the effect of predation pressure.

PubMed

Magnhagen, Carin; Hellström, Gustav; Borcherding, Jost; Heynen, Martina

2012-11-01

1. Populations of the same species often display different behaviours, for example, in their response to predators. The question is whether this difference is developed as part of a divergent selection caused by differences in predation pressure, or as a result of phenotypic responses to current environmental conditions. 2. Two populations of Eurasian perch were investigated over a time span of 6 years to see whether risk-taking behaviour in young-of-the-year perch were consistent across cohorts, or if behaviour varied over time with changes in predation regime. 3. Boldness was estimated in aquarium studies by looking at how the fish made trade-offs between foraging in a risky area and staying in shelter. Predation risk of each year and lake was estimated from fishing surveys, using an individual-based model calculating attack rates for cannibalistic perch. 4. The average boldness scores were consistently lower in perch from Fisksjön compared with those in Ängersjön, although the magnitude of the difference varied among years. Variance component analyses showed that differences between lakes in boldness scores only explained 12 per cent of the total variation. Differences between years were contributing at least similarly or more to the total variance, and the variation was higher in Fisksjön than in Ängersjön. 5. The observed risk-taking behaviour of young-of-the-year perch, compared across cohorts, was significantly correlated with the year-specific estimates of cannibalistic attack rates, with lower boldness scores in years with higher predation pressure. In Fisksjön, with significant changes over the years in population structure, the range of both predation risk and boldness scores was wider than in Ängersjön. 6. By following the two perch populations over several years, we have been able to show that the differences in risk-taking behaviour mainly are due to direct phenotypic responses to recent experience of predation risk. Long-term differences in behaviour among perch populations thus reflect consistent differences in predation regime rather than diverging inherent traits. © 2012 The Authors. Journal of Animal Ecology © 2012 British Ecological Society.

Classification of rollovers according to crash severity.

PubMed

Digges, K; Eigen, A

2006-01-01

NASS/CDS 1995-2004 was used to classify rollovers according to severity. The rollovers were partitioned into two classes - rollover as the first event and rollover preceded by an impact with a fixed or non-fixed object. The populations of belted and unbelted were examined separately and combined. The average injury rate for the unbelted was five times that for the belted. Approximately 21% of the severe injuries suffered by belted occupants were in crashes with harmful events prior to the rollover that produced severe damage to the vehicle. This group carried a much higher injury risk than the average. A planar damage measure in addition to the rollover measure was required to adequately capture the crash severity of this population. For rollovers as the first event, approximately 1% of the serious injuries to belted occupants occurred during the first quarter-turn. Rollovers that were arrested during the 1 ( st ) quarter-turn carried a higher injury rate than average. The number of quarter-turns were grouped in various ways including the number of times the vehicle roof faces the ground (number of vehicle inversions). The number of vehicle inversions was found to be a statistically significant injury predictor for 78% of the belted and unbelted populations with MAIS 3+F injuries in rollovers. The remaining 22% required crash severity metrics in addition to the number of vehicle inversions.

Classification of Rollovers According to Crash Severity

PubMed Central

Digges, K.; Eigen, A.

2006-01-01

NASS/CDS 1995–2004 was used to classify rollovers according to severity. The rollovers were partitioned into two classes – rollover as the first event and rollover preceded by an impact with a fixed or non-fixed object. The populations of belted and unbelted were examined separately and combined. The average injury rate for the unbelted was five times that for the belted. Approximately 21% of the severe injuries suffered by belted occupants were in crashes with harmful events prior to the rollover that produced severe damage to the vehicle. This group carried a much higher injury risk than the average. A planar damage measure in addition to the rollover measure was required to adequately capture the crash severity of this population. For rollovers as the first event, approximately 1% of the serious injuries to belted occupants occurred during the first quarter-turn. Rollovers that were arrested during the 1st quarter-turn carried a higher injury rate than average. The number of quarter-turns were grouped in various ways including the number of times the vehicle roof faces the ground (number of vehicle inversions). The number of vehicle inversions was found to be a statistically significant injury predictor for 78% of the belted and unbelted populations with MAIS 3+F injuries in rollovers. The remaining 22% required crash severity metrics in addition to the number of vehicle inversions. PMID:16968634

Fecal weight, colon cancer risk, and dietary intake of nonstarch polysaccharides (dietary fiber)

PubMed

Cummings, J H; Bingham, S A; Heaton, K W; Eastwood, M A

1992-12-01

Low fecal weight and slow bowel transit time are thought to be associated with bowel cancer risk, but few published data defining bowel habits in different communities exist. Therefore, data on stool weight were collected from 20 populations in 12 countries to define this risk more accurately, and the relationship between stool weight and dietary intake of nonstarch polysaccharides (NSP) (dietary fiber) was quantified. In 220 healthy U.K. adults undertaking careful fecal collections, median daily stool weight was 106 g/day (men, 104 g/day; women, 99 g/day; P = 0.02) and whole-gut transit time was 60 hours (men, 55 hours; women, 72 hours; P = 0.05); 17% of women, but only 1% of men, passed < 50 g stool/day. Data from other populations of the world show average stool weight to vary from 72 to 470 g/day and to be inversely related to colon cancer risk (r = -0.78). Meta-analysis of 11 studies in which daily fecal weight was measured accurately in 26 groups of people (n = 206) on controlled diets of known NSP content shows a significant correlation between fiber intake and mean daily stool weight (r = 0.84). Stool weight in many Westernized populations is low (80-120 g/day), and this is associated with increased colon cancer risk. Fecal output is increased by dietary NSP. Diets characterized by high NSP intake (approximately 18 g/day) are associated with stool weights of 150 g/day and should reduce the risk of bowel cancer.

Long-Term Natural History of Adult Wolff-Parkinson-White Syndrome Patients Treated With and Without Catheter Ablation.

PubMed

Bunch, T Jared; May, Heidi T; Bair, Tami L; Anderson, Jeffrey L; Crandall, Brian G; Cutler, Michael J; Jacobs, Victoria; Mallender, Charles; Muhlestein, Joseph B; Osborn, Jeffrey S; Weiss, J Peter; Day, John D

2015-12-01

There are a paucity of data about the long-term natural history of adult Wolff-Parkinson-White syndrome (WPW) patients in regard to risk of mortality and atrial fibrillation. We sought to describe the long-term outcomes of WPW patients and ascertain the impact of ablation on the natural history. Three groups of patients were studied: 2 WPW populations (ablation: 872, no ablation: 1461) and a 1:5 control population (n=11 175). Long-term mortality and atrial fibrillation rates were determined. The average follow-up for the WPW group was 7.9±5.9 (median: 6.9) years and was similar between the ablation and nonablation groups. Death rates were similar between the WPW group versus the control group (hazard ratio, 0.96; 95% confidence interval, 0.83-1.11; P=0.56). Nonablated WPW patients had a higher long-term death risk compared with ablated WPW patients (hazard ratio, 2.10; 95% confidence interval: 1.50-20.93; P<0.0001). Incident atrial fibrillation risk was higher in the WPW group compared with the control population (hazard ratio, 1.55; 95% confidence interval, 1.29-1.87; P<0.0001). Nonablated WPW patients had lower risk than ablated patients (hazard ratio, 0.39; 95% confidence interval, 0.28-0.53; P<0.0001). Long-term mortality rates in WPW patients are low and similar to an age-matched and gender-matched control population. WPW patients that underwent the multifactorial process of ablation had a lower mortality compared to nonablated WPW patients. Atrial fibrillation rates are high long-term, and ablation does not reduce this risk. © 2015 American Heart Association, Inc.

Gambling Participation, Expenditure and Risk of Harm in Australia, 1997-1998 and 2010-2011.

PubMed

Armstrong, Andrew Richard; Thomas, Anna; Abbott, Max

2018-03-01

Gambling-related harm results primarily from financial losses. Internationally Australia continues to rank as the largest spending nation per capita on gambling products. This would suggest that Australian gamblers are at disproportionately high risk of harm despite almost two decades of industry scrutiny and regulation, and investment in research, treatment and education programs. However, declines in participation rates, per capita expenditure, household expenditure, national disposable income spent on gambling and problem gambling rates have been cited as evidence that fewer people are gambling, that gamblers are spending less, and that gambling safety in Australia has improved. The current study investigated these propositions using national population and accounts data, and statistics from Australia's two population-representative gambling surveys conducted in 1997-1998 and 2010-2011. Despite a falling participation rate the study found no real change in the number of people gambling overall, and increasing numbers consuming casino table games, race wagering and sports betting. Further found were increases rather than decreases in average gambler expenditure, overall, and across most products, particularly electronic gaming machines (EGMs). Potentially risky levels of average expenditure were observed in both periods, overall and for race wagering, casino table gaming, and EGMs. Changes in the proportion of income spent on gambling suggest risks declined overall and for race wagering and casino table gaming, but increased for EGMs. Finally, while problem gambling statistics were not comparable between periods, the study found double the number of moderate risk gamblers previously estimated for 2010-2011 amongst the 2 million Australians found to have experienced one or more gambling-related problems. The findings have implications for public health policy and resourcing, and the way in which prevalence and expenditure statistics have been interpreted by researchers, government and industry in Australia and elsewhere.

Assessing the reliability of dose coefficients for exposure to radioiodine by members of the public, accounting for dosimetric and risk model uncertainties.

PubMed

Puncher, M; Zhang, W; Harrison, J D; Wakeford, R

2017-06-26

Assessments of risk to a specific population group resulting from internal exposure to a particular radionuclide can be used to assess the reliability of the appropriate International Commission on Radiological Protection (ICRP) dose coefficients used as a radiation protection device for the specified exposure pathway. An estimate of the uncertainty on the associated risk is important for informing judgments on reliability; a derived uncertainty factor, UF, is an estimate of the 95% probable geometric difference between the best risk estimate and the nominal risk and is a useful tool for making this assessment. This paper describes the application of parameter uncertainty analysis to quantify uncertainties resulting from internal exposures to radioiodine by members of the public, specifically 1, 10 and 20-year old females from the population of England and Wales. Best estimates of thyroid cancer incidence risk (lifetime attributable risk) are calculated for ingestion or inhalation of 129 I and 131 I, accounting for uncertainties in biokinetic model and cancer risk model parameter values. These estimates are compared with the equivalent ICRP derived nominal age-, sex- and population-averaged estimates of excess thyroid cancer incidence to obtain UFs. Derived UF values for ingestion or inhalation of 131 I for 1 year, 10-year and 20-year olds are around 28, 12 and 6, respectively, when compared with ICRP Publication 103 nominal values, and 9, 7 and 14, respectively, when compared with ICRP Publication 60 values. Broadly similar results were obtained for 129 I. The uncertainties on risk estimates are largely determined by uncertainties on risk model parameters rather than uncertainties on biokinetic model parameters. An examination of the sensitivity of the results to the risk models and populations used in the calculations show variations in the central estimates of risk of a factor of around 2-3. It is assumed that the direct proportionality of excess thyroid cancer risk and dose observed at low to moderate acute doses and incorporated in the risk models also applies to very small doses received at very low dose rates; the uncertainty in this assumption is considerable, but largely unquantifiable. The UF values illustrate the need for an informed approach to the use of ICRP dose and risk coefficients.

Population dose commitments due to radioactive releases from nuclear power plant sites in 1988

DOE Office of Scientific and Technical Information (OSTI.GOV)

Baker, D.A.

Population radiation dose commitments have been estimated from reported radionuclide releases from commercial power reactors operating during 1988. Fifty-year commitments for a one-year exposure from both liquid and atmospheric releases were calculated for four population groups (infant, child, teen-ager and adult) residing between 2 and 80 km from each of 71 reactor sites. This report tabulates the results of these calculations, showing the dose commitments for both water and airborne pathways for each age group and organ. Also included for each of the sites is a histogram showing the fraction of the total population within 2 to 80 km aroundmore » each site receiving various average dose commitments from the airborne pathways. The total collective dose commitments (from both liquid and airborne pathways) for each site ranged from a high of 16 person-rem to a low of 0.0011 person-rem for the sites with plants operating throughout the year with an arithmetic mean of 1.1 person-rem. The total population dose for all sites was estimated at 75 person-rem for the 150 million people considered at risk. The site average individual dose commitment from all pathways ranged from a low of 3 {times} 10{sup {minus}7} mrem to a high of 0.02 mrem. No attempt was made in this study to determine the maximum dose commitment received by any one individual from the radionuclides released at any of the sites. However, licensee calculation of doses to the maximally exposed individual at some sites indicated values of up to approximately 100 times average individual doses (on the order of a few millirem per year).« less

Population dose commitments due to radioactive releases from nuclear power plant sites in 1988. Volume 10

DOE Office of Scientific and Technical Information (OSTI.GOV)

Baker, D.A.

Population radiation dose commitments have been estimated from reported radionuclide releases from commercial power reactors operating during 1988. Fifty-year commitments for a one-year exposure from both liquid and atmospheric releases were calculated for four population groups (infant, child, teen-ager and adult) residing between 2 and 80 km from each of 71 reactor sites. This report tabulates the results of these calculations, showing the dose commitments for both water and airborne pathways for each age group and organ. Also included for each of the sites is a histogram showing the fraction of the total population within 2 to 80 km aroundmore » each site receiving various average dose commitments from the airborne pathways. The total collective dose commitments (from both liquid and airborne pathways) for each site ranged from a high of 16 person-rem to a low of 0.0011 person-rem for the sites with plants operating throughout the year with an arithmetic mean of 1.1 person-rem. The total population dose for all sites was estimated at 75 person-rem for the 150 million people considered at risk. The site average individual dose commitment from all pathways ranged from a low of 3 {times} 10{sup {minus}7} mrem to a high of 0.02 mrem. No attempt was made in this study to determine the maximum dose commitment received by any one individual from the radionuclides released at any of the sites. However, licensee calculation of doses to the maximally exposed individual at some sites indicated values of up to approximately 100 times average individual doses (on the order of a few millirem per year).« less

Rewriting the narrative of the epidemiology of HIV in sub-Saharan Africa.

PubMed

Baral, Stefan; Phaswana-Mafuya, Nancy

2012-01-01

The fight against HIV remains complicated with contracting donor resources and high burden of HIV among reproductive age adults still often limiting independent economic development. In the widespread HIV epidemics of sub-Saharan Africa (SSA), it is proposed that key populations with specific HIV acquisition and transmission risk factors, such as men who have sex with men (MSM), female sex workers (FSW), and people who use drugs (PUD), are less relevant because HIV transmission is sustained in the general population with average HIV acquisition and transmission risks. However, the understanding that key populations are less relevant in the epidemics of Africa is based on the surveillance system from which these populations are mostly excluded. Outside of SSA, the epidemics of HIV are generally concentrated in the same populations that are excluded from the primary HIV surveillance systems in SSA. The manuscripts included in this special issue present convincing data that FSW, MSM, and PUD carry disproportionate burdens of HIV wherever studied in SSA, are underrepresented in HIV programs and research, and require specific HIV prevention services. These manuscripts collectively suggest that the only effective path forward is one that transcends denial and stigma and focuses on systematically collecting data on all populations at risk for HIV. In addition, there is a need to move to a third generation of HIV surveillance as the current one inadvertently devalues HIV surveillance among key populations in the context of widespread HIV epidemics. Overall, the data reviewed here demonstrate that the dynamics of HIV in Africa are complex and achieving an AIDS-free generation necessitates acceptance of that complexity in all HIV surveillance, research, and prevention, treatment, and care programs.

Impacts of rising sea temperature on krill increase risks for predators in the Scotia Sea.

PubMed

Klein, Emily S; Hill, Simeon L; Hinke, Jefferson T; Phillips, Tony; Watters, George M

2018-01-01

Climate change is a threat to marine ecosystems and the services they provide, and reducing fishing pressure is one option for mitigating the overall consequences for marine biota. We used a minimally realistic ecosystem model to examine how projected effects of ocean warming on the growth of Antarctic krill, Euphausia superba, might affect populations of krill and dependent predators (whales, penguins, seals, and fish) in the Scotia Sea. We also investigated the potential to mitigate depletion risk for predators by curtailing krill fishing at different points in the 21st century. The projected effects of ocean warming on krill biomass were strongest in the northern Scotia Sea, with a ≥40% decline in the mass of individual krill. Projections also suggest a 25% chance that krill biomass will fall below an established depletion threshold (75% of its unimpacted level), with consequent risks for some predator populations, especially penguins. Average penguin abundance declined by up to 30% of its unimpacted level, with up to a 50% chance of falling below the depletion threshold. Simulated krill fishing at currently permitted harvest rates further increased risks for depletion, and stopping fishing offset the increased risks associated with ocean warming in our model to some extent. These results varied by location and species group. Risk reductions at smaller spatial scales also differed from those at the regional level, which suggests that some predator populations may be more vulnerable than others to future changes in krill biomass. However, impacts on predators did not always map directly to those for krill. Our findings indicate the importance of identifying vulnerable marine populations and targeting protection measures at appropriate spatial scales, and the potential for spatially-structured management to avoid aggravating risks associated with rising ocean temperatures. This may help balance tradeoffs among marine ecosystem services in an uncertain future.

Impacts of rising sea temperature on krill increase risks for predators in the Scotia Sea

PubMed Central

Hill, Simeon L.; Hinke, Jefferson T.; Phillips, Tony; Watters, George M.

2018-01-01

Climate change is a threat to marine ecosystems and the services they provide, and reducing fishing pressure is one option for mitigating the overall consequences for marine biota. We used a minimally realistic ecosystem model to examine how projected effects of ocean warming on the growth of Antarctic krill, Euphausia superba, might affect populations of krill and dependent predators (whales, penguins, seals, and fish) in the Scotia Sea. We also investigated the potential to mitigate depletion risk for predators by curtailing krill fishing at different points in the 21st century. The projected effects of ocean warming on krill biomass were strongest in the northern Scotia Sea, with a ≥40% decline in the mass of individual krill. Projections also suggest a 25% chance that krill biomass will fall below an established depletion threshold (75% of its unimpacted level), with consequent risks for some predator populations, especially penguins. Average penguin abundance declined by up to 30% of its unimpacted level, with up to a 50% chance of falling below the depletion threshold. Simulated krill fishing at currently permitted harvest rates further increased risks for depletion, and stopping fishing offset the increased risks associated with ocean warming in our model to some extent. These results varied by location and species group. Risk reductions at smaller spatial scales also differed from those at the regional level, which suggests that some predator populations may be more vulnerable than others to future changes in krill biomass. However, impacts on predators did not always map directly to those for krill. Our findings indicate the importance of identifying vulnerable marine populations and targeting protection measures at appropriate spatial scales, and the potential for spatially-structured management to avoid aggravating risks associated with rising ocean temperatures. This may help balance tradeoffs among marine ecosystem services in an uncertain future. PMID:29385153

Population- and individual-specific regulatory variation in Sardinia.

PubMed

Pala, Mauro; Zappala, Zachary; Marongiu, Mara; Li, Xin; Davis, Joe R; Cusano, Roberto; Crobu, Francesca; Kukurba, Kimberly R; Gloudemans, Michael J; Reinier, Frederic; Berutti, Riccardo; Piras, Maria G; Mulas, Antonella; Zoledziewska, Magdalena; Marongiu, Michele; Sorokin, Elena P; Hess, Gaelen T; Smith, Kevin S; Busonero, Fabio; Maschio, Andrea; Steri, Maristella; Sidore, Carlo; Sanna, Serena; Fiorillo, Edoardo; Bassik, Michael C; Sawcer, Stephen J; Battle, Alexis; Novembre, John; Jones, Chris; Angius, Andrea; Abecasis, Gonçalo R; Schlessinger, David; Cucca, Francesco; Montgomery, Stephen B

2017-05-01

Genetic studies of complex traits have mainly identified associations with noncoding variants. To further determine the contribution of regulatory variation, we combined whole-genome and transcriptome data for 624 individuals from Sardinia to identify common and rare variants that influence gene expression and splicing. We identified 21,183 expression quantitative trait loci (eQTLs) and 6,768 splicing quantitative trait loci (sQTLs), including 619 new QTLs. We identified high-frequency QTLs and found evidence of selection near genes involved in malarial resistance and increased multiple sclerosis risk, reflecting the epidemiological history of Sardinia. Using family relationships, we identified 809 segregating expression outliers (median z score of 2.97), averaging 13.3 genes per individual. Outlier genes were enriched for proximal rare variants, providing a new approach to study large-effect regulatory variants and their relevance to traits. Our results provide insight into the effects of regulatory variants and their relationship to population history and individual genetic risk.

Discrete event simulation model of sudden cardiac death predicts high impact of preventive interventions.

PubMed

Andreev, Victor P; Head, Trajen; Johnson, Neil; Deo, Sapna K; Daunert, Sylvia; Goldschmidt-Clermont, Pascal J

2013-01-01

Sudden Cardiac Death (SCD) is responsible for at least 180,000 deaths a year and incurs an average cost of $286 billion annually in the United States alone. Herein, we present a novel discrete event simulation model of SCD, which quantifies the chains of events associated with the formation, growth, and rupture of atheroma plaques, and the subsequent formation of clots, thrombosis and on-set of arrhythmias within a population. The predictions generated by the model are in good agreement both with results obtained from pathological examinations on the frequencies of three major types of atheroma, and with epidemiological data on the prevalence and risk of SCD. These model predictions allow for identification of interventions and importantly for the optimal time of intervention leading to high potential impact on SCD risk reduction (up to 8-fold reduction in the number of SCDs in the population) as well as the increase in life expectancy.

National-Level Multi-Hazard Risk Assessments in Sub-Saharan Africa

NASA Astrophysics Data System (ADS)

Murnane, R. J.; Balog, S.; Fraser, S. A.; Jongman, B.; Van Ledden, M.; Phillips, E.; Simpson, A.

2017-12-01

National-level risk assessments can provide important baseline information for decision-making on risk management and risk financing strategies. In this study, multi-hazard risk assessments were undertaken for 9 countries in Sub-Saharan Africa: Cape Verde, Ethiopia, Kenya, Niger, Malawi, Mali, Mozambique, Senegal and Uganda. The assessment was part of the Building Disaster Resilience in Sub-Saharan Africa Program and aimed at supporting the development of multi-risk financing strategies to help African countries make informed decisions to mitigate the socio-economic, fiscal and financial impacts of disasters. The assessments considered hazards and exposures consistent with the years 2010 and 2050. We worked with multiple firms to develop the hazard, exposure and vulnerability data and the risk results. The hazards include: coastal flood, drought, earthquake, landslide, riverine flood, tropical cyclone wind and storm surge, and volcanoes. For hazards expected to vary with climate, the 2050 hazard is based on the IPCC RCP 6.0. Geolocated exposure data for 2010 and 2050 at a 15 arc second ( 0.5 km) resolution includes: structures as a function of seven development patterns; transportation networks including roads, bridges, tunnels and rail; critical facilities such as schools, hospitals, energy facilities and government buildings; crops; population; and, gross domestic product (GDP). The 2050 exposure values for population are based on the IPCC SSP 2. Values for other exposure data are a function of population change. Vulnerability was based on openly available vulnerability functions. Losses were based on replacement values (e.g., cost/m2 or cost/km). Risk results are provided in terms of annual average loss and a variety of return periods at the national and Admin 1 levels. Assessments of recent historical events are used to validate the model results. In the future, it would be useful to use hazard footprints of historical events for validation purposes. The results will be visualized in a set of national risk profile documents intended to form the basis for conversations with governments on risk reduction and risk financing strategies.

Local variations in the timing of RSV epidemics.

PubMed

Noveroske, Douglas B; Warren, Joshua L; Pitzer, Virginia E; Weinberger, Daniel M

2016-11-11

Respiratory syncytial virus (RSV) is a primary cause of hospitalizations in children worldwide. The timing of seasonal RSV epidemics needs to be known in order to administer prophylaxis to high-risk infants at the appropriate time. We used data from the Connecticut State Inpatient Database to identify RSV hospitalizations based on ICD-9 diagnostic codes. Harmonic regression analyses were used to evaluate RSV epidemic timing at the county level and ZIP code levels. Linear regression was used to investigate associations between the socioeconomic status of a locality and RSV epidemic timing. 9,740 hospitalizations coded as RSV occurred among children less than 2 years old between July 1, 1997 and June 30, 2013. The earliest ZIP code had a seasonal RSV epidemic that peaked, on average, 4.64 weeks earlier than the latest ZIP code. Earlier epidemic timing was significantly associated with demographic characteristics (higher population density and larger fraction of the population that was black). Seasonal RSV epidemics in Connecticut occurred earlier in areas that were more urban (higher population density and larger fraction of the population that was). These findings could be used to better time the administration of prophylaxis to high-risk infants.

Anticholinergic Risk and Frequency of Anticholinergic Drug Prescriptions in a Population Older Than 65.

PubMed

Machado-Alba, Jorge Enrique; Castro-Rodríguez, Alejandro; Álzate-Piedrahita, John Alexander; Hoyos-Pulgarín, Julián Andrés; Medina-Morales, Diego Alejandro

2016-03-01

To determine the risk and frequency of anticholinergic drug prescriptions in a population affiliated with the Colombian General System of Social Security in Health. A cross-sectional study was conducted in 2013. Patients older than 65 years who received drugs with the potential to block cholinergic receptors, in accordance with an anticholinergic risk scale. The total anticholinergic load was determined by the sum of the risk of each prescribed drug. The study included a total of 27,654 patients with a mean age of 76.1 ± 7.6 years, and 61.9% were women. A total of 9.1% of the population older than 65 years had received a prescription of at least one of these drugs, and the prevalence of these prescriptions was 112.5 per 1000 members. The average number of drugs prescribed per patient was 1.4, and the drugs most frequently prescribed contained trazodone, methocarbamol, and loratadine. Being prescribed by practitioners of surgical or related specialties was the only variable significantly associated with prescriptions with high anticholinergic risk in the multivariate analysis (odds ratio 1.61; 95% confidence interval 1.335-1.934; P < .001). We found a high frequency of prescription medications with some degree of anticholinergic load, and in almost half of the patients, the anticholinergic risk score was very high. The prevalence of prescription of these drugs falls in the range of that reported globally. It is essential to educate prescribers about the risk to their patients. Copyright © 2016 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

Lifetime risk of developing coronary heart disease in Aboriginal Australians: a cohort study.

PubMed

Wang, Zhiqiang; Hoy, Wendy E

2013-01-30

Lifetime risk of coronary heart disease (CHD) is an important yardstick by which policy makers, clinicians and the general public can assess and promote the awareness and prevention of CHD. The lifetime risk in Aboriginal people is not known. Using a cohort with up to 20 years of follow-up, we estimated the lifetime risk of CHD in Aboriginal people. A cohort study. A remote Aboriginal region. 1115 Aboriginal people from one remote tribal group who were free from CHD at baseline were followed for up to 20 years. During the follow-up period, new CHD incident cases were identified through hospital and death records. We estimated the lifetime risks of CHD with and without adjusting for the presence of competing risk of death from non-CHD causes. Participants were followed up for 17 126 person-years, during which 185 developed CHD and 144 died from non-CHD causes. The average age at which the first CHD event occurred was 48 years for men and 49 years for women. The risk of developing CHD increased with age until 60 years and then decreased with age. Lifetime cumulative risk without adjusting for competing risk was 70.7% for men and 63.8% for women. Adjusting for the presence of competing risk of death from non-CHD causes, the lifetime risk of CHD was 52.6% for men and 49.2% for women. Lifetime risk of CHD is as high as one in two in both Aboriginal men and women. The average age of having first CHD events was under 50 years, much younger than that reported in non-Aboriginal populations. Our data provide useful knowledge for health education, screening and prevention of CHD in Aboriginal people.

Spatio-Temporal Migration Patterns of Pacific Salmon Smolts in Rivers and Coastal Marine Waters

PubMed Central

Melnychuk, Michael C.; Welch, David W.; Walters, Carl J.

2010-01-01

Background Migrations allow animals to find food resources, rearing habitats, or mates, but often impose considerable predation risk. Several behavioural strategies may reduce this risk, including faster travel speed and taking routes with shorter total distance. Descriptions of the natural range of variation in migration strategies among individuals and populations is necessary before the ecological consequences of such variation can be established. Methodology/Principal Findings Movements of tagged juvenile coho, steelhead, sockeye, and Chinook salmon were quantified using a large-scale acoustic tracking array in southern British Columbia, Canada. Smolts from 13 watersheds (49 watershed/species/year combinations) were tagged between 2004–2008 and combined into a mixed-effects model analysis of travel speed. During the downstream migration, steelhead were slower on average than other species, possibly related to freshwater residualization. During the migration through the Strait of Georgia, coho were slower than steelhead and sockeye, likely related to some degree of inshore summer residency. Hatchery-reared smolts were slower than wild smolts during the downstream migration, but after ocean entry, average speeds were similar. In small rivers, downstream travel speed increased with body length, but in the larger Fraser River and during the coastal migration, average speed was independent of body length. Smolts leaving rivers located towards the northern end of the Strait of Georgia ecosystem migrated strictly northwards after ocean entry, but those from rivers towards the southern end displayed split-route migration patterns within populations, with some moving southward. Conclusions/Significance Our results reveal a tremendous diversity of behavioural migration strategies used by juvenile salmon, across species, rearing histories, and habitats, as well as within individual populations. During the downstream migration, factors that had strong effects on travel speeds included species, wild or hatchery-rearing history, watershed size and, in smaller rivers, body length. During the coastal migration, travel speeds were only strongly affected by species differences. PMID:20886121

[Intake of vitamins D and K, and their impact on health in female population].

PubMed

Navia Lombán, Beatriz; Cuadrado Soto, Esther; Ortega, Rosa M

2015-07-18

Vitamins D and K are essential for maintaining bone and its deficiency has been associated with several chronic diseases. To know the intake of vitamins D and K in female population and analyze their involvement on health. Literature research regarding the topic. Intake of vitamin D in the Spanish female population from 17 to 60 years is lower than the estimated average requirement in the 95.5% of the studied participants and 30.2% of the Spanish population does not meet the established adequate intake for vitamin K. Several studies have emphasized the importance of maintaining optimal nutrition status of vitamin D for its role in the maintenance of bone, but also for its involvement in body weight control and prevention of diseases (cardiovascular disease, type 2 diabetes, cancer). Vitamin K deficiency is also associated with decreased bone density and increased cardiovascular risk besides exerting a protective effect against type 2 diabetes. In female population, the intake of vitamin K, but especially vitamin D, is often lower than recommended. Since a worse nutritional status in these vitamins is associated with damage in bone health, weight control, as well as an increased risk of several diseases, it seems appropriate to monitor and improve their intake. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.

Social safety and medical maintenance of the labour pool in surveillance areas of the nuclear power plants.

PubMed

Prylipko, V A; Ozerova, Yu Yu; Kotsubinskij, O V; Morozova, M M; Petrychenko, O O; Bondarenko, I V

2017-12-01

To study the contentment of population of NPP surveillance areas i.e. monitoring zones with specific components of quality of life, namely the social security, medical care, and socio economic compensation of risk. A sociological study of public opinion about the specific components of quality of life has been conducted in population of the NPP monitoring zone. A questionnaire with independent question blocks was developed. A non repeatable probabilistic selection was applied in population opinion poll. The sampled population was calculated on the basis of the total population living in the NPP monitoring zone. Sample error not exceeded 7.0%. A comparative assessment of the responses of various groups of the able bodied population on issues of social security, medical care, socio economic compensation of risk and analysis of statistical data for 2011-2015 on the resource potential of medical facility of the nuclear power plant overspill town has been conducted. The safety and security status is rated at below the average. Documents regulating the life safety of pop ulation of NPP monitoring zone provide them no confidence in their security. Probability estimates of man made accidents are higher in urban population and depend on education level. The socialized health care is assessed on low and average levels according to the studied parameters. Among the types of medical care the providing of nec essary medical goods, preventive examinations, scheduled medical examination service, ambulance activity, and medical psychological aid need to be improved. There was no significant change in resource potential of special ized healthcare infirmary of NPP overspill town for the last 5 years. Low rating by the monitoring zone population of work efficiency of health facilities is determined by a set of factors, some of which lies in the plane of state socio economic problems. Choice priority of the direct sub ventions in population of monitoring zone depends on the place of residence and occupation. Provisions on social security, protection and medical care of population of the NPP monitoring zones in Ukraine do not correspond to European standards and require a revision. V.A. Prylipko, Yu.Yu. Ozerova, O.V. Kotsubinskij, M.M. Morozova, O.O. Petrychenko, I.V. Bondarenko.

Spatial study of mortality in motorcycle accidents in the State of Pernambuco, Northeastern Brazil.

PubMed

Silva, Paul Hindenburg Nobre de Vasconcelos; Lima, Maria Luiza Carvalho de; Moreira, Rafael da Silveira; Souza, Wayner Vieira de; Cabral, Amanda Priscila de Santana

2011-04-01

To analyze the spatial distribution of mortality due to motorcycle accidents in the state of Pernambuco, Northeastern Brazil. A population-based ecological study using data on mortality in motorcycle accidents from 01/01/2000 to 31/12/2005. The analysis units were the municipalities. For the spatial distribution analysis, an average mortality rate was calculated, using deaths from motorcycle accidents recorded in the Mortality Information System as the numerator, and as the denominator the population of the mid-period. Spatial analysis techniques, mortality smoothing coefficient estimate by the local empirical Bayesian method and Moran scatterplot, applied to the digital cartographic base of Pernambuco were used. The average mortality rate for motorcycle accidents in Pernambuco was 3.47 per 100 thousand inhabitants. Of the 185 municipalities, 16 were part of five clusters identified with average mortality rates ranging from 5.66 to 11.66 per 100 thousand inhabitants, and were considered critical areas. Three clusters are located in the area known as sertão and two in the agreste of the state. The risk of dying from a motorcycle accident is greater in conglomerate areas outside the metropolitan axis, and intervention measures should consider the economic, social and cultural contexts.

Population dose commitments due to radioactive releases from nuclear-power-plant sites in 1978

DOE Office of Scientific and Technical Information (OSTI.GOV)

Peloquin, R.A.; Schwab, J.D.; Baker, D.A.

Population radiation dose commitments have been estimated from reported radionuclide releases from commercial power reactors operating during 1978. Fifty-year dose commitments from a one-year exposure were calculated from both liquid and atmospheric releases for four population groups (infant, child, teen-ager and adult) residing between 2 and 80 km from each site. This report tabulates the results of these calculations, showing the dose commitments for both liquid and airborne pathways for each age group and organ. Also included for each site is a histogram showing the fraction of the total population within 2 to 80 km around each site receiving variousmore » average dose commitments from the airborne pathways. The total dose commitment from both liquid and airborne pathways ranged from a high of 200 person-rem to a low of 0.0004 person-rem with an arithmetic mean of 14 person-rem. The total population dose for allsites was estimated at 660 person-rem for the 93 million people considered at risk. The average individual dose commitment from all pathways on a site basis ranged from a low of 3 x 10/sup -6/ mrem to a high of 0.08 mrem. No attempt was made in this study to determine the maximum dose commitment received by any one individual from the radionuclides released at any of the sites.« less

Population dose commitments due to radioactive releases from Nuclear-Power-Plant Sites in 1979

DOE Office of Scientific and Technical Information (OSTI.GOV)

Baker, D.A.; Peloquin, R.A.

Population radiation dose commitments have been estimated from reported radionuclide releases from commercial power reactors operating during 1979. Fifty-year dose commitments from a one-year exposure were calculated from both liquid and atmospheric releases for four population groups (infant, child, teen-ager and adult) residing between 2 and 80 km from each site. This report tabulates the results of these calculations, showing the dose commitments for both liquid and airborne pathways for each age group and organ. Also included for each site is a histogram showing the fraction of the total population within 2 to 80 km around each site receiving variousmore » average dose commitments from the airborne pathways. The total dose commitment from both liquid and airborne pathways ranged from a high of 1300 person-rem to a low of 0.0002 person-rem with an arithmetic mean of 38 person-rem. The total population dose for all sites was estimated at 1800 person-rem for the 94 million people considered at risk. The average individual dose commitment from all pathways on a site basis ranged from a low of 2 x 10/sup -6/ mrem to a high of 0.7 mrem. No attempt was made in this study to determine the maximum dose commitment received by any one individual from the radionuclides released at any of the sites.« less

Population Dose Commitments Due to Radioactive Releases from Nuclear Power Plant Sites in 1977

DOE Office of Scientific and Technical Information (OSTI.GOV)

Baker, D. A.

