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Sample records for brazil predictive risk

  1. 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

  2. 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.

  3. Prediction of health risk due to polycyclic aromatic hydrocarbons present in urban air in Rio de Janeiro, Brazil.

    PubMed

    Rainho, C R; Velho, A M A; Corrêa, S M; Mazzei, J L; Aiub, C A F; Felzenszwalb, I

    2013-02-28

    Risk assessment can provide a comprehensive estimate of potential effects of contaminants under specific, well-defined, and well-described circumstances, providing quantitative relationships between exposure and effects to identify and to define areas of concern. We investigated the mutagenic activity of particulate matter in air samples collected from three sites in Rio de Janeiro city. Samples were collected using a high-volume sampler at Avenida Brasil, at Campus of Universidade do Estado do Rio de Janeiro, and at Rebouças Tunnel. Six polycyclic aromatic hydrocarbons were quantified by gas chromatography/mass spectrometry. Salmonella typhimurium TA98 and the derivative strains TA98/1.8-DNP(6), YG1021, and YG1024, commonly used in mutagenicity assays, were treated (10-50 µg/plate), with and without exogenous metabolization. The highest values for the polycyclic aromatic hydrocarbons were detected at Rebouças Tunnel. For chrysene, as an example, the concentration was nearly 200 times higher than that established by the US Environmental Protection Agency. Frequent traffic jams can place bus drivers who go through the Rebouças Tunnel at risk of exposure to up to 0.69 ng/m(3) benzo(a) pyrene. Independent of exogenous metabolization, mutagenicity was detected in strains YG1021 and YG1024 at all the sites, suggesting nitro and amino derivatives of polycyclic aromatic hydrocarbons. Rebouças Tunnel air samples gave the highest values for rev/µg and rev/m(3). This could be due to the fact that the long, enclosed passageway through a mountain restricts ventilation. The cancer risk estimate in this study was 10(-3) for the benzo(a)pyrene, at the two sites, indicating a high risk.

  4. 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.

  5. 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.

  6. Exploring Joint Disease Risk Prediction

    PubMed Central

    Wang, Xiang; Wang, Fei; Hu, Jianying; Sorrentino, Robert

    2014-01-01

    Disease risk prediction has been a central topic of medical informatics. Although various risk prediction models have been studied in the literature, the vast majority were designed to be single-task, i.e. they only consider one target disease at a time. This becomes a limitation when in practice we are dealing with two or more diseases that are related to each other in terms of sharing common comorbidities, symptoms, risk factors, etc., because single-task prediction models are not equipped to identify these associations across different tasks. In this paper we address this limitation by exploring the application of multi-task learning framework to joint disease risk prediction. Specifically, we characterize the disease relatedness by assuming that the risk predictors underlying these diseases have overlap. We develop an optimization-based formulation that can simultaneously predict the risk for all diseases and learn the shared predictors. Our model is applied to a real Electronic Health Record (EHR) database with 7,839 patients, among which 1,127 developed Congestive Heart Failure (CHF) and 477 developed Chronic Obstructive Pulmonary Disease (COPD). We demonstrate that a properly designed multi-task learning algorithm is viable for joint disease risk prediction and it can discover clinical insights that single-task models would overlook. PMID:25954429

  7. 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.

  8. 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

  9. 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

    2016-01-01

    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. PMID:26910315

  10. [Predictive microbiology and risk assessment].

    PubMed

    Hildebrandt, G; Kleer, J

    2004-05-01

    Predictive microbiology (predictive modelling PM), in spite of its limits and short-comings, may often contribute to a reduction of the problems arising when HACCP systems are established or microbiological risk assessment is done. Having identified the agents which constitute a risk and the contamination rate and density in the raw material, the influences of production steps and storage on these microorganisms have to be examined. Finally, there should be an exposure assessment, i.e. an estimate of the contamination density in the final product at the time of consumption. Should the exposure assessment together with data from dose response assessments reveal a potential for intake of inacceptable numbers of organisms, the risk identified has to be characterized. As a consequence, risk management should result in a modification of the composition of the product and/or of the production process so that the risk does not surpass an acceptable limit. For this approach it is indispensable to have product- and process-specific information on the multiplication of pathogens prior to heat treatment, on reduction of their density by thermal treatment and on growth or dying of organisms having survived heat treatment or penetrated into the product after heat treatment as post-process contaminant. Commonly, challenge tests are conducted to provide such information. But they are time consuming and, as their results are only valid for the specific product tested and the conditions prevailing during the experiment, the have to be repeated if there is any modification of intrinsic or extrinsic factors. At least partially, the PM may replace the challenge tests. The efficiency of the models is rated particularly high if they are used already at the stage of product development when the question has to be answered whether a planned recipe or process of production are already save or have to be modified to become save. PMID:15233338

  11. Hearing Test May Predict Autism Risk Sooner

    MedlinePlus

    ... news/fullstory_160181.html Hearing Test May Predict Autism Risk Sooner: Study Researchers identify inner-ear problem ... may help identify young children at risk for autism before they're old enough to speak, a ...

  12. Lipoprotein Metabolism Indicators Improve Cardiovascular Risk Prediction

    PubMed Central

    van Schalkwijk, Daniël B.; de Graaf, Albert A.; Tsivtsivadze, Evgeni; Parnell, Laurence D.; van der Werff-van der Vat, Bianca J. C.; van Ommen, Ben; van der Greef, Jan; Ordovás, José M.

    2014-01-01

    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 investigate whether lipoprotein metabolism indicators can improve cardiovascular risk prediction and therapy management. Methods and Results We calculated lipoprotein metabolism indicators for 1981 subjects (145 cases, 1836 controls) from the Framingham Heart Study offspring cohort in which NMR lipoprotein profiles were measured. We applied a statistical learning algorithm using a support vector machine to select conventional risk factors and lipoprotein metabolism indicators that contributed to predicting risk for general cardiovascular disease. Risk prediction was quantified by the change in the Area-Under-the-ROC-Curve (ΔAUC) and by risk reclassification (Net Reclassification Improvement (NRI) and Integrated Discrimination Improvement (IDI)). Two VLDL lipoprotein metabolism indicators (VLDLE and VLDLH) improved cardiovascular risk prediction. We added these indicators to a multivariate model with the best performing conventional risk markers. Our method significantly improved both CVD prediction and risk reclassification. Conclusions Two calculated VLDL metabolism indicators significantly improved cardiovascular risk prediction. These indicators may help to reduce prescription of unnecessary cholesterol-lowering medication, reducing costs and possible side-effects. For clinical application, further validation is required. PMID:24667559

  13. 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…

  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. 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.

  16. 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.

  17. 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.

  18. 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.

  19. 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.

  20. 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.

  1. 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.

  2. 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.

  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. 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.

  5. 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…

  6. 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

  7. Improving genetic risk prediction by leveraging pleiotropy

    PubMed Central

    Li, Cong; Yang, Can; Gelernter, Joel

    2014-01-01

    An important task of human genetics studies is to predict accurately disease risks in individuals based on genetic markers, which allows for identifying individuals at high disease risks, and facilitating their disease treatment and prevention. Although hundreds of genome-wide association studies (GWAS) have been conducted on many complex human traits in recent years, there has been only limited success in translating these GWAS data into clinically useful risk prediction models. The predictive capability of GWAS data is largely bottlenecked by the available training sample size due to the presence of numerous variants carrying only small to modest effects. Recent studies have shown that different human traits may share common genetic bases. Therefore, an attractive strategy to increase the training sample size and hence improve the prediction accuracy is to integrate data from genetically correlated phenotypes. Yet the utility of genetic correlation in risk prediction has not been explored in the literature. In this paper, we analyzed GWAS data for bipolar and related disorders (BARD) and schizophrenia (SZ) with a bivariate ridge regression method, and found that jointly predicting the two phenotypes could substantially increase prediction accuracy as measured by the AUC (area under the receiver operating characteristic curve). We also found similar prediction accuracy improvements when we jointly analyzed GWAS data for Crohn’s disease (CD) and ulcerative colitis (UC). The empirical observations were substantiated through our comprehensive simulation studies, suggesting that a gain in prediction accuracy can be obtained by combining phenotypes with relatively high genetic correlations. Through both real data and simulation studies, we demonstrated pleiotropy can be leveraged as a valuable asset that opens up a new opportunity to improve genetic risk prediction in the future. PMID:24337655

  8. 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…

  9. Suicidality among pregnant women in Brazil: prevalence and risk factors.

    PubMed

    Castro e Couto, Tiago; Brancaglion, Mayra Yara Martins; Cardoso, Mauro Nogueira; Faria, Gustavo Coutinho; Garcia, Frederico Duarte; Nicolato, Rodrigo; Aguiar, Regina Amélia Lopes P; Leite, Henrique Vitor; Corrêa, Humberto

    2016-04-01

    Suicide is one of the major causes of preventable death. We evaluated suicidality among pregnant women who participated in prenatal care in Brazil. A total of 255 patients were assessed using semi-structured interviews as well as the Edinburgh Postnatal Depression Scale (EPDS), Beck Depression Inventory (BDI), and Mini-International Neuropsychiatric Interview (MINI) Plus. Thereafter, Stata 12 was used to identify the significant predictors of current suicide risk (CSR) among participants using univariate and multivariate analyses (p < 0.05). According to MINI Plus module C, the lifetime suicide attempt rate was 12.55%. The overall CSR was 23.53%, distributed across risk levels of low (12.55%), moderate (1.18%), and high (9.80%). Our rates approximate those found in another Brazilian study (18.4%). Antenatal depression (AD), lifetime bipolar disorder, and any current anxiety disorder (as measured using the MINI) as well as BDI scores ≥15 and EPDS scores ≥11 were identified as positive risk factors in a univariate analysis (p < 0.001). These factors changed after a multivariate analysis was employed, and only years of education [odds ratio (OR) = 0.45; 95% confidence intervals (CIs) = 0.21-0.99], AD (OR = 3.42; 95% CIs = 1.37-8.53), and EPDS scores ≥11 (OR = 4.44; 95% CIs = 1.97-9.97) remained independent risk factors. AD and other psychiatric disorders were the primary risk factors for suicidality, although only the former remained an independent factor after a multivariate analysis. More than 10 years of education and EPDS scores ≥11 were also independent factors; the latter can be used as a screening tool for suicide risk.

  10. SY 04-1 CVD RISK PREDICTION IN HIGH-RISK VERSUS LOW-RISK POPULATIONS.

    PubMed

    Kim, Hyeon Chang

    2016-09-01

    Disease risk prediction models have been developed to assess the impact of multiple risk factors and to estimate an individual's absolute disease risk. Accurate disease prediction is essential for personalized prevention, because the benefits, risks, and costs of alternative strategies must be weighed to choose the best preventive strategy for individual patients. Cardiovascular disease (CVD) prediction is the earliest example of individual risk predictions. Since the Framingham study reported a CVD risk prediction method in 1976, an increasing number of risk assessment tools have been developed to CVD risk in various settings. The Framingham study results are fundamental evidence for the prediction of CVD risk. However, the clinical utility of a disease prediction model can be population-specific because the baseline disease risk, subtype distribution of the disease, and level of exposure to risk factors differ by region and ethnicity.It has been proved that CVD prediction models which were developed in high-risk populations, such as the Framingham Risk Score, overestimate an individual's disease risk when applied to a low-risk population without re-calibration. Thus countries of relatively low CVD risk are trying to re-calibrate the existing CVD prediction models or to develop a new prediction model analyzing their own population data. However, even the re-calibrated or newly-developed CVD prediction models are often of little clinical value in a low-risk population. A good example is the CVD prediction in the Korean population. Compared to Western populations, the Korean population has much lower incidence of coronary heart disease. Therefore, the vast majority of individuals fall into the low-risk group when their disease risk is assessed with a prediction model. Even a well-validated prediction model may not identify high-risk individuals who merit aggressive preventive treatment.A few alternative approaches have been suggested for CVD risk prediction in a low-risk

  11. 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

  12. Assessing calibration of multinomial risk prediction models.

    PubMed

    Van Hoorde, Kirsten; Vergouwe, Yvonne; Timmerman, Dirk; Van Huffel, Sabine; Steyerberg, Ewout W; Van Calster, Ben

    2014-07-10

    Calibration, that is, whether observed outcomes agree with predicted risks, is important when evaluating risk prediction models. For dichotomous outcomes, several tools exist to assess different aspects of model calibration, such as calibration-in-the-large, logistic recalibration, and (non-)parametric calibration plots. We aim to extend these tools to prediction models for polytomous outcomes. We focus on models developed using multinomial logistic regression (MLR): outcome Y with k categories is predicted using k - 1 equations comparing each category i (i = 2, … ,k) with reference category 1 using a set of predictors, resulting in k - 1 linear predictors. We propose a multinomial logistic recalibration framework that involves an MLR fit where Y is predicted using the k - 1 linear predictors from the prediction model. A non-parametric alternative may use vector splines for the effects of the linear predictors. The parametric and non-parametric frameworks can be used to generate multinomial calibration plots. Further, the parametric framework can be used for the estimation and statistical testing of calibration intercepts and slopes. Two illustrative case studies are presented, one on the diagnosis of malignancy of ovarian tumors and one on residual mass diagnosis in testicular cancer patients treated with cisplatin-based chemotherapy. The risk prediction models were developed on data from 2037 and 544 patients and externally validated on 1107 and 550 patients, respectively. We conclude that calibration tools can be extended to polytomous outcomes. The polytomous calibration plots are particularly informative through the visual summary of the calibration performance.

  13. 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.

  14. 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

  15. 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

  16. 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

  17. Adding prediction risk to the theory of reward learning.

    PubMed

    Preuschoff, Kerstin; Bossaerts, Peter

    2007-05-01

    This article analyzes the simple Rescorla-Wagner learning rule from the vantage point of least squares learning theory. In particular, it suggests how measures of risk, such as prediction risk, can be used to adjust the learning constant in reinforcement learning. It argues that prediction risk is most effectively incorporated by scaling the prediction errors. This way, the learning rate needs adjusting only when the covariance between optimal predictions and past (scaled) prediction errors changes. Evidence is discussed that suggests that the dopaminergic system in the (human and nonhuman) primate brain encodes prediction risk, and that prediction errors are indeed scaled with prediction risk (adaptive encoding).

  18. 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

  19. Korean Risk Assessment Model for Breast Cancer Risk Prediction

    PubMed Central

    Park, Boyoung; Ma, Seung Hyun; Shin, Aesun; Chang, Myung-Chul; Choi, Ji-Yeob; Kim, Sungwan; Han, Wonshik; Noh, Dong-Young; Ahn, Sei-Hyun; Kang, Daehee; Yoo, Keun-Young; Park, Sue K.

    2013-01-01

    Purpose We evaluated the performance of the Gail model for a Korean population and developed a Korean breast cancer risk assessment tool (KoBCRAT) based upon equations developed for the Gail model for predicting breast cancer risk. Methods Using 3,789 sets of cases and controls, risk factors for breast cancer among Koreans were identified. Individual probabilities were projected using Gail's equations and Korean hazard data. We compared the 5-year and lifetime risk produced using the modified Gail model which applied Korean incidence and mortality data and the parameter estimators from the original Gail model with those produced using the KoBCRAT. We validated the KoBCRAT based on the expected/observed breast cancer incidence and area under the curve (AUC) using two Korean cohorts: the Korean Multicenter Cancer Cohort (KMCC) and National Cancer Center (NCC) cohort. Results The major risk factors under the age of 50 were family history, age at menarche, age at first full-term pregnancy, menopausal status, breastfeeding duration, oral contraceptive usage, and exercise, while those at and over the age of 50 were family history, age at menarche, age at menopause, pregnancy experience, body mass index, oral contraceptive usage, and exercise. The modified Gail model produced lower 5-year risk for the cases than for the controls (p = 0.017), while the KoBCRAT produced higher 5-year and lifetime risk for the cases than for the controls (p<0.001 and <0.001, respectively). The observed incidence of breast cancer in the two cohorts was similar to the expected incidence from the KoBCRAT (KMCC, p = 0.880; NCC, p = 0.878). The AUC using the KoBCRAT was 0.61 for the KMCC and 0.89 for the NCC cohort. Conclusions Our findings suggest that the KoBCRAT is a better tool for predicting the risk of breast cancer in Korean women, especially urban women. PMID:24204664

  20. 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

  1. Mathematical Modeling Applied to Prediction of Landslides in Southern Brazil

    NASA Astrophysics Data System (ADS)

    Silva, Lúcia; Araújo, João; Braga, Beatriz; Fernandes, Nelson

    2013-04-01

    Mass movements are natural phenomena that occur on the slopes and are important agents working in landscape development. These movements have caused serious damage to infrastructure and properties. In addition to the mass movements occurring in natural slopes, there is also a large number of accidents induced by human action in the landscape. The change of use and land cover for the introduction of agriculture is a good example that have affected the stability of slopes. Land use and/or land cover changes have direct and indirect effects on slope stability and frequently represent a major factor controlling the occurrence of man-induced mass movements. In Brazil, especially in the southern and southeastern regions, areas of original natural rain forest have been continuously replaced by agriculture during the last decades, leading to important modifications in soil mechanical properties and to major changes in hillslope hydrology. In these regions, such effects are amplified due to the steep hilly topography, intense summer rainfall events and dense urbanization. In November 2008, a major landslide event took place in a rural area with intensive agriculture in the state of Santa Catarina (Morro do Baú) where many catastrophic landslides were triggered after a long rainy period. In this area, the natural forest has been replaced by huge banana and pine plantations. The state of Santa Catarina in recent decades has been the scene of several incidents of mass movements such as this catastrophic event. In this study, based on field mapping and modeling, we characterize the role played by geomorphological and geological factors in controlling the spatial distribution of landslides in the Morro do Baú area. In order to attain such objective, a digital elevation model of the basin was generated with a 10m grid in which the topographic parameters were obtained. The spatial distribution of the scars from this major event was mapped from another image, obtained immediately

  2. 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.

  3. 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.

  4. Brazil.

    PubMed

    1985-09-01

    Brazil's population in 1985 was 135 million, with an annual growth rate (1982) of 2.3%. The infant mortality rate (1981) was 92/1000, and life expectancy stood at 62.8 years. 76% of the adult population was literate. Brazil is a federal republic which recognizes 5 political parties. 55% of the population is Portuguese, Italian, German, Japanese, African, or American Indian; 38% is white. Of the work force of 50 million, 35% are engaged in agriculture, 25% work in industry, and 40% are employed in services. Trade union membership totals 6 million. The agricultural sector accounts for 12% of the GDP and 40% of exports. Brazil is largely self-sufficient in terms of food. The GDP was US$218 billion in 1984, with an annual growth rate of 4%. Per capita GDP was US$1645. Brazil's power, transportation, and communications systems have improved greatly in recent years, providing a base for economic development. High inflation rates have been a persistent problem.

  5. 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…

  6. 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 comparison…

  7. 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

  8. 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…

  9. 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.

  10. 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

  11. 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.

  12. Lipoprotein metabolism indicators improve cardiovascular risk prediction

    Technology Transfer Automated Retrieval System (TEKTRAN)

    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...

  13. 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.

  14. 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

  15. Risk factors for early termination of breast feeding in Brazil.

    PubMed

    Giugliani, E R; Issler, R M; Justo, E B; Seffrin, C F; Hartmann, R M; Carvalho, N M

    1992-01-01

    A prospective study was undertaken to identify possible factors related to the duration of breast feeding. Two hundred and thirty-eight mothers who had delivered normal single babies with birth weights greater than 2.5 kg and had initiated breast feeding were randomly selected at the maternity hospital, Hospital de Clinicas de Porto Alegre, Brazil, and followed by mail questionnaires until termination of breast feeding, or until the end of the first year. If no reply was received, telephone contact or home visits were made. The group of mothers who stopped breast feeding prior to the end of the third month was compared with those who extended breast feeding beyond three months with respect to socioeconomic, biological, environmental, medical and psychological factors. The variables with a significant coefficient of association with early termination of breast feeding were maternal education, past experience with breast feeding, help of a maid, help with housework provided by a relative, breast feeding orientation during prenatal care and encouragement from the husband. These factors act simultaneously, with interactions among them.

  16. 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.

  17. 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

  18. 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…

  19. 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

  20. 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

  1. 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.

  2. Development and application of chronic disease risk prediction models.

    PubMed

    Oh, Sun Min; Stefani, Katherine M; Kim, Hyeon Chang

    2014-07-01

    Currently, non-communicable chronic diseases are a major cause of morbidity and mortality worldwide, and a large proportion of chronic diseases are preventable through risk factor management. However, the prevention efficacy at the individual level is not yet satisfactory. Chronic disease prediction models have been developed to assist physicians and individuals in clinical decision-making. A chronic disease prediction model assesses multiple risk factors together and estimates an absolute disease risk for the individual. Accurate prediction of an individual's future risk for a certain disease enables the comparison of benefits and risks of treatment, the costs of alternative prevention strategies, and selection of the most efficient strategy for the individual. A large number of chronic disease prediction models, especially targeting cardiovascular diseases and cancers, have been suggested, and some of them have been adopted in the clinical practice guidelines and recommendations of many countries. Although few chronic disease prediction tools have been suggested in the Korean population, their clinical utility is not as high as expected. This article reviews methodologies that are commonly used for developing and evaluating a chronic disease prediction model and discusses the current status of chronic disease prediction in Korea.

  3. SY 04-4 HOW TO IMPROVE CVD RISK PREDICTION IN A LOW-RISK POPULATION.

    PubMed

    Chia, Yook Chin

    2016-09-01

    : Many cardiovascular disease (CVD) risk prediction tools have been developed in an attempt to identify those at highest risk in order for them to benefit from interventional treatment. The first CVD risk tool that was developed was the coronary heart disease risk tool by the Framingham Heart Study in 1998 (1). However the Framingham Risk Score could overestimate (or underestimate) risk in populations other than the US population. Hence several other risk engines have also been developed, primarily for a better fit in the communities in which the tools are to be used (2, 3). Having said that the Framingham Heart Study risk tool has been validated in several populations (4, 5) and found to work reasonably well after some recalibration.Most risk prediction tools predict short term risk ie over a period of 10 years but since more recently risk tools now attempt to predict life-time risk or at least risk over the next 30 years. (6-8). The practical use of these risk prediction tools is that it is able to separate those at high risk (ie > 20% risk of a CVD event fatal or non-fatal event in the next 10 years) from those with the lowest risk (< 10% risk over 10 years). It then helps practitioners to triage them to either receive preventive therapy (high risk group) or none at all (low risk group) respectively. However in those with medium risk ie between 10-20%, the decision to offer treatment or not is less clear. In such a situation, other CVD risk factors for example family history of premature coronary heart disease, other biomarkers like elevated hs-CRP, presence of chronic kidney disease or albuminuria can be employed to further stratify risk.It is known that risk prediction tools are very much age dependent and in a younger individual with mildly raised CVD risk factors, his global CVD risk may be grossly under-estimated. Here additional CVD risk factors beyond those traditionally used in risk engines should be sought in order to recalibrate that individual

  4. 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. PMID:23692142

  5. 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.

  6. Risk of coronary heart disease among HIV-infected patients: a multicenter study in Brazil.

    PubMed

    Fuchs, Sandra C; Alencastro, Paulo R; Ikeda, Maria Letícia R; Barcellos, Nêmora T; Wolff, Fernando H; Brandão, Ajácio B M; Ximenes, Ricardo A A; Miranda-Filho, Demócrito de B; Lacerda, Heloísa Ramos; de Albuquerque, Maria de Fátima P M; Montarroyos, Ulisses Ramos; Nery, Max W; Turchi, Marilia D

    2013-01-01

    Cardiovascular disease has emerged as a crescent problem among HIV-infected population. This study aimed to determine the 10-year risk of coronary heart disease using the Framingham risk score among HIV-infected patients from three regions of Brazil. This is a pooled analysis of three cohort studies, which enrolled 3,829 individuals, 59% were men, 66% had white skin color, and mean age 39.0 ± 9.9 years. Comparisons among regions showed that there were marked differences in demographic, socioeconomic, clinical, and HIV-related characteristics. Prevalence of Framingham score ≥10 was 4.5% in the Southern, 4.2% in the Midwest, and 3.9% in the Northeast of Brazil. The Framingham score ≥10 was similar between regions for males, patients aged ≥60 years, with obesity, central obesity, hypertension, and diabetes mellitus. Women were three times more likely to have coronary heart disease in 10 years than men. Hypertension and diabetes increased more than four times the risk of coronary heart disease, followed by central obesity, obesity, and prehypertension. The use of antiretroviral agents and time since HIV diagnosis were not risk factors for coronary artery disease in 10 years. In conclusion, hypertension and diabetes are the strongest independent predictors of 10-year risk of coronary heart disease among HIV-infected population.

  7. Predicting Tick Presence by Environmental Risk Mapping

    PubMed Central

    Swart, Arno; Ibañez-Justicia, Adolfo; Buijs, Jan; van Wieren, Sip E.; Hofmeester, Tim R.; Sprong, Hein; Takumi, Katsuhisa

    2014-01-01

    Public health statistics recorded an increasing trend in the incidence of tick bites and erythema migrans (EM) in the Netherlands. We investigated whether the disease incidence could be predicted by a spatially explicit categorization model, based on environmental factors and a training set of tick absence–presence data. Presence and absence of Ixodes ricinus were determined by the blanket-dragging method at numerous sites spread over the Netherlands. The probability of tick presence on a 1 km by 1 km square grid was estimated from the field data using a satellite-based methodology. Expert elicitation was conducted to provide a Bayesian prior per landscape type. We applied a linear model to test for a linear relationship between incidence of EM consultations by general practitioners in the Netherlands and the estimated probability of tick presence. Ticks were present at 252 distinct sampling coordinates and absent at 425. Tick presence was estimated for 54% of the total land cover. Our model has predictive power for tick presence in the Netherlands, tick-bite incidence per municipality correlated significantly with the average probability of tick presence per grid. The estimated intercept of the linear model was positive and significant. This indicates that a significant fraction of the tick-bite consultations could be attributed to the I. ricinus population outside the resident municipality. PMID:25505781

  8. 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.

  9. 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. PMID:27301685

  10. A predictive Bayesian approach to risk analysis in health care

    PubMed Central

    Aven, Terje; Eidesen, Karianne

    2007-01-01

    Background The Bayesian approach is now widely recognised as a proper framework for analysing risk in health care. However, the traditional text-book Bayesian approach is in many cases difficult to implement, as it is based on abstract concepts and modelling. Methods The essential points of the risk analyses conducted according to the predictive Bayesian approach are identification of observable quantities, prediction and uncertainty assessments of these quantities, using all the relevant information. The risk analysis summarizes the knowledge and lack of knowledge concerning critical operations and other activities, and give in this way a basis for making rational decisions. Results It is shown that Bayesian risk analysis can be significantly simplified and made more accessible compared to the traditional text-book Bayesian approach by focusing on predictions of observable quantities and performing uncertainty assessments of these quantities using subjective probabilities. Conclusion The predictive Bayesian approach provides a framework for ensuring quality of risk analysis. The approach acknowledges that risk cannot be adequately described and evaluated simply by reference to summarising probabilities. Risk is defined by the combination of possible consequences and associated uncertainties. PMID:17714597

  11. 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

  12. 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.

  13. 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. PMID:25828551

  14. 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.

  15. Risk analysis of herbicide quinclorac residues in irrigated rice areas, Santa Catarina, Brazil.

    PubMed

    Resgalla, Charrid; Noldin, José A; Tamanaha, Márico S; Deschamps, Francisco C; Eberhardt, D S; Rörig, L R

    2007-11-01

    Deterministic and probabilistic risk analyses were carried out for seven hydrographic basins in the State of Santa Catarina (Brazil), where irrigated rice is cultivated. Monitoring studies conducted in 1998/1999 and 1999/2000 had found that the herbicide quinclorac was the most frequently detected agrochemical residue, occurring in five of the seven hydrographic basins. In order to assess the ecological risk posed by quinclorac, median lethal concentration (LC(50)) and median effective concentration (EC(50)) data were obtained for quinclorac in toxicity tests with organisms routinely used in Brazil for this purpose. Experiments were carried out on microcosms associated with the irrigated rice crop to evaluate the effects of the herbicide on the natural plankton community. The deterministic analyses showed that the risk presented by the herbicide residues to the phytoplankton require mitigating action, while the probabilistic analysis revealed that the levels of risk for the aquatic community were acceptable. Field experiments showed that the recommended application concentration of the product directly affects phytoplankton and has an indirect, short-term effect on the zooplankton community. PMID:17879160

  16. 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. PMID:26851592

  17. 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

  18. Reformulating Suicide Risk Formulation: From Prediction to Prevention.

    PubMed

    Pisani, Anthony R; Murrie, Daniel C; Silverman, Morton M

    2016-08-01

    Psychiatrists-in-training typically learn that assessments of suicide risk should culminate in a probability judgment expressed as "low," "moderate," or "high." This way of formulating risk has predominated in psychiatric education and practice, despite little evidence for its validity, reliability, or utility. We present a model for teaching and communicating suicide risk assessments without categorical predictions. Instead, we propose risk formulations which synthesize data into four distinct judgments to directly inform intervention plans: (1) risk status (the patient's risk relative to a specified subpopulation), (2) risk state (the patient's risk compared to baseline or other specified time points), (3) available resources from which the patient can draw in crisis, and (4) foreseeable changes that may exacerbate risk. An example case illustrates the conceptual shift from a predictive to a preventive formulation, and we outline steps taken to implement the model in an academic psychiatry setting. Our goal is to inform educational leaders, as well as individual educators, who can together cast a prevention-oriented vision in their academic programs. PMID:26667005

  19. [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.

  20. [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. PMID:7732221

  1. 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.

  2. Utility functions predict variance and skewness risk preferences in monkeys.

    PubMed

    Genest, Wilfried; Stauffer, William R; Schultz, Wolfram

    2016-07-26

    Utility is the fundamental variable thought to underlie economic choices. In particular, utility functions are believed to reflect preferences toward risk, a key decision variable in many real-life situations. To assess the validity of utility representations, it is therefore important to examine risk preferences. In turn, this approach requires formal definitions of risk. A standard approach is to focus on the variance of reward distributions (variance-risk). In this study, we also examined a form of risk related to the skewness of reward distributions (skewness-risk). Thus, we tested the extent to which empirically derived utility functions predicted preferences for variance-risk and skewness-risk in macaques. The expected utilities calculated for various symmetrical and skewed gambles served to define formally the direction of stochastic dominance between gambles. In direct choices, the animals' preferences followed both second-order (variance) and third-order (skewness) stochastic dominance. Specifically, for gambles with different variance but identical expected values (EVs), the monkeys preferred high-variance gambles at low EVs and low-variance gambles at high EVs; in gambles with different skewness but identical EVs and variances, the animals preferred positively over symmetrical and negatively skewed gambles in a strongly transitive fashion. Thus, the utility functions predicted the animals' preferences for variance-risk and skewness-risk. Using these well-defined forms of risk, this study shows that monkeys' choices conform to the internal reward valuations suggested by their utility functions. This result implies a representation of utility in monkeys that accounts for both variance-risk and skewness-risk preferences. PMID:27402743

  3. Utility functions predict variance and skewness risk preferences in monkeys

    PubMed Central

    Genest, Wilfried; Stauffer, William R.; Schultz, Wolfram

    2016-01-01

    Utility is the fundamental variable thought to underlie economic choices. In particular, utility functions are believed to reflect preferences toward risk, a key decision variable in many real-life situations. To assess the validity of utility representations, it is therefore important to examine risk preferences. In turn, this approach requires formal definitions of risk. A standard approach is to focus on the variance of reward distributions (variance-risk). In this study, we also examined a form of risk related to the skewness of reward distributions (skewness-risk). Thus, we tested the extent to which empirically derived utility functions predicted preferences for variance-risk and skewness-risk in macaques. The expected utilities calculated for various symmetrical and skewed gambles served to define formally the direction of stochastic dominance between gambles. In direct choices, the animals’ preferences followed both second-order (variance) and third-order (skewness) stochastic dominance. Specifically, for gambles with different variance but identical expected values (EVs), the monkeys preferred high-variance gambles at low EVs and low-variance gambles at high EVs; in gambles with different skewness but identical EVs and variances, the animals preferred positively over symmetrical and negatively skewed gambles in a strongly transitive fashion. Thus, the utility functions predicted the animals’ preferences for variance-risk and skewness-risk. Using these well-defined forms of risk, this study shows that monkeys’ choices conform to the internal reward valuations suggested by their utility functions. This result implies a representation of utility in monkeys that accounts for both variance-risk and skewness-risk preferences. PMID:27402743

  4. Utility functions predict variance and skewness risk preferences in monkeys.

    PubMed

    Genest, Wilfried; Stauffer, William R; Schultz, Wolfram

    2016-07-26

    Utility is the fundamental variable thought to underlie economic choices. In particular, utility functions are believed to reflect preferences toward risk, a key decision variable in many real-life situations. To assess the validity of utility representations, it is therefore important to examine risk preferences. In turn, this approach requires formal definitions of risk. A standard approach is to focus on the variance of reward distributions (variance-risk). In this study, we also examined a form of risk related to the skewness of reward distributions (skewness-risk). Thus, we tested the extent to which empirically derived utility functions predicted preferences for variance-risk and skewness-risk in macaques. The expected utilities calculated for various symmetrical and skewed gambles served to define formally the direction of stochastic dominance between gambles. In direct choices, the animals' preferences followed both second-order (variance) and third-order (skewness) stochastic dominance. Specifically, for gambles with different variance but identical expected values (EVs), the monkeys preferred high-variance gambles at low EVs and low-variance gambles at high EVs; in gambles with different skewness but identical EVs and variances, the animals preferred positively over symmetrical and negatively skewed gambles in a strongly transitive fashion. Thus, the utility functions predicted the animals' preferences for variance-risk and skewness-risk. Using these well-defined forms of risk, this study shows that monkeys' choices conform to the internal reward valuations suggested by their utility functions. This result implies a representation of utility in monkeys that accounts for both variance-risk and skewness-risk preferences.

  5. The impact of covariate measurement error on risk prediction.

    PubMed

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

    2015-07-10

    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

  6. 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.

  7. 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. PMID:25271457

  8. 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.

  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. 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. PMID:26263189

  11. 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.

  12. 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.

  13. 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.

  14. 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.

  15. 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. PMID:27352090

  16. 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

  17. Predicting perceived risk of crime: a multilevel study.

    PubMed

    Russo, Silvia; Roccato, Michele; Vieno, Alessio

    2011-12-01

    With a sample of Italians selected from 71 Italian counties (N = 1,868), we performed two multilevel analyses aimed at predicting the perceived risk of crime at local (i.e., in the participants' county of residence) and at societal (i.e., in the context of Italian society) levels. A significant proportion of the variation in local risk perception was at the county level. The following individual variables predicted higher levels of this variable: indirect victimization, the perception of social and physical disorder, being a woman, being poorly educated, and being an older person. Among the ecological predictors, the crime rate and unemployment rate predicted higher levels of local crime risk perception, while the immigrant rate did not. Perceived risk of crime at the societal level did not show significant variation at the county level. Education, being a man, trusting people, and adhesion to post-materialistic values predicted lower levels of societal crime risk perception, while number of sons/daughters and exposure to television news increased it. The limitations and possible development of this study are discussed.

  18. 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

  19. Risk assessment and remedial policy evaluation using predictive modeling

    SciTech Connect

    Linkov, L.; Schell, W.R.

    1996-06-01

    As a result of nuclear industry operation and accidents, large areas of natural ecosystems have been contaminated by radionuclides and toxic metals. Extensive societal pressure has been exerted to decrease the radiation dose to the population and to the environment. Thus, in making abatement and remediation policy decisions, not only economic costs but also human and environmental risk assessments are desired. This paper introduces a general framework for risk assessment and remedial policy evaluation using predictive modeling. Ecological risk assessment requires evaluation of the radionuclide distribution in ecosystems. The FORESTPATH model is used for predicting the radionuclide fate in forest compartments after deposition as well as for evaluating the efficiency of remedial policies. Time of intervention and radionuclide deposition profile was predicted as being crucial for the remediation efficiency. Risk assessment conducted for a critical group of forest users in Belarus shows that consumption of forest products (berries and mushrooms) leads to about 0.004% risk of a fatal cancer annually. Cost-benefit analysis for forest cleanup suggests that complete removal of organic layer is too expensive for application in Belarus and a better methodology is required. In conclusion, FORESTPATH modeling framework could have wide applications in environmental remediation of radionuclides and toxic metals as well as in dose reconstruction and, risk-assessment.

  20. 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.

  1. Investigation on Cardiovascular Risk Prediction Using Physiological Parameters

    PubMed Central

    Lin, Wan-Hua; Zhang, Heye; Zhang, Yuan-Ting

    2013-01-01

    Cardiovascular disease (CVD) is the leading cause of death worldwide. Early prediction of CVD is urgently important for timely prevention and treatment. Incorporation or modification of new risk factors that have an additional independent prognostic value of existing prediction models is widely used for improving the performance of the prediction models. This paper is to investigate the physiological parameters that are used as risk factors for the prediction of cardiovascular events, as well as summarizing the current status on the medical devices for physiological tests and discuss the potential implications for promoting CVD prevention and treatment in the future. The results show that measures extracted from blood pressure, electrocardiogram, arterial stiffness, ankle-brachial blood pressure index (ABI), and blood glucose carry valuable information for the prediction of both long-term and near-term cardiovascular risk. However, the predictive values should be further validated by more comprehensive measures. Meanwhile, advancing unobtrusive technologies and wireless communication technologies allow on-site detection of the physiological information remotely in an out-of-hospital setting in real-time. In addition with computer modeling technologies and information fusion. It may allow for personalized, quantitative, and real-time assessment of sudden CVD events. PMID:24489599

  2. QSAR in predictive models for ecological risk assessment

    SciTech Connect

    Passino-Reader, D.R.; Hickey, J.P.

    1994-12-31

    The end use of toxicity and exposure data is risk assessment to determine the probability that receptors experience harmful effects from exposure to environmental contaminants at a site. Determination of processes and development of predictive models precede the collection of data for risk assessment. The presence of hundreds of contaminants at a site and absence of data for many contaminants lead to the use of QSAR to implement the models. Examples of the use of linear salvation energy relationships (LSER) to provide estimates of aquatic toxicity and exposure endpoints will be provided. Integration of QSAR estimates and measured data must be addressed in the uncertainty analysis accompanying ecological risk assessment.

  3. HIV seroprevalence and high-risk sexual behavior among female sex workers in Central Brazil.

    PubMed

    Fernandes, Fernanda R P; Mousquer, Gina J; Castro, Lisie S; Puga, Marco A; Tanaka, Tayana S O; Rezende, Grazielli R; Pinto, Clarice S; Bandeira, Larissa M; Martins, Regina M B; Francisco, Roberta B L; Teles, Sheila A; Motta-Castro, Ana R C

    2014-01-01

    Female sex workers (FSWs) are considered a high-risk group for human immunodeficiency virus (HIV) infection due to their social vulnerability and factors associated with their work. We estimated the prevalence of HIV, and identified viral subtypes and risk factors among FSWs. A cross-sectional study using respondent-driven sampling (RDS) method was conducted among 402 FSWs in Campo Grande city, Brazil, from 2009 to 2011. Participants were interviewed using a standardized questionnaire about sociodemograpic characteristics and risk behavior. Blood samples were collected for serological testing of HIV. Of the 402 FSWs, median age and age of initiating sex work were 25 years (Interquartile range [IQR]: 9) and 20 years (IQR: 6), respectively. The majority reported use of alcohol (88.5%), had 5-9 years (median: 9; IQR: 3) of schooling (54.5%), 68.6% had tattoos/body piercings, and 45.1% had more than seven clients per week (median: 7; IQR: 10). Only 32.9% of FSW reported using a condom with nonpaying partners in the last sexual contact. Prevalence of HIV infection was 1.0% (95% CI: 0.1-2.6%). Genotyping for HIV-1 performed on three samples detected subtypes B, C, and F1. Sex work in the Midwestern region of Brazil is characterized by reduced education, large numbers of clients per week, and inconsistent condom use, mainly with nonpaying partners. Although prevalence of HIV infection is currently low, elevated levels of high-risk sexual behavior confirm a need to implement prevention measures. Specific interventions targeting FSWs must emphasize the risk associated with both clients and nonpaying partners while providing knowledge about HIV prevention.

  4. 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. PMID:24854500

  5. 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.

  6. 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.

  7. Risk Factors for Death from Visceral Leishmaniasis in an Urban Area of Brazil

    PubMed Central

    Druzian, Angelita F.; de Souza, Albert S.; de Campos, Diogo N.; Croda, Julio; Higa, Minoru G.; Dorval, Maria Elizabeth C.; Pompilio, Mauricio A.; de Oliveira, Polliana A.; Paniago, Anamaria M. M.

    2015-01-01

    Background Over the last three decades, the epidemiological profile of visceral leishmaniasis (VL) has changed with epidemics occurring in large urban centers of Brazil, an increase in HIV/AIDS co-infection, and a significant increase in mortality. The objective of this study was to identify the risk factors associated with death among adult patients with VL from an urban endemic area of Brazil. Methodology A prospective cohort study included 134 adult patients with VL admitted to the University Hospital of the Federal University of Mato Grosso do Sul between August 2011 and August 2013. Principal Findings Patients ranged from 18 to 93 years old, with a mean age of 43.6 (±15.7%). Of these patients, 36.6% were co-infected with HIV/AIDS, and the mortality rate was 21.6%. In a multivariate analysis, the risk factors associated with death were secondary bacterial infection (42.86, 5.05–363.85), relapse (12.17, 2.06–71.99), edema (7.74, 1.33–45.05) and HIV/AIDS co-infection (7.33, 1.22–43.98). Conclusions/Significance VL has a high mortality rate in adults from endemic urban areas, especially when coinciding with high rates of HIV/AIDS co-infection. PMID:26274916

  8. [Risk Analysis applied to food safety in Brazil: prospects and challenges].

    PubMed

    Figueiredo, Ana Virgínia de Almeida; Miranda, Maria Spínola

    2011-04-01

    The scope of this case study is to discuss the ideas of the Brazilian Codex Alimentarius Committee (CCAB) coordinated by National Institute of Metrology, Standardization and Industrial Quality (Inmetro), with respect to the Codex Alimentarius norm on Risk Analysis (RA) applied to Food Safety. The objectives of this investigation were to identify and analyze the opinion of CCAB members on RA and to register their proposals for the application of this norm in Brazil, highlighting the local limitations and potential detected. CCAB members were found to be in favor of the Codex Alimentarius initiative of instituting an RA norm to promote the health safety of foods that circulate on the international market. There was a consensus that the Brazilian government should incorporate RA as official policy to improve the country's system of food control and leverage Brazilian food exports. They acknowledge that Brazil has the technical-scientific capacity to apply this norm, though they stressed several political and institutional limitations. The members consider RA to be a valid initiative for tackling risks in food, due to its ability to improve food safety control measures adopted by the government.

