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Sample records for brazil predictive risk

  1. Predictive qualitative risk model of bovine rabies occurrence in Brazil.

    PubMed

    Braga, Guilherme Basseto; Grisi-Filho, José Henrique Hildebrand; Leite, Bruno Meireles; de Sena, Elaine Fátima; Dias, Ricardo Augusto

    2014-03-01

    Bovine rabies remains endemic in Brazil and despite control efforts, the disease still spreads insidiously. The main vector is the hematophagous bat, Desmodus rotundus. The present work aimed to create a predictive qualitative model of the occurrence of bovine rabies in each municipality in 25 of the 27 Brazilian States. The risk of rabies transmission from bats to bovine was estimated using decision-tree models of receptivity and vulnerability. Questionnaires, which covered a number of questions related to the surveillance of possible risk factors, such as bovine rabies outbreaks in the previous year, the presence of bat roosts, bat rabies positivity and environmental changes, were sent to the local veterinary units of each State. The bovine density and geomorphologic features were obtained from national databases and geographic information systems. Of the 433 municipalities presenting bovine rabies outbreaks in 2010, 178 (41.1%) were classified by the model as high risk, 212 (49.0%) were classified as moderate risk, 25 (5.8%) were classified as low risk, whereas the risk was undetermined in 18 municipalities (4.1%). An ROC curve was built to determine if the risk evaluated by the model could adequately discriminate between municipalities with and without rabies occurrence in future years. The risk estimator for the year 2011 was classified as moderately accurate. In the future, these models could allow the targeting of rabies control efforts, with the adoption of control measures directed to the higher risk locations and the optimization of the field veterinary staff deployment throughout the country. Additionally, efforts must be made to encourage continuous surveillance of risk factors.

  2. Predictive risk mapping of schistosomiasis in Brazil using Bayesian geostatistical models.

    PubMed

    Scholte, Ronaldo G C; Gosoniu, Laura; Malone, John B; Chammartin, Frédérique; Utzinger, Jürg; Vounatsou, Penelope

    2014-04-01

    Schistosomiasis is one of the most common parasitic diseases in tropical and subtropical areas, including Brazil. A national control programme was initiated in Brazil in the mid-1970s and proved successful in terms of morbidity control, as the number of cases with hepato-splenic involvement was reduced significantly. To consolidate control and move towards elimination, there is a need for reliable maps on the spatial distribution of schistosomiasis, so that interventions can target communities at highest risk. The purpose of this study was to map the distribution of Schistosoma mansoni in Brazil. We utilized readily available prevalence data from the national schistosomiasis control programme for the years 2005-2009, derived remotely sensed climatic and environmental data and obtained socioeconomic data from various sources. Data were collated into a geographical information system and Bayesian geostatistical models were developed. Model-based maps identified important risk factors related to the transmission of S. mansoni and confirmed that environmental variables are closely associated with indices of poverty. Our smoothed predictive risk map, including uncertainty, highlights priority areas for intervention, namely the northern parts of North and Southeast regions and the eastern part of Northeast region. Our predictive risk map provides a useful tool for to strengthen existing surveillance-response mechanisms. Copyright © 2014. Published by Elsevier B.V.

  3. Risk analysis and prediction of visceral leishmaniasis dispersion in São Paulo State, Brazil

    PubMed Central

    Mao, Liang; Galvis-Ovallos, Fredy; Tucker Lima, Joanna Marie; Valle, Denis

    2017-01-01

    Visceral leishmaniasis (VL) is an important neglected disease caused by a protozoan parasite, and represents a serious public health problem in many parts of the world. It is zoonotic in Europe and Latin America, where infected dogs constitute the main domestic reservoir for the parasite and play a key role in VL transmission to humans. In Brazil this disease is caused by the protozoan Leishmania infantum chagasi, and is transmitted by the sand fly Lutzomyia longipalpis. Despite programs aimed at eliminating infection sources, the disease continues to spread throughout the Country. VL in São Paulo State, Brazil, first appeared in the northwestern region, spreading in a southeasterly direction over time. We integrate data on the VL vector, infected dogs and infected human dispersion from 1999 to 2013 through an innovative spatial temporal Bayesian model in conjunction with geographic information system. This model is used to infer the drivers of the invasion process and predict the future progression of VL through the State. We found that vector dispersion was influenced by vector presence in nearby municipalities at the previous time step, proximity to the Bolívia-Brazil gas pipeline, and high temperatures (i.e., annual average between 20 and 23°C). Key factors affecting infected dog dispersion included proximity to the Marechal Rondon Highway, high temperatures, and presence of the competent vector within the same municipality. Finally, vector presence, presence of infected dogs, and rainfall (approx. 270 to 540mm/year) drove the dispersion of human VL cases. Surprisingly, economic factors exhibited no noticeable influence on disease dispersion. Based on these drivers and stochastic simulations, we identified which municipalities are most likely to be invaded by vectors and infected hosts in the future. Prioritizing prevention and control strategies within the identified municipalities may help halt the spread of VL while reducing monitoring costs. Our results

  4. Risk analysis and prediction of visceral leishmaniasis dispersion in São Paulo State, Brazil.

    PubMed

    Sevá, Anaiá da Paixão; Mao, Liang; Galvis-Ovallos, Fredy; Tucker Lima, Joanna Marie; Valle, Denis

    2017-02-01

    Visceral leishmaniasis (VL) is an important neglected disease caused by a protozoan parasite, and represents a serious public health problem in many parts of the world. It is zoonotic in Europe and Latin America, where infected dogs constitute the main domestic reservoir for the parasite and play a key role in VL transmission to humans. In Brazil this disease is caused by the protozoan Leishmania infantum chagasi, and is transmitted by the sand fly Lutzomyia longipalpis. Despite programs aimed at eliminating infection sources, the disease continues to spread throughout the Country. VL in São Paulo State, Brazil, first appeared in the northwestern region, spreading in a southeasterly direction over time. We integrate data on the VL vector, infected dogs and infected human dispersion from 1999 to 2013 through an innovative spatial temporal Bayesian model in conjunction with geographic information system. This model is used to infer the drivers of the invasion process and predict the future progression of VL through the State. We found that vector dispersion was influenced by vector presence in nearby municipalities at the previous time step, proximity to the Bolívia-Brazil gas pipeline, and high temperatures (i.e., annual average between 20 and 23°C). Key factors affecting infected dog dispersion included proximity to the Marechal Rondon Highway, high temperatures, and presence of the competent vector within the same municipality. Finally, vector presence, presence of infected dogs, and rainfall (approx. 270 to 540mm/year) drove the dispersion of human VL cases. Surprisingly, economic factors exhibited no noticeable influence on disease dispersion. Based on these drivers and stochastic simulations, we identified which municipalities are most likely to be invaded by vectors and infected hosts in the future. Prioritizing prevention and control strategies within the identified municipalities may help halt the spread of VL while reducing monitoring costs. Our results

  5. Chikungunya risk for Brazil

    PubMed Central

    Azevedo, Raimunda do Socorro da Silva; Oliveira, Consuelo Silva; Vasconcelos, Pedro Fernando da Costa

    2015-01-01

    This study aimed to show, based on the literature on the subject, the potential for dispersal and establishment of the chikungunya virus in Brazil. The chikungunya virus, a Togaviridae member of the genus Alphavirus, reached the Americas in 2013 and, the following year, more than a million cases were reported. In Brazil, indigenous transmission was registered in Amapa and Bahia States, even during the period of low rainfall, exposing the whole country to the risk of virus spreading. Brazil is historically infested by Ae. aegypti and Ae. albopictus, also dengue vectors. Chikungunya may spread, and it is important to take measures to prevent the virus from becoming endemic in the country. Adequate care for patients with chikungunya fever requires training general practitioners, rheumatologists, nurses, and experts in laboratory diagnosis. Up to November 2014, more than 1,000 cases of the virus were reported in Brazil. There is a need for experimental studies in animal models to understand the dynamics of infection and the pathogenesis as well as to identify pathophysiological mechanisms that may contribute to identifying effective drugs against the virus. Clinical trials are needed to identify the causal relationship between the virus and serious injuries observed in different organs and joints. In the absence of vaccines or effective drugs against the virus, currently the only way to prevent the disease is vector control, which will also reduce the number of cases of dengue fever. PMID:26398876

  6. Chikungunya risk for Brazil.

    PubMed

    Azevedo, Raimunda do Socorro da Silva; Oliveira, Consuelo Silva; Vasconcelos, Pedro Fernando da Costa

    2015-01-01

    This study aimed to show, based on the literature on the subject, the potential for dispersal and establishment of the chikungunya virus in Brazil. The chikungunya virus, a Togaviridae member of the genusAlphavirus, reached the Americas in 2013 and, the following year, more than a million cases were reported. In Brazil, indigenous transmission was registered in Amapa and Bahia States, even during the period of low rainfall, exposing the whole country to the risk of virus spreading. Brazil is historically infested by Ae. aegypti and Ae. albopictus, also dengue vectors. Chikungunya may spread, and it is important to take measures to prevent the virus from becoming endemic in the country. Adequate care for patients with chikungunya fever requires training general practitioners, rheumatologists, nurses, and experts in laboratory diagnosis. Up to November 2014, more than 1,000 cases of the virus were reported in Brazil. There is a need for experimental studies in animal models to understand the dynamics of infection and the pathogenesis as well as to identify pathophysiological mechanisms that may contribute to identifying effective drugs against the virus. Clinical trials are needed to identify the causal relationship between the virus and serious injuries observed in different organs and joints. In the absence of vaccines or effective drugs against the virus, currently the only way to prevent the disease is vector control, which will also reduce the number of cases of dengue fever.

  7. Accuracy of the Historical, Clinical and Risk Management Scales (HCR-20) in predicting violence and other offenses in forensic psychiatric patients in Brazil.

    PubMed

    Telles, Lisieux Elaine de Borba; Folino, Jorge Oscar; Taborda, José Geraldo Vernet

    2012-01-01

    Assessing the risk of violence is a complex task. In Latin America it is often based on clinical criteria that are not very objective or structured. HCR-20 has been used to increase the accuracy of this exam. The aim of this study was to examine the predictive validity of the Historical, Clinical and Risk Management Scales (HCR-20) violence risk assessment scale on a sample of Brazilian male forensic psychiatric inpatients. A concurrent prospective cohort design was used. The cohort was selected among the population of inpatients in Unit D (N=68) at Instituto Psiquiátrico Forense Mauricio Cardoso (IPF), Brazil. For the baseline assessment the following instruments: HCR-20-Assessing Risk for Violence, Version 2, and Hare Psychopathy Checklist, Revised (PCL-R) were used. During the one-year follow up, episodes of violent and/or anti-social behavior were assessed, and recorded on the Yudofsky's Overt Aggression Scale (OAS) and Tengström et al.'s Follow-Up Questionnaire. The accuracy of HCR-20 and PCL-R to predict violent and/or anti-social behavior was assessed. For the whole cohort, the mean total score of PCL-R was 13.54 and of HCR-20 it was 23.32. The rate of recidivism in the twelve month follow up was 73.5%. Outstanding among the risk factors explored for their predictive efficacy are scale HCR-20 and subscale H for any event, and scale HCR-20 for a violent event. The predictive efficacy of scales HCR-20 and PCL-R was greater for any antisocial event than for a violent event. By taking into account the possibility of recidivism and the probability of recidivism accumulated over time, instruments HCR-20 and PCL-R behaved as expected. In all these explorations, the instruments significantly differentiated the group of the sample that recidivated earlier. Copyright © 2012 Elsevier Ltd. All rights reserved.

  8. Melanoma risk prediction models.

    PubMed

    Nikolić, Jelena; Loncar-Turukalo, Tatjana; Sladojević, Srdan; Marinković, Marija; Janjić, Zlata

    2014-08-01

    The lack of effective therapy for advanced stages of melanoma emphasizes the importance of preventive measures and screenings of population at risk. Identifying individuals at high risk should allow targeted screenings and follow-up involving those who would benefit most. The aim of this study was to identify most significant factors for melanoma prediction in our population and to create prognostic models for identification and differentiation of individuals at risk. This case-control study included 697 participants (341 patients and 356 controls) that underwent extensive interview and skin examination in order to check risk factors for melanoma. Pairwise univariate statistical comparison was used for the coarse selection of the most significant risk factors. These factors were fed into logistic regression (LR) and alternating decision trees (ADT) prognostic models that were assessed for their usefulness in identification of patients at risk to develop melanoma. Validation of the LR model was done by Hosmer and Lemeshow test, whereas the ADT was validated by 10-fold cross-validation. The achieved sensitivity, specificity, accuracy and AUC for both models were calculated. The melanoma risk score (MRS) based on the outcome of the LR model was presented. The LR model showed that the following risk factors were associated with melanoma: sunbeds (OR = 4.018; 95% CI 1.724-9.366 for those that sometimes used sunbeds), solar damage of the skin (OR = 8.274; 95% CI 2.661-25.730 for those with severe solar damage), hair color (OR = 3.222; 95% CI 1.984-5.231 for light brown/blond hair), the number of common naevi (over 100 naevi had OR = 3.57; 95% CI 1.427-8.931), the number of dysplastic naevi (from 1 to 10 dysplastic naevi OR was 2.672; 95% CI 1.572-4.540; for more than 10 naevi OR was 6.487; 95%; CI 1.993-21.119), Fitzpatricks phototype and the presence of congenital naevi. Red hair, phototype I and large congenital naevi were only present in melanoma patients and thus

  9. Melanoma Risk Prediction Models

    Cancer.gov

    Developing statistical models that estimate the probability of developing melanoma cancer over a defined period of time will help clinicians identify individuals at higher risk of specific cancers, allowing for earlier or more frequent screening and counseling of behavioral changes to decrease risk.

  10. Cancer Risk Prediction and Assessment

    Cancer.gov

    Cancer prediction models provide an important approach to assessing risk and prognosis by identifying individuals at high risk, facilitating the design and planning of clinical cancer trials, fostering the development of benefit-risk indices, and enabling estimates of the population burden and cost of cancer.

  11. Shallow landslide prediction and analysis with risk assessment using a spatial model in a coastal region in the state of São Paulo, Brazil

    NASA Astrophysics Data System (ADS)

    Camarinha, P. I. M.; Canavesi, V.; Alvalá, R. C. S.

    2014-09-01

    This study presents a methodology for susceptibility mapping of shallow landslides just from data and software from the public domain. The study was conducted in a mountainous region located on the southeastern Brazilian coast, in the state of São Paulo. The proposal is that the methodology can be replicated in a practical and reliable way in several other municipalities that do not have such mappings and that often suffer from landslide-related disasters. The susceptibility mapping was generated based on the following maps: geological, soils, slope, horizontal and vertical curvatures, and land use. The thematic classes of these maps were weighted according to technical and scientific criteria related to the triggering of landslides, and were crossed by the fuzzy gamma technique. The mapping was compared with the risk sector survey made by the Brazilian Geological Survey (CPRM), which is the official database used by municipalities and civil defense in risk management. The results showed positive correlations, so that the critical risk sectors had higher proportions for the more susceptible classes. To compare the approach with other studies using landslide-scar maps, correlated indices were evaluated, which also showed satisfactory results, thus indicating that the methodology presented is appropriate for risk assessment in urban areas.

  12. Quantifying prognosis with risk predictions.

    PubMed

    Pace, Nathan L; Eberhart, Leopold H J; Kranke, Peter R

    2012-01-01

    Prognosis is a forecast, based on present observations in a patient, of their probable outcome from disease, surgery and so on. Research methods for the development of risk probabilities may not be familiar to some anaesthesiologists. We briefly describe methods for identifying risk factors and risk scores. A probability prediction rule assigns a risk probability to a patient for the occurrence of a specific event. Probability reflects the continuum between absolute certainty (Pi = 1) and certified impossibility (Pi = 0). Biomarkers and clinical covariates that modify risk are known as risk factors. The Pi as modified by risk factors can be estimated by identifying the risk factors and their weighting; these are usually obtained by stepwise logistic regression. The accuracy of probabilistic predictors can be separated into the concepts of 'overall performance', 'discrimination' and 'calibration'. Overall performance is the mathematical distance between predictions and outcomes. Discrimination is the ability of the predictor to rank order observations with different outcomes. Calibration is the correctness of prediction probabilities on an absolute scale. Statistical methods include the Brier score, coefficient of determination (Nagelkerke R2), C-statistic and regression calibration. External validation is the comparison of the actual outcomes to the predicted outcomes in a new and independent patient sample. External validation uses the statistical methods of overall performance, discrimination and calibration and is uniformly recommended before acceptance of the prediction model. Evidence from randomised controlled clinical trials should be obtained to show the effectiveness of risk scores for altering patient management and patient outcomes.

  13. Ecological risk assessment, prediction, and assessing risk predictions.

    PubMed

    Gibbs, Mark

    2011-11-01

    Ecological risk assessment embodied in an adaptive management framework is becoming the global standard approach for formally assessing and managing the ecological risks of technology and development. Ensuring the continual improvement of ecological risk assessment approaches is partly achieved through the dissemination of not only the types of risk assessment approaches used, but also their efficacy. While there is an increasing body of literature describing the results of general comparisons between alternate risk assessment methods and models, there is a paucity of literature that post hoc assesses the performance of specific predictions based on an assessment of risk and the effectiveness of the particular model used to predict the risk. This is especially the case where risk assessments have been used to grant consent or approval for the construction of major infrastructure projects. While postconstruction environmental monitoring is increasingly commonplace, it is not common for a postconstruction assessment of the accuracy and performance of the ecological risk assessment and underpinning model to be undertaken. Without this "assessment of the assessment," it is difficult for other practitioners to gain insight into the performance of the approach and models used and therefore, as argued here, this limits the rate of improvement of risk assessment approaches.

  14. Evaluating probabilistic dengue risk forecasts from a prototype early warning system for Brazil.

    PubMed

    Lowe, Rachel; Coelho, Caio As; Barcellos, Christovam; Carvalho, Marilia Sá; Catão, Rafael De Castro; Coelho, Giovanini E; Ramalho, Walter Massa; Bailey, Trevor C; Stephenson, David B; Rodó, Xavier

    2016-02-24

    Recently, a prototype dengue early warning system was developed to produce probabilistic forecasts of dengue risk three months ahead of the 2014 World Cup in Brazil. Here, we evaluate the categorical dengue forecasts across all microregions in Brazil, using dengue cases reported in June 2014 to validate the model. We also compare the forecast model framework to a null model, based on seasonal averages of previously observed dengue incidence. When considering the ability of the two models to predict high dengue risk across Brazil, the forecast model produced more hits and fewer missed events than the null model, with a hit rate of 57% for the forecast model compared to 33% for the null model. This early warning model framework may be useful to public health services, not only ahead of mass gatherings, but also before the peak dengue season each year, to control potentially explosive dengue epidemics.

  15. Neuroanatomy Predicts Individual Risk Attitudes

    PubMed Central

    Gilaie-Dotan, Sharon; Tymula, Agnieszka; Cooper, Nicole; Kable, Joseph W.; Glimcher, Paul W.

    2014-01-01

    Over the course of the last decade a multitude of studies have investigated the relationship between neural activations and individual human decision-making. Here we asked whether the anatomical features of individual human brains could be used to predict the fundamental preferences of human choosers. To that end, we quantified the risk attitudes of human decision-makers using standard economic tools and quantified the gray matter cortical volume in all brain areas using standard neurobiological tools. Our whole-brain analysis revealed that the gray matter volume of a region in the right posterior parietal cortex was significantly predictive of individual risk attitudes. Participants with higher gray matter volume in this region exhibited less risk aversion. To test the robustness of this finding we examined a second group of participants and used econometric tools to test the ex ante hypothesis that gray matter volume in this area predicts individual risk attitudes. Our finding was confirmed in this second group. Our results, while being silent about causal relationships, identify what might be considered the first stable biomarker for financial risk-attitude. If these results, gathered in a population of midlife northeast American adults, hold in the general population, they will provide constraints on the possible neural mechanisms underlying risk attitudes. The results will also provide a simple measurement of risk attitudes that could be easily extracted from abundance of existing medical brain scans, and could potentially provide a characteristic distribution of these attitudes for policy makers. PMID:25209279

  16. Developmental dyslexia: predicting individual risk.

    PubMed

    Thompson, Paul A; Hulme, Charles; Nash, Hannah M; Gooch, Debbie; Hayiou-Thomas, Emma; Snowling, Margaret J

    2015-09-01

    Causal theories of dyslexia suggest that it is a heritable disorder, which is the outcome of multiple risk factors. However, whether early screening for dyslexia is viable is not yet known. The study followed children at high risk of dyslexia from preschool through the early primary years assessing them from age 3 years and 6 months (T1) at approximately annual intervals on tasks tapping cognitive, language, and executive-motor skills. The children were recruited to three groups: children at family risk of dyslexia, children with concerns regarding speech, and language development at 3;06 years and controls considered to be typically developing. At 8 years, children were classified as 'dyslexic' or not. Logistic regression models were used to predict the individual risk of dyslexia and to investigate how risk factors accumulate to predict poor literacy outcomes. Family-risk status was a stronger predictor of dyslexia at 8 years than low language in preschool. Additional predictors in the preschool years include letter knowledge, phonological awareness, rapid automatized naming, and executive skills. At the time of school entry, language skills become significant predictors, and motor skills add a small but significant increase to the prediction probability. We present classification accuracy using different probability cutoffs for logistic regression models and ROC curves to highlight the accumulation of risk factors at the individual level. Dyslexia is the outcome of multiple risk factors and children with language difficulties at school entry are at high risk. Family history of dyslexia is a predictor of literacy outcome from the preschool years. However, screening does not reach an acceptable clinical level until close to school entry when letter knowledge, phonological awareness, and RAN, rather than family risk, together provide good sensitivity and specificity as a screening battery. © 2015 The Authors. Journal of Child Psychology and Psychiatry published by

  17. Developmental dyslexia: predicting individual risk

    PubMed Central

    Thompson, Paul A; Hulme, Charles; Nash, Hannah M; Gooch, Debbie; Hayiou-Thomas, Emma; Snowling, Margaret J

    2015-01-01

    Background Causal theories of dyslexia suggest that it is a heritable disorder, which is the outcome of multiple risk factors. However, whether early screening for dyslexia is viable is not yet known. Methods The study followed children at high risk of dyslexia from preschool through the early primary years assessing them from age 3 years and 6 months (T1) at approximately annual intervals on tasks tapping cognitive, language, and executive-motor skills. The children were recruited to three groups: children at family risk of dyslexia, children with concerns regarding speech, and language development at 3;06 years and controls considered to be typically developing. At 8 years, children were classified as ‘dyslexic’ or not. Logistic regression models were used to predict the individual risk of dyslexia and to investigate how risk factors accumulate to predict poor literacy outcomes. Results Family-risk status was a stronger predictor of dyslexia at 8 years than low language in preschool. Additional predictors in the preschool years include letter knowledge, phonological awareness, rapid automatized naming, and executive skills. At the time of school entry, language skills become significant predictors, and motor skills add a small but significant increase to the prediction probability. We present classification accuracy using different probability cutoffs for logistic regression models and ROC curves to highlight the accumulation of risk factors at the individual level. Conclusions Dyslexia is the outcome of multiple risk factors and children with language difficulties at school entry are at high risk. Family history of dyslexia is a predictor of literacy outcome from the preschool years. However, screening does not reach an acceptable clinical level until close to school entry when letter knowledge, phonological awareness, and RAN, rather than family risk, together provide good sensitivity and specificity as a screening battery. PMID:25832320

  18. Risk factors for hepatitis B transmission in South Brazil.

    PubMed

    Pereira, Vagner Reinaldo Zingalli Bueno; Wolf, Jonas Michel; Luz, Camila Albani da Silva; Stumm, Gláucia Zuleide; Boeira, Thais da Rocha; Galvan, Josiane; Simon, Daniel; Lunge, Vagner Ricardo

    2017-08-01

    Hepatitis B virus (HBV) infection is a major public health problem in Brazil. Several risk factors are involved in HBV infection and their identification by a rational and essential approach is required to prevent the transmission of this infection in Brazil. To evaluate risk factors associated with HBV infection in South Brazil. A total of 260 patients with HBV and 260 controls from Caxias do Sul (state of Rio Grande do Sul, Brazil) participated in this study. All participants were given a standard questionnaire to yield the sociodemographic information and to identify HBV risk factors. HBV infection was detected by HBsAg test in all participants. HBV infection in these cases was strongly associated with history of a family member HBV-infected, mainly mother [odds ratio (OR) = 4.86; 95% confidence intervals (CI): 1.69-13.91], father (OR = 5.28; 95% CI: 1.58-17.71), and/or siblings (OR = 22.16; 95% CI: 9.39-52.25); sharing personal objects (OR = 1.40; 95% CI: 1.37-2.38); and having history of blood transfusion (OR = 2.05; 95% CI: 1.10-2.84). HBV infection was strongly associated with having a family member infected with hepatitis B, sharing personal objects, and having history of blood transfusion.

  19. Evaluating probabilistic dengue risk forecasts from a prototype early warning system for Brazil

    PubMed Central

    Lowe, Rachel; Coelho, Caio AS; Barcellos, Christovam; Carvalho, Marilia Sá; Catão, Rafael De Castro; Coelho, Giovanini E; Ramalho, Walter Massa; Bailey, Trevor C; Stephenson, David B; Rodó, Xavier

    2016-01-01

    Recently, a prototype dengue early warning system was developed to produce probabilistic forecasts of dengue risk three months ahead of the 2014 World Cup in Brazil. Here, we evaluate the categorical dengue forecasts across all microregions in Brazil, using dengue cases reported in June 2014 to validate the model. We also compare the forecast model framework to a null model, based on seasonal averages of previously observed dengue incidence. When considering the ability of the two models to predict high dengue risk across Brazil, the forecast model produced more hits and fewer missed events than the null model, with a hit rate of 57% for the forecast model compared to 33% for the null model. This early warning model framework may be useful to public health services, not only ahead of mass gatherings, but also before the peak dengue season each year, to control potentially explosive dengue epidemics. DOI: http://dx.doi.org/10.7554/eLife.11285.001 PMID:26910315

  20. Youth Perspectives on Risk and Resiliency: A Case Study from Juiz De Fora, Brazil

    ERIC Educational Resources Information Center

    Morrison, Penelope; Nikolajski, Cara; Borrero, Sonya; Zickmund, Susan

    2014-01-01

    The present work seeks to contribute to studies of cross-cultural risk and resiliency by presenting results from qualitative research with adolescents attending programs for at-risk youth in Juiz de Fora, Brazil. In 1990, Brazil introduced the Child and Adolescent Act (ECA), a significant piece of legislation that has had a direct impact on how…

  1. Youth Perspectives on Risk and Resiliency: A Case Study from Juiz De Fora, Brazil

    ERIC Educational Resources Information Center

    Morrison, Penelope; Nikolajski, Cara; Borrero, Sonya; Zickmund, Susan

    2014-01-01

    The present work seeks to contribute to studies of cross-cultural risk and resiliency by presenting results from qualitative research with adolescents attending programs for at-risk youth in Juiz de Fora, Brazil. In 1990, Brazil introduced the Child and Adolescent Act (ECA), a significant piece of legislation that has had a direct impact on how…

  2. Gastrointestinal parasites of cats in Brazil: frequency and zoonotic risk.

    PubMed

    Monteiro, Maria Fernanda Melo; Ramos, Rafael Antonio Nascimento; Calado, Andréa Maria Campos; Lima, Victor Fernando Santana; Ramos, Ingrid Carla do Nascimento; Tenório, Rodrigo Ferreira Lima; Faustino, Maria Aparecida da Glória; Alves, Leucio Câmara

    2016-04-12

    Gastrointestinal helminths are considered to be the most common parasites affecting cats worldwide. Correct diagnosis of these parasites in animals living in urban areas is pivotal, especially considering the zoonotic potential of some species (e.g. Ancylostoma sp. and Toxocara sp.). In this study, a copromicroscopic survey was conducted using fecal samples (n = 173) from domestic cats living in the northeastern region of Brazil. Samples were examined through the FLOTAC technique and the overall results showed positivity of 65.31% (113/173) among the samples analyzed. Coinfections were observed in 46.01% (52/113) of the positive samples. The most common parasites detected were Ancylostoma sp., Toxocara cati, Strongyloides stercoralis, Trichuris sp., Dipylidium caninum and Cystoisospora sp. From an epidemiological point of view, these findings are important, especially considering that zoonotic parasites (e.g. Ancylostoma sp. and Toxocara sp.) were the nematodes most frequently diagnosed in this study. Therefore, the human population living in close contact with cats is at risk of infection caused by the zoonotic helminths of these animals. In addition, for the first time the FLOTAC has been used to diagnosing gastrointestinal parasites of cats in Brazil.

  3. Cervical Cancer Risk Prediction Models

    Cancer.gov

    Developing statistical models that estimate the probability of developing cervical cancer over a defined period of time will help clinicians identify individuals at higher risk of specific cancers, allowing for earlier or more frequent screening and counseling of behavioral changes to decrease risk.

  4. Developmental Dyslexia: Predicting Individual Risk

    ERIC Educational Resources Information Center

    Thompson, Paul A.; Hulme, Charles; Nash, Hannah M.; Gooch, Debbie; Hayiou-Thomas, Emma; Snowling, Margaret J.

    2015-01-01

    Background: Causal theories of dyslexia suggest that it is a heritable disorder, which is the outcome of multiple risk factors. However, whether early screening for dyslexia is viable is not yet known. Methods: The study followed children at high risk of dyslexia from preschool through the early primary years assessing them from age 3 years and 6…

  5. Developmental Dyslexia: Predicting Individual Risk

    ERIC Educational Resources Information Center

    Thompson, Paul A.; Hulme, Charles; Nash, Hannah M.; Gooch, Debbie; Hayiou-Thomas, Emma; Snowling, Margaret J.

    2015-01-01

    Background: Causal theories of dyslexia suggest that it is a heritable disorder, which is the outcome of multiple risk factors. However, whether early screening for dyslexia is viable is not yet known. Methods: The study followed children at high risk of dyslexia from preschool through the early primary years assessing them from age 3 years and 6…

  6. Prostate Cancer Risk Prediction Models

    Cancer.gov

    Developing statistical models that estimate the probability of developing prostate cancer over a defined period of time will help clinicians identify individuals at higher risk of specific cancers, allowing for earlier or more frequent screening and counseling of behavioral changes to decrease risk.

  7. Esophageal Cancer Risk Prediction Models

    Cancer.gov

    Developing statistical models that estimate the probability of developing esophageal cancer over a defined period of time will help clinicians identify individuals at higher risk of specific cancers, allowing for earlier or more frequent screening and counseling of behavioral changes to decrease risk.

  8. Liver Cancer Risk Prediction Models

    Cancer.gov

    Developing statistical models that estimate the probability of developing liver cancer over a defined period of time will help clinicians identify individuals at higher risk of specific cancers, allowing for earlier or more frequent screening and counseling of behavioral changes to decrease risk.

  9. Testicular Cancer Risk Prediction Models

    Cancer.gov

    Developing statistical models that estimate the probability of testicular cervical cancer over a defined period of time will help clinicians identify individuals at higher risk of specific cancers, allowing for earlier or more frequent screening and counseling of behavioral changes to decrease risk.

  10. Breast Cancer Risk Prediction Models

    Cancer.gov

    Developing statistical models that estimate the probability of developing breast cancer over a defined period of time will help clinicians identify individuals at higher risk of specific cancers, allowing for earlier or more frequent screening and counseling of behavioral changes to decrease risk.

  11. Bladder Cancer Risk Prediction Models

    Cancer.gov

    Developing statistical models that estimate the probability of developing bladder cancer over a defined period of time will help clinicians identify individuals at higher risk of specific cancers, allowing for earlier or more frequent screening and counseling of behavioral changes to decrease risk.

  12. Lung Cancer Risk Prediction Models

    Cancer.gov

    Developing statistical models that estimate the probability of developing lung cancer over a defined period of time will help clinicians identify individuals at higher risk of specific cancers, allowing for earlier or more frequent screening and counseling of behavioral changes to decrease risk.

  13. Colorectal Cancer Risk Prediction Models

    Cancer.gov

    Developing statistical models that estimate the probability of developing colorectal cancer over a defined period of time will help clinicians identify individuals at higher risk of specific cancers, allowing for earlier or more frequent screening and counseling of behavioral changes to decrease risk.

  14. Pancreatic Cancer Risk Prediction Models

    Cancer.gov

    Developing statistical models that estimate the probability of developing pancreatic cancer over a defined period of time will help clinicians identify individuals at higher risk of specific cancers, allowing for earlier or more frequent screening and counseling of behavioral changes to decrease risk.

  15. Ovarian Cancer Risk Prediction Models

    Cancer.gov

    Developing statistical models that estimate the probability of developing ovarian cancer over a defined period of time will help clinicians identify individuals at higher risk of specific cancers, allowing for earlier or more frequent screening and counseling of behavioral changes to decrease risk.

  16. Family Factors Predicting Categories of Suicide Risk

    ERIC Educational Resources Information Center

    Randell, Brooke P.; Wang, Wen-Ling; Herting, Jerald R.; Eggert, Leona L.

    2006-01-01

    We compared family risk and protective factors among potential high school dropouts with and without suicide-risk behaviors (SRB) and examined the extent to which these factors predict categories of SRB. Subjects were randomly selected from among potential dropouts in 14 high schools. Based upon suicide-risk status, 1,083 potential high school…

  17. Prediction of fracture risk. II: Other risk factors.

    PubMed

    Ross, P D

    1996-12-01

    Many osteoporotic fractures are probably preventable-by definition, prevention requires identification of those at risk prior to fracture. There is a continuum in fracture risk and a very wide range in risk among individuals. Bone density, previous fractures, and the frequency and types of falls are important risk factors for fractures. There are also many other risk factors for bone loss, falls, and fractures. People with multiple risk factors are at greater risk than those with either a single risk factor or none. Identification of risk factors can help when planning interventions. For example, dietary deficiencies are amenable to dietary modification or supplementation; however, the effects of many risk factors have not been quantified separately, making it difficult to determine the importance. In addition, it is not possible to accurately predict current bone density and fracture risk from risk factors for bone loss; bone density should always be measured directly.

  18. Risk and the physics of clinical prediction.

    PubMed

    McEvoy, John W; Diamond, George A; Detrano, Robert C; Kaul, Sanjay; Blaha, Michael J; Blumenthal, Roger S; Jones, Steven R

    2014-04-15

    The current paradigm of primary prevention in cardiology uses traditional risk factors to estimate future cardiovascular risk. These risk estimates are based on prediction models derived from prospective cohort studies and are incorporated into guideline-based initiation algorithms for commonly used preventive pharmacologic treatments, such as aspirin and statins. However, risk estimates are more accurate for populations of similar patients than they are for any individual patient. It may be hazardous to presume that the point estimate of risk derived from a population model represents the most accurate estimate for a given patient. In this review, we exploit principles derived from physics as a metaphor for the distinction between predictions regarding populations versus patients. We identify the following: (1) predictions of risk are accurate at the level of populations but do not translate directly to patients, (2) perfect accuracy of individual risk estimation is unobtainable even with the addition of multiple novel risk factors, and (3) direct measurement of subclinical disease (screening) affords far greater certainty regarding the personalized treatment of patients, whereas risk estimates often remain uncertain for patients. In conclusion, shifting our focus from prediction of events to detection of disease could improve personalized decision-making and outcomes. We also discuss innovative future strategies for risk estimation and treatment allocation in preventive cardiology. Copyright © 2014 Elsevier Inc. All rights reserved.

  19. Prevalence and risk factors related to preterm birth in Brazil.

    PubMed

    Leal, Maria do Carmo; Esteves-Pereira, Ana Paula; Nakamura-Pereira, Marcos; Torres, Jacqueline Alves; Theme-Filha, Mariza; Domingues, Rosa Maria Soares Madeira; Dias, Marcos Augusto Bastos; Moreira, Maria Elizabeth; Gama, Silvana Granado

    2016-10-17

    The rate of preterm birth has been increasing worldwide, including in Brazil. This constitutes a significant public health challenge because of the higher levels of morbidity and mortality and long-term health effects associated with preterm birth. This study describes and quantifies factors affecting spontaneous and provider-initiated preterm birth in Brazil. Data are from the 2011-2012 "Birth in Brazil" study, which used a national population-based sample of 23,940 women. We analyzed the variables following a three-level hierarchical methodology. For each level, we performed non-conditional multiple logistic regression for both spontaneous and provider-initiated preterm birth. The rate of preterm birth was 11.5 %, (95 % confidence 10.3 % to 12.9 %) 60.7 % spontaneous - with spontaneous onset of labor or premature preterm rupture of membranes - and 39.3 % provider-initiated, with more than 90 % of the last group being pre-labor cesarean deliveries. Socio-demographic factors associated with spontaneous preterm birth were adolescent pregnancy, low total years of schooling, and inadequate prenatal care. Other risk factors were previous preterm birth (OR 3.74; 95 % CI 2.92-4.79), multiple pregnancy (OR 16.42; 95 % CI 10.56-25.53), abruptio placentae (OR 2.38; 95 % CI 1.27-4.47) and infections (OR 4.89; 95 % CI 1.72-13.88). In contrast, provider-initiated preterm birth was associated with private childbirth healthcare (OR 1.47; 95 % CI 1.09-1.97), advanced-age pregnancy (OR 1.27; 95 % CI 1.01-1.59), two or more prior cesarean deliveries (OR 1.64; 95 % CI 1.19-2.26), multiple pregnancy (OR 20.29; 95 % CI 12.58-32.72) and any maternal or fetal pathology (OR 6.84; 95 % CI 5.56-8.42). The high proportion of provider-initiated preterm birth and its association with prior cesarean deliveries and all of the studied maternal/fetal pathologies suggest that a reduction of this type of prematurity may be possible. The association of spontaneous preterm birth with

  20. Trends and predictions for gastric cancer mortality in Brazil

    PubMed Central

    de Souza Giusti, Angela Carolina Brandão; de Oliveira Salvador, Pétala Tuani Candido; dos Santos, Juliano; Meira, Karina Cardoso; Camacho, Amanda Rodrigues; Guimarães, Raphael Mendonça; Souza, Dyego L B

    2016-01-01

    AIM: To analyze the effect of age-period and birth cohort on gastric cancer mortality, in Brazil and across its five geographic regions, by sex, in the population over 20 years of age, as well as make projections for the period 2010-2029. METHODS: An ecological study is presented herein, which distributed gastric cancer-related deaths in Brazil and its geographic regions. The effects of age-period and birth cohort were calculated by the Poisson regression model and projections were made with the age-period-cohort model in the statistical program R. RESULTS: Progressive reduction of mortality rates was observed in the 1980’s, and then higher and lower mortality rates were verified in the 2000’s, for both sexes, in Brazil and for the South, Southeast and Midwest regions. A progressive decrease in mortality rates was observed for the Northeast (both sexes) and North (men only) regions within the period 1995-1999, followed by rising rates. CONCLUSION: Regional differences were demonstrated in the mortality rates for gastric cancer in Brazil, and the least developed regions of the country will present increases in projected mortality rates. PMID:27605887

  1. Trends and predictions for gastric cancer mortality in Brazil.

    PubMed

    de Souza Giusti, Angela Carolina Brandão; de Oliveira Salvador, Pétala Tuani Candido; Dos Santos, Juliano; Meira, Karina Cardoso; Camacho, Amanda Rodrigues; Guimarães, Raphael Mendonça; Souza, Dyego L B

    2016-07-28

    To analyze the effect of age-period and birth cohort on gastric cancer mortality, in Brazil and across its five geographic regions, by sex, in the population over 20 years of age, as well as make projections for the period 2010-2029. An ecological study is presented herein, which distributed gastric cancer-related deaths in Brazil and its geographic regions. The effects of age-period and birth cohort were calculated by the Poisson regression model and projections were made with the age-period-cohort model in the statistical program R. Progressive reduction of mortality rates was observed in the 1980's, and then higher and lower mortality rates were verified in the 2000's, for both sexes, in Brazil and for the South, Southeast and Midwest regions. A progressive decrease in mortality rates was observed for the Northeast (both sexes) and North (men only) regions within the period 1995-1999, followed by rising rates. Regional differences were demonstrated in the mortality rates for gastric cancer in Brazil, and the least developed regions of the country will present increases in projected mortality rates.

  2. Risk analysis for occurrences of schistosomiasis in the coastal area of Porto de Galinhas, Pernambuco, Brazil

    PubMed Central

    2014-01-01

    Background Manson’s schistosomiasis continues to be a severe public health problem in Brazil, where thousands of people live under the risk of contracting this parasitosis. In the Northeast of Brazil, schistosomiasis has expanded from rural areas to the coast of Pernambuco State, where the intermediate host is Biomphalaria glabrata snails. This study aims at presenting situational analyses on schistosomiasis at the coastal locality of Porto de Galinhas, Pernambuco, Brazil, by determining the risk factors relating to its occurrence from the epidemiological and spatial perspectives. Methods In order to gather prevalence data, a parasitological census surveys were conducted in 2010 in the light of the Kato-Katz technique. Furthermore, malacological surveys were also conducted in the same years so as to define the density and infection rates of the intermediate host. Lastly, socioeconomic-behavioral survey was also conducted to determine the odds ratio for infection by Schistosoma mansoni. Based on these data, spatial analyses were done, resulting in maps of the risk of disease transmission. To predict the risk of schistosomiasis occurrence, a multivariate logistic regression was performed using R 2.13 software. Results Based on prevalence, malacological and socioeconomic-behavioural surveys, it was identified a prevalence of 15.7% in the investigated population (2,757 individuals). Due to the malacological survey, 36 breeding sites were identified, of which 11 were classified as foci of schistosomiasis transmission since they pointed out snails which were infected by Schistosoma mansoni. Overall, 11,012 snails (Biomphalaria glabrata) were collected. The multivariate regression model identified six explanatory variables of environmental, socioeconomic and demographic nature. Spatial sweep analysis by means of the Bernoulli method identified one statistically significant cluster in Salinas (RR = 2.2; p-value < 0.000), the district with the highest occurrence

  3. Calibrated predictions for multivariate competing risks models.

    PubMed

    Gorfine, Malka; Hsu, Li; Zucker, David M; Parmigiani, Giovanni

    2014-04-01

    Prediction models for time-to-event data play a prominent role in assessing the individual risk of a disease, such as cancer. Accurate disease prediction models provide an efficient tool for identifying individuals at high risk, and provide the groundwork for estimating the population burden and cost of disease and for developing patient care guidelines. We focus on risk prediction of a disease in which family history is an important risk factor that reflects inherited genetic susceptibility, shared environment, and common behavior patterns. In this work family history is accommodated using frailty models, with the main novel feature being allowing for competing risks, such as other diseases or mortality. We show through a simulation study that naively treating competing risks as independent right censoring events results in non-calibrated predictions, with the expected number of events overestimated. Discrimination performance is not affected by ignoring competing risks. Our proposed prediction methodologies correctly account for competing events, are very well calibrated, and easy to implement.

  4. Overview of entry risk predictions

    NASA Astrophysics Data System (ADS)

    Mrozinski, R.; Mendeck, G.; Cutri-Kohart, R.

    Risk to people on the ground from uncontrolled entries of spacecraft is a primary concern when analyzing end-of-life disposal options for satellites. Countries must balance this risk with the need to mitigate an exponentially growing space debris population. Currently the United States does this via guidelines that call for a satellite to be disposed of in a controlled manner if an uncontrolled entry would be too risky to people on the ground. This risk is measured by a quantity called "casualty expectation", or E , where casualty expectation is defined as the expectedc number of people suffering death or injury due to a spacecraft entry event. If Ec exceeds 1 in 10,000, U. S. guidelines state that the entry should be controlled rather than uncontrolled. Since this guideline can have serious impacts on the cost, lifetime, and even the mission and functionality of a satellite, it is critical that this quantity be estimated well, and decision makers understand all assumptions and limitations inherent in the resulting value. This paper discusses several issues regarding estimates of casualty expectation, beginning with an overview of relevant United States policies and guidelines. The equation the space industry typically uses to estimate casualty expectation is presented, along with a look at the sensitivity of the results to the typical assumptions, models, and initial condition uncertainties. Differences in these modeling issues with respect to launch failure Ec estimates are included in the discussion. An alternate quantity to assess risks due to spacecraft entries is introduced. "Probability of casualty", or Pc , is defined as the probability of one or more instances of people suffering death or injury due to a spacecraft entry event. The equation to estimate Pc is derived, where the same assumptions, modeling, and initial condition issues for Ec apply. Several examples are then given of both Ec and Pc estimate calculations. Due to the difficult issues in

  5. Predictive risk models for proximal aortic surgery

    PubMed Central

    Díaz, Rocío; Pascual, Isaac; Álvarez, Rubén; Alperi, Alberto; Rozado, Jose; Morales, Carlos; Silva, Jacobo; Morís, César

    2017-01-01

    Predictive risk models help improve decision making, information to our patients and quality control comparing results between surgeons and between institutions. The use of these models promotes competitiveness and led to increasingly better results. All these virtues are of utmost importance when the surgical operation entails high-risk. Although proximal aortic surgery is less frequent than other cardiac surgery operations, this procedure itself is more challenging and technically demanding than other common cardiac surgery techniques. The aim of this study is to review the current status of predictive risk models for patients who undergo proximal aortic surgery, which means aortic root replacement, supracoronary ascending aortic replacement or aortic arch surgery. PMID:28616348

  6. Predictive risk models for proximal aortic surgery.

    PubMed

    Hernandez-Vaquero, Daniel; Díaz, Rocío; Pascual, Isaac; Álvarez, Rubén; Alperi, Alberto; Rozado, Jose; Morales, Carlos; Silva, Jacobo; Morís, César

    2017-05-01

    Predictive risk models help improve decision making, information to our patients and quality control comparing results between surgeons and between institutions. The use of these models promotes competitiveness and led to increasingly better results. All these virtues are of utmost importance when the surgical operation entails high-risk. Although proximal aortic surgery is less frequent than other cardiac surgery operations, this procedure itself is more challenging and technically demanding than other common cardiac surgery techniques. The aim of this study is to review the current status of predictive risk models for patients who undergo proximal aortic surgery, which means aortic root replacement, supracoronary ascending aortic replacement or aortic arch surgery.

  7. Risk terrain modeling predicts child maltreatment.

    PubMed

    Daley, Dyann; Bachmann, Michael; Bachmann, Brittany A; Pedigo, Christian; Bui, Minh-Thuy; Coffman, Jamye

    2016-12-01

    As indicated by research on the long-term effects of adverse childhood experiences (ACEs), maltreatment has far-reaching consequences for affected children. Effective prevention measures have been elusive, partly due to difficulty in identifying vulnerable children before they are harmed. This study employs Risk Terrain Modeling (RTM), an analysis of the cumulative effect of environmental factors thought to be conducive for child maltreatment, to create a highly accurate prediction model for future substantiated child maltreatment cases in the City of Fort Worth, Texas. The model is superior to commonly used hotspot predictions and more beneficial in aiding prevention efforts in a number of ways: 1) it identifies the highest risk areas for future instances of child maltreatment with improved precision and accuracy; 2) it aids the prioritization of risk-mitigating efforts by informing about the relative importance of the most significant contributing risk factors; 3) since predictions are modeled as a function of easily obtainable data, practitioners do not have to undergo the difficult process of obtaining official child maltreatment data to apply it; 4) the inclusion of a multitude of environmental risk factors creates a more robust model with higher predictive validity; and, 5) the model does not rely on a retrospective examination of past instances of child maltreatment, but adapts predictions to changing environmental conditions. The present study introduces and examines the predictive power of this new tool to aid prevention efforts seeking to improve the safety, health, and wellbeing of vulnerable children.

  8. A comprehensive quantitative assessment of bird extinction risk in Brazil.

    PubMed

    Machado, Nathália; Loyola, Rafael Dias

    2013-01-01

    In an effort to avoid species loss, scientists have focused their efforts on the mechanisms making some species more prone to extinction than others. However, species show different responses to threats given their evolutionary history, behavior, and intrinsic biological features. We used bird biological features and external threats to (1) understand the multiple pathways driving Brazilian bird species to extinction, (2) to investigate if and how extinction risk is geographically structured, and (3) to quantify how much diversity is currently represented inside protected areas. We modeled the extinction risk of 1557 birds using classification trees and evaluated the relative contribution of each biological feature and external threat in predicting extinction risk. We also quantified the proportion of species and their geographic range currently protected by the network of Brazilian protected areas. The optimal classification tree showed different pathways to bird extinction. Habitat conversion was the most important predictor driving extinction risk though other variables, such as geographic range size, type of habitat, hunting or trapping and trophic guild, were also relevant in our models. Species under higher extinction risk were concentrated mainly in the Cerrado Biodiversity Hotspot and were not quite represented inside protected areas, neither in richness nor range. Predictive models could assist conservation actions, and this study could contribute by highlighting the importance of natural history and ecology in these actions.

  9. A Comprehensive Quantitative Assessment of Bird Extinction Risk in Brazil

    PubMed Central

    Machado, Nathália; Loyola, Rafael Dias

    2013-01-01

    In an effort to avoid species loss, scientists have focused their efforts on the mechanisms making some species more prone to extinction than others. However, species show different responses to threats given their evolutionary history, behavior, and intrinsic biological features. We used bird biological features and external threats to (1) understand the multiple pathways driving Brazilian bird species to extinction, (2) to investigate if and how extinction risk is geographically structured, and (3) to quantify how much diversity is currently represented inside protected areas. We modeled the extinction risk of 1557 birds using classification trees and evaluated the relative contribution of each biological feature and external threat in predicting extinction risk. We also quantified the proportion of species and their geographic range currently protected by the network of Brazilian protected areas. The optimal classification tree showed different pathways to bird extinction. Habitat conversion was the most important predictor driving extinction risk though other variables, such as geographic range size, type of habitat, hunting or trapping and trophic guild, were also relevant in our models. Species under higher extinction risk were concentrated mainly in the Cerrado Biodiversity Hotspot and were not quite represented inside protected areas, neither in richness nor range. Predictive models could assist conservation actions, and this study could contribute by highlighting the importance of natural history and ecology in these actions. PMID:23951302

  10. Landscape, Environmental and Social Predictors of Hantavirus Risk in São Paulo, Brazil

    PubMed Central

    Uriarte, Maria; Tambosi, Leandro Reverberi; Prado, Amanda; Pardini, Renata; D´Andrea, Paulo Sérgio; Metzger, Jean Paul

    2016-01-01

    Hantavirus Pulmonary Syndrome (HPS) is a disease caused by Hantavirus, which are negative-sense RNA viruses in the family Bunyaviridae that are highly virulent to humans. Numerous factors modify risk of Hantavirus transmission and consequent HPS risk. Human-driven landscape change can foster transmission risk by increasing numbers of habitat generalist rodent species that serve as the principal reservoir host. Climate can also affect rodent population dynamics and Hantavirus survival, and a number of social factors can influence probability of HPS transmission to humans. Evaluating contributions of these factors to HPS risk may enable predictions of future outbreaks, and is critical to development of effective public health strategies. Here we rely on a Bayesian model to quantify associations between annual HPS incidence across the state of São Paulo, Brazil (1993–2012) and climate variables (annual precipitation, annual mean temperature), landscape structure metrics (proportion of native habitat cover, number of forest fragments, proportion of area planted with sugarcane), and social factors (number of men older than 14 years and Human Development Index). We built separate models for the main two biomes of the state (cerrado and Atlantic forest). In both biomes Hantavirus risk increased with proportion of land cultivated for sugarcane and HDI, but proportion of forest cover, annual mean temperature, and population at risk also showed positive relationships in the Atlantic forest. Our analysis provides the first evidence that social, landscape, and climate factors are associated with HPS incidence in the Neotropics. Our risk map can be used to support the adoption of preventive measures and optimize the allocation of resources to avoid disease propagation, especially in municipalities that show medium to high HPS risk (> 5% of risk), and aimed at sugarcane workers, minimizing the risk of future HPS outbreaks. PMID:27780250

  11. Cardiovascular Risk in Men Aged Over 40 in Boa Vista, Brazil

    PubMed Central

    de Lima Junior, Mário Maciel; Bezerra, Emanuel Araújo; Ticianeli, José Geraldo

    2016-01-01

    Background: Cardiovascular disease is the most common cause of disease in the developed world. Early detection and risk prediction are a key component in reducing cardiovascular mortality. The Framingham Risk Score uses age, sex, cholesterol, blood pressure, diabetes, and smoking to calculate the 10-year risk probability of developing cardiovascular disease for a given patient. The aim of this study was to examine cardiovascular disease risk in men aged over 40 years in Boa Vista, Brazil and identify socioeconomic factors contributing to the risk. Methods: This was an epidemiological, cross-sectional, descriptive study. Physical examination and questionnaire survey were conducted on the participants. Results: Of the 598 participants (average age = 55.38 ± 10.77 years), 346 completed all the examinations and answered the survey, while 252 completed the survey and the physical examinations but did not undertake the laboratory tests. A large proportion of participants were overweight (42.6%) or obese (23.6%), 14.5% were hypertensive, and 71.9% were prehypertensive. Consumption of red meat and junk food was high, while participation in the exercise was low. Framingham scores ranged from −3 to 13 (mean score: 3.86 ± 3.16). A total of 204 participants (34.1%) had a low risk of cardiovascular disease, 98 (16.4%) had a medium risk, and 44 (7.4%) possessed high risk. Increased abdominal circumference (P = 0.013), resting pulse (P = 0.002), and prostate-specific antigen levels (P < 0.001) were associated with increased risk of cardiovascular disease. Conclusions: Our study highlights a worrying trend in increasing obesity and hypertension, most likely associated with increasingly poor diet and reduced participation in exercises. As the Brazilian population ages, this will drive increasing rates of cardiovascular mortality unless these trends are reversed. This study suggests that such campaigns should focus on men over the age of 40, who are married or divorced and of

  12. Cardiovascular Risk in Men Aged Over 40 in Boa Vista, Brazil.

    PubMed

    de Lima Junior, Mário Maciel; Bezerra, Emanuel Araújo; Ticianeli, José Geraldo

    2016-01-01

    Cardiovascular disease is the most common cause of disease in the developed world. Early detection and risk prediction are a key component in reducing cardiovascular mortality. The Framingham Risk Score uses age, sex, cholesterol, blood pressure, diabetes, and smoking to calculate the 10-year risk probability of developing cardiovascular disease for a given patient. The aim of this study was to examine cardiovascular disease risk in men aged over 40 years in Boa Vista, Brazil and identify socioeconomic factors contributing to the risk. This was an epidemiological, cross-sectional, descriptive study. Physical examination and questionnaire survey were conducted on the participants. Of the 598 participants (average age = 55.38 ± 10.77 years), 346 completed all the examinations and answered the survey, while 252 completed the survey and the physical examinations but did not undertake the laboratory tests. A large proportion of participants were overweight (42.6%) or obese (23.6%), 14.5% were hypertensive, and 71.9% were prehypertensive. Consumption of red meat and junk food was high, while participation in the exercise was low. Framingham scores ranged from -3 to 13 (mean score: 3.86 ± 3.16). A total of 204 participants (34.1%) had a low risk of cardiovascular disease, 98 (16.4%) had a medium risk, and 44 (7.4%) possessed high risk. Increased abdominal circumference (P = 0.013), resting pulse (P = 0.002), and prostate-specific antigen levels (P < 0.001) were associated with increased risk of cardiovascular disease. Our study highlights a worrying trend in increasing obesity and hypertension, most likely associated with increasingly poor diet and reduced participation in exercises. As the Brazilian population ages, this will drive increasing rates of cardiovascular mortality unless these trends are reversed. This study suggests that such campaigns should focus on men over the age of 40, who are married or divorced and of lower income.

  13. Composite risk scores for predicting dementia.

    PubMed

    Stephan, Blossom C M; Tang, Eugene; Muniz-Terrera, Graciela

    2016-03-01

    A key priority in dementia research is the development of tools to identify individuals at high risk of dementia. This is important to prevent or delay dementia onset and as we move towards personalized medicine. Numerous models (n > 50) for predicting dementia have been developed. These vary in the number (0 to 20+) and type (e.g. demographics, health, neuropsychological, and genetic) of predictor variables used for risk calculation, follow-up length (1-20 years) and age at screening (mid vs laterlife). Evaluation of the models shows that most have moderate-to-poor predictive accuracy. Few have been externally validated, raising questions about their generalizability outside the cohorts from which they were developed. The results highlight that if additional models are proposed the field will be overwhelmed with many competing risk models, making it difficult to reach consensus on which is best. Numerous models for predicting dementia have been proposed but are limited by a lack of external validation and evaluation of economic impact. Innovative methods and data designs may be needed to improve derivation of dementia risk scores. Having a method for predicting dementia risk could transform medical research and allow for earlier testing of intervention strategies.

  14. Global Potential Distribution of Bactrocera carambolae and the Risks for Fruit Production in Brazil.

    PubMed

    Marchioro, Cesar A

    2016-01-01

    The carambola fruit fly, Bactrocera carambolae, is a tephritid native to Asia that has invaded South America through small-scale trade of fruits from Indonesia. The economic losses associated with biological invasions of other fruit flies around the world and the polyphagous behaviour of B. carambolae have prompted much concern among government agencies and farmers with the potential spread of this pest. Here, ecological niche models were employed to identify suitable environments available to B. carambolae in a global scale and assess the extent of the fruit acreage that may be at risk of attack in Brazil. Overall, 30 MaxEnt models built with different combinations of environmental predictors and settings were evaluated for predicting the potential distribution of the carambola fruit fly. The best model was selected based on threshold-independent and threshold-dependent metrics. Climatically suitable areas were identified in tropical and subtropical regions of Central and South America, Sub-Saharan Africa, west and east coast of India and northern Australia. The suitability map of B. carambola was intersected against maps of fruit acreage in Brazil. The acreage under potential risk of attack varied widely among fruit species, which is expected because the production areas are concentrated in different regions of the country. The production of cashew is the one that is at higher risk, with almost 90% of its acreage within the suitable range of B. carambolae, followed by papaya (78%), tangerine (51%), guava (38%), lemon (30%), orange (29%), mango (24%) and avocado (20%). This study provides an important contribution to the knowledge of the ecology of B. carambolae, and the information generated here can be used by government agencies as a decision-making tool to prevent the carambola fruit fly spread across the world.

  15. Risk of Dengue for Tourists and Teams during the World Cup 2014 in Brazil

    PubMed Central

    van Panhuis, Willem G.; Hyun, Sangwon; Blaney, Kayleigh; Marques, Ernesto T. A.; Coelho, Giovanini E.; Siqueira, João Bosco; Tibshirani, Ryan; da Silva, Jarbas B.; Rosenfeld, Roni

    2014-01-01

    Abstract Background This year, Brazil will host about 600,000 foreign visitors during the 2014 FIFA World Cup. The concern of possible dengue transmission during this event has been raised given the high transmission rates reported in the past by this country. Methodology/Principal Findings We used dengue incidence rates reported by each host city during previous years (2001–2013) to estimate the risk of dengue during the World Cup for tourists and teams. Two statistical models were used: a percentile rank (PR) and an Empirical Bayes (EB) model. Expected IR's during the games were generally low (<10/100,000) but predictions varied across locations and between models. Based on current ticket allocations, the mean number of expected symptomatic dengue cases ranged from 26 (PR, 10th–100th percentile: 5–334 cases) to 59 (EB, 95% credible interval: 30–77 cases) among foreign tourists but none are expected among teams. These numbers will highly depend on actual travel schedules and dengue immunity among visitors. Sensitivity analysis for both models indicated that the expected number of cases could be as low as 4 or 5 with 100,000 visitors and as high as 38 or 70 with 800,000 visitors (PR and EB, respectively). Conclusion/Significance The risk of dengue among tourists during the World Cup is expected to be small due to immunity among the Brazil host population provided by last year's epidemic with the same DENV serotypes. Quantitative risk estimates by different groups and methodologies should be made routinely for mass gathering events. PMID:25079960

  16. Global Potential Distribution of Bactrocera carambolae and the Risks for Fruit Production in Brazil

    PubMed Central

    Marchioro, Cesar A.

    2016-01-01

    The carambola fruit fly, Bactrocera carambolae, is a tephritid native to Asia that has invaded South America through small-scale trade of fruits from Indonesia. The economic losses associated with biological invasions of other fruit flies around the world and the polyphagous behaviour of B. carambolae have prompted much concern among government agencies and farmers with the potential spread of this pest. Here, ecological niche models were employed to identify suitable environments available to B. carambolae in a global scale and assess the extent of the fruit acreage that may be at risk of attack in Brazil. Overall, 30 MaxEnt models built with different combinations of environmental predictors and settings were evaluated for predicting the potential distribution of the carambola fruit fly. The best model was selected based on threshold-independent and threshold-dependent metrics. Climatically suitable areas were identified in tropical and subtropical regions of Central and South America, Sub-Saharan Africa, west and east coast of India and northern Australia. The suitability map of B. carambola was intersected against maps of fruit acreage in Brazil. The acreage under potential risk of attack varied widely among fruit species, which is expected because the production areas are concentrated in different regions of the country. The production of cashew is the one that is at higher risk, with almost 90% of its acreage within the suitable range of B. carambolae, followed by papaya (78%), tangerine (51%), guava (38%), lemon (30%), orange (29%), mango (24%) and avocado (20%). This study provides an important contribution to the knowledge of the ecology of B. carambolae, and the information generated here can be used by government agencies as a decision-making tool to prevent the carambola fruit fly spread across the world. PMID:27832144

  17. Mortality Risk After Cardiac Surgery: Application of Inscor in a University Hospital in Brazil's Northeast

    PubMed Central

    Fortes, João Vyctor Silva; Silva, Mayara Gabrielle Barbosa e; Baldez, Thiago Eduardo Pereira; Costa, Marina de Albuquerque Gonçalves; da Silva, Luan Nascimento; Pinheiro, Renata Silva; Fecks, Zullma Sampaio; Borges, Daniel Lago

    2016-01-01

    Objective To apply the InsCor in patients undergoing cardiac surgery in a university hospital in Brazil's northeast. Methods It is a retrospective, quantitative and analytical study, carried out at the University Hospital of the Federal University of Maranhão. InsCor is a remodeling of two risk score models. It evaluates the prediction of mortality through variables such as gender, age, type of surgery or reoperation, exams, and preoperative events. Data from January to December 2015 were collected, using a Physical Therapy Evaluation Form and medical records. Quantitative variables were expressed as mean and standard deviation and qualitative variables as absolute and relative frequencies. Fisher's exact and Kruskal-Wallis tests were applied, considering significant differences when P value was < 0.05. Calibration was performed by Hosmer-Lemeshow test. Results One hundred and forty-eight patients were included. Thirty-six percent were female, with mean age of 54.7±15.8 years and mean body mass index (BMI) equal to 25.6 kg/m2. The most frequent surgery was coronary artery bypass grafting (51.3%). According to InsCor, 73.6% of the patients had low risk, 20.3% medium risk, and only 6.1% high risk. In this sample, 11 (7.4%) patients died. The percentage of death in patients classified as low, medium and high risk was 6.3, 7.1% and 11.1%, respectively. Conclusion InsCor presented easy applicability due to the reduced number of variables analyzed and it showed satisfactory prediction of mortality in this sample of cardiac surgery patients. PMID:27982349

  18. Crime and violence in Brazil: Systematic review of time trends, prevalence rates and risk factors☆

    PubMed Central

    Murray, Joseph; Cerqueira, Daniel Ricardo de Castro; Kahn, Tulio

    2013-01-01

    Between 1980 and 2010 there were 1 million homicides in Brazil. Dramatic increases in homicide rates followed rises in inequality, more young men in the population, greater availability of firearms, and increased drug use. Nevertheless, disarmament legislation may have helped reduce homicide rates in recent years. Despite its very high rate of lethal violence, Brazil appears to have similar levels of general criminal victimization as several other Latin American and North American countries. Brazil has lower rates of drug use compared to other countries such as the United States, but the prevalence of youth drug use in Brazil has increased substantially in recent years. Since 1990, the growth of the Brazilian prison population has been enormous, resulting in the fourth largest prison population in the world. Through a systematic review of the literature, we identified 10 studies assessing the prevalence of self-reported offending in Brazil and 9 studies examining risk factors. Levels of self-reported offending seem quite high among school students in Brazil. Individual and family-level risk factors identified in Brazil are very similar to those found in high-income countries. PMID:24027422

  19. Crime and violence in Brazil: Systematic review of time trends, prevalence rates and risk factors.

    PubMed

    Murray, Joseph; Cerqueira, Daniel Ricardo de Castro; Kahn, Tulio

    2013-09-01

    Between 1980 and 2010 there were 1 million homicides in Brazil. Dramatic increases in homicide rates followed rises in inequality, more young men in the population, greater availability of firearms, and increased drug use. Nevertheless, disarmament legislation may have helped reduce homicide rates in recent years. Despite its very high rate of lethal violence, Brazil appears to have similar levels of general criminal victimization as several other Latin American and North American countries. Brazil has lower rates of drug use compared to other countries such as the United States, but the prevalence of youth drug use in Brazil has increased substantially in recent years. Since 1990, the growth of the Brazilian prison population has been enormous, resulting in the fourth largest prison population in the world. Through a systematic review of the literature, we identified 10 studies assessing the prevalence of self-reported offending in Brazil and 9 studies examining risk factors. Levels of self-reported offending seem quite high among school students in Brazil. Individual and family-level risk factors identified in Brazil are very similar to those found in high-income countries.

  20. Pet snakes illegally marketed in Brazil: Climatic viability and establishment risk

    PubMed Central

    Rödder, Dennis; de Marco, Paulo

    2017-01-01

    Invasive species are one among many threats to biodiversity. Brazil has been spared, generically, of several destructive invasive species. Reports of invasive snakes’ populations are nonexistent, but the illegal pet trade might change this scenario. Despite the Brazilian laws forbid to import most animals, illegal trade is frequently observed and propagules are found in the wild. The high species richness within Brazilian biomes and accelerated fragmentation of natural reserves are a critical factors facilitating successful invasion. An efficient way to ease damages caused by invasive species is identifying potential invaders and consequent prevention of introductions. For the identification of potential invaders many factors need to be considered, including estimates of climate matching between areas (native vs. invaded). Ecological niche modelling has been widely used to predict potential areas for invasion and is an important tool for conservation biology. This study evaluates the potential geographical distribution and establishment risk of Lampropeltis getula (Linnaeus, 1766), Lampropeltis triangulum (Lacépède, 1789), Pantherophis guttatus (Linnaeus, 1766), Python bivittatus Kuhl, 1820 and Python regius (Shaw, 1802) through the Maximum Entropy modelling approach to estimate the potential distribution of the species within Brazil and qualitative evaluation of specific biological attributes. Our results suggest that the North and Midwest regions harbor major suitable areas. Furthermore, P. bivittatus and P. guttatus were suggested to have the highest invasive potential among the analyzed species. Potentially suitable areas for these species were predicted within areas which are highly relevant for Brazilian biodiversity, including several conservation units. Therefore, these areas require special attention and preventive measures should be adopted. PMID:28817630

  1. Pet snakes illegally marketed in Brazil: Climatic viability and establishment risk.

    PubMed

    Fonseca, Érica; Solé, Mirco; Rödder, Dennis; de Marco, Paulo

    2017-01-01

    Invasive species are one among many threats to biodiversity. Brazil has been spared, generically, of several destructive invasive species. Reports of invasive snakes' populations are nonexistent, but the illegal pet trade might change this scenario. Despite the Brazilian laws forbid to import most animals, illegal trade is frequently observed and propagules are found in the wild. The high species richness within Brazilian biomes and accelerated fragmentation of natural reserves are a critical factors facilitating successful invasion. An efficient way to ease damages caused by invasive species is identifying potential invaders and consequent prevention of introductions. For the identification of potential invaders many factors need to be considered, including estimates of climate matching between areas (native vs. invaded). Ecological niche modelling has been widely used to predict potential areas for invasion and is an important tool for conservation biology. This study evaluates the potential geographical distribution and establishment risk of Lampropeltis getula (Linnaeus, 1766), Lampropeltis triangulum (Lacépède, 1789), Pantherophis guttatus (Linnaeus, 1766), Python bivittatus Kuhl, 1820 and Python regius (Shaw, 1802) through the Maximum Entropy modelling approach to estimate the potential distribution of the species within Brazil and qualitative evaluation of specific biological attributes. Our results suggest that the North and Midwest regions harbor major suitable areas. Furthermore, P. bivittatus and P. guttatus were suggested to have the highest invasive potential among the analyzed species. Potentially suitable areas for these species were predicted within areas which are highly relevant for Brazilian biodiversity, including several conservation units. Therefore, these areas require special attention and preventive measures should be adopted.

  2. Exploring Dynamic Risk Prediction for Dialysis Patients

    PubMed Central

    Ganssauge, Malte; Padman, Rema; Teredesai, Pradip; Karambelkar, Ameet

    2016-01-01

    Despite substantial advances in the treatment of end-stage renal disease, mortality of hemodialysis patients remains high. Several models exist that predict mortality for this population and identify patients at risk. However, they mostly focus on patients at a particular stage of dialysis treatment, such as start of dialysis, and only use the most recent patient data. Generalization of such models for predictions in later periods can be challenging since disease characteristics change over time and the evolution of biomarkers is not adequately incorporated. In this research, we explore dynamic methods which allow updates of initial predictions when patients progress in time and new data is observed. We compare a Dynamic Bayesian Network (DBN) to regularized logistic regression models and a Cox model with landmarking. Our preliminary results indicate that the DBN achieves satisfactory performance for short term prediction horizons, but needs further refinement and parameter tuning for longer horizons. PMID:28269937

  3. Two criteria for evaluating risk prediction models.

    PubMed

    Pfeiffer, R M; Gail, M H

    2011-09-01

    We propose and study two criteria to assess the usefulness of models that predict risk of disease incidence for screening and prevention, or the usefulness of prognostic models for management following disease diagnosis. The first criterion, the proportion of cases followed PCF (q), is the proportion of individuals who will develop disease who are included in the proportion q of individuals in the population at highest risk. The second criterion is the proportion needed to follow-up, PNF (p), namely the proportion of the general population at highest risk that one needs to follow in order that a proportion p of those destined to become cases will be followed. PCF (q) assesses the effectiveness of a program that follows 100q% of the population at highest risk. PNF (p) assess the feasibility of covering 100p% of cases by indicating how much of the population at highest risk must be followed. We show the relationship of those two criteria to the Lorenz curve and its inverse, and present distribution theory for estimates of PCF and PNF. We develop new methods, based on influence functions, for inference for a single risk model, and also for comparing the PCFs and PNFs of two risk models, both of which were evaluated in the same validation data.

  4. Brazil.

    PubMed

    1983-07-01

    Attention in this discussion of Brazil focuses: the history of the country's demographic situation; government's overall approach to population problems; population data systems and development planning; institutional arrangements for the integration of population within development planning; government's view of the importance of population policy in achieving development objectives; population size, growth, and natural increase; fertility; international migration; and spatial distribution. The population of Brazil grew from 17 million in 1900 to about 119 million in 1960, making it the most populous country in the world and 1 of the relatively few countries to have sustained rates of population growth of more than 2% for over a century. The government has not adopted an explicit policy to modify fertility or population growth. Initially this was because of its positive perception of the benefits of population growth and a large population size and, amore recently, because of Brazil's gradual transition to more moderate levels of fertility and population growth. Brazil's main sources of demographic data are its 9 censuses, conducted in 1982, 1890, 1900, 1920, 1940, 1950, 1960, 1970, and most recently in August 1980. A nationwide system of vital registration data are still lacking in many geographic areas, researchers have had to rely on indirect estimation techniques to derive estimates of past trends in fertility and mortality. Population policy has been regarded as a highly sensitive issue by Brazilian officials, and the government remains cautious in regard to population issues. Preliminary results of Brazil's 1980 census indicate a population of 119 million and an annual rate of population growth of 2.1%, continuing the downward trend that was first evident in 1976. The government considers levels and trends of population growth to be satisfactory, and morbidity and mortality to be unacceptable, partly because of a lack of success in reducing the incidence of

  5. Shoulder dystocia: risk factors, predictability, and preventability.

    PubMed

    Mehta, Shobha H; Sokol, Robert J

    2014-06-01

    Shoulder dystocia remains an unpredictable obstetric emergency, striking fear in the hearts of obstetricians both novice and experienced. While outcomes that lead to permanent injury are rare, almost all obstetricians with enough years of practice have participated in a birth with a severe shoulder dystocia and are at least aware of cases that have resulted in significant neurologic injury or even neonatal death. This is despite many years of research trying to understand the risk factors associated with it, all in an attempt primarily to characterize when the risk is high enough to avoid vaginal delivery altogether and prevent a shoulder dystocia, whose attendant morbidities are estimated to be at a rate as high as 16-48%. The study of shoulder dystocia remains challenging due to its generally retrospective nature, as well as dependence on proper identification and documentation. As a result, the prediction of shoulder dystocia remains elusive, and the cost of trying to prevent one by performing a cesarean delivery remains high. While ultimately it is the injury that is the key concern, rather than the shoulder dystocia itself, it is in the presence of an identified shoulder dystocia that occurrence of injury is most common. The majority of shoulder dystocia cases occur without major risk factors. Moreover, even the best antenatal predictors have a low positive predictive value. Shoulder dystocia therefore cannot be reliably predicted, and the only preventative measure is cesarean delivery. Copyright © 2014 Elsevier Inc. All rights reserved.

