Update on the effect of exogenous hormone use on glioma risk in women: a meta-analysis of case-control and cohort studies.

PubMed

Lan, Yu-Long; Wang, Xun; Lou, Jia-Cheng; Ma, Bin-Bin; Xing, Jin-Shan; Zou, Shuang; Zhang, Bo

2018-04-01

Various studies have confirmed the important roles of endogenous hormones in the development of gliomas, while the roles of exogenous hormones remain controversial. Based on case-control studies and cohort studies, a meta-analysis was exerted to explore the effect of two exogenous hormones use (HRT: hormone replacement therapy; OC: oral contraceptives) on glioma risk. 16 eligible studies, including 11 case-control studies and 5 cohort studies, containing 8055027 women, were included in our study. All included studies have reported the relative risks (RRs) or odds ratios (ORs), and 95% confidence intervals (CIs). We use the fixed-effects model to calculate the estimated overall risk. In case-control studies, the risk of glioma was lower in women who had ever been treated with an exogenous hormone than in the control group (HRT: OR 0.91, 95% CI 0.84-0.99; OC: OR 0.99, 95% CI 0.91-1.07). In research of cohort studies, similar results have been obtained (HRT: RR 0.95, 95% CI 0.83-1.08; OC: RR 0.75, 95% CI 0.66-0.84). Our study further confirmed that the use of exogenous hormones has an important impact on the risk of glioma in women. However, more prospective studies are needed to further confirm this conclusion.

[Importance for surveillance on chronic obstructive pulmonary disease among Chinese adults].

PubMed

Fang, L W; Wang, L H

2018-05-10

The first national surveillance of COPD in mainland China was carried out in 2014, with the nationally representative data obtained. The national surveillance was significantly important for the monitoring of prevalence, risk factors, and changing trend of COPD among Chinese adults aged ≥ 40. The surveillance was also important in the development of national COPD prevention and control policy, the evaluation of prevention and control progress, the establishment of COPD comprehensive surveillance system, and the building of a professional COPD monitoring and prevention team. In this editorial, we briefly introduced the method and content of COPD surveillance, and reported the rate of spirometry examination and COPD awareness among adults aged ≥40 in China. We also analyzed the rate of main risk factors for COPD, such as tobacco smoking, occupational exposure to dust or chemical and indoor exposure to biomass or coal, and the distribution of high-risk population. This study provided fundamental data for the prevention and control of COPD in China.

Replication of prostate cancer risk loci in a Japanese case-control association study.

PubMed

Yamada, Hiroki; Penney, Kathryn L; Takahashi, Hiroyuki; Katoh, Takahiko; Yamano, Yuko; Yamakado, Minoru; Kimura, Takahiro; Kuruma, Hidetoshi; Kamata, Yuko; Egawa, Shin; Freedman, Matthew L

2009-10-07

Two prostate cancer genome-wide scans in populations of European ancestry identified several genetic variants that are strongly associated with prostate cancer risk. The effect of these risk variants and their cumulative effect in other populations are unknown. We evaluated the association of 23 risk single-nucleotide polymorphisms (SNPs) with prostate cancer risk and clinical covariates (Gleason score, tumor aggressiveness, and age at diagnosis) in men of Japanese ancestry (311 case subjects and 1035 control subjects) using unconditional logistic regression. We also used logistic regression to test the association between increasing numbers of independently associated risk alleles and the risk of prostate cancer, prostate cancer aggressiveness, and age at diagnosis. All statistical tests were two-sided. Seven of the 23 SNPs (five independent loci) were associated with prostate cancer risk (P values ranged from .0084 to 2.3 x 10(-8) and effect sizes [estimated as odds ratios, ORs] ranged from 1.35 to 1.82). None of the seven SNPs was associated with Gleason score or aggressive disease. rs6983561 and rs4430796 were associated with age at diagnosis (Ps = .0188 and .0339, respectively). Men with six or more risk alleles (27% of case patients and 11% of control subjects) had a higher risk of prostate cancer than men with two or fewer risk alleles (7% of case patients and 20% of control subjects) (OR = 6.22, P = 1.5 x 10(-12)). These results highlight the critical importance of considering ancestry in understanding how risk alleles influence disease and suggest that risk estimates and variants differ across populations. It is important to perform studies in multiple ancestral populations so that the composite genetic architecture of prostate cancer can be rigorously addressed.

Intensive cardiovascular risk reduction induces sustainable changes in expression of genes and pathways important to vascular function.

PubMed

Ellsworth, Darrell L; Croft, Daniel T; Weyandt, Jamie; Sturtz, Lori A; Blackburn, Heather L; Burke, Amy; Haberkorn, Mary Jane; McDyer, Fionnuala A; Jellema, Gera L; van Laar, Ryan; Mamula, Kimberly A; Chen, Yaqin; Vernalis, Marina N

2014-04-01

Healthy lifestyle changes are thought to mediate cardiovascular disease risk through pathways affecting endothelial function and progression of atherosclerosis; however, the extent, persistence, and clinical significance of molecular change during lifestyle modification are not well known. We examined the effect of a rigorous cardiovascular disease risk reduction program on peripheral blood gene expression profiles in 63 participants and 63 matched controls to characterize molecular responses and identify regulatory pathways important to cardiovascular health. Dramatic changes in dietary fat intake (-61%; P<0.001 versus controls) and physical fitness (+34%; P<0.001) led to significant improvements in cardiovascular disease risk factors. Analysis of variance with false discovery rate correction for multiple testing (P<0.05) identified 26 genes after 12 weeks and 143 genes after 52 weeks that were differentially expressed from baseline in participants. Controls showed little change in cardiovascular disease risk factors or gene expression. Quantitative reverse transcription polymerase chain reaction validated differential expression for selected transcripts. Lifestyle modification effectively reduced expression of proinflammatory genes associated with neutrophil activation and molecular pathways important to vascular function, including cytokine production, carbohydrate metabolism, and steroid hormones. Prescription medications did not significantly affect changes in gene expression. Successful and sustained modulation of gene expression through lifestyle changes may have beneficial effects on the vascular system not apparent from traditional risk factors. Healthy lifestyles may restore homeostasis to the leukocyte transcriptome by downregulating lactoferrin and other genes important in the pathogenesis of atherosclerosis. Clinical Trial Registration- URL: www.clinicaltrials.gov. Unique identifier: NCT01805492.

Alcohol dependence and domestic violence as sequelae of abuse and conduct disorder in childhood.

PubMed

Kunitz, S J; Levy, J E; McCloskey, J; Gabriel, K R

1998-11-01

To examine in the Navajo population: (1) the importance of childhood abuse as a risk factor for conduct disorder; (2) the importance of each form of abuse and conduct disorder as risk factors for alcohol dependence; and (3) the relative importance of each form of abuse, conduct disorder, and alcohol dependence as risk factors for being a perpetrator and/or victim of domestic violence. The study is based on a case-control design. Cases (204 men and 148 women) between the ages of 21 and 65 were interviewed in alcohol treatment program and matched to community controls. There were two groups of controls: alcohol dependent (374 men, 60 women) and nonalcohol dependent (157 men, 143 women). When adjusted for stratification by age, community of residence, and sex, the combined control groups comprise a representative sample of the Navajo male and female population 21-65 years of age. The prevalence of physical and sexual abuse before age 15 is within limits observed in other populations. Each form of abuse is a risk factor for conduct disorder. Along with conduct disorder, physical abuse is a risk factor for alcohol dependence. Physical abuse and alcohol dependence are independent risk factors for being involved in domestic violence as both perpetrator and victim. There appears to have been no secular trend in the incidence of childhood abuse over the past several generations, but there is suggestive evidence that domestic violence has become more common. Physical abuse is a significant risk factor for alcohol dependence as well as for domestic violence independent of the effects of alcohol abuse. The effects of sexual abuse with regard to both domestic violence and alcohol dependence do not appear to be significant.

[Parental Monitoring and its Relation to Behaviour Problems and Risk Behaviour in an Adolescent School Sample].

PubMed

Trick, Sarah; Jantzer, Vanessa; Haffner, Johann; Parzer, Peter; Resch, Franz

2016-10-01

Parental Monitoring and its Relation to Behaviour Problems and Risk Behaviour in an Adolescent School Sample Numerous research studies emphasize parental monitoring as a protective factor for adolescent problem behaviour. The purpose of the study presented was to use Stattin and Kerr's (2000) monitoring subscales for the first time in a German-speaking area and to explore the relations to behaviour problems in an adolescent school sample. The two active monitoring strategies "parental control" and "parental solicitation" as well as "parental knowledge" and "child disclosure" relating to behaviour problems and risk behaviour were examined. A sample of 494 pupils, grades 5, 7 and 9, of German secondary schools and their parents answered questions on "parental knowledge", "control", "solicitation" and "child disclosure". Adolescents also answered the German version of the Strengths and Difficulties Questionnaire (SDQ) and items about risk behaviour like frequency of violence, delinquency, substance abuse, self-injuring behaviour and school absenteeism. Behaviour problems in terms of the SDQ could be predicted sufficiently by "parental knowledge", but for the prediction of risk behaviour, the active parental monitoring strategies were of importance, too. More "parental knowledge", more "control" and less "solicitation" could predict less risk behaviour. Results confirm "parental knowledge" as a general protective factor for problem behaviour. However, they show the importance of "parental control" for adolescent risk behaviour.

Importance of good manufacturing practices in microbiological monitoring in processing human tissues for transplant.

PubMed

Pianigiani, Elisa; Ierardi, Francesca; Fimiani, Michele

2013-12-01

Skin allografts represent an important therapeutic resource in the treatment of severe skin loss. The risk associated with application of processed tissues in humans is very low, however, human material always carries the risk of disease transmission. To minimise the risk of contamination of grafts, processing is carried out in clean rooms where air quality is monitored. Procedures and quality control tests are performed to standardise the production process and to guarantee the final product for human use. Since we only validate and distribute aseptic tissues, we conducted a study to determine what type of quality controls for skin processing are the most suitable for detecting processing errors and intercurrent contamination, and for faithfully mapping the process without unduly increasing production costs. Two different methods for quality control were statistically compared using the Fisher exact test. On the basis of the current study we selected our quality control procedure based on pre- and post-processing tissue controls, operator and environmental controls. Evaluation of the predictability of our control methods showed that tissue control was the most reliable method of revealing microbial contamination of grafts. We obtained 100 % sensitivity by doubling tissue controls, while maintaining high specificity (77 %).

Integrating rapid risk mapping and mobile phone call record data for strategic malaria elimination planning.

PubMed

Tatem, Andrew J; Huang, Zhuojie; Narib, Clothilde; Kumar, Udayan; Kandula, Deepika; Pindolia, Deepa K; Smith, David L; Cohen, Justin M; Graupe, Bonita; Uusiku, Petrina; Lourenço, Christopher

2014-02-10

As successful malaria control programmes re-orientate towards elimination, the identification of transmission foci, targeting of attack measures to high-risk areas and management of importation risk become high priorities. When resources are limited and transmission is varying seasonally, approaches that can rapidly prioritize areas for surveillance and control can be valuable, and the most appropriate attack measure for a particular location is likely to differ depending on whether it exports or imports malaria infections. Here, using the example of Namibia, a method for targeting of interventions using surveillance data, satellite imagery, and mobile phone call records to support elimination planning is described. One year of aggregated movement patterns for over a million people across Namibia are analyzed, and linked with case-based risk maps built on satellite imagery. By combining case-data and movement, the way human population movements connect transmission risk areas is demonstrated. Communities that were strongly connected by relatively higher levels of movement were then identified, and net export and import of travellers and infection risks by region were quantified. These maps can aid the design of targeted interventions to maximally reduce the number of cases exported to other regions while employing appropriate interventions to manage risk in places that import them. The approaches presented can be rapidly updated and used to identify where active surveillance for both local and imported cases should be increased, which regions would benefit from coordinating efforts, and how spatially progressive elimination plans can be designed. With improvements in surveillance systems linked to improved diagnosis of malaria, detailed satellite imagery being readily available and mobile phone usage data continually being collected by network providers, the potential exists to make operational use of such valuable, complimentary and contemporary datasets on an ongoing basis in infectious disease control and elimination.

Integrating rapid risk mapping and mobile phone call record data for strategic malaria elimination planning

PubMed Central

2014-01-01

Background As successful malaria control programmes re-orientate towards elimination, the identification of transmission foci, targeting of attack measures to high-risk areas and management of importation risk become high priorities. When resources are limited and transmission is varying seasonally, approaches that can rapidly prioritize areas for surveillance and control can be valuable, and the most appropriate attack measure for a particular location is likely to differ depending on whether it exports or imports malaria infections. Methods/Results Here, using the example of Namibia, a method for targeting of interventions using surveillance data, satellite imagery, and mobile phone call records to support elimination planning is described. One year of aggregated movement patterns for over a million people across Namibia are analyzed, and linked with case-based risk maps built on satellite imagery. By combining case-data and movement, the way human population movements connect transmission risk areas is demonstrated. Communities that were strongly connected by relatively higher levels of movement were then identified, and net export and import of travellers and infection risks by region were quantified. These maps can aid the design of targeted interventions to maximally reduce the number of cases exported to other regions while employing appropriate interventions to manage risk in places that import them. Conclusions The approaches presented can be rapidly updated and used to identify where active surveillance for both local and imported cases should be increased, which regions would benefit from coordinating efforts, and how spatially progressive elimination plans can be designed. With improvements in surveillance systems linked to improved diagnosis of malaria, detailed satellite imagery being readily available and mobile phone usage data continually being collected by network providers, the potential exists to make operational use of such valuable, complimentary and contemporary datasets on an ongoing basis in infectious disease control and elimination. PMID:24512144

Selected Aspects Of The Risk In The Supply Chain In Context Of The Supplier Quality Management

NASA Astrophysics Data System (ADS)

Koblen, Ivan; Lestyánszka Škůrková, Katarína

2015-06-01

The introductory part of the paper underlines the importance of "Risk-based thinking" in the Quality Management System (QMS) and risk in the supply chain, as a principle part of the QMS. After introducing the key terms, the authors focused on the principle part of the article - explanation of the external and internal supply chain risks and the main factors concerning the supply risks, demand risks and environmental risks (as cardinal types of external supply chain risks) as well as the manufacturing and process risks, network/planning and control risks (as most important types of internal supply chain risks). The authors inform on the selected supply chain risk management tools, especially on those which are linked to the appropriate utilization of quality management tools.

Risk factors for unintentional poisoning in children aged 1-3 years in NSW Australia: a case-control study.

PubMed

Schmertmann, Marcia; Williamson, Ann; Black, Deborah; Wilson, Leigh

2013-05-24

Unintentional poisoning in young children is an important public health issue. Age pattern studies have demonstrated that children aged 1-3 years have the highest levels of poisoning risk among children aged 0-4 years, yet little research has been conducted regarding risk factors specific to this three-year age group and the methodologies employed varied greatly. The purpose of the current study is to investigate a broad range of potential risk factors for unintentional poisoning in children aged 1-3 years using appropriate methodologies. Four groups of children, one case group (children who had experienced a poisoning event) and three control groups (children who had been 'injured', 'sick' or who were 'healthy'), and their mothers (mother-child dyads) were enrolled into a case-control study. All mother-child dyads participated in a 1.5-hour child developmental screening and observation, with mothers responding to a series of questionnaires at home. Data were analysed as three case-control pairs with multivariate analyses used to control for age and sex differences between child cases and controls. Five risk factors were included in the final multivariate models for one or more case-control pairs. All three models found that children whose mothers used more positive control in their interactions during a structured task had higher odds of poisoning. Two models showed that maternal psychiatric distress increased poisoning risk (poisoning-injury and poisoning-healthy). Individual models identified the following variables as risk factors: less proximal maternal supervision during risk taking activities (poisoning-injury), medicinal substances stored in more accessible locations in bathrooms (poisoning-sick) and lower total parenting stress (poisoning-healthy). The findings of this study indicate that the nature of the caregiver-child relationship and caregiver attributes play an important role in influencing poisoning risk. Further research is warranted to explore the link between caregiver-child relationships and unintentional poisoning risk. Caregiver education should focus on the benefits of close interaction with their child as a prevention measure.

Risk factors for unintentional poisoning in children aged 1–3 years in NSW Australia: a case–control study

PubMed Central

2013-01-01

Background Unintentional poisoning in young children is an important public health issue. Age pattern studies have demonstrated that children aged 1–3 years have the highest levels of poisoning risk among children aged 0–4 years, yet little research has been conducted regarding risk factors specific to this three-year age group and the methodologies employed varied greatly. The purpose of the current study is to investigate a broad range of potential risk factors for unintentional poisoning in children aged 1–3 years using appropriate methodologies. Methods Four groups of children, one case group (children who had experienced a poisoning event) and three control groups (children who had been ‘injured’, ‘sick’ or who were ‘healthy’), and their mothers (mother-child dyads) were enrolled into a case–control study. All mother-child dyads participated in a 1.5-hour child developmental screening and observation, with mothers responding to a series of questionnaires at home. Data were analysed as three case–control pairs with multivariate analyses used to control for age and sex differences between child cases and controls. Results Five risk factors were included in the final multivariate models for one or more case–control pairs. All three models found that children whose mothers used more positive control in their interactions during a structured task had higher odds of poisoning. Two models showed that maternal psychiatric distress increased poisoning risk (poisoning-injury and poisoning-healthy). Individual models identified the following variables as risk factors: less proximal maternal supervision during risk taking activities (poisoning-injury), medicinal substances stored in more accessible locations in bathrooms (poisoning-sick) and lower total parenting stress (poisoning-healthy). Conclusions The findings of this study indicate that the nature of the caregiver-child relationship and caregiver attributes play an important role in influencing poisoning risk. Further research is warranted to explore the link between caregiver-child relationships and unintentional poisoning risk. Caregiver education should focus on the benefits of close interaction with their child as a prevention measure. PMID:23705679

Rapid case-based mapping of seasonal malaria transmission risk for strategic elimination planning in Swaziland

PubMed Central

2013-01-01

Background As successful malaria control programmes move towards elimination, they must identify residual transmission foci, target vector control to high-risk areas, focus on both asymptomatic and symptomatic infections, and manage importation risk. High spatial and temporal resolution maps of malaria risk can support all of these activities, but commonly available malaria maps are based on parasite rate, a poor metric for measuring malaria at extremely low prevalence. New approaches are required to provide case-based risk maps to countries seeking to identify remaining hotspots of transmission while managing the risk of transmission from imported cases. Methods Household locations and travel histories of confirmed malaria patients during 2011 were recorded through routine surveillance by the Swaziland National Malaria Control Programme for the higher transmission months of January to April and the lower transmission months of May to December. Household locations for patients with no travel history to endemic areas were compared against a random set of background points sampled proportionate to population density with respect to a set of variables related to environment, population density, vector control, and distance to the locations of identified imported cases. Comparisons were made separately for the high and low transmission seasons. The Random Forests regression tree classification approach was used to generate maps predicting the probability of a locally acquired case at 100 m resolution across Swaziland for each season. Results Results indicated that case households during the high transmission season tended to be located in areas of lower elevation, closer to bodies of water, in more sparsely populated areas, with lower rainfall and warmer temperatures, and closer to imported cases than random background points (all p < 0.001). Similar differences were evident during the low transmission season. Maps from the fit models suggested better predictive ability during the high season. Both models proved useful at predicting the locations of local cases identified in 2012. Conclusions The high-resolution mapping approaches described here can help elimination programmes understand the epidemiology of a disappearing disease. Generating case-based risk maps at high spatial and temporal resolution will allow control programmes to direct interventions proactively according to evidence-based measures of risk and ensure that the impact of limited resources is maximized to achieve and maintain malaria elimination. PMID:23398628

Rapid case-based mapping of seasonal malaria transmission risk for strategic elimination planning in Swaziland.

PubMed

Cohen, Justin M; Dlamini, Sabelo; Novotny, Joseph M; Kandula, Deepika; Kunene, Simon; Tatem, Andrew J

2013-02-11

As successful malaria control programmes move towards elimination, they must identify residual transmission foci, target vector control to high-risk areas, focus on both asymptomatic and symptomatic infections, and manage importation risk. High spatial and temporal resolution maps of malaria risk can support all of these activities, but commonly available malaria maps are based on parasite rate, a poor metric for measuring malaria at extremely low prevalence. New approaches are required to provide case-based risk maps to countries seeking to identify remaining hotspots of transmission while managing the risk of transmission from imported cases. Household locations and travel histories of confirmed malaria patients during 2011 were recorded through routine surveillance by the Swaziland National Malaria Control Programme for the higher transmission months of January to April and the lower transmission months of May to December. Household locations for patients with no travel history to endemic areas were compared against a random set of background points sampled proportionate to population density with respect to a set of variables related to environment, population density, vector control, and distance to the locations of identified imported cases. Comparisons were made separately for the high and low transmission seasons. The Random Forests regression tree classification approach was used to generate maps predicting the probability of a locally acquired case at 100 m resolution across Swaziland for each season. Results indicated that case households during the high transmission season tended to be located in areas of lower elevation, closer to bodies of water, in more sparsely populated areas, with lower rainfall and warmer temperatures, and closer to imported cases than random background points (all p < 0.001). Similar differences were evident during the low transmission season. Maps from the fit models suggested better predictive ability during the high season. Both models proved useful at predicting the locations of local cases identified in 2012. The high-resolution mapping approaches described here can help elimination programmes understand the epidemiology of a disappearing disease. Generating case-based risk maps at high spatial and temporal resolution will allow control programmes to direct interventions proactively according to evidence-based measures of risk and ensure that the impact of limited resources is maximized to achieve and maintain malaria elimination.

THE IMPORTANCE OF RISK COMMUNICATION

EPA Science Inventory

The goal of environmental and public health is to reduce the health risks associated with microbial and toxic agents in the environment, and also to agents of injury. There have generally been three approaches to managing these risks: first, control releases of the agent to the e...

A Total Quality-Control Plan with Right-Sized Statistical Quality-Control.

PubMed

Westgard, James O

2017-03-01

A new Clinical Laboratory Improvement Amendments option for risk-based quality-control (QC) plans became effective in January, 2016. Called an Individualized QC Plan, this option requires the laboratory to perform a risk assessment, develop a QC plan, and implement a QC program to monitor ongoing performance of the QC plan. Difficulties in performing a risk assessment may limit validity of an Individualized QC Plan. A better alternative is to develop a Total QC Plan including a right-sized statistical QC procedure to detect medically important errors. Westgard Sigma Rules provides a simple way to select the right control rules and the right number of control measurements. Copyright © 2016 Elsevier Inc. All rights reserved.

Opportunities for improving risk communication during the permitting process for entomophagous biological control agents: A review of current systems

USDA-ARS?s Scientific Manuscript database

Concerns about potentially irreversible non-target impacts from the importation and release of entomophagous biological control agents (BCAs) have resulted in increasingly stringent import requirements by National Plant Protection Organizations. Despite numerous scientific publications on the poten...

Health-related quality of life and risk factor control: the importance of educational level in prevention of cardiovascular diseases.

PubMed

Ose, Dominik; Rochon, Justine; Campbell, Stephen M; Wensing, Michel; Freund, Tobias; van Lieshout, Jan; Längst, Gerda; Szecsenyi, Joachim; Ludt, Sabine

2014-08-01

This study aimed to describe and to analyse the importance of educational level for controlled risk factors and health-related quality of life (HRQoL). This observational study was conducted in nine European countries (5632 patients in 249 practices). We compared patients with a low level of education (up to 9 years) with patients with a high level of education (>9 years), with regard to controlled cardiovascular disease risk factors and HRQoL. A multilevel approach was used for statistical analysis. Patients with a low level of education were older (P < 0.001), more often female (P < 0.001), more often single (P < 0.001) and had a higher number of other conditions (e.g. heart failure) (P < 0.001). Significant differences in terms of controlled risk factors were revealed for blood pressure (RR) ≤ 140/90 mmHg (P = 0.039) and the sum of controlled risk factors (P = 0.027). Higher age, lower education, female gender, living as single, patient group (coronary heart disease patients) and the number of other conditions were negatively associated with HRQoL. A higher sum of controlled risk factors were positively associated with higher HRQoL in the whole sample (r = 0.0086, P < 0.001) as well as in both educational-level groups (r = 0.0075, P = 0.038 in the low-level group and r = 0.0082, P = 0.001 in the high-level group). Patients with a lower educational level were more often females, singles, had a higher number of other conditions, a higher number of uncontrolled risk factors and a lower HRQoL. However, the higher the control of risk factors was, the higher the HRQoL was overall as well as in both educational-level groups. © The Author 2013. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

Health impacts of large releases of radionuclides. Mental health, stress and risk perception: insights from psychological research.

PubMed

Renn, O

1997-01-01

Risk perceptions are only slightly correlated with the expected values of a probability distribution for negative health impacts. Psychometric studies have documented that context variables such as dread or personal control are important predictors for the perceived seriousness of risk. Studies about cultural patterns of risk perceptions emphasize different response sets to risk information, depending on cultural priorities such as social justice versus personal freedom. This chapter reports the major psychological research results pertaining to the factors that govern individual risk perception and discusses the psychometric effects due to people's risk perception and the experience of severe stress. The relative importance of the psychometric context variables, the signals pertaining to each health risks and symbolic beliefs are explained.

Importance of sustained and "tight" blood pressure control in patients with high cardiovascular risk.

PubMed

Meredith, Peter A; Lloyd, Suzanne M; Ford, Ian; Elliott, Henry L

2016-01-01

A retrospective further analysis of the ACTION database evaluated the relationship between cardiovascular outcomes and the "quality" of the control of blood pressure (BP). The study population (n = 6287) comprised those patients with four BP measurements during year 1 subdivided according to the proportion of visits in which BP was controlled in relation to two BP targets: < 140/90mmHg and < 130/80 mmHg. Differences between the BP control groups for the major prespecified ACTION outcomes were investigated with Cox proportional hazards models. For all the prespecified cardiovascular endpoints the incidence declined as the proportion of visits with BP control increased. The greatest differences in outcomes between the different BP control groups were observed for the risk of stroke but were still apparent for all the other endpoints. For example, the risks for the primary outcome [hazard ratio (HR) 0.78; 95% confidence interval (CI) 0.67 to 0.90] were significantly less in the group with >_75% of visits with BP control than in the group with < 25% of visits with BP control. There were no significant treatment-related differences. Retrospective analyses are not definitive but these results highlight the importance of the attainment of BP control targets and the consistency of BP control during long-term follow-up.

[Epidemic situation of oversea imported schistosomiasis in China and thinking about its prevention and control].

PubMed

Zhu, Rong; Xu, Jing

2014-04-01

The imported schistosomiasis cases in the Chinese literature and reports from the infectious disease monitoring information system from 1979 to 2013 were collected and compiled. Totally 365 cases were reported to be infected with outside schistosomiasis, including 239 cases of schistosomiasis haematobia (74.0%) and 71 cases of schistosomiasis mansoni (22.0%), and 42 foreigners (11.5%) and 323 Chinese (88.5%). The infection areas involved 15 countries and regions in Africa. Totally 74.92% of patients worked in the construction or geological prospecting in the wild field. According to the analysis of these cases, we found that the management system of prevention and control of imported schistosomiasis cases was not perfect including the high missing re-port rate, high misdiagnosis rate, and no standard diagnostic criteria. We suggest that all the levels of CDC or health administrative authorities should adopt the following relevant control measures to strengthen the imported schistosomiasis prevention and control in order to reduce the damage to the public health and the risk of the spread of African schistosomiasis in China: (1) to establish and perfect the imported schistosomiasis monitoring and control system in China; (2) to integrate the dynamic information platform of labor export and establish the comprehensive prevention and control management system of infectious diseases; (3) to standardize the diagnosis and treatment of oversea imported schistosomiasis; (4) to strengthen the research on the transmission risk of imported schistosomiasis in the territory of China.

Effects of prenatal alcohol and cigarette exposure on offspring substance use in multiplex, alcohol-dependent families.

PubMed

O'Brien, Jessica W; Hill, Shirley Y

2014-12-01

Prenatal exposures to alcohol, cigarettes, and other drugs of abuse are associated with numerous adverse consequences for affected offspring, including increased risk for substance use and abuse. However, maternal substance use during pregnancy appears to occur more often in those with a family history of alcohol dependence. Utilizing a sample that is enriched for familial alcohol dependence and includes controls selected for virtual absence of familial alcohol dependence could provide important information on the relative contribution of familial risk and prenatal exposures to offspring substance use. A sample of multigenerational families specifically ascertained to be at either high or low risk for developing alcohol dependence (AD) provided biological offspring for a longitudinal prospective study. High-risk families were selected based on the presence of 2 alcohol-dependent sisters. Low-risk families were selected on the basis of minimal first and second-degree relatives with AD. High-risk (HR = 99) and Low-risk offspring (LR = 110) were assessed annually during childhood and biennially in young adulthood regarding their alcohol, drug, and cigarette use. At the first childhood visit, mothers were interviewed concerning their prenatal use of substances. High-risk mothers were more likely to use alcohol, cigarettes, and other drugs during pregnancy than low-risk control mothers, and to consume these substances in greater quantities. Across the sample, prenatal exposure to alcohol was associated with increased risk for both offspring cigarette use and substance use disorders (SUD), and prenatal cigarette exposure was associated with increased risk for offspring cigarette use. Controlling for risk status by examining patterns within the HR sample, prenatal cigarette exposure remained a specific predictor of offspring cigarette use, and prenatal alcohol exposure was specifically associated with increased risk for offspring SUD. Women with a family history of SUD are at increased risk for substance use during pregnancy. Both familial loading for alcohol dependence and prenatal exposure to alcohol or cigarettes are important risk factors in the development of offspring substance use. An inadequate assessment of family history may obscure important interactions between familial risk and prenatal exposures on offspring outcomes. Copyright © 2015 by the Research Society on Alcoholism.

Assessing dengue infection risk in the southern region of Taiwan: implications for control.

PubMed

Liao, C-M; Huang, T-L; Cheng, Y-H; Chen, W-Y; Hsieh, N-H; Chen, S-C; Chio, C-P

2015-04-01

Dengue, one of the most important mosquito-borne diseases, is a major international public health concern. This study aimed to assess potential dengue infection risk from Aedes aegypti in Kaohsiung and the implications for vector control. Here we investigated the impact of dengue transmission on human infection risk using a well-established dengue-mosquito-human transmission dynamics model. A basic reproduction number (R 0)-based probabilistic risk model was also developed to estimate dengue infection risk. Our findings confirm that the effect of biting rate plays a crucial role in shaping R 0 estimates. We demonstrated that there was 50% risk probability for increased dengue incidence rates exceeding 0.5-0.8 wk-1 for temperatures ranging from 26°C to 32°C. We further demonstrated that the weekly increased dengue incidence rate can be decreased to zero if vector control efficiencies reach 30-80% at temperatures of 19-32°C. We conclude that our analysis on dengue infection risk and control implications in Kaohsiung provide crucial information for policy-making on disease control.

Birth and adoptive parent anxiety symptoms moderate the link between infant attention control and internalizing problems in toddlerhood.

PubMed

Brooker, Rebecca J; Neiderhiser, Jenae M; Ganiban, Jody M; Leve, Leslie D; Shaw, Daniel S; Reiss, David

2014-05-01

Attention control plays an important role in the development of internalizing symptoms in children. We explored the degree to which infants' genetic and environmentally based risk moderated the link between attention control and internalizing problems during toddlerhood. These associations were examined within a prospective adoption design, enabling the disentanglement of genetic and environmental risk for internalizing problems. Attention control in adopted infants was observed during periods of distress at age 9 months. Birth parents' anxiety symptoms were used as an index of genetic risk, while adoptive parents' anxiety symptoms were used as an index of environmental risk. Adoptive mothers and fathers reported on children's internalizing problems when children were 18 and 27 months old. Greater attention control in infancy appeared to mitigate genetically based risk for internalizing problems during toddlerhood when children were raised by adoptive parents who were low in anxiety. Findings suggest that for genetically susceptible children who are raised in low-risk environments, attention control may provide a protective factor against developing internalizing problems across early life.

Birth and Adoptive Parent Anxiety Symptoms Moderate the Link Between Infant Attention Control and Internalizing Problems in Toddlerhood

PubMed Central

Brooker, Rebecca J.; Neiderhiser, Jenae M.; Ganiban, Jody M.; Leve, Leslie D.; Shaw, Daniel S.; Reiss, David

2013-01-01

Attention control plays an important role in the development of internalizing symptoms in children. We explored the degree to which infants' genetic- and environmentally-based risk moderated the link between attention control and internalizing problems during toddlerhood. These associations were examined within a prospective adoption design, enabling the disentanglement of genetic and environmental risk for internalizing problems. Attention control in adopted infants was observed during periods of distress at age 9 months. Birth parents' anxiety symptoms were used as an index of genetic risk, while adoptive parents' anxiety symptoms were used as an index of environmental risk. Adoptive mothers and fathers reported on children's internalizing problems when children were 18- and 27-months old. Greater attention control in infancy appeared to mitigate genetically-based risk for internalizing problems during toddlerhood when children were raised by adoptive parents who were low in anxiety. Findings suggest that for genetically-susceptible children who are raised in low-risk environments, attention control may provide a protective factor against developing internalizing problems across early life. PMID:24472311

[Analysis and countermeasure for quality risk in process of traditional Chinese medicine preparations].

PubMed

Yang, Ming; Yang, Yuan-Zhen; Wang, Ya-Qi; Wu, Zhen-Feng; Wang, Xue-Cheng; Luo, Jing

2017-03-01

Product quality relies on not only testing methods,but also the design and development, production control and product manufacturing all aspects of logistics management. Quality comes from the process control level.Therefore, it is very important to accurately identify the factors that may induce quality risk in the production process and quality control measures correspondingly.This article systematically analyzes the source of the quality risk of all aspects of the production process in traditional Chinese medicine preparation. Discussing ways and methods of quality risk identification of traditional Chinese medicine preparation and providing references for perfecting the whole process quality management of traditional Chinese medicine preparation. Copyright© by the Chinese Pharmaceutical Association.

Risk Factors for Diverticulosis, Diverticulitis, Diverticular Perforation, and Bleeding: A Plea for More Subtle History Taking

PubMed Central

Böhm, Stephan K.

2015-01-01

Background Diverticulosis is a very common condition. Around 20% of diverticula carriers are believed to suffer from diverticular disease during their lifetime. This makes diverticular disease one of the clinically and economically most significant conditions in gastroenterology. The etiopathogenesis of diverticulosis and diverticular disease is not well understood. Epidemiological studies allowed to define risk factors for the development of diverticulosis and the different disease entities associated with it, in particular diverticulitis, perforation, and diverticular bleeding. Methods A comprehensive literature search was performed, and the current knowledge about risk factors for diverticulosis and associated conditions reviewed. Results Non-controllable risk factors like age, sex, and genetics, and controllable risk factors like foods, drinks, and physical activity were identified, as well as comorbidities and drugs which increase or decrease the risk of developing diverticula or of suffering from complications. In naming risk factors, it is of utmost importance to differentiate between diverticulosis and the different disease entities. Conclusion Risk factors for diverticulosis and diverticular disease may give a clue towards the possible etiopathogenesis of the conditions. More importantly, knowledge of comorbidities and particularly drugs conferring a risk for development of complicated disease is crucial for patient management. PMID:26989377

Field application of a combined pig and poultry market chain and risk pathway analysis within the Pacific Islands region as a tool for targeted disease surveillance and biosecurity.

PubMed

Brioudes, Aurélie; Gummow, Bruce

2016-07-01

Limited resources are one of the major constraints in effective disease monitoring and control in developing countries. This paper examines the pig and poultry market chains of four targeted Pacific Island countries and territories (PICTs): Fiji, Papua New Guinea, Solomon Islands and Vanuatu and combines them with a risk pathway analysis to identify the highest risk areas (risk hotspots) and risky practices and behaviours (risk factors) of animal disease introduction and/or spread, using highly pathogenic avian influenza (HPAI) and foot-and-mouth disease (FMD) as model diseases because of their importance in the region. The results show that combining a market chain analysis with risk pathways is a practical way of communicating risk to animal health officials and improving biosecurity. It provides a participatory approach that helps officials to better understand the trading regulations in place in their country and to better evaluate their role as part of the control system. Common risk patterns were found to play a role in all four PICTs. Legal trade pathways rely essentially on preventive measures put in place in the exporting countries while no or only limited control measures are undertaken by the importing countries. Legal importations of animals and animal products are done mainly by commercial farms which then supply local smallholders. Targeting surveillance on these potential hotspots would limit the risk of introduction and spread of animal diseases within the pig and poultry industry and better rationalize use of skilled manpower. Swill feeding is identified as a common practice in the region that represents a recognized risk factor for dissemination of pathogens to susceptible species. Illegal introduction of animals and animal products is suspected, but appears restricted to small holder farms in remote areas, limiting the risk of spread of transboundary animal diseases along the market chain. Introduction of undeclared goods hidden within a legal trade activity was identified as a major risk pathway. Activities such as awareness campaigns for pig and poultry farmers regarding disease reporting, biosecurity measures or danger of swill feeding and training of biosecurity officers in basic animal health and import-associated risks are recommended to prevent and limit the spread of pathogens within the PICTs. Copyright © 2016 Elsevier B.V. All rights reserved.

Remote Sensing and Geographic Information Systems as Decision Support Tools for Malaria Control in the Republic of Korea

DTIC Science & Technology

2001-05-30

larviciding due to the larger number of at- risk personnel and the smaller size of the vector habitats. This study demonstrates the usefulness of remote sensing...climate and demonstrates both short and long incubation periods. Long incubation periods increase the risk of re-introducing malaria to the continental...United States, making malaria control in the ROK even more important (Walter Reed Army Institute of Research 1998). This increased risk is from U.S

Portfolio Purchasing Decision for Mobile Power Equipment of B2C E-Commerce Export Retailer Based on CVaR

NASA Astrophysics Data System (ADS)

Yanchun, Wan; Qiucen, Chen

2017-11-01

Purchasing is an important part of export e-commerce of B2C, which plays an important role on risk and cost control in supply management. From the perspective of risk control, the paper construct a CVaR model for portfolio purchase. We select a heavy sales mobile power equipment from a typical B2C e-commerce export retailer as study sample. This study optimizes the purchasing strategy of this type of mobile power equipment. The research has some reference for similar enterprises in purchasing portfolio decision.

78 FR 45729 - Foreign Supplier Verification Programs for Importers of Food for Humans and Animals

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-29

...The Food and Drug Administration (FDA) is proposing to adopt regulations on foreign supplier verification programs (FSVPs) for importers of food for humans and animals. The proposed regulations would require importers to help ensure that food imported into the United States is produced in compliance with processes and procedures, including reasonably appropriate risk-based preventive controls, that provide the same level of public health protection as those required under the hazard analysis and risk-based preventive controls and standards for produce safety sections of the Federal Food, Drug, and Cosmetic Act (the FD&C Act), is not adulterated, and is not misbranded with respect to food allergen labeling. We are proposing these regulations in accordance with the FDA Food Safety Modernization Act (FSMA). The proposed regulations would help ensure that imported food is produced in a manner consistent with U.S. standards.

Adolescent Neurodevelopment of Cognitive Control and Risk-taking in Negative Family Contexts

PubMed Central

McCormick, Ethan M.; Qu, Yang; Telzer, Eva H.

2015-01-01

Adolescents have an increased need to regulate their behavior as they gain access to opportunities for risky behavior; however, cognitive control systems necessary for this regulation remain relatively immature. Parents can impact their adolescent child's abilities to regulate their behavior and engagement in risk taking. Since adolescents undergo significant neural change, negative parent-child relationship quality may impede or alter development in prefrontal regions subserving cognitive control. To test this hypothesis, 20 adolescents completed a go/nogo task during two fMRI scans occurring 1 year apart. Adolescents reporting greater family conflict and lower family cohesion showed longitudinal increases in risk-taking behavior, which was mediated by longitudinal increases in left VLPFC activation during cognitive control. These results underscore the importance of parent-child relationships during early adolescence, and the neural processes by which cognitive control may be derailed and lead to increased risk taking. PMID:26434803

Adolescent neurodevelopment of cognitive control and risk-taking in negative family contexts.

PubMed

McCormick, Ethan M; Qu, Yang; Telzer, Eva H

2016-01-01

Adolescents have an increased need to regulate their behavior as they gain access to opportunities for risky behavior; however, cognitive control systems necessary for this regulation remain relatively immature. Parents can impact their adolescent child's abilities to regulate their behavior and engagement in risk taking. Since adolescents undergo significant neural change, negative parent-child relationship quality may impede or alter development in prefrontal regions subserving cognitive control. To test this hypothesis, 20 adolescents completed a Go/NoGo task during two fMRI scans occurring 1year apart. Adolescents reporting greater family conflict and lower family cohesion showed longitudinal increases in risk-taking behavior, which was mediated by longitudinal increases in left VLPFC activation during cognitive control. These results underscore the importance of parent-child relationships during early adolescence, and the neural processes by which cognitive control may be derailed and may lead to increased risk taking. Published by Elsevier Inc.

A quantitative risk assessment of bovine theileriosis entering Luapula Province from Central Province in Zambia via live cattle imports from traditional and commercial production sectors.

PubMed

Makungu, C; Mwacalimba, K K

2014-09-01

Theileriosis or East Coast Fever (ECF) is an important livestock disease widespread in Zambia except for some provinces such as Luapula. This freedom status has been achieved due to strict livestock movement regulations that only authorise cattle imports from commercial farms implementing strict ECF control regimens. Recent increases in both the demand and price of beef in Zambia are stimulating a policy change towards a more inclusive inter-provincial trade in live cattle. This may also encourage the introduction of breeding cattle from high production pastoral sectors such as Central Province to stimulate the beef industry in disease free low production areas such as the Luapula Province. To estimate and compare the risks linked with those potential introductions of cattle from the traditional or commercial production sectors of the Central Province, a quantitative risk assessment model was developed. This risk comparison was necessary because the traditional livestock production sector accounts for over 79% of breeding cattle trade in Central Province but is characterised by minimalistic tick-borne disease control and a higher prevalence of ECF. We estimate that should the importation of breeding cattle from Central into Luapula Province be permitted, we could expect to import ECF by the introduction of infected animals at a median rate (5th and 95th percentiles) of every 0.44 years (0.12, 2.60), from the traditional sector compared to every 3.57 years (0.37, 103.6) from the commercial sector. Infected ticks would be expected to enter every 3.46 (0.66, 43.8) years via traditional cattle imports. These risks are strongly influenced by the prevalence of infection, performance of pre-transport screening tests, and the effectiveness of pre-transport tick cleansing. This assessment is expected to provide a model for tick borne disease risk assessments in similar settings, as well as inform ECF control, cattle trade, and stock movement policies in Zambia. Copyright © 2014 Elsevier B.V. All rights reserved.

Comparative Effect of Contrast Media Type on the Incidence of Contrast-Induced Nephropathy: A Systematic Review and Meta-analysis.

PubMed

Eng, John; Wilson, Renee F; Subramaniam, Rathan M; Zhang, Allen; Suarez-Cuervo, Catalina; Turban, Sharon; Choi, Michael J; Sherrod, Cheryl; Hutfless, Susan; Iyoha, Emmanuel E; Bass, Eric B

2016-03-15

Iodine contrast media are essential components of many imaging procedures. An important potential side effect is contrast-induced nephropathy (CIN). To compare CIN risk for contrast media within and between osmolality classes in patients receiving diagnostic or therapeutic imaging procedures. PubMed, EMBASE, Cochrane Library, Clinical Trials.gov, and Scopus through June 2015. Randomized, controlled trials that reported CIN-related outcomes in patients receiving low-osmolar contrast media (LOCM) or iso-osmolar contrast media for imaging. Independent study selection and quality assessment by 2 reviewers and dual extraction of study characteristics and results. None of the 5 studies that compared types of LOCM reported a statistically significant or clinically important difference among study groups, but the strength of evidence was low. Twenty-five randomized, controlled trials found a slight reduction in CIN risk with the iso-osmolar contrast media agent iodixanol compared with a diverse group of LOCM that just reached statistical significance in a meta-analysis (pooled relative risk, 0.80 [95% CI, 0.65 to 0.99]; P = 0.045). This comparison's strength of evidence was moderate. In a meta regression of randomized, controlled trials of iodixanol, no relationship was found between route of administration and comparative CIN risk. Few studies compared LOCM. Procedural details about contrast administration were not uniformly reported. Few studies specified clinical indications or severity of baseline renal impairment. No differences were found in CIN risk among types of LOCM. Iodixanol had a slightly lower risk for CIN than LOCM, but the lower risk did not exceed a criterion for clinical importance. Agency for Healthcare Research and Quality.

Cardiovascular Risk Factors in Patients with Poorly Controlled Diabetes Mellitus.

PubMed

Dizdarevic-Bostandzic, Amela; Begovic, Ermin; Burekovic, Azra; Velija-Asimi, Zelija; Godinjak, Amina; Karlovic, Vanja

2018-02-01

Diabetes mellitus(DM) is considered an independent cardiovascular risk factor. Having in mind concomitant occurence of diabetes and other cardiovascular risk factors, it is expected that patients with poor glucoregulation will have more cardiovascular risk factors and higher cardiovascular risk than patients with good glucoregulation. To compare cardiovascular risk and cardiovascular risk factors between patients with poorly controlled and patients with well-controlled Diabetes mellitus. Hundered ten patients aged 40-70 years suffering from Diabetes mellitus type 2 were included. Research is designed as a retrospective, descriptive study. Patients with glycosylated hemoglobin (HbA1c) > 7% were considered to have poorly controlled diabetes. The following data and parameters were monitored: age,sex, family history, data on smoking and alcohol consumption, BMI (body mass index), blood pressure, blood glucose, total cholesterol, triglycerides, LDL, HDL, fibrinogen, uric acid. For the assessment of cardiovascular risk, the WHO / ISH (World Health Organization/International Society of hypertension) tables of the 10-year risk were used, and due to the assessment of the risk factors prevalence, the optimal values of individual numerical variables were defined. Differences in the mean values of systolic, diastolic blood pressure, fasting glucose, total cholesterol, LDL cholesterol are statistically significant higher in patients with poorly controlled diabetes. Hypertension more frequently occurre in patients with poorly controlled DM. The majority of patients with well-controlled DM belong to the group of low and medium cardiovascular risk, while the majority of patients with poorly controlled DM belong to the group of high and very high cardiovascular risk. In our research, there was a significant difference in cardiovascular risk in relation to the degree of DM regulation, and HbA1c proved to be an important indicator for the emergence of the CVD. There are significant differences in certain risk factors between patients with poorly controlled and well controlled DM. Patients with poorly controlled diabetes mellitus have a higher cardiovascular risk than patients with well controlled diabetes. The value of HbA1c should be considered when assessing cardiovascular risk.

Preterm delivery risk factors in singletons born after in vitro fertilization procedures.

PubMed

Ban Frangez, Helena; Korosec, Sara; Verdenik, Ivan; Kotar, Vanja; Kladnik, Urska; Vrtacnik Bokal, Eda

2014-05-01

Women delivering singletons after in vitro fertilization (IVF) procedures have a greater risk of preterm delivery (PD). The aim of our study was to analyze PD risk factors and to identify those that could possibly be prevented. In our matched controlled study we analyzed 1127 singleton deliveries after IVF and transfer of fresh embryos performed at the University Medical Center Ljubljana between 1 January 2002 and 31 December 2010. For every delivery included in the study group we chose three consecutive controls matched by maternal age, parity and maternity hospital. The main outcome measure was PD (<37 weeks). Investigated variables were: previous PD (PPD), conization, pregestational diabetes mellitus, uterine anomaly, operation on the uterus, chronic renal disease, maternal age and parity, and body mass index (BMI). Variables investigated within the IVF group were: stimulation protocol, laboratory procedure, number of retrieved oocytes and number and quality of transferred embryos. The PD rate after IVF was 1.5 times higher than after natural conception (11.5% in the IVF group and 7.7% in the control group, p<0.001). Conization and chronic renal disease were shown to be significant risk factors for PD in both the IVF group and the naturally conceiving controls. BMI>30 was an important risk factor only in the IVF group (OR 1.86 (1.06-3.27) vs. 1.10 (0.67-1.80)) and PPD only in the controls (OR 1.83 (0.78-4.28) vs. 3.22 (1.55-6.67)). Among the investigated PD risk factors, an IVF procedure was shown to be the fifth most important one. On analyzing parameters of the ovarian stimulation and IVF procedure, no PD risk factor was identified. IVF was shown to be a significant risk factor for PD. In the IVF population, BMI plays a far more important role in PD than in the fertile population. In our research PD reoccurrence in IVF group was less than expected, which could perhaps be explained by the surgical correction of gynecological pathology and, where necessary, its being combined with cerclage. The investigation of parameters related to the IVF procedure did not identify any risk factors for PD. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

[Challenge and strategy of prevention and control of important parasitic diseases under the Belt and Road Initiative].

PubMed

Chun-Li, Cao; Jia-Gang, Guo

2018-04-17

China was once a country with the heaviest burden of parasitic diseases. Under the leadership of the Communist Party and national authority, after more than 60 years' efforts of prevention and control, the remarkable results have been achieved in China. However, affected by the social and economic development and environmental changes, the prevention and control of parasitic diseases, especially imported parasitic diseases, are facing new challenges, and the parasitic diseases, such as malaria, schistosomiasis, leishmaniasis, filariasis and trypanosomiasis, appear increasingly. With the development of the Belt and Road Initiative, the transmission risks of these diseases are more increased. The purpose of this paper is to describe the experience and results of parasitic disease prevention and control in China, understand the present parasitic disease epidemic situation of the Belt and Road Initiative related countries, analyze the transmission risks of important parasitic diseases, and present some relevant suggestions, so as to provide the evidence for the health administrative department formulating the prevention and control strategies of such parasitic diseases timely and effectively.

The role of surgery in the management of gestational trophoblastic neoplasia.

PubMed

Doll, Kemi M; Soper, John T

2013-07-01

Although sensitive human chorionic gonadotropin assays and advances in chemotherapy have assumed primary importance in the management of gestational trophoblastic neoplasia, surgery remains important in the overall care of these patients. Management of molar pregnancies consists of surgical evacuation and subsequent monitoring. Hysterectomy decreases the risk of post-molar trophoblastic disease in appropriate patients and, when incorporated to primary management of gestational trophoblastic neoplasia, can decrease the chemotherapy requirements of patients with low-risk disease. In patients with high-risk disease, surgical intervention is frequently required to control complications of disease or as therapy to stabilize patients during chemotherapy. Hysterectomy, thoracotomy, or other extirpative procedures may be integrated into the management of patients with chemorefractory disease. Interventional procedures are useful adjuncts to control bleeding from metastases.

Suicide risk among individuals with sleep disturbances in Japan: a case-control psychological autopsy study.

PubMed

Kodaka, Manami; Matsumoto, Toshihiko; Katsumata, Yotaro; Akazawa, Masato; Tachimori, Hisateru; Kawakami, Norito; Eguchi, Nozomi; Shirakawa, Norihito; Takeshima, Tadashi

2014-04-01

This case-control psychological autopsy study aimed to explore a relationship between sleep disturbances and suicide among Japanese, as well as determine the importance and usability of screening for sleep disturbances in suicide prevention. A semi-structured interview was conducted with the close family members of 49 adult suicide completers and 145 gender-, age-, and residential municipality-matched living controls. The survey included sections on demographics, sleep disturbances, and mental disorders. Conditional logistic regression analyses were performed to compare sleep disturbance prevalence between the two groups. A significantly higher prevalence of sleep disturbances was found among the suicide group (75.5%) compared to the controls (11.0%) (odds ratio [OR]=21.6, p<0.001). The association remained significant after adjusting for mental disorders (OR=12.7, p<0.001). The population attributable risk percent of suicide associated with sleep disturbances and mental disorders was estimated to be 56.4% and 35.3%, respectively. The study confirmed that sleep disturbances are an important risk factor of suicide, independent of mental disorders. Sleep disturbances accounted for a greater proportion of suicide cases than did mental disorders in the Japanese population given the higher prevalence, and could thus be considered an important target in suicide prevention in Japan. Copyright © 2014 Elsevier B.V. All rights reserved.

The History of Injury Control and the Epidemiology of Child and Adolescent Injuries.

ERIC Educational Resources Information Center

Grossman, David C.

2000-01-01

Presents a historical overview of injury control and prevention in the United States and offers a summary of current knowledge about the importance of different causes of childhood injury, looking at risk and protective factors that have a bearing on preventive efforts. Injury remains the most important cause of death and disability for children…

Cancer Risk-Promoting Information: The Communication Environment of Young Adults.

PubMed

McCloud, Rachel F; Kohler, Racquel E; Viswanath, K

2017-09-01

Young adulthood represents a time of myriad transitions, which leave young adults (YAs) more susceptible to the influences of cancer risk-promoting information. The tobacco, alcohol, indoor tanning, and food and beverage industries engage in aggressive marketing strategies through both traditional and social media to target this age group to consume their products, which have known links to cancer. Despite this barrage of messaging, detailed data are lacking on the communication behaviors of subgroups of this diverse age group, particularly those from low SES. This paper explores the available data on media usage among YAs and describes the cancer risk-promoting information environment, with a focus on communication inequalities and their implications for cancer research and control. Nationally representative data on media consumption patterns indicate that the majority of YAs access a diverse range of traditional and social media platforms, but these data do not fully describe differences at the intersection of age and important factors such as SES, gender, race/ethnicity, or urban/rural residence. Meanwhile, risk-promoting information is heavily marketed to YAs across media, with an increasing focus on using social media sites to normalize products and evade marketing restrictions. Gaps in the available data on YAs' media consumption behaviors, coupled with aggressive risk-promoting marketing strategies toward YAs, may impede cancer control efforts. Relationships between exposure to various cancer risk-promoting information, concurrent risk behaviors, SES disparities, and communication inequalities should be investigated to develop innovative and effective control programs and policies to promote cancer control in this important group. Copyright © 2017 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Quality Risk Management: Putting GMP Controls First.

PubMed

O'Donnell, Kevin; Greene, Anne; Zwitkovits, Michael; Calnan, Nuala

2012-01-01

This paper presents a practical way in which current approaches to quality risk management (QRM) may be improved, such that they better support qualification, validation programs, and change control proposals at manufacturing sites. The paper is focused on the treatment of good manufacturing practice (GMP) controls during QRM exercises. It specifically addresses why it is important to evaluate and classify such controls in terms of how they affect the severity, probability of occurrence, and detection ratings that may be assigned to potential failure modes or negative events. It also presents a QRM process that is designed to directly link the outputs of risk assessments and risk control activities with qualification and validation protocols in the GMP environment. This paper concerns the need for improvement in the use of risk-based principles and tools when working to ensure that the manufacturing processes used to produce medicines, and their related equipment, are appropriate. Manufacturing processes need to be validated (or proven) to demonstrate that they can produce a medicine of the required quality. The items of equipment used in such processes need to be qualified, in order to prove that they are fit for their intended use. Quality risk management (QRM) tools can be used to support such qualification and validation activities, but their use should be science-based and subject to as little subjectivity and uncertainty as possible. When changes are proposed to manufacturing processes, equipment, or related activities, they also need careful evaluation to ensure that any risks present are managed effectively. This paper presents a practical approach to how QRM may be improved so that it better supports qualification, validation programs, and change control proposals in a more scientific way. This improved approach is based on the treatment of what are called good manufacturing process (GMP) controls during those QRM exercises. A GMP control can be considered to be any control that is put in place to assure product quality and regulatory compliance. This improved approach is also based on how the detectability of risks is assessed. This is important because when producing medicines, it is not always good practice to place a high reliance upon detection-type controls in the absence of an adequate level of assurance in the manufacturing process that leads to the finished medicine.

Contextual risk, maternal parenting and adolescent externalizing behaviour problems: the role of emotion regulation.

PubMed

Walton, A; Flouri, Eirini

2010-03-01

The objective of this study was to test if emotion regulation mediates the association between mothers' parenting and adolescents' externalizing behaviour problems (conduct problems and hyperactivity). The parenting dimensions were warmth, psychological control and behavioural control (measured with knowledge, monitoring and discipline). Adjustment was made for contextual risk (measured with the number of proximal adverse life events experienced), gender, age and English as an additional language. Data were from a UK community sample of adolescents aged 11-18 from a comprehensive school in a disadvantaged area. At the multivariate level, none of the parenting variables predicted hyperactivity, which was associated only with difficulties in emotion regulation, contextual risk and English as a first language. The parenting variables predicting conduct problems at the multivariate level were warmth and knowledge. Knowledge did not predict emotion regulation. However, warmth predicted emotion regulation, which was negatively associated with conduct problems. Contextual risk was a significant predictor of both difficulties in emotion regulation and externalizing behaviour problems. Its effect on conduct problems was independent of parenting and was not via its association with difficulties in emotion regulation. The findings add to the evidence for the importance of maternal warmth and contextual risk for both regulated emotion and regulated behaviour. The small maternal control effects on both emotion regulation and externalizing behaviour could suggest the importance of paternal control for adolescent outcomes.

The moderating effect of motivation on health-related decision-making.

PubMed

Berezowska, Aleksandra; Fischer, Arnout R H; Trijp, Hans C M van

2017-06-01

This study identifies how autonomous and controlled motivation moderates the cognitive process that drives the adoption of personalised nutrition services. The cognitive process comprises perceptions of privacy risk, personalisation benefit, and their determinants. Depending on their level of autonomous and controlled motivation, participants (N = 3453) were assigned to one of four motivational orientations, which resulted in a 2 (low/high autonomous motivation) × 2 (low/high controlled motivation) quasi-experimental design. High levels of autonomous motivation strengthened the extent to which: (1) the benefits of engaging with a service determined the outcome of a risk-benefit trade-off; (2) the effectiveness of a service determined benefit perceptions. High levels of controlled motivation influenced the extent to which: (1) the risk of privacy loss determined the outcome of a risk-benefit trade-off; (2) controlling personal information after disclosure and perceiving the disclosed personal information as sensitive determined the risk of potential privacy loss. To encourage the adoption of personalised dietary recommendations, for individuals with high levels of autonomous motivation emphasis should be on benefits and its determinants. For those with high levels of controlled motivation, it is important to focus on risk-related issues such as information sensitivity.

Family history and the risk of colorectal cancer: The importance of patients' history of colonoscopy.

PubMed

Weigl, Korbinian; Jansen, Lina; Chang-Claude, Jenny; Knebel, Phillip; Hoffmeister, Michael; Brenner, Hermann

2016-11-15

Registry-based studies on the risk of colorectal cancer (CRC) for persons with a family history (FH) typically did not control for important covariates, such as history of colonoscopy. We aimed to quantify the association between FH and CRC risk, carefully accounting for potential confounders. We conducted a population-based case-control study in Germany. A total of 4,313 patients with a first diagnosis of CRC (cases) and 3,153 controls recruited from 2003 to 2014 were included. We used multiple logistic regression analyses to assess the association between FH and risk of CRC with odds ratios (OR) and the resulting 95% confidence intervals (95% CI). A total of 582 cases (13.5%) and 321 (10.2%) controls reported a history of CRC in a first-degree relative, which was associated with a 41% increase in risk of CRC (OR: 1.41, 95% CI 1.22-1.63) after adjustment for sex and age. The OR substantially increased to 1.73 (95% CI, 1.48-2.03) after comprehensive adjustment including previous colonoscopies. Irrespective of their FH status, persons with history of colonoscopies had a lower CRC risk compared with persons without previous colonoscopies and without family history (OR: 0.25, 95% CI, 0.22-0.28 for persons without FH and OR 0.45, 95% CI, 0.36-0.56 for persons with FH). In an era of widespread use of colonoscopy, adjusting for previous colonoscopy is therefore crucial for deriving valid estimates of FH-related CRC risk. Colonoscopy reduces the risk of CRC among those with FH far below levels of people with no FH and no colonoscopy. © 2016 UICC.

PTEN IDENTIFIED AS IMPORTANT RISK FACTOR OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE

PubMed Central

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

2009-01-01

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

Measles control in Australia - threats, opportunities and future needs.

PubMed

MacIntyre, C Raina; Kpozehouen, Elizabeth; Kunasekaran, Mohana; Harriman, Kathleen; Conaty, Stephen; Rosewell, Alexander; Druce, Julian; Martin, Nicolee; Heywood, Anita E; Gidding, Heather F; Wood, James; Nicholl, Sonya

2018-06-19

Control of measles was the focus of a national workshop held in 2015 in Sydney, Australia, bringing together stakeholders in disease control and immunisation to discuss maintaining Australia's measles elimination status in the context of regional and global measles control. The global epidemiology of measles was reviewed, including outbreaks in countries that have achieved elimination, such as the Disneyland outbreak in the United States and large outbreaks in Sydney, Australia. Transmission of measles between Australia and New Zealand occurs, but has not been a focus of control measures. Risk groups, the genetic and seroepidemiology of measles as well as surveillance, modelling and waning vaccine-induced immunity were reviewed. Gaps in policy, research and practice for maintaining measles elimination status in Australia were identified and recommendations were developed. Elimination of measles globally is challenging because of the infectiousness of measles and the need for 2-dose vaccine coverage rates in excess of 95% in all countries to achieve it. Until this occurs, international travel will continue to permit measles importation from endemic countries to countries that have achieved elimination. When measles cases are imported, failure to diagnose and isolate cases places the health system at risk of measles outbreaks. Vaccine funding models can result in gaps in vaccine coverage for adults and migrants. Australia introduced a whole-of-life immunisation register in 2016 and catch-up vaccination for at-risk communities, which will improve measles control. Research on diagnosis, immunology, case management and modelling of vaccination strategies are important to ensure continued control of measles. Copyright © 2018.

Case-Control Study of Risk Factors for Sporadic Giardiasis and Parasite Assemblages in North West England.

PubMed

Minetti, Corrado; Lamden, Kenneth; Durband, Caroline; Cheesbrough, John; Platt, Katherine; Charlett, Andre; O'Brien, Sarah J; Fox, Andrew; Wastling, Jonathan M

2015-10-01

Giardia duodenalis is a major cause of infectious gastroenteritis worldwide, and it is diversified into eight genetic assemblages (A to H), which are distinguishable only by molecular typing. There is some evidence that the assemblages infecting humans (assemblages A and B) may have different transmission routes, but systematically acquired data, combining epidemiological and molecular findings, are required. We undertook a case-control study with Giardia genotyping in North West England, to determine general and parasite assemblage-specific risk factors. For people without a history of foreign travel, swimming in swimming pools and changing diapers were the most important risk factors for the disease. People infected with assemblage B reported a greater number of symptoms and higher frequencies of vomiting, abdominal pain, swollen stomach, and loss of appetite, compared with people infected with assemblage A. More importantly, keeping a dog was associated only with assemblage A infections, suggesting the presence of a potential zoonotic reservoir for this assemblage. This is the first case-control study to combine epidemiological data with Giardia genotyping, and it shows the importance of integrating these two levels of information for better understanding of the epidemiology of this pathogen. Copyright © 2015, Minetti et al.

Global importation and population risk factors for measles in New Zealand: a case study for highly immunized populations.

PubMed

Hayman, D T S; Marshall, J C; French, N P; Carpenter, T E; Roberts, M G; Kiedrzynski, T

2017-07-01

As endemic measles is eliminated through immunization, countries must determine the risk factors for the importation of measles into highly immunized populations to target control measures. Despite eliminating endemic measles, New Zealand suffers from outbreaks after introductions from abroad, enabling us to use it as a model for measles introduction risk. We used a generalized linear model to analyze risk factors for 1137 measles cases from 2007 to June 2014, provide estimates of national immunity levels, and model measles importation risk. People of European ethnicity made up the majority of measles cases. Age is a positive risk factor, particularly 0-2-year-olds and 5-17-year-old Europeans, along with increased wealth. Pacific islanders were also at greater risk, but due to 0-2-year-old cases. Despite recent high measles, mumps, and rubella vaccine immunization coverage, overall population immunity against measles remains ~90% and is lower in people born between 1982 and 2005. Greatest measles importation risk is during December, and countries predicted to be sources have historical connections and highest travel rates (Australia and UK), followed by Asian countries with high travel rates and higher measles incidences. Our results suggest measles importation due to travel is seeding measles outbreaks, and immunization levels are insufficient to continue to prevent outbreaks because of heterogeneous immunity in the population, leaving particular age groups at risk.

Neighborhood Drug Markets: A risk environment for bacterial sexually transmitted infections among urban youth

PubMed Central

Jennings, Jacky M.; Taylor, Ralph B.; Salhi, Rama A.; Furr-Holden, C.Debra M.; Ellen, Jonathan M.

2012-01-01

We hypothesized that neighborhoods with drug markets, as compared to those without, have a greater concentration of infected sex partners, i.e. core transmitters, and that in these areas, there is an increased risk environment for STIs. This study determined if neighborhood drug markets were associated with a high-risk sex partnership and, separately, with a current bacterial STI (chlamydia and/or gonorrhea) after controlling for individual demographic and sexual risk factors among a household sample of young people in Baltimore City, MD. Analyses also tested whether links were independent of neighborhood socioeconomic status. Data for this study were collected from a household study, systematic social observations and police arrest, public health STI surveillance and U.S. census data. Nonlinear multilevel models showed that living in neighborhoods with household survey-reported drug markets increased the likelihood of having a high-risk sex partnership after controlling for individual level demographic factors and illicit drug use and neighborhood socioeconomic status. Further, living in neighborhoods with survey-reported drug markets increased the likelihood of having a current bacterial STI after controlling for individual level demographic and sexual risk factors and neighborhood socioeconomic status. The results suggest that local conditions in neighborhoods with drug markets may play an important role in setting-up risk environments for high-risk sex partnerships and bacterial STIs. Patterns observed appeared dependent on the type of drug market indicator used. Future studies should explore how conditions in areas with local drug markets may alter sexual networks structures and whether specific types of drug markets are particularly important in determining STI risk. PMID:22386616

Trust, emotion, sex, politics, and science: surveying the risk-assessment battlefield.

PubMed

Slovic, P

1999-08-01

Risk management has become increasingly politicized and contentious. Polarized views, controversy, and conflict have become pervasive. Research has begun to provide a new perspective on this problem by demonstrating the complexity of the concept "risk" and the inadequacies of the traditional view of risk assessment as a purely scientific enterprise. This paper argues that danger is real, but risk is socially constructed. Risk assessment is inherently subjective and represents a blending of science and judgment with important psychological, social, cultural, and political factors. In addition, our social and democratic institutions, remarkable as they are in many respects, breed distrust in the risk arena. Whoever controls the definition of risk controls the rational solution to the problem at hand. If risk is defined one way, then one option will rise to the top as the most cost-effective or the safest or the best. If it is defined another way, perhaps incorporating qualitative characteristics and other contextual factors, one will likely get a different ordering of action solutions. Defining risk is thus an exercise in power. Scientific literacy and public education are important, but they are not central to risk controversies. The public is not irrational. Their judgments about risk are influenced by emotion and affect in a way that is both simple and sophisticated. The same holds true for scientists. Public views are also influenced by worldviews, ideologies, and values; so are scientists' views, particularly when they are working at the limits of their expertise. The limitations of risk science, the importance and difficulty of maintaining trust, and the complex, sociopolitical nature of risk point to the need for a new approach--one that focuses upon introducing more public participation into both risk assessment and risk decision making in order to make the decision process more democratic, improve the relevance and quality of technical analysis, and increase the legitimacy and public acceptance of the resulting decisions.

Risk of Substance Use Disorders in Adolescents with Bipolar Disorder

ERIC Educational Resources Information Center

Wilens, Timothy E.; Biederman, Joseph; Kwon, Anne; Ditterline, Jeffrey; Forkner, Peter; Moore, Hadley; Swezey, Allison; Snyder, Lindsey; Henin, Aude; Wozniak, Janet; Faraone, Stephen V.

2004-01-01

Objective: Previous work in adults and youths has suggested that juvenile onset bipolar disorder (BPD) is associated with an elevated risk of substance use disorders (SUD). Considering the public health importance of this issue, the authors now report on a controlled study of adolescents with and without BPD to evaluate the risk of SUD. Method:…

The moderating effect of gender on the relationship between coping and suicide risk in a Portuguese community sample of adults.

PubMed

Campos, Rui C; Holden, Ronald R; Costa, Fátima; Oliveira, Ana Rita; Abreu, Marta; Fresca, Natália

2017-02-01

Background and aims(s): The study evaluated the contribution of coping strategies, based on the Toulousiane conceptualization of coping, to the prediction of suicide risk and tested the moderating effect of gender, controlling for depressive symptoms. A two-time data collection design was used. A community sample of 195 adults (91 men and 104 women) ranging in age from 19 to 65 years and living in several Portuguese regions, mostly in Alentejo, participated in this research. Gender, depressive symptoms, control, and withdrawal and conversion significantly predicted suicide risk and gender interacted with control, withdrawal and conversion, and social distraction in the prediction of suicide risk. Coping predicted suicide risk only for women. Results have important implications for assessment and intervention with suicide at-risk individuals. In particular,the evaluation and development of coping skills is indicated as a goal for therapists having suicide at-risk women as clients.

[Threshold values for chemical agents in the light of the REACH regulation].

PubMed

Cavallo, Domenico Maria; Cattaneo, Andrea; Colosio, Claudio; Moretto, Angelo; Carrer, Paolo; Bartolucci, Giovanni Battista

2011-01-01

The European Regulation 1907/2006 (REACH--Registration, Evaluation, Authorization and Restriction of Chemicals) obliges manufacture companies and import chemicals to assess the risks arising from their use and to take the necessary measures to manage the risks identified. The Chemical Safety Report provides an accurate assessment of hazards to human health and the environment necessary to prepare an exposure scenario for the "identified uses" of the substance. An exposure scenario is the set of conditions that describe how the substance is manufactured or used during its life cycle and how the manufacturer or importer controls, or recommends downstream users to control the 'exposure to humans and the environment. Firms therefore need specific skills. The spectrum of toxicological risk is extremely large, the information required in some cases are very complex and undoubtedly require a thorough knowledge in toxicology and environmental industry. The expertise and experience in toxicology of the occupational physician in this case may become useful in the environmental field as well as another familiar figure of relevant importance is the occupational hygienist who develop exposure scenarios for workers and their uses experience for the exposure scenarios for the consumer. It provides an obvious involvement of medical toxicologists and occupational hygienists for public tasks of control and inspection of chemical safety reports and, locally, even the accuracy of risk that arise from this.

Risk management of PPP project in the preparation stage based on Fault Tree Analysis

NASA Astrophysics Data System (ADS)

Xing, Yuanzhi; Guan, Qiuling

2017-03-01

The risk management of PPP(Public Private Partnership) project can improve the level of risk control between government departments and private investors, so as to make more beneficial decisions, reduce investment losses and achieve mutual benefit as well. Therefore, this paper takes the PPP project preparation stage venture as the research object to identify and confirm four types of risks. At the same time, fault tree analysis(FTA) is used to evaluate the risk factors that belong to different parts, and quantify the influencing degree of risk impact on the basis of risk identification. In addition, it determines the importance order of risk factors by calculating unit structure importance on PPP project preparation stage. The result shows that accuracy of government decision-making, rationality of private investors funds allocation and instability of market returns are the main factors to generate the shared risk on the project.

Differences in perception of risk between people who have and have not experienced Salmonella food poisoning.

PubMed

Parry, Sharon M; Miles, Susan; Tridente, Ascanio; Palmer, Stephen R

2004-02-01

It is believed that food hygiene precautions in domestic kitchens are an important strategy in efforts to reduce the incidence of sporadic food poisoning, but recent research has shown that people who have suffered food poisoning handle the same types of foods and adopt similar food hygiene precautions in their kitchens to the rest of the population. This suggests the need to examine other factors. A case-control study of sporadic Salmonella food poisoning was conducted to investigate several domestic kitchen risk factors. Measures of perception of risk, knowledge, and control associated with food poisoning in case and control respondents are reported here. It was found that perceived personal risk from food poisoning in the home was less than perceived risk to other people. In contrast, ratings of personal knowledge about food poisoning and personal control over food poisoning in the home were seen to be greater than other people's knowledge and control. There were no differences between the cases and the controls in their ratings of knowledge about food poisoning or their control over food poisoning. However, cases perceived their personal risk from food poisoning to be higher than controls. Both case and control samples exhibited optimistic bias but this was reduced in the case sample, suggesting that experience with food poisoning may reduce optimistic bias.

Risks related to the introduction of exotic diseases: a European view.

PubMed

Janssen, J; Marchant, B

1995-12-01

The European Union (EU) has historically been free of a number of epidemic diseases of livestock and is approaching eradication of several others. This situation is put at risk by the importation of live animals and animal products. Animal products include products which are broadly described as veterinary biologicals. For the purposes of assessing and controlling risks, these fall into two groups: crude products (e.g. serum and other blood products) and medicinal products (e.g. vaccines and other immunological products). This second group is covered by another paper in this issue of the Review. Risk reduction methods may be applied to crude veterinary biologicals pre- or post-importation. Pre-importation methods include product treatment, or ensuring that the source of the product is "risk-free'. Post-importation risk reduction involves product testing, or treatment achieved by channelling products to commercial operations which are covered by European medicines legislation. At present, EU Member States issue health certificates individually for crude veterinary biologicals, and conditions for entry may differ between States. This process will soon be harmonised (the provisions for marketing medicinal products have already been harmonised).

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

PubMed

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

1996-01-01

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

Attendance at day care centers increases the risk of childhood pneumonia among the urban poor in Fortaleza, Brazil.

PubMed

Fonseca; Kirkwood; Barros; Misago; Correia; Flores; Fuchs; Victora

1996-04-01

We carried out a case-control study to investigate risk factors for childhood pneumonia in two groups of 650 children aged under two years in the city of Fortaleza, Ceará, Brazil. The cases were children recruited at the main pediatric hospital with a radiological diagnosis of pneumonia, and controls were children of the same age group recruited from the neighbourhood of the cases. In this paper we focus on variables related to childcare practices. Working mothers, proportion of time the mother had worked since the child was born, and use of day care centers emerged as important risk factors with estimated relative risks of 1.58, 1.76 and 5.22, respectively. Also important were the number of children living in the house and presence of grandparents. However, the presence of siblings under two years and the birth order were not associated with pneumonia. All analysis included adjustment for confounding by income, parents' education, and other risk factors as appropriate. This is the first study from a developing country to identify attendance at day care centers as a risk factor for increased childhood morbidity, in this case pneumonia. This finding is of significant public health importance for countries such as Brazil with growing urban populations and an increasing need by mothers to find work outside the home.

Challenges to developing countries after joining WTO: risk assessment of chemicals in food.

PubMed

Chen, Junshi

2004-05-20

FAO/WHO encourages member countries to develop national food control measures based on risk assessment in order to assure proper protection level to consumers and facilitate fair trade. This is particularly important for developing countries as WTO members because it is clearly stated in the Sanitary and Phytosanitary Measures (SPS) Agreement that: (a) SPS measures should be based on risk assessment techniques developed by relevant international organizations; and (b) Codex standards which is based on risk assessment are regarded as the international norm in trade dispute settlement. When conducting risk assessment on food chemicals (including additives and contaminants) in developing countries, in most cases it is not necessary to conduct their own hazard characterization because the ADIs or PTWIs of food chemicals developed by international expert groups (e.g. JECFA) are universally applicable and also developing countries do not have the resources to repeat those expensive toxicological studies. On the other hand, it is necessary to conduct exposure assessment in developing countries because exposure to food chemicals varies from country to country. This is not only crucial in setting national standards, but also very important for developing countries to participate in the process of developing Codex standards. In addition to food standard development, risk assessment is also useful in setting up priorities in imported food inspection and evaluating the success of various food safety control measures.

[Self-esteem, resilience, locus of control and suicide risk in nursing students].

PubMed

Montes-Hidalgo, Javier; Tomás-Sábado, Joaquín

2016-01-01

Assuming that suicide is the result of a series of factors acting cumulatively, the aim of this paper was to study the association of self-esteem, resilience and locus of control with the risk of suicidal behavior in a sample of nursing students. Observational, cross-sectional and correlational study with 186 nursing students who answered a questionnaire that contained, in addition to demographic data, the Spanish forms of Rosenberg self-esteem scale, the brief resilient coping scale, the Plutchik scale of suicide risk and the Rotter's internal-external locus of control scale. The scores of males and females are very similar on all scales except Locus of Control, where a significantly greater tendency of females attributed to external control. 6.4% of students have scores indicating suicide risk. Suicide risk scores correlated negatively and significantly with self-esteem and resilience and positively with locus of control. The multiple linear regression analysis identified self-esteem as the main variable related to suicide risk. The results suggest that students who have low self-esteem, have difficulty in adjusting to adverse situations and tend to the external attribution of the consequences of their actions may have an increased risk of suicidal behavior. Furthermore, the identification of self-esteem as the important factor involved in suicide risk can help in designing prevention programs. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

Reducing the Risk of Tick-Borne Diseases through Smart, Safe and Sustainable Pest Control

EPA Pesticide Factsheets

Each year PestWise programs form new partnerships to address ongoing and emerging issues. Reducing the risk from ticks and tick-borne disease is an issue of importance and EPA is contributing to a larger federal effort.

EPA’s Lead-based Paint Enforcement Helps Protect Children and Vulnerable Communities

EPA Pesticide Factsheets

The Toxic Substances Control Act (TSCA) New and Existing Chemicals (NEC) Program is exclusively a federal program that provides for review of the risk of chemicals prior to their manufacture and importation to prevent unreasonable risk to human health

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

PubMed

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

2012-03-27

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

Importation, Antibiotics, and Clostridium difficile Infection in Veteran Long-Term Care: A Multilevel Case-Control Study.

PubMed

Brown, Kevin A; Jones, Makoto; Daneman, Nick; Adler, Frederick R; Stevens, Vanessa; Nechodom, Kevin E; Goetz, Matthew B; Samore, Matthew H; Mayer, Jeanmarie

2016-06-21

Although clinical factors affecting a person's susceptibility to Clostridium difficile infection are well-understood, little is known about what drives differences in incidence across long-term care settings. To obtain a comprehensive picture of individual and regional factors that affect C difficile incidence. Multilevel longitudinal nested case-control study. Veterans Health Administration health care regions, from 2006 through 2012. Long-term care residents. Individual-level risk factors included age, number of comorbid conditions, and antibiotic exposure. Regional risk factors included importation of cases of acute care C difficile infection per 10 000 resident-days and antibiotic use per 1000 resident-days. The outcome was defined as a positive result on a long-term care C difficile test without a positive result in the prior 8 weeks. 6012 cases (incidence, 3.7 cases per 10 000 resident-days) were identified in 86 regions. Long-term care C difficile incidence (minimum, 0.6 case per 10 000 resident-days; maximum, 31.0 cases per 10 000 resident-days), antibiotic use (minimum, 61.0 days with therapy per 1000 resident-days; maximum, 370.2 days with therapy per 1000 resident-days), and importation (minimum, 2.9 cases per 10 000 resident-days; maximum, 341.3 cases per 10 000 resident-days) varied substantially across regions. Together, antibiotic use and importation accounted for 75% of the regional variation in C difficile incidence (R2 = 0.75). Multilevel analyses showed that regional factors affected risk together with individual-level exposures (relative risk of regional antibiotic use, 1.36 per doubling [95% CI, 1.15 to 1.60]; relative risk of importation, 1.23 per doubling [CI, 1.14 to 1.33]). Case identification was based on laboratory criteria. Admission of residents with recent C difficile infection from non-Veterans Health Administration acute care sources was not considered. Only 25% of the variation in regional C difficile incidence in long-term care remained unexplained after importation from acute care facilities and antibiotic use were accounted for, which suggests that improved infection control and antimicrobial stewardship may help reduce the incidence of C difficile in long-term care settings. U.S. Department of Veterans Affairs and Centers for Disease Control and Prevention.

