Sample records for considerably increased risk

  1. Management of Cardiovascular Risk in Patients with Chronic Inflammatory Diseases: Current Evidence and Future Perspectives.

    PubMed

    Lindhardsen, Jesper; Kristensen, Søren Lund; Ahlehoff, Ole

    2016-02-01

    An increased risk of cardiovascular disease (CVD) has been observed in a range of chronic inflammatory diseases (CID), including rheumatoid arthritis (RA), psoriasis, inflammatory bowel diseases (IBD), and systemic lupus erythematosus (SLE). The increased risk of CVDs and reduced life expectancy in these conditions has stimulated considerable research and started an ongoing discussion on the need for a multidisciplinary approach and dedicated guidelines on CVD prevention in these patients. In addition, the possibility of inhibiting inflammation as a means to preventing CVD in these patients has gained considerable interest in recent years. We briefly summarize the current level of evidence of the association between CIDs and CVD and cardiovascular risk management recommendations. Perspectives of ongoing and planned trials are discussed in consideration of potential ways to improve primary and secondary CVD prevention in patients with CID.

  2. Relationship of nutritional risk, Body Mass Index (BMI), and cognitive functioning in preschoolers

    USDA-ARS?s Scientific Manuscript database

    Objective: To determine the relationships, if any, between nutritional risk, BMI z-score, and cognitive function in preschoolers. Background: Excessive adipose tissue found in obesity places children at increased health risk. Considerable research has documented that obesity leads to increased ri...

  3. Cigarette graphic warning labels increase both risk perceptions and smoking myth endorsement.

    PubMed

    Evans, Abigail T; Peters, Ellen; Shoben, Abigail B; Meilleur, Louise R; Klein, Elizabeth G; Tompkins, Mary Kate; Tusler, Martin

    2018-02-01

    Cigarette graphic warning labels elicit negative emotion, which increases risk perceptions through multiple processes. We examined whether this emotion simultaneously affects motivated cognitions like smoking myth endorsement (e.g. 'exercise can undo the negative effects of smoking') and perceptions of cigarette danger versus other products. 736 adult and 469 teen smokers/vulnerable smokers viewed one of three warning label types (text-only, low emotion graphic or high emotion graphic) four times over two weeks. Emotional reactions to the warnings were reported during the first and fourth exposures. Participants reported how often they considered the warnings, smoking myth endorsement, risk perceptions and perceptions of cigarette danger relative to smokeless tobacco and electronic cigarettes. In structural equation models, emotional reactions influenced risk perceptions and smoking myth endorsement through two processes. Emotion acted as information about risk, directly increasing smoking risk perceptions and decreasing smoking myth endorsement. Emotion also acted as a spotlight, motivating consideration of the warning information. Warning consideration increased risk perceptions, but also increased smoking myth endorsement. Emotional reactions to warnings decreased perceptions of cigarette danger relative to other products. Emotional reactions to cigarette warnings increase smoking risk perceptions, but also smoking myth endorsement and misperceptions that cigarettes are less dangerous than potentially harm-reducing tobacco products.

  4. Chemical Mixtures and Epidemiologic Fundamentals for Risk Assessment Applications

    EPA Science Inventory

    Risk management options are increasingly being considered early in the risk assessment process to help scope the considerations and bound the inherent complexities related to potential exposures, risk and future clean-up decisions (including acceptable pollutant levels) related t...

  5. Cost-oriented evaluation of ecosystem services under consideration of income risks and risk attitudes of farmers.

    PubMed

    Dörschner, T; Musshoff, O

    2013-09-30

    Agri-environmental measures are often not as accepted among farmers as is expected. The present study investigates whether changes in income risks and the individual risk attitudes of farmers may constitute an explanatory approach for the low acceptance of the measures. For this purpose, a normative model is developed that calculates the premia claimed by the farmers for adopting environmental measures under the consideration of income risks and different risk attitudes. We apply this model to environmental measures aiming at an increase of the faunistic diversity of species on grassland and showing that changes in income risks and the decision makers' risk attitudes can significantly influence farmers' minimum compensation claims. Copyright © 2013 Elsevier Ltd. All rights reserved.

  6. Multidecadal Scale Detection Time for Potentially Increasing Atlantic Storm Surges in a Warming Climate

    NASA Astrophysics Data System (ADS)

    Lee, Benjamin Seiyon; Haran, Murali; Keller, Klaus

    2017-10-01

    Storm surges are key drivers of coastal flooding, which generate considerable risks. Strategies to manage these risks can hinge on the ability to (i) project the return periods of extreme storm surges and (ii) detect potential changes in their statistical properties. There are several lines of evidence linking rising global average temperatures and increasingly frequent extreme storm surges. This conclusion is, however, subject to considerable structural uncertainty. This leads to two main questions: What are projections under various plausible statistical models? How long would it take to distinguish among these plausible statistical models? We address these questions by analyzing observed and simulated storm surge data. We find that (1) there is a positive correlation between global mean temperature rise and increasing frequencies of extreme storm surges; (2) there is considerable uncertainty underlying the strength of this relationship; and (3) if the frequency of storm surges is increasing, this increase can be detected within a multidecadal timescale (≈20 years from now).

  7. Aspirin for Primary Prevention.

    PubMed

    Richman, Ilana B; Owens, Douglas K

    2017-07-01

    Aspirin reduces the risk of nonfatal myocardial infarction and stroke, and the risk of colorectal cancer. Aspirin increases the risk of gastrointestinal and intracranial bleeding. The best available evidence supports initiating aspirin in select populations. In 2016, the US Preventive Services Task Force recommended initiating aspirin for the primary prevention of both cardiovascular disease and colorectal cancer among adults ages 50 to 59 who are at increased risk for cardiovascular disease. Adults 60 to 69 who are at increased cardiovascular disease risk may also benefit. There remains considerable uncertainty about whether younger and older patients may benefit. Copyright © 2017 Elsevier Inc. All rights reserved.

  8. Discotheques and the Risk of Hearing Loss among Youth: Risky Listening Behavior and Its Psychosocial Correlates

    ERIC Educational Resources Information Center

    Vogel, Ineke; Brug, Johannes; Van Der Ploeg, Catharina P. B.; Raat, Hein

    2010-01-01

    There is an increasing population at risk of hearing loss and tinnitus due to increasing high-volume music listening. To inform prevention strategies and interventions, this study aimed to identify important protection motivation theory-based constructs as well as the constructs "consideration of future consequences" and "habit…

  9. Attending physician work hours: ethical considerations and the last doctor standing.

    PubMed

    Mercurio, Mark R; Peterec, Steven M

    2009-08-01

    Based at least in part on concerns for patient safety and evidence that long shifts are associated with an increased risk of physician error, residents' and fellows' work hours have been strictly limited for the past several years. Little attention has been paid, however, to excessive attending physician shift duration, although there seems to be no reason to assume that this common practice poses any less risk to patients. Potential justifications for allowing attending physicians to work without hourly limits include physician autonomy, workforce shortages in certain communities or subspecialties, continuity of care, and financial considerations. None of these clearly justify the apparent increased risk to patients, with the exception in some settings of workforce shortage. In many hospital settings, the practice of allowing attending physicians to work with no limit on shift duration could pose an unnecessary risk to patients.

  10. The epigenetic effects of assisted reproductive technologies: ethical considerations.

    PubMed

    Roy, M-C; Dupras, C; Ravitsky, V

    2017-08-01

    The use of assisted reproductive technologies (ART) has increased significantly, allowing many coping with infertility to conceive. However, an emerging body of evidence suggests that ART could carry epigenetic risks for those conceived through the use of these technologies. In accordance with the Developmental Origins of Health and Disease hypothesis, ART could increase the risk of developing late-onset diseases through epigenetic mechanisms, as superovulation, fertilization methods and embryo culture could impair the embryo's epigenetic reprogramming. Such epigenetic risks raise ethical issues for all stakeholders: prospective parents and children, health professionals and society. This paper focuses on ethical issues raised by the consideration of these risks when using ART. We apply two key ethical principles of North American bioethics (respect for autonomy and non-maleficence) and suggest that an ethical tension may emerge from conflicting duties to promote the reproductive autonomy of prospective parents on one hand, and to minimize risks to prospective children on the other. We argue that this tension is inherent to the entire enterprise of ART and thus cannot be addressed by individual clinicians in individual cases. We also consider the implications of the 'non-identity problem' in this context. We call for additional research that would allow a more robust evidence base for policy. We also call upon professional societies to provide clinicians with guidelines and educational resources to facilitate the communication of epigenetic risks associated with ART to patients, taking into consideration the challenges of communicating risk information whose validity is still uncertain.

  11. Risk factors for asthma and timing of exposure among first generation Arab immigrants: a pilot effort to elucidate the role of exposure to risk factors over multiple life stages

    EPA Science Inventory

    Considerable controversy exists over the role of aero-allergens in asthma etiology. Some studies show increased risk with microbe and allergen exposure, while others show decreased risk. These discrepancies may be explained by timing of exposure. Previous research suggests that e...

  12. Priorities for autism spectrum disorder risk communication and ethics.

    PubMed

    Yudell, Michael; Tabor, Holly K; Dawson, Geraldine; Rossi, John; Newschaffer, Craig

    2013-11-01

    Autism spectrum disorders are an issue of increasing public health significance. The incidence of autism spectrum disorders has been increasing in recent years, and they are associated with significant personal and financial impacts for affected persons and their families. In recent years, a large number of scientific studies have been undertaken, which investigate genetic and environmental risk factors for autism, with more studies underway. At present, much remains unknown regarding autism spectrum disorder risk factors, but the emerging picture of causation is in many cases complex, with multiple genes and gene-environment interactions being at play. The complexity and uncertainty surrounding autism spectrum disorder risk factors raise a number of questions regarding the ethical considerations that should be taken into account when undertaking autism spectrum disorder risk communication. At present, however, little has been written regarding autism spectrum disorder risk communication and ethics. This article summarizes the findings of a recent conference investigating ethical considerations and policy recommendations in autism spectrum disorder risk communication, which to the authors' knowledge is the first of its kind. Here, the authors discuss a number of issues, including uncertainty; comprehension; inadvertent harm; justice; and the appropriate roles of clinicians, scientists, and the media in autism spectrum disorder risk communication.

  13. The changing epidemiology of oral diseases in the elderly, their growing importance for care and how they can be managed.

    PubMed

    Batchelor, Paul

    2015-11-01

    This article provides an overview of the changing epidemiology of oral diseases and the impacts for the population. Considerable improvements have occurred in oral health, and many more people are retaining teeth for longer. However, the conditions of teeth and mouth are varied, and all older people are at risk of future oral disease. With the increased prevalence of other more general health conditions, the risks of poor oral health are increasing. Poor oral health gives rise to considerable problems that impact both on an individual's well-being and qualities of life as well as increasing the risks of general health issues. To ensure that the risks of such adverse impacts are minimised, a more collaborative approach involving all care workers is required, addressing the determinants of health and ensuring that better care management arrangements for older people are developed. © The Author 2015. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  14. Genetic predisposition to schizophrenia associated with increased use of cannabis

    PubMed Central

    Power, Robert A.; Verweij, Karin J.H.; Zuhair, Mohamed; Montgomery, Grant W.; Henders, Anjali K.; Heath, Andrew C.; Madden, Pamela A.F.; Medland, Sarah E.; Wray, Naomi R.; Martin, Nicholas G.

    2015-01-01

    Cannabis is the most commonly used illicit drug worldwide. With debate surrounding the legalization and control of use, investigating its health risks has become a pressing area of research. One established association is that between cannabis use and schizophrenia, a debilitating psychiatric disorder affecting approximately 1% of the population over their lifetime. Although considerable evidence implicates cannabis use as a component cause of schizophrenia, it remains unclear whether this is entirely due to cannabis directly raising risk of psychosis, or whether the same genes that increases psychosis risk may also increase risk of cannabis use. In a sample of 2,082 healthy individuals, we show an association between an individual’s burden of schizophrenia risk alleles and use of cannabis. This was significant both for comparing those who have ever vs. never used cannabis (p=2.6×10−4), and for quantity of use within users (p=3.0×10−3). While directly predicting only a small amount of the variance in cannabis use, these findings suggest that part of the association between schizophrenia and cannabis is due to a shared genetic aetiology. This form of gene-environment correlation is an important consideration when calculating the impact of environmental risk factors, including cannabis use. PMID:24957864

  15. Injury and Inclusion: Understanding Common Legal Concerns in Physical Education

    ERIC Educational Resources Information Center

    McCoy, Lauren; Esslinger, Keri; Baghurst, Timothy

    2017-01-01

    Physical education teachers are often focused on the many benefits of physical education to students, but there must also be a consideration of risk. How can the risks in physical education be minimized to maximize the benefits? One way to accomplish this goal is to increase physical educators' understanding of the legal risks related to…

  16. Risk perceptions for avian influenza virus infection among poultry workers, China.

    PubMed

    Yu, Qi; Liu, Linqing; Pu, Juan; Zhao, Jingyi; Sun, Yipeng; Shen, Guangnian; Wei, Haitao; Zhu, Junjie; Zheng, Ruifeng; Xiong, Dongyan; Liu, Xiaodong; Liu, Jinhua

    2013-02-01

    To determine risk for avian influenza virus infection, we conducted serologic surveillance for H5 and H9 subtypes among poultry workers in Beijing, China, 2009-2010, and assessed workers' understanding of avian influenza. We found that poultry workers had considerable risk for infection with H9 subtypes. Increasing their knowledge could prevent future infections.

  17. Changing the paradigm of organ utilization from PHS increased-risk donors: an opportunity whose time has come?

    PubMed

    Sibulesky, Lena; Javed, Imran; Reyes, Jorge D; Limaye, Ajit P

    2015-09-01

    Approximately 8-11% of all organ donors are classified by Public Health Service (PHS) as increased-risk. The proportion of PHS increased-risk donors is on the rise. At the University of Washington Medical Center, in 2014, the proportion of transplants from PHS increased-risk donors was 28% of liver transplants and 23% of kidney transplants. Nationally, transplant providers have been reluctant to use organs from PHS increased-risk donors because of concern for transmission of HIV, HCV, or HBV. There is also patient apprehension when these organs are being offered, and thus the discard rate of these otherwise good quality organs is high. Because of the organ shortage, preventing underutilization of such organs is essential. We provide data and considerations that should be used to guide the use of organs from PHS increased-risk donors. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  18. Risk management consideration in the bioeconomy

    Treesearch

    Camilla Abbati de Assis; Ronalds Gonzalez; Stephen Kelley; Hasan Jameel; Ted Bilek; Jesse Daystar; Robert Handfield; Jay Golden; Jeff Prestemon; Damien Singh

    2017-01-01

    In investing in a new venture, companies aim to increase their competitiveness and generate value in scenarios where volatile markets, geopolitical instabilities, and disruptive technologies create uncertainty and risk. The biobased industry poses additional challenges as it competes in a mature, highly efficient market, dominated by...

  19. Hispanic Americans living in the United States and their risk for obesity, diabetes and kidney disease: Genetic and environmental considerations.

    PubMed

    Yracheta, Joseph M; Alfonso, Javier; Lanaspa, Miguel A; Roncal-Jimenez, Carlos; Johnson, Sarah B; Sánchez-Lozada, Laura G; Johnson, Richard J

    2015-06-01

    The Hispanic American, the largest minority population in the United States, is at increased risk for obesity, diabetes and end-stage renal disease. Here we review genetic and environmental factors that might account for their increased risk for these conditions. Whereas many environmental and genetic factors have important roles in driving the increased risk for obesity and kidney disease in this population, a case is made that excessive intake of sugary beverages is a contributory cause. Studies focusing on decreasing intake of sugary beverages among the Hispanic American could potentially reduce renal and cardiovascular complications in this population.

  20. Workplace Violence: Practical Considerations for Mental Health Professionals in Consultation, Assessment, and Management of Risk.

    PubMed

    Saragoza, Philip; White, Stephen G

    2016-12-01

    Workplace predatory violence has been the focus of increased study over the past 30 years, leading to a more sophisticated understanding of the factors that contribute to it, and important considerations for its assessment and management. Risk assessment professionals involved in workplace violence consultations should be mindful of issues specific to the workplace context and the principles of threat assessment to provide a more precise opinion of risk, to inform and enhance critical decisions regarding the employment status of the individual of concern, security measures, possible treatment options, and other management responses, while being mindful of the employee's certain rights. Copyright © 2016 Elsevier Inc. All rights reserved.

  1. Hopelessness and Lack of Connectedness to Others as Risk Factors for Suicidal Behavior across the Lifespan: Implications for Cognitive-Behavioral Treatment

    ERIC Educational Resources Information Center

    Daniel, Stephanie S.; Goldston, David B.

    2012-01-01

    The rates of suicide attempts and death by suicide vary considerably over the lifespan, highlighting the influence of different contextual, risk, and protective factors at different points in development (Daniel & Goldston, 2009). Hopelessness and lack of connectedness to others are two factors that have been associated with increased risk for…

  2. Risk-adjusted Outcomes of Clinically Relevant Pancreatic Fistula Following Pancreatoduodenectomy: A Model for Performance Evaluation.

    PubMed

    McMillan, Matthew T; Soi, Sameer; Asbun, Horacio J; Ball, Chad G; Bassi, Claudio; Beane, Joal D; Behrman, Stephen W; Berger, Adam C; Bloomston, Mark; Callery, Mark P; Christein, John D; Dixon, Elijah; Drebin, Jeffrey A; Castillo, Carlos Fernandez-Del; Fisher, William E; Fong, Zhi Ven; House, Michael G; Hughes, Steven J; Kent, Tara S; Kunstman, John W; Malleo, Giuseppe; Miller, Benjamin C; Salem, Ronald R; Soares, Kevin; Valero, Vicente; Wolfgang, Christopher L; Vollmer, Charles M

    2016-08-01

    To evaluate surgical performance in pancreatoduodenectomy using clinically relevant postoperative pancreatic fistula (CR-POPF) occurrence as a quality indicator. Accurate assessment of surgeon and institutional performance requires (1) standardized definitions for the outcome of interest and (2) a comprehensive risk-adjustment process to control for differences in patient risk. This multinational, retrospective study of 4301 pancreatoduodenectomies involved 55 surgeons at 15 institutions. Risk for CR-POPF was assessed using the previously validated Fistula Risk Score, and pancreatic fistulas were stratified by International Study Group criteria. CR-POPF variability was evaluated and hierarchical regression analysis assessed individual surgeon and institutional performance. There was considerable variability in both CR-POPF risk and occurrence. Factors increasing the risk for CR-POPF development included increasing Fistula Risk Score (odds ratio 1.49 per point, P < 0.00001) and octreotide (odds ratio 3.30, P < 0.00001). When adjusting for risk, performance outliers were identified at the surgeon and institutional levels. Of the top 10 surgeons (≥15 cases) for nonrisk-adjusted performance, only 6 remained in this high-performing category following risk adjustment. This analysis of pancreatic fistulas following pancreatoduodenectomy demonstrates considerable variability in both the risk and occurrence of CR-POPF among surgeons and institutions. Disparities in patient risk between providers reinforce the need for comprehensive, risk-adjusted modeling when assessing performance based on procedure-specific complications. Furthermore, beyond inherent patient risk factors, surgical decision-making influences fistula outcomes.

  3. Section summary: Uncertainty and design considerations

    Treesearch

    Stephen Hagen

    2013-01-01

    Well planned sampling designs and robust approaches to estimating uncertainty are critical components of forest monitoring. The importance of uncertainty estimation increases as deforestation and degradation issues become more closely tied to financing incentives for reducing greenhouse gas emissions in the forest sector. Investors like to know risk and risk is tightly...

  4. Thinking about Feelings: Emotion Focus in the Parenting of Children with Early Developmental Risk

    ERIC Educational Resources Information Center

    Baker, J. K.; Crnic, K. A.

    2009-01-01

    Background: Children with developmental delays exhibit more difficulty with certain emotional processes than their typically developing peers, which seems to partially account for the increased risk for the development of social problems in this population. Despite considerable study with typically developing populations, research on parental…

  5. 40 CFR 1074.105 - Criteria for granting authorization.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... horsepower, the Administrator will give appropriate consideration to safety factors (including the potential increased risk of burn or fire) associated with compliance with the California standard. ...

  6. 40 CFR 1074.105 - Criteria for granting authorization.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... horsepower, the Administrator will give appropriate consideration to safety factors (including the potential increased risk of burn or fire) associated with compliance with the California standard. ...

  7. Consideration of species community composition in statistical analyses of coral disease risk

    EPA Science Inventory

    Diseases are increasing in marine ecosystems, and these increases have been attributed to a number of environmental factors including climate change, pollution, and overfishing. However, many studies pool disease prevalence into taxonomic groups, disregarding host species compos...

  8. Fundamentals of Sports Analytics.

    PubMed

    Wasserman, Erin B; Herzog, Mackenzie M; Collins, Christy L; Morris, Sarah N; Marshall, Stephen W

    2018-07-01

    Recently, the importance of statistics and analytics in sports has increased. This review describes measures of sports injury and fundamentals of sports injury research with a brief overview of some of the emerging measures of sports performance. We describe research study designs that can be used to identify risk factors for injury, injury surveillance programs, and common measures of injury risk and association. Finally, we describe measures of physical performance and training and considerations for using these measures. This review provides sports medicine clinicians with an understanding of current research measures and considerations for designing sports injury research studies. Copyright © 2018 Elsevier Inc. All rights reserved.

  9. Formaldehyde exposures from tobacco smoke: a review.

    PubMed Central

    Godish, T

    1989-01-01

    Reports of formaldehyde levels in mainstream, sidestream, and environmental tobacco smoke from nine studies are reviewed. Considerable disparity exists between formaldehyde production rates determined from mainstream-sidestream studies and those reporting levels in environmental tobacco smoke. Tobacco smoke does not appear to increase vapor-phase formaldehyde levels significantly in indoor environments, but formaldehyde exposure in mainstream smoke may pose a risk of upper respiratory system cancer and increase the risk of cancer in smokers. PMID:2665532

  10. 17 CFR 39.27 - Legal risk considerations.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... operations, risk management procedures, and related requirements. (c) Conflict of laws. If a derivatives... 17 Commodity and Securities Exchanges 1 2013-04-01 2013-04-01 false Legal risk considerations. 39... CLEARING ORGANIZATIONS Compliance with Core Principles § 39.27 Legal risk considerations. (a) Legal...

  11. 17 CFR 39.27 - Legal risk considerations.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... operations, risk management procedures, and related requirements. (c) Conflict of laws. If a derivatives... 17 Commodity and Securities Exchanges 1 2012-04-01 2012-04-01 false Legal risk considerations. 39... CLEARING ORGANIZATIONS Compliance with Core Principles § 39.27 Legal risk considerations. (a) Legal...

  12. Antithrombotic treatment for stroke prevention in atrial fibrillation: The Asian agenda.

    PubMed

    Chen, Chen-Huan; Chen, Mien-Cheng; Gibbs, Harry; Kwon, Sun U; Lo, Sidney; On, Young Keun; Rosman, Azhari; Suwanwela, Nijasri C; Tan, Ru San; Tirador, Louie S; Zirlik, Andreas

    2015-07-15

    Atrial fibrillation (AF) is the most common heart arrhythmia. Untreated AF incurs a considerable burden of stroke and associated healthcare costs. Asians have AF risk factors similar to Caucasians and a similarly increased risk of AF-related stroke; however, with a vast and rapidly ageing population, Asia bears a disproportionately large disease burden. Urgent action is warranted to avert this potential health crisis. Antithrombotic therapy with oral anticoagulants is the most effective means of preventing stroke in AF and is a particular priority in Asia given the increasing disease burden. However, AF in Asia remains undertreated. Conventional oral anticoagulation with warfarin is problematic in Asia due to suboptimal control and a propensity among Asians to warfarin-induced intracranial haemorrhage. Partly due to concerns about intracranial haemorrhage, there are considerable gaps between AF treatment guidelines and clinical practice in Asia, in particular overuse of antiplatelet agents and underuse of anticoagulants. Compared with warfarin, new direct thrombin inhibitors and Factor Xa inhibitors are non-inferior in preventing stroke and significantly reduce the risk of life-threatening bleeding, particularly intracranial bleeding. These agents may therefore provide an appropriate alternative to warfarin in Asian patients. There is considerable scope to improve stroke prevention in AF in Asia. Key priorities include: early detection of AF and identification of asymptomatic patients; assessment of stroke and bleeding risk for all AF patients; evidence-based pharmacotherapy with direct-acting oral anticoagulant agents or vitamin K antagonists for AF patients at risk of stroke; controlling hypertension; and awareness-raising, education and outreach among both physicians and patients. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  13. Genetic variants in the metabolism of omega-6 and omega-3 fatty acids: their role in the determination of nutritional requirements and chronic disease risk.

    PubMed

    Simopoulos, Artemis P

    2010-07-01

    The tissue composition of polyunsaturated fatty acids is important to health and depends on both dietary intake and metabolism controlled by genetic polymorphisms that should be taken into consideration in the determination of nutritional requirements. Therefore at the same dietary intake of linoleic acid (LA) and alpha-linolenic acid (ALA), their respective health effects may differ due to genetic differences in metabolism. Delta-5 and delta-6 desaturases, FADS1 and FADS2, respectively, influence the serum, plasma and membrane phospholipid levels of LA, ALA and long-chain polyunsaturated fatty acids during pregnancy, lactation, and may influence an infant's IQ, atopy and coronary heart disease (CHD) risk. At low intakes of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), polymorphisms at the 5-lipoxygenase (5-LO) level increase the risk for CHD whereas polymorphisms at cyclooxgenase-2 increase the risk for prostate cancer. At high intakes of LA the risk for breast cancer increases. EPA and DHA influence gene expression. In future, intervention studies on the biological effects of LA, ALA and LC-PUFAs, and the effects of genetic variants in FADS1 and FADS2, 5-LO and cyclooxygenase-2 should be taken into consideration both in the determination of nutritional requirements and chronic disease risk. Furthermore, genome-wide association studies need to include environmental exposures and include diet in the interaction between genetic variation and disease association.

  14. [Pharmacogenic osteoporosis beyond cortisone. Proton pump inhibitors, glitazones and diuretics].

    PubMed

    Kann, P H; Hadji, P; Bergmann, R S

    2014-05-01

    [corrected] There are many drugs which can cause osteoporosis or at least favor its initiation. The effect of hormones and drugs with antihormonal activity, such as glucocorticoids and aromatase inhibitors, on initiation of osteoporosis is well known. In addition, proton pump inhibitors, glitazones and diuretics also influence the formation of osteoporosis. The results of currently available studies on the correlation between proton pump inhibitors, glitazones and diuretics on formation of osteoporosis were evaluated and summarized. Proton pump inhibitors and glitazones increase the risk for osteoporotic fractures. Loop diuretics may slightly increase fracture risk, whereas thiazides were shown to be osteoprotective by reducing fracture probability on a relevant scale. Proton pump inhibitors should not be prescribed without serious consideration and then only as long as necessary. Alternatively, the administration of the less effective H2 antagonists should be considered when possible due to the reduction of acid secretion. Because the long-term intake of thiazides is associated with a clinically relevant reduction in the risk of fractures and they are economic and well-tolerated, prescription can be thoroughly recommended within the framework of differential diagnostic considerations in an appropriate clinical context. The briefly increased risk of falling immediately after starting diuretic therapy is the only point which needs to be considered.

  15. Systemic risk measures

    NASA Astrophysics Data System (ADS)

    Guerra, Solange Maria; Silva, Thiago Christiano; Tabak, Benjamin Miranda; de Souza Penaloza, Rodrigo Andrés; de Castro Miranda, Rodrigo César

    2016-01-01

    In this paper we present systemic risk measures based on contingent claims approach and banking sector multivariate density. We also apply network measures to analyze bank common risk exposure. The proposed measures aim to capture credit risk stress and its potential to become systemic. These indicators capture not only individual bank vulnerability, but also the stress dependency structure between them. Furthermore, these measures can be quite useful for identifying systemically important banks. The empirical results show that these indicators capture with considerable fidelity the moments of increasing systemic risk in the Brazilian banking sector in recent years.

  16. Risk-benefit considerations in the treatment of relapsing-remitting multiple sclerosis

    PubMed Central

    Lugaresi, Alessandra; di Ioia, Maria; Travaglini, Daniela; Pietrolongo, Erika; Pucci, Eugenio; Onofrj, Marco

    2013-01-01

    Multiple sclerosis (MS) is a chronic demyelinating disease of the central nervous system and mainly affects young adults. Its natural history has changed in recent years with the advent of disease-modifying drugs, which have been available since the early 1990s. The increasing number of first-line and second-line treatment options, together with the variable course of the disease and patient lifestyles and expectations, makes the therapeutic decision a real challenge. The aim of this review is to give a comprehensive overview of the main present and some future drugs for relapsing-remitting MS, including risk-benefit considerations, to enable readers to draw their own conclusions regarding the risk-benefit assessment of personalized treatment strategies, taking into account not only treatment-related but also disease-related risks. We performed a Medline literature search to identify studies on the treatment of MS with risk stratification and risk-benefit considerations. We focused our attention on studies of disease-modifying, immunomodulating, and immunosuppressive drugs, including monoclonal antibodies. Here we offer personal considerations, stemming from long-term experience in the treatment of MS and thorough discussions with other neurologists closely involved in the care of patients with the disease. MS specialists need to know not only the specific risks and benefits of single drugs, but also about drug interactions, either in simultaneous or serial combination therapy, and patient comorbidities, preferences, and fears. This has to be put into perspective, considering also the risks of untreated disease in patients with different clinical and radiological characteristics. There is no single best treatment strategy, but therapy has to be tailored to the patient. This is a time-consuming task, rich in complexity, and influenced by the attitude towards risk on the parts of both the patient and the clinical team. The broader the MS drug market becomes, the harder it will be for the clinician to help the patient decide which therapeutic strategy to opt for. PMID:23836975

  17. Extending pavement life using thin surfacing to counter the effect of increased truck traffic due to freight movements on highways.

    DOT National Transportation Integrated Search

    2010-07-01

    The highways in the Midwest are experiencing a considerable amount of truck traffic due to increased freight : transportation. There is clearly a risk to the highway infrastructure caused by this additional truck traffic that will also have : an incr...

  18. Cancer risks in Swedish Lapps who breed reindeer

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

    Wiklund, K.; Holm, L.E.; Eklund, G.

    1990-12-01

    Cancer risks during the period 1961-1984 were studied in a cohort of 2,034 Swedish reindeer-breeding Lapps, a unique group whose culture and life-style differ considerably from those in the rest of the Swedish population. A total of 100 cases of cancer were observed versus 163 expected. Statistically significantly decreased risks were found for cancers of the colon, respiratory organs, female breast, male genital organs, and kidneys, and for malignant lymphomas. The stomach was the only site with a significantly increased risk. Reindeer-breeding Lapps have ingested fallout products via the lichen-reindeer-man food chain since the 1950s. However, no increased risk wasmore » found for the cancer sites considered to be most sensitive to radiation.« less

  19. [The role of endogenous and exogenous factors in the etiology of skin melanoma].

    PubMed

    Zaridze, D G; Mukeriia, A F; Basieva, T Kh; Shlenskaia, I N; Bukin, Iu V

    1992-01-01

    The results of case-control study of skin melanoma carried out in Moscow are presented. They point to considerable influence of endogenous factors on the relative risk of melanoma. The risk of melanoma is increased by such factors as light color of the skin, presence of freckles and moles. Exposure to UV-radiation raised the risk of melanoma, however, after relevant adjustment for the said factors relative risk was reduced. Consumption of greens and high blood levels of alpha-tocopherol significantly decreased the risk of melanoma. Female users of oral contraceptives had significantly lower risk of skin melanoma.

  20. Approaches for Establishing Fraud Risk Assessment Programs and Conducting Fraud Audit Risk Assessments Within the Department of Defense

    DTIC Science & Technology

    2014-07-17

    Auditing Health Care Organizations _________ 35 Special Fraud Risk Considerations When Auditing Government Contracts ______________ 36 iv │ DODIG-2014...Auditor Fraud Risk Assessment Special Considerations Special Fraud Risk Considerations When Auditing Health Care Organizations...Learning Opportunities 0 Government Relations (Public Policy and Strategic Relations) Government Relations 0 Health Care Affairs Health Care Affairs 0 Human

  1. Assessing risks and preventing disease from environmental chemicals.

    PubMed

    Dunnette, D A

    1989-01-01

    In the last 25 years there has been considerable concern expressed about the extent to which chemical agents in the ambient and work environments are contributing to the causation of disease. This concern is a logical extension of our increased knowledge of the real and potential effects of environmental chemicals and the methodological difficulties in applying new knowledge that could help prevent environmentally induced disease. Chemical risk assessment offers an approach to estimating risks and involves consideration of relevant information including identification of chemical hazards, evaluation of the dose-response relationship, estimation of exposure and finally, risk characterization. Particularly significant uncertainties which are inherent in use of this and other risk models include animal-human and low dose-high dose extrapolation and estimation of exposure. Community public health risks from exposure to environmental chemicals appear to be small relative to other public health risks based on information related to cancer trends, dietary intake of synthetic chemicals, assessment data on substances such as DDT and "dioxin," public health effects of hazardous waste sites and contextual considerations. Because of inherent uncertainty in the chemical risk assessment process, however, we need to apply what methods are available in our efforts to prevent disease induced by environmental chemicals. There are a number of societal strategies which can contribute to overall reduction of risk from environmental chemicals. These include acquisition of information on environmental risk including toxicity, intensity and extensity of exposure, biological monitoring, disease surveillance, improvement in epidemiological methods, control of environmental chemical exposures, and dissemination of hazardous chemical information. Responsible environmental risk communication and information transfer appear to be among the most important of the available strategies for preventing disease induced by chemicals in the environment.

  2. Cancer Incidence among Heart, Kidney, and Liver Transplant Recipients in Taiwan.

    PubMed

    Lee, Kwai-Fong; Tsai, Yi-Ting; Lin, Chih-Yuan; Hsieh, Chung-Bao; Wu, Sheng-Tang; Ke, Hung-Yen; Lin, Yi-Chang; Lin, Feng-Yen; Lee, Wei-Hwa; Tsai, Chien-Sung

    2016-01-01

    Population-based evidence of the relative risk of cancer among heart, kidney, and liver transplant recipients from Asia is lacking. The Taiwan National Health Insurance Research Database was used to conduct a population-based cohort study of transplant recipients (n = 5396), comprising 801 heart, 2847 kidney, and 1748 liver transplant recipients between 2001 and 2012. Standardized incidence ratios and Cox regression models were used. Compared with the general population, the risk of cancer increased 3.8-fold after heart transplantation, 4.1-fold after kidney transplantation and 4.6-fold after liver transplantation. Cancer occurrence showed considerable variation according to transplanted organs. The most common cancers in all transplant patients were cancers of the head and neck, liver, bladder, and kidney and non-Hodgkin lymphoma. Male recipients had an increased risk of cancers of the head and neck and liver, and female kidney recipients had a significant risk of bladder and kidney cancer. The adjusted hazard ratio for any cancer in all recipients was higher in liver transplant recipients compared with that in heart transplant recipients (hazard ratio = 1.5, P = .04). Cancer occurrence varied considerably and posttransplant cancer screening should be performed routinely according to transplanted organ and sex.

  3. Sleep disturbances as an evidence-based suicide risk factor.

    PubMed

    Bernert, Rebecca A; Kim, Joanne S; Iwata, Naomi G; Perlis, Michael L

    2015-03-01

    Increasing research indicates that sleep disturbances may confer increased risk for suicidal behaviors, including suicidal ideation, suicide attempts, and death by suicide. Despite increased investigation, a number of methodological problems present important limitations to the validity and generalizability of findings in this area, which warrant additional focus. To evaluate and delineate sleep disturbances as an evidence-based suicide risk factor, a systematic review of the extant literature was conducted with methodological considerations as a central focus. The following methodologic criteria were required for inclusion: the report (1) evaluated an index of sleep disturbance; (2) examined an outcome measure for suicidal behavior; (3) adjusted for presence of a depression diagnosis or depression severity, as a covariate; and (4) represented an original investigation as opposed to a chart review. Reports meeting inclusion criteria were further classified and reviewed according to: study design and timeframe; sample type and size; sleep disturbance, suicide risk, and depression covariate assessment measure(s); and presence of positive versus negative findings. Based on keyword search, the following search engines were used: PubMed and PsycINFO. Search criteria generated N = 82 articles representing original investigations focused on sleep disturbances and suicide outcomes. Of these, N = 18 met inclusion criteria for review based on systematic analysis. Of the reports identified, N = 18 evaluated insomnia or poor sleep quality symptoms, whereas N = 8 assessed nightmares in association with suicide risk. Despite considerable differences in study designs, samples, and assessment techniques, the comparison of such reports indicates preliminary, converging evidence for sleep disturbances as an empirical risk factor for suicidal behaviors, while highlighting important, future directions for increased investigation.

  4. 17 CFR 39.27 - Legal risk considerations.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 17 Commodity and Securities Exchanges 1 2014-04-01 2014-04-01 false Legal risk considerations. 39... CLEARING ORGANIZATIONS Compliance with Core Principles § 39.27 Legal risk considerations. (a) Legal... by the appropriate foreign licensing authority. (b) Legal framework. A derivatives clearing...

  5. Policy considerations for improving influenza vaccination rates among pregnant women.

    PubMed

    Mollard, Elizabeth K; Guenzel, Nicholas; Brown, Peggy A; Keeler, Heidi J; Cramer, Mary E

    2014-01-01

    Influenza exposure during pregnancy can cause severe health problems for both the mother and her offspring, including an increased risk of mortality. Influenza vaccination during all trimesters of pregnancy is safe and effective, and recommended by professional organizations such as the American College of Obstetrics and Gynecology. Despite these recommendations, the U.S. vaccination rates remain low in this high-risk population. A policy analysis based on the five-part method identified by Teitelbaum and Wilensky () addresses factors to consider in identifying the best voluntary policy options to improve the vaccination rates. The authors provide discussion of the background, landscape, and stakeholder interests and the pros and cons of two voluntary policy options to increase vaccination. The policy options include: (a) financial incentives for providers and (b) an education emphasis for providers and staff. The authors conclude that based on considerations of cost, provider preference, and practicality of implementation, a continuing educational intervention is the preferred policy venue to increase vaccination rates. © 2014 Wiley Periodicals, Inc.

  6. Sex-related responses after traumatic brain injury: Considerations for preclinical modeling.

    PubMed

    Späni, Claudia B; Braun, David J; Van Eldik, Linda J

    2018-05-18

    Traumatic brain injury (TBI) has historically been viewed as a primarily male problem, since men are more likely to experience a TBI because of more frequent participation in activities that increase risk of head injuries. This male bias is also reflected in preclinical research where mostly male animals have been used in basic and translational science. However, with an aging population in which TBI incidence is increasingly sex-independent due to falls, and increasing female participation in high-risk activities, the attention to potential sex differences in TBI responses and outcomes will become more important. These considerations are especially relevant in designing preclinical animal models of TBI that are more predictive of human responses and outcomes. This review characterizes sex differences following TBI with a special emphasis on the contribution of the female sex hormones, progesterone and estrogen, to these differences. This information is potentially important in developing and customizing TBI treatments. Copyright © 2018 Elsevier Inc. All rights reserved.

  7. Multidisciplinary care considerations for gender nonconforming adolescents with eating disorders: A case series.

    PubMed

    Donaldson, Abigail A; Hall, Allison; Neukirch, Jodie; Kasper, Vania; Simones, Shannon; Gagnon, Sherry; Reich, Steven; Forcier, Michelle

    2018-05-01

    Gender nonconforming youth are at risk for body dissatisfaction and disordered eating. Currently, only a small body of literature addresses this high-risk group. The five cases in this series highlight important themes for this patient population from an interdisciplinary perspective. Identified themes include increased risk for self-harm/suicide, complex psychiatric, and medical implications of delay to treatment for either gender dysphoria or disordered eating, and the importance of collaborative management to maximize care and facilitate healthy development to adulthood. The purpose of this case series is to expand the interdisciplinary discussion regarding the breadth of presentation and management considerations for gender nonconforming adolescents with disordered eating. An interdisciplinary approach to care might enhance access to comprehensive, collaborative treatment for disordered eating, and gender dysphoria in this unique population. © 2018 Wiley Periodicals, Inc.

  8. Mental Health Concerns in Williams Syndrome: Intervention Considerations and Illustrations from Case Examples

    ERIC Educational Resources Information Center

    Phillips, Kristin D.; Klein-Tasman, Bonita P.

    2009-01-01

    The refinement of the Williams syndrome phenotype has frequently included the study of behavioral and temperamental features common to individuals with this disorder. Within this line of research, the importance of evaluating incidence of psychopathology has been increasingly recognized, with studies consistently identifying an increased risk for…

  9. Diabetes Drugs and Cardiovascular Safety

    PubMed Central

    2016-01-01

    Diabetes is a well-known risk factor of cardiovascular morbidity and mortality, and the beneficial effect of improved glycemic control on cardiovascular complications has been well established. However, the rosiglitazone experience aroused awareness of potential cardiovascular risk associated with diabetes drugs and prompted the U.S. Food and Drug Administration to issue new guidelines about cardiovascular risk. Through postmarketing cardiovascular safety trials, some drugs demonstrated cardiovascular benefits, while some antidiabetic drugs raised concern about a possible increased cardiovascular risk associated with drug use. With the development of new classes of drugs, treatment options became wider and the complexity of glycemic management in type 2 diabetes has increased. When choosing the appropriate treatment strategy for patients with type 2 diabetes at high cardiovascular risk, not only the glucose-lowering effects, but also overall benefits and risks for cardiovascular disease should be taken into consideration. PMID:27302713

  10. Collaborative Review: Risk-Based Prostate Cancer Screening

    PubMed Central

    Zhu, Xiaoye; Albertsen, Peter C.; Andriole, Gerald L.; Roobol, Monique J.; Schröder, Fritz H.; Vickers, Andrew J.

    2016-01-01

    Context Widespread mass screening of prostate cancer (PCa) is not recommended because the balance between benefits and harms is still not well established. The achieved mortality reduction comes with considerable harm such as unnecessary biopsies, overdiagnoses, and overtreatment. Therefore, patient stratification with regard to PCa risk and aggressiveness is necessary to identify those men who are at risk and may actually benefit from early detection. Objective This review critically examines the current evidence regarding risk-based PCa screening. Evidence acquisition A search of the literature was performed using the Medline database. Further studies were selected based on manual searches of reference lists and review articles. Evidence synthesis Prostate-specific antigen (PSA) has been shown to be the single most significant predictive factor for identifying men at increased risk of developing PCa. Especially in men with no additional risk factors, PSA alone provides an appropriate marker up to 30 yr into the future. After assessment of an early PSA test, the screening frequency may be determined based on individualized risk. A limited list of additional factors such as age, comorbidity, prostate volume, family history, ethnicity, and previous biopsy status have been identified to modify risk and are important for consideration in routine practice. In men with a known PSA, risk calculators may hold the promise of identifying those who are at increased risk of having PCa and are therefore candidates for biopsy. Conclusions PSA testing may serve as the foundation for a more risk-based assessment. However, the decision to undergo early PSA testing should be a shared one between the patient and his physician based on information balancing its advantages and disadvantages. PMID:22134009

  11. Risk-based framework using geographic information systems to identify transportation corridors vulnerable to development.

    DOT National Transportation Integrated Search

    2008-01-01

    The Virginia Department of Transportation (VDOT) is increasingly involved with the land development process in evolving transportation corridors. This process includes consideration of real estate interests, rezoning and permitting approvals, site pl...

  12. Mental illness, criminal risk factors and parole release decisions.

    PubMed

    Matejkowski, Jason; Draine, Jeffrey; Solomon, Phyllis; Salzer, Mark S

    2011-01-01

    Research has not examined whether higher rates of parole denial among inmates with mental illness (MI) are the result of the increased presence of criminal risk factors among this population. Employing a representative sample of inmates with (n  =  219) and without (n  =  184) MI receiving parole release decisions in 2007, this study tested whether the central eight risk factors for recidivism considered in parole release decisions intervened in the relationship between MI and parole release. MI was associated with possession of a substance use disorder, antisocial personality disorder and violent charges while incarcerated; however, these factors were not related to release decisions. MI was found to have neither a direct nor an indirect effect on release decisions. While results indicate that release decisions appear, to some extent, to be evidence-based, they also suggest considerable discretion is being implemented by parole board members in release decisions above and beyond consideration of criminal risk factors. Copyright © 2011 John Wiley & Sons, Ltd.

  13. Improving regulatory capacity to manage risks associated with trade agreements.

    PubMed

    Walls, Helen L; Smith, Richard D; Drahos, Peter

    2015-03-21

    Modern trade negotiations have delivered a plethora of bilateral and regional preferential trade agreements (PTAs), which involve considerable risk to public health, thus placing demands on governments to strengthen administrative regulatory capacities in regard to the negotiation, implementation and on-going management of PTAs. In terms of risk management, the administrative regulatory capacity requisite for appropriate negotiation of PTAs is different to that for the implementation or on-going management of PTAs, but at all stages the capacity needed is expensive, skill-intensive and requires considerable infrastructure, which smaller and poorer states especially struggle to find. It is also a task generally underestimated. If states do not find ways to increase their capacities then PTAs are likely to become much greater drivers of health inequities. Developing countries especially struggle to find this capacity. In this article we set out the importance of administrative regulatory capacity and coordination to manage the risks to public health associated with PTAs, and suggest ways countries can improve their capacity.

  14. Risk of diarrhoea from shallow groundwater contaminated with enteropathogens in the Kathmandu Valley, Nepal.

    PubMed

    Shrestha, Sadhana; Haramoto, Eiji; Malla, Rabin; Nishida, Kei

    2015-03-01

    Shallow groundwater is the main water source among many alternatives in the Kathmandu Valley, Nepal, which has a rapidly growing population and intermittent piped water supply. Although human pathogens are detected in groundwater, its health effects are unclear. We estimated risk of diarrhoea from shallow groundwater use using quantitative microbial risk assessment. Escherichia coli, Giardia cyst and Cryptosporidium oocyst levels were analysed in dug and tube wells samples. E. coli concentrations were converted to those of enteropathogenic E. coli (EPEC). Risks from EPEC in dug wells and from Cryptosporidium and Giardia in both dug and tube wells were higher than the acceptable limit (<10⁻⁴ infections/person-year) for both drinking and bathing exposures. Risk from protozoan enteropathogens increased the total risk 10,000 times, indicating that ignoring protozoans could lead to serious risk underestimation. Bathing exposure considerably increased risk, indicating that it is an important pathway. Point-of-use (POU) water treatment decreased the risk six-fold and decreased risk overestimation. Because removal efficiency of POU water treatment has the largest impact on total risk, increasing the coverage and efficiency of POU water treatment could be a practical risk management strategy in the Kathmandu Valley and similar settings.

  15. Incorporation of Indigenous Forces in Major Theater War: Advantages, Risks and Considerations

    DTIC Science & Technology

    2004-05-03

    USAWC STRATEGY RESEARCH PROJECT INCORPORATION OF INDIGENOUS FORCES IN MAJOR THEATER WAR: ADVANTAGES , RISKS AND CONSIDERATIONS by Ms. Priscilla... Advantages , Risks and Considerations 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) Priscilla Sellers 5d. PROJECT NUMBER...Std Z39-18 ii iii ABSTRACT AUTHOR: Priscilla Sellers TITLE: Incorporation of Indigenous Forces in Major Theater War: Advantages , Risks and

  16. Why Have Educational Disparities in Mortality Increased among White Women in the United States?

    ERIC Educational Resources Information Center

    Montez, Jennifer Karas; Zajacova, Anna

    2013-01-01

    Since the mid-1980s differences in mortality risk across education levels have widened considerably among non-Hispanic white women. For example, while mortality has "declined" among college-educated women, it has remained fairly "stable" among women with a high school credential or some college education and "increased" among women without a high…

  17. In Vitro Cytotoxicity of Silver Nanomaterials in Murine Macrophages

    EPA Science Inventory

    Silver nanomaterials are increasingly used as antimicrobial agents in a variety of products. Although there is considerable potential for human exposure to these nanomaterials, little is known about the health risks associated with their use. Macrophages are prominent immune cell...

  18. Concepts for risk-based surveillance in the field of veterinary medicine and veterinary public health: Review of current approaches

    PubMed Central

    Stärk, Katharina DC; Regula, Gertraud; Hernandez, Jorge; Knopf, Lea; Fuchs, Klemens; Morris, Roger S; Davies, Peter

    2006-01-01

    Background Emerging animal and zoonotic diseases and increasing international trade have resulted in an increased demand for veterinary surveillance systems. However, human and financial resources available to support government veterinary services are becoming more and more limited in many countries world-wide. Intuitively, issues that present higher risks merit higher priority for surveillance resources as investments will yield higher benefit-cost ratios. The rapid rate of acceptance of this core concept of risk-based surveillance has outpaced the development of its theoretical and practical bases. Discussion The principal objectives of risk-based veterinary surveillance are to identify surveillance needs to protect the health of livestock and consumers, to set priorities, and to allocate resources effectively and efficiently. An important goal is to achieve a higher benefit-cost ratio with existing or reduced resources. We propose to define risk-based surveillance systems as those that apply risk assessment methods in different steps of traditional surveillance design for early detection and management of diseases or hazards. In risk-based designs, public health, economic and trade consequences of diseases play an important role in selection of diseases or hazards. Furthermore, certain strata of the population of interest have a higher probability to be sampled for detection of diseases or hazards. Evaluation of risk-based surveillance systems shall prove that the efficacy of risk-based systems is equal or higher than traditional systems; however, the efficiency (benefit-cost ratio) shall be higher in risk-based surveillance systems. Summary Risk-based surveillance considerations are useful to support both strategic and operational decision making. This article highlights applications of risk-based surveillance systems in the veterinary field including food safety. Examples are provided for risk-based hazard selection, risk-based selection of sampling strata as well as sample size calculation based on risk considerations. PMID:16507106

  19. Examining the Developmental Process of Risk for Exposure to Community Violence among Urban Youth

    PubMed Central

    Lambert, Sharon F.; Bradshaw, Catherine P.; Cammack, Nicole L.; Ialongo, Nicholas S.

    2013-01-01

    Considerable research has documented the effects of community violence exposure on adolescents’ behavior and mental health functioning, yet there has been less research on the process by which early risks increase the likelihood that youth will be exposed to community violence. The current study used data from a community epidemiologically-defined sample of 623 urban youth followed from first grade through adolescence to examine the process by which early-onset aggressive behavior and poor academic readiness influenced risk for community violence exposure. Consistent with transactional developmental theories, early-onset aggressive and disruptive behavior was associated with poor academic readiness; these early risks contributed to later peer rejection, and subsequent conduct problems and greater affiliation with deviant peers, which in turn increased youths’ exposure to community violence. Having an enhanced understanding of the risk process directs attention to potential targets for preventive interventions for youth at risk for subsequent exposure to violence. PMID:21480029

  20. [Spatio-temporal characteristics of agricultural drought in Shaanxi Province, China based on integrated disaster risk index].

    PubMed

    He, Bin; Wang, Quan Jiu; Wu, Di; Zhou, Bei Bei

    2016-10-01

    With the change of climate, agricultural drought has directly threatened the food security. Based on the natural disaster risk theory, we analyzed the spatial and temporal characteristics of agricultural drought in Shanxi Province from 2009 to 2013. Four risk factors (hazard, exposure, vulnerability, and drought resistance ability) were selected with the consideration of influence factors of drought disasters. Subsequently, the index weight was determined by the analytic hierarchy process (AHP) and the aggregative indicator of natural disaster risk was established. The results showed that during the study period, the agricultural drought risk slightly declined in the northern Shaanxi, but increased sharply in the southern Shaanxi, especially in Shangluo City. While for the central part of Shaanxi Province, it maintained good stability, which was the highest in Xianyang City and the lowest in Xi'an City. Generally, the agricultural drought risk in Shaanxi Province gradually increased from south to north.

  1. Bleeding Risks With Aspirin Use for Primary Prevention in Adults: A Systematic Review for the U.S. Preventive Services Task Force.

    PubMed

    Whitlock, Evelyn P; Burda, Brittany U; Williams, Selvi B; Guirguis-Blake, Janelle M; Evans, Corinne V

    2016-06-21

    The balance between potential aspirin-related risks and benefits is critical in primary prevention. To evaluate the risk for serious bleeding with regular aspirin use in cardiovascular disease (CVD) primary prevention. PubMed, MEDLINE, Cochrane Central Register of Controlled Trials (2010 through 6 January 2015), and relevant references from other reviews. Randomized, controlled trials; cohort studies; and meta-analyses comparing aspirin with placebo or no treatment to prevent CVD or cancer in adults. One investigator abstracted data, another checked for accuracy, and 2 assessed study quality. In CVD primary prevention studies, very-low-dose aspirin use (≤100 mg daily or every other day) increased major gastrointestinal (GI) bleeding risk by 58% (odds ratio [OR], 1.58 [95% CI, 1.29 to 1.95]) and hemorrhagic stroke risk by 27% (OR, 1.27 [CI, 0.96 to 1.68]). Projected excess bleeding events with aspirin depend on baseline assumptions. Estimated excess major bleeding events were 1.39 (CI, 0.70 to 2.28) for GI bleeding and 0.32 (CI, -0.05 to 0.82) for hemorrhagic stroke per 1000 person-years of aspirin exposure using baseline bleeding rates from a community-based observational sample. Such events could be greater among older persons, men, and those with CVD risk factors that also increase bleeding risk. Power to detect effects on hemorrhagic stroke was limited. Harms other than serious bleeding were not examined. Consideration of the safety of primary prevention with aspirin requires an individualized assessment of aspirin's effects on bleeding risks and expected benefits because absolute bleeding risk may vary considerably by patient. Agency for Healthcare Research and Quality.

  2. Cardiovascular and metabolic risks in psoriasis and psoriatic arthritis: pragmatic clinical management based on available evidence.

    PubMed

    Johnsson, Hanna; McInnes, Iain B; Sattar, Naveed

    2012-04-01

    Several studies suggest that patients with psoriasis and, in particular, psoriatic arthritis (PsA) are at increased risk of cardiovascular disease. These patients are also more likely to be obese and to have diabetes and fatty liver disease. This article discusses the association between psoriasis and PsA and cardiometabolic disorders, emphasising the need for better consideration of simple lifestyle interventions. It also highlights areas for future research and proposes a simple and pragmatic test portfolio to screen for cardiovascular risk and metabolic disorders in patients at higher risk.

  3. Risk Protection, Service Use, and Health Outcomes under Colombia’s Health Insurance Program for the Poor

    PubMed Central

    Miller, Grant; Pinto, Diana

    2013-01-01

    Unexpected medical care spending imposes considerable financial risk on developing country households. Based on managed care models of health insurance in wealthy countries, Colombia’s Régimen Subsidiado is a publicly financed insurance program targeted to the poor, aiming both to provide risk protection and to promote allocative efficiency in the use of medical care. Using a “fuzzy” regression discontinuity design, we find that the program has shielded the poor from some financial risk while increasing the use of traditionally under-utilized preventive services – with measurable health gains. PMID:25346799

  4. Hearing loss among older construction workers: Updated analyses.

    PubMed

    Dement, John; Welch, Laura S; Ringen, Knut; Cranford, Kim; Quinn, Patricia

    2018-04-01

    A prior study of this construction worker population found significant noise-associated hearing loss. This follow-up study included a much larger study population and consideration of additional risk factors. Data included audiometry, clinical chemistry, personal history, and work history. Qualitative exposure metrics for noise and solvents were developed. Analyses compared construction workers to an internal reference group with lower exposures and an external worker population with low noise exposure. Among participants (n = 19 127) an overall prevalence of hearing loss of 58% was observed, with significantly increased prevalence across all construction trades. Construction workers had significantly increased risk of hearing loss compared to reference populations, with increasing risk by work duration. Noise exposure, solvent exposure, hypertension, and smoking were significant risk factors in multivariate models. Results support a causal relationship between construction trades work and hearing loss. Prevention should focus on reducing exposure to noise, solvents, and cigarette smoke. © 2018 Wiley Periodicals, Inc.

  5. Cancer in Transgender People: Evidence and Methodological Considerations

    PubMed Central

    Braun, Hayley; Nash, Rebecca; Tangpricha, Vin; Brockman, Janice; Ward, Kevin; Goodman, Michael

    2017-01-01

    Abstract Transgender people comprise a diverse group of individuals whose gender identity or expression differs from that originally assigned to them at birth. Some, but not all, transgender people elect to undergo medical gender affirmation, which may include therapy with cross-sex hormones and/or surgical change of the genitalia and other sex characteristics. As cross-sex hormones administered for the purposes of gender affirmation may be delivered at high doses and over a period of decades, the carcinogenicity of hormonal therapy in transgender people is an area of considerable concern. In addition, concerns about cancer risk in transgender patients have been linked to sexually transmitted infections, increased exposure to well-known risk factors such as smoking and alcohol use, and the lack of adequate access to screening. Several publications have identified cancer as an important priority in transgender health research and called for large-scale studies. The goals of this article are to summarize the evidence on factors that may differentially affect cancer risk in transgender people, assess the relevant cancer surveillance and epidemiologic data available to date, and offer an overview of possible methodological considerations for future studies investigating cancer incidence and mortality in this population. PMID:28486701

  6. Social Determinants of Health, Disaster Vulnerability, Severe and Morbid Obesity in Adults: Triple Jeopardy?

    PubMed Central

    2017-01-01

    Severe and morbid obesity are associated with highly elevated risks of adverse health outcomes and the prevalence of severe obesity is increasing globally. To date, disaster literature has not considered severe and morbid obesity as a specific vulnerability, despite reports of people being left behind during disasters because of their body size, shape or weight. The complex causes of obesity are associated with the social determinants of health and one’s potential vulnerability to disasters. The absence of appropriate considerations may lead to people being exposed to disproportionate and potentially avoidable risk. The intersection of the social determinants of health, disaster vulnerability, severe and morbid obesity is explored. Previously identified vulnerable groups are also represented in severe and morbid obesity data. This poses the prospect for ‘triple jeopardy’ compounding the social determinants of health, disaster vulnerability and considerations with and for people with morbid obesity. When working to reduce disaster risk for vulnerable groups, the author proposes specific consideration is required to ensure ‘all-of-society engagement and partnership’ in an inclusive, accessible and non-discriminatory manner, to ensure no one is left behind.

  7. Prevalence of gastrointestinal symptoms six months after bacterial gastroenteritis and risk factors for development of the irritable bowel syndrome: postal survey of patients.

    PubMed Central

    Neal, K. R.; Hebden, J.; Spiller, R.

    1997-01-01

    OBJECTIVE: To measure the prevalence of gastrointestinal symptoms six months after bacterial gastroenteritis and determine risk factors and associations with postdysenteric symptoms. DESIGN: Postal questionnaire. SETTING: Nottingham Health Authority. SUBJECTS: 544 people with microbiologically confirmed bacterial gastroenteritis between July 1994 and December 1994. MAIN OUTCOME MEASURES: Prevalence of gastrointestinal symptoms and relative risks for development of the irritable bowel syndrome and self reported altered bowel habit. RESULTS: A quarter of subjects reported persistence of altered bowel habit six months after an episode of infective gastroenteritis. Increasing duration of diarrhoea, younger age, and female sex increased this risk, whereas vomiting as part of the illness reduced the risk. One in 14 developed the irritable bowel syndrome with an increased risk seen in women (relative risk 3.4: 95% confidence interval 1.2 to 9.8) and with duration of diarrhoea (6.5; 1.3 to 34 for 15-21 days). CONCLUSIONS: Persistence of bowel symptoms commonly occurs after bacterial gastroenteritis and is responsible for considerable morbidity and health care costs. PMID:9080994

  8. Sleep apnea in total joint arthroplasty patients and the role for cardiac biomarkers for risk stratification: an exploration of feasibility

    PubMed Central

    Lyons, M Melanie; Bhatt, Nitin Y; Kneeland-Szanto, Elizabeth; Keenan, Brendan T; Pechar, Joanne; Stearns, Branden; Elkassabany, Nabil M; Memtsoudis, Stavros G; Pack, Allan I; Gurubhagavatula, Indira

    2016-01-01

    Obstructive sleep apnea (OSA) is highly prevalent in patients undergoing total joint arthroplasty (TJA) and is a major risk factor for postoperative cardiovascular complications and death. Recognizing this, the American Society of Anesthesiologists urges clinicians to implement special considerations in the perioperative care of OSA patients. However, as the volume of patients presenting for TJA increases, resources to implement these recommendations are limited. This necessitates mechanisms to efficiently risk stratify patients having OSA who may be susceptible to post-TJA cardiovascular complications. We explore the role of perioperative measurement of cardiac troponins (cTns) and brain natriuretic peptides (BNPs) in helping determine which OSA patients are at increased risk for post-TJA cardiovascular-related morbidity. PMID:26925513

  9. Work, obesity, and occupational safety and health.

    PubMed

    Schulte, Paul A; Wagner, Gregory R; Ostry, Aleck; Blanciforti, Laura A; Cutlip, Robert G; Krajnak, Kristine M; Luster, Michael; Munson, Albert E; O'Callaghan, James P; Parks, Christine G; Simeonova, Petia P; Miller, Diane B

    2007-03-01

    There is increasing evidence that obesity and overweight may be related, in part, to adverse work conditions. In particular, the risk of obesity may increase in high-demand, low-control work environments, and for those who work long hours. In addition, obesity may modify the risk for vibration-induced injury and certain occupational musculoskeletal disorders. We hypothesized that obesity may also be a co-risk factor for the development of occupational asthma and cardiovascular disease that and it may modify the worker's response to occupational stress, immune response to chemical exposures, and risk of disease from occupational neurotoxins. We developed 5 conceptual models of the interrelationship of work, obesity, and occupational safety and health and highlighted the ethical, legal, and social issues related to fuller consideration of obesity's role in occupational health and safety.

  10. Self-disgust as a potential mechanism underlying the association between PTSD and suicide risk.

    PubMed

    Brake, C Alex; Rojas, Sasha M; Badour, Christal L; Dutton, Courtney E; Feldner, Matthew T

    2017-04-01

    Suicide risk is highly prevalent among individuals with posttraumatic stress disorder (PTSD). Self-disgust, defined as disgust directed internally and comprised of disgust with oneself (disgusting self) and with one's behaviors (disgusting ways), may impact this increased risk. The present study examined self-disgust as a putative mechanism linking PTSD symptoms with suicide risk. A sample of 347 trauma-exposed undergraduates completed measures of PTSD symptoms, suicide risk, self-disgust, and depressive symptoms. Controlling for depressive symptoms, a process model indicated PTSD symptoms were positively linked to suicide risk via increased disgusting self but not disgusting ways. Process models examining individual PTSD symptom clusters revealed positive, indirect links between all PTSD symptom clusters except alterations in arousal and reactivity and suicide risk via disgusting self. These findings expand on growing literature documenting the importance of self-disgust in trauma-related pathology by identifying connections with suicide risk. Future directions and clinical considerations are discussed. Copyright © 2017 Elsevier Ltd. All rights reserved.

  11. Risks of municipal solid waste incineration: an environmental perspective.

    PubMed

    Denison, R A; Silbergeld, E K

    1988-09-01

    The central focus of the debate over incineration of municipal solid waste (MSW) has shifted from its apparent management advantages to unresolved risk issues. This shift is a result of the lack of comprehensive consideration of risks associated with incineration. We discuss the need to expand incinerator risk assessment beyond the limited view of incinerators as stationary air pollution sources to encompass the following: other products of incineration, ash in particular, and pollutants other than dioxins, metals in particular; routes of exposure in addition to direct inhalation; health effects in addition to cancer; and the cumulative nature of exposure and health effects induced by many incinerator-associated pollutants. Rational MSW management planning requires that the limitations as well as advantages of incineration be recognized. Incineration is a waste-processing--not a waste disposal--technology, and its products pose substantial management and disposal problems of their own. Consideration of the nature of these products suggests that incineration is ill-suited to manage the municipal wastestream in its entirety. In particular, incineration greatly enhances the mobility and bioavailability of toxic metals present in MSW. These factors suggest that incineration must be viewed as only one component in an integrated MSW management system. The potential for source reduction, separation, and recycling to increase the safety and efficiency of incineration should be counted among their many benefits. Risk considerations dictate that alternatives to the use of toxic metals at the production stage also be examined in designing an effective, long-term MSW management strategy.

  12. Exposure Estimation and Interpretation of Occupational Risk: Enhanced Information for the Occupational Risk Manager

    PubMed Central

    Waters, Martha; McKernan, Lauralynn; Maier, Andrew; Jayjock, Michael; Schaeffer, Val; Brosseau, Lisa

    2015-01-01

    The fundamental goal of this article is to describe, define, and analyze the components of the risk characterization process for occupational exposures. Current methods are described for the probabilistic characterization of exposure, including newer techniques that have increasing applications for assessing data from occupational exposure scenarios. In addition, since the probability of health effects reflects variability in the exposure estimate as well as the dose-response curve—the integrated considerations of variability surrounding both components of the risk characterization provide greater information to the occupational hygienist. Probabilistic tools provide a more informed view of exposure as compared to use of discrete point estimates for these inputs to the risk characterization process. Active use of such tools for exposure and risk assessment will lead to a scientifically supported worker health protection program. Understanding the bases for an occupational risk assessment, focusing on important sources of variability and uncertainty enables characterizing occupational risk in terms of a probability, rather than a binary decision of acceptable risk or unacceptable risk. A critical review of existing methods highlights several conclusions: (1) exposure estimates and the dose-response are impacted by both variability and uncertainty and a well-developed risk characterization reflects and communicates this consideration; (2) occupational risk is probabilistic in nature and most accurately considered as a distribution, not a point estimate; and (3) occupational hygienists have a variety of tools available to incorporate concepts of risk characterization into occupational health and practice. PMID:26302336

  13. Socially cued seminal fluid gene expression mediates responses in ejaculate quality to sperm competition risk.

    PubMed

    Simmons, Leigh W; Lovegrove, Maxine

    2017-08-30

    There is considerable evidence that males will increase the number of sperm ejaculated in response to sperm competition risk. However, whether they have the capacity to adjust seminal fluid components of the ejaculate has received less attention. Male crickets ( Teleogryllus oceanicus ) have been shown to adjust the viability of sperm in their ejaculate in response to sperm competition risk. Here we show that socially mediated plasticity in sperm viability is probably due, at least in part, to male adjustments in the protein composition of the seminal fluid. Seven seminal fluid protein genes were found to have an increased expression in males exposed to rival calls. Increased expression of these genes was correlated with increased sperm viability in whole ejaculates, and gene knockdown confirmed that at least one of these proteins promotes sperm viability. Our results lend support for recent theoretical models that predict complex responses in male allocation to seminal fluid composition in response to sperm competition risk. © 2017 The Author(s).

  14. Bon voyage: an update on safe travel in pregnancy.

    PubMed

    Jones, Claire Ann; Chan, Crystal

    2014-12-01

    Travel in pregnancy is common, particularly as international travel for work and leisure has become more commonplace. Few women are fully aware of the potential risks of travelling while pregnant, particularly the risk of delivering abroad. We describe here the medical risks and the many social, financial, and logistical considerations for travelling during pregnancy. Pertinent considerations include the risks of developing medical complications abroad, immunization considerations, access to obstetrical care in developing countries, travel medical insurance, and airline regulations.

  15. Focused Review of Perioperative Care of Patients with Pulmonary Hypertension and Proposal of a Perioperative Pathway.

    PubMed

    Steppan, Jochen; Diaz-Rodriguez, Natalia; Barodka, Viachaslau M; Nyhan, Daniel; Pullins, Erica; Housten, Traci; Damico, Rachel L; Mathai, Stephen C; Hassoun, Paul M; Berkowitz, Dan E; Maxwell, Bryan G; Kolb, Todd M

    2018-01-15

    Morbidity and mortality risk increase considerably for patients with pulmonary hypertension (PH) undergoing non-cardiac surgery. Unfortunately, there are no comprehensive, evidence-based guidelines for perioperative evaluation and management of these patients. We present a brief review of the literature on perioperative outcomes for patients with PH and describe the implementation of a collaborative perioperative management program for these high-risk patients at a tertiary academic center.

  16. Ionizing radiation exposure as a result of diagnostic imaging in patients with lymphoma.

    PubMed

    Crowley, M P; O'Neill, S B; Kevane, B; O'Neill, D C; Eustace, J A; Cahill, M R; Bird, B; Maher, M M; O'Regan, K; O'Shea, D

    2016-05-01

    Survival rates among patients with lymphoma continue to improve. Strategies aimed at reducing potential treatment-related toxicity are increasingly prioritized. While radiological procedures play an important role, ionizing radiation exposure has been linked to an increased risk of malignancy, particularly among individuals whose cumulative radiation exposure exceeds a specific threshold (75 millisieverts). Within this retrospective study, the cumulative radiation exposure dose was quantified for 486 consecutive patients with lymphoma. The median estimated total cumulative effective dose (CED) of ionizing radiation per subject was 69 mSv (42-118). However, younger patients (under 40 years) had a median CED of 89 mSv (55-124). This study highlights the considerable radiation exposure occurring among patients with lymphoma as a result of diagnostic imaging. To limit the risk of secondary carcinogenesis, consideration should be given to monitoring cumulative radiation exposure in individual patients as well as considering imaging modalities, which do not impart an ionizing radiation dose.

  17. Best practices in LGBT care: A guide for primary care physicians.

    PubMed

    McNamara, Megan C; Ng, Henry

    2016-07-01

    Lesbian, gay, bisexual, and transgender (LGBT) people have unique healthcare needs. While all LGBT people are at an increased risk for mental health and substance abuse disorders, certain health conditions vary by group. Overweight and obesity are more common in lesbian and bisexual women, whereas sexual minority men are at increased risk for infections such as human immunodeficiency virus (HIV) and syphilis. Breast, cervical, and prostate cancer screening should be offered to all LGBT individuals according to national guidelines and with consideration of a transgender person's natal and surgical anatomy. Copyright © 2016 Cleveland Clinic.

  18. White paper on the promotion of an integrated risk assessment concept in European regulatory frameworks for chemicals.

    PubMed

    Wilks, M F; Roth, N; Aicher, L; Faust, M; Papadaki, P; Marchis, A; Calliera, M; Ginebreda, A; Andres, S; Kühne, R; Schüürmann, G

    2015-07-15

    The vision of a sustainable and safe use of chemicals to protect human health, preserve the environment and maintain the ecosystem requires innovative and more holistic approaches to risk assessment (RA) in order to better inform decision making. Integrated risk assessment (IRA) has been proposed as a solution to current scientific, societal and policy needs. It is defined as the mutual exploitation of environmental risk assessment (ERA) for human health risk assessment (HHRA) and vice versa in order to coherently and more efficiently characterize an overall risk to humans and the environment for better informing the risk analysis process. Extrapolating between species which are relevant for HHRA and ERA requires a detailed understanding of pathways of toxicity/modes of action (MoA) for the various toxicological endpoints. Significant scientific advances, changes in chemical legislation, and increasing environmental consciousness have created a favourable scientific and regulatory environment to develop and promote the concept and vision of IRA. An initial proof of concept is needed to foster the incorporation of IRA approaches into different chemical sectorial regulations and demonstrate their reliability for regulatory purposes. More familiarity and confidence with IRA will ultimately contribute to an overall reduction in in vivo toxicity testing requirements. However, significant progress will only be made if long-term support for MoA-related research is secured. In the short term, further exchange and harmonization of RA terminology, models and methodologies across chemical categories and regulatory agencies will support these efforts. Since societal values, public perceptions and cultural factors are of increasing importance for the acceptance of risk analysis and successful implementation of risk mitigation measures, the integration of socio-economic analysis and socio-behavioural considerations into the risk analysis process may help to produce a more effective risk evaluation and consideration of the risks and benefits associated with the use of chemicals. Copyright © 2015 Elsevier B.V. All rights reserved.

  19. The controversy about a possible relationship between mobile phone use and cancer.

    PubMed

    Kundi, Michael

    2010-08-01

    Over the last decade, mobile phone use increased to almost 100% prevalence in many countries. Evidence for potential health hazards accumulated in parallel by epidemiologic investigations has raised controversies about the appropriate interpretation and the degree of bias and confounding responsible for reduced or increased risk estimates. Overall, 33 epidemiologic studies were identified in the peer-reviewed literature, mostly (25) about brain tumors. Methodologic considerations revealed that three important conditions for epidemiologic studies to detect an increased risk are not met:no evidence-based exposure metric is available; the observed duration of mobile phone use is generally still too low; no evidence-based selection of end points among the grossly different types of neoplasias is possible because of lack of etiologic hypotheses. The overall evidence speaks in favor of an increased risk, but its magnitude cannot be assessed at present because of insufficient information on long-term use.