  9. Evaluation of a Genetic Risk Score to Improve Risk Prediction for Alzheimer’s Disease

    PubMed Central

    Chouraki, Vincent; Reitz, Christiane; Maury, Fleur; Bis, Joshua C.; Bellenguez, Celine; Yu, Lei; Jakobsdottir, Johanna; Mukherjee, Shubhabrata; Adams, Hieab H.; Choi, Seung Hoan; Larson, Eric B.; Fitzpatrick, Annette; Uitterlinden, Andre G.; de Jager, Philip L.; Hofman, Albert; Gudnason, Vilmundur; Vardarajan, Badri; Ibrahim-Verbaas, Carla; van der Lee, Sven J.; Lopez, Oscar; Dartigues, Jean-François; Berr, Claudine; Amouyel, Philippe; Bennett, David A.; van Duijn, Cornelia; DeStefano, Anita L.; Launer, Lenore J.; Ikram, M. Arfan; Crane, Paul K.; Lambert, Jean-Charles; Mayeux, Richard; Seshadri, Sudha

    2016-01-01

    Effective prevention of Alzheimer’s disease (AD) requires the development of risk prediction tools permitting preclinical intervention. We constructed a genetic risk score (GRS) comprising common genetic variants associated with AD, evaluated its association with incident AD and assessed its capacity to improve risk prediction over traditional models based on age, sex, education, and APOE ε4. In eight prospective cohorts included in the International Genomics of Alzheimer’s Project (IGAP), we derived weighted sum of risk alleles from the 19 top SNPs reported by the IGAP GWAS in participants aged 65 and older without prevalent dementia. Hazard ratios (HR) of incident AD were estimated in Cox models. Improvement in risk prediction was measured by the difference in C-index (Δ–C), the integrated discrimination improvement (IDI) and continuous net reclassification improvement (NRI>0). Overall, 19,687 participants at risk were included, of whom 2,782 developed AD. The GRS was associated with a 17% increase in AD risk (pooled HR = 1.17; 95%CI = [1.13–1.21] per standard deviation increase in GRS; p-value = 2.86 × 10−16). This association was stronger among persons with at least one APOE ε4 allele (HRGRS = 1.24; 95%CI = [1.15–1.34]) than in others (HRGRS = 1.13; 95%CI = [1.08–1.18]; pinteraction = 3.45 × 10−2). Risk prediction after seven years of follow-up showed a small improvement when adding the GRS to age, sex, APOE ε4, and education (Δ–Cindex = 0.0043 [0.0019–0.0067]). Similar patterns were observed for IDI and NRI>0. In conclusion, a risk score incorporating common genetic variation outside the APOE ε4 locus improved AD risk prediction and may facilitate risk stratification for prevention trials. PMID:27340842

  10. 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

  11. Genome-Based Risk Prediction for Early Stage Breast Cancer

    PubMed Central

    Adaniel, Christina; Jhaveri, Komal; Heguy, Adriana

    2014-01-01

    Tests to better characterize tumor genomic architecture are quickly becoming a standard of care in oncology. For breast cancer, the use of gene expression assays for early stage disease is already common practice. These tests have found a place in risk stratifying the heterogeneous group of stage I–II breast cancers for recurrence, for predicting chemotherapy response, and for predicting breast cancer-related mortality. In the last 5 years, more assays have become available to the practicing oncologist. Given the rapidity with which this field has evolved, it is prudent to review the tests, their indications, and the studies from which they have been validated. We present a comprehensive review of the available gene expression assays for early stage breast cancer. We review data for several individual tests and comparative studies looking at risk prediction and cost-effectiveness. PMID:25187476

  12. Repeat Cardiovascular Risk Assessment after Four Years: Is There Improvement in Risk Prediction?

    PubMed Central

    Chamnan, Parinya; Simmons, Rebecca K.; Sharp, Stephen J.; Khaw, Kay-Tee; Wareham, Nicholas J.; Griffin, Simon J.

    2016-01-01

    Background Framingham risk equations are widely used to predict cardiovascular disease based on health information from a single time point. Little is known regarding use of information from repeat risk assessments and temporal change in estimated cardiovascular risk for prediction of future cardiovascular events. This study was aimed to compare the discrimination and risk reclassification of approaches using estimated cardiovascular risk at single and repeat risk assessments Methods Using data on 12,197 individuals enrolled in EPIC-Norfolk cohort, with 12 years of follow-up, we examined rates of cardiovascular events by levels of estimated absolute risk (Framingham risk score) at the first and second health examination four years later. We calculated the area under the receiver operating characteristic curve (aROC) and risk reclassification, comparing approaches using information from single and repeat risk assessments (i.e., estimated risk at different time points). Results The mean Framingham risk score increased from 15.5% to 17.5% over a mean of 3.7 years from the first to second health examination. Individuals with high estimated risk (≥20%) at both health examinations had considerably higher rates of cardiovascular events than those who remained in the lowest risk category (<10%) in both health examinations (34.0 [95%CI 31.7–36.6] and 2.7 [2.2–3.3] per 1,000 person-years respectively). Using information from the most up-to-date risk assessment resulted in a small non-significant change in risk classification over the previous risk assessment (net reclassification improvement of -4.8%, p>0.05). Using information from both risk assessments slightly improved discrimination compared to information from a single risk assessment (aROC 0.76 and 0.75 respectively, p<0.001). Conclusions Using information from repeat risk assessments over a period of four years modestly improved prediction, compared to using data from a single risk assessment. However, this

  13. RegCM4 Dynamical Downscaling of Seasonal Climate Predictions over the Southeast of Brazil

    NASA Astrophysics Data System (ADS)

    Reboita, Michelle S.; Dutra, Lívia M. M.; da Rocha, Rosmeri P.

    2013-04-01

    In this study the Regional Climate Model version 4 (RegCM4) was nested in the General Circulation Model from the Brazilian Center for Weather Forecasts and Climate Studies (CPTEC) to produce three month (seasonal) predictions to the southeast of Brazil (SB). The predictions for MAM (March-April-May), AMJ (April-May-June) and SON (September-October-November) of 2012 used six different parameterizations of convection: 1) Grell with Arakawa-Schubert (GAS) closure, 2) Grell with Fritsch-Chappell (GFC) closure, 3) Kuo, 4) Emanuel (EM), 5) Mixed-1 with GFC and Emanuel schemes over the land and ocean, respectively and 6) Mixed-2 with Emanuel and GFC over the land and ocean, respectively. The simulations started 48 days before the seasons of interest to permit a spin-up period. The predicted precipitation was compared with observation from Climate Prediction Center (CPC). For MAM/2012, the experiment with Kuo scheme presented the seasonal precipitation similar to CPC, while GAS, GFC and Mixed-1 experiments underestimated the precipitation (~1-2 mm/day) over the center of SB and EM and Mixed-2 schemes overestimated it (~4 mm/day) over most part of SB. For AMJ/2012 all experiments underestimated the precipitation (~2-3 mm/day) in the central-south part of SB, but they simulated the precipitation intensity close to the observation over the center-north SB (except the EM which shows overestimation in this area). For this season, Mixed-1 presented the smaller bias compared to the other convective schemes. For AMJ/2012, the experiments underestimated the precipitation (~2-4 mm/day) over the center-north of SB and overestimated it (~2-4 mm/day) in the eastern sector. In this period, the EM and Mixed-1 predictions presented the smaller bias compared to CPC. Considering the three seasons, this study suggests that the best convective scheme to seasonal predictions for SB is Mixed-1, while GFC, GAS and Kuo also produce satisfactory seasonal precipitation.

  14. 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…

  15. 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

    2011-01-01

    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. 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

  17. 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

  18. 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

  19. 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

  20. 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.

  1. 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.

  2. 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.

  3. 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. PMID:16479901

  4. 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.

  5. [Brazil: street children in the risk zone for HIV and AIDS].

    PubMed

    Ommundsen, C

    1993-08-26

    In the fall of 1992 the Foundation ARCA (Association for Prevention and Assistance of Street Children with AIDS) was established in Sao Paulo. Eventually cooperation developed between Sao Paulo state officials, Noah's Ark, the Swedish Red Cross, and ARCA with a view to establishing a home for street children with AIDS. The lifestyle of these children exposes them to a high risk of infection with AIDS because of narcotic use, sex behavior, and prostitution. Unofficial data from Mexico, the Dominican Republic, and Brazil suggest that 2-10% of street children may be infected with HIV. In February 1989 there 145 million children in the world who worked in the streets, 24 million of them in Brazil (7 million lived permanently in the streets). The state of Sao Paulo had 64% of the 22,545 AIDS cases reported up to March 1993. Approximately 100,000 HIV-positive people are treated at other health facilities in other states of Brazil. The shelter for AIDS-afflicted street children intends to treat the infections or give the children the opportunity to die with dignity. These children are 8-17 years old. The initial 15 beds are envisioned to increase to 60 beds. Preventive promotional campaigns are also planned to reduce the spread of HIV among street kids. In the summer of 1992 the mass media in Sao Paulo and ARCA hosted a cultural fundraiser to which influential persons were invited, and the profits were donated to ARCA. An abandoned motel has also ben donated to ARCA for carrying out the desired activities.

  6. Prediction of risk for drug use in high school students.

    PubMed

    Climent, C E; de Aragon, L V; Plutchik, R

    1990-05-01

    On the basis of questionnaires administered to almost 2,000 high school students in Cali, Colombia, a subset of items was selected that deal primarily with parent--child relationships. This 53-item set, referred to as the Drug Risk Scale (DRS), was administered to two new cross-validation samples, one consisting of high school students and the other consisting of drug addicts attending drug rehabilitation centers. Significant differences in parent--child relations were found between these new groups. The DRS was also found to have reasonably high sensitivity and specificity. Its potential value as a risk-prediction instrument is discussed. PMID:2258260

  7. Prediction of risk for drug use in high school students.

    PubMed

    Climent, C E; de Aragón, L V; Plutchik, R

    1989-11-01

    On the basis of questionnaires administered to almost 2,000 high school students in Cali, Colombia, a subset of items was selected that deal primarily with parent-child relationships. This 53 item set, referred to as the Drug Risk Scale (DRS), was administered to two new cross-validation samples, one consisting of high school students and the other consisting of drug addicts attending drug rehabilitation centers. Significant differences in parent-child relations were found between these new groups. The DRS was also found to have reasonably high sensitivity and specificity. Its potential value as a risk-prediction instrument is discussed. PMID:2628355

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

    PubMed Central

    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. PMID:26496190

  9. Prevalence and risk factors for bovine tuberculosis in Minas Gerais State, Brazil.

    PubMed

    Belchior, Ana Paula Cunha; Lopes, Luciano Bastos; Gonçalves, Vitor Salvador Picão; Leite, Rômulo Cerqueira

    2016-02-01

    The aim of the present study was to estimate the prevalence and regional spread of bovine tuberculosis in the state of Minas Gerais, Brazil, to identify herd-level risk factors, and to provide guidance for disease control and mitigation of its impact in public health. The study comprised a large-scale random sample survey of 22,990 animals and 1586 herds, distributed in seven regions. A questionnaire was applied on each farm to collect epidemiological and herd management data. Overall, 5.04 % of herds and 0.81 % of animals were positive for bovine tuberculosis. The highest herd prevalence was found in Alto Paranaíba, an expanding dairy region. The more technologically advanced dairy herds showed a prevalence ratio of 2.83 compared to others and are obvious candidates for risk-based surveillance and herd accreditation schemes. Small farms cannot be left out of disease control efforts because they are the vast majority of herds, albeit with lower individual risk. With regard to public health, there is widespread practice of producing homemade fresh cheese with raw milk and of slaughtering culled cows in places without sanitary inspection. This poses a risk to consumers and limits the efficacy of surveillance at slaughter. PMID:26584941

  10. Predicting the risk for lymphoma development in Sjogren syndrome

    PubMed Central

    Fragkioudaki, Sofia; Mavragani, Clio P.; Moutsopoulos, Haralampos M.

    2016-01-01

    Abstract The heightened risk of non-Hodgkin lymphoma (NHL) development in primary Sjogren syndrome (SS) is well established. Several adverse clinical and laboratory predictors have been described. In the current work, we aimed to formulate a predictive score for NHL development, based on clinical, serological, and histopathological findings at the time of SS diagnosis. In the present case–control study of 381 primary SS patients and 92 primary SS patients with concomitant NHL, clinical, serological, and histopathological variables at the time of SS diagnosis were retrospectively recorded. For the identification of predictors for NHL development univariate and multivariate models were constructed. Salivary gland enlargement (SGE), lymphadenopathy, Raynaud phenomenon, anti-Ro/SSA or/and anti-La/SSB autoantibodies, rheumatoid factor (RF) positivity, monoclonal gammopathy, and C4 hypocomplementemia were shown to be independent predictors for NHL development. On the basis of the number of independent risk factors identified, a predictive risk score for NHL development was formulated. Thus, patients presenting with ≤2 risk factors had a 3.8% probability of NHL development, those with 3 to 6 risk factors 39.9% (OR (95%CI): 16.6 [6.5–42.5], P < 0.05), while in the presence of all 7 risk factors the corresponding probability reached 100% (OR [95%CI]: 210.0 [10.0–4412.9], P < 0.0001). In conclusion, an easy to use diagnostic scoring tool for NHL development in the context of SS is presented. This model is highly significant for the design of early therapeutic interventions in high risk SS patients for NHL development. PMID:27336863

  11. 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.

  12. 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. PMID:24356890

  13. 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.

  14. 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

  15. 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. PMID:23163724

  16. 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.

  17. 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

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

    PubMed

    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.

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

    PubMed

    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

  20. Predicting the risk of extinction from shared ecological characteristics

    PubMed Central

    Kotiaho, Janne S.; Kaitala, Veijo; Komonen, Atte; Päivinen, Jussi

    2005-01-01

    Understanding the ultimate causes of population declines and extinction is vital in our quest to stop the currently rampant biodiversity loss. Comparison of ecological characteristics between threatened and nonthreatened species may reveal these ultimate causes. Here, we report an analysis of ecological characteristics of 23 threatened and 72 nonthreatened butterfly species. Our analysis reveals that threatened butterflies are characterized by narrow niche breadth, restricted resource distribution, poor dispersal ability, and short flight period. Based on the characteristics, we constructed an ecological extinction risk rank and predicted which of the currently nonthreatened species are at the highest risk of extinction. Our analysis reveals that two species currently classified as nonthreatened are, in fact, at high risk of extinction, and that the status of a further five species should be reconsidered. PMID:15671171

  1. 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.

  2. [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

  3. 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. PMID:18717691

  4. Risk of hypertension in Yozgat Province, Central Anatolia: application of Framingham Hypertension Prediction Risk Score.

    PubMed

    Kilic, M; Ede, H; Kilic, A I

    2016-07-10

    The aim of this cross-sectional study was to estimate the risk of hypertension in 1106 Caucasian individuals aged 20-69 years in Yozgat Province, using the Framingham Hypertension Risk Prediction Score (FHRPS). According to FHRPS, average risk of developing hypertension over 4 years was 6.2%. The participants were classified into low- (<5%), moderate- (5% to 10%) and high- (>10%) risk groups. The percentage of participants that fell into these groups was 59.4%, 19.8% and 20.8% respectively. The proportion of participants in the high-risk group was similar to the 4-year incidence of hypertension (21.3%) in the Turkish population. Regression analysis showed that high salt consumption and low educational level significantly increased the risk of hypertension. Economic level, fat consumption, life satisfaction, physical activity, and fruit and vegetable consumption were not correlated with risk of hypertension. This study shows that FHRPS can also be used for predicting risk of hypertension in Central Anatolia.

  5. 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. PMID:27359001

  6. 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.

  7. 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. PMID:27479455

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

    PubMed

    Shiao, S P K; Yu, C H

    2016-07-01

    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

  9. 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

  10. 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. PMID:22041638

  11. Sleep Duration Predicts Cardiometabolic Risk in Obese Adolescents

    PubMed Central

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

    2014-01-01

    Objective To examine the independent contributions of objectively measured sleep duration and fragmentation on cardiometabolic risk accumulation in free-living obese adolescents. Study design 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. Results 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. Conclusions 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. PMID:24612904

  12. Canine visceral leishmaniasis: incidence and risk factors for infection in a cohort study in Brazil.

    PubMed

    Coura-Vital, Wendel; Reis, Alexandre Barbosa; Reis, Levi Eduardo Soares; Braga, Samuel Leôncio; Roatt, Bruno Mendes; Aguiar-Soares, Rodrigo Dian de Oliveira; Marques, Marcos José; Veloso, Vanja Maria; Carneiro, Mariângela

    2013-11-01

    Zoonotic visceral leishmaniasis in Brazil is caused by Leishmania infantum parasites and is transmitted by sand flies of the Phlebotominae family. Dogs are the main urban reservoirs and represent the major source of contagion for the vectors. Studies have shown that most infected dogs are polymerase chain reaction-positive months before seroconversion. Herein, we describe a cohort study designed to identify the incidence of and risk factors for L. infantum infection as detected by polymerase chain reaction-restriction fragment length polymorphism. To determine the risk factors for infection, we conducted a baseline canine survey (n=1443) from which dogs were selected for the cohort study (n=282) involving three evaluations over the course of a 26-month follow-up period. Serology, molecular tests, and a structured questionnaire were used. The risk factors for infection were identified by means of the Cox regression model. The overall infection incidence was 5.8 per 100 dog-months (95% confidence interval 5.1-6.5). Increased risk of infection was associated with the presence of previous cases of canine visceral leishmaniasis in the domiciles (hazard ratio [HR] 1.4; 95% confidence interval [CI] 1.1-1.8) and unplastered house walls (HR 3.6; 95% CI 1.6-8.1). These risk factors suggest that insecticide spraying in cracks and crevices in unplastered walls can reduce biting rates within and around homes. Furthermore, our results demonstrate that the Visceral Leishmaniasis Control and Surveillance Program should adopt environmental management measures in homes with previous cases of canine visceral leishmaniasis, because these homes are more likely to maintain the transmission cycle.

  13. Chronic dietary risk for pesticide residues in food in Brazil: an update.

    PubMed

    Caldas, E D; Souza, L C K R

    2004-11-01

    The objective was to conduct a dietary risk assessment of pesticides registered in Brazil up to 14 January 2004. The theoretical maximum daily intake (TMDI) was calculated for 275 compounds using the Brazilian maximum residue limits (MRL) and food consumption. The chronic dietary risk assessment was conducted by comparing the TMDI with the Brazilian acceptable daily intake (ADI) or, when not available, with the ADI from other sources. The TMDI was higher than the ADI (%ADI>100) in at least one Brazilian region for eight pesticides, including five organophosphorus insecticides. For these compounds, the higher TMDI (expressed as %ADI) ranged from 140 (metam sodium) to 14,000 (methyl bromide). Rice, beans, citrus and tomato were the commodities that contributed most to ingestion. Change in pesticide use patterns and the establishment of ADIs by the Brazilian government have reduced the number of compounds for which the TMDI exceeded the ADI in the last 4 years. Risk assessment methodology based on TMDI calculation, however, is conservative as it assumes that the food supply is always treated with all the registered pesticides for that crop and that one always consumes food containing residues at the tolerance level. Furthermore, for six compounds with TMDI exceeding the ADI, a more realistic estimation of the pesticide daily intake was conducted using monitoring residue data from the Brazilian National Pesticide Residue Program. For these compounds, the higher refined intakes ranged from 2% (dimethoate) to 180% (fenitrothion) of the ADIs. The implementation of a national pesticide residue monitoring programme by the government was important to allow the refinement of the risk assessment. However, adequate daily food consumption data are still needed to assess better the public health risk to Brazilian consumers from food produced from crops treated with pesticides.

  14. 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

  15. Predicting risk selection following major changes in Medicare.

    PubMed

    Pizer, Steven D; Frakt, Austin B; Feldman, Roger

    2008-04-01

    The Medicare Modernization Act of 2003 created several new types of private insurance plans within Medicare, starting in 2006. Some of these plan types previously did not exist in the commercial market and there was great uncertainty about their prospects. In this paper, we show that statistical models and historical data from the Medicare Current Beneficiary Survey can be used to predict the experience of new plan types with reasonable accuracy. This lays the foundation for the analysis of program modifications currently under consideration. We predict market share, risk selection, and stability for the most prominent new plan type, the stand-alone Medicare prescription drug plan (PDP). First, we estimate a model of consumer choice across Medicare insurance plans available in the data. Next, we modify the data to include PDPs and use the model to predict the probability of enrollment for each beneficiary in each plan type. Finally, we calculate mean-adjusted actual spending by plan type. We predict that adverse selection into PDPs will be substantial, but that enrollment and premiums will be stable. Our predictions correspond well to actual experience in 2006. PMID:17557273

  16. 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

  17. Perinatal Immunotoxicity: Why Adult Exposure Assessment Fails to Predict Risk

    PubMed Central

    Dietert, Rodney R.; Piepenbrink, Michael S.

    2006-01-01

    Recent research has pointed to the developing immune system as a remarkably sensitive toxicologic target for environmental chemicals and drugs. In fact, the perinatal period before and just after birth is replete with dynamic immune changes, many of which do not occur in adults. These include not only the basic maturation and distribution of immune cell types and selection against autoreactive lymphocytes but also changes designed specifically to protect the pregnancy against immune-mediated miscarriage. The newborn is then faced with critical immune maturational adjustments to achieve an immune balance necessary to combat myriad childhood and later-life diseases. All these processes set the fetus and neonate completely apart from the adult regarding immunotoxicologic risk. Yet for decades, safety evaluation has relied almost exclusively upon exposure of the adult immune system to predict perinatal immune risk. Recent workshops and forums have suggested a benefit in employing alternative exposures that include exposure throughout early life stages. However, issues remain concerning when and where such applications might be required. In this review we discuss the reasons why immunotoxic assessment is important for current childhood diseases and why adult exposure assessment cannot predict the effect of xenobiotics on the developing immune system. It also provides examples of developmental immunotoxicants where age-based risk appears to differ. Finally, it stresses the need to replace adult exposure assessment for immune evaluation with protocols that can protect the developing immune system. PMID:16581533

  18. The Braden Scale for Predicting Pressure Sore Risk.

    PubMed

    Bergstrom, N; Braden, B J; Laguzza, A; Holman, V

    1987-01-01

    The Braden Scale for Predicting Pressure Sore Risk was developed to foster early identification of patients at risk for forming pressure sores. The scale is composed of six subscales that reflect sensory perception, skin moisture, activity, mobility, friction and shear, and nutritional status. Content and construct validity were established by expert opinion and empirical testing. Three studies of reliability are reported here, using raters who varied in level of educational preparation and geographic region. Two prospective studies of predictive validity were completed to determine the scale's sensitivity and specificity. Reliability ranged from r = .83 to r = .94 for nurses' aides and licensed practical nurses; when used by registered nurses, the reliability increased to r = .99. Predictive validity was calculated for each cut-off point of the scale. Using a cut-off point of 16, sensitivity was 100% in both studies. Specificity ranged from 64% to 90%. This instrument has highly satisfactory reliability when used by RNs, and greater sensitivity and specificity than instruments previously reported.

  19. Coordinating perioperative care for the 'high risk' general surgical patient using risk prediction scoring.

    PubMed

    Hafiz, Shaziz; Lees, Nicholas Peter

    2016-01-01

    Identifying 'high risk' (> 5% mortality score) emergency general surgical patients early, allows appropriate perioperative care to be allocated by securing critical care beds and ensuring the presence of senior surgeons and senior anesthetists intraoperatively. Scoring systems can be used to predict perioperative risk and coordinate resources perioperatively. Currently it is unclear which estimate of risk correlates with current resource deployment. A retrospective study was undertaken assessing the relationship between deployment of perioperative resources: senior surgeon, senior anesthetist and critical care bed. The study concluded that almost all high risk patients with high POSSUM mortality and morbidity scores had a consultant senior surgeon present intraoperatively. Critically unwell patients with higher operative severity and perioperative morbidity scores received higher care (HDU/ICU) beds postoperatively, ensuring that they received appropriate care if their condition deteriorated. Therefore POSSUM scoring should be used perioperatively in emergency cases to coordinate appropriate perioperative care for high risk general surgical patients. PMID:26901929

  20. 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?

  1. 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

  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. 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.

  4. [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.

  5. 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. PMID:26053403

  6. 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

  7. 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. PMID:25627765

  8. 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. PMID:26689181

  9. 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

  10. 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.

  11. Prevalence and risk factors for intestinal parasites in food handlers, southern Brazil.

    PubMed

    Colli, Cristiane Maria; Mizutani, Angelica Sayuri; Martins, Vanessa Aparecida; Ferreira, Erika Cristina; Gomes, Mônica Lúcia

    2014-01-01

    In this study, the prevalence and risk factors for enteroparasites were determined in food handlers from Maringá, Paraná State, southern Brazil. Fecal and subungual materials of 150 street food vendors were analyzed by the methods of Lutz, Faust, and Mello, respectively. A questionnaire on hygiene and sanitary conditions of the workplace and of domicile was applied. The prevalence of enteroparasites was 28%, and the protozoa infection was more expressive (21.3%) than by helminths (6.7%), but without significant difference (p > 0.05). Entamoeba coli was the most frequent species occurring in 15.3%, while the prevalence of protozoa pathogenic was low (Giardia lamblia: 2.7% and Entamoeba histolytica: 0.7%). The subungual material presented negative results. The presence of pets in domiciles has increased twice the risk of infection. The working conditions of the majority of street food vendors were inappropriate. The results highlight the need for more rigorous programs of continuing education, parasitological examination every six months, and health surveillance. In this way, the quality of the service provided to the population can be improved and the transmission of food-borne diseases can be prevented.

  12. Household survey of dengue infection in central Brazil: spatial point pattern analysis and risk factors assessment.

    PubMed

    Siqueira, João B; Martelli, Celina M T; Maciel, Ivan J; Oliveira, Renato M; Ribeiro, Maria G; Amorim, Flúvia P; Moreira, Bruno C; Cardoso, Divina D P; Souza, Wayner V; Andrade, Ana Lúcia S S

    2004-11-01

    Urban dengue fever is now considered a major public health threat in most American countries. A household survey was conducted in the city of Goiania in central Brazil in 2001 to assess prevalence of dengue infection and individual and area-based risk factors. Spatial point pattern analysis was performed using the dual Kernel method. A total of 1,610 households were surveyed; 1,585 individuals more than five years old had blood and data collected. Sera were tested for IgM/IgG antibodies by an enzyme-linked immunoassay. Area-based indicators derived from census data were linked to geocoded residential address. The seroprevalence of dengue was 29.5% and the estimate prevalence surface reached 50% in the outskirts areas. The risk of infection was significantly associated with older age (P < 0.01), low education (odds ratio [OR] = 3.45, 95% confidence interval [CI] = 1.82-6.55), and low income (OR = 1.32, 95% CI = 1.02-1.71) in multivariate analysis. This study highlighted the heterogeneity of dengue transmission within the city and can assist in spatial targeting control interventions.

  13. 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.

  14. Breast cancer risk prediction using a clinical risk model and polygenic risk score.

    PubMed

    Shieh, Yiwey; Hu, Donglei; Ma, Lin; Huntsman, Scott; Gard, Charlotte C; Leung, Jessica W T; Tice, Jeffrey A; Vachon, Celine M; Cummings, Steven R; Kerlikowske, Karla; Ziv, Elad

    2016-10-01

    Breast cancer risk assessment can inform the use of screening and prevention modalities. We investigated the performance of the Breast Cancer Surveillance Consortium (BCSC) risk model in combination with a polygenic risk score (PRS) comprised of 83 single nucleotide polymorphisms identified from genome-wide association studies. We conducted a nested case-control study of 486 cases and 495 matched controls within a screening cohort. The PRS was calculated using a Bayesian approach. The contributions of the PRS and variables in the BCSC model to breast cancer risk were tested using conditional logistic regression. Discriminatory accuracy of the models was compared using the area under the receiver operating characteristic curve (AUROC). Increasing quartiles of the PRS were positively associated with breast cancer risk, with OR 2.54 (95 % CI 1.69-3.82) for breast cancer in the highest versus lowest quartile. In a multivariable model, the PRS, family history, and breast density remained strong risk factors. The AUROC of the PRS was 0.60 (95 % CI 0.57-0.64), and an Asian-specific PRS had AUROC 0.64 (95 % CI 0.53-0.74). A combined model including the BCSC risk factors and PRS had better discrimination than the BCSC model (AUROC 0.65 versus 0.62, p = 0.01). The BCSC-PRS model classified 18 % of cases as high-risk (5-year risk ≥3 %), compared with 7 % using the BCSC model. The PRS improved discrimination of the BCSC risk model and classified more cases as high-risk. Further consideration of the PRS's role in decision-making around screening and prevention strategies is merited. PMID:27565998

  15. Tryptophan Predicts the Risk for Future Type 2 Diabetes.

    PubMed

    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

  16. 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

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

    PubMed

    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

    2016-03-01

    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

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

    PubMed

    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

    2016-03-01

    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.

  19. 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

  20. 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. PMID:24033371

  1. 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.

  2. 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

  3. ["Hormone bomb": risks of emergency contraception from the perspective of pharmacy attendants in Rio de Janeiro, Brazil].

    PubMed

    Brandão, Elaine Reis; Cabral, Cristiane da Silva; Ventura, Miriam; Paiva, Sabrina Pereira; Bastos, Luiza Lena; Oliveira, Naira Villas Boas Vidal de; Szabo, Iolanda

    2016-09-19

    This study focused on views towards emergency contraception among pharmacy attendants in Greater Metropolitan Rio de Janeiro, Brazil. The empirical material came from a socio-anthropological study with 20 semi-structured interviews of pharmacy attendants of both sexes (8 females and 12 males). The interviews showed negative views of emergency contraception, emphasizing its potential health risks. Interviews considered emergency contraception a "hormone bomb" that can harm the female reproductive organs and other organ systems. The pharmacy attendants highlighted the risks of "uncontrolled" or "indiscriminate" use, especially by adolescents and young women. Since they considered it "dangerous" to women's bodies, they assigned the responsibility for orientation and counseling on use of the method to gynecologists rather than to pharmacists. The article discusses the need to expand the public debate on emergency contraception in Brazil to include pharmacists and pharmacy attendants, in addition to health professionals in general and teachers.

  4. 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.

  5. ["Hormone bomb": risks of emergency contraception from the perspective of pharmacy attendants in Rio de Janeiro, Brazil].

    PubMed

    Brandão, Elaine Reis; Cabral, Cristiane da Silva; Ventura, Miriam; Paiva, Sabrina Pereira; Bastos, Luiza Lena; Oliveira, Naira Villas Boas Vidal de; Szabo, Iolanda

    2016-01-01

    This study focused on views towards emergency contraception among pharmacy attendants in Greater Metropolitan Rio de Janeiro, Brazil. The empirical material came from a socio-anthropological study with 20 semi-structured interviews of pharmacy attendants of both sexes (8 females and 12 males). The interviews showed negative views of emergency contraception, emphasizing its potential health risks. Interviews considered emergency contraception a "hormone bomb" that can harm the female reproductive organs and other organ systems. The pharmacy attendants highlighted the risks of "uncontrolled" or "indiscriminate" use, especially by adolescents and young women. Since they considered it "dangerous" to women's bodies, they assigned the responsibility for orientation and counseling on use of the method to gynecologists rather than to pharmacists. The article discusses the need to expand the public debate on emergency contraception in Brazil to include pharmacists and pharmacy attendants, in addition to health professionals in general and teachers. PMID:27653201

  6. 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.

  7. 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

  8. 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

  9. Epidemiology of trachoma in Bebedouro State of São Paulo, Brazil: prevalence and risk factors.

    PubMed

    Luna, E J; Medina, N H; Oliveira, M B; de Barros, O M; Vranjac, A; Melles, H H; West, S; Taylor, H R

    1992-02-01

    Trachoma was considered to have been 'eradicated' from the state of São Paulo, Brazil, until 1982 when a number of new cases of trachoma were reported in preschool children in Bebedouro, a small town in northwestern São Paulo. A household survey was undertaken to assess the prevalence and epidemiological characteristics of trachoma. A total of 2939 people of all ages was examined having been selected from a two-stage probalilistic household sampling frame based on census data. Overall, 7.2% of the population had evidence of one or more signs of trachoma and 2.1% had inflammatory trachoma. Inflammatory trachoma was more common in children aged one to ten years, especially in the peripheral urban and rural areas, and was more common in boys. The presence of chlamydia was confirmed by direct fluorescent antibody cytology. No cases of blindness due to trachoma were seen. A number of socioeconomic and hygiene variables were studied in order to determine the independent risk factors for trachoma in a household. Variables significantly associated with the occurrence of trachoma in the household were the number of children in the house aged one to ten years, the 'per capita' water consumption, the frequency of garbage collections, source of water, and the educational level of the head of household. Clustering of trachoma in different parts of this community was entirely explained by the concentration of households with these characteristics.

  10. 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.

  11. 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.

  12. 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.

  13. 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

  14. Periconceptional use of folic acid and risk of miscarriage – Findings of Oral Cleft Prevention Program in Brazil

    PubMed Central

    Vila-Nova, C; Wehby, GL; Queirós, F; Chakraborty, H; Félix, TM; Goco, N; Moore, J; Gewehr, EV; Lins, L; Affonso, CMC; Murray, JC

    2013-01-01

    We report on the risk of miscarriage due to high dosage periconceptional folic acid (FA) supplementation from a double blind randomized clinical trial for prevention of orofacial clefts in Brazil. The miscarriage rate was 14.2% in the low dose FA group (0.4 mg per day) and 11.3% for the high dose (4 mg per day) group (p=0.4877); the population miscarriage rate is 14%. 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. PMID:23669628

  15. Evaluation of the health risks to garment workers in the city of Xambrê-PR, Brazil.

    PubMed

    Sant'Ana, Marco Antônio; Kovalechen, Fabrício

    2012-01-01

    This study evaluated the risks for cardiovascular disease and the life habits of garment industry workers in northwestern Paraná state, Brazil. The following parameters were assessed: body composition, cardiorespiratory fitness, eating habits and physical activities by garment industry workers. Cardiovascular risk was observed in some of the studied subjects, in the form of high BMI and reduced maximal oxygen uptake. The development of a workplace quality-of-life program is suggested, aiming to stimulate the development of physical activities to improve the cardiovascular conditioning of workers.

  16. Predicting environmental risk: A road map for the future.

    PubMed

    Jager, Tjalling

    2016-01-01

    Frameworks for environmental risk assessment (ERA) focus on comparing results from separate exposure and effect assessments. Exposure assessment generally relies on mechanistic fate models, whereas the effects assessment is anchored in standard test protocols and descriptive statistics. This discrepancy prevents a useful link between these two pillars of ERA, and jeopardizes the realism and efficacy of the entire process. Similar to exposure assessment, effects assessment requires a mechanistic approach to translate the output of fate models into predictions for impacts on populations and food webs. The aim of this study was to discuss (1) the central importance of the individual level, (2) different strategies of dealing with biological complexity, and (3) the role that toxicokinetic-toxicodynamic (TKTD) models, energy budgets, and molecular biology play in a mechanistic revision of the ERA framework. Consequently, an outline for a risk assessment paradigm was developed that incorporates a mechanistic effects assessment in a consistent manner, and a "roadmap for the future." Such a roadmap may play a critical role to eventually arrive at a more scientific and efficient ERA process, and needs to be used to shape our long-term research agendas. PMID:27484139

  17. 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

  18. 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

  19. 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

  20. 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

  1. Predicting the risk of rheumatoid arthritis and its age of onset through modelling genetic risk variants with smoking.

    PubMed

    Scott, Ian C; Seegobin, Seth D; Steer, Sophia; Tan, Rachael; Forabosco, Paola; Hinks, Anne; Eyre, Stephen; Morgan, Ann W; Wilson, Anthony G; Hocking, Lynne J; Wordsworth, Paul; Barton, Anne; Worthington, Jane; Cope, Andrew P; Lewis, Cathryn M

    2013-01-01

    The improved characterisation of risk factors for rheumatoid arthritis (RA) suggests they could be combined to identify individuals at increased disease risks in whom preventive strategies may be evaluated. We aimed to develop an RA prediction model capable of generating clinically relevant predictive data and to determine if it better predicted younger onset RA (YORA). Our novel modelling approach combined odds ratios for 15 four-digit/10 two-digit HLA-DRB1 alleles, 31 single nucleotide polymorphisms (SNPs) and ever-smoking status in males to determine risk using computer simulation and confidence interval based risk categorisation. Only males were evaluated in our models incorporating smoking as ever-smoking is a significant risk factor for RA in men but not women. We developed multiple models to evaluate each risk factor's impact on prediction. Each model's ability to discriminate anti-citrullinated protein antibody (ACPA)-positive RA from controls was evaluated in two cohorts: Wellcome Trust Case Control Consortium (WTCCC: 1,516 cases; 1,647 controls); UK RA Genetics Group Consortium (UKRAGG: 2,623 cases; 1,500 controls). HLA and smoking provided strongest prediction with good discrimination evidenced by an HLA-smoking model area under the curve (AUC) value of 0.813 in both WTCCC and UKRAGG. SNPs provided minimal prediction (AUC 0.660 WTCCC/0.617 UKRAGG). Whilst high individual risks were identified, with some cases having estimated lifetime risks of 86%, only a minority overall had substantially increased odds for RA. High risks from the HLA model were associated with YORA (P<0.0001); ever-smoking associated with older onset disease. This latter finding suggests smoking's impact on RA risk manifests later in life. Our modelling demonstrates that combining risk factors provides clinically informative RA prediction; additionally HLA and smoking status can be used to predict the risk of younger and older onset RA, respectively. PMID:24068971

  2. Predicting the risk of rheumatoid arthritis and its age of onset through modelling genetic risk variants with smoking.

    PubMed

    Scott, Ian C; Seegobin, Seth D; Steer, Sophia; Tan, Rachael; Forabosco, Paola; Hinks, Anne; Eyre, Stephen; Morgan, Ann W; Wilson, Anthony G; Hocking, Lynne J; Wordsworth, Paul; Barton, Anne; Worthington, Jane; Cope, Andrew P; Lewis, Cathryn M

    2013-01-01

    The improved characterisation of risk factors for rheumatoid arthritis (RA) suggests they could be combined to identify individuals at increased disease risks in whom preventive strategies may be evaluated. We aimed to develop an RA prediction model capable of generating clinically relevant predictive data and to determine if it better predicted younger onset RA (YORA). Our novel modelling approach combined odds ratios for 15 four-digit/10 two-digit HLA-DRB1 alleles, 31 single nucleotide polymorphisms (SNPs) and ever-smoking status in males to determine risk using computer simulation and confidence interval based risk categorisation. Only males were evaluated in our models incorporating smoking as ever-smoking is a significant risk factor for RA in men but not women. We developed multiple models to evaluate each risk factor's impact on prediction. Each model's ability to discriminate anti-citrullinated protein antibody (ACPA)-positive RA from controls was evaluated in two cohorts: Wellcome Trust Case Control Consortium (WTCCC: 1,516 cases; 1,647 controls); UK RA Genetics Group Consortium (UKRAGG: 2,623 cases; 1,500 controls). HLA and smoking provided strongest prediction with good discrimination evidenced by an HLA-smoking model area under the curve (AUC) value of 0.813 in both WTCCC and UKRAGG. SNPs provided minimal prediction (AUC 0.660 WTCCC/0.617 UKRAGG). Whilst high individual risks were identified, with some cases having estimated lifetime risks of 86%, only a minority overall had substantially increased odds for RA. High risks from the HLA model were associated with YORA (P<0.0001); ever-smoking associated with older onset disease. This latter finding suggests smoking's impact on RA risk manifests later in life. Our modelling demonstrates that combining risk factors provides clinically informative RA prediction; additionally HLA and smoking status can be used to predict the risk of younger and older onset RA, respectively.

  3. Predicting the Risk of Rheumatoid Arthritis and Its Age of Onset through Modelling Genetic Risk Variants with Smoking

    PubMed Central

    Scott, Ian C.; Seegobin, Seth D.; Steer, Sophia; Tan, Rachael; Forabosco, Paola; Hinks, Anne; Eyre, Stephen; Morgan, Ann W.; Wilson, Anthony G.; Hocking, Lynne J.; Wordsworth, Paul; Barton, Anne; Worthington, Jane; Cope, Andrew P.; Lewis, Cathryn M.

    2013-01-01

    The improved characterisation of risk factors for rheumatoid arthritis (RA) suggests they could be combined to identify individuals at increased disease risks in whom preventive strategies may be evaluated. We aimed to develop an RA prediction model capable of generating clinically relevant predictive data and to determine if it better predicted younger onset RA (YORA). Our novel modelling approach combined odds ratios for 15 four-digit/10 two-digit HLA-DRB1 alleles, 31 single nucleotide polymorphisms (SNPs) and ever-smoking status in males to determine risk using computer simulation and confidence interval based risk categorisation. Only males were evaluated in our models incorporating smoking as ever-smoking is a significant risk factor for RA in men but not women. We developed multiple models to evaluate each risk factor's impact on prediction. Each model's ability to discriminate anti-citrullinated protein antibody (ACPA)-positive RA from controls was evaluated in two cohorts: Wellcome Trust Case Control Consortium (WTCCC: 1,516 cases; 1,647 controls); UK RA Genetics Group Consortium (UKRAGG: 2,623 cases; 1,500 controls). HLA and smoking provided strongest prediction with good discrimination evidenced by an HLA-smoking model area under the curve (AUC) value of 0.813 in both WTCCC and UKRAGG. SNPs provided minimal prediction (AUC 0.660 WTCCC/0.617 UKRAGG). Whilst high individual risks were identified, with some cases having estimated lifetime risks of 86%, only a minority overall had substantially increased odds for RA. High risks from the HLA model were associated with YORA (P<0.0001); ever-smoking associated with older onset disease. This latter finding suggests smoking's impact on RA risk manifests later in life. Our modelling demonstrates that combining risk factors provides clinically informative RA prediction; additionally HLA and smoking status can be used to predict the risk of younger and older onset RA, respectively. PMID:24068971

  4. Genetic determinants of risk factors for cardiovascular disease in a population from rural Brazil.

    PubMed

    Velásquez-Meléndez, Gustavo; Parra, Flavia C; Gazzinelli, Andrea; Williams-Blangero, Sarah; Correa-Oliveira, Rodrigo

    2007-04-01

    We investigate the heritability of and pleiotropic relationships among triglycerides and cholesterol lipoproteins that have long been considered traditional risk factors for cardiovascular disease. Quantitative lipid and lipoprotein phenotypes were determined for a cross-sectional sample of a community in Jequitinhonha valley in northern Minas Gerais state, Brazil. The sample consisted primarily of subsistence farmers. Two hundred sixty-nine individuals (128 males and 141 females), ages 18-88 years, were sampled. Eighty-eight percent (n = 252) of the individuals belonged to a single pedigree, which was highly informative for genetic analysis. Data on anthropometrics, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), total cholesterol, and triglycerides were available for each study participant. Extended pedigrees were constructed using the pedigree-based data management software PedSys. Univariate and bivariate variance-components analyses, adjusted by sex and age, were performed using the SOLAR software package. Heritability estimates of lipids and lipoproteins ranged from 29% to 45% (p < 0.008). The highest heritability estimated was for HDL-C (h2 = 44.8%, p < 0.0001), and this was the only trait that exhibited a significant household effect (c2 = 25%). Strong positive genetic correlations were found between triglycerides and very low density lipoprotein (VLDL) (rhog = 0.998) and between total cholesterol and LDL-C (rhog = 0.948). Significant genetic correlations were also found between triglycerides and LDL-C, between total cholesterol and VLDL, and between total cholesterol and LDL-C and VLDL, and finally between LDL and VLDL. There was a significant negative environmental correlation between triglycerides and HDL-C (rhoe = -0.406). PMID:18027813

  5. 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.

  6. Genetic determinants of risk factors for cardiovascular disease in a population from rural Brazil.

    PubMed

    Velásquez-Meléndez, Gustavo; Parra, Flavia C; Gazzinelli, Andrea; Williams-Blangero, Sarah; Correa-Oliveira, Rodrigo

    2007-04-01

    We investigate the heritability of and pleiotropic relationships among triglycerides and cholesterol lipoproteins that have long been considered traditional risk factors for cardiovascular disease. Quantitative lipid and lipoprotein phenotypes were determined for a cross-sectional sample of a community in Jequitinhonha valley in northern Minas Gerais state, Brazil. The sample consisted primarily of subsistence farmers. Two hundred sixty-nine individuals (128 males and 141 females), ages 18-88 years, were sampled. Eighty-eight percent (n = 252) of the individuals belonged to a single pedigree, which was highly informative for genetic analysis. Data on anthropometrics, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), total cholesterol, and triglycerides were available for each study participant. Extended pedigrees were constructed using the pedigree-based data management software PedSys. Univariate and bivariate variance-components analyses, adjusted by sex and age, were performed using the SOLAR software package. Heritability estimates of lipids and lipoproteins ranged from 29% to 45% (p < 0.008). The highest heritability estimated was for HDL-C (h2 = 44.8%, p < 0.0001), and this was the only trait that exhibited a significant household effect (c2 = 25%). Strong positive genetic correlations were found between triglycerides and very low density lipoprotein (VLDL) (rhog = 0.998) and between total cholesterol and LDL-C (rhog = 0.948). Significant genetic correlations were also found between triglycerides and LDL-C, between total cholesterol and VLDL, and between total cholesterol and LDL-C and VLDL, and finally between LDL and VLDL. There was a significant negative environmental correlation between triglycerides and HDL-C (rhoe = -0.406).