Technical Guidelines for Environmental Dredging of Contaminated Sediments

DTIC Science & Technology

2008-09-01

health and ecological risk assessments . • Evaluate the need for and effectiveness of source control. • Evaluate potential remedies. • Document... risk , resource damage assessments , remedy selec- tion, and remedy design). It is therefore important to consult as many data users as possible (e.g...Contaminated Sediment Risks at Hazardous Waste Sites (USEPA 2002a). Risk Management Prin- ciple Number 4 is: “Develop and refine a conceptual site model that

Understanding the side effects of classical biological control

Treesearch

Dean Pearson

2008-01-01

Classical biological control involves the use of imported natural enemies to suppress or control populations of the target pest species below an economically or ecologically relevant threshold. Biological control is a useful tool for mitigating the impacts of exotic invasive plants; however, its application is not without risk (see Carruthers and D’Antonio...

Are ready-to-eat salads ready to eat? An outbreak of Salmonella Coeln linked to imported, mixed, pre-washed and bagged salad, Norway, November 2013.

PubMed

Vestrheim, D F; Lange, H; Nygård, K; Borgen, K; Wester, A L; Kvarme, M L; Vold, L

2016-06-01

We investigated a nationwide outbreak of Salmonella Coeln in Norway, including 26 cases identified between 20 October 2013 and 4 January 2014. We performed a matched case-control study, environmental investigation and detailed traceback of food purchases to identify the source of the outbreak. In the case-control study, cases were found to be more likely than controls to have consumed a ready-to-eat salad mix (matched odds ratio 20, 95% confidence interval 2·7-∞). By traceback of purchases one brand of ready-to-eat salad was indicated, but all environmental samples were negative for Salmonella. This outbreak underlines that pre-washed and bagged salads carry a risk of infection despite thorough cleaning procedures by the importer. To further reduce the risk of infection by consumption of ready-to-eat salads product quality should be ensured by importers. Outbreaks linked to salads reinforce the importance of implementation of appropriate food safety management systems, including good practices in lettuce production.

FY2016 Enforcement Actions for the Lead Renovation, Repair and Painting Rule (RRP)

EPA Pesticide Factsheets

The Toxic Substances Control Act (TSCA) New and Existing Chemicals (NEC) Program is exclusively a federal program that provides for review of the risk of chemicals prior to their manufacture and importation to prevent unreasonable risk to human health

Nutrigenetics, metabolic syndrome risk and personalized nutrition.

PubMed

Perez-Martinez, Pablo; Phillips, Catherine M; Delgado-Lista, Javier; Garcia-Rios, Antonio; Lopez-Miranda, Jose; Perez-Jimenez, Francisco

2013-11-01

The metabolic syndrome (MetS) is a constellation of metabolic risk factors reflecting overnutrition and sedentary lifestyle and its increasing prevalence is reaching epidemic proportions. The importance of MetS lies in its close association with the risk of cardiometabolic disease. In this scenario, the principal goals of pharmacological therapy for these patients are to achieve and maintain an optimal cardiometabolic control, including lipids, blood glucose and blood pressure; in order to prevent and treat potential complications. Moreover nutrition has commonly been accepted as a cornerstone of treatment for MetS, with the expectation that an appropriate intake of energy and nutrients will improve its control. However the question arises as to whether dietary therapy may require a more personalised approach. In this regard improvements in genetic analysis have enhanced our understanding of the role of genetics in this dietrelated condition. In this review we will present recent data highlighting the importance of gene-nutrient interactions in the context of MetS risk.

Assessment of the risk posed to Singapore by the 2015 Middle East respiratory syndrome outbreak in the Republic of Korea

PubMed Central

Zhang, Emma Xuxiao; Oh, Olivia Seen Huey; See, Wanhan; Raj, Pream; James, Lyn; Khan, Kamran

2016-01-01

Objective To assess the public health risk to Singapore posed by the Middle East respiratory syndrome (MERS) outbreak in the Republic of Korea in 2015. Methods The likelihood of importation of MERS cases and the magnitude of the public health impact in Singapore were assessed to determine overall risk. Literature on the epidemiology and contextual factors associated with MERS coronavirus infection was collected and reviewed. Connectivity between the Republic of Korea and Singapore was analysed. Public health measures implemented by the two countries were reviewed. Results The epidemiology of the 2015 MERS outbreak in the Republic of Korea remained similar to the MERS outbreaks in Saudi Arabia. In addition, strong infection control and response measures were effective in controlling the outbreak. In view of the air traffic between Singapore and MERS-affected areas, importation of MERS cases into Singapore is possible. Nonetheless, the risk of a serious public health impact to Singapore in the event of an imported case of MERS would be mitigated by its strong health-care system and established infection control practices. Discussion The MERS outbreak was sparked by an exported case from the Middle East, which remains a concern as the reservoir of infection (thought to be camels) continues to exist in the Middle East, and sporadic cases in the community and outbreaks in health-care settings continue to occur there. This risk assessment highlights the need for Singapore to stay vigilant and to continue enhancing core public health capacities to detect and respond to MERS coronavirus. PMID:27508087

Assessment of the risk posed to Singapore by the 2015 Middle East respiratory syndrome outbreak in the Republic of Korea.

PubMed

Zhang, Emma Xuxiao; Oh, Olivia Seen Huey; See, Wanhan; Raj, Pream; James, Lyn; Khan, Kamran; Tey, Jeannie Su Hui

2016-01-01

To assess the public health risk to Singapore posed by the Middle East respiratory syndrome (MERS) outbreak in the Republic of Korea in 2015. The likelihood of importation of MERS cases and the magnitude of the public health impact in Singapore were assessed to determine overall risk. Literature on the epidemiology and contextual factors associated with MERS coronavirus infection was collected and reviewed. Connectivity between the Republic of Korea and Singapore was analysed. Public health measures implemented by the two countries were reviewed. The epidemiology of the 2015 MERS outbreak in the Republic of Korea remained similar to the MERS outbreaks in Saudi Arabia. In addition, strong infection control and response measures were effective in controlling the outbreak. In view of the air traffic between Singapore and MERS-affected areas, importation of MERS cases into Singapore is possible. Nonetheless, the risk of a serious public health impact to Singapore in the event of an imported case of MERS would be mitigated by its strong health-care system and established infection control practices. The MERS outbreak was sparked by an exported case from the Middle East, which remains a concern as the reservoir of infection (thought to be camels) continues to exist in the Middle East, and sporadic cases in the community and outbreaks in health-care settings continue to occur there. This risk assessment highlights the need for Singapore to stay vigilant and to continue enhancing core public health capacities to detect and respond to MERS coronavirus.

Polymorphism in cytochrome P450 1A2 and their interaction with risk factors in determining risk of squamous cell lung carcinoma in men.

PubMed

Singh, Arvind P; Pant, Mohan C; Ruwali, Munindra; Shah, Parag P; Prasad, Rajendra; Mathur, Neeraj; Parmar, Devendra

The present case-control study was carried out to investigate the association of functionally important polymorphisms of cytochrome P450 1A2 (CYP1A2) involved in the metabolic activation of tobacco derived procarcinogens with squamous cell carcinoma (SCC) of lung in North Indian men. The study consisted of 200 male cases with SCC of lung and an equal number of age and sex matched healthy controls. Our data showed that variant genotype of CYP1A2*1D and CYP1A2*1F were significantly associated with increased susceptibility to SCC of lung. Likewise, GSTM1 null genotype was found to be over represented in patients when compared to controls. Haplotype analysis revealed that haplotype, G-Tdel-T-C was significantly associated with risk to SCC of lung. Moreover, a significant increase in the risk to SCC of lung in the cases carrying combination of variant genotype of CYP1A2 with either CYP1A1 or GSTM1 have shown that gene-gene interactions may play an important role in squamous cell lung cancer risk. Our data also revealed that smokers or tobacco chewers carrying variant alleles of either CYP1A2*1D or CYP1A2*1F were at increased risk to SCC of lung, further demonstrating that CYP1A2 genotypes interact with environmental risk factors in enhancing the risk to squamous cell lung carcinoma.

The associations of social self-control, personality disorders, and demographics with drug use among high-risk youth.

PubMed

Sussman, Steve; McCuller, William J; Dent, Clyde W

2003-08-01

A 10-item self-report measure of social self-control was examined for its association with substance use, controlling for its associations with 12 personality disorder indices and 4 demographic variables among a sample of 1050 high-risk youth. Social self-control was found to be associated with 30-day cigarette smoking, alcohol use, marijuana use, and hard drug use, controlling for these other variables. The most consistent concurrent predictors of substance use were male gender, antisocial personality disorder, and social self-control. These results highlight the importance of social self-control as a unique concurrent predictor of substance use and suggest that social self-control skill training is relevant in substance abuse prevention programming.

Environmental risk factors associated with bovine tuberculosis among cattle in high-risk areas

PubMed Central

Winkler, B.; Mathews, F.

2015-01-01

Our research shows that environmental features are important predictors of bovine tuberculosis (bTB) in British cattle herds in high-prevalence regions. Data from 503 case and 808 control farms included in the randomized badger culling trial (RBCT) were analysed. bTB risk increased in larger herds and on farms with greater areas of maize, deciduous woodland and marsh, whereas a higher percentage of boundaries composed of hedgerows decreased the risk. The model was tested on another case–control study outside RBCT areas, and here it had a much smaller predictive power. This suggests that different infection dynamics operate outside high-risk areas, although it is possible that unknown confounding factors may also have played a role. PMID:26559511

Factors driving public tolerance levels and information‐seeking behaviour concerning insects in the household environment

PubMed Central

Poortvliet, P Marijn; Takken, Willem

2018-01-01

Abstract BACKGROUND The public's negative attitudes towards household insects drive tolerance for these insects and their control. Tolerance levels are important in integrated pest management (IPM), as are pest knowledge and information. The risk information seeking and processing (RISP) model describes the relationships between personal factors and information‐seeking behaviour. We combined IPM and RISP to determine important relationships between factors driving insect tolerance levels and information‐seeking behaviour through an online survey and tested whether this model is valid and generally applicable. RESULTS Relationships between variables from both IPM and RISP models were tested for seven insect species. Tolerance levels were measured with two factors: willingness to pay for pest control and whether insects are tolerated. Willingness to pay for control was positively affected by age, experience, risk perception, insect characteristics, and negative emotions and affected behavioural intention, by influencing information sufficiency and information‐seeking behaviour. Tolerability was influenced by perception of insect characteristics and determines whether control measures are taken. CONCLUSION It was possible to combine the RISP and IPM models. Relevant driving factors were a person's age, experience, risk perception, negative affective responses, tolerance levels, relevant channel beliefs about online forums, information sufficiency and information‐seeking behaviour. There was, however, variation in important factors between different insects. © 2017 The Authors. Pest Management Science published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry. PMID:29274106

Dissonance and Healthy Weight Eating Disorder Prevention Programs: Long-Term Effects from a Randomized Efficacy Trial

PubMed Central

Stice, Eric; Marti, C. Nathan; Spoor, Sonja; Presnell, Katherine; Shaw, Heather

2009-01-01

Adolescent girls with body dissatisfaction (N=481; SD=1.4) were randomized to a dissonance-based thin-ideal internalization reduction program, healthy weight control program, expressive-writing control condition, or assessment-only control condition. Dissonance participants showed significantly greater decreases in thin-ideal internalization, body dissatisfaction, negative affect, eating disorder symptoms, and psychosocial impairment, and lower risk for eating pathology onset through 2–3 year follow-up than assessment-only controls. Dissonance participants showed greater decreases in thin-ideal internalization, body dissatisfaction, and psychosocial impairment than expressive-writing controls. Healthy weight participants showed greater decreases in thin-ideal internalization, body dissatisfaction, negative affect, eating disorder symptoms, and psychosocial impairment, less increases in weight, and lower risk for eating pathology and obesity onset through 2–3 year follow-up than assessment-only controls. Healthy weight participants showed greater decreases in thin-ideal internalization and weight than expressive writing controls. Dissonance participants showed a 60% reduction in risk for eating pathology onset and healthy weight participants showed a 61% reduction in risk for eating pathology onset and a 55% reduction in risk for obesity onset relative to assessment-only controls through 3-year follow-up, implying that the effects are clinically important and enduring. PMID:18377128

Large-scale drivers of malaria and priority areas for prevention and control in the Brazilian Amazon region using a novel multi-pathogen geospatial model.

PubMed

Valle, Denis; Lima, Joanna M Tucker

2014-11-20

Most of the malaria burden in the Americas is concentrated in the Brazilian Amazon but a detailed spatial characterization of malaria risk has yet to be undertaken. Utilizing 2004-2008 malaria incidence data collected from six Brazilian Amazon states, large-scale spatial patterns of malaria risk were characterized with a novel Bayesian multi-pathogen geospatial model. Data included 2.4 million malaria cases spread across 3.6 million sq km. Remotely sensed variables (deforestation rate, forest cover, rainfall, dry season length, and proximity to large water bodies), socio-economic variables (rural population size, income, and literacy rate, mortality rate for children age under five, and migration patterns), and GIS variables (proximity to roads, hydro-electric dams and gold mining operations) were incorporated as covariates. Borrowing information across pathogens allowed for better spatial predictions of malaria caused by Plasmodium falciparum, as evidenced by a ten-fold cross-validation. Malaria incidence for both Plasmodium vivax and P. falciparum tended to be higher in areas with greater forest cover. Proximity to gold mining operations was another important risk factor, corroborated by a positive association between migration rates and malaria incidence. Finally, areas with a longer dry season and areas with higher average rural income tended to have higher malaria risk. Risk maps reveal striking spatial heterogeneity in malaria risk across the region, yet these mean disease risk surface maps can be misleading if uncertainty is ignored. By combining mean spatial predictions with their associated uncertainty, several sites were consistently classified as hotspots, suggesting their importance as priority areas for malaria prevention and control. This article provides several contributions. From a methodological perspective, the benefits of jointly modelling multiple pathogens for spatial predictions were illustrated. In addition, maps of mean disease risk were contrasted with that of statistically significant disease clusters, highlighting the critical importance of uncertainty in determining disease hotspots. From an epidemiological perspective, forest cover and proximity to gold mining operations were important large-scale drivers of disease risk in the region. Finally, the hotspot in Western Acre was identified as the area that should receive highest priority from the Brazilian national malaria prevention and control programme.

Risk assessment in the upstream crude oil supply chain: Leveraging analytic hierarchy process

NASA Astrophysics Data System (ADS)

Briggs, Charles Awoala

For an organization to be successful, an effective strategy is required, and if implemented appropriately the strategy will result in a sustainable competitive advantage. The importance of decision making in the oil industry is reflected in the magnitude and nature of the industry. Specific features of the oil industry supply chain, such as its longer chain, the complexity of its transportation system, its complex production and storage processes, etc., pose challenges to its effective management. Hence, understanding the risks, the risk sources, and their potential impacts on the oil industry's operations will be helpful in proposing a risk management model for the upstream oil supply chain. The risk-based model in this research uses a three-level analytic hierarchy process (AHP), a multiple-attribute decision-making technique, to underline the importance of risk analysis and risk management in the upstream crude oil supply chain. Level 1 represents the overall goal of risk management; Level 2 is comprised of the various risk factors; and Level 3 represents the alternative criteria of the decision maker as indicated on the hierarchical structure of the crude oil supply chain. Several risk management experts from different oil companies around the world were surveyed, and six major types of supply chain risks were identified: (1) exploration and production, (2) environmental and regulatory compliance, (3) transportation, (4) availability of oil, (5) geopolitical, and (6) reputational. Also identified are the preferred methods of managing risks which include; (1) accept and control the risks, (2) avoid the risk by stopping the activity, or (3) transfer or share the risks to other companies or insurers. The results from the survey indicate that the most important risk to manage is transportation risk with a priority of .263, followed by exploration/production with priority of .198, with an overall inconsistency of .03. With respect to major objectives the most preferred risk management policy option based on the result of the composite score is accept and control risk with a priority of .446, followed by transfer or share risk with a priority of .303. The least likely option is to terminate or forgo activity with a priority of .251.

Review of risk factors for human echinococcosis prevalence on the Qinghai-Tibet Plateau, China: a prospective for control options

PubMed Central

2014-01-01

Objective Echinococcosis is a major parasitic zoonosis of public health importance in western China. In 2004, the Chinese Ministry of Health estimated that 380,000 people had the disease in the region. The Qinghai-Tibet Plateau is highly co-endemic with both alveolar echinococcosis (AE) and cystic echinococcosis (CE). In the past years, the Chinese government has been increasing the financial support to control the diseases in this region. Therefore, it is very important to identify the significant risk factors of the diseases by reviewing studies done in the region in the past decade to help policymakers design appropriate control strategies. Review Selection criteria for which literature to review were firstly defined. Medline, CNKI (China National Knowledge Infrastructure), and Google Scholar were systematically searched for literature published between January 2000 and July 2011. Significant risk factors found by single factor and/or multiple factors analysis were listed, counted, and summarized. Literature was examined to check the comparability of the data; age and sex specific prevalence with same data structures were merged and used for further analysis. A variety of assumed social, economical, behavioral, and ecological risk factors were studied on the Plateau. Those most at risk were Tibetan herdsmen, the old and female in particular. By analyzing merged comparable data, it was found that females had a significant higher prevalence, and a positive linearity relationship existed between echinococcosis prevalence and increasing age. In terms of behavioral risk factors, playing with dogs was mostly correlated with CE and/or AE prevalence. In terms of hygiene, employing ground water as the drinking water source was significantly correlated with CE and AE prevalence. For definitive hosts, dog related factors were most frequently identified with prevalence of CE or/and AE; fox was a potential risk factor for AE prevalence only. Overgrazing and deforestation were significant for AE prevalence only. Conclusion Tibetan herdsmen communities were at the highest risk of echinococcosis prevalence and should be the focus of echinococcosis control. Deworming both owned and stray dogs should be a major measure for controlling echinococcosis; treatment of wild definitive hosts should also be considered for AE endemic areas. Health education activities should be in concert with the local people’s education backgrounds and languages in order to be able to improve behaviors. Further researches are needed to clarify the importance of wild hosts for AE/CE prevalence, the extent and range of the impacts of ecologic changes (overgrazing and deforestation) on the AE prevalence, and risk factors in Tibet. PMID:24475907

Review of risk factors for human echinococcosis prevalence on the Qinghai-Tibet Plateau, China: a prospective for control options.

PubMed

Wang, Qian; Huang, Yan; Huang, Liang; Yu, Wenjie; He, Wei; Zhong, Bo; Li, Wei; Zeng, Xiangman; Vuitton, Dominique A; Giraudoux, Patrick; Craig, Philip S; Wu, Weiping

2014-01-29

Echinococcosis is a major parasitic zoonosis of public health importance in western China. In 2004, the Chinese Ministry of Health estimated that 380,000 people had the disease in the region. The Qinghai-Tibet Plateau is highly co-endemic with both alveolar echinococcosis (AE) and cystic echinococcosis (CE). In the past years, the Chinese government has been increasing the financial support to control the diseases in this region. Therefore, it is very important to identify the significant risk factors of the diseases by reviewing studies done in the region in the past decade to help policymakers design appropriate control strategies. Selection criteria for which literature to review were firstly defined. Medline, CNKI (China National Knowledge Infrastructure), and Google Scholar were systematically searched for literature published between January 2000 and July 2011. Significant risk factors found by single factor and/or multiple factors analysis were listed, counted, and summarized. Literature was examined to check the comparability of the data; age and sex specific prevalence with same data structures were merged and used for further analysis.A variety of assumed social, economical, behavioral, and ecological risk factors were studied on the Plateau. Those most at risk were Tibetan herdsmen, the old and female in particular. By analyzing merged comparable data, it was found that females had a significant higher prevalence, and a positive linearity relationship existed between echinococcosis prevalence and increasing age. In terms of behavioral risk factors, playing with dogs was mostly correlated with CE and/or AE prevalence. In terms of hygiene, employing ground water as the drinking water source was significantly correlated with CE and AE prevalence. For definitive hosts, dog related factors were most frequently identified with prevalence of CE or/and AE; fox was a potential risk factor for AE prevalence only. Overgrazing and deforestation were significant for AE prevalence only. Tibetan herdsmen communities were at the highest risk of echinococcosis prevalence and should be the focus of echinococcosis control. Deworming both owned and stray dogs should be a major measure for controlling echinococcosis; treatment of wild definitive hosts should also be considered for AE endemic areas. Health education activities should be in concert with the local people's education backgrounds and languages in order to be able to improve behaviors. Further researches are needed to clarify the importance of wild hosts for AE/CE prevalence, the extent and range of the impacts of ecologic changes (overgrazing and deforestation) on the AE prevalence, and risk factors in Tibet.

Neighborhood drug markets: a risk environment for bacterial sexually transmitted infections among urban youth.

PubMed

Jennings, Jacky M; Taylor, Ralph B; Salhi, Rama A; Furr-Holden, C Debra M; Ellen, Jonathan M

2012-04-01

We hypothesized that neighborhoods with drug markets, as compared to those without, have a greater concentration of infected sex partners, i.e. core transmitters, and that in these areas, there is an increased risk environment for STIs. This study determined if neighborhood drug markets were associated with a high-risk sex partnership and, separately, with a current bacterial STI (chlamydia and/or gonorrhea) after controlling for individual demographic and sexual risk factors among a household sample of young people in Baltimore City, MD. Analyses also tested whether links were independent of neighborhood socioeconomic status. Data for this study were collected from a household study, systematic social observations and police arrest, public health STI surveillance and U.S. census data. Nonlinear multilevel models showed that living in neighborhoods with household survey-reported drug markets increased the likelihood of having a high-risk sex partnership after controlling for individual-level demographic factors and illicit drug use and neighborhood socioeconomic status. Further, living in neighborhoods with survey-reported drug markets increased the likelihood of having a current bacterial STI after controlling for individual-level demographic and sexual risk factors and neighborhood socioeconomic status. The results suggest that local conditions in neighborhoods with drug markets may play an important role in setting-up risk environments for high-risk sex partnerships and bacterial STIs. Patterns observed appeared dependent on the type of drug market indicator used. Future studies should explore how conditions in areas with local drug markets may alter sexual networks structures and whether specific types of drug markets are particularly important in determining STI risk. Copyright © 2012 Elsevier Ltd. All rights reserved.

The concurrent and longitudinal associations of temperament and nutritional risk factors in early childhood.

PubMed

van den Heuvel, M; Chen, Y; Abdullah, K; Maguire, J L; Parkin, P C; Birken, C S

2017-12-01

Early childhood temperament is increasingly recognized as an important attribute that may impact screen time use, outdoor play and childhood obesity. The relationship between temperament and nutrition in preschool children is less clear. The objective of the study is to investigate if temperament dimensions (negative affectivity, effortful control and surgency) in early childhood are associated with nutritional risk factors. Six hundred seventy-eight children were followed (mean age at baseline visit 3.1 years; mean time to follow-up 16.5 months). Parents reported on child temperament and nutritional risk factors during regularly scheduled well-child clinic visits. A mixed effect model demonstrated a significant association between higher negative affectivity (1.03; 95% CI 0.69 to 1.37) and higher effortful control (-0.88; 95% CI -1.27 to -0.49) on concurrent nutritional risk, independent of covariates. Multivariate linear regression analysis identified that higher effortful control, and not negative affectivity, was significantly associated with a decrease in nutritional risk (-0.67; 95% CI -1.10 to -0.24) over time, independent of covariates. There was no relationship identified between surgency and nutritional risk. Three-year-old children with higher effortful control had reduced nutritional risk at 5 years of age. Future nutritional risk prevention strategies may benefit from interventions to increase effortful control in early childhood. © 2016 World Obesity Federation.

Multi-ethnic genome-wide association study of 21,000 cases and 95,000 controls identifies new risk loci for atopic dermatitis

PubMed Central

Waage, Johannes; Baurecht, Hansjörg; Hotze, Melanie; Strachan, David P; Curtin, John A; Bønnelykke, Klaus; Tian, Chao; Takahashi, Atsushi; Esparza-Gordillo, Jorge; Alves, Alexessander Couto; Thyssen, Jacob P; den Dekker, Herman T; Ferreira, Manuel A; Altmaier, Elisabeth; Sleiman, Patrick MA; Xiao, Feng Li; Gonzalez, Juan R; Marenholz, Ingo; Kalb, Birgit; Yanes, Maria Pino; Xu, Cheng-Jian; Carstensen, Lisbeth; Groen-Blokhuis, Maria M; Venturini, Cristina; Pennell, Craig E; Barton, Sheila J; Levin, Albert M; Curjuric, Ivan; Bustamante, Mariona; Kreiner-Møller, Eskil; Lockett, Gabrielle A; Bacelis, Jonas; Bunyavanich, Supinda; Myers, Rachel A; Matanovic, Anja; Kumar, Ashish; Tung, Joyce Y; Hirota, Tomomitsu; Kubo, Michiaki; McArdle, Wendy L; Henderson, A J; Kemp, John P; Zheng, Jie; Smith, George Davey; Rüschendorf, Franz; Bauerfeind, Anja; Lee-Kirsch, Min Ae; Arnold, Andreas; Homuth, Georg; Schmidt, Carsten O; Mangold, Elisabeth; Cichon, Sven; Keil, Thomas; Rodríguez, Elke; Peters, Annette; Franke, Andre; Lieb, Wolfgang; Novak, Natalija; Fölster-Holst, Regina; Horikoshi, Momoko; Pekkanen, Juha; Sebert, Sylvain; Husemoen, Lise L; Grarup, Niels; de Jongste, Johan C; Rivadeneira, Fernando; Hofman, Albert; Jaddoe, Vincent WV; Pasmans, Suzanne GMA; Elbert, Niels J; Uitterlinden, André G; Marks, Guy B; Thompson, Philip J; Matheson, Melanie C; Robertson, Colin F; Ried, Janina S; Li, Jin; Zuo, Xian Bo; Zheng, Xiao Dong; Yin, Xian Yong; Sun, Liang Dan; McAleer, Maeve A; O'Regan, Grainne M; Fahy, Caoimhe MR; Campbell, Linda E; Macek, Milan; Kurek, Michael; Hu, Donglei; Eng, Celeste; Postma, Dirkje S; Feenstra, Bjarke; Geller, Frank; Hottenga, Jouke Jan; Middeldorp, Christel M; Hysi, Pirro; Bataille, Veronique; Spector, Tim; Tiesler, Carla MT; Thiering, Elisabeth; Pahukasahasram, Badri; Yang, James J; Imboden, Medea; Huntsman, Scott; Vilor-Tejedor, Natàlia; Relton, Caroline L; Myhre, Ronny; Nystad, Wenche; Custovic, Adnan; Weiss, Scott T; Meyers, Deborah A; Söderhäll, Cilla; Melén, Erik; Ober, Carole; Raby, Benjamin A; Simpson, Angela; Jacobsson, Bo; Holloway, John W; Bisgaard, Hans; Sunyer, Jordi; Hensch, Nicole M Probst; Williams, L Keoki; Godfrey, Keith M; Wang, Carol A; Boomsma, Dorret I; Melbye, Mads; Koppelman, Gerard H; Jarvis, Deborah; McLean, WH Irwin; Irvine, Alan D; Zhang, Xue Jun; Hakonarson, Hakon; Gieger, Christian; Burchard, Esteban G; Martin, Nicholas G; Duijts, Liesbeth; Linneberg, Allan; Jarvelin, Marjo-Riitta; Noethen, Markus M; Lau, Susanne; Hübner, Norbert; Lee, Young-Ae; Tamari, Mayumi; Hinds, David A; Glass, Daniel; Brown, Sara J; Heinrich, Joachim; Evans, David M; Weidinger, Stephan

2015-01-01

Genetic association studies have identified 21 loci associated with atopic dermatitis risk predominantly in populations of European ancestry. To identify further susceptibility loci for this common complex skin disease, we performed a meta-analysis of >15 million genetic variants in 21,399 cases and 95,464 controls from populations of European, African, Japanese and Latino ancestry, followed by replication in 32,059 cases and 228,628 controls from 18 studies. We identified 10 novel risk loci, bringing the total number of known atopic dermatitis risk loci to 31 (with novel secondary signals at 4 of these). Notably, the new loci include candidate genes with roles in regulation of innate host defenses and T-cell function, underscoring the important contribution of (auto-)immune mechanisms to atopic dermatitis pathogenesis. PMID:26482879

Multi-ancestry genome-wide association study of 21,000 cases and 95,000 controls identifies new risk loci for atopic dermatitis.

PubMed

Paternoster, Lavinia; Standl, Marie; Waage, Johannes; Baurecht, Hansjörg; Hotze, Melanie; Strachan, David P; Curtin, John A; Bønnelykke, Klaus; Tian, Chao; Takahashi, Atsushi; Esparza-Gordillo, Jorge; Alves, Alexessander Couto; Thyssen, Jacob P; den Dekker, Herman T; Ferreira, Manuel A; Altmaier, Elisabeth; Sleiman, Patrick Ma; Xiao, Feng Li; Gonzalez, Juan R; Marenholz, Ingo; Kalb, Birgit; Yanes, Maria Pino; Xu, Cheng-Jian; Carstensen, Lisbeth; Groen-Blokhuis, Maria M; Venturini, Cristina; Pennell, Craig E; Barton, Sheila J; Levin, Albert M; Curjuric, Ivan; Bustamante, Mariona; Kreiner-Møller, Eskil; Lockett, Gabrielle A; Bacelis, Jonas; Bunyavanich, Supinda; Myers, Rachel A; Matanovic, Anja; Kumar, Ashish; Tung, Joyce Y; Hirota, Tomomitsu; Kubo, Michiaki; McArdle, Wendy L; Henderson, A J; Kemp, John P; Zheng, Jie; Smith, George Davey; Rüschendorf, Franz; Bauerfeind, Anja; Lee-Kirsch, Min Ae; Arnold, Andreas; Homuth, Georg; Schmidt, Carsten O; Mangold, Elisabeth; Cichon, Sven; Keil, Thomas; Rodríguez, Elke; Peters, Annette; Franke, Andre; Lieb, Wolfgang; Novak, Natalija; Fölster-Holst, Regina; Horikoshi, Momoko; Pekkanen, Juha; Sebert, Sylvain; Husemoen, Lise L; Grarup, Niels; de Jongste, Johan C; Rivadeneira, Fernando; Hofman, Albert; Jaddoe, Vincent Wv; Pasmans, Suzanne Gma; Elbert, Niels J; Uitterlinden, André G; Marks, Guy B; Thompson, Philip J; Matheson, Melanie C; Robertson, Colin F; Ried, Janina S; Li, Jin; Zuo, Xian Bo; Zheng, Xiao Dong; Yin, Xian Yong; Sun, Liang Dan; McAleer, Maeve A; O'Regan, Grainne M; Fahy, Caoimhe Mr; Campbell, Linda E; Macek, Milan; Kurek, Michael; Hu, Donglei; Eng, Celeste; Postma, Dirkje S; Feenstra, Bjarke; Geller, Frank; Hottenga, Jouke Jan; Middeldorp, Christel M; Hysi, Pirro; Bataille, Veronique; Spector, Tim; Tiesler, Carla Mt; Thiering, Elisabeth; Pahukasahasram, Badri; Yang, James J; Imboden, Medea; Huntsman, Scott; Vilor-Tejedor, Natàlia; Relton, Caroline L; Myhre, Ronny; Nystad, Wenche; Custovic, Adnan; Weiss, Scott T; Meyers, Deborah A; Söderhäll, Cilla; Melén, Erik; Ober, Carole; Raby, Benjamin A; Simpson, Angela; Jacobsson, Bo; Holloway, John W; Bisgaard, Hans; Sunyer, Jordi; Hensch, Nicole M Probst; Williams, L Keoki; Godfrey, Keith M; Wang, Carol A; Boomsma, Dorret I; Melbye, Mads; Koppelman, Gerard H; Jarvis, Deborah; McLean, Wh Irwin; Irvine, Alan D; Zhang, Xue Jun; Hakonarson, Hakon; Gieger, Christian; Burchard, Esteban G; Martin, Nicholas G; Duijts, Liesbeth; Linneberg, Allan; Jarvelin, Marjo-Riitta; Noethen, Markus M; Lau, Susanne; Hübner, Norbert; Lee, Young-Ae; Tamari, Mayumi; Hinds, David A; Glass, Daniel; Brown, Sara J; Heinrich, Joachim; Evans, David M; Weidinger, Stephan

2015-12-01

Genetic association studies have identified 21 loci associated with atopic dermatitis risk predominantly in populations of European ancestry. To identify further susceptibility loci for this common, complex skin disease, we performed a meta-analysis of >15 million genetic variants in 21,399 cases and 95,464 controls from populations of European, African, Japanese and Latino ancestry, followed by replication in 32,059 cases and 228,628 controls from 18 studies. We identified ten new risk loci, bringing the total number of known atopic dermatitis risk loci to 31 (with new secondary signals at four of these loci). Notably, the new loci include candidate genes with roles in the regulation of innate host defenses and T cell function, underscoring the important contribution of (auto)immune mechanisms to atopic dermatitis pathogenesis.

[Metabolic control in children and adolescents with type 1 diabetes].

PubMed

Díaz-Cárdenas, Claudia; Wong, Carolina; Vargas Catalán, Nelson A

2016-01-01

Type 1 diabetes mellitus (T1D) is an important disease in children and adolescent being a major risk factor for early morbidity and mortality. To know the degree of metabolic control and prevalence of cardiovascular risk factors in T1D patients. Retrospective study including patients under 19 years of age with T1D controlled at a Chilean hospital in 2011. 94 patients were evaluated (average age at diagnosis: 7.3 years; current age: 11,9 years; evolution time: 4.5 years). Seventy-nine percent (79.8%) of patients presented glycated hemoglobin (HbA1c) over the recommended level with an average of 8.9%. The group between 13 and 19 years of age exhibited the worst metabolic control (86% with HbA1c abnormal levels). Overweight or obesity occurred in 26.6% of patients, 20.3% had LDL >100mg/dl and 4.2% had hypertension. Only about twenty percent of patients had adequate metabolic control as measured by HbA1c, although cardiovascular risk profile was acceptable. Therapeutic and educational efforts must be reinforced mainly in adolescents, emphasizing the importance of adequate nutritional management as a primary method to treat this entity. Copyright © 2015 Sociedad Chilena de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

The interplay between cognitive risk and resilience factors in remitted depression: A network analysis.

PubMed

Hoorelbeke, Kristof; Marchetti, Igor; De Schryver, Maarten; Koster, Ernst H W

2016-05-01

Individuals in remission from depression are at increased risk for developing future depressive episodes. Several cognitive risk- and resilience factors have been suggested to account for this vulnerability. In the current study we explored how risk- and protective factors such as cognitive control, adaptive and maladaptive emotion regulation, residual symptomatology, and resilience relate to one another in a remitted depressed (RMD) sample. We examined the relationships between these constructs in a cross-sectional dataset of 69 RMD patients using network analyses in order to obtain a comprehensive, data-driven view on the interplay between these constructs. We subsequently present an association network, a concentration network, and a relative importance network. In all three networks resilience formed the central hub, connecting perceived cognitive control (i.e., working memory complaints), emotion regulation, and residual symptomatology. The contribution of the behavioral measure for cognitive control in the network was negligible. Moreover, the directed relative importance network indicates bidirectional influences between these constructs, with all indicators of centrality suggesting a key role of resilience in remission from depression. The presented findings are cross-sectional and networks are limited to a fixed set of key constructs in the literature pertaining cognitive vulnerability for depression. These findings indicate the importance of resilience to successfully cope with stressors following remission from depression. Further in-depth studies will be essential to identify the specific underlying resilience mechanisms that may be key to successful remission from depression. Copyright © 2016 Elsevier B.V. All rights reserved.

An Informational Analysis and Communications Squadron Survey of Cyberspace Mission Assurance

DTIC Science & Technology

2010-06-01

such things as fraud, 11 business ethics, financial reporting, internal controls, and enterprise risk management . COSO is an organization...recognized world-wide and is highly respected. In 1992, COSO published a framework for risk management . It reopened the framework for modification to...The enterprise risk management facet of the COSO framework is pertinent to the cyber mission assurance discussion. COSO recognized the importance

What Did Schools Experience from Participating in a Randomised Controlled Study (PLAY) That Prioritised Risk and Challenge in Active Play for Children While at School?

ERIC Educational Resources Information Center

Farmer, Victoria L.; Fitzgerald, Ruth P.; Williams, Sheila M.; Mann, Jim I.; Schofield, Grant; McPhee, Julia C.; Taylor, Rachael W.

2017-01-01

"Risky" play is an important component of play, which positively affects the cognitive, social and emotional development of children. However, a growing culture of "risk aversion" may be limiting the degree of risk that children are allowed to encounter. We undertook qualitative interviews with eight schools to examine the…

Risk mapping of clonorchiasis in the People’s Republic of China: A systematic review and Bayesian geostatistical analysis

PubMed Central

Lai, Ying-Si; Zhou, Xiao-Nong; Pan, Zhi-Heng; Utzinger, Jürg; Vounatsou, Penelope

2017-01-01

Background Clonorchiasis, one of the most important food-borne trematodiases, affects more than 12 million people in the People’s Republic of China (P.R. China). Spatially explicit risk estimates of Clonorchis sinensis infection are needed in order to target control interventions. Methodology Georeferenced survey data pertaining to infection prevalence of C. sinensis in P.R. China from 2000 onwards were obtained via a systematic review in PubMed, ISI Web of Science, Chinese National Knowledge Internet, and Wanfang Data from January 1, 2000 until January 10, 2016, with no restriction of language or study design. Additional disease data were provided by the National Institute of Parasitic Diseases, Chinese Center for Diseases Control and Prevention in Shanghai. Environmental and socioeconomic proxies were extracted from remote-sensing and other data sources. Bayesian variable selection was carried out to identify the most important predictors of C. sinensis risk. Geostatistical models were applied to quantify the association between infection risk and the predictors of the disease, and to predict the risk of infection across P.R. China at high spatial resolution (over a grid with grid cell size of 5×5 km). Principal findings We obtained clonorchiasis survey data at 633 unique locations in P.R. China. We observed that the risk of C. sinensis infection increased over time, particularly from 2005 onwards. We estimate that around 14.8 million (95% Bayesian credible interval 13.8–15.8 million) people in P.R. China were infected with C. sinensis in 2010. Highly endemic areas (≥ 20%) were concentrated in southern and northeastern parts of the country. The provinces with the highest risk of infection and the largest number of infected people were Guangdong, Guangxi, and Heilongjiang. Conclusions/Significance Our results provide spatially relevant information for guiding clonorchiasis control interventions in P.R. China. The trend toward higher risk of C. sinensis infection in the recent past urges the Chinese government to pay more attention to the public health importance of clonorchiasis and to target interventions to high-risk areas. PMID:28253272

You have been framed! How antecedents of information need mediate the effects of risk communication messages.

PubMed

Terpstra, T; Zaalberg, R; de Boer, J; Botzen, W J W

2014-08-01

This study investigates the processes that mediate the effects of framing flood risks on people's information needs. Insight into the effects of risk frames is important for developing balanced risk communication that explains both risks and benefits of living near water. The research was inspired by the risk information seeking and processing model and related models. In a web-based survey, respondents (n = 1,457) were randomly assigned to one of three communication frames or a control frame (experimental conditions). Each frame identically explained flood risk and additionally refined the message by emphasizing climate change, the quality of flood risk management, or the amenities of living near water. We tested the extent to which risk perceptions, trust, and affective responses mediate the framing effects on information need. As expected, the frames on average resulted in higher information need than the control frame. Attempts to lower fear appeal by stressing safety or amenities instead of climate change were marginally successful, a phenomenon that is known as a "negativity bias." Framing effects were mediated by negative attributes (risk perception and negative affect) but not by positive attributes (trust and positive affect). This finding calls for theoretical refinement. Practically, communication messages will be more effective when they stimulate risk perceptions and evoke negative affect. However, arousal of fear may have unwanted side effects. For instance, fear arousal could lead to lower levels of trust in risk management among citizens. Regular monitoring of citizens' attitudes is important to prevent extreme levels of distrust or cynicism. © 2014 Society for Risk Analysis.

Estimating the malaria risk of African mosquito movement by air travel

PubMed Central

Tatem, Andrew J; Rogers, David J; Hay, Simon I

2006-01-01

Background The expansion of global travel has resulted in the importation of African Anopheles mosquitoes, giving rise to cases of local malaria transmission. Here, cases of 'airport malaria' are used to quantify, using a combination of global climate and air traffic volume, where and when are the greatest risks of a Plasmodium falciparum-carrying mosquito being importated by air. This prioritises areas at risk of further airport malaria and possible importation or reemergence of the disease. Methods Monthly data on climate at the World's major airports were combined with air traffic information and African malaria seasonality maps to identify, month-by-month, those existing and future air routes at greatest risk of African malaria-carrying mosquito importation and temporary establishment. Results The location and timing of recorded airport malaria cases proved predictable using a combination of climate and air traffic data. Extending the analysis beyond the current air network architecture enabled identification of the airports and months with greatest climatic similarity to P. falciparum endemic regions of Africa within their principal transmission seasons, and therefore at risk should new aviation routes become operational. Conclusion With the growth of long haul air travel from Africa, the identification of the seasonality and routes of mosquito importation is important in guiding effective aircraft disinsection and vector control. The recent and continued addition of air routes from Africa to more climatically similar regions than Europe will increase movement risks. The approach outlined here is capable of identifying when and where these risks are greatest. PMID:16842613

Important Risk Factors of Mortality Among Children Aged 1-59 Months in Rural Areas of Shahroud, Iran: A Community-based Nested Case-Control Study.

PubMed

Chaman, Reza; Alami, Ali; Emamian, Mohammad Hassan; Naieni, Kourosh Holakouie; Mirmohammadkhani, Majid; Ahmadnezhad, Elham; Entezarmahdi, Rasool; Shati, Mohsen; Shariati, Mohammad

2012-12-01

The aim of the study was to evaluate potential risk factors of children mortality between 1-59 months of age. This nested case-control study was conducted among children born from June 1999 to March 2009 in rural areas of Shahroud, located in the central region of Iran using health care visit reports and follow-up data available in household health records. MORTALITY WAS SIGNIFICANTLY ASSOCIATED WITH BREASTFEEDING DURATION (OR: 0.87, 95% CI: 0.81-0.93), total health care visits (OR: 0.90, 95% CI: 0.83-0.98) and low birth weight (LBW) (OR: 7.38, 95% CI: 1.37-39.67). In our study, a longer breastfeeding period and more frequent health care visits were two important protective factors, while LBW was an important risk factor for 1-59 month child mortality. It seems, that complex and multiple factors may be involved in mortality of under 5-year-old children, so combined efforts would be necessary to improve child health indicators.

Leukemia after exposure to benzene: temporal trends and implications for standards.

PubMed

Finkelstein, M M

2000-07-01

Benzene is a human leukemogen. Risk assessment, and the setting of occupational and environmental standards, has assumed that risk is constant in time after a unit of exposure. Leukemia risk is known to vary with time after exposure to ionizing radiation. A matched case-control study of leukemia risk in relation to the temporal pattern of benzene exposures was performed using data from the National Institute of Occupational Safety and Health. Leukemia risk following exposure to benzene varied with time in a manner similar to that following exposure to ionizing radiation. More recent exposures were more strongly associated with risk than were more distant ones. There was no significant relation between leukemia death and benzene exposures incurred more than 20 years previously. Recent analyses of specific occupational and environmental carcinogens, including benzene and radon, have indicated that cancer risk tends to decline as the time from exposure increases. This suggests that standards for the control of occupational or public risk must be selected to control exposures over a narrower time frame than the usual lifetime one. In the case of benzene, it would appear that risk is attributable primarily to exposures incurred during the previous 10 to 20 years, with exposures in the most recent 10 years being the most potent. To limit risk, exposures must be controlled during that interval. It is important that epidemiologists explore the temporal pattern of risk in their studies to facilitate the risk assessment of other carcinogens. Copyright 2000 Wiley-Liss, Inc.

Control beliefs and risk for 4-year mortality in older adults: a prospective cohort study.

PubMed

Duan-Porter, Wei; Hastings, Susan Nicole; Neelon, Brian; Van Houtven, Courtney Harold

2017-01-11

Control beliefs are important psychological factors that likely contribute to heterogeneity in health outcomes for older adults. We evaluated whether control beliefs are associated with risk for 4-year mortality, after accounting for established "classic" biomedical risk factors. We also determined if an enhanced risk model with control beliefs improved identification of individuals with low vs. high mortality risk. We used nationally representative data from the Health and Retirement Study (2006-2012) for adults 50 years or older in 2006 (n = 7313) or 2008 (n = 6301). We assessed baseline perceived global control (measured as 2 dimensions-"constraints" and "mastery"), and health-specific control. We also obtained baseline data for 12 established biomedical risk factors of 4-year mortality: age, sex, 4 medical conditions (diabetes mellitus, cancer, lung disease and heart failure), body mass index less than 25 kg/m 2 , smoking, and 4 functional difficulties (with bathing, managing finances, walking several blocks and pushing or pulling heavy objects). Deaths within 4 years of follow-up were determined through interviews with respondents' family and the National Death Index. After accounting for classic biomedical risk factors, perceived constraints were significantly associated with higher mortality risk (third quartile scores odds ratio [OR] 1.37, 95% CI 1.03-1.81; fourth quartile scores OR 1.45, 95% CI, 1.09-1.92), while health-specific control was significantly associated with lower risk (OR 0.69-0.78 for scores above first quartile). Higher perceived mastery scores were not consistently associated with decreased risk. The enhanced model with control beliefs found an additional 3.5% of participants (n = 222) with low predicted risk of 4-year mortality (i.e., 4% or less); observed mortality for these individuals was 1.8% during follow-up. Compared with participants predicted to have low mortality risk only by the classic biomedical model, individuals identified by only the enhanced model were older, had higher educational status, higher income, and higher prevalence of diabetes mellitus and cancer. Control beliefs were significantly associated with risk for 4-year mortality; accounting for these factors improved identification of low-risk individuals. More work is needed to determine how assessment of control beliefs could enable targeting of clinical interventions to support at-risk older adults.

The new dyslipidemia guidelines: what is the debate?

PubMed

Anderson, Todd J; Mancini, G B John; Genest, Jacques; Grégoire, Jean; Lonn, Eva M; Hegele, Robert A

2015-05-01

Dyslipidemia is a major risk factor for the development of atherosclerotic disease. Therefore, lifestyle interventions and pharmacological approaches to decrease cholesterol are widely used in cardiovascular disease prevention. The introduction and widespread use of 3-hydroxy-3 methylglutaryl coenzyme A inhibitors (statins) for individuals at risk of atherosclerotic disease has been an important advance in cardiovascular care. There can be no doubt that better control of dyslipidemia, even in subjects whose low-density lipoprotein cholesterol level is not particularly high, has reduced overall event rates. On a background of lifestyle interventions, statins are routinely used to decrease risk along with aspirin and interventions to control hypertension and diabetes. More than other risk factors, the approach to the identification and treatment of dyslipidemia has been heterogeneous and widely debated. The recent release of the 2013 American College of Cardiology/American Heart Association dyslipidemia guidelines has reignited the controversy over the best approach for risk stratification and treatment. In this article we review the importance of statin therapy for global cardiovascular risk reduction, compare the Canadian Cardiovascular Society dyslipidemia guidelines with other standards, and discuss the points of debate. Despite the seeming variety of recommendations, their common link is a systematic approach to risk stratification and treatment, which will continue to benefit our patients at risk. Copyright © 2015 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

Pharmacovigilance practice and risk control of Traditional Chinese Medicine drugs in China: current status and future perspective.

PubMed

Zhang, Li; Yan, Jingbo; Liu, Xinmin; Ye, Zuguang; Yang, Xiaohui; Meyboom, Ronald; Chan, Kelvin; Shaw, Debbie; Duez, Pierre

2012-04-10

Traditional Chinese Medicine (TCM), including Traditional Chinese Medicine drugs (TCM drugs), has been playing a very important role in health protection and disease control for thousands of years in China. Relying on natural products, mainly of herbal origin, used either as raw materials for decoction, as prepared herbal medicines or as formulated traditional medicines, TCM is still widely accepted by Chinese people, especially for chronic diseases treatment. This extensive use warrants safety measures and so TCM drug safety monitoring and risk management are becoming increasingly important tasks for the Chinese State Food and Drug Administration (SFDA). The Adverse Drug Reaction (ADR) monitoring system in China was established both for western and TCM drugs in 1989 as a voluntary reporting system with a National Center collecting and compiling reports. Serious or multi-case reports on individual TCM drug or formulated products are detailed in the Chinese ADR Information Bulletin to inform the public and Drug Administrative authorities for risk management. About 10-15% of the ADR reports received by the National Center are related to TCM drugs and mainly pertaining to the formulated products. In certain cases, the suspension of a particular TCM preparation is decided by SFDA China. The model of safety monitoring and risk management of TCM drugs is still under exploration. Indeed, the characteristics and risk factors associated with these drugs require both proper understanding and control of the risk by strengthening standardization of clinical applications, basic science research, quality control in manufacturing, exploration of the actives monitoring methodology and enhancement of international communication and cooperation. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

The Role and Quality of Software Safety in the NASA Constellation Program

NASA Technical Reports Server (NTRS)

Layman, Lucas; Basili, Victor R.; Zelkowitz, Marvin V.

2010-01-01

In this study, we examine software safety risk in the early design phase of the NASA Constellation spaceflight program. Obtaining an accurate, program-wide picture of software safety risk is difficult across multiple, independently-developing systems. We leverage one source of safety information, hazard analysis, to provide NASA quality assurance managers with information regarding the ongoing state of software safety across the program. The goal of this research is two-fold: 1) to quantify the relative importance of software with respect to system safety; and 2) to quantify the level of risk presented by software in the hazard analysis. We examined 154 hazard reports created during the preliminary design phase of three major flight hardware systems within the Constellation program. To quantify the importance of software, we collected metrics based on the number of software-related causes and controls of hazardous conditions. To quantify the level of risk presented by software, we created a metric scheme to measure the specificity of these software causes. We found that from 49-70% of hazardous conditions in the three systems could be caused by software or software was involved in the prevention of the hazardous condition. We also found that 12-17% of the 2013 hazard causes involved software, and that 23-29% of all causes had a software control. Furthermore, 10-12% of all controls were software-based. There is potential for inaccuracy in these counts, however, as software causes are not consistently scoped, and the presence of software in a cause or control is not always clear. The application of our software specificity metrics also identified risks in the hazard reporting process. In particular, we found a number of traceability risks in the hazard reports may impede verification of software and system safety.

A quantitative risk-analysis for introduction of Bovine Viral Diarrhoea Virus in the Netherlands through cattle imports.

PubMed

Santman-Berends, I M G A; Mars, M H; Van Duijn, L; Van den Broek, K W H; Van Schaik, G

2017-10-01

Many countries have implemented control programmes aiming to eradicate Bovine Viral Diarrhoea Virus (BVDV). After obtaining the free status, a risk of re-introduction of the virus through import may remain. Therefore the risk of introduction of BVDV through cattle imports in the Netherlands was quantified and the effectiveness of subsequent intervention measures was assessed. Data, literature and expert opinion were used to estimate values for input parameters to feed a stochastic simulation model. The probability that BVDV was imported was differentiated into persistently infected (PI) cattle, trojan cows that transmitted the virus vertically resulting in a PI foetus (TR) and transient infected cattle (TI). The import risk was stratified to beef, dairy, small scale, suckler, trade, veal and young stock herds. The intervention scenarios that were evaluated consisted of virus testing, a combination of virus testing and antibody testing in pregnant cows, abolishment of imports from high risk countries (i.e. countries with a BVDV prevalence >15%) and a combination of import restrictions and testing prior to import. Each year, 334 (5th and 95th percentile: 65-902) Dutch cattle herds were estimated to be infected with BVDV through import. Veal herds account for most infections associated with import (87%), whereas in the other herd types, only 9 beef, 6 dairy, 2 small scale, 16 suckler, 10 trade and 2 young stock herds are infected through imports per year. Import of PI cattle is the most important risk for introduction in veal herds, while import of TR cows is the main source of BVDV introduction in dairy, small scale and suckler herds. With the intervention scenarios, the number of BVDV infected herds in the Netherlands could be reduced to 81 and 58 herds per year when respectively virus testing or a combination of virus and antibody testing was applied or to 108 herds when import from high risk countries was abolished. With the scenario in which both import from high risk countries was abolished combined with virus and antibody testing, the number of BVDV infected herds could be reduced to 17 herds per year. The risk assessment showed that BVDV is regularly imported in the Netherlands. The import risk can effectively be reduced by implementing diagnostic testing prior to import and only import cattle with a favourable result, eventually combined with certain trade restrictions. Copyright © 2017. Published by Elsevier B.V.

Risky Decision Making in Juvenile Myoclonic Epilepsy.

PubMed

Unterberger, Iris; Zamarian, Laura; Prieschl, Manuela; Bergmann, Melanie; Walser, Gerald; Luef, Gerhard; Javor, Andrija; Ransmayr, Gerhard; Delazer, Margarete

2018-01-01

It is not known whether patients with juvenile myoclonic epilepsy (JME) differ from healthy people in decision making under risk, i.e., when the decision-making context offers explicit information about options, probabilities, and consequences already from the beginning. In this study, we adopted the Game of Dice Task-Double to investigate decision making under risk in a group of 36 patients with JME (mean age 25.25/SD 5.29 years) and a group of 38 healthy controls (mean age 26.03/SD 4.84 years). Participants also underwent a comprehensive neuropsychological assessment focused on frontal executive functions. Significant group differences were found in tests of psychomotor speed and divided attention, with the patients scoring lower than the controls. Importantly, patients made risky decisions more frequently than controls. In the patient group, poor decision making was associated with poor executive control, poor response inhibition, and a short interval since the last seizure episode. Executive control and response inhibition could predict 42% of variance in the frequency of risky decisions. This study indicates that patients with JME with poorer executive functions are more likely to make risky decisions than healthy controls. Decision making under risk is of major importance in every-day life, especially with regard to treatment decisions and adherence to long-term medical therapy. Since even a single disadvantageous decision may have long-lasting consequences, this finding is of high relevance.

The Risky Business of Dopamine Agonists in Parkinson Disease and Impulse Control Disorders

PubMed Central

Claassen, Daniel O.; van den Wildenberg, Wery P.M.; Ridderinkhof, K. Richard; Jessup, Charles K.; Harrison, Madaline B.; Wooten, G. Frederick; Wylie, Scott A.

2011-01-01

Risk-taking behavior is characterized by pursuit of reward in spite of potential negative consequences. Dopamine neurotransmission along the mesocorticolimbic pathway is a potential modulator of risk behavior. In patients with Parkinson's Disease (PD), impulse control disorder (ICD) can result from dopaminergic medication use, particularly Dopamine Agonists (DAA). Behaviors associated with ICD include hypersexuality as well as compulsive gambling, shopping, and eating, and are potentially linked to alterations to risk processing. Using the Balloon Analogue Risk task, we assessed the role of agonist therapy on risk-taking behavior in PD patients with (n=22) and without (n=19) active ICD symptoms. Patients performed the task both ‘on’ and ‘off’ DAA. DAA increased risk-taking in PD patients with active ICD symptoms, but did not affect risk behavior of PD controls. DAA dose was also important in explaining risk behavior. Both groups similarly reduced their risk-taking in high compared to low risk conditions and following the occurrence of a negative consequence, suggesting that ICD patients do not necessarily differ in their ability to process and adjust to some aspects of negative consequences. Our findings suggest dopaminergic augmentation of risk-taking behavior as a potential contributing mechanism for the emergence of ICD in PD patients. PMID:21604834

Predictors of Sexual Coercion and Alcohol Use among Female Juvenile Offenders

PubMed Central

Yeater, Elizabeth A.; Montanaro, Erika A.; Bryan, Angela D.

2014-01-01

Female juvenile offenders report high rates of sexual coercion and substance use, yet the temporal relationship between the two remains unclear. The focus of this study was to conduct a prospective examination of predictors of sexual coercion and substance use for a group of high-risk young women. Two hundred and forty five adolescent females (34% of a sample including males and females), between the ages of 14-17, and from a larger study of juvenile offenders, were recruited from juvenile probation offices to participate in a longitudinal study on substance use and sexual risk. At baseline, participants completed measures associated with increased risk for sexual coercion, including substance use, perceived relationship control, and externalizing behavior. At 6- and 24-month follow-up, participants also completed a measure assessing sexually coercive experiences. Path analysis revealed that less relationship control at baseline predicted sexual coercion at 6-months. Additionally, 6-month sexual coercion predicted alcohol use and sexual coercion at 24-month follow-up. Logistic regression analysis revealed also that alcohol use at 6-months predicted sexual revictimization at 24-months. Sexual coercion appears to be associated with subsequent increases in alcohol use, suggesting that female juvenile offenders may be using alcohol to cope with the psychological and emotional consequences of victimization. Alcohol use is linked to increased risk for repeat sexual coercion, suggesting that exposure to risky environments also may be important in understanding these girls' risk. Difficulties responding assertively in sexual relationships (i.e., low relationship control) also seem to increase female juvenile offenders' risk for sexual coercion. Finally, previous sexual coercion appears to increase risk for future victimization, highlighting the importance of early intervention for this at-risk group. PMID:25107488

Schistosoma mansoni reinfection: Analysis of risk factors by classification and regression tree (CART) modeling

PubMed Central

Oliveira-Prado, Roberta; Matoso, Leonardo Ferreira; Veloso, Bráulio M.; Andrade, Gisele; Kloos, Helmut; Bethony, Jeffrey M.; Assunção, Renato M.; Correa-Oliveira, Rodrigo

2017-01-01

Praziquantel (PZQ) is an effective chemotherapy for schistosomiasis mansoni and a mainstay for its control and potential elimination. However, it does not prevent against reinfection, which can occur rapidly in areas with active transmission. A guide to ranking the risk factors for Schistosoma mansoni reinfection would greatly contribute to prioritizing resources and focusing prevention and control measures to prevent rapid reinfection. The objective of the current study was to explore the relationship among the socioeconomic, demographic, and epidemiological factors that can influence reinfection by S. mansoni one year after successful treatment with PZQ in school-aged children in Northeastern Minas Gerais state Brazil. Parasitological, socioeconomic, demographic, and water contact information were surveyed in 506 S. mansoni-infected individuals, aged 6 to 15 years, resident in these endemic areas. Eligible individuals were treated with PZQ until they were determined to be negative by the absence of S. mansoni eggs in the feces on two consecutive days of Kato-Katz fecal thick smear. These individuals were surveyed again 12 months from the date of successful treatment with PZQ. A classification and regression tree modeling (CART) was then used to explore the relationship between socioeconomic, demographic, and epidemiological variables and their reinfection status. The most important risk factor identified for S. mansoni reinfection was their “heavy” infection at baseline. Additional analyses, excluding heavy infection status, showed that lower socioeconomic status and a lower level of education of the household head were also most important risk factors for S. mansoni reinfection. Our results provide an important contribution toward the control and possible elimination of schistosomiasis by identifying three major risk factors that can be used for targeted treatment and monitoring of reinfection. We suggest that control measures that target heavily infected children in the most economically disadvantaged households would be most beneficial to maintain the success of mass chemotherapy campaigns. PMID:28813451

Work-system risk factors for permanent work disability among home-care workers: a case-control study.

PubMed

Dellve, Lotta; Lagerström, Monica; Hagberg, Mats

2003-04-01

There is a growing need for home-care services in western societies. As home-care workers show high levels of absence related to poor health it is important that we broaden our knowledge about what factors in the work system contribute to this. The aim of this study was to explore and estimate the impact of the work system on permanent work disability and its relative importance compared with home-life risks among home-care workers. The cases (617 subjects) were all home-care workers in Sweden, whose disability pension was approved in 1997 or 1998. The controls (771 subjects) were home-care workers still working. We used a questionnaire to gain situation-specific information on working life and home life 5 and 15 years before disability pension entitlement. The most important risk factors in the work system were poor ergonomic/lifting conditions, time pressure and lack of professional caring technique. Fifteen years prior to disability pension entitlement, insufficient management (odds ratio (OR) 95%, CI 2.6[1.6;4.2]) and relational problems at work were also risk factors. Five years before disability pension entitlement, poor organisational support (4.1 [2.5;6.7]), opportunities for co-working and working climate (3.5 [2.4;5.2]) were also strongly related to a persisting work ability. The magnitude of exposure to a number of risk factors had an increased effect (highest 13.8 [5.6-33.8]). The strongest risk factor in home life was little opportunity to rest from work (4.9 [3.0;8.0]). The risk factors in working life were robust to the inclusion of the grouped risk factors of home life. The conclusion was that risk factors related to the work system are, alone, strongly related to permanent work disability among home-care workers. Also, exposure to several of the risk factors constitutes a notably strong risk for permanent work disability.

Effective standards and regulatory tools for respiratory gas monitors and pulse oximeters: the role of the engineer and clinician.

PubMed

Weininger, Sandy

2007-12-01

Developing safe and effective medical devices involves understanding the hazardous situations that can arise in clinical practice and implementing appropriate risk control measures. The hazardous situations may have their roots in the design or in the use of the device. Risk control measures may be engineering or clinically based. A multidisciplinary team of engineers and clinicians is needed to fully identify and assess the risks and implement and evaluate the effectiveness of the control measures. In this paper, I use three issues, calibration/accuracy, response time, and protective measures/alarms, to highlight the contributions of these groups. This important information is captured in standards and regulatory tools to control risk for respiratory gas monitors and pulse oximeters. This paper begins with a discussion of the framework of safety, explaining how voluntary standards and regulatory tools work. The discussion is followed by an examination of how engineering and clinical knowledge are used to support the assurance of safety.

A Case–Control Study on the Origin of Atypical Scrapie in Sheep, France

PubMed Central

Morignat, Eric; Ducrot, Christian; Calavas, Didier

2009-01-01

A matched case–control study (95 cases and 220 controls) was designed to study risk factors for atypical scrapie in sheep in France. We analyzed contacts with animals from other flocks, lambing and feeding practices, and exposure to toxic substances. Data on the prnp genotype were collected for some case and control animals and included in a complementary analysis. Sheep dairy farms had a higher risk for scrapie (odds ratio [OR] 15.1, 95% confidence interval [CI] 3.3–69.7). Lower risk was associated with organic farms (OR 0.15, 95% CI 0.02–1.26), feeding corn silage (OR 0.16, 95% CI 0.05–0.53), and feeding vitamin and mineral supplements (OR 0.6, 95% CI 0.32–1.14). Genetic effects were quantitatively important but only marginally changed estimates of other variables. We did not find any risk factor associated with an infectious origin of scrapie. Atypical scrapie could be a spontaneous disease influenced by genetic and metabolic factors. PMID:19402956

Management and risk factor control of coronary artery disease in elderly versus nonelderly: a multicenter registry.

PubMed

Phrommintikul, Arintaya; Krittayaphong, Rungroj; Wongcharoen, Wanwarang; Boonyaratavej, Smonporn; Wongvipaporn, Chaiyasith; Tiyanon, Woraporn; Dinchuthai, Pakaphan; Kunjara-Na-Ayudhya, Rapeephon; Tatsanavivat, Pyatat; Sritara, Piyamitr

2016-12-01

Coronary artery disease (CAD) is a leading cause of death in elderly because aging is the important non-modifiable risk factors of atherosclerosis and also a predictor of poor outcomes. Underuse of guideline directed therapy may contribute to suboptimal risk factor control and worse outcomes in the elderly. We aimed to explore the management of CAD, risk factors control as well as goal attainment in elderly compared to nonelderly CAD patients. The CORE-Thailand is an ongoing multicenter, prospective, observational registry of patients with high atherosclerotic risk in Thailand. The data of 4120 CAD patients enrolled in this cohort was analyzed comparing between the elderly (age ≥ 65 years) vs. nonelderly (age < 65 years). There were 2172 elderly and 1948 nonelderly patients. The elderly CAD patients had higher prevalence of hypertension, dyslipidemia, atrial fibrillation and chronic kidney disease. The proportion of patients who received coronary revascularization was not different between the elderly and nonelderly CAD patients. Antiplatelets were prescribed less in the elderly while statin was prescribed in the similar proportion. Goal attainments of risk factor control of glycemic control, low density lipoprotein cholesterol, and smoking cessation except the blood pressure goal were higher in the elderly CAD patients. The CORE-Thailand registry showed the equity in the treatment of CAD between elderly and non-elderly. Elderly CAD patients had higher rate of goal attainment in risk factor control except blood pressure goal. The effects of goal attainment on cardiovascular outcomes will be demonstrated from ongoing cohort.

'Battling my biology': psychological effects of genetic testing for risk of weight gain.

PubMed

Meisel, S F; Wardle, J

2014-04-01

The availability of genetic tests for multifactorial conditions such as obesity raises concerns that higher-risk results could lead to fatalistic reactions or lower-risk results to complacency. No study has investigated the effects of genetic test feedback for the risk of obesity in non-clinical samples. The present study explored psychological and behavioral reactions to genetic test feedback for a weight related gene (FTO) in a volunteer sample (n = 18) using semi-structured interviews. Respondents perceived the gene test result as scientifically objective; removing some of the emotion attached to the issue of weight control. Those who were struggling with weight control reported relief of self-blame. There was no evidence for either complacency or fatalism; all respondents emphasized the importance of lifestyle choices in long-term weight management, although they recognized the role of both genes and environment. Regardless of the test result, respondents evaluated the testing positively and found it motivating and informative. Genetic test feedback for risk of weight gain may offer psychological benefits beyond its objectively limited clinical utility. As the role of genetic counselors is likely to expand, awareness of reasons for genetic testing for common, complex conditions and reactions to the test result is important.

Burden of Noncommunicable Diseases and National Strategies to Control Them in Korea

PubMed Central

2013-01-01

Noncommunicable diseases (NCDs) are the most important causes of premature mortality and disability-adjusted life years in Korea. NCDs are also the main contributor to socioeconomic inequalities in mortality and life expectancy. Reduction of NCDs and NCD inequalities would result in significant improvement in healthy life expectancy and health equity in Korea. Major NCD risk factors such as dietary risks (including salt intake), alcohol consumption, cigarette smoking, and high blood pressure were found to be the leading modifiable risk factors of disability-adjusted life years in Korea, based on the 2010 Global Burden of Disease Study. Several Korean studies have shown that these risk factors play an important role in creating socioeconomic inequalities in NCD mortality and total mortality. Current international discussions on NCD policies in the United Nations and the World Health Organization would provide better opportunities for developing aggressive population-wide policy measures in Korea. Considering the paucity of population-wide policies to control major NCD risk factors in Korea, rigorous population approaches such as taxation and regulation of unhealthy commodities as well as public education and mass campaigns should be further developed in Korea. PMID:23946873

Risk factors for measles among adults in Tianjin, China: Who should be controls in a case-control study?

PubMed

Wagner, Abram L; Boulton, Matthew L; Gillespie, Brenda W; Zhang, Ying; Ding, Yaxing; Carlson, Bradley F; Luo, Xiaoyan; Montgomery, JoLynn P; Wang, Xiexiu

2017-01-01

Control groups in previous case-control studies of vaccine-preventable diseases have included people immune to disease. This study examines risk factors for measles acquisition among adults 20 to 49 years of age in Tianjin, China, and compares findings using measles IgG antibody-negative controls to all controls, both IgG-negative and IgG-positive. Measles cases were sampled from a disease registry, and controls were enrolled from community registries in Tianjin, China, 2011-2015. Through a best subsets selection procedure, we compared which variables were selected at different model sizes when using IgG-negative controls or all controls. We entered risk factors for measles in two separate logistic regression models: one with measles IgG-negative controls and the other with all controls. The study included 384 measles cases and 1,596 community controls (194 IgG-negative). Visiting a hospital was an important risk factor. For specialty hospitals, the odds ratio (OR) was 4.53 (95% confidence interval (CI): 1.28, 16.03) using IgG-negative controls, and OR = 5.27 (95% CI: 2.73, 10.18) using all controls. Variables, such as age or length of time in Tianjin, were differentially selected depending on the control group. Individuals living in Tianjin ≤3 years had 2.87 (95% CI: 1.46, 5.66) times greater odds of measles case status compared to all controls, but this relationship was not apparent for IgG-negative controls. We recommend that case-control studies examining risk factors for infectious diseases, particularly in the context of transmission dynamics, consider antibody-negative controls as the gold standard.

Factors driving public tolerance levels and information-seeking behaviour concerning insects in the household environment.

PubMed

Schoelitsz, Bruce; Poortvliet, P Marijn; Takken, Willem

2018-06-01

The public's negative attitudes towards household insects drive tolerance for these insects and their control. Tolerance levels are important in integrated pest management (IPM), as are pest knowledge and information. The risk information seeking and processing (RISP) model describes the relationships between personal factors and information-seeking behaviour. We combined IPM and RISP to determine important relationships between factors driving insect tolerance levels and information-seeking behaviour through an online survey and tested whether this model is valid and generally applicable. Relationships between variables from both IPM and RISP models were tested for seven insect species. Tolerance levels were measured with two factors: willingness to pay for pest control and whether insects are tolerated. Willingness to pay for control was positively affected by age, experience, risk perception, insect characteristics, and negative emotions and affected behavioural intention, by influencing information sufficiency and information-seeking behaviour. Tolerability was influenced by perception of insect characteristics and determines whether control measures are taken. It was possible to combine the RISP and IPM models. Relevant driving factors were a person's age, experience, risk perception, negative affective responses, tolerance levels, relevant channel beliefs about online forums, information sufficiency and information-seeking behaviour. There was, however, variation in important factors between different insects. © 2017 The Authors. Pest Management Science published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry. © 2017 The Authors. Pest Management Science published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.

Fiber facts: benefits and recommendations for individuals with type 2 diabetes.

PubMed

Vuksan, Vladimir; Rogovik, Alexander L; Jovanovski, Elena; Jenkins, Alexandra L

2009-10-01

In randomized controlled trials, viscous soluble fibers have demonstrated acute and long-term metabolic improvements in type 2 diabetes, such as reductions in hemoglobin A1c, fasting and post-prandial glycemia, insulinemia, and cardiovascular risk factors. In addition, they may be helpful in weight control through promoting feelings of fullness. Increasing consumption of foods containing fiber or use of fiber supplements could play an important role in managing diabetes with positive outcomes on vascular complications and reduced cardio-vascular disease risk.

Exploring public perception of non-native species from a visions of nature perspective.

PubMed

Verbrugge, Laura N H; Van den Born, Riyan J G; Lenders, H J Rob

2013-12-01

Not much is known about lay public perceptions of non-native species and their underlying values. Public awareness and engagement, however, are important aspects in invasive species management. In this study, we examined the relations between the lay public's visions of nature, their knowledge about non-native species, and their perceptions of non-native species and invasive species management with a survey administered in the Netherlands. Within this framework, we identified three measures for perception of non-native species: perceived risk, control and engagement. In general, respondents scored moderate values for perceived risk and personal engagement. However, in case of potential ecological or human health risks, control measures were supported. Respondents' images of the human-nature relationship proved to be relevant in engagement in problems caused by invasive species and in recognizing the need for control, while images of nature appeared to be most important in perceiving risks to the environment. We also found that eradication of non-native species was predominantly opposed for species with a high cuddliness factor such as mammals and bird species. We conclude that lay public perceptions of non-native species have to be put in a wider context of visions of nature, and we discuss the implications for public support for invasive species management.

Sleep duration, daytime napping, markers of obstructive sleep apnea and stroke in a population of southern China

PubMed Central

Wen, Ye; Pi, Fu-Hua; Guo, Pi; Dong, Wen-Ya; Xie, Yu-Qing; Wang, Xiang-Yu; Xia, Fang-Fang; Pang, Shao-Jie; Wu, Yan-Chun; Wang, Yuan-Yuan; Zhang, Qing-Ying

2016-01-01

Sleep habits are associated with stroke in western populations, but this relation has been rarely investigated in China. Moreover, the differences among stroke subtypes remain unclear. This study aimed to explore the associations of total stroke, including ischemic and hemorrhagic type, with sleep habits of a population in southern China. We performed a case-control study in patients admitted to the hospital with first stroke and community control subjects. A total of 333 patients (n = 223, 67.0%, with ischemic stroke; n = 110, 23.0%, with hemorrhagic stroke) and 547 controls were enrolled in the study. Participants completed a structured questionnaire to identify sleep habits and other stroke risk factors. Least absolute shrinkage and selection operator (Lasso) and multiple logistic regression were performed to identify risk factors of disease. Incidence of stroke, and its subtypes, was significantly associated with snorting/gasping, snoring, sleep duration, and daytime napping. Snorting/gasping was identified as an important risk factor in the Lasso logistic regression model (Lasso’ β = 0.84), and the result was proven to be robust. This study showed the association between stroke and sleep habits in the southern Chinese population and might help in better detecting important sleep-related factors for stroke risk. PMID:27698374

Genome-wide association analyses identify new risk variants and the genetic architecture of amyotrophic lateral sclerosis

PubMed Central

van Rheenen, Wouter; Shatunov, Aleksey; Dekker, Annelot M; McLaughlin, Russell L; Diekstra, Frank P; Pulit, Sara L; van der Spek, Rick A A; Võsa, Urmo; de Jong, Simone; Robinson, Matthew R; Yang, Jian; Fogh, Isabella; van Doormaal, Perry TC; Tazelaar, Gijs H P; Koppers, Max; Blokhuis, Anna M; Sproviero, William; Jones, Ashley R; Kenna, Kevin P; van Eijk, Kristel R; Harschnitz, Oliver; Schellevis, Raymond D; Brands, William J; Medic, Jelena; Menelaou, Androniki; Vajda, Alice; Ticozzi, Nicola; Lin, Kuang; Rogelj, Boris; Vrabec, Katarina; Ravnik-Glavač, Metka; Koritnik, Blaž; Zidar, Janez; Leonardis, Lea; Grošelj, Leja Dolenc; Millecamps, Stéphanie; Salachas, François; Meininger, Vincent; de Carvalho, Mamede; Pinto, Susana; Mora, Jesus S; Rojas-García, Ricardo; Polak, Meraida; Chandran, Siddharthan; Colville, Shuna; Swingler, Robert; Morrison, Karen E; Shaw, Pamela J; Hardy, John; Orrell, Richard W; Pittman, Alan; Sidle, Katie; Fratta, Pietro; Malaspina, Andrea; Topp, Simon; Petri, Susanne; Abdulla, Susanne; Drepper, Carsten; Sendtner, Michael; Meyer, Thomas; Ophoff, Roel A; Staats, Kim A; Wiedau-Pazos, Martina; Lomen-Hoerth, Catherine; Van Deerlin, Vivianna M; Trojanowski, John Q; Elman, Lauren; McCluskey, Leo; Basak, A Nazli; Tunca, Ceren; Hamzeiy, Hamid; Parman, Yesim; Meitinger, Thomas; Lichtner, Peter; Radivojkov-Blagojevic, Milena; Andres, Christian R; Maurel, Cindy; Bensimon, Gilbert; Landwehrmeyer, Bernhard; Brice, Alexis; Payan, Christine A M; Saker-Delye, Safaa; Dürr, Alexandra; Wood, Nicholas W; Tittmann, Lukas; Lieb, Wolfgang; Franke, Andre; Rietschel, Marcella; Cichon, Sven; Nöthen, Markus M; Amouyel, Philippe; Tzourio, Christophe; Dartigues, Jean-François; Uitterlinden, Andre G; Rivadeneira, Fernando; Estrada, Karol; Hofman, Albert; Curtis, Charles; Blauw, Hylke M; van der Kooi, Anneke J; de Visser, Marianne; Goris, An; Weber, Markus; Shaw, Christopher E; Smith, Bradley N; Pansarasa, Orietta; Cereda, Cristina; Bo, Roberto Del; Comi, Giacomo P; D’Alfonso, Sandra; Bertolin, Cinzia; Sorarù, Gianni; Mazzini, Letizia; Pensato, Viviana; Gellera, Cinzia; Tiloca, Cinzia; Ratti, Antonia; Calvo, Andrea; Moglia, Cristina; Brunetti, Maura; Arcuti, Simona; Capozzo, Rosa; Zecca, Chiara; Lunetta, Christian; Penco, Silvana; Riva, Nilo; Padovani, Alessandro; Filosto, Massimiliano; Muller, Bernard; Stuit, Robbert Jan; Blair, Ian; Zhang, Katharine; McCann, Emily P; Fifita, Jennifer A; Nicholson, Garth A; Rowe, Dominic B; Pamphlett, Roger; Kiernan, Matthew C; Grosskreutz, Julian; Witte, Otto W; Ringer, Thomas; Prell, Tino; Stubendorff, Beatrice; Kurth, Ingo; Hübner, Christian A; Leigh, P Nigel; Casale, Federico; Chio, Adriano; Beghi, Ettore; Pupillo, Elisabetta; Tortelli, Rosanna; Logroscino, Giancarlo; Powell, John; Ludolph, Albert C; Weishaupt, Jochen H; Robberecht, Wim; Van Damme, Philip; Franke, Lude; Pers, Tune H; Brown, Robert H; Glass, Jonathan D; Landers, John E; Hardiman, Orla; Andersen, Peter M; Corcia, Philippe; Vourc’h, Patrick; Silani, Vincenzo; Wray, Naomi R; Visscher, Peter M; de Bakker, Paul I W; van Es, Michael A; Pasterkamp, R Jeroen; Lewis, Cathryn M; Breen, Gerome; Al-Chalabi, Ammar; van den Berg, Leonard H; Veldink, Jan H

2017-01-01

To elucidate the genetic architecture of amyotrophic lateral sclerosis (ALS) and find associated loci, we assembled a custom imputation reference panel from whole-genome-sequenced patients with ALS and matched controls (n = 1,861). Through imputation and mixed-model association analysis in 12,577 cases and 23,475 controls, combined with 2,579 cases and 2,767 controls in an independent replication cohort, we fine-mapped a new risk locus on chromosome 21 and identified C21orf2 as a gene associated with ALS risk. In addition, we identified MOBP and SCFD1 as new associated risk loci. We established evidence of ALS being a complex genetic trait with a polygenic architecture. Furthermore, we estimated the SNP-based heritability at 8.5%, with a distinct and important role for low-frequency variants (frequency 1–10%). This study motivates the interrogation of larger samples with full genome coverage to identify rare causal variants that underpin ALS risk. PMID:27455348

Environmental- and health-risk-induced remediation design for benzene-contaminated groundwater under parameter uncertainty: a case study in Western Canada.

PubMed

Fan, X; He, L; Lu, H W; Li, J

2014-09-01

This study proposes an environmental- and health-risk-induced remediation design approach for benzene-contaminated groundwater. It involves exposure frequency and intake rates that are important but difficult to be exactly quantified as breakthrough point. Flexible health-risk control is considered in the simulation and optimization work. The proposed approach is then applied to a petroleum-contaminated site in western Canada. Different situations about remediation durations, public concerns, and satisfactory degrees are addressed by the approach. The relationship between environmental standards and health-risk limits is analyzed, in association with their effect on remediation costs. Insights of three uncertain factors (i.e. exposure frequency, intake rate and health-risk threshold) for the remediation system are also explored, on a basis of understanding their impacts on health risk as well as their importance order. The case study results show that (1) nature attenuation plays a more important role in long-term remediation scheme than the pump-and-treat system; (2) carcinogenic risks have greater impact on total pumping rates than environmental standards for long-term remediation; (3) intake rates are the second important factor affecting the remediation system's performance, followed by exposure frequency; (4) the 10-year remediation scheme is the most robust choice when environmental and health-risk concerns are not well quantified. Copyright © 2014 Elsevier Ltd. All rights reserved.

A case-control study of mesothelioma and employment in the Hawaii sugarcane industry.