  20. Counselling and management of cardiovascular risk factors after preeclampsia.

    PubMed

    van Kesteren, Floortje; Visser, Sanne; Hermes, Wietske; Teunissen, Pim W; Franx, Arie; van Pampus, Maria G; Mol, Ben W; de Groot, Christianne J M

    2016-01-01

    Women with a history of preeclampsia have an increased risk of cardiovascular disease. Gynaecologists have an important role in the counselling and management of cardiovascular risk factors after preeclampsia. We aimed to assess the role of gynaecologists in informing women on interventions and risk factor follow-up after early and late preeclampsia. In 2011 and 2014, all gynaecologists in the Netherlands were invited for a questionnaire. Results were analysed and compared over time. In 2011, the questionnaire was answered by 244 and in 2014 by 167 gynaecologists. After early preeclampsia, in 2011, 53% advised yearly blood pressure measurements; this increased to 65% in 2014. Over the years there was an increase in respondents advising an increased physical activity of 35% in 2011 to 56% in 2014. After late preeclampsia, in 2011, 36% advised yearly blood pressure measurements; this increased to 46% in 2014. There was an increase in gynaecologists advising increased activity (32% in 2011 to 56% in 2014). In both early and late preeclampsia, smoking cessation and weigh loss were advised often (70-80%); glucose and lipid screening were advised rarely (6-20%). Although there is still a considerable scope for improvement, an increasing number of gynaecologists advise women after preeclampsia on preventive interventions to decrease risks of cardiovascular disease.

  1. Travel-related thrombosis.

    PubMed

    Cannegieter, Suzanne C

    2012-09-01

    Travel-related thrombosis is a serious public health concern considering the large and increasing number of travellers. Due to a lack of evidence, counselling air travellers on their venous thrombosis risk is not immediately straightforward, and advice will have to be based mostly on theoretical grounds. In this review a basis for these considerations is given. First of all it needs to be recognized that venous thrombosis is a multicausal disease, i.e. several risk factors have to be present before an event occurs. This is reflected in the literature where clearly increased risks have been described for certain groups, such as subjects with factor V Leiden, those who use oral contraceptives or are obese. Also, an increased risk for tall and short people has been reported. So, for subjects with a known risk factor who plan to travel, benefits and risks of thrombosis prophylaxis, (pharmacological or other), need to be weighed. This review provides some theoretical examples. For all other travellers, the advice to move and exercise as much as possible is likely to be sufficient. Copyright © 2012. Published by Elsevier Ltd.

  2. Stressful life events in childhood and risk of infectious disease hospitalization.

    PubMed

    Nielsen, Nete Munk; Hansen, Anne Vinkel; Simonsen, Jacob; Hviid, Anders

    2012-01-01

    Individuals exposed to high levels of stress might have an increased risk of infectious diseases. However, most of the previous studies have been conducted among adults. To examine the effect of childhood stress, we conducted a nationwide cohort study including all Danish children born from 1977 to 2004. Stressful life events (SFLE) included parental death, death of sibling or parental divorce. Outcome was defined as hospitalizations due to less severe (LSID) or severe infectious diseases (SID). Children were followed until the age of 15 years. The association between SFLE and risk of infections was evaluated through rate ratios (RR) comparing infectious disease incidence ratios in children with and without a history of SFLE. Overall, children exposed to SFLE were at 13% increased risk of LSID (RR = 1.13 (1.10-1.15)), but at no increased risk of SID hospitalization (RR = 1.05 (0.97-1.14)). Looking at the specific type of SFLE, parental divorce increased the risk of LSID (RR = 1.11 (1.09-1.14)) and SID hospitalization (1.11 (1.02-1.21)) by 11%, whereas no increased risk of LSID and SID hospitalization was observed following parental death. Finally, a 34% increased risk of LSID hospitalization (RR = 1.34 (1.23-1.45)) was observed following death of sibling, in contrast to no increased risk of SID hospitalization. Childhood exposure to SFLE, especially parental divorce seems to increase the risk of infectious disease hospitalization. Although we cannot determine whether our observations are the result of a biological effect of stress, adoption of unhealthy behaviours or increased likelihood of hospitalization, our findings do have public health relevance as a considerable proportion of the children today will be exposed to SFLE, the majority to parental divorce.

  3. Conditioned aversion induced by Baccharis coridifolia in sheep and cattle

    USDA-ARS?s Scientific Manuscript database

    In Southern Brazil Baccharis coridifolia is an important toxic plant. The poisoning occurs when animals raised in areas without the plant are transported to, and allowed to graze in, pastures infested by B. coridifolia. Intoxication risk increases considerably when recently transported animals are s...

  4. Prematurity and low weight at birth as new conditions predisposing to an increased cardiovascular risk.

    PubMed

    Mercuro, Giuseppe; Bassareo, Pier Paolo; Flore, Giovanna; Fanos, Vassilios; Dentamaro, Ilaria; Scicchitano, Pietro; Laforgia, Nicola; Ciccone, Marco Matteo

    2013-04-01

    Although the survival rate for preterm subjects has improved considerably, due to the progress in the field of perinatal medicine, preterm birth is frequently the cause underlying a series of notorious complications: morphological, neurological, ophthalmological, and renal alterations. In addition, it has recently been demonstrated how low gestational age and reduced foetal growth contribute towards an increased cardiovascular risk in preterm neonates. In fact, cardiovascular mortality is higher among former preterm adults than those born at term. This condition is referred to as cardiovascular perinatal programming. In the light of the above, an early, constant, and prolonged cardiological followup programme should be implemented in former preterm individuals. The aim of this paper was to perform a comprehensive literature review about two new emerging conditions predisposing to an increased cardiovascular risk: prematurity and low weight at birth.

  5. Towards a systems approach to risk considerations for concurrent design

    NASA Technical Reports Server (NTRS)

    Meshkat, Leila; Oberto, Robert E.

    2004-01-01

    This paper describes the new process used by the Project Design Center at NASA's Jet Propulsion Laboratory for the identification, assessment and communication of risk elements throughout the lifecycle of a mission design. This process includes a software tool, 'RAP' that collects and communicates risk information between the various designers and a 'risk expert' who mediates this process. The establishment of this process is an attempt towards the systematic consideration of risk in the design decision making process. Using this process, we are able to better keep track of the risks associated with the design decisions. Furthermore, it helps us develop better risk profiles for the studies under consideration. We aim to refine and expand the current process to enable more thorough risk analysis capabilities in the future.

  6. What is new in diesel.

    PubMed

    Bunn, William B; Valberg, P A; Slavin, T J; Lapin, C A

    2002-10-01

    We review information from the past 5 years on changes in diesel exhaust (DE) emissions and developments in the study of DE toxicity. New DE technologies have changed the composition of DE considerably, reducing emissions of many of the components of health concern. The increasing similarity of modern diesel and compressed natural-gas engine emissions needs to be reflected in any regulatory analysis. Even for historical DE emissions, considerable study of DE exposure in animals or humans has not produced data useful for risk assessment. DE inhalation exposure in most species (hamsters, guinea pigs, mice) does not produce lung tumors. Inhalation studies of DE in rats found lung tumors only with lung overload, and tumors also occurred when inert dusts were inhaled at overload concentrations. The animal data are reassuring and show that DE is not a concern at ambient exposure levels. Re-analyses of occupational epidemiology have been shown to have serious shortcomings that do not allow the derivation of a quantitative cancer risk. Studies of railroad workers found no dose response; rather cancer risk appeared to decrease for individuals with greater DE exposure. Studies of truck drivers also suffer from serious flaws because of misconceptions about the year that diesel was introduced, lack of an adequate latency period, and the realization that drivers exhibited increased lung cancer risk even prior to the diesel era. Recent industrial hygiene studies of drivers show that DE was not likely to be a primary source of particles or polycyclic aromatic hydrocarbons. Further, there is no dose response across occupations. In fact, the occupation (underground miners) with the highest exposure to DE does not exhibit increased cancer risks. This new information seriously weakens earlier risk characterizations of DE by various regulatory groups. New research and better exposure measurements are needed before a reliable risk assessment of DE can be produced.

  7. Lifestyle modification and progressive renal failure.

    PubMed

    Ritz, Eberhard; Schwenger, Vedat

    2005-08-01

    There is increasing evidence that lifestyle factors impact on the risk of developing chronic kidney disease (CKD) and the risk of progression of CKD. Equally important is the consideration that patients with CKD are more likely to die from cardiovascular disease than to reach the stage of end-stage renal failure. It is advantageous that manoeuvres that interfere with progression at the same time also reduce the risk of cardiovascular events. Lifestyle factors that aggravate progression include, among others, smoking, obesity and dietary salt intake. Alcohol consumption, according to some preliminary information, has a bimodal relationship to cardiovascular risk and progression, with moderate consumption being protective.

  8. Tick Infestation Risk and Borrelia burgdorferi s.l. Infection-Induced Increase in Host-Finding Efficacy of Female Ixodes ricinus Under Natural Conditions

    DTIC Science & Technology

    2008-02-14

    worldwide, only a few are vaccine -preventable (e.g., tick-borne encephalitis, yellow fever, Japanese encephalitis, and plague). For this reason...western Germany underscore the considerable risk of acquiring Lyme borreliosis in Central Europe. Since no licensed vaccine exists for Lyme borreliosis...Acknowledgements We thank Marco Isack, Sabine Barz, Thorsten Lange, Bernd Bocklet and Dirk Hiller for their assistance with fieldwork. TibMolBiol

  9. 17 CFR 229.904 - (Item 904) Risk factors and other considerations.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 17 Commodity and Securities Exchanges 2 2011-04-01 2011-04-01 false (Item 904) Risk factors and... 904) Risk factors and other considerations. (a) Immediately following the summary required by Item 903 of this subpart (§ 229.903), describe in reasonable detail each material risk and effect of the roll...

  10. The development of mountain risk governance: challenges for application

    NASA Astrophysics Data System (ADS)

    Link, S.; Stötter, J.

    2015-01-01

    The complexity the management of mountain risks in the Alps has considerably increased since its institutionalisation in the late nineteenth century. In the history of approaches to dealing with mountain risks four successive paradigms can be distinguished on the basis of key indicators such as guiding principles, characteristic elements and typical instruments: "hazard protection", "hazard management", "risk management", and "risk governance". In this contribution, special attention is paid to the development of hazard zone planning and the growing importance of communication and participation over the course of this transformation. At present, the risk management paradigm has reached maturity. In the Alps, risk governance frameworks are not yet applied to risks from natural hazards. Based on a historical analysis, the suitability and applicability of general risk governance frameworks in the context of mountain risks are discussed. Necessary adaptations (e.g., in administration, educational, and legal structures) are proposed for the upcoming transformation towards mountain risk governance.

  11. Hydropower plans in eastern and southern Africa increase risk of concurrent climate-related electricity supply disruption

    NASA Astrophysics Data System (ADS)

    Conway, Declan; Dalin, Carole; Landman, Willem A.; Osborn, Timothy J.

    2017-12-01

    Hydropower comprises a significant and rapidly expanding proportion of electricity production in eastern and southern Africa. In both regions, hydropower is exposed to high levels of climate variability and regional climate linkages are strong, yet an understanding of spatial interdependences is lacking. Here we consider river basin configuration and define regions of coherent rainfall variability using cluster analysis to illustrate exposure to the risk of hydropower supply disruption of current (2015) and planned (2030) hydropower sites. Assuming completion of the dams planned, hydropower will become increasingly concentrated in the Nile (from 62% to 82% of total regional capacity) and Zambezi (from 73% to 85%) basins. By 2030, 70% and 59% of total hydropower capacity will be located in one cluster of rainfall variability in eastern and southern Africa, respectively, increasing the risk of concurrent climate-related electricity supply disruption in each region. Linking of nascent regional electricity sharing mechanisms could mitigate intraregional risk, although these mechanisms face considerable political and infrastructural challenges.

  12. Occupation and gastric cancer

    PubMed Central

    Raj, A; Mayberry, J; Podas, T

    2003-01-01

    Gastric cancer is a cause of significant morbidity and mortality. There are several risk factors, with occupation emerging as one of these. There is considerable evidence that occupations in coal and tin mining, metal processing, particularly steel and iron, and rubber manufacturing industries lead to an increased risk of gastric cancer. Other "dusty" occupations—for example, wood processing, or work in high temperature environments have also been implicated but the evidence is not strong. The mechanism of pathogenesis of gastric cancer is unclear and the identification of causative agents can be difficult. Dust is thought to be a contributor to the pathological process, but well known carcinogens such as N-nitroso compounds have been detected in some environments. Further research on responsible agents is necessary and screening for detection of precursor gastric cancer lesions at the workplace merits consideration. PMID:12782770

  13. Space Station logistics policy - Risk management from the top down

    NASA Technical Reports Server (NTRS)

    Paules, Granville; Graham, James L., Jr.

    1990-01-01

    Considerations are presented in the area of risk management specifically relating to logistics and system supportability. These considerations form a basis for confident application of concurrent engineering principles to a development program, aiming at simultaneous consideration of support and logistics requirements within the engineering process as the system concept and designs develop. It is shown that, by applying such a process, the chances of minimizing program logistics and supportability risk in the long term can be improved. The problem of analyzing and minimizing integrated logistics risk for the Space Station Freedom Program is discussed.

  14. [Bronchopulmonary diseases features in miners of Kolsky Transpolar area].

    PubMed

    Siurin, S A; Nikanov, A N

    2009-01-01

    Miners engaged into open-cast and underground extraction of copper-nickel ores in Kolsky Transpolar area have chronic bronchitis as a main nosologic entity among chronic bronchopulmonary diseases (19.1% of the workers). Considerably lower (4.0% of the workers) occurrence concerns chronic obstructive lung disease and bronchial asthma, both developed before the occupational involvement (1.3% of the workers). Complex of occupational and nonoccupational risk factors is connected mostly with smoking that increases COLD/CB risk 10.7-15.8-fold.

  15. The Value of Continued Followup in a Preventive Medicine Program

    NASA Technical Reports Server (NTRS)

    Villafana, C.; Mockbee, J.

    1970-01-01

    Continued monitoring of hypertension and cholesterol levels in NASA employees by regularly scheduled medical examinations prevents an increase in employee disability and cardiovascular mortality rates. Adequate therapeutic control for younger hypertensive employees is demonstrated by records on mortality and heart diseases over a period of 28 months. It confirmed the importance of systolic blood pressure as diagnostic tool for the inherent risk factor. The prevalence of additional coronary risk factors among employees with hypercholesterolemia is considerably less than in employees with hypertension.

  16. Risk of new psychiatric episodes in the year following divorce in midlife: cause or selection? A nationwide register-based study of 703,960 individuals.

    PubMed

    Björkenstam, Emma; Hallqvist, Johan; Dalman, Christina; Ljung, Rickard

    2013-12-01

    To examine if divorce is associated with an increased risk of psychiatric disorder. A register-based cohort study of all married or divorced individuals aged 45-54 in Sweden in 2006. After exclusion of 129,669 individuals with a history of psychiatric care in 1987-2005, we followed 703,960 persons for psychiatric disorder during 2007, measured as psychiatric inpatient care, outpatient care and use of psychotropic medication. Marital trajectories were taken into consideration. Data were analysed using Poisson regression. Divorced women and men had a higher risk for psychiatric inpatient care compared to married (ORwomen = 3.2, 95%CI = 1.6-6.3, ORmen = 3.3, 95%CI = 2.0-5.4). The longer the marriage, the lower the risk for psychiatric disorders. Lower educational level increased the risk for psychiatric inpatient care. In conclusion, our study supports both the selection hypothesis, linking healthy individuals to long and stable marriages, and the social causation hypothesis, linking the stress of recent divorce to increased psychiatric disorder for both women and men.

  17. Alternative approaches to vertebrate ecotoxicity tests in the 21st century: A review of developments over the last 2 decades and current status

    USGS Publications Warehouse

    Lillicrap, Adam; Belanger, Scott; Burden, Natalie; Du Pasquier, David; Embry, Michelle; Halder, Marlies; Lampi, Mark; Lee, Lucy; Norberg-King, Teresa J.; Rattner, Barnett A.; Schirmer, Kristin; Thomas, Paul

    2016-01-01

    The need for alternative approaches to the use of vertebrate animals for hazard assessment of chemicals and pollutants has become of increasing importance. It is now the first consideration when initiating a vertebrate ecotoxicity test, to ensure that unnecessary use of vertebrate organisms is minimized wherever possible. For some regulatory purposes, the use of vertebrate organisms for environmental risk assessments has been banned; in other situations, the number of organisms tested has been dramatically reduced or the severity of the procedure refined. However, there is still a long way to go to achieve a complete replacement of vertebrate organisms to generate environmental hazard data. The development of animal alternatives is based not just on ethical considerations but also on reducing the cost of performing vertebrate ecotoxicity tests and in some cases on providing better information aimed at improving environmental risk assessments. The present Focus article provides an overview of the considerable advances that have been made toward alternative approaches for ecotoxicity assessments over the last few decades.

  18. Dysphagia in the elderly: management and nutritional considerations

    PubMed Central

    Sura, Livia; Madhavan, Aarthi; Carnaby, Giselle; Crary, Michael A

    2012-01-01

    Dysphagia is a prevalent difficulty among aging adults. Though increasing age facilitates subtle physiologic changes in swallow function, age-related diseases are significant factors in the presence and severity of dysphagia. Among elderly diseases and health complications, stroke and dementia reflect high rates of dysphagia. In both conditions, dysphagia is associated with nutritional deficits and increased risk of pneumonia. Recent efforts have suggested that elderly community dwellers are also at risk for dysphagia and associated deficits in nutritional status and increased pneumonia risk. Swallowing rehabilitation is an effective approach to increase safe oral intake in these populations and recent research has demonstrated extended benefits related to improved nutritional status and reduced pneumonia rates. In this manuscript, we review data describing age related changes in swallowing and discuss the relationship of dysphagia in patients following stroke, those with dementia, and in community dwelling elderly. Subsequently, we review basic approaches to dysphagia intervention including both compensatory and rehabilitative approaches. We conclude with a discussion on the positive impact of swallowing rehabilitation on malnutrition and pneumonia in elderly who either present with dysphagia or are at risk for dysphagia. PMID:22956864

  19. Treatment options for hypertriglyceridemia: from risk reduction to pancreatitis

    PubMed Central

    Berglund, Lars; Brunzell, John D.; Goldberg, Anne C.; Goldberg, Ira J.; Stalenhoef, Anton

    2013-01-01

    While there has been considerable focus on the role and treatment of LDL cholesterol levels, a definitive role of triglycerides in the management of cardiovascular disease has been uncertain. Notably, with increasing triglyceride levels, there is a parallel increase in cholesterol levels carried by triglyceride-rich lipoproteins, which has prompted interest in the use of non-HDL cholesterol levels as a tool guiding interventions. Recent studies have provided evidence for an independent role of triglyceride levels as a cardiovascular risk factor, and recently, an Endocrine Society guideline was published for treatment of hypertriglyceridemia. In contrast to the relative uncertainty regarding triglycerides and cardiovascular disease, a role of very high triglyceride levels as a risk factor for pancreatitis has been well known. The present paper summarizes the underlying evidence for a risk role for triglyceride levels in cardiovascular disease and pancreatitis, current treatment recommendations and areas of future research. PMID:24840268

  20. Consequences of synergy between environmental carcinogens

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

    Berenbaum, M.C.

    1985-12-01

    As it is generally impossible to determine dose-response relationships for carcinogens at the low concentrations in which they occur in the environment, risk-benefit considerations are by consensus based on the linear, no-threshold model, on the assumption that this represents the worst case. However, this assumption does not take into account the possibility of synergistic interactions between carcinogens. It is shown here that, as a result of such interactions, the dose-response curve for added risk due to any individual carcinogen will generally be steeper at lower doses than at higher doses, and consequently the risk at low environmental levels will bemore » higher than would be expected from a linear response. Moreover, this excess risk at low doses is shown to increase as the general level of environmental carcinogens rises and, independently of this effect, it may also increase with the number of carcinogens present.« less

  1. A Critique of Recent Epidemiologic Studies of Cancer Mortality Among Nuclear Workers.

    PubMed

    Scott, Bobby R

    2018-01-01

    Current justification by linear no-threshold (LNT) cancer risk model advocates for its use in low-dose radiation risk assessment is now mainly based on results from flawed and unreliable epidemiologic studies that manufacture small risk increases (ie, phantom risks). Four such studies of nuclear workers, essentially carried out by the same group of epidemiologists, are critiqued in this article. Three of the studies that forcibly applied the LNT model (inappropriate null hypothesis) to cancer mortality data and implicated increased mortality risk from any radiation exposure, no matter how small the dose, are demonstrated to manufacture risk increases for doses up to 100 mSv (or 100 mGy). In a study where risk reduction (hormetic effect/adaptive response) was implicated for nuclear workers, it was assumed by the researchers to relate to a "strong healthy worker effect" with no consideration of the possibility that low radiation doses may help prevent cancer mortality (which is consistent with findings from basic radiobiological research). It was found with basic research that while large radiation doses suppress our multiple natural defenses (barriers) against cancer, these barriers are enhanced by low radiation doses, thereby decreasing cancer risk, essentially rendering the LNT model to be inconsistent with the data.

  2. [Therapeutic options for weight management in schizophrenic patients treated with atypical antipsychotics].

    PubMed

    Cordes, J; Sinha-Röder, A; Kahl, K G; Malevani, J; Thuenker, J; Lange-Asschenfeldt, C; Hauner, H; Agelink, M W; Klimke, A

    2008-12-01

    Extensive, selective literature review of 2500 articles from the last years (up to December 2007) predominantly from Medline and Cochrane, using as search terms "antipsychotic or schizophrenia or individual drug names (amisulpride, aripiprazole, clozapine, olanzapine, quetiapine, risperidone, ziprasidone)" and the terms "BMI, weight gain, metabolic syndrome, diabetes, lipid(s), cholesterol, triglycerides" was conducted. Regardless of the advantages ascribed to atypical antipsychotics and the special effectiveness of clozapine in patients resistant to therapy and at risk for suicide, the probability of weight gain is considerably increased for some of these substances. Patients with schizophrenia have a considerably reduced life expectancy associated with an increased prevalence of cardiovascular risk factors. There is a lack of practical guidelines integrated into clinical psychiatric care for the management of cardiovascular risk factors. The monitoring of patients treated with atypics, which has been recommended in the APA/ADA Consensus Paper in light of these facts, is insufficiently established in clinical practice. A regular monitoring can convey self control and motivation to the patient. In the case of corresponding risk constellations further decisions regarding indication and therapy have to be considered. Especially patients with a high cardiovascular risk profile are highly recommended to participate in a weight-management program for prevention purposes. Such a special program should include elements of dietetic treatment and behaviour and exercise therapy. First controlled studies suggest an effective prevention of weight gain and metabolic changes when applying such a structured program. The practice oriented step by step concept presented here is meant to provide points of reference for the implementation of required medical and psychoeducative measures facilitating the management of weight and further cardiovascular risk factors in the context of psychiatric care in patients with schizophrenia.

  3. Limiting financial disincentives in live organ donation: a rational solution to the kidney shortage.

    PubMed

    Gaston, R S; Danovitch, G M; Epstein, R A; Kahn, J P; Matas, A J; Schnitzler, M A

    2006-11-01

    Availability of kidney transplantation is limited by an inadequate supply of organs, with no apparent remedy on the immediate horizon and increasing reliance on living donors (LDs). While some have advocated financial remuneration to stimulate donation, the National Organ Transplant Act (NOTA) of 1984 expressly forbids the offer of 'valuable consideration.' However, recent developments indicate some fluidity in the definition of valuable consideration while evolving international standards highlight deficiencies (particularly regarding long-term care and follow-up) in the current American system. Recognizing that substantial financial and physical disincentives exist for LDs, we propose a policy change that offers the potential to enhance organ availability as well as address concerns regarding long-term care. Donors assume much greater risk than is widely acknowledged, risk that can be approximated for the purpose of determining appropriate compensation. Our proposal offsets donor risk via a package of specific benefits (life insurance, health insurance and a small amount of cash) to minimize hazard and ensure donor interests are protected after as well as before nephrectomy. It will fund medical follow-up and enable data collection so that long-term risk can be accurately assessed. The proposal should be cost effective with only a small increase in the number of LDs, and the net benefit will become greater if removal of disincentives stimulates even further growth. As importantly, by directly linking compensation to risk, we believe it preserves the essence of kidney donation as a gift, consistent with NOTA and implementable in the United States without altering current legal statutes.

  4. Adolescent Family Adversity and Mental Health Problems: The Role of Adaptive Self-Regulation Capacities. The TRAILS Study

    ERIC Educational Resources Information Center

    Bakker, Martin Paul; Ormel, Johan; Verhulst, Frank C.; Oldehinkel, Albertine J.

    2011-01-01

    Adolescent family adversity is a considerable adaptive challenge in an increasingly turbulent developmental period. Using data from a prospective population cohort of 2230 Dutch adolescents, we tested risk-buffering interactions between adolescent family adversity and self-regulation capacities on mental health. We used two adaptive…

  5. Collaboration in Academic R&D: A Decade of Growth in Pass-Through Funding. InfoBrief. NSF 12-325

    ERIC Educational Resources Information Center

    Hale, Katherine

    2012-01-01

    Research collaboration involving multiple institutions is a growing trend. Contributing to this growth are federal initiatives as well as practical considerations, such as technological advances that facilitate communication and opportunities for division of labor, risk sharing, and increased research credibility. One measure of this research…

  6. Riparian fuel treatments in the western USA: Challenges and considerations

    Treesearch

    Kathleen A. Dwire; Kristen E. Meyer; Gregg Riegel; Timothy Burton

    2016-01-01

    Fuel reduction treatments are being conducted throughout watersheds of the western United States to reduce hazardous fuels in efforts to decrease the risk of high-severity fire. The number of fuel reduction projects that include near-stream environments is increasing, bringing new challenges to riparian management. Riparian areas are protected by administrative...

  7. Fire weather technology for fire agrometeorology operations

    Treesearch

    Francis Fujioka

    2008-01-01

    Even as the magnitude of wildfire problems increases globally, United Nations agencies are acting to mitigate the risk of wildfire disasters to members. Fire management organizations worldwide may vary considerably in operational scope, depending on the number and type of resources an organization manages. In any case, good fire weather information is vital. This paper...

  8. Woman's Pre-Conception Evaluation: Genetic and Fetal Risk Considerations for Counselling and Informed Choice.

    PubMed

    Wilson, R Douglas

    2017-10-11

    To inform reproductive and other health care providers about genetic and fetal risk information to consider during a woman/couples' pre-conception evaluation, including considerations for genetic risk assessment, genetic screening, or testing to allow for improved counselling and informed choice. This genetic information can be used for patient education, planning, and possible pre-conception and/or prenatal testing. This information may allow improved risk assessment for pre-conception counselling for individual patients and their families. PubMed or Medline and the Cochrane Database were searched in May 2017 using appropriate key words ("pre-conception," "genetic disease," "maternal," "family history," "genetic," "health risk," "genetic health surveillance," "prenatal screening," "prenatal diagnosis," "birth defects," and "teratogen"). Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology assessment-related agencies, clinical practice guideline collections, and national and international medical specialty societies. The benefits for the patient and her family include an increased understanding of relevant genetic risk pre-conception and in early pregnancy, and better pregnancy outcomes as a result of use of the information. The harm includes potential increased anxiety or psychological stress associated with the possibility of identifying genetic risks. The evidence obtained was peer-reviewed by the Genetics Committee of The Society of Obstetricians and Gynaecologists of Canada. Consideration for Care Statements For this review article, the Consideration for Care Statements use the GRADE strength and quality as it is comparable for the clinician and the patient/public user. [GRADE from the Canadian Task Force on Preventive Health Care (www.canadiantaskforce.ca). For clinicians, Strong = The recommendation would apply to most individuals. Formal discussion aids are not likely to be needed to help individuals make decisions consistent with their values and preferences. For patients/public, Strong = We believe most people in this situation would want the recommended course of actions and only a small number would not. Quality of evidence (High, Moderate, Low) based on the confidence that the true effect lies close to that of the estimate of the effect.] Conclusion Pre-conception planning is presently underutilized by both patients and providers. Pre-conception genetic assessment is only a part of the counselling, education, and health management change that can improve perinatal and maternal morbidity and mortality. A published literature review on pre-conception genetic counselling identified mainly clinical cohort studies, surveys, and expert opinion with no RCTs. There is strong support for pre-conception counselling and moderate quality based on the understanding that most individuals would support and use pre-conception counselling when choice, timing, and ease of access is considered. Copyright © 2017 Society of Obstetricians and Gynaecologists of Canada. Published by Elsevier Inc. All rights reserved.

  9. Increased burden of cardiovascular disease in carriers of APOL1 genetic variants.

    PubMed

    Ito, Kaoru; Bick, Alexander G; Flannick, Jason; Friedman, David J; Genovese, Giulio; Parfenov, Michael G; Depalma, Steven R; Gupta, Namrata; Gabriel, Stacey B; Taylor, Herman A; Fox, Ervin R; Newton-Cheh, Christopher; Kathiresan, Sekar; Hirschhorn, Joel N; Altshuler, David M; Pollak, Martin R; Wilson, James G; Seidman, J G; Seidman, Christine

    2014-02-28

    Two distinct alleles in the gene encoding apolipoprotein L1 (APOL1), a major component of high-density lipoprotein, confer protection against Trypanosoma brucei rhodesiense infection and also increase risk for chronic kidney disease. Approximately 14% of Americans with African ancestry carry 2 APOL1 risk alleles, accounting for the high chronic kidney disease burden in this population. We tested whether APOL1 risk alleles significantly increase risk for atherosclerotic cardiovascular disease (CVD) in African Americans. We sequenced APOL1 in 1959 randomly selected African American participants in the Jackson Heart Study (JHS) and evaluated associations between APOL1 genotypes and renal and cardiovascular phenotypes. Previously identified association between APOL1 genotypes and chronic kidney disease was confirmed (P=2.4×10(-6)). Among JHS participants with 2 APOL1 risk alleles, we observed increased risk for CVD (50/763 events among participants without versus 37/280 events among participants with 2 risk alleles; odds ratio, 2.17; P=9.4×10(-4)). We replicated this novel association of APOL1 genotype with CVD in Women's Health Initiative (WHI) participants (66/292 events among participants without versus 37/101 events among participants with 2 risk alleles; odds ratio, 1.98; P=8.37×10(-3); JHS and WHI combined, P=8.5×10(-5); odds ratio, 2.12). The increased risk for CVD conferred by APOL1 alleles was robust to correction for both traditional CVD risk factors and chronic kidney disease. APOL1 variants contribute to atherosclerotic CVD risk, indicating a genetic component to cardiovascular health disparities in individuals of African ancestry. The considerable population of African Americans with 2 APOL1 risk alleles may benefit from intensive interventions to reduce CVD.

  10. The Role of Hedonic Behavior in Reducing Perceived Risk

    PubMed Central

    Jia, Jayson S.; Jia, Jianmin; Hsee, Christopher K.; Shiv, Baba

    2016-01-01

    Understanding how human populations naturally respond to and cope with risk is important for fields ranging from psychology to public health. We used geophysical and individual-level mobile-phone data (mobile-apps, telecommunications, and Web usage) of 157,358 victims of the 2013 Ya’an earthquake to diagnose the effects of the disaster and investigate how experiencing real risk (at different levels of intensity) changes behavior. Rather than limiting human activity, higher earthquake intensity resulted in graded increases in usage of communications apps (e.g., social networking, messaging), functional apps (e.g., informational tools), and hedonic apps (e.g., music, videos, games). Combining mobile data with a field survey (N = 2,000) completed 1 week after the earthquake, we use an instrumental-variable approach to show that only increases in hedonic behavior reduced perceived risk. Thus, hedonic behavior could potentially serve as a population-scale coping and recovery strategy that is often missing in risk management and policy considerations. PMID:27881710

  11. The Role of Hedonic Behavior in Reducing Perceived Risk.

    PubMed

    Jia, Jayson S; Jia, Jianmin; Hsee, Christopher K; Shiv, Baba

    2017-01-01

    Understanding how human populations naturally respond to and cope with risk is important for fields ranging from psychology to public health. We used geophysical and individual-level mobile-phone data (mobile-apps, telecommunications, and Web usage) of 157,358 victims of the 2013 Ya'an earthquake to diagnose the effects of the disaster and investigate how experiencing real risk (at different levels of intensity) changes behavior. Rather than limiting human activity, higher earthquake intensity resulted in graded increases in usage of communications apps (e.g., social networking, messaging), functional apps (e.g., informational tools), and hedonic apps (e.g., music, videos, games). Combining mobile data with a field survey ( N = 2,000) completed 1 week after the earthquake, we use an instrumental-variable approach to show that only increases in hedonic behavior reduced perceived risk. Thus, hedonic behavior could potentially serve as a population-scale coping and recovery strategy that is often missing in risk management and policy considerations.

  12. Comparative effectiveness research: what to do when experts disagree about risks.

    PubMed

    Lie, Reidar K; Chan, Francis K L; Grady, Christine; Ng, Vincent H; Wendler, David

    2017-06-19

    Ethical issues related to comparative effectiveness research, or research that compares existing standards of care, have recently received considerable attention. In this paper we focus on how Ethics Review Committees (ERCs) should evaluate the risks of comparative effectiveness research. We discuss what has been a prominent focus in the debate about comparative effectiveness research, namely that it is justified when "nothing is known" about the comparative effectiveness of the available alternatives. We argue that this focus may be misleading. Rather, we should focus on the fact that some experts believe that the evidence points in favor of one intervention, whereas other experts believe that the evidence favors the alternative(s). We will then introduce a case that illustrates this point, and based on that, discuss how ERCs should deal with such cases of expert disagreement. We argue that ERCs have a duty to assess the range of expert opinions and based on that assessment arrive at a risk judgment about the study under consideration. We also argue that assessment of expert disagreement is important for the assignment of risk level to a clinical trial: what is the basis for expert opinions, how strong is the evidence appealed to by various experts, and how can clinical trial monitoring affect the possible increased risk of clinical trial participation.

  13. [Anesthetic considerations in sickle cell anemia: a case report].

    PubMed

    Fernández-Meré, L A; Sopena-Zubiría, L A; Alvarez-Blanco, M

    2009-01-01

    Sickle cell anemia is the most common hemoglobinopathy. Advances in therapeutic techniques and anesthetic procedures have led to a considerable increase in the success of surgical procedures in these patients. We report the case of a 16-year-old black boy diagnosed with sickle cell anemia and beta-thalassemia who presented with chronic osteomyelitis of the tibia. He was scheduled for debridement of the lesion and musculocutaneous flap repair. We emphasize the importance of communication between anesthesiologists, surgeons, and hematologists in the perioperative period in order to determine the risk of complications and anticipate them.

  14. Drug Prohibition in the United States: Costs, Consequences, and Alternatives

    NASA Astrophysics Data System (ADS)

    Nadelmann, Ethan A.

    1989-09-01

    ``Drug legalization'' increasingly merits serious consideration as both an analytical model and a policy option for addressing the ``drug problem.'' Criminal justice approaches to the drug problem have proven limited in their capacity to curtail drug abuse. They also have proven increasingly costly and counterproductive. Drug legalization policies that are wisely implemented can minimize the risks of legalization, dramatically reduce the costs of current policies, and directly address the problems of drug abuse.

  15. Tree-based flood damage modeling of companies: Damage processes and model performance

    NASA Astrophysics Data System (ADS)

    Sieg, Tobias; Vogel, Kristin; Merz, Bruno; Kreibich, Heidi

    2017-07-01

    Reliable flood risk analyses, including the estimation of damage, are an important prerequisite for efficient risk management. However, not much is known about flood damage processes affecting companies. Thus, we conduct a flood damage assessment of companies in Germany with regard to two aspects. First, we identify relevant damage-influencing variables. Second, we assess the prediction performance of the developed damage models with respect to the gain by using an increasing amount of training data and a sector-specific evaluation of the data. Random forests are trained with data from two postevent surveys after flood events occurring in the years 2002 and 2013. For a sector-specific consideration, the data set is split into four subsets corresponding to the manufacturing, commercial, financial, and service sectors. Further, separate models are derived for three different company assets: buildings, equipment, and goods and stock. Calculated variable importance values reveal different variable sets relevant for the damage estimation, indicating significant differences in the damage process for various company sectors and assets. With an increasing number of data used to build the models, prediction errors decrease. Yet the effect is rather small and seems to saturate for a data set size of several hundred observations. In contrast, the prediction improvement achieved by a sector-specific consideration is more distinct, especially for damage to equipment and goods and stock. Consequently, sector-specific data acquisition and a consideration of sector-specific company characteristics in future flood damage assessments is expected to improve the model performance more than a mere increase in data.

  16. Risk factors for community-acquired pneumonia in adults in Europe: a literature review

    PubMed Central

    Torres, Antoni; Peetermans, Willy E; Viegi, Giovanni; Blasi, Francesco

    2013-01-01

    Background Community-acquired pneumonia (CAP) causes considerable morbidity and mortality in adults, particularly in the elderly. Methods Structured searches of PubMed were conducted to identify up-to-date information on the incidence of CAP in adults in Europe, as well as data on lifestyle and medical risk factors for CAP. Results The overall annual incidence of CAP in adults ranged between 1.07 to 1.2 per 1000 person-years and 1.54 to 1.7 per 1000 population and increased with age (14 per 1000 person-years in adults aged ≥65 years). Incidence was also higher in men than in women and in patients with chronic respiratory disease or HIV infection. Lifestyle factors associated with an increased risk of CAP included smoking, alcohol abuse, being underweight, having regular contact with children and poor dental hygiene. The presence of comorbid conditions, including chronic respiratory and cardiovascular diseases, cerebrovascular disease, Parkinson's disease, epilepsy, dementia, dysphagia, HIV or chronic renal or liver disease all increased the risk of CAP by twofold to fourfold. Conclusion A range of lifestyle factors and underlying medical conditions are associated with an increased risk of CAP in European adults. Understanding of the types of individual at greatest risk of CAP can help to ensure that interventions to reduce the risk of infection and burden of disease are targeted appropriately. PMID:24130229

  17. Classification models for subthreshold generalized anxiety disorder in a college population: Implications for prevention.

    PubMed

    Kanuri, Nitya; Taylor, C Barr; Cohen, Jeffrey M; Newman, Michelle G

    2015-08-01

    Generalized anxiety disorder (GAD) is one of the most common psychiatric disorders on college campuses and often goes unidentified and untreated. We propose a combined prevention and treatment model composed of evidence-based self-help (SH) and guided self-help (GSH) interventions to address this issue. To inform the development of this stepped-care model of intervention delivery, we evaluated results from a population-based anxiety screening of college students. A primary model was developed to illustrate how increasing levels of symptomatology could be linked to prevention/treatment interventions. We used screening data to propose four models of classification for populations at risk for GAD. We then explored the cost considerations of implementing this prevention/treatment stepped-care model. Among 2489 college students (mean age 19.1 years; 67% female), 8.0% (198/2489) met DSM-5 clinical criteria for GAD, in line with expected clinical rates for this population. At-risk Model 1 (subthreshold, but considerable symptoms of anxiety) identified 13.7% of students as potentially at risk for developing GAD. Model 2 (subthreshold, but high GAD symptom severity) identified 13.7%. Model 3 (subthreshold, but symptoms were distressing) identified 12.3%. Model 4 (subthreshold, but considerable worry) identified 17.4%. There was little overlap among these models, with a combined at-risk population of 39.4%. The efficiency of these models in identifying those truly at risk and the cost and efficacy of preventive interventions will determine if prevention is viable. Using Model 1 data and conservative cost estimates, we found that a preventive intervention effect size of even 0.2 could make a prevention/treatment model more cost-effective than existing models of "wait-and-treat." Copyright © 2015 Elsevier Ltd. All rights reserved.

  18. Using climate model simulations to assess the current climate risk to maize production

    NASA Astrophysics Data System (ADS)

    Kent, Chris; Pope, Edward; Thompson, Vikki; Lewis, Kirsty; Scaife, Adam A.; Dunstone, Nick

    2017-05-01

    The relationship between the climate and agricultural production is of considerable importance to global food security. However, there has been relatively little exploration of climate-variability related yield shocks. The short observational yield record does not adequately sample natural inter-annual variability thereby limiting the accuracy of probability assessments. Focusing on the United States and China, we present an innovative use of initialised ensemble climate simulations and a new agro-climatic indicator, to calculate the risk of severe water stress. Combined, these regions provide 60% of the world’s maize, and therefore, are crucial to global food security. To probe a greater range of inter-annual variability, the indicator is applied to 1400 simulations of the present day climate. The probability of severe water stress in the major maize producing regions is quantified, and in many regions an increased risk is found compared to calculations from observed historical data. Analysis suggests that the present day climate is also capable of producing unprecedented severe water stress conditions. Therefore, adaptation plans and policies based solely on observed events from the recent past may considerably under-estimate the true risk of climate-related maize shocks. The probability of a major impact event occurring simultaneously across both regions—a multi-breadbasket failure—is estimated to be up to 6% per decade and arises from a physically plausible climate state. This novel approach highlights the significance of climate impacts on crop production shocks and provides a platform for considerably improving food security assessments, in the present day or under a changing climate, as well as development of new risk based climate services.

  19. Fitness attenuates the prevalence of increased coronary artery calcium in individuals with metabolic syndrome.

    PubMed

    Ekblom-Bak, Elin; Ekblom, Örjan; Fagman, Erika; Angerås, Oskar; Schmidt, Caroline; Rosengren, Annika; Börjesson, Mats; Bergström, Göran

    2018-02-01

    Background The association between cardiorespiratory fitness, physical activity and coronary artery calcium (CAC) is unclear, and whether higher levels of fitness attenuate CAC prevalence in subjects with metabolic syndrome is not fully elucidated. The present study aims to: a) investigate the independent association of fitness on the prevalence of CAC, after adjustment for moderate-to-vigorous physical activity and sedentary time, and b) study the possible attenuation of increased CAC by higher fitness, in participants with metabolic syndrome. Design Cross-sectional. Methods In total 678 participants (52% women), 50-65 years old, from the SCAPIS pilot study were included. Fitness (VO 2 max) was estimated by submaximal cycle ergometer test and moderate-to-vigorous physical activity and sedentary time were assessed using hip-worn accelerometers. CAC score (CACS) was quantified using the Agatston score. Results The odds of having a significant CACS (≥100) was half in participants with moderate/high fitness compared with their low fitness counterparts. Further consideration of moderate-to-vigorous physical activity, sedentary time and number of components of the metabolic syndrome did only slightly alter the effect size. Those with metabolic syndrome had 47% higher odds for significant CAC compared with those without metabolic syndrome. However, moderate/high fitness seems to partially attenuate this risk, as further joint analysis indicated an increased odds for having significant CAC only in the unfit metabolic syndrome participants. Conclusions Being fit is associated with a reduced risk of having significant CAC in individuals with metabolic syndrome. While still very much underutilized, fitness should be taken into consideration in everyday clinical risk prediction in addition to the traditional risk factors of the metabolic syndrome.

  20. Scientific and Regulatory Considerations in Solid Oral Modified Release Drug Product Development.

    PubMed

    Li, Min; Sander, Sanna; Duan, John; Rosencrance, Susan; Miksinski, Sarah Pope; Yu, Lawrence; Seo, Paul; Rege, Bhagwant

    2016-11-01

    This review presents scientific and regulatory considerations for the development of solid oral modified release (MR) drug products. It includes a rationale for patient-focused development based on Quality-by-Design (QbD) principles. Product and process understanding of MR products includes identification and risk-based evaluation of critical material attributes (CMAs), critical process parameters (CPPs), and their impact on critical quality attributes (CQAs) that affect the clinical performance. The use of various biopharmaceutics tools that link the CQAs to a predictable and reproducible clinical performance for patient benefit is emphasized. Product and process understanding lead to a more comprehensive control strategy that can maintain product quality through the shelf life and the lifecycle of the drug product. The overall goal is to develop MR products that consistently meet the clinical objectives while mitigating the risks to patients by reducing the probability and increasing the detectability of CQA failures.

  1. European perspectives of food safety.

    PubMed

    Bánáti, Diána

    2014-08-01

    Food safety has been a growing concern among European Union (EU) citizens over the last decades. Despite the fact that food has never been safer, consumers are considerably uncertain and increasingly critical about the safety of their food. The introduction of new principles, such as the primary responsibility of producers, traceability, risk analysis, the separation of risk assessment and risk management provided a more transparent, science-based system in Europe, which can help to restore consumers' lost confidence. The present EU integrated approach to food safety 'from farm to fork' aims to assure a high level of food safety within the EU. © 2014 Society of Chemical Industry.

  2. Proximal risk factors and suicide methods among suicide completers from national suicide mortality data 2004-2006 in Korea.

    PubMed

    Im, Jeong-Soo; Choi, Soon Ho; Hong, Duho; Seo, Hwa Jeong; Park, Subin; Hong, Jin Pyo

    2011-01-01

    This study was conducted to examine differences in proximal risk factors and suicide methods by sex and age in the national suicide mortality data in Korea. Data were collected from the National Police Agency and the National Statistical Office of Korea on suicide completers from 2004 to 2006. The 31,711 suicide case records were used to analyze suicide rates, methods, and proximal risk factors by sex and age. Suicide rate increased with age, especially in men. The most common proximal risk factor for suicide was medical illness in both sexes. The most common proximal risk factor for subjects younger than 30 years was found to be a conflict in relationships with family members, partner, or friends. Medical illness was found to increase in prevalence as a risk factor with age. Hanging/Suffocation was the most common suicide method used by both sexes. The use of drug/pesticide poisoning to suicide increased with age. A fall from height or hanging/suffocation was more popular in the younger age groups. Because proximal risk factors and suicide methods varied with sex and age, different suicide prevention measures are required after consideration of both of these parameters. Copyright © 2011 Elsevier Inc. All rights reserved.

  3. Radiation Exposure and Attributable Cancer Risk in Patients With Esophageal Atresia.

    PubMed

    Yousef, Yasmine; Baird, Robert

    2018-02-01

    Cases of esophageal carcinoma have been documented in survivors of esophageal atresia (EA). Children with EA undergo considerable amounts of diagnostic imaging and consequent radiation exposure potentially increasing their lifetime cancer mortality risk. This study evaluates the radiological procedures performed on patients with EA and estimates their cumulative radiation exposure and attributable lifetime cancer mortality risk. Medical records of patients with EA managed at a tertiary care center were reviewed for demographics, EA subtype, and number and type of radiological investigations. Existing normative data were used to estimate the cumulative radiation exposure and lifetime cancer risk per patient. The present study included 53 patients with a mean follow-up of 5.7 years. The overall median and maximum estimated effective radiation dose in the neonatal period was 5521.4 μSv/patient and 66638.6 μSv/patient, respectively. This correlates to a median and maximum estimated cumulative lifetime cancer mortality risk of 1:1530 and 1:130, respectively. Hence, radiation exposure in the neonatal period increased the cumulative cancer mortality risk a median of 130-fold and a maximum of 1575-fold in EA survivors. Children with EA are exposed to significant amounts of radiation and an increased estimated cumulative cancer mortality risk. Efforts should be made to eliminate superfluous imaging.

  4. The Regulatory Perspectives on Endoscopic Devices for Obesity.

    PubMed

    Marrone, April K; Antonino, Mark J; Silverstein, Joshua S; Betz, Martha W; Venkataraman-Rao, Priya; Golding, Martin; Cordray, Diane; Cooper, Jeffrey W

    2017-04-01

    The recent increase in US Food and Drug Administration-approved weight-loss devices has diversified obesity treatment options. The regulatory pathways for endoscopically placed weight-loss devices and considerations for clinical trials are discussed, including the benefit-risk paradigm intended to aid in weight-loss-device trial development. Also discussed is the benefit-risk analysis of recently approved endoscopic devices. A strategic priority of the FDA Center for Devices and Radiological Health is to increase the use of patient input in decision making. Thus, we consider how endoscopic weight-loss devices with profiles similar to those that have been approved may be viewed in a patient preference study. Published by Elsevier Inc.

  5. Developmental vitamin D deficiency and schizophrenia: the role of animal models

    PubMed Central

    Schoenrock, S. A.; Tarantino, L. M.

    2016-01-01

    Schizophrenia is a debilitating neuropsychiatric disorder that affects 1% of the US population. Based on twin and genome-wide association studies, it is clear that both genetics and environmental factors increase the risk for developing schizophrenia. Moreover, there is evidence that conditions in utero, either alone or in concert with genetic factors, may alter neurodevelopment and lead to an increased risk for schizophrenia. There has been progress in identifying genetic loci and environmental exposures that increase risk, but there are still considerable gaps in our knowledge. Furthermore, very little is known about the specific neurodevelopmental mechanisms upon which genetics and the environment act to increase disposition to developing schizophrenia in adulthood. Vitamin D deficiency during the perinatal period has been hypothesized to increase risk for schizophrenia in humans. The developmental vitamin D (DVD) deficiency hypothesis of schizophrenia arises from the observation that disease risk is increased in individuals who are born in winter or spring, live further from the equator or live in urban vs. rural settings. These environments result in less exposure to sunlight, thereby reducing the initial steps in the production of vitamin D. Rodent models have been developed to characterize the behavioral and developmental effects of DVD deficiency. This review focuses on these animal models and discusses the current knowledge of the role of DVD deficiency in altering behavior and neurobiology relevant to schizophrenia. PMID:26560996

  6. Neglected Parasitic Infections in the United States: Trichomoniasis

    PubMed Central

    Secor, W. Evan; Meites, Elissa; Starr, Michelle C.; Workowski, Kimberly A.

    2014-01-01

    Trichomonas vaginalis is one of the most common human parasitic infections in the United States, as well as the most prevalent non-viral sexually transmitted infection. However, it has long received much less consideration than other parasitic and sexually transmitted diseases. Much of this inattention can be attributed to a poor understanding of the public health impact of trichomoniasis. Increasing recognition of the sequelae of infection, including increased risk of infection with human immunodeficiency virus and adverse outcomes of pregnancy, has led to increased interest in T. vaginalis. Recent innovations include development of diagnostic tests that could improve detection of the parasite. A number of important questions, such as the epidemiology among men and women, the true public health burden of symptomatic and asymptomatic T. vaginalis infections, and whether current treatments will be adequate to reduce the substantial health disparities and costs associated with trichomoniasis, need consideration to remedy neglect of this important disease. PMID:24808247

  7. Strategies for vascular disease prevention: the role of lipids and related markers including apolipoproteins, low-density lipoproteins (LDL)-particle size, high sensitivity C-reactive protein (hs-CRP), lipoprotein-associated phospholipase A2 (Lp-PLA₂) and lipoprotein(a) (Lp(a)).

    PubMed

    Dallmeier, Dhayana; Koenig, Wolfgang

    2014-06-01

    Considerable progress has been achieved in the treatment of dyslipidemias. However, half of cardiovascular events occur in individuals with average or low cholesterol levels and there is still a considerable residual risk with 70% of patients having an event despite statin treatment. In the era of personalized medicine there is increased interest in the incorporation of individual biomarkers in risk score algorithms in order to improve cardiovascular risk stratification followed by the prompt initiation of preventive measures. Since the 2001 third report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation and Treatment on High Blood Cholesterol in Adults (ATP III) several studies have evaluated the prognostic value of lipid related biomarkers such as non-HDL-cholesterol, apolipoprotein B, apolipoprotein B/apolipoprotein A1 ratio, lipoprotein(a), lipoprotein-associated phospholipase A2, and C-reactive protein. This article tries to summarize the most recent results in this area. Copyright © 2014 Elsevier Ltd. All rights reserved.

  8. Periprocedural considerations of transcatheter aortic valve implantation for anesthesiologists

    PubMed Central

    Afshar, Ata Hassani; Pourafkari, Leili; Nader, Nader D

    2016-01-01

    Transcatheter aortic valve replacement (TAVR) is rapidly gaining popularity as a viable option in the management of patients with symptomatic aortic stenosis (AS) and high risk for open surgical intervention. TAVR soon expanding its indications from "high-risk" group of patients to those with "intermediate-risk". As an anesthesiologist; understanding the procedure and the challenges inherent to it is of utmost importance, in order to implement optimal care for this generally frail population undergoing a rather novel procedure. Cardiac anesthesiologists generally play a pivotal role in the perioperative care of the patients, and therefore they should be fully familiar with the circumstances occurring surrounding the procedure. Along with increasing experience and technical developments for TAVR, the procedure time becomes shorter. Due to this improvement in the procedure time, more and more anesthesiologists feel comfortable in using monitored anesthesia care with moderate sedation for patients undergoing TAVR. A number of complications could arise during the procedure needing rapid diagnoses and occasionally conversion to general anesthesia. This review focuses on the periprocedural anesthetic considerations for TAVR. PMID:27489596

  9. Risk segmentation in Chilean social health insurance.

    PubMed

    Hidalgo, Hector; Chipulu, Maxwell; Ojiako, Udechukwu

    2013-01-01

    The objective of this study is to identify how risk and social variables are likely to be impacted by an increase in private sector participation in health insurance provision. The study focuses on the Chilean health insurance industry, traditionally dominated by the public sector. Predictive risk modelling is conducted using a database containing over 250,000 health insurance policy records provided by the Superintendence of Health of Chile. Although perceived with suspicion in some circles, risk segmentation serves as a rational approach to risk management from a resource perspective. The variables that have considerable impact on insurance claims include the number of dependents, gender, wages and the duration a claimant has been a customer. As shown in the case study, to ensure that social benefits are realised, increased private sector participation in health insurance must be augmented by regulatory oversight and vigilance. As it is clear that a "community-rated" health insurance provision philosophy impacts on insurance firm's ability to charge "market" prices for insurance provision, the authors explore whether risk segmentation is a feasible means of predicting insurance claim behaviour in Chile's private health insurance industry.

  10. Anxiety Disorders in Children and Adolescents with Autistic Spectrum Disorders: A Meta-Analysis

    ERIC Educational Resources Information Center

    van Steensel, Francisca J. A.; Bogels, Susan M.; Perrin, Sean

    2011-01-01

    There is considerable evidence that children and adolescents with autistic spectrum disorders (ASD) are at increased risk of anxiety and anxiety disorders. However, it is less clear which of the specific DSM-IV anxiety disorders occur most in this population. The present study used meta-analytic techniques to help clarify this issue. A systematic…

  11. "Bring Your Own Device": Considering Potential Risks to Student Health

    ERIC Educational Resources Information Center

    Merga, Margaret K.

    2016-01-01

    Background and context: Schools in Australia and internationally are increasingly adopting a Bring Your Own Device (BYOD) approach to teaching and learning. The review: While discussion of a BYOD approach has taken place, there is a dearth of consideration of the potential impact of BYOD policy on student health. Implementation of a BYOD policy…

  12. Evaluation and treatment of male hypogonadism in primary care.

    PubMed

    Pickett, Kim Anne

    2016-08-18

    Male hypogonadism is increasing in prevalence, particularly in the older male population. Signs and symptoms associated with hypogonadism are often nonspecific and may be difficult to categorize. This article discusses parameters for screening patients at risk, reviews how to establish the diagnosis of primary or secondary male hypogonadism, and offers important considerations for treatment of patients with hypogonadism.

  13. Disclosure and rationality: comparative risk information and decision-making about prevention.

    PubMed

    Schwartz, Peter H

    2009-01-01

    With the growing focus on prevention in medicine, studies of how to describe risk have become increasing important. Recently, some researchers have argued against giving patients "comparative risk information," such as data about whether their baseline risk of developing a particular disease is above or below average. The concern is that giving patients this information will interfere with their consideration of more relevant data, such as the specific chance of getting the disease (the "personal risk"), the risk reduction the treatment provides, and any possible side effects. I explore this view and the theories of rationality that ground it, and I argue instead that comparative risk information can play a positive role in decision-making. The criticism of disclosing this sort of information to patients, I conclude, rests on a mistakenly narrow account of the goals of prevention and the nature of rational choice in medicine.

  14. Crisis management in the treatment of childhood acute lymphoblastic leukemia: putting right what can go wrong (emergency complications of disease and treatment).

    PubMed

    Hough, Rachael; Vora, Ajay

    2017-12-08

    The improvement in overall survival in children with acute lymphoblastic leukemia (ALL) over the last 5 decades has been considerable, with around 90% now surviving long term. The risk of relapse has been reduced to such an extent that the risk of treatment-related mortality is now approaching that of mortality caused by relapse. Toxicities may also lead to the suboptimal delivery of chemotherapy (treatment delays, dose reductions, dose omissions), potentially increasing relapse risk, and short- and long-term morbidity, adding to the "burden of therapy" in an increasing number of survivors. Thus, the need to reduce toxicity in pediatric ALL is becoming increasingly important. This work focuses on the risk factors, pathogenesis, clinical features, and emergency management of the life-threatening complications of ALL at presentation and during subsequent chemotherapy, including leucostasis, tumor lysis syndrome, infection, methotrexate encephalopathy, thrombosis, and pancreatitis. Potential strategies to abrogate these toxicities in the future are also discussed. © 2016 by The American Society of Hematology. All rights reserved.

  15. Reinforcing effects of non-pathogenic bacteria and predation risk: from physiology to life history.

    PubMed

    Janssens, Lizanne; Stoks, Robby

    2014-10-01

    The important ecological role of predation risk in shaping populations, communities and ecosystems is becoming increasingly clear. In this context, synergistic effects between predation risk and other natural stressors on prey organisms are gaining attention. Although non-pathogenic bacteria can be widespread in aquatic ecosystems, their role in mediating effects of predation risk has been ignored. We here address the hypothesis that non-pathogenic bacteria may reinforce the negative effects of predation risk in larvae of the damselfly Coenagrion puella. We found synergistic effects for all three life history variables studied: mortality increased, growth reductions were magnified and bacterial load was higher when both non-lethal stressors were combined. The combined exposure to the bacterium and predation risk considerably impaired the two key antipredator mechanisms of the damselfly larvae: they no longer reduced their food intake under predation risk and showed a synergistic reduction in escape swimming speed. The reinforcing negative effects on the fitness-related traits could be explained by the observed synergistic effects on food intake, swimming muscle mass, immune function and oxidative damage. These are likely widespread consequences of energetic constraints and increased metabolic rates associated with the fight-or-flight response. We therefore hypothesize that the here documented synergistic interactions with non-pathogenic bacteria may be widespread. Our results highlight the ignored ecological role of non-pathogenic bacteria in reinforcing the negative effects of predation risk on prey organisms.

  16. Food groups and risk of type 2 diabetes mellitus: a systematic review and meta-analysis of prospective studies.

    PubMed

    Schwingshackl, Lukas; Hoffmann, Georg; Lampousi, Anna-Maria; Knüppel, Sven; Iqbal, Khalid; Schwedhelm, Carolina; Bechthold, Angela; Schlesinger, Sabrina; Boeing, Heiner

    2017-05-01

    The aim of this systematic review and meta-analysis was to synthesize the knowledge about the relation between intake of 12 major food groups and risk of type 2 diabetes (T2D). We conducted a systematic search in PubMed, Embase, Medline (Ovid), Cochrane Central, and Google Scholar for prospective studies investigating the association between whole grains, refined grains, vegetables, fruits, nuts, legumes, eggs, dairy, fish, red meat, processed meat, and sugar-sweetened beverages (SSB) on risk of T2D. Summary relative risks were estimated using a random effects model by contrasting categories, and for linear and non-linear dose-response relationships. Six out of the 12 food-groups showed a significant relation with risk of T2D, three of them a decrease of risk with increasing consumption (whole grains, fruits, and dairy), and three an increase of risk with increasing consumption (red meat, processed meat, and SSB) in the linear dose-response meta-analysis. There was evidence of a non-linear relationship between fruits, vegetables, processed meat, whole grains, and SSB and T2D risk. Optimal consumption of risk-decreasing foods resulted in a 42% reduction, and consumption of risk-increasing foods was associated with a threefold T2D risk, compared to non-consumption. The meta-evidence was graded "low" for legumes and nuts; "moderate" for refined grains, vegetables, fruit, eggs, dairy, and fish; and "high" for processed meat, red meat, whole grains, and SSB. Among the investigated food groups, selecting specific optimal intakes can lead to a considerable change in risk of T2D.

  17. A Probability Model of Decompression Sickness at 4.3 Psia after Exercise Prebreathe

    NASA Technical Reports Server (NTRS)

    Conkin, Johnny; Gernhardt, Michael L.; Powell, Michael R.; Pollock, Neal

    2004-01-01

    Exercise PB can reduce the risk of decompression sickness on ascent to 4.3 psia when performed at the proper intensity and duration. Data are from seven tests. PB times ranged from 90 to 150 min. High intensity, short duration dual-cycle ergometry was done during the PB. This was done alone, or combined with intermittent low intensity exercise or periods of rest for the remaining PB. Nonambulating men and women performed light exercise from a semi-recumbent position at 4.3 psia for four hrs. The Research Model with age tested the probability that DCS increases with advancing age. The NASA Model with gender hypothesized that the probability of DCS increases if gender is female. Accounting for exercise and rest during PB with a variable half-time compartment for computed tissue N2 pressure advances our probability modeling of hypobaric DCS. Both models show that a small increase in exercise intensity during PB reduces the risk of DCS, and a larger increase in exercise intensity dramatically reduces risk. These models support the hypothesis that aerobic fitness is an important consideration for the risk of hypobaric DCS when exercise is performed during the PB.

  18. Travel During Pregnancy: Considerations for the Obstetric Provider.

    PubMed

    Antony, Kathleen M; Ehrenthal, Deborah; Evensen, Ann; Iruretagoyena, J Igor

    2017-02-01

    Travel among US citizens is becoming increasingly common, and travel during pregnancy is also speculated to be increasingly common. During pregnancy, the obstetric provider may be the first or only clinician approached with questions regarding travel. In this review, we discuss the reasons women travel during pregnancy, medical considerations for long-haul air travel, destination-specific medical complications, and precautions for pregnant women to take both before travel and while abroad. To improve the quality of pretravel counseling for patients before or during pregnancy, we have created 2 tools: a guide for assessing the pregnant patient's risk during travel and a pretravel checklist for the obstetric provider. A PubMed search for English-language publications about travel during pregnancy was performed using the search terms "travel" and "pregnancy" and was limited to those published since the year 2000. Studies on subtopics were not limited by year of publication. Eight review articles were identified. Three additional studies that analyzed data from travel clinics were found, and 2 studies reported on the frequency of international travel during pregnancy. Additional publications addressed air travel during pregnancy (10 reviews, 16 studies), high-altitude travel during pregnancy (5 reviews, 5 studies), and destination-specific illnesses in pregnant travelers. Travel during pregnancy including international travel is common. Pregnant travelers have unique travel-related and destination-specific risks. We review those risks and provide tools for obstetric providers to use in counseling pregnant travelers.

  19. Medical Evaluation Before Operation

    PubMed Central

    Elliot, Diane L.; Linz, Douglas H.; Kane, Joseph A.

    1982-01-01

    Surgical outcome can be optimized by anticipation and prevention of medical complications. General considerations that apply to all patients include evaluation for coagulation disorders, prior anesthetic complications and drug history. Evaluation for organ-specific risk factors allows identification of patients at high surgical risk, minimization of risk and anticipation of postoperative complications. Review of the recent literature and a practical guide to therapy is presented for the major medical considerations before surgical procedures: cardiac disease, hypertension, pulmonary disease, endocrine considerations and hepatic disease. Attention to these areas and communication among internists, anesthesiologists and surgeons should provide optimal treatment of surgical patients with medical disease. PMID:7179956

  20. Risk of Long-Term Care Dependence for Dementia Patients is Associated with Type of Physician: An Analysis of German Health Claims Data for the Years 2006 to 2010.

    PubMed

    Fink, Anne; Doblhammer, Gabriele

    2015-01-01

    As the population ages, the numbers of people developing care- and cost-intensive forms of dementia are raising. We investigated the pathways of incident dementia patients to long-term care (LTC) dependence and death, and examined the effects of: (1) the type of the main treating physician, differentiated by neurologists/psychiatrists (NPs) and non-NPs; (2) the prescription of antidementive drugs on the risk of needing LTC, differentiated by the degree of care need. Longitudinal claims data of the largest German public sickness fund of 10,043 incident dementia cases aged 60 years and above were analyzed for the years 2006 to 2010. Cox proportional hazard models were performed to investigate the risk of LTC and death based on what type of physician was treating the patient, and whether the patient was prescribed antidementive drugs; adjusted for age, gender, cardiovascular comorbidities, and the previous LTC level. The patients who were primarily treated by NPs had a significantly lower risk of LTC than patients who were mainly treated by non-NPs (considerable LTC: RR = 0.72, p = 0.000, severe LTC: RR = 0.78, p = 0.000, extreme LTC: RR = 0.67, p = 0.001). They generally had a lower risk of death. Antidementive drug treatment was correlated with an increased risk of LTC (considerable LTC: RR = 1.66, p = 0.000, severe LTC: RR = 1.50, p = 0.000, extreme LTC: RR = 1.48, p = 0.000) but with a decreased risk of death. A higher rate of involvement of specialists in the treatment of dementia patients is associated with a reduced LTC dependence and increased survival of dementia patients. Antidementive drug treatments appear to extend live years with dementia.

  1. Alternative approaches to vertebrate ecotoxicity tests in the 21st century: A review of developments over the last 2 decades and current status.

    PubMed

    Lillicrap, Adam; Belanger, Scott; Burden, Natalie; Pasquier, David Du; Embry, Michelle R; Halder, Marlies; Lampi, Mark A; Lee, Lucy; Norberg-King, Teresa; Rattner, Barnett A; Schirmer, Kristin; Thomas, Paul

    2016-11-01

    The need for alternative approaches to the use of vertebrate animals for hazard assessment of chemicals and pollutants has become of increasing importance. It is now the first consideration when initiating a vertebrate ecotoxicity test, to ensure that unnecessary use of vertebrate organisms is minimized wherever possible. For some regulatory purposes, the use of vertebrate organisms for environmental risk assessments has been banned; in other situations, the number of organisms tested has been dramatically reduced or the severity of the procedure refined. However, there is still a long way to go to achieve a complete replacement of vertebrate organisms to generate environmental hazard data. The development of animal alternatives is based not just on ethical considerations but also on reducing the cost of performing vertebrate ecotoxicity tests and in some cases on providing better information aimed at improving environmental risk assessments. The present Focus article provides an overview of the considerable advances that have been made toward alternative approaches for ecotoxicity assessments over the last few decades. Environ Toxicol Chem 2016;35:2637-2646. © 2016 SETAC. © 2016 SETAC.

  2. Estimating the contribution of genetic variants to difference in incidence of disease between population groups.

    PubMed

    Moonesinghe, Ramal; Ioannidis, John P A; Flanders, W Dana; Yang, Quanhe; Truman, Benedict I; Khoury, Muin J

    2012-08-01

    Genome-wide association studies have identified multiple genetic susceptibility variants to several complex human diseases. However, risk-genotype frequency at loci showing robust associations might differ substantially among different populations. In this paper, we present methods to assess the contribution of genetic variants to the difference in the incidence of disease between different population groups for different scenarios. We derive expressions for the contribution of a single genetic variant, multiple genetic variants, and the contribution of the joint effect of a genetic variant and an environmental factor to the difference in the incidence of disease. The contribution of genetic variants to the difference in incidence increases with increasing difference in risk-genotype frequency, but declines with increasing difference in incidence between the two populations. The contribution of genetic variants also increases with increasing relative risk and the contribution of joint effect of genetic and environmental factors increases with increasing relative risk of the gene-environmental interaction. The contribution of genetic variants to the difference in incidence between two populations can be expressed as a function of the population attributable risks of the genetic variants in the two populations. The contribution of a group of genetic variants to the disparity in incidence of disease could change considerably by adding one more genetic variant to the group. Any estimate of genetic contribution to the disparity in incidence of disease between two populations at this stage seems to be an elusive goal.

  3. Estimating the contribution of genetic variants to difference in incidence of disease between population groups

    PubMed Central

    Moonesinghe, Ramal; Ioannidis, John PA; Flanders, W Dana; Yang, Quanhe; Truman, Benedict I; Khoury, Muin J

    2012-01-01

    Genome-wide association studies have identified multiple genetic susceptibility variants to several complex human diseases. However, risk-genotype frequency at loci showing robust associations might differ substantially among different populations. In this paper, we present methods to assess the contribution of genetic variants to the difference in the incidence of disease between different population groups for different scenarios. We derive expressions for the contribution of a single genetic variant, multiple genetic variants, and the contribution of the joint effect of a genetic variant and an environmental factor to the difference in the incidence of disease. The contribution of genetic variants to the difference in incidence increases with increasing difference in risk-genotype frequency, but declines with increasing difference in incidence between the two populations. The contribution of genetic variants also increases with increasing relative risk and the contribution of joint effect of genetic and environmental factors increases with increasing relative risk of the gene–environmental interaction. The contribution of genetic variants to the difference in incidence between two populations can be expressed as a function of the population attributable risks of the genetic variants in the two populations. The contribution of a group of genetic variants to the disparity in incidence of disease could change considerably by adding one more genetic variant to the group. Any estimate of genetic contribution to the disparity in incidence of disease between two populations at this stage seems to be an elusive goal. PMID:22333905

  4. Risk of cerebrovascular accidents and ischemic heart disease in patients with inflammatory bowel disease: a systematic review and meta-analysis.

    PubMed

    Singh, Siddharth; Singh, Harkirat; Loftus, Edward V; Pardi, Darrell S

    2014-03-01

    Inflammatory bowel disease (IBD) is associated with an increased risk of venous thromboembolic disease. However, it is unclear whether IBD modifies the risk of arterial thromboembolic events, including cerebrovascular accidents (CVA) and ischemic heart disease (IHD). We performed a systematic review and meta-analysis of cohort and case-control studies that reported incident cases of CVA and/or IHD in patients with IBD and a non-IBD control population (or compared with a standardized population). We calculated pooled odds ratios (ORs) with 95% confidence intervals (CIs). We analyzed data from 9 studies (2424 CVA events in 5 studies, 6478 IHD events in 6 studies). IBD was associated with a modest increase in the risk of CVA (5 studies; OR, 1.18; 95% CI, 1.09-1.27), especially among women (4 studies; OR, 1.28; 95% CI, 1.17-1.41) compared with men (OR, 1.11; 95% CI, 0.98-1.25), and in young patients (<40-50 y old). The increase in risk was observed for patients with Crohn's disease and in those with ulcerative colitis. IBD also was associated with a 19% increase in the risk of IHD (6 studies; OR, 1.19; 95% CI, 1.08-1.31), both in patients with Crohn's disease and ulcerative colitis. This risk increase was seen primarily in women (4 studies; OR, 1.26; 95% CI, 1.18-1.35) compared with men (OR, 1.05; 95% CI, 0.92-1.21), in young and old patients. IBD was not associated with an increased risk of peripheral arterial thromboembolic events. Considerable heterogeneity was observed in the overall analysis. IBD is associated with a modest increase in the risk of cardiovascular morbidity (from CVA and IHD)-particularly in women. These patients should be counseled routinely on aggressive risk factor modification. Copyright © 2014 AGA Institute. Published by Elsevier Inc. All rights reserved.

  5. Seniors, risk and rehabilitation: broadening our thinking.

    PubMed

    Egan, Mary Y; Laliberte Rudman, Debbie; Ceci, Christine; Kessler, Dorothy; McGrath, Colleen; Gardner, Paula; King, Judy; Lanoix, Monique; Malhotra, Ravi

    2017-06-01

    Conceptualizations of risk in seniors' rehabilitation emphasize potential physical injury, functional independence and cost containment, shifting rehabilitation from other considerations essential to promoting a satisfying life. In a two-day multidisciplinary planning meeting we critically examined and discussed alternatives to dominant conceptualizations. Invitees reflected on conceptualizations of risk in stroke rehabilitation and low vision rehabilitation, identified and explored positive and negative implications and generated alternative perspectives to support rehabilitation approaches related to living a good life. Current risk conceptualizations help focus rehabilitation teamwork and make this work publically recognizable and valued. However, they also lead to practice that is depersonalized, decontextualized and restrictive. Further research and practice development initiatives should include the voices of clinicians and seniors to more adequately support meaningfully living, and foster safe spaces for seniors and clinicians to speak candidly, comprehensively and respectfully about risk. To ensure that seniors' rehabilitation targets a satisfying life as defined by seniors, increased focus on the environment and more explicit examination of how cost containment concerns are driving services is also necessary. This work reinforced current concerns about conceptualizations of risk in seniors' rehabilitation and generated ways forward that re-focus rehabilitation more on promoting a satisfying life. Implications for rehabilitation In seniors' rehabilitation, considerations of risk focus on physical injury, functional dependence and cost containment. Focus on provider-defined risk of physical injury limits examination of patient goals and patients' histories of judging and dealing with risk. Focus on functional dependence and cost containment may lead to practice that is depersonalized and decontextualized. Abandonment of ableist and ageist thinking and an explicit focus on person-centered definitions of risk and a satisfying life are recommended.