  6. Predicting cognitive impairment and accident risk.

    PubMed

    Raslear, Thomas G; Hursh, Steven R; Van Dongen, Hans P A

    2011-01-01

    Sleep and cognition are temporally regulated by a homeostatic process generating pressure for sleep as a function of sleep/wake history, and a circadian process generating pressure for wakefulness as a function of time of day. Under normal nocturnal sleep conditions, these two processes are aligned in such a manner as to provide optimal daytime performance and consolidated nighttime sleep. Under conditions of sleep deprivation, shift work or transmeridian travel, the two processes are misaligned, resulting in fatigue and cognitive deficits. Mathematical models of fatigue and performance have been developed to predict these cognitive deficits. Recent studies showing long-term effects on performance of chronic sleep restriction suggest that the homeostatic process undergoes gradual changes that are slow to recover. New developments in mathematical modeling of performance are focused on capturing these gradual changes and their effects on fatigue. Accident risk increases as a function of fatigue severity as well as the duration of exposure to fatigue. Work schedule and accident rate information from an operational setting can thus be used to calibrate a mathematical model of fatigue and performance to predict accident risk. This provides a fatigue risk management tool that helps to direct mitigation resources to where they would have the greatest mitigating effect. Copyright © 2011 Elsevier B.V. All rights reserved.

  7. Trends in fire risk and burned area in Brazil in the 20th century

    NASA Astrophysics Data System (ADS)

    Silva, P.; Bastos, A.; DaCamara, C.; Libonati, R.

    2016-12-01

    Fire has a significant contribution to the global greenhouse gas emissions and vast ecological and climatic impacts. Worldwide, Brazil is one of the areas most affected by fire, which highly influences the state of the vegetation cover, the ecological diversity of the region and has significant consequences to the global CO2 balance [1]. Hence, with the increasing evidence of human induced climate change, it becomes essential to understand the present and future trends of fire risk in Brazil. Although a large number of fires in Brazil are anthropogenic, it has been shown that the burned area is mainly controlled by meteorological conditions [2], therefore being partially determined by fire risk. In this study we use a fire danger index specifically tailored for the Brazilian climate and biome characteristics, the MFDI developed by INPE, to assess the patterns and trends of fire risk in Brazil. The index relies on values of maximum temperature, accumulated precipitation over different periods, minimum relative humidity and vegetation cover to estimate the likelihood of fire occurrence. We test the sensitivity of the index to different climate reanalyses and evaluate the trends in fire risk in Brazil during the past four decades for different biomes. We further assess the link between the calculated fire risk and observed fire occurrence and burned area. Finally, we compare the results with fire risk simulated by a regional climate model (RCA4 forced by EC-Earth from CORDEX) in order to evaluate its suitability for future projections of fire risk and burned area. [1] Bowman, D. M. et al. Fire in the earth system. Science, v. 324, p. 481-484, 24 apr. 2009. [2] Libonati, R. et al. An Algorithm for Burned Area Detection in the Brazilian Cerrado Using 4 μm MODIS Imagery. Remote Sensing, v. 7, p. 15782-15803, 2015.

  8. Unrestrained outsourcing in Brazil: more precarization and health risks for workers.

    PubMed

    Druck, Graça

    2016-06-20

    This article discusses the current status of outsourcing in Brazil, with new regulation underway featuring a bill of law under review by the National Congress, aimed at allowing outsourcing for all activities. The authors argue that outsourcing and precarization of work are inseparable phenomena, based on the results of 20 years of research in Brazil that reveals the more precarious working conditions of outsourced workers in different occupational categories. They focus particularly on workers' health: outsourcing of risks has led to more fatal work accidents, invariably at higher rates in outsourced workers. Finally, the article contends that to remove restraints on outsourcing in Brazil amounts to legalizing and legitimizing predatory workforce exploitation, disregarding workers' physical limits, exposing them to risk of fatal accidents, and reverting to forms of work that violate the human condition.

  9. Risk prediction of hepatotoxicity in paracetamol poisoning.

    PubMed

    Wong, Anselm; Graudins, Andis

    2017-09-01

    Paracetamol (acetaminophen) poisoning is the most common cause of acute liver failure in the developed world. A paracetamol treatment nomogram has been used for over four decades to help determine whether patients will develop hepatotoxicity without acetylcysteine treatment, and thus indicates those needing treatment. Despite this, a small proportion of patients still develop hepatotoxicity. More accurate risk predictors would be useful to increase the early detection of patients with the potential to develop hepatotoxicity despite acetylcysteine treatment. Similarly, there would be benefit in early identification of those with a low likelihood of developing hepatotoxicity, as this group may be safely treated with an abbreviated acetylcysteine regimen. To review the current literature related to risk prediction tools that can be used to identify patients at increased risk of hepatotoxicity. A systematic literature review was conducted using the search terms: "paracetamol" OR "acetaminophen" AND "overdose" OR "toxicity" OR "risk prediction rules" OR "hepatotoxicity" OR "psi parameter" OR "multiplication product" OR "half-life" OR "prothrombin time" OR "AST/ALT (aspartate transaminase/alanine transaminase)" OR "dose" OR "biomarkers" OR "nomogram". The search was limited to human studies without language restrictions, of Medline (1946 to May 2016), PubMed and EMBASE. Original articles pertaining to the theme were identified from January 1974 to May 2016. Of the 13,975 articles identified, 60 were relevant to the review. Paracetamol treatment nomograms: Paracetamol treatment nomograms have been used for decades to help decide the need for acetylcysteine, but rarely used to determine the risk of hepatotoxicity with treatment. Reported paracetamol dose and concentration: A dose ingestion >12 g or serum paracetamol concentration above the treatment thresholds on the paracetamol nomogram are associated with a greater risk of hepatotoxicity. Paracetamol elimination half

  10. Spatial analysis and risk mapping of soil-transmitted helminth infections in Brazil, using Bayesian geostatistical models.

    PubMed

    Scholte, Ronaldo G C; Schur, Nadine; Bavia, Maria E; Carvalho, Edgar M; Chammartin, Frédérique; Utzinger, Jürg; Vounatsou, Penelope

    2013-11-01

    Soil-transmitted helminths (Ascaris lumbricoides, Trichuris trichiura and hookworm) negatively impact the health and wellbeing of hundreds of millions of people, particularly in tropical and subtropical countries, including Brazil. Reliable maps of the spatial distribution and estimates of the number of infected people are required for the control and eventual elimination of soil-transmitted helminthiasis. We used advanced Bayesian geostatistical modelling, coupled with geographical information systems and remote sensing to visualize the distribution of the three soil-transmitted helminth species in Brazil. Remotely sensed climatic and environmental data, along with socioeconomic variables from readily available databases were employed as predictors. Our models provided mean prevalence estimates for A. lumbricoides, T. trichiura and hookworm of 15.6%, 10.1% and 2.5%, respectively. By considering infection risk and population numbers at the unit of the municipality, we estimate that 29.7 million Brazilians are infected with A. lumbricoides, 19.2 million with T. trichiura and 4.7 million with hookworm. Our model-based maps identified important risk factors related to the transmission of soiltransmitted helminths and confirm that environmental variables are closely associated with indices of poverty. Our smoothed risk maps, including uncertainty, highlight areas where soil-transmitted helminthiasis control interventions are most urgently required, namely in the North and along most of the coastal areas of Brazil. We believe that our predictive risk maps are useful for disease control managers for prioritising control interventions and for providing a tool for more efficient surveillance-response mechanisms.

  11. Evaluation of a Training Program for Street Children and Adolescents At Risk in Brazil.

    ERIC Educational Resources Information Center

    Bandeira, Denise R.; And Others

    An experience in evaluating a program which is designed to help high risk adolescents is described. The program attempts to develop basic work and social skills of adolescents (N=40) living in slums or on the streets in Brazil. Psychological and social effects of the program were assessed by means of interviews and psychological tests…

  12. Venomous mollusks: the risks of human accidents by conus snails (gastropoda: conidae) in Brazil.

    PubMed

    Haddad, Vidal; de Paula Neto, João Batista; Cobo, Válter José

    2006-01-01

    Mollusks of the genus Conus present a venomous apparatus composed of radulae, a chitin structure linked to glands, which injects potent neurotoxic peptides, causing serious human envenomation and even death, associated with the blockage of certain receptors and muscular paralysis. No reported envenomation has occurred in Brazil, but certain populations are at risk of accidents.

  13. Risk Factors for Death from Pandemic (H1N1) 2009, Southern Brazil

    PubMed Central

    Skalinski, Lacita M.; Igansi, Cristine N.; de Souza, Libia R.O.; Iser, Betine P.M.; Reis, Priscilleyne O.; Barros, Eliana N.C.; Macário, Eduardo M.; Bercini, Marilina A.; Ranieri, Tani M.S.; Araújo, Wildo N.

    2011-01-01

    To identify risk factors for death from pandemic (H1N1) 2009, we obtained data for 157 hospitalized patients with confirmed cases of this disease. Multivariate analysis showed that diabetes and class III obesity were associated with death. These findings helped define priority vaccination groups in Brazil. PMID:21801625

  14. Brief Report: Young People at Risk for Eating Disorders in Southeast Brazil

    ERIC Educational Resources Information Center

    Moya, Tatiana; Fleitlich-Bilyk, Bacy; Goodman, Robert

    2006-01-01

    A representative sample of 7-14-year-old young people in southeast Brazil (N=1251) was assessed using standardized parent and youth interviews, thereby identifying an "at-risk" group of young people who met one or more DSM-IV criteria for anorexia and/or bulimia nervosa. These young people were compared with an age and gender matched…

  15. Risk factors for death from pandemic (H1N1) 2009, southern Brazil.

    PubMed

    Yokota, Renata T C; Skalinski, Lacita M; Igansi, Cristine N; de Souza, Libia R O; Iser, Betine P M; Reis, Priscilleyne O; Barros, Eliana N C; Macário, Eduardo M; Bercini, Marilina A; Ranieri, Tani M S; Araújo, Wildo N

    2011-08-01

    To identify risk factors for death from pandemic (H1N1) 2009, we obtained data for 157 hospitalized patients with confirmed cases of this disease. Multivariate analysis showed that diabetes and class III obesity were associated with death. These findings helped define priority vaccination groups in Brazil.

  16. Brief Report: Young People at Risk for Eating Disorders in Southeast Brazil

    ERIC Educational Resources Information Center

    Moya, Tatiana; Fleitlich-Bilyk, Bacy; Goodman, Robert

    2006-01-01

    A representative sample of 7-14-year-old young people in southeast Brazil (N=1251) was assessed using standardized parent and youth interviews, thereby identifying an "at-risk" group of young people who met one or more DSM-IV criteria for anorexia and/or bulimia nervosa. These young people were compared with an age and gender matched…

  17. Risk factors related to the global burden of disease in Brazil and its Federated Units, 2015.

    PubMed

    Malta, Deborah Carvalho; Felisbino-Mendes, Mariana Santos; Machado, Ísis Eloah; Passos, Valéria Maria de Azeredo; Abreu, Daisy Maria Xavier de; Ishitani, Lenice Harumi; Velásquez-Meléndez, Gustavo; Carneiro, Mariangela; Mooney, Meghan; Naghavi, Mohsen

    2017-05-01

    To analyze the global burden of disease related to disability adjusted life years (DALYs) attributed to selected risk factors in Brazil and its 27 Federated Units. Databases from the Global Burden of Disease study in Brazil and its Federated Units were used, estimating the summary exposure value (SEV) for selected environmental, behavioral, and metabolic risk factors (RFs), and their combinations. The DALYs were used as the main metric. The ranking of major RFs between 1990 and 2015 was compiled, comparing data by sex and states. The analyzed RFs account for 38.8% of the loss of DALYs in the country. Dietary risks was the main cause of DALYs in 2015. In men, dietary risks contributed to 12.2% of DALYs and in women, to 11.1%. Other RFs were high systolic blood pressure, high body mass index, smoking, high fasting plasma glucose and, among men, alcohol and drug use. The main RFs were metabolic and behavioral. In most states, dietary risks was the main RF, followed by high blood pressure. Dietary risks leads the RF ranking for Brazil and its Federated Units. Men are more exposed to behavioral risk factors, and women are more exposed to metabolic ones.

  18. Applicability of Two International Risk Scores in Cardiac Surgery in a Reference Center in Brazil

    PubMed Central

    Garofallo, Silvia Bueno; Machado, Daniel Pinheiro; Rodrigues, Clarissa Garcia; Bordim, Odemir; Kalil, Renato A. K.; Portal, Vera Lúcia

    2014-01-01

    Background The applicability of international risk scores in heart surgery (HS) is not well defined in centers outside of North America and Europe. Objective To evaluate the capacity of the Parsonnet Bernstein 2000 (BP) and EuroSCORE (ES) in predicting in-hospital mortality (IHM) in patients undergoing HS at a reference hospital in Brazil and to identify risk predictors (RP). Methods Retrospective cohort study of 1,065 patients, with 60.3% patients underwent coronary artery bypass grafting (CABG), 32.7%, valve surgery and 7.0%, CABG combined with valve surgery. Additive and logistic scores models, the area under the ROC (Receiver Operating Characteristic) curve (AUC) and the standardized mortality ratio (SMR) were calculated. Multivariate logistic regression was performed to identify the RP. Results Overall mortality was 7.8%. The baseline characteristics of the patients were significantly different in relation to BP and ES. AUCs of the logistic and additive BP were 0.72 (95% CI, from 0.66 to 0.78 p = 0.74), and of ES they were 0.73 (95% CI; 0.67 to 0.79 p = 0.80). The calculation of the SMR in BP was 1.59 (95% CI; 1.27 to 1.99) and in ES, 1.43 (95% CI; 1.14 to 1.79). Seven RP of IHM were identified: age, serum creatinine > 2.26 mg/dL, active endocarditis, systolic pulmonary arterial pressure > 60 mmHg, one or more previous HS, CABG combined with valve surgery and diabetes mellitus. Conclusion Local scores, based on the real situation of local populations, must be developed for better assessment of risk in cardiac surgery. PMID:25004415

  19. Predicting knee osteoarthritis risk in injured populations.

    PubMed

    Long, Michael J; Papi, Enrica; Duffell, Lynsey D; McGregor, Alison H

    2017-08-01

    Individuals who suffered a lower limb injury have an increased risk of developing knee osteoarthritis. Early diagnosis of osteoarthritis and the ability to track its progression is challenging. This study aimed to explore links between self-reported knee osteoarthritis outcome scores and biomechanical gait parameters, whether self-reported outcome scores could predict gait abnormalities characteristic of knee osteoarthritis in injured populations and, whether scores and biomechanical outcomes were related to osteoarthritis severity via Spearman's correlation coefficient. A cross-sectional study was conducted with asymptomatic participants, participants with lower-limb injury and those with medial knee osteoarthritis. Spearman rank determined relationships between knee injury and outcome scores and hip and knee kinetic/kinematic gait parameters. K-Nearest Neighbour algorithm was used to determine which of the evaluated parameters created the strongest classifier model. Differences in outcome scores were evident between groups, with knee quality of life correlated to first and second peak external knee adduction moment (0.47, 0.55). Combining hip and knee kinetics with quality of life outcome produced the strongest classifier (1.00) with the least prediction error (0.02), enabling classification of injured subjects gait as characteristic of either asymptomatic or knee osteoarthritis subjects. When correlating outcome scores and biomechanical outcomes with osteoarthritis severity only maximum external hip and knee abduction moment (0.62, 0.62) in addition to first peak hip adduction moment (0.47) displayed significant correlations. The use of predictive models could enable clinicians to identify individuals at risk of knee osteoarthritis and be a cost-effective method for osteoarthritis screening. Copyright © 2017. Published by Elsevier Ltd.

  20. Neonatal care in Brazil: hospital structure and adequacy according to newborn obstetric risk.

    PubMed

    de Azevedo Bittencourt, Sonia Duarte; Queiroz Gurgel, Ricardo; da Silva Menezes, Maria Alexsandra; Bastos, Leonardo S; do Carmo Leal, Maria

    2015-08-01

    In Brazil, hospital birth care is available to all, but there are important differences between hospitals in the public and private sectors, geographical regions and capitals/inland cities, resulting in inequalities of infant health. To assess the hospital structure for birth care in Brazil and analyze hospital adequacy to care for newborns according to levels of risk. Data were collected as part of a nationwide hospital-based cohort study, 'Birth in Brazil'. The hospitals were classified according to whether they had a neonatal intensive care unit and divided into two models of governance: public and private financing. Three structure domains were assessed: human resources, medications and equipment for post-natal women and newborn emergency care. Newborns were classified according to the obstetric risk. There are more NICUs in private hospitals and they cater mostly for low obstetric risk newborns; the public sector serves 50% of at-risk patients in hospitals without an NICU. The differences between hospital service structures according to geographic region and capital/inland cities were evident. Hospitals in less developed regions and inland cities had poorer adequacy in the three domains. The distribution of neonatal care to Brazilian infants varied between the public and private sectors. The public sector offered less complex services for newborns at risk, and infants without obstetric risk were born in facilities with an NICU, creating the possibility of unnecessary intervention, especially in the private sector.

  1. Determination of aflatoxin risk components for in-shell Brazil nuts.

    PubMed

    Vargas, E A; dos Santos, E A; Whitaker, T B; Slate, A B

    2011-09-01

    A study was conducted on the risk from aflatoxins associated with the kernels and shells of Brazil nuts. Samples were collected from processing plants in Amazonia, Brazil. A total of 54 test samples (40 kg) were taken from 13 in-shell Brazil nut lots ready for market. Each in-shell sample was shelled and the kernels and shells were sorted in five fractions: good kernels, rotten kernels, good shells with kernel residue, good shells without kernel residue, and rotten shells, and analysed for aflatoxins. The kernel:shell ratio mass (w/w) was 50.2/49.8%. The Brazil nut shell was found to be contaminated with aflatoxin. Rotten nuts were found to be a high-risk fraction for aflatoxin in in-shell Brazil nut lots. Rotten nuts contributed only 4.2% of the sample mass (kg), but contributed 76.6% of the total aflatoxin mass (µg) in the in-shell test sample. The highest correlations were found between the aflatoxin concentration in in-shell Brazil nuts samples and the aflatoxin concentration in all defective fractions (R(2)=0.97). The aflatoxin mass of all defective fractions (R(2)=0.90) as well as that of the rotten nut (R(2)=0.88) were also strongly correlated with the aflatoxin concentration of the in-shell test samples. Process factors of 0.17, 0.16 and 0.24 were respectively calculated to estimate the aflatoxin concentration in the good kernels (edible) and good nuts by measuring the aflatoxin concentration in the in-shell test sample and in all kernels, respectively.

  2. Brief report: young people at risk for eating disorders in Southeast Brazil.

    PubMed

    Moya, Tatiana; Fleitlich-Bilyk, Bacy; Goodman, Robert

    2006-04-01

    A representative sample of 7-14-year-old young people in southeast Brazil (N=1251) was assessed using standardized parent and youth interviews, thereby identifying an 'at-risk' group of young people who met one or more DSM-IV criteria for anorexia and/or bulimia nervosa. These young people were compared with an age and gender matched comparison group for body mass index (BMI) and socio-economic status (SES). The prevalence of young people at risk for eating disorders was 1.4% (higher in females and rising with age). 'At-risk' individuals did not differ from controls in BMI but were of higher SES. In Brazil, the link between symptoms of eating disorders and higher SES is not just a referral artefact but is evident in a representative community sample. This might reflect a stronger preference for thinness among more westernized social groups.

  3. Risk of microcephaly after Zika virus infection in Brazil, 2015 to 2016

    PubMed Central

    Rosenberger, Kerstin Daniela; Brito, Carlos; Brady, Oliver; Brasil, Patrícia; Marques, Ernesto TA

    2017-01-01

    Abstract Objective To estimate the risk of microcephaly in babies born to women infected by the Zika virus during pregnancy in Brazil in an epidemic between 2015 and 2016. Methods We obtained data on the number of notified and confirmed microcephaly cases in each Brazilian state between November 2015 and October 2016 from the health ministry. For Pernambuco State, one of the hardest hit, weekly data were available from August 2015 to October 2016 for different definitions of microcephaly. The absolute risk of microcephaly was calculated using the average number of live births reported in each state in the corresponding time period between 2012 and 2014 and assuming two infection rates: 10% and 50%. The relative risk was estimated using the reported background frequency of microcephaly in Brazil of 1.98 per 10 000 live births. Findings The estimated absolute risk of a notified microcephaly case varied from 0.03 to 17.1% according to geographical area, the definition of microcephaly used and the infection rate. Assuming a 50% infection rate, there was an 18–127 fold higher probability of microcephaly in children born to mothers with infection during pregnancy compared with children born to mothers without infection during pregnancy in Pernambuco State. For a 10% infection rate, the probability was 88–635 folds higher. Conclusion A large variation in the estimated risk of microcephaly was found in Brazil. Research is needed into possible effect modifiers, reliable measures of Zika virus infection and clear endpoints for congenital malformations. PMID:28250532

  4. Risk of symptomatic dengue for foreign visitors to the 2014 FIFA World Cup in Brazil.

    PubMed

    Massad, Eduardo; Wilder-Smith, Annelies; Ximenes, Raphael; Amaku, Marcos; Lopez, Luis Fernandez; Coutinho, Francisco Antonio Bezerra; Coelho, Giovanini Evelim; Silva, Jarbas Barbosa da; Struchiner, Claudio José; Burattini, Marcelo Nascimento

    2014-06-01

    Brazil will host the FIFA World Cup™, the biggest single-event competition in the world, from June 12-July 13 2014 in 12 cities. This event will draw an estimated 600,000 international visitors. Brazil is endemic for dengue. Hence, attendees of the 2014 event are theoretically at risk for dengue. We calculated the risk of dengue acquisition to non-immune international travellers to Brazil, depending on the football match schedules, considering locations and dates of such matches for June and July 2014. We estimated the average per-capita risk and expected number of dengue cases for each host-city and each game schedule chosen based on reported dengue cases to the Brazilian Ministry of Health for the period between 2010-2013. On the average, the expected number of cases among the 600,000 foreigner tourists during the World Cup is 33, varying from 3-59. Such risk estimates will not only benefit individual travellers for adequate pre-travel preparations, but also provide valuable information for public health professionals and policy makers worldwide. Furthermore, estimates of dengue cases in international travellers during the World Cup can help to anticipate the theoretical risk for exportation of dengue into currently non-infected areas.

  5. Risk of symptomatic dengue for foreign visitors to the 2014 FIFA World Cup in Brazil

    PubMed Central

    Massad, Eduardo; Wilder-Smith, Annelies; Ximenes, Raphael; Amaku, Marcos; Lopez, Luis Fernandez; Coutinho, Francisco Antonio Bezerra; Coelho, Giovanini Evelim; da Silva, Jarbas Barbosa; Struchiner, Claudio José; Burattini, Marcelo Nascimento

    2014-01-01

    Brazil will host the FIFA World Cup™, the biggest single-event competition in the world, from June 12-July 13 2014 in 12 cities. This event will draw an estimated 600,000 international visitors. Brazil is endemic for dengue. Hence, attendees of the 2014 event are theoretically at risk for dengue. We calculated the risk of dengue acquisition to non-immune international travellers to Brazil, depending on the football match schedules, considering locations and dates of such matches for June and July 2014. We estimated the average per-capita risk and expected number of dengue cases for each host-city and each game schedule chosen based on reported dengue cases to the Brazilian Ministry of Health for the period between 2010-2013. On the average, the expected number of cases among the 600,000 foreigner tourists during the World Cup is 33, varying from 3-59. Such risk estimates will not only benefit individual travellers for adequate pre-travel preparations, but also provide valuable information for public health professionals and policy makers worldwide. Furthermore, estimates of dengue cases in international travellers during the World Cup can help to anticipate the theoretical risk for exportation of dengue into currently non-infected areas. PMID:24863976

  6. Prediction of Cardiovascular Risk Using Framingham, ASSIGN and QRISK2: How Well Do They Predict Individual Rather than Population Risk?

    PubMed Central

    van Staa, Tjeerd-Pieter; Gulliford, Martin; Ng, Edmond S.-W.; Goldacre, Ben; Smeeth, Liam

    2014-01-01

    Background The objective of this study was to evaluate the performance of risk scores (Framingham, Assign and QRISK2) in predicting high cardiovascular disease (CVD) risk in individuals rather than populations. Methods and findings This study included 1.8 million persons without CVD and prior statin prescribing using the Clinical Practice Research Datalink. This contains electronic medical records of the general population registered with a UK general practice. Individual CVD risks were estimated using competing risk regression models. Individual differences in the 10-year CVD risks as predicted by risk scores and competing risk models were estimated; the population was divided into 20 subgroups based on predicted risk. CVD outcomes occurred in 69,870 persons. In the subgroup with lowest risks, risk predictions by QRISK2 were similar to individual risks predicted using our competing risk model (99.9% of people had differences of less than 2%); in the subgroup with highest risks, risk predictions varied greatly (only 13.3% of people had differences of less than 2%). Larger deviations between QRISK2 and our individual predicted risks occurred with calendar year, different ethnicities, diabetes mellitus and number of records for medical events in the electronic health records in the year before the index date. A QRISK2 estimate of low 10-year CVD risk (<15%) was confirmed by Framingham, ASSIGN and our individual predicted risks in 89.8% while an estimate of high 10-year CVD risk (≥20%) was confirmed in only 48.6% of people. The majority of cases occurred in people who had predicted 10-year CVD risk of less than 20%. Conclusions Application of existing CVD risk scores may result in considerable misclassification of high risk status. Current practice to use a constant threshold level for intervention for all patients, together with the use of different scoring methods, may inadvertently create an arbitrary classification of high CVD risk. PMID:25271417

  7. Contact with armadillos increases the risk of leprosy in Brazil: a case control study.

    PubMed

    Deps, P D; Alves, B L; Gripp, C G; Aragao, R L; Guedes, Bvs; Filho, J B; Andreatta, M K; Marcari, R S; Prates, Ica; Rodrigues, L C

    2008-01-01

    Mycobacterium leprae infection has recently been detected in wild armadillos in Brazil. Leprosy is still endemic in Brazil and although its transmission is mostly by person-to-person contact, many cases report no history of previously known leprosy contact. It has been suggested that other sources of M. leprae may contribute to the transmission of leprosy in some areas. Our objective was to investigate whether contact with armadillos is associated with leprosy. A case-control study was carried out in Brazil. Data was collected from 506 leprosy patients and 594 controls on exposure to armadillos and age, sex, place of birth and living conditions. Univariate analysis and unconditional logistic regression were conducted to investigate whether leprosy was associated with exposure to armadillos. Direct armadillo exposure was reported by 68% of leprosy cases and by 48% of controls (P < 0.001) roughly doubling the risk of leprosy, with odds ratio (OR) 2.0, 95% confidence interval (CI) [1.36-2.99]. The results of this study suggest that direct exposure to armadillos is a risk factor for leprosy in Brazil.

  8. Rural tourism: a risk factor for schistosomiasis transmission in Brazil.

    PubMed

    Enk, Martin Johannes; Amaral, Graciela Larissa; Costa e Silva, Matheus Fernandes; Silveira-Lemos, Denise; Teixeira-Carvalho, Andréa; Martins-Filho, Olindo Assis; Correa-Oliveira, Rodrigo; Gazinnelli, Giovanni; Coelho, Paulo Marcos Zech; Massara, Cristiano Lara

    2010-07-01

    This paper reports an outbreak of acute schistosomiasis among 38 tourists who rented a country house in the district of Igarapé, the metropolitan region of Belo Horizonte, Brazil, during a holiday period in 2006. A total number of 32 individuals were positive for Schistosoma mansoni. Results of stool examinations revealed individual S. mansoni egg counts per gram of faeces (epg) ranging from 4-768 epg with a geometric mean egg count of 45. The most frequent clinical symptoms were abdominal pain (78.1%), headache (75%), fever (65.6%), dry cough (65.2%) and both diarrhoea and asthenia (59.4%). A malacological survey of the area, where 22 specimens of Biomphalaria glabrata were collected, revealed three (13.6%) specimens eliminating Schistosoma cercariae. This investigation re-confirms a recently described pattern of schistosomiasis infection, resulting in the acute form of the disease and connected to rural tourism, which contributes to the spread of the disease among the middle-class and into non-endemic areas. The lack of specific knowledge about acute schistosomiasis among health services causes an increased number of unnecessary diagnostic procedures and delays in accurate diagnosis and treatment, resulting in considerable discomfort for the patients.

  9. Municipal temperature and heatwave predictions as a tool for integrated socio-environmental impact analysis in Brazil

    NASA Astrophysics Data System (ADS)

    Costa, D.

    2015-12-01

    Numerical climate models render data in a gridded format which is often problematic for integrated analysis with other kinds of data in jurisdictional formats. In this paper a joint analysis of municipal Gross Domestic Product per capita (GDPc) and predicted temperature increase was undertaken in order to estimate different levels of human and economic exposure. This is based on a method of converting model outputs into a country municipal grid which enabled depicting climate predictions from the Eta-Hadgem2-ES Regional Climate Model (RCM) into the municipal level in Brazil. The conversion to country municipality grid was made using a combination of interpolation and buffering techniques in ArcGIS for two emission scenarios (RCP 4.5 and 8.5) and three timeframes (2011-2040, 2041-2070, 2071-2100) for mean temperature increase and number of heatwave days (WSDI). The results were used to support the Third National Communication (TCN) of Brazil to the United Nations Framework Convention on Climate Change (UNFCCC) and show a coherent matching of the gridded output from the original RCM. The joint climate and GDPc analysis show that in the beginning of the century the more severe warming is centred over regions where GDPc is generally higher (Centre-West and Southeast). At the end of the century, critical levels of warming spread north and northeastwards where municipalities have the lowest GDPc levels. In the high emission scenario (RCP 8.5) the strongest warming and the spreading over poorer regions is anticipated to the mid-century. These results are key to further explore solutions for climate change adaptation based on current resources and prepare in different sectors, for long-term risk management and climate adaptation planning strategies.

  10. Substance use and sexual risk among at-risk adolescents in Juiz de Fora, Minas Gerais State, Brazil.

    PubMed

    Morrison, Penelope; Smith, Amy Erica; Akers, Aletha

    2014-04-01

    We examined the difference in prevalence of substance use and sexual risk behaviors among at-risk youth participants in programs offered by community-based organizations in Juiz de Fora, Minas Gerais State, Brazil, by gender and organization type (governmental vs. non-governmental). 388 adolescents were recruited from 25 intervention-based organizations servicing at-risk youth between the ages of 12 and 17 in Juiz de Fora. Participants completed a 15-item survey assessing substance use and sexual risk behaviors, along with socio-demographic predictors of these behaviors. Males were more likely to report drug and alcohol use associated with homelessness and abandonment. Females were more likely to report sexual risk taking associated with neighborhood crime. Participants from non-governmental organizations were less likely to engage in all measured risk behaviors. The present analysis points to the need to understand how Brazil's Child and Adolescent Act is being applied and the implications this has for intervention and the promotion of positive health outcomes for young people.

  11. Aflatoxins in food products consumed in Brazil: a preliminary dietary risk assessment.

    PubMed

    Andrade, P D; de Mello, M Homem; França, J A; Caldas, E D

    2013-01-01

    A preliminary dietary exposure assessment for aflatoxins (AFs; AFB1, AFB2, AFG1 and AFG2) was conducted to evaluate the potential carcinogenic risks for the Brazilian population. AF concentration data in food were obtained from analysis reports issued by the Central Public Health Laboratory of the Federal District (LACEN-DF) and from published work. Food consumption and body weight (bw) data were obtained from a national survey conducted in 2008/2009. Cancer risks arising from exposure to aflatoxins were assessed using the carcinogenic potency of AFs estimated by the JECFA, and hepatitis B virus prevalence in the Brazilian population. Additionally, margins of exposure (MOE) were also calculated for the various scenarios investigated. A total of 942 food samples were analysed for AFs in the Federal District between 2002 and 2011 with 4.5% of them being positive for at least one aflatoxin (LOQ = 2 µg kg(-1)). The highest percentage of contamination was found in peanuts (8.1%) and Brazil nuts (6.0%), with mean levels ranging from 6.7 µg kg(-1) in peanut products to 36.9 µg kg(-1) in Brazil nuts. Most of the studies conducted elsewhere in Brazil found similar results. Total AF intake for the total Brazilian population and high consumers of food relevant for AF contamination in Brazil (upper bound; samples < LOQ = 0.5 LOQ) were 6.8 and 27.6 ng kg(-1) bw day(-1), respectively. Cancer risk reached 0.0753 cancers year(-1) per 10(5) individuals for the total population and 0.3056 cancers year(-1) per 10(5) individuals for high consumers. MOE reached 25 and 6 for the total population and high consumers, respectively, indicating a potential risk for consumers. Aflatoxins are genotoxic carcinogens, and government action should be maintained and continuously improved in order to guarantee that human exposure levels are kept as low as possible.

  12. Using open source data for flood risk mapping and management in Brazil

    NASA Astrophysics Data System (ADS)

    Whitley, Alison; Malloy, James; Chirouze, Manuel

    2013-04-01

    Whitley, A., Malloy, J. and Chirouze, M. Worldwide the frequency and severity of major natural disasters, particularly flooding, has increased. Concurrently, countries such as Brazil are experiencing rapid socio-economic development with growing and increasingly concentrated populations, particularly in urban areas. Hence, it is unsurprising that Brazil has experienced a number of major floods in the past 30 years such as the January 2011 floods which killed 900 people and resulted in significant economic losses of approximately 1 billion US dollars. Understanding, mitigating against and even preventing flood risk is high priority. There is a demand for flood models in many developing economies worldwide for a range of uses including risk management, emergency planning and provision of insurance solutions. However, developing them can be expensive. With an increasing supply of freely-available, open source data, the costs can be significantly reduced, making the tools required for natural hazard risk assessment more accessible. By presenting a flood model developed for eight urban areas of Brazil as part of a collaboration between JBA Risk Management and Guy Carpenter, we explore the value of open source data and demonstrate its usability in a business context within the insurance industry. We begin by detailing the open source data available and compare its suitability to commercially-available equivalents for datasets including digital terrain models and river gauge records. We present flood simulation outputs in order to demonstrate the impact of the choice of dataset on the results obtained and its use in a business context. Via use of the 2D hydraulic model JFlow+, our examples also show how advanced modelling techniques can be used on relatively crude datasets to obtain robust and good quality results. In combination with accessible, standard specification GPU technology and open source data, use of JFlow+ has enabled us to produce large-scale hazard maps

  13. Mitochondrial DNA haplotype predicts deafness risk

    SciTech Connect

    Hutchin, T.; Cortopassi, G.

    1995-12-18

    Since mitochondrial DNA (mtDNA) does not recombine in humans, once deleterious variation arises within a particular mtDNA clone it remains linked to that clonal type. An A to G mutation at mtDNA position 1555 confers matrilineal deafness among Asians and others. Two major mtDNA types (I and II) have been defined in Asians by D-loop sequencing. We have determined the D-loop sequence of 8 unrelated deaf Asians bearing the 1555G mutation, and find that 7 are of type II, whereas only one is of type I. Thus the frequency of the 1555G mutation is higher in type II mtDNA than type I (P = 0.035, binomial test), and persons with type II mtDNA are more likely to become deaf. Type II mtDNAs are rare in the Caucasian population, which may explain the rarity of this form of deafness in the United States. Negative Darwinian selection is expected to rapidly eliminate mtDNAs bearing severely deleterious mutations; but mildly deleterious mutations whose phenotype is expressed after reproduction should persist on the mtDNA background in which they arose. Thus determination of mtDNA clonal type has the potential to predict human risk for diseases that are the result of mildly deleterious mtDNA mutations which confer a post-reproductive phenotype. 4 refs., 1 fig.

  14. Brain Scan Test Predicts Fall Risk in Elderly

    MedlinePlus

    ... page: https://medlineplus.gov/news/fullstory_162417.html Brain Scan Test Predicts Fall Risk in Elderly Such ... research suggests that measurements of healthy older adults' brain activity may help determine their future risk. "Our ...

  15. Relative Risk of Visceral Leishmaniasis in Brazil: A Spatial Analysis in Urban Area

    PubMed Central

    de Araújo, Valdelaine Etelvina Miranda; Pinheiro, Letícia Cavalari; Almeida, Maria Cristina de Mattos; de Menezes, Fernanda Carvalho; Morais, Maria Helena Franco; Reis, Ilka Afonso; Assunção, Renato Martins; Carneiro, Mariângela

    2013-01-01

    Background Visceral leishmaniasis (VL) is a vector-borne disease whose factors involved in transmission are poorly understood, especially in more urban and densely populated counties. In Brazil, the VL urbanization is a challenge for the control program. The goals were to identify the greater risk areas for human VL and the risk factors involved in transmission. Methodology This is an ecological study on the relative risk of human VL. Spatial units of analysis were the coverage areas of the Basic Health Units (146 small-areas) of Belo Horizonte, Minas Gerais State, Brazil. Human VL cases, from 2007 to 2009 (n = 412), were obtained in the Brazilian Reportable Disease Information System. Bayesian approach was used to model the relative risk of VL including potential risk factors involved in transmission (canine infection, socioeconomic and environmental features) and to identify the small-areas of greater risk to human VL. Principal Findings The relative risk of VL was shown to be correlated with income, education, and the number of infected dogs per inhabitants. The estimates of relative risk of VL were higher than 1.0 in 54% of the areas (79/146). The spatial modeling highlighted 14 areas with the highest relative risk of VL and 12 of them are concentrated in the northern region of the city. Conclusions The spatial analysis used in this study is useful for the identification of small-areas according to risk of human VL and presents operational applicability in control and surveillance program in an urban environment with an unequal spatial distribution of the disease. Thus the frequent monitoring of relative risk of human VL in small-areas is important to direct and prioritize the actions of the control program in urban environment, especially in big cities. PMID:24244776

  16. Elderly fall risk prediction using static posturography

    PubMed Central

    2017-01-01

    Maintaining and controlling postural balance is important for activities of daily living, with poor postural balance being predictive of future falls. This study investigated eyes open and eyes closed standing posturography with elderly adults to identify differences and determine appropriate outcome measure cut-off scores for prospective faller, single-faller, multi-faller, and non-faller classifications. 100 older adults (75.5 ± 6.7 years) stood quietly with eyes open and then eyes closed while Wii Balance Board data were collected. Range in anterior-posterior (AP) and medial-lateral (ML) center of pressure (CoP) motion; AP and ML CoP root mean square distance from mean (RMS); and AP, ML, and vector sum magnitude (VSM) CoP velocity were calculated. Romberg Quotients (RQ) were calculated for all parameters. Participants reported six-month fall history and six-month post-assessment fall occurrence. Groups were retrospective fallers (24), prospective all fallers (42), prospective fallers (22 single, 6 multiple), and prospective non-fallers (47). Non-faller RQ AP range and RQ AP RMS differed from prospective all fallers, fallers, and single fallers. Non-faller eyes closed AP velocity, eyes closed VSM velocity, RQ AP velocity, and RQ VSM velocity differed from multi-fallers. RQ calculations were particularly relevant for elderly fall risk assessments. Cut-off scores from Clinical Cut-off Score, ROC curves, and discriminant functions were clinically viable for multi-faller classification and provided better accuracy than single-faller classification. RQ AP range with cut-off score 1.64 could be used to screen for older people who may fall once. Prospective multi-faller classification with a discriminant function (-1.481 + 0.146 x Eyes Closed AP Velocity—0.114 x Eyes Closed Vector Sum Magnitude Velocity—2.027 x RQ AP Velocity + 2.877 x RQ Vector Sum Magnitude Velocity) and cut-off score 0.541 achieved an accuracy of 84.9% and is viable as a screening tool for older

  17. Maternal risk factors for HIV infection in infants in northeastern Brazil

    PubMed Central

    de Lemos, Lígia M.D.; Lippi, Joseph; Rutherford, George W.; Duarte, Gabriella S.; Martins, Nágyla G.R.; Santos, Victor S.; Gurgel, Ricardo Q.

    2017-01-01

    SUMMARY Introduction While the rate of vertically transmitted HIV infection has fallen in most regions of Brazil, there have been no similar decreases in northern and northeastern Brazil. Objective The objective of this study was to evaluate the risk factors associated with vertical transmission in the state of Sergipe in northeastern Brazil. Methods This was a retrospective cohort study. We recorded clinic and registry data for all HIV-infected pregnant women and exposed children diagnosed in Sergipe from 1990 to 2011. Results We identified 538 deliveries and 561 HIV-exposed infants (23 sets of twins). One hundred one (18.9%) infants were HIV-infected. In the multivariate analysis, infant antiretroviral prophylaxis was a significant protective factor (adjusted odds ratio (aOR) 0.07, 95% confidence interval (CI) 0.01–0.41, p=0.003). Breastfeeding was marginally associated with an increased odds of perinatal transmission (aOR 4.52, 95% CI 0.78–26.17, p = 0.092). The attributable risk percentage for breastfeeding over the study period was 91.0%. Transmission decreased from 91 per 100 live births before 1997 to 2 per 100 in 2011 following the adoption of the prevention protocol. Conclusion Transmission declined over the study period. The screening of pregnant women and timely initiation of prophylaxis and therapy are issues that require further attention. PMID:23791426

  18. Ecological niche modeling for visceral leishmaniasis in the state of Bahia, Brazil, using genetic algorithm for rule-set prediction and growing degree day-water budget analysis.

    PubMed

    Nieto, Prixia; Malone, John B; Bavia, Maria E

    2006-11-01

    Two predictive models were developed within a geographic information system using Genetic Algorithm Rule-Set Prediction (GARP) and the growing degree day (GDD)-water budget (WB) concept to predict the distribution and potential risk of visceral leishmaniasis (VL) in the State of Bahia, Brazil. The objective was to define the environmental suitability of the disease as well as to obtain a deeper understanding of the eco-epidemiology of VL by associating environmental and climatic variables with disease prevalence. Both the GARP model and the GDDWB model, using different analysis approaches and with the same human prevalence database, predicted similar distribution and abundance patterns for the Lutzomyia longipalpis-Leishmania chagasi system in Bahia. High and moderate prevalence sites for VL were significantly related to areas of high and moderate risk prediction by: (i) the area predicted by the GARP model, depending on the number of pixels that overlapped among eleven annual model years, and (ii) the number of potential generations per year that could be completed by the Lu. longipalpis-L. chagasi system by GDD-WB analysis. When applied to the ecological zones of Bahia, both the GARP and the GDD-WB prediction models suggest that the highest VL risk is in the interior region of the state, characterized by a semi-arid and hot climate known as Caatinga, while the risk in the Bahia interior forest and the Cerrado ecological regions is lower. The Bahia coastal forest was predicted to be a low-risk area due to the unsuitable conditions for the vector and VL transmission.

  19. HIV risk behaviors among outpatients with severe mental illness in Rio de Janeiro, Brazil

    PubMed Central

    WAINBERG, MILTON L.; MCKINNON, KAREN; ELKINGTON, KATHERINE; MATTOS, PAULO E.; GRUBER MANN, CLAUDIO; DE SOUZA PINTO, DIANA; OTTO-SALAJ, LAURA; COURNOS, FRANCINE; AND THE INVESTIGATORS OF PRISSMA

    2008-01-01

    We conducted the first study to examine rates of sexual activity, sexual risk behaviors, sexual protective behaviors, injection drug use (IDU), needle sharing, and knowledge about HIV/AIDS among outpatients with severe mental illness (SMI) in Rio de Janeiro, Brazil. Using a measure with demonstrated reliability, we found that 42% of 98 patients engaged in vaginal or anal sex within the past three months. Comorbid substance use disorder was significantly associated with sexual activity. Only 22% of sexually active patients used condoms consistently, despite having better HIV knowledge than those who were sexually abstinent. Overall, 45% of patients reported not engaging in any HIV protective behaviors. There were no reports of drug injection. Adults with SMI in Brazil are in need of efficacious HIV prevention programs and policies that can sustain these programs within mental health treatment settings. PMID:18836542

  20. Personalized Predictive Modeling and Risk Factor Identification using Patient Similarity.

    PubMed

    Ng, Kenney; Sun, Jimeng; Hu, Jianying; Wang, Fei

    2015-01-01

    Personalized predictive models are customized for an individual patient and trained using information from similar patients. Compared to global models trained on all patients, they have the potential to produce more accurate risk scores and capture more relevant risk factors for individual patients. This paper presents an approach for building personalized predictive models and generating personalized risk factor profiles. A locally supervised metric learning (LSML) similarity measure is trained for diabetes onset and used to find clinically similar patients. Personalized risk profiles are created by analyzing the parameters of the trained personalized logistic regression models. A 15,000 patient data set, derived from electronic health records, is used to evaluate the approach. The predictive results show that the personalized models can outperform the global model. Cluster analysis of the risk profiles show groups of patients with similar risk factors, differences in the top risk factors for different groups of patients and differences between the individual and global risk factors.

  1. AIDS risk-taking behavior during carnival in São Paulo, Brazil.

    PubMed

    Hughes, V; Stall, R D; Klouri, C; Barrett, D C; Arevalo, E I; Hearst, N

    1995-07-01

    The Brazilian Carnival is thought to be a time when the risk of HIV infection is likely to be high. We therefore compared the risk during Carnival to risk in the past month among male samba school participants in São Paulo, Brazil. A cross-sectional study was conducted among 380 male samba school drummers randomly sampled during rehearsal for the 1993 Carnival in São Paulo by means of a 20-min interviewer-administered questionnaire. The main outcome variable was condom use with non-steady partners. The sexual behavior of 36.1% of subjects risked HIV infection, but only 9.7% of all subjects were at risk only during Carnival. Subjects with a sexual risk of HIV differed from those without risk in substance use, attitudes towards condoms and expectations about Carnival; those who were at risk only during Carnival did not differ from those who were at risk at other times. About half of the subjects had been given free condoms during Carnival, although few of the men at risk had actually used them. Though more than a third of the drummers were at risk of HIV infection, only a small per cent were at risk only during Carnival. The level of sexual risk of HIV infection is probably better explained by factors in the men's daily lives, rather than through information on risks taken during Carnival. These results raise questions concerning the efficacy of universal condom distribution during Carnival, since about half of the men were given condoms but few of those at risk actually used them. A targeted distribution of condoms to populations with a high demonstrated risk may be more effective in preventing new HIV infection.

  2. CSF 5-HIAA Predicts Suicide Risk after Attempted Suicide.

    ERIC Educational Resources Information Center

    Nordstrom, Peter; And Others

    1994-01-01

    Studied suicide risk after attempted suicide, as predicted by cerebrospinal fluid (CSF) monoamine metabolite concentrations, in 92 psychiatric mood disorder inpatients admitted shortly after attempting suicide. Results revealed that low CSF 5-hydroxyindoleacetic acid (5-HIAA) predicted short-range suicide risk after attempted suicide in mood…

  3. Analysis of risk prediction capability and validity of Morse Fall Scale Brazilian version.

    PubMed

    Urbanetto, Janete de Souza; Pasa, Thiana Sebben; Bittencout, Hélio Radke; Franz, Flavia; Rosa, Vitor Pena Prazido; Magnago, Tânia Solange Bosi de Souza

    2017-02-16

    To analyse the power to predict risk and verify the validity of the Morse Fall Scale - Brazilian version (MFS-B). This is a methodological, longitudinal study with 1487 adult patients of two university hospitals of Rio Grande do Sul, Brazil conducted from November 2013 to March 2014. The MFS-B was used to assess the risk of falls. Statistical analysis comprised multivariate methods (discriminant function analysis and ROC curve). The research was approved by the ethics committees of the institutions. The best estimate to predict falls was at the cutoff point 44.78 of the average MFS-B score, with a sensitivity of 95.2% and a specificity of 64%. The occurrence of falls and the high-risk classification were significant (p<0.00001). The results show that the MFS-B can appropriately predict the risk of falls at the cutoff point for the high-risk classification, according to the original classification. The MFS-B had adequate validation test results and maintained the six items of the original scale.

  4. Detection and risk assessment of diarrheagenic E. coli in recreational beaches of Brazil.

    PubMed

    Rodrigues, Vanessa F V; Rivera, Irma N G; Lim, Keah-Ying; Jiang, Sunny C

    2016-08-15

    Marine beaches are important recreational and economic resources in Brazil, but the beaches' water quality is negatively impacted by the discharge of domestic sewage effluent. The occurrence of diarrheagenic Escherichiacoli among the E. coli isolated from three Brazilian marine beaches was investigated. Multiplex and single step PCR were used to screen 99 E. coli isolates for ten target toxin genes. Six toxin genes, stx1, eae, estp, esth, astA, and bfpA, were identified in 1% to 35% of the isolates. A quantitative microbial risk assessment (QMRA) of human exposure to diarrheagenic E. coli during marine recreation was carried out. The results indicated that the diarrheagenic E. coli risk is well below the U.S. EPA's recommended daily recreational risk benchmark. However, the overall recreational health risk due to all pathogens in the water could be much higher and exceeded the U.S. EPA's benchmark. Copyright © 2016 Elsevier Ltd. All rights reserved.

  5. Is the microagglutination test (MAT) good for predicting the infecting serogroup for leptospirosis in Brazil?

    PubMed

    Blanco, Roberta Morozetti; dos Santos, Luis Fernando; Galloway, Renee Lynn; Romero, Eliete Caló

    2016-02-01

    Leptospirosis is a zoonotic infection caused by pathogenic members of the genus Leptospira spp. Knowledge of the prevalent serovars and their maintenance hosts is essential to understand the disease. The aim of this study was to evaluate the ability of serology by the microscopic agglutination test (MAT) to predict the serogroups compared with results of identification of leptospires in São Paulo, Brazil. MAT correctly assigned the serogroup of the infecting isolate in 49/52 cases (94.23%). The serogroup Icterohaemorrhagiae was the predominant serogroup (88.46%). This study showed the usefulness of the MAT to correctly identify the infecting serogroup with a good overall agreement between the serologically-identified infecting serogroup and by identification of the isolate and can be used in epidemiological surveys in São Paulo. However, it should be complemented by the identification of Leptospira isolates. Copyright © 2015 Elsevier Ltd. All rights reserved.

  6. A Risk Score for Predicting Multiple Sclerosis

    PubMed Central

    Dobson, Ruth; Ramagopalan, Sreeram; Topping, Joanne; Smith, Paul; Solanky, Bhavana; Schmierer, Klaus; Chard, Declan; Giovannoni, Gavin

    2016-01-01

    Objective Multiple sclerosis (MS) develops as a result of environmental influences on the genetically susceptible. Siblings of people with MS have an increased risk of both MS and demonstrating asymptomatic changes in keeping with MS. We set out to develop an MS risk score integrating both genetic and environmental risk factors. We used this score to identify siblings at extremes of MS risk and attempted to validate the score using brain MRI. Methods 78 probands with MS, 121 of their unaffected siblings and 103 healthy controls were studied. Personal history was taken, and serological and genetic analysis using the illumina immunochip was performed. Odds ratios for MS associated with each risk factor were derived from existing literature, and the log values of the odds ratios from each of the risk factors were combined in an additive model to provide an overall score. Scores were initially calculated using log odds ratio from the HLA-DRB1*1501 allele only, secondly using data from all MS-associated SNPs identified in the 2011 GWAS. Subjects with extreme risk scores underwent validation studies. MRI was performed on selected individuals. Results There was a significant difference in the both risk scores between people with MS, their unaffected siblings and healthy controls (p<0.0005). Unaffected siblings had a risk score intermediate to people with MS and controls (p<0.0005). The best performing risk score generated an AUC of 0.82 (95%CI 0.75–0.88). Interpretations The risk score demonstrates an AUC on the threshold for clinical utility. Our score enables the identification of a high-risk sibling group to inform pre-symptomatic longitudinal studies. PMID:27802296

  7. A principal component approach for predicting the stem volume in Eucalyptus plantations in Brazil using airborne LiDAR data

    Treesearch

    Carlos Alberto Silva; Carine Klauberg; Andrew T. Hudak; Lee A. Vierling; Veraldo Liesenberg; Samuel P. C. e Carvalho; Luiz C. E. Rodriguez

    2016-01-01

    Improving management practices in industrial forest plantations may increase production efficiencies, thereby reducing pressures on native tropical forests for meeting global pulp needs. This study aims to predict stem volume (V) in plantations of fast-growing Eucalyptus hybrid clones located in southeast Brazil using field plot and airborne Light Detection...

  8. Toxoplasmosis screening and risk factors amongst pregnant females in Natal, northeastern Brazil.

    PubMed

    Barbosa, Isabelle Ribeiro; de Carvalho Xavier Holanda, Cecília Maria; de Andrade-Neto, Valter Ferreira

    2009-04-01

    Toxoplasmosis results in systemic disease, and if the mother is infected for the first time during gestation, the fetus may suffer substantial damage. Relatively little is known about the epidemiology of toxoplasmosis in pregnancy in most states of northeastern Brazil. Seroprevalence of toxoplasmosis among pregnant woman was studied in Natal, capital of Rio Grande do Norte State, in northeastern Brazil, from March to December 2007. The sera were tested for IgM and avidity of IgG antibodies to Toxoplasma by a microparticle enzyme immunoassay. The overall seroprevalence was high [126/190 (66.3%)]; prevalence increased with age indicating that in this setting most infections occur in adulthood (third decade of life). Only one pregnant woman was IgM positive and had high-avidity antibodies. The high percentage of pregnant women who are vulnerable to this parasite (33.1%) favors primary infection during pregnancy. Our studies show that direct contact with cats or dogs was highly associated with toxoplasmosis (odds ratio 2.72, P<0.001, 95% CI 1.46-5.02). The number of years in school (P<0.001), precarious socioeconomic status and limited knowledge about the disease (Prisk factors for infection corroborate other studies in Brazil.

  9. Intensification of cattle ranching production systems: socioeconomic and environmental synergies and risks in Brazil.

    PubMed

    Latawiec, A E; Strassburg, B B N; Valentim, J F; Ramos, F; Alves-Pinto, H N

    2014-08-01

    Intensification of Brazilian cattle ranching systems has attracted both national and international attention due to its direct relation with Amazon deforestation on the one hand and increasing demand of the global population for meat on the other. Since Brazilian cattle ranching is predominantly pasture-based, we particularly focus on pasture management. We summarize the most recurrent opportunities and risks associated with pasture intensification that are brought up within scientific and political dialogues, and discuss them within the Brazilian context. We argue that sustainable intensification of pasturelands in Brazil is a viable way to increase agricultural output while simultaneously sparing land for nature. Since environmental degradation is often associated with low-yield extensive systems in Brazil, it is possible to obtain higher yields, while reversing degradation, by adopting practices like rotational grazing, incorporation of legumes and integrated crop-livestock-forestry systems. Technical assistance is however essential, particularly for small- and medium-scale farmers. Sound complementary policies and good governance must accompany these measures so that a 'rebound effect' does not lead to increased deforestation and other adverse social and environmental impacts. It is also important that animal welfare is not compromised. Although the discussion is presented with respect to Brazil, some aspects are relevant to other developing countries.

  10. Risk Factor Fusion for Predicting Multifactorial Diseases

    DTIC Science & Technology

    2007-11-02

    validity of method is demonstrated by applying it to predict the occur- rence of gout in patients. 1. INTRODUCTION The goal in this paper is to...and parametric classifier design. In order to demonstrate the validity of the approach, the prediction of gout , which is a multifactorial disease...is considered. The goal is to classify a patient into one of two classes: gout or non- gout . The approach for gout classification is summarized in

  11. Lipoprotein metabolism indicators improve cardiovascular risk prediction

    USDA-ARS?s Scientific Manuscript database

    Background: Cardiovascular disease risk increases when lipoprotein metabolism is dysfunctional. We have developed a computational model able to derive indicators of lipoprotein production, lipolysis, and uptake processes from a single lipoprotein profile measurement. This is the first study to inves...

  12. Coronary risk factors in adult children of parents with coronary heart disease: a comparison survey of southeastern Brazil and southeastern United States.

    PubMed

    Bueno, Nelia; Fletcher, Barbara J; Fletcher, Gerald F; Serra, Salvador; Cruz, Pedro di Marco da; Kelly, Deborah; Meirelles, Luisa; Atkinson, Elizabeth; Tabor, Leigh Ann; Ramos, Adriana; Castro, Iran

    2005-01-01

    A survey was performed in southeastern Brazil and in the southeastern United States to: 1) compare coronary risk factors in adult children (>18 years old) of parents with coronary heart disease enrolled in cardiac rehabilitation programs in countries with different geographic, social, and economic factors; and 2) to assess the influence of coronary heart disease of parents on alteration of lifestyle in these adult children. There were 286 biological children available for the survey (135 Brazil, 151 United States). Of those, 142 completed the survey (78 Brazil, 64 United States) for an overall compliance rate of 50% (58% Brazil, 42% United States). The following differences were noted: blood pressure > 159/90 mm Hg (23% Brazil, 15% United States [nonsignificant]); total cholesterol > 181 mg/dL (5% Brazil, 30% United States [p < 0.001]); HDL-C < 35 mg/dL (95% Brazil, 21% United States [p < 0.001]); low-fat diet (29% Brazil, 64% United States [p < 0.001]); smoke/ever (41% Brazil, 34% United States [nonsignificant]); currently smoke (72% Brazil, 18% United States [p < 0.001]); any exercise [44% Brazil, 82% United States [p < 0.001]); exercise > 90 minute/week (18% Brazil, 20% United States [nonsignificant]); improved lifestyle habits (39% Brazil, 79% United States [p < 0.001]); improved lifestyle habits related to parent's coronary heart disease (66% Brazil, 35% United States [p < 0.05]). Such differences may reflect geographic, social, and/or economic factors.

  13. Seroprevalence and risk factors for Neospora caninum in goats in Santa Catarina state, Brazil.

    PubMed

    Topazio, Josué Pires; Weber, Augusto; Camillo, Giovana; Vogel, Fernanda Flores; Machado, Gustavo; Ribeiro, André; Moura, Anderson Barbosa; Lopes, Leandro Sâmia; Tonin, Alexandre Alberto; Soldá, Natan Marcos; Bräunig, Patrícia; Silva, Aleksandro Schafer da

    2014-01-01

    Neosporosis is an infectious disease caused by the parasite Neospora caninum. Knowledge regarding neosporosis in goats is still quite limited, especially in the state of Santa Catarina (SC), southern Brazil. Therefore, this study aimed to assess the seroprevalence and risk factors for N. caninum in goats in the western and mountain regions of SC. Blood samples were collected from 654 goats in 57 municipalities. The indirect immunofluorescence test was used for antibody detection against N. caninum. Thirty samples (4.58%) were seropositive, with titers ranging from 1:50 to 1:6400. An epidemiological survey was also conducted in order to identify risk factors for neosporosis in goats. It was found that reproductive problems on the farms, as well as the diet and direct contact with dogs were casual risks for neosporosis. These results indicate that N. caninum infects goats in these regions, which may lead to reproductive problems.

  14. Lung cancer risk prediction: a tool for early detection.

    PubMed

    Cassidy, Adrian; Duffy, Stephen W; Myles, Jonathan P; Liloglou, Triantafillos; Field, John K

    2007-01-01

    Although 45% of men and 39% of women will be diagnosed with cancer in their lifetime, it is difficult to predict which individuals will be affected. For some cancers, substantial progress in individual risk estimation has already been made. However, relatively few models have been developed to predict lung cancer risk beyond effects of age and smoking. This paper reviews published models for lung cancer risk prediction, discusses their potential contribution to clinical and research settings and suggests improvements to the risk modeling strategy for lung cancer. The sensitivity and specificity of existing cancer risk models is less than optimal. Improvement in individual risk prediction is important for selection of individuals for prevention or early detection interventions. In addition to smoking, factors related to occupational exposure, personal medical history and family history of cancer can add to the predictive power. A good risk prediction model is one that can identify a small fraction of the population in which a large proportion of the disease cases will occur. In the future, genetic and other biological markers are likely to be useful, although they will require rigorous evaluation. Validation is essential to establish the predictive effect and for ongoing monitoring of the model's continued relevance.

  15. Decreasing flood risk perception in Porto Alegre - Brazil and its influence on water resource management decisions

    NASA Astrophysics Data System (ADS)

    Allasia, D. G.; Tassi, R.; Bemfica, D.; Goldenfum, J. A.

    2015-06-01

    Porto Alegre is the capital and largest city in the Brazilian state of Rio Grande do Sul in Southern Brazil with approximately 1.5 million inhabitants. The city lies on the eastern bank of the Guaiba Lake, formed by the convergence of five rivers and leading to the Lagoa dos Patos, a giant freshwater lagoon navigable by even the largest of ships. This river junction has become an important alluvial port as well as a chief industrial and commercial centre. However, this strategic location resulted in severe damage because of its exposure to flooding from the river system, affecting the city in the years 1873, 1928, 1936, 1941 and 1967. In order to reduce flood risk, a complex system of levees and pump stations was implemented during 1960s and 1970s. Since its construction, not a single large flood event occurred. However, in recent years, the levees in the downtown region of Porto Alegre were severally criticized by city planners and population. Several projects have been proposed to demolish the Mauá Wall due to the false perception of lack of flood risk. Similar opinions and reactions against flood infrastructure have been observed in other cities in Brazil, such as Itajaí and Blumenau, with disastrous consequences. This paper illustrates how the perception of flood risk in Porto Alegre has changed over recent years as a result of flood infrastructure, and how such changes in perceptions can influence water management decisions.

  16. Association between perceived lifetime risk of cardiovascular disease and calculated risk in a male population in Brazil

    PubMed Central

    de Lima, Mário Maciel; da Silva, Glaciane Rocha; Jensem Filho, Sebastião Salazar; Granja, Fabiana

    2016-01-01

    Aim Cardiovascular disease is the major cause of morbidity and mortality across the world. Despite health campaigns to improve awareness of cardiovascular risk factors, there has been little improvement in cardiovascular mortality. In this study, we sought to examine the association between cardiovascular risk factors and people’s perception on cardiovascular risk. Methods This was an epidemiological, cross-sectional, descriptive, prospective study of Masonic men aged >40 years in Boa Vista, Brazil. Participants completed a health survey, which included three questions about perception of their stress level, overall health status, and risk of a heart attack. In addition, demographic and biological data were collected. Results A total of 101 Masonic men took part in the study; their mean age (± standard deviation) was 55.35±9.17 years and mean body mass index was 28.77±4.51 kg/m2. Answers to the lifestyle questionnaire suggested an overall healthy lifestyle, including good diet and moderate exercise, although despite this ~80% were classified as overweight or obese. The majority of participants felt that they had a low stress level (66.3%), good overall general health (63.4%), and were at low risk of having a heart attack (71.3%). Masons who were overweight were significantly more likely to perceive themselves to be at risk of a heart attack (P=0.025). Conclusion Despite over half of participants having a moderate to high risk of cardiovascular disease according to traditional risk factors, less than a third perceived themselves to be at high risk. Public health campaigns need to better communicate the significance of traditional cardiovascular risk in order to improve awareness of risk among the general population. PMID:27382297

  17. Risk prediction models for hepatocellular carcinoma in different populations

    PubMed Central

    Ma, Xiao; Yang, Yang; Tu, Hong; Gao, Jing; Tan, Yu-Ting; Zheng, Jia-Li; Bray, Freddie; Xiang, Yong-Bing

    2016-01-01

    Hepatocellular carcinoma (HCC) is a malignant disease with limited therapeutic options due to its aggressive progression. It places heavy burden on most low and middle income countries to treat HCC patients. Nowadays accurate HCC risk predictions can help making decisions on the need for HCC surveillance and antiviral therapy. HCC risk prediction models based on major risk factors of HCC are useful and helpful in providing adequate surveillance strategies to individuals who have different risk levels. Several risk prediction models among cohorts of different populations for estimating HCC incidence have been presented recently by using simple, efficient, and ready-to-use parameters. Moreover, using predictive scoring systems to assess HCC development can provide suggestions to improve clinical and public health approaches, making them more cost-effective and effort-effective, for inducing personalized surveillance programs according to risk stratification. In this review, the features of risk prediction models of HCC across different populations were summarized, and the perspectives of HCC risk prediction models were discussed as well. PMID:27199512

  18. Predicting cancer risks from dental computed tomography.

    PubMed

    Wu, T-H; Lin, W-C; Chen, W-K; Chang, Y-C; Hwang, J-J

    2015-01-01

    Dental computed tomography (CT) has become a common tool when carrying out dental implants, yet there is little information available on its associated cancer risk. The objective of this study was to estimate the lifetime-attributable risk (LAR) of cancer incidence that is associated with the radiation dose from dental CT scans and to evaluate the effect of scan position, sex, and age on the cancer risk. This retrospective cohort study involved 505 participants who underwent CT scans. The mean effective doses for male and female patients in the maxilla group were 408 and 389 µSv (P = 0.055), respectively, whereas the mean effective doses for male and female patients in the mandible groups were 475 and 450 µSv (P < 0.001), respectively. The LAR for cancer incidence after mandible CT scanning varied from 1 in 16,196 for a 30-y-old woman to 1 in 114,680 for a 70-y-old man. The organ-specific cancer risks for thyroid cancer, other cancers, leukemia, and lung cancer account for 99% of the LAR. Among patients of all ages, the estimated LAR of a mandible scan was higher than that of a maxilla scan. Furthermore, the LAR for female thyroid cancer had a peak before age 45 y. The risk for a woman aged 30 y is roughly 8 times higher than that of a woman aged 50 y. After undergoing a dental CT scan, the possible cancer risks related to sex and age across various different anatomical regions are not similar. The greatest risk due to a dental CT scan is for a mandible scan when the woman is younger than 45 y. Given the limits of the sample size, machine parameters, and the retrospective nature of this study, the results need to be interpreted within the context of this patient population. Future studies will be of value to corroborate these findings. © International & American Associations for Dental Research 2014.

  19. Predicting the risk of sudden cardiac death

    PubMed Central

    Lerma, Claudia

    2016-01-01

    Abstract Sudden cardiac death (SCD) is the result of a change of cardiac activity from normal (typically sinus) rhythm to a rhythm that does not pump adequate blood to the brain. The most common rhythms leading to SCD are ventricular tachycardia (VT) or ventricular fibrillation (VF). These result from an accelerated ventricular pacemaker or ventricular reentrant waves. Despite significant efforts to develop accurate predictors for the risk of SCD, current methods for risk stratification still need to be improved. In this article we briefly review current approaches to risk stratification. Then we discuss the mathematical basis for dynamical transitions (called bifurcations) that may lead to VT and VF. One mechanism for transition to VT or VF involves a perturbation by a premature ventricular complex (PVC) during sinus rhythm. We describe the main mechanisms of PVCs (reentry, independent pacemakers and abnormal depolarizations). An emerging approach to risk stratification for SCD involves the development of individualized dynamical models of a patient based on measured anatomy and physiology. Careful analysis and modelling of dynamics of ventricular arrhythmia on an individual basis will be essential in order to improve risk stratification for SCD and to lay a foundation for personalized (precision) medicine in cardiology. PMID:26660287

  20. Predicting the risk of sudden cardiac death.

    PubMed

    Lerma, Claudia; Glass, Leon

    2016-05-01

    Sudden cardiac death (SCD) is the result of a change of cardiac activity from normal (typically sinus) rhythm to a rhythm that does not pump adequate blood to the brain. The most common rhythms leading to SCD are ventricular tachycardia (VT) or ventricular fibrillation (VF). These result from an accelerated ventricular pacemaker or ventricular reentrant waves. Despite significant efforts to develop accurate predictors for the risk of SCD, current methods for risk stratification still need to be improved. In this article we briefly review current approaches to risk stratification. Then we discuss the mathematical basis for dynamical transitions (called bifurcations) that may lead to VT and VF. One mechanism for transition to VT or VF involves a perturbation by a premature ventricular complex (PVC) during sinus rhythm. We describe the main mechanisms of PVCs (reentry, independent pacemakers and abnormal depolarizations). An emerging approach to risk stratification for SCD involves the development of individualized dynamical models of a patient based on measured anatomy and physiology. Careful analysis and modelling of dynamics of ventricular arrhythmia on an individual basis will be essential in order to improve risk stratification for SCD and to lay a foundation for personalized (precision) medicine in cardiology. © 2015 The Authors. The Journal of Physiology © 2015 The Physiological Society.

  1. Predicting extinction risk in declining species.

    PubMed Central

    Purvis, A; Gittleman, J L; Cowlishaw, G; Mace, G M

    2000-01-01

    What biological attributes predispose species to the risk of extinction? There are many hypotheses but so far there has been no systematic analysis for discriminating between them. Using complete phylogenies of contemporary carnivores and primates, we present, to our knowledge, the first comparative test showing that high trophic level, low population density slow life history and, in particular, small geographical range size are all significantly and independently associated with a high extinction risk in declining species. These traits together explain nearly 50% of the total between-species variation in extinction risk. Much of the remaining variation can be accounted for by external anthropogenic factors that affect species irrespective of their biology. PMID:11075706

  2. Adolescent dietary intakes predict cardiometabolic risk clustering.

    PubMed

    Moore, Lynn L; Singer, Martha R; Bradlee, M Loring; Daniels, Stephen R

    2016-03-01

    To prospectively examine the relation between adolescent dietary intake and cardiometabolic risk (CMR) clustering at the end of adolescence. Data from the NHLBI Growth and Health Study on 1369 girls enrolled at ages 9-10 in 1987-1988 and followed for 10 years were used to estimate the relative risk of having multiple (≥2 or ≥3) risk factors in late adolescence associated with usual food intake patterns from 9 to 17 years of age. Mean food intakes were derived from multiple 3-day diet records and CMR factors included larger waist circumference, insulin resistance, low high-density lipoprotein cholesterol, high low-density lipoprotein cholesterol, high triglycerides, and elevated systolic or diastolic blood pressures. Of 1369 subjects, 18.4 % girls had 3-6 prevalent risk factors by the end of adolescence and 35.0 % had at least two. Higher intakes of fruit and non-starchy vegetables, dairy, and grains were independently associated with having fewer risk factors as were eating patterns characterized by higher combined intakes of these food groups. After adjusting for age, race, socio-economic status, height, physical activity, and television watching, girls with high intakes of dairy and fruits and non-starchy vegetables (vs. those with lower intakes of both) were nearly 50 % less likely to have three or more CMR factors in late adolescence; girls with higher intakes of grains plus fruits and non-starchy vegetables were nearly 60 % less likely. These results suggest that healthy food consumption patterns during adolescence may prevent accumulation of cardiometabolic risk.

  3. Variation of surface ozone in Campo Grande, Brazil: meteorological effect analysis and prediction.

    PubMed

    Pires, J C M; Souza, A; Pavão, H G; Martins, F G

    2014-09-01

    The effect of meteorological variables on surface ozone (O3) concentrations was analysed based on temporal variation of linear correlation and artificial neural network (ANN) models defined by genetic algorithms (GAs). ANN models were also used to predict the daily average concentration of this air pollutant in Campo Grande, Brazil. Three methodologies were applied using GAs, two of them considering threshold models. In these models, the variables selected to define different regimes were daily average O3 concentration, relative humidity and solar radiation. The threshold model that considers two O3 regimes was the one that correctly describes the effect of important meteorological variables in O3 behaviour, presenting also a good predictive performance. Solar radiation, relative humidity and rainfall were considered significant for both O3 regimes; however, wind speed (dispersion effect) was only significant for high concentrations. According to this model, high O3 concentrations corresponded to high solar radiation, low relative humidity and wind speed. This model showed to be a powerful tool to interpret the O3 behaviour, being useful to define policy strategies for human health protection regarding air pollution.

  4. Risk prediction model: Statistical and artificial neural network approach

    NASA Astrophysics Data System (ADS)

    Paiman, Nuur Azreen; Hariri, Azian; Masood, Ibrahim

    2017-04-01

    Prediction models are increasingly gaining popularity and had been used in numerous areas of studies to complement and fulfilled clinical reasoning and decision making nowadays. The adoption of such models assist physician's decision making, individual's behavior, and consequently improve individual outcomes and the cost-effectiveness of care. The objective of this paper is to reviewed articles related to risk prediction model in order to understand the suitable approach, development and the validation process of risk prediction model. A qualitative review of the aims, methods and significant main outcomes of the nineteen published articles that developed risk prediction models from numerous fields were done. This paper also reviewed on how researchers develop and validate the risk prediction models based on statistical and artificial neural network approach. From the review done, some methodological recommendation in developing and validating the prediction model were highlighted. According to studies that had been done, artificial neural network approached in developing the prediction model were more accurate compared to statistical approach. However currently, only limited published literature discussed on which approach is more accurate for risk prediction model development.

  5. Updating Risk Prediction Tools: A Case Study in Prostate Cancer

    PubMed Central

    Ankerst, Donna P.; Koniarski, Tim; Liang, Yuanyuan; Leach, Robin J.; Feng, Ziding; Sanda, Martin G.; Partin, Alan W.; Chan, Daniel W; Kagan, Jacob; Sokoll, Lori; Wei, John T; Thompson, Ian M.