PubMed

Sinks, T; Goodman, M T; Kolonel, L N; Anderson, B

1994-07-01

We conducted a case-control study of 93 mesothelioma cases and 281 cancer controls to determine whether sugarcane workers exposed to biogenic silica fibers were at increased risk of mesothelioma. We found no important excess risk of mesothelioma in sugarcane workers [odds ratio (OR) = 1.3; 95% confidence interval (CI) = 0.4-3.8] when we excluded all control subjects with cancer of sites suspected of being associated with asbestos exposure. We could not identify any sugarcane workers who developed mesothelioma and worked in jobs where high exposure levels of biogenic silica fibers have been measured. We did confirm that mesothelioma risk in Hawaii is associated with probable occupational asbestos exposure. Work at the Pearl Harbor Naval Shipyard was associated with a 10-fold increase in mesothelioma when we excluded controls with cancer of sites related to asbestos exposure (OR = 10.1; 95% CI = 2.6-56.6). Work in the medical industry was also associated with an unexpected increased risk for mesothelioma (OR = 4.2; 95% CI = 1.2-15.5).

Who reaps the benefits, who bears the risks? Comparative optimism, comparative utility, and regulatory preferences for mobile phone technology.

PubMed

White, Mathew P; Eiser, J Richard; Harris, Peter R; Pahl, Sabine

2007-06-01

Although the issue of risk target (e.g., self, others, children) is widely acknowledged in risk perception research, its importance appears underappreciated. To date, most research has been satisfied with demonstrating comparative optimism, i.e., lower perceived risk for the self than others, and exploring its moderators, such as perceived controllability and personal exposure. Much less research has investigated how the issue of target may affect benefit perceptions or key outcomes such as stated preferences for hazard regulation. The current research investigated these issues using data from a public survey of attitudes toward mobile phone technology (N= 1,320). First, results demonstrated comparative optimism for this hazard, and also found moderating effects of both controllability and personal exposure. Second, there was evidence of comparative utility, i.e., users believed that the benefits from mobile phone technology are greater for the self than others. Third, and most important for policy, preferences for handset regulation were best predicted by perceptions of the risks to others but perceived benefits for the self. Results suggest a closer awareness of target can improve prediction of stated preferences for hazard regulation and that it would be profitable for future research to pay more attention to the issue of target for both risk and benefit perceptions.

Intensive risk factor control in stroke prevention

PubMed Central

2013-01-01

Stroke prevention is an urgent priority because of the aging of the population and the steep association of age and risk of stroke. Direct costs of stroke are expected to more than double in the US between 2012 and 2030. By getting everything right, patients can reduce the risk of stroke by 80% or more; however, getting everything right is a tall order. Roughly in order of importance, this requires smoking cessation, maintenance of a healthy weight, a Cretan Mediterranean diet, blood pressure control, lipid-lowering drugs, appropriate use of antiplatelet agents and anticoagulants, and appropriate carotid endarterectomy and stenting. A new approach called “treating arteries instead of targeting risk factors” appears promising but requires validation in randomized trials. PMID:24167723

Operational Risk Management of Fatigue Effects

DTIC Science & Technology

2005-05-01

response time (RT) and reduced response accuracy 2f. Impaired manual control 2g. Vigilance impairment 2h. Narrowed attention 2i. Hypnagogic hallucinations...exclusion of other essential parameters). Important for both command and control teams and for aircrews. 2i. Hypnagogic hallucinations. Dreams that occur

Adverse Effects of Heavy Prenatal Maternal Smoking on Attentional Control in Children with ADHD

ERIC Educational Resources Information Center

Motlagh, Maria G.; Sukhodolsky, Denis G.; Landeros-Weisenberger, Angeli; Katsovich, Liliya; Thompson, Nancy; Scahill, Lawrence; King, Robert A.; Peterson, Bradley S.; Schultz, Robert T.; Leckman, James F.

2011-01-01

Objective: Exposure to heavy maternal cigarette smoking in pregnancy and severe maternal psychosocial stress during pregnancy appear to be important risk factors for the development of ADHD. This study aimed to determine whether these perinatal risk factors were associated with neuropsychological deficits commonly seen in ADHD. Method: We examined…

Expert ratings of job demand and job control as predictors of injury and musculoskeletal disorder risk in a manufacturing cohort

PubMed Central

Cantley, Linda F; Tessier-Sherman, Baylah; Slade, Martin D; Galusha, Deron; Cullen, Mark R

2016-01-01

Objective To examine associations between workplace injury and musculoskeletal disorder (MSD) risk and expert ratings of job-level psychosocial demand and job control, adjusting for job-level physical demand. Methods Among a cohort of 9260 aluminium manufacturing workers in jobs for which expert ratings of job-level physical and psychological demand and control were obtained during the 2 years following rating obtainment, multivariate mixed effects models were used to estimate relative risk (RR) of minor injury and minor MSD, serious injury and MSD, minor MSD only and serious MSD only by tertile of demand and control, adjusting for physical demand as well as other recognised risk factors. Results Compared with workers in jobs rated as having low psychological demand, workers in jobs with high psychological demand had 49% greater risk of serious injury and serious MSD requiring medical treatment, work restrictions or lost work time (RR=1.49; 95% CI 1.10 to 2.01). Workers in jobs rated as having low control displayed increased risk for minor injury and minor MSD (RR=1.45; 95% CI 1.12 to 1.87) compared with those in jobs rated as having high control. Conclusions Using expert ratings of job-level exposures, this study provides evidence that psychological job demand and job control contribute independently to injury and MSD risk in a blue-collar manufacturing cohort, and emphasises the importance of monitoring psychosocial workplace exposures in addition to physical workplace exposures to promote worker health and safety. PMID:26163544

Working on wellness (WOW): A worksite health promotion intervention programme

PubMed Central

2012-01-01

Background Insufficient PA has been shown to cluster with other CVD risk factors including insufficient fruit and vegetable intake, overweight, increased serum cholesterol concentrations and elevated blood pressure. This paper describes the development of Working on Wellness (WOW), a worksite intervention program incorporating motivational interviewing by wellness specialists, targeting employees at risk. In addition, we describe the evaluation the effectiveness of the intervention among employees at increased risk for cardiovascular disease. Methods The intervention mapping (IM) protocol was used in the planning and design of WOW. Focus group discussions and interviews with employees and managers identified the importance of addressing risk factors for CVD at the worksite. Based on the employees’ preference for individual counselling, and previous evidence of the effectiveness of this approach in the worksite setting, we decided to use motivational interviewing as part of the intervention strategy. Thus, as a cluster-randomised, controlled control trial, employees at increased risk for CVD (N = 928) will be assigned to a control or an intervention group, based on company random allocation. The sessions will include motivational interviewing techniques, comprised of two face-to-face and four telephonic sessions, with the primary aim to increase habitual levels of PA. Measures will take place at baseline, 6 and 12 months. Secondary outcomes include changes in nutritional habits, serum cholesterol and glucose concentrations, blood pressure and BMI. In addition, healthcare expenditure and absenteeism will be measured for the economic evaluation. Analysis of variance will be performed to determine whether there were significant changes in physical activity habits in the intervention and control groups at 6 and 12 months. Discussion The formative work on which this intervention is based suggests that the strategy of targeting employees at increased risk for CVD is preferred. Importantly, this study extends the work of a previous, similar study, Health Under Construction, in a different setting. Finally, this study will allow an economic evaluation of the intervention that will be an important outcome for health care funders, who ultimately will be responsible for implementation of such an intervention. Trial registration United States Clinical Trails Register NCT 01494207 PMID:22625844

Working on wellness (WOW): a worksite health promotion intervention programme.

PubMed

Kolbe-Alexander, Tracy L; Proper, Karin I; Lambert, Estelle V; van Wier, Marieke F; Pillay, Julian D; Nossel, Craig; Adonis, Leegale; Van Mechelen, Willem

2012-05-24

Insufficient PA has been shown to cluster with other CVD risk factors including insufficient fruit and vegetable intake, overweight, increased serum cholesterol concentrations and elevated blood pressure. This paper describes the development of Working on Wellness (WOW), a worksite intervention program incorporating motivational interviewing by wellness specialists, targeting employees at risk. In addition, we describe the evaluation the effectiveness of the intervention among employees at increased risk for cardiovascular disease. The intervention mapping (IM) protocol was used in the planning and design of WOW. Focus group discussions and interviews with employees and managers identified the importance of addressing risk factors for CVD at the worksite. Based on the employees' preference for individual counselling, and previous evidence of the effectiveness of this approach in the worksite setting, we decided to use motivational interviewing as part of the intervention strategy. Thus, as a cluster-randomised, controlled control trial, employees at increased risk for CVD (N = 928) will be assigned to a control or an intervention group, based on company random allocation. The sessions will include motivational interviewing techniques, comprised of two face-to-face and four telephonic sessions, with the primary aim to increase habitual levels of PA. Measures will take place at baseline, 6 and 12 months. Secondary outcomes include changes in nutritional habits, serum cholesterol and glucose concentrations, blood pressure and BMI. In addition, healthcare expenditure and absenteeism will be measured for the economic evaluation. Analysis of variance will be performed to determine whether there were significant changes in physical activity habits in the intervention and control groups at 6 and 12 months. The formative work on which this intervention is based suggests that the strategy of targeting employees at increased risk for CVD is preferred. Importantly, this study extends the work of a previous, similar study, Health Under Construction, in a different setting. Finally, this study will allow an economic evaluation of the intervention that will be an important outcome for health care funders, who ultimately will be responsible for implementation of such an intervention. United States Clinical Trails Register NCT 01494207.

Mapping Malaria Risk in Low Transmission Settings: Challenges and Opportunities.

PubMed

Sturrock, Hugh J W; Bennett, Adam F; Midekisa, Alemayehu; Gosling, Roly D; Gething, Peter W; Greenhouse, Bryan

2016-08-01

As malaria transmission declines, it becomes increasingly focal and prone to outbreaks. Understanding and predicting patterns of transmission risk becomes an important component of an effective elimination campaign, allowing limited resources for control and elimination to be targeted cost-effectively. Malaria risk mapping in low transmission settings is associated with some unique challenges. This article reviews the main challenges and opportunities related to risk mapping in low transmission areas including recent advancements in risk mapping low transmission malaria, relevant metrics, and statistical approaches and risk mapping in post-elimination settings. Copyright © 2016. Published by Elsevier Ltd.

Factors associated with nutrition risk in older Māori: a cross sectional study.

PubMed

Wham, Carol; Maxted, Eruera; Teh, Ruth; Kerse, Ngaire

2015-08-21

To investigate factors associated with nutrition risk among older Māori. Māori aged 75-79 years living in the Northland and Bay of Plenty regions of New Zealand were assessed for nutrition risk using the validated screening tool 'Seniors in the Community: Risk Evaluation for Eating and Nutrition' (SCREENII). Demographic, physical and sociocultural data were collected. Of the 67 participants, two thirds (63%) were identified to be at high-risk for malnutrition. More than half (56%) used te reo Māori (Māori language) for everyday conversation and those who rated language and culture as moderately important to wellbeing were at lower nutrition risk. Controlling for age, gender and living arrangements, participants who rated traditional foods as important, were able to access them, had a higher waist-to-hip ratio and an absence of depressive symptoms, were at lower nutrition risk. Cultural factors associated with nutrition risk are related to an indigenous view of health. Participants with a higher waist-to-hip ratio were at lower nutrition risk and this may be a protective factor for older Māori. Interventions to improve the nutrition status of older Māori need to be based on a holistic Māori worldview and acknowledge the importance of traditional Māori foods.

Subtypes of Benign Breast Disease as a Risk Factor for Breast Cancer: A Systematic Review and Meta-Analysis Protocol

PubMed Central

Zendehdel, Manoosh; Niakan, Babak; Keshtkar, Abbasali; Rafiei, Elahe; Salamat, Fatemeh

2018-01-01

Breast cancer is a multifactorial disease. Benign breast disease (BBD) is one of the most important risk factors for breast cancer. The etiology of BBD is unknown. It is divided into nonproliferative and proliferative diseases. The selection of studies will be based on titles, abstract screening, inclusion and exclusion criteria, and quality assessment. Previous studies have shown that all types of BBD increase the risk of breast cancer, but the risk degree is different for each one. Accurate risk estimation of breast cancer in each category can be very important for proper clinical management. This systematic review and meta-analysis will be conducted on observational studies (traditional case control, nested case control, case cohort, and cohort) published in the Web of Science (ISI), PubMed (MEDLINE), Scopus, Google Scholar, and the key journals of this field such as Breast Cancer Research and Treatment and Cancer Research from January 2000 to June 2015. Reference lists and gray literature will be reviewed too. All the initial retrievals will be performed by 2 researchers independently. The data extraction form will consist of general information concerning the studies, study eligibility, method, risk of bias assessment, and results—including odds ratios, risk ratios, rate ratios, and hazard ratios. The PRISMA and MOOSE guidelines will be used to report our findings. Registration Details: PROSPERO-42016035243 PMID:29398746

Assessing the Health-Care Risk: The Clinical-VaR, a Key Indicator for Sound Management.

PubMed

Jiménez-Rodríguez, Enrique; Feria-Domínguez, José Manuel; Sebastián-Lacave, Alonso

2018-03-30

Clinical risk includes any undesirable situation or operational factor that may have negative consequences for patient safety or capable of causing an adverse event (AE). The AE, intentional or unintentionally, may be related to the human factor, that is, medical errors (MEs). Therefore, the importance of the health-care risk management is a current and relevant issue on the agenda of many public and private institutions. The objective of the management has been evolving from the identification of AE to the assessment of cost-effective and efficient measures that improve the quality control through monitoring. Consequently, the goal of this paper is to propose a Key Risk Indicator (KRI) that enhances the advancement of the health-care management system. Thus, the application of the Value at Risk (VaR) concept in combination to the Loss Distribution Approach (LDA) is proved to be a proactive tool, within the frame of balanced scorecard (BSC), in health organizations. For this purpose, the historical events recorded in the Algo-OpData ® database (Algorithmics Inc., Toronto, ON, Canada, IBM, Armonk, NY, USA) have been used. The analysis highlights the importance of risk in the financials outcomes of the sector. The results of paper show the usefulness of the Clinical-VaR to identify and monitor the risk and sustainability of the implemented controls.

Assessing the Health-Care Risk: The Clinical-VaR, a Key Indicator for Sound Management

PubMed Central

Jiménez-Rodríguez, Enrique; Sebastián-Lacave, Alonso

2018-01-01

Clinical risk includes any undesirable situation or operational factor that may have negative consequences for patient safety or capable of causing an adverse event (AE). The AE, intentional or unintentionally, may be related to the human factor, that is, medical errors (MEs). Therefore, the importance of the health-care risk management is a current and relevant issue on the agenda of many public and private institutions. The objective of the management has been evolving from the identification of AE to the assessment of cost-effective and efficient measures that improve the quality control through monitoring. Consequently, the goal of this paper is to propose a Key Risk Indicator (KRI) that enhances the advancement of the health-care management system. Thus, the application of the Value at Risk (VaR) concept in combination to the Loss Distribution Approach (LDA) is proved to be a proactive tool, within the frame of balanced scorecard (BSC), in health organizations. For this purpose, the historical events recorded in the Algo-OpData® database (Algorithmics Inc., Toronto, ON, Canada, IBM, Armonk, NY, USA) have been used. The analysis highlights the importance of risk in the financials outcomes of the sector. The results of paper show the usefulness of the Clinical-VaR to identify and monitor the risk and sustainability of the implemented controls. PMID:29601529

Subtypes of Benign Breast Disease as a Risk Factor for Breast Cancer: A Systematic Review and Meta-Analysis Protocol.

PubMed

Zendehdel, Manoosh; Niakan, Babak; Keshtkar, Abbasali; Rafiei, Elahe; Salamat, Fatemeh

2018-01-01

Breast cancer is a multifactorial disease. Benign breast disease (BBD) is one of the most important risk factors for breast cancer. The etiology of BBD is unknown. It is divided into nonproliferative and proliferative diseases. The selection of studies will be based on titles, abstract screening, inclusion and exclusion criteria, and quality assessment. Previous studies have shown that all types of BBD increase the risk of breast cancer, but the risk degree is different for each one. Accurate risk estimation of breast cancer in each category can be very important for proper clinical management. This systematic review and meta-analysis will be conducted on observational studies (traditional case control, nested case control, case cohort, and cohort) published in the Web of Science (ISI), PubMed (MEDLINE), Scopus, Google Scholar, and the key journals of this field such as Breast Cancer Research and Treatment and Cancer Research from January 2000 to June 2015. Reference lists and gray literature will be reviewed too. All the initial retrievals will be performed by 2 researchers independently. The data extraction form will consist of general information concerning the studies, study eligibility, method, risk of bias assessment, and results-including odds ratios, risk ratios, rate ratios, and hazard ratios. The PRISMA and MOOSE guidelines will be used to report our findings. Registration Details: PROSPERO-42016035243.

Menopause and myocardial infarction risk among employed women in relation to work and family psychosocial factors in Lithuania.

PubMed

Malinauskiene, Vilija; Tamosiunas, Abdonas

2010-05-01

To assess the relationship between menopause and age at menopause and the risk of the first non-fatal myocardial infarction taking into account the possible influence of psychosocial job characteristics, marital stress, level of social support, educational level, occupation, age and traditional ischemic heart disease risk factors. Population-based case-control study among 35-61 years old employed women in Kaunas, Lithuania. Totally 122 myocardial infarction cases and 371 controls were interviewed in 2001-2004. The logistic regression analysis was performed. Younger age at menopause (

Control of Risks Through the Use of Procedures: A Method for Evaluating the Change in Risk

NASA Technical Reports Server (NTRS)

Praino, Gregory T.; Sharit, Joseph

2010-01-01

This paper considers how procedures can be used to control risks faced by an organization and proposes a means of recognizing if a particular procedure reduces risk or contributes to the organization's exposure. The proposed method was developed out of the review of work documents and the governing procedures performed in the wake of the Columbia accident by NASA and the Space Shuttle prime contractor, United Space Alliance, LLC. A technique was needed to understand the rules, or procedural controls, in place at the time in the context of how important the role of each rule was. The proposed method assesses procedural risks, the residual risk associated with a hazard after a procedure's influence is accounted for, by considering each clause of a procedure as a unique procedural control that may be beneficial or harmful. For procedural risks with consequences severe enough to threaten the survival of the organization, the method measures the characteristics of each risk on a scale that is an alternative to the traditional consequence/likelihood couple. The dual benefits of the substitute scales are that they eliminate both the need to quantify a relationship between different consequence types and the need for the extensive history a probabilistic risk assessment would require. Control Value is used as an analog for the consequence, where the value of a rule is based on how well the control reduces the severity of the consequence when operating successfully. This value is composed of two parts: the inevitability of the consequence in the absence of the control, and the opportunity to intervene before the consequence is realized. High value controls will be ones where there is minimal need for intervention but maximum opportunity to actively prevent the outcome. Failure Likelihood is used as the substitute for the conventional likelihood of the outcome. For procedural controls, a failure is considered to be any non-malicious violation of the rule, whether intended or not. The model used for describing the Failure Likelihood considers how well a task was established by evaluating that task on five components. The components selected to define a well established task are: that it be defined, assigned to someone capable, that they be trained appropriately, that the actions be organized to enable proper completion and that some form of independent monitoring be performed. Validation of the method was based on the information provided by a group of experts in Space Shuttle ground processing when they were presented with 5 scenarios that identified a clause from a procedure. For each scenario, they recorded their perception of how important the associated rule was and how likely it was to fail. They then rated the components of Control Value and Failure Likelihood for all the scenarios. The order in which each reviewer ranked the scenarios Control Value and Failure Likelihood was compared to the order in which they ranked the scenarios for each of the associated components; inevitability and opportunity for Control Value and definition, assignment, training, organization and monitoring for Failure Likelihood. This order comparison showed how the components contributed to a relative relationship to the substitute risk element. With the relationship established for Space Shuttle ground processing, this method can be used to gauge if the introduction or removal of a particular rule will increase or decrease the .risk associated with the hazard it is intended to control.

Adherence to Tuberculosis Treatment among Migrant Pulmonary Tuberculosis Patients in Shandong, China: A Quantitative Survey Study

PubMed Central

Zhou, Chengchao; Chu, Jie; Liu, Jinan; Gai Tobe, Ruoyan; Gen, Hong; Wang, Xingzhou; Zheng, Wengui; Xu, Lingzhong

2012-01-01

Adherence to TB treatment is the most important requirement for efficient TB control. Migrant TB patients’ “migratory” nature affects the adherence negatively, which presents an important barrier for National TB Control Program in China. Therefore, TB control among migrants is of high importance.The aim of this study is to describe adherence to TB treatment among migrant TB patients and to identify factors associated with adherence. A total of 12 counties/districts of Shandong Province, China were selected as study sites. 314 confirmed smear positive TB patients were enrolled between August 2nd 2008 and October 17th 2008, 16% of whom were non-adherent to TB therapy. Risk factors for non-adherence were: the divorced or bereft of spouse, patients not receiving TB-related health education before chemotherapy, weak incentives for treatment adherence, and self supervision on treatment. Based on the risk factors identified, measures are recommended such as implementing health education for all migrant patients before chemotherapy and encouraging primary care workers to supervise patients. PMID:23284993

Reduced Risk of Importing Ebola Virus Disease because of Travel Restrictions in 2014: A Retrospective Epidemiological Modeling Study.

PubMed

Otsuki, Shiori; Nishiura, Hiroshi

An epidemic of Ebola virus disease (EVD) from 2013-16 posed a serious risk of global spread during its early growth phase. A post-epidemic evaluation of the effectiveness of travel restrictions has yet to be conducted. The present study aimed to estimate the effectiveness of travel restrictions in reducing the risk of importation from mid-August to September, 2014, using a simple hazard-based statistical model. The hazard rate was modeled as an inverse function of the effective distance, an excellent predictor of disease spread, which was calculated from the airline transportation network. By analyzing datasets of the date of EVD case importation from the 15th of July to the 15th of September 2014, and assuming that the network structure changed from the 8th of August 2014 because of travel restrictions, parameters that characterized the hazard rate were estimated. The absolute risk reduction and relative risk reductions due to travel restrictions were estimated to be less than 1% and about 20%, respectively, for all models tested. Effectiveness estimates among African countries were greater than those for other countries outside Africa. The travel restrictions were not effective enough to expect the prevention of global spread of Ebola virus disease. It is more efficient to control the spread of disease locally during an early phase of an epidemic than to attempt to control the epidemic at international borders. Capacity building for local containment and coordinated and expedited international cooperation are essential to reduce the risk of global transmission.

Reduced Risk of Importing Ebola Virus Disease because of Travel Restrictions in 2014: A Retrospective Epidemiological Modeling Study

PubMed Central

Otsuki, Shiori

2016-01-01

Background An epidemic of Ebola virus disease (EVD) from 2013–16 posed a serious risk of global spread during its early growth phase. A post-epidemic evaluation of the effectiveness of travel restrictions has yet to be conducted. The present study aimed to estimate the effectiveness of travel restrictions in reducing the risk of importation from mid-August to September, 2014, using a simple hazard-based statistical model. Methodology/Principal Findings The hazard rate was modeled as an inverse function of the effective distance, an excellent predictor of disease spread, which was calculated from the airline transportation network. By analyzing datasets of the date of EVD case importation from the 15th of July to the 15th of September 2014, and assuming that the network structure changed from the 8th of August 2014 because of travel restrictions, parameters that characterized the hazard rate were estimated. The absolute risk reduction and relative risk reductions due to travel restrictions were estimated to be less than 1% and about 20%, respectively, for all models tested. Effectiveness estimates among African countries were greater than those for other countries outside Africa. Conclusions The travel restrictions were not effective enough to expect the prevention of global spread of Ebola virus disease. It is more efficient to control the spread of disease locally during an early phase of an epidemic than to attempt to control the epidemic at international borders. Capacity building for local containment and coordinated and expedited international cooperation are essential to reduce the risk of global transmission. PMID:27657544

A practical discussion of risk management for manufacturing of pharmaceutical products.

PubMed

Mollah, A Hamid; Baseman, Harold S; Long, Mike; Rathore, Anurag S

2014-01-01

Quality risk management (QRM) is now a regulatory expectation, and it makes good business sense. The goal of the risk assessment is to increase process understanding and deliver safe and effective product to the patients. Risk analysis and management is an acceptable and effective way to minimize patient risk and determine the appropriate level of controls in manufacturing. While understanding the elements of QRM is important, knowing how to apply them in the manufacturing environment is essential for effective process performance and control. This article will preview application of QRM in pharmaceutical and biopharmaceutical manufacturing to illustrate how QRM can help the reader achieve that objective. There are several areas of risk that a drug company may encounter in pharmaceutical manufacturing, specifically addressing oral solid and liquid formulations. QRM tools can be used effectively to identify the risks and develop strategy to minimize or control them. Risks are associated throughout the biopharmaceutical manufacturing process-from raw material supply through manufacturing and filling operations to final distribution via a controlled cold chain process. Assessing relevant attributes and risks for biotechnology-derived products is more complicated and challenging for complex pharmaceuticals. This paper discusses key risk factors in biopharmaceutical manufacturing. Successful development and commercialization of pharmaceutical products is all about managing risks. If a company was to take zero risk, most likely the path to commercialization would not be commercially viable. On the other hand, if the risk taken was too much, the product is likely to have a suboptimal safety and efficacy profile and thus is unlikely to be a successful product. This article addresses the topic of quality risk management with the key objective of minimizing patient risk while creating an optimal process and product. Various tools are presented to aid implementation of these concepts. © PDA, Inc. 2014.

The role of the affect and availability heuristics in risk communication.

PubMed

Keller, Carmen; Siegrist, Michael; Gutscher, Heinz

2006-06-01

Results of past research suggest that affect plays an important role in risk perception. Because affect may also increase the availability of risks, affect and availability are closely related concepts. Three studies tested the hypothesis that evoking negative affect (fear), either through past experience or through experimental manipulation, results in greater perceived risk. The present research focused on perception of flooding risk. Study 1 and Study 2 showed that participants who received risk information concerning a longer time period (e.g., 30 years) perceived more danger compared with participants who received risk information for one year. Study 2 showed that the interpretation of risk information was influenced by participants' own experiences with flooding. In Study 3, affect was experimentally manipulated. After looking at photographs depicting houses in a flooded region, participants perceived greater risk compared with participants in a control group. Taken together, the results of these three studies suggest that affect is important for successful risk communication. Results of the present research are in line with the affect heuristic proposed by Slovic and colleagues.

Flood risk analysis for flood control and sediment transportation: a case study in the catchments of the Loess Plateau, China

NASA Astrophysics Data System (ADS)

Wang, Y.; Chang, J.; Guo, A.

2017-12-01

Traditional flood risk analysis focuses on the probability of flood events exceeding the design flood of downstream hydraulic structures while neglecting the influence of sedimentation in river channels on flood control systems. Given this focus, a univariate and copula-based bivariate hydrological risk framework focusing on flood control and sediment transport is proposed in the current work. Additionally, the conditional probabilities of occurrence of different flood events under various extreme precipitation scenarios are estimated by exploiting the copula model. Moreover, a Monte Carlo-based algorithm is used to evaluate the uncertainties of univariate and bivariate hydrological risk. Two catchments located on the Loess plateau are selected as study regions: the upper catchments of the Xianyang and Huaxian stations (denoted as UCX and UCH, respectively). The results indicate that (1) 2-day and 3-day consecutive rainfall are highly correlated with the annual maximum flood discharge (AMF) in UCX and UCH, respectively; and (2) univariate and bivariate return periods, risk and reliability for the purposes of flood control and sediment transport are successfully estimated. Sedimentation triggers higher risks of damaging the safety of local flood control systems compared with the AMF, exceeding the design flood of downstream hydraulic structures in the UCX and UCH. Most importantly, there was considerable sampling uncertainty in the univariate and bivariate hydrologic risk analysis, which would greatly challenge measures of future flood mitigation. The proposed hydrological risk framework offers a promising technical reference for flood risk analysis in sandy regions worldwide.

Eating among Teens: Do Family Mealtimes Make a Difference for Adolescents' Nutrition?

ERIC Educational Resources Information Center

Neumark-Sztainer, Dianne

2006-01-01

Adolescents are at risk for poor dietary intake and unhealthy weight control behaviors. Family meals appear to play an important role in helping adolescents make healthier food choices and avoid engaging in unhealthy weight control and binge eating behaviors. (Contains 2 figures.)

Parental perceptions of neighborhood processes, stress, personal control, and risk for physical child abuse and neglect.

PubMed

Guterman, Neil B; Lee, Shawna J; Taylor, Catherine A; Rathouz, Paul J

2009-12-01

This study set out to examine whether mothers' individual perceptions of their neighborhood social processes predict their risk for physical child abuse and neglect directly and/or indirectly via pathways involving parents' reported stress and sense of personal control in the parenting role. In-home and phone interview data were examined cross-sectionally from a national birth cohort sample of 3,356 mothers across 20 US cities when the index child was 3 years of age. Mothers' perceptions of neighborhood social processes, parenting stress, and personal control were examined as predictors, and three subscales of the Parent-To-Child Conflict Tactics Scale (CTS-PC) were employed as proxies of physical child abuse and neglect risk. Structural equation modeling (SEM) was employed to test direct and indirect pathways (via parenting stress and control) from perceived neighborhood processes to proxy measures of physical child abuse and neglect. Multiple group SEM was conducted to test for differences across major ethnic groups: African American, Hispanic, and White. Although perceived negative neighborhood processes had only a mild direct role in predicting risk for physical child abuse, and no direct role on child neglect, these perceptions had a discernable indirect role in predicting risk via parenting stress and personal control pathways. Parenting stress exerted the clearest direct role on both physical abuse and neglect risk. This predictor model did not significantly differ across ethnic groups. Although neighborhood conditions may not play a clear directly observable role on physical child abuse and neglect risk, the indirect role they play underscores the importance of parents' perceptions of their neighborhoods, and especially the role they play via parents' reported stress and personal control. Such findings suggest that targeting parents' sense of control and stress in relation to their immediate social environment holds particular potential to reduce physical child abuse and neglect risk. Addressing parents' perceptions of their neighborhood challenges may serve to reduce parenting risk via improving parents' felt control and stress.

Contemporary Management and Control of Uncomplicated Hypertension in Canada: Insight From the Primary Care Audit of Global Risk Management (PARADIGM) Study.

PubMed

Gupta, Milan; Szmitko, Paul; Singh, Narendra; Tsigoulis, Michelle; Kajil, Mahesh; Stone, James

2015-05-01

Although clinical practice guidelines for the management of hypertension exist in Canada, the rate of contemporary blood pressure (BP) control remains unclear. In the Primary Care Audit of Global Risk Management (PARADIGM) study, 3015 healthy, middle-aged Canadians, free of cardiovascular disease (CVD) or diabetes were evaluated. In this analysis, we characterized the CVD risk factors, treatment patterns, and BP control rates in subjects with uncomplicated hypertension. A total of 917 subjects (30.4%) had a diagnosis of hypertension. The median age was 59 ± 8 years. The mean treated systolic/diastolic BP were 134 ± 14 mm Hg/82 ± 9 mm Hg, respectively. CVD risk factors included past/current smoking (35.9%), abdominal obesity (62.5%), and dyslipidemia (59.4%). Using the Framingham Risk Score, 20.4%, 41.0%, and 38.5% of the subjects were at low, intermediate, and high risk, respectively. Of the 88% with treated hypertension, 46.9%, 38.7%, and 14.3% received 1, 2, or ≥3 drugs, respectively. The rate of BP control was 57.4% (systolic BP < 140 and diastolic BP < 90 mm Hg). The rate of BP control was lower in patients prescribed diuretic monotherapy (53.2%) vs those who received angiotensin converting enzyme inhibitor/angiotensin receptor blocker monotherapy (66.5%; P < 0.01). Importantly, BP control deteriorated with increasing Framingham Risk Score, and was lower in patients with metabolic syndrome vs those without (P < 0.00001 for both). PARADIGM demonstrated that CVD risk factors are prevalent in Canadians with uncomplicated hypertension. BP control was modest (57.4%) and was lowest in patients prescribed diuretic monotherapy and in those at highest CVD risk. Despite the success of national hypertension strategies, enhanced efforts are warranted to improve BP control in Canada. Copyright © 2015 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

Toxoplasma gondii infection and food consumption: A systematic review and meta-analysis of case-controlled studies.

PubMed

Belluco, Simone; Simonato, Giulia; Mancin, Marzia; Pietrobelli, Mario; Ricci, Antonia

2017-10-11

Toxoplasmosis is a zoonotic disease causing severe symptoms in pregnant women and immunocompromised individuals. On average, worldwide, around 30% of people are seropositive. The oral transmission route is of great significance and food, particularly meat, is an important transmission vehicle for T. gondii. However, the role of different food matrices is debated. The aim of this review was to assess the risk of humans developing acute T. gondii infection via the foodborne route. Case-control studies including acute cases of T. gondii infection were included after literature searches, without time limits, in several databases. All studies estimating the risk of acquiring T. gondii infection after consumption of specific food categories were included. Three risk factors proved to be significantly associated with acute T. gondii infection in humans: consumption of raw/undercooked meat, Odds Ratio (OR) 3.44 (1.29-9.16), consumption of raw/undercooked beef, OR 2.22 (1.57-3.12), and consumption of raw/undercooked sheep meat, OR 3.85 (1.85-8.00). Consumption of raw/undercooked pork, raw eggs, and unpasteurized milk proved to be non-significant risk factors. Limitations in the present review and meta-analysis are due to the low number of case-control studies available for analysis and the lack of a search strategy targeting gray literature. Consumption of raw/undercooked beef and sheep meat are important risk factors for T. gondii infection. Their consumption should be avoided in order to prevent toxoplasmosis, particularly by those in at-risk categories, including pregnant women. The review protocol is registered in PROSPERO database (CRD42016043295).

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

PubMed

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

2017-12-06

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

Mapping and Modelling Malaria Risk Areas Using Climate, Socio-Demographic and Clinical Variables in Chimoio, Mozambique.

PubMed

Ferrao, Joao L; Niquisse, Sergio; Mendes, Jorge M; Painho, Marco

2018-04-19

Background : Malaria continues to be a major public health concern in Africa. Approximately 3.2 billion people worldwide are still at risk of contracting malaria, and 80% of deaths caused by malaria are concentrated in only 15 countries, most of which are in Africa. These high-burden countries have achieved a lower than average reduction of malaria incidence and mortality, and Mozambique is among these countries. Malaria eradication is therefore one of Mozambique’s main priorities. Few studies on malaria have been carried out in Chimoio, and there is no malaria map risk of the area. This map is important to identify areas at risk for application of Public Precision Health approaches. By using GIS-based spatial modelling techniques, the research goal of this article was to map and model malaria risk areas using climate, socio-demographic and clinical variables in Chimoio, Mozambique. Methods : A 30 m × 30 m Landsat image, ArcGIS 10.2 and BioclimData were used. A conceptual model for spatial problems was used to create the final risk map. The risks factors used were: the mean temperature, precipitation, altitude, slope, distance to water bodies, distance to roads, NDVI, land use and land cover, malaria prevalence and population density. Layers were created in a raster dataset. For class value comparisons between layers, numeric values were assigned to classes within each map layer, giving them the same importance. The input dataset were ranked, with different weights according to their suitability. The reclassified outputs of the data were combined. Results : Chimoio presented 96% moderate risk and 4% high-risk areas. The map showed that the central and south-west “Residential areas”, namely, Centro Hipico, Trangapsso, Bairro 5 and 1° de Maio, had a high risk of malaria, while the rest of the residential areas had a moderate risk. Conclusions : The entire Chimoio population is at risk of contracting malaria, and the precise estimation of malaria risk, therefore, has important precision public health implications and for the planning of effective control measures, such as the proper time and place to spray to combat vectors, distribution of bed nets and other control measures.

[Suicide in the elderly – risk factors and prevention].

PubMed

Linnemann, Christoph; Leyhe, Thomas

2015-10-01

Suicide rates are highest among the elderly in Switzerland. The estimated number of unreported cases is particularly high in this age group. The risk factors are multidimensional, including depression and social isolation. The detection and management of the controllable risk factors, foremost depression, is of particular importance for suicide prevention. Old age depression often shows an atypical presentation, is misinterpreted as a normal process of aging and is not adequately treated.

The low-carbohydrate diet and cardiovascular risk factors: Evidence from epidemiologic studies

PubMed Central

Hu, T.; Bazzano, L. A.

2015-01-01

Aims Obesity is an important public health issue because of its high prevalence and concomitant increase in risk of cardiovascular diseases. Low carbohydrate diets are popular for weight loss and weight management but are not recommended in leading guidelines due to the perception that increases in dietary fat intake may lead to an adverse cardiovascular risk profile. To clarify the effects of a low-carbohydrate diet for weight loss on cardiovascular disease risk factors as compared to a low fat diet for weight loss, we systematically reviewed data from randomized controlled clinical trials and large observational studies. Data synthesis We searched the MEDLINE database (Jan 1966–Nov 2013) to identify studies that examined a low-carbohydrate diet as compared to a low-fat diet for weight loss or the improvement of cardiovascular disease risk factors. Conclusions Recent randomized controlled trials document that low-carbohydrate diets not only decrease body weight but also improve cardiovascular risk factors. In light of this evidence from randomized controlled trials, dietary guidelines should be re-visited advocating a healthy low carbohydrate dietary pattern as an alternative dietary strategy for the prevention of obesity and cardiovascular disease risk factors. PMID:24613757

Social network analysis of Equidae movements and its application to risk-based surveillance and to control of spread of potential Equidae diseases.

PubMed

Sánchez-Matamoros, A; Martínez-López, B; Sánchez-Vizcaíno, F; Sánchez-Vizcaíno, J M

2013-10-01

Movements of animals and animal products are one of the most important ways of disease introduction and spread between regions and countries. Maybe one of the most complex animal species in terms of diversity of uses, nature and extent of movements are equidae, for which animal movement records are usually not available. The study presented here is the first characterization of a complete and reliable network of equidae movements in Castile and Leon, which is one of the most important equidae production regions of Spain. Social network analysis and space-time cluster analysis were used to describe the contact patterns of the equidae network and to identify the most important premises, areas and time periods for potential disease introduction or spread into the region. The studied network was complex, with very heterogeneous types of premises and diverse nature and extent of the movements compared with other livestock species, which have important implications for prevention and control of equidae diseases. Centrality measures revealed that production and reproduction farms and centres of livestock competition were the most important type of premises in the studied network. Cluster analyses allowed to identify seventeen significant spatio-temporal clusters of premises at high risk of dispatching or receiving equidae, which formed four interconnected compartments. These clusters were mainly located in the north-west region and in the second part of the year. The results of this study may be useful to design risk-based surveillance and control programmes of equidae diseases and increase the speed of detection and control of potential secondary outbreaks in future epidemics. Consequently, these results will help to minimize the great economic and sanitary impact of equidae diseases. The analytical approach used here may be easily extended to characterize the equidae movement patterns in other countries and regions of the world. © 2012 Blackwell Verlag GmbH.

Global trade in ornamental fish from an Australian perspective: the case for revised import risk analysis and management strategies.

PubMed

Whittington, R J; Chong, R

2007-09-14

Over 1 billion ornamental fish comprising more than 4000 freshwater and 1400 marine species are traded internationally each year, with 8-10 million imported into Australia alone. Compared to other commodities, the pathogens and disease translocation risks associated with this pattern of trade have been poorly documented. The aim of this study was to conduct an appraisal of the effectiveness of risk analysis and quarantine controls as they are applied according to the Sanitary and Phytosanitary (SPS) agreement in Australia. Ornamental fish originate from about 100 countries and hazards are mostly unknown; since 2000 there have been 16-fold fewer scientific publications on ornamental fish disease compared to farmed fish disease, and 470 fewer compared to disease in terrestrial species (cattle). The import quarantine policies of a range of countries were reviewed and classified as stringent or non-stringent based on the levels of pre-border and border controls. Australia has a stringent policy which includes pre-border health certification and a mandatory quarantine period at border of 1-3 weeks in registered quarantine premises supervised by government quarantine staff. Despite these measures there have been many disease incursions as well as establishment of significant exotic viral, bacterial, fungal, protozoal and metazoan pathogens from ornamental fish in farmed native Australian fish and free-living introduced species. Recent examples include Megalocytivirus and Aeromonas salmonicida atypical strain. In 2006, there were 22 species of alien ornamental fish with established breeding populations in waterways in Australia and freshwater plants and molluscs have also been introduced, proving a direct transmission pathway for establishment of pathogens in native fish species. Australia's stringent quarantine policies for imported ornamental fish are based on import risk analysis under the SPS agreement but have not provided an acceptable level of protection (ALOP) consistent with government objectives to prevent introduction of pests and diseases, promote development of future aquaculture industries or maintain biodiversity. It is concluded that the risk analysis process described by the Office International des Epizooties under the SPS agreement cannot be used in a meaningful way for current patterns of ornamental fish trade. Transboundary disease incursions will continue and exotic pathogens will become established in new regions as a result of the ornamental fish trade, and this will be an international phenomenon. Ornamental fish represent a special case in live animal trade where OIE guidelines for risk analysis need to be revised. Alternatively, for countries such as Australia with implied very high ALOP, the number of species traded and the number of sources permitted need to be dramatically reduced to facilitate hazard identification, risk assessment and import quarantine controls.

76 FR 31171 - Importation of Plants for Planting; Establishing a Category of Plants for Planting Not Authorized...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-27

...We are amending the regulations to establish a new category of regulated articles in the regulations governing the importation of nursery stock, also known as plants for planting. This category will list taxa of plants for planting whose importation is not authorized pending pest risk analysis. If scientific evidence indicates that a taxon of plants for planting is a quarantine pest or a host of a quarantine pest, we will publish a notice that will announce our determination that the taxon is a quarantine pest or a host of a quarantine pest, cite the scientific evidence we considered in making this determination, and give the public an opportunity to comment on our determination. If we receive no comments that change our determination, the taxon will subsequently be added to the new category. We will allow any person to petition for a pest risk analysis to be conducted to consider whether to remove a taxon that has been added to the new category. After the pest risk analysis is completed, we will remove the taxon from the category and allow its importation subject to general requirements, allow its importation subject to specific restrictions, or prohibit its importation. We will consider applications for permits to import small quantities of germplasm from taxa whose importation is not authorized pending pest risk analysis, for experimental or scientific purposes under controlled conditions. This new category will allow us to take prompt action on evidence that the importation of a taxon of plants for planting poses a risk while continuing to allow for public participation in the process.

Health insurance status and control of diabetes and coronary artery disease risk factors on enrollment into the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial.

PubMed

Grogan, Mary; Jenkins, Margaret; Sansing, Veronica V; MacGregor, Joan; Brooks, Maria Mori; Julien-Williams, Patricia; Amendola, Angela; Abbott, J Dawn

2010-01-01

The purpose of this study was to examine measures of chronic disease severity and treatment according to insurance status in a clinical trial setting. Baseline insurance status of 776 patients with type 2 diabetes and stable coronary artery disease (CAD) enrolled in the United States in the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial was analyzed with regard to measures of metabolic and cardiovascular risk factor control. Compared with patients with private or public insurance, the uninsured were younger, more often female, and less often white non-Hispanic. Uninsured patients had the greatest burden of CAD. Patients with public insurance were treated with the greatest number of medications, had the greatest self-reported functional status, and the lowest mean glycosylated hemoglobin and low-density lipoprotein (LDL) cholesterol values. Overall, for 5 measured risk factor targets, the mean number above goal was 2.49 ± 1.18. After adjustment for demographic and clinical variables, insurance status was not associated with a difference in risk factor control. In the BARI 2D trial, we did not observe a difference in baseline cardiovascular risk factor control according to insurance status. An important observation, however, was that risk factor control overall was suboptimal, which highlights the difficulty in treating type 2 diabetes and CAD irrespective of insurance status.

The Role of Preschool Teacher-Child Interactions in Academic Adjustment: An Intervention Study with Playing-2-Gether

ERIC Educational Resources Information Center

Van Craeyevelt, Sanne; Verschueren, Karine; Vancraeyveldt, Caroline; Wouters, Sofie; Colpin, Hilde

2017-01-01

Background: Social relationships can serve as important risk or protective factors for child development in general, and academic adjustment in particular. Aims: This study investigated the role of teacher-child interactions in academic adjustment among preschool boys at risk of externalizing behaviour, using a randomized controlled trial study…

Automatic Processes in Self-Regulation: Implications for Alcohol Interventions

ERIC Educational Resources Information Center

Palfai, Tibor

2004-01-01

A number of learning-based interventions for problem drinking have emphasized the importance of behavioral self-control skills to help manage responses to high-risk cues. Self-management interventions typically have been based on the premise that effective self-regulation involves the use of conscious, controlled strategies to override habitual…

Sodium intake, salt taste and gastric cancer risk according to Helicobacter pylori infection, smoking, histological type and tumor site in China.

PubMed

Zhong, Chen; Li, Kai-Nan; Bi, Jing-Wang; Wang, Bao-Cheng

2012-01-01

The risk factors mostly strongly associated with gastric cancer are gastric bacteria Helicobacter pylori and diet. Using a case-control study among residents in Jinan, we examined the association between the salt taste and gastric cancer according to H. pylori infection, smoking and histological type as well as tumor site. This population-based case-control study included 207 cases and 410 controls. Data on potential risk factors of gastric cancer were obtained by interview of cases and controls with a questionnaire, salt taste preference was measured for all subjects, and IgG antibodies to H. pylori were applied to assess infection. Risk measures were determined using unconditional logistic regression. The proportions of salt taste at intervals of 1.8-7.2 g/L and ≥ 7.2 g/L were significantly higher in cases than controls, with ORs of 1.56 (1.23-3.64) and 2.03 (2.12- 4.11), respectively, subjects with high salt intake having an elevated risk for gastric cancer when infected with H. pylori. Significant modification by smoking and tumor site was observed across the different measures of salt intake, the highest salt taste showed higher cancer risk in ever smokers or with non-cardia cancers. Our study supports the view that high intake of sodium is an important dietary risk factor for gastric cancer, with a synergistic effect found between salt and H.pylori and smoking, dependent on the tumor site.

Behavioral Inhibition and Developmental Risk: A Dual-Processing Perspective

PubMed Central

Henderson, Heather A; Pine, Daniel S; Fox, Nathan A

2015-01-01

Behavioral inhibition (BI) is an early-appearing temperament characterized by strong reactions to novelty. BI shows a good deal of stability over childhood and significantly increases the risk for later diagnosis of social anxiety disorder (SAD). Despite these general patterns, many children with high BI do not go on to develop clinical, or even subclinical, anxiety problems. Therefore, understanding the cognitive and neural bases of individual differences in developmental risk and resilience is of great importance. The present review is focused on the relation of BI to two types of information processing: automatic (novelty detection, attention biases to threat, and incentive processing) and controlled (attention shifting and inhibitory control). We propose three hypothetical models (Top-Down Model of Control; Risk Potentiation Model of Control; and Overgeneralized Control Model) linking these processes to variability in developmental outcomes for BI children. We argue that early BI is associated with an early bias to quickly and preferentially process information associated with motivationally salient cues. When this bias is strong and stable across development, the risk for SAD is increased. Later in development, children with a history of BI tend to display normative levels of performance on controlled attention tasks, but they demonstrate exaggerated neural responses in order to do so, which may further potentiate risk for anxiety-related problems. We conclude by discussing the reviewed studies with reference to the hypothetical models and make suggestions regarding future research and implications for treatment. PMID:25065499

[Crisis management in pediatric anesthesia].

PubMed

Takeuchi, Mamoru; Otsuka, Yoji; Taga, Naoyuki; Sato, Yuki; Iwai, Hidetaka; Okada, Osamu

2009-05-01

We describe the risk management of pediatric anesthesia. The most important risk management of pediatric anesthesia is airway and temperature management. Neonates and infants easily become hypoxic due to their insufficient functional residual capacity. Therefore airway management is most important not only during induction of anesthesia but also during maintenance of anesthesia and extubation. The management of patients' temperature, including control of room temperature should be taken into consideration. In addition, careful attention should be paid not to introduce air bubbles in any lines, especially in patients with congenital heart diseases.

Inhibitory Motor Control at Five Years as a Function of Prenatal Cocaine Exposure

PubMed Central

BENDERSKY, MARGARET; GAMBINI, GIORGIA; LASTELLA, ANNA; BENNETT, DAVID S.; LEWIS, MICHAEL

2006-01-01

This study examined children’s (n = 140, age 5 years) ability to inhibit a motor response as a function of prenatal cocaine exposure. We hypothesized that cocaine-exposed children would perform worse than unexposed children on the Contrary Tapping task. Results indicated that cocaine exposure, high environmental risk, male gender, and low child IQ each were related to poorer inhibitory control. An interaction indicated that cocaine effects were specific to children who lived in relatively low-risk environments. Cocaine-exposed children made an error sooner than unexposed children if they lived in low-risk environments but not if they lived in high-risk environments. Potential underlying mechanisms and the importance of examining cocaine exposure effects in the context of children’s existing environment are discussed. PMID:14578695

Personal Control and Service Connection as Paths to Improved Mental Health and Exiting Homelessness among Severely Marginalized Homeless Youth.

PubMed

Slesnick, Natasha; Zhang, Jing; Brakenhoff, Brittany

2017-02-01

Non-service connected, continuously homeless youth are arguably one of the most vulnerable populations in the U.S. These youth reside at society's margins experiencing an accumulation of risks over time. Research concludes that as vulnerabilities increase so do poor long-term outcomes. This study tested the mediating effects of service connection and personal control as mediators of cumulative risk and housing, health and mental health outcomes. By understanding the processes associated with therapeutic change among those with the most vulnerabilities, service providers and researchers can target those factors to enhance positive outcomes. Seventy-nine, non-service connected, substance using homeless youth were offered a strengths-based outreach and engagement intervention and were assessed at baseline 3, 6 and 9 months post-baseline. Personal control mediated the effects of cumulative risk on housing stability, and service utilization mediated the effects of cumulative risk on mental health. This study specifies important targets of intervention for a population at high risk for continuing homelessness. In particular, service providers should target youths' sense of personal control and link them to needed community-based services in order to help them exit street life and improve mental health outcomes.

Forefoot Adduction Is a Risk Factor for Jones Fracture.

PubMed

Fleischer, Adam E; Stack, Rebecca; Klein, Erin E; Baker, Jeffrey R; Weil, Lowell; Weil, Lowell Scott

Jones fractures are among the most common fractures of the foot; however, much remains unknown about their etiology. The purpose of the present study was to further examine the risk factors of forefoot and hindfoot alignment on Jones fractures using an epidemiologic study design. We used a retrospective, matched, case-control study design. Cases consisted of patients with acute, isolated Jones fractures confirmed on plain film radiographs seen at our institute from January 2009 to December 2013. Patients presenting with pain unrelated to metatarsal fractures served as controls. Controls were matched to cases by age (±2 years), gender, and year of presentation. Weightbearing foot radiographs were assessed for 13 angular relationships by a single rater. Conditional multivariable logistic regression was used to identify important risk factors. Fifty patients with acute Jones fractures and 200 controls were included. The only significant variables in the final multivariable model were the metatarsus adductus angle (odds ratio [OR] 1.16, 95% confidence interval [CI] 1.08 to 1.25) and fourth/fifth intermetatarsal angle (OR 0.69, 95% CI 0.57 to 0.83)-both measures of static forefoot adduction. The presence of metatarsus adductus (defined as >15°) on foot radiographs was associated with a 2.4 times greater risk of a Jones fracture (adjusted OR 2.4, 95% CI 1.2 to 4.8). We have concluded that the risk of Jones fracture increases with an adducted forefoot posture. In our population, which consisted primarily of patients presenting after a fall (10 of 50; 20%) or misstep/inversion injury (19 of 50; 38%), the hindfoot alignment appeared to be a less important factor. Copyright © 2017 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Risk factors for squamous cell carcinoma of the penis--population-based case-control study in Denmark.

PubMed

Madsen, Birgitte Schütt; van den Brule, Adriaan J C; Jensen, Helle Lone; Wohlfahrt, Jan; Frisch, Morten

2008-10-01

Few etiologic studies of squamous cell carcinoma (SCC) of the penis have been carried out in populations where childhood circumcision is rare. A total of 71 patients with invasive (n=53) or in situ (n=18) penile SCC, 86 prostate cancer controls, and 103 population controls were interviewed in a population-based case-control study in Denmark. For 37 penile SCC patients, tissue samples were PCR examined for human papillomavirus (HPV) DNA. Overall, 65% of PCR-examined penile SCCs were high-risk HPV-positive, most of which (22 of 24; 92%) were due to HPV16. Penile SCC risk was positively associated with measures of early and high sexual activity, including lifetime number of female sex partners, number of female sex partners before age 20, age at first intercourse, penile-oral sex, a history of anogenital warts, and never having used condoms. Histories of phimosis and priapism at least 5 years before diagnosis were also significant risk factors, whereas alcohol abstinence was associated with reduced risk. Our study confirms sexually transmitted HPV16 infection and phimosis as major risk factors for penile SCC and suggests that penile-oral sex may be an important means of viral transmission. The association with priapism was unexpected and needs replication.

A community-based, case-control study of childhood stroke risk associated with congenital heart disease

PubMed Central

Fox, Christine K.; Sidney, Stephen; Fullerton, Heather J.

2014-01-01

Background and Purpose A better understanding of the stroke risk factors in children with congenital heart disease (CHD) could inform stroke prevention strategies. We analyzed pediatric stroke associated with CHD in a large community-based, case-control study. Methods From 2.5 million children (< 20 years) enrolled in a Northern California integrated healthcare plan, we identified ischemic and hemorrhagic strokes and randomly selected age and facility-matched stroke-free controls (3 per case). We determined exposure to CHD (diagnosed prior to stroke) and used conditional logistic regression to analyze stroke risk. Results CHD was identified in 15/412 cases (4%) versus 7/1,236 controls (0.6%). Children (28 days – 20 years) with CHD had 19-fold (Odds Ratio [OR] 19; 95% Confidence Interval [CI] 4.2, 83) increased stroke risk compared to controls. History of CHD surgery was associated with >30-fold increased risk of stroke (OR 31; CI 4, 241 compared to controls). After excluding peri-operative strokes, a history of CHD surgery still increased childhood stroke risk (OR 13; CI 1.5, 114). The majority of children with stroke and CHD were outpatient at the time of stroke, and almost half the cases who underwent cardiac surgery had their stroke >5 years after the most recent procedure. An estimated 7% of ischemic and 2% of hemorrhagic childhood strokes in the population were attributable to CHD. Conclusions CHD is an important childhood stroke risk factor. Children who undergo CHD surgery remain at elevated risk outside of the peri-operative period, and would benefit from optimized long-term stroke prevention strategies. PMID:25516197

The interleukin-6-572G/C gene polymorphism and the risk of intracranial aneurysms in a Chinese population.

PubMed

Liu, Yi; Sun, Jidong; Wu, Cong; Cao, Xudong; He, Min; You, Chao

2012-07-01

Interleukin-6 (IL-6) is an important proinflammatory cytokine that plays an important role in the pathogenesis of intracranial aneurysms (IAs). The aim of this study was to investigate the association between the IL-6-572G/C polymorphism and the risk of IAs in a Chinese population. The IL-6-572G/C gene polymorphisms in 220 IA cases and 220 controls were analyzed using the polymerase chain reaction-restriction fragment length polymorphism method. The IL-6-572GG (odds ratio [OR]=3.35, 95% confidence intervals [CIs]=1.65, 6.82; p=0.001) and G allele frequencies (OR=1.48, 95% CIs=1.09, 2.00; p=0.01) in the IA group were higher than those in the control group. The C allele frequencies (OR=0.68, 95% CIs=0.50, 0.92; p=0.01) were significantly lower in patients than in controls. When stratified by the site, shape, size, and the Fisher Grade of IAs, no statistically significant result was observed. This study suggested that the IL-6-572GG genotype was associated with a higher risk of IA in a Chinese population.

Upper gastrointestinal bleeding in severely burned patients: a case-control study to assess risk factors, causes, and outcome.

PubMed

Kim, Young Jin; Koh, Dong Hee; Park, Se Woo; Park, Sun Man; Choi, Min Ho; Jang, Hyun Joo; Kae, Sea Hyub; Lee, Jin; Byun, Hyun Woo

2014-01-01

To determine the risk factors, causes, and outcome of clinically important upper gastrointestinal bleeding that occurs in severely burned patients. The charts of all patients admitted to the burn intensive care unit were analyzed retrospectively over a 4-year period (from January 2006 to December 2009). Cases consisted of burned patients who developed upper gastrointestinal bleeding more than 24 hours after admission to the burn intensive care unit. Controls were a set of patients, in the burn intensive care unit, without upper gastrointestinal bleeding matched with cases for age and gender. Cases and controls were compared with respect to the risk factors of upper gastrointestinal bleeding and outcomes. During the study period, clinically important upper gastrointestinal bleeding occurred in 20 patients out of all 964 patients. The most common cause of upper gastrointestinal bleeding was duodenal ulcer (11 of 20 cases, 55%). In the multivariate analysis, mechanical ventilation (p = 0.044) and coagulopathy (p = 0.035) were found to be the independent predictors of upper gastrointestinal bleeding in severely burned patients. Upper gastrointestinal hemorrhage tends to occur more frequently after having prolonged mechanical ventilation and coagulopathy.

Expert ratings of job demand and job control as predictors of injury and musculoskeletal disorder risk in a manufacturing cohort.

PubMed

Cantley, Linda F; Tessier-Sherman, Baylah; Slade, Martin D; Galusha, Deron; Cullen, Mark R

2016-04-01

To examine associations between workplace injury and musculoskeletal disorder (MSD) risk and expert ratings of job-level psychosocial demand and job control, adjusting for job-level physical demand. Among a cohort of 9260 aluminium manufacturing workers in jobs for which expert ratings of job-level physical and psychological demand and control were obtained during the 2 years following rating obtainment, multivariate mixed effects models were used to estimate relative risk (RR) of minor injury and minor MSD, serious injury and MSD, minor MSD only and serious MSD only by tertile of demand and control, adjusting for physical demand as well as other recognised risk factors. Compared with workers in jobs rated as having low psychological demand, workers in jobs with high psychological demand had 49% greater risk of serious injury and serious MSD requiring medical treatment, work restrictions or lost work time (RR=1.49; 95% CI 1.10 to 2.01). Workers in jobs rated as having low control displayed increased risk for minor injury and minor MSD (RR=1.45; 95% CI 1.12 to 1.87) compared with those in jobs rated as having high control. Using expert ratings of job-level exposures, this study provides evidence that psychological job demand and job control contribute independently to injury and MSD risk in a blue-collar manufacturing cohort, and emphasises the importance of monitoring psychosocial workplace exposures in addition to physical workplace exposures to promote worker health and safety. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Diabetes, bone and glucose-lowering agents: clinical outcomes.

PubMed

Schwartz, Ann V

2017-07-01

Older adults with diabetes are at higher risk of fracture and of complications resulting from a fracture. Hence, fracture risk reduction is an important goal in diabetes management. This review is one of a pair discussing the relationship between diabetes, bone and glucose-lowering agents; an accompanying review is provided in this issue of Diabetologia by Beata Lecka-Czernik (DOI 10.1007/s00125-017-4269-4 ). Specifically, this review discusses the challenges of accurate fracture risk assessment in diabetes. Standard tools for risk assessment can be used to predict fracture but clinicians need to be aware of the tendency for the bone mineral density T-score and the fracture risk assessment tool (FRAX) to underestimate risk in those with diabetes. Diabetes duration, complications and poor glycaemic control are useful clinical markers of increased fracture risk. Glucose-lowering agents may also affect fracture risk, independent of their effects on glycaemic control, as seen with the negative skeletal effects of the thiazolidinediones; in this review, the potential effects of glucose-lowering medications on fracture risk are discussed. Finally, the current understanding of effective fracture prevention in older adults with diabetes is reviewed.

Health issues in the Arab American community. Male infertility in Lebanon: a case-controlled study.

PubMed

Kobeissi, Loulou; Inhorn, Marcia C

2007-01-01

The impact of risk factors, such as consanguinity and familial clustering, reproductive infections, traumas, and diseases, lifestyle factors and occupational and war exposures on male infertility, was investigated in a case-controlled study conducted in Lebanon. One-hundred-twenty males and 100 controls of Lebanese, Syrian or Lebanese-Palestinian descents were selected from two in-vitro fertilization (IVF) clinics located in Beirut, Lebanon. All cases suffered from impaired sperm count and function, according to World Health Organization guidelines for semen analysis. Controls were the fertile husbands of infertile women. Data were collected using a semi-structured interview, laboratory blood testing and the results of the most recent semen analysis. Univariate, bivariate and multivariate logistic regression analyses were used for data analysis, along with checks for effect modification and control of confounders. Consanguinity and the familial clustering of male infertility cases, as well as reproductive illnesses and war exposures were independently significant risk factors for male infertility. The odds of having infertility problems in the immediate family were 2.6 times higher in cases than controls. The odds of reproductive illness were 2 times higher in cases than controls. The odds of war exposures were 1.57 times higher in cases than controls. Occupational exposures, such as smoking and caffeine intake, were not shown to be important risk factors. This case-controlled study highlights the importance of investigating the etiology of male infertility in Middle Eastern communities. It suggests the need to expand research on male reproductive health in the Middle East in order to improve the prevention and management of male infertility and other male reproductive health problems.

The Relationship Between Self-Reported Sexually Explicit Media Consumption and Sexual Risk Behaviors Among Men Who Have Sex With Men in China.

PubMed

Xu, Yin; Zheng, Yong; Rahman, Qazi

2017-03-01

Previous studies have indicated that viewing sexually explicit media (SEM) might be associated with sexual risk behaviors in men who have sex with men (MSM). However, most prior research has not explored this association cross-culturally or the potential influence that important covariates might have on the association. To explore the association between self-reports of viewing SEM depicting various sexual risk behaviors and engagement in sexual risk behaviors after controlling for relevant covariates in MSM in China. Three hundred fourteen Chinese MSM participated in a web-based survey. SEM consumption, sexual risk behavior, and measurements of covariates. SEM consumption was frequent in MSM in China. Viewing a larger proportion of SEM depicting sexual risk behaviors was associated with a larger number of regular partners with whom MSM reported engaging in sexual risk behaviors, but not with the number of casual partners, after controlling for covariates. HIV-related knowledge and seeking male sex partners were associated with the number of regular partners with whom MSM had engaged in sexual risk behaviors. Seeking sexual sensation, HIV-related knowledge, and seeking male sex partners were associated with the number of casual partners with whom MSM had engaged in sexual risk behaviors. Future research exploring the relation between SEM use and sexual health risk behaviors should consider theoretically important psychological and behavioral covariates. Xu Y, Zheng Y, Rahman Q. The Relationship Between Self-Reported Sexually Explicit Media Consumption and Sexual Risk Behaviors Among Men Who Have Sex With Men in China. J Sex Med 2017;14:357-365. Copyright © 2017 International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.

Local environmental and meteorological conditions influencing the invasive mosquito Ae. albopictus and arbovirus transmission risk in New York City.

PubMed

Little, Eliza; Bajwa, Waheed; Shaman, Jeffrey

2017-08-01

Ae. albopictus, an invasive mosquito vector now endemic to much of the northeastern US, is a significant public health threat both as a nuisance biter and vector of disease (e.g. chikungunya virus). Here, we aim to quantify the relationships between local environmental and meteorological conditions and the abundance of Ae. albopictus mosquitoes in New York City. Using statistical modeling, we create a fine-scale spatially explicit risk map of Ae. albopictus abundance and validate the accuracy of spatiotemporal model predictions using observational data from 2016. We find that the spatial variability of annual Ae. albopictus abundance is greater than its temporal variability in New York City but that both local environmental and meteorological conditions are associated with Ae. albopictus numbers. Specifically, key land use characteristics, including open spaces, residential areas, and vacant lots, and spring and early summer meteorological conditions are associated with annual Ae. albopictus abundance. In addition, we investigate the distribution of imported chikungunya cases during 2014 and use these data to delineate areas with the highest rates of arboviral importation. We show that the spatial distribution of imported arboviral cases has been mostly discordant with mosquito production and thus, to date, has provided a check on local arboviral transmission in New York City. We do, however, find concordant areas where high Ae. albopictus abundance and chikungunya importation co-occur. Public health and vector control officials should prioritize control efforts to these areas and thus more cost effectively reduce the risk of local arboviral transmission. The methods applied here can be used to monitor and identify areas of risk for other imported vector-borne diseases.

Local environmental and meteorological conditions influencing the invasive mosquito Ae. albopictus and arbovirus transmission risk in New York City

PubMed Central

Bajwa, Waheed; Shaman, Jeffrey

2017-01-01

Ae. albopictus, an invasive mosquito vector now endemic to much of the northeastern US, is a significant public health threat both as a nuisance biter and vector of disease (e.g. chikungunya virus). Here, we aim to quantify the relationships between local environmental and meteorological conditions and the abundance of Ae. albopictus mosquitoes in New York City. Using statistical modeling, we create a fine-scale spatially explicit risk map of Ae. albopictus abundance and validate the accuracy of spatiotemporal model predictions using observational data from 2016. We find that the spatial variability of annual Ae. albopictus abundance is greater than its temporal variability in New York City but that both local environmental and meteorological conditions are associated with Ae. albopictus numbers. Specifically, key land use characteristics, including open spaces, residential areas, and vacant lots, and spring and early summer meteorological conditions are associated with annual Ae. albopictus abundance. In addition, we investigate the distribution of imported chikungunya cases during 2014 and use these data to delineate areas with the highest rates of arboviral importation. We show that the spatial distribution of imported arboviral cases has been mostly discordant with mosquito production and thus, to date, has provided a check on local arboviral transmission in New York City. We do, however, find concordant areas where high Ae. albopictus abundance and chikungunya importation co-occur. Public health and vector control officials should prioritize control efforts to these areas and thus more cost effectively reduce the risk of local arboviral transmission. The methods applied here can be used to monitor and identify areas of risk for other imported vector-borne diseases. PMID:28832586

Quantile uncertainty and value-at-risk model risk.

PubMed

Alexander, Carol; Sarabia, José María

2012-08-01

This article develops a methodology for quantifying model risk in quantile risk estimates. The application of quantile estimates to risk assessment has become common practice in many disciplines, including hydrology, climate change, statistical process control, insurance and actuarial science, and the uncertainty surrounding these estimates has long been recognized. Our work is particularly important in finance, where quantile estimates (called Value-at-Risk) have been the cornerstone of banking risk management since the mid 1980s. A recent amendment to the Basel II Accord recommends additional market risk capital to cover all sources of "model risk" in the estimation of these quantiles. We provide a novel and elegant framework whereby quantile estimates are adjusted for model risk, relative to a benchmark which represents the state of knowledge of the authority that is responsible for model risk. A simulation experiment in which the degree of model risk is controlled illustrates how to quantify Value-at-Risk model risk and compute the required regulatory capital add-on for banks. An empirical example based on real data shows how the methodology can be put into practice, using only two time series (daily Value-at-Risk and daily profit and loss) from a large bank. We conclude with a discussion of potential applications to nonfinancial risks. © 2012 Society for Risk Analysis.

Tuberculosis disease mapping in Kedah using standardized morbidity ratio

NASA Astrophysics Data System (ADS)

Diah, Ijlal Mohd; Aziz, Nazrina; Kasim, Maznah Mat

2017-10-01

This paper presents the results of relative risk estimation that applied to TB data in Kedah using the most common approach, Standardized Morbidity Ratio (SMR). Disease mapping has been recognized as one of the methods that can be used by government and public health in order to control diseases since it can give a clear picture of the risk areas. To get good disease mapping, relative risk estimation is an important issue that need to be considered. TB risk areas will be recognized through the map. From the result, Kulim shows the lowest risk areas of contracting TB while Kota Setar has the highest risk area.

Comparison of a Stratified Group Intervention (STarT Back) With Usual Group Care in Patients With Low Back Pain: A Nonrandomized Controlled Trial.

PubMed

Murphy, Susan E; Blake, Catherine; Power, Camillus K; Fullen, Brona M

2016-04-01

A nonrandomized controlled trial. This study aims to explore the effectiveness of group-based stratified care in primary care. Stratified care based on psychosocial screening (STarT Back) has demonstrated greater clinical and cost-effectiveness in patients with low back pain. However, low back pain interventions are often delivered in groups and evaluating this system of care in a group setting is important. Patients were recruited from 60 general practices and linked physiotherapy services. A new group stratified intervention was compared with a historical nonstratified control group. Patients stratified as low, medium and high risk were offered risk-matched group care. Consenting participants completed self-report measures of functional disability (primary outcome measure), pain, psychological distress, and beliefs. The historical control received a generic group intervention. Analysis was by intention to treat. In total, 251 patients in the new stratified intervention and 332 in the historical control were included in the primary analysis at 12 weeks. The mean age of patients was 43 ± 10.98 years. Overall adjusted mean changes in the RMDQ scores were higher in the stratified intervention than in the control arm at 12-week follow-up (P = 0.028). Exploring the risk groups, individually the high-risk stratified group, demonstrated better outcome over the controls (P = 0.031). The medium-risk stratified intervention demonstrated equally good outcomes (P = 0.125), and low-risk stratified patients, despite less intervention, did as well as the historical controls (P = 0.993). Stratified care delivered in a group setting demonstrated superior outcomes in the high-risk patients, and equally good outcomes for the medium and low-risk groups. This model, embedded in primary care, provides an early and effective model of chronic disease management and adds another dimension to the utility of the STarT Back system of care. 2.

Focusing on cardiovascular disease in type 2 diabetes mellitus: an introduction to bromocriptine QR.

PubMed

Bell, David S

2012-09-01

Cardiovascular risk reduction is a key priority in patients with diabetes. The relationship between glycemic control and macrovascular outcomes, such as the benefit of intensive glucose control and the importance of postprandial or fasting blood glucose, is still under debate. A number of pharmacologic options are available to treat type 2 diabetes mellitus and these options have differing evidence for their cardiovascular safety. In this article, the novel agent bromocriptine quick release is discussed. Recently approved, this once-daily treatment provides glycemic control as monotherapy or in combination with other antihyperglycemic medications and has been shown in a prospective phase 3 safety study to not increase cardiovascular risk. Therefore, bromocriptine quick release increases the range of options available to treat patients with type 2 diabetes mellitus without increasing cardiovascular risk.

Quantitative risk assessment for the introduction of African swine fever virus into the European Union by legal import of live pigs.

PubMed

Mur, L; Martínez-López, B; Martínez-Avilés, M; Costard, S; Wieland, B; Pfeiffer, D U; Sánchez-Vizcaíno, J M

2012-04-01

The recent incursion and spread of African swine fever virus (ASFV) in the Russian Federation and Caucasus region, close to European Union (EU) borders, have increased the concerns regarding the probability of ASFV introduction into the EU. There are many potential routes of ASFV entry into EU, but here we specifically aimed to assess the probability of ASFV introduction by legal trade of pigs, which historically has been one of the most important ways of exotic diseases introduction into the EU. A stochastic model was used to estimate the monthly probability of ASFV introduction for each country of the EU. Results of this model suggest an annual probability for ASFV introduction in the whole EU by this way of 5.22*10(-3) , which approximately corresponds with one outbreak in 192years. The risk of ASFV introduction via live pigs was highest in Poland (69%), particularly during the months of November and December. As expected, Russian Federation is the country that most contributes to this risk, representing 68% of the overall annual risk. Methods and results presented here may be useful for informing risk-based surveillance and control programmes and, ultimately, for prevention and control of potential ASFV incursions into the EU. © 2011 Blackwell Verlag GmbH.

Imported Wines: Identifying and Removing Wines Contaminated with Diethylene Glycol.

DTIC Science & Technology

1986-03-01

at controlling health risks, BATF has used its labeling authority to prohibit the marketing of alcoholic beverages that are mislabeled by virtue of...or beverages contaminated with harmful substances into the U.S. market . DEG, a toxic substance, would be such a contaminant. The BATF’S authority in...representing a significant risk to health are identified and removed from k the market . BATF did not conduct a risk assessment or seek an assess- ment from

Previous experiences with illness and traumatic experiences: a specific risk factor for hypochondriasis?

PubMed

Weck, Florian; Neng, Julia M B; Göller, Kathrin; Müller-Marbach, Alexis M

2014-01-01

Previous experiences with illness and traumatic experiences are considered as important risk factors for the development of health anxiety and hypochondriasis. However, empirical research is insufficient and lacks adequate comparison groups. Therefore, we sought to determine whether experiences with illness and traumatic experiences are really specific risk factors for hypochondriasis. In the current study, patients with the diagnosis of hypochondriasis (n = 80), patients with a primary anxiety disorder (n = 80), and healthy controls (n = 83) were investigated regarding their previous experiences with illness (self and other) and traumatic childhood experiences. We found that patients with hypochondriasis reported a higher level of experience with illness and with traumatic childhood experiences than healthy controls. However, no differences were found between patients with hypochondriasis and those with an anxiety disorder, regarding their level of experience with illness and traumatic experiences. Previous experiences with illness and traumatic childhood experiences did not prove to be specific risk factors for the development of hypochondriasis. The importance of both experiences with illness and traumatic experiences as risk factors, as considered in the Diagnostic and Statistical Manual and in established cognitive-behavioral models, does not seem to be supported empirically. Further research should therefore also consider other potential risk factors discussed in the literature. © 2013 Published by Academy of Psychosomatic Medicine on behalf of Academy of Psychosomatic Medicine.

The Quantity and Quality of Illegally Imported Products of Animal Origin in Personal Consignments into the European Union Seized at Two German Airports between 2010 And 2014

PubMed Central

Jansen, Wiebke; Merkle, Majella; Daun, Anna; Flor, Matthias; Grabowski, Nils Th.; Klein, Günter

2016-01-01

The import of products of animal origin (POAO) in travellers’ personal consignments presents a considerable risk of introducing animal diseases and emerging zoonoses into the European Union. The current regulation (EU) 206/2009 implements strict measures for illegally imported POAO, whereupon non-complying products have to be seized and destroyed regardless. Especially airports serve as global bottlenecks for illegally imported POAO where passenger controls of non-European flights are performed by customs and veterinary services in collaboration. Results of these control measures have to be submitted in the form of annual reports to the European Commission. However, few data on qualities and quantities of seizures have been published so far. In this study, POAO seized at two German airports between 2010 and 2014 were analysed in terms of quantities, qualitative categories and region of origin. In most years considered, more than 20 tonnes POAO were seized at each airport. However, reported amounts of seizures seem to be only the tip of the iceberg as an all-passenger control is not feasible and therefore travellers are only spot-checked. The analysis suggests that the organisational structures of both customs and official veterinary services and their different risk perceptions interfere in completing an effective ban on the illegal import of POAO. PMID:26901158

The Quantity and Quality of Illegally Imported Products of Animal Origin in Personal Consignments into the European Union Seized at Two German Airports between 2010 And 2014.

PubMed

Jansen, Wiebke; Merkle, Majella; Daun, Anna; Flor, Matthias; Grabowski, Nils Th; Klein, Günter

2016-01-01

The import of products of animal origin (POAO) in travellers' personal consignments presents a considerable risk of introducing animal diseases and emerging zoonoses into the European Union. The current regulation (EU) 206/2009 implements strict measures for illegally imported POAO, whereupon non-complying products have to be seized and destroyed regardless. Especially airports serve as global bottlenecks for illegally imported POAO where passenger controls of non-European flights are performed by customs and veterinary services in collaboration. Results of these control measures have to be submitted in the form of annual reports to the European Commission. However, few data on qualities and quantities of seizures have been published so far. In this study, POAO seized at two German airports between 2010 and 2014 were analysed in terms of quantities, qualitative categories and region of origin. In most years considered, more than 20 tonnes POAO were seized at each airport. However, reported amounts of seizures seem to be only the tip of the iceberg as an all-passenger control is not feasible and therefore travellers are only spot-checked. The analysis suggests that the organisational structures of both customs and official veterinary services and their different risk perceptions interfere in completing an effective ban on the illegal import of POAO.

Effect of Economic Assets on Sexual Risk-Taking Intentions Among Orphaned Adolescents in Uganda

PubMed Central

Han, Chang-Keun; Neilands, Torsten B.; Ismayilova, Leyla; Sperber, Elizabeth

2010-01-01

Objectives. We examined the effect of economic assets on sexual risk-taking intentions among school-going AIDS-orphaned adolescents in rural Uganda. Methods. AIDS-orphaned adolescents from 15 comparable schools were randomly assigned to control (n = 133) or treatment (n = 127) conditions. Treatment participants received child savings accounts, workshops, and mentorship. This economic intervention was in addition to the traditional care and support services for school-going orphaned adolescents (counseling and school supplies) provided to both treatment and control groups. Adolescents in the treatment condition were compared with adolescents in the control condition at baseline and at 10 months after the intervention. Results. After control for sociodemographic factors, child-caregiver/parental communication, and peer pressure, adolescents in the economic intervention group reported a significant reduction in sexual risk-taking intentions compared with adolescents in the control condition. Conclusions. The findings indicate that in Uganda, a country devastated by poverty and disease (including HIV/AIDS), having access to economic assets plays an important role in influencing adolescents' sexual risk-taking intentions. These findings have implications for the care and support of orphaned adolescents, especially in poor African countries devastated by poverty and sexually transmitted diseases. PMID:20075323

[Naturally occurring reassortants of infectious bursal disease virus - A review].

PubMed

Qi, Xiaole; Gao, Li; Wang, Xiaomei

2016-05-04

Infectious bursal disease virus (IBDV) is an important representative of Birnaviridae, which causes infectious bursal disease (IBD), one important immuno-suppressive and fatal disease threatening the poultry husbandry. The naturally occurring reassortants of IBDV induced new risks to disease prevention and control. Here, we reviewed the main types of the genome segments reassortants and intragenic recombination, the inherent mechanism and the biological significances were analyzed, which would give us new insights into the virus genetic evolution research and the disease control strategy.

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

PubMed

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

2015-08-17

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

Temperament and its Association with Autism Symptoms in a High-risk Population.

PubMed

Garon, Nancy; Zwaigenbaum, Lonnie; Bryson, Susan; Smith, Isabel M; Brian, Jessica; Roncadin, Caroline; Vaillancourt, Tracy; Armstrong, Vickie; Sacrey, Lori-Ann R; Roberts, Wendy

2016-05-01

Temperament was investigated in a group of high-risk infants (N = 383; 45 % girls) who had an older sibling with autism spectrum disorder (ASD), and in community control infants (N = 162; 46 % girls) with no family history of ASD (low-risk). The infants were assessed at age 12 months using the Infant Behavior Questionnaire, and at 24 months using the Toddler Behavior Assessment Questionnaire. At 36 months, an independent blind diagnostic assessment for ASD was conducted using the Autism Diagnostic Interview-Revised (ADI-R) and the Autism Diagnostic Observation Schedule (ADOS). The results indicate not only differences in temperament traits between the high- and low-risk groups, but also differences in the structure of higher-order temperament factors. The results support the importance of early reactive temperament in the development of Effortful Control in the high-risk sample. Furthermore, Effortful Control at 24 months appears to play a critical role in predicting later ASD symptoms (at 36 months). Taken together, these findings support the use of early temperament as an endophenotype for ASD.

Hospital-treated mental and behavioral disorders and risk of Alzheimer's disease: A nationwide nested case-control study.