  7. Predicting reading problems in at-risk children.

    PubMed

    Menyuk, P; Chesnick, M; Liebergott, J W; Korngold, B; D'Agostino, R; Belanger, A

    1991-08-01

    This study was designed to determine early predictors of reading problems in children at risk for such problems. Three groups of children participated in the study: those with a specific language impairment; those who presumably had a language delay or disorder early in life and had no or a mild disorder at present; and a group of premature children. The data collected were standard speech and language test measures, given as the children entered the study, measures of language meta-processing abilities on an experimental battery, given 6 months after they entered the study; and standard measures of reading, given when the children were aged 80 to 96 months. Many significant relations were found between measures of oral language ability and meta-processing ability at an earlier age and reading ability in first and second grade. The language processing battery scores accounted for a somewhat greater amount of variance on the reading tests than did the scores on the standard language tests. Three ability groups, comparatively high, middle, and low, were found in the population as a result of cluster analysis. Some premature children and some children with early language disorder or mild language disorder at entry into the study, as well as most SLI children, were members of the low language-ability group. These data were then examined to see if membership in the low language-ability group, as measured by either standard speech and language tests or the language meta-processing battery predicted at-risk reading performance on the WRAT. Forty-six children were found to be at risk by this test. Twenty-one of the children were identified by either set of measures, an additional 10 were identified by the language meta-processing measures alone, an additional 3 by the intake measures alone, and 12 of the children were not identified by either set of measures as potential problem readers. The results indicate that early measures of language awareness are good predictors of

  8. 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.

  9. 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.

  10. 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

  11. Decision-making competence predicts domain-specific risk attitudes.

    PubMed

    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.

  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. 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

  14. 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. PMID:27342783

  15. Serological markers and risk factors related to hepatitis B virus in dentists in the Central West region of Brazil.

    PubMed

    de Paiva, Enilza Maria Mendonça; Tiplle, Anaclara Ferreira Veiga; de Paiva Silva, Eliane; de Paula Cardoso, Divina das Dores

    2008-04-01

    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.

  16. 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

  17. Prediction of Risk Factors of Frequent Relapse Idiopathic Nephrotic Syndrome.

    PubMed

    Jahan, I; Hanif, M; Ali, M A; Hoque, M M

    2015-10-01

    This case control study was aimed to identify the predictive risk factors for frequent relapse idiopathic nephrotic syndrome (INS) and conducted in Sir Salimullah Medical College & Mitford Hospital, Dhaka and at Renal and Dialysis Unit of Dhaka Shishu Hospital and Bangladesh Institute of Child Health (BICH), Dhaka, from January 2006 to December 2006. We examined retrospectively the clinical course of fifty cases of frequent relapse nephrotic syndrome (FRNS) as cases and fifty cases of infrequent relapse nephrotic syndrome (IRNS) as control who met the predefined enrollment criteria, followed for at least one year after initial onset of disease. After enrollment following parameters were studied as predictors of frequent relapse: i) Socio-demographic variables: age, sex, socio-economic condition, number of living room ii) Disease related variables i.e. age of onset, duration of illness, frequency of relapse within the 1st year, regimen of initial steroid therapy, total cumulative dose of steroid for remission, day of remission after starting steroid, association with atopy and infection, concomitant upper respiratory illness iii) Biochemical and pathological variables (at the time of initial attack) i.e. Serum albumin, serum cholesterol, blood urea, 24 hours urinary protein, serum creatinine, complete blood count, urine RBC, urine pus cell, urine culture. The test statistics used to analyses the data were descriptive statistics, Chi-square probability test, Student's t-test and Binary logistic regression analysis for Odds ratio. Both univariate and multivariate logistic regression analysis revealed that age of onset (P<0.001, OR=0.9, 95% CI=0.85-0.95), poor socioeconomic status (P<0.034, OR=0.5.8, 95% CI=1.14-29.5) and low serum albumin level at the time of initial presentation (P<0.022, OR=0.8, 95% CI=0.65-0.97) were independent predictors of frequent relapse nephrotic syndrome. In conclusion, we demonstrated that age at onset, poor socioeconomic condition and low

  18. 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

  19. Risk prediction of hepatitis B virus-related hepatocellular carcinoma in the era of antiviral therapy

    PubMed Central

    Song, Il Han; Kim, So Mi; Choo, Young Kwang

    2013-01-01

    Hepatocellular carcinoma (HCC) is a grave primary liver cancer that has a limited therapeutic option because it is generally diagnosed later in an advanced stage due to its aggressive biologic behavior. The early detection of HCC has a great impact on the treatment efficacy and survival of patients at high risk for cancer. Potential host, environmental, and virus-related risk factors have been introduced. Hepatitis B virus (HBV) is a major cause of end-stage liver diseases such as liver cirrhosis or HCC in endemic areas, and its serologic or virologic status is considered an important risk factor. HCC risk prediction derived from the identification of major risk factors is necessary for providing adequate screening/surveillance strategies to high-risk individuals. Several risk prediction models for HBV-related HCC have been presented recently with simple, efficient, and readily available to use parameters applicable to average- or unknown-risk populations as well as high-risk individuals. Predictive scoring systems of risk estimation to assess HCC development can provide the way to an evidence-based clinical approach for cost- and effort-effective outcomes, capable of inducing a personalized surveillance program according to risk stratification. In this review, the concepts and perspectives of the risk prediction of HCC are discussed through the analysis of several risk prediction models of HBV-related HCC. PMID:24379609

  20. Risk factors associated with selected indicators of milk quality in semiarid northeastern Brazil.

    PubMed

    Oliveira, C J B; Lopes Júnior, W D; Queiroga, R C R E; Givisiez, P E N; Azevedo, P S; Pereira, W E; Gebreyes, W A

    2011-06-01

    The aim of this study was to gain information on quality traits, mainly bacterial and somatic cell counts of bulk milk, produced by small- and medium-scale producers in a semiarid northeastern region of Brazil and to identify and characterize possible risk factors associated with those quality traits. A cross-sectional study was performed on 50 farms. Bulk milk samples were collected for bacterial and somatic cell counts. Additionally, information about farm demographics, general management practices, hygiene, and milking procedures was also obtained. Multivariable analysis using logistic regression was performed with predictors previously identified by univariate analysis using a Fisher's Exact test. Aerobic mesophilic bacteria counts varied from 3.59 log to 6.95 log cfu/mL, with geometric mean of 5.27 log cfu/mL. Mean total coliform count was 3.27 log (1.52 log to 5.89 log) most probable number (MPN)/mL, whereas mean thermotolerant coliforms was 2.38 log (1.48 log to 4.75 log) MPN/mL. A high positive correlation was observed between aerobic mesophilic bacteria and coliform counts. Although most farms met the standard for the current regulations for total bacteria (88%) and somatic cell counts (94%), nearly half of the producers (46%) would have problems in achieving the 2012 threshold limit for total bacteria count if no improvement in milk quality occurs. Mean value for staphylococci was 3.99 log (2.31 log to 6.24 log) cfu/mL, and Staphylococcus aureus was detected in 33 (66%) farms. Premilking teat-end wash procedure (odds ratio=0.191) and postmilking teat dip (odds ratio=0.67) were associated with lower aerobic mesophilic bacteria and Staphylococcus aureus counts in bulk milk, respectively. Considering that the farm characteristics in this study are representative of the semiarid northeastern region, these findings encourage further investigations for supporting intervention measures intended to improve the quality of milk produced by smallholders. PMID

  1. 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.

  2. 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

  3. 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

  4. [Risk factors for chronic non-communicable diseases: a domiciliary survey in the municipality of São Paulo, SP (Brazil). Methodology and preliminary results].

    PubMed

    Rego, R A; Berardo, F A; Rodrigues, S S; Oliveira, Z M; Oliverira, M B; Vasconcellos, C; Aventurato, L V; Moncau, J E; Ramos, L R

    1990-08-01

    The non-communicable chronic diseases are important causes of death in Brazil, mainly in the great urban centres. There are various risk factors related to these diseases, whose remotion or attenuation would contribute to a fall in mortality. The methodology of the first comprehensive multicenter study into risk factors of non-communicable chronic diseases carried out in Latin America is explained. In Brazil, this study was carried out in the cities of S. Paulo, SP and Porto Alegre, RS. Preliminary results from the city of S. Paulo as to the prevalence of arterial hypertension (22.3%), tabagism (37.9%), obesity (18.0%), alcoholism (7.7%) and sedentarism (69.3%) are presented. These results are compared with existing data from Brazil and other countries, and the relationship between various risk factors and the mortality from cardiovascular diseases in S. Paulo and some developed countries is discussed. PMID:2103645

  5. 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

  6. 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

  7. 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.

  8. 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. PMID:27303124

  9. 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.

  10. 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. PMID:24665927

  11. 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.

  12. 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. PMID:26308806

  13. Predicting long-term cardiovascular risk using the mayo clinic cardiovascular risk score in a referral population.

    PubMed

    Dhoble, Abhijeet; Lahr, Brian D; Allison, Thomas G; Bailey, Kent R; Thomas, Randal J; Lopez-Jimenez, Francisco; Kullo, Iftikhar J; Gupta, Bhanu; Kopecky, Stephen L

    2014-09-01

    Exercise testing provides valuable information but is rarely integrated to derive a risk prediction model in a referral population. In this study, we assessed the predictive value of conventional cardiovascular risk factors and exercise test parameters in 6,546 consecutive adults referred for exercise testing, who were followed for a period of 8.1 ± 3.7 years for incident myocardial infarction, coronary revascularization, and cardiovascular death. A risk prediction model was developed, and cross-validation of model was performed by splitting the data set into 10 equal random subsets, with model fitting based on 9 of the 10 subsets and testing in of the remaining subset, repeated in all 10 possible ways. The best performing model was chosen based on measurements of model discrimination and stability. A risk score was constructed from the final model, with points assigned for the presence of each predictor based on the regression coefficients. Using both conventional risk factors and exercise test parameters, a total of 9 variables were identified as independent and robust predictors and were included in a risk score. The prognostic ability of this model was compared with that of the Adult Treatment Panel III model using the net reclassification and integrated discrimination index. From the cross-validation results, the c statistic of 0.77 for the final model indicated strong predictive power. In conclusion, we developed, tested, and internally validated a novel risk prediction model using exercise treadmill testing parameters. PMID:25052544

  14. 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. PMID:26596650

  15. The Neonatal Skin Risk Assessment Scale for predicting skin breakdown in neonates.

    PubMed

    Huffines, B; Logsdon, M C

    1997-01-01

    An instrument was developed to assess neonates at risk for skin breakdown, based on the Braden Scale for Predicting Pressure Sore Risk in adults. Using such an instrument to predict, and thus prevent, skin breakdown could decrease costs associated with prolonged hospital stays in neonates. The Neonatal Skin Risk Assessment Scale (NSRAS) was piloted with 32 neonates. Reliability was high for the subscales of general physical condition, activity, and nutrition, but low in the other three subscales. For predictive validity, sensitivity was 83% and specificity was 81%. The NSRAS appears to be useful in predicting days most likely for skin breakdown to occur.

  16. Predicting urban outdoor thermal comfort by the Universal Thermal Climate Index UTCI—a case study in Southern Brazil

    NASA Astrophysics Data System (ADS)

    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.

  17. 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.

  18. Prevalence and risk factors for Toxoplasma gondii in sheep in the State of Paraíba, Northeastern Brazil.

    PubMed

    Correia, Érico Luís de Barros; Feitosa, Thais Ferreira; Santos, Fabrine Alexandre dos; Azevedo, Sérgio Santos de; Pena, Hilda Fátima de Jesus; Gennari, Solange Maria; Mota, Rinaldo Aparecido; Alves, Clebert José

    2015-01-01

    The aims of this survey were to determine the flock-level and animal-level prevalences of anti-Toxoplasma gondii antibodies in sheep in the State of Paraíba, Northeastern Brazil, and to identify risk factors. Blood samples were collected from 540 sheep in 63 flocks in 14 municipalities in the Sertão mesoregion. To serologically diagnose T. gondiii nfection, the indirect immunofluorescent antibody test (IFAT) was used. Flocks with at least one seropositive animal were considered positive. Among the 63 flocks, 28 (44.44%) were positive, and 60 (11.11%) of the 540 animals were seropositive. Variable flock size > 25 animals was identified as a risk factor (odds ratio = 3.2; 95% CI = 1.09 - 9.34; P = 0.033). The results from this survey demonstrate that T. gondii is spread among sheep in the State of Paraíba. PMID:26291143

  19. 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

  20. Perceived mental illness stigma and HIV risk behaviors among adult psychiatric outpatients in Rio de Janeiro, Brazil.

    PubMed

    Elkington, Katherine S; McKinnon, Karen; Mann, Claudio Gruber; Collins, Pamela Y; Leu, Cheng-Shiun; Wainberg, Milton L

    2010-02-01

    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 3 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

  1. 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. PMID:22328705

  2. 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…

  3. 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.

  4. 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.

  5. 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 predictive validity regarding their individual and/or combined use in risk assessments. The current study compares three structured adolescent risk instruments, Youth Level of Service/Case Management Inventory…

  6. [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.

  7. Cardiovascular Lifetime Risk Predicts Incidence of Coronary Calcification in Individuals With Low Short‐Term Risk: The Dallas Heart Study

    PubMed Central

    Paixao, Andre R. M.; Ayers, Colby R.; Rohatgi, Anand; Das, Sandeep R.; de Lemos, James A.; Khera, Amit; Lloyd‐Jones, Donald; Berry, Jarett D.

    2014-01-01

    Background The absence of coronary artery calcium (CAC) in middle age is associated with very low short‐term risk for coronary events. However, the long‐term implications of a CAC score of 0 are uncertain, particularly among individuals with high cardiovascular lifetime risk. We sought to characterize the association between predicted lifetime risk and incident CAC among individuals with low short‐term risk. Methods and Results We included 754 Dallas Heart Study participants with serial CAC scans (6.9 years apart) and both low short‐term risk and baseline CAC=0. Lifetime risk for cardiovascular disease was estimated according to risk factor burden. Among this group, 365 individuals (48.4%) were at low lifetime risk and 389 (51.6%) at high lifetime risk. High lifetime risk was associated with higher annualized CAC incidence (4.2% versus 2.7%; P < 0.001). Similarly, mean follow‐up CAC scores were higher among participants with high lifetime risk (7.8 versus 2.4 Agatston units). After adjustment for age, sex, and race, high lifetime risk remained independently associated with incident CAC (OR 1.60; 95% CI 1.12 to 2.27; P=0.01). When assessing risk factor burden at the follow‐up visit, 66.7% of CAC incidence observed in the low lifetime risk group occurred among individuals reclassified to a higher short‐ or long‐term risk category. Conclusion Among individuals with low short‐term risk and CAC scores of 0, high lifetime risk is associated with a higher incidence of CAC. These findings highlight the importance of lifetime risk even among individuals with very low short‐term risk. PMID:25424574

  8. Predicting carbon dynamics in integrated production systems in Brazil using the CQESTR model

    Technology Transfer Automated Retrieval System (TEKTRAN)

    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...

  9. Intelligence Predicts Scholastic Achievement Irrespective of SES Factors: Evidence from Brazil

    ERIC Educational Resources Information Center

    Colom, Roberto; Flores-Mendoza, Carmen E.

    2007-01-01

    This study explores whether or not intelligence tests' scores predict individual differences in scholastic achievement irrespective of SES factors such parents' income and education. The variables of interest are analyzed considering three independent samples of participants comprising a total of 641 children. The participants belonged to a…

  10. 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.

  11. The development of an automated ward independent delirium risk prediction model.

    PubMed

    de Wit, Hugo A J M; Winkens, Bjorn; Mestres Gonzalvo, Carlota; Hurkens, Kim P G M; Mulder, Wubbo J; Janknegt, Rob; Verhey, Frans R; van der Kuy, Paul-Hugo M; Schols, Jos M G A

    2016-08-01

    Background A delirium is common in hospital settings resulting in increased mortality and costs. Prevention of a delirium is clearly preferred over treatment. A delirium risk prediction model can be helpful to identify patients at risk of a delirium, allowing the start of preventive treatment. Current risk prediction models rely on manual calculation of the individual patient risk. Objective The aim of this study was to develop an automated ward independent delirium riskprediction model. To show that such a model can be constructed exclusively from electronically available risk factors and thereby implemented into a clinical decision support system (CDSS) to optimally support the physician to initiate preventive treatment. Setting A Dutch teaching hospital. Methods A retrospective cohort study in which patients, 60 years or older, were selected when admitted to the hospital, with no delirium diagnosis when presenting, or during the first day of admission. We used logistic regression analysis to develop a delirium predictive model out of the electronically available predictive variables. Main outcome measure A delirium risk prediction model. Results A delirium risk prediction model was developed using predictive variables that were significant in the univariable regression analyses. The area under the receiver operating characteristics curve of the "medication model" model was 0.76 after internal validation. Conclusions CDSSs can be used to automatically predict the risk of a delirium in individual hospitalised patients' by exclusively using electronically available predictive variables. To increase the use and improve the quality of predictive models, clinical risk factors should be documented ready for automated use. PMID:27177868

  12. 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.

  13. A novel programme to evaluate and communicate 10-year risk of CHD reduces predicted risk and improves patients' modifiable risk factor profile

    PubMed Central

    Benner, J S; Erhardt, L; Flammer, M; Moller, R A; Rajicic, N; Changela, K; Yunis, C; Cherry, S B; Gaciong, Z; Johnson, E S; Sturkenboom, M C J M; García-Puig, J; Girerd, X

    2008-01-01

    Aims We assessed whether a novel programme to evaluate/communicate predicted coronary heart disease (CHD) risk could lower patients' predicted Framingham CHD risk vs. usual care. Methods The Risk Evaluation and Communication Health Outcomes and Utilization Trial was a prospective, controlled, cluster-randomised trial in nine European countries, among patients at moderate cardiovascular risk. Following baseline assessments, physicians in the intervention group calculated patients' predicted CHD risk and were instructed to advise patients according to a risk evaluation/communication programme. Usual care physicians did not calculate patients' risk and provided usual care only. The primary end-point was Framingham 10-year CHD risk at 6 months with intervention vs. usual care. Results Of 1103 patients across 100 sites, 524 patients receiving intervention, and 461 receiving usual care, were analysed for efficacy. After 6 months, mean predicted risks were 12.5% with intervention, and 13.7% with usual care [odds ratio = 0.896; p = 0.001, adjusted for risk at baseline (17.2% intervention; 16.9% usual care) and other covariates]. The proportion of patients achieving both blood pressure and low-density lipoprotein cholesterol targets was significantly higher with intervention (25.4%) than usual care (14.1%; p < 0.001), and 29.3% of smokers in the intervention group quit smoking vs. 21.4% of those receiving usual care (p = 0.04). Conclusions A physician-implemented CHD risk evaluation/communication programme improved patients' modifiable risk factor profile, and lowered predicted CHD risk compared with usual care. By combining this strategy with more intensive treatment to reduce residual modifiable risk, we believe that substantial improvements in cardiovascular disease prevention could be achieved in clinical practice. PMID:18691228

  14. Predictive performance of prostate cancer risk in Chinese men using 33 reported prostate cancer risk-associated SNPs

    PubMed Central

    Zheng, Jie; Liu, Fang; Lin, Xiaoling; Wang, Xiang; Ding, Qiang; Jiang, Haowen; Chen, Hongyan; Lu, Daru; Jin, Guangfu; Hsing, Ann W.; Shao, Qiang; Qi, Jun; Ye, Yu; Wang, Zhong; Gao, Xin; Wang, Guozeng; Chu, Lisa W.; OuYang, Jun; Huang, Yichen; Chen, Yanbo; Gao, Yutang; Shi, Rong; Wu, Qijun; Wang, Meilin; Zhang, Zhengdong; Hu, Yanlin; Sun, Jielin; Zheng, S. Lilly; Gao, Xu; Xu, Chuanliang; Mo, Zengnan; Sun, Yinghao; Xu, Jianfeng

    2011-01-01

    Background Genome-wide association studies (GWAS) have identified more than 30 single nucleotide polymorphisms (SNPs) that were reproducibly associated with prostate cancer (PCa) risk in populations of European descent. In aggregate, these variants have shown potential to predict risk for PCa in European men. However, their utility for PCa risk prediction in Chinese men is unknown. Methods We selected 33 PCa risk-related SNPs that were originally identified in populations of European descent. Genetic scores were estimated for subjects in a Chinese case-control study (1,108 cases and 1,525 controls) based on these SNPs. To assess the performance of the genetic score on its ability to predict risk for PCa, we calculated Area under the curve (AUC) of the receiver operating characteristic (ROC) in combination with 10-fold cross-validation. Results The genetic score was significantly higher for cases than controls (P = 5.91×10-20), and was significantly associated with risk of PCa in a dose-dependent manner (P for trend: 4.78×10-18). The AUC of the genetic score was 0.604 for risk prediction of PCa in Chinese men. When ORs derived from this Chinese study population were used to calculate genetic score, the AUCs were 0.631 for all 33 SNPs and 0.617 when using only the 11 significant SNPs. Conclusion Our results indicate that genetic variants related to PCa risk may be useful for risk prediction in Chinese men. Prospective studies are warranted to further evaluate these findings. PMID:21796652

  15. Predictive Malaria Risk and Uncertainty Mapping in Nchelenge District, Zambia: Evidence of Widespread, Persistent Risk and Implications for Targeted Interventions.

    PubMed

    Pinchoff, Jessie; Chaponda, Mike; Shields, Timothy; Lupiya, James; Kobayashi, Tamaki; Mulenga, Modest; Moss, William J; Curriero, Frank C

    2015-12-01

    Malaria risk maps may be used to guide policy decisions on whether vector control interventions should be targeted and, if so, where. Active surveillance for malaria was conducted through household surveys in Nchelenge District, Zambia from April 2012 through December 2014. Households were enumerated based on satellite imagery and randomly selected for study enrollment. At each visit, participants were administered a questionnaire and a malaria rapid diagnostic test (RDT). Logistic regression models were used to construct spatial prediction risk maps and maps of risk uncertainty. A total of 461 households were visited, comprising 1,725 participants, of whom 48% were RDT positive. Several environmental features were associated with increased household malaria risk in a multivariable logistic regression model adjusting for seasonal variation. The model was validated using both internal and external evaluation measures to generate and assess root mean square error, as well as sensitivity and specificity for predicted risk. The final, validated model was used to predict and map malaria risk including a measure of risk uncertainty. Malaria risk in a high, perennial transmission setting is widespread but heterogeneous at a local scale, with seasonal variation. Targeting malaria control interventions may not be appropriate in this epidemiological setting.

  16. 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

  17. 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.

  18. Genomic risk prediction of complex human disease and its clinical application.

    PubMed

    Abraham, Gad; Inouye, Michael

    2015-08-01

    Recent advances in genome-wide association studies have stimulated interest in the genomic prediction of disease risk, potentially enabling individual-level risk estimates for early intervention and improved diagnostic procedures. Here, we review recent findings and approaches to genomic prediction model construction and performance, then contrast the potential benefits of such models in two complex human diseases, aiding diagnosis in celiac disease and prospective risk prediction for cardiovascular disease. Early indications are that optimal application of genomic risk scores will differ substantially for each disease depending on underlying genetic architecture as well as current clinical and public health practice. As costs decline, genomic profiles become common, and popular understanding of risk and its communication improves, genomic risk will become increasingly useful for the individual and the clinician.

  19. Risk factors for childhood pneumonia among the urban poor in Fortaleza, Brazil: a case--control study.

    PubMed

    Fonseca, W; Kirkwood, B R; Victora, C G; Fuchs, S R; Flores, J A; Misago, C

    1996-01-01

    Reported are the results of a case-control study carried out between July 1989 and June 1990 in Fortaleza city, Ceará State, Brazil, to determine the factors that place young children living in urban slum conditions at increased risk of contracting pneumonia. Cases were 650 under-2-year-olds with a radiological diagnosis of pneumonia who were recruited at the main paediatric hospital in the city over a full calendar year. Age-matched controls were recruited from the neighbourhood where the cases lived. Cases and controls were compared with respect to a variety of sociodemographic, environmental, reproductive, nutritional, and morbidity factors, and a risk factor questionnaire was administered to the mother of each child or to the child's normal guardian. Cases and controls were also weighed and measured. Malnutrition was the most important risk factor for childhood pneumonia in the study population, with weight-for-age, height-for-age, and weight-for-height also being important risk factors. In view of the high prevalence of stunting in the study population, there is an urgent need to reduce the level of malnutrition as a priority. Attendance at a day care centre was also associated with a high odds ratio. In view of the growing numbers of children attending day care centres in both developing and developed countries, it is essential that ways be identified to improve the design and management of such centres in order to minimize the risk of pneumonia. Increased risks of childhood pneumonia were also associated with low birth weight, non-breast-feeding, crowding, high parity, and incomplete vaccination status, but not with socioeconomic status or environmental variables. Finally, children who had suffered from previous episodes of wheezing or been hospitalized for pneumonia had a greater than threefold increased risk of contracting the disease.

  20. 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.

  1. 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

  2. Predicting reading disability: early cognitive risk and protective factors.

    PubMed

    Eklund, Kenneth Mikael; Torppa, Minna; Lyytinen, Heikki

    2013-02-01

    This longitudinal study examined early cognitive risk and protective factors for Grade 2 reading disability (RD). We first examined the reading outcome of 198 children in four developmental cognitive subgroups that were identified in our previous analysis: dysfluent trajectory, declining trajectory, unexpected trajectory and typical trajectory. We found that RD was unevenly distributed among the subgroups, although children with RD were found in all subgroups. A majority of the children with RD had familial risk for dyslexia. Second, we examined in what respect children with similar early cognitive development but different RD outcome differ from each other in cognitive skills, task-focused behaviour and print exposure. The comparison of the groups with high cognitive risk but different RD outcome showed significant differences in phonological skills, in the amount of shared reading and in task-focused behaviour. Children who ended up with RD despite low early cognitive risk had poorer cognitive skills, more task avoidance and they were reading less than children without RD and low cognitive risk. In summary, lack of task avoidance seemed to act as a protective factor, which underlines the importance of keeping children interested in school work and reading. PMID:23297103

  3. Predicting reading disability: early cognitive risk and protective factors.

    PubMed

    Eklund, Kenneth Mikael; Torppa, Minna; Lyytinen, Heikki

    2013-02-01

    This longitudinal study examined early cognitive risk and protective factors for Grade 2 reading disability (RD). We first examined the reading outcome of 198 children in four developmental cognitive subgroups that were identified in our previous analysis: dysfluent trajectory, declining trajectory, unexpected trajectory and typical trajectory. We found that RD was unevenly distributed among the subgroups, although children with RD were found in all subgroups. A majority of the children with RD had familial risk for dyslexia. Second, we examined in what respect children with similar early cognitive development but different RD outcome differ from each other in cognitive skills, task-focused behaviour and print exposure. The comparison of the groups with high cognitive risk but different RD outcome showed significant differences in phonological skills, in the amount of shared reading and in task-focused behaviour. Children who ended up with RD despite low early cognitive risk had poorer cognitive skills, more task avoidance and they were reading less than children without RD and low cognitive risk. In summary, lack of task avoidance seemed to act as a protective factor, which underlines the importance of keeping children interested in school work and reading.

  4. Predicting Risk of Suicide Attempt Using History of Physical Illnesses From Electronic Medical Records

    PubMed Central

    Luo, Wei; Tran, Truyen; Berk, Michael; Venkatesh, Svetha

    2016-01-01

    Background Although physical illnesses, routinely documented in electronic medical records (EMR), have been found to be a contributing factor to suicides, no automated systems use this information to predict suicide risk. Objective The aim of this study is to quantify the impact of physical illnesses on suicide risk, and develop a predictive model that captures this relationship using EMR data. Methods We used history of physical illnesses (except chapter V: Mental and behavioral disorders) from EMR data over different time-periods to build a lookup table that contains the probability of suicide risk for each chapter of the International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10) codes. The lookup table was then used to predict the probability of suicide risk for any new assessment. Based on the different lengths of history of physical illnesses, we developed six different models to predict suicide risk. We tested the performance of developed models to predict 90-day risk using historical data over differing time-periods ranging from 3 to 48 months. A total of 16,858 assessments from 7399 mental health patients with at least one risk assessment was used for the validation of the developed model. The performance was measured using area under the receiver operating characteristic curve (AUC). Results The best predictive results were derived (AUC=0.71) using combined data across all time-periods, which significantly outperformed the clinical baseline derived from routine risk assessment (AUC=0.56). The proposed approach thus shows potential to be incorporated in the broader risk assessment processes used by clinicians. Conclusions This study provides a novel approach to exploit the history of physical illnesses extracted from EMR (ICD-10 codes without chapter V-mental and behavioral disorders) to predict suicide risk, and this model outperforms existing clinical assessments of suicide risk. PMID:27400764

  5. Long‐Term Post‐CABG Survival: Performance of Clinical Risk Models Versus Actuarial Predictions

    PubMed Central

    Carr, Brendan M.; Romeiser, Jamie; Ruan, Joyce; Gupta, Sandeep; Seifert, Frank C.; Zhu, Wei

    2015-01-01

    Abstract Background/aim Clinical risk models are commonly used to predict short‐term coronary artery bypass grafting (CABG) mortality but are less commonly used to predict long‐term mortality. The added value of long‐term mortality clinical risk models over traditional actuarial models has not been evaluated. To address this, the predictive performance of a long‐term clinical risk model was compared with that of an actuarial model to identify the clinical variable(s) most responsible for any differences observed. Methods Long‐term mortality for 1028 CABG patients was estimated using the Hannan New York State clinical risk model and an actuarial model (based on age, gender, and race/ethnicity). Vital status was assessed using the Social Security Death Index. Observed/expected (O/E) ratios were calculated, and the models' predictive performances were compared using a nested c‐index approach. Linear regression analyses identified the subgroup of risk factors driving the differences observed. Results Mortality rates were 3%, 9%, and 17% at one‐, three‐, and five years, respectively (median follow‐up: five years). The clinical risk model provided more accurate predictions. Greater divergence between model estimates occurred with increasing long‐term mortality risk, with baseline renal dysfunction identified as a particularly important driver of these differences. Conclusions Long‐term mortality clinical risk models provide enhanced predictive power compared to actuarial models. Using the Hannan risk model, a patient's long‐term mortality risk can be accurately assessed and subgroups of higher‐risk patients can be identified for enhanced follow‐up care. More research appears warranted to refine long‐term CABG clinical risk models. doi: 10.1111/jocs.12665 (J Card Surg 2016;31:23–30) PMID:26543019

  6. Predictions of Leukemia Risks to Astronauts from Solar Particle Events

    NASA Technical Reports Server (NTRS)

    Cucinotta, F. A.; Atwell, W.; Kim, M. Y.; George, K. A.; Ponomarev, A.; Nikjoo, H.; Wilson, J. W.

    2006-01-01

    Leukemias consisting of acute and chronic myeloid leukemia and acute lymphatic lymphomas represent the earliest cancers that appear after radiation exposure, have a high lethality fraction, and make up a significant fraction of the overall fatal cancer risk from radiation for adults. Several considerations impact the recommendation of a preferred model for the estimation of leukemia risks from solar particle events (SPE's): The BEIR VII report recommends several changes to the method of calculation of leukemia risk compared to the methods recommended by the NCRP Report No. 132 including the preference of a mixture model with additive and multiplicative components in BEIR VII compared to the additive transfer model recommended by NCRP Report No. 132. Proton fluences and doses vary considerably across marrow regions because of the characteristic spectra of primary solar protons making the use of an average dose suspect. Previous estimates of bone marrow doses from SPE's have used an average body-shielding distribution for marrow based on the computerized anatomical man model (CAM). We have developed an 82-point body-shielding distribution that faithfully reproduces the mean and variance of SPE doses in the active marrow regions (head and neck, chest, abdomen, pelvis and thighs) allowing for more accurate estimation of linear- and quadratic-dose components of the marrow response. SPE's have differential dose-rates and a pseudo-quadratic dose response term is possible in the peak-flux period of an event. Also, the mechanistic basis for leukemia risk continues to improve allowing for improved strategies in choosing dose-rate modulation factors and radiation quality descriptors. We make comparisons of the various choices of the components in leukemia risk estimates in formulating our preferred model. A major finding is that leukemia could be the dominant risk to astronauts for a major solar particle event.

  7. Cardiorespiratory fitness is a stronger indicator of cardiometabolic risk factors and risk prediction than self-reported physical activity levels.

    PubMed

    Gray, Benjamin J; Stephens, Jeffrey W; Williams, Sally P; Davies, Christine A; Turner, Daniel; Bracken, Richard M

    2015-11-01

    This study investigated the relationships of self-reported physical activity levels and cardiorespiratory fitness in 81 males to assess which measurement is the greatest indicator of cardiometabolic risk. Physical activity levels were determined by the General Practice Physical Activity Questionnaire tool and cardiorespiratory fitness assessed using the Chester Step Test. Cardiovascular disease risk was estimated using the QRISK2, Framingham Lipids, Framingham body mass index and Joint British Societies' Guidelines-2 equations, and type 2 diabetes mellitus risk calculated using QDiabetes, Leicester Risk Assessment, Finnish Diabetes Risk Score and Cambridge Risk Score models. Categorising employees by cardiorespiratory fitness categories ('Excellent/Good' vs 'Average/Below Average') identified more differences in cardiometabolic risk factor (body mass index, waist circumference, total cholesterol, total cholesterol:high-density lipoprotein ratio, high-density lipoprotein cholesterol, triglycerides, HbA(1c)) scores than physical activity (waist circumference only). Cardiorespiratory fitness levels also demonstrated differences in all four type 2 diabetes mellitus risk prediction models and both the QRISK2 and Joint British Societies' Guidelines-2 cardiovascular disease equations. Furthermore, significant negative correlations (p < 0.001) were observed between individual cardiorespiratory fitness values and estimated risk in all prediction models. In conclusion, from this preliminary observational study, cardiorespiratory fitness levels reveal a greater number of associations with markers of cardiovascular disease or type 2 diabetes mellitus compared to physical activity determined by the General Practice Physical Activity Questionnaire tool.

  8. Cardiorespiratory fitness is a stronger indicator of cardiometabolic risk factors and risk prediction than self-reported physical activity levels.

    PubMed

    Gray, Benjamin J; Stephens, Jeffrey W; Williams, Sally P; Davies, Christine A; Turner, Daniel; Bracken, Richard M

    2015-11-01

    This study investigated the relationships of self-reported physical activity levels and cardiorespiratory fitness in 81 males to assess which measurement is the greatest indicator of cardiometabolic risk. Physical activity levels were determined by the General Practice Physical Activity Questionnaire tool and cardiorespiratory fitness assessed using the Chester Step Test. Cardiovascular disease risk was estimated using the QRISK2, Framingham Lipids, Framingham body mass index and Joint British Societies' Guidelines-2 equations, and type 2 diabetes mellitus risk calculated using QDiabetes, Leicester Risk Assessment, Finnish Diabetes Risk Score and Cambridge Risk Score models. Categorising employees by cardiorespiratory fitness categories ('Excellent/Good' vs 'Average/Below Average') identified more differences in cardiometabolic risk factor (body mass index, waist circumference, total cholesterol, total cholesterol:high-density lipoprotein ratio, high-density lipoprotein cholesterol, triglycerides, HbA(1c)) scores than physical activity (waist circumference only). Cardiorespiratory fitness levels also demonstrated differences in all four type 2 diabetes mellitus risk prediction models and both the QRISK2 and Joint British Societies' Guidelines-2 cardiovascular disease equations. Furthermore, significant negative correlations (p < 0.001) were observed between individual cardiorespiratory fitness values and estimated risk in all prediction models. In conclusion, from this preliminary observational study, cardiorespiratory fitness levels reveal a greater number of associations with markers of cardiovascular disease or type 2 diabetes mellitus compared to physical activity determined by the General Practice Physical Activity Questionnaire tool. PMID:26361778

  9. Prediction versus management models relevant to risk assessment: the importance of legal decision-making context.

    PubMed

    Heilbrun, K

    1997-08-01

    Most of the theoretical and empirical literature on violence risk to date has focused on the task of predicting who will behave violently. In the present article, it is argued that at least two models of risk assessment may be applied to the varying legal decisions in which violence risk is a consideration: prediction (with an emphasis on overall accuracy) and management (with an emphasis on risk reduction). These two models are described, and discussed in the contexts of the literatures on forensic assessment and therapeutic jurisprudence. The implications for research, policy, and practice are considered.

  10. 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

  11. Prediction of Violence Perpetration Among High-Risk Youth

    ERIC Educational Resources Information Center

    Sussman, Steve; Skara, Silvana; Weiner, Michelle D.; Dent, Clyde W.

    2004-01-01

    Objectives: To prospectively examine demographic background, personality, perceived environment, and behavior as violence perpetration predictors in emerging adulthood among high-risk adolescents using problem-behavior theory as a conceptual perspective. Methods: Self-report questionnaires were administered 5 years apart to 676 participants.…

  12. Predicting Children's Depressive Symptoms from Community and Individual Risk Factors

    ERIC Educational Resources Information Center

    Dallaire, Danielle H.; Cole, David A.; Smith, Thomas M.; Ciesla, Jeffrey A.; LaGrange, Beth; Jacquez, Farrah M.; Pineda, Ashley Q.; Truss, Alanna E.; Folmer, Amy S.

    2008-01-01

    Community, demographic, familial, and personal risk factors of childhood depressive symptoms were examined from an ecological theoretical approach using hierarchical linear modeling. Individual-level data were collected from an ethnically diverse (73% African-American) community sample of 197 children and their parents; community-level data were…

  13. Androidal fat dominates in predicting cardiometabolic risk in postmenopausal women

    Technology Transfer Automated Retrieval System (TEKTRAN)

    We hypothesized that soy isoflavones would attenuate the anticipated increase in androidal fat mass in postmenopausal women during the 36-month treatment, and thereby favorably modify the circulating cardiometabolic risk factors: triacylglycerol, LDLC, HDL-C, glucose, insulin, uric acid, C-reactive ...

  14. Optimization of agricultural field workability predictions for improved risk management

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Risks introduced by weather variability are key considerations in agricultural production. The sensitivity of agriculture to weather variability is of special concern in the face of climate change. In particular, the availability of workable days is an important consideration in agricultural practic...

  15. PREDICTING RISKS TO WILDLIFE FROM THE OFFTARGET MOVEMENT OF HERBICIDES

    EPA Science Inventory

    While insecticide applications are generally thought of as the greatest pesticide risk to wildlife, the recent literature would suggest the indirect effects of herbicides on wildlife are much greater. The resulting alteration of habitat and decrease in food sources from the off ...

  16. Enhancement of Mammographic Density Measures in Breast Cancer Risk Prediction

    PubMed Central

    Cheddad, Abbas; Czene, Kamila; Shepherd, John A.; Li, Jingmei; Hall, Per; Humphreys, Keith

    2016-01-01

    Background Mammographic density is a strong risk factor for breast cancer. Methods We present a novel approach to enhance area density measures that takes advantage of the relative density of the pectoral muscle that appears in lateral mammographic views. We hypothesized that the grey scale of film mammograms is normalized to volume breast density but not pectoral density and thus pectoral density becomes an independent marker of volumetric density. Results From analysis of data from a Swedish case–control study (1,286 breast cancer cases and 1,391 control subjects, ages 50–75 years), we found that the mean intensity of the pectoral muscle (MIP) was highly associated with breast cancer risk [per SD: OR = 0.82; 95% confidence interval (CI), 0.75–0.88; P = 6 × 10−7] after adjusting for a validated computer-assisted measure of percent density (PD), Cumulus. The area under curve (AUC) changed from 0.600 to 0.618 due to using PD with the pectoral muscle as reference instead of a standard area-based PD measure. We showed that MIP is associated with a genetic variant known to be associated with mammographic density and breast cancer risk, rs10995190, in a subset of women with genetic data. We further replicated the association between MIP and rs10995190 in an additional cohort of 2,655 breast cancer cases (combined P = 0.0002). Conclusions MIP is a marker of volumetric density that can be used to complement area PD in mammographic density studies and breast cancer risk assessment. Impact Inclusion of MIP in risk models should be considered for studies using area PD from analog films. PMID:24722754

  17. Predicting Disease Risk, Identifying Stakeholders, and Informing Control Strategies: A Case Study of Anthrax in Montana.

    PubMed

    Morris, Lillian R; Blackburn, Jason K

    2016-06-01

    Infectious diseases that affect wildlife and livestock are challenging to manage and can lead to large-scale die-offs, economic losses, and threats to human health. The management of infectious diseases in wildlife and livestock is made easier with knowledge of disease risk across space and identifying stakeholders associated with high-risk landscapes. This study focuses on anthrax, caused by the bacterium Bacillus anthracis, risk to wildlife and livestock in Montana. There is a history of anthrax in Montana, but the spatial extent of disease risk and subsequent wildlife species at risk are not known. Our objective was to predict the potential geographic distribution of anthrax risk across Montana, identify wildlife species at risk and their distributions, and define stakeholders. We used an ecological niche model to predict the potential distribution of anthrax risk. We overlaid susceptible wildlife species distributions and land ownership delineations on our risk map. We found that there was an extensive region across Montana predicted as potential anthrax risk. These potentially risky landscapes overlapped the ranges of all 6 ungulate species considered in the analysis and livestock grazing allotments, and this overlap was on public and private land for all species. Our findings suggest that there is the potential for a multi-species anthrax outbreak on multiple landscapes across Montana. Our potential anthrax risk map can be used to prioritize landscapes for surveillance and for implementing livestock vaccination programs. PMID:27169560

  18. Cross-sectional study to assess the association of population density with predicted breast cancer risk.

    PubMed

    Lee, Jeannette Y; Klimberg, Suzanne; Bondurant, Kristina L; Phillips, Martha M; Kadlubar, Susan A

    2014-01-01

    The Gail and CARE models estimate breast cancer risk for white and African-American (AA) women, respectively. The aims of this study were to compare metropolitan and nonmetropolitan women with respect to predicted breast cancer risks based on known risk factors, and to determine if population density was an independent risk factor for breast cancer risk. A cross-sectional survey was completed by 15,582 women between 35 and 85 years of age with no history of breast cancer. Metropolitan and nonmetropolitan women were compared with respect to risk factors, and breast cancer risk estimates, using general linear models adjusted for age. For both white and AA women, tisk factors used to estimate breast cancer risk included age at menarche, history of breast biopsies, and family history. For white women, age at first childbirth was an additional risk factor. In comparison to their nonmetropolitan counterparts, metropolitan white women were more likely to report having a breast biopsy, have family history of breast cancer, and delay childbirth. Among white metropolitan and nonmetropolitan women, mean estimated 5-year risks were 1.44% and 1.32% (p < 0.001), and lifetime risks of breast cancer were 10.81% and 10.01% (p < 0.001), respectively. AA metropolitan residents were more likely than those from nonmetropolitan areas to have had a breast biopsy. Among AA metropolitan and nonmetropolitan women, mean estimated 5-year risks were 1.16% and 1.12% (p = 0.039) and lifetime risks were 8.94%, and 8.85% (p = 0.344). Metropolitan residence was associated with higher predicted breast cancer risks for white women. Among AA women, metropolitan residence was associated with a higher predicted breast cancer risk at 5 years, but not over a lifetime. Population density was not an independent risk factor for breast cancer.

  19. 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. PMID:25971852

  20. 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.

  1. Prediction of the level of ionospheric scintillation at equatorial latitudes in Brazil using a neural network

    NASA Astrophysics Data System (ADS)

    Lima, G. R. T.; Stephany, S.; Paula, E. R.; Batista, I. S.; Abdu, M. A.