    2013-01-01

    Online risk prediction tools for common cancers are now easily accessible and widely used by patients and doctors for informed decision-making concerning screening and diagnosis. A practical problem is as cancer research moves forward and new biomarkers and risk factors are discovered, there is a need to update the risk algorithms to include them. Typically the new markers and risk factors cannot be retrospectively measured on the same study participants used to develop the original prediction tool, necessitating the merging of a separate study of different participants, which may be much smaller in sample size and of a different design. Validation of the updated tool on a third independent data set is warranted before the updated tool can go online. This article reports on the application of Bayes rule for updating risk prediction tools to include a set of biomarkers measured in an external study to the original study used to develop the risk prediction tool. The procedure is illustrated in the context of updating the online Prostate Cancer Prevention Trial Risk Calculator to incorporate the new markers %freePSA and [−2]proPSA measured on an external case control study performed in Texas, U.S.. Recent state-of-the art methods in validation of risk prediction tools and evaluation of the improvement of updated to original tools are implemented using an external validation set provided by the U.S. Early Detection Research Network. PMID:22095849

  6. Predicting Risk Sensitivity in Humans and Lower Animals: Risk as Variance or Coefficient of Variation

    ERIC Educational Resources Information Center

    Weber, Elke U.; Shafir, Sharoni; Blais, Ann-Renee

    2004-01-01

    This article examines the statistical determinants of risk preference. In a meta-analysis of animal risk preference (foraging birds and insects), the coefficient of variation (CV), a measure of risk per unit of return, predicts choices far better than outcome variance, the risk measure of normative models. In a meta-analysis of human risk…

  7. Predicting Risk Sensitivity in Humans and Lower Animals: Risk as Variance or Coefficient of Variation

    ERIC Educational Resources Information Center

    Weber, Elke U.; Shafir, Sharoni; Blais, Ann-Renee

    2004-01-01

    This article examines the statistical determinants of risk preference. In a meta-analysis of animal risk preference (foraging birds and insects), the coefficient of variation (CV), a measure of risk per unit of return, predicts choices far better than outcome variance, the risk measure of normative models. In a meta-analysis of human risk…

  8. Submission Form for Peer-Reviewed Cancer Risk Prediction Models

    Cancer.gov

    If you have information about a peer-reviewd cancer risk prediction model that you would like to be considered for inclusion on this list, submit as much information as possible through the form on this page.

  9. [Rural work and health risks: a review into de "safe use" of pesticides in Brazil].

    PubMed

    de Abreu, Pedro Henrique Barbosa; Alonzo, Herling Gregorio Aguilar

    2014-10-01

    The paradigm of the "safe use" of pesticides is based on measures to control risks in the handling of these products. However, studies carried out in various regions of Brazil reveal a situation of widespread exposure and health damages among rural workers, revealing the ineffectiveness of this paradigm. This work presents a critical review of the "safe use" approach for pesticides in scientific papers published in Brazil in the past 15 years. Results indicate that these studies do not address, simultaneously, all the work activities that involve exposure and risk of intoxication (acquisition, transportation, storage, preparation and application, final disposal of empty containers and sanitization of contaminated clothes/ PPEs), nor do they comprehensively address the "safe use" measures recommended in safety manuals, which are mandatory for each activity. A total of 25 studies were selected and analyzed, revealing a high number of results and analyses regarding activities of preparation and application and final disposal of empty containers. The range of the approaches was seen to be timely in the six work activities. For future studies, a broader approach of the "safe use" of pesticides is recommended, seeking to reveal the complete infeasibility of this safety paradigm.

  10. Use of transgenic Aedes aegypti in Brazil: risk perception and assessment.

    PubMed

    Paes de Andrade, Paulo; Aragão, Francisco José Lima; Colli, Walter; Dellagostin, Odir Antônio; Finardi-Filho, Flávio; Hirata, Mario Hiroyuki; Lira-Neto, Amaro de Castro; Almeida de Melo, Marcia; Nepomuceno, Alexandre Lima; Gorgônio da Nóbrega, Francisco; Delfino de Sousa, Gutemberg; Valicente, Fernando Hercos; Zanettini, Maria Helena Bodanese

    2016-10-01

    The OX513A strain of Aedes aegypti, which was developed by the British company Oxitec, expresses a self-limiting transgene that prevents larvae from developing to adulthood. In April 2014, the Brazilian National Technical Commission on Biosafety completed a risk assessment of OX513A and concluded that the strain did not present new biological risks to humans or the environment and could be released in Brazil. At that point, Brazil became the first country to approve the unconstrained release of a genetically modified mosquito. During the assessment, the commission produced a comprehensive list of - and systematically analysed - the perceived hazards. Such hazards included the potential survival to adulthood of immature stages carrying the transgene - should the transgene fail to be expressed or be turned off by exposure to sufficient environmental tetracycline. Other perceived hazards included the potential allergenicity and/or toxicity of the proteins expressed by the gene, the potential for gene flow or increased transmission of human pathogens and the occupation of vacant breeding sites by other vector species. The Zika epidemic both elevated the perceived importance of Ae. aegypti as a vector - among policy-makers and regulators as well as the general public - and increased concerns over the release of males of the OX513A strain. We have therefore reassessed the potential hazards. We found that release of the transgenic mosquitoes would still be both safe and of great potential value in the control of diseases spread by Ae. aegypti, such as chikungunya, dengue and Zika.

  11. Analysis of working conditions focusing on biological risk: firefighters in Campo Grande, MS, Brazil.

    PubMed

    Contrera-Moreno, Luciana; de Andrade, Sonia Maria Oliveira; Motta-Castro, Ana Rita Coimbra; Pinto, Alexandra Maria Almeida Carvalho; Salas, Frederico Reis Pouso; Stief, Alcione Cavalheiros Faro

    2012-01-01

    Firefighters are exposed to a wide range of risks, among them, biological risk. The objective was to analyze working conditions of firefighters in the city of Campo Grande, MS, Brazil, focusing on risk conditions of exposure to biological material. Three hundred and seven (307) firefighters were interviewed for data collection and observed for ergonomic job analysis (AET). 63.5% of the firefighters suffered some kind of job related accident with blood or body fluids. Statistically significant association was found between having suffered accidents at work and incomplete use of personal protective equipment (PPE). About AET regarding the biological risks, 57.1% of all patients had blood or secretions, which corresponds in average to 16.0% of the total work time, based on a working day of 24 h. Besides biological risks, other stressing factors were identified: emergency and complexity of decision, high responsibility regarding patients and environment, and conflicts. Health promotion and accident prevention actions must be emphasized as measures to minimize these risks.

  12. Quantitative risk assessment for human salmonellosis through the consumption of pork sausage in Porto Alegre, Brazil.

    PubMed

    Mürmann, Lisandra; Corbellini, Luis Gustavo; Collor, Alexandre Ávila; Cardoso, Marisa

    2011-04-01

    A quantitative microbiology risk assessment was conducted to evaluate the risk of Salmonella infection to consumers of fresh pork sausages prepared at barbecues in Porto Alegre, Brazil. For the analysis, a prevalence of 24.4% positive pork sausages with a level of contamination between 0.03 and 460 CFU g(-1) was assumed. Data related to frequency and habits of consumption were obtained by a questionnaire survey given to 424 people. A second-order Monte Carlo simulation separating the uncertain parameter of cooking time from the variable parameters was run. Of the people interviewed, 87.5% consumed pork sausage, and 85.4% ate it at barbecues. The average risk of salmonellosis per barbecue at a minimum cooking time of 15.6 min (worst-case scenario) was 6.24 × 10(-4), and the risk assessed per month was 1.61 × 10(-3). Cooking for 19 min would fully inactivate Salmonella in 99.9% of the cases. At this cooking time, the sausage reached a mean internal temperature of 75.7°C. The results of the quantitative microbiology risk assessment revealed that the consumption of fresh pork sausage is safe when cooking time is approximately 19 min, whereas undercooked pork sausage may represent a nonnegligible health risk for consumers.

  13. Evaluating karst geotechnical risk in the urbanized area of Sete Lagoas, Minas Gerais, Brazil

    NASA Astrophysics Data System (ADS)

    Galvão, Paulo; Halihan, Todd; Hirata, Ricardo

    2015-11-01

    An increase in groundwater consumption in the municipality of Sete Lagoas (Minas Gerais, Brazil) has induced subsidence and collapse in the last three decades. The area is associated with natural karst conditions. The primary objective of this research was to evaluate and identify the potential subsidence or collapse risk zones. Aerial photographs, lithologic well profiles, optical well logs, and geologic mapping were utilized to categorize risk factors influencing karst subsidence and collapse, which were then applied to an index system. The study showed that the majority of the urbanized area overlies mantled limestone from the Sete Lagoas Formation covered with unconsolidated sediments, contained within a graben, resulting in barrier boundaries for groundwater flow. This structure, together with natural karst processes, explains the location of solutionally enlarged bedding-plane conduits and high hydraulic conductivity in the limestone. Five risks zones in the municipality were identified (negligible, low, moderate, considerable, and high risks) related to geologic and hydrologic risk factors. The urbanized area is located largely in the high risk zone where the majority of the collapse features are located. Additional intensive groundwater extraction in that area will likely generate additional events.

  14. Ensemble Streamflow Predictions in the Três Marias Basin, Brazil

    NASA Astrophysics Data System (ADS)

    Mainardi Fan, Fernando; Schwanenberg, Dirk; Kuwajima, Julio; Assis dos Reis, Alberto; Collischonn, Walter

    2014-05-01

    Hydropower is the main electricity source of Brazil. The related hydropower reservoirs are multi-purpose thus besides efficient and reliable energy production, they are relevant for flood control. In this context, the present study shows results of an Ensemble Streamflow Prediction (ESP) for supporting the operational decision making implemented at Três Marias hydroelectric power project located in the São Francisco River basin in Brazil. It is a large tropical river basin with approximately 55,000km² up to the Três Marias dam. The hydrological model used in the study is the MGB-IPH (Modelo de Grandes Bacias from Instituto de Pesquisas Hidráulicas), a large scale distributed hydrological model. Applied in an operational forecasting mode, it uses an empirical data assimilation method to take into account real time streamflow observations to update its state variables. We present results of a hindcast experiment with observed precipitation and streamflow data from the local energy utility, CEMIG (Companhia Energética de Minas Gerais), and from the Brazilian water agency, ANA (Agencia Nacional de Água),. Probabilistic Numerical Weather Predictions (NWP) from CPTEC (Centro de Previsão de Tempo e Estudos Climáticos), ECMWF (European Centre for Medium-Range Weather Forecast) and NOAA (National Oceanic and Atmospheric Administration) are used to generate the ESP. The data products and the MGB-IPH model are integrated into an open shell forecasting platform based on the software package Delft-FEWS. Inside the forecasting platform a hindcast mode over a forecast lead time of 10-16 days in recent rainfall periods is applied in. The ESP results are compared to deterministic forecasts of the Três Marias reservoir inflow. The results assessment verifies the added value of the ESP in general in comparison to the use of deterministic forecasts by means of different performance indicators. The ESP derived from the ECMWP ensemble shows the best performance. A future

  15. Use of a predictive model for food insecurity estimates in Brazil.

    PubMed

    Gubert, Muriel Bauermann; Benício, Maria Helena D'Aquino; da Silva, Joseane Padilha; da Costa Rosa, Tereza Etsuko; dos Santos, Soane Mota; dos Santos, Leonor Maria Pacheco

    2010-06-01

    In 2004 the National Household Survey (Pesquisa Nacional por Amostras de Domicilios-PNAD) estimated the prevalence of food and nutrition insecurity in Brazil. However, PNAD data cannot be disaggregated at the municipal level. The objective of this study was to build a statistical model to predict severe food insecurity for Brazilian municipalities based on the PNAD dataset. Exclusion criteria were: incomplete food security data (19.30%); informants younger than 18 years old (0.07%); collective households (0.05%); households headed by indigenous persons (0.19%). The modeling was carried out in three stages, beginning with the selection of variables related to food insecurity using univariate logistic regression. The variables chosen to construct the municipal estimates were selected from those included in PNAD as well as the 2000 Census. Multivariate logistic regression was then initiated, removing the non-significant variables with odds ratios adjusted by multiple logistic regression. The Wald Test was applied to check the significance of the coefficients in the logistic equation. The final model included the variables: per capita income; years of schooling; race and gender of the household head; urban or rural residence; access to public water supply; presence of children; total number of household inhabitants and state of residence. The adequacy of the model was tested using the Hosmer-Lemeshow test (p = 0.561) and ROC curve (area = 0.823). Tests indicated that the model has strong predictive power and can be used to determine household food insecurity in Brazilian municipalities, suggesting that similar predictive models may be useful tools in other Latin American countries.

  16. Identification of Risk Areas for Visceral Leishmaniasis in Teresina, Piaui State, Brazil

    PubMed Central

    de Almeida, Andréa S.; de Andrade Medronho, Roberto; Werneck, Guilherme L.

    2011-01-01

    This study used spatial analysis to identify areas at greatest risk of visceral leishmaniasis (VL) in the urban area of Teresina, Brazil during 2001–2006. The results from kernel ratios showed that peripheral census tracts were the most heavily affected. Local spatial analysis showed that in the beginning of the study period local clusters of high incidence of VL were mostly located in the southern and northeastern parts of the city, but in subsequent years those clusters also appeared in the northern region of the city, suggesting that the pattern of VL is not static, and the disease may occasionally spread to other areas of the municipality. We also observed a spatial correlation between VL rates and all socioeconomic and demographic indicators evaluated (P < 0.01). The concentration of interventions in high-risk areas could be an effective strategy to control the disease in the urban setting. PMID:21540375

  17. Leptospirosis seroprevalence and risk factors for sheep in Maranhão state, Brazil.

    PubMed

    de Carvalho, Sônia Maria; Mineiro, Ana Lys B B; Castro, Vanessa; Genovez, Margareth E; Azevedo, Sérgio Santos; Costa, Francisco A L

    2014-02-01

    This study was conducted to determine leptospirosis seroprevalence in sheep and their spatial distribution as well as identify risk factors associated with seropositivity in sheep from 37 herds and 11 municipalities in the Presidente Dutra microregion, Maranhão state, Brazil. We analyzed 379 blood serum samples using a Microscopic Agglutination Test (MAT). The individual seroprevalence was 32%. Of the 37 herds studied, 30 (81%, 95% CI 69-94%) had at least one seropositive animal. In seven municipalities, we observed infection in 100% of the herds. The serovars recorded were Grippotyphosa (67%), Wollfi with Hardjo (9%), Bratislava (9%), Hardjo (5%), Icterohaemorrhagiae (5%), Pomona (2%), Castellonis (2%) and Copenhageni (0.8%). We concluded that the Leptospira spp. in sheep is widespread in the area of sheep farms in Maranhão state, and a risk factor is the animals' water source.

  18. HIV infection and risk behaviors among male port workers in Santos, Brazil.

    PubMed Central

    Larcerda, R; Stall, R; Gravato, N; Tellini, R; Hudes, E S; Hearst, N

    1996-01-01

    OBJECTIVES. This paper measured the extent to which human immunodeficiency virus (HIV) infection has spread among the male working-class population of Santos, Brazil. METHODS. Questionnaires on risk behaviors and blood tests were administered to a random sample (n = 395) of male port workers employed by the Santos Port Authority. RESULTS. Although the rate of HIV infection among these men- the working-class male population of Santos-remains low (1.1%), self-reported behavioral risks for HIV infection are common. CONCLUSIONS. There is still time to prevent a widespread outbreak of HIV infection among the hetero-sexual population of Santos and of the transportation corridors emanating from that city. PMID:8712280

  19. Predicting child maltreatment: A meta-analysis of the predictive validity of risk assessment instruments.

    PubMed

    van der Put, Claudia E; Assink, Mark; Boekhout van Solinge, Noëlle F

    2017-09-22

    Risk assessment is crucial in preventing child maltreatment since it can identify high-risk cases in need of child protection intervention. Despite widespread use of risk assessment instruments in child welfare, it is unknown how well these instruments predict maltreatment and what instrument characteristics are associated with higher levels of predictive validity. Therefore, a multilevel meta-analysis was conducted to examine the predictive accuracy of (characteristics of) risk assessment instruments. A literature search yielded 30 independent studies (N=87,329) examining the predictive validity of 27 different risk assessment instruments. From these studies, 67 effect sizes could be extracted. Overall, a medium significant effect was found (AUC=0.681), indicating a moderate predictive accuracy. Moderator analyses revealed that onset of maltreatment can be better predicted than recurrence of maltreatment, which is a promising finding for early detection and prevention of child maltreatment. In addition, actuarial instruments were found to outperform clinical instruments. To bring risk and needs assessment in child welfare to a higher level, actuarial instruments should be further developed and strengthened by distinguishing risk assessment from needs assessment and by integrating risk assessment with case management. Copyright © 2017 Elsevier Ltd. All rights reserved.

  20. Prediction of Psychosis in Youth at High Clinical Risk

    PubMed Central

    Cannon, Tyrone D.; Cadenhead, Kristin; Cornblatt, Barbara; Woods, Scott W.; Addington, Jean; Walker, Elaine; Seidman, Larry J.; Perkins, Diana; Tsuang, Ming; McGlashan, Thomas; Heinssen, Robert

    2011-01-01

    Context Early detection and prospective evaluation of individuals who will develop schizophrenia or other psychotic disorders are critical to efforts to isolate mechanisms underlying psychosis onset and to the testing of preventive interventions, but existing risk prediction approaches have achieved only modest predictive accuracy. Objectives To determine the risk of conversion to psychosis and to evaluate a set of prediction algorithms maximizing positive predictive power in a clinical high-risk sample. Design, Setting, and Participants Longitudinal study with a 2½-year follow-up of 291 prospectively identified treatment-seeking patients meeting Structured Interview for Prodromal Syndromes criteria. The patients were recruited and underwent evaluation across 8 clinical research centers as part of the North American Prodrome Longitudinal Study. Main Outcome Measure Time to conversion to a fully psychotic form of mental illness. Results The risk of conversion to psychosis was 35%, with a decelerating rate of transition during the 2½-year follow-up. Five features assessed at baseline contributed uniquely to the prediction of psychosis: a genetic risk for schizophrenia with recent deterioration in functioning, higher levels of unusual thought content, higher levels of suspicion/paranoia, greater social impairment, and a history of substance abuse. Prediction algorithms combining 2 or 3 of these variables resulted in dramatic increases in positive predictive power (ie, 68%–80%) compared with the prodromal criteria alone. Conclusions These findings demonstrate that prospective ascertainment of individuals at risk for psychosis is feasible, with a level of predictive accuracy comparable to that in other areas of preventive medicine. They provide a benchmark for the rate and shape of the psychosis risk function against which standardized preventive intervention programs can be compared. PMID:18180426

  1. Clustering of Risk Factors for Non-Communicable Diseases among Adolescents from Southern Brazil

    PubMed Central

    2016-01-01

    Introduction The aim of this study was to investigate the simultaneous presence of risk factors for non-communicable diseases and the association of these risk factors with demographic and economic factors among adolescents from southern Brazil. Methods The study included 916 students (14–19 years old) enrolled in the 2014 school year at state schools in São José, Santa Catarina, Brazil. Risk factors related to lifestyle (i.e., physical inactivity, excessive alcohol consumption, smoking, sedentary behaviour and unhealthy diet), demographic variables (sex, age and skin colour) and economic variables (school shift and economic level) were assessed through a questionnaire. Simultaneous behaviours were assessed by the ratio between observed and expected prevalences of risk factors for non-communicable diseases. The clustering of risk factors was analysed by multinomial logistic regression. The clusters of risk factors that showed a higher prevalence were analysed by binary logistic regression. Results The clustering of two, three, four, and five risk factors were found in 22.2%, 49.3%, 21.7% and 3.1% of adolescents, respectively. Subgroups that were more likely to have both behaviours of physical inactivity and unhealthy diet simultaneously were mostly composed of girls (OR = 3.03, 95% CI = 1.57–5.85) and those with lower socioeconomic status (OR = 1.83, 95% CI = 1.05–3.21); simultaneous physical inactivity, excessive alcohol consumption, sedentary behaviour and unhealthy diet were mainly observed among older adolescents (OR = 1.49, 95% CI = 1.05–2.12). Subgroups less likely to have both behaviours of sedentary behaviour and unhealthy diet were mostly composed of girls (OR = 0.58, 95% CI = 0.38–0.89); simultaneous physical inactivity, sedentary behaviour and unhealthy diet were mainly observed among older individuals (OR = 0.66, 95% CI = 0.49–0.87) and those of the night shift (OR = 0.59, 95% CI = 0.43–0.82). Conclusion Adolescents had a high prevalence

  2. Risk avoidance in sympatric large carnivores: reactive or predictive?

    PubMed

    Broekhuis, Femke; Cozzi, Gabriele; Valeix, Marion; McNutt, John W; Macdonald, David W

    2013-09-01

    1. Risks of predation or interference competition are major factors shaping the distribution of species. An animal's response to risk can either be reactive, to an immediate risk, or predictive, based on preceding risk or past experiences. The manner in which animals respond to risk is key in understanding avoidance, and hence coexistence, between interacting species. 2. We investigated whether cheetahs (Acinonyx jubatus), known to be affected by predation and competition by lions (Panthera leo) and spotted hyaenas (Crocuta crocuta), respond reactively or predictively to the risks posed by these larger carnivores. 3. We used simultaneous spatial data from Global Positioning System (GPS) radiocollars deployed on all known social groups of cheetahs, lions and spotted hyaenas within a 2700 km(2) study area on the periphery of the Okavango Delta in northern Botswana. The response to risk of encountering lions and spotted hyaenas was explored on three levels: short-term or immediate risk, calculated as the distance to the nearest (contemporaneous) lion or spotted hyaena, long-term risk, calculated as the likelihood of encountering lions and spotted hyaenas based on their cumulative distributions over a 6-month period and habitat-associated risk, quantified by the habitat used by each of the three species. 4. We showed that space and habitat use by cheetahs was similar to that of lions and, to a lesser extent, spotted hyaenas. However, cheetahs avoided immediate risks by positioning themselves further from lions and spotted hyaenas than predicted by a random distribution. 5. Our results suggest that cheetah spatial distribution is a hierarchical process, first driven by resource acquisition and thereafter fine-tuned by predator avoidance; thus suggesting a reactive, rather than a predictive, response to risk.

  3. Protective and risk factors for toxocariasis in children from two different social classes of Brazil.

    PubMed

    Santarém, Vamilton Alvares; Leli, Flávia Noris Chagas; Rubinsky-Elefant, Guita; Giuffrida, Rogério

    2011-01-01

    The aim of this study was to analyze the prevalence of Toxocara spp. antibodies in children from two different socioeconomic classes in the Presidente Prudente municipality, São Paulo State, Brazil, and the protective and risk factors associated with toxocariasis. One hundred and twenty-six middle-class (MC) and 126 disadvantaged children (DC) were included in this study. Anti-Toxocara ELISA test was performed in order to evaluate seroprevalence. A survey was applied to the children's guardians/parents in order to analyze the protective and risk factors. The overall prevalence was 11.1%, and of 9.5% (12/126) and 12.7% (16/126) for MC and DC subgroups, respectively. Toxocara seropositivity was inversely proportional to the family income. A high household income was considered a protective factor for toxocariasis in the total population and in both MC and DC subgroups. Being a girl was considered a protective factor for the total population and for both subgroups. Whilst being an owner of cat was a risk factor for children belonging to the total and for both MC and DC subgroups, having dog was considered as a risk factor for only the MC. Epidemiologic protective/factor risks can be distinct depending on the strata of the same population. Thus, it is relevant to evaluate these factors independently for different socioeconomic classes in order to design future investigations and programs for preventing the infection of human beings by Toxocara spp. and other geohelminths.

  4. Risk communication concerning welding fumes for the primary preventive care of welding apprentices in southern Brazil.

    PubMed

    Cezar-Vaz, Marta Regina; Bonow, Clarice Alves; Vaz, Joana Cezar

    2015-01-19

    This study's aim was to assess the perceptions of welding apprentices concerning welding fumes being associated with respiratory and cardiovascular disorders and assess the implementation of risk communication as a primary prevention tool in the welding training process. This quasi-experimental, non-randomized study with before-and-after design was conducted with 84 welding apprentices in Southern Brazil. Poisson Regression analysis was used. Relative Risk was the measure used with a 95% confidence interval and 5% (p ≤ 0.05) significance level. Significant association was found between perceptions of worsened symptoms of respiratory disorders caused by welding fumes and educational level (p = 0.049), the use of goggles to protect against ultraviolet rays (p = 0.023), and access to services in private health facilities without insurance coverage (p = 0.001). Apprentices younger than 25 years old were 4.9 times more likely to perceive worsened cardiovascular symptoms caused by welding fumes after risk communication (RR = 4.91; CI 95%: 1.09 to 22.2). The conclusion is that risk communication as a primary preventive measure in continuing education processes implemented among apprentices, who are future welders, was efficacious. Thus, this study confirms that risk communication can be implemented as a primary prevention tool in welding apprenticeships.

  5. Risk Perception and Occupational Accidents: A Study of Gas Station Workers in Southern Brazil

    PubMed Central

    Cezar-Vaz, Marta Regina; Rocha, Laurelize Pereira; Bonow, Clarice Alves; da Silva, Mara Regina Santos; Vaz, Joana Cezar; Cardoso, Letícia Silveira

    2012-01-01

    The present study aimed to identify the perceptions of gas station workers about physical, chemical, biological and physiological risk factors to which they are exposed in their work environment; identify types of occupational accidents involving gas station workers and; report the development of a socioenvironmental intervention as a tool for risk communication to gas station workers. A quantitative study was performed with 221 gas station workers in southern Brazil between October and December 2010. Data collection was performed between October to December 2010 via structured interviews. The data were analyzed using SPSS 19.0. The participants identified the following risk types: chemical (93.7%), physical (88.2%), physiological (64.3%) and biological (62.4%). In this sample, 94.1% of gas station workers reported occupational accidents, and 74.2% reported fuel contact with the eyes (p < 0.05). It is concluded that workers perceive risks, and that they tend to relate risks with the occurrence of occupational accidents as an indicator of the dangerous nature of their work environment. PMID:22851948

  6. Risk Communication Concerning Welding Fumes for the Primary Preventive Care of Welding Apprentices in Southern Brazil

    PubMed Central

    Cezar-Vaz, Marta Regina; Bonow, Clarice Alves; Cezar Vaz, Joana

    2015-01-01

    This study’s aim was to assess the perceptions of welding apprentices concerning welding fumes being associated with respiratory and cardiovascular disorders and assess the implementation of risk communication as a primary prevention tool in the welding training process. This quasi-experimental, non-randomized study with before-and-after design was conducted with 84 welding apprentices in Southern Brazil. Poisson Regression analysis was used. Relative Risk was the measure used with a 95% confidence interval and 5% (p ≤ 0.05) significance level. Significant association was found between perceptions of worsened symptoms of respiratory disorders caused by welding fumes and educational level (p = 0.049), the use of goggles to protect against ultraviolet rays (p = 0.023), and access to services in private health facilities without insurance coverage (p = 0.001). Apprentices younger than 25 years old were 4.9 times more likely to perceive worsened cardiovascular symptoms caused by welding fumes after risk communication (RR = 4.91; CI 95%: 1.09 to 22.2). The conclusion is that risk communication as a primary preventive measure in continuing education processes implemented among apprentices, who are future welders, was efficacious. Thus, this study confirms that risk communication can be implemented as a primary prevention tool in welding apprenticeships. PMID:25607606

  7. Predicting the risk of coral disease outbreak using satellite SST.

    NASA Astrophysics Data System (ADS)

    Heron, S. F.; Willis, B. L.; Skirving, W. J.; Page, C. A.; Eakin, C. M.; Miller, I. R.; Christensen, T. R.; Gledhill, D. K.; Liu, G.; Morgan, J. A.; Parker, B. A.; Strong, A. E.

    2009-05-01

    Several environmental parameters have been linked to outbreaks of coral disease. Here we describe the influence of remotely-sensed summer and winter temperatures, as well as local observations of coral cover, to predict the risk of White Syndrome disease outbreaks on the Great Barrier Reef, Australia. Coral disease is an emerging risk to coral reef ecosystems that is likely to escalate with ocean warming due to climate change. The aim of this work is to provide reef managers with an expert system for predicting disease risk on coral reefs as far as six months in advance of summer outbreaks.

  8. On the estimation of risk associated with an attenuation prediction

    NASA Technical Reports Server (NTRS)

    Crane, R. K.

    1992-01-01

    Viewgraphs from a presentation on the estimation of risk associated with an attenuation prediction is presented. Topics covered include: link failure - attenuation exceeding a specified threshold for a specified time interval or intervals; risk - the probability of one or more failures during the lifetime of the link or during a specified accounting interval; the problem - modeling the probability of attenuation by rainfall to provide a prediction of the attenuation threshold for a specified risk; and an accounting for the inadequacy of a model or models.

  9. Gastrointestinal and ectoparasites from urban stray dogs in Fortaleza (Brazil): high infection risk for humans?

    PubMed

    Klimpel, Sven; Heukelbach, Jörg; Pothmann, David; Rückert, Sonja

    2010-08-01

    Dogs are important definite or reservoir hosts for zoonotic parasites. However, only few studies on the prevalence of intestinal parasites in urban areas in Brazil are available. We performed a comprehensive study on parasites of stray dogs in a Brazilian metropolitan area. We included 46 stray dogs caught in the urban areas of Fortaleza (northeast Brazil). After euthanization, dogs were autopsied. Ectoparasites were collected, and the intestinal content of dogs were examined for the presence of parasites. Faecal samples were collected and analysed using merthiolate iodine formaldehyde concentration method. A total of nine different parasite species were found, including five endoparasite (one protozoan, one cestode and three nematode species) and four ectoparasite species (two flea, one louse and one tick species). In the intestinal content, 3,162 specimens of four helminth species were found: Ancylostoma caninum (prevalence, 95.7%), Dipylidium caninum (45.7%), Toxocara canis (8.7%) and Trichuris vulpis (4.3%). A total of 394 ectoparasite specimens were identified, including Rhipicephalus sanguineus (prevalence, 100.0%), Heterodoxus spiniger (67.4%), Ctenocephalides canis (39.1%) and Ctenocephalides felis (17.4%). In the faeces, intestinal parasites were detected in 38 stray dogs (82.6%), including oocysts of Giardia sp. (2.2%) and eggs of the nematode A. caninum (82.6%). Neither eggs nor larval stages of D. caninum, T. canis or T. vulpis were detected in dog faeces. Sensitivity of faecal examination for A. caninum was 86.4% (95% confidence interval, 72.0-94.3) but zero percentage for the other intestinal helminth species. Our data show that stray dogs in northeast Brazil carry a multitude of zoonotic ecto- and endoparasites, posing a considerable risk for humans. With the exception of A. caninum, sensitivity of faecal examination was negligible.

  10. Risk factors for inadequate prenatal care use in the metropolitan area of Aracaju, Northeast Brazil

    PubMed Central

    Ribeiro, Eleonora RO; Guimarães, Alzira Maria DN; Bettiol, Heloísa; Lima, Danilo DF; Almeida, Maria Luiza D; de Souza, Luiz; Silva, Antônio Augusto M; Gurgel, Ricardo Q

    2009-01-01

    Background The aim of prenatal care is to promote good maternal and foetal health and to identify risk factors for adverse pregnancy outcomes in an attempt to promptly manage and solve them. Although high prenatal care attendance is reported in most areas in Brazil, perinatal and neonatal mortalities are disproportionally high, raising doubts about the quality and performance of the care provided. The objective of the present study was to evaluate the adequacy of prenatal care use and the risk factors involved in inadequate prenatal care utilization in the metropolitan area of Aracaju, Northeast Brazil. Methods A survey was carried out with puerperal women who delivered singleton liveborns in all four maternity hospitals of Aracaju. A total of 4552 singleton liveborns were studied. The Adequacy of Prenatal Care Utilization Index, modified according to the guidelines of the Prenatal Care and Birth Humanization Programme, was applied. Socioeconomic, demographic, biological, life style and health service factors were evaluated by multiple logistic regression. Results: Prenatal care coverage in Aracaju was high (98.3%), with a mean number of 6.24 visits. Prenatal care was considered to be adequate or intensive in 66.1% of cases, while 33.9% were considered to have inadequate usage. Age < 18 to 34 years at delivery, low maternal schooling, low family income, two or more previous deliveries, maternal smoking during pregnancy, having no partner and prenatal care obtained outside Aracaju were associated with inadequate prenatal care use. In contrast, private service attendance protected from inadequate prenatal care use. Conclusion Prenatal care coverage was high. However, a significant number of women still had inadequate prenatal care use. Socioeconomic inequalities, demographic factors and behavioural risk factors are still important factors associated with inadequate prenatal care use. PMID:19622174

  11. Risk factors for inadequate prenatal care use in the metropolitan area of Aracaju, Northeast Brazil.

    PubMed

    Ribeiro, Eleonora R O; Guimarães, Alzira Maria D N; Bettiol, Heloísa; Lima, Danilo D F; Almeida, Maria Luiza D; de Souza, Luiz; Silva, Antônio Augusto M; Gurgel, Ricardo Q

    2009-07-22

    The aim of prenatal care is to promote good maternal and foetal health and to identify risk factors for adverse pregnancy outcomes in an attempt to promptly manage and solve them. Although high prenatal care attendance is reported in most areas in Brazil, perinatal and neonatal mortalities are disproportionally high, raising doubts about the quality and performance of the care provided. The objective of the present study was to evaluate the adequacy of prenatal care use and the risk factors involved in inadequate prenatal care utilization in the metropolitan area of Aracaju, Northeast Brazil. A survey was carried out with puerperal women who delivered singleton liveborns in all four maternity hospitals of Aracaju. A total of 4552 singleton liveborns were studied. The Adequacy of Prenatal Care Utilization Index, modified according to the guidelines of the Prenatal Care and Birth Humanization Programme, was applied. Socioeconomic, demographic, biological, life style and health service factors were evaluated by multiple logistic regression. Prenatal care coverage in Aracaju was high (98.3%), with a mean number of 6.24 visits. Prenatal care was considered to be adequate or intensive in 66.1% of cases, while 33.9% were considered to have inadequate usage. Age < 18 to 34 years at delivery, low maternal schooling, low family income, two or more previous deliveries, maternal smoking during pregnancy, having no partner and prenatal care obtained outside Aracaju were associated with inadequate prenatal care use. In contrast, private service attendance protected from inadequate prenatal care use. Prenatal care coverage was high. However, a significant number of women still had inadequate prenatal care use. Socioeconomic inequalities, demographic factors and behavioural risk factors are still important factors associated with inadequate prenatal care use.

  12. Brain structure predicts risk for obesity ☆

    PubMed Central

    Smucny, Jason; Cornier, Marc-Andre; Eichman, Lindsay C.; Thomas, Elizabeth A.; Bechtell, Jamie L.; Tregellas, Jason R.

    2014-01-01

    The neurobiology of obesity is poorly understood. Here we report findings of a study designed to examine the differences in brain regional gray matter volume in adults recruited as either Obese Prone or Obese Resistant based on self-identification, body mass index, and personal/family weight history. Magnetic resonance imaging was performed in 28 Obese Prone (14 male, 14 female) and 25 Obese Resistant (13 male, 12 female) healthy adults. Voxel-based morphometry was used to identify gray matter volume differences between groups. Gray matter volume was found to be lower in the insula, medial orbitofrontal cortex and cerebellum in Obese Prone, as compared to Obese Resistant individuals. Adjusting for body fat mass did not impact these results. Insula gray matter volume was negatively correlated with leptin concentration and measures of hunger. These findings suggest that individuals at risk for weight gain have structural differences in brain regions known to be important in energy intake regulation, and that these differences, particularly in the insula, may be related to leptin. PMID:22963736

  13. Ethical and social aspects of risk predictions.

    PubMed

    Fletcher, J C

    1984-01-01

    This paper reviews past, present and future social and ethical considerations of screening carriers of autosomal disorders and other heterozygotes. A body of ethical and social guidance has evolved in the 1970's and 1980's for screening. The values of voluntaristic participation and informed consent are high. The goal of programs should be to provide couples, families, and individuals with knowledge respecting their reproductive choices. The dangers are coercive strategies, stigmatization, and careless communication of risk information. It is assumed that the number of autosomal carrier states that are screenable will undoubtedly increase as will states of heterozygosity that cause susceptibility to common diseases. Before the end of the century, something approaching a "biopsy of the human genome" will be a practical reality. To balance the potential for harmful psychological and social effects of so much new genetic knowledge, new efforts must be made to find treatments for progeny affected by recessive disorders. Maternal and paternal screening, prenatal diagnosis and treatment will be increasingly linked in the future. This paper will report on a case of fetal therapy for congenital adrenal hyperplasia as a paradigm for the future. The argument will be made that society ought to put a higher priority on prenatal care and prevention of disorders of prematurity than genetic disorders with a low frequency, lest genetic screening be distorted by unfounded concern about eugenics.

  14. Patterns of Migration and Risks Associated with Leprosy among Migrants in Maranhão, Brazil

    PubMed Central

    Murto, Christine; Chammartin, Frédérique; Schwarz, Karolin; da Costa, Lea Marcia Melo; Kaplan, Charles; Heukelbach, Jorg

    2013-01-01

    Leprosy remains a public health problem in Brazil with new case incidence exceeding World Health Organization (WHO) goals in endemic clusters throughout the country. Migration can facilitate movement of disease between endemic and non-endemic areas, and has been considered a possible factor in continued leprosy incidence in Brazil. A study was conducted to investigate migration as a risk factor for leprosy. The study had three aims: (1) examine past five year migration as a risk factor for leprosy, (2) describe and compare geographic and temporal patterns of migration among past 5-year migrants with leprosy and a control group, and (3) examine social determinants of health associated with leprosy among past 5-year migrants. The study implemented a matched case-control design and analysis comparing individuals newly diagnosed with leprosy (n = 340) and a clinically unapparent control group (n = 340) without clinical signs of leprosy, matched for age, sex and location in four endemic municipalities in the state of Maranhão, northeastern Brazil. Fishers exact test was used to conduct bivariate analyses. A multivariate logistic regression analysis was employed to control for possible confounding variables. Eighty cases (23.5%) migrated 5-years prior to diagnosis, and 55 controls (16.2%) migrated 5-years prior to the corresponding case diagnosis. Past 5 year migration was found to be associated with leprosy (OR: 1.59; 95% CI 1.07–2.38; p = 0.02), and remained significantly associated with leprosy after controlling for leprosy contact in the family, household, and family/household contact. Poverty, as well as leprosy contact in the family, household and other leprosy contact, was associated with leprosy among past 5-year migrants in the bivariate analysis. Alcohol consumption was also associated with leprosy, a relevant risk factor in susceptibility to infection that should be explored in future research. Our findings provide insight into patterns of

  15. Patterns of migration and risks associated with leprosy among migrants in Maranhão, Brazil.

    PubMed

    Murto, Christine; Chammartin, Frédérique; Schwarz, Karolin; da Costa, Lea Marcia Melo; Kaplan, Charles; Heukelbach, Jorg

    2013-01-01

    Leprosy remains a public health problem in Brazil with new case incidence exceeding World Health Organization (WHO) goals in endemic clusters throughout the country. Migration can facilitate movement of disease between endemic and non-endemic areas, and has been considered a possible factor in continued leprosy incidence in Brazil. A study was conducted to investigate migration as a risk factor for leprosy. The study had three aims: (1) examine past five year migration as a risk factor for leprosy, (2) describe and compare geographic and temporal patterns of migration among past 5-year migrants with leprosy and a control group, and (3) examine social determinants of health associated with leprosy among past 5-year migrants. The study implemented a matched case-control design and analysis comparing individuals newly diagnosed with leprosy (n = 340) and a clinically unapparent control group (n = 340) without clinical signs of leprosy, matched for age, sex and location in four endemic municipalities in the state of Maranhão, northeastern Brazil. Fishers exact test was used to conduct bivariate analyses. A multivariate logistic regression analysis was employed to control for possible confounding variables. Eighty cases (23.5%) migrated 5-years prior to diagnosis, and 55 controls (16.2%) migrated 5-years prior to the corresponding case diagnosis. Past 5 year migration was found to be associated with leprosy (OR: 1.59; 95% CI 1.07-2.38; p = 0.02), and remained significantly associated with leprosy after controlling for leprosy contact in the family, household, and family/household contact. Poverty, as well as leprosy contact in the family, household and other leprosy contact, was associated with leprosy among past 5-year migrants in the bivariate analysis. Alcohol consumption was also associated with leprosy, a relevant risk factor in susceptibility to infection that should be explored in future research. Our findings provide insight into patterns of migration

  16. Tuberculosis prevalence and risk factors for water buffalo in Pará, Brazil.

    PubMed

    Barbosa, José D; da Silva, Jenevaldo B; Rangel, Charles P; da Fonseca, Adivaldo H; Silva, Natália S; Bomjardim, Henrique A; Freitas, Nayra F Q R

    2014-03-01

    The prevalence of and possible risk factors for tuberculosis were studied in water buffalo from Pará, Brazil. In this study, 3,917 pregnant and nonpregnant female Murrah and Mediterranean buffaloes were studied; 2,089 originated from Marajó Island, and 1,108 were from the mainland. The comparative cervical tuberculin test was used as a diagnostic test for tuberculosis in these animals. The prevalence of positive buffaloes was 3.5 % (100/2,809) on Marajó Island and 7.2 % (80/1,108) on the mainland. The municipalities with the highest tuberculosis prevalence rates in animals were Ipixuna do Pará (10.1 %), Marapanim (9.8 %), Chaves (9.4 %), Paragominas (8.6 %), and Cachoeira do Arari (6.7 %). The tuberculosis prevalence was not significantly different between the Murrah (4.3 %) and Mediterranean (4.8 %) breeds or between pregnant (5 %) and nonpregnant (4.3 %) buffaloes. Tuberculosis was detected in water buffaloes from Pará, Brazil; the mainland buffalo exhibited the highest tuberculosis prevalence. These results indicate that this disease is dangerous to public health and buffalo farming in Pará.

  17. RISK FACTORS ASSOCIATED WITH AMERICAN CUTANEOUS LEISHMANIASIS IN AN ENDEMIC AREA OF BRAZIL

    PubMed Central

    de ARAUJO, Alberon Ribeiro; PORTELA, Nairomberg Cavalcanti; FEITOSA, Ana Paula Sampaio; da SILVA, Otamires Alves; XIMENES, Ricardo Andrade Arraes; ALVES, Luiz Carlos; BRAYNER, Fábio André

    2016-01-01

    SUMMARY Brazil is among the top five countries worldwide regarding the number of cases of leishmaniasis, which are present in all of the regions of the country. The northeastern region continues to have higher numbers of cases every year and in the state of Pernambuco, 34% of the municipalities are endemic for this disease. The diversity of vectors, reservoirs and etiological agents, in association with socioeconomic and environmental conditions, gives rise to factors that can modify the behavior of American cutaneous leishmaniasis. Consequently, the aim of the present study was to determine the risk factors associated with American cutaneous leishmaniasis in the municipality of Timbaúba, Brazil. A case-control study was conducted. A validated questionnaire was used for data collection. The study included 58 cases and 174 controls, and they were serologically diagnosed at the Oswaldo Cruz Foundation (FIOCRUZ). Our results showed that some factors were associated with American cutaneous leishmaniasis: biological (gender), economic (work activity, hours spent away from home and water supply) and peridomestic (presence of animals). In our study, the associations of these variables with leishmaniasis were linked to precarious housing conditions and poverty, which are parameters that can be managed in order to prevent the disease in this region. PMID:27982352

  18. Changing patterns of cocaine use and hiv risks in the south of Brazil.

    PubMed

    Inciardi, James A; Surratt, Hilary L; Pechansky, Flavio; Kessler, Felix; von Diemen, Lisia; da Silva, Elisabeth Meyer; Martin, Steven S

    2006-09-01

    For well over a decade, researchers in Porto Alegre, Brazil, have been documenting the extent of the AIDS epidemic in the region, with a specific focus on the linkages between drug use and HIV seropositivity. Virtually all of the studies conducted during those years found injection drug use (IDU) to be the major vector for HIV seropositivity in this population. However, recent research found that the number of IDUs had declined significantly. Qualitative interviews and focus groups suggested many reasons for this decline: (1) many had died, because they had never heard of AIDS or HIV, and were unaware of how HIV is transmitted. As a result, they had become infected through the sharing of injection paraphernalia. (2) The quality of street cocaine had declined, making injection difficult. (3) Because of a fear of AIDS, some shifted to the smoking of crack, which had become a newly availability commodity in the street culture. Within this context, this article describes the qualitative data describing the decline of cocaine injecting and the corresponding emergence of crack use in Porto Alegre, Brazil, and related HIV risks.

  19. Predicting medical practices using various risk attitude measures.

    PubMed

    Massin, Sophie; Nebout, Antoine; Ventelou, Bruno

    2017-08-31

    This paper investigates the predictive power of several risk attitude measures on a series of medical practices. We elicit risk preferences on a sample of 1500 French general practitioners (GPs) using two different classes of tools: scales, which measure GPs' own perception of their willingness to take risks between 0 and 10; and lotteries, which require GPs to choose between a safe and a risky option in a series of hypothetical situations. In addition to a daily life risk scale that measures a general risk attitude, risk taking is measured in different domains for each tool: financial matters, GPs' own health, and patients' health. We take advantage of the rare opportunity to combine these multiple risk attitude measures with a series of self-reported or administratively recorded medical practices. We successively test the predictive power of our seven risk attitude measures on eleven medical practices affecting the GPs' own health or their patients' health. We find that domain-specific measures are far better predictors than the general risk attitude measure. Neither of the two classes of tools (scales or lotteries) seems to perform indisputably better than the other, except when we concentrate on the only non-declarative practice (prescription of biological tests), for which the classic money-lottery test works well. From a public health perspective, appropriate measures of willingness to take risks may be used to make a quick, but efficient, profiling of GPs and target them with personalized communications, or interventions, aimed at improving practices.

  20. Predicting relapse risk in childhood acute lymphoblastic leukaemia.

    PubMed

    Teachey, David T; Hunger, Stephen P

    2013-09-01

    Intensive multi-agent chemotherapy regimens and the introduction of risk-stratified therapy have substantially improved cure rates for children with acute lymphoblastic leukaemia (ALL). Current risk allocation schemas are imperfect, as some children are classified as lower-risk and treated with less intensive therapy relapse, while others deemed higher-risk are probably over-treated. Most cooperative groups previously used morphological clearance of blasts in blood and marrow during the initial phases of chemotherapy as a primary factor for risk group allocation; however, this has largely been replaced by the detection of minimal residual disease (MRD). Other than age and white blood cell count (WBC) at presentation, many clinical variables previously used for risk group allocation are no longer prognostic, as MRD and the presence of sentinel genetic lesions are more reliable at predicting outcome. Currently, a number of sentinel genetic lesions are used by most cooperative groups for risk stratification; however, in the near future patients will probably be risk-stratified using genomic signatures and clustering algorithms, rather than individual genetic alterations. This review will describe the clinical, biological, and response-based features known to predict relapse risk in childhood ALL, including those currently used and those likely to be used in the near future to risk-stratify therapy.

  1. Predicting risk from multiple stressors in watershed ecosystems

    SciTech Connect

    Marcy, S.K.M.

    1995-12-31

    Watersheds provide a definable geomorphological boundary where the influence of diverse human activities on land and in water are naturally combined within waters flowing through a watershed. The combined risk of multiple impacts have been essentially ignored in risk estimates in the past. Although significant effort is currently directed toward developing management plans to protect ecological resources within watersheds, success will be difficult to achieve without systematic evaluation of the individual, combined and cumulative impacts of chemical, physical and biological stressors normally impacting watershed ecosystems. Watershed level ecological risk assessment methodology, now being developed through case studies, provides a format for predicting the combined risk of diverse stressors on one system. Discussion will focus on the appropriate selection of assessment endpoints, development of three levels of conceptual models and a format for analysis plans as the basis for predicting the relative and combined risk of diverse stressors.

  2. Predicting adolescent's cyberbullying behavior: A longitudinal risk analysis.

    PubMed

    Barlett, Christopher P

    2015-06-01

    The current study used the risk factor approach to test the unique and combined influence of several possible risk factors for cyberbullying attitudes and behavior using a four-wave longitudinal design with an adolescent US sample. Participants (N = 96; average age = 15.50 years) completed measures of cyberbullying attitudes, perceptions of anonymity, cyberbullying behavior, and demographics four times throughout the academic school year. Several logistic regression equations were used to test the contribution of these possible risk factors. Results showed that (a) cyberbullying attitudes and previous cyberbullying behavior were important unique risk factors for later cyberbullying behavior, (b) anonymity and previous cyberbullying behavior were valid risk factors for later cyberbullying attitudes, and (c) the likelihood of engaging in later cyberbullying behavior increased with the addition of risk factors. Overall, results show the unique and combined influence of such risk factors for predicting later cyberbullying behavior. Results are discussed in terms of theory.

  3. Cardiovascular risk prediction tools for populations in Asia

    PubMed Central

    Collaboration, Asia Pacific Cohort Studies

    2007-01-01

    Background Cardiovascular risk equations are traditionally derived from the Framingham Study. The accuracy of this approach in Asian populations, where resources for risk factor measurement may be limited, is unclear. Objective To compare “low‐information” equations (derived using only age, systolic blood pressure, total cholesterol and smoking status) derived from the Framingham Study with those derived from the Asian cohorts, on the accuracy of cardiovascular risk prediction. Design Separate equations to predict the 8‐year risk of a cardiovascular event were derived from Asian and Framingham cohorts. The performance of these equations, and a subsequently “recalibrated” Framingham equation, were evaluated among participants from independent Chinese cohorts. Setting Six cohort studies from Japan, Korea and Singapore (Asian cohorts); six cohort studies from China; the Framingham Study from the US. Participants 172 077 participants from the Asian cohorts; 25 682 participants from Chinese cohorts and 6053 participants from the Framingham Study. Main results In the Chinese cohorts, 542 cardiovascular events occurred during 8 years of follow‐up. Both the Asian cohorts and the Framingham equations discriminated cardiovascular risk well in the Chinese cohorts; the area under the receiver–operator characteristic curve was at least 0.75 for men and women. However, the Framingham risk equation systematically overestimated risk in the Chinese cohorts by an average of 276% among men and 102% among women. The corresponding average overestimation using the Asian cohorts equation was 11% and 10%, respectively. Recalibrating the Framingham risk equation using cardiovascular disease incidence from the non‐Chinese Asian cohorts led to an overestimation of risk by an average of 4% in women and underestimation of risk by an average of 2% in men. Interpretation A low‐information Framingham cardiovascular risk prediction tool, which, when recalibrated with

  4. Risk factors for Toxoplasma gondii infection in sheep and cattle from Fernando de Noronha Island, Brazil.

    PubMed

    Magalhães, Fernando Jorge Rodrigues; Ribeiro-Andrade, Müller; Alcântara, Adrianne Mota de; Pinheiro, José Wilton; Sena, Maria José de; Porto, Wagnner José Nascimento; Vieira, Rafael Felipe da Costa; Mota, Rinaldo Aparecido

    2016-01-01

    Toxoplasmosis is a zoonotic disease of global distribution that affects all warm-blooded animals. The purpose of this investigation was to determine the prevalence of T. gondii infection and identify the risk factors associated with its occurrence in domestic ruminants raised on the island of Fernando de Noronha, Brazil, and to confirm that cattle and sheep raised in Fernando de Noronha Island present statistically different T. gondii prevalence rates. Serum samples were collected from sheep (n=240) and cattle (n=140) for the detection of antibodies by indirect immunofluorescence. Samples were collected from all the animals on all the farms. Risk factors were analyzed by univariate analysis and logistic regression. The prevalence rate of positive sheep was 85.0% while that of cattle was 10.7%. A multivariate analysis revealed that the site of contact of sheep with felines was a risk factor. For cattle, the risk factors identified in this study were: extensive farming system, water source, more than three cats per farm, and the presence of rats in feed storage locations. The findings revealed a significant difference in the prevalence rates in sheep and cattle raised in this insular environment.

  5. High-risk behaviors and experiences with traffic law among night drivers in Curitiba, Brazil.

    PubMed

    Ulinski, Sandra L; Moysés, Simone T; Werneck, Renata I; Moysés, Samuel J

    2016-01-08

    To explore high-risk behaviors and experiences with traffic law among night drivers in Curitiba, Brazil. Data from 398 drivers on sociodemographic parameters, high-risk behaviors, experiences with traffic law, and traffic law violations were collected through interviews conducted at sobriety checkpoints. Exploratory-descriptive and analytical statistics were used. The mean age of the participants was 32.6±11.2 years (range, 18 to 75 years). Half of the drivers reported having driven after drinking in the last year, predominantly single men aged 18 to 29 years who drive cars and drink alcohol frequently. Only 55% of the drivers who had driven after drinking in the last year self-reported some concern about being detected in a police operation. A significant association was found between sociodemographic variables and behavior, which can help tailor public interventions to a specific group of drivers: young men who exhibit high-risk behaviors in traffic, such as driving after drinking alcohol, some of whom report heavy alcohol consumption. This group represents a challenge for educational and enforcement interventions, particularly because they admit to violating current laws and have a low perception of punishment due to the low risk of being detected by the police.

  6. [Spatial distribution of risks for work-related injuries in a city of Southeastern Brazil].

    PubMed

    Zangirolani, Lia Thieme Oikawa; Cordeiro, Ricardo; Medeiros, Maria Angélica Tavares de; Stephan, Celso

    2008-04-01

    To assess spatial distribution of risks for work-related injuries controlled for nutritional variables and other covariables. Hospital-based spatial case-control study with work-related injuries spatial distribution as the main variable of interest. A total of 794 workers were selected between May and October 2004. Inclusion criteria for cases (N=263) were: worker with work-related injury; living in Piracicaba (Southeastern Brazil); age between 15 and 60 years old; and cared at an orthopedics and trauma center. Controls (N=531) met the same criteria for age and residence, but had non-work-related injuries and workers accompanying cases were included as well. Spatial distribution was estimated by adjusting a generalized additive model with geographical coordinates of cases and controls as spatial non-linear component and the remaining covariables as linear components. The variation of estimated spatial risks for work-related injuries controlled for gender (OR=1.87, p<0.001), schooling (OR=0.85, p<0.0001), self-employed (OR=0.36, p<0.01), and waist circumference (OR=0.98, p=0.05) showed that the mideastern area and north-to-south "strip" have higher risk for injuries. The use of geoprocessing tools and nutritional variables can provide input for understanding the universe of risks for work-related injuries. Further investigation exploring these factors is needed.

  7. [Statistical prediction methods in violence risk assessment and its application].

    PubMed

    Liu, Yuan-Yuan; Hu, Jun-Mei; Yang, Min; Li, Xiao-Song

    2013-06-01

    It is an urgent global problem how to improve the violence risk assessment. As a necessary part of risk assessment, statistical methods have remarkable impacts and effects. In this study, the predicted methods in violence risk assessment from the point of statistics are reviewed. The application of Logistic regression as the sample of multivariate statistical model, decision tree model as the sample of data mining technique, and neural networks model as the sample of artificial intelligence technology are all reviewed. This study provides data in order to contribute the further research of violence risk assessment.

  8. The Impact of Covariate Measurement Error on Risk Prediction

    PubMed Central

    Khudyakov, Polyna; Gorfine, Malka; Zucker, David; Spiegelman, Donna

    2015-01-01

    In the development of risk prediction models, predictors are often measured with error. In this paper, we investigate the impact of covariate measurement error on risk prediction. We compare the prediction performance using a costly variable measured without error, along with error-free covariates, to that of a model based on an inexpensive surrogate along with the error-free covariates. We consider continuous error-prone covariates with homoscedastic and heteroscedastic errors, and also a discrete misclassified covariate. Prediction performance is evaluated by the area under the receiver operating characteristic curve (AUC), the Brier score (BS), and the ratio of the observed to the expected number of events (calibration). In an extensive numerical study, we show that (i) the prediction model with the error-prone covariate is very well calibrated, even when it is mis-specified; (ii) using the error-prone covariate instead of the true covariate can reduce the AUC and increase the BS dramatically; (iii) adding an auxiliary variable, which is correlated with the error-prone covariate but conditionally independent of the outcome given all covariates in the true model, can improve the AUC and BS substantially. We conclude that reducing measurement error in covariates will improve the ensuing risk prediction, unless the association between the error-free and error-prone covariates is very high. Finally, we demonstrate how a validation study can be used to assess the effect of mismeasured covariates on risk prediction. These concepts are illustrated in a breast cancer risk prediction model developed in the Nurses’ Health Study. PMID:25865315

  9. Enhanced clinical pharmacy service targeting tools: risk-predictive algorithms.

    PubMed

    El Hajji, Feras W D; Scullin, Claire; Scott, Michael G; McElnay, James C

    2015-04-01

    This study aimed to determine the value of using a mix of clinical pharmacy data and routine hospital admission spell data in the development of predictive algorithms. Exploration of risk factors in hospitalized patients, together with the targeting strategies devised, will enable the prioritization of clinical pharmacy services to optimize patient outcomes. Predictive algorithms were developed using a number of detailed steps using a 75% sample of integrated medicines management (IMM) patients, and validated using the remaining 25%. IMM patients receive targeted clinical pharmacy input throughout their hospital stay. The algorithms were applied to the validation sample, and predicted risk probability was generated for each patient from the coefficients. Risk threshold for the algorithms were determined by identifying the cut-off points of risk scores at which the algorithm would have the highest discriminative performance. Clinical pharmacy staffing levels were obtained from the pharmacy department staffing database. Numbers of previous emergency admissions and admission medicines together with age-adjusted co-morbidity and diuretic receipt formed a 12-month post-discharge and/or readmission risk algorithm. Age-adjusted co-morbidity proved to be the best index to predict mortality. Increased numbers of clinical pharmacy staff at ward level was correlated with a reduction in risk-adjusted mortality index (RAMI). Algorithms created were valid in predicting risk of in-hospital and post-discharge mortality and risk of hospital readmission 3, 6 and 12 months post-discharge. The provision of ward-based clinical pharmacy services is a key component to reducing RAMI and enabling the full benefits of pharmacy input to patient care to be realized. © 2014 John Wiley & Sons, Ltd.

  10. Predictive Modeling of Risk Factors and Complications of Cataract Surgery

    PubMed Central

    Gaskin, Gregory L; Pershing, Suzann; Cole, Tyler S; Shah, Nigam H

    2016-01-01

    Purpose To quantify the relationship between aggregated preoperative risk factors and cataract surgery complications, as well as to build a model predicting outcomes on an individual-level—given a constellation of demographic, baseline, preoperative, and intraoperative patient characteristics. Setting Stanford Hospital and Clinics between 1994 and 2013. Design Retrospective cohort study Methods Patients age 40 or older who received cataract surgery between 1994 and 2013. Risk factors, complications, and demographic information were extracted from the Electronic Health Record (EHR), based on International Classification of Diseases, 9th edition (ICD-9) codes, Current Procedural Terminology (CPT) codes, drug prescription information, and text data mining using natural language processing. We used a bootstrapped least absolute shrinkage and selection operator (LASSO) model to identify highly-predictive variables. We built random forest classifiers for each complication to create predictive models. Results Our data corroborated existing literature on postoperative complications—including the association of intraoperative complications, complex cataract surgery, black race, and/or prior eye surgery with an increased risk of any postoperative complications. We also found a number of other, less well-described risk factors, including systemic diabetes mellitus, young age (<60 years old), and hyperopia as risk factors for complex cataract surgery and intra- and post-operative complications. Our predictive models based on aggregated outperformed existing published models. Conclusions The constellations of risk factors and complications described here can guide new avenues of research and provide specific, personalized risk assessment for a patient considering cataract surgery. The predictive capacity of our models can enable risk stratification of patients, which has utility as a teaching tool as well as informing quality/value-based reimbursements. PMID:26692059

  11. Risk factors that predict future onset of each DSM-5 eating disorder: Predictive specificity in high-risk adolescent females.

    PubMed

    Stice, Eric; Gau, Jeff M; Rohde, Paul; Shaw, Heather

    2017-01-01

    Because no single report has examined risk factors that predict future onset each type of eating disorder and core symptom dimensions that crosscut disorders, we addressed these aims to advance knowledge regarding risk factor specificity. Data from 3 prevention trials that targeted young women with body dissatisfaction (N = 1,272; Mage = 18.5, SD = 4.2) and collected annual diagnostic interview data over 3-year follow-up were combined to identify predictors of subthreshold/threshold anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), and purging disorder (PD). Negative affect and functional impairment predicted onset of all eating disorders. Thin-ideal internalization, body dissatisfaction, dieting, overeating, and mental health care predicted onset of subthreshold/threshold BN, BED, and PD; positive thinness expectations, denial of cost of pursuing the thin ideal, and fasting predicted onset of 2 of these 3 disorders. Similar risk factors predicted core eating disorder symptom onset. Low BMI and dieting specifically predicted onset of subthreshold/threshold AN or low BMI. Only a subset of factors showed unique predictive effects in multivariate models, likely due to moderate correlations between the risk factors (M r = .14). Results provide support for the theory that pursuit of the thin ideal and the resulting body dissatisfaction, dieting, and unhealthy weight control behaviors increase risk for binge/purge spectrum eating disorders, but suggest that youth who are inherently lean, rather than purposely pursuing the thin ideal, are at risk for AN. Impaired interpersonal functioning and negative affect are transdiagnostic risk factors, suggesting these factors should be targeted in prevention programs. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  12. Predicting neutropenia risk in patients with cancer using electronic data.

    PubMed

    Pawloski, Pamala A; Thomas, Avis J; Kane, Sheryl; Vazquez-Benitez, Gabriela; Shapiro, Gary R; Lyman, Gary H

    2017-04-01

    Clinical guidelines recommending the use of myeloid growth factors are largely based on the prescribed chemotherapy regimen. The guidelines suggest that oncologists consider patient-specific characteristics when prescribing granulocyte-colony stimulating factor (G-CSF) prophylaxis; however, a mechanism to quantify individual patient risk is lacking. Readily available electronic health record (EHR) data can provide patient-specific information needed for individualized neutropenia risk estimation. An evidence-based, individualized neutropenia risk estimation algorithm has been developed. This study evaluated the automated extraction of EHR chemotherapy treatment data and externally validated the neutropenia risk prediction model. A retrospective cohort of adult patients with newly diagnosed breast, colorectal, lung, lymphoid, or ovarian cancer who received the first cycle of a cytotoxic chemotherapy regimen from 2008 to 2013 were recruited from a single cancer clinic. Electronically extracted EHR chemotherapy treatment data were validated by chart review. Neutropenia risk stratification was conducted and risk model performance was assessed using calibration and discrimination. Chemotherapy treatment data electronically extracted from the EHR were verified by chart review. The neutropenia risk prediction tool classified 126 patients (57%) as being low risk for febrile neutropenia, 44 (20%) as intermediate risk, and 51 (23%) as high risk. The model was well calibrated (Hosmer-Lemeshow goodness-of-fit test = 0.24). Discrimination was adequate and slightly less than in the original internal validation (c-statistic 0.75 vs 0.81). Chemotherapy treatment data were electronically extracted from the EHR successfully. The individualized neutropenia risk prediction model performed well in our retrospective external cohort.

  13. [Early pregnancy risk: development and validation of a predictive instrument].

    PubMed

    Burrows, R; Rosales, M E; Díaz, M; Muzzo, S

    1994-06-01

    An early pregnancy risk scale, with scores ranging from 11 to 66 points from lower to higher risk, was constructed using variables associated with teenager's pregnancy. This scale was applied to 3000 female teenagers, coming from Metropolitan Santiago public schools. The sample was divided in three risk groups: group A (high risk) with scores equal or over 35 points, group B (low risk) with scores equal or below 20 points and group B (intermediate risk) with scores between 20.1 and 34.9 points. These girls were followed during 2 years. During this period, 84 girls became pregnant, 24 of 184 (13%) in group A, 60 of 2332 (2.6%) in group C and none of 307 in group B. There were 104 school desertions in group A and 37 in group B. To study associations and analyze risk, the sample was divided in two risk groups: high, with scores over 27 and low, with scores below 27. There was a high association between pregnancy risk score and the occurrence of pregnancy (RR 5.25 p < 0.0001) and school desertion (RR 3.32 p < 0.0001). Pregnancy was predicted with a 78% sensitivity and 55.6% specificity. School desertion was predicted with a 74% sensitivity and 56% specificity. The importance variable weighing using multiple regression models, to improve the predictor's sensitivity and specificity, is discussed.

  14. Risk factors associated with leptospirosis in dairy goats under tropical conditions in Brazil.

    PubMed

    Lilenbaum, Walter; Varges, Renato; Medeiros, Luciana; Cordeiro, Ana Gabriela; Cavalcanti, Amanda; Souza, Guilherme N; Richtzenhain, Leonardo; Vasconcellos, Silvio A

    2008-02-01

    Serum samples from 248 adult dairy goats from 13 flocks with lowered fertility farmed in the Rio de Janeiro region of Brazil were examined for Leptospira antibodies by MAT with 24 serovars, cut off 100. A questionnaire was completed for each herd. Antibodies were detected in 20.8% of these goats, mainly to serovar Hardjo. Risk factors associated with seroprevalence to leptospirosis were the frequency of professional veterinary supervision (OR = 2.35), climate (OR = 2.63) and grazing for more than 2h a day. Flock factors as size, type of milking and offering of food supplementation, as well as the location and topography, the type of animal housing or the presence of silos did not significantly affect seroprevalence. We suggest that a successful control program for goat leptospirosis should include a complete investigation of herd management practices, which could influence in the occurrence of the infection.

  15. [Non-communicable chronic diseases in Brazil: from risk factors to social impact].

    PubMed

    Lessa, I; Mendonça, G A; Teixeira, M T

    1996-05-01

    The current epidemiologic profile of Brazil includes both the diseases of underdevelopment and those associated with modern life. Consequently, the country faces the difficult task of carrying out health promotion and protection activities aimed at controlling communicable diseases as well as noncommunicable chronic diseases (NCDs). This study sought to describe the epidemiologic situation of Brazilian adults with regard to NCDs and to present available data on the quality of care provided for these diseases and their social impact. To these ends, a literature review was conducted for the period 1964-1995--that is, since the beginning of the production and dissemination of data on cardiovascular diseases, cancer, and diabetes. Of the 153 bibliographic references that were discovered, 97 were used. The social, political, economic, and health inequities that exist among Brazil's geographic regions are reflected in the national scientific production, which is concentrated in the Southeast and South. Most of the studies based on primary data come from those regions. Information is scarce from the North-east, except the city of Salvador. Therefore, the health profile of adults--including risk factors and morbidity and mortality--can be better delineated for residents of the South and Southeast of the country, whereas for the other regions the necessary information is practically nonexistent. Risk factors linked to life-style are as widespread and important in Brazil as they are in industrialized countries. Prevalence and mortality rates among persons with or without certain socio-environmental risks (such as low level of schooling or unskilled occupations) indicate that NCDs predominate in the lowest social strata. Inter-regional differences in the prevalence of arterial hypertension and diabetes mellitus, the most common fatal cardiovascular causes, and the predominant cancers, as well as morbidity and mortality in both sexes, illustrate the political, social, and

  16. Transfer of sampling methods for studies on most-at-risk populations (MARPs) in Brazil.

    PubMed

    Barbosa Júnior, Aristides; Pascom, Ana Roberta Pati; Szwarcwald, Célia Landmann; Kendall, Carl; McFarland, Willi

    2011-01-01

    The objective of this paper was to describe the process of transferring two methods for sampling most-at-risk populations: respondent-driven sampling (RDS) and time-space sampling (TSS). The article describes steps in the process, the methods used in the 10 pilot studies, and lessons learned. The process was conducted in six steps, from a state-of-the-art seminar to a workshop on writing articles with the results of the pilot studies. The principal investigators reported difficulties in the fieldwork and data analysis, independently of the pilot sampling method. One of the most important results of the transfer process is that Brazil now has more than 100 researchers able to sample MARPs using RDS or TSS. The process also enabled the construction of baselines for MARPS, thus providing a broader understanding of the dynamics of HIV infection in the country and the use of evidence to plan the national response to the epidemic in these groups.

  17. Assessing patients' risk of febrile neutropenia: is there a correlation between physician-assessed risk and model-predicted risk?

    PubMed

    Lyman, Gary H; Dale, David C; Legg, Jason C; Abella, Esteban; Morrow, Phuong Khanh; Whittaker, Sadie; Crawford, Jeffrey

    2015-08-01

    This study evaluated the correlation between the risk of febrile neutropenia (FN) estimated by physicians and the risk of severe neutropenia or FN predicted by a validated multivariate model in patients with nonmyeloid malignancies receiving chemotherapy. Before patient enrollment, physician and site characteristics were recorded, and physicians self-reported the FN risk at which they would typically consider granulocyte colony-stimulating factor (G-CSF) primary prophylaxis (FN risk intervention threshold). For each patient, physicians electronically recorded their estimated FN risk, orders for G-CSF primary prophylaxis (yes/no), and patient characteristics for model predictions. Correlations between physician-assessed FN risk and model-predicted risk (primary endpoints) and between physician-assessed FN risk and G-CSF orders were calculated. Overall, 124 community-based oncologists registered; 944 patients initiating chemotherapy with intermediate FN risk enrolled. Median physician-assessed FN risk over all chemotherapy cycles was 20.0%, and median model-predicted risk was 17.9%; the correlation was 0.249 (95% CI, 0.179-0.316). The correlation between physician-assessed FN risk and subsequent orders for G-CSF primary prophylaxis (n = 634) was 0.313 (95% CI, 0.135-0.472). Among patients with a physician-assessed FN risk ≥ 20%, 14% did not receive G-CSF orders. G-CSF was not ordered for 16% of patients at or above their physician's self-reported FN risk intervention threshold (median, 20.0%) and was ordered for 21% below the threshold. Physician-assessed FN risk and model-predicted risk correlated weakly; however, there was moderate correlation between physician-assessed FN risk and orders for G-CSF primary prophylaxis. Further research and education on FN risk factors and appropriate G-CSF use are needed.

  18. Assessing patients’ risk of febrile neutropenia: is there a correlation between physician-assessed risk and model-predicted risk?

    PubMed Central

    Lyman, Gary H; Dale, David C; Legg, Jason C; Abella, Esteban; Morrow, Phuong Khanh; Whittaker, Sadie; Crawford, Jeffrey

    2015-01-01

    This study evaluated the correlation between the risk of febrile neutropenia (FN) estimated by physicians and the risk of severe neutropenia or FN predicted by a validated multivariate model in patients with nonmyeloid malignancies receiving chemotherapy. Before patient enrollment, physician and site characteristics were recorded, and physicians self-reported the FN risk at which they would typically consider granulocyte colony-stimulating factor (G-CSF) primary prophylaxis (FN risk intervention threshold). For each patient, physicians electronically recorded their estimated FN risk, orders for G-CSF primary prophylaxis (yes/no), and patient characteristics for model predictions. Correlations between physician-assessed FN risk and model-predicted risk (primary endpoints) and between physician-assessed FN risk and G-CSF orders were calculated. Overall, 124 community-based oncologists registered; 944 patients initiating chemotherapy with intermediate FN risk enrolled. Median physician-assessed FN risk over all chemotherapy cycles was 20.0%, and median model-predicted risk was 17.9%; the correlation was 0.249 (95% CI, 0.179−0.316). The correlation between physician-assessed FN risk and subsequent orders for G-CSF primary prophylaxis (n = 634) was 0.313 (95% CI, 0.135−0.472). Among patients with a physician-assessed FN risk ≥20%, 14% did not receive G-CSF orders. G-CSF was not ordered for 16% of patients at or above their physician’s self-reported FN risk intervention threshold (median, 20.0%) and was ordered for 21% below the threshold. Physician-assessed FN risk and model-predicted risk correlated weakly; however, there was moderate correlation between physician-assessed FN risk and orders for G-CSF primary prophylaxis. Further research and education on FN risk factors and appropriate G-CSF use are needed. PMID:25810005

  19. Risk Models to Predict Hypertension: A Systematic Review

    PubMed Central

    Echouffo-Tcheugui, Justin B.; Batty, G. David; Kivimäki, Mika; Kengne, Andre P.

    2013-01-01

    Background As well as being a risk factor for cardiovascular disease, hypertension is also a health condition in its own right. Risk prediction models may be of value in identifying those individuals at risk of developing hypertension who are likely to benefit most from interventions. Methods and Findings To synthesize existing evidence on the performance of these models, we searched MEDLINE and EMBASE; examined bibliographies of retrieved articles; contacted experts in the field; and searched our own files. Dual review of identified studies was conducted. Included studies had to report on the development, validation, or impact analysis of a hypertension risk prediction model. For each publication, information was extracted on study design and characteristics, predictors, model discrimination, calibration and reclassification ability, validation and impact analysis. Eleven studies reporting on 15 different hypertension prediction risk models were identified. Age, sex, body mass index, diabetes status, and blood pressure variables were the most common predictor variables included in models. Most risk models had acceptable-to-good discriminatory ability (C-statistic>0.70) in the derivation sample. Calibration was less commonly assessed, but overall acceptable. Two hypertension risk models, the Framingham and Hopkins, have been externally validated, displaying acceptable-to-good discrimination, and C-statistic ranging from 0.71 to 0.81. Lack of individual-level data precluded analyses of the risk models in subgroups. Conclusions The discrimination ability of existing hypertension risk prediction tools is acceptable, but the impact of using these tools on prescriptions and outcomes of hypertension prevention is unclear. PMID:23861760

  20. Mapping risk of bovine fasciolosis in the south of Brazil using Geographic Information Systems.

    PubMed

    Dutra, L H; Molento, M B; Naumann, C R C; Biondo, A W; Fortes, F S; Savio, D; Malone, J B

    2010-04-19

    Fasciolosis, caused by Fasciola hepatica, is an endemic disease of ruminants that occurs in several countries of South America where it can lead to decreased production and fertility and, in severe cases, animal death. Although very prevalent, information on the epidemiology of the disease is incomplete in Brazil. The objective of the present study was to define the prevalence of F. hepatica in the livers of cattle from slaughterhouses and correlate the data with the animal's origin (climate and altitude) using a Geographic Information System (GIS). The data was used to create an epidemiological map of fasciolosis by state (Rio Grande do Sul, Santa Catarina, Paraná), by municipality (n=530) and by year (2003-2008). Information was analyzed using a databank from slaughterhouses with Federal Inspection Services of the Ministry of Agriculture. The highest cattle infection rate was found in the two most Southern states of Rio Grande do Sul (18.7%) and Santa Catarina (10.1%). Animals from the Campanha region of Rio Grande do Sul and from the central coast area of Santa Catarina had prevalences of greater than 40%. Cattle from low altitudes municipalities were significantly more likely to have the disease (p<0.05). No significant differences were found between high or low prevalence and ambient temperatures. Risk maps resulting from this study provide information on the epidemiology and transmission of F. hepatica in Southern Brazil needed for design of appropriate control measures to control economic impacts. F. hepatica may represent an important source of zoonotic infection of humans as well; therefore these findings may be complemented by future studies on human infections in high risk areas.