  6. Safety considerations in the pharmacological management of atrial fibrillation.

    PubMed

    Camm, A John

    2008-07-21

    The pharmacological management of atrial fibrillation (AF) requires careful consideration from a safety perspective. This article focuses primarily on maintenance therapy using antiarrhythmic drugs (AADs). The foremost safety issue for AADs is the propensity of class IA and III agents to cause torsade de pointes arrhythmias. Class IA drugs, particularly quinidine, can induce torsade de pointes at low or subtherapeutic doses, but higher doses are not necessarily associated with an increased incidence. 'Pure' class III drugs such as dofetilide induce torsade de pointes in a dose-related manner, but some class III agents with more complex actions such as amiodarone have a markedly lower potential to cause this arrhythmia. The risk of torsade de pointes precludes the use of class IA and 'pure' class III agents in patients with left ventricular hypertrophy and bradycardia. Class IC agents may cause sustained monomorphic ventricular tachycardias and are generally precluded in ischaemic and structural heart disease. Advanced heart failure patients may be treated with amiodarone or dofetilide, but most other AADs are unsuitable. The most important extracardiac toxicities occurring with AADs are those of amiodarone. Drug interactions are a significant safety issue in the management of AF, including pharmacokinetic interactions in which plasma levels of the AAD are raised - increasing the risk of proarrhythmia - and concomitant use of drugs that prolong the QT interval. Notwithstanding these considerations, most patients with AF can be considered for rhythm control, provided there is adequate pre-treatment assessment and protocols for initiation, dosing and monitoring are followed with care.

  7. Frequency of extreme weather events and increased risk of motor vehicle collision in Maryland.

    PubMed

    Liu, Ann; Soneja, Sutyajeet I; Jiang, Chengsheng; Huang, Chanjuan; Kerns, Timothy; Beck, Kenneth; Mitchell, Clifford; Sapkota, Amir

    2017-02-15

    Previous studies have shown increased precipitation to be associated with higher frequency of traffic collisions. However, data regarding how extreme weather events, projected to grow in frequency, intensity, and duration in response to a changing climate, might affect the risk of motor vehicle collisions is particularly limited. We investigated the association between frequency of extreme heat and precipitation events and risk of motor vehicle collision in Maryland between 2000 and 2012. Motor vehicle collision data was obtained from the Maryland Automated Accident Reporting System. Each observation in the data set corresponded to a unique collision event. This data was linked to extreme heat and precipitation events that were calculated using location and calendar day specific thresholds. A time-stratified case-crossover analysis was utilized to assess the association between exposure to extreme heat and precipitation events and risk of motor vehicle collision. Additional stratified analyses examined risk by road condition, season, and collisions involving only one vehicle. Overall, there were over 1.28 million motor vehicle collisions recorded in Maryland between 2000 and 2012, of which 461,009 involved injuries or death. There was a 23% increase in risk of collision for every 1-day increase in extreme precipitation event (Odds Ratios (OR) 1.23, 95% Confidence Interval (CI): 1.22, 1.27). This risk was considerably higher for collisions on roads with a defect or obstruction (OR: 1.46, 95% CI: 1.40, 1.52) and those involving a single vehicle (OR: 1.41, 95% CI: 1.39, 1.43). Change in risk associated with extreme heat events was marginal at best. Extreme precipitation events are associated with an increased risk of motor vehicle collisions in Maryland. Copyright © 2016 Elsevier B.V. All rights reserved.

  8. Documented family violence and risk of suicide attempt among U.S. Army soldiers.

    PubMed

    Ursano, Robert J; Stein, Murray B; Herberman Mash, Holly B; Naifeh, James A; Fullerton, Carol S; Zaslavsky, Alan M; Ng, Tsz Hin Hinz; Aliaga, Pablo A; Wynn, Gary H; Dinh, Hieu M; McCarroll, James E; Sampson, Nancy A; Kao, Tzu-Cheg; Schoenbaum, Michael; Heeringa, Steven G; Kessler, Ronald C

    2018-04-01

    Suicide attempt (SA) rates in the U.S. Army increased substantially during the wars in Afghanistan and Iraq. This study examined associations of family violence (FV) history with SA risk among soldiers. Using administrative data from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS), we identified person-month records of active duty, Regular Army, enlisted soldiers with medically documented SAs from 2004 to 2009 (n = 9650) and a sample of control person-months (n = 153,528). Logistic regression analyses examined associations of FV with SA, adjusting for socio-demographics, service-related characteristics, and prior mental health diagnosis. Odds of SA were higher in soldiers with a FV history and increased as the number of FV events increased. Soldiers experiencing past-month FV were almost five times as likely to attempt suicide as those with no FV history. Odds of SA were elevated for both perpetrators and those who were exclusively victims. Male perpetrators had higher odds of SA than male victims, whereas female perpetrators and female victims did not differ in SA risk. A discrete-time hazard function indicated that SA risk was highest in the initial months following the first FV event. FV is an important consideration in understanding risk of SA among soldiers. Published by Elsevier B.V.

  9. No increased risk of carcinogenesis with mesh-based hernia repairs.

    PubMed

    Chughtai, Bilal; Sedrakyan, Art; Thomas, Dominique; Mao, Jialin; Eilber, Karyn S; Clemens, J Quentin; Anger, Jennifer T

    2017-12-06

    The use of synthetic mesh has been placed under considerable scrutiny. We sought to evaluate whether there is a link between placement of synthetic polypropylene mesh for hernia repair and a subsequent cancer diagnosis. Adult men undergoing mesh-based hernia repair from January 2008-December 2009 in New York State were identified and followed through December 2014. Control cohorts of men undergoing cholecystectomy and total knee replacement were control cohorts. 1894 patients undergoing hernia repair, 912 patients in the cholecystectomy control cohort, and 1099 in the TKA control cohort with a cancer diagnosis. In the matched analyses of mesh-based hernia repair and cholecystectomy patients 6.5% vs. 7.1% developed cancer. In the matched analysis of hernia patients and TKA patients, 9.3% vs. 9.1% developed cancer. No association between mesh-based hernia surgery and increased risk of cancer was found. Mesh-based hernia repair was not associated with an increased risk of subsequent development of cancer in men. Copyright © 2017 Elsevier Inc. All rights reserved.

  10. Integrative assessment of multiple pesticides as risk factors for non-Hodgkin's lymphoma among men.

    PubMed

    De Roos, A J; Zahm, S H; Cantor, K P; Weisenburger, D D; Holmes, F F; Burmeister, L F; Blair, A

    2003-09-01

    An increased rate of non-Hodgkin's lymphoma (NHL) has been repeatedly observed among farmers, but identification of specific exposures that explain this observation has proven difficult. During the 1980s, the National Cancer Institute conducted three case-control studies of NHL in the midwestern United States. These pooled data were used to examine pesticide exposures in farming as risk factors for NHL in men. The large sample size (n = 3417) allowed analysis of 47 pesticides simultaneously, controlling for potential confounding by other pesticides in the model, and adjusting the estimates based on a prespecified variance to make them more stable. Reported use of several individual pesticides was associated with increased NHL incidence, including organophosphate insecticides coumaphos, diazinon, and fonofos, insecticides chlordane, dieldrin, and copper acetoarsenite, and herbicides atrazine, glyphosate, and sodium chlorate. A subanalysis of these "potentially carcinogenic" pesticides suggested a positive trend of risk with exposure to increasing numbers. Consideration of multiple exposures is important in accurately estimating specific effects and in evaluating realistic exposure scenarios.

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

    PubMed

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

    2004-04-01

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

  12. Exploring the factors that influence the perception of risk: The case of Volcán de Colima, Mexico

    NASA Astrophysics Data System (ADS)

    Gavilanes-Ruiz, Juan Carlos; Cuevas-Muñiz, Alicia; Varley, Nick; Gwynne, Gemma; Stevenson, John; Saucedo-Girón, Ricardo; Pérez-Pérez, Anaid; Aboukhalil, Mary; Cortés-Cortés, Abel

    2009-10-01

    Volcán de Colima has increased its activity considerably since 1998 with four periods of effusion and since 2003, daily Vulcanian explosions. During 2005 the magnitude of the explosivity increased, producing many pyroclastic flows, two of which reached over 5 km from the volcano, making them the largest events since the last Plinian eruption in 1913. A significant risk is also presented by the lahar hazard, with various examples of damage to infrastructure during the last few years and 23 people killed in 1955. Nearly 5000 people live in small settlements within 15 km of the volcano. Since 1997 six studies have been carried out in the region in an attempt to define the relationship that exists between the population and its neighbour. Although the methodologies used were different, each study considered the results of the previous and attempted to contribute further data to define geographical variation in the perception of risk. The results of the studies highlight the minor role of increasing activity on risk perception, and distance from the volcano was shown to not directly influence risk perception. In most cases it is the combination of various socio-cultural, historical and political factors that defines the perception of volcanic risk within these villages. By studying the social representation of the risk, such complexity could be better understood. The 1997-2000 information campaign evidently improved risk perception; however, it is clear that this type of program needs to be continued to achieve a long lasting impact. Increased knowledge, however, does not guarantee willing participation in official risk mitigation strategies.

  13. Hyperuricemia and the risk for coronary heart disease morbidity and mortality a systematic review and dose-response meta-analysis

    NASA Astrophysics Data System (ADS)

    Li, Min; Hu, Xiaolan; Fan, Yingli; Li, Kun; Zhang, Xiaowei; Hou, Wenshang; Tang, Zhenyu

    2016-01-01

    Considerable controversy exists regarding the association between hyperuricemia and coronary heart disease (CHD). Therefore, we performed a systematic review and dose-response meta-analysis of prospective studies to examine the controversy. Prospective cohort studies with relative risks (RRs) and 95% confidence intervals (CIs) for CHD according to serum uric acid levels in adults were eligible. A random-effects model was used to compute the pooled risk estimate. The search yielded 29 prospective cohort studies (n = 958410 participants). Hyperuricemia was associated with increased risk of CHD morbidity (adjusted RR 1.13; 95% CI 1.05 to 1.21) and mortality (adjusted RR 1.27; 95% CI 1.16 to 1.39). For each increase of 1 mg/dl in uric acid level, the pooled multivariate RR of CHD mortality was 1.13 (95% CI 1.06 to 1.20). Dose-response analysis indicated that the combined RR of CHD mortality for an increase of 1 mg uric acid level per dl was 1.02 (95% CI 0.84 to 1.24) without heterogeneity among males (P = 0.879, I2 = 0%) and 2.44 (95% CI 1.69 to 3.54) without heterogeneity among females (P = 0.526, I2 = 0%). The increased risk of CHD associated with hyperuricemia was consistent across most subgroups. Hyperuricemia may increase the risk of CHD events, particularly CHD mortality in females.

  14. A revised estimate of the risk of carcinogenesis from x-rays to scoliosis patients

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

    Rao, P.S.; Gregg, E.C.

    A considerable amount of concern has been felt recently for the risk of carcinogenesis from x-rays to scoliosis patients. This paper re-evaluates risk in quantitative terms by using some data measured by us and other data recently published in the literature. The risks are considerably smaller than had been estimated earlier. Compared with the natural incidence of cancer in the general population, the cumulative additional risk for scoliosis patients varies from 0.2% for breast carcinoma to 5% for leukemia.

  15. The costs of housing developments on sites with elevated landslide risk in the UK

    NASA Astrophysics Data System (ADS)

    Barclay, K.; Heath, A.

    2015-09-01

    New housing targets are being set for local planning authorities resulting in more areas being zoned for development. There is currently no requirement for a landslide assessment prior to this zoning, and sites at elevated risk of landslides are being put forward for development without consideration of the additional costs and other impacts of building on these higher risk sites. This study aimed to reveal the increased financial, economic, social and environmental costs associated with these decisions. Case studies were focused on the city of Bath, an area of increasing population and “one of the most intensely landslipped areas in Britain’’. The case studies found the financial costs associated with building in a landslide risk area to be significantly higher than the equivalent construction in areas of greater geological stability. Furthermore, it was found that uncertainty in cost when developing in unstable areas exacerbates this problem as the final cost cannot be accurately predicted before construction.

  16. Berry Fruit Consumption and Metabolic Syndrome

    PubMed Central

    Vendrame, Stefano; Del Bo’, Cristian; Ciappellano, Salvatore; Riso, Patrizia; Klimis-Zacas, Dorothy

    2016-01-01

    Metabolic Syndrome is a cluster of risk factors which often includes central obesity, dyslipidemia, insulin resistance, glucose intolerance, hypertension, endothelial dysfunction, as well as a pro-inflammatory, pro-oxidant, and pro-thrombotic environment. This leads to a dramatically increased risk of developing type II diabetes mellitus and cardiovascular disease, which is the leading cause of death both in the United States and worldwide. Increasing evidence suggests that berry fruit consumption has a significant potential in the prevention and treatment of most risk factors associated with Metabolic Syndrome and its cardiovascular complications in the human population. This is likely due to the presence of polyphenols with known antioxidant and anti-inflammatory effects, such as anthocyanins and/or phenolic acids. The present review summarizes the findings of recent dietary interventions with berry fruits on human subjects with or at risk of Metabolic Syndrome. It also discusses the potential role of berries as part of a dietary strategy which could greatly reduce the need for pharmacotherapy, associated with potentially deleterious side effects and constituting a considerable financial burden. PMID:27706020

  17. Changes in erosion and flooding risk due to long-term and cyclic oceanographic trends

    USGS Publications Warehouse

    Wahl, Thomas; Plant, Nathaniel G.

    2015-01-01

    We assess temporal variations in waves and sea level, which are driving factors for beach 23 erosion and coastal flooding in the northern Gulf of Mexico. We find that long-term trends in 24 the relevant variables have caused an increase of ~30% in the erosion/flooding risk since the 25 1980s. Changes in the wave climate-which have often been ignored in earlier assessments-26 were at least as important as sea-level rise (SLR). In the next decades, SLR will likely become 27 the dominating driver and may in combination with ongoing changes in the wave climate (and 28 depending on the emission scenario) escalate the erosion/flooding risk by up to 300% over the 29 next 30 years. We also find significant changes in the seasonal cycles of sea level and 30 significant wave height, which have in combination caused a considerable increase of the 31 erosion/flooding risk in summer and decrease in winter (superimposed onto the long-term 32 trends)

  18. Cardiovascular benefits of dietary fiber.

    PubMed

    Satija, Ambika; Hu, Frank B

    2012-12-01

    The relationship between dietary fiber and risk of cardiovascular disease (CVD) has been extensively studied. There is considerable epidemiological evidence indicating an inverse association between dietary fiber intake and CVD risk. The association has been found to be stronger for cereal fiber than for fruit or vegetable fiber, and several studies have also found increased whole grain consumption to be associated with CVD risk reduction. In light of this evidence, recent US dietary guidelines have endorsed increased consumption of fiber rich whole grains. Regular consumption of dietary fiber, particularly fiber from cereal sources, may improve CVD health through multiple mechanisms including lipid reduction, body weight regulation, improved glucose metabolism, blood pressure control, and reduction of chronic inflammation. Future research should focus on various food sources of fiber, including different types of whole grains, legumes, fruits, vegetables, and nuts, as well as resistant starch in relation to CVD risk and weight control; explore the biological mechanisms underlying the cardioprotective effect of fiber-rich diets; and study different ethnic groups and populations with varying sources of dietary fiber.

  19. Wilderness Preparticipation Evaluation and Considerations for Special Populations.

    PubMed

    Joy, Elizabeth; Van Baak, Karin; Dec, Katherine L; Semakula, Barbara; Cardin, Ashlea D; Lemery, Jay; Wortley, George C; Yaron, Michael; Madden, Christopher

    2015-12-01

    Children, older adults, disabled and special needs athletes, and female athletes who participate in outdoor and wilderness sports and activities each face unique risks. For children and adolescents traveling to high altitude, the preparticipation physical evaluation should focus on risk assessment, prevention strategies, early recognition of altitude-related symptoms, management plans, and appropriate follow-up. As the risk and prevalence of chronic disease increases with age, both older patients and providers need to be aware of disease and medication-specific risks relative to wilderness sport and activity participation. Disabled and special needs athletes benefit from careful pre-event planning for the potential medical issues and equipment modifications that may affect their health in wilderness environments. Issues that demand special consideration for female adventurers include pregnancy, contraceptive use, menses, and ferritin levels at altitude. A careful preparticipation evaluation that factors in unique, population- specific risks will help special populations stay healthy and safe on wilderness adventures. The PubMed and SportDiscus databases were searched in 2014 using both MeSH terms and text words and include peer-reviewed English language articles from 1977 to 2014. Additional information was accessed from Web-based sources to produce this narrative review on preparticipation evaluation for special populations undertaking wilderness adventures. Key words include children, adolescent, pediatric, seniors, elderly, disabled, special needs, female, athlete, preparticipiation examination, wilderness medicine, and sports. Copyright © 2015. Published by Elsevier Inc.

  20. Attitudes towards the sharing of genetic information with at-risk relatives: results of a quantitative survey.

    PubMed

    Heaton, Timothy J; Chico, Victoria

    2016-01-01

    To investigate public attitudes towards receiving genetic information arising from a test on a relative, 955 University of Sheffield students and staff were surveyed using disease vignettes. Strength of attitude was measured on whether, in the event of relevant information being discovered, they, as an at-risk relative, would want to be informed, whether the at-risk relative's interest should override proband confidentiality, and, if they had been the proband, willingness to give up confidentiality to inform such relatives. Results indicated considerably more complexity to the decision-making than simple statistical risk. Desire for information only slightly increased with risk of disease manifestation [log odds 0.05 (0.04, 0.06) per percentage point increase in manifestation risk]. Condition preventability was the primary factor increasing desire [modifiable baseline, non-preventable log odds -1.74 (-2.04, -1.44); preventable 0.64 (0.34, 0.95)]. Disease seriousness also increased desire [serious baseline, non-serious log odds -0.89 (-1.19, -0.59); fatal 0.55 (0.25, 0.86)]. Individuals with lower education levels exhibited much greater desire to be informed [GCSE log odds 1.67 (0.64, 2.66)]. Age did not affect desire. Our findings suggest that attitudes were influenced more by disease characteristics than statistical risk. Respondents generally expressed strong attitudes demonstrating that this was not an issue which people felt ambivalent about. We provide estimates of the British population in favour/against disclosure for various disease scenarios.

  1. New medical risks affecting obstetrics after implementation of the two-child policy in China.

    PubMed

    Li, Qiang; Deng, Dongrui

    2017-12-01

    China recently instituted a two-child policy in response to its aging population, declining workforce and demographic dividend, and the need to develop asocial economy. Additionally, women generally delay having a second child because of the overwhelming pressure in their lives. With the improvements in assisted fertility technologies in recent years, the number of elderly women attempting to bear children has increased. The quality of woman's eggs and a man's sperm declined dramatically with increasing age, leading to an increased risk of pregnancy-related complications among older women. Therefore, the types of fertility problems experienced by elderly females must be provided with considerable attention by obstetricians. This commentary article focuses on the medical problems faced by older second-child pregnant women. This work discusses their increased rates of infertility, spontaneous abortion, fetal malformation, gestational diabetes, cesarean section, placenta previa, postpartum hemorrhage, postpartum depression, and hypertensive disorders, which complicate pregnancy.

  2. Locating spatial variation in the association between wildland fire risk and social vulnerability across six southern states

    Treesearch

    Neelam Poudyal; Cassandra Johnson Gaither; Scott Goodrick; J.M. Bowker; Jianbang Gan

    2012-01-01

    Wildland fire in the South commands considerable attention, given the expanding wildland urban interface (WUI) across the region. Much of this growth is propelled by higher income retirees and others desiring natural amenity residential settings. However, population growth in the WUI increases the likelihood of wildfire fire ignition caused by people, as humans account...

  3. The Participation and Decision Making of "At Risk" Youth in Community Music Projects: An Exploration of Three Case Studies

    ERIC Educational Resources Information Center

    Rimmer, Mark

    2012-01-01

    In the UK, recent years have witnessed a considerable growth in youth participation activities that seek to involve children and young people in various forms of decision-making. One such form of youth participation to benefit from increased government support since the late 1990s concerns community arts activities, especially those targeting…

  4. HAART Adherence Strategies for Methadone Clients Who Are HIV-Positive: A Treatment Manual for Implementing Contingency Management and Medication Coaching

    ERIC Educational Resources Information Center

    Haug, Nancy A.; Sorensen, James L.; Gruber, Valerie A.; Lollo, Nicole; Roth, Gregory

    2006-01-01

    Research demonstrates that injection drug users with HIV and/or AIDS have difficulty adhering to complex regimens of HIV medications. Because of the risk of increased viral resistance associated with irregular medication adherence, there is considerable clinical need to assist clients who abuse substances in taking their antiretroviral medications…

  5. Increasing frost risk associated with advanced citrus flowering dates in Kerman and Shiraz, Iran: 1960-2010.

    PubMed

    Fitchett, Jennifer M; Grab, Stefan W; Thompson, Dave I; Roshan, Gholamreza

    2014-10-01

    Flowering dates and the timing of late season frost are both driven by local ambient temperatures. However, under climatic warming observed over the past century, it remains uncertain how such impacts affect frost risk associated with plant phenophase shifts. Any increase in frost frequency or severity has the potential to damage flowers and their resultant yields and, in more extreme cases, the survival of the plant. An accurate assessment of the relationship between the timing of last frost events and phenological shifts associated with warmer climate is thus imperative. We investigate spring advances in citrus flowering dates (orange, tangerine, sweet lemon, sour lemon and sour orange) for Kerman and Shiraz, Iran from 1960 to 2010. These cities have experienced increases in both T max and T min, advances in peak flowering dates and changes in last frost dates over the study period. Based on daily instrumental climate records, the last frost dates for each year are compared with the peak flowering dates. For both cities, the rate of last frost advance lags behind the phenological advance, thus increasing frost risk. Increased frost risk will likely have considerable direct impacts on crop yields and on the associated capacity to adapt, given future climatic uncertainty.

  6. Strategies for continuous evaluation of the benefit-risk profile of HPV-16/18-AS04-adjuvanted vaccine.

    PubMed

    Angelo, Maria-Genalin; Taylor, Sylvia; Struyf, Frank; Tavares Da Silva, Fernanda; Arellano, Felix; David, Marie-Pierre; Dubin, Gary; Rosillon, Dominique; Baril, Laurence

    2014-11-01

    The HPV types 16/18-AS04-adjuvanted cervical cancer vaccine, Cervarix(®) (HPV-16/18-vaccine, GlaxoSmithKline, Belgium) was first approved in 2007 and is licensed in 134 countries for the prevention of persistent infection, premalignant cervical lesions and cervical cancer caused by oncogenic HPV. Benefit-risk status requires continual re-evaluation as vaccine uptake increases, as the epidemiology of the disease evolves and as new information becomes available. This paper provides an example of benefit-risk considerations and risk-management planning. Evaluation of the benefit-risk of HPV-16/18-vaccine post-licensure includes studies with a range of designs in many countries and in collaboration with national public agencies and regulatory authorities. The strategy to assess benefit versus risk will continue to evolve and adapt to the changing HPV-16/18-vaccine market.

  7. Modeling intelligent adversaries for terrorism risk assessment: some necessary conditions for adversary models.

    PubMed

    Guikema, Seth

    2012-07-01

    Intelligent adversary modeling has become increasingly important for risk analysis, and a number of different approaches have been proposed for incorporating intelligent adversaries in risk analysis models. However, these approaches are based on a range of often-implicit assumptions about the desirable properties of intelligent adversary models. This "Perspective" paper aims to further risk analysis for situations involving intelligent adversaries by fostering a discussion of the desirable properties for these models. A set of four basic necessary conditions for intelligent adversary models is proposed and discussed. These are: (1) behavioral accuracy to the degree possible, (2) computational tractability to support decision making, (3) explicit consideration of uncertainty, and (4) ability to gain confidence in the model. It is hoped that these suggested necessary conditions foster discussion about the goals and assumptions underlying intelligent adversary modeling in risk analysis. © 2011 Society for Risk Analysis.

  8. Statins: pros and cons.

    PubMed

    Pinal-Fernandez, Iago; Casal-Dominguez, Maria; Mammen, Andrew L

    2018-05-23

    Statins inhibit the critical step of cholesterol synthesis in which 3-hydroxy-3-methylglutaryl coenzyme A (HMGC) is transformed to mevalonate by the enzyme HMGC reductase. By doing so, they have a potent lipid-lowering effect that reduces cardiovascular risk and decreases mortality. Since the mevalonate pathway also influences endothelial function, the inflammatory response, and coagulation, the effects of statins reach well beyond their cholesterol lowering properties. As with all drugs, statins may have adverse effects; these include musculoskeletal symptoms, increased risk of diabetes, and higher rates of hemorrhagic stroke. However, the frequency of adverse effects is extremely low and, in selected patient populations, the benefits of statins considerably outweigh the potential risks. Published by Elsevier España, S.L.U.

  9. Management of Ciguatoxin Risk in Eastern Australia

    PubMed Central

    Farrell, Hazel; Murray, Shauna A.; Zammit, Anthony; Edwards, Alan W.

    2017-01-01

    Between 2014 and 2016, five cases of ciguatera fish poisoning (CFP), involving twenty four individuals, were linked to Spanish Mackerel (Scomberomorus commerson) caught in the coastal waters of the state of New South Wales (NSW) on the east coast of Australia. Previously, documented cases of CFP in NSW were few, and primarily linked to fish imported from other regions. Since 2015, thirteen individuals were affected across four additional CFP cases in NSW, linked to fish imported from tropical locations. The apparent increase in CFP in NSW from locally sourced catch, combined with the risk of CFP from imported fish, has highlighted several considerations that should be incorporated into risk management strategies to minimize CFP exposure for seafood consumers. PMID:29135913

  10. Smoking and stroke: the more you smoke the more you stroke

    PubMed Central

    Shah, Reena S; Cole, John W

    2010-01-01

    Cigarette smoking is a well-established risk factor for all forms of stroke. While both the general public and the global healthcare system are aware of the vascular risks associated with smoking, the prevalence of tobacco use has remained largely unchanged over the last quarter of a century. Approximately one in five US adults are classified as regular smokers, with the initiation of smoking typically occurring during the teenage years. Although the increased risk of stroke associated with smoking is generally acknowledged, it is less well recognized that considerable scientific evidence implicates a strong dose–response relationship between smoking and stroke risk. In this article, we summarize the literature regarding smoking-related stroke risk, the dose–response relationship, and the costs of this detrimental habit to both the individual and society as a whole. PMID:20602553

  11. Stress and food allergy: mechanistic considerations.

    PubMed

    Schreier, Hannah M C; Wright, Rosalind J

    2014-04-01

    Recent years have seen a marked increase in food allergy prevalence among children, particularly in Western countries, that cannot be explained by genetic factors alone. This has resulted in an increased effort to identify environmental risk factors underlying food allergies and to understand how these factors may be modified through interventions. Food allergy is an immune-mediated adverse reaction to food. Consequently, considerations of candidate risk factors have begun to focus on environmental influences that perturb the healthy development of the emerging immune system during critical periods of development (eg, prenatally and during early childhood), particularly in the gut. Given that psychosocial stress is known to play an important role in other allergic and inflammatory diseases, such as asthma, its potential role in food allergy is a growing area of research. However, research to date has largely focused on animal studies. This review synthesizes relevant animal research and epidemiological data, providing proof of concept for moderating influences of psychological stress on food allergy outcomes in humans. Pathways that may underlie associations between psychosocial stress and the expression of food allergy are discussed. Copyright © 2014 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

  12. The switch to refillable bottled water in Indonesia: a serious health risk.

    PubMed

    Komarulzaman, Ahmad; de Jong, Eelke; Smits, Jeroen

    2017-10-01

    In recent years, the consumption of refillable bottled water has increased considerably in emerging countries. However, the quality of this water is often questionable, as authorities lack the capacity to properly check refilling depots. Given that refillable bottled water not only replaces unimproved water sources, but also better-quality sources, like piped and branded bottled water, its increasing use poses a major health risk. We investigate the motives behind the decision to switch to refillable bottled water in Indonesia. Findings indicate that this switch is driven by lifestyle motives, as well as by cost and availability considerations. It is mostly the young affluent households who switch from piped and 'other' sources to refillable bottled water. In rural areas, the tendency to make this switch is negatively affected by availability problems and the higher price of refillable bottled water. Availability and cost also influence the switch from branded bottled to refillable bottled water, but here it is the poorer households who have a higher propensity to switch. Further exploration of the lifestyle motive and affordability issues, as well as better monitoring of the refilling depots, are needed to improve the quality of drinking water in Indonesia and other emerging countries.

  13. Risk of treatment-related esophageal cancer among breast cancer survivors.

    PubMed

    Morton, L M; Gilbert, E S; Hall, P; Andersson, M; Joensuu, H; Vaalavirta, L; Dores, G M; Stovall, M; Holowaty, E J; Lynch, C F; Curtis, R E; Smith, S A; Kleinerman, R A; Kaijser, M; Storm, H H; Pukkala, E; Weathers, R E; Linet, M S; Rajaraman, P; Fraumeni, J F; Brown, L M; van Leeuwen, F E; Fossa, S D; Johannesen, T B; Langmark, F; Lamart, S; Travis, L B; Aleman, B M P

    2012-12-01

    Radiotherapy for breast cancer may expose the esophagus to ionizing radiation, but no study has evaluated esophageal cancer risk after breast cancer associated with radiation dose or systemic therapy use. Nested case-control study of esophageal cancer among 289 748 ≥5-year survivors of female breast cancer from five population-based cancer registries (252 cases, 488 individually matched controls), with individualized radiation dosimetry and information abstracted from medical records. The largest contributors to esophageal radiation exposure were supraclavicular and internal mammary chain treatments. Esophageal cancer risk increased with increasing radiation dose to the esophageal tumor location (P(trend )< 0.001), with doses of ≥35 Gy associated with an odds ratio (OR) of 8.3 [95% confidence interval (CI) 2.7-28]. Patients with hormonal therapy ≤5 years preceding esophageal cancer diagnosis had lower risk (OR = 0.4, 95% CI 0.2-0.8). Based on few cases, alkylating agent chemotherapy did not appear to affect risk. Our data were consistent with a multiplicative effect of radiation and other esophageal cancer risk factors (e.g. smoking). Esophageal cancer is a radiation dose-related complication of radiotherapy for breast cancer, but absolute risk is low. At higher esophageal doses, the risk warrants consideration in radiotherapy risk assessment and long-term follow-up.

  14. Psoriasis treatment considerations in military patients: unique patients, unique drugs.

    PubMed

    Evans, Thomas; Davidson, Nathan; Logemann, Nicholas

    2016-12-01

    Psoriasis is a common dermatologic problem with a chronic and sometimes debilitating course. Psoriasis can impair a service member's ability to perform job-related activities and should certainly be treated; however, use of immunosuppressive treatments can prevent deployment to strategic locations around the world for numerous reasons, such as the need for laboratory monitoring, minimal access to climate-controlled storage, and potential increased risk of exposure to virulent pathogens while on these medications. Similar obstacles can exist for nonmilitary patients who are placed in austere conditions or participate in worldwide travel. Although treatment efficacy, cost, and side-effect profiles are always paramount considerations in deciding on treatment regimens with patients, herein we focus our discussion on a consideration that might be easily overlooked when treating patients in modern society, that being the "logistics" of treatment.

  15. Dealing with the predicted increase in demand for revision total knee arthroplasty: challenges, risks and opportunities.

    PubMed

    Hamilton, D F; Howie, C R; Burnett, R; Simpson, A H R W; Patton, J T

    2015-06-01

    Worldwide rates of primary and revision total knee arthroplasty (TKA) are rising due to increased longevity of the population and the burden of osteoarthritis. Revision TKA is a technically demanding procedure generating outcomes which are reported to be inferior to those of primary knee arthroplasty, and with a higher risk of complication. Overall, the rate of revision after primary arthroplasty is low, but the number of patients currently living with a TKA suggests a large potential revision healthcare burden. Many patients are now outliving their prosthesis, and consideration must be given to how we are to provide the necessary capacity to meet the rising demand for revision surgery and how to maximise patient outcomes. The purpose of this review was to examine the epidemiology of, and risk factors for, revision knee arthroplasty, and to discuss factors that may enhance patient outcomes. ©2015 The British Editorial Society of Bone & Joint Surgery.

  16. Right-sided infective endocarditis: recent epidemiologic changes

    PubMed Central

    Yuan, Shi-Min

    2014-01-01

    Background: Infective endocarditis (IE) has been increasingly reported, however, little is available regarding recent development of right-sided IE. Methods: Right-sided IE was comprehensively analyzed based on recent 5⅓-year literature. Results: Portal of entry, implanted foreign material, and repaired congenital heart defects were the main predisposing risk factors. Vegetation size on the right-sided valves was much smaller than those beyond the valves. Multiple logistic regression analysis revealed that predisposing risk factors, and vegetation size and locations were independent predictive risks of patients’ survival. Conclusions: Changes of right-sided IE in the past 5⅓ years included younger patient age, and increased vegetation size, but still prominent Staphylococcus aureus infections. Complication spectrum has changed into more valve insufficiency, more embolic events, reduced abscess formation, and considerably decreased valve perforations. With effective antibiotic regimens, prognoses of the patients seemed to be better than before. PMID:24482708

  17. Assisted reproductive technologies and children's neurodevelopmental outcomes.

    PubMed

    Hediger, Mary L; Bell, Erin M; Druschel, Charlotte M; Buck Louis, Germaine M

    2013-02-01

    Initial reports suggested that children conceived with assisted reproductive technologies (ART) may be at increased risk for a spectrum of developmental disabilities. Evolving evidence suggests that some of the early risks may have been overstated when not taking plurality of birth or gestational age at delivery into consideration, as both are independent risk factors for neurodevelopmental disabilities arising from alterations in structure and function or limitations in activities. Continued research is needed to overcome lingering data gaps in light of the equivocal literature for many neurodevelopmental disabilities relative to ART, increasing utilization of services, and changes in the clinical management of infecund couples such as the adoption of natural cycles or in vitro maturation treatment options. Population-based cohorts with longitudinal assessment of the multifaceted nature of neurodevelopment across critical and sensitive windows is paramount for the development of empirically based guidance for clinical and population health. Copyright © 2013 American Society for Reproductive Medicine. All rights reserved.

  18. Integrative assessment of multiple pesticides as risk factors for non-Hodgkin's lymphoma among men

    PubMed Central

    De Roos, A J; Zahm, S; Cantor, K; Weisenburger, D; Holmes, F; Burmeister, L; Blair, A

    2003-01-01

    Methods: During the 1980s, the National Cancer Institute conducted three case-control studies of NHL in the midwestern United States. These pooled data were used to examine pesticide exposures in farming as risk factors for NHL in men. The large sample size (n = 3417) allowed analysis of 47 pesticides simultaneously, controlling for potential confounding by other pesticides in the model, and adjusting the estimates based on a prespecified variance to make them more stable. Results: Reported use of several individual pesticides was associated with increased NHL incidence, including organophosphate insecticides coumaphos, diazinon, and fonofos, insecticides chlordane, dieldrin, and copper acetoarsenite, and herbicides atrazine, glyphosate, and sodium chlorate. A subanalysis of these "potentially carcinogenic" pesticides suggested a positive trend of risk with exposure to increasing numbers. Conclusion: Consideration of multiple exposures is important in accurately estimating specific effects and in evaluating realistic exposure scenarios. PMID:12937207

  19. Do HMO and its for-profit expansion jeopardize the survival of hospital safety net services?

    PubMed

    Shen, Yu-Chu

    2009-03-01

    This study examines the effect of health maintenance organizations (HMOs) and for-profit HMO share on the survival of safety net services in hospitals between 1990 and 2004. The primary data sources are the American Hospital Association Annual Surveys, the Medicare hospital cost reports, and the HMO enrollment and ownership data from Interstudy. I analyze the risks of shutting down each safety net service separately using the proportional hazard models. I find that the risks of shutting down hospital safety net services do not vary by different levels of overall HMO penetration. However, conditional on the overall HMO penetration level, increasing for-profit presence of HMO does increase the risks of shutting down several safety net services. Policies evaluating the for-profit expansion or ownership conversion of health plans should take this potential adverse effect into consideration.

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

    USDA-ARS?s Scientific Manuscript database

    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...

  1. Adequacy of the default values for skin surface area used for risk assessment and French anthropometric data by a probabilistic approach.

    PubMed

    Dornic, N; Ficheux, A S; Bernard, A; Roudot, A C

    2017-08-01

    The notes of guidance for the testing of cosmetic ingredients and their safety evaluation by the Scientific Committee on Consumer Safety (SCCS) is a document dedicated to ensuring the safety of European consumers. This contains useful data for risk assessment such as default values for Skin Surface Area (SSA). A more in-depth study of anthropometric data across Europe reveals considerable variations. The default SSA value was derived from a study on the Dutch population, which is known to be one of the tallest nations in the World. This value could be inadequate for shorter populations of Europe. Data were collected in a survey on cosmetic consumption in France. Probabilistic treatment of these data and analysis of the case of methylisothiazolinone, a sensitizer recently evaluated by a deterministic approach submitted to SCCS, suggest that the default value for SSA used in the quantitative risk assessment might not be relevant for a significant share of the French female population. Others female populations of Southern Europe may also be excluded. This is of importance given that some studies show an increasing risk of developping skin sensitization among women. The disparities in anthropometric data across Europe should be taken into consideration. Copyright © 2017 Elsevier Ltd. All rights reserved.

  2. Recent developments in suicide prevention among the Indigenous peoples of Australia.

    PubMed

    Dudgeon, Pat; Holland, Christopher

    2018-04-01

    Suicide is an Aboriginal and Torres Strait Islander (hereafter 'Indigenous') population health issue. Over 2015-2016, the Aboriginal and Torres Strait Islander Suicide Prevention Project (ATSISPEP) aimed to identify success factors in Indigenous suicide prevention. For non-Indigenous practitioners working with indigenous clients at risk of suicide, ATSISPEP identified important considerations to make treatment more effective. The start is acknowledging the differences in the historical, cultural, political, social and economic experiences of Indigenous peoples, and their greater exposure to trauma, psychological distress and risks to mental health. These mental health difficulties are specific and more prevalent amongst Indigenous peoples and communities due to the ongoing impacts of colonisation in Australia including a range of social determinants impacting on the well-being of Indigenous peoples today. Working effectively with Indigenous clients also includes being able to establish culturally safe work environments, and the ability of non-Indigenous practitioners to work in a culturally competent and trauma-informed manner. There are also considerations regarding time protocols and client follow-up. Further, postvention responses might be required. Supporting selective suicide prevention activity among younger people (and other groups at increased risk) and community-level work is an important complement to working with Indigenous individuals at risk of suicide.

  3. Using Risk Assessment Methodologies to Meet Management Objectives

    NASA Technical Reports Server (NTRS)

    DeMott, D. L.

    2015-01-01

    Current decision making involves numerous possible combinations of technology elements, safety and health issues, operational aspects and process considerations to satisfy program goals. Identifying potential risk considerations as part of the management decision making process provides additional tools to make more informed management decision. Adapting and using risk assessment methodologies can generate new perspectives on various risk and safety concerns that are not immediately apparent. Safety and operational risks can be identified and final decisions can balance these considerations with cost and schedule risks. Additional assessments can also show likelihood of event occurrence and event consequence to provide a more informed basis for decision making, as well as cost effective mitigation strategies. Methodologies available to perform Risk Assessments range from qualitative identification of risk potential, to detailed assessments where quantitative probabilities are calculated. Methodology used should be based on factors that include: 1) type of industry and industry standards, 2) tasks, tools, and environment 3) type and availability of data and 4) industry views and requirements regarding risk & reliability. Risk Assessments are a tool for decision makers to understand potential consequences and be in a position to reduce, mitigate or eliminate costly mistakes or catastrophic failures.

  4. Abdominal surgery in neonatal foals.

    PubMed

    Bryant, James E; Gaughan, Earl M

    2005-08-01

    Abdominal surgery in foals under 30 days old has become more common with improved neonatal care. Early recognition of a foal at risk and better nursing care have increased the survival rates of foals that require neonatal care. The success of improved neonatal care also has increased the need for accurate diagnosis and treatment of gastrointestinal, umbilical, and bladder disorders in these foals. This chapter focuses on the early and accurate diagnosis of specific disorders that require abdominal exploratory surgery and the specific treatment considerations and prognosis for these disorders.

  5. US Vulnerability to Natural Disasters

    NASA Astrophysics Data System (ADS)

    van der Vink, G.; Apgar, S.; Batchelor, A.; Carter, C.; Gail, D.; Jarrett, A.; Levine, N.; Morgan, W.; Orlikowski, M.; Pray, T.; Raymar, M.; Siebert, A.; Shawa, T. W.; Wallace, C.

    2002-05-01

    Natural disasters result from the coincidence of natural events with the built environment. Our nation's infrastructure is growing at an exponential rate in many areas of high risk, and the Federal government's liability is increasing proportionally. By superimposing population density with predicted ground motion from earthquakes, historical hurricane tracks, historical tornado locations, and areas within the flood plain, we are able to identify locations of high vulnerability within the United States. We present a comprehensive map of disaster risk for the United States that is being produced for the Senate Natural Hazards Caucus. The map allows for the geographic comparison of natural disaster risk with past disaster declarations, the expenditure of Federal dollars for disaster relief, population increase, and variations of GDP. Every state is vulnerable to natural disasters. Although their frequency varies considerably, the annualized losses for disaster relief from hurricanes, earthquakes, and floods are approximately equivalent. While fast-growing states such as California and Florida remain highly vulnerable, changes in the occurrence of natural events combined with population increases are making areas such as Texas, North Carolina, and the East Coast increasingly vulnerable.

  6. Diabetes Mellitus Following Renal Transplantation: Clinical and Pharmacological Considerations for the Elderly Patient.

    PubMed

    Langsford, David; Steinberg, Adam; Dwyer, Karen M

    2017-08-01

    Post-transplant diabetes mellitus occurs in 30-50% of cases during the first year post-renal transplantation. It is associated with increased morbidity, mortality and healthcare costs. Risk factors include age and specific immunosuppression regimens. At the same time, renal transplantation is increasingly indicated in elderly (aged >65 years) patients as this proportion of older patients in the prevalent dialysis population has increased. The immune system and β cells undergo senescence and this impacts on the risk for developing post-transplant diabetes and our ability to prevent such development. It may, however, be possible to identify patients at risk of developing post-transplant diabetes, enabling treatment protocols that prevent or reduce the impact of post-transplant diabetes. Much work remains to be completed in this area and is facilitated by the growing base of knowledge regarding the pathophysiology of post-transplant diabetes. Should post-transplant diabetes develop, there are a range of treatment options available. There is increasing interest in using newer agents, although their safety and efficacy in transplant recipients remains to be conclusively established.

  7. Uric acid: A Danger Signal from the RNA World that may have a role in the Epidemic of Obesity, Metabolic Syndrome and CardioRenal Disease: Evolutionary Considerations

    PubMed Central

    Johnson, Richard J; Lanaspa, Miguel A; Gaucher, Eric A

    2011-01-01

    All humans are uricase knockouts; we lost the uricase gene due to a mutation that occurred in the mid Miocene approximately 15 million years ago. The consequence of being a uricase knockout is that we have higher serum uric acid levels that are less regulatable and can be readily influenced by diet. This increases our risk for gout and kidney stones, but there is also increasing evidence that uric acid increases our risk for hypertension, kidney disease, obesity and diabetes. This raises the question of why this mutation occurred. In this paper we review current hypotheses. We suggest that uric acid is a danger and survival signal carried over from the RNA world. The mutation of uricase that occurred during the food shortage and global cooling that occurred in the Miocene resulted in a survival advantage for early primates, particularly in Europe. Today, the loss of uricase functions as a thrifty gene, increasing our risk for obesity and cardiorenal disease. PMID:22000645

  8. Flood precautionary behaviour of private households in Can Tho city in the Mekong Delta

    NASA Astrophysics Data System (ADS)

    Kreibich, Heidi; Gani Adnan, Sarfaraz; Thi Chinh, Do; Bubeck, Philip

    2015-04-01

    Flood risk is high and it is projected to increase in many places due to the effects of climate change and the on-going intensification of human activities in risk-prone areas. These projections and the considerable uncertainties associated with these developments increasingly require integrated approaches in flood risk management. In addition to flood protection, private precautionary measures aim at reducing the potential negative consequences of floods. Thus, insights into flood precautionary behaviour are important. This study is grounded on the Protection Motivation Theory (PMT), which refers to the cognitive process that people undergo when evaluating their own ability to avoid a certain risk. Results of a survey among 858 flood-prone households in Can Tho city in the Mekong Delta, Vietnam are presented. It is shown that flood-coping appraisal is an important variable in terms of precautionary behaviour. Thus, risk communication should focus more on the potential of precautionary measures to effectively reduce flood damage, as well as on information about how to implement such measures in practice.

  9. The Vulnerabilities of Orphaned Children Participating in Research: A Critical Review and Factors for Consideration for Participation in Biomedical and Behavioral Research

    PubMed Central

    Thompson, Rachel T.; Meslin, Eric M.; Braitstein, Paula K. A.; Nyandiko, Winstone M.; Ayaya, Samuel O.; Vreeman, Rachel C.

    2013-01-01

    Orphans are a subpopulation with a unique set of additional vulnerabilities. Increasing focus on children’s rights, pediatric global health, and pediatric research makes it imperative to recognize and address unique vulnerabilities of orphaned children. This paper describes the unique vulnerabilities of the orphaned pediatric population and offers a structured set of factors that require consideration when including orphans in biomedical research. Pediatric orphans are particularly vulnerable due to decreased economic resources, psychosocial instability, increased risk of abuse, and delayed/decreased access to healthcare. These vulnerabilities are significant. By carefully considering each issue in a population in a culturally specific and study-specific manner, researchers can make valuable contributions to the overall health and well-being of this uniquely vulnerable population. PMID:23086048

  10. Main drivers of flood-risk dynamics along the Po River

    NASA Astrophysics Data System (ADS)

    Domeneghetti, Alessio; Carisi, Francesca; Castellarin, Attilio; Brath, Armando

    2017-04-01

    The increasing frequency with which floods damages are recorded, or reported by media, strengthen the common perception that the flood risk is dramatically increasing in Europe and other areas of the world, due to a combination of different causes, among which climate change is often described as the major factor. However, there is a growing awareness of how anthropogenic pressures, such as uncontrolled urban and industrial expansion on flood-prone areas, may strongly impact the evolution of flood-risk in a given area, increasing potential flood damages and losses. Starting from these considerations, our study aims at shedding some light on the impact and relative importance of different factors controlling the flood risk. Focusing in particular on the middle-lower portion of the River Po, we analyze the evolution of flood hazard in the last half century referring to long streamflow series for different gauging stations located along the study reach ( 450 km), while the modification of anthropogenic pressure is evaluated by referring to land-use and demographic dynamics observed from 1950s. Our study proposes simplified flood-vulnerability indices to be used for large scale flood-risk assessments and, on the basis of these indices, (1) we assess the importance of the different elements contributing to the definition of flood risk and (2) represent the evolution of flood risk in time along the middle and lower portion of the River Po.

  11. Guidelines for Adolescent Preventive Services: the GAPS in practice.

    PubMed

    Gadomski, Anne; Bennett, Shannon; Young, Margaret; Wissow, Lawrence S

    2003-05-01

    Pre- and post-Guidelines for Adolescent Preventive Services (GAPS) comparison of outcomes gathered via chart audit. A rural hospital-based general pediatric clinic. Adolescents who underwent annual examinations between April 1, 1998, and March 31, 2001. A random sample of 441 medical records was reviewed. Training in the GAPS model and use of the questionnaire began in April 1998. Detection of, discussion of, and referrals for GAPS-related risk behavior. The medical records of 162 younger adolescents (aged 11-15 years) and 279 older adolescents (aged 16-19 years) were audited. Detection of risk behaviors increased from 19% at baseline to 95% with the initial GAPS and 87% with the periodic GAPS. The most prevalent risk factor was having a rifle or gun in the home (younger adolescents, 47% and older adolescents, 39%). The mean number of risk behaviors and health concerns documented was higher in the initial GAPS (4.8 and 1.3, respectively) than in the periodic GAPS (3.8 and 0.7) (P =.01 and.006). The GAPS questionnaires detected lower levels of risk behavior compared with a local Youth Risk Behavior Survey. Controlling for sex, age, and clinician, discussion of psychosocial topics increased during the study period; however, there was considerable variation among clinicians regarding the topics addressed. The GAPS-related referral rate did not change significantly. The GAPS model increases clinicians' detection and discussion of risk behaviors.

  12. Birth asphyxia measured by the pH value of the umbilical cord blood may predict an increased risk of attention deficit hyperactivity disorder.

    PubMed

    Mikkelsen, Susanne Hvolgaard; Olsen, Jørn; Bech, Bodil Hammer; Wu, Chunsen; Liew, Zeyan; Gissler, Mika; Obel, Carsten; Arah, Onyebuchi

    2017-06-01

    Although birth asphyxia is a major risk factor for neonatal and childhood morbidity and mortality, it has not been investigated much in relation to attention deficit hyperactivity disorder (ADHD). We examined whether birth asphyxia measured by the pH of the blood in the umbilical artery cord was associated with childhood ADHD. A population-based cohort of 295 687 children born in Finland between 1991 and 2002 was followed until December 31, 2007. ADHD was identified by the International Classification of Diseases, 10th edition, as a diagnosis of hyperkinetic disorder. We examined the risk of ADHD with varying pH values using Cox regression, taking time trends into consideration. When compared to the reference group, a pH value below 7.10 was significantly associated with an increased risk of ADHD. The strongest risks were observed among children with a pH value <7.15 and a gestational age of <32 weeks. The pH value did not contribute much to the risk among children with an Apgar score of 0-3. Birth asphyxia, defined by low pH value, may predict an increased risk of ADHD in childhood. The association between the pH value and ADHD was homogenous when stratified by gestational age and the Apgar score. ©2017 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

  13. Developmental vitamin D deficiency and schizophrenia: the role of animal models.

    PubMed

    Schoenrock, S A; Tarantino, L M

    2016-01-01

    Schizophrenia is a debilitating neuropsychiatric disorder that affects 1% of the US population. Based on twin and genome-wide association studies, it is clear that both genetics and environmental factors increase the risk for developing schizophrenia. Moreover, there is evidence that conditions in utero, either alone or in concert with genetic factors, may alter neurodevelopment and lead to an increased risk for schizophrenia. There has been progress in identifying genetic loci and environmental exposures that increase risk, but there are still considerable gaps in our knowledge. Furthermore, very little is known about the specific neurodevelopmental mechanisms upon which genetics and the environment act to increase disposition to developing schizophrenia in adulthood. Vitamin D deficiency during the perinatal period has been hypothesized to increase risk for schizophrenia in humans. The developmental vitamin D (DVD) deficiency hypothesis of schizophrenia arises from the observation that disease risk is increased in individuals who are born in winter or spring, live further from the equator or live in urban vs. rural settings. These environments result in less exposure to sunlight, thereby reducing the initial steps in the production of vitamin D. Rodent models have been developed to characterize the behavioral and developmental effects of DVD deficiency. This review focuses on these animal models and discusses the current knowledge of the role of DVD deficiency in altering behavior and neurobiology relevant to schizophrenia. © 2015 John Wiley & Sons Ltd and International Behavioural and Neural Genetics Society.

  14. Pharmacological modulation of dietary lipid-induced cerebral capillary dysfunction: Considerations for reducing risk for Alzheimer's disease.

    PubMed

    Pallebage-Gamarallage, Menuka; Takechi, Ryusuke; Lam, Virginie; Elahy, Mina; Mamo, John

    2016-01-01

    An increasing body of evidence suggests that cerebrovascular dysfunction and microvessel disease precede the evolution of hallmark pathological features that characterise Alzheimer's disease (AD), consistent with a causal association for onset or progression. Recent studies, principally in genetically unmanipulated animal models, suggest that chronic ingestion of diets enriched in saturated fats and cholesterol may compromise blood-brain barrier (BBB) integrity resulting in inappropriate blood-to-brain extravasation of plasma proteins, including lipid macromolecules that may be enriched in amyloid-β (Aβ). Brain parenchymal retention of blood proteins and lipoprotein bound Aβ is associated with heightened neurovascular inflammation, altered redox homeostasis and nitric oxide (NO) metabolism. Therefore, it is a reasonable proposition that lipid-lowering agents may positively modulate BBB integrity and by extension attenuate risk or progression of AD. In addition to their robust lipid lowering properties, reported beneficial effects of lipid-lowering agents were attributed to their pleiotropic properties via modulation of inflammation, oxidative stress, NO and Aβ metabolism. The review is a contemporary consideration of a complex body of literature intended to synthesise focussed consideration of mechanisms central to regulation of BBB function and integrity. Emphasis is given to dietary fat driven significant epidemiological evidence consistent with heightened risk amongst populations consuming greater amounts of saturated fats and cholesterol. In addition, potential neurovascular benefits associated with the use of hypolipidemic statins, probucol and fenofibrate are also presented in the context of lipid-lowering and pleiotropic properties.

  15. Key Considerations for an Economic and Legal Framework Facilitating Medical Travel

    PubMed Central

    Hinrichs-Krapels, Saba; Bussmann, Sarah; Dobyns, Christopher; Kácha, Ondřej; Ratzmann, Nora; Holm Thorvaldsen, Julie; Ruggeri, Kai

    2016-01-01

    Medical travel has the capacity to counter increasing costs of health care by creating new markets and increased revenue for health services, potentially benefiting local populations, economies, and health-care systems. This paper is part of a broad, comprehensive project aimed at developing a global health access policy (GHAP). It presents key issues to consider in terms of ensuring economic viability, sustainability, and limiting risk to the many stakeholders involved in the rapidly expanding industry of medical travel. The noted economic and legal barriers to medical travel are based on a synthesis of themes found in an extensive review of the available literature. Economic considerations, when setting up a GHAP, include a dynamic approach to pricing that is fair to the local population. Legal considerations include the implementation of international quality standards and the protection of the rights of those traveling as well as those of local populations in recipient countries. By taking into account these opportunities, the GHAP will more adequately address existing gaps in the economic and legal regulation of medical travel. PMID:27066467

  16. Key Considerations for an Economic and Legal Framework Facilitating Medical Travel.

    PubMed

    Hinrichs-Krapels, Saba; Bussmann, Sarah; Dobyns, Christopher; Kácha, Ondřej; Ratzmann, Nora; Holm Thorvaldsen, Julie; Ruggeri, Kai

    2016-01-01

    Medical travel has the capacity to counter increasing costs of health care by creating new markets and increased revenue for health services, potentially benefiting local populations, economies, and health-care systems. This paper is part of a broad, comprehensive project aimed at developing a global health access policy (GHAP). It presents key issues to consider in terms of ensuring economic viability, sustainability, and limiting risk to the many stakeholders involved in the rapidly expanding industry of medical travel. The noted economic and legal barriers to medical travel are based on a synthesis of themes found in an extensive review of the available literature. Economic considerations, when setting up a GHAP, include a dynamic approach to pricing that is fair to the local population. Legal considerations include the implementation of international quality standards and the protection of the rights of those traveling as well as those of local populations in recipient countries. By taking into account these opportunities, the GHAP will more adequately address existing gaps in the economic and legal regulation of medical travel.

  17. Colon cancer: a civilization disorder.

    PubMed

    Watson, Alastair J M; Collins, Paul D

    2011-01-01

    Colorectal cancer arises in individuals with acquired or inherited genetic predisposition who are exposed to a range of risk factors. Many of these risk factors are associated with affluent Western societies. More than 95% of colorectal cancers are sporadic, arising in individuals without a significant hereditary risk. Geographic variation in the incidence of colorectal cancer is considerable with a higher incidence observed in the West. Environmental factors contribute substantially to this variation. A number of these risk factors are associated with a Western lifestyle and could be considered a product of 'civilization'. Recently, smoking has been recognized as a risk factor. Energy consumption also influences colorectal cancer risk, with obesity increasing risk and exercise reducing risk. However, the strongest contribution to environmental risk for colorectal cancer is dietary. Consumption of fat, alcohol and red meat is associated with an increased risk. Fresh fruit and vegetables and dietary fibre may be protective. Much has been learnt recently about the molecular pathogenesis of colorectal cancer. Colorectal cancer always arises in the context of genomic instability. There is inactivation of the tumour suppressor genes adenomatous polyposis coli, p53, transforming growth factor-β, activation of oncogene pathways including K-ras, and activation of the cyclooxygenase-2, epidermal growth factor receptor and vascular endothelial growth factor pathways. The mechanisms by which some environmental factors modify the mutation risk in these pathways have been described. Copyright © 2011 S. Karger AG, Basel.

  18. “Man-ing” up and Getting Drunk: The Role of Masculine Norms, Alcohol Intoxication and Alcohol-Related Problems among College Men

    PubMed Central

    Iwamoto, Derek Kenji; Cheng, Alice; Lee, Christina S.; Takamatsu, Stephanie; Gordon, Derrick

    2011-01-01

    Compared to college women, college men face elevated risks for problematic drinking and negative alcohol-related consequences. These risks highlight the critical need to investigate gender issues and risk factors contributing to intoxication and related problems among men. Theoretical models suggest that conforming to masculine norms or the beliefs and expectations of what it means to be a man, may help explain patterns of problematic drinking among men. The current study advances the literature by investigating the association between masculine norms, drinking to intoxication, and alcohol-related consequences among 776 undergraduate males after taking into account the importance of fraternity status and perceived peer norms. Results indicate that fraternity status and higher perceived peer norms regarding drinking increased the risks of getting drunk and experiencing alcohol-related consequences. Specifically, the masculine norms of being a “playboy”, risk-taking, and winning were risk factors of drinking to intoxication; while, being a “playboy”, risk-taking, and self-reliance increased the risks of alcohol-related problems. Primacy of work and heterosexual presentation were two masculine norms that were protective of drinking to intoxication. Our findings contribute to important future considerations for prevention, clinical interventions, and public-health implications in college settings. PMID:21620570

  19. "Man-ing" up and getting drunk: the role of masculine norms, alcohol intoxication and alcohol-related problems among college men.

    PubMed

    Iwamoto, Derek Kenji; Cheng, Alice; Lee, Christina S; Takamatsu, Stephanie; Gordon, Derrick

    2011-09-01

    Compared to college women, college men face elevated risks for problematic drinking and negative alcohol-related consequences. These risks highlight the critical need to investigate gender issues and risk factors contributing to intoxication and related problems among men. Theoretical models suggest that conforming to masculine norms or the beliefs and expectations of what it means to be a man, may help explain patterns of problematic drinking among men. The current study advances the literature by investigating the association between masculine norms, drinking to intoxication, and alcohol-related consequences among 776 undergraduate males after taking into account the importance of fraternity status and perceived peer norms. Results indicate that fraternity status and higher perceived peer norms regarding drinking increased the risks of getting drunk and experiencing alcohol-related consequences. Specifically, the masculine norms of being a "playboy", risk-taking, and winning were risk factors of drinking to intoxication; while, being a "playboy", risk-taking, and self-reliance increased the risks of alcohol-related problems. Primacy of work and heterosexual presentation were two masculine norms that were protective of drinking to intoxication. Our findings contribute to important future considerations for prevention, clinical interventions, and public-health implications in college settings. Copyright © 2011 Elsevier Ltd. All rights reserved.

  20. Specific aspects of modern life for people with multiple sclerosis: considerations for the practitioner

    PubMed Central

    Oreja-Guevara, Celia; Wiendl, Heinz; Airas, Laura

    2014-01-01

    Multiple sclerosis (MS) is a chronic, debilitating, neurodegenerative disease that has a high impact on patients’ quality of life. Individuals are often diagnosed in early adulthood and are faced with the difficulty of managing their lifestyle within the context of this chronic illness. Here we review factors that influence the disease course and the challenges that might be encountered when managing patients with MS. The majority of diagnosed patients are women of childbearing age, making pregnancy-related issues a key concern. MS typically stabilizes during pregnancy and evidence suggests that the disease has no impact on the risk of complications or outcomes. However, the effect of disease-modifying therapies on outcomes is less clear, and discontinuation of treatment prior to pregnancy or when breastfeeding is recommended. Awareness of genetic risk factors is important for patients planning a family, as several genes increase the risk of MS. Further aspects that require consideration include infections, vaccinations, environmental factors, surgery and the emergence of osteoporosis. Vaccinations are generally not a risk factor for MS and may be beneficial in terms of protection against infection and reducing the number of relapses. Environmental factors such as vitamin D deficiency, low exposure to sunlight, smoking and Epstein−Barr virus infection can all negatively influence the disease course. Furthermore, osteoporosis is generally higher in patients with MS than the general population, and the risk is increased by the environmental and genetic factors associated with the disease; bone mineral density should be assessed and smoking cessation and correction of serum vitamin D levels are recommended. Finally, as patients with MS are typically young, they are at low risk of surgery-related complications, although they should be carefully monitored postoperatively. Awareness of, and planning around, these factors may minimize the impact of the disease on patients’ lifestyle. PMID:24587828

  1. Alternative approaches for vertebrate ecotoxicity tests in the ...

    EPA Pesticide Factsheets

    The need for alternative approaches to the use of vertebrate animals for hazard assessing chemicals and pollutants has become of increasing importance. It is now the first consideration when initiating a vertebrate ecotoxicity test, to ensure that unnecessary use of vertebrate organisms is minimised wherever possible. For some regulatory purposes, the use of vertebrate organisms for environmental risk assessments (ERA) has even been banned, and in other situations the numbers of organisms tested has been dramatically reduced, or the severity of the procedure refined. However, there is still a long way to go to achieve replacement of vertebrate organisms to generate environmental hazard data. The development of animal alternatives is not just based on ethical considerations but also to reduce the cost of performing vertebrate ecotoxicity tests and in some cases to provide better information aimed at improving ERAs. The present focus paper provides an overview of the considerable advances that have been made towards alternative approaches for ecotoxicity assessments over the last few decades. The need for alternative approaches to the use of vertebrate animals for hazard assessing chemicals and pollutants has become of increasing importance. It is now the first consideration when initiating a vertebrate ecotoxicity test, to ensure that unnecessary use of vertebrate organisms is minimised wherever possible. For some regulatory purposes, the use of vertebrate organi

  2. Considerations for Developing a Dosimetry-Based Cumulative Risk Assessment Approach for Mixtures of Environmental Contaminants (Final Report)

    EPA Science Inventory

    EPA announced the availability of the final report, Considerations for Developing a Dosimetry-Based Cumulative Risk Assessment Approach for Mixtures of Environmental Contaminants. This report describes a process that can be used to determine the potential value of develop...

  3. Responding to and Supporting Students with Disabilities: Risk Management Considerations

    ERIC Educational Resources Information Center

    Lundquist, Anne; Shackelford, Allan

    2011-01-01

    Making the "right" risk management decisions involving students with significant psychological disabilities requires a clear and comprehensive understanding of the legal obligations and duties at issue. It also requires taking into consideration the best interests of these individual students. At the same time, decision makers must focus…

  4. Why Do Only Some Hyperopes Become Strabismic?

    PubMed Central

    Babinsky, Erin; Candy, T. Rowan

    2013-01-01

    Children with hyperopia greater than +3.5 diopters (D) are at increased risk for developing refractive esotropia. However, only approximately 20% of these hyperopes develop strabismus. This review provides a systematic theoretical analysis of the accommodation and vergence oculomotor systems with a view to understanding factors that could either protect a hyperopic individual or precipitate a strabismus. The goal is to consider factors that may predict refractive esotropia in an individual and therefore help identify the subset of hyperopes who are at the highest risk for this strabismus, warranting the most consideration in a preventive effort PMID:23883788

  5. Relevance of a family history of seizures.

    PubMed Central

    Baraitser, M

    1983-01-01

    The approximately tenfold increase in risk (1 in 250 to 1 in 25) to those who have a positive but not extensive family history of recurrent seizures would seem to be considerable but the actual figure of 4% is small. Only if the family history concerns at least 2 closely related members does the risk reach the 10% mark (on the borderline between high and low), but even then the burden of the disorder and response to treatment in the other family members should be taken into account. Familial epilepsy often responds more readily to therapy than other types. PMID:6407403

  6. Clean Energy Finance: Challenges and Opportunities of Early-Stage Energy Investing (Presentation)

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

    Heap, D.; Pless, J.; Aieta, N.

    Characterized by a changing landscape and new opportunities, today's increasingly complex energy decision space will need innovative financing and investment models to appropriately assess risk and profitability. This report provides an overview of the current state of clean energy finance across the entire spectrum but with a focus on early stage investing, and it includes insights from investors across all investment classes. Further, this report aims to provide a roadmap with the mechanisms, limitations, and considerations involved in making successful investments by identifying risks, challenges, and opportunities in the clean energy sector.

  7. Managing cancer risk and decision making after kidney transplantation.

    PubMed

    Webster, A C; Wong, G; Craig, J C; Chapman, J R

    2008-11-01

    Kidney transplant recipients are at higher risk of cancer at most sites, and cancer after transplantation causes considerable morbidity and mortality. To optimize long-term patient outcomes, clinicians balance the prospect of graft failure and dialysis, with competing risks of diabetes, cardiovascular and cerebrovascular disease and the risk of malignancy. In this paper we critically examine the assumptions underpinning primary prevention, immunization, chemoprevention and screening programs, and highlight considerations when applying evidence to the kidney transplant population, and suggest a clinical research agenda that aims to define a rational approach to managing posttransplant cancer risk.

  8. Dietary habits and risk of urothelial cancer death in a large-scale cohort study (JACC Study) in Japan.

    PubMed

    Sakauchi, Fumio; Mori, Mitsuru; Washio, Masakazu; Watanabe, Yoshiyuki; Ozasa, Kotaro; Hayashi, Kyohei; Miki, Tsuneharu; Nakao, Masahiro; Mikami, Kazuya; Ito, Yoshinori; Wakai, Kenji; Tamakoshi, Akiko

    2004-01-01

    In the present study, the associations of dietary habits with the risk of urothelial cancer death were evaluated taking into consideration sex, age, and smoking habits. The Japan Collaborative Cohort Study was established in 1988-1990 and consisted of 47,997 men and 66,520 women observed until the end of 1999. A self-administered food-frequency questionnaire was used as a baseline survey. Hazard ratios for dietary factors were calculated by Cox's proportional hazards model. During the observation period, 63 men and 25 women died of urothelial cancer. Increasing age, male gender, and history of smoking were all significantly associated with increased risk of urothelial cancer death. A high intake of milk and fruits other than oranges reduced the risk significantly and dose dependently, in particular among subjects with smoking history. However, consumption of butter and yogurt had no associations with the risk. Intakes of cabbage, lettuce, green leafy vegetables, carrots, squash, tomatoes, and oranges were not significantly associated with the risk. It was suggested that urothelial cancer death could be potentially preventable by smoking cessation and regular intake of milk and fruit.

  9. Dynamic Relationships Between Parental Monitoring, Peer Risk Involvement and Sexual Risk Behavior Among Bahamian Mid-Adolescents

    PubMed Central

    Wang, Bo; Stanton, Bonita; Deveaux, Lynette; Li, Xiaoming; Lunn, Sonja

    2015-01-01

    CONTEXT Considerable research has examined reciprocal relationships between parenting, peers and adolescent problem behavior; however, such studies have largely considered the influence of peers and parents separately. It is important to examine simultaneously the relationships between parental monitoring, peer risk involvement and adolescent sexual risk behavior, and whether increases in peer risk involvement and changes in parental monitoring longitudinally predict adolescent sexual risk behavior. METHODS Four waves of sexual behavior data were collected between 2008/2009 and 2011 from high school students aged 13–17 in the Bahamas. Structural equation and latent growth curve modeling were used to examine reciprocal relationships between parental monitoring, perceived peer risk involvement and adolescent sexual risk behavior. RESULTS For both male and female youth, greater perceived peer risk involvement predicted higher sexual risk behavior index scores, and greater parental monitoring predicted lower scores. Reciprocal relationships were found between parental monitoring and sexual risk behavior for males and between perceived peer risk involvement and sexual risk behavior for females. For males, greater sexual risk behavior predicted lower parental monitoring; for females, greater sexual risk behavior predicted higher perceived peer risk involvement. According to latent growth curve models, a higher initial level of parental monitoring predicted decreases in sexual risk behavior, whereas both a higher initial level and a higher growth rate of peer risk involvement predicted increases in sexual risk behavior. CONCLUSION Results highlight the important influence of peer risk involvement on youths’ sexual behavior and gender differences in reciprocal relationships between parental monitoring, peer influence and adolescent sexual risk behavior. PMID:26308261

  10. Dynamic Relationships Between Parental Monitoring, Peer Risk Involvement and Sexual Risk Behavior Among Bahamian Mid-Adolescents.

    PubMed

    Wang, Bo; Stanton, Bonita; Deveaux, Lynette; Li, Xiaoming; Lunn, Sonja

    2015-06-01

    Considerable research has examined reciprocal relationships between parenting, peers and adolescent problem behavior; however, such studies have largely considered the influence of peers and parents separately. It is important to examine simultaneously the relationships between parental monitoring, peer risk involvement and adolescent sexual risk behavior, and whether increases in peer risk involvement and changes in parental monitoring longitudinally predict adolescent sexual risk behavior. Four waves of sexual behavior data were collected between 2008/2009 and 2011 from high school students aged 13-17 in the Bahamas. Structural equation and latent growth curve modeling were used to examine reciprocal relationships between parental monitoring, perceived peer risk involvement and adolescent sexual risk behavior. For both male and female youth, greater perceived peer risk involvement predicted higher sexual risk behavior index scores, and greater parental monitoring predicted lower scores. Reciprocal relationships were found between parental monitoring and sexual risk behavior for males and between perceived peer risk involvement and sexual risk behavior for females. For males, greater sexual risk behavior predicted lower parental monitoring; for females, greater sexual risk behavior predicted higher perceived peer risk involvement. According to latent growth curve models, a higher initial level of parental monitoring predicted decreases in sexual risk behavior, whereas both a higher initial level and a higher growth rate of peer risk involvement predicted increases in sexual risk behavior. Results highlight the important influence of peer risk involvement on youths' sexual behavior and gender differences in reciprocal relationships between parental monitoring, peer influence and adolescent sexual risk behavior.

  11. Mode of action human relevance (species concordance) framework: Evolution of the Bradford Hill considerations and comparative analysis of weight of evidence.

    PubMed

    Meek, M E Bette; Palermo, Christine M; Bachman, Ammie N; North, Colin M; Jeffrey Lewis, R

    2014-06-01

    The mode of action human relevance (MOA/HR) framework increases transparency in systematically considering data on MOA for end (adverse) effects and their relevance to humans. This framework continues to evolve as experience increases in its application. Though the MOA/HR framework is not designed to address the question of "how much information is enough" to support a hypothesized MOA in animals or its relevance to humans, its organizing construct has potential value in considering relative weight of evidence (WOE) among different cases and hypothesized MOA(s). This context is explored based on MOA analyses in published assessments to illustrate the relative extent of supporting data and their implications for dose-response analysis and involved comparisons for chemical assessments on trichloropropane, and carbon tetrachloride with several hypothesized MOA(s) for cancer. The WOE for each hypothesized MOA was summarized in narrative tables based on comparison and contrast of the extent and nature of the supporting database versus potentially inconsistent or missing information. The comparison was based on evolved Bradford Hill considerations rank ordered to reflect their relative contribution to WOE determinations of MOA taking into account increasing experience in their application internationally. This clarification of considerations for WOE determinations as a basis for comparative analysis is anticipated to contribute to increasing consistency in the application of MOA/HR analysis and potentially, transparency in separating science judgment from public policy considerations in regulatory risk assessment. Copyright © 2014. The Authors. Journal of Applied Toxicology Published by John Wiley & Sons Ltd.

  12. Integrated NTP Vehicle Radiation Design

    NASA Technical Reports Server (NTRS)

    Caffrey, Jarvis A.; Rodriquez, Mitchell A.