Population radiation dose commitments have been estimated from reported radionuclide releases from commercial power reactors operating during 1977. Fifty-year dose commitments from a one-year exposure were calculated from both liquid and atmospheric releases for four population groups (infant, child, teen-ager and adult) residing between 2 and 80 km from each site. This report tabulates the results of these calculations, showing the dose commitments for both liquid and airborne pathways for each age group and organ, Also included for each site is a histogram showing the fraction of the total population within 2 to 80 km around each site receiving variousmore » average dose commitments from the airborne pathways. The total dose commitment from both liquid and airborne pathways ranged from a high of 220 person-rem to a low of 0.003 person-rem with an arithmetic mean of 16 person-rem. The total population dose for all sites was estimated at 700 person-rem for the 92 million people considered at risk. The average individual dose commitment from all pathways on a site basis ranged from a low of 2 x 10{sup -5} mrem to a high of 0.1 mrem. No attempt was made in this study to determine the maximum dose commitment received by any one individual from the radionuclides released at any of the sites.« less

Cold periods and coronary events: an analysis of populations worldwide

PubMed Central

Barnett, A.; Dobson, A.; McElduff, P.; Salomaa, V.; Kuulasmaa, K.; Sans, S.; t for

2005-01-01

Study objective: To investigate the association between cold periods and coronary events, and the extent to which climate, sex, age, and previous cardiac history increase risk during cold weather. Design: A hierarchical analyses of populations from the World Health Organisation's MONICA project. Setting: Twenty four populations from the WHO's MONICA project, a 21 country register made between 1980 and 1995. Patients: People aged 35–64 years who had a coronary event. Main results: Daily rates of coronary events were correlated with the average temperature over the current and previous three days. In cold periods, coronary event rates increased more in populations living in warm climates than in populations living in cold climates, where the increases were slight. The increase was greater in women than in men, especially in warm climates. On average, the odds for women having an event in the cold periods were 1.07 higher than the odds for men (95% posterior interval: 1.03 to 1.11). The effects of cold periods were similar in those with and without a history of a previous myocardial infarction. Conclusions: Rates of coronary events increased during comparatively cold periods, especially in warm climates. The smaller increases in colder climates suggest that some events in warmer climates are preventable. It is suggested that people living in warm climates, particularly women, should keep warm on cold days. PMID:15965137

Focused study of interweaving hazards across the Caribbean

NASA Astrophysics Data System (ADS)

Braun, John J.; Mattioli, Glen S.; Calais, Eric; Carlson, David; Dixon, Timothy H.; Jackson, Michael E.; Kursinski, E. Robert; Mora-Paez, Hector; Miller, M. Meghan; Pandya, Rajul; Robertson, Richard; Wang, Guoquan

2012-02-01

The Caribbean is a region of lush vegetation, beaches, active volcanoes, and significant mountain ranges, all of which create a natural aesthetic that is recognized globally. Yet these very same features, molded through geological, oceanic, and atmospheric processes, also pose natural hazards for the developing countries in the Caribbean. The rise in population density, migration to coastal areas, and substandard building practices, combined with the threat of natural hazards, put the region's human population at risk for particularly devastating disasters. These demographic and social characteristics exist against a backdrop of the threat of an evolving climate, which produces a more vigorous hurricane environment and a rising average sea level.

Nurse's Desk: food bank-based outreach and screening to decrease unmet referral needs.

PubMed

Larsson, Laura S; Kuster, Emilie

2013-01-01

The Nurse's Desk health screening project used the Intervention Wheel model to conduct outreach, screening, education, and referral for food bank clients (n = 506). Blood glucose, blood pressure, health care utilization, and unmet referral needs were assessed. Screening results identified 318 clients (62.8%) with 1 or more unmet referral needs, including 6 clients (3.16%) with capillary blood glucose more than 199 mg/dL and 132 (31.9%) with hypertension. Clients had higher-than-average systolic and diastolic blood pressures and undiagnosed diabetes than in the general population. A client-approved method for tracking completed referrals is needed for this potentially high-risk population.

Relationship of soil terrestrial radionuclide concentrations and the excess of lifetime cancer risk in western Mazandaran Province, Iran.

PubMed

Abbaspour, M; Moattar, F; Okhovatian, A; Kharrat Sadeghi, M

2010-12-01

The main goal of this study is to lay out the map of the soil radionuclide activity concentrations and the terrestrial outdoor gamma dose rates in the western Mazandaran Province of Iran, and to present an evaluation scheme. Mazandaran Province was selected due to its special geographical characteristics, high population density and the long terrestrial and aquatic borders with the neighbouring countries possessing nuclear facilities. A total of 54 topsoil samples were collected, ranging from the Nour to Ramsar regions, and were based on geological conditions, vegetation coverage and the sampling standards outlined by the International Atomic Energy Agency. The excess lifetime cancer risks (ELCRs) were evaluated and the coordinates of sampling locations were determined by the global positioning system. The average terrestrial outdoor gamma dose rate was 612.38 ± 3707.93 nGy h(-1), at 1 m above the ground. The annual effective gamma dose at the western part of Mazandaran Province was 750 μSv, and the ELCR was 0.26 × 10(-2). Soil samples were analysed by gamma spectrometry with a high-purity germanium detector. The average (226)Ra, (232)Th, (40)K and (137)Cs activities were 1188.50 ± 7838.40, 64.92 ± 162.26, 545.10 ± 139.42 and 10.41 ± 7.86 Bq kg(-1), respectively. The average soil radionuclide concentrations at the western part of Mazandaran Province were higher than the worldwide range. The excess lifetime risks of cancer and the annual effective gamma doses were also higher than the global average.

Mapping asthma-associated variants in admixed populations

PubMed Central

Mersha, Tesfaye B.

2015-01-01

Admixed populations arise when two or more previously isolated populations interbreed. Mapping asthma susceptibility loci in an admixed population using admixture mapping (AM) involves screening the genome of individuals of mixed ancestry for chromosomal regions that have a higher frequency of alleles from a parental population with higher asthma risk as compared with parental population with lower asthma risk. AM takes advantage of the admixture created in populations of mixed ancestry to identify genomic regions where an association exists between genetic ancestry and asthma (in contrast to between the genotype of the marker and asthma). The theory behind AM is that chromosomal segments of affected individuals contain a significantly higher-than-average proportion of alleles from the high-risk parental population and thus are more likely to harbor disease–associated loci. Criteria to evaluate the applicability of AM as a gene mapping approach include: (1) the prevalence of the disease differences in ancestral populations from which the admixed population was formed; (2) a measurable difference in disease-causing alleles between the parental populations; (3) reduced linkage disequilibrium (LD) between unlinked loci across chromosomes and strong LD between neighboring loci; (4) a set of markers with noticeable allele-frequency differences between parental populations that contributes to the admixed population (single nucleotide polymorphisms (SNPs) are the markers of choice because they are abundant, stable, relatively cheap to genotype, and informative with regard to the LD structure of chromosomal segments); and (5) there is an understanding of the extent of segmental chromosomal admixtures and their interactions with environmental factors. Although genome-wide association studies have contributed greatly to our understanding of the genetic components of asthma, the large and increasing degree of admixture in populations across the world create many challenges for further efforts to map disease-causing genes. This review, summarizes the historical context of admixed populations and AM, and considers current opportunities to use AM to map asthma genes. In addition, we provide an overview of the potential limitations and future directions of AM in biomedical research, including joint admixture and association mapping for asthma and asthma-related disorders. PMID:26483834

Spatiotemporal patterns of population distribution as crucial element for risk management

NASA Astrophysics Data System (ADS)

Gokesch, Karin; Promper, Catrin; van Westen, Cees J.; Glade, Thomas

2014-05-01

The spatiotemporal distribution and presence of the population in a certain area is a crucial element within natural hazard risk management, especially in the case of rapid onset hazard events and emergency management. When fast onset hazards such as earthquakes, flash floods or industrial accidents occur, people may not have adequate time for evacuation and the emergency management requires a fast response and reaction. Therefore, information on detailed distribution of people affected by a certain hazard is important for a fast assessment of the situation including the number and the type of people (distinguishing between elderly or handicapped people, children, working population etc.) affected. This study thus aims at analyzing population distribution on an hourly basis for different days e.g. workday or holiday. The applied method combines the basic assessment of population distribution in a given area with specific location-related patterns of distribution-changes over time. The calculations are based on detailed information regarding the expected presence of certain groups of people, e.g. school children, working or elderly people, which all show different patterns of movement over certain time periods. The study area is the city of Waidhofen /Ybbs located in the Alpine foreland in the Southwest of Lower Austria. This city serves as a regional center providing basic infrastructure, shops and schools for the surrounding countryside. Therefore a lot of small and medium businesses are located in this area showing a rather high variation of population present at different times of the day. The available building footprint information was classified with respect to building type and occupancy type, which was used to estimate the expected residents within the buildings, based on the floorspace of the buildings and the average floorspace per person. Additional information on the distribution and the average duration of stay of the people in these buildings was assessed using general population statistics and specific information about selected buildings, such as schools, hospitals or homes for the elderly, to calculate the distribution patterns for each group of people over time.

Inequalities in multiple health outcomes by education, sex, and race in 93 US counties: why we should measure them all.

PubMed

Asada, Yukiko; Whipp, Alyce; Kindig, David; Billard, Beverly; Rudolph, Barbara

2014-06-13

Regular reporting of health inequalities is essential to monitoring progress of efforts to reduce health inequalities. While reporting of population health became increasingly common, reporting of a subpopulation group breakdown of each indicator of the health of the population is rarely a standard practice. This study reports education-, sex-, and race-related inequalities in four health outcomes in each of the selected 93 counties in the United States in a systematic and comparable manner. This study is a cross-sectional analysis of large, publicly available data, 2008, 2009, and 2010 Behavioral Risk Factor Surveillance System (BRFSS) Selected Metropolitan/Micropolitan Area Risk Trends (SMART) and 2008, 2009, and 2010 United States Birth Records from the National Vital Statistics System. The study population is American adults older than 25 years of age residing in the selected 93 counties, representing about 30% of the US population, roughly equally covering all geographic regions of the country. Main outcome measures are: (1) Attribute (group characteristic)-specific inequality: education-, sex-, or race-specific inequality in each of the four health outcomes (poor or fair health, poor physical health days, poor mental health days, and low birthweight) in each county; (2) Overall inequality: the average of these three attribute-specific inequalities for each health outcome in each county; and (3) Summary inequality in total morbidity: the weighted average of the overall inequalities across the four health outcomes in each county. The range of inequality across the counties differed considerably by health outcome; inequality in poor or fair health had the widest range and the highest median among inequalities in all health outcomes. In more than 70% of the counties, education-specific inequality was the largest in all health outcomes except for low birthweight. It is feasible to extend population health reporting to include reporting of a subpopulation group breakdown of each indicator of the health of the population at a small jurisdictional level using publicly available data. No single group characteristic or health outcome represents the whole picture of health inequalities in a population. Examining multiple group characteristics and outcomes in a comparable manner is essential in reporting health inequalities.

Correlations suggest low magnesium may lead to higher rates of type 2 diabetes in Indigenous Australians.

PubMed

Longstreet, D A; Heath, D L; Panaretto, K S; Vink, R

2007-01-01

Diabetes accounts for a significant part of the morbidity and mortality experienced by Australian Aboriginal and Torres Strait Islander populations. Research over the past two decades has provided evidence of a clinical correlation between diabetes and low magnesium intake. Hypomagnesaemia is the most common electrolyte abnormality in diabetic outpatients and may be linked to the development of both macrovascular and microvascular diabetic complications. A diabetes risk reduction of 33%-34% has been found among those with diets highest in magnesium. This study examines the case for magnesium as a potential contributor to diabetes in Australia, especially among Aboriginal and Torres Strait Islander peoples. Specifically explored are associations between diabetes and the magnesium content of drinking water and diet, as well as climatic and socioeconomic factors that may impact on magnesium status including temperature, rainfall, education, employment and income. Queensland age-standardized death rates due to diabetes were correlated with the magnesium content of drinking water, maximum average temperature, rainfall, unemployment rate, proportion of population with post-school qualification, weekly income, and the percentage population identified as Indigenous. Multiple-pass 24-hour recalls from a convenience sample of 100 Indigenous patients at a regional centre were also analyzed to estimate dietary magnesium intake. The Indigenous nutrient intake was then compared with the Australian National Nutrition Survey estimates. Diabetes related mortality was significantly correlated to the percentage of the population identified as Indigenous (r = 0.675), to water magnesium levels (r = -.414), and to average maximum daily temperature (r = 0.579). The average daily magnesium intake in an Indigenous cohort from a regional centre was 248 mg (men: 267 mg +/- 17; women: 245 mg +/- 6 mg), significantly less than intakes observed in the 1995 National Nutrition Survey (p<.001). Although not representative of all Indigenous people, this study identified low dietary magnesium intake among an Indigenous cohort from a regional centre. We also found a significant correlation between the magnesium content of municipal water supplies and age-standardized deaths due to diabetes. We hypothesise that low magnesium dietary intake, compounded by inadequate magnesium replenishment in drinking water, may increase the risk of hypomagnesaemia in the Indigenous population of Queensland. The associations identified in this study support the hypothesis that magnesium may be a potential contributor to diabetes in Australia, especially among Indigenous people, and confirm the need for further research.

Intervention strategies to reduce the burden of non-communicable diseases in Mexico: cost effectiveness analysis

PubMed Central

Carvalho, Natalie; Gutiérrez-Delgado, Cristina; Orozco, Ricardo; Mancuso, Anna; Hogan, Daniel R; Lee, Diana; Murakami, Yuki; Sridharan, Lakshmi; Medina-Mora, María Elena; González-Pier, Eduardo

2012-01-01

Objective To inform decision making regarding intervention strategies against non-communicable diseases in Mexico, in the context of health reform. Design Cost effectiveness analysis based on epidemiological modelling. Interventions 101 intervention strategies relating to nine major clusters of non-communicable disease: depression, heavy alcohol use, tobacco use, cataracts, breast cancer, cervical cancer, chronic obstructive pulmonary disease, cardiovascular disease, and diabetes. Data sources Mexican data sources were used for most key input parameters, including administrative registries; disease burden and population estimates; household surveys; and drug price databases. These sources were supplemented as needed with estimates for Mexico from the WHO-CHOICE unit cost database or with estimates extrapolated from the published literature. Main outcome measures Population health outcomes, measured in disability adjusted life years (DALYs); costs in 2005 international dollars ($Int); and costs per DALY. Results Across 101 intervention strategies examined in this study, average yearly costs at the population level would range from around ≤$Int1m (such as for cataract surgeries) to >$Int1bn for certain strategies for primary prevention in cardiovascular disease. Wide variation also appeared in total population health benefits, from <1000 DALYs averted a year (for some components of cancer treatments or aspirin for acute ischaemic stroke) to >300 000 averted DALYs (for aggressive combinations of interventions to deal with alcohol use or cardiovascular risks). Interventions in this study spanned a wide range of average cost effectiveness ratios, differing by more than three orders of magnitude between the lowest and highest ratios. Overall, community and public health interventions such as non-personal interventions for alcohol use, tobacco use, and cardiovascular risks tended to have lower cost effectiveness ratios than many clinical interventions (of varying complexity). Even within the community and public health interventions, however, there was a 200-fold difference between the most and least cost effective strategies examined. Likewise, several clinical interventions appeared among the strategies with the lowest average cost effectiveness ratios—for example, cataract surgeries. Conclusions Wide variations in costs and effects exist within and across intervention categories. For every major disease area examined, at least some strategies provided excellent value for money, including both population based and personal interventions. PMID:22389335

Residential and service-population exposure to multiple natural hazards in the Mount Hood region of Clackamas County, Oregon

USGS Publications Warehouse

Mathie, Amy M.; Wood, Nathan

2013-01-01

The objective of this research is to document residential and service-population exposure to natural hazards in the rural communities of Clackamas County, Oregon, near Mount Hood. The Mount Hood region of Clackamas County has a long history of natural events that have impacted its small, tourism-based communities. To support preparedness and emergency-management planning in the region, a geospatial analysis of population exposure was used to determine the number and type of residents and service populations in flood-, wildfire-, and volcano-related hazard zones. Service populations are a mix of residents and tourists temporarily benefitting from local services, such as retail, education, or recreation. In this study, service population includes day-use visitors at recreational sites, overnight visitors at hotels and resorts, children at schools, and community-center visitors. Although the heavily-forested, rural landscape suggests few people are in the area, there are seasonal peaks of thousands of visitors to the region. “Intelligent” dasymetric mapping efforts using 30-meter resolution land-cover imagery and U.S. Census Bureau data proved ineffective at adequately capturing either the spatial distribution or magnitude of population at risk. Consequently, an address-point-based hybrid dasymetric methodology of assigning population to the physical location of buildings mapped with a global positioning system was employed. The resulting maps of the population (1) provide more precise spatial distributions for hazard-vulnerability assessments, (2) depict appropriate clustering due to higher density structures, such as apartment complexes and multi-unit commercial buildings, and (3) provide new information on the spatial distribution and temporal variation of people utilizing services within the study area. Estimates of population exposure to flooding, wildfire, and volcanic hazards were determined by using overlay analysis in a geographic information system. Population exposure to flood hazards is low (less than 10 percent of residents) and does not vary substantially between 100-year and 500-year flood-hazard scenarios. Moderate, moderate-to-high, and high wildfire-risk areas within the study region account for 72 percent of residents, 62 percent of employees, and 60 percent of daytime visitors to recreation sites. Fifteen percent of businesses in the study area are in moderate-to-high or high wildfire-risk areas but these businesses represent 51 percent of the local workforce. A volcanic event at Mount Hood could directly impact up to 60 percent of residents in their homes and 87 percent of employees at their workplaces. The proximal volcanic-hazard zone alone includes 65 percent of employees, 80 percent of schools and community facilities, more than 60 percent of overnight visitors in peak seasons, and 82–100 percent of daytime visitors to recreation sites during the summer and winter months, respectively. The number of day-use visitors to recreation sites in the region is greatest during winter months (averaging 129,300 people per month), whereas overnight visitors are greatest during summer months (averaging 34,000 per month). This analysis of residential and service-population exposure to natural hazards supports the development of targeted risk-reduction efforts in the region, while also expanding the discourse on characterizing and assessing population dynamics in tourist-frequented areas.

Vulnerability to Substance Abuse and the Risk of Suicide in Students of Region 12 of Islamic Azad University

PubMed Central

Monirpoor, Nader; Khoosfi, Helen; Gholamy Zarch, Morteza; Tamaddonfard, Mohsen; Tabatabaei Mir, Seyed Farzad; Mohammad Alipour, Maryam; Karimi, Yasamin

2014-01-01

Background: Substance abuse prevalence and the number of suicides among university students is less than public population; however the sensitivity of society regarding the occurrence of such damages among students puts special emphasis on appraising these variables. More than 30% of Iranian students study in Islamic Azad University. Objectives: The current research aimed to appraise the vulnerability of substance abuse and the risk of suicide in students of region 12 of Islamic Azad University. Patients and Methods: In the current study, 1053 students (606 boys and 447 girls) with the average age of 22.55 years were selected through stratified sampling from Karaj, Takestan, Qazvin and Qom branches of Islamic Azad University. In order to assess the variables, Mental Health Worksheet of Central Counseling Office of the Ministry Science, Research and Technology was utilized. Results: Average, standard deviation, minimum and maximum scores in substance abuse vulnerability of the students in region 12 were measured as 36.28, 14.68, 11.22 and 92.87; and the same for risk of suicide were 31.29, 15.61, 7.93 and 96.30, respectively. Students in Qom branch were significantly less vulnerable to substance abuse and less exposed to the risk of suicide than their peers in Karaj, Qazvin and Takestan branches. Conclusions: Less significant possibility of substance abuse and risk of suicide in students of Qom branch in comparison with other branches could be due to numerous variables particularly their religious attitudes. Nevertheless the average of these variables among the students of region 12 were higher than the reported scores of their peers in the state universities which reflects the serious need for precise assessments and providing preventive services and mental health interventions. PMID:25032157

Vulnerability to substance abuse and the risk of suicide in students of region 12 of islamic azad university.

PubMed

Monirpoor, Nader; Khoosfi, Helen; Gholamy Zarch, Morteza; Tamaddonfard, Mohsen; Tabatabaei Mir, Seyed Farzad; Mohammad Alipour, Maryam; Karimi, Yasamin

2014-06-01

Substance abuse prevalence and the number of suicides among university students is less than public population; however the sensitivity of society regarding the occurrence of such damages among students puts special emphasis on appraising these variables. More than 30% of Iranian students study in Islamic Azad University. The current research aimed to appraise the vulnerability of substance abuse and the risk of suicide in students of region 12 of Islamic Azad University. In the current study, 1053 students (606 boys and 447 girls) with the average age of 22.55 years were selected through stratified sampling from Karaj, Takestan, Qazvin and Qom branches of Islamic Azad University. In order to assess the variables, Mental Health Worksheet of Central Counseling Office of the Ministry Science, Research and Technology was utilized. Average, standard deviation, minimum and maximum scores in substance abuse vulnerability of the students in region 12 were measured as 36.28, 14.68, 11.22 and 92.87; and the same for risk of suicide were 31.29, 15.61, 7.93 and 96.30, respectively. Students in Qom branch were significantly less vulnerable to substance abuse and less exposed to the risk of suicide than their peers in Karaj, Qazvin and Takestan branches. Less significant possibility of substance abuse and risk of suicide in students of Qom branch in comparison with other branches could be due to numerous variables particularly their religious attitudes. Nevertheless the average of these variables among the students of region 12 were higher than the reported scores of their peers in the state universities which reflects the serious need for precise assessments and providing preventive services and mental health interventions.

Time-dependent effect of intensity of smoking and of occupational exposure to asbestos on the risk of lung cancer: results from the ICARE case-control study.

PubMed

Lévêque, Emilie; Lacourt, Aude; Luce, Danièle; Sylvestre, Marie-Pierre; Guénel, Pascal; Stücker, Isabelle; Leffondré, Karen

2018-05-18

To estimate the impact of intensity of both smoking and occupational exposure to asbestos on the risk of lung cancer throughout the whole exposure history. Data on 2026 male cases and 2610 male controls came from the French ICARE (Investigation of occupational and environmental causes of respiratory cancers) population-based, case-control study. Lifetime smoking history and occupational history were collected from standardised questionnaires and face-to-face interviews. Occupational exposure to asbestos was assessed using a job exposure matrix. The effects of annual average daily intensity of smoking (reported average number of cigarettes smoked per day) and asbestos exposure (estimated average daily air concentration of asbestos fibres at work) were estimated using a flexible weighted cumulative index of exposure in logistic regression models. Intensity of smoking in the 10 years preceding diagnosis had a much stronger association with the risk of lung cancer than more distant intensity. By contrast, intensity of asbestos exposure that occurred more than 40 years before diagnosis had a stronger association with the risk of lung cancer than more recent intensity, even if intensity in the 10 years preceding diagnosis also had a significant effect. Our results illustrate the dynamic of the effect of intensity of both smoking and occupational exposure to asbestos on the risk of lung cancer. They confirm that the timing of exposure plays an important role, and suggest that standard analytical methods assuming equal weights of intensity over the whole exposure history may be questionable. © 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.

The risk of groundling fatalities from unintentional airplane crashes.

PubMed

Thompson, K M; Rabouw, R F; Cooke, R M

2001-12-01

The crashes of four hijacked commercial planes on September 11, 2001, and the repeated televised images of the consequent collapse of the World Trade Center and one side of the Pentagon will inevitably change people's perceptions of the mortality risks to people on the ground from crashing airplanes. Goldstein and colleagues were the first to quantify the risk for Americans of being killed on the ground from a crashing airplane for unintentional events, providing average point estimates of 6 in a hundred million for annual risk and 4.2 in a million for lifetime risk. They noted that the lifetime risk result exceeded the commonly used risk management threshold of 1 in a million, and suggested that the risk to "groundlings" could be a useful risk communication tool because (a) it is a man-made risk (b) arising from economic activities (c) from which the victims derive no benefit and (d) exposure to which the victims cannot control. Their results have been used in risk communication. This analysis provides updated estimates of groundling fatality risks from unintentional crashes using more recent data and a geographical information system approach to modeling the population around airports. The results suggest that the average annual risk is now 1.2 in a hundred million and the lifetime risk is now 9 in ten million (below the risk management threshold). Analysis of the variability and uncertainty of this estimate, however, suggests that the exposure to groundling fatality risk varies by about a factor of approximately 100 in the spatial dimension of distance to an airport, with the risk declining rapidly outside the first 2 miles around an airport. We believe that the risk to groundlings from crashing airplanes is more useful in the context of risk communication when information about variability and uncertainty in the risk estimates is characterized, but we suspect that recent events will alter its utility in risk communication.

Motivations for contralateral prophylactic mastectomy as a function of socioeconomic status.

PubMed

Baptiste, Dadrie F; MacGeorge, Erina L; Venetis, Maria K; Mouton, Ashton; Friley, L Brooke; Pastor, Rebekah; Hatten, Kristen; Lagoo, Janaka; Clare, Susan E; Bowling, Monet W

2017-02-01

Despite no demonstrated survival advantage for women at average risk of breast cancer, rates of contralateral prophylactic mastectomy (CPM) continue to increase. Research reveals women with higher socioeconomic status (SES) are more likely to select CPM. This study examines how indicators of SES, age, and disease severity affect CPM motivations. Patients (N = 113) who underwent CPM at four Indiana University affiliated hospitals completed telephone interviews in 2013. Participants answered questions about 11 CPM motivations and provided demographic information. Responses to motivation items were factor analyzed, resulting in 4 motivational factors: reducing long-term risk, symmetry, avoiding future medical visits, and avoiding treatments. Across demographic differences, reducing long-term risk was the strongest CPM motivation. Lower income predicted stronger motivation to reduce long-term risk and avoid treatment. Older participants were more motivated to avoid treatment; younger and more-educated patients were more concerned about symmetry. Greater severity of diagnosis predicted avoiding treatments. Reducing long-term risk is the primary motivation across groups, but there are also notable differences as a function of age, education, income, and disease severity. To stop the trend of increasing CPM, physicians must tailor patient counseling to address motivations that are consistent across patient populations and those that vary between populations.

Ciguatera risk management in French Polynesia: the case study of Raivavae Island (Australes Archipelago).

PubMed

Chinain, Mireille; Darius, H Taiana; Ung, André; Fouc, Mote Tchou; Revel, Taina; Cruchet, Philippe; Pauillac, Serge; Laurent, Dominique

2010-10-01

Based on epidemiological data available through long-term monitoring surveys conducted by both the Public Health Directorate and the Louis Malardé Institute, ciguatera is highly endemic in French Polynesia, most notably in Raivavae (Australes) which appears as a hot spot of ciguatera with an average incidence rate of 140 cases/10,000 population for the period 2007-2008. In order to document the ciguatera risk associated with Raivavae lagoon, algal and toxin-based field monitoring programs were conducted in this island from April 2007 to May 2008. Practically, the distribution, abundance and toxicity of Gambierdiscus populations, along with the toxicity levels in 160 fish distributed within 25 distinct species, were assessed in various sampling locations. Herbivores such as Scarids (parrotfish) and Acanthurids (unicornfish) were rated as high-risk species based on receptor-binding assay toxicity data. A map of the risk stratification within the Raivavae lagoon was also produced, which indicates that locations where both natural and man-made disturbances have occurred remained the most susceptible to CFP incidents. Our findings also suggest that, locally, the traditional knowledge about ciguatera may not be scientifically complete but is functionally correct. Community education resulted in self-regulating behaviour towards avoidance of high-risk fish species and fishing locations. Copyright 2009 Elsevier Ltd. All rights reserved.

The demography of menopause.

PubMed

Hill, K

1996-03-01

Menopause marks a time of dramatic hormonal and often social change for women. Both risk factors and health needs are likely to change as women pass through menopause. This paper examines the demographic characteristics of the world population of menopausal and post-menopausal women, and also examines the implication of menopause for mortality risks. The numbers of women involved are large. Using age 50 as a proxy for menopause, about 25 million women pass through menopause each year, and we estimate that in 1990 there were 467 million post-menopausal women in the world, with an average age of about 60 years. By 2030, the world population of menopausal and postmenopausal women is projected to increase to 1.2 billion, with 47 million new entrants each year. The mortality implications of menopause are also substantial. Ratios of female to male mortality risks from all causes and from all major cause groups except neoplasms decline to low levels around menopause or shortly thereafter, and then rise again to near unity. This pattern is taken as evidence that the female reproductive period is broadly protective of health, but that this protection disappears after menopause. The main protective effect is through reduced risk of cardiovascular disease mortality, partially offset by increased risks of cancer mortality, particularly of the breast and endometrium.

Health risk assessment of environmental selenium: Emerging evidence and challenges

PubMed Central

Vinceti, Marco; Filippini, Tommaso; Cilloni, Silvia; Bargellini, Annalisa; Vergoni, Anna Valeria; Tsatsakis, Aristides; Ferrante, Margherita

2017-01-01

New data have been accumulated in the scientific literature in recent years which allow a more adequate risk assessment of selenium with reference to human health. This new evidence comes from environmental studies, carried out in populations characterized by abnormally high or low selenium intakes, and from high-quality and large randomized controlled trials with selenium recently carried out in the US and in other countries. These trials have consistently shown no beneficial effect on cancer and cardiovascular risk, and have yielded indications of unexpected toxic effects of selenium exposure. Overall, these studies indicate that the minimal amount of environmental selenium which is source of risk to human health is much lower than anticipated on the basis of older studies, since toxic effects were shown at levels of intake as low as around 260 µg/day for organic selenium and around 16 µg/day for inorganic selenium. Conversely, populations with average selenium intake of less than 13–19 µg/day appear to be at risk of a severe cardiomyopathy, Keshan disease. Overall, there is the need to reconsider the selenium standards for dietary intake, drinking water, outdoor and indoor air levels, taking into account the recently discovered adverse health effects of low-dose selenium overexposure, and carefully assessing the significance of selenium-induced proteomic changes. PMID:28339083

Health risk assessment of environmental selenium: Emerging evidence and challenges (Review).

PubMed

Vinceti, Marco; Filippini, Tommaso; Cilloni, Silvia; Bargellini, Annalisa; Vergoni, Anna Valeria; Tsatsakis, Aristides; Ferrante, Margherita

2017-05-01

New data have been accumulated in the scientific literature in recent years which allow a more adequate risk assessment of selenium with reference to human health. This new evidence comes from environmental studies, carried out in populations characterized by abnormally high or low selenium intakes, and from high-quality and large randomized controlled trials with selenium recently carried out in the US and in other countries. These trials have consistently shown no beneficial effect on cancer and cardiovascular risk, and have yielded indications of unexpected toxic effects of selenium exposure. Overall, these studies indicate that the minimal amount of environmental selenium which is source of risk to human health is much lower than anticipated on the basis of older studies, since toxic effects were shown at levels of intake as low as around 260 µg/day for organic selenium and around 16 µg/day for inorganic selenium. Conversely, populations with average selenium intake of less than 13-19 µg/day appear to be at risk of a severe cardiomyopathy, Keshan disease. Overall, there is the need to reconsider the selenium standards for dietary intake, drinking water, outdoor and indoor air levels, taking into account the recently discovered adverse health effects of low-dose selenium overexposure, and carefully assessing the significance of selenium-induced proteomic changes.

Spectacular improvement in vitamin D status in elderly osteoporotic women: 8-year analysis of an osteoporotic population treated in a dedicated fracture liaison service.

PubMed

Amouzougan, A; Deygat, A; Trombert, B; Constant, E; Denarié, D; Marotte, H; Thomas, T

2015-12-01

In a population of postmenopausal women with a fragility fracture, we found a drastic reduction in the proportion of women with severe (<25 nmol/L) and moderate (25 to 75 nmol/L) hypovitaminosis D, especially from 2009 onwards. These results show that supplementation has been very widely integrated into current practice. Vitamin D (25(OH)D) is essential for bone health. In institutionalised osteoporotic women, it reduces the risk of fragility fractures. Numerous articles suggesting the possibility of extraosseous effects have generated a growing number of publications and recommendations on more widespread administration, to limit the risks of moderate or severe hypovitaminosis D. We assessed the impact on clinical practice of these recommendations concerning 25(OH)D supplementation in elderly at-risk populations. A total of 1486 postmenopausal osteoporotic women were seen in the context of a fracture liaison service (i.e. a rheumatology consultation following a peripheral fragility fracture), between May 2005 and December 2012. Of these, 1107 had a 25(OH)D assay (femur, n = 520; humerus, n = 207; wrist, n = 380). The average age of the total population was 76.7 ± 9.9 years, while for women with an available 25(OH)D assay, the average age was 75.1 ± 11.8 years. The average 25(OH)D (nmol/L) level was similar for the three fracture sites: femur, 30 ± 36.2; humerus, 27.5 ± 24; and wrist, 31 ± 26. A drastic reduction in the proportion of women with severe (<25 nmol/L) and moderate (25 to 75 nmol/L) hypovitaminosis D was observed, especially from 2009 onwards, with a mean prevalence of 69 and 30 % respectively before that year and 35 and 52 % thereafter. Conversely, the proportion of women with 25(OH)D at the threshold value of 75 nmol/L increased from 1.2 to 24 %. Overall, mean serum 25(OH)D levels were significantly higher when comparing the two periods 2005-2008 and 2009-1012 (17.6 ± 14.6 and 48.4 ± 39.2 nmol/L, respectively; p < 0.0001). These results show that supplementation has been very widely integrated into current practice. We can expect it to yield beneficial effects in osseous and extraosseous terms in osteoporotic women, particularly the very elderly.

Ultrasound as an Adjunct to Mammography for Breast Cancer Screening: A Health Technology Assessment

PubMed Central

Nikitovic-Jokic, Milica; Tu, Hong Anh; Palimaka, Stefan; Higgins, Caroline; Holubowich, Corinne

2016-01-01

Background Screening with mammography can detect breast cancer early, before clinical symptoms appear. Some cancers, however, are not captured with mammography screening alone. Ultrasound has been suggested as a safe adjunct screening tool that can detect breast cancers missed on mammography. We investigated the benefits, harms, cost-effectiveness, and cost burden of ultrasound as an adjunct to mammography compared with mammography alone for screening women at average risk and at high risk for breast cancer. Methods We searched Ovid MEDLINE, Ovid Embase, EBM Reviews, and the NHS Economic Evaluation Database, from January 1998 to June 2015, for evidence of effectiveness, harms, diagnostic accuracy, and cost-effectiveness. Only studies evaluating the use of ultrasound as an adjunct to mammography in the specified populations were included. We also conducted a cost analysis to estimate the costs in Ontario over the next 5 years to fund ultrasound as an adjunct to mammography in breast cancer screening for high-risk women who are contraindicated for MRI, the current standard of care to supplement mammography. Results No studies in average-risk women met the inclusion criteria of the clinical review. We included 5 prospective, paired cohort studies in high-risk women, 4 of which were relevant to the Ontario context. Adjunct ultrasound identified between 2.3 and 5.9 additional breast cancers per 1,000 screens. The average pooled sensitivity of mammography and ultrasound was 53%, a statistically significant increase relative to mammography alone (absolute increase 13%; P < .05). The average pooled specificity of the combined test was 96%, an absolute increase in the false-positive rate of 2% relative to mammography screening alone. The GRADE for this body of evidence was low. Additional annual costs of using breast ultrasound as an adjunct to mammography for high-risk women in Ontario contraindicated for MRI would range from $15,500 to $30,250 in the next 5 years. Conclusions We found no evidence that evaluated the comparative effectiveness or diagnostic accuracy of screening breast ultrasound as an adjunct to mammography among average-risk women aged 50 years and over. In women at high risk of developing breast cancer, there is low-quality evidence that screening with mammography and adjunct ultrasound detects additional cases of disease, with improved sensitivity compared to mammography alone. Screening with adjunct ultrasound also increases the number of false-positive findings and subsequent biopsy recommendations. It is unclear if the use of screening breast ultrasound as an adjunct to mammography will reduce breast cancer–related mortality among high-risk women. The annual cost burden of using adjunct ultrasound to screen high-risk women who cannot receive MRI in Ontario would be small. PMID:27468326

Identification of Genes and Genetic Variants Associated with Poor Treatment Response in Patients with Prostate Cancer

DTIC Science & Technology

2013-10-01

collection of information is estimated to average 1 hour per response, including the time for reviewing instructions, searching existing data sources...gathering and maintaining the data needed, and completing and reviewing this collection of information. Send comments regarding this burden estimate...variants which explain much more than a small amount of risk for prostate cancer among a small population of men. Even less progress has been made

Pakistan’s Nuclear Future: Reining in the Risk

DTIC Science & Technology

2009-12-01

Pakistan has developed gaps between average yields and yields obtained by the best farmers; between the best farmers and those obtained by research... yield gap —outputs of the current livestock population compared with the output obtained in more developed systems—at between 60 to 80 percent. The...unprecedented increase in rate of inflation, a significant increase in the incidence of poverty, a widening in the already large regional income gap

What's the hospitalisation's impact on background treatments of patients over 65 years.