PubMed

Tapiainen, V; Hartikainen, S; Taipale, H; Tiihonen, J; Tolppanen, A-M

2017-06-01

Studies investigating psychiatric disorders as Alzheimer's disease (AD) risk factors have yielded heterogeneous findings. Differences in time windows between the exposure and outcome could be one explanation. We examined whether (1) mental and behavioral disorders in general or (2) specific mental and behavioral disorder categories increase the risk of AD and (3) how the width of the time window between the exposure and outcome affects the results. A nationwide nested case-control study of all Finnish clinically verified AD cases, alive in 2005 and their age, sex and region of residence matched controls (n of case-control pairs 27,948). History of hospital-treated mental and behavioral disorders was available since 1972. Altogether 6.9% (n=1932) of the AD cases and 6.4% (n=1784) of controls had a history of any mental and behavioral disorder. Having any mental and behavioral disorder (adjusted OR=1.07, 95% CI=1.00-1.16) or depression/other mood disorder (adjusted OR=1.17, 95% CI=1.05-1.30) were associated with higher risk of AD with 5-year time window but not with 10-year time window (adjusted OR, 95% CI 0.99, 0.91-1.08 for any disorder and 1.08, 0.96-1.23 for depression). The associations between mental and behavioral disorders and AD were modest and dependent on the time window. Therefore, some of the disorders may represent misdiagnosed prodromal symptoms of AD, which underlines the importance of proper differential diagnostics among older persons. These findings also highlight the importance of appropriate time window in psychiatric and neuroepidemiology research. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

PDA survey of quality risk management practices in the pharmaceutical, devices, & biotechnology industries.

PubMed

Ahmed, Ruhi; Baseman, Harold; Ferreira, Jorge; Genova, Thomas; Harclerode, William; Hartman, Jeffery; Kim, Samuel; Londeree, Nanette; Long, Michael; Miele, William; Ramjit, Timothy; Raschiatore, Marlene; Tomonto, Charles

2008-01-01

In July 2006 the Parenteral Drug Association's Risk Management Task Force for Aseptic Processes, conducted an electronic survey of PDA members to determine current industry practices regarding implementation of Quality Risk Management in their organizations. This electronic survey was open and publicly available via the PDA website and targeted professionals in our industry who are involved in initiating, implementing, or reviewing risk management programs or decisions in their organizations. One hundred twenty-nine members participated and their demographics are presented in the sidebar "Correspondents Profile". Among the major findings are: *The "Aseptic Processing/Filling" operation is the functional area identified as having the greatest need for risk assessment and quality risk management. *The most widely used methodology in industry to identify risk is Failure Mode and Effects Analysis (FMEA). This tool was most widely applied in assessing change control and for adverse event, complaint, or failure investigations. *Despite the fact that personnel training was identified as the strategy most used for controlling/minimizing risk, the largest contributors to sterility failure in operations are still "Personnel". *Most companies still rely on "Manufacturing Controls" to mitigate risk and deemed the utilization of Process Analytical Technology (PAT) least important in this aspect. *A majority of correspondents verified that they did not periodically assess their risk management programs. *A majority of the correspondents desired to see case studies or examples of risk analysis implementation (as applicable to aseptic processing) in future PDA technical reports on risk management.

Risk factors for falls with severe fracture in elderly people living in a middle-income country: a case control study.

PubMed

Coutinho, Evandro S F; Fletcher, Astrid; Bloch, Katia V; Rodrigues, Laura C

2008-08-26

Fracture after falling has been identified as an important problem in public health. Most studies of risk factors for fractures due to falls have been carried out in developed countries, although the size of the elderly population is increasing fast in middle income countries. The objective of this paper is to identify risk factors for fall related to severe fractures in those aged 60 or more in a middle-income country. A case-control study was carried out in Rio de Janeiro-Brazil based general hospitals between 2002-2003. Two hundred-fifty hospitalised cases of fracture were matched with 250 community controls by sex, age group and living area. Data were collected for socio-demographic variables, health status and drugs used before the fall. A conditional logistic regression model was fitted to identify variables associated with the risk of fall related severe fracture. Low body mass index, cognitive impairment, stroke and lack of urine control were associated with increased risk of severe fall related fractures. Benzodiazepines and muscle relaxants were also related to an increased risk of severe fractures while moderate use of alcohol was associated with reduced risk. Although the association between benzodiazepines and fractures due to fall has been consistently demonstrated for old people, this has not been the case for muscle relaxant drugs. The decision to prescribe muscle relaxants for elderly people should take into account the risk of severe fracture associated with these drugs.

An epidemiological survey on road traffic crashes in Iran: application of the two logistic regression models.

PubMed

Bakhtiyari, Mahmood; Mehmandar, Mohammad Reza; Mirbagheri, Babak; Hariri, Gholam Reza; Delpisheh, Ali; Soori, Hamid

2014-01-01

Risk factors of human-related traffic crashes are the most important and preventable challenges for community health due to their noteworthy burden in developing countries in particular. The present study aims to investigate the role of human risk factors of road traffic crashes in Iran. Through a cross-sectional study using the COM 114 data collection forms, the police records of almost 600,000 crashes occurred in 2010 are investigated. The binary logistic regression and proportional odds regression models are used. The odds ratio for each risk factor is calculated. These models are adjusted for known confounding factors including age, sex and driving time. The traffic crash reports of 537,688 men (90.8%) and 54,480 women (9.2%) are analysed. The mean age is 34.1 ± 14 years. Not maintaining eyes on the road (53.7%) and losing control of the vehicle (21.4%) are the main causes of drivers' deaths in traffic crashes within cities. Not maintaining eyes on the road is also the most frequent human risk factor for road traffic crashes out of cities. Sudden lane excursion (OR = 9.9, 95% CI: 8.2-11.9) and seat belt non-compliance (OR = 8.7, CI: 6.7-10.1), exceeding authorised speed (OR = 17.9, CI: 12.7-25.1) and exceeding safe speed (OR = 9.7, CI: 7.2-13.2) are the most significant human risk factors for traffic crashes in Iran. The high mortality rate of 39 people for every 100,000 population emphasises on the importance of traffic crashes in Iran. Considering the important role of human risk factors in traffic crashes, struggling efforts are required to control dangerous driving behaviours such as exceeding speed, illegal overtaking and not maintaining eyes on the road.

Early Adolescent Relationship Predictors of Emerging Adult Outcomes: Youth with and without Type 1 Diabetes

PubMed Central

Helgeson, Vicki S.; Palladino, Dianne K.; Reynolds, Kerry A.; Becker, Dorothy; Escobar, Oscar; Siminerio, Linda

2013-01-01

Background Emerging adulthood is a high-risk period for mental health problems and risk behaviors for youth generally and for physical health problems among those with type 1 diabetes. Purpose To examine whether adolescents’ relationships with parents and friends predict health and risk behaviors during emerging adulthood. Method Youth with and without diabetes were enrolled at average age 12 and followed for 7 years. Parent and friend relationship variables, measured during adolescence, were used to predict emerging adulthood outcomes: depression, risk behavior, and, for those with diabetes, diabetes outcomes. Results Parent relationship quality predicted decreased depressive symptoms and, for those with diabetes, decreased alcohol use. Parent control predicted increased smoking, reduced college attendance, and, for control participants, increased depressive symptoms. For those with diabetes, parent control predicted decreased depressive symptoms and better self-care. Friend relationship variables predicted few outcomes. Conclusions Adolescent parent relationships remain an important influence on emerging adults’ lives. PMID:24178509

Giant Constrictors: Biological and Management Profiles and an Establishment Risk Assessment for Nine Large Species of Pythons, Anacondas, and the Boa Constrictor

USGS Publications Warehouse

Reed, Robert N.; Rodda, Gordon H.

2009-01-01

Giant Constrictors: Biological and Management Profiles and an Establishment Risk Assessment for Nine Large Species of Pythons, Anacondas, and the Boa Constrictor, estimates the ecological risks associated with colonization of the United States by nine large constrictors. The nine include the world's four largest snake species (Green Anaconda, Eunectes murinus; Indian or Burmese Python, Python molurus; Northern African Python, Python sebae; and Reticulated Python, Broghammerus reticulatus), the Boa Constrictor (Boa constrictor), and four species that are ecologically or visually similar to one of the above (Southern African Python, Python natalensis; Yellow Anaconda, Eunectes notaeus; DeSchauensee's Anaconda, Eunectes deschauenseei; and Beni Anaconda, Eunectes beniensis). At present, the only probable pathway by which these species would become established in the United States is the pet trade. Although importation for the pet trade involves some risk that these animals could become established as exotic or invasive species, it does not guarantee such establishment. Federal regulators have the task of appraising the importation risks and balancing those risks against economic, social, and ecological benefits associated with the importation. The risk assessment quantifies only the ecological risks, recognizing that ecosystem processes are complex and only poorly understood. The risk assessment enumerates the types of economic impacts that may be experienced, but leaves quantification of economic costs to subsequent studies. Primary factors considered in judging the risk of establishment were: (1) history of establishment in other countries, (2) number of each species in commerce, (3) suitability of U.S. climates for each species, and (4) natural history traits, such as reproductive rate and dispersal ability, that influence the probability of establishment, spread, and impact. In addition, the risk assessment reviews all management tools for control of invasive giant constrictor populations. There is great uncertainty about many aspects of the risk assessment; the level of uncertainty is estimated separately for each risk component. Overall risk was judged to be high for five of the giant constrictors studied, and medium for the other four species. Because all nine species shared a large number of natural history traits that promote invasiveness or impede population control, none of the species was judged to be of low risk.

9 CFR 95.14 - Blood meal, tankage, meat meal, and similar products, for use as fertilizer or animal feed...

Code of Federal Regulations, 2014 CFR

2014-01-01

... 9 Animals and Animal Products 1 2014-01-01 2014-01-01 false Blood meal, tankage, meat meal, and... controlled risk or undetermined risk for BSE of processed animal protein derived from animals other than... protein derived from animals other than ruminants is prohibited importation into the United States unless...

Suicidal behavior and related traits among inpatient adolescents with first-episode schizophrenia.

PubMed

Shoval, Gal; Feld-Olspanger, Joy; Nahshoni, Eitan; Gothelf, Doron; Misgav, Sagit; Manor, Iris; Apter, Alan; Zalsman, Gil

2011-01-01

Suicide is a major cause of death in adolescents with first-episode schizophrenia (FES). The aim of this pilot study was to compare suicide-related traits between subjects with FES and those with other psychopathologies to evaluate risk factors for suicidal behavior. Twenty-five inpatient adolescents with FES and a control group of 28 psychiatric inpatients matched for sex and age were assessed for depression, anger, criminal behavior, aggression, and suicidal ideation, risk, and potential. The adolescents with FES had significantly lower depression (P = .003), anger (P = .025), and criminal behavior (P = .022) than did the controls. However, although suicide ideation was greater in the subjects with FES (P = .003), suicide risk was significantly lower than that in controls (P = .004). Decreased levels of both depression and anger as part of affective constriction in the group with schizophrenia could explain why the increased suicide ideation did not lead to a higher suicide risk in these inpatients. This study highlights the importance of distinguishing between suicidal ideation and actual suicide risk. We demonstrated that thoughts of suicide do not necessarily translate into an actual risk of suicidal behavior in adolescents with schizophrenia. Copyright © 2011 Elsevier Inc. All rights reserved.

Compliance with recommendations for pandemic influenza H1N1 2009: the role of trust and personal beliefs.

PubMed

Prati, Gabriele; Pietrantoni, Luca; Zani, Bruna

2011-10-01

To investigate the relationship between risk perception, worry, control, trust, exposure to an educational campaign, media exaggeration with recommendations for pandemic influenza H1N1 2009. Cross sectional telephone survey using random digit dialing. A total of 1010 adult Italians were interviewed by telephone between 16 and 19 February 2010. The survey instrument included demographic data, measures on risk perception, worry, trust and compliance with recommendations for pandemic influenza H1N1 2009. Controlling for socio-demographic variables, compliance with all the recommended behaviors was associated with media trust, trust in the Ministry of Health, worry and perceived severity of illness. Perceptions that the risk of catching pandemic influenza H1N1 2009 is high, that the authorities are acting in the public's best interest in dealing with it, that the media had exaggerated the risks of catching it and that people can control their risk of catching it were associated with compliance with some recommended behaviors even after considering effects of socio-demographic characteristics. The results underscore the importance of building public trust and to consider the influence of risk perception and affective response in promoting compliance with recommended behaviors.

Cyclooxygenase-2 polymorphisms in Parkinson's disease.

PubMed

Håkansson, Anna; Bergman, Olle; Chrapkowska, Cecilia; Westberg, Lars; Belin, Andrea Carmine; Sydow, Olof; Johnels, Bo; Olson, Lars; Holmberg, Björn; Nissbrandt, Hans

2007-04-05

Accumulating evidence indicate that cyclooxygenase-2 (COX-2) is of pathophysiological importance for the neurodegeneration in Parkinson's disease (PD). For example, in a large epidemiological study, use of NSAIDs was associated with a lower risk of PD. Genetic variants of the COX-2 gene might therefore influence the risk of developing the disease. The genotype distribution of four common single nucleotide polymorphisms (SNPs) in the COX-2 gene (rs689466:A496G, rs20417:G926C, rs5277:G3050C, rs5275:C8473T) was analyzed in PD patients and control subjects in a Swedish population. No differences could be seen between the PD-patient and controls regarding the A496G, G926C, and G3050C SNPs, but the allele frequency of the C8473T SNP was found to differ when male patients were compared to controls (P = 0.007). In females no difference could be seen between PD-patients and controls. In conclusion, the results suggest a possible influence of the COX-2 C8473T SNP in PD, although it only seems to be of importance in men. (c) 2006 Wiley-Liss, Inc.

Individuals with Type 1 and Type 2 Diabetes Mellitus Trade Increased Hyperglycemia for Decreased Hypoglycemia When Glycemic Variability is not Improved.

PubMed

Jangam, Sujit R; Hayter, Gary; Dunn, Timothy C

2018-02-01

Glycemic variability refers to oscillations in blood glucose within a day and differences in blood glucose at the same time on different days. Glycemic variability is linked to hypoglycemia and hyperglycemia. The relationship among these three important metrics is examined here, specifically to show how reduction in both hypo- and hyperglycemia risk is dependent on changes in variability. To understand the importance of glycemic variability in the simultaneous reduction of hypoglycemia and hyperglycemia risk, we introduce the glycemic risk plot-estimated HbA1c % (eA1c) vs. minutes below 70 mg/dl (MB70) with constant variability contours for predicting post-intervention risks in the absence of a change in glycemic variability. The glycemic risk plot illustrates that individuals who do not reduce glycemic variability improve one of the two metrics (hypoglycemia risk or hyperglycemia risk) at the cost of the other. It is important to reduce variability to improve both risks. These results were confirmed by data collected in a randomized controlled trial consisting of individuals with type 1 and type 2 diabetes on insulin therapy. For type 1, a total of 28 individuals out of 35 (80%) showed improvement in at least one of the risks (hypo and/or hyper) during the 100-day course of the study. Seven individuals (20%) showed improvement in both. Similar data were observed for type 2 where a total of 36 individuals out of 43 (84%) showed improvement in at least one risk and 8 individuals (19%) showed improvement in both. All individuals in the study who showed improvement in both hypoglycemia and hyperglycemia risk also showed a reduction in variability. Therapy changes intended to improve an individual's hypoglycemia or hyperglycemia risk often result in the reduction of one risk at the expense of another. It is important to improve glucose variability to reduce both risks or at least maintain one risk while reducing the other. Abbott Diabetes Care.

Guidance on home blood pressure monitoring: A statement of the HOPE Asia Network.

PubMed

Kario, Kazuomi; Park, Sungha; Buranakitjaroen, Peera; Chia, Yook-Chin; Chen, Chen-Huan; Divinagracia, Romeo; Hoshide, Satoshi; Shin, Jinho; Siddique, Saulat; Sison, Jorge; Soenarta, Arieska Ann; Sogunuru, Guru Prasad; Tay, Jam Chin; Turana, Yuda; Wong, Lawrence; Zhang, Yuqing; Wang, Ji-Guang

2018-03-01

Hypertension is an important modifiable cardiovascular risk factor and a leading cause of death throughout Asia. Effective prevention and control of hypertension in the region remain a significant challenge despite the availability of several regional and international guidelines. Out-of-office measurement of blood pressure (BP), including home BP monitoring (HBPM), is an important hypertension management tool. Home BP is better than office BP for predicting cardiovascular risk and HBPM should be considered for all patients with office BP ≥ 130/85 mm Hg. It is important that HBPM is undertaken using a validated device and patients are educated about how to perform HBPM correctly. During antihypertensive therapy, monitoring of home BP control and variability is essential, especially in the morning. This is because HBPM can facilitate the choice of individualized optimal therapy. The evidence and practice points in this document are based on the Hypertension Cardiovascular Outcome Prevention and Evidence (HOPE) Asia Network expert panel consensus recommendations for HBPM in Asia. ©2018 Wiley Periodicals, Inc.

Banding the world together; the global growth of control banding and qualitative occupational risk management.

PubMed

Zalk, David M; Heussen, Ga Henri

2011-12-01

Control Banding (CB) strategies to prevent work-related illness and injury for 2.5 billion workers without access to health and safety professionals has grown exponentially this last decade. CB originates from the pharmaceutical industry to control active pharmaceutical ingredients without a complete toxicological basis and therefore no occupational exposure limits. CB applications have broadened into chemicals in general - including new emerging risks like nanomaterials and recently into ergonomics and injury prevention. CB is an action-oriented qualitative risk assessment strategy offering solutions and control measures to users through "toolkits". Chemical CB toolkits are user-friendly approaches used to achieve workplace controls in the absence of firm toxicological and quantitative exposure information. The model (technical) validation of these toolkits is well described, however firm operational analyses (implementation aspects) are lacking. Consequentially, it is often not known if toolkit use leads to successful interventions at individual workplaces. This might lead to virtual safe workplaces without knowing if workers are truly protected. Upcoming international strategies from the World Health Organization Collaborating Centers request assistance in developing and evaluating action-oriented procedures for workplace risk assessment and control. It is expected that to fulfill this strategy's goals, CB approaches will continue its important growth in protecting workers.

An updated review of case-control studies of lung cancer and indoor radon-Is indoor radon the risk factor for lung cancer?

PubMed

Sheen, Seungsoo; Lee, Keu Sung; Chung, Wou Young; Nam, Saeil; Kang, Dae Ryong

2016-01-01

Lung cancer is a leading cause of cancer-related death in the world. Smoking is definitely the most important risk factor for lung cancer. Radon ((222)Rn) is a natural gas produced from radium ((226)Ra) in the decay series of uranium ((238)U). Radon exposure is the second most common cause of lung cancer and the first risk factor for lung cancer in never-smokers. Case-control studies have provided epidemiological evidence of the causative relationship between indoor radon exposure and lung cancer. Twenty-four case-control study papers were found by our search strategy from the PubMed database. Among them, seven studies showed that indoor radon has a statistically significant association with lung cancer. The studies performed in radon-prone areas showed a more positive association between radon and lung cancer. Reviewed papers had inconsistent results on the dose-response relationship between indoor radon and lung cancer risk. Further refined case-control studies will be required to evaluate the relationship between radon and lung cancer. Sufficient study sample size, proper interview methods, valid and precise indoor radon measurement, wide range of indoor radon, and appropriate control of confounders such as smoking status should be considered in further case-control studies.

Early Initiation of Substance Use and Subsequent Risk Factors Related to Suicide among Urban High School Students

PubMed Central

Cho, Hyunsan; Hallfors, Denise Dion; Iritani, Bonita J.

2013-01-01

Objective To examine the association between onset of substance use and risk factors related to suicide. Method 1,252 adolescents in two urban school districts completed surveys as part of a large, randomized controlled prevention effectiveness trial. Risk factors measured included depressive symptoms, suicide ideation, suicide ideation specifically with alcohol and/or drug use, endorsement of suicide as a personal option, and suicide attempt. Results In our final multivariate models that controlled for current substance use and demographic characteristics, we found that earlier onset of hard drug use among boys was associated with all five suicide risk factors. In comparison, among girls, earlier onset of regular cigarette smoking, getting drunk, and hard drug use was associated with some of suicide risk factors. Conclusions The findings confirm the importance of screening for substance use in early adolescence. The association between early substance use and suicide risk factors differed by gender; both research and intervention efforts need to incorporate gender differences. PMID:17210230

Prospect theory and the decision to move or stay.

PubMed

Clark, William A V; Lisowski, William

2017-09-05

Migration has always involved stress and risk. More risk-averse households are less likely to move, while less risk-averse households will seek out opportunities and migrate. We investigate how the theoretical contributions of prospect theory, and specifically the endowment effect, can provide new understanding about decisions whether to migrate or not. We test the hypothesis that risk aversion extends the length of stay in the dwelling and, by extension, in the local labor and housing markets. How long people remain in place is a function, we hypothesize, of their independently self-assessed propensity to take risks, after controlling for a range of demographic and socioeconomic characteristics. We use the theoretical insights of prospect theory and the endowment effect (the notion of the "use value" differing from the "exchange value") to explain the likelihood of staying after controlling for life-course events. The results confirm the explanatory power of self-assessed risk in the decision to migrate or stay and, equally important, confirm the role of the endowment effect.

Prospect theory and the decision to move or stay

PubMed Central

Clark, William A. V.

2017-01-01

Migration has always involved stress and risk. More risk-averse households are less likely to move, while less risk-averse households will seek out opportunities and migrate. We investigate how the theoretical contributions of prospect theory, and specifically the endowment effect, can provide new understanding about decisions whether to migrate or not. We test the hypothesis that risk aversion extends the length of stay in the dwelling and, by extension, in the local labor and housing markets. How long people remain in place is a function, we hypothesize, of their independently self-assessed propensity to take risks, after controlling for a range of demographic and socioeconomic characteristics. We use the theoretical insights of prospect theory and the endowment effect (the notion of the “use value” differing from the “exchange value”) to explain the likelihood of staying after controlling for life-course events. The results confirm the explanatory power of self-assessed risk in the decision to migrate or stay and, equally important, confirm the role of the endowment effect. PMID:28827341

Prevalence, awareness, treatment, control, and risk factors of hypertension among adults: a cross-sectional study in Iran.

PubMed

Eghbali Babadi, Maryam; Khosravi, Alireza; Feizi, Awat; Mansouri, Asieh; Mahaki, Behzad; Sarrafzadegan, Nizal

2018-05-18

hypertension (HTN) is one of important risk factors of cardiovascular disease. Considering the importance of this disease for public health, this study was designed in order to determine the prevalence, awareness, treatment, control and risk factors of hypertension in Iranian adult population. This cross-sectional study was conducted on 2107 residents of Isfahan, Iran. Samples were selected through random, multistage, cluster sampling in 2015-2016. Outcome variable was hypertension determined by measuring right arm blood pressure via an arm digital blood pressure monitor. Awareness, treatment and control of HTN was assessed by a valid and reliable researcher-made questionnaire. Other demographic and clinical variables were assessed via a demographic questionnaire. The overall prevalence of hypertension was 17.3% (18.9% and 15.5% in men and women, respectively). The prevalence of hypertension increased in both genders with age. the prevalence of awareness of HTN among people with HTN was 69.2% of which 92.4% and 59.9% had drug treatment and controlled HTN, respectively. Logistic regression identified age, BMI, having diabetes and hyperlipidemia and positive family history of HTN as determinants of awareness of HTN. The results showed that hypertension is highly prevalent in the community, especially in men and in the middle-aged and older adults. Approximately 30% of patients are unaware of their disease, and there is less awareness among younger adults. Despite high frequency of drug treatment for hypertension, hypertension is uncontrolled in more than 40% of patients. Health policies should therefore consider appropriate preventive and therapeutic strategies for these high-risk groups.

Increased risk for an atypical autism diagnosis following Thimerosal-containing vaccine exposure in the United States: A prospective longitudinal case-control study in the Vaccine Safety Datalink.

PubMed

Geier, David A; Kern, Janet K; Geier, Mark R

2017-07-01

Thimerosal is an organic-mercury (Hg)-containing compound (49.55% Hg by weight) historically added to many multi-dose vials of vaccine as a preservative and still added to some vaccines today. Concerns about the toxic effects from Thimerosal-containing childhood vaccines and the risk of an atypical autism diagnosis were evaluated in this study. A hypothesis-testing, prospective longitudinal, case-control study assessed exposure to Hg from Thimerosal-containing hepatitis B vaccines (TM-HepB) among cases diagnosed with atypical autism (n=164) and controls (n=15,216). Automated medical records for subjects born from 1991 to 2000 and continuously enrolled in the Vaccine Safety Datalink (VSD) database were examined. Cases diagnosed with atypical autism were statistically significantly more likely to have received greater overall and dose-dependent exposures to Hg from TM-HepB vaccines administered within the first month of life, first two months of life, and first six months of life than the controls. Similar phenomena were observed when cases and controls were separated by gender. Routine childhood vaccination is an important public health tool to reduce infectious diseases. The present study provides important epidemiological evidence significantly associating increasing Hg exposure from Thimerosal-containing childhood vaccines and the subsequent risk of atypical autism diagnosis, and suggests that Thimerosal should be eliminated from vaccines. Copyright © 2017 Elsevier GmbH. All rights reserved.

Adherence to drug-drug interaction alerts in high-risk patients: a trial of context-enhanced alerting.

PubMed

Duke, Jon D; Li, Xiaochun; Dexter, Paul

2013-05-01

Drug-drug interaction (DDI) alerting is an important form of clinical decision support, yet physicians often fail to attend to critical DDI warnings due to alert fatigue. We previously described a model for highlighting patients at high risk of a DDI by enhancing alerts with relevant laboratory data. We sought to evaluate the effect of this model on alert adherence in high-risk patients. A 6-month randomized controlled trial involving 1029 outpatient physicians was performed. The target interactions were all DDIs known to cause hyperkalemia. Alerts in the intervention group were enhanced with the patient's most recent potassium and creatinine levels. The control group received unmodified alerts. High -risk patients were those with baseline potassium >5.0 mEq/l and/or creatinine ≥1.5 mg/dl (132 μmol/l). We found no significant difference in alert adherence in high-risk patients between the intervention group (15.3%) and the control group (16.8%) (p=0.71). Adherence in normal risk patients was significantly lower in the intervention group (14.6%) than in the control group (18.6%) (p<0.01). In neither group did physicians increase adherence in patients at high risk. Physicians adhere poorly to hyperkalemia-associated DDI alerts even in patients with risk factors for a clinically significant interaction, and the display of relevant laboratory data in these alerts did not improve adherence levels in the outpatient setting. Further research is necessary to determine optimal strategies for conveying patient-specific DDI risk.

Hormone, metabolic peptide, and nutrient levels in the earliest phases of rheumatoid arthritis-contribution of free fatty acids to an increased cardiovascular risk during very early disease.

PubMed

Tang, Man Wai; Koopman, Frieda A; Visscher, Jan P M; de Hair, Maria J; Gerlag, Danielle M; Tak, Paul Peter

2017-02-01

Rheumatoid arthritis (RA) is a chronic autoimmune disease associated with changes in several hormones and metabolic peptides. Crosstalk between these factors and the immune system may be important for homeostasis during inflammation. Here, we studied the levels of hormones, metabolic peptides, and nutrients in individuals at risk for developing RA (at risk). In total, 18 hormones, metabolic peptides, and nutrients were measured in fasting serum samples from 45 autoantibody-positive individuals at risk, 22 RA patients, and 16 healthy subjects. Triglyceride (TG) levels were also measured in an independent validation cohort of 32 individuals at risk, 20 early arthritis patients, and 20 healthy controls. We found an elevated TG level in individuals at risk and significantly higher TG levels in RA patients compared to healthy controls. These results were confirmed in the validation cohort. Similarly, free fatty acid (FFA) levels showed an increase in individuals at risk and were significantly higher in RA patients compared to healthy controls. In RA patients, FFA levels were positively correlated with disease activity. Pancreatic polypeptide (PP) and norepinephrine levels were highly significantly increased in individuals at risk and RA patients compared to healthy controls. TG and FFA levels are increased in RA patients and positively correlated with disease activity parameters. The results presented here suggest a role for FFAs in the pathogenesis of RA. Furthermore, PP and norepinephrine may be a biomarker that could assist in the identification of individuals at risk.

The Relationship Between Young Adult Smokers' Beliefs About Nicotine Addiction and Smoking-Related Affect and Cognitions.

PubMed

Waters, Erika A; Janssen, Eva; Kaufman, Annette R; Peterson, Laurel M; Muscanell, Nicole L; Guadagno, Rosanna E; Stock, Michelle L

2016-06-01

Risk beliefs and self-efficacy play important roles in explaining smoking-related outcomes and are important to target in tobacco control interventions. However, information is lacking about the underlying beliefs that drive these constructs. The present study investigated the interrelationships among young adult smokers' beliefs about the nature of nicotine addiction and smoking-related affect and cognitions (i.e., feelings of risk, worry about experiencing the harms of smoking, self-efficacy of quitting, and intentions to quit). Smokers (n = 333) were recruited from two large universities. Results showed that quit intentions were associated with feelings of risk, but not with worry or self-efficacy. Furthermore, higher feelings of risk were associated with lower beliefs that addiction is an inevitable consequence of smoking and with lower beliefs that the harms of smoking are delayed. This suggests that it is important for health messages to counter the possible negative effects of messages that strongly emphasize the addictiveness of nicotine, possibly by emphasizing the importance of quitting earlier rather than later. The findings also add to the evidence base that feelings of risk are powerful predictors of behavioral intentions. Furthermore, our results suggest that in some circumstances, feelings of risk predict quit intentions beyond that predicted by worry and self-efficacy. Gaining additional understanding of the tobacco-related beliefs that can increase feelings of risk and incorporating those beliefs into educational campaigns may improve the quality of such campaigns and reduce tobacco use.

77 FR 48124 - Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-13

...: Importation of Pork-Filled Pasta. OMB Control Number: 0579-0214. Summary of Collection: The Animal Health... pasta from certain regions pose a minimal risk of introducing swine vesicular disease into the United...

Anorexia nervosa versus bulimia nervosa: differences based on retrospective correlates in a case-control study.

PubMed

Machado, Bárbara C; Gonçalves, Sónia F; Martins, Carla; Brandão, Isabel; Roma-Torres, António; Hoek, Hans W; Machado, Paulo P

2016-06-01

This study is the result of two Portuguese case-control studies that examined the replication of retrospective correlates and preceding life events in anorexia nervosa (AN) and bulimia nervosa (BN) development. This study aims to identify retrospective correlates that distinguish AN and BN METHOD: A case-control design was used to compare a group of women who met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for AN (N = 98) and BN (N = 79) with healthy controls (N = 86) and with other psychiatric disorders (N = 68). Each control group was matched with AN patients regarding age and parental social categories. Risk factors were assessed by interviewing each person with the Oxford Risk Factor Interview. Compared to AN, women with BN reported significantly higher rates of paternal high expectations, excessive family importance placed on fitness/keeping in shape, and negative consequences due to adolescent overweight and adolescent objective overweight. Overweight during adolescence emerged as the most relevant retrospective correlate in the distinction between BN and AN participants. Family expectations and the importance placed on keeping in shape were also significant retrospective correlates in the BN group.

Male bladder cancer risk and occupational exposure according to a job-exposure matrix-a case-control study in British Columbia, Canada.

PubMed

Richardson, Kathryn; Band, Pierre R; Astrakianakis, George; Le, Nhu D

2007-12-01

The authors investigated the risk of bladder cancer in association with exposure to over 12 000 occupational chemical agents, complex mixtures, and other substances (hereafter referred to as chemical agents). Adult males diagnosed with cancer between 1983 and 1990 in British Columbia, Canada, were surveyed. Detailed occupational histories and confounding information was provided by a self-administered questionnaire. Cancer controls were matched to bladder cancer cases, resulting in 1062 cases and 8057 controls for the analysis. An extensive United-States-based job-exposure matrix was applied to estimate cumulative exposure to occupational chemical agents. Odds ratios for bladder cancer due to exposure to chemical agents were estimated via conditional logistic regression analyses, adjusted for important confounders. A significantly (P<0.05) increased risk was detected for ever exposure to 635 chemical agents, and 341 chemical agents exhibited a significantly increasing dose-response relationship. Adjustment for multiple comparisons resulted in a subset of 29 chemical agents that continued to show significant results. A principal components analysis classified these 29 chemical agents into five independent groups, distinguished mainly by job. Exposures to these chemical agents were largely due to employment in the logging and construction industries and occupations involving motor vehicles. Consistent results were observed for bladder carcinogens reported in the literature. This study suggests that several specific chemical agents were significantly associated with the risk of bladder cancer. The chemical agents were mainly derivatives or combustion products of fossil fuels. The results corroborate important findings from the literature and document a risk for specific chemical agents not previously reported.

Childhood pneumonia and crowding, bed-sharing and nutrition: a case-control study from The Gambia.

PubMed

Howie, S R C; Schellenberg, J; Chimah, O; Ideh, R C; Ebruke, B E; Oluwalana, C; Mackenzie, G; Jallow, M; Njie, M; Donkor, S; Dionisio, K L; Goldberg, G; Fornace, K; Bottomley, C; Hill, P C; Grant, C C; Corrah, T; Prentice, A M; Ezzati, M; Greenwood, B M; Smith, P G; Adegbola, R A; Mulholland, K

2016-10-01

Greater Banjul and Upper River Regions, The Gambia. To investigate tractable social, environmental and nutritional risk factors for childhood pneumonia. A case-control study examining the association of crowding, household air pollution (HAP) and nutritional factors with pneumonia was undertaken in children aged 2-59 months: 458 children with severe pneumonia, defined according to the modified WHO criteria, were compared with 322 children with non-severe pneumonia, and these groups were compared to 801 neighbourhood controls. Controls were matched by age, sex, area and season. Strong evidence was found of an association between bed-sharing with someone with a cough and severe pneumonia (adjusted OR [aOR] 5.1, 95%CI 3.2-8.2, P < 0.001) and non-severe pneumonia (aOR 7.3, 95%CI 4.1-13.1, P < 0.001), with 18% of severe cases estimated to be attributable to this risk factor. Malnutrition and pneumonia had clear evidence of association, which was strongest between severe malnutrition and severe pneumonia (aOR 8.7, 95%CI 4.2-17.8, P < 0.001). No association was found between pneumonia and individual carbon monoxide exposure as a measure of HAP. Bed-sharing with someone with a cough is an important risk factor for severe pneumonia, and potentially tractable to intervention, while malnutrition remains an important tractable determinant.

Observed management practices in relation to the risk of infection with paratuberculosis and to the spread of Mycobacterium avium subsp. paratuberculosis in Swiss dairy and beef herds

PubMed Central

2014-01-01

Background Many studies have been conducted to define risk factors for the transmission of bovine paratuberculosis, mostly in countries with large herds. Little is known about the epidemiology in infected Swiss herds and risk factors important for transmission in smaller herds. Therefore, the presence of known factors which might favor the spread of paratuberculosis and could be related to the prevalence at animal level of fecal shedding of Mycobacterium avium subsp. paratuberculosis were assessed in 17 infected herds (10 dairy, 7 beef). Additionally, the level of knowledge of herd managers about the disease was assessed. In a case–control study with 4 matched negative control herds per infected herd, the association of potential risk factors with the infection status of the herd was investigated. Results Exposure of the young stock to feces of older animals was frequently observed in infected and in control herds. The farmers’ knowledge about paratuberculosis was very limited, even in infected herds. An overall prevalence at animal level of fecal shedding of Mycobacterium avium subsp. paratuberculosis of 6.1% was found in infected herds, whereby shedders younger than 2 years of age were found in 46.2% of the herds where the young stock was available for testing. Several factors related to contamination of the heifer area with cows’ feces and the management of the calving area were found to be significantly associated with the within-herd prevalence. Animal purchase was associated with a positive herd infection status (OR = 7.25, p = 0.004). Conclusions Numerous risk factors favoring the spread of Mycobacterium avium subsp. paratuberculosis from adult animals to the young stock were observed in infected Swiss dairy and beef herds, which may be amenable to improvement in order to control the disease. Important factors were contamination of the heifer and the calving area, which were associated with higher within-herd prevalence of fecal shedding. The awareness of farmers of paratuberculosis was very low, even in infected herds. Animal purchase in a herd was significantly associated with the probability of a herd to be infected and is thus the most important factor for the control of the spread of disease between farms. PMID:24930008

Implementation of Enhanced Propulsion Control Modes for Emergency Flight Operation

NASA Technical Reports Server (NTRS)

Csank, Jeffrey T.; Chin, Jeffrey C.; May, Ryan D.; Litt, Jonathan S.; Guo, Ten-Huei

2011-01-01

Aircraft engines can be effective actuators to help pilots avert or recover from emergency situations. Emergency control modes are being developed to enhance the engines performance to increase the probability of recovery under these circumstances. This paper discusses a proposed implementation of an architecture that requests emergency propulsion control modes, allowing the engines to deliver additional performance in emergency situations while still ensuring a specified safety level. In order to determine the appropriate level of engine performance enhancement, information regarding the current emergency scenario (including severity) and current engine health must be known. This enables the engine to operate beyond its nominal range while minimizing overall risk to the aircraft. In this architecture, the flight controller is responsible for determining the severity of the event and the level of engine risk that is acceptable, while the engine controller is responsible for delivering the desired performance within the specified risk range. A control mode selector specifies an appropriate situation-specific enhanced mode, which the engine controller then implements. The enhanced control modes described in this paper provide additional engine thrust or response capabilities through the modification of gains, limits, and the control algorithm, but increase the risk of engine failure. The modifications made to the engine controller to enable the use of the enhanced control modes are described, as are the interaction between the various subsystems and importantly, the interaction between the flight controller/pilot and the propulsion control system. Simulation results demonstrate how the system responds to requests for enhanced operation and the corresponding increase in performance.

Is there a new finding added to the fibromyalgia syndrome?

PubMed

Sarifakioglu, Banu; Guzelant, Aliye Yildirim; Alpsoy, Seref; Topcu, Birol; Unsal, Cuneyt; Sahin, Nilay

2014-01-01

The aim of this study is to examine depression and anxiety related arrhytmia risk in fibromyalgia syndrome (FMS). Fifty-nine patients with the diagnosis of FMS and 20 control participants were included in the study. Fibromyalgia Impact Questionnaire (FIQ), Visual Pain Scale (VPS) surveys were applied to determine the severity of the disease. Beck Anxiety (BAS) and Beck Depression scales (BDS) were applied to all participants. Electrocardiograms were obtained from all participants. P-wave dispersions (Pd) were estimated to determine the risk of the atrial arrhythmia, and QT wave dispersion (QTd) and corrected QT(QTdd) values were used to predict the risk of ventricular arrhythmia. BAS and BDS results were significantly higher in the patient group compared to the control group (p˂0001). In the patient group, Pd was significantly longer (p=0.034). Other clinical, and demographic data did not differ significantly between groups. In this study, the risk of arrhythmia in FMS was evaluated and increased Pd in patients with FMS compared to the control group was detected. This finding shows increased risk of atrial fibrilation (AF) in patients with FMS. If we consider that patients with fibromyalgia consist relatively of young patients together with the increased risk of AF with age, it is important to follow-up these patients in later ages for AF risk.

Association between RTEL1, PHLDB1, and TREH Polymorphisms and Glioblastoma Risk: A Case-Control Study

PubMed Central

Yang, Bo; Heng, Liang; Du, Shuli; Yang, Hua; Jin, Tianbo; Lang, Hongjuan; Li, Shanqu

2015-01-01

Background Glioblastoma (GBM) is a highly invasive, aggressive, and incurable brain tumor. Genetic factors play important roles in GBM risk. The aim of this study was to elucidate the influence of gene polymorphism on GBM susceptibility. Material/Methods In this case-control study, we included 72 GBM patients and 320 healthy controls to analyze the association between 29 single-nucleotide polymorphisms and GBM cancer risk in the Chinese Han population. The single-nucleotide polymorphisms were determined by Sequenom MassARRAY RS1000 and statistical analysis was performed using SPSS software and SNPStats software. Results Using the χ2 test, we found that rs2297440 and rs6010620 in RTEL1 increased risk of GBM. In the recessive model, we also found that the genotypes “CC” of rs2297440 and “GG” of rs6010620 in RTEL1 significantly increased GBM risk. The variant TT genotype of TREH rs17748 and the variant TT genotype of PHLDB1 rs498872 decreased GBM risk in the recessive model. We also found that the TREH rs17748 variant C allele showed an increased risk in males in the dominant model. Conclusions Our results suggest a significant association between the RETL1, TREH, and PHLDB1 genes and GBM development in the Han Chinese population. PMID:26156397

Association between RTEL1, PHLDB1, and TREH Polymorphisms and Glioblastoma Risk: A Case-Control Study.

PubMed

Yang, Bo; Heng, Liang; Du, Shuli; Yang, Hua; Jin, Tianbo; Lang, Hongjun; Li, Shanqu

2015-07-09

Glioblastoma (GBM) is a highly invasive, aggressive, and incurable brain tumor. Genetic factors play important roles in GBM risk. The aim of this study was to elucidate the influence of gene polymorphism on GBM susceptibility. In this case-control study, we included 72 GBM patients and 320 healthy controls to analyze the association between 29 single-nucleotide polymorphisms and GBM cancer risk in the Chinese Han population. The single-nucleotide polymorphisms were determined by Sequenom MassARRAY RS1000 and statistical analysis was performed using SPSS software and SNPStats software. Using the χ(2) test, we found that rs2297440 and rs6010620 in RTEL1 increased risk of GBM. In the recessive model, we also found that the genotypes "CC" of rs2297440 and "GG" of rs6010620 in RTEL1 significantly increased GBM risk. The variant TT genotype of TREH rs17748 and the variant TT genotype of PHLDB1 rs498872 decreased GBM risk in the recessive model. We also found that the TREH rs17748 variant C allele showed an increased risk in males in the dominant model. Our results suggest a significant association between the RETL1, TREH, and PHLDB1 genes and GBM development in the Han Chinese population.

A case-control study of risk factors for multiple sclerosis in Iran.

PubMed

Alonso, Alvaro; Cook, Stuart D; Maghzi, Amir-Hadi; Divani, Afshin A

2011-05-01

Numerous studies have assessed risk factors for multiple sclerosis (MS), although none have been conducted previously in Iran. The objective of this study was to study lifestyle and environmental risk factors of MS in the Iranian population. A case-control study, including 394 MS cases and 394 matched controls, was conducted in MS clinics in different Iranian cities. Information on lifestyles, environmental exposures, and past medical history was obtained from medical charts and phone interviews. In multivariable analysis, sunlight exposure was associated with a lower risk of MS: the odds ratio (OR) and 95% confidence interval (CI) of MS associated with a 1-h increment in daily sunlight was 0.62 (0.53-0.73). Smoking was associated with MS risk in women (OR: 6.48, 95% CI: 1.46-28.78), but not in men (OR: 0.72, 95% CI: 0.31-1.68) (p=0.002 for interaction). Finally, past history of common surgical procedures, infectious disorders, or exposure to pets and farm animals was not associated with MS risk. Different modifiable lifestyles, including sunlight exposure and smoking, were associated with lower MS risk in Iran. Interventions aimed at promoting smoking cessation and, more importantly, at increasing exposure to sunlight might contribute to the prevention of MS.

Are there effective interventions to prevent hospital-acquired Legionnaires' disease or to reduce environmental reservoirs of Legionella in hospitals? A systematic review.

PubMed

Almeida, Dejanira; Cristovam, Elisabete; Caldeira, Daniel; Ferreira, Joaquim J; Marques, Teresa

2016-11-01

Legionnaires' disease (LD) is recognized as an important hospital-acquired disease. Despite the several methods available, the optimal method to control hospital-acquired LD is not well established and their overall efficacy requires further evaluation. To systematically review all controlled trials evaluating the efficacy of interventions to prevent hospital-acquired LD in patients at high risk of developing the disease and its effects on environmental colonization. A database search was performed through PubMed and the Cochrane Central Register of Controlled Trials (inception-November 2014). Eligible studies included all controlled studies evaluating interventions to prevent hospital-acquired LD in patients at high risk or evaluating the effect on environmental colonization. Both individual and pooled risk estimates were reported using risk ratio (RR) and 95% confidence intervals (95% CIs). There were no studies evaluating the risk reduction in hospital-acquired LD, but 4 studies evaluated the influence of copper-silver ionization and ultraviolet light in the reduction of environmental reservoirs of Legionella. The meta-analysis showed a significant 95% risk reduction of Legionella positivity in environmental samples using copper-silver ionization (RR, 0.05; 95% CI, 0.01-0.17) and 97% risk reduction with ultraviolet light (RR, 0.03; 95% CI, 0.002-0.41). The best available evidence suggests that copper-silver ionization and ultraviolet light are effective in reducing Legionella positivity in environmental samples. Nevertheless, the low quality of evidence weakens the robustness of conclusions. Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Is introversion a risk factor for suicidal behaviour in depression?

PubMed

Roy, A

1998-11-01

Personality is an important determinant of suicidal behaviour. However, it has been studied little in relation to suicidal behaviour in depression. Depressed patients who had attempted suicide (N = 41) were compared with depressed patients who had never attempted suicide (N = 56) and normal controls (N = 56) for their scores on three personality questionnaires. Introversion was the only personality dimension where the post hoc test showed a different pattern between the two groups of depressed patients in their relation to controls. In particular, only depressed patients who had attempted suicide had significantly lower introversion scores than controls. The personality dimension of introversion may be a risk factor for suicidal behaviour in depression.

The @RISK Study: Risk communication for patients with type 2 diabetes: design of a randomised controlled trial.

PubMed

Welschen, Laura M C; Bot, Sandra D M; Dekker, Jacqueline M; Timmermans, Daniëlle R M; van der Weijden, Trudy; Nijpels, Giel

2010-08-05

Patients with type 2 diabetes mellitus (T2DM) have an increased risk to develop severe diabetes related complications, especially cardiovascular disease (CVD). The risk to develop CVD can be estimated by means of risk formulas. However, patients have difficulties to understand the outcomes of these formulas. As a result, they may not recognize the importance of changing lifestyle and taking medication in time. Therefore, it is important to develop risk communication methods, that will improve the patients' understanding of risks associated with having diabetes, which enables them to make informed choices about their diabetes care.The aim of this study is to investigate the effects of an intervention focussed on the communication of the absolute 10-year risk to develop CVD on risk perception, attitude and intention to change lifestyle behaviour in patients with T2DM. The conceptual framework of the intervention is based on the Theory of Planned Behaviour and the Self-regulation Theory. A randomised controlled trial will be performed in the Diabetes Care System West-Friesland (DCS), a managed care system. Newly referred T2DM patients of the DCS, younger than 75 years will be eligible for the study. The intervention group will be exposed to risk communication on CVD, on top of standard managed care of the DCS. This intervention consists of a simple explanation on the causes and consequences of CVD, and possibilities for prevention. The probabilities of CVD in 10 year will be explained in natural frequencies and visualised by a population diagram. The control group will receive standard managed care. The primary outcome is appropriateness of risk perception. Secondary outcomes are attitude and intention to change lifestyle behaviour and illness perception. Differences between baseline and follow-up (2 and 12 weeks) between groups will be analysed according to the intention-to-treat principle. The study was powered on 120 patients in each group. This innovative risk communication method based on two behavioural theories might improve patient's appropriateness of risk perception and attitude concerning lifestyle change. With a better understanding of their CVD risk, patients will be able to make informed choices concerning diabetes care. The trial is registered as NTR1556 in the Dutch Trial Register.

The influence of parental monitoring and parent-adolescent communication on Bahamian adolescent risk involvement: A three-year longitudinal examination

PubMed Central

Wang, Bo; Stanton, Bonita; Li, Xiaoming; Cottrell, Lesley; Deveaux, Lynette; Kaljee, Linda

2014-01-01

The literature suggests that parental monitoring can best be conceptualized and measured through the domains of parental knowledge, youth disclosure, parental solicitation, and parental control. Using longitudinal data on 913 grade-six Bahamian students followed over a period of three years, we examined the unique and independent roles of these domains of parental monitoring and parent–adolescent communication in relation to adolescent involvement in delinquency, substance use, and sexual risk behaviors. The results obtained with mixed-effects models indicate that parental knowledge, youth disclosure, and parental control are negatively associated with both delinquency and substance use. Open parent—adolescent communication was associated with decreased sexual risk behavior, whereas problematic parent–adolescent communication was associated with increased sexual risk behavior. The results obtained with path models indicate that youth disclosure is a significant longitudinal predictor of reduced adolescent delinquency and that parental control during early adolescence predicted reduced substance use in middle adolescence. The findings suggest that parental knowledge, youth disclosure and parental control differ in their impacts on substance use, delinquency and sexual risk behaviors. Problematic parent–adolescent communication is consistently associated with increases in all three types of adolescent risk behaviors. Future parental monitoring interventions should focus on enhancing parents’ interpersonal communication skills and emphasize the differences in and importance of the unique components of parental monitoring. PMID:24161101

The influence of parental monitoring and parent-adolescent communication on Bahamian adolescent risk involvement: a three-year longitudinal examination.

PubMed

Wang, Bo; Stanton, Bonita; Li, Xiaoming; Cottrell, Lesley; Deveaux, Lynette; Kaljee, Linda

2013-11-01

The literature suggests that parental monitoring can best be conceptualized and measured through the domains of parental knowledge, youth disclosure, parental solicitation, and parental control. Using longitudinal data on 913 grade-six Bahamian students followed over a period of three years, we examined the unique and independent roles of these domains of parental monitoring and parent-adolescent communication in relation to adolescent involvement in delinquency, substance use, and sexual risk behaviors. The results obtained with mixed-effects models indicate that parental knowledge, youth disclosure, and parental control are negatively associated with both delinquency and substance use. Open parent-adolescent communication was associated with decreased sexual risk behavior, whereas problematic parent-adolescent communication was associated with increased sexual risk behavior. The results obtained with path models indicate that youth disclosure is a significant longitudinal predictor of reduced adolescent delinquency and that parental control during early adolescence predicted reduced substance use in middle adolescence. The findings suggest that parental knowledge, youth disclosure and parental control differ in their impacts on substance use, delinquency and sexual risk behaviors. Problematic parent-adolescent communication is consistently associated with increases in all three types of adolescent risk behaviors. Future parental monitoring interventions should focus on enhancing parents' interpersonal communication skills and emphasize the differences in and importance of the unique components of parental monitoring. Copyright © 2013. Published by Elsevier Ltd.

Assessing the risk of highly pathogenic avian influenza H5N1 transmission through poultry movements in Bali, Indonesia.

PubMed

Roche, Sharon E; Cogger, Naomi; Garner, M Graeme; Putra, Anak Agung Gde; Toribio, Jenny-Ann L M L

2014-03-01

Indonesia continues to report the highest number of human and poultry cases of highly pathogenic avian influenza H5N1. The disease is considered to be endemic on the island of Bali. Live bird markets are integral in the poultry supply chain on Bali and are important, nutritionally and culturally, for the rural and urban human populations. Due to the lack of biosecurity practiced along the supply chain from producer to live bird markets, there is a need to understand the risks associated with the spread of H5N1 through live bird movements for effective control. Resources to control H5N1 in Indonesia are very limited and cost effective strategies are needed. We assessed the probability a live bird market is infected through live poultry movements and assessed the effects of implementing two simple and low cost control measures on this risk. Results suggest there is a high risk a live bird market is infected (0.78), and risk mitigation strategies such as detecting and removing infected poultry from markets reduce this risk somewhat (range 0.67-0.76). The study demonstrates the key role live poultry movements play in transmitting H5N1 and the need to implement a variety of control measures to reduce disease spread. Copyright © 2014 Elsevier B.V. All rights reserved.

Cigarette Smoking and the Risk of Bladder Cancer in Men and Women

PubMed Central

Quirk, Jeffrey T; Li, Qiang; Natarajan, Nachimuthu; Mettlin, Curtis J; Cummings, K Michael

2004-01-01

Although cigarette smoking is a principal risk factor for bladder cancer in both men and women, few studies have statistically evaluated whether gender modifies the effect of smoking on bladder cancer risk. We initiated the present case-control study at Roswell Park Cancer Institute in Buffalo, New York, U.S., to provide further data on this important issue. We observed similar risk estimates for men and women with comparable smoking exposures, but did not observe a statistically significant interaction between gender and lifetime smoking exposure. We conclude that cigarette smoking is a major risk factor for bladder cancer in both sexes, but that gender does not modify the effect of smoking on bladder cancer risk.

78 FR 7674 - Foreign Quarantine; Import Regulations for Infectious Biological Agents, Infectious Substances...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-04

... potential to pose a risk to public health and safety. Since 2009, we have refined the HHS/CDC import permit... DEPARTMENT OF HEALTH AND HUMAN SERVICES [Docket No. CDC-2011-0007] 42 CFR Part 71 RIN 0920-AA37... Vectors AGENCY: Centers for Disease Control and Prevention (CDC), Department of Health and Human Services...

78 FR 69602 - Foreign Supplier Verification Programs for Importers of Food for Humans and Animals; Extension of...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-11-20

... ``Current Good Manufacturing Practice and Hazard Analysis and Risk-Based Preventive Controls for Food for... DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration 21 CFR Part 1 [Docket No. FDA-2011-N-0143] RIN 0910-AG64 Foreign Supplier Verification Programs for Importers of Food for Humans and...

[A 6-year evaluation of dyslipidemia in a health center: Importance of improvement actions].

PubMed

Antón-García, F; Correcher-Salvador, E; Rodríguez-Lagos, F A; González-Caminero, S

2014-01-01

Dyslipidemia, especially an increased LDL-cholesterol, has been shown to be one of the most important risk factors in the genesis of coronary involvement. The prevalence of dyslipidemias in Spain is high. The objective of this study is to assess the progress of dyslipidemic patients in our health center over a 6-year period, and see if there has been any improvement in its control after the presentation of the evaluation of the first 3 years, as well as an updated dyslipidemia protocol. Assessment Period 1 (2006-2008): 267 patients with dyslipidemia. Assessment Period 2 (2009-2011): 222 patients, excluding exitus and address changes. age, sex, personal history of CVD, vascular risk factors, lipids, drug treatment, risk levels, and percentages of CV control objectives. Mean age was 66.2 years (SD 13.4), 66.3% women. Period 1-Period 2: Total cholesterol: 221.9-196.6 mg/dl (P=.000); LDL-cholesterol: 147.9-115.8 mg/dl (P=.000). In high risk patients, therapeutic targets: 14-50.5% (P=.024); medium risk: 35-68.1% (P=.038); low risk: 44-68.2% (P=NS). Pharmacotherapy 68-77% (P=.000). Changing treatment: 30-43% (P=.001). Adherence: 75-86% (P=.003). Untreated high risk: 15.4-16.3% (P=NS). There was a significant improvement in Period 2, especially in high-risk patients, after presenting the results of the evaluation for Period 1 and with the updated dyslipidemia protocol. There are high risk patients without lipid-lowering treatment to be detected and reviewed. Copyright © 2013 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España. All rights reserved.

Risk Management Implementation Tool

NASA Technical Reports Server (NTRS)

Wright, Shayla L.

2004-01-01

Continuous Risk Management (CM) is a software engineering practice with processes, methods, and tools for managing risk in a project. It provides a controlled environment for practical decision making, in order to assess continually what could go wrong, determine which risk are important to deal with, implement strategies to deal with those risk and assure the measure effectiveness of the implemented strategies. Continuous Risk Management provides many training workshops and courses to teach the staff how to implement risk management to their various experiments and projects. The steps of the CRM process are identification, analysis, planning, tracking, and control. These steps and the various methods and tools that go along with them, identification, and dealing with risk is clear-cut. The office that I worked in was the Risk Management Office (RMO). The RMO at NASA works hard to uphold NASA s mission of exploration and advancement of scientific knowledge and technology by defining and reducing program risk. The RMO is one of the divisions that fall under the Safety and Assurance Directorate (SAAD). I worked under Cynthia Calhoun, Flight Software Systems Engineer. My task was to develop a help screen for the Continuous Risk Management Implementation Tool (RMIT). The Risk Management Implementation Tool will be used by many NASA managers to identify, analyze, track, control, and communicate risks in their programs and projects. The RMIT will provide a means for NASA to continuously assess risks. The goals and purposes for this tool is to provide a simple means to manage risks, be used by program and project managers throughout NASA for managing risk, and to take an aggressive approach to advertise and advocate the use of RMIT at each NASA center.

Reputation, relationships, risk communication, and the role of trust in the prevention and control of communicable disease: a review.

PubMed

Cairns, Georgina; de Andrade, Marisa; MacDonald, Laura

2013-01-01

Population-level compliance with health protective behavioral advice to prevent and control communicable disease is essential to optimal effectiveness. Multiple factors affect perceptions of trustworthiness, and trust in advice providers is a significant predeterminant of compliance. While competency in assessment and management of communicable disease risks is critical, communications competency may be equally important. Organizational reputation, quality of stakeholder relationships and risk information provision strategies are trust moderating factors, whose impact is strongly influenced by the content, timing and coordination of communications. This article synthesizes the findings of 2 literature reviews on trust moderating communications and communicable disease prevention and control. We find a substantial evidence base on risk communication, but limited research on other trust building communications. We note that awareness of good practice historically has been limited although interest and the availability of supporting resources is growing. Good practice and policy elements are identified: recognition that crisis and risk communications require different strategies; preemptive dialogue and planning; evidence-based approaches to media relations and messaging; and building credibility for information sources. Priority areas for future research include process and cost-effectiveness evaluation and the development of frameworks that integrate communication and biomedical disease control and prevention functions, conceptually and at scale.

Vehicle year and the risk of car crash injury

PubMed Central

Blows, S; Ivers, R; Woodward, M; Connor, J; Ameratunga, S; Norton, R

2003-01-01

Objective: To quantify the association between vehicle age and risk of car crash injury. Design and setting: Data from a population based case-control study conducted in the Auckland region in 1998/99 was used to examine the adjusted risk of car crash injury or death due to vehicle age, after controlling for a range of known confounders. Cases were all cars involved in crashes in which at least one occupant was hospitalized or killed anywhere in the Auckland region, and controls were randomly selected cars on Auckland roads. The drivers of the 571 case vehicles and 588 control vehicles completed a structured interview. Main outcome measure: Hospitalisation or death of a vehicle occupant due to car crash injury. Results: Vehicles constructed before 1984 had significantly greater chance of being involved in an injury crash than those constructed after 1994 (odds ratio 2.88, 95% confidence interval (CI) 1.20 to 6.91), after adjustment for potential confounders. There was also a trend for increasing crash risk with each one year increase in vehicle age after adjustment for potential confounders (odds ratio 1.05, 95% CI 0.99 to 1.11; p = 0.09). Conclusion: This study quantifies the increased risk of car crash injury associated with older vehicle year and confirms this as an important public health issue. PMID:14693899

Vehicle year and the risk of car crash injury.

PubMed

Blows, S; Ivers, R Q; Woodward, M; Connor, J; Ameratunga, S; Norton, R

2003-12-01

To quantify the association between vehicle age and risk of car crash injury. Data from a population based case-control study conducted in the Auckland region in 1998/99 was used to examine the adjusted risk of car crash injury or death due to vehicle age, after controlling for a range of known confounders. Cases were all cars involved in crashes in which at least one occupant was hospitalized or killed anywhere in the Auckland region, and controls were randomly selected cars on Auckland roads. The drivers of the 571 case vehicles and 588 control vehicles completed a structured interview. Hospitalisation or death of a vehicle occupant due to car crash injury. Vehicles constructed before 1984 had significantly greater chance of being involved in an injury crash than those constructed after 1994 (odds ratio 2.88, 95% confidence interval (CI) 1.20 to 6.91), after adjustment for potential confounders. There was also a trend for increasing crash risk with each one year increase in vehicle age after adjustment for potential confounders (odds ratio 1.05, 95% CI 0.99 to 1.11; p = 0.09). This study quantifies the increased risk of car crash injury associated with older vehicle year and confirms this as an important public health issue.

Toddlers’ dysregulated fear predicts delta-beta coupling during preschool

PubMed Central

Phelps, Randi A.; Brooker, Rebecca J.; Buss, Kristin A.

2015-01-01

Dysregulated fear, or the persistence of high levels of fear in low-threat contexts, is an early risk factor for the development of anxiety symptoms. Previous work has suggested both propensities for over-control and under-control of fearfulness as risk factors for anxiety problems, each of which may be relevant to observations of dysregulated fear. Given difficulty disentangling over-control and under-control through traditional behavioral measures, we used delta-beta coupling to begin to understand the degree to which dysregulated fear may reflect propensities for over- or under-control. We found that toddlers who showed high levels of dysregulated fear evidenced greater delta-beta coupling at frontal and central electrode sites as preschoolers relative to children who were low in dysregulated fear. Importantly, these differences were not observed when comparisons were made based on fear levels in high threat contexts. Results suggest dysregulated fear may involve tendencies toward over-control at the neural level. PMID:26624221

Continuous Risk Management: An Overview

NASA Technical Reports Server (NTRS)

Rosenberg, Linda; Hammer, Theodore F.

1999-01-01

Software risk management is important because it helps avoid disasters, rework, and overkill, but more importantly because it stimulates win-win situations. The objectives of software risk management are to identify, address, and eliminate software risk items before they become threats to success or major sources of rework. In general, good project managers are also good managers of risk. It makes good business sense for all software development projects to incorporate risk management as part of project management. The Software Assurance Technology Center (SATC) at NASA GSFC has been tasked with the responsibility for developing and teaching a systems level course for risk management that provides information on how to implement risk management. The course was developed in conjunction with the Software Engineering Institute at Carnegie Mellon University, then tailored to the NASA systems community. This is an introductory tutorial to continuous risk management based on this course. The rational for continuous risk management and how it is incorporated into project management are discussed. The risk management structure of six functions is discussed in sufficient depth for managers to understand what is involved in risk management and how it is implemented. These functions include: (1) Identify the risks in a specific format; (2) Analyze the risk probability, impact/severity, and timeframe; (3) Plan the approach; (4) Track the risk through data compilation and analysis; (5) Control and monitor the risk; (6) Communicate and document the process and decisions.

Stomach Cancer Risk After Treatment for Hodgkin Lymphoma

PubMed Central

Morton, Lindsay M.; Dores, Graça M.; Curtis, Rochelle E.; Lynch, Charles F.; Stovall, Marilyn; Hall, Per; Gilbert, Ethel S.; Hodgson, David C.; Storm, Hans H.; Johannesen, Tom Børge; Smith, Susan A.; Weathers, Rita E.; Andersson, Michael; Fossa, Sophie D.; Hauptmann, Michael; Holowaty, Eric J.; Joensuu, Heikki; Kaijser, Magnus; Kleinerman, Ruth A.; Langmark, Frøydis; Pukkala, Eero; Vaalavirta, Leila; van den Belt-Dusebout, Alexandra W.; Fraumeni, Joseph F.; Travis, Lois B.; Aleman, Berthe M.; van Leeuwen, Flora E.

2013-01-01

Purpose Treatment-related stomach cancer is an important cause of morbidity and mortality among the growing number of Hodgkin lymphoma (HL) survivors, but risks associated with specific HL treatments are unclear. Patients and Methods We conducted an international case-control study of stomach cancer nested in a cohort of 19,882 HL survivors diagnosed from 1953 to 2003, including 89 cases and 190 matched controls. For each patient, we quantified cumulative doses of specific alkylating agents (AAs) and reconstructed radiation dose to the stomach tumor location. Results Stomach cancer risk increased with increasing radiation dose to the stomach (Ptrend < .001) and with increasing number of AA-containing chemotherapy cycles (Ptrend = .02). Patients who received both radiation to the stomach ≥ 25 Gy and high-dose procarbazine (≥ 5,600 mg/m2) had strikingly elevated stomach cancer risk (25 cases, two controls; odds ratio [OR], 77.5; 95% CI, 14.7 to 1452) compared with those who received radiation < 25 Gy and procarbazine < 5,600 mg/m2 (Pinteraction < .001). Risk was also elevated (OR, 2.8; 95% CI, 1.3 to 6.4) among patients who received radiation to the stomach ≥ 25 Gy but procarbazine < 5,600 mg/m2; however, no procarbazine-related risk was evident with radiation < 25 Gy. Treatment with dacarbazine also increased stomach cancer risk (12 cases, nine controls; OR, 8.8; 95% CI, 2.1 to 46.6), after adjustment for radiation and procarbazine doses. Conclusion Patients with HL who received subdiaphragmatic radiotherapy had dose-dependent increased risk of stomach cancer, with marked risks for patients who also received chemotherapy containing high-dose procarbazine. For current patients, risks and benefits of exposure to both procarbazine and subdiaphragmatic radiotherapy should be weighed carefully. For patients treated previously, GI symptoms should be evaluated promptly. PMID:23980092

Superior Efficacy of a Human Immunodeficiency Virus Vaccine Combined with Antiretroviral Prevention in Simian-Human Immunodeficiency Virus-Challenged Nonhuman Primates

PubMed Central

Le Grand, Roger; Dereuddre-Bosquet, Nathalie; Dispinseri, Stefania; Gosse, Leslie; Desjardins, Delphine; Shen, Xiaoying; Tolazzi, Monica; Ochsenbauer, Christina; Saidi, Hela; Tomaras, Georgia; Prague, Mélanie; Barnett, Susan W.; Thiebaut, Rodolphe; Scarlatti, Gabriella

2016-01-01

ABSTRACT Although vaccines and antiretroviral (ARV) prevention have demonstrated partial success against human immunodeficiency virus (HIV) infection in clinical trials, their combined introduction could provide more potent protection. Furthermore, combination approaches could ameliorate the potential increased risk of infection following vaccination in the absence of protective immunity. We used a nonhuman primate model to determine potential interactions of combining a partially effective ARV microbicide with an envelope-based vaccine. The vaccine alone provided no protection from infection following 12 consecutive low-dose intravaginal challenges with simian-HIV strain SF162P3, with more animals infected compared to naive controls. The microbicide alone provided a 68% reduction in the risk of infection relative to that of the vaccine group and a 45% reduction relative to that of naive controls. The vaccine-microbicide combination provided an 88% reduction in the per-exposure risk of infection relative to the vaccine alone and a 79% reduction relative to that of the controls. Protected animals in the vaccine-microbicide group were challenged a further 12 times in the absence of microbicide and demonstrated a 98% reduction in the risk of infection. A total risk reduction of 91% was observed in this group over 24 exposures (P = 0.004). These important findings suggest that combined implementation of new biomedical prevention strategies may provide significant gains in HIV prevention. IMPORTANCE There is a pressing need to maximize the impact of new biomedical prevention tools in the face of the 2 million HIV infections that occur each year. Combined implementation of complementary biomedical approaches could create additive or synergistic effects that drive improved reduction of HIV incidence. Therefore, we assessed a combination of an untested vaccine with an ARV-based microbicide in a nonhuman primate vaginal challenge model. The vaccine alone provided no protection (and may have increased susceptibility to a simian-HIV vaginal challenge), while the microbicide reduced the infection risk compared to that of vaccinated and naive animals. Importantly, the combined interventions provided the greatest level of protection, which was sustained following withdrawal of the microbicide. The data suggest that provision of ARV prophylaxis during vaccination reduces the potential for unexpected increased risks of infection following immunization and augments vaccine efficacy. These findings are important for the potential adoption of ARV prophylaxis as the baseline intervention for future HIV/AIDS vaccines. PMID:27009957

Risk factors for tuberculosis among health care workers in South India: a nested case-control study.

PubMed

Mathew, Anoop; David, Thambu; Thomas, Kurien; Kuruvilla, P J; Balaji, V; Jesudason, Mary V; Samuel, Prasanna

2013-01-01

The epidemiology of tuberculosis (TB) among health care workers (HCWs) in India remains under-researched. This study is a nested case-control design assessing the risk factors for acquiring TB among HCWs in India. It is a nested case-control study conducted at a tertiary teaching hospital in India. Cases (n = 101) were HCWs with active TB. Controls (n = 101) were HCWs who did not have TB, randomly selected from the 6,003 subjects employed at the facility. Cases and controls were compared with respect to clinical and demographic variables. The cases and controls were of similar age. Logistic regression analysis showed that body mass index (BMI) <19 kg/m(2) (odds ratio [OR]: 2.96, 95% confidence interval [CI]: 1.49-5.87), having frequent contact with patients (OR: 2.83, 95% CI: 1.47-5.45) and being employed in medical wards (OR: 12.37, 95% CI: 1.38-110.17) or microbiology laboratories (OR: 5.65, 95% CI: 1.74-18.36) were independently associated with increased risk of acquiring TB. HCWs with frequent patient contact and those with BMI <19 kg/m(2) were at high risk of acquiring active TB. Nosocomial transmission of TB was pronounced in locations, such as medical wards and microbiology laboratories. Surveillance of high-risk HCWs and appropriate infrastructure modifications may be important to prevent interpersonal TB transmission in health care facilities. Copyright © 2013 Elsevier Inc. All rights reserved.

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

PubMed

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

2015-01-01

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

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

PubMed Central

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

2015-01-01

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

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

PubMed

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

2014-08-23

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

Command Process Modeling & Risk Analysis

NASA Technical Reports Server (NTRS)

Meshkat, Leila

2011-01-01

Commanding Errors may be caused by a variety of root causes. It's important to understand the relative significance of each of these causes for making institutional investment decisions. One of these causes is the lack of standardized processes and procedures for command and control. We mitigate this problem by building periodic tables and models corresponding to key functions within it. These models include simulation analysis and probabilistic risk assessment models.

Focusing on appraisals: how and why anger and fear influence driving risk perception.

PubMed

Lu, Jingyi; Xie, Xiaofei; Zhang, Ruogu

2013-06-01

The present research explores how and why anger and fear influence driving risk perception. Based on appraisal tendency framework, researchers hypothesized that anger and fear would influence driving risk perception in opposite directions due to their differences in appraisals. Study 1 showed that anger reduced risk perception, whereas fear increased it. In Studies 2, 3, and 4, the researchers adopted the paradigm of reappraisal to investigate the causes of the opposite effects found in Study 1. Consistent with our hypothesis, appraisals accounted for these effects: After reappraisals along the dimensions of certainty (Study 2), control (Study 3), and responsibility (Study 4), the different effects between anger and fear on driving risk perception diminished or disappeared. In addition, fearful or angry experience mediated the effects of reappraisals on driving risk perception. The findings highlight the necessity to differentiate anger and fear in road safety management. Additionally, the current research also provides feasible methods (e.g., certainty, control, or responsibility reappraisal) to intervene in driving risk perception, which is important for driving safety. Copyright © 2013 National Safety Council and Elsevier Ltd. All rights reserved.

The global geographical overlap of aflatoxin and hepatitis C: Controlling risk factors for liver cancer worldwide

PubMed Central

Palliyaguru, Dushani L.; Wu, Felicia

2012-01-01

About 85% of hepatocellular carcinoma (HCC, liver cancer) cases occur in low-income countries, where the risk factors of dietary aflatoxin exposure and chronic hepatitis B and C (HBV and HCV) viral infection are common. While studies have shown synergism between aflatoxin and HBV in causing HCC, much less is known about whether aflatoxin and HCV synergize similarly. From an exposure perspective, we examine whether there is a geographical overlap in populations worldwide exposed to high dietary aflatoxin levels and with high HCV prevalence. While HCV is one of the most important risk factors for HCC in high-income nations (where aflatoxin exposure is low), we find that HCV prevalence is much higher in Africa and Asia, where aflatoxin exposure is also high. However, within a given world region, there are some inconsistencies regarding exposure and cancer risk. Therefore, there is a need to control risk factors such as aflatoxin and hepatitis viruses in a cost-effective manner to prevent global HCC, while continuing to evaluate biological mechanisms by which these risk factors interact to increase HCC risk. PMID:23281740

[Security of the medicinal therapy: Cartography of risks a priori within service of orthopaedic surgery].

PubMed

Razurel, A; Bertrand, É; Deranlot, J; Benhamou, F; Tritz, T; Le Mercier, F; Hardy, P

2015-11-01

Security and quality of the Medicinal Therapy are one of the most important objectives of the April 6th, 2011 order. The objective is to realize this study of the risks incurred by patients related to management and security of medicinal therapy in order to establish a plan to reduce the risks of drug's dispensation. The method of the Preliminary Risk Analysis (PRA) has been implemented by a multidisciplinary group in a hospital service of orthopaedic surgery. The study focused on the dispensation phase of medicinal circuit. This analysis revealed 148 scenarii, 35 were criticality unacceptable. Fifty-four initial risk control actions were proposed and their stress levels to put them in place were evaluated. The main measures of risk management are: training, information, communication, computerization, automation, dual control, updating the documentation system, drug reconciliation and respect for Best Practices Hospitallers (BPH). Risk management requires a significant human and financial investment as well as, material resources and multidisciplinary expertise in order to offer the best solutions. Copyright © 2015 Académie Nationale de Pharmacie. Published by Elsevier Masson SAS. All rights reserved.

Risk-sensitivity and the mean-variance trade-off: decision making in sensorimotor control

PubMed Central

Nagengast, Arne J.; Braun, Daniel A.; Wolpert, Daniel M.

2011-01-01

Numerous psychophysical studies suggest that the sensorimotor system chooses actions that optimize the average cost associated with a movement. Recently, however, violations of this hypothesis have been reported in line with economic theories of decision-making that not only consider the mean payoff, but are also sensitive to risk, that is the variability of the payoff. Here, we examine the hypothesis that risk-sensitivity in sensorimotor control arises as a mean-variance trade-off in movement costs. We designed a motor task in which participants could choose between a sure motor action that resulted in a fixed amount of effort and a risky motor action that resulted in a variable amount of effort that could be either lower or higher than the fixed effort. By changing the mean effort of the risky action while experimentally fixing its variance, we determined indifference points at which participants chose equiprobably between the sure, fixed amount of effort option and the risky, variable effort option. Depending on whether participants accepted a variable effort with a mean that was higher, lower or equal to the fixed effort, they could be classified as risk-seeking, risk-averse or risk-neutral. Most subjects were risk-sensitive in our task consistent with a mean-variance trade-off in effort, thereby, underlining the importance of risk-sensitivity in computational models of sensorimotor control. PMID:21208966

Risk Factors for Hospital-acquired Clostridium difficile Infection Among Pediatric Patients With Cancer.

PubMed

Daida, Atsuro; Yoshihara, Hiroki; Inai, Ikuko; Hasegawa, Daisuke; Ishida, Yasushi; Urayama, Kevin Y; Manabe, Atsushi

2017-04-01

Hospital-acquired Clostridium difficile infection (CDI) may cause life-threatening colitis for children with cancer, making identification of risk factors important. We described characteristics of pediatric cancer patients with primary and recurring CDI, and evaluated potential risk factors. Among 189 cancer patients, 51 cases (27%) of CDI and 94 matched controls of cancer patients without CDI were analyzed. Multivariable logistic regression was used to evaluate the association between CDI and several potential risk factors. Median age of CDI cases was lower (3.3 y; 0.60 to 16.2) than controls (7.7 y; 0.4 to 20.5). Median duration of neutropenia before CDI was longer for CDI cases (10.0 d; 0.0 to 30.0) compared with duration calculated from reference date in controls (6.0 d; 0.0 to 29.0). Multivariable analysis showed that older age was associated with reduced risk (≥7 vs. 0 to 3 y, odds ratio=0.11; 95% confidence interval, 0.02-0.54), and prolonged neutropenia was associated with increased risk (odds ratio=1.11; 95% confidence interval, 1.01-1.22). CDI recurred in 26% of cases. Younger age and prolonged neutropenia were risk factors for CDI in children with cancer. Increasing awareness to these risk factors will help to identify opportunities for CDI prevention in cancer patients.

Stillbirth risk factors according to timing of exposure.

PubMed

Dodds, Linda; King, Will D; Fell, Deshayne B; Armson, B Anthony; Allen, Alexander; Nimrod, Carl

2006-08-01

The purpose of the present study is to identify risk factors for stillbirth and explore hypotheses about the cause of stillbirth based on the time in gestation when exposures occur. Relationships between lifestyle factors, pregnancy conditions, medication use, and occupation on risk for stillbirth were examined within a population-based case-control study. Women who had a stillbirth and a random sample of women who had a live birth between 1999 and 2001 were identified through perinatal databases in Nova Scotia and Eastern Ontario, Canada. Exposure data were collected for each month of pregnancy and analyzed within trimesters. Case-control data were converted to case-cohort data, and hazard ratios (HRs) and 95% confidence intervals (CIs) were determined from Cox proportional hazards models. This study included 105 stillbirth cases and 389 live-birth controls. Fertility treatment in the present pregnancy was associated with increased risk for stillbirth (adjusted HR, 4.0; 95% CI, 1.4-11.6). Smoking during the first trimester also was associated with increased risk for stillbirth (adjusted HR, 2.4; 95% CI, 1.2-4.9). Other risk factors included antiemetic use during the first trimester, second-trimester antibiotic use, low family income, and age older than 35 years. Risk factors identified in this study concur with findings of previous studies and support the importance of early pregnancy exposures on stillbirth risk.

Influence of Insulation Monitoring Devices on the Operation of DC Control Circuits

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

Olszowiec, Piotr, E-mail: olpio@o2.pl

The insulation level of DC control circuits is an important safety-critical factor and, thus, should be subject to continuous and periodic monitoring. The methods used for monitoring the insulation in live circuits may, however, disturb the reliable operation of control relays. The risks of misoperation and failure to reset of relays posed by the operation of various insulation monitoring and fault location systems are evaluated.

Sleep apnoea syndromes and the cardiovascular system.

PubMed

Pepperell, Justin C

2011-06-01

Management of SAS and cardiovascular disease risk should be closely linked. It is important to screen for cardiovascular disease risk in patients with SAS and vice versa. CSA/CSR may be improved by ventilation strategies in heart failure, but benefit remains to be proven. For OSA, although CPAP may reduce cardiovascular disease risk, its main benefit is symptom control. In the longer-term, CPAP should be used alongside standard cardiovascular risk reduction strategies including robust weight management programmes, with referral for bariatric surgery in appropriate cases. CPAP and NIV should be considered for acute admissions with decompensated cardiac failure.

Rising Educational Gradients in Mortality: The Role of Behavioral Risk Factors

PubMed Central

Cutler, David M; Meara, Ellen; Richards-Shubik, Seth; Ruhm, Christopher J

2013-01-01

The long-standing inverse relationship between education and mortality strengthened substantially at the end of the 20th century. This paper examines the reasons for this increase. We show that behavioral risk factors are not of primary importance. Smoking declined more for the better educated, but not enough to explain the trend. Obesity rose at similar rates across education groups, and control of blood pressure and cholesterol increased fairly uniformly as well. Rather, our results show that the mortality returns to risk factors, and conditional on risk factors, the return to education, have grown over time. PMID:21925754

Identification and prediction of group-based glycemic control trajectories during the transition to adolescence.

PubMed

Rohan, Jennifer M; Rausch, Joseph R; Pendley, Jennifer Shroff; Delamater, Alan M; Dolan, Lawrence; Reeves, Grafton; Drotar, Dennis

2014-10-01

To identify trajectories of glycemic control over a period of 3 years in a pediatric sample of youth diagnosed with Type 1 diabetes transitioning to adolescence. A second aim was to examine a set of modifiable individual and family level baseline predictors of glycemic control group membership. This multisite, prospective study included 239 children and adolescents (ages 9-11 years at baseline) diagnosed with Type 1 diabetes and their caregivers. Glycemic control was based on hemoglobin A1c (HbA1c) collected at 6-month intervals over a period of 3 years. Predictors of glycemic control membership included baseline global executive functioning, diabetes self-management, diabetes-specific family conflict, blood glucose monitoring frequency, and relevant individual and family level covariates. Group-based trajectory analyses were used to describe patterns of glycemic control from baseline to 36 months and 3 trajectories were identified: low risk (42.9%), elevated risk (44.6%), and high risk (12.1%) subgroups. Baseline maternal-reported family conflict, blood glucose monitoring frequency, and gender were significant predictors of glycemic control group membership. Higher levels of baseline family conflict, lower frequency of blood glucose monitoring, and female gender were associated with elevated and high-risk group membership. These findings underscore the importance of examining trajectories of HbA1c across time. These results suggest that problematic trajectories of glycemic control are evident during the transition to adolescence. Furthermore, there are modifiable individual and family level characteristics that predict group membership and hence could be targeted in interventions to ensure adequate glycemic control is maintained over time and that risks for diabetes-related complications are reduced.