    2018-01-01

    The development of a nuclear thermal propulsion stage requires consideration for radiation emitted from the nuclear reactor core. Applying shielding mass is an effective mitigating solution, but a better alternative is to incorporate some mitigation strategies into the propulsion stage and crew habitat. In this way, the required additional mass is minimized and the mass that must be applied may in some cases be able to serve multiple purposes. Strategies for crew compartment shielding are discussed that reduce dose from both engine and cosmic sources, and in some cases may also serve to reduce life support risks by permitting abundant water reserves. Early consideration for integrated mitigation solutions in a crewed nuclear thermal propulsion (NTP) vehicle will enable reduced radiation burden from both cosmic and nuclear sources, improved thrust-to-weight ratio or payload capacity by reducing 'dead mass' of shielding, and generally support a more robust risk posture for a NTP-powered Mars mission by permitting shorter trip times and increased water reserves.

  13. The potential anesthetic threats, challenges and intensive care considerations in patients with HIV infection

    PubMed Central

    Bajwa, Sukhminder Jit Singh; Kulshrestha, Ashish

    2013-01-01

    Acquired immunodeficiency syndrome (AIDS) has become a pandemic with ever looming danger of its transmission in health professionals. The number of AIDS patients has increased tremendously over the last two decades, who present for surgical procedures as well as who get admitted in intensive care unit for their critical condition. As such anesthesiologists and intensivists are exposed to potential risk of disease transmission on a daily basis from such patients. The guidelines and protocols formulated in the western world regarding prevention of disease transmission cannot be applied uniformly in the developing nations, such as India due to various factors and limitations. As such there is a continuous need felt in this arena to prevent the catastrophic consequences of AIDS in our medical fraternity while treating such patients in operation theatres and critical care units. This study reviews the various pathophysiological aspects, anesthetic considerations, intensive care implications, and various areas where current knowledge about AIDS can be applied to prevent its potential transmission in high-risk clinical groups. PMID:23559818

  14. Ethics of Social Media Research: Common Concerns and Practical Considerations

    PubMed Central

    Goniu, Natalie; Moreno, Peter S.; Diekema, Douglas

    2013-01-01

    Abstract Social media Websites (SMWs) are increasingly popular research tools. These sites provide new opportunities for researchers, but raise new challenges for Institutional Review Boards (IRBs) that review these research protocols. As of yet, there is little-to-no guidance regarding how an IRB should review the studies involving SMWs. The purpose of this article was to review the common risks inherent in social media research and consider how researchers can consider these risks when writing research protocols. We focused this article on three common research approaches: observational research, interactive research, and survey/interview research. Concomitant with these research approaches, we gave particular attention to the issues pertinent to SMW research, including privacy, consent, and confidentiality. After considering these challenges, we outlined key considerations for both researchers and reviewers when creating or reviewing SMW IRB protocols. Our goal in this article was to provide a detailed examination of relevant ethics and regulatory issues for both researchers and those who review their protocols. PMID:23679571

  15. Ethics of social media research: common concerns and practical considerations.

    PubMed

    Moreno, Megan A; Goniu, Natalie; Moreno, Peter S; Diekema, Douglas

    2013-09-01

    Social media Websites (SMWs) are increasingly popular research tools. These sites provide new opportunities for researchers, but raise new challenges for Institutional Review Boards (IRBs) that review these research protocols. As of yet, there is little-to-no guidance regarding how an IRB should review the studies involving SMWs. The purpose of this article was to review the common risks inherent in social media research and consider how researchers can consider these risks when writing research protocols. We focused this article on three common research approaches: observational research, interactive research, and survey/interview research. Concomitant with these research approaches, we gave particular attention to the issues pertinent to SMW research, including privacy, consent, and confidentiality. After considering these challenges, we outlined key considerations for both researchers and reviewers when creating or reviewing SMW IRB protocols. Our goal in this article was to provide a detailed examination of relevant ethics and regulatory issues for both researchers and those who review their protocols.

  16. Middle East respiratory syndrome in children. Dental considerations.

    PubMed

    Al-Sehaibany, Fares S

    2017-04-01

    As of January 2016, 1,633 laboratory-confirmed cases of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infection and 587 MERS-related deaths have been reported by the World Health Organization globally. Middle East Respiratory Syndrome Coronavirus  may occur sporadically in communities or may be transmitted within families or hospitals. The number of confirmed MERS-CoV cases among healthcare workers has been increasing. Middle East Respiratory Syndrome Coronavirus may also spread through aerosols generated during various dental treatments, resulting in transmission between patients and dentists. As MERS-CoV cases have also been reported among children, pediatric dentists are at risk of MERS-CoV infection. This review discusses MERS-CoV infection in children and healthcare workers, especially pediatric dentists, and considerations pertaining to pediatric dentistry. Although no cases of MERS-CoV transmission between a patient and a dentist have yet been reported, the risk of MERS-CoV transmission from an infected patient may be high due to the unique work environment of dentists (aerosol generation).

  17. Scabies: Advances in Noninvasive Diagnosis.

    PubMed

    Micali, Giuseppe; Lacarrubba, Francesco; Verzì, Anna Elisa; Chosidow, Olivier; Schwartz, Robert A

    2016-06-01

    Scabies is a common, highly contagious skin parasitosis caused by Sarcoptes scabiei var. hominis. Early identification and prompt treatment of infested subjects is essential, as missed diagnosis may result in outbreaks, considerable morbidity, and significantly increased economic burden. The standard diagnostic technique consists of mites' identification by microscopic examination of scales obtained by skin scraping. This is a time-consuming and risk-associated procedure that is also not suitable to a busy practice. In recent years, some advanced and noninvasive techniques such as videodermatoscopy, dermatoscopy, reflectance confocal microscopy, and optical coherence tomography have demonstrated improved efficacy in the diagnosis of scabies. Their advantages include rapid, noninvasive mass screening and post-therapeutic follow-up, with no physical risk. A greater knowledge of these techniques among general practitioners and other specialists involved in the intake care of overcrowded populations vulnerable to scabies infestations is now viewed as urgent and important in the management of outbreaks, as well as in consideration of the recent growing inflow of migrants in Europe from North Africa.

  18. Scabies: Advances in Noninvasive Diagnosis

    PubMed Central

    Lacarrubba, Francesco; Verzì, Anna Elisa; Chosidow, Olivier; Schwartz, Robert A.

    2016-01-01

    Scabies is a common, highly contagious skin parasitosis caused by Sarcoptes scabiei var. hominis. Early identification and prompt treatment of infested subjects is essential, as missed diagnosis may result in outbreaks, considerable morbidity, and significantly increased economic burden. The standard diagnostic technique consists of mites’ identification by microscopic examination of scales obtained by skin scraping. This is a time-consuming and risk-associated procedure that is also not suitable to a busy practice. In recent years, some advanced and noninvasive techniques such as videodermatoscopy, dermatoscopy, reflectance confocal microscopy, and optical coherence tomography have demonstrated improved efficacy in the diagnosis of scabies. Their advantages include rapid, noninvasive mass screening and post-therapeutic follow-up, with no physical risk. A greater knowledge of these techniques among general practitioners and other specialists involved in the intake care of overcrowded populations vulnerable to scabies infestations is now viewed as urgent and important in the management of outbreaks, as well as in consideration of the recent growing inflow of migrants in Europe from North Africa. PMID:27311065

  19. Integrated NTP Vehicle Radiation Design

    NASA Technical Reports Server (NTRS)

    Caffrey, Jarvis; Rodriquez, Mitchell

    2018-01-01

    The development of a nuclear thermal propulsion stage requires consideration for radiation emitted from the nuclear reactor core. Applying shielding mass is an effective mitigating solution, but a better alternative is to incorporate some mitigation strategies into the propulsion stage and crew habitat. In this way, the required additional mass is minimized and the mass that must be applied may in some cases be able to serve multiple purposes. Strategies for crew compartment shielding are discussed that reduce dose from both engine and cosmic sources, and in some cases may also serve to reduce life support risks by permitting abundant water reserves. Early consideration for integrated mitigation solutions in a crewed nuclear thermal propulsion (NTP) vehicle will enable reduced radiation burden from both cosmic and nuclear sources, improved thrust-to-weight ratio or payload capacity by reducing 'dead mass' of shielding, and generally support a more robust risk posture for a NTP-powered Mars mission by permitting shorter trip times and increased water reserves

  20. Solar ultraviolet radiation, vitamin D and skin cancer surveillance in organ transplant recipients (OTRs): an update.

    PubMed

    Reichrath, Jörg

    2014-01-01

    During the last decades, the annual numbers of performed solid organ transplants have continuously increased world-wide. Solid organ transplant recipients (OTR) have a greater risk to develop malignancies, with skin cancer representing the most common neoplasia. Additionally, OTRs in general develop a more aggressive form of malignancies. In consequence, dermatologic surveillance is of high importance for OTRs and these patients represent an increasing and significant challenge to clinicians including dermatologists. In OTRs, patient and organ survival have increased considerably and continuously over the past two decades as a result of better immunosuppressive regimens and better posttransplant care. Great progress has been made in our understanding that individual immunosuppressive regiments differ in their effect on skin cancer risk in OTRs, and that effects of individual immunosuppressive regiments on skin cancer risk depend on various other factors including viral infections. Since sunlight is the major source of vitamin D for most humans, OTRs, who have to protect themselves consequently against solar or artificial UV radiation, are at high risk of developing vitamin D deficiency. Vitamin D deficiency is not only associated with increased risk for metabolic bone disease, but with other severe health problems including various types of malignancies. As a consequence, screening for and treatment of vitamin D deficiency is warranted in OTRs. In this review, we give an update on our present understanding of skin cancer surveillance in OTRs.

  1. Mate guarding in the Seychelles warbler is energetically costly and adjusted to paternity risk.

    PubMed

    Komdeur, J

    2001-10-22

    Males may increase their fitness through extra-pair copulations (copulations outside the pair bond) that result in extra-pair fertilizations, but also risk lost paternity when they leave their own mate unguarded. The fitness costs of cuckoldry for Seychelles warblers (Acrocephalus sechellensis) are considerable because warblers have a single-egg clutch and, given the short breeding season, no time for a successful replacement clutch. Neighbouring males are the primary threat to a male's genetic paternity. Males minimize their loss of paternity by guarding their mates to prevent them from having extra-pair copulations during their fertile period. Here, I provide experimental evidence that mate-guarding behaviour is energetically costly and that the expression of this trade-off is adjusted to paternity risk (local male density). Free-living males that were induced to reduce mate guarding spent significantly more time foraging and gained significantly better body condition than control males. The larger the reduction in mate guarding, the more pronounced was the increase in foraging and body condition (accounting for food availability). An experimental increase in paternity risk resulted in an increase in mate-guarding intensity and a decrease in foraging and body condition, and vice versa. This is examined using both cross-sectional and longitudinal data. This study on the Seychelles warbler offers experimental evidence that mate guarding is energetically costly and adjusted to paternity risk.

  2. Childhood adversity, recent life stressors and suicidal behavior in Chinese college students.

    PubMed

    You, Zhiqi; Chen, Mingxi; Yang, Sen; Zhou, Zongkui; Qin, Ping

    2014-01-01

    Although the independent effects of childhood adversities and of recent negative events on suicidality have been well-documented, the combinative role of childhood and recent adversities on risk for suicidality is still underexplored, especially in the context of Chinese culture and in consideration of specific types of negative events. 5989 students, randomly sampled from six universities in central China, completed the online survey for this study. Suicidal behavior, life adversity during childhood and stressful events in recent school life were assessed with designed questionnaires. Students experiencing recent stressful life events more often reported an experience of life adversity during childhood. While recent stressful life events and childhood life adversity both were associated with an increased risk for suicidal behavior, the two exposures presented conjunctively and acted interactively to increase the risk. There was noticeable variation of effects associated with specific childhood life adversities, and sexual abuse, poor parental relationship, divorce of parents and loss of a parent were among the adversities associated with the highest increased risk. Recent conflicts with classmates, poor school performance and rupture of romantic relationships were the recent school life stressors associated with the highest increased risk. Childhood adversity and recent school life stressors had a combinative role in predicting suicidality of young people studying in Chinese colleges. Unhappy family life during childhood and recent interpersonal conflicts in school were the most important predictors of suicidality in this population.

  3. Committee Opinion No. 726 Summary: Hospital Disaster Preparedness for Obstetricians and Facilities Providing Maternity Care.

    PubMed

    2017-12-01

    Large-scale catastrophic events and infectious disease outbreaks highlight the need for disaster planning at all community levels. Features unique to the obstetric population (including antepartum, intrapartum, postpartum and neonatal care) warrant special consideration in the event of a disaster. Pregnancy increases the risks of untoward outcomes from various infectious diseases. Trauma during pregnancy presents anatomic and physiologic considerations that often can require increased use of resources such as higher rates of cesarean delivery. Recent evidence suggests that floods and human-influenced environmental disasters increase the risks of spontaneous miscarriages, preterm births, and low-birth-weight infants among pregnant women. The potential surge in maternal and neonatal patient volume due to mass-casualty events, transfer of high-acuity patients, or redirection of patients because of geographic barriers presents unique challenges for obstetric care facilities. These circumstances require that facilities plan for additional increases in necessary resources and staffing. Although emergencies may be unexpected, hospitals and obstetric delivery units can prepare to implement plans that will best serve maternal and pediatric care needs when disasters occur. Clear designation of levels of maternal and neonatal care facilities, along with establishment of a regional network incorporating hospitals that provide maternity services and those that do not, will enable rapid transport of obstetric patients to the appropriate facilities, ensuring the right care at the right time. Using common terminology for triage and transfer and advanced knowledge of regionalization and levels of care will facilitate disaster preparedness.

  4. Committee Opinion No. 726: Hospital Disaster Preparedness for Obstetricians and Facilities Providing Maternity Care.

    PubMed

    2017-12-01

    Large-scale catastrophic events and infectious disease outbreaks highlight the need for disaster planning at all community levels. Features unique to the obstetric population (including antepartum, intrapartum, postpartum and neonatal care) warrant special consideration in the event of a disaster. Pregnancy increases the risks of untoward outcomes from various infectious diseases. Trauma during pregnancy presents anatomic and physiologic considerations that often can require increased use of resources such as higher rates of cesarean delivery. Recent evidence suggests that floods and human-influenced environmental disasters increase the risks of spontaneous miscarriages, preterm births, and low-birth-weight infants among pregnant women. The potential surge in maternal and neonatal patient volume due to mass-casualty events, transfer of high-acuity patients, or redirection of patients because of geographic barriers presents unique challenges for obstetric care facilities. These circumstances require that facilities plan for additional increases in necessary resources and staffing. Although emergencies may be unexpected, hospitals and obstetric delivery units can prepare to implement plans that will best serve maternal and pediatric care needs when disasters occur. Clear designation of levels of maternal and neonatal care facilities, along with establishment of a regional network incorporating hospitals that provide maternity services and those that do not, will enable rapid transport of obstetric patients to the appropriate facilities, ensuring the right care at the right time. Using common terminology for triage and transfer and advanced knowledge of regionalization and levels of care will facilitate disaster preparedness.

  5. Efficacy of the I Can Control Asthma and Nutrition Now (ICAN) Pilot Program on Health Outcomes in High School Students with Asthma

    ERIC Educational Resources Information Center

    Kouba, Joanne; Velsor-Friedrich, Barbarba; Militello, Lisa; Harrison, Patrick R.; Becklenberg, Amy; White, Barb; Surya, Shruti; Ahmed, Avais

    2013-01-01

    Asthma is the most prevalent chronic illness in childhood affecting 7 million youth. Many youth with asthma face another risk factor in obesity. Obesity, in turn, increases disorders such as asthma. Studies have recommended that asthma programs also address weight management in youth. Taking this into consideration, the I Can Control Asthma and…

  6. To Test or Not to Test? The Role of Attitudes, Knowledge, and Religious Involvement among U.s. Adults on Intent-to-Obtain Adult Genetic Testing

    ERIC Educational Resources Information Center

    Botoseneanu, Anda; Alexander, Jeffrey A.; Banaszak-Holl, Jane

    2011-01-01

    Genetic testing can advance cancer prevention if current screening behaviors improve. Increased prevalence of high-risk genotypes within specific religious groups, use of religious venues for recruiting to genetic screening, and ethical-religious considerations argue for exploring the role of religiosity in forming genetic testing decisions. This…

  7. Mounting Pressures Facing the U.S. Workforce and the Increasing Need for Adult Education and Literacy

    ERIC Educational Resources Information Center

    Jones, Dennis; Kelly, Patrick

    2007-01-01

    At a time when economic competitiveness is determined to a considerable extent by the education levels of a nation's workforce, the United States is at serious risk of losing its edge in this realm. While the U.S. still has the best-educated workforce in the world, the advantage arises because of the superior education attainment levels of the…

  8. Effect of mood states and infertility stress on patients' attitudes toward embryo transfer and multiple pregnancy.

    PubMed

    Newton, Christopher; Feyles, Valter; Asgary-Eden, Veronica

    2013-08-01

    To examine whether mood state or infertility stress influences perceptions of risk, preferences for embryo transfer, or views on multiple pregnancy. Observational cohort study. Hospital-based fertility clinic. One hundred seventy-six women participating in IVF treatment. None. Mood scores, ratings of risk, preference for multiple embryo transfer, and attitudes toward multiple pregnancy. Growing feelings of tension across the cycle corresponded with increases in the perceived riskiness of double-embryo transfer, but there was no change in strength of transfer preferences. Women experiencing negative moods, such as depression, viewed twin and triplet pregnancy as less likely, whereas increasing positive feelings across the cycle were associated with increasing desire for twin pregnancy. Overall, women perceived double- and triple-embryo transfer as less risky by cycle end than at cycle beginning and felt more certain about multiple-embryo transfer. The dyssynchrony observed among changes in mood, perceptions of risk, and transfer preferences challenges assumptions about the way medical risk information influences transfer preferences, and the findings suggest that mood states experienced during an IVF cycle might affect transfer preferences by influencing attitudes toward multiple pregnancy. Additional considerations beyond providing risk information are needed to facilitate effective patient decision making. Crown Copyright © 2013. Published by Elsevier Inc. All rights reserved.

  9. Are ACE Inhibitors and Beta-blockers Dangerous in Patients at Risk for Anaphylaxis?

    PubMed

    Coop, Christopher A; Schapira, Rebecca S; Freeman, Theodore M

    The objective of this article is to review the available studies regarding angiotensin converting enzyme (ACE) inhibitors and beta-blockers and their effect on patients at risk for anaphylaxis. A literature search was conducted in PUBMED to identify peer-reviewed articles using the following keywords: anaphylaxis, ACE inhibitor, beta-blocker, food allergy, radiocontrast media, venom allergy, skin testing, and immunotherapy. Some studies show an increased risk of anaphylaxis in patients who are taking ACE inhibitors and beta-blockers, whereas others studies do not show an increased risk. For venom immunotherapy, there are more data supporting the concomitant use of beta-blockers and ACE inhibitors in the build-up and maintenance phases. Most of the medical literature is limited to case reports and retrospective data. Prospective controlled trials are needed on this important topic. For those patients at risk of anaphylaxis who lack cardiovascular disease, it is recommended to avoid beta-blockers and possibly ACE inhibitors. However, for those patients with cardiovascular disease, beta-blockers and ACE inhibitors have been shown to increase life expectancy. Consideration should be given for the concomitant use of these medications while patients are receiving venom immunotherapy. Copyright © 2017 American Academy of Allergy, Asthma & Immunology. All rights reserved.

  10. Gender Differences in Risk Factors for Adolescent Binge Drinking and Implications for Intervention and Prevention

    PubMed Central

    Dir, Allyson L.; Bell, Richard L.; Adams, Zachary W.; Hulvershorn, Leslie A.

    2017-01-01

    Alcohol use, particularly binge drinking (BD), is a major public health concern among adolescents. Recent national data show that the gender gap in alcohol use is lessening, and BD among girls is rising. Considering the increase in BD among adolescent girls, as well as females’ increased risk of experiencing more severe biopsychosocial negative effects and consequences from BD, the current review sought to examine gender differences in risk factors for BD. The review highlights gender differences in (1) developmental-related neurobiological vulnerability to BD, (2) psychiatric comorbidity and risk phenotypes for BD, and (3) social-related risk factors for BD among adolescents, as well as considerations for BD prevention and intervention. Most of the information gleaned thus far has come from preclinical research. However, it is expected that, with recent advances in clinical imaging technology, neurobiological effects observed in lower mammals will be confirmed in humans and vice versa. A synthesis of the literature highlights that males and females experience unique neurobiological paths of development, and although there is debate regarding the specific nature of these differences, literature suggests that these differences in turn influence gender differences in psychiatric comorbidity and risk for BD. For one, girls are more susceptible to stress, depression, and other internalizing behaviors and, in turn, these symptoms contribute to their risk for BD. On the other hand, males, given gender differences across the lifespan as well as gender differences in development, are driven by an externalizing phenotype for risk of BD, in part, due to unique paths of neurobiological development that occur across adolescence. With respect to social domains, although social and peer influences are important for both adolescent males and females, there are gender differences. For example, girls may be more sensitive to pressure from peers to fit in and impress others, while male gender role stereotypes regarding BD may be more of a risk factor for boys. Given these unique differences in male and female risk for BD, further research exploring risk factors, as well as tailoring intervention and prevention, is necessary. Although recent research has tailored substance use intervention to target males and females, more literature on gender considerations in treatment for prevention and intervention of BD in particular is warranted. PMID:29312017

  11. Gender Differences in Risk Factors for Adolescent Binge Drinking and Implications for Intervention and Prevention.

    PubMed

    Dir, Allyson L; Bell, Richard L; Adams, Zachary W; Hulvershorn, Leslie A

    2017-01-01

    Alcohol use, particularly binge drinking (BD), is a major public health concern among adolescents. Recent national data show that the gender gap in alcohol use is lessening, and BD among girls is rising. Considering the increase in BD among adolescent girls, as well as females' increased risk of experiencing more severe biopsychosocial negative effects and consequences from BD, the current review sought to examine gender differences in risk factors for BD. The review highlights gender differences in (1) developmental-related neurobiological vulnerability to BD, (2) psychiatric comorbidity and risk phenotypes for BD, and (3) social-related risk factors for BD among adolescents, as well as considerations for BD prevention and intervention. Most of the information gleaned thus far has come from preclinical research. However, it is expected that, with recent advances in clinical imaging technology, neurobiological effects observed in lower mammals will be confirmed in humans and vice versa . A synthesis of the literature highlights that males and females experience unique neurobiological paths of development, and although there is debate regarding the specific nature of these differences, literature suggests that these differences in turn influence gender differences in psychiatric comorbidity and risk for BD. For one, girls are more susceptible to stress, depression, and other internalizing behaviors and, in turn, these symptoms contribute to their risk for BD. On the other hand, males, given gender differences across the lifespan as well as gender differences in development, are driven by an externalizing phenotype for risk of BD, in part, due to unique paths of neurobiological development that occur across adolescence. With respect to social domains, although social and peer influences are important for both adolescent males and females, there are gender differences. For example, girls may be more sensitive to pressure from peers to fit in and impress others, while male gender role stereotypes regarding BD may be more of a risk factor for boys. Given these unique differences in male and female risk for BD, further research exploring risk factors, as well as tailoring intervention and prevention, is necessary. Although recent research has tailored substance use intervention to target males and females, more literature on gender considerations in treatment for prevention and intervention of BD in particular is warranted.

  12. The role of progesterone in prevention of preterm birth

    PubMed Central

    Dodd, Jodie M; Crowther, Caroline A

    2010-01-01

    Preterm birth continues to provide an enormous challenge in the delivery of perinatal health care, and is associated with considerable short and long-term health consequences for surviving infants. Progesterone has a role in maintaining pregnancy, by suppression of the calcium–calmodulin–myosin light chain kinase system. Additionally, progesterone has recognized anti-inflammatory properties, raising a possible link between inflammatory processes, alterations in progesterone receptor expression and the onset of preterm labor. Systematic reviews of randomized controlled trials evaluating the use of intramuscular and vaginal progesterone in women considered to be at increased risk of preterm birth have been published, with primary outcomes of perinatal death, preterm birth <34 weeks, and neurodevelopmental handicap in childhood. Eleven randomized controlled trials were included in the systematic review, involving 2714 women and 3452 infants, with results presented according to the reason women were considered to be at increased risk of preterm birth. While there is a potential beneficial effect in the use of progesterone for some women considered to be at increased risk of preterm birth, primarily in the reduction in the risk of preterm birth before 34 weeks gestation, it remains unclear if the observed prolongation of pregnancy translates into improved health outcomes for the infant. PMID:21072277

  13. Chronic Kidney Disease in Pregnancy.

    PubMed

    Koratala, Abhilash; Bhattacharya, Deepti; Kazory, Amir

    2017-09-01

    With the increasing prevalence of chronic kidney disease (CKD) worldwide, the number of pregnant women with various degrees of renal dysfunction is expected to increase. There is a bidirectional relation between CKD and pregnancy in which renal dysfunction negatively affects pregnancy outcomes, and the pregnancy can have a deleterious impact on various aspects of kidney disease. It has been shown that even mild renal dysfunction can increase considerably the risk of adverse maternal and fetal outcomes. Moreover, data suggest that a history of recovery from acute kidney injury is associated with adverse pregnancy outcomes. In addition to kidney dysfunction, maternal hypertension and proteinuria predispose women to negative outcomes and are important factors to consider in preconception counseling and the process of risk stratification. In this review, we provide an overview of the physiologic renal changes during pregnancy as well as available data regarding CKD and pregnancy outcomes. We also highlight the important management strategies in women with certain selected renal conditions that are seen commonly during the childbearing years. We call for future research on underexplored areas such as the concept of renal functional reserve to develop a potential clinical tool for prognostication and risk stratification of women at higher risk for complications during pregnancy.

  14. Romance, risk, and replication: Can consumer choices and risk-taking be primed by mating motives?

    PubMed

    Shanks, David R; Vadillo, Miguel A; Riedel, Benjamin; Clymo, Ashley; Govind, Sinita; Hickin, Nisha; Tamman, Amanda J F; Puhlmann, Lara M C

    2015-12-01

    Interventions aimed at influencing spending behavior and risk-taking have considerable practical importance. A number of studies motivated by the costly signaling theory within evolutionary psychology have reported that priming inductions (such as looking at pictures of attractive opposite sex members) designed to trigger mating motives increase males' stated willingness to purchase conspicuous consumption items and to engage in risk-taking behaviors, and reduce loss aversion. However, a meta-analysis of this literature reveals strong evidence of either publication bias or p-hacking (or both). We then report 8 studies with a total sample of over 1,600 participants which sought to reproduce these effects. None of the studies, including one that was fully preregistered, was successful. The results question the claim that romantic primes can influence risk-taking and other potentially harmful behaviors. (c) 2015 APA, all rights reserved).

  15. Risk stratification for sudden death in arrhythmogenic right ventricular cardiomyopathy.

    PubMed

    Cadrin-Tourigny, Julia; Tadros, Rafik; Talajic, Mario; Rivard, Lena; Abadir, Sylvia; Khairy, Paul

    2015-06-01

    Arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC) is an uncommon but increasingly recognized inherited cardiomyopathy that is associated with malignant ventricular arrhythmias and sudden cardiac death, particularly in young individuals. The implantable cardioverter-defibrillator (ICD) is widely regarded as the only treatment modality with evidence to support improved survival in patients with ARVC and secondary prevention indications. In contrast, there is no universally accepted risk stratification scheme to guide ICD therapy for primary prevention against sudden cardiac death. Potential benefits must be weighed against the considerable risks of complications and inappropriate shocks in this young patient population. This article tackles the challenges of risk stratification for sudden cardiac death in ARVC and critically appraises available evidence for various proposed risk factors. The authors' over-arching objective is to provide the clinician with evidence-based guidance to inform decisions regarding the selection of appropriate candidates with ARVC for ICD therapy.

  16. Thromboembolism in inflammatory bowel disease: results from a prospective, population-based European inception cohort.

    PubMed

    Isene, Rune; Bernklev, Tomm; Høie, Ole; Langholz, Ebbe; Tsianos, Epameonondas; Stockbrügger, Reinhold; Odes, Selwyn; Småstuen, Milada; Moum, Bjørn

    2014-07-01

    Patients with inflammatory bowel disease (IBD) have proven an increased risk of venous thromboembolism (VTE), particularly when hospitalized. The estimate of the true risk varies considerably between studies, primarily due to differences in methodology. We set out to determine the incidence of VTE in a population-based European inception cohort. IBD patients were incepted into a cohort that was prospectively followed from the early 1990s to the early 2000s. A total of 1145 patients were followed for a total of 10,634 patient-years (p.y.). A total of 19 thromboembolic events were identified - 13 deep vein thrombosis and 6 with pulmonary embolism. The incidence rate of VTE was 1.8 per 1000 p.y. The risk of VTE was elevated in this IBD cohort but lower than previously reported. The highest risk was seen in hospitalized patients, but corticosteroids-requiring disease in outpatients also conferred some risk.

  17. Caring capacity in the management of the nutrition crisis in infants, young children and women in Nigeria.

    PubMed

    Igbedioh, S O

    1996-01-01

    Nigeria's nutrition crisis has been shown to have a considerable negative impact on infants, young children and women. Available evidence suggests that 'caring capacity' when properly planned and targeted at the most-at-risk can help. Strategies that can achieve this care are increasing women's income and control over income, increasing investment in women's education and improving access to credit facilities. Others are the aggressive promotion of gender-biased labour saving technology, increasing women's access to basic health and family planning services and implementing reforms in land ownership while instituting social security for women.

  18. Glucocerebrosidase mutations and neuropsychiatric phenotypes in Parkinson's disease and Lewy body dementias: Review and meta-analyses.

    PubMed

    Creese, Byron; Bell, Emily; Johar, Iskandar; Francis, Paul; Ballard, Clive; Aarsland, Dag

    2018-03-01

    Heterozygous mutations in glucocerebrosidase gene (GBA) are a major genetic risk factor for Parkinson's disease (PD) and dementia with Lewy bodies (DLB). Recently, there has been a considerable focus on the relationship between GBA mutations and emergence of cognitive impairment and neuropsychiatric symptoms in these diseases. Here, we review the literature in this area, with a particular focus, including meta-analysis, on the key neuropsychiatric symptoms of cognitive impairment, psychosis, and depression in Parkinson's disease. Our meta-analysis demonstrated that GBA mutations are associated with a 2.4-fold increased risk of cognitive impairment. In addition, our novel meta-analyses of psychosis and depression showed a 1.8- and 2.2-fold increased risk respectively associated with GBA mutations, although due to possible bias and heterogeneity the depression findings should be interpreted with caution. While the precise mechanisms which increase susceptibility to neurodegeneration in GBA carriers are not known, evidence of greater cortical Lewy body pathology, reduced patterns of cortical activation, and hippocampal pathology in animal models are all consistent with a direct effect of GBA mutations on these symptoms. Extension of this work in DLB and individuals without neurodegeneration will be important in further characterizing how GBA mutations increase risk for PD and DLB and influence disease course. © 2017 Wiley Periodicals, Inc.

  19. Effects on DNA Damage and/or Repair Processes as Biological Mechanisms Linking Psychological Stress to Cancer Risk

    PubMed Central

    Jenkins, Frank J.; Van Houten, Bennett; Bovbjerg, Dana H.

    2014-01-01

    Considerable research effort in the past several decades has focused on the impact of psychological stress, and stress hormones, on cancer progression. Numerous studies have reported that stress hormone treatment or in vivo stress exposure can enhance the growth of tumor cell lines in vitro, as well as tumors in animal models, and have begun to explore molecular mechanisms. Comparatively little research has focused on the impact of psychological stress and stress hormones on cancer initiation, in part due to inherent methodological challenges, but also because potential underlying biological mechanisms have remained obscure. In this review, we present a testable theoretical model of pathways by which stress may result in cellular transformation and tumorigenesis. This model supports our overarching hypothesis that psychological stress, acting through increased levels of catecholamines and/or cortisol, can increase DNA damage and/or reduce repair mechanisms, resulting in increased risk of DNA mutations leading to carcinogenesis. A better understanding of molecular pathways by which psychological stress can increase the risk of cancer initiation would open new avenues of translational research, bringing together psychologists, neuroscientists, and molecular biologists, potentially resulting in the development of novel approaches for cancer risk reduction at the population level. PMID:24891812

  20. Racializing drug design: implications of pharmacogenomics for health disparities.

    PubMed

    Lee, Sandra Soo-Jin

    2005-12-01

    Current practices of using "race" in pharmacogenomics research demands consideration of the ethical and social implications for understandings of group difference and for efforts to eliminate health disparities. This discussion focuses on an "infrastructure of racialization" created by current trajectories of research on genetic differences among racially identified groups, the use of race as a proxy for risk in clinical practice, and increasing interest in new market niches by the pharmaceutical industry. The confluence of these factors has resulted in the conflation of genes, disease, and race. I argue that public investment in pharmacogenomics requires careful consideration of current inequities in health status and social and ethical concerns over reifying race and issues of distributive justice.

  1. A Minority Report for Social Work? The Predictive Risk Model (PRM) and the Tuituia Assessment Framework in addressing the needs of New Zealand's Vulnerable Children

    PubMed Central

    Oak, Eileen

    2016-01-01

    This article examines the viability of the Risk Predictor Model (RPM) and its counterpart the actuarial risk assessment (ARA) tool in the form of the Tuituia Assessment Framework to address child vulnerability in New Zealand. In doing so, it suggests that these types of risk-assessment tools fail to address issues of contingency and complexity at the heart of the relationship-based nature of social work practice. Such developments have considerable implications for the capacity to enhance critical reflexive practice skills, whilst the introduction of these risk tools is occurring at a time when the reflexive space is being eroded as a result of the increased regulation of practice and supervision. It is further asserted that the primary aim of such instruments is not so much to detect risk, but rather to foster professional conformity with these managerialist risk-management systems so prevalent in contemporary Western societies. PMID:27559223

  2. [Quantitative assessment of fungal risk in the case of construction works in healthcare establishments: Proposed indicators for the determination of the impact of management precautions on the risk of fungal infection].

    PubMed

    Gangneux, J-P; Adjidé, C-C; Bernard, L; Botterel, F; Carel, A; Castel, O; Derouin, F; Hoarau, G; Labussière, H; Lafaurie, M; Millon, L; Pottecher, B; Thiebaut, A; Turco, M; Baron, R

    2012-03-01

    Construction works in healthcare establishments produce airborne fungal spores and considerably increase the risk of exposure of immunosuppressed patients. It is necessary to reinforce protective measures, or even to implement specific precautions, during this critical phase. The aim of these precautions is to protect both those areas, which are susceptible to dust, and patients at risk of a fungal infection particularly invasive aspergillosis. When construction works are planned in healthcare establishments, the first step consists in the characterisation of the environmental fungal risk and the second one in proposing risk management methods. It is then essential to establish impact indicators in order to evaluate the risk management precautions applied. The working group promoted by the French societies of medical mycology and hospital hygiene (SFMM & SF2H) details here both environmental and epidemiological impact indicators that can be used. Copyright © 2012. Published by Elsevier SAS.

  3. [Health security--GMOs in therapeutics].

    PubMed

    Trouvin, J-H

    2003-03-01

    The recent progress in human therapeutics has been made possible thanks to molecular biology and its use in producing proteins having the same sequence and structure as that of human proteins. The use of GMOs allows production of proteins with high added value in therapeutics, which are of satisfactory quality. GMOs may also be directly administered to patients as gene therapy vectors. However, the use of GMOs in therapeutics must take into consideration some risks, particularly those of microbiological contamination, of neo-antigenicity as well as environmental risks with regard to the way of use of the GMO. Nevertheless, those risks are taken in due consideration in the development of these new medicinal products; solutions have been found to allow their use in therapeutics with a very positive benefit/risk ratio. Medicinal products from biotechnology have enabled considerable therapeutic progress without compromising health security.

  4. Coastal and river flood risk analyses for guiding economically optimal flood adaptation policies: a country-scale study for Mexico

    NASA Astrophysics Data System (ADS)

    Haer, Toon; Botzen, W. J. Wouter; van Roomen, Vincent; Connor, Harry; Zavala-Hidalgo, Jorge; Eilander, Dirk M.; Ward, Philip J.

    2018-06-01

    Many countries around the world face increasing impacts from flooding due to socio-economic development in flood-prone areas, which may be enhanced in intensity and frequency as a result of climate change. With increasing flood risk, it is becoming more important to be able to assess the costs and benefits of adaptation strategies. To guide the design of such strategies, policy makers need tools to prioritize where adaptation is needed and how much adaptation funds are required. In this country-scale study, we show how flood risk analyses can be used in cost-benefit analyses to prioritize investments in flood adaptation strategies in Mexico under future climate scenarios. Moreover, given the often limited availability of detailed local data for such analyses, we show how state-of-the-art global data and flood risk assessment models can be applied for a detailed assessment of optimal flood-protection strategies. Our results show that especially states along the Gulf of Mexico have considerable economic benefits from investments in adaptation that limit risks from both river and coastal floods, and that increased flood-protection standards are economically beneficial for many Mexican states. We discuss the sensitivity of our results to modelling uncertainties, the transferability of our modelling approach and policy implications. This article is part of the theme issue `Advances in risk assessment for climate change adaptation policy'.

  5. Decision analysis and risk models for land development affecting infrastructure systems.

    PubMed

    Thekdi, Shital A; Lambert, James H

    2012-07-01

    Coordination and layering of models to identify risks in complex systems such as large-scale infrastructure of energy, water, and transportation is of current interest across application domains. Such infrastructures are increasingly vulnerable to adjacent commercial and residential land development. Land development can compromise the performance of essential infrastructure systems and increase the costs of maintaining or increasing performance. A risk-informed approach to this topic would be useful to avoid surprise, regret, and the need for costly remedies. This article develops a layering and coordination of models for risk management of land development affecting infrastructure systems. The layers are: system identification, expert elicitation, predictive modeling, comparison of investment alternatives, and implications of current decisions for future options. The modeling layers share a focus on observable factors that most contribute to volatility of land development and land use. The relevant data and expert evidence include current and forecasted growth in population and employment, conservation and preservation rules, land topography and geometries, real estate assessments, market and economic conditions, and other factors. The approach integrates to a decision framework of strategic considerations based on assessing risk, cost, and opportunity in order to prioritize needs and potential remedies that mitigate impacts of land development to the infrastructure systems. The approach is demonstrated for a 5,700-mile multimodal transportation system adjacent to 60,000 tracts of potential land development. © 2011 Society for Risk Analysis.

  6. Heat and risk of myocardial infarction: hourly level case-crossover analysis of MINAP database

    PubMed Central

    Armstrong, Ben; Hajat, Shakoor; Haines, Andy; Wilkinson, Paul; Smeeth, Liam

    2012-01-01

    Objective To quantify the association between exposure to higher temperatures and the risk of myocardial infarction at an hourly temporal resolution. Design Case-crossover study. Setting England and Wales Myocardial Ischaemia National Audit Project (MINAP) database. Participants 24 861 hospital admissions for myocardial infarction occurring in 11 conurbations during the warmest months (June to August) of the years 2003-09. Main outcome measure Odds ratio of myocardial infarction for a 1°C increase in temperature. Results Strong evidence was found for an effect of heat acting 1-6 hours after exposure to temperatures above an estimated threshold of 20°C (95% confidence interval 16°C to 25°C). For each 1°C increase in temperature above this threshold, the risk of myocardial infarction increased by 1.9% (0.5% to 3.3%, P=0.009). Later reductions in risk seemed to offset early increases in risk: the cumulative effect of a 1°C rise in temperature above the threshold was 0.2% (−2.1% to 2.5%) by the end of the third day after exposure. Conclusions Higher ambient temperatures above a threshold of 20°C seem to be associated with a transiently increased risk of myocardial infarction 1-6 hours after exposure. Reductions in risk at longer lags are consistent with heat triggering myocardial infarctions early in highly vulnerable people who would otherwise have had a myocardial infarction some time later (“short term displacement”). Policies aimed at reducing the health effects of hot weather should include consideration of effects operating at sub-daily timescales. PMID:23243290

  7. Quantitative Risk Assessment of Antimicrobial-Resistant Foodborne Infections in Humans Due to Recombinant Bovine Somatotropin Usage in Dairy Cows.

    PubMed

    Singer, Randall S; Ruegg, Pamela L; Bauman, Dale E

    2017-07-01

    Recombinant bovine somatotropin (rbST) is a production-enhancing technology that allows the dairy industry to produce milk more efficiently. Concern has been raised that cows supplemented with rbST are at an increased risk of developing clinical mastitis, which would potentially increase the use of antimicrobial agents and increase human illnesses associated with antimicrobial-resistant bacterial pathogens delivered through the dairy beef supply. The purpose of this study was to conduct a quantitative risk assessment to estimate the potential increased risk of human infection with antimicrobial-resistant bacteria and subsequent adverse health outcomes as a result of rbST usage in dairy cattle. The quantitative risk assessment included the following steps: (i) release of antimicrobial-resistant organisms from the farm, (ii) exposure of humans via consumption of contaminated beef products, and (iii) consequence of the antimicrobial-resistant infection. The model focused on ceftiofur (parenteral and intramammary) and oxytetracycline (parenteral) treatment of clinical mastitis in dairy cattle and tracked the bacteria Campylobacter spp., Salmonella enterica subsp. enterica, and Escherichia coli in the gastrointestinal tract of the cow. Parameter estimates were developed to be maximum risk to overestimate the risk to humans. The excess number of cows in the U.S. dairy herd that were predicted to carry resistant bacteria at slaughter due to rbST administration was negligible. The total number of excess human illnesses caused by resistant bacteria due to rbST administration was also predicted to be negligible with all risks considerably less than one event per 1 billion people at risk per year for all bacteria. The results indicate a high probability that the use of rbST according to label instructions presents a negligible risk for increasing the number of human illnesses and subsequent adverse outcomes associated with antimicrobial-resistant Campylobacter, Salmonella, or E. coli .

  8. Consumer phase risk assessment for Listeria monocytogenes in deli meats.

    PubMed

    Yang, Hong; Mokhtari, Amirhossein; Jaykus, Lee-Ann; Morales, Roberta A; Cates, Sheryl C; Cowen, Peter

    2006-02-01

    The foodborne disease risk associated with the pathogen Listeria monocytogenes has been the subject of recent efforts in quantitative microbial risk assessment. Building upon one of these efforts undertaken jointly by the U.S. Food and Drug Administration and the U.S. Department of Agriculture (USDA), the purpose of this work was to expand on the consumer phase of the risk assessment to focus on handling practices in the home. One-dimensional Monte Carlo simulation was used to model variability in growth and cross-contamination of L. monocytogenes during food storage and preparation of deli meats. Simulations approximated that 0.3% of the servings were contaminated with >10(4) CFU/g of L. monocytogenes at the time of consumption. The estimated mean risk associated with the consumption of deli meats for the intermediate-age population was approximately 7 deaths per 10(11) servings. Food handling in homes increased the estimated mean mortality by 10(6)-fold. Of all the home food-handling practices modeled, inadequate storage, particularly refrigeration temperatures, provided the greatest contribution to increased risk. The impact of cross-contamination in the home was considerably less. Adherence to USDA Food Safety and Inspection Service recommendations for consumer handling of ready-to-eat foods substantially reduces the risk of listeriosis.

  9. Psychosocial risk and protective factors for the health and well-being of professionals working in emergency and non-emergency medical transport services, identified via questionnaires.

    PubMed

    Navarro Moya, P; González Carrasco, M; Villar Hoz, E

    2017-09-06

    Medical transport (MT) professionals are subject to considerable emotional demands due to their involvement in life-or-death situations and their exposure to the serious health problems of their clients. An increase in the demand for MT services has, in turn, increased interest in the study of the psychosocial risk factors affecting the health of workers in this sector. However, research thus far has not distinguished between emergency (EMT) and non-emergency (non-EMT) services, nor between the sexes. Furthermore, little emphasis has been placed on the protective factors involved. The main objective of the present study is to identify any existing differential exposure - for reasons of work setting (EMT and non-EMT) or of gender - to the various psychosocial risk and protective factors affecting the health of MT workers. Descriptive and transversal research with responses from 201 professionals. The scores obtained on the various psychosocial scales in our study - as indicators of future health problems - were more unfavourable for non-EMT workers than they were for EMT workers. Work setting, but not gender, was able to account for these differences. The scores obtained for the different psychosocial factors are generally more favourable for the professionals we surveyed than those obtained in previous samples. The significant differences observed between EMT and non-EMT personnel raise important questions regarding the organization of work in companies that carry out both services at the same time in the same territory. The relationships among the set of risk/protective factors suggests a need for further investigation into working conditions as well as a consideration of the workers' sense of coherence and subjective well-being as protective factors against occupational burnout syndrome.

  10. HealthMarts, HIPCs (health insurance purchasing cooperatives), MEWAs (multiple employee welfare arrangements), and AHPs (association health plans): a guide for the perplexed.

    PubMed

    Hall, M A; Wicks, E K; Lawlor, J S

    2001-01-01

    This paper considers how pending proposals to authorize new forms of group purchasing arrangements for health insurance would fit and function within the existing, highly complex market and regulatory landscape and whether these proposals are likely to meet their stated objectives and avoid unintended consequences. Cost savings are more likely to result from increased risk segmentation than through true market efficiencies. Thus, these proposals could erode previous market reforms whose goal is increased risk pooling. On the other hand, these proposals contain important enhancements, clarifications, and simplification of state and federal regulatory oversight of group purchasing vehicles. Also, they address some of the problems that have hampered the performance of purchasing cooperatives. On balance, although these proposals should receive cautious and careful consideration, they are not likely to produce a significant overall reduction in premiums or increase in coverage.

  11. Beyond post-marketing research and MedWatch: Long-term studies of drug risks.

    PubMed

    Resnik, David B

    2007-10-01

    Critics of the drug safety system have discussed many different potential reforms, ranging from mandatory registration of clinical trials to increasing the power of regulatory agencies, but few have discussed one of the most important ways of enhancing safety: increasing the number of long-term studies of medications. Long-term studies of the risks and benefits of drugs can provide useful information for regulators, healthcare professionals, and patients. Government funding agencies should lead the effort to conduct long-term studies of drugs, but private companies should also be required to lend financial support. Because cost-effectiveness is likely to be an important consideration in conducting this research, funding agencies should focus, at first, on drugs that are used to treat common, chronic conditions.

  12. Beyond post-marketing research and MedWatch: Long-term studies of drug risks

    PubMed Central

    Resnik, David B

    2007-01-01

    Critics of the drug safety system have discussed many different potential reforms, ranging from mandatory registration of clinical trials to increasing the power of regulatory agencies, but few have discussed one of the most important ways of enhancing safety: increasing the number of long-term studies of medications. Long-term studies of the risks and benefits of drugs can provide useful information for regulators, healthcare professionals, and patients. Government funding agencies should lead the effort to conduct long-term studies of drugs, but private companies should also be required to lend financial support. Because cost-effectiveness is likely to be an important consideration in conducting this research, funding agencies should focus, at first, on drugs that are used to treat common, chronic conditions. PMID:19727333

  13. Characterizing chronic and acute health risks of residues of veterinary drugs in food: latest methodological developments by the joint FAO/WHO expert committee on food additives.

    PubMed

    Boobis, Alan; Cerniglia, Carl; Chicoine, Alan; Fattori, Vittorio; Lipp, Markus; Reuss, Rainer; Verger, Philippe; Tritscher, Angelika

    2017-11-01

    The risk assessment of residues of veterinary drugs in food is a field that continues to evolve. The toxicological end-points to be considered are becoming more nuanced and in light of growing concern about the development of antimicrobial resistance, detailed analysis of the antimicrobial activity of the residues of veterinary drugs in food is increasingly incorporated in the assessment. In recent years, the Joint FAO/WHO Expert Committee on Food Additives (JECFA) has refined its approaches to provide a more comprehensive and fit-for-purpose risk assessment. This publication describes in detail the consideration of acute and chronic effects, the estimation of acute and chronic dietary exposure, current approaches for including microbiological endpoints in the risk assessment, and JECFA's considerations for the potential effects of food processing on residues from veterinary drugs. JECFA now applies these approaches in the development of health-based guidance values (i.e. safe exposure levels) for residues of veterinary drugs. JECFA, thus, comprehensively addresses acute and chronic risks by using corresponding estimates for acute and chronic exposure and suitable correction for the limited bioavailability of bound residues by the Gallo-Torres model. On a case-by-case basis, JECFA also considers degradation products that occur from normal food processing of food containing veterinary drug residues. These approaches will continue to be refined to ensure the most scientifically sound basis for the establishment of health-based guidance values for veterinary drug residues.

  14. The moderating role of social support on the relationship between impulsivity and suicide risk.

    PubMed

    Kleiman, Evan M; Riskind, John H; Schaefer, Karen E; Weingarden, Hilary

    2012-01-01

    Suicide is the second leading cause of death among college students. There has been considerable research into risk factors for suicide, such as impulsivity, but considerably less research on protective factors. The present study examines the role that social support plays in the relationship between impulsivity and suicide risk. Participants were 169 undergraduates who completed self-report measures of impulsivity and social support. Suicide risk was assessed using an interview measure. Social support moderates the relationship between impulsivity and suicide risk, such that those who are highly impulsive are less likely to be at risk for suicide if they also have high levels of social support. Social support can be a useful buffer to suicide risk for at-risk individuals who are highly impulsive.

  15. Community Stress, Psychosocial Hazards, and EPA Decision-Making in Communities Impacted by Chronic Technological Disasters

    PubMed Central

    Coles, Charlton J.

    2011-01-01

    Psychosocial stress has emerged as an important consideration in managing environmental health risks. Stress has adverse impacts on health and may interact with environmental hazards to increase health risk. This article's primary objective was to explore psychosocial stress related to environmental contamination. We hypothesized that knowledge about stress should be used in conjunction with chemical risk assessment to inform environmental risk management decisions. Knowledge of psychosocial stress at contaminated sites began by exploring the relationships among social capital, collective efficacy, and contamination at the community level. We discussed stress at the family and individual levels, focusing on stress proliferation, available resources, and coping styles and mechanisms. We then made recommendations on how to improve the use of information on psychosocial stress in environmental decision-making, particularly in communities facing chronic technological disasters. PMID:21836109

  16. Bipolar Disorder in Pregnancy and Postpartum: Principles of Management.

    PubMed

    Khan, Sabrina J; Fersh, Madeleine E; Ernst, Carrie; Klipstein, Kim; Albertini, Elizabeth Streicker; Lusskin, Shari I

    2016-02-01

    Pregnancy and postpartum represent times of increased vulnerability for women with bipolar disorder, yet this condition remains under-diagnosed and under-treated. As 50 % of pregnancies are unplanned, the risks associated with the illness and the potential risks associated with treatment should be considered when a woman of reproductive age first presents for evaluation. This article reviews the epidemiology of perinatal bipolar disorder, screening recommendations, and treatment with pharmacotherapy and electroconvulsive therapy (ECT). An overview of the data in pregnancy and lactation is presented for lithium, lamotrigine, valproic acid, newer antipsychotics, and ECT. General principles of management include close monitoring in pregnancy and postpartum, careful adjustment of the treatment regimen to attenuate the risk of relapse, and avoidance of valproic acid when possible. Thoughtful consideration of these issues will minimize the risks to the mother and baby.

  17. Risk of treatment-related esophageal cancer among breast cancer survivors

    PubMed Central

    Morton, L. M.; Gilbert, E. S.; Hall, P.; Andersson, M.; Joensuu, H.; Vaalavirta, L.; Dores, G. M.; Stovall, M.; Holowaty, E. J.; Lynch, C. F.; Curtis, R. E.; Smith, S. A.; Kleinerman, R. A.; Kaijser, M.; Storm, H. H.; Pukkala, E.; Weathers, R. E.; Linet, M. S.; Rajaraman, P.; Fraumeni, J. F.; Brown, L. M.; van Leeuwen, F. E.; Fossa, S. D.; Johannesen, T. B.; Langmark, F.; Lamart, S.; Travis, L. B.; Aleman, B. M. P.

    2012-01-01

    Background Radiotherapy for breast cancer may expose the esophagus to ionizing radiation, but no study has evaluated esophageal cancer risk after breast cancer associated with radiation dose or systemic therapy use. Design Nested case–control study of esophageal cancer among 289 748 ≥5-year survivors of female breast cancer from five population-based cancer registries (252 cases, 488 individually matched controls), with individualized radiation dosimetry and information abstracted from medical records. Results The largest contributors to esophageal radiation exposure were supraclavicular and internal mammary chain treatments. Esophageal cancer risk increased with increasing radiation dose to the esophageal tumor location (Ptrend < 0.001), with doses of ≥35 Gy associated with an odds ratio (OR) of 8.3 [95% confidence interval (CI) 2.7–28]. Patients with hormonal therapy ≤5 years preceding esophageal cancer diagnosis had lower risk (OR = 0.4, 95% CI 0.2–0.8). Based on few cases, alkylating agent chemotherapy did not appear to affect risk. Our data were consistent with a multiplicative effect of radiation and other esophageal cancer risk factors (e.g. smoking). Conclusions Esophageal cancer is a radiation dose-related complication of radiotherapy for breast cancer, but absolute risk is low. At higher esophageal doses, the risk warrants consideration in radiotherapy risk assessment and long-term follow-up. PMID:22745217

  18. Hospitalisation for chronic obstructive pulmonary disease and risk of suicide: a population-based case–control study

    PubMed Central

    Strid, Jennie Maria Christin; Christiansen, Christian Fynbo; Olsen, Morten; Qin, Ping

    2014-01-01

    Objectives To examine risk of suicide among individuals with hospitalised chronic obstructive pulmonary disease (COPD) and to profile differences according to sex, age, psychiatric history, and recency and frequency of COPD hospitalisations. Design Nested case–control study. Setting Data were retrieved from Danish national registries. Participants All suicide cases aged 40–95 years deceased between 1981 and 2006 in Denmark (n=19 869) and up to 20 live population controls per case matched on sex and date of birth (n=321 867 controls). Main outcome measures The relative risk of suicide associated with COPD was computed using conditional logistic regression and adjusted for effects of psychiatric history and important sociodemographic factors. Results In our study population, 3% of suicide cases had been hospitalised for COPD compared with 1% of matched population controls. Thus, a hospitalised COPD was associated with a significantly increased risk for suicide (OR 2.6; 95% CI 2.3 to 2.8). The increased risk remained significant after adjustment for psychiatric history and sociodemographic variables (OR 2.0; 95% CI 1.8 to 2.2), and increased progressively with frequency and recency of COPD hospitalisation. At the same time, suicide risk associated with COPD differed significantly by sex, age and psychiatric status. The relative risk was more pronounced in women, in individuals older than 60 years and in persons with no history of psychiatric illness. Conclusions COPD confers an important risk factor for suicide completion. Risk assessment and prevention efforts should take patients’ sex, age and psychiatric history into consideration. PMID:25421339

  19. Efficacy of behavioural interventions for transport behaviour change: systematic review, meta-analysis and intervention coding.

    PubMed

    Arnott, Bronia; Rehackova, Lucia; Errington, Linda; Sniehotta, Falko F; Roberts, Jennifer; Araujo-Soares, Vera

    2014-11-28

    Reducing reliance on motorised transport and increasing use of more physically active modes of travel may offer an opportunity to address physical inactivity. This review evaluates the evidence for the effects of behavioural interventions to reduce car use for journeys made by adults and codes intervention development and content. The review follows the procedure stated in the registration protocol published in the PROSPERO database (registration number CRD42011001797). Controlled studies evaluating behavioural interventions to reduce car use compared with no interventions or alternative interventions on outcome measures of transport behaviours taken in adult participants are included in this review. Searches were conducted on all records in Applied Social Sciences Index and Abstracts (ASSIA), Ovid Embase, Ovid Medline, Ovid PsycInfo, Scopus, Sociological Abstracts, Transportation Research Information Service (TRIS), Transportation Research International Documentation (TRID), and Web of Science databases. Peer reviewed publications in English language meeting the inclusion criteria are eligible. Methodological quality is assessed using the Cochrane Risk of Bias Tool. Interventions are categorised in terms of behavioural frameworks, theories and techniques. 15 full text articles are included, representing 13 unique studies, with 4895 participants and 27 intervention arms. Risk of bias across the review is appraised as considerable due to the unclear methodological quality of individual studies. Heterogeneity of included studies is considerable. Meta-analyses reveal no significant effect on reduction of frequency of car use or on increasing the proportion of journeys by alternative, more active modes of transport. There is insufficient data relating to alternative outcomes such as distance and duration which may have important health implications. Interventions were top-down but could not be described as theory-based. Intervention efficacy was associated with the use of a combination of information provision and behavioural regulation techniques. There was a lack of consideration of opportunity for change and behaviour in context. There is no evidence for the efficacy of existing behavioural interventions to reduce car trips included in this review. The evidence for efficacy of behavioural interventions to decrease distance and duration of car journeys is limited and inconclusive. Overall the evidence is highly heterogeneous and is at considerable risk of bias. Future research should investigate alternative behavioural interventions in high quality, controlled studies informed by existing evidence, theory, and viewers of potential users. Future intervention studies should increase scientific rigour, include objective outcome measures, and incorporate thorough evaluations as standard.

  20. Risk factors for early cytologic abnormalities after loop electrosurgical excision procedure.

    PubMed

    Dietrich, Charles S; Yancey, Michael K; Miyazawa, Kunio; Williams, David L; Farley, John

    2002-02-01

    To evaluate risk factors for early cytologic abnormalities and recurrent cervical dysplasia after loop electrosurgical excision procedure (LEEP). A retrospective analysis was performed of all pathology records for LEEPs performed at our institution from January 1996 through July 1998. Follow-up cytology from 2 through 12 months after LEEP was reviewed. Patients with abnormal cytology were referred for further colposcopic evaluation. Statistical analysis using chi2 test for trend, proportional hazards model test, Fisher exact tests, and life table analysis were performed to identify risk factors for early cytologic abnormalities after LEEP and to determine relative risk of recurrent dysplasia. A total of 298 women underwent LEEP during the study period, and 29% of these had cytologic abnormalities after LEEP. Grade of dysplasia, ectocervical marginal status, endocervical marginal status, and glandular involvement with dysplasia were not found to be independent risk factors for early cytologic abnormalities. However, when risk factors were analyzed cumulatively, the abnormal cytology rate increased from 24% with no risk factors to 67% with three risk factors present (P =.037). Of patients with abnormal cytology after LEEP, 40% developed subsequent dysplasia, and the mean time to diagnosis was approximately 6 months. The relative risk of subsequent dysplasia ranged from a 20% increase to twice the risk if post-LEEP cytology was low-grade squamous intraepithelial lesion or high-grade squamous intraepithelial lesion, respectively. Based on these results, consideration should be given for early colposcopic examination of patients who have evidence of marginal involvement or endocervical glandular involvement with dysplasia. These patients are at increased risk for abnormal cytology and recurrent dysplasia. This initial visit should occur at 6 months, as the mean time to recurrence of dysplasia was 6.5 months.

  1. Personality disorder risk factors for suicide attempts over 10 years of follow-up.

    PubMed

    Ansell, Emily B; Wright, Aidan G C; Markowitz, John C; Sanislow, Charles A; Hopwood, Christopher J; Zanarini, Mary C; Yen, Shirley; Pinto, Anthony; McGlashan, Thomas H; Grilo, Carlos M

    2015-04-01

    Identifying personality disorder (PD) risk factors for suicide attempts is an important consideration for research and clinical care alike. However, most prior research has focused on single PDs or categorical PD diagnoses without considering unique influences of different PDs or of severity (sum) of PD criteria on the risk for suicide-related outcomes. This has usually been done with cross-sectional or retrospective assessment methods. Rarely are dimensional models of PDs examined in longitudinal, naturalistic prospective designs. In addition, it is important to consider divergent risk factors in predicting the risk of ever making a suicide attempt versus the risk of making an increasing number of attempts within the same model. This study examined 431 participants who were followed for 10 years in the Collaborative Longitudinal Personality Disorders Study. Baseline assessments of personality disorder criteria were summed as dimensional counts of personality pathology and examined as predictors of suicide attempts reported at annual interviews throughout the 10-year follow-up period. We used univariate and multivariate zero-inflated Poisson regression models to simultaneously evaluate PD risk factors for ever attempting suicide and for increasing numbers of attempts among attempters. Consistent with prior research, borderline PD was uniquely associated with ever attempting. However, only narcissistic PD was uniquely associated with an increasing number of attempts. These findings highlight the relevance of both borderline and narcissistic personality pathology as unique contributors to suicide-related outcomes. (c) 2015 APA, all rights reserved).

  2. Congenital cerebral palsy, child sex and parent cardiovascular risk.

    PubMed

    Streja, Elani; Wu, Chunsen; Uldall, Peter; Grove, Jakob; Arah, Onyebuchi; Olsen, Jørn

    2013-01-01

    Genes associated with cardiovascular disease may also be risk factors for congenital cerebral palsy (CP) and these associations may be modified by sex, since there is an increased risk of CP in male children. We investigated the association between CP of the child with cardiovascular disease in parents, taking sex of the child into consideration. All parents of non-adopted singletons born in Denmark between 1973 and 2003 were included. Parents of a child with CP, confirmed by the Danish National CP registry, were considered exposed. Cox proportional hazards regressions were used to model risk of cardiovascular outcomes for exposed parents compared to all other parents beginning at the child's 10(th) birthday. We identified 733,730 mothers and 666,652 fathers among whom 1,592 and 1,484, respectively, had a child with CP. The mean age for mothers at end of follow up was 50 ± 8 years. After adjustment for maternal age, parental education, child's sex, child's residence, child being small for gestational age and maternal hypertensive disorder during pregnancy, mothers of CP male children had an excess risk of cardiovascular disease (HR: 1.52, 95% CI: 1.16-2.00), attributable mostly to an increased incidence of hypertension and cerebrovascular disease. After additional adjustment for preterm birth, the association was markedly attenuated for cardiovascular disease (1.34, 95%CI: 1.02 - 1.76), became nonsignificant for hypertension, but remained significant for cerebrovascular disease (HR: 2.73, 95% CI: 1.45- 5.12). There was no increased risk of cardiovascular events in mothers of female CP children, or fathers of CP children of any sex. Women that have a male child with CP are at increased risk for premature cardiovascular disease. Part of this association may be related to risk factors for preterm births.

  3. Aircraft, road and railway traffic noise as risk factors for heart failure and hypertensive heart disease-A case-control study based on secondary data.

    PubMed

    Seidler, Andreas; Wagner, Mandy; Schubert, Melanie; Dröge, Patrik; Römer, Karin; Pons-Kühnemann, Jörn; Swart, Enno; Zeeb, Hajo; Hegewald, Janice

    2016-11-01

    Several studies point to an elevated risk for cardiovascular diseases induced by traffic noise. We examined the association between aircraft, road traffic and railway noise and heart failure or hypertensive heart disease (HHD) in a large case-control study. The study population consisted of individuals that were insured by three large statutory health insurance funds in the Rhine-Main area of Germany. Based on insurance claims and prescription data, 104,145 cases of heart failure or HHD diagnosed 2006-10 were identified and compared with 654,172 control subjects. Address-specific exposure to aircraft, road and railway traffic noise in 2005 was estimated. Odds Ratios were calculated using logistic regression analysis, adjusted for age, sex, local proportion of persons receiving unemployment benefits, and individual socioeconomic status (available for 39% of the individuals). A statistically significant linear exposure-risk relationship with heart failure or hypertensive heart disease was found for aircraft traffic noise (1.6% risk increase per 10dB increase in the 24-h continuous noise level; 95% CI 0.3-3.0%), road traffic noise (2.4% per 10dB; 95% CI 1.6-3.2%), and railway noise (3.1% per 10dB; 95% CI 2.2-4.1%). For individuals with 24-h continuous aircraft noise levels <40dB and nightly maximum aircraft noise levels exceeding 50dB six or more times, a significantly increased risk was observed. In general, risks of HHD were considerably higher than the risks of heart failure. Regarding the high prevalence of traffic noise from various sources, even low risk increases for frequent diseases are relevant for the population as a whole. Copyright © 2016 Elsevier GmbH. All rights reserved.

  4. Occupation and malignant lymphoma: a population based case control study in Germany

    PubMed Central

    Mester, B; Nieters, A; Deeg, E; Elsner, G; Becker, N; Seidler, A

    2006-01-01

    Aims To identify occupations suspected to be associated with malignant lymphoma and to generate new hypotheses about occupational risks in a multicentre, population based case control study. Methods Male and female patients with malignant lymphoma (n = 710) aged 18–80 years of age were prospectively recruited in six study regions in Germany. For each newly recruited lymphoma case, a sex, region, and age matched control was drawn from the population registers. Odds ratios and 95% confidence intervals for major occupations and industries were calculated using conditional logistic regression analysis, adjusted for smoking (in pack‐years) and alcohol consumption. Patients with specific lymphoma subentities were additionally compared with the entire control group using unconditional logistic regression analysis. Results The following economic/industrial sectors were positively associated with lymphoma: food products, beverages, tobacco; paper products, publishing and printing; and metals. Chemicals; real estate, renting, and business activities were negatively associated with lymphoma diagnosis. The authors observed an increased overall lymphoma risk among architects; maids; farmers; glass formers; and construction workers. Shoemaking and leather goods making was negatively associated with the lymphoma diagnosis (although based on small numbers). In the occupational group analysis of lymphoma subentities, Hodgkin's lymphoma was significantly associated only with rubber and plastic products making; diffuse large B cell lymphoma risk was considerably increased among metal processors; follicular lymphoma showed highly significant risk increases for several occupational groups (medical, dental, and veterinary workers; sales workers; machinery fitters; and electrical fitters); and multiple myeloma showed a particularly pronounced risk increase for farmers as well as for agriculture and animal husbandry workers. Conclusions The results partly confirm previously defined occupational risks. Occupational risk factors for follicular lymphomas might differ from the overall risk factors for malignant lymphoma. PMID:16361401

  5. Real-time assessment of fog-related crashes using airport weather data: a feasibility analysis.

    PubMed

    Ahmed, Mohamed M; Abdel-Aty, Mohamed; Lee, Jaeyoung; Yu, Rongjie

    2014-11-01

    The effect of reduction of visibility on crash occurrence has recently been a major concern. Although visibility detection systems can help to mitigate the increased hazard of limited-visibility, such systems are not widely implemented and many locations with no systems are experiencing considerable number of fatal crashes due to reduction in visibility caused by fog and inclement weather. On the other hand, airports' weather stations continuously monitor all climate parameters in real-time, and the gathered data may be utilized to mitigate the increased risk for the adjacent roadways. This study aims to examine the viability of using airport weather information in real-time road crash risk assessment in locations with recurrent fog problems. Bayesian logistic regression was utilized to link six years (2005-2010) of historical crash data to real-time weather information collected from eight airports in the State of Florida, roadway characteristics and aggregate traffic parameters. The results from this research indicate that real-time weather data collected from adjacent airports are good predictors to assess increased risk on highways. Copyright © 2014 Elsevier Ltd. All rights reserved.

  6. A new perspective on nonprescription statins: an opportunity for patient education and involvement.

    PubMed

    Fuster, Valentin

    2007-09-01

    Education of the public and encouragement of patients' involvement in their own health care have been repeatedly proved effective means of increasing health awareness, promoting lifestyle modifications, and improving early disease detection in a variety of clinical scenarios. Despite substantial efforts from different public and private organizations to educate the population on cardiovascular risk, coronary heart disease remains the leading cause of death in the United States, and its prevalence continues to grow. Therefore, alternative approaches with the potential to elicit a meaningful impact in the community deserve consideration. A nonprescription statin program could provide consumers with a tool of proved benefit in cardiovascular risk prevention. The magnitude of the target population (millions of subjects with intermediate to high risk), as well as the safety and efficacy profile of lovastatin 20 mg, support the consideration of this drug for "over-the-counter" availability. Moreover, a nonprescription statin program could represent a unique opportunity not only to enhance patients' involvement in primary prevention but also to reinforce the education of the public and to encourage interaction with health care providers. The success of such a program will undoubtedly require precise labeling of the risks and benefits of the therapy, as well as active support and participation from major medical organizations. In conclusion, nonprescription statin availability, through enhanced unique patients' involvement, offers the potential for enormous public health benefit.

  7. Bleeding complications after endovascular therapy of cerebral arteriovenous malformations.

    PubMed

    Heidenreich, J O; Hartlieb, S; Stendel, R; Pietilä, T A; Schlattmann, P; Wolf, K-J; Schilling, A M

    2006-02-01

    Intracerebral hemorrhages after embolization of arteriovenous malformations (AVMs) are the most dreaded complications of this well-established therapy. Apart from the known risk factors, our center noticed a high incidence of complications during postinterventional monitoring in medical intensive care units (ICUs) and stroke units. We report 125 consecutive interventions performed on 66 patients by using flow-dependent microcatheters and n-butyl cyanoacrylate as the embolic agent. Postinterventional intensive care monitoring was performed in an interdisciplinary operative ICU, a stroke unit, or a medical ICU. Patients were compared with regard to bleeding complications, AVM morphology, embolization result, postinterventional monitoring, and demographic factors. Intracerebral hemorrhages occurred in 7 patients. Significant differences in outcome were found between 66 patients monitored in the interdisciplinary operative ICU from medical ICU or stroke unit. This was also true when adjusted for age and extent of AVM reduction by using exact logistic regression. A partial AVM reduction of >60% was a considerable risk factor for hemorrhage (odds ratio [OR] = 18.8; 95% confidence interval [CI] [1.341, not available]. Age was also an essential risk factor. An age difference of 10 years leads to an OR of 2.545 (95% CI [1.56, 7.35]). A considerable AVM reduction in one session appears to increase the risk of hemorrhage technically. This suggests a distribution of the interventions in many partial steps.

  8. Risk Factors and Therapeutic Targets in Pancreatic Cancer

    PubMed Central

    Wörmann, Sonja Maria; Algül, Hana

    2013-01-01

    Pancreatic cancer (PC) is one of the most challenging tumor entities worldwide, characterized as a highly aggressive disease with dismal overall prognosis and an incidence rate equalling mortality rate. Over the last decade, substantial progress has been made to define the morphological changes and key genetic events in pancreatic carcinogenesis. And yet, it is still unclear what factors trigger PC. Some risk factors appear to be associated with sex, age, race/ethnicity, or other rare genetic conditions. Additionally, modifying factors such as smoking, obesity, diabetes, occupational risk factors, etc., increase the potential for acquiring genetic mutations that may result in PC. Another hallmark of PC is its poor response to radio- and chemo-therapy. Current chemotherapeutic regimens could not provide substantial survival benefit with a clear increase in overall survival. Recently, several new approaches to significantly improve the clinical outcome of PC have been described involving downstream signaling cascades desmoplasia and stromal response as well as tumor microenvironment, immune response, vasculature, and angiogenesis. This review summarizes major risk factors for PC and tries to illuminate relevant targets considerable for new therapeutic approaches. PMID:24303367

  9. Sources of uncertanity as a basis to fill the information gap in a response to flood

    NASA Astrophysics Data System (ADS)

    Kekez, Toni; Knezic, Snjezana

    2016-04-01

    Taking into account uncertainties in flood risk management remains a challenge due to difficulties in choosing adequate structural and/or non-structural risk management options. Despite stated measures wrong decisions are often being made when flood occurs. Parameter and structural uncertainties which include model and observation errors as well as lack of knowledge about system characteristics are the main considerations. Real time flood risk assessment methods are predominantly based on measured water level values and vulnerability as well as other relevant characteristics of flood affected area. The goal of this research is to identify sources of uncertainties and to minimize information gap between the point where the water level is measured and the affected area, taking into consideration main uncertainties that can affect risk value at the observed point or section of the river. Sources of uncertainties are identified and determined using system analysis approach and relevant uncertainties are included in the risk assessment model. With such methodological approach it is possible to increase response time with more effective risk assessment which includes uncertainty propagation model. Response phase could be better planned with adequate early warning systems resulting in more time and less costs to help affected areas and save human lives. Reliable and precise information is necessary to raise emergency operability level in order to enhance safety of citizens and reducing possible damage. The results of the EPISECC (EU funded FP7) project are used to validate potential benefits of this research in order to improve flood risk management and response methods. EPISECC aims at developing a concept of a common European Information Space for disaster response which, among other disasters, considers the floods.