PubMed

Gasperini, Guillaume; Molinier, Sylvain; Marimoutou, Catherine; Denormandie, Philippe; Sanchez, Stéphane

2016-12-01

As our population aging increases, it requires a particular attention from the health system. Indeed, elderly are often frail, with several diseases and presenting high risk of adverse drug accident. Prescribing appropriately to the elderly has become an important matter. Hospitalization and consultation with the general practitioner are key moments for drug prescription. However, their real impact on background treatments of this population has been barely evaluated. A retrospective descriptive study was conducted with 300 patients over 65 years old, hospitalized at the Laveran military hospital in Marseille. Treatment modifications, consecutive to hospitalization and to the first consultation with the general practitioner, were identified and analyzed. We found an average prescription of 5.93 drugs in prehospital period and 66% of the patients with polypharmacy. Drugs for cardiovascular system were the most prescribed and the most modified. Hospitalization generated a rate of modification by prescription of 28.5% and the consultation with the general practitioner following this hospitalization led to further change in 48% of cases. Beside the important prevalence of patients with polypharmacy, this study shows that hospitalization entails a significant change in background treatments in that population at risk. Therefore, it is important to have a consensus in the re-evaluation of these treatments, in order to prevent the iatrogenic risk.

Traffic-related air pollution increased the risk of Parkinson's disease in Taiwan: A nationwide study.

PubMed

Lee, Pei-Chen; Liu, Li-Ling; Sun, Yu; Chen, Yu-An; Liu, Chih-Ching; Li, Chung-Yi; Yu, Hwa-Lung; Ritz, Beate

2016-11-01

Ambient air pollution has been associated with many health conditions, but little is known about its effects on neurodegenerative diseases, such as Parkinson's disease (PD). In this study, we investigated the influence of ambient air pollution on PD in a nationwide population-based case-control study in Taiwan. We identified 11,117 incident PD patients between 2007 and 2009 from the Taiwanese National Health Insurance Research Database and selected 44,468 age- and gender-matched population controls from the longitudinal health insurance database. The average ambient pollutant exposure concentrations from 1998 through the onset of PD were estimated using quantile-based Bayesian Maximum Entropy models. Basing from logistic regression models, we estimated the odds ratios (ORs) and 95% confidence intervals (CIs) of ambient pollutant exposures and PD risk. We observed positive associations between NO x , CO exposures, and PD. In multi-pollutant models, for NO x and CO above the 75th percentile exposure compared with the lowest percentile, the ORs of PD were 1.37 (95% CI=1.23-1.52) and 1.17 (95% CI=1.07-1.27), respectively. This study suggests that ambient air pollution exposure, especially from traffic-related pollutants such as NO x and CO, increases PD risk in the Taiwanese population. Copyright © 2016 Elsevier Ltd. All rights reserved.

Cancer-Incidence, prevalence and mortality in the oldest-old. A comprehensive review.

PubMed

Nolen, Shantell C; Evans, Marcella A; Fischer, Avital; Corrada, Maria M; Kawas, Claudia H; Bota, Daniela A

2017-06-01

Chronic health conditions are commonplace in older populations. The process of aging impacts many of the world's top health concerns. With the average life expectancy continuing to climb, understanding patterns of morbidity in aging populations has become progressively more important. Cancer is an age-related disease, whose risk has been proven to increase with age. Limited information is published about the epidemiology of cancer and the cancer contribution to mortality in the 85+ age group, often referred to as the oldest-old. In this review, we perform a comprehensive assessment of the most recent (2011-2016) literature on cancer prevalence, incidence and mortality in the oldest-old. The data shows cancer prevalence and cancer incidence increases until ages 85-89, after which the rates decrease into 100+ ages. However the number of overall cases has steadily increased over time due to the rise in population. Cancer mortality continues to increase after age 85+. This review presents an overview of plausible associations between comorbidity, genetics and age-related physiological effects in relation to cancer risk and protection. Many of these age-related processes contribute to the lowered risk of cancer in the oldest-old, likewise other certain health conditions may "protect" from cancer in this age group. Copyright © 2017 Elsevier B.V. All rights reserved.

Cardiometabolic health and risk of amyotrophic lateral sclerosis.

PubMed

Timmins, Hannah C; Saw, Wilfred; Cheah, Benjamin C; Lin, Cindy S Y; Vucic, Steve; Ahmed, Rebekah M; Kiernan, Matthew C; Park, Susanna B

2017-10-01

Patients diagnosed with amyotrophic lateral sclerosis (ALS) generally have a limited medical history and a normal body mass index, raising the possibility of a premorbid ALS phenotype. The prevalence of cardiometabolic factors was analyzed in 58 ALS patients via comprehensive cardiovascular assessments and compared with Australian population norms. ALS patients had good cardiac fitness and no reported cardiovascular events. Average blood pressure, heart rate, PR interval, and corrected QT interval were in the normal range. There were significantly fewer obese women in the ALS cohort (13.6%, P < 0.05) and more men with a normal body mass index than in the general population (47.2%, P < 0.001). The percentage of individuals who had never smoked was greater for the ALS cohort (55.8%, P ≤ 0.001), and the prevalence of dyslipidemia was lower (38.7%) compared with the general population (74.4%, P < 0.001). ALS patients had good cardiometabolic health, with evidence of a reduced vascular risk profile. Muscle Nerve 56: 721-725, 2017. © 2016 Wiley Periodicals, Inc.

Predictors of Breast Cancer Worry in a Hispanic and predominantly immigrant mammography screening population

PubMed Central

April-Sanders, Ayana; Oskar, Sabine; Shelton, Rachel C.; Schmitt, Karen; Desperito, Elise; Protacio, Angeline; Tehranifar, Parisa

2017-01-01

Objective Worry about developing breast cancer (BC worry) has been associated with participation in screening and genetic testing and with follow-up of abnormal screening results. Little is known about the scope and predictors of BC worry in Hispanic and immigrant populations. Methods We collected in-person interview data from 250 self-identified Hispanic women recruited from an urban mammography facility (average age 50.4 years; 82% foreign-born). Women reported whether they worried about developing breast cancer rarely/never (low worry), sometimes (moderate worry) or often/all the time (high worry). We examined whether sociocultural and psychological factors (e.g., acculturation, education, perceived risk), and risk factors and objective risk for breast cancer (e.g., family history, Gail model 5-year risk estimates, parity) predicted BC worry using multinomial and binary logistic regression. Results In multivariable models, women who perceived higher absolute breast cancer risk (OR=1.66, 95% CI: 1.28, 2.14 for one unit increase in perceived lifetime risk) and comparative breast cancer risk (e.g., OR=2.37, 95% CI: 1.23, 6.06) were more likely to report high BC worry than moderate or low BC worry. There were no associations between BC worry and indicators of objective risk or acculturation. Conclusions In Hispanic women undergoing screening mammography, higher perceptions of breast cancer risk, on both absolute and comparative terms, were independently associated with high BC worry, and were stronger predictors of BC worry than indicators of objective breast cancer risk, including family history, mammographic density and personal breast cancer risk estimates. PMID:27863982

Do we need personalized recommendations for infants at risk of developing disease?

PubMed

Hernell, Olle; West, Christina

2008-01-01

Current nutrition recommendations, directed towards populations, are based on estimated average nutrient requirements for a target population and intend to meet the needs of most individuals within that population. They also aim at preventing common diseases such as obesity, diabetes and cardiovascular disease. For infants with specific genetic polymorphisms, e.g. some inborn errors of metabolism, adherence to current recommendations will cause disease symptoms and they need personalized nutrition recommendations. Some other monogenic polymorphisms, e.g. adult hypolactasia, are common but with varying prevalence between ethnic groups and within populations. Ages at onset as well as the degree of the resulting lactose intolerance also vary, making population-based as well as personalized recommendations difficult. The tolerable intake is best set by each individual based on symptoms. For polygenetic diseases such as celiac disease, type-1 diabetes and allergic disease, current knowledge is insufficient to suggest personalized recommendations aiming at primary prevention for all high-risk infants, although it may be justified to provide such recommendations on an individual level should the parents ask for them. New technologies such as nutrigenetics and nutrigenomics are promising tools with which current nutrition recommendations can possibly be refined and the potential of individualized nutrition be explored. It seems likely that in the future it will be possible to offer more subgroups within a population personalized recommendations.

Human health risk analysis from disinfection by-products (DBPs) in drinking and bathing water of some Indian cities

PubMed Central

2014-01-01

Background Human health risk assessment from exposure to disinfection by-products (DBPs) during drinking and bathing water vary from country to country as per life expectancy, body mass index, water consumption pattern and individual concentration of DBPs component, etc. Methods Present study considered average direct water intake per person for adult males and females as 4 & 3 L/day, respectively as per Indian literature for risk evaluation from another component of pollutant. While other important factor like average life expectancy, body weight & body surface area for male and female were considered 64 & 67 years, 51.9 & 45.4 Kg and 1.54 & 1.38 m2 respectively as per Indian Council of Medical Research and WHO report. The corresponding lifetime cancer risk of the formed THMs to human beings was estimated by the USEPA and IRIS method as per Indian population. Results The total cancer risk reached 8.99 E-04 and 8.92 E-04 for males and females, respectively, the highest risk from THMs seems to be from the inhalation route followed by ingestion and dermal contacts. Conclusions The multipath way evaluations of lifetime cancer risks for THMs exposure through ingestion, dermal absorption, and inhalation exposure were examined at the highest degree of danger. Results reveals that water containing THMs of the selected water treatment plant of the eastern part of India was unsafe in terms of risk evaluation through inhalation and ingestion, while dermal route of risk was found very close to permissible limit of USEPA. Sensitivity analysis shows that every input parameter is sole responsible for total risk potential, whereas exposure duration playing important role for estimation of total risk. PMID:24872885

Residential Exposure to 50 Hz Magnetic Fields and the Association with Miscarriage Risk: A 2-Year Prospective Cohort Study

PubMed Central

Wang, Qiang; Cao, Zhaojin; Qu, Yingli; Peng, Xiaowu; Guo, Shu; Chen, Li

2013-01-01

Objective The hypothesis of whether exposure to extremely low-frequency magnetic fields (ELF-MF) may increase miscarriage risk is controversial. A 2-year prospective cohort study was designed to study the association between exposure to 50 Hz magnetic fields (MF) and the miscarriage risk for women residing in the area of the Pearl-River Delta of China. Method Two towns with densely distributed power supply constructions were selected as the study sites. From 2010 to 2012, 552 women in the region who were at approximately 8 weeks of gestation or who planned to have a baby within 1 year were selected as candidate subjects. Exposure to MF was estimated by measurements at their front doors and in the alley in front of the subjects’ houses. The average exposure level was used as a cutoff point to define the exposed group. Clinical miscarriage was diagnosed by local obstetricians. Staffs from the local population and family planning service stations were responsible for the follow-up interviews every 2 months. Results Four hundred and thirteen pregnant women were selected for the cohort study. The average residential exposure to MF was 0.099 µT. No significantly increased risk of miscarriage was found to be associated with the average front-door exposure (p>0.05). However, miscarriage risk was found to be significantly associated with maximum alley exposure (p=0.001). The relative risk (RR) of miscarriage from maximum alley exposure was 2.35 (95% C.I.: 1.18-4.71). In addition, Cox regression analysis showed that the adjusted hazard ratio of maximum alley exposure for miscarriage was 1.72 (95% C.I.:1.10-2.69). Conclusion Although the miscarriage incidence was shown to be positively associated with the maximum alley MF exposure, the association between miscarriage risk and the exposure to MF was not confirmed in the study. The results of this study are of interest concerning MF exposure assessment and pregnancy outcomes. PMID:24312633

Artificial intelligence-assisted occupational lung disease diagnosis.

PubMed

Harber, P; McCoy, J M; Howard, K; Greer, D; Luo, J

1991-08-01

An artificial intelligence expert-based system for facilitating the clinical recognition of occupational and environmental factors in lung disease has been developed in a pilot fashion. It utilizes a knowledge representation scheme to capture relevant clinical knowledge into structures about specific objects (jobs, diseases, etc) and pairwise relations between objects. Quantifiers describe both the closeness of association and risk, as well as the degree of belief in the validity of a fact. An independent inference engine utilizes the knowledge, combining likelihoods and uncertainties to achieve estimates of likelihood factors for specific paths from work to illness. The system creates a series of "paths," linking work activities to disease outcomes. One path links a single period of work to a single possible disease outcome. In a preliminary trial, the number of "paths" from job to possible disease averaged 18 per subject in a general population and averaged 25 per subject in an asthmatic population. Artificial intelligence methods hold promise in the future to facilitate diagnosis in pulmonary and occupational medicine.

Contingent Vouchers and Motivational Interviewing for Cigarette Smokers in Residential Substance Abuse Treatment

PubMed Central

Rohsenow, Damaris J.; Tidey, Jennifer W.; Martin, Rosemarie A.; Colby, Suzanne M.; Sirota, Alan D.; Swift, Robert M.; Monti, Peter M.

2015-01-01

Residential drug treatment provides an opportunity to intervene with smokers substance use disorders (SUD). A randomized controlled clinical trial compared: (1) Contingent Vouchers (CV) for smoking abstinence to Noncontingent Vouchers (NCV), crossed with (2) Motivational Interviewing (MI) or Brief Advice (BA), for 184 smokers in SUD treatment. During the voucher period, 36% of carbon monoxide readings indicated smoking abstinence for those receiving CV versus 13% with NCV (p < .001). Post-treatment point-prevalence abstinence rates were low (3–4% at each follow up), with more abstinence when CV was combined with MI (6.6% on average) than with BA (0% on average). No differential effects on drug use or motivation to quit smoking occurred. Thus, CV had limited effects on long-term smoking abstinence in this population but effects were improved when CV was combined with MI. More effective methods are needed to increase motivation to quit smoking and quit rates in this high-risk population. PMID:25805668

Risk to a Changing Climate in the Mexico City Metropolitan Area

NASA Astrophysics Data System (ADS)

Vargas, N. D.

2016-12-01

The issue of climate change has dominated the atmospheric sciences agenda in recent decades. The concern about an increase in climate related disasters, mainly in large population centers, has led to ask whether they are mainly due to changes in climate or in vulnerability.The Mexico City Metropolitan Area (MCMA) is an example of megalopolis under high climate risk, where floods, landslides, health problems, high air pollution events, socioeconomic droughts are becoming important environmental and social problems. As urbanization spreads and population increases exposure to natural hazards increases, and so the magnitude of risk to a changing climate and the negative impacts. Since the late nineteenth century, in the MCMA an average maximum temperature could be around 22°C, whereas today it is about 24.5ºC. That is, the increase in the average temperature in Mexico City is around 3°C in a hundred years. But there are areas where an increase in the average temperature is similar in only thirty years. The heating rate of the city can vary depending on the change in land use. Areas that conserve forested regions in the process of urbanization tend to warm less than areas where the transformation into concrete and cement is almost complete. Thus, the climate of the MCMA shows important changes mainly in relation to land use changes. Global warming and natural climate variability were also analyzed as possible forcing factors of the observed warming by comparing low frequency variations in local temperature and indices for natural forcing. The hydrological cycle of the MCMA has also changed with urbanization. The "bubble of hot air" over the urban area has more capacity to hold moisture now than before the UHI. However, the increased risk to floods, heat or drought appears to be related not only to more frequent intense climatic hazards induced by the urbanization effect. This process also induces increased vulnerability to a changing climate. The establishment of areas with trees, water parks or green infrastructure can recover some ecosystem services and therefore, reduce climate risk in cities, with co-benefits that costly infrastructure does not always provide. Contemplating the services of urban ecosystems in the management of cities would lead to lower impacts of climate change for residents of cities.

Migration, sexual networks, and HIV in Agbogbloshie, Ghana

PubMed Central

Cassels, Susan; Jenness, Samuel M.; Biney, Adriana A. E.; Ampofo, William Kwabena; Dodoo, F. Nii-Amoo

2014-01-01

BACKGROUND HIV is spread through structured sexual networks, which are influenced by migration patterns, but network-oriented studies of mobility and HIV risk behavior have been limited. OBJECTIVE We present a comprehensive description and initial results from our Migration & HIV in Ghana (MHG) study in Agbogbloshie, an urban slum area within Accra, Ghana. METHODS The MHG study was a population-based cross-sectional study of adults aged 18–49 in Agbogbloshie in 2012. We used a one-year retrospective relationship history calendar to collect egocentric network data on sexual partners as well as migration and short-term mobility, and tested for prevalent HIV-1/2 infection. RESULTS HIV prevalence was 5.5%, with prevalence among women (7.2%) over twice that of men (2.8%). Three-quarters of residents were born outside the Greater Accra region, but had lived in Agbogbloshie an average of 10.7 years. Only 7% had moved housing structures within the past year. However, short-term mobility was common. Residents had an average of 7.3 overnight trips in the last year, with women reporting more travel than men. Thirty-seven percent of men and 9% of women reported more than one sexual partner in the last year. CONCLUSIONS Population-based surveys of migration and sexual risk behavior using relationship history calendars in low-resource settings can produce high quality data. Residents in Agbogbloshie are disproportionately affected by HIV, and have high levels of short-term mobility. HIV prevention interventions targeted to highly mobile populations in high prevalence settings may have far-reaching and long-term implications. PMID:25364298

Pigment Dispersion Syndrome Progression to Pigmentary Glaucoma in a Latin American Population.

PubMed

Gomez Goyeneche, Hector Fernando; Hernandez-Mendieta, Diana Patricia; Rodriguez, Diego Andres; Sepulveda, Ana Irene; Toledo, Jose Daniel

2015-01-01

To determine the progression of pigment dispersion syndrome (PDS) into pigmentary glaucoma (PG) in a population at the Central Military Hospital in Bogotá, Colombia. A retrospective study was conducted, based on a review of medical records of patients with PDS evaluated in the Glaucoma Clinic. Data were collected in a database in excel and subsequently analyzed with the software Statistical Package for the Social Sciences (SPSS), performing Chi-square test analysis and Spearman's rho test. Forty-eight eyes of 24 patients were included. Forty-two percent were women and 58% were men. Pigmentation of the trabecular meshwork was the most frequent clinical sign (100%), followed by Krukenberg's spindle (91.7%), the least frequent were the iris concavity and iris heterochromia (4.2%), the average of the spherical equivalent was of - 1.33 (SD 2.07). The rate of conversion of PDS to PG was 37.5%, after an average follow-up of 50.7 months. Having an intraocular pressure (IOP) greater than 21 mm Hg was statistically the only significant risk factor for conversion. We found several differences in frequency and clinical signs in these patients in contrast to previous data, probably due to different racial characteristics. The rate of progression is similar to previous reports despite of heterogeneity of these. Having IOP > 21 mm Hg was the only risk factor associated with progression in this sample. How to cite this article: Gomez Goyeneche HF, Hernandez-Mendieta DP, Rodriguez DA, Sepulveda AI, Toledo JD. Pigment Dispersion Syndrome Progression to Pigmentary Glaucoma in a Latin American Population. J Curr Glaucoma Pract 2015;9(3):69-72.

[Mortality rates of circulatory system diseases and malignant neoplasms in Zagreb population younger than sixty-five--call for alarm].

PubMed

Vizintin, Marina Polić; Mrcela, Nada Tomasović; Kovacić, Luka

2012-12-01

The aim of this work was to analyze the public health indicators for circulatory heart diseases and malignant neoplasms in the population younger than 65 in the City of Zagreb, Croatia, and compare them with the European Union (EU) countries. The purpose was to evaluate the situation and propose the public health preventive measures. The study population were Zagreb citizens aged 0-64 according to the 2001 census. Total Zagreb population was 779145, making 17.6% of total Croatian population. Data from the Croatian Bureau of Statistics and Dr Andrija Stampar Institute of Public Health were used. The standardized 0-64 mortality rates of the selected diseases 2006-2010 were used in the analysis. In 2010, the standardized mortality rates of all analyzed diseases were significantly higher in Zagreb population aged 0-64 than the EU averages except for cervical cancer. In 2010, the mortality rates in Zagreb population aged 0-64 were as follows: circulatory system diseases 61.22, ischemic heart disease 28.99, cerebrovascular diseases 12.51, malignant neoplasms 94.69, tracheal and lung cancer 24.92, breast cancer 21.08 and cervical cancer 2.05. Standardized mortality rates in Zagreb population aged 0-64 for circulatory system were lower than for Croatia (61.22 vs. 63.25), but higher for malignant neoplasms (94.69 vs. 91.2), except for cervical cancer (2.05 vs. 3.14). High standardized mortality rates for the selected diseases in the City of Zagreb, Croatia, were observed. The rates were higher in Zagreb population compared to EU averages except for cervical cancer. This situation urges revision of the public health strategy and implementation of more intensive preventive and screening measures to reduce the risk factors.

Sun exposure profile in the French population. Results of the EDIFICE Melanoma survey.

PubMed

Sassolas, B; Grange, F; Touboul, C; Lebbe, C; Saiag, P; Mortier, L; Lhomel, C; Robert, C

2015-02-01

The incidence of melanoma is increasing worldwide, causing significant economic burden at community and individual levels. Ultraviolet radiation, from natural sunlight or artificial sources, is the main environmental, modifiable risk factor for melanoma. The present analysis assesses the profile of sun exposure in the French population as well as the level of awareness about ultraviolet risk and protection. The survey was conducted via telephone interviews in September and October 2011. In total, 1502 respondents were questioned about their own sun exposure with the question "do you ever, even occasionally, spend time in the sun, during leisure-time, vacation or your professional occupation?" They were also asked about sun protection measures used: protective clothing, a hat or sunscreen. More than three respondents out of four (78%) declared exposing themselves to the sun, with an average of 113 days per year. Of these, 38% did not use appropriate sun protection measures. We identified the following characteristics of individuals declaring high sun exposure: chiefly men under the age of 40, higher socio-professional levels, and adults with no children. Individuals who make a poor use of protective measures are mostly men and of low educational levels. Individuals declaring low sun exposure were chiefly: women, individuals over the age of 60, and those with no professional activity. The high sun protection population comprises mostly: women, higher socio-professional levels, with no specific age-group profile. Analysis of the EDIFICE Melanoma survey provides information about the attitudes of the French population towards sun exposure. The most frequent contexts of sun exposure and the associated socio-demographic characteristics of the population with at-risk attitudes regarding sun exposure are identified. This deeper insight into the profile of at-risk populations will allow interventions to be more accurately targeted, thus potentially improving public health benefits. © 2015 European Academy of Dermatology and Venereology.

Correlation Assessment of Climate and Geographic Distribution of Tuberculosis Using Geographical Information System (GIS).

PubMed

Beiranvand, Reza; Karimi, Asrin; Delpisheh, Ali; Sayehmiri, Kourosh; Soleimani, Samira; Ghalavandi, Shahnaz

2016-01-01

Tuberculosis (TB) spread pattern is influenced by geographic and social factors. Nowadays Geographic Information System (GIS) is one of the most important epidemiological instrumentation identifying high-risk population groups and geographic areas of TB. The aim of this study was to determine the correlation between climate and geographic distribution of TB in Khuzestan Province using GIS during 2005-2012. Through an ecological study, all 6363 patients with definite diagnosis of TB from 2005 until the end of September 2012 in Khuzestan Province, southern Iran were diagnosed. Data were recorded using TB- Register software. Tuberculosis incidence based on the climate and the average of annual rain was evaluated using GIS. Data were analyzed through SPSS software. Independent t-test, ANOVA, Linear regression, Pearson and Eta correlation coefficient with a significance level of less than 5% were used for the statistical analysis. The TB incidence was different in various geographic conditions. The highest mean of TB cumulative incidence rate was observed in extra dry areas (P= 0.017). There was a significant inverse correlation between annual rain rate and TB incidence rate (R= -0.45, P= 0.001). The lowest TB incidence rate (0-100 cases per 100,000) was in areas with the average of annual rain more than 1000 mm (P= 0.003). The risk of TB has a strong relationship with climate and the average of annual rain, so that the risk of TB in areas with low annual rainfall and extra dry climate is more than other regions. Services and special cares to high-risk regions of TB are recommended.

Programs and Place: Risk and Asset Mapping for Fall Prevention

PubMed Central

Smith, Matthew Lee; Towne, Samuel D.; Motlagh, Audry S.; Smith, Donald R.; Boolani, Ali; Horel, Scott A.; Ory, Marcia G.

2017-01-01

Identifying ways to measure access, availability, and utilization of health-care services, relative to at-risk areas or populations, is critical in providing practical and actionable information to key stakeholders. This study identified the prevalence and geospatial distribution of fall-related emergency medical services (EMS) calls in relation to the delivery of an evidence-based fall prevention program in Tarrant County, Texas over a 3-year time period. It aims to educate public health professionals and EMS first respondents about the application of geographic information system programs to identify risk-related “hot spots,” service gaps, and community assets to reduce falls among older adults. On average, 96.09 (±108.65) calls were received per ZIP Code (ranging from 0 calls to 386 calls). On average, EMS calls per ZIP Code increased from 30.80 (±34.70) calls in 2009 to 33.75 (±39.58) calls in 2011, which indicate a modest annual call increase over the 3-year study period. The percent of ZIP Codes offering A Matter of Balance/Volunteer Lay Leader Model (AMOB/VLL) workshops increased from 27.3% in 2009 to 34.5% in 2011. On average, AMOB/VLL workshops were offered in ZIP Codes with more fall-related EMS calls over the 3-year study period. Findings suggest that the study community was providing evidence-based fall prevention programming (AMOB/VLL workshops) in higher-risk areas. Opportunities for strategic service expansion were revealed through the identification of fall-related hot spots and asset mapping. PMID:28361049

Using state-issued identification cards for obesity tracking.

PubMed

Morris, Daniel S; Schubert, Stacey S; Ngo, Duyen L; Rubado, Dan J; Main, Eric; Douglas, Jae P

2015-01-01

Obesity prevention has emerged as one of public health's top priorities. Public health agencies need reliable data on population health status to guide prevention efforts. Existing survey data sources provide county-level estimates; obtaining sub-county estimates from survey data can be prohibitively expensive. State-issued identification cards are an alternate data source for community-level obesity estimates. We computed body mass index for 3.2 million adult Oregonians who were issued a driver license or identification card between 2003 and 2010. Statewide estimates of obesity prevalence and average body mass index were compared to the Oregon Behavioral Risk Factor Surveillance System (BRFSS). After geocoding addresses we calculated average adult body mass index for every census tract and block group in the state. Sub-county estimates reveal striking patterns in the population's weight status. Annual obesity prevalence estimates from identification cards averaged 18% lower than the BRFSS for men and 31% lower for women. Body mass index estimates averaged 2% lower than the BRFSS for men and 5% lower for women. Identification card records are a promising data source to augment tracking of obesity. People do tend to misrepresent their weight, but the consistent bias does not obscure patterns and trends. Large numbers of records allow for stable estimates for small geographic areas. Copyright © 2014 Asian Oceanian Association for the Study of Obesity. All rights reserved.

Environmental triggers of acute myocardial infarction: results of a nationwide multiple-factorial population study.

PubMed

Claeys, Marc J; Coenen, Sarah; Colpaert, Charlotte; Bilcke, Joke; Beutels, Phillip; Wouters, Kristien; Legrand, Victor; Van Damme, Pierre; Vrints, Christiaan

2015-12-01

The objective of this study was to study the independent environmental triggers of ST-elevation myocardial infarction (STEMI) in a multifactorial environmental population model. Daily counts of all STEMI patients who underwent urgent percutaneous coronary intervention over the period 2006-2009 in Belgium were associated with average daily meteorological data and influenza-like illness incidence data. The following meteorological measures were investigated: particulate matter less than 10 μM (PM10) and less than 2.5 μM (PM(2.5)), ozone, black smoke, temperature and relative humidity. During the study period a total of 15,964 STEMI patients (mean age 63, 75% male) were admitted with a daily average admission rate of 11 ± 4 patients. A multivariate Poisson regression analysis showed that only the temperature was significantly correlated with STEMI, with an 8% increase in the risk of STEMI for each 10°C decrease in temperature (adjusted incidence risk ratio (IRR) 0.92, 95% CI 0.89-0.96). The effects of temperature were consistent among several subpopulations but the strongest effect was seen in diabetic patients (IRR 0.85, 95% CI 0.78 -0.95). There was a trend for an incremental risk of STEMI for each 10 μg/m³ PM(2.5) increase and during influenza epidemics with IRR of 1.02 (95% CI 1.00-1.04) and 1.07 (95% CI 0.98-1.16), respectively. In a global environmental model, low temperature is the most important environmental trigger for STEMI, whereas air pollution and influenza epidemics only seem to have a modest effect.

Costs of a public health model to increase receipt of hepatitis-related services for persons with mental illness.

PubMed

Slade, Eric P; Rosenberg, Stanley; Dixon, Lisa B; Goldberg, Richard W; Wolford, George L; Himelhoch, Seth; Tapscott, Stephanie

2013-02-01

This study examined the costs and impact on receipt of hepatitis and HIV testing and hepatitis immunization services of a public health intervention model that was designed for use by persons with serious mental illness and co-occurring substance use disorders. Between 2006 and 2008, a random sample of 202 nonelderly, predominantly African-American males with a psychotic or major depressive disorder and a co-occurring substance use disorder was recruited at four community mental health outpatient programs in a large metropolitan area. Participants were randomly assigned at each site to enhanced treatment as usual (N=97), including education about blood-borne diseases and referrals for testing and vaccinations, or to an experimental intervention (N=105) that provided on-site infectious disease education, screening of risk level, pretest counseling, testing for HIV and hepatitis B and C, vaccination for hepatitis A and B, and personalized risk-reduction counseling. The authors compared the two study groups to assess the average costs of improving hepatitis and HIV testing and hepatitis A and B vaccination in this population. The average cost per participant was $423 for the intervention and $24 for the comparison condition (t=52.7, df=201, p<.001). The costs per additional person tested was $706 for hepatitis C, $776 for hepatitis B, and $3,630 for HIV, and the cost per additional person vaccinated for hepatitis was $561. Delivery of hepatitis and HIV public health services to persons with serious mental illness in outpatient mental health settings can be as cost-effective as similar interventions for other at-risk populations.

Spatial variation of pneumonia hospitalization risk in Twin Cities metro area, Minnesota.

PubMed

Iroh Tam, P Y; Krzyzanowski, B; Oakes, J M; Kne, L; Manson, S

2017-11-01

Fine resolution spatial variability in pneumonia hospitalization may identify correlates with socioeconomic, demographic and environmental factors. We performed a retrospective study within the Fairview Health System network of Minnesota. Patients 2 months of age and older hospitalized with pneumonia between 2011 and 2015 were geocoded to their census block group, and pneumonia hospitalization risk was analyzed in relation to socioeconomic, demographic and environmental factors. Spatial analyses were performed using Esri's ArcGIS software, and multivariate Poisson regression was used. Hospital encounters of 17 840 patients were included in the analysis. Multivariate Poisson regression identified several significant associations, including a 40% increased risk of pneumonia hospitalization among census block groups with large, compared with small, populations of ⩾65 years, a 56% increased risk among census block groups in the bottom (first) quartile of median household income compared to the top (fourth) quartile, a 44% higher risk in the fourth quartile of average nitrogen dioxide emissions compared with the first quartile, and a 47% higher risk in the fourth quartile of average annual solar insolation compared to the first quartile. After adjusting for income, moving from the first to the second quartile of the race/ethnic diversity index resulted in a 21% significantly increased risk of pneumonia hospitalization. In conclusion, the risk of pneumonia hospitalization at the census-block level is associated with age, income, race/ethnic diversity index, air quality, and solar insolation, and varies by region-specific factors. Identifying correlates using fine spatial analysis provides opportunities for targeted prevention and control.

The risk-adjusted vision beyond casemix (DRG) funding in Australia. International lessons in high complexity and capitation.

PubMed

Antioch, Kathryn M; Walsh, Michael K

2004-06-01

Hospitals throughout the world using funding based on diagnosis-related groups (DRG) have incurred substantial budgetary deficits, despite high efficiency. We identify the limitations of DRG funding that lack risk (severity) adjustment for State-wide referral services. Methods to risk adjust DRGs are instructive. The average price in casemix funding in the Australian State of Victoria is policy based, not benchmarked. Average cost weights are too low for high-complexity DRGs relating to State-wide referral services such as heart and lung transplantation and trauma. Risk-adjusted specified grants (RASG) are required for five high-complexity respiratory, cardiology and stroke DRGs incurring annual deficits of $3.6 million due to high casemix complexity and government under-funding despite high efficiency. Five stepwise linear regressions for each DRG excluded non-significant variables and assessed heteroskedasticity and multicollinearlity. Cost per patient was the dependent variable. Significant independent variables were age, length-of-stay outliers, number of disease types, diagnoses, procedures and emergency status. Diagnosis and procedure severity markers were identified. The methodology and the work of the State-wide Risk Adjustment Working Group can facilitate risk adjustment of DRGs State-wide and for Treasury negotiations for expenditure growth. The Alfred Hospital previously negotiated RASG of $14 million over 5 years for three trauma and chronic DRGs. Some chronic diseases require risk-adjusted capitation funding models for Australian Health Maintenance Organizations as an alternative to casemix funding. The use of Diagnostic Cost Groups can facilitate State and Federal government reform via new population-based risk adjusted funding models that measure health need.

Phenotypic plasticity in age at first reproduction of female northern sea otters (Enhydra lutris kenyoni)

USGS Publications Warehouse

Von Biela, V.R.; Gill, V.A.; Bodkin, James L.; Burns, Jennifer M.

2009-01-01

Life-history theory predicts that within a species, reproduction and survival rates will differ among populations that differ in resource availability or predation rates through phenotypic plasticity. When populations are near carrying capacity (K) or when they are declining due to reduced prey resources, the average age at 1st reproduction (average AFR) is predicted to be older than in populations below K. Differences between the trajectories of northern sea otter (Enhydra lutris kenyoni) populations in Alaska provides an opportunity to examine phenotypic plasticity. Using premolar teeth or reproductive tracts, we estimated average AFR from demographically distinct populations of sea otters in Alaska. We obtained samples from 2 populations near K, Prince William Sound (PWS) and the Aleutian Archipelago (archived samples), and from 2populations below K, the Kodiak Archipelago and Sitka. The average AFR was lower in populations below K (3.60 years ??0.16 SD)compared to those near K (4.21 ?? 0.13 years, P <0.001), and differed among all populations, with the Aleutian population possessing the oldest average AFR (4.29 ?? 0.09 years) followed by PWS (4.05 ?? 0.24 years), Sitka (3.80 ?? 0.21 years), and Kodiak (3.19 ?? 0.37 years). The difference in average AFR among populations supports life-history theory and provides evidence of phenotypic plasticity in sea otters. Our findings highlight the value of using average AFR as a tool for monitoring mammalian populations. ?? 2009 American Society of Mammalogists.