    2015-08-01

    Electron density irregularity structures, often associated with ionospheric plasma bubbles, drive amplitude and phase fluctuations in radio signals that, in turn, create a phenomenon known as ionospheric scintillation. The phenomenon occurs frequently around the magnetic equator where plasma instability mechanisms generate postsunset plasma bubbles and density depletions. A previous correlation study suggested that scintillation at the magnetic equator may provide a forecast of subsequent scintillation at the equatorial ionization anomaly southern peak. In this work, it is proposed to predict the level of scintillation over São Luís (2.52°S, 44.3°W; dip latitude: ~2.5°S) near the magnetic equator with lead time of hours but without specifying the moment at which the scintillation starts or ends. A collection of extended databases relating scintillation to ionospheric variables for São Luís is employed to perform the training of an artificial neural network with a new architecture. Two classes are considered, not strong (null/weak/moderate) and strong scintillation. An innovative scheme preprocesses the data taking into account similarities of the values of the variables for the same class. A formerly proposed resampling heuristic is employed to provide a balanced number of tuples of each class in the training set. Tests were performed showing that the proposed neural network is able to predict the level of scintillation over the station on the evening ahead of the data sample considered between 17:30 and 19:00 LT.

  2. The prevalence and correlates of behavioral risk factors for cardiovascular health among Southern Brazil adolescents: a cross-sectional study

    PubMed Central

    2012-01-01

    Background The adoption of health-related behaviors is an important part of adolescence. This study examined the prevalence and correlates of the isolated and simultaneous presence of behavioral risk factors for cardiovascular health (BRFCH) among adolescents in Curitiba, Southern Brazil. Methods A cross-sectional study was performed with 1,628 adolescents (aged 11-17.9 years, 52.5% males) that were randomly selected from 44 public schools. Self-report instruments were used to assess the variables. Six BRFCH were analyzed: insufficiently active, excessive TV watching, current alcohol and tobacco use, daily soft drinks consumption and inadequate fruit and vegetable consumption. Sociodemographic and behavioral variables were studied as possible correlates of the presence of BRFCH. Results The BRFCH with the highest prevalence were insufficiently active (50.5%, 95% confidence interval [95% CI]: 48.0-52.9) and daily soft drinks consumption (47.6%, 95% CI: 45.1-50.0). Approximately 30% of the adolescents presented three or more BRFCH simultaneously. Girls, adolescents who did not participate in organized physical activity, and who used computer/video games daily were the main high-risk subgroups for insufficiently active. Boys and those who used computer/video games daily were the high-risk subgroups for daily soft drinks consumption. For excessive TV watching, we identified to be at risk those who were from a high economic class, unemployed, and who used computer/video games daily. For current alcohol use, we identified older adolescents, who were from a high economic class and who worked to be at risk. Older adolescents, who worked and who spent little active time during a physical education class were the high-risk subgroups for current tobacco use. For inadequate fruit and vegetable consumption, we identified those who did not participate in organized physical activity to be at risk. Older adolescents, who were from a high economic class, who did not participate

  3. Radiation risk predictions for Space Station Freedom orbits

    NASA Technical Reports Server (NTRS)

    Cucinotta, Francis A.; Atwell, William; Weyland, Mark; Hardy, Alva C.; Wilson, John W.; Townsend, Lawrence W.; Shinn, Judy L.; Katz, Robert

    1991-01-01

    Risk assessment calculations are presented for the preliminary proposed solar minimum and solar maximum orbits for Space Station Freedom (SSF). Integral linear energy transfer (LET) fluence spectra are calculated for the trapped proton and GCR environments. Organ dose calculations are discussed using the computerized anatomical man model. The cellular track model of Katz is applied to calculate cell survival, transformation, and mutation rates for various aluminum shields. Comparisons between relative biological effectiveness (RBE) and quality factor (QF) values for SSF orbits are made.

  4. Radiation risk predictions for Space Station Freedom orbits

    NASA Astrophysics Data System (ADS)

    Cucinotta, Francis A.; Atwell, William; Weyland, Mark; Hardy, Alva C.; Wilson, John W.; Townsend, Lawrence W.; Shinn, Judy L.; Katz, Robert

    1991-06-01

    Risk assessment calculations are presented for the preliminary proposed solar minimum and solar maximum orbits for Space Station Freedom (SSF). Integral linear energy transfer (LET) fluence spectra are calculated for the trapped proton and GCR environments. Organ dose calculations are discussed using the computerized anatomical man model. The cellular track model of Katz is applied to calculate cell survival, transformation, and mutation rates for various aluminum shields. Comparisons between relative biological effectiveness (RBE) and quality factor (QF) values for SSF orbits are made.

  5. Endocrine and Metabolic Biomarkers Predicting Early Childhood Obesity Risk.

    PubMed

    Socha, Piotr; Hellmuth, Christian; Gruszfeld, Dariusz; Demmelmair, Hans; Rzehak, Peter; Grote, Veit; Weber, Martina; Escribano, Joaquin; Closa-Monasterolo, Ricardo; Dain, Elena; Langhendries, Jean-Paul; Riva, Enrica; Verduci, Elvira; Koletzko, Berthold

    2016-01-01

    There is growing evidence of long-term effects of early dietary intervention in infancy on later obesity risk. Many studies showed reduced risk of obesity with breastfeeding in infancy, which could be related to the reduced protein intake with human milk compared to infant formula. In a randomized controlled trial (Childhood Obesity Project), we were able to show that infant formula with reduced protein content results in lower BMI both at 2 and 6 years. These effects seem to be mediated mainly by branched-chain amino acids which stimulate the insulin-like growth factor (IGF)-1 axis and insulin release. In this trial, we also showed an influence of high-protein diet on larger kidney size, which seems to be partly explained by a significant effect of free IGF-1 on kidney volume. The IGF-1 axis was shown to regulate early growth, adipose tissue differentiation and early adipogenesis in animals and in humans. Leptin and adiponectin can also be regarded as important endocrine regulators of obesity. These markers were tested in observational studies. Leptin seems to be closely correlated with BMI but changes in adiponectin require further exploration. Still, there is a lack of good data or some results are contradictory to indicate the role of either leptin or adiponectin in infancy for determining later obesity risk.

  6. Endocrine and Metabolic Biomarkers Predicting Early Childhood Obesity Risk.

    PubMed

    Socha, Piotr; Hellmuth, Christian; Gruszfeld, Dariusz; Demmelmair, Hans; Rzehak, Peter; Grote, Veit; Weber, Martina; Escribano, Joaquin; Closa-Monasterolo, Ricardo; Dain, Elena; Langhendries, Jean-Paul; Riva, Enrica; Verduci, Elvira; Koletzko, Berthold

    2016-01-01

    There is growing evidence of long-term effects of early dietary intervention in infancy on later obesity risk. Many studies showed reduced risk of obesity with breastfeeding in infancy, which could be related to the reduced protein intake with human milk compared to infant formula. In a randomized controlled trial (Childhood Obesity Project), we were able to show that infant formula with reduced protein content results in lower BMI both at 2 and 6 years. These effects seem to be mediated mainly by branched-chain amino acids which stimulate the insulin-like growth factor (IGF)-1 axis and insulin release. In this trial, we also showed an influence of high-protein diet on larger kidney size, which seems to be partly explained by a significant effect of free IGF-1 on kidney volume. The IGF-1 axis was shown to regulate early growth, adipose tissue differentiation and early adipogenesis in animals and in humans. Leptin and adiponectin can also be regarded as important endocrine regulators of obesity. These markers were tested in observational studies. Leptin seems to be closely correlated with BMI but changes in adiponectin require further exploration. Still, there is a lack of good data or some results are contradictory to indicate the role of either leptin or adiponectin in infancy for determining later obesity risk. PMID:27088335

  7. Predicting women's alcohol risk-taking while abroad.

    PubMed

    Smith, Gabie; Klein, Sarah

    2010-05-01

    Numerous studies have examined risk factors that are associated with heavy alcohol use; however, much of this research has not addressed factors that specifically relate to women's alcohol use. The current study has extended the previous literature on women's alcohol-use behavior by examining factors associated with risky drinking in young women traveling abroad (n = 55). Using a pretest-posttest design, we examined the influence of disinhibition sensation-seeking and endorsement of social enhancement alcohol expectancies in relation to participation in risky alcohol use while abroad for three weeks. Analyses confirmed that disinhibition sensation-seeking and social enhancement alcohol expectancies were associated with participation in risky alcohol-use behaviors while abroad (controlling for alcohol-use at the pretest). Analysis of qualitative data reinforced the importance of social facilitation in women's alcohol risk-taking. Participants' qualitative data also emphasized characteristics of situational disinhibition relating to travel as well as culturally-specific motivations for alcohol-use behaviors. Further research examining women's personal need for disinhibition and the role of situational disinhibition in motivating alcohol risk-taking is warranted. In addition, the current findings suggest that interventions focusing on the connections between alcohol use and enhancement of social relationships and the potential isolating effects of non-use are necessary. PMID:20512745

  8. 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

  9. An Improved Patient-Specific Mortality Risk Prediction in ICU in a Random Forest Classification Framework.

    PubMed

    Ghose, Soumya; Mitra, Jhimli; Khanna, Sankalp; Dowling, Jason

    2015-01-01

    Dynamic and automatic patient specific prediction of the risk associated with ICU mortality may facilitate timely and appropriate intervention of health professionals in hospitals. In this work, patient information and time series measurements of vital signs and laboratory results from the first 48 hours of ICU stays of 4000 adult patients from a publicly available dataset are used to design and validate a mortality prediction system. An ensemble of decision trees are used to simultaneously predict and associate a risk score against each patient in a k-fold validation framework. Risk assessment prediction accuracy of 87% is achieved with our model and the results show significant improvement over a baseline algorithm of SAPS-I that is commonly used for mortality prediction in ICU. The performance of our model is further compared to other state-of-the-art algorithms evaluated on the same dataset. PMID:26210418

  10. A utility/cost analysis of breast cancer risk prediction algorithms

    NASA Astrophysics Data System (ADS)

    Abbey, Craig K.; Wu, Yirong; Burnside, Elizabeth S.; Wunderlich, Adam; Samuelson, Frank W.; Boone, John M.

    2016-03-01

    Breast cancer risk prediction algorithms are used to identify subpopulations that are at increased risk for developing breast cancer. They can be based on many different sources of data such as demographics, relatives with cancer, gene expression, and various phenotypic features such as breast density. Women who are identified as high risk may undergo a more extensive (and expensive) screening process that includes MRI or ultrasound imaging in addition to the standard full-field digital mammography (FFDM) exam. Given that there are many ways that risk prediction may be accomplished, it is of interest to evaluate them in terms of expected cost, which includes the costs of diagnostic outcomes. In this work we perform an expected-cost analysis of risk prediction algorithms that is based on a published model that includes the costs associated with diagnostic outcomes (true-positive, false-positive, etc.). We assume the existence of a standard screening method and an enhanced screening method with higher scan cost, higher sensitivity, and lower specificity. We then assess expected cost of using a risk prediction algorithm to determine who gets the enhanced screening method under the strong assumption that risk and diagnostic performance are independent. We find that if risk prediction leads to a high enough positive predictive value, it will be cost-effective regardless of the size of the subpopulation. Furthermore, in terms of the hit-rate and false-alarm rate of the of the risk prediction algorithm, iso-cost contours are lines with slope determined by properties of the available diagnostic systems for screening.

  11. 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

  12. Risk factors associated with seropositivity for Leishmania spp. and Trypanosoma cruzi in dogs in the state of Paraiba, Brazil.

    PubMed

    Fernandes, Annielle Regina da Fonseca; Pimenta, Carla Lauise Rodrigues Menezes; Vidal, Ivana Fernandes; Oliveira, Gabriela Capriogli; Sartori, Raissa Saran; Araújo, Raizza Barros; Melo, Márcia Almeida; Langoni, Hélio; Azevedo, Sérgio Santos

    2016-01-01

    The aim of this survey was to determine the seropositivity and risk factors for Leishmania spp. and Trypanosoma cruzi in dogs in the State of Paraíba, Northeastern Brazil. A total of 1,043 dogs were tested, and the serological diagnoses of Chagas disease (CD) and canine visceral leishmaniasis (CVL) was performed by the indirect fluorescent antibody test (IFAT). Animals that tested seropositive for both diseases (by IFAT) were further subjected to ELISA. Of the 1,043 dogs 81 (7.8%; 95% CI = 6.1-9.4%) tested seropositive for Leishmania spp., while 83 were seropositive for T. cruzi (7.9%; 95% CI = 6.3-9.6%). Simultaneous serological reactions were detected in 49 animals (4.6%; 95% CI= 3.6-6.2%). Semi-domiciled housing (OR = 2.044), free housing (OR = 4.151), and soil (OR = 3.425) and soil/cement (OR = 3.065) environmental conditions were identified as risk factors for CVL seropositivity. The risk factors identified for CD seropositivity were semi-domiciled (OR = 2.353) or free housing (OR = 3.454), and contact with bovine (OR = 2.015). This study revealed the presence of dogs in the Paraíba State seropositive for CVL and CD, suggesting the need for revisiting and intensification of disease control measures through constant monitoring of the canine population. PMID:26982555

  13. 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.

  14. 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. PMID:20004487

  15. A comprehensive genetic approach for improving prediction of skin cancer risk in humans.

    PubMed

    Vazquez, Ana I; de los Campos, Gustavo; Klimentidis, Yann C; Rosa, Guilherme J M; Gianola, Daniel; Yi, Nengjun; Allison, David B

    2012-12-01

    Prediction of genetic risk for disease is needed for preventive and personalized medicine. Genome-wide association studies have found unprecedented numbers of variants associated with complex human traits and diseases. However, these variants explain only a small proportion of genetic risk. Mounting evidence suggests that many traits, relevant to public health, are affected by large numbers of small-effect genes and that prediction of genetic risk to those traits and diseases could be improved by incorporating large numbers of markers into whole-genome prediction (WGP) models. We developed a WGP model incorporating thousands of markers for prediction of skin cancer risk in humans. We also considered other ways of incorporating genetic information into prediction models, such as family history or ancestry (using principal components, PCs, of informative markers). Prediction accuracy was evaluated using the area under the receiver operating characteristic curve (AUC) estimated in a cross-validation. Incorporation of genetic information (i.e., familial relationships, PCs, or WGP) yielded a significant increase in prediction accuracy: from an AUC of 0.53 for a baseline model that accounted for nongenetic covariates to AUCs of 0.58 (pedigree), 0.62 (PCs), and 0.64 (WGP). In summary, prediction of skin cancer risk could be improved by considering genetic information and using a large number of single-nucleotide polymorphisms (SNPs) in a WGP model, which allows for the detection of patterns of genetic risk that are above and beyond those that can be captured using family history. We discuss avenues for improving prediction accuracy and speculate on the possible use of WGP to prospectively identify individuals at high risk.

  16. 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

  17. Comparison of Measured and Predicted Bioconcentration Estimates of Pharmaceuticals in Fish Plasma and Prediction of Chronic Risk.

    PubMed

    Nallani, Gopinath; Venables, Barney; Constantine, Lisa; Huggett, Duane

    2016-05-01

    Evaluation of the environmental risk of human pharmaceuticals is now a mandatory component in all new drug applications submitted for approval in EU. With >3000 drugs currently in use, it is not feasible to test each active ingredient, so prioritization is key. A recent review has listed nine prioritization approaches including the fish plasma model (FPM). The present paper focuses on comparison of measured and predicted fish plasma bioconcentration factors (BCFs) of four common over-the-counter/prescribed pharmaceuticals: norethindrone (NET), ibuprofen (IBU), verapamil (VER) and clozapine (CLZ). The measured data were obtained from the earlier published fish BCF studies. The measured BCF estimates of NET, IBU, VER and CLZ were 13.4, 1.4, 0.7 and 31.2, while the corresponding predicted BCFs (based log Kow at pH 7) were 19, 1.0, 7.6 and 30, respectively. These results indicate that the predicted BCFs matched well the measured values. The BCF estimates were used to calculate the human: fish plasma concentration ratios of each drug to predict potential risk to fish. The plasma ratio results show the following order of risk potential for fish: NET > CLZ > VER > IBU. The FPM has value in prioritizing pharmaceutical products for ecotoxicological assessments. PMID:27003806

  18. Clinical prediction of fall risk and white matter abnormalities: a diffusion tensor imaging study

    Technology Transfer Automated Retrieval System (TEKTRAN)

    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 deter...

  19. School Violence in Taiwan: Examining How Western Risk Factors Predict School Violence in an Asian Culture

    ERIC Educational Resources Information Center

    Chen, Ji-Kang; Astor, Ron Avi

    2010-01-01

    The current study explores whether theorized risk factors in Western countries can be used to predict school violence perpetration in an Asian cultural context. The study examines the associations between risk factors and school violence perpetration in Taiwan. Data were obtained from a nationally representative sample of 14,022 students from…

  20. The Predictive Validity of the Structured Assessment of Violence Risk in Youth in Secondary Educational Settings

    ERIC Educational Resources Information Center

    McGowan, Mark R.; Horn, Robert A.; Mellott, Ramona N.

    2011-01-01

    Current developments in violence risk assessment warrant consideration for use within educational settings. Using a structured professional judgment (SPJ) model, the present study investigated the predictive validity of the Structured Assessment of Violence in Youth (SAVRY) within educational settings. The predictive accuracy of the SAVRY scales…

  1. Characterizing Decision-Analysis Performances of Risk Prediction Models Using ADAPT Curves

    PubMed Central

    Lee, Wen-Chung; Wu, Yun-Chun

    2016-01-01

    Abstract The area under the receiver operating characteristic curve is a widely used index to characterize the performance of diagnostic tests and prediction models. However, the index does not explicitly acknowledge the utilities of risk predictions. Moreover, for most clinical settings, what counts is whether a prediction model can guide therapeutic decisions in a way that improves patient outcomes, rather than to simply update probabilities. Based on decision theory, the authors propose an alternative index, the “average deviation about the probability threshold” (ADAPT). An ADAPT curve (a plot of ADAPT value against the probability threshold) neatly characterizes the decision-analysis performances of a risk prediction model. Several prediction models can be compared for their ADAPT values at a chosen probability threshold, for a range of plausible threshold values, or for the whole ADAPT curves. This should greatly facilitate the selection of diagnostic tests and prediction models. PMID:26765451

  2. A Novel Risk Score to the Prediction of 10-year Risk for Coronary Artery Disease Among the Elderly in Beijing Based on Competing Risk Model

    PubMed Central

    Liu, Long; Tang, Zhe; Li, Xia; Luo, Yanxia; Guo, Jin; Li, Haibin; Liu, Xiangtong; Tao, Lixin; Yan, Aoshuang; Guo, Xiuhua

    2016-01-01

    Abstract The study aimed to construct a risk prediction model for coronary artery disease (CAD) based on competing risk model among the elderly in Beijing and develop a user-friendly CAD risk score tool. We used competing risk model to evaluate the risk of developing a first CAD event. On the basis of the risk factors that were included in the competing risk model, we constructed the CAD risk prediction model with Cox proportional hazard model. Time-dependent receiver operating characteristic (ROC) curve and time-dependent area under the ROC curve (AUC) were used to evaluate the discrimination ability of the both methods. Calibration plots were applied to assess the calibration ability and adjusted for the competing risk of non-CAD death. Net reclassification index (NRI) and integrated discrimination improvement (IDI) were applied to quantify the improvement contributed by the new risk factors. Internal validation of predictive accuracy was performed using 1000 times of bootstrap re-sampling. Of the 1775 participants without CAD at baseline, 473 incident cases of CAD were documented for a 20-year follow-up. Time-dependent AUCs for men and women at t = 10 years were 0.841 [95% confidence interval (95% CI): 0.806–0.877], 0.804 (95% CI: 0.768–0.839) in Fine and Gray model, 0.784 (95% CI: 0.738–0.830), 0.733 (95% CI: 0.692–0.775) in Cox proportional hazard model. The competing risk model was significantly superior to Cox proportional hazard model on discrimination and calibration. The cut-off values of the risk score that marked the difference between low-risk and high-risk patients were 34 points for men and 30 points for women, which have good sensitivity and specificity. A sex-specific multivariable risk factor algorithm-based competing risk model has been developed on the basis of an elderly Chinese cohort, which could be applied to predict an individual's risk and provide a useful guide to identify the groups at a high risk for CAD among the Chinese

  3. A Novel Risk Score to the Prediction of 10-year Risk for Coronary Artery Disease Among the Elderly in Beijing Based on Competing Risk Model.

    PubMed

    Liu, Long; Tang, Zhe; Li, Xia; Luo, Yanxia; Guo, Jin; Li, Haibin; Liu, Xiangtong; Tao, Lixin; Yan, Aoshuang; Guo, Xiuhua

    2016-03-01

    The study aimed to construct a risk prediction model for coronary artery disease (CAD) based on competing risk model among the elderly in Beijing and develop a user-friendly CAD risk score tool. We used competing risk model to evaluate the risk of developing a first CAD event. On the basis of the risk factors that were included in the competing risk model, we constructed the CAD risk prediction model with Cox proportional hazard model. Time-dependent receiver operating characteristic (ROC) curve and time-dependent area under the ROC curve (AUC) were used to evaluate the discrimination ability of the both methods. Calibration plots were applied to assess the calibration ability and adjusted for the competing risk of non-CAD death. Net reclassification index (NRI) and integrated discrimination improvement (IDI) were applied to quantify the improvement contributed by the new risk factors. Internal validation of predictive accuracy was performed using 1000 times of bootstrap re-sampling. Of the 1775 participants without CAD at baseline, 473 incident cases of CAD were documented for a 20-year follow-up. Time-dependent AUCs for men and women at t = 10 years were 0.841 [95% confidence interval (95% CI): 0.806-0.877], 0.804 (95% CI: 0.768-0.839) in Fine and Gray model, 0.784 (95% CI: 0.738-0.830), 0.733 (95% CI: 0.692-0.775) in Cox proportional hazard model. The competing risk model was significantly superior to Cox proportional hazard model on discrimination and calibration. The cut-off values of the risk score that marked the difference between low-risk and high-risk patients were 34 points for men and 30 points for women, which have good sensitivity and specificity. A sex-specific multivariable risk factor algorithm-based competing risk model has been developed on the basis of an elderly Chinese cohort, which could be applied to predict an individual's risk and provide a useful guide to identify the groups at a high risk for CAD among the Chinese adults over 55

  4. Predicting condom use in young women: demographics, behaviours and knowledge from a population-based sample in Brazil.

    PubMed

    Miranda, A E; Figueiredo, N C; McFarland, W; Schmidt, R; Page, K

    2011-10-01

    The goal of this study was to assess condom use and related behaviour in young women in Vitória, Brazil. From March to December 2006, a cross-sectional sample of women aged 18-29 years was recruited into a population-based study. Risk behaviours for HIV and sexually transmitted infections (STIs) were surveyed. Condom use at last intercourse was assessed as a principal outcome describing protective sexual behaviour. Of 1200 eligible women identified, 1029 (85.8%) enrolled. Among them, 904 (87.9%) reported a history of sexual activity. Only 36.6% reported condom use at last intercourse; those who did were more likely to report commercial sex work (odds ratio [OR] 9.01 [1.46-55.55]), to state that STI prevention was a primary reason for using condoms (OR = 6.84 [4.81-9.71]), to have been previously diagnosed with an STI (OR = 2.39 [1.36-4.21]), to report that 'it is easy to tell a sexual partner they will not have vaginal/anal sex without a condom' (OR = 2.30 [1.56-3.39]), to report that sexual intercourse is only risky when people have anal sex (OR = 1.98 [1.22-3.22]); and less likely to be married (OR = 0.65 [0.54-0.78]), and to find it difficult to use condom consistently in all sexual encounters (OR = 0.36 [0.25-0.52]). Women who reported condom use were more concerned with preventing STIs, and to report less difficulty insisting on condom use with partners.

  5. Prediction of near-term breast cancer risk using a Bayesian belief network

    NASA Astrophysics Data System (ADS)

    Zheng, Bin; Ramalingam, Pandiyarajan; Hariharan, Harishwaran; Leader, Joseph K.; Gur, David

    2013-03-01

    Accurately predicting near-term breast cancer risk is an important prerequisite for establishing an optimal personalized breast cancer screening paradigm. In previous studies, we investigated and tested the feasibility of developing a unique near-term breast cancer risk prediction model based on a new risk factor associated with bilateral mammographic density asymmetry between the left and right breasts of a woman using a single feature. In this study we developed a multi-feature based Bayesian belief network (BBN) that combines bilateral mammographic density asymmetry with three other popular risk factors, namely (1) age, (2) family history, and (3) average breast density, to further increase the discriminatory power of our cancer risk model. A dataset involving "prior" negative mammography examinations of 348 women was used in the study. Among these women, 174 had breast cancer detected and verified in the next sequential screening examinations, and 174 remained negative (cancer-free). A BBN was applied to predict the risk of each woman having cancer detected six to 18 months later following the negative screening mammography. The prediction results were compared with those using single features. The prediction accuracy was significantly increased when using the BBN. The area under the ROC curve increased from an AUC=0.70 to 0.84 (p<0.01), while the positive predictive value (PPV) and negative predictive value (NPV) also increased from a PPV=0.61 to 0.78 and an NPV=0.65 to 0.75, respectively. This study demonstrates that a multi-feature based BBN can more accurately predict the near-term breast cancer risk than with a single feature.

  6. Mediated effects of physical risk factors, leader-member exchange and empowerment in predicting perceived injury risk.

    PubMed

    Muldoon, Jeffery; Matthews, Russell A; Foley, Caroline

    2012-04-01

    In the context of conservation of resources theory, we examine the indirect (mediated) effects of physical risk factors, leader-member exchange (LMX) and empowerment on perceived injury risk in a heterogeneous sample (N = 226) of individuals employed in occupations related to production, construction and installation/maintenance. Positioning work role stressors and upward safety communications as two important mediating variables, as predicted, LMX and empowerment demonstrated significant indirect effects on perceived injury risk. Results from our model also provide preliminary evidence that an asymmetrical dualistic process exists in terms of the effect physical risk factors have on perceived injury risk via depletion of both psychological (i.e. role stressors) and physical resources (i.e. physical symptoms). Theoretical and practical implications based on the results of our model are also discussed.

  7. 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.

  8. Population-Level Prediction of Type 2 Diabetes From Claims Data and Analysis of Risk Factors.

    PubMed

    Razavian, Narges; Blecker, Saul; Schmidt, Ann Marie; Smith-McLallen, Aaron; Nigam, Somesh; Sontag, David

    2015-12-01

    We present a new approach to population health, in which data-driven predictive models are learned for outcomes such as type 2 diabetes. Our approach enables risk assessment from readily available electronic claims data on large populations, without additional screening cost. Proposed model uncovers early and late-stage risk factors. Using administrative claims, pharmacy records, healthcare utilization, and laboratory results of 4.1 million individuals between 2005 and 2009, an initial set of 42,000 variables were derived that together describe the full health status and history of every individual. Machine learning was then used to methodically enhance predictive variable set and fit models predicting onset of type 2 diabetes in 2009-2011, 2010-2012, and 2011-2013. We compared the enhanced model with a parsimonious model consisting of known diabetes risk factors in a real-world environment, where missing values are common and prevalent. Furthermore, we analyzed novel and known risk factors emerging from the model at different age groups at different stages before the onset. Parsimonious model using 21 classic diabetes risk factors resulted in area under ROC curve (AUC) of 0.75 for diabetes prediction within a 2-year window following the baseline. The enhanced model increased the AUC to 0.80, with about 900 variables selected as predictive (p < 0.0001 for differences between AUCs). Similar improvements were observed for models predicting diabetes onset 1-3 years and 2-4 years after baseline. The enhanced model improved positive predictive value by at least 50% and identified novel surrogate risk factors for type 2 diabetes, such as chronic liver disease (odds ratio [OR] 3.71), high alanine aminotransferase (OR 2.26), esophageal reflux (OR 1.85), and history of acute bronchitis (OR 1.45). Liver risk factors emerge later in the process of diabetes development compared with obesity-related factors such as hypertension and high hemoglobin A1c. In conclusion

  9. Population-Level Prediction of Type 2 Diabetes From Claims Data and Analysis of Risk Factors.

    PubMed

    Razavian, Narges; Blecker, Saul; Schmidt, Ann Marie; Smith-McLallen, Aaron; Nigam, Somesh; Sontag, David

    2015-12-01

    We present a new approach to population health, in which data-driven predictive models are learned for outcomes such as type 2 diabetes. Our approach enables risk assessment from readily available electronic claims data on large populations, without additional screening cost. Proposed model uncovers early and late-stage risk factors. Using administrative claims, pharmacy records, healthcare utilization, and laboratory results of 4.1 million individuals between 2005 and 2009, an initial set of 42,000 variables were derived that together describe the full health status and history of every individual. Machine learning was then used to methodically enhance predictive variable set and fit models predicting onset of type 2 diabetes in 2009-2011, 2010-2012, and 2011-2013. We compared the enhanced model with a parsimonious model consisting of known diabetes risk factors in a real-world environment, where missing values are common and prevalent. Furthermore, we analyzed novel and known risk factors emerging from the model at different age groups at different stages before the onset. Parsimonious model using 21 classic diabetes risk factors resulted in area under ROC curve (AUC) of 0.75 for diabetes prediction within a 2-year window following the baseline. The enhanced model increased the AUC to 0.80, with about 900 variables selected as predictive (p < 0.0001 for differences between AUCs). Similar improvements were observed for models predicting diabetes onset 1-3 years and 2-4 years after baseline. The enhanced model improved positive predictive value by at least 50% and identified novel surrogate risk factors for type 2 diabetes, such as chronic liver disease (odds ratio [OR] 3.71), high alanine aminotransferase (OR 2.26), esophageal reflux (OR 1.85), and history of acute bronchitis (OR 1.45). Liver risk factors emerge later in the process of diabetes development compared with obesity-related factors such as hypertension and high hemoglobin A1c. In conclusion

  10. Anxiety and depression symptoms as risk factors for non-adherence to antiretroviral therapy in Brazil.

    PubMed

    Campos, Lorenza Nogueira; Guimarães, Mark Drew Crosland; Remien, Robert H

    2010-04-01

    Depression and anxiety are common among HIV-infected people and rank among the strongest predictors of non-adherence to antiretroviral therapy (ART). This longitudinal study aimed to assess whether symptoms of anxiety and depression are predictors of non-adherence among patients initiating ART at two public referral centers (n = 293) in Belo Horizonte, Brazil. Prevalence of severe anxiety and depression symptoms before starting ART was 12.6% and 5.8%, respectively. Severe anxiety was a predictor of non-adherence to ART during follow-up period (RH = 1.87; 95% CI = 1.14-3.06) adjusted for low education, unemployment, alcohol use in the last month and symptoms of AIDS; while a history of injection drug use had borderline statistical significance with non-adherence. These findings suggest that using a brief screening procedure to assess anxiety and depression symptoms before initiating ART help identify individuals for interventions to improve adherence and quality of life.

  11. Predicting (un)healthy behavior: A comparison of risk-taking propensity measures

    PubMed Central

    Szrek, Helena; Chao, Li-Wei; Ramlagan, Shandir; Peltzer, Karl

    2013-01-01

    We compare four different risk-taking propensity measures on their ability to describe and to predict actual risky behavior in the domain of health. The risk-taking propensity measures we compare are: (1) a general measure of risk-taking propensity derived from a one-item survey question (Dohmen et al., 2011), (2) a risk aversion index calculated from a set of incentivized monetary gambles (Holt & Laury, 2002), (3) a measure of risk taking derived from an incentive compatible behavioral task—the Balloon Analog Risk Task (Lejuez et al., 2002), and (4) a composite score of risk-taking likelihood in the health domain from the Domain-Specific Risk Taking (DOSPERT) scale (Weber et al., 2002). Study participants are 351 clients of health centers around Witbank, South Africa. Our findings suggest that the one-item general measure is the best predictor of risky health behavior in our population, predicting two out of four behaviors at the 5% level and the remaining two behaviors at the 10% level. The DOSPERT score in the health domain performs well, predicting one out of four behaviors at the 1% significance level and two out of four behaviors at the 10% level, but only if the DOSPERT instrument contains a hypothetical risk-taking item that is similar to the actual risky behavior being predicted. Incentivized monetary gambles and the behavioral task were unrelated to actual health behaviors; they were unable to predict any of the risky health behaviors at the 10% level. We provide evidence that this is not because the participants had trouble understanding the monetary trade-off questions or performed poorly in the behavioral task. We conclude by urging researchers to further test the usefulness of the one-item general measure, both in explaining health related risk-taking behavior and in other contexts. PMID:24307919

  12. Psychological Distress and Arrhythmia: Risk Prediction and Potential Modifiers

    PubMed Central

    Peacock, James; Whang, William

    2014-01-01

    The connection between the heart and the brain has long been anecdotally recognized but systematically studied only relatively recently. Cardiac arrhythmias, especially sudden cardiac death, remain a major public health concern and there is mounting evidence that psychological distress plays a critical role as both a predictor of high-risk cardiac substrate and as an inciting trigger. The transient, unpredictable nature of emotions and cardiac arrhythmias have made their study challenging, but evolving technologies in monitoring and imaging along with larger epidemiological data sets have encouraged more sophisticated studies examining this relationship. Here we review the research on psychological distress including anger, depression and anxiety on cardiac arrhythmias, insights into proposed mechanisms, and potential avenues for future research. PMID:23621968

  13. Inflammation and Arterial Hypertension: From Pathophysiological Links to Risk Prediction.

    PubMed

    Pietri, Panagiota; Vlachopoulos, Charalambos; Tousoulis, Dimitris

    2015-01-01

    Over the last years, ample data have demonstrated the pivotal role of low-grade inflammation in the pathophysiology of atherosclerosis and cardiovascular disease. It is well established that inflammatory activation, serving either as a substrate, in the chronic phase of atherosclerotic disease, or as a trigger, in the acute phase, increases cardiovascular events. Considering hypertension, the inflammatory process is implicated in its pathophysiology through a bidirectional relationship since arterial hypertension may enhance inflammation and vice versa. Inflammatory biomarkers such as high-sensitivity C-reactive protein, have shown predictive value for both the incidence of hypertension and the clinical outcomes in hypertensive patients. In the present review, data on the association between arterial hypertension and low-grade inflammation will be reported and potential pathophysiological pathways and clinical implications underlying this association will be discussed.

  14. Perspectives on the Use of Multiple Sclerosis Risk Genes for Prediction

    PubMed Central

    van Duijn, Cornelia M.; Janssens, A. Cecile J. W.; Hintzen, Rogier Q.

    2011-01-01

    Objective A recent collaborative genome-wide association study replicated a large number of susceptibility loci and identified novel loci. This increase in known multiple sclerosis (MS) risk genes raises questions about clinical applicability of genotyping. In an empirical set we assessed the predictive power of typing multiple genes. Next, in a modelling study we explored current and potential predictive performance of genetic MS risk models. Materials and Methods Genotype data on 6 MS risk genes in 591 MS patients and 600 controls were used to investigate the predictive value of combining risk alleles. Next, the replicated and novel MS risk loci from the recent and largest international genome-wide association study were used to construct genetic risk models simulating a population of 100,000 individuals. Finally, we assessed the required numbers, frequencies, and ORs of risk SNPs for higher discriminative accuracy in the future. Results Individuals with 10 to 12 risk alleles had a significantly increased risk compared to individuals with the average population risk for developing MS (OR 2.76 (95% CI 2.02–3.77)). In the simulation study we showed that the area under the receiver operating characteristic curve (AUC) for a risk score based on the 6 SNPs was 0.64. The AUC increases to 0.66 using the well replicated 24 SNPs and to 0.69 when including all replicated and novel SNPs (n = 53) in the risk model. An additional 20 SNPs with allele frequency 0.30 and ORs 1.1 would be needed to increase the AUC to a slightly higher level of 0.70, and at least 50 novel variants with allele frequency 0.30 and ORs 1.4 would be needed to obtain an AUC of 0.85. Conclusion Although new MS risk SNPs emerge rapidly, the discriminatory ability in a clinical setting will be limited. PMID:22164203

  15. Occurrence and risk factors associated to Toxoplasma gondii infection in sheep from Rio de Janeiro, Brazil

    Technology Transfer Automated Retrieval System (TEKTRAN)

    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...

  16. Improving Personalized Clinical Risk Prediction Based on Causality-Based Association Rules

    PubMed Central

    Cheng, Chih-wen; Wang, May D.

    2016-01-01

    Developing clinical risk prediction models is one of the main tasks of healthcare data mining. Advanced data collection techniques in current Big Data era have created an emerging and urgent need for scalable, computer-based data mining methods. These methods can turn data into useful, personalized decision support knowledge in a flexible, cost-effective, and productive way. In our previous study, we developed a tool, called icuARM- II, that can generate personalized clinical risk prediction evidence using a temporal rule mining framework. However, the generation of final risk prediction possibility with icuARM-II still relied on human interpretation, which was subjective and, most of time, biased. In this study, we propose a new mechanism to improve icuARM-II’s rule selection by including the concept of causal analysis. The generated risk prediction is quantitatively assessed using calibration statistics. To evaluate the performance of the new rule selection mechanism, we conducted a case study to predict short-term intensive care unit mortality based on personalized lab testing abnormalities. Our results demonstrated a better-calibrated ICU risk prediction using the new causality-base rule selection solution by comparing with conventional confidence-only rule selection methods. PMID:27532063

  17. Predictive Factors and Risk Mapping for Rift Valley Fever Epidemics in Kenya

    PubMed Central

    Munyua, Peninah M.; Murithi, R. Mbabu; Ithondeka, Peter; Hightower, Allen; Thumbi, Samuel M.; Anyangu, Samuel A.; Kiplimo, Jusper; Bett, Bernard; Vrieling, Anton; Breiman, Robert F.; Njenga, M. Kariuki

    2016-01-01

    Background To-date, Rift Valley fever (RVF) outbreaks have occurred in 38 of the 69 administrative districts in Kenya. Using surveillance records collected between 1951 and 2007, we determined the risk of exposure and outcome of an RVF outbreak, examined the ecological and climatic factors associated with the outbreaks, and used these data to develop an RVF risk map for Kenya. Methods Exposure to RVF was evaluated as the proportion of the total outbreak years that each district was involved in prior epizootics, whereas risk of outcome was assessed as severity of observed disease in humans and animals for each district. A probability-impact weighted score (1 to 9) of the combined exposure and outcome risks was used to classify a district as high (score ≥ 5) or medium (score ≥2 - <5) risk, a classification that was subsequently subjected to expert group analysis for final risk level determination at the division levels (total = 391 divisions). Divisions that never reported RVF disease (score < 2) were classified as low risk. Using data from the 2006/07 RVF outbreak, the predictive risk factors for an RVF outbreak were identified. The predictive probabilities from the model were further used to develop an RVF risk map for Kenya. Results The final output was a RVF risk map that classified 101 of 391 divisions (26%) located in 21 districts as high risk, and 100 of 391 divisions (26%) located in 35 districts as medium risk and 190 divisions (48%) as low risk, including all 97 divisions in Nyanza and Western provinces. The risk of RVF was positively associated with Normalized Difference Vegetation Index (NDVI), low altitude below 1000m and high precipitation in areas with solonertz, luvisols and vertisols soil types (p <0.05). Conclusion RVF risk map serves as an important tool for developing and deploying prevention and control measures against the disease. PMID:26808021

  18. Prevalence and risk factors associated with bovine genital campylobacteriosis and bovine trichomonosis in the state of Pernambuco, Brazil.

    PubMed

    de Oliveira, Júnior Mário Baltazar; da Silva, Gesika Maria; Batista Filho, Antônio Fernando Barbosa; de Melo Borges, Jonas; de Oliveira, Pollyanne Raysa Fernandes; Brandespim, Daniel Friguglietti; Mota, Rinaldo Aparecido; Pinheiro, José Wilton

    2015-03-01

    The aim of the present study was to determine the prevalence and risk factors associated with Campylobacter fetus subsp. venerealis and Tritrichomonas foetus infection in cows from dairy herds in the state of Pernambuco, Brazil. In total, 383 samples of cervico-vaginal mucus were collected from cows on 21 herds in 19 districts. Genomic DNA was extracted from the samples and submitted for polymerase chain reaction analysis. An investigative questionnaire was used to analyze the risk factors, using questions related to reproductive and hygiene/sanitation management. A prevalence of 1.8% (0.8-3.9%; confidence interval (CI) 95%) and 33.4% (28.7-38.4%; CI 95%) was found for C. fetus subsp. venerealis and T. foetus, respectively. In terms of the number of foci, 28.6% of the herds contained at least one animal that was positive for C. fetus subsp. venerealis and 90.5% for T. foetus. The present study identified herds larger than 100 animals as a risk factor for bovine genital campylobacteriosis (OR = 7.2; CI 1.3-38.4%; p = 0.020) and the use of natural breeding as a risk factor for bovine trichomonosis (OR = 2.4; CI 1.1-5.9%; p = 0.041). In conclusion, C. fetus subsp. venerealis and T. foetus infections occurred in the region studied and high numbers of foci were found. Thus, prophylaxis and control measures, such as diagnosis, separation, and sexual rest for infected females, are suggested. An artificial insemination program with early rigorous sanitary care should be implemented on the properties in order to avoid the spread of agents in the herds.

  19. 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.

  20. 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. PMID:25760066

  1. A Risk Score to Predict Hypertension in Primary Care Settings in Rural India

    PubMed Central

    Sathish, Thirunavukkarasu; Kannan, Srinivasan; Sarma, P. Sankara; Razum, Oliver; Thrift, Amanda Gay; Thankappan, Kavumpurathu Raman

    2015-01-01

    We used the data of 297 participants (15–64 years old) from a cohort study (2003–2010) who were free from hypertension at baseline, to develop a risk score to predict hypertension by primary health care workers in rural India. Age ≥35 years, current smoking, prehypertension, and central obesity were significantly associated with incident hypertension. The optimal cutoff value of ≥3 had a sensitivity of 78.6%, specificity of 65.2%, positive predictive value of 41.1%, and negative predictive value of 90.8%. The area under the receiver operating characteristic curve of the risk score was 0.802 (95% confidence interval = 0.748–0.856). This simple and easy to administer risk score could be used to predict hypertension in primary care settings in rural India. PMID:26354334

  2. A Risk Score to Predict Hypertension in Primary Care Settings in Rural India.

    PubMed

    Sathish, Thirunavukkarasu; Kannan, Srinivasan; Sarma, P Sankara; Razum, Oliver; Thrift, Amanda Gay; Thankappan, Kavumpurathu Raman

    2016-01-01

    We used the data of 297 participants (15-64 years old) from a cohort study (2003-2010) who were free from hypertension at baseline, to develop a risk score to predict hypertension by primary health care workers in rural India. Age ≥35 years, current smoking, prehypertension, and central obesity were significantly associated with incident hypertension. The optimal cutoff value of ≥3 had a sensitivity of 78.6%, specificity of 65.2%, positive predictive value of 41.1%, and negative predictive value of 90.8%. The area under the receiver operating characteristic curve of the risk score was 0.802 (95% confidence interval = 0.748-0.856). This simple and easy to administer risk score could be used to predict hypertension in primary care settings in rural India.

  3. Unravelling the structure of species extinction risk for predictive conservation science.

    PubMed

    Lee, Tien Ming; Jetz, Walter

    2011-05-01

    Extinction risk varies across species and space owing to the combined and interactive effects of ecology/life history and geography. For predictive conservation science to be effective, large datasets and integrative models that quantify the relative importance of potential factors and separate rapidly changing from relatively static threat drivers are urgently required. Here, we integrate and map in space the relative and joint effects of key correlates of The International Union for Conservation of Nature-assessed extinction risk for 8700 living birds. Extinction risk varies significantly with species' broad-scale environmental niche, geographical range size, and life-history and ecological traits such as body size, developmental mode, primary diet and foraging height. Even at this broad scale, simple quantifications of past human encroachment across species' ranges emerge as key in predicting extinction risk, supporting the use of land-cover change projections for estimating future threat in an integrative setting. A final joint model explains much of the interspecific variation in extinction risk and provides a remarkably strong prediction of its observed global geography. Our approach unravels the species-level structure underlying geographical gradients in extinction risk and offers a means of disentangling static from changing components of current and future threat. This reconciliation of intrinsic and extrinsic, and of past and future extinction risk factors may offer a critical step towards a more continuous, forward-looking assessment of species' threat status based on geographically explicit environmental change projections, potentially advancing global predictive conservation science.