  10. The influence of deprivation on malnutrition risk in outpatients with chronic obstructive pulmonary disease (COPD).

    PubMed

    Collins, P F; Elia, M; Kurukulaaratchy, R J; Stratton, R J

    2018-02-01

    The social gradient in chronic obstructive pulmonary disease (COPD) is considerable, but the influence of deprivation on common clinical risk factors such as malnutrition is unclear. This study aimed to explore the relationship between COPD disease-severity, deprivation and malnutrition. 424 outpatients with a confirmed diagnosis of COPD were routinely screened for malnutrition risk using the 'Malnutrition Universal Screening Tool' ('MUST') while attending respiratory clinics across two hospitals; a large city hospital (site A) and a smaller community hospital (site B). Deprivation was assessed for each outpatient according to their address (postcode) using the English governments' index of multiple deprivation (IMD) and related to malnutrition risk. Each postcode was attributed to both an IMD score and IMD rank, where a higher IMD score and a lower IMD ranking indicated increased deprivation. Overall prevalence of malnutrition was 22% (95% CI 18-26%; 9% medium risk, 13% high risk). It was significantly higher at site A (28% vs 17%; p = 0.004) where patients were also significantly more likely to reside in areas of more deprivation than those at site B (IMD rank: 15,510 SD 8137 vs 22,877 SD 6827; p < 0.001). COPD disease-severity was positively associated with malnutrition (p < 0.001) whilst a higher rank IMD was negatively associated with malnutrition (p = 0.014). Deprivation is a significant independent risk factor for malnutrition in outpatients with COPD. Consideration of deprivation is important in the identification of malnutrition and the nutritional management of patients with COPD. Crown Copyright © 2016. Published by Elsevier Ltd. All rights reserved.

  11. Subtypes of Native American ancestry and leading causes of death: Mapuche ancestry-specific associations with gallbladder cancer risk in Chile

    PubMed Central

    González Silos, Rosa; Marcelain, Katherine; Baez Benavides, Pablo; Barahona Ponce, Carol; Fischer, Christine; Peil, Barbara; Sinsheimer, Janet; Barajas, Olga; Gonzalez-Jose, Rolando; Cátira Bortolini, Maria; Canizales-Quinteros, Samuel; Gallo, Carla; Ruiz Linares, Andres; Rothhammer, Francisco

    2017-01-01

    Latin Americans are highly heterogeneous regarding the type of Native American ancestry. Consideration of specific associations with common diseases may lead to substantial advances in unraveling of disease etiology and disease prevention. Here we investigate possible associations between the type of Native American ancestry and leading causes of death. After an aggregate-data study based on genome-wide genotype data from 1805 admixed Chileans and 639,789 deaths, we validate an identified association with gallbladder cancer relying on individual data from 64 gallbladder cancer patients, with and without a family history, and 170 healthy controls. Native American proportions were markedly underestimated when the two main types of Native American ancestry in Chile, originated from the Mapuche and Aymara indigenous peoples, were combined together. Consideration of the type of Native American ancestry was crucial to identify disease associations. Native American ancestry showed no association with gallbladder cancer mortality (P = 0.26). By contrast, each 1% increase in the Mapuche proportion represented a 3.7% increased mortality risk by gallbladder cancer (95%CI 3.1–4.3%, P = 6×10−27). Individual-data results and extensive sensitivity analyses confirmed the association between Mapuche ancestry and gallbladder cancer. Increasing Mapuche proportions were also associated with an increased mortality due to asthma and, interestingly, with a decreased mortality by diabetes. The mortality due to skin, bladder, larynx, bronchus and lung cancers increased with increasing Aymara proportions. Described methods should be considered in future studies on human population genetics and human health. Complementary individual-based studies are needed to apportion the genetic and non-genetic components of associations identified relying on aggregate-data. PMID:28542165

  12. Subtypes of Native American ancestry and leading causes of death: Mapuche ancestry-specific associations with gallbladder cancer risk in Chile.

    PubMed

    Lorenzo Bermejo, Justo; Boekstegers, Felix; González Silos, Rosa; Marcelain, Katherine; Baez Benavides, Pablo; Barahona Ponce, Carol; Müller, Bettina; Ferreccio, Catterina; Koshiol, Jill; Fischer, Christine; Peil, Barbara; Sinsheimer, Janet; Fuentes Guajardo, Macarena; Barajas, Olga; Gonzalez-Jose, Rolando; Bedoya, Gabriel; Cátira Bortolini, Maria; Canizales-Quinteros, Samuel; Gallo, Carla; Ruiz Linares, Andres; Rothhammer, Francisco

    2017-05-01

    Latin Americans are highly heterogeneous regarding the type of Native American ancestry. Consideration of specific associations with common diseases may lead to substantial advances in unraveling of disease etiology and disease prevention. Here we investigate possible associations between the type of Native American ancestry and leading causes of death. After an aggregate-data study based on genome-wide genotype data from 1805 admixed Chileans and 639,789 deaths, we validate an identified association with gallbladder cancer relying on individual data from 64 gallbladder cancer patients, with and without a family history, and 170 healthy controls. Native American proportions were markedly underestimated when the two main types of Native American ancestry in Chile, originated from the Mapuche and Aymara indigenous peoples, were combined together. Consideration of the type of Native American ancestry was crucial to identify disease associations. Native American ancestry showed no association with gallbladder cancer mortality (P = 0.26). By contrast, each 1% increase in the Mapuche proportion represented a 3.7% increased mortality risk by gallbladder cancer (95%CI 3.1-4.3%, P = 6×10-27). Individual-data results and extensive sensitivity analyses confirmed the association between Mapuche ancestry and gallbladder cancer. Increasing Mapuche proportions were also associated with an increased mortality due to asthma and, interestingly, with a decreased mortality by diabetes. The mortality due to skin, bladder, larynx, bronchus and lung cancers increased with increasing Aymara proportions. Described methods should be considered in future studies on human population genetics and human health. Complementary individual-based studies are needed to apportion the genetic and non-genetic components of associations identified relying on aggregate-data.

  13. Ecological and Human Health Risk Assessment Guidance for Aquatic Environments

    DTIC Science & Technology

    1999-12-01

    been reported to considerably increase tissue cadmium levels (Agency for Toxic Substances and Disease Registry (ATSDR 1992)). Nonoccupational...inhalation, cadmium is distributed to most tissues of the body. Initially, highest levels are found in the liver. Later, relocation occurs and highest...concentrations appear in the renal cortex (ATSDR 1992). In a study exposing rats daily to cadmium fumes, the distribution of Cd in the tissue was

  14. Computer systems to support census geography.

    PubMed

    Deecker, G; Cunningham, R; Kidd, K

    1986-01-01

    The development of computer systems that support the geography of the census in Canada is described. The authors "present proposals for the 1991 Census that increase the level of automation, whether the geography changes or not. In addition, opportunities for change and improvement, should the geography change, are outlined. To minimize the risks involved, it is important to give these different proposals serious consideration early in the planning of a census." excerpt

  15. The Medicare bundled payment pilot program participation considerations.

    PubMed

    Pearce, Jonathan W; Harris, John M

    2010-09-01

    The Medicare bundled payment pilot program is scheduled to begin in January 2013 and will run for five years. The program holds the promise of increased alignment between hospitals and physicians, presenting opportunities for hospital cost reduction and improvements in quality. Nonetheless, the program carries fixed costs and assumption of risks that hospitals need to evaluate as they deliberate over whether to seek to participate in the program.

  16. Improving treatment in Hispanic/Latino patients.

    PubMed

    Cersosimo, Eugenio; Musi, Nicolas

    2011-10-01

    The prevalence of type 2 diabetes mellitus is higher in Hispanic/Latino individuals living in the United States compared with their non-Hispanic white counterparts. Many factors contribute to the increased prevalence of type 2 diabetes, including biological characteristics, socioeconomic conditions, and cultural aspects. The contribution of genetics to the risk of type 2 diabetes in Hispanic/Latino patients is becoming increasingly clear, but this inherent risk factor cannot be modified. However, certain socioeconomic and cultural factors, such as reduced access to healthcare, language barriers, cultural beliefs, and lack of cultural competence by the healthcare provider, are modifiable and should be overcome in order to improve the management of type 2 diabetes in Hispanic/Latino patients. At the healthcare system level, policies should be put into place to reduce disparities between Hispanics/Latinos and non-Hispanic whites regarding health insurance coverage and access to healthcare. At the healthcare provider and patient level, cultural beliefs should be taken into consideration when selecting adequate treatment. Overall, type 2 diabetes management should be individualized by identifying the preferred language and level of acculturation for each patient. These considerations are necessary to further improve communication through culturally appropriate educational materials and programs. These strategies may help to overcome the barriers in the treatment of type 2 diabetes in Hispanic/Latino patients. Copyright © 2011 Elsevier Inc. All rights reserved.

  17. Promoting pro-environmental action in climate change deniers

    NASA Astrophysics Data System (ADS)

    Bain, Paul G.; Hornsey, Matthew J.; Bongiorno, Renata; Jeffries, Carla

    2012-08-01

    A sizeable (and growing) proportion of the public in Western democracies deny the existence of anthropogenic climate change. It is commonly assumed that convincing deniers that climate change is real is necessary for them to act pro-environmentally. However, the likelihood of `conversion' using scientific evidence is limited because these attitudes increasingly reflect ideological positions. An alternative approach is to identify outcomes of mitigation efforts that deniers find important. People have strong interests in the welfare of their society, so deniers may act in ways supporting mitigation efforts where they believe these efforts will have positive societal effects. In Study 1, climate change deniers (N=155) intended to act more pro-environmentally where they thought climate change action would create a society where people are more considerate and caring, and where there is greater economic/technological development. Study 2 (N=347) replicated this experimentally, showing that framing climate change action as increasing consideration for others, or improving economic/technological development, led to greater pro-environmental action intentions than a frame emphasizing avoiding the risks of climate change. To motivate deniers' pro-environmental actions, communication should focus on how mitigation efforts can promote a better society, rather than focusing on the reality of climate change and averting its risks.

  18. Cancer incidence in men with Klinefelter syndrome.

    PubMed Central

    Hasle, H.; Mellemgaard, A.; Nielsen, J.; Hansen, J.

    1995-01-01

    Many case reports have suggested an association between Klinefelter syndrome (KS) and cancer, but studies of the cancer incidence in larger groups of men with KS are lacking. A cohort of 696 men with KS was established from the Danish Cytogenetic Register. Information on the cancer incidence in the cohort was obtained from the Danish Cancer Registry and compared with the expected number calculated from the age, period and site specific cancer rates for Danish men. A total of 39 neoplasms were diagnosed (relative risk = 1.1). Four mediastinal tumours were observed (relative risk = 67); all four were malignant germ cell tumours. No cases of breast cancer or testis cancer were observed. One case of prostate cancer occurred within a previously irradiated field. No excess of leukaemia or lymphoma was found. An increased risk of cancer occurred in the age group 15-30 years (relative risk = 2.7). All six tumours in this group were germ cell tumours or sarcomas. The overall cancer incidence is not increased and no routine cancer screening seems to be justified. A considerably elevated risk of mediastinal germ cell tumours occurs in the period from early adolescence until the age of 30. PMID:7841064

  19. The urban environment and sexual risk behavior among men who have sex with men.

    PubMed

    Frye, Victoria; Latka, Mary H; Koblin, Beryl; Halkitis, Perry N; Putnam, Sara; Galea, Sandro; Vlahov, David

    2006-03-01

    Increasingly, studies show that characteristics of the urban environment influence a wide variety of health behaviors and disease outcomes, yet few studies have focused on the sexual risk behaviors of men who have sex with men (MSM). This focus is important as many gay men reside in or move to urban areas, and sexual risk behaviors and associated outcomes have increased among some urban MSM in recent years. As interventions aimed at changing individual-level risk behaviors have shown mainly short-term effects, consideration of broader environmental influences is needed. Previous efforts to assess the influence of environmental characteristics on sexual behaviors and related health outcomes among the general population have generally applied three theories as explanatory models: physical disorder, social disorganization and social norms theories. In these models, the intervening mechanisms specified to link environmental characteristics to individual-level outcomes include stress, collective efficacy, and social influence processes, respectively. Whether these models can be empirically supported in generating inferences about the sexual behavior of urban MSM is underdeveloped. Conceptualizing sexual risk among MSM to include social and physical environmental characteristics provides a basis for generating novel and holistic disease prevention and health promotion interventions.

  20. Birth order and risk of non-hodgkin lymphoma--true association or bias?

    PubMed

    Grulich, Andrew E; Vajdic, Claire M; Falster, Michael O; Kane, Eleanor; Smedby, Karin Ekstrom; Bracci, Paige M; de Sanjose, Silvia; Becker, Nikolaus; Turner, Jenny; Martinez-Maza, Otoniel; Melbye, Mads; Engels, Eric A; Vineis, Paolo; Costantini, Adele Seniori; Holly, Elizabeth A; Spinelli, John J; La Vecchia, Carlo; Zheng, Tongzhang; Chiu, Brian C H; Franceschi, Silvia; Cocco, Pierluigi; Maynadié, Marc; Foretova, Lenka; Staines, Anthony; Brennan, Paul; Davis, Scott; Severson, Richard K; Cerhan, James R; Breen, Elizabeth C; Birmann, Brenda; Cozen, Wendy

    2010-09-15

    There is inconsistent evidence that increasing birth order may be associated with risk of non-Hodgkin lymphoma (NHL). The authors examined the association between birth order and related variables and NHL risk in a pooled analysis (1983-2005) of 13,535 cases and 16,427 controls from 18 case-control studies within the International Lymphoma Epidemiology Consortium (InterLymph). Overall, the authors found no significant association between increasing birth order and risk of NHL (P-trend = 0.082) and significant heterogeneity. However, a significant association was present for a number of B- and T-cell NHL subtypes. There was considerable variation in the study-specific risks which was partly explained by study design and participant characteristics. In particular, a significant positive association was present in population-based studies, which had lower response rates in cases and controls, but not in hospital-based studies. A significant positive association was present in higher-socioeconomic-status (SES) participants only. Results were very similar for the related variable of sibship size. The known correlation of high birth order with low SES suggests that selection bias related to SES may be responsible for the association between birth order and NHL.

  1. Atherosclerosis in epilepsy: its causes and implications.

    PubMed

    Hamed, Sherifa A

    2014-12-01

    Evidence from epidemiological, longitudinal, prospective, double-blinded clinical trials as well as case reports documents age-accelerated atherosclerosis with increased carotid artery intima media thickness (CA-IMT) in patients with epilepsy. These findings raise concern regarding their implications for age-accelerated cognitive and behavioral changes in midlife and risk of later age-related cognitive disorders including neurodegenerative processes such as Alzheimer's disease (AD). Chronic epilepsy, cerebral atherosclerosis, and age-related cognitive disorders including AD share many clinical manifestations (e.g. characteristic cognitive deficits), risk factors, and structural and pathological brain abnormalities. These shared risk factors include increased CA-IMT, hyperhomocysteinemia (HHcy), lipid abnormalities, weight gain and obesity, insulin resistance (IR), and high levels of inflammatory and oxidative stresses. The resulting brain structural and pathological abnormalities include decreased volume of the hippocampus, increased cortical thinning of the frontal lobe, ventricular expansion and increased white matter ischemic disease, total brain atrophy, and β-amyloid protein deposition in the brain. The knowledge that age-accelerated atherosclerosis may contribute to age-accelerated cognitive and behavioral abnormalities and structural brain pathologies in patients with chronic epilepsy represents an important research path to pursue future clinical and management considerations. Copyright © 2014 Elsevier Inc. All rights reserved.

  2. Global risk of deadly heat

    NASA Astrophysics Data System (ADS)

    Mora, Camilo; Dousset, Bénédicte; Caldwell, Iain R.; Powell, Farrah E.; Geronimo, Rollan C.; Bielecki, Coral R.; Counsell, Chelsie W. W.; Dietrich, Bonnie S.; Johnston, Emily T.; Louis, Leo V.; Lucas, Matthew P.; McKenzie, Marie M.; Shea, Alessandra G.; Tseng, Han; Giambelluca, Thomas W.; Leon, Lisa R.; Hawkins, Ed; Trauernicht, Clay

    2017-07-01

    Climate change can increase the risk of conditions that exceed human thermoregulatory capacity. Although numerous studies report increased mortality associated with extreme heat events, quantifying the global risk of heat-related mortality remains challenging due to a lack of comparable data on heat-related deaths. Here we conducted a global analysis of documented lethal heat events to identify the climatic conditions associated with human death and then quantified the current and projected occurrence of such deadly climatic conditions worldwide. We reviewed papers published between 1980 and 2014, and found 783 cases of excess human mortality associated with heat from 164 cities in 36 countries. Based on the climatic conditions of those lethal heat events, we identified a global threshold beyond which daily mean surface air temperature and relative humidity become deadly. Around 30% of the world's population is currently exposed to climatic conditions exceeding this deadly threshold for at least 20 days a year. By 2100, this percentage is projected to increase to ~48% under a scenario with drastic reductions of greenhouse gas emissions and ~74% under a scenario of growing emissions. An increasing threat to human life from excess heat now seems almost inevitable, but will be greatly aggravated if greenhouse gases are not considerably reduced.

  3. Practice considerations in providing cancer risk assessment and genetic testing in women's health.

    PubMed

    Mahon, Suzanne M; Crecelius, Mary E

    2013-01-01

    Providers of women's health services are often confronted with questions about cancer genetic testing. The provision of these services is complex. The process begins with accurate risk assessment and identification of individuals who might benefit from genetic testing services. There are practice, administrative, legal, and ethical considerations that should be considered when developing policies for the referral of at-risk individuals or before deciding to provide genetic services. © 2013 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.

  4. Mode of action human relevance (species concordance) framework: Evolution of the Bradford Hill considerations and comparative analysis of weight of evidence

    PubMed Central

    Meek, M E (Bette); Palermo, Christine M; Bachman, Ammie N; North, Colin M; Jeffrey Lewis, R

    2014-01-01

    The mode of action human relevance (MOA/HR) framework increases transparency in systematically considering data on MOA for end (adverse) effects and their relevance to humans. This framework continues to evolve as experience increases in its application. Though the MOA/HR framework is not designed to address the question of “how much information is enough” to support a hypothesized MOA in animals or its relevance to humans, its organizing construct has potential value in considering relative weight of evidence (WOE) among different cases and hypothesized MOA(s). This context is explored based on MOA analyses in published assessments to illustrate the relative extent of supporting data and their implications for dose–response analysis and involved comparisons for chemical assessments on trichloropropane, and carbon tetrachloride with several hypothesized MOA(s) for cancer. The WOE for each hypothesized MOA was summarized in narrative tables based on comparison and contrast of the extent and nature of the supporting database versus potentially inconsistent or missing information. The comparison was based on evolved Bradford Hill considerations rank ordered to reflect their relative contribution to WOE determinations of MOA taking into account increasing experience in their application internationally. This clarification of considerations for WOE determinations as a basis for comparative analysis is anticipated to contribute to increasing consistency in the application of MOA/HR analysis and potentially, transparency in separating science judgment from public policy considerations in regulatory risk assessment. Copyright © 2014. The Authors. Journal of Applied Toxicology Published by John Wiley & Sons Ltd. The potential value of the mode of action (MOA)/human relevance (species concordance) framework in considering relative weight of evidence (WOE) amongst different cases and hypothesized MOA(s) is explored based on the content of several published assessments. The comparison is based on evolved Bradford Hill considerations rank ordered to reflect their relative contribution to WOE determinations for MOA based on experience internationally. PMID:24777878

  5. Assessment, Planning, and Execution Considerations for Conjunction Risk Assessment and Mitigation Operations

    NASA Technical Reports Server (NTRS)

    Frigm, Ryan C.; Levi, Joshua A.; Mantziaras, Dimitrios C.

    2010-01-01

    An operational Conjunction Assessment Risk Analysis (CARA) concept is the real-time process of assessing risk posed by close approaches and reacting to those risks if necessary. The most effective way to completely mitigate conjunction risk is to perform an avoidance maneuver. The NASA Goddard Space Flight Center has implemented a routine CARA process since 2005. Over this period, considerable experience has been gained and many lessons have been learned. This paper identifies and presents these experiences as general concepts in the description of the Conjunction Assessment, Flight Dynamics, and Flight Operations methodologies and processes. These general concepts will be tied together and will be exemplified through a case study of an actual high risk conjunction event for the Aura mission.

  6. Increasing ENSO-Driven Drought and Wildfire Risks in a Warming Climate

    NASA Astrophysics Data System (ADS)

    Fasullo, J.; Otto-Bliesner, B. L.; Stevenson, S.

    2015-12-01

    ENSO-related teleconnections occurring in the transient climate states of the 20th and 21st centuries are examined using the NCAR CESM1-CAM5 Large Ensemble (LE). A focus is given to quantifying the changing nature of related variability in a warming climate, the statistical robustness of which is enhanced by the numerous members of the LE (presently ~40). It is found that while the dynamical components of ENSO's teleconnections weaken considerably in a warming world, associated variability over land is in many cases sustained by changes in the background state, such as for rainfall due to the background rise in specific humidity. In some fields, particularly those associated with associated with thermal stress (e.g. drought and wildfire), ENSO-related variance increases dramatically. This, combined with the fact that ENSO variance itself increases in a warming climate in the LE, contributes to dramatic projected increases in ENSO-driven drought and wildfire risks in a warming world.

  7. Stress fractures about the tibia, foot, and ankle.

    PubMed

    Shindle, Michael K; Endo, Yoshimi; Warren, Russell F; Lane, Joseph M; Helfet, David L; Schwartz, Elliott N; Ellis, Scott J

    2012-03-01

    In competitive athletes, stress fractures of the tibia, foot, and ankle are common and lead to considerable delay in return to play. Factors such as bone vascularity, training regimen, and equipment can increase the risk of stress fracture. Management is based on the fracture site. In some athletes, metabolic workup and medication are warranted. High-risk fractures, including those of the anterior tibial diaphysis, navicular, proximal fifth metatarsal, and medial malleolus, present management challenges and may require surgery, especially in high-level athletes who need to return to play quickly. Noninvasive treatment modalities such as pulsed ultrasound and extracorporeal shock wave therapy may have some benefit but require additional research.

  8. Transfer of risk: "right to sue" legislation and managed care organization stock performance.

    PubMed

    Weeks, W B; Nells, T; Wallace, A E

    2001-01-01

    We examined whether Congress's consideration of legislation that gave consumers the right to sue managed care organizations impacted the performance of these companies' stocks relative to that of the market. For each company examined, the total return related to such legislation was negative and substantially lower than that expected from the market model; losses in market value were from 17 percent to 48 percent for individual companies and 22 percent for a capitalization-weighted portfolio. The study suggests that equity markets responded to the proposed legislation quickly and that the impact of proposed legislation is felt through loss of market value and increased corporate risk.

  9. Diabetic foot ulcers: Part II. Management.

    PubMed

    Alavi, Afsaneh; Sibbald, R Gary; Mayer, Dieter; Goodman, Laurie; Botros, Mariam; Armstrong, David G; Woo, Kevin; Boeni, Thomas; Ayello, Elizabeth A; Kirsner, Robert S

    2014-01-01

    The management of diabetic foot ulcers can be optimized by using an interdisciplinary team approach addressing the correctable risk factors (ie, poor vascular supply, infection control and treatment, and plantar pressure redistribution) along with optimizing local wound care. Dermatologists can initiate diabetic foot care. The first step is recognizing that a loss of skin integrity (ie, a callus, blister, or ulcer) considerably increases the risk of preventable amputations. A holistic approach to wound assessment is required. Early detection and effective management of these ulcers can reduce complications, including preventable amputations and possible mortality. Copyright © 2013 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.

  10. Perceptions of health risks of cigarette smoking: A new measure reveals widespread misunderstanding

    PubMed Central

    Krosnick, Jon A.; Malhotra, Neil; Bruera, Eduardo F.; Chang, LinChiat; Pasek, Josh; Thomas, Randall K.

    2017-01-01

    Most Americans recognize that smoking causes serious diseases, yet many Americans continue to smoke. One possible explanation for this paradox is that perhaps Americans do not accurately perceive the extent to which smoking increases the probability of adverse health outcomes. This paper examines the accuracy of Americans’ perceptions of the absolute risk, attributable risk, and relative risk of lung cancer, and assesses which of these beliefs drive Americans’ smoking behavior. Using data from three national surveys, statistical analyses were performed by comparing means, medians, and distributions, and by employing Generalized Additive Models. Perceptions of relative risk were associated as expected with smoking onset and smoking cessation, whereas perceptions of absolute risk and attributable risk were not. Additionally, the relation of relative risk with smoking status was stronger among people who held their risk perceptions with more certainty. Most current smokers, former smokers, and never-smokers considerably underestimated the relative risk of smoking. If, as this paper suggests, people naturally think about the health consequences of smoking in terms of relative risk, smoking rates might be reduced if public understanding of the relative risks of smoking were more accurate and people held those beliefs with more confidence. PMID:28806420

  11. Impact of a Computerized Antithrombotic Risk Assessment Tool on the Prescription of Thromboprophylaxis in Atrial Fibrillation: Hospital Setting.

    PubMed

    Pandya, E; Masood, N; Wang, Y; Krass, I; Bajorek, B

    2018-01-01

    The computerized antithrombotic risk assessment tool (CARAT) is an online decision-support algorithm that facilitates a systematic review of a patient's stroke risk, bleeding risk, and pertinent medication safety considerations, to generate an individualized treatment recommendation. The CARAT was prospectively applied across 2 hospitals in the greater Sydney area. Its impact on antithrombotics utilization for thromboprophylaxis in patients with nonvalvular atrial fibrillation was evaluated. Factors influencing prescribers' treatment selection were identified. The CARAT recommended a change in baseline therapy for 51.8% of patients. Among anticoagulant-eligible patients (ie, where the risk of stroke outweighed the risk of bleeding) using "nil therapy" or antiplatelet therapy at baseline, the CARAT recommended an upgrade to warfarin in 60 (30.8%) patients. For those in whom the bleeding risk outweighed the stroke risk, the CARAT recommended a downgrade from warfarin to safer alternatives (eg, aspirin) in 37 (19%) patients. Among the "most eligible" (ie, high stroke risk, low bleeding risk, no contraindications; n = 75), the CARAT recommended warfarin for all cases. Discharge therapy observed a marginal increase in anticoagulation prescription in eligible patients (n = 116; 57.8% vs 64.7%, P = .35) compared to baseline. Predictors of warfarin use (vs antiplatelets) included congestive cardiac failure, diabetes mellitus, and polypharmacy. The CARAT was able to optimize the selection of therapy, increasing anticoagulant use among eligible patients. With the increasing complexity of decision-making, such tools may be useful adjuncts in therapy selection in atrial fibrillation. Future studies should explore the utility of such tools in selecting therapies from within an expanded treatment armamentarium comprising the non-vitamin K antagonist oral anticoagulants.

  12. Breast cancer and circadian disruption from electric lighting in the modern world.

    PubMed

    Stevens, Richard G; Brainard, George C; Blask, David E; Lockley, Steven W; Motta, Mario E

    2014-01-01

    Breast cancer is the leading cause of cancer death among women worldwide, and there is only a limited explanation of why. Risk is highest in the most industrialized countries but also is rising rapidly in the developing world. Known risk factors account for only a portion of the incidence in the high-risk populations, and there has been considerable speculation and many false leads on other possibly major determinants of risk, such as dietary fat. A hallmark of industrialization is the increasing use of electricity to light the night, both within the home and without. It has only recently become clear that this evolutionarily new and, thereby, unnatural exposure can disrupt human circadian rhythmicity, of which three salient features are melatonin production, sleep, and the circadian clock. A convergence of research in cells, rodents, and humans suggests that the health consequences of circadian disruption may be substantial. An innovative experimental model has shown that light at night markedly increases the growth of human breast cancer xenografts in rats. In humans, the theory that light exposure at night increases breast cancer risk leads to specific predictions that are being tested epidemiologically: evidence has accumulated on risk in shift workers, risk in blind women, and the impact of sleep duration on risk. If electric light at night does explain a portion of the breast cancer burden, then there are practical interventions that can be implemented, including more selective use of light and the adoption of recent advances in lighting technology and application. © 2013 American Cancer Society, Inc.

  13. Effects of oestrogens and anti-oestrogens on normal breast tissue from women bearing BRCA1 and BRCA2 mutations

    PubMed Central

    Bramley, M; Clarke, R B; Howell, A; Evans, D G R; Armer, T; Baildam, A D; Anderson, E

    2006-01-01

    There is considerable interest in whether anti-oestrogens can be used to prevent breast cancer in women bearing mutations in the BRCA1 and BRCA2 genes. The effects of oestradiol (E2), tamoxifen (TAM) and fulvestrant (FUL) on proliferation and steroid receptor expression were assessed in normal breast epithelium taken from women at varying risks of breast cancer and implanted into athymic nude mice, which were treated with E2 in the presence and absence of TAM or FUL. Tissue samples were taken at various time points thereafter for assessment of proliferative activity and expression of oestrogen and progesterone receptors (ERα and PgR) by immunohistochemistry. Oestradiol increased proliferation in the breast epithelium from women carrying mutations in the BRCA1/2 genes, those otherwise at increased risk and those at population risk of breast cancer. This increase was reduced by both TAM and FUL in all risk groups. In the absence of E2, PgR expression was reduced in all risk groups but significantly more so in the BRCA-mutated groups. Subsequent E2 treatment caused a rapid, complete induction of PgR expression in the population-risk group but not in the high-risk or BRCA-mutated groups in which PgR induction was significantly delayed. These data suggest that the mechanisms by which E2 induces breast epithelial PgR expression are impaired in BRCA1/2 mutation carriers, whereas those regulating proliferation remain intact. We conclude that early anti-oestrogen treatment should prevent breast cancer in very high-risk women. PMID:16538216

  14. Drawing the line on the sand

    NASA Astrophysics Data System (ADS)

    Ranasinghe, R.; Jongejan, R.; Wainwright, D.; Callaghan, D. P.

    2016-02-01

    Up to 70% of the world's sandy coastlines are eroding, resulting in gradual and continuous coastline recession. The rate of coastline recession is likely to increase due to the projected impacts of climate change on mean sea levels, offshore wave climate and storm surges. At the same time, rapid development in the world's coastal zones continues to increase potential damages, while often reducing the resilience of coastal systems. The risks associated with coastline recession are thus likely to increase over the coming decades, unless effective risk management plans are put in place. Land-use restrictions are a key component of coastal zone risk management plans. These involve the use of coastal setback lines which are mainly established by linearly adding the impacts of storms, recession due to sea level rise, and ambient long term trends in shoreline evolution. This approach does not differentiate between uncertainties that develop differently over time, nor takes into account the value and lifetime of property developments. Both shortcomings could entail considerable social cost. For balancing risk and reward, probabilistic estimates of coastline recession are a pre-requisite. Yet the presently adopted deterministic methods for establishing setback lines are unable to provide such estimates. Here, we present a quantitative risk analysis (QRA) model, underpinned by a multi-scale, physics based coastal recession model capable of providing time-dependent risk estimates. The modelling approach presented enables the determination of setback lines in terms of exceedance probabilities, a quantity that directly feeds into risk evaluations and economic optimizations. As a demonstration, the risk-informed approach is applied to Narrabeen beach, Sydney, Australia.

  15. Dose limits for astronauts

    NASA Technical Reports Server (NTRS)

    Sinclair, W. K.

    2000-01-01

    Radiation exposures to individuals in space can greatly exceed natural radiation exposure on Earth and possibly normal occupational radiation exposures as well. Consequently, procedures limiting exposures would be necessary. Limitations were proposed by the Radiobiological Advisory Panel of the National Academy of Sciences/National Research Council in 1970. This panel recommended short-term limits to avoid deterministic effects and a single career limit (of 4 Sv) based on a doubling of the cancer risk in men aged 35 to 55. Later, when risk estimates for cancer had increased and were recognized to be age and sex dependent, the NCRP, in Report No. 98 in 1989, recommended a range of career limits based on age and sex from 1 to 4 Sv. NCRP is again in the process of revising recommendations for astronaut exposure, partly because risk estimates have increased further and partly to recognize trends in limiting radiation exposure occupationally on the ground. The result of these considerations is likely to be similar short-term limits for deterministic effects but modified career limits.

  16. Relations of Behavioral Autonomy to Health Outcomes Among Emerging Adults With and Without Type 1 Diabetes

    PubMed Central

    Reynolds, Kerry A.; Becker, Dorothy; Escobar, Oscar; Siminerio, Linda

    2014-01-01

    Objective To examine the relation of behavioral autonomy to psychological, behavioral, and physical health among emerging adults with and without type 1 diabetes. Methods High school seniors with (n = 118) and without type 1 diabetes (n = 122) completed online questionnaires for three consecutive years. Behavioral autonomy, psychological health, risk behaviors, and diabetes outcomes were assessed. Regression analyses were conducted to predict Time 2 and 3 outcomes, controlling for Time 1 outcomes. Results There were no group differences in behavioral autonomy. Behavioral autonomy predicted better psychological health but only for emerging adults without diabetes. Behavioral autonomy was related to increased risk behavior for both groups. Behavioral autonomy was unrelated to self-care but predicted better glycemic control for females. Conclusions Behavioral autonomy may be beneficial for psychological health, but is related to increased risk behavior. The implications of behavioral autonomy for emerging adults with type 1 diabetes require careful consideration. PMID:25157070

  17. Potential of the Trad-MCN assay applied with inflorescences of Tradescantia pallida 'Purpurea' for evaluating air contamination by naphthalene.

    PubMed

    Alves, Edenise Segala; de Souza, Silvia Ribeiro; Pedroso, Andrea Nunes Vaz; Domingos, Marisa

    2008-11-01

    The aims of this study were to determine clastogenic responses of Tradescantia pallida cv. Purpurea to naphthalene (NAPH) by means of the bioassay Trad-MCN with inflorescences of T. pallida cv. Purpurea and to verify if this assay might be an indicator of the potential risk imposed in a workplace, where solid insecticide containing NAPH is usually applied. The clastogenic potential of NAPH was assessed by using static and dynamic experimental systems. In both systems, increased micronucleus frequencies were observed in inflorescences submitted to increasing concentrations of solid or gaseous NAPH. The evident clastogenicity verified in inflorescences exposed experimentally to 25-50 mg m(-3) of NAPH during 6h points to a narrow threshold of plant sensitivity, indicating risks under lower NAPH levels than the standards established by OSHA and therefore revealing its suitability for biomonitoring purposes. However, the clastogenic risk should be carefully investigated by other monitoring methods if human health is taken into consideration.

  18. Dose-response relationships between internally-deposited uranium and select health outcomes in gaseous diffusion plant workers, 1948-2011.

    PubMed

    Yiin, James H; Anderson, Jeri L; Bertke, Stephen J; Tollerud, David J

    2018-05-09

    To examine dose-response relationships between internal uranium exposures and select outcomes among a cohort of uranium enrichment workers. Cox regression was conducted to examine associations between selected health outcomes and cumulative internal uranium with consideration for external ionizing radiation, work-related medical X-rays and contaminant radionuclides technetium ( 99 Tc) and plutonium ( 239 Pu) as potential confounders. Elevated and monotonically increasing mortality risks were observed for kidney cancer, chronic renal diseases, and multiple myeloma, and the association with internal uranium absorbed organ dose was statistically significant for multiple myeloma. Adjustment for potential confounders had minimal impact on the risk estimates. Kidney cancer, chronic renal disease, and multiple myeloma mortality risks were elevated with increasing internal uranium absorbed organ dose. The findings add to evidence of an association between internal exposure to uranium and cancer. Future investigation includes a study of cancer incidence in this cohort. © 2018 Wiley Periodicals, Inc.

  19. Towards Providing Culturally Aware Nutritional Care for Transgender People: Key Issues and Considerations.

    PubMed

    Fergusson, Pamela; Greenspan, Nicole; Maitland, Lukas; Huberdeau, Rémy

    2018-06-01

    Transgender people are an important group for whom access to healthcare is often problematic. Dietitians need to be aware of key issues in transgender health to provide culturally competent clinical nutritional care. This article serves as a primer, clarifying key terms and concepts, exploring the impact of stigma and discrimination on health and nutrition for people from transgender communities, and offering practical advice for nutritional and other related issues. Education for dietitians both pre- and postqualification is an important part of improving care and building skills and awareness of cultural humility. Transgender people may be at increased nutritional risk due to increased risk of cardiovascular disease, HIV, body image issues, and food insecurity. This risk profile, along with the history of trauma both outside and related to the medical community means that there is an urgent need for dietitians to develop practice tools for assessment, care, and referral to improve the nutritional status and well-being of this client group.

  20. Special Considerations in Distracted Driving with Teens

    PubMed Central

    Durbin, Dennis R; McGehee, Daniel V; Fisher, Donald; McCartt, Anne

    2014-01-01

    Novice teen drivers have long been known to have an increased risk of crashing, as well as increased tendencies toward unsafe and risky driving behaviors. Teens are unique as drivers for several reasons, many of which have implications specifically in the area of distracted driving. This paper reviews several of these features, including the widespread prevalence of mobile device use by teens, their lack of driving experience, the influence of peer passengers as a source of distraction, the role of parents in influencing teens’ attitudes and behaviors relevant to distracted driving and the impact of laws designed to prevent mobile device use by teen drivers. Recommendations for future research include understanding how engagement in a variety of secondary tasks by teen drivers affects their driving performance or crash risk; understanding the respective roles of parents, peers and technology in influencing teen driver behavior; and evaluating the impact of public policy on mitigating teen crash risk related to driver distraction. PMID:24776228

  1. Choosing Pre-conception Planning for Women/Families: Counselling and Informed Consent (Part 2) - Pre-conception Reproductive Planning, Lifestyle, Immunization, and Psychosocial Issues.

    PubMed

    Wilson, R Douglas

    2017-12-06

    To inform reproductive and other health care providers about pre-conception evaluation, including considerations for reproductive planning, lifestyle modification, immunization status and attitudes, and psychosocial issues. This counselling information can be used for patient education and planning and possible pre-conception and/or prenatal testing. This information may allow for improved risk assessment when pre-conception counselling for individual patients and their families is used. CONSIDERATIONS FOR PRE-CONCEPTION CARE (PART 2) REGARDING PRE-CONCEPTION REPRODUCTIVE PLANNING, LIFESTYLE, IMMUNIZATIONS, AND PSYCHOSOCIAL ISSUES: CONSIDERATION FOR CARE STATEMENTS: For this review article, the Consideration for Care Statements use the Grading of Recommendations, Assessment, Development and Evaluations strength and quality principles because they are comparable for the clinician and the patient/public user. For example, "Strong" for clinicians is defined as "the recommendation would apply to most individuals. Formal discussion aids are not likely to be needed to help individuals make decisions consistent with their values and preferences." For patients/the public, "Strong" is defined as, "we believe most people in this situation would want the recommended course of actions and only a small number would not." Quality of evidence (High, Moderate, Low) is based on the confidence that the true effect lies close to that of the estimate of the effect. In addition, the Canadian Task Force on Preventive Health Care key to evidence statements and grading of recommendations are included. PubMed, Medline, and the Cochrane Database were searched until May 2017, using appropriate key words (i.e., preconception, reproductive planning, lifestyle modification, immunization risks and benefits, psychosocial pregnancy factors/issues). Grey (unpublished) literature was identified through searching websites of health technology assessment and health technology assessment-related agencies, clinical practice guideline collections, and national and international medical specialty societies. The benefits for the patient and her family from receiving this pre-conception counseling would include an increased understanding of the relevant issues for both pre-conception and in early pregnancy as well as better pregnancy outcomes. Harm includes potential increased anxiety or psychological stress associated with the possibility of identifying maternal pregnancy risks. Copyright © 2017 Society of Obstetricians and Gynaecologists of Canada. Published by Elsevier Inc. All rights reserved.

  2. Delayed diagnosis of Birt-Hogg-Dubé syndrome due to marked intrafamilial clinical variability: a case report.

    PubMed

    Sattler, E C; Steinlein, O K

    2018-03-16

    Birt-Hogg-Dubé syndrome is a genetic syndrome caused by mutations in the FLCN gene. The main symptoms are lung bullae and pneumothorax, benign and malignant kidney tumors, and facial fibrofolliculoma. The risk of pneumothorax is considerable between ages 20-40 years, but decreases markedly after this age range and first-time pneumothorax after age 50 years is rare. Fibrofolliculomas usually occur between ages 35 and 45 years, while the risk for kidney cancer increases steadily with age, starting in young adulthood. However, we demonstrate here that within the same family patients might develop symptoms significantly before or after the usual age range, obscuring the typical clinical pattern and delaying diagnosis. The 43 year old index patient had a history of lung bullae and recurrent pneumothoraces starting 14 years earlier. His father (age 83 years) and one of the paternal uncles experienced their first pneumothorax unusually late after the age of 60 years. The uncle subsequently had four more pneumothoraces, and was diagnosed with kidney in his early 70s. Considerable differences in age of onset were also observed with regard to facial fibrofolliculomas that both paternal uncles developed very early around age 20 years, but which the father only started to show in his eighth decade. Birt-Hogg-Dubé syndrome was finally diagnosed when the index patient started to develop fibrofolliculomas within the typical age range. The family described here illustrates that Birt-Hogg-Dubé syndrome can be difficult to recognize, if presenting with considerable intrafamilial clinical variability. With a life-time kidney cancer risk of about 14-35% the consequences of delayed diagnosis might be grave for the affected family members. The possibility of Birt-Hogg-Dubé syndrome should therefore be taken into consideration in apparently sporadic patients presenting with lung bullae and pneumothorax.

  3. Weighing the Social and Ethical Considerations of Maternal-Fetal Surgery.

    PubMed

    Antiel, Ryan M; Flake, Alan W; Collura, Christopher A; Johnson, Mark P; Rintoul, Natalie E; Lantos, John D; Curlin, Farr A; Tilburt, Jon C; Brown, Stephen D; Feudtner, Chris

    2017-12-01

    The ethics of maternal-fetal surgery involves weighing the importance of potential benefits, risks, and other consequences involving the pregnant woman, fetus, and other family members. We assessed clinicians' ratings of the importance of 9 considerations relevant to maternal-fetal surgery. This study was a discrete choice experiment contained within a 2015 national mail-based survey of 1200 neonatologists, pediatric surgeons, and maternal-fetal medicine physicians, with latent class analysis subsequently used to identify groups of physicians with similar ratings. Of 1176 eligible participants, 660 (56%) completed the discrete choice experiment. The highest-ranked consideration was of neonatal benefits, which was followed by consideration of the risk of maternal complications. By using latent class analysis, we identified 4 attitudinal groups with similar patterns of prioritization: "fetocentric" ( n = 232), risk-sensitive ( n = 197), maternal autonomy ( n = 167), and family impact and social support ( n = 64). Neonatologists were more likely to be in the fetocentric group, whereas surgeons were more likely to be in the risk-sensitive group, and maternal-fetal medicine physicians made up the largest percentage of the family impact and social support group. Physicians vary in how they weigh the importance of social and ethical considerations regarding maternal-fetal surgery. Understanding these differences may help prevent or mitigate disagreements or tensions that may arise in the management of these patients. Copyright © 2017 by the American Academy of Pediatrics.

  4. Radiation protection issues in galactic cosmic ray risk assessment

    NASA Technical Reports Server (NTRS)

    Sinclair, W. K.

    1994-01-01

    Radiation protection involves the limitation of exposure to below threshold doses for direct (or deterministic) effects and a knowledge of the risk of stochastic effects after low doses. The principal stochastic risk associated with low dose rate galactic cosmic rays is the increased risk of cancer. Estimates of this risk depend on two factors (a) estimates of cancer risk for low-LET radiation and (b) values of the appropriate radiation weighting factors, WR, for the high-LET radiations of galactic cosmic rays. Both factors are subject to considerable uncertainty. The low-LET cancer risk derived from the late effects of the atomic bombs is vulnerable to a number of uncertainties including especially that from projection in time, and from extrapolation from high to low dose rate. Nevertheless, recent low dose studies of workers and others tend to confirm these estimates. WR, relies on biological effects studied mainly in non-human systems. Additional laboratory studies could reduce the uncertainties in WR and thus produce a more confident estimate of the overall risk of galactic cosmic rays.

  5. Radiation protection issues in galactic cosmic ray risk assessment.

    PubMed

    Sinclair, W K

    1994-01-01

    Radiation protection involves the limitation of exposure to below threshold doses for direct (or deterministic) effects and a knowledge of the risk of stochastic effects after low doses. The principal stochastic risk associated with low dose rate galactic cosmic rays is the increased risk of cancer. Estimates of this risk depend on two factors (a) estimates of cancer risk for low-LET radiation and (b) values of the appropriate radiation weighting factors, WR, for the high-LET radiations of galactic cosmic rays. Both factors are subject to considerable uncertainty. The low-LET cancer risk derived from the late effects of the atomic bombs is vulnerable to a number of uncertainties including especially that from projection in time, and from extrapolation from high to low dose rate. Nevertheless, recent low dose studies of workers and others tend to confirm these estimates. WR, relies on biological effects studied mainly in non-human systems. Additional laboratory studies could reduce the uncertainties in WR and thus produce a more confident estimate of the overall risk of galactic cosmic rays.

  6. Technology Considerations for Inclusion of Survivability in MDAO

    NASA Technical Reports Server (NTRS)

    Alexandrov, Natalia M.

    2017-01-01

    Rising traffic density, along with autonomy and diversity of vehicles in the air, will fundamentally change the safety environment of the future air transportation system. The change in risk is two-fold: increasing chances of mid-air collisions with non-cooperative objects and increasing chances of crashes over highly populated areas. The changing nature of the vehicles populating the airspace means that civilian aircraft design must now explicitly include considerations of survivability in the event of collision with other vehicles, as well as prevention of damage to people, animals and property on the ground, to a much greater extent than today. This paper offers a preliminary perspective on how MDAO could contribute toward these goals. One of the conclusions is that, in contrast to traditional vehicle design, to accommodate the complexity of the future airspace safely and efficiently, vehicle design requirements, modeling, and design optimization must be closely connected to the properties of the airspace, including those of other vehicles in the air. Thus, the total measure of a vehicle's survivability should include the traditional survivability in malfunction scenarios, combined with new considerations of survivability in collisions and survivability of the public on the ground.

  7. Childhood Adversity, Recent Life Stressors and Suicidal Behavior in Chinese College Students

    PubMed Central

    You, Zhiqi; Chen, Mingxi; Yang, Sen; Zhou, Zongkui; Qin, Ping

    2014-01-01

    Background Although the independent effects of childhood adversities and of recent negative events on suicidality have been well-documented, the combinative role of childhood and recent adversities on risk for suicidality is still underexplored, especially in the context of Chinese culture and in consideration of specific types of negative events. Method 5989 students, randomly sampled from six universities in central China, completed the online survey for this study. Suicidal behavior, life adversity during childhood and stressful events in recent school life were assessed with designed questionnaires. Results Students experiencing recent stressful life events more often reported an experience of life adversity during childhood. While recent stressful life events and childhood life adversity both were associated with an increased risk for suicidal behavior, the two exposures presented conjunctively and acted interactively to increase the risk. There was noticeable variation of effects associated with specific childhood life adversities, and sexual abuse, poor parental relationship, divorce of parents and loss of a parent were among the adversities associated with the highest increased risk. Recent conflicts with classmates, poor school performance and rupture of romantic relationships were the recent school life stressors associated with the highest increased risk. Conclusions Childhood adversity and recent school life stressors had a combinative role in predicting suicidality of young people studying in Chinese colleges. Unhappy family life during childhood and recent interpersonal conflicts in school were the most important predictors of suicidality in this population. PMID:24681891

  8. Critical Evaluation of Risk Factors and Early Complications in 564 Consecutive Two-Stage Implant-Based Breast Reconstructions Using Acellular Dermal Matrix at a Single Center.

    PubMed

    Selber, Jesse C; Wren, James H; Garvey, Patrick B; Zhang, Hong; Erickson, Cameron; Clemens, Mark W; Butler, Charles E

    2015-07-01

    Acellular dermal matrix for implant-based breast reconstruction appears to cause higher early complication rates, but long-term outcomes are perceived to be superior. This dichotomy is the subject of considerable debate. The authors hypothesized that patient characteristics and operative variables would have a greater impact on complications than the type of acellular dermal matrix used. A retrospective cohort study was performed of consecutive patients who underwent two-stage, implant-based breast reconstruction with human cadaveric or bovine acellular dermal matrix from 2006 to 2012 at a single institution. Patient characteristics and operative variables were analyzed using logistic regression analyses to identify risk factors for complications. The authors included 564 reconstructions in the study. Radiation therapy and obesity increased the odds of all complications. Every 100-ml increase in preoperative breast volume increased the odds of any complication by 1 percent, the odds of infection by 27 percent, and the risk of explantation by 16 percent. The odds of seroma increased linearly with increasing surface area of acellular dermal matrix. Odds of infection were higher with an intraoperative expander fill volume greater than 50 percent of the total volume. Risk of explantation was twice as high when intraoperative expander fill volume was greater than 300 ml. Radiation therapy, obesity, larger breasts, higher intraoperative fill volumes, and larger acellular dermal matrices are all independent risk factors for early complications. Maximizing the initial mastectomy skin envelope fill must be balanced with the understanding that higher complication rates may result from a larger intraoperative breast mound. Risk, III.

  9. Hip fracture risk and cadmium in erythrocytes: a nested case-control study with prospectively collected samples.

    PubMed

    Sommar, Johan Nilsson; Pettersson-Kymmer, Ulrika; Lundh, Thomas; Svensson, Olle; Hallmans, Göran; Bergdahl, Ingvar A

    2014-02-01

    Several studies have investigated the relation between bone mass density and cadmium exposure, but only few studies have been performed on fractures and biomarkers of cadmium. This study analyzed the association between hip fracture risk and cadmium in erythrocytes (Ery-Cd). Prospective samples from the Northern Sweden Health and Disease Study's biobank were used for 109 individuals who later in life had sustained a low-trauma hip fracture, matched with two controls of the same age and gender. The mean concentration of Ery-Cd (±SD) in case samples was 1.3 ± 1.4 versus 0.9 ± 1.0 μg/L in controls. The odds ratio (OR) was 1.63 [95% confidence interval (CI) 1.10-2.42] for suffering a hip fracture for each microgram per liter increase in Ery-Cd. However, when taking smoking into consideration (never, former, or current), neither Ery-Cd nor smoking showed a statistically significant increase in fracture risk. Using multiple conditional logistic regression with BMI, height, and smoking, the estimated OR for a 1-μg/L increase in Ery-Cd was 1.52 (95% CI 0.77-2.97). Subgroup analysis showed an increased fracture risk among women (OR = 1.94, 95% CI 1.18-3.20, for a 1 μg/L increase), which also remained in the multiple analysis (OR = 3.33, 95% CI 1.29-8.56). This study shows that fracture risk is associated with Ery-Cd. It is, however, not possible to draw firm conclusions on whether cadmium is the causal factor or whether other smoking-related factors cause this association. Subgroup analysis shows that cadmium is a risk factor for hip fracture among women.

  10. Climate change will increase the naturalization risk from garden plants in Europe.

    PubMed

    Dullinger, Iwona; Wessely, Johannes; Bossdorf, Oliver; Dawson, Wayne; Essl, Franz; Gattringer, Andreas; Klonner, Günther; Kreft, Holger; Kuttner, Michael; Moser, Dietmar; Pergl, Jan; Pyšek, Petr; Thuiller, Wilfried; van Kleunen, Mark; Weigelt, Patrick; Winter, Marten; Dullinger, Stefan; Beaumont, Linda

    2017-01-01

    Plant invasions often follow initial introduction with a considerable delay. The current non-native flora of a region may hence contain species that are not yet naturalized but may become so in the future, especially if climate change lifts limitations on species spread. In Europe, non-native garden plants represent a huge pool of potential future invaders. Here, we evaluate the naturalization risk from this species pool and how it may change under a warmer climate. Europe. We selected all species naturalized anywhere in the world but not yet in Europe from the set of non-native European garden plants. For this subset of 783 species, we used species distribution models to assess their potential European ranges under different scenarios of climate change. Moreover, we defined geographical hotspots of naturalization risk from those species by combining projections of climatic suitability with maps of the area available for ornamental plant cultivation. Under current climate, 165 species would already find suitable conditions in > 5% of Europe. Although climate change substantially increases the potential range of many species, there are also some that are predicted to lose climatically suitable area under a changing climate, particularly species native to boreal and Mediterranean biomes. Overall, hotspots of naturalization risk defined by climatic suitability alone, or by a combination of climatic suitability and appropriate land cover, are projected to increase by up to 102% or 64%, respectively. Our results suggest that the risk of naturalization of European garden plants will increase with warming climate, and thus it is very likely that the risk of negative impacts from invasion by these plants will also grow. It is therefore crucial to increase awareness of the possibility of biological invasions among horticulturalists, particularly in the face of a warming climate.

  11. Racializing Drug Design: Implications of Pharmacogenomics for Health Disparities

    PubMed Central

    Lee, Sandra Soo-Jin

    2005-01-01

    Current practices of using “race” in pharmacogenomics research demands consideration of the ethical and social implications for understandings of group difference and for efforts to eliminate health disparities. This discussion focuses on an “infrastructure of racialization” created by current trajectories of research on genetic differences among racially identified groups, the use of race as a proxy for risk in clinical practice, and increasing interest in new market niches by the pharmaceutical industry. The confluence of these factors has resulted in the conflation of genes, disease, and race. I argue that public investment in pharmacogenomics requires careful consideration of current inequities in health status and social and ethical concerns over reifying race and issues of distributive justice. PMID:16257939

  12. Multi-angle Indicators System of Non-point Pollution Source Assessment in Rural Areas: A Case Study Near Taihu Lake

    NASA Astrophysics Data System (ADS)

    Huang, Lei; Ban, Jie; Han, Yu Ting; Yang, Jie; Bi, Jun

    2013-04-01

    This study aims to identify key environmental risk sources contributing to water eutrophication and to suggest certain risk management strategies for rural areas. The multi-angle indicators included in the risk source assessment system were non-point source pollution, deficient waste treatment, and public awareness of environmental risk, which combined psychometric paradigm methods, the contingent valuation method, and personal interviews to describe the environmental sensitivity of local residents. Total risk values of different villages near Taihu Lake were calculated in the case study, which resulted in a geographic risk map showing which village was the critical risk source of Taihu eutrophication. The increased application of phosphorus (P) and nitrogen (N), loss vulnerability of pollutant, and a lack of environmental risk awareness led to more serious non-point pollution, especially in rural China. Interesting results revealed by the quotient between the scores of objective risk sources and subjective risk sources showed what should be improved for each study village. More environmental investments, control of agricultural activities, and promotion of environmental education are critical considerations for rural environmental management. These findings are helpful for developing targeted and effective risk management strategies in rural areas.

  13. Adolescent development and risk of injury: Using developmental science to improve interventions

    PubMed Central

    Johnson, Sara B.; Jones, Vanya C.

    2015-01-01

    In adolescence, there is a complex interaction among physical, cognitive, and psychosocial developmental processes, culminating in greater risk-taking and novelty-seeking. Concurrently, adolescents face an increasingly demanding environment, which results in heightened vulnerability to injury. In this paper, we provide an overview of developmental considerations for adolescent injury interventions based on developmental science including findings from behavioral neuroscience and psychology. We examine the role that typical developmental processes play in the way adolescents perceive and respond to risk and how this integrated body of developmental research adds to our understanding of how to do injury prevention with adolescents. We then highlight strategies to improve the translation of developmental research into adolescent injury prevention practice, calling on examples of existing interventions including graduated driver licensing. PMID:20876765

  14. The impact of social contagion on non-suicidal self-injury: a review of the literature.

    PubMed

    Jarvi, Stephanie; Jackson, Benita; Swenson, Lance; Crawford, Heather

    2013-01-01

    In this review, we explore social contagion as an understudied risk factor for non-suicidal self-injury (NSSI) among adolescents and young adults, populations with a high prevalence of NSSI. We review empirical studies reporting data on prevalence and risk factors that, through social contagion, may influence the transmission of NSSI. Findings in this literature are consistent with social modeling/learning of NSSI increasing risk of initial engagement in NSSI among individuals with certain individual and/or psychiatric characteristics. Preliminary research suggests iatrogenic effects of social contagion of NSSI through primary prevention are not likely. Thus, social contagion factors may warrant considerable empirical attention. Intervention efforts may be enhanced, and social contagion reduced, by implementation of psychoeducation and awareness about NSSI in schools, colleges, and treatment programs.

  15. Risk Factors, Pathobiomechanics and Physical Examination of Rotator Cuff Tears

    PubMed Central

    Moulton, Samuel G.; Greenspoon, Joshua A.; Millett, Peter J.; Petri, Maximilian

    2016-01-01

    Background: It is important to appreciate the risk factors for the development of rotator cuff tears and specific physical examination maneuvers. Methods: A selective literature search was performed. Results: Numerous well-designed studies have demonstrated that common risk factors include age, occupation, and anatomic considerations such as the critical shoulder angle. Recently, research has also reported a genetic component as well. The rotator cuff axially compresses the humeral head in the glenohumeral joint and provides rotational motion and abduction. Forces are grouped into coronal and axial force couples. Rotator cuff tears are thought to occur when the force couples become imbalanced. Conclusion: Physical examination is essential to determining whether a patient has an anterosuperior or posterosuperior tear. Diagnostic accuracy increases when combining a series of examination maneuvers. PMID:27708731

  16. Role of Light in Breast Cancer

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

    Stevens, Richard G.; Anderson, Larry E.; Michael F. Holick

    1999-06-14

    There is a prima facie reason for studying possible biological effects of light-at-night (LAN) in the laboratory and human health effects in the population at large: LAN from the use of electricity represent exposures in the human environment not previously encountered in human evolution. These LAN exposures are pervasive in industrialized societies, and any adverse health effects from them could result in considerable consequences for the population. In particular, exposures of pregnant women to LAN that might result in increased estrogen exposure in utero to their child may lead to increased tissue mass and increased lifetime risk of breast cancermore » of the child.« less

  17. The controversy about a possible relationship between mobile phone use and cancer.

    PubMed

    Kundi, Michael

    2009-03-01

    During the last decade, mobile phone use increased to almost 100% prevalence in many countries of the world. Evidence for potential health hazards accumulated in parallel by epidemiologic investigations has raised controversies about the appropriate interpretation and the degree of bias and confounding responsible for reduced or increased risk estimates. Overall, I identified 33 epidemiologic studies in the peer-reviewed literature, most of which (25) were about brain tumors. Two groups have collected data for >or=10 years of mobile phone use: Hardell and colleagues from Sweden and the Interphone group, an international consortium from 13 countries coordinated by the International Agency for Research on Cancer. Combined odds ratios (95% confidence intervals) from these studies for glioma, acoustic neuroma, and meningioma were 1.5 (1.2-1.8); 1.3 (0.95-1.9); and 1.1 (0.8-1.4), respectively. Methodologic considerations revealed that three important conditions for epidemiologic studies to detect an increased risk are not met: a ) no evidence-based exposure metric is available; b) the observed duration of mobile phone use is generally still too low; c) no evidence-based selection of end points among the grossly different types of neoplasias is possible because of lack of etiologic hypotheses. Concerning risk estimates, selection bias, misclassification bias, and effects of the disease on mobile phone use could have reduced estimates, and recall bias may have led to spuriously increased risks. The overall evidence speaks in favor of an increased risk, but its magnitude cannot be assessed at present because of insufficient information on long-term use.

  18. CONSIDERATIONS IN RISK COMMUNICATION: A DIGEST OF RISK COMMUNICATION AS A RISK MANAGEMENT TOOL

    EPA Science Inventory

    Risk communication is the process of informing people about hazards. Like all communication, communicating risk is a two-way exchange in which you inform the target community about possible hazards, but also gather information about those affected by the risk. The purpose of risk...

  19. Effects of PCSK1 genetic variants on obesity among Thai children and their family members: in relation to health risk, and biochemical and anthropometric parameters.

    PubMed

    Kulanuwat, Sirikul; Phonrat, Benjaluck; Tungtrongchitr, Anchalee; Limwongse, Chanin; Chongviriyaphan, Nalinee; Tungtrongchitr, Rungsunn; Santiprabhob, Jeerunda

    2014-01-01

    Single nucleotide polymorphisms (SNPs) in PCSK1, namely, rs6234, rs6235, and rs271939 have been linked to obesity in European population; and rs3811951 has also been connected to type 2 diabetes and obesity parameters in Chinese population. In this family-based case-control study, we analyzed links between PCSK1 genetic variants and obesity in Thai children and their families. Eleven obese children with a percent weight for height > or = 140 who had family history of obesity and 69 family members were recruited. SNPs rs6234, rs6235, rs3811951, and rs271939 of PCSK1 were analyzed using PCR and gene sequencing methods. DNA of 200 normal weight subjects was used as control. Participants with variant genotypes in the rs6234-6235 pair are at significantly more risk of being obese [OR = 2.44 (1.35-4.43), p = 0.003], and also at increased risk of being severely obese (obese class III) [OR = 3.03 (1.20-7.66), p = 0.015]. Variant rs3811951 showed no association with being obese, but is significantly linked to an increased risk of being severely obese [OR = 3.59 (1.42-9.08) p = 0.005]. Moreover, high density lipoprotein (HDL)-C levels between normal and variant rs3811951 group differed considerably, with patients with variant genotype having a lower HDL-C level (p = 0.037). Thus, Thais carrying SNPs rs6234-5 are at increased risk of being obese, and the risk of severe obesity increases when carrying both rs6234-5 and rs3811951, but not with rs271939. Furthermore, patients with genetic variations at rs3811951 are at risk of having low HDL-C levels.

  20. Chronic Fructose Ingestion as a Major Health Concern: Is a Sedentary Lifestyle Making It Worse? A Review

    PubMed Central

    Bidwell, Amy J.

    2017-01-01

    Obesity contributes to metabolic abnormalities such as insulin resistance, dyslipidemia, hypertension, and glucose intolerance, all of which are risk factors associated with metabolic syndrome. The growing prevelance of metabolic syndrome seems to be an end result of our current lifestyle which promotes high caloric, high-fat foods and minimal physical activity, resulting in a state of positive energy balance. Increased adiposity and physical inactivity may represent the beginning of the appearance of these risk factors. Understanding the metabolic and cardiovascular disturbances associated with diet and exercise habits is a crucial step towards reducing the risk factors for metabolic syndrome. Although considerable research has been conducted linking chronic fructose ingestion to the increased prevalence of obesity and metabolic syndrome risk factors, these studies have mainly been performed on animals, and/or in a post-absorptive state. Further, the magnitude of the effect of fructose may depend on other aspects of the diet, including the total amount of carbohydrates and fats in the diet and the overall consumption of meals. Therefore, the overall aim of this review paper is to examine the effects of a diet high in fructose on postprandial lipidemia, inflammatory markers and glucose tolerance, all risk factors for diabetes and cardiovascular disease. Moreover, an objective is to investigate whether increased physical activity can alter such effects. PMID:28555043

  1. Chronic Fructose Ingestion as a Major Health Concern: Is a Sedentary Lifestyle Making It Worse? A Review.

    PubMed

    Bidwell, Amy J

    2017-05-28

    Obesity contributes to metabolic abnormalities such as insulin resistance, dyslipidemia, hypertension, and glucose intolerance, all of which are risk factors associated with metabolic syndrome. The growing prevelance of metabolic syndrome seems to be an end result of our current lifestyle which promotes high caloric, high-fat foods and minimal physical activity, resulting in a state of positive energy balance. Increased adiposity and physical inactivity may represent the beginning of the appearance of these risk factors. Understanding the metabolic and cardiovascular disturbances associated with diet and exercise habits is a crucial step towards reducing the risk factors for metabolic syndrome. Although considerable research has been conducted linking chronic fructose ingestion to the increased prevalence of obesity and metabolic syndrome risk factors, these studies have mainly been performed on animals, and/or in a post-absorptive state. Further, the magnitude of the effect of fructose may depend on other aspects of the diet, including the total amount of carbohydrates and fats in the diet and the overall consumption of meals. Therefore, the overall aim of this review paper is to examine the effects of a diet high in fructose on postprandial lipidemia, inflammatory markers and glucose tolerance, all risk factors for diabetes and cardiovascular disease. Moreover, an objective is to investigate whether increased physical activity can alter such effects.

  2. Risk stratification, genomic data and the law.

    PubMed

    Hall, Alison; Finnegan, Thomas; Chowdhury, Susmita; Dent, Tom; Kroese, Mark; Burton, Hilary

    2018-02-22

    Risk prediction models have a key role in stratified disease prevention, and the incorporation of genomic data into these models promises more effective personalisation. Although the clinical utility of incorporating genomic data into risk prediction tools is increasingly compelling, at least for some applications and disease types, the legal and regulatory implications have not been examined and have been overshadowed by discussions about clinical and scientific utility and feasibility. We held a workshop to explore relevant legal and regulatory perspectives from four EU Member States: France, Germany, the Netherlands and the UK. While we found no absolute prohibition on the use of such data in those tools, there are considerable challenges. Currently, these are modest and result from genomic data being classified as sensitive data under existing Data Protection regulation. However, these challenges will increase in the future following the implementation of EU Regulations on data protection which take effect in 2018, and reforms to the governance of the manufacture, development and use of in vitro diagnostic devices to be implemented in 2022. Collectively these will increase the regulatory burden placed on these products as risk stratification tools will be brought within the scope of these new Regulations. The failure to respond to the challenges posed by the use of genomic data in disease risk stratification tools could therefore prove costly to those developing and using such tools.

  3. Coal Seam Methane Pressure as a Parameter Determining the Level of the Outburst Risk - Laboratory and in Situ Research / Ciśnienie Złożowe Jako Parametr Określający Stan Zagrożenia Wyrzutami Metanu I Skał - Badania Laboratoryjne I Kopalniane

    NASA Astrophysics Data System (ADS)

    Skoczylas, Norbert

    2012-12-01

    Scarcity of research focusing on the evaluation of the coal seam methane pressure as a parameter determining the outburst risk makes it difficult to assess the value for which the level of this risk increases considerably. It is obvious that, apart from the gas factor, the evaluation of the threat should also take into account the strength factor. The research presented in this paper attempted at estimating the level of the outburst risk on the basis of the coal seam methane pressure value and firmness of coal. In this work, the author seeks to present both the relevant laboratory research and the measurements carried out in mines.

  4. Kidney Disease and Youth Onset Type 2 Diabetes: Considerations for the General Practitioner

    PubMed Central

    Dart, Allison B.; Sellers, Elizabeth A.; Dean, Heather J.

    2012-01-01

    Youth onset type 2 diabetes (T2DM) continues to increase worldwide, concomitant with the rising obesity epidemic. There is evidence to suggest that youth with T2DM are affected by the same comorbidities and complications as adults diagnosed with T2DM. This review highlights specifically the kidney disease associated with youth onset T2DM, which is highly prevalent and associated with a high risk of end-stage kidney disease in early adulthood. A general understanding of this complex disease by primary care providers is critical, so that at-risk individuals are identified and managed early in the course of their disease, such that progression can be modified in this high-risk group of children and adolescents. A review of the pediatric literature will include a focus on the epidemiology, risk factors, pathology, screening, and treatment of kidney disease in youth onset T2DM. PMID:22315622

  5. The ethics of paediatric anti-depressant use: erring on the side of caution.

    PubMed

    Shearer, M C; Bermingham, S L

    2008-10-01

    This paper aims to outline the ethical concerns regarding the use of antidepressant medication in children and adolescents. Recent debates surrounding this issue have focused on the link between selective serotonin reuptake inhibitor use and an increased risk of suicidal thinking/behaviour, and weighed that against the benefit of the alleviation of depressive symptoms. It is argued here that such an approach is simplistic. There are several serious risks surrounding antidepressant use in the young that ought to be included in the equation, along with a consideration of the neuroethical concerns surrounding pharmacotherapy for affective disorders. Using the precautionary principle as a framework for analysis it is concluded that the risks are sufficiently serious and plausible that the prescribing of antidepressant medication to the young ought to be severely restricted; further it is imperative that the child and their parents are made fully aware of the risks, short-term and long-term, involved.

  6. Feasibility of Valve-in-Valve Procedure for Degenerated St. Jude Medical Trifecta Bioprosthesis.

    PubMed

    Verhoye, Jean-philippe; Harmouche, Majid; Soulami, Reda Belhaj; Thebault, Christophe; Boulmier, Dominique; Leguerrier, Alain; Anselmi, Amedeo

    2015-07-01

    The valve-in-valve (ViV) procedure is an option for patients with symptomatic structural degeneration of a bioprosthesis and excessive reoperative risk. The risk of coronary obstruction appears to be increased if ViV is performed for certain pericardial prostheses in which the leaflets are mounted outside the stent posts. Herein is described a successful ViV for a degenerated Trifecta aortic bioprosthesis, and the technical considerations for performing a ViV procedure within such types of prosthesis are considered. Emphasis is placed on the importance of preoperative investigations (computed tomography scan-based measurements of coronary ostial height and of sinus of Valsalva diameters), and on the precise deployment of the valve (transapical approach with transesophageal echocardiography control) to minimize the risk of major complications. The presence of a failing Trifecta bioprosthesis should not be considered an absolute contraindication to ViV on the basis of the risk of coronary obstruction.

  7. Ferrets as Models for Influenza Virus Transmission Studies and Pandemic Risk Assessments

    PubMed Central

    Barclay, Wendy; Barr, Ian; Fouchier, Ron A.M.; Matsuyama, Ryota; Nishiura, Hiroshi; Peiris, Malik; Russell, Charles J.; Subbarao, Kanta; Zhu, Huachen

    2018-01-01

    The ferret transmission model is extensively used to assess the pandemic potential of emerging influenza viruses, yet experimental conditions and reported results vary among laboratories. Such variation can be a critical consideration when contextualizing results from independent risk-assessment studies of novel and emerging influenza viruses. To streamline interpretation of data generated in different laboratories, we provide a consensus on experimental parameters that define risk-assessment experiments of influenza virus transmissibility, including disclosure of variables known or suspected to contribute to experimental variability in this model, and advocate adoption of more standardized practices. We also discuss current limitations of the ferret transmission model and highlight continued refinements and advances to this model ongoing in laboratories. Understanding, disclosing, and standardizing the critical parameters of ferret transmission studies will improve the comparability and reproducibility of pandemic influenza risk assessment and increase the statistical power and, perhaps, accuracy of this model. PMID:29774862

  8. Cardiovascular considerations in middle-aged athletes at risk for coronary artery disease.

    PubMed

    Reamy, Brian V; Ledford, Christopher C

    2013-01-01

    Cardiovascular disease remains the leading cause of death in the United States despite a 50% decrease in deaths from myocardial infarction and stroke in the past 30 years associated with improvements in blood pressure and lipid control. The National Health and Nutrition Evaluation Survey found that the least prevalent metrics of cardiovascular health in adults were healthy diets, normal weights, and optimal levels of exercise. A further reduction in rates of cardiovascular disease will require an increase in exercise. Clinicians who encourage exercise in middle-aged patients face several dilemmas. This article reviews exercise-related risks for sudden death and the performance of a global cardiovascular risk assessment. The need for additional preexercise risk stratification with electrocardiogram, graded exercise testing, or echocardiography is outlined. In addition, the optimum choice of medications for hypertension or dyslipidemia treatment and the effects of these medications and aspirin on endurance exercise are reviewed.

  9. [Musculoskeletal pathology in occupational risks and common degenerative disease: reflections on the intensity and duration of the risk].

    PubMed

    Bergamini, Roberta; Astengo, Rossana

    2014-01-01

    Nowadays, in Italy the reports of mnusculoskeletal diseases increase as confirmed in the last INAIL (national insurance for occupational diseases and injuries) annual report. The Emilia-Ronmagna is one of the region with the highest number of reports: 15.9% of the total in 2012. The decree no. 81/08 has partially simplified the medico-legal activities related to musculoskeletal diseases; however, the medico-legal physicians have still to deal with some issues such as risk assessment quality, economic crisis, and specific work environments (e.g. agriculture and many handicraft activities). Tire risk factors of musculoskeletal diseases and their assessments are quite well studied. The latency period of these diseases needs to be investigated, since it could be a relevant aspect for legal medical judgment, insurance protection and prevention. Based on literature data and INAIL experience, authors propose some considerations useful for a scientific debate.