  1. Use of transgenic Aedes aegypti in Brazil: risk perception and assessment

    PubMed Central

    Aragão, Francisco José Lima; Colli, Walter; Dellagostin, Odir Antônio; Finardi-Filho, Flávio; Hirata, Mario Hiroyuki; Lira-Neto, Amaro de Castro; Almeida de Melo, Marcia; Nepomuceno, Alexandre Lima; Gorgônio da Nóbrega, Francisco; Delfino de Sousa, Gutemberg; Valicente, Fernando Hercos; Zanettini, Maria Helena Bodanese

    2016-01-01

    Abstract The OX513A strain of Aedes aegypti, which was developed by the British company Oxitec, expresses a self-limiting transgene that prevents larvae from developing to adulthood. In April 2014, the Brazilian National Technical Commission on Biosafety completed a risk assessment of OX513A and concluded that the strain did not present new biological risks to humans or the environment and could be released in Brazil. At that point, Brazil became the first country to approve the unconstrained release of a genetically modified mosquito. During the assessment, the commission produced a comprehensive list of – and systematically analysed – the perceived hazards. Such hazards included the potential survival to adulthood of immature stages carrying the transgene – should the transgene fail to be expressed or be turned off by exposure to sufficient environmental tetracycline. Other perceived hazards included the potential allergenicity and/or toxicity of the proteins expressed by the gene, the potential for gene flow or increased transmission of human pathogens and the occupation of vacant breeding sites by other vector species. The Zika epidemic both elevated the perceived importance of Ae. aegypti as a vector – among policy-makers and regulators as well as the general public – and increased concerns over the release of males of the OX513A strain. We have therefore reassessed the potential hazards. We found that release of the transgenic mosquitoes would still be both safe and of great potential value in the control of diseases spread by Ae. aegypti, such as chikungunya, dengue and Zika. PMID:27843167

  2. Predicting risk sensitivity in humans and lower animals: risk as variance or coefficient of variation.

    PubMed

    Weber, Elke U; Shafir, Sharoni; Blais, Ann-Renee

    2004-04-01

    This article examines the statistical determinants of risk preference. In a meta-analysis of animal risk preference (foraging birds and insects), the coefficient of variation (CV), a measure of risk per unit of return, predicts choices far better than outcome variance, the risk measure of normative models. In a meta-analysis of human risk preference, the superiority of the CV over variance in predicting risk taking is not as strong. Two experiments show that people's risk sensitivity becomes strongly proportional to the CV when they learn about choice alternatives like other animals, by experiential sampling over time. Experience-based choices differ from choices when outcomes and probabilities are numerically described. Zipf's law as an ecological regularity and Weber's law as a psychological regularity may give rise to the CV as a measure of risk.

  3. International risk of yellow fever spread from the ongoing outbreak in Brazil, December 2016 to May 2017

    PubMed Central

    Dorigatti, Ilaria; Hamlet, Arran; Aguas, Ricardo; Cattarino, Lorenzo; Cori, Anne; Donnelly, Christl A; Garske, Tini; Imai, Natsuko; Ferguson, Neil M

    2017-01-01

    States in south-eastern Brazil were recently affected by the largest Yellow Fever (YF) outbreak seen in a decade in Latin America. Here we provide a quantitative assessment of the risk of travel-related international spread of YF indicating that the United States, Argentina, Uruguay, Spain, Italy and Germany may have received at least one travel-related YF case capable of seeding local transmission. Mitigating the risk of imported YF cases seeding local transmission requires heightened surveillance globally. PMID:28749337

  4. A model for individualized risk prediction of contralateral breast cancer.

    PubMed

    Chowdhury, Marzana; Euhus, David; Onega, Tracy; Biswas, Swati; Choudhary, Pankaj K

    2017-01-01

    Patients diagnosed with invasive breast cancer (BC) or ductal carcinoma in situ are increasingly choosing to undergo contralateral prophylactic mastectomy (CPM) to reduce their risk of contralateral BC (CBC). This is a particularly disturbing trend as a large proportion of these CPMs are believed to be medically unnecessary. Many BC patients tend to substantially overestimate their CBC risk. Thus, there is a pressing need to educate patients effectively on their CBC risk. We develop a CBC risk prediction model to aid physicians in this task. We used data from two sources: Breast Cancer Surveillance Consortium and Surveillance, Epidemiology, and End Results to build the model. The model building steps are similar to those used in developing the BC risk assessment tool (popularly known as Gail model) for counseling women on their BC risk. Our model, named CBCRisk, is exclusively designed for counseling women diagnosed with unilateral BC on the risk of developing CBC. We identified eight factors to be significantly associated with CBC-age at first BC diagnosis, anti-estrogen therapy, family history of BC, high-risk pre-neoplasia status, estrogen receptor status, breast density, type of first BC, and age at first birth. Combining the relative risk estimates with the relevant hazard rates, CBCRisk projects absolute risk of developing CBC over a given period. By providing individualized CBC risk estimates, CBCRisk may help in counseling of BC patients. In turn, this may potentially help alleviate the rate of medically unnecessary CPMs.

  5. Does the Risk Assessment and Prediction Tool predict discharge disposition after joint replacement?

    PubMed

    Hansen, Viktor J; Gromov, Kirill; Lebrun, Lauren M; Rubash, Harry E; Malchau, Henrik; Freiberg, Andrew A

    2015-02-01

    Payers of health services and policymakers place a major focus on cost containment in health care. Studies have shown that early planning of discharge is essential in reducing length of stay and achieving financial benefit; tools that can help predict discharge disposition would therefore be of use. The Risk Assessment and Prediction Tool (RAPT) is a preoperative survey constructed to predict discharge disposition after total joint arthroplasty (TJA). The RAPT was developed and tested on a population of Australian patients undergoing joint replacement, but its validity in other populations is unknown. A low RAPT score is reported to indicate a high risk of needing any form of inpatient rehabilitation after TJA, including short-term nursing facilities. This study attempts (1) to assess predictive accuracy of the RAPT on US patients undergoing total hip and knee arthroplasty (THA/TKA); and (2) to determine predictive accuracy of each individual score (1-12). Between June 2006 and December 2011, RAPT scores of 3213 patients (1449 THAs; 1764 TKAs) were prospectively captured during the preoperative clinical visit. Scores were stored along with other clinical data, including discharge disposition, in a dedicated database on a secure server. The database was queried by the nursing case manager to retrieve the RAPT scores of all patients captured during this time period. Binary logistic regression was used to analyze the scores and determine predictive accuracy. Overall predictive accuracy was 78%. RAPT scores<6 and >10 (of 12) predicted with >90% accuracy discharge to inpatient rehabilitation and home, respectively. Predictive accuracy was lowest for scores between 7 and 10 at 65.2% and almost 50% of patients received scores in this range. Based on our findings, the risk categories in our populations should be high risk<7, intermediate risk 7 to 10, and low risk>10. The RAPT accurately predicted discharge disposition for high- and low-risk patients in our cohort. Based

  6. Characterisation of complete high- and low-risk human papillomavirus genomes isolated from cervical specimens in southern Brazil.

    PubMed

    Oliveira, Gisele R de; Siqueira, Juliana D; Finger-Jardim, Fabiana; Vieira, Valdimara C; Silva, Ronald L; Gonçalves, Carla V; Soares, Esmeralda A; Martinez, Ana Maria Barral de; Soares, Marcelo A

    2017-10-01

    The classification of human papillomavirus (HPV) intratypic lineages by complete genome sequencing is a determinant in understanding biological differences in association with this disease. In this work, we have characterised complete HPV genomes from southern Brazil. Fifteen cervicovaginal Pap smear negative samples previously categorised as HPV-positive were sequenced using ultradeep sequencing, and 18 complete genomes from 13 different HPV types were assembled. Phylogenetic and genetic distance analyses were performed to classify the HPV genomes into lineages and sublineages. This is the first report describing the distribution of HPV intratype lineages of high and low oncogenic risk in asymptomatic women from southern Brazil.

  7. Characterisation of complete high- and low-risk human papillomavirus genomes isolated from cervical specimens in southern Brazil

    PubMed Central

    de Oliveira, Gisele R; Siqueira, Juliana D; Finger-Jardim, Fabiana; Vieira, Valdimara C; Silva, Ronald L; Gonçalves, Carla V; Soares, Esmeralda A; de Martinez, Ana Maria Barral; Soares, Marcelo A

    2017-01-01

    The classification of human papillomavirus (HPV) intratypic lineages by complete genome sequencing is a determinant in understanding biological differences in association with this disease. In this work, we have characterised complete HPV genomes from southern Brazil. Fifteen cervicovaginal Pap smear negative samples previously categorised as HPV-positive were sequenced using ultradeep sequencing, and 18 complete genomes from 13 different HPV types were assembled. Phylogenetic and genetic distance analyses were performed to classify the HPV genomes into lineages and sublineages. This is the first report describing the distribution of HPV intratype lineages of high and low oncogenic risk in asymptomatic women from southern Brazil. PMID:28954002

  8. Vertebral fracture status and the World Health Organization risk factors for predicting osteoporotic fracture risk.

    PubMed

    Chen, Peiqi; Krege, John H; Adachi, Jonathan D; Prior, Jerilynn C; Tenenhouse, Alan; Brown, Jacques P; Papadimitropoulos, Emmanuel; Kreiger, Nancy; Olszynski, Wojciech P; Josse, Robert G; Goltzman, David

    2009-03-01

    Vertebral fractures are the most common osteoporotic fracture, and patients with prevalent vertebral fractures have a greater risk of future fractures. However, radiographically determined vertebral fractures are not identified as a distinct risk factor in the World Health Organization (WHO) fracture risk assessment tool. The objective of this study was to evaluate and compare potential risk factors including morphometric spine fracture status and the WHO risk factors for predicting 5-yr fracture risk. We hypothesized that spine fracture status provides prognostic information in addition to consideration of the WHO risk factors alone. A randomly selected, population-based community cohort of 2761 noninstitutionalized men and women > or =50 yr of age living within 50 km of one of nine regional centers was enrolled in the Canadian Multicentre Osteoporosis Study (CaMOS), a prospective and longitudinal cohort study following subjects for 5 yr. Prevalent and incident spine fractures were identified from lateral spine radiographs. Incident nonvertebral fragility fractures were determined by an annual, mailed fracture questionnaire with validation, and nonvertebral fragility fracture was defined by investigators as a fracture with minimal trauma. A model considering the WHO risk factors plus spine fracture status provided greater prognostic information regarding future fracture risk than a model considering the WHO risk factors alone. In univariate analyses, age, BMD, and spine fracture status had the highest gradient of risk. A model considering these three risk factors captured almost all of the predictive information provided by a model considering spine fracture status plus the WHO risk factors and provided greater predictive information than a model considering the WHO risk factors alone. The use of spine fracture status along with age and BMD predicted future fracture risk with greater simplicity and higher prognostic accuracy than consideration of the risk factors

  9. Individualized Risk Prediction Model for Lung Cancer in Korean Men

    PubMed Central

    Park, Sohee; Nam, Byung-Ho; Yang, Hye-Ryung; Lee, Ji An; Lim, Hyunsun; Han, Jun Tae; Park, Il Su; Shin, Hai-Rim; Lee, Jin Soo

    2013-01-01

    Purpose Lung cancer is the leading cause of cancer deaths in Korea. The objective of the present study was to develop an individualized risk prediction model for lung cancer in Korean men using population-based cohort data. Methods From a population-based cohort study of 1,324,804 Korean men free of cancer at baseline, the individualized absolute risk of developing lung cancer was estimated using the Cox proportional hazards model. We checked the validity of the model using C statistics and the Hosmer–Lemeshow chi-square test on an external validation dataset. Results The risk prediction model for lung cancer in Korean men included smoking exposure, age at smoking initiation, body mass index, physical activity, and fasting glucose levels. The model showed excellent performance (C statistic = 0.871, 95% CI = 0.867–0.876). Smoking was significantly associated with the risk of lung cancer in Korean men, with a four-fold increased risk in current smokers consuming more than one pack a day relative to non-smokers. Age at smoking initiation was also a significant predictor for developing lung cancer; a younger age at initiation was associated with a higher risk of developing lung cancer. Conclusion This is the first study to provide an individualized risk prediction model for lung cancer in an Asian population with very good model performance. In addition to current smoking status, earlier exposure to smoking was a very important factor for developing lung cancer. Since most of the risk factors are modifiable, this model can be used to identify those who are at a higher risk and who can subsequently modify their lifestyle choices to lower their risk of lung cancer. PMID:23408946

  10. Risk assessment and life prediction of complex engineering systems

    SciTech Connect

    Garcia, M.D.; Varma, R.; Heger, A.S.

    1996-03-01

    Many complex engineering systems will exceed their design life expectancy within the next 10 to 15 years. It is also expected that these systems must be maintained and operated beyond their design life. This paper presents a integrated approach for managing the risks associated with aging effects and predicting the residually expectancy these systems, The approach unifies risk assessment, enhanced surveillance and testing, and robust computational models to assess the risk, predict age, and develop a life-extension management procedure. It also relies on the state of the art in life-extension and risk assessment methods from the nuclear power industry. Borrowing from the developments in decision analysis, this approach should systematically identify the options available for managing the existing aging systems beyond their intended design life.

  11. Cadmium and lead in seafood from the Aratu Bay, Brazil and the human health risk assessment.

    PubMed

    Silva da Araújo, Cecilia Freitas; Lopes, Mariângela Vieira; Vaz Ribeiro, Mirian Rocha; Porcino, Thiago Santos; Vaz Ribeiro, Amanda Santos; Rodrigues, Juliana Lima Gomes; do Prado Oliveira, Sérgio Soares; Menezes-Filho, José Antonio

    2016-04-01

    This study aimed to evaluate cadmium (Cd) and lead (Pb) levels in seafood and perform a risk assessment based on individual food consumption frequency of inhabitants of the Aratu Bay, Brazil. From December 2013 to November 2014, ready-to-market seafood, including fish [pititinga (Lile piquitinga) and small green eel (Gobionellus oceanicus)], mollusks [mussel (Mytella guyanensis) and oyster (Crassostrea rhizophorae)], and crustaceans [white shrimp (Litopenaeus schmitti) and blue crab (Callinectes exasperatus)], were purchased bimonthly from a local artisanal shellfish harvester. Metal levels were analyzed by graphite furnace atomic absorption spectrometry (GFAAS). Based on the volunteer’ seafood consumption, estimates of the non-carcinogenic target hazard quotients (THQs) were calculated. The annual concentrations (μg/g, w/w) of Cd were 0.007 (±0.001) in crustaceans, 0.001 (±0.0003) in fish, and 0.446 (±0.034) in mollusks. Lead levels were risk; however, 9.1 % presented THQs between ≥1 and <9.9. These data are important to inform the community of the imminent exposure risk through communication strategies, with the purpose of minimizing exposure and, consequently, the health effects associated with it.

  12. Ecological risk analysis of pesticides used on irrigated rice crops in southern Brazil.

    PubMed

    Vieira, Danielle Cristina; Noldin, José Alberto; Deschamps, Francisco C; Resgalla, Charrid

    2016-11-01

    Based on studies conducted in the past decade in the southern region of Brazil to determine residue levels of the pesticides normally used on irrigated rice crops, changes can be observed in relation to the presence of pesticides in the waters of the main river basins in Santa Catarina State. In previous harvests, the presence of residues of 7 pesticides was determined, with the herbicide bentazon and the insecticide carbofuran being the products showing highest frequency. Following toxicological tests conducted with 8 different test organisms, deterministic and probabilistic risk analysis was performed to assess the situation of the river basins in areas used for the production of irrigated rice. Of the species tested, the herbicide bentazon showed greatest toxicity toward plants, but did not present an ecological risk because in the worst-case scenario the highest concentration of this pesticide in the environment is 37 times lower than the lowest EC50/LC50 value obtained in the tests. The insecticide carbofuran, which had the highest toxicity toward the organisms used in the tests, presented an ecological risk in the deterministic analysis, but without any associated probability. The results highlight the need for increased efforts in training farmers in crop management practices and for the continual monitor of water bodies for the presence of pesticide residues. Copyright © 2016 Elsevier Ltd. All rights reserved.

  13. Cycling to work in Brazil: users profile, risk behaviors, and traffic accident occurrence.

    PubMed

    Bacchieri, Giancarlo; Barros, Aluísio J D; Dos Santos, Janaína V; Gigante, Denise P

    2010-07-01

    In 2006, we carried out a cross-sectional study in the urban area of Pelotas, Southern Brazil, with the aim of outlining the profile of bicycle commuters, analyzing their use of safety equipment and risk behaviors and the association between these variables and involvement in traffic accidents in the previous 12 months. This study was based on the baseline survey carried out prior to an educational intervention aimed at reducing accidents among cyclists. The sample included 1133 male subjects aged 20 years or more, and who used a bicycle for commuting. Crude and adjusted analyses were carried out using Poisson regression. We recorded a total of 152 reported traffic accidents in the 12 months preceding the interview, involving 10.8% of subjects. Most risk behaviors studied and the use of safety equipment showed no significant association with accidents. Only commuting by bicycle seven days per week, as opposed to five or six, and a combination of extremely imprudent behaviors such as zigzagging through traffic, riding after ingesting alcohol, and high-speed riding were found to be risk factors for accidents. Our findings suggest that in the context where the study was done (poor road signaling, limited policing, aggressive driving) changing cyclist behavior may not have substantial impact in terms of accident reduction before other road traffic interventions are implemented. Copyright 2009 Elsevier Ltd. All rights reserved.

  14. Risk prediction tools for cancer in primary care

    PubMed Central

    Usher-Smith, Juliet; Emery, Jon; Hamilton, Willie; Griffin, Simon J; Walter, Fiona M

    2015-01-01

    Numerous risk tools are now available, which predict either current or future risk of a cancer diagnosis. In theory, these tools have the potential to improve patient outcomes through enhancing the consistency and quality of clinical decision-making, facilitating equitable and cost-effective distribution of finite resources such as screening tests or preventive interventions, and encouraging behaviour change. These potential uses have been recognised by the National Cancer Institute as an ‘area of extraordinary opportunity' and an increasing number of risk prediction models continue to be developed. The data on predictive utility (discrimination and calibration) of these models suggest that some have potential for clinical application; however, the focus on implementation and impact is much more recent and there remains considerable uncertainty about their clinical utility and how to implement them in order to maximise benefits and minimise harms such as over-medicalisation, anxiety and false reassurance. If the potential benefits of risk prediction models are to be realised in clinical practice, further validation of the underlying risk models and research to assess the acceptability, clinical impact and economic implications of incorporating them in practice are needed. PMID:26633558

  15. Predicting Disease Risk Using Bootstrap Ranking and Classification Algorithms

    PubMed Central

    Manor, Ohad; Segal, Eran

    2013-01-01

    Genome-wide association studies (GWAS) are widely used to search for genetic loci that underlie human disease. Another goal is to predict disease risk for different individuals given their genetic sequence. Such predictions could either be used as a “black box” in order to promote changes in life-style and screening for early diagnosis, or as a model that can be studied to better understand the mechanism of the disease. Current methods for risk prediction typically rank single nucleotide polymorphisms (SNPs) by the p-value of their association with the disease, and use the top-associated SNPs as input to a classification algorithm. However, the predictive power of such methods is relatively poor. To improve the predictive power, we devised BootRank, which uses bootstrapping in order to obtain a robust prioritization of SNPs for use in predictive models. We show that BootRank improves the ability to predict disease risk of unseen individuals in the Wellcome Trust Case Control Consortium (WTCCC) data and results in a more robust set of SNPs and a larger number of enriched pathways being associated with the different diseases. Finally, we show that combining BootRank with seven different classification algorithms improves performance compared to previous studies that used the WTCCC data. Notably, diseases for which BootRank results in the largest improvements were recently shown to have more heritability than previously thought, likely due to contributions from variants with low minimum allele frequency (MAF), suggesting that BootRank can be beneficial in cases where SNPs affecting the disease are poorly tagged or have low MAF. Overall, our results show that improving disease risk prediction from genotypic information may be a tangible goal, with potential implications for personalized disease screening and treatment. PMID:23990773

  16. Predicting disease risk using bootstrap ranking and classification algorithms.

    PubMed

    Manor, Ohad; Segal, Eran

    2013-01-01

    Genome-wide association studies (GWAS) are widely used to search for genetic loci that underlie human disease. Another goal is to predict disease risk for different individuals given their genetic sequence. Such predictions could either be used as a "black box" in order to promote changes in life-style and screening for early diagnosis, or as a model that can be studied to better understand the mechanism of the disease. Current methods for risk prediction typically rank single nucleotide polymorphisms (SNPs) by the p-value of their association with the disease, and use the top-associated SNPs as input to a classification algorithm. However, the predictive power of such methods is relatively poor. To improve the predictive power, we devised BootRank, which uses bootstrapping in order to obtain a robust prioritization of SNPs for use in predictive models. We show that BootRank improves the ability to predict disease risk of unseen individuals in the Wellcome Trust Case Control Consortium (WTCCC) data and results in a more robust set of SNPs and a larger number of enriched pathways being associated with the different diseases. Finally, we show that combining BootRank with seven different classification algorithms improves performance compared to previous studies that used the WTCCC data. Notably, diseases for which BootRank results in the largest improvements were recently shown to have more heritability than previously thought, likely due to contributions from variants with low minimum allele frequency (MAF), suggesting that BootRank can be beneficial in cases where SNPs affecting the disease are poorly tagged or have low MAF. Overall, our results show that improving disease risk prediction from genotypic information may be a tangible goal, with potential implications for personalized disease screening and treatment.

  17. Utilizing environmental, socioeconomic data and GIS techniques to estimate the risk for ascariasis and trichuriasis in Minas Gerais, Brazil.

    PubMed

    Scholte, Ronaldo G C; Freitas, Corina C; Dutra, Luciano V; Guimaraes, Ricardo J P S; Drummond, Sandra C; Oliveira, Guilherme; Carvalho, Omar S

    2012-02-01

    The impact of intestinal helminths on human health is well known among the population and health authorities because of their wide geographic distribution and the serious problems they cause. Geohelminths are highly prevalent and have a big impact on public health, mainly in underdeveloped and developing countries. Geohelminths are responsible for the high levels of debility found in the younger population and are often related to cases of chronic diarrhea and malnutrition, which put the physical and intellectual development of children at risk. These geohelminths have not been sufficiently studied. One obstacle in implementing a control program is the lack of knowledge of the prevalence and geographical distribution. Geographical information systems (GIS) and remote sensing (RS) have been utilized to improve understanding of infectious disease distribution and climatic patterns. In this study, GIS and RS technologies, as well as meteorological, social, and environmental variables were utilized for the modeling and prediction of ascariasis and trichuriasis. The GIS and RS technologies specifically used were those produced by orbital sensing including the Moderate Resolution Imaging Spectroradiometer (MODIS) and the Shuttle Radar Topography Mission (SRTM). The results of this study demonstrated important factors related to the transmission of ascariasis and trichuriasis and confirmed the key association between environmental variables and the poverty index, which enabled us to identify priority areas for intervention planning in the state of Minas Gerais in Brazil. Copyright © 2011 Elsevier B.V. All rights reserved.

  18. A new explained-variance based genetic risk score for predictive modeling of disease risk.

    PubMed

    Che, Ronglin; Motsinger-Reif, Alison A

    2012-09-25

    The goal of association mapping is to identify genetic variants that predict disease, and as the field of human genetics matures, the number of successful association studies is increasing. Many such studies have shown that for many diseases, risk is explained by a reasonably large number of variants that each explains a very small amount of disease risk. This is prompting the use of genetic risk scores in building predictive models, where information across several variants is combined for predictive modeling. In the current study, we compare the performance of four previously proposed genetic risk score methods and present a new method for constructing genetic risk score that incorporates explained variance information. The methods compared include: a simple count Genetic Risk Score, an odds ratio weighted Genetic Risk Score, a direct logistic regression Genetic Risk Score, a polygenic Genetic Risk Score, and the new explained variance weighted Genetic Risk Score. We compare the methods using a wide range of simulations in two steps, with a range of the number of deleterious single nucleotide polymorphisms (SNPs) explaining disease risk, genetic modes, baseline penetrances, sample sizes, relative risks (RR) and minor allele frequencies (MAF). Several measures of model performance were compared including overall power, C-statistic and Akaike's Information Criterion. Our results show the relative performance of methods differs significantly, with the new explained variance weighted GRS (EV-GRS) generally performing favorably to the other methods.

  19. Cumulative risk hypothesis: Predicting and preventing child maltreatment recidivism.

    PubMed

    Solomon, David; Åsberg, Kia; Peer, Samuel; Prince, Gwendolyn

    2016-08-01

    Although Child Protective Services (CPS) and other child welfare agencies aim to prevent further maltreatment in cases of child abuse and neglect, recidivism is common. Having a better understanding of recidivism predictors could aid in preventing additional instances of maltreatment. A previous study identified two CPS interventions that predicted recidivism: psychotherapy for the parent, which was related to a reduced risk of recidivism, and temporary removal of the child from the parent's custody, which was related to an increased recidivism risk. However, counter to expectations, this previous study did not identify any other specific risk factors related to maltreatment recidivism. For the current study, it was hypothesized that (a) cumulative risk (i.e., the total number of risk factors) would significantly predict maltreatment recidivism above and beyond intervention variables in a sample of CPS case files and that (b) therapy for the parent would be related to a reduced likelihood of recidivism. Because it was believed that the relation between temporary removal of a child from the parent's custody and maltreatment recidivism is explained by cumulative risk, the study also hypothesized that that the relation between temporary removal of the child from the parent's custody and recidivism would be mediated by cumulative risk. After performing a hierarchical logistic regression analysis, the first two hypotheses were supported, and an additional predictor, psychotherapy for the child, also was related to reduced chances of recidivism. However, Hypothesis 3 was not supported, as risk did not significantly mediate the relation between temporary removal and recidivism.

  20. Risk index proposal to predict atrial fibrillation after cardiac surgery.

    PubMed

    Silva, Rogério Gomes da; Lima, Gustavo Glotz de; Guerra, Nelma; Bigolin, André Vicente; Petersen, Lucas Celia

    2010-01-01

    Atrial fibrillation (AF) is a common complication following cardiac surgery and is associated with an increased patient morbidity and mortality. The objective of this study was to develop a risk index proposal to predict AF after cardiac surgery. A prospective observational study in that 452 patients were selected to assess the incidence and risk factors associated with postoperative AF. Only patients following cardiac surgery were selected. Continuous cardiac monitor and daily electrocardiogram were assessed. The most associated in a multivariable logistic model were selected for the risk index. The average incidence of AF was 22.1%. The most associated factors with AF were: patients older than 75 years of age, mitral valve disease, no use of a beta blocker, withdrawal of a beta-blocker and a positive fluid balance. The absence risk factor determined 4.6% chance to postoperative AF, and for one, two and three or more risk factors, the chance was 16.6%, 25.9% and 46.3%, respectively. In a multivariable logistic model was possible to develop a risk index proposal to predict postoperative AF with a major risk of 46.3% in the presence of three or more risk factors.

  1. Prediction and Informative Risk Factor Selection of Bone Diseases.

    PubMed

    Li, Hui; Li, Xiaoyi; Ramanathan, Murali; Zhang, Aidong

    2015-01-01

    With the booming of healthcare industry and the overwhelming amount of electronic health records (EHRs) shared by healthcare institutions and practitioners, we take advantage of EHR data to develop an effective disease risk management model that not only models the progression of the disease, but also predicts the risk of the disease for early disease control or prevention. Existing models for answering these questions usually fall into two categories: the expert knowledge based model or the handcrafted feature set based model. To fully utilize the whole EHR data, we will build a framework to construct an integrated representation of features from all available risk factors in the EHR data and use these integrated features to effectively predict osteoporosis and bone fractures. We will also develop a framework for informative risk factor selection of bone diseases. A pair of models for two contrast cohorts (e.g., diseased patients versus non-diseased patients) will be established to discriminate their characteristics and find the most informative risk factors. Several empirical results on a real bone disease data set show that the proposed framework can successfully predict bone diseases and select informative risk factors that are beneficial and useful to guide clinical decisions.

  2. Predicting the Risk of a Second Basal Cell Carcinoma.

    PubMed

    Verkouteren, Joris A C; Smedinga, Hilde; Steyerberg, Ewout W; Hofman, Albert; Nijsten, Tamar

    2015-11-01

    A third of basal cell carcinoma (BCC) patients will develop subsequent BCCs. We aimed to develop a simple model to predict the absolute risk of a second BCC. We observed 14,628 participants of Northern European ancestry from a prospective population-based cohort study. BCCs were identified using a linkage with the Dutch Pathology Registry (Pathological Anatomy National Automated Archive). Predictors for a second BCC included 13 phenotypic, lifestyle, and tumor-specific characteristics. The prediction model was based on the Fine and Gray regression model to account for the competing risk of death from other causes. Among 1,077 participants with at least one BCC, 293 developed a second BCC at a median of 3 years. Several well-known risk factors for a first BCC were not prognostic for a second BCC, whereas having more than one initial BCC was the strongest predictor. Discriminative ability at 3 years was reasonable (bootstrap validated c-index=0.65). Three groups were created, with 7, 12, and 28% risk of a second BCC within 3 years. We conclude that a combination of readily available clinical characteristics can reasonably identify patients at high risk of a second BCC. External validation and extension with stronger predictors is desirable to further improve risk prediction.

  3. Identification of the high risk emergency surgical patient: Which risk prediction model should be used?

    PubMed Central

    Stonelake, Stephen; Thomson, Peter; Suggett, Nigel

    2015-01-01

    Introduction National guidance states that all patients having emergency surgery should have a mortality risk assessment calculated on admission so that the ‘high risk’ patient can receive the appropriate seniority and level of care. We aimed to assess if peri-operative risk scoring tools could accurately calculate mortality and morbidity risk. Methods Mortality risk scores for 86 consecutive emergency laparotomies, were calculated using pre-operative (ASA, Lee index) and post-operative (POSSUM, P-POSSUM and CR-POSSUM) risk calculation tools. Morbidity risk scores were calculated using the POSSUM predicted morbidity and compared against actual morbidity according to the Clavien–Dindo classification. Results The actual mortality was 10.5%. The average predicted risk scores for all laparotomies were: ASA 26.5%, Lee Index 2.5%, POSSUM 29.5%, P-POSSUM 18.5%, CR-POSSUM 10.5%. Complications occurred following 67 laparotomies (78%). The majority (51%) of complications were classified as Clavien–Dindo grade 2–3 (non-life-threatening). Patients having a POSSUM morbidity risk of greater than 50% developed significantly more life-threatening complications (CD 4–5) compared with those who predicted less than or equal to 50% morbidity risk (P = 0.01). Discussion Pre-operative risk stratification remains a challenge because the Lee Index under-predicts and ASA over-predicts mortality risk. Post-operative risk scoring using the CR-POSSUM is more accurate and we suggest can be used to identify patients who require intensive care post-operatively. Conclusions In the absence of accurate risk scoring tools that can be used on admission to hospital it is not possible to reliably audit the achievement of national standards of care for the ‘high-risk’ patient. PMID:26468369

  4. Spatial clustering and local risk of leprosy in São Paulo, Brazil.

    PubMed

    Ramos, Antônio Carlos Vieira; Yamamura, Mellina; Arroyo, Luiz Henrique; Popolin, Marcela Paschoal; Chiaravalloti Neto, Francisco; Palha, Pedro Fredemir; Uchoa, Severina Alice da Costa; Pieri, Flávia Meneguetti; Pinto, Ione Carvalho; Fiorati, Regina Célia; Queiroz, Ana Angélica Rêgo de; Belchior, Aylana de Souza; Dos Santos, Danielle Talita; Garcia, Maria Concebida da Cunha; Crispim, Juliane de Almeida; Alves, Luana Seles; Berra, Thaís Zamboni; Arcêncio, Ricardo Alexandre

    2017-02-01

    Although the detection rate is decreasing, the proportion of new cases with WHO grade 2 disability (G2D) is increasing, creating concern among policy makers and the Brazilian government. This study aimed to identify spatial clustering of leprosy and classify high-risk areas in a major leprosy cluster using the SatScan method. Data were obtained including all leprosy cases diagnosed between January 2006 and December 2013. In addition to the clinical variable, information was also gathered regarding the G2D of the patient at diagnosis and after treatment. The Scan Spatial statistic test, developed by Kulldorff e Nagarwalla, was used to identify spatial clustering and to measure the local risk (Relative Risk-RR) of leprosy. Maps considering these risks and their confidence intervals were constructed. A total of 434 cases were identified, including 188 (43.31%) borderline leprosy and 101 (23.28%) lepromatous leprosy cases. There was a predominance of males, with ages ranging from 15 to 59 years, and 51 patients (11.75%) presented G2D. Two significant spatial clusters and three significant spatial-temporal clusters were also observed. The main spatial cluster (p = 0.000) contained 90 census tracts, a population of approximately 58,438 inhabitants, detection rate of 22.6 cases per 100,000 people and RR of approximately 3.41 (95%CI = 2.721-4.267). Regarding the spatial-temporal clusters, two clusters were observed, with RR ranging between 24.35 (95%CI = 11.133-52.984) and 15.24 (95%CI = 10.114-22.919). These findings could contribute to improvements in policies and programming, aiming for the eradication of leprosy in Brazil. The Spatial Scan statistic test was found to be an interesting resource for health managers and healthcare professionals to map the vulnerability of areas in terms of leprosy transmission risk and areas of underreporting.

  5. The Impact of Dietary and Metabolic Risk Factors on Cardiovascular Diseases and Type 2 Diabetes Mortality in Brazil

    PubMed Central

    de Oliveira Otto, Marcia C.; Afshin, Ashkan; Micha, Renata; Khatibzadeh, Shahab; Fahimi, Saman; Singh, Gitanjali; Danaei, Goodarz; Sichieri, Rosely; Monteiro, Carlos A; Louzada, Maria L. C.; Ezzati, Majid; Mozaffarian, Dariush

    2016-01-01

    Background Trends in food availability and metabolic risk factors in Brazil suggest a shift toward unhealthy dietary patterns and increased cardiometabolic disease risk, yet little is known about the impact of dietary and metabolic risk factors on cardiometabolic mortality in Brazil. Methods Based on data from Global Burden of Disease (GBD) Study, we used comparative risk assessment to estimate the burden of 11 dietary and 4 metabolic risk factors on mortality due to cardiovascular diseases and diabetes in Brazil in 2010. Information on national diets and metabolic risks were obtained from the Brazilian Household Budget Survey, the Food and Agriculture Organization database, and large observational studies including Brazilian adults. Relative risks for each risk factor were obtained from meta-analyses of randomized trials or prospective cohort studies; and disease-specific mortality from the GBD 2010 database. We quantified uncertainty using probabilistic simulation analyses, incorporating uncertainty in dietary and metabolic data and relative risks by age and sex. Robustness of findings was evaluated by sensitivity to varying feasible optimal levels of each risk factor. Results In 2010, high systolic blood pressure (SBP) and suboptimal diet were the largest contributors to cardiometabolic deaths in Brazil, responsible for 214,263 deaths (95% uncertainty interval [UI]: 195,073 to 233,936) and 202,949 deaths (95% UI: 194,322 to 211,747), respectively. Among individual dietary factors, low intakes of fruits and whole grains and high intakes of sodium were the largest contributors to cardiometabolic deaths. For premature cardiometabolic deaths (before age 70 years, representing 40% of cardiometabolic deaths), the leading risk factors were suboptimal diet (104,169 deaths; 95% UI: 99,964 to 108,002), high SBP (98,923 deaths; 95%UI: 92,912 to 104,609) and high body-mass index (BMI) (42,643 deaths; 95%UI: 40,161 to 45,111). Conclusion suboptimal diet, high SBP, and high

  6. The Impact of Dietary and Metabolic Risk Factors on Cardiovascular Diseases and Type 2 Diabetes Mortality in Brazil.

    PubMed

    Otto, Marcia C de Oliveira; Afshin, Ashkan; Micha, Renata; Khatibzadeh, Shahab; Fahimi, Saman; Singh, Gitanjali; Danaei, Goodarz; Sichieri, Rosely; Monteiro, Carlos A; Louzada, Maria L C; Ezzati, Majid; Mozaffarian, Dariush

    2016-01-01

    Trends in food availability and metabolic risk factors in Brazil suggest a shift toward unhealthy dietary patterns and increased cardiometabolic disease risk, yet little is known about the impact of dietary and metabolic risk factors on cardiometabolic mortality in Brazil. Based on data from Global Burden of Disease (GBD) Study, we used comparative risk assessment to estimate the burden of 11 dietary and 4 metabolic risk factors on mortality due to cardiovascular diseases and diabetes in Brazil in 2010. Information on national diets and metabolic risks were obtained from the Brazilian Household Budget Survey, the Food and Agriculture Organization database, and large observational studies including Brazilian adults. Relative risks for each risk factor were obtained from meta-analyses of randomized trials or prospective cohort studies; and disease-specific mortality from the GBD 2010 database. We quantified uncertainty using probabilistic simulation analyses, incorporating uncertainty in dietary and metabolic data and relative risks by age and sex. Robustness of findings was evaluated by sensitivity to varying feasible optimal levels of each risk factor. In 2010, high systolic blood pressure (SBP) and suboptimal diet were the largest contributors to cardiometabolic deaths in Brazil, responsible for 214,263 deaths (95% uncertainty interval [UI]: 195,073 to 233,936) and 202,949 deaths (95% UI: 194,322 to 211,747), respectively. Among individual dietary factors, low intakes of fruits and whole grains and high intakes of sodium were the largest contributors to cardiometabolic deaths. For premature cardiometabolic deaths (before age 70 years, representing 40% of cardiometabolic deaths), the leading risk factors were suboptimal diet (104,169 deaths; 95% UI: 99,964 to 108,002), high SBP (98,923 deaths; 95%UI: 92,912 to 104,609) and high body-mass index (BMI) (42,643 deaths; 95%UI: 40,161 to 45,111). suboptimal diet, high SBP, and high BMI are major causes of cardiometabolic

  7. Falls risk prediction tools for hospital inpatients: do they work?

    PubMed

    Oliver, David; Healy, Frances

    A fall is the most reported safety incident in inpatients and occurs in all adult clinical areas. There is growing interest in prevention strategies and, as part of this, in risk assessment tools. These may be useful if the aim is to flag up common risk factors or causes of falls and prompt interventions that are actually delivered. Tools that claim to predict patients' risk of falling as 'high' or 'low' do not work well and may provide false reassurance that 'something is being done'. Falls prevention should focus on a wider range of actions at the level of patients and across organisations.

  8. Child and environmental risk factors predicting readiness for learning in children at high risk of dyslexia.

    PubMed

    Dilnot, Julia; Hamilton, Lorna; Maughan, Barbara; Snowling, Margaret J

    2017-02-01

    We investigate the role of distal, proximal, and child risk factors as predictors of reading readiness and attention and behavior in children at risk of dyslexia. The parents of a longitudinal sample of 251 preschool children, including children at family risk of dyslexia and children with preschool language difficulties, provided measures of socioeconomic status, home literacy environment, family stresses, and child health via interviews and questionnaires. Assessments of children's reading-related skills, behavior, and attention were used to define their readiness for learning at school entry. Children at family risk of dyslexia and children with preschool language difficulties experienced more environmental adversities and health risks than controls. The risks associated with family risk of dyslexia and with language status were additive. Both home literacy environment and child health predicted reading readiness while home literacy environment and family stresses predicted attention and behavior. Family risk of dyslexia did not predict readiness to learn once other risks were controlled and so seems likely to be best conceptualized as representing gene-environment correlations. Pooling across risks defined a cumulative risk index, which was a significant predictor of reading readiness and, together with nonverbal ability, accounted for 31% of the variance between children.

  9. Body mass index, waist circumference, body adiposity index, and risk for type 2 diabetes in two populations in Brazil: general and Amerindian.

    PubMed

    Alvim, Rafael de Oliveira; Mourao-Junior, Carlos Alberto; de Oliveira, Camila Maciel; Krieger, José E; Mill, José G; Pereira, Alexandre C

    2014-01-01

    The use of the anthropometric indices of adiposity, especially body mass index and waist circumference in the prediction of diabetes mellitus has been widely explored. Recently, a new body composition index, the body adiposity index was proposed. The aim of this study was to compare the effectiveness of body mass index, waist circumference, and body adiposity index in the risk assessment for type 2 diabetes mellitus. A total of 1,572 individuals from the general population of Vitoria City, Brazil and 620 Amerindians from the Aracruz Indian Reserve, Brazil were randomly selected. BMI, waist circumference, and BAI were determined according to a standard protocol. Type 2 diabetes mellitus was diagnosed by the presence of fasting glucose ≥126 mg/dL or by the use of antidiabetic drugs. The area under the curve was similar for all anthropometric indices tested in the Amerindian population, but with very different sensitivities or specificities. In women from the general population, the area under the curve of waist circumference was significantly higher than that of the body adiposity index. Regarding risk assessment for type 2 diabetes mellitus, the body adiposity index was a better risk predictor than body mass index and waist circumference in the Amerindian population and was the index with highest odds ratio for type 2 diabetes mellitus in men from the general population, while in women from the general population waist circumference was the best risk predictor. Body adiposity index was the best risk predictor for type 2 diabetes mellitus in the Amerindian population and men from the general population. Our data suggest that the body adiposity index is a useful tool for the risk assessment of type 2 diabetes mellitus in admixture populations.

  10. Body Mass Index, Waist Circumference, Body Adiposity Index, and Risk for Type 2 Diabetes in Two Populations in Brazil: General and Amerindian

    PubMed Central

    Alvim, Rafael de Oliveira; Mourao-Junior, Carlos Alberto; de Oliveira, Camila Maciel; Krieger, José E.; Mill, José G.; Pereira, Alexandre C.

    2014-01-01

    Objective The use of the anthropometric indices of adiposity, especially body mass index and waist circumference in the prediction of diabetes mellitus has been widely explored. Recently, a new body composition index, the body adiposity index was proposed. The aim of this study was to compare the effectiveness of body mass index, waist circumference, and body adiposity index in the risk assessment for type 2 diabetes mellitus. Design and methods A total of 1,572 individuals from the general population of Vitoria City, Brazil and 620 Amerindians from the Aracruz Indian Reserve, Brazil were randomly selected. BMI, waist circumference, and BAI were determined according to a standard protocol. Type 2 diabetes mellitus was diagnosed by the presence of fasting glucose ≥126 mg/dL or by the use of antidiabetic drugs. Results The area under the curve was similar for all anthropometric indices tested in the Amerindian population, but with very different sensitivities or specificities. In women from the general population, the area under the curve of waist circumference was significantly higher than that of the body adiposity index. Regarding risk assessment for type 2 diabetes mellitus, the body adiposity index was a better risk predictor than body mass index and waist circumference in the Amerindian population and was the index with highest odds ratio for type 2 diabetes mellitus in men from the general population, while in women from the general population waist circumference was the best risk predictor. Conclusion Body adiposity index was the best risk predictor for type 2 diabetes mellitus in the Amerindian population and men from the general population. Our data suggest that the body adiposity index is a useful tool for the risk assessment of type 2 diabetes mellitus in admixture populations. PMID:24937307

  11. Systematic review of risk prediction models for falls after stroke.

    PubMed

    Walsh, Mary E; Horgan, N Frances; Walsh, Cathal D; Galvin, Rose

    2016-05-01

    Falls are a significant cause of morbidity after stroke. The aim of this review was to identify, critically appraise and summarise risk prediction models for the occurrence of falling after stroke. A systematic literature search was conducted in December 2014 and repeated in June 2015. Studies that used multivariable analysis to build risk prediction models for falls early after stroke were included. 2 reviewers independently assessed methodological quality. Data relating to model calibration, discrimination (C-statistic) and clinical utility (sensitivity and specificity) were extracted. A narrative review of models was conducted. PROSPERO reference: CRD42014015612. The 12 included articles presented 18 risk prediction models. 7 studies predicted falls among inpatients only and 5 recorded falls in the community. Methodological quality was variable. A C-statistic was reported for 7 models and values ranged from 0.62 to 0.87. Models for use in the inpatient setting most frequently included measures of hemi-inattention, while those predicting community events included falls (or near-falls) history and balance measures most commonly. Only 2 studies reported any form of validation, and none presented a validated model with acceptable performance. A number of falls-risk prediction models have been developed for use in the acute and subacute stages of stroke. Future research should focus on validating and improving existing models, with reference to the Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis (TRIPOD) guidelines to ensure quality reporting and expedite clinical implementation. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  12. Predicting operative risk for coronary artery surgery in the United Kingdom: a comparison of various risk prediction algorithms

    PubMed Central

    Bridgewater, B; Neve, H; Moat, N; Hooper, T; Jones, M

    1998-01-01

    Objective—To compare the ability of four risk models to predict operative mortality after coronary artery bypass graft surgery (CABG) in the United Kingdom.
Design—Prospective study.
Setting—Two cardiothoracic centres in the United Kingdom.
Subjects—1774 patients having CABG.
Main outcome measures—Risk factors were recorded for all patients, along with in-hospital mortality. Predicted mortality was derived from the American Society of Thoracic Surgeons (STS) risk program, Ontario Province risk score (PACCN), Parsonnet score, and the UK Society of Cardiothoracic Surgeons risk algorithm.
Results—There were significant differences (p < 0.05) between the British and American populations from which the STS risk algorithm was derived with respect to most variables. The observed mortality in the British population was 3.7% (65 of 1774). The mean pre- dicted mortality by STS score, PACCN, Parsonnet score, and UK algorithms were 1.1%, 1.6%, 4.6%, and 4.7% respectively. The overall predictive ability of the models as measured by the area under the receiver operating characteristic curve were 0.64, 0.60, 0.73, and 0.75, respectively.
Conclusions—There are differences between the British and American populations for CABG and the North American algorithms are not useful for predicting mortality in the United Kingdom. The UK Society of Cardiothoracic Surgeons algorithm is the best of the models tested but still only has limited predictive ability. Great care must be exercised when using methods of this type for comparisons of units and surgeons.

 Keywords: cardiac surgery;  risk stratification;  audit PMID:9616341

  13. Predictive Protein Toxicity and Its Use in Risk Assessment.

    PubMed

    Franceschi, Niccolò; Paraskevopoulos, Konstantinos; Waigmann, Elisabeth; Ramon, Matthew

    2017-06-01

    In the EU novel proteins used in food or feed are assessed for their potential toxic effects in humans and livestock animals. The discovery of clear molecular features linked to the toxicity of a protein may be an important step towards the use of predictive protein toxicity in risk assessment. Copyright © 2017 Elsevier Ltd. All rights reserved.

  14. Risk Factors for Mycobacterium abscessus subsp. bolletii infection after laparoscopic surgery during an outbreak in Brazil.

    PubMed

    Baruque Villar, Gabriela; de Mello Freitas, Felipe Teixeira; Pais Ramos, Jesus; Dias Campos, Carlos Eduardo; de Souza Caldas, Paulo Cesar; Santos Bordalo, Fernanda; Amorim Ramos, Tatyana Costa; do Nascimento Pereira, Vívian; Cordeiro-Santos, Marcelo; Abdalla Santos, Joao Hugo; Coelho Motta, Glauco; Gomes, Suzie Marie; Mendes de Souza, Verena Maria; de Araujo, Wildo Navegantes

    2015-01-01

    OBJECTIVE To identify risk factors related to Mycobacterium abscessus subsp. bolletii infection during an outbreak, associated with laparoscopic surgery and to propose recommendations for preventing new cases. DESIGN A retrospective cohort study. SETTING A private hospital in Manaus, Brazil. PATIENTS A cohort of 222 patients who underwent laparoscopic surgery between July 2009 and August 2010 by a single surgical team. METHODS We collected information about the patients and the surgical procedure using a standard form. We included sex, age, and variables with P≤0.2 in the bivariate analysis in a logistic regression model. Additionally, we reviewed the procedures for reprocessing the laparoscopic surgery equipment, and the strains obtained with culture were identified by molecular methods. RESULTS We recorded 60 (27%) cases of infection. After multivariate analysis, the duration of surgery beyond 1 hour (odds ratio [OR] 2.4; 95% confidence interval [CI] 1.2-4.5), not to have been the first operated patient on a given day (OR, 2.7; 95% CI, 1.4-5.2), and the use of permanent trocar (OR, 2.2; 95% CI, 1.1-4.2) were associated with infection. We observed that the surgical team attempted to sterilize the equipment in glutaraldehyde solution when sanitary authorities had already prohibited it. Eleven strains presented 100% DNA identity with a single strain, known as BRA100 clone. CONCLUSIONS Because contaminated material can act as vehicle for infection, ensuring adequate sterilization processing of video-assisted surgery equipment was crucial to stopping this single clonal outbreak of nonturbeculous mycobacteria in Brazil.

  15. Predicting Stroke Risk in Hypertensive Patients With Coronary Artery Disease

    PubMed Central

    Coca, Antonio; Messerli, Franz H.; Benetos, Athanase; Zhou, Qian; Champion, Annette; Cooper-DeHoff, Rhonda M.; Pepine, Carl J.

    2009-01-01

    Background and Purpose Our understanding of factors influencing stroke risk among patients with coronary artery disease is incomplete. Accordingly, factors predicting stroke risk in hypertensive, clinically stable coronary artery disease patients were determined with data from the INternational VErapamil SR-trandolapril STudy (INVEST). Methods The effect of baseline characteristics and on-treatment blood pressure (BP) were analyzed to determine the risk of stroke (fatal or nonfatal) among the 22 576 patients enrolled. Cox proportional-hazards models (unadjusted, adjusted, and time dependent) were used to identify predictors of stroke among subgroups with these characteristics present at entry and on-treatment BP. Results Excellent BP control (at 24 months, >70% <140/90 mm Hg) was achieved during 61 835 patient-years of follow-up, as 377 patients had a stroke (6.1 strokes/1000 patient-years) and 28% of those patients had a fatal stroke. Increased age, black race, US residency, and history of prior myocardial infarction, smoking, stroke/transient ischemic attack, arrhythmia, diabetes, and coronary bypass surgery were associated with an increased risk of stroke. Achieving a systolic BP <140 mm Hg and a diastolic BP <90 mm Hg was associated with a decreased risk of stroke. There was no statistically significant difference in stroke risk comparing the verapamil SR–based with the atenolol-based treatment strategy (adjusted hazard ratio=0.87; 95% CI, 0.71 to 1.06; P=0.17). Conclusions Among hypertensive patients with chronic coronary artery disease, stroke was an important complication associated with significant mortality. Black race, US residency, and conditions associated with increased vascular disease severity and arrhythmia predicted increased stroke risk, whereas achieving a BP <140/90 mm Hg on treatment predicted a reduced stroke risk. PMID:18162623

  16. Risk Prediction for Adverse Pregnancy Outcomes in a Medicaid Population

    PubMed Central

    Hall, Eric S.; Greenberg, James M.; Kelly, Elizabeth A.

    2015-01-01

    Abstract Background: Despite prior efforts to develop pregnancy risk prediction models, there remains a lack of evidence to guide implementation in clinical practice. The current aim was to develop and validate a risk tool grounded in social determinants theory for use among at-risk Medicaid patients. Methods: This was a retrospective cohort study of 409 women across 17 Cincinnati health centers between September 2013 and April 2014. The primary outcomes included preterm birth, low birth weight, intrauterine fetal demise, and neonatal death. After random allocation into derivation and validation samples, a multivariable model was developed, and a risk scoring system was assessed and validated using area under the receiver operating characteristic curve (AUROC) values. Results: The derived multivariable model (n=263) included: prior preterm birth, interpregnancy interval, late prenatal care, comorbid conditions, history of childhood abuse, substance use, tobacco use, body mass index, race, twin gestation, and short cervical length. Using a weighted risk score, each additional point was associated with an odds ratio of 1.57 for adverse outcomes, p<0.001, AUROC=0.79. In the validation sample (n=146), each additional point conferred an odds ratio of 1.20, p=0.03, AUROC=0.63. Using a cutoff of 20% probability for the outcome, sensitivity was 29%, with specificity 82%. Positive and negative predictive values were 22% and 85%, respectively. Conclusions: Risk scoring based on social determinants can discriminate pregnancy risk within a Medicaid population; however, performance is modest and consistent with prior prediction models. Future research is needed to evaluate whether implementation of risk scoring in Medicaid prenatal care programs improves clinical outcomes. PMID:26102375

  17. Cumulative Family Risk Predicts Sibling Adjustment to Childhood Cancer

    PubMed Central

    Long, Kristin A.; Marsland, Anna L.; Alderfer, Melissa A.

    2013-01-01

    Background Prolonged, intensive treatment regimens often disrupt families of children with cancer. Siblings are at increased risk for distress, but factors underlying this risk have received limited empirical attention. This study examined associations between the family context and sibling distress. Methods Siblings of children with cancer (ages 8–18, N=209) and parents (186 mothers, 70 fathers) completed measures of sibling distress, family functioning, parenting, and parent posttraumatic stress. Associations between sibling distress and each family risk factor were evaluated. Then, family risks were considered simultaneously by calculating cumulative family risk index scores. Results After controlling for socio-demographic covariates, greater sibling distress was associated with more sibling-reported problems with family functioning and parental psychological control, lower sibling-reported maternal acceptance, and lower paternal self-reported acceptance. When risk factors were considered together, results supported a quadratic model in which associations between family risk and sibling distress were stronger at higher levels of risk. Conclusions Findings support a contextual model of sibling adjustment to childhood cancer in which elevated distress is predicted by family risk factors, alone and in combination. PMID:23576115

  18. Cardiovascular risk prediction in people with chronic kidney disease.

    PubMed

    Matsushita, Kunihiro; Ballew, Shoshana H; Coresh, Josef

    2016-11-01

    Clinical guidelines are not consistent regarding whether or how to utilize information on measures of chronic kidney disease (CKD) for predicting the risk of cardiovascular disease (CVD). This review summarizes recent literature regarding CVD prediction in the context of CKD. Previous studies used different definitions of CKD measures and CVD outcomes, and applied distinct statistical approaches. A recent individual-level meta-analysis from the CKD Prognosis Consortium is of value as it has uniformly investigated creatinine-based estimated glomerular filtration rate (eGFR) and albuminuria as CKD measures and applied the same statistical approach across 24 cohorts with more than 630 000 participants. In this meta-analysis, eGFR and albuminuria improve CVD risk prediction beyond traditional CVD risk factors, particularly for CVD mortality and heart failure. Albuminuria demonstrates more evident improvement than eGFR. Moreover, several recent studies have shown that other filtration markers, for example, cystatin C and β2-microglobulin, and measures of atherosclerosis or cardiac damage (e.g., coronary artery calcium and cardiac troponins) can further improve CVD prediction in the CKD population. Future clinical guidelines may require updates regarding whether/how to incorporate CKD measures and other biomarkers in CVD prediction, depending on the CVD outcomes of interest, target population, and availability of those measures/biomarkers in that population.

  19. Providing access to risk prediction tools via the HL7 XML-formatted risk web service.

    PubMed

    Chipman, Jonathan; Drohan, Brian; Blackford, Amanda; Parmigiani, Giovanni; Hughes, Kevin; Bosinoff, Phil

    2013-07-01

    Cancer risk prediction tools provide valuable information to clinicians but remain computationally challenging. Many clinics find that CaGene or HughesRiskApps fit their needs for easy- and ready-to-use software to obtain cancer risks; however, these resources may not fit all clinics' needs. The HughesRiskApps Group and BayesMendel Lab therefore developed a web service, called "Risk Service", which may be integrated into any client software to quickly obtain standardized and up-to-date risk predictions for BayesMendel tools (BRCAPRO, MMRpro, PancPRO, and MelaPRO), the Tyrer-Cuzick IBIS Breast Cancer Risk Evaluation Tool, and the Colorectal Cancer Risk Assessment Tool. Software clients that can convert their local structured data into the HL7 XML-formatted family and clinical patient history (Pedigree model) may integrate with the Risk Service. The Risk Service uses Apache Tomcat and Apache Axis2 technologies to provide an all Java web service. The software client sends HL7 XML information containing anonymized family and clinical history to a Dana-Farber Cancer Institute (DFCI) server, where it is parsed, interpreted, and processed by multiple risk tools. The Risk Service then formats the results into an HL7 style message and returns the risk predictions to the originating software client. Upon consent, users may allow DFCI to maintain the data for future research. The Risk Service implementation is exemplified through HughesRiskApps. The Risk Service broadens the availability of valuable, up-to-date cancer risk tools and allows clinics and researchers to integrate risk prediction tools into their own software interface designed for their needs. Each software package can collect risk data using its own interface, and display the results using its own interface, while using a central, up-to-date risk calculator. This allows users to choose from multiple interfaces while always getting the latest risk calculations. Consenting users contribute their data for future

  20. Validity of cardiovascular risk prediction models in kidney transplant recipients.

    PubMed

    Mansell, Holly; Stewart, Samuel Alan; Shoker, Ahmed

    2014-01-01

    Predicting cardiovascular risk is of great interest in renal transplant recipients since cardiovascular disease is the leading cause of mortality. To conduct a systematic review to assess the validity of cardiovascular risk prediction models in this population. Five databases were searched (MEDLINE, EMBASE, SCOPUS, CINAHL, and Web of Science) and cohort studies with at least one year of follow-up were included. Variables that described population characteristics, study design, and prognostic performance were extracted. The Quality in Prognostic Studies (QUIPS) tool was used to evaluate bias. Seven studies met the criteria for inclusion, of which, five investigated the Framingham risk score and three used a transplant-specific model. Sample sizes ranged from 344 to 23,575, and three studies lacked sufficient event rates to confidently reach conclusion. Four studies reported discrimination (as measured by c-statistic), which ranged from 0.701 to 0.75, while only one risk model was both internally and externally validated. The Framingham has underestimated cardiovascular events in renal transplant recipients, but these studies have not been robust. A risk prediction model has been externally validated at least on one occasion, but comprehensive validation in multiple cohorts and impact analysis are recommended before widespread clinical application is advocated.

  1. Metal concentrations in surface water and sediments from Pardo River, Brazil: human health risks.

    PubMed

    Alves, Renato I S; Sampaio, Carolina F; Nadal, Martí; Schuhmacher, Marta; Domingo, José L; Segura-Muñoz, Susana I

    2014-08-01

    Pardo River (Brazil) is suffering from an important anthropogenic impact due to the pressure of highly populated areas and the influence of sugarcane cultivation. The objective of the present study was to determine the levels of 13 trace elements (As, Be, Cd, Cr, Cu, Pb, Mn, Hg, Ni, Tl, Sn, V and Zn) in samples of surface water and sediments from the Pardo River. Furthermore, the human health risks associated with exposure to those metals through oral intake and dermal absorption were also evaluated. Spatial and seasonal trends of the data were closely analyzed from a probabilistic approach. Manganese showed the highest mean concentrations in both water and sediments, remarking the incidence of the agricultural activity and the geological characteristics within the basin. Thallium and arsenic were identified as two priority pollutants, being the most important contributors to the Hazard Index (HI). Since non-carcinogenic risks due to thallium exposure slightly exceeded international guidelines (HI>1), a special effort should be made on this trace element. However, the current concentrations of arsenic, a carcinogenic element, were in accordance to acceptable lifetime risks. Nowadays, there is a clear increasing growth in human population and economic activities in the Pardo River, whose waters have become a serious strategic alternative for the potential supply of drinking water. Therefore, environmental monitoring studies are required not only to assure that the current state of pollution of Pardo River does not mean a risk for the riverside population, but also to assess the potential trends in the environmental levels of those elements. Copyright © 2014 Elsevier Inc. All rights reserved.

  2. Ethnozoology in Brazil: analysis of the methodological risks in published studies.

    PubMed

    Lyra-Neves, R M; Santos, E M; Medeiros, P M; Alves, R R N; Albuquerque, U P

    2015-11-01

    There has been a growth in the field of Ethnozoology throughout the years, especially in Brazil, where a considerable number of scientific articles pertaining to this subject has been published in recent decades. With this increase in publications comes the opportunity to assess the quality of these publications, as there are no known studies assessing the methodological risks in this area. Based on this observation, our objectives were to compile the papers published on the subject of ethnozoology and to answer the following questions: 1) Do the Brazilian ethnozoological studies use sound sampling methods?; 2) Is the sampling quality influenced by characteristics of the studies/publications? The studies found in databases and using web search engines were compiled to answer these questions. The studies were assessed based on their nature, sampling methods, use of hypotheses and tests, journal's impact factor, and animal group studied. The majority of the studies analyzed exhibited problems associated with the samples, as 144 (66.98%) studies were classified as having a high risk of bias. With regard to the characteristics analyzed, we determined that a quantitative nature and the use of tests are essential components of good sampling. Most studies classified as moderate and low risk either did not provide these data or provided data that were not clear; therefore, these studies were classified as being of a quali-quantitative nature. Studies performed with vertebrate groups were of high risk. Most of the papers analyzed here focused on fish, insects, and/or mollusks, thus highlighting the difficulties associated with conducting interviews regarding tetrapod vertebrates. Such difficulties are largely related to the extremely strict Brazilian laws, justified by the decline and extinction of some species, related to the use of wild tetrapod vertebrates.

  3. Hybrid data mining ensemble for predicting osteoporosis risk.

    PubMed

    Wang, Wenjia; Richards, Graeme; Rea, Sarah

    2005-01-01

    This paper presents the research in developing data mining ensembles for predicting the risk of osteoporosis prevalence in women. Osteoporosis is a bone disease that commonly occurs among postmenopausal women and no effective treatments are available at the moment, except prevention, which requires early diagnosis. However, early detection of the disease is very difficult. This research aims to devise an intelligent diagnosis support system by using data mining ensemble technology to assist General Practitioners assessing patient's risk at developing osteoporosis. The paper describes the methods for constructing effective ensembles through measuring diversity between individual predictors. Hybrid ensembles are implemented by neural networks and decision tress. The ensembles built for predicting osteoporosis are evaluated by the real-world data and the results indicate that the hybrid ensembles have relatively high-level of diversity and thus are able to improve prediction accuracy.

  4. Seroprevalence and risk factors associated with ovine toxoplasmosis in Northeast Brazil

    PubMed Central

    Andrade, Milena M. Clementino; Carneiro, Mariangela; Medeiros, Andrea D.; Neto, Valter Andrade; Vitor, Ricardo W.A.

    2013-01-01

    Serum samples of 930 sheep were tested by ELISA to assess the prevalence of anti-Toxoplasma gondii antibodies and to identify risk factors associated with the presence of toxoplasmosis in two regions of Rio Grande do Norte (Northeast Brazil), with different climatic conditions. The overall estimated prevalence was 22.1%, with 26.3% and 17.8% positive sheep in Leste Potiguar and Central Potiguar regions, respectively. Among the positive sheep, 18.1% had low-avidity IgG antibodies, suggesting the occurrence of recent toxoplasmosis. The risk factors for toxoplasmosis in sheep were: presence of cats (odds ratio (OR) = 1.55; confidence interval (CI) 95% = 1.11–2.16), age of the animals, with adults presenting a greater chance of infection (OR = 2.44; CI 95% = 1.58–3.75), and the use of running water (OR = 1.61; CI 95% = 1.25–2.09), characterizing the existence of transmission by sporulated oocysts of T. gondii in the environment. PMID:23707895

  5. Trichomonas vaginalis PREVALENCE AND RISK FACTORS FOR WOMEN IN SOUTHERN BRAZIL

    PubMed Central

    AMBROZIO, Cíntia Lima; NAGEL, Andréia Saggin; JESKE, Sabrina; BRAGANÇA, Guilherme Cassão Marques; BORSUK, Sibele; VILLELA, Marcos Marreiro

    2016-01-01

    SUMMARY Trichomonas vaginalis infections have been associated with other diseases so that epidemiological studies of the parasite are important and help to prevent the spread of the disease. This study aimed to determine the prevalence of T. vaginalis in female patients of 19 counties in southwestern Rio Grande do Sul, Brazil. For diagnosis, was used direct examination, followed by applying a socio-epidemiological questionnaire. We analyzed 300 women and 9% were infected by Trichomonas vaginalis. The highest frequency occurred in women between 18 and 39 years old, single/divorced/widowed, whose family income was at one minimum wage or less, and they had not completed the primary school. Statistically significant risk factors were: women reporting two or more sexual partners in the last year were 3.3 times more likely to acquire the parasite, and those in use of oral contraceptives were 2.7 times more likely to have T. vaginalis. Importantly, 33% of the asymptomatic women were infected, and most of the negative results were from women presenting symptoms consistent with the infection. The findings emphasize that it is necessary to expand the knowledge of individuals about the disease, especially among women with the above mentioned risk factors and also to include the regular screening of Trichomonas vaginalis infections in health centers. PMID:27680166

  6. Health risks due to pre-harvesting sugarcane burning in São Paulo State, Brazil.

    PubMed

    Paraiso, Maria Leticia de Souza; Gouveia, Nelson

    2015-01-01

    After 2003, a new period of expansion of the sugarcane culture began in Brazil. Pre-harvesting burning of sugarcane straw is an agricultural practice that, despite the nuisance for the population and pollution generated, still persisted in over 70% of the municipalities of São Paulo State in 2010. In order to study the distribution of this risk factor, an ecological epidemiological study was conducted associating the rates of deaths and hospital admissions for respiratory diseases, for each municipality in the State, with the exposure to the pre-harvesting burning of sugarcane straw. A Bayesian multivariate regression model, controlled for the possible effects of socioeconomic and climate (temperature, humidity, and rainfall) variations, has been used. The effect on health was measured by the standardized mortality and morbidity ratio. The measures of exposure to the pre-harvesting burning used were: percentage of the area of sugarcane harvested with burning, average levels of aerosol, and number of outbreaks of burning. The autocorrelation between data was controlled using a neighborhood matrix. It was observed that the increase in the number of outbreaks of burning was significantly associated with higher rates of hospital admissions for respiratory disease in children under five years old. Pre-harvesting burning of sugarcane effectively imposes risk to population health and therefore it should be eliminated.

  7. Risk factors for Toxoplasma gondii and Neospora caninum seropositivity in buffaloes in Paraiba State, Brazil.

    PubMed

    Brasil, Arthur Willian de Lima; Parentoni, Roberta Nunes; Feitosa, Thais Ferreira; Bezerra, Camila de Sousa; Vilela, Vinicius Longo Ribeiro; Pena, Hilda Fátima de Jesus; de Azevedo, Sergio Santos

    2015-01-01

    The aims of this survey were to determine the frequency of anti-Toxoplasma gondii and anti-Neospora caninum antibodies and to identify the risk factors associated with seropositivity among buffaloes in the state of Paraíba, Brazil. This survey included 136 buffaloes belonging to 14 herds. To detect anti-T. gondii and anti-N. caninum antibodies, the indirect fluorescent antibody test (IFAT) was used. Among the 136 samples analyzed, 17 (12.5%) were positive for anti-T. gondii antibodies with titers ranging from 64 to 1,024, and 26 (19.1%) for anti-N. caninum with titers from 200 to 1,600. Animals seropositive for both T. gondii and N. caninum were found in 10 of the 14 herds (71.4%). Semi-intensive management systems (odds ratio = 2.99) and presence of pigs (odds ratio = 4.33) were identified as risk factors for T. gondii and N. caninum, respectively. It can be suggested that T. gondii and N. caninum are widespread in buffaloes in Paraíba, and that additional surveys are needed in order to ascertain the importance of these agents for this species and for pigs, and the influence of the farming type on occurrences of seropositive animals.

  8. Potential risks of the residue from Samarco's mine dam burst (Bento Rodrigues, Brazil).

    PubMed

    Segura, Fabiana Roberta; Nunes, Emilene Arusievicz; Paniz, Fernanda Pollo; Paulelli, Ana Carolina Cavalheiro; Rodrigues, Gabriela Braga; Braga, Gilberto Úbida Leite; Dos Reis Pedreira Filho, Walter; Barbosa, Fernando; Cerchiaro, Giselle; Silva, Fábio Ferreira; Batista, Bruno Lemos

    2016-11-01

    On November 5th, 2015, Samarco's iron mine dam - called Fundão - spilled 50-60 million m(3) of mud into Gualaxo do Norte, a river that belongs to Rio Doce Basin. Approximately 15 km(2) were flooded along the rivers Gualaxo do Norte, Carmo and Doce, reaching the Atlantic Ocean on November 22nd, 2015. Six days after, our group collected mud, soil and water samples in Bento Rodrigues (Minas Gerais, Brazil), which was the first impacted area. Overall, the results, water samples - potable and surface water from river - presented chemical elements concentration according to Brazilian environmental legislations, except silver concentration in surface water that ranged from 1.5 to 1087 μg L(-1). In addition, water mud-containing presented Fe and Mn concentrations approximately 4-fold higher than the maximum limit for water bodies quality assessment, according to Brazilian laws. Mud particle size ranged from 1 to 200 μm. SEM-EDS spot provided us some semi quantitative data. Leaching/extraction tests suggested that Ba, Pb, As, Sr, Fe, Mn and Al have high potential mobilization from mud to water. Low microbial diversity in mud samples compared to background soil samples. Toxicological bioassays (HepG2 and Allium cepa) indicated potential risks of cytotoxicity and DNA damage in mud and soil samples used in both assays. The present study provides preliminary information aiming to collaborate to the development of future works for monitoring and risk assessment.

  9. Predicting the Individual Risk of Acute Severe Colitis at Diagnosis.

    PubMed

    Cesarini, Monica; Collins, Gary S; Rönnblom, Anders; Santos, Antonieta; Wang, Lai Mun; Sjöberg, Daniel; Parkes, Miles; Keshav, Satish; Travis, Simon P L

    2017-03-01

    Acute severe colitis [ASC] is associated with major morbidity. We aimed to develop and externally validate an index that predicted ASC within 3 years of diagnosis. The development cohort included patients aged 16-89 years, diagnosed with ulcerative colitis [UC] in Oxford and followed for 3 years. Primary outcome was hospitalization for ASC, excluding patients admitted within 1 month of diagnosis. Multivariable logistic regression examined the adjusted association of seven risk factors with ASC. Backwards elimination produced a parsimonious model that was simplified to create an easy-to-use index. External validation occurred in separate cohorts from Cambridge, UK, and Uppsala, Sweden. The development cohort [Oxford] included 34/111 patients who developed ASC within a median 14 months [range 1-29]. The final model applied the sum of 1 point each for extensive disease, C-reactive protein [CRP] > 10mg/l, or haemoglobin < 12g/dl F or < 14g/dl M at diagnosis, to give a score from 0/3 to 3/3. This predicted a 70% risk of developing ASC within 3 years [score 3/3]. Validation cohorts included different proportions with ASC [Cambridge = 25/96; Uppsala = 18/298]. Of those scoring 3/3 at diagnosis, 18/18 [Cambridge] and 12/13 [Uppsala] subsequently developed ASC. Discriminant ability [c-index, where 1.0 = perfect discrimination] was 0.81 [Oxford], 0.95 [Cambridge], 0.97 [Uppsala]. Internal validation using bootstrapping showed good calibration, with similar predicted risk across all cohorts. A nomogram predicted individual risk. An index applied at diagnosis reliably predicts the risk of ASC within 3 years in different populations. Patients with a score 3/3 at diagnosis may merit early immunomodulator therapy.

  10. Landmark Risk Prediction of Residual Life for Breast Cancer Survival

    PubMed Central

    Parast, Layla; Cai, Tianxi

    2013-01-01

    The importance of developing personalized risk prediction estimates has become increasingly evident in recent years. In general, patient populations may be heterogenous and represent a mixture of different unknown subtypes of disease. When the source of this heterogeneity and resulting subtypes of disease are unknown, accurate prediction of survival may be difficult. However, in certain disease settings the onset time of an observable short term event may be highly associated with these unknown subtypes of disease and thus may be useful in predicting long term survival. One approach to incorporate short term event information along with baseline markers for the prediction of long term survival is through a landmark Cox model, which assumes a proportional hazards model for the residual life at a given landmark point. In this paper, we use this modeling framework to develop procedures to assess how a patient’s long term survival trajectory may change over time given good short term outcome indications along with prognosis based on baseline markers. We first propose time-varying accuracy measures to quantify the predictive performance of landmark prediction rules for residual life and provide resampling-based procedures to make inference about such accuracy measures. Simulation studies show that the proposed procedures perform well in finite samples. Throughout, we illustrate our proposed procedures using a breast cancer dataset with information on time to metastasis and time to death. In addition to baseline clinical markers available for each patient, a chromosome instability genetic score, denoted by CIN25, is also available for each patient and has been shown to be predictive of survival for various types of cancer. We provide procedures to evaluate the incremental value of CIN25 for the prediction of residual life and examine how the residual life profile changes over time. This allows us to identify an informative landmark point, t0, such that accurate risk

  11. Predicting the risk of tick-borne diseases.

    PubMed

    Randolph, Sarah

    2002-06-01

    This brief review focuses on the value of predictive risk mapping and the question of how to test predictions of the spatial and temporal variation in risk of tick-borne diseases, specifically as caused by tick-borne encephalitis virus (TBEv). Predictions of the present distribution of TBEv, driven by satellite data, match the mapped records of TBE cases with 90% accuracy in the Baltic region and 81% accuracy in central Europe. Many of the apparently false predictions of TBE presence coincide with recent records of new or reactivated foci, and highlight regions for active surveillance. Predictions of the changes in TBEv distribution under the influence of climate change suggest that TBEv may be driven into increasingly high latitude and high altitude regions, until by the 2080s it is confined to parts of Scandinavia. This is consistent with the fact that enzootic TBEv cycles are inherently fragile and depend for their existence on specific seasonal temperature profiles and moisture conditions, which may be disrupted by climate change. Changes in the incidence of TBE in many countries since the 1990s are also consistent with these predictions, although there is evidence that local non-biological factors also play an important role in determining the incidence of disease.