  4. The potential of novel biomarkers to improve risk prediction of type 2 diabetes.

    PubMed

    Herder, Christian; Kowall, Bernd; Tabak, Adam G; Rathmann, Wolfgang

    2014-01-01

    The incidence of type 2 diabetes can be reduced substantially by implementing preventive measures in high-risk individuals, but this requires prior knowledge of disease risk in the individual. Various diabetes risk models have been designed, and these have all included a similar combination of factors, such as age, sex, obesity, hypertension, lifestyle factors, family history of diabetes and metabolic traits. The accuracy of prediction models is often assessed by the area under the receiver operating characteristic curve (AROC) as a measure of discrimination, but AROCs should be complemented by measures of calibration and reclassification to estimate the incremental value of novel biomarkers. This review discusses the potential of novel biomarkers to improve model accuracy. The range of molecules that serve as potential predictors of type 2 diabetes includes genetic variants, RNA transcripts, peptides and proteins, lipids and small metabolites. Some of these biomarkers lead to a statistically significant increase of model accuracy, but their incremental value currently seems too small for routine clinical use. However, only a fraction of potentially relevant biomarkers have been assessed with regard to their predictive value. Moreover, serial measurements of biomarkers may help determine individual risk. In conclusion, current risk models provide valuable tools of risk estimation, but perform suboptimally in the prediction of individual diabetes risk. Novel biomarkers still fail to have a clinically applicable impact. However, more efficient use of biomarker data and technological advances in their measurement in clinical settings may allow the development of more accurate predictive models in the future.

  5. No Association between Low Birth Weight and Cardiovascular Risk Factors in Early Adulthood: Evidence from São Paulo, Brazil

    PubMed Central

    Gomes, Filumena Maria; Subramanian, S. V.; Escobar, Ana Maria de Ulhôa; Valente, Maria Helena; Grisi, Sandra Josefina Ferraz Ellero; Brentani, Alexandra; Fink, Günther

    2013-01-01

    Background A growing literature suggests that low birth weight increases the risk of poor health outcomes in adulthood. We tested this hypothesis among young adults living in São Paulo State, Brazil. Methods and Findings To identify the effects of low birth weight on young adulthood outcomes, a medical assessment of 297 individuals born between 1977 and 1989 was conducted at a primary care unit in São Paulo State, Brazil. We analyzed body mass index (BMI), waist-hip ratio, blood pressure, fasting glucose and total cholesterol levels using linear and logistic regressions. Low birth was negatively associated with BMI (β = −2.0, 95% CI: −3.69, −0.27, p = 0.02), fasting glucose levels (β = −1.9, 95% CI: −3.9, −0.07, p = 0.05), waist-hip ratio (β = −0.03, 95% CI: −0.07, −0.01, p = 0.10), systolic blood pressure (β = −3.32, 95% CI: −7.60, 0.96, p = 0.12), and total cholesterol levels (β = −3.19, 95% CI: −16.43, 10.05, p = 0.636). Low birth weight was also associated with lower odds of young adults being overweight and obese, but neither association was statistically significant. Weight gain in the first 12 months of life was associated with higher adult BMI (β = 0.79, 95% CI: −0.0455, 1.623, p = 0.064) and blood pressure (β = 2.79, 95% CI: 0.22, 5.35, p = 0.034). No associations were found between low birth weight and early life (catch-up) growth. Conclusions Low birth weight was not associated with poor health outcomes among young adults in Brazil. These results appear inconsistent with the original Barker hypothesis, but will need to be corroborated in larger samples with longer follow-ups to allow a more general evaluation of the validity of the hypothesis in low and middle income countries. PMID:23799115

  6. Cardiovascular risk prediction: a comparative study of Framingham and quantum neural network based approach

    PubMed Central

    Narain, Renu; Saxena, Sanjai; Goyal, Achal Kumar

    2016-01-01

    Purpose Currently cardiovascular diseases (CVDs) are the main cause of death worldwide. Disease risk estimates can be used as prognostic information and support for treating CVDs. The commonly used Framingham risk score (FRS) for CVD prediction is outdated for the modern population, so FRS may not be accurate enough. In this paper, a novel CVD prediction system based on machine learning is proposed. Methods This study has been conducted with the data of 689 patients showing symptoms of CVD. Furthermore, the dataset of 5,209 CVD patients of the famous Framingham study has been used for validation purposes. Each patient’s parameters have been analyzed by physicians in order to make a diagnosis. The proposed system uses the quantum neural network for machine learning. This system learns and recognizes the pattern of CVD. The proposed system has been experimentally evaluated and compared with FRS. Results During testing, patients’ data in combination with the doctors’ diagnosis (predictions) are used for evaluation and validation. The proposed system achieved 98.57% accuracy in predicting the CVD risk. The CVD risk predictions by the proposed system, using the dataset of the Framingham study, confirmed the potential risk of death, deaths which actually occurred and had been recorded as due to myocardial infarction and coronary heart disease in the dataset of the Framingham study. The accuracy of the proposed system is significantly higher than FRS and other existing approaches. Conclusion The proposed system will serve as an excellent tool for a medical practitioner in predicting the risk of CVD. This system will be serving as an aid to medical practitioners for planning better medication and treatment strategies. An early diagnosis may be effectively made by using this system. An overall accuracy of 98.57% has been achieved in predicting the risk level. The accuracy is considerably higher compared to the other existing approaches. Thus, this system must be used

  7. PREVALENCE OF HERPES SIMPLEX VIRUS TYPE 2 AND RISK FACTORS ASSOCIATED WITH THIS INFECTION IN WOMEN IN SOUTHERN BRAZIL

    PubMed Central

    Caldeira, Thaís Duquia Moraes; Gonçalves, Carla Vitola; de Oliveira, Gisele Rodrigues; da Fonseca, Tânia Vieira; Gonçalves, Regina; do Amaral, Clair Teixeira; da Hora, Vanusa Pousada; de Martinez, Ana Maria Barral

    2013-01-01

    SUMMARY The herpes simplex virus type 2 (HVS-2) is the most prevalent infection worldwide. It is a cofactor in the acquisition of human immunodeficiency virus (HIV) and the persistence of human papillomavirus (HPV). This study evaluated the prevalence of HSV-2, using the polymerase chain reaction (PCR), and associated factors in patients treated at the Federal University of Rio Grande (FURG) and Basic Health Units (BHU) in Rio Grande, Brazil. The observed prevalence of HSV-2 was 15.6%. Among the 302 women studied, 158 had received assistance in BHU and 144 were treated at FURG. The prevalence of HSV-2 in these groups was 10.8% and 20.8%, respectively, RR 1.9 and p = 0.012. Knowledge about the Pap smear, and the presence of lesions showed no association with HSV-2 infection. Multivariate analysis showed that the variable that most influenced the risk of HSV-2 infection was the presence of HIV infection, with a relative risk of 1.9 and p = 0.04. Discussion: Genital ulcers are an important entry point for HIV, and condom use is an important strategy to reduce transmission of HIV and HSV-2. PMID:24037285

  8. 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

  9. 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.

  10. Oral mucosal lesions in Indians from Northeast Brazil: cross-sectional study of prevalence and risk indicators.

    PubMed

    Cury, Patricia Ramos; Porto, Lia Pontes Arruda; dos Santos, Jean Nunes; Figueiredo e Ribeiro, Livia Silva; de Aquino Xavier, Flavia Caló; Figueiredo, Andreia Leal; Ramalho, Luciana Maria Pedreira

    2014-12-01

    The aim of this cross-sectional study was to evaluate the prevalence of oral mucosal lesions, and their risk indicators in adult Kiriri Indians from Northeast Brazil. Clinical oral examination was performed on a representative sample of 223 Indians (age ≥ 19 years). A systematic evaluation of lips, labial mucosa and sulcus, commissures, buccal mucosa and sulcus, gingiva and alveolar ridge, tongue, floor of the mouth, and soft and hard palate was performed. Bivariate analysis was conducted to assess associations between mucosal conditions and age, gender, income, educational level, diabetic status, and smoking status. Mucosal lesions were found in 50 participants (22.4%). The most prevalent lesions were fistulae (6.2%) and traumatic ulcers (4.48%). Oral mucosal was associated with higher age (≥ 35 years; odds ratio [OR] = 1.99, 95% confidence interval [CI]: 1.05-3.76, P = 0.03) and lower education level (<9 years; OR = 2.13, 95% CI: 0.96-4.71, P = 0.06). Mucosal conditions are prevalent in Kiriri Indians and the presence of mucosal lesions is associated with advanced age and lower education. A public health program aimed at preventing and treating mucosal lesions and targeted toward the high-risk group is vital to improve the oral health status of this population.

  11. 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

  12. 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. PMID:26827853

  13. Prevalence of hepatitis C virus among users attending a voluntary testing centre in Rio Grande, southern Brazil: predictive factors and hepatitis C virus genotypes.

    PubMed

    Germano, F N; dos Santos, C A; Honscha, G; Strasburg, A; Gabbi, B; Mendoza-Sassi, R A; Soares, E A; Seuánez, H N; Soares, M A; Martínez, A M B

    2010-07-01

    We estimated the prevalence of hepatitis C (HCV) infection and associated risk factors in 750 individuals attending the Voluntary Counseling and Testing Center of Rio Grande (VCT/RG), in Southern Brazil, and identified viral genotypes. Demographic data and risk factors for HCV transmission were also collected and analysed. Anti-HCV antibody-positive individuals were tested for HCV-RNA and genotyped by sequencing the 5' untranslated region of the viral genome. Prevalence estimates of anti-HCV and HCV-RNA were 6% and 5.5%, respectively. We identified genotypes 1 (67%), 2 (2%) and 3 (31%); the latter was more prevalent than in other regions of Brazil. Anti-HCV prevalence in VCT/RG users was similar to previous reports. Age, previous blood transfusion, sexual orientation and injecting drug use were independent predictors of HCV infection. The presence of multiple risk factors was also associated with a higher risk for HCV infection. HCV genotype was not associated with any variable analysed in this study. PMID:20852195

  14. Prediction models for cardiovascular disease risk in the general population: systematic review

    PubMed Central

    Hooft, Lotty; Schuit, Ewoud; Debray, Thomas P A; Collins, Gary S; Tzoulaki, Ioanna; Lassale, Camille M; Siontis, George C M; Chiocchia, Virginia; Roberts, Corran; Schlüssel, Michael Maia; Gerry, Stephen; Black, James A; Heus, Pauline; van der Schouw, Yvonne T; Peelen, Linda M; Moons, Karel G M

    2016-01-01

    Objective To provide an overview of prediction models for risk of cardiovascular disease (CVD) in the general population. Design Systematic review. Data sources Medline and Embase until June 2013. Eligibility criteria for study selection Studies describing the development or external validation of a multivariable model for predicting CVD risk in the general population. Results 9965 references were screened, of which 212 articles were included in the review, describing the development of 363 prediction models and 473 external validations. Most models were developed in Europe (n=167, 46%), predicted risk of fatal or non-fatal coronary heart disease (n=118, 33%) over a 10 year period (n=209, 58%). The most common predictors were smoking (n=325, 90%) and age (n=321, 88%), and most models were sex specific (n=250, 69%). Substantial heterogeneity in predictor and outcome definitions was observed between models, and important clinical and methodological information were often missing. The prediction horizon was not specified for 49 models (13%), and for 92 (25%) crucial information was missing to enable the model to be used for individual risk prediction. Only 132 developed models (36%) were externally validated and only 70 (19%) by independent investigators. Model performance was heterogeneous and measures such as discrimination and calibration were reported for only 65% and 58% of the external validations, respectively. Conclusions There is an excess of models predicting incident CVD in the general population. The usefulness of most of the models remains unclear owing to methodological shortcomings, incomplete presentation, and lack of external validation and model impact studies. Rather than developing yet another similar CVD risk prediction model, in this era of large datasets, future research should focus on externally validating and comparing head-to-head promising CVD risk models that already exist, on tailoring or even combining these models to local

  15. A Global Risk Score (GRS) to Simultaneously Predict Early and Late Tumor Recurrence Risk after Resection of Hepatocellular Carcinoma1

    PubMed Central

    Dekervel, Jeroen; Popovic, Dusan; van Malenstein, Hannah; Windmolders, Petra; Heylen, Line; Libbrecht, Louis; Bulle, Ashenafi; De Moor, Bart; Van Cutsem, Eric; Nevens, Frederik; Verslype, Chris; van Pelt, Jos

    2016-01-01

    OBJECTIVES: Recurrence of hepatocellular carcinoma can arise from the primary tumor (“early recurrence”) or de novo from tumor formation in a cirrhotic environment (“late recurrence”). We aimed to develop one simple gene expression score applicable in both the tumor and the surrounding liver that can predict the recurrence risk. METHODS: We determined differentially expressed genes in a cell model of cancer aggressiveness. These genes were first validated in three large published data sets of hepatocellular carcinoma from which we developed a seven-gene risk score. RESULTS: The gene score was applied on two independent large patient cohorts. In the first cohort, with only tumor data available, it could predict the recurrence risk at 3 years after resection (68 ± 10% vs 35 ± 7%, P = .03). In the second cohort, when applied on the tumor, this gene score predicted early recurrence (62 ± 5% vs 37 ± 4%, P < .001), and when applied on the surrounding liver tissue, the same genes also correlated with late recurrence. Four patient classes with each different time patterns and rates of recurrence could be identified based on combining tumor and liver scores. In a multivariate Cox regression analysis, our gene score remained significantly associated with recurrence, independent from other important cofactors such as disease stage (P = .007). CONCLUSIONS: We developed a Global Risk Score that is able to simultaneously predict the risk of early recurrence when applied on the tumor itself, as well as the risk of late recurrence when applied on the surrounding liver tissue. PMID:27084430

  16. Prevalence and risk factors of Hepatitis C virus infection in Brazil, 2005 through 2009: a cross-sectional study

    PubMed Central

    2013-01-01

    Background Hepatitis C chronic liver disease is a major cause of liver transplant in developed countries. This article reports the first nationwide population-based survey conducted to estimate the seroprevalence of HCV antibodies and associated risk factors in the urban population of Brazil. Methods The cross sectional study was conducted in all Brazilian macro-regions from 2005 to 2009, as a stratified multistage cluster sample of 19,503 inhabitants aged between 10 and 69 years, representing individuals living in all 26 State capitals and the Federal District. Hepatitis C antibodies were detected by a third-generation enzyme immunoassay. Seropositive individuals were retested by Polymerase Chain Reaction and genotyped. Adjusted prevalence was estimated by macro-regions. Potential risk factors associated with HCV infection were assessed by calculating the crude and adjusted odds ratios, 95% confidence intervals (95% CI) and p values. Population attributable risk was estimated for multiple factors using a case–control approach. Results The overall weighted prevalence of hepatitis C antibodies was 1.38% (95% CI: 1.12%–1.64%). Prevalence of infection increased in older groups but was similar for both sexes. The multivariate model showed the following to be predictors of HCV infection: age, injected drug use (OR = 6.65), sniffed drug use (OR = 2.59), hospitalization (OR = 1.90), groups socially deprived by the lack of sewage disposal (OR = 2.53), and injection with glass syringe (OR = 1.52, with a borderline p value). The genotypes 1 (subtypes 1a, 1b), 2b and 3a were identified. The estimated population attributable risk for the ensemble of risk factors was 40%. Approximately 1.3 million individuals would be expected to be anti-HCV-positive in the country. Conclusions The large estimated absolute numbers of infected individuals reveals the burden of the disease in the near future, giving rise to costs for the health care system and society at

  17. [The risk of urban yellow fever outbreaks in Brazil by dengue vectors. Aedes aegypti and Aedes albopictus].

    PubMed

    Mondet, B; da Rosa, A P; Vasconcelos, P F

    1996-01-01

    Urban yellow fever (YF) epidemics have disappeared from Brazil since about 50 years, but a selvatic cycle still exist. In many States, cases are more or less numerous each year. Ae. aegypti was eradicated in 1954, re-appeared temporarily in 1967, and then definitively in 1976-1977. Ae. aegypti is a vector of yellow few (YF), but also of dengue, whose first cases were reported in 1982. Today, dengue is endemic in many regions. A second Flavivirus vector, Aedes albopictus is present since about ten years in some States, from which Säo Paulo. The analysis of the YF cases between 1972 and 1994 allowed us to determine the epidemiologic regions. In the first region, the endemic area, the YF virus is circulating "silently" among monkeys, and the emergence of human cases is rare. In the second region, the epidemic area, some epizootics occur in a more or less cyclic way, and human cases can be numerous. Nevertheless, these outbreaks are considered "selvatic" epidemics, as long as Ae. aegypti is not concerned. From the Amazonian region, the virus moves forward along the forest galleries of the Amazone tributaries, from North to South. Actually, dengue epidemics appear in quite all States, and reflect the geographical distribution of Ae. aegypti. Recently, Ae. aegypti was found in the southern part of the Pará State, in the Carajás region considered to be the source of the main YF epidemics. In another hand, Ae. albopictus is now increasing its distribution area, specially in the suburban zones. The ecology of this potential vector, which seems to have a great adaptative capacity, give this vector an intermediate position between the forest galleries, where the YF virus circulates, and the agglomerations infested with Ae. aegypti. Since a few years, the possibility of urban YF is threatening Brazil, it is more and more predictable and we must survey very carefully the epidemiological situation in some regions of the country.

  18. Prediction at First Year of Incident New-Onset Diabetes After Kidney Transplantation by Risk Prediction Models

    PubMed Central

    Rodrigo, Emilio; Santos, Lidia; Piñera, Celestino; Ruiz San Millán, Juan Carlos; Quintela, Maria Estrella; Toyos, Carmen; Allende, Natalia; Gómez-Alamillo, Carlos; Arias, Manuel

    2012-01-01

    OBJECTIVE Our aim was to analyze the performance of two scores developed for predicting diabetes in nontransplant populations for identifying kidney transplant recipients with a higher new-onset diabetes mellitus after transplantation (NODAT) risk beyond the first year after transplantation. RESEARCH DESIGN AND METHODS We analyzed 191 kidney transplants, which had at least 1-year follow-up posttransplant. First-year posttransplant variables were collected to estimate the San Antonio Diabetes Prediction Model (SADPM) and Framingham Offspring Study–Diabetes Mellitus (FOS-DM) algorithm. RESULTS Areas under the receiver operating characteristic curve of FOS-DM and SADPM scores to predict NODAT were 0.756 and 0.807 (P < 0.001), respectively. FOS-DM and SADPM scores over 75 percentile (hazard ratio 5.074 and 8.179, respectively, P < 0.001) were associated with NODAT. CONCLUSIONS Both scores can be used to identify kidney recipients at higher risk for NODAT beyond the first year. SADPM score detects some 25% of kidney transplant patients with an eightfold risk for NODAT. PMID:22279030

  19. Predicting the Unpredictable? Identifying High-Risk versus Low-Risk Parents with Intellectual Disabilities

    ERIC Educational Resources Information Center

    McGaw, Sue; Scully, Tamara; Pritchard, Colin

    2010-01-01

    Objectives: This study set out to identify risk factors affecting parents with intellectual disabilities (IDs) by determining: (i) whether perception of family support differs between parents with IDs, referring professionals, and a specialist parenting service; (ii) whether multivariate familial and demographic factors differentiates "high-risk"…

  20. Utilizing Dental Electronic Health Records Data to Predict Risk for Periodontal Disease.

    PubMed

    Thyvalikakath, Thankam P; Padman, Rema; Vyawahare, Karnali; Darade, Pratiksha; Paranjape, Rhucha

    2015-01-01

    Periodontal disease is a major cause for tooth loss and adversely affects individuals' oral health and quality of life. Research shows its potential association with systemic diseases like diabetes and cardiovascular disease, and social habits such as smoking. This study explores mining potential risk factors from dental electronic health records to predict and display patients' contextualized risk for periodontal disease. We retrieved relevant risk factors from structured and unstructured data on 2,370 patients who underwent comprehensive oral examinations at the Indiana University School of Dentistry, Indianapolis, IN, USA. Predicting overall risk and displaying relationships between risk factors and their influence on the patient's oral and general health can be a powerful educational and disease management tool for patients and clinicians at the point of care.

  1. Polygenic Risk Predicts Obesity in Both White and Black Young Adults

    PubMed Central

    Domingue, Benjamin W.; Belsky, Daniel W.; Harris, Kathleen Mullan; Smolen, Andrew; McQueen, Matthew B.; Boardman, Jason D.

    2014-01-01

    Objective To test transethnic replication of a genetic risk score for obesity in white and black young adults using a national sample with longitudinal data. Design and Methods A prospective longitudinal study using the National Longitudinal Study of Adolescent Health Sibling Pairs (n = 1,303). Obesity phenotypes were measured from anthropometric assessments when study members were aged 18–26 and again when they were 24–32. Genetic risk scores were computed based on published genome-wide association study discoveries for obesity. Analyses tested genetic associations with body-mass index (BMI), waist-height ratio, obesity, and change in BMI over time. Results White and black young adults with higher genetic risk scores had higher BMI and waist-height ratio and were more likely to be obese compared to lower genetic risk age-peers. Sibling analyses revealed that the genetic risk score was predictive of BMI net of risk factors shared by siblings. In white young adults only, higher genetic risk predicted increased risk of becoming obese during the study period. In black young adults, genetic risk scores constructed using loci identified in European and African American samples had similar predictive power. Conclusion Cumulative information across the human genome can be used to characterize individual level risk for obesity. Measured genetic risk accounts for only a small amount of total variation in BMI among white and black young adults. Future research is needed to identify modifiable environmental exposures that amplify or mitigate genetic risk for elevated BMI. PMID:24992585

  2. Assessment of uncertainties in radiation-induced cancer risk predictions at clinically relevant doses

    SciTech Connect

    Nguyen, J.; Moteabbed, M.; Paganetti, H.

    2015-01-15

    Purpose: Theoretical dose–response models offer the possibility to assess second cancer induction risks after external beam therapy. The parameters used in these models are determined with limited data from epidemiological studies. Risk estimations are thus associated with considerable uncertainties. This study aims at illustrating uncertainties when predicting the risk for organ-specific second cancers in the primary radiation field illustrated by choosing selected treatment plans for brain cancer patients. Methods: A widely used risk model was considered in this study. The uncertainties of the model parameters were estimated with reported data of second cancer incidences for various organs. Standard error propagation was then subsequently applied to assess the uncertainty in the risk model. Next, second cancer risks of five pediatric patients treated for cancer in the head and neck regions were calculated. For each case, treatment plans for proton and photon therapy were designed to estimate the uncertainties (a) in the lifetime attributable risk (LAR) for a given treatment modality and (b) when comparing risks of two different treatment modalities. Results: Uncertainties in excess of 100% of the risk were found for almost all organs considered. When applied to treatment plans, the calculated LAR values have uncertainties of the same magnitude. A comparison between cancer risks of different treatment modalities, however, does allow statistically significant conclusions. In the studied cases, the patient averaged LAR ratio of proton and photon treatments was 0.35, 0.56, and 0.59 for brain carcinoma, brain sarcoma, and bone sarcoma, respectively. Their corresponding uncertainties were estimated to be potentially below 5%, depending on uncertainties in dosimetry. Conclusions: The uncertainty in the dose–response curve in cancer risk models makes it currently impractical to predict the risk for an individual external beam treatment. On the other hand, the ratio

  3. One vs. Two Breast Density Measures to Predict 5- and 10- Year Breast Cancer Risk

    PubMed Central

    Kerlikowske, Karla; Gard, Charlotte C.; Sprague, Brian L.; Tice, Jeffrey A.; Miglioretti, Diana L.

    2015-01-01

    Background One measure of Breast Imaging Reporting and Data System (BI-RADS) breast density improves 5-year breast cancer risk prediction, but the value of sequential measures is unknown. We determined if two BI-RADS density measures improves the predictive accuracy of the Breast Cancer Surveillance Consortium 5-year risk model compared to one measure. Methods We included 722,654 women aged 35–74 years with two mammograms with BI-RADS density measures on average 1.8 years apart; 13,715 developed invasive breast cancer. We used Cox regression to estimate the relative hazards of breast cancer for age, race/ethnicity, family history of breast cancer, history of breast biopsy, and one or two density measures. We developed a risk prediction model by combining these estimates with 2000–2010 Surveillance, Epidemiology, and End Results incidence and 2010 vital statistics for competing risk of death. Results The two-measure density model had marginally greater discriminatory accuracy than the one-measure model (AUC=0.640 vs. 0.635). Of 18.6% of women (134,404/722,654) who decreased density categories, 15.4% (20,741/134,404) of women whose density decreased from heterogeneously or extremely dense to a lower density category with one other risk factor had a clinically meaningful increase in 5-year risk from <1.67% with the one-density model to ≥1.67% with the two-density model. Conclusion The two-density model has similar overall discrimination to the one-density model for predicting 5-year breast cancer risk and improves risk classification for women with risk factors and a decrease in density. Impact A two-density model should be considered for women whose density decreases when calculating breast cancer risk. PMID:25824444

  4. Evaluation of the Modified Asthma Predictive Index in High-Risk Preschool Children

    PubMed Central

    Chang, Timothy S.; Lemanske, Robert F.; Guilbert, Theresa W.; Gern, James E.; Coen, Michael H.; Evans, Michael D.; Gangnon, Ronald E.; Page, C. David; Jackson, Daniel J.

    2013-01-01

    BACKGROUND Prediction of subsequent school-age asthma during the preschool years has proven challenging. OBJECTIVE To confirm in a post hoc analysis the predictive ability of the modified Asthma Predictive Index (mAPI) in a high-risk cohort and a theoretical unselected population. We also tested a potential mAPI modification with a 2-wheezing episode requirement (m2API) in the same populations. METHODS Subjects (n = 289) with a family history of allergy and/or asthma were used to predict asthma at age 6, 8, and 11 years with the use of characteristics collected during the first 3 years of life. The mAPI and the m2API were tested for predictive value. RESULTS For the mAPI and m2API, school-age asthma prediction improved from 1 to 3 years of age. The mAPI had high predictive value after a positive test (positive likelihood ratio ranging from 4.9 to 55) for asthma development at years 6, 8, and 11. Lowering the number of wheezing episodes to 2 (m2API) lowered the predictive value after a positive test (positive likelihood ratio ranging from 1.91 to 13.1) without meaningfully improving the predictive value of a negative test. Posttest probabilities for a positive mAPI reached 72% and 90% in unselected and high-risk populations, respectively. CONCLUSIONS In a high-risk cohort, a positive mAPI greatly increased future asthma probability (eg, 30% pretest probability to 90% posttest probability) and is a preferred predictive test to the m2API. With its more favorable positive posttest probability, the mAPI can aid clinical decision making in assessing future asthma risk for preschool-age children. PMID:24187656

  5. The role of the implementation of policies for the prevention of exposure to Radon in Brazil-a strategy for controlling the risk of developing lung cancer.

    PubMed

    Lino, Aline da Rocha; Abrahão, Carina Meira; Amarante, Marcus Paulo Fernandes; de Sousa Cruz, Marcelo Rocha

    2015-01-01

    Lung cancer is the leading cause of cancer death in the United States and other industrialised countries. The most important risk factor is active smoking. However, given the increased incidence of lung cancer in non-smokers, it is necessary to improve knowledge regarding other risk factors. Radon (Rn) is a noble gas and is the most important natural source of human exposure to ionizing radiation. Exposure to high levels of this radioactive gas is related to an increased risk of developing lung cancer. The objective of this work is to highlight the importance of measuring indoor concentration of this gas and identify which steps should be taken for achieving radiological protection. A survey was conducted on the websites of the National Health Surveillance Agency (ANVISA), LAMIN (Mineral Analysis Laboratory), CPRM (Geological Survey of Brazil), Ministry of Health and PubMed. Using the words 'radon', 'lung', 'cancer', and PubMed®, 1,371 results were obtained; when using the words 'radon', 'lung', 'cancer', and with 'Brazil' or 'Brazilians', only six results were obtained. We emphasise that lung cancer is a major public health problem and the exposure to Rn indoors should be considered as a risk factor for lung cancer in non-smokers. Buildings or houses with high concentrations of Rn should be identified. However, currently in Brazil-a country with great potential for mineral extraction-there are no specific regulated recommendations to control indoor exposure to Rn.

  6. The role of the implementation of policies for the prevention of exposure to Radon in Brazil-a strategy for controlling the risk of developing lung cancer.

    PubMed

    Lino, Aline da Rocha; Abrahão, Carina Meira; Amarante, Marcus Paulo Fernandes; de Sousa Cruz, Marcelo Rocha

    2015-01-01

    Lung cancer is the leading cause of cancer death in the United States and other industrialised countries. The most important risk factor is active smoking. However, given the increased incidence of lung cancer in non-smokers, it is necessary to improve knowledge regarding other risk factors. Radon (Rn) is a noble gas and is the most important natural source of human exposure to ionizing radiation. Exposure to high levels of this radioactive gas is related to an increased risk of developing lung cancer. The objective of this work is to highlight the importance of measuring indoor concentration of this gas and identify which steps should be taken for achieving radiological protection. A survey was conducted on the websites of the National Health Surveillance Agency (ANVISA), LAMIN (Mineral Analysis Laboratory), CPRM (Geological Survey of Brazil), Ministry of Health and PubMed. Using the words 'radon', 'lung', 'cancer', and PubMed®, 1,371 results were obtained; when using the words 'radon', 'lung', 'cancer', and with 'Brazil' or 'Brazilians', only six results were obtained. We emphasise that lung cancer is a major public health problem and the exposure to Rn indoors should be considered as a risk factor for lung cancer in non-smokers. Buildings or houses with high concentrations of Rn should be identified. However, currently in Brazil-a country with great potential for mineral extraction-there are no specific regulated recommendations to control indoor exposure to Rn. PMID:26435745

  7. The assisted prediction modelling frame with hybridisation and ensemble for business risk forecasting and an implementation

    NASA Astrophysics Data System (ADS)

    Li, Hui; Hong, Lu-Yao; Zhou, Qing; Yu, Hai-Jie

    2015-08-01

    The business failure of numerous companies results in financial crises. The high social costs associated with such crises have made people to search for effective tools for business risk prediction, among which, support vector machine is very effective. Several modelling means, including single-technique modelling, hybrid modelling, and ensemble modelling, have been suggested in forecasting business risk with support vector machine. However, existing literature seldom focuses on the general modelling frame for business risk prediction, and seldom investigates performance differences among different modelling means. We reviewed researches on forecasting business risk with support vector machine, proposed the general assisted prediction modelling frame with hybridisation and ensemble (APMF-WHAE), and finally, investigated the use of principal components analysis, support vector machine, random sampling, and group decision, under the general frame in forecasting business risk. Under the APMF-WHAE frame with support vector machine as the base predictive model, four specific predictive models were produced, namely, pure support vector machine, a hybrid support vector machine involved with principal components analysis, a support vector machine ensemble involved with random sampling and group decision, and an ensemble of hybrid support vector machine using group decision to integrate various hybrid support vector machines on variables produced from principle components analysis and samples from random sampling. The experimental results indicate that hybrid support vector machine and ensemble of hybrid support vector machines were able to produce dominating performance than pure support vector machine and support vector machine ensemble.

  8. Prediction of clinical risks by analysis of preclinical and clinical adverse events.

    PubMed

    Clark, Matthew

    2015-04-01

    This study examines the ability of nonclinical adverse event observations to predict human clinical adverse events observed in drug development programs. In addition it examines the relationship between nonclinical and clinical adverse event observations to drug withdrawal and proposes a model to predict drug withdrawal based on these observations. These analyses provide risk assessments useful for both planning patient safety programs, as well as a statistical framework for assessing the future success of drug programs based on nonclinical and clinical observations. Bayesian analyses were undertaken to investigate the connection between nonclinical adverse event observations and observations of that same event in clinical trial for a large set of approved drugs. We employed the same statistical methods used to evaluate the efficacy of diagnostic tests to evaluate the ability of nonclinical studies to predict adverse events in clinical studies, and adverse events in both to predict drug withdrawal. We find that some nonclinical observations suggest higher risk for observing the same adverse event in clinical studies, particularly arrhythmias, QT prolongation, and abnormal hepatic function. However the lack of these events in nonclinical studies is found to not be a good predictor of safety in humans. Some nonclinical and clinical observations appear to be associated with high risk of drug withdrawal from market, especially arrhythmia and hepatic necrosis. We use the method to estimate the overall risk of drug withdrawal from market using the product of the risks from each nonclinical and clinical observation to create a risk profile.

  9. Prediction of clinical risks by analysis of preclinical and clinical adverse events.

    PubMed

    Clark, Matthew

    2015-04-01

    This study examines the ability of nonclinical adverse event observations to predict human clinical adverse events observed in drug development programs. In addition it examines the relationship between nonclinical and clinical adverse event observations to drug withdrawal and proposes a model to predict drug withdrawal based on these observations. These analyses provide risk assessments useful for both planning patient safety programs, as well as a statistical framework for assessing the future success of drug programs based on nonclinical and clinical observations. Bayesian analyses were undertaken to investigate the connection between nonclinical adverse event observations and observations of that same event in clinical trial for a large set of approved drugs. We employed the same statistical methods used to evaluate the efficacy of diagnostic tests to evaluate the ability of nonclinical studies to predict adverse events in clinical studies, and adverse events in both to predict drug withdrawal. We find that some nonclinical observations suggest higher risk for observing the same adverse event in clinical studies, particularly arrhythmias, QT prolongation, and abnormal hepatic function. However the lack of these events in nonclinical studies is found to not be a good predictor of safety in humans. Some nonclinical and clinical observations appear to be associated with high risk of drug withdrawal from market, especially arrhythmia and hepatic necrosis. We use the method to estimate the overall risk of drug withdrawal from market using the product of the risks from each nonclinical and clinical observation to create a risk profile. PMID:25746390

  10. Predicting Stroke Risk Based on Health Behaviours: Development of the Stroke Population Risk Tool (SPoRT)

    PubMed Central

    Manuel, Douglas G.; Tuna, Meltem; Perez, Richard; Tanuseputro, Peter; Hennessy, Deirdre; Bennett, Carol; Rosella, Laura; Sanmartin, Claudia; van Walraven, Carl; Tu, Jack V.

    2015-01-01

    Background Health behaviours, important factors in cardiovascular disease, are increasingly a focus of prevention. We appraised whether stroke risk can be accurately assessed using self-reported information focused on health behaviours. Methods Behavioural, sociodemographic and other risk factors were assessed in a population-based survey of 82 259 Ontarians who were followed for a median of 8.6 years (688 000 person-years follow-up) starting in 2001. Predictive algorithms for 5-year incident stroke resulting in hospitalization were created and then validated in a similar 2007 survey of 28 605 respondents (median 4.2 years follow-up). Results We observed 3 236 incident stroke events (1 551 resulting in hospitalization; 1 685 in the community setting without hospital admission). The final algorithms were discriminating (C-stat: 0.85, men; 0.87, women) and well-calibrated (in 65 of 67 subgroups for men; 61 of 65 for women). An index was developed to summarize cumulative relative risk of incident stroke from health behaviours and stress. For men, each point on the index corresponded to a 12% relative risk increase (180% risk difference, lowest (0) to highest (9) scores). For women, each point corresponded to a 14% relative risk increase (340% difference, lowest (0) to highest (11) scores). Algorithms for secondary stroke outcomes (stroke resulting in death; classified as ischemic; excluding transient ischemic attack; and in the community setting) had similar health behaviour risk hazards. Conclusion Incident stroke can be accurately predicted using self-reported information focused on health behaviours. Risk assessment can be performed with population health surveys to support population health planning or outside of clinical settings to support patient-focused prevention. PMID:26637172

  11. Evaluation of human health risks associated to coal mining in Brazil

    NASA Astrophysics Data System (ADS)

    Castilhos, Z. C.

    2003-05-01

    Brazilian coal contains about 5% of sulfur, mainly as pyrite. The ROM has to be washed for cleaning and became useful for energy generation, and almost 60% of ROM is rejected as waste. Acid mine drainage is a common process in coal mining, and the acid can dissolve metals previously bound up in ore and surrounding rock. When carried in runoff, the metals then enter aquatic environments where they can contaminate surface waters. It might have devastating effects on aquatic life and may cause adverse effects in humans. This work presents a conceptual model for human exposure to toxic agents released by coal mining in south State in Brazil, in order to supply a basic framework for human health hazard assessment, considering the site-specific conditions. Additionaly, a quantitative non-carcinogenic hazard due to consumption of contaminated surface water was performed at the screening level. The results show that there is not concern regarding all water bodies studied, except in mouth of Maina River. However, we should taken into account that was detected several gaps in the information needed to perform a complete human health hazard.

  12. Anxiety and depression symptoms as risk factors for non-adherence to antiretroviral therapy in Brazil

    PubMed Central

    Campos, Lorenza Nogueira; Guimarães, Mark Drew Crosland; Remien, Robert H.

    2009-01-01

    Depression and anxiety are common among HIV-infected people and rank among the strongest predictors of non-adherence to antiretroviral therapy (ART). This longitudinal study aimed to assess whether symptoms of anxiety and depression are predictors of non-adherence among patients initiating ART at two public referral centers (n=293) in Belo Horizonte, Brazil. Prevalence of severe anxiety and depression symptoms before starting ART was 12.6% and 5.8%, respectively. Severe anxiety was a predictor of non-adherence to ART during follow-up period (RH=1.87; 95% CI=1.14–3.06) adjusted for low education, unemployment, alcohol use in the last month and symptoms of AIDS; while a history of injection drug use had borderline statistical significance with non-adherence. These findings suggest that using a brief screening procedure to assess anxiety and depression symptoms before initiating ART help identify individuals for interventions to improve adherence and quality of life. PMID:18648925

  13. Risk Prediction Models for Mortality in Community-Acquired Pneumonia: A Systematic Review

    PubMed Central

    Loke, Yoon K.; Myint, Phyo Kyaw

    2013-01-01

    Background. Several models have been developed to predict the risk of mortality in community-acquired pneumonia (CAP). This study aims to systematically identify and evaluate the performance of published risk prediction models for CAP. Methods. We searched MEDLINE, EMBASE, and Cochrane library in November 2011 for initial derivation and validation studies for models which predict pneumonia mortality. We aimed to present the comparative usefulness of their mortality prediction. Results. We identified 20 different published risk prediction models for mortality in CAP. Four models relied on clinical variables that could be assessed in community settings, with the two validated models BTS1 and CRB-65 showing fairly similar balanced accuracy levels (0.77 and 0.72, resp.), while CRB-65 had AUROC of 0.78. Nine models required laboratory tests in addition to clinical variables, and the best performance levels amongst the validated models were those of CURB and CURB-65 (balanced accuracy 0.73 and 0.71, resp.), with CURB-65 having an AUROC of 0.79. The PSI (AUROC 0.82) was the only validated model with good discriminative ability among the four that relied on clinical, laboratorial, and radiological variables. Conclusions. There is no convincing evidence that other risk prediction models improve upon the well-established CURB-65 and PSI models. PMID:24228253

  14. Predictive capacity of risk assessment scales and clinical judgment for pressure ulcers: a meta-analysis.

    PubMed

    García-Fernández, Francisco Pedro; Pancorbo-Hidalgo, Pedro L; Agreda, J Javier Soldevilla

    2014-01-01

    A systematic review with meta-analysis was completed to determine the capacity of risk assessment scales and nurses' clinical judgment to predict pressure ulcer (PU) development. Electronic databases were searched for prospective studies on the validity and predictive capacity of PUs risk assessment scales published between 1962 and 2010 in English, Spanish, Portuguese, Korean, German, and Greek. We excluded gray literature sources, integrative review articles, and retrospective or cross-sectional studies. The methodological quality of the studies was assessed according to the guidelines of the Critical Appraisal Skills Program. Predictive capacity was measured as relative risk (RR) with 95% confidence intervals. When 2 or more valid original studies were found, a meta-analysis was conducted using a random-effect model and sensitivity analysis. We identified 57 studies, including 31 that included a validation study. We also retrieved 4 studies that tested clinical judgment as a risk prediction factor. Meta-analysis produced the following pooled predictive capacity indicators: Braden (RR = 4.26); Norton (RR = 3.69); Waterlow (RR = 2.66); Cubbin-Jackson (RR = 8.63); EMINA (RR = 6.17); Pressure Sore Predictor Scale (RR = 21.4); and clinical judgment (RR = 1.89). Pooled analysis of 11 studies found adequate risk prediction capacity in various clinical settings; the Braden, Norton, EMINA (mEntal state, Mobility, Incontinence, Nutrition, Activity), Waterlow, and Cubbin-Jackson scales showed the highest predictive capacity. The clinical judgment of nurses was found to achieve inadequate predictive capacity when used alone, and should be used in combination with a validated scale.

  15. The environmental risk as a culture in the Sinos Valley, Brazil.

    PubMed

    Pedde, Valdir; Figueiredo, João A; Tundisi, José G; Lenz, Cátia A

    2014-12-01

    The proposal of analysis of the social-environmental perception will be developed from the discourse as a constitutive element of reality. The discourse practices and their concretion will be the source of meaning and social-cultural value. Thus, the chosen research method was the qualitative and quantitative case study. In the first part of the text we will recapture a theoretical input by Mary Douglas on risk and culture, as well as on the acceptance of the risks in society. In the second part, we cover a few data of the case of the risks resulting from the tanning industry and on how the society of the "Vale do Rio dos Sinos" relates to these risks. In this article we conclude that risk perception of the population is directly related with past experiences, thus, assigning a meaning to all new events. This meaning is the result of a sociocultural construction. It is worth noting that behind this history, there are basic issues related to population survival, i.e., both the industrialists and workers establish partnerships when the society creates a movement against the leather industry. PMID:25493693

  16. The environmental risk as a culture in the Sinos Valley, Brazil.

    PubMed

    Pedde, Valdir; Figueiredo, João A; Tundisi, José G; Lenz, Cátia A

    2014-12-01

    The proposal of analysis of the social-environmental perception will be developed from the discourse as a constitutive element of reality. The discourse practices and their concretion will be the source of meaning and social-cultural value. Thus, the chosen research method was the qualitative and quantitative case study. In the first part of the text we will recapture a theoretical input by Mary Douglas on risk and culture, as well as on the acceptance of the risks in society. In the second part, we cover a few data of the case of the risks resulting from the tanning industry and on how the society of the "Vale do Rio dos Sinos" relates to these risks. In this article we conclude that risk perception of the population is directly related with past experiences, thus, assigning a meaning to all new events. This meaning is the result of a sociocultural construction. It is worth noting that behind this history, there are basic issues related to population survival, i.e., both the industrialists and workers establish partnerships when the society creates a movement against the leather industry. PMID:25590748

  17. The environmental risk as a culture in the Sinos Valley, Brazil.

    PubMed

    Pedde, Valdir; Figueiredo, João A; Tundisi, José G; Lenz, Cátia A

    2014-12-09

    The proposal of analysis of the social-environmental perception will be developed from the discourse as a constitutive element of reality. The discourse practices and their concretion will be the source of meaning and social-cultural value. Thus, the chosen research method was the qualitative and quantitative case study. In the first part of the text we will recapture a theoretical input by Mary Douglas on risk and culture, as well as on the acceptance of the risks in society. In the second part, we cover a few data of the case of the risks resulting from the tanning industry and on how the society of the "Vale do Rio dos Sinos" relates to these risks. In this article we conclude that risk perception of the population is directly related with past experiences, thus, assigning a meaning to all new events. This meaning is the result of a sociocultural construction. It is worth noting that behind this history, there are basic issues related to population survival, i.e., both the industrialists and workers establish partnerships when the society creates a movement against the leather industry.