  10. Establishing a Program for Individuals at High Risk for Breast Cancer

    PubMed Central

    Cadiz, Fernando; Kuerer, Henry M.; Puga, Julio; Camacho, Jamile; Cunill, Eduardo; Arun, Banu

    2013-01-01

    Our need to create a program for individuals at high risk for breast cancer development led us to research the available data on such programs. In this paper, we summarize our findings and our thinking process as we developed our own program. Breast cancer incidence is increasing worldwide. Even though there are known risk factors for breast cancer development, approximately 60% of patients with breast cancer have no known risk factor, although this situation will probably change with further research, especially in genetics. For patients with risk factors based on personal or family history, different models are available for assessing and quantifying risk. Assignment of risk levels permits tailored screening and risk reduction strategies. Potential benefits of specialized programs for women with high breast cancer risk include more cost -effective interventions as a result of patient stratification on the basis of risk; generation of valuable data to advance science; and differentiation of breast programs from other breast cancer units, which can result in increased revenue that can be directed to further improvements in patient care. Guidelines for care of patients at high risk for breast cancer are available from various groups. However, running a high-risk breast program involves much more than applying a guideline. Each high-risk program needs to be designed by its institution with consideration of local resources and country legislation, especially related to genetic issues. Development of a successful high-risk program includes identifying strengths, weaknesses, opportunities, and threats; developing a promotion plan; choosing a risk assessment tool; defining “high risk”; and planning screening and risk reduction strategies for the specific population served by the program. The information in this article may be useful for other institutions considering creation of programs for patients with high breast cancer risk. PMID:23833688

  11. Psoriasis and cardiovascular risk. Assessment by different cardiovascular risk scores.

    PubMed

    Fernández-Torres, R; Pita-Fernández, S; Fonseca, E

    2013-12-01

    Psoriasis is an inflammatory disease associated with an increased risk of cardiovascular morbidity and mortality. However, very few studies determine cardiovascular risk by means of Framingham risk score or other indices more appropriate for countries with lower prevalence of cardiovascular risk factors. To determine multiple cardiovascular risk scores in psoriasis patients, the relation between cardiovascular risk and psoriasis features and to compare our results with those in the literature. We assessed demographic data, smoking status, psoriasis features, blood pressure and analytical data. Cardiovascular risk was determined by means of Framingham, SCORE, DORICA and REGICOR scores. A total of 395 patients (59.7% men and 40.3% women) aged 18-86 years were included. The proportion of patients at intermediate and high risk of suffering a major cardiovascular event in the next 10 years was 30.5% and 11.4%, respectively, based on Framingham risk score; 26.9% and 2.2% according to DORICA and 6.8% and 0% using REGICOR score. According to the SCORE index, 22.1% of patients had a high risk of death due to a cardiovascular event over the next 10 years. Cardiovascular risk was not related to psoriasis characteristics, except for the Framingham index, with higher risk in patients with more severe psoriasis (P = 0.032). A considerable proportion of patients had intermediate or high cardiovascular risk, without relevant relationship with psoriasis characteristics and treatment schedules. Therefore, systematic evaluation of cardiovascular risk scores in all psoriasis patients could be useful to identify those with increased cardiovascular risk, subsidiary of lifestyle changes or therapeutic interventions. © 2012 The Authors. Journal of the European Academy of Dermatology and Venereology © 2012 European Academy of Dermatology and Venereology.

  12. Adiposity and hyperglycaemia in pregnancy and related health outcomes in European ethnic minorities of Asian and African origin: a review

    PubMed Central

    Jenum, Anne Karen; Sommer, Christine; Sletner, Line; Mørkrid, Kjersti; Bærug, Anne; Mosdøl, Annhild

    2013-01-01

    Background Ethnic minorities in Europe have high susceptibility to type 2 diabetes (T2DM) and, in some groups, also cardiovascular disease (CVD). Pregnancy can be considered a stress test that predicts future morbidity patterns in women and that affects future health of the child. Objective To review ethnic differences in: 1) adiposity, hyperglycaemia, and pre-eclampsia during pregnancy; 2) future risk in the mother of obesity, T2DM and CVD; and 3) prenatal development and possible influences of maternal obesity, hyperglycaemia, and pre-eclampsia on offspring's future disease risk, as relevant for ethnic minorities in Europe of Asian and African origin. Design Literature review. Results Maternal health among ethnic minorities is still sparsely documented. Higher pre-pregnant body mass index (BMI) is found in women of African and Middle Eastern descent, and lower BMI in women from East and South Asia compared with women from the majority population. Within study populations, risk of gestational diabetes mellitus (GDM) is considerably higher in many minority groups, particularly South Asians, than in the majority population. This increased risk is apparent at lower BMI and younger ages. Women of African origin have higher risk of pre-eclampsia. A GDM pregnancy implies approximately seven-fold higher risk of T2DM than normal pregnancies, and both GDM and pre-eclampsia increase later risk of CVD. Asian neonates have lower birth weights, and mostly also African neonates. This may translate into increased risks of later obesity, T2DM, and CVD. Foetal overgrowth can promote the same conditions. Breastfeeding represents a possible strategy to reduce risk of T2DM in both the mother and the child. Conclusions Ethnic minority women in Europe with Asian and African origin and their offspring seem to be at increased risk of T2DM and CVD, both currently and in the future. Pregnancy is an important window of opportunity for short and long-term disease prevention. PMID:23467680

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

    PubMed Central

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

    2017-01-01

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

  14. Dental Management of a Pediatric Patient with Moyamoya Syndrome: A Rare Clinical Entity.

    PubMed

    Ko, Brittany L; Unkel, John H

    2018-01-01

    Moyamoya disease (MMD) is a rare cerebrovascular disorder involving progressive constriction of the internal carotid artery and its branches. The disease has a particularly aggressive course in very young patients, and early surgical intervention is often necessary to prevent permanent neurological damage. MMD patients have an increased risk of stroke development, which may be provoked by pain or anxiety. Currently, no reports of pediatric patients with MMD exist in the dental literature. The purpose of this paper was to discuss the dental management of a two-year-old with moyamoya disease who presented with early childhood caries and dental fear, offering recommendations for dental providers with emphasis on stroke prevention, collaboration with the medical team, anesthesia considerations for patients with increased stroke risk, and the challenges to maintain the oral health of a patient undergoing complex medical treatment.

  15. Some chronobiological considerations related to physical exercise.

    PubMed

    Reilly, T; Atkinson, G; Gregson, W; Drust, B; Forsyth, J; Edwards, B; Waterhouse, J

    2006-01-01

    Variables associated with physical activity show circadian rhythms in resting subjects; these rhythms have both exogenous (due to the individual's lifestyle and environment) and endogenous (due to the "body clock") components. During exercise, many of the rhythms persist, even though some show decreasing amplitude with increasing severity of exercise. Whilst the value of physical fitness is not disputed (for elite athletes, for individuals who just want to be physically fit, or for patients undertaking physical rehabilitation regimens), there are certain times of the day when special care is needed. These times are soon after waking--when there is the possibility of an increased risk of cardiovascular morbidity and damage to the spine--and late in the day--when there is an increased risk of respiratory difficulties. Since physical exercise is inextricably linked with thermoregulation, there are special considerations to bear in mind when exercise takes place in cold or hot environments. Further, due to the effects of the body clock, exercise and activity during night work and after time-zone transitions presents problems peculiar to these circumstances. In addition, the menstrual cycle affects physical performance, and these circatrigintan rhythms interact with the circadian ones. Bearing in mind these factors, advice that is based upon knowledge of circadian and circatrigintan rhythms can be given to all those contemplating physical activity. Chronobiologically, there is advantage in undertaking physical activity programmes towards the middle of the waking day and not at times when a sleep or nap has just been taken.

  16. Contemporary Issues Surrounding Folic Acid Fortification Initiatives

    PubMed Central

    Choi, Jeong-Hwa; Yates, Zoe; Veysey, Martin; Heo, Young-Ran; Lucock, Mark

    2014-01-01

    The impact of folate on health and disease, particularly pregnancy complications and congenital malformations, has been extensively studied. Mandatory folic acid fortification therefore has been implemented in multiple countries, resulting in a reduction in the occurrence of neural tube defects. However, emerging evidence suggests increased folate intake may also be associated with unexpected adverse effects. This literature review focuses on contemporary issues of concern, and possible underlying mechanisms as well as giving consideration the future direction of mandatory folic acid fortification. Folate fortification has been associated with the presence of unmetabolized folic acid (PteGlu) in blood, masking of vitamin B12 deficiency, increased dosage for anti-cancer medication, photo-catalysis of PteGlu leading to potential genotoxicity, and a role in the pathoaetiology of colorectal cancer. Increased folate intake has also been associated with twin birth and insulin resistance in offspring, and altered epigenetic mechanisms of inheritance. Although limited data exists to elucidate potential mechanisms underlying these issues, elevated blood folate level due to the excess use of PteGlu without consideration of an individual’s specific phenotypic traits (e.g. genetic background and undiagnosed disease) may be relevant. Additionally, the accumulation of unmetabolized PteGlu may lead to inhibition of dihydrofolate reductase and other enzymes. Concerns notwithstanding, folic acid fortification has achieved enormous advances in public health. It therefore seems prudent to target and carefully monitor high risk groups, and to conduct well focused further research to better understand and to minimize any risk of mandatory folic acid fortification. PMID:25580388

  17. Routine obstetric ultrasound examinations in South Africa: cost and effect on perinatal outcome--a prospective randomised controlled trial.

    PubMed

    Geerts, L T; Brand, E J; Theron, G B

    1996-06-01

    To compare routine midtrimester with selective obstetric ultrasonography concerning the Health Service cost and the effect on perinatal outcome. A randomised controlled trial. Urban area served by Tygerberg Hospital, a tertiary referral centre in South Africa. Pregnant patients without risk factors for congenital anomalies referred for ultrasonography between 18 and 24 weeks of gestation. Between 18 and 24 weeks, a level one ultrasound examination was performed on study patients only. Except for the routine scan, both groups received the same antenatal care and could be referred later for additional scans as judged by their clinicians. Overall adverse perinatal outcome and use of antenatal and neonatal services. The groups did not differ significantly in their use of antenatal and neonatal services except for a greater number of ultrasound scans in the study group. More suspected postdate pregnancies occurred in control patients, as well as more amniocenteses for confirmation of lung maturity. More babies of low birthweight were born in the study group. The incidence of overall or major adverse perinatal outcome was comparable. Routine ultrasonography was accompanied by a considerable increase in costs. Selective use of obstetric ultrasonography did not increase the use of antenatal and neonatal services. Not routinely performing ultrasonography has led to considerable Health Service savings without increasing the risk for adverse perinatal outcome. It saved 75% of selected patients a referral to an ultrasound unit. Specific problems related to inaccurate gestational age determination need to be addressed.

  18. The relation between rice consumption, arsenic contamination, and prevalence of diabetes in South Asia

    PubMed Central

    Hassan, Fatima Ismail; Niaz, Kamal; Khan, Fazlullah; Maqbool, Faheem; Abdollahi, Mohammad

    2017-01-01

    Rice is the major staple food for about two billion people living in Asia. It has been reported to contain considerable amount of inorganic arsenic which is toxic to pancreatic beta cells and disrupt glucose homeostasis. Articles and conference papers published between 1992 and 2017, indexed in Scopus, PubMed, EMBASE, Google, and Google scholar were used. Arsenic exposure has been associated with increased blood glucose and insulin levels, or decreased sensitization of insulin cells to glucose uptake. Several studies have shown the association between inorganic arsenic exposure and incidence of diabetes mellitus. Considerable amounts of arsenic have been reported in different types of rice which may be affected by cultivation methods, processing, and country of production. Use of certain microbes, fertilizers, and enzymes may reduce arsenic uptake or accumulation in rice, which may reduce its risk of toxicity. Combined exposure to contaminated rice, other foods and drinking water may increase the risk of diabetes in these countries. Maximum tolerated daily intake of arsenic contaminated rice (2.1 µg/day kg body weight) has been set by WHO, which may be exceeded depending on its content in rice and amount consumed. Hence, increased prevalence of diabetes in South Asia may be related to the consumption of arsenic contaminated rice depending on its content in the rice and daily amount consumed. In this review, we have focused on the possible relation between rice consumption, arsenic contamination, and prevalence of diabetes in South Asia. PMID:29285009

  19. Photography and Social Media Use in Community-Based Participatory Research with Youth: Ethical Considerations.

    PubMed

    Kia-Keating, Maryam; Santacrose, Diana; Liu, Sabrina

    2017-12-01

    Community-based participatory researchers increasingly incorporate photography and social media into their work. Despite its relative infancy, social media has created a powerful network that allows individuals to convey messages quickly to a widespread audience. In addition to its potential benefits, the use of social media in research also carries risk, given the fast pace of exchanges, sharing of personal images and ideas in high accessibility, low privacy contexts and continually shifting options and upgrades. This article contributes to the literature examining ethical considerations for photography and social media use in community-based participatory research. We describe three key ethical dilemmas that we encountered during our participatory photography project with Latina/o youth: (a) use and content of images and risk; (b) incentives and coercion; and (c) social media activity and confidentiality. We provide our responses to these challenges, contextualized in theory and practice, and share lessons learned. We raise the question of how to contend with cultural shifts in boundaries and privacy. We propose that evaluating participant vulnerability versus potential empowerment may be more fitting than the standard approach of assessing risks and benefits. Finally, we recommend upholding the principles of participatory research by co-producing ethical practices with one's participants. © Society for Community Research and Action 2017.

  20. Photography and Social Media Use in Community-Based Participatory Research with Youth: Ethical Considerations

    PubMed Central

    Santacrose, Diana; Liu, Sabrina

    2017-01-01

    Community-based participatory researchers increasingly incorporate photography and social media into their work. Despite its relative infancy, social media has created a powerful network that allows individuals to convey messages quickly to a widespread audience. In addition to its potential benefits, the use of social media in research also carries risk, given the fast pace of exchanges, sharing of personal images and ideas in high accessibility, low privacy contexts and continually shifting options and upgrades. This article contributes to the literature examining ethical considerations for photography and social media use in community-based participatory research. We describe three key ethical dilemmas that we encountered during our participatory photography project with Latina/o youth: (a) use and content of images and risk; (b) incentives and coercion; and (c) social media activity and confidentiality. We provide our responses to these challenges, contextualized in theory and practice, and share lessons learned. We raise the question of how to contend with cultural shifts in boundaries and privacy. We propose that evaluating participant vulnerability versus potential empowerment may be more fitting than the standard approach of assessing risks and benefits. Finally, we recommend upholding the principles of participatory research by co-producing ethical practices with one’s participants. PMID:28944473

  1. [Late complications of liver cirrhosis - management of gastrointestinal bleeding in the presence of portal hypertension].

    PubMed

    Hejda, Václav

    Cirrhosis is the end stage of progressive development of different liver diseases and is associated with significant morbidity and mortality rates. Cirrhosis is associated with a number of potential complications, in particular with development of portal hypertension. Portal hypertension with the production of ascites, hepatic and gastric varices bleeding in the upper part of the gastrointestinal tract, presents the breakpoint in the natural course of cirrhosis, and it is associated with a considerably worse prognosis of patients, with a dramatically increased risk of mortality. A major progress was reached during the past 10-20 years in diagnosing liver cirrhosis (including non-invasive methods), in primary prevention of the initial episode of upper gastrointestinal bleeding and in the therapy of acute bleeding due to modern pharmacotherapy, with regard to expanding possibilities of therapeutic endoscopy and relatively new options for management of acute bleeding (esophageal stents, TIPS and suchlike). However acute upper gastrointestinal bleeding associated with portal hypertension still presents a considerable risk of premature death (15-20 %). Early diagnosing and causal treatment of numerous liver diseases may lead to slowing or regression of fibrosis and cirrhosis and possibly even of the degree of portal hypertension and thereby also the risk of bleeding.Key words: cirrhosis - esophageal varices - treatment of bleeding - portal hypertension.

  2. A guide to the contained use of plant virus infectious clones.

    PubMed

    Brewer, Helen C; Hird, Diane L; Bailey, Andy M; Seal, Susan E; Foster, Gary D

    2018-04-01

    Plant virus infectious clones are important tools with wide-ranging applications in different areas of biology and medicine. Their uses in plant pathology include the study of plant-virus interactions, and screening of germplasm as part of prebreeding programmes for virus resistance. They can also be modified to induce transient plant gene silencing (Virus Induced Gene Silencing - VIGS) and as expression vectors for plant or exogenous proteins, with applications in both plant pathology and more generally for the study of plant gene function. Plant viruses are also increasingly being investigated as expression vectors for in planta production of pharmaceutical products, known as molecular farming. However, plant virus infectious clones may pose a risk to the environment due to their ability to reconstitute fully functional, transmissible viruses. These risks arise from both their inherent pathogenicity and the effect of any introduced genetic modifications. Effective containment measures are therefore required. There has been no single comprehensive review of the biosafety considerations for the contained use of genetically modified plant viruses, despite their increasing importance across many biological fields. This review therefore explores the biosafety considerations for working with genetically modified plant viruses in contained environments, with focus on plant growth facilities. It includes regulatory frameworks, risk assessment, assignment of biosafety levels, facility features and working practices. The review is based on international guidance together with information provided by plant virus researchers. © 2017 The Authors. Plant Biotechnology Journal published by Society for Experimental Biology and The Association of Applied Biologists and John Wiley & Sons Ltd.

  3. The interrelation between hypothyroidism and glaucoma: a critical review and meta-analyses.

    PubMed

    Thvilum, Marianne; Brandt, Frans; Brix, Thomas Heiberg; Hegedüs, Laszlo

    2017-12-01

    Data on the association between hypothyroidism and glaucoma are conflicting. We sought to shed light on this by conducting a critical review and meta-analyses. The meta-analyses were conducted in adherence with the widely accepted MOOSE guidelines. Using the Medical Subject Heading (MeSH) terms: hypothyroidism, myxoedema and glaucoma or intraocular pressure, case-control studies, cohort studies and cross-sectional studies were identified (PubMed) and reviewed. Using meta-analysis, the relative risk (RR) of coexistence of glaucoma and hypothyroidism was calculated. Based on the literature search, thirteen studies fulfilled the inclusion criteria and could be categorized into two groups based on the exposure. The designs of the studies varied considerably, and there was heterogeneity related to lack of power, weak phenotype classifications and length of follow-up. Eight studies had glaucoma (5757 patients) as exposure and hypothyroidism as outcome. Among these, we found a non-significantly increased risk of hypothyroidism associated with glaucoma (RR 1.65; 95% confidence interval [CI]: 0.97-2.82). Based on five studies (168 006 patients) with hypothyroidism as exposure and glaucoma as outcome, we found the risk of glaucoma to be significantly increased (RR 1.33; 95% CI: 1.13-1.58). Based on these meta-analyses, there seems to be an association between hypothyroidism and glaucoma, which does not seem to be the case between glaucoma and hypothyroidism. However, larger scale studies with better phenotype classification, longer follow-up and taking comorbidity and other biases into consideration are needed to address a potential causal relationship. © 2017 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

  4. Aggregate Exposure and Cumulative Risk Assessment—Integrating Occupational and Non-occupational Risk Factors

    PubMed Central

    Lentz, T. J.; Dotson, G. S.; Williams, P. R.D.; Maier, A.; Gadagbui, B.; Pandalai, S. P.; Lamba, A.; Hearl, F.; Mumtaz, M.

    2015-01-01

    Occupational exposure limits have traditionally focused on preventing morbidity and mortality arising from inhalation exposures to individual chemical stressors in the workplace. While central to occupational risk assessment, occupational exposure limits have limited application as a refined disease prevention tool because they do not account for all of the complexities of the work and non-occupational environments and are based on varying health endpoints. To be of greater utility, occupational exposure limits and other risk management tools could integrate broader consideration of risks from multiple exposure pathways and routes (aggregate risk) as well as the combined risk from exposure to both chemical and non-chemical stressors, within and beyond the workplace, including the possibility that such exposures may cause interactions or modify the toxic effects observed (cumulative risk). Although still at a rudimentary stage in many cases, a variety of methods and tools have been developed or are being used in allied risk assessment fields to incorporate such considerations in the risk assessment process. These approaches, which are collectively referred to as cumulative risk assessment, have potential to be adapted or modified for occupational scenarios and provide a tangible path forward for occupational risk assessment. Accounting for complex exposures in the workplace and the broader risks faced by the individual also requires a more complete consideration of the composite effects of occupational and non-occupational risk factors to fully assess and manage worker health problems. Barriers to integrating these different factors remain, but new and ongoing community-based and worker health-related initiatives may provide mechanisms for identifying and integrating risk from aggregate exposures and cumulative risks from all relevant sources, be they occupational or non-occupational. PMID:26583907

  5. Aggregate Exposure and Cumulative Risk Assessment--Integrating Occupational and Non-occupational Risk Factors.

    PubMed

    Lentz, T J; Dotson, G S; Williams, P R D; Maier, A; Gadagbui, B; Pandalai, S P; Lamba, A; Hearl, F; Mumtaz, M

    2015-01-01

    Occupational exposure limits have traditionally focused on preventing morbidity and mortality arising from inhalation exposures to individual chemical stressors in the workplace. While central to occupational risk assessment, occupational exposure limits have limited application as a refined disease prevention tool because they do not account for all of the complexities of the work and non-occupational environments and are based on varying health endpoints. To be of greater utility, occupational exposure limits and other risk management tools could integrate broader consideration of risks from multiple exposure pathways and routes (aggregate risk) as well as the combined risk from exposure to both chemical and non-chemical stressors, within and beyond the workplace, including the possibility that such exposures may cause interactions or modify the toxic effects observed (cumulative risk). Although still at a rudimentary stage in many cases, a variety of methods and tools have been developed or are being used in allied risk assessment fields to incorporate such considerations in the risk assessment process. These approaches, which are collectively referred to as cumulative risk assessment, have potential to be adapted or modified for occupational scenarios and provide a tangible path forward for occupational risk assessment. Accounting for complex exposures in the workplace and the broader risks faced by the individual also requires a more complete consideration of the composite effects of occupational and non-occupational risk factors to fully assess and manage worker health problems. Barriers to integrating these different factors remain, but new and ongoing community-based and worker health-related initiatives may provide mechanisms for identifying and integrating risk from aggregate exposures and cumulative risks from all relevant sources, be they occupational or non-occupational.

  6. Effect of ethanol on psychomotor performance and on risk taking behaviour.

    PubMed

    Farquhar, K; Lambert, K; Drummond, G B; Tiplady, B; Wright, P

    2002-12-01

    Ethanol may increase the willingness to take risks, but this issue remains controversial. We used a risk-taking paradigm in which volunteers answered a series of general knowledge questions with numerical answers and were asked to judge the length of a line that would just fit into a given gap. A maximum score was given for an exactly correct answer. For answers that were less than the correct value, the score was reduced gradually to zero, while answers even slightly over the correct value were penalized considerably. Total points were rewarded by cash payments, so volunteers were taking real risks when making their responses. Performance was assessed in a two-period, double-blind crossover study, comparing ethanol (0.7 g/kg) with placebo in 20 female volunteers aged 19-20 years. Tests were carried out before and at 45 min after dosing. Mean (SD) ethanol blood alcohol concentrations were 65 (10.5) mg/100 ml. Ethanol impaired the skill/ability measure of the length estimation test (SD of difference between length of line and gap), which increased from 5.9 to 6.6 (p < 0.05), indicating a reduced accuracy of estimation. The risk measures in both tasks were not significantly affected. The skill/ability measure in the general knowledge task was not significantly affected. Other performance tests showed that ethanol produced the expected impairment of both speed and accuracy. These results suggest that risk-taking is not increased by ethanol at doses approaching the UK legal limit for driving.

  7. Coastal and river flood risk analyses for guiding economically optimal flood adaptation policies: a country-scale study for Mexico.

    PubMed

    Haer, Toon; Botzen, W J Wouter; van Roomen, Vincent; Connor, Harry; Zavala-Hidalgo, Jorge; Eilander, Dirk M; Ward, Philip J

    2018-06-13

    Many countries around the world face increasing impacts from flooding due to socio-economic development in flood-prone areas, which may be enhanced in intensity and frequency as a result of climate change. With increasing flood risk, it is becoming more important to be able to assess the costs and benefits of adaptation strategies. To guide the design of such strategies, policy makers need tools to prioritize where adaptation is needed and how much adaptation funds are required. In this country-scale study, we show how flood risk analyses can be used in cost-benefit analyses to prioritize investments in flood adaptation strategies in Mexico under future climate scenarios. Moreover, given the often limited availability of detailed local data for such analyses, we show how state-of-the-art global data and flood risk assessment models can be applied for a detailed assessment of optimal flood-protection strategies. Our results show that especially states along the Gulf of Mexico have considerable economic benefits from investments in adaptation that limit risks from both river and coastal floods, and that increased flood-protection standards are economically beneficial for many Mexican states. We discuss the sensitivity of our results to modelling uncertainties, the transferability of our modelling approach and policy implications.This article is part of the theme issue 'Advances in risk assessment for climate change adaptation policy'. © 2018 The Author(s).

  8. Child passenger injury risk in motor vehicle crashes: a comparison of nighttime and daytime driving by teenage and adult drivers.

    PubMed

    Chen, Irene G; Durbin, Dennis R; Elliott, Michael R; Senserrick, Teresa; Winston, Flaura K

    2006-01-01

    To examine the association between child passenger injury risk, restraint use, and crash time (day vs. night) for children in crashes of vehicles driven by teenage versus adult drivers. Cross-sectional study involving telephone interviews with insured drivers in a probability sample of 6,184 crashes involving 10,028 children. Child passengers in teen nighttime crashes had an increased injury risk and an increased risk of restraint nonuse compared with those in teen daytime crashes. This increased injury risk can be explained by differences in the age of child passengers, collision type, and child passenger's restraint status associated with time of day. In order to limit the risk of injury to child passengers driven by teens, Graduated Driver Licensing (GDL) laws should include provisions restricting nighttime driving, as well as mandates for age-appropriate restraint for child passengers. Consideration should also be given for education in child passenger safety for novice teen drivers as part of the licensing process. Results of this study can be used to support advocacy efforts by the automotive industry and others to promote nighttime driving restrictions on novice drivers. In addition, given that both driver groups were more likely to be involved in a single-vehicle collision during the night, technologies such as electronic stability control may offer opportunities for protection. Further reseach on specific circumstances of teen nighttime crashes is needed to inform industry efforts to improve visibility or vehicle operation under poor lighting conditions.

  9. Splenectomy and the incidence of venous thromboembolism and sepsis in patients with immune thrombocytopenia

    PubMed Central

    Boyle, Soames; White, Richard H.; Brunson, Ann

    2013-01-01

    Patients with immune thrombocytopenia (ITP) who relapse after an initial trial of corticosteroid treatment present a therapeutic challenge. Current guidelines recommend consideration of splenectomy, despite the known risks associated with surgery and the postsplenectomy state. To better define these risks, we identified a cohort of 9976 patients with ITP, 1762 of whom underwent splenectomy. The cumulative incidence of abdominal venous thromboembolism (AbVTE) was 1.6% compared with 1% in patients who did not undergo splenectomy; venous thromboembolism (VTE) (deep venous thrombosis and pulmonary embolus) after splenectomy was 4.3% compared with 1.7% in patients who did not undergo splenectomy. There was increased risk of AbVTE early (<90 days; hazard ratio [HR] 5.4 [confidence interval (CI), 2.3-12.5]), but not late (≥90 days; HR 1.5 [CI, 0.9-2.6]) after splenectomy. There was increased risk of VTE both early (HR 5.2 [CI, 3.2-8.5]) and late (HR 2.7 [CI, 1.9-3.8]) after splenectomy. The cumulative incidence of sepsis was 11.1% among the ITP patients who underwent splenectomy and 10.1% among the patients who did not. Splenectomy was associated with a higher adjusted risk of sepsis, both early (HR 3.3 [CI, 2.4-4.6]) and late (HR 1.6 or 3.1, depending on comorbidities). We conclude that ITP patients post splenectomy are at increased risk for AbVTE, VTE, and sepsis. PMID:23637127

  10. Association of polycyclic aromatic hydrocarbons metabolites and risk of diabetes in coke oven workers.

    PubMed

    Yang, Liangle; Yan, Kai; Zeng, Dan; Lai, Xuefeng; Chen, Xuguang; Fang, Qin; Guo, Huan; Wu, Tangchun; Zhang, Xiaomin

    2017-04-01

    Elevated polycyclic aromatic hydrocarbons (PAHs) metabolites have recently been linked to increased risk of diabetes in the general population, but little is known about the risk of diabetes due to high pollution levels of PAHs exposure. We aimed to examine whether occupational exposure to PAHs would be one of the important risk factors for diabetes in the coke oven workers. A total of 1472 coke oven workers with complete data were qualified for the present study. We measured 12 urinary monohydroxy polycyclic aromatic hydrocarbons (OH-PAHs) by gas chromatography-mass spectrometry (GC-MS). Multiple logistic regression was used to evaluate the associations between urinary OH-PAHs and risk of diabetes, with adjustment for the potential confounders. We found that elevated urinary 4-hydroxyphenanthrene (4-OHPh) was significantly associated, in a dose-dependent manner, with increased risk of diabetes (P trend  = 0.003). Compared with individuals with 4-OHPh in the lowest quartile, the adjusted odds ratio (OR) of diabetes among those in the highest quartile was 2.80 (95% CI = 1.37-5.71). In stratified analysis, the association was more prominent in those who were smokers, overweight (BMI ≥24 kg/m 2 ), with longer working years (≥20 years) and worked at coke oven settings. In addition, high levels of 4-OHPh combined with longer working years or overweight had a joint effect on the risk of diabetes. Our data suggested that elevated 4-OHPh was dose-responsive associated with increased risk of diabetes in the coke oven workers. The risk assessment of diabetes related to occupational PAHs exposure should take working years and BMI into consideration. Copyright © 2017 Elsevier Ltd. All rights reserved.

  11. Role of environmental exposures and filaggrin mutations on associations of ethnic origin with risk of childhood eczema. The Generation R Study.

    PubMed

    Elbert, Niels J; Duijts, Liesbeth; den Dekker, Herman T; Jaddoe, Vincent W V; Sonnenschein-van der Voort, Agnes M M; de Jongste, Johan C; Pasmans, Suzanne G M A

    2016-09-01

    The prevalence of childhood eczema varies considerably between ethnic groups. However, data from longitudinal studies remain scarce. We examined the associations of ethnic origin with the development of eczema from birth until the age of 4 years, and whether known environmental and genetic risk factors explain these associations. This study was performed in a multiethnic population-based prospective cohort among 5,082 children. Ethnic origin was based on the parents' country of birth. Data on physician-diagnosed eczema were obtained by annual questionnaires. Information on environmental risk factors was mostly obtained by questionnaires. Filaggrin (FLG) mutations (2282del4, R2447X, R501X, and S3247X) were genotyped for 3,096 children. We used generalized estimating equation models to examine the associations of ethnic origin with the longitudinal odds of eczema at 6 months and 1, 2, 3, and 4 years of age overall and independently. Compared with Dutch children, Cape Verdean, Dutch Antillean, Surinamese-Creole, and Surinamese-Hindustani children had overall increased risks of eczema (OR (95%-CI): 1.53 (1.15, 2.03), 1.60 (1.21, 2.12), 1.95 (1.56, 2.44), and 2.06 (1.65, 2.57), respectively). Effect estimates for the associations of Cape Verdean and Dutch Antillean origin with eczema became non-significant after adjustment for genetic risk factors or both environmental and genetic risk factors, respectively. Surinamese-Creole and Surinamese-Hindustani children remained to have increased risks of eczema. Cape Verdean, Dutch Antillean, Surinamese-Creole, and Surinamese-Hindustani children had increased risks of eczema in the first 4 years of life. Environmental and genetic risk factors partly weakened these associations. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  12. Worldwide Emerging Environmental Issues Affecting the U.S. Military

    DTIC Science & Technology

    2010-08-01

    Brazil protecting non-Amazonian tropical forests . A summary of the consultations across the region are presented in the UNDP LAC Regional...North-American Environmental Integration……..13 6.6 World’s Humid Tropical Forests to Suffer Considerable Biodiversity Change by 2100….…13 6.7 Latin...35456&Cr=sanitation&Cr1 Item 2. Food Security Concerns Increase Around the World The Food Security Risk Index 2010 reveals that the countries most

  13. Increased risk of comorbid rheumatic disorders in vitiligo patients: A nationwide population-based study.

    PubMed

    Choi, Chong Won; Eun, Sung Hye; Choi, Kwang Hyun; Bae, Jung Min

    2017-08-01

    Vitiligo is a common acquired depigmentation disorder. Previous studies have shown that vitiligo is associated with a variety of autoimmune disorders. However, a large-scale epidemiological study focused on comorbid rheumatic disorders has not been undertaken. To clarify the associations between vitiligo and various rheumatic disorders, we performed a cross-sectional study using data from the Korean National Health Insurance claims database. Between 2009 and 2013, totals of 86 210 patients with vitiligo and 172 420 age- and sex-matched controls without vitiligo were enrolled in this study. Vitiligo patients were found to be at increased risk of systemic lupus erythematosus, systemic sclerosis, Sjögren's syndrome and rheumatoid arthritis, but no significant association was found between vitiligo and dermatomyositis/polymyositis, Behçet's disease or ankylosing spondylitis. Subgroup analysis showed an increased risk of dermatomyositis/polymyositis in male and ankylosing spondylitis in female vitiligo patients. The risks of dermatomyositis/polymyositis or ankylosing spondylitis were higher in young vitiligo patients. Our study confirms a significant association between vitiligo and rheumatic disorders. Differences in comorbid rheumatic disorders by age group and sex suggest the need for patient-specific approaches. Careful consideration of rheumatic disorders is required for the proper management of comorbidities in vitiligo patients. © 2017 Japanese Dermatological Association.

  14. Risk methodology overview. [for carbon fiber release

    NASA Technical Reports Server (NTRS)

    Credeur, K. R.

    1979-01-01

    Some considerations of risk estimation, how risk is measured, and how risk analysis decisions are made are discussed. Specific problems of carbon fiber release are discussed by reviewing the objective, describing the main elements, and giving an example of the risk logic and outputs.

  15. Ethical implications for clinical practice and future research in "at risk" individuals.

    PubMed

    Singh, Fiza; Mirzakhanian, Heline; Fusar-Poli, Paolo; de la Fuente-Sandoval, Camilo; Cadenhead, Kristin S

    2012-01-01

    The last 15 years have witnessed a shift in schizophrenia research with increasing interest in earlier stages of illness with the hope of early intervention and ultimately prevention of psychotic illness. Large-scale longitudinal studies have identified clinical and biological risk factors associated with increased risk of psychotic conversion, which together with symptomatic and demographic risk factors may improve the power of prediction algorithms for psychotic transition. Despite these advances, 45-70% of at risk subjects in most samples do not convert to frank psychosis, but continue to function well below their age matched counterparts. The issue is of utmost importance in light of the upcoming DSM-V and the possible inclusion of the attenuated psychotic symptoms syndrome (APSS) diagnosis, with clinical and ethical implications. Clinical considerations include feasibility of reliably diagnosing the at risk state in non-academic medical centers, variable psychotic conversion rates, a non-uniform definition of conversion and extensive debate about treatment for individuals with an ill-defined outcome. On the ethical side, diagnosing APSS could lead to unnecessary prescribing of antipsychotics with long-term deleterious consequences, slow research by providing a false sense of comfort in the diagnosis, and have psychosocial implications for those who receive a diagnosis. Thus it may be prudent to engage at risk populations early and to use broad-spectrum treatments with low risk benefit ratios to relieve functional impairments, while simultaneously studying all subsets of the at risk population.

  16. Risk prediction for chronic kidney disease progression using heterogeneous electronic health record data and time series analysis.

    PubMed

    Perotte, Adler; Ranganath, Rajesh; Hirsch, Jamie S; Blei, David; Elhadad, Noémie

    2015-07-01

    As adoption of electronic health records continues to increase, there is an opportunity to incorporate clinical documentation as well as laboratory values and demographics into risk prediction modeling. The authors develop a risk prediction model for chronic kidney disease (CKD) progression from stage III to stage IV that includes longitudinal data and features drawn from clinical documentation. The study cohort consisted of 2908 primary-care clinic patients who had at least three visits prior to January 1, 2013 and developed CKD stage III during their documented history. Development and validation cohorts were randomly selected from this cohort and the study datasets included longitudinal inpatient and outpatient data from these populations. Time series analysis (Kalman filter) and survival analysis (Cox proportional hazards) were combined to produce a range of risk models. These models were evaluated using concordance, a discriminatory statistic. A risk model incorporating longitudinal data on clinical documentation and laboratory test results (concordance 0.849) predicts progression from state III CKD to stage IV CKD more accurately when compared to a similar model without laboratory test results (concordance 0.733, P<.001), a model that only considers the most recent laboratory test results (concordance 0.819, P < .031) and a model based on estimated glomerular filtration rate (concordance 0.779, P < .001). A risk prediction model that takes longitudinal laboratory test results and clinical documentation into consideration can predict CKD progression from stage III to stage IV more accurately than three models that do not take all of these variables into consideration. © The Author 2015. Published by Oxford University Press on behalf of the American Medical Informatics Association.

  17. Uptake of the NHS Health Checks programme in a deprived, culturally diverse setting: cross-sectional study.

    PubMed

    Dalton, Andrew R H; Bottle, Alex; Okoro, Cyprian; Majeed, Azeem; Millett, Christopher

    2011-09-01

    The UK is embarking on a national cardiovascular risk assessment programme called NHS Health Checks; in order to be effective, high and equitable uptake is paramount. A cross-sectional study, using data extracted from electronic medical records of persons aged 35-74 years estimated to be at a high risk of developing cardiovascular disease, to examine the uptake of the Health Checks using logistic regression and statin prescribing. A total of 44.8% of high risk patients invited for a Health Check attended. Uptake was lower among younger men but higher among patients from south Asian (AOR = 1.71 [1.29-2.27] compared with white) or mixed ethnic backgrounds (AOR = 2.42 [1.50-3.89]), and patients registered with smaller practices (AOR = 2.53 [1.09-5.84] <3000 patients compared with 3000-5999). The percentage of patients confirmed to be at high risk of CVD prescribed a statin increased from 24.7 to 44.8%. Uptake of cardiovascular risk assessment and prescribing of statins in high risk patients was considerably lower than projected in the first year of NHS Health Checks programme. Targeting efforts to increase uptake and adherence to interventions in high risk populations and reinvesting resources into population wide strategies to reduce obesity, smoking and salt intake may prove more cost-effective in reducing the burden of cardiovascular disease in the UK.

  18. Emotion and Decision-Making Under Uncertainty: Physiological arousal predicts increased gambling during ambiguity but not risk

    PubMed Central

    FeldmanHall, Oriel; Glimcher, Paul; Baker, Augustus L; Phelps, Elizabeth A

    2016-01-01

    Uncertainty, which is ubiquitous in decision-making, can be fractionated into known probabilities (risk) and unknown probabilities (ambiguity). Although research illustrates that individuals more often avoid decisions associated with ambiguity compared to risk, it remains unclear why ambiguity is perceived as more aversive. Here we examine the role of arousal in shaping the representation of value and subsequent choice under risky and ambiguous decisions. To investigate the relationship between arousal and decisions of uncertainty, we measure skin conductance response—a quantifiable measure reflecting sympathetic nervous system arousal—during choices to gamble under risk and ambiguity. To quantify the discrete influences of risk and ambiguity sensitivity and the subjective value of each option under consideration, we model fluctuating uncertainty, as well as the amount of money that can be gained by taking the gamble. Results reveal that while arousal tracks the subjective value of a lottery regardless of uncertainty type, arousal differentially contributes to the computation of value—i.e. choice—depending on whether the uncertainty is risky or ambiguous: enhanced arousal adaptively decreases risk-taking only when the lottery is highly risky but increases risk-taking when the probability of winning is ambiguous (even after controlling for subjective value). Together, this suggests that the role of arousal during decisions of uncertainty is modulatory and highly dependent on the context in which the decision is framed. PMID:27690508

  19. Gait alterations can reduce the risk of edge loading.

    PubMed

    Wesseling, Mariska; Meyer, Christophe; De Groote, Friedl; Corten, Kristoff; Simon, Jean-Pierre; Desloovere, Kaat; Jonkers, Ilse

    2016-06-01

    Following metal-on-metal hip arthroplasty, edge loading (i.e., loading near the edge of a prosthesis cup) can increase wear and lead to early revision. The position and coverage angle of the prosthesis cup influence the risk of edge loading. This study investigates the effect of altered gait patterns, more specific hip, and pelvis kinematics, on the orientation of hip contact force and the consequent risk of antero-superior edge loading using muscle driven simulations of gait. With a cup orientation of 25° anteversion and 50° inclination and a coverage angle of 168°, many gait patterns presented risk of edge loading. Specifically at terminal double support, 189 out of 405 gait patterns indicated a risk of edge loading. At this time instant, the high hip contact forces and the proximity of the hip contact force to the edge of the cup indicated the likelihood of the occurrence of edge loading. Although the cup position contributed most to edge loading, altering kinematics considerably influenced the risk of edge loading. Increased hip abduction, resulting in decreasing hip contact force magnitude, and decreased hip extension, resulting in decreased risk on edge loading, are gait strategies that could prevent edge loading. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1069-1076, 2016. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  20. Social change, globalization and transcultural psychiatry--some considerations from a study on women and depression.

    PubMed

    Dech, Heike; Ndetei, David M; Machleidt, Wieland

    2003-01-01

    Transcultural psychiatry, whose scientific founder Emil Kraepelin is considered as, in its 100 years of tradition has not only developed a varied range of methods but has also brought about a change in the respective scientific questions as well as in related research and clinical applications. Whereas transcultural research on the psychopathology of depression contributed to the further development of psychiatric nosology, transcultural psychiatry has recently been increasingly faced with issues concerning phenomena of social change and globalization. One region, where such conditions can be observed in particular is Africa, where the dissolving of traditional standards and support systems and growing economic insecurity causes a considerable burden especially on women. As an example, results from a cross-sectional study on East African women using a two step design as well as qualitative and quantitative, standardized psychiatric methods are discussed concerning the association of social change, psycho-social risk factors and the development of depressive disorders. Efficient clinical methods towards diagnosis and treatment of new risk groups will have to be developed, of which an important aspect will be crisis intervention.

  1. Rose's population strategy of prevention need not increase social inequalities in health.

    PubMed

    McLaren, Lindsay; McIntyre, Lynn; Kirkpatrick, Sharon

    2010-04-01

    Geoffrey Rose's 1985 paper, Sick individuals and sick populations, continues to spark debate and discussion. Since this original publication, there have been two notable challenges to Rose's population strategy of prevention. First, identification of high-risk individuals has improved considerably in accuracy, which some believe obviates the need for population-wide prevention strategies. Secondly, and more recently, it has been suggested that population strategies of prevention may inadvertently worsen social inequalities in health. We argue that population prevention will not necessarily worsen social inequalities in health, and the likelihood of it doing so will depend on whether the prevention strategy is more structural (targets conditions in which behaviours occur) or agentic (targets behaviour change among individuals) in nature. Also, there are potential drawbacks of approaches that focus on discrete populations (i.e. high risk or vulnerable) that need to be considered when selecting a strategy. Although Rose's ideas need to be continually scrutinized, his population strategy of prevention still holds considerable merit for improving population health and narrowing social inequalities in health.

  2. Finnish policy approach and measures for the promotion of sustainability in contaminated land management.

    PubMed

    Reinikainen, Jussi; Sorvari, Jaana; Tikkanen, Sarianne

    2016-12-15

    The importance of sustainability considerations in contaminated land management (CLM) is highlighted in policy frameworks all around the world. It means that while the reduction of risks to human health and the environment remains the main goal of CLM, a variety of other environmental factors as well as economic and social aspects have an increasing role in decision making. The success of finding the right balance between these considerations and incorporating them in the risk management approach defines the overall sustainability of the outcome. Although the concept and principles of sustainable CLM are already widely accepted, they have not been fully realized in national procedures. According to several studies this often results from the lack of explicit policy measures. A sound policy framework in conjunction with functional policy instruments is therefore a prerequisite for the attainment of sustainable practices. In Finland, the environmental administration along with other key stakeholder groups, including regional authorities, landowners, consultants, industries, research institutes and academia, has developed a national strategy and associated policy measures in order to promote sustainable CLM. Copyright © 2016 Elsevier Ltd. All rights reserved.

  3. Evaluating the Financial Vulnerability of a Major Electric Utility in the Southeastern U.S. to Drought under Climate Change and an Evolving Generation Mix.

    PubMed

    Kern, Jordan D; Characklis, Gregory W

    2017-08-01

    There is increasing recognition of the vulnerability of electric power systems to drought and the potential for both climate change and a shifting generation mix to alter this vulnerability. Nonetheless, the considerable research in this area has not been synthesized to inform electric utilities with respect to a key factor that influences their decisions about critical infrastructure: financial risk for shareholders. This study addresses this gap in knowledge by developing a systems framework for assessing the financial exposure of utilities to drought, with further consideration of the effects of climate change and a shifting generation mix. We then apply this framework to a major utility in the Southeastern U.S. Results suggest that extreme drought could cause profit shortfalls of more than $100 million if water temperature regulations are strictly enforced. However, even losses of this magnitude would not significantly impact returns for shareholders. This may inadvertently reduce pressure internally at utilities to incorporate drought vulnerability into long-term strategic planning, potentially leaving utilities and their customers at greater risk in the future.

  4. The effect of control and display lag on unmanned air system internal pilot manual landing performance

    NASA Astrophysics Data System (ADS)

    Lloyd, Marshall Everett

    An important characteristic of UASs is lag because it can become a considerable challenge to successful human-in-the-loop control. As such, UASs are designed and configured to minimize system lag, though this can increase acquisition and operation costs considerably. In an effort to cut costs, an organization may choose to accept greater risk and deploy a UAS with high system lag. Before this risk can be responsibly accepted, it must be quantified. While many studies have examined system lag, very few have been able to quantify the risk that various levels of lag pose to an internally piloted, manually landed UAS. This study attempted to do so by evaluating pilot landing performance in a simulator with 0 ms, 240 ms, and 1000 ms of additional lag. Various measures were used, including a novel coding technique. Results indicated that 1000 ms of lag was unsafe by all measures. They also indicate that 240 ms of lag degrades performance, but participants were able to successfully land the simulated aircraft. This study showed the utility of using several measures to evaluate the effect of lag on landing performance and it helped demonstrate that while 1000 ms poses a high risk, 240 ms of lag may be a much more manageable risk. Future research suggested by this research includes: investigating lag between 240 ms and 1000 ms, introducing different weather phenomena, developing system lag training techniques for operators, and investigating the effect of aides such as predictive displays and autopilot-assisted recovery.

  5. Risk factors for recurrence of scabies: a retrospective study of scabies patients in a long-term care hospital.

    PubMed

    Makigami, Kuniko; Ohtaki, Noriko; Ishii, Norihisa; Tamashiro, Tetsuko; Yoshida, Sadao; Yasumura, Seiji

    2011-09-01

    A considerable number of patients suffer recurrence of scabies. To elucidate risk factors for recurrence of scabies, we compared patients who experienced scabies recurrence and those who suffered scabies only once. We conducted a retrospective review of medical records of all scabies patients in a long-term care hospital for the elderly (300 beds; six wards) for a period of 42 months to determine frequency of scabies onsets, underlying diseases, history of treatment, and demographic data such as age and sex. One hundred and forty-eight patients and five hospital staff members suffered scabies during the 42-month study period. All staff members and 98 patients had no recurrence, while 50 patients experienced at least one recurrence of scabies. The cumulative number of scabies diagnoses was 228. The rates of scabies onset and recurrence were considerably different among wards. The dementia unit showed the highest rate of onset and recurrence. In addition to frequent exposure to infectious sources, problematic behavior, such as lying in other patients beds, might cause the high recurrence rate in dementia units. Higher serum total lymphocyte count and topical use of γ-benzene hexachloride were associated with lower risk of scabies recurrence. Recurrence of scabies is not uncommon among elderly patients in institutional settings. Impaired immunity may be a risk factor for recurrence of scabies. Groups with a high onset rate of scabies pose a high likelihood of recurrence. Problematic behavior of demented patients may increase the risk of recurrence. Use of effective topical treatment may effectively prevent recurrence. © 2011 Japanese Dermatological Association.

  6. Typology of Nightclubs in São Paulo, Brazil: Alcohol and Illegal Drug Consumption, Sexual Behavior and Violence in the Venues.

    PubMed

    Carlini, Claudia M; Sanchez, Zila M

    2018-02-21

    Nightclubs are venues in which excessive alcohol use and illegal drug consumption occur in addition to other high-risk behaviors, such as violence and sexual risk behaviors. Environmental factors common in nightclubs and the personal characteristics of patrons might increase the risk of these events. To better understand the relationship between these factors, typologies were formulated that clustered nightclubs according to definite profiles to identify differences to be taken into consideration in preventive interventions. The present study aim was to construct a typology of nightclubs in São Paulo, Brazil. This typology was constructed using mixed methods research through the triangulation of several data sources as follows: 307 hours of ethnographic observation at 31 nightclubs, 8 focus group sessions with nightclub patrons (n = 34) and 30 semi-structured interviews with nightclub employees. Content analysis and qualitative typology were used. Four nightclub types were defined based on four analyzed thematic axes (Intoxicating, Violent, Dancing and Highly Sexualized nightclubs). Excessive alcohol use was detected in almost all of the investigated nightclubs, and drug use was observed in approximately one-third of them. Triangulation of the data revealed a relationship among environmental factors (especially alcohol sales strategies and promotion and the availability of areas for sex) and a more considerable presence of high-risk behaviors. The study shows that nightclubs are settings in which high-risk behaviors are potentiated by facilitating environmental factors as well as by the lack of laws restricting excessive alcohol use stimulated by the promotion strategies applied at these venues.

  7. Monitoring for Renal Stone Recurrence in Astronauts With History of Stone

    NASA Technical Reports Server (NTRS)

    Reyes, David P.; Sargsyan, Ashot; Locke, James; Davis, Jeffrey

    2014-01-01

    After an initial stone episode persons are at increased risk for future stone formation. A systematic approach is required to monitor the efficacy of treatment and preventive measures, and to assess the risk of developing new stones. This is important for persons working in critical jobs or austere environments, such as astronauts. A literature review of the current standards of care for renal stone monitoring and imaging was done. Military and civil aviation standards were also reviewed, as well as the medical precedents from the space program. Additionally, a new, more effective, renal stone ultrasound protocol has been developed. Using this work, a monitoring algorithm was proposed that takes into consideration the unique mission and operational environment of spaceflight. The approach to imaging persons with history of renal stones varies widely in the literature. Imaging is often done yearly or biannually, which may be too long for mission critical personnel. In the proposed algorithm astronauts with a history of renal stone, who may be under consideration for assignment, are imaged by a detailed, physiciandriven, ultrasound protocol. Unassigned personnel are monitored by yearly ultrasound and urine studies. Any positive ultrasound study is then followed by low-dose renal computed tomography scan. Other criteria are also established. The proposed algorithm provides a balanced approach between efficacy and reduced radiation exposure for the monitoring of astronauts with a renal stone history. This may eventually allow a transition from a risk-averse, to a risk-modifying approach that can enable continued service of individuals with history of renal stone that have adequately controlled risk factors.

  8. [Lipid spectrum changes and ECG in patients with paranoid schizophrenia in the course of therapy with atypical antipsychotics].

    PubMed

    Smirnova, L P; Parshukova, D A; Borodyuk, Yu N; Kornetova, E G; Tkacheva, G D; Seregin, A A; Burdovitsina, T G; Semke, A V

    2015-01-01

    To study correlations between parameters of lipid metabolism and ECG in patients with schizophrenia in light of therapy with atypical antipsychotics. We examined 42 patients with paranoid schizophrenia. All patients received atypical neuroleptics - seroquel, zyprexa, and rispolept. A group of controls included 25 healthy people. There was a significant increase (p=0.0002) in body mass (in average by 1.5 kg) in 88% patients. A significant increase in the concentration of serum triglycerides was identified as well. The concentration of VLDL in the patients with schizophrenia was 2 times higher compared to controls. After treatment, VLDL concentration increased even more considerably An increase in atherogenic index (AI) was up to 3.1 in patients with schizophrenia compared to 2.2 in controls. After treatment, Al increased up to 4 that demonstrated the high risk of development of atherosclerosis. A significant increase in QT interval in the ECG and heart rate (p=0.03) was revealed only in patients receiving rispolept. In patients receiving zyprexa and seroquel only heart rate was increased. The antipsychotics studied increase the risk of development of cardiovascular pathology.

  9. Prevalence of upper gastrointestinal bleeding risk factors among the general population and osteoarthritis patients.

    PubMed

    Kim, Sang Hyuck; Yun, Jae Moon; Chang, Chong Bum; Piao, Heng; Yu, Su Jong; Shin, Dong Wook

    2016-12-28

    To assess the prevalence of possible risk factors of upper gastrointestinal bleeding (UGIB) and their age-group specific trend among the general population and osteoarthritis patients. We utilized data from the National Health Insurance Service that included claims data and results of the national health check-up program. Comorbid conditions (peptic ulcer, diabetes, liver disease, chronic renal failure, and gastroesophageal reflux disease), concomitant drugs (aspirin, clopidogrel, cilostazol, non-steroidal anti-inflammatory drugs, steroid, anticoagulants, and SSRI), personal habits (smoking, and alcohol consumption) were considered as possible UGIB risk factors. We randomly imputed the prevalence of infection in the data considering the age-specific prevalence of Helicobacter pylori ( H. pylori ) infection in Korea. The prevalence of various UGIB risk factors and the age-group specific trend of the prevalence were identified. Prevalence was compared between osteoarthritis patients and others. A total of 801926 subjects (93855 osteoarthritis patients) aged 20 and above were included. The prevalence of individual and concurrent multiple risk factors became higher as the age increased. The prevalence of each comorbid condition and concomitant drug were higher in osteoarthritis patients. Thirty-five point zero two percent of the overall population and 68.50% of osteoarthritis patients had at least one or more risk factors of UGIB. The prevalence of individual and concurrent multiple risk factors in younger age groups were also substantial. Furthermore, when personal habits (smoking, and alcohol consumption) and H. pylori infection were included, the prevalence of concurrent multiple risk factors increased greatly even in younger age groups. Prevalence of UGIB risk factors was high in elderly population, but was also considerable in younger population. Patient with osteoarthritis was at higher UGIB risk than those without osteoarthritis. Physicians should consider individualized risk assessment regardless of age when prescribing drugs or performing procedures that may increase the risk of UGIB, and take necessary measures to reduce modifiable risk factors such as H. pylori eradication or lifestyle counseling.

  10. Denosumab for the Treatment of Osteoporosis

    PubMed Central

    Zaheer, Sarah; LeBoff, Meryl; Lewiecki, E. Michael

    2015-01-01

    Introduction Low trauma fractures due to osteoporosis are a major health concern worldwide. Despite the availability of many therapeutic compounds to reduce fracture risk, osteoporosis remains undertreated and the burden of osteoporotic fractures remains high. Denosumab is a novel agent that acts to reduce bone turnover, improve bone mineral density, and reduce fracture risk, offering a favorable efficacy and safety profile. Areas covered This review covers the pharmacology and major clinical trials with extension/post-marketing follow-up, including trials for all FDA-approved indications of denosumab to date. Expert Opinion Denosumab is an efficacious and safe osteoporosis treatment option, with current data up to 8 years of continued use showing continued improvement in bone density with sustained fracture risk reduction. Safety profiles overall are similar to placebo, with no new safety concerns in extension trials, though a theoretical increased risk of infection exists with RANKL inhibition. Future considerations include safety of prolonged treatment beyond 8 years, and efficacy/fracture risk after discontinuation or with non-adherence, given the characteristic pharmacodynamic profile of denosumab. PMID:25614274

  11. Risk Profiles for Endometriosis in Japanese Women: Results From a Repeated Survey of Self-Reports

    PubMed Central

    Yasui, Toshiyuki; Hayashi, Kunihiko; Nagai, Kazue; Mizunuma, Hideki; Kubota, Toshiro; Lee, Jung-Su; Suzuki, Shosuke

    2015-01-01

    Background The prevalence and risk factors for endometriosis may differ according to diagnosis methodologies, such as study populations and diagnostic accuracy. We examined risk profiles in imaging-diagnosed endometriosis with and without surgical confirmation in a large population of Japanese women, as well as the differences in risk profiles of endometriosis based on history of infertility. Methods Questionnaires that included items on sites of endometriosis determined by imaging techniques and surgical procedure were mailed to 1025 women who self-reported endometriosis in a baseline survey of the Japan Nurses’ Health Study (n = 15 019). Results Two hundred and ten women had surgically confirmed endometriosis (Group A), 120 had imaging-diagnosed endometriosis without a surgical procedure (Group B), and 264 had adenomyosis (Group C). A short menstrual cycle at 18–22 years of age and cigarette smoking at 30 years of age were associated with significantly increased risk of endometriosis (Group A plus Group B), while older age was associated with risk of adenomyosis (Group C). In women with a history of infertility, a short menstrual cycle was associated with a significantly increased risk of endometriosis in both Group A and Group B, but risk profiles of endometriosis were different between Group A and Group B in women without a history of infertility. Conclusions Women with surgically confirmed endometriosis and those with imaging-diagnosed endometriosis without surgery have basically common risk profiles, but these risk profiles are different from those with adenomyosis. The presence of a history of infertility should be taken into consideration for evaluation of risk profiles. PMID:25716280

  12. Transcatheter aortic-valve replacement with a self-expanding prosthesis.

    PubMed

    Adams, David H; Popma, Jeffrey J; Reardon, Michael J; Yakubov, Steven J; Coselli, Joseph S; Deeb, G Michael; Gleason, Thomas G; Buchbinder, Maurice; Hermiller, James; Kleiman, Neal S; Chetcuti, Stan; Heiser, John; Merhi, William; Zorn, George; Tadros, Peter; Robinson, Newell; Petrossian, George; Hughes, G Chad; Harrison, J Kevin; Conte, John; Maini, Brijeshwar; Mumtaz, Mubashir; Chenoweth, Sharla; Oh, Jae K

    2014-05-08

    We compared transcatheter aortic-valve replacement (TAVR), using a self-expanding transcatheter aortic-valve bioprosthesis, with surgical aortic-valve replacement in patients with severe aortic stenosis and an increased risk of death during surgery. We recruited patients with severe aortic stenosis who were at increased surgical risk as determined by the heart team at each study center. Risk assessment included the Society of Thoracic Surgeons Predictor Risk of Mortality estimate and consideration of other key risk factors. Eligible patients were randomly assigned in a 1:1 ratio to TAVR with the self-expanding transcatheter valve (TAVR group) or to surgical aortic-valve replacement (surgical group). The primary end point was the rate of death from any cause at 1 year, evaluated with the use of both noninferiority and superiority testing. A total of 795 patients underwent randomization at 45 centers in the United States. In the as-treated analysis, the rate of death from any cause at 1 year was significantly lower in the TAVR group than in the surgical group (14.2% vs. 19.1%), with an absolute reduction in risk of 4.9 percentage points (upper boundary of the 95% confidence interval, -0.4; P<0.001 for noninferiority; P = 0.04 for superiority). The results were similar in the intention-to-treat analysis. In a hierarchical testing procedure, TAVR was noninferior with respect to echocardiographic indexes of valve stenosis, functional status, and quality of life. Exploratory analyses suggested a reduction in the rate of major adverse cardiovascular and cerebrovascular events and no increase in the risk of stroke. In patients with severe aortic stenosis who are at increased surgical risk, TAVR with a self-expanding transcatheter aortic-valve bioprosthesis was associated with a significantly higher rate of survival at 1 year than surgical aortic-valve replacement. (Funded by Medtronic; U.S. CoreValve High Risk Study ClinicalTrials.gov number, NCT01240902.).

  13. Smoking and subsequent risk of early retirement due to permanent disability.

    PubMed

    Husemoen, Lise Lotte N; Osler, Merete; Godtfredsen, Nina S; Prescott, Eva

    2004-03-01

    Smoking is the most important single preventable cause of a variety of common diseases, and a considerable share of premature death is attributable to smoking. Although the effects of smoking on morbidity and mortality are widely recognized, little is known about the impact of smoking on early retirement due to chronic disease. The objective of the study is to determine the effects of smoking behaviour on early retirement due to permanent disability in a large sample of the general population. Follow-up study based on data from three longitudinal population studies conducted in the Copenhagen area. The final study population comprised 9,053 persons, 5,623 men and 3,430 women. Endpoint was grant of disability pension in the period 1980-1985. Baseline information was obtained from a self-administered questionnaire. Information about disability pensions was obtained from Statistics Denmark. Data analysis was performed by univariate and multiple logistic regression analyses. Smoking was found to be strongly associated with the risk of being granted a disability pension after adjustment for various confounders. The risk increased with daily consumption reaching a maximum odds ratio of 5.66 (1.88-17.00) and 5.61 (2.11-14.92) in heavily smoking men and women, respectively, who were below age 60. Smokers are at considerably higher risk of early retirement due to chronic disease. In addition to the burden of disease, this leads to social and economic problems for the individual and has a significant economic impact on society.

  14. Optimization of radiotherapy. Some notes on the principles and practice of optimization in cancer treatment and implications for clinical research.

    PubMed

    Andrews, J R

    1981-01-01

    Two methods dominate cancer treatment--one, the traditional best practice, individualized treatment method and two, the a priori determined decision method of the interinstitutional, cooperative, clinical trial. In the first, choices are infinite and can be made at the time of treatment; in the second, choices are finite and are made in advance of treatment on a random basis. Neither method systematically selects, identifies, or formalizes the optimum level of effect in the treatment chosen. Of the two, it can be argued that the first, other things being equal, is more likely to select the optimum treatment. The determination of level of effect for the optimization of cancer treatment requires the generation of dose-response relationships for both benefit and risk and the introduction of benefit and risk considerations and judgements. The clinical trial, as presently constituted, doses not yield this kind of information, it being, generally, of the binary yes or no, better or worse type. The best practice, individualized treatment method can yield, when adequately documented, both a range of dose-response relationships and a variety of benefit and risk considerations. The presentation will be limited to a consideration of a single modality of cancer treatment, radiation therapy, but an analogy with other modalities of cancer treatment will be inferred. Criteria for optimization will be developed and graphic means for its identification and formalization will be demonstrated with examples taken from the radiotherapy literature. The general problem of optimization theory and practice will be discussed; the necessity for its exploration in relation to the increasing complexity of cancer treatment will be developed; and recommendations for clinical research will be made including a proposal for the support of clinics as an alternative to the support of programs.

  15. The language of risk: common understanding or diverse perspectives?

    PubMed

    Clancy, Leonie; Happell, Brenda; Moxham, Lorna

    2014-07-01

    Risk as a concept now takes high priority in contemporary mental health services, with increasing pressure on mental health services to develop risk assessment and management practices. This focus on risk has been criticised for its over-reliance on measurement and management at the expense of therapeutic care and is perpetuated by the language of risk which reinforces power differentials and limits capacity for consumers and carers to influence discussions and debates. Furthermore, to date, most work in this area reflects adult settings with limited consideration of the unique needs of older people and the impact of risk assessment on the care they receive. A qualitative, exploratory approach was undertaken using individual interviews and focus groups to enhance understanding of how risk is conceptualised within an older persons' setting. Managers, clinicians, consumers, and carers from a large metropolitan service participated (n = 57). The language of risk was a major theme emerging from this work. This language, so familiar to providers of services, was not familiar to consumers and carers. A reframing of risk is necessary to reflect consumers' and carers' experiences and understandings. This approach will be essential in promoting consumer and carer participation within recovery-based services, reflecting significant goals of government policy.

  16. Organic matter and soil structure in the Everglades Agricultural Area

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

    Wright, Alan L.; Hanlon, Edward A.

    This publication pertains to management of organic soils (Histosols) in the Everglades Agricultural Area (EAA). These former wetland soils are a major resource for efficient agricultural production and are important globally for their high organic matter content. Recognition of global warming has led to considerable interest in soils as a repository for carbon. Soils rich in organic matter essentially sequester or retain carbon in the profile and can contribute directly to keeping that sequestered carbon from entering the atmosphere. Identification and utilization of management practices that minimize the loss of carbon from organic soils to the atmosphere can minimize effectsmore » on global warming and increase the longevity of subsiding Histosols for agricultural use. Understanding and predicting how these muck soils will respond to current and changing land uses will help to manage soil carbon. The objectives of this document are to: a. Discuss organic soil oxidation relative to storing or releasing carbon and nitrogen b. Evaluate effects of cultivation (compare structure for sugarcane vs. uncultivated soil) Based upon the findings from the land-use comparison (sugarcane or uncultivated), organic carbon was higher with cultivation in the lower depths. There is considerable potential for minimum tillage and residue management to further enhance carbon sequestration in the sugarcane system. Carbon sequestration is improved and soil subsidence is slowed with sugarcane production, and both of these are positive outcomes. Taking action to increase or maintain carbon sequestration appears to be appropriate but may introduce some risk to farming operations. Additional management methods are needed to reduce this risk. For both the longevity of these organic soils and from a global perspective, slowing subsidence through BMP implementation makes sense. Since these BMPs also have considerable societal benefit, it remains to be seen if society will help to offset a part or all of the additional risk through some form of cost-sharing program or carbon credits trading. In general, the subsidence throughout the EAA has been slowed because of higher water table management and implementation of other selected BMPs. In addition, the comparison of soil with different land uses shows that the humification rate, conversion of organic matter from peat to humus, has changed. Another likely factor is a relative increase in the mineral content of soil as the organic constituents are lost through subsidence.« less

  17. Telecommuting: Occupational health considerations for employee health and safety.

    PubMed

    Healy, M L

    2000-06-01

    1. Information technology has moved "work" out of a centralized location. Employees who telecommute pose significant challenges and considerations for the practice of occupational health nursing. 2. Employer and employee benefits associated with telecommuting are reportedly associated with high levels of job satisfaction. However, the occupational health and safety risks of this new work environment need to be fully assessed and understood. 3. The ergonomic controls to minimize the risk of repetitive motion injuries are the same for both office and home locations. Additional attention need to be paid to implementing risk controls for other physical hazards and psychosocial considerations, as well as personal safety and security issues. 4. The scope of occupational health nursing practice needs to remain dynamic, recognizing the impact new technologies have on the workplace, to continue to meet the needs of the changing workplace.

  18. History of the development of radiation protection standards for space activities

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

    Sinclair, W K

    Initial recommendations for limitations on radiation exposures in space were made in 1970 by the Radiobiological Advisory Panel of the Committee on Space Medicine, National Academy of Sciences/National Research Council (NAS/NRC). Using a risk-based approach and taking into consideration a range of factors, the Panel recommended an overall career limit of 4 Sv. Because it was assumed that only small numbers of people would be involved, most of whom would be in excess of 30 y of age, the question of genetic effects did not appear to be of concern. On the basis of subsequent epidemiological findings, the values ofmore » the risk coefficients were increased. As a result of this and other considerations, NASA in the early 1980s asked the NCRP to re-examine both the risks and the philosophy for protecting astronauts. In undertaking this task, the NCRP decided to treat the radiation exposures of crew members and payload specialists as an occupational hazard and to evaluate their risks in terms of those to radiation workers and to workers in other industries. Noting that in the less safe but not the most hazardous occupations, workers had an average lifetime risk of mortality of about three percent, the NCRP concluded that a reasonable career limit for astronauts should be based on a lifetime absolute excess risk of mortality of three percent. Using this as a base, the NCRP recommended a career limit for 25 y olds of 1 Sv for females and 1.5 Sv for males. Since the risk decreases the older the age at which the exposures begin, the limits culminated with a career limit of 3 Sv for females and 4 Sv for males whose initial exposure occurred at age 55. These recommendations were based on an assumed nominal value of a lifetime risk of fatal cancers for all ages of about 2 {times} 10{sup -2} Sv{sup -1}.« less

  19. Considerably decreased risk of cardiovascular disease with combined reductions in HbA1c, blood pressure and blood lipids in type 2 diabetes: Report from the Swedish National Diabetes Register.

    PubMed

    Eeg-Olofsson, Katarina; Zethelius, Björn; Gudbjörnsdottir, Soffia; Eliasson, Björn; Svensson, Ann-Marie; Cederholm, Jan

    2016-07-01

    Assess the effect of risk factors changes on risk for cardiovascular disease and mortality in patients with type 2 diabetes selected from the Swedish National Diabetes Register. Observational study of 13,477 females and males aged 30-75 years, with baseline HbA1c 41-67 mmol/mol, systolic blood pressure 122-154 mmHg and ratio non-HDL:HDL 1.7-4.1, followed for mean 6.5 years until 2012. Four groups were created: a reference group (n = 6757) with increasing final versus baseline HbA1c, systolic blood pressure and non-HDL:HDL cholesterol during the study period, and three groups with decreasing HbA1c (n = 1925), HbA1c and systolic blood pressure (n = 2050) or HbA1c and systolic blood pressure and non-HDL:HDL (n = 2745). Relative risk reduction for fatal/nonfatal cardiovascular disease was 35% with decrease in HbA1c only (mean 6 to final 49 mmol/mol), 56% with decrease in HbA1c and systolic blood pressure (mean 12 to final 128 mmHg) and 75% with combined decreases in HbA1c, systolic blood pressure and non-HDL:HDL (mean 0.8 to final 2.1), all p < 0.001 adjusting for clinical characteristics, other risk factors, treatments and previous cardiovascular disease. Similar risk reductions were found for fatal/nonfatal coronary heart disease, fatal cardiovascular disease, all-cause mortality and also in a subgroup of 3038 patients with albuminuria. Considerable risk reductions for cardiovascular disease and mortality were seen with combined long-term risk factor improvement. © The Author(s) 2016.

  20. Risk communication related to animal products derived from biotechnology.

    PubMed

    McCrea, D

    2005-04-01

    Previous chapters of this review have dealt with the key considerations related to the application of biotechnology in veterinary science and animal production. This article explores the theory and practice of risk communication and sets out the basic principles for good risk communication when dealing with new technologies, uncertainty, and cautious and sceptical consumers. After failure to communicate with consumers and stakeholders about the risk to human health from bovine spongiform encephalopathy (BSE) in the 1990s, Government Agencies in the United Kingdom have made significant improvements in risk communication. The official inquiry that followed the BSE crisis concluded that a policy of openness was the correct approach, and this article emphasises the importance of consultation, consistency and transparency. There are, however, many different factors that affect public perception of risk (religious, political, social, cultural, etc.) and developing effective risk communication strategies must take all of these complex issues into consideration.

  1. Health and environmental policy issues in Canada: the role of watershed management in sustaining clean drinking water quality at surface sources.

    PubMed

    Davies, John-Mark; Mazumder, Asit

    2003-07-01

    Sustaining clean and safe drinking water sources is increasingly becoming a priority because of global pollution. The means of attaining and maintaining clean drinking water sources requires effective policies that identify, document, and reduce watershed risks. These risks are defined by their potential impact to human health. Health and risk are, therefore, indelibly linked because they are in part defined by each other. Understanding pathogen ecology and identifying watershed sources remains a priority because of the associated acute risks. Surface water quality changes resulting from inputs of human waste, nutrients and chemicals are associated with higher drinking water risks. Nutrient input can increase primary production and the resulting increase of organic matter results in greater disinfection by-product formation or requires greater treatment intensity. Many drinking water disease outbreaks have resulted from breaches in treatment facilities, therefore, even with greater treatment intensity poor source water quality intrinsically has greater associated health risks. Government and international agencies play a critical role in developing policy. The goal of maintaining water supplies whose availability is maximized and risks are minimized (i.e. sustainable) should be a vital part of such policy. Health risks are discussed in the context of a multi-barrier perspective and it is concluded that both passive (protection) and active (prescriptive management) management is necessary for sustainability. Canadian aboriginal water systems, British Columbian water policy and US EPA policies are given as examples. The basis for developing effective policies includes a strong reliance on sound science and effective instrumentation with careful consideration of stakeholders' interests. Only with such directed policies can the future availability of clean drinking water sources be ensured.

  2. Parent of origin, mosaicism, and recurrence risk: probabilistic modeling explains the broken symmetry of transmission genetics.

    PubMed

    Campbell, Ian M; Stewart, Jonathan R; James, Regis A; Lupski, James R; Stankiewicz, Paweł; Olofsson, Peter; Shaw, Chad A

    2014-10-02

    Most new mutations are observed to arise in fathers, and increasing paternal age positively correlates with the risk of new variants. Interestingly, new mutations in X-linked recessive disease show elevated familial recurrence rates. In male offspring, these mutations must be inherited from mothers. We previously developed a simulation model to consider parental mosaicism as a source of transmitted mutations. In this paper, we extend and formalize the model to provide analytical results and flexible formulas. The results implicate parent of origin and parental mosaicism as central variables in recurrence risk. Consistent with empirical data, our model predicts that more transmitted mutations arise in fathers and that this tendency increases as fathers age. Notably, the lack of expansion later in the male germline determines relatively lower variance in the proportion of mutants, which decreases with paternal age. Subsequently, observation of a transmitted mutation has less impact on the expected risk for future offspring. Conversely, for the female germline, which arrests after clonal expansion in early development, variance in the mutant proportion is higher, and observation of a transmitted mutation dramatically increases the expected risk of recurrence in another pregnancy. Parental somatic mosaicism considerably elevates risk for both parents. These findings have important implications for genetic counseling and for understanding patterns of recurrence in transmission genetics. We provide a convenient online tool and source code implementing our analytical results. These tools permit varying the underlying parameters that influence recurrence risk and could be useful for analyzing risk in diverse family structures. Copyright © 2014 The American Society of Human Genetics. Published by Elsevier Inc. All rights reserved.