Interpreting biomonitoring data for 2,4-dichlorophenoxyacetic acid: Update to Biomonitoring Equivalents and population biomonitoring data.

PubMed

Aylward, L L; Hays, S M

2015-12-01

Urinary biomonitoring data for 2,4-dichlorophenoxyacetic acid (2,4-D) reflect aggregate population exposures to trace 2,4-D residues in diet and the environment. These data can be interpreted in the context of current risk assessments by comparison to a Biomonitoring Equivalent (BE), which is an estimate of the average biomarker concentration consistent with an exposure guidance value such as the US EPA Reference Dose (RfD). BE values are updated here from previous published BE values to reflect a change in the US EPA RfD. The US EPA RfD has been updated to reflect a revised point of departure (POD) based on new information from additional toxicological studies and updated assessment of applicable uncertainty factors. In addition, new biomonitoring data from both the US National Health and Nutrition Examination Survey (NHANES) and the Canadian Health Measures Survey (CHMS) have been published. The updated US EPA chronic RfD of 0.21 mg/kg-d results in updated BE values of 10,500 and 7000 μg/L for adults and children, respectively. Comparison of the current population-representative data to these BE values shows that upper bound population biomarker concentrations are more than 5000-fold below BE values corresponding to the updated US EPA RfD. This biomonitoring-based risk assessment supports the conclusion that current use patterns in the US and Canada result in incidental exposures in the general population that can be considered negligible in the context of the current 2,4-D risk assessment. Copyright © 2015 Elsevier Inc. All rights reserved.

Increased risk of chronic obstructive pulmonary disease in patients with bipolar disorder: A population-based study.

PubMed

Hsu, Jer-Hwa; Chien, I-Chia; Lin, Ching-Heng

2017-10-01

We conducted this nationwide study to examine the prevalence and incidence of chronic obstructive pulmonary disease (COPD) among patients with bipolar disorder in Taiwan. We used a random sample of 766,427 subjects who were aged ≥18 years in 2005. Patients with at least one primary diagnosis of bipolar disorder were identified. Study participants with one primary or secondary diagnosis of COPD for either ambulatory or inpatient care were also identified. We compared the prevalence of COPD in patients with bipolar disorder and the general population in 2005. In addition, we further investigated this cohort from 2006 to 2010 to detect incident cases of COPD in patients with bipolar disorder compared with the general population. The factors associated with COPD among patients with bipolar disorder were also analyzed. The prevalence of COPD in patients with bipolar disorder was higher than in the general population in 2005 (5.68% vs. 2.88%, odds ratio 2.03; 95% confidence interval, 1.53-2.67). The average annual incidence of COPD in patients with bipolar disorder was also higher than in the general population (2.03% vs. 1.03%, risk ratio 1.94; 95% confidence interval, 1.65-2.29) from 2006 to 2010. Some risk factors for COPD such as substance use, obesity, or lifestyle pattern were not available in this study. Patients with bipolar disorder had a higher prevalence and incidence of COPD compared with the general population. Higher prevalence of COPD among bipolar patients was associated with increased age, males, hypertension, and second-generation antidepressant use. Copyright © 2017 Elsevier B.V. All rights reserved.

Environmental risks for nontuberculous mycobacteria. Individual exposures and climatic factors in the cystic fibrosis population.

PubMed

Prevots, D Rebecca; Adjemian, Jennifer; Fernandez, Aisling G; Knowles, Michael R; Olivier, Kenneth N

2014-09-01

Persons with cystic fibrosis are at high risk of pulmonary nontuberculous mycobacterial infection, with a national prevalence estimated at 13%. The risk of nontuberculous mycobacteria associated with specific environmental exposures, and the correlation with climatic conditions in this population has not been described. To describe the association of pulmonary nontuberculous mycobacteria with individual exposures to water and soil aerosols, and the population associations of these infections with climatic factors. We conducted a nested case-control study within a cohort study of pulmonary nontuberculous mycobacteria prevalence at 21 geographically diverse national cystic fibrosis centers. Incident nontuberculous mycobacterial infection cases (at least one prior negative culture followed by one positive culture) were age- and sex-matched to culture-negative controls. Exposures to water and soil were assessed by administering a standardized questionnaire. Cohort prevalence at each of the 21 centers was correlated with climatic conditions in the same area through linear regression modeling. Overall, 48 cases and 85 control subjects were enrolled. Indoor swimming was associated with incident infection (adjusted odds ratio, 5.9, 95% confidence interval, 1.3-26.1), although only nine cases (19%) and five control subjects (6%) reported indoor swimming in the 4 months prior to infection. Exposure to showering and municipal water supply was common among both cases and control subjects: 77% of cases and 76% of control subjects reported showering at least daily. In linear regression, average annual atmospheric water vapor content was significantly predictive of center prevalence (P = 0.0019), with R(2) = 0.40. Atmospheric conditions explain more of the variation in disease prevalence than individual behaviors. The risk of specific exposures may vary by geographic region due to differences in conditions favoring mycobacterial growth and survival. However, because exposure to these organisms is ubiquitous and behaviors are similar among persons with and without pulmonary nontuberculous mycobacteria, genetic susceptibility beyond cystic fibrosis is likely to be important for disease development. Common individual risk factors in high-risk populations remain to be identified.

Patient-specific radiation dose and cancer risk estimation in pediatric chest CT: a study in 30 patients

NASA Astrophysics Data System (ADS)

Li, Xiang; Samei, Ehsan; Segars, W. Paul; Sturgeon, Gregory M.; Colsher, James G.; Frush, Donald P.

2010-04-01

Radiation-dose awareness and optimization in CT can greatly benefit from a dosereporting system that provides radiation dose and cancer risk estimates specific to each patient and each CT examination. Recently, we reported a method for estimating patientspecific dose from pediatric chest CT. The purpose of this study is to extend that effort to patient-specific risk estimation and to a population of pediatric CT patients. Our study included thirty pediatric CT patients (16 males and 14 females; 0-16 years old), for whom full-body computer models were recently created based on the patients' clinical CT data. Using a validated Monte Carlo program, organ dose received by the thirty patients from a chest scan protocol (LightSpeed VCT, 120 kVp, 1.375 pitch, 40-mm collimation, pediatric body scan field-of-view) was simulated and used to estimate patient-specific effective dose. Risks of cancer incidence were calculated for radiosensitive organs using gender-, age-, and tissue-specific risk coefficients and were used to derive patientspecific effective risk. The thirty patients had normalized effective dose of 3.7-10.4 mSv/100 mAs and normalized effective risk of 0.5-5.8 cases/1000 exposed persons/100 mAs. Normalized lung dose and risk of lung cancer correlated strongly with average chest diameter (correlation coefficient: r = -0.98 to -0.99). Normalized effective risk also correlated strongly with average chest diameter (r = -0.97 to -0.98). These strong correlations can be used to estimate patient-specific dose and risk prior to or after an imaging study to potentially guide healthcare providers in justifying CT examinations and to guide individualized protocol design and optimization.

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.

Application of MODIS GPP to Forecast Risk of Hantavirus Pulmonary Syndrome Based on Fluctuations in Reservoir Population Density

NASA Astrophysics Data System (ADS)

Loehman, R.; Heinsch, F. A.; Mills, J. N.; Wagoner, K.; Running, S.

2003-12-01

Recent predictive models for hantavirus pulmonary syndrome (HPS) have used remotely sensed spectral reflectance data to characterize risk areas with limited success. We present an alternative method using gross primary production (GPP) from the MODIS sensor to estimate the effects of biomass accumulation on population density of Peromyscus maniculatus (deer mouse), the principal reservoir species for Sin Nombre virus (SNV). The majority of diagnosed HPS cases in North America are attributed to SNV, which is transmitted to humans through inhalation of excretions and secretions from infected rodents. A logistic model framework is used to evaluate MODIS GPP, temperature, and precipitation as predictors of P. maniculatus density at established trapping sites across the western United States. Rodent populations are estimated using monthly minimum number alive (MNA) data for 2000 through 2002. Both local meteorological data from nearby weather stations and 1.25 degree x 1 degree gridded data from the NASA DAO were used in the regression model to determine the spatial sensitivity of the response. MODIS eight-day GPP data (1-km resolution) were acquired and binned to monthly average and monthly sum GPP for 3km x 3km grids surrounding each rodent trapping site. The use of MODIS GPP to forecast HPS risk may result in a marked improvement over past reflectance-based risk area characterizations. The MODIS GPP product provides a vegetation dynamics estimate that is unique to disease models, and targets the fundamental ecological processes responsible for increased rodent density and amplified disease risk.

Risk of congenital anomalies in the vicinity of municipal solid waste incinerators

PubMed Central

Cordier, S; Chevrier, C; Robert-Gnansia, E; Lorente, C; Brula, P; Hours, M

2004-01-01

Background: Although municipal solid waste incineration (MSWI) has contributed to increase the overall environmental load of particulate matter containing dioxins and metals, evidence of health consequences to populations is sparse. Aims: To assess at a regional level (in southeast France) the impact of these emissions on birth defect rates. Methods: Communities with fewer than 50 000 inhabitants surrounding the 70 incinerators that operated at least one year from 1988 to 1997 were studied. Each exposed community (n = 194) was assigned an exposure index estimated from a Gaussian plume model. Poisson models and a reference population of the 2678 unexposed communities in the region were used to calculate relative risks for congenital malformations, adjusted for year of birth, maternal age, department of birth, population density, average family income, and when available, local road traffic. Results: The rate of congenital anomalies was not significantly higher in exposed compared with unexposed communities. Some subgroups of major anomalies, specifically facial clefts and renal dysplasia, were more frequent in the exposed communities. Among exposed communities, a dose-response trend of risk with increasing exposure was observed for obstructive uropathies. Risks of cardiac anomalies, obstructive uropathies, and skin anomalies increased linearly with road traffic density. Conclusions: Although both incinerator emissions and road traffic may plausibly explain some of the excess risks observed, several alternative explanations, including exposure misclassification, ascertainment bias, and residual confounding cannot be excluded. Some of the effects observed, if real, might be attributable to old-technology MSWIs and the persistent pollution they have generated. PMID:14691267

An Epidemiological Study of Gastroesophageal Reflux Disease and Related Risk Factors in Urban Population of Mashhad, Iran

PubMed Central

Vossoughinia, Hassan; Salari, Masoumeh; Mokhtari Amirmajdi, Elham; Saadatnia, Hassan; Abedini, Siavash; Shariati, Alireza; Shariati, Mohammadjavad; Khosravi Khorashad, Ahmad

2014-01-01

Background: Gastroesophageal Reflux Disease (GERD) is a chronic and common disease, which is characterized by heartburn and regurgitation. In the last couple of decades, GERD has received much attention and studies have shown an increase in its prevalence. Although there have been a few studies on the prevalence of GERD in Iran, no study has yet been done in the northeastern part of the country. The aim of our study was to evaluate the prevalence of GERD and its risk factors in a population from Mashhad. Objectives: To evaluate the epidemiology of GERD based on a population study in Mashhad. Patients and Methods: This was a cross sectional descriptive study conducted in 2010. In total, 2500 participants were selected based on cluster sampling. Modified and validated Mayo Clinic questionnaire for GERD was used for data collection. Overall, 1685 questionnaires were retrieved. Fifty-one participants were excluded because of pregnancies, history of abdominal surgery and being less than 18 years old. We analyzed data using the SPSS software version 16. Prevalence of GERD and significant risk factors (P value < 0.05) were determined. Results: In total, 420 participants (25.7%) had GERD symptoms. Risk factors with significant effects consisted of smoking, consumption of non-steroidal anti-inflammatory drugs (NASIDs), overeating, chronic diseases, tea and coffee consumption and GERD in spouse. Conclusions: The prevalence of GERD among people living in Mashhad was above the average prevalence in other cities of Iran. However, risk factors seemed to be similar to those reported by other studies. PMID:25763231

Association between sucrose intake and acute coronary event risk and effect modification by lifestyle factors: Malmö Diet and Cancer Cohort Study.

PubMed

Warfa, K; Drake, I; Wallström, P; Engström, G; Sonestedt, E

2016-11-01

Previous studies have suggested that a high intake of sugar-sweetened beverages is positively associated with the risk of a coronary event. However, a few studies have examined the association between sucrose (the most common extrinsic sugar in Sweden) and incident coronary events. The objective of the present study was to examine the associations between sucrose intake and coronary event risk and to determine whether these associations are specific to certain subgroups of the population (i.e. according to physical activity, obesity status, educational level, alcohol consumption, smoking habits, intake of fat and intake of fruits and vegetables). We performed a prospective analysis on 26 190 individuals (62 % women) free from diabetes and without a history of CVD from the Swedish population-based Malmö Diet and Cancer cohort. Over an average of 17 years of follow-up (457 131 person-years), 2493 incident cases of coronary events were identified. Sucrose intake was obtained from an interview-based diet history method, including 7-d records of prepared meals and cold beverages and a 168-item diet questionnaire covering other foods. Participants who consumed >15 % of their energy intake (E%) from sucrose showed a 37 (95 % CI 13, 66) % increased risk of a coronary event compared with the lowest sucrose consumers (<5 E%) after adjusting for potential confounders. The association was not modified by the selected lifestyle factors. The results indicated that sucrose consumption higher than 15 E% (5 % of this population) is associated with an increased risk of a coronary event.

Twenty-Four-Hour Central Pulse Pressure for Cardiovascular Events Prediction in a Low-Cardiovascular-Risk Population: Results From the Bordeaux Cohort.

PubMed

Cremer, Antoine; Boulestreau, Romain; Gaillard, Prune; Lainé, Marion; Papaioannou, Georgios; Gosse, Philippe

2018-02-23

Central blood pressure (BP) is a promising marker to identify subjects with higher cardiovascular risk than expected by traditional risk factors. Significant results have been obtained in populations with high cardiovascular risk, but little is known about low-cardiovascular-risk patients, although the differences between central and peripheral BP (amplification) are usually greater in this population. The study aim was to evaluate central BP over 24 hours for cardiovascular event prediction in hypertensive subjects with low cardiovascular risk. Peripheral and central BPs were recorded during clinical visits and over 24 hours in hypertensive patients with low cardiovascular risk (Systematic Coronary Risk Evaluation ≤5%). Our primary end point is the occurrence of a cardiovascular event during follow-up. To assess the potential interest in central pulse pressure over 24 hours, we performed Cox proportional hazard models analysis and comparison of area under the curves using the contrast test for peripheral and central BP. A cohort of 703 hypertensive subjects from Bordeaux were included. After the first 24 hours of BP measurement, the subjects were then followed up for an average of 112.5±70 months. We recorded 65 cardiovascular events during follow-up. Amplification was found to be significantly associated with cardiovascular events when added to peripheral 24-hour pulse pressure ( P =0.0259). The area under the curve of 24-hour central pulse pressure is significantly more important than area under the curve of office BP ( P =0.0296), and there is a trend of superiority with the area under the curve of peripheral 24-hour pulse pressure. Central pulse pressure over 24 hours improves the prediction of cardiovascular events for hypertensive patients with low cardiovascular risk compared to peripheral pulse pressure. © 2018 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

Combining radar and direct observation to estimate pelican collision risk at a proposed wind farm on the Cape west coast, South Africa

PubMed Central

Reid, Tim; du Plessis, Johan; Colyn, Robin; Benn, Grant; Millikin, Rhonda

2018-01-01

Pre-construction assessments of bird collision risk at proposed wind farms are often confounded by insufficient or poor quality data describing avian flight paths through the development area. These limitations can compromise the practical value of wind farm impact studies. We used radar- and observer-based methods to quantify great white pelican flights in the vicinity of a planned wind farm on the Cape west coast, South Africa, and modelled turbine collision risk under various scenarios. Model outputs were combined with pre-existing demographic data to evaluate the possible influence of the wind farm on the pelican population, and to examine impact mitigation options. We recorded high volumes of great white pelican movement through the wind farm area, coincident with the breeding cycle of the nearby colony and associated with flights to feeding areas located about 50 km away. Pelicans were exposed to collision risk at a mean rate of 2.02 High Risk flights.h-1. Risk was confined to daylight hours, highest during the middle of the day and in conditions of strong north-westerly winds, and 82% of High Risk flights were focused on only five of the proposed 35 turbine placements. Predicted mean mortality rates (22 fatalities.yr-1, 95% Cl, 16–29, with average bird and blade speeds and 95% avoidance rates) were not sustainable, resulting in a negative population growth rate (λ = 0.991). Models suggested that removal of the five highest risk turbines from the project, or institution of a curtailment regimen that shuts down at least these turbines at peak traffic times, could theoretically reduce impacts to manageable levels. However, in spite of the large quantities of high quality data used in our analyses, our collision risk model remains compromised by untested assumptions about pelican avoidance rates and uncertainties about the existing dynamics of the pelican population, and our findings are probably not reliable enough to ensure sustainable development. PMID:29408877

Combining radar and direct observation to estimate pelican collision risk at a proposed wind farm on the Cape west coast, South Africa.

PubMed

Jenkins, Andrew R; Reid, Tim; du Plessis, Johan; Colyn, Robin; Benn, Grant; Millikin, Rhonda

2018-01-01

Pre-construction assessments of bird collision risk at proposed wind farms are often confounded by insufficient or poor quality data describing avian flight paths through the development area. These limitations can compromise the practical value of wind farm impact studies. We used radar- and observer-based methods to quantify great white pelican flights in the vicinity of a planned wind farm on the Cape west coast, South Africa, and modelled turbine collision risk under various scenarios. Model outputs were combined with pre-existing demographic data to evaluate the possible influence of the wind farm on the pelican population, and to examine impact mitigation options. We recorded high volumes of great white pelican movement through the wind farm area, coincident with the breeding cycle of the nearby colony and associated with flights to feeding areas located about 50 km away. Pelicans were exposed to collision risk at a mean rate of 2.02 High Risk flights.h-1. Risk was confined to daylight hours, highest during the middle of the day and in conditions of strong north-westerly winds, and 82% of High Risk flights were focused on only five of the proposed 35 turbine placements. Predicted mean mortality rates (22 fatalities.yr-1, 95% Cl, 16-29, with average bird and blade speeds and 95% avoidance rates) were not sustainable, resulting in a negative population growth rate (λ = 0.991). Models suggested that removal of the five highest risk turbines from the project, or institution of a curtailment regimen that shuts down at least these turbines at peak traffic times, could theoretically reduce impacts to manageable levels. However, in spite of the large quantities of high quality data used in our analyses, our collision risk model remains compromised by untested assumptions about pelican avoidance rates and uncertainties about the existing dynamics of the pelican population, and our findings are probably not reliable enough to ensure sustainable development.

The safety of flavocoxid, a medical food, in the dietary management of knee osteoarthritis.

PubMed

Morgan, Sarah L; Baggott, Joseph E; Moreland, Larry; Desmond, Renee; Kendrach, Angela C

2009-10-01

This study was designed to determine the safety of a medical food, flavocoxid, a proprietary blend of free-B ring flavonoids and flavans from the root of Scutellaria baicalensis (Chinese skullcap) and the bark of Acacia catechu in the dietary management of knee osteoarthritis. The 12-week, randomized, double-blind, placebo-controlled trial in an academic medical center enrolled 59 patients with moderate osteoarthritis of at least one knee who were recruited who were classified as having "below average" to "a moderately above average cardiovascular risk" with a Framingham-based scoring tool. Subjects were randomized to flavocoxid 250 mg twice a day versus identical placebo. Safety measures, including recording of adverse events, incidence of serious adverse events, and results of routine laboratory values, were compared between the two groups. There were no major differences in the baseline demographic characteristics of the placebo and flavocoxid groups. With one exception no significant differences were found between the two groups with respect to adverse events by body system, blood pressure, or laboratory values. There was a significantly higher incidence of upper respiratory adverse events in the placebo group (35.4% vs. 5.8%, P = .0003). There were no intra- or inter-group differences in any of the laboratory parameters from study baseline to completion. Thus, flavocoxid is safe when used in a population with "below average" to "moderately above average cardiovascular risk" compared to placebo.

Locating helicopter emergency medical service bases to optimise population coverage versus average response time.

PubMed

Garner, Alan A; van den Berg, Pieter L

2017-10-16

New South Wales (NSW), Australia has a network of multirole retrieval physician staffed helicopter emergency medical services (HEMS) with seven bases servicing a jurisdiction with population concentrated along the eastern seaboard. The aim of this study was to estimate optimal HEMS base locations within NSW using advanced mathematical modelling techniques. We used high resolution census population data for NSW from 2011 which divides the state into areas containing 200-800 people. Optimal HEMS base locations were estimated using the maximal covering location problem facility location optimization model and the average response time model, exploring the number of bases needed to cover various fractions of the population for a 45 min response time threshold or minimizing the overall average response time to all persons, both in green field scenarios and conditioning on the current base structure. We also developed a hybrid mathematical model where average response time was optimised based on minimum population coverage thresholds. Seven bases could cover 98% of the population within 45mins when optimised for coverage or reach the entire population of the state within an average of 21mins if optimised for response time. Given the existing bases, adding two bases could either increase the 45 min coverage from 91% to 97% or decrease the average response time from 21mins to 19mins. Adding a single specialist prehospital rapid response HEMS to the area of greatest population concentration decreased the average state wide response time by 4mins. The optimum seven base hybrid model that was able to cover 97.75% of the population within 45mins, and all of the population in an average response time of 18 mins included the rapid response HEMS model. HEMS base locations can be optimised based on either percentage of the population covered, or average response time to the entire population. We have also demonstrated a hybrid technique that optimizes response time for a given number of bases and minimum defined threshold of population coverage. Addition of specialized rapid response HEMS services to a system of multirole retrieval HEMS may reduce overall average response times by improving access in large urban areas.

Tsunamis: Global Exposure and Local Risk Analysis

NASA Astrophysics Data System (ADS)

Harbitz, C. B.; Løvholt, F.; Glimsdal, S.; Horspool, N.; Griffin, J.; Davies, G.; Frauenfelder, R.

2014-12-01

The 2004 Indian Ocean tsunami led to a better understanding of the likelihood of tsunami occurrence and potential tsunami inundation, and the Hyogo Framework for Action (HFA) was one direct result of this event. The United Nations International Strategy for Disaster Risk Reduction (UN-ISDR) adopted HFA in January 2005 in order to reduce disaster risk. As an instrument to compare the risk due to different natural hazards, an integrated worldwide study was implemented and published in several Global Assessment Reports (GAR) by UN-ISDR. The results of the global earthquake induced tsunami hazard and exposure analysis for a return period of 500 years are presented. Both deterministic and probabilistic methods (PTHA) are used. The resulting hazard levels for both methods are compared quantitatively for selected areas. The comparison demonstrates that the analysis is rather rough, which is expected for a study aiming at average trends on a country level across the globe. It is shown that populous Asian countries account for the largest absolute number of people living in tsunami prone areas, more than 50% of the total exposed people live in Japan. Smaller nations like Macao and the Maldives are among the most exposed by population count. Exposed nuclear power plants are limited to Japan, China, India, Taiwan, and USA. On the contrary, a local tsunami vulnerability and risk analysis applies information on population, building types, infrastructure, inundation, flow depth for a certain tsunami scenario with a corresponding return period combined with empirical data on tsunami damages and mortality. Results and validation of a GIS tsunami vulnerability and risk assessment model are presented. The GIS model is adapted for optimal use of data available for each study. Finally, the importance of including landslide sources in the tsunami analysis is also discussed.

Prognostic discrimination in "good-risk" chronic granulocytic leukemia.

PubMed

Sokal, J E; Cox, E B; Baccarani, M; Tura, S; Gomez, G A; Robertson, J E; Tso, C Y; Braun, T J; Clarkson, B D; Cervantes, F

1984-04-01

The prognostic significance of disease features recorded at the time of diagnosis was examined among 813 patients with Philadelphia chromosome-positive, nonblastic chronic granulocytic leukemia (CGL) collected from six European and American series. The survival pattern for this population was typical of "good-risk" patients, and median survival was 47 mo. There were multiple interrelationships among different disease features, which led to highly significant correlations with survival for some that had no primary prognostic significance, such as hematocrit. Multivariable regression analysis indicated that spleen size and the percentage of circulating blasts were the most important prognostic indicators. These features, and age, behaved as continuous variables with progressively unfavorable import at higher values. The platelet count did not influence survival significantly at values below 700 X 10(9)/liter but was increasingly unfavorable above this level. Basophils plus eosinophils over 15%, more than 5% marrow blasts, and karyotypic abnormalities in addition to the Ph1 were also significant unfavorable signs. The Cox model, generated with four variables representing percent blasts, spleen size, platelet count, and age, provided a useful representation of risk status in this population, with good fit between predicted and observed survival over more than a twofold survival range. A hazard function derived from half of the patient population successfully segregated the remainder into three groups with significantly different survival patterns. We conclude that it should be possible to identify a lower risk group of patients with a 2-yr survival of 90%, subsequent risk averaging somewhat less than 20%/yr and median survival of 5 yr, an intermediate group, and a high-risk group with a 2-yr survival of 65%, followed by a death rate of about 35%/yr and median survival of 2.5 yr.

Association between family history risk categories and prevalence of diabetes in Chinese population.

PubMed

Zhang, Jinping; Yang, Zhaojun; Xiao, Jianzhong; Xing, Xiaoyan; Lu, Juming; Weng, Jianping; Jia, Weiping; Ji, Linong; Shan, Zhongyan; Liu, Jie; Tian, Haoming; Ji, Qiuhe; Zhu, Dalong; Ge, Jiapu; Chen, Li; Guo, Xiaohui; Zhao, Zhigang; Li, Qiang; Zhou, Zhiguang; Lin, Lixiang; Wang, Na; Yang, Wenying

2015-01-01

To investigate the association between different family history risk categories and prevalence of diabetes in the Chinese population. The family history of diabetes was obtained from each subject, and an oral glucose tolerance test was performed for measuring the fasting and postload glucose and insulin levels based on a national representative cross-sectional survey of 46,239 individuals (age ≥ 20 years) in the 2007-2008 China National Diabetes and Metabolism Disorders Study. The family history risk categories of diabetes were high, moderate, and average (FH2 and FH1: at least two generations and one generation of first-degree relatives with diabetes, respectively; FH0: no first-degree relatives with diabetes). The age- and gender-adjusted prevalence rates of diabetes were 32.7% (95% confidence interval (CI): 26.4-39.7%) in FH2, 20.1% (95% CI: 18.2-22.1%) in FH1, and 8.4% (95% CI: 7.9-8.9%) in FH0 (P < 0.0001). The calculated homeostatic model assessment-estimated insulin resistance (HOMA-IR), Matsuda insulin sensitivity index (ISI), and insulinogenic index (ΔI30/ΔG30) values showed significant trending changes among the three risk categories, with the most negative effects in FH2. Multivariate logistic regression analysis showed that the odds ratios of having diabetes were 6.16 (95% CI: 4.46-8.50) and 2.86 (95% CI: 2.41-3.39) times higher in FH2 and FH1, respectively, than in FH0 after adjustment for classical risk factors for diabetes. Family history risk categories of diabetes have a significant, independent, and graded association with the prevalence of this disease in the Chinese population.

Sleep, Cognitive impairment, and Alzheimer's disease: A Systematic Review and Meta-Analysis.

PubMed

Bubu, Omonigho M; Brannick, Michael; Mortimer, James; Umasabor-Bubu, Ogie; Sebastião, Yuri V; Wen, Yi; Schwartz, Skai; Borenstein, Amy R; Wu, Yougui; Morgan, David; Anderson, William M

2017-01-01

Mounting evidence implicates disturbed sleep or lack of sleep as one of the risk factors for Alzheimer's disease (AD), but the extent of the risk is uncertain. We conducted a broad systematic review and meta-analysis to quantify the effect of sleep problems/disorders on cognitive impairment and AD. Original published literature assessing any association of sleep problems or disorders with cognitive impairment or AD was identified by searching PubMed, Embase, Web of Science, and the Cochrane library. Effect estimates of individual studies were pooled and relative risks (RR) and 95% confidence intervals (CI) were calculated using random effects models. We also estimated the population attributable risk. Twenty-seven observational studies (n = 69216 participants) that provided 52 RR estimates were included in the meta-analysis. Individuals with sleep problems had a 1.55 (95% CI: 1.25-1.93), 1.65 (95% CI: 1.45-1.86), and 3.78 (95% CI: 2.27-6.30) times higher risk of AD, cognitive impairment, and preclinical AD than individuals without sleep problems, respectively. The overall meta-analysis revealed that individuals with sleep problems had a 1.68 (95% CI: 1.51-1.87) times higher risk for the combined outcome of cognitive impairment and/or AD. Approximately 15% of AD in the population may be attributed to sleep problems. This meta-analysis confirmed the association between sleep and cognitive impairment or AD and, for the first time, consolidated the evidence to provide an "average" magnitude of effect. As sleep problems are of a growing concern in the population, these findings are of interest for potential prevention of AD. © Sleep Research Society 2016. Published by Oxford University Press on behalf of the Sleep Research Society. All rights reserved. For permissions, please e-mail journals.permissions@oup.com.

Early Warning System for West Nile Virus Risk Areas, California, USA

PubMed Central

Ahearn, Sean C.; McConchie, Alan; Glaser, Carol; Jean, Cynthia; Barker, Chris; Park, Bborie; Padgett, Kerry; Parker, Erin; Aquino, Ervic; Kramer, Vicki

2011-01-01

The Dynamic Continuous-Area Space-Time (DYCAST) system is a biologically based spatiotemporal model that uses public reports of dead birds to identify areas at high risk for West Nile virus (WNV) transmission to humans. In 2005, during a statewide epidemic of WNV (880 cases), the California Department of Public Health prospectively implemented DYCAST over 32,517 km2 in California. Daily risk maps were made available online and used by local agencies to target public education campaigns, surveillance, and mosquito control. DYCAST had 80.8% sensitivity and 90.6% specificity for predicting human cases, and κ analysis indicated moderate strength of chance-adjusted agreement for >4 weeks. High-risk grid cells (populations) were identified an average of 37.2 days before onset of human illness; relative risk for disease was >39× higher than for low-risk cells. Although prediction rates declined in subsequent years, results indicate DYCAST was a timely and effective early warning system during the severe 2005 epidemic. PMID:21801622

Public health risk assessment associated with heavy metal and arsenic exposure near an abandoned mine (Kirki, Greece).

PubMed

Nikolaidis, Christos; Orfanidis, Moysis; Hauri, Dimitri; Mylonas, Stratos; Constantinidis, Theodore

2013-12-01

The 'Agios Philippos' lead-zinc mine in the Kirki region (NE Greece) is now closed, but its legacy of heavy metal contamination remains at the site. At present, management of the contaminated land is of major concern. The area is in a reclamation process and requires immediate remediation action, whereas human risks need to be carefully evaluated. In order to assess these risks, samples from around the mine were collected and analyzed and a scenario involving the oral, dermal, and inhaled doses of arsenic and heavy metals was formulated. A Monte Carlo approach was undertaken, in order to model the average daily dose and quantify the corresponding hazard index and cancer risk. A toxicological risk was associated with samples collected in the vicinity of the mine (floatation, mine tailings) and a pronounced carcinogenic risk for arsenic was evident at the broader occupational/environmental setting. These findings urge for immediate rehabilitation actions that will mitigate population exposures and promote long-term environmental safety in the area.

Sexual selection affects local extinction and turnover in bird communities

USGS Publications Warehouse

Doherty, P.F.; Sorci, G.; Royle, J. Andrew; Hines, J.E.; Nichols, J.D.; Boulinier, T.

2003-01-01

Predicting extinction risks has become a central goal for conservation and evolutionary biologists interested in population and community dynamics. Several factors have been put forward to explain risks of extinction, including ecological and life history characteristics of individuals. For instance, factors that affect the balance between natality and mortality can have profound effects on population persistence. Sexual selection has been identified as one such factor. Populations under strong sexual selection experience a number of costs ranging from increased predation and parasitism to enhanced sensitivity to environmental and demographic stochasticity. These findings have led to the prediction that local extinction rates should be higher for species/populations with intense sexual selection. We tested this prediction by analyzing the dynamics of natural bird communities at a continental scale over a period of 21 years (1975-1996), using relevant statistical tools. In agreement with the theoretical prediction, we found that sexual selection increased risks of local extinction (dichromatic birds had on average a 23% higher local extinction rate than monochromatic species). However, despite higher local extinction probabilities, the number of dichromatic species did not decrease over the period considered in this study. This pattern was caused by higher local turnover rates of dichromatic species, resulting in relatively stable communities for both groups of species. Our results suggest that these communities function as metacommunities, with frequent local extinctions followed by colonization. Anthropogenic factors impeding dispersal might therefore have a significant impact on the global persistence of sexually selected species.

Accounting for Shared and Unshared Dosimetric Uncertainties in the Dose Response for Ultrasound-Detected Thyroid Nodules after Exposure to Radioactive Fallout

PubMed Central

Hoffman, F. Owen; Moroz, Brian; Drozdovitch, Vladimir; Bouville, André; Beck, Harold; Luckyanov, Nicholas; Weinstock, Robert M.; Simon, Steven L.