  18. The environmental risk as a culture in the Sinos Valley, Brazil.

    PubMed

    Pedde, Valdir; Figueiredo, João A; Tundisi, José G; Lenz, Cátia A

    2014-12-01

    The proposal of analysis of the social-environmental perception will be developed from the discourse as a constitutive element of reality. The discourse practices and their concretion will be the source of meaning and social-cultural value. Thus, the chosen research method was the qualitative and quantitative case study. In the first part of the text we will recapture a theoretical input by Mary Douglas on risk and culture, as well as on the acceptance of the risks in society. In the second part, we cover a few data of the case of the risks resulting from the tanning industry and on how the society of the "Vale do Rio dos Sinos" relates to these risks. In this article we conclude that risk perception of the population is directly related with past experiences, thus, assigning a meaning to all new events. This meaning is the result of a sociocultural construction. It is worth noting that behind this history, there are basic issues related to population survival, i.e., both the industrialists and workers establish partnerships when the society creates a movement against the leather industry.

  19. A spline-based tool to assess and visualize the calibration of multiclass risk predictions.

    PubMed

    Van Hoorde, K; Van Huffel, S; Timmerman, D; Bourne, T; Van Calster, B

    2015-04-01

    When validating risk models (or probabilistic classifiers), calibration is often overlooked. Calibration refers to the reliability of the predicted risks, i.e. whether the predicted risks correspond to observed probabilities. In medical applications this is important because treatment decisions often rely on the estimated risk of disease. The aim of this paper is to present generic tools to assess the calibration of multiclass risk models. We describe a calibration framework based on a vector spline multinomial logistic regression model. This framework can be used to generate calibration plots and calculate the estimated calibration index (ECI) to quantify lack of calibration. We illustrate these tools in relation to risk models used to characterize ovarian tumors. The outcome of the study is the surgical stage of the tumor when relevant and the final histological outcome, which is divided into five classes: benign, borderline malignant, stage I, stage II-IV, and secondary metastatic cancer. The 5909 patients included in the study are randomly split into equally large training and test sets. We developed and tested models using the following algorithms: logistic regression, support vector machines, k nearest neighbors, random forest, naive Bayes and nearest shrunken centroids. Multiclass calibration plots are interesting as an approach to visualizing the reliability of predicted risks. The ECI is a convenient tool for comparing models, but is less informative and interpretable than calibration plots. In our case study, logistic regression and random forest showed the highest degree of calibration, and the naive Bayes the lowest.

  20. Police referral to victim support: the predictive and diagnostic value of the RISK (10) screening instrument.

    PubMed

    Winkel, Frans Willem; Wohlfarth, Tamar; Blaauw, Eric

    2004-01-01

    One of the basic rights of crime victims granted under victim-orientated legislation introduced during the last 20 years in more than 100 countries worldwide is the right to be referred to victim support by the police. The under-utilization of psychological services by crime victims who are objectively in need of external support is substantial. Current legal procedures tend to perpetuate this unwanted condition. Programs aimed at the early detection and prevention of persistent postvictimization distress are more in line with the ideals of therapeutic jurisprudence. The RISK (10) screening instrument, which was specifically developed to be administered by police officers, may provide a basis for early detection. RISK (10) consists of a selection of 10 Risk factors with prior empirical evidence and theoretical significance. The focus of the present study was to examine the predictive and diagnostic power of RISK (10) components to detect persistent future psychological distress, among other things, in terms of Adjustment Disorder. Analyses were based on a sample of 93 crime victims who participated in the police and (3 months) follow-up parts of the study. Findings provided initial validation for the predictive accuracy of most RISK (10) components, and confirm the diagnostic value (in terms of specificity, sensitivity, positive and negative predictive power) of risk factors, such as engaging in character attributions, upward comparison processes, fatalistic appraisals of the episode, and the initial reporting of expected deficiencies in social support. The clinical utility of RISK (10) for early detection in police stations is confirmed.

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

    PubMed Central

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

    2014-01-01

    Background The majority of coeliac disease (CD) patients are not being properly diagnosed and therefore remain untreated, leading to a greater risk of developing CD-associated complications. The major genetic risk heterodimer, HLA-DQ2 and DQ8, is already used clinically to help exclude disease. However, approximately 40% of the population carry these alleles and the majority never develop CD. Objective We explored whether CD risk prediction can be improved by adding non-HLA-susceptible variants to common HLA testing. Design We developed an average weighted genetic risk score with 10, 26 and 57 single nucleotide polymorphisms (SNP) in 2675 cases and 2815 controls and assessed the improvement in risk prediction provided by the non-HLA SNP. Moreover, we assessed the transferability of the genetic risk model with 26 non-HLA variants to a nested case–control population (n=1709) and a prospective cohort (n=1245) and then tested how well this model predicted CD outcome for 985 independent individuals. Results Adding 57 non-HLA variants to HLA testing showed a statistically significant improvement compared to scores from models based on HLA only, HLA plus 10 SNP and HLA plus 26 SNP. With 57 non-HLA variants, the area under the receiver operator characteristic curve reached 0.854 compared to 0.823 for HLA only, and 11.1% of individuals were reclassified to a more accurate risk group. We show that the risk model with HLA plus 26 SNP is useful in independent populations. Conclusions Predicting risk with 57 additional non-HLA variants improved the identification of potential CD patients. This demonstrates a possible role for combined HLA and non-HLA genetic testing in diagnostic work for CD. PMID:23704318

  2. Evaluation of Major Online Diabetes Risk Calculators and Computerized Predictive Models.

    PubMed

    Stiglic, Gregor; Pajnkihar, Majda

    2015-01-01

    Classical paper-and-pencil based risk assessment questionnaires are often accompanied by the online versions of the questionnaire to reach a wider population. This study focuses on the loss, especially in risk estimation performance, that can be inflicted by direct transformation from the paper to online versions of risk estimation calculators by ignoring the possibilities of more complex and accurate calculations that can be performed using the online calculators. We empirically compare the risk estimation performance between four major diabetes risk calculators and two, more advanced, predictive models. National Health and Nutrition Examination Survey (NHANES) data from 1999-2012 was used to evaluate the performance of detecting diabetes and pre-diabetes. American Diabetes Association risk test achieved the best predictive performance in category of classical paper-and-pencil based tests with an Area Under the ROC Curve (AUC) of 0.699 for undiagnosed diabetes (0.662 for pre-diabetes) and 47% (47% for pre-diabetes) persons selected for screening. Our results demonstrate a significant difference in performance with additional benefits for a lower number of persons selected for screening when statistical methods are used. The best AUC overall was obtained in diabetes risk prediction using logistic regression with AUC of 0.775 (0.734) and an average 34% (48%) persons selected for screening. However, generalized boosted regression models might be a better option from the economical point of view as the number of selected persons for screening of 30% (47%) lies significantly lower for diabetes risk assessment in comparison to logistic regression (p < 0.001), with a significantly higher AUC (p < 0.001) of 0.774 (0.740) for the pre-diabetes group. Our results demonstrate a serious lack of predictive performance in four major online diabetes risk calculators. Therefore, one should take great care and consider optimizing the online versions of questionnaires that were

  3. Evaluation of Major Online Diabetes Risk Calculators and Computerized Predictive Models.

    PubMed

    Stiglic, Gregor; Pajnkihar, Majda

    2015-01-01

    Classical paper-and-pencil based risk assessment questionnaires are often accompanied by the online versions of the questionnaire to reach a wider population. This study focuses on the loss, especially in risk estimation performance, that can be inflicted by direct transformation from the paper to online versions of risk estimation calculators by ignoring the possibilities of more complex and accurate calculations that can be performed using the online calculators. We empirically compare the risk estimation performance between four major diabetes risk calculators and two, more advanced, predictive models. National Health and Nutrition Examination Survey (NHANES) data from 1999-2012 was used to evaluate the performance of detecting diabetes and pre-diabetes. American Diabetes Association risk test achieved the best predictive performance in category of classical paper-and-pencil based tests with an Area Under the ROC Curve (AUC) of 0.699 for undiagnosed diabetes (0.662 for pre-diabetes) and 47% (47% for pre-diabetes) persons selected for screening. Our results demonstrate a significant difference in performance with additional benefits for a lower number of persons selected for screening when statistical methods are used. The best AUC overall was obtained in diabetes risk prediction using logistic regression with AUC of 0.775 (0.734) and an average 34% (48%) persons selected for screening. However, generalized boosted regression models might be a better option from the economical point of view as the number of selected persons for screening of 30% (47%) lies significantly lower for diabetes risk assessment in comparison to logistic regression (p < 0.001), with a significantly higher AUC (p < 0.001) of 0.774 (0.740) for the pre-diabetes group. Our results demonstrate a serious lack of predictive performance in four major online diabetes risk calculators. Therefore, one should take great care and consider optimizing the online versions of questionnaires that were

  4. Predicting Prostate Cancer Mortality Among Men With Intermediate to High-Risk Disease and Multiple Unfavorable Risk Factors

    SciTech Connect

    Nguyen, Paul L. Chen Minghui; Catalona, William J.; Moul, Judd W.; Sun, Leon; D'Amico, Anthony V.

    2009-03-01

    Purpose: To determine whether the number of unfavorable risk factors could be used to predict the risk of prostate cancer-specific mortality (PCSM) among men with intermediate- to high-risk prostate cancer. Methods and Materials: We studied 1,063 men who underwent radical prostatectomy (n = 559), external beam radiotherapy (n = 288), or radiotherapy plus androgen suppression therapy (n = 116) for prostate cancer between 1965 and 2002. Fine and Gray's regression analysis was used to determine whether an increasing number of unfavorable risk factors (prostate-specific antigen level >10 ng/mL, Gleason score of {>=}7, clinical Stage T2b or greater, or pretreatment prostate-specific antigen velocity >2.0 ng/mL/y) was associated with the interval to PCSM and all-cause mortality. Results: Median follow-up was 5.6 years. Compared with those with one risk factor, the adjusted hazard ratio for PCSM was 2.3 (95% confidence interval 1.1-4.8; p = 0.03) for two risk factors, 5.4 (95% confidence interval 2.7-10.7; p < 0.0001) for three risk factors, and 13.6 (95% confidence interval 6.3-29.2; p < 0.0001) for all four risk factors. The 5-year cumulative incidence of PCSM was 2.4% for one factor, 2.4% for two factors, 7.0% for three factors, and 14.7% for all four factors. Prostate cancer deaths as a proportion of all deaths was 19% for one factor, 33% for two factors, 53% for three factors, and 80% for four factors. Conclusion: The number of unfavorable risk factors was significantly associated with PCSM. Prostate cancer was the major cause of death in men with at least three risk factors. Therefore, these men should be considered for clinical trials designed to assess whether survival is prolonged with the addition of novel agents to current standards of practice.

  5. Assessment of the landslide and flood risks in São Paulo City, Brazil

    NASA Astrophysics Data System (ADS)

    Vieira, Bianca; Listo, Fabrízio

    2010-05-01

    In Brazilian cities, especially during summer, the landslides and floods cause disaster and economic losses. Aricanduva basin is one of the most critical in the Metropolitan Region of São Paulo (RMSP), where many types of morphodynamic processes occur. This is the largest river basin in São Paulo City. The current situation is characterized by intense urbanization, soil sealing and consequent reduction of soil infiltration, increasing the frequency of flood events in this area. Thus, the main objective of this paper is to map risk areas of landslides and floods in the sub-basin Limoeiro, located in the head of the Aricanduva basin. For mapping the risk areas, we prepared a record field to floods and landslides, based on several studies. Initially, it were identified the natural indicators (vegetation, topography, surface cover and drainage) and anthropogenic (urban pattern, soil cover, building types, occupation density, road conditions, infrastructure, drainage systems, distance between houses and slope, at the top and base, and the drainage channel). On the second step of this research, we identified the evidences of mass movements (scars, cracks, subsidence, trees, poles and inclined walls). Thus, on the basis of this analysis it was possible to define the risk probability: R1 (low or no risk), R2 (moderate), R3 (high) and, R4 (very high). Subsequently, by means of oblique photographs (taken from helicopter flight) it was possible to define risk areas in the basin. In all the sectors identified, were recorded approximately 903 urban settlements. The results showed that from the 25 sectors of risk, 14 sectors (56%) presented landslide risk and 11 (44%), flood risk. Of the sectors that showed landslide risk areas, 21% have very high probability (R4), 21% high (R3), 29% moderate (R2) and 29% low (R1). The sectors at flood risk presented 45% of very high probability (R4), 10% high (R3), 18% moderate (R2) and 27% low (R1). There is large presence of sediments from

  6. Persisting arthralgia due to Mayaro virus infection in a traveler from Brazil: is there a risk for attendants to the 2014 FIFA World Cup?

    PubMed

    Slegers, C A D; Keuter, M; Günther, S; Schmidt-Chanasit, J; van der Ven, A J; de Mast, Q

    2014-07-01

    The 2014 FIFA World Cup and the 2016 Olympic Games will attract large groups of visitors to Brazil. These visitors will be at risk for different arboviral infections, some of which not well known outside endemic areas. We report a case of a 52-year-old Dutch woman who presented with persistent arthralgia due to a Mayaro virus (MAYV) infection which she contracted in the Amazon basin in Brazil. MAYV is a mosquito-borne alphavirus which primarily circulates in humid tropical forests of South America. Infections are rarely reported in travelers and are characterized by an acute febrile illness which is often followed by a prolonged and sometimes incapacitating polyarthralgia. Both travelers and physicians should be aware of the risk of these arboviral infections and the importance of mosquito bite prevention should be stressed.

  7. Identical neural risk factors predict cognitive deficit in dyslexia and schizophrenia.

    PubMed

    Leonard, Christiana M; Kuldau, John M; Maron, Leeza; Ricciuti, Nikki; Mahoney, Bryan; Bengtson, Michael; DeBose, Cheryl

    2008-03-01

    In previous work, the authors found that an anatomical risk index created from the combination of 7 neuroanatomical measures predicted reading and oral language skills in individuals with learning disabilities. Individuals with small auditory brain structures and reduced asymmetry had more deficits than those with large structures and exaggerated asymmetry. In the present study, the same anatomical index predicted reading and other cognitive abilities in 45 individuals with chronic schizophrenia. The anatomical risk index was significantly associated with broad cognitive ability (Pearson r = .53, p < .0001), reading comprehension (r = .58, p < .0001), and a measure of nonverbal reasoning (r = .39, p < .01), but not with age, parental socioeconomic status, symptom measures, alcohol use, or processing speed. These findings support the prediction that reduced size and asymmetry in temporal lobe auditory cortex and cerebellum may not be specific risk factors for schizophrenia but for cognitive deficits that characterize a broad spectrum of developmental disorders.

  8. The importance of cardiovascular risk factors for thrombosis prediction in patients with essential thrombocythemia.

    PubMed

    Lekovic, Danijela; Gotic, Mirjana; Milic, Natasa; Miljic, Predrag; Mitrovic, Mirjana; Cokic, Vladan; Elezovic, Ivo

    2014-10-01

    The current widely accepted stratification defined by age and previous thrombosis in patients with essential thrombocythemia (ET) probably deserves deeper analysis. The aim of our study was to identify additional factors at the time of diagnosis, which have an impact on the thrombosis prediction. We conducted a study of 244 consecutive ET patients with median follow-up of 83 months. We analyzed the influence of age, gender, laboratory parameters, history of previous thrombosis, spleen size, JAK2 mutation as well as cardiovascular (CV) risk factors including arterial hypertension, diabetes, active tobacco use and hyperlipidemia in the terms of thrombosis. The most important predictors of thrombosis in multivariate Cox regression model were the presence of CV risk factors (p=0.004) and previous thrombosis (p=0.038). Accordingly, we assigned risk scores based on multivariable analysis-derived hazard ratios (HR) to the presence of 1 CV risk factor (HR=3.5; 1 point), >1 CV risk factors (HR=8.3; 2 points) and previous thrombosis (HR=2.0; 1 point). A final three-tiered prognostic model for thrombosis prediction was developed as low (score 0), intermediate (score 1 or 2) and high risk (score 3) (p<0.001). The hazard of thrombosis was 3.8% in low-risk group, 16.7% in the intermediate-risk group and 60% in the high-risk group (p<0.001). Patients with thrombotic complications during the follow-up had a significantly shorter survival (p=0.018). The new score based on CV risk factors and previous thrombotic events allows a better patient selection within prognostic-risk groups and improved identification of the high-risk patients for thrombosis.

  9. Sociodemographic and environmental risk factors for American cutaneous leishmaniasis (ACL) in the State of Alagoas, Brazil.

    PubMed

    Pedrosa, Fernando de Araújo; Ximenes, Ricardo Arraes de Alencar

    2009-08-01

    The multiplicity of factors involved in the transmission of the American cutaneous leishmaniasis (ACL) constitutes a challenge to its control. Thus, knowledge of such factors may contribute extremely toward redefining the control strategies. The aim of this study was to identify sociodemographic and environmental factors relating to ACL transmission in the State of Alagoas, Brazil. A case-control study with incident cases was conducted. Diagnostic criteria were the presence of compatible skin lesions, laboratory confirmation, and clinical cure after treatment. Two control groups were matched to cases by sex and age: one comprising neighbors and the other from a community-based draw; controls were individuals with no lesion and a negative Montenegro intradermal reaction. Between July 1, 2004 and February 1, 2007, 98 cases and the same number of controls per group were selected. In the multivariate analysis, for both control groups, ACL was associated with absence of a gas stove and forest less than 200 m away; for neighborhood controls with schooling of 4 years or less, family income greater than one minimum salary, birds inside the home, forest-related leisure activities, and rural work or school activities; and for community controls with non-durable wall material in the house, per capita income greater than US$ 28.31, animals inside the house, and absence of dogs and cats around the house. Specific control measures are recommended for areas with similar characteristics: protection for individuals undertaking forest-related leisure activities; distancing houses from forests by more than 200 m; and elimination of bird or other animal-rearing inside homes. General measures of improved housing and living conditions are also recommended.

  10. Statistical innovations improve prevalence estimates of nutrient risk populations: applications in São Paulo, Brazil.

    PubMed

    Morimoto, Juliana Masami; Marchioni, Dirce Maria Lobo; Cesar, Chester Luiz Galvão; Fisberg, Regina Mara

    2012-10-01

    The objective of this study was to estimate the prevalence of inadequate micronutrient intake and excess sodium intake among adults age 19 years and older in the city of São Paulo, Brazil. Twenty-four-hour dietary recall and sociodemographic data were collected from each participant (n=1,663) in a cross-sectional study, Inquiry of Health of São Paulo, of a representative sample of the adult population of the city of São Paulo in 2003 (ISA-2003). The variability in intake was measured through two replications of the 24-hour recall in a subsample of this population in 2007 (ISA-2007). Usual intake was estimated by the PC-SIDE program (version 1.0, 2003, Department of Statistics, Iowa State University), which uses an approach developed by Iowa State University. The prevalence of nutrient inadequacy was calculated using the Estimated Average Requirement cut-point method for vitamins A and C, thiamin, riboflavin, niacin, copper, phosphorus, and selenium. For vitamin D, pantothenic acid, manganese, and sodium, the proportion of individuals with usual intake equal to or more than the Adequate Intake value was calculated. The percentage of individuals with intake equal to more than the Tolerable Upper Intake Level was calculated for sodium. The highest prevalence of inadequacy for males and females, respectively, occurred for vitamin A (67% and 58%), vitamin C (52% and 62%), thiamin (41% and 50%), and riboflavin (29% and 19%). The adjustment for the within-person variation presented lower prevalence of inadequacy due to removal of within-person variability. All adult residents of São Paulo had excess sodium intake, and the rates of nutrient inadequacy were high for certain key micronutrients.

  11. An agro-climatic approach to determine citrus postbloom fruit drop risk in Southern Brazil

    NASA Astrophysics Data System (ADS)

    Soares-Colletti, Ana R.; Alvares, Clayton A.; Sentelhas, Paulo C.

    2016-06-01

    Postbloom fruit drop (PFD) causes lesions on the petals of citrus flowers and induces fruit abscission causing severe damage to production when the flowering period coincides with intense rainfall. The aims of this study were to develop a phenological-climatological model for citrus PFD occurrence and, together with weather data series from several locations, to determine and map the agro-climatic favorability of PFD occurrence in the state of São Paulo, Southern Brazil. A phenological flowering model was developed to identify when citrus flowering occurs. The flowering starts after when a temperature below 10 °C in the months of June or July is reached followed by cumulative rainfall within 5 days of at least 20 mm, and then 96 °C days. Between the beginning of flowering and its peak, 147 °C days are required, and between the peak and its end, approximately 229 °C days, being 206 °C days from the peak to the moment when flowers remaining are about 50 % of total. The relationship between PFD incidence and accumulated rainfall during the critical period (between flowering peak and 50 % of flowers remaining) was adjusted by the Gompertz model ( R 2 = 0.99, p < 0.05). After its validation, this model was used to estimate PFD incidence for 29 locations in the state, from 1993 to 2013, which allowed to map the PFD climatic favorability for the state through a Geographical Information System using linear models based on latitude, longitude, and altitude. The obtained map showed a trend of PFD incidence increasing from the northwest of the state of São Paulo towards the south and the coastal region, with medium to very high favorability in the center of the state. The results of this study can be used by growers as a guide for disease control planning as well as for defining the regions where the climatic conditions are likely to escape this disease.

  12. An Empiric HIV Risk Scoring Tool to Predict HIV-1 Acquisition in African Women

    PubMed Central

    Brown, Elizabeth; Palanee, Thesla; Nair, Gonasagrie; Gafoor, Zakir; Zhang, Jingyang; Richardson, Barbra A.; Chirenje, Zvavahera M.; Marrazzo, Jeanne M.; Baeten, Jared M.

    2016-01-01

    Objective: To develop and validate an HIV risk assessment tool to predict HIV acquisition among African women. Design: Data were analyzed from 3 randomized trials of biomedical HIV prevention interventions among African women (VOICE, HPTN 035, and FEM-PrEP). Methods: We implemented standard methods for the development of clinical prediction rules to generate a risk-scoring tool to predict HIV acquisition over the course of 1 year. Performance of the score was assessed through internal and external validations. Results: The final risk score resulting from multivariable modeling included age, married/living with a partner, partner provides financial or material support, partner has other partners, alcohol use, detection of a curable sexually transmitted infection, and herpes simplex virus 2 serostatus. Point values for each factor ranged from 0 to 2, with a maximum possible total score of 11. Scores ≥5 were associated with HIV incidence >5 per 100 person-years and identified 91% of incident HIV infections from among only 64% of women. The area under the curve (AUC) for predictive ability of the score was 0.71 (95% confidence interval [CI]: 0.68 to 0.74), indicating good predictive ability. Risk score performance was generally similar with internal cross-validation (AUC = 0.69; 95% CI: 0.66 to 0.73) and external validation in HPTN 035 (AUC = 0.70; 95% CI: 0.65 to 0.75) and FEM-PrEP (AUC = 0.58; 95% CI: 0.51 to 0.65). Conclusions: A discrete set of characteristics that can be easily assessed in clinical and research settings was predictive of HIV acquisition over 1 year. The use of a validated risk score could improve efficiency of recruitment into HIV prevention research and inform scale-up of HIV prevention strategies in women at highest risk. PMID:26918545

  13. Predictive Validity of Pressure Ulcer Risk Assessment Tools for Elderly: A Meta-Analysis.

    PubMed

    Park, Seong-Hi; Lee, Young-Shin; Kwon, Young-Mi

    2016-04-01

    Preventing pressure ulcers is one of the most challenging goals existing for today's health care provider. Currently used tools which assess risk of pressure ulcer development rarely evaluate the accuracy of predictability, especially in older adults. The current study aimed at providing a systemic review and meta-analysis of 29 studies using three pressure ulcer risk assessment tools: Braden, Norton, and Waterlow Scales. Overall predictive validities of pressure ulcer risks in the pooled sensitivity and specificity indicated a similar range with a moderate accuracy level in all three scales, while heterogeneity showed more than 80% variability among studies. The studies applying the Braden Scale used five different cut-off points representing the primary cause of heterogeneity. Results indicate that commonly used screening tools for pressure ulcer risk have limitations regarding validity and accuracy for use with older adults due to heterogeneity among studies.

  14. Applying Social Psychological Models to Predicting HIV-Related Sexual Risk Behaviors Among African Americans.

    PubMed

    Cochran, Susan D; Mays, Vickie M

    1993-05-01

    Existing models of attitude-behavior relationships, including the Health Belief Model, the Theory of Reasoned Action, and the Self-Efficacy Theory, are increasingly being used by psychologists to predict human immunodeficiency virus (HIV)-related risk behaviors. The authors briefly highlight some of the difficulties that might arise in applying these models to predicting the risk behaviors of African Americans. These social psychological models tend to emphasize the importance of individualistic, direct control of behavioral choices and deemphasize factors, such as racism and poverty, particularly relevant to that segment of the African American population most at risk for HIV infection. Applications of these models without taking into account the unique issues associated with behavioral choices within the African American community may fail to capture the relevant determinants of risk behaviors.

  15. Learning to Predict Post-Hospitalization VTE Risk from EHR Data

    PubMed Central

    Kawaler, Emily; Cobian, Alexander; Peissig, Peggy; Cross, Deanna; Yale, Steve; Craven, Mark

    2012-01-01

    We consider the task of predicting which patients are most at risk for post-hospitalization venothromboembolism (VTE) using information automatically elicited from an EHR. Given a set of cases and controls, we use machine-learning methods to induce models for making these predictions. Our empirical evaluation of this approach offers a number of interesting and important conclusions. We identify several risk factors for VTE that were not previously recognized. We show that machine-learning methods are able to induce models that identify high-risk patients with accuracy that exceeds previously developed scoring models for VTE. Additionally, we show that, even without having prior knowledge about relevant risk factors, we are able to learn accurate models for this task. PMID:23304314

  16. Developing and validating risk prediction models in an individual participant data meta-analysis

    PubMed Central

    2014-01-01

    Background Risk prediction models estimate the risk of developing future outcomes for individuals based on one or more underlying characteristics (predictors). We review how researchers develop and validate risk prediction models within an individual participant data (IPD) meta-analysis, in order to assess the feasibility and conduct of the approach. Methods A qualitative review of the aims, methodology, and reporting in 15 articles that developed a risk prediction model using IPD from multiple studies. Results The IPD approach offers many opportunities but methodological challenges exist, including: unavailability of requested IPD, missing patient data and predictors, and between-study heterogeneity in methods of measurement, outcome definitions and predictor effects. Most articles develop their model using IPD from all available studies and perform only an internal validation (on the same set of data). Ten of the 15 articles did not allow for any study differences in baseline risk (intercepts), potentially limiting their model’s applicability and performance in some populations. Only two articles used external validation (on different data), including a novel method which develops the model on all but one of the IPD studies, tests performance in the excluded study, and repeats by rotating the omitted study. Conclusions An IPD meta-analysis offers unique opportunities for risk prediction research. Researchers can make more of this by allowing separate model intercept terms for each study (population) to improve generalisability, and by using ‘internal-external cross-validation’ to simultaneously develop and validate their model. Methodological challenges can be reduced by prospectively planned collaborations that share IPD for risk prediction. PMID:24397587

  17. Framingham Coronary Heart Disease Risk Score Can be Predicted from Structural Brain Images in Elderly Subjects

    PubMed Central

    Rondina, Jane Maryam; Squarzoni, Paula; Souza-Duran, Fabio Luis; Tamashiro-Duran, Jaqueline Hatsuko; Scazufca, Marcia; Menezes, Paulo Rossi; Vallada, Homero; Lotufo, Paulo A.; de Toledo Ferraz Alves, Tania Correa; Busatto Filho, Geraldo

    2014-01-01

    Recent literature has presented evidence that cardiovascular risk factors (CVRF) play an important role on cognitive performance in elderly individuals, both those who are asymptomatic and those who suffer from symptoms of neurodegenerative disorders. Findings from studies applying neuroimaging methods have increasingly reinforced such notion. Studies addressing the impact of CVRF on brain anatomy changes have gained increasing importance, as recent papers have reported gray matter loss predominantly in regions traditionally affected in Alzheimer’s disease (AD) and vascular dementia in the presence of a high degree of cardiovascular risk. In the present paper, we explore the association between CVRF and brain changes using pattern recognition techniques applied to structural MRI and the Framingham score (a composite measure of cardiovascular risk largely used in epidemiological studies) in a sample of healthy elderly individuals. We aim to answer the following questions: is it possible to decode (i.e., to learn information regarding cardiovascular risk from structural brain images) enabling individual predictions? Among clinical measures comprising the Framingham score, are there particular risk factors that stand as more predictable from patterns of brain changes? Our main findings are threefold: (i) we verified that structural changes in spatially distributed patterns in the brain enable statistically significant prediction of Framingham scores. This result is still significant when controlling for the presence of the APOE 4 allele (an important genetic risk factor for both AD and cardiovascular disease). (ii) When considering each risk factor singly, we found different levels of correlation between real and predicted factors; however, single factors were not significantly predictable from brain images when considering APOE4 allele presence as covariate. (iii) We found important gender differences, and the possible causes of that finding are discussed. PMID

  18. Risk Prediction of One-Year Mortality in Patients with Cardiac Arrhythmias Using Random Survival Forest

    PubMed Central

    Miao, Fen; Cai, Yun-Peng; Zhang, Yu-Xiao; Li, Ye; Zhang, Yuan-Ting

    2015-01-01

    Existing models for predicting mortality based on traditional Cox proportional hazard approach (CPH) often have low prediction accuracy. This paper aims to develop a clinical risk model with good accuracy for predicting 1-year mortality in cardiac arrhythmias patients using random survival forest (RSF), a robust approach for survival analysis. 10,488 cardiac arrhythmias patients available in the public MIMIC II clinical database were investigated, with 3,452 deaths occurring within 1-year followups. Forty risk factors including demographics and clinical and laboratory information and antiarrhythmic agents were analyzed as potential predictors of all-cause mortality. RSF was adopted to build a comprehensive survival model and a simplified risk model composed of 14 top risk factors. The built comprehensive model achieved a prediction accuracy of 0.81 measured by c-statistic with 10-fold cross validation. The simplified risk model also achieved a good accuracy of 0.799. Both results outperformed traditional CPH (which achieved a c-statistic of 0.733 for the comprehensive model and 0.718 for the simplified model). Moreover, various factors are observed to have nonlinear impact on cardiac arrhythmias prognosis. As a result, RSF based model which took nonlinearity into account significantly outperformed traditional Cox proportional hazard model and has great potential to be a more effective approach for survival analysis. PMID:26379761

  19. Risk Prediction of One-Year Mortality in Patients with Cardiac Arrhythmias Using Random Survival Forest.

    PubMed

    Miao, Fen; Cai, Yun-Peng; Zhang, Yu-Xiao; Li, Ye; Zhang, Yuan-Ting

    2015-01-01

    Existing models for predicting mortality based on traditional Cox proportional hazard approach (CPH) often have low prediction accuracy. This paper aims to develop a clinical risk model with good accuracy for predicting 1-year mortality in cardiac arrhythmias patients using random survival forest (RSF), a robust approach for survival analysis. 10,488 cardiac arrhythmias patients available in the public MIMIC II clinical database were investigated, with 3,452 deaths occurring within 1-year followups. Forty risk factors including demographics and clinical and laboratory information and antiarrhythmic agents were analyzed as potential predictors of all-cause mortality. RSF was adopted to build a comprehensive survival model and a simplified risk model composed of 14 top risk factors. The built comprehensive model achieved a prediction accuracy of 0.81 measured by c-statistic with 10-fold cross validation. The simplified risk model also achieved a good accuracy of 0.799. Both results outperformed traditional CPH (which achieved a c-statistic of 0.733 for the comprehensive model and 0.718 for the simplified model). Moreover, various factors are observed to have nonlinear impact on cardiac arrhythmias prognosis. As a result, RSF based model which took nonlinearity into account significantly outperformed traditional Cox proportional hazard model and has great potential to be a more effective approach for survival analysis.

  20. The Risk GP Model: the standard model of prediction in medicine.

    PubMed

    Fuller, Jonathan; Flores, Luis J

    2015-12-01

    With the ascent of modern epidemiology in the Twentieth Century came a new standard model of prediction in public health and clinical medicine. In this article, we describe the structure of the model. The standard model uses epidemiological measures-most commonly, risk measures-to predict outcomes (prognosis) and effect sizes (treatment) in a patient population that can then be transformed into probabilities for individual patients. In the first step, a risk measure in a study population is generalized or extrapolated to a target population. In the second step, the risk measure is particularized or transformed to yield probabilistic information relevant to a patient from the target population. Hence, we call the approach the Risk Generalization-Particularization (Risk GP) Model. There are serious problems at both stages, especially with the extent to which the required assumptions will hold and the extent to which we have evidence for the assumptions. Given that there are other models of prediction that use different assumptions, we should not inflexibly commit ourselves to one standard model. Instead, model pluralism should be standard in medical prediction.

  1. Comparison of time series models for predicting campylobacteriosis risk in New Zealand.

    PubMed

    Al-Sakkaf, A; Jones, G

    2014-05-01

    Predicting campylobacteriosis cases is a matter of considerable concern in New Zealand, after the number of the notified cases was the highest among the developed countries in 2006. Thus, there is a need to develop a model or a tool to predict accurately the number of campylobacteriosis cases as the Microbial Risk Assessment Model used to predict the number of campylobacteriosis cases failed to predict accurately the number of actual cases. We explore the appropriateness of classical time series modelling approaches for predicting campylobacteriosis. Finding the most appropriate time series model for New Zealand data has additional practical considerations given a possible structural change, that is, a specific and sudden change in response to the implemented interventions. A univariate methodological approach was used to predict monthly disease cases using New Zealand surveillance data of campylobacteriosis incidence from 1998 to 2009. The data from the years 1998 to 2008 were used to model the time series with the year 2009 held out of the data set for model validation. The best two models were then fitted to the full 1998-2009 data and used to predict for each month of 2010. The Holt-Winters (multiplicative) and ARIMA (additive) intervention models were considered the best models for predicting campylobacteriosis in New Zealand. It was noticed that the prediction by an additive ARIMA with intervention was slightly better than the prediction by a Holt-Winter multiplicative method for the annual total in year 2010, the former predicting only 23 cases less than the actual reported cases. It is confirmed that classical time series techniques such as ARIMA with intervention and Holt-Winters can provide a good prediction performance for campylobacteriosis risk in New Zealand. The results reported by this study are useful to the New Zealand Health and Safety Authority's efforts in addressing the problem of the campylobacteriosis epidemic. PMID:23551848

  2. Predicting crash risk and identifying crash precursors on Korean expressways using loop detector data.

    PubMed

    Kwak, Ho-Chan; Kho, Seungyoung

    2016-03-01

    In order to improve traffic safety on expressways, it is important to develop proactive safety management strategies with consideration for segment types and traffic flow states because crash mechanisms have some differences by each condition. The primary objective of this study is to develop real-time crash risk prediction models for different segment types and traffic flow states on expressways. The mainline of expressways is divided into basic segment and ramp vicinity, and the traffic flow states are classified into uncongested and congested conditions. Also, Korean expressways have irregular intervals between loop detector stations. Therefore, we investigated on the effect and application of the detector stations at irregular intervals for the crash risk prediction on expressways. The most significant traffic variables were selected by conditional logistic regression analysis which could control confounding factors. Based on the selected traffic variables, separate models to predict crash risk were developed using genetic programming technique. The model estimation results showed that the traffic flow characteristics leading to crashes are differed by segment type and traffic flow state. Especially, the variables related to the intervals between detector stations had a significant influence on crash risk prediction under the uncongested condition. Finally, compared with the single model for all crashes and the logistic models used in previous studies, the proposed models showed higher prediction performance. The results of this study can be applied to develop more effective proactive safety management strategies for different segment types and traffic flow states on expressways with loop detector stations at irregular intervals. PMID:26710266

  3. Predicting crash risk and identifying crash precursors on Korean expressways using loop detector data.

    PubMed

    Kwak, Ho-Chan; Kho, Seungyoung

    2016-03-01

    In order to improve traffic safety on expressways, it is important to develop proactive safety management strategies with consideration for segment types and traffic flow states because crash mechanisms have some differences by each condition. The primary objective of this study is to develop real-time crash risk prediction models for different segment types and traffic flow states on expressways. The mainline of expressways is divided into basic segment and ramp vicinity, and the traffic flow states are classified into uncongested and congested conditions. Also, Korean expressways have irregular intervals between loop detector stations. Therefore, we investigated on the effect and application of the detector stations at irregular intervals for the crash risk prediction on expressways. The most significant traffic variables were selected by conditional logistic regression analysis which could control confounding factors. Based on the selected traffic variables, separate models to predict crash risk were developed using genetic programming technique. The model estimation results showed that the traffic flow characteristics leading to crashes are differed by segment type and traffic flow state. Especially, the variables related to the intervals between detector stations had a significant influence on crash risk prediction under the uncongested condition. Finally, compared with the single model for all crashes and the logistic models used in previous studies, the proposed models showed higher prediction performance. The results of this study can be applied to develop more effective proactive safety management strategies for different segment types and traffic flow states on expressways with loop detector stations at irregular intervals.

  4. Separate and interactive contributions of weak inhibitory control and threat sensitivity to prediction of suicide risk.

    PubMed

    Venables, Noah C; Sellbom, Martin; Sourander, Andre; Kendler, Kenneth S; Joiner, Thomas E; Drislane, Laura E; Sillanmäki, Lauri; Elonheimo, Henrik; Parkkola, Kai; Multimaki, Petteri; Patrick, Christopher J

    2015-04-30

    Biobehavioral dispositions can serve as valuable referents for biologically oriented research on core processes with relevance to many psychiatric conditions. The present study examined two such dispositional variables-weak response inhibition (or disinhibition; INH-) and threat sensitivity (or fearfulness; THT+)-as predictors of the serious transdiagnostic problem of suicide risk in two samples: male and female outpatients from a U.S. clinic (N=1078), and a population-based male military cohort from Finland (N=3855). INH- and THT+ were operationalized through scores on scale measures of disinhibition and fear/fearlessness, known to be related to DSM-defined clinical conditions and brain biomarkers. Suicide risk was assessed by clinician ratings (clinic sample) and questionnaires (both samples). Across samples and alternative suicide indices, INH- and THT+ each contributed uniquely to prediction of suicide risk-beyond internalizing and externalizing problems in the case of the clinic sample where diagnostic data were available. Further, in both samples, INH- and THT+ interactively predicted suicide risk, with individuals scoring concurrently high on both dispositions exhibiting markedly augmented risk. Findings demonstrate that dispositional constructs of INH- and THT+ are predictive of suicide risk, and hold potential as referents for biological research on suicidal behavior. PMID:25712631

  5. Risk factors associated with an outbreak of dengue fever in a favela in Fortaleza, north-east Brazil.

    PubMed

    Heukelbach, J; de Oliveira, F A; Kerr-Pontes, L R; Feldmeier, H

    2001-08-01

    To increase the effectiveness of ongoing anti-dengue control measures, we conducted a case-control study in a favela in Fortaleza (north-east Brazil) during an outbreak of dengue fever. Cases were defined according to the national guidelines for dengue control as well as based on the detection of IgM-dengue antibodies, and 34 cases and 34 controls were investigated. Significant risk factors were: living in a street perpendicular to the beach on which the favela is situated (P < 0.0001), an interval > 30 days since the last visit of the vector control agent (P=0.001), receptacles in the garden or courtyard (P=0.001), plants with temporary water pools on the property, gutter to collect rainwater, uncovered water storage container (all P=0.02), and no waste collection (P=0.03). Socio-economic variables were not associated with dengue fever. The probable starting point of the epidemic was an uncovered water tank on the roof of the house adjacent to the index case. From there, the outbreak spread uphill parallel to the prevailing direction of the wind. Thus, the chronological and spatial evolution of the epidemic could have been forecast after the first cases had occurred. This example of investigative epidemiology in an operational setting shows that targeted intervention leading to increased effectiveness of control measures is possible.

  6. Serological survey and risk factors for brucellosis in water buffaloes in the state of Pará, Brazil.

    PubMed

    da Silva, Jenevaldo Barbosa; Rangel, Charles Passos; da Fonseca, Adivaldo Henrique; de Morais, Eziquiel; Vinhote, Wagner Marcelo Souza; da Silva Lima, Danillo Henrique; da Silva e Silva, Natália; Barbosa, José Diomedes

    2014-02-01

    To evaluate the prevalence and possible risk factors for brucellosis caused by Brucella abortus in water buffaloes in the state of Pará, Brazil, 3,917 female buffalo serum samples from pregnant and non-pregnant animals were examined: 2,809 from Marajó Island and 1,108 from the mainland. The buffered acidified plate antigen (BAPA) screening test positively diagnosed 4.8% (188/3,917) of the animals with brucellosis, and the 2-mercaptoethanol (2-ME) confirmatory test affirmed 95.7% (180/188) of the results. The brucellosis prevalence was 4.17 times greater in mainland animals than on Marajó Island, with the highest prevalence in Tailândia (11.30%) and Paragominas (12.38%). Brucellosis seroprevalence was significantly influenced (p < 0.05) by reproductive status, with pregnant females being most vulnerable. These results demonstrate that brucellosis infection is active in the Brazilian region containing the largest buffalo population and that this disease poses a threat to public health and buffalo production in Pará.

  7. Family food insecurity and nutritional risk in adolescents from a low-income area of Rio de Janeiro, Brazil.

    PubMed

    Lopes, Taís S; Sichieri, Rosely; Salles-Costa, Rosana; Veiga, Gloria V; Pereira, Rosangela A

    2013-09-01

    The study objective was to analyse the association between food insecurity and the weight and height status of adolescents from a low-income area in the metropolitan region of Rio de Janeiro, Brazil. The population-based cross-sectional survey included 523 adolescents aged 12-18 years, selected by a three-stage cluster sample. Dietary intake was ascertained with a food frequency questionnaire and family food insecurity was assessed with a validated questionnaire. The analysis estimated weighted means of energy and nutrient intakes by families' socioeconomic characteristics and the association between dietary intake with overweight and stunting. The prevalence of mild family food insecurity was 36%, and 24% of the families reported moderate or severe food insecurity. Overweight prevalence was 24%, and the prevalence of stunting was 9%, with no significant differences between sex or age groups. Family food insecurity was associated with unfavourable socioeconomic characteristics, but there was no association between socioeconomic characteristics (including family food insecurity) and overweight or stunting. Moderate or severe family food insecurity was inversely associated with intake of protein and calcium. In addition, stunting was associated with low calcium and iron intake. The co-existence of family food insecurity with overweight and stunting implies a high nutritional risk for adolescents from poor areas of Rio de Janeiro. Nevertheless, the observed absence of a statistical association between family food insecurity and weight status attests to the complexity of this issue.

  8. INCIDENCE DENSITY, PROPORTIONATE MORTALITY, AND RISK FACTORS OF ASPERGILLOSIS IN MAGELLANIC PENGUINS IN A REHABILITATION CENTER FROM BRAZIL.

    PubMed

    Silva Filho, Rodolfo Pinho da; Xavier, Melissa Orzechowski; Martins, Aryse Moreira; Ruoppolo, Valéria; Mendoza-Sassi, Raúl Andrés; Adornes, Andréa Corrado; Cabana, Ângela Leitzke; Meireles, Mário Carlos Araújo

    2015-12-01

    Aspergillosis, an opportunistic mycosis caused by the Aspergillus genus, affects mainly the respiratory system and is considered one of the most significant causes of mortality in captive penguins. This study aimed to examine a 6-yr period of cases of aspergillosis in penguins at the Centro de Recuperação de Animais Marinhos (CRAM-FURG), Rio Grande, Brazil. A retrospective cohort study was conducted using the institution's records of penguins received from January 2004 to December 2009. Animals were categorized according to the outcome "aspergillosis," and analyzed by age group, sex, oil fouling, origin, prophylactic administration of itraconazole, period in captivity, body mass, hematocrit, and total plasma proteins. A total of 327 Magellanic penguins (Spheniscus magellanicus) was studied, 66 of which died of aspergillosis. Proportionate mortality by aspergillosis was 48.5%, and incidence density was 7.3 lethal aspergillosis cases per 100 penguins/mo. Approximately 75% of the aspergillosis cases occurred in penguins that had been transferred from other rehabilitation centers, and this was considered a significant risk factor for the disease. Significant differences were also observed between the groups in regard to the period of time spent in captivity until death, hematocrit and total plasma proteins upon admission to the center, and body mass gain during the period in captivity. The findings demonstrate the negative impacts of aspergillosis on the rehabilitation of Magellanic penguins, with a high incidence density and substantial mortality.