  12. Risk Factors Predictive of the Problem Behavior of Children at Risk for Emotional and Behavioral Disorders

    ERIC Educational Resources Information Center

    Nelson, J. Ron; Stage, Scott; Duppong-Hurley, Kristin; Synhorst, Lori; Epstein, Michael H.

    2007-01-01

    Logistic regression analyses were used to establish the most robust set of risk factors that would best predict borderline/clinical levels of problem behavior (i.e., a t score at or above 60 on the Child Behavior Checklist Total Problem scale) of kindergarten and first-grade children at risk for emotional and behavioral disorders. Results showed…

  13. The Reliability and Predictive Validity of the Stalking Risk Profile.

    PubMed

    McEwan, Troy E; Shea, Daniel E; Daffern, Michael; MacKenzie, Rachel D; Ogloff, James R P; Mullen, Paul E

    2016-06-14

    This study assessed the reliability and validity of the Stalking Risk Profile (SRP), a structured measure for assessing stalking risks. The SRP was administered at the point of assessment or retrospectively from file review for 241 adult stalkers (91% male) referred to a community-based forensic mental health service. Interrater reliability was high for stalker type, and moderate-to-substantial for risk judgments and domain scores. Evidence for predictive validity and discrimination between stalking recidivists and nonrecidivists for risk judgments depended on follow-up duration. Discrimination was moderate (area under the curve = 0.66-0.68) and positive and negative predictive values good over the full follow-up period (Mdn = 170.43 weeks). At 6 months, discrimination was better than chance only for judgments related to stalking of new victims (area under the curve = 0.75); however, high-risk stalkers still reoffended against their original victim(s) 2 to 4 times as often as low-risk stalkers. Implications for the clinical utility and refinement of the SRP are discussed.

  14. Predicting impacts of climate change on Fasciola hepatica risk.

    PubMed

    Fox, Naomi J; White, Piran C L; McClean, Colin J; Marion, Glenn; Evans, Andy; Hutchings, Michael R

    2011-01-10

    Fasciola hepatica (liver fluke) is a physically and economically devastating parasitic trematode whose rise in recent years has been attributed to climate change. Climate has an impact on the free-living stages of the parasite and its intermediate host Lymnaea truncatula, with the interactions between rainfall and temperature having the greatest influence on transmission efficacy. There have been a number of short term climate driven forecasts developed to predict the following season's infection risk, with the Ollerenshaw index being the most widely used. Through the synthesis of a modified Ollerenshaw index with the UKCP09 fine scale climate projection data we have developed long term seasonal risk forecasts up to 2070 at a 25 km square resolution. Additionally UKCIP gridded datasets at 5 km square resolution from 1970-2006 were used to highlight the climate-driven increase to date. The maps show unprecedented levels of future fasciolosis risk in parts of the UK, with risk of serious epidemics in Wales by 2050. The seasonal risk maps demonstrate the possible change in the timing of disease outbreaks due to increased risk from overwintering larvae. Despite an overall long term increase in all regions of the UK, spatio-temporal variation in risk levels is expected. Infection risk will reduce in some areas and fluctuate greatly in others with a predicted decrease in summer infection for parts of the UK due to restricted water availability. This forecast is the first approximation of the potential impacts of climate change on fasciolosis risk in the UK. It can be used as a basis for indicating where active disease surveillance should be targeted and where the development of improved mitigation or adaptation measures is likely to bring the greatest benefits.

  15. Predicting Impacts of Climate Change on Fasciola hepatica Risk

    PubMed Central

    Fox, Naomi J.; White, Piran C. L.; McClean, Colin J.; Marion, Glenn; Evans, Andy; Hutchings, Michael R.

    2011-01-01

    Fasciola hepatica (liver fluke) is a physically and economically devastating parasitic trematode whose rise in recent years has been attributed to climate change. Climate has an impact on the free-living stages of the parasite and its intermediate host Lymnaea truncatula, with the interactions between rainfall and temperature having the greatest influence on transmission efficacy. There have been a number of short term climate driven forecasts developed to predict the following season's infection risk, with the Ollerenshaw index being the most widely used. Through the synthesis of a modified Ollerenshaw index with the UKCP09 fine scale climate projection data we have developed long term seasonal risk forecasts up to 2070 at a 25 km square resolution. Additionally UKCIP gridded datasets at 5 km square resolution from 1970-2006 were used to highlight the climate-driven increase to date. The maps show unprecedented levels of future fasciolosis risk in parts of the UK, with risk of serious epidemics in Wales by 2050. The seasonal risk maps demonstrate the possible change in the timing of disease outbreaks due to increased risk from overwintering larvae. Despite an overall long term increase in all regions of the UK, spatio-temporal variation in risk levels is expected. Infection risk will reduce in some areas and fluctuate greatly in others with a predicted decrease in summer infection for parts of the UK due to restricted water availability. This forecast is the first approximation of the potential impacts of climate change on fasciolosis risk in the UK. It can be used as a basis for indicating where active disease surveillance should be targeted and where the development of improved mitigation or adaptation measures is likely to bring the greatest benefits. PMID:21249228

  16. Common polygenic variation enhances risk prediction for Alzheimer's disease.

    PubMed

    Escott-Price, Valentina; Sims, Rebecca; Bannister, Christian; Harold, Denise; Vronskaya, Maria; Majounie, Elisa; Badarinarayan, Nandini; Morgan, Kevin; Passmore, Peter; Holmes, Clive; Powell, John; Brayne, Carol; Gill, Michael; Mead, Simon; Goate, Alison; Cruchaga, Carlos; Lambert, Jean-Charles; van Duijn, Cornelia; Maier, Wolfgang; Ramirez, Alfredo; Holmans, Peter; Jones, Lesley; Hardy, John; Seshadri, Sudha; Schellenberg, Gerard D; Amouyel, Philippe; Williams, Julie

    2015-12-01

    The identification of subjects at high risk for Alzheimer's disease is important for prognosis and early intervention. We investigated the polygenic architecture of Alzheimer's disease and the accuracy of Alzheimer's disease prediction models, including and excluding the polygenic component in the model. This study used genotype data from the powerful dataset comprising 17 008 cases and 37 154 controls obtained from the International Genomics of Alzheimer's Project (IGAP). Polygenic score analysis tested whether the alleles identified to associate with disease in one sample set were significantly enriched in the cases relative to the controls in an independent sample. The disease prediction accuracy was investigated in a subset of the IGAP data, a sample of 3049 cases and 1554 controls (for whom APOE genotype data were available) by means of sensitivity, specificity, area under the receiver operating characteristic curve (AUC) and positive and negative predictive values. We observed significant evidence for a polygenic component enriched in Alzheimer's disease (P = 4.9 × 10(-26)). This enrichment remained significant after APOE and other genome-wide associated regions were excluded (P = 3.4 × 10(-19)). The best prediction accuracy AUC = 78.2% (95% confidence interval 77-80%) was achieved by a logistic regression model with APOE, the polygenic score, sex and age as predictors. In conclusion, Alzheimer's disease has a significant polygenic component, which has predictive utility for Alzheimer's disease risk and could be a valuable research tool complementing experimental designs, including preventative clinical trials, stem cell selection and high/low risk clinical studies. In modelling a range of sample disease prevalences, we found that polygenic scores almost doubles case prediction from chance with increased prediction at polygenic extremes.

  17. Coronary risk prediction for those with and without diabetes.

    PubMed

    2006-02-01

    Coronary risk prediction 'engines' are now in common use, and their worth is well proven. There remains the question of how to deal with a prior diagnosis of diabetes. An individual participant meta-analysis of 33 cohort studies involving 364 566 subjects. Fatal coronary hazard ratios for age, smoking, systolic blood pressure and cholesterol, were computed from Cox models, comparing those with and without diabetes. Three risk prediction equations were compared: a 'stepped model', which included the risk factors and diabetes status; an 'interaction model', which included interactions between diabetes and the risk factors; and a 'fixed model', which fixed the 10-year rate of coronary death amongst those with diabetes to be 7%. These were compared through the area under the receiver operating characteristic curve (AUC) and Hosmer-Lemeshow statistics. The hazard ratio for age was greater for those without diabetes than those with, for men (P=0.005) and women (P=0.02); for men only, systolic blood pressure showed a similar differential (P=0.011). Nevertheless, AUCs were only 0.001 different for the stepped and interaction models for each sex. The AUC for the fixed model was lower and, unlike the other two, showed significant lack of fit for both sexes (P<0.001). There is no justification for developing separate risk prediction models for those with and without diabetes, nor for assuming that everyone with diabetes should be considered as being at a common high level of risk. Diabetes status might, instead, be used as a risk variable in an overall population equation.

  18. The development of an early warning system for climate-sensitive disease risk with a focus on dengue epidemics in Southeast Brazil.

    PubMed

    Lowe, Rachel; Bailey, Trevor C; Stephenson, David B; Jupp, Tim E; Graham, Richard J; Barcellos, Christovam; Carvalho, Marilia Sá

    2013-02-28

    Previous studies demonstrate statistically significant associations between disease and climate variations, highlighting the potential for developing climate-based epidemic early warning systems. However, limitations include failure to allow for non-climatic confounding factors, limited geographical/temporal resolution, or lack of evaluation of predictive validity. Here, we consider such issues for dengue in Southeast Brazil using a spatio-temporal generalised linear mixed model with parameters estimated in a Bayesian framework, allowing posterior predictive distributions to be derived in time and space. This paper builds upon a preliminary study by Lowe et al. but uses extended, more recent data and a refined model formulation, which, amongst other adjustments, incorporates past dengue risk to improve model predictions. For the first time, a thorough evaluation and validation of model performance is conducted using out-of-sample predictions and demonstrates considerable improvement over a model that mirrors current surveillance practice. Using the model, we can issue probabilistic dengue early warnings for pre-defined 'alert' thresholds. With the use of the criterion 'greater than a 50% chance of exceeding 300 cases per 100,000 inhabitants', there would have been successful epidemic alerts issued for 81% of the 54 regions that experienced epidemic dengue incidence rates in February-April 2008, with a corresponding false alarm rate of 25%. We propose a novel visualisation technique to map ternary probabilistic forecasts of dengue risk. This technique allows decision makers to identify areas where the model predicts with certainty a particular dengue risk category, to effectively target limited resources to those districts most at risk for a given season.

  19. Subgroup specific incremental value of new markers for risk prediction

    PubMed Central

    Zhou, Qian M.; Zheng, Yingye

    2013-01-01

    In many clinical applications, understanding when measurement of new markers is necessary to provide added accuracy to existing prediction tools could lead to more cost effective disease management. Many statistical tools for evaluating the incremental value (IncV) of the novel markers over the routine clinical risk factors have been developed in recent years. However, most existing literature focuses primarily on global assessment. Since the IncVs of new markers often vary across subgroups, it would be of great interest to identify subgroups for which the new markers are most/least useful in improving risk prediction. In this paper we provide novel statistical procedures for systematically identifying potential traditional-marker based subgroups in whom it might be beneficial to apply a new model with measurements of both the novel and traditional markers. We consider various conditional time-dependent accuracy parameters for censored failure time outcome to assess the subgroup-specific IncVs. We provide non-parametric kernel-based estimation procedures to calculate the proposed parameters. Simultaneous interval estimation procedures are provided to account for sampling variation and adjust for multiple testing. Simulation studies suggest that our proposed procedures work well in finite samples. The proposed procedures are applied to the Framingham Offspring Study to examine the added value of an inflammation marker, C-reactive protein, on top of the traditional Framingham risk score for predicting 10-year risk of cardiovascular disease. PMID:23263882

  20. Pedophilia: an evaluation of diagnostic and risk prediction methods.

    PubMed

    Wilson, Robin J; Abracen, Jeffrey; Looman, Jan; Picheca, Janice E; Ferguson, Meaghan

    2011-06-01

    One hundred thirty child sexual abusers were diagnosed using each of following four methods: (a) phallometric testing, (b) strict application of Diagnostic and Statistical Manual of Mental Disorders (4th ed., text revision [DSM-IV-TR]) criteria, (c) Rapid Risk Assessment of Sex Offender Recidivism (RRASOR) scores, and (d) "expert" diagnoses rendered by a seasoned clinician. Comparative utility and intermethod consistency of these methods are reported, along with recidivism data indicating predictive validity for risk management. Results suggest that inconsistency exists in diagnosing pedophilia, leading to diminished accuracy in risk assessment. Although the RRASOR and DSM-IV-TR methods were significantly correlated with expert ratings, RRASOR and DSM-IV-TR were unrelated to each other. Deviant arousal was not associated with any of the other methods. Only the expert ratings and RRASOR scores were predictive of sexual recidivism. Logistic regression analyses showed that expert diagnosis did not add to prediction of sexual offence recidivism over and above RRASOR alone. Findings are discussed within a context of encouragement of clinical consistency and evidence-based practice regarding treatment and risk management of those who sexually abuse children.

  1. Effective Genetic-Risk Prediction Using Mixed Models

    PubMed Central

    Golan, David; Rosset, Saharon

    2014-01-01

    For predicting genetic risk, we propose a statistical approach that is specifically adapted to dealing with the challenges imposed by disease phenotypes and case-control sampling. Our approach (termed Genetic Risk Scores Inference [GeRSI]), combines the power of fixed-effects models (which estimate and aggregate the effects of single SNPs) and random-effects models (which rely primarily on whole-genome similarities between individuals) within the framework of the widely used liability-threshold model. We demonstrate in extensive simulation that GeRSI produces predictions that are consistently superior to current state-of-the-art approaches. When applying GeRSI to seven phenotypes from the Wellcome Trust Case Control Consortium (WTCCC) study, we confirm that the use of random effects is most beneficial for diseases that are known to be highly polygenic: hypertension (HT) and bipolar disorder (BD). For HT, there are no significant associations in the WTCCC data. The fixed-effects model yields an area under the ROC curve (AUC) of 54%, whereas GeRSI improves it to 59%. For BD, using GeRSI improves the AUC from 55% to 62%. For individuals ranked at the top 10% of BD risk predictions, using GeRSI substantially increases the BD relative risk from 1.4 to 2.5. PMID:25279982

  2. Supplementation with Brazil nuts and green tea extract regulates targeted biomarkers related to colorectal cancer risk in humans.

    PubMed

    Hu, Ying; McIntosh, Graeme H; Le Leu, Richard K; Somashekar, Roshini; Meng, Xing Q; Gopalsamy, Geetha; Bambaca, Libby; McKinnon, Ross A; Young, Graeme P

    2016-12-01

    Se and green tea have been shown in epidemiological, observational and preclinical studies to be inversely related to the risk of developing colorectal cancer (CRC). However, there are limited studies to evaluate their regulatory effects on genes/proteins that relate to CRC oncogenesis in human subjects, such as selenoproteins, WNT signalling pathway, inflammation and methylation. This study examined the effects of supplementation of Se using Brazil nuts and green tea extract (GTE) capsules, alone and in combination, on targeted biomarkers. In total, thirty-two volunteers (>50 years of age) with plasma Se≤1·36 µmol/l were randomised to one of three treatment groups: nine to Se (approximately 48 µg/d) as six Brazil nuts, eleven to four GTE capsules (800 mg (-)-epigallocatechin-3-gallate) and twelve to a combination of Brazil nuts and GTE. Blood and rectal biopsies were obtained before and after each intervention. Plasma Se levels, rectal selenoprotein P (SePP) and β-catenin mRNA increased significantly in subjects consuming Brazil nuts alone or in combination, whereas rectal DNA methyltransferase (DNMT1) and NF-κB mRNA were reduced significantly in subjects consuming GTE alone or in combination. None of the interventions significantly affected rectal acetylated histone H3 or Ki-67 expression at the protein level or plasma C-reactive protein. Effects of the combination of Brazil nuts and GTE did not differ from what would be expected from either agent alone. In conclusion, supplementation of Brazil nuts and/or GTE regulates targeted biomarkers related to CRC oncogenesis, specifically genes associated with selenoproteins (SePP), WNT signalling (β-catenin), inflammation (NF-κB) and methylation (DNMT1). Their combination does not appear to provide additional effects compared with either agent alone.

  3. Risk Factors for Bartonella species Infection in Blood Donors from Southeast Brazil

    PubMed Central

    Diniz, Pedro Paulo Vissotto de Paiva; Velho, Paulo Eduardo Neves Ferreira; Pitassi, Luiza Helena Urso; Drummond, Marina Rovani; Lania, Bruno Grosselli; Barjas-Castro, Maria Lourdes; Sowy, Stanley; Breitschwerdt, Edward B.; Scorpio, Diana Gerardi

    2016-01-01

    Bacteria from the genus Bartonella are emerging blood-borne bacteria, capable of causing long-lasting infection in marine and terrestrial mammals, including humans. Bartonella are generally well adapted to their main host, causing persistent infection without clinical manifestation. However, these organisms may cause severe disease in natural or accidental hosts. In humans, Bartonella species have been detected from sick patients presented with diverse disease manifestations, including cat scratch disease, trench fever, bacillary angiomatosis, endocarditis, polyarthritis, or granulomatous inflammatory disease. However, with the advances in diagnostic methods, subclinical bloodstream infection in humans has been reported, with the potential for transmission through blood transfusion been recently investigated by our group. The objective of this study was to determine the risk factors associated with Bartonella species infection in asymptomatic blood donors presented at a major blood bank in Southeastern Brazil. Five hundred blood donors were randomly enrolled and tested for Bartonella species infection by specialized blood cultured coupled with high-sensitive PCR assays. Epidemiological questionnaires were designed to cover major potential risk factors, such as age, gender, ethnicity, contact with companion animals, livestock, or wild animals, bites from insects or animal, economical status, among other factors. Based on multivariate logistic regression, bloodstream infection with B. henselae or B. clarridgeiae was associated with cat contact (adjusted OR: 3.4, 95% CI: 1.1–9.6) or history of tick bite (adjusted OR: 3.7, 95% CI: 1.3–13.4). These risk factors should be considered during donor screening, as bacteremia by these Bartonella species may not be detected by traditional laboratory screening methods, and it may be transmitted by blood transfusion. PMID:26999057

  4. Risk and other factors associated with toxoplasmosis and toxocariasis in pregnant women from southern Brazil.

    PubMed

    Santos, P C; Telmo, P L; Lehmann, L M; Mattos, G T; Klafke, G B; Lorenzi, C; Hirsch, C; Lemos, L; Berne, M E A; Gonçalves, C V; Scaini, C J

    2017-09-01

    Toxoplasmosis causes complications during pregnancy that have serious effects on fetal development. Thus far, toxocariasis has been reported to spread only via vertical transmission. Nonetheless, the population of pregnant women is also exposed to this infection. Co-infection with both Toxoplasma gondii and Toxocara spp. has been reported in children, but there are no reports of co-infection in the population of pregnant women. The aim of this study was to determine the prevalence of co-infection with T. gondii and Toxocara spp. in pregnant women at a university hospital in southern Brazil, and to identify the risk factors associated with infection by both parasites. Two hundred pregnant women were tested for the presence of anti-T. gondii and anti-Toxocara spp. antibodies and were asked to complete an epidemiological questionnaire. In this study, the co-infection rate observed in the total population of pregnant women was 8%. In addition, women with a positive result for a serology test for Toxocara spp. were at increased risk of infection by T. gondii (P = 0.019). Co-infection with both parasites in pregnant women was associated with low birth weights in neonates. The similar modes of transmission of both parasites could explain the co-infection. Only a few previous studies have investigated this phenomenon. The findings of the present study emphasize the importance of serological diagnosis during prenatal care and further research in this area to identify risk factors associated with this co-infection, and the possible implications of this co-infection during pregnancy and on the health of newborns.

  5. HIV/AIDS risk among female sex workers who use crack in Southern Brazil.

    PubMed

    Malta, Monica; Monteiro, Simone; Lima, Rosa Maria Jeronymo; Bauken, Suzana; Marco, Aliamar de; Zuim, Gleisse Cristine; Bastos, Francisco Inacio; Singer, Merrill; Strathdee, Steffanie Anne

    2008-10-01

    To understand the social context of female sex workers who use crack and its impact on HIV/AIDS risk behaviors. METHODODOLOGICAL PROCEDURES: Qualitative study carried out in Foz do Iguaçu, Southern Brazil, in 2003. Twenty-six in-depth interviews and two focus groups were carried out with female commercial sex workers who frequently use crack. In-depth interviews with health providers, community leaders and public policy managers, as well as field observations were also conducted. Transcript data was entered into Atlas.ti software and grounded theory methodology was used to analyze the data and develop a conceptual model as a result of this study. Female sex workers who use crack had low self-perceived HIV risk in spite of being engaged in risky behaviors (e.g. unprotected sex with multiple partners). Physical and sexual violence among clients, occasional and stable partners was widespread jeopardizing negotiation and consistent condom use. According to health providers, community leaders and public policy managers, several female sex workers who use crack are homeless or live in slums, and rarely have access to health services, voluntary counseling and testing, social support, pre-natal and reproductive care. Female sex workers who use crack experience a plethora of health and social problems, which apparently affect their risks for HIV infection. Low-threshold, user-friendly and gender-tailored interventions should be implemented, in order to increase the access to health and social-support services among this population. Those initiatives might also increase their access to reproductive health in general, and to preventive strategies focusing on HIV/AIDS and other sexually transmitted infections.

  6. A risk scoring system for prediction of haemorrhagic stroke.

    PubMed

    Zodpey, S P; Tiwari, R R

    2005-01-01

    The present pair-matched case control study was carried out at Government Medical College Hospital, Nagpur, India, a tertiary care hospital with the objective to devise and validate a risk scoring system for prediction of hemorrhagic stroke. The study consisted of 166 hospitalized CT scan proved cases of hemorrhagic stroke (ICD 9, 431-432), and a age and sex matched control per case. The controls were selected from patients who attended the study hospital for conditions other than stroke. On conditional multiple logistic regression five risk factors- hypertension (OR = 1.9. 95% Cl = 1.5-2.5). raised scrum total cholesterol (OR = 2.3, 95% Cl = 1.1-4.9). use of anticoagulants and antiplatelet agents (OR = 3.4, 95% Cl =1.1-10.4). past history of transient ischaemic attack (OR = 8.4, 95% Cl = 2.1- 33.6) and alcohol intake (OR = 2.1, 95% Cl = 1.3-3.6) were significant. These factors were ascribed statistical weights (based on regression coefficients) of 6, 8, 12, 21 and 8 respectively. The nonsignificant factors (diabetes mellitus, physical inactivity, obesity, smoking, type A personality, history of claudication, family history of stroke, history of cardiac diseases and oral contraceptive use in females) were not included in the development of scoring system. ROC curve suggested a total score of 21 to be the best cut-off for predicting haemorrhag stroke. At this cut-off the sensitivity, specificity, positive predictivity and Cohen's kappa were 0.74, 0.74, 0.74 and 0.48 respectively. The overall predictive accuracy of this additive risk scoring system (area under ROC curve by Wilcoxon statistic) was 0.79 (95% Cl = 0.73-0.84). Thus to conclude, if substantiated by further validation, this scorincy system can be used to predict haemorrhagic stroke, thereby helping to devise effective risk factor intervention strategy.

  7. Design and prospective evaluation of a risk-based surveillance system for shrimp grow-out farms in northeast Brazil.

    PubMed

    Marques, Ana Rita; Pereira, Marcelo; Ferreira Neto, Jose Soares; Ferreira, Fernando

    2015-12-01

    The farming of Pacific white shrimp Litopennaeus vannamei in northeast Brazil, has proven to be a promising sector. However, the farming of Pacific white shrimp in Brazil has been affected negatively by the occurrence of viral diseases, threatening this sector's expansion and sustainability. For this reason, the drafting of a surveillance system for early detection and definition of freedom from viral diseases, whose occurrence could result in high economic loses, is of the utmost importance. The stochastic model AquaVigil was implemented to prospectively evaluate different surveillance strategies to determine freedom from disease and identify the strategy with the lowest sampling efforts, making the best use of available resources through risk-based surveillance. The worked example presented was designed for regional application for the state of Ceará and can easily be applied to other Brazilian states. The AquaVigil model can analyse any risk-based surveillance system that considers a similar outline to the strategy here presented.

  8. Long-term cortisol measures predict Alzheimer disease risk.

    PubMed

    Ennis, Gilda E; An, Yang; Resnick, Susan M; Ferrucci, Luigi; O'Brien, Richard J; Moffat, Scott D

    2017-01-24

    To examine whether long-term measures of cortisol predict Alzheimer disease (AD) risk. We used a prospective longitudinal design to examine whether cortisol dysregulation was related to AD risk. Participants were from the Baltimore Longitudinal Study of Aging (BLSA) and submitted multiple 24-hour urine samples over an average interval of 10.56 years. Urinary free cortisol (UFC) and creatinine (Cr) were measured, and a UFC/Cr ratio was calculated to standardize UFC. To measure cortisol regulation, we used within-person UFC/Cr level (i.e., within-person mean), change in UFC/Cr over time (i.e., within-person slope), and UFC/Cr variability (i.e., within-person coefficient of variation). Cox regression was used to assess whether UFC/Cr measures predicted AD risk. UFC/Cr level and UFC/Cr variability, but not UFC/Cr slope, were significant predictors of AD risk an average of 2.9 years before AD onset. Elevated UFC/Cr level and elevated UFC/Cr variability were related to a 1.31- and 1.38-times increase in AD risk, respectively. In a sensitivity analysis, increased UFC/Cr level and increased UFC/Cr variability predicted increased AD risk an average of 6 years before AD onset. Cortisol dysregulation as manifested by high UFC/Cr level and high UFC/Cr variability may modulate the downstream clinical expression of AD pathology or be a preclinical marker of AD. © 2016 American Academy of Neurology.

  9. Prediction of cardiac risk in patients undergoing vascular surgery

    SciTech Connect

    Morise, A.P.; McDowell, D.E.; Savrin, R.A.; Goodwin, C.A.; Gabrielle, O.F.; Oliver, F.N.; Nullet, F.R.; Bekheit, S.; Jain, A.C.

    1987-03-01

    In an attempt to determine whether noninvasive cardiac testing could be used to assess cardiac risk in patients undergoing surgery for vascular disease, the authors studied 96 patients. Seventy-seven patients eventually underwent major vascular surgery with 11 (14%) experiencing a significant cardiac complication. Thallium imaging was much more likely to be positive (p less than 0.01) in patients with a cardiac complication; however, there was a significant number of patients with cardiac complications who had a positive history or electrocardiogram for myocardial infarction. When grouped by complication and history of infarction, thallium imaging, if negative, correctly predicted low cardiac risk in the group with a history of infarction. Thallium imaging, however, did not provide a clear separation of risk in those without a history of infarction. Age and coronary angiography, on the other hand, did reveal significant differences within the group without a history of infarction. The resting radionuclide ejection fraction followed a similar pattern to thallium imaging. It is concluded that a positive history of myocardial infarction at any time in the past is the strongest risk predictor in this population and that the predictive value of noninvasive testing is dependent on this factor. Considering these findings, a proposed scheme for assessing risk that will require further validation is presented.

  10. Risk perception and communication regarding pesticide use in rural work: a case study in Rio de Janeiro State, Brazil.

    PubMed

    Peres, Frederico; Moreira, Josino C; Rodrigues, Karla M; Claudio, Luz

    2006-01-01

    In an agricultural region of Rio de Janeiro State, Brazil, rapid assessment procedures were used for risk-perception studies based on methodologic triangulation that included semi-structured interviews, participatory observations, and focus groups. Data were qualitatively categorized. Women's risk perception was prioritized, as they did not recognize some risks they were exposed to during work activities. To reach women likely to be exposed to pesticides, a photographic soap opera (fotonovela) was constructed in collaboration with rural workers, using community-based participatory research methods. Contents of the risk-communication strategies included the harmful effects of pesticides. Results showed that the inclusion of risk-perception studies in the development of educative and risk-communication campaigns is very important, bridging research to action.

  11. Improving default risk prediction using Bayesian model uncertainty techniques.

    PubMed

    Kazemi, Reza; Mosleh, Ali

    2012-11-01

    Credit risk is the potential exposure of a creditor to an obligor's failure or refusal to repay the debt in principal or interest. The potential of exposure is measured in terms of probability of default. Many models have been developed to estimate credit risk, with rating agencies dating back to the 19th century. They provide their assessment of probability of default and transition probabilities of various firms in their annual reports. Regulatory capital requirements for credit risk outlined by the Basel Committee on Banking Supervision have made it essential for banks and financial institutions to develop sophisticated models in an attempt to measure credit risk with higher accuracy. The Bayesian framework proposed in this article uses the techniques developed in physical sciences and engineering for dealing with model uncertainty and expert accuracy to obtain improved estimates of credit risk and associated uncertainties. The approach uses estimates from one or more rating agencies and incorporates their historical accuracy (past performance data) in estimating future default risk and transition probabilities. Several examples demonstrate that the proposed methodology can assess default probability with accuracy exceeding the estimations of all the individual models. Moreover, the methodology accounts for potentially significant departures from "nominal predictions" due to "upsetting events" such as the 2008 global banking crisis. © 2012 Society for Risk Analysis.

  12. Spatio-temporal modelling of climate-sensitive disease risk: Towards an early warning system for dengue in Brazil

    NASA Astrophysics Data System (ADS)

    Lowe, Rachel; Bailey, Trevor C.; Stephenson, David B.; Graham, Richard J.; Coelho, Caio A. S.; Sá Carvalho, Marilia; Barcellos, Christovam

    2011-03-01

    This paper considers the potential for using seasonal climate forecasts in developing an early warning system for dengue fever epidemics in Brazil. In the first instance, a generalised linear model (GLM) is used to select climate and other covariates which are both readily available and prove significant in prediction of confirmed monthly dengue cases based on data collected across the whole of Brazil for the period January 2001 to December 2008 at the microregion level (typically consisting of one large city and several smaller municipalities). The covariates explored include temperature and precipitation data on a 2.5°×2.5° longitude-latitude grid with time lags relevant to dengue transmission, an El Niño Southern Oscillation index and other relevant socio-economic and environmental variables. A negative binomial model formulation is adopted in this model selection to allow for extra-Poisson variation (overdispersion) in the observed dengue counts caused by unknown/unobserved confounding factors and possible correlations in these effects in both time and space. Subsequently, the selected global model is refined in the context of the South East region of Brazil, where dengue predominates, by reverting to a Poisson framework and explicitly modelling the overdispersion through a combination of unstructured and spatio-temporal structured random effects. The resulting spatio-temporal hierarchical model (or GLMM—generalised linear mixed model) is implemented via a Bayesian framework using Markov Chain Monte Carlo (MCMC). Dengue predictions are found to be enhanced both spatially and temporally when using the GLMM and the Bayesian framework allows posterior predictive distributions for dengue cases to be derived, which can be useful for developing a dengue alert system. Using this model, we conclude that seasonal climate forecasts could have potential value in helping to predict dengue incidence months in advance of an epidemic in South East Brazil.

  13. Maternal relationship during adolescence predicts cardiovascular disease risk in adulthood.

    PubMed

    Doom, Jenalee R; Gunnar, Megan R; Clark, Cari Jo

    2016-04-01

    The current study investigated whether greater maternal support during adolescence is associated with lower levels of cardiovascular disease (CVD) risk in adulthood, and whether maternal support serves as a moderator or a mediator of the socioeconomic status (SES) and CVD risk association. In addition, potential moderators and mediators of the association between adult CVD risk and adolescent maternal support and SES were tested. Using the National Longitudinal Study of Adolescent to Adult Health (n = 11,013), we examined relations between maternal support during adolescence (M = 15.3 years) and CVD risk in young adulthood (M = 28.7 years) via path analysis. Maternal support was assessed by a composite of adolescent and mother report. CVD risk was calculated with a Framingham-based prediction model that uses age, sex, body mass index, smoking, systolic blood pressure, diabetes, and use of antihypertensive medication. Greater maternal support in adolescence was related to lower CVD risk in young adulthood (B = -0.56, 95% CI: -0.91 to -0.20, p < .01). The interaction between adolescent SES and maternal support was not significant, (p > .05), but there was an interaction between maternal support and race such that African American adolescents were more sensitive than Whites to the effects of maternal support on CVD risk (B = -0.90, 95% CI: -1.56, -0.25, p < .01). In addition, there was no evidence that maternal support mediated the association between SES and CVD risk (p > .05), and there was no association between SES and maternal support (p > .05), adjusting for confounders. However, the relations of adolescent maternal support and SES to adult CVD risk were mediated by young adult health behaviors and financial stress but not by depressive symptoms. Greater maternal support during adolescence appears to act independently of SES when impacting CVD risk and may operate through health behaviors and financial stress. (PsycINFO Database Record (c) 2016 APA, all rights

  14. Lifestyle predicts falls independent of physical risk factors.

    PubMed

    Faulkner, K A; Cauley, J A; Studenski, S A; Landsittel, D P; Cummings, S R; Ensrud, K E; Donaldson, M G; Nevitt, M C

    2009-12-01

    Many falls occur among older adults with no traditional risk factors. We examined potential independent effects of lifestyle on fall risk. Not smoking and going outdoors frequently or infrequently were independently associated with more falls, indicating lifestyle-related behavioral and environmental risk factors are important causes of falls in older women. Physical and lifestyle risk factors for falls and population attributable risks (PAR) were examined. We conducted a 4-year prospective study of 8,378 community-dwelling women (mean age = 71 years, SD = 3) enrolled in the Study of Osteoporotic Fractures. Data on number of falls were self-reported every 4 months. Fall rates were calculated (# falls/woman-years). Poisson regression was used to estimate relative risks (RR). Physical risk factors (p < or = 0.05 for all) included tall height (RR = 0.89 per 5 in.), dizziness (RR = 1.16), fear of falling (RR = 1.20), self-reported health decline (RR = 1.19), difficulty with Instrumental Activities of Daily Living (IADLs) (RR = 1.12, per item), fast usual-paced walking speed (RR = 1.18, per 2 SD), and use of antidepressants (RR = 1.20), benzodiazepines (RR = 1.11), or anticonvulsants (RR = 1.62). Protective physical factors (p < or = 0.05 for all) included good visual acuity (RR = 0.87, per 2 SD) and good balance (RR = 0.85 vs. poor). Lifestyle predicted fewer falls including current smoking (RR = 0.76), going outdoors at least twice weekly but not more than once a day (RR = 0.89 and vs. twice daily). High physical activity was associated with more falls but only among IADL impaired women. Five potentially modifiable physical risk factors had PAR > or = 5%. Fall interventions addressing modifiable physical risk factors with PAR > or = 5% while considering environmental/behavioral risk factors are indicated.

  15. Predictions of space radiation fatality risk for exploration missions

    NASA Astrophysics Data System (ADS)

    Cucinotta, Francis A.; To, Khiet; Cacao, Eliedonna

    2017-05-01

    In this paper we describe revisions to the NASA Space Cancer Risk (NSCR) model focusing on updates to probability distribution functions (PDF) representing the uncertainties in the radiation quality factor (QF) model parameters and the dose and dose-rate reduction effectiveness factor (DDREF). We integrate recent heavy ion data on liver, colorectal, intestinal, lung, and Harderian gland tumors with other data from fission neutron experiments into the model analysis. In an earlier work we introduced distinct QFs for leukemia and solid cancer risk predictions, and here we consider liver cancer risks separately because of the higher RBE's reported in mouse experiments compared to other tumors types, and distinct risk factors for liver cancer for astronauts compared to the U.S. population. The revised model is used to make predictions of fatal cancer and circulatory disease risks for 1-year deep space and International Space Station (ISS) missions, and a 940 day Mars mission. We analyzed the contribution of the various model parameter uncertainties to the overall uncertainty, which shows that the uncertainties in relative biological effectiveness (RBE) factors at high LET due to statistical uncertainties and differences across tissue types and mouse strains are the dominant uncertainty. NASA's exposure limits are approached or exceeded for each mission scenario considered. Two main conclusions are made: 1) Reducing the current estimate of about a 3-fold uncertainty to a 2-fold or lower uncertainty will require much more expansive animal carcinogenesis studies in order to reduce statistical uncertainties and understand tissue, sex and genetic variations. 2) Alternative model assumptions such as non-targeted effects, increased tumor lethality and decreased latency at high LET, and non-cancer mortality risks from circulatory diseases could significantly increase risk estimates to several times higher than the NASA limits.

  16. Predictions of space radiation fatality risk for exploration missions.

    PubMed

    Cucinotta, Francis A; To, Khiet; Cacao, Eliedonna

    2017-05-01

    In this paper we describe revisions to the NASA Space Cancer Risk (NSCR) model focusing on updates to probability distribution functions (PDF) representing the uncertainties in the radiation quality factor (QF) model parameters and the dose and dose-rate reduction effectiveness factor (DDREF). We integrate recent heavy ion data on liver, colorectal, intestinal, lung, and Harderian gland tumors with other data from fission neutron experiments into the model analysis. In an earlier work we introduced distinct QFs for leukemia and solid cancer risk predictions, and here we consider liver cancer risks separately because of the higher RBE's reported in mouse experiments compared to other tumors types, and distinct risk factors for liver cancer for astronauts compared to the U.S. The revised model is used to make predictions of fatal cancer and circulatory disease risks for 1-year deep space and International Space Station (ISS) missions, and a 940 day Mars mission. We analyzed the contribution of the various model parameter uncertainties to the overall uncertainty, which shows that the uncertainties in relative biological effectiveness (RBE) factors at high LET due to statistical uncertainties and differences across tissue types and mouse strains are the dominant uncertainty. NASA's exposure limits are approached or exceeded for each mission scenario considered. Two main conclusions are made: 1) Reducing the current estimate of about a 3-fold uncertainty to a 2-fold or lower uncertainty will require much more expansive animal carcinogenesis studies in order to reduce statistical uncertainties and understand tissue, sex and genetic variations. 2) Alternative model assumptions such as non-targeted effects, increased tumor lethality and decreased latency at high LET, and non-cancer mortality risks from circulatory diseases could significantly increase risk estimates to several times higher than the NASA limits. Copyright © 2017 The Committee on Space Research (COSPAR

  17. Maternal Alcohol Consumption during Pregnancy and Early Age Leukemia Risk in Brazil

    PubMed Central

    Ferreira, Jeniffer Dantas; Couto, Arnaldo Cézar; Pombo-de-Oliveira, Maria S.; Koifman, Sergio

    2015-01-01

    Objectives. To investigate the association between the maternal alcohol consumption during pregnancy and early age leukemia (EAL) in offspring. Methods. Datasets were analyzed from a case-control study carried out in Brazil during 1999–2007. Data were obtained by maternal interviews using a standardized questionnaire. The present study included 675 children (193 acute lymphoid leukemia (ALL), 59 acute myeloid leukemia (AML), and 423 controls). Unconditional logistic regression was performed, and adjusted odds ratios (adj. OR) on the association between alcohol consumption and EAL were ascertained. Results. Alcohol consumption was reported by 43% of ALL and 39% of AML case mothers and 35.5% of controls'. Beer consumption before and during pregnancy was associated with ALL in crude analysis (OR = 1.54, 95% CI, 1.08–2.19), although in adjusted analysis no statistical significance was found. For weekly intake of ≤1 glass (adj. OR = 1.30, 95% CI, 0.71–2.36) and ≥1 glass/week (adj. OR = 1.47, 95% CI, 0.88–2.46) a potential dose-response was observed (P trend < 0.03). Conclusion. This study failed to support the hypothesis of an increased risk of EAL associated with maternal alcohol intake during pregnancy, neither with the interaction with tobacco nor with alcohol consumption. PMID:26090439

  18. Respiratory syncytial virus seasonality in Brazil: implications for the immunisation policy for at-risk populations

    PubMed Central

    Freitas, André Ricardo Ribas; Donalisio, Maria Rita

    2016-01-01

    Respiratory syncytial virus (RSV) infection is the leading cause of hospitalisation for respiratory diseases among children under 5 years old. The aim of this study was to analyse RSV seasonality in the five distinct regions of Brazil using time series analysis (wavelet and Fourier series) of the following indicators: monthly positivity of the immunofluorescence reaction for RSV identified by virologic surveillance system, and rate of hospitalisations per bronchiolitis and pneumonia due to RSV in children under 5 years old (codes CID-10 J12.1, J20.5, J21.0 and J21.9). A total of 12,501 samples with 11.6% positivity for RSV (95% confidence interval 11 - 12.2), varying between 7.1 and 21.4% in the five Brazilian regions, was analysed. A strong trend for annual cycles with a stable stationary pattern in the five regions was identified through wavelet analysis of the indicators. The timing of RSV activity by Fourier analysis was similar between the two indicators analysed and showed regional differences. This study reinforces the importance of adjusting the immunisation period for high risk population with the monoclonal antibody palivizumab taking into account regional differences in seasonality of RSV. PMID:27120006

  19. Toxoplasma gondii in goats from Curitiba, Paraná, Brazil: risks factors and epidemiology.

    PubMed

    Garcia, Guilherme; Sotomaior, Cristina; do Nascimento, Aguinaldo José; Navarro, Italmar Teodorico; Soccol, Vanete Thomaz

    2012-01-01

    Toxoplasmosis is a zoonosis caused by Toxoplasma gondii, a protozoan with wide geographical distribution and minimal parasitic specificity that affects many species of wild and domestic animals. In livestock, especially in small ruminants like goats, toxoplasmosis can cause abortion and the birth of weak animals, leading to economic losses to farmers, and is a major source of human infection. This is a seroepidemiological study of toxoplasmosis in goats in the state of Paraná, Brazil. Sera from 405 goats from the metropolitan mesoregion of Curitiba, eastern state, were tested by the enzyme-linked immunosorbent assay (ELISA) and indirect immunofluorescence antibody test (IFAT). Information on properties and goat characteristics was also collected using questionnaires. The prevalence of toxoplasmosis was 39.41 and 35.96% by ELISA and IFAT, respectively. T. gondii antibody prevalence increased with age. The risk factors for T. gondii infection in goats were: age over one year; exposure to cats, type of management and purpose of breeding. Other epidemiological factors and relevant control measures are discussed in the current study.

  20. Tooth loss prevalence and risk indicators among 12-year-old schoolchildren from South Brazil.

    PubMed

    Alves, L S; Susin, C; Damé-Teixeira, N; Maltz, M

    2014-01-01

    This population-based cross-sectional study aimed to assess the prevalence and risk indicators for tooth loss due to dental caries among 12-year-old schoolchildren from South Brazil. 1,528 out of 1,837 (participation rate = 83.17%) schoolchildren were included. Tooth loss prevalence was 5.81% (95% CI = 3.71-8.98) and 0.08 (95% CI = 0.04-0.12) teeth were missing. Schoolchildren with low socioeconomic status (OR = 2.28, 95% CI = 1.23-4.21), who repeated years in school (OR = 1.56, 95% CI = 1.01-2.42), and with gingivitis (OR = 1.81, 95% CI = 1.33-2.45) were more likely to have missing teeth. Schoolchildren brushing 2 times/day (OR = 0.78, 95% CI = 0.64-0.96) or more (OR = 0.49, 95% CI = 0.33-0.74), and those with dental insurance or private dentists (OR = 0.60, 95% CI = 0.39-0.93) were less likely to present missing teeth. © 2014 S. Karger AG, Basel. © 2014 S. Karger AG, Basel.

  1. [Risk factors for sexually transmitted diseases among sex workers in the interior of Piaui, Brazil].

    PubMed

    Penha, Jardeliny Corrêa da; Aquino, Caroline Batista de Queiroz; Neri, Érica de Alencar Rodrigues; Reis, Thaís Gomes Oliveira Dos; Aquino, Priscila de Souza; Pinheiro, Ana Karina Bezerra

    2015-06-01

    To identify the risk factors for STD among female sex workers and the characteristics of this population, and to verify the association between condom use by their male partners and clients. Cross-sectional and correlational study conducted with 73 sex workers registered at the Sex Workers´ Association of the municipality of Picos -PI, Brazil. Data were collected in September and October 2010 using a questionnaire to obtain sociodemographic information and the participants´ background in the sex industry. Ethical aspects were observed. There was no significant association between most of the sociodemographic variables and background in the sex industry and condom use by male partners or clients. However, there was a significant association with years in the sex industry (p = 0.029). Sex workers who had been in the industry for the longest used condoms for protection against sexually transmitted diseases. It is essential to create health promotion strategies that observe the real-life experiences of sex workers.

  2. Use of Chronic Kidney Disease to Enhance Prediction of Cardiovascular Risk in Those at Medium Risk.

    PubMed

    Chia, Yook Chin; Lim, Hooi Min; Ching, Siew Mooi

    2015-01-01

    Based on global cardiovascular (CV) risk assessment for example using the Framingham risk score, it is recommended that those with high risk should be treated and those with low risk should not be treated. The recommendation for those of medium risk is less clear and uncertain. We aimed to determine whether factoring in chronic kidney disease (CKD) will improve CV risk prediction in those with medium risk. This is a 10-year retrospective cohort study of 905 subjects in a primary care clinic setting. Baseline CV risk profile and serum creatinine in 1998 were captured from patients record. Framingham general cardiovascular disease risk score (FRS) for each patient was computed. All cardiovascular disease (CVD) events from 1998-2007 were captured. Overall, patients with CKD had higher FRS risk score (25.9% vs 20%, p = 0.001) and more CVD events (22.3% vs 11.9%, p = 0.002) over a 10-year period compared to patients without CKD. In patients with medium CV risk, there was no significant difference in the FRS score among those with and without CKD (14.4% vs 14.6%, p = 0.84) However, in this same medium risk group, patients with CKD had more CV events compared to those without CKD (26.7% vs 6.6%, p = 0.005). This is in contrast to patients in the low and high risk group where there was no difference in CVD events whether these patients had or did not have CKD. There were more CV events in the Framingham medium risk group when they also had CKD compared those in the same risk group without CKD. Hence factoring in CKD for those with medium risk helps to further stratify and identify those who are actually at greater risk, when treatment may be more likely to be indicated.

  3. Predicting Epidemic Risk from Past Temporal Contact Data

    PubMed Central

    Valdano, Eugenio; Poletto, Chiara; Giovannini, Armando; Palma, Diana; Savini, Lara; Colizza, Vittoria

    2015-01-01

    Understanding how epidemics spread in a system is a crucial step to prevent and control outbreaks, with broad implications on the system’s functioning, health, and associated costs. This can be achieved by identifying the elements at higher risk of infection and implementing targeted surveillance and control measures. One important ingredient to consider is the pattern of disease-transmission contacts among the elements, however lack of data or delays in providing updated records may hinder its use, especially for time-varying patterns. Here we explore to what extent it is possible to use past temporal data of a system’s pattern of contacts to predict the risk of infection of its elements during an emerging outbreak, in absence of updated data. We focus on two real-world temporal systems; a livestock displacements trade network among animal holdings, and a network of sexual encounters in high-end prostitution. We define the node’s loyalty as a local measure of its tendency to maintain contacts with the same elements over time, and uncover important non-trivial correlations with the node’s epidemic risk. We show that a risk assessment analysis incorporating this knowledge and based on past structural and temporal pattern properties provides accurate predictions for both systems. Its generalizability is tested by introducing a theoretical model for generating synthetic temporal networks. High accuracy of our predictions is recovered across different settings, while the amount of possible predictions is system-specific. The proposed method can provide crucial information for the setup of targeted intervention strategies. PMID:25763816

  4. Risk prediction with machine learning and regression methods.

    PubMed

    Steyerberg, Ewout W; van der Ploeg, Tjeerd; Van Calster, Ben

    2014-07-01

    This is a discussion of issues in risk prediction based on the following papers: "Probability estimation with machine learning methods for dichotomous and multicategory outcome: Theory" by Jochen Kruppa, Yufeng Liu, Gérard Biau, Michael Kohler, Inke R. König, James D. Malley, and Andreas Ziegler; and "Probability estimation with machine learning methods for dichotomous and multicategory outcome: Applications" by Jochen Kruppa, Yufeng Liu, Hans-Christian Diener, Theresa Holste, Christian Weimar, Inke R. König, and Andreas Ziegler.

  5. Cardiovascular surgery risk prediction from the patient's perspective.

    PubMed

    Miyata, Hiroaki; Motomura, Noboru; Yozu, Ryohei; Kyo, Shunei; Takamoto, Shinichi

    2011-09-01

    Previous studies have developed cardiovascular surgery outcome prediction models using only patient risk factors, but surgery outcomes from the patient's perspective seem to differ between hospitals. We have developed outcome prediction models that incorporate preoperative patient risks, as well as hospital processes and structure. Data were collected from the Japan Cardiovascular Database for patients scheduled for cardiovascular surgery between January 2005 and December 2007. We analyzed 33,821 procedures in 102 hospitals. Logistic regression was used to generate risk models, which were then validated through split-sample validation. Odds ratios, 95% confidence intervals, and P values for structures and processes in the mortality prediction model were as follows: "hospital annual adult cardiac surgery volume (continuous; every 1 procedure increase per year)" (odds ratio, 0.998; confidence interval, 0.997-0.999; P < .001); "recommended staffing and equipment" (odds ratio, 0.75; confidence interval, 0.64-0.87; P < .001); "daily conferences with cardiologists" (odds ratio, 0.79; confidence interval, 0.60-1.02; P = .073); "intensivists involved in postsurgical management" (odds ratio, 0.89; confidence interval, 0.77-1.02; P = .90); "public hospitals" (odds ratio, 0.80; confidence interval, 0.70-0.93; P = .003); "surgeons lacking miscellaneous duties" (odds ratio, 0.80; confidence interval, 0.70-0.93; P = .003); and "surgeons who work no more than 32 hours per week" (odds ratio, 0.55; confidence interval, 0.32-0.95; P = .032). The mortality prediction model had a C-index of 0.85 and a Hosmer-Lemeshow P value of .79. Our models yielded good discrimination and calibration, so they may prove useful for hospital selection based on individual patient risks and circumstances. Improved surgeon work environments were also shown to be important for both surgeons and patients. Copyright © 2011 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights

  6. [Mortality due to ill-defined causes in Brazil (1979-2002) and a predictive model for age].

    PubMed

    Costa, Marli Ramos da; Marcopito, Luiz Francisco

    2008-05-01

    This study focused on the percentage of deaths due to ill-defined causes in Brazil, from 1979 to 2002. The objectives were to: (a) describe changes over the 24-year period; (b) identify the age group in which the percentage of ill-defined causes correlated most closely with the total percentage of ill-defined causes; (c) select a predictive model for the percentage of ill-defined causes in such age group, given the total percentage of ill-defined causes; (d) describe changes in the distributions of each age group in the total ill-defined causes; and (e) verify whether the percentage of deaths in-hospital shows any relationship to the percentage of ill-defined causes. Results showed that the total percentage of deaths from ill-defined causes decreased in Brazil. The percentage of ill-defined causes in the > 50-year age group correlated most closely with the total percentage of ill-defined causes, and cubic regression was the most appropriate predictive model. Age > 50 showed the highest increase in its share of total ill-defined causes from 1979 to 2002. The percentage of in-hospital deaths showed an inverse relationship with the percentage of deaths from ill-defined causes.

  7. Carnival or football, is there a real risk for acquiring dengue fever in Brazil during holidays seasons?

    NASA Astrophysics Data System (ADS)

    Aguiar, Maíra; Rocha, Filipe; Pessanha, José Eduardo Marques; Mateus, Luis; Stollenwerk, Nico

    2015-02-01

    More than 600,000 football fans, coming from all over the world, were expected to visit Brazil during the FIFA World Cup 2014. International travel can become a public health problem when the visitors start to become sick, needing medical intervention and eventually hospitalization. The occurrence of dengue fever infections in Brazil is persistent and has been increasing since the 1980s, and the health authorities were expected to take preventive measures and to warn the visitors about the risks during the tournament period. Before the World Cup started, studies have been published stating that dengue could be a significant problem in some of the Brazilian cities hosting the games. These conclusions were taken after a brief observation of the available data, analyzing its mean and standard deviation only, or based on seasonal climate forecasts, causing alarm for the world cup in Brazil. Here, with a more careful data analysis, we show that the seasonality of the disease plays a major role in dengue transmission. The density of dengue cases in Brazil is residual during winter in the Southern hemisphere (mid June to mid September) and the fans of football were not likely to get dengue during the tournament period.

  8. Carnival or football, is there a real risk for acquiring dengue fever in Brazil during holidays seasons?

    PubMed Central

    Aguiar, Maíra; Rocha, Filipe; Pessanha, José Eduardo Marques; Mateus, Luis; Stollenwerk, Nico

    2015-01-01

    More than 600,000 football fans, coming from all over the world, were expected to visit Brazil during the FIFA World Cup 2014. International travel can become a public health problem when the visitors start to become sick, needing medical intervention and eventually hospitalization. The occurrence of dengue fever infections in Brazil is persistent and has been increasing since the 1980s, and the health authorities were expected to take preventive measures and to warn the visitors about the risks during the tournament period. Before the World Cup started, studies have been published stating that dengue could be a significant problem in some of the Brazilian cities hosting the games. These conclusions were taken after a brief observation of the available data, analyzing its mean and standard deviation only, or based on seasonal climate forecasts, causing alarm for the world cup in Brazil. Here, with a more careful data analysis, we show that the seasonality of the disease plays a major role in dengue transmission. The density of dengue cases in Brazil is residual during winter in the Southern hemisphere (mid June to mid September) and the fans of football were not likely to get dengue during the tournament period. PMID:25684648

  9. Carnival or football, is there a real risk for acquiring dengue fever in Brazil during holidays seasons?

    PubMed

    Aguiar, Maíra; Rocha, Filipe; Pessanha, José Eduardo Marques; Mateus, Luis; Stollenwerk, Nico

    2015-02-16

    More than 600,000 football fans, coming from all over the world, were expected to visit Brazil during the FIFA World Cup 2014. International travel can become a public health problem when the visitors start to become sick, needing medical intervention and eventually hospitalization. The occurrence of dengue fever infections in Brazil is persistent and has been increasing since the 1980s, and the health authorities were expected to take preventive measures and to warn the visitors about the risks during the tournament period. Before the World Cup started, studies have been published stating that dengue could be a significant problem in some of the Brazilian cities hosting the games. These conclusions were taken after a brief observation of the available data, analyzing its mean and standard deviation only, or based on seasonal climate forecasts, causing alarm for the world cup in Brazil. Here, with a more careful data analysis, we show that the seasonality of the disease plays a major role in dengue transmission. The density of dengue cases in Brazil is residual during winter in the Southern hemisphere (mid June to mid September) and the fans of football were not likely to get dengue during the tournament period.

  10. Risk Prediction Models for Lung Cancer: A Systematic Review.

    PubMed

    Gray, Eoin P; Teare, M Dawn; Stevens, John; Archer, Rachel

    2016-03-01

    Many lung cancer risk prediction models have been published but there has been no systematic review or comprehensive assessment of these models to assess how they could be used in screening. We performed a systematic review of lung cancer prediction models and identified 31 articles that related to 25 distinct models, of which 11 considered epidemiological factors only and did not require a clinical input. Another 11 articles focused on models that required a clinical assessment such as a blood test or scan, and 8 articles considered the 2-stage clonal expansion model. More of the epidemiological models had been externally validated than the more recent clinical assessment models. There was varying discrimination, the ability of a model to distinguish between cases and controls, with an area under the curve between 0.57 and 0.879 and calibration, the model's ability to assign an accurate probability to an individual. In our review we found that further validation studies need to be considered; especially for the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial 2012 Model Version (PLCOM2012) and Hoggart models, which recorded the best overall performance. Future studies will need to focus on prediction rules, such as optimal risk thresholds, for models for selective screening trials. Only 3 validation studies considered prediction rules when validating the models and overall the models were validated using varied tests in distinct populations, which made direct comparisons difficult. To improve this, multiple models need to be tested on the same data set with considerations for sensitivity, specificity, model accuracy, and positive predictive values at the optimal risk thresholds. Copyright © 2016 Elsevier Inc. All rights reserved.

  11. How to make predictions about future infectious disease risks

    PubMed Central

    Woolhouse, Mark

    2011-01-01

    Formal, quantitative approaches are now widely used to make predictions about the likelihood of an infectious disease outbreak, how the disease will spread, and how to control it. Several well-established methodologies are available, including risk factor analysis, risk modelling and dynamic modelling. Even so, predictive modelling is very much the ‘art of the possible’, which tends to drive research effort towards some areas and away from others which may be at least as important. Building on the undoubted success of quantitative modelling of the epidemiology and control of human and animal diseases such as AIDS, influenza, foot-and-mouth disease and BSE, attention needs to be paid to developing a more holistic framework that captures the role of the underlying drivers of disease risks, from demography and behaviour to land use and climate change. At the same time, there is still considerable room for improvement in how quantitative analyses and their outputs are communicated to policy makers and other stakeholders. A starting point would be generally accepted guidelines for ‘good practice’ for the development and the use of predictive models. PMID:21624924

  12. Mortality determinants and prediction of outcome in high risk newborns.

    PubMed

    Dalvi, R; Dalvi, B V; Birewar, N; Chari, G; Fernandez, A R

    1990-06-01

    The aim of this study was to determine independent patient-related predictors of mortality in high risk newborns admitted at our centre. The study population comprised 100 consecutive newborns each, from the premature unit (PU) and sick baby care unit (SBCU), respectively. Thirteen high risk factors (variables) for each of the two units, were entered into a multivariate regression analysis. Variables with independent predictive value for poor outcome (i.e., death) in PU were, weight less than 1 kg, hyaline membrane disease, neurologic problems, and intravenous therapy. High risk factors in SBCU included, blood gas abnormality, bleeding phenomena, recurrent convulsions, apnea, and congenital anomalies. Identification of these factors guided us in defining priority areas for improvement in our system of neonatal care. Also, based on these variables a simple predictive score for outcome was constructed. The prediction equation and the score were cross-validated by applying them to a 'test-set' of 100 newborns each for PU and SBCU. Results showed a comparable sensitivity, specificity and error rate.

  13. Predicting adverse drug reactions in older adults; a systematic review of the risk prediction models

    PubMed Central

    Stevenson, Jennifer M; Williams, Josceline L; Burnham, Thomas G; Prevost, A Toby; Schiff, Rebekah; Erskine, S David; Davies, J Graham

    2014-01-01

    Adverse drug reaction (ADR) risk-prediction models for use in older adults have been developed, but it is not clear if they are suitable for use in clinical practice. This systematic review aimed to identify and investigate the quality of validated ADR risk-prediction models for use in older adults. Standard computerized databases, the gray literature, bibliographies, and citations were searched (2012) to identify relevant peer-reviewed studies. Studies that developed and validated an ADR prediction model for use in patients over 65 years old, using a multivariable approach in the design and analysis, were included. Data were extracted and their quality assessed by independent reviewers using a standard approach. Of the 13,423 titles identified, only 549 were associated with adverse outcomes of medicines use. Four met the inclusion criteria. All were conducted in inpatient cohorts in Western Europe. None of the models satisfied the four key stages in the creation of a quality risk prediction model; development and validation were completed, but impact and implementation were not assessed. Model performance was modest; area under the receiver operator curve ranged from 0.623 to 0.73. Study quality was difficult to assess due to poor reporting, but inappropriate methods were apparent. Further work needs to be conducted concerning the existing models to enable the development of a robust ADR risk-prediction model that is externally validated, with practical design and good performance. Only then can implementation and impact be assessed with the aim of generating a model of high enough quality to be considered for use in clinical care to prioritize older people at high risk of suffering an ADR. PMID:25278750

  14. Meta-Prediction of MTHFR Gene Polymorphism Mutations and Associated Risk for Colorectal Cancer

    PubMed Central

    Yu, C. H.

    2016-01-01

    The methylenetetrahydrofolate reductase (MTHFR) gene is one of the most investigated of the genes associated with chronic human diseases because of its associations with hyperhomocysteinemia and toxicity. It has been proposed as a prototype gene for the prevention of colorectal cancer (CRC). The major objectives of this meta-analysis were to examine the polymorphism-mutation patterns of MTHFR and their associations with risk for CRC as well as potential contributing factors for mutations and disease risks. This analysis included 33,626 CRC cases and 48,688 controls across 92 studies for MTHFR 677 and 16,367 cases and 24,874 controls across 54 studies for MTHFR 1298, comprising data for various racial and ethnic groups, both genders, and multiple cancer sites. MTHFR 677 homozygous TT genotype was protective (p < .05) for CRC for all included populations; however, with heterogeneity across various racial–ethnic groups and opposing findings, it was a risk genotype for the subgroup of Hispanics (p < .01). Additional countries for which subgroup analyses resulted in 677 TT as a risk genotype included Turkey, Romania, Croatia, Hungary, Portugal, Mexico, Brazil, U.S. Hawai’i, Taiwan, India, and Egypt. Countries with the highest mutation rates and risks for both MTHFR 677 and 1298 genotypes are presented using global maps to visualize the grouping patterns. Meta-predictive analyses revealed that air pollution levels were associated with gene polymorphisms for both genotypes. Future nursing research should be conducted to develop proactive measures to protect populations in cities where air pollution causes more deaths. PMID:26858257

  15. Interpreting Hemoglobin A1C in Combination With Conventional Risk Factors for Prediction of Cardiovascular Risk

    PubMed Central

    Jarmul, Jamie A.; Pignone, Michael; Pletcher, Mark J.

    2015-01-01

    Background Hemoglobin A1C (HbA1C) is associated with increased risk of cardiovascular events, but its use for prediction of cardiovascular disease (CVD) events in combination with conventional risk factors has not been well defined. Methods and Results To understand the effect of HbA1C on CVD risk in the context of other CVD risk factors, we analyzed HbA1C and other CVD risk factor measurements in 2000 individuals aged 40-79 years old without pre-existing diabetes or cardiovascular disease from the 2011-2012 NHANES survey. The resulting regression model was used to predict the HbA1C distribution based on individual patient characteristics. We then calculated post-test 10-year atherosclerotic cardiovascular disease (ASCVD) risk incorporating the actual versus predicted HbA1C, according to established methods, for a set of example scenarios. Age, gender, race/ethnicity and traditional cardiovascular risk factors were significant predictors of HbA1C in our model, with the expected HbA1C distribution being significantly higher in non-Hispanic black, non-Hispanic Asian and Hispanic individuals than non-Hispanic white/other individuals. Incorporating the expected HbA1C distribution into pretest ASCVD risk has a modest effect on post-test ASCVD risk. In the patient examples we assessed, having an HbA1C < 5.7% reduced post-test risk by 0.4%-2.0% points, whereas having an HbA1C ≥ 6.5% increased post-test risk by 1.0%-2.5% points, depending on the scenario. The post-test risk increase from having an HbA1C ≥ 6.5 % tends to approximate the risk increase from being five years older in age. Conclusions HbA1C has modest effects on predicted ASCVD risk when considered in the context of conventional risk factors. PMID:26349840

  16. Short-range ensemble predictions based on convection perturbations in the Eta Model for the Serra do Mar region in Brazil

    NASA Astrophysics Data System (ADS)

    Bustamante, J. F. F.; Chou, S. C.; Gomes, J. L.

    2009-04-01

    The Southeast Brazil, in the coastal and mountain region called Serra do Mar, between Sao Paulo and Rio de Janeiro, is subject to frequent events of landslides and floods. The Eta Model has been producing good quality forecasts over South America at about 40-km horizontal resolution. For that type of hazards, however, more detailed and probabilistic information on the risks should be provided with the forecasts. Thus, a short-range ensemble prediction system (SREPS) based on the Eta Model is being constructed. Ensemble members derived from perturbed initial and lateral boundary conditions did not provide enough spread for the forecasts. Members with model physics perturbation are being included and tested. The objective of this work is to construct more members for the Eta SREPS by adding physics perturbed members. The Eta Model is configured at 10-km resolution and 38 layers in the vertical. The domain covered is most of Southeast Brazil, centered over the Serra do Mar region. The constructed members comprise variations of the cumulus parameterization Betts-Miller-Janjic (BMJ) and Kain-Fritsch (KF) schemes. Three members were constructed from the BMJ scheme by varying the deficit of saturation pressure profile over land and sea, and 2 members of the KF scheme were included using the standard KF and a momentum flux added to KF scheme version. One of the runs with BMJ scheme is the control run as it was used for the initial condition perturbation SREPS. The forecasts were tested for 6 cases of South America Convergence Zone (SACZ) events. The SACZ is a common summer season feature of Southern Hemisphere that causes persistent rain for a few days over the Southeast Brazil and it frequently organizes over Serra do Mar region. These events are particularly interesting because of the persistent rains that can accumulate large amounts and cause generalized landslides and death. With respect to precipitation, the KF scheme versions have shown to be able to reach the

  17. Predicting risk of habitat conversion in native temperate grasslands.

    PubMed

    Stephens, Scott E; Walker, Johann A; Blunck, Darin R; Jayaraman, Aneetha; Naugle, David E; Ringelman, James K; Smith, Aaron J

    2008-10-01

    Native grasslands that support diverse populations of birds are being converted to cropland at an increasing rate in the Prairie Pothole Region of North America. Although limited funding is currently available to mitigate losses, accurate predictions of probability of conversion would increase the efficiency of conservation measures. We studied conversion of native grassland to cropland in the Missouri Coteau region of North and South Dakota (U.S.A.) during 1989-2003. We estimated the probability of conversion of native grassland to cropland with satellite imagery and logistic regression models that predicted risk of conversion and by comparing the overlap between areas of high biological value and areas most vulnerable to conversion. Annualized probability of conversion was 0.004, and 36,540 ha of native grassland were converted to cropland during the period of our study. Our predictive models fit the data and correctly predicted 70% of observed conversions of grassland. Probability of conversion varied spatially and was correlated with landscape features like amount of surrounding grassland, slope, and soil productivity. Tracts of high biological value were not always at high risk of conversion. We concluded the most biologically valuable areas that are most vulnerable to conversion should be prioritized for conservation. This approach can be applied broadly to other systems and offers great utility for implementing conservation in areas with spatially variable biological value and probability of conversion.

  18. Does Erectile Dysfunction Contribute to Cardiovascular Disease Risk Prediction beyond the Framingham Risk Score?

    PubMed Central

    Araujo, Andre B.; Hall, Susan A.; Ganz, Peter; Chiu, Gretchen R.; Rosen, Raymond C.; Kupelian, Varant; Travison, Thomas G.; McKinlay, John B.

    2010-01-01

    Objective To determine whether erectile dysfunction (ED) predicts cardiovascular disease (CVD) beyond traditional risk factors. Background ED and CVD share pathophysiological mechanisms and often co-occur. It is unknown whether ED improves the prediction of CVD beyond traditional risk factors. Methods This was a prospective, population-based study of 1,709 men (of 3,258 eligible) aged 40–70 years. ED was measured by self-report. Subjects were followed for CVD for an average follow-up of 11.7 years. The association between ED and CVD was examined using the Cox proportional hazards regression model. The discriminatory capability of ED was examined using c statistics. The reclassification of CVD risk associated with ED was assessed using a method that quantifies net reclassification improvement. Results 1,057 men with complete risk factor data who were free of CVD and diabetes at baseline were included. During follow-up, 261 new cases of CVD occurred. ED was associated with CVD incidence controlling for age (Hazard Ratio (HR): 1.42 (95% Confidence Interval (CI)): 1.05, 1.90), age and traditional CVD risk factors (HR: 1.41, 95% CI: 1.05, 1.90), as well as age and Framingham risk score (HR: 1.40, 95% CI: 1.04–1.88). Despite these significant findings, ED did not significantly improve the prediction of CVD incidence beyond traditional risk factors. Conclusions Independent of established CVD risk factors, ED is significantly associated with increased CVD incidence. Nonetheless, ED does not improve the prediction of who will and will not develop CVD beyond that offered by traditional risk factors. PMID:20117441

  19. Osteoporosis risk prediction using machine learning and conventional methods.

    PubMed

    Kim, Sung Kean; Yoo, Tae Keun; Oh, Ein; Kim, Deok Won

    2013-01-01

    A number of clinical decision tools for osteoporosis risk assessment have been developed to select postmenopausal women for the measurement of bone mineral density. We developed and validated machine learning models with the aim of more accurately identifying the risk of osteoporosis in postmenopausal women, and compared with the ability of a conventional clinical decision tool, osteoporosis self-assessment tool (OST). We collected medical records from Korean postmenopausal women based on the Korea National Health and Nutrition Surveys (KNHANES V-1). The training data set was used to construct models based on popular machine learning algorithms such as support vector machines (SVM), random forests (RF), artificial neural networks (ANN), and logistic regression (LR) based on various predictors associated with low bone density. The learning models were compared with OST. SVM had significantly better area under the curve (AUC) of the receiver operating characteristic (ROC) than ANN, LR, and OST. Validation on the test set showed that SVM predicted osteoporosis risk with an AUC of 0.827, accuracy of 76.7%, sensitivity of 77.8%, and specificity of 76.0%. We were the first to perform comparisons of the performance of osteoporosis prediction between the machine learning and conventional methods using population-based epidemiological data. The machine learning methods may be effective tools for identifying postmenopausal women at high risk for osteoporosis.

  20. Methods and Techniques for Risk Prediction of Space Shuttle Upgrades

    NASA Technical Reports Server (NTRS)

    Hoffman, Chad R.; Pugh, Rich; Safie, Fayssal

    1998-01-01

    Since the Space Shuttle Accident in 1986, NASA has been trying to incorporate probabilistic risk assessment (PRA) in decisions concerning the Space Shuttle and other NASA projects. One major study NASA is currently conducting is in the PRA area in establishing an overall risk model for the Space Shuttle System. The model is intended to provide a tool to predict the Shuttle risk and to perform sensitivity analyses and trade studies including evaluation of upgrades. Marshall Space Flight Center (MSFC) and its prime contractors including Pratt and Whitney (P&W) are part of the NASA team conducting the PRA study. MSFC responsibility involves modeling the External Tank (ET), the Solid Rocket Booster (SRB), the Reusable Solid Rocket Motor (RSRM), and the Space Shuttle Main Engine (SSME). A major challenge that faced the PRA team is modeling the shuttle upgrades. This mainly includes the P&W High Pressure Fuel Turbopump (HPFTP) and the High Pressure Oxidizer Turbopump (HPOTP). The purpose of this paper is to discuss the various methods and techniques used for predicting the risk of the P&W redesigned HPFTP and HPOTP.

  1. Problems With Risk Reclassification Methods for Evaluating Prediction Models

    PubMed Central

    Pepe, Margaret S.