Identification and Prediction of Group-Based Glycemic Control Trajectories during the Transition to Adolescence

PubMed Central

Rohan, Jennifer M.; Rausch, Joseph R.; Pendley, Jennifer Shroff; Delamater, Alan M.; Dolan, Lawrence; Reeves, Grafton; Drotar, Dennis

2014-01-01

Objective To identify trajectories of glycemic control over a period of three years in a pediatric sample of youth diagnosed with type 1 diabetes transitioning to adolescence. A second aim was to examine a set of modifiable individual and family-level baseline predictors of glycemic control group membership. Methods This multisite, prospective study included 239 children and adolescents (ages 9–11 years at baseline) diagnosed with type 1 diabetes and their caregivers. Glycemic control was based on hemoglobin A1c (HbA1c) collected at six month intervals over a period of three years. Predictors of glycemic control membership included baseline global executive functioning, diabetes self-management, diabetes-specific family conflict, blood glucose monitoring frequency, and relevant individual and family level covariates. Results Group-based trajectory analyses were used to describe patterns of glycemic control from baseline to 36 months and three trajectories were identified: low risk (42.9%), elevated risk (44.6%), and high risk (12.1%) subgroups. Baseline maternal-reported family conflict, blood glucose monitoring frequency, and gender were significant predictors of glycemic control group membership. Higher levels of baseline family conflict, lower frequency of blood glucose monitoring, and female gender were associated with elevated and high risk group membership. Conclusions These findings underscore the importance of examining trajectories of HbA1c across time. These results suggest that problematic trajectories of glycemic control are evident during the transition to adolescence. Furthermore, there are modifiable individual and family-level characteristics that predict group membership and hence could be targeted in interventions to ensure adequate glycemic control is maintained over time and that risks for diabetes-related complications are reduced. PMID:24274797

Fuzzy Comprehensive Evaluation-Based Disaster Risk Assessment of Desertification in Horqin Sand Land, China

PubMed Central

Wang, Yongfang; Zhang, Jiquan; Guo, Enliang; Sun, Zhongyi

2015-01-01

Desertification is a typical disaster risk event in which human settlements and living environments are destroyed. Desertification Disaster Risk Assessment can control and prevent the occurrence and development of desertification disasters and reduce their adverse influence on human society. This study presents the methodology and procedure for risk assessment and zoning of desertification disasters in Horqin Sand Land. Based on natural disaster risk theory and the desertification disaster formation mechanism, the Desertification Disaster Risk Index (DDRI) combined hazard, exposure, vulnerability and restorability factors and was developed mainly by using multi-source data and the fuzzy comprehensive evaluation method. The results showed that high risk and middle risk areas account for 28% and 23% of the study area, respectively. They are distributed with an “S” type in the study area. Low risk and very low risk areas account for 21% and 10% of the study area, respectively. They are distributed in the west-central and southwestern parts. Very high risk areas account for 18% of the study area and are distributed in the northeastern parts. The results can be used to know the desertification disaster risk level. It has important theoretical and practical significance to prevention and control of desertification in Horqin Sand Land and even in Northern China. PMID:25654772

Fuzzy comprehensive evaluation-based disaster risk assessment of desertification in Horqin Sand Land, China.

PubMed

Wang, Yongfang; Zhang, Jiquan; Guo, Enliang; Sun, Zhongyi

2015-02-03

Desertification is a typical disaster risk event in which human settlements and living environments are destroyed. Desertification Disaster Risk Assessment can control and prevent the occurrence and development of desertification disasters and reduce their adverse influence on human society. This study presents the methodology and procedure for risk assessment and zoning of desertification disasters in Horqin Sand Land. Based on natural disaster risk theory and the desertification disaster formation mechanism, the Desertification Disaster Risk Index (DDRI) combined hazard, exposure, vulnerability and restorability factors and was developed mainly by using multi-source data and the fuzzy comprehensive evaluation method. The results showed that high risk and middle risk areas account for 28% and 23% of the study area, respectively. They are distributed with an "S" type in the study area. Low risk and very low risk areas account for 21% and 10% of the study area, respectively. They are distributed in the west-central and southwestern parts. Very high risk areas account for 18% of the study area and are distributed in the northeastern parts. The results can be used to know the desertification disaster risk level. It has important theoretical and practical significance to prevention and control of desertification in Horqin Sand Land and even in Northern China.

Metabolic syndrome and subsequent risk of type 2 diabetes and cardiovascular disease in elderly women: Challenging the current definition.

PubMed

Dragsbæk, Katrine; Neergaard, Jesper S; Laursen, Janne M; Hansen, Henrik B; Christiansen, Claus; Beck-Nielsen, Henning; Karsdal, Morten A; Brix, Susanne; Henriksen, Kim

2016-09-01

The prognostic value of the metabolic syndrome (MetS) is believed to vary with age. With an elderly population expecting to triple by 2060, it is important to evaluate the validity of MetS in this age group. We examined the association of MetS risk factors with later risk of type 2 diabetes (T2DM) and cardiovascular disease (CVD) in elderly Caucasian women. We further investigated if stratification of individuals not defined with MetS would add predictive power in defining future disease prevalence of individuals with MetS.The Prospective Epidemiological Risk Factor Study, a community-based cohort study, followed 3905 Danish women since 2000 (age: 70.1 ± 6.5) with no previous diagnosis of T2DM or CVD, holding all measurements used for MetS definition; central obesity, hypertension, hyperlipidemia, and hyperglycemia combined with register-based follow-up information.Elderly women with defined MetS presented a 6.3-fold increased risk of T2DM (95% confidence interval: [3.74-10.50]) and 1.7-fold increased risk of CVD (1.44-2.05) compared to women with no MetS risk factors. Subdividing the control group without defined MetS revealed that both centrally obese controls and controls holding other MetS risk factors also had increased risk of T2DM (hazard ratio (HR) = 2.21 [1.25-3.93] and HR = 1.75 [1.04-2.96]) and CVD (HR = 1.51 [1.25-1.83] and HR = 1.36 [1.15-1.60]) when compared to controls with no MetS risk factors.MetS in elderly Caucasian women increased risk of future T2DM and CVD. While not defined with MetS, women holding only some risk factors for MetS were also at increased risk of T2DM or CVD compared to women with no MetS risk factors.

Metabolic syndrome and subsequent risk of type 2 diabetes and cardiovascular disease in elderly women

PubMed Central

Dragsbæk, Katrine; Neergaard, Jesper S.; Laursen, Janne M.; Hansen, Henrik B.; Christiansen, Claus; Beck-Nielsen, Henning; Karsdal, Morten A.; Brix, Susanne; Henriksen, Kim

2016-01-01

Abstract The prognostic value of the metabolic syndrome (MetS) is believed to vary with age. With an elderly population expecting to triple by 2060, it is important to evaluate the validity of MetS in this age group. We examined the association of MetS risk factors with later risk of type 2 diabetes (T2DM) and cardiovascular disease (CVD) in elderly Caucasian women. We further investigated if stratification of individuals not defined with MetS would add predictive power in defining future disease prevalence of individuals with MetS. The Prospective Epidemiological Risk Factor Study, a community-based cohort study, followed 3905 Danish women since 2000 (age: 70.1 ± 6.5) with no previous diagnosis of T2DM or CVD, holding all measurements used for MetS definition; central obesity, hypertension, hyperlipidemia, and hyperglycemia combined with register-based follow-up information. Elderly women with defined MetS presented a 6.3-fold increased risk of T2DM (95% confidence interval: [3.74–10.50]) and 1.7-fold increased risk of CVD (1.44–2.05) compared to women with no MetS risk factors. Subdividing the control group without defined MetS revealed that both centrally obese controls and controls holding other MetS risk factors also had increased risk of T2DM (hazard ratio (HR) = 2.21 [1.25–3.93] and HR = 1.75 [1.04–2.96]) and CVD (HR = 1.51 [1.25–1.83] and HR = 1.36 [1.15–1.60]) when compared to controls with no MetS risk factors. MetS in elderly Caucasian women increased risk of future T2DM and CVD. While not defined with MetS, women holding only some risk factors for MetS were also at increased risk of T2DM or CVD compared to women with no MetS risk factors. PMID:27603394

78 FR 41314 - Review of Foreign Ownership Policies for Common Carrier and Aeronautical Radio Licensees

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-10

... individuals, governments, and corporations in U.S.-organized entities that directly or indirectly control a U....-organized entities that do not control the licensee, to the extent the Commission determines such foreign... foreign investment that may pose a risk of harm to important national policies. WTO and Non-WTO Investment...

The Relationships between Television Viewing in Midlife and the Development of Alzheimer's Disease in a Case-Control Study

ERIC Educational Resources Information Center

Lindstrom, H.A.; Fritsch, T.; Petot, G.; Smyth, K.A.; Chen, C.H.; Debanne, S.M.; Lerner, A.J.; Friedland, R.P.

2005-01-01

The relationship between leisure activities and development of cognitive impairment in aging has been the subject of recent research. We examined television viewing in association with risk of developing Alzheimer's disease (AD) in a case-control study. Given recent focus on the importance of intellectually stimulating activities as preventive…

Fraction Intervention for Students with Mathematics Difficulties: Lessons Learned from Five Randomized Controlled Trials

ERIC Educational Resources Information Center

Fuchs, Lynn S.; Malone, Amelia S.; Schumacher, Robin F.; Namkung, Jessica; Wang, Amber

2017-01-01

In this article, the authors summarize results from 5 randomized controlled trials assessing the effects of intervention to improve the fraction performance of fourth-grade students at risk for difficulty in learning about fractions. The authors begin by explaining the importance of competence with fractions and why an instructional focus on…

Anthropometric measurements and epithelial ovarian cancer risk in African-American and White women.

PubMed

Hoyo, Cathrine; Berchuck, Andrew; Halabi, Susan; Bentley, Rex C; Moorman, Patricia; Calingaert, Brian; Schildkraut, Joellen M

2005-10-01

Previous studies of anthropometric factors and ovarian cancer risk have been inconsistent and none have evaluated the association among African-American women. Data from a population-based, case-control study of 593 cases and 628 controls were used to evaluate ovarian cancer risk in relation to weight, height, body mass index (BMI) and waist-to-hip ratio (WHR). Odds ratios (ORs) and 95% confidence intervals (CIs) were computed and established risk factors were adjusted for using logistic regression models, stratified by race. Among all races, weight at age 18, WHR, weight and BMI one year prior to interview were associated with elevated ovarian cancer risk. When stratified by race, the association between WHR and ovarian was similar among Whites and among African Americans. However, African-American women in the fourth quartile of height had an elevated risk of ovarian cancer (OR = 3.2; 95% CI = 1.3-7.8), but this risk was not apparent in Whites (OR = 1.0; 95% CI = 0.7-1.4). These findings support the hypothesis that obesity is an important risk factor of ovarian cancer among African-Americans and Whites and also suggest that height may be a risk factor specific to African-Americans.

Polycyclic Aromatic Hydrocarbons and Esophageal Squamous Cell Carcinoma-A Review

PubMed Central

Roshandel, Gholamreza; Semnani, Shahryar; Malekzadeh, Reza; Dawsey, Sanford M.

2018-01-01

Esophageal cancer (EC) is the 8th most common cancer and the 6th most frequent cause of cancer mortality worldwide. Esophageal squamous cell carcinoma (ESCC) is the most common type of EC. Exposure to polycyclic aromatic hydrocarbons (PAHs) has been suggested as a risk factor for developing ESCC. In this paper we will review different aspects of the relationship between PAH exposure and ESCC. PAHs are a group of compounds that are formed by incomplete combustion of organic matter. Studies in humans have shown an association between PAH exposure and development of ESCC in many populations. The results of a recent case-control study in a high risk population in northeastern Iran showed a dramatic dose-response relationship between PAH content in non-tumor esophageal tissue (the target tissue for esophageal carcinogenesis) and ESCC case status, consistent with a causal role for PAH exposure in the pathogenesis of ESCC. Identifying the main sources of exposure to PAHs may be the first and most important step in designing appropriate PAH-reduction interventions for controlling ESCC, especially in high risk areas. Coal smoke and drinking mate have been suggested as important modifiable sources of PAH exposure in China and Brazil, respectively. But the primary source of exposure to PAHs in other high risk areas for ESCC, such as northeastern Iran, has not yet been identified. Thus, environmental studies to determining important sources of PAH exposure should be considered as a high priority in future research projects in these areas. PMID:23102250

But I Trust My Teen: Parents' Attitudes and Response to a Parental Monitoring Intervention

PubMed Central

Metzger, Aaron; Ice, Christa; Cottrell, Lesley

2012-01-01

Parental knowledge gained from monitoring activities protects against adolescent risk involvement. Parental monitoring approaches are varied and may be modified with successful interventions but not all parents or adolescents respond to monitoring programs the same way. 339 parent-adolescent dyads randomized to receive a parental monitoring intervention and 169 parent-adolescent dyads in the control group were followed for one year over four measurement periods. Parent attitudes about the usefulness of monitoring, the importance of trust and respecting their teens' privacy, and the appropriateness of adolescent risk-taking behavior and experimentation were examined as predictors of longitudinal change in parental monitoring and open communication. Similar effects were found in both the intervention and control group models regarding open communication. Parental attitudes impacted longitudinal patterns of teen-reported parent monitoring, and these patterns differed across experimental groups. In the intervention group, parents' beliefs about the importance of trust and privacy were associated with a steeper decline in monitoring across time. Finally, parents' attitudes about the normative nature of teen experimentation were associated with a quadratic parental monitoring time trend in the intervention but not the control group. These findings suggest that parental attitudes may impact how families respond to an adolescent risk intervention. PMID:22720144

Conspicuous impacts of inconspicuous hosts on the Lyme disease epidemic.

PubMed

Brisson, Dustin; Dykhuizen, Daniel E; Ostfeld, Richard S

2008-01-22

Emerging zoonotic pathogens are a constant threat to human health throughout the world. Control strategies to protect public health regularly fail, due in part to the tendency to focus on a single host species assumed to be the primary reservoir for a pathogen. Here, we present evidence that a diverse set of species can play an important role in determining disease risk to humans using Lyme disease as a model. Host-targeted public health strategies to control the Lyme disease epidemic in North America have focused on interrupting Borrelia burgdorferi sensu stricto (ss) transmission between blacklegged ticks and the putative dominant reservoir species, white-footed mice. However, B. burgdorferi ss infects more than a dozen vertebrate species, any of which could transmit the pathogen to feeding ticks and increase the density of infected ticks and Lyme disease risk. Using genetic and ecological data, we demonstrate that mice are neither the primary host for ticks nor the primary reservoir for B. burgdorferi ss, feeding 10% of all ticks and 25% of B. burgdorferi-infected ticks. Inconspicuous shrews feed 35% of all ticks and 55% of infected ticks. Because several important host species influence Lyme disease risk, interventions directed at a multiple host species will be required to control this epidemic.

Heme Oxygenase-1 and 2 Common Genetic Variants and Risk for Restless Legs Syndrome

PubMed Central

García-Martín, Elena; Jiménez-Jiménez, Félix Javier; Alonso-Navarro, Hortensia; Martínez, Carmen; Zurdo, Martín; Turpín-Fenoll, Laura; Millán-Pascual, Jorge; Adeva-Bartolomé, Teresa; Cubo, Esther; Navacerrada, Francisco; Rojo-Sebastián, Ana; Rubio, Lluisa; Ortega-Cubero, Sara; Pastor, Pau; Calleja, Marisol; Plaza-Nieto, José Francisco; Pilo-de-la-Fuente, Belén; Arroyo-Solera, Margarita; García-Albea, Esteban; Agúndez, José A.G.

2015-01-01

Abstract Several neurochemical, neuropathological, neuroimaging, and experimental data, suggest that iron deficiency plays an important role in the pathophysiology of restless legs syndrome (RLS). Heme-oxygenases (HMOX) are an important defensive mechanism against oxidative stress, mainly through the degradation of heme to biliverdin, free iron, and carbon monoxide. We analyzed whether HMOX1 and HMOX2 genes are related with the risk to develop RLS. We analyzed the distribution of genotypes and allelic frequencies of the HMOX1 rs2071746, HMOX1 rs2071747, HMOX2 rs2270363, and HMOX2 rs1051308 SNPs, as well as the presence of Copy number variations (CNVs) of these genes in 205 subjects RLS and 445 healthy controls. The frequencies of rs2071746TT genotype and rs2071746T allelic variant were significantly lower in RLS patients than that in controls, although the other 3 studied SNPs did not differ between RLS patients and controls. None of the studied polymorphisms influenced the disease onset, severity of RLS, family history of RLS, serum ferritin levels, or response to dopaminergic agonist, clonazepam or GABAergic drugs. The present study suggests a weak association between HMOX1 rs2071746 polymorphism and the risk to develop RLS in the Spanish population. PMID:26313808

Heme Oxygenase-1 and 2 Common Genetic Variants and Risk for Restless Legs Syndrome.

PubMed

García-Martín, Elena; Jiménez-Jiménez, Félix Javier; Alonso-Navarro, Hortensia; Martínez, Carmen; Zurdo, Martín; Turpín-Fenoll, Laura; Millán-Pascual, Jorge; Adeva-Bartolomé, Teresa; Cubo, Esther; Navacerrada, Francisco; Rojo-Sebastián, Ana; Rubio, Lluisa; Ortega-Cubero, Sara; Pastor, Pau; Calleja, Marisol; Plaza-Nieto, José Francisco; Pilo-de-la-Fuente, Belén; Arroyo-Solera, Margarita; García-Albea, Esteban; Agúndez, José A G

2015-08-01

Several neurochemical, neuropathological, neuroimaging, and experimental data, suggest that iron deficiency plays an important role in the pathophysiology of restless legs syndrome (RLS). Heme-oxygenases (HMOX) are an important defensive mechanism against oxidative stress, mainly through the degradation of heme to biliverdin, free iron, and carbon monoxide. We analyzed whether HMOX1 and HMOX2 genes are related with the risk to develop RLS.We analyzed the distribution of genotypes and allelic frequencies of the HMOX1 rs2071746, HMOX1 rs2071747, HMOX2 rs2270363, and HMOX2 rs1051308 SNPs, as well as the presence of Copy number variations (CNVs) of these genes in 205 subjects RLS and 445 healthy controls.The frequencies of rs2071746TT genotype and rs2071746T allelic variant were significantly lower in RLS patients than that in controls, although the other 3 studied SNPs did not differ between RLS patients and controls. None of the studied polymorphisms influenced the disease onset, severity of RLS, family history of RLS, serum ferritin levels, or response to dopaminergic agonist, clonazepam or GABAergic drugs.The present study suggests a weak association between HMOX1 rs2071746 polymorphism and the risk to develop RLS in the Spanish population.

The rearing environment and risk for drug abuse: a Swedish national high-risk adopted and not adopted co-sibling control study

PubMed Central

Kendler, K. S.; Ohlsson, H.; Sundquist, K.; Sundquist, J.

2016-01-01

Background Although drug abuse (DA) is strongly familial, with important genetic influences, we need to know more about the role of rearing environment in the risk for DA. To address this question, we utilized a high-risk adopted and non-adopted co-sibling control design. Method High-risk offspring had one or more biological parents registered for DA, alcohol use disorders or criminal behavior. Using Swedish registries, we identified 1161 high-risk full-sibships and 3085 high-risk half-sibships containing at least one member who was adopted-away and one member who was not. Registration for DA was via national criminal, medical and pharmacy registers. In Sweden, adoptive families are screened to provide high-quality rearing environment for adoptees. Results Controlling for parental age at birth and gender (and, in half-siblings, high-risk status of the other parent), risk for DA was substantially lower in the full- and half-siblings who were adopted v. not adopted [hazard ratios and 95% confidence intervals: 0.55 (0.45–0·69) and 0.55 (95% CI 0.48–0.63), respectively]. The protective effect of adoption on risk for DA was significantly stronger in the full- and half-sibling pairs with very high familial liability (two high-risk parents) and significantly weaker when the adoptive family was broken by death or divorce, or contained a high-risk parent. Conclusions In both full- and half-sibling pairs, we found replicated evidence that rearing environment strongly impacts on risk for DA. High-quality rearing environments can substantively reduce risk for DA in those at high genetic risk. PMID:26753502

The rearing environment and risk for drug abuse: a Swedish national high-risk adopted and not adopted co-sibling control study.

PubMed

Kendler, K S; Ohlsson, H; Sundquist, K; Sundquist, J

2016-05-01

Although drug abuse (DA) is strongly familial, with important genetic influences, we need to know more about the role of rearing environment in the risk for DA. To address this question, we utilized a high-risk adopted and non-adopted co-sibling control design. High-risk offspring had one or more biological parents registered for DA, alcohol use disorders or criminal behavior. Using Swedish registries, we identified 1161 high-risk full-sibships and 3085 high-risk half-sibships containing at least one member who was adopted-away and one member who was not. Registration for DA was via national criminal, medical and pharmacy registers. In Sweden, adoptive families are screened to provide high-quality rearing environment for adoptees. Controlling for parental age at birth and gender (and, in half-siblings, high-risk status of the other parent), risk for DA was substantially lower in the full- and half-siblings who were adopted v. not adopted [hazard ratios and 95% confidence intervals: 0.55 (0.45-0·69) and 0.55 (95% CI 0.48-0.63), respectively]. The protective effect of adoption on risk for DA was significantly stronger in the full- and half-sibling pairs with very high familial liability (two high-risk parents) and significantly weaker when the adoptive family was broken by death or divorce, or contained a high-risk parent. In both full- and half-sibling pairs, we found replicated evidence that rearing environment strongly impacts on risk for DA. High-quality rearing environments can substantively reduce risk for DA in those at high genetic risk.

Social support and maternal mental health at 4 months and 1 year postpartum: analysis from the All Our Families cohort.

PubMed

Hetherington, Erin; McDonald, Sheila; Williamson, Tyler; Patten, Scott B; Tough, Suzanne C

2018-06-19

Low social support is consistently associated with postpartum depression. Previous studies do not always control for previous mental health and do not consider what type of support (tangible, emotional, informational or positive social interaction) is most important. The objectives are: to examine if low social support contributes to subsequent risk of depressive or anxiety symptoms and to determine which type of support is most important. Data from the All Our Families longitudinal pregnancy cohort were used (n=3057). Outcomes were depressive or anxiety symptoms at 4 months and 1 year postpartum. Exposures were social support during pregnancy and at 4 months postpartum. Log binomial models were used to calculate risk ratios (RRs) and absolute risk differences, controlling for past mental health. Low total social support during pregnancy was associated with an increased risk of depressive symptoms (RR 1.50, 95% CI 1.24 to 1.82) and anxiety symptoms (RR 1.63, 95% CI 1.38 to 1.93) at 4 months postpartum. Low total social support at 4 months was associated with an increased risk of anxiety symptoms (RR 1.65, 95% CI 1.31 to 2.09) at 1 year. Absolute risk differences were largest among women with previous mental health challenges resulting in a number needed to treat of 5 for some outcomes. Emotional/informational support was the most important type of support for postpartum anxiety. Group prenatal care, prenatal education and peer support programmes have the potential to improve social support. Prenatal interventions studies are needed to confirm these findings in higher risk groups. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Quantitative Risk Mapping of Urban Gas Pipeline Networks Using GIS

NASA Astrophysics Data System (ADS)

Azari, P.; Karimi, M.

2017-09-01

Natural gas is considered an important source of energy in the world. By increasing growth of urbanization, urban gas pipelines which transmit natural gas from transmission pipelines to consumers, will become a dense network. The increase in the density of urban pipelines will influence probability of occurring bad accidents in urban areas. These accidents have a catastrophic effect on people and their property. Within the next few years, risk mapping will become an important component in urban planning and management of large cities in order to decrease the probability of accident and to control them. Therefore, it is important to assess risk values and determine their location on urban map using an appropriate method. In the history of risk analysis of urban natural gas pipeline networks, the pipelines has always been considered one by one and their density in urban area has not been considered. The aim of this study is to determine the effect of several pipelines on the risk value of a specific grid point. This paper outlines a quantitative risk assessment method for analysing the risk of urban natural gas pipeline networks. It consists of two main parts: failure rate calculation where the EGIG historical data are used and fatal length calculation that involves calculation of gas release and fatality rate of consequences. We consider jet fire, fireball and explosion for investigating the consequences of gas pipeline failure. The outcome of this method is an individual risk and is shown as a risk map.

Raw materials in the manufacture of biotechnology products: regulatory considerations.

PubMed

Cordoba-Rodriguez, Ruth

2010-01-01

The Food and Drug Administration's Pharmaceutical cGMPs for the 21st Century initiative emphasizes science and risk-based approaches in the manufacture of drugs. These approaches are reflected in the International Conference on Harmonization (ICH) guidances ICH Q8, Q9, and Q10 and encourage a comprehensive assessment of the manufacture of a biologic, including all aspects of manufacture that have the potential to affect the finished drug product. Appropriate assessment and management of raw materials are an important part of this initiative. Ideally, a raw materials program should strive to assess and minimize the risk to product quality. With this in mind, risk-assessment concepts and control strategies will be discussed and illustrated by examples, with an emphasis on the impact of raw materials on cell substrates. Finally, the life cycle of the raw material will be considered, including its potential to affect the drug product life cycle. In this framework, the supply chain and the vendor-manufacturer relationship will be explored as important parts of an adequate raw materials control strategy.

Combining field work and laboratory work in the study of financial risk-taking.

PubMed

Coates, John; Gurnell, Mark

2017-06-01

A contribution to a special issue on Hormones and Human Competition. Financial markets are periodically destabilized by bubbles and crashes during which investors display respectively what has been called "irrational exuberance" and "irrational pessimism". How can we best study these pathologies in competitive and risk-taking behaviours? In this article, we argue that a science of risk-taking and of the financial markets needs to draw heavily on physiology and especially endocrinology, due to their central roles in moderating human behaviour. Importantly, this science of competition and risk requires the same spectrum of research protocols as is found in mature biological and medical sciences, a spectrum running from field work conducted within financial institutions themselves to more controlled laboratory studies, which permit cause to be distinguished from effect. Such a spectrum of studies is especially important for translational behavioural science. Copyright © 2017 Elsevier Inc. All rights reserved.

Incorporating concepts of inequality and inequity into health benefits analysis

PubMed Central

Levy, Jonathan I; Chemerynski, Susan M; Tuchmann, Jessica L

2006-01-01

Background Although environmental policy decisions are often based in part on both risk assessment information and environmental justice concerns, formalized approaches for addressing inequality or inequity when estimating the health benefits of pollution control have been lacking. Inequality indicators that fulfill basic axioms and agree with relevant definitions and concepts in health benefits analysis and environmental justice analysis can allow for quantitative examination of efficiency-equality tradeoffs in pollution control policies. Methods To develop appropriate inequality indicators for health benefits analysis, we provide relevant definitions from the fields of risk assessment and environmental justice and consider the implications. We evaluate axioms proposed in past studies of inequality indicators and develop additional axioms relevant to this context. We survey the literature on previous applications of inequality indicators and evaluate five candidate indicators in reference to our proposed axioms. We present an illustrative pollution control example to determine whether our selected indicators provide interpretable information. Results and Conclusions We conclude that an inequality indicator for health benefits analysis should not decrease when risk is transferred from a low-risk to high-risk person, and that it should decrease when risk is transferred from a high-risk to low-risk person (Pigou-Dalton transfer principle), and that it should be able to have total inequality divided into its constituent parts (subgroup decomposability). We additionally propose that an ideal indicator should avoid value judgments about the relative importance of transfers at different percentiles of the risk distribution, incorporate health risk with evidence about differential susceptibility, include baseline distributions of risk, use appropriate geographic resolution and scope, and consider multiple competing policy alternatives. Given these criteria, we select the Atkinson index as the single indicator most appropriate for health benefits analysis, with other indicators useful for sensitivity analysis. Our illustrative pollution control example demonstrates how these indices can help a policy maker determine control strategies that are dominated from an efficiency and equality standpoint, those that are dominated for some but not all societal viewpoints on inequality averseness, and those that are on the optimal efficiency-equality frontier, allowing for more informed pollution control policies. PMID:16569243

Risk factors for Staphylococcus aureus postpartum breast abscess.

PubMed

Branch-Elliman, Westyn; Golen, Toni H; Gold, Howard S; Yassa, David S; Baldini, Linda M; Wright, Sharon B

2012-01-01

Staphylococcus aureus (SA) breast abscesses are a complication of the postpartum period. Risk factors for postpartum SA breast abscesses are poorly defined, and literature is conflicting. Whether risk factors for methicillin-resistant SA (MRSA) and methicillin-susceptible SA (MSSA) infections differ is unknown. We describe novel risk factors associated with postpartum breast abscesses and the changing epidemiology of this infection. We conducted a cohort study with a nested case-control study (n = 216) involving all patients with culture-confirmed SA breast abscess among >30 000 deliveries at our academic tertiary care center from 2003 through 2010. Data were collected from hospital databases and through abstraction from medical records. All SA cases were compared with both nested controls and full cohort controls. A subanalysis was completed to determine whether risk factors for MSSA and MRSA breast abscess differ. Univariate analysis was completed using Student's t test, Wilcoxon rank-sum test, and analysis of variance, as appropriate. A multivariable stepwise logistic regression was used to determine final adjusted results for both the case-control and the cohort analyses. Fifty-four cases of culture-confirmed abscess were identified: 30 MRSA and 24 MSSA. Risk factors for postpartum SA breast abscess in multivariable analysis include in-hospital identification of a mother having difficulty breastfeeding (odds ratio, 5.00) and being a mother employed outside the home (odds ratio, 2.74). Risk factors did not differ between patients who developed MRSA and MSSA infections. MRSA is an increasingly important pathogen in postpartum women; risk factors for postpartum SA breast abscess have not changed with the advent of community-associated MRSA.

Nutrition habits, physical activity, and lung cancer: an authoritative review.

PubMed

Koutsokera, Alexandra; Kiagia, Maria; Saif, Muhammad W; Souliotis, Kyriakos; Syrigos, Kostas N

2013-07-01

Lung cancer is the leading cause of cancer death worldwide. Because of high incidence rates and low survival rates, it is important to study the risk factors that may help prevent the disease from developing. It has been well established that cigarette smoking is the most important risk factor for lung cancer. Nonetheless it is likely that there are other modifiable risk factors that would assist in the prevention of lung cancer. Research on factors such as nutrition and physical activity and their influence on lung cancer has been carried out for nearly 3 decades. A systematic review in the MEDLINE database of published studies was conducted, focusing on systematic reviews, meta-analyses, and large prospective studies. The association between physical activity and lung cancer has been conflicting. Among the researched studies, 10 showed an inverse association, whereas 11 reported no association. A meta-analysis that was conducted from 1996 to October 2003 showed that leisure physical activity (LPA) prevents lung cancer. Data from 11 cohort and case-control studies showed an inverse relationship between fruit and vegetable consumption and lung cancer. Evidence from case-control studies suggests a positive association between meat intake and risk of lung cancer, although several more recent studies have presented doubts about these findings. The possible association of physical activity, nutrition, and the risk of lung cancer development remains controversial. Further prospective studies should be conducted to determine the potential influence of these 2 risk factors. Copyright © 2013 Elsevier Inc. All rights reserved.

Importance of Control Groups When Delineating Antibiotic Use as Risk Factors for Carbapenem-Resistance, Extreme-Drug and Pan-Drug Resistance in Acinetobacter baumannii and Pseudomonas aeruginosa: A Systematic Review and Meta-Analysis.

PubMed

Lim, Cheryl Li Ling; Chua, Alvin Qijia; Teo, Jocelyn Qi Min; Cai, Yiying; Lee, Winnie; Kwa, Andrea Lay-Hoon

2018-06-02

Carbapenem-resistant (CR), extreme-drug-resistant (XDR) & pan-drug-resistant (PDR) AB and PA (AB-PA) pose a huge clinical threat. This study reviews the impact of control groups on association of antecedent antibiotic use & acquisition of CR/XDR/PDR AB-PA. Studies investigating the role of antibiotics as risk factor for CR/XDR/PDR AB-PA acquisition in adult hospitalized patients from 1950 to 2016 were identified with databases. These were divided into 2 groups: antibiotic-resistant versus antibiotic-sensitive pathogens (Group I); versus no infection (Group II). A random effects model was performed. Eighty-five studies (46 AB, 38 PA, 1 both) with 22,396 patients were included. CR, XDR & PDR was investigated in 60, 20 and 2 studies respectively. Prior antibiotic exposure was associated with significant acquisition of CR/XDR/PDR AB-PA in both Groups I and II (p <0.05). Antibiotic classes implicated in both groups include aminoglycosides, carbapenems, glycopeptides and penicillins. Cephalosporin use was not associated with resistance in either group. Fluoroquinolones exposure was only associated with resistance in Group I but not Group II. Control groups play an important role in determining magnitudes of risk estimates for risk factor studies, hence careful selection is necessary. Antibiotic exposure increases acquisition of highly-resistant AB-PA, thus appropriate antibiotic use is imperative. Copyright © 2018. Published by Elsevier Ltd.

Men Traveling Away from Home Are More Likely to Bring Malaria into High Altitude Villages, Northwest Ethiopia

PubMed Central

Alemu, Kassahun; Worku, Alemayehu; Berhane, Yemane; Kumie, Abera

2014-01-01

Background Information about malaria risk factors at high altitudes is scanty. Understanding the risk factors that determine the risk of malaria transmission at high altitude villages is important to facilitate implementing sustainable malaria control and prevention programs. Methods An unmatched case control study was conducted among patients seeking treatment at health centers in high altitude areas. Either microscopy or rapid diagnostic tests were used to confirm the presence of plasmodium species. A generalized linear model was used to identify the predictors of malaria transmission in high altitude villages. Results Males (AOR = 3.11, 95%CI: 2.28, 4.23), and those who traveled away from the home in the previous month (AOR = 2.01, 95% CI: 1.56, 2.58) were strongly associated with presence of malaria in high altitude villages. Other significant factors, including agriculture in occupation (AOR = 1.41, 95% CI: 1.05, 1.93), plants used for fencing (AOR = 1.70, 95% CI: 1.18, 2.52) and forests near the house (AOR = 1.60, 95% CI: 1.15, 2.47), were found predictors for malaria in high altitude villages. Conclusion Travel outside of their home was an important risk of malaria infections acquisition. Targeting males who frequently travel to malarious areas can reduce malaria transmission risks in high altitude areas. PMID:24748159

Decisions under risk in Parkinson's disease: preserved evaluation of probability and magnitude.

PubMed

Sharp, Madeleine E; Viswanathan, Jayalakshmi; McKeown, Martin J; Appel-Cresswell, Silke; Stoessl, A Jon; Barton, Jason J S

2013-11-01

Unmedicated Parkinson's disease patients tend to be risk-averse while dopaminergic treatment causes a tendency to take risks. While dopamine agonists may result in clinically apparent impulse control disorders, treatment with levodopa also causes shift in behaviour associated with an enhanced response to rewards. Two important determinants in decision-making are how subjects perceive the magnitude and probability of outcomes. Our objective was to determine if patients with Parkinson's disease on or off levodopa showed differences in their perception of value when making decisions under risk. The Vancouver Gambling task presents subjects with a choice between one prospect with larger outcome and a second with higher probability. Eighteen age-matched controls and eighteen patients with Parkinson's disease before and after levodopa were tested. In the Gain Phase subjects chose between one prospect with higher probability and another with larger reward to maximize their gains. In the Loss Phase, subjects played to minimize their losses. Patients with Parkinson's disease, on or off levodopa, were similar to controls when evaluating gains. However, in the Loss Phase before levodopa, they were more likely to avoid the prospect with lower probability but larger loss, as indicated by the steeper slope of their group psychometric function (t(24) = 2.21, p = 0.04). Modelling with prospect theory suggested that this was attributable to a 28% overestimation of the magnitude of loss, rather than an altered perception of its probability. While pre-medicated patients with Parkinson's disease show risk-aversion for large losses, patients on levodopa have normal perception of magnitude and probability for both loss and gain. The finding of accurate and normally biased decisions under risk in medicated patients with PD is important because it indicates that, if there is indeed anomalous risk-seeking behaviour in such a cohort, it may derive from abnormalities in components of decision making that are separate from evaluations of size and probability. © 2013 Elsevier Ltd. All rights reserved.

Visual risk factors for falls in older people.

PubMed

Lord, Stephen R

2006-09-01

Poor vision reduces postural stability and significantly increases the risk of falls and fractures in older people. Most studies have found that poor visual acuity increases the risk of falls. However, studies that have included multiple visual measures have found that reduced contrast sensitivity and depth perception are the most important visual risk factors for falls. Multifocal glasses may add to this risk because their near-vision lenses impair distance contrast sensitivity and depth perception in the lower visual field. This reduces the ability of an older person to detect environmental hazards. There is now evidence that maximising vision through cataract surgery is an effective strategy for preventing falls. Further randomised controlled trials are required to determine whether individual strategies (such as restriction of use of multifocal glasses) or multi-strategy visual improvement interventions can significantly reduce falls in older people. Public health initiatives are required to raise awareness in older people and their carers of the importance of regular eye examinations and use of appropriate prescription glasses.

Cardiovascular risk in rheumatoid arthritis: assessment, management and next steps

PubMed Central

Zegkos, Thomas; Kitas, George; Dimitroulas, Theodoros

2016-01-01

Rheumatoid arthritis (RA) is associated with increased cardiovascular (CV) morbidity and mortality which cannot be fully explained by traditional CV risk factors; cumulative inflammatory burden and antirheumatic medication-related cardiotoxicity seem to be important contributors. Despite the acknowledgment and appreciation of CV disease burden in RA, optimal management of individuals with RA represents a challenging task which remains suboptimal. To address this need, the European League Against Rheumatism (EULAR) published recommendations suggesting the adaptation of traditional risk scores by using a multiplication factor of 1.5 if two of three specific criteria are fulfilled. Such guidance requires proper coordination of several medical specialties, including general practitioners, rheumatologists, cardiologists, exercise physiologists and psychologists to achieve a desirable result. Tight control of disease activity, management of traditional risk factors and lifestyle modification represent, amongst others, the most important steps in improving CV disease outcomes in RA patients. Rather than enumerating studies and guidelines, this review attempts to critically appraise current literature, highlighting future perspectives of CV risk management in RA. PMID:27247635

[Tuberculosis recurrence and its risk factors].

PubMed

de Oliveira, H B; Moreira Filho, D de C

2000-04-01

The persistence of tuberculosis bacilli in patients who are cured, thus causing recurrence, is an important issue. This case-control study investigated individual and institutional risk factors for relapse by analyzing independent variables related to the patient, the use of antituberculosis drugs, and the service delivered at health care institutions; 56 cases and 105 controls were interviewed. Recurrence was defined as a new tuberculosis episode after the patient had been successfully treated. Controls were selected from among patients who were treated and cured of pulmonary tuberculosis and who did not experience a relapse. Regression models were proposed to control confounding factors or effect modifiers. The variables identified as risk factors for relapse were those related to erratic patient behavior (missing medical appointments and therefore not picking up the medication, not taking the medication, taking the wrong dosage), age, and stress from life events; adverse reactions to antituberculosis drugs; and problems in the organization of health care services that resulted in patients receiving insufficient dosages or amounts of antituberculosis drugs. Receiving information regarding treatment duration provided protection against recurrence. The knowledge regarding these risk factors should result in more intensive follow-up and in more use of directly observed treatment of tuberculosis in order to prevent relapse.

Is diabetes mellitus a risk factor for HCV infection?

PubMed

Picerno, I; Di Pietro, A; Spataro, P; Di Benedetto, A; Romano, G; Scoglio, M E

2002-01-01

The aim of this study was to investigate whether or not the diabetes mellitus may be considered a risk factor for the HCV infection. The HCV seroprevalence was evaluated in 254 diabetic subjects, whose anamnestic data and risk factors are known, in comparison to 223 first-time blood donors, carefully age- and gender-matched. The statistical analysis showed that the studied groups belonged to the same population (Mann-Whitney U test) and that there were no significant differences between cases and controls as regards HCV prevalence (Yates corrected chi 2 test). The obtained data underline the importance of the control group selection, especially in the studies considering age-related pathologies. The authors disprove type 2 diabetes as a risk factor for the HCV infection and consider that this is a valid hypothesis only when the hepatitis C was unknown and not adequate prevention was used.

Contribution of Established Stroke Risk Factors to the Burden of Stroke in Young Adults.

PubMed

Aigner, Annette; Grittner, Ulrike; Rolfs, Arndt; Norrving, Bo; Siegerink, Bob; Busch, Markus A

2017-07-01

As stroke in young adults is assumed to have different etiologies and risk factors than in older populations, the aim of this study was to examine the contribution of established potentially modifiable cardiovascular risk factors to the burden of stroke in young adults. A German nationwide case-control study based on patients enrolled in the SIFAP1 study (Stroke In Young Fabry Patients) 2007 to 2010 and controls from the population-based GEDA study (German Health Update) 2009 to 2010 was performed. Cases were 2125 consecutive patients aged 18 to 55 years with acute first-ever stroke from 26 clinical stroke centers; controls (age- and sex-matched, n=8500, without previous stroke) were from a nationwide community sample. Adjusted population-attributable risks of 8 risk factors (hypertension, hyperlipidemia, diabetes mellitus, coronary heart disease, smoking, heavy episodic alcohol consumption, low physical activity, and obesity) and their combinations for all stroke, ischemic stroke, and primary intracerebral hemorrhage were calculated. Low physical activity and hypertension were the most important risk factors, accounting for 59.7% (95% confidence interval, 56.3-63.2) and 27.1% (95% confidence interval, 23.6-30.6) of all strokes, respectively. All 8 risk factors combined explained 78.9% (95% confidence interval, 76.3-81.4) of all strokes. Population-attributable risks of all risk factors were similar for all ischemic stroke subtypes. Population-attributable risks of most risk factors were higher in older age groups and in men. Modifiable risk factors previously established in older populations also account for a large part of stroke in younger adults, with 4 risk factors explaining almost 80% of stroke risk. URL: http://www.clinicaltrials.gov. Unique identifier: NCT00414583. © 2017 American Heart Association, Inc.

Lipid and blood pressure control for the prevention of cardiovascular disease in hypertensive patients: a subanalysis of the OMEGA study.

PubMed

Teramoto, Tamio; Kawamori, Ryuzo; Miyazaki, Shigeru; Teramukai, Satoshi; Sato, Yuki; Okuda, Yasuyuki; Shirayama, Masayuki

2015-01-01

The aim of this analysis was to investigate the relationships between dyslipidemia, achieved blood pressure (BP) values and the lipid levels, as well as the control of four cardiovascular risk factors (BP, low-density lipoprotein: LDL cholesterol, hemoglobin A1c: HbA1c and smoking) and the incidence of cardiovascular disease (CVD), in Japanese patients receiving antihypertensive therapy. A total of 13,052 patients with no history of CVD were included in this subanalysis of the prospective observational OMEGA study in Japanese hypertensive patients treated with olmesartan. Multivariable Cox regression models were used to evaluate the relationship with the risk of CVD. The incidence of CVD during the 36-month study period was 5.59/1,000 patient-years among the patients with dyslipidemia (n = 6,297) and 5.57/1,000 patient-years among the patients without dyslipidemia (n = 6,755), with no significant differences between the two groups. Higher achieved BP values tended to be associated with an increased CVD risk in both the patients with and without dyslipidemia. In addition, the risk of CVD tended to be higher in the patients with an achieved LDL cholesterol level of ≥ 120 mg/dL than in those with an LDL level of ＜ 120 mg/dL (trend p = 0.0005) and in the patients with an achieved high-density lipoprotein cholesterol level of ＜ 60 mg/dL than in those with an HDL level of ≥ 60 mg/dL (trend p = 0.0017). Furthermore, the risk of CVD was higher among the patients with fewer controlled risk factors than among those with control of all four risk factors (trend p ＜ 0.0001). In order to prevent CVD in olmesartan-treated hypertensive patients with no history of CVD, it is important to control both the lipid and BP levels and aim for comprehensive risk factor control.

Effects of rational emotive occupational health therapy intervention on the perceptions of organizational climate and occupational risk management practices among electronics technology employees in Nigeria

PubMed Central

Ogbuanya, Theresa Chinyere; Eseadi, Chiedu; Orji, Chibueze Tobias; Ede, Moses Onyemaechi; Ohanu, Ifeanyi Benedict; Bakare, Jimoh

2017-01-01

Abstract Background: Improving employees’ perception of organizational climate, and coaching them to remain steadfast when managing occupational risks associated with their job, might have an important effect on their psychosocial wellbeing and occupational health. This study examined the effects of a rational emotive occupational health therapy intervention program on the perceptions of organizational climate and occupational risk management practices. Methods: The participants were 77 electronics technology employees in the south-east of Nigeria. The study used a pretest–posttest control group design. Results: The rational emotive occupational health therapy intervention program significantly improved perceptions of the organizational climate for the people in the treatment group compared to those in the waitlist control group at post-intervention and follow-up assessments. Occupational risk management practices of the employees in the treatment group were also significantly better than those in the waitlist control group at the same 2 assessments. Conclusions: Corporate application of a rational emotive behavior therapy as an occupational health therapy intervention program is essential for improving the perceptions of organizational climate and promoting the adoption of feasible occupational risk management strategies in the workplace. PMID:28471971

Effects of rational emotive occupational health therapy intervention on the perceptions of organizational climate and occupational risk management practices among electronics technology employees in Nigeria.

PubMed

Ogbuanya, Theresa Chinyere; Eseadi, Chiedu; Orji, Chibueze Tobias; Ede, Moses Onyemaechi; Ohanu, Ifeanyi Benedict; Bakare, Jimoh

2017-05-01

Improving employees' perception of organizational climate, and coaching them to remain steadfast when managing occupational risks associated with their job, might have an important effect on their psychosocial wellbeing and occupational health. This study examined the effects of a rational emotive occupational health therapy intervention program on the perceptions of organizational climate and occupational risk management practices. The participants were 77 electronics technology employees in the south-east of Nigeria. The study used a pretest-posttest control group design. The rational emotive occupational health therapy intervention program significantly improved perceptions of the organizational climate for the people in the treatment group compared to those in the waitlist control group at post-intervention and follow-up assessments. Occupational risk management practices of the employees in the treatment group were also significantly better than those in the waitlist control group at the same 2 assessments. Corporate application of a rational emotive behavior therapy as an occupational health therapy intervention program is essential for improving the perceptions of organizational climate and promoting the adoption of feasible occupational risk management strategies in the workplace.

Assessing risk factors in the organic control system: evidence from inspection data in Italy.

PubMed

Zanoli, Raffaele; Gambelli, Danilo; Solfanelli, Francesco

2014-12-01

Certification is an essential feature in organic farming, and it is based on inspections to verify compliance with respect to European Council Regulation-EC Reg. No 834/2007. A risk-based approach to noncompliance that alerts the control bodies to activate planning inspections would contribute to a more efficient and cost-effective certification system. An analysis of factors that can affect the probability of noncompliance in organic farming has thus been developed. This article examines the application of zero-inflated count data models to farm-level panel data from inspection results and sanctions obtained from the Ethical and Environmental Certification Institute, one of the main control bodies in Italy. We tested many a priori hypotheses related to the risk of noncompliance. We find evidence of an important role for past noncompliant behavior in predicting future noncompliance, while farm size and the occurrence of livestock also have roles in an increased probability of noncompliance. We conclude the article proposing that an efficient risk-based inspection system should be designed, weighting up the known probability of occurrence of a given noncompliance according to the severity of its impact. © 2014 Society for Risk Analysis.

Geographic Region, Weather, Pilot Age and Air Carrier Crashes: a Case-Control Study

PubMed Central

Li, Guohua; Pressley, Joyce C.; Qiang, Yandong; Grabowski, Jurek G.; Baker, Susan P.; Rebok, George W.

2009-01-01

Background Information about risk factors of aviation crashes is crucial for developing effective intervention programs. Previous studies assessing factors associated with crash risk were conducted primarily in general aviation, air taxis and commuter air carriers. Methods A matched case-control design was used to examine the associations of geographic region, basic weather condition, and pilot age with the risk of air carrier (14 CFR Part 121) crash involvement. Cases (n=373) were air carrier crashes involving aircraft made by Boeing, McDonnell Douglas, and Airbus, recorded in the National Transportation Safety Board’s aviation crash database during 1983 through 2002, and controls (n=746) were air carrier incidents involving aircraft of the same three makes selected at random from the Federal Aviation Administration’s aviation incident database. Each case was matched with two controls on the calendar year when the index crash occurred. Conditional logistic regression was used for statistical analysis. Results With adjustment for basic weather condition, pilot age, and total flight time, the risk of air carrier crashes in Alaska was more than three times the risk for other regions [adjusted odds ratio (OR) 3.18, 95% confidence interval (CI) 1.35 – 7.49]. Instrument meteorological conditions were associated with an increased risk for air carrier crashes involving pilot error (adjusted OR 2.26, 95% CI 1.15 – 4.44) and a decreased risk for air carrier crashes without pilot error (adjusted OR 0.57, 95% CI 0.40 – 0.87). Neither pilot age nor total flight time was significantly associated with the risk of air carrier crashes. Conclusions The excess risk of air carrier crashes in Alaska and the effect of adverse weather on pilot-error crashes underscore the importance of environmental hazards in flight safety. PMID:19378910

Geographic region, weather, pilot age, and air carrier crashes: a case-control study.

PubMed

Li, Guohua; Pressley, Joyce C; Qiang, Yandong; Grabowski, Jurek G; Baker, Susan P; Rebok, George W

2009-04-01

Information about risk factors of aviation crashes is crucial for developing effective intervention programs. Previous studies assessing factors associated with crash risk were conducted primarily in general aviation, air taxis, and commuter air carriers. A matched case-control design was used to examine the associations of geographic region, basic weather condition, and pilot age with the risk of air carrier (14 CFR Part 121) crash involvement. Cases (N = 373) were air carrier crashes involving aircraft made by Boeing, McDonnell Douglas, and Airbus recorded in the National Transportation Safety Board's aviation crash database during 1983 through 2002, and controls (N = 746) were air carrier incidents involving aircraft of the same three makes selected at random from the Federal Aviation Administration's aviation incident database. Each case was matched with two controls on the calendar year when the index crash occurred. Conditional logistic regression was used for statistical analysis. With adjustment for basic weather condition, pilot age, and total flight time, the risk of air carrier crashes in Alaska was more than three times the risk for other regions ladjusted odds ratio (OR) 3.18, 95% confidence interval (CI) 1.35-7.49]. Instrument meteorological conditions were associated with an increased risk for air carrier crashes involving pilot error (adjusted OR 2.26, 95% CI 1.15-4.44) and a decreased risk for air carrier crashes without pilot error (adjusted OR 0.60, 95% CI 0.37-0.96). Neither pilot age nor total flight time were significantly associated with the risk of air carrier crashes. The excess risk of air carrier crashes in Alaska and the effect of adverse weather on pilot-error crashes underscore the importance of environmental hazards in flight safety.

Empirical performance of the self-controlled case series design: lessons for developing a risk identification and analysis system.

PubMed

Suchard, Marc A; Zorych, Ivan; Simpson, Shawn E; Schuemie, Martijn J; Ryan, Patrick B; Madigan, David

2013-10-01

The self-controlled case series (SCCS) offers potential as an statistical method for risk identification involving medical products from large-scale observational healthcare data. However, analytic design choices remain in encoding the longitudinal health records into the SCCS framework and its risk identification performance across real-world databases is unknown. To evaluate the performance of SCCS and its design choices as a tool for risk identification in observational healthcare data. We examined the risk identification performance of SCCS across five design choices using 399 drug-health outcome pairs in five real observational databases (four administrative claims and one electronic health records). In these databases, the pairs involve 165 positive controls and 234 negative controls. We also consider several synthetic databases with known relative risks between drug-outcome pairs. We evaluate risk identification performance through estimating the area under the receiver-operator characteristics curve (AUC) and bias and coverage probability in the synthetic examples. The SCCS achieves strong predictive performance. Twelve of the twenty health outcome-database scenarios return AUCs >0.75 across all drugs. Including all adverse events instead of just the first per patient and applying a multivariate adjustment for concomitant drug use are the most important design choices. However, the SCCS as applied here returns relative risk point-estimates biased towards the null value of 1 with low coverage probability. The SCCS recently extended to apply a multivariate adjustment for concomitant drug use offers promise as a statistical tool for risk identification in large-scale observational healthcare databases. Poor estimator calibration dampens enthusiasm, but on-going work should correct this short-coming.

Traumatic Stress Interacts With Bipolar Disorder Genetic Risk to Increase Risk for Suicide Attempts

PubMed Central

Wilcox, Holly C.; Fullerton, Janice M.; Glowinski, Anne L.; Benke, Kelly; Kamali, Masoud; Hulvershorn, Leslie A.; Stapp, Emma K.; Edenberg, Howard J.; Roberts, Gloria M.P.; Ghaziuddin, Neera; Fisher, Carrie; Brucksch, Christine; Frankland, Andrew; Toma, Claudio; Shaw, Alex D.; Kastelic, Elizabeth; Miller, Leslie; McInnis, Melvin G.; Mitchell, Philip B.; Nurnberger, John I.

2018-01-01

Objective Bipolar disorder (BD) is one of the most heritable psychiatric conditions and is associated with high suicide risk. To explore the reasons for this link, this study examined the interaction between traumatic stress and BD polygenic risk score in relation to suicidal ideation, suicide attempt, and nonsuicidal self-injury (NSSI) in adolescent and young adult offspring and relatives of persons with BD (BD-relatives) compared with adolescent and young adult offspring of individuals without psychiatric disorders (controls). Method Data were collected from 4 sites in the United States and 1 site in Australia from 2006 through 2012. Generalized estimating equation models were used to compare rates of ideation, attempts, and NSSI between BD-relatives (n = 307) and controls (n = 166) and to determine the contribution of demographic factors, traumatic stress exposure, lifetime mood or substance (alcohol/drug) use disorders, and BD polygenic risk score. Results After adjusting for demographic characteristics and mood and substance use disorders, BD-relatives were at increased risk for suicidal ideation and attempts but not for NSSI. Independent of BD-relative versus control status, demographic factors, or mood and substance use disorders, exposure to trauma within the past year (including bullying, sexual abuse, and domestic violence) was associated with suicide attempts (p = .014), and BD polygenic risk score was marginally associated with attempts (p = .061). Importantly, the interaction between BD polygenic risk score and traumatic event exposures was significantly associated with attempts, independent of demographics, relative versus control status, and mood and substance use disorders (p = .041). Conclusion BD-relatives are at increased risk for suicide attempts and ideation, especially if they are exposed to trauma and have evidence of increased genetic vulnerability. PMID:29173741

African Americans and Hispanics Remain at Lower Risk of Ovarian Cancer Than Non-Hispanic Whites after Considering Nongenetic Risk Factors and Oophorectomy Rates.

PubMed

Wu, Anna H; Pearce, Celeste L; Tseng, Chiu-Chen; Pike, Malcolm C

2015-07-01

Risk factors for invasive epithelial ovarian cancer (IEOC) among Hispanics and African Americans are understudied despite notable differences in incidence relative to non-Hispanic whites. We used multivariate logistic regression to examine parity, oral contraceptive use, tubal ligation, endometriosis, family history of ovarian cancer, and talc use and risk of IEOC among Hispanics (308 cases and 380 controls), African Americans (128 cases and 143 controls), and non-Hispanic whites (1,265 cases and 1,868 controls) using four case-control studies we conducted in Los Angeles County. We expressed each of these factors in the form of increasing risk and calculated population attributable risk percentage (PAR%) estimates for the six risk factors separately and jointly in the three groups. The risk associations with these six well-accepted factors were comparable in the three groups. The significant racial/ethnic differences in the prevalence of these factors and differences in their oophorectomy rates explained 31% of the lower incidence in African Americans compared with non-Hispanic whites, but only 13% of the lower incidence in Hispanics. The PAR%s ranged from 27.5% to 31.0% for no tubal ligation, 15.9% to 22.2% for not using oral contraceptives, and 12.2% to 15.1% for using talc in the three groups. All six risk factors are comparably important in the three groups. Differences in the prevalence of these factors and their oophorectomy rates explained approximately one third of the difference in incidence between African Americans and non-Hispanic whites. Devising strategies to lessen the burden of IEOC will be applicable to all three racial/ethnic groups. ©2015 American Association for Cancer Research.

Use of acid-suppressive drugs and risk of fracture: a meta-analysis of observational studies.

PubMed

Eom, Chun-Sick; Park, Sang Min; Myung, Seung-Kwon; Yun, Jae Moon; Ahn, Jeong-Soo

2011-01-01

Previous studies have reported inconsistent findings regarding the association between the use of acid-suppressive drugs such as proton pump inhibitors (PPIs) and histamine 2 receptor antagonists (H(2)RAs) and fracture risk. We investigated this association using meta-analysis. We searched MEDLINE (PubMed), EMBASE, and the Cochrane Library from inception through December 2010 using common key words. We included case-control, nested case-control, and cohort studies. Two evaluators independently reviewed and selected articles. We determined pooled effect estimates by using random-effects meta-analysis, because of heterogeneity. Of 1,809 articles meeting our initial inclusion criteria, 5 case-control studies, 3 nested case-control studies, and 3 cohort studies were included in the final analyses. The pooled odds ratio (OR) for fracture was 1.29 (95% confidence interval [CI], 1.18-1.41) with use of PPIs and 1.10 (95% CI, 0.99-1.23) with use of H(2)RAs when compared with nonuse of the respective medications. Long-term use of PPIs increased the risk of any fracture (adjusted OR = 1.30; 95% CI, 1.15-1.48) and hip fracture risk (adjusted OR = 1.34; 95% CI, 1.09-1.66), whereas long-term H(2)RA use was not significantly associated with fracture risk. We found possible evidence linking PPI use to an increased risk of fracture, but no association between H(2)RA use and fracture risk. Widespread use of PPIs with the potential risk of fracture is of great importance to public health. Clinicians should carefully consider their decision to prescribe PPIs for patients already having an elevated risk of fracture because of age or other factors.

Risk and Vulnerability Assessment Using Cybernomic Computational Models: Tailored for Industrial Control Systems

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

Abercrombie, Robert K; Sheldon, Federick T.; Schlicher, Bob G

2015-01-01

There are many influencing economic factors to weigh from the defender-practitioner stakeholder point-of-view that involve cost combined with development/deployment models. Some examples include the cost of countermeasures themselves, the cost of training and the cost of maintenance. Meanwhile, we must better anticipate the total cost from a compromise. The return on investment in countermeasures is essentially impact costs (i.e., the costs from violating availability, integrity and confidentiality / privacy requirements). The natural question arises about choosing the main risks that must be mitigated/controlled and monitored in deciding where to focus security investments. To answer this question, we have investigated themore » cost/benefits to the attacker/defender to better estimate risk exposure. In doing so, it s important to develop a sound basis for estimating the factors that derive risk exposure, such as likelihood that a threat will emerge and whether it will be thwarted. This impact assessment framework can provide key information for ranking cybersecurity threats and managing risk.« less

[Temporary employment and health: a multivariate analysis of occupational injury risk by job tenure].

PubMed

Bena, Antonella; Giraudo, Massimiliano

2013-01-01

To study the relationship between job tenure and injury risk, controlling for individual factors and company characteristics. Analysis of incidence and injury risk by job tenure, controlling for gender, age, nationality, economic activity, firm size. Sample of 7% of Italian workers registered in the INPS (National Institute of Social Insurance) database. Private sector employees who worked as blue collars or apprentices. First-time occupational injuries, all occupational injuries, serious occupational injuries. Our findings show an increase in injury risk among those who start a new job and an inverse relationship between job tenure and injury risk. Multivariate analysis confirm these results. Recommendations for improving this situation include the adoption of organizational models that provide periods of mentoring from colleagues already in the company and the assignment to simple and not much hazardous tasks. The economic crisis may exacerbate this problem: it is important for Italy to improve the systems of monitoring relations between temporary employment and health.

Early-warning signals of topological collapse in interbank networks

NASA Astrophysics Data System (ADS)

Squartini, Tiziano; van Lelyveld, Iman; Garlaschelli, Diego

2013-11-01

The financial crisis clearly illustrated the importance of characterizing the level of `systemic' risk associated with an entire credit network, rather than with single institutions. However, the interplay between financial distress and topological changes is still poorly understood. Here we analyze the quarterly interbank exposures among Dutch banks over the period 1998-2008, ending with the crisis. After controlling for the link density, many topological properties display an abrupt change in 2008, providing a clear - but unpredictable - signature of the crisis. By contrast, if the heterogeneity of banks' connectivity is controlled for, the same properties show a gradual transition to the crisis, starting in 2005 and preceded by an even earlier period during which anomalous debt loops could have led to the underestimation of counter-party risk. These early-warning signals are undetectable if the network is reconstructed from partial bank-specific data, as routinely done. We discuss important implications for bank regulatory policies.

Perceived risks and perceived benefits of different nanotechnology foods and nanotechnology food packaging.

PubMed

Siegrist, Michael; Stampfli, Nathalie; Kastenholz, Hans; Keller, Carmen

2008-09-01

Nanotechnology has the potential to generate new food products and new food packaging. In a mail survey in the German speaking part of Switzerland, lay people's (N=337) perceptions of 19 nanotechnology applications were examined. The goal was to identify food applications that are more likely and food applications that are less likely to be accepted by the public. The psychometric paradigm was employed, and applications were described in short scenarios. Results suggest that affect and perceived control are important factors influencing risk and benefit perception. Nanotechnology food packaging was assessed as less problematic than nanotechnology foods. Analyses of individual data showed that the importance of naturalness in food products and trust were significant factors influencing the perceived risk and the perceived benefit of nanotechnology foods and nanotechnology food packaging.

Recommendations for safe vaccination in children at the risk of taking allergic reactions to vaccine components

PubMed

2018-04-01

Vaccines are one of the most important advances in medicine as a public health tool for the control of immunopreventable diseases. Occasionally, adverse reactions may occur. If a child has a reaction to a vaccine, it is likely to disrupt his immunization schedule with risks to himself and the community. This establishes the importance of correctly diagnosing a possible allergy and defining appropriate behavior. Allergic reactions to vaccines may be due to the immunogenic component, to the residual proteins in the manufacturing process and to antimicrobial agents, stabilizers, preservatives and any other element used in the manufacturing process. Vaccination should be a priority in the entire child population, so this document describes particular situations of allergic children to minimize the risk of immunizations and achieve safe vaccination.

[Importance of age and other risk factors in NSAID-induced gastropathy].

PubMed

Lee, Hang Lak; Han, Dong Soo; Kim, Jin Bae; Kim, Jong Pyo; Jeon, Yong Chul; Sohn, Joo Hyun; Hahm, Joon Soo

2004-11-01

It is clinically important to analyze the risk factors of NSAID-induced gastropathy because there could be no symptoms. Age is the most important risk factor according to previous reports. The aim of this study was to find risk factors of NSAID-induced gastropathy and to confirm the association between NSAID-induced gastropathy and age. We retrospectively assessed 300 patients who conducted an upper gastroscopy during the course of chronic NSAID treatment. Median age of patients group is 51.4 +/- 12.2 years. In multivariate analysis, age and ulcer history are two significant risk factors. Median age is 46.7 +/- 10.7 years for the patients with nonspecific gastroscopic finding, 53.0 +/- 12.5 for those with erosion, 57.6 +/- 10.0 for those with ulcer, and 63.2 +/- 8.9 for those with hemorrhage. The proportion of ulcer patients is as follows: 6% in the patients of under 40 years old, 14.9% in patients of the 40s, 20% in patients of the 50s, 30.9% in patients of the 60s, 33.3% in patients over 70 years. The proportion of nonspecific findings is 62.2% in patients of the 40s, 37.8% in patients of the 50s, and 29% in patients over 60 years. Age is the most important risk factor of the NSAID-induced gastrointestinal mucosal injury. A larger randomized prospective control study will be required in the future for more conclusive results.

Socioeconomic inequalities in risk of hospitalization for community-acquired bacteremia: a Danish population-based case-control study.

PubMed

Koch, Kristoffer; Søgaard, Mette; Nørgaard, Mette; Thomsen, Reimar Wernich; Schønheyder, Henrik Carl

2014-05-01

In a Danish population-based case-control study, we examined the association between socioeconomic status (SES) and risk of community-acquired bacteremia, as well as the contribution of chronic diseases and substance abuse to differences in bacteremia risk. Analyses were based on 4,117 patients aged 30-65 years who were hospitalized with first-time community-acquired bacteremia during 2000-2008 and 41,170 population controls matched by sex, age, and region of residence. Individual-level information on SES (education and income), chronic diseases, and substance abuse was retrieved from public and medical registries. Conditional logistic regression was used to compute odds ratios for bacteremia. Persons of low SES had a substantially higher risk of bacteremia than those of high SES (for short duration of education vs. long duration, odds ratio = 2.30 (95% confidence interval: 2.10, 2.52); for low income vs. high income, odds ratio = 2.77 (95% confidence interval: 2.54, 3.02)). A higher prevalence of chronic diseases and substance abuse in low-SES individuals versus high-SES individuals explained 43%-48% of the socioeconomic differences in bacteremia risk. In a country with a universal welfare system, differences in the burden of chronic diseases and substance abuse seem to have major importance in explaining inequalities in bacteremia risk.

A Multicenter Study of Glucocerebrosidase Mutations in Dementia With Lewy Bodies

PubMed Central

Nalls, Michael A.; Duran, Raquel; Lopez, Grisel; Kurzawa-Akanbi, Marzena; McKeith, Ian G.; Chinnery, Patrick F.; Morris, Christopher M.; Theuns, Jessie; Crosiers, David; Cras, Patrick; Engelborghs, Sebastiaan; De Deyn, Peter Paul; Van Broeckhoven, Christine; Mann, David M. A.; Snowden, Julie; Pickering-Brown, Stuart; Halliwell, Nicola; Davidson, Yvonne; Gibbons, Linda; Harris, Jenny; Sheerin, Una-Marie; Bras, Jose; Hardy, John; Clark, Lorraine; Marder, Karen; Honig, Lawrence S.; Berg, Daniela; Maetzler, Walter; Brockmann, Kathrin; Gasser, Thomas; Novellino, Fabiana; Quattrone, Aldo; Annesi, Grazia; De Marco, Elvira Valeria; Rogaeva, Ekaterina; Masellis, Mario; Black, Sandra E.; Bilbao, Juan M.; Foroud, Tatiana; Ghetti, Bernardino; Nichols, William C.; Pankratz, Nathan; Halliday, Glenda; Lesage, Suzanne; Klebe, Stephan; Durr, Alexandra; Duyckaerts, Charles; Brice, Alexis; Giasson, Benoit I.; Trojanowski, John Q.; Hurtig, Howard I.; Tayebi, Nahid; Landazabal, Claudia; Knight, Melanie A.; Keller, Margaux; Singleton, Andrew B.; Wolfsberg, Tyra G.; Sidransky, Ellen

2013-01-01

Importance While mutations in glucocerebrosidase (GBA1) are associated with an increased risk for Parkinson disease (PD), it is important to establish whether such mutations are also a common risk factor for other Lewy body disorders. Objective To establish whether GBA1 mutations are a risk factor for dementia with Lewy bodies (DLB). Design We compared genotype data on patients and controls from 11 centers. Data concerning demographics, age at onset, disease duration, and clinical and pathological features were collected when available. We conducted pooled analyses using logistic regression to investigate GBA1 mutation carrier status as predicting DLB or PD with dementia status, using common control subjects as a reference group. Random-effects meta-analyses were conducted to account for additional heterogeneity. Setting Eleven centers from sites around the world performing genotyping. Participants Seven hundred twenty-one cases met diagnostic criteria for DLB and 151 had PD with dementia. We compared these cases with 1962 controls from the same centers matched for age, sex, and ethnicity. Main Outcome Measures Frequency of GBA1 mutations in cases and controls. Results We found a significant association between GBA1 mutation carrier status and DLB, with an odds ratio of 8.28 (95% CI, 4.78–14.88). The odds ratio for PD with dementia was 6.48 (95% CI, 2.53–15.37). The mean age at diagnosis of DLB was earlier in GBA1 mutation carriers than in noncarriers (63.5 vs 68.9 years; P<.001), with higher disease severity scores. Conclusions and Relevance Mutations in GBA1 are a significant risk factor for DLB. GBA1 mutations likely play an even larger role in the genetic etiology of DLB than in PD, providing insight into the role of glucocerebrosidase in Lewy body disease. PMID:23588557

Risk of malignant neoplasms in acromegaly: a case-control study.

PubMed

Wolinski, K; Stangierski, A; Dyrda, K; Nowicka, K; Pelka, M; Iqbal, A; Car, A; Lazizi, M; Bednarek, N; Czarnywojtek, A; Gurgul, E; Ruchala, M

2017-03-01

Acromegaly is a chronic disease resulting from pathological oversecretion of growth hormone and subsequently insulin growth factor-1. Several complications of the disease have been reported, including cardiovascular diseases, respiratory disorders but also increased risk of benign and malignant neoplasms. The aim of the study was to evaluate the risk of malignant neoplasms in the patients with acromegaly in comparison with the control group. Medical documentation of acromegalic patients treated in one medical center between 2005 and 2016 has been analyzed. Results were compared with sex- and age-matched group of subjects with prolactinomas and hormonally inactive pituitary lesions hospitalized in the same department. Two hundred patients with acromegaly were included. Control group was composed of 145 patients. Any malignant neoplasm in anamnesis was present in 27 (13.5 %) patients with acromegaly and six (4.1 %) subjects from control group (p = 0.003). Thyroid cancer was present in 14 (7.0 %) patients with acromegaly and two (1.4 %) in control group (p = 0.02). Breast cancer was present in seven women (5.4 % of women) in acromegaly group but none of subjects in control group (p = 0.02). Colon cancer-4 (2.0 %) patients in acromegaly group and 0 in control group (p = 0.14). Malignant neoplasms are significantly more common in patients with acromegaly. Particularly, risk of thyroid cancer was increased over fivefold. Systematic screening for neoplastic diseases should be important part of follow-up in these patients. Further case-control studies are strongly indicated to evaluate which neoplasms are more common in acromegalic patients and what is the exact risk of malignancy.

Risk of Autism Spectrum Disorders in Children Born to Mothers With Rheumatoid Arthritis: A Systematic Literature Review.

PubMed

Wojcik, Sophie; Bernatsky, Sasha; Platt, Robert W; Pineau, Christian A; Clarke, Ann E; Fombonne, Éric; Bérard, Anick; Vinet, Évelyne

2017-12-01

There is recent evidence to suggest that in utero exposure to maternal antibodies and cytokines is an important risk factor for autism spectrum disorders (ASDs). We aimed to systematically review the risk of ASDs in children born to mothers with rheumatoid arthritis (RA) compared to children born to mothers without RA. We conducted a systematic review of original articles using the electronic databases PubMed, Embase, and Web of Science. Our literature search yielded a total of 70 articles. Of the potentially relevant studies retrieved, 67 were excluded for lack of relevance and/or because they did not report original data. Three studies were included in the final analysis. A case-control study found no difference in the prevalence of RA in mothers of children with ASDs versus control mothers. Another case-control study showed a statistically significant 8-fold increase in autoimmune disorders, including RA, in mothers of offspring with ASDs compared to controls. Forty-six percent of offspring with ASDs had a first-degree relative with RA, compared to 26% of controls. And in a population-based cohort study, investigators observed an increased risk of ASDs in children with a maternal history of RA compared to children born to unaffected mothers. These studies had methodologic limitations: none controlled for medication exposures, only 1 controlled for obstetric complications and considered the timing of RA diagnosis in relation to pregnancy, and all but 1 used a case-control study design. Observational studies suggest a potentially increased risk of ASDs in children born to mothers with RA compared to children born to mothers without RA, although data are limited. © 2017, American College of Rheumatology.

Funding for malaria control 2006-2010: a comprehensive global assessment.

PubMed

Pigott, David M; Atun, Rifat; Moyes, Catherine L; Hay, Simon I; Gething, Peter W

2012-07-28

The last decade has seen a dramatic increase in international and domestic funding for malaria control, coupled with important declines in malaria incidence and mortality in some regions of the world. As the ongoing climate of financial uncertainty places strains on investment in global health, there is an increasing need to audit the origin, recipients and geographical distribution of funding for malaria control relative to populations at risk of the disease. A comprehensive review of malaria control funding from international donors, bilateral sources and national governments was undertaken to reconstruct total funding by country for each year 2006 to 2010. Regions at risk from Plasmodium falciparum and/or Plasmodium vivax transmission were identified using global risk maps for 2010 and funding was assessed relative to populations at risk. Those nations with unequal funding relative to a regional average were identified and potential explanations highlighted, such as differences in national policies, government inaction or donor neglect. US$8.9 billion was disbursed for malaria control and elimination programmes over the study period. Africa had the largest levels of funding per capita-at-risk, with most nations supported primarily by international aid. Countries of the Americas, in contrast, were supported typically through national government funding. Disbursements and government funding in Asia were far lower with a large variation in funding patterns. Nations with relatively high and low levels of funding are discussed. Global funding for malaria control is substantially less than required. Inequity in funding is pronounced in some regions particularly when considering the distinct goals of malaria control and malaria elimination. Efforts to sustain and increase international investment in malaria control should be informed by evidence-based assessment of funding equity.

Funding for malaria control 2006–2010: A comprehensive global assessment

PubMed Central

2012-01-01

Background The last decade has seen a dramatic increase in international and domestic funding for malaria control, coupled with important declines in malaria incidence and mortality in some regions of the world. As the ongoing climate of financial uncertainty places strains on investment in global health, there is an increasing need to audit the origin, recipients and geographical distribution of funding for malaria control relative to populations at risk of the disease. Methods A comprehensive review of malaria control funding from international donors, bilateral sources and national governments was undertaken to reconstruct total funding by country for each year 2006 to 2010. Regions at risk from Plasmodium falciparum and/or Plasmodium vivax transmission were identified using global risk maps for 2010 and funding was assessed relative to populations at risk. Those nations with unequal funding relative to a regional average were identified and potential explanations highlighted, such as differences in national policies, government inaction or donor neglect. Results US$8.9 billion was disbursed for malaria control and elimination programmes over the study period. Africa had the largest levels of funding per capita-at-risk, with most nations supported primarily by international aid. Countries of the Americas, in contrast, were supported typically through national government funding. Disbursements and government funding in Asia were far lower with a large variation in funding patterns. Nations with relatively high and low levels of funding are discussed. Conclusions Global funding for malaria control is substantially less than required. Inequity in funding is pronounced in some regions particularly when considering the distinct goals of malaria control and malaria elimination. Efforts to sustain and increase international investment in malaria control should be informed by evidence-based assessment of funding equity. PMID:22839432

The genetic validation of heterogeneity in schizophrenia.

PubMed

Tsutsumi, Atsushi; Glatt, Stephen J; Kanazawa, Tetsufumi; Kawashige, Seiya; Uenishi, Hiroyuki; Hokyo, Akira; Kaneko, Takao; Moritani, Makiko; Kikuyama, Hiroki; Koh, Jun; Matsumura, Hitoshi; Yoneda, Hiroshi

2011-10-07

Schizophrenia is a heritable disorder, however clear genetic architecture has not been detected. To overcome this state of uncertainty, the SZGene database has been established by including all published case-control genetic association studies appearing in peer-reviewed journals. In the current study, we aimed to determine if genetic variants strongly suggested by SZGene are associated with risk of schizophrenia in our case-control samples of Japanese ancestry. In addition, by employing the additive model for aggregating the effect of seven variants, we aimed to verify the genetic heterogeneity of schizophrenia diagnosed by an operative diagnostic manual, the DSM-IV. Each positively suggested genetic polymorphism was ranked according to its p-value, then the seven top-ranked variants (p < 0.0005) were selected from DRD2, DRD4, GRIN2B, TPH1, MTHFR, and DTNBP1 (February, 2007). 407 Schizophrenia cases and 384 controls participated in this study. To aggregate the vulnerability of the disorder based on the participants' genetic information, we calculated the "risk-index" by adding the number of genetic risk factors. No statistically significant deviation between cases and controls was observed in the genetic risk-index derived from all seven variants on the top-ranked polymorphisms. In fact, the average risk-index score in the schizophrenia group (6.5+/-1.57) was slightly lower than among controls (6.6+/-1.39). The current work illustrates the difficulty in identifying universal and definitive risk-conferring polymorphisms for schizophrenia. Our employed number of samples was small, so we can not preclude the possibility that some or all of these variants are minor risk factors for schizophrenia in the Japanese population. It is also important to aggregate the updated positive variants in the SZGene database when the replication work is conducted.

Prevention and control of food safety risks: the role of governments, food producers, marketers, and academia.

PubMed

Lupien, John R

2007-01-01

Food systems are rapidly changing as world population grows, increasing urbanization occurs, consumer tastes and preferences change and differ in various countries and cultures, large scale food production increases, and food imports and exports grow in volume and value. Consumers in all countries have become more insistent that foods available in the marketplace are of good quality and safe, and do not pose risks to them and their families. Publicity about food risk problems and related risks, including chemical and microbiological contamination of foods, mad-cow disease, avian flu, industrial chemical contamination all have made consumers and policy makers more aware of the need of the control of food safety risk factors in all countries. To discuss changes in food systems, and in consumer expectations, that have placed additional stress on the need for better control of food safety risks. Food producers, processors, and marketers have additional food law and regulations to meet; government agencies must increase monitoring and enforcement of adequate food quality and safety legislation and coordinate efforts between agriculture, health, trade, justice and customs agencies; and academia must take action to strengthen the education of competent food legislation administrators, inspectorate, and laboratory personnel for work in government and industry, including related food and food safety research . Both Government and the food industry must assure that adequate control programs are in place to control the quality and safety of all foods, raw or processed, throughout the food chain from production to final consumption. This includes appropriate laboratory facilities to perform necessary analysis of foods for risk and quality factors, and to carry out a wide range of food science, toxicological and related research.

Risk management measures for chemicals: the "COSHH essentials" approach.

PubMed

Garrod, A N I; Evans, P G; Davy, C W

2007-12-01

"COSHH essentials" was developed in Great Britain to help duty holders comply with the Control of Substances Hazardous to Health (COSHH) Regulations. It uses a similar approach to that described in the new European "REACH" Regulation (Registration, Evaluation, Authorisation and Restriction of Chemicals; EC No. 1907/2006 of the European Parliament), insofar as it identifies measures for managing the risk for specified exposure scenarios. It can therefore assist REACH duty holders with the identification and communication of appropriate risk-management measures. The technical basis for COSHH essentials is explained in the original papers published in the Annals of Occupational Hygiene. Its details will, therefore, not be described here; rather, its ability to provide a suitable means for communicating risk-management measures will be explored. COSHH essentials is a simple tool based on an empirical approach to risk assessment and risk management. The output is a "Control Guidance Sheet" that lists the "dos" and "don'ts" for control in a specific task scenario. The guidance in COSHH essentials recognises that exposure in the workplace will depend not just on mechanical controls, but also on a number of other factors, including administrative and behavioural controls, such as systems of work, supervision and training. In 2002, COSHH essentials was made freely available via the internet (http://www.coshh-essentials.org.uk/). This electronic delivery enabled links to be made between product series that share tasks, such as drum filling, and with ancillary guidance, such as setting up health surveillance for work with a respiratory sensitiser. COSHH essentials has proved to be a popular tool for communicating good control practice. It has attracted over 1 million visits to its site since its launch. It offers a common benchmark of good practice for chemical users, manufacturers, suppliers and importers, as well as regulators and health professionals.

Cardiovascular risk profile and management of atrial fibrillation in India: Real world data from RealiseAF survey.