  9. Tubal ligation regret and related risk factors: findings from a case-control study in Pernambuco State, Brazil.

    PubMed

    Ludermir, Ana Bernarda; Machado, Kátia Maria de Melo; Costa, Aurélio Molina da; Alves, Sandra Valongueiro; Araújo, Thália Velho Barreto de

    2009-06-01

    A case-control study was carried out at a public teaching hospital in Recife, Pernambuco State, Brazil in 1997 to investigate risk factors among women who feel regret after undergoing sterilization through tubal ligation. The study compared sterilized women who had requested or undergone a tubal reversal with women who were also sterilized but had not undergone this surgery, nor had requested to do so. Women showing a significantly greater probability of regret were those sterilized at a young age, those who had not themselves made the decision to undergo surgery , those for whom the sterilization was carried out up to the 45th day after childbirth and those who had acquired knowledge about contraceptive methods after the tubal ligation procedure. Having had a deceased child, a partner with no children prior to the current union or a change of partner after the tubal sterilization procedure were also associated to the request for or submission to tubal sterilization reversal. It is necessary to assess women's psycho-socio-demographic profiles, their reasons for requesting tubal ligation and to advise the patient about family planning in order to reduce rates of post-sterilization regret.

  10. INCIDENCE DENSITY, PROPORTIONATE MORTALITY, AND RISK FACTORS OF ASPERGILLOSIS IN MAGELLANIC PENGUINS IN A REHABILITATION CENTER FROM BRAZIL.

    PubMed

    Silva Filho, Rodolfo Pinho da; Xavier, Melissa Orzechowski; Martins, Aryse Moreira; Ruoppolo, Valéria; Mendoza-Sassi, Raúl Andrés; Adornes, Andréa Corrado; Cabana, Ângela Leitzke; Meireles, Mário Carlos Araújo

    2015-12-01

    Aspergillosis, an opportunistic mycosis caused by the Aspergillus genus, affects mainly the respiratory system and is considered one of the most significant causes of mortality in captive penguins. This study aimed to examine a 6-yr period of cases of aspergillosis in penguins at the Centro de Recuperação de Animais Marinhos (CRAM-FURG), Rio Grande, Brazil. A retrospective cohort study was conducted using the institution's records of penguins received from January 2004 to December 2009. Animals were categorized according to the outcome "aspergillosis," and analyzed by age group, sex, oil fouling, origin, prophylactic administration of itraconazole, period in captivity, body mass, hematocrit, and total plasma proteins. A total of 327 Magellanic penguins (Spheniscus magellanicus) was studied, 66 of which died of aspergillosis. Proportionate mortality by aspergillosis was 48.5%, and incidence density was 7.3 lethal aspergillosis cases per 100 penguins/mo. Approximately 75% of the aspergillosis cases occurred in penguins that had been transferred from other rehabilitation centers, and this was considered a significant risk factor for the disease. Significant differences were also observed between the groups in regard to the period of time spent in captivity until death, hematocrit and total plasma proteins upon admission to the center, and body mass gain during the period in captivity. The findings demonstrate the negative impacts of aspergillosis on the rehabilitation of Magellanic penguins, with a high incidence density and substantial mortality. PMID:26667521

  11. A study of multidrug-resistant tuberculosis in risk groups in the city of Santos, São Paulo, Brazil.

    PubMed

    Coelho, Andréa Gobetti Vieira; Zamarioli, Liliana Aparecida; Telles, Maria Alice; Ferrazoli, Lucilaine; Waldman, Eliseu Alves

    2012-09-01

    Monitoring the extent of and trends in multidrug-resistant tuberculosis (MDR-TB) is a priority of the Brazilian National Tuberculosis Control Programme. The current study aimed to estimate the incidence of MDR-TB, describe the profile of TB drug resistance in risk groups and examine whether screening for MDR-TB adhered to the recommended guidelines. A descriptive study that examined diagnosed cases of pulmonary TB was conducted in the city of Santos, Brazil, between 2000-2004. Of the 2,176 pulmonary TB cases studied, 671 (30.8%) met the criteria for drug sensitivity testing and, of these cases, 31.7% (213/671) were tested. Among the tested cases, 9.4% were resistant to one anti-TB drug and 15% were MDR. MDR was observed in 11.6% of 86 new TB cases and 17.3% of 127 previously treated cases. The average annual incidence of MDR-TB was 1.9 per 100,000 inhabitants-years. The extent of known MDR-TB in the city of Santos is high, though likely to be underestimated. Our study therefore indicates an inadequate adherence to the guidelines for MDR-TB screening and suggests the necessity of alternative strategies of MDR-TB surveillance.

  12. Risk factors associated with toxoplasmosis and toxocariasis in populations of children from nine cities in southern Brazil.

    PubMed

    Marchioro, A A; Colli, C M; Ferreira, É C; Viol, B M; Araújo, S M; Falavigna-Guilherme, A L

    2015-07-01

    This study investigated the epidemiological factors that contribute to the seroprevalence of Toxoplasma gondii and Toxocara spp. in children from Paraná state, Brazil. Immunoglobulin G (IgG) antibodies to T. gondii were detected using indirect immunofluorescence, and IgG antibodies to Toxocara were detected using an enzyme-linked immunosorbent assay. For each individual, a questionnaire was completed that contained epidemiological and clinical data. The data analysis was performed using multiple logistic regression. Of the 544 children investigated, 3.2% presented co-infection with T. gondii and Toxocara spp. Of this total, 7.4% were positive for antibodies to T. gondii, and 25% were positive for antibodies to Toxocara spp. The presence of antibodies to Toxocara spp. increased the risk of T. gondii infection (P = 0.029). Children who were 1-8 years of age were less infected by T. gondii than those who were 9-12 years of age. The variables that influenced positivity for anti-Toxocara spp. were the origin of the children and contact with sand. Children with positive serology for Toxocara spp. presented more eosinophilia compared with those with non-reactive serology. Infection with both parasites reveals the need for preventive measures, such as guidance about modes of infection, parasite control and monitoring recreational areas. PMID:24725417

  13. Association between vehicular emissions and cardiorespiratory disease risk in Brazil and its variation by spatial clustering of socio-economic factors.

    PubMed

    Requia, Weeberb J; Koutrakis, Petros; Roig, Henrique L; Adams, Matthew D; Santos, Cleide M

    2016-10-01

    Many studies have suggested that socio-economic factors are strong modifiers of human vulnerability to air pollution effects. Most of these studies were performed in developed countries, specifically in the US and Europe. Only a few studies have been performed in developing countries, and analyzed small regions (city level) with no spatial disaggregation. The aim of this study was to assess the association between vehicle emissions and cardiorespiratory disease risk in Brazil and its modification by spatial clustering of socio-economic conditions. We used a quantile regression model to estimate the risk and a geostatistical approach (K means) to execute spatial cluster analysis. We performed the risk analysis in three stages. First, we analyzed the entire study area (primary analysis), and then we conducted a spatial cluster analysis based on various municipal-level socio-economic factors, followed by a sensitivity analysis. We studied 5444 municipalities in Brazil between 2008 and 2012. Our findings showed a significant association between cardiorespiratory disease risk and vehicular emissions. We found that a 15% increase in air pollution is associated with a 6% increase in hospital admissions rates. The results from the spatial cluster analysis revealed two groups of municipalities with distinct sets of socio-economic factors and risk levels of cardiorespiratory disease related to exposure to vehicular emissions. For example, for vehicle emissions of PM in 2008, we found a relative risk of 4.18 (95% CI: 3.66, 4.93) in the primary analysis; in Group 1, the risk was 0.98 (95% CI: 0.10, 2.05) while in Group 2, the risk was 5.56 (95% CI: 4.46, 6.25). The risk in Group 2 was 480% higher than the risk in Group 1, and 35% higher than the risk in the primary analysis. Group 1 had higher values (3rd quartile) for urbanization rate, highway density, and GDP; very high values (≥3rd quartile) for population density; median values for distance from the capital; and lower

  14. Association between vehicular emissions and cardiorespiratory disease risk in Brazil and its variation by spatial clustering of socio-economic factors.

    PubMed

    Requia, Weeberb J; Koutrakis, Petros; Roig, Henrique L; Adams, Matthew D; Santos, Cleide M

    2016-10-01

    Many studies have suggested that socio-economic factors are strong modifiers of human vulnerability to air pollution effects. Most of these studies were performed in developed countries, specifically in the US and Europe. Only a few studies have been performed in developing countries, and analyzed small regions (city level) with no spatial disaggregation. The aim of this study was to assess the association between vehicle emissions and cardiorespiratory disease risk in Brazil and its modification by spatial clustering of socio-economic conditions. We used a quantile regression model to estimate the risk and a geostatistical approach (K means) to execute spatial cluster analysis. We performed the risk analysis in three stages. First, we analyzed the entire study area (primary analysis), and then we conducted a spatial cluster analysis based on various municipal-level socio-economic factors, followed by a sensitivity analysis. We studied 5444 municipalities in Brazil between 2008 and 2012. Our findings showed a significant association between cardiorespiratory disease risk and vehicular emissions. We found that a 15% increase in air pollution is associated with a 6% increase in hospital admissions rates. The results from the spatial cluster analysis revealed two groups of municipalities with distinct sets of socio-economic factors and risk levels of cardiorespiratory disease related to exposure to vehicular emissions. For example, for vehicle emissions of PM in 2008, we found a relative risk of 4.18 (95% CI: 3.66, 4.93) in the primary analysis; in Group 1, the risk was 0.98 (95% CI: 0.10, 2.05) while in Group 2, the risk was 5.56 (95% CI: 4.46, 6.25). The risk in Group 2 was 480% higher than the risk in Group 1, and 35% higher than the risk in the primary analysis. Group 1 had higher values (3rd quartile) for urbanization rate, highway density, and GDP; very high values (≥3rd quartile) for population density; median values for distance from the capital; and lower

  15. Space Weather Influence on Power Systems: Prediction, Risk Analysis, and Modeling

    NASA Astrophysics Data System (ADS)

    Yatsenko, Vitaliy

    2016-04-01

    This report concentrates on dynamic probabilistic risk analysis of optical elements for complex characterization of damages using physical model of solid state lasers and predictable level of ionizing radiation and space weather. The following main subjects will be covered by our report: (a) solid-state laser model; (b) mathematical models for dynamic probabilistic risk assessment; and (c) software for modeling and prediction of ionizing radiation. A probabilistic risk assessment method for solid-state lasers is presented with consideration of some deterministic and stochastic factors. Probabilistic risk assessment is a comprehensive, structured, and logical analysis method aimed at identifying and assessing risks in solid-state lasers for the purpose of cost-e®ectively improving their safety and performance. This method based on the Conditional Value-at-Risk measure (CVaR) and the expected loss exceeding Value-at-Risk (VaR). We propose to use a new dynamical-information approach for radiation damage risk assessment of laser elements by cosmic radiation. Our approach includes the following steps: laser modeling, modeling of ionizing radiation in°uences on laser elements, probabilistic risk assessment methods, and risk minimization. For computer simulation of damage processes at microscopic and macroscopic levels the following methods are used: () statistical; (b) dynamical; (c) optimization; (d) acceleration modeling, and (e) mathematical modeling of laser functioning. Mathematical models of space ionizing radiation in°uence on laser elements were developed for risk assessment in laser safety analysis. This is a so-called `black box' or `input-output' models, which seeks only to reproduce the behaviour of the system's output in response to changes in its inputs. The model inputs are radiation in°uences on laser systems and output parameters are dynamical characteristics of the solid laser. Algorithms and software for optimal structure and parameters of

  16. Predictive validity of dynamic factors: assessing violence risk in forensic psychiatric inpatients.

    PubMed

    Wilson, Catherine M; Desmarais, Sarah L; Nicholls, Tonia L; Hart, Stephen D; Brink, Johann

    2013-12-01

    There is general consensus that dynamic factors ought to be considered in the assessment of violence risk, but little direct evidence exists to demonstrate that within-individual fluctuations in putative dynamic factors are associated with changes in risk. We examined these issues in a sample of 30 male forensic psychiatric inpatients using a pseudoprospective design. Static and dynamic factors were coded on the basis of chart review using 2 structured measures of violence risk: Version 2 of the Historical-Clinical-Risk Management-20 (HCR-20; C. D. Webster, K. S. Douglas, D. Eaves, & S. D. Hart, 1997, HCR-20: Assessing risk for violence, Version 2, Vancouver, BC, Canada: Mental Health, Law, and Policy Institute, Simon Fraser University) and the Short-Term Assessment of Risk and Treatability (START; C. D. Webster, M. L. Martin, J. Brink, T. L. Nicholls, & S. L. Desmarais, 2009, Short-Term Assessment of Risk and Treatability [START], Version 1.1, Coquitlam, BC, Canada: British Columbia Mental Health and Addiction Services). HCR-20 and START assessments were repeated every 3 months for a period of 1 year. Institutional violence in the 3 months following each assessment was coded using a modified version of the Overt Aggression Scale (S. C. Yudofsky, J. M. Silver, W. Jackson, J. Endicott, & D. W. Williams, 1986, The Overt Aggression Scale for the objective rating of verbal and physical aggression, The American Journal of Psychiatry, Vol. 143, pp. 35-39). Dynamic risk and strength factors showed predictive validity for institutional aggression. Results of event history analyses demonstrated that changes in dynamic risk factors significantly predicted institutional violence, even after controlling for static risk factors. This is one of the first studies to provide clear and direct support for the utility of dynamic factors in the assessment of violence risk. PMID:23815092

  17. EVALUATING RISK-PREDICTION MODELS USING DATA FROM ELECTRONIC HEALTH RECORDS

    PubMed Central

    WANG, LE; SHAW, PAMELA A.; MATHELIER, HANSIE M.; KIMMEL, STEPHEN E.; FRENCH, BENJAMIN

    2016-01-01

    The availability of data from electronic health records facilitates the development and evaluation of risk-prediction models, but estimation of prediction accuracy could be limited by outcome misclassification, which can arise if events are not captured. We evaluate the robustness of prediction accuracy summaries, obtained from receiver operating characteristic curves and risk-reclassification methods, if events are not captured (i.e., “false negatives”). We derive estimators for sensitivity and specificity if misclassification is independent of marker values. In simulation studies, we quantify the potential for bias in prediction accuracy summaries if misclassification depends on marker values. We compare the accuracy of alternative prognostic models for 30-day all-cause hospital readmission among 4548 patients discharged from the University of Pennsylvania Health System with a primary diagnosis of heart failure. Simulation studies indicate that if misclassification depends on marker values, then the estimated accuracy improvement is also biased, but the direction of the bias depends on the direction of the association between markers and the probability of misclassification. In our application, 29% of the 1143 readmitted patients were readmitted to a hospital elsewhere in Pennsylvania, which reduced prediction accuracy. Outcome misclassification can result in erroneous conclusions regarding the accuracy of risk-prediction models. PMID:27158296

  18. Utility of a Language Screening Measure for Predicting Risk for Language Impairment in Bilinguals

    PubMed Central

    Peña, Elizabeth D.; Bedore, Lisa M.; Gillam, Ronald B.

    2015-01-01

    Purpose This study evaluated the accuracy of an experimental version of the Bilingual English Spanish Oral Screener (BESOS; Peña, Bedore, Iglesias, Gutiérrez-Clellen, & Goldstein, 2008) for predicting the long-term risk for language impairment (LI) for a matched group of preschool-aged Spanish–English bilingual children with and without LI. Method A total of 1,029 Spanish–English bilingual children completed the BESOS before entering kindergarten. A subset of 167 participants completed a follow-up language evaluation in 1st grade. Twenty-one of these children were identified as having LI and were matched to a group of 21 typically developing peers from the larger sample. A series of discriminant analyses were used to determine the combination of scores on the BESOS that most accurately predicted 2 years later which children presented with and without LI. Results The linear combination of the semantics and morphosyntax scores in the best language resulted in predictive sensitivity of 95.2% and predictive specificity of 71.4%, with an overall accuracy of 81% for predicting risk for LI. Conclusion A bilingual language screener administered before kindergarten can be useful for predicting risk for LI in bilingual children in 1st grade. PMID:25885932

  19. Predicting Risk-Mitigating Behaviors From Indecisiveness and Trait Anxiety: Two Cognitive Pathways to Task Avoidance.

    PubMed

    McNeill, Ilona M; Dunlop, Patrick D; Skinner, Timothy C; Morrison, David L

    2016-02-01

    Past research suggests that indecisiveness and trait anxiety may both decrease the likelihood of performing risk-mitigating preparatory behaviors (e.g., preparing for natural hazards) and suggests two cognitive processes (perceived control and worrying) as potential mediators. However, no single study to date has examined the influence of these traits and processes together. Examining them simultaneously is necessary to gain an integrated understanding of their relationship with risk-mitigating behaviors. We therefore examined these traits and mediators in relation to wildfire preparedness in a two-wave field study among residents of wildfire-prone areas in Western Australia (total N = 223). Structural equation modeling results showed that indecisiveness uniquely predicted preparedness, with higher indecisiveness predicting lower preparedness. This relationship was fully mediated by perceived control over wildfire-related outcomes. Trait anxiety did not uniquely predict preparedness or perceived control, but it did uniquely predict worry, with higher trait anxiety predicting more worrying. Also, worry trended toward uniquely predicting preparedness, albeit in an unpredicted positive direction. This shows how the lack of performing risk-mitigating behaviors can result from distinct cognitive processes that are linked to distinct personality traits. It also highlights how simultaneous examination of multiple pathways to behavior creates a fuller understanding of its antecedents.

  20. PREDICTING RISKS OF UNCHARACTERISTIC WILDFIRES: APPLICATION OF THE RISK ASSESSMENT PROCESS

    EPA Science Inventory

    The U.S. Forest Service is struggling with a legacy of over 100 years of fire suppression on the country's national forest lands and an increasing occurrence of uncharacteristically large, intense wildfires. This paper reviews the risk assessment process and describes how it can...

  1. SNPs and breast cancer risk prediction for African American and Hispanic women.

    PubMed

    Allman, Richard; Dite, Gillian S; Hopper, John L; Gordon, Ora; Starlard-Davenport, Athena; Chlebowski, Rowan; Kooperberg, Charles

    2015-12-01

    For African American or Hispanic women, the extent to which clinical breast cancer risk prediction models are improved by including information on susceptibility single nucleotide polymorphisms (SNPs) is unknown, even though these women comprise increasing proportions of the US population and represent a large proportion of the world's population. We studied 7539 African American and 3363 Hispanic women from the Women's Health Initiative. The age-adjusted 5-year risks from the BCRAT and IBIS risk prediction models were measured and combined with a risk score based on >70 independent susceptibility SNPs. Logistic regression, adjusting for age group, was used to estimate risk associations with log-transformed age-adjusted 5-year risks. Discrimination was measured by the odds ratio (OR) per standard deviation (SD) and the area under the receiver operator curve (AUC). When considered alone, the ORs for African American women were 1.28 for BCRAT, and 1.04 for IBIS. When combined with the SNP risk score (OR 1.23), the corresponding ORs were 1.39 and 1.22. For Hispanic women the corresponding ORs were 1.25 for BCRAT, and 1.15 for IBIS. When combined with the SNP risk score (OR 1.39), the corresponding ORs were 1.48 and 1.42. There was no evidence that any of the combined models were not well calibrated. Including information on known breast cancer susceptibility loci provides approximately 10 and 19% improvement in risk prediction using BCRAT for African Americans and Hispanics, respectively. The corresponding figures for IBIS are approximately 18 and 26%, respectively.

  2. SNPs and breast cancer risk prediction for African American and Hispanic women.

    PubMed

    Allman, Richard; Dite, Gillian S; Hopper, John L; Gordon, Ora; Starlard-Davenport, Athena; Chlebowski, Rowan; Kooperberg, Charles

    2015-12-01

    For African American or Hispanic women, the extent to which clinical breast cancer risk prediction models are improved by including information on susceptibility single nucleotide polymorphisms (SNPs) is unknown, even though these women comprise increasing proportions of the US population and represent a large proportion of the world's population. We studied 7539 African American and 3363 Hispanic women from the Women's Health Initiative. The age-adjusted 5-year risks from the BCRAT and IBIS risk prediction models were measured and combined with a risk score based on >70 independent susceptibility SNPs. Logistic regression, adjusting for age group, was used to estimate risk associations with log-transformed age-adjusted 5-year risks. Discrimination was measured by the odds ratio (OR) per standard deviation (SD) and the area under the receiver operator curve (AUC). When considered alone, the ORs for African American women were 1.28 for BCRAT, and 1.04 for IBIS. When combined with the SNP risk score (OR 1.23), the corresponding ORs were 1.39 and 1.22. For Hispanic women the corresponding ORs were 1.25 for BCRAT, and 1.15 for IBIS. When combined with the SNP risk score (OR 1.39), the corresponding ORs were 1.48 and 1.42. There was no evidence that any of the combined models were not well calibrated. Including information on known breast cancer susceptibility loci provides approximately 10 and 19% improvement in risk prediction using BCRAT for African Americans and Hispanics, respectively. The corresponding figures for IBIS are approximately 18 and 26%, respectively. PMID:26589314

  3. Occurrence and potential risk of triclosan in freshwaters of São Paulo, Brazil--the need for regulatory actions.

    PubMed

    Montagner, Cassiana C; Jardim, Wilson F; Von der Ohe, Peter C; Umbuzeiro, Gisela A

    2014-02-01

    Triclosan (TCS) is a broad-spectrum bactericide, highly toxic to algae, which is released into the environment via wastewater effluents. Predicted no-effect concentrations (PNECs) for aquatic biota have been proposed in the literature, varying from 1.4 to 1,550 ng/L, reflecting contradicting protection goals. In this work, six rivers in the state of São Paulo were monitored for TCS and caffeine, a tracer for untreated sewage disposal, over a period of more than 1 year. From 71 samples analyzed, 32 contained TCS at concentrations above the limit of quantification, ranging from 2.2 to 66 ng/L, corresponding to a frequency of exceedance of the lowest PNEC of 86 % (six out of seven sites). No correlation between TCS and caffeine was observed, and one of the reasons for that could be the different use patterns in the local populations. Given the high values found in the investigated rivers, TCS seems to be a strong candidate in the priority list of compounds that should be regulated in Brazil to preserve the aquatic environment.

  4. An agro-climatic approach to determine citrus postbloom fruit drop risk in Southern Brazil.

    PubMed

    Soares-Colletti, Ana R; Alvares, Clayton A; Sentelhas, Paulo C

    2016-06-01

    Postbloom fruit drop (PFD) causes lesions on the petals of citrus flowers and induces fruit abscission causing severe damage to production when the flowering period coincides with intense rainfall. The aims of this study were to develop a phenological-climatological model for citrus PFD occurrence and, together with weather data series from several locations, to determine and map the agro-climatic favorability of PFD occurrence in the state of São Paulo, Southern Brazil. A phenological flowering model was developed to identify when citrus flowering occurs. The flowering starts after when a temperature below 10 °C in the months of June or July is reached followed by cumulative rainfall within 5 days of at least 20 mm, and then 96 °C days. Between the beginning of flowering and its peak, 147 °C days are required, and between the peak and its end, approximately 229 °C days, being 206 °C days from the peak to the moment when flowers remaining are about 50 % of total. The relationship between PFD incidence and accumulated rainfall during the critical period (between flowering peak and 50 % of flowers remaining) was adjusted by the Gompertz model (R (2) = 0.99, p < 0.05). After its validation, this model was used to estimate PFD incidence for 29 locations in the state, from 1993 to 2013, which allowed to map the PFD climatic favorability for the state through a Geographical Information System using linear models based on latitude, longitude, and altitude. The obtained map showed a trend of PFD incidence increasing from the northwest of the state of São Paulo towards the south and the coastal region, with medium to very high favorability in the center of the state. The results of this study can be used by growers as a guide for disease control planning as well as for defining the regions where the climatic conditions are likely to escape this disease. PMID:26493198

  5. An agro-climatic approach to determine citrus postbloom fruit drop risk in Southern Brazil.

    PubMed

    Soares-Colletti, Ana R; Alvares, Clayton A; Sentelhas, Paulo C

    2016-06-01

    Postbloom fruit drop (PFD) causes lesions on the petals of citrus flowers and induces fruit abscission causing severe damage to production when the flowering period coincides with intense rainfall. The aims of this study were to develop a phenological-climatological model for citrus PFD occurrence and, together with weather data series from several locations, to determine and map the agro-climatic favorability of PFD occurrence in the state of São Paulo, Southern Brazil. A phenological flowering model was developed to identify when citrus flowering occurs. The flowering starts after when a temperature below 10 °C in the months of June or July is reached followed by cumulative rainfall within 5 days of at least 20 mm, and then 96 °C days. Between the beginning of flowering and its peak, 147 °C days are required, and between the peak and its end, approximately 229 °C days, being 206 °C days from the peak to the moment when flowers remaining are about 50 % of total. The relationship between PFD incidence and accumulated rainfall during the critical period (between flowering peak and 50 % of flowers remaining) was adjusted by the Gompertz model (R (2) = 0.99, p < 0.05). After its validation, this model was used to estimate PFD incidence for 29 locations in the state, from 1993 to 2013, which allowed to map the PFD climatic favorability for the state through a Geographical Information System using linear models based on latitude, longitude, and altitude. The obtained map showed a trend of PFD incidence increasing from the northwest of the state of São Paulo towards the south and the coastal region, with medium to very high favorability in the center of the state. The results of this study can be used by growers as a guide for disease control planning as well as for defining the regions where the climatic conditions are likely to escape this disease.

  6. Ecological risks of trace metals in Guanabara Bay, Rio de Janeiro, Brazil: An index analysis approach.

    PubMed

    de Carvalho Aguiar, Valquiria Maria; de Lima, Michelle Nunes; Abuchacra, Rodrigo Coutinho; Abuchacra, Paula Ferreira Falheiro; Neto, José Antônio Baptista; Borges, Heloísa Vargas; de Oliveira, Vitor Calôr

    2016-11-01

    Total concentrations of Ni, Cr, Cu, Pb and Zn were determined in surface sediments from 30 stations in Guanabara Bay in 1999 and 2008. An approach using various environmental indices was used to assess contamination status of metals. This approach allowed the comparison with different coastal areas. Background Enrichment Index, Contamination index and Ecological Risk index (Pollution Load Index; Sediment Quality Guideline Quotient and Ecological Risk Index) were calculated for the metals. Results revealed a great load of organic matter and significant increases in Cu and Pb levels between 1999 and 2008. The concentrations of Cr and Zn were of great concern, surpassing the values of Probable Effect Level reference values. In spite of the differences of each index, results effectively revealed the striking contamination in Guanabara Bay concerning trace metals, and also suggested potential risk to local biota. The contamination of the northwest area was notably higher than the rest of the bay. In comparison with some other coastal bays around the world, Guanabara Bay stood out as a remarkably contaminated environment. PMID:27479775

  7. Ecological risks of trace metals in Guanabara Bay, Rio de Janeiro, Brazil: An index analysis approach.

    PubMed

    de Carvalho Aguiar, Valquiria Maria; de Lima, Michelle Nunes; Abuchacra, Rodrigo Coutinho; Abuchacra, Paula Ferreira Falheiro; Neto, José Antônio Baptista; Borges, Heloísa Vargas; de Oliveira, Vitor Calôr

    2016-11-01

    Total concentrations of Ni, Cr, Cu, Pb and Zn were determined in surface sediments from 30 stations in Guanabara Bay in 1999 and 2008. An approach using various environmental indices was used to assess contamination status of metals. This approach allowed the comparison with different coastal areas. Background Enrichment Index, Contamination index and Ecological Risk index (Pollution Load Index; Sediment Quality Guideline Quotient and Ecological Risk Index) were calculated for the metals. Results revealed a great load of organic matter and significant increases in Cu and Pb levels between 1999 and 2008. The concentrations of Cr and Zn were of great concern, surpassing the values of Probable Effect Level reference values. In spite of the differences of each index, results effectively revealed the striking contamination in Guanabara Bay concerning trace metals, and also suggested potential risk to local biota. The contamination of the northwest area was notably higher than the rest of the bay. In comparison with some other coastal bays around the world, Guanabara Bay stood out as a remarkably contaminated environment.

  8. Admission Risk Score to Predict Inpatient Pediatric Mortality at Four Public Hospitals in Uganda.

    PubMed

    Mpimbaza, Arthur; Sears, David; Sserwanga, Asadu; Kigozi, Ruth; Rubahika, Denis; Nadler, Adam; Yeka, Adoke; Dorsey, Grant

    2015-01-01

    Mortality rates among hospitalized children in many government hospitals in sub-Saharan Africa are high. Pediatric emergency services in these hospitals are often sub-optimal. Timely recognition of critically ill children on arrival is key to improving service delivery. We present a simple risk score to predict inpatient mortality among hospitalized children. Between April 2010 and June 2011, the Uganda Malaria Surveillance Project (UMSP), in collaboration with the National Malaria Control Program (NMCP), set up an enhanced sentinel site malaria surveillance program for children hospitalized at four public hospitals in different districts: Tororo, Apac, Jinja and Mubende. Clinical data collected through March 2013, representing 50249 admissions were used to develop a mortality risk score (derivation data set). One year of data collected subsequently from the same hospitals, representing 20406 admissions, were used to prospectively validate the performance of the risk score (validation data set). Using a backward selection approach, 13 out of 25 clinical parameters recognizable on initial presentation, were selected for inclusion in a final logistic regression prediction model. The presence of individual parameters was awarded a score of either 1 or 2 based on regression coefficients. For each individual patient, a composite risk score was generated. The risk score was further categorized into three categories; low, medium, and high. Patient characteristics were comparable in both data sets. Measures of performance for the risk score included the receiver operating characteristics curves and the area under the curve (AUC), both demonstrating good and comparable ability to predict deathusing both the derivation (AUC =0.76) and validation dataset (AUC =0.74). Using the derivation and validation datasets, the mortality rates in each risk category were as follows: low risk (0.8% vs. 0.7%), moderate risk (3.5% vs. 3.2%), and high risk (16.5% vs. 12.6%), respectively. Our

  9. Admission Risk Score to Predict Inpatient Pediatric Mortality at Four Public Hospitals in Uganda

    PubMed Central

    Mpimbaza, Arthur; Sears, David; Sserwanga, Asadu; Kigozi, Ruth; Rubahika, Denis; Nadler, Adam; Yeka, Adoke; Dorsey, Grant

    2015-01-01

    Mortality rates among hospitalized children in many government hospitals in sub-Saharan Africa are high. Pediatric emergency services in these hospitals are often sub-optimal. Timely recognition of critically ill children on arrival is key to improving service delivery. We present a simple risk score to predict inpatient mortality among hospitalized children. Between April 2010 and June 2011, the Uganda Malaria Surveillance Project (UMSP), in collaboration with the National Malaria Control Program (NMCP), set up an enhanced sentinel site malaria surveillance program for children hospitalized at four public hospitals in different districts: Tororo, Apac, Jinja and Mubende. Clinical data collected through March 2013, representing 50249 admissions were used to develop a mortality risk score (derivation data set). One year of data collected subsequently from the same hospitals, representing 20406 admissions, were used to prospectively validate the performance of the risk score (validation data set). Using a backward selection approach, 13 out of 25 clinical parameters recognizable on initial presentation, were selected for inclusion in a final logistic regression prediction model. The presence of individual parameters was awarded a score of either 1 or 2 based on regression coefficients. For each individual patient, a composite risk score was generated. The risk score was further categorized into three categories; low, medium, and high. Patient characteristics were comparable in both data sets. Measures of performance for the risk score included the receiver operating characteristics curves and the area under the curve (AUC), both demonstrating good and comparable ability to predict deathusing both the derivation (AUC =0.76) and validation dataset (AUC =0.74). Using the derivation and validation datasets, the mortality rates in each risk category were as follows: low risk (0.8% vs. 0.7%), moderate risk (3.5% vs. 3.2%), and high risk (16.5% vs. 12.6%), respectively. Our

  10. Admission Risk Score to Predict Inpatient Pediatric Mortality at Four Public Hospitals in Uganda.

    PubMed

    Mpimbaza, Arthur; Sears, David; Sserwanga, Asadu; Kigozi, Ruth; Rubahika, Denis; Nadler, Adam; Yeka, Adoke; Dorsey, Grant

    2015-01-01

    Mortality rates among hospitalized children in many government hospitals in sub-Saharan Africa are high. Pediatric emergency services in these hospitals are often sub-optimal. Timely recognition of critically ill children on arrival is key to improving service delivery. We present a simple risk score to predict inpatient mortality among hospitalized children. Between April 2010 and June 2011, the Uganda Malaria Surveillance Project (UMSP), in collaboration with the National Malaria Control Program (NMCP), set up an enhanced sentinel site malaria surveillance program for children hospitalized at four public hospitals in different districts: Tororo, Apac, Jinja and Mubende. Clinical data collected through March 2013, representing 50249 admissions were used to develop a mortality risk score (derivation data set). One year of data collected subsequently from the same hospitals, representing 20406 admissions, were used to prospectively validate the performance of the risk score (validation data set). Using a backward selection approach, 13 out of 25 clinical parameters recognizable on initial presentation, were selected for inclusion in a final logistic regression prediction model. The presence of individual parameters was awarded a score of either 1 or 2 based on regression coefficients. For each individual patient, a composite risk score was generated. The risk score was further categorized into three categories; low, medium, and high. Patient characteristics were comparable in both data sets. Measures of performance for the risk score included the receiver operating characteristics curves and the area under the curve (AUC), both demonstrating good and comparable ability to predict deathusing both the derivation (AUC =0.76) and validation dataset (AUC =0.74). Using the derivation and validation datasets, the mortality rates in each risk category were as follows: low risk (0.8% vs. 0.7%), moderate risk (3.5% vs. 3.2%), and high risk (16.5% vs. 12.6%), respectively. Our

  11. HCV Genotypes, Characterization of Mutations Conferring Drug Resistance to Protease Inhibitors, and Risk Factors among Blood Donors in São Paulo, Brazil

    PubMed Central

    Nishiya, Anna S.; de Almeida-Neto, Cesar; Ferreira, Suzete C.; Alencar, Cecília S.; Di-Lorenzo-Oliveira, Claudia; Levi, José E.; Salles, Nanci A.; Mendrone, Alfredo; Sabino, Ester C.

    2014-01-01

    Background Hepatitis C virus (HCV) infection is a global health problem estimated to affect almost 200 million people worldwide. The aim of this study is to analyze the subtypes and existence of variants resistant to protease inhibitors and their association with potential HCV risk factors among blood donors in Brazil. Methods Repeat anti-HCV reactive blood donors are systematically asked to return for retest, notification, and counseling in which they are interviewed for risk factors for transfusion-transmitted diseases. We analyzed 202 donors who returned for counseling from 2007 to 2010 and presented enzyme immunoassay- and immunoblot-reactive results. The HCV genotypes and resistance mutation analyses were determined by the direct sequencing of the NS5b and NS3 regions, respectively. The HCV viral load was determined using an in-house real-time PCR assay targeting the 5′-NCR. Results HCV subtypes 1b, 1a, and 3a were found in 45.5%, 32.0%, and 18.0% of the donors, respectively. The mean viral load of genotype 1 was significantly higher than that of the genotype 3 isolates. Subtype 1a was more frequent among young donors and 3a was more frequent among older donors. Protease inhibitor-resistant variants were detected in 12.8% of the sequenced samples belonging to genotype 1, and a higher frequency was observed among subtype 1a (20%) in comparison to 1b (8%). There was no difference in the prevalence of HCV risk factors among the genotypes or drug-resistant variants. Conclusions We found a predominance of subtype 1b, with an increase in the frequency of subtype 1a, in young subjects. Mutations conferring resistance to NS3 inhibitors were frequent in treatment-naïve blood donors, particularly those infected with subtype 1a. These variants were detected in the major viral population of HCV quasispecies, have replicative capacities comparable to nonresistant strains, and could be important for predicting the response to antiviral triple therapy. PMID:24466079

  12. Nottingham prognostic index plus (NPI+) predicts risk of distant metastases in primary breast cancer.

    PubMed

    Green, Andrew R; Soria, D; Powe, D G; Nolan, C C; Aleskandarany, M; Szász, M A; Tőkés, A M; Ball, G R; Garibaldi, J M; Rakha, E A; Kulka, J; Ellis, I O

    2016-05-01

    The Nottingham prognostic index plus (NPI+) is based on the assessment of biological class combined with established clinicopathologic prognostic variables providing improved patient outcome stratification for breast cancer superior to the traditional NPI. This study aimed to determine prognostic capability of the NPI+ in predicting risk of development of distant disease. A well-characterised series of 1073 primary early-stage BC cases treated in Nottingham and 251 cases from Budapest were immunohistochemically assessed for cytokeratin (Ck)5/6, Ck18, EGFR, oestrogen receptor (ER), progesterone receptor, HER2, HER3, HER4, Mucin 1 and p53 expression. NPI+ biological class and prognostic scores were assigned using individual algorithms for each biological class incorporating clinicopathologic parameters and investigated in terms of prediction of distant metastases-free survival (MFS). The NPI+ identified distinct prognostic groups (PG) within each molecular class which were predictive of MFS providing improved patient outcome stratification superior to the traditional NPI. NPI+ PGs, between series, were comparable in predicting patient outcome between series in luminal A, basal p53 altered and HER2+/ER+ (p > 0.01) tumours. The low-risk groups were similarly validated in luminal B, luminal N, basal p53 normal tumours (p > 0.01). Due to small patient numbers the remaining PGs could not be validated. NPI+ was additionally able to predict a higher risk of metastases at certain distant sites. This study may indicate the NPI+ as a useful tool in predicting the risk of metastases. The NPI+ provides accurate risk stratification allowing improved individualised clinical decision making for breast cancer. PMID:27116185

  13. Ventral striatum activation to prosocial rewards predicts longitudinal declines in adolescent risk taking.

    PubMed

    Telzer, Eva H; Fuligni, Andrew J; Lieberman, Matthew D; Galván, Adriana

    2013-01-01

    Adolescence is a period of intensified emotions and an increase in motivated behaviors and passions. Evidence from developmental neuroscience suggests that this heightened emotionality occurs, in part, due to a peak in functional reactivity to rewarding stimuli, which renders adolescents more oriented toward reward-seeking behaviors. Most prior work has focused on how reward sensitivity may create vulnerabilities, leading to increases in risk taking. Here, we test whether heightened reward sensitivity may potentially be an asset for adolescents when engaged in prosocial activities. Thirty-two adolescents were followed over a one-year period to examine whether ventral striatum activation to prosocial rewards predicts decreases in risk taking over a year. Results show that heightened ventral striatum activation to prosocial stimuli relates to longitudinal declines in risk taking. Therefore, the very same neural region that has conferred vulnerability for adolescent risk taking may also be protective against risk taking. PMID:23245219

  14. Salivary testosterone change following monetary wins and losses predicts future financial risk-taking.

    PubMed

    Apicella, Coren L; Dreber, Anna; Mollerstrom, Johanna

    2014-01-01

    While baseline testosterone has recently been implicated in risk-taking in men, less is known about the effects of changing levels of testosterone on financial risk. Here we attempt to influence testosterone in men by having them win or lose money in a chance-based competition against another male opponent. We employ two treatments where we vary the amount of money at stake so that we can directly compare winners to losers who earn the same amount, thereby abstracting from income effects. We find that men who experience a greater increase in bioactive testosterone take on more risk, an association that remains when controlling for whether the participant won the competition. In fact, whether subjects won the competition did not predict future risk. These results suggest that testosterone change, and thus individual differences in testosterone reactivity, rather than the act of winning or losing, influence financial risk-taking. PMID:24275004

  15. Risk factors assessment and risk prediction models in lung cancer screening candidates

    PubMed Central

    Wachuła, Ewa; Szabłowska-Siwik, Sylwia; Boratyn-Nowicka, Agnieszka; Czyżewski, Damian

    2016-01-01

    From February 2015, low-dose computed tomography (LDCT) screening entered the armamentarium of diagnostic tools broadly available to individuals at high-risk of developing lung cancer. While a huge number of pulmonary nodules are identified, only a small fraction turns out to be early lung cancers. The majority of them constitute a variety of benign lesions. Although it entails a burden of the diagnostic work-up, the undisputable benefit emerges from: (I) lung cancer diagnosis at earlier stages (stage shift); (II) additional findings enabling the implementation of a preventive action beyond the realm of thoracic oncology. This review presents how to utilize the risk factors from distinct categories such as epidemiology, radiology and biomarkers to target the fraction of population, which may benefit most from the introduced screening modality. PMID:27195269

  16. Predictive Mapping of Human Risk for West Nile Virus (WNV) Based on Environmental and Socioeconomic Factors

    PubMed Central

    Rochlin, Ilia; Turbow, David; Gomez, Frank; Ninivaggi, Dominick V.; Campbell, Scott R.