  3. Reproducibility and Transparency of Omics Research - Impacts on Human Health Risk Assessment

    EPA Science Inventory

    Omics technologies are becoming more widely used in toxicology, necessitating their consideration in human health hazard and risk assessment programs. Today, risk assessors in the United States Environmental Protection Agency’s Integrated Risk Information System (IRIS) Toxicologi...

  4. Induction of Oral Tolerance with Transgenic Plants Expressing Antigens for Prevention/Treatment of Autoimmune, Allergic and Inflammatory Diseases.

    PubMed

    Ma, Shengwu; Liao, Yu-Cai; Jevnikar, Anthony M

    2015-01-01

    The prevalence and incidence of autoimmune and allergic diseases have increased dramatically over the last several decades, especially in the developed world. The treatment of autoimmune and allergic diseases is typically with the use of non-specific immunosuppressive agents that compromise the integrity of the host immune system and therefore, increase the risk of infections. Antigenspecific immunotherapy by reinstating immunological tolerance towards self antigens without compromising immune functions is a much desired goal for the treatment of autoimmune and allergic diseases. Mucosal administration of antigen is a long-recognized method of inducing antigen-specific immune tolerance known as oral tolerance, which is viewed as having promising potential in the treatment of autoimmune and allergic diseases. Plant-based expression and delivery of recombinant antigens provide a promising new platform to induce oral tolerance, having considerable advantages including reduced cost and increased safety. Indeed, in recent years the use of tolerogenic plants for oral tolerance induction has attracted increasing attention, and considerable progress has been made. This review summarizes recent advances in using plants to deliver tolerogens for induction of oral tolerance in the treatment of autoimmune, allergic and inflammatory diseases.

  5. Early warning of climate tipping points

    NASA Astrophysics Data System (ADS)

    Lenton, Timothy M.

    2011-07-01

    A climate 'tipping point' occurs when a small change in forcing triggers a strongly nonlinear response in the internal dynamics of part of the climate system, qualitatively changing its future state. Human-induced climate change could push several large-scale 'tipping elements' past a tipping point. Candidates include irreversible melt of the Greenland ice sheet, dieback of the Amazon rainforest and shift of the West African monsoon. Recent assessments give an increased probability of future tipping events, and the corresponding impacts are estimated to be large, making them significant risks. Recent work shows that early warning of an approaching climate tipping point is possible in principle, and could have considerable value in reducing the risk that they pose.

  6. Effects of noise and electromagnetic fields on reproductive outcomes.

    PubMed Central

    Meyer, R E; Aldrich, T E; Easterly, C E

    1989-01-01

    Much public health research has been directed to studies of cancer risks due to chemical agents. Recently, increasing attention has been given to adverse reproductive outcomes as another, shorter-term biologic indicator of public health impact. Further, several low-level ubiquitous physical agents have been implicated recently as possibly affecting human health. These physical factors (noise and electromagnetic fields) represent difficult topics for research with epidemiologic study methods. This paper provides a brief review of the published data related to the risk of adverse reproductive outcomes and exposure to noise or electromagnetic fields. The discussion includes ideas for possible biologic mechanisms, considerations for exposure assessment, and suggestions for epidemiologic research. PMID:2667980

  7. Exercise considerations in coronary artery disease, peripheral vascular disease, and diabetes mellitus.

    PubMed

    Armen, Joseph; Smith, Bryan W

    2003-01-01

    Physical inactivity is a risk factor for cardiovascular disease. Regular aerobic and resistance training increases exercise capacity and plays a role both in the primary and secondary prevention of cardiovascular disease. Patients with coronary artery disease, peripheral vascular disease, or diabetes mellitus must be considered individually when prescribing exercise because their clinical status can vary greatly. In addition, a majority of these patients have multiple comorbid disorders such as renal, neurologic, and retinal disease that may affect their ability to exercise safely. Therefore, a preparticipation medical evaluation is required. An exercise prescription should be tailored to each person's unique set of circumstances and reflect an effort to maximize the anticipated benefits while minimizing the risks.

  8. Voices from the bush: remote area nurses prioritise hazards that contribute to violence in their workplace.

    PubMed

    McCullough, K M; Williams, A M; Lenthall, S

    2012-01-01

    Remote Area Nurses (RANs) in Australia frequently encounter hazards that contribute to violence in the work place. Resources to deal with this problem are limited. Adopting a risk management approach and using the Delphi method, a panel of expert RANs (n=10) from geographically diverse communities across Australia, identified and prioritised hazards that increase the risk of violence to nurses. This descriptive study found that RANs encounter a wide variety of hazards from a variety of sources. Environmental hazards are complicated by living in remote areas and practicing in different locations. Relationships between the nurse and the community can be complex and lack of experience and organisational support may contribute to an increased risk of violence. Hazards prioritised as 'major' or 'extreme' risks included: clinic maintenance and security features, attending to patients at staff residences, RAN inexperience and lack of knowledge about the community, as well as intoxicated clients with mental health issues. A work culture that accepts verbal abuse as 'part of the job' was identified as a significant organisational risk to RANs. A lack of action from management when hazards are identified by clinic staff and insufficient recognition of the risk of violence by employers were also significant hazards. Further consideration of the hazards described in this study following the risk management process, may provide opportunities to reduce the risk of violence towards RANs. Proposed control measures should be developed in consultation with RANs and the remote communities they work in.

  9. Poster — Thur Eve — 41: Considerations for Patients with Permanently Implant Radioactive Sources Requiring Unrelated Surgery

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

    Basran, P. S; Beckham, WA; Baxter, P

    Permanent implant of sealed radioactive sources is an effective technique for treating cancer. Typically, the radioactive sources are implanted in and near the disease, depositing dose locally over several months. There may be instances where these patients must undergo unrelated surgical procedures when the radioactive material remains active enough to pose risks. This work explores these risks, discusses strategies to mitigate those risks, and describes a case study for a permanent I-125 prostate brachytherapy implant patient who developed colo-rectal cancer and required surgery 6 months after brachytherapy. The first consideration is identifying the risk from unwarranted radiation to the patientmore » and staff before, during, and after the surgical procedure. The second is identifying the risk the surgical procedure may have on the efficacy of the brachytherapy implant. Finally, there are considerations for controlling for radioactive substances from a regulatory perspective. After these risks are defined, strategies to mitigate those risks are considered. These strategies may include applying the concepts of ALARA, the use of protective equipment and developing a best practice strategy with the operating room team. We summarize this experience with some guidelines: If the surgical procedure is near (ex: 5 cm) of the implant; and, the surgical intervention may dislodge radioisotopes enough to compromise treatment or introduces radiation safety risks; and, the radioisotope has not sufficiently decayed to background levels; and, the surgery cannot be postponed, then a detailed analysis of risk is advised.« less

  10. Risk factors for cardiovascular disease in subclinical hypothyroidism.

    PubMed

    Decandia, F

    2018-02-01

    Subclinical hypothyroidism (SH), defined as an increased serum thyrotropin (TSH) level and normal plasma-free thyroid hormones' concentrations, is common in the general population, in particular, among elderly women. Its prevalence ranges from 4 to 15% and up to 20% among females aged > 60 year. Although SH has been associated with atherosclerotic cardiovascular disease (CVD), it is acknowledged that the high prevalence of dyslipidemia in elderly people is considered a common biochemical condition. Therefore, whether SH is associated with a higher risk for CVD is still controversial. At the moment, no consensus exists on the clinical significance and treatment of the mild form of thyroid failure, although available data suggest that only patients with plasma TSH levels above 10 mU/L may have an increased risk of CVD. However, treatment of SH in older individual requires special consideration with regard to thyroid hormone replacement therapy and expected clinical outcomes, since the increase of TSH observed in this population may represent a physiological process. It is likely that age affects TSH levels, and some studies suggest that modified reference limits for elderly populations should be considered in the diagnosis of mild thyroid failure.

  11. [Communication on health and safety risk control in contemporary society: an interdisciplinary approach].

    PubMed

    Rangel-S, Maria Ligia

    2007-01-01

    This paper discusses communication as a technology for risk control with health and safety protection and promotion, within the context of a "risk society". As a component of Risk Analysis, risk communication is a technology that appears in risk literature, with well defined objectives, principles and models. These aspects are described and the difficulties are stressed, taking into consideration the multiple rationales related to risks in the culture and the many different aspects of risk regulation and control in the so-called "late modernity". Consideration is also given to the complexity of the communications process, guided by theoretical and methodological discussions in the field. In order to understand the true value of the communications field for risk control with health and safety protection and promotion, this paper also offers an overview of communication theories that support discussions of this matter, proposing a critical approach to models that include the dimensions of power and culture in the context of a capitalist society.

  12. Breast cancer risks and risk prediction models.

    PubMed

    Engel, Christoph; Fischer, Christine

    2015-02-01

    BRCA1/2 mutation carriers have a considerably increased risk to develop breast and ovarian cancer. The personalized clinical management of carriers and other at-risk individuals depends on precise knowledge of the cancer risks. In this report, we give an overview of the present literature on empirical cancer risks, and we describe risk prediction models that are currently used for individual risk assessment in clinical practice. Cancer risks show large variability between studies. Breast cancer risks are at 40-87% for BRCA1 mutation carriers and 18-88% for BRCA2 mutation carriers. For ovarian cancer, the risk estimates are in the range of 22-65% for BRCA1 and 10-35% for BRCA2. The contralateral breast cancer risk is high (10-year risk after first cancer 27% for BRCA1 and 19% for BRCA2). Risk prediction models have been proposed to provide more individualized risk prediction, using additional knowledge on family history, mode of inheritance of major genes, and other genetic and non-genetic risk factors. User-friendly software tools have been developed that serve as basis for decision-making in family counseling units. In conclusion, further assessment of cancer risks and model validation is needed, ideally based on prospective cohort studies. To obtain such data, clinical management of carriers and other at-risk individuals should always be accompanied by standardized scientific documentation.

  13. Simulating the Risk of Liver Fluke Infection using a Mechanistic Hydro-epidemiological Model

    NASA Astrophysics Data System (ADS)

    Beltrame, Ludovica; Dunne, Toby; Rose, Hannah; Walker, Josephine; Morgan, Eric; Vickerman, Peter; Wagener, Thorsten

    2016-04-01

    Liver Fluke (Fasciola hepatica) is a common parasite found in livestock and responsible for considerable economic losses throughout the world. Risk of infection is strongly influenced by climatic and hydrological conditions, which characterise the host environment for parasite development and transmission. Despite on-going control efforts, increases in fluke outbreaks have been reported in recent years in the UK, and have been often attributed to climate change. Currently used fluke risk models are based on empirical relationships derived between historical climate and incidence data. However, hydro-climate conditions are becoming increasingly non-stationary due to climate change and direct anthropogenic impacts such as land use change, making empirical models unsuitable for simulating future risk. In this study we introduce a mechanistic hydro-epidemiological model for Liver Fluke, which explicitly simulates habitat suitability for disease development in space and time, representing the parasite life cycle in connection with key environmental conditions. The model is used to assess patterns of Liver Fluke risk for two catchments in the UK under current and potential future climate conditions. Comparisons are made with a widely used empirical model employing different datasets, including data from regional veterinary laboratories. Results suggest that mechanistic models can achieve adequate predictive ability and support adaptive fluke control strategies under climate change scenarios.

  14. Two-stage seasonal streamflow forecasts to guide water resources decisions and water rights allocation

    NASA Astrophysics Data System (ADS)

    Block, P. J.; Gonzalez, E.; Bonnafous, L.

    2011-12-01

    Decision-making in water resources is inherently uncertain producing copious risks, ranging from operational (present) to planning (season-ahead) to design/adaptation (decadal) time-scales. These risks include human activity and climate variability/change. As the risks in designing and operating water systems and allocating available supplies vary systematically in time, prospects for predicting and managing such risks become increasingly attractive. Considerable effort has been undertaken to improve seasonal forecast skill and advocate for integration to reduce risk, however only minimal adoption is evident. Impediments are well defined, yet tailoring forecast products and allowing for flexible adoption assist in overcoming some obstacles. The semi-arid Elqui River basin in Chile is contending with increasing levels of water stress and demand coupled with insufficient investment in infrastructure, taxing its ability to meet agriculture, hydropower, and environmental requirements. The basin is fed from a retreating glacier, with allocation principles founded on a system of water rights and markets. A two-stage seasonal streamflow forecast at leads of one and two seasons prescribes the probability of reductions in the value of each water right, allowing water managers to inform their constituents in advance. A tool linking the streamflow forecast to a simple reservoir decision model also allows water managers to select a level of confidence in the forecast information.

  15. Essential problems in the interpretation of epidemiologic evidence for an association between mobile phone use and brain tumours

    NASA Astrophysics Data System (ADS)

    Kundi, Michael

    2010-11-01

    Due to the close proximity of a mobile phone to the head when placing a call, concerns have been raised that exposure from microwaves during mobile phone use may exert adverse health effects and, in particular, may increase the risk of brain tumours. In response to these concerns epidemiological studies have been conducted, most applying the case-control design. While epidemiology can provide decisive evidence for an association between an exposure and a disease fundamental problems arise if exposure is short compared to the natural history of the disease. For brain tumours latencies of decades have been implicated making special considerations about potential effects of exposures necessary that commence during an already growing tumour. It is shown that measures of disease risk like odds ratios and relative risks can under such circumstances not be interpreted as indicators of a long term effect on incidences in the exposed population. Besides this problem, the issues of a suitable exposure metric and the selection of endpoints are unresolved. It is shown that the solution of these problems affords knowledge about the mechanism of action by which exposure increases the risk of manifest disease.

  16. Influence of diabetes on the risk of urothelial cancer according to body mass index: a 10-year nationwide population-based observational study.

    PubMed

    Bae, Woong Jin; Choi, Jin Bong; Moon, Hyong Woo; Park, Young Hyun; Cho, Hyuk Jin; Hong, Sung-Hoo; Lee, Ji Youl; Kim, Sae Woong; Han, Kyung-Do; Ha, U-Syn

    2018-01-01

    To examine the association between obesity and urothelial cancer, we used a representative data from the National Health Insurance System (NHIS). Participants included 826,170 men aged 20 years and older who experienced a health examination at least one time between 2004 and 2008. The study thus excluded people aged <20 years and women. We used a multivariate adjusted Cox regression analysis to examine the association between urothelial cancer and body mass index (BMI) via a hazard ratio (HR) and 95% confidence interval (CI). The age- or multivariable-adjusted HR for urothelial cancer was stratified by BMI. Men with a higher BMI were more likely to acquire urothelial cancer independent of variables. In the population with diabetes, there showed a considerable, increasing trend in the risk of urothelial cancer in the overweight and obesity group, compared to the group with the same BMI but without diabetes. This population-based study showed evidence of an association between obesity and the development of urothelial cancer, where the presence of diabetes increased the risk of urothelial cancer. Additionally, the higher the BMI, the higher the risk for urothelial cancer.

  17. Social risk or genetic liability for psychosis? A study of children born in Sweden and reared by adoptive parents.

    PubMed

    Wicks, Susanne; Hjern, Anders; Dalman, Christina

    2010-10-01

    Recent studies suggest a role for social factors during childhood in the later development of schizophrenia. Since social conditions in childhood are closely related to parental psychiatric illness, there is a need to disentangle how genes and social environmental factors interact. A total of 13,163 children born in Sweden between 1955 and 1984 and reared in Swedish adoptive families were linked to the National Patient Register until 2006 regarding admissions for non-affective psychoses, including schizophrenia. Hazard ratios for nonaffective psychoses were estimated in relation to three indicators of socioeconomic position in childhood (household data of the rearing family obtained via linkage to the National Censuses of 1960-1985) and in relation to indicator of genetic liability (biological parental inpatient care for psychosis). In addition, the total Swedish-born population was investigated. Increased risks for nonaffective psychosis were found among adoptees (without biological parental history of psychosis) reared in families with disadvantaged socioeconomic position, which consisted of adoptive parental unemployment (hazard ratio=2.0), single-parent household (hazard ratio=1.2), and living in apartments (hazard ratio=1.3). The risk was also increased among persons with genetic liability for psychosis alone (hazard ratio=4.7). Among those exposed to both genetic liability and a disadvantaged socioeconomic situation in childhood, the risk was considerably higher (hazard ratio=15.0, 10.3, and 5.7 for parental unemployment, single-parent household, and apartment living, respectively). Analyses in the larger population supported these results. The results indicate that children reared in families with a disadvantaged socioeconomic position have an increased risk for psychosis. There was also some support for an interaction effect, suggesting that social disadvantage increases this risk more in children with genetic liability for psychosis.

  18. Cryptorchidism and increased risk of neurodevelopmental disorders.

    PubMed

    Chen, Jianping; Sørensen, Henrik Toft; Miao, Maohua; Liang, Hong; Ehrenstein, Vera; Wang, Ziliang; Yuan, Wei; Li, Jiong

    2018-01-01

    Male congenital malformations as cryptorchidism may contribute to the development of neurodevelopmental disorders directly or via shared familial genetic and/or environmental factors, but the evidence is sparse. Using population-based health registries, we conducted a cohort study of all liveborn singleton boys in Denmark during 1979-2008. Boys with a diagnosis of cryptorchidism were categorized into the exposed cohort and the other boys into the unexposed comparison cohort. The outcomes were diagnoses of any neurodevelopmental disorders and their subtypes. We used Cox proportional hazards regression to compute hazard ratios (HRs), taking into consideration several potential confounders. Among 884,083 male infants, 27,505 received a diagnosis of cryptorchidism during follow-up. Boys with cryptorchidism were more likely to be diagnosed with intellectual disability (HR = 1.77; 95%confidence interval [CI]:1.59,1.97), autism spectrum disorders (ASD) (HR = 1.24; 95% CI:1.13,1.35), attention-deficit hyperactivity disorder (ADHD) (HR = 1.17; 95% CI: 1.08,1.26), anxiety (HR = 1.09; 95% CI: 1.01,1.17), and other behavioral/emotional disorders (HR = 1.16; 95% CI: 1.08,1.26) compared to boys without cryptorchidism. The observed risks of intellectual disability, ASD, and ADHD were increased further in boys with bilateral cryptorchidism. Except for anxiety, cryptorchid boys had higher risks of neurodevelopmental disorders than their non-cryptorchid full brothers. The observed increased risks were similar among boys who underwent orchiopexy, as well as among those with shorter waiting times for this surgery. Cryptorchidism may be associated with increased risks of intellectual disability, ASD, ADHD, and other behavioral/emotional disorders. Cryptorchidism and neurodevelopmental disorders may have shared genetic or in-utero/early postnatal risk factors, which need to be further investigated. Copyright © 2017. Published by Elsevier Ltd.

  19. Aligning policy to promote cascade genetic screening for prevention and early diagnosis of heritable diseases.

    PubMed

    George, Rani; Kovak, Karen; Cox, Summer L

    2015-06-01

    Cascade genetic screening is a methodology for identifying and testing close blood relatives of individuals at increased risk for heritable conditions and follows a sequential process, minimizing testing costs and the number of family members who need to be tested. It offers considerable potential for cost savings and increased awareness of heritable conditions within families. CDC-classified Tier 1 genomic applications for hereditary breast and ovarian cancer syndrome (HBOC), Lynch Syndrome (LS), and familial hypercholesterolemia (FH) are recommended for clinical use and support the use of cascade genetic screening. Most individuals are unaware of their increased risk for heritable conditions such as HBOC, LS, and FH. Consistent implementation of cascade genetic screening could significantly increase awareness and prevention of heritable conditions. Limitations to effective implementation of cascade genetic screening include: insufficient genetic risk assessment and knowledge by a majority of healthcare providers without genetics credentials; a shortage of genetic specialists, especially in rural areas; a low rate of reimbursement for comprehensive genetic counseling services; and an individual focus on prevention by clinical guidelines and insurance coverage. The family-centric approach of cascade genetic screening improves prevention and early diagnosis of heritable diseases on a population health level. Cascade genetic screening could be better supported and augmented through changes in health policy.

  20. Pregnancy and the Use of Disease-Modifying Therapies in Patients with Multiple Sclerosis: Benefits versus Risks

    PubMed Central

    Altintas, Ayse; Al Jumah, Mohammed; Sahraian, Mohammadali; Alsharoqi, Issa; AlTahan, Abdurahman; Dahdaleh, Maurice; Deleu, Dirk; Fernandez, Oscar; Inshasi, Jihad; Karabudak, Rana; Taha, Karim; Totolyan, Natalia; Yamout, Bassem I.; Zakaria, Magd; Bohlega, Saeed

    2016-01-01

    The burden of multiple sclerosis (MS) in women of childbearing potential is increasing, with peak incidence around the age of 30 years, increasing incidence and prevalence, and growing female : male ratio. Guidelines recommend early use of disease-modifying therapies (DMTs), which are contraindicated or recommended with considerable caution, during pregnancy/breastfeeding. Many physicians are reluctant to prescribe them for a woman who is/is planning to be pregnant. Interferons are not absolutely contraindicated during pregnancy, since interferon-β appears to lack serious adverse effects in pregnancy, despite a warning in its labelling concerning risk of spontaneous abortion. Glatiramer acetate, natalizumab, and alemtuzumab also may not induce adverse pregnancy outcomes, although natalizumab may induce haematologic abnormalities in newborns. An accelerated elimination procedure is needed for teriflunomide if pregnancy occurs on treatment or if pregnancy is planned. Current evidence supports the contraindication for fingolimod during pregnancy; data on other DMTs remains limited. Increased relapse rates following withdrawal of some DMTs in pregnancy are concerning and require further research. The postpartum period brings increased risk of disease reactivation that needs to be carefully addressed through effective communication between treating physicians and mothers intending to breastfeed. We address the potential for use of the first- and second-line DMTs in pregnancy and lactation. PMID:28078140

  1. Prevention of inhibitor development in hemophilia A in 2016. A glimpse into the future?

    PubMed

    Franchini, Massimo; Lippi, Giuseppe

    2016-12-01

    Thanks to considerable progresses made over the last 30years, hemophilia benefits from the most efficacious and safe treatment among the many monogenic inherited disorders. The most challenging complication of replacement therapy in hemophilia A is the occurrence of alloantibodies against infused factor VIII (FVIII), thus predisposing the patients to increased morbidity and disability. Extensive research in this field has definitively unraveled that development of inhibitors in hemophilia A is a complex and multifactorial process, in which inherited and environmental factors dynamically interact. This narrative review, after providing a concise overview about the main genetic and non-genetic risk factors, is aimed to focus on prediction risk models and preventive strategies for minimizing the risk of developing inhibitors in hemophilia A patients. Copyright © 2016 Elsevier Ltd. All rights reserved.

  2. Hepatitis C, human immunodeficiency virus and metabolic syndrome: interactions.

    PubMed

    Kotler, Donald P

    2009-03-01

    Significant concerns have been raised about the metabolic effects of antiretroviral medication, including the classic triad of dyslipidaemia, insulin resistance (IR) and characteristic alterations in fat distribution (lipoatrophy and lipohypertrophy). Co-infection with hepatitis C appears to exacerbate IR, reduce serum lipids and induce prothrombotic changes in the treated human immunodeficiency virus patient. The effects of co-infection are complex. While combination antiretroviral therapy has been shown to be associated with an increased risk of cardiovascular events through promotion of dyslipidaemia, IR and fat redistribution, co-infection exacerbates IR while reducing serum lipids. Co-infection also promotes a prothrombotic state characterized by endothelial dysfunction and platelet activation, which may enhance risk for cardiovascular disease. Consideration must be given to selection of appropriate treatment regimens and timing of therapy in co-infected patients to minimize metabolic derangements and, ultimately, reduce cardiovascular risk.

  3. Spatiotemporal analysis of the agricultural drought risk in Heilongjiang Province, China

    NASA Astrophysics Data System (ADS)

    Pei, Wei; Fu, Qiang; Liu, Dong; Li, Tian-xiao; Cheng, Kun; Cui, Song

    2017-06-01

    Droughts are natural disasters that pose significant threats to agricultural production as well as living conditions, and a spatial-temporal difference analysis of agricultural drought risk can help determine the spatial distribution and temporal variation of the drought risk within a region. Moreover, this type of analysis can provide a theoretical basis for the identification, prevention, and mitigation of drought disasters. In this study, the overall dispersion and local aggregation of projection points were based on research by Friedman and Tukey (IEEE Trans on Computer 23:881-890, 1974). In this work, high-dimensional samples were clustered by cluster analysis. The clustering results were represented by the clustering matrix, which determined the local density in the projection index. This method avoids the problem of determining a cutoff radius. An improved projection pursuit model is proposed that combines cluster analysis and the projection pursuit model, which offer advantages for classification and assessment, respectively. The improved model was applied to analyze the agricultural drought risk of 13 cities in Heilongjiang Province over 6 years (2004, 2006, 2008, 2010, 2012, and 2014). The risk of an agricultural drought disaster was characterized by 14 indicators and the following four aspects: hazard, exposure, sensitivity, and resistance capacity. The spatial distribution and temporal variation characteristics of the agricultural drought risk in Heilongjiang Province were analyzed. The spatial distribution results indicated that Suihua, Qigihar, Daqing, Harbin, and Jiamusi are located in high-risk areas, Daxing'anling and Yichun are located in low-risk areas, and the differences among the regions were primarily caused by the aspects exposure and resistance capacity. The temporal variation results indicated that the risk of agricultural drought in most areas presented an initially increasing and then decreasing trend. A higher value for the exposure aspect increased the risk of drought, whereas a higher value for the resistance capacity aspect reduced the risk of drought. Over the long term, the exposure level of the region presented limited increases, whereas the resistance capacity presented considerable increases. Therefore, the risk of agricultural drought in Heilongjiang Province will continue to exhibit a decreasing trend.

  4. Anxiety: towards a decision-theoretic perspective.

    PubMed

    Shechter, M; Zeidner, M

    1990-05-01

    This paper sets out to illustrate how anxiety may be incorporated into a formal decision theoretic utility model of choice, and to suggest several measurement procedures towards that end. The major propositions derived and posited in this paper lend considerable support to intuitive notions with respect to the effects of anxiety on human behaviour in risky decision situations. Namely, that the willingness of an individual to pay to reduce health risks (an economic indicator of individual welfare associated with reduced morbidity or increased longevity) tends to be positive and higher when anxiety is present than when it is not. The formal results of the analysis show that when psychological considerations are incorporated into a state-dependent utility model, the normative results customarily obtained concerning value-of-life need to be qualified.

  5. The cardiovascular system and diving risk.

    PubMed

    Bove, Alfred A

    2011-01-01

    Recreational scuba diving is a sport that requires a certain physical capacity, in addition to consideration of the environmental stresses produced by increased pressure, low temperature and inert gas kinetics in tissues of the body. Factors that may influence ability to dive safely include age, physical conditioning, tolerance of cold, ability to compensate for central fluid shifts induced by water immersion, and ability to manage exercise demands when heart disease might compromise exercise capacity. Patients with coronary heart disease, valvular heart disease, congenital heart disease and cardiac arrhythmias are capable of diving, but consideration must be given to the environmental factors that might interact with the cardiac disorder. Understanding of the interaction of the diving environment with various cardiac disorders is essential to providing a safe diving environment to individual divers with known heart disease.

  6. Risk Mechanisms in Development: Some Conceptual and Methodological Considerations.

    ERIC Educational Resources Information Center

    O'Connor, Thomas G.; Rutter, Michael

    1996-01-01

    Comments on problems raised in this special issue, focusing on the distinctive aspects of the risk research reported. Highlights issues like sample characteristics, measurement strategies, specificity of risk factors, and risk mechanisms. Discusses the challenges of integrating alternative models of risk, with special references to research into…

  7. Liver and gallbladder cancer in immigrants to Sweden.

    PubMed

    Hemminki, Kari; Mousavi, Seyed Mohsen; Brandt, Andreas; Ji, Jianguang; Sundquist, Jan

    2010-03-01

    The changes of cancer incidence upon immigration can be used as an estimator of environmental influence on cancer risk. We studied site-specific liver and biliary cancers in first-generation immigrants to Sweden with an aim to search for aetiological clues and to find evidence for indigenous incidence rates. We used the nation-wide Swedish Family-Cancer Database to calculate standardised incidence ratios (SIRs) in immigrants compared to native Swedes. A total of 1428 cancers were identified in immigrants whose median ages (years) at immigration were 27 for men and 26 for women and whose median diagnostic ages were 64 and 66, respectively. The highest SIRs of 6.7 for primary liver cancer were observed for men from East Asia and sub-Saharan Africa. Increased SIRs were recorded for male immigrants from previous Yugoslavia (1.78), Southern Europe (2.91), Turkey (2.15) and Asian Arab countries (2.89). For gallbladder cancer, only women from the Indian subcontinent (3.84) and Chile (2.34) had increased risk while some Northern European immigrants showed decreased risks. Primary liver cancer was increased in immigrants from endemic regions of hepatitis B virus infection but also from large regions lacking cancer incidence data, North Africa, Asian Arab countries, Turkey and previous Yugoslavia; these are probably intermediary risk regions for this infection. The consideration of these regions as risk areas would justify active diagnostic and vaccination programs. The increase in gallbladder cancer in Chileans and Indians suggests that some persistent damage was inflicted before emigration, characterisation of which will be a challenge for aetiological studies. Copyright 2009 Elsevier Ltd. All rights reserved.

  8. Episodic HIV Risk Behavior Can Greatly Amplify HIV Prevalence and the Fraction of Transmissions from Acute HIV Infection.

    PubMed

    Zhang, Xinyu; Zhong, Lin; Romero-Severson, Ethan; Alam, Shah Jamal; Henry, Christopher J; Volz, Erik M; Koopman, James S

    2012-11-01

    A deterministic compartmental model was explored that relaxed the unrealistic assumption in most HIV transmission models that behaviors of individuals are constant over time. A simple model was formulated to better explain the effects observed. Individuals had a high and a low contact rate and went back and forth between them. This episodic risk behavior interacted with the short period of high transmissibility during acute HIV infection to cause dramatic increases in prevalence as the differences between high and low contact rates increased and as the duration of high risk better matched the duration of acute HIV infection. These same changes caused a considerable increase in the fraction of all transmissions that occurred during acute infection. These strong changes occurred despite a constant total number of contacts and a constant total transmission potential from acute infection. Two phenomena played a strong role in generating these effects. First, people were infected more often during their high contact rate phase and they remained with high contact rates during the highly contagious acute infection stage. Second, when individuals with previously low contact rates moved into an episodic high-risk period, they were more likely to be susceptible and thus provided more high contact rate susceptible individuals who could get infected. These phenomena make test and treat control strategies less effective and could cause some behavioral interventions to increase transmission. Signature effects on genetic patterns between HIV strains could make it possible to determine whether these episodic risk effects are acting in a population.

  9. Risk factors associated with Cryptosporidium parvum infection in dairy cattle in southeastern New York State.

    PubMed

    Mohammed, H O; Wade, S E; Schaaf, S

    1999-06-01

    An observational analytical epidemiologic study was carried out to identify factors associated with the risk of infection with Cryptosporidium parvum in dairy herds in southeastern New York state. A random sample of 2943 cattle on 109 farms was selected from the target population. Fecal samples were collected from animals in three different age groups and examined for the presence of C. parvum using a quantitative centrifugation concentration flotation method. Data on intrinsic, preweaning, postweaning, maternity, and general management factors were collected and evaluated for their association with the risk of infection with C. parvum. Indices for each of these categories of management were developed from factors significantly associated with the risk of infection with C. parvum. Significant factors were identified using the logistic regression statistical technique. A final analysis, including the indices, age, and season, was performed to identify factors significantly associated with the risk of infection with C. parvum while simultaneously controlling for the effect of other factors. The farm effect was evaluated using a mixed effect model. Preweaning factors found to be significantly associated with a decreased risk of infection were: use of ventilation in calf rearing areas, daily addition of bedding, feeding of milk replacer, daily disposal and cleaning of bedding, and use of antibiotics. Postweaning factors such as moving of the animals after weaning, cleaning of soiled bedding, and use of antibiotics and ionophores as preventive measures were significantly associated with the decreased risk of an infection with C. parvum. Consideration of maternity management factors showed that winter housing of cows individually within 2 months of calving, use of fresh colostrum to feed calves, and having a concrete floor in the calving area were significantly associated with decreased risk of C. parvum infection. The total number of dairy cattle, total number of other species of agricultural animals on the farm, and the distance of the barn water source from the septic system were found to be significantly associated with increased risk of C. parvum infection. In the final analysis, the risk of infection with C. parvum was significantly decreased with an increased value of the maternity management index score. The general management significantly affected the risk of infection with C. parvum where the risk increased with the increase of the value of the index. The risk of infection significantly decreased with increase in the age of the animal.

  10. 16 CFR 314.4 - Elements.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... program. (b) Identify reasonably foreseeable internal and external risks to the security, confidentiality... in place to control these risks. At a minimum, such a risk assessment should include consideration of risks in each relevant area of your operations, including: (1) Employee training and management; (2...

  11. Nucleic acids-based tools for ballast water surveillance, monitoring, and research

    NASA Astrophysics Data System (ADS)

    Darling, John A.; Frederick, Raymond M.

    2018-03-01

    Understanding the risks of biological invasion posed by ballast water-whether in the context of compliance testing, routine monitoring, or basic research-is fundamentally an exercise in biodiversity assessment, and as such should take advantage of the best tools available for tackling that problem. The past several decades have seen growing application of genetic methods for the study of biodiversity, driven in large part by dramatic technological advances in nucleic acids analysis. Monitoring approaches based on such methods have the potential to increase dramatically sampling throughput for biodiversity assessments, and to improve on the sensitivity, specificity, and taxonomic accuracy of traditional approaches. The application of targeted detection tools (largely focused on PCR but increasingly incorporating novel probe-based methodologies) has led to a paradigm shift in rare species monitoring, and such tools have already been applied for early detection in the context of ballast water surveillance. Rapid improvements in community profiling approaches based on high throughput sequencing (HTS) could similarly impact broader efforts to catalogue biodiversity present in ballast tanks, and could provide novel opportunities to better understand the risks of biotic exchange posed by ballast water transport-and the effectiveness of attempts to mitigate those risks. These various approaches still face considerable challenges to effective implementation, depending on particular management or research needs. Compliance testing, for instance, remains dependent on accurate quantification of viable target organisms; while tools based on RNA detection show promise in this context, the demands of such testing require considerable additional investment in methods development. In general surveillance and research contexts, both targeted and community-based approaches are still limited by various factors: quantification remains a challenge (especially for taxa in larger size classes), gaps in nucleic acids reference databases are still considerable, uncertainties in taxonomic assignment methods persist, and many applications have not yet matured sufficiently to offer standardized methods capable of meeting rigorous quality assurance standards. Nevertheless, the potential value of these tools, their growing utilization in biodiversity monitoring, and the rapid methodological advances over the past decade all suggest that they should be seriously considered for inclusion in the ballast water surveillance toolkit.

  12. Long-Acting Opioid Use Independently Predicts Perioperative Complication in Total Joint Arthroplasty.

    PubMed

    Sing, David C; Barry, Jeffrey J; Cheah, Jonathan W; Vail, Thomas P; Hansen, Erik N

    2016-09-01

    Opioid therapy is an increasingly used modality for treatment of musculoskeletal pain despite multiple associated risks. The purpose of this study was to evaluate how preoperative opioid use affects early outcomes after total joint arthroplasty. A total of 174 patients undergoing total joint arthroplasty were matched by age, gender, and procedure into 3 groups stratified by preoperative opioid use (nonuser, short acting [eg, Vicodin], long acting [eg, Oxycontin]). Compared to nonusers, preoperative long-acting use was associated with increased postoperative mean opioid consumption (46 mg vs 366 mg mean morphine equivalents, P < .001) and independently predicted complications within 90 days (odds ratio: 6.15, confidence interval: [1.46, 25.95], P = .013). Preoperative opioid use should be disclosed as a risk factor for complication to patients and taken into consideration by physicians before initiating opioid management. Copyright © 2016 Elsevier Inc. All rights reserved.

  13. Hypercortisolism in obesity-associated hypertension.

    PubMed

    Varughese, Amy G; Nimkevych, Oksana; Uwaifo, Gabriel I

    2014-07-01

    Obesity is prevalent worldwide and associated with co-morbidities that result in increased cardiovascular risk. Hypertension is the most prevalent obesity comorbidity associated with increased cardiovascular risk. Obesity hypertension is a distinct subtype of essential hypertension. While endogenous Cushing's syndrome is an uncommon cause of both obesity and hypertension, the recent recognition of other hypercortisolemic states has raised the profile of hypercortisolism as an important contributor in obesity hypertension. The high prevalence of exogenous, iatrogenic, pseudo, and subclinical Cushing's syndromes makes hypercortisolism an important diagnostic consideration in the evaluation and management of patients with obesity hypertension who are resistant to conventional management. Available data suggest that the renin-angiotensin-aldosterone system modulating antihypertensives have the best efficacy in hypercortisolism-mediated obesity hypertension. Strategies aimed at reducing cortisol production and action also have utility. This review provides a comprehensive overview of the epidemiology, etiopathogenesis and management options available for glucocorticoid-mediated obesity hypertension.

  14. Neurobiological consequences of childhood trauma.

    PubMed

    Nemeroff, Charles B

    2004-01-01

    There is considerable evidence to suggest that adverse early-life experiences have a profound effect on the developing brain. Neurobiological changes that occur in response to untoward early-life stress can lead to lifelong psychiatric sequelae. Children who are exposed to sexual or physical abuse or the death of a parent are at higher risk for development of depressive and anxiety disorders later in life. Preclinical and clinical studies have shown that repeated early-life stress leads to alterations in central neurobiological systems, particularly in the corticotropin-releasing factor system, leading to increased responsiveness to stress. Clearly, exposure to early-life stressors leads to neurobiological changes that increase the risk of psychopathology in both children and adults. Identification of the neurobiological substrates that are affected by adverse experiences in early life should lead to the development of more effective treatments for these disorders. The preclinical and clinical studies evaluating the consequences of early-life stress are reviewed.

  15. Personality and learning predictors of adolescent alcohol consumption trajectories.

    PubMed

    Peterson, Sarah J; Davis, Heather A; Smith, Gregory T

    2018-05-31

    In a sample of 1,897 youth studied across the last year of elementary school to the second year of high school, we identified five trajectories of drinking frequency. Three of those (nondrinkers, middle onset, and late onset drinkers) were not drinking in elementary school; two others (moderate drinkers and early high drinkers) were. Among originally nondrinking groups, multiple impulsigenic traits and the acquired preparedness risk model predicted membership in groups that subsequently began drinking. Membership in trajectory groups characterized by drinking during this age period was associated with (a) the experience of alcohol-related problems and (b) further increases in both impulsigenic traits and alcohol expectancies. Youth vary considerably in the development of drinking behavior across the transitions from elementary to high school. Harms associated with early drinking involve both problems from drinking and increases in high-risk personality traits. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

  16. The mental health of prisoners: a review of prevalence, adverse outcomes and interventions

    PubMed Central

    Fazel, Seena; Hayes, Adrian J; Bartellas, Katrina; Clerici, Massimo; Trestman, Robert

    2016-01-01

    There are more than 10 million prisoners worldwide, and the prevalence of all investigated mental disorders is higher than general population comparisons. Although the extent to which prison increases the incidence of mental disorders is uncertain, there is considerable evidence of low rates of identification and treatment of psychiatric disorders. Prisoners are also at increased risk of all-cause mortality, suicide, self-harm, violence, and victimization, and research has outlined some modifiable risk factors. High quality treatment trials for psychiatric disorders in prisoners have been limited. Despite this, it has been shown in trials that opiate substitution treatments reduce substance misuse relapse and possibly reoffending. The mental health needs of women and older adults in prison are distinct, and national policies should be developed to meet these. Clinical, research, and policy recommendations to improve prison mental healthcare are presented. National attempts to meet these recommendations should be annually surveyed. PMID:27426440

  17. Best Practices in Management of Postpartum Pain.

    PubMed

    Fahey, Jenifer O

    Pain has been documented as a major concern for women in the postpartum period. Management of postpartum pain, however, is a relatively neglected area of clinical research. As a result, evidence to support interventions to alleviate the discomforts associated with childbirth is sparse. This paucity of research on postpartum pain management is particularly surprising given that in the United States alone nearly 4 million women give birth each year. Inadequate pain relief in the hours to months following childbirth can interfere with maternal-newborn bonding and feeding and, by impeding mobility, can increase the risk of postpartum complications. In addition, pain that is not adequately managed may increase the risk of chronic pain that lasts beyond the postpartum period. In this article, the more common causes of pain following childbirth are reviewed and recommendations for pain management based on available evidence are outlined. Considerations for pain management in lactating women and for hospital discharge are discussed.

  18. Insulin Resistance of Puberty.

    PubMed

    Kelsey, Megan M; Zeitler, Philip S

    2016-07-01

    Puberty is a time of considerable metabolic and hormonal change. Notably, puberty is associated with a marked decrease in insulin sensitivity, on par with that seen during pregnancy. In otherwise healthy youth, there is a nadir in insulin sensitivity in mid-puberty, and then it recovers at puberty completion. However, there is evidence that insulin resistance (IR) does not resolve in youth who are obese going into puberty and may result in increased cardiometabolic risk. Little is known about the underlying pathophysiology of IR in puberty, and how it might contribute to increased disease risk (e.g., type 2 diabetes). In this review, we have outlined what is known about the IR in puberty in terms of pattern, potential underlying mechanisms and other mediating factors. We also outline other potentially related metabolic changes that occur during puberty, and effects of underlying insulin resistant states (e.g., obesity) on pubertal changes in insulin sensitivity.

  19. PREDICTING RECIDIVISM FOR RELEASED STATE PRISON OFFENDERS

    PubMed Central

    Stahler, Gerald J.; Mennis, Jeremy; Belenko, Steven; Welsh, Wayne N.; Hiller, Matthew L.; Zajac, Gary

    2013-01-01

    We examined the influence of individual and neighborhood characteristics and spatial contagion in predicting reincarceration on a sample of 5,354 released Pennsylvania state prisoners. Independent variables included demographic characteristics, offense type, drug involvement, various neighborhood variables (e.g., concentrated disadvantage, residential mobility), and spatial contagion (i.e., proximity to others who become reincarcerated). Using geographic information systems (GIS) and logistic regression modeling, our results showed that the likelihood of reincarceration was increased with male gender, drug involvement, offense type, and living in areas with high rates of recidivism. Older offenders and those convicted of violent or drug offenses were less likely to be reincarcerated. For violent offenders, drug involvement, age, and spatial contagion were particular risk factors for reincarceration. None of the neighborhood environment variables were associated with increased risk of reincarceration. Reentry programs need to particularly address substance abuse issues of ex-offenders as well as take into consideration their residential locations. PMID:24443612

  20. Sublethal Lead Exposure Alters Movement Behavior in Free-Ranging Golden Eagles.

    PubMed

    Ecke, Frauke; Singh, Navinder J; Arnemo, Jon M; Bignert, Anders; Helander, Björn; Berglund, Åsa M M; Borg, Hans; Bröjer, Caroline; Holm, Karin; Lanzone, Michael; Miller, Tricia; Nordström, Åke; Räikkönen, Jannikke; Rodushkin, Ilia; Ågren, Erik; Hörnfeldt, Birger

    2017-05-16

    Lead poisoning of animals due to ingestion of fragments from lead-based ammunition in carcasses and offal of shot wildlife is acknowledged globally and raises great concerns about potential behavioral effects leading to increased mortality risks. Lead levels in blood were correlated with progress of the moose hunting season. Based on analyses of tracking data, we found that even sublethal lead concentrations in blood (25 ppb, wet weight), can likely negatively affect movement behavior (flight height and movement rate) of free-ranging scavenging Golden Eagles (Aquila chrysaetos). Lead levels in liver of recovered post-mortem analyzed eagles suggested that sublethal exposure increases the risk of mortality in eagles. Such adverse effects on animals are probably common worldwide and across species, where game hunting with lead-based ammunition is widespread. Our study highlights lead exposure as a considerably more serious threat to wildlife conservation than previously realized and suggests implementation of bans of lead ammunition for hunting.

  1. Advanced heart failure due to cancer therapy.

    PubMed

    Shah, Sachin; Nohria, Anju

    2015-01-01

    Certain chemotherapeutic agents and mediastinal irradiation can be cardiotoxic and place cancer survivors at risk for developing advanced heart failure (HF). Anthracyclines are the prototypical agents associated with left ventricular (LV) dysfunction. Newer agents including trastuzumab and certain tyrosine kinase inhibitors such as sunitinib can also cause cardiomyopathy. Cancer survivors with advanced HF refractory to standard medical management should be considered for advanced therapies, including mechanical circulatory support (MCS) and transplantation. While overall outcomes after MCS and transplantation are similar in cancer survivors compared to other etiologies of HF, patients with radiation-induced restrictive cardiomyopathy have a significantly worse prognosis after transplantation. The increased need for right ventricular (RV) support after MCS in cancer survivors necessitates a careful evaluation for pre-operative RV dysfunction. Special consideration must also be given to the risk for recurrent malignancy, neurocognitive dysfunction, and increased psychological needs in this patient population.

  2. New trends of short-term humanitarian medical volunteerism: professional and ethical considerations.

    PubMed

    Asgary, Ramin; Junck, Emily

    2013-10-01

    Short-term humanitarian medical volunteerism has grown significantly among both clinicians and trainees over the past several years. Increasingly, both volunteers and their respective institutions have faced important challenges in regard to medical ethics and professional codes that should not be overlooked. We explore these potential concerns and their risk factors in three categories: ethical responsibilities in patient care, professional responsibility to communities and populations, and institutional responsibilities towards trainees. We discuss factors increasing the risk of harm to patients and communities, including inadequate preparation, the use of advanced technology and the translation of Western medicine, issues with clinical epidemiology and test utility, difficulties with the principles of justice and clinical justice, the lack of population-based medicine, sociopolitical effects of foreign aid, volunteer stress management, and need for sufficient trainee supervision. We review existing resources and offer suggestions for future skill-based training, organisational responsibilities, and ethical preparation.

  3. Treatment of impulse control disorders in Parkinson's disease: Practical considerations and future directions.

    PubMed

    Ramirez-Zamora, Adolfo; Gee, Lucy; Boyd, James; Biller, José

    2016-01-01

    Impulse control disorders (ICDs) including compulsive gambling, buying, sexual behaviors, and eating occur relatively frequently in Parkinson disease (PD) with at least one ICD identified in 14% of PD patients in a large, multicenter, observational study. ICDs behaviors range widely in severity but can lead to catastrophic consequences, including financial ruin, divorce, loss of employment, and increased health risks. The main risk factor for ICDs in PD is the use of Dopamine agonists (DAs) and discontinuation of the offending agent is considered first line treatment. However, many patients do not tolerate this intervention as consequence of increased motor and psychiatric disability or appearance of DA withdrawal syndrome. In this article, we review current management strategies and emerging new interventions for treatment of ICDs in PD. Pharmacological treatment should be individualized based on patient's unique neuropsychiatric profile, social support, medical comorbidities, tolerability and motor symptoms.

  4. Elderly postmenopausal patients with breast cancer are at increased risk for distant recurrence: a tamoxifen exemestane adjuvant multinational study analysis.

    PubMed

    van de Water, Willemien; Seynaeve, Caroline; Bastiaannet, Esther; Markopoulos, Christos; Jones, Steve E; Rea, Daniel; Hasenburg, Annette; Putter, Hein; Hille, Elysée T M; Paridaens, Robert; de Craen, Anton J M; Westendorp, Rudi G J; van de Velde, Cornelis J H; Liefers, Gerrit-Jan

    2013-01-01

    For postmenopausal patients with hormone-sensitive breast cancer, outcome is worse with increasing age at diagnosis. The aim of this study was to assess the incidence of breast cancer recurrence (locoregional and distant), and contralateral breast cancer by age at diagnosis. Patients enrolled in the Tamoxifen Exemestane Adjuvant Multinational (TEAM) trial were included. Primary endpoints were locoregional recurrence, distant recurrence, and contralateral breast cancer. Age at diagnosis was categorized as younger than 65 years, 65-74 years, and 75 years or older. Overall, 9,766 patients were included, of which 5,349 were younger than 65 years (reference group), 3,060 were 65-74 years, and 1,357 were 75 years or older. With increasing age, a decreased administration of radiotherapy after breast conserving surgery (94%, 92%, and 88%, respectively) and adjuvant chemotherapy (51%, 23%, and 5%, respectively) was observed. Risk of distant recurrence increased with age at diagnosis; multivariable hazard ratio for patients aged 65-74 years was 1.20 (95% confidence interval [CI]: 1.00-1.44), hazard ratio for patients aged 75 years or older was 1.39 (95% CI: 1.08-1.79). Risks of locoregional recurrence and contralateral breast cancer were not significantly different across age groups. Elderly patients with breast cancer were at increased risk for distant recurrence. Other studies have shown that the risk of distant recurrence is mainly affected by adjuvant systemic therapy. All TEAM patients received adjuvant endocrine treatment; however, chemotherapy was administered less often in elderly patients. These findings are suggestive for consideration of chemotherapy in relatively fit elderly breast cancer patients with hormone-sensitive disease.

  5. Elderly Postmenopausal Patients With Breast Cancer Are at Increased Risk for Distant Recurrence: A Tamoxifen Exemestane Adjuvant Multinational Study Analysis

    PubMed Central

    van de Water, Willemien; Seynaeve, Caroline; Bastiaannet, Esther; Markopoulos, Christos; Jones, Steve E.; Rea, Daniel; Hasenburg, Annette; Putter, Hein; Hille, Elysée T.M.; Paridaens, Robert; de Craen, Anton J.M.; Westendorp, Rudi G.J.; Liefers, Gerrit-Jan

    2013-01-01

    Introduction. For postmenopausal patients with hormone-sensitive breast cancer, outcome is worse with increasing age at diagnosis. The aim of this study was to assess the incidence of breast cancer recurrence (locoregional and distant), and contralateral breast cancer by age at diagnosis. Methods. Patients enrolled in the Tamoxifen Exemestane Adjuvant Multinational (TEAM) trial were included. Primary endpoints were locoregional recurrence, distant recurrence, and contralateral breast cancer. Age at diagnosis was categorized as younger than 65 years, 65–74 years, and 75 years or older. Results. Overall, 9,766 patients were included, of which 5,349 were younger than 65 years (reference group), 3,060 were 65–74 years, and 1,357 were 75 years or older. With increasing age, a decreased administration of radiotherapy after breast conserving surgery (94%, 92%, and 88%, respectively) and adjuvant chemotherapy (51%, 23%, and 5%, respectively) was observed. Risk of distant recurrence increased with age at diagnosis; multivariable hazard ratio for patients aged 65–74 years was 1.20 (95% confidence interval [CI]: 1.00–1.44), hazard ratio for patients aged 75 years or older was 1.39 (95% CI: 1.08–1.79). Risks of locoregional recurrence and contralateral breast cancer were not significantly different across age groups. Conclusion. Elderly patients with breast cancer were at increased risk for distant recurrence. Other studies have shown that the risk of distant recurrence is mainly affected by adjuvant systemic therapy. All TEAM patients received adjuvant endocrine treatment; however, chemotherapy was administered less often in elderly patients. These findings are suggestive for consideration of chemotherapy in relatively fit elderly breast cancer patients with hormone-sensitive disease. PMID:23263290

  6. [Use of a methodology to assess a risk at the stage of substantiating the choice of a ground area for placing industrial enterprises].

    PubMed

    Perminova, L A; Karpenko, I L; Barkhatova, L A; Chekryzhov, I V

    2009-01-01

    Human health risk was screened at the stage of supporting the choice of a building site for a petroleum refinery. Based on the calculated exposure levels, the risk to the Buguruslan population was characterized under different conditions: without consideration for the impact of the projected enterprise; with consideration for the pollutants contained in the emissions of the projected enterprise; at the border of an apartment block and at that of an estimated control area in five receptor points. The assessment of a human risk has revealed that the industrial enterprise cannot be sited on this territory and the estimated control area is inadequate due to the high carcinogenic and toxic risk from the formed emission of the projected enterprise.

  7. Using Risk Assessment Methodologies to Meet Management Objectives

    NASA Technical Reports Server (NTRS)

    DeMott, D. L.

    2015-01-01

    Corporate and program objectives focus on desired performance and results. ?Management decisions that affect how to meet these objectives now involve a complex mix of: technology, safety issues, operations, process considerations, employee considerations, regulatory requirements, financial concerns and legal issues. ?Risk Assessments are a tool for decision makers to understand potential consequences and be in a position to reduce, mitigate or eliminate costly mistakes or catastrophic failures. Using a risk assessment methodology is only a starting point. ?A risk assessment program provides management with important input in the decision making process. ?A pro-active organization looks to the future to avoid problems, a reactive organization can be blindsided by risks that could have been avoided. ?You get out what you put in, how useful your program is will be up to the individual organization.

  8. [Ethics and prevention: environmental and individual disparities].

    PubMed

    Ricciardi, Claudio

    2004-01-01

    The complex interactions which exist between environmental variabilities, genetic susceptibility of population subgroups, and high individual variability for age, sex, gender, ethnicity and general status of health, acquire an ever-increasing bioethical significance. Different risk conditions caused by toxic environmental agents and environmental inequities and inequalities are increasingly evident. "Social determinants" of health increase the probability of health effects and an effective intervention of prevision and prevention for environmental pathologies is needed. The debate on environmental inequalities caused by cultural, social and economic factors and the uncertainty about possible prevention emphasize the limits of the "bio-medical model". Ethics with its further anthropological and philosophical considerations may strongly help to understand the relationship between environmental pollution and health.

  9. Workarounds in the Workplace: A Second Look.

    PubMed

    Seaman, Jennifer B; Erlen, Judith A

    2015-01-01

    Nursing workarounds have garnered increased attention over the past 15 years, corresponding with an increased focus on patient safety and evidence-based practice and a rise in the use of health information technologies (HITs). Workarounds have typically been viewed as deviations from best practice that put patients at risk for poor outcomes. However, this narrow view fails to take into consideration the multifactorial origins of workarounds. The authors explore the ways in which evidence-based protocols and HIT, designed to improve patient safety and quality, can have an unintended consequence of increasing the likelihood of nurses engaging in workarounds. The article also examines workarounds considering the ethical obligations of both nurses and administrative leaders to optimize patient safety and quality.

  10. A risk assessment methodology for critical transportation infrastructure.

    DOT National Transportation Integrated Search

    2002-01-01

    Infrastructure protection typifies a problem of risk assessment and management in a large-scale system. This study offers a methodological framework to identify, prioritize, assess, and manage risks. It includes the following major considerations: (1...

  11. Problem formulation for risk assessment of combined exposures to chemicals and other stressors in humans.

    PubMed

    Solomon, Keith R; Wilks, Martin F; Bachman, Ammie; Boobis, Alan; Moretto, Angelo; Pastoor, Timothy P; Phillips, Richard; Embry, Michelle R

    2016-11-01

    When the human health risk assessment/risk management paradigm was developed, it did not explicitly include a "problem formulation" phase. The concept of problem formulation was first introduced in the context of ecological risk assessment (ERA) for the pragmatic reason to constrain and focus ERAs on the key questions. However, this need also exists for human health risk assessment, particularly for cumulative risk assessment (CRA), because of its complexity. CRA encompasses the combined threats to health from exposure via all relevant routes to multiple stressors, including biological, chemical, physical and psychosocial stressors. As part of the HESI Risk Assessment in the 21st Century (RISK21) Project, a framework for CRA was developed in which problem formulation plays a critical role. The focus of this effort is primarily on a chemical CRA (i.e., two or more chemicals) with subsequent consideration of non-chemical stressors, defined as "modulating factors" (ModFs). Problem formulation is a systematic approach that identifies all factors critical to a specific risk assessment and considers the purpose of the assessment, scope and depth of the necessary analysis, analytical approach, available resources and outcomes, and overall risk management goal. There are numerous considerations that are specific to multiple stressors, and proper problem formulation can help to focus a CRA to the key factors in order to optimize resources. As part of the problem formulation, conceptual models for exposures and responses can be developed that address these factors, such as temporal relationships between stressors and consideration of the appropriate ModFs.

  12. Methodology for evaluation of railroad technology research projects

    DOT National Transportation Integrated Search

    1981-04-01

    This Project memorandum presents a methodology for evaluating railroad research projects. The methodology includes consideration of industry and societal benefits, with special attention given to technical risks, implementation considerations, and po...

  13. The impact of multiplex genetic testing on disease risk perceptions.

    PubMed

    Shiloh, S; deHeer, H D; Peleg, S; Hensley Alford, S; Skapinsky, K; Roberts, J S; Hadley, D W

    2015-02-01

    This study assessed the effects of multiplex genetic testing on disease risk perceptions among 216 healthy adults. Participants, aged 25-40, were recruited through the Multiplex Initiative, which offered a genetic susceptibility test for eight common diseases. Participants completed baseline telephone and web-based surveys prior to making the testing decision. Three months after the receipt of mailed test results, participants completed a follow-up telephone survey. Risk perceptions for the eight diseases were measured at baseline and follow-up, along with beliefs about genetic causation of those diseases. The main results were: (i) mean risk perceptions were considerably stable from baseline to follow-up; (ii) the best predictors of follow-up risk perceptions were the corresponding baseline perceptions and family history; and (iii) within-individuals, most participants increased or decreased their risk perceptions for specific diseases in concordance with the number of risk markers they carry, their family history and their beliefs about genetic causality of diseases. In conclusion, participants presented a vigilant approach to the interpretation of genetic test results, which provides reassurance with regard to a potential inflation of risk perceptions in the population because of multiplex genetic testing. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  14. Ontogeny of energy allocation reveals selective pressure promoting risk-taking behaviour in young fish cohorts

    PubMed Central

    Biro, Peter A; Post, John R; Abrahams, Mark V

    2005-01-01

    Given limited food, prey fishes in a temperate climate must take risks to acquire sufficient reserves for winter and/or to outgrow vulnerability to predation. However, how can we distinguish which selective pressure promotes risk-taking when larger body size is always beneficial? To address this question, we examined patterns of energy allocation in populations of age-0 trout to determine if greater risk-taking corresponds with energy allocation to lipids or to somatic growth. Trout achieved maximum growth rates in all lakes and allocated nearly all of their acquired energy to somatic growth when small in early summer. However, trout in low-food lakes took greater risks to achieve this maximal growth, and therefore incurred high mortality. By late summer, age-0 trout allocated considerable energy to lipids and used previously risky habitats in all lakes. These results indicate that: (i) the size-dependent risk of predation (which is independent of behaviour) promotes risk-taking behaviour of age-0 trout to increase growth and minimize time spent in vulnerable sizes; and (ii) the physiology of energy allocation and behaviour interact to mediate growth/mortality trade-offs for young animals at risk of predation and starvation. PMID:16011918

  15. Traffic, Air Pollution, Minority and Socio-Economic Status: Addressing Inequities in Exposure and Risk

    PubMed Central

    Pratt, Gregory C.; Vadali, Monika L.; Kvale, Dorian L.; Ellickson, Kristie M.

    2015-01-01

    Higher levels of nearby traffic increase exposure to air pollution and adversely affect health outcomes. Populations with lower socio-economic status (SES) are particularly vulnerable to stressors like air pollution. We investigated cumulative exposures and risks from traffic and from MNRiskS-modeled air pollution in multiple source categories across demographic groups. Exposures and risks, especially from on-road sources, were higher than the mean for minorities and low SES populations and lower than the mean for white and high SES populations. Owning multiple vehicles and driving alone were linked to lower household exposures and risks. Those not owning a vehicle and walking or using transit had higher household exposures and risks. These results confirm for our study location that populations on the lower end of the socio-economic spectrum and minorities are disproportionately exposed to traffic and air pollution and at higher risk for adverse health outcomes. A major source of disparities appears to be the transportation infrastructure. Those outside the urban core had lower risks but drove more, while those living nearer the urban core tended to drive less but had higher exposures and risks from on-road sources. We suggest policy considerations for addressing these inequities. PMID:25996888

  16. Considerations for biomarker-targeted intervention strategies for tuberculosis disease prevention.

    PubMed

    Fiore-Gartland, Andrew; Carpp, Lindsay N; Naidoo, Kogieleum; Thompson, Ethan; Zak, Daniel E; Self, Steve; Churchyard, Gavin; Walzl, Gerhard; Penn-Nicholson, Adam; Scriba, Thomas J; Hatherill, Mark

    2018-03-01

    Current diagnostic tests for Mycobacterium tuberculosis (MTB) infection have low prognostic specificity for identifying individuals who will develop tuberculosis (TB) disease, making mass preventive therapy strategies targeting all MTB-infected individuals impractical in high-burden TB countries. Here we discuss general considerations for a risk-targeted test-and-treat strategy based on a highly specific transcriptomic biomarker that can identify individuals who are most likely to progress to active TB disease as well as individuals with TB disease who have not yet presented for medical care. Such risk-targeted strategies may offer a rapid, ethical and cost-effective path towards decreasing the burden of TB disease and interrupting transmission and would also be critical to achieving TB elimination in countries nearing elimination. We also discuss design considerations for a Correlate of Risk Targeted Intervention Study (CORTIS), which could provide proof-of-concept for the strategy. One such study in South Africa is currently enrolling 1500 high-risk and 1700 low-risk individuals, as defined by biomarker status, and is randomizing high-risk participants to TB preventive therapy or standard of care treatment. All participants are monitored for progression to active TB with primary objectives to assess efficacy of the treatment and performance of the biomarker. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

  17. Operationalizing the assessment and management of violence risk in the short-term.

    PubMed

    Doyle, Michael; Logan, Caroline

    2012-01-01

    Assessing risk of violence in the short term is crucial for managing and preventing violence, especially in institutions such as psychiatric units and prisons. Despite a lack of consensus on the definition of "short term", a number of recent tools and guidelines have been developed to aid short-term clinical decision-making. Whereas the supporting evidence for the new tools is impressive, limitations remain in terms of the focus on prediction, limited consideration of strengths, and poor integration with formulation and risk management. The Short-Term Assessment of Risk and Treatability (START) is a brief clinical guide for the dynamic assessment of risks, strengths and treatability. It focuses on short-term risks and the characteristics of the individual that, if changed, might lead to an increase or decrease in risk. The START has the potential to operationalize the structured professional judgment (SPJ) approach in order to inform the evaluation of multiple risk domains relevant to everyday psychiatric clinical practice. However, explicit guidance on integrating risk assessment, formulation and management is limited in the START and this paper describes the SPJ approach, reviews recent developments in approaches to risk, and considers how the START can be used to inform SPJ approaches and link risk assessment, formulation, and management. Copyright © 2012 John Wiley & Sons, Ltd.

  18. Predictors associated with MRI surveillance screening in women with a personal history of unilateral breast cancer but without a genetic predisposition for future contralateral breast cancer.

    PubMed

    Hegde, John V; Wang, Xiaoyan; Attai, Deanna J; DiNome, Maggie L; Kusske, Amy; Hoyt, Anne C; Hurvitz, Sara A; Weidhaas, Joanne B; Steinberg, Michael L; McCloskey, Susan A

    2017-11-01

    For women with a personal history of breast cancer (PHBC), no validated mechanisms exist to calculate future contralateral breast cancer (CBC) risk. The Manchester risk stratification guidelines were developed to evaluate CBC risk in women with a PHBC, primarily for surgical decision making. This tool may be informative for the use of MRI screening, as CBC risk is an assumed consideration for high-risk surveillance. Three hundred twenty-two women with a PHBC were treated with unilateral surgery within our multidisciplinary breast clinic. We calculated lifetime CBC risk using the Manchester tool, which incorporates age at diagnosis, family history, genetic mutation status, estrogen receptor positivity, and endocrine therapy use. Univariate and multivariate logistic regression analyses (UVA/MVA) were performed, evaluating whether CBC risk predicted MRI surveillance. For women with invasive disease undergoing MRI surveillance, 66% had low, 23% above-average, and 11% moderate/high risk for CBC. On MVA, previous mammography-occult breast cancer [odds ratio (OR) 18.95, p < 0.0001], endocrine therapy use (OR 3.89, p = 0.009), dense breast tissue (OR 3.69, p = 0.0007), mastectomy versus lumpectomy (OR 3.12, p = 0.0041), and CBC risk (OR 3.17 for every 10% increase, p = 0.0002) were associated with MRI surveillance. No pathologic factors increasing ipsilateral breast cancer recurrence were significant on MVA. Although CBC risk predicted MRI surveillance, 89% with invasive disease undergoing MRI had <20% calculated CBC risk. Concerns related to future breast cancer detectability (dense breasts and/or previous mammography-occult disease) predominate decision making. Pathologic factors important for determining ipsilateral recurrence risk, aside from age, were not associated with MRI surveillance.

  19. Congenital Cerebral Palsy, Child Sex and Parent Cardiovascular Risk

    PubMed Central

    Streja, Elani; Wu, Chunsen; Uldall, Peter; Grove, Jakob; Arah, Onyebuchi; Olsen, Jørn

    2013-01-01

    Objective Genes associated with cardiovascular disease may also be risk factors for congenital cerebral palsy (CP) and these associations may be modified by sex, since there is an increased risk of CP in male children. We investigated the association between CP of the child with cardiovascular disease in parents, taking sex of the child into consideration. Methods All parents of non-adopted singletons born in Denmark between 1973 and 2003 were included. Parents of a child with CP, confirmed by the Danish National CP registry, were considered exposed. Cox proportional hazards regressions were used to model risk of cardiovascular outcomes for exposed parents compared to all other parents beginning at the child’s 10th birthday. Results We identified 733,730 mothers and 666,652 fathers among whom 1,592 and 1,484, respectively, had a child with CP. The mean age for mothers at end of follow up was 50±8 years. After adjustment for maternal age, parental education, child’s sex, child’s residence, child being small for gestational age and maternal hypertensive disorder during pregnancy, mothers of CP male children had an excess risk of cardiovascular disease (HR: 1.52, 95% CI: 1.16-2.00), attributable mostly to an increased incidence of hypertension and cerebrovascular disease. After additional adjustment for preterm birth, the association was markedly attenuated for cardiovascular disease (1.34, 95%CI: 1.02 - 1.76), became nonsignificant for hypertension, but remained significant for cerebrovascular disease (HR: 2.73, 95% CI: 1.45- 5.12). There was no increased risk of cardiovascular events in mothers of female CP children, or fathers of CP children of any sex. Conclusions Women that have a male child with CP are at increased risk for premature cardiovascular disease. Part of this association may be related to risk factors for preterm births. PMID:24223882

  20. Using BMI to Determine Cardiovascular Risk in Childhood: How Do the BMI Cutoffs Fare?

    PubMed Central

    Skinner, Asheley Cockrell; Mayer, Michelle L.; Flower, Kori; Perrin, Eliana M.; Weinberger, Morris

    2010-01-01

    OBJECTIVE Although adverse health outcomes are increased among children with BMI above the 85th (overweight) and 95th (obese) percentiles, previous studies have not clearly defined the BMI percentile at which adverse health outcomes begin to increase. We examined whether the existing BMI percentile cutoffs are optimal for defining increased risk for dyslipidemia, dysglycemia, and hypertension. METHODS This was a cross-sectional analysis of the National Health and Nutrition Examination Survey from 2001 to 2006. Studied were 8216 children aged 6 to 17 years, representative of the US population. BMI was calculated by using measured height and weight and converted to percentiles for age in months and gender. Outcome measures (dyslipidemia, dysglycemia, and hypertension) were based on laboratory and physical examination results; these were analyzed as both continuous and categorical outcomes. RESULTS Significant increases for total cholesterol values and prevalence of abnormal cholesterol begin at the 80th percentile. Significant increases in glycohemoglobin values and prevalence of abnormal values begin at the 99th percentile. Consistent significant increases in the prevalence of high or borderline systolic blood pressure begin at the 90th percentile. CONCLUSIONS Intervening for overweight children and their health requires clinical interventions that target the right children. On the basis of our data, a judicious approach to screening could include consideration of lipid screening for children beginning at the 80th percentile but for dysglycemia at the 99th percentile. Current definitions of overweight and obese may be more useful for general recognition of potential health problems and discussions with parents and children about the need to address childhood obesity. WHAT'S KNOWN ON THIS SUBJECT: Previous research has shown that cardiovascular risk factors are related to the currently used definitions of obesity in children but has not specified the BMI percentiles at which risk increases.WHAT THIS STUDY ADDS: Nationally representative data indicate greater risk for abnormal lipid values in children who are not considered overweight by current definitions, risk for diabetes only in very obese children, and risk for hypertension at the 90th percentile of BMI. PMID:19858150

  1. Considerations in HIV Prevention for Women Affected by the Criminal Justice System

    PubMed Central

    Comfort, Megan

    2011-01-01

    Within the national dialogue of HIV prevention strategies, relatively little consideration is given to the millions of women and girls affected by the criminal justice system either through their own incarceration or that of their partners. Yet statistics indicate that these women and girls are disproportionately infected or at risk for HIV and other sexually transmitted infections and much of this risk is directly related to the dynamics and circumstances that led to their incarceration or relationships with incarcerated men. As we look for the link between public health and correctional health within our National HIV/AIDS Strategy, it is imperative that the risks, obstacles, and opportunities facing women and girls affected by incarceration are brought into the discussion. Gender responsive HIV prevention policies and practices must be developed to address the unique risks and opportunities for these women and girls. This paper presents data on HIV risk and other health issues specific to this community of women and girls, discusses key factors for consideration when developing gender-responsive HIV strategies for these communities, and makes recommendations for inclusion in the National HIV/AIDS Strategy and other state and local HIV prevention efforts. PMID:21782463

  2. Considerations in HIV prevention for women affected by the criminal justice system.

    PubMed

    Kramer, Katie; Comfort, Megan

    2011-11-01

    Within the national dialogue of HIV prevention strategies, relatively little consideration is given to the millions of women and girls affected by the criminal justice system, either through their own incarceration or that of their partners. Statistics indicate that these women and girls are disproportionately infected or at risk for HIV and other sexually transmitted infections and much of this risk is directly related to the dynamics and circumstances that led to their incarceration or relationships with incarcerated men. As we look for the link between public health and correctional health within our National HIV/AIDS Strategy, it is imperative that the risks, obstacles, and opportunities facing women and girls affected by incarceration are brought into the discussion. Gender-responsive HIV prevention policies and practices must be developed to address the unique risks and opportunities for these women and girls. This paper presents data on HIV risk and other health issues specific to this community of women and girls, discusses key factors for consideration when developing gender-responsive HIV strategies for these communities, and makes recommendations for inclusion in the National HIV/AIDS Strategy and other state and local HIV prevention efforts. Published by Elsevier Inc.

  3. Risk Evaluation and Mitigation Strategies (REMS) for extended-release and long-acting opioid analgesics: considerations for palliative care practice.

    PubMed

    Gudin, Jeffrey

    2012-06-01

    Prescription opioid analgesics are an essential treatment option for patients with moderate to severe pain. Over the last decade the increased medical use of these agents has contributed to a public health epidemic of abuse, addiction, and overdose-related deaths. These medications remain mainstays in both primary care and pain management practices. As palliative services are incorporated at earlier stages of the disease process and the number of individuals with chronic illness increases, palliative care specialists may encounter an increasing number of patients with opioid abuse and addiction problems. Extended-release (ER) and long-acting (LA) opioid formulations are administered to patients with moderate to severe chronic pain requiring around-the-clock analgesia. Given the large quantity of active ingredient contained within some dosage strengths, this medication class is associated with serious risks when taken improperly. In response to growing reports of abuse and overdose deaths, the US Food and Drug Administration (FDA) announced the need for a risk mitigation strategy for the entire class of medication. The class-wide Risk Evaluation and Mitigation Strategy (REMS) for ER/LA opioids will emphasize prescriber training and patient education to ensure that the therapeutic benefits outweigh the risks of addiction, unintentional overdose, and death. As primary care, pain management, and palliative care clinicians often encounter patients who require ER/LA opioids, an understanding of the suggested requirements and potential impact of this regulation is essential.