PubMed

Narasimhan, C; Verma, Jagmohan Singh; Ravi Kishore, A G; Singh, Balbir; Dani, Sameer; Chawala, Kamaldeep; Haque, Azizul; Khan, Aftab; Nair, Mohan; Vora, Amit; Rajasekhar, V; Thomas, Joy M; Gupta, Anoop; Naik, Ajay; Prakash, V S; Naditch, Lisa; Gabriel Steg, P

Atrial fibrillation (AF) is the most common sustained arrhythmia with high risk for many cardiovascular (CV) complications. Adherence to recommended management guidelines is important to avoid complications. In India, there is little knowledge on how AF is managed in real world. This is a cross-sectional study of patients in India enrolled in RealiseAF survey between February 2010 and March 2010 with a diagnosis of AF within the last 12 months. From 15 centers, 301 patients {mean age 59.9 years (14.4); 52.5% males} were recruited. AF was controlled in 50% of patients with 77 (26.7%) in sinus rhythm and 67 (23.3%) with heart rate <80beats/min. Hypertension (50.8%), valvular heart disease (40.7%), heart failure (25.9%), and diabetes (20.4%) were the most common underlying CV diseases. Increased risk for stroke (CHADS 2 score≥2) was present in 36.6%. Most of the patients (85%) were symptomatic. AF was paroxysmal, persistent, and permanent in 28.7%, 22.7%, and 34.3% respectively. In 14%, AF was diagnosed as first episode. Forty-six percent of patients had rate control, 35.2% rhythm control, 0.3% both strategies, and 18.4% received no therapy for AF before the visit. At the end of the visit, adoption to rate control strategy increased to 52.3% and patients with no therapy decreased to 7%. AF in India is not adequately controlled. Concomitant CV risk factors and risk of stroke are high. The study underscores the need for improved adoption of guideline-directed management for optimal control of AF and reducing the risk of stroke. Copyright © 2016. Published by Elsevier B.V.

Beyond stereotypes of adolescent risk taking: Placing the adolescent brain in developmental context☆

PubMed Central

Romer, Daniel; Reyna, Valerie F.; Satterthwaite, Theodore D.

2017-01-01

Recent neuroscience models of adolescent brain development attribute the morbidity and mortality of this period to structural and functional imbalances between more fully developed limbic regions that subserve reward and emotion as opposed to those that enable cognitive control. We challenge this interpretation of adolescent development by distinguishing risk-taking that peaks during adolescence (sensation seeking and impulsive action) from risk taking that declines monotonically from childhood to adulthood (impulsive choice and other decisions under known risk). Sensation seeking is primarily motivated by exploration of the environment under ambiguous risk contexts, while impulsive action, which is likely to be maladaptive, is more characteristic of a subset of youth with weak control over limbic motivation. Risk taking that declines monotonically from childhood to adulthood occurs primarily under conditions of known risks and reflects increases in executive function as well as aversion to risk based on increases in gist-based reasoning. We propose an alternative Lifespan Wisdom Model that highlights the importance of experience gained through exploration during adolescence. We propose, therefore, that brain models that recognize the adaptive roles that cognition and experience play during adolescence provide a more complete and helpful picture of this period of development. PMID:28777995

Psychological autopsy study comparing suicide decedents, suicide ideators, and propensity score matched controls: results from the study to assess risk and resilience in service members (Army STARRS).

PubMed

Nock, M K; Dempsey, C L; Aliaga, P A; Brent, D A; Heeringa, S G; Kessler, R C; Stein, M B; Ursano, R J; Benedek, D

2017-11-01

The suicide rate has increased significantly among US Army soldiers over the past decade. Here we report the first results from a large psychological autopsy study using two control groups designed to reveal risk factors for suicide death among soldiers beyond known sociodemographic factors and the presence of suicide ideation. Informants were next-of-kin and Army supervisors for: 135 suicide cases, 137 control soldiers propensity-score-matched on known sociodemographic risk factors for suicide and Army history variables, and 118 control soldiers who reported suicide ideation in the past year. Results revealed that most (79.3%) soldiers who died by suicide have a prior mental disorder; mental disorders in the prior 30-days were especially strong risk factors for suicide death. Approximately half of suicide decedents tell someone that they are considering suicide. Virtually all of the risk factors identified in this study differed between suicide cases and propensity-score-matched controls, but did not significantly differ between suicide cases and suicide ideators. The most striking difference between suicides and ideators was the presence in the former of an internalizing disorder (especially depression) and multi-morbidity (i.e. 3+ disorders) in the past 30 days. Most soldiers who die by suicide have identifiable mental disorders shortly before their death and tell others about their suicidal thinking, suggesting that there are opportunities for prevention and intervention. However, few risk factors distinguish between suicide ideators and decedents, pointing to an important direction for future research.

Increasing Treatment Seeking Among at-Risk Service Members Returning from Warzones

DTIC Science & Technology

2016-03-01

SUPPLEMENTARY NOTES 14. ABSTRACT We propose a randomized controlled clinical trial of 1,200 military service members who are at increased risk for suicide but...n/a INTRODUCTION TO SPECIFIC AIMS Reducing suicide is a national priority and an urgent concern within the Department...of Defense and the Department of Veterans Affairs. The passage of the Joshua Omvig Veterans Suicide Prevention Act highlights the importance that

Febrile infectious childhood diseases in the history of cancer patients and matched controls.

PubMed

Albonico, H U; Bräker, H U; Hüsler, J

1998-10-01

The present study was designed to investigate the hypothesis that febrile infectious childhood diseases (FICDs) are associated with a lower cancer risk in adulthood, since biographical considerations are of great importance in anthroposophic medicine. Cancer patients and control patients of 35 anthroposophic general practitioners in Switzerland were matched with respect to gender, age and physician. All patients completed a questionnaire on their FICD. We collected 424 cases; of these we could analyze 379 matched pairs. The study consistently revealed a lower cancer risk for patients with a history of FICD. The strongest associations were found between patients with non-breast cancers and rubella respectively chickenpox. A strong association was also found with the overall number of FICD both 'classical' (measles, mumps, rubella, pertussis, scarlet-fever and chickenpox) and 'other'. None of these associations was apparent for patients with breast cancer. Unexpectedly, we found that cancer was diagnosed significantly earlier in life in cancer patients with a history of FICD compared to those without FICD. Our retrospective study showed a significant association between FICD and the risk of developing cancer. The number of FICD decreased the cancer risk, in particular for non-breast cancers. The relationship with tumor site seems to be important also, but can only be addressed in a larger study.

The risk of bronchospasm in asthmatics undergoing general anaesthesia and/or intravascular administration of radiographic contrast media. physiopatology and clinical/functional evaluation.

PubMed

Liccardi, G; Salzillo, A; Piccolo, A; De Napoli, I; D'Amato, G

2010-10-01

It is well known that patients suffering from bronchial asthma undergoing to surgical procedures requiring general anaesthesia (GA) or the administration of water soluble radiographic contrast media (RCM) experience a risk of potentially severe bronchospasm. Nevertheless, little attention has been devoted on the possible preventive measures to reduce the occurrence of this potentially life-threatening event. It has been shown that the most important risk factor for bronchospasm during GA induction and/or the use of RCM is represented by a high degree of bronchial hyperreactivity with airway instability not adequately controlled by long-term anti-inflammatory treatment. The aim of this review is to underline the need for an accurate clinical and functional evaluation of asthmatics (especially those with a relevant degree of asthma severity) undergoing GA or administration of RCM. Guidelines shared by pulmonologists, allergologists, anesthesiologists and radiologists should be produced in the future for a better evaluation and management of these patients. General practitioner plays an important role in managing asthmatic patients in "Real Life". It is likely that "Real Life"--optimally controlled asthmatics could undergo GA/RCM with lower risks especially in emergency conditions when it is not possible to perform any preoperative evaluation.

Association of FAS A-670G Polymorphism and Risk of Uterine Leiomyoma in a Southeast Iranian Population

PubMed Central

Mohammadpour-Gharehbagh, Abbas; Salimi, Saeedeh; Keshavarzi, Farshid; Zakerian, Sepideh; Sajadian, Mojtaba; Mokhtari, Mojgan

2016-01-01

Background: Uterine leiomyoma (UL) is a benign tumor of uterine smooth muscle that affects women in reproductive ages. FAS has an important role in initial stages of apoptosis. Previous studies have shown an association between the FAS gene and tumorigenesis. In the present study, we evaluated the relationship between FAS A-670G (rs 1800682) and UL risk Methods: The FAS gene polymorphism of 155 women with UL and 157 healthy controls was analyzed by the polymerase chain reaction restriction fragment length polymorphism method Results: The AA, AG, and GG genotype frequencies of the FAS A-670G polymorphism were respectively 37.4, 42.6, and 20% in women with UL, and 46, 42.6, and 11.5% in healthy controls. The risk of UL in women was 1.5-fold greater in GG-genotype women than in AA-genotype women. The G allele frequencies were 41% in women with UL and 33% in healthy controls and statistically different (P = 0.03) Conclusion: The FAS polymorphism was associated with the risk of UL in a sample of Iranian women. PMID:28070535

Air pollution involving nitrogen dioxide exposure and wheezing bronchitis in children.

PubMed

Pershagen, G; Rylander, E; Norberg, S; Eriksson, M; Nordvall, S L

1995-12-01

A population-based case-control study was performed in Stockholm to assess the influence of air pollution on the occurrence of severe wheezing bronchitis in children. The study included 197 children aged 4 months to 4 years, who were hospitalized because of breathing difficulties with wheezing, and 350 population controls. Information on potential risk factors for childhood wheezing and a residential history was obtained at home interview with parents. Outdoor nitrogen dioxide (NO2) concentrations at home addresses and day care centres from birth on were estimated from validated models, mainly using data on traffic intensity from municipal registers. The risk of wheezing bronchitis was related to time-weighted mean outdoor NO2 exposure in girls (P = 0.02), but not in boys. A gas stove in the home appeared to be a risk factor primarily for girls. All analyses controlled for parental asthma and maternal smoking, which were independent risk factors for wheezing bronchitis. The results suggest that exposure to combustion products containing NO2 may be of particular importance for the development of wheezing bronchitis in girls.

Modelling risk aversion to support decision-making for controlling zoonotic livestock diseases.

PubMed

van Asseldonk, M A P M; Bergevoet, R H M; Ge, L

2013-12-01

Zoonotic infectious livestock diseases are becoming a significant burden for both animal and human health and are rapidly gaining the attention of decision-makers who manage public health programmes. If control decisions have only monetary components, governments are generally regarded as being risk-neutral and the intervention strategy with the highest expected benefit (lowest expected net costs) should be preferred. However, preferences will differ and alternative intervention plans will prevail if (human) life and death outcomes are involved. A rational decision framework must therefore consider risk aversion in the decision-maker and controversial values related to public health. In the present study, risk aversion and its impact on both the utility for the monetary component and the utility for the non-monetary component is shown to be an important element when dealing with emerging zoonotic infectious livestock diseases and should not be ignored in the understanding and support of decision-making. The decision framework was applied to several control strategies for the reduction of human cases of brucellosis (Brucella melitensis) originating from sheep in Turkey.

Shift changes, updates, and the on-call architecture in space shuttle mission control.

PubMed

Patterson, E S; Woods, D D

2001-01-01

In domains such as nuclear power, industrial process control, and space shuttle mission control, there is increased interest in reducing personnel during nominal operations. An essential element in maintaining safe operations in high risk environments with this 'on-call' organizational architecture is to understand how to bring called-in practitioners up to speed quickly during escalating situations. Targeted field observations were conducted to investigate what it means to update a supervisory controller on the status of a continuous, anomaly-driven process in a complex, distributed environment. Sixteen shift changes, or handovers, at the NASA Johnson Space Center were observed during the STS-76 Space Shuttle mission. The findings from this observational study highlight the importance of prior knowledge in the updates and demonstrate how missing updates can leave flight controllers vulnerable to being unprepared. Implications for mitigating risk in the transition to 'on-call' architectures are discussed.

Shift changes, updates, and the on-call architecture in space shuttle mission control

NASA Technical Reports Server (NTRS)

Patterson, E. S.; Woods, D. D.

2001-01-01

In domains such as nuclear power, industrial process control, and space shuttle mission control, there is increased interest in reducing personnel during nominal operations. An essential element in maintaining safe operations in high risk environments with this 'on-call' organizational architecture is to understand how to bring called-in practitioners up to speed quickly during escalating situations. Targeted field observations were conducted to investigate what it means to update a supervisory controller on the status of a continuous, anomaly-driven process in a complex, distributed environment. Sixteen shift changes, or handovers, at the NASA Johnson Space Center were observed during the STS-76 Space Shuttle mission. The findings from this observational study highlight the importance of prior knowledge in the updates and demonstrate how missing updates can leave flight controllers vulnerable to being unprepared. Implications for mitigating risk in the transition to 'on-call' architectures are discussed.

Patterns and timing of sunlight exposure and risk of basal cell and squamous cell carcinomas of the skin--a case-control study.

PubMed

Iannacone, Michelle R; Wang, Wei; Stockwell, Heather G; O'Rourke, Kathleen; Giuliano, Anna R; Sondak, Vernon K; Messina, Jane L; Roetzheim, Richard G; Cherpelis, Basil S; Fenske, Neil A; Rollison, Dana E

2012-09-20

Non-melanoma skin cancer (NMSC), comprised of basal (BCC) and squamous (SCC) cell carcinomas, is the most common cancer in Caucasians. Ultraviolet radiation (UVR) exposure is the most important environmental risk factor for NMSC. However, the precise relationship between UVR and the risk of NMSC is complex, and the relationship may differ by skin cancer type. A case-control study was conducted among Florida residents to investigate measures of patterns (intermittent vs. continuous) and timing (childhood vs. adulthood) of sunlight exposure in BCC and SCC. Participants included 218 BCC and 169 SCC cases recruited from a university dermatology clinic and 316 controls with no history of skin or other cancers. A history of blistering sunburn (a measure of intermittent sunlight exposure) was associated with both BCC (OR = 1.96, 95% CI = 1.27-3.03) and SCC (OR = 2.02, 95% CI = 1.22-3.33). Additionally, having a job in the sun for ≥ 3 months for 10 years or longer (a measure of continuous sunlight exposure) was also associated with both BCC and SCC in our study population. With the exception of younger age at first blistering sunburn, measures of younger age at sunlight exposure tended to be associated with SCC, but not BCC risk. Results from the current study suggest that sunlight exposure is associated with both BCC and SCC risk regardless of the pattern in which the exposure was received (i.e. intermittent vs. continuous). The data also suggest that sunlight exposure at a younger age may be more important for SCC but not BCC, however additional studies are needed to further characterize sunlight exposure-response relationships in different types of NMSC.

Patterns and timing of sunlight exposure and risk of basal cell and squamous cell carcinomas of the skin – a case–control study

PubMed Central

2012-01-01

Background Non-melanoma skin cancer (NMSC), comprised of basal (BCC) and squamous (SCC) cell carcinomas, is the most common cancer in Caucasians. Ultraviolet radiation (UVR) exposure is the most important environmental risk factor for NMSC. However, the precise relationship between UVR and the risk of NMSC is complex, and the relationship may differ by skin cancer type. Methods A case–control study was conducted among Florida residents to investigate measures of patterns (intermittent vs. continuous) and timing (childhood vs. adulthood) of sunlight exposure in BCC and SCC. Participants included 218 BCC and 169 SCC cases recruited from a university dermatology clinic and 316 controls with no history of skin or other cancers. Results A history of blistering sunburn (a measure of intermittent sunlight exposure) was associated with both BCC (OR = 1.96, 95% CI = 1.27-3.03) and SCC (OR = 2.02, 95% CI = 1.22-3.33). Additionally, having a job in the sun for ≥3 months for 10 years or longer (a measure of continuous sunlight exposure) was also associated with both BCC and SCC in our study population. With the exception of younger age at first blistering sunburn, measures of younger age at sunlight exposure tended to be associated with SCC, but not BCC risk. Conclusions Results from the current study suggest that sunlight exposure is associated with both BCC and SCC risk regardless of the pattern in which the exposure was received (i.e. intermittent vs. continuous). The data also suggest that sunlight exposure at a younger age may be more important for SCC but not BCC, however additional studies are needed to further characterize sunlight exposure-response relationships in different types of NMSC. PMID:22994655

Sleep problems outperform depression and hopelessness as cross-sectional and longitudinal predictors of suicidal ideation and behavior in young adults in the military.

PubMed

Ribeiro, Jessica D; Pease, James L; Gutierrez, Peter M; Silva, Caroline; Bernert, Rebecca A; Rudd, M David; Joiner, Thomas E

2012-02-01

Sleep problems appear to represent an underappreciated and important warning sign and risk factor for suicidal behaviors. Given past research indicating that disturbed sleep may confer such risk independent of depressed mood, in the present report we compared self-reported insomnia symptoms to several more traditional, well-established suicide risk factors: depression severity, hopelessness, PTSD diagnosis, as well as anxiety, drug abuse, and alcohol abuse symptoms. Using multiple regression, we examined the cross-sectional and longitudinal relationships between insomnia symptoms and suicidal ideation and behavior, controlling for depressive symptom severity, hopelessness, PTSD diagnosis, anxiety symptoms, and drug and alcohol abuse symptoms in a sample of military personnel (N=311). In support of a priori hypotheses, self-reported insomnia symptoms were cross-sectionally associated with suicidal ideation, even after accounting for symptoms of depression, hopelessness, PTSD diagnosis, anxiety symptoms and drug and alcohol abuse. Self-reported insomnia symptoms also predicted suicide attempts prospectively at one-month follow up at the level of a non-significant trend, when controlling for baseline self-reported insomnia symptoms, depression, hopelessness, PTSD diagnosis and anxiety, drug and alcohol abuse symptoms. Insomnia symptoms were unique predictors of suicide attempt longitudinally when only baseline self-reported insomnia symptoms, depressive symptoms and hopelessness were controlled. The assessment of insomnia symptoms consisted of only three self-report items. Findings may not generalize outside of populations at severe suicide risk. These findings suggest that insomnia symptoms may be an important target for suicide risk assessment and the treatment development of interventions to prevent suicide. Copyright © 2011 Elsevier B.V. All rights reserved.

Smoking cessation and the risk of cardiovascular disease outcomes predicted from established risk scores: results of the Cardiovascular Risk Assessment among Smokers in Primary Care in Europe (CV-ASPIRE) study.

PubMed

Mallaina, Pablo; Lionis, Christos; Rol, Hugo; Imperiali, Renzo; Burgess, Andrew; Nixon, Mark; Malvestiti, Franco Mondello

2013-04-18

Smoking is a major risk factor for cardiovascular disease (CVD). This multicenter, cross-sectional survey was designed to estimate the cardiovascular (CV) risk attributable to smoking using risk assessment tools, to better understand patient behaviors and characteristics related to smoking, and characterize physician practice patterns. 1,439 smokers were recruited from Europe during 2011. Smokers were ≥40 years old, smoked > 10 cigarettes/day and had recent measurements on blood pressure and lipids. CV risk was calculated using the SCORE system, Framingham risk equations, and Progetto CUORE model. The CV risk attributable to smoking was evaluated using a simulated control (hypothetical non-smoker) with identical characteristics as the enrolled smoker. Risks assessed included CV mortality, coronary heart disease (CHD), CVD and hard CHD. Demographics, comorbidities, primary reasons for consultation, behavior towards previous attempts to quit, and interest in smoking cessation was assessed. Dependence on nicotine was evaluated using the Fagerström Test for Nicotine Dependence. GP practice patterns were assessed through a questionnaire. The prediction models consistently demonstrated a high CV risk attributable to smoking. For instance, the SCORE model demonstrated that this study population of smokers have a 100% increased probability of death due to cardiovascular disease in the next 10-years compared to non-smokers. A considerable amount of patients would like to hear from their GP about the different alternatives available to support their quitting attempt. The findings of this study reinforce the importance of smoking as a significant predictor of long-term cardiovascular events. One of the best gains in health could be obtained by tackling the most important modifiable risk factors; these results suggest smoking is among the most important.

Evaluation of an active learning module to teach hazard and risk in Hazard Analysis and Critical Control Points (HACCP) classes.

PubMed

Oyarzabal, Omar A; Rowe, Ellen

2017-04-01

The terms hazard and risk are significant building blocks for the organization of risk-based food safety plans. Unfortunately, these terms are not clear for some personnel working in food manufacturing facilities. In addition, there are few examples of active learning modules for teaching adult participants the principles of hazard analysis and critical control points (HACCP). In this study, we evaluated the effectiveness of an active learning module to teach hazard and risk to participants of HACCP classes provided by the University of Vermont Extension in 2015 and 2016. This interactive module is comprised of a questionnaire; group playing of a dice game that we have previously introduced in the teaching of HACCP; the discussion of the terms hazard and risk; and a self-assessment questionnaire to evaluate the teaching of hazard and risk. From 71 adult participants that completed this module, 40 participants (56%) provided the most appropriate definition of hazard, 19 participants (27%) provided the most appropriate definition of risk, 14 participants (20%) provided the most appropriate definitions of both hazard and risk, and 23 participants (32%) did not provide an appropriate definition for hazard or risk. Self-assessment data showed an improvement in the understanding of these terms (P < 0.05). Thirty participants (42%) stated that the most valuable thing they learned with this interactive module was the difference between hazard and risk, and 40 participants (65%) responded that they did not attend similar presentations in the past. The fact that less than one third of the participants answered properly to the definitions of hazard and risk at baseline is not surprising. However, these results highlight the need for the incorporation of modules to discuss these important food safety terms and include more active learning modules to teach food safety classes. This study suggests that active learning helps food personnel better understand important food safety terms that serve as building blocks for the understanding of more complex food safety topics.

Cigarette Smoking and the Risk of Bladder Cancer in Men and Women

PubMed Central

Quirk, Jeffrey T; Li, Qiang; Natarajan, Nachimuthu; Mettlin, Curtis J; Cummings, K Michael

2004-01-01

Although cigarette smoking is a principal risk factor for bladder cancer in both men and women, few studies have statistically evaluated whether gender modifies the effect of smoking on bladder cancer risk. We initiated the present case-control study at Roswell Park Cancer Institute in Buffalo, New York, U.S., to provide further data on this important issue. We observed similar risk estimates for men and women with comparable smoking exposures, but did not observe a statistically significant interaction between gender and lifetime smoking exposure. We conclude that cigarette smoking is a major risk factor for bladder cancer in both sexes, but that gender does not modify the effect of smoking on bladder cancer risk. PMID:19570280

Gender-based violence and HIV: relevance for HIV prevention in hyperendemic countries of southern Africa.

PubMed

Andersson, Neil; Cockcroft, Anne; Shea, Bev

2008-12-01

Gender-based violence (GBV) is common in southern Africa. Here we use GBV to include sexual and non-sexual physical violence, emotional abuse, and forms of child sexual abuse. A sizeable literature now links GBV and HIV infection.Sexual violence can lead to HIV infection directly, as trauma increases the risk of transmission. More importantly, GBV increases HIV risk indirectly. Victims of childhood sexual abuse are more likely to be HIV positive, and to have high risk behaviours.GBV perpetrators are at risk of HIV infection, as their victims have often been victimised before and have a high risk of infection. Including perpetrators and victims, perhaps one third of the southern African population is involved in the GBV-HIV dynamic.A randomised controlled trial of income enhancement and gender training reduced GBV and HIV risk behaviours, and a trial of a learning programme reported a non-significant reduction in HIV incidence and reduction of male risk behaviours (primary prevention). Interventions among survivors of GBV can reduce their HIV risk (secondary prevention). Various strategies can reduce spread of HIV from infected GBV survivors (tertiary prevention). Dealing with GBV could have an important effect on the HIV epidemic.A policy shift is necessary. HIV prevention policy should recognise the direct and indirect implications of GBV for HIV prevention, the importance of perpetrator dynamics, and that reduction of GBV should be part of HIV prevention programmes. Effective interventions are likely to include a structural component, and a GBV awareness component.

Fraction Intervention for Students with Mathematics Difficulties: Lessons Learned from Five Randomized Control Trials

ERIC Educational Resources Information Center

Fuchs, Lynn S.; Malone, Amelia S.; Schumacher, Robin F.; Namkung, Jessica; Wang, Amber

2016-01-01

The purpose of this article was to summarize results from 5 randomized control trials assessing the effects of intervention to improve the fraction performance of 4th-grade students at-risk for difficulty in learning about fractions. We begin by explaining the importance of competence with fractions and why an instructional focus on fractions…

Risk factors for venous thromboembolism in pre-and postmenopausal women.

PubMed

Bergendal, Annica; Bremme, Katarina; Hedenmalm, Karin; Lärfars, Gerd; Odeberg, Jacob; Persson, Ingemar; Sundström, Anders; Kieler, Helle

2012-10-01

Hemostasis in women is affected by changes of estrogen levels. The role of endogenous estrogens on risk of venous thromboembolism (VTE) remains unclear. The aim of this study was to investigate the importance of acquired and genetic risk factors for VTE in pre-and postmenopausal women. In a nationwide case-control study we included as cases 1470 women, 18 to 64years of age with a first time VTE. The 1590 controls were randomly selected and matched by age to the cases. Information on risk factors was obtained by interviews and DNA-analyses. We used unconditional logistic regression to calculate odds ratios (ORs) with 95% confidence intervals (CIs). The ORs were generally of similar magnitude in pre- and postmenopausal women. The highest risk was for the combination of surgery and cast (adjusted OR 54.12, 95% CI 16.62-176.19) in postmenopausal women. The adjusted OR for use of menopausal hormone therapy was 3.73 (95% CI 1.86-7.50) in premenopausal and 2.22 (95% CI 1.54-3.19) in postmenopausal women. Overweight was linked to an increased risk and exercise to a decreased risk, regardless of menopausal status. Menopausal status had only minor influence on the risk levels. Acquired transient risk factors conveyed the highest risks for VTE. Copyright © 2012 Elsevier Ltd. All rights reserved.

Wound Bioburden and Infection-Related Complications in Diabetic Foot Ulcers

PubMed Central

Gardner, Sue E.; Frantz, Rita A.

2013-01-01

The identification and diagnosis of diabetic foot ulcer (DFU) infections remains a complex problem. Because inflammatory responses to microbial invasion may be diminished in persons with diabetes, clinical signs of infection are often absent in persons with DFUs when infection is limited to localized tissue. In the absence of these clinical signs, microbial load is believed to be the best indicator of infection. Some researchers, however, believe microbial load to be insignificant and type of organism growing in the ulcer to be most important. Previous studies on the microbiology of DFUs have not provided enough evidence to determine the microbiological parameters of importance. Infection-related complications of DFUs include wound deterioration, osteomyelitis, and amputation. Risk factors for amputation include age, peripheral vascular disease, low transcutaneous oxygen, smoking, and poor glycemic control. These risk factors are best measured directly with physiological measures of arterial perfusion, glycemic control, sensory neuropathy, plantar pressures, and activity level and by controlling off-loading. DFU bioburden has not been examined as a risk factor for infection-related complications. To address the relationship between wound bioburden and the development of infection-related complications in DFUs, tightly controlled prospective studies based on clearly defined, valid measures of wound bioburden and wound outcomes are needed. This article reviews the literature and proposes a model of hypothesized relationships between wound bioburden—including microbial load, microbial diversity, and pathogenicity of organisms—and the development of infection-related complications. PMID:18647759

Promoting breast health among women in the U.S. Virgin Islands: a focused study of the needs of Caribbean women.

PubMed

Underwood, Sandra; Johnson, Edith Ramsay; Callwood, Gloria; Evans, Edris E; Matthew, Alina; Scotland-Brooks, Casandra; Hanley, Chantal; Johnson-Harrigan, Damali; LeFlore, Devette; Williams, Dionne; Samuels, Harricia; Francis, Jahtara; Arthur, Jamela; Clinkscales, Jowana; Joseph, Martha; Heskey, Nihjole; D'Abreau, Rachel; Fleming, Rashima; Penn, Stacey; Browne, Tameka A; Donastorg, Tiffany; Scarbriel, Yvette

2007-12-01

Breast cancer is the number one cause of cancer death among women in the United States Virgin Islands. Consequently, the Bureau of Health has identified breast cancer as a priority health concern. Within the medical community, increasing emphasis is being placed on the importance of hereditary, familial, environmental, and behavioral risk factors to breast cancer control. Little research has been conducted regarding these factors, however, to explore their influence on breast cancer detection and breast cancer risk management. This report highlights the outcomes of a study undertaken to explore the associations between breast cancer risk, risk assessment, risk communication, screening, and receptivity to the management of breast cancer risk among women from the United States Virgin Islands. Results of this study suggest a need within the territory to expand the systems that are responsible for monitoring and reporting breast cancer trends; forums to discuss concerns of women relative to breast health; forums to discuss communication with health-care providers; and, research efforts that address breast cancer detection and control among women in the United States Virgin Islands.

Promoting Breast Health among Women in the U.S. Virgin Islands: A Focused Study of the Needs of Caribbean Women

PubMed Central

Underwood, Sandra Millon; Ramsay-Johnson, Edith M.; Callwood, Gloria; Evans, Edris E.; Matthew, Alina; Scotland-Brooks, Casandra; Hanley, Chantal; Johnson-Harrigan, Damali; LeFlore, Devette; Williams, Dionne; Samuels, Harricia; Francis, Jahtara; Arthur, Jamela; Clinkscales, Jowana; Joseph, Martha; Heskey, Nihjole; D’Abreau, Rachel; Fleming, Rashima; Penn, Stacey; Browne, Tameka A.; Donastorg, Tiffany; Scarbriel, Yvette

2011-01-01

Breast cancer is the number one cause of cancer death among women in the United States Virgin Islands. Consequently, the Bureau of Health has identified breast cancer as a priority health concern. Within the medical community, increasing emphasis is being placed on the importance of hereditary, familial, environmental, and behavioral risk factors to breast cancer control. Little research has been conducted regarding these factors, however, to explore their influence on breast cancer detection and breast cancer risk management. This report highlights the outcomes of a study undertaken to explore the associations between breast cancer risk, risk assessment, risk communication, screening, and receptivity to the management of breast cancer risk among women from the United States Virgin Islands. Results of this study suggest a need within the territory to expand the systems that are responsible for monitoring and reporting breast cancer trends; forums to discuss concerns of women relative to breast health; forums to discuss communication with health-care providers; and, research efforts that address breast cancer detection and control among women in the United States Virgin Islands. PMID:18318332

DISEASE RISK ANALYSIS--A TOOL FOR POLICY MAKING WHEN EVIDENCE IS LACKING: IMPORT OF RABIES-SUSCEPTIBLE ZOO MAMMALS AS A MODEL.

PubMed

Hartley, Matt; Roberts, Helen

2015-09-01

Disease control management relies on the development of policy supported by an evidence base. The evidence base for disease in zoo animals is often absent or incomplete. Resources for disease research in these species are limited, and so in order to develop effective policies, novel approaches to extrapolating knowledge and dealing with uncertainty need to be developed. This article demonstrates how qualitative risk analysis techniques can be used to aid decision-making in circumstances in which there is a lack of specific evidence using the import of rabies-susceptible zoo mammals into the United Kingdom as a model.

[Risk management project: reactive or proactive approach?].

PubMed

Vastola, Pasquale; Saracino, Donato M T

2006-01-01

Risk management in healthcare refers to the process of developing strategies aimed at preventing and controlling the risk of occurrence of errors and harmful events. The final objective is primarily that of increasing patient safety and secondarily, that of reducing the financial burden of adverse events. The implementation of a risk management system is therefore of vital strategic importance. Nevertheless, a fundamental question that needs to be answered in the operational phase is: should a proactive or reactive approach to risk management be taken? In our view, proactive risk management has many advantages over a reactive approach and is therefore preferable. The reactive approach should be taken exclusively to obtain information regarding risk and errors, in the preliminary, as well as monitoring and follow-up phases of the project.

The application of hazard analysis and critical control points and risk management in the preparation of anti-cancer drugs.

PubMed

Bonan, Brigitte; Martelli, Nicolas; Berhoune, Malik; Maestroni, Marie-Laure; Havard, Laurent; Prognon, Patrice

2009-02-01

To apply the Hazard analysis and Critical Control Points method to the preparation of anti-cancer drugs. To identify critical control points in our cancer chemotherapy process and to propose control measures and corrective actions to manage these processes. The Hazard Analysis and Critical Control Points application began in January 2004 in our centralized chemotherapy compounding unit. From October 2004 to August 2005, monitoring of the process nonconformities was performed to assess the method. According to the Hazard Analysis and Critical Control Points method, a multidisciplinary team was formed to describe and assess the cancer chemotherapy process. This team listed all of the critical points and calculated their risk indexes according to their frequency of occurrence, their severity and their detectability. The team defined monitoring, control measures and corrective actions for each identified risk. Finally, over a 10-month period, pharmacists reported each non-conformity of the process in a follow-up document. Our team described 11 steps in the cancer chemotherapy process. The team identified 39 critical control points, including 11 of higher importance with a high-risk index. Over 10 months, 16,647 preparations were performed; 1225 nonconformities were reported during this same period. The Hazard Analysis and Critical Control Points method is relevant when it is used to target a specific process such as the preparation of anti-cancer drugs. This method helped us to focus on the production steps, which can have a critical influence on product quality, and led us to improve our process.

Enhanced biological control of yellow starthistle and tumbleweed (Russian thistle).

DOT National Transportation Integrated Search

2006-07-01

Yellow starthistle and tumbleweed (Russian thistle) are two of the most important weeds on California Department of Transportation : (Caltrans) rights-of-way. They occur in high densities, out-competing desirable grasses and increasing risk of wildfi...

40 CFR 721.6090 - Phosphoramide.

Code of Federal Regulations, 2010 CFR

2010-07-01

....6090 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) TOXIC SUBSTANCES CONTROL ACT...) Hazard communication program. A significant new use of this substance is any manner or method of manufacture, import, or processing associated with any use of this substance without providing risk...

Analysis of en route operational errors : probability of resolution and time-on-position.

DOT National Transportation Integrated Search

2012-02-01

The Federation Administrations Air Traffic Control Organization Safety Management System (SMS) is : designed to prevent the introduction of unacceptable safety risk into the National Airspace System. One of the : most important safety metrics used...

Gallstones and gallbladder cancer-volume and weight of gallstones are associated with gallbladder cancer: a case-control study.

PubMed

Roa, Iván; Ibacache, Gilda; Roa, Juan; Araya, Juan; de Aretxabala, Xabier; Muñoz, Sergio

2006-06-15

Gallstones are considered the most important risk factor for gallbladder cancer. To identify differences in the number, weight, volume, and density of gallstones associated with chronic cholecystitis (CC), gallbladder dysplasia (GD), and gallbladder cancer (GBC). A total of 125 cases were selected, of which 93 had gallstones associated with GBC and 31 had gallstones associated with GD. The controls were those with CC, matched by sex and age. The number, weight, volume, and density of these gallstones were examined in order to determine differences and relative cancer risk. Number: Multiple gallstones were present in over 76% of cases (GBC and GD) and controls (P = ns). The average number of multiple stones was 21 in GBC versus 14 in controls (P < 0.01). Weight: The average weight of the gallstones was 9.6 g in GBC versus 6.0 g in controls (P = 0.0004). The average weight in multiple stones over 10 g had strong association with GBC (P = 0.0006). Volume: The average volume was 11.7 and 6.48 ml in GBC and controls (P = 0.0002). Average volumes of 6, 8, and 10 ml had a relative cancer risk of 5, 7, and 11 times, respectively. Size: No differences were shown between GBC, GD, and controls. The volume of gallstones associated with other risk factors of GBC may be helpful in prioritizing cholecystectomies in symptomatic patients. Copyright 2006 Wiley-Liss, Inc.

Motor Control Exercise for Nonspecific Low Back Pain: A Cochrane Review.

PubMed

Saragiotto, Bruno T; Maher, Christopher G; Yamato, Tiê P; Costa, Leonardo O P; Costa, Luciola C Menezes; Ostelo, Raymond W J G; Macedo, Luciana G

2016-08-15

A systematic review. The aim of this review was to evaluate the effectiveness of motor control exercise (MCE) in patients with nonspecific low back pain (LBP). MCE is a common form of exercise used for managing LBP. MCE focuses on the activation of the deep trunk muscles and targets the restoration of control and coordination of these muscles, progressing to more complex and functional tasks integrating the activation of deep and global trunk muscles. We conducted electronic searches of CENTRAL, MEDLINE, EMBASE, five other databases, and two trials registers from their inception up to April 2015. Two independent review authors screened the search results, assessed risk of bias, and extracted the data. A third reviewer resolved any disagreement. We included randomized controlled trials comparing MCE with no treatment, another treatment, or as a supplement to other interventions in patients with nonspecific LBP. Primary outcomes were pain intensity and disability. We assessed risk of bias using the Cochrane Back and Neck (CBN) Review Group 12-item criteria. We combined results in a meta-analysis expressed as mean difference and 95% confidence interval. We assessed the overall quality of the evidence using the GRADE approach. We included 32 trials (n = 2628). Most included trials had a low risk of bias. For acute LBP, low to moderate quality evidence indicates no clinically important differences between MCE and spinal manipulative therapy or other forms of exercise. There is very low-quality evidence that the addition of MCE to medical management does not provide clinically important improvements. For recurrence at one year, there is very low-quality evidence that MCE and medical management decrease the risk of recurrence. For chronic LBP, there is low to moderate quality evidence that MCE is effective for reducing pain compared with minimal intervention. There is low to high-quality evidence that MCE is not clinically more effective than other exercises or manual therapy. There is very low to low quality evidence that MCE is clinically more effective than exercise and electrophysical agents (EPAs) or telerehabilitation for pain and disability. MCE is probably more effective than a minimal intervention for reducing pain, but probably does not have an important effect on disability, in patients with chronic LBP. There was no clinically important difference between MCE and other forms of exercises or manual therapy for acute and chronic LBP. 1.

Improving adolescent mental health and resilience through a resilience-based intervention in schools: study protocol for a randomised controlled trial.

PubMed

Dray, Julia; Bowman, Jenny; Freund, Megan; Campbell, Elizabeth; Wolfenden, Luke; Hodder, Rebecca K; Wiggers, John

2014-07-18

Research investigating the effectiveness of universal interventions to reduce the risk of mental health problems remains limited. Schools are a promising setting within which adolescents can receive interventions aimed at promoting their mental health. The aim of this study is to assess the effectiveness of a resilience-based prevention-focused intervention in reducing the risk of mental health problems among adolescents attending secondary school in socio-economically disadvantaged areas. A cluster randomised control trial will be conducted, with schools as the unit of randomisation. Initially, 32 secondary schools will be randomly allocated to a control or intervention group (12 control and 20 intervention). An intervention focused on improving student internal and external resilience factors will be implemented in intervention schools. A survey of students in Grade 7 in both intervention and control schools will be conducted (baseline) and repeated three years later when the students are in Grade 10. The Strengths and Difficulties Questionnaire will be used to measure the risk of mental health problems. At follow-up, the risk of mental health problems will be compared between Grade 10 students in intervention and control schools to determine intervention effectiveness. The study presents an opportunity to determine the effectiveness of a comprehensive resilience-based intervention in reducing the risk of mental health problems in adolescents attending secondary schools. The outcomes of the trial are of importance to youth, schools, mental health clinicians and policymakers. Australian New Zealand Clinical Trials Registry, ACTRN12611000606987, registered 14 June 2011.

Improving adolescent mental health and resilience through a resilience-based intervention in schools: study protocol for a randomised controlled trial

PubMed Central

2014-01-01

Background Research investigating the effectiveness of universal interventions to reduce the risk of mental health problems remains limited. Schools are a promising setting within which adolescents can receive interventions aimed at promoting their mental health. The aim of this study is to assess the effectiveness of a resilience-based prevention-focused intervention in reducing the risk of mental health problems among adolescents attending secondary school in socio-economically disadvantaged areas. Methods/design A cluster randomised control trial will be conducted, with schools as the unit of randomisation. Initially, 32 secondary schools will be randomly allocated to a control or intervention group (12 control and 20 intervention). An intervention focused on improving student internal and external resilience factors will be implemented in intervention schools. A survey of students in Grade 7 in both intervention and control schools will be conducted (baseline) and repeated three years later when the students are in Grade 10. The Strengths and Difficulties Questionnaire will be used to measure the risk of mental health problems. At follow-up, the risk of mental health problems will be compared between Grade 10 students in intervention and control schools to determine intervention effectiveness. Discussion The study presents an opportunity to determine the effectiveness of a comprehensive resilience-based intervention in reducing the risk of mental health problems in adolescents attending secondary schools. The outcomes of the trial are of importance to youth, schools, mental health clinicians and policymakers. Trial registration Australian New Zealand Clinical Trials Registry, ACTRN12611000606987, registered 14 June 2011. PMID:25037455

Risk factors for sporadic Giardia infection in the USA: a case-control study in Colorado and Minnesota.

PubMed

Reses, H E; Gargano, J W; Liang, J L; Cronquist, A; Smith, K; Collier, S A; Roy, S L; Vanden Eng, J; Bogard, A; Lee, B; Hlavsa, M C; Rosenberg, E S; Fullerton, K E; Beach, M J; Yoder, J S

2018-05-09

Giardia duodenalis is the most common intestinal parasite of humans in the USA, but the risk factors for sporadic (non-outbreak) giardiasis are not well described. The Centers for Disease Control and Prevention and the Colorado and Minnesota public health departments conducted a case-control study to assess risk factors for sporadic giardiasis in the USA. Cases (N = 199) were patients with non-outbreak-associated laboratory-confirmed Giardia infection in Colorado and Minnesota, and controls (N = 381) were matched by age and site. Identified risk factors included international travel (aOR = 13.9; 95% CI 4.9-39.8), drinking water from a river, lake, stream, or spring (aOR = 6.5; 95% CI 2.0-20.6), swimming in a natural body of water (aOR = 3.3; 95% CI 1.5-7.0), male-male sexual behaviour (aOR = 45.7; 95% CI 5.8-362.0), having contact with children in diapers (aOR = 1.6; 95% CI 1.01-2.6), taking antibiotics (aOR = 2.5; 95% CI 1.2-5.0) and having a chronic gastrointestinal condition (aOR = 1.8; 95% CI 1.1-3.0). Eating raw produce was inversely associated with infection (aOR = 0.2; 95% CI 0.1-0.7). Our results highlight the diversity of risk factors for sporadic giardiasis and the importance of non-international-travel-associated risk factors, particularly those involving person-to-person transmission. Prevention measures should focus on reducing risks associated with diaper handling, sexual contact, swimming in untreated water, and drinking untreated water.

[Health risks from pest control products].

PubMed

Pieper, C; Holthenrich, D; Schneider, H

2014-05-01

According to European biocide legislation, pest control products require assessment and authorization by the responsible national or European authorities. Biocidal products can only be authorized if they have no unacceptable effects on human health. The health risk assessment performed for authorization comprises (a) the derivation of reference values for the active substances and substances of concern contained in the biocidal product and (b) an exposure assessment. These parameters are required for risk characterization. No unacceptable health risks are expected if the determined exposure is less than the relevant reference value. In addition, the toxicological information is used for classification of the biocidal product. The assessment may, where necessary, result in specific conditions for use or other restrictions aimed at minimizing risk. The risk to human health from pest control products is mainly based on the toxicological properties of their active substances. Commonly, the coformulants used in pest control products are of less concern than the active substances (e.g., food ingredients and animal feed products). For example, most rodenticides belong to the group of anticoagulants, which are also effective in humans. Regarding intoxications through insecticides, the group of pyrethroids is of particular importance. Fumigants containing metal phosphides, hydrogen cyanide, or sulfuryl difluoride are particularly toxic. This toxicity is linked to the high acute inhalation toxicity of the gaseous active substances themselves or, in the case of phosphides, of the released gas phosphane. The aim of health risk assessment for the authorization of biocidal products is to ensure their safe application for users and all other persons involved, assuming an adequate and label-compliant use.

Mobile phone use and the risk for malignant brain tumors: a case-control study on deceased cases and controls.

PubMed

Hardell, Lennart; Carlberg, Michael; Hansson Mild, Kjell

2010-08-01

We investigated the use of mobile or cordless phones and the risk for malignant brain tumors in a group of deceased cases. Most previous studies have either left out deceased cases of brain tumors or matched them to living controls and therefore a study matching deceased cases to deceased controls is warranted. Recall error is one issue since it has been claimed that increased risks reported in some studies could be due to cases blaming mobile phones as a cause of the disease. This should be of less importance for deceased cases and if cancer controls are used. In this study brain tumor cases aged 20-80 years diagnosed during 1997-2003 that had died before inclusion in our previous studies on the same topic were included. Two control groups were used: one with controls that had died from another type of cancer than brain tumor and one with controls that had died from other diseases. Exposure was assessed by a questionnaire sent to the next-of-kin for both cases and controls. Replies were obtained for 346 (75%) cases, 343 (74%) cancer controls and 276 (60%) controls with other diseases. Use of mobile phones gave an increased risk, highest in the >10 years' latency group yielding odds ratio (OR) = 2.4, and 95% confidence interval (CI) = 1.4-4.1. The risk increased with cumulative number of lifetime hours for use, and was highest in the >2,000 h group (OR = 3.4, 95% CI = 1.6-7.1). No clear association was found for use of cordless phones, although OR = 1.7, 95% CI = 0.8-3.4 was found in the group with >2,000 h of cumulative use. This investigation confirmed our previous results of an association between mobile phone use and malignant brain tumors. Copyright 2010 S. Karger AG, Basel.

Mapping intra-urban transmission risk of dengue fever with big hourly cellphone data.

PubMed

Mao, Liang; Yin, Ling; Song, Xiaoqing; Mei, Shujiang

2016-10-01

Cellphone tracking has been recently integrated into risk assessment of disease transmission, because travel behavior of disease carriers can be depicted in unprecedented details. Still in its infancy, such an integration has been limited to: 1) risk assessment only at national and provincial scales, where intra-urban human movements are neglected, and 2) using irregularly logged cellphone data that miss numerous user movements. Furthermore, few risk assessments have considered positional uncertainty of cellphone data. This study proposed a new framework for mapping intra-urban disease risk with regularly logged cellphone tracking data, taking the dengue fever in Shenzhen city as an example. Hourly tracking records of 5.85 million cellphone users, combined with the random forest classification and mosquito activities, were utilized to estimate the local transmission risk of dengue fever and the importation risk through travels. Stochastic simulations were further employed to quantify the uncertainty of risk. The resultant maps suggest targeted interventions to maximally reduce dengue cases exported to other places, as well as appropriate interventions to contain risk in places that import them. Given the popularity of cellphone use in urbanized areas, this framework can be adopted by other cities to design spatio-temporally resolved programs for disease control. Copyright © 2016 Elsevier B.V. All rights reserved.

Toward a cumulative ecological risk model for the etiology of child maltreatment

PubMed Central

MacKenzie, Michael J.; Kotch, Jonathan B.; Lee, Li-Ching

2011-01-01

The purpose of the current study was to further the integration of cumulative risk models with empirical research on the etiology of child maltreatment. Despite the well-established literature supporting the importance of the accumulation of ecological risk, this perspective has had difficulty infiltrating empirical maltreatment research and its tendency to focus on more limited risk factors. Utilizing a sample of 842 mother-infant dyads, we compared the capacity of individual risk factors and a cumulative index to predict maltreatment reports in a prospective longitudinal investigation over the first sixteen years of life. The total load of risk in early infancy was found to be related to maternal cognitions surrounding her new role, measures of social support and well-being, and indicators of child cognitive functioning. After controlling for total level of cumulative risk, most single factors failed to predict later maltreatment reports and no single variable provided odd-ratios as powerful as the predictive power of a cumulative index. Continuing the shift away from simplistic causal models toward an appreciation for the cumulative nature of risk would be an important step forward in the way we conceptualize intervention and support programs, concentrating them squarely on alleviating the substantial risk facing so many of society’s families. PMID:24817777

Predictive risk models for proximal aortic surgery

PubMed Central

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

2017-01-01

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

[Cooking as a therapy for dangerous mental health patients: controlled risk-taking].

PubMed

Geay, Janique; Schmitt, Stéphane; Bouchard, Jean-Pierre

2015-01-01

Among the range of therapeutic mediators used with dangerous mental health patients in the unit for dangerous patients in Cadillac, cooking holds an important place. Led by caregivers, this activity has undeniable positive effects for the psychotic and non-psychotic patients taking part. These effects concern notably their capacities for conception, creation, organisation, execution, sensation, collaboration and socialisation. For some patients, it is also the opportunity to take the drama out of handling utensils which they previously used as weapons. As the risk factors are controlled before and during the activity, no dangerous acting out has ever occurred. Copyright © 2015. Published by Elsevier Masson SAS.

Infestation by Triatoma pallidipennis (Hemiptera: Reduviidae: Triatominae) is associated with housing characteristics in rural Mexico.

PubMed

Cohen, Justin M; Wilson, Mark L; Cruz-Celis, Adriana; Ordoñez, Rosalinda; Ramsey, Janine M

2006-11-01

Long-term control of Chagas disease requires not only interruption of the human transmission cycle of Trypanosoma cruzi Schyzotrypanum, Chagas, 1909 by controlling its domestic triatomine vectors but also surveillance to prevent reinfestation of residences from sylvatic or persistent peridomestic populations. Although a number of potential risk factors for infestation have been implicated in previous studies, the explanatory power of resulting models has been low. Two years after cessation of triatomine vector control efforts in the town of Chalcatzingo, Morelos, 78 environmental, socioecological, and spatial variables were analyzed for association with infestation by Triatoma pallidipennis Stal 1872 (Hemiptera: Reduviidae: Triatominae), the principal vector of T. cruzi. We studied 712 residences in this rural community to identify specific intradomestic and peridomestic risk factors that predicted infestation with T. pallidipennis. From numerous characteristics that were identified as correlated with infestation, we derived multivariate logistic regression models to predict residences that were more or less likely to be infested with T. pallidipennis. The most important risk factors for infestation included measurements of house age, upkeep, and spatial location in the town. The effects of certain risk factors on infestation were found to be modified by spatial characteristics of residences. The results of this study provide new information regarding risk factors for infestation by T. pallidipennis that may aid in designing sustainable disease control programs in rural Mexico.

Lifetime physical inactivity is associated with increased risk for Hodgkin and non-Hodgkin lymphoma: A case-control study.

PubMed

Etter, John Lewis; Cannioto, Rikki; Soh, Kah Teong; Alquassim, Emad; Almohanna, Hani; Dunbar, Zachary; Joseph, Janine M; Balderman, Sophia; Hernandez-Ilizaliturri, Francisco; Moysich, Kirsten B

2018-06-01

Although physical activity is a well-established risk factor for several cancer types, studies evaluating its association with lymphoma have yielded inconclusive results. In such cases where physical activity is not clearly associated with cancer risk in a dose-dependent manner, investigators have begun examining physical inactivity as an independent exposure of interest. Associations of self-reported, lifetime physical inactivity with risk of developing Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL) were evaluated in a hospital-based case control study using data from the Patient Epidemiology Data System at Roswell Park Comprehensive Cancer Center. Participants included 87 patients with HL and 236 patients with NHL as well as 348 and 952 cancer-free controls, respectively. Multivariable-adjusted logistic regression models were fit to calculate odds ratios (OR) and 95% confidence intervals (CI) estimating the association between physical inactivity and lymphoma risk. We observed significant, positive associations between lifetime recreational physical inactivity and risk of both HL (OR = 1.90, 95% CI: 1.15-3.15) and NHL (OR = 1.35, 95% CI: 1.01-1.82). The current analysis provides evidence for a positive association between physical inactivity and risk of both HL and NHL. These results add to a growing body of research suggesting that lifetime physical inactivity may be an important independent, modifiable behavioral risk factor for cancer. Copyright © 2018 Elsevier Ltd. All rights reserved.

Common genetic variants related to genomic integrity and risk of papillary thyroid cancer

PubMed Central

Neta, Gila; Brenner, Alina V.; Sturgis, Erich M.; Pfeiffer, Ruth M.; Hutchinson, Amy A.; Aschebrook-Kilfoy, Briseis; Yeager, Meredith; Xu, Li; Wheeler, William; Abend, Michael; Ron, Elaine; Tucker, Margaret A.; Chanock, Stephen J.; Sigurdson, Alice J.

2011-01-01

DNA damage is an important mechanism in carcinogenesis, so genes related to maintaining genomic integrity may influence papillary thyroid cancer (PTC) risk. Candidate gene studies targeting some of these genes have identified only a few polymorphisms associated with risk of PTC. Here, we expanded the scope of previous candidate studies by increasing the number and coverage of genes related to maintenance of genomic integrity. We evaluated 5077 tag single-nucleotide polymorphisms (SNPs) from 340 candidate gene regions hypothesized to be involved in DNA repair, epigenetics, tumor suppression, apoptosis, telomere function and cell cycle control and signaling pathways in a case–control study of 344 PTC cases and 452 matched controls. We estimated odds ratios for associations of single SNPs with PTC risk and combined P values for SNPs in the same gene region or pathway to obtain gene region-specific or pathway-specific P values using adaptive rank-truncated product methods. Nine SNPs had P values <0.0005, three of which were in HDAC4 and were inversely related to PTC risk. After multiple comparisons adjustment, no SNPs remained associated with PTC risk. Seven gene regions were associated with PTC risk at P < 0.01, including HUS1, ALKBH3, HDAC4, BAK1, FAF1_CDKN2C, DACT3 and FZD6. Our results suggest a possible role of genes involved in maintenance of genomic integrity in relation to risk of PTC. PMID:21642358

Risk determination after an acute myocardial infarction: review of 3 clinical risk prediction tools.

PubMed

Scruth, Elizabeth Ann; Page, Karen; Cheng, Eugene; Campbell, Michelle; Worrall-Carter, Linda

2012-01-01

The objective of the study was to provide comprehensive information for the clinical nurse specialist (CNS) on commonly used clinical prediction (risk assessment) tools used to estimate risk of a secondary cardiac or noncardiac event and mortality in patients undergoing primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI). The evolution and widespread adoption of primary PCI represent major advances in the treatment of acute myocardial infarction, specifically STEMI. The American College of Cardiology and the American Heart Association have recommended early risk stratification for patients presenting with acute coronary syndromes using several clinical risk scores to identify patients' mortality and secondary event risk after PCI. Clinical nurse specialists are integral to any performance improvement strategy. Their knowledge and understandings of clinical prediction tools will be essential in carrying out important assessment, identifying and managing risk in patients who have sustained a STEMI, and enhancing discharge education including counseling on medications and lifestyle changes. Over the past 2 decades, risk scores have been developed from clinical trials to facilitate risk assessment. There are several risk scores that can be used to determine in-hospital and short-term survival. This article critiques the most common tools: the Thrombolytic in Myocardial Infarction risk score, the Global Registry of Acute Coronary Events risk score, and the Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications risk score. The importance of incorporating risk screening assessment tools (that are important for clinical prediction models) to guide therapeutic management of patients cannot be underestimated. The ability to forecast secondary risk after a STEMI will assist in determining which patients would require the most aggressive level of treatment and monitoring postintervention including outpatient monitoring. With an increased awareness of specialist assessment tools, the CNS can play an important role in risk prevention and ongoing cardiovascular health promotion in patients diagnosed with STEMI. Knowledge of clinical prediction tools to estimate risk for mortality and risk of secondary events after PCI for acute coronary syndromes including STEMI is essential for the CNS in assisting with improving short- and long-term outcomes and for performance improvement strategies. The risk score assessment utilizing a collaborative approach with the multidisciplinary healthcare team provides for the development of a treatment plan including any invasive intervention strategy for the patient. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

[Thoracic surgery for patients with bronchial asthma].

PubMed

Iyoda, A; Satoh, Y

2012-07-01

Thoracic surgery poses a risk for complications in the respiratory system. In particular, for patients with bronchial asthma, we need to care for perioperative complications because it is well known that these patients frequently have respiratory complications after surgery, and they may have bronchial spasms during surgery. If we can get good control of their bronchial asthma, we can usually perform surgery for these patients without limitations. For safe postoperative care, it is desirable that these patients have stable asthma conditions that are well-controlled before surgery, as thoracic surgery requires intrabronchial intubation for anesthesia and sometimes bronchial resection. These stimulations to the bronchus do not provide for good conditions because of the risk of bronchial spasm. Therefore, we should use the same agents that are used to control bronchial asthma if it is already well controlled. If it is not, we have to administer a β₂ stimulator, aminophylline, or steroidal agents for good control. Isoflurane or sevoflurane are effective for the safe control of anesthesia during surgery, and we should use a β₂ stimulator, with or without inhalation, or steroidal agents after surgery. It is important to understand that we can perform thoracic surgery for asthma patients if we can provide perioperative control of bronchial asthma, although these patients still have severe risks.

Single Nucleotide Polymorphism in ATM Gene, Cooking Oil Fumes and Lung Adenocarcinoma Susceptibility in Chinese Female Non-Smokers: A Case-Control Study

PubMed Central

Shen, Li; Yin, Zhihua; Wu, Wei; Ren, Yangwu; Li, Xuelian; Zhou, Baosen

2014-01-01

Background The ataxia-telangiectasia mutated (ATM) gene plays an important role in the DNA double-strand breaks repair pathway. Single nucleotide polymorphisms (SNPs) of DNA repair genes are suspected to influence the risk of lung cancer. This study aimed to investigate the association between the ATM -111G>A (rs189037) polymorphism, environmental risk factors and the risk of lung adenocarcinoma in Chinese female non-smokers. Methods A hospital-based case-control study of 487 lung cancer patients and 516 matched cancer-free controls was conducted. Information concerning demographic and environmental risk factors was obtained for each case and control by a trained interviewer. After informed consent was obtained, 10 ml venous blood was collected from each subject for biomarker testing. Single nucleotide polymorphism was determined by using TaqMan method. Results This study showed that the individuals with ATM rs189037 AA genotype were at an increased risk for lung adenocarcinoma compared with those carrying the GA or GG genotype (adjusted odds ratios (OR) 1.44, 95% confidence interval (CI) 1.02–2.02, P = 0.039). The stratified analysis suggested that increased risk associated with ATM rs189037 AA genotype in individuals who never or seldom were exposed to cooking oil fumes (adjusted OR 1.89, 95%CI 1.03–3.49, P = 0.040). Conclusions ATM rs189037 might be associated with the risk of lung adenocarcinoma in Chinese non-smoking females. Furthermore, ATM rs189037 AA genotype might be a risk factor of lung adenocarcinoma among female non-smokers without cooking oil fume exposure. PMID:24819391

Risk Factors for Human Immunodeficiency Virus Infection among Brazilian Blood Donors; a Multicenter Case-Control Study Using Audio Computer-Assisted Structured-Interviews

PubMed Central

de Almeida-Neto, Cesar; Goncalez, Thelma T.; Birch, Rebecca Jeffries; de Carvalho, Silvia Maia F.; Capuani, Ligia; Leão, Silvana Carneiro; Miranda, Carolina; Rocha, Pedro Capuani; Carneiro-Proietti, Anna Barbara; Johnson, Bryce R.; Wright, David J.; Murphy, Edward L.; Custer, Brian

2013-01-01

Background Although risk factors for HIV infection are known, it is important for blood centers to understand local epidemiology and disease transmission patterns. Current risk factors for HIV infection in blood donors in Brazil were assessed. Methods A case-control study was conducted at large public blood centers located in four major cities between April 2009 – March 2011. Cases were persons whose donations were confirmed positive by enzyme immunoassays followed by Western Blot confirmation. Audio computer-assisted structured-interviews (ACASI) were completed by all cases and controls. Multivariable logistic regression was used to estimate adjusted odds ratios (AORs) and associated 95% confidence intervals (CIs). Results There were 341 cases, including 47 with recently-acquired infection, and 791 controls. Disclosed risk factors for both females and males were sex with an HIV-positive person (adjusted odds ratio (AOR) 11.3, 95% CI [4.1, 31.7]) and being an IVDU or sexual partner of an IVDU (AOR 4.65 [1.8, 11.7]). For female blood donors, additional risk factors were having male sex partners who also are MSM (AOR 13.5 [3.1, 59.8]), and having unprotected sex with multiple sexual partners (AOR 5.19 [2.1, 12.9]). The primary risk factor for male blood donors was MSM activity (AOR 21.6 [8.8, 52.9.]). Behaviors associated with recently-acquired HIV were being a MSM or sex partner of MSM (13.82, [4.7, 40.3]), and IVDU (11.47, [3.0, 43.2]). Conclusion Risk factors in blood donors parallel those in the general population in Brazil. Identified risk factors suggest that donor compliance with selection procedures at the participating blood centers is inadequate. PMID:23517235

The Impact of Smokeless Tobacco Risk Information on Smokers' Risk Perceptions and Use Intentions: A News Media Experiment.

PubMed

Wackowski, Olivia A; Manderski, Michelle T Bover; Lewis, M Jane; Delnevo, Cristine D

2017-12-13

Little research exists on the impact of risk information comparing smokeless tobacco (SLT) use, particularly snus, to cigarette smoking. This study explored this topic using a communication channel where smokers may be exposed to such information-the news media. We randomly assigned 1008 current smokers to read one of three constructed news stories or to a control group (no article). The "favorable" story framed snus as a "safer" smoking alternative while the "cautious" story described snus risks. The "mixed" version described potential risks and harm-reduction benefits. Participants completed a post-article survey with snus risk and harm perception and use intention measures. Article condition was significantly associated with perceived harm of daily snus use relative to smoking (1 = a lot less harmful - 5 = a lot more harmful; p < .0001), and mean ratings of snus harm in the favorable (2.46) and mixed conditions (2.66) were significantly lower than those of the cautious (2.96) and control conditions (2.98). Mean interest in trying snus in the next 6 months was low, but significantly higher for those in the favorable (1.55) and mixed conditions (1.32) versus those in the cautious (1.17) and control conditions (1.16)(1 = not at all - 5 = extremely interested, p < .0001). There were no significant differences by group in terms of the story's perceived interestingness, importance, or relevance. Exposure to reduced-risk news messages about SLT and snus relative to cigarettes may impact smokers' SLT harm perceptions and use intentions. Tobacco control professionals and FDA officials should consider the potential impact of the news media when communicating about tobacco risks.

Relation of type A behavior pattern and job-related psychosocial factors to nonfatal myocardial infarction: a case-control study of Japanese male workers and women.

PubMed

Yoshimasu, K

2001-01-01

To study the relation of type A behavior pattern and job-related psychosocial factors to the risk of myocardial infarction. Study subjects comprised 290 cases (173 male workers and 117 women) of nonfatal acute myocardial infarction (AMI) and 489 controls (303 male workers and 186 women) recruited from among residents of the study area. Participation rates of cases and controls were 86% and 50%, respectively. Type A behavior pattern, job-related psychosocial factors, and other coronary risk factors were ascertained by interview using a questionnaire. Type A behavior pattern was measured by 12 questions, and job strain by the method of Karasek. Logistic regression analysis was used to calculate odds ratio and 95% confidence interval with adjustment for potential confounding variables. The relation to job strain was examined only in men. Type A behavior pattern was significantly associated with an increased risk of AMI in male workers (adjusted OR = 1.9, 95% CI, 1.2-2.9) and in women (adjusted OR = 2.8, 95% CI, 1.6-4.9). Although job control and job demand showed no material association with AMI, job strain, a combination of low job control and high job demand was associated with an increased risk of AMI (adjusted OR = 2.2, 95% CI, 1.1-4.5). Abbreviated type A score and job demand score were higher among nonparticipant control candidates than participant controls in male workers. Type A behavior pattern may be an important risk factor for AMI especially in Japanese women. The present study also revealed persons in stressful psychosocial circumstances were less likely to participate in the study.

Metabolism and biochemistry in hypogravity

NASA Technical Reports Server (NTRS)

Leach, Carolyn S.

1991-01-01

The headward shift of body fluid and increase in stress-related hormones that occur in hypogravity bring about a number of changes in metabolism and biochemistry of the human body. Such alterations may have important effects on health during flight and during a recovery period after return to earth. Body fluid and electrolytes are lost, and blood levels of several hormones that control metabolism are altered during space flight. Increased serum calcium may lead to an increased risk of renal stone formation during flight, and altered drug metabolism could influence the efficacy of therapeutic agents. Orthostatic intolerance and an increased risk of fracturing weakened bones are concerns at landing. It is important to understand biochemistry and metabolism in hypogravity so that clinically important developments can be anticipated and prevented or ameliorated.

Managing ethical performance in organizations: insights from the corporate world.

PubMed

Soule, Edward

2007-03-01

Medical organizations can learn at least three lessons from the recent spate of corporate scandals and the regulatory response they triggered. One is the importance of identifying and eliminating those conflicts of interest that pose unacceptable risks to an organization's reputation or to an industry's public profile. Second, although disclosing a risk attendant to a conflict of interest is of crucial importance, disclosures are not automatic absolutions, regardless of how full and complete they may be. Third, an organization's ethical performance is first and foremost a function of its culture. If there were any doubt, the likes of Enron Corporation and WorldCom confirmed that formal controls and legal sanctions are no substitute for the importance that members of an organization accord to playing by the rules and working with integrity.

Factors influencing wound dehiscence.

PubMed

Riou, J P; Cohen, J R; Johnson, H

1992-03-01

Thirty-one abdominal fascial wound dehiscences occurred in 2,761 patients undergoing major abdominal surgery during a 5-year period (1%). Twenty-two specific local and systemic risk factors were analyzed and compared with the risk factors of a control group of 38 patients undergoing similar procedures without dehiscence. Through multivariate analysis, each factor was assessed as an independent statistical variable. Significant factors (p less than 0.05) were found to include age over 65, wound infection, pulmonary disease, hemodynamic instability, and ostomies in the incision. Additional systemic risk factors that were found to be significant included hypoproteinemia, systemic infection, obesity, uremia, hyperalimentation, malignancy, ascites, steroid use, and hypertension. Risk factors not found to be important independent variables included sex, type of incision, type of closure, foreign body in the wound, anemia, jaundice, and diabetes. When dehiscence and control groups were combined, 30% of patients with at least five significant risk factors developed dehiscence, and all the patients with more than eight risk factors developed a wound dehiscence. There was an overall mortality of 29%, which was directly related to the number of significant risk factors. The co-existence of 9 risk factors portended death in one third of the patients, and all the patients with more than 10 risk factors died.

Early Intermodal Integration in Offspring of Parents With Psychosis

PubMed Central

Gamma, Franziska; Goldstein, Jill M.; Seidman, Larry J.; Fitzmaurice, Garrett M.; Tsuang, Ming T.; Buka, Stephen L.

2014-01-01

Identifying early developmental indicators of risk for schizophrenia is important for prediction and possibly illness prevention. Disturbed intermodality has been proposed as one important neurodevelopmental risk for schizophrenia. Early intermodal integration (EII) is the infant’s ability to link motility and perception and to relate perception across modalities. We hypothesized that infants of parents with schizophrenia would have more EII abnormalities than infants of healthy parents and that infants of parents with affective psychosis would be intermediate in severity. The New England Family Study high-risk sample, ascertained from community populations, was utilized. Eight-month-old infants of parents with schizophrenia (n = 58), affective psychoses (n = 128), and healthy controls (n = 174) were prospectively assessed. Diagnoses of parents were determined 30 years later blind to offspring data. EII measures were grouped into 3 domains characterizing different aspects of infant development: (1) one’s own body, (2) objects, and (3) social interactions. Results demonstrated that body- and object-related EII abnormalities were significantly increased for infants of parents with schizophrenia compared with control infants and not significantly increased for infants of parents with affective psychoses. EII abnormalities in relation to social interactions were significantly increased in infants of parents with schizophrenia and affective psychoses. Thus, body- and object-related EII abnormalities were most severe in infants of parents with schizophrenia, supporting the importance of intermodality dysfunction as an early indicator of the vulnerability to schizophrenia. Future research should evaluate how this dysfunction evolves with development and its associations with other psychopathological and neurodevelopmental deficits in youth at risk for psychosis. PMID:23986303

Animal food intake and cooking methods in relation to endometrial cancer risk in Shanghai

PubMed Central

Xu, W-H; Dai, Q; Xiang, Y-B; Zhao, G-M; Zheng, W; Gao, Y-T; Ruan, Z-X; Cheng, J-R; Shu, X-O

2006-01-01

We evaluated animal food intake and cooking methods in relation to endometrial cancer risk in a population-based case–control study in Shanghai, China. A validated food frequency questionnaire was used to collect the usual dietary habits of 1204 cases and 1212 controls aged 30–69 years between 1997 and 2003. Statistical analyses were based on an unconditional logistic regression model adjusting for potential confounders. High intake of meat and fish was associated with an increased risk of endometrial cancer, with adjusted odds ratios for the highest vs the lowest quartile groups being 1.7 (95% confidence interval: 1.3–2.2) and 2.4 (1.8–3.1), respectively. The elevated risk was observed for all types of meat and fish intake. Intake of eggs and milk was not related to risk. Cooking methods and doneness levels for meat and fish were not associated with risk, nor did they modify the association with meat and fish consumption. Our study suggests that animal food consumption may play an important role in the aetiology of endometrial cancer, but cooking methods have minimal influence on risk among Chinese women. PMID:17060930

Breast cancer correlates in a cohort of breast screening program participants in Riyadh, KSA.

PubMed

Al-Amri, Fahad A; Saeedi, Mohammed Y; Al-Tahan, Fatina M; Ali, Arwa M; Alomary, Shaker A; Arafa, Mostafa; Ibrahim, Ahmed K; Kassim, Kassim A

2015-06-01

Breast cancer is the first cancer among females in the Kingdom of Saudi Arabia, accounting for 27.4% of all newly diagnosed female cancers in 2010. There are several risk factors affecting the incidence of breast cancer where some factors influence the risk more than the others. We aimed to identify the different risk factors related to breast cancer among females participating in the breast-screening program in Riyadh, KSA. Based on data from phase-I of the breast-screening program, a case-control study was conducted on women living in Riyadh, KSA. A sample of 349 women (58 cases and 290 controls) was recruited to examine the different breast cancer correlates. Multivariate regression model was built to investigate the most important risk factors. The mean age of cases was 48.5±7.1 years. Age at marriage, number of pregnancy, age at menopause, oral contraceptive pills, breast feeding and family history of breast cancer in first-degree relative were identified as the most important correlates among the studied cohort. The findings of the current work suggested that age at marriage, age at menopause ⩾50 years and 1st degree family history of breast cancer were risk factors for breast cancer, while, age at menopause <50 years, number of pregnancies and practicing breast feeding were protective factors against breast cancer. There was no effect of body mass index or physical inactivity. Further studies are needed to explore the hereditary, familial and genetic background risk factors in Saudi population. Copyright © 2015 The Authors. Production and hosting by Elsevier B.V. All rights reserved.

Evaluation of agricultural nonpoint source pollution potential risk over China with a Transformed-Agricultural Nonpoint Pollution Potential Index method.

PubMed

Yang, Fei; Xu, Zhencheng; Zhu, Yunqiang; He, Chansheng; Wu, Genyi; Qiu, Jin Rong; Fu, Qiang; Liu, Qingsong

2013-01-01

Agricultural nonpoint source (NPS) pollution has been the most important threat to water environment quality. Understanding the spatial distribution of NPS pollution potential risk is important for taking effective measures to control and reduce NPS pollution. A Transformed-Agricultural Nonpoint Pollution Potential Index (T-APPI) model was constructed for evaluating the national NPS pollution potential risk in this study; it was also combined with remote sensing and geographic information system techniques for evaluation on the large scale and at 1 km2 spatial resolution. This model considers many factors contributing to the NPS pollution as the original APPI model, summarized as four indicators of the runoff, sediment production, chemical use and the people and animal load. These four indicators were analysed in detail at 1 km2 spatial resolution throughout China. The T-APPI model distinguished the four indicators into pollution source factors and transport process factors; it also took their relationship into consideration. The studied results showed that T-APPI is a credible and convenient method for NPS pollution potential risk evaluation. The results also indicated that the highest NPS pollution potential risk is distributed in the middle-southern Jiangsu province. Several other regions, including the North China Plain, Chengdu Basin Plain, Jianghan Plain, cultivated lands in Guangdong and Guangxi provinces, also showed serious NPS pollution potential. This study can provide a scientific reference for predicting the future NPS pollution risk throughout China and may be helpful for taking reasonable and effective measures for preventing and controlling NPS pollution.

Tri-county comprehensive assessment of risk factors for sporadic reportable bacterial enteric infection in children

PubMed Central

Denno, Donna M.; Keene, William E.; Hutter, Carolyn M.; Koepsell, Jennifer K.; Patnode, Marianne; Flodin-Hursh, Denny; Stewart, Laurie K.; Duchin, Jeffrey S.; Rasmussen, Laurette; Jones, Robert; Tarr, Phillip I.

2009-01-01

Background. The aim of this study was to determine risk factors for childhood sporadic reportable enteric infection (REI) caused by bacteria, specifically Campylobacter, Salmonella, Escherichia coli O157, or Shigella (REI-B). Methods. Matched case-control study. Case patients aged <19 years who were reported to 3 Washington State county health departments and matched control subjects were interviewed from November 2003–November 2005. Matched odds ratios (ORs) were calculated by using conditional logistic regression. Population attributable risk percentages were calculated for exposures associated with infection. Results. Two hundred ninety-six case patients were matched to 580 control subjects. Aquatic recreation was the most important factor associated with all REI-Bs studied (beach water exposure [OR for Salmonella infection, 28.3 {CI, 7.2–112.2}; OR for Shigella infection, 14.5 {CI 1.5–141.0} or any recreational water exposure [OR for Campylobacter infection, 2.7 {CI, 1.5–4.8}; OR for Escherichia coli O157 infection, 7.4 {CI, 2.1–26.1}]). Suboptimal kitchen hygiene after preparation of raw meat or chicken (OR, 7.1 [CI, 2.1–24.1]) and consumption of food from restaurants were additional risks for Campylobacter infection. Infection with Salmonella was associated with the use of private wells as sources of drinking water (OR, 6.5 [CI, 1.4–29.7]), and the use of residential septic systems was a risk for both Salmonella (OR, 3.2 [CI, 1.3–7.8]) and E. coli (OR, 5.7 [CI, 1.2–27.2]) O157 infection. Conclusions. Overall, non-food exposures were as important as food-related exposures with regard to their contributions to the proportion of cases. Infection prevention efforts should address kitchen hygiene practices and non-food exposures, such as recreational water exposure, in addition to food-consumption risks. PMID:19281302

[Classical cardiovascular risk factors: predictive value and treatment of the elderly. The rocky road to evidence-based medicine].

PubMed

Thomas, H P

2001-04-01

Coronary heart disease and cerebrovascular disease are still the most common causes of death in Western countries. A number of risk factors have been identified in young and middle-aged adults, such as dyslipidemia, hypertension and diabetes. Their prevalence and importance, however, are less clear in the elderly. In terms of dyslipedemia it is questionable whether hypercholesterolemia is a definite risk factor. On the other hand, mortality can be reduced by lowering LDL cholesterol, but the benefit in the oldest old is not yet known. Systolic blood pressure rises with age and is discussed controversely as a potential risk factor in the elderly. Some large trials could show a clear relationship between high blood pressure while others did not see any association. Similar to the treatment of hypercholesterolemia, antihypertensive drugs showed beneficial effects in elderly people until the age of 80. But the treatment of the oldest old cannot be recommended in general. Diabetes and impaired glucose tolerance are some of the most common diseases in elderly people. They are considered to be an important risk factor until the age of 75. Their role in the oldest old is still under debate. Until now, we do not know anything about possible treatment effects because of the lack of controlled trials. Elderly people seem to have a risk profile different from younger people; especially in extreme ages the predictive role of classical risk factors is unclear. On the other hand, drug treatment could reduce mortality and morbidity in patients with hypercholesterolemia or hypertension. There are no studies which investigated the effects of blood glucose control in the elderly. The collection of sufficient data is a geriatric challange in order to decide whether treatment is useful or not.

To Fear Is to Gain? The Role of Fear Recognition in Risky Decision Making in TBI Patients and Healthy Controls

PubMed Central

Visser-Keizer, Annemarie C.; Westerhof-Evers, Herma J.; Gerritsen, Marleen J. J.; van der Naalt, Joukje; Spikman, Jacoba M.

2016-01-01

Fear is an important emotional reaction that guides decision making in situations of ambiguity or uncertainty. Both recognition of facial expressions of fear and decision making ability can be impaired after traumatic brain injury (TBI), in particular when the frontal lobe is damaged. So far, it has not been investigated how recognition of fear influences risk behavior in healthy subjects and TBI patients. The ability to recognize fear is thought to be related to the ability to experience fear and to use it as a warning signal to guide decision making. We hypothesized that a better ability to recognize fear would be related to a better regulation of risk behavior, with healthy controls outperforming TBI patients. To investigate this, 59 healthy subjects and 49 TBI patients were assessed with a test for emotion recognition (Facial Expression of Emotion: Stimuli and Tests) and a gambling task (Iowa Gambling Task (IGT)). The results showed that, regardless of post traumatic amnesia duration or the presence of frontal lesions, patients were more impaired than healthy controls on both fear recognition and decision making. In both groups, a significant relationship was found between better fear recognition, the development of an advantageous strategy across the IGT and less risk behavior in the last blocks of the IGT. Educational level moderated this relationship in the final block of the IGT. This study has important clinical implications, indicating that impaired decision making and risk behavior after TBI can be preceded by deficits in the processing of fear. PMID:27870900

To Fear Is to Gain? The Role of Fear Recognition in Risky Decision Making in TBI Patients and Healthy Controls.

PubMed

Visser-Keizer, Annemarie C; Westerhof-Evers, Herma J; Gerritsen, Marleen J J; van der Naalt, Joukje; Spikman, Jacoba M

2016-01-01

Fear is an important emotional reaction that guides decision making in situations of ambiguity or uncertainty. Both recognition of facial expressions of fear and decision making ability can be impaired after traumatic brain injury (TBI), in particular when the frontal lobe is damaged. So far, it has not been investigated how recognition of fear influences risk behavior in healthy subjects and TBI patients. The ability to recognize fear is thought to be related to the ability to experience fear and to use it as a warning signal to guide decision making. We hypothesized that a better ability to recognize fear would be related to a better regulation of risk behavior, with healthy controls outperforming TBI patients. To investigate this, 59 healthy subjects and 49 TBI patients were assessed with a test for emotion recognition (Facial Expression of Emotion: Stimuli and Tests) and a gambling task (Iowa Gambling Task (IGT)). The results showed that, regardless of post traumatic amnesia duration or the presence of frontal lesions, patients were more impaired than healthy controls on both fear recognition and decision making. In both groups, a significant relationship was found between better fear recognition, the development of an advantageous strategy across the IGT and less risk behavior in the last blocks of the IGT. Educational level moderated this relationship in the final block of the IGT. This study has important clinical implications, indicating that impaired decision making and risk behavior after TBI can be preceded by deficits in the processing of fear.

Predicting Relapse among Young Adults: Psychometric Validation of the Advanced Warning of Relapse (AWARE) Scale

PubMed Central

Kelly, John F.; Hoeppner, Bettina B.; Urbanoski, Karen A.; Slaymaker, Valerie

2011-01-01

Objective Failure to maintain abstinence despite incurring severe harm is perhaps the key defining feature of addiction. Relapse prevention strategies have been developed to attenuate this propensity to relapse, but predicting who will, and who will not, relapse has stymied attempts to more efficiently tailor treatments according to relapse risk profile. Here we examine the psychometric properties of a promising relapse risk measure - the Advance WArning of RElapse scale (AWARE) scale (Miller and Harris, 2000) in an understudied but clinically important sample of young adults. Method Inpatient youth (N=303; Age 18-24; 26% female) completed the AWARE scale and the Brief Symptom Inventory-18 (BSI) at the end of residential treatment, and at 1-, 3-, and 6-months following discharge. Internal and convergent validity was tested for each of these four timepoints using confirmatory factor analysis and correlations (with BSI scores). Predictive validity was tested for relapse 1, 3, and 6 months following discharge, as was incremental utility, where AWARE scores were used as predictors of any substance use while controlling for treatment entry substance use severity and having spent time in a controlled environment following treatment. Results Confirmatory factor analysis revealed a single, internally consistent, 25-item factor that demonstrated convergent validity and predicted subsequent relapse alone and when controlling for other important relapse risk predictors. Conclusions The AWARE scale may be a useful and efficient clinical tool for assessing short-term relapse risk among young people and, thus, could serve to enhance the effectiveness of relapse prevention efforts. PMID:21700396

Predicting relapse among young adults: psychometric validation of the Advanced WArning of RElapse (AWARE) scale.