    2011-01-01

    For comparing the performance of a baseline risk prediction model with one that includes an additional predictor, a risk reclassification analysis strategy has been proposed. The first step is to cross-classify risks calculated according to the 2 models for all study subjects. Summary measures including the percentage of reclassification and the percentage of correct reclassification are calculated, along with 2 reclassification calibration statistics. The author shows that interpretations of the proposed summary measures and P values are problematic. The author's recommendation is to display the reclassification table, because it shows interesting information, but to use alternative methods for summarizing and comparing model performance. The Net Reclassification Index has been suggested as one alternative method. The author argues for reporting components of the Net Reclassification Index because they are more clinically relevant than is the single numerical summary measure. PMID:21555714

  2. Risk prediction models for contrast induced nephropathy: systematic review

    PubMed Central

    Silver, Samuel A; Shah, Prakesh M; Chertow, Glenn M; Wald, Ron

    2015-01-01

    Objectives To look at the available literature on validated prediction models for contrast induced nephropathy and describe their characteristics. Design Systematic review. Data sources Medline, Embase, and CINAHL (cumulative index to nursing and allied health literature) databases. Review methods Databases searched from inception to 2015, and the retrieved reference lists hand searched. Dual reviews were conducted to identify studies published in the English language of prediction models tested with patients that included derivation and validation cohorts. Data were extracted on baseline patient characteristics, procedural characteristics, modelling methods, metrics of model performance, risk of bias, and clinical usefulness. Eligible studies evaluated characteristics of predictive models that identified patients at risk of contrast induced nephropathy among adults undergoing a diagnostic or interventional procedure using conventional radiocontrast media (media used for computed tomography or angiography, and not gadolinium based contrast). Results 16 studies were identified, describing 12 prediction models. Substantial interstudy heterogeneity was identified, as a result of different clinical settings, cointerventions, and the timing of creatinine measurement to define contrast induced nephropathy. Ten models were validated internally and six were validated externally. Discrimination varied in studies that were validated internally (C statistic 0.61-0.95) and externally (0.57-0.86). Only one study presented reclassification indices. The majority of higher performing models included measures of pre-existing chronic kidney disease, age, diabetes, heart failure or impaired ejection fraction, and hypotension or shock. No prediction model evaluated its effect on clinical decision making or patient outcomes. Conclusions Most predictive models for contrast induced nephropathy in clinical use have modest ability, and are only relevant to patients receiving contrast for

  3. Spatial clustering and local risk of leprosy in São Paulo, Brazil

    PubMed Central

    Yamamura, Mellina; Arroyo, Luiz Henrique; Popolin, Marcela Paschoal; Chiaravalloti Neto, Francisco; Palha, Pedro Fredemir; Uchoa, Severina Alice da Costa; Pieri, Flávia Meneguetti; Pinto, Ione Carvalho; Fiorati, Regina Célia; de Queiroz, Ana Angélica Rêgo; Belchior, Aylana de Souza; dos Santos, Danielle Talita; Garcia, Maria Concebida da Cunha; Crispim, Juliane de Almeida; Alves, Luana Seles; Berra, Thaís Zamboni; Arcêncio, Ricardo Alexandre

    2017-01-01

    Background Although the detection rate is decreasing, the proportion of new cases with WHO grade 2 disability (G2D) is increasing, creating concern among policy makers and the Brazilian government. This study aimed to identify spatial clustering of leprosy and classify high-risk areas in a major leprosy cluster using the SatScan method. Methods Data were obtained including all leprosy cases diagnosed between January 2006 and December 2013. In addition to the clinical variable, information was also gathered regarding the G2D of the patient at diagnosis and after treatment. The Scan Spatial statistic test, developed by Kulldorff e Nagarwalla, was used to identify spatial clustering and to measure the local risk (Relative Risk—RR) of leprosy. Maps considering these risks and their confidence intervals were constructed. Results A total of 434 cases were identified, including 188 (43.31%) borderline leprosy and 101 (23.28%) lepromatous leprosy cases. There was a predominance of males, with ages ranging from 15 to 59 years, and 51 patients (11.75%) presented G2D. Two significant spatial clusters and three significant spatial-temporal clusters were also observed. The main spatial cluster (p = 0.000) contained 90 census tracts, a population of approximately 58,438 inhabitants, detection rate of 22.6 cases per 100,000 people and RR of approximately 3.41 (95%CI = 2.721–4.267). Regarding the spatial-temporal clusters, two clusters were observed, with RR ranging between 24.35 (95%CI = 11.133–52.984) and 15.24 (95%CI = 10.114–22.919). Conclusion These findings could contribute to improvements in policies and programming, aiming for the eradication of leprosy in Brazil. The Spatial Scan statistic test was found to be an interesting resource for health managers and healthcare professionals to map the vulnerability of areas in terms of leprosy transmission risk and areas of underreporting. PMID:28241038

  4. Prediction of ground-level ozone concentration in São Paulo, Brazil: Deterministic versus statistic models

    NASA Astrophysics Data System (ADS)

    Hoshyaripour, G.; Brasseur, G.; Andrade, M. F.; Gavidia-Calderón, M.; Bouarar, I.; Ynoue, R. Y.

    2016-11-01

    Two state-of-the-art models (deterministic: Weather Research and Forecast model with Chemistry (WRF-Chem) and statistic: Artificial Neural Networks: (ANN)) are implemented to predict the ground-level ozone concentration in São Paulo (SP), Brazil. Two domains are set up for WRF-Chem simulations: a coarse domain (with 50 km horizontal resolution) including whole South America (D1) and a nested domain (with horizontal resolution of 10 km) including South Eastern Brazil (D2). To evaluate the spatial distribution of the chemical species, model results are compared to the Measurements of Pollution in The Troposphere (MOPITT) data, showing that the model satisfactorily predicts the CO concentrations in both D1 and D2. The model also reproduces the measurements made at three air quality monitoring stations in SP with the correlation coefficients of 0.74, 0.70, and 0.77 for O3 and 0.51, 0.48, and 0.57 for NOx. The input selection for ANN model is carried out using Forward Selection (FS) method. FS-ANN is then trained and validated using the data from two air quality monitoring stations, showing correlation coefficients of 0.84 and 0.75 for daily mean and 0.64 and 0.67 for daily peak ozone during the test stage. Then, both WRF-Chem and FS-ANN are deployed to forecast the daily mean and peak concentrations of ozone in two stations during 5-20 August 2012. Results show that WRF-Chem preforms better in predicting mean and peak ozone concentrations as well as in conducting mechanistic and sensitivity analysis. FS-ANN is only advantageous in predicting mean daily ozone concentrations considering its significantly lower computational costs and ease of development and implementation, compared to that of WRF-Chem.

  5. Risk stratification using data from electronic medical records better predicts suicide risks than clinician assessments

    PubMed Central

    2014-01-01

    Background To date, our ability to accurately identify patients at high risk from suicidal behaviour, and thus to target interventions, has been fairly limited. This study examined a large pool of factors that are potentially associated with suicide risk from the comprehensive electronic medical record (EMR) and to derive a predictive model for 1–6 month risk. Methods 7,399 patients undergoing suicide risk assessment were followed up for 180 days. The dataset was divided into a derivation and validation cohorts of 4,911 and 2,488 respectively. Clinicians used an 18-point checklist of known risk factors to divide patients into low, medium, or high risk. Their predictive ability was compared with a risk stratification model derived from the EMR data. The model was based on the continuation-ratio ordinal regression method coupled with lasso (which stands for least absolute shrinkage and selection operator). Results In the year prior to suicide assessment, 66.8% of patients attended the emergency department (ED) and 41.8% had at least one hospital admission. Administrative and demographic data, along with information on prior self-harm episodes, as well as mental and physical health diagnoses were predictive of high-risk suicidal behaviour. Clinicians using the 18-point checklist were relatively poor in predicting patients at high-risk in 3 months (AUC 0.58, 95% CIs: 0.50 – 0.66). The model derived EMR was superior (AUC 0.79, 95% CIs: 0.72 – 0.84). At specificity of 0.72 (95% CIs: 0.70-0.73) the EMR model had sensitivity of 0.70 (95% CIs: 0.56-0.83). Conclusion Predictive models applied to data from the EMR could improve risk stratification of patients presenting with potential suicidal behaviour. The predictive factors include known risks for suicide, but also other information relating to general health and health service utilisation. PMID:24628849

  6. Assessing the Relative Ecological Importance and Deforestation Risks of Unprotected Areas in Western Brazil Using Landsat, CBERS and Quantum GIS

    NASA Astrophysics Data System (ADS)

    Smith, A.; Sevilla, C.; Lanclos, A.; Carson, C.; Larson, J.; Sankaran, M.; Saad, M.

    2012-12-01

    In addition to understanding Brazilian policies and currently utilized methodologies, the measurement of the impacts of deforestation is essential for enhancing techniques to reduce deforestation in the future. Adverse impacts of deforestation include biodiversity loss, increased carbon dioxide emissions, and a reduced rate of evapotranspiration, all of which contribute directly or indirectly to global warming. With the continual growth in population in developing countries such as Brazil, increased demands are placed on infrastructural development and food production. As a result, forested areas are cleared for agricultural production. Recently, exploration for hydrocarbons in Western Brazil has also intensified as a means to stimulate the economy, as abundant oil and gas is believed to be found in these regions. Unfortunately, hydrocarbon-rich regions of Western Brazil are also home to thousands of species. Many of these regions are as of yet untapped but are at risk of ecological disruption as a result of impending human activity. This project utilized Landsat 5 TM to monitor deforestation in a subsection of the Brazilian states of Rondônia and Amazonas. A risk map identifying areas susceptible to future deforestation, based on factors such as proximity to roads, bodies of water, cities, and proposed hydrocarbon activities such as pipeline construction, was created. Areas at higher risk of clearance were recommended to be a target for enhanced monitoring and law enforcement. In addition, an importance map was created based on biodiversity and location of endangered species. This map was used to identify potential areas for future protection. A Chinese-Brazilian satellite, CBERS 2B CCD was also utilized for comparison. The NDVI model was additionally replicated in Quantum GIS, an open source software, so that local communities and policymakers could benefit without having to pay for expensive ArcGIS software. The capabilities of VIIRS were also investigated to

  7. Risk prediction models for hospital readmission: a systematic review.

    PubMed

    Kansagara, Devan; Englander, Honora; Salanitro, Amanda; Kagen, David; Theobald, Cecelia; Freeman, Michele; Kripalani, Sunil

    2011-10-19

    Predicting hospital readmission risk is of great interest to identify which patients would benefit most from care transition interventions, as well as to risk-adjust readmission rates for the purposes of hospital comparison. To summarize validated readmission risk prediction models, describe their performance, and assess suitability for clinical or administrative use. The databases of MEDLINE, CINAHL, and the Cochrane Library were searched from inception through March 2011, the EMBASE database was searched through August 2011, and hand searches were performed of the retrieved reference lists. Dual review was conducted to identify studies published in the English language of prediction models tested with medical patients in both derivation and validation cohorts. Data were extracted on the population, setting, sample size, follow-up interval, readmission rate, model discrimination and calibration, type of data used, and timing of data collection. Of 7843 citations reviewed, 30 studies of 26 unique models met the inclusion criteria. The most common outcome used was 30-day readmission; only 1 model specifically addressed preventable readmissions. Fourteen models that relied on retrospective administrative data could be potentially used to risk-adjust readmission rates for hospital comparison; of these, 9 were tested in large US populations and had poor discriminative ability (c statistic range: 0.55-0.65). Seven models could potentially be used to identify high-risk patients for intervention early during a hospitalization (c statistic range: 0.56-0.72), and 5 could be used at hospital discharge (c statistic range: 0.68-0.83). Six studies compared different models in the same population and 2 of these found that functional and social variables improved model discrimination. Although most models incorporated variables for medical comorbidity and use of prior medical services, few examined variables associated with overall health and function, illness severity, or social

  8. International risk of yellow fever spread from the ongoing outbreak in Brazil, December 2016 to May 2017.

    PubMed

    Dorigatti, Ilaria; Hamlet, Arran; Aguas, Ricardo; Cattarino, Lorenzo; Cori, Anne; Donnelly, Christl A; Garske, Tini; Imai, Natsuko; Ferguson, Neil M

    2017-07-13

    States in south-eastern Brazil were recently affected by the largest Yellow Fever (YF) outbreak seen in a decade in Latin America. Here we provide a quantitative assessment of the risk of travel-related international spread of YF indicating that the United States, Argentina, Uruguay, Spain, Italy and Germany may have received at least one travel-related YF case capable of seeding local transmission. Mitigating the risk of imported YF cases seeding local transmission requires heightened surveillance globally. This article is copyright of The Authors, 2017.

  9. Landmark risk prediction of residual life for breast cancer survival.

    PubMed

    Parast, Layla; Cai, Tianxi

    2013-09-10

    The importance of developing personalized risk prediction estimates has become increasingly evident in recent years. In general, patient populations may be heterogenous and represent a mixture of different unknown subtypes of disease. When the source of this heterogeneity and resulting subtypes of disease are unknown, accurate prediction of survival may be difficult. However, in certain disease settings, the onset time of an observable short-term event may be highly associated with these unknown subtypes of disease and thus may be useful in predicting long-term survival. One approach to incorporate short-term event information along with baseline markers for the prediction of long-term survival is through a landmark Cox model, which assumes a proportional hazards model for the residual life at a given landmark point. In this paper, we use this modeling framework to develop procedures to assess how a patient's long-term survival trajectory may change over time given good short-term outcome indications along with prognosis on the basis of baseline markers. We first propose time-varying accuracy measures to quantify the predictive performance of landmark prediction rules for residual life and provide resampling-based procedures to make inference about such accuracy measures. Simulation studies show that the proposed procedures perform well in finite samples. Throughout, we illustrate our proposed procedures by using a breast cancer dataset with information on time to metastasis and time to death. In addition to baseline clinical markers available for each patient, a chromosome instability genetic score, denoted by CIN25, is also available for each patient and has been shown to be predictive of survival for various types of cancer. We provide procedures to evaluate the incremental value of CIN25 for the prediction of residual life and examine how the residual life profile changes over time. This allows us to identify an informative landmark point, t(0) , such that

  10. Development of a Risk Prediction Model to Individualize Risk Factors for Surgical Site Infection after Mastectomy

    PubMed Central

    Olsen, Margaret A.; Nickel, Katelin B.; Margenthaler, Julie A.; Fox, Ida K.; Ball, Kelly E.; Mines, Daniel; Wallace, Anna E.; Colditz, Graham A.; Fraser, Victoria J.

    2016-01-01

    Background Little data are available regarding individual patients’ risk of surgical site infection (SSI) following mastectomy with or without immediate reconstruction. Our objective was to develop a risk prediction model for mastectomy-related SSI. Methods We established a cohort of women < 65 years of age with mastectomy from 1/1/2004–12/31/2011 using commercial claims data. ICD-9-CM diagnosis codes were used to identify SSI within 180 days after surgery. SSI risk factors were determined with multivariable logistic regression using derivation data from 2004-2008 and validated with 2009–2011 data using discrimination and calibration measures. Results In the derivation cohort 595 SSIs were identified in 7,607 (7.8%) women, and 396 SSIs were coded in 4,366 (9.1%) women in the validation cohort. Independent risk factors for SSIs included rural residence, rheumatologic disease, depression, diabetes, hypertension, liver disease, obesity, preexisting pneumonia or urinary tract infection, tobacco use disorder, smoking-related diseases, bilateral mastectomy, and immediate reconstruction. Receipt of home health care was associated with lower risk. The model performed equally in the validation cohort per discrimination (C statistics 0.657 and 0.649) and calibration (Hosmer-Lemeshow P=0.091 and 0.462 for derivation and validation, respectively). Three risk strata were created based on predicted SSI risk, which demonstrated good correlation with the proportion of observed infections in the strata. Conclusions We developed and internally validated an SSI risk prediction model that can be used to counsel women concerning their individual risk of SSI post-mastectomy. Immediate reconstruction, diabetes, and smoking-related diseases were important risk factors for SSI in this nonelderly population of women undergoing mastectomy. PMID:26822880

  11. Readmission to medical intensive care units: risk factors and prediction.

    PubMed

    Jo, Yong Suk; Lee, Yeon Joo; Park, Jong Sun; Yoon, Ho Il; Lee, Jae Ho; Lee, Choon-Taek; Cho, Young-Jae

    2015-03-01

    The objectives of this study were to find factors related to medical intensive care unit (ICU) readmission and to develop a prediction index for determining patients who are likely to be readmitted to medical ICUs. We performed a retrospective cohort study of 343 consecutive patients who were admitted to the medical ICU of a single medical center from January 1, 2008 to December 31, 2012. We analyzed a broad range of patients' characteristics on the day of admission, extubation, and discharge from the ICU. Of the 343 patients discharged from the ICU alive, 33 (9.6%) were readmitted to the ICU unexpectedly. Using logistic regression analysis, the verified factors associated with increased risk of ICU readmission were male sex [odds ratio (OR) 3.17, 95% confidence interval (CI) 1.29-8.48], history of diabetes mellitus (OR 3.03, 95% CI 1.29-7.09), application of continuous renal replacement therapy during ICU stay (OR 2.78, 95% CI 0.85-9.09), white blood cell count on the day of extubation (OR 1.13, 95% CI 1.07-1.21), and heart rate just before ICU discharge (OR 1.03, 95% CI 1.01-1.06). We established a prediction index for ICU readmission using the five verified risk factors (area under the curve, 0.76, 95% CI 0.66-0.86). By using specific risk factors associated with increased readmission to the ICU, a numerical index could be established as an estimation tool to predict the risk of ICU readmission.

  12. Cardiovascular risk prediction in chronic kidney disease patients.

    PubMed

    Cedeño Mora, Santiago; Goicoechea, Marian; Torres, Esther; Verdalles, Úrsula; Pérez de José, Ana; Verde, Eduardo; García de Vinuesa, Soledad; Luño, José

    Scores underestimate the prediction of cardiovascular risk (CVR) as they are not validated in patients with chronic kidney disease (CKD). Two of the most commonly used scores are the Framingham Risk Score (FRS-CVD) and the ASCVD (AHA/ACC 2013). The aim of this study is to evaluate the predictive ability of experiencing a cardiovascular event (CVE) via these 2scores in the CKD population. Prospective, observational study of 400 prevalent patients with CKD (stages 4 and 5 according the KDOQI; not on dialysis). Cardiovascular risk was calculated according to the 2scores and the predictive capacity of cardiovascular events (atherosclerotic events: myocardial infarction, ischaemic and haemorrhagic stroke, peripheral vascular disease; and non-atherosclerotic events: heart failure) was analysed. Forty-nine atherosclerotic cardiovascular events occurred in 40.3±6.6 months of follow-up. Most of the patients were classified as high CVR by both scores (59% by the FRS-CVD and 75% by the ASCVD). All cardiovascular events occurred in the high CVR patients and both scores (FRS-CVD log-rank 12.2, P<.001, HR 3.1 [95% CI: 1.3-7.1] P: 0.006 and ASCVD log-rank 8.5 P<.001, HR 3.2 [95% CI: 1.1-9.4] P: 0.03) were independent predictors adjusted to renal function, albuminuria and previous cardiovascular events. The cardiovascular risk scores (FRS-CVD and ASCVD [AHA/ACC 2013]) can estimate the probability of atherosclerotic cardiovascular events in patients with CKD regardless of renal function, albuminuria and previous cardiovascular events. Copyright © 2016 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.

  13. Risk assessment chart for predicting fatty liver in Japanese subjects.

    PubMed

    Inabe, Fumiyo; Takahashi, Eiko; Moriyama, Kengo; Negami, Masako; Otsuka, Hiroki

    2012-12-20

    The diagnosis of fatty liver is done mainly by ultrasonography, which it is not included in the usual health checkup examinations. The aim of this study was to develop an index to predict the existence of fatty liver using tests that are part of specific health examinations. A total of 7,305 Japanese (4,042 men; 3,263 women) who underwent annual health checks were enrolled. Body mass index (BMI), Waist circumference (WC), blood pressure, and levels of triglyceride (TG), high-density lipoprotein cholesterol, fasting plasma glucose (FPG), alanine aminotransferase (ALT), and gamma-glutamyl transpeptidase were used to predict fatty liver, and a stepwise procedure was used to select an optimal subset of dummy regressors. The probabilities for predicting fatty liver were calculated from the logistic regression equation using the constant and coefficients for each variable. Risk assessment charts for predicting the probability of fatty liver were developed. These probabilities were displayed in a color-coded manner by combining BMI, TG, FPG, ALT, and WC. Our fatty liver-predicting index consisted of the components of metabolic syndrome (MetS) and ALT, thus indicating a close relationship of fatty liver and MetS. The use of this index enables quantitative assessments of the severity of MetS.

  14. Cardiovascular risk factors in children and adolescents living in an urban area of Southeast of Brazil: Ouro Preto Study.

    PubMed

    Cândido, Ana Paula C; Benedetto, Raquel; Castro, Ana Paula P; Carmo, Joseane S; Nicolato, Roney L C; Nascimento-Neto, Raimundo M; Freitas, Renata N; Freitas, Sílvia N; Caiaffa, Waleska T; Machado-Coelho, George L L

    2009-11-01

    This study aims to identify risk factors for cardiovascular disorders in schoolchildren living in Ouro Preto City, Brazil. A cross-sectional study was carried out in a population-based sampling of schoolchildren (6-14 years old), randomly selected and stratified by the proportion of students according to age and gender in each schools of the city. Biochemical, clinical and anthropometric variables as well as physical activity and family history were used in a logistic regression model for obesity or arterial hypertension. Out of 780 schoolchildren sampled, the risk of obesity was greater in subjects presenting high triglyceride and low high density lipoprotein-cholesterol levels, and those whose parents were obese, while the risk of hypertension was high in obese subjects and those who presented low birth weight. It was observed that 44.4% of the schoolchildren were exposed to two or three cardiovascular disease (CVD) risk factors and 8.2% were exposed to four or six factors. These findings should be considered in preventive measures to reduce the future risk for CVD among schoolchildren in Brazil.

  15. A quantitative risk assessment model for Vibrio parahaemolyticus in raw oysters in Sao Paulo State, Brazil.

    PubMed

    Sobrinho, Paulo de S Costa; Destro, Maria T; Franco, Bernadette D G M; Landgraf, Mariza

    2014-06-16

    A risk assessment of Vibrio parahaemolyticus associated with raw oysters produced and consumed in São Paulo State was developed. The model was built according to the United States Food and Drug Administration framework for risk assessment. The outcome of the exposure assessment estimated the prevalence and density of pathogenic V. parahaemolyticus in raw oysters from harvest to consumption. The result of the exposure step was combined with a Beta-Poisson dose-response model to estimate the probability of illness. The model predicted that the average risks per serving of raw oysters were 4.7×10(-4), 6.0×10(-4), 4.7×10(-4) and 3.1×10(-4) for spring, summer, fall and winter, respectively. Sensitivity analyses indicated that the most influential variables on the risk of illness were the total density of V. parahaemolyticus at harvest, transport temperature, relative prevalence of pathogenic strains and storage time at retail. Only storage time under refrigeration at retail showed negative correlation with the risk of illness.

  16. Childhood body mass index trajectories predicting cardiovascular risk in adolescence.

    PubMed

    Boyer, Brittany P; Nelson, Jackie A; Holub, Shayla C

    2015-06-01

    The present study compared growth parameters of girls' and boys' body mass index (BMI) trajectories from infancy to middle childhood and evaluated these parameters as predictors of cardiovascular disease (CVD) risk in adolescence. Using 657 children from the NICHD Study of Early Child Care and Youth Development, quadratic growth curve analyses were conducted to establish growth parameters (intercept, slope, and quadratic term) for girls and boys from age 15 months to 10.5 years. Parameters were compared across gender and evaluated as predictors of a CVD risk index at the age of 15 years, controlling for characteristics of the adiposity rebound (AR) including age at which it occurred and children's BMI at the rebound. Boys had more extreme trajectories of growth than girls with higher initial BMI at age 15 months (intercept), more rapid declines in BMI before the AR (slope), and sharper rebound growth in BMI after the rebound (quadratic term). For boys and girls, higher intercept, slope, and quadratic term values predicted higher CVD risk at the age of 15 years, controlling for characteristics of the AR. Findings suggest that individuals at risk for developing CVD later in life may be identified before the AR by elevated BMI at 15 months and slow BMI declines. Because of the importance of early intervention in altering lifelong health trajectories, consistent BMI monitoring is essential in identifying high-risk children. Copyright © 2015 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

  17. Childhood BMI Trajectories Predicting Cardiovascular Risk in Adolescence

    PubMed Central

    Boyer, Brittany P.; Nelson, Jackie A.; Holub, Shayla C.

    2015-01-01

    Objective The current study compared growth parameters of girls’ and boys’ BMI trajectories from infancy to middle childhood, and evaluated these parameters as predictors of cardiovascular disease (CVD) risk in adolescence. Methods Using 657 children from the NICHD Study of Early Child Care and Youth Development (SECCYD), quadratic growth curve analyses were conducted to establish growth parameters (intercept, slope, quadratic term) for girls and boys from 15 months to age 10 ½. Parameters were compared across gender and evaluated as predictors of a CVD risk index at age 15, controlling for characteristics of the adiposity rebound (AR) including age at which it occurred and children’s BMI at the rebound. Results Boys had more extreme trajectories of growth compared to girls with higher initial BMI at 15 months (intercept), more rapid declines in BMI before the AR (slope), and sharper rebound growth in BMI after the rebound (quadratic term). For boys and girls, higher intercept, slope, and quadratic term values predicted higher CVD risk at age 15, controlling for characteristics of the AR. Conclusions Findings suggest that individuals at risk for developing CVD later in life may be identified before the AR by elevated BMI at 15 months and slow BMI declines. Due to the importance of early intervention in altering lifelong health trajectories, consistent BMI monitoring is essential in identifying high-risk children. PMID:25746172

  18. Sleep duration predicts cardiometabolic risk in obese adolescents.

    PubMed

    Iglayreger, Heidi B; Peterson, Mark D; Liu, Dongmei; Parker, Christine A; Woolford, Susan J; Sallinen Gafka, Bethany J; Hassan, Fauziya; Gordon, Paul M

    2014-05-01

    To examine the independent contributions of objectively measured sleep duration and fragmentation on cardiometabolic risk accumulation in free-living obese adolescents. Characteristics of metabolic syndrome (waist circumference, mean arterial pressure, fasting high-density lipoprotein cholesterol, triglycerides, glucose) were measured in obese adolescents and standardized residuals (z-scores) were summed (inverse high-density lipoprotein cholesterol) to create a continuous cardiometabolic risk score (cMetScore), adjusted for age, sex, and race. Sleep and physical activity were objectively measured in habitual, free-living conditions for 7 days (SenseWear Pro3, BodyMedia, Pittsburgh, Pennsylvania; n = 37; 54% female, ages 11-17 years). Associations between sleep duration and cMetScore were assessed via multiple linear regression. Body mass index, total sleep time, and sleep session length were each correlated with cMetScore (P < .05 all). Total sleep time was inversely and independently associated with cMetScore (r = -0.535, P = .001) and was the best independent predictor of metabolic risk. Sleep duration inversely predicts cardiometabolic risk in obese adolescents, even when we controlled for various measures of physical activity, anthropometry, and adiposity. Further research should investigate the biological mechanism of this relationship and the potential treatment effect of sleep intervention in decreasing cardiometabolic risk in this population. Copyright © 2014 Elsevier Inc. All rights reserved.

  19. Predictive environmental risk assessment of chemical mixtures: a conceptual framework.

    PubMed

    Backhaus, Thomas; Faust, Michael

    2012-03-06

    Environmental risks of chemicals are still often assessed substance-by-substance, neglecting mixture effects. This may result in risk underestimations, as the typical exposure is toward multicomponent chemical "cocktails". We use the two well established mixture toxicity concepts (Concentration Addition (CA) and Independent Action (IA)) for providing a tiered outline for environmental hazard and risk assessments of mixtures, focusing on general industrial chemicals and assuming that the "base set" of data (EC50s for algae, crustaceans, fish) is available. As mixture toxicities higher than predicted by CA are rare findings, we suggest applying CA as a precautious first tier, irrespective of the modes/mechanisms of action of the mixture components. In particular, we prove that summing up PEC/PNEC ratios might serve as a justifiable CA-approximation, in order to estimate in a first tier assessment whether there is a potential risk for an exposed ecosystem if only base-set data are available. This makes optimum use of existing single substance assessments as more demanding mixture investigations are requested only if there are first indications of an environmental risk. Finally we suggest to call for mode-of-action driven analyses only if error estimations indicate the possibility for substantial differences between CA- and IA-based assessments.

  20. The ARIC predictive model reliably predicted risk of type II diabetes in Asian populations

    PubMed Central

    2012-01-01

    Background Identification of high-risk individuals is crucial for effective implementation of type 2 diabetes mellitus prevention programs. Several studies have shown that multivariable predictive functions perform as well as the 2-hour post-challenge glucose in identifying these high-risk individuals. The performance of these functions in Asian populations, where the rise in prevalence of type 2 diabetes mellitus is expected to be the greatest in the next several decades, is relatively unknown. Methods Using data from three Asian populations in Singapore, we compared the performance of three multivariate predictive models in terms of their discriminatory power and calibration quality: the San Antonio Health Study model, Atherosclerosis Risk in Communities model and the Framingham model. Results The San Antonio Health Study and Atherosclerosis Risk in Communities models had better discriminative powers than using only fasting plasma glucose or the 2-hour post-challenge glucose. However, the Framingham model did not perform significantly better than fasting glucose or the 2-hour post-challenge glucose. All published models suffered from poor calibration. After recalibration, the Atherosclerosis Risk in Communities model achieved good calibration, the San Antonio Health Study model showed a significant lack of fit in females and the Framingham model showed a significant lack of fit in both females and males. Conclusions We conclude that adoption of the ARIC model for Asian populations is feasible and highly recommended when local prospective data is unavailable. PMID:22497781

  1. The ARIC predictive model reliably predicted risk of type II diabetes in Asian populations.

    PubMed

    Chin, Calvin Woon-Loong; Chia, Elian Hui San; Ma, Stefan; Heng, Derrick; Tan, Maudrene; Lee, Jeanette; Tai, E Shyong; Salim, Agus

    2012-04-13

    Identification of high-risk individuals is crucial for effective implementation of type 2 diabetes mellitus prevention programs. Several studies have shown that multivariable predictive functions perform as well as the 2-hour post-challenge glucose in identifying these high-risk individuals. The performance of these functions in Asian populations, where the rise in prevalence of type 2 diabetes mellitus is expected to be the greatest in the next several decades, is relatively unknown. Using data from three Asian populations in Singapore, we compared the performance of three multivariate predictive models in terms of their discriminatory power and calibration quality: the San Antonio Health Study model, Atherosclerosis Risk in Communities model and the Framingham model. The San Antonio Health Study and Atherosclerosis Risk in Communities models had better discriminative powers than using only fasting plasma glucose or the 2-hour post-challenge glucose. However, the Framingham model did not perform significantly better than fasting glucose or the 2-hour post-challenge glucose. All published models suffered from poor calibration. After recalibration, the Atherosclerosis Risk in Communities model achieved good calibration, the San Antonio Health Study model showed a significant lack of fit in females and the Framingham model showed a significant lack of fit in both females and males. We conclude that adoption of the ARIC model for Asian populations is feasible and highly recommended when local prospective data is unavailable.

  2. Recent Enhancements to the Genetic Risk Prediction Model BRCAPRO

    PubMed Central

    Mazzola, Emanuele; Blackford, Amanda; Parmigiani, Giovanni; Biswas, Swati

    2015-01-01

    BRCAPRO is a widely used model for genetic risk prediction of breast cancer. It is a function within the R package BayesMendel and is used to calculate the probabilities of being a carrier of a deleterious mutation in one or both of the BRCA genes, as well as the probability of being affected with breast and ovarian cancer within a defined time window. Both predictions are based on information contained in the counselee’s family history of cancer. During the last decade, BRCAPRO has undergone several rounds of successive refinements: the current version is part of release 2.1 of BayesMendel. In this review, we showcase some of the most notable features of the software resulting from these recent changes. We provide examples highlighting each feature, using artificial pedigrees motivated by complex clinical examples. We illustrate how BRCAPRO is a comprehensive software for genetic risk prediction with many useful features that allow users the flexibility to incorporate varying amounts of available information. PMID:25983549

  3. How many longitudinal covariate measurements are needed for risk prediction?

    PubMed

    Reinikainen, Jaakko; Karvanen, Juha; Tolonen, Hanna

    2016-01-01

    In epidemiologic follow-up studies, many key covariates, such as smoking, use of medication, blood pressure, and cholesterol, are time varying. Because of practical and financial limitations, time-varying covariates cannot be measured continuously, but only at certain prespecified time points. We study how the number of these longitudinal measurements can be chosen cost-efficiently by evaluating the usefulness of the measurements for risk prediction. The usefulness is addressed by measuring the improvement in model discrimination between models using different amounts of longitudinal information. We use simulated follow-up data and the data from the Finnish East-West study, a follow-up study, with eight longitudinal covariate measurements carried out between 1959 and 1999. In a simulation study, we show how the variability and the hazard ratio of a time-varying covariate are connected to the importance of remeasurements. In the East-West study, it is seen that for older people, the risk predictions obtained using only every other measurement are almost equivalent to the predictions obtained using all eight measurements. Decisions about the study design have significant effects on the costs. The cost-efficiency can be improved by applying the measures of model discrimination to data from previous studies and simulations. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. Potential risk of re-emergence of urban transmission of Yellow Fever virus in Brazil facilitated by competent Aedes populations.

    PubMed

    Couto-Lima, Dinair; Madec, Yoann; Bersot, Maria Ignez; Campos, Stephanie Silva; Motta, Monique de Albuquerque; Santos, Flávia Barreto Dos; Vazeille, Marie; Vasconcelos, Pedro Fernando da Costa; Lourenço-de-Oliveira, Ricardo; Failloux, Anna-Bella

    2017-07-07

    Yellow fever virus (YFV) causing a deadly viral disease is transmitted by the bite of infected mosquitoes. In Brazil, YFV is restricted to a forest cycle maintained between non-human primates and forest-canopy mosquitoes, where humans can be tangentially infected. Since late 2016, a growing number of human cases have been reported in Southeastern Brazil at the gates of the most populated areas of South America, the Atlantic coast, with Rio de Janeiro state hosting nearly 16 million people. We showed that the anthropophilic mosquitoes Aedes aegypti and Aedes albopictus as well as the YFV-enzootic mosquitoes Haemagogus leucocelaenus and Sabethes albiprivus from the YFV-free region of the Atlantic coast were highly susceptible to American and African YFV strains. Therefore, the risk of reemergence of urban YFV epidemics in South America is major with a virus introduced either from a forest cycle or by a traveler returning from the YFV-endemic region of Africa.

  5. Threat and error management for anesthesiologists: a predictive risk taxonomy.

    PubMed

    Ruskin, Keith J; Stiegler, Marjorie P; Park, Kellie; Guffey, Patrick; Kurup, Viji; Chidester, Thomas

    2013-12-01

    Patient care in the operating room is a dynamic interaction that requires cooperation among team members and reliance upon sophisticated technology. Most human factors research in medicine has been focused on analyzing errors and implementing system-wide changes to prevent them from recurring. We describe a set of techniques that has been used successfully by the aviation industry to analyze errors and adverse events and explain how these techniques can be applied to patient care. Threat and error management (TEM) describes adverse events in terms of risks or challenges that are present in an operational environment (threats) and the actions of specific personnel that potentiate or exacerbate those threats (errors). TEM is a technique widely used in aviation, and can be adapted for the use in a medical setting to predict high-risk situations and prevent errors in the perioperative period. A threat taxonomy is a novel way of classifying and predicting the hazards that can occur in the operating room. TEM can be used to identify error-producing situations, analyze adverse events, and design training scenarios. TEM offers a multifaceted strategy for identifying hazards, reducing errors, and training physicians. A threat taxonomy may improve analysis of critical events with subsequent development of specific interventions, and may also serve as a framework for training programs in risk mitigation.

  6. Recent innovations in intensive care unit risk-prediction models.

    PubMed

    Rosenberg, Andrew L

    2002-08-01

    During the past 20 years, ICU risk-prediction models have undergone significant development, validation, and refinement. Among the general ICU severity of illness scoring systems, the Acute Physiology and Chronic Health Evaluation (APACHE), Mortality Prediction Model (MPM), and the Simplified Acute Physiology Score (SAPS) have become the most accepted and used. To risk-adjust patients with longer, more severe illnesses like sepsis and acute respiratory distress syndrome, several models of organ dysfunction or failure have become available, including the Multiple Organ Dysfunction Score (MODS), the Sequential Organ Failure Assessment (SOFA), and the Logistic Organ Dysfunction Score (LODS). Recent innovations in risk adjustment include automatic physiology and diagnostic variable retrieval and the use of artificial intelligence. These innovations have the potential of extending the uses of case-mix and severity-of-illness adjustment in the areas of clinical research, patient care, and administration. The challenges facing intensivists in the next few years are to further develop these models so that they can be used throughout the IUC stay to assess quality of care and to extend them to more specific patient groups such as the elderly and patients with chronic ICU courses.

  7. Threat and error management for anesthesiologists: a predictive risk taxonomy

    PubMed Central

    Ruskin, Keith J.; Stiegler, Marjorie P.; Park, Kellie; Guffey, Patrick; Kurup, Viji; Chidester, Thomas

    2015-01-01

    Purpose of review Patient care in the operating room is a dynamic interaction that requires cooperation among team members and reliance upon sophisticated technology. Most human factors research in medicine has been focused on analyzing errors and implementing system-wide changes to prevent them from recurring. We describe a set of techniques that has been used successfully by the aviation industry to analyze errors and adverse events and explain how these techniques can be applied to patient care. Recent findings Threat and error management (TEM) describes adverse events in terms of risks or challenges that are present in an operational environment (threats) and the actions of specific personnel that potentiate or exacerbate those threats (errors). TEM is a technique widely used in aviation, and can be adapted for the use in a medical setting to predict high-risk situations and prevent errors in the perioperative period. A threat taxonomy is a novel way of classifying and predicting the hazards that can occur in the operating room. TEM can be used to identify error-producing situations, analyze adverse events, and design training scenarios. Summary TEM offers a multifaceted strategy for identifying hazards, reducing errors, and training physicians. A threat taxonomy may improve analysis of critical events with subsequent development of specific interventions, and may also serve as a framework for training programs in risk mitigation. PMID:24113268

  8. Predicting risk of adverse drug reactions in older adults

    PubMed Central

    Lavan, Amanda Hanora; Gallagher, Paul

    2016-01-01

    Adverse drug reactions (ADRs) are common in older adults, with falls, orthostatic hypotension, delirium, renal failure, gastrointestinal and intracranial bleeding being amongst the most common clinical manifestations. ADR risk increases with age-related changes in pharmacokinetics and pharmacodynamics, increasing burden of comorbidity, polypharmacy, inappropriate prescribing and suboptimal monitoring of drugs. ADRs are a preventable cause of harm to patients and an unnecessary waste of healthcare resources. Several ADR risk tools exist but none has sufficient predictive value for clinical practice. Good clinical practice for detecting and predicting ADRs in vulnerable patients includes detailed documentation and regular review of prescribed and over-the-counter medications through standardized medication reconciliation. New medications should be prescribed cautiously with clear therapeutic goals and recognition of the impact a drug can have on multiple organ systems. Prescribers should regularly review medication efficacy and be vigilant for ADRs and their contributory risk factors. Deprescribing should occur at an individual level when drugs are no longer efficacious or beneficial or when safer alternatives exist. Inappropriate prescribing and unnecessary polypharmacy should be minimized. Comprehensive geriatric assessment and the use of explicit prescribing criteria can be useful in this regard. PMID:26834959

  9. Prevalence and risk factors for transition period diseases in grazing dairy cows in Brazil.

    PubMed

    Daros, Rolnei R; Hötzel, Maria J; Bran, Jose A; LeBlanc, Stephen J; von Keyserlingk, Marina A G

    2017-09-15

    The aim of this cross-sectional study was to describe the incidence risk of dystocia, retained placenta (RP), pathological recumbence (down cow), the prevalence of metritis and subclinical ketosis (SCK), and the risk factors for SCK, metritis, and RP in grazing dairy herds in Southern Brazil. Fifty-three herds were visited 2-6 times from February to October of 2015. Body condition score (BCS), breed, days in milk (DIM), parity and disease status were recorded for each cow that was between 3 and 21 DIM at the time of the visits. Management practices were determined using a survey and environmental inspection was performed on each visit. SCK was identified if blood β-hydroxybutyrate was ≥1.2mmol/L and metritis by inspection of the vaginal discharge; cows were assessed once between 3 and 21 DIM. Multilevel logistic regression models, controlling for farm as a random effect, were built to identify risk factors for each disease and to assess the proportion of variance at the herd and cow levels. Models were constructed based on causal diagrams and variable screening. Overall, prevalence of SCK and metritis and incidence risk of RP were 21, 11 and 14%, respectively. Reported incidence risk of down cow was 6% and displaced abomasum was 1%. The odds (OR; 95% CI) of a cow having SCK were higher in herds with high (>10%) incidence of down cows (2.7; 1.4-5.0), limited access to water (1.9; 1.1-3.1), Jersey cows (OR: 2.2; 1.2-4.1) and in cows that were in third or greater lactation (2.9; 1.4-5.5). BCS 3.0-3.5 decreased the odds (0.4; 0.2-0.8) of metritis, while DIM, RP and being in a herd with a dirty holding area increased the odds of metritis by 1.1 (1.1-1.2), 19.5 (9.9-38.3) and 2.1 (1.0-4.2) fold, respectively. Parity >2 and dystocia increased the odds of RP by 2.4 (1.2-4.6) and 3.0 (1.6-5.4) fold, respectively. Jersey breed, use of a maternity pen and keeping the newborn calf with the cow >12h decreased the odds of having RP by 0.1 (0.0-0.4), 0.5 (0.3-1.0) and 0.4 (0

  10. Peak Pc Prediction in Conjunction Analysis: Conjunction Assessment Risk Analysis. Pc Behavior Prediction Models

    NASA Technical Reports Server (NTRS)

    Vallejo, J.J.; Hejduk, M.D.; Stamey, J. D.

    2015-01-01

    Satellite conjunction risk typically evaluated through the probability of collision (Pc). Considers both conjunction geometry and uncertainties in both state estimates. Conjunction events initially discovered through Joint Space Operations Center (JSpOC) screenings, usually seven days before Time of Closest Approach (TCA). However, JSpOC continues to track objects and issue conjunction updates. Changes in state estimate and reduced propagation time cause Pc to change as event develops. These changes a combination of potentially predictable development and unpredictable changes in state estimate covariance. Operationally useful datum: the peak Pc. If it can reasonably be inferred that the peak Pc value has passed, then risk assessment can be conducted against this peak value. If this value is below remediation level, then event intensity can be relaxed. Can the peak Pc location be reasonably predicted?

  11. Rural tourism as risk factor for the transmission of schistosomiasis in Minas Gerais, Brazil.

    PubMed

    Enk, Martin J; Caldeira, Roberta L; Carvalho, Omar S; Schall, Virginia T

    2004-01-01

    Recently, the booming rural tourism in endemic areas of the state of Minas Gerais was identified as a contributing factor in the dissemination of the infection with Schistosoma mansoni. This article presents data from six holiday resorts in a rural district approximately 100 km distant from Belo Horizonte, MG, Brazil, where a possibly new and until now unperceived way of transmission was observed. The infection takes place in swimming pools and little ponds, which are offered to tourists and the local population for fishing and leisure activities. The health authorities of the district reported cases of schistosomiasis among the local population after visiting these sites. As individuals of the non-immune middle class parts of the society of big urban centers also frequent these resorts, infection of these persons cannot be excluded. A malacological survey revealed the presence of molluscs of the species Biomphalaria glabrata and Biomphalaria straminea at the resorts. The snails (B. glabrata) of one resort tested positive for S. mansoni. In order to resolve this complex problem a multidisciplinary approach including health education, sanitation measures, assistance to the local health services, and evolvement of the local political authorities, the local community, the tourism association, and the owners of the leisure resorts is necessary. This evidence emphasizes the urgent need for a participative strategic plan to develop the local tourism in an organized and well-administered way. Only so this important source of income for the region can be ensured on the long term without disseminating the disease and putting the health of the visitors at risk.

  12. Risk Prediction for Early CKD in Type 2 Diabetes

    PubMed Central

    Gao, Peggy; Lee, Shun Fu; Heinze, Georg; Clase, Catherine M.; Tobe, Sheldon; Teo, Koon K.; Gerstein, Hertzel; Mann, Johannes F.E.

    2015-01-01

    Background and objectives Quantitative data for prediction of incidence and progression of early CKD are scarce in individuals with type 2 diabetes. Therefore, two risk prediction models were developed for incidence and progression of CKD after 5.5 years and the relative effect of predictors were ascertained. Design, setting, participants, & measurements Baseline and prospective follow-up data of two randomized clinical trials, ONgoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial (ONTARGET) and Outcome Reduction with Initial Glargine Intervention (ORIGIN), were used as development and independent validation cohorts, respectively. Individuals aged ≥55 years with type 2 diabetes and normo- or microalbuminuria at baseline were included. Incidence or progression of CKD after 5.5 years was defined as new micro- or macroalbuminuria, doubling of creatinine, or ESRD. The competing risk of death was considered as an additional outcome state in the multinomial logistic models. Results Of the 6766 ONTARGET participants with diabetes, 1079 (15.9%) experienced incidence or progression of CKD, and 1032 (15.3%) died. The well calibrated, parsimonious laboratory prediction model incorporating only baseline albuminuria, eGFR, sex, and age exhibited an externally validated c-statistic of 0.68 and an R2 value of 10.6%. Albuminuria, modeled to depict the difference between baseline urinary albumin/creatinine ratio and the threshold for micro- or macroalbuminuria, was mostly responsible for the predictive performance. Inclusion of clinical predictors, such as glucose control, diabetes duration, number of prescribed antihypertensive drugs, previous vascular events, or vascular comorbidities, increased the externally validated c-statistic and R2 value only to 0.69 and 12.1%, respectively. Explained variation was largely driven by renal and not clinical predictors. Conclusions Albuminuria and eGFR were the most important factors to predict onset and

  13. Optimized outcome prediction in breast cancer by combining the 70-gene signature with clinical risk prediction algorithms.

    PubMed

    Drukker, C A; Nijenhuis, M V; Bueno-de-Mesquita, J M; Retèl, V P; van Harten, W H; van Tinteren, H; Wesseling, J; Schmidt, M K; Van't Veer, L J; Sonke, G S; Rutgers, E J T; van de Vijver, M J; Linn, S C

    2014-06-01

    Clinical guidelines for breast cancer treatment differ in their selection of patients at a high risk of recurrence who are eligible to receive adjuvant systemic treatment (AST). The 70-gene signature is a molecular tool to better guide AST decisions. The aim of this study was to evaluate whether adding the 70-gene signature to clinical risk prediction algorithms can optimize outcome prediction and consequently treatment decisions in early stage, node-negative breast cancer patients. A 70-gene signature was available for 427 patients participating in the RASTER study (cT1-3N0M0). Median follow-up was 61.6 months. Based on 5-year distant-recurrence free interval (DRFI) probabilities survival areas under the curve (AUC) were calculated and compared for risk estimations based on the six clinical risk prediction algorithms: Adjuvant! Online (AOL), Nottingham Prognostic Index (NPI), St. Gallen (2003), the Dutch National guidelines (CBO 2004 and NABON 2012), and PREDICT plus. Also, survival AUC were calculated after adding the 70-gene signature to these clinical risk estimations. Systemically untreated patients with a high clinical risk estimation but a low risk 70-gene signature had an excellent 5-year DRFI varying between 97.1 and 100 %, depending on the clinical risk prediction algorithms used in the comparison. The best risk estimation was obtained in this cohort by adding the 70-gene signature to CBO 2012 (AUC: 0.644) and PREDICT (AUC: 0.662). Clinical risk estimations by all clinical algorithms improved by adding the 70-gene signature. Patients with a low risk 70-gene signature have an excellent survival, independent of their clinical risk estimation. Adding the 70-gene signature to clinical risk prediction algorithms improves risk estimations and therefore might improve the identification of early stage node-negative breast cancer patients for whom AST has limited value. In this cohort, the PREDICT plus tool in combination with the 70-gene signature provided the

  14. 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.

  15. Predicting stroke through genetic risk functions: the CHARGE Risk Score Project.

    PubMed

    Ibrahim-Verbaas, Carla A; Fornage, Myriam; Bis, Joshua C; Choi, Seung Hoan; Psaty, Bruce M; Meigs, James B; Rao, Madhu; Nalls, Mike; Fontes, Joao D; O'Donnell, Christopher J; Kathiresan, Sekar; Ehret, Georg B; Fox, Caroline S; Malik, Rainer; Dichgans, Martin; Schmidt, Helena; Lahti, Jari; Heckbert, Susan R; Lumley, Thomas; Rice, Kenneth; Rotter, Jerome I; Taylor, Kent D; Folsom, Aaron R; Boerwinkle, Eric; Rosamond, Wayne D; Shahar, Eyal; Gottesman, Rebecca F; Koudstaal, Peter J; Amin, Najaf; Wieberdink, Renske G; Dehghan, Abbas; Hofman, Albert; Uitterlinden, André G; Destefano, Anita L; Debette, Stephanie; Xue, Luting; Beiser, Alexa; Wolf, Philip A; Decarli, Charles; Ikram, M Arfan; Seshadri, Sudha; Mosley, Thomas H; Longstreth, W T; van Duijn, Cornelia M; Launer, Lenore J

    2014-02-01

    Beyond the Framingham Stroke Risk Score, prediction of future stroke may improve with a genetic risk score (GRS) based on single-nucleotide polymorphisms associated with stroke and its risk factors. The study includes 4 population-based cohorts with 2047 first incident strokes from 22,720 initially stroke-free European origin participants aged ≥55 years, who were followed for up to 20 years. GRSs were constructed with 324 single-nucleotide polymorphisms implicated in stroke and 9 risk factors. The association of the GRS to first incident stroke was tested using Cox regression; the GRS predictive properties were assessed with area under the curve statistics comparing the GRS with age and sex, Framingham Stroke Risk Score models, and reclassification statistics. These analyses were performed per cohort and in a meta-analysis of pooled data. Replication was sought in a case-control study of ischemic stroke. In the meta-analysis, adding the GRS to the Framingham Stroke Risk Score, age and sex model resulted in a significant improvement in discrimination (all stroke: Δjoint area under the curve=0.016, P=2.3×10(-6); ischemic stroke: Δjoint area under the curve=0.021, P=3.7×10(-7)), although the overall area under the curve remained low. In all the studies, there was a highly significantly improved net reclassification index (P<10(-4)). The single-nucleotide polymorphisms associated with stroke and its risk factors result only in a small improvement in prediction of future stroke compared with the classical epidemiological risk factors for stroke.

  16. Adolescent expectations of early death predict adult risk behaviors.

    PubMed

    Nguyen, Quynh C; Villaveces, Andres; Marshall, Stephen W; Hussey, Jon M; Halpern, Carolyn T; Poole, Charles

    2012-01-01

    Only a handful of public health studies have investigated expectations of early death among adolescents. Associations have been found between these expectations and risk behaviors in adolescence. However, these beliefs may not only predict worse adolescent outcomes, but worse trajectories in health with ties to negative outcomes that endure into young adulthood. The objectives of this study were to investigate perceived chances of living to age 35 (Perceived Survival Expectations, PSE) as a predictor of suicidal ideation, suicide attempt and substance use in young adulthood. We examined the predictive capacity of PSE on future suicidal ideation/attempt after accounting for sociodemographics, depressive symptoms, and history of suicide among family and friends to more fully assess its unique contribution to suicide risk. We investigated the influence of PSE on legal and illegal substance use and varying levels of substance use. We utilized the National Longitudinal Study of Adolescent Health (Add Health) initiated in 1994-95 among 20,745 adolescents in grades 7-12 with follow-up interviews in 1996 (Wave II), 2001-02 (Wave III) and 2008 (Wave IV; ages 24-32). Compared to those who were almost certain of living to age 35, perceiving a 50-50 or less chance of living to age 35 at Waves I or III predicted suicide attempt and ideation as well as regular substance use (i.e., exceeding daily limits for moderate drinking; smoking ≥ a pack/day; and using illicit substances other than marijuana at least weekly) at Wave IV. Associations between PSE and detrimental adult outcomes were particularly strong for those reporting persistently low PSE at both Waves I and III. Low PSE at Wave I or Wave III was also related to a doubling and tripling, respectively, of death rates in young adulthood. Long-term and wide-ranging ties between PSE and detrimental outcomes suggest these expectations may contribute to identifying at-risk youth.

  17. Adolescent Expectations of Early Death Predict Adult Risk Behaviors

    PubMed Central

    Nguyen, Quynh C.; Villaveces, Andres; Marshall, Stephen W.; Hussey, Jon M.; Halpern, Carolyn T.; Poole, Charles

    2012-01-01

    Only a handful of public health studies have investigated expectations of early death among adolescents. Associations have been found between these expectations and risk behaviors in adolescence. However, these beliefs may not only predict worse adolescent outcomes, but worse trajectories in health with ties to negative outcomes that endure into young adulthood. The objectives of this study were to investigate perceived chances of living to age 35 (Perceived Survival Expectations, PSE) as a predictor of suicidal ideation, suicide attempt and substance use in young adulthood. We examined the predictive capacity of PSE on future suicidal ideation/attempt after accounting for sociodemographics, depressive symptoms, and history of suicide among family and friends to more fully assess its unique contribution to suicide risk. We investigated the influence of PSE on legal and illegal substance use and varying levels of substance use. We utilized the National Longitudinal Study of Adolescent Health (Add Health) initiated in 1994–95 among 20,745 adolescents in grades 7–12 with follow-up interviews in 1996 (Wave II), 2001–02 (Wave III) and 2008 (Wave IV; ages 24–32). Compared to those who were almost certain of living to age 35, perceiving a 50–50 or less chance of living to age 35 at Waves I or III predicted suicide attempt and ideation as well as regular substance use (i.e., exceeding daily limits for moderate drinking; smoking ≥ a pack/day; and using illicit substances other than marijuana at least weekly) at Wave IV. Associations between PSE and detrimental adult outcomes were particularly strong for those reporting persistently low PSE at both Waves I and III. Low PSE at Wave I or Wave III was also related to a doubling and tripling, respectively, of death rates in young adulthood. Long-term and wide-ranging ties between PSE and detrimental outcomes suggest these expectations may contribute to identifying at-risk youth. PMID:22870260

  18. Towards malaria risk prediction in Afghanistan using remote sensing

    PubMed Central

    2010-01-01

    Background Malaria is a significant public health concern in Afghanistan. Currently, approximately 60% of the population, or nearly 14 million people, live in a malaria-endemic area. Afghanistan's diverse landscape and terrain contributes to the heterogeneous malaria prevalence across the country. Understanding the role of environmental variables on malaria transmission can further the effort for malaria control programme. Methods Provincial malaria epidemiological data (2004-2007) collected by the health posts in 23 provinces were used in conjunction with space-borne observations from NASA satellites. Specifically, the environmental variables, including precipitation, temperature and vegetation index measured by the Tropical Rainfall Measuring Mission and the Moderate Resolution Imaging Spectoradiometer, were used. Regression techniques were employed to model malaria cases as a function of environmental predictors. The resulting model was used for predicting malaria risks in Afghanistan. The entire time series except the last 6 months is used for training, and the last 6-month data is used for prediction and validation. Results Vegetation index, in general, is the strongest predictor, reflecting the fact that irrigation is the main factor that promotes malaria transmission in Afghanistan. Surface temperature is the second strongest predictor. Precipitation is not shown as a significant predictor, as it may not directly lead to higher larval population. Autoregressiveness of the malaria epidemiological data is apparent from the analysis. The malaria time series are modelled well, with provincial average R2 of 0.845. Although the R2 for prediction has larger variation, the total 6-month cases prediction is only 8.9% higher than the actual cases. Conclusions The provincial monthly malaria cases can be modelled and predicted using satellite-measured environmental parameters with reasonable accuracy. The Third Strategic Approach of the WHO EMRO Malaria Control and

  19. Towards malaria risk prediction in Afghanistan using remote sensing.

    PubMed

    Adimi, Farida; Soebiyanto, Radina P; Safi, Najibullah; Kiang, Richard

    2010-05-13

    Malaria is a significant public health concern in Afghanistan. Currently, approximately 60% of the population, or nearly 14 million people, live in a malaria-endemic area. Afghanistan's diverse landscape and terrain contributes to the heterogeneous malaria prevalence across the country. Understanding the role of environmental variables on malaria transmission can further the effort for malaria control programme. Provincial malaria epidemiological data (2004-2007) collected by the health posts in 23 provinces were used in conjunction with space-borne observations from NASA satellites. Specifically, the environmental variables, including precipitation, temperature and vegetation index measured by the Tropical Rainfall Measuring Mission and the Moderate Resolution Imaging Spectoradiometer, were used. Regression techniques were employed to model malaria cases as a function of environmental predictors. The resulting model was used for predicting malaria risks in Afghanistan. The entire time series except the last 6 months is used for training, and the last 6-month data is used for prediction and validation. Vegetation index, in general, is the strongest predictor, reflecting the fact that irrigation is the main factor that promotes malaria transmission in Afghanistan. Surface temperature is the second strongest predictor. Precipitation is not shown as a significant predictor, as it may not directly lead to higher larval population. Autoregressiveness of the malaria epidemiological data is apparent from the analysis. The malaria time series are modelled well, with provincial average R2 of 0.845. Although the R2 for prediction has larger variation, the total 6-month cases prediction is only 8.9% higher than the actual cases. The provincial monthly malaria cases can be modelled and predicted using satellite-measured environmental parameters with reasonable accuracy. The Third Strategic Approach of the WHO EMRO Malaria Control and Elimination Plan is aimed to develop a cost

  20. Risk Factors and Prediction Models for Retinopathy of Prematurity

    PubMed Central

    Senthil, Mallika Prem; Salowi, Mohamad Aziz; Bujang, Mohamad Adam; Kueh, Adeline; Siew, Chong Min; Sumugam, Kala; Gaik, Chan Lee; Kah, Tan Aik

    2015-01-01

    Objectives To develop a simple prediction model for the pre-screening of Retinopathy of Prematurity (ROP) among preterm babies. Methods This was a prospective study. The test dataset (January 2007 until December 2010) was used to construct risk prediction models, and the validation dataset (January 2011 until March 2012) was used to validate the models developed from the test dataset. Two prediction models were produced using the test dataset based on logistic regression equations in which the development of ROP was used as the outcome. Results The sensitivity and specificity for model 1 [gestational age (GA), birth weight (BW), intraventricular haemorrhage (IVH) and respiratory distress syndrome (RDS)] was 82 % and 81.7%, respectively; for model 2, (GA and BW) the sensitivity and specificity were 80.5% and 80.3%, respectively. Conclusion Model 2 was preferable, as it only required two predictors (GA and BW). Our prediction model can be used for early detection of ROP to avoid poor outcomes. PMID:28239269

  1. Clinical Prediction of Fall Risk and White Matter Abnormalities

    PubMed Central

    Koo, Bang-Bon; Bergethon, Peter; Qiu, Wei Qiao; Scott, Tammy; Hussain, Mohammed; Rosenberg, Irwin; Caplan, Louis R.; Bhadelia, Rafeeque A.

    2015-01-01

    Background The Tinetti scale is a simple clinical tool designed to predict risk of falling by focusing on gait and stance impairment in elderly persons. Gait impairment is also associated with white matter (WM) abnormalities. Objective To test the hypothesis that elderly subjects at risk for falling, as determined by the Tinetti scale, have specific patterns of WM abnormalities on diffusion tensor imaging. Design, Setting, and Patients Community-based cohort of 125 homebound elderly individuals. Main Outcome Measures Diffusion tensor imaging scans were analyzed using tract-based spatial statistics analysis to determine the location of WM abnormalities in subjects with Tinetti scale scores of 25 or higher (without risk of falls) and lower than 25 (with risk of falls). Multivariate linear least squares correlation analysis was performed to determine the association between Tinetti scale scores and local fractional anisotropy values on each skeletal voxel controlling for possible confounders. Results In subjects with risk of falls (Tinetti scale score <25), clusters of abnormal WM were seen in the medial frontal and parietal subcortical pathways, genu and splenium of corpus callosum, posterior cingulum, prefrontal and orbitofrontal pathways, and longitudinal pathways that connect frontal-parietal-temporal lobes. Among these abnormalities, those in medial frontal and parietal subcortical pathways correlated with Mini-Mental State Examination scores, while the other locations were unrelated to these scores. Conclusions Elderly individuals at risk for falls as determined by the Tinetti scale have WM abnormalities in specific locations on diffusion tensor imaging, some of which correlate with cognitive function scores. PMID:22332181

  2. Polygenic risk scores for schizophrenia and bipolar disorder predict creativity.

    PubMed

    Power, Robert A; Steinberg, Stacy; Bjornsdottir, Gyda; Rietveld, Cornelius A; Abdellaoui, Abdel; Nivard, Michel M; Johannesson, Magnus; Galesloot, Tessel E; Hottenga, Jouke J; Willemsen, Gonneke; Cesarini, David; Benjamin, Daniel J; Magnusson, Patrik K E; Ullén, Fredrik; Tiemeier, Henning; Hofman, Albert; van Rooij, Frank J A; Walters, G Bragi; Sigurdsson, Engilbert; Thorgeirsson, Thorgeir E; Ingason, Andres; Helgason, Agnar; Kong, Augustine; Kiemeney, Lambertus A; Koellinger, Philipp; Boomsma, Dorret I; Gudbjartsson, Daniel; Stefansson, Hreinn; Stefansson, Kari

    2015-07-01

    We tested whether polygenic risk scores for schizophrenia and bipolar disorder would predict creativity. Higher scores were associated with artistic society membership or creative profession in both Icelandic (P = 5.2 × 10(-6) and 3.8 × 10(-6) for schizophrenia and bipolar disorder scores, respectively) and replication cohorts (P = 0.0021 and 0.00086). This could not be accounted for by increased relatedness between creative individuals and those with psychoses, indicating that creativity and psychosis share genetic roots.

  3. A Model to Predict the Risk of Keratinocyte Carcinomas.

    PubMed

    Whiteman, David C; Thompson, Bridie S; Thrift, Aaron P; Hughes, Maria-Celia; Muranushi, Chiho; Neale, Rachel E; Green, Adele C; Olsen, Catherine M

    2016-06-01

    Basal cell and squamous cell carcinomas of the skin are the commonest cancers in humans, yet no validated tools exist to estimate future risks of developing keratinocyte carcinomas. To develop a prediction tool, we used baseline data from a prospective cohort study (n = 38,726) in Queensland, Australia, and used data linkage to capture all surgically excised keratinocyte carcinomas arising within the cohort. Predictive factors were identified through stepwise logistic regression models. In secondary analyses, we derived separate models within strata of prior skin cancer history, age, and sex. The primary model included terms for 10 items. Factors with the strongest effects were >20 prior skin cancers excised (odds ratio 8.57, 95% confidence interval [95% CI] 6.73-10.91), >50 skin lesions destroyed (odds ratio 3.37, 95% CI 2.85-3.99), age ≥ 70 years (odds ratio 3.47, 95% CI 2.53-4.77), and fair skin color (odds ratio 1.75, 95% CI 1.42-2.15). Discrimination in the validation dataset was high (area under the receiver operator characteristic curve 0.80, 95% CI 0.79-0.81) and the model appeared well calibrated. Among those reporting no prior history of skin cancer, a similar model with 10 factors predicted keratinocyte carcinoma events with reasonable discrimination (area under the receiver operator characteristic curve 0.72, 95% CI 0.70-0.75). Algorithms using self-reported patient data have high accuracy for predicting risks of keratinocyte carcinomas. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

  4. Predicting the use of Individualized Risk Assessment for Breast Cancer

    PubMed Central

    Bartle-Haring, Suzanne; Toviessi, Paula; Katafiasz, Heather

    2008-01-01

    Purpose The purpose of this study was to investigate the decision to obtain individualized risk assessment after a breast cancer education session. Methods A sample of both African American and Caucasian women was used to determine if there were differences by race/ethnicity in uptake of the assessment and differences in the variables that were most predictive of uptake. The sample included 166 women between the ages of 18 and 80. Sixty-two percent of the sample were African American women. Key Findings The results suggested that African American women and Caucasian women used different factors and used other factors differently to decide whether or not to obtain an individualized risk assessment. Conclusions and Implications These results are discussed within the context of health disparities among ethnic minority and Caucasian women with implications for breast cancer control programs. The results of this study would suggest that knowledge alone does not lead to opting for a personalized risk assessment, and that African American and Caucasian women use different pieces of information, or information differently to make decision about getting more personalized information about risk. PMID:18319147

  5. [Severe intimate partner violence risk prediction scale-revised].

    PubMed

    Echeburúa, Enrique; Amor, Pedro Javier; Loinaz, Ismael; de Corral, Paz

    2010-11-01

    The aim of this study was to describe the psychometric properties of the Severe Intimate Partner Violence Risk Prediction Scale and to revise it in order to ponderate the 20 items according to their discriminant capacity and to solve the missing item problem. The sample for this study consisted of 450 male batterers who were reported to the police station. The victims were classified as high-risk (18.2%), moderate-risk (45.8%) and low-risk (36%), depending on the cutoff scores in the original scale. Internal consistency (Cronbach's alpha=.72) and interrater reliability (r=.73) were acceptable. The point biserial correlation coefficient between each item and the corrected total score of the 20-item scale was calculated to determine the most discriminative items, which were associated with the context of intimate partner violence in the last month, with the male batterer's profile and with the victim's vulnerability. A revised scale (EPV-R) with new cutoff scores and indications on how to deal with the missing items were proposed in accordance with these results. This easy-to-use tool appears to be suitable to the requirements of criminal justice professionals and is intended for use in safety planning. Implications of these results for further research are discussed.

  6. Predicting head injury risk during International Space Station increments.

    PubMed

    Weaver, Aaron S; Zakrajsek, Anne D; Lewandowski, Beth E; Brooker, John E; Myers, Jerry G

    2013-01-01

    NASA's Human Research Program is using a probabilistic risk assessment approach to identify acute and chronic medical risks to manned spaceflight. The objective of this project was to estimate the likelihood of a neurological head injury to a crewmember severe enough to require medical assessment, treatment, or evacuation during a typical International Space Station (ISS) increment. A 2 degree-of-freedom analytical model of the human head was created to allow for analysis of the impact response. The output of the model is acceleration of the head, which was used to determine the probability that the simulated impact resulted in a head injury with an Abbreviated Injury Scale (AIS) score of 3 or greater. These data were then integrated into a probabilistic risk assessment, which outputs a likelihood of injury with a representative measure of the uncertainty. A Monte Carlo simulation was performed to vary input parameters over their defined distributions. The mean probability of a moderate neurological injury (AIS 3 or greater) occurring due to a head impact by a crewmember translating through the ISS is 1.16 x 10(-4) per 6-mo mission increment (2.32 x 10(-4) per year). Our head injury prediction model has shown that there is a low, yet not insignificant, probability of neurological head injury of AIS score 3 or greater. The results from this simulation will be input into the parent Integrated Medical Model, which incorporates the risks of over 80 different medical events in order to inform mission planning scenarios.

  7. Improving prediction of surgical site infection risk with multilevel modeling.

    PubMed

    Saunders, Lauren; Perennec-Olivier, Marion; Jarno, Pascal; L'Hériteau, François; Venier, Anne-Gaëlle; Simon, Loïc; Giard, Marine; Thiolet, Jean-Michel; Viel, Jean-François

    2014-01-01

    Surgical site infection (SSI) surveillance is a key factor in the elaboration of strategies to reduce SSI occurrence and in providing surgeons with appropriate data feedback (risk indicators, clinical prediction rule). To improve the predictive performance of an individual-based SSI risk model by considering a multilevel hierarchical structure. Data were collected anonymously by the French SSI active surveillance system in 2011. An SSI diagnosis was made by the surgical teams and infection control practitioners following standardized criteria. A random 20% sample comprising 151 hospitals, 502 wards and 62280 patients was used. Three-level (patient, ward, hospital) hierarchical logistic regression models were initially performed. Parameters were estimated using the simulation-based Markov Chain Monte Carlo procedure. A total of 623 SSI were diagnosed (1%). The hospital level was discarded from the analysis as it did not contribute to variability of SSI occurrence (p  = 0.32). Established individual risk factors (patient history, surgical procedure and hospitalization characteristics) were identified. A significant heterogeneity in SSI occurrence between wards was found (median odds ratio [MOR] 3.59, 95% credibility interval [CI] 3.03 to 4.33) after adjusting for patient-level variables. The effects of the follow-up duration varied between wards (p<10-9), with an increased heterogeneity when follow-up was <15 days (MOR 6.92, 95% CI 5.31 to 9.07]). The final two-level model significantly improved the discriminative accuracy compared to the single level reference model (p<10-9), with an area under the ROC curve of 0.84. This study sheds new light on the respective contribution of patient-, ward- and hospital-levels to SSI occurrence and demonstrates the significant impact of the ward level over and above risk factors present at patient level (i.e., independently from patient case-mix).

  8. Next-generation ecological risk assessment: Predicting risk from molecular initiation to ecosystem service delivery.

    PubMed

    Forbes, Valery E; Galic, Nika

    2016-05-01

    Ecological risk assessment is the process of evaluating how likely it is that the environment may be impacted as the result of exposure to one or more chemicals and/or other stressors. It is not playing as large a role in environmental management decisions as it should be. A core challenge is that risk assessments often do not relate directly or transparently to protection goals. There have been exciting developments in in vitro testing and high-throughput systems that measure responses to chemicals at molecular and biochemical levels of organization, but the linkage between such responses and impacts of regulatory significance - whole organisms, populations, communities, and ecosystems - are not easily predictable. This article describes some recent developments that are directed at bridging this gap and providing more predictive models that can make robust links between what we typically measure in risk assessments and what we aim to protect.

  9. Spatial distribution of the risk of dengue fever in southeast Brazil, 2006-2007

    PubMed Central

    2011-01-01

    Background Many factors have been associated with circulation of the dengue fever virus and vector, although the dynamics of transmission are not yet fully understood. The aim of this work is to estimate the spatial distribution of the risk of dengue fever in an area of continuous dengue occurrence. Methods This is a spatial population-based case-control study that analyzed 538 cases and 727 controls in one district of the municipality of Campinas, São Paulo, Brazil, from 2006-2007, considering socio-demographic, ecological, case severity, and household infestation variables. Information was collected by in-home interviews and inspection of living conditions in and around the homes studied. Cases were classified as mild or severe according to clinical data, and they were compared with controls through a multinomial logistic model. A generalized additive model was used in order to include space in a non-parametric fashion with cubic smoothing splines. Results Variables associated with increased incidence of all dengue cases in the multiple binomial regression model were: higher larval density (odds ratio (OR) = 2.3 (95%CI: 2.0-2.7)), reports of mosquito bites during the day (OR = 1.8 (95%CI: 1.4-2.4)), the practice of water storage at home (OR = 2.5 (95%CI: 1.4, 4.3)), low frequency of garbage collection (OR = 2.6 (95%CI: 1.6-4.5)) and lack of basic sanitation (OR = 2.9 (95%CI: 1.8-4.9)). Staying at home during the day was protective against the disease (OR = 0.5 (95%CI: 0.3-0.6)). When cases were analyzed by categories (mild and severe) in the multinomial model, age and number of breeding sites more than 10 were significant only for the occurrence of severe cases (OR = 0.97, (95%CI: 0.96-0.99) and OR = 2.1 (95%CI: 1.2-3.5), respectively. Spatial distribution of risks of mild and severe dengue fever differed from each other in the 2006/2007 epidemic, in the study area. Conclusions Age and presence of more than 10 breeding sites were significant only for severe

  10. Risk factors associated with sero-positivity to Toxoplasma gondii in captive neotropical felids from Brazil.

    PubMed

    Ramos Silva, Jean Carlos; Marvulo, Maria Fernanda Vianna; Dias, Ricardo Augusto; Ferreira, Fernando; Amaku, Marcos; Adania, Cristina Harumi; Ferreira Neto, José Soares

    2007-03-17

    From September 1995 to February 2001, blood samples were collected from 865 neotropical felids belonging to 8 different species. These animals were housed in 86 institutions located in 78 cities of 20 Brazilian states. Our goal was to identify the risk factors associated with sero-positivity to Toxoplasma gondii in captive neotropical felids from Brazil. All serum samples were tested by the modified agglutination test (MAT), using formalin-fixed whole tachyzoites and mercaptoethanol. For each animal an individual questionnaire was filled with questions about tattoo number, felid species, age, sex, origin, number of animals in the group, introduction of new animals in the group, time in the institution, eating meat previously frozen for a period <7 days in the last 6 months, eating meat of run-over or euthanized animals in the last 6 months, predation of rodents or birds in the last 6 months and presence of domestic cats near the enclosures in the last 6 months. The total sero-prevalence was 55% (95% CI: 52%, 57%). We estimated a prevalence of 46% (95% CI: 40%, 54%) for jaguarundi (Puma yagouaroundi); 58% (95% CI: 53%, 63%) for ocelot (Leopardus pardalis); 50% (95% CI: 45%, 56%) for oncilla (L. tigrinus); 54% (95% CI: 46%, 62%) for margay (L. wiedii); 12% (95% CI: 4%, 31%) for Pampas-cat (L. colocolo); 83% (95% CI: 65%, 93%) for Geoffroy's-cat (L. geoffroyi); 64% (95% CI: 50%, 68%) for jaguar (Panthera onca) and 48% (95% CI: 42%, 54%) for puma (Puma concolor). Multiple logistic regression was used to evaluate the association between the variables in the questionnaire and sero-positivity to T. gondii. We concluded that the independent risk factors for toxoplasmosis were: age >3 years (OR=4.75 [2.75; 8.2]), eating meat previously frozen for a period <7 days (OR=2.23 [1.24; 4.01]), and consumption of animals that were run-over or euthanized (OR=1.64; [1.14; 2.37]).

  11. Associations between noncommunicable disease risk factors, race, education, and health insurance status among women of reproductive age in Brazil - 2011.

    PubMed

    Mpofu, Jonetta Johnson; de Moura, Lenildo; Farr, Sherry L; Malta, Deborah Carvalho; Iser, Betine Moehlecke; Ivata Bernal, Regina Tomie; Robbins, Cheryl L; Lobelo, Felipe

    2016-06-01

    Noncommunicable disease (NCD) risk factors increase the risk of adverse reproductive health outcomes and are becoming increasingly common in Brazil. We analyzed VIGITEL 2011 telephone survey data for 13,745 Brazilian women aged 18-44 years in a probabilistic sample from 26 Brazilian state capitals and the Federal District. We examined associations between NCD risk factors (fruit and vegetable intake, leisure time physical activity, alcohol consumption, smoking status, BMI and hypertension status) and race, education, and insurance using chi-square tests and multivariable logistic regression models, estimating the average marginal effects to produce adjusted relative risk ratios (aRRs). Analyses were conducted using SAS 9.3 survey procedures and weighted to reflect population estimates. Women with less than a college education were more likely to report physical inactivity (adjusted relative risk (aRR) and 95% confidence interval = 1.1 (1.1-1.2)), smoking (aRR = 1.7 (1.3-2.2)), and self-reported diagnoses of hypertension (aRR = 2.0 (1.6-2.5)) compared to women with a college education or greater. Similarly, women without health insurance were more likely to report physical inactivity (aRR = 1.1 (1.1-1.2)), smoking (aRR = 1.4 (1.1-1.8)), and self-reported diagnoses of hypertension aRR = 1.4 (1.1-1.7)) compared to women with health insurance. Less variation was found by race and NCD risk factors. Targeted public health strategies and policies are needed to increase healthcare access and decrease educational and racial disparities in NCD risk factors among women of reproductive age in Brazil.