    2011-01-01

    A West Nile virus (WNV) human risk map was developed for Suffolk County, New York utilizing a case-control approach to explore the association between the risk of vector-borne WNV and habitat, landscape, virus activity, and socioeconomic variables derived from publically available datasets. Results of logistic regression modeling for the time period between 2000 and 2004 revealed that higher proportion of population with college education, increased habitat fragmentation, and proximity to WNV positive mosquito pools were strongly associated with WNV human risk. Similar to previous investigations from north-central US, this study identified middle class suburban neighborhoods as the areas with the highest WNV human risk. These results contrast with similar studies from the southern and western US, where the highest WNV risk was associated with low income areas. This discrepancy may be due to regional differences in vector ecology, urban environment, or human behavior. Geographic Information Systems (GIS) analytical tools were used to integrate the risk factors in the 2000–2004 logistic regression model generating WNV human risk map. In 2005–2010, 41 out of 46 (89%) of WNV human cases occurred either inside of (30 cases) or in close proximity (11 cases) to the WNV high risk areas predicted by the 2000–2004 model. The novel approach employed by this study may be implemented by other municipal, local, or state public health agencies to improve geographic risk estimates for vector-borne diseases based on a small number of acute human cases. PMID:21853103

  17. Simple risk factors to predict urgent endoscopy in nonvariceal upper gastrointestinal bleeding pre-endoscopically

    PubMed Central

    Wang, Jianzong; Hu, Duanming; Tang, Wen; Hu, Chuanyin; Lu, Qin; Li, Juan; Zhu, Jianhong; Xu, Liming; Sui, Zhenyu; Qian, Mingjie; Wang, Shaofeng; Yin, Guojian

    2016-01-01

    Abstract The goal of this study is to evaluate how to predict high-risk nonvariceal upper gastrointestinal bleeding (NVUGIB) pre-endoscopically. A total of 569 NVUGIB patients between Match 2011 and January 2015 were retrospectively studied. The clinical characteristics and laboratory data were statistically analyzed. The severity of NVUGIB was based on high-risk NVUGIB (Forrest I–IIb), and low-risk NVUGIB (Forrest IIc and III). By logistic regression and receiver-operating characteristic curve, simple risk score systems were derived which predicted patients’ risks of potentially needing endoscopic intervention to control bleeding. Risk score systems combined of patients’ serum hemoglobin (Hb) ≤75 g/L, red hematemesis, red stool, shock, and blood urine nitrogen ≥8.5 mmol/L within 24 hours after admission were derived. As for each one of these clinical signs, the relatively high specificity was 97.9% for shock, 96.4% for red stool, 85.5% for red hematemesis, 76.7% for Hb ≤75 g/L, and the sensitivity was 50.8% for red hematemesis, 47.5% for Hb ≤75 g/L, 14.2% for red stool, and 10.9% for shock. When these 5 clinical signs were presented as a risk score system, the highest area of receiver-operating characteristic curve was 0.746, with sensitivity 0.675 and specificity 0.733, which discriminated well with high-risk NVUGIB. These simple risk factors identified patients with high-risk NVUGIB of needing treatment to manage their bleeding pre-endoscopically. Further validation in the clinic was required. PMID:27367977

  18. Simple risk factors to predict urgent endoscopy in nonvariceal upper gastrointestinal bleeding pre-endoscopically.

    PubMed

    Wang, Jianzong; Hu, Duanming; Tang, Wen; Hu, Chuanyin; Lu, Qin; Li, Juan; Zhu, Jianhong; Xu, Liming; Sui, Zhenyu; Qian, Mingjie; Wang, Shaofeng; Yin, Guojian

    2016-06-01

    The goal of this study is to evaluate how to predict high-risk nonvariceal upper gastrointestinal bleeding (NVUGIB) pre-endoscopically. A total of 569 NVUGIB patients between Match 2011 and January 2015 were retrospectively studied. The clinical characteristics and laboratory data were statistically analyzed. The severity of NVUGIB was based on high-risk NVUGIB (Forrest I-IIb), and low-risk NVUGIB (Forrest IIc and III). By logistic regression and receiver-operating characteristic curve, simple risk score systems were derived which predicted patients' risks of potentially needing endoscopic intervention to control bleeding. Risk score systems combined of patients' serum hemoglobin (Hb) ≤75 g/L, red hematemesis, red stool, shock, and blood urine nitrogen ≥8.5 mmol/L within 24 hours after admission were derived. As for each one of these clinical signs, the relatively high specificity was 97.9% for shock, 96.4% for red stool, 85.5% for red hematemesis, 76.7% for Hb ≤75 g/L, and the sensitivity was 50.8% for red hematemesis, 47.5% for Hb ≤75 g/L, 14.2% for red stool, and 10.9% for shock. When these 5 clinical signs were presented as a risk score system, the highest area of receiver-operating characteristic curve was 0.746, with sensitivity 0.675 and specificity 0.733, which discriminated well with high-risk NVUGIB. These simple risk factors identified patients with high-risk NVUGIB of needing treatment to manage their bleeding pre-endoscopically. Further validation in the clinic was required. PMID:27367977

  19. SY 04-2 LONG-TERM CVD RISK PREDICTION IN LOW-INCIDENCE EUROPEAN POPULATIONS.

    PubMed

    Veronesi, Giovanni

    2016-09-01

    In Italy, the European SCORE Project risk score is the recommended tool for cardiovascular disease risk stratification in the primary prevention setting. Among non-diabetic subjects aged 40 to 64, the model estimates the 10-year probability of death due to cardiovascular disease based on individual's age, total cholesterol, blood pressure and smoking status. A growing body of evidence suggests that in middle-aged adults this stratification may suffer from two major drawbacks. First, mortality risk severely underestimates the global burden of disease incidence. Second, younger individuals and women are likely to be classified in the "low 10-year risk" category despite the presence of risk factors.The latest European and American guidelines have eventually introduced the assessment of long-term risk of disease as additional tool to improve risk communication and increase risk awareness. Long-term risk scores were first developed in the US and in the UK, i.e. in high-risk populations. In low-incidence populations, these models may have poor calibration and discrimination ability, as shown for the Framingham equation. Therefore, our research team developed and validated a 20-year risk score for the Italian population. As part of a collaborative study with the Italian Health Institute, we pooled 7 population-based cohorts of middle-aged individuals recruited in Northern and in Central Italy in mid 1980 s and early 1990 s following a similar protocol with standardized MONICA procedures. Overall, more than 10500 men and women 35-69 years old and free of CVD at baseline, who developed 830 first major atherosclerotic events (coronary heart disease or ischemic strokes) during a median 17 years of follow-up. The score was based on traditional risk factors (age, blood lipids, systolic blood pressure and treatment, smoking and diabetes). In addition, social status and family history of coronary heart disease did improve risk prediction, at least in men. Finally we showed

  20. Parental Literacy Predicts Children's Literacy: A Longitudinal Family-Risk Study

    ERIC Educational Resources Information Center

    Torppa, Minna; Eklund, Kenneth; van Bergen, Elsje; Lyytinen, Heikki

    2011-01-01

    This family-risk (FR) study examined whether the literacy skills of parents with dyslexia are predictive of the literacy skills of their offspring. We report data from 31 child-parent dyads where both had dyslexia (FR-D) and 68 dyads where the child did not have dyslexia (FR-ND). Findings supported the differences in liability of FR children with…

  1. Predicting Recidivism Among Adjudicated Delinquents: A Model to Identify High Risk Offenders.

    ERIC Educational Resources Information Center

    Grenier, Charles E.; Roundtree, George A.

    1987-01-01

    Studied 100 clients of the East Baton Rouge Parish Family Court to develop predictive model for identifying offenders at high risk for recidivism. Found important predictor variables to be presence of delinquent siblings or friends, school problems, type of offense committed, and gender of delinquent. (Author/NB)

  2. A Naive Bayes machine learning approach to risk prediction using censored, time-to-event data.

    PubMed

    Wolfson, Julian; Bandyopadhyay, Sunayan; Elidrisi, Mohamed; Vazquez-Benitez, Gabriela; Vock, David M; Musgrove, Donald; Adomavicius, Gediminas; Johnson, Paul E; O'Connor, Patrick J

    2015-09-20

    Predicting an individual's risk of experiencing a future clinical outcome is a statistical task with important consequences for both practicing clinicians and public health experts. Modern observational databases such as electronic health records provide an alternative to the longitudinal cohort studies traditionally used to construct risk models, bringing with them both opportunities and challenges. Large sample sizes and detailed covariate histories enable the use of sophisticated machine learning techniques to uncover complex associations and interactions, but observational databases are often 'messy', with high levels of missing data and incomplete patient follow-up. In this paper, we propose an adaptation of the well-known Naive Bayes machine learning approach to time-to-event outcomes subject to censoring. We compare the predictive performance of our method with the Cox proportional hazards model which is commonly used for risk prediction in healthcare populations, and illustrate its application to prediction of cardiovascular risk using an electronic health record dataset from a large Midwest integrated healthcare system.

  3. The Utility of Risk Assessment Instruments for the Prediction of Recidivism in Sexual Homicide Perpetrators

    ERIC Educational Resources Information Center

    Hill, Andreas; Rettenberger, Martin; Habermann, Niels; Berner, Wolfgang; Eher, Reinhard; Briken, Peer

    2012-01-01

    To examine the predictive accuracy of four well established risk assessment instruments (PCL-R, HCR-20, SVR-20, and Static-99) in an important subgroup of sexual offenders, these instruments were assessed retrospectively based on information from forensic psychiatric court reports in a sample of 90 released male sexual homicide offenders (out of…

  4. Disorganized symptoms and executive functioning predict impaired social functioning in subjects at risk for psychosis.

    PubMed

    Eslami, Ali; Jahshan, Carol; Cadenhead, Kristin S

    2011-01-01

    Predictors of social functioning deficits were assessed in 22 individuals "at risk" for psychosis. Disorganized symptoms and executive functioning predicted social functioning at follow-up. Early intervention efforts that focus on social and cognitive skills are indicated in this vulnerable population.

  5. DOSIMETRY MODELING OF INHALED FORMALDEHYDE: BINNING NASAL FLUX PREDICTIONS FOR QUANTITATIVE RISK ASSESSMENT

    EPA Science Inventory

    Dosimetry Modeling of Inhaled Formaldehyde: Binning Nasal Flux Predictions for Quantitative Risk Assessment. Kimbell, J.S., Overton, J.H., Subramaniam, R.P., Schlosser, P.M., Morgan, K.T., Conolly, R.B., and Miller, F.J. (2001). Toxicol. Sci. 000, 000:000.

    Interspecies e...

  6. Using Predictive Modelling to Identify Students at Risk of Poor University Outcomes

    ERIC Educational Resources Information Center

    Jia, Pengfei; Maloney, Tim

    2015-01-01

    Predictive modelling is used to identify students at risk of failing their first-year courses and not returning to university in the second year. Our aim is twofold. Firstly, we want to understand the factors that lead to poor first-year experiences at university. Secondly, we want to develop simple, low-cost tools that would allow universities to…

  7. Predicting High Risk Adolescents' Substance Use over Time: The Role of Parental Monitoring

    ERIC Educational Resources Information Center

    Clark, Heddy Kovach; Shamblen, Stephen R.; Ringwalt, Chris L.; Hanley, Sean

    2012-01-01

    We examined whether parental monitoring at baseline predicted subsequent substance use in a high-risk youth population. Students in 14 alternative high schools in Washington State completed self-report surveys at three time points over the course of 2 years. Primary analyses included 1,423 students aged 14-20 who lived with at least one parent or…

  8. Predicting the Risk of Attrition for Undergraduate Students with Time Based Modelling

    ERIC Educational Resources Information Center

    Chai, Kevin E. K.; Gibson, David

    2015-01-01

    Improving student retention is an important and challenging problem for universities. This paper reports on the development of a student attrition model for predicting which first year students are most at-risk of leaving at various points in time during their first semester of study. The objective of developing such a model is to assist…

  9. Predictive validity of adult risk assessment tools with juveniles who offended sexually.

    PubMed

    Ralston, Christopher A; Epperson, Douglas L

    2013-09-01

    An often-held assumption in the area of sexual recidivism risk assessment is that different tools should be used for adults and juveniles. This assumption is driven either by the observation that adolescents tend to be in a constant state of flux in the areas of development, education, and social structure or by the fact that the judicial system recognizes that juveniles and adults are different. Though the assumption is plausible, it is largely untested. The present study addressed this issue by scoring 2 adult sexual offender risk assessment tools, the Minnesota Sex Offender Screening Tool-Revised and the Static-99, on an exhaustive sample (N = 636) of juveniles who had sexually offended (JSOs) in Utah. For comparison, 2 tools designed for JSOs were also scored: the Juvenile-Sex Offender Assessment Protocol-II and the Juvenile Risk Assessment Scale. Recidivism data were collected for 2 time periods: before age 18 (sexual, violent, any recidivism) and from age 18 to the year 2004 (sexual). The adult actuarial risk assessment tools predicted all types of juvenile recidivism significantly and at approximately the same level of accuracy as juvenile-specific tools. However, the accuracy of longer term predictions of adult sexual recidivism across all 4 tools was substantially lower than the accuracy achieved in predicting juvenile sexual recidivism, with 2 of the tools producing nonsignificant results, documenting the greater difficulty in making longer term predictions on the basis of adolescent behavior.

  10. Predicting Dyslexia at Age 11 from a Risk Index Questionnaire at Age 5

    ERIC Educational Resources Information Center

    Helland, Turid; Plante, Elena; Hugdahl, Kenneth

    2011-01-01

    This study focused on predicting dyslexia in children ahead of formal literacy training. Because dyslexia is a constitutional impairment, risk factors should be seen in preschool. It was hypothesized that data gathered at age 5 using questions targeting the dyslexia endophenotype should be reliable and valid predictors of dyslexia at age 11. A…

  11. How can we better predict the risk of spontaneous miscarriage among women experiencing threatened miscarriage?

    PubMed

    Ku, Chee Wai; Allen, John C; Malhotra, Rahul; Chong, Han Chung; Tan, Nguan Soon; Østbye, Truls; Lek, Sze Min; Lie, Desiree; Tan, Thiam Chye

    2015-01-01

    This study seeks to establish progesterone and progesterone-induced blocking factor (PIBF) levels as predictors of subsequent completed miscarriage among women presenting with threatened miscarriage between 6 and 10 weeks of gestation. Our secondary objective was to assess the known maternal risk factors, toward development of a parsimonious and clinician-friendly risk assessment model for predicting completed miscarriage. In this article, we present a prospective cohort study of 119 patients presenting with threatened miscarriage from gestation weeks 6 to 10 at a tertiary women's hospital emergency unit in Singapore. Thirty (25.2%) women had a spontaneous miscarriage. Low progesterone and PIBF levels are similarly predictive of subsequent completed miscarriage. Study results (OR, 95% CI) showed that higher levels of progesterone (0.91, 95% CI 0.88-0.94) and PIBF (0.99, 95% CI 0.98-0.99) were associated with lower risk of miscarriage. Low progesterone level was a very strong predictor of miscarriage risk in our study despite previous concerns about its pulsatile secretion. Low serum progesterone and PIBF levels predicted spontaneous miscarriage among women presenting with threatened miscarriage between gestation weeks 6 to 10. Predictive models to calculate probability of spontaneous miscarriage based on serum progesterone, together with maternal BMI and fetal heart are proposed. PMID:26036717

  12. How can we better predict the risk of spontaneous miscarriage among women experiencing threatened miscarriage?

    PubMed

    Ku, Chee Wai; Allen, John C; Malhotra, Rahul; Chong, Han Chung; Tan, Nguan Soon; Østbye, Truls; Lek, Sze Min; Lie, Desiree; Tan, Thiam Chye

    2015-01-01

    This study seeks to establish progesterone and progesterone-induced blocking factor (PIBF) levels as predictors of subsequent completed miscarriage among women presenting with threatened miscarriage between 6 and 10 weeks of gestation. Our secondary objective was to assess the known maternal risk factors, toward development of a parsimonious and clinician-friendly risk assessment model for predicting completed miscarriage. In this article, we present a prospective cohort study of 119 patients presenting with threatened miscarriage from gestation weeks 6 to 10 at a tertiary women's hospital emergency unit in Singapore. Thirty (25.2%) women had a spontaneous miscarriage. Low progesterone and PIBF levels are similarly predictive of subsequent completed miscarriage. Study results (OR, 95% CI) showed that higher levels of progesterone (0.91, 95% CI 0.88-0.94) and PIBF (0.99, 95% CI 0.98-0.99) were associated with lower risk of miscarriage. Low progesterone level was a very strong predictor of miscarriage risk in our study despite previous concerns about its pulsatile secretion. Low serum progesterone and PIBF levels predicted spontaneous miscarriage among women presenting with threatened miscarriage between gestation weeks 6 to 10. Predictive models to calculate probability of spontaneous miscarriage based on serum progesterone, together with maternal BMI and fetal heart are proposed.

  13. Risk factors associated with resistance to HIV testing among transwomen in Brazil.

    PubMed

    Pinheiro Júnior, F M L; Kendall, C; Martins, T A; Mota, R M S; Macena, R H M; Glick, J; Kerr-Correa, F; Kerr, L

    2016-01-01

    Transwomen are a high-risk population for HIV/AIDS worldwide. However, many transwomen do not test for HIV. This study aimed to identify factors associated with resistance to HIV testing among transwomen in Fortaleza/CE. A cross-sectional study was conducted between August and December 2008 with a sample of 304 transwomen recruited through respondent-driven sampling. Data analysis utilized Respondent-Driven Sampling Analysis Tool and SPSS 11.0. Univariate, bivariate, and multivariate analyses examined risk factors associated with resistance to HIV testing. Less than 18 years of age (OR = 4.221; CI = 2.419-7.364), sexual debut before 10 years of age (OR = 6.760; CI = 2.996-15.256), using illegal drugs during sex (OR = 2.384; CI = 1.310-4.339), experience of discrimination (OR = 3.962; CI = 1.540-10.195) and a belief that the test results were not confidential (OR = 3.763; CI = 2.118-6.688) are independently associated with resistance to testing. Intersectoral and targeted strategies aimed at encouraging the adoption of safer sexual behaviors and testing for HIV among transwomen are required. PMID:26274065

  14. [Association between health risk behaviors in parents and adolescents in a rural area in southern Brazil].

    PubMed

    Raphaelli, Chirle de Oliveira; Azevedo, Mario Renato; Hallal, Pedro C

    2011-12-01

    This article aimed to assess the association between health risk behaviors in parents and adolescents in a rural area. The sample included 377 schoolchildren 10 to 18 years of age and 338 parents. The following variables were analyzed: level of leisure-time and commuting physical activity, inadequate eating habits, overweight/obesity, smoking, and alcohol consumption. Prevalence rates for smoking and alcohol consumption by adolescents in the previous 30 days were 6.7% and 27%, respectively. Forty-five percent of adolescents failed to reach the target physical activity score. Adherence to steps to healthy eating was low. Physical activity in adolescents was positively associated with that of parents, and adolescent drinking was associated with maternal alcohol consumption. There was no significant association for other behaviors. In the analysis stratified by gender, level of physical exercise in female adolescents was associated with that of fathers. Parental health risk behaviors were associated with the behaviors in the adolescent children in this rural area.

  15. Separate and interactive contributions of weak inhibitory control and threat sensitivity to prediction of suicide risk

    PubMed Central

    Venables, Noah C.; Sellbom, Martin; Sourander, Andre; Kendler, Kenneth S.; Joiner, Thomas E.; Drislane, Laura E.; Sillanmäki, Lauri; Elonheimo, Henrik; Parkkola, Kai; Multimaki, Petteri; Patrick, Christopher J.

    2015-01-01

    Biobehavioral dispositions can serve as valuable referents for biologically-oriented research on core processes with relevance to many psychiatric conditions. The present study examined two such dispositional variables—weak response inhibition (or disinhibition; INH−) and threat sensitivity (or fearfulness; THT+)—as predictors of the serious transdiagnostic problem of suicide risk in two samples: male and female outpatients from a U.S. clinic (N=1,078), and a population-based male military cohort from Finland (N=3,855). INH− and THT+ were operationalized through scores on scale measures of disinhibition and fear/fearlessness, known to be related to DSM-defined clinical conditions and brain biomarkers. Suicide risk was assessed by clinician ratings (clinic sample) and questionnaires (both samples). Across samples and alternative suicide indices, INH− and THT+ each contributed uniquely to prediction of suicide risk—beyond internalizing and externalizing problems in the case of the clinic sample where diagnostic data were available. Further, in both samples, INH− and THT+ interactively predicted suicide risk, with individuals scoring concurrently high on both dispositions exhibiting markedly augmented risk. Findings demonstrate that dispositional constructs of INH− and THT+ are predictive of suicide risk, and hold potential as referents for biological research on suicidal behavior. PMID:25712631

  16. A Risk Prediction Model for Smoking Experimentation in Mexican American Youth

    PubMed Central

    Talluri, Rajesh; Wilkinson, Anna V.; Spitz, Margaret R.; Shete, Sanjay

    2014-01-01

    Background Smoking experimentation in Mexican American youth is problematic. In light of the research showing that preventing smoking experimentation is a valid strategy for smoking prevention, there is a need to identify Mexican American youth at high risk for experimentation. Methods A prospective population-based cohort of 1179 adolescents of Mexican descent was followed for 5 years starting in 2005–06. Participants completed a baseline interview at a home visit followed by three telephone interviews at intervals of approximately 6 months and additional interviews at two home visits in 2008–09 and 2010–11. The primary end point of interest in this study was smoking experimentation. Information regarding social, cultural, and behavioral factors (e.g., acculturation, susceptibility to experimentation, home characteristics, household influences) was collected at baseline using validated questionnaires. Results Age, sex, cognitive susceptibility, household smoking behavior, peer influence, neighborhood influence, acculturation, work characteristics, positive outcome expectations, family cohesion, degree of tension, ability to concentrate, and school discipline were found to be associated with smoking experimentation. In a validation dataset, the proposed risk prediction model had an AUC of 0.719 (95% confidence interval, 0.637 to 0.801)for predicting absolute risk for smoking experimentation within 1 year. Conclusions The proposed risk prediction model is able to quantify the risk of smoking experimentation in Mexican American adolescents. PMID:25063521

  17. A risk index model for predicting eastern equine encephalitis virus transmission to horses in Florida.

    PubMed

    Kelen, Patrick Vander; Downs, Joni A; Unnasch, Thomas; Stark, Lillian

    2014-03-01

    A GIS-based risk index model was developed to quantify EEEV transmission risk to horses in the State of Florida. EEEV is a highly pathogenic arbovirus that is endemic along the east coast of the United States, and it is generally fatal to both horses and humans. The model evaluates EEEV transmission risk at individual raster cells in map on a continuous scale of 0 to 1. The risk index is derived based on local habitat features and the composition and configuration of surrounding land cover types associated with EEEV transmission. The model was verified and validated using the locations of documented horse cases of EEEV. These results of the verification and validation indicate that the model is able to predict locations of EEEV transmission to horses broadly across the state. The model is relatively robust to regional variation in EEEV transmission and habitat conditions in Florida, and it accurately predicted nearly all verification and validation cases in the Panhandle, North, and Central regions of the state. The model performed less accurately in the South, where relatively few cases are documented. Despite these differences, the model provides a useful way to assess EEEV risk both from a regional perspective and at more localized scales. The resulting predictive maps are designed to guide EEEV surveillance and prevention efforts by county mosquito control districts. PMID:24764607

  18. Potential ecological risk assessment and prediction of soil heavy metal pollution around coal gangue dump

    NASA Astrophysics Data System (ADS)

    Jiang, X.; Lu, W. X.; Yang, Q. C.; Yang, Z. P.

    2014-03-01

    Aim of the present study is to evaluate the potential ecological risk and predict the trend of soil heavy metal pollution around a~coal gangue dump in Jilin Province (Northeast China). The concentrations of Cd, Pb, Cu, Cr and Zn were monitored by inductively coupled plasma mass spectrometry (ICP-MS). The potential ecological risk index method developed by Hakanson (1980) was employed to assess the potential risk of heavy metal pollution. The potential ecological risk in an order of E(Cd) > E(Pb) > E(Cu) > E(Cr) > E(Zn) have been obtained, which showed that Cd was the most important factor led to risk. Based on the Cd pollution history, the cumulative acceleration and cumulative rate of Cd were estimated, and the fixed number of years exceeding standard prediction model was established, which was used to predict the pollution trend of Cd under the accelerated accumulation mode and the uniform mode. Pearson correlation analysis and correspondence analysis are employed to identify the sources of heavy metal, and the relationship between sampling points and variables. These findings provide some useful insights for making appropriate management strategies to prevent and decrease heavy metal pollution around coal gangue dump in Yangcaogou coal mine and other similar areas elsewhere.

  19. Practical prediction model for the risk of 2-year mortality of individuals in the general population.

    PubMed

    Goldfarb-Rumyantzev, Alexander; Gautam, Shiva; Brown, Robert S

    2016-04-01

    This study proposed to validate a prediction model and risk-stratification tool of 2-year mortality rates of individuals in the general population suitable for office practice use. A risk indicator (R) derived from data in the literature was based on only 6 variables: to calculate R for an individual, starting with 0, for each year of age above 60, add 0.14; for a male, add 0.9; for diabetes mellitus, add 0.7; for albuminuria > 30 mg/g of creatinine, add 0.7; for stage ≥ 3 chronic kidney disease (CKD), add 0.9; for cardiovascular disease (CVD), add 1.4; or for both CKD and CVD, add 1.7. We developed a univariate logistic regression model predicting 2-year individual mortality rates. The National Health and Nutrition Examination Survey (NHANES) data set (1999-2004 with deaths through 2006) was used as the target for validation. These 12,515 subjects had a mean age of 48.9 ± 18.1 years, 48% males, 9.5% diabetes, 11.7% albuminuria, 6.8% CVD, 5.4% CKD, and 2.8% both CKD and CVD. Using the risk indicator R alone to predict mortality demonstrated good performance with area under the receiver operating characteristic (ROC) curve of 0.84. Dividing subjects into low-risk (R=0-1.0), low intermediate risk (R > 1.0-3.0), high intermediate risk (R > 3.0-5.0) or high-risk (R > 5.0) categories predicted 2-year mortality rates of 0.52%, 1.44%, 5.19% and 15.24%, respectively, by the prediction model compared with actual mortality rates of 0.29%, 2.48%, 5.13% and 13.40%, respectively. We have validated a model of risk stratification using easily identified clinical characteristics to predict 2-year mortality rates of individuals in the general population. The model demonstrated performance adequate for its potential use for clinical practice and research decisions.

  20. A biological approach to the interspecies prediction of radiation-induced mortality risk

    SciTech Connect

    Carnes, B.A.; Grahn, D.; Olshansky, S.J.

    1997-08-01

    Evolutionary explanations for why sexually reproducing organisms grow old suggest that the forces of natural selection affect the ages when diseases occur that are subject to a genetic influence (referred to here as intrinsic diseases). When extended to the population level for a species, this logic leads to the general prediction that age-specific death rates from intrinsic causes should begin to rise as the force of selection wanes once the characteristic age of sexual maturity is attained. Results consistent with these predictions have been found for laboratory mice, beagles, and humans where, after adjusting for differences in life span, it was demonstrated that these species share a common age pattern of mortality for intrinsic causes of death. In quantitative models used to predict radiation-induced mortality, risks are often expressed as multiples of those observed in a control population. A control population, however, is an aging population. As such, mortality risks related to exposure must be interpreted relative to the age-specific risk of death associated with aging. Given the previous success in making interspecies predictions of age-related mortality, the purpose of this study was to determine whether radiation-induced mortality observed in one species could also be predicted quantitatively from a model used to describe the mortality consequences of exposure to radiation in a different species. Mortality data for B6CF{sub 1} mice and beagles exposed to {sup 60}Co {gamma}-rays for the duration of life were used for analysis.

  1. Predicting intentions and behaviours in populations with or at-risk of diabetes: A systematic review

    PubMed Central

    Akbar, Heena; Anderson, Debra; Gallegos, Danielle

    2015-01-01

    Purpose To systematically review the Theory of Planned Behaviour studies predicting self-care intentions and behaviours in populations with and at-risk of diabetes. Methods A systematic review using six electronic databases was conducted in 2013. A standardised protocol was used for appraisal. Studies eligibility included a measure of behaviour for healthy eating, physical activity, glucose monitoring, medication use (ii) the TPB variables (iii) the TPB tested in populations with diabetes or at-risk. Results Sixteen studies were appraised for testing the utility of the TPB. Studies included cross-sectional (n = 7); prospective (n = 5) and randomised control trials (n = 4). Intention (18%–76%) was the most predictive construct for all behaviours. Explained variance for intentions was similar across cross-sectional (28–76%); prospective (28–73%); and RCT studies (18–63%). RCTs (18–43%) provided slightly stronger evidence for predicting behaviour. Conclusions Few studies tested predictability of the TPB in populations with or at-risk of diabetes. This review highlighted differences in the predictive utility of the TPB suggesting that the model is behaviour and population specific. Findings on key determinants of specific behaviours contribute to a better understanding of mechanisms of behaviour change and are useful in designing targeted behavioural interventions for different diabetes populations. PMID:26844083

  2. Improving prediction of outcomes in African Americans with normal stress echocardiograms using a risk scoring system.

    PubMed

    Sutter, David A; Thomaides, Athanasios; Hornsby, Kyle; Mahenthiran, Jothiharan; Feigenbaum, Harvey; Sawada, Stephen G

    2013-06-01

    Cardiovascular mortality is high in African Americans, and those with normal results on stress echocardiography remain at increased risk. The aim of this study was to develop a risk scoring system to improve the prediction of cardiovascular events in African Americans with normal results on stress echocardiography. Clinical data and rest echocardiographic measurements were obtained in 548 consecutive African Americans with normal results on rest and stress echocardiography and ejection fractions ≥50%. Patients were followed for myocardial infarction and death for 3 years. Predictors of cardiovascular events were determined with Cox regression, and hazard ratios were used to determine the number of points in the risk score attributed to each independent predictor. During follow-up of 3 years, 47 patients (8.6%) had events. Five variables-age (≥45 years in men, ≥55 years in women), history of coronary disease, history of smoking, left ventricular hypertrophy, and exercise intolerance (<7 METs in men, <5 METs in women, or need for dobutamine stress)-were independent predictors of events. A risk score was derived for each patient (ranging from 0 to 8 risk points). The area under the curve for the risk score was 0.82 with the optimum cut-off risk score of 6. Among patients with risk scores ≥6, 30% had events, compared with 3% with risk score <6 (p <0.001). In conclusion, African Americans with normal results on stress echocardiography remain at significant risk for cardiovascular events. A risk score can be derived from clinical and echocardiographic variables, which can accurately distinguish high- and low-risk patients.

  3. Prediction of high-risk types of human papillomaviruses using statistical model of protein "sequence space".

    PubMed

    Wang, Cong; Hai, Yabing; Liu, Xiaoqing; Liu, Nanfang; Yao, Yuhua; He, Pingan; Dai, Qi

    2015-01-01

    Discrimination of high-risk types of human papillomaviruses plays an important role in the diagnosis and remedy of cervical cancer. Recently, several computational methods have been proposed based on protein sequence-based and structure-based information, but the information of their related proteins has not been used until now. In this paper, we proposed using protein "sequence space" to explore this information and used it to predict high-risk types of HPVs. The proposed method was tested on 68 samples with known HPV types and 4 samples without HPV types and further compared with the available approaches. The results show that the proposed method achieved the best performance among all the evaluated methods with accuracy 95.59% and F1-score 90.91%, which indicates that protein "sequence space" could potentially be used to improve prediction of high-risk types of HPVs.

  4. A Permutation Method to Assess Heterogeneity in External Validation for Risk Prediction Models

    PubMed Central

    Wang, Ling-Yi; Lee, Wen-Chung

    2015-01-01

    The value of a developed prediction model depends on its performance outside the development sample. The key is therefore to externally validate the model on a different but related independent data. In this study, we propose a permutation method to assess heterogeneity in external validation for risk prediction models. The permutation p value measures the extent of homology between development and validation datasets. If p < 0.05, the model may not be directly transported to the external validation population without further revision or updating. Monte-Carlo simulations are conducted to evaluate the statistical properties of the proposed method, and two microarray breast cancer datasets are analyzed for demonstration. The permutation method is easy to implement and is recommended for routine use in external validation for risk prediction models. PMID:25606854

  5. Predicting the number of cases of dengue infection in Ribeirão Preto, São Paulo State, Brazil, using a SARIMA model.

    PubMed

    Martinez, Edson Zangiacomi; Silva, Elisângela Aparecida Soares da

    2011-09-01

    This study aimed to develop a forecasting model for the incidence of dengue in Ribeirão Preto, São Paulo State, Brazil, using time series analysis. The model was performed using the Seasonal Autoregressive Integrated Moving Average (SARIMA). Firstly, we fitted a model considering monthly notifications of cases of dengue recorded from 2000 to 2008 in Ribeirão Preto. We then extracted predicted values for 2009 from the adjusted model and compared them with the number of cases observed for that year. The SARIMA (2,1,3)(1,1,1)12 model offered best fit for the dengue incidence data. The results showed that the seasonal ARIMA model predicts the number of dengue cases very effectively and reliably, and is a useful tool for disease control and prevention. PMID:21986608

  6. At risk or not at risk? A meta-analysis of the prognostic accuracy of psychometric interviews for psychosis prediction.

    PubMed

    Fusar-Poli, Paolo; Cappucciati, Marco; Rutigliano, Grazia; Schultze-Lutter, Frauke; Bonoldi, Ilaria; Borgwardt, Stefan; Riecher-Rössler, Anita; Addington, Jean; Perkins, Diana; Woods, Scott W; McGlashan, Thomas H; Lee, Jimmy; Klosterkötter, Joachim; Yung, Alison R; McGuire, Philip

    2015-10-01

    An accurate detection of individuals at clinical high risk (CHR) for psychosis is a prerequisite for effective preventive interventions. Several psychometric interviews are available, but their prognostic accuracy is unknown. We conducted a prognostic accuracy meta-analysis of psychometric interviews used to examine referrals to high risk services. The index test was an established CHR psychometric instrument used to identify subjects with and without CHR (CHR+ and CHR-). The reference index was psychosis onset over time in both CHR+ and CHR- subjects. Data were analyzed with MIDAS (STATA13). Area under the curve (AUC), summary receiver operating characteristic curves, quality assessment, likelihood ratios, Fagan's nomogram and probability modified plots were computed. Eleven independent studies were included, with a total of 2,519 help-seeking, predominately adult subjects (CHR+: N=1,359; CHR-: N=1,160) referred to high risk services. The mean follow-up duration was 38 months. The AUC was excellent (0.90; 95% CI: 0.87-0.93), and comparable to other tests in preventive medicine, suggesting clinical utility in subjects referred to high risk services. Meta-regression analyses revealed an effect for exposure to antipsychotics and no effects for type of instrument, age, gender, follow-up time, sample size, quality assessment, proportion of CHR+ subjects in the total sample. Fagan's nomogram indicated a low positive predictive value (5.74%) in the general non-help-seeking population. Albeit the clear need to further improve prediction of psychosis, these findings support the use of psychometric prognostic interviews for CHR as clinical tools for an indicated prevention in subjects seeking help at high risk services worldwide. PMID:26407788

  7. At risk or not at risk? A meta-analysis of the prognostic accuracy of psychometric interviews for psychosis prediction

    PubMed Central

    Fusar-Poli, Paolo; Cappucciati, Marco; Rutigliano, Grazia; Schultze-Lutter, Frauke; Bonoldi, Ilaria; Borgwardt, Stefan; Riecher-Rössler, Anita; Addington, Jean; Perkins, Diana; Woods, Scott W; McGlashan, Thomas H; Lee, Jimmy; Klosterkötter, Joachim; Yung, Alison R; McGuire, Philip

    2015-01-01

    An accurate detection of individuals at clinical high risk (CHR) for psychosis is a prerequisite for effective preventive interventions. Several psychometric interviews are available, but their prognostic accuracy is unknown. We conducted a prognostic accuracy meta-analysis of psychometric interviews used to examine referrals to high risk services. The index test was an established CHR psychometric instrument used to identify subjects with and without CHR (CHR+ and CHR−). The reference index was psychosis onset over time in both CHR+ and CHR− subjects. Data were analyzed with MIDAS (STATA13). Area under the curve (AUC), summary receiver operating characteristic curves, quality assessment, likelihood ratios, Fagan’s nomogram and probability modified plots were computed. Eleven independent studies were included, with a total of 2,519 help-seeking, predominately adult subjects (CHR+: N=1,359; CHR−: N=1,160) referred to high risk services. The mean follow-up duration was 38 months. The AUC was excellent (0.90; 95% CI: 0.87-0.93), and comparable to other tests in preventive medicine, suggesting clinical utility in subjects referred to high risk services. Meta-regression analyses revealed an effect for exposure to antipsychotics and no effects for type of instrument, age, gender, follow-up time, sample size, quality assessment, proportion of CHR+ subjects in the total sample. Fagan’s nomogram indicated a low positive predictive value (5.74%) in the general non-help-seeking population. Albeit the clear need to further improve prediction of psychosis, these findings support the use of psychometric prognostic interviews for CHR as clinical tools for an indicated prevention in subjects seeking help at high risk services worldwide. PMID:26407788

  8. Pretreatment Nomogram to Predict the Risk of Acute Urinary Retention After I-125 Prostate Brachytherapy

    SciTech Connect

    Roeloffzen, Ellen M.; Vulpen, Marco van; Battermann, Jan J.; Roermund, Joep G. van; Saibishkumar, Elantholi P.; Monninkhof, Evelyn M.

    2011-11-01

    Purpose: Acute urinary retention (AUR) after iodine-125 (I-125) prostate brachytherapy negatively influences long-term quality of life and therefore should be prevented. We aimed to develop a nomogram to preoperatively predict the risk of AUR. Methods: Using the preoperative data of 714 consecutive patients who underwent I-125 prostate brachytherapy between 2005 and 2008 at our department, we modeled the probability of AUR. Multivariate logistic regression analysis was used to assess the predictive ability of a set of pretreatment predictors and the additional value of a new risk factor (the extent of prostate protrusion into the bladder). The performance of the final model was assessed with calibration and discrimination measures. Results: Of the 714 patients, 57 patients (8.0%) developed AUR after implantation. Multivariate analysis showed that the combination of prostate volume, IPSS score, neoadjuvant hormonal treatment and the extent of prostate protrusion contribute to the prediction of AUR. The discriminative value (receiver operator characteristic area, ROC) of the basic model (including prostate volume, International Prostate Symptom Score, and neoadjuvant hormonal treatment) to predict the development of AUR was 0.70. The addition of prostate protrusion significantly increased the discriminative power of the model (ROC 0.82). Calibration of this final model was good. The nomogram showed that among patients with a low sum score (<18 points), the risk of AUR was only 0%-5%. However, in patients with a high sum score (>35 points), the risk of AUR was more than 20%. Conclusion: This nomogram is a useful tool for physicians to predict the risk of AUR after I-125 prostate brachytherapy. The nomogram can aid in individualized treatment decision-making and patient counseling.

  9. Net reclassification indices for evaluating risk prediction instruments: a critical review.

    PubMed

    Kerr, Kathleen F; Wang, Zheyu; Janes, Holly; McClelland, Robyn L; Psaty, Bruce M; Pepe, Margaret S

    2014-01-01

    Net reclassification indices have recently become popular statistics for measuring the prediction increment of new biomarkers. We review the various types of net reclassification indices and their correct interpretations. We evaluate the advantages and disadvantages of quantifying the prediction increment with these indices. For predefined risk categories, we relate net reclassification indices to existing measures of the prediction increment. We also consider statistical methodology for constructing confidence intervals for net reclassification indices and evaluate the merits of hypothesis testing based on such indices. We recommend that investigators using net reclassification indices should report them separately for events (cases) and nonevents (controls). When there are two risk categories, the components of net reclassification indices are the same as the changes in the true- and false-positive rates. We advocate the use of true- and false-positive rates and suggest it is more useful for investigators to retain the existing, descriptive terms. When there are three or more risk categories, we recommend against net reclassification indices because they do not adequately account for clinically important differences in shifts among risk categories. The category-free net reclassification index is a new descriptive device designed to avoid predefined risk categories. However, it experiences many of the same problems as other measures such as the area under the receiver operating characteristic curve. In addition, the category-free index can mislead investigators by overstating the incremental value of a biomarker, even in independent validation data. When investigators want to test a null hypothesis of no prediction increment, the well-established tests for coefficients in the regression model are superior to the net reclassification index. If investigators want to use net reclassification indices, confidence intervals should be calculated using bootstrap methods

  10. Net Reclassification Indices for Evaluating Risk-Prediction Instruments: A Critical Review

    PubMed Central

    Kerr, Kathleen F.; Wang, Zheyu; Janes, Holly; McClelland, Robyn L.; Psaty, Bruce M.; Pepe, Margaret S.

    2014-01-01

    Net reclassification indices have recently become popular statistics for measuring the prediction increment of new biomarkers. We review the various types of net reclassification indices and their correct interpretations. We evaluate the advantages and disadvantages of quantifying the prediction increment with these indices. For pre-defined risk categories, we relate net reclassification indices to existing measures of the prediction increment. We also consider statistical methodology for constructing confidence intervals for net reclassification indices and evaluate the merits of hypothesis testing based on such indices. We recommend that investigators using net reclassification indices should report them separately for events (cases) and nonevents (controls). When there are two risk categories, the components of net reclassification indices are the same as the changes in the true-positive and false-positive rates. We advocate use of true- and false-positive rates and suggest it is more useful for investigators to retain the existing, descriptive terms. When there are three or more risk categories, we recommend against net reclassification indices because they do not adequately account for clinically important differences in shifts among risk categories. The category-free net reclassification index is a new descriptive device designed to avoid pre-defined risk categories. However, it suffers from many of the same problems as other measures such as the area under the receiver operating characteristic curve. In addition, the category-free index can mislead investigators by overstating the incremental value of a biomarker, even in independent validation data. When investigators want to test a null hypothesis of no prediction increment, the well-established tests for coefficients in the regression model are superior to the net reclassification index. If investigators want to use net reclassification indices, confidence intervals should be calculated using bootstrap

  11. An Update on the Utility of Coronary Artery Calcium Scoring for Coronary Heart Disease and Cardiovascular Disease Risk Prediction.

    PubMed

    Kianoush, Sina; Al Rifai, Mahmoud; Cainzos-Achirica, Miguel; Umapathi, Priya; Graham, Garth; Blumenthal, Roger S; Nasir, Khurram; Blaha, Michael J

    2016-03-01

    Estimating cardiovascular disease (CVD) risk is necessary for determining the potential net benefit of primary prevention pharmacotherapy. Risk estimation relying exclusively on traditional CVD risk factors may misclassify risk, resulting in both undertreatment and overtreatment. Coronary artery calcium (CAC) scoring personalizes risk prediction through direct visualization of calcified coronary atherosclerotic plaques and provides improved accuracy for coronary heart disease (CHD) or CVD risk estimation. In this review, we discuss the most recent studies on CAC, which unlike historical studies, focus sharply on clinical application. We describe the MESA CHD risk calculator, a recently developed CAC-based 10-year CHD risk estimator, which can help guide preventive therapy allocation by better identifying both high- and low-risk individuals. In closing, we discuss calcium density, regional distribution of CAC, and extra-coronary calcification, which represent the future of CAC and CVD risk assessment research and may lead to further improvements in risk prediction.

  12. Schistosomiasis risk estimation in Minas Gerais State, Brazil, using environmental data and GIS techniques.

    PubMed

    Guimarães, Ricardo J P S; Freitas, Corina C; Dutra, Luciano V; Moura, Ana C M; Amaral, Ronaldo S; Drummond, Sandra C; Scholte, Ronaldo G C; Carvalho, Omar S

    2008-01-01

    The influence of climate and environmental variables to the distribution of schistosomiasis has been assessed in several previous studies. Also Geographical Information System (GIS), is a tool that has been recently tested for better understanding the spatial disease distribution. The objective of this paper is to further develop the GIS technology for modeling and control of schistosomiasis using meteorological and social variables and introducing new potential environmental-related variables, particularly those produced by recently launched orbital sensors like the Moderate Resolution Imaging Spectroradiometer (MODIS) and the Shuttle Radar Topography Mission (SRTM). Three different scenarios have been analyzed, and despite of not quite large determination factor, the standard deviation of risk estimates was considered adequate for public health needs. The main variables selected as important for modeling purposes was topographic elevation, summer minimum temperature, the NDVI vegetation index, and the social index HDI91. PMID:18692017

  13. Prediction of cardiovascular disease risk among low-income urban dwellers in metropolitan Kuala Lumpur, Malaysia.

    PubMed

    Su, Tin Tin; Amiri, Mohammadreza; Mohd Hairi, Farizah; Thangiah, Nithiah; Bulgiba, Awang; Majid, Hazreen Abdul

    2015-01-01

    We aimed to predict the ten-year cardiovascular disease (CVD) risk among low-income urban dwellers of metropolitan Malaysia. Participants were selected from a cross-sectional survey conducted in Kuala Lumpur. To assess the 10-year CVD risk, we employed the Framingham risk scoring (FRS) models. Significant determinants of the ten-year CVD risk were identified using General Linear Model (GLM). Altogether 882 adults (≥30 years old with no CVD history) were randomly selected. The classic FRS model (figures in parentheses are from the modified model) revealed that 20.5% (21.8%) and 38.46% (38.9%) of respondents were at high and moderate risk of CVD. The GLM models identified the importance of education, occupation, and marital status in predicting the future CVD risk. Our study indicated that one out of five low-income urban dwellers has high chance of having CVD within ten years. Health care expenditure, other illness related costs and loss of productivity due to CVD would worsen the current situation of low-income urban population. As such, the public health professionals and policy makers should establish substantial effort to formulate the public health policy and community-based intervention to minimize the upcoming possible high mortality and morbidity due to CVD among the low-income urban dwellers. PMID:25821810

  14. Prediction of cardiovascular disease risk among low-income urban dwellers in metropolitan Kuala Lumpur, Malaysia.

    PubMed

    Su, Tin Tin; Amiri, Mohammadreza; Mohd Hairi, Farizah; Thangiah, Nithiah; Bulgiba, Awang; Majid, Hazreen Abdul

    2015-01-01

    We aimed to predict the ten-year cardiovascular disease (CVD) risk among low-income urban dwellers of metropolitan Malaysia. Participants were selected from a cross-sectional survey conducted in Kuala Lumpur. To assess the 10-year CVD risk, we employed the Framingham risk scoring (FRS) models. Significant determinants of the ten-year CVD risk were identified using General Linear Model (GLM). Altogether 882 adults (≥30 years old with no CVD history) were randomly selected. The classic FRS model (figures in parentheses are from the modified model) revealed that 20.5% (21.8%) and 38.46% (38.9%) of respondents were at high and moderate risk of CVD. The GLM models identified the importance of education, occupation, and marital status in predicting the future CVD risk. Our study indicated that one out of five low-income urban dwellers has high chance of having CVD within ten years. Health care expenditure, other illness related costs and loss of productivity due to CVD would worsen the current situation of low-income urban population. As such, the public health professionals and policy makers should establish substantial effort to formulate the public health policy and community-based intervention to minimize the upcoming possible high mortality and morbidity due to CVD among the low-income urban dwellers.