2015-01-01

Dosimetic uncertainties, particularly those that are shared among subgroups of a study population, can bias, distort or reduce the slope or significance of a dose response. Exposure estimates in studies of health risks from environmental radiation exposures are generally highly uncertain and thus, susceptible to these methodological limitations. An analysis was published in 2008 concerning radiation-related thyroid nodule prevalence in a study population of 2,994 villagers under the age of 21 years old between August 1949 and September 1962 and who lived downwind from the Semi-palatinsk Nuclear Test Site in Kazakhstan. This dose-response analysis identified a statistically significant association between thyroid nodule prevalence and reconstructed doses of fallout-related internal and external radiation to the thyroid gland; however, the effects of dosimetric uncertainty were not evaluated since the doses were simple point “best estimates”. In this work, we revised the 2008 study by a comprehensive treatment of dosimetric uncertainties. Our present analysis improves upon the previous study, specifically by accounting for shared and unshared uncertainties in dose estimation and risk analysis, and differs from the 2008 analysis in the following ways: 1. The study population size was reduced from 2,994 to 2,376 subjects, removing 618 persons with uncertain residence histories; 2. Simulation of multiple population dose sets (vectors) was performed using a two-dimensional Monte Carlo dose estimation method; and 3. A Bayesian model averaging approach was employed for evaluating the dose response, explicitly accounting for large and complex uncertainty in dose estimation. The results were compared against conventional regression techniques. The Bayesian approach utilizes 5,000 independent realizations of population dose vectors, each of which corresponds to a set of conditional individual median internal and external doses for the 2,376 subjects. These 5,000 population dose vectors reflect uncertainties in dosimetric parameters, partly shared and partly independent, among individual members of the study population. Risk estimates for thyroid nodules from internal irradiation were higher than those published in 2008, which results, to the best of our knowledge, from explicitly accounting for dose uncertainty. In contrast to earlier findings, the use of Bayesian methods led to the conclusion that the biological effectiveness for internal and external dose was similar. Estimates of excess relative risk per unit dose (ERR/Gy) for males (177 thyroid nodule cases) were almost 30 times those for females (571 cases) and were similar to those reported for thyroid cancers related to childhood exposures to external and internal sources in other studies. For confirmed cases of papillary thyroid cancers (3 in males, 18 in females), the ERR/Gy was also comparable to risk estimates from other studies, but not significantly different from zero. These findings represent the first reported dose response for a radiation epidemiologic study considering all known sources of shared and unshared errors in dose estimation and using a Bayesian model averaging (BMA) method for analysis of the dose response. PMID:25574587

Variation in urinary spot sample, 24 h samples, and longer-term average urinary concentrations of short-lived environmental chemicals: implications for exposure assessment and reverse dosimetry

PubMed Central

Aylward, Lesa L; Hays, Sean M; Zidek, Angelika

2017-01-01

Population biomonitoring data sets such as the Canadian Health Measures Survey (CHMS) and the United States National Health and Nutrition Examination Survey (NHANES) collect and analyze spot urine samples for analysis for biomarkers of exposure to non-persistent chemicals. Estimation of population intakes using such data sets in a risk-assessment context requires consideration of intra- and inter-individual variability to understand the relationship between variation in the biomarker concentrations and variation in the underlying daily and longer-term intakes. Two intensive data sets with a total of 16 individuals with collection and measurement of serial urine voids over multiple days were used to examine these relationships using methyl paraben, triclosan, bisphenol A (BPA), monoethyl phthalate (MEP), and mono-2-ethylhexyl hydroxyl phthalate (MEHHP) as example compounds. Composited 24 h voids were constructed mathematically from the individual collected voids, and concentrations for each 24 h period and average multiday concentrations were calculated for each individual in the data sets. Geometric mean and 95th percentiles were compared to assess the relationship between distributions in spot sample concentrations and the 24 h and multiday collection averages. In these data sets, spot sample concentrations at the 95th percentile were similar to or slightly higher than the 95th percentile of the distribution of all 24 h composite void concentrations, but tended to overestimate the maximum of the multiday concentration averages for most analytes (usually by less than a factor of 2). These observations can assist in the interpretation of population distributions of spot samples for frequently detected analytes with relatively short elimination half-lives. PMID:27703149

Description of a New Predictive Modeling Approach That Correlates the Risk and Associated Cost of Well-Defined Diabetes-Related Complications With Changes in Glycated Hemoglobin (HbA1c)

PubMed Central

Fortwaengler, Kurt; Parkin, Christopher G.; Neeser, Kurt; Neumann, Monika; Mast, Oliver

2017-01-01

The modeling approach described here is designed to support the development of spreadsheet-based simple predictive models. It is based on 3 pillars: association of the complications with HbA1c changes, incidence of the complications, and average cost per event of the complication. For each pillar, the goal of the analysis was (1) to find results for a large diversity of populations with a focus on countries/regions, diabetes type, age, diabetes duration, baseline HbA1c value, and gender; (2) to assess the range of incidences and associations previously reported. Unlike simple predictive models, which mostly are based on only 1 source of information for each of the pillars, we conducted a comprehensive, systematic literature review. Each source found was thoroughly reviewed and only sources meeting quality expectations were considered. The approach allows avoidance of unintended use of extreme data. The user can utilize (1) one of the found sources, (2) the found range as validation for the found figures, or (3) the average of all found publications for an expedited estimate. The modeling approach is intended for use in average insulin-treated diabetes populations in which the baseline HbA1c values are within an average range (6.5% to 11.5%); it is not intended for use in individuals or unique diabetes populations (eg, gestational diabetes). Because the modeling approach only considers diabetes-related complications that are positively associated with HbA1c decreases, the costs of negatively associated complications (eg, severe hypoglycemic events) must be calculated separately. PMID:27510441

LIFETIME LUNG CANCER RISKS ASSOCIATED WITH INDOOR RADON EXPOSURE BASED ON VARIOUS RADON RISK MODELS FOR CANADIAN POPULATION.

PubMed

Chen, Jing

2017-04-01

This study calculates and compares the lifetime lung cancer risks associated with indoor radon exposure based on well-known risk models in the literature; two risk models are from joint studies among miners and the other three models were developed from pooling studies on residential radon exposure from China, Europe and North America respectively. The aim of this article is to make clear that the various models are mathematical descriptions of epidemiologically observed real risks in different environmental settings. The risk from exposure to indoor radon is real and it is normal that variations could exist among different risk models even when they were applied to the same dataset. The results show that lifetime risk estimates vary significantly between the various risk models considered here: the model based on the European residential data provides the lowest risk estimates, while models based on the European miners and Chinese residential pooling with complete dosimetry give the highest values. The lifetime risk estimates based on the EPA/BEIR-VI model lie within this range and agree reasonably well with the averages of risk estimates from the five risk models considered in this study. © Crown copyright 2016.

Forecasting high-priority infectious disease surveillance regions: a socioeconomic model.

PubMed

Chan, Emily H; Scales, David A; Brewer, Timothy F; Madoff, Lawrence C; Pollack, Marjorie P; Hoen, Anne G; Choden, Tenzin; Brownstein, John S

2013-02-01

Few researchers have assessed the relationships between socioeconomic inequality and infectious disease outbreaks at the population level globally. We use a socioeconomic model to forecast national annual rates of infectious disease outbreaks. We constructed a multivariate mixed-effects Poisson model of the number of times a given country was the origin of an outbreak in a given year. The dataset included 389 outbreaks of international concern reported in the World Health Organization's Disease Outbreak News from 1996 to 2008. The initial full model included 9 socioeconomic variables related to education, poverty, population health, urbanization, health infrastructure, gender equality, communication, transportation, and democracy, and 1 composite index. Population, latitude, and elevation were included as potential confounders. The initial model was pared down to a final model by a backwards elimination procedure. The dependent and independent variables were lagged by 2 years to allow for forecasting future rates. Among the socioeconomic variables tested, the final model included child measles immunization rate and telephone line density. The Democratic Republic of Congo, China, and Brazil were predicted to be at the highest risk for outbreaks in 2010, and Colombia and Indonesia were predicted to have the highest percentage of increase in their risk compared to their average over 1996-2008. Understanding socioeconomic factors could help improve the understanding of outbreak risk. The inclusion of the measles immunization variable suggests that there is a fundamental basis in ensuring adequate public health capacity. Increased vigilance and expanding public health capacity should be prioritized in the projected high-risk regions.

Anthropometric traits, blood pressure, and dietary and physical exercise habits in health sciences students; the obesity observatory project.

PubMed

Gutiérrez-Salmeán, Gabriela; Meaney, Alejandra; Ocharán, M Esther; Araujo, Juan M; Ramírez-Sánchez, Israel; Olivares-Corichi, Ivonne M; García-Sánchez, Rubén; Castillo, Guadalupe; Méndez-Bolaina, Enrique; Meaney, Eduardo; Ceballos, Guillermo

2013-01-01

Obesity and the metabolic syndrome affect a considerable segment of the population worldwide, including health professionals. In fact, several studies have reported that physicians tend to have more cardiovascular risk factors than their patients. The present cross-sectional study assessed whether the Health Sciences students had a healthier lifestyle, thus could have a more preventive attitude towards chronic diseases than the general population. Students of the medical-biological areas were surveyed by answering a questionnaire about familiar cardiovascular risk factors, personal smoking, alcohol drinking, dietary and exercise habits. Blood pressure was also measured, along with weight, height, and abdominal circumference. 23.4% of the participants were overweight and 10% obese. Parental obesity was the most frequent risk factor, followed by social drinking and smoking. We found high consumption of animal derived foods, breakfast- like cereals, pastries, white bread and sweetened beverages; while low intake of fruit and vegetables were reported. More than half the sample reported to practice very little or no exercise at all. We found similar or even higher rates of risk factors than the average population, that may eventually lead to the development of chronic cardiometabolic diseases. Thus we can infer that biomedical education is inefficient in inducing healthy lifestyles among biomedical students, which could have impact in their future practice as they will most probable become obese health-professionals, thus fail to effectively treat their own patients. Copyright © AULA MEDICA EDICIONES 2013. Published by AULA MEDICA. All rights reserved.

Dose–response associations between cycling activity and risk of hypertension in regular cyclists: The UK Cycling for Health Study

PubMed Central

Hollingworth, M; Harper, A; Hamer, M

2015-01-01

Most population studies on physical activity and health have involved largely inactive men and women, thus making it difficult to infer if health benefits occur at exercise levels above the current minimum guidelines. The aim was to examine associations between cycling volume and classical cardiovascular risk markers, including hypertension and hypercholesterolemia, in a population sample of habitual cyclists. A nationwide sample comprising 6949 men and women (aged 47.6 years on average) completed questions about their cycling levels, demographics and health. Nearly the entire sample (96.3%) achieved the current minimum physical activity recommendation through cycling alone. There was a dose–response association between cycling volume and risk of diagnosed hypertension (P-trend =0.001), with odds ratios of 0.98 (95% confidence interval (CI), 0.80–1.21), 0.86 (0.70, 1.06), 0.67 (95% CI, 0.53–0.83) across categories of 23–40, 40–61 and >61 metabolic equivalent hours/week (MET-h/week) compared with <23 MET-h/week. These associations persisted in models adjusted for age, sex, smoking, alcohol, body mass index (BMI) and other moderatevigorous physical activities. We also observed inverse associations between cycling volume and other risk factors including BMI and hypercholesterolemia. In summary, results from a population sample of cyclists suggest that additional cardiovascular health benefits can be achieved beyond the current minimum physical activity recommendation. PMID:25273856

Living With Volcanic Risk in the Cascades

USGS Publications Warehouse

Dzurisin, Daniel; Stauffer, Peter H.; Hendley, James W.

1997-01-01

The Cascade Range of the Pacific Northwest has more than a dozen potentially active volcanoes. Cascade volcanoes tend to erupt explosively, and on average two eruptions occur per century?the most recent were at Mount St. Helens, Washington (1980?86 and 2004?8), and Lassen Peak, California (1914?17). To help protect the Pacific Northwest?s rapidly expanding population, USGS scientists at the Cascades Volcano Observatory in Vancouver, Washington, monitor and assess the hazards posed by the region?s volcanoes.

High-Risk List

DTIC Science & Technology

2017-01-01

and profits from selling it can wind up in the hands of insurgents.33 SIGAR has been told that a high percentage of fuel has been stolen and that...ANDSF will immediately act against insurgent activity in a hold-or-fight area, such as key population centers, major economic arteries, and the Ring Road...world, averaging 9% of GDP from 2006 through 2013, according to the IMF.96 It slipped to 8.5% of GDP in 2014.97 On a positive note, the Afghan

The etiology, risk factors, and interactions of enteric infections and malnutrition and the consequences for child health and development study (MAL-ED): description of the Tanzanian site.

PubMed

Mduma, Estomih R; Gratz, Jean; Patil, Crystal; Matson, Kristine; Dakay, Mary; Liu, Sarah; Pascal, John; McQuillin, Lauren; Mighay, Emmanuel; Hinken, Elizabeth; Ernst, Alexandra; Amour, Caroline; Mvungi, Regisiana; Bayyo, Eliwaza; Zakaria, Yeconia; Kivuyo, Sokoine; Houpt, Eric R; Svensen, Erling

2014-11-01

The Haydom, Tanzania, site (TZH) of The Etiology, Risk Factors and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development (MAL-ED) Study is in north-central Tanzania, 300 km from the nearest urban center. TZH is in a remote rural district where most of the population are agropastoralists and grow maize as the staple food. The average household size is 7. The average woman achieves a parity of 6 and has 1 child death. Socioeconomic indicators are poor, with essentially no household having access to electricity, piped water, or improved sanitary facilities (compared with 14%, 7%, and 12%, respectively, reported nationally). The Demographic Health Survey Tanzania 2004 indicated that the region had high rates of stunting and underweight (40% and 31% of children aged <5 years had a height-for-age z score and weight-for-age z score, respectively, of <-2 ) and an under-5 child mortality rate of 5.8%. Human immunodeficiency virus prevalence among 18-month-old children is <0.5%. TZH represents a remote rural African population with profound poverty and malnutrition, but a strong community-based research infrastructure. © The Author 2014. 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.

Understanding relationships among abundance, extirpation, and climate at ecoregional scales.

PubMed

Beever, Erik A; Dobrowski, S Z; Long, J; Mynsberge, A R; Piekielek, N B

2013-07-01

Recent research on mountain-dwelling species has illustrated changes in species distributional patterns in response to climate change. Abundance of a species will likely provide an earlier warning indicator of change than will occupancy, yet relationships between abundance and climatic factors have received less attention. We tested whether predictors of counts of American pikas (Ochotona princeps) during surveys from the Great Basin region in 1994-1999 and 2003-2008 differed between the two periods. Additionally, we tested whether various modeled aspects of ecohydrology better predicted relative density than did average annual precipitation, and whether risk of site-wide extirpation predicted subsequent population counts of pikas. We observed several patterns of change in pika abundance at range edges that likely constitute early warnings of distributional shifts. Predictors of pika abundance differed strongly between the survey periods, as did pika extirpation patterns previously reported from this region. Additionally, maximum snowpack and growing-season precipitation resulted in better-supported models than those using average annual precipitation, and constituted two of the top three predictors of pika density in the 2000s surveys (affecting pikas perhaps via vegetation). Unexpectedly, we found that extirpation risk positively predicted subsequent population size. Our results emphasize the need to clarify mechanisms underlying biotic responses to recent climate change at organism-relevant scales, to inform management and conservation strategies for species of concern.

Understanding relationships among abundance, extirpation,and climate at ecoregional scales

USGS Publications Warehouse

Beever, Erik A.; Solomon Dubrowski,; ,; ,; J. Long,; ,; A. Mysnberge,; Piekielek, N. B.

2014-01-01

Recent research on mountain-dwelling species has illustrated changes in species’ distributional patterns in response to climate change. Abundance of a species will likely provide an earlier warning indicator of change than will occupancy, yet relationships between abundance and climatic factors have received less attention. We tested whether predictors of counts of American pikas (Ochotona princeps) during surveys from the Great Basin region in 1994–1999 and 2003–2008 differed between the two periods. Additionally, we tested whether various modeled aspects of ecohydrology better predicted relative density than did average annual precipitation, and whether risk of site-wide extirpation predicted subsequent population counts of pikas. We observed several patterns of change in pika abundance at range edges that likely constitute early warnings of distributional shifts. Predictors of pika abundance differed strongly between the survey periods, as did pika extirpation patterns previously reported from this region. Additionally, maximum snowpack and growing-season precipitation resulted in better-supported models than those using average annual precipitation, and constituted two of the top three predictors of pika density in the 2000s surveys (affecting pikas perhaps via vegetation). Unexpectedly, we found that extirpation risk positively predicted subsequent population size. Our results emphasize the need to clarify mechanisms underlying biotic responses to recent climate change at organism-relevant scales, to inform management and conservation strategies for species of concern.

[Education and use of drugs in Norway].

PubMed

Hjellvik, Vidar; Mahic, Milada; Tverdal, Aage

2012-10-16

Many studies have demonstrated that a low socioeconomic status is associated with poor health. The aim of the study was to investigate whether use of prescription drugs, generally and within selected categories, varies with education. Data on education from the 2001 Population and Housing Census for 645,023 men and women born in the period 1960-1969 and living in Norway in 2001 were linked to data from the Norwegian Prescription Database on drugs dispensed in the period 2004-2009. The overall frequency of drug dispensing was compared with six levels of education. The relative risk associated with limited education (≤ 10 years) compared with long education (> 10 years) of having at least one drug dispensed during the period was calculated for 42 selected drug categories. There was a dose-response relationship between education and the number of drug prescriptions dispensed. Subjects with lower secondary education collected prescription drugs about three times as often on average as subjects with researcher education. The average relative risk of drug dispensing for subjects with short education (≤ 10 years) compared with long (>10 years) for the 42 selected drug categories was 1.29 for men and 1.31 for women. Given that dispensing of drugs is an expression of state of health, our findings support earlier studies that have shown that there is social inequality in the health of the adult population.

Estimates of annual survival, growth, and recruitment of a white-tailed ptarmigan population in Colorado over 43 years

USGS Publications Warehouse

Wann, Greg; Aldridge, Cameron L.; Braun, Clait E.

2014-01-01

Long-term datasets for high-elevation species are rare, and considerable uncertainty exists in understanding how high-elevation populations have responded to recent climate warming. We present estimates of demographic vital rates from a 43-year population study of white-tailed ptarmigan (Lagopus leucura), a species endemic to alpine habitats in western North America. We used capture-recapture models to estimate annual rates of apparent survival, population growth, and recruitment for breeding-age ptarmigan, and we fit winter weather covariates to models in an attempt to explain annual variation. There were no trends in survival over the study period but there was strong support for age and sex effects. The average rate of annual growth suggests a relatively stable breeding-age population ( λ ¯ = 1.036), but there was considerable variation between years for both population growth and recruitment rates. Winter weather covariates only explained a small amount of variation in female survival and were not an important predictor of male survival. Cumulative winter precipitation was found to have a quadratic effect on female survival, with survival being highest during years of average precipitation. Cumulative winter precipitation was positively correlated with population growth and recruitment rates, although this covariate only explained a small amount of annual variation in these rates and there was considerable uncertainty among the models tested. Our results provide evidence for an alpine-endemic population that has not experienced extirpation or drastic declines. However, more information is needed to understand risks and vulnerabilities of warming effects on juveniles as our analysis was confined to determination of vital rates for breeding-age birds.

Genetic risk factors for nonsyndromic cleft lip with or without cleft palate in a Brazilian population with high African ancestry.

PubMed

do Rego Borges, Andrea; Sá, Jamile; Hoshi, Ryuichi; Viena, Camila Sane; Mariano, Lorena C; de Castro Veiga, Patricia; Medrado, Alena Peixoto; Machado, Renato Assis; de Aquino, Sibele Nascimento; Messetti, Ana Camila; Spritz, Richard A; Coletta, Ricardo D; Reis, Silvia R A

2015-10-01

Nonsyndromic cleft lip with or without cleft palate (NSCL ± P) is the most common orofacial birth defect, exhibiting variable prevalence around the world, often attributed to ethnic and environmental differences. Linkage analyses and genome-wide association studies have identified several genomic susceptibility regions for NSCL ± P, mostly in European-derived or Asian populations. Genetic predisposition to NSCL ± P is ethnicity-dependent, and the genetic basis of susceptibility to NSCL ± P likely varies among populations. The population of Brazil is highly admixed, with highly variable ancestry; thus, the genetic determinants of NSCL ± P susceptibility may be quite different. This study tested association of 8 single-nucleotide polymorphisms (SNPs), previously identified by genome-wide studies in other populations, with NSCL ± P in a Brazilian population with high African ancestry. SNPs rs560426, rs642961, rs1530300, rs987525, rs3758249, rs7078160, rs17085106, and rs13041247 were genotyped in 293 Brazilian patients with NSCL ± P and 352 unaffected Brazilian controls. Each sample was also genotyped for 40 biallelic short insertion/deletion polymorphic markers to characterize genetic ancestry. The average African ancestry background was 31.1% for the NSCL ± P group and 36.7% for the control group. After adjustment for ancestry and multiple testing, the minor alleles of rs3758249 (OR: 1.58, 95% CI: 1.25-2.01, P = 0.0001) and rs7078160 (OR: 1.59, 95% CI: 1.21-2.07, P = 0.0002) were significantly associated with risk of NSCL ± P. Polymorphisms located in IRF6 (rs642961) and 8q24 (rs1530300 and rs987525) showed marginal associations in this Brazilian population with high African ancestry. These results indicate that rs3758249 at 9q22 and rs7078160 at 10q25.3 represent risk loci for NSCL ± P in the Brazilian population with high African ancestry. © 2015 Wiley Periodicals, Inc.

Human health risk assessment of mercury vapor around artisanal small-scale gold mining area, Palu city, Central Sulawesi, Indonesia.

PubMed

Nakazawa, Koyomi; Nagafuchi, Osamu; Kawakami, Tomonori; Inoue, Takanobu; Yokota, Kuriko; Serikawa, Yuka; Cyio, Basir; Elvince, Rosana

2016-02-01

Emissions of elemental mercury, Hg(0), from artisanal small-scale gold mining activities accounted for 37% of total global Hg(0) emissions in 2010. People who live near gold-mining areas may be exposed to high concentrations of Hg(0). Here, we assessed the human health risk due to Hg(0) exposure among residents of Palu city (Central Sulawesi Province, Indonesia). The area around the city has more than 60t of gold reserves, and the nearby Poboya area is the most active gold-mining site in Indonesia. Owing to its geography, the city experiences alternating land and sea breezes. Sampling was done over a period of 3 years (from 2010 Aug. to 2012 Dec.) intermittently with a passive sampler for Hg(0), a portable handheld mercury analyzer, and a mercury analyzer in four areas of the city and in the Poboya gold-processing area, as well as wind speeds and directions in one area of the city. The 24-h average concentration, wind speed, and wind direction data show that the ambient air in both the gold-processing area and the city was always covered by high concentration of mercury vapor. The Hg(0) concentration in the city was higher at night than in the daytime, owing to the effect of land breezes. These results indicate that the inhabitants of the city were always exposed to high concentrations of Hg(0). The average daytime point-sample Hg(0) concentrations in the city, as measured with a handheld mercury analyzer over 3 days in July 2011, ranged from 2096 to 3299ngm(-3). In comparison, the average daytime Hg(0) concentration in the Poboya gold-processing area was 12,782ngm(-3). All of these concentrations are substantially higher than the World Health Organization air-quality guideline for annual average Hg exposure (1000ngm(-3)). We used the point-sample concentrations to calculate hazard quotient ratios by means of a probabilistic risk assessment method. The results indicated that 93% of the sample population overall was at risk (hazard quotient ratio ≥1 and cut off at the 95th percentile value of the sample population) of mercury toxicity, that is, damage to the central nervous system due to chronic exposure. The corresponding percentages for the northern, central, southern, and western areas of the city were 83%, 84%, 95%, and 95%, respectively. Our results indicate that the residents of Palu city are at serious risk from exposure to high concentrations of atmospheric Hg(0). Copyright © 2015 Elsevier Inc. All rights reserved.

An Integrated Probabilistic-Fuzzy Assessment of Uncertainty Associated with Human Health Risk to MSW Landfill Leachate Contamination

NASA Astrophysics Data System (ADS)

Mishra, H.; Karmakar, S.; Kumar, R.

2016-12-01

Risk assessment will not remain simple when it involves multiple uncertain variables. Uncertainties in risk assessment majorly results from (1) the lack of knowledge of input variable (mostly random), and (2) data obtained from expert judgment or subjective interpretation of available information (non-random). An integrated probabilistic-fuzzy health risk approach has been proposed for simultaneous treatment of random and non-random uncertainties associated with input parameters of health risk model. The LandSim 2.5, a landfill simulator, has been used to simulate the Turbhe landfill (Navi Mumbai, India) activities for various time horizons. Further the LandSim simulated six heavy metals concentration in ground water have been used in the health risk model. The water intake, exposure duration, exposure frequency, bioavailability and average time are treated as fuzzy variables, while the heavy metals concentration and body weight are considered as probabilistic variables. Identical alpha-cut and reliability level are considered for fuzzy and probabilistic variables respectively and further, uncertainty in non-carcinogenic human health risk is estimated using ten thousand Monte-Carlo simulations (MCS). This is the first effort in which all the health risk variables have been considered as non-deterministic for the estimation of uncertainty in risk output. The non-exceedance probability of Hazard Index (HI), summation of hazard quotients, of heavy metals of Co, Cu, Mn, Ni, Zn and Fe for male and female population have been quantified and found to be high (HI>1) for all the considered time horizon, which evidently shows possibility of adverse health effects on the population residing near Turbhe landfill.

Genetic modifiers of CHEK2*1100delC associated breast cancer risk

PubMed Central

Muranen, Taru A.; Greco, Dario; Blomqvist, Carl; Aittomäki, Kristiina; Khan, Sofia; Hogervorst, Frans; Verhoef, Senno; Pharoah, Paul D.P.; Dunning, Alison M.; Shah, Mitul; Luben, Robert; Bojesen, Stig E.; Nordestgaard, Børge G.; Schoemaker, Minouk; Swerdlow, Anthony; García-Closas, Montserrat; Figueroa, Jonine; Dörk, Thilo; Bogdanova, Natalia V.; Hall, Per; Li, Jingmei; Khusnutdinova, Elza; Bermisheva, Marina; Kristensen, Vessela; Borresen-Dale, Anne-Lise; Peto, Julian; dos Santos Silva, Isabel; Couch, Fergus J.; Olson, Janet E.; Hillemans, Peter; Park-Simon, Tjoung-Won; Brauch, Hiltrud; Hamann, Ute; Burwinkel, Barbara; Marme, Frederik; Meindl, Alfons; Schmutzler, Rita K.; Cox, Angela; Cross, Simon S.; Sawyer, Elinor J.; Tomlinson, Ian; Lambrechts, Diether; Moisse, Matthieu; Lindblom, Annika; Margolin, Sara; Hollestelle, Antoinette; Martens, John W.M.; Fasching, Peter A.; Beckmann, Matthias W.; Andrulis, Irene L.; Knight, Julia A.; Anton-Culver, Hoda; Ziogas, Argyrios; Giles, Graham G.; Milne, Roger L.; Brenner, Hermann; Arndt, Volker; Mannermaa, Arto; Kosma, Veli-Matti; Chang-Claude, Jenny; Rudolph, Anja; Devilee, Peter; Seynaeve, Caroline; Hopper, John L.; Southey, Melissa C.; John, Esther M.; Whittemore, Alice S.; Bolla, Manjeet K.; Wang, Qin; Michailidou, Kyriaki; Dennis, Joe; Easton, Douglas F.; Schmidt, Marjanka K.; Nevanlinna, Heli

2016-01-01

Purpose CHEK2*1100delC is a founder variant in European populations conferring a 2–3 fold increased risk of breast cancer (BC). Epidemiologic and family studies have suggested that the risk associated with CHEK2*1100delC is modified by other genetic factors in a multiplicative fashion. We have investigated this empirically using data from the Breast Cancer Association Consortium (BCAC). Methods With genotype data of 39,139 (624 1100delC carriers) BC patients and 40,063 (224) healthy controls from 32 BCAC studies, we analyzed the combined risk effects of CHEK2*1100delC and 77 common variants in terms of a polygenic risk score (PRS) and pairwise interaction. Results The PRS conferred an odds ratio (OR) of 1.59 [95% CI 1.21–2.09] per standard deviation for BC for CHEK2*1100delC carriers and 1.58 [1.55–1.62] for non-carriers. No evidence for deviation from the multiplicative model was found. The OR for the highest quintile of the PRS was 2.03 [0.86–4.78] for CHEK2*1100delC carriers placing them to the high risk category according to UK NICE guidelines. OR for the lowest quintile was 0.52 [0.16–1.74], indicating life-time risk close to population average. Conclusion Our results confirm the multiplicative nature of risk effects conferred by CHEK2*1100delC and the common susceptibility variants. Furthermore, the PRS could identify the carriers at a high life-time risk for clinical actions. PMID:27711073

Genetic modifiers of CHEK2*1100delC-associated breast cancer risk.

PubMed

Muranen, Taru A; Greco, Dario; Blomqvist, Carl; Aittomäki, Kristiina; Khan, Sofia; Hogervorst, Frans; Verhoef, Senno; Pharoah, Paul D P; Dunning, Alison M; Shah, Mitul; Luben, Robert; Bojesen, Stig E; Nordestgaard, Børge G; Schoemaker, Minouk; Swerdlow, Anthony; García-Closas, Montserrat; Figueroa, Jonine; Dörk, Thilo; Bogdanova, Natalia V; Hall, Per; Li, Jingmei; Khusnutdinova, Elza; Bermisheva, Marina; Kristensen, Vessela; Borresen-Dale, Anne-Lise; Investigators, Nbcs; Peto, Julian; Dos Santos Silva, Isabel; Couch, Fergus J; Olson, Janet E; Hillemans, Peter; Park-Simon, Tjoung-Won; Brauch, Hiltrud; Hamann, Ute; Burwinkel, Barbara; Marme, Frederik; Meindl, Alfons; Schmutzler, Rita K; Cox, Angela; Cross, Simon S; Sawyer, Elinor J; Tomlinson, Ian; Lambrechts, Diether; Moisse, Matthieu; Lindblom, Annika; Margolin, Sara; Hollestelle, Antoinette; Martens, John W M; Fasching, Peter A; Beckmann, Matthias W; Andrulis, Irene L; Knight, Julia A; Investigators, kConFab/Aocs; Anton-Culver, Hoda; Ziogas, Argyrios; Giles, Graham G; Milne, Roger L; Brenner, Hermann; Arndt, Volker; Mannermaa, Arto; Kosma, Veli-Matti; Chang-Claude, Jenny; Rudolph, Anja; Devilee, Peter; Seynaeve, Caroline; Hopper, John L; Southey, Melissa C; John, Esther M; Whittemore, Alice S; Bolla, Manjeet K; Wang, Qin; Michailidou, Kyriaki; Dennis, Joe; Easton, Douglas F; Schmidt, Marjanka K; Nevanlinna, Heli

2017-05-01

CHEK2*1100delC is a founder variant in European populations that confers a two- to threefold increased risk of breast cancer (BC). Epidemiologic and family studies have suggested that the risk associated with CHEK2*1100delC is modified by other genetic factors in a multiplicative fashion. We have investigated this empirically using data from the Breast Cancer Association Consortium (BCAC). Using genotype data from 39,139 (624 1100delC carriers) BC patients and 40,063 (224) healthy controls from 32 BCAC studies, we analyzed the combined risk effects of CHEK2*1100delC and 77 common variants in terms of a polygenic risk score (PRS) and pairwise interaction. The PRS conferred odds ratios (OR) of 1.59 (95% CI: 1.21-2.09) per standard deviation for BC for CHEK2*1100delC carriers and 1.58 (1.55-1.62) for noncarriers. No evidence of deviation from the multiplicative model was found. The OR for the highest quintile of the PRS was 2.03 (0.86-4.78) for CHEK2*1100delC carriers, placing them in the high risk category according to UK NICE guidelines. The OR for the lowest quintile was 0.52 (0.16-1.74), indicating a lifetime risk close to the population average. Our results confirm the multiplicative nature of risk effects conferred by CHEK2*1100delC and the common susceptibility variants. Furthermore, the PRS could identify carriers at a high lifetime risk for clinical actions.Genet Med advance online publication 06 October 2016.

Abortion, substance abuse and mental health in early adulthood: Thirteen-year longitudinal evidence from the United States

PubMed Central

Sullins, Donald Paul

2016-01-01

Objective: To examine the links between pregnancy outcomes (birth, abortion, or involuntary pregnancy loss) and mental health outcomes for US women during the transition into adulthood to determine the extent of increased risk, if any, associated with exposure to induced abortion. Method: Panel data on pregnancy history and mental health history for a nationally representative cohort of 8005 women at (average) ages 15, 22, and 28 years from the National Longitudinal Study of Adolescent to Adult Health were examined for risk of depression, anxiety, suicidal ideation, alcohol abuse, drug abuse, cannabis abuse, and nicotine dependence by pregnancy outcome (birth, abortion, and involuntary pregnancy loss). Risk ratios were estimated for time-dynamic outcomes from population-averaged longitudinal logistic and Poisson regression models. Results: After extensive adjustment for confounding, other pregnancy outcomes, and sociodemographic differences, abortion was consistently associated with increased risk of mental health disorder. Overall risk was elevated 45% (risk ratio, 1.45; 95% confidence interval, 1.30–1.62; p < 0.0001). Risk of mental health disorder with pregnancy loss was mixed, but also elevated 24% (risk ratio, 1.24; 95% confidence interval, 1.13–1.37; p < 0.0001) overall. Birth was weakly associated with reduced mental disorders. One-eleventh (8.7%; 95% confidence interval, 6.0–11.3) of the prevalence of mental disorders examined over the period were attributable to abortion. Conclusion: Evidence from the United States confirms previous findings from Norway and New Zealand that, unlike other pregnancy outcomes, abortion is consistently associated with a moderate increase in risk of mental health disorders during late adolescence and early adulthood. PMID:27781096

A comparison of future recruitment needs in urban and rural hospitals: the rural imperative.

PubMed

Williams, Thomas E; Satiani, Bhagwan; Ellison, E Christopher

2011-10-01

The potential impact of shortages of the surgical workforce on both urban and rural hospitals is undefined. There is a predicted shortage of 30,000 surgeons by 2030 and the need to train and hire more than 100,000 surgeons. The aim of this study is to estimate the average recruitment needs in our nation's hospitals for 7 surgical specialties to ensure adequate access to surgical care as the U.S. population grows to 364 million by 2030. We used the census figure of 309 million in 2010 for U.S. population. Currently there are estimated to be 3,012 urban hospitals and 1,998 rural hospitals in the U.S. (American Hospital Association's Trend Watch report, 2009). At 253 million people (82 % of the population of 309 million in 2010) receive healthcare in urban hospitals; 56 million people receive healthcare in rural hospitals (18%). We assumed a work force model based on our previous publications, equal population growth in all geographic areas, recruitment by rural hospitals limited to Ob-Gyn, General Surgery, and Orthopedics, and that the percentage of the population receiving care at urban and rural hospitals will stay constant. Rural hospitals will have to recruit an average of 3.4 OBGYN's, and an average of 1.6 Orthos, and 2.0 GS for a total of 7 full-time equivalents in the period from 2011 to 2030. Urban hospitals which have to recruit surgical specialists will have to recruit ten Ob-Gyns, about 5 Orthos, 6 GS's, 5 ear, nose, and throat surgeons (ENT's), an average of 2.5 urologists, a neurosurgeon, and a thoracic surgeon to meet the recruiting goals for the surgical services for their hospitals. Rural hospitals will be in competition with urban hospitals for hiring from a limited pool of surgeons. As urban hospitals have a socioeconomic advantage in hiring, surgical care in rural areas may be at risk. It is imperative that each rural hospital analyze local future healthcare needs and devise strategies that will enhance hiring and retention to optimize access to surgical care. Copyright © 2011 Mosby, Inc. All rights reserved.

Recent advances in the management of transient ischemic attacks

PubMed Central

Gomez, Camilo R.; Schneck, Michael J.; Biller, Jose

2017-01-01

Significant advances in our understanding of transient ischemic attack (TIA) have taken place since it was first recognized as a major risk factor for stroke during the late 1950's. Recently, numerous studies have consistently shown that patients who have experienced a TIA constitute a heterogeneous population, with multiple causative factors as well as an average 5–10% risk of suffering a stroke during the 30 days that follow the index event. These two attributes have driven the most important changes in the management of TIA patients over the last decade, with particular attention paid to effective stroke risk stratification, efficient and comprehensive diagnostic assessment, and a sound therapeutic approach, destined to reduce the risk of subsequent ischemic stroke. This review is an outline of these changes, including a discussion of their advantages and disadvantages, and references to how new trends are likely to influence the future care of these patients. PMID:29263784

Traditional CVD risk factors and socio-economic deprivation in Roma minority population of Croatia.

PubMed

Zeljko, Hrvojka; Skarić-Jurić, Tatjana; Narancic, Nina Smolej; Salihović, Marijana Pericić; Klarić, Irena Martinović; Barbalić, Maja; Starcević, Boris; Lauc, Lovorka Barać; Janićijević, Branka

2008-09-01

Researches into health inequalities consistently show disadvantages in health status, morbidity and mortality for various ethnic minority groups. Current knowledge about prevention of cardiovascular diseases (CVD) mainly derives from studies carried out in populations of European origin while the evidences involving Roma population are scarce. Roma, an ethnic minority of northern Indian origin, live in many countries throughout the world and are well known for preserved traditions and resistance to assimilation. They are most often marginalized economically, spatially, politically and in terms of culture. In order to assess the health status and health-related lifestyle attributes, a multidisciplinary anthropological and epidemiological community-based study was carried out including a total of 423 members of the Bayash Roma minority population living in two regions of Croatia (144 men and 279 women, aged 18-84 yrs). Hypertension (HT) was found in 24.8% Bayash Roma (21.5% men and 26.5% women) using standard diagnostic criteria (i.e. BP > or = 140/90 mm Hg or taking antihypertensive therapy). The prevalence increases from 5.9% in the age group 18-34 yrs; 35.0% in the age group 35-64 yrs, and 51.4% in the age group 65+ yrs. The prevalence of hypertension in the Bayash Roma is almost half of the magnitude of what is usually reported for the general population of Croatia. It is also lower when compared with other European populations and this finding is not due to comparatively younger average age of the Bayash sample. The significant association of hypertension with age and BMI was confirmed in this study and the importance of non-traditional SES-related CVD risk factors was highlighted. Smoking is a part of traditional Roma life-style and with 70% of smokers almost the entire population is equally exposed to this risk factor in their family environment. Since homogenously distributed, this risk factor did not show to be a significant predictor of hypertension. The extent to which hypertension is influenced by traditional CVD risk factors as well as by some SES indicators was also assessed using a forward stepwise method of the multivariate logistic analysis. Each risk factor was explored as quantitative variable as well as qualitative one using various cut-offs. The best model showed to be the one having age and BMI presented as quantitative variables and sex, region, smoking status, income and schooling years as categorical ones; with cut-off 3 for number of income sources and 8 for the number of schooling years. In spite of the low prevalence of hypertension, the presented results are showing that Bayash Roma are bearing a high CVD risk factors load. We expect that with westernization of their life-style and along with increase of the economic power, the proportion of CVD in population of Bayash Roma will also increase. Therefore, it is important to recognize the need for early cardiovascular disease risk factors prevention in this minority population.