PubMed

Kelly, John F; Hoeppner, Bettina B; Urbanoski, Karen A; Slaymaker, Valerie

2011-10-01

Failure to maintain abstinence despite incurring severe harm is perhaps the key defining feature of addiction. Relapse prevention strategies have been developed to attenuate this propensity to relapse, but predicting who will, and who will not, relapse has stymied attempts to more efficiently tailor treatments according to relapse risk profile. Here we examine the psychometric properties of a promising relapse risk measure-the Advance WArning of RElapse (AWARE) scale (Miller & Harris, 2000) in an understudied but clinically important sample of young adults. Inpatient youth (N=303; Ages 18-24; 26% female) completed the AWARE scale and the Brief Symptom Inventory-18 (BSI) at the end of residential treatment, and at 1-, 3-, and 6-months following discharge. Internal and convergent validity was tested for each of these four timepoints using confirmatory factor analysis and correlations (with BSI scores). Predictive validity was tested for relapse 1, 3, and 6 months following discharge, as was incremental utility, where AWARE scores were used as predictors of any substance use while controlling for treatment entry substance use severity and having spent time in a controlled environment following treatment. Confirmatory factor analysis revealed a single, internally consistent, 25-item factor that demonstrated convergent validity and predicted subsequent relapse alone and when controlling for other important relapse risk predictors. The AWARE scale may be a useful and efficient clinical tool for assessing short-term relapse risk among young people and, thus, could serve to enhance the effectiveness of relapse prevention efforts. Copyright © 2011 Elsevier Ltd. All rights reserved.

Vaccination in the county jail as a strategy to reach high risk adults during a community-based hepatitis A outbreak among methamphetamine drug users.

PubMed

Vong, Sirenda; Fiore, Anthony E; Haight, Daniel O; Li, Jinfeng; Borgsmiller, Nancy; Kuhnert, Wendi; Pinero, Frances; Boaz, Kathy; Badsgard, Tracy; Mancini, Carmela; Nainan, Omana V; Wiersma, Steven; Bell, Beth P

2005-01-11

Illicit drug use (IDU) is an important risk factor for hepatitis A, but implementing vaccination programs among drug users is difficult. During January 2001-July 2002, 403 hepatitis A cases were reported in Polk County, Florida; 48% were drug users and of these, 80% were recently in jail. To assess the county jail as a potential vaccination venue, we interviewed 280 inmates and conducted a serologic survey during July--August 2002. Of these, 227 (81%) reported a past IDU history. Previous HAV infection was found in 33%. In communities with illicit drug users at risk for hepatitis A and who are frequently jailed, vaccination programs in jails could be an important component of a community-based strategy to control hepatitis A outbreaks among illicit drug users.

[Parasites of zoonotic importance in dog feces collected in parks and public squares of the city of Los Angeles, Bío-Bío, Chile].

PubMed

Luzio, Álvaro; Belmar, Pablo; Troncoso, Ignacio; Luzio, Patricia; Jara, Alexis; Fernández, Ítalo

2015-08-01

The contamination of public squares and parks with dog feces poses a risk to the population, since it may contain parasitic elements of zoonotic importance. To identify human pathogenic parasites in samples of dog feces collected from parks and public squares. 452 fecal dog samples collected from 65 squares and public parks were analyzed using the technique of Burrows. 60% (39/65) of the samples contained some parasitic forms with a zoonotic potential. Parasitic taxa with zoonotic risk were Toxocara sp., Ancylostoma sp., Dipylidium caninum, Giardia sp., Taenia sp., Toxascaris sp., Strongyloides sp., and Uncinaria sp. The detected parasites present a risk to human health, so it seems necessary to implement health education activities in the community, develop deworming plans, and control the canine overpopulation.

[Factors associated to pulmonary tuberculosis in patients with diabetes mellitus from Veracruz, México].

PubMed

Pérez-Navarro, Lucía Montserrat; Fuentes-Domínguez, Francisco; Morales-Romero, Jaime; Zenteno-Cuevas, Roberto

2011-01-01

In Mexico, 20% of cases of tuberculosis (TB) are associated with diabetes mellitus (DM). However, the behavior of the factors related to this comorbidity is unknown, so the aim of this study was to estimate the risk factors and outcome for TB-DM in a population from the state of Veracruz, Mexico. We developed a double-design study: cases and controls for the estimation of risk factors, and a retrospective cohort for the outcome factors. The populations surveyed were 67 patients with the comorbidity TB-DB and 109 with TB. The risk factors for tuberculosis in the diabetic population studied were: age ≥ 35 with an OR of 2.5 (95% CI: 1.4-4.3) and IMC ≥ 25 with an OR of 8.5 (95% CI: 3.1-23.3). According to the outcome variables, the patients with TB-DM showed an increased risk of 2.8 (95% CI: 2.2-3.4) for the development of drug resistance against tuberculosis. In conclusion, age and overweight are important risk factors, and drug resistance is an important outcome factor for the binomial TB-DM in the population from Veracruz. This information will have important effects on the development of surveillance programs against TB, with emphasis on the characteristics of the diabetic population.

Radiation and cancer risk in atomic-bomb survivors.

PubMed

Kodama, K; Ozasa, K; Okubo, T

2012-03-01

With the aim of accurately assessing the effects of radiation exposure in the Japanese atomic-bomb survivors, the Radiation Effects Research Foundation has, over several decades, conducted studies of the Life Span Study (LSS) cohort, comprising 93 000 atomic-bomb survivors and 27 000 controls. Solid cancer: the recent report on solid cancer incidence found that at age 70 years following exposure at age 30 years, solid cancer rates increase by about 35%  Gy(-1) for men and 58% Gy(-1) for women. Age-at-exposure is an important risk modifier. In the case of lung cancer, cigarette smoking has been found to be an important risk modifier. Radiation has similar effects on first-primary and second-primary cancer risks. Finally, radiation-associated increases in cancer rates appear to persist throughout life. Leukaemia: the recent report on leukaemia mortality suggests that radiation effects on leukaemia mortality persisted for more than 50 years. Moreover, significant dose-response for myelodysplastic syndrome was observed in Nagasaki LSS members even 40-60 years after radiation exposure. Future perspective: given the continuing solid cancer increase in the survivor population, the LSS will likely continue to provide important new information on radiation exposure and solid cancer risks for another 15-20 years, especially for those exposed at a young age.

Modeling Finite-Time Failure Probabilities in Risk Analysis Applications.

PubMed

Dimitrova, Dimitrina S; Kaishev, Vladimir K; Zhao, Shouqi

2015-10-01

In this article, we introduce a framework for analyzing the risk of systems failure based on estimating the failure probability. The latter is defined as the probability that a certain risk process, characterizing the operations of a system, reaches a possibly time-dependent critical risk level within a finite-time interval. Under general assumptions, we define two dually connected models for the risk process and derive explicit expressions for the failure probability and also the joint probability of the time of the occurrence of failure and the excess of the risk process over the risk level. We illustrate how these probabilistic models and results can be successfully applied in several important areas of risk analysis, among which are systems reliability, inventory management, flood control via dam management, infectious disease spread, and financial insolvency. Numerical illustrations are also presented. © 2015 Society for Risk Analysis.

Nosocomial infections with metallo-beta-lactamase-producing Pseudomonas aeruginosa: molecular epidemiology, risk factors, clinical features and outcomes.

PubMed

Lucena, A; Dalla Costa, L M; Nogueira, K S; Matos, A P; Gales, A C; Paganini, M C; Castro, M E S; Raboni, S M

2014-08-01

Metallo-β-lactamases (MBLs) have emerged as one of the most important bacterial resistance mechanisms because of their ability to hydrolyse virtually all β-lactam agents. MBL-producing Pseudomonas aeruginosa (MBL-PA) are an important cause of nosocomial infections, particularly in intensive care units (ICUs), where they are associated with serious infections and present a significant clinical risk. To assess the molecular epidemiology, risk factors and outcomes of nosocomial infections caused by MBL-PA in a teaching hospital in Southern Brazil. From January 2001 to December 2008, 142 carbapenem-resistant P. aeruginosa strains were isolated from distinct clinical samples from hospitalized patients. These isolates were screened for MBLs, and underwent polymerase chain reaction, sequencing and pulsed-field gel electrophoresis (PFGE). Patients infected with carbapenem-resistant MBL-PA were considered as cases, and patients infected with non-MBL-PA were considered as controls. Eighty-four of 142 patients with positive carbapenem-resistant P. aeruginosa cultures met the criteria of the Centers for Disease Control and Prevention for infection. Fifty-eight patients were infected with MBL-PA (69%) and 26 patients were infected with non-MBL-PA (31%). Multi-variate analysis revealed that ICU stay [P = 0.003, odds ratio (OR) 4.01, 95% confidence interval (CI) 1.15-14.01] and urinary tract infection (P = 0.001, OR 9.67, 95% CI 1.72-54.48) were important risk factors for MBL-PA infection. Patients infected with MBL-PA showed faster onset of infection (P = 0.002) and faster progression to death (P = 0.04). These results showed the severity of MBL-PA infections, and demonstrated the urgent need for strategies to improve infection control measures to prevent an increase in these nosocomial infections. Copyright © 2014 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

Quantifying the impact of human mobility on malaria

PubMed Central

Wesolowski, Amy; Eagle, Nathan; Tatem, Andrew J.; Smith, David L.; Noor, Abdisalan M.; Snow, Robert W.; Buckee, Caroline O.

2013-01-01

Human movements contribute to the transmission of malaria on spatial scales that exceed the limits of mosquito dispersal. Identifying the sources and sinks of imported infections due to human travel and locating high-risk sites of parasite importation could greatly improve malaria control programs. Here we use spatially explicit mobile phone data and malaria prevalence information from Kenya to identify the dynamics of human carriers that drive parasite importation between regions. Our analysis identifies specific importation routes that contribute to malaria epidemiology on regional spatial scales. PMID:23066082

Vitamin D receptor gene polymorphisms, serum 25-hydroxyvitamin D levels, and melanoma: UK case-control comparisons and a meta-analysis of published VDR data

PubMed Central

Randerson-Moor, Juliette A.; Taylor, John C.; Elliott, Faye; Chang, Yu-Mei; Beswick, Samantha; Kukalizch, Kairen; Affleck, Paul; Leake, Susan; Haynes, Sue; Karpavicius, Birute; Marsden, Jerry; Gerry, Edwina; Bale, Linda; Bertram, Chandra; Field, Helen; Barth, Julian; dos Santos Silva, Isabel; Swerdlow, Anthony; Kanetsky, Peter A.; Barrett, Jennifer H.; Bishop, D. Timothy; Bishop, Julia A. Newton

2009-01-01

We have carried out melanoma case-control comparisons for six vitamin D receptor (VDR) gene single nucleotide polymorphisms (SNPs) and serum 25-hydroxyvitamin D3 levels in order to investigate the role of vitamin D in melanoma susceptibility. There was no significant evidence of an association between any VDR SNP and risk in 1028 population-ascertained cases and 402 controls from Leeds, UK. In a second Leeds case-control study (299 cases and 560 controls) the FokI T allele was associated with increased melanoma risk (OR 1.42, 95% CI 1.06-1.91, p=0.02). In a meta-analysis in conjunction with published data from other smaller data sets (total 3769 cases and 3636 controls), the FokI T allele was associated with increased melanoma risk (odds ratio (OR) 1.19, 95% confidence interval (CI) 1.05-1.35), and the BsmI A allele was associated with a reduced risk (OR 0.81, 95% CI 0.72-0.92), in each instance under a parsimonious dominant model. In the first Leeds case-control comparison cases were more likely to have a higher body mass index (BMI) than controls (p=0.007 for linear trend). There was no evidence of a case-control difference in serum 25-hydroxyvitamin D3 levels. In 1043 incident cases from the first Leeds case-control study, a single estimation of serum 25-hydroxyvitamin D3 level taken at recruitment was inversely correlated with Breslow thickness (p=0.03 for linear trend). These data provide evidence to support the view that vitamin D and VDR may have a small but potentially important role in melanoma susceptibility, and putatively a greater role in disease progression. PMID:19615888

[The role of German official medicines control laboratories in combating counterfeit medicines].

PubMed

Wiegard, Andrea; Heuermann, Matthias

2017-11-01

An official medicines control laboratory (OMCL) provides an important contribution to combat counterfeit and illegal medicines. The OMCL supports the competent authorities in controlling the quality of authorised medicinal products in the legal supply chain. For detecting counterfeit medicines in the legal supply chain, a risk-based approach in choice of products is conducted. Furthermore, the OMCL analyses suspicious medicines from the illegal supply chain for any other authority. The chemical analysis of a suspicious sample is needed to identify such a sample as a counterfeit medicine. The analytical results are fundamental for the evaluation of the legal status of the product and for the assessment of it's inherent hazard to public health. The global market of illegal medicines is rapidly changing. Therefore a good national and international working liaison and co-operation between laboratories and authorities is obligatory to protect public health. The OMCL provides important knowledge of new trends in counterfeit and illegal medicines. Hence, it is an essential part in surveillance of medicinal products. The efficient networking enables prompt official interventions. Thus, risks for the public health by substandard medicines were reduced. Beside the chemical analysis, the OMCL can help to raise public awareness about counterfeit and illegal medicines. In Germany, the risk of counterfeit medicines reaching patients through the legal supply chain is still low, but the possibility cannot be ignored.

Higher Mosquito Production in Low-Income Neighborhoods of Baltimore and Washington, DC: Understanding Ecological Drivers and Mosquito-Borne Disease Risk in Temperate Cities

PubMed Central

LaDeau, Shannon L.; Leisnham, Paul T.; Biehler, Dawn; Bodner, Danielle

2013-01-01

Mosquito-vectored pathogens are responsible for devastating human diseases and are (re)emerging in many urban environments. Effective mosquito control in urban landscapes relies on improved understanding of the complex interactions between the ecological and social factors that define where mosquito populations can grow. We compared the density of mosquito habitat and pupae production across economically varying neighborhoods in two temperate U.S. cities (Baltimore, MD and Washington, DC). Seven species of mosquito larvae were recorded. The invasive Aedes albopictus was the only species found in all neighborhoods. Culex pipiens, a primary vector of West Nile virus (WNV), was most abundant in Baltimore, which also had more tire habitats. Both Culex and Aedes pupae were more likely to be sampled in neighborhoods categorized as being below median income level in each city and Aedes pupae density was also greater in container habitats found in these lower income neighborhoods. We infer that lower income residents may experience greater exposure to potential disease vectors and Baltimore residents specifically, were at greater risk of exposure to the predominant WNV vector. However, we also found that resident-reported mosquito nuisance was not correlated with our measured risk index, indicating a potentially important mismatch between motivation needed to engage participation in control efforts and the relative importance of control among neighborhoods. PMID:23583963

Evaluation of infection control advice for patients at risk of chemotherapy-induced neutropenia in 2 pediatric oncology centers: Cape Town, South Africa, and Newcastle-Upon-Tyne, UK.

PubMed

Woolner, Andrea Forman; Davidson, Alan; Skinner, Rod; King, Derek

2012-02-01

Childhood cancers are treated with myelotoxic chemotherapy. Resultant neutropenia can lead to life-threatening infections. There is no consistent guidance on infection control precautions for neutropenic patients who are not yet febrile or infected. Although it is not possible to eradicate infection risk, it is conceivable that the risk could be reduced by effective infection prevention. This study compared infection control measures advised to pediatric and adolescent oncology patients receiving chemotherapy in 2 centers (Cape Town, South Africa, and Newcastle, UK). Prospective, observational, cross-sectional surveys of staff and patients/parents were undertaken using standardized, study-specific questionnaires. Seventy-eight staff and 56 patients/parents participated. Precautions advised in Newcastle were significantly different to Cape Town (all P < .05), except both agreed inpatient isolation was unnecessary. Over 40% of patients/parents felt isolation was important (P < .01). In Cape Town, staff and patients had similar views. In Newcastle, patients/parents had stricter opinions on particular precautions than staff, for example, attending school, playing outside and avoiding busy places (P < .01). Patient/parent responses were similar between centers. Over 90% of staff felt advising patients/parents about hand washing was important. Currently infection prevention advice is inconsistent. Further research is needed to elucidate effective guidance for infection prevention in pediatric neutropenic patients.

Depressive and anxiety disorders on-the-job: the importance of job characteristics for good work functioning in persons with depressive and anxiety disorders.

PubMed

Plaisier, Inger; de Graaf, Ron; de Bruijn, Jeanne; Smit, Johannes; van Dyck, Richard; Beekman, Aartjan; Penninx, Brenda

2012-12-30

This study examines the importance of job characteristics on absence and on-the-job performance in a large group of employees with diagnosed depressive and anxiety disorders. In a sample of 1522 employees (1129 persons with and 393 persons without psychopathology) participating in Netherlands Study of Depression and Anxiety (NESDA, n=2981) we examined associations between job characteristics and work functioning (absenteeism and work performance) in multinominal logistic regression models. Job characteristics were working hours, psychosocial working conditions and occupational status. As expected, depressed and anxious patients were at significantly elevated risk for absenteeism and poor work performance. In analyses adjusted for psychopathology, absenteeism and poor performance were significantly lower among persons reporting high job support, high job control, less working hours, self-employed and high skilled jobs. Associations were comparable between persons with and without psychopathology. High job support, high job control and reduced working hours were partially related to work functioning in both workers with- and without-psychopathology. Since depressed and anxious employees are at a substantially increased risk for absenteeism and poor work performance, strategies that improve job support and feelings of control at work may be especially helpful to prevent poor work functioning in this at-risk group of employees. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

[Analysis of overseas imported malaria situation and implication for control in Jiangsu Province, PR China].

PubMed

Liu, Yao-Bao; Cao, Jun; Zhou, Hua-Yun; Wang, Wei-Ming; Cao, Yuan-Yuan; Gao, Qi

2013-02-01

To analyze the epidemiological characteristics of overseas imported malaria in Jiangsu Province and explore the strategies and priorities in prevention and control, so as to provide the evidence for improving the diagnosis, treatment and management of imported malaria. The data of overseas imported malaria as well as the case epidemiological investigation in Jiangsu Province from July 18, 2011 to June 30, 2012 were collected and analyzed descriptively for the species composition, original countries, population distribution, regional distribution, onset time, diagnosis and treatment, channels to go abroad, and counterparts returned together with the patients. A total of 233 overseas imported malaria cases were reported, and 226 cases (97.0%) were imported from African countries. A total of 208 cases (89.3%) were falciparum malaria, and 224 cases (96.1%) were laboratory-confirmed. The imported malaria cases were young adults who were mainly migrant farmer and skilled male workers. There was no significant seasonal variation for onset time. Totally 145 cases (62.2%) got malaria onset in 20 days after returning home. The median time from onset to seeing doctor was two days and the median time from seeing doctor to being diagnosed was one day. The first visit health facilities by the patients were relatively scattered and the diagnostic health facilities were mainly medical institutions and CDC at the county level and above (220 cases, accounting for 94.4%). The ratio of standard treatment after malaria diagnosis was 100%. A total of 205 cases (88.0%) were workers dispatched to abroad as labor export by the company, and 142 cases (60.9%) cases had counterparts returned together. The situation of overseas imported malaria in Jiangsu Province is severe. It is necessary to further strengthen the professional training and multi-sectoral cooperation, establish the collaborative investigation mechanism for high-risk groups, and take effective prevention and control measures to reduce the risk of overseas imported malaria.

Predicting Epidemic Risk from Past Temporal Contact Data

PubMed Central

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

2015-01-01

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

Sunlight exposure is important for preventing hip fractures in patients with Alzheimer's disease, Parkinson's disease, or stroke.

PubMed

Iwamoto, J; Takeda, T; Matsumoto, H

2012-04-01

Hypovitaminosis D as a result of malnutrition or sunlight deprivation, increased bone resorption, low bone mineral density (BMD), or an increased risk of falls may contribute to an increased risk of hip fractures in patients with neurological diseases, including Alzheimer's disease, Parkinson's disease, and stroke. The purpose of this study was to clarify the efficacy of sunlight exposure for reducing the risk of hip fractures in patients with such neurological diseases. The English literature was searched using PubMed, and randomized controlled trials evaluating the efficacy of sunlight exposure for reducing the risk of hip fractures in patients with Alzheimer's disease, Parkinson's disease, and stroke were identified. The relative risk and the 95% confidence interval were calculated for individual randomized controlled trials, and a pooled data analysis (meta-analysis) was performed. Three randomized controlled trials were identified. Sunlight exposure improved hypovitaminosis D and increased the BMD. The relative risk (95% confidence interval) of hip fractures was 0.22 (0.05, 1.01) for Alzheimer's disease, 0.27 (0.08, 0.96) for Parkinson's disease, and 0.17 (0.02, 1.36) for stroke. The relative risk (95% confidence interval) calculated for the pooled data analysis was 0.23 (0.10, 0.56) (P = 0.0012), suggesting a significant risk reduction rate of 77%. The present meta-analysis added additional evidence indicating the efficacy of sunlight exposure for reducing the risk of hip fractures in patients with Alzheimer's disease, Parkinson's disease, and stroke. © 2011 John Wiley & Sons A/S.

"Employment and arthritis: making it work" a randomized controlled trial evaluating an online program to help people with inflammatory arthritis maintain employment (study protocol).

PubMed

Carruthers, Erin C; Rogers, Pamela; Backman, Catherine L; Goldsmith, Charles H; Gignac, Monique A; Marra, Carlo; Village, Judy; Li, Linda C; Esdaile, John M; Lacaille, Diane

2014-07-21

Arthritis and musculoskeletal conditions are the leading cause of long-term work disability (WD), an outcome with a major impact on quality of life and a high cost to society. The importance of decreased at-work productivity has also recently been recognized. Despite the importance of these problems, few interventions have been developed to reduce the impact of arthritis on employment. We have developed a novel intervention called "Making It Work", a program to help people with inflammatory arthritis (IA) deal with employment issues, prevent WD and improve at-work productivity. After favorable results in a proof-of-concept study, we converted the program to a web-based format for broader dissemination and improved accessibility. The objectives of this study are: 1) to evaluate in a randomized controlled trial (RCT) the effectiveness of the program at preventing work cessation and improving at-work productivity; 2) to perform a cost-utility analysis of the intervention. 526 participants with IA will be recruited from British Columbia, Alberta, and Ontario in Canada. The intervention consists of a) 5 online group sessions; b) 5 web-based e-learning modules; c) consultations with an occupational therapist for an ergonomic work assessment and a vocational rehabilitation counselor. Questionnaires will be administered online at baseline and every 6 months to collect information about demographics, disease measures, costs, work-related risk factors for WD, quality of life, and work outcomes. Primary outcomes include at-work productivity and time to work cessation of > 6 months for any reason. Secondary outcomes include temporary work cessation, number of days missed from work per year, reduction in hours worked per week, quality adjusted life year for the cost utility analysis, and changes from baseline in employment risk factors. Analysis of Variance will evaluate the intervention's effect on at-work productivity, and multivariable Cox regression models will estimate the risk of work cessation associated with the intervention after controlling for risk factors for WD and other important predictors imbalanced at baseline. This program fills an important gap in arthritis health services and addresses an important and costly problem. Knowledge gained from the RCT will be useful to health care professionals, policy planners and arthritis stakeholders. ClinicalTrials.gov NCT01852851; registered April 13, 2012; first participant randomized on July 6, 2013.

Adding Salt to Meals as a Risk Factor of Type 2 Diabetes Mellitus: A Case-Control Study.

PubMed

Radzeviciene, Lina; Ostrauskas, Rytas

2017-01-13

Type 2 diabetes mellitus (T2DM) is thought to arise from the complex interplay between genetic and environmental factors. It is important to identify modifiable risk factors that may help to reduce the risk of diabetes. Data on salt intake and the risk of type 2 diabetes are limited. The aim of this study was to assess the relationship between adding salt to prepared meals and the risk of type 2 diabetes. In a case-control study, we included 234 cases, all of whom were patients aged 35-86 years with a newly confirmed diagnosis of T2DM, and 468 controls that were free of the disease. Cases and controls (ratio 1:2) were matched by gender and age (±5 years). A questionnaire was used to collect information on possible risk factors for diabetes. Adding salt to prepared meals was assessed according to: Never, when there was not enough, or almost every time without tasting. The odds ratios (OR), and 95% confidence intervals (CI) for type 2 diabetes was calculated using a conditional logistic regression. The cases had a higher body mass index and a significantly lower education level compared to the controls. Variables such as waist circumference, body mass index, eating speed, smoking, family history of diabetes, arterial hypertension, plasma triglycerides, educational level, occupational status, morning exercise, marital status, daily urine sodium excretion, and daily energy intake were retained in the models as confounders. After adjusting for possible confounders, an approximately two-fold increased risk of type 2 diabetes was determined in subjects who add salt to prepared meals when "it is not enough" or "almost every time without tasting" (1.82; 95% CI 1.19-2.78; p = 0.006) compared with never adding salt. Presented data suggest the possible relationship between additional adding of salt to prepared meals and an increased risk of type 2 diabetes.

Platelet Count Mediates the Contribution of a Genetic Variant in LRRC16A to ARDS Risk

PubMed Central

Wei, Yongyue; Wang, Zhaoxi; Su, Li; Chen, Feng; Tejera, Paula; Bajwa, Ednan K.; Wurfel, Mark M.; Lin, Xihong

2015-01-01

BACKGROUND: Platelets are believed to be critical in pulmonary-origin ARDS as mediators of endothelial damage through their interactions with fibrinogen and multiple signal transduction pathways. A prior meta-analysis identified five loci for platelet count (PLT): BAD, LRRC16A, CD36, JMJD1C, and SLMO2. This study aims to validate the quantitative trait loci (QTLs) of PLT within BAD, LRRC16A, CD36, JMJD1C, and SLMO2 among critically ill patients and to investigate the associations of these QTLs with ARDS risk that may be mediated through PLT. METHODS: ARDS cases and at-risk control subjects were recruited from the intensive care unit of the Massachusetts General Hospital. Exome-wide genotyping data of 629 ARDS cases and 1,026 at-risk control subjects and genome-wide gene expression profiles of 18 at-risk control subjects were generated for analysis. RESULTS: Single-nucleotide polymorphism (SNP) rs7766874 within LRRC16A was a significant locus for PLT among at-risk control subjects (β = −13.00; 95% CI, −23.22 to −2.77; P = .013). This association was validated using LRRC16A gene expression data from at-risk control subjects (β = 77.03 per 1 SD increase of log2-transformed expression; 95% CI, 27.26-126.80; P = .005). Further, rs7766874 was associated with ARDS risk conditioned on PLT (OR = 0.68; 95% CI, 0.51-0.90; P = .007), interacting with PLT (OR = 1.15 per effect allele per 100 × 103/μL of PLT; 95% CI, 1.03-1.30; P = .015), and mediated through PLT (indirect OR = 1.045; 95% CI, 1.007-1.085; P = .021). CONCLUSIONS: Our findings support the role of LRRC16A in platelet formation and suggest the importance of LRRC16A in ARDS pathophysiology by interacting with, and being mediated through, platelets. PMID:25254322

Sexuality and intimacy among people living with serious mental illnesses: Factors contributing to sexual activity.

PubMed

Bonfils, Kelsey A; Firmin, Ruth L; Salyers, Michelle P; Wright, Eric R

2015-09-01

Limited research has focused on sexuality for those diagnosed with a severe mental illness. We aimed to extend existing work by exploring relationships between mastery (perception of control of one's life and future), sexual self-esteem (perceptions of one's capacity to engage in healthy sexual behavior), sexual attitudes (permissive ideas about sexuality), and perceived importance of relationships/sexuality and number of sexual partners. A secondary analysis of survey data from adult participants living with a severe mental illness (N = 401) in the Indiana Mental Health Services and HIV-Risk Study (Perry & Wright, 2006) was conducted. Analysis of covariance (controlling for marital status) compared those with 0 partners, 1 partner, or multiple partners over the past 3 months on the dependent variables of mastery, sexual self-esteem, sexual attitudes, and perceived importance. Participants with more permissive attitudes, greater perceived importance, and higher mastery were more likely to be sexually active with multiple partners. Self-esteem did not differentiate groups. Given the key role of sexual satisfaction in quality of life and the high rates of sexual risk behavior in this population, it is important that clinicians systematically assess mastery, perceived importance, and attitudes about sexuality when working with consumers diagnosed with a severe mental illness. Individually tailoring existing interventions on the basis of consumers' levels of mastery, related to self-efficacy for implementing changes in life, could improve long-term outcomes for these programs. Future research should examine other constructs that may account for more variance in sexual activity, such as perceptions of risk, intentions for sexual safety, or romantic relationship functioning. (c) 2015 APA, all rights reserved).

Sexuality and intimacy among people living with serious mental illnesses: Factors contributing to sexual activity

PubMed Central

Bonfils, Kelsey A.; Firmin, Ruth L.; Salyers, Michelle P.; Wright, Eric R.

2015-01-01

Objective Limited research has focused on sexuality for those diagnosed with a severe mental illness. We aimed to extend existing work by exploring relationships between mastery (perception of control of one's life and future), sexual self-esteem (perceptions of one's capacity to engage in healthy sexual behavior), sexual attitudes (permissive ideas about sexuality), and perceived importance of relationships/sexuality and number of sexual partners. Methods A secondary analysis of survey data from adult participants living with a severe mental illness (N=401) in the Indiana Mental Health Services and HIV-Risk Study (Perry & Wright, 2006) was conducted. Analysis of covariance (controlling for marital status) compared those with zero partners, one partner, or multiple partners over the past three months on the dependent variables of mastery, sexual self-esteem, sexual attitudes, and perceived importance. Results Participants with more permissive attitudes, greater perceived importance, and higher mastery were more likely to be sexually active with multiple partners. Self-esteem did not differentiate groups. Conclusions and Implications for Practice Given the key role of sexual satisfaction in quality of life and the high rates of sexual risk behavior in this population, it is important that clinicians systematically assess mastery, perceived importance, and attitudes about sexuality when working with consumers diagnosed with a severe mental illness. Individually tailoring existing interventions based on consumers' levels of mastery, related to self-efficacy for implementing changes in life, could improve long-term outcomes for these programs. Future research should examine other constructs that may account for more variance in sexual activity, such as perceptions of risk, intentions for sexual safety, or romantic relationship functioning. PMID:25664756

Toward an understanding of late life suicidal behavior: the role of lifespan developmental theory.

PubMed

Fiske, Amy; O'Riley, Alisa A

2016-01-01

Suicidal behavior in late life differs in important ways from suicidal behavior that occurs earlier in the lifespan, suggesting the possibility of developmental differences in the etiology of suicidal behavior. This paper examines late life suicidal behavior within the context of lifespan developmental theory. This paper presents a conceptual framework for using lifespan developmental theory to better understand late life suicidal behavior. We argue that the motivational theory of lifespan development, which focuses on control, is particularly relevant to late life suicide. This theory posits that opportunities to exert control over important aspects of one's life diminish in late life as a result of declines in physical functioning and other factors, and that successful aging is associated with adaptive regulation of this developmental change. Although continued striving to meet goals is normative throughout the lifespan, most individuals also increase the use of compensatory strategies in old age or when faced with a decline in functioning. We propose that individuals who do not adapt to developmental changes by altering their strategies for exerting control will be at risk for suicidal behavior in late life. This paper reviews evidence that supports the importance of control with respect to suicidal outcomes in older adults, as well as findings regarding specific types of control strategies that may be related to suicide risk in older adults with health-related limitations. Although suicidal behavior is not a normal part of aging, the application of lifespan developmental theory may be useful in understanding and potentially preventing suicide among older adults.

Effects of Three Depression Prevention Interventions on Risk for Depressive Disorder Onset in the Context of Depression Risk Factors

PubMed Central

Rohde, Paul; Stice, Eric; Gau, Jeff M.

2013-01-01

Study aims were to identify subgroups of adolescents with elevated depressive symptoms who had the highest likelihood of developing future major/minor depressive disorder on the basis of depression risk factors and participation in three depression prevention programs, with the goal of evaluating the preventive effect of indicated prevention interventions in the context of known risk factors. Adolescents (N = 341) with elevated depressive symptoms were randomized to one of four prevention intervention conditions (cognitive-behavioral group, supportive-expressive group, cognitive-behavioral bibliotherapy, educational brochure control). By 2-year follow-up, 14% showed onset of major/minor depressive disorders. Classification tree analysis (CTA) revealed that negative attributional style was the most important risk factor: youth with high scores showed a 4-fold increase in depression onset compared to youth who did not endorse this attributional style. For adolescents with negative attributional style, prevention condition emerged as the most important predictor: those receiving bibliotherapy showed a 5-fold reduction in depression disorder onset relative to adolescents in the three other intervention conditions. For adolescents who reported low negative attributional style scores, elevated levels of depressive symptoms at baseline emerged as the most potent predictor. Results implicate two key pathways to depression involving negative attributional style and elevated depressive symptoms in this population, and suggest that bibliotherapy may offset the risk conveyed by the most important depression risk factor in this sample. PMID:22932745

Flood risk awareness during the 2011 floods in the central United States: showcasing the importance of hydrologic data and interagency collaboration

USGS Publications Warehouse

Holmes, Robert R.; Schwein, Noreen O.; Shadie, Charles E.

2012-01-01

Floods have long had a major impact on society and the environment, evidenced by the more than 1,500 federal disaster declarations since 1952 that were associated with flooding. Calendar year 2011 was an epic year for floods in the United States, from the flooding on the Red River of the North in late spring to the Ohio, Mississippi, and Missouri River basin floods in the spring and summer to the flooding caused by Hurricane Irene along the eastern seaboard in August. As a society, we continually seek to reduce flood impacts, with these efforts loosely grouped into two categories: mitigation and risk awareness. Mitigation involves such activities as flood assessment, flood control implementation, and regulatory activities such as storm water and floodplain ordinances. Risk awareness ranges from issuance of flood forecasts and warnings to education of lay audiences about the uncertainties inherent in assessing flood probability and risk. This paper concentrates on the issue of flood risk awareness, specifically the importance of hydrologic data and good interagency communication in providing accurate and timely flood forecasts to maximize risk awareness. The 2011 floods in the central United States provide a case study of the importance of hydrologic data and the value of proper, timely, and organized communication and collaboration around the collection and dissemination of that hydrologic data in enhancing the effectiveness of flood forecasting and flood risk awareness.

Effects of three depression prevention interventions on risk for depressive disorder onset in the context of depression risk factors.

PubMed

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

2012-12-01

Study aims were to identify subgroups of adolescents with elevated depressive symptoms who had the highest likelihood of developing future major/minor depressive disorder on the basis of depression risk factors and participation in three depression prevention programs, with the goal of evaluating the preventive effect of indicated prevention interventions in the context of known risk factors. Adolescents (N = 341) with elevated depressive symptoms were randomized to one of four prevention intervention conditions (cognitive-behavioral group, supportive-expressive group, cognitive-behavioral bibliotherapy, educational brochure control). By 2-year follow-up, 14% showed onset of major/minor depressive disorders. Classification tree analysis (CTA) revealed that negative attributional style was the most important risk factor: Youth with high scores showed a 4-fold increase in depression onset compared to youth who did not endorse this attributional style. For adolescents with negative attributional style, prevention condition emerged as the most important predictor: Those receiving bibliotherapy showed a 5-fold reduction in depression disorder onset relative to adolescents in the three other intervention conditions. For adolescents who reported low negative attributional style scores, elevated levels of depressive symptoms at baseline emerged as the most potent predictor. Results implicate two key pathways to depression involving negative attributional style and elevated depressive symptoms in this population, and suggest that bibliotherapy may offset the risk conveyed by the most important depression risk factor in this sample.

Cardiovascular Disease and Associated Risk Factors in Cuba: Prospects for Prevention and Control

PubMed Central

Cooper, Richard S.; Orduñez, Pedro; Iraola Ferrer, Marcos D.; Munoz, Jose Luis Bernal; Espinosa-Brito, Alfredo

2006-01-01

Objectives. An adequate description of the trends in cardiovascular disease (CVD) is not available for most of the developing world. Cuba provides an important exception, and we sought to use available data to offer insights into the changing patterns of CVD there. Methods. We reviewed Cuban public health statistics, surveys, and reports of health services. Results. CVD has been the leading cause of death since 1970. A 45% reduction in heart disease deaths was observed from 1970 to 2002; the decline in stroke was more limited. There are moderate prevalences of all major risk factors. Conclusions. The Cuban medical care system has responded vigorously to the challenge of CVD; levels of control of hypertension are the highest in the world. Nonindustrialized countries can decisively control CVD. PMID:16317211

Pregnant Women's Perceptions of the Risks and Benefits of Disclosure During Web-Based Mental Health E-Screening Versus Paper-Based Screening: Randomized Controlled Trial.

PubMed

Kingston, Dawn; Biringer, Anne; Veldhuyzen van Zanten, Sander; Giallo, Rebecca; McDonald, Sarah; MacQueen, Glenda; Vermeyden, Lydia; Austin, Marie-Paule

2017-10-20

Pregnant women's perceptions of the risks and benefits during mental health screening impact their willingness to disclose concerns. Early research in violence screening suggests that such perceptions may vary by mode of screening, whereby women view the anonymity of e-screening as less risky than other approaches. Understanding whether mode of screening influences perceptions of risk and benefit of disclosure is important in screening implementation. The objective of this randomized controlled trial was to compare the perceptions of pregnant women randomized to a Web-based screening intervention group and a paper-based screening control group on the level of risk and benefit they perceive in disclosing mental health concerns to their prenatal care provider. A secondary objective was to identify factors associated with women's perceptions of risk and benefit of disclosure. Pregnant women recruited from maternity clinics, hospitals, and prenatal classes were computer-randomized to a fully automated Web-based e-screening intervention group or a paper-based control. The intervention group completed the Antenatal Psychosocial Health Assessment and the Edinburgh Postnatal Depression Scale on a computer tablet, whereas the control group completed them on paper. The primary outcome was women's perceptions of the risk and benefits of mental health screening using the Disclosure Expectations Scale (DES). A completer analysis was conducted. Statistical significance was set at P<.05. We used t tests to compare the means of the risk and benefit subscales between groups. Of the 675 eligible women approached, 636 (94.2%) agreed to participate and were randomized to the intervention (n=305) and control (n=331) groups. There were no significant baseline differences between groups. The mode of screening was not associated with either perceived risk or benefit of screening. There were no differences in groups in the mean scores of the risk and benefit of disclosure subscales. Over three-quarters of women in both intervention and control groups perceived that mental health screening was beneficial. However, 43.1% (272/631) of women in both groups reported feeling very, moderately, or somewhat vulnerable during mental health screening. We found that women of low income, those treated previously for depression or anxiety, and those pregnant with their first child were more likely to perceive greater risk. However, these associations were very small. Pregnant women in both the e-screening and paper-based screening groups perceived benefit and risk of disclosure similarly, suggesting that providers can implement the mode of screening that is most ideal for their clinical setting. Regardless of the mode of screening, a substantial number of women reported feeling vulnerable during mental health screening, highlighting the importance of the need to reduce women's vulnerability throughout the screening process with strategies such as addressing women's concerns, explaining the rationale for screening, and discussing how results will be used. Clinicaltrials.gov NCT01899534; https://clinicaltrials.gov/ct2/show/NCT01899534 (Archived by WebCite at http://www.webcitation.org/6tRKtGC4M). ©Dawn Kingston, Anne Biringer, Sander Veldhuyzen van Zanten, Rebecca Giallo, Sarah McDonald, Glenda MacQueen, Lydia Vermeyden, Marie-Paule Austin. Originally published in JMIR Mental Health (http://mental.jmir.org), 20.10.2017.

SECURE INTERNET OF THINGS-BASED CLOUD FRAMEWORK TO CONTROL ZIKA VIRUS OUTBREAK.

PubMed

Sareen, Sanjay; Sood, Sandeep K; Gupta, Sunil Kumar

2017-01-01

Zika virus (ZikaV) is currently one of the most important emerging viruses in the world which has caused outbreaks and epidemics and has also been associated with severe clinical manifestations and congenital malformations. Traditional approaches to combat the ZikaV outbreak are not effective for detection and control. The aim of this study is to propose a cloud-based system to prevent and control the spread of Zika virus disease using integration of mobile phones and Internet of Things (IoT). A Naive Bayesian Network (NBN) is used to diagnose the possibly infected users, and Google Maps Web service is used to provide the geographic positioning system (GPS)-based risk assessment to prevent the outbreak. It is used to represent each ZikaV infected user, mosquito-dense sites, and breeding sites on the Google map that helps the government healthcare authorities to control such risk-prone areas effectively and efficiently. The performance and accuracy of the proposed system are evaluated using dataset for 2 million users. Our system provides high accuracy for initial diagnosis of different users according to their symptoms and appropriate GPS-based risk assessment. The cloud-based proposed system contributed to the accurate NBN-based classification of infected users and accurate identification of risk-prone areas using Google Maps.

Effects of E-Cigarette Health Warnings and Modified Risk Ad Claims on Adolescent E-Cigarette Craving and Susceptibility.

PubMed

Andrews, J Craig; Mays, Darren; Netemeyer, Richard G; Burton, Scot; Kees, Jeremy

2018-04-16

A between-subjects experiment examines the effects of different warning types and modified risk e-cigarette ad claims on adolescent e-cigarette craving and future e-cigarette susceptibility for two different themes. One theme focuses on nicotine and addiction, and the other on the effects of potentially harmful constituents (e.g., flavored chemicals and lung disease). The effects of warning type (control, text-only, graphic health warning (GHW) and text) and modified risk e-cigarette ad claims (control, exposure reduction, risk reduction) are tested experimentally with two different arms (themes) for a sample of 1,011 adolescents who had tried either e-cigarettes or cigarettes. For addiction, the text-only warning led to significantly less e-cigarette susceptibility than the no warning control condition. As expected, there were no differences between the GHW + text condition and text-only or control conditions for e-cigarette craving. An interaction between warning type and modified risk claims revealed significantly fewer e-cigarette cravings and less susceptibility for the text-only warning and no claim (control) condition than for any other condition. For fatal lung disease, the GHW + text condition led to fewer e-cigarette cravings and less susceptibility than the text-only warning and no warning (control) conditions. Warning type effects can be very different under different themes (e.g., addiction, fatal lung disease). In general, our results point to the effectiveness of the text-only warning for addiction and GHW + text for fatal lung disease. Relative exposure and risk modification claims (e.g., less nicotine; less addicting) tend to undercut addiction warnings. More than one type of e-cigarette warning may be necessary as e-cigarette research evolves. Our results show different warning type effects (e.g., text-only; GHW + text) on e-cigarette craving and future susceptibility for adolescent experimenters depending on the risk theme (e.g., addiction; lung disease) and presence of ad claims (e.g., exposure and risk reduction). As research emerges on risks associated with e-cigarette use, it is important to first know what at-risk populations (e.g., adolescents) believe about such risks. Such research will aid our understanding of what types of warnings might be most effective, especially in the presence of ad claims.

Frequency of Subclinical Atherosclerosis in Brazilian HIV-Infected Patients.

PubMed

Salmazo, Péricles Sidnei; Bazan, Silméia Garcia Zanati; Shiraishi, Flávio Gobbis; Bazan, Rodrigo; Okoshi, Katashi; Hueb, João Carlos

2018-04-09

AIDS as well as atherosclerosis are important public health problems. The longer survival among HIV-infected is associated with increased number of cardiovascular events in this population, and this association is not fully understood. To identify the frequency of subclinical atherosclerosis in HIV-infected patients compared to control subjects; to analyze associations between atherosclerosis and clinical and laboratory variables, cardiovascular risk factors, and the Framingham coronary heart disease risk score (FCRS). Prospective cross-sectional case-control study assessing the presence of subclinical atherosclerosis in 264 HIV-infected patients and 279 controls. Clinical evaluation included ultrasound examination of the carotid arteries, arterial stiffness by pulse wave velocity (PWV) and augmentation index (AIx), laboratory analysis of peripheral blood, and cardiovascular risk according to FCRS criteria. The significance level adopted in the statistical analysis was p < 0.05. Plaques were found in 37% of the HIV group and 4% of controls (p < 0.001). Furthermore, carotid intima-media thickness was higher in the HIV group than in controls (p < 0.001). Patients with carotid plaque had higher fasting glucose, total cholesterol, low-density lipoprotein cholesterol, and triglycerides than those without plaques. The presence of HIV, adjusted for age, overweight/obesity, and smoking increased by almost fivefold the risk of atherosclerotic carotid plaque (OR: 4.9; 95%CI: 2.5-9.9; p < 0.001). Exposure to protease inhibitors did not influence carotid intima-media thickness, was not associated with carotid plaque frequency, and did not alter the mechanical characteristics of the arterial system (PWV and AIx). HIV-infected patients are at increased risk of atherosclerosis in association with classical cardiovascular risk factors. Treatment with protease inhibitors does not promote functional changes in the arteries, and shows no association with increased frequency of atherosclerotic plaques in carotid arteries. The FCRS may be inappropriate for this population.

Autonomic nervous system dysfunction in psychiatric disorders and the impact of psychotropic medications: a systematic review and meta-analysis

PubMed Central

Alvares, Gail A.; Quintana, Daniel S.; Hickie, Ian B.; Guastella, Adam J.

2016-01-01

Background Autonomic nervous system (ANS) dysfunction is a putative underlying mechanism for increased cardiovascular disease risk in individuals with psychiatric disorders. Previous studies suggest that this risk may be related to psychotropic medication use. In the present study we systematically reviewed and analyzed published studies of heart rate variability (HRV), measuring ANS output, to determine the effect of psychiatric illness and medication use. Methods We searched for studies comparing HRV in physically healthy adults with a diagnosed psychiatric disorder to controls and comparing HRV pre- and post-treatment with a psychotropic medication. Results In total, 140 case–control (mood, anxiety, psychosis, dependent disorders, k = 151) and 30 treatment (antidepressants, antipsychotics; k = 43) studies were included. We found that HRV was reduced in all patient groups compared to controls (Hedges g = −0.583) with a large effect for psychotic disorders (Hedges g = −0.948). Effect sizes remained highly significant for medication-free patients compared to controls across all disorders. Smaller and significant reductions in HRV were observed for specific antidepressants and antipsychotics. Limitations Study quality significantly moderated effect sizes in case–control analyses, underscoring the importance of assessing methodological quality when interpreting HRV findings. Conclusion Combined findings confirm substantial reductions in HRV across psychiatric disorders, and these effects remained significant even in medication-free individuals. Reductions in HRV may therefore represent a significant mechanism contributing to elevated cardiovascular risk in individuals with psychiatric disorders. The negative impact of specific medications on HRV suggest increased risk for cardiovascular disease in these groups, highlighting a need for treatment providers to consider modifiable cardiovascular risk factors to attenuate this risk. PMID:26447819

Risk factors for incident delirium in an acute general medical setting: a retrospective case-control study.

PubMed

Tomlinson, Emily Jane; Phillips, Nicole M; Mohebbi, Mohammadreza; Hutchinson, Alison M

2017-03-01

To determine predisposing and precipitating risk factors for incident delirium in medical patients during an acute hospital admission. Incident delirium is the most common complication of hospital admission for older patients. Up to 30% of hospitalised medical patients experience incident delirium. Determining risk factors for delirium is important for identifying patients who are most susceptible to incident delirium. Retrospective case-control study with two controls per case. An audit tool was used to review medical records of patients admitted to acute medical units for data regarding potential risk factors for delirium. Data were collected between August 2013 and March 2014 at three hospital sites of a healthcare organisation in Melbourne, Australia. Cases were 161 patients admitted to an acute medical ward and diagnosed with incident delirium between 1 January 2012 and 31 December 2013. Controls were 321 patients sampled from the acute medical population admitted within the same time range, stratified for admission location and who did not develop incident delirium during hospitalisation. Identified using logistic regression modelling, predisposing risk factors for incident delirium were dementia, cognitive impairment, functional impairment, previous delirium and fracture on admission. Precipitating risk factors for incident delirium were use of an indwelling catheter, adding more than three medications during admission and having an abnormal sodium level during admission. Multiple risk factors for incident delirium exist; patients with a history of delirium, dementia and cognitive impairment are at greatest risk of developing delirium during hospitalisation. Nurses and other healthcare professionals should be aware of patients who have one or more risk factors for incident delirium. Knowledge of risk factors for delirium has the potential to increase the recognition and understanding of patients who are vulnerable to delirium. Early recognition and prevention of delirium can contribute to improved patients safety and reduction in harm. © 2016 John Wiley & Sons Ltd.

GST Theta null genotype is associated with an increased risk for ulcerative colitis: a case-control study and meta-analysis of GST Mu and GST Theta polymorphisms in inflammatory bowel disease.

PubMed

Broekman, Mark M T J; Bos, Caro; Te Morsche, René H M; Hoentjen, Frank; Roelofs, Hennie M J; Peters, Wilbert H M; Wanten, Geert J A; de Jong, Dirk J

2014-10-01

Glutathione S-transferases (GSTs) are important in the detoxification of many compounds, including reactive oxygen species. Polymorphisms in GSTs resulting in a decreased enzyme activity might enhance the risk for inflammatory bowel disease by eliciting a state of oxidative stress. Previous case-control studies showed divergent results and were frequently limited in sample size; therefore we conducted a meta-analysis including results from our case-control study. For the case-control study, we genotyped 552 patients with Crohn's disease (CD), 223 patients with ulcerative colitis (UC) and 972 healthy controls by PCR for functional deletions in GST Mu and GST Theta. Both were not analyzed in recent genome-wide association studies. For the meta-analysis, PubMed, EMBASE and Web of Science were searched. In this meta-analysis, we show an enhanced susceptibility for UC in individuals with the GSTT1null genotype (odds ratio (OR) 2.27, 95% confidence interval (CI) 1.31-3.92). In our case-control study, a reduced risk for CD was seen with the GSTT1null genotype (OR 0.58, 95% CI 0.43-0.77); however, pooled analysis showed an OR of 1.67, 95% CI 0.81-3.45. In this meta-analysis, we showed an increased risk for UC in individuals with the GSTT1null genotype.

Variation in the CYP19A1 gene and risk of colon and rectal cancer

PubMed Central

Slattery, Martha L.; Lundgreen, Abbie; Herrick, Jennifer S.; Kadlubar, Susan; Caan, Bette J.; Potter, John D.; Wolff, Roger K.

2011-01-01

CYP19A1, or aromatase, influences estrogen-metabolizing enzymes and may influence cancer risk. We examine variation in the CYP19A1 gene and risk of colorectal cancer using data from population-based case–control studies (colon n = 1,574 cases, 1,970 controls; rectal n = 791 cases, 999 controls). Four SNPs were statistically significantly associated with colon cancer and four were associated with rectal cancer. After adjustment for multiple comparisons, the AA genotype of rs12591359 was associated with an increased risk of colon cancer (OR 1.44 95% CI 1.16–1.80) and the AA genotype of rs2470144 was associated with a reduced risk of rectal cancer (OR 0.65 95% CI 0.50–0.84). Variants of CYP19A1 were associated with CIMP+ and CIMP+/KRAS2-mutated tumors. CT/TT genotypes of rs1961177 were significantly associated with an increased likelihood of a MSI+ colon tumor (OR 1.77 95% CI 1.26–2.37). We observed statistically significant interactions between genetic variation in NFκB1 and CYP19A1 for both colon and rectal cancer. Our data suggest the importance of CYP19A1 in the development of colon and rectal cancer and that estrogen may influence risk through an inflammation-related mechanism. PMID:21479914

Risk of secondary cancers in women with breast cancer and the influence of radiotherapy: A national cohort study in Taiwan.

PubMed

Lin, Cheng-Yao; Chen, Sih-Hao; Huang, Chien-Cheng; Weng, Shih-Feng; Lee, Song-Tay; Guo, How-Ran; Kuo, Shu-Chun; Su, Shih-Bin

2016-12-01

Breast cancer is the most common cancer in women worldwide; thus, the prolongation of survival, and the incidence and risk factors, including radiotherapy, for developing secondary malignancies are important. We compared the incidence of secondary and new primary cancers in women with breast cancer (CA) and well-matched for age, geographic region, and monthly income cancer-free controls (CA). The risk for secondary cancers with and without radiotherapy was also compared in CA women. We enrolled 2422 CA patients and CA 12,110 controls. In a 4-year follow-up, the secondary cancers risk was significant in the CA group (adjusted hazard ratio [AHR]: 1.59; 95% confidence interval [CI]: 1.17-2.18). Only the risk of uterine cancer was significant compared with the controls (AHR: 6.30; 95% CI: 2.28-17.38). CA patients and <50 years old had a higher risk for secondary cancers. Developing secondary cancers was significant in the first follow-up year (AHR: 1.51; 95% CI: 1.11-2.06). Radiotherapy had no significant effect on the CA group, but it was significant (P = 0.0298) in women ≥60 years old (elderly). We recommend monitoring secondary cancers in CA women, especially those <50 years old, and during the first year of follow-up. Radiotherapy should be used more carefully in elderly CA women.

Risk factors for age-related maculopathy.

PubMed

Connell, Paul P; Keane, Pearse A; O'Neill, Evelyn C; Altaie, Rasha W; Loane, Edward; Neelam, Kumari; Nolan, John M; Beatty, Stephen

2009-01-01

Age-related maculopathy (ARM) is the leading cause of blindness in the elderly. Although beneficial therapeutic strategies have recently begun to emerge, much remains unclear regarding the etiopathogenesis of this disorder. Epidemiologic studies have enhanced our understanding of ARM, but the data, often conflicting, has led to difficulties with drawing firm conclusions with respect to risk for this condition. As a consequence, we saw a need to assimilate the published findings with respect to risk factors for ARM, through a review of the literature appraising results from published cross-sectional studies, prospective cohort studies, case series, and case control studies investigating risk for this condition. Our review shows that, to date, and across a spectrum of epidemiologic study designs, only age, cigarette smoking, and family history of ARM have been consistently demonstrated to represent risk for this condition. In addition, genetic studies have recently implicated many genes in the pathogenesis of age-related maculopathy, including Complement Factor H, PLEKHA 1, and LOC387715/HTRA1, demonstrating that environmental and genetic factors are important for the development of ARM suggesting that gene-environment interaction plays an important role in the pathogenesis of this condition.

A geographic information system forecast model for strategic control of fasciolosis in Ethiopia.

PubMed

Yilma, J M; Malone, J B

1998-07-31

A geographic information system (GIS) forecast model based on moisture and thermal regime was developed to assess the risk of Fasciola hepatica, a temperate species, and its tropical counterpart, Fasciola gigantica, in Ethiopia. Agroecological map zones and corresponding environmental features that control the distribution and abundance of the disease and its snail intermediate hosts were imported from the Food and Agriculture Organization (FAO) Crop Production System Zones (CPSZ) database on east Africa and used to construct a GIS using ATLAS GIS 3.0 software. Base temperatures of 10 degrees C and 16 degrees C were used for F. hepatica and F. gigantica, respectively, to calculate growing degree days in a previously developed climate forecast system that was modified to allow use of monthly climate data values. The model was validated by comparison of risk indices and environmental features to available survey data on fasciolosis. Monthly Fasciola risk indices of four climatic regions in Ethiopia were used to project infection transmission patterns under varying climatic conditions and strategic chemotherapeutic fasciolosis control schemes. Varying degrees of F. hepatica risk occurred in most parts of the country and distinct regional F. hepatica transmission patterns could be identified. In the humid west, cercariae-shedding was predicted to occur from May to October. In the south it occurred from April to May and September to October, depending on the annual abundance of rain. In the north-central and central regions, risk was highest during heavy summer rains and pasture contamination with metacercariae was predicted to occur during August-September, except in wet years, when it may start as early as July and extend up to October. At cooler sites above altitude of 2800 m, completion of an infection cycle may require more than a year. Fasciola gigantica risk was present in the western, southern and north-central regions of the country at altitudes of 1440-2560 m. However, a transmission cycle could be completed in a single year only at elevations below 1700 m. The greatest risk of F. gigantica infection was in the humid western region. Regional strategic chemotherapy schemes of two or three treatments per year were developed. Results suggest that the model can be extrapolated to all CPSZ in the country and adapted for use in control of other vector-borne diseases of economic and public health importance.

Synergistic Association of Genetic Variants with Environmental Risk Factors in Susceptibility to Essential Hypertension.

PubMed

Sousa, Ana Célia; Mendonça, Maria I; Pereira, Andreia; Gouveia, Sara; Freitas, Ana I; Guerra, Graça; Rodrigues, Mariana; Henriques, Eva; Freitas, Sónia; Borges, Sofia; Pereira, Décio; Brehm, António; Palma Dos Reis, Roberto

2017-10-01

Essential hypertension (EH) is a disease in which both environment and genes have an important role. This study was designed to identify the interaction model between genetic variants and environmental risk factors that most highly potentiates EH development. We performed a case-control study with 1641 participants (mean age 50.6 ± 8.1 years), specifically 848 patients with EH and 793 controls, adjusted for gender and age. Traditional risk factors, biochemical and genetic parameters, including the genotypic discrimination of 14 genetic variants previously associated with EH, were investigated. Multifactorial dimensionality reduction (MDR) software was used to analyze gene-environment interactions. Validation was performed using logistic regression analysis with environmental risk factors, significant genetic variants, and the best MDR model. The best model indicates that the interactions among the ADD1 rs4961 640T allele, diabetes, and obesity (body mass index ≥30) increase approximately four-fold the risk of EH (odds ratio = 3.725; 95% confidence interval: 2.945-4.711; p < 0.0001). This work showed that the interaction between the ADD1 rs4961 variant, obesity, and the presence of diabetes increased the susceptibility to EH four-fold. In these circumstances, lifestyle adjustment and diabetes control should be intensified in patients who carry the ADD1 variant.

Risk factors for relinquishment of cats to an animal shelter.

PubMed

Patronek, G J; Glickman, L T; Beck, A M; McCabe, G P; Ecker, C

1996-08-01

To identify feline and household characteristics associated with relinquishment of a pet cat to an animal shelter. Case-control study. Households that relinquished cats for adoption (case households) and a random sample of current cat-owning households in the same community (control households). Potentially modifiable risk factors with the highest population attributable risk for relinquishment were owners having specific expectations about the cat's role in the household, allowing the cat outdoors, owning a sexually intact cat, never having read a book about cat behavior, cats having daily or weekly inappropriate elimination, and inappropriate care expectations. Frequency of inappropriate elimination and aggression toward people were not associated with declaw status, but these behaviors were more common among sexually intact cats, compared with sterilized cats. Owners of cats in case households were more likely than owners in control households to cite cost of sterilization as a reason a cat was sexually intact. Cats found as strays and cats acquired with minimal planning were at decreased risk of relinquishment. The identified risk factors can be modified by cat owners and veterinarians to decrease the estimated 4 million cats euthanatized annually in animal shelters. Owner education programs are needed as well as increased awareness on the part of cat owners and veterinarians of the importance of resolving feline inappropriate elimination problems.

Mothers with alcoholic liver disease and the risk for preterm and small-for-gestational-age birth.

PubMed

Stokkeland, Knut; Ebrahim, Fereshte; Hultcrantz, Rolf; Ekbom, Anders; Stephansson, Olof

2013-01-01

To study pregnancy outcome in women with alcoholic liver disease (ALD). Using the Swedish nation-wide Patient and Medical Birth Registers, we investigated risk of adverse pregnancy outcome in 720 women diagnosed with ALD before and 1720 diagnosed after birth and compared them with 24 460 population-based control births. Women with ALD diagnosed before or after birth were generally of higher age and body mass index, more likely to smoke cigarettes during pregnancy and to have a low socio-economic status compared with controls. Women diagnosed with ALD before birth had an increased risk of moderately and very preterm birth, adjusted odd ratio (OR) = 1.53 (95% confidence interval (CI): 1.37-1.72 and 1.15-2.06 95%), respectively. Infants of mothers with ALD before birth were more often small-for-gestational age, adjusted OR = 1.22 (95% CI: 1.05-1.43), and were at increased risk for low Apgar scores (<7) at 5 min, adjusted OR = 1.49 (95% CI: 1.15-1.92) compared with controls. Similar associations with slightly lower-risk estimates were found among women diagnosed with ALD after birth. ALD is associated with adverse-birth outcomes, highlighting the importance of screening women for alcohol dependence in antenatal care.

Worksite Cancer Prevention Activities in the National Comprehensive Cancer Control Program

PubMed Central

Nahmias, Zachary; Townsend, Julie S.; Neri, Antonio; Stewart, Sherri L.

2016-01-01

Background Workplaces are one setting for cancer control planners to reach adults at risk for cancer and other chronic diseases. However, the extent to which Centers for Disease Control and Prevention-funded National Comprehensive Cancer Control Programs (NCCCP) implement interventions in the workplace setting is not well characterized. Methods We conducted a qualitative content analysis of program action plans submitted by NCCCP grantees from 2013–2015 to identify and describe cancer prevention objectives and interventions in the workplace setting. Results Nearly half of NCCCP action reports contained at least one cancer prevention objective or intervention in the workplace setting. Common interventions included education about secondhand smoke exposure in the workplace, and the importance of obtaining colorectal cancer screening. Conclusion Workplace interventions were relatively common among NCCCP action plans, and serve as one way to address low percentages of CRC screening, and reduce risk for obesity- and tobacco-related cancers. PMID:26874944

Neurocysticercosis: regional status, epidemiology, impact and control measures in the Americas.

PubMed

Flisser, Ana; Sarti, Elsa; Lightowlers, Marshall; Schantz, Peter

2003-06-01

The analysis of epidemiological data concerning human cysticercosis point to important advances in understanding the magnitude and distribution of this parasitic disease in Latin America, as well as the relationship of the elements that conform the life cycle of Taenia solium. The data indicate that the main risk factor for acquiring human neurocysticercosis and swine cysticercosis is the presence of the tapeworm carrier in the household. Therefore, several intervention measures for the control of cysticercosis have been evaluated: mass treatment in order to cure tapeworm carriers, health education towards understanding the risk factors, pig control by restraining them, experimental vaccination of pigs and treatment of swine cysticercosis. In this paper, we review the information obtained in these areas. We hope it will be useful in other endemic countries that wish to elaborate an action plan for the control and ultimate eradication of T. solium.

Running away from home: a longitudinal study of adolescent risk factors and young adult outcomes.

PubMed

Tucker, Joan S; Edelen, Maria Orlando; Ellickson, Phyllis L; Klein, David J

2011-05-01

Little is known about the adolescent risk factors and young adult health-related outcomes associated with running away from home. We examined these correlates of running away using longitudinal data from 4,329 youth (48% female, 85% white) who were followed from Grade 9 to age 21. Nearly 14% of the sample reported running away in the past year at Grade 10 and/or Grade 11. Controlling for demographics and general delinquency, running away from home was predicted by lack of parental support, school disengagement, greater depressive affect, and heavier substance use at Grade 9. In turn, runaways had higher drug dependence scores and more depressive symptoms at age 21 than non-runaways, even after taking these antecedent risk factors into account. Runaway status did not predict alcohol dependence risk at age 21. Results highlight the importance of substance use and depression, both as factors propelling adolescents to run away and as important long-term consequences of running away.

Nuts for diabetes prevention and management

USDA-ARS?s Scientific Manuscript database

Type 2 diabetes mellitus is an important preventable disease and a growing public health problem. Epidemiologic and clinical studies suggest that healthy eating, physical activity, and body weight control are the main driving forces to reduce diabetes risk. Owing to their low available carbohydrate ...

What Matters to Women When Making Decisions About Breast Cancer Chemoprevention?

PubMed

Martinez, Kathryn A; Fagerlin, Angela; Witteman, Holly O; Holmberg, Christine; Hawley, Sarah T

2016-04-01

Despite the effectiveness of chemoprevention (tamoxifen and raloxifene) in preventing breast cancer among women at high risk for the disease, uptake is low. The objective of this study was to determine the tradeoff preferences for various attributes associated with chemoprevention among women not currently taking the drugs. We used rating-based conjoint analysis to evaluate the relative importance of a number of attributes associated with chemoprevention, including risk of side effects, drug effectiveness, time needed to take the drugs, and availability of a blood test to see if the drugs were working in an Internet sample of women. We generated mean importance values and part-worth utilities for all attribute levels associated with taking chemoprevention. We then used multivariable linear regression to examine attribute importance scores controlling for participant age, race, Hispanic ethnicity, educational level, and a family history of breast cancer. Overall interest in taking chemoprevention was low among the 1094 women included in the analytic sample, even for the scenario in which participants would receive the greatest benefit and fewest risks associated with taking the drugs. Time needed to take the pill for it to work and 5-year risk of breast cancer were the most important attributes driving tradeoff preferences between the chemoprevention scenarios. Interest in taking chemoprevention among this sample of women at average risk was low. Addressing women's concerns about the time needed to take chemoprevention for it to work may help clinicians improve uptake of the drugs among those likely to benefit.

Child Effortful Control, Teacher-student Relationships, and Achievement in Academically At-risk Children: Additive and Interactive Effects

PubMed Central

Liew, Jeffrey; Chen, Qi; Hughes, Jan N.

2009-01-01

The joint contributions of child effortful control (using inhibitory control and task accuracy as behavioral indices) and positive teacher-student relationships at first grade on reading and mathematics achievement at second grade were examined in 761 children who were predominantly from low-income and ethnic minority backgrounds and assessed to be academically at-risk at entry to first grade. Analyses accounted for clustering effects, covariates, baselines of effortful control measures, and prior levels of achievement. Even with such conservative statistical controls, interactive effects were found for task accuracy and positive teacher-student relationships on future achievement. Results suggest that task accuracy served as a protective factor so that children with high task accuracy performed well academically despite not having positive teacher-student relationships. Further, positive teacher-student relationships served as a compensatory factor so that children with low task accuracy performed just as well as those with high task accuracy if they were paired with a positive and supportive teacher. Importantly, results indicate that the influence of positive teacher-student relationships on future achievement was most pronounced for students with low effortful control on tasks that require fine motor skills, accuracy, and attention-related skills. Study results have implications for narrowing achievement disparities for academically at-risk children. PMID:20161421

Child Effortful Control, Teacher-student Relationships, and Achievement in Academically At-risk Children: Additive and Interactive Effects.

PubMed

Liew, Jeffrey; Chen, Qi; Hughes, Jan N

2010-01-01

The joint contributions of child effortful control (using inhibitory control and task accuracy as behavioral indices) and positive teacher-student relationships at first grade on reading and mathematics achievement at second grade were examined in 761 children who were predominantly from low-income and ethnic minority backgrounds and assessed to be academically at-risk at entry to first grade. Analyses accounted for clustering effects, covariates, baselines of effortful control measures, and prior levels of achievement. Even with such conservative statistical controls, interactive effects were found for task accuracy and positive teacher-student relationships on future achievement. Results suggest that task accuracy served as a protective factor so that children with high task accuracy performed well academically despite not having positive teacher-student relationships. Further, positive teacher-student relationships served as a compensatory factor so that children with low task accuracy performed just as well as those with high task accuracy if they were paired with a positive and supportive teacher. Importantly, results indicate that the influence of positive teacher-student relationships on future achievement was most pronounced for students with low effortful control on tasks that require fine motor skills, accuracy, and attention-related skills. Study results have implications for narrowing achievement disparities for academically at-risk children.

Beyond stereotypes of adolescent risk taking: Placing the adolescent brain in developmental context.

PubMed

Romer, Daniel; Reyna, Valerie F; Satterthwaite, Theodore D

2017-10-01

Recent neuroscience models of adolescent brain development attribute the morbidity and mortality of this period to structural and functional imbalances between more fully developed limbic regions that subserve reward and emotion as opposed to those that enable cognitive control. We challenge this interpretation of adolescent development by distinguishing risk-taking that peaks during adolescence (sensation seeking and impulsive action) from risk taking that declines monotonically from childhood to adulthood (impulsive choice and other decisions under known risk). Sensation seeking is primarily motivated by exploration of the environment under ambiguous risk contexts, while impulsive action, which is likely to be maladaptive, is more characteristic of a subset of youth with weak control over limbic motivation. Risk taking that declines monotonically from childhood to adulthood occurs primarily under conditions of known risks and reflects increases in executive function as well as aversion to risk based on increases in gist-based reasoning. We propose an alternative Life-span Wisdom Model that highlights the importance of experience gained through exploration during adolescence. We propose, therefore, that brain models that recognize the adaptive roles that cognition and experience play during adolescence provide a more complete and helpful picture of this period of development. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

Behavioral control in at-risk toddlers: the influence of the family check-up.

PubMed

Shelleby, Elizabeth C; Shaw, Daniel S; Cheong, Jeewon; Chang, Hyein; Gardner, Frances; Dishion, Thomas J; Wilson, Melvin N

2012-01-01

This study examines the role of one component of emotion regulation, behavioral control, in the growth of children's early behavior problems by examining whether increases in parental positive behavior support brought about by a family-centered intervention were associated with greater child behavioral control, and whether greater behavioral control at age 3 mediated the association between improvements in aspects of positive behavior support from ages 2 to 3 and decreases in growth of behavior problems from ages 2 to 4. The sample included 713 at-risk children (50% female) and their primary caregivers (50% European American, 28% African American, 13% biracial, 9% other) who were randomly assigned to the intervention or control group. Children had a mean age of 29.91 months at the initial assessment. Data were collected through home visits at child ages 2 to 4, which involved questionnaires for primary caregivers and structured and unstructured play activities for children with primary and alternative caregivers and siblings. Results indicated that the intervention improved parental positive behavior support and reduced growth of child behavior problems. One dimension of positive behavior support, proactive parenting, was modestly associated with behavioral control at age 3, which in turn was significantly associated with growth in behavior problems from ages 2 to 4, with greater behavioral control related to lower levels of growth in behavior problems. Results provide support for the notion that proactive parenting is an important factor in the development of children's behavioral control and that behavioral control plays an important role in the growth of behavior problems.

Pilot case-control study of paediatric falls from windows.

PubMed

Johnston, Brian D; Quistberg, D Alexander; Shandro, Jamie R; Partridge, Rebecca L; Song, Hyun Rae; Ebel, Beth E

2011-12-01

Unintentional falls from windows are an important cause of paediatric morbidity. There have been no controlled studies to identify modifiable environmental risk factors for window falls in young children. The authors have piloted a case-control study to test procedures for case identification, subject enrolment, and environmental data collection. Case windows were identified when a child 0-9 years old presented for care after a fall from that window. Control windows were identified (1) from the child's home and (2) from the home of an age- and gender-matched child seeking care for an injury diagnosis not related to a window fall. Study staff visited enrolled homes to collect window measurements and conduct window screen performance tests. The authors enrolled and collected data on 18 case windows, 18 in-home controls, and 14 matched community controls. Six potential community controls were contacted for every one enrolled. Families who completed the home visit viewed study procedures positively. Case windows were more likely than community controls to be horizontal sliders (100% vs 50%), to have deeper sills (6.28 vs 4.31 inches), to be higher above the exterior surface (183 vs 82 inches), and to have screens that failed below a threshold derived from the static pressure of a 3-year-old leaning against the mesh (60.0% vs 16.7%). Case windows varied very little from in-home controls. Case-control methodology can be used to study risk factors for paediatric falls from windows. Recruitment of community controls is challenging but essential, because in-home controls tend to be over-matched on important variables. A home visit allows direct measurement of window type, height, sill depth, and screen performance. These variables should all be investigated in subsequent, larger studies covering major housing markets.

[Development of whole process quality control and management system of traditional Chinese medicine decoction pieces based on traditional Chinese medicine quality tree].

PubMed

Yu, Wen-Kang; Dong, Ling; Pei, Wen-Xuan; Sun, Zhi-Rong; Dai, Jun-Dong; Wang, Yun

2017-12-01

The whole process quality control and management of traditional Chinese medicine (TCM) decoction pieces is a system engineering, involving the base environment, seeds and seedlings, harvesting, processing and other multiple steps, so the accurate identification of factors in TCM production process that may induce the quality risk, as well as reasonable quality control measures are very important. At present, the concept of quality risk is mainly concentrated in the aspects of management and regulations, etc. There is no comprehensive analysis on possible risks in the quality control process of TCM decoction pieces, or analysis summary of effective quality control schemes. A whole process quality control and management system for TCM decoction pieces based on TCM quality tree was proposed in this study. This system effectively combined the process analysis method of TCM quality tree with the quality risk management, and can help managers to make real-time decisions while realizing the whole process quality control of TCM. By providing personalized web interface, this system can realize user-oriented information feedback, and was convenient for users to predict, evaluate and control the quality of TCM. In the application process, the whole process quality control and management system of the TCM decoction pieces can identify the related quality factors such as base environment, cultivation and pieces processing, extend and modify the existing scientific workflow according to their own production conditions, and provide different enterprises with their own quality systems, to achieve the personalized service. As a new quality management model, this paper can provide reference for improving the quality of Chinese medicine production and quality standardization. Copyright© by the Chinese Pharmaceutical Association.

Descriptive epidemiology of cardiovascular risk factors and diabetes in sub-Saharan Africa.

PubMed

Mensah, George A

2013-01-01

Reliable data on risk factor levels, exposure history, and population distribution can help inform policies and programs for disease prevention and control. With rare exception however, ideal local data on major risk factors and causes of death and disease burden have been scarce in sub-Saharan Africa (SSA). Basic community surveys in some countries and recent systematic analysis of disease burden attributable to 67 risk factors and risk factor clusters in 21 regions of the world provide an opportunity to examine and relate diabetes and cardiovascular risk factors to mortality and burden in SSA. Rising body mass index, especially in women in Southern Africa; and rising systolic blood pressure in East Africa for both sexes, and in West Africa for women are the major cardiometabolic risk factors. Harmful use of alcohol, especially in Southern SSA, tobacco use, and physical inactivity are also important. Improving vital registration and risk factor surveillance remain major challenges. © 2013.

Bridging the etiologic and prognostic outlooks in individualized assessment of absolute risk of an illness: application in lung cancer.

PubMed

Karp, Igor; Sylvestre, Marie-Pierre; Abrahamowicz, Michal; Leffondré, Karen; Siemiatycki, Jack

2016-11-01

Assessment of individual risk of illness is an important activity in preventive medicine. Development of risk-assessment models has heretofore relied predominantly on studies involving follow-up of cohort-type populations, while case-control studies have generally been considered unfit for this purpose. To present a method for individualized assessment of absolute risk of an illness (as illustrated by lung cancer) based on data from a 'non-nested' case-control study. We used data from a case-control study conducted in Montreal, Canada in 1996-2001. Individuals diagnosed with lung cancer (n = 920) and age- and sex-matched lung-cancer-free subjects (n = 1288) completed questionnaires documenting life-time cigarette-smoking history and occupational, medical, and family history. Unweighted and weighted logistic models were fitted. Model overfitting was assessed using bootstrap-based cross-validation and 'shrinkage.' The discriminating ability was assessed by the c-statistic, and the risk-stratifying performance was assessed by examination of the variability in risk estimates over hypothetical risk-profiles. In the logistic models, the logarithm of incidence-density of lung cancer was expressed as a function of age, sex, cigarette-smoking history, history of respiratory conditions and exposure to occupational carcinogens, and family history of lung cancer. The models entailed a minimal degree of overfitting ('shrinkage' factor: 0.97 for both unweighted and weighted models) and moderately high discriminating ability (c-statistic: 0.82 for the unweighted model and 0.66 for the weighted model). The method's risk-stratifying performance was quite high. The presented method allows for individualized assessment of risk of lung cancer and can be used for development of risk-assessment models for other illnesses.

The impact of MTHFR 677C → T risk knowledge on changes in folate intake: findings from the Food4Me study.

PubMed

O'Donovan, Clare B; Walsh, Marianne C; Forster, Hannah; Woolhead, Clara; Celis-Morales, Carlos; Fallaize, Rosalind; Macready, Anna L; Marsaux, Cyril F M; Navas-Carretero, Santiago; San-Cristobal, Rodrigo; Kolossa, Silvia; Mavrogianni, Christina; Lambrinou, Christina P; Moschonis, George; Godlewska, Magdalena; Surwillo, Agnieszka; Bouwman, Jildau; Grimaldi, Keith; Traczyk, Iwona; Drevon, Christian A; Daniel, Hannelore; Manios, Yannis; Martinez, J Alfredo; Saris, Wim H M; Lovegrove, Julie A; Mathers, John C; Gibney, Michael J; Brennan, Lorraine; Gibney, Eileen R

2016-01-01

It is hypothesised that individuals with knowledge of their genetic risk are more likely to make health-promoting dietary and lifestyle changes. The present study aims to test this hypothesis using data from the Food4Me study. This was a 6-month Internet-based randomised controlled trial conducted across seven centres in Europe where individuals received either general healthy eating advice or varying levels of personalised nutrition advice. Participants who received genotype-based personalised advice were informed whether they had the risk (CT/TT) ( n  = 178) or non-risk (CC) ( n  = 141) alleles of the methylenetetrahydrofolate reductase ( MTHFR ) gene in relation to cardiovascular health and the importance of a sufficient intake of folate. General linear model analysis was used to assess changes in folate intake between the MTHFR risk, MTHFR non-risk and control groups from baseline to month 6 of the intervention. There were no differences between the groups for age, gender or BMI. However, there was a significant difference in country distribution between the groups ( p  = 0.010). Baseline folate intakes were 412 ± 172, 391 ± 190 and 410 ± 186 μg per 10 MJ for the risk, non-risk and control groups, respectively. There were no significant differences between the three groups in terms of changes in folate intakes from baseline to month 6. Similarly, there were no changes in reported intake of food groups high in folate. These results suggest that knowledge of MTHFR 677C → T genotype did not improve folate intake in participants with the risk variant compared with those with the non-risk variant. ClinicalTrials.gov NCT01530139.

Adolescent perceptions of orthodontic treatment risks and risk information: A qualitative study.

PubMed

Perry, John; Johnson, Ilona; Popat, Hashmat; Morgan, Maria Z; Gill, Paul

2018-04-24

For effective risk communication, clinicians must understand patients' values and beliefs in relation to the risks of treatment. This qualitative study aimed to explore adolescent perceptions of orthodontic treatment risks and risk information. Five focus groups were carried out with 32 school/college pupils aged 12-18 in Wales, UK. Participants were purposively selected and had all experienced orthodontic treatment. A thematic approach was used for analysis and data collection was completed at the point of data saturation. Four themes emerged from the data; (a) day-to-day risks of orthodontic treatment, (b) important orthodontic risk information, (c) engaging with orthodontic risk information and (d) managing the risks of orthodontic treatment. Day-to-day risks of orthodontic treatment that were affecting participants "here and now" were of most concern. Information about preventing the risks of treatment was deemed to be important. Participants did not actively seek risk information but engaged passively with information from convenient sources. Perceptions of risk susceptibility influenced participants' management of the risks of orthodontic treatment. This study demonstrates that adolescent patients can understand information about the nature and severity of orthodontic treatment risks. However, adolescent patients can have false perceptions if the risks are unfamiliar, perceived only to have a future impact or if seen as easy to control. Adolescent patients must be provided with timely and easily accessible risk information and with practical solutions to prevent the risks of treatment. The views and experiences gathered in this study can assist clinicians to better understand their young patients' beliefs about treatment risks, facilitate effective risk communication and contribute to improved patient-centred care. Copyright © 2018 Elsevier Ltd. All rights reserved.