  4. Subclinical hypothyroidism: Should we treat?

    PubMed

    Redford, Christopher; Vaidya, Bijay

    2017-06-01

    Subclinical hypothyroidism (also known as compensated hypothyroidism or mild hypothyroidism) is a condition associated with a raised serum concentration of thyroid stimulating hormone (TSH) but a normal serum free thyroxine (FT4). It is common, affecting about 10% of women above the age of 55 years. Autoimmunity is the commonest cause of subclinical hypothyroidism. About 2.5% of patients with subclinical hypothyroidism progress to clinically overt hypothyroidism each year; the rate of progression is higher in patients with thyroid autoantibodies and higher thyroid stimulating hormone levels. However, thyroid function normalises spontaneously in up to 40% cases. Only a small minority of patients with subclinical hypothyroidism have symptoms, and the evidence to support that levothyroxine ameliorate the symptoms in these patients is weak. Subclinical hypothyroidism in younger patients (<65 years) is associated with an increased risk of coronary heart disease, heart failure and cerebrovascular disease. The risk increases with increasing levels of thyroid stimulating hormone, and is particularly high in patients with TSH levels ≥10.0 mu/L. There is lack of evidence from randomised controlled trials as to whether levothyroxine treatment can prevent these risks, although a large observational study of the UK general practice research database has shown that levothyroxine may reduce the risk of coronary heart disease in younger patients (<70 years). Therefore, the decision whether to treat or not to treat subclinical hypothyroidism should be made after careful consideration of the patient's age, the presence of symptoms, the presence of thyroid antibodies and other risk factors such as cardiovascular disease.

  5. Longer habitual afternoon napping is associated with a higher risk for impaired fasting plasma glucose and diabetes mellitus in older adults: results from the Dongfeng-Tongji cohort of retired workers.

    PubMed

    Fang, Weimin; Li, Zhongliang; Wu, Li; Cao, Zhongqiang; Liang, Yuan; Yang, Handong; Wang, Youjie; Wu, Tangchun

    2013-10-01

    Afternoon napping is a common habit in China. We used data obtained from the Dongfeng-Tongji cohort to examine if duration of habitual afternoon napping was associated with risks for impaired fasting plasma glucose (IFG) and diabetes mellitus (DM) in a Chinese elderly population. A total of 27,009 participants underwent a physical examination, laboratory tests, and face-to-face interview. They were categorized into four groups according to nap duration (no napping, <30, 30 to <60, 60 to <90, and > or =90 min). Logistic regression models were used to examine the odds ratios (ORs) of napping duration with IFG and DM. Of the participants, 18,515 (68.6%) reported regularly taking afternoon naps. Those with longer nap duration had considerably higher prevalence of IFG and DM. Napping duration was associated in a dose-dependent manner with IFG and DM (P<.001). After adjusting for possible confounders, longer nap duration (>60 min; all P<.05) was still significantly associated with increased risk for IFG, and longer nap duration (>30 min) was associated with increased risk for DM; however, this finding was not significant in the group with a nap duration of 60-90 min. Longer habitual afternoon napping was associated with a moderate increase for DM risk, independent of several covariates. This finding suggests that longer nap duration may represent a novel risk factor for DM and higher blood glucose levels. Copyright © 2013. Published by Elsevier B.V.

  6. Road Traffic Related Injury Severity in Truck Drivers: A Prospective Medical and Technical Analysis of 582 Truck Crashes.

    PubMed

    Decker, Sebastian; Otte, Dietmar; Muller, Christian Walter; Omar, Mohamed; Krettek, Christian; Haasper, Carl; Brand, Stephan

    2016-06-01

    While cyclists and pedestrians are known to be at significant risk for severe injuries when exposed to road traffic accidents (RTA) involving trucks, little is known about RTA injury risk for truck drivers. The aim of this study was to analyze the injury severity in truck drivers following RTAs. Our local accident research unit prospectively documented 43000 RTAs involving 582 trucks between 2000 and 2011. Injury severity, including the abbreviated injury scale (AIS) and the maximum abbreviated injury scale (MAIS) were analyzed. Technical parameters (e.g. delta-v, direction of impact), the location of accident, and its dependency on the road type were also taken into consideration. Thirteen percent (77/582) of truck drivers were injured. Extremities were found to be at highest risk of injury with the lower extremities (36x) being injured most severely (10x: AIS 2 and 3). Death occurred only after collisions with other trucks, and severity of injuries increased with an increased speed limit. The maximum abbreviated injury scale was higher in the crash opponents (56x MAIS ≥ 3) compared to the truck drivers (8x MAIS ≥ 3). Overall, 82% of the crash opponents were injured. The safety of truck drivers is assured by their vehicles, the consequence being that the risk of becoming injured is likely to be low. However, the legs especially are at high risk for severe injuries during RTAs. This probability increases in the instance of a collision with another truck. Nevertheless, in RTAs involving trucks and regular passenger vehicles, the other party is in higher risk of injury.

  7. [Hospital risk management from the viewpoint of insurers].

    PubMed

    Gausmann, Peter; Petry, Franz Michael

    2004-10-01

    The present article deals with the significance of risk management in hospitals from the viewpoint of liability insurers. From the perspective of insurance companies, the liability risk of a hospital and its personnel has considerably increased during the past 25 years. The present risk situation is characterized by a growing number of reported liability cases, as well as by an enormous increase of average compensation claims. This development has led some insurance companies to financial deficits in the segment of hospital liability. While some insurers have withdrawn their activities from this market segment, others have reacted by raising their premiums. Since in Germany the premiums usually depend on the number of beds held by a hospital, the problem of rising premiums is exacerbated by the general increase of the number of clinical cases in the face of a parallel reduction of the number of beds. In the process of finding new criteria or methods for adequate premium calculation, a key role will be played by the individual future risk development of a hospital and by the evaluation of this risk by its insurance company. An extensive system of clinical quality management supported by elements of risk management will have persistent positive effects on the development of individual insurance premiums and on the insurability of clinical liability. Risk management is defined as the totality of measures taken by a company to identify risks that could lead to reduced success. Clinical risk management must be regarded in the context of a general trend that is not limited to the field of health service. In this process, the handling of errors and their causes plays a central role. Further variants of hospital risk management are the technical and economic risk management, both of which are increasingly important and are in part implemented in the German legislation. Clinical risk management has originated from the U.S., where as early as in the nineteen-seventies instruments and methods have been developed to avoid errors. Important application fields are anesthetics, surgery, orthopedics, and obstetrics. Risk management is primarily a task of the internal personnel of a hospital. The support by external consultants promises additional benefits for the hospital. Measures of classical risk management usually are essential elements of any quality management system; as such, they are therefore certifiable. Certification alone, however, does not prove the sustained efficiency of a risk-prevention system.

  8. On the forecasting the unfavorable periods in the technosphere by the space weather factors

    NASA Astrophysics Data System (ADS)

    Lyakhov, N. N.

    2002-12-01

    There is the considerable progress in development of geomagnetic disturbances forecast technique, in the necessary time, by solar activity phenomena last years. The possible relationship between violations of the traffic safety terms (VTS) in East Siberian Railway during 1986-1999 and the space weather factors was investigated. The overall number of cases under consideration is equal to 11575. By methods of correlation and spectral analysis it was shown, that statistics of VTS has not a random and it's character is probably caused by space weather factors. The principal difference between rhythmic of VTS by purely technical reasons (MECH) (failures in mechanical systems) and, that of VTS caused by wrong operations of a personnel (MAN), is noted. Increase of sudden storm commencements number results in increase of probability of mistakable actions of an operator. Probability of violations in mechanical systems increases with increase of number of quiet geomagnetic conditions. This, in its turn, dictate different approach to the ordered rows of MECH and MAN data when forecasting the unfavourable periods as the priods of increased risk in working out a wrong decision by technological process participants. The advances in forecasting of geomagnetic environment technique made possible to start construction of systems of the operative informing about unfavourable factors of space weather for the interested organizations.

  9. The role of risk perceptions in the risk mitigation process: The case of wildfire in high risk communities

    Treesearch

    Wade E. Martin; Ingrid M. Martin; Brian Kent

    2009-01-01

    An important policy question receiving considerable attention concerns the risk perception-risk mitigation process that guides how individuals choose to address natural hazard risks. This question is considered in the context of wildfire. We analyze the factors that influence risk reduction behaviors by homeowners living in the wildland-urban interface. The factors...

  10. Incidence trends of adenocarcinoma of the cervix in 13 European countries.

    PubMed

    Bray, Freddie; Carstensen, Bendix; Møller, Henrik; Zappa, Marco; Zakelj, Maja Primic; Lawrence, Gill; Hakama, Matti; Weiderpass, Elisabete

    2005-09-01

    Rapid increases in cervical adenocarcinoma incidence have been observed in Western countries in recent decades. Postulated explanations include an increasing specificity of subtype-the capability to diagnose the disease, an inability of cytologic screening to reduce adenocarcinoma, and heterogeneity in cofactors related to persistent human papillomavirus infection. This study examines the possible contribution of these factors in relation with trends observed in Europe. Age-period-cohort models were fitted to cervical adenocarcinoma incidence trends in women ages <75 in 13 European countries. Age-adjusted adenocarcinoma incidence rates increased throughout Europe, the rate of increase ranging from around 0.5% per annum in Denmark, Sweden, and Switzerland to >/=3% in Finland, Slovakia, and Slovenia. The increases first affected generations born in the early 1930s through the mid-1940s, with risk invariably higher in women born in the mid-1960s relative to those born 20 years earlier. The magnitude of this risk ratio varied considerably from around 7 in Slovenia to almost unity in France. Declines in period-specific risk were observed in United Kingdom, Denmark, and Sweden, primarily among women ages >30. Whereas increasing specificity of subtype with time may be responsible for some of the increases in several countries, the changing distribution and prevalence of persistent infection with high-risk human papillomavirus types, alongside an inability to detect cervical adenocarcinoma within screening programs, would accord with the temporal profile observed in Europe. The homogeneity of trends in adenocarcinoma and squamous cell carcinoma in birth cohort is consistent with the notion that they share a similar etiology irrespective of the differential capability of screen detection. Screening may have had at least some impact in reducing cervical adenocarcinoma incidence in several countries during the 1990s.

  11. Risking a Debate--Redefining Risk and Risk Management: A New Zealand Case Study.

    ERIC Educational Resources Information Center

    Zink, Robyn; Leberman, Sarah

    2001-01-01

    Interviews with 12 New Zealand outdoor instructors found that they viewed risk as an opportunity to gain something of value, as opposed to losing something of value. Repositioning risk in this manner could allow the debate around adventure education to move away from being dominated by risk management, allowing consideration of adventure…

  12. Risk-adaptive radiotherapy

    NASA Astrophysics Data System (ADS)

    Kim, Yusung

    Currently, there is great interest in integrating biological information into intensity-modulated radiotherapy (IMRT) treatment planning with the aim of boosting high-risk tumor subvolumes. Selective boosting of tumor subvolumes can be accomplished without violating normal tissue complication constraints using information from functional imaging. In this work we have developed a risk-adaptive optimization-framework that utilizes a nonlinear biological objective function. Employing risk-adaptive radiotherapy for prostate cancer, it is possible to increase the equivalent uniform dose (EUD) by up to 35.4 Gy in tumor subvolumes having the highest risk classification without increasing normal tissue complications. Subsequently, we have studied the impact of functional imaging accuracy, and found on the one hand that loss in sensitivity had a large impact on expected local tumor control, which was maximal when a low-risk classification for the remaining low risk PTV was chosen. While on the other hand loss in specificity appeared to have a minimal impact on normal tissue sparing. Therefore, it appears that in order to improve the therapeutic ratio a functional imaging technique with a high sensitivity, rather than specificity, is needed. Last but not least a comparison study between selective boosting IMRT strategies and uniform-boosting IMRT strategies yielding the same EUD to the overall PTV was carried out, and found that selective boosting IMRT considerably improves expected TCP compared to uniform-boosting IMRT, especially when lack of control of the high-risk tumor subvolumes is the cause of expected therapy failure. Furthermore, while selective boosting IMRT, using physical dose-volume objectives, did yield similar rectal and bladder sparing when compared its equivalent uniform-boosting IMRT plan, risk-adaptive radiotherapy, utilizing biological objective functions, did yield a 5.3% reduction in NTCP for the rectum. Hence, in risk-adaptive radiotherapy the therapeutic ratio can be increased over that which can be achieved with conventional selective boosting IMRT using physical dose-volume objectives. In conclusion, a novel risk-adaptive radiotherapy strategy is proposed and promises increased expected local control for locoregionally advanced tumors with equivalent or better normal tissue sparing.

  13. The calcium scare--what would Austin Bradford Hill have thought?

    PubMed

    Nordin, B E C; Lewis, J R; Daly, R M; Horowitz, J; Metcalfe, A; Lange, K; Prince, R L

    2011-12-01

    Detailed consideration of the suggested association between calcium supplementation and heart attacks has revealed weakness in the evidence which make the hypothesis highly implausible. The aim of this study was to evaluate the strength of the evidence that calcium supplementation increases the risk of myocardial infarction. This study used critical examination of a meta-analysis of the effects of calcium supplements on heart attacks in five prospective trials on 8,016 men and women, and consideration of related publications by the same author. The meta-analysis was found to be subject to several limitations including non-adherence to the clinical protocol, multiple endpoint testing and failure to correctly adjust for endpoint ascertainment. The main risk factors for myocardial infarction were not available for 65% of the participants, and none of the trials had cardiovascular disease as its primary endpoint. There were more overweight participants, more subjects on thyroxine and more men on calcium than on placebo. In particular, over 65% of all the heart attacks were self-reported. When the evidence was considered in the light of Austin Bradford Hill's six main criteria for disease causation, it was found not to be biologically plausible or strong or to reflect a dose-response relationship or to be consistent or to reflect the relationship between the trends in calcium supplementation and heart attacks in the community or to have been confirmed by experiment. The addition of a more recent trial on 1,460 women over 5 years reduced the relative risk to 1.23 (P = 0.0695). Present evidence that calcium supplementation increases heart attacks is too weak to justify a change in prescribing habits.

  14. Carraguard acceptability among men and women in a couples study in Thailand.

    PubMed

    Martin, Sarah; Blanchard, Kelly; Manopaiboon, Chomnad; Chaikummao, Supaporn; Schaffer, Kate; Friedland, Barbara; Kilmarx, Peter H

    2010-08-01

    The aim of this study is to evaluate the use and acceptability of Carraguard among men and women enrolled as couples in a microbicide trial. Focus groups were conducted with participants in a 6-month randomized, placebo-controlled trial that enrolled sexually active, low-risk couples in Thailand. Participants were blinded as to which gel they had received at the time of the discussions. Most men and women liked the gel and found it acceptable. The majority of men and women thought that using the gel increased sexual pleasure, although participants disagreed about whether using the gel increased sexual frequency. Drawbacks of gel use included that it was too wet or messy, and nearly all respondents thought that the applicator was too hard. Most men and women questioned the utility of using the gel among married couples since gel use was tied to perception of HIV/STI risk. However, those who perceived themselves to be at risk expressed interest in using the product as an alternative to condoms. Many women were particularly interested in a product that also had contraceptive properties. Gel use also raised issues of trust and fidelity among couples and questions about men's ability to detect women's use of the product. Men and women in this study found the gel acceptable and thought that it should be made available if it is found to be safe and effective. Strategies for marketing a potential microbicide product must take the target population into consideration. For married couples, key considerations may be partner dynamics and trust issues, whereas messages focusing on sexual pleasure or disease prevention may resonate more strongly with sex workers or other populations.

  15. Surveillance and response for high-risk populations: what can malaria elimination programmes learn from the experience of HIV?

    PubMed

    Jacobson, Jerry O; Cueto, Carmen; Smith, Jennifer L; Hwang, Jimee; Gosling, Roly; Bennett, Adam

    2017-01-18

    To eliminate malaria, malaria programmes need to develop new strategies for surveillance and response appropriate for the changing epidemiology that accompanies transmission decline, in which transmission is increasingly driven by population subgroups whose behaviours place them at increased exposure. Conventional tools of malaria surveillance and response are likely not sufficient in many elimination settings for accessing high-risk population subgroups, such as mobile and migrant populations (MMPs), given their greater likelihood of asymptomatic infections, illegal risk behaviours, limited access to public health facilities, and high mobility including extended periods travelling away from home. More adaptive, targeted strategies are needed to monitor transmission and intervention coverage effectively in these groups. Much can be learned from HIV programmes' experience with "second generation surveillance", including how to rapidly adapt surveillance and response strategies to changing transmission patterns, biological and behavioural surveys that utilize targeted sampling methods for specific behavioural subgroups, and methods for population size estimation. This paper reviews the strategies employed effectively for HIV programmes and offers considerations and recommendations for adapting them to the malaria elimination context.

  16. Chronic traumatic encephalopathy: a potential late and under recognized consequence of rugby union?

    PubMed

    Stewart, W; McNamara, P H; Lawlor, B; Hutchinson, S; Farrell, M

    2016-01-01

    The association between exposure to head injury and increased risk of neurodegenerative disease, specifically chronic traumatic encephalopathy (CTE), is widely recognized. Historically, this was largely considered a phenomenon restricted to boxers, with more recent case series identifying further 'high risk' individuals, such as former American footballers, or military personnel. However, in all cases thus far reported, it is clear that it is the exposure to head injury which is associated with increased dementia risk, and not the circumstances or environment of exposure. As such, there is considerable potential for under-recognition of CTE in patients presenting with neurodegenerative disease, particularly where head injury exposure might have been historical and through sport. This article reviews current understanding of CTE and, via an illustrative case in rugby union, highlights the value of a detailed history on head injury and also draws attention to imaging studies in assessing patients with neurodegenerative disease. © The Author 2015. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  17. Relations of behavioral autonomy to health outcomes among emerging adults with and without type 1 diabetes.

    PubMed

    Helgeson, Vicki S; Reynolds, Kerry A; Becker, Dorothy; Escobar, Oscar; Siminerio, Linda

    2014-01-01

    To examine the relation of behavioral autonomy to psychological, behavioral, and physical health among emerging adults with and without type 1 diabetes. High school seniors with (n = 118) and without type 1 diabetes (n = 122) completed online questionnaires for three consecutive years. Behavioral autonomy, psychological health, risk behaviors, and diabetes outcomes were assessed. Regression analyses were conducted to predict Time 2 and 3 outcomes, controlling for Time 1 outcomes. There were no group differences in behavioral autonomy. Behavioral autonomy predicted better psychological health but only for emerging adults without diabetes. Behavioral autonomy was related to increased risk behavior for both groups. Behavioral autonomy was unrelated to self-care but predicted better glycemic control for females. Behavioral autonomy may be beneficial for psychological health, but is related to increased risk behavior. The implications of behavioral autonomy for emerging adults with type 1 diabetes require careful consideration. © The Author 2014. Published by Oxford University Press on behalf of the Society of Pediatric Psychology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  18. Probabilistic framework for assessing the arsenic exposure risk from cooked fish consumption.

    PubMed

    Ling, Min-Pei; Wu, Chiu-Hua; Chen, Szu-Chieh; Chen, Wei-Yu; Chio, Chia-Pin; Cheng, Yi-Hsien; Liao, Chung-Min

    2014-12-01

    Geogenic arsenic (As) contamination of groundwater is a major ecological and human health problem in southwestern and northeastern coastal areas of Taiwan. Here, we present a probabilistic framework for assessing the human health risks from consuming raw and cooked fish that were cultured in groundwater As-contaminated ponds in Taiwan by linking a physiologically based pharmacokinetics model and a Weibull dose-response model. Results indicate that As levels in baked, fried, and grilled fish were higher than those of raw fish. Frying resulted in the greatest increase in As concentration, followed by grilling, with baking affecting the As concentration the least. Simulation results show that, following consumption of baked As-contaminated fish, the health risk to humans is <10(-6) excess bladder cancer risk level for lifetime exposure; as the incidence ratios of liver and lung cancers are generally acceptable at risk ranging from 10(-6) to 10(-4), the consumption of baked As-contaminated fish is unlikely to pose a significant risk to human health. However, contaminated fish cooked by frying resulted in significant health risks, showing the highest cumulative incidence ratios of liver cancer. We also show that males have higher cumulative incidence ratio of liver cancer than females. We found that although cooking resulted in an increase for As levels in As-contaminated fish, the risk to human health of consuming baked fish is nevertheless acceptable. We suggest the adoption of baking as a cooking method and warn against frying As-contaminated fish. We conclude that the concentration of contaminants after cooking should be taken into consideration when assessing the risk to human health.

  19. Willingness to Use Pre-Exposure Prophylaxis (PrEP): An Empirical Test of the Information-Motivation-Behavioral Skills (IMB) Model among High-Risk Drug Users in Treatment.

    PubMed

    Shrestha, Roman; Altice, Frederick L; Huedo-Medina, Tania B; Karki, Pramila; Copenhaver, Michael

    2017-05-01

    Evidence from recent pre-exposure prophylaxis (PrEP) trials has demonstrated its safety and efficacy in significantly reducing the risk of HIV acquisition for those who are at considerable risk of acquiring HIV infection. With a rapid increase in the amount of research on the efficacy of PrEP for HIV prevention, complementary research on the willingness to use PrEP has grown, especially among MSM, but limited research has been focused among people who use drugs (PWUD). As part of the formative process, we utilized the information-motivation-behavioral skills (IMB) model of health behavior change to characterize and guide intervention development for promoting willingness to use PrEP among high-risk PWUD. The analysis included 400 HIV-negative high-risk PWUD enrolled in a community-based methadone maintenance treatment who reported drug- and/or sex-related HIV risk behaviors in the past 6-months. Analyses revealed support for the IMB model as PrEP-related behavioral skills were found to mediate the influence of PrEP-related information and motivation on willingness to use PrEP. The results provide evidence as to the utility of the IMB model to increase willingness to use PrEP among high-risk PWUD. It therefore makes an important contribution to our understanding of the applicability of theoretically-grounded models of willingness to use PrEP among high-risk PWUD, who are one of the key risk populations who could benefit from the use of PrEP.

  20. Willingness to Use Pre-Exposure Prophylaxis (PrEP): An Empirical Test of the Information-Motivation-Behavioral Skills (IMB) Model among High-Risk Drug Users in Treatment

    PubMed Central

    Shrestha, Roman; Altice, Frederick L.; Huedo-Medina, Tania B.; Karki, Pramila; Copenhaver, Michael

    2016-01-01

    Evidence from recent pre-exposure prophylaxis (PrEP) trials has demonstrated its safety and efficacy in significantly reducing the risk of HIV acquisition for those who are at considerable risk of acquiring HIV infection. With a rapid increase in the amount of research on the efficacy of PrEP for HIV prevention, complementary research on the willingness to use PrEP has grown, especially among MSM, but limited research has been focused among people who use drugs (PWUD). As part of the formative process, we utilized the Information-Motivation-Behavioral Skills (IMB) model of health behavior change to characterize and guide intervention development for promoting willingness to use PrEP among high-risk PWUD. The analysis included 400 HIV-negative high-risk PWUD enrolled in a community-based methadone maintenance treatment who reported drug- and/or sex-related HIV risk behaviors in the past 6-months. Analyses revealed support for the IMB model as PrEP-related behavioral skills were found to mediate the influence of PrEP-related information and motivation on willingness to use PrEP. The results provide evidence as to the utility of the IMB model to increase willingness to use PrEP among high-risk PWUD. It therefore makes an important contribution to our understanding of the applicability of theoretically-grounded models of willingness to use PrEP among high-risk PWUD, who are one of the key risk populations who could benefit from the use of PrEP. PMID:27990587

  1. Longitudinal influences of friends and parents upon unprotected vaginal intercourse in adolescents.

    PubMed

    Kim, Catherine; Gebremariam, Acham; Iwashyna, Theodore J; Dalton, Vanessa K; Lee, Joyce M

    2011-02-01

    Both friends and parents may influence occurrence of adolescent sexual intercourse, but these influences have not been studied together and prospectively. We conducted a longitudinal analysis of a nationally representative sample of adolescents aged 15-18 years (n=6649), the National Longitudinal Study of Adolescent Health (Add Health). Baseline in-home and school interviews were conducted during 1995 and follow-up interviews in 1996. The main outcome measure was self-reported unprotected vaginal intercourse. In models which adjusted for age, race, parental attitudes towards contraception and pregnancy, and adolescent sexual intercourse practices at baseline, having a friend who engaged in sexual intercourse at baseline, either unprotected (OR 2.2, 95% CI 1.6-3.2) or protected (OR 1.8, 95% CI 1.4-2.4), increased the odds of unprotected intercourse vs. never intercourse in the adolescent at follow-up (p<.001). A distant relationship with the father (OR 2.4, 95% CI 1.3-4.3) vs. a close relationship at baseline also increased the odds of unprotected intercourse at follow-up compared to never intercourse (p=.028). Parental attitudes were not associated with the outcome after consideration of the adolescent's attitudes and baseline sexual practices. Having a friend who engages in sexual intercourse, unprotected or protected, increases the risk of unprotected intercourse. Parental attitudes are less influential after consideration of adolescent baseline attitudes and sexual practices, suggesting that parental influences are strongest before 15 years of age. Our results suggest that early intervention among both parents and adolescents may decrease the risk of unprotected intercourse. Copyright © 2011 Elsevier Inc. All rights reserved.

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

    PubMed

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

    2017-04-25

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

  3. Exposure to diagnostic radiation and risk of breast cancer among carriers of BRCA1/2 mutations: retrospective cohort study (GENE-RAD-RISK).

    PubMed

    Pijpe, Anouk; Andrieu, Nadine; Easton, Douglas F; Kesminiene, Ausrele; Cardis, Elisabeth; Noguès, Catherine; Gauthier-Villars, Marion; Lasset, Christine; Fricker, Jean-Pierre; Peock, Susan; Frost, Debra; Evans, D Gareth; Eeles, Rosalind A; Paterson, Joan; Manders, Peggy; van Asperen, Christi J; Ausems, Margreet G E M; Meijers-Heijboer, Hanne; Thierry-Chef, Isabelle; Hauptmann, Michael; Goldgar, David; Rookus, Matti A; van Leeuwen, Flora E

    2012-09-06

    To estimate the risk of breast cancer associated with diagnostic radiation in carriers of BRCA1/2 mutations. Retrospective cohort study (GENE-RAD-RISK). Three nationwide studies (GENEPSO, EMBRACE, HEBON) in France, United Kingdom, and the Netherlands, 1993 female carriers of BRCA1/2 mutations recruited in 2006-09. Risk of breast cancer estimated with a weighted Cox proportional hazards model with a time dependent individually estimated cumulative breast dose, based on nominal estimates of organ dose and frequency of self reported diagnostic procedures. To correct for potential survival bias, the analysis excluded carriers who were diagnosed more than five years before completion of the study questionnaire. In carriers of BRCA1/2 mutations any exposure to diagnostic radiation before the age of 30 was associated with an increased risk of breast cancer (hazard ratio 1.90, 95% confidence interval 1.20 to 3.00), with a dose-response pattern. The risks by quarter of estimated cumulative dose <0.0020 Gy, ≥ 0.0020-0.0065 Gy, ≥ 0.0066-0.0173 Gy, and ≥ 0.0174 Gy were 1.63 (0.96 to 2.77), 1.78 (0.88 to 3.58), 1.75 (0.72 to 4.25), and 3.84 (1.67 to 8.79), respectively. Analyses on the different types of diagnostic procedures showed a pattern of increasing risk with increasing number of radiographs before age 20 and before age 30 compared with no exposure. A history of mammography before age 30 was also associated with an increased risk of breast cancer (hazard ratio 1.43, 0.85 to 2.40). Sensitivity analysis showed that this finding was not caused by confounding by indication of family history. In this large European study among carriers of BRCA1/2 mutations, exposure to diagnostic radiation before age 30 was associated with an increased risk of breast cancer at dose levels considerably lower than those at which increases have been found in other cohorts exposed to radiation. The results of this study support the use of non-ionising radiation imaging techniques (such as magnetic resonance imaging) as the main tool for surveillance in young women with BRCA1/2 mutations.

  4. Twenty Years of Progress in Violence Risk Assessment

    ERIC Educational Resources Information Center

    Hanson, R. Karl

    2005-01-01

    Violence risk assessment has advanced considerably in the last 20 years. In the 1980s, leading professionals questioned the very possibility of valid violence risk assessments; now, many of the major risk factors have been identified, and professional debate focuses on how best to combine these risk factors into meaningful evaluations. An…

  5. Effect of asthma on falling into poverty: the overlooked costs of illness.

    PubMed

    Callander, Emily J; Schofield, Deborah J

    2015-05-01

    Studies on the indirect costs of asthma have taken a narrow view of how the condition affects the living standards of patients by examining only the association with employment and income. To build on the current cost-of-illness literature and identify whether having asthma is associated with an increased risk of poverty, thus giving a more complete picture of the costs of asthma to individuals and society. Longitudinal analysis of the nationally representative Household Income and Labour Dynamics in Australian survey to estimate the relative risk of income poverty, multidimensional poverty, and long-term multidimensional poverty between 2007 and 2012 and population attributable risk method to estimate the proportion of poverty between 2007 and 2012 directly attributable to asthma. No significant difference was found in the risk of falling into income poverty between those with and without asthma (P = .07). Having asthma increased the risk of falling into multidimensional poverty by 1.35 (95% confidence interval [CI], 1.01-1.83) and the risk of falling into chronic multidimensional poverty by 2.22 (95% CI, 1.20-4.10). Between 2007 and 2012, a total of 5.2% of income poverty cases (95% CI, 5.1%-5.4%), 7.8% of multidimensional poverty cases (95% CI, 7.7%-8.0%), and 19.6% of chronic multidimensional poverty cases (95% CI, 19.2%-20.0%) can be attributed to asthma. Asthma is associated with an increased risk of falling into poverty. This should be taken into consideration when considering the suitability of different treatment options for patients with asthma. Copyright © 2015 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

  6. Uncertainty and Sensitivity of Direct Economic Flood Damages: the FloodRisk Free and Open-Source Software

    NASA Astrophysics Data System (ADS)

    Albano, R.; Sole, A.; Mancusi, L.; Cantisani, A.; Perrone, A.

    2017-12-01

    The considerable increase of flood damages in the the past decades has shifted in Europe the attention from protection against floods to managing flood risks. In this context, the expected damages assessment represents a crucial information within the overall flood risk management process. The present paper proposes an open source software, called FloodRisk, that is able to operatively support stakeholders in the decision making processes with a what-if approach by carrying out the rapid assessment of the flood consequences, in terms of direct economic damage and loss of human lives. The evaluation of the damage scenarios, trough the use of the GIS software proposed here, is essential for cost-benefit or multi-criteria analysis of risk mitigation alternatives. However, considering that quantitative assessment of flood damages scenarios is characterized by intrinsic uncertainty, a scheme has been developed to identify and quantify the role of the input parameters in the total uncertainty of flood loss model application in urban areas with mild terrain and complex topography. By the concept of parallel models, the contribution of different module and input parameters to the total uncertainty is quantified. The results of the present case study have exhibited a high epistemic uncertainty on the damage estimation module and, in particular, on the type and form of the utilized damage functions, which have been adapted and transferred from different geographic and socio-economic contexts because there aren't depth-damage functions that are specifically developed for Italy. Considering that uncertainty and sensitivity depend considerably on local characteristics, the epistemic uncertainty associated with the risk estimate is reduced by introducing additional information into the risk analysis. In the light of the obtained results, it is evident the need to produce and disseminate (open) data to develop micro-scale vulnerability curves. Moreover, the urgent need to push forward research into the implementation of methods and models for the assimilation of uncertainties in decision-making processes emerges.

  7. Intensified food production and correlated risks to human health in the Greater Mekong Subregion: a systematic review.

    PubMed

    Richter, Carsten H; Custer, Benjamin; Steele, Jennifer A; Wilcox, Bruce A; Xu, Jianchu

    2015-05-26

    Intensified food production, i.e. agricultural intensification and industrialized livestock operations may have adverse effects on human health and promote disease emergence via numerous mechanisms resulting in either direct impacts on humans or indirect impacts related to animal and environmental health. For example, while biodiversity is intentionally decreased in intensive food production systems, the consequential decrease in resilience in these systems may in turn bear increased health risks. However, quantifying these risks remains challenging, even if individual intensification measures are examined separately. Yet, this is an urgent task, especially in rapidly developing areas of the world with few regulations on intensification measures, such as in the Greater Mekong Subregion (GMS). We systematically searched the databases PubMed and Scopus for recent studies conducted on the association between agricultural (irrigation, fertilization, pesticide application) and livestock (feed additives, animal crowding) intensification measures and human health risks in the GMS. The search terms used were iteratively modified to maximize the number of retrieved studies with relevant quantitative data. We found that alarmingly little research has been done in this regard, considering the level of environmental contamination with pesticides, livestock infection with antibiotic resistant pathogens and disease vector proliferation in irrigated agroecosystems reported in the retrieved studies. In addition, each of the studies identified focused on specific aspects of intensified food production and there have been no efforts to consolidate the health risks from the simultaneous exposures to the range of hazardous chemicals utilized. While some of the studies identified already reported environmental contamination bearing considerable health risks for local people, at the current state of research the actual consolidated risk from regional intensification measures cannot be estimated. Efforts in this area of research need to be rapidly and considerably scaled up, keeping pace with the current level of regional intensification and the speed of pesticide and drug distribution to facilitate the development of agriculture related policies for regional health promotion.

  8. Osteoporosis, bone mineral density and CKD-MBD complex (I): Diagnostic considerations.

    PubMed

    Bover, Jordi; Ureña-Torres, Pablo; Torregrosa, Josep-Vicent; Rodríguez-García, Minerva; Castro-Alonso, Cristina; Górriz, José Luis; Laiz Alonso, Ana María; Cigarrán, Secundino; Benito, Silvia; López-Báez, Víctor; Lloret Cora, María Jesús; daSilva, Iara; Cannata-Andía, Jorge

    2018-04-24

    Osteoporosis (OP) and chronic kidney disease (CKD) independently influence bone and cardiovascular health. A considerable number of patients with CKD, especially those with stages 3a to 5D, have a significantly reduced bone mineral density leading to a high risk of fracture and a significant increase in associated morbidity and mortality. Independently of classic OP related to age and/or gender, the mechanical properties of bone are also affected by inherent risk factors for CKD ("uraemic OP"). In the first part of this review, we will analyse the general concepts regarding bone mineral density, OP and fractures, which have been largely undervalued until now by nephrologists due to the lack of evidence and diagnostic difficulties in the context of CKD. It has now been proven that a reduced bone mineral density is highly predictive of fracture risk in CKD patients, although it does not allow a distinction to be made between the causes which generate it (hyperparathyroidism, adynamic bone disease and/or senile osteoporosis, etc.). Therefore, in the second part, we will analyse the therapeutic indications in different CKD stages. In any case, the individual assessment of factors which represent a higher or lower risk of fracture, the quantification of this risk (i.e. using tools such as FRAX ® ) and the potential indications for densitometry in patients with CKD could represent an important first step pending new clinical guidelines based on randomised studies which do not exclude CKD patients, all the while avoiding therapeutic nihilism in an area of growing importance. Copyright © 2018 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.

  9. Proprotein convertase subtilisin/kexin type 9 inhibition: a new therapeutic mechanism for reducing cardiovascular disease risk.

    PubMed

    Bergeron, Nathalie; Phan, Binh An P; Ding, Yunchen; Fong, Aleyna; Krauss, Ronald M

    2015-10-27

    Proprotein convertase subtilisin/kexin type 9 (PCSK9) plays an important role in the regulation of cholesterol homeostasis. By binding to hepatic low-density lipoprotein (LDL) receptors and promoting their lysosomal degradation, PCSK9 reduces LDL uptake, leading to an increase in LDL cholesterol concentrations. Gain-of-function mutations in PCSK9 associated with high LDL cholesterol and premature cardiovascular disease have been causally implicated in the pathophysiology of autosomal-dominant familial hypercholesterolemia. In contrast, the more commonly expressed loss-of-function mutations in PCSK9 are associated with reduced LDL cholesterol and cardiovascular disease risk. The development of therapeutic approaches that inhibit PCSK9 function has therefore attracted considerable attention from clinicians and the pharmaceutical industry for the management of hypercholesterolemia and its associated cardiovascular disease risk. This review summarizes the effects of PCSK9 on hepatic and intestinal lipid metabolism and the more recently explored functions of PCSK9 in extrahepatic tissues. Therapeutic approaches that prevent interaction of PCSK9 with hepatic LDL receptors (monoclonal antibodies, mimetic peptides), inhibit PCSK9 synthesis in the endoplasmic reticulum (antisense oligonucleotides, siRNAs), and interfere with PCSK9 function (small molecules) are also described. Finally, clinical trials testing the safety and efficacy of monoclonal antibodies to PCSK9 are reviewed. These have shown dose-dependent decreases in LDL cholesterol (44%-65%), apolipoprotein B (48%-59%), and lipoprotein(a) (27%-50%) without major adverse effects in various high-risk patient categories, including those with statin intolerance. Initial reports from 2 of these trials have indicated the expected reduction in cardiovascular events. Hence, inhibition of PCSK9 holds considerable promise as a therapeutic option for decreasing cardiovascular disease risk. © 2015 American Heart Association, Inc.

  10. Pre-eclampsia in American Indians/Alaska Natives and Whites: The Significance of Body Mass Index.

    PubMed

    Zamora-Kapoor, Anna; Nelson, Lonnie A; Buchwald, Dedra S; Walker, Leslie R; Mueller, Beth A

    2016-11-01

    Introduction The prevalence of pre-eclampsia, a major cause of maternal morbidity, varies by race, being greater in African Americans, and lower in Asians and Hispanics than in White women. Little is known about its prevalence in American Indians/Alaska Natives (AI/ANs). We estimated pre-eclampsia risk in AI/ANs compared to Whites, with consideration of the potential effect of obesity, a major risk factor for pre-eclampsia, and a condition disproportionately affecting AI/AN women. Methods This retrospective cohort study of linked birth-hospital discharge data from Washington State (2003-2013) included all AI/AN women and a sample of White first-time mothers with singleton deliveries. Logistic regression was used to estimate odds ratio (OR) and 95 % confidence intervals (CI) for pre-eclampsia risk in AI/ANs compared to Whites, first controlling for several important risk factors, and subsequently with additional adjustment for pre-pregnancy body mass index (BMI). Results AI/ANs had an increased risk of pre-eclampsia compared to Whites after controlling for all covariates except BMI (OR 1.17, 95 % CI 1.06-1.29). After further adjustment for BMI, the racial disparity in pre-eclampsia risk was greatly attenuated (OR 1.05, 95 % CI 0.95-1.16). Discussion This population-based study suggests that any increased risk in AI/ANs relative to Whites may be at least partly due to differences in BMI.

  11. Emotion and decision-making under uncertainty: Physiological arousal predicts increased gambling during ambiguity but not risk.

    PubMed

    FeldmanHall, Oriel; Glimcher, Paul; Baker, Augustus L; Phelps, Elizabeth A

    2016-10-01

    Uncertainty, which is ubiquitous in decision-making, can be fractionated into known probabilities (risk) and unknown probabilities (ambiguity). Although research has illustrated that individuals more often avoid decisions associated with ambiguity compared to risk, it remains unclear why ambiguity is perceived as more aversive. Here we examine the role of arousal in shaping the representation of value and subsequent choice under risky and ambiguous decisions. To investigate the relationship between arousal and decisions of uncertainty, we measure skin conductance response-a quantifiable measure reflecting sympathetic nervous system arousal-during choices to gamble under risk and ambiguity. To quantify the discrete influences of risk and ambiguity sensitivity and the subjective value of each option under consideration, we model fluctuating uncertainty, as well as the amount of money that can be gained by taking the gamble. Results reveal that although arousal tracks the subjective value of a lottery regardless of uncertainty type, arousal differentially contributes to the computation of value-that is, choice-depending on whether the uncertainty is risky or ambiguous: Enhanced arousal adaptively decreases risk-taking only when the lottery is highly risky but increases risk-taking when the probability of winning is ambiguous (even after controlling for subjective value). Together, this suggests that the role of arousal during decisions of uncertainty is modulatory and highly dependent on the context in which the decision is framed. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

  12. Pre-eclampsia in American Indians/Alaska Natives and Whites: The Significance of Body Mass Index

    PubMed Central

    Nelson, Lonnie A.; Buchwald, Dedra S.; Walker, Leslie R.; Mueller, Beth A.

    2016-01-01

    Introduction The prevalence of pre-eclampsia, a major cause of maternal morbidity, varies by race, being greater in African Americans, and lower in Asians and Hispanics than in White women. Little is known about its prevalence in American Indians/Alaska Natives (AI/ANs). We estimated pre-eclampsia risk in AI/ANs compared to Whites, with consideration of the potential effect of obesity, a major risk factor for pre-eclampsia, and a condition disproportionately affecting AI/AN women. Methods This retrospective cohort study of linked birth-hospital discharge data from Washington State (2003–2013) included all AI/AN women and a sample of White first-time mothers with singleton deliveries. Logistic regression was used to estimate odds ratio (OR) and 95 % confidence intervals (CI) for pre-eclampsia risk in AI/ANs compared to Whites, first controlling for several important risk factors, and subsequently with additional adjustment for pre-pregnancy body mass index (BMI). Results AI/ANs had an increased risk of pre-eclampsia compared to Whites after controlling for all covariates except BMI (OR 1.17, 95 % CI 1.06–1.29). After further adjustment for BMI, the racial disparity in pre-eclampsia risk was greatly attenuated (OR 1.05, 95 % CI 0.95–1.16). Discussion This population-based study suggests that any increased risk in AI/ANs relative to Whites may be at least partly due to differences in BMI. PMID:27461024

  13. Long working hours increase the risk of sharp and needlestick injury in nurses: the need for new policy implication.

    PubMed

    Ilhan, Mustafa N; Durukan, Elif; Aras, Evin; Türkçüoğlu, Sertaç; Aygün, Remzi

    2006-12-01

    This paper reports a study to determine the sharp and needlestick injury incidence in nurses working at a university hospital and the contributing factors. Although it is generally felt that working in the healthcare sector is clean and without risk, healthcare staff and especially physicians and nurses who generally work very long hours are actually exposed to various occupational risks. Sharps and needlestick injuries are important problems for healthcare workers as they increase the risk of spread of infection. A self-administered questionnaire was completed in October 2005 by 449 of the 516 nurses working at a Turkish hospital (response rate 87.0%). The percentage of nurses experiencing a sharp or needlestick injury during their professional life was 79.7%. The incidence of exposure to sharp or needlestick injury in the last year was 68.4%. The factors increasing the rate of sharp and needlestick injury were: age 24 years and less,

  14. Association of Personality Traits with Elder Self-Neglect in a Community Dwelling Population

    PubMed Central

    Dong, XinQi; Simon, Melissa; Wilson, Robert; Beck, Todd; McKinell, Kelly; Evans, Denis

    2010-01-01

    Objective Elder self-neglect is an important public health issue. However, little is known about the association between personality traits and risk of elder self-neglect among community-dwelling populations. The objectives of this study are: 1) to examine the association of personality traits with elder self-neglect and 2) to examine the association of personality traits with elder self-neglect severity. Methods Population-based study conducted from 1993–2005 of community-dwelling older adults (N=9,056) participating in the Chicago Health Aging Project (CHAP). Subsets of the CHAP participants (N=1,820) were identified for suspected self-neglect by social services agency, which assessed the severity. Personality traits assessed included neuroticism, extraversion, rigidity and information processing. Logistic and linear regressions were used to assess these associations. Results In the bivariate analyses, personality traits (neuroticism, extraversion, information processing, and rigidity) were significantly associated with increased risk of elder self-neglect. However, after adjusting for potential confounders, the above associations were no longer statistically significant. In addition, personality traits were not associated with increased risk of greater self-neglect severity. Furthermore, interaction term analyses of personality traits with health and psychosocial factors were not statistically significant with elder self-neglect outcomes. Conclusion Neuroticism, extraversion, rigidity and information processing were not associated with significantly increased risk of elder self-neglect after consideration of potential confounders. PMID:21788924

  15. [Heparin-induced thrombocytopenia type II (HIT II) : A medical-economic view].

    PubMed

    Riedel, R; Schmieder, A; Koster, A; Kim, S; Baumgarten, G; Schewe, J C

    2017-05-01

    In the context of inpatient and increasingly ambulatory thrombosis prophylaxis, heparins have been recognised as standard therapy for decades. In addition to the therapeutic benefit, therapy with heparins also entails the risk of undesirable side effects, such as bleeding and thrombocytopenia. Heparin-induced thrombocytopenia (HIT II) is deemed a serious side effect. In the following work, HIT II is subjected to a medico-economic consideration (treatment, pharmaceuticals, subsequent costs due to possible complications) and, with regard to a possible HIT II prophylaxis, aspects of increasingly respected patient safety are also considered. In the context of a literature search the active ingredients argatroban and danaparoid, which are approved for HIT II treatment, were evaluated. HIT II - especially in combination with thromboembolic complications - represents a medical-economic burden for the hospital. Although this is only an orientation guide, it shows that HIT II syndrome is not adequately cost-covered by the G‑DRG system. An early thrombosis prophylaxis with argatroban/danaparoid for HIT II risk patients should therefore be taken into account for medical-related as well as patient safety-relevant aspects. According to experience, the pharmaceutical supply for these medically needed products (anticoagulants) should be ensured for reasons of patient safety. The risk of an immunological response to heparin therapy is known. Within the context of increased patient safety, thrombosis prophylaxis should be issued with a risk-adjusted prophylaxis.

  16. Seizures and Epilepsy in Alzheimer’s Disease

    PubMed Central

    Friedman, Daniel; Honig, Lawrence S.; Scarmeas, Nikolaos

    2013-01-01

    Introduction Many studies have shown that patients with Alzheimer’s disease (AD) are at increased risk for developing seizures and epilepsy. However, reported prevalence and incidence of seizures and relationship of seizures to disease measures such as severity, outcome and progression vary widely between studies. Methods Literature review of the available clinical and epidemiological data on the topic of seizures in patients with AD. We review seizure rates and types, risk factors for seizures, electroencephalogram (EEG)studies, and treatment responses. Finally, we consider limitations and methodological issues. Results There is considerable variability in the reported prevalence and incidence of seizures in patients with AD - with reported lifetime prevalence rates of 1.5 - 64%. More recent, prospective, and larger studies in general report lower rates. Some, but not all, studies have noted increased seizure risk with increasing dementia severity or with younger age of AD onset. Generalized convulsive seizures are the most commonly reported type, but often historical information is the only basis used to determine seizure type and the manifestation of seizures may be difficult to distinguish from other behaviors common in demented patients. EEG has infrequently been performed and reported. Data on treatment of seizures in AD are extremely limited. Similarly, the relationship between seizures and cognitive impairment in AD is unclear. Conclusions The literature on seizures and epilepsy in AD, including diagnosis, risk factors, and response to treatment suffers from methodological limitations and gaps. PMID:22070283

  17. Sleep and sleepiness: impact of entering or leaving shiftwork--a prospective study.

    PubMed

    Akerstedt, Torbjörn; Nordin, Maria; Alfredsson, Lars; Westerholm, Peter; Kecklund, Göran

    2010-07-01

    Very little is known about the effects on sleep and sleepiness of entering or exiting shiftwork. The present study used a longitudinal database (n = 3637). Participants completed a questionnaire on work hours, sleep, and work environment at the start and end of a 5-yr period. Changes in shift/day work status were related to change in a number of subjective sleep variables using logistic regression analysis. The analyses were adjusted for age, sex, and differences in socioeconomic status, work demands, work control, physical workload, marriage status, and number of children. In comparison with constant day work, entering shiftwork (with or without night shifts) from day work increased the risk of difficulties in falling asleep, and leaving shiftwork reduced this risk (odds ratio [OR] = 2.8 [confidence interval, CI = 1.8-4.5]). Also falling asleep at work showed a consistent pattern; an increased risk of falling asleep for those with shiftwork on both occasions, and for those with night work on both occasions. Also entering night work was associated with a strongly increased risk of falling asleep at work (OR = 2.9 [CI = 1.3-6.7]). These results suggest that entering and leaving shiftwork has a considerable impact on sleep and alertness. However, there is a need for large and more extended longitudinal studies to support our findings.

  18. Three essays on resource economics. Demand systems for energy forecasting: Practical considerations for estimating a generalized logit model, To borrow or not to borrow: A variation on the MacDougal-Kemp theme, and, Valuing reduced risk for households with children or the retired

    NASA Astrophysics Data System (ADS)

    Weng, Weifeng

    This thesis presents papers on three areas of study within resource and environmental economics. "Demand Systems For Energy Forecasting" provides some practical considerations for estimating a Generalized Logit model. The main reason for using this demand system for energy and other factors is that the derived price elasticities are robust when expenditure shares are small. The primary objective of the paper is to determine the best form of the cross-price weights, and a simple inverse function of the expenditure share is selected. A second objective is to demonstrate that the estimated elasticities are sensitive to the units specified for the prices, and to show how price scales can be estimated as part of the model. "To Borrow or Not to Borrow: A Variation on the MacDougal-Kemp Theme" studies the impact of international capital movements on the conditional convergence of economies differing from each other only in initial wealth. We found that in assets, income, consumption and utility, convergence obtains, with and only with, the absence of international capital movement. When a rich country invests in a poor country, the balance of debt increases forever. Asset ownership is increased in all periods for the lender, and asset ownership of the borrower is deceased. Also, capital investment decreases the lender's utility for early periods, but increases it forever after a cross-over point. In contrast, the borrower's utility increases for early periods, but then decreases forever. "Valuing Reduced Risk for Households with Children or the Retired" presents a theoretical model of how families value risk and then exams family automobile purchases to impute the average Value of a Statistical Life (VSL) for each type of family. Data for fatal accidents are used to estimate survival rates for individuals in different types of accidents, and the probabilities of having accidents for different types of vehicle. These models are used to determine standardized risks for vehicles in hedonic models of the purchase price and fuel efficiency. The hedonic models determine the marginal capital and operating costs of reducing the risk of mortality. We find that households with children are valued much more highly than the average VSL of $2 million, and households with seniors are valued less than average.

  19. Understanding growers' decisions to manage invasive pathogens at the farm level.

    PubMed

    Breukers, Annemarie; van Asseldonk, Marcel; Bremmer, Johan; Beekman, Volkert

    2012-06-01

    Globalization causes plant production systems to be increasingly threatened by invasive pests and pathogens. Much research is devoted to support management of these risks. Yet, the role of growers' perceptions and behavior in risk management has remained insufficiently analyzed. This article aims to fill this gap by addressing risk management of invasive pathogens from a sociopsychological perspective. An analytical framework based on the Theory of Planned Behavior was used to explain growers' decisions on voluntary risk management measures. Survey information from 303 Dutch horticultural growers was statistically analyzed, including regression and cluster analysis. It appeared that growers were generally willing to apply risk management measures, and that poor risk management was mainly due to perceived barriers, such as high costs and doubts regarding efficacy of management measures. The management measures applied varied considerably among growers, depending on production sector and farm-specific circumstances. Growers' risk perception was found to play a role in their risk management, although the causal relation remained unclear. These results underscore the need to apply a holistic perspective to farm level management of invasive pathogen risk, considering the entire package of management measures and accounting for sector- and farm-specific circumstances. Moreover, they demonstrate that invasive pathogen risk management can benefit from a multidisciplinary approach that incorporates growers' perceptions and behavior.

  20. 78 FR 32255 - HHS-Operated Risk Adjustment Data Validation Stakeholder Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-05-29

    ...-Operated Risk Adjustment Data Validation Stakeholder Meeting AGENCY: Centers for Medicare & Medicaid... Act HHS-operated risk adjustment data validation process. The purpose of this public meeting is to... interested parties about key HHS policy considerations pertaining to the HHS-operated risk adjustment data...

  1. Risk of bleeding and antibiotic use in patients receiving continuous phenprocoumon therapy. A case-control study nested in a large insurance- and population-based German cohort.

    PubMed

    Abbas, Sascha; Ihle, Peter; Harder, Sebastian; Schubert, Ingrid

    2014-05-05

    There is major concern about coumarins interacting with various drug classes and increasing the risk of overanticoagulation. The aim of the study was to assess bleeding risk in patients with concurrent use of antibiotics and phenprocoumon, the most widely prescribed coumarin in many European countries. We conducted a nested-case-control study within a cohort of 513,338 incident and continuous phenprocoumon users ≥ 18 years of age using claims data of the statutory health insurance company AOK, covering 30% of the German population. Bleeding risk associated with current use of antibiotics for systemic use (antibacterials/antimycotics) was calculated using conditional logistic regression in 13,785 cases with a bleeding event and 55,140 risk-set sampling-matched controls. Bleeding risk associated with any antibacterial use in phenprocoumon users was significantly increased [odds ratio (OR) 2.37, 95% confidence interval (CI) 2.20-2.56]. The association was stronger for gastrointestinal than for cerebral bleeding (OR 2.09, 95% CI 1.84-2.38 and OR 1.34, 95% CI 1.03-1.74, respectively) and highest for other/unspecified bleeding (OR 2.92, 95% CI 2.62-3.26). Specific antibiotic classes were strongly associated with bleeding risk, e.g. cotrimoxazole (OR 3.86, 95% CI 3.08-4.84) and fluorquinolones (OR 3.13, 95% CI 2.74-3.59), among those highest for ofloxacin (OR 5.00, 95% CI 3.01-8.32). Combined use of phenprocoumon and antimycotics was not significantly associated with bleeding risk. Risk was not significantly modified by age (pint=0.25) or sex (pint=0.96). The association was stronger the closer the antibiotic exposure was to the bleeding event. Among continuous phenprocoumon users, antibiotics - particularly quinolones and cotrimoxazole - should be prescribed after careful consideration due to an increased bleeding risk. Close monitoring of international normalised ratio levels after prescription is recommended.

  2. Cancer risk of sulfonylureas in patients with type 2 diabetes mellitus: A systematic review.

    PubMed

    Chen, Yuehong; Du, Liang; Li, Ling; Ma, Jun; Geng, Xingyuan; Yao, Xun; Liu, Guanjian; Sun, Xin

    2017-05-01

    Increasing evidence suggests that oral hypoglycemic agents used in type 2 diabetes mellitus (T2DM) may affect cancer risk. Sulfonylureas (SUs) are the most frequently used antidiabetic medications for T2DM. Whether using SUs has any effect on cancer has received considerable attention. The aim of this study was to assess the effects of SUs on cancer risk in T2DM patients. Published studies were identified in PubMed, EMBASE, and the Cochrane Register of Clinical Studies, and ClinicalTrials.gov was searched for additional information to identify randomized controlled trials (RCTs), cohort studies, and case-control studies. The abstracts and full text were screened, data collected, and the risk of bias assessed for each individual study. Seventy-seven studies (33 RCTs, 27 cohort studies, and 17 case-control studies) were analyzed. The RCTs did not report a difference in the risk of malignant tumor between SU-treated T2DM patients and controls (odds ratio [OR] 0.96; 95% confidence interval [CI] 0.78-1.18); cohort studies showed that cancer risk was higher in patients using SUs than metformin (relative risk 1.60 [95%CI 1.37-1.87]; adjusted hazard ratio 1.13 [95%CI 1.06-1.19]), and case-control studies suggested a trend for increased cancer risk in those using SUs compared with non-SU users (adjusted OR 1.13; 95%CI 0.93-1.37). The available evidence clearly shows that SUs can significantly increase the risk of cancer compared with metformin. Although the evidence suggests the possibility that SU users may have a higher risk of cancer than those using alternative medications in addition to metformin, it remains inadequate to enable definitive conclusions to be drawn. © 2016 Ruijin Hospital, Shanghai Jiaotong University School of Medicine and John Wiley & Sons Australia, Ltd.

  3. Laboratory approach for diagnosis of toluene-based inhalant abuse in a clinical setting

    PubMed Central

    Jain, Raka; Verma, Arpita

    2016-01-01

    The steady increase of inhalant abuse is a great challenge for analytical toxicologists. This review describes an overview of inhalant abuse including the extent of the problem, types of products abused, modes of administration, pharmacology and effects of inhalants, the role of laboratory, interpretation of laboratory results and clinical considerations. Regular laboratory screening for inhalant abuse as well as other substance abuse and health risk behaviors must be a part of standard clinical care. PMID:26957863

  4. Emerging health care-associated infections in the geriatric population.

    PubMed Central

    Strausbaugh, L. J.

    2001-01-01

    The increasing number of persons >65 years of age form a special population at risk for nosocomial and other health care-associated infections. The vulnerability of this age group is related to impaired host defenses such as diminished cell-mediated immunity. Lifestyle considerations, e.g., travel and living arrangements, and residence in nursing homes, can further complicate the clinical picture. The magnitude and diversity of health care-associated infections in the aging population are generating new arenas for prevention and control efforts. PMID:11294721

  5. Psychoactive Substance Dependence: A Dentist's Challenge.

    PubMed

    Millar, Lynsey

    2015-05-01

    Given the number of individuals who are dependent on alcohol and/or drugs, it is inevitable that they will present for dental treatment. They are at an increased risk of dental disease for multiple reasons. This paper aims to provide an overview for general dental practitioners (GDPs) of the challenges that can arise in treating such patients, alongside some suggestions for meeting these challenges. General issues are taken into consideration first, then a focus is made on each of the most common substances, together with their implications in dentistry.

  6. Of Malthus and Methuselah: does longevity treatment aggravate global catastrophic risks?

    NASA Astrophysics Data System (ADS)

    Jebari, Karim

    2014-12-01

    Global catastrophic risk is a term that refers to the risk of the occurrence of an event that kills at least millions of people across several continents. While it has been argued by a number of scholars that one major potential risk comes from technology, the obscure nature of future technologies makes it difficult to utilize traditional probabilistic risk for the meaningful study of these risks. This article describes an alternative approach and applies it to a research program that has attracted a considerable amount of resources recently: namely longevity research. The aim of this research is to delay or reverse the ageing process. This article argues that this research program is much more risky or less beneficial than its proponents argue. In particular, they tend to underestimate the concerns associated with the potentially drastic population growth that longevity treatment could cause. The ethical benefit often ascribed to longevity treatment is that such treatment would add more subjective life-years that are worth living. However, in light of contemporary environmental problems, such an increase of the human population might be reckless. Drastically reducing fertility to reduce risks associated with environmental stress would make the benefits of such technology much less compelling.

  7. Double-bundle anterior cruciate ligament reconstruction is superior to single-bundle reconstruction in terms of revision frequency: a study of 22,460 patients from the Swedish National Knee Ligament Register.

    PubMed

    Svantesson, Eleonor; Sundemo, David; Hamrin Senorski, Eric; Alentorn-Geli, Eduard; Musahl, Volker; Fu, Freddie H; Desai, Neel; Stålman, Anders; Samuelsson, Kristian

    2017-12-01

    Studies comparing single- and double-bundle anterior cruciate ligament (ACL) reconstructions often include a combined analysis of anatomic and non-anatomic techniques. The purpose of this study was to compare the revision rates between single- and double-bundle ACL reconstructions in the Swedish National Knee Ligament Register with regard to surgical variables as determined by the anatomic ACL reconstruction scoring checklist (AARSC). Patients from the Swedish National Knee Ligament Register who underwent either single- or double-bundle ACL reconstruction with hamstring tendon autograft during the period 2007-2014 were included. The follow-up period started with primary ACL reconstruction, and the outcome measure was set as revision surgery. An online questionnaire based on the items of the AARSC was used to determine the surgical technique implemented in the single-bundle procedures. These were organized into subgroups based on surgical variables, and the revision rates were compared with the double-bundle ACL reconstruction. Hazard ratios (HR) with 95% confidence interval (CI) was calculated and adjusted for confounders by Cox regression. A total of 22,460 patients were included in the study, of which 21,846 were single-bundle and 614 were double-bundle ACL reconstruction. Double-bundle ACL reconstruction had a revision frequency of 2.0% (n = 12) and single-bundle 3.2% (n = 689). Single-bundle reconstruction had an increased risk of revision surgery compared with double-bundle [adjusted HR 1.98 (95% CI 1.12-3.51), p = 0.019]. The subgroup analysis showed a significantly increased risk of revision surgery in patients undergoing single-bundle with anatomic technique using transportal drilling [adjusted HR 2.51 (95% CI 1.39-4.54), p = 0.002] compared with double-bundle ACL reconstruction. Utilizing a more complete anatomic technique according to the AARSC lowered the hazard rate considerably when transportal drilling was performed but still resulted in significantly increased risk of revision surgery compared with double-bundle ACL reconstruction [adjusted HR 1.87 (95% CI 1.04-3.38), p = 0.037]. Double-bundle ACL reconstruction is associated with a lower risk of revision surgery than single-bundle ACL reconstruction. Single-bundle procedures performed using transportal femoral drilling technique had significantly higher risk of revision surgery compared with double-bundle. However, a reference reconstruction with transportal drilling defined as a more complete anatomic reconstruction reduces the risk of revision surgery considerably. III.

  8. Race, Ethnicity, and Adolescent Violent Victimization.

    PubMed

    Tillyer, Marie Skubak; Tillyer, Rob

    2016-07-01

    The risk of adolescent violent victimization in the United States varies considerably across racial and ethnic populations; it is unknown whether the sources of risk also vary by race and ethnicity. This study examined the correlates of violent victimization for White, Black, and Hispanic youth. Data collected from 11,070 adolescents (51 % female, mean age = 15.04 years) during the first two waves of the National Longitudinal Study of Adolescent to Adult Health were used to estimate group-specific multilevel logistic regression models. The results indicate that male, violent offending, peer deviance, gang membership, and low self-control were significantly associated with increased odds of violent victimization for all groups. Some activities-including getting drunk, sneaking out, and unstructured socializing with peers-were risk factors for Black adolescents only; skipping school was a risk factor only for Hispanic adolescents. Although there are many similarities across groups, the findings suggest that minority adolescents are particularly vulnerable to violent victimization when they engage in some activities and minor forms of delinquency.

  9. Beyond preadoptive risk: The impact of adoptive family environment on adopted youth's psychosocial adjustment.

    PubMed

    Ji, Juye; Brooks, Devon; Barth, Richard P; Kim, Hansung

    2010-07-01

    Adopted children often are exposed to preadoptive stressors--such as prenatal substance exposure, child maltreatment, and out-of-home placements--that increase their risks for psychosocial maladjustment. Psychosocial adjustment of adopted children emerges as the product of pre- and postadoptive factors. This study builds on previous research, which fails to simultaneously assess the influences of pre- and postadoptive factors, by examining the impact of adoptive family sense of coherence on adoptee's psychosocial adjustment beyond the effects of preadoptive risks. Using a sample of adoptive families (n = 385) taking part in the California Long Range Adoption Study, structural equation modeling analyses were performed. Results indicate a significant impact of family sense of coherence on adoptees' psychosocial adjustment and a considerably less significant role of preadoptive risks. The findings suggest the importance of assessing adoptive family's ability to respond to stress and of helping families to build and maintain their capacity to cope with stress despite the sometimes fractious pressures of adoption.

  10. A systematic review of randomized controlled trials of interventions designed to decrease child abuse in high-risk families

    PubMed Central

    Levey, Elizabeth J.; Gelaye, Bizu; Bain, Paul; Rondon, Marta B.; Borba, Christina P.C.; Henderson, David C.; Williams, Michelle A.

    2017-01-01

    Child abuse is a global problem, and parents with histories of childhood abuse are at increased risk of abusing their offspring. The objective of this systematic review is to provide a clear overview of the existing literature of randomized controlled trials evaluating the effectiveness of interventions to prevent child abuse. PubMed, PsychINFO, Web of Science, Sociological Abstracts, and CINAHL were systematically searched and expanded by hand search. This review includes all randomized controlled trials (RCTs) of interventions designed to prevent abuse among mothers identified as high-risk. Of the eight studies identified, only three found statistically significant reductions in abuse by any measure, and only two found reductions in incidents reported to child protective services. While much has been written about child abuse in high-risk families, few RCTs have been performed. Only home visitation has a significant evidence base for reducing child abuse, and the findings vary considerably. Also, data from low- and middle-income countries are limited. PMID:28110205

  11. The application of consequence models in risk assessment: A regulator`s view

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

    Nussey, C.; Carter, D.A.; Cassidy, K.

    1995-12-31

    Quantified risk assessment (QRA) is a technique for aiding decision making. The UK Health and Safety Executive (HSE) uses QRA in the Major Hazards (MH) area to formulate advice to Local Planning Authorities (LPAs) on the siting of MH installations and the development of land in the vicinity of existing MH installations. The region around UK MH sites within which LPAs are required to consult HSE on land-use planning matters (i.e. the Consultation Distance (CD)) is increasingly being redefined by adopting a risk based approach. The authors are now in the process of conducting or updated site specific QRAs tomore » redefine CDs. This process enables them to identify risk reduction measures and discuss them with companies, taking into consideration the ALARP--as low as is reasonably practicable--philosophy. The paper outlines the basis of the QRAs and the role of consequence assessment models and procedures in this process, and illustrates by examples the setting of CDs and the application of the ALARP philosophy.« less

  12. Outpatient management of schizophrenia.

    PubMed

    Martin, R L

    1991-03-01

    As effective antipsychotic pharmacotherapy has become available, patients with schizophrenia are increasingly managed in an outpatient setting by primary care physicians. Pharmacotherapy is generally effective in treating "positive," or psychotic, symptoms and lessening the risks of relapse, but ineffective in improving "negative," or deficit, symptoms. Aggressive attempts to totally control positive symptoms and to ameliorate negative symptoms tend to increase side effects and may be detrimental to the patient. Intensive psychotherapeutic and rehabilitative approaches are generally unproductive. Attempting to obtain a cure is unrealistic. A moderate approach is recommended, taking into consideration the limitations of existing treatments, achieving control of extreme symptoms and minimizing social and occupational limitations.

  13. Adipose tissue as an endocrine organ.

    PubMed

    McGown, Christine; Birerdinc, Aybike; Younossi, Zobair M

    2014-02-01

    Obesity is one of the most important health challenges faced by developed countries and is increasingly affecting adolescents and children. Obesity is also a considerable risk factor for the development of numerous other chronic diseases, such as insulin resistance, type 2 diabetes, heart disease and nonalcoholic fatty liver disease. The epidemic proportions of obesity and its numerous comorbidities are bringing into focus the highly complex and metabolically active adipose tissue. Adipose tissue is increasingly being considered as a functional endocrine organ. This article discusses the endocrine effects of adipose tissue during obesity and the systemic impact of this signaling. Copyright © 2014 Elsevier Inc. All rights reserved.

  14. The high producing dairy cow and its reproductive performance

    PubMed Central

    Dobson, H; Smith, RF; Royal, MD; Knight, CH; Sheldon, IM

    2009-01-01

    Contents: Intensive genetic selection has resulted in modern dairy cow with very high milk yields but reduced fertility, due mainly to an increase in postpartum clinical problems, poor expression of oestrus, defective oocytes/embryos and uterine infections. It is a challenge to get enough food into these cows to meet the high demands of peak milk yields in early lactation and the animals require considerable veterinary attention in the early period after calving. Both genetic and management changes to increase the persistency of lactations would reduce the number and intensity of clinical risk periods throughout a cow's life without compromising milk output. PMID:17688598

  15. Acute Neurological Issues in Pregnancy and the Peripartum

    PubMed Central

    Hosley, Catherine M.; McCullough, Louise D.

    2011-01-01

    Acute neurological diseases requiring hospitalization are relatively rare in women of childbearing age. However, during pregnancy and the postpartum period, several diseases increase in prevalence. Some are unique to the pregnant/postpartum state including preeclampsia and delivery-associated neuropathies. Others, although indirectly related to pregnancy, such as cerebral venous thrombosis, ischemic stroke, and intracerebral hemorrhage, increase in frequency and carry considerable risk of morbidity and mortality. In addition, treatment options are often limited. This review discusses the diseases more commonly seen during pregnancy and the postpartum period, with a focus on emergent neurological diseases and their management. Interventional therapies will also be discussed. PMID:23983844

  16. Youth Risk Taking Behavior: The Role of Schools. A Center Policy & Practice Analysis Brief

    ERIC Educational Resources Information Center

    Center for Mental Health in Schools at UCLA, 2007

    2007-01-01

    Risk taking is natural. As the bumper stickers says: "Risk taking happens!" Risk taking behavior may be beneficial or harmful. Some risk taking is unintentional. But a considerable amount stems from proactive or reactive motivation. For schools, some forms of student risk taking behavior are a necessity, and some forms are a problem. With respect…

  17. At-Risk Students: Portraits, Policies, Programs, and Practices.

    ERIC Educational Resources Information Center

    Donmoyer, Robert, Ed.; Kos, Raylene, Ed.

    This book presents papers that address research methods, policies, and programs that can accommodate the considerable student diversity commonly found among at-risk students as well as portraits of particular at-risk students. The following papers and their authors are included: "At-Risk Students: Insights from/about Research" (Robert…

  18. Climate change will increase the naturalization risk from garden plants in Europe

    PubMed Central

    Wessely, Johannes; Bossdorf, Oliver; Dawson, Wayne; Essl, Franz; Gattringer, Andreas; Klonner, Günther; Kreft, Holger; Kuttner, Michael; Moser, Dietmar; Pergl, Jan; Pyšek, Petr; Thuiller, Wilfried; van Kleunen, Mark; Weigelt, Patrick; Winter, Marten; Dullinger, Stefan; Beaumont, Linda

    2016-01-01

    Abstract Aim Plant invasions often follow initial introduction with a considerable delay. The current non‐native flora of a region may hence contain species that are not yet naturalized but may become so in the future, especially if climate change lifts limitations on species spread. In Europe, non‐native garden plants represent a huge pool of potential future invaders. Here, we evaluate the naturalization risk from this species pool and how it may change under a warmer climate. Location Europe. Methods We selected all species naturalized anywhere in the world but not yet in Europe from the set of non‐native European garden plants. For this subset of 783 species, we used species distribution models to assess their potential European ranges under different scenarios of climate change. Moreover, we defined geographical hotspots of naturalization risk from those species by combining projections of climatic suitability with maps of the area available for ornamental plant cultivation. Results Under current climate, 165 species would already find suitable conditions in > 5% of Europe. Although climate change substantially increases the potential range of many species, there are also some that are predicted to lose climatically suitable area under a changing climate, particularly species native to boreal and Mediterranean biomes. Overall, hotspots of naturalization risk defined by climatic suitability alone, or by a combination of climatic suitability and appropriate land cover, are projected to increase by up to 102% or 64%, respectively. Main conclusions Our results suggest that the risk of naturalization of European garden plants will increase with warming climate, and thus it is very likely that the risk of negative impacts from invasion by these plants will also grow. It is therefore crucial to increase awareness of the possibility of biological invasions among horticulturalists, particularly in the face of a warming climate. PMID:28111525

  19. Management of Early Stage, High-Risk Endometrial Carcinoma: Preoperative and Surgical Considerations

    PubMed Central

    Pettigrew, Gaetan

    2013-01-01

    Endometrial cancer is the most common gynecologic malignancy in the developed world. Most cases are diagnosed at an early stage and have low-grade histology, portending an overall excellent prognosis. There exists a subgroup of patients with early, high-risk disease, whose management remains controversial, as current data is clouded by inclusion of early stage tumors with different high-risk features for recurrence, unstandardized protocols for surgical staging, and an evolving staging system by which we are grouping these patients. Here, we present preoperative and intraoperative considerations that should be taken into account when planning surgical management for this population of patients. PMID:23878545

  20. Epstein-Barr virus and renal transplantation.

    PubMed

    Le, Jade; Durand, Christine M; Agha, Irfan; Brennan, Daniel C

    2017-01-01

    Epstein-Barr virus (EBV) is a gamma herpesvirus associated with diseases ranging from asymptomatic viremia to post-transplant malignancies in kidney transplant recipients. EBV specifically is associated with post-transplantation lymphoproliferative disorder (PTLD), in kidney transplant recipients, with increased risk in EBV seronegative patients with EBV seropositive donors on intensified immunosuppression. The diagnosis of PTLD relies on clinical suspicion plus tissue biopsy with polymerase chain reaction (PCR) testing of blood currently used for risk determination in high-risk recipients. Therapeutic strategies for PTLD include reduction of immunosuppression, chemotherapy and rituximab, and consideration of sirolimus-based immunosuppression. Antivirals such as ganciclovir are used to prevent reactivation of cytomegalovirus and other herpes viruses but are not onco-therapeutic. Radiation therapy or surgery is indicated for bulky, disseminated or recalcitrant disease. Prognosis varies depending on the type of malignancy identified and stage of disease. Copyright © 2016 Elsevier Inc. All rights reserved.

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