Spatiotemporal Pattern Analysis of Scarlet Fever Incidence in Beijing, China, 2005–2014

PubMed Central

Mahara, Gehendra; Wang, Chao; Huo, Da; Xu, Qin; Huang, Fangfang; Tao, Lixin; Guo, Jin; Cao, Kai; Long, Liu; Chhetri, Jagadish K.; Gao, Qi; Wang, Wei; Wang, Quanyi; Guo, Xiuhua

2016-01-01

Objective: To probe the spatiotemporal patterns of the incidence of scarlet fever in Beijing, China, from 2005 to 2014. Methods: A spatiotemporal analysis was conducted at the district/county level in the Beijing region based on the reported cases of scarlet fever during the study period. Moran’s autocorrelation coefficient was used to examine the spatial autocorrelation of scarlet fever, whereas the Getis-Ord Gi* statistic was used to determine the hotspot incidence of scarlet fever. Likewise, the space-time scan statistic was used to detect the space-time clusters, including the relative risk of scarlet fever incidence across all settings. Results: A total of 26,860 scarlet fever cases were reported in Beijing during the study period (2005–2014). The average annual incidence of scarlet fever was 14.25 per 100,000 population (range, 6.76 to 32.03 per 100,000). The incidence among males was higher than that among females, and more than two-thirds of scarlet fever cases (83.8%) were among children 3–8 years old. The seasonal incidence peaks occurred from March to July. A higher relative risk area was mainly in the city and urban districts of Beijing. The most likely space-time clusters and secondary clusters were detected to be diversely distributed in every study year. Conclusions: The spatiotemporal patterns of scarlet fever were relatively unsteady in Beijing from 2005 to 2014. The at-risk population was mainly scattered in urban settings and dense districts with high population, indicating a positive relationship between population density and increased risk of scarlet fever exposure. Children under 15 years of age were the most susceptible to scarlet fever. PMID:26784213

Spatiotemporal Pattern Analysis of Scarlet Fever Incidence in Beijing, China, 2005-2014.

PubMed

Mahara, Gehendra; Wang, Chao; Huo, Da; Xu, Qin; Huang, Fangfang; Tao, Lixin; Guo, Jin; Cao, Kai; Long, Liu; Chhetri, Jagadish K; Gao, Qi; Wang, Wei; Wang, Quanyi; Guo, Xiuhua

2016-01-15

To probe the spatiotemporal patterns of the incidence of scarlet fever in Beijing, China, from 2005 to 2014. A spatiotemporal analysis was conducted at the district/county level in the Beijing region based on the reported cases of scarlet fever during the study period. Moran's autocorrelation coefficient was used to examine the spatial autocorrelation of scarlet fever, whereas the Getis-Ord Gi* statistic was used to determine the hotspot incidence of scarlet fever. Likewise, the space-time scan statistic was used to detect the space-time clusters, including the relative risk of scarlet fever incidence across all settings. A total of 26,860 scarlet fever cases were reported in Beijing during the study period (2005-2014). The average annual incidence of scarlet fever was 14.25 per 100,000 population (range, 6.76 to 32.03 per 100,000). The incidence among males was higher than that among females, and more than two-thirds of scarlet fever cases (83.8%) were among children 3-8 years old. The seasonal incidence peaks occurred from March to July. A higher relative risk area was mainly in the city and urban districts of Beijing. The most likely space-time clusters and secondary clusters were detected to be diversely distributed in every study year. The spatiotemporal patterns of scarlet fever were relatively unsteady in Beijing from 2005 to 2014. The at-risk population was mainly scattered in urban settings and dense districts with high population, indicating a positive relationship between population density and increased risk of scarlet fever exposure. Children under 15 years of age were the most susceptible to scarlet fever.

Modern prescription theory and application: realistic expectations for speech recognition with hearing AIDS.

PubMed

Johnson, Earl E

2013-01-01

A major decision at the time of hearing aid fitting and dispensing is the amount of amplification to provide listeners (both adult and pediatric populations) for the appropriate compensation of sensorineural hearing impairment across a range of frequencies (e.g., 160-10000 Hz) and input levels (e.g., 50-75 dB sound pressure level). This article describes modern prescription theory for hearing aids within the context of a risk versus return trade-off and efficient frontier analyses. The expected return of amplification recommendations (i.e., generic prescriptions such as National Acoustic Laboratories-Non-Linear 2, NAL-NL2, and Desired Sensation Level Multiple Input/Output, DSL m[i/o]) for the Speech Intelligibility Index (SII) and high-frequency audibility were traded against a potential risk (i.e., loudness). The modeled performance of each prescription was compared one with another and with the efficient frontier of normal hearing sensitivity (i.e., a reference point for the most return with the least risk). For the pediatric population, NAL-NL2 was more efficient for SII, while DSL m[i/o] was more efficient for high-frequency audibility. For the adult population, NAL-NL2 was more efficient for SII, while the two prescriptions were similar with regard to high-frequency audibility. In terms of absolute return (i.e., not considering the risk of loudness), however, DSL m[i/o] prescribed more outright high-frequency audibility than NAL-NL2 for either aged population, particularly, as hearing loss increased. Given the principles and demonstrated accuracy of desensitization (reduced utility of audibility with increasing hearing loss) observed at the group level, additional high-frequency audibility beyond that of NAL-NL2 is not expected to make further contributions to speech intelligibility (recognition) for the average listener.

A Public-Private Partnership Develops and Externally Validates a 30-Day Hospital Readmission Risk Prediction Model

PubMed Central

Choudhry, Shahid A.; Li, Jing; Davis, Darcy; Erdmann, Cole; Sikka, Rishi; Sutariya, Bharat

2013-01-01

Introduction: Preventing the occurrence of hospital readmissions is needed to improve quality of care and foster population health across the care continuum. Hospitals are being held accountable for improving transitions of care to avert unnecessary readmissions. Advocate Health Care in Chicago and Cerner (ACC) collaborated to develop all-cause, 30-day hospital readmission risk prediction models to identify patients that need interventional resources. Ideally, prediction models should encompass several qualities: they should have high predictive ability; use reliable and clinically relevant data; use vigorous performance metrics to assess the models; be validated in populations where they are applied; and be scalable in heterogeneous populations. However, a systematic review of prediction models for hospital readmission risk determined that most performed poorly (average C-statistic of 0.66) and efforts to improve their performance are needed for widespread usage. Methods: The ACC team incorporated electronic health record data, utilized a mixed-method approach to evaluate risk factors, and externally validated their prediction models for generalizability. Inclusion and exclusion criteria were applied on the patient cohort and then split for derivation and internal validation. Stepwise logistic regression was performed to develop two predictive models: one for admission and one for discharge. The prediction models were assessed for discrimination ability, calibration, overall performance, and then externally validated. Results: The ACC Admission and Discharge Models demonstrated modest discrimination ability during derivation, internal and external validation post-recalibration (C-statistic of 0.76 and 0.78, respectively), and reasonable model fit during external validation for utility in heterogeneous populations. Conclusions: The ACC Admission and Discharge Models embody the design qualities of ideal prediction models. The ACC plans to continue its partnership to further improve and develop valuable clinical models. PMID:24224068

Consumption of freshwater fish by recreational and native freshwater anglers in the upper St-Maurice (Quebec, Canada) and estimation of the intake of methylmercury in humans

DOE Office of Scientific and Technical Information (OSTI.GOV)

Loranger, S.; Houde, L.; Schetagne, R.

1995-12-31

Hydro-Quebec is planning to build two hydroelectric reservoirs in the upper Saint-Maurice River, which would flood about 80% of the surrounding area. The methylmercury (MeHg) content in freshwater fish will therefore tend to increase during the first few years. This development will have a direct impact on the amount of MeHg that the actual users of this river section are exposed to. The objective of this study is to assess the consumption of local fish of these target groups using a Monte-Carlo approach. This study is part of a larger research project aimed at assessing human exposure and the healthmore » risks related to MeHg contamination in local fish. The fish consumption rate for recreational freshwater anglers was calculated using the duration of the average annual fishing trip, the average number of catches per species, the average fish weight per species exceeding a specific length of fish usually caught, and the edible portion of fish consumed. This rate was calculated for the native communities based on the total number of meals per year per species, the average fish weight per species, and the edible portion. Based on these calculations, average intake for sport fishermen is estimated at 6.9 g/day (sd = 6.4). This value is 5 to 25 times lower on average than for other North American native communities. However, it must be pointed out that the food habits of the native population were very similar to those of non-native populations; less than 30% of the food comes from traditional sources.« less

LEUKEMIA, LYMPHOMA AND MULTIPLE MYELOMA MORTALITY (1950–1999) AND INCIDENCE (1969–1999) IN THE ELDORADO URANIUM WORKERS COHORT

PubMed Central

Zablotska, Lydia B.; Lane, Rachel S.D.; Frost, Stanley E.; Thompson, Patsy A.

2014-01-01

Uranium workers are chronically exposed to low levels of radon decay products (RDP) and gamma (γ) radiation. Risks of leukemia from acute and high doses of γ-radiation are well-characterized, but risks from lower doses and dose-rates and from RDP exposures are controversial. Few studies have evaluated risks of other hematologic cancers in uranium workers. The purpose of this study was to analyze radiation-related risks of hematologic cancers in the cohort of Eldorado uranium miners and processors first employed in 1932–1980 in relation to cumulative RDP exposures and γ-ray doses. The average cumulative RDP exposure was 100.2 working level months and the average cumulative whole-body γ-radiation dose was 52.2 millisievert. We identified 101 deaths and 160 cases of hematologic cancers in the cohort. Overall, male workers had lower mortality and cancer incidence rates for all outcomes compared with the general Canadian male population, a likely healthy worker effect. No statistically significant association between RDP exposure or γ-ray doses, or a combination of both, and mortality or incidence of any hematologic cancer was found. We observed consistent but non-statistically significant increases in risks of chronic lymphocytic leukemia (CLL) and Hodgkin lymphoma (HL) incidence and non-Hodgkin lymphoma (NHL) mortality with increasing γ-ray doses. These findings are consistent with recent studies of increased risks of CLL and NHL incidence after γ-radiation exposure. Further research is necessary to understand risks of other hematologic cancers from low-dose exposures to γ-radiation. PMID:24583244

Heritability of Boldness and Hypoxia Avoidance in European Seabass, Dicentrarchus labrax.

PubMed

Ferrari, Sébastien; Horri, Khaled; Allal, François; Vergnet, Alain; Benhaim, David; Vandeputte, Marc; Chatain, Béatrice; Bégout, Marie-Laure

2016-01-01

To understand the genetic basis of coping style in European seabass, fish from a full factorial mating (10 females x 50 males) were reared in common garden and individually tagged. Individuals coping style was characterized through behavior tests at four different ages, categorizing fish into proactive or reactive: a hypoxia avoidance test (at 255 days post hatching, dph) and 3 risk-taking tests (at 276, 286 and 304 dph). We observed significant heritability of the coping style, higher for the average of risk-taking scores (h2 = 0.45 ± 0.14) than for the hypoxia avoidance test (h2 = 0.19 ± 0.10). The genetic correlations between the three risk-taking scores were very high (rA = 0.96-0.99) showing that although their repeatability was moderately high (rP = 0.64-0.72), successive risk-taking tests evaluated the same genetic variation. A mild genetic correlation between the results of the hypoxia avoidance test and the average of risk-taking scores (0.45 ± 0.27) suggested that hypoxia avoidance and risk-taking tests do not address exactly the same behavioral and physiological responses. Genetic correlations between weight and risk taking traits showed negative values whatever the test used in our population i.e. reactive individual weights were larger. The results of this quantitative genetic analysis suggest a potential for the development of selection programs based on coping styles that could increase seabass welfare without altering growth performances. Overall, it also contributes to a better understanding of the origin and the significance of individual behavioral differences.

Risk Segmentation Related to the Offering of a Consumer-Directed Health Plan: A Case Study of Humana Inc.

PubMed Central

Tollen, Laura A; Ross, Murray N; Poor, Stephen

2004-01-01

Objective To determine whether the offering of a consumer-directed health plan (CDHP) is likely to cause risk segmentation in an employer group. Study Setting and Data Source The study population comprises the approximately 10,000 people (employees and dependents) enrolled as members of the employee health benefit program of Humana Inc. at its headquarters in Louisville, Kentucky, during the benefit years starting July 1, 2000, and July 1, 2001. This analysis is based on primary collection of claims, enrollment, and employment data for those employees and dependents. Study Design This is a case study of the experience of a single employer in offering two consumer-directed health plan options (“Coverage First 1” and “Coverage First 2”) to its employees. We assessed the risk profile of those choosing the Coverage First plans and those remaining in more traditional health maintenance organization (HMO) and preferred provider organization (PPO) coverage. Risk was measured using prior claims (in dollars per member per month), prior utilization (admissions/1,000; average length of stay; prescriptions/1,000; physician office visit services/1,000), a pharmacy-based risk assessment tool (developed by Ingenix), and demographics. Data Collection/Extraction Methods Complete claims and administrative data were provided by Humana Inc. for the two-year study period. Unique identifiers enabled us to track subscribers' individual enrollment and utilization over this period. Principal Findings Based on demographic data alone, there did not appear to be a difference in the risk profiles of those choosing versus not choosing Coverage First. However, based on prior claims and prior use data, it appeared that those who chose Coverage First were healthier than those electing to remain in more traditional coverage. For each of five services, prior-year usage by people who subsequently enrolled in Coverage First 1 (CF1) was below 60 percent of the average for the whole group. Hospital and maternity admissions per thousand were less than 30 percent of the overall average; length of stay per hospital admission, physician office services per thousand, and prescriptions per thousand were all between 50 and 60 percent of the overall average. Coverage First 2 (CF2) subscribers' prior use of services was somewhat higher than CF1 subscribers', but it was still below average in every category. As with prior use, prior claims data indicated that Coverage First subscribers were healthier than average, with prior total claims less than 50 percent of average. Conclusions In this case, the offering of high-deductible or consumer-directed health plan options alongside more traditional options caused risk segmentation within an employer group. The extent to which these findings are applicable to other cases will depend on many factors, including the employer premium contribution policies and employees' perception of the value of the various plan options. Further research is needed to determine whether risk segmentation will worsen in future years for this employer and if so, whether it will cause premiums for more traditional health plans to increase. PMID:15230919

[Increase of beta 2-microglobulin in drug addicts with anti-HIV antibodies and high risk of AIDS].

PubMed

D'Angelo, G; Giardini, C; Zanco, M D; Calvano, D; Crovetti, G; De Filippo, C

1991-01-01

The beta 2-Microglobulin is a polypeptide present on the surface membrane of both B and T cells and is integrated into the structure of HLA antigenes. The beta 2-Microglobulin concentration have been used as a reliable indicator of glomerular and tubular function of the kidney. Increased serum concentration of beta 2-Microglobulin are observed also in lymphoproliferative disorders with high cell proliferation rates. More recently, increased concentration of beta 2-Microglobulin was shown in patients with anti-HIV antibodies with or without symptomatic AIDS. We have determined beta 2-Microglobulin in 61 subjects: 40 between the ages of 25 and 35 and seemingly healthy, 21 patients between the ages of 22 and 32 and intravenous drug abuser with anti-HIV antibodies and at high-risk for AIDS. In all subjects we have tested: BUN, creatinine, beta 2-Microglobulin and T4/T8 ratio. In 40 subjects as normal controls, beta 2-Microglobulin average was means = 1.07 mg/L (SD = 0.39), T4/T8 ratio average: means = 1.06 (SD = 0.119). In 21 patients drug abuser with anti-HIV antibodies, the beta 2-Microglobulin average was cleanly increased: means = 4.72 mg/L (SD = 2.23), the T4/T8 ratio average cleanly decreased: means = 0.54 (SD = 0.21). We believe the beta 2-Microglobulin quantitation, even if not specific for patient with symptomatic AIDS, used in conjunction with other laboratory tests, principally T4/T8 ratio, will be a useful marker for recognizing persons with possible asymptomatic AIDS who are members of populations known to be at high-risk for AIDS.

Resource utilization and costs during the initial years of lung cancer screening with computed tomography in Canada.

PubMed

Cressman, Sonya; Lam, Stephen; Tammemagi, Martin C; Evans, William K; Leighl, Natasha B; Regier, Dean A; Bolbocean, Corneliu; Shepherd, Frances A; Tsao, Ming-Sound; Manos, Daria; Liu, Geoffrey; Atkar-Khattra, Sukhinder; Cromwell, Ian; Johnston, Michael R; Mayo, John R; McWilliams, Annette; Couture, Christian; English, John C; Goffin, John; Hwang, David M; Puksa, Serge; Roberts, Heidi; Tremblay, Alain; MacEachern, Paul; Burrowes, Paul; Bhatia, Rick; Finley, Richard J; Goss, Glenwood D; Nicholas, Garth; Seely, Jean M; Sekhon, Harmanjatinder S; Yee, John; Amjadi, Kayvan; Cutz, Jean-Claude; Ionescu, Diana N; Yasufuku, Kazuhiro; Martel, Simon; Soghrati, Kamyar; Sin, Don D; Tan, Wan C; Urbanski, Stefan; Xu, Zhaolin; Peacock, Stuart J

2014-10-01

It is estimated that millions of North Americans would qualify for lung cancer screening and that billions of dollars of national health expenditures would be required to support population-based computed tomography lung cancer screening programs. The decision to implement such programs should be informed by data on resource utilization and costs. Resource utilization data were collected prospectively from 2059 participants in the Pan-Canadian Early Detection of Lung Cancer Study using low-dose computed tomography (LDCT). Participants who had 2% or greater lung cancer risk over 3 years using a risk prediction tool were recruited from seven major cities across Canada. A cost analysis was conducted from the Canadian public payer's perspective for resources that were used for the screening and treatment of lung cancer in the initial years of the study. The average per-person cost for screening individuals with LDCT was $453 (95% confidence interval [CI], $400-$505) for the initial 18-months of screening following a baseline scan. The screening costs were highly dependent on the detected lung nodule size, presence of cancer, screening intervention, and the screening center. The mean per-person cost of treating lung cancer with curative surgery was $33,344 (95% CI, $31,553-$34,935) over 2 years. This was lower than the cost of treating advanced-stage lung cancer with chemotherapy, radiotherapy, or supportive care alone, ($47,792; 95% CI, $43,254-$52,200; p = 0.061). In the Pan-Canadian study, the average cost to screen individuals with a high risk for developing lung cancer using LDCT and the average initial cost of curative intent treatment were lower than the average per-person cost of treating advanced stage lung cancer which infrequently results in a cure.

Predictors of body mass index in female parents whose children participate in a competitive, creative, problem-solving program

PubMed Central

Moustaid-Moussa, Naima; Costello, Carol A.; Greer, Betty P.; Spence, Marsha; Fitzhugh, Eugene; Muenchen, Robert; Kalupahana, Nishan S.

2012-01-01

Background Recent findings from our research indicate that children participating in a creative afterschool program exhibit overall healthier lifestyle practices compared to the average US pediatric population. This observation led us to investigate the prevalence of overweight/obesity and lifestyle practices of their parents. Objective To determine the strongest predictors of weight status for female parents whose children were participating in such creative afterschool program. Design Surveyed subjects were parents of children who competed in the 2008 and 2009 Destination ImagiNation® Global Finals in Knoxville, Tennessee. A total of 4,608 children participated in data collection, with parental consent. For the combined 2 years, 1,118 parents, 87% of whom were females (n=1,032) completed online questionnaires, which were based on the Behavioral Risk Factor Surveillance System and included self-reported height, weight, dietary intake, physical activity, and socioeconomic status. The majority of this population was white, and less than 5% were African American or Hispanic. Results We report here results obtained for the female parents. Only 45.2% of these female parents were overweight/obese, compared to a national average of 64.1% reported by the National Health Nutrition Examination Surveys for 2007—2008. Furthermore, this population was significantly more physically active compared to national average. Most parents (76%) had completed a college degree and reported high incomes. Parents with the lowest income were the most obese in this population. Finally, we found a significant association between parent and child weight status. Conclusions These studies demonstrate that female parents of children who have healthy lifestyles were physically active, which likely accounts for the parents’ lower overweight/obesity rates. In addition to physical activity, income and percentage of calories from fat were all predictors of weight status. PMID:22912600

Predictors of body mass index in female parents whose children participate in a competitive, creative, problem-solving program.

PubMed

Moustaid-Moussa, Naima; Costello, Carol A; Greer, Betty P; Spence, Marsha; Fitzhugh, Eugene; Muenchen, Robert; Kalupahana, Nishan S

2012-01-01

Recent findings from our research indicate that children participating in a creative afterschool program exhibit overall healthier lifestyle practices compared to the average US pediatric population. This observation led us to investigate the prevalence of overweight/obesity and lifestyle practices of their parents. To determine the strongest predictors of weight status for female parents whose children were participating in such creative afterschool program. Surveyed subjects were parents of children who competed in the 2008 and 2009 Destination ImagiNation(®) Global Finals in Knoxville, Tennessee. A total of 4,608 children participated in data collection, with parental consent. For the combined 2 years, 1,118 parents, 87% of whom were females (n=1,032) completed online questionnaires, which were based on the Behavioral Risk Factor Surveillance System and included self-reported height, weight, dietary intake, physical activity, and socioeconomic status. The majority of this population was white, and less than 5% were African American or Hispanic. We report here results obtained for the female parents. Only 45.2% of these female parents were overweight/obese, compared to a national average of 64.1% reported by the National Health Nutrition Examination Surveys for 2007-2008. Furthermore, this population was significantly more physically active compared to national average. Most parents (76%) had completed a college degree and reported high incomes. Parents with the lowest income were the most obese in this population. Finally, we found a significant association between parent and child weight status. These studies demonstrate that female parents of children who have healthy lifestyles were physically active, which likely accounts for the parents' lower overweight/obesity rates. In addition to physical activity, income and percentage of calories from fat were all predictors of weight status.

Shifts in an invasive rodent community favoring black rats (Rattus rattus) following restoration of native forest

USGS Publications Warehouse

Shiels, Aaron B.; Medeiros, Arthur C.; von Allmen, Erica I.

2017-01-01

One potential, unintended ecological consequence accompanying forest restoration is a shift in invasive animal populations, potentially impacting conservation targets. Eighteen years after initial restoration (ungulate exclusion, invasive plant control, and out planting native species) at a 4 ha site on Maui, Hawai'i, we compared invasive rodent communities in a restored native dry forest and adjacent non-native grassland. Quarterly for 1 year, we trapped rodents on three replicate transects (107 rodent traps) in each habitat type for three consecutive nights. While repeated trapping may have reduced the rat (Black rat, Rattus rattus) population in the forest, it did not appear to reduce the mouse (House mouse, Mus musculus) population in the grassland. In unrestored grassland, mouse captures outnumbered rat captures 220:1, with mice averaging 54.9 indiv./night versus rats averaging 0.25 indiv./night. In contrast, in restored native forest, rat captures outnumbered mouse captures by nearly 5:1, averaging 9.0 indiv./night versus 1.9 indiv./night for mice. Therefore, relatively recent native forest restoration increased Black rat abundance and also increased their total biomass in the restored ecosystem 36-fold while reducing House mouse biomass 35-fold. Such a community shift is worrisome because Black rats pose a much greater threat than do mice to native birds and plants, perhaps especially to large-seeded tree species. Land managers should be aware that forest restoration (i.e. converting grassland to native forest) can invoke shifts in invasive rodent populations, potentially favoring Black rats. Without intervention, this shift may pose risks for intended conservation targets and modify future forest restoration trajectories.

Cancer Risk in Astronauts: A Constellation of Uncommon Consequences

NASA Technical Reports Server (NTRS)

Milder, Caitlin M.; Elgart, S. Robin; Chappell, Lori; Charvat, Jaqueline M.; Van Baalen, Mary; Huff, Janice L.; Semones, Edward J.

2017-01-01

Excess cancers resulting from external radiation exposures have been noted since the early 1950s, when a rise in leukemia rates was first reported in young atomic bomb survivors [1]. Further studies in atomic bomb survivors, cancer patients treated with radiotherapy, and nuclear power plant workers have confirmed that radiation exposure increases the risk of not only leukemia, but also a wide array of solid cancers [2,3]. NASA has long been aware of this risk and limits astronauts' risk of exposure-induced death (REID) from cancer by specifying permissible mission durations (PMD) for astronauts on an individual basis. While cancer is present among astronauts, current data does not suggest any excess of known radiation-induced cancers relative to a comparable population of U.S. adults; however, very uncommon cancers have been diagnosed in astronauts including nasopharyngeal cancer, lymphoma of the brain, and acral myxoinflammatory fibroblastic sarcoma. In order to study cancer risk in astronauts, a number of obstacles must be overcome. Firstly, several factors make the astronaut cohort considerably different from the cohorts that have previously been studied for effects resulting from radiation exposure. The high rate of accidents and the much healthier lifestyle of astronauts compared to the U.S. population make finding a suitable comparison population a problematic task. Space radiation differs substantially from terrestrial radiation exposures studied in the past; therefore, analyses of galactic cosmic radiation (GCR) in animal models must be conducted and correctly applied to the human experience. Secondly, a large enough population of exposed astronauts must exist in order to obtain the data necessary to see any potential statistically significant differences between the astronauts and the control population. Thirdly, confounders and effect modifiers, such as smoking, diet, and other space stressors, must be correctly identified and controlled for in those analyses. In order to begin work assessing the astronaut population, the earliest groups of astronauts (selection groups 1-7) provide a unique model. These astronauts were relatively homogenous, white males whose lifestyle characteristics were similar to an average U.S. citizen of the same birth cohort. This work reviews radiation exposure levels, age, and causes of mortality among these early NASA astronauts and discusses the benefits and limitations of assessing such a cohort for radiation-induced cancer risk.

Quantitative estimation of landslide risk from rapid debris slides on natural slopes in the Nilgiri hills, India

NASA Astrophysics Data System (ADS)

Jaiswal, P.; van Westen, C. J.; Jetten, V.

2011-06-01

A quantitative procedure for estimating landslide risk to life and property is presented and applied in a mountainous area in the Nilgiri hills of southern India. Risk is estimated for elements at risk located in both initiation zones and run-out paths of potential landslides. Loss of life is expressed as individual risk and as societal risk using F-N curves, whereas the direct loss of properties is expressed in monetary terms. An inventory of 1084 landslides was prepared from historical records available for the period between 1987 and 2009. A substantially complete inventory was obtained for landslides on cut slopes (1042 landslides), while for natural slopes information on only 42 landslides was available. Most landslides were shallow translational debris slides and debris flowslides triggered by rainfall. On natural slopes most landslides occurred as first-time failures. For landslide hazard assessment the following information was derived: (1) landslides on natural slopes grouped into three landslide magnitude classes, based on landslide volumes, (2) the number of future landslides on natural slopes, obtained by establishing a relationship between the number of landslides on natural slopes and cut slopes for different return periods using a Gumbel distribution model, (3) landslide susceptible zones, obtained using a logistic regression model, and (4) distribution of landslides in the susceptible zones, obtained from the model fitting performance (success rate curve). The run-out distance of landslides was assessed empirically using landslide volumes, and the vulnerability of elements at risk was subjectively assessed based on limited historic incidents. Direct specific risk was estimated individually for tea/coffee and horticulture plantations, transport infrastructures, buildings, and people both in initiation and run-out areas. Risks were calculated by considering the minimum, average, and maximum landslide volumes in each magnitude class and the corresponding minimum, average, and maximum run-out distances and vulnerability values, thus obtaining a range of risk values per return period. The results indicate that the total annual minimum, average, and maximum losses are about US 44 000, US 136 000 and US 268 000, respectively. The maximum risk to population varies from 2.1 × 10-1 for one or more lives lost to 6.0 × 10-2 yr-1 for 100 or more lives lost. The obtained results will provide a basis for planning risk reduction strategies in the Nilgiri area.

Risk assessment for furan contamination through the food chain in Belgian children.

PubMed

Scholl, Georges; Huybrechts, Inge; Humblet, Marie-France; Scippo, Marie-Louise; De Pauw, Edwin; Eppe, Gauthier; Saegerman, Claude

2012-08-01

Young, old, pregnant and immuno-compromised persons are of great concern for risk assessors as they represent the sub-populations most at risk. The present paper focuses on risk assessment linked to furan exposure in children. Only the Belgian population was considered because individual contamination and consumption data that are required for accurate risk assessment were available for Belgian children only. Two risk assessment approaches, the so-called deterministic and probabilistic, were applied and the results were compared for the estimation of daily intake. A significant difference between the average Estimated Daily Intake (EDI) was underlined between the deterministic (419 ng kg⁻¹ body weight (bw) day⁻¹) and the probabilistic (583 ng kg⁻¹ bw day⁻¹) approaches, which results from the mathematical treatment of the null consumption and contamination data. The risk was characterised by two ways: (1) the classical approach by comparison of the EDI to a reference dose (RfD(chronic-oral)) and (2) the most recent approach, namely the Margin of Exposure (MoE) approach. Both reached similar conclusions: the risk level is not of a major concern, but is neither negligible. In the first approach, only 2.7 or 6.6% (respectively in the deterministic and in the probabilistic way) of the studied population presented an EDI above the RfD(chronic-oral). In the second approach, the percentage of children displaying a MoE above 10,000 and below 100 is 3-0% and 20-0.01% in the deterministic and probabilistic modes, respectively. In addition, children were compared to adults and significant differences between the contamination patterns were highlighted. While major contamination was linked to coffee consumption in adults (55%), no item predominantly contributed to the contamination in children. The most important were soups (19%), dairy products (17%), pasta and rice (11%), fruit and potatoes (9% each).

Urban-hazard risk analysis: mapping of heat-related risks in the elderly in major Italian cities.

PubMed

Morabito, Marco; Crisci, Alfonso; Gioli, Beniamino; Gualtieri, Giovanni; Toscano, Piero; Di Stefano, Valentina; Orlandini, Simone; Gensini, Gian Franco

2015-01-01

Short-term impacts of high temperatures on the elderly are well known. Even though Italy has the highest proportion of elderly citizens in Europe, there is a lack of information on spatial heat-related elderly risks. Development of high-resolution, heat-related urban risk maps regarding the elderly population (≥ 65). A long time-series (2001-2013) of remote sensing MODIS data, averaged over the summer period for eleven major Italian cities, were downscaled to obtain high spatial resolution (100 m) daytime and night-time land surface temperatures (LST). LST was estimated pixel-wise by applying two statistical model approaches: 1) the Linear Regression Model (LRM); 2) the Generalized Additive Model (GAM). Total and elderly population density data were extracted from the Joint Research Centre population grid (100 m) from the 2001 census (Eurostat source), and processed together using "Crichton's Risk Triangle" hazard-risk methodology for obtaining a Heat-related Elderly Risk Index (HERI). The GAM procedure allowed for improved daytime and night-time LST estimations compared to the LRM approach. High-resolution maps of daytime and night-time HERI levels were developed for inland and coastal cities. Urban areas with the hazardous HERI level (very high risk) were not necessarily characterized by the highest temperatures. The hazardous HERI level was generally localized to encompass the city-centre in inland cities and the inner area in coastal cities. The two most dangerous HERI levels were greater in the coastal rather than inland cities. This study shows the great potential of combining geospatial technologies and spatial demographic characteristics within a simple and flexible framework in order to provide high-resolution urban mapping of daytime and night-time HERI. In this way, potential areas for intervention are immediately identified with up-to-street level details. This information could support public health operators and facilitate coordination for heat-related emergencies.

Urban-Hazard Risk Analysis: Mapping of Heat-Related Risks in the Elderly in Major Italian Cities

PubMed Central

Morabito, Marco; Crisci, Alfonso; Gioli, Beniamino; Gualtieri, Giovanni; Toscano, Piero; Di Stefano, Valentina; Orlandini, Simone; Gensini, Gian Franco

2015-01-01

Background Short-term impacts of high temperatures on the elderly are well known. Even though Italy has the highest proportion of elderly citizens in Europe, there is a lack of information on spatial heat-related elderly risks. Objectives Development of high-resolution, heat-related urban risk maps regarding the elderly population (≥65). Methods A long time-series (2001–2013) of remote sensing MODIS data, averaged over the summer period for eleven major Italian cities, were downscaled to obtain high spatial resolution (100 m) daytime and night-time land surface temperatures (LST). LST was estimated pixel-wise by applying two statistical model approaches: 1) the Linear Regression Model (LRM); 2) the Generalized Additive Model (GAM). Total and elderly population density data were extracted from the Joint Research Centre population grid (100 m) from the 2001 census (Eurostat source), and processed together using “Crichton’s Risk Triangle” hazard-risk methodology for obtaining a Heat-related Elderly Risk Index (HERI). Results The GAM procedure allowed for improved daytime and night-time LST estimations compared to the LRM approach. High-resolution maps of daytime and night-time HERI levels were developed for inland and coastal cities. Urban areas with the hazardous HERI level (very high risk) were not necessarily characterized by the highest temperatures. The hazardous HERI level was generally localized to encompass the city-centre in inland cities and the inner area in coastal cities. The two most dangerous HERI levels were greater in the coastal rather than inland cities. Conclusions This study shows the great potential of combining geospatial technologies and spatial demographic characteristics within a simple and flexible framework in order to provide high-resolution urban mapping of daytime and night-time HERI. In this way, potential areas for intervention are immediately identified with up-to-street level details. This information could support public health operators and facilitate coordination for heat-related emergencies. PMID:25985204

Population dose commitments due to radioactive releases from nuclear power plant sites in 1985

DOE Office of Scientific and Technical Information (OSTI.GOV)

Baker, D.A.

Population radiation dose commitments have been estimated from reported radionuclide releases from commericial power reactors operating during 1985. Fifty-year dose commitments from a one-year exposure were calculated from both liquid and atmospheric releases for four population groups (infant, child, teen-ager and adult) residing between 2 and 80 km from each of 61 sites. This report tabulates the results of these calculations, showing the dose commitments for both liquid and airborne pathways for each age group and organ. Also included for each of the sites is a histogram showing the fraction of the total population within 2 to 80 km aroundmore » each site receiving various average dose commitments from the airborne pathways. The total dose commitments (from both liquid and airborne pathways) for each site ranged from a high of 73 person-rem to a low of 0.011 person-rem for the sites with plants operating throughout the year with an arithmetic mean of 3 person-rem. The total population dose for all sites was estimated at 200 person-rem for the 110 million people considered at risk. The site average individual dose commitment from all pathways ranged from a low of 5 /times/ 10/sup /minus/6/ mrem to a high of 0.02 mrem. No attempt was made in this study to determine the maximum dose commitment received by any one individual from the radionuclides released at any of the sites.« less

Population dose commitments due to radioactive releases from nuclear power plant sites in 1984

DOE Office of Scientific and Technical Information (OSTI.GOV)

Baker, D.A.