Radon exposure and the risk of leukemia: a review of epidemiological studies.

PubMed

Laurier, D; Valenty, M; Tirmarche, M

2001-09-01

Since the 1990's, several authors estimated that radon inhalation may deliver a small amount of irradiation to the red bone marrow, and consequently may increase the risk of leukemia in humans. The objective of this review is to conduct a critical analysis of epidemiologic results currently available concerning the relationship between radon exposure and the risk of leukemia. Nineteen ecological studies, six miner cohort studies, and eight case-control studies published between 1987 and 2000 are included in this review. The limitations associated with each of these studies are discussed. The results of the ecological studies are relatively concordant and suggest an association between radon concentrations and the risk of leukemia at a geographic level. But these ecological studies present important limitations, and some are only crude analyses. Moreover, the results of the cohort and case-control studies, based on individual data, do not show any significant association between radon exposure and leukemia risk. Our conclusion is that the overall epidemiologic results currently available do not provide evidence for an association between radon exposure and leukemia.

The role of meat in foodborne disease: Is there a coming revolution in risk assessment and management?

PubMed

Fegan, Narelle; Jenson, Ian

2018-04-20

Meat has featured prominently as a source of foodborne disease and a public health concern. For about the past 20 years the risk management paradigm has dominated international thinking about food safety. Control through the supply chain is supported by risk management concepts, as the public health risk at the point of consumption becomes the accepted outcome based measure. Foodborne pathogens can be detected at several points in the supply chain and determining the source of where these pathogens arise and how they behave throughout meat production and processing are important parts of risk based approaches. Recent improvements in molecular and genetic based technologies and data analysis for investigating source attribution and pathogen behaviour have enabled greater insights into how foodborne outbreaks occur and where controls can be implemented. These new approaches will improve our understanding of the role of meat in foodborne disease and are expected to have a significant impact on our understanding in the coming years. Copyright © 2018 Elsevier Ltd. All rights reserved.

[The characteristics of psychosocial risks in the banking sector: a brief report].

PubMed

Stańczak, Aleksander; Merecz-Kot, Dorota

2014-01-01

Psychosocial risks in workplace are common phenomenon, stressing even for so-called white collar workers. The aim of the study was to indicate the most important threats in terms of banking sector employees. The studied subjects were 484 employees employed in 26 companies. The Scale of Psychosocial Risk (SPR) was used as a research tool. The most frequent and the most stressful categories of threats were: lack of control over workload and lack of career development chances. Banking sector employees are obliged to follow strict procedures of customer service and they regard their promotion chances as low. Employees's appraisal system is another strongly stressful factor. Work in a banking sector involves a great mental strain and the high risk of dismissal. Interpersonal relationships at work turned out to be the least stressful work facet in the banking sector. Given the most serious sources of psychosocial risks, the authors suggested to take the following actions: changes in work and work control system, education of employees and managerial staff and regular monitoring of occurring threats.

Mediation Analysis of the Efficacy of the Eban HIV/STD Risk-Reduction Intervention for African American HIV Serodiscordant Couples.

PubMed

El-Bassel, Nabila; Jemmott, John B; Bellamy, Scarlett L; Pequegnat, Willo; Wingood, Gina M; Wyatt, Gail E; Landis, J Richard; Remien, Robert H

2016-06-01

Targeting couples is a promising behavioral HIV risk-reduction strategy, but the mechanisms underlying the effects of such interventions are unknown. We report secondary analyses testing whether Social-Cognitive-Theory variables mediated the Eban HIV-risk-reduction intervention's effects on condom-use outcomes. In a multisite randomized controlled trial conducted in four US cities, 535 African American HIV-serodiscordant couples were randomized to the Eban HIV risk-reduction intervention or attention-matched control intervention. Outcomes were proportion condom-protected sex, consistent condom use, and frequency of unprotected sex measured pre-, immediately post-, and 6 and 12 months post-intervention. Potential mediators included Social-Cognitive-Theory variables: outcome expectancies and self-efficacy. Mediation analyses using the product-of-coefficients approach in a generalized-estimating-equations framework revealed that condom-use outcome expectancy, partner-reaction outcome expectancy, intention, self-efficacy, and safer-sex communication improved post-intervention and mediated intervention-induced improvements in condom-use outcomes. These findings underscore the importance of targeting outcome expectancies, self-efficacy, and safer-sex communication in couples-level HIV risk-reduction interventions.

Cooperative Crisis Management and Avian Influenza. A Risk Assessment Guide for International Contagious Disease Prevention and Risk Mitigation

DTIC Science & Technology

2006-03-01

with a decrease in trade restrictions between neighboring countries, make it easier for microbes , disease- causing insects, and infected animals to...with a collection of information if it does not display a currently valid OMB control number. 1. REPORT DATE MAR 2006 2. REPORT TYPE 3. DATES COVERED...are important aspects of managing external perceptions. External perceptions can cause unaffected countries to consider more drastic measures for

Prevalence of and Risk Factors for Multidrug-Resistant Acinetobacter baumannii Colonization Among High-Risk Nursing Home Residents

PubMed Central

Mody, Lona; Gibson, Kristen E.; Horcher, Amanda; Prenovost, Katherine; McNamara, Sara E.; Foxman, Betsy; Kaye, Keith S.; Bradley, Suzanne

2015-01-01

OBJECTIVE To characterize the epidemiology of multidrug-resistant (MDR) Acinetobacter baumannii colonization in high-risk nursing home (NH) residents. DESIGN Nested case-control study within a multicenter prospective intervention trial. SETTING Four NHs in Southeast Michigan. PARTICIPANTS Case patients and control subjects were NH residents with an indwelling device (urinary catheter and/or feeding tube) selected from the control arm of the Targeted Infection Prevention study. Cases were residents colonized with MDR (resistant to ≥3 classes of antibiotics) A. baumannii; controls were never colonized with MDR A. baumannii. METHODS For active surveillance cultures, specimens from the nares, oropharynx, groin, perianal area, wounds, and device insertion site(s) were collected upon study enrollment, day 14, and monthly thereafter. A. baumannii strains and their susceptibilities were identified using standard microbiologic methods. RESULTS Of 168 NH residents, 25 (15%) were colonized with MDR A. baumannii. Compared with the 143 controls, cases were more functionally disabled (Physical Self-Maintenance Score >24; odds ratio, 5.1 [95% CI, 1.8–14.9]; P < .004), colonized with Proteus mirabilis (5.8 [1.9–17.9]; P < .003), and diabetic (3.4 [1.2–9.9]; P < .03). Most cases (22 [88%]) were colonized with multiple antibiotic-resistant organisms and 16 (64%) exhibited co-colonization with at least one other resistant gram-negative bacteria. CONCLUSION Functional disability, P. mirabilis colonization, and diabetes mellitus are important risk factors for colonization with MDR A. baumannii in high-risk NH residents. A. baumannii exhibits widespread antibiotic resistance and a preference to colonize with other antibiotic-resistant organisms, meriting enhanced attention and improved infection control practices in these residents. PMID:26072936

Increased Long-Term Cardiovascular Risk After Total Hip Arthroplasty

PubMed Central

Gordon, Max; Rysinska, Agata; Garland, Anne; Rolfson, Ola; Aspberg, Sara; Eisler, Thomas; Garellick, Göran; Stark, André; Hailer, Nils P.; Sköldenberg, Olof

2016-01-01

Abstract Total hip arthroplasty is a common and important treatment for osteoarthritis patients. Long-term cardiovascular effects elicited by osteoarthritis or the implant itself remain unknown. The purpose of the present study was to determine if there is an increased risk of late cardiovascular mortality and morbidity after total hip arthroplasty surgery. A nationwide matched cohort study with data on 91,527 osteoarthritis patients operated on, obtained from the Swedish Hip Arthroplasty Register. A control cohort (n = 270,688) from the general Swedish population was matched 1:3 to each case by sex, age, and residence. Mean follow-up time was 10 years (range, 7–21). The exposure was presence of a hip replacement for more than 5 years. The primary outcome was cardiovascular mortality after 5 years. Secondary outcomes were total mortality and re-admissions due to cardiovascular events. During the first 5 to 9 years, the arthroplasty cohort had a lower cardiovascular mortality risk compared with the control cohort. However, the risk in the arthroplasty cohort increased over time and was higher than in controls after 8.8 years (95% confidence interval [CI] 7.0–10.5). Between 9 and 13 years postoperatively, the hazard ratio was 1.11 (95% CI 1.05–1.17). Arthroplasty patients were also more frequently admitted to hospital for cardiovascular reasons compared with controls, with a rate ratio of 1.08 (95% CI 1.06–1.11). Patients with surgically treated osteoarthritis of the hip have an increased risk of cardiovascular morbidity and mortality many years after the operation when compared with controls. PMID:26871792

Dietary factors and gastric cancer risk. A case-control study in Spain.

PubMed

Ramón, J M; Serra, L; Cerdó, C; Oromí, J

1993-03-01

Evidence supports that gastric cancer has an environmental etiology, of which diet appears to be the most important component. The authors examined the effect of diet on the risk of gastric cancer. A case-control study of dietary factors and gastric cancer was conducted between September 1986 and March 1989 in the Barcelona metropolitan area, Spain. One hundred seventeen cases with histologically confirmed diagnosis of gastric adenocarcinoma were matched by age, gender, and whether they possessed a telephone to 234 community controls. One hundred eighty-eight (80.3%) controls were selected by random-digit telephone dialing and 46 (19.7%) by neighborhood of residence. Information about frequency and amount of consumption of 89 food items in one year was gathered by using a questionnaire, and cases and controls were interviewed in their homes by trained interviewers. Unconditional logistic regression was used for the analysis. Gastric cancer risk rose with increasing intake of smoked and pickled foods (OR 3.67 for upper tertile) and salt (OR 2.11 for upper quartile). Intake of citrus fruits (OR 0.47 for upper tertile) and raw-green vegetables (OR 0.56 for upper quartile) appeared to be protective. Gastric cancer risk was not associated with intake of cereals, rice, total vegetables, and fruits as a whole. These data suggest that high intake of salt and smoked and pickled food may be associated with a high risk of gastric cancer, and this association could be due to intragastric formation of nitrosamines. The negative association with citric and green vegetables consumption to be associated with the inhibition of nitrosation process.

HIV, antiretroviral treatment, hypertension, and stroke in Malawian adults: A case-control study.

PubMed

Benjamin, Laura A; Corbett, Elizabeth L; Connor, Myles D; Mzinganjira, Henry; Kampondeni, Sam; Choko, Augustine; Hopkins, Mark; Emsley, Hedley C A; Bryer, Alan; Faragher, Brian; Heyderman, Robert S; Allain, Theresa J; Solomon, Tom

2016-01-26

To investigate HIV, its treatment, and hypertension as stroke risk factors in Malawian adults. We performed a case-control study of 222 adults with acute stroke, confirmed by MRI in 86%, and 503 population controls, frequency-matched for age, sex, and place of residence, using Global Positioning System for random selection. Multivariate logistic regression models were used for case-control comparisons. HIV infection (population attributable fraction [PAF] 15%) and hypertension (PAF 46%) were strongly linked to stroke. HIV was the predominant risk factor for young stroke (≤45 years), with a prevalence of 67% and an adjusted odds ratio (aOR) (95% confidence interval) of 5.57 (2.43-12.8) (PAF 42%). There was an increased risk of a stroke in patients with untreated HIV infection (aOR 4.48 [2.44-8.24], p < 0.001), but the highest risk was in the first 6 months after starting antiretroviral therapy (ART) (aOR 15.6 [4.21-46.6], p < 0.001); this group had a lower median CD4(+) T-lymphocyte count (92 vs 375 cells/mm(3), p = 0.004). In older participants (HIV prevalence 17%), HIV was associated with stroke, but with a lower PAF than hypertension (5% vs 68%). There was no interaction between HIV and hypertension on stroke risk. In a population with high HIV prevalence, where stroke incidence is increasing, we have shown that HIV is an important risk factor. Early ART use in immunosuppressed patients poses an additional and potentially treatable stroke risk. Immune reconstitution inflammatory syndrome may be contributing to the disease mechanisms. © 2015 American Academy of Neurology.

Impact of particles on sediment accumulation in a drinking water distribution system.

PubMed

Vreeburg, J H G; Schippers, D; Verberk, J Q J C; van Dijk, J C

2008-10-01

Discolouration of drinking water is one of the main reasons customers complain to their water company. Though corrosion of cast iron is often seen as the main source for this problem, the particles originating from the treatment plant play an important and potentially dominant role in the generation of a discolouration risk in drinking water distribution systems. To investigate this thesis a study was performed in a drinking water distribution system. In two similar isolated network areas the effect of particles on discolouration risk was studied with particle counting, the Resuspension Potential Method (RPM) and assessment of the total accumulated sediment. In the 'Control Area', supplied with normal drinking water, the discolouration risk was regenerated within 1.5 year. In the 'Research Area', supplied with particle-free water, this will take 10-15 years. An obvious remedy for controlling the discolouration risk is to improve the treatment with respect to the short peaks that are caused by particle breakthrough.

Variability in Estrogen-Metabolizing Genes and Their Association with Genomic Instability in Untreated Breast Cancer Patients and Healthy Women

PubMed Central

Alves dos Santos, Raquel; Teixeira, Ana Cláudia; Mayorano, Mônica Beatriz; Carrara, Hélio Humberto Angotti; Moreira de Andrade, Jurandyr; Takahashi, Catarina Satie

2011-01-01

In the present study, we investigated the relationship between polymorphisms in the estrogen-metabolizing genes CYP17, CYP1B1, CYP1A1, and COMT and genomic instability in the peripheral blood lymphocytes of 62 BC patients and 62 controls considering that increased or prolonged exposure to estrogen can damage the DNA molecule and increase the genomic instability process in breast tissue. Our data demonstrated increased genomic instability in BC patients and that individuals with higher frequencies of MN exhibited higher risk to BC when belonging Val/Met genotype of the COMT gene. We also observed that CYP17 and CYP1A1 polymorphisms can modify the risk to BC depending on the menopause status. We can conclude that the genetic background in estrogen metabolism pathway can modulate chromosome damage in healthy controls and patients and thereby influence the risk to BC. These findings suggest the importance to ally biomarkers of susceptibility and effects to estimate risk groups. PMID:21716904

Family, peer, and neighborhood influences on academic achievement among African-American adolescents: one-year prospective effects.

PubMed

Gonzales, N A; Cauce, A M; Friedman, R J; Mason, C A

1996-06-01

Using a 1-year prospective design, this study examined the influence of family status variables (family income, parental education, family structure), parenting variables (maternal support and restrictive control), peer support, and neighborhood risk on the school performance of 120 African American junior high school students. In addition to main effects of these variables, neighborhood risk was examined as a moderator of the effects of parenting and peer support. Family status variables were not predictive of adolescent school performance as indexed by self-reported grade point average. Maternal support at Time 1 was prospectively related to adolescent grades at Time 2. Neighborhood risk was related to lower grades, while peer support predicted better grades in the prospective analyses. Neighborhood risk also moderated the effects of maternal restrictive control and peer support on adolescent grades in prospective analyses. These findings highlight the importance of an ecological approach to the problem of academic underachievement within the African American Community.

Which Fearful Toddlers Should We Worry About? Context, Fear Regulation, and Anxiety Risk

PubMed Central

Buss, Kristin A.

2010-01-01

The current study tests a model of risk for anxiety in fearful toddlers characterized by the regulation of the intensity of withdrawal behavior across a variety of contexts. Participants included 111, low-risk, 24-month-old toddlers followed longitudinally each year through the fall of their kindergarten year. The key hypothesis was that being fearful in situations that are relatively low in threat (i.e., are predictable, controllable, and in which children have many coping resources) is an early precursor to risk for anxiety development as measured by parent and teacher report of anxious behaviors in kindergarten. Results supported the prediction such that it is not how much fear is expressed, but when the fear is expressed and how it is expressed that is important for characterizing adaptive behavior. Implications are discussed for a model of risk that includes the regulation of fear, the role of eliciting context, social wariness, and the importance of examining developmental transitions, such as the start of formal schooling. These findings have implications for the way we identify fearful children who may be at risk for developing anxiety-related problems. PMID:21463035

Serum betaine but not choline is inversely associated with breast cancer risk: a case-control study in China.

PubMed

Du, Yu-Feng; Lin, Fang-Yu; Long, Wei-Qing; Luo, Wei-Ping; Yan, Bo; Xu, Ming; Mo, Xiong-Fei; Zhang, Cai-Xia

2017-04-01

Choline and betaine are important for DNA methylation and synthesis, and may affect tumor carcinogenesis. To our knowledge, no previous study has examined the association between serum choline and betaine and breast cancer risk. This study aimed to examine whether serum choline and betaine were inversely associated with breast cancer risk among Chinese women. This hospital-based case-control study consecutively recruited 510 breast cancer cases and 518 frequency-matched (age and residence) controls, and blood samples were available for 500 cases and 500 controls. Serum choline and betaine were assayed by high-performance liquid chromatography-tandem mass spectrometry. Multiple unconditional logistic regression was used to estimate odds ratios (ORs) and 95 % confidence intervals (CIs). An inverse association with breast cancer risk was observed for serum betaine (fourth vs first quartile adjusted OR 0.68, 95 % CI 0.47-0.97) and for the ratio of serum betaine to choline (fourth vs first quartile adjusted OR 0.70, 95 % CI 0.48-1.00), but not for serum choline (fourth vs first quartile adjusted OR 0.80, 95 % CI 0.56-1.15). Serum betaine was inversely associated with breast cancer risk in subjects with below-median dietary folate intake (fourth vs first quartile adjusted OR 0.48, 95 % CI 0.30-0.77). This study suggested that serum betaine but not choline was inversely associated with breast cancer risk. This result needed to be further confirmed by the prospective studies.

Approaches to Quality Risk Management When Using Single-Use Systems in the Manufacture of Biologics.

PubMed

Ishii-Watabe, Akiko; Hirose, Akihiko; Katori, Noriko; Hashii, Norikata; Arai, Susumu; Awatsu, Hirotoshi; Eiza, Akira; Hara, Yoshiaki; Hattori, Hideshi; Inoue, Tomomi; Isono, Tetsuya; Iwakura, Masahiro; Kajihara, Daisuke; Kasahara, Nobuo; Matsuda, Hiroyuki; Murakami, Sei; Nakagawa, Taishiro; Okumura, Takehiro; Omasa, Takeshi; Takuma, Shinya; Terashima, Iyo; Tsukahara, Masayoshi; Tsutsui, Maiko; Yano, Takahiro; Kawasaki, Nana

2015-10-01

Biologics manufacturing technology has made great progress in the last decade. One of the most promising new technologies is the single-use system, which has improved the efficiency of biologics manufacturing processes. To ensure safety of biologics when employing such single-use systems in the manufacturing process, various issues need to be considered including possible extractables/leachables and particles arising from the components used in single-use systems. Japanese pharmaceutical manufacturers, together with single-use suppliers, members of the academia and regulatory authorities have discussed the risks of using single-use systems and established control strategies for the quality assurance of biologics. In this study, we describe approaches for quality risk management when employing single-use systems in the manufacturing of biologics. We consider the potential impact of impurities related to single-use components on drug safety and the potential impact of the single-use system on other critical quality attributes as well as the stable supply of biologics. We also suggest a risk-mitigating strategy combining multiple control methods which includes the selection of appropriate single-use components, their inspections upon receipt and before releasing for use and qualification of single-use systems. Communication between suppliers of single-use systems and the users, as well as change controls in the facilities both of suppliers and users, are also important in risk-mitigating strategies. Implementing these control strategies can mitigate the risks attributed to the use of single-use systems. This study will be useful in promoting the development of biologics as well as in ensuring their safety, quality and stable supply.

Higher risk of progressing breast cancer in Kurdish population associated to CDH1 -160 C/A polymorphism

PubMed Central

Zarei, Farzaneh; Menbari, Mohammad Nazir; Ghaderi, Bayazid; Abdi, Mohammad; Vahabzadeh, Zakaria

2017-01-01

There is an increasing interest about studying possible effects of genetic polymorphisms and risk of cancer progression. E-cadherin (CDH1) involves in many important cellular processes including cell-cell interactions, cell development and genetic changes of this molecule has been associated with greater tumor metastasis. The present study was aimed to evaluate the possible role of CDH1 -160 C/A polymorphism as a potential risk factor for breast cancer in Kurdish population. This case-control study consisted of 100 breast cancer patients and 200 healthy controls. Clinicopathological findings of all individuals were reported and immunohistochemistry staining was carried out on tissue samples. The CDH1 -160 C/A genotype was determined by polymerase chain reaction- restriction fragment length polymorphism method (PCR-RFLP). CDH1 -160 C/A polymorphism was differently distributed between patient and control groups. The A allele of CDH1 -160 C/A polymorphism significantly increased in patients compared to controls. In addition we found that the A allele of this polymorphism might be a potential risk factor for progression of breast cancer in our studied population. Patients with A allele of CDH1 -160 C/A was in higher risk to progress invasive ductal carcinoma. The A allele was also correlated with high grade and stage IV and also with metastatic tumors in studied subjects. The CDH1 -160 C/A polymorphism is correlated with clinicopathologial findings of breast cancer patients. The A allele of CDH1 -160 C/A may be a risk factor for progression of breast cancer in Kurdish patients. PMID:29285016

Higher risk of progressing breast cancer in Kurdish population associated to CDH1 -160 C/A polymorphism.

PubMed

Zarei, Farzaneh; Menbari, Mohammad Nazir; Ghaderi, Bayazid; Abdi, Mohammad; Vahabzadeh, Zakaria

2017-01-01

There is an increasing interest about studying possible effects of genetic polymorphisms and risk of cancer progression. E-cadherin (CDH1) involves in many important cellular processes including cell-cell interactions, cell development and genetic changes of this molecule has been associated with greater tumor metastasis. The present study was aimed to evaluate the possible role of CDH1 -160 C/A polymorphism as a potential risk factor for breast cancer in Kurdish population. This case-control study consisted of 100 breast cancer patients and 200 healthy controls. Clinicopathological findings of all individuals were reported and immunohistochemistry staining was carried out on tissue samples. The CDH1 -160 C/A genotype was determined by polymerase chain reaction- restriction fragment length polymorphism method (PCR-RFLP). CDH1 -160 C/A polymorphism was differently distributed between patient and control groups. The A allele of CDH1 -160 C/A polymorphism significantly increased in patients compared to controls. In addition we found that the A allele of this polymorphism might be a potential risk factor for progression of breast cancer in our studied population. Patients with A allele of CDH1 -160 C/A was in higher risk to progress invasive ductal carcinoma. The A allele was also correlated with high grade and stage IV and also with metastatic tumors in studied subjects. The CDH1 -160 C/A polymorphism is correlated with clinicopathologial findings of breast cancer patients. The A allele of CDH1 -160 C/A may be a risk factor for progression of breast cancer in Kurdish patients.

Dental scaling and risk reduction in infective endocarditis: a nationwide population-based case-control study.

PubMed

Chen, Su-Jung; Liu, Chia-Jen; Chao, Tze-Fan; Wang, Kang-Ling; Wang, Fu-Der; Chen, Tzeng-Ji; Chiang, Chern-En

2013-04-01

Infective endocarditis (IE) is an uncommon but potentially life-threatening disease. Poor oral hygiene has been assumed as an important risk factor for IE. We aimed to investigate whether the improvement of oral hygiene through dental scaling could reduce the risk of IE. From January 1, 2000 to December 31, 2009, a total of 736 patients with newly diagnosed IE were identified from the National Health Insurance Research Database. On the same date of enrollment, 10 patients (without IE) with matched age, sex, and underlying diseases were selected to be the control group for each study patient. The frequency of dental scaling before the enrollment was analyzed and compared between the study and the control groups. The percentages of patients who ever received dental scaling before the enrollment were higher in the control group than that in the study group. For patients who received dental scaling once in 2 years, the risk of IE can be reduced by about 15% (odds ratio, 0.845; 95% confidence interval, 0.693-1.012) with a borderline P value (P = 0.058). Moreover, the risk of IE decreased significantly among patients who received dental scaling at least once per year, with an odds ratio of 0.696 (95% confidence interval, 0.542-0.894; P = 0.005). Improvement of oral hygiene by dental scaling may reduce the risk of IE. More frequent and regular dental scaling (at least once per year) was associated with a significant decrease in IE. Copyright © 2013 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

Risk factors associated with deforming oral habits in children aged 5 to 11: a case-control study.

PubMed

Reyes Romagosa, Daniel Enrique; Paneque Gamboa, María Rosa; Almeida Muñiz, Yamilka; Quesada Oliva, Leticia María; Escalona Oliva, Damiana; Torres Naranjo, Sonia

2014-03-31

Dental and maxillofacial anomalies have multiple and complex causes. Most frequent among these are poor oral habits. A large number of children present with oral malocclusions, most of which are caused by deforming oral habits. It is important to learn about risk factors for this condition in order to institute preventive measures, early detection and treatment, and identification of low- and high-risk groups. To identify risk factors associated with deforming oral habits, which, if maintained over time, are responsible for occlusion defects, speech disorders, and can affect physical and emotional child development. A case-control study of children presenting with deforming oral habits in the municipality of Manzanillo in Granma province was conducted between January and August 2013. 540 children aged 5 to 11 were included of which 180 had deforming oral habits and were asked to fill out a survey to identify specific type of habits leading to malocclusion. The case group was composed of children with deforming habits, and the remaining 360 children without poor oral habits were the control group. Each case was randomly matched to two control cases. The children mothers were also surveyed to gather supplemental information. Children with deforming oral habits were mostly female. At age 10, onychophagia was the predominant oral deforming habit. Risk factors detected for these habits were sociobiological maternal and child variables such as low and high birth weight, maternal breastfeeding inexperience, and discord in the family. The study identified likely risk factors associated with deforming oral habits. These are discord in the family, birth weight, and lack of breastfeeding experience.

Mobile phones and malaria: modeling human and parasite travel

PubMed Central

Buckee, Caroline O.; Wesolowski, Amy; Eagle, Nathan; Hansen, Elsa; Snow, Robert W.

2013-01-01

Human mobility plays an important role in the dissemination of malaria parasites between regions of variable transmission intensity. Asymptomatic individuals can unknowingly carry parasites to regions where mosquito vectors are available, for example, undermining control programs and contributing to transmission when they travel. Understanding how parasites are imported between regions in this way is therefore an important goal for elimination planning and the control of transmission, and would enable control programs to target the principal sources of malaria. Measuring human mobility has traditionally been difficult to do on a population scale, but the widespread adoption of mobile phones in low-income settings presents a unique opportunity to directly measure human movements that are relevant to the spread of malaria. Here, we discuss the opportunities for measuring human mobility using data from mobile phones, as well as some of the issues associated with combining mobility estimates with malaria infection risk maps to meaningfully estimate routes of parasite importation. PMID:23478045

Insolvency and challenges of regulating providers that bear risk.

PubMed

Brewster, L R; Jackson, L; Lesser, C S

2000-02-01

Risk contracting and capitation are two widely used financial mechanisms that give incentives to health care providers to control costs. Risk-bearing arrangements have failed in a number of communities, however. This has shaken local markets, disrupting consumers' access to health care services and triggering losses for physicians and hospitals. It also has raised questions about the adequacy of related regulatory oversight, which holds important implications for local and national policy makers. This Issue Brief provides case studies of failed risk-contracting arrangements in two of the 12 communities that the Center for Studying Health System Change (HSC) tracks intensively--Northern New Jersey and Orange County, Calif.--and examines implications for policy makers.

Hypoglycemia: The neglected complication

PubMed Central

Kalra, Sanjay; Mukherjee, Jagat Jyoti; Venkataraman, Subramanium; Bantwal, Ganapathi; Shaikh, Shehla; Saboo, Banshi; Das, Ashok Kumar; Ramachandran, Ambady

2013-01-01

Hypoglycemia is an important complication of glucose-lowering therapy in patients with diabetes mellitus. Attempts made at intensive glycemic control invariably increases the risk of hypoglycemia. A six-fold increase in deaths due to diabetes has been attributed to patients experiencing severe hypoglycemia in comparison to those not experiencing severe hypoglycemia Repeated episodes of hypoglycemia can lead to impairment of the counter-regulatory system with the potential for development of hypoglycemia unawareness. The short- and long-term complications of diabetes related hypoglycemia include precipitation of acute cerebrovascular disease, myocardial infarction, neurocognitive dysfunction, retinal cell death and loss of vision in addition to health-related quality of life issues pertaining to sleep, driving, employment, recreational activities involving exercise and travel. There is an urgent need to examine the clinical spectrum and burden of hypoglycemia so that adequate control measures can be implemented against this neglected life-threatening complication. Early recognition of hypoglycemia risk factors, self-monitoring of blood glucose, selection of appropriate treatment regimens with minimal or no risk of hypoglycemia and appropriate educational programs for healthcare professionals and patients with diabetes are the major ways forward to maintain good glycemic control, minimize the risk of hypoglycemia and thereby prevent long-term complications. PMID:24083163

Dietary Inflammatory Index and risk of esophageal squamous cell cancer in a case-control study from Iran

PubMed Central

Shivappa, Nitin; Hébert, James R.; Rashidkhani, Bahram

2015-01-01

Background Diet and inflammation have been suggested to be important risk factors for esophageal squamous cell carcinoma (ESCC). In this study, we examined the ability of the dietary inflammatory index (DII) to predict ESCC in a case-control study conducted in Iran. Methods This study included 47 ESCC cases and 96 controls hospitalized for acute non-neoplastic diseases. The DII was computed based on dietary intake assessed by a previously validated food frequency questionnaire. Logistic regression models were used to estimate odds ratios (ORs) adjusted for age, energy, sex, BMI, years of education, physical activity, smoking and gastro-esophageal reflux. Results Subjects with higher DII scores (i.e., with a more pro-inflammatory diet) had a higher risk of ESCC, with the DII being used as both a continuous variable (ORcontinuous 3.58, 95% confidence interval, CI, 1.76–7.26; one unit increase corresponding to ≈16% of its range in the current study) and a categorical variable (ORdii>1.20 vs ≤ 1.208.24, 95%CI 2.03–33.47). Conclusion These results indicate that a pro-inflammatory diet is associated with increased risk of ESCC. PMID:26400625

Healthy dietary patterns decrease the risk of colorectal cancer in the Mecca Region, Saudi Arabia: a case-control study.

PubMed

Azzeh, Firas S; Alshammari, Eyad M; Alazzeh, Awfa Y; Jazar, Abdelelah S; Dabbour, Ibrahim R; El-Taani, Hani A; Obeidat, Ahmed A; Kattan, Fayrooz A; Tashtoush, Sufyan H

2017-06-29

Colorectal cancer (CRC) is the first most common cancer in males and the third most common cancer in females in Saudi Arabia. Dietary habits are strongly associated with the inhibition or proliferation of malignancy. Therefore, this study is aiming to investigate the risks and protective benefits of dietary factors affecting CRC in the Mecca region of Saudi Arabia. A case-control study was conducted from June 2014 to March 2015. One hundred thirty-seven patients with colon and/or rectal cancer were recruited in the case group, while 164 healthy participants were recruited in the control group. A questionnaire was completed with the help of trained dietitians to study the effects of several dietary patterns on the risk of CRC. Dairy product intake of 1-5 servings/day, legume intake of 3-5 servings/week, leafy vegetables intake of 1-5 servings/week, olive oil intake of 1-5 servings/week, black tea intake of three or more cups/day, and coffee intake of one or more cups/day was found to decrease the risk of CRC in participants. This study highlights the importance of changing dietary habits to decrease CRC incidence in the Mecca region.

Oral cancer associated with chronic mechanical irritation of the oral mucosa.

PubMed

Piemonte, E; Lazos, J; Belardinelli, P; Secchi, D; Brunotto, M; Lanfranchi-Tizeira, H

2018-03-01

Most of the studies dealing with Chronic Mechanical Irritation (CMI) and Oral Cancer (OC) only considered prosthetic and dental variables separately, and CMI functional factors are not registered. Thus, the aim of this study was to assess OC risk in individuals with dental, prosthetic and functional CMI. Also, we examined CMI presence in relation to tumor size. A case-control study was carried out from 2009 to 2013. Study group were squamous cell carcinoma cases; control group was patients seeking dental treatment in the same institution. 153 patients were studied (Study group n=53, Control group n=100). CMI reproducibility displayed a correlation coefficient of 1 (p<0.0001). Bivariate analysis showed statistically significant associations for all variables (age, gender, tobacco and alcohol consumption and CMI). Multivariate analysis exhibited statistical significance for age, alcohol, and CMI, but not for gender or tobacco. Relationship of CMI with tumor size showed no statistically significant differences. CMI could be regarded as a risk factor for oral cancer. In individuals with other OC risk factors, proper treatment of the mechanical injuring factors (dental, prosthetic and functional) could be an important measure to reduce the risk of oral cancer.

New Evidence in the Management of Chronic Hypertension in Pregnancy.

PubMed

Podymow, Tiina; August, Phyllis

2017-07-01

Chronic hypertension complicates 1% to 5% of all pregnancies, but debate continues regarding the benefits of lowering blood pressure in pregnancy as well as the optimal blood pressure targets. Women with chronic hypertension are at significant risk for maternal and fetal morbidity and mortality, yet it remains unclear whether antihypertensive treatment during pregnancy lowers these risks. Severe hypertension (systolic ≥ 160 mm Hg) should be treated, but there is considerable variability in the approach to mild-to-moderate hypertension (140-159/90-109 mm Hg). The recently published CHIPS (Control of Hypertension in Pregnancy Study) trial is an important effort to attempt to determine treatment goals in mild to moderate pregnancy hypertension. The risks and benefits of tight versus less tight control of blood pressure in nonproteinuric hypertensive women, most of whom had pre-existing hypertension, were evaluated. A main finding was an increased risk of severe hypertension (adjusted odds ratio, 1.8) when blood pressure was not tightly controlled. In this review, general management of chronic hypertension in pregnancy is discussed, including changes in treatment that may be appropriate in light of new clinical trial data. Copyright © 2017 Elsevier Inc. All rights reserved.

Verification and Implementation of Operations Safety Controls for Flight Missions

NASA Technical Reports Server (NTRS)

Smalls, James R.; Jones, Cheryl L.; Carrier, Alicia S.

2010-01-01

There are several engineering disciplines, such as reliability, supportability, quality assurance, human factors, risk management, safety, etc. Safety is an extremely important engineering specialty within NASA, and the consequence involving a loss of crew is considered a catastrophic event. Safety is not difficult to achieve when properly integrated at the beginning of each space systems project/start of mission planning. The key is to ensure proper handling of safety verification throughout each flight/mission phase. Today, Safety and Mission Assurance (S&MA) operations engineers continue to conduct these flight product reviews across all open flight products. As such, these reviews help ensure that each mission is accomplished with safety requirements along with controls heavily embedded in applicable flight products. Most importantly, the S&MA operations engineers are required to look for important design and operations controls so that safety is strictly adhered to as well as reflected in the final flight product.

Six Sigma Quality Management System and Design of Risk-based Statistical Quality Control.

PubMed

Westgard, James O; Westgard, Sten A

2017-03-01

Six sigma concepts provide a quality management system (QMS) with many useful tools for managing quality in medical laboratories. This Six Sigma QMS is driven by the quality required for the intended use of a test. The most useful form for this quality requirement is the allowable total error. Calculation of a sigma-metric provides the best predictor of risk for an analytical examination process, as well as a design parameter for selecting the statistical quality control (SQC) procedure necessary to detect medically important errors. Simple point estimates of sigma at medical decision concentrations are sufficient for laboratory applications. Copyright © 2016 Elsevier Inc. All rights reserved.

Fifty years of stroke researches in India

PubMed Central

Banerjee, Tapas Kumar; Das, Shyamal Kumar

2016-01-01

Currently, the stroke incidence in India is much higher than Western industrialized countries. Large vessel intracranial atherosclerosis is the commonest cause of ischemic stroke in India. The common risk factors, that is, hypertension, diabetes, smoking, and dyslipidemia are quite prevalent and inadequately controlled; mainly because of poor public awareness and inadequate infrastructure. Only a small number of ischemic stroke cases are able to have the benefit of thrombolytic therapy. Benefits from stem cell therapy in established stroke cases are under evaluation. Presently, prevention of stroke is the best option considering the Indian scenario through control and/or avoiding risk factors of stroke. Interventional studies are an important need for this scenario. PMID:27011621

DNA repair variants and breast cancer risk.

PubMed

Grundy, Anne; Richardson, Harriet; Schuetz, Johanna M; Burstyn, Igor; Spinelli, John J; Brooks-Wilson, Angela; Aronson, Kristan J

2016-05-01

A functional DNA repair system has been identified as important in the prevention of tumour development. Previous studies have hypothesized that common polymorphisms in DNA repair genes could play a role in breast cancer risk and also identified the potential for interactions between these polymorphisms and established breast cancer risk factors such as physical activity. Associations with breast cancer risk for 99 single nucleotide polymorphisms (SNPs) from genes in ten DNA repair pathways were examined in a case-control study including both Europeans (644 cases, 809 controls) and East Asians (299 cases, 160 controls). Odds ratios in both additive and dominant genetic models were calculated separately for participants of European and East Asian ancestry using multivariate logistic regression. The impact of multiple comparisons was assessed by correcting for the false discovery rate within each DNA repair pathway. Interactions between several breast cancer risk factors and DNA repair SNPs were also evaluated. One SNP (rs3213282) in the gene XRCC1 was associated with an increased risk of breast cancer in the dominant model of inheritance following adjustment for the false discovery rate (P < 0.05), although no associations were observed for other DNA repair SNPs. Interactions of six SNPs in multiple DNA repair pathways with physical activity were evident prior to correction for FDR, following which there was support for only one of the interaction terms (P < 0.05). No consistent associations between variants in DNA repair genes and breast cancer risk or their modification by breast cancer risk factors were observed. © 2016 Wiley Periodicals, Inc.

CYP17 genetic polymorphism, breast cancer, and breast cancer risk factors.

PubMed

Ambrosone, Christine B; Moysich, Kirsten B; Furberg, Helena; Freudenheim, Jo L; Bowman, Elise D; Ahmed, Sabrina; Graham, Saxon; Vena, John E; Shields, Peter G

2003-01-01

Findings from previous studies regarding the association between the CYP17 genotype and breast cancer are inconsistent. We investigated the role of the MspAI genetic polymorphism in the 5' region of CYP17 on risk of breast cancer and as a modifier of reproductive risk factors. Questionnaire and genotyping data were obtained from a population-based, case-control study of premenopausal (n = 182) and postmenopausal (n = 214) European-American Caucasian women in western New York. Cases and controls were frequency matched by age and by county of residence. Odds ratios and 95% confidence intervals were used to estimate relative risks. The CYP17 genotype was not associated with breast cancer risk; however, controls with the A2/A2 genotype (associated with higher estrogens) had earlier menarche and earlier first full-term pregnancy. Premenopausal women with A1/A1 genotypes, but not with A2 alleles, were at significantly decreased risk with late age at menarche (odds ratio = 0.37, 95% confidence interval = 0.14-0.99), and at increased risk with late age at first full-term pregnancy (odds ratio = 4.30, 95% confidence interval = 1.46-12.67) and with use of oral contraceptives (odds ratio = 3.24, 95% confidence interval = 1.08-9.73). Associations were weaker among postmenopausal women. These results suggest that the effects of factors that may alter breast cancer risk through a hormonal mechanism may be less important among premenopausal women with putative higher lifetime exposures to circulating estrogens related to the CYP17 A2 allele.

Mapping malaria risk among children in Côte d'Ivoire using Bayesian geo-statistical models.

PubMed

Raso, Giovanna; Schur, Nadine; Utzinger, Jürg; Koudou, Benjamin G; Tchicaya, Emile S; Rohner, Fabian; N'goran, Eliézer K; Silué, Kigbafori D; Matthys, Barbara; Assi, Serge; Tanner, Marcel; Vounatsou, Penelope

2012-05-09

In Côte d'Ivoire, an estimated 767,000 disability-adjusted life years are due to malaria, placing the country at position number 14 with regard to the global burden of malaria. Risk maps are important to guide control interventions, and hence, the aim of this study was to predict the geographical distribution of malaria infection risk in children aged <16 years in Côte d'Ivoire at high spatial resolution. Using different data sources, a systematic review was carried out to compile and geo-reference survey data on Plasmodium spp. infection prevalence in Côte d'Ivoire, focusing on children aged <16 years. The period from 1988 to 2007 was covered. A suite of Bayesian geo-statistical logistic regression models was fitted to analyse malaria risk. Non-spatial models with and without exchangeable random effect parameters were compared to stationary and non-stationary spatial models. Non-stationarity was modelled assuming that the underlying spatial process is a mixture of separate stationary processes in each ecological zone. The best fitting model based on the deviance information criterion was used to predict Plasmodium spp. infection risk for entire Côte d'Ivoire, including uncertainty. Overall, 235 data points at 170 unique survey locations with malaria prevalence data for individuals aged <16 years were extracted. Most data points (n = 182, 77.4%) were collected between 2000 and 2007. A Bayesian non-stationary regression model showed the best fit with annualized rainfall and maximum land surface temperature identified as significant environmental covariates. This model was used to predict malaria infection risk at non-sampled locations. High-risk areas were mainly found in the north-central and western area, while relatively low-risk areas were located in the north at the country border, in the north-east, in the south-east around Abidjan, and in the central-west between two high prevalence areas. The malaria risk map at high spatial resolution gives an important overview of the geographical distribution of the disease in Côte d'Ivoire. It is a useful tool for the national malaria control programme and can be utilized for spatial targeting of control interventions and rational resource allocation.

Mapping malaria risk among children in Côte d’Ivoire using Bayesian geo-statistical models

PubMed Central

2012-01-01

Background In Côte d’Ivoire, an estimated 767,000 disability-adjusted life years are due to malaria, placing the country at position number 14 with regard to the global burden of malaria. Risk maps are important to guide control interventions, and hence, the aim of this study was to predict the geographical distribution of malaria infection risk in children aged <16 years in Côte d’Ivoire at high spatial resolution. Methods Using different data sources, a systematic review was carried out to compile and geo-reference survey data on Plasmodium spp. infection prevalence in Côte d’Ivoire, focusing on children aged <16 years. The period from 1988 to 2007 was covered. A suite of Bayesian geo-statistical logistic regression models was fitted to analyse malaria risk. Non-spatial models with and without exchangeable random effect parameters were compared to stationary and non-stationary spatial models. Non-stationarity was modelled assuming that the underlying spatial process is a mixture of separate stationary processes in each ecological zone. The best fitting model based on the deviance information criterion was used to predict Plasmodium spp. infection risk for entire Côte d’Ivoire, including uncertainty. Results Overall, 235 data points at 170 unique survey locations with malaria prevalence data for individuals aged <16 years were extracted. Most data points (n = 182, 77.4%) were collected between 2000 and 2007. A Bayesian non-stationary regression model showed the best fit with annualized rainfall and maximum land surface temperature identified as significant environmental covariates. This model was used to predict malaria infection risk at non-sampled locations. High-risk areas were mainly found in the north-central and western area, while relatively low-risk areas were located in the north at the country border, in the north-east, in the south-east around Abidjan, and in the central-west between two high prevalence areas. Conclusion The malaria risk map at high spatial resolution gives an important overview of the geographical distribution of the disease in Côte d’Ivoire. It is a useful tool for the national malaria control programme and can be utilized for spatial targeting of control interventions and rational resource allocation. PMID:22571469

Chronic obstructive pulmonary disease among lung cancer-free smokers: The importance of healthy controls.

PubMed

Karpman, Michelle D; Eldridge, Ronald; Follis, Jack L; Etzel, Carol J; Shete, Sanjay; El-Zein, Randa A

2018-01-01

The prevalence of chronic obstructive pulmonary disease (COPD) in smokers enrolled as "healthy" controls in studies is 10-50%. The COPD status of ideal smoker populations for lung cancer case-control studies should be checked via spirometry; however, this is often not feasible, because no medical indications exist for asymptomatic smokers to undergo spirometry prior to study enrollment. Therefore, there is an unmet need for robust, cost effective assays for identifying undiagnosed lung disease among asymptomatic smokers. Such assays would help excluding unhealthy smokers from lung cancer case-control studies. We used the cytokinesis-blocked micronucleus (CBMN) assay (a measure of genetic instability) to identify undiagnosed lung disease among asymptomatic smokers. We used a convenience population from an on-going lung cancer case-control study including smokers with lung cancer (n = 454), smoker controls (n = 797), and a self-reported COPD (n = 200) contingent within the smoker controls. Significant differences for all CBMN endpoints were observed when comparing lung cancer to All controls (which included COPD) and Healthy controls (with no COPD). The risk ratio (RR) was increased in the COPD group vs. Healthy controls for nuclear buds (RR 1.28, 95% confidence interval 1.01-1.62), and marginally increased for micronuclei (RR 1.06, 0.98-1.89) and nucleoplasmic bridges (RR 1.07, 0.97-1.15). These findings highlight the importance of using truly healthy controls in studies geared toward assessment of lung cancer risk. Using genetic instability biomarkers would facilitate the identification of smokers susceptible to tobacco smoke carcinogens and therefore predisposed to either disease. Copyright © 2017 The Japanese Respiratory Society. All rights reserved.

Acceptability of tick control interventions to prevent Lyme disease in Switzerland and Canada: a mixed-method study.

PubMed

Aenishaenslin, Cécile; Michel, Pascal; Ravel, André; Gern, Lise; Waaub, Jean-Philippe; Milord, François; Bélanger, Denise

2016-01-05

Lyme disease control strategies may include tick control interventions in high risk areas. Public authorities may be interested to assess how these types of interventions are perceived by the public which may then impact their acceptability. The aims of this paper are to compare socio-cognitive factors associated with high acceptability of tick control interventions and to describe perceived issues that may explain their low acceptability in populations living in two different regions, one being an endemic region for LD since the last 30 years, the Neuchâtel canton, in Switzerland, and another where the disease is emerging, the Montérégie region, in Canada. A mixed methods' design was chosen. Quantitative data were collected using web-surveys conducted in both regions (n = 814). Multivariable logistic regressions were used to compare socio-cognitive factors associated with high acceptability of selected interventions. Qualitative data were collected using focus group's discussions to describe perceived issues relative to these interventions. Levels of acceptability in the studied populations were the lowest for the use of acaricides and landscaping and were under 50 % in both regions for six out of eight interventions, but were higher overall in Montérégie. High perceived efficacy of the intervention was strongly associated with high acceptability of tick control interventions. A high perceived risk about LD was also associated with a high acceptability of intervention under some models. High level of knowledge about LD was negatively associated with high acceptability of the use of acaricides in Neuchâtel. Perceived issues explaining low acceptability included environmental impacts, high costs to the public system, danger of individual disempowerment and perceptions that tick control interventions were disproportionate options for the level of LD risk. This study suggests that the perceived efficacy and LD risk perception may be key factors to target to increase the acceptability of tick control interventions. Community-level issues seem to be important considerations driving low acceptability of public health interventions. Results of this study highlight the importance for decision-makers to account for socio-cognitive factors and perceived issues that may affect the acceptability of public health interventions in order to maximize the efficacy of actions to prevent and control LD.

Predator-induced neophobia in juvenile cichlids.

PubMed

Meuthen, Denis; Baldauf, Sebastian A; Bakker, Theo C M; Thünken, Timo

2016-08-01

Predation is an important but often fluctuating selection factor for prey animals. Accordingly, individuals plastically adopt antipredator strategies in response to current predation risk. Recently, it was proposed that predation risk also plastically induces neophobia (an antipredator response towards novel cues). Previous studies, however, do not allow a differentiation between general neophobia and sensory channel-specific neophobic responses. Therefore, we tested the neophobia hypothesis focusing on adjustment in shoaling behavior in response to a novel cue addressing a different sensory channel than the one from which predation risk was initially perceived. From hatching onwards, juveniles of the cichlid Pelvicachromis taeniatus were exposed to different chemical cues in a split-clutch design: conspecific alarm cues which signal predation risk and heterospecific alarm cues or distilled water as controls. At 2 months of age, their shoaling behavior was examined prior and subsequent to a tactical disturbance cue. We found that fish previously exposed to predation risk formed more compact shoals relative to the control groups in response to the novel disturbance cue. Moreover, the relationship between shoal density and shoal homogeneity was also affected by experienced predation risk. Our findings indicate predator-induced, increased cross-sensory sensitivity towards novel cues making neophobia an effective antipredator mechanism.

Predicting Suicide Ideation in the Military: The Independent Role of Aggression.

PubMed

Start, Amanda R; Allard, Yvonne; Adler, Amy; Toblin, Robin

2018-03-02

The purpose of this study was to examine the longitudinal relationship between aggression and suicide ideation when controlling for other externalizing (i.e., alcohol misuse and risk-taking) and internalizing (i.e., depression and sleep problems) risk factors in an active duty, military sample. Preexisting data from a longitudinal study were analyzed to assess the wellness of service members across the deployment cycle. Participants were 944 active duty service members (95% male, 48% between 18 and 24 years old) who completed surveys upon initial return from deployment and approximately 3 months later. After controlling for other externalizing (alcohol misuse, risk-taking) and internalizing (depression, sleep problems) risk factors, service members reporting aggression were significantly more likely to report suicide ideation than those reporting no aggression (OR = 3.19; OR 95% CI: 1.16-8.80). The independent nature of the relationship between anger and suicidality suggests aggression may be an important indicator of suicidality for service members. Understanding the role of aggression in suicidality may improve the ability to identify at-risk service members and to develop effective interventions to reduce suicide risk. © 2018 The American Association of Suicidology.

Superior Efficacy of a Human Immunodeficiency Virus Vaccine Combined with Antiretroviral Prevention in Simian-Human Immunodeficiency Virus-Challenged Nonhuman Primates.

PubMed

Le Grand, Roger; Dereuddre-Bosquet, Nathalie; Dispinseri, Stefania; Gosse, Leslie; Desjardins, Delphine; Shen, Xiaoying; Tolazzi, Monica; Ochsenbauer, Christina; Saidi, Hela; Tomaras, Georgia; Prague, Mélanie; Barnett, Susan W; Thiebaut, Rodolphe; Cope, Alethea; Scarlatti, Gabriella; Shattock, Robin J

2016-06-01

Although vaccines and antiretroviral (ARV) prevention have demonstrated partial success against human immunodeficiency virus (HIV) infection in clinical trials, their combined introduction could provide more potent protection. Furthermore, combination approaches could ameliorate the potential increased risk of infection following vaccination in the absence of protective immunity. We used a nonhuman primate model to determine potential interactions of combining a partially effective ARV microbicide with an envelope-based vaccine. The vaccine alone provided no protection from infection following 12 consecutive low-dose intravaginal challenges with simian-HIV strain SF162P3, with more animals infected compared to naive controls. The microbicide alone provided a 68% reduction in the risk of infection relative to that of the vaccine group and a 45% reduction relative to that of naive controls. The vaccine-microbicide combination provided an 88% reduction in the per-exposure risk of infection relative to the vaccine alone and a 79% reduction relative to that of the controls. Protected animals in the vaccine-microbicide group were challenged a further 12 times in the absence of microbicide and demonstrated a 98% reduction in the risk of infection. A total risk reduction of 91% was observed in this group over 24 exposures (P = 0.004). These important findings suggest that combined implementation of new biomedical prevention strategies may provide significant gains in HIV prevention. There is a pressing need to maximize the impact of new biomedical prevention tools in the face of the 2 million HIV infections that occur each year. Combined implementation of complementary biomedical approaches could create additive or synergistic effects that drive improved reduction of HIV incidence. Therefore, we assessed a combination of an untested vaccine with an ARV-based microbicide in a nonhuman primate vaginal challenge model. The vaccine alone provided no protection (and may have increased susceptibility to a simian-HIV vaginal challenge), while the microbicide reduced the infection risk compared to that of vaccinated and naive animals. Importantly, the combined interventions provided the greatest level of protection, which was sustained following withdrawal of the microbicide. The data suggest that provision of ARV prophylaxis during vaccination reduces the potential for unexpected increased risks of infection following immunization and augments vaccine efficacy. These findings are important for the potential adoption of ARV prophylaxis as the baseline intervention for future HIV/AIDS vaccines. Copyright © 2016 Le Grand et al.

The Intervention Selection Bias: An Underrecognized Confound in Intervention Research

ERIC Educational Resources Information Center

Larzelere, Robert E.; Kuhn, Brett R.; Johnson, Byron

2004-01-01

Selection bias can be the most important threat to internal validity in intervention research, but is often insufficiently recognized and controlled. The bias is illustrated in research on parental interventions (punishment, homework assistance); medical interventions (hospitalization); and psychological interventions for suicide risk, sex…

Potential Scenarios for Nanomaterial Release and Subsequent Alteration in the Environment

EPA Science Inventory

The risk associated with engineered nanomaterials (ENMs) will be determined in part by the processes that control their environmental fate and transformation. These processes act not only on ENMs that might be released directly to the environment, but perhaps more importantly als...

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

PubMed

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

2013-11-01

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

Exposure to pesticides as risk factor for non-Hodgkin's lymphoma and hairy cell leukemia: pooled analysis of two Swedish case-control studies.

PubMed

Hardell, Lennart; Eriksson, Mikael; Nordstrom, Marie

2002-05-01

Increased risk for non-Hodgkin's lymphoma (NHL) following exposure to certain pesticides has previously been reported. To further elucidate the importance of phenoxyacetic acids and other pesticides in the etiology of NHL a pooled analysis was performed on two case-control studies, one on NHL and another on hairy cell leukemia (HCL), a rare subtype of NHL. The studies were population based with cases identified from cancer registry and controls from population registry. Data assessment was ascertained by questionnaires supplemented over the telephone by specially trained interviewers. The pooled analysis of NHL and HCL was based on 515 cases and 1141 controls. Increased risks in univariate analysis were found for subjects exposed to herbicides (OR 1.75, CI 95% 1.26-2.42), insecticides (OR 1.43, CI 95% 1.08-1.87), fungicides (OR 3.11, CI 95% 1.56-6.27) and impregnating agents (OR 1.48, CI 95% 1.11-1.96). Among herbicides, significant associations were found for glyphosate (OR 3.04, CI 95% 1.08-8.52) and 4-chloro-2-methyl phenoxyacetic acid (MCPA) (OR 2.62, CI 95% 1.40-4.88). For several categories of pesticides the highest risk was found for exposure during the latest decades before diagnosis. However, in multivariate analyses the only significantly increased risk was for a heterogeneous category of other herbicides than above.

Early-warning signals of topological collapse in interbank networks

PubMed Central

Squartini, Tiziano; van Lelyveld, Iman; Garlaschelli, Diego

2013-01-01

The financial crisis clearly illustrated the importance of characterizing the level of ‘systemic’ risk associated with an entire credit network, rather than with single institutions. However, the interplay between financial distress and topological changes is still poorly understood. Here we analyze the quarterly interbank exposures among Dutch banks over the period 1998–2008, ending with the crisis. After controlling for the link density, many topological properties display an abrupt change in 2008, providing a clear – but unpredictable – signature of the crisis. By contrast, if the heterogeneity of banks' connectivity is controlled for, the same properties show a gradual transition to the crisis, starting in 2005 and preceded by an even earlier period during which anomalous debt loops could have led to the underestimation of counter-party risk. These early-warning signals are undetectable if the network is reconstructed from partial bank-specific data, as routinely done. We discuss important implications for bank regulatory policies. PMID:24285089

The role of HIV infection in the etiology and epidemiology of diarrheal disease among children aged 0-59 months in Manhiça district, Rural Mozambique.

PubMed

Acácio, Sozinho; Nhampossa, Tacilta; Quintó, Llorenç; Vubil, Delfino; Sacoor, Charfudin; Kotloff, Karen; Farag, Tamer; Dilruba, Nasrin; Macete, Eusebio; Levine, Myron M; Alonso, Pedro; Mandomando, Inácio; Bassat, Quique

2018-05-28

Diarrhea is an important health problem among HIV-infected patients. This study evaluates the role of HIV on the epidemiology, etiology and severity of diarrheal disease among children. The Global Enteric Multicenter Study enrolled children with moderate-to-severe (MSD) and less severe (LSD) diarrhea between December 2007 and November 2012. One to three controls for MSD cases and one per LSD case were enrolled and matched by age, sex and neighborhood. All children were tested for HIV. Clinical, anthropometric data and stools were collected. A follow-up was performed at 60 days. 214 MSD cases and 418 controls, together with 349 LSD cases and 214 controls were tested. HIV prevalence among MSD cases was 25% (4% for matched controls) and 6% among LSD cases (6% among matched controls). HIV-infected children were more likely to have MSD (OR=5.6, p< 0.0001). Mortality rates were higher among HIV-infected children compared with uninfected (34 vs. 5 per 1000 children-weeks at risk; p=0.0039). Cryptosporidium, Giardia, EAEC (aatA only) were more prevalent among HIV-infected MSD-cases than uninfected ones. HIV is an important risk factor for MSD. The high mortality rate implies that children with MSD should be screened for HIV and managed accordingly. Copyright © 2018. Published by Elsevier Ltd.

Traumatic Stress Interacts With Bipolar Disorder Genetic Risk to Increase Risk for Suicide Attempts.

PubMed

Wilcox, Holly C; Fullerton, Janice M; Glowinski, Anne L; Benke, Kelly; Kamali, Masoud; Hulvershorn, Leslie A; Stapp, Emma K; Edenberg, Howard J; Roberts, Gloria M P; Ghaziuddin, Neera; Fisher, Carrie; Brucksch, Christine; Frankland, Andrew; Toma, Claudio; Shaw, Alex D; Kastelic, Elizabeth; Miller, Leslie; McInnis, Melvin G; Mitchell, Philip B; Nurnberger, John I

2017-12-01

Bipolar disorder (BD) is one of the most heritable psychiatric conditions and is associated with high suicide risk. To explore the reasons for this link, this study examined the interaction between traumatic stress and BD polygenic risk score in relation to suicidal ideation, suicide attempt, and nonsuicidal self-injury (NSSI) in adolescent and young adult offspring and relatives of persons with BD (BD-relatives) compared with adolescent and young adult offspring of individuals without psychiatric disorders (controls). Data were collected from 4 sites in the United States and 1 site in Australia from 2006 through 2012. Generalized estimating equation models were used to compare rates of ideation, attempts, and NSSI between BD-relatives (n = 307) and controls (n = 166) and to determine the contribution of demographic factors, traumatic stress exposure, lifetime mood or substance (alcohol/drug) use disorders, and BD polygenic risk score. After adjusting for demographic characteristics and mood and substance use disorders, BD-relatives were at increased risk for suicidal ideation and attempts but not for NSSI. Independent of BD-relative versus control status, demographic factors, or mood and substance use disorders, exposure to trauma within the past year (including bullying, sexual abuse, and domestic violence) was associated with suicide attempts (p = .014), and BD polygenic risk score was marginally associated with attempts (p = .061). Importantly, the interaction between BD polygenic risk score and traumatic event exposures was significantly associated with attempts, independent of demographics, relative versus control status, and mood and substance use disorders (p = .041). BD-relatives are at increased risk for suicide attempts and ideation, especially if they are exposed to trauma and have evidence of increased genetic vulnerability. Copyright © 2017 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.

Biological risk factors for deep vein trombosis.

PubMed

Vayá, Amparo; Mira, Yolanda; Martínez, Marcial; Villa, Piedad; Ferrando, Fernando; Estellés, Amparo; Corella, Dolores; Aznar, Justo

2002-01-01

Hypercoagulable states due either to inherited or acquired thrombotic risk factors are only present in approximately half of cases of DVT, but the causes in the other half, remain unknown. The importance of biological risk factors such as hyperlipidemia, hypofibrinolysis and hemorheological alterations in the pathogenesis of DVT has not been well established. In order to ascertain whether the above mentioned biological factors are associated with DVT and could constitute independent risk factors, we carried out a case-control study in 109 first DVT patients in whom inherited or acquired thrombophilic risk factors had been ruled out and 121 healthy controls age (42+/-15 years) and sex matched. From all the biological variables analyzed (cholesterol, triglycerides, glucose, fibrinogen, erythrocyte aggregation, hematocrit, plasma viscosity and PAI-1) only fibrinogen concentration reached a statistically significant difference on the comparison of means (290+/-73 mg/dl in cases vs 268+/-58 mg/dl in controls, p<0.05). After this continuous variables were dichotomized according to our reference values, the percentage of cases with cholesterolemia >220 mg/dl, hematocrit >45% and fibrinogen >300 mg/dl was higher in cases than in controls: 38% vs 22%; p<0.01; 43% vs 27%; p<0.05; 36% vs 23%; p<0.05, respectively. The percentage of cases with PAI-1 values >30 ng/ml, 37% vs 25% was borderline significant; p=0.055. Multivariate logistic regression analysis showed that cholesterolemia >220 mg/dl and fibrinogen >300 mg/dl constitute independent predictors of venous thrombotic risk. The adjusted OR's were 2.03 (95% CI; 1.12-3.70) for cholesterolemia and 1.94 (95% CI; 1.07-3.55) for fibrinogen. When these two variables combined DVT risk rose about fourfold (3.96; p<0.05). Our results suggest that hypercholesterolemia and hyperfibrinogenemia should be added to the list of known DVT risk factors and we recommend adopting measures to decrease these variables in the population with a high risk of DVT.

Burnout and Workload Among Health Care Workers: The Moderating Role of Job Control

PubMed Central

Portoghese, Igor; Galletta, Maura; Coppola, Rosa Cristina; Finco, Gabriele; Campagna, Marcello

2014-01-01

Background As health care workers face a wide range of psychosocial stressors, they are at a high risk of developing burnout syndrome, which in turn may affect hospital outcomes such as the quality and safety of provided care. The purpose of the present study was to investigate the moderating effect of job control on the relationship between workload and burnout. Methods A total of 352 hospital workers from five Italian public hospitals completed a self-administered questionnaire that was used to measure exhaustion, cynicism, job control, and workload. Data were collected in 2013. Results In contrast to previous studies, the results of this study supported the moderation effect of job control on the relationship between workload and exhaustion. Furthermore, the results found support for the sequential link from exhaustion to cynicism. Conclusion This study showed the importance for hospital managers to carry out management practices that promote job control and provide employees with job resources, in order to reduce the burnout risk. PMID:25379330

Industrial Control Systems/SCADA systems risk assessment in the energy sector

NASA Astrophysics Data System (ADS)

Falodun, Babatunde

The energy sector is one of the most critical components of our national infrastructure. It not only provides the electrical power and petroleum required to run day-to-day operations and mechanisms in society, it's also an important element that directly impacts the economy with regard to growth and stability. Industrial Control Systems (ICS) /Supervisory Control and Data Acquisition Systems (SCADA) are computerized mechanisms, they are both software and hardware that are used to control real time processes and operations in power plants and oil production facilities. A significant attack on these control systems that leads to widespread disruption of energy could result in catastrophic consequences for any major city and even the nation. This research paper explores cyber threats and vulnerabilities faced by ICS/SCADA systems in the energy sector and also highlights possible outcomes of a successful breach. Furthermore, the research underscores mitigation strategies that could be used to prevent and respond to an attack. Keywords: Cybersecurity, SCADA, Cyber Attacks, Threats, Vulnerabilities, Risk Assessment, Dr. Albert Orbinati.

Ictal Cardiac Ryhthym Abnormalities.

PubMed

Ali, Rushna

2016-01-01

Cardiac rhythm abnormalities in the context of epilepsy are a well-known phenomenon. However, they are under-recognized and often missed. The pathophysiology of these events is unclear. Bradycardia and asystole are preceded by seizure onset suggesting ictal propagation into the cortex impacting cardiac autonomic function, and the insula and amygdala being possible culprits. Sudden unexpected death in epilepsy (SUDEP) refers to the unanticipated death of a patient with epilepsy not related to status epilepticus, trauma, drowning, or suicide. Frequent refractory generalized tonic-clonic seizures, anti-epileptic polytherapy, and prolonged duration of epilepsy are some of the commonly identified risk factors for SUDEP. However, the most consistent risk factor out of these is an increased frequency of generalized tonic-clonic seizures (GTC). Prevention of SUDEP is extremely important in patients with chronic, generalized epilepsy. Since increased frequency of GTCS is the most consistently reported risk factor for SUDEP, effective seizure control is the most important preventive strategy.

Lipoprotein(a): Biology and Clinical Importance

PubMed Central

McCormick, Sally P A

2004-01-01

Lipoprotein(a) [Lp(a)] is a unique lipoprotein that has emerged as an independent risk factor for developing vascular disease. Plasma Lp(a) levels above the common cut-off level of 300 mg/L place individuals at risk of developing heart disease particularly if combined with other lipid and thrombogenic risk factors. Studies in humans have shown Lp(a) levels to be hugely variable and under strict genetic control, largely by the apolipoprotein(a) [apo(a)] gene. In general, Lp(a) levels have proven difficult to manipulate, although some factors have been identified that can influence levels. Research has shown that Lp(a) has a high affinity for the arterial wall and displays many athero-thrombogenic properties. While a definite function for Lp(a) has not been identified, the last two decades of research have provided much information on the biology and clinical importance of Lp(a). PMID:18516206

Family Functioning and High Risk Adolescents' Aggressive Behavior: Examining Effects by Ethnicity.

PubMed

Henneberger, Angela K; Varga, Shannon M; Moudy, Alyssa; Tolan, Patrick H

2016-01-01

The relationship between family functioning and adolescents' physical aggression has been well established, but whether these relationships might differ by ethnicity has received less attention. Ethnic variations may be important for targeting prevention programs to specific youth and families. This study examined the longitudinal relationship between family cohesion, parental monitoring, and physical aggression using data from the Multisite Violence Prevention Project sample of high-risk youth (elevated aggression). Participants were 1,232 high-risk middle school students (65% male; 70% African American; 15% Hispanic). Meaningful demographic variations were identified. After controlling for intervention condition and study site, family cohesion was significantly negatively related to physical aggression, more so for Hispanic youth. Parental monitoring was negatively associated with physical aggression for African American youth only. Our findings point to the importance of developing culturally sensitive family interventions to prevent physical aggression in middle school.

Family Functioning and High Risk Adolescents’ Aggressive Behavior: Examining Effects by Ethnicity

PubMed Central

Varga, Shannon M.; Moudy, Alyssa; Tolan, Patrick H.

2014-01-01

The relationship between family functioning and adolescents’ physical aggression has been well established, but whether these relationships might differ by ethnicity has received less attention. Ethnic variations may be important for targeting prevention programs to specific youth and families. This study examined the longitudinal relationship between family cohesion, parental monitoring, and physical aggression using data from the Multisite Violence Prevention Project sample of high-risk youth (elevated aggression). Participants were 1,232 high-risk middle school students (65% male; 70% African American; 15% Hispanic). Meaningful demographic variations were identified. After controlling for intervention condition and study site, family cohesion was significantly negatively related to physical aggression, more so for Hispanic youth. Parental monitoring was negatively associated with physical aggression for African American youth only. Our findings point to the importance of developing culturally sensitive family interventions to prevent physical aggression in middle school. PMID:25416227

Conscientiousness, career success, and longevity: a lifespan analysis.

PubMed

Kern, Margaret L; Friedman, Howard S; Martin, Leslie R; Reynolds, Chandra A; Luong, Gloria

2009-04-01

Markers of executive functioning, such as prudent planning for the future and impulse control, are related to conscientiousness and may be central to both occupational success and health outcomes. The aim of the study was to examine relations among conscientiousness, career success, and mortality risk across a 65-year period. Using data derived from 693 male participants in the Terman Life Cycle Study, we examined associations among childhood personality, midlife objective career success, and lifelong mortality risk through 2006. Conscientiousness and career success each predicted lower mortality risk (N = 693, relative hazard (rh) = 0.82 [95% confidence interval = 0.74, 0.91] and rh = 0.80 [0.71, 0.91], respectively), with both shared and unique variance. Importantly, childhood personality moderated the success-longevity link; conscientiousness was most relevant for least successful individuals. Conscientiousness and career success predicted longevity, but not in a straightforward manner. Findings highlight the importance of lifespan processes.

Update on traveler's diarrhea.

PubMed

Strum, W B

1988-07-01

Traveler's diarrhea affects a substantial number of travelers to high-risk areas of the world. The key to controlling this troublesome disease is prevention. The most important preventive measures depend on educating patients to consume only safe foods and pure water. Physicians cannot overemphasize the importance of avoiding high-risk foods and of boiling water if a safe water supply is not available. Prophylactic medications are a secondary consideration and should be prescribed with discretion. In most cases, diarrhea is mild and self-limited, requiring only fluid and electrolyte replacement and perhaps an antidiarrheal agent. In moderate to severe cases, the addition of an antimicrobial agent may be of benefit. Until an efficacious polyvalent vaccine is developed, caution and common sense, together with discretionary dietary and hygienic practices, are the best defenses against traveler's diarrhea. The ultimate solution is greatly improved sanitation and personal hygiene, especially in high-risk countries. However, only dreamers will consider waiting for this transformation to occur.

Disease intelligence for highly pathogenic avian influenza.

PubMed

Domenech, J; Slingenbergh, J; Martin, V; McLeod, A; Lubroth, J; Sims, L D

2007-01-01

A comprehensive approach to highly pathogenic avian influenza (HPAI) is crucial for identifying all the factors that contribute to its emergence, spread and persistence. Epidemiological understanding makes it possible to predict the evolution of the virus and to prevent and control the socioeconomic, environmental, institutional and policy consequences. At FAO, risk assessment and intelligence with regard to HPAI are based on lessons learnt from assisting countries to design strategies and on implementation of technical assistance programmes, which reveal important elements, such as the roles of ducks, live-bird markets and trade. Wild birds were found to contribute, by transporting the H5N1 virus over long distances. The contributions of different poultry farming systems and market chains in the epidemiology of HPAI are well recognized; however, the respective roles of smallholder systems and commercial farms are unclear. FAO considers that smallholders will continue to be an important factor and should be taken into account in control and prevention programmes. Changes in poultry farming are essentially driven by the private sector and market forces and could have negative consequences on the livelihoods of smallholders and on ecologically balanced production systems and agricultural biodiversity. Biosecurity can, however, be improved at the level of farms and markets. Institutional factors, such as the capacity of animal health systems to deliver control programmes, are also important, requiring strengthening and innovation in risk analysis and management.

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

PubMed

Khormi, Hassan M; Kumar, Lalit

2012-05-01

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

Environmental risks for nontuberculous mycobacteria. Individual exposures and climatic factors in the cystic fibrosis population.

PubMed

Prevots, D Rebecca; Adjemian, Jennifer; Fernandez, Aisling G; Knowles, Michael R; Olivier, Kenneth N

2014-09-01

Persons with cystic fibrosis are at high risk of pulmonary nontuberculous mycobacterial infection, with a national prevalence estimated at 13%. The risk of nontuberculous mycobacteria associated with specific environmental exposures, and the correlation with climatic conditions in this population has not been described. To describe the association of pulmonary nontuberculous mycobacteria with individual exposures to water and soil aerosols, and the population associations of these infections with climatic factors. We conducted a nested case-control study within a cohort study of pulmonary nontuberculous mycobacteria prevalence at 21 geographically diverse national cystic fibrosis centers. Incident nontuberculous mycobacterial infection cases (at least one prior negative culture followed by one positive culture) were age- and sex-matched to culture-negative controls. Exposures to water and soil were assessed by administering a standardized questionnaire. Cohort prevalence at each of the 21 centers was correlated with climatic conditions in the same area through linear regression modeling. Overall, 48 cases and 85 control subjects were enrolled. Indoor swimming was associated with incident infection (adjusted odds ratio, 5.9, 95% confidence interval, 1.3-26.1), although only nine cases (19%) and five control subjects (6%) reported indoor swimming in the 4 months prior to infection. Exposure to showering and municipal water supply was common among both cases and control subjects: 77% of cases and 76% of control subjects reported showering at least daily. In linear regression, average annual atmospheric water vapor content was significantly predictive of center prevalence (P = 0.0019), with R(2) = 0.40. Atmospheric conditions explain more of the variation in disease prevalence than individual behaviors. The risk of specific exposures may vary by geographic region due to differences in conditions favoring mycobacterial growth and survival. However, because exposure to these organisms is ubiquitous and behaviors are similar among persons with and without pulmonary nontuberculous mycobacteria, genetic susceptibility beyond cystic fibrosis is likely to be important for disease development. Common individual risk factors in high-risk populations remain to be identified.

Risk of acute coronary events associated with glyburide compared with gliclazide use in patients with type 2 diabetes: a nested case-control study.

PubMed

Abdelmoneim, A S; Eurich, D T; Gamble, J M; Johnson, J A; Seubert, J M; Qiu, W; Simpson, S H

2014-01-01

Sulfonylureas might increase the risk of adverse cardiovascular events; however, emerging evidence suggests there may be important differences amongst these drugs. Some, like glyburide, inhibit KATP channels in the heart and pancreas, while others, like gliclazide, are more likely to selectively inhibit KATP channels in the pancreas. We hypothesized that the risk of acute coronary syndrome (ACS) events would be higher in patients using glyburide compared with gliclazide. This nested case-control study used administrative health data from Alberta, Canada. New users of glyburide or gliclazide aged ≥66 years between 1998 and 2010 were included. Cases were individuals with an ACS-related hospitalization or death. Up to four controls were matched based on birth year, sex, cohort-entry year and follow-up time. Multivariable conditional logistic regression was used to estimate adjusted odds ratios (OR), controlling for baseline drug use and co-morbidities. Our cohort included 7441 gliclazide and 13 884 glyburide users; 51.4% men, mean (s.d.) age 75.5 (6.6) years and mean (s.d.) duration of follow-up 5.5 (4.0) years. A total of 4239 patients had an ACS-related hospitalization or death and were matched to 16 723 controls. Compared with gliclazide use, glyburide use was associated with a higher risk (adjusted OR 1.14; 95% CI 1.06-1.23) of ACS-related hospitalization or death over 5.5 years (number needed to harm: 50). In this observational study, glyburide use was associated with a 14% higher risk of ACS events compared with gliclazide use. Although the difference is small and probably to have implications at the population level rather than the individual patient or clinician, any causal inferences regarding sulfonylurea use and adverse cardiovascular risk should be tested in a large-scale randomized controlled trial. © 2013 John Wiley & Sons Ltd.

Adolescent Suicidal Behavior and Substance Use: Developmental Mechanisms

PubMed Central

Dawes, Michael A; Mathias, Charles W; Richard, Dawn M; Hill-Kapturczak, Nathalie; Dougherty, Donald M

2008-01-01

Adolescent suicidal behaviors and substance use are disturbingly common. Research suggests overlap of some of the etiological mechanisms for both adolescent suicidal behavior and substance use, yet clear understanding of the complex relations between these behaviors and their causal underpinnings is lacking. A growing body of evidence and a diathesis model (Mann et al. 1999; Mann, 2003) highlight the importance of impulse control as a proximal risk factor for adolescent suicidal and substance use behaviors. This literature review extends current theory on the relationships between adolescent suicidal behavior and substance use by: (1) examining how, when, and to what extent adolescent development is affected by poor impulse control, stressful life events, substance use behavior, and biological factors; (2) presenting proposed causal mechanisms by which these risk factors interact to increase risk for suicidal behaviors and substance use; and (3) proposing specific new hypotheses to extend the diathesis model to adolescents at risk for suicide and substance use. More specifically, new hypotheses are presented that predict bidirectional relationships between stressful life events and genetic markers of 5-HT dysregulation; substance use behavior and impulsivity; and substance use behavior and suicide attempts. The importance of distinguishing between different developmental trajectories of suicidal and substance use behaviors, and the effects of specific risk and protective mechanisms are discussed. Use of new statistical approaches that provide for the comparison of latent growth curves and latent class models is recommended to identify differences in developmental trajectories of suicidal behavior and substance use. Knowledge gained from these prospective longitudinal methods should lead to greater understanding on the timing, duration, and extent to which specific risk and protective factors influence the outcomes of suicidal behavior and substance use. In turn, findings from these studies should inform researchers who conduct future treatment and prevention studies. PMID:20651946

Risk factors for multidrug-resistant Gram-negative infection in burn patients.

PubMed

Vickers, Mark L; Dulhunty, Joel M; Ballard, Emma; Chapman, Paul; Muller, Michael; Roberts, Jason A; Cotta, Menino O

2018-05-01

Infection with multidrug-resistant (MDR) Gram-negative organisms leads to poorer outcomes in the critically ill burn patient. The aim of this study was to identify the risk factors for MDR Gram-negative pathogen infection in critically ill burn patients admitted to a major tertiary referral intensive care unit (ICU) in Australia. A retrospective case-control study of all adult burn patients admitted over a 7-year period was conducted. Twenty-one cases that cultured an MDR Gram-negative organism were matched with 21 controls of similar age, gender, burn size and ICU stay. Multivariable conditional logistic regression was used to individually assess risk factors after adjusting for Acute Burn Severity Index. Adjusted odds ratios (ORs) were reported. P-values < 0.25 were considered as potentially important risk factors. Factors increasing the risk of MDR Gram-negative infection included superficial partial thickness burn size (OR: 1.08; 95% confidence interval (CI): 1.01-1.16; P-value: 0.034), prior meropenem exposure (OR: 10.39; 95% CI: 0.96-112.00; P-value: 0.054), Gram-negative colonization on admission (OR: 9.23; 95% CI: 0.65-130.15; P-value: 0.10) and escharotomy (OR: 2.66; 95% CI: 0.52-13.65; P-value: 0.24). For cases, mean age was 41 (SD: 13) years, mean total body surface area burned was 47% (SD: 18) and mean days in ICU until MDR specimen collection was 17 (SD: 10) days. Prior meropenem exposure, Gram-negative colonization on admission, escharotomy and superficial partial thickness burn size may be potentially important factors for increasing the risk of MDR Gram-negative infection in the critically ill burn patient. © 2017 Royal Australasian College of Surgeons.

Circadian clock-related genetic risk scores and risk of placental abruption.

PubMed

Qiu, Chunfang; Gelaye, Bizu; Denis, Marie; Tadesse, Mahlet G; Luque Fernandez, Miguel Angel; Enquobahrie, Daniel A; Ananth, Cande V; Sanchez, Sixto E; Williams, Michelle A

2015-12-01

The circadian clock plays an important role in several aspects of female reproductive biology. Evidence linking circadian clock-related genes to pregnancy outcomes has been inconsistent. We sought to examine whether variations in single nucleotide polymorphisms (SNPs) of circadian clock genes are associated with PA risk. Maternal blood samples were collected from 470 PA case and 473 controls. Genotyping was performed using the Illumina Cardio-MetaboChip platform. We examined 119 SNPs in 13 candidate genes known to control circadian rhythms (e.g., CRY2, ARNTL, and RORA). Univariate and penalized logistic regression models were fit to estimate odds ratios (ORs); and the combined effect of multiple SNPs on PA risk was estimated using a weighted genetic risk score (wGRS). A common SNP in the RORA gene (rs2899663) was associated with a 21% reduced odds of PA (P < 0.05). The odds of PA increased with increasing wGRS (Ptrend < 0.001). The corresponding ORs were 1.00, 1.83, 2.81 and 5.13 across wGRS quartiles. Participants in the highest wGRS quartile had a 5.13-fold (95% confidence interval: 3.21-8.21) higher odds of PA compared to those in the lowest quartile. Although the test for interaction was not significant, the odds of PA was substantially elevated for preeclamptics with the highest wGRS quartile (OR = 14.44, 95%CI: 6.62-31.53) compared to normotensive women in the lowest wGRS quartile. Genetic variants in circadian rhythm genes may be associated with PA risk. Larger studies are needed to corroborate these findings and to further elucidate the pathogenesis of this important obstetrical complication. Copyright © 2015 Elsevier Ltd. All rights reserved.