  12. Tryptophan Predicts the Risk for Future Type 2 Diabetes

    PubMed Central

    Chen, Tianlu; Zheng, Xiaojiao; Ma, Xiaojing; Bao, Yuqian; Ni, Yan; Hu, Cheng; Rajani, Cynthia; Huang, Fengjie; Zhao, Aihua; Jia, Weiping; Jia, Wei

    2016-01-01

    Recently, 5 amino acids were identified and verified as important metabolites highly associated with type 2 diabetes (T2D) development. This report aims to assess the association of tryptophan with the development of T2D and to evaluate its performance with existing amino acid markers. A total of 213 participants selected from a ten-year longitudinal Shanghai Diabetes Study (SHDS) were examined in two ways: 1) 51 subjects who developed diabetes and 162 individuals who remained metabolically healthy in 10 years; 2) the same 51 future diabetes and 23 strictly matched ones selected from the 162 healthy individuals. Baseline fasting serum tryptophan concentrations were quantitatively measured using ultra-performance liquid chromatography triple quadruple mass spectrometry. First, serum tryptophan level was found significantly higher in future T2D and was positively and independently associated with diabetes onset risk. Patients with higher tryptophan level tended to present higher degree of insulin resistance and secretion, triglyceride and blood pressure. Second, the prediction potential of tryptophan is non-inferior to the 5 existing amino acids. The predictive performance of the combined score improved after taking tryptophan into account. Our findings unveiled the potential of tryptophan as a new marker associated with diabetes risk in Chinese populations. The addition of tryptophan provided complementary value to the existing amino acid predictors. PMID:27598004

  13. Value-at-risk prediction using context modeling

    NASA Astrophysics Data System (ADS)

    Denecker, K.; van Assche, S.; Crombez, J.; Vander Vennet, R.; Lemahieu, I.

    2001-04-01

    In financial market risk measurement, Value-at-Risk (VaR) techniques have proven to be a very useful and popular tool. Unfortunately, most VaR estimation models suffer from major drawbacks: the lognormal (Gaussian) modeling of the returns does not take into account the observed fat tail distribution and the non-stationarity of the financial instruments severely limits the efficiency of the VaR predictions. In this paper, we present a new approach to VaR estimation which is based on ideas from the field of information theory and lossless data compression. More specifically, the technique of context modeling is applied to estimate the VaR by conditioning the probability density function on the present context. Tree-structured vector quantization is applied to partition the multi-dimensional state space of both macroeconomic and microeconomic priors into an increasing but limited number of context classes. Each class can be interpreted as a state of aggregation with its own statistical and dynamic behavior, or as a random walk with its own drift and step size. Results on the US S&P500 index, obtained using several evaluation methods, show the strong potential of this approach and prove that it can be applied successfully for, amongst other useful applications, VaR and volatility prediction. The October 1997 crash is indicated in time.

  14. Injury risk prediction from computational simulations of ocular blast loading.

    PubMed

    Weaver, Ashley A; Stitzel, Sarah M; Stitzel, Joel D

    2017-04-01

    A predictive Lagrangian-Eulerian finite element eye model was used to analyze 2.27 and 0.45 kg trinitrotoluene equivalent blasts detonated from 24 different locations. Free air and ground level blasts were simulated directly in front of the eye and at lateral offset locations with box, average, less protective, and more protective orbital anthropometries, resulting in 96 simulations. Injury risk curves were developed for hyphema, lens dislocation, retinal damage, and globe rupture from experimental and computational data to compute risk from corneoscleral stress and intra-ocular pressure computational outputs. Corneoscleral stress, intra-ocular pressure, and injury risks increased when the blast size was larger and located nearer to the eye. Risks ranged from 20-100 % for hyphema, 1-100 % for lens dislocation, 2-100 % for retinal damage, and 0-98 % for globe rupture depending on the blast condition. Orbital geometry affected the stresses, pressures, and associated ocular injury risks of the blast conditions simulated. Orbital geometries that more fully surrounded the eye such as the more protective orbit tended to produce higher corneoscleral stresses and compression of the eye against the surrounding rigid orbit contributing to high stresses as the blast wave propagated. However, the more protective orbit tended to produce lower intra-ocular pressures in comparison with the other three orbital geometries which may indicate that the more protective orbit inhibits propagation of the blast wave and reduces ocular loading. Results of this parametric computational study of ocular blast loading are valuable to the design of eye protection equipment and the mitigation of blast-related eye injuries.

  15. Predictive model of avian electrocution risk on overhead power lines.

    PubMed

    Dwyer, J F; Harness, R E; Donohue, K

    2014-02-01

    Electrocution on overhead power structures negatively affects avian populations in diverse ecosystems worldwide, contributes to the endangerment of raptor populations in Europe and Africa, and is a major driver of legal action against electric utilities in North America. We investigated factors associated with avian electrocutions so poles that are likely to electrocute a bird can be identified and retrofitted prior to causing avian mortality. We used historical data from southern California to identify patterns of avian electrocution by voltage, month, and year to identify species most often killed by electrocution in our study area and to develop a predictive model that compared poles where an avian electrocution was known to have occurred (electrocution poles) with poles where no known electrocution occurred (comparison poles). We chose variables that could be quantified by personnel with little training in ornithology or electric systems. Electrocutions were more common at distribution voltages (≤ 33 kV) and during breeding seasons and were more commonly reported after a retrofitting program began. Red-tailed Hawks (Buteo jamaicensis) (n = 265) and American Crows (Corvus brachyrhynchos) (n = 258) were the most commonly electrocuted species. In the predictive model, 4 of 14 candidate variables were required to distinguish electrocution poles from comparison poles: number of jumpers (short wires connecting energized equipment), number of primary conductors, presence of grounding, and presence of unforested unpaved areas as the dominant nearby land cover. When tested against a sample of poles not used to build the model, our model distributed poles relatively normally across electrocution-risk values and identified the average risk as higher for electrocution poles relative to comparison poles. Our model can be used to reduce avian electrocutions through proactive identification and targeting of high-risk poles for retrofitting. © 2013 Society for Conservation

  16. Violence risk prediction. Clinical and actuarial measures and the role of the Psychopathy Checklist.

    PubMed

    Dolan, M; Doyle, M

    2000-10-01

    Violence risk prediction is a priority issue for clinicians working with mentally disordered offenders. To review the current status of violence risk prediction research. Literature search (Medline). Key words: violence, risk prediction, mental disorder. Systematic/structured risk assessment approaches may enhance the accuracy of clinical prediction of violent outcomes. Data on the predictive validity of available clinical risk assessment tools are based largely on American and North American studies and further validation is required in British samples. The Psychopathy Checklist appears to be a key predictor of violent recidivism in a variety of settings. Violence risk prediction is an inexact science and as such will continue to provoke debate. Clinicians clearly need to be able to demonstrate the rationale behind their decisions on violence risk and much can be learned from recent developments in research on violence risk prediction.

  17. Cardiopulmonary risk index does not predict complications after thoracic surgery.

    PubMed

    Melendez, J A; Carlon, V A

    1998-07-01

    The preoperative cardiopulmonary risk index (CPRI) is a multifactorial index intended to predict postoperative outcome after thoracic surgery. It combines cardiac and pulmonary information into one parameter that ranges from 1 to 10, with 10 being the worst. A CPRI > or = 4 has been advocated as an effective predictor of postoperative pulmonary and cardiac complications. This study prospectively evaluates the predictive value of CPRI in a large population of patients undergoing thoracic surgery. We performed prospective calculation of CPRI in patients about to undergo thoracic surgery. Postthoracic surgery occurrence of pneumonia, atelectasis, arrhythmias, congestive heart failure, respiratory failure requiring therapy, or death occurring within 30 days of surgery was compared with preoperative CPRI and its components. One hundred eighty consecutive patients, aged 15 to 87 years, were studied. Operations performed included 114 lobectomies, 35 wedge resections, 19 pneumonectomies, 5 pleurectomies, 5 lymph node dissections, 1 thoracic wall resection, and 1 paravertebral tumor resection. Twenty-seven percent of patients experienced complications. CPRI and its components did not predict complications, deaths, or the number of in-hospital days. We found a CPRI > or = 4 to be a moderate predictor of outcome for patients undergoing pneumonectomy (n = 19). It correctly identified four of nine postpneumonectomy complications. The preoperative CPRI and its components are inadequate predictors of medical complications after thoracic surgery in a general population. In the subgroup of patients undergoing pneumonectomy, the index may be of some value in forecasting outcome.

  18. Presence of high-risk clones of OXA-23-producing Acinetobacter baumannii (ST79) and SPM-1-producing Pseudomonas aeruginosa (ST277) in environmental water samples in Brazil.

    PubMed

    Turano, Helena; Gomes, Fernando; Medeiros, Micheli; Oliveira, Silvane; Fontes, Lívia C; Sato, Maria I Z; Lincopan, Nilton

    2016-09-01

    This study reports the presence of hospital-associated high-risk lineages of OXA-23-producing ST79 Acinetobacter baumannii and SPM-1-producing ST277 Pseudomonas aeruginosa in urban rivers in Brazil. These findings indicate that urban rivers can act as reservoirs of clinically important multidrug-resistant bacteria, which constitute a potential risk to human and animal health.

  19. Serological markers and risk factors related to hepatitis B virus in dentists in the Central West region of Brazil

    PubMed Central

    de Paiva, Enilza Maria Mendonça; Tiplle, Anaclara Ferreira Veiga; de Paiva Silva, Eliane; de Paula Cardoso, Divina das Dores

    2008-01-01

    The hepatitis B virus (HBV) has been considered the major occupational risk agent for dentists. The Central West region of Brazil is considered an intermediate endemic pattern area, but currently there is no information about the HBV prevalence in dentists of Goiânia, Goiás. This study aimed at the detection of the HBV infection rate and risk factors for dentists of Goiânia and the comparison of the obtained data with the general population and other groups. A randomized sample of 680 professionals participated in this study. All dentists gave written consent for the procedure and filled out a questionnaire about risk factors. The HBV serological markers were analyzed using ELISA test and the presence of anti-HBc was observed in 41 (6.0%) of the dentists. None of them was HBsAg positive. Significant relationships with HBV positivity were observed with gender, the time working as a dentist and the use of incomplete personal protective equipment (PPE). The HBV prevalence found in this group of dentists was lower than the endemic pattern of the general population, other health care workers of the region and the dentists from other regions in Brazil. These results may indicate a positive impact of vaccination considering the high adherence of the dentists to the immunization program (98.4%). Finally, the use of complete PPE by the majority as well as other standard precautions recommended for health care workers could be responsible for the low HBV seroprevalence. PMID:24031211

  20. What predicts the risk of recurrent lung metastases?

    PubMed

    Murrell, Zaria; Dasgupta, Roshni

    2013-05-01

    The purpose of this study was to determine what factors predict recurrent lung metastatic disease in pediatric oncology patients. A retrospective review of 50 patients who underwent resection of lung nodules that were positive for metastatic disease from 1998 to 2011 was performed. Risk factors for recurrence were determined by multi-variable logistic regression models. Fifty pediatric oncology patients underwent resection of discrete lung nodules seen on CT scans during work-up for metastasis or for routine surveillance. Out of this patient cohort, 23 (46%) patients had recurrent disease. The only significant factors that influenced risk of recurrence were original PET positive study (p<0.05) and patients with osteosarcoma (p<0.002). The type of surgical procedure, margins of original resection, race, age, gender, size, or the number of original nodules was not found to be significant. Patients with osteosarcoma and PET positive disease at original presentation appear to be at the highest risk of recurrent pulmonary metastatic disease. New pulmonary lesions in these patients should undergo biopsy to confirm metastatic disease. Copyright © 2013 Elsevier Inc. All rights reserved.

  1. Using liver enzymes as screening tests to predict mortality risk.

    PubMed

    Fulks, Michael; Stout, Robert L; Dolan, Vera F

    2008-01-01

    Determine the relationship between liver function test results (GGT, alkaline phosphatase, AST, and ALT) and all-cause mortality in life insurance applicants. By use of the Social Security Master Death File, mortality was examined in 1,905,664 insurance applicants for whom blood samples were submitted to the Clinical Reference Laboratory. There were 50,174 deaths observed in this study population. Results were stratified by 3 age/sex groups: females, age <60; males, age <60; and all, age 60+. Liver function test values were grouped using percentiles of their distribution in these 3 age/sex groups, as well as ranges of actual values. Using the risk of the middle 50% of the population by distribution as a reference, relative mortality observed for GGT and alkaline phosphatase was linear with a steep slope from very low to relatively high values. Relative mortality was increased at lower values for both AST and ALT. ALT did not predict mortality for values above the middle 50% of its distribution. GGT and alkaline phosphatase are significant predictors of mortality risk for all values. ALT is still useful for triggering further testing for hepatitis, but AST should be used instead to assess mortality risk linked with transaminases.

  2. Predicting Low-Risk Prostate Cancer from Transperineal Saturation Biopsies

    PubMed Central

    van Leeuwen, Pim J.; Siriwardana, Amila; Roobol, Monique; Ting, Francis; Nieboer, Daan; Thompson, James; Delprado, Warick; Haynes, Anne-Marie; Brenner, Phillip; Stricker, Phillip

    2016-01-01

    Introduction. To assess the performance of five previously described clinicopathological definitions of low-risk prostate cancer (PC). Materials and Methods. Men who underwent radical prostatectomy (RP) for clinical stage ≤T2, PSA <10 ng/mL, Gleason score <8 PC, diagnosed by transperineal template-guided saturation biopsy were included. The performance of five previously described criteria (i.e., criteria 1–5, criterion 1 stringent (Gleason score 6 + ≤5 mm total max core length PC + ≤3 mm max per core length PC) up to criterion 5 less stringent (Gleason score 6-7 with ≤5% Gleason grade 4) was analysed to assess ability of each to predict insignificant disease in RP specimens (defined as Gleason score ≤6 and total tumour volume <2.5 mL, or Gleason score 7 with ≤5% grade 4 and total tumour volume <0.7 mL). Results. 994 men who underwent RP were included. Criterion 4 (Gleason score 6) performed best with area under the curve of receiver operating characteristics 0.792. At decision curve analysis, criterion 4 was deemed clinically the best performing transperineal saturation biopsy-based definition for low-risk PC. Conclusions. Gleason score 6 disease demonstrated a superior trade-off between sensitivity and specificity for clarifying low-risk PC that can guide treatment and be used as reference test in diagnostic studies. PMID:27148459

  3. [Triatominae and Cactaceae: a risk for the transmission of the American trypanosomiasis in the peridomicilary space (Northeast Brazil)].

    PubMed

    Emperaire, L; Romaña, C A

    2006-06-01

    Field observations carried in semi-arid Brazil Northeast point out the frequent association, in the peridomiciliary space, between a cactus, Cereus jamacaru, the occurrence of nests in its branches and the occurrence of two species of insects vectors of Trypanosoma cruzi, pathogenic agent of Chagas disease: Rhodnius neglectus and Triatoma pseudomaculata. The analysis of the architectural variables of this Cactaceae shows that the presence of nests, and thus of insects, depends on the traditional practices of management of this cactus. This study underlines the relevance of an integrated approach of the ecology of Triatominae for the identification of factors of risk.

  4. Predicting stroke through genetic risk functions: The CHARGE risk score project

    PubMed Central

    Ibrahim-Verbaas, Carla A; Fornage, Myriam; Bis, Joshua C; Choi, Seung Hoan; Psaty, Bruce M; Meigs, James B; Rao, Madhu; Nalls, Mike; Fontes, Joao D; O’Donnell, Christopher J.; Kathiresan, Sekar; Ehret, Georg B.; Fox, Caroline S; Malik, Rainer; Dichgans, Martin; Schmidt, Helena; Lahti, Jari; Heckbert, Susan R; Lumley, Thomas; Rice, Kenneth; Rotter, Jerome I; Taylor, Kent D; Folsom, Aaron R; Boerwinkle, Eric; Rosamond, Wayne D; Shahar, Eyal; Gottesman, Rebecca F.; Koudstaal, Peter J; Amin, Najaf; Wieberdink, Renske G.; Dehghan, Abbas; Hofman, Albert; Uitterlinden, André G; DeStefano, Anita L.; Debette, Stephanie; Xue, Luting; Beiser, Alexa; Wolf, Philip A.; DeCarli, Charles; Ikram, M. Arfan; Seshadri, Sudha; Mosley, Thomas H; Longstreth, WT; van Duijn, Cornelia M; Launer, Lenore J

    2014-01-01

    Background and Purpose Beyond the Framingham Stroke Risk Score (FSRS), prediction of future stroke may improve with a genetic risk score (GRS) based on Single nucleotide polymorphisms (SNPs) associated with stroke and its risk factors. Methods The study includes four population-based cohorts with 2,047 first incident strokes from 22,720 initially stroke-free European origin participants aged 55 years and older, who were followed for up to 20 years. GRS were constructed with 324 SNPs implicated in stroke and 9 risk factors. The association of the GRS to first incident stroke was tested using Cox regression; the GRS predictive properties were assessed with Area under the curve (AUC) statistics comparing the GRS to age sex, and FSRS models, and with reclassification statistics. These analyses were performed per cohort and in a meta-analysis of pooled data. Replication was sought in a case-control study of ischemic stroke (IS). Results In the meta-analysis, adding the GRS to the FSRS, age and sex model resulted in a significant improvement in discrimination (All stroke: Δjoint AUC =0.016, p-value=2.3*10-6; IS: Δ joint AUC =0.021, p-value=3.7*10−7), although the overall AUC remained low. In all studies there was a highly significantly improved net reclassification index (p-values <10−4). Conclusions The SNPs associated with stroke and its risk factors result only in a small improvement in prediction of future stroke compared to the classical epidemiological risk factors for stroke. PMID:24436238

  5. Maternal Gene Polymorphisms Involved in Folate Metabolism as Risk Factors for Down Syndrome Offspring in Southern Brazil

    PubMed Central

    Brandalize, Ana Paula Carneiro; Bandinelli, Eliane; Santos, Pollyanna Almeida Dos; Schüler-Faccini, Lavínia

    2010-01-01

    This study aimed to investigate the role of maternal polymorphisms, as well as their risk genotypes combinations of MTR A2756G, MTRR A66G, CBS 844ins68, and RFC A80G, involved in folate/homocysteine metabolism, as possible risk factors for Down syndrome (DS) in Southern Brazil. A case-control study was conducted with 239~mothers of DS children and 197 control mothers. The investigation of polymorphisms was performed by PCR and PCR-RFLP. The distribution of genotypic variants was similar in both groups when they were analyzed separately. An investigation of combined risk genotypes showed that the risk of having a DS child for one, two or three risk genotypes was 6.23, 6.96 and 5.84 (95%CI 1.48–26.26; 1.69–28.66; 1.37–24.86), respectively. The combined MTRR 66G and MTHFR 677T alleles were significantly more common among mothers of children with DS than among control mothers (OR 1.55; IC 95% 1.03–2.35). The results show that individual polymorphisms studied in this work are not associated with DS; however, the effects of the combined risk genotypes among MTR, MTRR, CBS and RFC genes are considered maternal risk factors for DS offspring in our population. PMID:21045269

  6. Predicting Pneumonitis Risk: A Dosimetric Alternative to Mean Lung Dose

    SciTech Connect

    Tucker, Susan L.; Mohan, Radhe; Liengsawangwong, Raweewan; Martel, Mary K.; Liao Zhongxing

    2013-02-01

    Purpose: To determine whether the association between mean lung dose (MLD) and risk of severe (grade {>=}3) radiation pneumonitis (RP) depends on the dose distribution pattern to normal lung among patients receiving 3-dimensional conformal radiation therapy for non-small-cell lung cancer. Methods and Materials: Three cohorts treated with different beam arrangements were identified. One cohort (2-field boost [2FB]) received 2 parallel-opposed (anteroposterior-posteroanterior) fields per fraction initially, followed by a sequential boost delivered using 2 oblique beams. The other 2 cohorts received 3 or 4 straight fields (3FS and 4FS, respectively), ie, all fields were irradiated every day. The incidence of severe RP was plotted against MLD in each cohort, and data were analyzed using the Lyman-Kutcher-Burman (LKB) model. Results: The incidence of grade {>=}3 RP rose more steeply as a function of MLD in the 2FB cohort (N=120) than in the 4FS cohort (N=138), with an intermediate slope for the 3FS group (N=99). The estimated volume parameter from the LKB model was n=0.41 (95% confidence interval, 0.15-1.0) and led to a significant improvement in fit (P=.05) compared to a fit with volume parameter fixed at n=1 (the MLD model). Unlike the MLD model, the LKB model with n=0.41 provided a consistent description of the risk of severe RP in all three cohorts (2FB, 3FS, 4FS) simultaneously. Conclusions: When predicting risk of grade {>=}3 RP, the mean lung dose does not adequately take into account the effects of high doses. Instead, the effective dose, computed from the LKB model using volume parameter n=0.41, may provide a better dosimetric parameter for predicting RP risk. If confirmed, these findings support the conclusion that for the same MLD, high doses to small lung volumes ('a lot to a little') are worse than low doses to large volumes ('a little to a lot').

  7. A Genetics-based Biomarker Risk Algorithm for Predicting Risk of Alzheimer’s Disease

    PubMed Central

    Lutz, Michael W.; Sundseth, Scott S.; Burns, Daniel K.; Saunders, Ann M.; Hayden, Kathleen M.; Burke, James R.; Welsh-Bohmer, Kathleen A.; Roses, Allen D.

    2016-01-01

    Background A straightforward, reproducible blood-based test that predicts age dependent risk of Alzheimer’s disease (AD) could be used as an enrichment tool for clinical development of therapies. This study evaluated the prognostic performance of a genetics-based biomarker risk algorithm (GBRA) established on a combination of Apolipoprotein E (APOE)/Translocase of outer mitochondrial membrane 40 homolog (TOMM40) genotypes and age, then compare it to cerebrospinal fluid (CSF) biomarkers, neuroimaging and neurocognitive tests using data from two independent AD cohorts. Methods The GBRA was developed using data from the prospective Bryan-ADRC study (n=407; 86 conversion events (mild cognitive impairment (MCI) or late onset Alzheimer’s disease (LOAD)). The performance of the algorithm was tested using data from the ADNI study (n=660; 457 individuals categorized as MCI or LOAD). Results The positive predictive values (PPV) and negative predictive values (NPV) of the GBRA are in the range of 70–80%. The relatively high odds ratio (approximately 3–5) and significant net reclassification index (NRI) scores comparing the GBRA to a version based on APOE and age alone support the value of the GBRA in risk prediction for MCI due to LOAD. Performance of the GBRA compares favorably with CSF and imaging (fMRI) biomarkers. In addition, the GBRA “high” and “low” AD-risk categorizations correlated well with pathological CSF biomarker levels, PET amyloid burden and neurocognitive scores. Conclusions Unlike dynamic markers (i.e., imaging, protein or lipid markers) that may be influenced by factors unrelated to disease, genomic DNA is easily collected, stable, and the technical methods for measurement are robust, inexpensive, and widely available. The performance characteristics of the GBRA support its use as a pharmacogenetic enrichment tool for LOAD delay of onset clinical trials, and merits further evaluation for its clinical utility in evaluating therapeutic

  8. Causes of death and associated risk factors among climacteric women from Southern Brazil: a population based-study

    PubMed Central

    2014-01-01

    Background Aging and menopause are particular cardiovascular risk factors for women, due to estrogen deprivation at the time of menopause. Studies show that diabetes mellitus (DM), smoking, hypertension, high body mass index (BMI), and serum lipids are associated with increased risk of cardiovascular disease (CVD), the main cause of female mortality in Brazil. The aim of this study was to assess the mortality rate, causes of death and associated risk factors in a cohort of women from Brazil. Methods A longitudinal population-based study of menopausal status is currently underway in a city in South Brazil. In 2010, a third follow-up of this population was performed to assess cardiovascular risk and mortality rate between 1995 and 2011. For this analysis, 358 participants were studied. At baseline, participants had completed a standardized questionnaire including demographic, lifestyle, medical and reproductive characteristics. In addition to the contacts with relatives, mortality data were obtained through review of medical records in all city hospitals and the Center for Health Information (NIS/RS-SES). Multivariate-adjusted hazard risk (HR) and 95% confidence intervals (CI95%) were estimated using Cox proportional hazards regression. Survival curves were estimated using the Kaplan-Meier curve. Results There were 17 (4.7%) deaths from all causes during the study period. Seven (41.2%) deaths were caused by CVD, including four cases of stroke and three cases of myocardial infarction. Six (35.3%) deaths were due to cancer, and four (23.5%) were due to other reasons. In the age and smoking-adjusted multivariate models, diabetes (HR 6.645, 95% CI: 1.938–22.79, p = 0.003), alcohol intake (HR 1.228, 95% CI: 1.014-1.487, p = 0.035) and postmenopausal status (HR = 6.216, 95% CI: 0.963–40.143, p = 0.055) were associated with all-cause mortality. A significant association was found between abdominal obesity (WHR ≥ 0.85) and mortality even after the adjustment for BMI

  9. Personalized medicine: risk prediction, targeted therapies and mobile health technology.

    PubMed

    Hayes, Daniel F; Markus, Hugh S; Leslie, R David; Topol, Eric J

    2014-02-28

    Personalized medicine is increasingly being employed across many areas of clinical practice, as genes associated with specific diseases are discovered and targeted therapies are developed. Mobile apps are also beginning to be used in medicine with the aim of providing a personalized approach to disease management. In some areas of medicine, patient-tailored risk prediction and treatment are applied routinely in the clinic, whereas in other fields, more work is required to translate scientific advances into individualized treatment. In this forum article, we asked specialists in oncology, neurology, endocrinology and mobile health technology to discuss where we are in terms of personalized medicine, and address their visions for the future and the challenges that remain in their respective fields.

  10. Personalized medicine: risk prediction, targeted therapies and mobile health technology

    PubMed Central

    2014-01-01

    Personalized medicine is increasingly being employed across many areas of clinical practice, as genes associated with specific diseases are discovered and targeted therapies are developed. Mobile apps are also beginning to be used in medicine with the aim of providing a personalized approach to disease management. In some areas of medicine, patient-tailored risk prediction and treatment are applied routinely in the clinic, whereas in other fields, more work is required to translate scientific advances into individualized treatment. In this forum article, we asked specialists in oncology, neurology, endocrinology and mobile health technology to discuss where we are in terms of personalized medicine, and address their visions for the future and the challenges that remain in their respective fields. PMID:24580858

  11. Prediction models for early risk detection of cardiovascular event.

    PubMed

    Purwanto; Eswaran, Chikkannan; Logeswaran, Rajasvaran; Abdul Rahman, Abdul Rashid

    2012-04-01

    Cardiovascular disease (CVD) is the major cause of death globally. More people die of CVDs each year than from any other disease. Over 80% of CVD deaths occur in low and middle income countries and occur almost equally in male and female. In this paper, different computational models based on Bayesian Networks, Multilayer Perceptron,Radial Basis Function and Logistic Regression methods are presented to predict early risk detection of the cardiovascular event. A total of 929 (626 male and 303 female) heart attack data are used to construct the models.The models are tested using combined as well as separate male and female data. Among the models used, it is found that the Multilayer Perceptron model yields the best accuracy result.

  12. Risk factors for hepatitis C virus infection among blood donors in southern Brazil: a case-control study

    PubMed Central

    Brandão, Ajacio BM; Costa Fuchs, Sandra

    2002-01-01

    Background In Brazil, it is estimated that between 2.5 and 4.9% of the general population present anti-hepatitis C virus (HCV) antibodies, which corresponds to as many as 3.9 to 7.6 million chronic carriers. Chronic liver disease is associated with HCV infection in 20% to 58% of the Brazilian patients. The objective of this case-control study was to investigate the risk factors for presence of anti-HCV antibody in blood donors in southern Brazil. Methods One hundred and seventy eight blood donors with two positive ELISA results for anti-HCV were cases, and 356 controls tested negative. A standardized questionnaire was used to collect data concerning demographic and socioeconomic aspects, history of previous hepatitis infection, social and sexual behaviors, and number of donations. Variables were grouped into sets of hierarchical categories. Cases and controls were compared using logistic regression, odds ratios, and 95% confidence intervals. The statistical significance of the associations was assessed through likelihood ratio tests based on a P value < 0.05. Results The prevalence of anti-HCV among blood donors was 1.1%. Most of the donors were white and males. In the multivariate analysis, independent predictors of anti-HCV positivity were: intravenous drug use, blood transfusion >10 years earlier, having had two to four sexually transmitted diseases, incarceration, tattooing, sex with a hepatitis B or C virus carrier or with intravenous drug users. Conclusion Intravenous drug use, blood transfusion, and tattooing were the main risk factors for anti-HCV positivity among blood donors from southern Brazil, but sexual HCV transmission should also be considered. PMID:12169200

  13. Predicting bioaccumulation of PAHs in the trophic chain in the estuary region of Paranagua, Brazil.

    PubMed

    Froehner, Sandro; Maceno, Marcell; Machado, Karina Scurupa

    2011-03-01

    The presence of polycyclic aromatic hydrocarbon (PAH) compounds in sediment and water samples collected in the estuary area of Paranagua, southern Brazil, was investigated. There is a lot of port activity in the region. Recreational fishing is widespread; thus, there is concern about possible contamination by PAHs. The 16 priority PAHs were investigated, and only eight were found. The total concentration of PAHs ranged from 40.8 to 406.8 ng/g. High molecular weight were the most abundant, while PAHs with a low molecular weight were absent. There are suspicions that the main source of PAHs is combustion, but some uncertainties exist, and there may even be the presence of PAHs resulting from accidental spills of crude oil. Although the sediments contain PAHs, the amount is below the maximum concentrations allowed by the Brazilian environmental legislation, as well as the maximum levels at which adverse effects are observed. From the analytical results, a probable bioaccumulation was assessed in the local trophic chain using a mathematical model (Arnot and Gobas, Environ Toxicol Chem 23(10):2343-2355, 2004). The model showed that there is a possibility of biomagnification along the food chain selected. Three fishes with high local consumption were selected, and the concentration of some PAHs could be found in those fishes.

  14. Climatic Variables Do Not Directly Predict Spider Richness and Abundance in Semiarid Caatinga Vegetation, Brazil.

    PubMed

    Carvalho, Leonardo S; Sebastian, Nicholas; Araújo, Helder F P; Dias, Sidclay C; Venticinque, Eduardo; Brescovit, Antonio D; Vasconcellos, Alexandre

    2015-02-01

    Spiders are abundant in tropical ecosystems and exert predatory pressure on a wide variety of invertebrate populations and also serve as prey for many others organisms, being part of complex interrelationships influenced directly and indirectly by a myriad of factors. We examined the influence of biotic (i.e., prey availability) and abiotic (i.e., temperature, precipitation, relative humidity, real evapotranspiration) factors on species richness and abundance during a two-year period in the semiarid Caatinga vegetation in northeastern Brazil. Data were analyzed through partial autocorrelation functions, cross correlations, and a path analysis. A total of 2522 spiders were collected with beating tray, pit-fall traps, and malaise traps, comprising 91 species and 34 families. Spider abundance peaked in the rainy season. Our results suggest that total invertebrate abundance has a direct influence on spider richness and abundance, whereas the effects of precipitation were mainly indirectly related to most spider assemblage parameters. The increase in vegetation cover with the rainy season in the Caatinga provides more breeding and foraging sites for spiders and stimulates their activities. Additionally, rainfall in arid and semiarid ecosystems stimulated the activity and reproduction of many herbivore and detritivore invertebrates dependent on plant biomass and necromass consumption, leading to an increase in spider prey availability. © The Author 2015. Published by Oxford University Press on behalf of Entomological Society of America. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  15. Predicting urban outdoor thermal comfort by the Universal Thermal Climate Index UTCI--a case study in Southern Brazil.

    PubMed

    Bröde, Peter; Krüger, Eduardo L; Rossi, Francine A; Fiala, Dusan

    2012-05-01

    Recognising that modifications to the physical attributes of urban space are able to promote improved thermal outdoor conditions and thus positively influence the use of open spaces, a survey to define optimal thermal comfort ranges for passers-by in pedestrian streets was conducted in Curitiba, Brazil. We applied general additive models to study the impact of temperature, humidity, and wind, as well as long-wave and short-wave radiant heat fluxes as summarised by the recently developed Universal Thermal Climate Index (UTCI) on the choice of clothing insulation by fitting LOESS smoothers to observations from 944 males and 710 females aged from 13 to 91 years. We further analysed votes of thermal sensation compared to predictions of UTCI. The results showed that females chose less insulating clothing in warm conditions compared to males and that observed values of clothing insulation depended on temperature, but also on season and potentially on solar radiation. The overall pattern of clothing choice was well reflected by UTCI, which also provided for good predictions of thermal sensation votes depending on the meteorological conditions. Analysing subgroups indicated that the goodness-of-fit of the UTCI was independent of gender and age, and with only limited influence of season and body composition as assessed by body mass index. This suggests that UTCI can serve as a suitable planning tool for urban thermal comfort in sub-tropical regions.

  16. Lifestyle risk factors predict healthcare costs in an aging cohort.

    PubMed

    Leigh, J Paul; Hubert, Helen B; Romano, Patrick S

    2005-12-01

    While the U.S. elderly population uses a disproportionate amount of healthcare resources, there is limited knowledge from prospective studies regarding the impact of lifestyle-related factors on costs in this group. The association was examined between smoking, drinking, exercise, body mass index (BMI), and changes in these risk factors, and healthcare costs after 4 years among 68- to 95-year-olds. A total of 1323 participants completed annual surveys providing information on lifestyle factors (1986-1994) and health utilization (1994-1998). Healthcare costs in nine categories were ascertained from validated utilization. The relationships between risk factors and costs were examined in 2004 using linear regression models. Fewer cigarette pack-years and lower BMI were the most significant predictors of lower total costs in 1998 (p<0.001), controlling for baseline sociodemographic factors, costs, and conditions. Associations with smoking were strongest for hospitalizations, diagnostic tests, and physician and nursing-home visits. Those who reduced smoking by one pack per day experienced cost savings of 1160 dollars (p<0.05). The costs for normal weight compared to minimally obese seniors were approximately 1548 dollars lower, with diagnostic testing, physician visits, and medications accounting for much of this difference. Daily walking, measured at baseline, also predicted lower costs for hospitalizations and diagnostic testing. Seniors who were leaner, smoked fewer cigarettes over a lifetime, reduced their smoking, or walked farther had significant subsequent cost savings compared to those with less-healthy lifestyle-related habits.

  17. Genomic medicine and risk prediction across the disease spectrum.

    PubMed

    Kotze, Maritha J; Lückhoff, Hilmar K; Peeters, Armand V; Baatjes, Karin; Schoeman, Mardelle; van der Merwe, Lize; Grant, Kathleen A; Fisher, Leslie R; van der Merwe, Nicole; Pretorius, Jacobus; van Velden, David P; Myburgh, Ettienne J; Pienaar, Fredrieka M; van Rensburg, Susan J; Yako, Yandiswa Y; September, Alison V; Moremi, Kelebogile E; Cronje, Frans J; Tiffin, Nicki; Bouwens, Christianne S H; Bezuidenhout, Juanita; Apffelstaedt, Justus P; Hough, F Stephen; Erasmus, Rajiv T; Schneider, Johann W

    2015-01-01

    Genomic medicine is based on the knowledge that virtually every medical condition, disease susceptibility or response to treatment is caused, regulated or influenced by genes. Genetic testing may therefore add value across the disease spectrum, ranging from single-gene disorders with a Mendelian inheritance pattern to complex multi-factorial diseases. The critical factors for genomic risk prediction are to determine: (1) where the genomic footprint of a particular susceptibility or dysfunction resides within this continuum, and (2) to what extent the genetic determinants are modified by environmental exposures. Regarding the small subset of highly penetrant monogenic disorders, a positive family history and early disease onset are mostly sufficient to determine the appropriateness of genetic testing in the index case and to inform pre-symptomatic diagnosis in at-risk family members. In more prevalent polygenic non-communicable diseases (NCDs), the use of appropriate eligibility criteria is required to ensure a balance between benefit and risk. An additional screening step may therefore be necessary to identify individuals most likely to benefit from genetic testing. This need provided the stimulus for the development of a pathology-supported genetic testing (PSGT) service as a new model for the translational implementation of genomic medicine in clinical practice. PSGT is linked to the establishment of a research database proven to be an invaluable resource for the validation of novel and previously described gene-disease associations replicated in the South African population for a broad range of NCDs associated with increased cardio-metabolic risk. The clinical importance of inquiry concerning family history in determining eligibility for personalized genotyping was supported beyond its current limited role in diagnosing or screening for monogenic subtypes of NCDs. With the recent introduction of advanced microarray-based breast cancer subtyping, genetic testing

  18. Spatial distribution of the risk for metabolic complications: an application in south-east Brazil, 2006-2007.

    PubMed

    Nucci, Luciana B; Zangirolani, Lia To; Mafra, Ana Carolina C N; de Medeiros, Maria Angélica T; Cordeiro, Ricardo

    2012-06-01

    To identify spatial variation in the risk for metabolic complications (RMC) by means of a semi-parametric approach for multinomial data. Cross-sectional study. We visited 730 households selected in the first of a two-stage sample in South health district in Campinas, São Paulo, Brazil, 2006-2007. We interviewed 651 individuals and obtained their respective anthropometric measures and geographical coordinates of their house location. They were classified according to a combination of BMI and abdominal circumference as having no risk, increased, high or very high RMC. Gender, age and schooling were associated with RMC. Crude spatial risk for the three levels of RMC in relation to the absence of risk suggested different patterns in each level. Adjusted spatial risk for the RMC showed smaller significant areas, but the pattern remained similar to crude risk. Spatial point analysis with a multinomial approach improves the understanding of differences in RMC found, as we could identify specific areas in which to intervene. The public health significance of these findings may lie in the additional evidence provided that spatial location and its features can influence patterns of RMC.

  19. Undisclosed Human Immunodeficiency Virus Risk Factors Identified through a Computer-based Questionnaire Program among Blood Donors in Brazil

    PubMed Central

    Blatyta, Paula Fraiman; Custer, Brian; Gonçalez, Thelma Terezinha; Birch, Rebecca; Lopes, Maria Esther; Ferreira, Maria Ines Lopes; Proietti, Anna Barbara Carneiro; Sabino, Ester Cerdeira; Page, Kimberly; de Almeida Neto, Cesar

    2013-01-01

    Background HIV risk factor screening among blood donors remains a cornerstone for the safety of blood supply and is dependent on prospective donor self-disclosure and an attentive predonation interview. Residual risk of HIV transmission through blood transfusion is higher in Brazil than in many other countries. Audio computer-assisted structured-interview (ACASI) has been shown to increase self-reporting of risk behaviors. Study design and methods This cross-sectional study was conducted between January 2009 and March 2011 at four Brazilian blood centers to identify the population of HIV-negative eligible blood donors that answered face-to-face interviews without disclosing risks, but subsequently disclosed deferrable risk factors by ACASI. Compared to the donor interview, the ACASI contained expanded content on demographics, sexual behavior and other HIV risk factors questions. Results 901 HIV-negative blood donors were interviewed. On the ACASI, 13% of donors (N=120) declared a risk factor that would have resulted in deferral that was not disclosed during the face-to-face assessment. The main risk factors identified were recent unprotected sex with an unknown or irregular partner (49 donors), sex with a person with exposure to blood/ fluids (26 donors), multiple sexual partners (19 donors), and male-male sexual behavior (10 donors). Independent factors associated with the disclosure of any risk factor for HIV were age (≥40 years vs. 18–25 years, AOR=0.45; 95% CI 0.23–0.88) and blood center (Hemope vs. Hemominas, AOR=2.51; 95% CI 1.42–4.44). Conclusion ACASI elicited increased disclosure of HIV risk factors among blood donors. ACASI may be a valuable modality of interview to be introduced in Brazilian blood banks. PMID:23521083

  20. Scientific reporting is suboptimal for aspects that characterize genetic risk prediction studies: a review of published articles based on the Genetic RIsk Prediction Studies statement.

    PubMed

    Iglesias, Adriana I; Mihaescu, Raluca; Ioannidis, John P A; Khoury, Muin J; Little, Julian; van Duijn, Cornelia M; Janssens, A Cecile J W

    2014-05-01

    Our main objective was to raise awareness of the areas that need improvements in the reporting of genetic risk prediction articles for future publications, based on the Genetic RIsk Prediction Studies (GRIPS) statement. We evaluated studies that developed or validated a prediction model based on multiple DNA variants, using empirical data, and were published in 2010. A data extraction form based on the 25 items of the GRIPS statement was created and piloted. Forty-two studies met our inclusion criteria. Overall, more than half of the evaluated items (34 of 62) were reported in at least 85% of included articles. Seventy-seven percentage of the articles were identified as genetic risk prediction studies through title assessment, but only 31% used the keywords recommended by GRIPS in the title or abstract. Seventy-four percentage mentioned which allele was the risk variant. Overall, only 10% of the articles reported all essential items needed to perform external validation of the risk model. Completeness of reporting in genetic risk prediction studies is adequate for general elements of study design but is suboptimal for several aspects that characterize genetic risk prediction studies such as description of the model construction. Improvements in the transparency of reporting of these aspects would facilitate the identification, replication, and application of genetic risk prediction models. Copyright © 2014 Elsevier Inc. All rights reserved.

  1. Predicting Risk of Endovascular Device Infection in Patients with Staphylococcus aureus Bacteremia (PREDICT-SAB)

    PubMed Central

    Sohail, M. Rizwan; Palraj, Bharath Raj; Khalid, Sana; Uslan, Daniel Z.; Al-Saffar, Farah; Friedman, Paul A.; Hayes, David L.; Lohse, Christine M.; Wilson, Walter R.; Steckelberg, James M.; Baddour, Larry M.

    2014-01-01

    Background Prompt recognition of underlying cardiovascular implantable electronic device (CIED) infection in patients presenting with S. aureus bacteremia (SAB) is critical for optimal management of these cases. The goal of this study was to identify clinical predictors of CIED infection in patients presenting with SAB and no signs of pocket infection. Methods and Results All cases of SAB in CIED recipients at Mayo Clinic from 2001 to 2011 were retrospectively reviewed. We identified 131 patients with CIED who presented with SAB and had no clinical signs of device pocket infection. Forty-five (34%) of these patients had underlying CIED infection based on clinical and/or echocardiographic criteria. The presence of a permanent pacemaker rather than an implantable cardioverter-defibrillator (OR 3.90, 95% CI 1.65–9.23), P=0.002), >1 device-related procedure (OR 3.30, 95% CI 1.23–8.86, P=0.018), and duration of SAB ≥4 days (OR 5.54, 95% CI 3.32–13.23, P<0.001) were independently associated with an increased risk of CIED infection in a multivariable model. The area under the receiver operating characteristics curve (AUC) for the multivariable model was 0.79, indicating a good discriminatory capacity to distinguish SAB patients with and without CIED infection. Conclusions Among patients presenting with SAB and no signs of pocket infection, the risk of underlying CIED infection can be calculated based on the type of device, number of device-related procedures, and duration of SAB. We propose that patients without any of these high-risk features have a very low risk of underlying CIED infection and may be monitored closely without immediate device extraction. Prospective studies are needed to validate this risk prediction model. PMID:25504648

  2. Predicting risk of endovascular device infection in patients with Staphylococcus aureus bacteremia (PREDICT-SAB).

    PubMed

    Sohail, M Rizwan; Palraj, Bharath Raj; Khalid, Sana; Uslan, Daniel Z; Al-Saffar, Farah; Friedman, Paul A; Hayes, David L; Lohse, Christine M; Wilson, Walter R; Steckelberg, James M; Baddour, Larry M

    2015-02-01

    Prompt recognition of underlying cardiovascular implantable electronic device (CIED) infection in patients presenting with Staphylococcus aureus bacteremia (SAB) is critical for optimal management of these cases. The goal of this study was to identify clinical predictors of CIED infection in patients presenting with SAB and no signs of pocket infection. All cases of SAB in CIED recipients at Mayo Clinic from 2001 to 2011 were retrospectively reviewed. We identified 131 patients with CIED who presented with SAB and had no clinical signs of device pocket infection. Forty-five (34%) of these patients had underlying CIED infection based on clinical or echocardiographic criteria. The presence of a permanent pacemaker rather than an implantable cardioverter-defibrillator (odds ratio, 3.90; 95% confidence interval, 1.65-9.23; P=0.002), >1 device-related procedure (odds ratio, 3.30; 95% confidence interval, 1.23-8.86; P=0.018), and duration of SAB ≥4 days (odds ratio, 5.54; 95% confidence interval, 3.32-13.23; P<0.001) were independently associated with an increased risk of CIED infection in a multivariable model. The area under the receiver operating characteristics curve for the multivariable model was 0.79, indicating a good discriminatory capacity to distinguish SAB patients with and without CIED infection. Among patients presenting with SAB and no signs of pocket infection, the risk of underlying CIED infection can be calculated based on the type of device, number of device-related procedures, and duration of SAB. We propose that patients without any of these high-risk features have a low risk of underlying CIED infection and may be monitored closely without immediate device extraction. Prospective studies are needed to validate this risk prediction model. © 2014 American Heart Association, Inc.

  3. Is More Better? Combining Actuarial Risk Scales to Predict Recidivism among Adult Sex Offenders

    ERIC Educational Resources Information Center

    Seto, Michael C.

    2005-01-01

    The present study was conducted to determine whether combining the results of multiple actuarial risk scales increases accuracy in predicting sex offender recidivism. Multiple methods of combining 4 validated actuarial risk scales--the Violence Risk Appraisal Guide, the Sex Offender Risk Appraisal Guide, the Rapid Risk Assessment for Sexual…

  4. Case-control study evaluating the sow's risk factors associated with stillbirth piglets in Midwestern in Brazil.

    PubMed

    Silva, Gustavo Sousa; da Costa Lana, Marconni Victor; Dias, Geovanny Bruno Gonçalves; da Cruz, Raquel Aparecida Sales; Lopes, Leticya Lerner; Machado, Gustavo; Corbellini, Luis Gustavo; Gava, Danielle; Souza, Marcos Almeida; Pescador, Caroline Argenta

    2015-02-01

    Reproductive failure in swine herds is often difficult to diagnose and is important to swine production. The present study aims to identify the potential risk factors (infectious/noninfectious) for stillborn piglets in two commercial swine farms situated in midwestern region of Brazil. The potential risk factors were included in a multivariable logistic model, and the dependent variable was defined as the presence of at least one stillborn piglet in a given litter (yes or no). In the best fit model, two variables from the multivariable analysis, total litter size (p = 0.01), and average birth weight (p = 0.03) were significantly associated with the presence of stillborn piglets at the farms examined in this study. Porcine circovirus type 2 (PCV2) was detected in 29.1 % of the litters. Neither parvovirus (PPV) nor leptospirosis infections were identified in this study, suggesting that they have a minor impact on reproductive disease.

  5. Antibodies to Leptospira interrogans in goats and risk factors of the disease in Santa Catarina (West side), Brazil.

    PubMed

    Topazio, Josué; Tonin, Alexandre A; Machado, Gustavo; Noll, Jessica C G; Ribeiro, André; Moura, Anderson B; Carmo, Guilherme M; Grosskopf, Hyolanda M; Martins, Jorge L R; Badke, Manoel R T; Stefani, Lenita M; Lopes, Leandro S; Da Silva, Aleksandro S

    2015-04-01

    Leptospirosis is an infectious disease caused by the bacterium Leptospira spp. In goats, the productive impact of leptospirosis is not well known and totally unknown in Santa Catarina (SC), Brazil. This study aimed to investigate leptospirosis seroprevalence and its risk factors in goats in the west side of SC. A total of 654 blood samples were analyzed using the microscopic agglutination technique and 35.47% (232) of the animals were seropositives. Except for serogroup Autumnalis, positive samples for all other serogroups were found as follows: Sejroe (Hardjo, Wolffi), Grippotyphosa (Grippotyphosa), Canicola (Canicola), Icterohaemorrhagiae (Icterohaemorrhagiae, Copenhageni), Australis (Australis, Bratislava) and Pomona (Pomona). The contact among sheep and goats, and the addition of concentrate as food supplement were found to be risk factors for leptospirosis. Based on these results, we conclude that there is a high occurrence of anti-Leptospira antibodies in goats in the Western part of Santa Catarina State. Copyright © 2015 Elsevier Ltd. All rights reserved.

  6. Perceived Mental Illness Stigma and HIV Risk Behaviors Among Adult Psychiatric Outpatients in Rio de Janeiro, Brazil

    PubMed Central

    Elkington, Katherine S.; McKinnon, Karen; Mann, Claudio Gruber; Collins, Pamela Y.; Leu, Cheng-Shiun; Wainberg, Milton L.

    2009-01-01

    We examined the associations between perceived mental illness stigma and HIV risk and protective behaviors among adults with severe mental illness (SMI) in Rio de Janeiro, Brazil. We measured mental illness stigma across three domains (“Personal Experiences,” “Perceived Attractiveness,” and “Relationship Discrimination”), and examined the relationship between experiences of stigma in each domain and HIV risk and protective behaviors over the past three months in 98 outpatients with SMI. Those who reported greater “Relationship Discrimination” stigma were significantly more likely to be sexually active and to have unprotected sex; they were significantly less likely to report deliberately having fewer partners as a way to protect themselves from HIV. The role of stigma in unprotected sexual behavior should be examined further and considered in any HIV prevention intervention for people with SMI. PMID:19543974

  7. Genetic risk prediction and neurobiological understanding of alcoholism.

    PubMed

    Levey, D F; Le-Niculescu, H; Frank, J; Ayalew, M; Jain, N; Kirlin, B; Learman, R; Winiger, E; Rodd, Z; Shekhar, A; Schork, N; Kiefer, F; Kiefe, F; Wodarz, N; Müller-Myhsok, B; Dahmen, N; Nöthen, M; Sherva, R; Farrer, L; Smith, A H; Kranzler, H R; Rietschel, M; Gelernter, J; Niculescu, A B

    2014-05-20

    We have used a translational Convergent Functional Genomics (CFG) approach to discover genes involved in alcoholism, by gene-level integration of genome-wide association study (GWAS) data from a German alcohol dependence cohort with other genetic and gene expression data, from human and animal model studies, similar to our previous work in bipolar disorder and schizophrenia. A panel of all the nominally significant P-value SNPs in the top candidate genes discovered by CFG  (n=135 genes, 713 SNPs) was used to generate a genetic  risk prediction score (GRPS), which showed a trend towards significance (P=0.053) in separating  alcohol dependent individuals from controls in an independent German test cohort. We then validated and prioritized our top findings from this discovery work, and subsequently tested them in three independent cohorts, from two continents. A panel of all the nominally significant P-value single-nucleotide length polymorphisms (SNPs) in the top candidate genes discovered by CFG (n=135 genes, 713 SNPs) were used to generate a Genetic Risk Prediction Score (GRPS), which showed a trend towards significance (P=0.053) in separating alcohol-dependent individuals from controls in an independent German test cohort. In order to validate and prioritize the key genes that drive behavior without some of the pleiotropic environmental confounds present in humans, we used a stress-reactive animal model of alcoholism developed by our group, the D-box binding protein (DBP) knockout mouse, consistent with the surfeit of stress theory of addiction proposed by Koob and colleagues. A much smaller panel (n=11 genes, 66 SNPs) of the top CFG-discovered genes for alcoholism, cross-validated and prioritized by this stress-reactive animal model showed better predictive ability in the independent German test cohort (P=0.041). The top CFG scoring gene for alcoholism from the initial discovery step, synuclein alpha (SNCA) remained the top gene after the stress

  8. A New Method to Predict the Epidemiology of Fungal Keratitis by Monitoring the Sales Distribution of Antifungal Eye Drops in Brazil

    PubMed Central

    Ibrahim, Marlon Moraes; de Angelis, Rafael; Lima, Acacio Souza; Viana de Carvalho, Glauco Dreyer; Ibrahim, Fuad Moraes; Malki, Leonardo Tannus; de Paula Bichuete, Marina; de Paula Martins, Wellington; Rocha, Eduardo Melani

    2012-01-01

    Purpose Fungi are a major cause of keratitis, although few medications are licensed for their treatment. The aim of this study is to observe the variation in commercialisation of antifungal eye drops, and to predict the seasonal distribution of fungal keratitis in Brazil. Methods Data from a retrospective study of antifungal eye drops sales from the only pharmaceutical ophthalmologic laboratory, authorized to dispense them in Brazil (Opthalmos) were gathered. These data were correlated with geographic and seasonal distribution of fungal keratitis in Brazil between July 2002 and June 2008. Results A total of 26,087 antifungal eye drop units were sold, with a mean of 2.3 per patient. There was significant variation in antifungal sales during the year (p<0.01). A linear regression model displayed a significant association between reduced relative humidity and antifungal drug sales (R2 = 0.17,p<0.01). Conclusions Antifungal eye drops sales suggest that there is a seasonal distribution of fungal keratitis. A possible interpretation is that the third quarter of the year (a period when the climate is drier), when agricultural activity is more intense in Brazil, suggests a correlation with a higher incidence of fungal keratitis. A similar model could be applied to other diseases, that are managed with unique, or few, and monitorable medications to predict epidemiological aspects. PMID:22457787

  9. Iron Status Predicts Malaria Risk in Malawian Preschool Children

    PubMed Central

    Jonker, Femkje A. M.; Calis, Job C. J.; van Hensbroek, Michael Boele; Phiri, Kamija; Geskus, Ronald B.; Brabin, Bernard J.; Leenstra, Tjalling

    2012-01-01

    Introduction Iron deficiency is highly prevalent in pre-school children in developing countries and an important health problem in sub-Saharan Africa. A debate exists on the possible protective effect of iron deficiency against malaria and other infections; yet consensus is lacking due to limited data. Recent studies have focused on the risks of iron supplementation but the effect of an individual's iron status on malaria risk remains unclear. Studies of iron status in areas with a high burden of infections often are exposed to bias. The aim of this study was to assess the predictive value of baseline iron status for malaria risk explicitly taking potential biases into account. Methods and materials We prospectively assessed the relationship between baseline iron deficiency (serum ferritin <30 µg/L) and malaria risk in a cohort of 727 Malawian preschool children during a year of follow-up. Data were analyzed using marginal structural Cox regression models and confounders were selected using causal graph theory. Sensitivity of results to bias resulting from misclassification of iron status by concurrent inflammation and to bias from unmeasured confounding were assessed using modern causal inference methods. Results and Conclusions The overall incidence of malaria parasitemia and clinical malaria was 1.9 (95% CI 1.8–2.0) and 0.7 (95% CI 0.6–0.8) events per person-year, respectively. Children with iron deficiency at baseline had a lower incidence of malaria parasitemia and clinical malaria during a year of follow-up; adjusted hazard ratio's 0.55 (95%-CI:0.41–0.74) and 0.49 (95%-CI:0.33–0.73), respectively. Our results suggest that iron deficiency protects against malaria parasitemia and clinical malaria in young children. Therefore the clinical importance of treating iron deficiency in a pre-school child should be weighed carefully against potential harms. In malaria endemic areas treatment of iron deficiency in children requires sustained prevention of

  10. Predicting carbon dynamics in integrated production systems in Brazil using the CQESTR model

    USDA-ARS?s Scientific Manuscript database

    Process-based carbon models are research tools to predict management impact on soil organic carbon (SOC) and options to increase SOC stocks and reduce CO2. The CQESTR model was used to examine the effect of soil management practices, including integrated crop-livestock system (iCLS), and various sc...

  11. Risk assessment tools used to predict outcomes of total hip and total knee arthroplasty.

    PubMed

    Konopka, Joseph F; Hansen, Viktor J; Rubash, Harry E; Freiberg, Andrew A

    2015-07-01

    This article reviews recently proposed clinical tools for predicting risks and outcomes in total hip arthroplasty and total knee arthroplasty patients. Additionally, we share the Massachusetts General Hospital experience with using the Risk Assessment and Prediction Tool to predict the need for an extended care facility after total joint arthroplasty.

  12. Reproductive risk factors differ among breast cancer patients and controls in a public hospital of Paraiba, northeast Brazil.

    PubMed

    Sarmento de Almeida, Gibran; Leal Almeida, Layze Amanda; Rodrigues Araujo, Gilmara Marques; Weller, Mathias

    2015-01-01

    The incidence and mortality rates of breast cancer in Northeast Brazil are increasing and little is known about prevailing reproductive factors contributing to this increase. A case-control study was conducted in a public hospital of Campina Grande, state of Paraiba, including 81 women with diagnosed invasive breast cancer and 162 age matched (±5 years) controls. Binominal logistic regression analysis was applied to estimate odds ratio (OR) and confidence intervals (CI) of risk factors. In this model, age at menarche≤12 (OR=2.120; CI: 1.043-4.308; p=0.038), single parity (OR=3.748; CI: 1.459- 9.627; p=0.06) and reproductive period>10 years (OR=3.042; CI: 1.421- 6.512; p=0.04) were identified as independent variables that significantly increased breast cancer risk of parous women. Compared to parous women who never practised breastfeeding, total breastfeeding time>24 months decreased the risk of breast cancer (OR=0.258; CI: 0.084- 0.787; p=0.017). The results indicated that modifiable reproductive factors contribute to breast cancer risk in women included in the present study. Women's knowledge about factors such as the protective effect of breastfeeding could reduce the risk of breast cancer.

  13. [FIBRA-RJ Network: frailty and risk of hospitalization in the elderly in Rio de Janeiro, Brazil].

    PubMed

    Perez, Mariangela; Lourenço, Roberto Alves

    2013-07-01

    The objective of this study was to determine the risk profile and factors associated with frailty in elderly community residents. The population consisted of individuals 65 years or older living in the northern districts of the city of Rio de Janeiro, Brazil, and who held private health insurance policies. The cross-sectional study was done at baseline in a cohort with a sample (N = 764) stratified by gender and age. Risk stratification used probability of repeated admissions (PRA) as the screening instrument. Following bivariate analyses, logistic regression analyses were performed to study associations between probability of repeated admissions and socio-demographic, health-status, functional, and cognitive variables. Of the total sample, 6.7% were classified as high risk. Cancer, falls, chronic obstructive pulmonary disease, use of medication, receiving a visit from a health professional, being bedridden at home, living alone, and level of activities of daily living were statistically associated with risk of hospitalization. The instrument appeared to be useful for stratifying risk in the elderly.

  14. [Temporary workers' perceptions of occupational risks in the port of Rio Grande, Rio Grande do Sul State, Brazil].

    PubMed

    Soares, Jorgana Fernanda de Souza; Cezar-Vaz, Marta Regina; Mendoza-Sassi, Raul Andrés; Almeida, Tabajara Lucas de; Muccillo-Baisch, Ana Luiza; Soares, Maria Cristina Flores; Costa, Valdecir Zavarese da

    2008-06-01

    This was a cross-sectional, descriptive, quantitative study in the port of Rio Grande, Rio Grande do Sul, Brazil, aimed at identifying occupational risk perceptions in a sample of 306 temporary dockworkers. Most temporary dockworkers (93.46%) acknowledged the existence of health risks on the job, independently of schooling (p = 0.44) and job activity (p = 0.47). Risks identified by temporary workers as a whole included falling of suspended objects (8.43 +/- 2.47), noise (8.06 +/- 2.32), and bad weather conditions (8.05 +/- 2.48). Risks that varied significantly between jobs were: noise (p = 0.00), lifting loads manually (p = 0.00), work tools (p = 0,00), insufficient number of work team members (p = 0.03), extra wages based on productivity (p = 0.00), work pace (p = 0.01), working on scaffolding and other high areas (p = 0.00), workers moving on top of cargo (p = 0.00), and ship's ladders and gangways (p = 0.00). The study corroborated that temporary dock work is unhealthy and hazardous, and that the risks affect workers according to the specific jobs they perform.

  15. Novelty seeking is related to individual risk preference and brain activation associated with risk prediction during decision making

    PubMed Central

    Wang, Ying; Liu, Ying; Yang, Lizhuang; Gu, Feng; Li, Xiaoming; Zha, Rujing; Wei, Zhengde; Pei, Yakun; Zhang, Peng; Zhou, Yifeng; Zhang, Xiaochu

    2015-01-01

    Novelty seeking (NS) is a personality trait reflecting excitement in response to novel stimuli. High NS is usually a predictor of risky behaviour such as drug abuse. However, the relationships between NS and risk-related cognitive processes, including individual risk preference and the brain activation associated with risk prediction, remain elusive. In this fMRI study, participants completed the Tridimensional Personality Questionnaire to measure NS and performed a probabilistic decision making task. Using a mathematical model, we estimated individual risk preference. Brain regions associated with risk prediction were determined via fMRI. The NS score showed a positive correlation with risk preference and a negative correlation with the activation elicited by risk prediction in the right posterior insula (r-PI), left anterior insula (l-AI), right striatum (r-striatum) and supplementary motor area (SMA). Within these brain regions, only the activation associated with risk prediction in the r-PI showed a correlation with NS after controlling for the effect of risk preference. Resting-state functional connectivity between the r-PI and r-striatum/l-AI was negatively correlated with NS. Our results suggest that high NS may be associated with less aversion to risk and that the r-PI plays an important role in relating risk prediction to NS. PMID:26065910

  16. Serum Irisin Predicts Mortality Risk in Acute Heart Failure Patients.

    PubMed

    Shen, Shutong; Gao, Rongrong; Bei, Yihua; Li, Jin; Zhang, Haifeng; Zhou, Yanli; Yao, Wenming; Xu, Dongjie; Zhou, Fang; Jin, Mengchao; Wei, Siqi; Wang, Kai; Xu, Xuejuan; Li, Yongqin; Xiao, Junjie; Li, Xinli

    2017-01-01

    Irisin is a peptide hormone cleaved from a plasma membrane protein fibronectin type III domain containing protein 5 (FNDC5). Emerging studies have indicated association between serum irisin and many major chronic diseases including cardiovascular diseases. However, the role of serum irisin as a predictor for mortality risk in acute heart failure (AHF) patients is not clear. AHF patients were enrolled and serum was collected at the admission and all patients were followed up for 1 year. Enzyme-linked immunosorbent assay was used to measure serum irisin levels. To explore predictors for AHF mortality, the univariate and multivariate logistic regression analysis, and receiver-operator characteristic (ROC) curve analysis were used. To determine the role of serum irisin levels in predicting survival, Kaplan-Meier survival analysis was used. In this study, 161 AHF patients were enrolled and serum irisin level was found to be significantly higher in patients deceased in 1-year follow-up. The univariate logistic regression analysis identified 18 variables associated with all-cause mortality in AHF patients, while the multivariate logistic regression analysis identified 2 variables namely blood urea nitrogen and serum irisin. ROC curve analysis indicated that blood urea nitrogen and the most commonly used biomarker, NT-pro-BNP, displayed poor prognostic value for AHF (AUCs ≤ 0.700) compared to serum irisin (AUC = 0.753). Kaplan-Meier survival analysis demonstrated that AHF patients with higher serum irisin had significantly higher mortality (P<0.001). Collectively, our study identified serum irisin as a predictive biomarker for 1-year all-cause mortality in AHF patients though large multicenter studies are highly needed. © 2017 The Author(s). Published by S. Karger AG, Basel.

  17. Childhood trauma and suicide risk in a sample of young individuals aged 14-35 years in southern Brazil.

    PubMed

    Barbosa, Luana Porto; Quevedo, Luciana; da Silva, Giovanna Del Grande; Jansen, Karen; Pinheiro, Ricardo Tavares; Branco, Jerônimo; Lara, Diogo; Oses, Jean; da Silva, Ricardo Azevedo

    2014-07-01

    Suicide is among the main causes of death of people aged between 15 and 44 years old. Childhood trauma is an important risk factor for suicide. Hence, the objective of this study was to verify the relationship between childhood trauma and current suicide risk (suicidal behavior and ideation) in individuals aged 14-35 years, in the city of Pelotas, Brazil. This is a cross-sectional, population-based study. Sample selection was performed by clusters. Suicide risk was evaluated using the Mini International Neuropsychiatric Interview (MINI) and Childhood trauma was assessed with the Childhood Trauma Questionnaire (CTQ). Moreover, the participants responded to a questionnaire concerning socioeconomic status, work, and substance use. The sample was composed of 1,380 individuals. The prevalence of suicide risk was 11.5%. The prevalence figures of childhood trauma were 15.2% (emotional neglect), 13.5% (physical neglect), 7.6% (sexual abuse), 10.1% (physical abuse), and 13.8% (emotional abuse). Suicide risk was associated (p<.001) with gender, work, alcohol abuse, tobacco use, and all types of childhood trauma. The odds of suicide risk were higher in women (OR=1.8), people who were not currently working (OR=2.3), individuals who presented alcohol abuse (OR=2.6), and among tobacco smokers (OR=3.4). Moreover, suicide risk was increased in all types of trauma: emotional neglect (OR=3.7), physical neglect (OR=2.8), sexual abuse (OR=3.4), physical abuse (OR=3.1), and emotional abuse (OR=6.6). Thus, preventing early trauma may reduce suicide risk in young individuals. Copyright © 2014 Elsevier Ltd. All rights reserved.

  18. Age and regional differences in clinical presentation and risk of hospitalization for dengue in Brazil, 2000-2014

    PubMed Central

    Burattini, Marcelo N.; Lopez, Luis F.; Coutinho, Francisco A.B.; Siqueira, João B.; Homsani, Sheila; Sarti, Elsa; Massad, Eduardo

    2016-01-01

    OBJECTIVES: Dengue cases range from asymptomatic to severe, eventually leading to hospitalization and death. Timely and appropriate management is critical to reduce morbidity. Since 1980, dengue has spread throughout Brazil, affecting an increasing number of individuals. This paper describes age and regional differences in dengue’s clinical presentation and associated risk of hospitalization based on more than 5 million cases reported to the Brazilian Ministry of Health from 2000-2014. METHODS: We performed a retrospective analysis of ∼5,450,000 dengue cases, relating clinical manifestations and the risk of hospitalization to age, gender, previous infection by dengue, dengue virus serotype, years of formal education, delay to first attendance and the occurrence of dengue during outbreaks and in different Brazilian regions. RESULTS: Complicated forms of dengue occurred more frequently among those younger than 10 years (3.12% vs 1.92%) and those with dengue virus 2 infection (7.65% vs 2.42%), with a delay to first attendance >2 days (3.18% vs 0.82%) and with ≤4 years of formal education (2.02% vs 1.46%). The risk of hospitalization was higher among those aged 6-10 years old (OR 4.57; 95% CI 1.43-29.96) and those who were infected by dengue virus 2 (OR 6.36; 95% CI 2.52-16.06), who lived in the Northeast region (OR 1.38; 95% CI 1.11-2.10) and who delayed first attendance by >5 days (composite OR 3.15; 95% CI 1.33-8.9). CONCLUSIONS: In Brazil, the occurrence of severe dengue and related hospitalization is associated with being younger than 10 years old, being infected by dengue virus 2 or 3, living in the Northeast region (the poorest and the second most populated) and delaying first attendance for more than 2 days. PMID:27626476

  19. Development and validation of a cardiovascular risk prediction model for Japanese: the Hisayama study.

    PubMed

    Arima, Hisatomi; Yonemoto, Koji; Doi, Yasufumi; Ninomiya, Toshiharu; Hata, Jun; Tanizaki, Yumihiro; Fukuhara, Masayo; Matsumura, Kiyoshi; Iida, Mitsuo; Kiyohara, Yutaka

    2009-12-01

    The objective of this paper is to develop a new risk prediction model of cardiovascular disease and to validate its performance in a general population of Japanese. The Hisayama study is a population-based prospective cohort study. A total of 2634 participants aged 40 years or older were followed up for 14 years for incident cardiovascular disease (stroke and coronary heart disease (myocardial infarction, coronary revascularization and sudden cardiac death)). We used data among a random two-thirds (the derivation cohort, n=1756) to develop a new risk prediction model that was then tested to compare observed and predicted outcomes in the remaining one-third (the validation cohort, n=878). A multivariable cardiovascular risk prediction model was developed that incorporated age, sex, systolic blood pressure, diabetes, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol and smoking. We assessed the performance of the model for predicting individual cardiovascular event among the validation cohort. The risk prediction model demonstrated good discrimination (c-statistic=0.81; 95% confidence interval, 0.77 to 0.86) and calibration (Hosmer-Lemeshow chi(2)-statistic=6.46; P=0.60). A simple risk score sheet based on the cardiovascular risk prediction model was also presented. We developed and validated a new cardiovascular risk prediction model in a general population of Japanese. The risk prediction model would provide a useful guide to estimate absolute risk of cardiovascular disease and to treat individual risk factors.

  20. Risk prediction of pulmonary tuberculosis using genetic and conventional risk factors in adult Korean population

    PubMed Central

    Hong, Eun Pyo; Go, Min Jin; Kim, Hyung-Lae

    2017-01-01

    A complex interplay among host, pathogen, and environmental factors is believed to contribute to the risk of developing pulmonary tuberculosis (PTB). The lack of replication of published genome-wide association study (GWAS) findings limits the clinical utility of reported single nucleotide polymorphisms (SNPs). We conducted a GWAS using 467 PTB cases and 1,313 healthy controls obtained from two community-based cohorts in Korea. We evaluated the performance of PTB risk models based on different combinations of genetic and nongenetic factors and validated the results in an independent Korean population comprised of 179 PTB cases and 500 healthy controls. We demonstrated the polygenic nature of PTB and nongenetic factors such as age, sex, and body mass index (BMI) were strongly associated with PTB risk. None of the SNPs achieved genome-wide significance; instead, we were able to replicate the associations between PTB and ten SNPs near or in the genes, CDCA7, GBE1, GADL1, SPATA16, C6orf118, KIAA1432, DMRT2, CTR9, CCDC67, and CDH13, which may play roles in the immune and inflammatory pathways. Among the replicated SNPs, an intergenic SNP, rs9365798, located downstream of the C6orf118 gene showed the most significant association under the dominant model (OR = 1.59, 95% CI 1.32–1.92, P = 2.1×10−6). The performance of a risk model combining the effects of ten replicated SNPs and six nongenetic factors (i.e., age, sex, BMI, cigarette smoking, systolic blood pressure, and hemoglobin) were validated in the replication set (AUC = 0.80, 95% CI 0.76–0.84). The strategy of combining genetic and nongenetic risk factors ultimately resulted in better risk prediction for PTB in the adult Korean population. PMID:28355295

  1. Risk prediction for myocardial infarction via generalized functional regression models.

    PubMed

    Ieva, Francesca; Paganoni, Anna M

    2016-08-01

    In this paper, we propose a generalized functional linear regression model for a binary outcome indicating the presence/absence of a cardiac disease with multivariate functional data among the relevant predictors. In particular, the motivating aim is the analysis of electrocardiographic traces of patients whose pre-hospital electrocardiogram (ECG) has been sent to 118 Dispatch Center of Milan (the Italian free-toll number for emergencies) by life support personnel of the basic rescue units. The statistical analysis starts with a preprocessing of ECGs treated as multivariate functional data. The signals are reconstructed from noisy observations. The biological variability is then removed by a nonlinear registration procedure based on landmarks. Thus, in order to perform a data-driven dimensional reduction, a multivariate functional principal component analysis is carried out on the variance-covariance matrix of the reconstructed and registered ECGs and their first derivatives. We use the scores of the Principal Components decomposition as covariates in a generalized linear model to predict the presence of the disease in a new patient. Hence, a new semi-automatic diagnostic procedure is proposed to estimate the risk of infarction (in the case of interest, the probability of being affected by Left Bundle Brunch Block). The performance of this classification method is evaluated and compared with other methods proposed in literature. Finally, the robustness of the procedure is checked via leave-j-out techniques.

  2. Variability, Predictability, and Risk in the Alaskan Arctic Waters

    NASA Astrophysics Data System (ADS)

    Arbetter, T. E.; Goldstein, M. A.; Lynch, A. H.

    2015-12-01

    Summer sea ice extent in the Arctic has been in decline since 1996, but after successive record September minimums in 2005, 2007, and 2012, the possibility of developing the high Arctic has rapidly changed from something decades away to an imminent opportunity. The Obama administration permitted Royal Dutch Shell to conduct exploratory oil drilling in the Chukchi Sea in summer 2015. If successful, further development will follow. The Bering Strait, as the exit of the Northern Sea Route, has already seen increased ship traffic, and this will likely continue if the sea ice remains reliably low. While not the only factor, predictability of sea ice extent, particularly on seasonal scales (3-12 months), is essential; a wrong decision will be costly if not catastrophic (e.g, Kulluk 2012). Using a reduced form model, we investigate geophysical processes which govern the advance and retreat of the sea ice edge at key points (e.g., Nome, Kotzebue, Barrow, Prudhoe Bay). Using the Black-Scholes Option Pricing formula, we estimate costs and risks associated with the ice edge variability.