Population radiation dose commitments have been estimated from reported radionuclide releases from commercial power reactors operating during 1984. Fifty-year dose commitments from a one-year exposure were calculated from both liquid and atmospheric releases for four population groups (infant, child, teen-ager and adult) residing between 2 and 80 km from each of 56 sites. This report tabulates the results of these calculations, showing the dose commitments for both liquid and airborne pathways for each age group and organ. Also included for each of the sites is a histogram showing the fraction of the total population within 2 to 80 km aroundmore » each site receiving various average dose commitments from the airborne pathways. The total dose commitments (from both liquid and airborne pathways) for each site ranged from a high of 110 person-rem to a low of 0.002 person-rem for the sites with plants operating throughout the year with an arithmetic mean of 5 person-rem. The total population dose for all sites was estimated at 280 person-rem for the 100 million people considered at risk. The site average individual dose commitment from all pathways ranged from a low of 6 x 10/sup -6/ mrem to a high of 0.04 mrem. No attempt was made in this study to determine the maximum dose commitment received by any one individual from the radionuclides released at any of the sites.« less

Population dose commitments due to radioactive releases from nuclear power plant sites in 1986

DOE Office of Scientific and Technical Information (OSTI.GOV)

Baker, D.A.

Population radiation dose commitments have been estimated from reported radionuclide releases from commercial power reactors operating during 1986. Fifty-year dose commitments for a one-year exposure from both liquid and atmospheric releases were calculated for four population groups (infant, child, teen-ager and adult) residing between 2 and 80 km from each of 66 reactor sites. This report tabulates the results of these calculations, showing the dose commitments for both water and airborne pathways for each age group and organ. Also included for each of the sites is a histogram showing the fraction of the total population within 2 to 80 kmmore » around each site receiving various average dose commitments from the airborne pathways. The total dose commitments (from both liquid and airborne pathways) for each site ranged from a high of 31 person-rem to a low of 0.0007 person-rem for the sites with plants operating throughout the year with an arithmetic mean of 1.7 person-rem. The total population dose for all sites was estimated at 110 person-rem for the 140 million people considered at risk. The site average individual dose commitment from all pathways ranged from a low of 2 {times} 10{sup -6} mrem to a high of 0.02 mrem. No attempt was made in this study to determine the maximum dose commitment received by any one individual from the radionuclides released at any of the sites. 12 refs.« less

Population dose commitments due to radioactive releases from nuclear power plant sites in 1982. Volume 4

DOE Office of Scientific and Technical Information (OSTI.GOV)

Baker, D.A.; Peloquin, R.A.

Population radiation dose commitments have been estimated from reported radionuclide releases from commercial power reactors operating during 1982. Fifty-year dose commitments from a one-year exposure were calculated from both liquid and atmospheric releases for four population groups (infant, child, teen-ager and adult) residing between 2 and 80 km from each of 51 sites. This report tabulates the results of these calculations, showing the dose commitments for both liquid and airborne pathways for each age group and organ. Also included for each site is a histogram showing the fraction of the total population within 2 to 80 km around each sitemore » receiving various average dose commitments from the airborne pathways. The total dose commitments from both liquid and airborne pathways ranged from a high of 30 person-rem to a low of 0.007 person-rem for the sites with plants operating throughout the year with an arithmetic mean of 3 person-rem. The total population dose for all sites was estimated at 130 person-rem for the 100 million people considered at risk. The average individual dose commitment from all pathways on a site basis ranged from a low of 6 x 10/sup -7/ mrem to a high of 0.06 mrem. No attempt was made in this study to determine the maximum dose commitment received by any one individual from the radionuclides released at any of the sites.« less

Prevalence and associated factors of pinguecula in a rural population in Shanghai, Eastern China.

PubMed

Le, Qihua; Xiang, Jun; Cui, Xinhan; Zhou, Xiaodong; Xu, Jianjiang

2015-04-01

To determine the prevalence and associated factors of pinguecula in a rural Chinese population aged ≥ 50 years in Eastern China. This cross-sectional, population-based survey included an age-stratified random sample of 1108 residents living in Lvxiang Town of Jinshan District. Participants were requested to complete a comprehensive questionnaire to collect demographic data, history of systemic diseases and lifestyle details. The presence of pinguecula on slit lamp examination was recorded. The prevalence of pinguecula and its associated factors were investigated by logistic regression models. Among 1108 eligible subjects, 959 participated in the study, with an average age of 65.1 ± 9.2 years (range 50-89 years). The overall age-adjusted prevalence of pinguecula in this population was 75.57% (95% confidence interval 71.79-79.35%). Logistic regression analysis revealed that age (p = 0.002) and working outdoors (daily sunlight exposure ≥ 2 hours; p = 0.001) were independent risk factors for pinguecula. In addition, sex, education level, alcohol intake, smoking and decreased tear break-up time did not have associations with the development of pinguecula after adjusting for age and outdoor work occupations. The prevalence of pinguecula was 75.57% in this Chinese population aged ≥ 50 years from a coastal rural area of Shanghai, Eastern China, which was higher than the majority of previous findings. Age and working outdoors were independent risk factors for pinguecula.

Lifetime risk of renal replacement therapy in Europe: a population-based study using data from the ERA-EDTA Registry.

PubMed

van den Brand, Jan A J G; Pippias, Maria; Stel, Vianda S; Caskey, Fergus J; Collart, Frederic; Finne, Partik; Heaf, James; Jais, Jean-Philippe; Kramar, Reinhard; Massy, Ziad A; De Meester, Johan; Traynor, Jamie P; Reisæter, Anna Varberg; Wetzels, Jack F M; Jager, Kitty J

2017-02-01

Upcoming KDIGO guidelines for the evaluation of living kidney donors are expected to move towards a personal risk-based evaluation of potential donors. We present the age and sex-specific lifetime risk of renal replacement therapy (RRT) for end-stage renal disease in 10 European countries. We defined lifetime risk of RRT as the cumulative incidence of RRT up to age 90 years. We obtained RRT incidence rates per million population by 5-year age groups and sex using data from the European Renal Association-European Dialysis and Transplant Association (ERA-EDTA) Registry, and used these to estimate the cumulative incidence of RRT, adjusting for competing mortality risk. Lifetime risk of RRT varied from 0.44% to 2.05% at age 20 years and from 0.17% to 1.59% at age 70 years across countries, and was twice as high in men as in women. Lifetime RRT risk decreased with age, ranging from an average of 0.77% to 0.44% in 20- to- 70-year-old women, and from 1.45% to 0.96% in 20- to- 70-year-old men. The lifetime risk of RRT increased slightly over the past decade, more so in men than in women. However, it appears to have stabilized or even decreased slightly in more recent years. The lifetime risk of RRT decreased with age, was lower in women as compared with men of equal age and varied considerably throughout Europe. Given the substantial differences in lifetime risk of RRT between the USA and Europe, country-specific estimates should be used in the evaluation and communication of the risk of RRT for potential living kidney donors. © The Author 2016. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.

Support Vector Hazards Machine: A Counting Process Framework for Learning Risk Scores for Censored Outcomes.

PubMed

Wang, Yuanjia; Chen, Tianle; Zeng, Donglin

2016-01-01

Learning risk scores to predict dichotomous or continuous outcomes using machine learning approaches has been studied extensively. However, how to learn risk scores for time-to-event outcomes subject to right censoring has received little attention until recently. Existing approaches rely on inverse probability weighting or rank-based regression, which may be inefficient. In this paper, we develop a new support vector hazards machine (SVHM) approach to predict censored outcomes. Our method is based on predicting the counting process associated with the time-to-event outcomes among subjects at risk via a series of support vector machines. Introducing counting processes to represent time-to-event data leads to a connection between support vector machines in supervised learning and hazards regression in standard survival analysis. To account for different at risk populations at observed event times, a time-varying offset is used in estimating risk scores. The resulting optimization is a convex quadratic programming problem that can easily incorporate non-linearity using kernel trick. We demonstrate an interesting link from the profiled empirical risk function of SVHM to the Cox partial likelihood. We then formally show that SVHM is optimal in discriminating covariate-specific hazard function from population average hazard function, and establish the consistency and learning rate of the predicted risk using the estimated risk scores. Simulation studies show improved prediction accuracy of the event times using SVHM compared to existing machine learning methods and standard conventional approaches. Finally, we analyze two real world biomedical study data where we use clinical markers and neuroimaging biomarkers to predict age-at-onset of a disease, and demonstrate superiority of SVHM in distinguishing high risk versus low risk subjects.

Predictors of Breast Cancer Worry in a Hispanic and Predominantly Immigrant Mammography Screening Population.

PubMed

April-Sanders, Ayana; Oskar, Sabine; Shelton, Rachel C; Schmitt, Karen M; Desperito, Elise; Protacio, Angeline; Tehranifar, Parisa

Worry about developing breast cancer (BC) has been associated with participation in screening and genetic testing and with follow-up of abnormal screening results. Little is known about the scope and predictors of BC worry in Hispanic and immigrant populations. We collected in-person interview data from 250 self-identified Hispanic women recruited from an urban mammography facility (average age 50.4 years; 82% foreign-born). Women reported whether they worried about developing breast cancer rarely/never (low worry), sometimes (moderate worry), or often/all the time (high worry). We examined whether sociocultural and psychological factors (e.g., acculturation, education, perceived risk), and risk factors and objective risk for BC (e.g., family history, Gail model 5-year risk estimates, parity) predicted BC worry using multinomial and logistic regression. In multivariable models, women who perceived higher absolute BC risk (odds ratio, 1.66 [95% confidence interval, 1.28-2.14] for a one-unit increase in perceived lifetime risk) and comparative BC risk (e.g., odds ratio, 2.73, 95% confidence interval, 1.23-6.06) were more likely to report high BC worry than moderate or low BC worry. There were no associations between BC worry and indicators of objective risk or acculturation. In Hispanic women undergoing screening mammography, higher perceptions of BC risk, in both absolute and comparative terms, were associated independently with high BC worry, and were stronger predictors of BC worry than indicators of objective BC risk, including family history, mammographic density, and personal BC risk estimates. Copyright © 2016 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

Double Exposure and the Climate Gap: Changing demographics and extreme heat in Ciudad Juárez, Mexico

PubMed Central

Collins, Timothy W.; McDonald, Yolanda J.; Aldouri, Raed; Aboargob, Faraj; Eldeb, Abdelatif; Aguilar, María de Lourdes Romo; Velázquez-Angulo, Juárez Gilberto

2013-01-01

Scholars have recognized a climate gap, wherein poor communities face disproportionate impacts of climate change. Others have noted that climate change and economic globalization may mutually affect a region or social group, leading to double exposure. This paper investigates how current and changing patterns of neighborhood demographics are associated with extreme heat in the border city of Juárez, Mexico. Many Juárez neighborhoods are at-risk to triple exposures, in which residents suffer due to the conjoined effects of the global recession, drug war violence, and extreme heat. Due to impacts of the recession on maquiladora employment and the explosion of drug violence (since 2008), over 75% of neighborhoods experienced decreasing population density between 2000 and 2010 and the average neighborhood saw a 40% increase in the proportion of older adults. Neighborhoods with greater drops in population density and increases in the proportion of older residents over the decade are at significantly higher risk to extreme heat, as are neighborhoods with lower population density and lower levels of education. In this context, triple exposures are associated with a climate gap that most endangers lower socioeconomic status and increasingly older aged populations remaining in neighborhoods from which high proportions of residents have departed. PMID:25642135

Double Exposure and the Climate Gap: Changing demographics and extreme heat in Ciudad Juárez, Mexico.

PubMed

Grineski, Sara E; Collins, Timothy W; McDonald, Yolanda J; Aldouri, Raed; Aboargob, Faraj; Eldeb, Abdelatif; Aguilar, María de Lourdes Romo; Velázquez-Angulo, Juárez Gilberto

2015-02-01

Scholars have recognized a climate gap, wherein poor communities face disproportionate impacts of climate change. Others have noted that climate change and economic globalization may mutually affect a region or social group, leading to double exposure. This paper investigates how current and changing patterns of neighborhood demographics are associated with extreme heat in the border city of Juárez, Mexico. Many Juárez neighborhoods are at-risk to triple exposures, in which residents suffer due to the conjoined effects of the global recession, drug war violence, and extreme heat. Due to impacts of the recession on maquiladora employment and the explosion of drug violence (since 2008), over 75% of neighborhoods experienced decreasing population density between 2000 and 2010 and the average neighborhood saw a 40% increase in the proportion of older adults. Neighborhoods with greater drops in population density and increases in the proportion of older residents over the decade are at significantly higher risk to extreme heat, as are neighborhoods with lower population density and lower levels of education. In this context, triple exposures are associated with a climate gap that most endangers lower socioeconomic status and increasingly older aged populations remaining in neighborhoods from which high proportions of residents have departed.

Cervical cancer screening intervals and management for women living with HIV: a risk benchmarking approach.

PubMed

Robbins, Hilary A; Strickler, Howard D; Massad, L Stewart; Pierce, Christopher B; Darragh, Teresa M; Minkoff, Howard; Keller, Marla J; Fischl, Margaret; Palefsky, Joel; Flowers, Lisa; Rahangdale, Lisa; Milam, Joel; Shrestha, Sadeep; Colie, Christine; DʼSouza, Gypsyamber

2017-04-24

We suggested cervical cancer screening strategies for women living with HIV (WLHIV) by comparing their precancer risks to general population women, and then compared our suggestions with current Centers for Disease Control and Prevention (CDC) guidelines. We compared risks of biopsy-confirmed cervical high-grade squamous intraepithelial neoplasia or worse (bHSIL+), calculated among WLHIV in the Women's Interagency HIV Study, to 'risk benchmarks' for specific management strategies in the general population. We applied parametric survival models among 2423 WLHIV with negative or atypical squamous cell of undetermined significance (ASC-US) cytology during 2000-2015. Separately, we synthesized published general population bHSIL+ risks to generate 3-year risk benchmarks for a 3-year return (after negative cytology, i.e. 'rescreening threshold'), a 6-12-month return (after ASC-US), and immediate colposcopy [after low-grade squamous intraepithelial lesion (LSIL)]. Average 3-year bHSIL+ risks among general population women ('risk benchmarks') were 0.69% for a 3-year return (after negative cytology), 8.8% for a 6-12-month return (after ASC-US), and 14.4% for colposcopy (after LSIL). Most CDC guidelines for WLHIV were supported by comparing risks in WLHIV to these benchmarks, including a 3-year return with CD4 greater than 500 cells/μl and after either three negative cytology tests or a negative cytology/oncogenic human papillomavirus cotest (all 3-year risks≤1.3%); a 1-year return after negative cytology with either positive oncogenic human papillomavirus cotest (1-year risk = 1.0%) or CD4 cell count less than 500 cells/μl (1-year risk = 1.1%); and a 6-12-month return after ASC-US (3-year risk = 8.2% if CD4 cell count at least 500 cells/μl; 10.4% if CD4 cell count = 350-499 cells/μl). Other suggestions differed modestly from current guidelines, including colposcopy (vs. 6-12 month return) for WLHIV with ASC-US and CD4 cell count less than 350 cells/μl (3-year risk = 16.4%) and a lengthened 2-year (vs. 1-year) interval after negative cytology with CD4 cell count at least 500 cells/μl (2-year risk = 0.98%). Current cervical cancer screening guidelines for WLHIV are largely appropriate. CD4 cell count may inform risk-tailored strategies.

40 CFR Table Jj-1 to Subpart Jj of... - Animal Population Threshold Level Below Which Facilities Are Not Required To Report Emissions...

Code of Federal Regulations, 2014 CFR

2014-07-01

... Emissions Under Subpart JJ 1 2 Animal group Average annual animal population (Head) 3 Beef 29,300 Dairy 3... groups except dairy, the average annual animal population represents the total number of animals present at the facility. For dairy facilities, the average annual animal population represents the number of...

40 CFR Table Jj-1 to Subpart Jj of... - Animal Population Threshold Level Below Which Facilities Are Not Required To Report Emissions...

Code of Federal Regulations, 2013 CFR

2013-07-01

... Emissions Under Subpart JJ 1,2 Animal group Average annual animal population (Head) 3 Beef 29,300 Dairy 3... groups except dairy, the average annual animal population represents the total number of animals present at the facility. For dairy facilities, the average annual animal population represents the number of...

Sudden Cardiac Death During Sports Activities in the General Population.

PubMed

Narayanan, Kumar; Bougouin, Wulfran; Sharifzadehgan, Ardalan; Waldmann, Victor; Karam, Nicole; Marijon, Eloi; Jouven, Xavier

2017-12-01

Regular exercise reduces cardiovascular and overall mortality. Participation in sports is an important determinant of cardiovascular health and fitness. Regular sports activity is associated with a smaller risk of sudden cardiac death (SCD). However, there is a small risk of sports-related SCD. Sports-related SCD accounts for approximately 5% of total SCD. SCD among athletes comprises only a fraction of all sports-related SCD. Sport-related SCD has a male predominance and an average age of affliction of 45 to 50 years. Survival is better than for other SCD. This review summarizes links between sports and SCD and discusses current knowledge and controversies. Copyright © 2017 Elsevier Inc. All rights reserved.

Social communication competence and functional adaptation in a general population of children: preliminary evidence for sex-by-verbal IQ differential risk.

PubMed

Skuse, David H; Mandy, William; Steer, Colin; Miller, Laura L; Goodman, Robert; Lawrence, Kate; Emond, Alan; Golding, Jean

2009-02-01

The proportion of schoolchildren with mild social communicative deficits far exceeds the number diagnosed with an autistic spectrum disorder (ASD). We aimed to ascertain both the population distribution of such deficits and their association with functional adaptation and cognitive ability in middle childhood. The parent-report Social and Communication Disorders Checklist was administered to participants (n = 8,094) in the Avon Longitudinal Study of Parents and Children. We correlated impairment severity with independent clinical diagnoses of ASD, cognitive abilities, and teacher-rated maladaptive behavior. Social and Communication Disorders Checklist scores were continuously distributed in the general population; boys had mean scores 30% higher than girls. Social communicative deficits were associated with functional impairment at school, especially in domains of hyperactivity and conduct disorders. A sex-by-verbal IQ interaction effect occurred: verbal IQ was protective against social communication impairments across the range of abilities in female subjects only. In male subjects, this protective effect did not exist for those with above-average verbal IQ. Social communicative deficits are of prognostic significance, in terms of behavioral adjustment at school, for boys and girls. Their high general population prevalence emphasizes the importance of measuring such traits among clinically referred children who do not meet diagnostic ASD criteria. Above-average verbal IQ seems to confer protection against social communication impairments in female subjects but not in male subjects.

Iteroparity in the variable environment of the salamander Ambystoma tigrinum

USGS Publications Warehouse

Church, D.R.; Bailey, L.L.; Wilbur, H.M.; Kendall, W.L.; Hines, J.E.

2007-01-01

Simultaneous estimation of survival, reproduction, and movement is essential to understanding how species maximize lifetime reproduction in environments that vary across space and time. We conducted a four-year, capture–recapture study of three populations of eastern tiger salamanders (Ambystoma tigrinum tigrinum) and used multistate mark–recapture statistical methods to estimate the manner in which movement, survival, and breeding probabilities vary under different environmental conditions across years and among populations and habitats. We inferred how individuals may mitigate risks of mortality and reproductive failure by deferring breeding or by moving among populations. Movement probabilities among populations were extremely low despite high spatiotemporal variation in reproductive success and survival, suggesting possible costs to movements among breeding ponds. Breeding probabilities varied between wet and dry years and according to whether or not breeding was attempted in the previous year. Estimates of survival in the nonbreeding, forest habitat varied among populations but were consistent across time. Survival in breeding ponds was generally high in years with average or high precipitation, except for males in an especially ephemeral pond. A drought year incurred severe survival costs in all ponds to animals that attempted breeding. Female salamanders appear to defer these episodic survival costs of breeding by choosing not to breed in years when the risk of adult mortality is high. Using stochastic simulations of survival and breeding under historical climate conditions, we found that an interaction between breeding probabilities and mortality limits the probability of multiple breeding attempts differently between the sexes and among populations.

Arylamine N-acetyltransferase 2 gene polymorphism in an Algerian population.

PubMed

Chelouti, Hiba; Khelil, Malika

2017-09-01

The arylamine N-acetyltransferase 2 (NAT2) is a key enzyme in the biotransformation of xenobiotics. NAT2 gene polymorphisms have been associated with the risk of isoniazid hepatotoxicity and these polymorphisms change among different populations. The objective of this study is to investigate NAT2 polymorphisms in order to predict the prevalence of NAT2 phenotype in an Algerian population. Genotyping of NAT2 was done using a PCR-RFLP method. Haplotype was analysed using the software package PHASE, version 2.0. The major haplotypes were NAT2*5B (23.72%), NAT2*6 A (18.61%), NAT2*4 (14.60%) and NAT2*5 F (10%). The average of the expected slow acetylator phenotype was 53%. Our results suggest that the high frequency of slow acetylator phenotype requires investigation into its possible association with ATDH.

Environmental influences on childhood obesity: ethnic and cultural influences in context.

PubMed

Kumanyika, Shiriki K

2008-04-22

Ethnicity is associated with differences in food-related beliefs, preferences, and behaviors, and cultural influences may contribute to the higher than average risk of obesity among children and youth in U.S. ethnic minority populations. However, cultural attitudes and beliefs are not the only potential source of ethnic variation in childhood obesity prevalence and should not be studied in isolation. Demographic, socio-structural, and environmental variables must also be considered. Available evidence indicates ethnic differences along several pathways that may increase risks of obesity development during gestation, infancy, childhood and adolescence. These include above-average prevalence of obesity in adult females and of maternal diabetes during pregnancy, parental attitudes and practices that may lead to overfeeding children, above-average levels of consumption of certain high calorie foods and beverages, and inadequate physical activity. Environments with lower than average neighborhood availability of healthful foods and higher than average availability of fast food restaurants, along with exposure to ethnically targeted food marketing may contribute to reliance on high calorie foods and beverages, and these foods may be socially and culturally valued. Attitudes about and environmental contexts for physical activity are also relevant. Increasingly, it is acknowledged that individual behaviors and lifestyles, e.g. food choices or child feeding practices, are responsive to the ecological contexts in which they are practiced. Focusing attention on the fluid interactions of cultural influences with contextual factors, of recognized importance for the study of childhood undernutrition, can also lead to further understanding of how to address ethnic disparities in childhood obesity.

Implicit Measure of Life/Death Orientation Predicts Response of Suicidal Ideation to Treatment in Psychiatric Inpatients.

PubMed

Ellis, Thomas E; Rufino, Katrina A; Green, Kelly L

2016-01-01

In this study, we set out to extend empirical research on the Life-Death Implicit Association Test (IAT) by administering the measure to an adult psychiatric inpatient population with suicidal ideation. We sought to examine its association with other suicide-relevant measures and to determine whether it adds predictive utility beyond that offered by other measures of suicide risk. The IAT was administered (N = 124) at biweekly intervals as part of an assessment battery at an inpatient facility for complex, treatment resistant psychiatric disorders (average length of stay: approximately 6 weeks). Multiple regression procedures were utilized to examine relationships among the measures and their predictive utility with respect to suicidal ideation at discharge. Consistent with prior research with other populations, significant associations were found between IAT performance and explicit (self-report and interview) measures of suicide risk. Moreover, the IAT was found to predict suicidal ideation at discharge above and beyond number of prior suicide attempts and admission scores on measures of depression, suicidal ideation, and hopelessness. Change in IAT performance over the course of treatment was observed. The IAT shows promise as an addition to explicit measures conventionally used to estimate suicide risk in psychiatric patients. These findings are consistent with a cognitive vulnerability model of suicide risk.

The changing profile of disability in the U.S. Army: 1981-2005.

PubMed

Bell, Nicole S; Schwartz, Carolyn E; Harford, Thomas; Hollander, Ilyssa E; Amoroso, Paul J

2008-01-01

we sought to provide a profile of U.S. Army soldiers discharged with a permanent disability and to clarify whether underlying demographic changes explain increasing risks. frequency distributions and logistic regression analyses describe active-duty Army soldiers discharged with a disability (January 1981 through December 2005; N = 108,119). Time-series analysis describes temporal changes in demographic factors associated with disability. disability risk has increased 7-fold over the past 25 years. In 2005, there were 1,262 disability discharges per 100,000 active-duty soldiers. Risk factors include female gender, lower rank, married or formerly married, high school education or less, and age 40 or younger. Army population demographics changed during this time; the average age and tenure of soldiers increased, and the proportion of soldiers who were officers, women, and college educated grew. Adjusting for these demographic changes did not explain the rapidly increasing risk of disability. Time-series models revealed that disability among women is increasing independently of the increasing number of women in the Army; disability is also increasing at a faster pace for younger, lower-ranked, enlisted, and shorter-tenured soldiers. disability is costly and growing in the Army. Temporal changes in underlying Army population demographics do not explain overall disability increases. Disability is increasing most rapidly among female, junior enlisted, and younger soldiers.

[Evaluation of the cost of treating pressure ulcers in hospitalized patients using industrialized dressings].

PubMed

Lima, Angela Cristina Beck; Guerra, Diana Mendonça

2011-01-01

This work evaluated wound dresses used in the Neurosurgery Department of Restauração Hospital: polyurethane, hydrogel and activated carbon wound dresses and hydrogel with alginate used for pressure ulcer care. This work aimed to identify a critical factor that increases demand and cost of wound dresses. The evaluation conducted at the Neurosurgery Department identified individuals at risk of pressure ulcer development. Sixty-two patients were evaluated and the prevalence of pressure ulcer was 22.6% according to the Braden scale. Comparative evaluation between patients that didn't receive preventive measures and others that received, showed that the average daily cost of hospitalization for the first group was 45% higher than the mean for the second group. The Wilcoxon-Mann-Withiney test compared the population at risk to develop pressure ulcer and population at low risk showing that the evaluation of Braden Scale scores between the groups presents statistically significant differences and confidence limits of 95%. Pressure ulcer is a key quality indicator in health services.It is possible to reduce costs and offer higher quality public health services by implementing a training program of nursing staff using a preventive measure protocol based on a test to evaluate risk as Braden Scale.

Perception of health risks among adolescents due to consumption of cigarettes, alcohol and psychoactive substances in the Federation of Bosnia and Herzegovina.

PubMed

Pilav, A; Rudić, A; Branković, S; Djido, V

2015-07-01

This article describes the perception of health risks in adolescents due to the consumption of cigarettes, alcohol and psychoactive substances in the Federation of Bosnia and Herzegovina (FBIH), as well as their observation of the behavior of their peers related to addictive behaviors. For the analysis was used a database from the European School Survey Project on Alcohol and Other Drugs (ESPAD) survey which was conducted in FBIH in 2011. The target population were students in the second grade of secondary schools in FBIH born in 1995 according to the ESPAD protocol. The total number of respondents from the cohort born in 1995 was 3813 students. The research results showed that the prevalence of risk perception due to the consumption of cigarettes, alcohol and psychoactive substances among adolescents in the FBIH is lower than the mean prevalence in countries which have implemented the ESPAD survey of 2011. PPreventive activities should be aimed at adolescent risk behaviours and empower them to make the right decisions that can have far reaching significance. Attention has to be paid to selective prevention that is directed towards individuals or subgroup of population where the risk of developing disorder is much higher than average. Copyright © 2015 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Sun Protection Practices and Sun Exposure among Children with a Parental History of Melanoma

PubMed Central

Glenn, Beth A.; Lin, Tiffany; Chang, L. Cindy; Okada, Ashley; Wong, Weng Kee; Glanz, Karen; Bastani, Roshan

2014-01-01

Background First-degree relatives of melanoma survivors have a substantially higher lifetime risk for melanoma than individuals with no family history. Exposure to ultraviolet radiation is the primary modifiable risk factor for the disease. Reducing UV exposure through sun protection may be particularly important for children with a parental history of melanoma. Nonetheless, limited prior research has investigated sun protection practices and sun exposure among these children. Methods The California Cancer Registry was used to identify melanoma survivors eligible to participate in a survey to assess their children's sun protection practices and sun exposure. The survey was administered by mail, telephone, or web to Latino and non-Latino white melanoma survivors with at least one child (0–17 years; N = 324). Results Sun exposure was high and the rate of sunburn was equivalent to or higher than estimates from average risk populations. Use of sun protection was suboptimal. Latino children were less likely to wear sunscreen and hats and more likely to wear sunglasses, although these differences disappeared in adjusted analyses. Increasing age of the child was associated with lower sun protection and higher risk for sunburn whereas higher objective risk for melanoma predicted improved sun protection and a higher risk for sunburns. Perception of high barriers to sun protection was the strongest modifiable correlate of sun protection. Conclusions Interventions to improve sun protection and reduce sun exposure and sunburns in high risk children are needed. Impact Intervening in high risk populations may help reduce the burden of melanoma in the U.S. PMID:25587110

Habitat stability, predation risk and 'memory syndromes'.

PubMed

Dalesman, S; Rendle, A; Dall, S R X

2015-05-27

Habitat stability and predation pressure are thought to be major drivers in the evolutionary maintenance of behavioural syndromes, with trait covariance only occurring within specific habitats. However, animals also exhibit behavioural plasticity, often through memory formation. Memory formation across traits may be linked, with covariance in memory traits (memory syndromes) selected under particular environmental conditions. This study tests whether the pond snail, Lymnaea stagnalis, demonstrates consistency among memory traits ('memory syndrome') related to threat avoidance and foraging. We used eight populations originating from three different habitat types: i) laboratory populations (stable habitat, predator-free); ii) river populations (fairly stable habitat, fish predation); and iii) ditch populations (unstable habitat, invertebrate predation). At a population level, there was a negative relationship between memories related to threat avoidance and food selectivity, but no consistency within habitat type. At an individual level, covariance between memory traits was dependent on habitat. Laboratory populations showed no covariance among memory traits, whereas river populations showed a positive correlation between food memories, and ditch populations demonstrated a negative relationship between threat memory and food memories. Therefore, selection pressures among habitats appear to act independently on memory trait covariation at an individual level and the average response within a population.

Risk factors for whole carcass condemnations in the Swiss slaughter cattle population.

PubMed

Vial, Flavie; Schärrer, Sara; Reist, Martin

2015-01-01

We used meat-inspection data collected over a period of three years in Switzerland to evaluate slaughterhouse-level, farm-level and animal-level factors that may be associated with whole carcass condemnation (WCC) in cattle after slaughter. The objective of this study was to identify WCC risk factors so they can be communicated to, and managed by, the slaughter industry and veterinary services. During meat inspection, there were three main important predictors of the risk of WCC; the slaughtered animal's sex, age, and the size of the slaughterhouse it was processed in. WCC for injuries and significant weight loss (visible welfare indicators) were almost exclusive to smaller slaughterhouses. Cattle exhibiting clinical syndromes that were not externally visible (e.g. pneumonia lesions) and that are associated with fattening of cattle, end up in larger slaughterhouses. For this reason, it is important for animal health surveillance to collect data from both types of slaughterhouses. Other important risk factors for WCC were on-farm mortality rate and the number of cattle on the farm of origin. This study highlights the fact that the many risk factors for WCC are as complex as the production system itself, with risk factors interacting with one another in ways which are sometimes difficult to interpret biologically. Risk-based surveillance aimed at farms with reoccurring health problems (e.g. a history of above average condemnation rates) may be more appropriate than the selection, of higher-risk animals arriving at slaughter. In Switzerland, the introduction of a benchmarking system that would provide feedback to the farmer with information on condemnation reasons, and his/her performance compared to the national/regional average could be a first step towards improving herd-management and financial returns for producers.

Risk Factors for Whole Carcass Condemnations in the Swiss Slaughter Cattle Population

PubMed Central

Vial, Flavie; Schärrer, Sara; Reist, Martin

2015-01-01

We used meat-inspection data collected over a period of three years in Switzerland to evaluate slaughterhouse-level, farm-level and animal-level factors that may be associated with whole carcass condemnation (WCC) in cattle after slaughter. The objective of this study was to identify WCC risk factors so they can be communicated to, and managed by, the slaughter industry and veterinary services. During meat inspection, there were three main important predictors of the risk of WCC; the slaughtered animal's sex, age, and the size of the slaughterhouse it was processed in. WCC for injuries and significant weight loss (visible welfare indicators) were almost exclusive to smaller slaughterhouses. Cattle exhibiting clinical syndromes that were not externally visible (e.g. pneumonia lesions) and that are associated with fattening of cattle, end up in larger slaughterhouses. For this reason, it is important for animal health surveillance to collect data from both types of slaughterhouses. Other important risk factors for WCC were on-farm mortality rate and the number of cattle on the farm of origin. This study highlights the fact that the many risk factors for WCC are as complex as the production system itself, with risk factors interacting with one another in ways which are sometimes difficult to interpret biologically. Risk-based surveillance aimed at farms with reoccurring health problems (e.g. a history of above average condemnation rates) may be more appropriate than the selection, of higher-risk animals arriving at slaughter. In Switzerland, the introduction of a benchmarking system that would provide feedback to the farmer with information on condemnation reasons, and his/her performance compared to the national/regional average could be a first step towards improving herd-management and financial returns for producers. PMID:25901751

Screening for celiac disease in average-risk and high-risk populations

PubMed Central

Aggarwal, Saurabh; Lebwohl, Benjamin

2012-01-01

The prevalence of celiac disease is rising. As a result there is increasing interest in the associated mortality and morbidity of the disease. Screening of asymptomatic individuals in the general population is not currently recommended; instead, a strategy of case finding is the preferred approach, taking into account the myriad modes of presentation of celiac disease. Although a gluten-free diet is the treatment of choice in symptomatic patients with celiac disease, there is no consensus on whether institution of a gluten-free diet will improve the quality of life in asymptomatic screen-detected celiac disease patients. A review of the studies that have been performed on this subject is presented. Certain patient groups such as those with autoimmune diseases may be offered screening in the context of an informed discussion regarding the potential benefits, with the caveat that the data on this issue are sparse. Active case finding seems to be the most prudent option in most clinical situations. PMID:22282707

Preferential partner selection in an evolutionary study of Prisoner's Dilemma.

PubMed

Ashlock, D; Smucker, M D; Stanley, E A; Tesfatsion, L

1996-01-01

Partner selection is an important process in many social interactions, permitting individuals to decrease the risks associated with cooperation. In large populations, defectors may escape punishment by roving from partner to partner, but defectors in smaller populations risk social isolation. We investigate these possibilities for an evolutionary Prisoner's Dilemma in which agents use expected payoffs to choose and refuse partners. In comparison to random or round-robin partner matching, we find that the average payoffs attained with preferential partner selection tend to be more narrowly confined to a few isolated payoff regions. Most ecologies evolve to essentially full cooperative behavior, but when agents are intolerant of defections, or when the costs of refusal and social isolation are small, we also see the emergence of wallflower ecologies in which all agents are socially isolated. Between these two extremes, we see the emergence of ecologies whose agents tend to engage in a small number of defections followed by cooperation thereafter. The latter ecologies exhibit a plethora of interesting social interaction patterns.

Integrating expert opinion with modelling for quantitative multi-hazard risk assessment in the Eastern Italian Alps

NASA Astrophysics Data System (ADS)

Chen, Lixia; van Westen, Cees J.; Hussin, Haydar; Ciurean, Roxana L.; Turkington, Thea; Chavarro-Rincon, Diana; Shrestha, Dhruba P.

2016-11-01

Extreme rainfall events are the main triggering causes for hydro-meteorological hazards in mountainous areas, where development is often constrained by the limited space suitable for construction. In these areas, hazard and risk assessments are fundamental for risk mitigation, especially for preventive planning, risk communication and emergency preparedness. Multi-hazard risk assessment in mountainous areas at local and regional scales remain a major challenge because of lack of data related to past events and causal factors, and the interactions between different types of hazards. The lack of data leads to a high level of uncertainty in the application of quantitative methods for hazard and risk assessment. Therefore, a systematic approach is required to combine these quantitative methods with expert-based assumptions and decisions. In this study, a quantitative multi-hazard risk assessment was carried out in the Fella River valley, prone to debris flows and flood in the north-eastern Italian Alps. The main steps include data collection and development of inventory maps, definition of hazard scenarios, hazard assessment in terms of temporal and spatial probability calculation and intensity modelling, elements-at-risk mapping, estimation of asset values and the number of people, physical vulnerability assessment, the generation of risk curves and annual risk calculation. To compare the risk for each type of hazard, risk curves were generated for debris flows, river floods and flash floods. Uncertainties were expressed as minimum, average and maximum values of temporal and spatial probability, replacement costs of assets, population numbers, and physical vulnerability. These result in minimum, average and maximum risk curves. To validate this approach, a back analysis was conducted using the extreme hydro-meteorological event that occurred in August 2003 in the Fella River valley. The results show a good performance when compared to the historical damage reports.

Residential exposure to aircraft noise and hospital admissions for cardiovascular diseases: multi-airport retrospective study.

PubMed

Correia, Andrew W; Peters, Junenette L; Levy, Jonathan I; Melly, Steven; Dominici, Francesca

2013-10-08

To investigate whether exposure to aircraft noise increases the risk of hospitalization for cardiovascular diseases in older people (≥ 65 years) residing near airports. Multi-airport retrospective study of approximately 6 million older people residing near airports in the United States. We superimposed contours of aircraft noise levels (in decibels, dB) for 89 airports for 2009 provided by the US Federal Aviation Administration on census block resolution population data to construct two exposure metrics applicable to zip code resolution health insurance data: population weighted noise within each zip code, and 90th centile of noise among populated census blocks within each zip code. 2218 zip codes surrounding 89 airports in the contiguous states. 6 027 363 people eligible to participate in the national medical insurance (Medicare) program (aged ≥ 65 years) residing near airports in 2009. Percentage increase in the hospitalization admission rate for cardiovascular disease associated with a 10 dB increase in aircraft noise, for each airport and on average across airports adjusted by individual level characteristics (age, sex, race), zip code level socioeconomic status and demographics, zip code level air pollution (fine particulate matter and ozone), and roadway density. Averaged across all airports and using the 90th centile noise exposure metric, a zip code with 10 dB higher noise exposure had a 3.5% higher (95% confidence interval 0.2% to 7.0%) cardiovascular hospital admission rate, after controlling for covariates. Despite limitations related to potential misclassification of exposure, we found a statistically significant association between exposure to aircraft noise and risk of hospitalization for cardiovascular diseases among older people living near airports.

Pigment Dispersion Syndrome Progression to Pigmentary Glaucoma in a Latin American Population

PubMed Central

Hernandez-Mendieta, Diana Patricia; Rodriguez, Diego Andres; Sepulveda, Ana Irene; Toledo, Jose Daniel

2015-01-01

ABSTRACT Objective: To determine the progression of pigment dispersion syndrome (PDS) into pigmentary glaucoma (PG) in a population at the Central Military Hospital in Bogotá, Colombia. Materials and methods: A retrospective study was conducted, based on a review of medical records of patients with PDS evaluated in the Glaucoma Clinic. Data were collected in a database in excel and subsequently analyzed with the software Statistical Package for the Social Sciences (SPSS), performing Chi-square test analysis and Spearman’s rho test. Results: Forty-eight eyes of 24 patients were included. Forty-two percent were women and 58% were men. Pigmentation of the trabecular meshwork was the most frequent clinical sign (100%), followed by Krukenberg’s spindle (91.7%), the least frequent were the iris concavity and iris heterochromia (4.2%), the average of the spherical equivalent was of - 1.33 (SD 2.07). The rate of conversion of PDS to PG was 37.5%, after an average follow-up of 50.7 months. Having an intraocular pressure (IOP) greater than 21 mm Hg was statistically the only significant risk factor for conversion. Conclusion: We found several differences in frequency and clinical signs in these patients in contrast to previous data, probably due to different racial characteristics. The rate of progression is similar to previous reports despite of heterogeneity of these. Having IOP > 21 mm Hg was the only risk factor associated with progression in this sample. How to cite this article: Gomez Goyeneche HF, Hernandez-Mendieta DP, Rodriguez DA, Sepulveda AI, Toledo JD. Pigment Dispersion Syndrome Progression to Pigmentary Glaucoma in a Latin American Population. J Curr Glaucoma Pract 2015;9(3):69-72. PMID:26997839

The global burden of cholera

PubMed Central

Lopez, Anna Lena; You, Young Ae; Kim, Young Eun; Sah, Binod; Maskery, Brian; Clemens, John

2012-01-01

Abstract Objective To estimate the global burden of cholera using population-based incidence data and reports. Methods Countries with a recent history of cholera were classified as endemic or non-endemic, depending on whether they had reported cholera cases in at least three of the five most recent years. The percentages of the population in each country that lacked access to improved sanitation were used to compute the populations at risk for cholera, and incidence rates from published studies were applied to groups of countries to estimate the annual number of cholera cases in endemic countries. The estimates of cholera cases in non-endemic countries were based on the average numbers of cases reported from 2000 to 2008. Literature-based estimates of cholera case-fatality rates (CFRs) were used to compute the variance-weighted average cholera CFRs for estimating the number of cholera deaths. Findings About 1.4 billion people are at risk for cholera in endemic countries. An estimated 2.8 million cholera cases occur annually in such countries (uncertainty range: 1.4–4.3) and an estimated 87 000 cholera cases occur in non-endemic countries. The incidence is estimated to be greatest in children less than 5 years of age. Every year about 91 000 people (uncertainty range: 28 000 to 142 000) die of cholera in endemic countries and 2500 people die of the disease in non-endemic countries. Conclusion The global burden of cholera, as determined through a systematic review with clearly stated assumptions, is high. The findings of this study provide a contemporary basis for planning public health interventions to control cholera. PMID:22461716

Residential exposure to aircraft noise and hospital admissions for cardiovascular diseases: multi-airport retrospective study

PubMed Central

Correia, Andrew W; Peters, Junenette L; Levy, Jonathan I; Melly, Steven

2013-01-01

Objective To investigate whether exposure to aircraft noise increases the risk of hospitalization for cardiovascular diseases in older people (≥65 years) residing near airports. Design Multi-airport retrospective study of approximately 6 million older people residing near airports in the United States. We superimposed contours of aircraft noise levels (in decibels, dB) for 89 airports for 2009 provided by the US Federal Aviation Administration on census block resolution population data to construct two exposure metrics applicable to zip code resolution health insurance data: population weighted noise within each zip code, and 90th centile of noise among populated census blocks within each zip code. Setting 2218 zip codes surrounding 89 airports in the contiguous states. Participants 6 027 363 people eligible to participate in the national medical insurance (Medicare) program (aged ≥65 years) residing near airports in 2009. Main outcome measures Percentage increase in the hospitalization admission rate for cardiovascular disease associated with a 10 dB increase in aircraft noise, for each airport and on average across airports adjusted by individual level characteristics (age, sex, race), zip code level socioeconomic status and demographics, zip code level air pollution (fine particulate matter and ozone), and roadway density. Results Averaged across all airports and using the 90th centile noise exposure metric, a zip code with 10 dB higher noise exposure had a 3.5% higher (95% confidence interval 0.2% to 7.0%) cardiovascular hospital admission rate, after controlling for covariates. Conclusions Despite limitations related to potential misclassification of exposure, we found a statistically significant association between exposure to aircraft noise and risk of hospitalization for cardiovascular diseases among older people living near airports. PMID:24103538

Invasive Cancer Incidence, 2004-2013, and Deaths, 2006-2015, in Nonmetropolitan and Metropolitan Counties - United States.

PubMed

Henley, S Jane; Anderson, Robert N; Thomas, Cheryll C; Massetti, Greta M; Peaker, Brandy; Richardson, Lisa C

2017-07-07

Previous reports have shown that persons living in nonmetropolitan (rural or urban) areas in the United States have higher death rates from all cancers combined than persons living in metropolitan areas. Disparities might vary by cancer type and between occurrence and death from the disease. This report provides a comprehensive assessment of cancer incidence and deaths by cancer type in nonmetropolitan and metropolitan counties. 2004-2015. Cancer incidence data from CDC's National Program of Cancer Registries and the National Cancer Institute's Surveillance, Epidemiology, and End Results program were used to calculate average annual age-adjusted incidence rates for 2009-2013 and trends in annual age-adjusted incidence rates for 2004-2013. Cancer mortality data from the National Vital Statistics System were used to calculate average annual age-adjusted death rates for 2011-2015 and trends in annual age-adjusted death rates for 2006-2015. For 5-year average annual rates, counties were classified into four categories (nonmetropolitan rural, nonmetropolitan urban, metropolitan with population <1 million, and metropolitan with population ≥1 million). For the trend analysis, which used annual rates, these categories were combined into two categories (nonmetropolitan and metropolitan). Rates by county classification were examined by sex, age, race/ethnicity, U.S. census region, and cancer site. Trends in rates were examined by county classification and cancer site. During the most recent 5-year period for which data were available, nonmetropolitan rural areas had lower average annual age-adjusted cancer incidence rates for all anatomic cancer sites combined but higher death rates than metropolitan areas. During 2006-2015, the annual age-adjusted death rates for all cancer sites combined decreased at a slower pace in nonmetropolitan areas (-1.0% per year) than in metropolitan areas (-1.6% per year), increasing the differences in these rates. In contrast, annual age-adjusted incidence rates for all cancer sites combined decreased approximately 1% per year during 2004-2013 both in nonmetropolitan and metropolitan counties. This report provides the first comprehensive description of cancer incidence and mortality in nonmetropolitan and metropolitan counties in the United States. Nonmetropolitan rural counties had higher incidence of and deaths from several cancers related to tobacco use and cancers that can be prevented by screening. Differences between nonmetropolitan and metropolitan counties in cancer incidence might reflect differences in risk factors such as cigarette smoking, obesity, and physical inactivity, whereas differences in cancer death rates might reflect disparities in access to health care and timely diagnosis and treatment. Many cancer cases and deaths could be prevented, and public health programs can use evidence-based strategies from the U.S. Preventive Services Task Force and Advisory Committee for Immunization Practices (ACIP) to support cancer prevention and control. The U.S. Preventive Services Task Force recommends population-based screening for colorectal, female breast, and cervical cancers among adults at average risk for these cancers and for lung cancer among adults at high risk; screening adults for tobacco use and excessive alcohol use, offering counseling and interventions as needed; and using low-dose aspirin to prevent colorectal cancer among adults considered to be at high risk for cardiovascular disease based on specific criteria. ACIP recommends vaccination against cancer-related infectious diseases including human papillomavirus and hepatitis B virus. The Guide to Community Preventive Services describes program and policy interventions proven to increase cancer screening and vaccination rates and to prevent tobacco use, excessive alcohol use, obesity, and physical inactivity.

Population exposure to fine particles and estimated excess mortality in Finland from an East European wildfire episode.

PubMed

Hänninen, Otto O; Salonen, Raimo O; Koistinen, Kimmo; Lanki, Timo; Barregard, Lars; Jantunen, Matti

2009-05-01

Long-range transported particulate matter (PM) air pollution episodes associated with wildfires in the Eastern Europe are relatively common in Southern and Southeastern Finland. In severe cases such as in August-September 2002, the reduced visibility and smell of the smoke, and symptoms such as irritation of eyes and airways experienced by the population raise the issue into the headlines. Because PM air pollution, in general, has been identified as a major health risk, and the exposures are of repeating nature, the issue warrants a risk assessment to estimate the magnitude of the problem. The current work uses the available air quality data in Finland to estimate population exposures caused by one of the worst episodes experienced in this decade. This episode originated from wildfires in Russia, Belarus, Ukraine, and the Baltic countries. The populations of 11 Southern Finnish provinces were exposed between 26 August and 8 September 2002, for 2 weeks to an additional population-weighted average PM(2.5) level of 15.7 microg/m(3). Assuming similar effect on mortality for these particles as observed in epidemiological time series studies on urban particles (0.5%-2% increase in mortality per 10 microg/m(3), central estimate 1%), this exposure level would be associated with 9-34 cases (17 cases central estimate) of additional mortality. Epidemiological evidence specific to particles from biomass combustion is scarce, affecting also the reliability of the current risk assessment. Do the wildfire aerosols exhibit the same level of toxicity as the urban particles? To shed light on this question, it is interesting to look at the exposure data in relationship to the observed daily mortality in Finland, even though the limited duration of the episode allows only for a weak statistical power. The percentage increases observed (0.8%-2.1% per 10 microg/m(3) of fine PM) are in line with the more general estimates for urban PM and those used in the current risk assessment.

A randomized comparison of print and web communication on colorectal cancer screening.

PubMed

Weinberg, David S; Keenan, Eileen; Ruth, Karen; Devarajan, Karthik; Rodoletz, Michelle; Bieber, Eric J

2013-01-28

New methods to enhance colorectal cancer (CRC) screening rates are needed. The web offers novel possibilities to educate patients and to improve health behaviors, such as cancer screening. Evidence supports the efficacy of health communications that are targeted and tailored to improve the uptake of recommendations. We identified unscreened women at average risk for CRC from the scheduling databases of obstetrics and gynecology practices in 2 large health care systems. Participants consented to a randomized controlled trial that compared CRC screening uptake after receipt of CRC screening information delivered via the web or in print form. Participants could also be assigned to a control (usual care) group. Women in the interventional arms received tailored information in a high- or low-monitoring Cognitive Social Information Processing model-defined attentional style. The primary outcome was CRC screening participation at 4 months. A total of 904 women were randomized to the interventional or control group. At 4 months, CRC screening uptake was not significantly different in the web (12.2%), print (12.0%), or control (12.9%) group. Attentional style had no effect on screening uptake for any group. Some baseline participant factors were associated with greater screening, including higher income (P = .03), stage of change (P < .001), and physician recommendation to screen (P < .001). A web-based educational intervention was no more effective than a print-based one or control (no educational intervention) in increasing CRC screening rates in women at average risk of CRC. Risk messages tailored to attentional style had no effect on screening uptake. In average-risk populations, use of the Internet for health communication without additional enhancement is unlikely to improve screening participation. clinicaltrials.gov Identifier: NCT00459030.

The association of colonoscopy quality indicators with the detection of screen-relevant lesions, adverse events, and postcolonoscopy cancers in an asymptomatic Canadian colorectal cancer screening population.

PubMed

Hilsden, Robert J; Dube, Catherine; Heitman, Steven J; Bridges, Ronald; McGregor, S Elizabeth; Rostom, Alaa

2015-11-01

Although several quality indicators of colonoscopy have been defined, quality assurance activities should be directed at the measurement of quality indicators that are predictive of key screening colonoscopy outcomes. The goal of this study was to examine the association among established quality indicators and the detection of screen-relevant lesions (SRLs), adverse events, and postcolonoscopy cancers. Historical cohort study. Canadian colorectal cancer screening center. A total of 18,456 asymptomatic men and women ages 40 to 74, at either average risk or increased risk for colorectal cancer because of a family history, who underwent a screening colonoscopy from 2008 to 2010. Using univariate and multivariate analyses, we explored the association among procedural quality indicators and 3 colonoscopy outcomes: detection of SRLs, adverse events, and postcolonoscopy cancers. The crude rates of SRLs, adverse events, and postcolonoscopy cancers were 240, 6.44, and .54 per 1000 colonoscopies, respectively. Several indicators, including endoscopist withdrawal time (OR, 1.3; 95% CI, 1.2-1.4) and cecal intubation rate (OR, 13.9; 95% CI, 1.9-96.9), were associated with the detection of SRLs. No quality indicator was associated with the risk of adverse events. Endoscopist average withdrawal time over 6 minutes (OR, .12; 95% CI, .002-.85) and SRL detection rate over 20% (OR, .17; 95% CI, .03-.74) were associated with a reduced risk of postcolonoscopy cancers. Single-center study. Quality assurance programs should prioritize the measurement of endoscopist average withdrawal time and adenoma (SRL) detection rate. Copyright © 2015 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

Health risk among asbestos cement sheet manufacturing workers in Thailand.

PubMed

Phanprasit, Wantanee; Sujirarat, Dusit; Chaikittiporn, Chalermchai

2009-12-01

To assess asbestos exposure and calculate the relative risks of lung cancer among asbestos cement roof sheet workers and to predict the incidence rate of lung cancer caused by asbestos in Thailand. A cross-sectional study was conducted in four asbestos cement roof factories. Both area and personal air samples were collected and analyzed employing NIOSH method # 7400 and counting rule A for all procesess and activities. The time weight average exposures were calculated for each studied task using average area concentrations of the mill and personal concentrations. Then, cumulative exposures were estimated based on the past nation-wide air sampling concentrations and those from the present study. The relative risk (RR) of lung cancer among asbestos cement sheet workers was calculated and the number of asbestos related lung cancer case was estimated. The roof fitting polishers had the highest exposure to airborne asbestos fiber (0.73 fiber/ml). The highest average area concentration was at the conveyor to the de-bagger areas (0.02 fiber/ml). The estimated cumulative exposure for the workers performed studied-tasks ranged in between 90.13-115.65 fiber-years/ml while the relative risk of lung cancer calculated using US. EPA's model were 5.37-5.96. Based on the obtained RR, lung cancer among AC sheet in Thailand would be 2 case/year. In case that AC sheet will not be prohibited from being manufactured, even though only chrysotile is allowed, the surveillance system should be further developed and more seriously implemented. The better control measures for all processes must be implemented. Furthermore, due to the environmental persistence of asbestos fiber, its life cycle analysis should be conducted in order to control environmental exposure of general population.

Salmon restoration in the Umatilla River: A study of straying and risk containment

USGS Publications Warehouse

Hayes, M.C.; Carmichael, R.W.

2002-01-01

The use of artificial propagation may produce unexpected results and the need for risk containment. Stray chinook salmon (Oncorhynchus tshawytscha) from Umatilla River releases put the threatened Snake River stock at risk, caused conflict between two plans, altered management, and greatly increased the costs for hatchery-based restoration. Stray Umatilla returns captured or observed in the Snake River averaged more than 200 fish annually and comprised up to 26% of the escapement. The risk to the threatened population stimulated a series of containment actions, including wire tagging 2-3 million fish annually, use of acclimation ponds, altering release locations, flow enhancement, and broodstock management changes. Actions for the use of artificial propagation where straying or unexpected results are a concern include marking or tagging most or all fish, limiting the number of fish initially released, recognizing environmental variables that influence straying, ensuring that funding for risk containment is available when undesirable results occur, and recognizing that unexpected results may not be manifested or identified immediately.

Benign and malignant thyroid neoplasms after childhood irradiation for Tinea capitis. [X-ray

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ron, E.; Modan, B.

1980-07-01

The incidence of all thyroid surgery was studied among 10,842 persons whose thyroid glands had been exposed in childhood to an average dose of 9 rads of x-radiation during treatment for tinea capitis and among 2 matched control groups. A statistically significant increased risk for both benign and malignant neoplasms was found in the exposed group. The excess risk was 8.3 cases/year/rad/million population. There were no differences in other surgical conditions between the irradiated and nonirradiated groups. Persons irradiated under age 6 years had the highest excess risk for developing carcinomas. The incidence of thyroid neoplasms was approximately threefold highermore » in women than in men among the irradiated persons and among the controls, but the relative risk for the irradiated group of women was greater than the addition of the relative risks of the other groups. Low-dose radiation is instrumental in the development of both benign and malignant thyroid neoplasms.« less

A content analysis of Internet resources about the risks of seafood consumption.

PubMed

Henderson, Heather C; Hong, Jie; Friedman, Daniela B; Porter, Dwayne E; Halfacre, Angela C; Scott, Geoffrey I; Lead, Jamie R

2016-08-01

Seafood consumption is a main source of human exposure to certain environmental contaminants. Therefore, it is valuable to assess the online health risk messages focused on this topic, as people in the US are increasingly accessing the Internet for health-related information. Previous research indicates that online health information tends to be written at a reading level that is more advanced than ability of the general population. The purpose of this research was to examine the content and readability of Internet resources targeted toward consumers in the US regarding the health risks from consumption of contaminated seafood. Sources for analysis were gathered through a targeted search of state and national government websites, as well as through a Google search. The overall mean readability level was Grade 9.21, which is slightly above the average reading level of US adults. Future research should evaluate the accuracy of the health risk messages, as well as consumer perceptions of risk.

[Potential health risks from consumption of water with arsenic in Colima, Mexico].

PubMed

Mendoza-Cano, Oliver; Sánchez-Piña, Ramón Alberto; Barrón-Quintana, Julián; Cuevas-Arellano, Herguin Benjamin; Escalante-Minakata, Pilar; Solano-Barajas, Ramón

2017-01-01

To estimate potential health risks due to chronic ingestion of arsenic from groundwater in Colima, Mexico. Samples were randomly taken in 36 wells from 10 local aquifers. Analysis was performed by ICP-OES following international standards. Geostatistical interpolation was performed with ArcGIS, implementing a model weighting inverse distance to estimate arsenic routes of exposure and consumption on each locality. The Hazard Quotient Ratio (HQ) and carcinogenic risk (R) for As were estimated. The weighted average HQ for arsenic in Colima is 2.41. There are HQ> 1 values indicating adverse non-cancer health effects by continuous and prolonged intake of water with arsenic, which could affect 183 832 individuals in the state. The risk of developing any type of cancer among the population in this study due to high arsenic concentrations in groundwater (R) is 1.089E-3, which could statistically cause 446 cases of cancer. Current levels of arsenic in groundwater increase carcinogenic and non-carcinogenic human health risks in Colima.

Risk assessment of airborne pesticides in a Mediterranean region of Spain.

PubMed

López, Antonio; Yusà, Vicent; Muñoz, Amalia; Vera, Teresa; Borràs, Esther; Ródenas, Milagros; Coscollà, Clara

2017-01-01

A risk assessment strategy based on the quantitative target analysis and semi-quantitative retrospective screening determination of pesticides in PM10 has been developed. The proposed methodology was applied to 345 real samples from nine stations of a Mediterranean area in Spain, and the risk was assessed for adult, children and infants. Forty pesticides were detected with average concentrations ranging from 8 to 30,000pgm -3 . Each station showed its specific pesticide profile, which is linked to the different types of crops around each station. For adults, children and infants the estimated chronic inhalation risk, expressed as Hazard Quotient (HQ), was <1 for all pesticides. The cumulative exposure for organophosphates, neonicotinoids, benzimidazoles, carbamates, micro-organism and triazoles pesticides (HI, Hazard Index) were <1 for the three groups of populations assessed. For infants, the cancer risk estimated for the detected pesticides classified as possible and potential carcinogens were lower than 1.0 E-06, except for carbendazim and hexythiazox. Copyright © 2016 Elsevier B.V. All rights reserved.

Evidence and gaps in the literature on orthorexia nervosa.

PubMed

Varga, Márta; Dukay-Szabó, Szilvia; Túry, Ferenc; van Furth, Eric F; van Furth Eric, F

2013-06-01

To review the literature on the prevalence, risk groups and risk factors of the alleged eating disorder orthorexia nervosa. We searched Medline and Pubmed using several key terms relating to orthorexia nervosa (ON) and checked the reference list of the articles that we found. Attention was given to methodological problems in these studies, such as the use of non-validated assessment instruments, small sample size and sample characteristics, which make generalization of the results impossible. Eleven studies were found. The average prevalence rate for orthorexia was 6.9 % for the general population and 35-57.8 % for high-risk groups (healthcare professionals, artists). Dieticians and other healthcare professionals are at high risk of ON. Risk factors include obsessive-compulsive features, eating-related disturbances and higher socioeconomic status. Relevant clinical experience, published literature and research data have increased in the last few years. The definition and diagnostic criteria of ON remain unclear. Further studies are needed to clarify appropriate diagnostic methods and the place of ON among psychopathological categories.

Estimation of in situ mating systems in wild sorghum (Sorghum bicolor (L.) Moench) in Ethiopia using SSR-based progeny array data: implications for the spread of crop genes into the wild.

PubMed

Adugna, Asfaw; Sweeney, Patty M; Bekele, Endashaw

2013-04-01

Because transgenic sorghum (Sorghum bicolor L.) is being developed for Africa, we investigated the potential for transgenes to spread to conspecific wild/weedy sorghum populations in Ethiopia, which is considered the centre of origin of cultivated sorghum. In the current study, the extent of outcrossing, and uniparental and biparental inbreeding were investigated in seven wild/weedy sorghum populations collected at elevations ranging from 631 to 1709 m. Based on allele frequency data of 1120 progenies and 140 maternal plants from five polymorphic microsatellite markers, outcrossing rates were estimated using standard procedures. The average multilocus outcrossing rate was 0.51, with a range of 0.31-0.65 among populations, and the family outcrossing rate was in the extreme range of 0 to 100%. The highest outcrossing (t(m) = 0.65) was recorded in a weedy population that was intermixed with an improved crop variety in Abuare (Wello region). It was also observed that the inbreeding coefficient of the progenies (F(p)) tend to be more than the inbreeding coefficient of both their maternal parents (F(m)) and the level of inbreeding expected at equilibrium (F(eq)), which is a characteristic of predominantly outbreeding species. Biparental inbreeding was evident in all populations and averaged 0.24 (range = 0.10-0.33). The high outcrossing rates of wild/weedy sorghum populations in Ethiopia indicate a high potential for crop genes (including transgenes) to spread within the wild pool. Therefore, effective risk management strategies may be needed if the introgression of transgenes or other crop genes from improved cultivars into wild or weedy populations is deemed to be undesirable.

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

PubMed

Zhang, Xiang; Woodall, William H

2015-11-10

The risk-adjusted Bernoulli cumulative sum (CUSUM) chart developed by Steiner et al. (2000) is an increasingly popular tool for monitoring clinical and surgical performance. In practice, however, the use of a fixed control limit for the chart leads to a quite variable in-control average run length performance for patient populations with different risk score distributions. To overcome this problem, we determine simulation-based dynamic probability control limits (DPCLs) patient-by-patient for the risk-adjusted Bernoulli CUSUM charts. By maintaining the probability of a false alarm at a constant level conditional on no false alarm for previous observations, our risk-adjusted CUSUM charts with DPCLs have consistent in-control performance at the desired level with approximately geometrically distributed run lengths. Our simulation results demonstrate that our method does not rely on any information or assumptions about the patients' risk distributions. The use of DPCLs for risk-adjusted Bernoulli CUSUM charts allows each chart to be designed for the corresponding particular sequence of patients for a surgeon or hospital. Copyright © 2015 John Wiley & Sons, Ltd.

Inadequate Riboflavin Intake and Anemia Risk in a Chinese Population: Five-Year Follow Up of the Jiangsu Nutrition Study

PubMed Central

Shi, Zumin; Zhen, Shiqi; Wittert, Gary A.; Yuan, Baojun; Zuo, Hui; Taylor, Anne W.

2014-01-01

Objectives Riboflavin (vitamin B2) has been shown in animal studies to affect the absorption and metabolism of iron. Cross-sectional population studies show a relationship between riboflavin intake and anemia but prospective population studies are limited. The aim of the study was to determine the relationship between riboflavin intake and the risk of anemia in a Chinese cohort. Method The study used data from 1253 Chinese men and women who participated in two waves of the Jiangsu Nutrition Study (JIN), five years apart, in 2002 and 2007. Riboflavin intake and hemoglobin (Hb) were quantitatively assessed together with dietary patterns, lifestyle, socio-demographic and health-related factors. Results At baseline, 97.2% of participants had inadequate riboflavin intake (below the estimate average requirement). Riboflavin intake was positively associated with anemia at baseline, but low riboflavin intake was associated with an increased risk of anemia at follow-up among those anemic at baseline. In the multivariate model, adjusting for demographic and lifestyle factors and dietary patterns, the relative risk and 95% confidence interval for anemia at follow-up, across quartiles of riboflavin intake were: 1, 0.82(0.54–1.23), 0.56(0.34–0.93), 0.52(0.28–0.98) (p for trend 0.021). There was a significant interaction between riboflavin and iron intake; when riboflavin intake was low, a high iron intake was associated with a lower probability of anemia at follow-up. This association disappeared when riboflavin intake was high. Conclusion Inadequate riboflavin intake is common and increases the risk of anemia in Chinese adults. Given the interaction with iron intake correcting inadequate riboflavin intake may be a priority in the prevention of anemia, and population based measurement and intervention trials are required. PMID:24533156

Minireview on the toxicity of dietary acrylamide.

PubMed

Parzefall, Wolfram

2008-04-01

Acrylamide is a commodity chemical with many industrial and laboratory uses. It is also formed from carbohydrate and amino acid containing food by heating (primarily in fried potato products, bread, coffee). Neurotoxicity was detected as the primary toxic effect after occupational exposure. In rats and mice AA is toxic for reproduction and development and to male germ cells, is genotoxic through a reactive metabolite, glycidamide, and carcinogenic to several organs. Epidemiological studies did not point to an association between either occupational or dietary exposure and an excess of cancer incidence. Health risks of the general population are based on an average exposure to 1 microg/kg bw/day increasing for high consumers to 4 microg/kg bw/day. For average consumers a margin of exposure of 200 for neurotoxicity can be regarded as sufficiently protective. However, a margin of 300 for carcinogenic risks appears not sufficient when applying a precautionary principle. This is also illustrated when the benchmark dose lower confidence limit for cancer is divided by an uncertainty factor of 300, which arrives at a tolerable daily intake of 1 microg/kg bw/day, and thus is in the range of average consumption. Further measures to minimize acrylamide formation in food should therefore be explored to reduce human exposure.

The hostel or the warehouse? Spatiotemporal exposure assessment for natural hazards

NASA Astrophysics Data System (ADS)

Fuchs, S.; Keiler, M.; Zischg, A.

2015-04-01

A spatially explicit object-based temporal assessment of buildings and citizens exposed to natural hazards in Austria is presented, including elements at risk to river flooding, torrential flooding, and snow avalanches. It is shown that the repeatedly-stated assumption of increasing losses due to continued population growth and related increase in assets has to be opposed to the local development of building stock. While some regions have shown a clearly above-average increase in assets, other regions were characterised by a below-average development. This mirrors the topography of the country, but also the different economic activities. While hotels and hostels are extraordinary prone to mountain hazards, commercial buildings as well as buildings used for recreation purpose are considerably exposed to river flooding. Residential buildings have shown an average exposure, compared to the amount of buildings of this type in the overall building stock. In sum, around 5% of all buildings are exposed to mountain hazards, and around 9% to river flooding, with around 1% of the buildings stock being multi-exposed. It is shown that the dynamics of elements at risk exposed have a time lag once land use regulations are enforced, and it is concluded that an object-based assessment has clear advantages compared to the assessment using aggregated land use data.

Susceptibility to Myxobolus cerebralis among Tubifex tubifex populations from ten major drainage basins in Colorado where Cutthroat Trout are endemic.

PubMed

Nehring, R Barry; Lukacs, P M; Baxa, D V; Stinson, M E T; Chiaramonte, L; Wise, S K; Poole, B; Horton, A

2014-03-01

Establishment of Myxobolus cerebralis (Mc) resulted in declines of wild Rainbow Trout Oncorhynchus mykiss populations in streams across Colorado during the 1990s. However, the risk for establishment and spread of this parasite into high-elevation habitats occupied by native Cutthroat Trout O. clarkii was unknown. Beginning in 2003, tubificid worms were collected from all major drainages where Cutthroat Trout were endemic and were assayed by quantitative PCR to determine the occurrence and distribution of the various lineages of Tubifex tubifex (Tt) oligochaetes. Over a 5-year period, 40 groups of Tt oligochaetes collected from 27 streams, 3 natural lakes, 2 private ponds, and a reservoir were evaluated for their relative susceptibility to Mc. Exposure groups were drawn from populations of pure lineage III Tt, mixed-lineage populations where one or more of the highly resistant (lineage I) or nonsusceptible lineages (V or VI) were the dominant oligochaete and susceptible lineage III worms were the subdominant worm, or pure lineage VI Tt. Experimental replicates of 250 oligochaetes were exposed to 50 Mc myxospores per worm. The parasite amplification ratio (total triactinomyxons [TAMs] produced / total myxospore exposure) was very high among all pure lineage III Colorado exposure groups, averaging 363 compared with 8.24 among the mixed-lineage exposure groups. Lineage III oligochaetes from Mt. Whitney Hatchery in California, which served as the laboratory standard for comparative purposes, had an average parasite amplification ratio of 933 among 10 exposed replicates over a 5-year period. Lineage I oligochaetes were highly resistant to infection and did not produce any TAMs. Lineages V and VI Tt did not become infected and did not produce any TAMs. These results suggest that the risk of establishment of Mc is high for aquatic habitats in Colorado where Cutthroat Trout and lineage III Tt are sympatric.

Occupational eye injury and risk reduction: Kentucky workers' compensation claim analysis 1994-2003.

PubMed

McCall, B P; Horwitz, I B; Taylor, O A

2009-06-01

Occupational eye injuries are a significant source of injury in the workplace. Little population-based research in the area has been conducted, and is necessary for developing and prioritizing effective interventions. Workers' compensation data from the state of Kentucky for the years 1994-2003 were analysed by demographics, injury nature and cause, cost, and occupational and industrial characteristics. The US Bureau of Labor Statistics' Current Population Survey was utilised to compute injury rates for demographic and occupational groups. There were 10,545 claims of ocular injury, representing 6.29 claims per 10,000 workers on average annually. A substantial drop in the claim rate was found after the state passed monetary penalties for injuries caused by employer negligence or OSHA violations. Claims by men were over three times more likely than those by women to have associated claim costs (OR 0.52; 95% CI 0.32 to 0.85; p = 0.009). The highest eye injury rates per 10,000 of 13.46 (95% CI 12.86 to 14.07) were found for the helpers/labourers occupation, and of 19.95 (95% CI 18.73 to 21.17) for the construction industry. The total cost of claim payments over the period was over $3,480,000, and average cost per claim approximated $331. Eye injuries remain a significant risk to worker health, especially among men in jobs requiring intensive manual labour. Evidence showed that increased legislative regulation led to a decline in eye injuries, which was consistent with other recent findings in the area. Additionally, targeting groups most at risk, increasing worker training, providing effective eye protection equipment, and developing workplace safety cultures may together reduce occupational eye injuries.

Aflatoxin and PAH exposure biomarkers in a U.S. population with a high incidence of hepatocellular carcinoma

PubMed Central

Johnson, Natalie M.; Qian, Guoqing; Xu, Li; Tietze, Danielle; Marroquin-Cardona, Alicia; Robinson, Abraham; Rodriguez, Melanie; Kaufman, Linda; Cunningham, Kyle; Wittmer, James; Guerra, Fernando; Donnelly, Kirby C.; Williams, Jonathan H.; Wang, Jia-Sheng; Phillips, Timothy D.

2010-01-01

The incidence of hepatocellular carcinoma (HCC) is significantly elevated in a Hispanic community in Bexar County, Texas. Chronic exposure to dietary aflatoxins (AFs) is a major risk factor for HCC; increased risk has been linked to polycyclic aromatic hydrocarbon (PAH) co-exposure and hepatitis virus infection. The aims of this study were to assess AF and PAH exposures, investigate dietary factors that may contribute to increased AF exposure, and determine the prevalence of hepatitis virus infection in Bexar Co. Blood and urine samples were collected from 184 volunteers for biomarker analyses and hepatitis screening. Serum AFB1-lysine adduct, urinary AFM1 and 1-hydroxypyrene (1-OHP) levels were measured using high-performance liquid chromatography. The average AFB1-lysine adduct level detected in 20.6% of serums was 3.84 ± 3.11 pg/mg albumin (range 1.01-16.57 pg/mg). AFM1 was detected in 11.7% of urines, averaging 223.85 ± 250.56 pg/mg creatinine (range 1.89-935.49 pg/mg). AFM1 detection was associated with increased consumption of corn tortillas (p = 0.009), nuts (p = 0.033) and rice (p = 0.037). A significant difference was observed between mean 1-OHP values of non-smokers (0.07 ± 0.13) and smokers (0.80 ± 0.68) μmol/mol creatinine (p < 0.01). A high hepatitis C virus positivity rate (7.1%) was observed. Findings suggest that the incidence and level of AF and PAH exposure was less than that observed in a high-risk population; however, participants consuming higher amounts of foods prone to AF contamination may be more vulnerable to exposure and interactions with other environmental/biological factors (i.e., HCV). PMID:20870273