  3. Interpreting incremental value of markers added to risk prediction models.

    PubMed

    Pencina, Michael J; D'Agostino, Ralph B; Pencina, Karol M; Janssens, A Cecile J W; Greenland, Philip

    2012-09-15

    The discrimination of a risk prediction model measures that model's ability to distinguish between subjects with and without events. The area under the receiver operating characteristic curve (AUC) is a popular measure of discrimination. However, the AUC has recently been criticized for its insensitivity in model comparisons in which the baseline model has performed well. Thus, 2 other measures have been proposed to capture improvement in discrimination for nested models: the integrated discrimination improvement and the continuous net reclassification improvement. In the present study, the authors use mathematical relations and numerical simulations to quantify the improvement in discrimination offered by candidate markers of different strengths as measured by their effect sizes. They demonstrate that the increase in the AUC depends on the strength of the baseline model, which is true to a lesser degree for the integrated discrimination improvement. On the other hand, the continuous net reclassification improvement depends only on the effect size of the candidate variable and its correlation with other predictors. These measures are illustrated using the Framingham model for incident atrial fibrillation. The authors conclude that the increase in the AUC, integrated discrimination improvement, and net reclassification improvement offer complementary information and thus recommend reporting all 3 alongside measures characterizing the performance of the final model.

  4. Beyond sensation seeking: affect regulation as a framework for predicting risk-taking behaviors in high-risk sport.

    PubMed

    Castanier, Carole; Le Scanff, Christine; Woodman, Tim

    2010-10-01

    Sensation seeking has been widely studied when investigating individual differences in the propensity for taking risks. However, risk taking can serve many different goals beyond the simple management of physiological arousal. The present study is an investigation of affect self-regulation as a predictor of risk-taking behaviors in high-risk sport. Risk-taking behaviors, negative affectivity, escape self-awareness strategy, and sensation seeking data were obtained from 265 high-risk sportsmen. Moderated hierarchical regression analysis revealed significant main and interaction effects of negative affectivity and escape self-awareness strategy in predicting risk-taking behaviors: high-risk sportsmen's negative affectivity leads them to adopt risk-taking behaviors only if they also use escape self-awareness strategy. Furthermore, the affective model remained significant when controlling for sensation seeking. The present study contributes to an in-depth understanding of risk taking in high-risk sport.

  5. Modifiable risk factors for overweight and obesity in children and adolescents from São Paulo, Brazil

    PubMed Central

    2011-01-01

    Background Brazil is currently experiencing a nutrition transition: the displacement of traditional diets with foods high in saturated fat, sodium, and cholesterol and an increase in sedentary lifestyles. Despite these trends, our understanding of child obesity in Brazil is limited. Thus, the aims of this study were (1) to investigate the current prevalence of overweight and obesity in a large sample of children and adolescents living in São Paulo, Brazil, and (2) to identify the lifestyle behaviors associated with an increased risk of obesity in young Brazilians. Methods A total of 3,397 children and adolescents (1,596 male) aged 7-18 years were randomly selected from 22 schools in São Paulo, Brazil. Participants were classified as normal weight, overweight, or obese based on international age- and sex-specific body mass index thresholds. Selected sociodemographic, physical activity, and nutrition behaviors were assessed via questionnaire. Results Overall, 19.4% of boys and 16.1% of girls were overweight while 8.9% and 4.3% were obese. Two-way analysis of variance revealed that the prevalence of overweight and obesity was significantly higher in boys and in younger children when compared to girls and older children, respectively (P < 0.05 for both). Logistic regression analysis revealed that overweight was associated with more computer usage, parental encouragement to be active, and light soft drink consumption after controlling for differences in sex, age, and parental education (P < 0.05 for all). Conversely, overweight was associated with less active transport to school, eating before sleep, and consumption of breakfast, full-sugar soft drinks, fried food and confectionery (P < 0.05 for all). Conclusions Our results show that obesity in São Paulo children and adolescents has reached a level equivalent to that seen in many developed countries. We have also identified three key modifiable factors related to obesity that may be appropriate targets for future

  6. Modifiable risk factors for overweight and obesity in children and adolescents from São Paulo, Brazil.

    PubMed

    Duncan, Scott; Duncan, Elizabeth K; Fernandes, Romulo A; Buonani, Camila; Bastos, Karolynne D-N; Segatto, Aline F M; Codogno, Jamile S; Gomes, Igor C; Freitas, Ismael F

    2011-07-22

    Brazil is currently experiencing a nutrition transition: the displacement of traditional diets with foods high in saturated fat, sodium, and cholesterol and an increase in sedentary lifestyles. Despite these trends, our understanding of child obesity in Brazil is limited. Thus, the aims of this study were (1) to investigate the current prevalence of overweight and obesity in a large sample of children and adolescents living in São Paulo, Brazil, and (2) to identify the lifestyle behaviors associated with an increased risk of obesity in young Brazilians. A total of 3,397 children and adolescents (1,596 male) aged 7-18 years were randomly selected from 22 schools in São Paulo, Brazil. Participants were classified as normal weight, overweight, or obese based on international age- and sex-specific body mass index thresholds. Selected sociodemographic, physical activity, and nutrition behaviors were assessed via questionnaire. Overall, 19.4% of boys and 16.1% of girls were overweight while 8.9% and 4.3% were obese. Two-way analysis of variance revealed that the prevalence of overweight and obesity was significantly higher in boys and in younger children when compared to girls and older children, respectively (P < 0.05 for both). Logistic regression analysis revealed that overweight was associated with more computer usage, parental encouragement to be active, and light soft drink consumption after controlling for differences in sex, age, and parental education (P < 0.05 for all). Conversely, overweight was associated with less active transport to school, eating before sleep, and consumption of breakfast, full-sugar soft drinks, fried food and confectionery (P < 0.05 for all). Our results show that obesity in São Paulo children and adolescents has reached a level equivalent to that seen in many developed countries. We have also identified three key modifiable factors related to obesity that may be appropriate targets for future intervention in Brazilian youth

  7. Genetic risk prediction and neurobiological understanding of alcoholism

    PubMed Central

    Levey, D F; Le-Niculescu, H; Frank, J; Ayalew, M; Jain, N; Kirlin, B; Learman, R; Winiger, E; Rodd, Z; Shekhar, A; Schork, N; Kiefe, F; Wodarz, N; Müller-Myhsok, B; Dahmen, N; Nöthen, M; Sherva, R; Farrer, L; Smith, A H; Kranzler, H R; Rietschel, M; Gelernter, J; Niculescu, A B

    2014-01-01

    We have used a translational Convergent Functional Genomics (CFG) approach to discover genes involved in alcoholism, by gene-level integration of genome-wide association study (GWAS) data from a German alcohol dependence cohort with other genetic and gene expression data, from human and animal model studies, similar to our previous work in bipolar disorder and schizophrenia. A panel of all the nominally significant P-value SNPs in the top candidate genes discovered by CFG  (n=135 genes, 713 SNPs) was used to generate a genetic  risk prediction score (GRPS), which showed a trend towards significance (P=0.053) in separating  alcohol dependent individuals from controls in an independent German test cohort. We then validated and prioritized our top findings from this discovery work, and subsequently tested them in three independent cohorts, from two continents. In order to validate and prioritize the key genes that drive behavior without some of the pleiotropic environmental confounds present in humans, we used a stress-reactive animal model of alcoholism developed by our group, the D-box binding protein (DBP) knockout mouse, consistent with the surfeit of stress theory of addiction proposed by Koob and colleagues. A much smaller panel (n=11 genes, 66 SNPs) of the top CFG-discovered genes for alcoholism, cross-validated and prioritized by this stress-reactive animal model showed better predictive ability in the independent German test cohort (P=0.041). The top CFG scoring gene for alcoholism from the initial discovery step, synuclein alpha (SNCA) remained the top gene after the stress-reactive animal model cross-validation. We also tested this small panel of genes in two other independent test cohorts from the United States, one with alcohol dependence (P=0.00012) and one with alcohol abuse (a less severe form of alcoholism; P=0.0094). SNCA by itself was able to separate alcoholics from controls in the alcohol-dependent cohort (P=0.000013) and the alcohol abuse

  8. Social deprivation index and lymphatic filariasis: a tool for mapping urban areas at risk in northeastern Brazil.

    PubMed

    Bonfim, Cristine; Aguiar-Santos, Ana Maria; Pedroza, Dinilson; Costa, Tadeu Rodrigues; Portugal, José Luiz; Oliveira, Conceição; Medeiros, Zulma

    2009-09-01

    This paper describes the construction and application of a social deprivation index that was created to explore the relationship between lymphatic filariasis and socioenvironmental variables in the municipality of Jaboatão dos Guararapes, Pernambuco, Brazil, thereby contributing towards identifying priority areas for interventions. This indicator was obtained from principal-component factor analysis. Variables available from the national census representing socioenvironmental conditions, household characteristics and urban services were used. Epidemiological data came from a parasitological survey on lymphatic filariasis. 23 673 individuals were examined and 323 were positive (1.4%). Two factors that together explained 80.61% of the total variance were selected. The social deprivation strata were capable of indicating a risk gradient, with 74.9% of the microfilaremia cases situated in the high-risk stratum. Principal-component factor analysis was shown to be sensitive for selecting indicators associated with the risk of lymphatic filariasis transmission and for detecting areas potentially at risk. The capacity of the social deprivation index for picking up social inequalities qualifies it as a new tool for use in planning interventions aimed at controlling lymphatic filariasis in urban spaces.

  9. Risk factors and prevalence of newborn hearing loss in a private health care system of Porto Velho, Northern Brazil

    PubMed Central

    de Oliveira, Juliana Santos; Rodrigues, Liliane Barbosa; Aurélio, Fernanda Soares; da Silva, Virgínia Braz

    2013-01-01

    OBJECTIVE: To determine the prevalence of hearing loss and to analyze the results of newborn hearing screening and audiological diagnosis in private health care systems. METHODS Cross-sectional and retrospective study in a database of newborn hearing screening performed by a private clinic in neonates born in private hospitals of Porto Velho, Rondônia, Northern Brazil. The screening results, the risk for hearing loss, the risk indicators for hearing loss and the diagnosis were descriptively analyzed. Newborns cared in rooming in with their mothers were compared to those admitted to the Intensive Care Unit regarding risk factors for hearing loss. RESULTS: Among 1,146 (100%) enrolled newborns, 1,064 (92.8%) passed and 82 (7.2%) failed the hearing screening. Among all screened neonates, 1,063 (92.8%) were cared in rooming and 83 (7.2%) needed intensive care; 986 (86.0%) were considered at low risk and 160 (14.0%) at high risk for hearing problems. Of the 160 patients identified as having high risk for hearing loss, 83 (37.7%) were admitted to an hospitalized in the Intensive Care Unit, 76 (34.5%) used ototoxic drugs and 38 (17.2%) had a family history of hearing loss in childhood. Hearing loss was diagnosed in two patients (0.2% of the screened sample). CONCLUSIONS: The prevalence of hearing loss in newborns from private hospitals was two cases per 1,000 evaluated patients. The use of ototoxic drugs, admission to Intensive Care Unit and family history of hearing loss were the most common risk factors for hearing loss in the studied population. PMID:24142311

  10. Ryegrass cv. Lema and guava cv. Paluma biomonitoring suitability for estimating nutritional contamination risks under seasonal climate in Southeastern Brazil.

    PubMed

    Bulbovas, Patricia; Camargo, Carla Z S; Domingos, Marisa

    2015-08-01

    The risks posed by nutrient deposition due to air pollution on ecosystems and their respective services to human beings can be appropriately estimated by bioindicator plants when they are well acclimated to the study region environmental conditions. This assumption encouraged us to comparatively evaluate the accumulation potential of ryegrass cv. Lema and guava cv. Paluma macro and micronutrients. We also indicated the most appropriate species for biomonitoring nutrient contamination risks in tropical areas of Southeastern Brazil, which are characterized by marked dry and wet seasons and complex mixtures of air pollutants from different sources (industries, vehicle traffic and agriculture). The study was conducted in 14 sites with different neighboring land uses, within the Metropolitan Region of Campinas, central-eastern region of São Paulo State. The exposure experiments with ryegrass and guava were consecutively repeated 40 (28 days each) and 12 (84 days each) times, respectively, from Oct/2010 to Sept/2013. Macro and micronutrients were analyzed and background concentrations and enrichment ratios (ER) were estimated to classify the contamination risk within the study region. Significantly higher ER suggested that ryegrass were the most appropriate accumulator species for N, S, Mg, Fe, Mn, Cu and Zn deposition and guava for K, Ca, P and B deposition. Based on these biomonitoring adjustments, we concluded that the nutrient deposition was spatially homogeneous in the study area, but clear seasonality in the contamination risk by nutritional inputs was evidenced. Significantly higher contamination risk by S, Fe, K and B occurred during the dry season and enhanced contamination risk by Mn, Cu and Zn were highlighted during the wet season. Distinctly high contamination risk was estimated for S, Fe and Mn in several exposure experiments.

  11. Improving Disease Prediction by Incorporating Family Disease History in Risk Prediction Models with Large-Scale Genetic Data.

    PubMed

    Gim, Jungsoo; Kim, Wonji; Kwak, Soo Heon; Choi, Hosik; Park, Changyi; Park, Kyong Soo; Kwon, Sunghoon; Park, Taesung; Won, Sungho

    2017-09-12

    Despite the many successes of genome-wide association studies (GWAS), the known susceptibility variants identified by GWAS have modest effect sizes, leading to notable skepticism about the effectiveness of building a risk prediction model from large-scale genetic data. However, in contrast to genetic variants, the family history of diseases has been largely accepted as an important risk factor in clinical diagnosis and risk prediction. Nevertheless, the complicated structures of the family history of diseases have limited their application in clinical practice. Here, we developed a new method that enables incorporation of the general family history of diseases with a liability threshold model, and propose a new analysis strategy for risk prediction with penalized regression analysis that incorporates both large numbers of genetic variants and clinical risk factors. Application of our model to type 2 diabetes (T2D) in the Korean population (1846 cases and 1846 controls) demonstrated that single nucleotide polymorphisms accounted for 32.5% of the variation explained by the predicted risk scores in the test data set, and incorporation of family history led to an additional 6.3% improvement in prediction. Our results illustrate that the family medical history is valuable information on the variation of complex diseases and improves prediction performance. Copyright © 2017, Genetics.

  12. AN APPROACH TO PREDICT RISKS TO WILDLIFE POPULATIONS FROM MERCURY AND OTHER STRESSORS

    EPA Science Inventory

    The U.S. Environmental Protection Agency's National Health and Environmental Effects Research Laboratory (NHEERL) is developing tools for predicting risks of multiple stressors to wildlife populations, which support the development of risk-based protective criteria. NHEERL's res...

  13. Heart Rate Change When Standing Up Might Predict Older Adult's Death Risk

    MedlinePlus

    ... Change When Standing Up Might Predict Older Adult's Death Risk People with slower heart rate recovery had ... they stand up might reveal their risk of death over the next several years, a new study ...

  14. AN APPROACH TO PREDICT RISKS TO WILDLIFE POPULATIONS FROM MERCURY AND OTHER STRESSORS

    EPA Science Inventory

    The U.S. Environmental Protection Agency's National Health and Environmental Effects Research Laboratory (NHEERL) is developing tools for predicting risks of multiple stressors to wildlife populations, which support the development of risk-based protective criteria. NHEERL's res...

  15. Different type 2 diabetes risk assessments predict dissimilar numbers at 'high risk': a retrospective analysis of diabetes risk-assessment tools.

    PubMed

    Gray, Benjamin J; Bracken, Richard M; Turner, Daniel; Morgan, Kerry; Thomas, Michael; Williams, Sally P; Williams, Meurig; Rice, Sam; Stephens, Jeffrey W

    2015-12-01

    Use of a validated risk-assessment tool to identify individuals at high risk of developing type 2 diabetes is currently recommended. It is under-reported, however, whether a different risk tool alters the predicted risk of an individual. This study explored any differences between commonly used validated risk-assessment tools for type 2 diabetes. Cross-sectional analysis of individuals who participated in a workplace-based risk assessment in Carmarthenshire, South Wales. Retrospective analysis of 676 individuals (389 females and 287 males) who participated in a workplace-based diabetes risk-assessment initiative. Ten-year risk of type 2 diabetes was predicted using the validated QDiabetes(®), Leicester Risk Assessment (LRA), FINDRISC, and Cambridge Risk Score (CRS) algorithms. Differences between the risk-assessment tools were apparent following retrospective analysis of individuals. CRS categorised the highest proportion (13.6%) of individuals at 'high risk' followed by FINDRISC (6.6%), QDiabetes (6.1%), and, finally, the LRA was the most conservative risk tool (3.1%). Following further analysis by sex, over one-quarter of males were categorised at high risk using CRS (25.4%), whereas a greater percentage of females were categorised as high risk using FINDRISC (7.8%). The adoption of a different valid risk-assessment tool can alter the predicted risk of an individual and caution should be used to identify those individuals who really are at high risk of type 2 diabetes. © British Journal of General Practice 2015.

  16. Decision-making competence predicts domain-specific risk attitudes

    PubMed Central

    Weller, Joshua A.; Ceschi, Andrea; Randolph, Caleb

    2015-01-01

    Decision-making competence (DMC) reflects individual differences in rational responding across several classic behavioral decision-making tasks. Although it has been associated with real-world risk behavior, less is known about the degree to which DMC contributes to specific components of risk attitudes. Utilizing a psychological risk-return framework, we examined the associations between risk attitudes and DMC. Italian community residents (n = 804) completed an online DMC measure, using a subset of the original Adult-DMC battery. Participants also completed a self-reported risk attitude measure for three components of risk attitudes (risk-taking, risk perceptions, and expected benefits) across six risk domains. Overall, greater performance on the DMC component scales were inversely, albeit modestly, associated with risk-taking tendencies. Structural equation modeling results revealed that DMC was associated with lower perceived expected benefits for all domains. In contrast, its association with perceived risks was more domain-specific. These analyses also revealed stronger indirect effects for the DMC → expected benefits → risk-taking path than the DMC → perceived riskrisk-taking path, especially for behaviors that may be considered more maladaptive in nature. These results suggest that DMC performance differentially impacts specific components of risk attitudes, and may be more strongly related to the evaluation of expected value of a specific behavior. PMID:26029128

  17. 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.

  18. Prevalence and risk factors for cannabis use in low-income pregnant women in São Paulo, Brazil.

    PubMed

    Shu, Janet E; Huang, Hsiang; Menezes, Paulo R; Faisal-Cury, Alexandre

    2016-02-01

    Cannabis is the most commonly used illicit drug during the perinatal period and has potential risks to the fetus. The purpose of this study is to estimate the 1-year prevalence of cannabis use and identify associated factors for a population of low-income pregnant women in Brazil. We performed a cross-sectional analysis of 831 women surveyed using a structured questionnaire to collect sociodemographic, clinical, and substance use history. The 1-year prevalence of antenatal cannabis use was 4.2 %; reported lifetime use was 9.6 %. The presence of a common mental disorder and active tobacco smoking were independently associated with cannabis use, OR = 3.3 (95 % CI 1.65-6.59) and OR = 6.89 (95 % CI 3.45-13.8), respectively.

  19. The link between childhood undernutrition and risk of chronic diseases in adulthood: a case study of Brazil.

    PubMed

    Sawaya, Ana L; Martins, Paula; Hoffman, Daniel; Roberts, Susan B

    2003-05-01

    Obesity, cardiovascular disease, and type 2 diabetes mellitus are now prevalent among adults living in developing countries; these chronic diseases affect socioeconomically disadvantaged adults living in impoverished families with undernourished children. This review summarizes data from Brazil--a developing country undergoing the nutrition transition--suggesting an association between childhood undernutrition and obesity and chronic degenerative disease. Potential mechanisms for the association include long-term effects of childhood undernutrition on energy expenditure, fat oxidation, regulation of food intake, susceptibility to the effects of high-fat diets, and altered insulin sensitivity. The combination of childhood undernutrition and adult chronic degenerative disease results in enormous social and economic burdens for developing countries. Further research is urgently needed to examine the effect of childhood undernutrition on risk of obesity and chronic degenerative diseases; one goal of such research would be to determine and provide low-cost methods for prevention and treatment.

  20. Biological and environmental factors associated with risk of schistosomiasis mansoni transmission in Porto de Galinhas, Pernambuco State, Brazil.

    PubMed

    Leal Neto, Onicio Batista; Gomes, Elainne Christine de Souza; Oliveira Junior, Fernando José Moreira de; Andrade, Rafael; Reis, Diego Leandro; Souza-Santos, Reinaldo; Bocanegra, Silvana; Barbosa, Constança Simões

    2013-02-01

    Schistosomiasis has expanded to the coast of Pernambuco State, Brazil, where there are frequent reports of Biomphalaria glabrata snails and human cases of the disease. This study analyzes factors related to schistosomiasis transmission risk in Porto de Galinhas. A one-year malacological survey was conducted to identify biological, abiotic, and environmental factors related to the host snail breeding sites. Data analysis used Excel 2010, GTM Pro, and ArcGis 10. A total of 11,012 B. glabrata snails were captured in 36 breeding sites, and 11 schistosomiasis transmission foci were identified. A negative correlation was found between breeding site temperature and snail density and infection rate, and a positive correlation with pH and salinity. The rainy season showed a positive correlation with snail density and infection rate. The study emphasizes the factors involved in the maintenance of schistosomiasis breeding sites, in light of persistence of this disease in Porto de Galinhas for more than 10 years.

  1. Landscape risk factors for attacks of vampire bats on cattle in Sao Paulo, Brazil.

    PubMed

    Gomes, Murilo Novaes; Monteiro, Antonio Miguel Vieira; Lewis, Nicola; Gonçalves, Celso Alberto; Filho, Vladimir de Souza Nogueira

    2010-02-01

    Vampire-bat (Desmodus rotundus) attacks on cattle are a major concern for cattle-raising area. Blood loss and paralytic rabies due to bat bites can impose severe losses on the livestock. We took four municipalities inside the Sao Joao da Boa Vista veterinary district (Sao Paulo, Brazil) as a study area and tested a set of landscape features for spatial correlation with distance to areas in which vampire-bat attacks on cattle were documented. Bat- and cattle-related data from the Sao Paulo State Rabies Control Program were used. Landscape data (first-order rivers and their tributaries, main roads, railways and urban areas) were obtained from official cartographic agencies; forest, sugarcane and pasture data were acquired from remote-sensing mappings. The study area was taken as a grid split into 178 cells. Each 4kmx4km cell was filled with bat, cattle and landscape data. Our analysis detected that grid cells that were closer to areas of bat attacks on cattle had higher cattle density and a greater percentage of the land committed to sugarcane cropping, and were close to forest fragments. These results shed light on the need for rethink the Rabies Control Program strategies for defining the surveillance of vampire-bat populations and rabies control in the state of Sao Paulo, Brazil.

  2. Is Food Insecurity Associated with HIV Risk? Cross-Sectional Evidence from Sexually Active Women in Brazil

    PubMed Central

    Tsai, Alexander C.; Hung, Kristin J.; Weiser, Sheri D.

    2012-01-01

    Background Understanding how food insecurity among women gives rise to differential patterning in HIV risks is critical for policy and programming in resource-limited settings. This is particularly the case in Brazil, which has undergone successive changes in the gender and socio-geographic composition of its complex epidemic over the past three decades. We used data from a national survey of Brazilian women to estimate the relationship between food insecurity and HIV risk. Methods and Findings We used data on 12,684 sexually active women from a national survey conducted in Brazil in 2006–2007. Self-reported outcomes were (a) consistent condom use, defined as using a condom at each occasion of sexual intercourse in the previous 12 mo; (b) recent condom use, less stringently defined as using a condom with the most recent sexual partner; and (c) itchy vaginal discharge in the previous 30 d, possibly indicating presence of a sexually transmitted infection. The primary explanatory variable of interest was food insecurity, measured using the culturally adapted and validated Escala Brasiliera de Segurança Alimentar. In multivariable logistic regression models, severe food insecurity with hunger was associated with a reduced odds of consistent condom use in the past 12 mo (adjusted odds ratio [AOR] = 0.67; 95% CI, 0.48–0.92) and condom use at last sexual intercourse (AOR = 0.75; 95% CI, 0.57–0.98). Self-reported itchy vaginal discharge was associated with all categories of food insecurity (with AORs ranging from 1.46 to 1.94). In absolute terms, the effect sizes were large in magnitude across all outcomes. Underweight and/or lack of control in sexual relations did not appear to mediate the observed associations. Conclusions Severe food insecurity with hunger was associated with reduced odds of condom use and increased odds of itchy vaginal discharge, which is potentially indicative of sexually transmitted infection, among sexually active women in Brazil

  3. Does albuminuria predict renal risk and/or cardiovascular risk in obese type 2 diabetic patients?

    PubMed Central

    Bentata, Yassamine; Abouqal, Redouane

    2014-01-01

    Increased urinary albumin excretion (UAE) is a marker of renal and cardiovascular risk in patients with type 2 diabetes (DT2). What about the obese patient with DT2? Does albuminuria predict the progression of renal disease and/or cardiovascular disease? The objective of this study is to determine the link between albuminuria, renal risk and cardiovascular risk in a cohort of obese DT2 patients. This is a prospective study begun in September 2006. It included DT2 patients presenting obesity defined by a body mass index (BMI)>30 Kg/m2. Three groups of patients were defined: normo-albuminuria (Urinary Albumin Excretion UAE<30 mg/day or Albumin Creatinine Ratio ACR<30 mg/g), micro-albuminuria (UAE=30-300 mg/day or ACR=30-300 mg/g) and macro-albuminuria (UAE>300 mg/day or ACR>300 mg/g). Data on 144 obese DT2 patients were compiled: The mean age of our patients was 59 ± 9 years and the sex ratio 0.26. The incidence of ESRD was higher in the macro-albuminuria group than in the two other groups (26.5% vs. 1.2%, p<0.001). The incidence of cardiovascular events was 15.4%, 14.3% and 23.5% in the normo, micro and macro-albuminuria groups (p=0.48). A history of cardiovascular comorbidities was the main cardiovascular risk in multivariate analysis (0R=15.07; 95% CI=5.30-42.82; p<0.001) and the low admission GFR (0R=5.67; 95% CI=1.23-9.77; p=0.008) was the main factor for progression of kidney disease in multivariate analysis. Albuminuria may be a better marker of kidney disease progression than of cardiovascular risk in the obese DT2 patient, according to our results. However, to accurately demonstrate the link albuminuria - renal risk and albuminuria - cardiovascular risk in the obese DT2 patient, additional studies using very strict criteria of selection and judgment are needed. PMID:24551483

  4. Distribution of Short-Term and Lifetime Predicted Risks of Cardiovascular Diseases in Peruvian Adults

    PubMed Central

    Quispe, Renato; Bazo-Alvarez, Juan Carlos; Burroughs Peña, Melissa S; Poterico, Julio A; Gilman, Robert H; Checkley, William; Bernabé-Ortiz, Antonio; Huffman, Mark D; Miranda, J Jaime

    2015-01-01

    Background Short-term risk assessment tools for prediction of cardiovascular disease events are widely recommended in clinical practice and are used largely for single time-point estimations; however, persons with low predicted short-term risk may have higher risks across longer time horizons. Methods and Results We estimated short-term and lifetime cardiovascular disease risk in a pooled population from 2 studies of Peruvian populations. Short-term risk was estimated using the atherosclerotic cardiovascular disease Pooled Cohort Risk Equations. Lifetime risk was evaluated using the algorithm derived from the Framingham Heart Study cohort. Using previously published thresholds, participants were classified into 3 categories: low short-term and low lifetime risk, low short-term and high lifetime risk, and high short-term predicted risk. We also compared the distribution of these risk profiles across educational level, wealth index, and place of residence. We included 2844 participants (50% men, mean age 55.9 years [SD 10.2 years]) in the analysis. Approximately 1 of every 3 participants (34% [95% CI 33 to 36]) had a high short-term estimated cardiovascular disease risk. Among those with a low short-term predicted risk, more than half (54% [95% CI 52 to 56]) had a high lifetime predicted risk. Short-term and lifetime predicted risks were higher for participants with lower versus higher wealth indexes and educational levels and for those living in urban versus rural areas (P<0.01). These results were consistent by sex. Conclusions These findings highlight potential shortcomings of using short-term risk tools for primary prevention strategies because a substantial proportion of Peruvian adults were classified as low short-term risk but high lifetime risk. Vulnerable adults, such as those from low socioeconomic status and those living in urban areas, may need greater attention regarding cardiovascular preventive strategies. PMID:26254303

  5. Flock-level risk factors associated with leptospirosis in dairy goats in a semiarid region of Northeastern Brazil.

    PubMed

    Higino, Severino S S; Santos, Fabrine A; Costa, Diego F; Santos, Carolina S A B; Silva, Maria L C R; Alves, Clebert J; Azevedo, Sérgio S

    2013-04-01

    A cross-sectional study based on a planned sampling was carried out to determine flock-level risk factors associated to Leptospira spp. infection in dairy goat flocks in a semiarid region of Northeastern Brazil. Serum samples from 975 adult dairy goats from 110 flocks were examined for Leptospira spp. antibodies by MAT using 24 serovars. A structured questionnaire focusing on risk factors for leptospirosis was completed for each flock. Of the 110 flocks 48 (43.6%; 95% CI: 34.2-53.4%) presented at least one seropositive animal, and most frequent serovar was Autumnalis (10.9%). Ninety-eight (8.7%; 95% CI: 5.7-12.9%; design effect=4.23) of the 975 goats tested seropositive at MAT, and serovar Autumnalis was also the most frequent (1.74%). Presence of rodents (OR=2.78; P=0.015) was identified as a risk factor. There was also association between history of infertility (OR=14.74; P=0.015) and prevalence of positive flocks. We suggest that a program of rodent control should be included in the flock management practices aiming to reduce transmission of the agent and then to reduce prevalence of positive flocks and occurrence of reproductive disorders such as impaired fertility. Copyright © 2012 Elsevier B.V. All rights reserved.

  6. Risk estimation to human health caused by the mercury content of Sushi and Sashimi sold in Japanese restaurants in Brazil.

    PubMed

    Alves, Jeanne Clécia; Lima de Paiva, Esther; Milani, Raquel Fernanda; Bearzoti, Eduardo; Morgano, Marcelo Antonio; Diego Quintaes, Késia

    2017-03-08

    Although fish is a healthy alternative for meat, it can be a vehicle for mercury (Hg), including in its most toxic organic form, methylmercury (MeHg). The objective of the present study was to estimate the risk to human health caused by the consumption of sushi and sashimi as commercialized by Japanese food restaurants in the city of Campinas (SP, Brazil). The total Hg content was determined by atomic absorption spectrometry with thermal decomposition and amalgamation, and the MeHg content calculated considering that 90% of the total Hg is in the organic form. The health risk was estimated from the values for the provisional tolerable weekly ingestion (PTWI) by both adults and children. The mean concentrations for total Hg were: 147.99, 6.13, and 3.42 µg kg(-1) in the tuna, kani, and salmon sushi samples, respectively, and 589.09, 85.09, and 11.38 µg kg(-1) in the tuna, octopus and salmon sashimi samples, respectively. The tuna samples showed the highest Hg concentrations. One portion of tuna sashimi exceeded the PTWI value for MeHg established for children and adults. The estimate of risk for human health indicated that the level of toxicity depended on the type of fish and size of the portion consumed.

  7. Population prevalence of hereditary breast cancer phenotypes and implementation of a genetic cancer risk assessment program in southern Brazil

    PubMed Central

    2009-01-01

    In 2004, a population-based cohort (the Núcleo Mama Porto Alegre - NMPOA Cohort) was started in Porto Alegre, southern Brazil and within that cohort, a hereditary breast cancer study was initiated, aiming to determine the prevalence of hereditary breast cancer phenotypes and evaluate acceptance of a genetic cancer risk assessment (GCRA) program. Women from that cohort who reported a positive family history of cancer were referred to GCRA. Of the 9218 women enrolled, 1286 (13.9%) reported a family history of cancer. Of the 902 women who attended GCRA, 55 (8%) had an estimated lifetime risk of breast cancer ≥ 20% and 214 (23.7%) had pedigrees suggestive of a breast cancer predisposition syndrome; an unexpectedly high number of these fulfilled criteria for Li-Fraumeni-like syndrome (122 families, 66.7%). The overall prevalence of a hereditary breast cancer phenotype was 6.2% (95%CI: 5.67-6.65). These findings identified a problem of significant magnitude in the region and indicate that genetic cancer risk evaluation should be undertaken in a considerable proportion of the women from this community. The large proportion of women who attended GCRA (72.3%) indicates that the program was well-accepted by the community, regardless of the potential cultural, economic and social barriers. PMID:21637504

  8. Periconceptional use of folic acid and risk of miscarriage - findings of the Oral Cleft Prevention Program in Brazil.

    PubMed

    Vila-Nova, Camila; Wehby, George L; Queirós, Fernanda C; Chakraborty, Hrishkesh; Félix, Temis M; Goco, Norman; Moore, Janet; Gewehr, Eduardo V; Lins, Lorene; Affonso, Carla M C; Murray, Jeffrey C

    2013-07-01

    We report on the risk of miscarriage with high- and low-dosage periconceptional folic acid (FA) supplementation from a double-blind randomized clinical trial for prevention of orofacial cleft recurrence in Brazil. Women at risk of recurrence of orofacial clefts in their offspring were randomized into high (4 mg/day) and low (0.4 mg/day) doses of FA supplementation. The women received the study pills before pregnancy, and supplementation continued throughout the first trimester. Miscarriage rates were compared between the two FA groups and with the population rate. A total of 268 pregnancies completed the study protocol, with 141 in the 4.0-mg group and 127 in the 0.4-mg group. The miscarriage rate was 14.2% in the low-dose FA group (0.4 mg/day) and 11.3% for the high-dose group (4 mg/day) (P=0.4877). These miscarriage rates are not significantly different from the miscarriage rate in the Brazilian population, estimated to be around 14% (P=0.311). These results indicate that high-dose FA does not increase miscarriage risk in this population and add further information to the literature on the safety of high FA supplementation for prevention of birth defect recurrence.

  9. GIS-based prediction of malaria risk in Egypt.

    PubMed

    Hassan, A N; Kenawy, M A; Kamal, H; Abdel Sattar, A A; Sowilem, M M

    2003-07-01

    Environmental variables in a malaria geographic information system (GIS) database were analysed to discriminate between governorates at high and low risk of malaria. Only Fayoum governorate was categorized as a high risk area for malaria during the last 2 decades. Discriminant models correctly classified 96.3% of the risk categories and indicated that the most important predictor of risk is hydrogeology. Further GIS spatial analysis indicated that the high malaria risk in Fayoum is associated with a unique environmental envelope of biotic (presence of both efficient malaria vectors) and abiotic (hydrogeology and soil) variables. Recommendations for surveillance and control are discussed.

  10. A predictive score followed by nucleic acid amplification for adult tuberculous meningitis diagnosis in Southern Brazil.

    PubMed

    Anselmo, Lívia Maria Pala; Feliciano, Cinara; Mauad, Fernando; do Nascimento, Margarida Passeri; Pocente, Renata Candido; Silva, Jorgete Maria; Bollela, Valdes Roberto

    2017-08-15

    From 2012 to 2013, 300 adults under investigation of tuberculous meningitis (TBM) were tested with polymerase chain reaction (PCR) in central spinal fluid (CSF), followed by TBM score calculation. There were 33(11%) confirmed TBM cases based on clinical findings, CSF-culture; biopsy/necropsy exams and clinical improvement after tuberculosis specific treatment. Other 267 adults were classified as non-TBM. Based on the original score there were 143 possible cases (6≤score≤11) and 20(60.6%) out of 33 TBM; among 27 probable TBM (score≥12) there were 13/33 (39.4%) confirmed cases. The CSF-PCR detected 48% (16/33) of TBM. Based on these findings, a new cut-off point was proposed to differentiate probable (score≥10) from possible (6≤score≤9) TBM. After score adjustment, there were 61 probable TBM with 26/33 (78.8%) TBM, and among the 109 possible TBM there were 7/33(21.2%) confirmed cases. In both systems, there were 130 non-TBM (score≤5) and no confirmed TBM. The association of adjusted score (≥10) and CSF-PCR showed high sensitivity (90.9%) and specificity (86.9%), positive and negative predictive value of 46.2% and 98.9%, respectively. The combination of CSF-PCR and TBM score is a useful tool for the management of adults under investigation of TBM, but the best cut-off point may need local/regional adjustments. Copyright © 2017 Elsevier B.V. All rights reserved.

  11. Population-based genetic risk prediction and stratification for ovarian cancer: views from women at high risk.

    PubMed

    Rahman, Belinda; Meisel, Susanne F; Fraser, Lindsay; Side, Lucy; Gessler, Sue; Wardle, Jane; Lanceley, Anne

    2015-03-01

    There is an opportunity to improve outcomes for ovarian cancer (OC) through advances in risk stratification, early detection and diagnosis. A population-based OC genetic risk prediction and stratification program is being developed. A previous focus group study with individuals from the general population showed support for the proposed program. This qualitative interview study explores the attitudes of women at high risk of OC. Eight women participated in one-on-one, in-depth, semi-structured interviews to explore: experiences of learning of OC risk, risk perceptions, OC knowledge and awareness, and opinions on risk stratification approach. There was evidence of strong support for the proposed program. Benefits were seen as providing reassurance to women at low risk, and reducing worry in women at high risk through appropriate clinical management. Stratification into 'low' and 'high' risk groups was well-received. Participants were more hesitant about stratification to the 'intermediate' risk group. The data suggest formats to effectively communicate OC risk estimates will require careful thought. Interactions with GPs were highlighted as a barrier to OC risk assessment and diagnosis. These results are encouraging for the possible introduction and uptake of a risk prediction and stratification program for OC in the general population.

  12. Risk factors for intestinal parasitic infections in preschoolers in a low socio-economic area, Diamantina, Brazil

    PubMed Central

    Nobre, Luciana N; Silva, Renata V; Macedo, Mariana S; Teixeira, Romero A; Lamounier, Joel A; Franceschini, Sylvia C C

    2013-01-01

    Objective To verify the prevalence of intestinal parasitic infections among preschoolers and to identify the associated risk factors. Methods The study is a cross-sectional study nested in a cohort of children who were born and resident in Diamantina, Minas Gerais, Brazil. At the time of the study, all children were aged 60 months ± five months. They were recruited after written informed consent was obtained from parents or guardians. The study was carried out between July 2009 and July 2010. In total 214 children provided a stool sample for examination on intestinal parasitic infections. Information on potential risk factors for parasitosis was obtained from parents and guardians of the children by a questionnaire. Logistic regression was used for analysis. Results Intestinal parasitic infections were found in 27.5% (n = 59) of children. The boys' infection prevalence (26.1%, n = 36) was slightly lower than the infection prevalence of the girls (30.3%, n = 23), but not statistically different (p = 0.51). Fourteen children, (23.7%) were infected with two or more parasite species and forty-five (76.3%) with single parasites. A low per capita income of family was strongly associated with an increased risk for an infection (OR = 2.89; P = 0.003). Preschoolers whose mothers did not work outside home had a significantly lower risk for infection (OR = 0.41; p = 0.01). Conclusion Intestinal parasite infection is a health problem among Diamantina preschoolers. Poverty was implicated as an important risk factor for infection, while the presence of the mother at home full-time was a protective factor. PMID:23683337

  13. A novel air quality analysis and prediction system for São Paulo, Brazil to support decision-making

    NASA Astrophysics Data System (ADS)

    Hoshyaripour, Gholam Ali; Brasseur, Guy; Andrade, Maria Fatima; Gavidia-Calderón, Mario; Bouarar, Idir

    2016-04-01

    The extensive economic development and urbanization in southeastern Brazil (SEB) in recent decades have notably degraded the air quality with adverse impacts on human health. Since the Metropolitan Area of São Paulo (MASP) accommodates the majority of the economic growth in SEB, it overwhelmingly suffers from the air pollution. Consequently, there is a strong demand for developing ever-better assessment mechanisms to monitor the air quality and to assist the decision makers to mitigate the air pollution in MASP. Here we present the results of an air quality modeling system designed for SEB with focuses on MASP. The Weather Research and Forecast model with Chemistry (WRF-Chem) is used considering the anthropogenic, biomass-burning and biogenic emissions within a 1000×1500 km domain with resolution of 10 km. FINN and MEGAN are used for the biomass-burning and biogenic emissions, respectively. For the anthropogenic emissions we use a local bottom-up inventory for the transport sector and the HTAPv2 global inventory for all other sectors. The bottom-up inventory accounts for the traffic patterns, vehicle types and their emission factors in the area and thus could be used to evaluate the effect of changes in these parameters on air quality in MASP. The model outputs are compered to the satellite and ground-based observations for O3 and NOx. The results show that using the bottom-up or top-down inventories individually can result in a huge deviation between the predictions and observations. On the other hand, combining the inventories significantly enhances the forecast accuracy. It also provides a powerful tool to quantify the effects of traffic and vehicle emission policies on air quality in MASP.

  14. The potential of large studies for building genetic risk prediction models

    Cancer.gov

    NCI scientists have developed a new paradigm to assess hereditary risk prediction in common diseases, such as prostate cancer. This genetic risk prediction concept is based on polygenic analysis—the study of a group of common DNA sequences, known as singl

  15. The Efficacy of Violence Prediction: A Meta-Analytic Comparison of Nine Risk Assessment Tools

    ERIC Educational Resources Information Center

    Yang, Min; Wong, Stephen C. P.; Coid, Jeremy

    2010-01-01

    Actuarial risk assessment tools are used extensively to predict future violence, but previous studies comparing their predictive accuracies have produced inconsistent findings as a result of various methodological issues. We conducted meta-analyses of the effect sizes of 9 commonly used risk assessment tools and their subscales to compare their…

  16. The Efficacy of Violence Prediction: A Meta-Analytic Comparison of Nine Risk Assessment Tools

    ERIC Educational Resources Information Center

    Yang, Min; Wong, Stephen C. P.; Coid, Jeremy

    2010-01-01

    Actuarial risk assessment tools are used extensively to predict future violence, but previous studies comparing their predictive accuracies have produced inconsistent findings as a result of various methodological issues. We conducted meta-analyses of the effect sizes of 9 commonly used risk assessment tools and their subscales to compare their…

  17. Developing Risk Prediction Models for Postoperative Pancreatic Fistula: a Systematic Review of Methodology and Reporting Quality.

    PubMed

    Wen, Zhang; Guo, Ya; Xu, Banghao; Xiao, Kaiyin; Peng, Tao; Peng, Minhao

    2016-04-01

    Postoperative pancreatic fistula is still a major complication after pancreatic surgery, despite improvements of surgical technique and perioperative management. We sought to systematically review and critically access the conduct and reporting of methods used to develop risk prediction models for predicting postoperative pancreatic fistula. We conducted a systematic search of PubMed and EMBASE databases to identify articles published before January 1, 2015, which described the development of models to predict the risk of postoperative pancreatic fistula. We extracted information of developing a prediction model including study design, sample size and number of events, definition of postoperative pancreatic fistula, risk predictor selection, missing data, model-building strategies, and model performance. Seven studies of developing seven risk prediction models were included. In three studies (42 %), the number of events per variable was less than 10. The number of candidate risk predictors ranged from 9 to 32. Five studies (71 %) reported using univariate screening, which was not recommended in building a multivariate model, to reduce the number of risk predictors. Six risk prediction models (86 %) were developed by categorizing all continuous risk predictors. The treatment and handling of missing data were not mentioned in all studies. We found use of inappropriate methods that could endanger the development of model, including univariate pre-screening of variables, categorization of continuous risk predictors, and model validation. The use of inappropriate methods affects the reliability and the accuracy of the probability estimates of predicting postoperative pancreatic fistula.

  18. Comparison between frailty index of deficit accumulation and fracture risk assessment tool (FRAX) in prediction of risk of fractures.

    PubMed

    Li, Guowei; Thabane, Lehana; Papaioannou, Alexandra; Adachi, Jonathan D

    2015-08-01

    A frailty index (FI) of deficit accumulation could quantify and predict the risk of fractures based on the degree of frailty in the elderly. We aimed to compare the predictive powers between the FI and the fracture risk assessment tool (FRAX) in predicting risk of major osteoporotic fracture (hip, upper arm or shoulder, spine, or wrist) and hip fracture, using the data from the Global Longitudinal Study of Osteoporosis in Women (GLOW) 3-year Hamilton cohort. There were 3985 women included in the study, with the mean age of 69.4 years (standard deviation [SD] = 8.89). During the follow-up, there were 149 (3.98%) incident major osteoporotic fractures and 18 (0.48%) hip fractures reported. The FRAX and FI were significantly related to each other. Both FRAX and FI significantly predicted risk of major osteoporotic fracture, with a hazard ratio (HR) of 1.03 (95% confidence interval [CI]: 1.02-1.05) and 1.02 (95% CI: 1.01-1.04) for per-0.01 increment for the FRAX and FI respectively. The HRs were 1.37 (95% CI: 1.19-1.58) and 1.26 (95% CI: 1.12-1.42) for an increase of per-0.10 (approximately one SD) in the FRAX and FI respectively. Similar discriminative ability of the models was found: c-index = 0.62 for the FRAX and c-index = 0.61 for the FI. When cut-points were chosen to trichotomize participants into low-risk, medium-risk and high-risk groups, a significant increase in fracture risk was found in the high-risk group (HR = 2.04, 95% CI: 1.36-3.07) but not in the medium-risk group (HR = 1.23, 95% CI: 0.82-1.84) compared with the low-risk women for the FI, while for FRAX the medium-risk (HR = 2.00, 95% CI: 1.09-3.68) and high-risk groups (HR = 2.61, 95% CI: 1.48-4.58) predicted risk of major osteoporotic fracture significantly only when survival time exceeded 18months (550 days). Similar findings were observed for hip fracture and in sensitivity analyses. In conclusion, the FI is comparable with FRAX in the prediction of risk of future fractures, indicating that

  19. Applying the Framingham risk score for prediction of metabolic syndrome: The Kerman Coronary Artery Disease Risk Study, Iran

    PubMed Central

    Yousefzadeh, Gholamreza; Shokoohi, Mostafa; Najafipour, Hamid; Shadkamfarokhi, Mitra

    2015-01-01

    BACKGROUND There has been a few studies about the predictability of metabolic syndrome (MetS) based on the Framingham risk score (FRS) as a tool for predicting the risk of 10-years cardiovascular diseases (CVD) in Iranian population. The aim of this study was to compare the risk stratification obtained with the FRS and MetS in a cohort of the Iranian population. METHODS In this population-based study Kerman Coronary Artery Disease Risk study, Iran, MetS was diagnosed as defined by the revised National Cholesterol Education Program definition criteria (ATPIII) and the FRS was calculated using a computer program, previously reported algorithm. RESULTS Overall, the prevalence 10-years risk of CVD for patients with MetS was significantly different with those without MetS (74.3 vs. 86.4% for low-risk patients, 18.1 vs. 12.3% for intermediate-risk people, and 7.6 vs. 1.3% for high-risk individuals) (P < 0.001). The frequency of intermediate-risk and high-risk for 10-year CVD in men with MetS (39.5 and 18.3%, respectively) was considerably higher than women with MetS (3.2 and 0.1%, respectively). Using multiple logistic regression, the odds ratio of MetS in intermediate-risk and high-risk FRS group was 1.7 and 6.7, respectively (P < 0.001). CONCLUSION Significant association between the presence of MetS and high risk for CVD based on FRS was revealed in both men and women indicating a good concordance between MetS and FRS in predicting the risk of CVDs. However, the odds ratio of the development of risk of cardiovascular events among women was higher than men with MetS. PMID:26405450

  20. Predicting extinction risk of Brazilian Atlantic forest angiosperms.

    PubMed

    Leão, Tarciso C C; Fonseca, Carlos R; Peres, Carlos A; Tabarelli, Marcelo

    2014-10-01

    Understanding how plant life history affects species vulnerability to anthropogenic disturbances and environmental change is a major ecological challenge. We examined how vegetation type, growth form, and geographic range size relate to extinction risk throughout the Brazilian Atlantic Forest domain. We used a database containing species-level information of 6,929 angiosperms within 112 families and a molecular-based working phylogeny. We used decision trees, standard regression, and phylogenetic regression to explore the relationships between species attributes and extinction risk. We found a significant phylogenetic signal in extinction risk. Vegetation type, growth form, and geographic range size were related to species extinction risk, but the effect of growth form was not evident after phylogeny was controlled for. Species restricted to either rocky outcrops or scrub vegetation on sandy coastal plains exhibited the highest extinction risk among vegetation types, a finding that supports the hypothesis that species adapted to resource-limited environments are more vulnerable to extinction. Among growth forms, epiphytes were associated with the highest extinction risk in non-phylogenetic regression models, followed by trees, whereas shrubs and climbers were associated with lower extinction risk. However, the higher extinction risk of epiphytes was not significant after correcting for phylogenetic relatedness. Our findings provide new indicators of extinction risk and insights into the mechanisms governing plant vulnerability to extinction in a highly diverse flora where human disturbances are both frequent and widespread.

  1. The utility and predictive value of combinations of low penetrance genes for screening and risk prediction of colorectal cancer.

    PubMed

    Hawken, Steven J; Greenwood, Celia M T; Hudson, Thomas J; Kustra, Rafal; McLaughlin, John; Yang, Quanhe; Zanke, Brent W; Little, Julian

    2010-07-01

    Despite the fact that colorectal cancer (CRC) is a highly treatable form of cancer if detected early, a very low proportion of the eligible population undergoes screening for this form of cancer. Integrating a genomic screening profile as a component of existing screening programs for CRC could potentially improve the effectiveness of population screening by allowing the assignment of individuals to different types and intensities of screening and also by potentially increasing the uptake of existing screening programs. We evaluated the utility and predictive value of genomic profiling as applied to CRC, and as a potential component of a population-based cancer screening program. We generated simulated data representing a typical North American population including a variety of genetic profiles, with a range of relative risks and prevalences for individual risk genes. We then used these data to estimate parameters characterizing the predictive value of a logistic regression model built on genetic markers for CRC. Meta-analyses of genetic associations with CRC were used in building science to inform the simulation work, and to select genetic variants to include in logistic regression model-building using data from the ARCTIC study in Ontario, which included 1,200 CRC cases and a similar number of cancer-free population-based controls. Our simulations demonstrate that for reasonable assumptions involving modest relative risks for individual genetic variants, that substantial predictive power can be achieved when risk variants are common (e.g., prevalence > 20%) and data for enough risk variants are available (e.g., approximately 140-160). Pilot work in population data shows modest, but statistically significant predictive utility for a small collection of risk variants, smaller in effect than age and gender alone in predicting an individual's CRC risk. Further genotyping and many more samples will be required, and indeed the discovery of many more risk loci

  2. Performance of risk prediction for inflammatory bowel disease based on genotyping platform and genomic risk score method.

    PubMed

    Chen, Guo-Bo; Lee, Sang Hong; Montgomery, Grant W; Wray, Naomi R; Visscher, Peter M; Gearry, Richard B; Lawrance, Ian C; Andrews, Jane M; Bampton, Peter; Mahy, Gillian; Bell, Sally; Walsh, Alissa; Connor, Susan; Sparrow, Miles; Bowdler, Lisa M; Simms, Lisa A; Krishnaprasad, Krupa; Radford-Smith, Graham L; Moser, Gerhard

    2017-08-29

    Predicting risk of disease from genotypes is being increasingly proposed for a variety of diagnostic and prognostic purposes. Genome-wide association studies (GWAS) have identified a large number of genome-wide significant susceptibility loci for Crohn's disease (CD) and ulcerative colitis (UC), two subtypes of inflammatory bowel disease (IBD). Recent studies have demonstrated that including only loci that are significantly associated with disease in the prediction model has low predictive power and that power can substantially be improved using a polygenic approach. We performed a comprehensive analysis of risk prediction models using large case-control cohorts genotyped for 909,763 GWAS SNPs or 123,437 SNPs on the custom designed Immunochip using four prediction methods (polygenic score, best linear genomic prediction, elastic-net regularization and a Bayesian mixture model). We used the area under the curve (AUC) to assess prediction performance for discovery populations with different sample sizes and number of SNPs within cross-validation. On average, the Bayesian mixture approach had the best prediction performance. Using cross-validation we found little differences in prediction performance between GWAS and Immunochip, despite the GWAS array providing a 10 times larger effective genome-wide coverage. The prediction performance using Immunochip is largely due to the power of the initial GWAS for its marker selection and its low cost that enabled larger sample sizes. The predictive ability of the genomic risk score based on Immunochip was replicated in external data, with AUC of 0.75 for CD and 0.70 for UC. CD patients with higher risk scores demonstrated clinical characteristics typically associated with a more severe disease course including ileal location and earlier age at diagnosis. Our analyses demonstrate that the power of genomic risk prediction for IBD is mainly due to strongly associated SNPs with considerable effect sizes. Additional SNPs that are

  3. Evaluation of the predictability of real-time crash risk models.

    PubMed

    Xu, Chengcheng; Liu, Pan; Wang, Wei

    2016-09-01

    The primary objective of the present study was to investigate the predictability of crash risk models that were developed using high-resolution real-time traffic data. More specifically the present study sought answers to the following questions: (a) how to evaluate the predictability of a real-time crash risk model; and (b) how to improve the predictability of a real-time crash risk model. The predictability is defined as the crash probability given the crash precursor identified by the crash risk model. An equation was derived based on the Bayes' theorem for estimating approximately the predictability of crash risk models. The estimated predictability was then used to quantitatively evaluate the effects of the threshold of crash precursors, the matched and unmatched case-control design, and the control-to-case ratio on the predictability of crash risk models. It was found that: (a) the predictability of a crash risk model can be measured as the product of prior crash probability and the ratio between sensitivity and false alarm rate; (b) there is a trade-off between the predictability and sensitivity of a real-time crash risk model; (c) for a given level of sensitivity, the predictability of the crash risk model that is developed using the unmatched case-controlled sample is always better than that of the model developed using the matched case-controlled sample; and (d) when the control-to-case ratio is beyond 4:1, the increase in control-to-case ratio does not lead to clear improvements in predictability.

  4. Which Risk Factors Predict the Basic Reading Skills of Children at Risk for Emotional and Behavioral Disorders?

    ERIC Educational Resources Information Center

    Nelson, J. Ron; Stage, Scott; Trout, Alex; Duppong-Hurley, Kristin; Epstein, Michael H.

    2008-01-01

    Multinomial stepwise logistic regression analyses were used to establish the most robust set of risk factors that would best predict low basic reading skills (i.e., a standard score less than 85 on the Woodcock Reading Mastery Test-Revised Basic Reading Skills cluster) of kindergarten and first-grade children at risk for emotional and behavioral…

  5. Derivation and validation of a prediction rule for estimating advanced colorectal neoplasm risk in average-risk Chinese.

    PubMed

    Cai, Quan-Cai; Yu, En-Da; Xiao, Yi; Bai, Wen-Yuan; Chen, Xing; He, Li-Ping; Yang, Yu-Xiu; Zhou, Ping-Hong; Jiang, Xue-Liang; Xu, Hui-Min; Fan, Hong; Ge, Zhi-Zheng; Lv, Nong-Hua; Huang, Zhi-Gang; Li, You-Ming; Ma, Shu-Ren; Chen, Jie; Li, Yan-Qing; Xu, Jian-Ming; Xiang, Ping; Yang, Li; Lin, Fu-Lin; Li, Zhao-Shen

    2012-03-15

    No prediction rule is currently available for advanced colorectal neoplasms, defined as invasive cancer, an adenoma of 10 mm or more, a villous adenoma, or an adenoma with high-grade dysplasia, in average-risk Chinese. In this study between 2006 and 2008, a total of 7,541 average-risk Chinese persons aged 40 years or older who had complete colonoscopy were included. The derivation and validation cohorts consisted of 5,229 and 2,312 persons, respectively. A prediction rule was developed from a logistic regression model and then internally and externally validated. The prediction rule comprised 8 variables (age, sex, smoking, diabetes mellitus, green vegetables, pickled food, fried food, and white meat), with scores ranging from 0 to 14. Among the participants with low-risk (≤3) or high-risk (>3) scores in the validation cohort, the risks of advanced neoplasms were 2.6% and 10.0% (P < 0.001), respectively. If colonoscopy was used only for persons with high risk, 80.3% of persons with advanced neoplasms would be detected while the number of colonoscopies would be reduced by 49.2%. The prediction rule had good discrimination (area under the receiver operating characteristic curve = 0.74, 95% confidence interval: 0.70, 0.78) and calibration (P = 0.77) and, thus, provides accurate risk stratification for advanced neoplasms in average-risk Chinese.

  6. Which Risk Factors Predict the Basic Reading Skills of Children at Risk for Emotional and Behavioral Disorders?

    ERIC Educational Resources Information Center

    Nelson, J. Ron; Stage, Scott; Trout, Alex; Duppong-Hurley, Kristin; Epstein, Michael H.

    2008-01-01

    Multinomial stepwise logistic regression analyses were used to establish the most robust set of risk factors that would best predict low basic reading skills (i.e., a standard score less than 85 on the Woodcock Reading Mastery Test-Revised Basic Reading Skills cluster) of kindergarten and first-grade children at risk for emotional and behavioral…

  7. Failure mode and effects analysis based risk profile assessment for stereotactic radiosurgery programs at three cancer centers in Brazil

    SciTech Connect

    Teixeira, Flavia C.

    2016-01-15

    Purpose: The goal of this study was to evaluate the safety and quality management program for stereotactic radiosurgery (SRS) treatment processes at three radiotherapy centers in Brazil by using three industrial engineering tools (1) process mapping, (2) failure modes and effects analysis (FMEA), and (3) fault tree analysis. Methods: The recommendations of Task Group 100 of American Association of Physicists in Medicine were followed to apply the three tools described above to create a process tree for SRS procedure for each radiotherapy center and then FMEA was performed. Failure modes were identified for all process steps and values of risk priority number (RPN) were calculated from O, S, and D (RPN = O × S × D) values assigned by a professional team responsible for patient care. Results: The subprocess treatment planning was presented with the highest number of failure modes for all centers. The total number of failure modes were 135, 104, and 131 for centers I, II, and III, respectively. The highest RPN value for each center is as follows: center I (204), center II (372), and center III (370). Failure modes with RPN ≥ 100: center I (22), center II (115), and center III (110). Failure modes characterized by S ≥ 7, represented 68% of the failure modes for center III, 62% for center II, and 45% for center I. Failure modes with RPNs values ≥100 and S ≥ 7, D ≥ 5, and O ≥ 5 were considered as high priority in this study. Conclusions: The results of the present study show that the safety risk profiles for the same stereotactic radiotherapy process are different at three radiotherapy centers in Brazil. Although this is the same treatment process, this present study showed that the risk priority is different and it will lead to implementation of different safety interventions among the centers. Therefore, the current practice of applying universal device-centric QA is not adequate to address all possible failures in clinical processes at different

  8. Occurrence and risk factors associated to Toxoplasma gondii infection in sheep from Rio de Janeiro, Brazil

    USDA-ARS?s Scientific Manuscript database

    Toxoplasmosis is an important cause of abortion in sheep and a zoonotic risk to humans, leading to significant hazards to health and to economic losses. This study examined the soroprevalence and associated risk factors for infection with Toxoplama gondii in 379 sheep from 12 flocks in Rio de Janeir...

  9. Risk Prediction Models for Other Cancers or Multiple Sites

    Cancer.gov

    Developing statistical models that estimate the probability of developing other multiple cancers over a defined period of time will help clinicians identify individuals at higher risk of specific cancers, allowing for earlier or more frequent screening and counseling of behavioral changes to decrease risk.

  10. Fluoride concentrations in the water of Maringá, Brazil, considering the benefit/risk balance of caries and fluorosis.

    PubMed

    Bergamo, Edmara Tatiely Pedroso; Barbana, Marlon; Terada, Raquel Sano Suga; Cury, Jaime Aparecido; Fujimaki, Mitsue

    2015-01-01

    Current Brazilian law regarding water fluoridation classification is dichotomous with respect to the risks of and benefits for oral diseases, and fluoride (F) concentrations less than 0.6 or above 0.8 mg F/L are considered outside the normal limits. Thus, the law does not consider that both caries and fluorosis are dependent on the dosage and duration of fluoride exposure because they are both chronic diseases. Therefore, this study evaluated the quality of water fluoridation in Maringá, PR, Brazil, considering a new classification for the concentration of F in water the supply, based on the anticaries benefit and risk of fluorosis (CECOL/USP, 2011). Water samples (n = 325) were collected monthly over one year from 28 distribution water networks: 20 from treatment plants and 8 from artesian wells. F concentrations were determined using a specific ion electrode. The average F concentration was 0.77 mg F/L (ppm F), ranging from 0.44 to 1.22 mg F/L. Considering all of the water samples analyzed, 83.7% of them presented from 0.55 to 0.84 mg F/L, and according to the new classification used, they would provide maximum anticaries benefit with a low risk of fluorosis. This percentage was lower (75.4%) in the water samples supplied from artesian wells than from those distributed by the treatment plant (86%). In conclusion, based on the new classification of water F concentrations, the quality of water fluoridation in Maringá is adequate and is within the range of the best balance between risk and benefit.

  11. Risk of ingesting As, Cd, and Pb in animal products in north Rio de Janeiro state, Brazil.

    PubMed

    Caldas, D; Pestana, I A; Almeida, M G; Henry, F C; Salomão, M S M B; de Souza, C M M

    2016-12-01

    This study evaluated the levels of As, Cd, and Pb in muscle and liver the cattle and chicken. The risk was estimated for the adult population of a midsized city in southeast Brazil, concerning the tolerable ingestion and cancer risk. Samples of muscle and liver (cattle and chicken) were collected (n = 250). Samples of mineral supplements for cattle (n = 4) and chicken feed samples (n = 4) were evaluated as one of many potential source of contamination. Muscle, liver, mineral supplement, and feed samples were dissolved in acid medium and analyzed by ICP-OES. Daily muscle and liver intake was estimated using a questionnaire (N = 427). Daily intake of trace elements by the population based on the consumption of cattle muscle, cattle liver, chicken muscle, and chicken liver was low, corresponding to 2.76%, 0.33%, 2.12%, and 0.22% of the Tolerable Intake defined by the WHO for As; 0.54%, 0.29% 0.55%, 0.01%, for Cd; and 0.80%, 0.07%, 0.62%, 0.02%, for Pb. The mean of total ingestion of As, Cd and Pb was 5.43%, 1.18% and 1.51%, respectively of Tolerable Intake defined by WHO. Cancer risk was lower than 5 × 10(-5) year(-1). The results indicate that the muscle and liver consumption is a source of As, Cd, and Pb. Consumers that ingest cattle and chicken muscle need attention in terms the risk of cancer related to intake of As and Cd. Feed and mineral supplementation remain as one of many sources of exposure of As, Cd, and Pb. Copyright © 2016 Elsevier Ltd. All rights reserved.

  12. Risk tools for the prediction of violence: 'VRAG, HCR-20, PCL-R'.

    PubMed

    Jaber, F S; Mahmoud, K F

    2015-03-01

    Many instruments have been introduced as measures of violence risk prediction. Studies on risk assessment displayed two major approaches - clinical risk evaluation and actuarial measures - and three tools were mostly used: (1) Violence Risk Appraisal Guide, (2) Historical-Clinical-Risk-20 item scale and (3) Psychopathy Checklist-Revised. Although these tools are commonly used in clinical practice, they differ in their uses, benefits and limitations, and their ability to predict future violence. Subsequently, this paper aim to provide the readers an in-depth description that specifies these aspects, as well as a comparison of these tools in order to help readers decide which tool to use.

  13. Assessing the risk of bovine fasciolosis using linear regression analysis for the state of Rio Grande do Sul, Brazil.

    PubMed

    Silva, Ana Elisa Pereira; Freitas, Corina da Costa; Dutra, Luciano Vieira; Molento, Marcelo Beltrão

    2016-02-15

    Fasciola hepatica is the causative agent of fasciolosis, a disease that triggers a chronic inflammatory process in the liver affecting mainly ruminants and other animals including humans. In Brazil, F. hepatica occurs in larger numbers in the most Southern state of Rio Grande do Sul. The objective of this study was to estimate areas at risk using an eight-year (2002-2010) time series of climatic and environmental variables that best relate to the disease using a linear regression method to municipalities in the state of Rio Grande do Sul. The positivity index of the disease, which is the rate of infected animal per slaughtered animal, was divided into three risk classes: low, medium and high. The accuracy of the known sample classification on the confusion matrix for the low, medium and high rates produced by the estimated model presented values between 39 and 88% depending of the year. The regression analysis showed the importance of the time-based data for the construction of the model, considering the two variables of the previous year of the event (positivity index and maximum temperature). The generated data is important for epidemiological and parasite control studies mainly because F. hepatica is an infection that can last from months to years.

  14. [Analysis of protection or risk factors for dental fluorosis in 6 to 8 year-old children in Fortaleza, Brazil].

    PubMed

    Teixeira, Ana Karine Macedo; Bezerra de Menezes, Léa Maria; Dias, Aldo Angelim; Morais de Alencar, Carlos Henrique; Leitão de Almeida, Maria Eneide

    2010-12-01

    To investigate protection or risk factors for dental fluorosis in permanent teeth of 6 to 8 year-old children in a neighborhood of Fortaleza, Brazil. This case-control study included 57 controls and 67 children with fluorosis affecting superior and inferior incisors teeth as determined by the Dean classification criteria. Presence of fluorosis was considered as the dependent variable. Data concerning independent variables were obtained through interviews with the parents. Fisher's exact test was used to determine associations between fluorosis and the independent variables. Odds ratios (OR) were calculated to investigate associations and likelihood of fluorosis in the case group, with 95% significance level. Fluorosis was significantly associated with type of housing (owned, rented or squatted), but not with the source of drinking water or use of fluoridated toothpaste and fluoride supplements. Univariate analysis showed that the risk of fluorosis was higher in children who began drinking powdered milk mixed with water before 2 years of age (OR = 4.53; IC95%: 1.07-26.74) and in those who did not breastfeed (OR = 6.66; IC95%: 1.61-38.62). In the multivariate analysis, only breastfeeding was associated with fluorosis (4.54; IC95%: 1.21-16.66). Breastfeeding was a protection factor against fluorosis. More specific categorization criteria must be established to investigate relationships between fluorosis and socioeconomic class.

  15. Informal Trade of Psychoactive Herbal Products in the City of Diadema, SP, Brazil: Quality and Potential Risks

    PubMed Central

    Soares Neto, Julino Assunção Rodrigues; Kato, Edna Myiake; Galduróz, José Carlos F.; Marques, Luis Carlos; Macrini, Thiago; Rodrigues, Eliana

    2013-01-01

    The present study aimed to assess the quality and risks involved in the consumption of psychoactive herbal products (PHs) that are available through informal commerce in the city of Diadema, SP, Brazil. Methods of ethnography were used to conduct the fieldwork during which four dealers were selected to record the collection, handling, packaging, types of PHs marketed, and their therapeutic purposes. In addition, lots of the PHs selected were purchased from the dealers and analyzed using microbiology and pharmacognosy techniques. 217 PHs were recorded and categorized into two main groups: stimulants (67%) and depressants (27%) of the central nervous system; sixteen of them were selected, and their 52 lots were acquired. The deficiencies observed in handling and packaging these lots by dealers were confirmed by microbiological analysis; 80.8% of them presented risk according to the indicators defined by the Brazilian Pharmacopoeia. The pharmacognostic analysis confirmed the authenticity of only 9 to 16 PHs analyzed. In addition, descriptions of contraindications, adverse reactions, and drug interactions were found in the literature for the PHs. The results of this study allow the observation of the priorities for the sanitary adequacy of the popular trade of herbs. PMID:23818934

  16. Wheezing conditions in early childhood: prevalence and risk factors in the city of São Paulo, Brazil.

    PubMed Central

    Benício, Maria Helena D.; Ferreira, Marcelo U.; Cardoso, Maria Regina A.; Konno, Sílvia C.; Monteiro, Carlos A.

    2004-01-01

    OBJECTIVE: To investigate the prevalence and risk factors for wheezing disorders in early childhood in São Paulo, Brazil, the largest metropolitan area of South America. METHODS: A population-based cross-sectional survey of 1132 children aged 6-59 months was carried out between 1995 and 1996 to obtain information on recent wheezing and on independent variables such as demographic, socioeconomic, environmental, maternal and nutritional variables and immunization status. Intestinal parasitic infections were diagnosed using standard techniques. Multiple unconditional logistic regression was used to describe associations between outcome and independent variables. FINDINGS: The prevalence of recent wheezing (one or more reported episodes in the past 12 months) was 12.5%; 93% of children with wheezing were also reported to have a medical diagnosis of asthma. Recent wheezing was associated with low per capita income, poor quality of housing, day-care attendance, low birth weight and infection with intestinal helminths. CONCLUSION: Wheezing in early childhood in São Paulo, although more common than in most developing countries, remains less prevalent than in urban areas of industrialized countries. Low income and conditions associated with poverty (poor housing, low birth weight and parasitic infections) are some of the main risk factors for wheezing disorders among young children in this city. PMID:15508196

  17. Leishmania infantum: illness, transmission profile and risk factors for asymptomatic infection in an endemic metropolis in Brazil.

    PubMed

    Dos Santos Marques, Letícia Helena; DA Rocha, Iara Caixeta Marques; Reis, Ilka Afonso; DA Cunha, Gisele Macedo Rodrigues; Oliveira, Edward; Pfeilsticker, Thais Ribeiro; DE Araújo, Valdelaine Etelvina Miranda; Morais, Maria Helena Franco; Rabello, Ana; Carneiro, Mariângela

    2017-04-01

    To evaluate the distribution of asymptomatic infection by Leishmania infantum in a metropolis in Brazil with different relative risks (RRs) for disease and risk factors associated with the infection, an ecological study was conducted using a Bayesian approach to estimate the RR of human visceral leishmaniasis (HVL) based on cases between 2008 and 2011. The areas were categorized and selected according to disease incidence: low (area-1), medium (area-2) and high (area-3). Cross-sectional study enrolling 935 children was used to estimate the prevalence of infection by L. infantum. Volunteers from these three areas were tested for L. infantum infection by ELISA (rK39 and soluble antigens). Infection prevalence rates were estimated and compared with the RR of disease. Multilevel logistic regression model evaluated the relationship between infection and the analysed variables. The RR of HVL was distributed heterogeneously in the municipality. The infection prevalence rates were: 34·9% in area-1; 29·3% in area-2; and 33·6% in area-3, with no significant differences between these areas. The variables 'Presence of backyards in the neighbourhood' and 'Younger children' were associated with L. infantum infection. We conclude that infection by L. infantum affects a significant proportion of the infant population regardless of the RR of disease.

  18. Fractionation and potential toxic risk of metals from superficial sediment in Itaipu Lake--boundary between Brazil and Paraguay.

    PubMed

    Kalwa, Miguel; Quináia, Sueli Pércio; Pletsch, Adelmo L; Techy, Laura; Felsner, Maria Lurdes

    2013-01-01

    The objective of this study was to evaluate fractions of metals (labile and pseudo-total) extracted from sediment samples collected in Itaipu Lake (boundary between Brazil and Paraguay) and to assess the dynamics and mobility of these fractions by identifying the same bioavailability and ecological risk to metals in the aquatic environment. The concentrations of metal ions were determined by flame atomic absorption spectrometry. There was a correlation between the metal ions, both in the labile and the pseudo-total, with regard to particle size. To assess metals concentrations in sediment, numerical sediment-quality guidelines were applied. The concentrations of aluminum, cadmium, iron, manganese, lead, and zinc in all sediment samples are lower than the proposed probable effects level (PEL), thus possibly indicating that there are no harmful effects from these metals. In contrast, concentrations of copper, chromium, and nickel exceeded the PEL in some samples, thus indicating that these stations are at potential risk. The level of contamination in sediments of Itaipu Lake for all metals was evaluated using contamination factor, degree of contamination, and sum-of-metals toxic unit.

  19. [Vaccination coverage and risk factors associated to non-vaccination in a urban area of northeastern Brazil, 1994].

    PubMed

    da Silva, A A; Gomes, U A; Tonial, S R; da Silva, R A

    1999-04-01

    The assessment of vaccination coverage and risk factors for non-vaccination is important to evaluate vaccination programs and to identify children not properly vaccinated. A cross-sectional household survey was carried out in the municipality of S. Luís, Maranhão, Brazil by means of a standardized questionnaire. Multistage cluster sampling was used to identify children of 12-59 months of age residing in the city in 1994. The mother or other person responsible for the children was interviewed. Fifty census clusters were visited and 40 households were sampled in each. On average, 15 children were found in each cluster. Design effect was calculated for each estimate. Health service utilization was analyzed according to socioeconomic and demographic indicators, and perceived morbidity using proportional hazard modeling (Cox's regression). Vaccination coverage levels were 72.4% for BCG, 59.9% for three doses of polio vaccine, 57% for three doses of DTP vaccine and 54.7% for measles vaccine. Vaccination levels have remained statistically unchanged over the last three years. Lower maternal schooling continues to be associated with increased risk of non-vaccination in the multivariable analysis. Vaccination levels were low. Health education activities are one of the suggested strategies to increase vaccination coverage.

  20. A Comparative Study of Adolescent Risk Assessment Instruments: Predictive and Incremental Validity

    ERIC Educational Resources Information Center

    Welsh, Jennifer L.; Schmidt, Fred; McKinnon, Lauren; Chattha, H. K.; Meyers, Joanna R.

    2008-01-01

    Promising new adolescent risk assessment tools are being incorporated into clinical practice but currently possess limited evidence of pred